Monthly Archives: January 2015

Your Blood Sugar, Diabetes Or Not

29.1 million or 9.3 percent of people in the US have diabetes and of those people, over 27% do not even know they have it.  Another 86 million or one in three people have pre-diabetes, which without lifestyle changes can lead to Type 2 diabetes.  If you have a parent with Type 2 diabetes or if you have diabetes then you should be checking your post meal blood sugars occasionally.

As a certified diabetes educator it has often surprised me to hear my patients say that their health care provider told them they did not have to check their blood sugars, let alone blood sugars after a meal.  I also have heard the shock from my patients when they first were told they had diabetes.  For those newly diagnosed with diabetes, looking back at their fasting basic metabolic panel which includes a blood glucose test, I often find that they have had pre-diabetes for years.  With all that health care providers have to do today in a short office visit, it is no wonder these lab results are overlooked.

Why Check Your Blood Sugar

Checking your blood sugar is like checking the pulse of your pancreas.  The pancreas is the organ that makes insulin.  Insulin is the hormone that helps to bring the sugar from digested food into the cells for energy and lowers the blood sugars circulating in the blood vessels.  Blood sugars are highest one to two hours after a meal depending on the food choice and combination.  We also know that high blood sugars over time can lead to kidney, eye, nerve and cardiovascular damage.   Think of your pancreas as the brake system for you blood sugars.  Over time with repeated insults from high blood sugars the brake system weakens and eventually leads to permanent damage.  Brakes can just be replaced, but for people with diabetes the only choice is to go on more medications and eventually insulin through injections or a pump.

There is a strong genetic link to the development of type 2 diabetes, much stronger than in type 1 diabetes.  According to the American Diabetes Association, if you have a parent who developed diabetes before age 50 then you have a 1 in 7 chance of developing it.  If your parent was diagnosed with type 2 diabetes after age 50 you have a 1 in 13 chance of developing it.  So, if you have not been diagnosed with pre-diabetes then checking your blood sugars two hours after that pizza or Chinese buffet splurge will tell you how your pancreas is handling your indulgences and maybe convince you to keep those portions smaller and less frequent.  Borrow your parents glucometer to check or heck, treat yourself to a meter from Walmart (the Reli-On is only about $30).  And if you already have type 2 diabetes, occasionally checking your blood sugars two hours after a meal could help you navigate towards healthier food choices, slow down the diabetes process, and possibly keep you from ever needing insulin injections.

How Food Impacts Blood Sugars

Stress, infection and certain medications can cause hyperglycemia, or high blood sugars, but on a day-to-day basis it is the amount and types of carbohydrates we eat that cause blood sugars to rise. Carbohydrates are made up of starches and sugars and include things like cereals, pasta, soda and sweetened teas, grains, breads, milk, chips, ice cream, starchy veggies, sweets and even large servings of fruit.  The more processed the starch, the more rapidly it can impact blood sugars.  So eating a cereal like Cinnamon Toast Crunch or Rice Krispies that has been stripped of its fiber and has little protein or heart healthy fat, will cause a rapid rise in your blood sugar and less satiety than a breakfast with the right combination and amount of protein, fat and carbohydrates.  Based on a 2000 calorie diet, the RDA for carbohydrates is no more than 300 grams a day.  If someone has diabetes then the recommendation is between 45-60 grams per meal depending on activity level.  I have worked with many people with pre-diabetes or diabetes who have tried to stock pile their carbohydrates by skipping or eating a very small breakfast and lunch and then eating a large amount of carbs in the course of an evening.  This overworks and will eventually tire out the pancreas leading to diabetes or the need for insulin injections.

Blood Sugar Patterns

CGM strip graph2The first graph is a blood sugar pattern of someone with a healthy pancreas who has no pre-diabetes or diabetes.  This strip shows three different days worth of blood sugars with each color representing a different day. The insulin in their body is able to do the work required to keep blood sugars in a normal range as evidenced by the fact that the blood sugars never went above 140 mg/dl.  In pre-diabetes blood sugars can go as high as 199 mg/dl after a meal.  If someone with pre-diabetes or diabetes has a meal with a lot of carbohydrates, especially ones stripped of their fiber (think donuts, juice, pasta, soda, rice) their blood sugar will rise rapidly and well above 140.  An hour after their meal they might feel really tired or feel irritable or shaky due to a surge in insulin as their body tries to cope with the barrage of quickly digested carbs.

