tag:blogger.com,1999:blog-47982043941832829512024-03-13T09:30:02.781-07:00SkepticRDSkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.comBlogger181125tag:blogger.com,1999:blog-4798204394183282951.post-78227412029899190322017-11-30T05:04:00.001-08:002017-11-30T05:05:04.477-08:00Diabetes Month Tip of the Workday<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Question</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Thanks for a month’s worth of information. But now, how can I use this information to help my friends and family members with diabetes and not feel like I’m being too intrusive? (In other words, how can I not be a “that guy” to people with diabetes?)</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So glad you asked! Here’s a summary of some tips offered by William Polonsky, Ph.D., a psychologist who specializes in treating people with diabetes (full article below).</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recognize that managing diabetes is a lot of work; it will help you be more empathetic toward that person. That person might also be coping with pain or other chronic conditions that make it hard to manage self care activities, and the diabetes is just that much more to cope with.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do not offer </span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">unsolicited</span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> advice about nutrition (“Should you be eating that?”) and other aspects of diabetes care. Treat adults like adults who are capable of making their own informed choices—including the choice to eat high carbohydrate foods sometimes. If they are Type 1, chances are they have thought long and hard about how much insulin they need to take to compensate for the pecan pie or whatever it is they are eating.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do offer to join in when someone is making healthy lifestyle choices. Bring healthy food to share at work instead of the high carbohydrate leftovers from your pantry.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t share horror stories about other people you know with diabetes (unless they ask, of course). Diabetes is scary enough, and hearing about your dead grandmother or your amputee aunt isn’t going to help make it any less scarier.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do simply ask “how can I help you?” Maybe they’ll give a suggestion, or maybe they’ll tell you they are fine.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t look horrified when the other person checks their glucose or uses insulin. They are just using a set of tools to stay healthy—it’s not much different that using a fork to eat or a wheelchair to move around in.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do offer a supportive environment, particularly for food choices. Throwing a dinner party? At least have them look over the proposed menu.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t give thoughtless reassurances. If you haven’t been through it, you probably don’t want to say “It can’t be that hard….”</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t peek at or comment on blood sugar numbers without asking. Those numbers are private and an extension of a person’s body. Don’t invade their privacy.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do offer loving encouragement—sometimes the other person just likes knowing you care.</span></div>
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</ol>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Full article: <a href="http://www.diabeticlivingonline.com/newly-diagnosed/coping/diabetes-etiquette-what-to-say-and-what-to-keep-to-yourself?page=0%2C1">Here</a></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">More humor about what NOT to say to a person with diabetes:</span></div>
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<a href="http://asweetlife.org/feature/10-things-not-to-say-to-a-person-with-diabetes/">10 things NOT to Say to a Person with Diabetes.</a></div>
<span id="docs-internal-guid-2e6d7dc5-0ccd-1f95-8cd5-64cac2b1ee35"></span><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 10pt; margin-top: 0pt;">
<a href="https://www.diabetesdaily.com/blog/2013/03/top-29-most-annoying-things-to-say-to-people-with-diabetes/">29 Annoying Things Said to People with Diabetes.</a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-67914515626522791802017-11-29T04:12:00.000-08:002017-11-29T04:12:19.098-08:00Diabetes Month Tip of the Workday<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Question</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This lifestyle information has been interesting, but I know there are a lot of people on medicine or insulin to control their blood glucose. Why are there so many different types of medicine or insulin?</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I could spend a whole week talking about that, so let’s see if I can condense. Your friendly pharmacists can give you a good answer too!</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Remember that our blood sugar is regulated by a complicated process influenced by how much insulin you make, how well you make insulin, how well you “use” insulin, how well you absorb your food after digesting, how much glucose your liver stores and releases into the blood stream, and how sensitive you are to insulin suppressing hormones (Whew!).</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Each different type of medicine works on a different part of the regulation process—and not every person with diabetes has a “deficiency” in all areas of regulating glucose. The amount and type of medication you take will depend on what part of the process needs correcting. For example, if someone has Type 2 diabetes, and their doctor thinks it is caught early, they will often start on a medication like Metformin (aka Glucophage) to keep the liver from releasing too much glucose into the bloodstream and help them "use" insulin better. They will still be encouraged to change their carb intake and become more active, but some people just need extra help. I've had a lot of trouble over the years with people assuming they have "failed" diabetes because they require medication and/or insulin to keep blood glucose under control. This is simply not true, medication is just another tool in the toolbox that some of us need. This type of shaming and ignorant attitude is particularly dangerous for people with Type 1 diabetes--I had at least one friend go into diabetic ketoacidosis while recovering from surgery because he didn't get his insulin.</span></div>
<span id="docs-internal-guid-2e6d7dc5-07a6-9e15-44f7-4a594845df7e"></span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As far as insulin is concerned—remember that those of us who don’t have diabetes have a certain amount of insulin in our blood stream all the time. This is usually referred to as a basal or “background” insulin. When we eat carbohydrate our pancreas will give a short burst (or bolus) of insulin the moment the carbohydrate hits our tongue, and then another burst/bolus of insulin once that glucose hits our blood stream. People with Type 1 diabetes (remember, they don’t make any insulin at all) will usually need to take a shot of basal insulin (once or twice per day depending on the type) and a “bolus” type insulin whenever they eat. People with Type 2 might “only” need a bit of bolus insulin, or if they’ve been diabetic for a long time, they might need a combination of the two. Some insulins also contain a mixture of background and bolus insulin or people have to mix the two in a syringe. Again, it depends on how much “correction” a person needs and how well they eat, etc.</span></div>
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<span style="font-family: Calibri;"><span style="white-space: pre-wrap;">All that said, each person with diabetes should spend some time with their doctor going over what the medicine is used for, what the side effects are, and the risks/benefits. Way easier said than done in this day and age of doctors having limited time to spend with you. If your insurance allows it, try to get into and endocrinologist or a diabetes center that will allow you to spend more quality time with a diabetes specialist and/or a diabetes educator to help you understand how to best take your medicine/insulin.</span></span></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-70358070832820351602017-11-28T04:17:00.000-08:002017-11-28T04:22:14.105-08:00Diabetes Month Tip of the Workday<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; vertical-align: baseline; white-space: pre-wrap;"><b><u>Question</u></b></span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What is the best type of exercise for someone who has Type 2 diabetes?</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The short answer </span><span style="font-family: "calibri"; font-size: 16px; white-space: pre-wrap;">is a combination of strength training and cardiovascular exercises, but a</span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">ny exercise helps if it is done safely. </span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">Naturally, people need to consult their providers and whenever possible, a qualified physical therapist so they have an idea of both </span><span style="font-family: "calibri"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">how much</span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> exercise they can do safely and </span><span style="font-family: "calibri"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">wha</span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">t they can do safely. If you have a chronic illness and/or already have complications from diabetes, you will want to be especially careful when seeking out a personal trainer. Here is a short post on what to look for if you are seeking help from a <a href="http://the%20best%20type%20is%20a%20combination%20of%20strength%20training%20and%20cardiovascular%20exercises./">personal trainer</a>.</span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<span id="docs-internal-guid-2e6d7dc5-0279-ea57-3989-59a0d4c2b861"><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">People should also be reminded that if they are trying to lose weight that most of the weight loss will come from changing the diet as opposed to exercise. </span><span style="font-family: "calibri"; font-size: 12pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Let me repeat that, if you are trying to lose weight your diet will make more of a difference than your exercise</span><span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">. Unless you are a triathlete, professional athlete, competitive body builder, etc, you really don't have much wiggle room to take in extra calories or need extra protein. Anyone who tells you otherwise is probably trying to sell you something you don't need.</span></span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">Even if exercise doesn't help with weight loss as much as you thought it did, there are still plenty of of benefits to exercising.</span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">1) Overall lower blood sugar in people with diabetes. Exercise that builds and maintains muscle will help you become more "sensitive" to insulin and help your overall blood sugar better.</span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">2) Increased lean body mass or muscle. Starting in your late twenties and early thirties you lose lean body mass unless you do something to prevent it.</span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">3) Increased strength and balance, this is particularly important for older folks who might already have other issues affecting their ability to walk safely.</span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;">4) Prevention bone loss in older people</span><br />
<span style="vertical-align: baseline;"><span style="font-family: "calibri";"><span style="font-size: 12pt; white-space: pre-wrap;">5) Help your emotional </span><span style="white-space: pre-wrap;">well-being</span><span style="font-size: 12pt; white-space: pre-wrap;">.</span></span></span><br />
<span style="vertical-align: baseline;"><span style="font-family: "calibri";"><span style="font-size: 12pt; white-space: pre-wrap;"><br /></span></span></span>
<span style="vertical-align: baseline;"><span style="font-family: "calibri";"><span style="font-size: 12pt; white-space: pre-wrap;">Dr. Yoni Freedhoff of Weighty Matters, a physician who specializes in weight loss, has blogged about this topic of <a href="http://www.weightymatters.ca/2017/11/whether-or-not-you-can-outrun-bad-diet.html">"exercise for health, not for weight loss"</a> quite a bit. <a href="http://www.weightymatters.ca/2014/04/the-5th-myth-of-modern-day-dieting-you.html">Here</a> is one of his videos that he did a few years ago, and if you like that video, he has a lot more information. Happy watching and reading!</span></span></span><br />
<span style="font-family: "calibri"; font-size: 12pt; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-3148663492193090542017-11-27T05:11:00.003-08:002017-11-27T05:14:04.696-08:00Diabetes Month Tip of the Work Day--Part Two<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; vertical-align: baseline; white-space: pre-wrap;"><b><u>Question</u></b></span><span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What about alcohol? I've gotten a lot of different "opinions" on this one.</span></div>
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<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">You've probably gotten a lot of different opinions on this one because a) the consumption of alcohol has a huge social/societal component to it, and many of us in healthcare let that color our answer, sometimes more than we should and b) people with diabetes have a lot of things to consider before they take that first drink. I've included a list of considerations below.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">*Moderate drinking to maintain good health is defined as no more than two drinks maximum for a larger person and one drink a day for a smaller person. </span></div>
<span id="docs-internal-guid-2e6d7dc5-fd8f-4062-3dbc-abfe911ea6f5"></span><br />
<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Is my blood glucose level in what I consider good control or poor control?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For people that already have blood sugar levels well above goal or tend to “swing” wildly; you probably shouldn’t add empty calories and extra carbohydrate into that mix.</span></div>
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</ol>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do I have any other conditions that do not mix with alcohol?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Many people with diabetes have other conditions like kidney disease, neuropathy, congestive heart failure, etc that are aggravated by alcohol consumption and might be better off avoiding it.</span></div>
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</ol>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do I take any medications that do not mix with alcohol?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Again, many people with diabetes will taking other medications that do not mix well with alcohol. Ask your provider or pharmacist about your medications if you can, as the internet might give you a lot of seemingly conflicting information too.</span></div>
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</ol>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do I have access to food for when I take that first drink of alcohol?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Our bodies engage in many wondrous complex regulatory processes, including a process called gluconeogenesis, which allows the liver to store glucose and release glucose into the bloodstream when your blood glucose levels drop. Alcohol can hinder that same process and cause the blood sugar to drop if you drink on an empty stomach. </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">On a related note, if you have diabetes and are going to be drinking with friends or family, make sure they know that you need to eat with alcohol. That way if your food intake is delayed, and you become “wobbly,” your friends can remind you to check your glucose instead of just assuming you are tipsy. Keep easily chewed and swallowed carbohydrate sources with you, and make sure you are wearing your medic alert bracelet or necklace.</span></div>
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</ol>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How many extra calories and carbohydrate grams am I getting?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Most alcoholic beverages do not have a label on them to tell you this—so again, yay for the internet (calorieking.com) and smartphones to help you figure this information out. Again, planning ahead before you go out to a place that doesn't have good internet service is a good idea.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In general, dry red wines and lite beers have only 2-4 grams of carbohydrate and distilled liquors (like vodka) have none. You still have to count the calories though.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mixed drinks (like margaritas) will often have the most calories and carbohydrates.</span></div>
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</ol>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What is my past experience with alcohol/can I truly moderate my drinking?</span></div>
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<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: lower-alpha; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "calibri"; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Have you had trouble stopping after one or two drinks in the past? Did a fun night of drinking result in a hospital visit? Probably not a good idea for you personally to be drinking then.</span></div>
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<div>
<span style="font-family: "calibri";"><span style="white-space: pre-wrap;">Se you tomorrow for some information about exercise!</span></span></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-75582380504443537742017-11-27T04:58:00.002-08:002017-11-27T04:58:28.773-08:00Diabetes Month Tip of the Workday--part one<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="color: black; font-family: "Times New Roman"; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; vertical-align: baseline; white-space: pre-wrap;">I meant to publish this the day after Thanksgiving, but Google apparently did not save my document correctly. I was out of town and too frustrated to fix on Spouse's laptop. Then this morning the cat literally walked over the keyboard and erased what I had written. So here is a twofer for you.</span></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="color: black; font-family: "Times New Roman"; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; vertical-align: baseline; white-space: pre-wrap;"><u style="font-weight: bold;">Qu</u></span><span style="color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: bold; text-decoration-line: underline; vertical-align: baseline; white-space: pre-wrap;">estion</span></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I live in the United</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> States and I did not want to check my blood glucose this morning as I had a pretty carbohydrate heavy day yesterday. I started thinking about all the carbohydrate heavy holidays spanning from Halloween to Valentine's Day, and I want to find a good "halfway" strategy that doesn't involve beating myself up about my eating habits for months on end or devolve into me not caring so I wind up in the emergency room. How can I start to do this?</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Good for you for wanting to do the hard work of truly taking care of yourself both mentally and physically during the holidays.</span></div>
