November 30, 2010

Holiday Food Strategies

A lot of those of you reading this have been doing very well with your diets over the past weeks, months or even years. You know what's at stake and you're willing to forgo tempting high-carb treats if that's what it takes to avoid blindness, amputation or kidney failure. You have found meals that work for you, things to eat at lunch at work, and treats that don't raise your blood sugar to the levels that will harm you.

Then the holidays come and it gets ugly. Suddenly there's food everywhere and all of it is bad for you. Making good choices four or five times a day is tough enough. Making them 21 times a day can overwhelm the best of us.

And even worse, the food you encounter at this time of year comes with a lifetime's worth of emotionally plangent associations. It hurts to say no to a slice of Aunt Mary's Pecan Pie--your favorite since you were four. It's even worse not to be able to eat the cake you have baked every year since you had your own kids using your grandma's recipe--passed on from her own grandmother. The parties at work are full of things you used to love eating. The parties your friends give are full of once-a-year treats, too.

Everyone else can eat them, promising themselves they'll go on a diet in January. Not you. You know too well that indulging in six weeks of unrestrained eating will undo the very hard work you've done over the past year and possibly derail the good habits you've worked so hard to develop.

But avoiding it all can end up sending you into a deep depression, or fill you with rage at those people around you who are so carelessly damaging their bodies. Because food is so tightly linked with other emotions it is tough for most of us to turn away from food without paying a psychic cost.

So what to do?

The answer will be different for each of us, as our life histories and physiologies will also differ. But to help you out I've listed some strategies that have worked for myself and other people with diabetes over the years. Perhaps some of them will help you get through this stressful time of year.

1. Schedule Indulgence. Some of us do best if we build "safety valves" into our dietary regimens. If you know you can eat whatever you want on certain days (or hours) you might find it easier to say "no" to the food temptations that assail you the rest of the time. One day of high blood sugars every two weeks won't kill you and if you know you will eat freely at your Aunt Mary's traditional Christmas banquet--it's easier to say "no" to the packaged cookies, stale donuts, and mix-made brownies that assail you at work.

2. Keep the Foods that Really Tempt You OUT of the House One of the most helpful rules of dieting is this: If it isn't there you can't eat it. I have learned through dire experience that if there's a box of peppermint bark anywhere in the house, I'm in trouble. I do give myself permission to buy a small bar of the stuff and enjoy it, but when it's gone, it's gone. Family members, who agree I'm much cuter with all my toes, are respectful of my limits and do not fill the fridge with things that will make my life hard. Fortunately, there are plenty of holiday foods that don't appeal to me that they like, which are the ones they do bring home.

3. Fill the Fridge with Low Carb Treats. You can make Low carb cheesecake, pumpkin bread, rum flavored chocolate truffles, fudge and a host of other foods which are legal and will give you something to eat when the need to eat holiday junk becomes overwhelming. Buy yourself a wheel of Brie (sold this time of year at Whole Foods at a very reasonable price.) Pate is another holiday treat food which can be indulged in freely as are fancy sausages and ham.

4. Set a Reasonable Diet Goal. If you're in weight loss mode, it may be a lot easier to set as your holiday goal to end up at the same weight on January 2 as you were on November 24 rather than to lose weight during the holiday period. Everyone diets in January, which makes it much easier to get back on track then.

5. Learn About the Physiological Reasons Why Food Can Get Out of Control When You Indulge. If you've been controlling by keeping your carbs low, you may be taken aback at the ravenous hunger that may emerge when you indulge in high carb treats. Too many people take this as a personal failing which turns self-hatred into yet another factor making them eat even more. I have put up a web page that explains why this happens and how to get the best of it when it does: When You Crash Off Your Diet

6. Give Your Self Some Motivating Alternative Rewards. Set yourself goals and if you achieve them, reward yourself with some non-food gift to yourself that you wouldn't otherwise indulge in. Make it something you really want. If your finances are strapped ask your family or best friends to help you with this. If you know you'll get that piece of jewelry you've longed for, or a weekend away, in January, if you achieve your diet goals, it may be easier to achieve them.

