Why is World Diabetes Day Important?

November 14th was World Diabetes Day. To acknowledge this, it is important to understand why there is a day dedicated to diabetes awareness. The burden of diabetes has quadrupled over the past decades; the World Health Organization estimates there are 422 million adults who currently have diabetes worldwide. That is 1 in 11 adults. Data from the National Diabetes Statistics Report found that in 2017, there were 30.3 million people who had diabetes, of which 23.1 million people are diagnosed and 7.2 million people remain undiagnosed.

The burden of diabetes is not just in the numbers affected but also in health costs, and, most importantly, quality of life. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputations. WHO projects that diabetes will be the seventh leading cause of death in 2030. Currently, it is estimated that 1.6 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose in 2015 and 2012, respectively.

The above numbers are why we must focus on awareness, prevention and treatment of diabetes.

What are the symptoms of diabetes?

Diabetes can be treated. Dietary and lifestyles factors have been proven to make the largest impact on decreasing, preventing and treating the complications from diabetes. As with most progressive illnesses, diabetes onset typically goes unrecognized by the patient for a number of years, with the exception of type 1 diabetes, which is typically a sudden onset of symptoms. So what are the warning signs of high blood sugars and possibly undiagnosed diabetes?

Symptoms of hyperglycemia to look for:

  • Frequent urination
  • Frequent thirst and hunger, even right after eating
  • Extreme fatigue
  • Changes in vision
  • Sores that won’t heal
  • Gum disease, gums pulling away from teeth, red, swollen gums or changes in the way your dentures fit
  • Weight loss
  • Tingling, pain or numbness in hands or feet

How does a diabetes diagnosis happen?

When should someone consider getting screened for diabetes?

  • Are overweight (BMI >25)
  • Are 45 years or older
  • Have a parent or sibling with type 2 diabetes
  • Have ever had gestational diabetes or given birth to a baby who weighed more than 9 pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (Some Pacific Islanders and Asian Americans are also at higher risk.)

What tests will my providers/doctors order, and what will they mean?

Result A1c
Normal less than 5.7%
Prediabetes 5.7% to 6.4%
Diabetes 6.5% or higher

 

Result Fasting Plasma Glucose (FPG)
Normal less than 100 mg/dl
Prediabetes 100 mg/dl to 125 mg/dl
Diabetes 126 mg/dl or higher

 

Result Oral Glucose Tolerance Test (OGTT)
Normal  less than 140 mg/dl
Prediabetes  140 mg/dl to 199 mg/dl
Diabetes  200 mg/dl or higher

 

Your doctor will typically use two methods to confirm a diagnosis of prediabetes or diabetes.

What comes after a diabetes diagnosis?

In either case of prediabetes or diabetes, the treatment includes a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco. It is important to incorporate these with any medication regimen your doctor may prescribe. In fact, diet and lifestyle changes have been shown to decrease your hemoglobin A1c by one to two percent!

When you are thinking of beginning a new dietary plan, you must incorporate schedule, food behaviors, and even your favorite foods. For example, if you grew up on meat and potatoes, I would not say you could never eat those foods again. Instead, it is important to discuss healthier cuts of meat or poultry or healthier types, portions and ways to prepare potatoes. Many people think a diet is depriving yourself of food—instead think of adding new foods to portion-controlled foods you enjoy. A good guideline is the USDA’s Plate Method.

Using this method, you can incorporate a controlled amount of carbohydrate sources, while increasing your non-starchy vegetable intake. The most challenging part for most individuals is making half of your plate non-starchy vegetables. It helps to get creative with your vegetables—explore zucchini noodles, spaghetti squash pasta or even eggplant pizzas! Or, try this cauliflower rice recipe:

Cauliflower “Rice” Salad

Salad

  • 12 ounces of cauliflower florets or pre-made cauliflower “rice”
  • 1 cup cucumber, diced
  • 1 cup grape tomatoes, cut in half
  • 2 green onions, sliced
  • 3 tablespoons sliced Kalamata olives

Dressing

  • 1/4 cup red wine vinegar
  • 2 tablespoons olive oil
  • 1/2 tablespoon Dijon mustard

Instructions

  1. Make your own cauliflower rice by placing cauliflower florets in a food processor and processing them to rice-like consistency. (Be careful not to over-process.)
  2. In a salad bowl, combine all salad ingredients.
  3. In a small bowl, whisk together the dressing ingredients.
  4. Pour dressing over salad and serve with reduced-fat feta cheese, if desired.

