Diabetes Specialty Center

Senin, 14 September 2015

VMG is now on Social Media!

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Did you know VMG is now on social media?

You can now find (and "like"!) Valley Medical Group at:

Facebook - https://www.facebook.com/valleymedgroup

Twitter- https://twitter.com/valleymedgroup

Thanks,

From the VMG Diabetes Team

Senin, 24 Agustus 2015

Are you caring for a child with diabetes?

Here are some things to think about while getting ready for the first day of school:

1. Communicate clearly with teachers.

Joslin posted their advice last week, advising that you discuss symptoms of hyper- and hypo-glycemia, and when the child should go to the nurse's office. You may also want to clearly outline what the child needs to be allowed to do in the classroom, such as checking blood sugars or carrying snacks.

Depending on the child's age, you may need to emphasize that your child may not be able to tell the teacher when he or she is having a low.

2. Do your homework.

Work with your child's doctor to update your Diabetes Medical Management Plan (DMMP). You can use the DMMP to draft an Individualized Education Plan (IEP) with the school, clearly outlining the school's responsibilities and who should be trained - this includes the teacher, the school nurse, and depending on the age of the child, possibly other staff such as the bus driver.

http://www.cdc.gov/features/diabetesinschool/

3. Be prepared.

The CDC offers this list of suggestions for packing a diabetes kit for your child's backpack:

Blood glucose (sugar) meter, testing strips, lancets, and extra batteries for the meter.
Ketone testing supplies.
Insulin and syringes/pens.
Antiseptic wipes.
Water.
For children who wear an insulin pump, backup insulin and syringes/pens in case of pump failure,
All children on insulin need glucose tablets or other fast-acting glucose snacks (a carbohydrate that will raise blood sugar levels relatively quickly when eaten). Here are examples of fast-acting snacks that provide about 10 to 15 grams of carbohydrate:

3-5 pieces of hard candy.
4-6 ounces of regular (non-diet) soda.
4-6 ounces of orange juice.
2 tablespoons of raisins.
8 ounces of nonfat or low-fat milk.

http://www.cdc.gov/features/diabetesinschool/

4. Stay healthy and active as a family

The back-to-school season can be a stressful time, but it's important to keep up with all your family's healthy habits, including:

Packing or encouraging healthy balanced breakfasts, lunches, and snacks
60 minutes of physical activity per day - especially if you can do activities together, such as walking or bike riding together after school
Limiting screen time
Staying up to date on doctor appointments and vaccinations

Is there anything else you have learned from experience about getting ready for this fall? Please let us know in the comments section below!

For more information, check out:
http://www.cdc.gov/features/diabetesinschool/
http://blog.joslin.org/2013/08/back-to-school-tips-for-diabetes-management-teacher-edition/

Senin, 27 Juli 2015

Two News Items

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Good Morning!
Two news items were brought to my attention by VMG Diabetes team members recently that I thought I should share with you. It's kind of a good news/bad news situation.

Let's do the bad news first: the FDA has issued a drug warning for the diabetes medications Invokana (canagliflozin), Farxiga (dapagliflozin), and Jardiance (empagliflozin). These are a group of medications called SGLT2 inhibitors.

The warning is being issued because 20 patients being treated with these medications were hospitalized with Diabetic Ketoacidosis (DKA). You might have heard of DKA happening to people with type I diabetes, and being associated with very high blood sugars. These cases were unusual because these were people with Type 2 diabetes, with relatively normal blood sugars.

If you are taking one of these medications, you are not advised to stop taking it without speaking to your provider, but do be on the lookout for the symptoms of DKA, which the FDA lists as: difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. You can read the full FDA warning here.

photo from Weill Cornell Medical College's article

Today's good news? Changing the order in which you eat your meal may help improve blood sugar control! A recent study out of Weill Cornell Medical College found that eating protein and vegetables before carbohydrates resulted in lower post-meal blood sugars and insulin levels in people with type 2 diabetes on oral medications.

They emphasize that more research is needed to confirm the finding and to explain why exactly this works, but I don't think it can hurt to try it out for yourself!

Any other big diabetes news you've noticed in the past couple weeks? Let us know in the comments section below!

Senin, 13 Juli 2015

Looking for Weight Loss Inspiration?

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For those of you who may be trying to lose weight, I want to share some of my favorite online resources for inspiration, information, and support.

