Diabetes Self Management by juliamichelle80

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Harvest FA L L FO R T H E AU T U M N

FINDING PAIN RELIEF

STRATEGIES FOR HEALTHY EATING

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DiabetesSelfManagement.com

SOMETHING TO SMILE ABOUT

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Groundbreaking Research Shows

How to Regain Healthy Blood Sugar and Lose Weight One answer to healthy blood sugar levels is found in high-protein low-glycemic nutrition.

The problem is that, even when we do try to eat right and exercise, our bodies still need extra help from our metabolism to light the fires of our glucose-burning furnace that’s necessary for weight loss. Knowing this, in 1985 German holistic therapist Hubertus Trouillé developed a low-glycemic high-protein formula to be used as nutritional therapy by his patients living with diabetes and slow metabolism. After following his dietary advice, Trouillé discovered that the formula not only helped his patients increase metabolism but also regain glycemic control and lose weight. Today, his unique formula, called Almased, has been scientifically studied for over 30 years.

Low-Glycemic High-Protein Nutrition and Glucose Health In a 2017 study by Kerstin Kempf and a group of German researchers, a 12-week telemedical lifestyle intervention (TeLiPro) was carried out in patients with advanced type 2 diabetes.1 It included weekly phone calls by trained diabetes educators who talked about diet, exercise, and options for overall lifestyle changes. For the first 12 weeks, the TeLiPro group also received a low-glycemic high-protein dietary supplement — in place of three meals a day for the first week, two meals a day for weeks 2 to 4, then one meal a day for weeks 5 to 12.

Study results show the Almased participants experienced: Weight loss Healthy HbA1c Reduced hunger Increased quality of life

Healthy blood sugar Enhanced glucose handling and metabolism

Weight Reduction Mean Weight Loss (kg)

People who live with diabetes want better options for getting a handle on their blood sugar, especially their HbA1c levels.

Control Group

TeLiPro Group

Time (Weeks)

1. Kempf K, et al. Eﬃcacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: A randomized controlled trial. Diabetes Care. 2017 Jul;40(7):863–871. 2. Lean M, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2017;391(10120):541–551.

Nature has a solution and a cure for all of our problems. Taking guidance from mother nature, a manual has been created that helps cure Type-2 diabetes in a completely natural way, and its name is Diabetes Freedom. All one has to do is follow everything step by step from the Diabetes Freedom manual. Diabetes Freedom is available in e-form and can be downloaded on any of your devices. There will be no need to follow any exercise or diet plans; just through changes in diet patterns, one can avail of benefits. Click to Order Diabetes Freedom Program For an Exclusive Discounted Price

The results? The HbA1c levels in the TeLiPro group were, on average, reduced by 1.1, from 8.4% to 7.3%.

What makes Almased so diﬀerent?

In this group, there were also significant reductions in fasting blood glucose, body weight, body mass index, blood pressure, cardiovascular risk factors, and requirements for diabetes medications — a 20% lower need for medications and a nearly 50% reduction in insulin needs.

Made from high-quality soy, probiotic yogurt and enzymerich honey, Almased is diabetic-friendly — 27 on the Glycemic Index score.

These improvements were even seen after 52 weeks of follow-up. There are other lifestyle intervention studies, with other diets, that have had some success, such as the 2017 DiRECT study in the U.K., which suggested that a very-low-calorie total diet replacement for up to 5 months, along with coaching by health practitioners, could achieve weight loss and reductions in HbA1c levels.2 But the U.K. study was hard to follow (25% dropped out), had some unwanted side effects, and had a 2:1 ratio of carbs to protein.

The Power of Almased

Supported by over 30 years of scientiﬁc research. Unique fermentation process. All essential amino acids.

Almased can help: ○ Lower HbA1c and blood-sugar levels.* ○ Burn fat while retaining muscle.* ○ Aid the gut microbiome in supporting digestive and immune health.* ○ Curb cravings and support a healthy balance of the hunger hormones, leptin and ghrelin.* ○ Boost energy and support mood.*

Bioactive peptides. Honey-derived digestive enzymes. Vegetarian and gluten-free. No artificial fillers, flavors, sugars, preservatives or stimulants. To learn more and to download your free diet plan go to almased.com/DM03E or call us toll-free at 1-877-256-2733 or e-mail us at info@almased.com.

The German researchers chose a formula that was high in protein (Almased) but low in carbohydrates (nearly 2:1 protein to carbs), knowing that more protein in the diet naturally reduces insulin demand and increases fat burning. The takeaway from this research, and other published studies, is that while supporting glycemic control can be hard, it can be easier when our metabolism is working with us.

The high-protein, scientiﬁcally proven, Almased Diet can help you reduce your HbA1c and blood sugar levels while supporting glycemic control.

Find Almased at these ﬁne retailers! * Results are not typical. Individual results may vary based on starting weight and program adherence. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

If you have type 2 diabetes

Get tested for diabetic kidney disease

Up to 40% of people with type 2 diabetes (T2D) develop diabetic kidney disease (DKD) DKD can lead to kidney failure and dialysis and increases your risk for heart attack. DKD often has no symptoms until it’s too late, but when it’s caught early, there is more you can do to protect your kidneys. Ask your doctor for a UACR (urine albumin-to-creatinine ratio) urine test once a year. It checks for protein in the urine, one of the earliest signs of DKD or kidney damage. For more information, visit KidneyAlert.com or scan code © 2021 Bayer Pharmaceuticals, Inc. All rights reserved. BAYER and the Bayer Cross are registered trademarks of Bayer. Last Updated 06/2021 PP-UN-CAR-US-0310–1

••• EDITOR’S NOTE •••

Editorial Director, Wellness Division Diane Fennell

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utumn is upon us, and with it have arrived all the changes this time of year brings: The weather is cooling down, leaves are turning vibrant colors, and shorts and tees have been exchanged for jackets and sweaters. Eager to usher in the season with some positive changes of your own? Read on. Blood glucose control is the cornerstone of diabetes management, and strategies such as regular monitoring, following a healthful meal plan, and getting regular physical activity are familiar steps that can help keep it in check. But there are a variety of other, less-well-known measures that can help, many of which you can start implementing today. Curious? Find out more in “Lifestyle Hacks for Better Blood Glucose Management” (page 24). If pain plagues your days, you may feel run-down and hopeless. But what you may not know is that pain and diabetes can be linked in a variety of ways, and there are approaches that can help bring relief. Learn about the connection between the two conditions and get helpful tips for managing pain at home in “Pain and Diabetes” (page 32). Remember, there is hope! Eating: It’s something we all do, but the trick is in knowing what and how much—often easier said than done. Indeed, whether you’re newly diagnosed or you’ve had diabetes for many years, this area of selfmanagement can be challenging. Fortunately, there are some easy approaches that can get you on the right dietary path. Get started with the expert tips in “Strategies for Healthy Eating” (page 40). No matter what area of your management routine you choose to focus on in the coming months, you should be proud of all the hard work you’re putting in to stay healthy. Be well, and have a fantastic fall! All the best,

Diane Fennell Editorial Director, Wellness Division

4 DiabetesSelfManagement.com • Fall 2021

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In memory of Susan Fitzgerald, COO, 1966-2018 Newsstand Distribution Weekly Retail Service Diabetes Self-Management, Fall 2021, Volume 38, Number 3. Diabetes Self-Management (ISSN 0741-6253) (USPS 003-865) is published quarterly by Madavor Media, LLC, 35 Braintree Hill Office Park, Suite 101 Braintree, MA 02184. Periodicals postage paid at Boston, MA and at additional mailing offices. Copyright © 2021 Madavor Media, LLC. U.S. subscriptions $29.94 per year. Postmaster: Please send changes of address to Diabetes Self-Management, PO Box 460700, Escondido CA 92046. DiabetesSelf-Management@pcspublink.com. For customer service or subscription information, please call (855) 367-4813. Outside US: 760-496-7575. Advertising Sales: Madavor Media, LLC (800) 437-5828. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any other means, without the prior written permission of Madavor Media, LLC. Statements and opinions expressed in this publication are those of the authors and not necessarily those of the publishers or advertisers. The purpose of this magazine is to provide readers with accurate and up-to-date medical information. It is not intended to provide medical advice on personal health matters, which should be obtained directly from a physician. We regret that we are unable to respond to inquiries about personal health matters. We sometimes make our list of subscribers available to carefully screened organizations whose products and activities may interest you. While many subscribers find this type of information valuable, some prefer not to receive unsolicited mail. Please contact our customer service department at (855) 367-4813 if you do not wish to receive such mailings. Photographs contained in this magazine are for illustration purposes only.

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Dear Readers,

EDITORIAL BOARD William H. Polonsky, PhD, CDCES Pamela Allweiss, MD, MPH Assistant Clinical Professor, CDC Division of Diabetes Translation Department of Psychiatry, Amy P. Campbell, MS, RD, LDN, CDCES University of California, San Diego Boston, Massachusetts Jeanne L. Rosenthal, MD Shana Cunningham, Attending Surgeon, Retinal Service, MSN, RN, MLDE, BC-ADM, CDCES New York Eye and Ear Infirmary, New York, New York Diabetes Education Service Coordinator, Gary Scheiner, MS, CDCES UK HealthCare Barnstable Brown Diabetes Center, Owner and Clinical Director, Integrated Diabetes Services, University of Kentucky, Lexington, Kentucky Wynnewood, Pennsylvania Robert S. Dinsmoor Bernard P. Shagan, MD South Hamilton, Massachusetts Director, Diabetes Education Center, David E. Goldstein, MD Monmouth Medical Center, Long Branch, New Jersey Professor Emeritus, University of Missouri Richard M. Weil, MEd, CDCES Health Science Center, Columbia, Missouri Exercise Physiologist and Director, Mount Sinai St. Luke’s Laura Hieronymus, Weight Loss Program, Mount Sinai St. Luke’s Hospital, DNP, MSEd, MLDE, BC-ADM, CDCES, FADCES New York, New York Associate Director, Education & Quality Services, Susan Weiner, MS, RDN, CDCES, CDN, FADCES UK HealthCare, Barnstable Brown Diabetes Center, Owner, Susan Weiner Nutrition, PLLC, Long Island, New York University of Kentucky, Lexington, Kentucky Stephen Z. Wolner, DDS Jeff Plumer, Vice Chair, New York, New York JDRF International Board of Directors

••• DiabetesSelfManagement.com •••

NUTRITION

Are Beans Good for Diabetes?

Sugar: Fact or Fiction A lot of misinformation surrounds diabetes, especially when it comes to sugar. How do you make sense of sugar in terms of what types and how much is “allowed”? Let’s clear up some of that confusion and set the record straight. bit.ly/34ce3Kd EXERCISE

FREE PROGRAM

Beans have quietly risen to superfood status, thanks to their nutrition profile and low cost. You might be wondering if and how they can be part of your eating plan if you have diabetes. Are beans good or bad for blood sugars? Let’s take a look. bit.ly/3ue4bKx

RECIPE

E-COURSE TYPE 2 WELLNESS JOURNEY A 21 -DAY E - C OU R S E

Type 2 e-Course

If you’re interested in an active autumn, hiking might be just the exercise for you. Don’t be intimidated by the image of backpackers climbing the Rocky Mountains. The reality is that hiking can be as mild or rigorous as you choose. Get our tips for enjoying the great outdoors (and learn more on page 17)! bit.ly/3fuWo5K

If you or a loved one is living with type 2 diabetes, you probably have a lot of questions. Whether you’re brand new to the diagnosis or a seasoned veteran of dealing with the condition, our free e-course can help you find the information you need to live a happier, healthier life. bit.ly/3vbLDfk

INTERACT WITH US Get more news, tools and recipes all month long! @ManageDiabetes

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Good-for-You Chicken Noodle Soup In the crisp days of fall, nothing hits the spot better than a steaming, hydrating bowl of chicken soup. Using skinless chicken breasts cuts down on the fat and calories in this low-carb version of the classic. bit.ly/3f5jukC

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••• THE DOSE ••• News & Notes

Fasting Glucose and Waist Size Predict Risk of Diabetes Complications F

asting glucose level, waist circumference and age at diabetes diagnosis are factors that help predict who will develop diabetes complications, according to a new study published in the Journal of Diabetes and its Complications. Researchers looked at a diverse, multiethnic group of 1,587 participants, all of whom had diabetes, in a study called the Multi-Ethnic Study of Atherosclerosis. Participants were divided into eight different groups based on three factors that split participants into two categories each. The first factor was age at diabetes diagnosis, with participants divided based on an age of 45 or younger, or older than 45. The second factor was fasting glucose level, with participants divided based on a measurement of 140 mg/ dl or higher, or below this level. And the third factor was waist circumference, with women divided based on a

8 DiabetesSelfManagement.com • Fall 2021

measurement of 105 centimeters (41.3 inches) or greater, or below this level, and men divided based on a measurement of 110 centimeters (43.3 inches) or greater, or below this level. The researchers were interested in how each of these factors—age at diagnosis, fasting glucose level and waist circumference—was related to outcomes including death from all causes, cardiovascular disease, chronic kidney disease, heart failure, dementia and diabetic retinopathy (eye disease) during a follow-up period of about 17 years. In calculating how these factors were related to outcomes, the researchers adjusted for demographic differences (like age or race), known behavioral differences, and known differences in clinical risk factors (such as other health conditions). They found that the group of participants with both an early age at diabetes diagnosis and high fasting

glucose experienced a higher risk of death, cardiovascular disease, heart failure, chronic kidney disease and retinopathy. The group with both an early age at diagnosis and a high waist circumference experienced a higher risk of cardiovascular disease, heart failure, chronic kidney disease and retinopathy. The group that had all three higher risk factors—early age at diagnosis, high fasting glucose and high waist circumference—experienced a higher risk of death, heart failure, chronic kidney disease and retinopathy. The researchers noted that these results reinforce the importance of assessing the risk for complications among people with diabetes based on their age at diagnosis, fasting glucose level and waist circumference—as well as the importance of using these findings to communicate with patients and to develop a strategy for preventing diabetes complications. DSM

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BY QUINN PHILLIPS

••• THE DOSE ••• News & Notes

Too Many Older Adults May Be Taking Daily Aspirin T

wo commonly recommended or prescribed drugs—daily aspirin and the cholesterol-lowering drugs statins—may not be taken by the right proportion of older adults, according to a new study published in the Journal of the American Geriatrics Society. Both daily aspirin and statins have been shown to reduce the risk of cardiovascular events in some people, but they’re not recommended universally. Aspirin is generally recommended for adults with a moderate to high risk of developing atherosclerotic cardiovascular disease (fatty deposits in the arteries) who have a remaining life expectancy of at least 10 years and are willing to take aspirin daily for at least 10 years. This means aspirin is most likely to be recommended for adults ages 50-59, with less evidence to support its benefits for people ages 60-69. People under 50 or at least 70 are generally not considered candidates for daily aspirin without a history of cardiovascular disease (CVD).

