Diabetes newsletter - October 2019

DIABETES NEWSLETTER

OCTOBER 2019

WE NEED YOUR HELP! The diabetes team needs your input on creating the best possible experience for patients and families. We know the voice of patients and families is essential to planning, developing and implementing improvements. We want to design your care collaboratively with you.

If you are interested in sharing ideas with us on clinic initiatives, projects, and program changes, come to our inaugural brainstorming session on Nov 14! Alternatively, you can always send suggestions or ideas by email to DiabetesIdeas@smh.ca.

Did You Know? Physical activity often improves glucose control and has multiple other health benefits such as improving heart health even if weight and glucose control do not change.

We are excited to hear from you!

Diabetes Brainstorming

Editors’ Note Welcome to the fall edition of our Newsletter! This is the time of year when the weather gets cooler and we have the opportunity to see the leaves turn into beautiful shades of orange, yellow and red.

This can also be the perfect time for you to kick start an exercise plan to enjoy the crisp outdoors, before the arrival of winter.

In this issues you will find useful information to help you get started and to help you control your blood sugar during exercise. Included is the story of Mark Ma, who uses exercise and a variety of other strategies to improve his diabetes care. You will also receive advice from Jason Liu our Chiropodist, on how to keep your feet healthy when exercising.

Please take time to challenge yourself and use the chart provided on page 5 to track your activity. Even 5 to 10 minutes per day is better than zero.

Share ideas with us about how we can better provide care, services, or activities to best support you in managing diabetes.

November 14, 2019 (World Diabetes Day) 10 – 11:30 a.m.

7th floor conference room Please register in advance via email to DiabetesIdeas@smh.ca Can’t make it? We welcome your suggestions by email to DiabetesIdeas@smh.ca.

World Diabetes Day is November 14

As we strive to improve your clinic experience we look forward to your feedback in person or at the Brainstorming session.

If you have any questions, comments, suggestions or contributions for this Newsletter, please send us an email. We value your opinion.

Annabell Hall RN, MN, CDE and Lucy Chen PharmD, CDE

World Diabetes Day

Get involved!

Annabell.Hall@unityhealth.to or Lucy.chen@unityhealth.to

Printed on 100 per cent recycled paper

OCT 2019 | DIABETES | 1

Physical activity and diabetes Key Messages for People with Diabetes, from Diabetes Canada Clinical Guidelines 2018

From: Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes.

2018;42(Suppl 1):S1-S325.

Recommendations from Diabetes Canada Guidelines for people with Type 1 Diabetes To reduce risk of low blood sugar during and after exercise, the following 5 strategies can be considered: •

Reduce the bolus dose of the insulin that is most active at the time of exercise.

•

Significantly reduce basal insulin for the duration of your exercise and lower the basal rate overnight after exercise by ~20%.

•

Increase carbohydrate intake prior to, during and after exercise, as necessary.

•

Perform resistance exercise before aerobic exercise.

•

Perform brief (10 seconds), maximal-intensity sprints at the start of exercise periodically during the activity or at the end of exercise.

2 | DIABETES | OCT 2019

•

Physical activity often improves glucose control and has multiple other health benefits even if weight and glucose control do not change.

•

It is best to avoid prolonged sitting. Try to interrupt sitting time by getting up briefly every 20 to 30 minutes.

•

Using a step monitor (pedometer or accelerometer) can be helpful in tracking your activity.

•

Try to do at least two sessions per week of strength training (like exercises with weights, or weight machines).

•

Try to get at least 150 minutes per week of aerobic exercise (like walking, bicycling or jogging).

•

If you cannot reach these levels of activity, doing smaller amounts of activity still has some health benefits.

Want to learn more?

Visit guidelines.diabetes.ca to learn more about what experts recommend for different aspects of diabetes care.

Each chapter includes a Key Messages for People with Diabetes section, written specifically for a non-medical audience.

