LIVING WELL WITH DIABETES – JULY 2015

VACATION WITH MODERATION!

By: Director of Education – Jessica Cook MS, RD, LD, CDE

Summer presents a great time to travel, explore and take a vacation with friends and family. Many people view vacation as a time to relax, get away and enjoy pleasures you may not experience the rest of the year. One of these pleasures may include food. Trying new foods, enjoying comfort foods and indulging in your favorite food choices may seem appropriate for vacation, but remember food intake makes a huge impact on blood sugar control! Even when you’re letting loose and enjoying the moment of vacation remember these easy tips to prevent a blood sugar disaster when indulging:

1. Drink water. During vacation consuming alcoholic beverages, high carbohydrate foods and high temperatures may cause for blood glucose elevation and dehydration. Make sure to drink at least eight 8oz. glasses of plain water each day to stay hydrated and flush out your kidneys.
2. Stay active! Even when on vacation don’t forget to move! Walking for 10-20 minutes after a meal can help keep lower blood sugar levels after fun, vacation meals. Swimming, walking, biking and dancing are great ways to help lower blood glucose levels even when far from home.
3. Choose to indulge moderately when dining out. Many of my patients treat dining out like a free for all, ordering rolls with butter, creamy soups, high calorie salads or huge portions of pasta with cream sauce followed by a creamy slice of cheesecake. Don’t get me wrong, just because you have diabetes doesn’t mean you cannot eat any of those food items, but you need to be smart about it! If enjoying fresh baked bread at a restaurant then simply order double portions of vegetables with dinner versus ordering bread and having a side of pasta too! Or if you have been eying the dessert menu and would like a treat then skip the bread, potato and rice in order to make room for your favorite confection or maybe share a slice of pie with a friend.
4. Plan ahead and pack snacks. The worst part of traveling for many people are the unplanned snacks that they consume in between meals when flights are delayed or road trips last for hours. The trick is to be prepared. Try packing healthy choices ahead of time, so when hunger strikes you know you have a delicious, balanced snack to satisfy your hunger before you break out the chips and cookies! Instead pack unsalted, dry roasted nuts or sunflower seeds, apples, low fat string cheese and baby carrots or celery with creamy natural almond butter. Come join us at our healthy meal planning class to discover even more tricks to dining out and snacking healthfully too!

Thank you for taking the time to read our Living Well with Diabetes July Newsletter and we hope you have a great Summer season!

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Diabetes Be Ready for Hurricane Season!

By: Paul Casanova MD

The best way to prepare and respond to an emergency is before it happens. Few people can think clearly and logically in a crisis or emergency, so it is important to do so in advance, when you have time to be thorough. Emergencies are especially difficult for people with chronic diseases such as diabetes which affects 29.1 million Americans according to the Centers for Disease Control and Prevention (CDC). So be ready in hurricane season!

Here a list of suggestion recommended by the American Association of Clinical Endocrinologists (AACE)

1. List of the following information:
   1. Type of diabetes.
   2. All of your medical conditions, allergies and prior surgeries
   3. All medications (include pharmacy contact information, active prescription information and eligible refills)
   4. Previous diabetes medications and reason for discontinuation
   5. Contact information for all your healthcare providers
2. Letter from your diabetes healthcare providers with most recent diabetes medication regimen (especially if you are taking insulin or an injectable non-insulin diabetes medication). Make sure that all vaccinations, including tetanus, are up-to-date.
3. Most recent laboratory results (especially A1C, kidney and liver tests).
4. As possible, a 30-day supply of all medications taken by mouth or injection for diabetes as well as all other medical conditions. (If you are taking insulin or an injectable non-insulin diabetes medication; include them and a severe hypoglycemia emergency kit–if prescribed (always check expiration date.))
5. Blood glucose testing supplies and, if possible, 2 glucose meters with extra batteries
6. A cooler for 4 refreezable gel packs, insulin and unused injectable diabetes medications to be added when ready to go. Note: Do not use dry ice and avoid freezing the medication
7. Empty plastic bottles or sharps containers for syringes, needles and lancets.
8. Source of carbohydrate to treat hypoglycemic reactions (For example, glucose tablets, 4 oz juice boxes, glucose gel, regular soda, sugar, honey or hard candy)
9. A 2-day supply of nonperishable food (For example, peanut butter or cheese crackers, meal replacement shakes or bars, etc.) and at least a 3-day supply of bottled water.
10. Pen/pencil and notepad to record blood sugar, other test results and any new signs/symptoms suggesting medical problems
11. First aid supplies like bandages, cotton swabs, dressings and topical medications (antibiotic ointments or creams)
12. Wear shoes at all times and examine your feet often for cuts, sores, red spots, swelling, blisters, calluses and infected toenails or any unusual condition Pack extra comfortable clothing, including undergarments.
13. Take a mobile phone with an extra charger or extra batteries for you and family members.
14. Choose a designated meeting place in case you are separated from your family and are unable to reach them by phone.