<span id="docs-internal-guid-2e6d7dc5-fd72-0f2f-a71e-13a6f4519dfa"></span><br />
<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Start with congratulating yourself for wanting to take care of yourself. You might have to do this every morning by journaling or whatever you do to take care of you!</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do your homework on your favorite carbohydrate rich holiday foods before your next big family gathering (or before that particular work day when you know you're co-workers are going to bring in certain foods. Websites like calorieking.com can give you a pretty good idea of how much carbohydrate is in what you like to eat. It can also get you started estimating portion sizes which, unless you're a trained chef, is always a challenge and may take a little more measuring.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Figure out which carbohydrate foods you “need” to have to have a happy holiday and which foods can live without or don’t really like anyway. Maybe you really "need" your favorite Uncle's cornbread stuffing to have a good day, but you really don't want your other Uncle's mushy corn casserole. If your gatherings are big enough, someone is probably letting "that uncle's" casserole sit by itself anyway.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Intentionally pick which days are going to be carbohydrate heavy so you don't mindlessly take in more than you want from from Halloween to Valentine’s Day.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you have trouble with “food pushing” family members (or co-workers), try getting advice from your favorite mental health professional or your favorite culture sharing supportive group of friends on how to safely negotiate challenging family situations and/set boundaries with friends and co-workers. You might need to sneak away or surreptitiously text or call an understanding friend to vent.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="white-space: pre-wrap;">Have your own snacks and lunch items available at work, even if it means combining what you eat with what is brought.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Focus on traditions that don’t involve food (like going for a walk or playing games or try to form some new family traditions or travel. And if you can make that walk about having fun and getting out of the house, and not burning calories, even better! </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Experiment with some lower carb versions of your favorite foods to see if there is a worthy substitute. Preferably on a day that is not before the family gathering if you can help it. I have some pumpkin muffins that I make with coconut flour that are so moist and tasty that even my texture sensitive spouse likes them. And I've also had some low carb baked goods that I've thrown in the trash. If your exciting food experiment turns out to be not so exciting (or edible), don’t be afraid to be glad you tried, laugh, and move on. Enjoy the regular item in a smaller amount.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Have a plan to donate or freeze leftovers, or even spend some time working at soup kitchen or other charity. A lonely neighbor, or a local homeless shelter or giveaway group might want to have something homemade. Sometimes you might also find that if your cookies (or whatever) are in the freezer you are less likely to eat them. And if you are like me, you might not want to have tempting items in the house anywhere.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Have a plan in place for if you do overindulge and your blood sugars are raging out of control. Keep some protein/veggies in the freezer so you can have a carb free meal until everything settles down. Have more test strips on hand to check more often and monitor the situation.</span></div>
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<span style="font-family: Calibri;"><span style="white-space: pre-wrap;"><br /></span></span></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-79987358299126489962017-11-22T04:57:00.001-08:002017-11-22T04:57:23.758-08:00Diabetes Month Tip of the Workday<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="font-family: Calibri;"><span style="background-color: white; white-space: pre-wrap;"><b><u>Question</u></b></span></span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How many times per day should a person with diabetes eat?</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The answer to this question ultimately depends on what type of medication and insulin regimen the person is on (if any), what other medical problems they might have that can interfere with nutrient absorption, and to a certain extent, how old they are. </span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you are trying to control your blood glucose without any type of medication (pills or injectables), you might benefit from eating at least three times a day to keep your carbohydrate and your protein intake spread throughout the day. Some people can get away with keeping in spread through two meals a day, others need to have something in the morning to keep them from overeating later. Whatever helps you achieve your basic carbohydrate/protein intake, create a caloric deficit if you are trying to lose weight, and keep from being miserable because you are skipping meals.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If your provider has you on a medicine like metformin (aka Glucophage), you will probably have to take this medication with a meal that has protein in it to reduce your chance of side effects like nausea and diarrhea. To keep yourself from being miserable, it is better that you have 2-3 meals a day.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you take a medication like Victoza orExenatide to help with blood glucose control and weight loss, you will have to be careful to avoid overeating at meals to keep from having nausea and vomiting as well. Even if you are trying to lose weight you need to get enough nutrition, ergo, you will be better off eating three times per day.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Most of the people that I work with, because of their station in life, wind up taking some of our long standing medications like Glipizide (Diabeta) and insulin 70/30, or insulin NPH. These medications/insulin require a pretty rigid schedule to prevent hypoglycemia (low blood glucose). Therefore, people who take these medications would benefit from eating three meals per day at roughly the same time each day so that they can get enough protein, avoid hypoglycemia, and avoid overeating. If they take Glipizide or insulin 70/30, they probably need to eat a snack at night as well. (And sometimes a small snack can be worked in for those with a schedule that keeps more than 4-5 hours between meals).</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Over the years many people with Type 2 diabetes have been told to eat six smaller meals per day. This statement is NOT based in evidence and usually leads to weight gain, since they will likely consume more calories and never have a chance to “tap into” their fat stores. They will also likely have even worse blood sugar control. If someone feels compelled to eat in between meals to avoid hypoglycemia they most likely need a reduction in insulin and/or medication as no one should have to “feed” their insulin. Leave the six meal a day recommendations to those who need to gain weight (like little kids with Type 1), have certain digestive conditions (like IBS that is diarrhea-dominant), and/or just a generally poor appetite.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The need to have a regular eating schedule to prevent hypoglycemia and to get enough protein taps into another problem that many of the people that I work with face; that of food security. I would like to give this attention in another blog post. But, usually if someone is having a lot of low blood glucose levels at the end of the month it might be because they are running out of food by that time. I sometimes see people’s glucose levels go a lot higher at the end of the month because they have only higher carbohydrate staples to consume. Eating regularly and in balanced amounts is currently something that not everyone has access to, and needs to be taken into account when we try to be compassionate towards others.</span></div>
<span id="docs-internal-guid-849876af-e3cc-6ab6-5c1b-0b7c948cf32a"></span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Thanks again for reading, see you the day after United States Thanksgiving!</span></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-19361487152494038902017-11-21T04:49:00.000-08:002017-11-21T04:49:06.600-08:00Diabetes Month Tip of the Day<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Question</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I heard that people with diabetes with diabetes are supposed to eat protein with their carbohydrate because it will help “balance out” or “stabilize” the blood sugar. Is that true?</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The short answer is no. (And you were hoping that piece of chicken would cancel out the pasta, weren’t you?). Also, the concept of “balancing out” and stabilizing are pretty much vague </span><span style="background-color: transparent; color: black; font-family: 'Times New Roman'; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">terms that don't really do anything except maybe help us feel virtuous about our eating.</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> I think what some people mean is that they hope that by eating protein that they will “prevent blood glucose from spiking” or “the chicken will actually cancel out the pasta somehow.”</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Eating protein with carbohydrate does not “stop” or “slow down” the carbohydrate from spiking the blood sugar, and eating protein does not bring high blood sugar down. At one point in time I think people actually believed that protein at bedtime would somehow prevent low blood sugars from happening overnight or during the day, however, once we studied that it turned out not to be the case. Adding fat and fiber to the meal can slow down the emptying of the stomach and therefore slow the absorption of carbohydrate, but ultimately the blood sugar spike and any other fluctuations will be mostly determined by the </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">amount</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> of carbohydrate that someone eats.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Now, none of that should take away from the need to eat protein! Meals that contain protein often help you feel fuller faster and for longer periods of time; meaning that for some people eating protein might help you not eat as much at that meal and help you not eat as much in between meals. </span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Indirectly</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, that helps keep the blood sugar levels from being elevated because you are just not eating as much carbohydrate. Protein also helps us maintain muscle mass and skin integrity (particularly when we are trying to lose extra body fat), and older people will absorb protein better (and be more likely to get enough) if they eat it at each meal instead of just once or twice per day. I had a co-worker also ask me about protein helping you “burn” more calories, each day, also known as the Thermic Effect of Food. Your resting metabolism might increase very slightly if you added more protein, but the minute you eat more than one or two Oreos cookies or a slice of bread, that effect is gone. So no, adding more protein doesn’t excuse your need to reduce carbohydrate or calories.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you’ve heard “eat a portion of protein” about the size of your palm before, it’s because that size of chicken breast, etc. is going to be about 2-4 ounces of protein. Most adults will need about that much per meal—which also translates to 14-28 grams of protein. And guess what? Protein also contains calories too. If you are trying to lose extra body fat and maintain your lean muscle, you will still have to watch the amount of calories you eat. </span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So when you hear about a “balanced” meal, what that translates to is a meal that contains adequate/appropriate amounts of carb, protein, healthy fats, and vegetables. No magical prevention of blood glucose spikes, no magical prevention of low blood glucose, just earlier satisfaction with the meal and maybe eating fewer calories during the day.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Want to keep reading?</span></div>
<span id="docs-internal-guid-849876af-de9a-5375-65f9-9e117c2de62e"></span><br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<a href="http://blog.joslin.org/2012/04/protein-breakdown-what-it-does-for-your-diabetes/" style="text-decoration: none;"><span style="background-color: transparent; color: blue; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">http://blog.joslin.org/2012/04/protein-breakdown-what-it-does-for-your-diabetes/</span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-58879950949863952912017-11-20T05:04:00.000-08:002017-11-22T13:08:36.670-08:00Diabetes Month Tip of the Workday<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Question</span></span></u></b></div>
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">What about these products marketed to
diabetics like sugar substitutes, “low carb” ice cream or “sugar free”
cookies?<span style="mso-spacerun: yes;"> </span>Are they helpful?</span></span></span></span></div>
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Answer</span></span></u></b></span></span></span></span></div>
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">This is one of my favorite topics to
rant about, so get ready for a sarcastic ride.</span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">The short answer to your question is maybe,
maybe not, <b style="mso-bidi-font-weight: normal;">you only know if you look at
the label</b> and compare the serving size and carbohydrate content of the
“new” product to the “original” product.<span style="mso-spacerun: yes;">
</span>Sometimes you might see a huge difference in carbohydrate content per
serving--like if you compare the label of a diet soft drink to a regular soft
drink—52 grams of carbohydrate per can versus zero, but most likely you only
see a difference in the price (and maybe half a gram different in
carbohydrate). </span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><br /></span></span></span></span></span></span></span></span></span></span>
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">A lot of the candies and other baked goods that are labeled
“sugar free” also contain sugar alcohols; these are fermented starches that
have a sweet taste and only about half of them are absorbed in the intestine—so only half of those
carbohydrate grams change to blood glucose. They also tend to have a powerful
laxative effect if you eat too much. And by too much, the threshold depends on the individual. Some people can eat a handful of the "sugar free" candies without issues, other people start having cramping with one or two pieces. One of the more amusing examples of this
in popular culture is the reviews left on Amazon.com about the <a href="https://www.amazon.com/Albanese-Candy-Sugar-Assorted-5-pound/product-reviews/B00DE4GWWY">Haribo sugarfree gummy bears</a>. </span></span><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">If
you have Irritable Bowel Syndrome (IBS) or any other digestive condition, like I do, I
wouldn’t go near anything with sugar alcohols (erythritol being the one
exception). </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Now for the real question that you
were hemming and hawing about.<span style="mso-spacerun: yes;"> </span>Sugar
substitutes….</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Q:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
I heard that Equal/Splenda/Sweet and Low give you “the cancer.”</span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>There are many, many, different kinds of
cancer, with many, many different kinds of causes.<span style="mso-spacerun: yes;"> </span>If you are referring to the “the cancer” that
the rats got from saccharine (Sweet and Low)—it was because they ate about
60-70 times their own body weight in saccharine. <strong>There haven’t been any real
scientific studies that link “the cancer” to the intake of aspartame or
sucralose as well.</strong><span style="mso-spacerun: yes;"> </span>Keep in mind that too
much of anything will probably contribute to some kind of illness in some way, shape, or
form. Michael over at Skeptical Raptor
has also written extensively about the safety of <a href="https://www.skepticalraptor.com/skepticalraptorblog.php/aspartame-safe-scientific-consensus">aspartame in particular</a>. </span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Q: </span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">I
heard that Splenda “causes” diabetes and/or problems with the “good” bacteria
in the gut.</span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>First of all, most of those studies were done
in rats, and rats aren’t humans (I know, you are surprised! </span></span><span style="font-family: "wingdings"; font-size: 12pt; line-height: 115%;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">J</span></span><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">).<span style="mso-spacerun: yes;">
</span>Second of all, the amount of sugar substitute fed to the rats was rather
large (about 11-12 cans of diet soda per day!), and doesn’t necessarily reflect
“real life.” Third, when human studies were done, the amount of people studied
was so small we can’t actually apply them to the larger population. In short,
if you use a little bit of Splenda, etc. to sweeten your coffee in the morning,
you are probably ok.<span style="mso-spacerun: yes;"> </span>If you have Splenda
in the coffee, Splenda on the cereal, Splenda in your yogurt, Splenda in your
Cole-slaw (yes really), and drink diet drinks all day long (you know who you are),
it wouldn’t be a bad idea to start reducing your consumption. And even then, it's not really the Splenda that you need to cut down on, it might be the stuff that you're putting sucralose on that you need to reduce to keep your overall calorie and/or carbohydrate intake down.</span></span></div>
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Q:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
But I heard that diet sodas were actually worse for you than regular sodas!</span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
Go back and read what I just wrote about “the cancer” and “portion control”