10 DiabetesSelfManagement.com • Fall 2021

Statins, on the other hand, are generally recommended at low to moderate doses for adults ages 40-75 who don’t have a history of CVD but who have one or more cardiovascular risk factors (such as diabetes, high blood pressure or abnormal cholesterol or triglyceride levels) and a moderate to high risk of developing atherosclerotic CVD. There isn’t enough high-quality evidence, the researchers write, to recommend that most adults over age 75 take either aspirin or a statin daily to help prevent CVD. Using data from the U.S. National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018, the researchers looked at the use of both aspirin and statins in adults age 50 and older. They found that daily use of aspirin—mostly at low doses, as is recommended for preventive benefits— tended to increase with age and was quite similar across the range of years in the study. In 2017 and 2018, rates of daily aspirin use, almost always at the

recommendation of a doctor, ranged from 20.0% in adults ages 50-54 to 49.6% in adults ages 70-74 to 53.7% in those age 75 and older. Daily use of statins also tended to increase with age, ranging in 2017 and 2018 from 17.8% in adults ages 50-54 to 47.7% in adults ages 70-74 to 52.3% in those age 75 and older. While these numbers are broadly similar to those for daily aspirin, the different clinical recommendations for each drug mean it’s likely that more older adults could benefit from taking statins than currently take them—while it’s likely that too many older adults are taking daily aspirin and may be at higher risk for adverse effects like bleeding as a result. “Education...regarding the compelling benefits of using statins for the secondary prevention of CVD is important,” the researchers wrote. Additionally, they note, “Healthcare providers should inform their older patients about the appropriate aspirin use.” DSM

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BY QUINN PHILLIPS

Groundbreaking New Weight-Loss Drug Approved BY QUINN PHILLIPS

he U.S. Food and Drug Administration (FDA) has approved Novo Nordisk’s application to market a new formulation of the drugmaker’s type 2 diabetes drug Ozempic (semaglutide) as a onceweekly injection for weight loss. Sold under the brand name Wegovy, the new formulation for weight loss is a higher-dose version of Ozempic, a treatment to improve blood sugar levels that was approved by the FDA in 2017. Wegovy is intended to be combined with a reduced-calorie diet and increased physical activity to achieve weight loss in people who are overweight or obese, and who

have medical problems related to their excess body weight. The new FDA approval is based on the results of a clinical trial called STEP (Semaglutide Treatment Effect in People with Obesity) that included about 4,500 participants. Trial participants who received Wegovy lost an average of 14.9% of their body weight over the course of 68 weeks, compared with 2.4% for participants who received a placebo (inactive treatment). What’s more, 83.5% of participants in the Wegovy group lost at least 5% of their body weight, compared with just 31.1% who lost this much body weight in the placebo group. “This is the first time we have

seen this magnitude of weight loss with a medicine,” said Robert F. Kushner, MD, a professor of medicine and medical education at Northwestern Medicine’s Feinberg School of Medicine in Chicago. Wegovy should not be taken with any other products that contain semaglutide—such as Ozempic or Rybelsus—or any other drug in the GLP-1 receptor agonist family, which includes Trulicity (dulaglutide), Byetta and Bydureon (exenatide), Victoza (liraglutide), and Adlyxin (lixisenatide). Like many other drugs in this family, digestive upset is the most common category of side effects for Wegovy. DSM

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••• THE DOSE ••• News & Notes

TYPE 1 DIABETES LINKED TO MUSCULOSKELETAL CONDITIONS BY QUINN PHILLIPS

T PORTION CONTROL BY LISA CANTKIER

ortion sizes matter when it comes to a healthy diet, particularly if you have diabetes. With obesity rates at an all-time high in the United States and around the world, we need to examine not only what we eat but also how much we eat. Odds are, your portion sizes may be larger than they should be. Find out what your portions should look like and how to truly take charge of your plate by taking this quiz. (Everyone is different, so be sure to ask your healthcare provider about your diet and meal portions to determine what is best for you.) 1. True/False: The “plate method” is a strategy that can help you achieve portion control. O True O False 2. Controlling the portions on your plate can: O A. Result in healthy weight loss. O B. Lead to a decrease in diabetes medication. O C. Improve blood glucose control. O D. All of the above. 3. Weight loss in people with diabetes who are overweight is associated with which of the following? O A. Decreased muscle tone. O B. Normalized blood glucose levels and a reduced risk of other health problems. O C. Increased LDL (“bad”) cholesterol. O D. An increased risk of hypertension (high blood pressure). 4. How can you estimate portion sizes for your plate? O A. Use measuring cups and measuring spoons. O B. Use food scales. O C. Use the palm of your hand, fist, fingers and thumb. O D. Eyeball it. 5. True/False: Using a smaller plate size does not help control meal portions. O True O False See page 14 for answers.

12 DiabetesSelfManagement.com • Fall 2021

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QUIZ

ype 1 diabetes is linked to a higher risk of developing musculoskeletal problems, including conditions like frozen shoulder and carpal tunnel syndrome, according to new research presented at the Diabetes UK Professional Conference (DUKPC) 2021. Researchers at the University of Exeter in England based their findings on an analysis of data from the UK Biobank—one of the largest general health studies in the world—and from FinnGen, a similar large study based in Finland. The researchers used both genetic information and health data to find out whether people with type 1 are at higher risk for a wide range of health conditions. They found that type 1 was likely to play a causal role in developing a range of musculoskeletal conditions, including frozen shoulder, carpal tunnel syndrome, trigger finger and Dupuytren’s contracture. Each of these conditions is marked by pain and reduced mobility in the shoulder, wrist, hand or fingers. They also found that type 1 was unlikely to play a causal role in developing osteoarthritis (the most common form of arthritis, in which joints degenerate). This study is the first large-scale analysis to show that type 1 diabetes is responsible for a higher risk of developing musculoskeletal problems. Now that this connection is known, the researchers noted, people with type 1 and their doctors can be on the lookout for musculoskeletal problems that may develop as a result of diabetes. More research is needed, the researchers pointed out, to learn how diabetes and elevated blood glucose may contribute to the development of musculoskeletal problems. DSM

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••• THE DOSE ••• News & Notes

QUIZ ANSWERS

2. D. Portion size is an important determinant of energy intake. In people with type 2 diabetes, weight reduction improves blood glucose control. According to research, portion control tools are effective in leading to weight loss and enable people with diabetes to decrease their blood glucose medications without sacrificing glycemic control. 3. B. According to Diabetes Canada, “Portion size is an important part of weight loss. If you’re overweight or obese, weight loss is the most important and effective way to help normalize blood sugar levels and reduce your risk of other health problems.” DC says you should fill half your plate with vegetables and fruits. The organization also notes that “Low-glycemicindex foods such as legumes, whole grains, and fruits and vegetables can help control blood sugar...and can make you feel full longer to help with losing weight.” 4. A, B, C. Measuring cups and spoons and food scales are useful tools for determining portion size. The Centers for Disease Control and Prevention teaches people how to estimate portion size using their hands when these tools aren’t available. For example, 3 ounces of meat, fish or poultry = the palm of the hand (no fingers), 1 cup or 1 medium fruit = a fist, 1 tablespoon = a thumb tip (tip to first joint), 1 teaspoon = a fingertip (tip to first joint). 5. False. The results of a study in the journal BMC Obesity showed that using a plate smaller than a traditional dinner plate resulted in participants consuming smaller food portions. This is an effective strategy you can try to help manage your portions. (Just be mindful that portion control plates have the potential to reduce portion sizes of important items—if you try this, don’t skimp on your nonstarchy veggies!) DSM

Lisa Cantkier is a writer and educator specializing in nutrition and health. She is coauthor of the diabetes-friendly cookbook The Paleo Diabetes Diet Solution. 14 DiabetesSelfManagement.com • Fall 2021

REDUCED-CARBOHYDRATE, HIGH-PROTEIN DIET SHOWS BENEFITS IN TYPE 2 BY QUINN PHILLIPS

ollowing a reduced-carbohydrate, high-protein diet may provide a variety of benefits to people with type 2 diabetes, including better glucose control and reduced hunger, according to a small study published in the American Journal of Physiology-Endocrinology and Metabolism. The study’s participants were 28 adults with type 2 diabetes, who were randomly assigned to follow either a reduced-carbohydrate, high-protein diet or a conventional diabetes diet for six weeks. The reduced-carbohydrate diet got 30% of its calories from carbohydrate, 30% from protein and 40% from fat, while the conventional diabetes diet got 50% from carbohydrate, 17% from protein and 33% from fat. The researchers found that following a reduced-carbohydrate, high-protein diet resulted in total after-meal glucose elevation (“area under the curve”) that was 60% lower on average, as well as 24-hour glucose levels that were 13% lower, compared with the conventional diabetes diet. Participants’ after-meal insulin secretion rate was also 24% lower, while pancreatic beta cell sensitivity to insulin increased by 45% on this diet. Stomach emptying was delayed by an average of 15 minutes, while self-reported fullness between meals increased by 18%. These results show dramatic benefits, and no significant disadvantages or risks, linked to following a reduced-carbohydrate, high-protein diet in a small group of people with type 2 diabetes. “It is noteworthy that these results were achieved in a setting that aimed at body weight maintenance,” rather than weight loss, the researchers wrote—suggesting that the difference in diet composition, rather than a reduction in overall calories, was responsible for the benefits observed. Based on these results, the researchers concluded, many people with type 2 diabetes may benefit from a modest shift in their diet composition away from carbohydrate and toward protein. DSM

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See page 12 for questions. 1. True. According to the American Diabetes Association, the “plate method” can help you create “perfectly portioned meals with a healthy balance of vegetables, protein and carbohydrates without any counting, calculating, weighing or measuring…all you need is a plate.” This method suggests you fill one-quarter of your plate with protein, one-quarter with whole grains or other whole-food carbohydrates, and half with colorful nonstarchy vegetables. The recommended beverage of choice for the plate method is filtered water. Avoid processed foods.

••• THE DOSE ••• Product Spotlight

Cool New Products to Try BY AMY CAMPBELL, MS, RD, LDN, CDCES

Quility Weighted Blanket For people with diabetes, constant stress and lack of sleep can make it harder to manage blood sugars. A quick and easy way to improve your sleep and banish stress is to use a weighted blanket. Weighted blankets, such as the Quility Weighted Blanket, provide the right amount of pressure on your body—much like getting a good hug. This blanket is made from high-quality, durable materials, including microglass beads and a removable, breathable duvet cover. You’ll feel comforted and relaxed, and you’ll finally get a good night’s sleep without getting overheated. quilityblankets.com

Tea Forte Single Steeps Tea Chest Sampler There are so many reasons to enjoy a hot cup of tea. Some are health-related, including a lower risk of heart disease, type 2 diabetes and some types of cancer, and less depression and anxiety. Drinking a cup of tea can also help you unwind from a busy day or let you catch up with a good friend. Whatever your reasons are, you’ll be sure to appreciate Tea Forte’s Single Steeps Tea Chest Sampler. You’ll get to experience a wide range of different teas (28, to be exact) from around the world. Fix yourself the perfect cup of tea anytime, anywhere with Tea Forte’s single-serve pouches. teaforte.com

Philips SmartSleep Sleep & Wake-Up Light If the longer nights have you yearning for more time in bed, maybe it’s time to treat yourself to the gift of healthy sleep. The Philips SmartSleep Sleep & Wake-Up Light is a sound investment in your health. You can customize your nighttime and morning routines with sunset and sunrise simulation, which allows you to wake up more naturally using a combination of light and sound. This device also provides an FM radio, a reading lamp with 10 brightness settings and a tap snooze in case you want to sleep a bit longer. Fall asleep faster and wake up feeling energized. usa.philips.com Fall 2021 • DiabetesSelfManagement.com

Diabetes Freedom – What is it all about? A large amount of the population today suffers from the deadly disease called diabetes; especially Type-2 diabetes is becoming a common problem among the population. A large number of diabetic patients get their legs amputated. Many times, diabetic patients are left helpless because there seems to be no cure for their condition. They can only survive if they take their medications on time. Their bodies get so used to the support from these tablets that the body’s ability to function on its own is diminished. For years people have been dealing with type-2 diabetes, but no permanent cure still exists for the condition. Or is the world being fooled by all the big drug companies and manufacturers? There are natural ways through which one can bring under control one’s blood sugar level.

••• THE DOSE ••• Ask Away

Hypoglycemia Defined, Hidden Carbs BY GARY SCHEINER, MS, CDCES

There is a great deal of debate in the medical/scientific world about the true definition of hypoglycemia (low blood glucose). For anyone at risk of hypoglycemia, including those who take insulin or medications that increase insulin production, the general rule has always been that anything below 70 mg/dl is considered too low and should be avoided. Glucose levels below 70 mg/dl will usually cause the body to produce adrenaline, which leads to the classic symptoms of hypoglycemia (e.g., shaking, sweating, rapid heartbeat, intense hunger). While these symptoms can be unpleasant and disruptive, they are not necessarily dangerous. Research has shown that, for most people, the mind and body can still function reasonably well even with glucose levels in the 60s. However, once glucose dips below 55 mg/dl, things change dramatically. At this point, the brain lacks the energy to function properly. Confusion can set in, and it may

16 DiabetesSelfManagement.com • Fall 2021

become difficult or impossible to eat or drink something to treat the low. And some people experience this at levels higher than 55 mg/dl. Given how quickly glucose can drop, most people aim to keep their levels from going below 70 mg/dl. Think of glucose levels in the 60s as a guardrail that keeps you from falling over a cliff. You’re safe as long as you stay behind the guardrail, but if you push against it too hard or lean too far over it, you can easily wind up falling into a pit of doom. Best to have a discussion with your diabetes care team to determine precisely how low is too low for you.

The other day, all I had for lunch was a salad with some cashews. Within a few hours, my blood glucose had risen almost 100 mg/dl! Why would it rise so much if I didn’t have any sugar or starch?

Welcome to the world of “hidden” carbohydrates. Many people think the only sources of bloodglucose-raising carbs are obvious foods such as bread, potatoes, fruit and sweets. But there are carbs in almost everything we eat. Salads, for

example, contain an average of about 4 to 5 grams of carbohydrate per cup. And cooked nonstarchy vegetables, such as steamed broccoli, contain 8 to 10 grams per cup. A handful of cashews contains about 10 grams of carbohydrate, and a handful of peanuts contains roughly 6 grams (of course, handful sizes may vary!). Milk is another source of carbs—about 12 grams per cup. And that doesn’t even touch on sauces, dressings and condiments. A single tablespoon of barbecue sauce can contain 5 to 10 grams of carbohydrate! There are a few exceptions. Most meats, eggs and cheeses are completely carb-free. But carbs may be added during food preparation. It pays to look up the contents of your common meals and snacks to make sure your carb counts match what you actually consume. DSM Gary Scheiner, MS, CDCES, has lived with type 1 diabetes for 30 years and was named Diabetes Educator of the Year 2014 by the Association of Diabetes Care & Education Specialists. Have a question about diabetes? Email gary@integrateddiabetes.com.

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My lab work says that a blood glucose level in the 60s mg/ dl is normal, but I’ve always been told that anything below 70 mg/dl is too low. Which is correct?

••• THE DOSE ••• Curmudgeonly Athlete

Take a Hike! BY ROB DINSMOOR

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’ve always enjoyed hiking, but I especially came to love it during the pandemic because it gave me an excuse to leave my house, breathe fresh air, and enjoy the scenery. If you haven’t hiked before, it’s never too late to begin. Hiking can increase stamina, improve bone density, strengthen leg muscles, strengthen your core, and improve your balance. It can also help you control your weight, improve blood pressure, lower blood glucose levels, and generally reduce the risk of heart disease. A wide variety of fancy gear is marketed to hikers, but all you really need to start out is a lightweight backpack and sturdy, durable hiking boots that fit well. (I remember hiking in old boots that seemed to be made of lead, but there are many lightweight yet durable options available today.) Hiking poles are also recommended, especially on hills, because they help you keep your balance, particularly going downhill, and take some of the stress off knees and hips.