7. Forgive Yourself. If despite your best efforts things don't work out as you'd have liked, admit you're human and move on. People with diabetes have enough to contend with without adding self-hatred into the mix. Do the best you can and if it isn't enough, start over--not next week or next year, but right now. When you start over, analyze what it was that derailed you this time, so you can come up with an alternate strategy that will work better with your own, unique personality.

What have you found most helpful in getting through this season of non-stop food orgies?


November 23, 2010

Gift Ideas for People With Diabetes

It's that time again. I've blogged on this topic several times before. You'll find those posts here. I have updated the links where they needed to be updated:

Great Gifts for People with Diabetes (2009)

Holiday Gifts for People with Diabetes (2008)

The suggestions you'll find in these older posts are still useful. But here are some more.

1.Erythritol for baking There are several different brands of this sugar alcohol sweetener available online. It's expensive, but it is the one sugar alcohol that does not raise blood sugar and I've found that if you mix it up with a bit of Da Vinci Sugar free syrup it gives baked goods a very nice flavor.

2. Accu-Chek Multiclix Lancet Device Kit. This is a great gift for someone who does not use an Accuchek meter. The lancet comes free with the meters, so it's a waste of money for someone who does. The advantage of this lancet is that it is by far the most painless blood sugar testing device on the market. The lancets come in drums of six and since I only change to the next lancet every three months or so a box of the lancet drums will last many years.

3. Yoga, Swimming, or Other Fitness Classes at a local Gym or Y. These often cost extra above monthly membership prices, so if your giftee already belongs to a gym, they might appreciate your gift of some of these classes. Make sure you check which gym they attend. A three month membership in a gym that has a pool with lots of free swim time and hot tub is a wonderful "vacation at home" gift, especially in cold climates. (Oh how I wish there was a pool like that near me I could sign up for!)

4.Hypnosis Sessions to Help Achieve Dietary Goals. Some people find hypnotic suggestion very helpful in giving themselves a boost in their motivation. Dr. Bernstein recommends this technique in his book, and though I haven't used it for dieting, I have used it for other applications and have found it very useful. Look for someone who has been in practice for a while in your area and who can give you local references. A good hypnotist will ask the person exactly what suggestions they want to have implanted and create a CD of the session they can use at home. If you live in New England I highly recommend the services of Janet Masucci in Gill, MA.

5. Carb Counting and Nutritional Database Apps for Smartphones. Having nutritional information at your fingertips makes it a lot easier to track carb and calorie intake. This pays off for either weight loss or insulin dosing. Apps that give restaurant food counts can be very helpful. Look for nutritional sofware that makes clear portion size as counts without this vital information are useless.

6. Pulse Rate Monitor A very safe, healthy way for older people who are out of shape to improve fitness is to calculate the target pulse rate for low intensity workouts (there are sites online that will do this for you) and then to use a pulse rate monitor to stay in the "zone" where they are getting a good but safe workout doing simple exercises like brisk walking or biking. There are quite a few inexpensive monitors on the market nowadays which can be helpful for reassuring people that they are exercising enough to get benefits from it.

7. Help Paying for Meds and Testing Supplies. A shocking number of prescriptions go unfilled because people can't afford them, or because the copays are too high. People on Medicare may also have run out of coverage this time of year. Don't be shy about asking friends with diabetes if they'd like the gift of help in paying for essential medications.

That's a start. Please add your own suggestions in the comments section.

This is the time of year to make sure in advance that your friends and family know NOT to give you food gifts labelled "SUGAR FREE" or "DIABETIC.: These foods are invariably very high in carbs and the candies will often give you the runs. Just tell people that if they want to give you diabetes friendly food gifts they should stick to cheese, meat, nuts, dry wines, and dark chocolates (70% and higher).


November 18, 2010

Inhaled Cortisone Raises Risk of Diabetes By 34 Percent and Worsens Existing Cases

As someone who saw her marginal blood sugar control deteriorate dramatically and permanently after a single course of prednisone I know that cortisone can cause permanent damange to blood sugar control.

Years ago when I posted about this on the old board, several people sent me emails reporting that the same thing had happened to them. Prescription cortisones had either made them diabetic or, if they were diabetic but in good control, the cortisones had made their blood sugar control much harder, in some cases forcing them to use insulin.