An interview with Mark Ma: using different strategies to improve self management

By Lucy Chen, CDE, Care & Transitions Facilitator Mark Ma was diagnosed with pre-diabetes more than 10 years ago. Over the last decade, Mark tried different ways of bringing his blood sugar levels under control. At times, it was a struggle when his numbers didn’t seem to budge no matter what he tried.

We sat down with Mark to talk about how he recently discovered an effective exercise and nutrition regimen for himself.

What do you do for exercise? How did you start?

I’ve been exercising for years. It didn’t really seem to help until I made a conscious effort of counting how far I walked every day.

This started 1 year ago, when I bought a fitness tracker. I made a goal of the number of steps I had to walk every day. I challenged myself to walk 17,500 steps every day. Right now, today, I just have about 3600 steps. I know I have to walk about 10,000 steps during the day, and then after I get home I can do more walking after dinner.

Just exercising alone is not good enough. It’s also what you put into your body. I made a more conscious effort to have portion control. I still eat the food I like, but I eat smaller portions. I find that some diets are very restrictive. What is the point of life if I cannot enjoy anything?

I Lowered My Blood Sugar and Cholesterol with Diet and Exercise 9 8

8.4

Fasting blood glucose (mmol/L)

7 6 5 4 3 2 1 0

6.25

4.22

2.21

6.1 4.65

2.78

0.98 Before

After

Total cholesterol (mmol/L) LDL cholesterol (mmol/L) Triglyceride (mmol/L)

Mark works out as one of the ways he controls his blood sugar.

I still get to enjoy ice cream, or fruits, when I want but I limit the size.

When I started intermittent fasting, this strategy seemed to speed results up as well. I eat during an 8-hour period every day, ending with supper at 6 pm. That helped even more. I’m burning fat that I wouldn’t normally be burning. At first I was worried that I’d be faint or weak in the morning, but after a while I got used to it.

Have you noticed if exercise has an impact on your diabetes control? What kind of impact?

I’ve been fighting with blood sugar and cholesterol for a long time and nothing seemed to help. After I started my exercise regimen and controlling my portions, both my blood sugar and cholesterol levels went down quite a bit. A year ago, my A1C was 8.9% but most recently it is down to 6.6%. My LDL cholesterol is also at its lowest level ever in the last couple years.

Dr. Josse said he couldn’t believe the results. I’ve been resisting

Continued on page 4 OCT 2019 | DIABETES | 3

Mark Ma interview continued from page 3 starting a medication for my cholesterol for years. I’m really glad to bring down my cholesterol through exercise and diet.

I lost 10 pounds in the last year. I also feel stronger because I started strength training to build more muscle. My shirts and pants have all had to be taken in.

What keeps you motivated to keep exercising?

My fitness tracker can match you up with a group of people. You can have a competition of how many steps.

I always like to win. If I want to beat the other person, I will walk another 10 minutes. But, tracking is useful for everyone though, even if you are not competitive. It makes you aware of how little you have a walked throughout the day.

Mark’s personal steps recorder

What advice do you have for others who live with diabetes?

Look into intermittent fasting.

Before, I always thought people with diabetes must have consistent amount of sugar in the bloodstream, so I always ate a snack every night at 9 or 10 pm, even if I was just a little hungry. This easily added another 200 calories every day.

When I first heard about intermittent fasting, I was skeptical because it went against everything I had learned up to that point. But I knew I had to try a different approach. If I keep doing the same thing I used to do, it’d be ludicrous to expect a different result.

4 | DIABETES | OCT 2019

Expert Commentary Johanna Prehogan, RD Intermittent fasting is a great tool for some, but it may not be safe for everyone.

For example, if you use insulin or take certain types of diabetes medications, intermittent fasting might be unsafe. It’s best to check with your diabetes doctor or educator before starting any new diet plan. The most important thing is not to get discouraged. Learn about different options and don’t be afraid to discuss them with your diabetes team. Like Mark has done, it’s about finding a plan that fits you and your life.”