The next graph belongs to a person with long-standing Type 2 diabetes.  You can see in this graph that the blood sugars are well above 200 and as high as 350 after eating.  If this person was checking his blood sugars two hours from the first bite of food he would learn how his food choices were causing such a high blood sugar.  This person was having cold cereal, milk, bananas and juice for breakfast which explains the sudden rise in blood sugar because all those foods are high carbohydrates when all combined, and low in protein and fiber.  It would have been interesting to see how much lower his morning blood sugar would have been if he had tried a breakfast of 2 whole grain slices of bread with a half cup of low-fat cottage cheese or perhaps my smoothie recipe.

How To Avoid High Blood Sugars

The best way to avoid the sudden rises in blood sugars is to combine foods in a specific way to slow down digestion and lower the blood sugar rise.  This eating strategy not only keeps blood sugars under better control, but it takes the work load off the pancreas, will keep you fuller longer, and will help you to lose weight.

The simplest way to learn about the way to combine foods is to use the Choosemyplate method.  Breakfast might consist of a serving of whole grains, some lean protein coming from eggs, low-fat cheese, Greek yogurt or lean meats like Canadian bacon and some healthy fat from nuts or flax seed.  Your lunch and dinner plate along with a glass of skim or low-fat milk, should consist of a smaller 9-10″ plate divided in four with each quarter containing:

  1. A non-starchy veggie like broccoli, salad or some other green
  2. A lean protein like chicken, lean pork, fish, Greek yogurt, low-fat cheese (can still be high in saturated fat so be aware of your serving size), eggs and nut butters
  3. A fruit
  4. Grains like brown rice, a slice of whole grain bread, whole grain pasta

Checking Your Blood Sugars After Eating

Healthcare is changing and gone are the days that your health care provider will be able to manage everything to keep you in good health.  People need to learn to take responsibility for their own health by knowing their family history, by being proactive and informed, and willing to check-in with their own body.  Borrow a meter, buy a cheap one at Walmart, but be informed and check the pulse of your own pancreas today if you have a family history of diabetes and certainly if you already have diabetes.  Who knows, you might find checking your blood sugar might be just the impetus you need to eat better, feel better and live a longer, healthier life.

Cravings

Time, The Test For Cravings

I have to admit, I love a good deal.  There are few things as rewarding to me as buying an item  way below cost, especially if the item is something I really need.  And the weeks right after the holidays are one of the best times to get great deals.

Recently, I was on one of my favorite websites, Sierra Trading Post, prompted by an email promotion for free shipping and extra 30% off on clearance items.  My impulse was to check out the online clearance items immediately but after spending 10 minutes on the website it occurred to me that I was not shopping with a particular purpose.  I was shopping for the pursuit of “the deal”.  The pants I saw looked wonderful and had great reviews and the price was ridiculously cheap, but I realized I was being sucked into the shopping vortex of aimless buying without a real need, just to take advantage of “the deal”.

I stopped myself, closed the window and said to myself, if I feel the same way about the pants tomorrow then I would consider purchasing them, but only after letting 24 hours pass.   The next day, I realized that I really did not want the pants and my strong impulse to buy them had passed.  I also realized that this impulse to shop online was triggered by a tempting email promotion.  Had I not received the email, I would not have wasted 15 minutes of my day.  This lead me to go through my emails and “unsubscribe” to several of my favorite clothing vendors.  Get rid of the trigger, decrease the impulse.

Food Cravings

The shopping impulse is very similar to food cravings.  The holidays are finally over which means gone are the many temptations of cookies, sweet breads, chocolate and other mouth satisfying seasonal treats.  I can look back and recall the times I found myself in the kitchen reaching for the box of homemade toffee and wanting just a little piece.  I also noticed that these cravings passed more easily on some days.  It became a little game for me to witness my desires for all the holiday goodies and to create some personal rules to abide by. First of all I had to understand what made my resistance to temptation stronger on some days more than others.  This is what I observed:

  • On days I did not eat 3 balanced meals, I had more cravings in the afternoon and evening
  • I noticed that days when I had more on my mind and was more distracted, I had more cravings.
  • I found that when I brought the whole container of tempting foods out to the room while I watched TV, I ate much more of it than I had intended and really regretted my choice.
  • I noticed that keeping tempting foods out of eye sight made a big difference in the frequency of my cravings.
  • I noticed that I had more cravings when I was bored, feeling anxious or felt justified to enjoy a treat because “this only happens once a year”.
  • Lastly I noticed that over time my cravings diminished in the course of an evening and that other things, like drinking hot tea, helped assuage my desires.