My doctors have continued to tell me that the changes that cortisone makes in blood sugar are temporary. Now large study confirms that exposure to another form of cortisone, that found in the inhalers used to treat asthma and allergies, dramatically raises the risk of diabetes and worsens the blood sugar control of people who already have diabetes. The study is:

Inhaled corticosteroids linked to increases in diabetes incidence
Suissa S. Am J Med. 2010;doi:10.1016/j.amjmed.2010.06.019.

You can find an excellent summary of the study findings at Endocrinology Today here:

ET: Inhaled corticosteroids linked to increases in diabetes incidence

Here's the gist of the study as reported by Endocrinology Today:
The study cohort was composed of 388,584 patients, with 30,167 experiencing diabetes onset during a mean of 5.5 years of follow-up. Calculations put annual incidence rate at 14.2 per 1,000 patients.

Results also revealed that 2,099 patients progressed from oral hypoglycemic treatment to insulin, translating to an annual incidence rate of 14.2 per 1,000 patients for diabetes progression.

Data also linked inhaled corticosteroids with a 34% boost in the incidence of diabetes onset (RR=1.34; 95% CI, 1.29-1.39), although the greatest increase was seen among patients receiving the highest doses or the equivalent of at least 1,000 mcg of fluticasone daily.

Incidence of diabetes progression also rose with the current use of inhaled corticosteroids, with results indicating an RR of 1.64 (95% CI, 1.52-1.76). Again, the highest doses were associated with the greatest increase in incidence of diabetes progression (RR=1.54; 95% CI, 1.18-2.02).
These inhalers may be necessary for people with life-threatening asthma, and if you need one for that reason, you may just have to take the hit to your blood sugar.

But I know, from personal experience with family members, that doctors prescribe these powerful corticosteroid inhalers to people for mild allergies and bronchitis. In that case the risk involved is much higher than is justified by the relief the inhalers provide.

If you have a family history of diabetes, diabetes yourself, or know that you are insulin resistant, avoid these inhalers unless you need them to prevent severe asthma crises.

The same is true of all other forms of cortisone. Orthopedic surgeons will offer just about any one that comes into their office complaining of a sore joint a steroid injection, even in cases, like frozen shoulder, where the clinical evidence proves that these shots do nothing to speed up healing. My guess is that the surgeons do this because it makes the patient feel that they've done something to justify the whopping bill for the appointment.

Unfortunately, what these shots may also have done is damage your blood sugar control permanently. So think twice before you allow a large shot of any cortisone to be injected into your body.

Cortisone does not always cause permanent damage. The amount of the dose seems to be important, as the study above suggests. In most cases cortisone treatments will elevate blood sugar for a week or so and then the blood sugar will return to where it was before the treatment. The cortisone creams you apply to skin shouldn't raise your blood sugar at all, though over time if you over use them they will thin your skin.

Save cortisone treatments for the applications where they are appropriate--these are the conditions where it is necessary to turn off an out of control immune attack before it does serious damage. Cortisone helps in some difficult autoimmune conditions and can be lifesaving in others.

But for run of the mill pain and inflammation, like that from a stressed joint, torn tendon, or bad back, cortisone is overkill.

A huge review confirms that cortisone injections for tendon problems like frozen shoulder helps pain short term but yields worse outcomes middle and long term. In short, cortisone shots make it harder for tendon injuries to heal--while significantly raising the risk of diabetes (though the last wasn't explored in this particular study.)

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.
Brooke K Coombes et al. The Lancet , Volume 376, Issue 9754, Pages 1751 - 1767, 20 November 2010.doi:10.1016/S0140-6736(10)61160-9

If the problem is nerve pain, try a low dose of Tylenol.If the problem is inflammation use the lowest dose of a NSAID that works for you. Both these classes of drugs can be hard on your kidneys and liver if you take them too frequently so only take them when you really need to, and keep in mind the the less you use the better.