Try cauliflower rice in other traditional rice dishes—you might be surprised!

From http://www.diabetes.org/mfa-recipes/recipes/2016-07-cauliflower-rice-salad.html.

What do you know about your sugar?

I recently attended the American Association of Diabetes Educators conference in Indianapolis. How great and refreshing it was to be with 3,000 other diabetes educators from across the U.S. At this conference, there was a great display from the Abbott Freestyle “Know Your Sugar Tour” bus, which is a cross-country expedition to raise awareness about the ill effects of sugar on the body. This tour, featuring one-of-a-kind sugar sculptures made by world-renowned Irish sculptors Brendan Jamison and Mark Revels, promotes the importance of understanding sugar’s effects on the body.

When there is extra sugar, it can be stored in muscles and liver for later use, but it also can be stored as fat.

We Need Sugar—to an Extent

Our body is fueled by carbohydrates, fats and proteins. Sugar is a type of carbohydrate that occurs naturally in foods, but can also be added during food processing. Sugar is consumed in many different forms, but our bodies digest almost all of the sugar we eat into glucose. Glucose is the primary sugar our bodies use to create energy.

Our bodies do need a minimum amount of sugar every day to function properly. The reason for this is that glucose is the only source of energy for the brain and red blood cells. The human bloodstream normally contains only about 5 grams of glucose at any one time, which is the equivalent of just one teaspoon of sugar.

But Too Much Sugar Can Risk your Health

Sugar is not the enemy, as it is our fuel source, but too much sugar can be. So when we eat, this is what happens…

When there is extra sugar, it can be stored in muscles and liver for later use, but it also can be stored as fat. Additionally, if there is too much sugar, adverse effects start to occur within our bodies. Too much glucose in the bloodstream is the third highest risk factor for premature death worldwide, preceded only by tobacco use and high blood pressure. Additionally, consistent high blood glucose can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys and nerves.

Steps for Managing your Sugar

Now, I’m not trying to alarm you! Insulin resistance, an effect of too much sugar in our bodies commonly known as type 2 diabetes, can be managed with healthy eating, increased physical activity and education and awareness. Complications in diabetes can also be better managed with:
• early diagnosis
• health professional support
• controlling glucose levels, blood pressure and cholesterol levels
• access to insulin, oral medications and monitoring devices.

You can get started on eating less sugar right away by making the following food choices:
• non-starchy vegetables
• whole-grain foods
• fish 2-3 times a week (fried fish doesn’t count)
• lean cuts of beef and pork
• removing the skin from chicken and turkey
• non-fat or low-fat dairy products
• water, unsweetened tea, coffee and calorie-free ‘diet’ drinks instead of drinks with sugar
• liquid oils for cooking instead of solid fats (limit quantities)

In addition to changing what you eat, you can change how you eat. Consider making the following changes to your eating habits for better health and balance:
• eat a variety of foods
• eat small portions several times a day
• match how much you eat with your activity level
• eat few foods high in calories, cholesterol, saturated fat, trans fat and sodium.

I know this sounds like a lot, so to simplify:

Try to not go more than 3-4 hours without eating, get a portioned amount of carbohydrates and protein together and follow My Plate guidelines with portioning all types of foods. Strive to get some movement in daily. This could be going to a gym, walking, “chair walking,” water therapy, exercise classes—anything you want, really, as long as you’re moving! Don’t hesitate to also set up an appointment with one of the dietitians at Springfield Clinic, too.

Can you control your diabetes?