What do you put in your backpack? Water is the most important item, since hiking inevitably builds a thirst, and there are usually no water fountains or convenience stores in the wild. It’s also prudent to carry blood glucose monitoring supplies and snacks and/ or glucose tablets in case of hypoglycemia (low blood glucose). If there’s any chance of being out after dark, definitely pack a flashlight. All geared up with nowhere to go? Members of the Appalachian Mountain Club (outdoors.org) have access to organized hiking trips and related events. The Hiking Project (hikingproject.com) offers maps for hiking trails all over the world and allows you to search for trails near you. Meetup.com has regional hiking groups that provide group hikes, most of which are free to members. Most if not all states have hiker-friendly state parks and forests, often with large trail maps on display and smaller trail maps that you can carry. The U.S. Forest Service (fs.usda.gov) has

a searchable database of forests and grasslands in various states. For people who prefer flat surfaces, consider abandoned railroad tracks that have been converted to hiking and biking trails, offering natural scenery you can’t usually see from the road. Over 22,000 miles of trails in the U.S. alone have been converted by the Rails-to-Trails Conservancy (railstotrails.org), which can give you information about converted rails in your state. I also enjoy walking on nearby beaches, some of which go on for miles—and if I want a more intense workout, I hike up and down the dunes. Safety is particularly important when you’re starting out. It’s a very good idea to hike with a friend, so you can help each other if one of you gets hurt. You should also stay on marked paths and trails. Check the weather forecast so you can dress accordingly, especially if there is likely to be cold weather or rain. Above all, have fun! DSM Fall 2021 • DiabetesSelfManagement.com

••• HEALTHY LIVING ••• The Right Moves SINGLE LEG CHAIR TO STAND

Move In All the Ways BY LAUREL DIERKING, MED, NASM, 700-ERYT

t is easy to get caught up in the widespread mentality that we should move in only certain ways. Some advocates for specific types of exercise—yoga, strength training, running, you name it—will encourage you to “just do this, it’s the only workout you need!” You can be sure this is a marketing gimmick, and unfortunately, it gives a false impression of what our bodies actually need. So, what should we be doing, then? Our bodies are dynamic, versatile and always adapting to what we do often (even if we don’t do it well). In other words, we should move in all the ways available to us (or, as the popular meme goes, do ALL the things). If you were to step into a yoga class, your instructor might suggest you position your body in particular ways to “accomplish” different poses. What they may not tell you is that each body on each mat should look different. This is the same for generally all types of movement: We each have a unique skeleton that directly influences our ability (or inability) to move, shift and bend. (That does not mean, however, that maintaining proper alignment is not important.) There are fundamental movement patterns that most people’s skeletons are generally able to achieve. Skeletal variations such as where your hip socket sits in your pelvis (which varies greatly from person to person) and many other structural differences determine how you are able to move and how you will be able to optimize a particular movement. Exploring new

18 DiabetesSelfManagement.com • Fall 2021

movements can help you learn what is best for your unique body. In Western society, there is a detrimental and often dangerous fixation on the way things look. We are obsessed with symmetry, which is ironic considering that our bodies are built asymmetrically (e.g., we have a heart on one side, a liver on one side, and so on). This asymmetry alone creates a cascade of structural “misalignments” from the ribcage to the pelvis and to the joints beyond. With all that being the case, why then should we move in just one way? The answer is, we shouldn’t. Our bodies are built for and crave a variety of types of movement, and there is not a single “magic” way to train that is for everyone. Exploring new patterns of movement and incorporating variety into your routine can help reduce your risk of overuse injuries from repeating the same things over and over (even sitting can cause overuse injuries). Try these simple and fun movements to notice your own imbalances and add some diversity to your physical activity regimen. DSM Laurel Dierking, MEd, NASM, 700ERYT, is a movement specialist with a concentration in yoga, strength conditioning, exercise physiology and postural restoration. With 10 years of extensive experience, Dierking seeks to enhance self-awareness by guiding individuals through mindful movement, functional training, body awareness and breath work.

• Sit in a secure chair with your spine tall and your heels under your knees. • Extend one leg off the floor (for more support, extend the leg while keeping the heel on the floor). • Without using your hands (unless you have to), come up to a standing position using just your one leg. • Slowly, with control, return back to your seat, still with just the one leg. • Repeat five to 10 repetitions on each leg.

ARMS OVER HEAD AND SHAKE

• Set a timer for 1 minute. • Stand with your feet hip-width apart or wider, reaching your arms overhead. • Begin to gently bounce in your legs and shake your arms vigorously overhead. • Breathe steadily as you shake and bounce your limbs. • After 1 minute, gently bring your arms down beside you and relax your posture, returning your breathing to normal (in and out through the nose).

SINGLE LEG REACHES

• Stand on one leg next to a desk or a wall in case you need support (perform this exercise with no support for a challenge, but have support nearby). • Keep your knee straight (but not locked) and hinge (on an exhale), folding from your waist to reach as far forward in front of you toward an object as you can. Keep your back leg reaching back. • Inhale and come right back up to standing. Repeat 10 times on each leg.

AARON ASHLEY

Fall 2021 • DiabetesSelfManagement.com

••• HEALTHY LIVING ••• Weighty Matters

4 Ways to Healthy Habits BY DR. NICOLA DAVIES, PHD

Recognize and manage mood dips. Experts recognize that, with less daylight and the stress of the looming holiday season, fall can cause mood dips. Being on a strict diet can worsen these dips, making you feel constantly “hangry.” One tried-andtested weight-management strategy that can help avoid low moods is being mindful of what you are eating. Don’t deny yourself food—simply replace empty calories with healthier options. Replace chips with baked crackers or plain popcorn, for

20 DiabetesSelfManagement.com • Fall 2021

example. If you crave bread, go for a whole-grain, low-glycemic version. Keep track of your intake using an app. Above all, slow down and enjoy your food.

Harness the power of healthy fall foods. The autumn harvest is perfectly suited for those looking to embrace a healthy diet. You can use pumpkin, broccoli and butternut squash to make warming, hearty soups that are low in calories. Fresh apples and pears can satisfy sweet cravings. Other filling fall produce, such as cauliflower and Brussels sprouts, can be included in your meal plan to help you keep the weight off without feeling hungry. (Read “Making the Most of Autumn” [page 22] for some more inspiration.)

Gear your exercise routine to the fall weather. Fall weather motivates people to get moving. The chillier temperatures and colorful outdoors can make exercising a pleasure. Take advantage of this by planning hikes along scenic trails or jogging through your local

park. Fall is also a great time to get into sports with family and friends— lacrosse, baseball or football are just a few ideas.

Stay active indoors. Yes, sometimes the air may be just too chilly for you to enjoy the outdoors. However, staying indoors doesn’t mean you need to give up your exercise routine. There are a variety of ways to bring your exercise inside—consider yoga, aerobics or even dancing. There are plenty of fitness apps and videos available online to help you stay fit without leaving the house.

In it for the long haul Weight management needs to be a long-term lifestyle change rather than something that comes and goes like the seasons. Tweaking your usual habits this fall may help you avoid “holiday weight” altogether. DSM Dr. Nicola Davies, PhD, health psychology, is the author of I Can Beat Obesity! Finding the Motivation, Confidence and Skills to Lose Weight and Avoid Relapse.

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all conjures up images of mountains of roasted turkey, freshbaked pumpkin pie and bright candy apples—none of which are ideal for weight management! Fortunately, though, the season has many redeeming features that can help you get closer to your health goals. Indeed, the good news for people with diabetes is that studies show blood glucose levels are typically lower during the autumn months. Here are a few tips for embracing the fall to accelerate your healthy habits.

••• HEALTHY LIVING ••• Smart Smarter Smartest

Soup BY AMY CAMPBELL, MS, RD, LDN, CDCES

hosen wisely, soup is a great way to sneak in some vegetables, whole grains and even an ounce or two of protein. Homemade soup is generally your best nutritional option, but the reality is that store-bought soups are a mainstay for many of us—they’re quick, convenient and

easy to prepare. The downside of store-bought soups? Sodium, and lots of it. Excess sodium contributes to high blood pressure, stroke and heart attack. Luckily, there’s a decent assortment of store-bought soups that are reasonable (and even low) in sodium and that are tasty, too! Choose soups

with less than 480 milligrams (mg) of sodium, less than 5 mg of saturated fat, and at least 3 grams (g) of fiber per serving. If possible, look for at least 7 g of protein per serving, too. As for higher-sodium soups? Enjoy them in moderation and limit your portion (go for a cup rather than a bowl). DSM

RECOMMENDED SERVING CAL SODIUM

SAT FAT CARBS FIBER SUGAR PROTEIN (g) (g) (g) (g) (g)

SMART Tabatchnick Balsamic Tomato & Rice Soup Amy’s Black Bean Vegetable Soup Pacific Foods Organic Cashew Carrot Ginger Bisque Bar Harbor Rhode Island Style Clam Chowder Pacific Foods Organic Chicken & Wild Rice Soup Campbell’s Well Yes! Garden Vegetable With Pasta, Lightly Salted Campbell’s Well Yes! Chicken Noodle Soup

1 pouch 1 cup 1 cup 1 cup 1 cup 1 cup 1 cup

100 210 140 140 120 90 110

530 540 570 570 610 640 640

0 0 3.5 1 1 0 0.5

20 35 22 19 16 18 13

4 7 4 0 2 3 2

4 4 11 1 2 5 2

3 9 2 9 5 3 8

1 cup 1 cup 1 cup 1 cup 1 cup 1 can 1 cup

120 150 130 120 70 110 120

400 410 430 450 470 480 480

0.5 0.5 1 3 0 0 0

20 24 18 13 9 12 21

3 5 3 2 1 2 4

4 3 1 5 2 1 4

7 12 10 4 5 11 5

1 pouch 1 cup 1 cup 1 cup 1 cup 1 cup 1 cup

180 100 80 100 120 130 140

35 45 130 230 270 280 340

0 0 0 0 0 0 0.5

33 18 13 21 18 24 20

13 3 1 2 4 9 4

5 5 1 7 4 3 4

12 4 5 1 4 8 4

SMARTER Healthy Choice Vegetable Beef Campbell’s Chunky Healthy Request Split Pea & Ham Soup Pacific Foods Organic White Bean Kale & Millet Soup Made With Chicken Bone Broth Pacific Foods Organic Creamy Golden Cauliflower Soup Progresso Light Beef Pot Roast Soup Healthy Choice Chicken With Rice Soup Made With Chicken Bone Broth Progresso Reduced Sodium Hearty Minestrone Soup

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SMARTEST Tabatchnick Split Pea Soup, Low Sodium Health Valley Organic Minestrone Soup Health Valley Organic Chicken Noodle Soup, No Salt Added Imagine Butternut Squash Creamy Soup, Light in Sodium Amy’s Organic Minestrone Soup, Light in Sodium Dr. McDougall’s Right Foods French Lentil Soup, Lower Sodium Amy’s Organic Fire Roasted Southwestern Vegetable Soup, Light in Sodium

Fall 2021 • DiabetesSelfManagement.com

••• HEALTHY LIVING ••• Food For Thought

Making the Most of Autumn Meal and snack ideas BY ALISON MASSEY, MS, RD, LDN, CDCES

APPLES NUTRITION FACTS: MEDIUM: CALORIES: 104, FAT: 0.0 G, PROTEIN: 0.5 G, CARBOHYDRATE: 28.0 G, FIBER: 4.8 G

Baked Apples. Bake apples with cinnamon, walnuts and raisins. Breakfast Apple Quesadilla. Spread your favorite nut butter on a low-carbohydrate wrap and add thinly sliced apples. Savory Apple Coleslaw/Salad. Add sliced apples to coleslaw and salads. Butternut Squash and Apples. Bake butternut squash and apples with your favorite fall spices or combine for a savory-and-sweet soup.

22 DiabetesSelfManagement.com • Fall 2021

Homemade Applesauce. Use your favorite recipe for homemade applesauce to add to pancakes and muffins, or simply enjoy with a sprinkle of cinnamon for a snack.

BEETS NUTRITION FACTS: 1 CUP: CALORIES: 77, FAT: 0.0 G, PROTEIN: 2.8 G, CARBOHYDRATE: 17.0 G, FIBER: 5.0 G

Berry Beet Smoothie. Combine frozen berries, ½ cup of pineapple or banana, cooked beets and yogurt (or a nondairy option) for a simple refreshing smoothie. Roasted Beet Side Salad. Roast fresh beets and drizzle with balsamic vinegar and top with 1 ounce of feta or crumbled goat cheese. Strawberry and Beet Ice Pops. Combine frozen strawberries, ½ cup of cooked beets, nondairy milk, pure vanilla extract and sweetener to taste. Put mixture in a popsicle mold and freeze for two to three hours, until frozen. Pickled Beets. Look for a no-sugar pickled beet recipe or reduce the sugar in your favorite recipe for a tangy treat to top salads or eat as a simple side dish. Raw Beet Salad. Grate raw beets and add shredded carrots, onions and your favorite vinaigrette.

COLLARD GREENS NUTRITION FACTS: 1 CUP, COOKED: CALORIES: 44, FAT: 0.8 G, PROTEIN: 4.0 G, CARBOHYDRATE: 8.0 G, FIBER: 5.5 G

Braised Collard Greens. Use vegetable or chicken stock and water to

cook collard greens over low heat in a covered pot. Add red pepper flakes, garlic, or lemon juice and zest for flavor. Collard Slaw. Thinly slice collard greens, purple cabbage, carrots, red onion or any vegetables of choice to create a custom collard slaw to treat your taste buds. Dress with your favorite creamy slaw dressing. Shredded Collard Green Salad With Roasted Vegetables. Remove stems and thinly shred collard greens for the salad base. Top with your favorite fall roasted vegetables, such as sweet potatoes or butternut squash. Add 1 ounce of goat cheese and lightly salted nuts or seeds for added texture, flavor and protein. Skillet Greens With Ham. Pan-fry collard greens with onion, garlic, and Canadian bacon or ham.

CRANBERRIES NUTRITION FACTS: 1 CUP, RAW: CALORIES: 46, FAT: 0.0 G, PROTEIN: 0.0 G, CARBOHYDRATE: 12.0 G, FIBER: 3.6 G

Cranberry and Orange Relish. Try making a no-sugar-added cranberry sauce by combining fresh cranberries, 1 navel orange, fresh orange zest and sweetener of choice (to taste) in a food processor. Pulse until the mixture is chunky but without large pieces. Fresh Cranberry Chutney and Pork Tenderloin. Combine fresh cranberries, apples or pears, and spices to create a fragrant and flavorful chutney to use with pork tenderloin or turkey. Cranberry and Orange Parfaits. Layer low-fat yogurt with 2 tablespoons of fresh cranberry sauce and sliced oranges and top with 1 to 2 table-

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utumn is upon us! What are the best ways to incorporate fall harvest fruits and vegetables into a healthy meal plan for managing diabetes? One way to create natural variety in your eating pattern is to change your produce selection based on the season. What is seasonally available will vary somewhat regionally, but this roundup includes commonly available fall produce, along with tasty ways to add these items to your diet. (Each person with diabetes needs to decide how to incorporate various types of produce into their meal plan and recognize that while nothing is completely off-limits, portions and produce choices may impact blood glucose levels in different ways. The way foods are paired with fats and proteins can slow digestion and also minimize a postmeal rise in blood glucose in some cases. Speak with a registered dietitian about the best produce picks and pairings for your meal plan.)

spoons of chopped nuts for a quick snack or breakfast. Cranberry Applesauce. Consider adding some fresh cranberries to your next batch of homemade applesauce for a tangy-sweet combination.

