Diabetes Specialty Center

Senin, 01 Desember 2014

Recipe of the Week - Pumpkin Cranberry Applesauce!

07.15 0

I hope you all had a nice Thanksgiving weekend!

I love the seasonal flavors of fall - apples, spices, pumpkin... but I am already getting sick of rich holiday food.

I made up this recipe this weekend just to use up some apples, but I think it has already become a new favorite dessert in my house! And it uses no sweetener at all - just the natural sugar in the apples.

PUMPKIN CRANBERRY APPLESAUCE

Ingredients:

8-10 apples (macintosh or cortland type work best)
1 bag of fresh or frozen cranberries
1 sugar pumpkin
Spices: cinnamon, nutmeg, cloves, pumpkin pie spice, ginger...

First, I microwaved the pumpkin to soften it and make it easier to chop up. In my microwave, this took about 5 minutes on high. Slice the pumpkin in half and scoop out the seeds. Slice off the outer rind and dice the pumpkin flesh up into big chunks.

Core and slice the apples and add them and the diced pumpkin all to one large stock pot. Add cranberries. Cook on medium heat until juices are released and the whole mixture starts to bubble, then cover and let simmer on low until everything starts to soften and blend together when you stir it.

Options: This recipe is super flexible. Instead of a pumpkin, you could use a butternut squash, some leftover sweet potato puree from thanksgiving dinner, or a can of prepared pumpkin. Be creative and use what you have!

This recipe is nice and tart the way I like it - but if you have more of a sweet tooth, I think adding some stevia would sweeten this up nicely. When I made it for company, I put a tablespoon of butter in the bottom of the pan before I added the apples.

Feel free to experiment - and enjoy!

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

Guest Post

07.01 0

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

03.00 0

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, 27 Oktober 2014

Guest Post - "I Know Better"

Guest Post

06.12 0

Today we are lucky enough to have another guest post from Seth, a VMG patient. Seth has type I diabetes and has completed our diabetes education program. Thanks Seth!

I hate vacations, not that this has ever stopped me from taking one. Maybe I should say that it's my diabetes that hates them. Truly, I'm not sure I can tell the difference between me and my diabetes. It�s the excess that usually does me in. Excessive lack of exercise and excessive eating push the bg bar line on my cgm up to Himalayan levels. I feel rotten about my poor self-control.

For the past week I�ve been on a staycation. This time was going to be different. In the end It was, too. Just not exactly what I wanted it to be. I told myself I was going to be very, very, good. O.k., I knew I�d be pretty good and, really, I have been. I�ve exercised and eaten right almost everyday. I relaxed. I watched the final two seasons of Borgen. I read magazines that had been piling up on my sofa. I finished a book I�m preparing for the book club I lead. I even lost a few pounds. Heaven.

I still hate vacations. Most days started well. I managed to wake up with a bg around 100 and feel 100% proud of myself. I had the kind of super healthy breakfast certain internet sites say will prevent colds: a single portion of steel-cut oatmeal with half a banana and walnuts, soymilk and an egg on the side. When I�m working, I count that at 25 carbs�yes, I know that it�s actually more than that, but that�s what I bolus for if I don�t want to sink into the 70s two hours later�and, yes, I know there's a better of way to do that.

So there you have it. I�d wake up with a great, no, not just great, a perfect blood sugar. I�d eat a beautiful, healthy breakfast. I�d drink too much coffee, but I�m pretty sure that�s a good thing. Over the next 2 hours my blood sugar would rise a bit, just as it should. I'd get on the exercycle and peddle through half-an-hour of a Borgen episode. Post-exercise my bg is back to it�s near-hundred level. I�m in the groove. I�m throwing a no-hitter. I�m going to Harvard on these test scores.

Then it all goes wrong. For the rest of the morning my bg would rise until by lunch I�m around 140. This happened all week. I know 140mg isn�t that bad. But a lunch time bolus for 65 carbs�way more than I�m really eating�didn�t change anything. I'm eating the kind of super healthy super foods that certain internet sites say cure colds, and in good portions, too. Still, my blood sugar was the same or worse at dinner, and even then, bolusing for way more carbs than I ate worked just as well as it did at lunch. I�d finish the day with a correction bolus.

Which is why I really hate vacations. As much as I need them, my diabetes needs special coaxing to behave itself when I change my schedule. I�m guessing that it missed the small, steady amounts of activity I get at work. I tried upping my basal. But that didn�t help, either. Probably I should have upped it more than I did, but for once I thought I�d better be cautious. I decided I didn�t want to bump it again because I�d be back at work in a few days, anyway. I have a suspicion that makes no sense, and I should have known better. At least I'll go to work tomorrow. Hope no one has left any cookies in the staff lounge.

P.S. Borgen is a great TV show.

Senin, 06 Oktober 2014

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

Guest Post

11.58 0

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.