World Health Day was celebrated on April 7 and this year’s theme was “Beat Diabetes.” Our department provides education for type II diabetes on a daily basis. I often find that patients are diagnosed without a clear understanding of what diabetes actually is. According to The World Health Organization, “Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.” Insulin is needed to help the body utilize carbohydrates, a main energy source found in some foods. Hyperglycemia, or elevated blood sugar, is common in uncontrolled diabetes and can lead to damage in the body over time. Damage may occur in nerves and blood vessels and may lead to problems with eyes, kidneys, and other areas of the body.

Can you control your diabetesAs a dietitian, I educate patients about foods that contain carbohydrates and turn into a form of sugar called glucose. Once carbohydrates in food turn into glucose, this has a direct impact on elevating blood glucose (blood sugar) levels. It is important to balance carbohydrates with other foods that do not have an impact on blood sugar. I use the idea below for diabetic educations:

food plate

Diabeticlivingonline.com. ¼ plate foods that contain carbohydrates and turn into glucose, ¼ plate protein that does not turn into glucose, and ½ plate non-starchy vegetables that do not turn into glucose.

Many patients have a vague understanding of foods that are “bad” and those that are “good.” They are often told that they can never eat bread or rice again. They should avoid sweets and stock up on sugar-free items. With that being said, it is so beneficial to meet with a registered dietitian to build a better knowledge about nutrition and diabetes. The “how and what you eat” are very important factors in diabetes management. Physical activity is also an essential component.

The World Health Organization estimates that 350 million people worldwide have diabetes and this number is expected to double in the next 20 years. This is such an alarming number considering many cases of type II diabetes could be prevented with better food choices and increased physical activity.

Recommendations for prevention:

  • Eat a variety of foods, including those that contain carbohydrates, lean proteins, and non-starchy vegetables.
  • Use the plate method above as a guide at main meals. www.choosemyplate.gov is a great resource when learning about the different food groups and healthy eating.
  • Aim for 150 minutes of physical activity weekly.

Click here to find out more information on World Healthy Day 2016 and diabetes.

 

Alana Scopel

What it Means to Follow a Diabetic Diet

When a patient sees me for diabetic diet education, the majority of the session is devoted to talking about carbs. It is the carbs in our food, not the protein or fat that gets broken down into the simple sugar molecule glucose. Once carbs are broken down into glucose, they are then released into the bloodstream. Individuals with pre-diabetes and diabetes have struggles with controlling their blood sugar levels and also have elevated insulin levels.

Insulin is known as the storage hormone in the body; too much of it promotes excess fat storage and even inflammation; however, too little of it is also just as deadly (like Type 1 diabetics experience because their pancreas produce no insulin). Insulin is typically released by the pancreas when glucose enters the bloodstream; thus the higher amount of carbs one eats, the greater the insulin response will result. Older individuals and those with excess body fat on them are more prone to developing insulin resistance, which means that extra insulin is needed to get nutrients into the cells. There are no real symptoms of insulin resistance and this can begin to develop long before blood sugar levels become elevated. The bottom line is…controlling insulin levels will help you get to a better state of health.

diabetes causesUnderstanding the foods that contain carbs is essential for following a diabetic-friendly diet. It’s not necessary to cut out all forms of carbohydrates from the diet; however, individuals do need to practice better portion control and moderation with many of these food items. The following food groups all contain carbs:

  • Grains: breads, cereals, pancakes, waffles, biscuits, pasta, rice, crackers, pretzels, popcorn, granola bars, chips
  • Starchy Vegetables: potatoes, peas, corn, beans
  • Dairy: milk and yogurt
  • Fruit: bananas, apples, oranges, grapes, dried fruit, juice
  • Sweets: cookies, candy, cake, ice cream, jelly, syrup, honey, BBQ sauce, sweet coffee drinks

Meats and healthy fats like eggs, chicken, fish and nuts and seeds have very little or even no carbohydrate content in them. These foods help fill you up without spiking your blood sugar level. This is why it is important to include a lean protein or healthy fat source with all of your meals and snacks. Non-starchy vegetables like spinach, onions, peppers, mushrooms, broccoli and green beans contain very small amounts of carbs. The carbs found in these veggies (like natural fiber) have very minimal effects on blood sugar and insulin levels. I encourage patients to fill at least half of their plates with nutritious, low-carb, non-starchy vegetables. They can be consumed raw or cooked.