Your 30 Day Activity Challenge Challenge yourself to do some sort of activity EVERY DAY for 30 DAYS. Even if you have only 5 or 10 minutes, find an activity that can fit into your day wherever you are. Remember that 5 or 10 minutes is better than zero minutes! Any activity counts: walking, stretching, dancing, yoga, gardening, and beyond.

You can use the chart below to track your progress.

Day

Activity

Time

Day

Activity

Time

1

16

2

17

3

18

4

19

5

20

6

21

7

22

8

23

9

24

10

25

11

26

12

27

13

28

14

29

15

30

Recommendation from the experts “To increase physical activity, employ strategies such as setting specific physical activity goals, using self-monitoring tools (pedometers or accelerometers), and developing plans to overcome anticipated barriers”.

Diabetes Canada 2018 Clinical Guidelines OCT 2019 | DIABETES | 5

Families provide crucial support in diabetes care Adapted from original article by Mary Dickie, Communications Advisor Each year, World Diabetes Day is celebrated on November 14. In 2018 and 2019, the focus is “The Family and Diabetes”. Last year, we asked some patients who receive care and services through the St. Michael’s Diabetes Comprehensive Care Program to tell us about their experiences with diabetes, and the family support systems that help them manage the disease.

Elaine Smith, 79, whose family support is her partner, Sandra Fishleigh, says she was diagnosed with diabetes at 23. “It was not a surprise, because there are people with diabetes on both sides of my family,” she says. “I never considered it a major debilitating condition, it was just a fact that I had to live with. St. Mike’s is wonderful, the staff are very supportive and helpful, and I’ve been able to make use of all of their services over the years.”

Things changed for Smith about 15 years ago, when she became blind. “It was horrific for a while,” she admits. “There’s a grieving that happens when you lose something, your sight or a limb or whatever, and I was not prepared for that.”

That’s when Fishleigh went from being an observer in Smith’s care to an active participant. “My role has changed a lot through the years,” she explains. “When Elaine first started on insulin, I was just a witness, it was Elaine’s issue, and she managed it. I mean, I supported things around meals and not having desserts and that kind of thing, but she was in charge. She also has Parkinson’s

Elaine and Sandra now. So with Parkinson’s and blindness, my role changed. I do the measuring of the insulin and the blood sugar. I see myself as actively involved in the care of diabetes, whereas before I was an observer.”

“Sandra is my partner, she guides me not just through diabetes, but through my life,” adds Smith. “She helps me to get from point A to point B and describes everything to me. She’s my right hand.”

Let’s talk about Auto Mode: In August we hosted an event for people who have Type 1 diabetes and are wearing the new Medtronic 670G insulin pump.

The unique feature of this pump is that it delivers insulin every 5 minutes according to the blood glucose readings from the continuous blood glucose monitor. At this event people were able to discuss any challenges that they were experiencing, interact with each other and receive tips from the Medtronic experts.

Participants shared a meal together and were able to discuss carb counting challenges and successes.

6 | DIABETES | OCT 2019

Participants can be seen networking with each other, the educators, and the experts from Medtronic.

Choose the right shoes: Tips for keeping feet healthy when exercising

By Jason Liu, Chiropodist In a survey among people with diabetes, the most feared complication identified was amputation of the leg, foot or toes, as a result of wounds that fail to heal due to infection or poor blood flow. Therefore, it is important that people with diabetes monitor their feet daily in order to detect dry cracked skin, calluses, corns, redness, Charcot foot, deformity of the toes, cuts, blisters and wounds.

If you have diabetes, your feet should be checked by a licensed chiropodist regularly. A chiropodist will check your feet to see if there is good blood flow and good nerve sensation. To assess blood circulation, the chiropodist checks general skin colour, skin temperature, and feels for pulses in the feet. To check nerve sensation, they use special instruments called monofilament or tuning fork to see if any areas of your feet are lacking in sensation. Based on the findings, the chiropodist will develop a treatment plan unique to each person.

Treatments may include regular nail care, as well as callus and corn removal. It is critical to reduce calluses regularly. Excessive callus build-up can increase pressure on the skin underneath and cause skin breakdown and ulcers.