GRAPES NUTRITION FACTS: 1 CUP, FRESH: CALORIES: 104, FAT: 0.0 G, PROTEIN: 1.0 G, CARBOHYDRATE: 27.0 G, FIBER: 1.3 G

Roasted Grapes and Brussels Sprouts. Toss Brussels sprouts in olive oil and sprinkle with salt and pepper. Bake in a preheated oven at 450°F for about 20 to 30 minutes. In a saucepan, add grapes, thyme and 1 to 2 tablespoons of butter. Cook until grapes are glazed. Pour mixture over prepared Brussels sprouts. Pecan Chicken and Grape Salad. Prepare chicken salad as usual and add toasted chopped pecans and fresh sliced grapes. Jell-O Frozen Grapes. Wash grapes (don’t dry). Empty a sachet of sugar-free Jell-O powder into a bowl. Roll grapes in the Jell-O powder until coated. Place the Jell-O-covered grapes in a single layer in a freezer-safe container and freeze for at least 1 to 2 hours. Balsamic Grape Crostini. Toss grapes in 1 to 2 tablespoons of olive oil to coat and bake in a preheated oven at 375°F for about 15 minutes. Use warm grape topping on pre-prepared warm French baguette slices and drizzle with balsamic vinegar.

until the vegetables are tender. Place the carrots and parsnips into a food processer and add ½ tablespoon of olive oil, orange zest, salt and pepper. Process until the vegetables reach a creamy texture. Parsnip “Rice.” Wash and peel parsnips. Slice into large cubes and add to a food processor. Pulse until the parsnips reach a rice-like size. Sauté the riced parsnips over medium heat for about 8 minutes when ready to use.

PEARS NUTRITION FACTS: 1 CUP, FRESH: CALORIES: 71, FAT: 0.0 G , PROTEIN: 0.0 G, CARBOHYDRATE: 19.0 G, FIBER: 3.8 G

Poached Pears. Bosc pears are the best choice for poaching. Pears can be poached in a liquid of choice, such as apple cider or red wine. Look for a recipe that suits your tastes and adjust any added sugars to best fit your goals for your eating plan. Baked Pears With Walnuts. Preheat oven to 350°F. Cut pears in half and place on a baking sheet. Use a melon baller and scoop out the seeds. Sprinkle each ½ pear with walnuts, cinnamon and a drizzle of maple syrup or honey. Bake for about 30 minutes. Ricotta Toast With Sliced Pears. Combine ricotta, orange zest and 1 teaspoon of maple syrup or sweetener of choice. Spread ricotta mixture on toast. Top with ½ ripe sliced pear and sprinkle with toasted almonds or walnuts.

PARSNIPS

RUTABAGAS

NUTRITION FACTS: 1 CUP, COOKED: CALORIES: 146, FAT: 4.5 G, PROTEIN: 2.0 G, CARBOHYDRATE: 26.0 G, FIBER: 5.6 G

NUTRITION FACTS: 1 CUP, COOKED: CALORIES: 72, FAT: 0.0 G, PROTEIN: 2.0 G, CARBOHYDRATE: 16.0 G, FIBER: 4.0 G

Roasted Parsnip “Fries.” Wash and peel parsnips. Slice lengthwise into strips and coat with olive oil, finely chopped rosemary and a sprinkle of salt and pepper. Bake in a 450°F preheated oven for about 20 minutes, or until the parsnips are tender and slightly browned. Mashed Parsnips and Carrots. Wash and peel parsnips and carrots. Steam for about 15 to 20 minutes, or

Mashed Rutabagas. Boil rutabagas and then mash with butter or olive oil as you would potatoes. Rutabaga Oven “Fries.” Wash and peel rutabaga and slice into strips. Coat in olive oil and toss with your favorite seasonings, such as cayenne, salt, pepper or garlic powder. Roast in a preheated oven at 425°F for about 30 minutes.

Raw Rutabaga Salad. Shave or grate rutabaga and carrots and add sliced scallions. Toss in your favorite vinaigrette dressing.

TURNIPS NUTRITION FACTS: 1 CUP, COOKED: CALORIES: 34, FAT: 0.0 G, PROTEIN: 1.0 G, CARBOHYDRATE: 8.0 G, FIBER: 3.0 G

Parmesan Turnip Chips. Using a mandolin, slice turnips as thinly as possible. Toss turnip slices in olive oil and sprinkle with salt. Lay turnip slices on a baking sheet and bake in a preheated oven at 425°F for about 30 to 35 minutes, until the chips are cooked evenly. Sprinkle the baked chips with grated parmesan cheese. Turnip-Potato Mash. Place peeled and chunked turnips and potatoes into boiling water. Cook for about 20 minutes, or until the potatoes and turnips are easily pierced with a fork. Drain the turnips and potatoes in a colander and return to the pot. Blend the turnips and potatoes with an immersion blender until they are a creamy consistency (add milk or nondairy milk and butter, as you would during the preparation of mashed potatoes).

WINTER SQUASH (ACORN) NUTRITION FACTS: 1 CUP, CUBED: CALORIES: 115, FAT: 0.0 G, PROTEIN: 2.0 G, CARBOHYDRATE: 30.0 G, FIBER: 9.0 G

Baked Acorn Squash. Bake acorn squash and use to top salads or a winter slaw. Acorn Squash Purée. Bake or steam acorn squash and then purée and add a pinch of cinnamon or nutmeg. Add to your pasta sauce or soups for a boost of extra nutrition. Casseroles/Vegetable Lasagna. Add baked or roasted acorn squash to any of your favorite casseroles or even a vegetable lasagna. DSM Alison Massey, MS, RD, CDCES, is a registered dietitian and certified diabetes educator in Maryland. She blogs at amassey.com. Fall 2021 • DiabetesSelfManagement.com

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Diabetes Freedom Worth Buying? Reviews – Can George Reilly & James Freeman’s Main Manual control your blood sugar level naturally?

Lifestyle Hacks for Better Blood Glucose Management

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BY GILLES BEAUDIN, CSEP-CEP, MSc

Fall 2021 • DiabetesSelfManagement.com

any health conditions are multifactorial, meaning that there’s usually more than one cause, and diabetes is no exception. Most people with type 2 diabetes know how important regulating their carbohydrate intake and getting enough exercise are for managing their diabetes. Recent research has found that other lifestyle modifications can also have a positive influence on blood glucose levels. These modifications involve:

• EXERCISE INTENSITY • EXERCISE TIMING • SLEEP • COLD EXPOSURE • GUT BACTERIA What’s more, the impacts of these lifestyle hacks are not limited to glucose control. They will benefit many aspects of your life. If you are curious, read on. You will discover how you can incorporate them into your daily routine.

EXERCISE INTENSITY Work a little harder, sometimes. You hopefully have a regular exercise routine. If you don’t, you may have the same reason as most nonexercisers: lack of time. But recent research shows that you can get a lot of benefits from short training sessions. The secret? Work a little harder, in intervals. In studies, increasing the intensity of exercise has resulted in similar or better metabolic improvements than longer, less-intense routines for people with type 2 diabetes, all in a fraction of the time. Part of the reason is that higher intensities use more muscle fibers, which in turn use more glucose. In fact, your muscles are responsible for clearing the majority of the glucose from your blood. To make them more sensitive to insulin, you just need to reduce their glucose stores. Because higher-intensity exercise requires more muscle fibers to be used, this reduces the glucose stores in more fibers. A review article published in 2015 reported that interval walking (alternating intervals of fast- and slow-paced walking) better improves

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glycemic control in people with type 2 diabetes than consistently paced walking that uses a similar amount of energy. This indicates that how many calories you burn matters less than how you burn them. If more of those calories come from glucose, it will have a bigger effect on blood glucose control. How to up your intensity. Evidence shows that interval training is generally safe and has metabolic benefits for those with type 2 diabetes. After getting the go-ahead from your doctor, it is important to progress gradually and ease into higher-intensity intervals. As you get better, you can go a little harder. Just give your body a chance to adapt. If you exercise a few times a week, only try higher-intensity intervals twice a week to start. It’s not necessary to incorporate them into every exercise session. The intensity of your intervals will depend on your level of fitness and tolerance. If you are a beginner, walking faster for 30 to 60 seconds during a stroll may be a good place to start. This is equivalent to what fitness expert Covert Bailey called wind sprints: small modifications in intensity that will challenge your wind. One word of caution: Before your exercise session, check your blood glucose. If it is over 240 mg/dl, check your urine for ketones. If you have ketones, do not exercise, as this could make your glucose go even higher.

EXERCISE TIMING When you exercise. Now that we have established that it matters how hard you exercise, the question is: Does it matter when you exercise to improve your glucose control and/or insulin sensitivity? Studies have shown that the peak in blood glucose happens around 90 minutes after the start of a meal. Making storage space for glucose in your muscles by being physically active is the best way to reduce that peak, and exercising within 30 minutes of a meal is the best way to maximize the effects of your training session. That goes for any type of exercise. Also, it has been reported

that exercising after meals is more effective than exercising once a day for blood glucose control in people with type 2 diabetes. How to time exercise. Glucose from a meal starts to trickle into your blood roughly 15 minutes after you start to eat. Exercise will open up space in your muscle fibers, making them more responsive to the effects of insulin. If you can change the timing of your exercise sessions, give it a try. Here’s my rule of thumb: Try to exercise 30 minutes before or after a meal. If your preference is shorter, higher-intensity workouts, I would suggest you exercise before your meal. High-intensity activities after eating may disturb your digestion. But there’s nothing wrong with a brisk walk after a meal.

SLEEP ON IT Researchers are learning more about the effects of not getting enough restful sleep. And that’s a good thing: Sleep is one aspect of wellness that doesn’t get its fair share of attention. The Centers for Disease Control and Prevention (CDC) call insufficient sleep a public health epidemic. Experts generally recommend that healthy adults sleep seven to nine hours a night, but about 35% of Americans report typically sleeping less than seven. Sleep deprivation has been linked to a variety of metabolic dysfunctions, including reduced insulin sensitivity. Even one night of four hours’ sleep can decrease insulin sensitivity. Six nights at this rate will drop your insulin sensitivity by 24%. And don’t think that you can compensate for it on the weekend: Running a sleep deficit during the week and sleeping in on the weekend will not readjust your insulin sensitivity. Do you find it hard to resist your cravings? Your willpower may not be to blame. Sleep deprivation will also disturb certain appetite hormones, which will make you hungrier. How’s that for a double whammy? How to get more sleep. When it comes to the influence of sleep on blood glucose control, recent evidence suggests that lifestyle modifications

are better than relying on medication in order to regulate appetite and glucose metabolism. Get into a sleep routine: Go to bed and wake up at the same time each day. Also be aware that light sends the message that it is time to get up. Dim the lights and stay away from screens at least 30 minutes before bed, and use light-blocking shades to make your room as dark as possible, so you don’t get woken early by the sunrise. Here’s an extra trick—you can boost melatonin naturally by practicing deep

Sleep deprivation has been linked to a variety of metabolic dysfunctions, including reduced insulin sensitivity. breathing. Researchers reported a reduction in stress hormones and an increase in melatonin from deep diaphragmatic breathing. Doing this before bed will help improve the quality of your sleep. Try this: Lie down on your back, knees bent and feet flat on the floor. Put one hand on your chest and the other on your belly, below the ribs. Take a deep breath and make the hand on your belly move up. The one on your chest should stay stable. Take three to four seconds to breathe in and six to eight seconds to breathe

out. You want to feel your lower ribs expand. That rib expansion is from the contraction of your diaphragm. Practice this until it becomes a smooth flow in and out.

COLD EXPOSURE Turn on your furnace. Your body always aims for a state of homeostasis, or balance. That includes maintaining a certain body temperature. When the environmental temperature drops, your body has mechanisms in place to maintain its own temperature. One of those is activating a type of fat that is known as brown adipose tissue (BAT). This tissue is like a mini furnace, using energy to create heat. In people used to living in temperature-controlled environments, it gets activated less, just like an unused muscle. Research shows that by exposing your body to a colder environment, you will get BAT to take up glucose and fatty acids to crank up the heat. A review article published in 2016 concluded that mild cold exposure is a good strategy for the prevention and treatment of type 2 diabetes. How to master cold exposure. One word of caution: Cold exposure is like exercise for your blood vessels. It makes them contract. Check with your doctor before trying this, particularly if you have a heart condition. Also, if you are a beginner, don’t push too hard. Your body is adaptable, but it needs time to make adaptations, so go at it easily. If you live in a part of the world that gets cold winters, you can drop the thermostat a few degrees. You can also slowly get used to taking a shower with colder water. Start your shower as usual. After washing yourself, gradually lower the temperature of the water. Get used to colder water every week, just for one to two minutes. You will eventually “train” your BAT to become more active.

GUT BACTERIA Trust your gut. This is fairly new knowledge, and we don’t know all the details, but the evidence is too strong to ignore. The gut is often referred to as the second brain. Its

nervous system is very complex, and it secretes certain substances that have influences on other body tissues. The data in humans are still scarce, but an article published in 2019 reported that certain bacteria that populate your gut could influence insulin resistance. In fact, the link between the two appeared very strong, and it was shown that people with type 2 diabetes have a lower count of certain gut bacteria. Is this just a link, or does one cause the other? That remains to be determined. How to adjust your gut. Fortunately, there’s no need to wait for the answer. A healthy gut is important to your overall health. It has been shown that certain pesticides can reduce your good gut bacteria, and the use of antibiotics can ravage your intestinal flora. To rebuild it, eating foods rich in prebiotics (food for your gut’s healthy bacteria)—such as onions, garlic and leeks—and probiotics (health-promoting bacteria and yeasts)—such as those found in yogurt, kefir and sauerkraut—can be helpful. Also, eat a variety of fresh foods, favor high-fiber vegetables and fruits, and eat organic when you can. And as much as possible, stay away from processed products. (Sound familiar? Healthy eating has many benefits.)

Take the first step As Albert Einstein wisely said, “The definition of insanity is doing the same thing over and over again but expecting different results.” That applies to your social circle, your family life, your financial position and your health. If you want to see a change, you need to change your habits. In most cases, lifestyle modifications work well. They are not always easy because they involve changes to the way you live, and they tend not to work as quickly as medications. But they are always the right thing to do. Give your body what it needs, and you will see results. DSM Gilles Beaudin, CSEP-CEP, MSc, is a clinical exercise physiologist at Cleveland Clinic Canada. Fall 2021 • DiabetesSelfManagement.com

s you are probably aware, diabetes is best managed with a team approach. Your team includes your diabetes medical providers (physicians, nurse practitioners and physician assistants), diabetes care and education specialists, dietitians, exercise experts, nurses, pharmacists, mental health professionals and, most importantly, you! But did you know that your team should also include dental specialists? It is important to establish an ongoing relationship with a dental hygienist and dentist for your oral health care. Your dental hygienist will conduct a professional cleaning and provide instruction on routine home care and cleaning to maintain or reestablish oral health, while your dentist will perform an oral examination and diagnose conditions such as cavities, gum disease, and yeast and/ or fungal infections. As part of your care, you should also receive an oral cancer screening during a dental visit. In fact, taking care of your mouth and teeth is a big part of your diabetes health. It is very important to make every effort to ensure you keep up your daily oral hygiene practices and schedule regular visits with your dentist and dental hygienist for cleanings and oral health checkups.

