Diabetes Specialty Center: Blood Sugars

Senin, 11 Mei 2015

Carb Counting the Cookout

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Summer cookout season is starting, so I thought I would offer a few tips to help you count your carbs and keep your blood sugars on track all summer long, without missing any of the fun.

1. Remember Key Carb Exchanges

A few key 15 gram carb servings can be used to estimate the carb content of a wide variety of dishes. For example, knowing that 1/2 cup of potato is around 15g of carb might help you to estimate the carb content of a similar size portion of potato salad or fries. Here are a few more that I use all the time to help me "guesstimate":

15 grams of carbs is:

- 1/2 of a hamburger or hot dog bun

- 1/3 cup of pasta or rice

- 1/2 of a large corn-on-the-cob

- 1/2 cup of beans (but only 1/3 cup of baked beans with the sugary sauce!)

- 9-13 potato or tortilla chips

- 1 1/4 cups of watermelon cubes

- 1/2 cup of ice cream

2. Use Your Hands

When you can't use a measuring cup to check your portion size, try comparing what's on your plate to these visuals:

your palm = 1/2 cup

your fist = 1 cup

your thumb = 1 tablespoon

your thumb tip = 1 teaspoon

3. Don't Forget to Count the Condiments...

1 tablespoon ketchup = 5g carb

1 tablespoon of barbeque sauce = 7g carb

4. ... And the Beverages

8 oz lemonade = 25g carb

1 can (12oz) soda/soft drink = 35g carb

5. Avoid The "Fillers"

Social gatherings and special seasonal foods are important to all of us, and you don't want to miss Aunt So-and-So's amazing famous dish. But at most of these events, there are many other foods you have all the time or that are just not that exciting. It's different for everyone - some people skip the boring white hamburger buns so they can have macaroni salad; others wait all year for that one taste of white bread. But be mindful and have a strategy - choose what you really love, savor it, and skip the rest.

6. Contribute Something Healthy

I like to volunteer to bring something healthy and lower in carbs, so I know there will be something I can have a larger portion of that will be filling. Chances are, others will appreciate this too. Try bringing something like a green salad or a chopped salad with beans that will be filling, colorful, and healthy.

Don't forget to have fun and enjoy the season!

Senin, 01 Desember 2014

Thoughts from a Doc: Why do my sugars DO that?!? (Part 3)

Guest Post

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Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director

This is Part 3 of 3 of this series from Dr. Chipkin. So far we have heard his thoughts on exercise, food, insulin, and counter-insulin hormones. This week - his thoughts on a few remaining factors that can influence your numbers.

Insulin-sensitizing hormones: these are sometimes called �incretins� because they increase the action of insulin. There are now medications based on these incretin hormones which help to lower blood glucose levels and also have modest benefits on weight loss. Examples are exenatide [Byetta] and liraglutide [Victoza]. Other medications inhibit the enzymes that break down the body�s own incretin hormones- these medications generally don�t help with weight loss- they include sitagliptin [Januvia], saxagliptin [Onglyza] and linagliptin [Tradjenta]

Factors x, y, and z: These are the wild cards that sometimes make it really hard to either predict or understand why glucose values do what they do. Most of these won�t change blood glucose values by large amounts but can contribute to not having them be exactly on target. Examples can include: hormonal changes during phases of the menstrual cycle, the efficiency or inefficiency of how food is absorbed from the intestines, emotional stresses, antibodies that some people make against insulin, etc.

With all these different factors, and the ways that each of these factors can change blood sugar values, it�s pretty impressive we every get things close to being on target!! This is where each individual has to learn their own personal diabetes and some of the �quirks� of how their body responds.

Kamis, 30 Oktober 2014

Thoughts from a Doc: Why do my sugars DO that?!? (Part 2)

Guest Post

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Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director.

This is Part 2 of 3 of this series from Dr. Chipkin. Last week we heard his thoughts on how exercise and food impact blood sugars - this week we get his perspective on some medications that can influence your numbers.

Thoughts from a Doc:
Why do my sugars DO that?!? (Part 2)

Insulin: (as my daughter would say- d�uh!). Oral pills like glipizide [Glucatrol], glimepiride [Amaryl] or glyburide [Micronase] cause your pancreas to release insulin which can certainly lower glucose values over the course of many hours. Other medications (repaglinide [Prandin] or nateglinide [Starlix]) act more rapidly and only cause insulin to be released for a few hours. But the effectiveness of these pills is based on two things: (1) the ability of your pancreas to make and release insulin; and (2) the ability of your body to use the amount of insulin made by the pancreas. If your pancreas �worn out�, then these medications won�t be very effective (the analogy is that you can�t squeeze anything out of a dry sponge). Even if these pills help the pancreas to release insulin, if your body is very resistant to insulin, then it won�t be enough. Resistance to insulin can occur for many reasons including excess weight, infections, and steroid medications such as prednisone, hydrocortisone or dexamethasone.

Counter-insulin hormones: These can be thought of as �anti-insulin� hormones - fighting against the action of insulin. The most common of these are steroid medications like prednisone, hydrocortisone or dexamethasone. These medicines are sometimes used as pills for weeks at a time and can raise blood sugars a lot. Sometimes, they are injected into joints or other locations and can raise glucose values for a few days. Other counter-insulin hormones are stress hormones that are released when people are sick with other illnesses.

Next week's post will discuss a few other factors, including the "element of mystery" that anyone with diabetes knows all too well. Not as simple as it seems, sometimes!!

Senin, 06 Oktober 2014

Thoughts from a Doc: Why do my sugars DO that?!?

Guest Post

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Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director.

This is only Part 1 - stay tuned in coming weeks for more.

Thoughts from a Doc:
Why do my sugars DO that?!? (Part 1)

I get asked this question several times a week. I usually take this as a chance to remind people how complicated blood sugar control is.

There are at least six factors that influence blood sugar (glucose) levels. Let's start with two:

Food: obvious, and yet not so easy. �Simple� sugars cause rapid increases in blood sugar. More complex sugars (those from milk, grains, starches) cause glucose levels to rise more slowly and over a longer period of time. We try and take advantage of that when we talk about eating more �complex� carbohydrates- either to let your body �catch up� to the carbohydrates that have been eaten or to be available over a longer period of time (after exercise or after a low blood sugar). And it turns out that the way sugar is absorbed can be affected by other foods such as fiber or fat. So sometimes foods make sugar levels go up fast and sometimes they go up more slowly.

Exercise: also obvious but also not so easy. Activity that uses a lot of muscles cause those muscle cells to absorb glucose (sugar) from the blood. But your liver usually makes extra glucose for your muscle cells. Very vigorous exercise (e.g., running longer distances) can cause your body to release adrenalin (also called epinephrine) which makes your blood glucose levels rise further. But those muscle cells that absorbed the sugar during exercise continue to absorb it after exercise. In addition to �soaking up� more sugar following exercise, muscle cells also become more sensitive to insulin. In some cases, the increase in sensitivity can last over 12 hours! So sometimes exercise can raise your blood sugars initially but sometimes exercise can make your glucose levels decrease after exercise and then, sometimes, your body may seem to overreact to insulin for many hours afterwards (not typically more than 18 hours).

Next week's post will discuss other factors, including hormones, medications, not to mention the "element of mystery" that anyone with diabetes knows all too well. With all these different factors, and the ways that each of these factors can change blood sugar values, it�s pretty impressive we ever get things close to being on target!! This is why each individual has to learn about their own personal diabetes and some of the �quirks� of how their body responds.