please.<span style="mso-spacerun: yes;"> </span>I’ll wait. (Plays hold music)</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Ok, first of all, if someone cuts out
all that sugar and drinks something less acidic—they are likely going to have
better control of their blood glucose, take in fewer calories, and have
something that is less harmful to their teeth, they are probably going to do
better with the health goals. As far as “diet sodas make you gain weight”
trope—it appears as though people usually drink diet sodas to justify not
changing any other habits besides their soft drink habit.<span style="mso-spacerun: yes;"> </span>Remember that joke about the dude who orders
the extra-large fast food meal with a diet coke?<span style="mso-spacerun: yes;"> </span>The thing is….we humans are masters of
rationalizing the choices that we make.<span style="mso-spacerun: yes;">
</span>If you are really and truly going for a carbohydrate and calorie
reduction….you probably need to look at other sources of such besides your soft
drinks.<span style="mso-spacerun: yes;"> </span>Now, to be fair, some people
have claimed that they have increased hunger when they drink a lot of diet
sodas—there might<span style="mso-spacerun: yes;"> </span>actually be something
to that—however, it’s the overeating on other foods that causes the weight
gain, not the actual diet soda themselves.</span></span></div>
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Q:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
So I can drink diet sodas all day long?</span></span></div>
<br />
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
No really, go back and read what I just wrote about portion control.<span style="mso-spacerun: yes;"> </span>For everything. Really. I’ll wait,
again.<span style="mso-spacerun: yes;"> </span>(Plays hold music again)</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">In addition, for those us (me) that need the whole "portion control" thing reinforced in our brains, most bottled products will have sodium in them, and some of us don’t need the extra on that either, particularly the population that I work with--those that already have cardiac and renal (kidney) issues. There is also that whole "hard on the teeth" thing that can happen (even without the sugar) in the cola
type beverages.<span style="mso-spacerun: yes;"> Some people might also have conditions, along with the diabetes, that make them super sensitive to caffeine. And then, for me, there's always been the issue of cost. I like a good diet ginger ale sometimes, and the bubbly feel of sparkling water, but I also like the lower cost of tap water or tea I make myself.</span></span></span></div>
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<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Q:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
What about “natural” things like stevia? Or could I use honey/agave
nectar/brown sugar/maple syrup, etc.?</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A:</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">
“Natural” does not mean better.<span style="mso-spacerun: yes;"> </span>Getting
mauled by a bear is “natural” but not something you want to do on a regular
basis (or at all, really).<span style="mso-spacerun: yes;"> </span>The evidence
says Stevia hasn’t been shown to cause any problems when used in moderation, so
if you find a product you like (some products have a bitter taste) you can probably
use it safely in small amounts. There are also some other plants, like monk fruit, that seem to be safe if you are watching the amounts. Some formulations of stevia also have a bitter taste, or some people (me) forget that stevia is much sweeter than sugar and get a sharp realization about that once they take that first sip of coffee.</span></span></div>
<br />
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Honey, agave nectar, maple syrup brown
sugar, etc. are still all carbohydrates so each tablespoon will provide 15
grams of carbohydrate.<span style="mso-spacerun: yes;"> </span>If you use these
items you will need to “count” them toward your carbohydrate intake. I
personally would rather just take my coffee black or dump in a packet of
Splenda so I have one less thing to think about, but again, that’s my personal
choice of where I want to spend my carbohydrates.</span></span></div>
<br />
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Want to keep reading?</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">For a humorous take on this (he’s a
little sweary too): </span></span><a href="http://www.bodyforwife.com/does-diet-soda-increase-belly-fat/"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">http://www.bodyforwife.com/does-diet-soda-increase-belly-fat/</span></span></a></div>
<br />
<div style="margin: 0in 0in 10pt;">
<a href="http://blog.joslin.org/tag/artificial-sweeteners/"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">http://blog.joslin.org/tag/artificial-sweeteners/</span></span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-36385689884421265722017-11-17T05:27:00.000-08:002017-11-17T05:27:01.593-08:00Diabetes Month Tip of the Day
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Question</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">What about “low carbohydrate diets”
like Atkins? Or very low carbohydrate plans like the “ketogenic” diets.</span></span></span></span></div>
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<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Answer</span></span></u></b></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">You might be surprised, but even the
American Diabetes Association states that very low and low carbohydrate diets, like
the Atkins, are one acceptable plan to follow for people with Type 2 diabetes who
are trying to lose weight. (See <a href="http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf">here:</a>) <span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">In short, the plans that limit carbohydrate and make provisions to
obtain adequate protein, fat, and vegetables are actually backed up by
evidence. <span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Unfortunately there are some problems and/or concerns with the low and very low carbohydrate plans that I have encountered over the years:</span></span></span></span></span></span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">1) Some <span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">plans (like
Atkins) will encourage reliance on a particular company’s products (shakes,
bars, special low carb cookies, etc.) <span style="mso-spacerun: yes;"> </span>These products are often expensive and
usually not very nutritious (and people become bored with the particular
products). People who want to follow a plan like Atkins, South Beach, Protein
Power, etc. might need encouragement to stick with “regular” food instead
of convenience items. That doesn't mean that you can't ever use said items; people who are traveling, who have limited skills/time/facilities for cooking, or who have <a href="https://en.wikipedia.org/wiki/Executive_dysfunction">executive dysfunction</a> problems might need to rely on some of these at first. If you find yourself disliking the taste and/or expense of said products, just remember it's one stepping stone in changing your food journey. <span style="mso-spacerun: yes;"> </span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;">2) </span>Some people think that on these plans that they can
eat whatever they want without paying any attention to portions or calories—and
the calories on those “low carb” brownies really add up.<span style="mso-spacerun: yes;"> There are many people who have spent years trying to find the perfect diet and the appeal of something "easy" is quite powerful. </span>I noticed this ignoring of the need for a reduction in calories a lot in the early 2000’s,
when the South Beach Diet first appeared on the scene and there was a
proliferation of low carb stores with low carb pasta, low carb tortillas, etc.<span style="mso-spacerun: yes;"> </span>People would spend a lot of money on these
products, lose a bunch of weight at first, and then see the weight loss plateau because they forgot that they won’t
lose weight if there isn’t some kind of <a href="http://www.bodyforwife.com/understanding-caloric-deficits-for-weight-loss/">caloric restriction</a>.<span style="mso-spacerun: yes;"> If you find a brand of low carb pasta, etc. that you really like, and find that it helps you stay on your plan (and you can afford it) by all means use it. Just remember the portion will still count. </span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="mso-spacerun: yes;"></span>3) Some people have
other health problems that don’t allow them to follow a very low carb diet. For
example, if you have gall bladder disease (or have had it removed) you probably
won’t be able to tolerate the amount of fat required for very low carbohydrate
plan. Some other people with bowel problems find the lack of fiber and/or resistant starch causes additional problems with constipation and/or and alteration in gut flora that may cause constipation or diarrhea. And of course, if you are a Type 1 diabetic who is not trying to lose weight, you will likely need to eat a minimum amount of carbohydrate grams each day to keep yourself from forming ketones. </span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">4) <strong>Some</strong> <b style="mso-bidi-font-weight: normal;">people also find these type of diets so
unlike what they are used to that they can’t keep them up long term</b>.<span style="mso-spacerun: yes;"> This problem probably should have been labeled number one on the list. </span>In other words, they might benefit from a
plan that emphasizes <i style="mso-bidi-font-style: normal;">gradual and
consistent</i> reduction of carbohydrate so they can actually stay on their
plan. <span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">A meal plan, or diet, or whatever you want to call it, is only a good idea IF YOU FIND IT SUSTAINABLE.<span style="mso-spacerun: yes;"> If you can't keep this up long term you might find yourself discouraged/unmotivated, and faced with health problems that come raging back. (I have
also had friends/acquaintances that have used all the forms of low carbohydrate diets as a way of "acting out" their disordered eating. If you think you fit that bill, definitely consult with a mental health professional (if you can) before undertaking a restrictive plan.</span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Other the other hand, some people do try and find ways to find low carbohydrate eating sustainable. That’s why there are so many blogs, support
groups in real life and online, social media groups, etc. for eating for diabetes, eating low carb,
eating a ketogenic diet, etc.<span style="mso-spacerun: yes;"> </span>Low
carbohydrate/carbohydrate controlled plans can be very doable, but not
necessarily easy to follow at first, and most of us need a little support and
encouragement along the way if we are going to stay with it.<span style="mso-spacerun: yes;"> (And if you are in an online support group that is...not so supportive....see if you can find another community before giving up). </span>Keep in mind too that updated versions of books like the
Atkin’s diet will give instructions for a more moderate approach<span style="mso-spacerun: yes;"> </span>to carbohydrate restriction.<span style="mso-spacerun: yes;"> </span>(The newer version of that plan was actually
co-authored by a Registered Dietitian).</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">I also remind people that “low
carbohydrate” doesn’t really have a definition.<span style="mso-spacerun: yes;">
</span>(“Lower than what?” is my usual snarky question).<span style="mso-spacerun: yes;"> </span>I prefer the term “carbohydrate controlled”
which implies that the person is aware of what their carbohydrate budget is (as
in about how many grams a day, or which foods affect you) and is taking steps
to stay within a certain amount.</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Want to keep reading about the
evidence for carbohydrate controlled plans?</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<a href="http://www.lowcarbdietitian.com/research.html"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: Calibri;">http://www.lowcarbdietitian.com/research.html</span></span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-74444165350907787862017-11-16T04:38:00.000-08:002017-11-16T04:38:14.966-08:00Diabetes Month Tip of the Day
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Question</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">I really, really tried that
carbohydrate counting yesterday and I got cranky because all my meals were
turned into a math equation.<span style="mso-spacerun: yes;"> </span>I know some
people have to do this…but isn’t there something easier I could try for now?</span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Answer</span></span></u></b></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">If you know which foods fit the
different groups—(mostly carbohydrate, protein, fat, or non-starchy
vegetables*), there is an easier way to think about this.<span style="mso-spacerun: yes;"> </span>Think of your plate as a divided picnic
plate.<span style="mso-spacerun: yes;"> </span>Fill half the plate with green
vegetables, ¼ with protein, and the remaining ¼ with a healthy
carbohydrate.<span style="mso-spacerun: yes;"> </span>It will look something
like this:</span></span></span></span></span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-no-proof: yes;"><img height="192" src="data:image/png;base64,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" v:shapes="Picture_x0020_1" width="147" /></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">And since I couldn’t get a good
picture of food at home, something like this:</span></span></div>
<br />
<div style="line-height: normal; margin: 0in 0in 9pt 0.25in;">
<a href="https://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=https://diabetessource.ca/ask-the-rd-what-is-the-diabetes-diet/&ei=rw9mVNHhMcKkyAT0jYG4AQ&bvm=bv.79142246,d.aWw&psig=AFQjCNEZGCr_oi1j5wqRu9dVuLIV41Roig&ust=1416061187315295"><span style="color: blue; font-family: "Arial",sans-serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman"; mso-no-proof: yes; text-decoration: none; text-underline: none;"><span style="mso-ignore: vglayout;"><img alt="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcQACFOe8B57231YZuF9lIt27peSyH51lTII6QgjmhhV2oWDRJZV" border="0" height="300" 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" v:shapes="Picture_x0020_2" width="300" /></span></span></a></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">It’s very similar to the Myplate
graphic from the USDA, but a little “tighter” on the carbohydrate content.<span style="mso-spacerun: yes;"> </span>This is a great way for people to at least
start thinking about reducing their portions of carbohydrate (and eat more
vegetables) even if they are not willing to or feel able to count actual carbohydrate grams. In addition,
this graphic is also a great way remind us that the way people with diabetes
are “supposed” to eat is a very healthy way for us all to be eating, and it
also helps us estimate portions when eating out too.</span></span></div>
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Speaking of “portions” there is a lot
of information about portion and serving sizes out there—most of it is
meaningless with some kind of context about how much carbohydrate you tolerate
(or how many calories you need). For more context, please go back to the
beginning of this series, staring on November 1rst, and do some figuring out
about how much carbohydrate you think might be right for you. Again, some of
you might decide that the best thing for you is to not have certain
carbohydrate foods readily available; for example, maybe you don’t want to
bother with figuring out “just” the right amount of rice to eat (or you don’t
want to bother with the small portion) so rice just won’t be on the menu very
often.<span style="mso-spacerun: yes;"> </span>Other people might find that
there are certain readily available favorite foods that they want to work in regularly, and will work very hard to
do so.<span style="mso-spacerun: yes;"> </span></span></span><br />
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">*You can find lists of food, as well
as a lot more info, at educational websites geared toward diabetes and portion control like </span></span><a href="http://www.joslin.org/info/diabetes-and-nutrition.html"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: Calibri;">http://www.joslin.org/info/diabetes-and-nutrition.html</span></span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-62423361724215684362017-11-15T04:48:00.005-08:002017-11-15T04:48:47.969-08:00Diabetes Month Tip of the Day
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Question</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Ok, so I learned where carbohydrates
are, and which ones might be better choices, and I have a rough idea of how
much might be a good idea to eat at each meal.<span style="mso-spacerun: yes;">
</span>Now, how do I “count” these carbohydrates at each meal?</span></span></div>
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Answer</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Great question, but the answer is
going to involve some work. Let’s go step by step.</span></span></div>
<ol style="direction: ltr; list-style-type: decimal;">
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: bold;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Decide what
kind of carbohydrate food to eat based on price, cooking skills, availability
at store, and what everyone in the household likes to eat (Whew!).<span style="mso-spacerun: yes;"> </span></span></div>
<ol style="list-style-type: lower-alpha;">
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">If you are new to carbohydrate counting, start
with the carbohydrate foods your family normally eats the most of.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Better yet, choose something that you already
have in the house as a staple.<span style="mso-spacerun: yes;"> </span>We’re
here to learn, not condemn our choices!</span></div>
</li>
</ol>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Pick-up said food at the store or out of the
pantry or fridge (let’s use rice as an example).</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Look up the amount of carbohydrate on the
label, on your favorite carb counting smartphone app, or on the internet (I
like calorieking.com). </span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Finds out that 1/3 of a cup of rice (cooked)
has about 15 grams of carb. </span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Figures out how much dry rice makes a cooked
portion. Sighs because even 2/3 of a cup (30 grams of carb) doesn’t seem very
much.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Cooks rice.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Portion out about 30 grams worth for me and 45
grams worth for my husband, then pack up leftovers for lunch.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri",sans-serif; font-size: 11pt; font-style: normal; font-weight: normal; margin-bottom: 10pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Add in roasted chicken (protein) and steamed