Fried egg open sandwich

If weight loss is desired, the typical female may be recommended to consume 30-45 grams of carbs with meals and men may consume 45-60 grams of carbs with meals. These levels reflect average recommendations as these amounts can vary depending on height, weight and activity level. The types of carbs one consumes may also influence weight status.

Carb counting is not the only method for controlling diabetes as meal times and exercise patterns can also greatly influence blood sugar control. For a more detailed assessment and meal pattern recommendation, please schedule a consult with your Springfield Clinic dietitian.

Fruit: Is there really a good and bad choice?

fruit_woman_iStock_000019680537XXXLargeWhen it comes to fruit, numerous patients have asked me if there is such a thing as good and bad fruit. Many will read on the internet that bananas are bad for you and grapes are too high in sugar. Messages like this can be quite confusing because after all, isn’t fruit supposed to be good for you?  The perk of eating fruit is that it is low in calories and contains a bundle of vitamins and minerals. The downfall of fruit is that it also contains natural sugars and like we know, too much sugar (even natural) is not a good thing.

I don’t really like to say that there are good fruits and bad fruits, but I do try encouraging some fruits over others based on their glycemic index. Glycemic index is a value assigned to foods that indicates what type of affect that food may have on one’s blood sugar and insulin level. A low glycemic food such as broccoli will have a minimal effect on blood sugar and insulin whereas a high glycemic food like a white potato will make both levels skyrocket. This information is especially important for someone who is diabetic or even pre-diabetic. In fact, a recent meta-analysis in the American Journal for Clinical Nutrition suggests that high intakes of foods with a high glycemic index can greatly increase one’s risk for developing diabetes. Elevated levels of insulin can also increase LDL (the bad cholesterol) as well as promote fat storage. It is understood that elevated insulin levels can make it more difficult for the body to burn stored fat; therefore, choosing foods with a lower glycemic index can help reduce insulin levels and thus, may help the body burn more fat and promote weight loss. Other consequences of chronically elevated insulin levels can include increased sugar cravings, elevated triglyceride levels and hypertension.

The glycemic index is a scale of 0-100. Foods with a score of 70 or higher are considered high glycemic foods and are encouraged to be limited. Foods with a medium score of 50-70 are considered moderate glycemic foods and should be eaten in moderation while foods with a score of less than 50 are lower on the glycemic index and should make up the bulk of one’s dietary choices. Below is a list of common fruits and their GI values.

Where does your favorite fruit fall on the list?

Fruit GI Value
Cherries 22
Grapefruit 25
Prunes 29
Apricot, dried 30
Apple 38
Pear, fresh 38
Peach, canned in juice 38
Plum 39
Orange 40
Peach, fresh 42
Grapes 46
Mango 51
Banana 52
Fruit Cocktail 55
Papaya 56
Raisins 56
Apricots, fresh 57
Kiwi 58
Figs, dried 61
Cantaloupe 65
Pineapple 66
Watermelon 72
Dates 103

Remember, just because a fruit has a high glycemic index doesn’t mean that you have to cut it completely out of your diet. It’s perfectly fine to enjoy some of these fruits from time to time guilt-free but at least try to mix up your choices with a variety of GI values.

How Carb Smart Are You?

Carbohydrate-food-shot-carbsWhat do breads, cereals, fruits, juices, milk, yogurt, pasta, rice, potatoes, beans, vegetables, soda and desserts all have in common? If you didn’t already guess it from the title, it’s Carbs. When asked what foods contain carbohydrates, bread, pasta and potatoes are the most commonly identified. Many people do not realize that carbs are actually found in almost our entire food supply with the exception of meats, cheeses and fats.

As Americans, we generally consume way too many carbs throughout the day. Most breakfast meals include toast, Poptarts, pancakes, biscuits or cereal followed by sandwiches, pizza, spaghetti and burger and fries for the rest of the day. These foods are also highly processed menu items that often contain preservatives and other added chemicals.

