SPRING IS IN THE AIR!

By: Jessica Cook MS, RD, LD/N, CDE (Director of Education)

Here at Palm Beach Diabetes and Endocrine Specialists, we have put together a great edition of Healthy Living with Diabetes Newsletter for you to enjoy and to help you spring into a healthy way of life. Maintaining

a healthy lifestyle starts with your attitude, knowledge and behaviors, so hopefully through this newsletter we can help you jump start into a healthy lifestyle. Plus don’t forget to take advantage of our gorgeous South Florida weather and fresh produce. Staying active and eating plenty of vegetables will not only lower A1c levels, but increases energy, aids in weight loss and will have you feeling younger. Thank you for taking your time to read April’s Healthy Living with Diabetes newsletter. Have a lovely spring season!

Treatment Option for Diabetes

By: Jaime Steinsapir MD

A patient – centered approach is important in diabetes management. Physicians continue to develop patient-centered approaches to guide choice of pharmacological agents to be used in diabetes treatment.

These approaches to diabetes treatment include the following:

Efficacy: how effective a medication is to achieve your goals of glucose control.

Cost: the cost of any given drug or agents used for diabetes treatment can limit the capacity of the patient to follow treatment. Alternatively, it can limit the capacity of the patient to adhere to specific changes in his/her treatment plan designed to improve glucose control.

Side effects: potential toxicity and side effects are an important consideration in the selection of a diabetes therapy plan.

Weight gain: this can be induced by a given medication and must be considered in the selection of specific therapeutic agents.

Hypoglycemia risk: hypoglycemia induced by oral agents, injectable agents or insulin used for glucose control is important to be kept in mind in your plan of diabetes management.

Other conditions or diseases that may modify risk and tolerance to a medication: For example, kidney disease can decrease the elimination rate of a medication, and as a consequence, increase blood levels of that medication, that lead to increased risk of hypoglycemia.

There are now multiple options for diabetes treatment:

Metformin, if not contraindicated, and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes.

There are also oral and injectable agents that increase pancreatic secretion of insulin, decrease glucagon secretion (glucagon is a pancreatic hormone that normally rises blood glucose, thus, decreasing glucagon may improve blood glucose), and decreases appetite.

Other option is oral agents that block re-absorption of glucose in the kidneys that will lead to increased renal excretion of glucose. Increased glucose elimination will in turn decrease blood levels of glucose.

Eventually, due to the progressive nature of type 2 diabetes, insulin may be indicated for many patients with type 2 diabetes.

Remember the goal here is to bring blood sugar into a range that will allow you to decrease the risk of vascular diseases and avoid diabetic complications. Doing that much will in turn make you lose weight if you adhere to a meal plan advised by your dietician and your physician. These goals are not vague and unreachable. Glycemic goals recommended by the American Association of Clinical Endocrinologists (AACE) include keeping a hemoglobin A1C below or equal to 6.5% if you are otherwise healthy, without concurrent illnesses and at low risk for hypoglycemia. If you have other concurrent illnesses and are at risk for hypoglycemia, goals of glycemic control are individualized (A1C higher than 6.5%).

Work closely with your doctor to develop a safe, individualized program of diabetes management and care that will allow you to achieve these glycemic goals, and as a consequence, decrease your risk of diabetic complications and keep your health costs lower.

Forward Nutrition!

By: Rosemarie Steinsapir MS, RD, LD/N, CDE

Years ago, as a dietitian, I focused on explaining the need to restrict certain foods to patients with diabetes. Some patients did very well, quickly reducing carbohydrate and sugars, and following the old ADA recommended meal plans based on exchange lists. This was the best game in town for controlling intake and therefore, blood sugars. It worked so well in fact (for those who could stay the course), that Jean Nidetch developed Weight Watchers meal plans following the exchange lists based on the New York ADA chapter’s meal plans.

But then, some patients didn’t do very well. Some came back each month with very little improvement or control over their intake. It was frustrating for both educator and patient. Study after study after study coughed up information meant to improve the process of teaching/learning methods for diet improvement.