Your dental toolkit A healthy mouth begins with proper maintenance. Always keep a toothbrush and toothpaste on hand. Brush your teeth at least twice a day, in the morning and evening, ideally after meals and snacks. Soft-bristled toothbrushes are best to clean the teeth and along the gum line. Hard or firm bristles can irritate your gums and cause them to recede (or pull away from the teeth) over time. Make sure your toothbrush is in good condition,

with bristles that are not bent or frayed. Be certain to replace your toothbrush about every three months. Your toothbrush should be a comfortable size for your mouth. A toothbrush that is too big can make it hard to reach all tooth surfaces and limit your range of movement—the ability to move the toothbrush around—while brushing. Whether to use a manual or an electric toothbrush is up to you. However, your dentist or dental hygienist might suggest an electric toothbrush if they see you are having trouble cleaning thoroughly with a manual brush. If you start to use an electric brush, you will likely be asked to bring it to one of your office visits so the hygienist can show you how to use it based on the design. To use a manual brush, you should hold the toothbrush at an angle and brush your teeth with short circular strokes, being sure to cover all surfaces of the teeth, including the gum line. When using an electric brush, most of the movement is done for you, but you’ll still want to work with your dentist and hygienist to make sure you’re getting the best possible results. Remember, the goal of brushing is to remove food debris and the “sticky” plaque that can be easily missed along the gum line. Brushing all of your teeth should take about two minutes. Flossing and cleaning between your teeth is especially important and is recommended as a daily practice. Your dentist or hygienist will help determine what type of floss or flossing device is best to clean these hard-to-reach areas. Flossing is a learned skill, and the selection of the best interdental cleaner should be recommended by the dentist or hygienist, with one-onone instruction provided for how to use it. While dental floss is the best

choice for many people, other tools, such as preloaded floss on a dental pick, interdental brushes or StimU-Dents, might work better for you. These tools help break up and remove plaque and trapped food that the toothbrush can’t reach. Your dentist or hygienist can help you learn how to floss or show you how to use one of the other interdental cleaning tools to make it easier if you have arthritis or difficulty moving your hands. You should practice good dental care on a daily basis and schedule a visit with your dentist and hygienist at least twice a year for a cleaning and oral health checkup.

Diabetes and dental disease People with diabetes are at higher risk for dental complications. These include gum disease, tooth loss and dry mouth that could cause thrush or other infections. The American Dental Association says that one out of five cases of tooth loss is connected to diabetes, and that 22% of people with diabetes have gum disease. If you have diabetes and are a smoker, the risk for gum disease is 20 times higher.

Hyperglycemia and your mouth Hyperglycemia (high blood glucose) can make dental problems much worse. When blood glucose levels are consistently high, the glucose in your saliva also increases, which provides “food” to the harmful bacteria in your mouth, helping it grow. In addition, consuming foods high in sugars and starches can make your saliva thick and add to the growth of bacteria, which increases the amount of plaque. Plaque is a soft, sticky film that can be found most commonly at the gum line. If plaque is not removed by proper brushing and flossing, it can turn into

Dental Definitions Gingivitis: Red, swollen and bleeding gums caused by inflammation from plaque. Periodontitis: Gum disease caused by infection in the gums, which can lead to irreversible damage to the teeth, bone and tissues. Plaque: Sticky film along the gums containing bacteria. 30 DiabetesSelfManagement.com • Fall 2021

Tartar: Hardened plaque that has not been removed. Thrush: A naturally occurring fungus that grows uncontrollably, causing white patches in the mouth that may progress to open sores. Also known as candidiasis. Xerostomia: Lack of saliva in the mouth, or “dry mouth,” which can lead to pain, cracked lips and mouth sores.

tartar, which is hard and can’t be removed with routine brushing and flossing. Tartar can only be removed by your dentist or dental hygienist. Plaque and tartar buildup that is not removed can lead to swollen, inflamed gums that become tender, red and bleed easily. This condition is called gingivitis, and 50% to 90% of people worldwide have it, but it is reversible. However, a condition called periodontitis is not reversible, and it can develop if your gingivitis is not treated. Periodontitis is a chronic gum disease that causes the gums to pull away from the teeth and form spaces, or “pockets,” around the teeth. These pockets collect food debris and bacteria and limit your ability to clean your teeth at home. Without proper cleaning, these pockets can become infected. As these infections spread between teeth and under the gum line, they can begin to damage the bone and gum tissues that support the teeth. This can lead to loose teeth, difficulty chewing and eventual tooth loss. Periodontal disease is a risk associated with diabetes. Some studies have shown that screening for diabetes in dental offices has resulted in up to 30% of individuals being diagnosed with prediabetes or diabetes when referred back to their primary care provider. Bleeding and inflamed gums can be a window into what is happening to the rest of the body. Bacteria from infected gums can move into the bloodstream with normal activities like eating, flossing or brushing your teeth. Once these bacteria enter the bloodstream, they can start a chain reaction in the body’s defense system, which can trigger problems in the mouth and throughout the rest of the body. This increase in the defense system can have harmful effects and lead to more inflammation, which could cause blood glucose levels to climb even higher by making your body more resistant to insulin. In addition, the higher blood glucose can delay healing of wounds and infections, which can increase your risk for gum swelling and bleeding gums, increased pockets and bone damage, and certain infections. Hyperglycemia can also increase

your risk for dry mouth and an oral fungal infection called thrush (also known as candidiasis). Hyperglycemia can cause dry mouth by decreasing the production of saliva, which is one of the body’s natural weapons to protect your oral health. Saliva washes away food debris and it also dilutes the harmful acids from food and bacteria. Without enough saliva, bacteria and acids can build up and lead to tooth problems and gum disease. Thrush is caused when a fungus that normally occurs in the mouth begins to grow uncontrollably. Sore white or red patches can be found on the roof of the mouth, gums, tongue and cheeks, causing pain and discomfort, especially with eating and drinking. Medication can be prescribed by your dentist or diabetes care provider to treat thrush. Your toothbrush (as well as anything that touched your mouth during the outbreak) should be replaced.

Good news Research shows that thorough, routine dental cleaning at home and regular dental checkups can ensure optimal oral health by reducing inflammation of the teeth and gums and actually improving blood glucose levels in people with type 2 diabetes. Treatment of severe gum disease in people with type 2 diabetes has been shown to lower A1C levels (a long-term measure of glucose control), with the benefit being about the same as you might experience if your diabetes care provider added another diabetes medication. Now that is something to smile about! DSM Korinne Callihan is a doctor of nursing practice student at the University of Kentucky College of Nursing. Dawn Dawson is a registered dental hygienist and certified clinical research coordinator at the University of Kentucky College of Dentistry. Laura Hieronymus is a doctor of nursing practice, master licensed diabetes educator, and the associate director of education and quality services at the UK Barnstable Brown Diabetes Center.

Stay on Track You can do many things to limit your risk of dental problems. If you have diabetes and are concerned about your oral health, consider these tips to keep you on the right track: • Stay connected with your diabetes care provider and diabetes care and education specialist for optimal blood glucose control. • Keep your gums as healthy as possible at home by using good dental care practices. • Check your mouth often for any signs of red, swollen or bleeding gums. • Be sure to visit your dentist at least twice a year and ask the hygienist to discuss the measures they take to check your gums for pockets and any signs of damage. • Plan for your visit! Contact the dental office ahead of your appointment to discuss your medications and how long the visit will take, so you can plan around meals. • Take your diabetes medicine and eat your meals on your regular schedule. If your medicine can cause hypoglycemia (low blood glucose) or if the visit will interfere with your mealtime, plan to bring a snack or source of treatment to the office with you. • Have your blood glucose monitor on hand to check your levels before the dental visit and while you are there, if necessary. • Talk to your diabetes care provider and your dentist about the best way to prepare for your appointment. • Finally, if you smoke, work with your diabetes care provider to make a plan to quit. Smoking increases your risk for gum disease, oral and throat cancers, and fungal infections in the mouth like thrush. Smoking also raises your risk for many other diabetesrelated complications. Fall 2021 • DiabetesSelfManagement.com

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Pain and Diabetes

What’s the connection, and how to get relief BY ALICIA DOWNS, RN, MSN, CDCES

iabetes is a chronic, lifelong condition, so it’s not surprising that it both impacts and is impacted by so many areas of our lives. It can also be associated with its share of stigma, and people living with diabetes may hear things like “Just do what your doctor says, and it will get better” or “You can change it if you really want to.” These messages can wear us down and leave us feeling hopeless. Similarly, pain can be a chronic, lifelong condition. For some, pain comes and goes, but for others, it is a part of every day. As with diabetes, pain conditions can impact many areas of our lives and can also be associated with stigma. Fall 2021 • DiabetesSelfManagement.com

The combination of having to manage pain and having to manage diabetes can feel overwhelming, and some may react by avoiding dealing with either one. You may be surprised to learn, though, that your diabetes and your pain may be linked in a number of ways, and improving your care and management in one area can improve the other. Let’s dive into how diabetes and pain are linked and learn about some ways to get relief.

The link between diabetes and pain Diabetes can directly affect our experience of pain. Studies have shown that elevated blood glucose levels reduce our body’s pain suppression mechanisms. In other words, the chemical, neurological and hormonal processes that should reduce our experience of pain are inhibited. There is also evidence that when blood glucose levels are elevated, pain medications may be

less effective. People with diabetes may therefore need additional assistance with pain management. Muscles and joints. Diabetes can also cause changes in our bodies that are painful. The muscles and joints are two of the most commonly affected areas. These issues often start with postural or movement injuries that lead to loss of flexibility. This loss of flexibility leads to tension, stress on joints, and pressure on nerves, which can be very painful. This pain, in turn, then leads to less movement and less flexibility. Eventually, muscles can shorten or even atrophy (waste away), and the cycle is very hard to break. Did you know that elevated blood glucose levels also cause loss of flexibility? When there is excess glucose in our blood, the connective tissues (tendons and ligaments) that hold our muscles and bones together and keep our joints in alignment get glycated (linked with sugar molecules).

As a result, they become more rigid and less flexible, which adds pain to everyday tasks and can make being active less enjoyable. Nerves. Another pain condition experienced by many people with diabetes is a long-term complication called neuropathy (nerve damage). Damage from high blood glucose levels to the small blood vessels leads to reduced circulation to nerve fibers. Without sufficient oxygen and nutrients, these nerves begin to die. Nerve damage can cause numbness, and it can also be extremely painful. (Anyone who’s had a hand or foot “fall asleep” and felt the pins and needles of nerves briefly deprived of oxygen flow has an inkling of the pain potential of nerve damage.) PAD. People with diabetes are also at higher risk of developing peripheral arterial disease (PAD), a condition in which arteries become blocked and circulation is reduced. When PAD affects the legs, symptoms can include

Tips and Techniques for Managing Pain What can we do to help manage pain? Prescription medication options can be effective, but they also carry risks and the potential for side effects. Before we look to steroids, opiates, nerve blocks and other medicines and procedures, what can we do to help reduce and manage our pain issues at home? Here are a few suggestions. (Be aware that, because pain can increase blood glucose levels, starting pain management can result in low blood glucose, or hypoglycemia. A reduction in insulin or other bloodglucose-lowering medications may be needed at the start of treatment, so work with your healthcare team to have a plan in place.) Avoid injury. Maintain a healthy weight, since carrying extra weight increases the risk of joint and back injury and pain. Also adopt a stretching routine. Maintaining flexibility reduces strain on joints and nerve pressure, so stretch daily. Be sure to stretch both before and after exercise to avoid muscle and joint injuries. Consider hot and cold therapy. Talk to your doctor about the use of hot and cold therapy to relieve pain, particularly muscle pain. From heating pads and hot water bottles to cold compresses and cooling sprays, these therapies can reduce inflammation, improve circulation, reduce swelling and increase comfort. 34 DiabetesSelfManagement.com • Fall 2021

Try physical therapy/chiropractic care. Don’t think of these as another appointment; think of them as a personal trainer your insurance will pay for! Physical therapy can help you increase range of motion and flexibility. Your therapist can give you exercises to strengthen muscles and reduce the burden on painful joints. They can even help you find patterns of misuse that have been leading to your pain in the first place. Physical therapy is available and covered by insurance for nearly any cause of pain, and coverage is often continued until the issue is resolved. These professionals can also guide you in the use of stimulation therapy. This involves using a device that emits a low electrical impulse, which can help block pain receptors if worn long-term. Some versions can even be implanted for pain management. In shorter-term use, this treatment creates tiny micromovements in the muscles that can help them release tension and increase circulation to reduce pain and nerve impingement. Get moving to stay moving. It may hurt to get moving at first, but the more we move, the less it will hurt. So, while an injury may have us briefly sidelined while healing, it should never stop us from moving entirely. As we move, circulation increases, helping muscles to receive oxygen and nutrients and heal better, reducing fluid in joints that causes painful stiffness, and allowing muscles

pain in the calves, thighs and hips, which typically occurs with activity and goes away with rest.

Blood glucose and pain The risk of developing these painful complications can be reduced by keeping blood glucose levels in target range and taking steps to avoid erratic blood glucose swings. This can be complicated, however, since not only does diabetes impact pain, but pain can impact blood glucose. Why is this? For one thing, when we are in pain, it is hard to maintain regular physical activity, which in turn makes it harder to keep blood glucose levels stable and in target range. Experiencing pain can also raise our levels of stress hormones, which increase insulin resistance and elevate blood glucose levels. Inflammation from a chronic injury can also cause persistent low-level elevation in blood glucose. In these

cases, diabetes medications may need to be increased to keep blood glucose levels well-managed. Additionally, people who live with chronic pain are also far more likely to self-medicate with food—rates of food addiction and binge eating disorders are much higher in those who report chronic pain—and to deal with depression. People in pain are also more likely to miss or cancel healthcare appointments, which leads to a general reduction in overall wellness. If we struggle due to the burdens presented by a pain condition, our diabetes may take a back seat. So, as we can see, managing pain is not just important for quality of life—it can actually be a critical component of diabetes management, too See the tips and techniques below to help you get started.

There is hope I live with chronic pain, and I live

to strengthen and stabilize injured areas. It may ache to get started, but remember that the more we move, the less we hurt. Work with your doctor on a plan to manage that initial pain and ensure you can get moving without further injury. Stretching is a fantastic place to start! Investigate topical options. Topical pain relievers can be effective for muscle pain and short-term relief. Options include menthol gels, magnesium oil sprays, lidocaine and numbing creams. These great options are available over the counter, cheaply and without sedative or digestive side effects (be aware, though, that too much magnesium can cause loose stools) or the potential for addiction. Topical pain relievers are of minimal assistance for more severe nerve pain or joint pain, but they can

with diabetes. Managing both of these conditions together is key to staying healthy and active and enjoying life. Just as it is for you, it is important that I work with my entire medical team to achieve my goals and to ensure they understand how my pain control and blood glucose management are equally important and depend on one another. With good communication and a collaborative approach, you can feel better. DSM Alicia Downs, RN, MSN, CDCES, is the director of patient care and education at Integrated Diabetes Services in Wynnewood, Pennsylvania. After an initial diagnosis of type 2 diabetes, she was diagnosed with LADA (latent autoimmune diabetes in adults) and uses her personal experience and diverse nursing background to coach people with diabetes. Visit integrateddiabetes.com to learn more.

provide temporary relief to assist in mobility. Look into over-the-counter medications. Speak with your provider about the use of over-the-counter medications. While these options can be highly effective, using them long-term can pose some potential health risks (such as liver function issues from acetaminophen or blood pressure and digestive impacts from long-term NSAID use). They may also interact with other medications you take. However, these medicines can be highly effective for treating pain. A recent study even showed that alternating acetaminophen and ibuprofen every four hours resulted in pain control comparable to opioid pain management. Talk with your prescriber about appropriate use, timing and dosages to meet your needs. Fall 2021 • DiabetesSelfManagement.com

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How Am I Going to Remember to Do That? 8 strategies to manage your daily diabetes regimen BY SUSAN WEINER, MS, RDN, CDCES, FADCES, AND LESLIE JOSEL

o you feel pressure trying to remember everything you need to do to manage both your busy life and

your diabetes? You are not alone! Juggling your daily diabetes to-do list along with home and family responsibilities, plus school and work, can overwhelm even the most organized person. Although life is filled with unexpected distractions, we believe you can create systems and strate-

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Fall 2021 • DiabetesSelfManagement.com

Here are eight surefire tips and tools to help get you started.