Do I feel that carbs are contributing to many of our current diseases and illnesses? Absolutely. Does that mean that in order to be healthy, one must cut out all carbs? Not at all.  In fact, many athletes actually need to increase their carbohydrate intake to ensure optimal performance. Research has shown that vegetarians, who are known for having high-carb diets, tend to have reduced risks for obesity, diabetes and heart disease.1

Going “low-carb” is a very popular diet trend to lose weight. While consuming fewer carbohydrates can help decrease circulating levels of insulin, which in turn can help the body switch to a fat-burning mode, weight loss is typically more attributed (but not conclusive in all studies) to the combination of consuming fewer calories, better food choices, less processed foods and improved physical activity habits. Researchers in a 2007 study in the American Journal of Clinical Nutrition suggest that low-carb diets may give individuals a “metabolic advantage” meaning that more weight loss may be achieved per calories consumed (versus the same amount of calories consumed from a standard high-carb meal plan).2  

This is a very controversial subject since these findings somewhat violate the laws of thermodynamics. Since there is no consensus on what low-carb actually is (for some studies it’s a mere 5% of total calories and for others it’s defined as 45% of total caloric intake), the term smart-carb has become more popular.

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Today, research is investigating the health benefits of low-moderate carb meal plans:

  • Following a “smart-carb” diet in addition to exercise can help improve insulin sensitivity and assist in weight reduction in women with polycystic ovary syndrome.
  • A Duke University study found that obese individuals with type 2 diabetes who ate a low-carb diet versus a low-glycemic diet experienced greater weight reduction and greater reduction in HgbA1C. In this same study, most of the subjects (95.2%) in the low-carb group were able to reduce or eliminate their diabetic medications compared to only (62%) in the low-glycemic group.3
  • There also appears to be some variation in low-carb meal plans. A group of Swedish subjects showed greater benefits in waist circumference reduction and improved blood sugar control when following a diet based of meat, fish, fruits, vegetables, eggs and nuts (paleo diet) when compared to a subjects who followed the Mediterranean diet.4
  • The obvious concern with consuming a low-carb diet is the increased fat intake and potential increased risk for heart disease. Fortunately, studies are confirming that higher fat intake when associated with a low-carb diet may not be as big of a problem as once thought.

Low-carb meal plans may not always be the best, but choosing smart-carb lifestyles such as the Mediterranean and Paleo lifestyles are much more suitable for day to day living. Here are a few ways to smarten up your carb choices.

  • Nix pretzels, crackers, chips and granola bars and opt for healthier carb and non-carb snack food choices such as fruits, vegetables, yogurt and nuts.
  • Vary up your breakfast meal. Swap sugar-sweetened cereal and refined white bread for a veggie omelet, turkey sausage frittata or fruit with Greek yogurt.
  • Serve vegetables with a side of vegetables. Many people state that they always have to have a starch with their dinner meals. Why not swap the rice and pasta for vegetable starches such as sweet potatoes, butternut squash or spaghetti squash?
  • If choosing grains, consider whole grain choices such as oatmeal, quinoa or wild rice.

Remember, limiting carbs is not the only way for improved health. The mere reduction of processed foods in one’s diet can have positive health effects.

  1. American Heart Association. Vegetarian Diets. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Vegetarian-Diets_UCM_306032_Article.jsp
  2. Westman, E., et. Al. (2007). Low-carbohydrate nutrition and metabolism. The American Journal of Clinical Nutrition, 86(2), 276-284. http://ajcn.nutrition.org/content/86/2/276.full.pdf+html?sid=ac06d160-abd0-4ba6-8a19-8b5560469446
  3. Westman, E.C., Yancy, W,S, Jr., Mavropoulos, J.C., Marquart, M. and McDuffie, J.R. (2008).The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes. Nutrition and Metabolism, 5, 36. http://www.nutritionandmetabolism.com/content/5/1/36
  4. Lindeberg, S., Jönsson, T., Granfeldt, Y., et al. (2007). A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia,50(9):1795-1807.