broccoli with olive oil and balsamic vinegar (non-starchy vegetables, healthy
fats, non-caloric flavorings).<span style="mso-spacerun: yes;"> </span>(You
remembered to get that at the store and cook it, right?)</span></div>
</li>
</ol>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Seem complicated?<span style="mso-spacerun: yes;"> </span>If it does, you might have an idea of why
many people struggle with meal planning and/or struggle with keeping their
carbs under a certain amount. Counting carbohydrates does get easier, but you
have to practice—like learning any new skill. Sometimes you even have to
practice that skill with a healthy dose of “I don’t want to but I know I’ll be
better for this!” thrown in. In a later post I will address some “non-counting”
methods of reducing carbohydrate intake since the idea of making all meals into
a math exercise is not for everyone. Just for the fun of it though, try
counting your carbohydrates today if you are not used to it.</span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">If you have Type 1 diabetes, on the
other hand, carbohydrate counting is definitely going to be your friend in
keeping the blood glucose from going too high or too low (a dangerous condition
called hypoglycemia).<span style="mso-spacerun: yes;"> </span>If you are able to
become proficient at counting/estimating carbohydrates your endocrinology team
will be able to assist you in figuring out how much insulin to give yourself
based on how much carbohydrate you eat.<span style="mso-spacerun: yes;">
</span>This means that you are more likely to have your insulin regimen actually
work more like a functioning pancreas to keep your blood glucose levels right
where they need to be—not too high or too low.</span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Many people will turn to “sample
diabetic menus” on the internet and/or from a pamphlet they got from their
doctor’s office. On those same sample menus you might have seen the term,
“carbohydrate serving” or “carbohydrate choice.” A “carbohydrate serving” is a
portion of food that is equal to 15 grams of carbohydrate.<span style="mso-spacerun: yes;"> </span>There is a history behind the use of the
number fifteen (based on how many units of insulin are required to cover 15
grams of carbohydrate), but suffice to say, one particular group of educators
wanted an “easier” way to keep track of carbohydrates. As a result, some
wonderful group of people took all of those carbohydrate foods and gave us a
list of serving sizes where each one is equal to 15 grams of carbohydrate (glad
I didn’t have that job).<span style="mso-spacerun: yes;"> </span>Once a person
works out how many carbohydrate servings is suitable for them, they can choose
from a list of carbohydrate foods and use up their “choices” however they want
as long as the portions are within a certain amount.<span style="mso-spacerun: yes;"> </span>I have never been fond of this method myself,
but some people find this an easier way to conceptualize of their “carbohydrate
budget.”</span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: Calibri;">Want to keep reading?</span></span></div>
<div style="margin: 0in 0in 10pt;">
<a href="http://www.joslin.org/info/Carbohydrate_Counting_101.html"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: Calibri;">http://www.joslin.org/info/Carbohydrate_Counting_101.html</span></span></a></div>
<div style="margin: 0in 0in 10pt;">
<br /></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-78230880261282164352017-11-14T04:58:00.003-08:002017-11-14T05:04:12.109-08:00Diabetes Month Tip of the Day<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Question</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Are some carbohydrate foods healthier
than others?</span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Answer</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><strong>The short answer is yes, but remember you still have to watch the amount of
carbohydrate you eat.</strong></span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Otherwise, the healthiest
carbohydrates are those that give you the most nutrition per portion and have
very little processing done to them.<span style="mso-spacerun: yes;"> </span>In
other words, if you aren’t trying to eat as much, you want what you <b style="mso-bidi-font-weight: normal;">do eat</b> to be nutritious, satisfying,
and hopefully taste good.<span style="mso-spacerun: yes;"> </span>Winter squash
(like butternut), tubers (like sweet potatoes), legumes (like pinto beans), and
whole fruits are generally “healthier” carbohydrate choices. Real whole grains
(like whole oats or barley) can safely be incorporated in by some people with
diabetes, but other people might still notice a sharp increase in the blood
glucose levels with grains of any type.<span style="mso-spacerun: yes;">
</span>Always use your blood glucose meter to determine both what and how much
of these foods are safe for you personally.<span style="mso-spacerun: yes;">
</span>Anyway, these “healthier” carbohydrates, for the most part, are
considered such because they contain vitamins and minerals, and fiber. So, if your doctor has ever told you to eat brown rice instead of white, etc., your doctor was "probably" trying to get you to include higher fiber carbohydrate selections.</span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Some of these “healthier carbohydrate
foods” are beneficial because they contain something called “resistant starch.”
Resistant starch is not digested by the body, meaning that it won’t convert to
blood glucose, meaning that you can eat a more satisfying portion while still
eating less carbohydrate. Some people even find that if they include a good
source of resistant starch at the first meal of the day they can fewer have
spikes in blood glucose during the day. (In a later blog post we will discuss
meal timing and frequency of meals.)<span style="mso-spacerun: yes;"> </span>For
more about resistant starch, which foods contain it, and how to incorporate it
into your diet, go to this link: (</span><a href="https://www.healthline.com/nutrition/9-foods-high-in-resistant-starch#section1"><span style="color: blue; font-family: "calibri";">https://www.healthline.com/nutrition/9-foods-high-in-resistant-starch#section1</span></a><span style="font-family: "calibri";">)
One of my favorite ways to include resistant starch is cooked and cooled
potatoes.<span style="mso-spacerun: yes;"> </span>Roast a pan of potatoes the night
before (</span><a href="http://allrecipes.com/recipe/18324/roast-potatoes/"><span style="color: blue; font-family: "calibri";">http://allrecipes.com/recipe/18324/roast-potatoes/</span></a><span style="font-family: "calibri";">),
cool them in a safe manner, and toss them with scrambled eggs and vegetables
the next morning.</span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Many types of bread, pasta, baked
goods, fruit juices, cereals (even the ones labeled “made with whole grain),
etc. have had most of the nutrition stripped from them and are not very
satisfying in small amounts.<span style="mso-spacerun: yes;"> </span>As stated
before, there aren’t too many people who really want to eat “just a small
amount” of pasta or “a few” tortilla chips.<span style="mso-spacerun: yes;">
</span>Most people will feel more satisfied if they have chewier, higher fiber,
higher resistant starch forms of carbohydrate. I should also give a warning
here that even though you might need more fiber and more resistant starch in
your diet, start small and build up gradually. If you don’t, like many of my
patients found out the hard way, you might get bloating, gas, hard stools,
etc.<span style="mso-spacerun: yes;"> </span>Start low, go slow, and drink
plenty of non caloric fluids! I also cannot emphasize enough that you need to evaluate all these foods against your own blood glucose meter as much as possible. Some people will find very little different between brown rice and white rice and/or whole grain bread or white bread, for example. You will also find that it is best to stick with foods that have "naturally" occurring fiber instead of the added type as the added fibers usually have very little impact on blood glucose control.</span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Speaking of, sweets and soft drinks
are traditionally called “empty calories.”<span style="mso-spacerun: yes;">
</span>They will raise the blood glucose levels and provide calories but not do
anything beneficial for your body.<span style="mso-spacerun: yes;">
</span>That’s why letting go of the sweets and soft drinks is the first step
for a lot of people in reducing their carb intake (it just shouldn’t be the
only step!)</span></span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">*Please note that I have avoided the use of
“complex” and “simple” carbohydrates.</span></b><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Those terms describe the chemical configuration
(i.e. how the molecules are strung together) of a carbohydrate but do not
actually say anything about the nutrient density or the impact on the blood
glucose levels.<span style="mso-spacerun: yes;"> </span>For example, pasta has a
more “complex” configuration that table sugar (sucrose), but white flour pasta
is not really more nutritious, nor does it have a different impact on the blood
glucose levels. I have written about this before here: </span></span><a href="http://skepticrd.blogspot.com/2013/04/chemistry-is-complex.html"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">http://skepticrd.blogspot.com/2013/04/chemistry-is-complex.html</span></span></a></span></span></span></span></span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="color: windowtext; font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-underline: none;"><span style="font-family: "calibri";">Think about what
kind of carbohydrates you are choosing, and tomorrow we will talk about how to
count them!</span></span></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-48143752715066206282017-11-13T04:07:00.001-08:002017-11-13T04:07:28.866-08:00Diabetes Month Tip of the Day<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"> Question</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="font-family: Calibri; font-size: 12pt; white-space: pre-wrap;">I did what you said and I tried to keep track of the amount of carbohydrates in the foods that l eat. 30-45 grams for one meal doesn’t seem like very much. And for the people who have to eat less than that at one meal....wow, I can see why this might be a huge learning curve. And hard to follow if you have budget restrictions that cause you to rely on staples like pasta and rice.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="font-family: Calibri; font-size: 12pt; white-space: pre-wrap;">You are right, those numbers are much less than many people in the United States are used to eating. My personal carbohydrate tolerance (based on my what my blood glucose meter says) is only about 30 grams per meal, and even as a Registered Dietitian who is proficient in carbohydrate counting, that can be tough to maintain! </span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you eat roughly a cup of pasta you’ve eaten 30 grams of carbohydrate, so you’re done for that meal. Fortunately you do get to fill in with lean protein, healthy fats, and vegetables to make a complete meal (more about that later), but that’s still a big adjustment for some people. Now, hopefully you are also be getting an idea why many people who successfully control their blood sugars with diet alone usually give up their sodas (40 or more grams of carbohydrate for one can of Coke), fruit juices (30 grams of carbohydrate for 8 oz. of juice), and/or their morning breakfast cereal (45 grams for 1 cup of cereal), etc. And some people even wind up giving up bread, pasta, or certain fruits because they don’t want to bother with the small portions "required" to keep their blood glucose below a certain amount. (In other words, they know that a little bit of rice will just leave them wanting more, so they don't bother).</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Keep in mind it’s not just a lack of motivation/lack of desire to “cut back” or “give up” foods that keeps people from controlling their carbohydrate intake, it can also be a lack of access to food for physical or financial reasons. Foods like pasta and other refined carbohydrates are cheap and easy to prepare, so some people have to make that decision to either eat the bowl of Ramen or not eat anything at all. Some people who have trouble chewing, swallowing, or other digestive issues wind up eating a lot of carbohydrate foods because they seem easier to chew, swallow, or digest (mashed potatoes, anyone?). And as I said before, some people have made the conscious decision to not give up/limit certain foods because of how it affects their quality of life.</span></div>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Meanwhile, if you are trying to reduce your carbohydrate intake here are a few suggestions for reducing carbohydrates without necessarily counting them. Just make sure you still look at the labels as “sugar-free” doesn’t mean “carbohydrate free!”</span></div>
<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trade your favorite cola out for iced tea with your favorite sugar substitute (or drink unsweetened).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trade out your favorite soft drink for flavored sparkling water.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trade out your favorite cold cereal for a small portion of whole rolled oats (yes, you can make them in the microwave!)</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trade out your favorite fruit juice for a small piece of fruit.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trade out favorite fruit juice for flavored sparkling water or a carbohydrate free beverage (like crystal lite).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Use bread for sandwiches only, and avoid eating bread at meal times.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Choose “lite” bread or “thins” instead of “regular” bread. (Check labels and serving size to make sure you are really reducing your carbohydrate intake).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Use large lettuce leaves instead of bread or tortillas to make “wraps.”</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you have potatoes at your meal, avoid having pasta/corn/rice at the same meal (and vice versa).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Switch to corn tortillas instead of flour (just check the label and the quantity!).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cook more meals at home so you don’t get “hidden” carbohydrates as fillers in processed foods.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Add more green vegetables to your plate so there is less room for starches.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Use pureed cauliflower instead of mashed potatoes (many recipes can be found on line, and some grocery stores sell finely chopped cauliflower in bags).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Use spiralized vegetables instead of pasta (again, many recipes and techniques for preparation can be found online).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Experiment with non-wheat flours like almond flour or coconut flour. If you are not used to cooking with these flours though, make sure you follow the recipes as listed first so you reduce your chance of having a gooey mess.</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When donating to a food pantry, try to focus on donating protein rich foods so they have more than pasta and rice to give out. </span><span style="background-color: transparent; color: black; font-family: 'Noto Sans Symbols'; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">☺</span></div>
</li>
</ol>
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<span style="font-family: Noto Sans Symbols;"><span style="white-space: pre-wrap;"><br /></span></span></div>
<div>
<span style="white-space: pre-wrap;"><span style="font-family: Arial, Helvetica, sans-serif;">Tomorrow we will talk about which carbohydrate foods carry a bit more nutrition than others, and we will discuss a bit more about the formation of resistant starch.</span></span></div>
<b id="docs-internal-guid-4bd90936-b535-61af-fcdb-9164e498d8fa" style="font-weight: normal;"><br /></b>
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Want to keep reading?</span></div>
<br />
<div dir="ltr" style="line-height: 1.3800000000000001; margin-bottom: 10pt; margin-top: 0pt;">
<span style="background-color: transparent; color: blue; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><a href="http://www.joslin.org/info/diet_and_diabetes_a_personalized_approach.html" style="text-decoration: none;">http://www.joslin.org/info/diet_and_diabetes_a_personalized_approach.html</a></span></div>
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SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-5637227898106629802017-11-09T05:31:00.000-08:002017-11-09T05:39:02.357-08:00Diabetes Month Tip of the Day<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Question</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">How much carbohydrate can a person
with diabetes eat and still keep the blood glucose under control? And still
make an attempt to have good quality of life?</span></span></span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Answer</span></span></u></b></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">The answer depends on the person’s age,
body size, activity level, weight loss goals (if any), what the blood sugar
meter says, and how tightly they want their blood glucose controlled by diet.<span style="mso-spacerun: yes;"> </span>In other words, the carbohydrate intake needs
to be individualized based on those goals, often with the help of a Registered
Dietitian and Certified Diabetes Educator.</span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">There are also books and online
resources that you can use to help personalize your carbohydrate intake based
on what your blood glucose monitoring device says and what your health goals
are.<span style="mso-spacerun: yes;"> </span>Said online and published resources
are not a substitute for seeing an endocrinologist and/or a Certified Diabetes
Educator, however, I know that sometimes seeing an educator is cost prohibitive
and/or discussing food with a stranger can seem awkward as well.<span style="mso-spacerun: yes;"> </span>One of the books that I like to recommend as
a way to get started with picking out a blood glucose monitor and setting
carbohydrate goal is “Blood Sugar 101: What They Don’t Tell You About Diabetes”
(<a href="https://www.amazon.com/Blood-Sugar-101-About-Diabetes/dp/0964711664/ref=sr_1_2?ie=UTF8&qid=1510234155&sr=8-2&keywords=blood+sugar+101+by+jenny+ruhl">Link</a>).<span style="mso-spacerun: yes;"> </span>Despite the rather ominous sounding title, this
book outlines a simple plan for understanding what carbohydrates are, target
blood glucose goals, and adjusting your carbohydrate intake to include foods
you like in the right portions for you. For a more extensive read on diabetes, testing
equipment, diet, and a testing plan there is<a href="https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving-ebook/dp/B004QZ9PC4/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1509129233&sr=1-1&keywords=dr+bernstein+diabetes+solution"> Dr. Bernstein’s Diabetes Solution</a>.
