November is American Diabetes Month, which is a time to take action together to raise awareness and draw attention to the importance of proper diabetes education. Learn more at www.diabetes.org.
“You don’t realize how bad your body feels until you change something. I feel so much better now and that was worth it.”
When we think about treating diabetes, the first thing that usually comes to mind is insulin injections or staring down a pillbox. But instead of looking into the medicine cabinet, is there a way we can take a glance in our fridge and manage type 2 diabetes? Yes! As the Greek physician, Hippocrates said, “Let food be thy medicine and let medicine be thy food.”
Type 2 diabetes occurs when the body doesn’t respond to insulin. Think of insulin as a key that unlocks the door to let sugar or glucose into your cells. When the key is not working, then the extra glucose floats around in our bloodstream and we get high blood sugar readings.
Why does this happen? Exactly why is unknown, but we do know our genes and lifestyles (including being overweight and/or inactive) influence it. We can’t really mess with our genes. We have to deal with the deck of cards we are dealt, BUT we can control lifestyle choices.
So, the million-dollar question: What is the diet I need to be following to positively affect type 2 diabetes? Is it high fat? Is it low carb? How does the nutrition community feel about keto nowadays?
The answer – and to be honest, you may not like it – isn’t simple and you need to look at what YOUR body says. Doing your research and gathering data is the best way to answer this question. Working on small lifestyle changes can make the body more sensitive to insulin.
Even though it’s the holiday season, there’s no reason to wait to get started. The following strategies can help you start making positive changes NOW:
- Watch your carbohydrate intake – there are lots of free apps that can help you track daily intake.
- Increase your fiber to at least 25 grams per day – think leafy greens, broccoli, cauliflower, and beans.
- Choose less-processed carbohydrates over highly processed carbs – an apple a day keeps the doctor a day, not an apple juice box a day!
- When possible replace saturated fats with polyunsaturated fats – think less fat from protein (meat) and more from plants (like avocados).
- Watch how a high-fat meal affects blood sugar – high-fat meals may delay the breakdown of food and blood sugar spike, and also increase insulin requirements.
- Lower your calorie intake, either through food or increasing movement – this helps the body use the glucose better and tends to lower blood sugars.
- Regularly check your blood sugar to make sure it is in range and to identify how your diet and exercise impact the numbers.
But what benefit do you get out of focusing on how to eat? Some numbers are lower on a glucose meter, so what? Our clients tell us every day why making good choices is important! One client was diagnosed with type 2 diabetes and started checking his blood sugar per doctor’s orders. He could not seem to get it below 200 mg/dL, which is a high reading. We focused on making small changes like eating smaller portions, eating out one day less in a week, and giving up bread. He recently told us that his blood sugar no longer goes above 140 mg/dL, a reading well within range! He also said, “You know, you don’t realize how bad your body feels until you change something. I feel so much better now and that was worth it.”
Another client really struggled with adjusting his NPH insulin. Because this is a fixed dose of rapid and background insulin, the client must eat the same amount of carbohydrates at around the same time per day. In the summer this was a hard routine to follow. A lot was going on, this client’s weight had gotten to his highest point, and he was taking around 38 units of insulin twice a day. Sometimes at night, he would go so low that he would have to use glucose tabs. With trial and error and working with his Registered Dietitian, he tested what foods worked for him. He decided on a lower-carbohydrate meal pattern. Each day, he planned for 2 proteins, 2 servings of fruit, 3 servings of veggies, and 2 servings of carbs. Through focusing on this lower-carb, balanced approach for three months, he is down 20 pounds and is only using 18 units of insulin a day!
Lifestyle choices allow us to be in charge of type 2 diabetes. Nutrition is a way to feel better, lower blood sugar levels, lose weight, and possibly reduce medication needs. If you’d like extra help with meal planning or have questions related to type 2 diabetes, feel free to reach out to contact us today to set up a consultation!
