Managing diabetes is not always easy

 My husband has type 2 diabetes, and lately he has been frustrated about his blood sugar. Even though he gives himself the proper dose of insulin according to his carbohydrate intake, his glucose levels often don’t go down as much as they should. He has a doctor’s appointment, but can you shed some light about what’s going on?

Talking with his doctor, or a registered dietitian or diabetes educator, to gain some insight is a good idea. But many things can affect blood glucose levels. He might need to adjust his insulin, but physical activity, or lack of it, can make a big difference. Worry, frustration and feelings of burnout regarding diabetes have also been associated with higher blood sugar levels, according to a 2010 study in the journal Diabetes Care. The biology and the science behind insulin and blood sugars aren’t as cut and dried as you might wish.

Your husband also might benefit from a new online course developed by Ohio State University Extension. “Dining with Diabetes: Beyond the Kitchen” is available for free at go.osu.edu/DWD_BTK, as part of the online eXtension campus, which is a service of the U.S. Cooperative Extension System. The course includes:

  • Narrated PowerPoint presentations on “Carbohydrates,” “Fats and Sodium,” and “Vitamins, Minerals and Fiber.”
  • Videos with ideas on making smarter decisions at the grocery store.
  • Links to information from authoritative sources.
  • Quizzes to test your knowledge.
  • The ability to post questions and experiences — and to read those of other participants.

Participants who sign up and view all presentations and videos, complete the quizzes, and submit a final evaluation are eligible for a quarterly drawing for a $100 Amazon gift card.

Your husband might particularly be interested in one of the resources available in the course, a blog post from the Joslin Diabetes Center. It describes how a high-fat meal can affect blood glucose, both by slowing the time it takes for the glucose to be digested and reach the bloodstream, and by affecting the liver’s ability to absorb glucose. Depending on your husband’s eating habits, this might help explain what’s happening with him.

The online course is an offshoot of in-person Dining with Diabetes classes offered periodically in 27 Ohio counties by OSU Extension. The three-session program, co-presented by an Extension educator and a certified diabetes educator, provides information on menu planning, carbohydrate counting and other topics, and includes live cooking demonstrations of healthy recipes with taste-testing. To find out if the program is offered near you, contact your county Extension office. Find it at go.osu.edu/extoffices.

Living with the ups and downs of diabetes can be aggravating. But getting answers to questions when they arise, and connecting with others facing the same issues, can help.

Chow Line is a service of the College of Food, Agricultural, and Environmental Sciences and its outreach and research arms, Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 364 W. Lane Ave., Suite B120, Columbus, OH 43201, or filipic.3@osu.edu.

Editor: November is National Diabetes Month. This column was reviewed by Dan Remley, Food, Nutrition and Wellness field specialist for Ohio State University Extension.

Eat fruit, but know how it affects blood sugar

Fruit Harvest Selection in BowlsI know I should be eating more fresh fruit, but I have type 2 diabetes. Last weekend I enjoyed a few slices of watermelon, and I was surprised when I tested my blood sugar and saw that it spiked over 200. Should I forget about eating more fresh fruit?

No! Fresh fruit should be included in every diet, even if you have diabetes. Aim for 1.5-2 cups a day.

Fresh fruit contains all sorts of nutrients, including vitamins, minerals, phytochemicals and fiber. As you probably experienced with the watermelon, fruit can also satisfy your sweet tooth while providing huge nutritional benefits that cake and candy simply don’t offer.

But you should be aware that, as with any carbohydrate-containing foods, portion size matters to your blood sugar. And, different fruits have different levels of carbohydrates and fiber, both of which affect your blood sugar, or blood glucose. You likely already know that unmanaged high blood glucose can cause serious, even life-threatening consequences, including blindness, kidney disease, heart and vascular disease, and neuropathy (a disease of the nervous system).

The American Diabetes Association recommends that people with diabetes keep their blood glucose level to less than 180 milligrams per deciliter of blood two hours after eating. For people without diabetes, the normal level is less than 140 mg/dl. You and your doctor may have set your after-meals target lower, but whatever the case, it’s good to recognize what might spike your blood sugar so you can take steps to reduce your risk.

Fruits lower in carbohydrate and higher in fiber will likely have less of an effect on your blood sugar. Below is the calorie, carbohydrate and fiber content for specific portion sizes of some common fruits. Find information about other fruits in the National Nutrition Database, available under “What’s In Food” atnutrition.gov.