</span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Naturally, when I start to talk about
“carbohydrate counting” and “testing” I frequently get a panicked look as many
of the people I work with have not had the chance to make testing or math their
friend just yet. Or they might be willing to test their blood sugars, but their
insurance will only pay for a certain amount of test strips and they don’t feel
like they can afford the out of pocket costs for additional strips.<span style="mso-spacerun: yes;"> </span>As a result of this, some people will ask for
a “ball park” answer. <span style="mso-spacerun: yes;"> </span>Said answer, and
this is a HUGE ballpark now, people with Type 2 diabetes will usually need to
keep their carbohydrate intake about 20-40% of calories.<span style="mso-spacerun: yes;"> </span>For the population that I work with, (older,
less active) that usually means 100-130 grams per day, or about 30-45 grams at
each meal and 15-20 grams per snack (most people eat two or three times that
amount).<span style="mso-spacerun: yes;"> </span>Again—emphasis on the huge
ballpark number.<span style="mso-spacerun: yes;"> </span>I have some folks that
only eat about 15 grams at meal and some can do the 45, but the portion control
is paramount to helping people with diabetes eat a variety of foods while still
meeting their blood glucose goals. </span></span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">For people with Type 1 diabetes, they
will usually get better control if their blood sugars if they are able to count
carbohydrates and inject meal time insulin based on how much carb they are
eating and add a correction factor based on their blood sugar.<span style="mso-spacerun: yes;"> </span>(That was a very simple answer to a process that
requires a lot more reading about Type 1 diabetes in general; as well as
different kinds of insulin and how they work—hard to add in to this particular blog
post. Adjusting your insulin based on carbohydrate intake also involves a lot
more testing—up to 4 or more times per day, which sounds daunting but becomes
easier with time and practice.<span style="mso-spacerun: yes;"> </span>Many
people also find that making every meal into a mathematical equation is hard at
first, and then becomes easier to do with time. </span></span></span></span></span></span></span></span></span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Think about how much carbohydrate you
eat every day, and next week we’ll talk about some basic ways to help people
reduce it. (These tips are corresponding to my work week.<span style="mso-spacerun: yes;"> </span>Happy Veterans Day tomorrow!)</span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Want to keep reading about how to
individualize carbohydrate counting? </span></span></div>
<br />
<div style="margin: 0in 0in 10pt;">
<a href="http://www.phlaunt.com/diabetes/14046989.php"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">http://www.phlaunt.com/diabetes/14046989.php</span></span></a></div>
<br />
<div style="margin: 0in 0in 10pt;">
<a href="http://www.diabetes-book.com/"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">http://www.diabetes-book.com/</span></span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-14601277459908956822017-11-08T05:08:00.002-08:002017-11-08T05:08:36.310-08:00Diabetes Month Tip of the Day<br />
<div style="margin: 0in 0in 10pt;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Question</span></span></u></b><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">What are carbohydrate foods and why
are people with diabetes told to limit them?</span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><br /></span></span></u></b></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Answer</span></span></u></b></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Simply put (in non-chemistry terms), a
carbohydrate food is a food that contains mostly starch and/or mostly
sugar.<span style="mso-spacerun: yes;"> </span>From a practical sense
carbohydrate foods include the “grain” group, starchy vegetables like potatoes
and corn, fruits like apples and oranges, milk and yogurt, and all “sweets” and
sweetened drinks.<span style="mso-spacerun: yes;"> </span>Many of the people I
have worked with do a pretty good job (or have very good intentions, rather) of
cutting out the “added carbohydrate” or “concentrated carbohydrate” by avoiding
sweets and “regular” soft drinks, but if they haven’t gone beyond the basics
they are often surprised to find out that fruit, cereal, and milk could be
affecting their blood sugar as well.</span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><br /></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Now that you’ve finished that
paragraph—go back and read it again and familiarize yourself with which foods
groups contain carbohydrate.<span style="mso-spacerun: yes;"> </span>Why?
Because for many of us, once they have figured out the “sweets” part, our
brains now only want to associate carbohydrate with grains and starches.<span style="mso-spacerun: yes;"> </span>So if you have cut your bread but you are
still consuming large amounts of fruit, you might still be having trouble with
your blood glucose. Getting to know your carbohydrates will definitely take
some getting used to and a lot of reading, but it does get a little easier with
practice.<span style="mso-spacerun: yes;"> </span>I also find that having a
smart phone app, like this one done in conjunction with Joslin Diabetes center
(</span></span><a href="https://itunes.apple.com/us/app/healthediabetes/id757759280?mt=8"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="color: blue; font-family: "calibri";">https://itunes.apple.com/us/app/healthediabetes/id757759280?mt=8</span></span></a><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">) is invaluable.</span></span></span></span></span></span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Learning about your carbohydrate
intake, and how to adjust it if desired, with help with blood glucose control because
carbohydrate foods change to blood glucose faster than protein foods, fats,
and/or non-starchy vegetables do.<span style="mso-spacerun: yes;"> </span>People
with diabetes have to limit how much they eat of ANY carbohydrate foods (even
the ones they thought were healthy) as a first line defense in controlling
their blood glucose levels.<span style="mso-spacerun: yes;"> </span>For many
people this requires a pretty drastic reduction in amounts that they were
eating, and some people wind up giving up certain foods because it’s hard for
some of us to eat “just a bit” of certain foods.<span style="mso-spacerun: yes;"> </span>For example, have you ever tried to eat
“just a few” chips or “just one cookie” and succeeded? Okay, so my Type 1
Spouse can, but I don’t find that particularly easy.<span style="mso-spacerun: yes;"> </span>And it is definitely not easy for most of the
people I work with after having years of not paying attention to food content
in general, let alone carbohydrate content.</span></span></span></span><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><br /></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">Speaking of people with Type 1 diabetes, especially those who are not trying to lose weight and are trying to gain muscle mass, they will usually need to make sure they get a minimum amount of carbohydrate every day. This is often difficult to understand in a world where most people with diabetes have Type 2 and are told to "avoid" carbohydrates (although, as stated above, it's not a matter of avoiding, it is a matter of counting). If a person with Type 1 diabetes does not get a minimum amount of carbohydrate daily they can start breaking down fat for energy and then the body produces ketones. If there are too many ketones in the blood stream, combined with less that optimal amounts of insulin (and higher than should-be blood glucose) this can cause a dangerous condition called ketoacidosis. If this condition is left untreated it can lead to severe dehydration and death.</span></span></span></span></span></span></span></span></span></span><br />
<span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";"><span style="font-size: 12pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="font-family: "calibri";">We’ll talk more tomorrow about how
much carbohydrate is recommended, but for now if you want to keep reading click
on the link below:</span></span></span></span></span></span></span></span></div>
<div style="margin: 0in 0in 10pt;">
<br />
<div style="margin: 0in 0in 10pt;">
<a href="http://www.joslin.org/info/Carbohydrate_Counting_101.html">Carbohydrate counting</a></div>
<div style="margin: 0in 0in 10pt;">
<a href="https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/definition/con-20026470">Diabetic Ketoacidosis</a></div>
</div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-86282592982858731382017-11-07T04:06:00.004-08:002017-11-07T04:06:56.177-08:00Diabetes Month Tip of the Day<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Question</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Why are so many people with Type 2 diabetes told to lose weight? Can weight loss “cure” Type 2 diabetes? </span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Answer</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To answer those questions requires a very simplified version of how insulin works.</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Think of the cells in our bodies cells as a locked room and think of the blood glucose as the “workers” trying to get in the room to do their jobs of creating energy. Now think of insulin as the “key” that lets those workers into the room. People in the early stages of Type 2 diabetes often produce plenty of “keys” (insulin) to allow all the “workers” (glucose) into the room, but their “locks” are “jammed up” by excess body fat, lack of exercise, medications, smoking, genetic history, or some combination of all the above! In this case, we want to try to unstick the locks as much as we can, so that the keys will work. There are some things we can’t change, like our history or our genetics , but we can potentially change a person’s body fat/fat distribution, amount of muscle mass they have, their exercise routine, whether or not they smoke, and what medications he/she is on. To get back to the “weight” question, however—basically if a person with Type 2 diabetes loses extra body fat (and hopefully gains some muscle), they can potentially “unstick” some of those locks and allow the insulin to do its job of removing the glucose from the blood and allowing it into the cells. It doesn’t have to be a huge weight loss either—even just 5-10% weight loss from the current weight can make a difference in blood sugar control for some folks.</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As far as a “cure” is concerned, following a diet and exercise plan that results in weight loss might help someone control the blood sugar so that they don’t need medication or insulin. But since you have to follow that carbohydrate controlled diet FOR THE REST OF YOUR LIFE, most people would not consider that a “cure.” People who have had weight loss surgery that resulted in a rapid weight loss sometimes claim their diabetes was cured as they no longer needed medication or insulin; however, you still have to follow a strict diet to keep the weight (and the high blood sugars) from returning. So, it appears weight loss surgery “manages” diabetes instead of “cures” it. </span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Also keep in mind that not everyone with Type 2 diabetes is overweight or obese, and that telling everyone with Type 2 that weight loss will automatically lead to removal of medication or insulin is misleading</span><span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. When bringing up weight loss, you also want to remember that many people who are overweight or obese know they are overweight, and are pretty aware of the risks of such. Many of them have tried different diets, are aware of their need to cut back, etc, but they don’t change their diet for a variety of reasons—lack of financial resources to obtain healthy food and physical disabilities that hinder cooking at home are among them. Keep in mind that trying to shame someone into losing weight will usually backfire on you. Telling them to achieve a weight they have never achieved in their life doesn’t help either. It helps first to find out what the person’s weight loss goals (if any) are, and what they might need to actually achieve those goals, instead of just telling them to lose weight. </span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">And there is currently no “cure” for Type 1 diabetes, although there are some people who have received a pancreas transplant, an expensive and still risky procedure. There is also some pretty interesting research into an artificial pancreases and stem cell research that also looks promising and a lot closer to be on the market than when I was writing these tips last year. Many type 1s are also to manage their insulin doses more closely with the use of insulin pumps and continuous glucose monitors (CGMs) to get a more physiologic dose of insulin.</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<span style="background-color: transparent; color: black; font-family: Calibri; font-size: 12pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Want to keep reading?</span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<a href="http://www.joslin.org/info/will_diabetes_go_away.html">Will diabetes go away?</a></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<a href="http://jdrf.org/research/treat/artificial-pancreas-project/">Artificial pancreas.</a></div>
<span id="docs-internal-guid-007c8991-965a-7493-a5a3-e29cb250fb3c"></span><br />
<div dir="ltr" style="line-height: 1.2; margin-bottom: 5pt; margin-top: 5pt;">
<a href="http://www.joslin.org/info/the_advantages_and_disadvantages_of_an_insulin_pump.html">Insulin pump pros and cons.</a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-20417345113751325402017-11-06T04:42:00.002-08:002017-11-06T04:42:46.245-08:00Diabetes Month Tip of the Day<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Question</span></u></b><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Can Type 2 diabetes be controlled with diet
and exercise alone?</span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Short
Answer</span></u></b></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Yes, if the person with diabetes is diagnosed
early enough and they have the resources to follow the diet and exercise plan
that works best for them. </span></span></span></span></span></span></div>
<div style="margin: 1em 0in;">
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><strong><u><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Long
Answer</span></u></b></u></strong></span></span></div>
<div style="margin: 1em 0in;">
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">While everyone
with diabetes can benefit from following a carb controlled diet and exercising
as much and as safely as they can, lifestyle changes alone may not work for
everybody.<span style="mso-spacerun: yes;"> </span>The ability to control Type 2
diabetes with lifestyle changes alone depends on a lot of different factors,
like:</span></span></span></span></span></span></span></span></span></span></div>
<div style="margin: 1em 0in;">
<ul>
<li><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">How high the blood glucose was when you were diagnosed.</span></span></span></span></span></li>
<li><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Other medical problems you have.</span></span></span></span></span></span></li>