When exercising, footwear must be considered in order to prevent injury. It is best to have a chiropodist assess your foot type to ensure the footwear is appropriate. However, there are common features to look for when choosing good shoes.

Try on shoes at the end of the day to accommodate foot swelling. Remember to try both shoes on while standing. Make sure there is 1 cm of room between your longest toe and the end of the shoe. Always wear socks (nylon or wool) to prevent blisters and infections.

Replace footwear every 8 to 12 months or every 500 to 700 kilometers.

Here are a few tips that can help protect your feet from possible wounds and infection •

Check your feet every night using a hand-held mirror.

•

Moisturize daily, but avoid areas between toes where fungus and bacteria can grow.

•

Wear white socks, so any blood or pus can be easily detected.

•

Check the inside of your shoes with your hands, to ensure that nothing is stuck in them.

•

Never walk barefoot, always wear supportive shoes, both indoors and outdoors.

•

Do not let your feet get wet in rain or snow. Always keep them dry.

•

Most importantly, visit the chiropodist regularly to have professional callus and nail care. Never treat a corn or a callus yourself, especially not with an over-the-counter corn pad.

Features of a good shoe Cushioned tongue

Soft upper material containing no seams

Deep and wide toe box

Firm sole and back of the shoe, must not be too soft that the foot will distort the shoe and cause pressure points

Remember to get your flu shot!

People with diabetes are more likely to get seriously ill from the flu. Having the flu can also make your blood sugar levels hard to control.

To protect yourself, you can get a FREE flu shot from your family doctor, your local pharmacy or at a community centre.

The flu shot is available every fall, usually in October.

OCT 2019 | DIABETES | 7

Crispy Chickpeas & Pumpkin Seeds with Lime Prep Time: 5 minutes Cook Time: 35 minutes

Ingredients: 2 cans (14oz) chickpeas, drained and rinsed 2 tbsp canola oil 2 tsp smoked paprika 1 tsp cumin 1 tsp garlic powder ½ cup hulled pumpkin seeds Grated zest from 1 medium lime Recipe courtesy of Diabetes Canada / canolainfo.org

Nutritional Information Per 1/3 cup (75 mL) Calories 316 Fat 7 g (Saturated 1 g + Trans 0 g) Cholesterol 0 mg Sodium 200 mg Carbohydrate 14 g (Fibre 4 g + Sugars 2 g) Protein 6 g

Instructions: Preheat oven to 425F In a medium bowl combine chickpeas, oil and spices. Reserve pumpkin seeds and lime zest. Toss chickpeas until well coated.

Spread mixture on a baking sheet in a single layer and bake for 30 minutes (or until beginning to brown) stirring every 10 minutes.

Remove tray from oven and sprinkle with pumpkin seeds, stir, and bake for 5 minutes more or until chickpeas are crispy. Be careful they do not burn.

Remove from oven and toss with lime zest. Let stand on baking sheet for 30-45 minutes for crisp texture and best flavors.

When cooled, store in airtight container at room temperature for up to two days.

Across 2. do this activity in a lake ocean or pool 4. treatment for low blood sugar 6. highly caffeinated 10. carbohydrate is another word for a food that turns into 11. weight ___ can improve insulin sensitivity 13. low ______ index (GI) foods help control blood sugar and cholesterol 14. Insulin ______ is a component of type 2 diabetes 16. keeps you hydrated 18. insulin _______means “requiring insulin” 19. basket ______, volley ______, foot ______

Diabetes crossword

Down 1. protein helps to build 3. blood sugar may become _____ after aerobic exercise 5. helps to decrease blood sugar 7. get 150 minutes per week of aerobic _____ 8. comfortable _______ to prevent foot injury 9. these should fill half of your plate 12. apply this to prevent skin cancer 15. high intensity interval training (acronym) 17. bike or run on the Martin Goodman ____ in Toronto

DIABETES NEWSLETTER

OCT 2019

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