1. WHAT’S YOUR STYLE? Recognize how you prefer to remember to do things and tap into the practices that work for you. For example, perhaps you like your reminders fun and visual, so leaving yourself colorful notes on your bathroom mirror (e.g., to remember to check your blood sugar or pack your lunch) might work for you. If you are comfortable and familiar with technology and find the alarms and alerts from an insulin pump or continuous glucose monitor (CGM) useful, then timers and smartwatches that also use alarms as reminders may be the way to go. It doesn’t matter what your personal style is, as long as it helps to get those memory juices flowing. PRO TIP: If you spend a good part of your day in front of your computer, set alerts for to-dos on your desktop

calendar. Notifications will pop up on your screen without making any noise, so your work or virtual meetups won’t be disrupted.

2. ROUTINE, RITUAL, REPEAT. The beauty of routines or rituals is that they take away the need to “remember to remember.” Think of a routine as something that needs to be planned only once. It provides the ability to move through your tasks without thinking about what’s next. Think about the routines and rituals you already have in place that are working for you. Perhaps you always charge your phone in the kitchen and never forget it since you pass through that room often. Or you leave your diabetes supply bag by the front door, so you literally must step over it to leave your home. If you have a system or routine that is already working for you, pairing it with another task you want to remember may be an easy

way to adopt an additional routine. For example, if you never miss your morning brew, place your oral medications or pill box in your “coffee drawer,” and voilà! Every morning you will be presented with a gentle visual reminder to take your medication. PRO TIP: One of our favorite apps for habit building is The Habit Hub. It’s customizable and encourages you to create daily habits by reminding you to perform your tasks and tracking when you complete them. The app creates a visual “chain” when tasks are completed; as the chain gets longer, it serves as an incentive for you to keep at the task so you don’t break the chain.

3. PUT THE ITEM FRONT AND CENTER! If you are prescribed oral medications (or routinely take vitamin and mineral supplements), you can use the bottles or containers as a visual reminder.

ALERTS AND REMINDERS FOR PEOPLE WHO ARE HEARING IMPAIRED • For iOS, turn on the “LED Flash for Alerts” feature. Go to Settings > Accessibility > Hearing >Audio/ Visual. The phone will flash with a bright light when you have a notification (such as a programmed CGM alert).

• While sleeping (or when you may not be able to look at your device), wear your smartphone on an armband and enable the vibration feature. 38 DiabetesSelfManagement.com • Fall 2021

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• For Android, turn on the “Flash Notification.” Go to Settings > General > Accessibility > Hearing.

Place the bottles where you’ll see them at the time of day you have to take them. Turn the bottles upside down when you take them. Then at the end of the day, turn them right-side up again. This will act not only as a visual reminder that you need to take your medications but also as a sign that the task was completed. If you take certain medications twice a day in two different locations, then separate the medications into two containers. Along similar lines, self-care and grooming items, such as a toothbrush, are typically kept in the same place— on the sink or counter in the bathroom. Keep blood-glucose-checking supplies (except test strips, which can be affected by humidity), dental floss or foot moisturizer (and a makeup mirror so you can self-check the bottom of your feet) nearby so you’ll be reminded to perform these essential tasks at the same time as brushing your teeth. This approach is called “checking in pairs” and is a great way to set up a natural and effective routine for self-care. PRO TIP. Ask your local pharmacy if they can provide you with medicine bottles that have lids with built-in alarms.

4. LEAVE YOURSELF A WRITTEN NOTE. Sometimes that’s all it takes for us to remember to do something. It might be a brightly-colored sticky note on the bathroom mirror to remember to floss, a whiteboard by the front door with a reminder of everything that should be included in your diabetes supply bag (including glucose tablets or other fast-acting sources of carbohydrate to treat low blood sugar), or even a folded index card on the nightstand with a reminder to take evening medicines or perform other nighttime diabetes-related rituals. PRO TIP. Pin an index card to the outside of your diabetes supply bag listing the contents of the bag, and update it based on daily usage. This way, when you use any of your supplies (glucose tablets or test strips, for example), you’ll remember to replace them before you head out the door.

5. USE PHOTO PROMPTS. Research shows that we remember images more effectively than we do words because our brain has to work a lot harder to process them. This explains why after a while why we stop “seeing” charts and to-do lists. So, try this out-of-the-box idea instead: Have someone take pictures of you moving through your necessary routines. These should be “action shots” of activities such as preparing nutritious meals or making a phone call to schedule a follow-up doctor appointment. Post the photos in the areas of your home where you perform these tasks. PRO TIP. You can also use photos of the specific items used during each task. So, for example, post a photo of your medicine bottle, dental floss or nonalcohol-based foot moisturizer to serve as a visual cue to perform the tasks using those objects.

6. MAP OUT YOUR SCHEDULE. First, it’s critical to understand the rhythm of your day. Once you understand how your days progress, you’ll be able to establish set times to, for instance, check your blood glucose or CGM, take your insulin or medications, and eat meals and snacks. Once you’ve mapped out your daily schedule, input those times in your calendar as non-negotiable appointments. Always include your diabetes-related activities in your daily calendar to serve as a reminder and to protect that time. As the rest of your schedule starts to take shape with errands, meetings, appointments, etc., you’ll already have time set aside to manage your diabetes. Most smartphones and computers have alerts to remind you 10 to 15 minutes before your preset appointment starts. Sticking to these appointments is critical— giving your diabetes-related tasks and to-dos the same importance as the other focuses in your life is key to successful diabetes management. PRO TIP: Many pharmacies now offer a month of your medications prepacked—and sorted by dosage and date and time to be taken—at

no extra cost. This is a great way to reduce time spent sorting out medications and reduce countertop clutter.

7. SET ALARMS OR TIMERS. The beauty of alarms is that they put the responsibility of remembering on something else! Or, in other words, they hold future time, allowing you to free up your brain to be completely in the present. If you are overwhelmed with your daily diabetes to-do list, try using an electronic timer or cellphone alert as a reminder to check your CGM or other monitoring device. (An added benefit of glucose monitoring alerts on a cellphone is that the device can also be used to share the data with others, if need be.) The routine aspect of using these types of reminders helps make these practices habitual and therefore seamless. PRO TIP. There are a number of free mobile apps that provide medication reminders. Some of our favorites are Pill Reminder—Drugs. com, Mango Health, Med Helper Pill Reminder and Medisafe.

8. WEAR A WATCH WITH A BUILT-IN ALARM FEATURE. Many medical watches can provide reminders as well as alarms. Websites such as epill.com and Amazon carry a variety of medical watches, including Cadex and Vibralite. These allow you to set alarms multiple times a day. PRO TIP. Are you looking for a talking clock that can record reminders? Reminder Rosie is a great option and one of our favorite voice-activated alarm clocks. It allows you to record up to 25 reminders a day in your own voice and can be used for both repeated tasks at a specific time and day or one-time reminders. DSM Susan Weiner, MS, RDN, CDCES, FADCES, is an award-winning author, consultant and speaker, and owner of Susan Weiner Nutrition, PLLC. Leslie Josel is an ADHD coach, productivity expert and award-winning author, and owner of Order Out of Chaos. Together they wrote The Complete Diabetes Organizer: Your Guide to a Less Stressful and More Manageable Diabetes Life. Fall 2021 • DiabetesSelfManagement.com

HEALTHY EATING STRATEGIES • Eat breakfast • Include protein • Eat fruits and veggies • Control carbs • Switch order of foods

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• Learn effects on glucose

40 DiabetesSelfManagement.com • Fall 2021

Strategies for Healthy Eating BY AMY CAMPBELL, MS, RD, LDN, CDCES

hether you’re brand new to having diabetes or you’ve had it for many years, one of the areas of diabetes self-management that can be the most challenging is healthy eating. You might feel confused about what you should eat, in part due to what you might read on the internet or the latest news about foods to avoid. These tips can help.

Eating patterns Healthy eating to help manage your diabetes doesn’t have to be confusing. Gone are the days of rigid “diabetic diets” with foods that don’t always taste good or that are different from what your family eats. There’s a lot of flexibility when it comes to how you prefer to eat—in other words, what eating pattern you might choose to follow. You might decide to try a vegetarian eating plan, a Mediterranean-style eating plan or even a low-carbohydrate eating plan. It’s important to communicate your preferences with your healthcare team so that they can support you and adapt your diabetes treatment plan accordingly. For example, if you choose a lower-carb eating plan, you may need less of your diabetes medication.

STRATEGIES FOR HEALTHY EATING No matter what eating pattern you choose, there are some basic “strategies” that can be helpful as you navigate the effects of your food choices, amounts and timing on your diabetes management. Remember, too, that other factors besides food impact your glucose levels: medication, physical activity, stress and illness all play a role as well. Let’s take a closer look at what tends to work for most people.

Start the day off right: Eat breakfast Not everyone is a fan of eating breakfast in the morning, but there’s a reason for eating something when you wake up: You’re providing your body with nourishment to fuel yourself for the day ahead. Studies show that eating breakfast may make it easier to lose weight, especially if the breakfast includes protein to help stave off cravings late morning and help you feel fuller throughout the day. When it comes to diabetes, eating breakfast is important if you take mealtime insulin or diabetes pills in certain drug classes (such as sulfonylureas or meglitinides) that

may cause your blood sugar to drop. Taking your medication and not eating puts you at risk for hypoglycemia (low blood sugar). Even if you don’t take medicines like insulin, sulfonylureas or meglitinides, breakfast can help keep your glucose levels more stable (fewer peaks and valleys) over the course of the day. Common breakfast foods tend to be full of sugary and refined carbs. Not only are these foods lower in nutrition than whole-grain, unrefined carbs, but also they can cause your blood sugars to crash and burn, leaving you feeling depleted and sluggish later on. STRATEGY: Go for a breakfast that combines unrefined carbs with protein and some healthy fat. Suggestions include whole-grain toast topped with an egg and some avocado, plain Greek yogurt or skyr topped with nuts and berries (which are lower in carb than some other fruit), steel-cut oatmeal with a dollop of nut butter, or a breakfast burrito made with eggs, beans and the veggies of your choice (try baby spinach and red pepper).

Include protein at each meal Protein, one of the three major nutrients, is needed for building, Fall 2021 • DiabetesSelfManagement.com

maintaining and repairing tissues and organs, making hormones and enzymes, and supporting a healthy immune system. Including a protein food at your meals may help you feel full, which, in turn can help you eat less and make it easier to keep your blood sugars in your target range. While some protein is good, more isn’t necessarily better. In fact, eating large amounts of protein foods (think: a 12-ounce steak), especially if they’re not combined with some carb, has been shown to significantly increase postmeal glucose levels in people with type 1 diabetes. And remember: Protein contains calories and, depending on the source, may contain saturated fat, too. STRATEGY: As you plan your meals, make room for a few ounces of protein. Examples include poultry, fish, lean meat, eggs, tofu, beans, nut butters, cottage cheese and Greek yogurt. If you have kidney disease, talk with your doctor or dietitian about how much protein is safe for you to eat.

Eat those fruits and veggies Fruits and vegetables are the mainstays of a healthy eating plan—even for people who have diabetes. Yes, fruit and even some vegetables contain carbohydrate. But that doesn’t mean you can’t eat them if you have diabetes. And here are reasons why you should eat them: • Lower blood pressure • Reduced risk of heart disease and stroke • Lower risk of some types of cancer • Improved eye health • Fewer digestive problems • Reaching and maintaining a healthy weight Including fruits and vegetables in your eating plan may make it easier for you to manage your blood sugars, too. That’s because they contain fiber (which can help slow the rise in blood sugar) and, compared to other foods, they tend to be lower in calories. Nonstarchy vegetables, such as green beans, lettuce, summer squash and broccoli, are really low in carb, too. STRATEGY: Challenge yourself

42 DiabetesSelfManagement.com • Fall 2021

to include a serving of fruit (e.g., a small piece of fruit or 1/2 cup of cut-up fresh or frozen fruit) or a vegetable (1/2 cup cooked or 1 cup raw)—or even both—at each of your meals. Steer clear of fruit juices or canned fruit packed in syrup.

Control your carbs Foods that contain carbohydrate include grains (and foods made from grains, such as bread and cereal), fruit, milk and yogurt, sweets and sweetened drinks. Beans, or legumes, contain carb as well as protein. Carbs give you energy, and when you choose healthful ones, they provide a lot of other nutrients, as well. Managing diabetes is a balancing act when it comes to carbs, though. That’s because carb foods, when digested, raise blood sugar. The good news is that watching your carb food portions, staying active and, if needed, taking diabetes medicine as prescribed can help you balance out your blood sugars with the carbs that you eat. If you need help with or have questions about the right amount of carb for you, meet with a dietitian or diabetes educator. They can give you guidance around carb goals based on your individual preferences. It’s also a good idea to meet with a dietitian if you’re thinking of following a lowcarb eating plan; talk out the pros and cons of doing so, and if you go forward with this, make sure to discuss the impact of a low-carb plan on other factors, such as the dose of your diabetes medications, your kidney health and even your food budget. STRATEGY: Go for carb foods that are less refined—that means wholegrain bread, pasta, rice and cereal, as well as fresh fruit and unsweetened milk and yogurt. When it comes to portions, aim to fill one-quarter of your plate with a carb food.

Switch up the order in which you eat your foods Meal planning can seem so complex, and it’s not uncommon for people with diabetes to struggle with the “eating part” of diabetes manage-

ment. But some things about eating with diabetes aren’t really that difficult, and that includes the order in which you eat your foods. A study published in the journal Diabetes Care in 2015 looked at adults with type 2 diabetes and obesity who took metformin. They were fed meals containing carbohydrate, vegetables, protein and fat but switched up the order in which they ate their foods. The findings: Blood sugars were lower after meals when the subjects ate their vegetables and protein foods before the carb foods. STRATEGY: Start off your meals by eating your vegetables/salad and protein food first; save the carbs for last.

Experiment to learn how foods affect your glucose levels Not everyone with diabetes checks their blood sugars, but there definitely are benefits to doing so. It’s hard to know how your food, as well as your activity level and medications, impacts your glucose levels unless you check your blood sugar with a meter. Some people use CGM (continuous glucose monitoring) instead of a meter; CGM gives you your glucose levels every few minutes, 24 hours a day. Even if you don’t check your blood sugars often, you might benefit from doing so before and after your meals on occasion (called paired checking). This will give you insight into how your blood sugars change after you eat a meal or a particular food. STRATEGY: Check your blood sugar right before you start eating your meal or snack. Then, two hours later, do another blood sugar check. A blood sugar rise of no more than 30 to 50 points means that the meal or snack was a good choice for you! And for most people with diabetes, a blood sugar of 180 two hours after a meal is the goal. Amy Campbell, MS, RD, LDN, CDCES, is a registered dietitian, certified diabetes care and education specialist, and CDE Lead at Good Measures, LLC.