If you are a smartphone user, you probably already know there are many apps available to help you on your weight loss journey - maybe too many. These are the ones that I have seen the most people succeed with:

Fooducate or Shopwell: Scan barcodes while shopping � these apps will help you make healthy choices.
Myfitnesspal or LoseIt: Track your intake to meet daily calorie or nutrient goals
HealthyOut Healthy Meal Finder: Search for the healthiest restaurant or takeout food options

If you are looking for trustworthy information, recipes, or community, these are some websites that you might want to try:

CalorieKing.com: Find the facts on almost any food!
Sparkpeople.com: A combination of an online food diary, informative articles, and a supportive online community.
Mayo Clinic Recipes: Large database of healthy recipes from a trustworthy source
Oldways: Not strictly for weight loss, this collection of Mediterranean Diet recipes may help you include more heart-healthy choices in your weight loss meal plan

My favorite weight loss resources of all, however, have always been first-person accounts of real life experiences. I think these blogs are inspiring, funny, and very helpful. If you have all the information you need, but could use a boost from a real person's story, check out these blogs:

Authentically Emmie: Cheerful and positive, documents the author�s journey down from 455 pounds.
Prior Fat Girl: Honest advice from a writer who has maintained her weight loss
Does this Blog Make Us Look Fat: Very funny take on weight loss, with some very good advice
Can You Stay for Dinner?:Heartfelt personal story of weight loss and the author�s struggle with emotional eating and body image. Also includes many wonderful recipes!
Cranky Fitness: This blogger doesn�t like to exercise either, but does it anyway.
Roni�s Weigh: Inspirational story of weight loss, with lots of helpful tips.

Do you have any favorite online resources to share? Let us know in the comments section below!

Senin, 29 Juni 2015

Update on Artificial Sweeteners - Plus Summer Beverage Ideas!

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Lately, the question I hear most often is "what is the best artificial sweetener? And is it true that regular sugar is actually healthier for me?

If you have diabetes, you know that one of the first thing your healthcare providers will suggest is to reduce or eliminate sweetened beverages from your diet. Artificial sweeteners such as aspartame, saccharin, or sucralose have been commonly recommended as safe sugar alternatives for people trying to lose weight or manage diabetes.

The problem is, the research has been mixed. Some studies show they help with weight loss. Other research suggests they cause weight gain, "metabolic derangement", and/or insulin resistance by "tricking" the brain. (Studies here, here, and here.)

Now, a new study may have uncovered the mechanism. This article from NPR explains the findings of the new study:

"What we find is that a subgroup [four of the seven people] developed significant disturbances in their blood glucose even after short-term exposure to artificial sweeteners," Elinav says.

"For example, results of a glucose tolerance test found that some individuals' blood sugar temporarily shot up to levels that are characterized as pre-diabetic within just a few days of introducing the artificial sweetener.

And how it's happening may be even more surprising. Their experiments showed that artificial sweeteners can alter the mix of bacteria in the guts of mice and people in a way that can lead some to become glucose intolerant.�

Amazing! And alarming. But drinking sugar- or corn-syrup-sweetened beverages was not helping us, either. So what to do? Here are some ideas:

1. Flavor your water with:

Lemon, lime, or orange slices
Cucumber
Fresh mint
Frozen berries
1 oz fruit juice

2. Try seltzer - but avoid club soda, which has added sodium. Plain seltzer could be flavored with the ideas above, or there are many sodium-free unsweetened flavored options to choose from!

3. Make your own iced tea with black, green or herbal teas. Stevia is a safe sweetener to add if desired, or you could add some fruit or mint to these, too!

4. Iced coffee - order plain/black and add your own stevia and skim milk. Try adding natural flavors such as vanilla extract or cinnamon.

5. Try low sodium V8 or no-salt added vegetable juices. You can add tabasco/hot sauce, curry powder, or lemon/lime juice for extra flavor

Do you have any other fun beverage ideas? Let us know in the comments section below!

Enjoy, and happy summer!

Jumat, 12 Juni 2015

Safe Fasting with Diabetes

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Whether it is for religious purposes or fad diets, people with diabetes often have questions about fasting. With Ramadan starting next week, let's review some strategies for safely fasting with diabetes.

A recent article in Diabetes Forecast outlines the challenges of fasting with diabetes, and offers recommendations and some examples: click here for the full article.

The article notes that fasting doesn't just put you at risk of low blood sugars. Blood sugars can also rise too high during a fast, because the liver can release glucose into the bloodstream.

Most medical professionals do not recommend fasting as part of any weight loss plan or diet. It can put you in unnecessary danger, and may not lead to any lasting weight loss.