  • Raspberries, 1 cup (4.3 ounces): 65 calories, 15 grams carbohydrate, 8 grams fiber.
  • Peach, medium (5.3 ounces, about 1 cup sliced): 60 calories, 14 grams carbohydrate, 2 grams fiber.
  • Strawberries, 1 cup halves (5.4 ounces): 50 calories, 12 grams carbohydrate, 3 grams fiber.
  • Orange, 1 cup sections (6.5 ounces): 85 calories, 21 grams carbohydrate, 4.5 grams fiber.
  • Blueberries, 1 cup (5.2 ounces): 85 calories, 21 grams carbohydrate, 3.5 grams fiber.
  • Apple, extra small (3.5 ounces, about 1 cup sliced): 55 calories, 21 grams carbohydrate, 3.5 grams fiber.
  • Cantaloupe, 1 cup diced (5.5 ounces): 55 calories, 13 grams carbohydrate, 1.5 grams fiber.
  • Banana, extra large (5.4 ounces, about 1 cup sliced): 135 calories, 35 grams carbohydrate, 4 grams fiber.
  • Honeydew, 1 cup diced (6 ounces): 60 calories, 15 grams carbohydrate, 1.5 grams fiber.
  • Grapes, 1 cup (5.3 ounces): 105 calories, 27 grams carbohydrate, 1.5 grams fiber.
  • Watermelon, 1 cup diced (5.4 ounces): 45 calories, 11.5 grams carbohydrate, 0.5 grams fiber.

Chow Line is a service of the College of Food, Agricultural, and Environmental Sciences and its outreach and research arms, Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH 43210-1043, orfilipic.3@osu.edu.

Editor: This column was reviewed by Dan Remley, specialist in Food, Nutrition and Wellness with Ohio State University Extension. OSU Extension is the outreach arm of the College of Food, Agricultural, and Environmental Sciences at The Ohio State University.

For a PDF of this column, please click here.

 

Nutrient-packed beans a hearty addition to diet

chow_030416-164065142We’re thinking of incorporating more beans in our meals, primarily to reduce the amount of meat we’re eating (and buying), but also because they’re supposed to be very good for you. But my husband, who has type 2 diabetes, is worried about adding more carbohydrates. Is this a bad idea?

Actually, beans are a great option for everyone, perhaps especially for people with diabetes.

A 2012 study in Nutrition Journal tested the effect that pinto beans, black beans and dark red kidney beans have on blood sugar in people with type 2 diabetes when eaten with white rice, which is known to cause blood sugar spikes. The researchers tested participants’ blood sugar every 30 minutes for three hours after the participants ate either white rice alone or rice with one type of the beans. Even though the meals with beans contained more total carbohydrates, the participants’ blood sugar was highest at each interval after they ate the rice alone than when the rice was paired with beans.

If your husband is concerned, though, encourage him to keep a close eye on his blood sugar levels after eating a bean-based meal. If he notices significant differences and is on insulin, he should discuss any changes in dosage with a health professional.

That said, beans are a healthful option that deserve a place at the table for just about everyone. In the Dietary Guidelines for Americans, beans are considered a unique food: They can be considered as either a meat substitute or a vegetable. They are high in both plant protein and fiber, as well as B vitamins, iron, folate, calcium, potassium, phosphorus and zinc.

The fiber in beans can be significant. Adults should eat anywhere between 22 grams to 34 grams of fiber a day, depending on their caloric intake — most Americans don’t get nearly that amount. Neither do Americans consume enough beans and other legumes, eating only about half the recommended amounts of 1.5-3 cups a week for men and 1-2 cups for women. Adding a bean-based meal or two to your weekly menu could go a long way to helping you meet those recommendations.

If you use canned beans, consider buying those that are lower in sodium. Or, rinse the beans before using them — that alone will reduce the sodium quite a bit.

If you start with dry beans — an economical option — first rinse them in cold water, picking out any pebbles or stems. Cover the beans with three times their amount of water and either soak for six hours, or bring to a boil and soak for at least two hours. Soaking overnight or after boiling makes them less likely to give you gas. Then, drain the beans and cook them in fresh water according to package directions.

If you currently don’t eat a lot of beans, you may want to add them gradually to your diet. This will allow your body to get used to them and reduce the chance of gas and other gastrointestinal distress.

Chow Line is a service of the College of Food, Agricultural, and Environmental Sciences and its outreach and research arms, Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH 43210-1043, or filipic.3@osu.edu.

Editor: This column was reviewed by Carolyn Gunther, Ohio State University Extension specialist in Community Nutrition Education.

For a PDF of this column, please click here.

Type 1 diabetes requires lifelong action

chow_091115_477783632Our 11-year-old son was diagnosed with type 1 diabetes. We’re learning a lot very quickly. What do we need to be aware of as we settle in to living with diabetes?

The diagnosis of diabetes is always difficult, especially when it’s type 1. With type 2 diabetes, in which the pancreas still produces insulin, there’s a chance that diet, exercise and oral medications can help the body use the insulin it makes to control the amount of glucose in the bloodstream, allowing it to be used for energy.