When my kids had fevers, I used to give them toddler sized doses of Tylenol until they were teens. They worked. The current trend is to package all these drugs in monster sized pills. Tylenol, which is effective in 325 mg pills, for example, is now sold mostly in 500 mg pills and caplets and in even larger sizes. Check the shelf for the small size pills, and start with a half tablet. Then work up to the dose that is effective. I often find half a Tylenol does the trick for my back pain.

There's a lifetime relationship between the total amount of Tylenol and NSAIDs you take and your risk of end stage kidney disease. So the less you take the better off you'll be, but there are times when you are in pain and they can be very helpful.

And if a doctor tries to prescribe any form of cortisone for you, do a bit of research on your own to find out if it really is appropriate. The saddest part about the prednisone that ruined my blood sugar control is that it was prescribed for something it had no chance of curing. The doctor gave it to me as is so often the case so he could say he'd done something rather than telling me the truth, which was that the condition I'd shown up with was one that would not respond to medical treatment.


November 14, 2010

Do Something that Actually Helps

I don't know about you, but I'm sick of diabetes awareness events that accomplish nothing.

Wearing ribbons, lighting candles, and thinking about your friends with diabetes is what we call "Slactivism." You feel like you've done something, but all you've done is make yourself feel good. Nothing changes.

So go on, light all the virtual candles you want, but when you are done, consider what the impact might have been if all that money and media power that went into promoting this slactivist event had been put to the task of telling the public the single fact that might give them a fighting chance against diabetes: that the starches and sugars they eat are what raise their blood sugar and that if they cut back hard on starch and sugar they could lower their blood sugar and avoid all the complications their doctors think are inevitable.

That a "healthy diet for diabetes" is a diet low in carbs is a simple idea that 80% of people with diabetes never hear about. Many doctors don't even know it. If they did, they wouldn't be handing their newly diagnosed diabetic patients ADA sanctioned brochures telling them to eat oatmeal, bananas, apples, potatoes and whole wheat toast. (And no I'm not exaggerating. My doctor gave me that brochure just 3 years ago.)

So celebrate World Diabetes Day by telling everyone you meet the truth about what people with Type 2 diabetes need to do to regain their health: test their blood sugar after meals and cut back on carbohydrates until they see normal blood sugars.

It's that simple. If 1/1000s of the resources put into promoting these slactivist festivals were put into distributing the How to Lower Your Blood Sugar flyer thousands of people might avoid nerve damage, impotence, retinal damage and kidney failure.

For people with diabetes every day is Diabetes Day. They need information not feel good media events. If you have that information, share it with a neighbor or relative who could use it. Maybe it will help, maybe not, but at least you tried.


November 6, 2010

Diabetes Hit Parade: The Top 10 Pages on This Blog

Every week I get statistics that tell me, among other things, what pages on this blog get the most visitors.

Since the traffic counts I get apply only to the previous month, the supremacy of these pages has nothing to do with cumulative traffic, but reflects the fact that the topics they discuss are the ones that people with diabetes commonly search on.

Because many of you reading this are here because you subscribed to this blog sometime over the past four and a half years it has been in existence or because you stumbled over it in a way that didn't bring you to one of the more popular pages, I though it might be useful to post a list of the ten pages that are currently the most popular. So here without more ado are [Cue drum roll]:


  1. Metformin vs. Metformin ER 11/30/2006
  2. When to Test Blood Sugar in Type 2 11/16/2007
  3. Can Type 2 Diabetes Be Reversed? 8/18/2009
  4. Beta Blockers Worsen Blood Sugar May Cause Diabetes 9/2/2008
  5. How to Reverse Fatty Liver 3/13/2009
  6. Onglyza: Just Like Januvia But with More Side Effects 8/3/2009
  7. Victoza: A New Competitor for Byetta 1/26/2010
  8. What Does That C-Peptide Test Mean? 9/22/2008
  9. Massive A1c Fail: It Does Not Accurately Diagnose Diabetes 10/18/2010
  10. Yet Another Problem with Januvia 9/12/2008
I'm happy to see that a couple posts from every year of the blog's history are represented here. These Top 10 posts also tell me that my visitors are most likely to find this blog when looking for information about drugs--especially new drugs--and blood sugar tests.

Do you have a favorite blog post you come back to or recommend to friend?