••• AT THE TABLE •••

Fall Harvest

Bonanza BY LORENA DRAGO, MS, RDN, CDN, CDCES

alk into the produce section of the supermarket, and you will be surrounded by an array of colors, scents and textures. During the fall season, in particular, you will find a bounty of various types of apples. Whether you prefer the sweetness of Red Delicious, the red-and-yellowspeckled skin and floral aroma of Gala, the tartness and crispness of Granny Smith, or the unique flavors of one of the many other varieties, you will be able to find an apple that suits your taste. If you are lucky enough to visit an orchard and go apple picking during this season, you will walk away with bags full of apples and a smile on your face. This collection provides plenty of options for using those apples in recipes that are both sweet and savory. And the fall harvest bonanza does not end there: take advantage of all it has to offer with our dishes featuring pomegranate, cabbage, mushrooms, pumpkins and pears. Yum!

SHUTTERSTOCK

OUR RECIPES Like everyone, you’re busy— and we keep that in mind when we select recipes. Many of them can be prepared in

30 minutes or less. Others require short preparation times followed by long cooking times. We’ve also included symbols to help you more easily find those recipes especially high in fiber, low in fat, carbohydrates and sodium.

V FI HIGH-FIBER RECIPE

W LC LOW-CARB RECIPE

5g or more of fiber per serving

15g or less of carbs per serving

W LF LOW-FAT RECIPE

W LS LOW-SODIUM RECIPE

3g or less of fat per serving

140mg or less of sodium per serving

Fall 2021 • DiabetesSelfManagement.com

••• AT THE TABLE ••• Apple Fest

1 1¼ 3 ½ ½ 1 1 1 1 1 ¼ 1 1 ½

Nonstick cooking spray package (about 15 ounces) spice or carrot cake mix cups water, divided eggs cup plain fat-free yogurt cup pecan pieces unpeeled tart apple (such as Granny Smith), sliced unpeeled baking apple (such as Red Delicious), sliced unpeeled ripe pear, sliced tablespoon lemon juice (optional) teaspoon ground cinnamon teaspoon ground nutmeg tablespoon sucralose-based sugar substitute tablespoon margarine or butter teaspoon vanilla or vanilla, butter and nut flavoring

1. Preheat oven to 350°F. Spray jelly-roll pan with nonstick cooking spray. 2. Beat cake mix, 1 cup water, eggs and yogurt in medium bowl according to package directions. Pour batter into prepared pan; smooth top. 3. Bake 20 minutes, or until toothpick inserted into center comes out clean. Cool completely in pan on wire rack. 4. Cook and stir pecans in large nonstick skillet over

you know there are more than conditions such as heart disease and cancer. TIP Did 7,500 varieties of apples worldwide? Is there any truth to the old adage about There are about 100 types in the United States alone. And apples are no nutrition slouch: They have vitamin C and are rich in quercetin, a naturally occurring substance that has antioxidant and anti-inflammatory properties. Antioxidants help protect against

44 DiabetesSelfManagement.com • Fall 2021

the health benefits of eating an apple a day? In a study published in the Journal of the American College of Nutrition in 2005, people who ate one or more apples daily had a 28% lower risk of type 2 diabetes compared with those who did not eat apples.

medium-high heat about 2 minutes, or until lightly browned. Remove to plate; set aside. 5. Add remaining ¼ cup water, apples, pear, lemon juice, cinnamon and nutmeg to same skillet; bring to a boil. Reduce heat to medium; cook 3 minutes, or until fruit is crisptender. Remove from heat; gently stir in sugar substitute, margarine, vanilla and pecans. Spoon evenly over cooled cake. Cut into 24 squares.

2 tablespoons low-fat granola with almonds Nonstick cooking spray 1 red apple (8 ounces), such as Gala, diced into ½-inch pieces 1 tablespoon dried sweetened cranberries 1⁄4 teaspoon apple pie spice or ground cinnamon 1 teaspoon diet margarine 1 packet sugar substitute 1⁄4 teaspoon almond extract 2 tablespoons vanilla low-fat ice cream

1. Place granola in small resealable food storage bag. Crush lightly with rolling pin to form coarse crumbs; set aside.

almond extract. Spoon into 2 dessert bowls or dessert plates; sprinkle with granola. Top with ice cream. Serve immediately.

2. Heat large skillet over medium heat until hot; spray with nonstick cooking spray. Add apple, cranberries and apple pie spice; cook and stir 4 minutes, or until apples are just tender.

Note: You may prepare apple mixture up to 8 hours in advance; top with granola and ice cream at time of serving. To rewarm crisp, microwave apple mixture 20 to 30 seconds on high, or until warm, before adding granola and ice cream.

3. Remove from heat; stir in margarine, sugar substitute and

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••• AT THE TABLE ••• Apple Fest

2 medium cooking apples, halved and cored 1⁄3 cup sugar-free maple syrup 2 tablespoons mixed chopped dried fruit 1⁄3 cup warm water, divided 2 tablespoons chopped walnuts ¼ cup apple juice

1. Preheat oven to 350°F. 2. Arrange apples, cut sides up, in 8-inch square baking dish. Brush cut sides of apples with 2 tablespoons syrup; set remaining syrup aside. 3. Combine dried fruit and 1 tablespoon warm water in small

fresh, whole apples including the skin—removing the skin strips the TIP Eat apple of most of its dietary fiber and flavonoids. Apples contain soluble fiber, which can help prevent constipation. Concerns about the use of pesticides have led to an increase in organic apple production. If you have purchased conventionally grown apples, soaking them in a baking soda solution and rinsing for two minutes under water removes some of the pesticides.

46 DiabetesSelfManagement.com • Fall 2021

bowl. Stir in walnuts. Fill apple centers with fruit mixture. Combine remaining warm water and apple juice in small bowl. Pour into baking dish around apples. 4. Bake 45 to 55 minutes, or until apples are tender. Drizzle with remaining syrup just before serving.

Sautéed Apples Supreme 2 SERVINGS | 1½ CUPS APPLE MIXTURE PLUS 1½ TEASPOONS WALNUTS W LS

2 small apples or 1 large apple 1 teaspoon butter ¼ cup unsweetened apple juice or cider 2 teaspoons brown sugar substitute ½ teaspoon ground cinnamon 2⁄3 cup fat-free, no-sugar-added vanilla ice cream or frozen yogurt (optional) 1 tablespoon chopped walnuts, toasted

1. Cut apples into quarters; remove cores and cut into ½-inch-thick slices. 2. Melt butter in large nonstick skillet over medium heat. Add apples; cook 4 minutes, stirring occasionally. 3. Combine apple juice, brown sugar substitute and cinnamon in small bowl; pour over apples. Simmer 5 minutes, or until apples are tender and sauce thickens. Transfer to serving bowls; serve with ice cream, if desired. Sprinkle with walnuts.

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••• AT THE TABLE ••• Apple Fest

1 cup unsweetened 100% cranberry juice, chilled ½ cup frozen unsweetened apple juice concentrate, thawed 1 large Red Delicious apple, peeled and cut into chunks 1⁄8 teaspoon ground cinnamon 3 cups ice cubes 1. Combine cranberry juice, apple juice concentrate, apple chunks and cinnamon in blender. Blend until smooth. Add ice; blend using on/off pulses until smooth and icy. 2. Pour into 4 glasses. Serve immediately. Note: Freeze any leftovers in 1-cup servings in small airtight microwavable containers. To serve, microwave each serving for 15 seconds on high; stir. Continue to microwave in 10-second increments until slushy.

TIP Store apples in the refrigerator, as leaving them outside will cause them to lose flavor and crispness. Also be aware that apple flesh will turn brown once exposed to air. After you slice them, rub them with lemon or lime to minimize the oxidation process.

48 DiabetesSelfManagement.com • Fall 2021

••• AT THE TABLE ••• Crunchy Cabbage

½ 2 2 2 ½ ¼ 2 2 ¾

cup finely chopped cilantro tablespoons fresh lime juice tablespoons olive oil teaspoons honey teaspoon ground cumin teaspoon salt cups sliced napa cabbage cups sliced red cabbage pound baby red potatoes (about 4 potatoes), quartered and cooked ½ cup sliced green onions 2 tablespoons unsalted sunflower kernels 1. Whisk cilantro, lime juice, oil, honey, cumin and salt in small bowl until smooth and well blended. Let stand 30 minutes to allow flavors to develop. 2. Combine napa cabbage, red cabbage, potatoes and green onions in large bowl; mix well. Add dressing; toss to coat evenly. Sprinkle with sunflower kernels just before serving. V FI HIGH-FIBER | W LF LOW-FAT | W LC LOW-CARBOHYDRATE | W LS LOW-SODIUM

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••• AT THE TABLE ••• Crunchy Cabbage is in season from the fall through the spring. TIP Cabbage Choose the red variety, the green variety or both! Don’t you hate it when you buy produce and it wilts before you’ve had time to use it? One advantage of cabbage is that it can be stored for a long time before it goes bad. If the scent of cooked cabbage permeates your kitchen, follow these tips to minimize the smell: Cook cabbage in stainless steel or enameled cast-iron pans. Add bay leaf, lemon or a few drops of lemon to the pan. You’ve probably heard your dietitian preach the nutrition virtue of eating green leafy vegetables or eating the rainbow, and cabbage is no exception. Besides being a good source of vitamins C and K, folate and potassium, this veggie also contains glucosinolates, compounds that may help prevent cancer. In addition to all these nutrients, red cabbage also contains polyphenols and vitamins A and C.

salad TIP This tastes even better the next day.

6 ounces cooked pork tenderloin, cut into ½-inch cubes (about 11⁄3 cups) 2 cups finely shredded red cabbage 1 medium carrot, shredded 1 green onion, thinly sliced (green and white parts) 2 tablespoons orange juice 1½ tablespoons garlic chili sauce 1 tablespoon reduced-sodium soy sauce 1⁄8 teaspoon black pepper 1⁄16 teaspoon red pepper flakes

2. Stir together juice, garlic chili sauce, soy sauce, black pepper and pepper flakes in small bowl. Pour over salad mixture. Toss gently but well. 50 DiabetesSelfManagement.com • Fall 2021

ANGELA SACKETT

1. Combine pork, cabbage, carrot and green onion in large bowl. Toss gently but well.

Pork With Apples, Fennel and Cabbage 4 SERVINGS | SERVING SIZE: 1 CUP CABBAGE MIXTURE, 1 PORK CHOP, 1⁄3 CUP SAUCE V FI

1 cup apple juice, divided, plus additional as needed 2 tablespoons balsamic vinegar ½ teaspoon caraway seeds ½ teaspoon dried thyme 4 boneless pork chops (about ¾ pound total) ¼ teaspoon salt ¼ teaspoon pepper 1 teaspoon canola oil 3 cups sliced green cabbage 1 medium bulb fennel, cut into ¼-inch slices 1 small onion, sliced into ¼-inch rings 1 large apple, thinly sliced 1 tablespoon cornstarch

1. Combine 2⁄3 cup apple juice, vinegar, caraway seeds and thyme in small bowl. 2. Sprinkle pork chops with salt and pepper. Heat oil in large nonstick skillet over medium-high heat. Add pork chops; cook 5 minutes, or until lightly browned, turning once. Transfer to plate. 3. Place cabbage, fennel and onion in same skillet. Pour in apple juice mixture. Reduce heat to medium-low. Cover and cook 15 minutes, stirring occasionally.

4. Return pork chops and any accumulated juices to skillet. Add apple; cover and cook 5 minutes, or until pork chops are barely pink in center. Use slotted spoon to transfer pork, apple and vegetables to plate; keep warm. Measure juices from skillet and add additional apple juice to equal 1 cup. Return to skillet. 5. Stir remaining 1⁄3 cup apple juice into cornstarch in small bowl until smooth. Add to skillet; cook and stir over medium heat until sauce boils and thickens. Serve over pork and vegetables.

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••• AT THE TABLE ••• Crunchy Cabbage

2 6 1 1 1 1 1½ 1 2 ½ 1½ 2

1. Lightly coat 9x13-inch oven-safe baking dish with nonstick cooking spray. 2. Place chicken on microwave-safe plate and cover with paper towel. Microwave on high 6 minutes. Set aside to cool. 3. Place collard greens in microwavesafe bowl and cover with paper towel. Microwave on high 6 minutes. Set aside to cool. 4. Pierce sweet potato with fork in several places. Place on a microwavesafe dish. Cook on high 10 minutes. Set aside to cool. 5. Cut head of cabbage in half lengthwise. Remove damaged outer leaves. Peel off large leaves without breaking. You should have 18 leaves. (Refrigerate remaining cabbage for other uses.)

6. Make 6 cabbage pockets by overlapping 2 leaves to form each pocket. Place pockets in microwave-safe baking dish. 7. Chop chicken. Mix together chicken, bell pepper, greens, tomatoes, rice, black pepper, parsley and sage in large mixing bowl. 8. Divide mixture among cabbage pockets, about 1 cup per pocket. Tuck cabbage leaf on top of each pocket. Cover baking dish with paper towels. Microwave on high 18 minutes. 9. Scoop out cooled sweet potato into small saucepan. Mash thoroughly with fork. Add broth, syrup and red pepper. Cook over medium-high heat, stirring occasionally, 10 minutes, or until mixture thickens slightly. To serve, spoon sauce over cabbage pockets.

ANGELA SACKETT

Nonstick cooking spray boneless skinless chicken breasts (8 ounces each) cups chopped collard greens medium sweet potato (about 5 ounces) small head green cabbage orange bell pepper, cored and chopped can (14½ ounces) reducedsodium diced tomatoes cups cooked brown rice teaspoon black pepper teaspoons dried parsley teaspoon dried sage cups fat-free, reduced-sodium chicken broth tablespoons sugar-free maple syrup teaspoon cracked red pepper

52 DiabetesSelfManagement.com • Fall 2021

••• AT THE TABLE ••• Marvelous Mushrooms

4 large portobello mushrooms 2 tablespoons sweet rice wine 2 tablespoons reduced-sodium soy sauce 2 cloves garlic, minced 1 teaspoon dark sesame oil

1. Prepare grill for direct cooking over medium heat. 2. Remove and discard stems from mushrooms; set caps aside. Whisk rice wine, soy sauce, garlic and sesame oil in small bowl until well blended. 3. Brush both sides of mushroom caps

with soy sauce mixture. Grill, top sides up, covered, 3 to 4 minutes. Brush tops with soy sauce mixture; turn and grill 2 minutes, or until grill marks appear. Turn again and grill, basting frequently, 4 to 5 minutes, or until tender. Remove mushrooms; cut diagonally into ½-inchthick slices.

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••• AT THE TABLE ••• Marvelous Mushrooms

TIP **Using prepared gravy is an easy way to help control fat, sodium and carb intake, especially during the food-heavy holiday season. With canned gravy, you know exactly what the nutrients are per serving size, something you can only guess with homemade gravy. A healthful serving of gravy is 2 tablespoons.

2 4 2 1 2

teaspoons canola oil ounces sliced fresh mushrooms* cloves garlic, minced can (10½ ounces) turkey gravy** tablespoons chopped fresh parsley 1 tablespoon dry sherry (optional) ¼ cup water or chicken broth 1. Heat oil in large nonstick skillet over medium-high heat. Add mushrooms. Cook 6 minutes, or until lightly browned, stirring frequently. Add garlic; cook 15 seconds. Add gravy; cook until heated through, stirring frequently. 2. Stir in parsley and sherry, if desired. Thin with water, if necessary. *Note: Fresh mushrooms are best to use in this recipe because canned mushrooms would add sodium in addition to the sodium already found in the prepared gravy.