With type 1 diabetes, which accounts for 5 to 10 percent of diabetes cases, the pancreas produces little to no insulin, causing blood glucose to reach dangerously high levels. In addition to taking a prescribed amount of “basal” or long-acting insulin every day, you have to also take additional insulin whenever you eat to prevent blood glucose from staying in the bloodstream for too long.

It’s like being forced to learn to drive a car with a manual transmission overnight when all you’ve ever known is an automatic, with serious physical consequences if you don’t get it right. That’s a lot to put on a kid. Or a parent.

While complications of diabetes can be serious, including blindness, kidney or nerve damage, and heart and blood vessel disease, the risks significantly drop with good blood sugar control.

Years ago, children with diabetes were told they needed to eliminate sugar from their diet. Today, the medical community realizes that all sugars and starches affect blood sugar and can be part of a diet well-balanced with proteins and fats. To stay on track, your son needs to frequently monitor his blood sugar and take insulin.

Here’s some advice for parents of children with diabetes from the American Diabetes Association, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Academy of Nutrition and Dietetics:

Work closely with your son’s healthcare providers. Don’t be afraid to ask questions. Be honest with your health care team especially regarding how the diabetes is impacting your finances, your relationships, or other areas.

Find books, support groups, websites and other resources on type 1 diabetes. For example, the ADA offers diabetes camps that many kids find rewarding. It helps to learn from others’ experiences, but remember, your medical team is the first authority for your son’s care.

Talk about the diagnosis with your son’s teachers and other adults in his life. Don’t assume they know much about diabetes or the difference between type 1 and type 2 diabetes. Emphasize how important it is for him to monitor his blood glucose and give himself insulin, and make sure he has the time and privacy to do so.

Understand that if you’re like most people, this diagnosis can seem overwhelming. Have patience and know you’ll always keep learning and finding new ways to help your son live with diabetes.

Additional helpful information is available at diabetes.org and childrenwithdiabetes.org.

Chow Line is a service of the College of Food, Agricultural, and Environmental Sciences and its outreach and research arms, Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH 43210-1043, or filipic.3@osu.edu.

Editor: This column was reviewed by Dan Remley, Ohio State University Extension field specialist in Food, Nutrition and Wellness.

For a PDF of this column, please click here.

Diabetes can cause serious issues

185831476My father has been diagnosed with Type 2 diabetes. I’m surprised to learn about all of the complications that can result. What’s the best way we can help him reduce his risk?

You’re right. Diabetes — really, the high blood sugar that results — can cause all sorts of complications.

When glucose stays in your bloodstream instead of entering cells, that means it can’t be used by cells for energy, causing you to feel tired or lethargic. All that sugar running through your bloodstream also damages blood vessels. That includes small blood vessels such as those in the eyes, which can cause blindness, and in the kidneys, which can lead to kidney failure. It also includes large blood vessels, leading to heart attack and stroke. High blood sugar can also cause nerve damage, particularly in the feet, which can lead to amputation.

Given all that, keeping blood sugar under control should be the top priority for anyone with diabetes.

Recently, researchers offered one bit of good news. A study by the Centers for Disease Control and Prevention reported that the incidence of five major diabetes complications declined between 1990 and 2010. Heart attacks and other cardiac problems declined by 60 percent; stroke and amputations declined by about half; and end-stage kidney failure dropped by about 30 percent.

Still, the researchers warned that the incidence of all of these complications remains high. And with so many more Americans contracting diabetes — nearly 26 million today compared with 6.5 million in 1990 — many more people are experiencing serious diabetes-related issues despite the impressive declines in percentages reported in the study.

To help your father stay on top of his diabetes, be sure he has an A1C blood test at least twice a year. The A1C test measures overall blood glucose levels from the past two to three months, and it should be below 7.0. Blood pressure and cholesterol levels should also be monitored and kept at healthy levels. Encourage him to keep his appointments and follow medical advice.

What else? Help him focus on eating a healthful diet, centered on fruits and vegetables, fish, lean meat, dry peas or beans, whole grains and low- or nonfat dairy, combined with 30 to 60 minutes of physical activity nearly every day.

See more practical guidance from the American Diabetes Association at www.diabetes.org. Also, Ohio State University Extension offers diabetes-related healthy cooking schools in many communities. Seefcs.osu.edu/nutrition/dining-diabetes/ for details.

Chow Line is a service of Ohio State University’s College of Food, Agricultural, and Environmental Sciences and its outreach and research arms, Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH, 43210-1043, or filipic.3@osu.edu.

Details important in breakfast study

121682410I heard something about research showing that eating a big breakfast is good for people with diabetes. Can you tell me details? 

You probably saw some news coverage of a relatively small study reported at the European Association for the Study of Diabetes annual meeting in late September.