So be ready and make your plan before the emergency happens.

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Is snacking sabotaging your weight loss?

By: Jessica Cook MS, RD, LD, CDE (Director of education)

Snacking has recently increased in popularity and it seems everywhere you go snacks are readily available. And although snacking can help prevent hypoglycemia, reduce hunger at meals and possibly prevent overeating at meal time, it can also add extra calories, translating into extra inches on your waistline. With a wide variety of snacks including pretzels, potato chips, candies, cookies, popcorn, crackers and ice cream it is no surprise Americans are consuming more calories from snack foods than actual meals during the day. The problem increases when these high carbohydrate snacks increase blood sugar levels in patients with diabetes resulting in increased medication use in efforts to control blood glucose levels. Instead of choosing low nutrient dense, but high energy dense snacks, reach for something delicious, satisfying but with half the calories and less carbohydrates!

The first rule of snacking includes listening to your body. You should not snack unless you are feeling physical hunger. Listen to the hunger cues in your body and if you are having cravings without physical hunger, try brushing your teeth, chewing sugar free gum, grabbing a glass of water or hot tea. If you are physically hungry mid-morning or mid-afternoon, then remember the next most important snacking rule… Fiber & Protein! Fiber and protein not only relieve hunger pangs, but add satiety for several hours and do not raise blood glucose levels. So which snacks contain low carbohydrates, but high fiber and protein? Here are a few examples:

1. ½ cup low-fat cottage cheese topped with ½ cup cantaloupe cubes

(130 cals, 14 g carbs, 12 g pro)

2. 1 small apple, sliced, spread with 1 Tbsp natural peanut butter

(150 cals, 18 g carb, 5 g pro)

3. StarKist Ready-Made Albacore Tuna Salad Packet & Sliced Cucumbers

(98 cals, 2 g carb, 10 g pro)

4. Dry Roasted, unsalted Sunflower Seeds ¼ cup

(163 cal, 7 g carb, 5 g pro)

5. ½ Cup Baby Carrots with 2 Tbsp. light ranch dressing

(103 cals, 9 g carb, 1 g pro)

6. 5 stalks celery, fill with 2 Tbsp natural almond butter

(200 cals, 13 g carb, 5 g pro)

By keeping these healthy snacking solutions stocked in your fridge, at the office or by packing extra snacks when traveling, it will prevent you from hitting the vending machine or local gas station for high fat, high sugar snack food items.

Probably the worst time to snack however is after dinner. I have seen countless patients gain weight, need more diabetes medications and continue to struggle with elevated A1c levels due to night time snacking. You only need a snack before bed time if blood glucose levels are less than 100 before bed or if you have a history of nocturnal hypoglycemia. Again you may have a snack before bed if you are feeling physical hunger, but try to remember there are other factors affecting why we snack at night. Boredom, depression, anxiety, sleeplessness and frustration are common reasons we reach for snacks even when we are not physically hungry. If you are experiencing any of these emotions regularly which are causing extra snacking in the evening, try going for a walk, practicing medication, join a group or find a hobby to help take your mind off of food. If you are feeling depressed, sad, distraught or anxious, speaking with a licensed clinical social worker or psychologist may help you to better handle your emotions rather than eating.

Lastly, do not be fooled by the food industry’s push for these high carbohydrate snack foods claiming they give you energy, no sugar added, sugar free, low fat or fat free. Always remember to read the carbohydrates on the food label to better understand how these foods will affect your blood sugar levels. Check out overall caloric content of your snacks as well because consuming an extra 500 calories a day can lead to steady weight gain and increased medications. If you need additional help designing a meal plan, creating healthy snacks and reviewing carbohydrate counting make sure to schedule an appointment with a registered dietitian at one of our four office locations. Regular meetings with a registered dietitian are often covered through insurance with a diagnosis of diabetes and may prevent you from needing additional medications to treat your diabetes or aid in weight loss! To schedule your appointment with a registered dietitian please call (561) 513-5100 today!

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COME LEARN HOW TO PLAN HEALTHY MEALS FOR DIABETES, WEIGHT LOSS AND HEART HEALTH!

Join us at our healthy meal planning refresher class in West Palm Beach. We hold classes every month which include how to plan healthy meals, weight loss, tips on grocery shopping as well as dining out, healthy substitutions and more!

If you have tried losing weight on your own without success why not try our Healthy Meal Planning with Diabetes Refresher Course to help you get back on track with your weight loss goals. If interested attending this program please contact our scheduling department at (561) 513-5100 today!

At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended. You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!

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