If you have not been diagnosed with type 2 diabetes, but have prediabetes or are at risk of prediabetes, check out our virtual Diabetes Prevention Programs. These online programs are sponsored by the Ohio Department of Health and free to participants. Classes start in January, so sign up today: https://www.gemcarewellness.com/programs/diabetes-prevention/
November is American Diabetes Month, and today, Nov. 14, 2020 is World Diabetes Day. This is a time to take action together to raise awareness and draw attention to the importance of proper diabetes education. Learn more at www.diabetes.org and www.worlddiabetesday.org.
Just when we were all getting familiar with our A1C levels, a fairly new buzz-worthy phrase has emerged in relation to diabetes control, and that’s “time-in-range.” What “range” do the experts mean? According to the American Diabetes Association, it’s your target range for blood glucose (BG) levels and is generally 70 to 180 mg/dl. This includes BG readings before meals and after meals.
If you’re not familiar with time-in-range (TIR) now, you will be soon. As the adoption of continuous glucose monitors (CGM) continues to increase, you’ll see more people talking about TIR. The only way to accurately measure TIR is by continuously monitoring your blood glucose with a CGM, which will show you the history of your BG, not just a snapshot in time like a fingerstick measures. This information helps you identify trends and manage your diabetes more confidently.
Now that we know the target range is 70 to 180 mg/dl, the next step is to determine at what percentage of the day should you be within this range. What is a reasonable percentage? Should it be 100% of the time? Should it be 90% of the time?
Ultimately the answer depends on where you’re starting. For example, if you are in the range 50% of the time, then aim 60% of the time. Also, know that your medication regimen may also make achieving a high percent more challenging, and you and your healthcare team may choose a lower TIR goal. Managing diabetes is always individualized, and identifying TIR goals is no different.
And that achieving that TIR goal isn’t your only objective. Let’s say that you have a 90% TIR, which sounds great, right? But if the other 10% of the time your blood sugar is less than 70, you run the risk of hypoglycemic episodes that could be dangerous and should be avoided. Your goal, then, would be to work on avoiding the lows, even if it means that your percent time in range is a little lower, especially at first. Ideally, you want your time below 70 to be no greater than 3%. If you are having BG less than 70 more often than 3% of the time, it is likely time to reduce a medication that can cause lows.
As people with diabetes will know, most doctors judge your degree of blood sugar control on your A1C, which is based on the average blood sugar level over a three-month period. If you are using a CGM, you may wonder which is more important, TIR or A1C?
A1C has a well-known relationship with the risk of complications. Risks for things like kidney issues, eye problems, vascular, and nerve problems increase as the A1C goes up. But the problem with A1C is that it is an average of your blood sugar! You might be averaging very high numbers with very low numbers. These swings in blood sugar are not healthy.
Consider the chart below from DiaTribe. It shows the limitations of only looking at A1C results. As you can see, each graphic shows a different time-in-range, but they all have the same A1C of 7.0% (an average BG of 154mg/dl). Because we want to limit highs and slows, the third graphic with a 100% TIR is optimal.
CGM users are finding that they are empowered when knowing their BG levels immediately. With the advent of the CGM, waiting three months to find out how you’re doing is no longer status quo. At GemCare Wellness, we work with many people who have diabetes and use CGM along with health coaching from us to help manage their condition:
Gloria P. has recently said that she is now aware of the “evil carbs.” The CGM helped her recognize that “all carbs are not created equal” and that certain carbs impacted her blood sugar more than others. Since then, she has tried to limit use of rice, apples, and corn because they act as “bad carbs” for her, even in small portions.
Jason M. found that he could lower his medication use now that he has the CGM. By being aware of the changes in his blood glucose levels, he changed his diet and added exercise when his blood sugar was on the rise. He’s now reduced his medications in half, has better control, and is even saving money with lower medication costs! He reports that “all is good! I am saving money on meds and improving my lifestyle.”
Both of these individuals have successfully improved their time-in-range and now are awaiting that three-month A1C check. Hopefully, that number will make them proud — we’re already proud of them for all the work they’ve done to improve their health.
If you’re interested in working with GemCare Wellness, please contact us today to set up a consultation! Whether you’re an individual looking to improve your health or an employer focused on a healthier population, GemCare Wellness has a program to fit your needs!