Next, I addressed each of the observations.  I did not skip lunch – I had at least a protein and carb like low fat cottage cheese and fruit or a piece of whole grain toast.  I made lists of the things I had to do to give me more focus and sense of control.  I tried to make plans just for the next day and not jump too far ahead in my thoughts.

I put the chex mix out of sight and quit taking the whole container out by the TV.  I changed my self talk to “you are going to regret the extra pounds you will put on if you continue to eat this way” and strongly considered the feelings of regret for the 2-15 minutes of splurging.  And finally, I did not immediately react to my craving – I gave myself at least 15 minutes before acting on my temptations while also getting back in the habit of fixing a hot cup of tea around 7:30 in the evening.  I find having something warm to drink is satisfying and diminishes my desires for something sweet or crunchie.

Time

Lord Byron, an early 1800 British poet said:

“Time! the corrector when our judgments err”

Although, lord Byron most likely was talking about discernment of the heart, this saying can  apply to coping with cravings as well.  Giving in to impulses is usually due to poor judgment and lack of planning.  Having a plan to control temptations and having a rule to delay immediate satisfaction will not only improve your sense of self-control, but will leave you with more time to do things you really want to do!

New Year’s Goal: Get The Right Ratio

Forest Gump may believe life is like a box of chocolates, but I believe life should be like a bowl of Chex Mix – with the perfect ratio of ingredients.  I believe a happy life consists of the right balance of work, relationships, responsibilities, fun and taking care of one’s self.  An imbalance among these areas is like Chex Mix without the right ratio of ingredients.

Chex mix

Chex mix

Every holiday my family always has at least one discussion about what it takes to make the perfect Chex Mix.  We know it takes the right balance of Rice Chex, to Wheat Chex, to peanuts and pretzels.  It also takes the right amount of “hot kick” in the seasoning.  The right amount of butter(and only butter) and just the right amount of cooking time.  If one area is off-balance then I get  “the message”.  Life should be like Chex Mix – striving for the right ratio.  When too much of your life is consumed by one area (or your life consumes too much of one area), then the other areas get diminished and out of balance.  This imbalance impacts work quality, relationships, attitude, and our health due to chronic stress.

Chronic Stress Is Like Soggy Chex Mix Without The Crunch

I have learned to mix the warm, seasoned butter with the Rice Chex, peanuts and pretzels first, before stirring in the Wheat Chex.  If I put the Wheat Chex in with everything else from the start, the Wheat Chex act like little sponges and become soggy.  And if those sheets of Chex Mix are not baked for at least 20 minutes at 325 and tossed around half way, then the mix won’t crisp up.

Chronic stress leaves our thoughts half-baked, hearts soggy and life without crispness.  Short episodes of stress gives us a boost of energy from the release of hormones that prepare our bodies for action.  However, prolonged periods of stress with long-term exposure to these hormones, can not only cause headaches, indigestion, poor sleep, depression and anxiety but increased inflammation that speeds up aging.   Furthermore, chronic stress has been linked to cardiovascular disease, diabetes and even a weakened immune system.

It’s Your Life – Get the Right Ratio!

It’s so easy to put off taking care of ourselves.  I hear people say frequently how unhappy they are in their job.  It always makes me wonder if they have considered all possibilities like a change in jobs, moving, or reassessing needs and wants.  It makes me wonder whether or not they have created their own financial prisons thinking they must have a certain lifestyle, house, camp, travel or multiple things that only bring temporary happiness.

I hear my clients say often that they will start exercising when  “the kids go to school” or “when I have more time” or “when I go south in the winter” instead of just finding ten minutes to go for a fast walk that week.  Or sometimes a client will talk about their loneliness instead of doing something about it by joining clubs or meet-up’s or getting active in the community.

Sometimes people take on too many responsibilities through work, family or volunteering and don’t ask for help or know when to say “no”.  And sometimes people don’t have enough responsibilities and have too much fun so that they lose out on that feeling of personal satisfaction and fulfillment.

I believe getting the right life ratio starts with knowing why it is important and then re-prioritizing.  The “life Chex Mix ratio” doesn’t happen overnight, but gradually everyone can find that balance of work, responsibilities, fun, relationships and taking care of one’s self if they really want it.  My Chex mix was not perfect the first time, but I can certainly boast that today, after 30 years of making it, it is mighty fine with just the right amount of cereal, nuts and pretzels, “spicy kick”, butter and baking that is not soggy, nor without delicious buttery crunch!