Breakthroughs are now claimed by many different professional fields: the gastroenterologists claim that stomach stapling, lap banding, etc, holds a cure for obesity and diabetes (yeah, wow), the FDA is rapidly closing in on a wide range of drugs that alter appetite and fullness sensation, some already on the market, and individual counselors all have a personal approach to presenting nutrition and consequently finally gaining control over what you eat.

As a dietitian who prefers the “I’d rather help myself method,” I do first acknowledge that there are people whose levels of obesity and weight may be better served by lap-banding or pharmacology. That said, knowing a few things about weight gain, loss, and control of appetite can put you on a better footing for good health, including diabetes.

Listed are some things I’ve learned about intake over the years both in educating patients privately, and through available nutrition research:

In the late 1990’s, The National Weight Control Registry was formed. You can find them on the web. They don’t offer advice, instead they collect data from people who have lost weight and dieted, sifting through the data to determine what works. (Weight Watchers was right there to grab the first bit of information!) It seems that those people who wrote down what they ate on a meal by meal basis far exceeded pounds lost and days maintained on a diet then those who breezed through the day unencumbered.

Acknowledge that having an appetite is normal, and then acknowledge that feeding it is normal. In fact, the only cure for being hungry is food. Delaying intake by skipping meals is a guarantee for overeating at the next meal. Choosing to eat on time before you’ve reached the famished stage allows you to choose foods in the lower calorie range and to be satisfied with them.

Nobody will eat food that doesn’t taste good. You can’t make them. It seems to help, women especially, to talk about food and its presentation and gather information about making the sterile chicken breast new again. The vast increase in food awareness coming from television seems to be leading both our taste trends and purchasing trends. The hard part for all of us is the ability to quickly judge the prepared food as high or low calorie, whether on TV or in a restaurant.

There is a whole field in nutrition that studies and relates to starvation. World Health Organization hires dietitians and agricultural economists to address some of these highly charged political and human issues. If you study the methodology of starvation, you quickly learn that one food above all others will prevent starvation. It is starch. (Put it long term memory as wheat, corn, rice, potatoes, and peas and beans. These are the world’s five major starches.) Starch has a ratio of carbohydrate, protein, and fat that is very similar to milk. It is a very powerful ratio: lots of carbohydrate, modest protein, tiny fat. But it also has quality in each nutrient, making milk and starches the two strongest, nutrient-dense foods on the planet. How can this help you and me to lose weight? Starvation (unintentional) and weight loss (intentional) follow the same dictates. Remove the starch and the carbohydrate shift in your daily intake will be phenomenal.

Exercise is the key to functional health and blood sugar control. It is not the key to weight loss. Practically speaking, you can eat 800 calories of pastry in 4 minutes or less, and it might take as much as 3 hours to work it off. If you don’t/can’t exercise for 3 hours, consider that you will probably store it as fat. The lap-band and the new drugs don’t rely on exercise either. To lose the pounds, you have to stop the calories at the lips.

Groups encourage group-like behavior. Pick your groups carefully. If you come from a family of high calorie eaters, you will really have to tread carefully. Some families are beginning to approach their weight issues as a group and supporting each other.

Portion Control is to weight loss like money is to a nice retirement. Maybe that’s enough for now on this topic.

To put the above in a handy box of mental tools:

Write down what you eat and hold yourself accountable until you reach your goal.
Eat 3 meals a day (at least) and on time.
Enjoy your food and try to estimate calories (as high or low) before ordering or preparing food.
When you eat out, or at supper, leave off the starch and replace it with vegetables.
Increase your steps and activity to feel better.
Be especially careful in groups of friendly people offering delicious food.
Retirement and Portion Control are possible.

Want to learn more on eating properly to manage Diabetes?

Come join us at our Healthy Meal Planning with Diabetes Class!

Here at Palm Beach Diabetes & Endocrine Specialists we offer a Healthy Meal Planning with Diabetes refresher course on Monday May 18th 2015 from 10am – 12pm in West Palm Beach. This class will cover how to plan and prepare healthy meals, how to make healthy snacks; grocery shopping, reading food labels and you even get to enjoy a yummy snack in class! This class also comes with a free recipe booklet with delicious recipes written by our very own diabetes educators and registered dietitians.

Call our scheduling department today to make an appointment at (561) 513-5100.

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 our Healthy Living with Diabetes Monthly Newsletter 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!