Jumat, 08 Agustus 2014

Good and Cheap

Recipe

12.17 0

Hi guys! Today I wanted to share a great FREE resource with you. According to NPR, Leanne Brown wrote this cookbook to help inspire folks on SNAP benefits/food stamps to eat healthier. For any of you who think it's too expensive to eat healthy, this is the help you needed (and finally, evidence that it CAN be done!)

Download for free here: Good and Cheap

Now remember - not all of these recipes are guaranteed low fat or low carbohydrate - but I do think they will give you some new ideas for using a lot of different types of vegetables in creative ways, and getting through the week more efficiently! Don't forget about portion size - everything in moderation.

Have a good weekend!

Rabu, 23 Juli 2014

Should I Eat Butter?

Nutrition

07.00 0

If you watch or read the news, you may have seen a headline lately stating "Eat Butter", or this Time Magazine article - "Ending the War on Fat". I think the information circulating is confusing - let's clear up a few points.

1. The association between saturated fat and heart disease may have been overstated or overemphasized - but this does not mean there is no correlation. The two are still linked. It just seems that there are some other factors - such as what ends up replacing them in our diets, and how full we feel without them. For a more balanced analysis, check out this PubMed overview of the evidence.

2. Fat does seem to keep people more satisfied. People on low fat diets seem to feel less full and have a harder time sticking to their diets than people on the Mediterranean Diet, which emphasizes reintroducing unsaturated fats such as olive oil and nuts. These type of fats seem to be definitely beneficial for heart health. Calories still count - and fat is still a dense source of calories - but including some of these foods in moderation will definitely help you feel more satisfied.

3. Cutting out saturated fat, and replacing it with refined carbs, does not help. It seems like the biggest mistake we made in the American Diet was not reducing saturated fats, but replacing it with the wrong foods. Avoiding fat by eating unlimited amounts of bagels, sweetened yogurts, and fat free cookies was a popular strategy - and has been blamed for the simultaneous rise in rates of obesity and diabetes nationwide. Now, a new study indicates that the amount of added sugar in our diets puts us at increased risk of heart disease, regardless of how healthy a person eats otherwise!

But are we really surprised? I think we all knew that low fat cookies were not helping us. The truth about nutrition is always simpler than we want it to be.

What is the solution? A whole foods, plant based diet like the Mediterranean Diet. In other words - vegetables, fruits, whole grains, "good" fats, lean protein. Simple but delicious. For some recipe inspiration, check out oldwayspt.org.

Rabu, 02 Juli 2014

Recipe of the Week - Cucumber and Black Bean Salad!

Recipe

06.38 0

I don't know about you, but in this hot weather I haven't felt like turning the oven on lately (or the stove or crockpot for that matter...) and I've been looking for some no-cook options for easy suppers. I made up this recipe and it fit the bill perfectly. I made a big batch of it, and had it for both dinner and lunch the next day alongside some quick grilled chicken.

CUCUMBER AND BLACK BEAN SALAD

Recipe makes about 6 servings of 1 cup each.

INGREDIENTS

2 tablespoons extra-virgin olive oil
2 tablespoons lemon juice
1 long english cucumber or 2 smaller cucumbers - diced
1 14-ounce can low sodium black beans, rinsed
2 tomatoes, diced
1/2 cup crumbled lowfat feta cheese
1/2 of a red onion, diced up pretty small
1 medium avocado, diced
Mrs. Dash or herbs & spices of your choice

PREPARATION

Combine cucumber, beans, tomatoes, feta, onion and avocado in a large bowl. Dress with olive oil, lemon juice, and herbs and toss to coat. Serve at room temperature or chilled. Tastes just as good the next day!

NUTRITION

Per serving: 190 kcal; 19g carb; 11g fat (mostly the good kind!); 8g protein; 160mg sodium

Carbohydrate Servings: 1

Do you have a favorite hot weather recipe? Let us know in the comments section - we'd love to hear from you!!

Selasa, 01 Juli 2014

What Does Self-Management Mean?

Diabetes

08.13 0

We use the term "diabetes self-management" a lot. One patient recently asked me, "does that mean I have to do everything myself?"

At Valley Medical, we offer Diabetes Education, Nutrition, and Endocrinology because we want to make sure you have everybody on your team that you need to better manage your diabetes. That includes:

� Endocrinology
� Eye Care
� Foot Care
� Behavioral Health Services
� Physical Therapy

And, of course, Diabetes Self-Management Education. That means classes or one-on-one appointments with diabetes educators and/or nutritionists to help you learn more about diabetes, trouble shoot your lifestyle choices, answer your questions, and help you to set goals.

So what does Diabetes Self-Management look like? It might include:
- monitoring your blood sugars at home
- keeping a food diary
- counting carbohydrates or measuring out your portion sizes
- incorporating physical activity into your routine
- seeing your doctor regularly
- managing stress

But you don't have to do any of it by yourself - we are here to teach you how, help you through, and continuously adapt your plan to your personal wants and needs.

Our goal is to see you empowered with the tools you need to manage your diabetes effectively - but when you need us, the resources are here. That's what self-management education means to us.