54 DiabetesSelfManagement.com • Fall 2021

Turkey and Stuffing Stack 4 SERVINGS | SERVING SIZE: 3 OUNCES TURKEY AND ABOUT ¾ CUP STUFFING W LF

1. Preheat oven to 350°F. Heat oil in large nonstick skillet over medium-high heat. Add bell pepper, onion, garlic, mushrooms, rosemary and black pepper. Cook vegetables, stirring frequently, until bell pepper is tender, about 6 to 10 minutes. Pour in ¼ cup broth and scrape up browned bits. Stir in rice and salt. Set aside.

slice. Pour 1 cup broth into pan. Lightly cover pan with sheet of heavy-duty foil. Roast turkey stack 15 minutes. Remove foil; roast 15 to 20 minutes more, until breadcrumbs are golden brown and turkey is completely cooked.

2. Place half of turkey to form a bottom “slice” in shallow medium-size roasting pan. Spoon rice mixture over turkey, packing down. (Some rice may spill over.) Cover with remaining turkey, pressing down to form top “slice.” Sprinkle breadcrumbs over top turkey

4. Stir together cornstarch and remaining ½ cup broth. Place roasting pan on stove over medium heat. Pour in cornstarch mixture. Cook, stirring, until mixture is slightly thickened. Strain, if desired. To serve, slice turkey stack into 4 pieces. Serve with gravy.

ANGELA SACKETT

1 teaspoon olive oil 1 medium green bell pepper, cored, seeded and chopped 1 small onion, chopped 1 clove garlic, minced 1 cup sliced shiitake mushroom caps 1⁄4 teaspoon dried rosemary ¼ teaspoon black pepper 1¾ cups reduced-sodium chicken broth, divided 1 cup cooked wild rice 1⁄4 teaspoon salt 12 ounces turkey breast cutlets, about ½ inch thick 2 tablespoons fresh breadcrumbs 2 teaspoons cornstarch

3. Remove turkey stack to serving platter. Add any rice mixture from pan. Lightly cover with foil to keep warm.

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••• AT THE TABLE ••• Marvelous Mushrooms

Mushroom and Parmesan Omelet 2 SERVINGS | ½ OF OMELET W LC

56 DiabetesSelfManagement.com • Fall 2021

1. Heat oil in medium nonstick skillet with sloping sides over medium-high heat. Add mushrooms and shallots; cook 5 minutes, or until mushrooms are tender and liquid evaporates, stirring occasionally. Transfer mixture to bowl; set aside. (Do not wash skillet.) 2. Combine egg whites, egg, water, salt and pepper in medium bowl; mix well. 3. Heat same skillet over medium

heat. Add egg mixture; cook 2 minutes, or until eggs begin to set. Gently lift edge of omelet with spatula to allow uncooked portion to flow underneath. Continue cooking 2 minutes, or until center is almost set. 4. Spoon mushroom mixture over half of omelet; top with cheese. Fold opposite side of omelet over filling. Reduce heat to low; cook 1 minute, or until cheese is melted and center of omelet is set. Cut omelet in half.

ANGELA SACKETT

2 teaspoons olive oil 1 small package (4 ounces) sliced mixed mushrooms or whole button mushrooms, sliced 2 tablespoons chopped shallots or red onion 2 egg whites 1 egg 1 tablespoon water ¼ teaspoon salt 1⁄8 teaspoon freshly ground black pepper ¼ cup freshly grated parmesan cheese

••• AT THE TABLE ••• Pleasing Pears

2 ½ 3 2 ½ ¼ 4 1⁄3

pears, peeled and chopped cup unsweetened applesauce tablespoons chopped walnuts tablespoons sugar substitute* teaspoon ground cinnamon teaspoon ground nutmeg slices multigrain bread cup finely shredded Swiss cheese Chopped dried cranberries

1. Preheat oven to 425°F. Combine pears, applesauce, walnuts, sugar substitute, cinnamon and nutmeg in medium bowl. 2. Toast bread; place on nonstick baking sheet. Top evenly with pear mixture. Sprinkle with cheese. Bake 8 minutes, or until cheese melts. 3. Garnish with cranberries. *Note: This recipe was tested with sucralosebased sugar substitute.

discovered that you bought unripe pears? Place them in TIP Just a paper bag until they are soft and ready to eat. Pears are an excellent source of vitamin C and fiber. There are roughly 3,000 types of pears grown worldwide; some of the more common varieties include Anjou, Bartlett, Bosc, Comice, Forelle and Seckel. Select pears with unblemished skin and with a fragrant aroma. If you’ve bought them in a plastic bag, discard it when you get home to help the pears retain their freshness. The phytonutrients in pears are found in the skin, and the flavonoids in these fruits may help reduce blood glucose spikes.

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••• AT THE TABLE ••• Pleasing Pears

½ cup water ¼ cup dried cranberries ¼ cup dried apricots, cut into quarters ¼ cup no-sugar-added raspberry fruit spread 1 tablespoon red wine vinegar ¼ teaspoon ground cinnamon ¼ teaspoon plus 1⁄8 teaspoon salt, divided 1 medium pear, peeled and cut into ½-inch pieces ½ teaspoon vanilla

58 DiabetesSelfManagement.com • Fall 2021

4 bone-in lamb loin chops (about 5 ounces each) 2 cloves garlic, minced ¼ teaspoon dried rosemary, crushed Black pepper Nonstick cooking spray 1. Preheat broiler. For chutney, combine water, cranberries, apricots, fruit spread, vinegar, cinnamon and 1⁄8 teaspoon salt in medium saucepan; bring to a boil over high heat. Reduce heat to medium-low; simmer, uncovered, 12

minutes, or until mixture is thickened. Remove from heat; stir in pear and vanilla. 2. Rub both sides of lamb chops with garlic. Sprinkle with remaining ¼ teaspoon salt, rosemary and pepper. Coat broiler pan and rack with nonstick cooking spray; arrange lamb chops on prepared rack. 3. Broil lamb at least 5 inches from heat source for 7 minutes. Turn and broil 7 minutes more, or until desired doneness. Serve lamb chops with chutney.

••• AT THE TABLE ••• Plentiful Pomegranates

3 2 3-4 2 1

cups water, divided spiced chai tea bags tablespoons sugar substitute tablespoons lemon juice cup blueberry pomegranate juice

1. Bring 1 cup water to a boil in small saucepan over high heat. Remove from heat. Add tea bags. Steep 3 minutes. Discard tea bags. 2. Pour remaining ingredients into pitcher. Mix well. Add brewed tea; stir. Serve immediately over ice, or cover and chill. Variation: Also may be served hot.

probably have TIP You seen or tasted pomegranate juice and perhaps have come across the whole fruit, complete with its round, deep-red, leathery skin. Don’t let the tough exterior deter you from trying this ancient Iranian fruit, filled with plump and juicy seeds. Select pomegranates that have no blemishes or bruises on their coating and feel very heavy. When cutting the pomegranate, scoop the seeds out with your hand or tap the bottom with a spoon until the seeds fall out. Make sure you do this over a large bowl, as it could get quite messy. Pomegranate is high in vitamins C and K. It is also a good source of folate, potassium, copper and polyphenols (a type of antioxidant). In the United States, most pomegranates are grown in California.

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••• AT THE TABLE ••• Plentiful Pomegranates

Spinach Salad With Pomegranate Vinaigrette 4 SERVINGS | ¼ OF TOTAL RECIPE W LC

1 ½ ¼ 2 ¼ 2 1 1 ¼ ¼

package (5 ounces) baby spinach cup pomegranate seeds (arils) cup crumbled goat cheese tablespoons chopped walnuts, toasted* cup pomegranate juice tablespoons olive oil tablespoon red wine vinegar tablespoon honey teaspoon salt teaspoon black pepper

1. Combine spinach, pomegranate seeds, goat cheese and walnuts in large bowl. 2. Whisk pomegranate juice, oil, vinegar, honey, salt and pepper in small bowl until well blended. Pour over salad; gently toss to coat. Serve immediately. *Note: To toast walnuts, spread in single layer in heavybottomed skillet. Cook over medium heat 1 to 2 minutes, stirring frequently, until nuts are lightly browned. Remove from skillet immediately. Cool before using.

easier removal of pomegranate seeds, cut TIP For a pomegranate into pieces and immerse in a bowl of cold water. The membrane that holds the seeds in place will float to the top; discard it and collect the seeds. For convenience, you can find containers of ready-to-use pomegranate seeds in the refrigerated produce section of some supermarkets.

60 DiabetesSelfManagement.com • Fall 2021

••• AT THE TABLE ••• Plump Pumpkins

1 ¼ ¼ 1 1 ½ 1 ½ ¼ 1⁄8

can (4 ounces) diced green chiles cup plain nonfat Greek yogurt cup fresh cilantro leaves can (15 ounces) solid-pack pumpkin can (about 14 ounces) fat-free reduced-sodium chicken or vegetable broth cup water teaspoon ground cumin teaspoon chili powder teaspoon garlic powder teaspoon ground red pepper (optional) Additional plain nonfat Greek yogurt (optional)

1. Combine chiles, ¼ cup yogurt and cilantro in food processor or blender; process until smooth.* 2. Combine pumpkin, broth, water, cumin, chili powder, garlic powder and red pepper, if desired, in medium saucepan; stir in ¼ cup green chile mixture. Bring to a boil; reduce heat to medium. Simmer, uncovered, 5 minutes, stirring occasionally. 3. Ladle into four bowls. Top each serving with small dollops of remaining green chile mixture and additional yogurt, if desired. Run tip of spoon through dollops to swirl. *Note: Or add chiles directly to soup. Finely chop cilantro and stir into yogurt. Top soup with dollops of yogurt-cilantro mixture as directed.

ANGEL TUCKER

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Fall 2021 • DiabetesSelfManagement.com

••• AT THE TABLE ••• Plump Pumpkins

Creamy Pumpkin Baked Penne 9 SERVINGS | 1⁄9 OF TOTAL RECIPE V FI

Nonstick cooking spray package (14½ ounces) multigrain penne teaspoon olive oil small onion, chopped cloves garlic, minced cup low-fat ricotta cheese cup reduced-sodium chicken broth can (15 ounces) solid-pack pumpkin can (28 ounces) crushed tomatoes tablespoon Italian seasoning teaspoon red pepper flakes cup (4 ounces) shredded reduced-fat mozzarella cheese 1⁄3 cup grated parmesan cheese

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DiabetesSelfManagement.com/recipes 62 DiabetesSelfManagement.com • Fall 2021

1. Preheat oven to 375°F. Spray 13x9-inch baking dish with nonstick cooking spray. Cook pasta according to package directions until al dente, omitting any salt or fat. 2. Heat oil in Dutch oven. Add onion and garlic; cook and stir 3 minutes. 3. Add next 6 ingredients to Dutch oven. Bring to a boil; simmer 5 minutes. Add pasta; toss to combine. 4. Transfer pasta mixture to prepared baking dish. Sprinkle mozzarella and parmesan cheeses evenly over top. Bake 30 to 35 minutes, or until cheeses are golden brown.

recipe index

Pumpkin Snacker Cakes 24 SERVINGS | 2 CAKES

APPLE FEST

W LF

44 Apple Pecan Spice Squares 45 Enlightened Apple Crisp W LF | W LS

¼ ¼ 1 1¼ 3

cup old-fashioned or quick oats cup shredded unsweetened coconut package (about 18 ounces) spice cake mix cups water eggs or 6 egg whites or ¾ cup cholesterol-free egg substitute 1 cup solid-pack pumpkin ½ teaspoon ground nutmeg or apple pie spice ½ teaspoon vanilla or vanilla, butter and nut flavoring

1. Preheat oven to 325°F. Line 48 mini (1¾-inch) muffin cups with paper baking cups. 2. Toast oats and coconut in large nonstick skillet over medium heat 3 to 4 minutes, or until coconut starts to brown, stirring constantly. Remove from skillet; set aside. 3. Combine cake mix, water and eggs in large bowl. Beat with electric mixer at low speed 30 seconds, or until moistened. Beat at medium speed 2 minutes, scraping bottom and side of bowl. Add pumpkin, nutmeg and vanilla; beat until well blended. 4. Spoon batter into prepared muffin cups, filling twothirds full. Sprinkle oat mixture evenly over top of batter. Bake 10 minutes, or until toothpick inserted into centers comes out clean. Cool in pans on wire racks 10 minutes. Remove cupcakes to racks; cool completely. Store in tightly sealed container.

46 Maple Glazed Apples W LF | W LS 47 Sautéed Apples Supreme W LS 48 Frozen Apple Slushies W LF | W LS CRUNCHY CABBAGE 49 Cabbage and Red Potato Salad With Cilantro-Lime Dressing

50 Pork Tenderloin and Cabbage Salad With Chili Dressing W LF | W LC

5 1 Pork With Apples, Fennel and Cabbage

V FI

52 Cabbage Pockets

V FI | W LF

MARVELOUS MUSHROOMS 53 54 55 56

Mushrooms Sesame W LF | W LC Mushroom Gravy

W LF | W LC

Turkey and Stuffing Stack

W LF

Mushroom and Parmesan Omelet W LC

PLEASING PEARS 57 Open-Face Pear and Walnut Breakfast Sandwiches

FI | W LS

58 Lamb Chops With CranberryPear Chutney

PLENTIFUL POMEGRANATES 59 Iced Pomegranate Tea W LF | W LC | W LS

60 Spinach Salad With Pomegranate Vinaigrette

W LC

PLUMP PUMPKINS 61 Spicy Pumpkin Soup With Green Chile Swirl

W LF | W LC

62 Creamy Pumpkin Baked Penne V FI

63 Pumpkin Snacker Cakes V FI HIGH-FIBER | W LF LOW-FAT | W LC LOW-CARBOHYDRATE | W LS LOW-SODIUM

W LF

Fall 2021 • DiabetesSelfManagement.com

••• FINAL COUNTDOWN •••

All in the Details BY DIANE FENNELL

Hiking is the fourth most popular outdoor activity in the United States. Roughly 44.9 million people went for a hike in 2017. This exercise can help improve sleep, combat bone density loss, reduce anxiety and depression, and more. There are more than 12,000 miles of trails in America’s national parks. Take a hike over to the “Curmudgeonly Athlete” (page 17) and learn about getting started in this popular pastime.

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Back pain is the most common pain condition. Although the brain interprets pain signals, it cannot feel pain itself. Redheads are more sensitive to pain. There is a rare genetic condition that makes certain individuals unable to feel pain. If pain is putting a damper on your days, visit “Pain and Diabetes” (page 32) to learn about the connection between these conditions and how to get relief.

The earliest evidence of soup consumption dates back to 6000 B.C. Americans eat more than 10 billion bowls of soup annually. Chicken noodle is the most popular variety of soup in the United States. Women are twice as likely to order soup at a restaurant as men. If you’re feeling soup-er, head over to our “Smart, Smarter, Smartest” column (page 21) for a list of some top soup picks.

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A part of the brain called the hippocampus plays an important role in memory. Scents can help trigger memories. Each time a memory is created, new brain connections are formed. A good night’s sleep can help improve memory. Short-term memory lasts just 20 to 30 seconds. Remember to read “How Am I Going to Remember to Do That?” (page 36) for hacks that can help you keep track of your diabetes routine.

SHUTTERSTOCK

Tooth enamel is the hardest substance found in the human body. The average American spends 38.5 days brushing their teeth over the course of a lifetime. There are more than 300 types of bacteria in dental plaque. Commercial floss was first produced in 1882. Do these facts have you smiling? Head over to page 28 for tips on how to keep your mouth in top shape.