<li><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">What symptoms of diabetes you are having.</span></span></span></span></span></span></span></li>
<li><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The ability of the person to follow a carbohydrate controlled plan.<span style="mso-spacerun: yes;"> </span>And by “ability” I mean the financial resources, access to healthy food, cooking skills, access to cooking facilities, the physical ability to cook, etc.</span></span></span></span></span></span></span></span></li>
<li><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The desire to follow a carbohydrate controlled plan. For some folks abstention from certain foods is not conducive to their quality life; this is especially true for the elderly home bound population that I work with.</span></span></span></span></span></span></span></span></span></li>
</ul>
</div>
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Some people walk around with undiagnosed
diabetes for several years and by the time they are diagnosed they have to take
medication or insulin to control their blood glucose levels because their
bodies physically cannot make or use insulin.<span style="mso-spacerun: yes;">
</span>Some people cannot or will not change their lifestyle in such a way to
control his/her blood glucose by diet alone<b style="mso-bidi-font-weight: normal;">.</b><span style="mso-spacerun: yes;"> </span>Some people need medication or insulin when
they are diagnosed and don’t need it after changing their lifestyle.<span style="mso-spacerun: yes;"> </span>It’s ultimately up to each individual and his/her
medical team to decide what is the best way to control their blood glucose
levels.</span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Over the years, I have had some people who
were afraid to take insulin or medication to control their blood sugars, even
though they were feeling miserable, because they thought they would be “shamed”
for “failing” diabetes. I told them to them to think about it this way—if
someone is having a heart attack, I am not going to stand over her and say “You
know, you really ought to stop smoking, eat more vegetables, etc.”<span style="mso-spacerun: yes;"> </span>I’m going to help that person get the best
medical care possible, than once she is stable, we’ll work on the eating
better, etc.<span style="mso-spacerun: yes;"> </span>It’s the same thing for a
very poorly controlled diabetic—get them stable medically to preserve his/her
internal organs, then work on the lifestyle part if he/she is willing and able.</span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Please remember that people with Type 1 MUST
have insulin or they will develop a serious condition called diabetic
ketoacidosis and they could die within a week or two if not treated.<span style="mso-spacerun: yes;"> </span>Before insulin was “discovered” in 1920 (and
tested on humans in 1922), doctors would attempt to keep people alive by having
them follow a very low calorie diet—most people starved to death within a year.</span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Want to keep reading? Click on the links!</span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br />
<div style="font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;">
<a href="http://www.joslin.org/info/will_diabetes_go_away.html">Will diabetes go away?</a></div>
<div style="font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;">
<a href="http://www.joslin.org/info/History_of_Insulin.html">History of Insulin.</a></div>
<div style="font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;">
</div>
<ul style="direction: ltr; list-style-type: disc;">
</ul>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-76267366584392187092017-11-03T05:14:00.000-07:002017-11-03T05:14:09.910-07:00Diabetes Month Day 3--Know Your Risk Factors
<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Question</span></u></b></div>
<div style="margin: 1em 0in;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Who is at risk for Type 2 diabetes? What about
Type 1 diabetes?</span></span></div>
<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Answer</span></u></b></div>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I think it is also important to embed a little lesson on risk factors versus causality before moving on to a discussion of risk factors: Here is <a href="http://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_causality/EP713_Causality3.html">one tutorial</a>.</span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Even though we don’t fully understand why some
people develop Type 2 diabetes and others do not, we do know that there are
some factors that increase the risk:</span><br />
<br />
<ol style="direction: ltr; list-style-type: decimal;">
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Being overweight (as determined by you
and your primary care provider)—the more excess fatty tissue you have, the harder it
is for your cells to use insulin. <b style="mso-bidi-font-weight: normal;"><span style="mso-spacerun: yes;"> </span>Please remember that not everyone who is
overweight will develop diabetes, and some people develop diabetes even though
they are not overweight. You cannot tell if a person has diabetes or will
develop diabetes just by looking at them; and their health is between them and
their doctor, period.</b></span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Having fat distribution in the abdomen
vs. fat distribution in the hips/thighs. If you are visiting with a dietitian
who is qualified in doing a Nutrition Focused Physical Exam (NFPE) they might
do a waist circumference measure/ratio to help determine your risk.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Being inactive or less active—less
active people will have cells that are more resistant to the action of insulin.
<strong>Again, people may have reduced activity levels for a lot of reasons and not all lower
activity folks will develop diabetes.</strong></span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Family history—your risk is higher if
your parent or sibling has diabetes.</span></div>
</li>
<li style="color: black; font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Race/Ethnicity—African Americans,
Hispanics, American Indians, and Asian-Americans are at higher risk of
developing type 2 diabetes.<span style="mso-spacerun: yes;"> </span></span></div>
</li>
<li style="font-family: "Calibri",sans-serif; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em; mso-list: l0 level1 lfo1;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Previous diagnosis of pre-diabetes,
gestational diabetes, or polycystic ovary syndrome.</span></div>
<div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Type 1 diabetes risk factors seem to be
related to a family history and genetics, although other causes are being
investigated.</span></div>
<div style="color: black; font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Want to keep reading? Click on the link!</span></div>
<div style="font-family: "Times New Roman",serif; font-size: 12pt; font-style: normal; font-weight: normal; margin-bottom: 1em; margin-top: 1em;">
<a href="http://www.joslin.org/info/Type_2_Diabetes_Know_Your_Risk_Factors.html"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">http://www.joslin.org/info/Type_2_Diabetes_Know_Your_Risk_Factors.html</span></span></a></div>
</li>
</ol>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-68278946735139790782017-11-02T04:48:00.002-07:002017-11-02T04:49:56.688-07:00Diabetes Month Tip of the Day--Day 2<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Question</span></u></b><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">How is diabetes diagnosed?</span></span></div>
<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Answer</span></u></b><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Let’s start by talking a little bit about what
“non-diabetic” parameters are. If you get blood drawn and lab work done by at
your primary care clinic, you will hopefully get a printout (or an online
version) of your results and what are considered “usual” values (and hopefully
the opportunity to talk to your doctor about them). A “non-diabetic” fasting
(nothing to eat for 8-12 hours before the blood test) blood glucose level is
70-99 mg/dL, and if you don’t have any issues with blood glucose regulation, your
blood glucose levels won’t budge over that even if you’ve eaten something high
in carbohydrate the night before. Over the years I’ve had many patients “deny”
that anything was wrong because they “indulged” the night before the lab test;
and I’ve had to be the one to point out that if everything was working as usual
that the body would be able to regulate the blood sugar levels despite the
birthday cake (or whatever) it was that you ate.</span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">If you have an “out of range” fasting blood
glucose, your primary care provider might send you for an Oral Glucose
Tolerance Test (OGTT) to diagnose pre-diabetes or overt diabetes.<span style="mso-spacerun: yes;"> </span>Details of this procedure are listed here (</span><a href="http://www.joslin.org/info/diagnosing_impaired_glucose_tolerance_IGT.html"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">http://www.joslin.org/info/diagnosing_impaired_glucose_tolerance_IGT.html</span></span></a><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">).<span style="mso-spacerun: yes;"> </span>This particular test
does involve more time and money so insurance coverage and the person’s ability
to go through the test will come into play. If someone is not willing or able
to do the OGTT, the primary care provider will likely order additional lab work
to try to determine the diagnosis of diabetes. If your fasting blood glucose level
is between 100-125 mg/dL, this level is called “pre-diabetes,” which is pretty
serious as you have a 25% chance of progressing to diabetes in 3-5 years.<span style="mso-spacerun: yes;"> </span>At the same time, if someone has two
consecutive fasting blood glucose levels of 126 mg/dL or greater, or a random
blood glucose level of 200 or greater, that is enough for us to diagnose
diabetes. <span style="mso-spacerun: yes;"> </span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><br /></span></span></span></span><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">We can also do a lab test called an Hemoglobin
A1c (A1c) to monitor those we suspect are at risk for Type 2 diabetes.<span style="mso-spacerun: yes;"> </span>I list this one last because when I started
my career 20 years ago this lab test was not standardized and could not be used
to “diagnose” diabetes.<span style="mso-spacerun: yes;"> I'm glad that we have this available to us now as </span>having one
blood test to help diagnose you is way less time intensive and expensive than taking the glucose drink for
an OGTT (although I hear it doesn’t taste as awful as it used to). An A1c is a
measure of the average concentration or percentage of glucose “clinging” to the
red cells in our blood.<span style="mso-spacerun: yes;"> </span>Think of it this
way—picture your red blood cells as M & M’s and the A1c is a measure of the
“thickness” of the candy coating. Some people have called in an “average blood
sugar over 3 months” but that really isn’t an accurate description. A
“non-diabetic or non-pre-diabetic” A1C is between 4.2-5.8%.<span style="mso-spacerun: yes;"> </span>If someone’s A1C is over 6.5% that cause to
diagnose someone with diabetes.<span style="mso-spacerun: yes;"> </span>We will
then try to keep their A1C less than 6.5-7% unless they are other circumstances
at play like advanced age or an advanced chronic condition (e.g. advanced heart
disease). (A good “goal” A1c is something that every diabetic should discuss
with their doctor).</span></span></span></span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></span></span></span></span></span></span><br />
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Some of you might be old enough to remember
the term “borderline diabetes;” and you might still hear this thrown around. This
was never an actual diagnosis even though it was often used to refer to either
pre-diabetes or diet/exercise controlled type 2 diabetes.<span style="mso-spacerun: yes;"> </span>The main problems with that term was that no
one could ever tell you what that really meant (i.e. criteria for diagnosis) or
feel that they should take their diabetes seriously as they were not in need of
medicine.<span style="mso-spacerun: yes;"> </span>If you use this term today
(and you know who you are), someone (me) will probably remind you that that’s
analogous to being “borderline pregnant.”<span style="mso-spacerun: yes;">
</span>You either are, or you aren’t diabetic .</span></span></span></span></span></span></span></span></div>
<br />
<div style="margin: 1em 0in;">
<span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Want to keep reading? Click on the link! </span><a href="http://www.joslin.org/info/all_about_a1c.html"><span style="font-family: "calibri" , sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">http://www.joslin.org/info/all_about_a1c.html</span></span></a></div>
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-17261643462477608592017-11-01T05:09:00.001-07:002017-11-01T05:09:26.342-07:00Diabetes Month Day 1For the month of November, I will be doing informational blog posts for diabetes awareness month on most of the working days. Typically I do a short blurb at my workspace for co-workers, but I thought my friends in cyberspace might want some information too. Most of the information presented here is an expansion of what I want to say at work.<br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Question</span></u></b></div>
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">What is diabetes? Are there different
kinds?<span style="mso-spacerun: yes;"> </span>Is one worse than another?</span><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span></u></b><br />
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Answer</span></u></b><br />
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Diabetes, or diabetes mellitus, is the name
given to a group of diseases in which a person has high blood glucose (blood
sugar).<span style="mso-spacerun: yes;"> </span>The blood glucose becomes high
either because the body does not make enough of the hormone insulin, or because
the body’s cells do not respond properly to insulin, or some combination of the
two.<span style="mso-spacerun: yes;"> </span>The three types of diabetes that I
see the most often in my practice are: </span><br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Type
1:</span></b><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>Type 1
diabetes only makes up about 5-10% of the cases of diabetes in the United
States.<span style="mso-spacerun: yes;"> </span>In this form of diabetes the
body does not produce insulin at all.<span style="mso-spacerun: yes;"> </span>People
with Type 1 diabetes must take insulin to survive and follow a carbohydrate
controlled diet to “match” the amount of insulin they take. People with Type 1
are <i style="mso-bidi-font-style: normal;">usually</i> diagnosed before their 40<sup>th</sup>
year and <i style="mso-bidi-font-style: normal;">usually</i> present with the
symptoms of weight loss, frequent urination, increased thirst, and increased
hunger.<span style="mso-spacerun: yes;"> </span>Type 1 diabetes used to be
called “insulin dependent diabetes” or IDDM, “juvenile diabetes,” “or
early-onset diabetes.”<span style="mso-spacerun: yes;"> </span>These terms were
discontinued by the medical community because they are too confusing and not