Many religious observances such as Ramadan involve fasting from sunrise to sundown, breaking the fast only in the evening. However, most religious leaders seem to agree that safety comes first, and allow for exceptions for anyone with medical reasons for being unable to fast.

If you decide to fast:
- consult with your provider about which medications to take or to stop during your fast
- check your blood sugars more frequently
- keep a source of fast-acting carbohydrates handy, such as juice or glucose tablets, in case of a low
- if your blood sugar drops too low, break the fast

In the article, a teenager with type 1 diabetes offers the advice to follow the spirit of the fast by limiting intake to bland, sick-day type foods such as toast. By avoiding rich or sweet foods, she feels that she is able to participate in the meaning of the experience, without putting herself in danger. I think that sounds like a wonderful compromise.

I'd encourage you to check out the article at http://www.diabetesforecast.org/2014/10-oct/safe-fasting-with-diabetes.html.

If you have any advice or experiences to share, please do so in the comments section below!

Senin, 11 Mei 2015

Carb Counting the Cookout

Nutrition

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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, 27 April 2015

VMG's Diabetes Services

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Happy spring (finally!)!

Are you taking advantage of these VMG services to help you manage your diabetes? Confused about what these mean? We offer:

Endocrinology:

To help you manage your diabetes, analyze your blood sugar levels and develop a regimen of lifestyle changes and medicines which are right for you.

Diabetes Education in an Individual or GroupSetting:

To help you understand your diabetes and your treatment plan, including help with blood sugar monitoring, medications, insulin, and more. Focused on practical and personalized goal setting.

Nutrition Therapy:

One-on-one education, support, and goal setting. Incorporating all your medical and lifestyle needs into a practical and personalized plan.

Support Groups:

We offer free support groups for both diabetes and weight loss, led by our diabetes educators and nutritionists! These are a great opportunity to connect with others in a fun, informal setting. These vary by center - check HERE for current dates/times.

We also recommend taking advantage of these VMG services:

Eye Care

Comprehensive eye examinations

Foot Care

Diabetes foot care from a podiatrist

Behavioral Health

Psychiatrists, psychologists, social workers and therapists to help you navigate the social and emotional stressors of managing diabetes

Physical Therapy

Physical therapists to help you prepare for increasing your physical activity and establishing a program of exercise for you to complete independently

Questions or feedback - our contact information is listed in the "meet our educators" tab - please let us know how we can help you!

Senin, 06 April 2015

National Nutrition Month: Wrap-Up

National Nutrition Month

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Thanks to all who participated in our National Nutrition Month activities! We had four prize winners in all four centers, and 4 UMass students who volunteered their time to staff our tables and offer healthy creative food samples and recipes. It was a great month!

Before we get too far away from March I wanted to share some info about one more awesome phytochemical with you - LUTEIN!

Lutein is a type of phytochemical called a carotenoid. It concentrates in the macula of the eye, and research shows it can actually prevent or slow macular degeneration! Macular degeneration is a leading cause of blindness in the elderly.

Lutein's antioxidant power can also help reduce the risk of heart disease and certain types of cancer.

Fill up on these (mostly green leafy) vegetables to get your lutein and protect your eyes:

collard greens
kale
spinach
broccoli
Brussels sprouts
lettuces
artichokes

For more information, recipes, and more visit: http://www.fruitsandveggiesmorematters.org/

Senin, 16 Maret 2015

Recipe: Cauliflower Rice!

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This week's recipe comes from Margie Sobil - she made this last week with her Diabetes Support Group and they enjoyed it both ways!

Cauliflower Rice

This makes a wonderful side dish on its own, or could be used any way you'd use rice. For example, I have served stew, chili, or saucy curry over a spoonful of this "rice", and I have used it in stuffed peppers or cabbage rolls as part of the filling instead of rice.

This helps to make your meal lower in total carbohydrates, even if you have a big heaping spoonful (or two). It adds a lot of fiber and volume, without a lot of calories.

Ingredients:
1 head raw cauliflower
1 yellow onion
olive oil
salt, pepper, garlic, herbs or spices to taste

Chop the cauliflower in a food processor until it is approximately the size and texture of rice:

Dice the onion. Saute onion in a pan with olive oil for a few minutes, then add the cauliflower "rice" to the pan. Saute until slightly softened. Flavor to taste.

In the support group we tried making it two ways. One recipe used salt, pepper and garlic powder. The other used about a tsp of curry powder. You could invent many more ways to use this versatile dish - share in the comments section if you come up with any more yummy variations!!