accurate, however, in popular culture it is hard to get rid of this
terminology. (Actually, in the medical community it is hard for some of us old
farts to get rid of these terms too, come to think of it).</span></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Type
2:</span></b><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="mso-spacerun: yes;"> </span>This
is the most common form of diabetes (about 90% of cases) in the United States
and the form that I deal with the most since I work with an older and elderly
adult population.<span style="mso-spacerun: yes;"> </span>In Type 2 diabetes the
cells in the body do not react to insulin (called “insulin resistance”), or the
body does not produce enough insulin, or some combination of both. If caught
early enough this form of diabetes can be treated with a carbohydrate
controlled diet and exercise alone.<span style="mso-spacerun: yes;"> </span>For
those who are diagnosed “later” or who are unable to follow a carbohydrate
controlled diet plan, they may need to be treated with medications that help
sensitize the body to insulin or help the body make more insulin.<span style="mso-spacerun: yes;"> </span>Type 2 diabetes is progressive and many
people do wind up having to take insulin to control blood glucose levels. (Some
people think they have “converted” to Type 1 and this is simply not true).<span style="mso-spacerun: yes;"> </span>This form of diabetes used to be called
“non-insulin dependent” diabetes (NIDDM) or “Adult Onset Diabetes.” Again,
these terms were discontinued because they are too confusing and not accurate;
people can be diagnosed with Type 1 diabetes in their 20’s, 30’s, and 40’s and
children have been diagnosed with Type 2.</span><br />
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Gestational:</span></b><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"> This form of diabetes is used to describe elevated blood glucose
levels in pregnancy when the woman’s body becomes resistant to insulin.<span style="mso-spacerun: yes;"> </span>Some women are able to control this with a
carbohydrate controlled diet alone and others may require insulin during that
time.<span style="mso-spacerun: yes;"> </span>Gestational diabetes usually
resolves after giving birth, but some women are more at risk for Type 2
diabetes in the future.</span></div>
<div style="margin: 1em 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Is
Type 1 “worse” than Type 2? </span></b><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">No, both forms of diabetes are equally
serious and can result in complications, such as blindness or kidney failure,
if left uncontrolled. </span></div>
<br /><br />
<div style="margin: 1em 0in;">
<span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Want more information. Click on the link! </span><a href="https://www.joslin.org/info/an_overview_of_diabetes.html"><span style="font-family: "Calibri",sans-serif; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="color: blue;">https://www.joslin.org/info/an_overview_of_diabetes.html</span></span></a></div>
<br />SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com0tag:blogger.com,1999:blog-4798204394183282951.post-63224820640193623372014-04-07T16:09:00.006-07:002014-04-08T03:12:56.582-07:00Do vegetarians have poorer health?I spend a lot of time, probably more than I should, skulking around in nutrition related forums where people share the successes and failures they've had with various weight loss plans and/or change of eating habits for a variety of health conditions. If someone has had good success with one way of eating, chances are they will talk smack about other plans that are in opposition to their way of eating, and sometimes the points they are making are evidence based, sometimes they are not. The <a href="http://skepticrd.blogspot.com/2014/03/smoking-meat.html">last blog post I did</a> was based on an article that a vegan friend was using to try to talk people out of their "paleo" diet; now it looks like the more omnivorous types could potentially fire back after reading an article like this one: <a href="http://atlanta.cbslocal.com/2014/04/01/study-vegetarians-less-healthy-lower-quality-of-life-than-meat-eaters/">Study: Vegetarians Less Healthy, Lower Quality of Life than Meat Eaters.</a> So do they have any evidence to truly turn the tables? Let's apply the same <a href="http://www.doublexscience.org/science-health-medical-news-freaking-you-out-do-the-double-x-double-take-first/">Double X Double-Take</a> to this news article. <br />
<br />
1) <b>Skip the Headline.</b> Step away from the <a href="http://www.logicallyfallacious.com/index.php/logical-fallacies/29-appeal-to-emotion">Appeal to Emotion Fallacy</a>.<br />
<br />
2) <b>What is the Basis of the Article? </b>This one was easy, click on the link in the article and ta-da! <a href="http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0088278&representation=PDF">Looks like we have access to the full article!</a> Now you get to read it, I'll wait.....<br />
Did you see the "lots of people, lots of data, lots of analysis" to indicate that this is original research that has undergone a peer review.<br />
<br />
3) <b>Look at the words in the article</b>. You did read the article? All the way through? Including the part that has "limitations" printed in bold? Here, I'll help:<br />
"Potential limitations of our results are due to the fact that the survey was based on cross-sectional data. Therefore, no statements can be made whether the poorer health in vegetarians in our study is caused by their dietary habits or if they consume this form of diet due to their poorer health status. We cannot state whether a causal relationship exists, but describe ascertained associations. Moreover, we cannot give any information regarding the long-term consequences of consuming a special diet nor concerning mortality rates. <i>Thus, further longitudinal studies will be required to substantiate our results. Further limitations include the measurement of dietary habits as a self-reported variable and the fact that subjects were asked how they would describe their eating behavior, with giving them a clear definition of the various dietary habit groups." </i>(Emphasis mine).<br />
In other words, based on the people sampled we can't necessarily extrapolate to the larger population, correlation does not equal causation, we need more studies, and we can't rely of people's memory and subjective description of what they ate to determine treatment. <br />
<br />
4) <b>Look at the original source of the information.</b> As I said before, you will want to ensure that the journal and the article are <a href="http://guides.lib.jjay.cuny.edu/content.php?pid=209679&sid=1746812"><span style="color: #992211;">peer reviewed</span></a> and not just commentary by an "expert." Experts are human and can be prone to some not so scientific idea. In this particular case a Google search about the journal indicates it is peer reviewed.<br />
<br />
5) <b>Remember that every single person involved in what you're reading has a dog in the hunt.<i> </i></b>Once again, be careful that your speculations about what dog is in the hunt doesn't devolve into a variation of the <a href="http://www.skepdic.com/adhominem.html">ad hominem fallacy</a>, so hold off on the inflammatory language for a bit.<br />
<br />
6) <b>Ask a scientist</b>. Once again, I'm so glad you asked! Some other points to ponder:<br />
1) This study was done in Austria, and the news article was geared to people living in the United States. Just because the majority of people in each country speak English doesn't mean they have the same eating habits and access to food. A typical vegetarian diet in Austria is likely different than in the US, I personally would have to research that more so I'm not going on assumptions.<br />
2) As it states above, we don't know if the vegetarians in this group were already in poor health before they changed their diet. I can remember doing a rotation on the oncology ward as an intern and seeing people that were trying a variety of different diets, vegetarian and otherwise in the hopes that they would be able to cure their cancer. Perhaps some of these people were having similar struggles with their physical and/or mental health and were making dietary changes that they thought might help.<br />
3) The term vegetarian and vegan mean that you eschew animal flesh and all animal products respectively, these terms actually don't say anything about the quality of a person's diet. As one friend of mine said about her husband, "He's more of a "sugartarian" than anything else..." So perhaps these vegetarians weren't actually eating vegetables and were surviving on rice and chocolate and we can't extrapolate their data to a greater population of vegans who spend time planning their meals to include vegetables, soaking their beans to extract more nutrition, etc. And before some of you start sputtering about how "that's not a vegetarian diet" you might want to study up on the <a href="http://www.logicalfallacies.info/presumption/no-true-scotsman/">No True Scotsman</a> fallacy. And remember, you can take just about any eating plan and make it unhealthy (I'm looking at you, people who survive on Atkins company diet products!)<br />
<br />
So what do we do with this information?<br />
1) Don't smoke (sound familiar?).<br />
2) Moderate alcohol intake.<br />
3) Include lots of vegetables and some fruit.<br />
4) Don't over or under do your protein intake.<br />
<br />
<i>Edited to correct Australia to Austria thanks to alert reader Eve. My spell-check needs spell-check.</i>SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com1tag:blogger.com,1999:blog-4798204394183282951.post-65749765034228713912014-03-17T12:58:00.000-07:002014-03-17T12:58:04.820-07:00Smoking Meat?One of the fun parts about blogging is trying to think up catchy titles for blog posts, particularly since "news" writers get to think up scary sounding titles like <a href="http://news.discovery.com/human/health/diet-high-in-meat-cheese-can-be-as-bad-as-smoking-140304.htm">Diet High in Meat and Cheese Can Be Bad as Smoking</a> and <a href="http://shine.yahoo.com/healthy-living/scary-news-paleo-diet-190000020.html">The Scary News about the Paleo Diet.</a> Of course, since my sense of humor runs toward the teenage variety, that first title make me think of someone lighting up a sausage and smoking it like a cigarette, hence my title. (I was probably the only one who thought was funny, unless you are also twelve years old). So, if you thought I was going to talk about various culinary techniques, thanks for reading so far, but I'm actually going to be talking about whether or not we should be as fearful of eating animal protein as these articles imply.<br />
<br />
I think this calls for a review of Emily Willingham's excellent post on how to read science and medical news over at Double X Science: <a href="http://www.doublexscience.org/science-health-medical-news-freaking-you-out-do-the-double-x-double-take-first/">Science, health, medical news freaking you out? Do the Double X Double-Take first!</a> So let's apply this to some of the article about this topic, shall we?<br />
<br />
1) <strong>Skip the Headline.</strong> This one is hard (for me anyway), but remember that these titles often employ the <a href="http://www.logicallyfallacious.com/index.php/logical-fallacies/29-appeal-to-emotion">Appeal to Emotion</a> fallacy to get your attention. (I think a lot of your friends that post these articles on social media use this appeal as well!).<br />
<br />
2) <strong>What is the Basis of the Article? </strong>Some news articles will make it easy to find the original article (like <a href="http://www.sciencedaily.com/releases/2014/03/140304125639.htm">this one),</a> with other articles you will need Google as your friend to input as much detail as you can find--I used the author's name, the journal, and protein. We also lucked out in that the entire article was available for viewing online and you didn't have to sidle up to one of your friends with access to a particular journal and/or seek out your nearest medical library to see if they had a copy of that journal. Now if you read the article (you did, didn't you? If not, we'll be here while you do) you can see that this article <a href="http://www.doublexscience.org/science-health-medical-news-freaking-you-out-do-the-double-x-double-take-first/">"lots of people or mice or flies, lots of data, lots of analysis, a hypothesis tested, statistics done–is considered “original research.” </a> So it looks like this was original research that has undergone a peer review.<br />
<br />
3) <strong>Look at the words in the article</strong>. Here you see words like "risk" and "association" tossed around, so, you are going to see a "correlation" here, but not necessarily a "causation."<br />
<br />
4) <strong>Look at the original source of the information.</strong> You will also want to make sure that the journal and the article are <a href="http://guides.lib.jjay.cuny.edu/content.php?pid=209679&sid=1746812">peer reviewed</a> and not just commentary by an "expert" as even some of the experts can have some not so scientific ideas! In this particular case you can go to the "about" or "<a href="http://www.cell.com/cell-metabolism/Reviewers">journal information</a>" section to see that this is a peer reviewed journal.<br />
<br />
5) <strong>Remember that every single person involved in what you're reading has a dog in the hunt.<em> </em></strong>Fairly self explanatory, except sometimes the speculation about what dog you have in the hunt can launch into quite the <a href="http://www.skepdic.com/adhominem.html">ad hominem fallacy</a> where suddenly a person who just wants to find out about protein intake finds themselves labeled as a grant whore (and that was one of the nicer terms I've seen), etc. Michael over at <a href="http://www.skepticalraptor.com/skepticalraptorblog.php/not-been-member-big-pharma-shill-party/">Skeptical Raptor</a> sums up his frustration with this statement quite nicely: "The problem with actually trying to dismiss these accusations is that it’s nearly impossible to dismiss the accusations with evidence, because as we know, proving the negative is almost impossible."<br />
<br />
6) <strong>Ask a scientist</strong>. What do I think about this? I'm so glad you asked! Other than the "correlation does not equal causation statement I found some other points to ponder:<br />
--The human data was observational and appeared to rely on people reporting intake, meaning that people could have over or under reported their protein intake. Do you remember exactly how much you ate yesterday? Last week? Last year?<br />
--The study didn't appear to take into account how much or what type of carbohydrate the people ate. If they ate a bunch of white flour with their protein, and therefore consumed extra calories and/or increased your risk of blood glucose related issues, that could increase your mortality. At the same time, the people eating less animal protein could have been eating less sugar and engaging in the other healthy behaviors as well.<br />
--I didn't see mention of taking the amount and/or type of fat into account either.<br />
--What about fruit and vegetable intake?<br />
--What about exercise?<br />
--What about the different between feedlot beef and grass-fed, or farm raised fish vs. wild caught, etc?<br />
--Human beings aren't the same as rats, although you can use the info from the animal studies as the basis for future human studies.<br />
--If you actually look at some of diets pointed out as being problematic, like the Atkins', they don't usually advocate "high protein" as even too much protein can cause problems with blood glucose levels, etc. Loads of cheese isn't part of the Paleo plan either.<br />
--A lot of the news article neglected to mention that a higher protein intake can be beneficial for older adults.<br />
--Going overboard on anything will probably hurt you.<br />
<br />
So what should we do with this information?<br />
1) Don't smoke tobacco.<br />
2) Figure out what your protein needs really are. (0.8-1 gm protein per kg body weight on average, and for older adults it might be more like 1-1.2 gm protein per kg body weight). The very overweight/obese might need to use a "lean body mass calculator" to get an estimate on what "weight" to use to calculate protein needs (some need more protein at the beginning of their weight loss plan to maintain lean body mass and then it will reduce as you lose weight)<br />
3) Find out how much protein in is the food that you are eating. If you are reading this, you probably have regular or semi-regular access to the Internet and can easily access sites like calorieking.com. Keep a record of how much you're eating for at least 3 days.<br />
4) Limit or avoid added sugars and processed carbohydrates, choose fresh fruit and tubers for your starches as often as you can. If you tolerate grains, choose unprocessed ones. (Hint, most bread products are "made with whole grain" and not actually whole grain.)<br />
5) Consume vegetables at every meal.<br />
6) Avoid deep fried foods and trans fats.<br />
7) If you tolerate vegetable protein sources, find ways to incorporate them (legumes aren't part of my <a href="http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP-Diet-Handout.pdf">low FODMAPS plan</a>), but that doesn't mean other people can't include them.<br />
8) Find ways to be as active as possible.<br />
<br />
Take home message--Always question the news articles you read, particularly if they appeal to emotion. Finding out how much protein you are eating, from any source, and not overdoing can help you meet your health goals.<br />
SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com1tag:blogger.com,1999:blog-4798204394183282951.post-52680027453329195832014-03-04T09:00:00.000-08:002014-03-04T09:35:04.486-08:00Opinion: New Food LabelLast night I had the privilege to chat with dentists Jason and Grant of the <a href="http://www.prismpodcast.com/">Prism Podcast</a> about diabetes, nutrition and pseudoscience, and my favorite gluten free beer (It's <a href="http://omissionbeer.com/">Omission</a> by the way). I was asked about my thoughts on the new nutrition label, and I thought I would expand on my thoughts in writing (which has always been my preferred medium of expression over the spoken word anyway).<br />
<br />
Currently there are two different label formats that are proposed, as shown in this graphic from the <a href="http://www.washingtonpost.com/national/health-science/a-look-at-the-proposed-nutrition-labels/2014/02/26/4a5be144-9f50-11e3-b8d8-94577ff66b28_graphic.html">Washington Post</a>: <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi328vLlNItIKwtOwBfBBZynvwZ0RERptqY46pt5IoFgPsjudnIJtRI1SHfs28LxwUqKwFrx5Q6m33hfw7t7mpLAleweAlZaXHiwnbwVz51FloSqDReqX971_rYT3OTc15AMdKvwqhpYxdd/s1600/w-nutritionlabels0227.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi328vLlNItIKwtOwBfBBZynvwZ0RERptqY46pt5IoFgPsjudnIJtRI1SHfs28LxwUqKwFrx5Q6m33hfw7t7mpLAleweAlZaXHiwnbwVz51FloSqDReqX971_rYT3OTc15AMdKvwqhpYxdd/s1600/w-nutritionlabels0227.jpg" height="288" width="320" /></a></div>
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What I like about the proposed changes to the "new" label:<br />
<br />
1) I like to have easy access to basic information about food, and I like for my patients/clients to have the same access. Not everybody is equipped with smart phones to be able to look up information in the grocery store, and not everyone has Internet access at home to make up their grocery list either.<br />
<br />
2) I like the bigger print for the serving sizes and calories, particularly since I work with a population that tends to have diminishing eye sight.<br />
<br />
3) I like the addition of the mineral "potassium" to the food label. One of the unfortunate consequences of being a diabetes educator is that you wind up working with people who have already developed kidney failure (usually from uncontrolled diabetes, uncontrolled blood pressure, or both)and they have to be cognizant of how much potassium they take in since the kidneys can no longer filter any excess potassium.<br />
<br />
4) There has been an effort to make the serving sizes more in line with what <br />
people might actually eat.<br />
<br />
What I don't like about the proposed changes/wish they would have done differently:<br />
<br />
1) I wish they would leave the percentages off, as I have never found them useful in teaching people how to read a food label. Who wants to calculate a percentage while they are in the grocery store anyway? Many people already don't have a framework for how many calories, carbohydrate grams, etc they should have--and those that do have a framework are going to look at the calories/grams, etc and not look at the percentage.<br />
<br />
2) I wish they would do away with the serving sizes and give the information for the entire container. It would remove one more way that food companies can manipulate the serving size to cause a product to look healthier than what it really is, and I think more people would rather adjust for their own serving size.<br />
<br />
3) I hope they don't go with proposal 2, as it's a more crowded format, they are still emphasizing saturated fat as a problem (when it's not really) while ignoring the added sugars, and once again I don't think people respond well to being "told" what to do either.<br />
<br />
For those of you who are wanting to establish a good framework for how many calories you need, etc, I recommend the use of the <a href="http://www.niddk.nih.gov/research-funding/at-niddk/labs-branches/LBM/integrative-physiology-section/body-weight-simulator/Pages/body-weight-simulator.aspx">Body Weight Simulator</a> as it uses the most up to date info on how much to cut back over time and what to do to maintain your weight. For those of you with diabetes/re-diabetes/insulin resistant conditions who are trying to figure out your carbohydrate intake, your ball park intake will be no more than 100 grams of carbohydrate per day if you are trying to lose weight and no more than 150 grams per day if you are trying to maintain (and that's just ball park, if you have diabetes you will only figure out your optimum intake by testing your blood glucose before and after meals when trying new foods. Try not to aim for more than a 30 mg/dL increase 2 hours after eating).<br />
<br />
For other info on label reading and portion control from this blog:<br />
<a href="http://skepticrd.blogspot.com/2012/10/label-reading-carbohydrate-edition.html">Label reading: Carbohydrate Edition </a><br />
<a href="http://skepticrd.blogspot.com/2013/04/portion-distortion.html">Portion Distortion</a><br />
<a href="http://skepticrd.blogspot.com/2012/07/one-of-major-complaints-i-get-when-i.html">Grocery Shopping with Radio Lab</a><br />
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<br />SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com1tag:blogger.com,1999:blog-4798204394183282951.post-65988087957481831922014-03-03T10:54:00.003-08:002014-03-03T10:54:58.489-08:00On My Reading List: The Diet FixI have been asked before to do a blog post about "diet books that don't contain a lot of woo." I've avoided doing that post because even though I can think of books that have good information, I have trouble finding ones that also do not contain a lot of <a href="http://www.skepdic.com/adhominem.html">ad hominem fallacies</a> or that promote enough flexibility to keep the plan sustainable. Today, as I was catching up on blog postings from <a href="http://sciencebasedmedicine.org/">ScienceBasedMedicine.org</a> I found one that looks promising: <a href="http://www.amazon.com/Diet-Fix-Diets-Fail-Yours-ebook/dp/B00C8S9VYI/ref=sr_1_1?ie=UTF8&qid=1393870953&sr=8-1&keywords=the+diet+fix">The Diet Fix, by Yoni Freedhoff, MD.</a><br />
<br />
I say "looks promising" because it won't be published until tomorrow (I have pre-ordered), and because I like the highlights that Scott Gavura gave over at this <a href="http://www.sciencebasedmedicine.org/the-diet-fix/">this blog post.</a> I am also happy because it looks like we might finally have a book that does not ascribe demonic powers to either saturated fat (yay bacon and coconut oil!) or all carbohydrates for all people. I also like his (seeming) focus on sustainability and self awareness (i.e. a diet plan only works as long as you have a plan for that pasta taking a leap into your shopping cart). I'm also looking forward to reading a book that doesn't contain references to toxins/detoxing/cleansing.<br />
<br />
I'm still waiting, however, to check out his references and look at the kind of language he uses. I'm already wishing he hadn't used the term "Post Traumatic Dieting Disorder" as many of my patients with Post Traumatic Stress Disorder (PTSD) have eating problems that are tied up with their PTSD and I would really hate to draw a false equivalency.<br />
<br />
Will report back with my findings/thoughts. Meanwhile, if your reading list isn't long enough, check out this Goodreads list of recommended books: <a href="https://www.goodreads.com/list/show/52624.Science_Based_Medicine_Recommends">Science Based Medicine Recommends.</a><br />
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SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com2tag:blogger.com,1999:blog-4798204394183282951.post-3741732202142333752014-02-19T12:19:00.001-08:002014-02-19T12:19:28.641-08:00The Brain Diet?Immediately after I typed the title for this blog I realized that those who know me, and my twisted sense of humor, would assume that I was making a zombie joke. While I do entertain a fondness for <a href="http://www.amctv.com/shows/the-walking-dead">The Walking Dead</a> (both the graphic novels and the TV show) I actually happen to be referring to an article that was linked from a blog post giving otherwise good advice on helping your loved ones who have depression; the related tip involved making healthy food for people whose desire to get out of bed, let alone go to a grocery store and cook, is little to none. While the <a href="http://www.thedarlingbakers.com/10-ways-show-love-someone-depression/">tips were actually very good</a> (speaking from my experience), this article linked to <a href="http://www.maryvancenc.com/2013/12/overcome-depression-naturally/">this post</a> which had me asking why I click on links in the first place. Is there any evidence to any of advice she is giving?<br />
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This article does not start off well, as she starts off talking about our depression caused by "toxins." As I have <a href="http://skepticrd.blogspot.com/2013/01/stop-cleansing.html">said before</a>, "Toxin" is usually just a modern day word for "miasma," "imbalanced humors," or even "evil spirits." So it is a) unlikely that you can be cleansed from something that doesn't exist, and b) if you really were poisoned, it is highly unlikely that <a href="http://skepticrd.blogspot.com/2013/01/stop-cleansing.html">eating cilantro</a>, <a href="http://skepticrd.blogspot.com/2013/02/herbs-for-organs-part-one.html">eating certain herbs</a>, <a href="http://skepticrd.blogspot.com/2013/03/colon-scrubs.html">eating diatomaceous earth</a>, or <a href="http://skepticrd.blogspot.com/2012/07/over-years-one-of-other-questions-i.html">juicing your vegetables</a> will remove the poison (or clear up your depression for that matter). Remember to, there really isn't any good evidence that <a href="http://www.ncbi.nlm.nih.gov/pubmed/22944875">organic food is always safer or healthier for you.</a> Now to qualify that last statement, <em>I'm not talking about taste, environmental issues, or supporting your local farmers, or saving money by growing your own food here</em>--that's another blog post. the point is that this paragraph on toxins is about fear and selling a book on a pointless "cleansing" procedure.<br />
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The section foods to include for a healthy brain is another interesting mixture or information that might have some truth to it mixed in with unfounded assertions. The assertions about obtaining adequate protein, adequate fat, adequate B vitamins, and antioxidants is good information for anybody, and basically part of a general healthy diet for anyone. And as I've <a href="http://skepticrd.blogspot.com/2012/11/food-and-mood.html">said before</a>, this really is an "anti-depression" diet, it's a "be healthy so you don't aggravate or develop underlying health conditions that might contribute to depression" diet. Now, the point about getting adequate fat is intriguing to me, as there have been some studies (<a href="http://www.sciencedirect.com/science/article/pii/0165032795000925">1,</a> <a href="http://www.psychologytoday.com/articles/200304/the-risks-low-fat-diets">2)</a> that indicate that a very low fat diet can also increase a risk for depression, but, as the Psychology Today article pointed out, finding the causes is complicated. It is possible that those who ate too low in fat didn't get enough essential fats (like the omega-3s), or that they weren't getting enough fat to keep them satiated at meals and the subsequent hunger influenced depression, or that they replaced the fat with refined carbohydrates which led to blood glucose regulation issues which influenced depression, or maybe some combination thereof. I also find the link between gut bacteria and depression to be intriguing, but there isn't really a clear link there either (<a href="http://www.livescience.com/40255-how-bacteria-affect-mental-health.html">Link</a>).<br />
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When it comes to testing urine for neurotransmitters, I recommend reading this excellent post from SciencebasedMedicine.org: <a href="http://www.sciencebasedmedicine.org/bogus-diagnostic-tests/">Bogus Diagnostic Tests</a>. Neurotransmitters are found in other tissues in the body (peripheral), and so any neurotransmitters that appear in the urine do not reflect the levels in the brain. As far as the supplements are concerned, remember that <a href="http://skepticrd.blogspot.com/2013/12/supplement-specifics.html">you don't need to supplement unless you are deficient</a>, and that "natural" does not mean better or free of side effects. Notice that one of the supplements recommended, 5-HTP, has been associated with dizziness, nausea, and diarrhea (<a href="http://summaries.cochrane.org/CD003198/tryptophan-and-5-hydroxytryptophan-for-depression">Link).</a><br />
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Several of the lifestyle changes like getting adequate sleep, meditation, limiting alcohol, and exercise have evidence to back them up, the others, not so much. Also remember too that when I talk about eating in such a way as to not aggravate other health conditions, I am not talking about dubious diagnoses like "<a href="http://www.quackwatch.com/01QuackeryRelatedTopics/candida.html">Dubious Yeast Allergies."</a><br />
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Take home message--Eating a healthy diet, particularly with the help of loved ones when you don't feel like cooking, can help alleviate symptoms of depression. Unfortunately there are no certain "magic" foods or supplements that will relieve it.<br />
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<br />SkepticRDhttp://www.blogger.com/profile/01092612953833296570noreply@blogger.com1