The findings were intriguing. Participants in the study’s “big breakfast” group ended up with blood sugar level reductions three times greater than those in the “small breakfast” group. About one-third of the big breakfast participants were able to reduce their daily diabetic medication within the study period of three months.

However, it’s important to remember some key facts: The study hasn’t yet been published in a peer-reviewed journal, so its findings are considered preliminary. Reports were based solely on the presentation and a press release from the association.

Also, the study involved just 59 people, was relatively brief and appeared to have a high dropout rate. So scientists are anxious to see if the results can be reproduced in more robust studies.

Finally, the big breakfasts in this study also had a higher percentage of protein and fat, which rules out high-carbohydrate morning fare such as a tall stack of pancakes with syrup.

In the study, participants who were in the big breakfast group ate 33 percent of their total daily calories at breakfast time, compared to 12.5 percent of total calories for the small breakfast group.

That means that for participants who consumed 1,800 calories a day, their “big breakfast” would have consisted of 600 calories. It’s not clear what the study participants actually ate, but an example of a 600-calorie breakfast that’s higher in protein and fat would be two extra-large eggs (160 calories); an ounce of cheddar cheese (115 calories); a whole-wheat honey English muffin (130 calories); a tablespoon of peanut butter (95 calories); and a cup of 1 percent milk (100 calories).

In comparison, people in the “small breakfast” group consuming the same 1,800 calories in a day would be limited to 225 calories for breakfast, with a lower proportion of protein and fat. Again, it’s not clear what was on their menu, but they might have had cereal with low-fat milk, for example, or a slice of toast with jam and orange juice.

While results are preliminary, consistently eating breakfast — especially one with lean protein — is associated with better weight management and lower blood sugar levels. Talk with your doctor or nutritionist for more information.

Know warning signs, risk of diabetes

No one in my family has ever had diabetes. Does that mean I’m not at risk for developing it?

Although there is a genetic component to diabetes, it’s not 100 percent: Many people develop type 2 diabetes without having a family history of the disease. Conversely, it’s not guaranteed that you’ll develop the disease even if you have close family members who have it, though your risk is higher.

A warning: You may think no one in your family has ever had diabetes, but many cases go undiagnosed. So you may be operating under a false sense of security.

Type 2 diabetes accounts for about 95 percent of all diabetes cases. It’s marked by high blood glucose levels primarily caused by the body’s inability to use its insulin efficiently. In contrast, type 1 diabetes is caused by the inability of the pancreas to produce insulin. Insulin is what gets glucose out of the bloodstream and into cells where it can do its work.

According to the American Diabetes Association (ADA), if one of your parents has type 2 diabetes, your risk of getting diabetes is 1 in 7 if your parent was diagnosed before age 50, and 1 in 13 if your parent was diagnosed after age 50. If both parents have type 2 diabetes, your risk is about 1 in 2.

Overall, it’s estimated that diabetes (both types) affects 1 in 12 Americans, though only about 1 in 17 Americans have been diagnosed.

A better way to estimate your chance of developing type 2 diabetes is to take a close look at your risk factors. The ADA offers an online tool to evaluate your risk — just go to http://www.diabetes.org and search for “risk test.” Risk factors include age, being overweight or obese, not exercising regularly, and having high blood pressure.

Studies also show that people with untreated sleep-related problems, such as sleep apnea, also have a greater risk of developing the disease.

Even small changes can lower your risk. Losing just 10 to 15 pounds and starting an exercise program of 30 minutes a day, five days a week, can greatly reduce the chance of developing diabetes.

Early detection and treatment can reduce the chance of developing complications, including serious problems with your eyes, feet, kidneys and heart. Be sure to see a doctor quickly if you experience symptoms such as:

  • Frequent urination.
  • Unusual thirst.
  • Extreme hunger.
  • Unusual weight loss.
  • Extreme fatigue and irritability.
  • Frequent infections.
  • Blurred vision.
  • Cuts or bruises that heal slowly.
  • Tingling or numbness in the hands or feet.
  • Recurring skin, gum or bladder infections.

Lots of fruits, veggies might stem diabetes

I’ve been told that I’m “pre-diabetic.” Should I cut way back on fruit? I know it contains a lot of sugar.

First, for individual health-related advice, it’s always best to talk directly to your doctor or, in cases like this, a registered dietitian, who could work with you personally to examine your normal day-to-day eating patterns and help you make improvements.

But if you’re like most Americans, you likely aren’t eating enough fruit. And your question indicates that you have the common misconception that eating sweets causes diabetes. It doesn’t. It’s caused by the body’s inability to handle blood sugar, but that comes from many kinds of foods, not just those that taste sweet.

In fact, a recent study published in the journal Diabetes Care indicates that people who eat a lot of fruits and vegetables — and, even more importantly, a lot of different kinds of fruits and vegetables — may have a lower risk of developing type 2 diabetes.

The study included more than 3,700 adults in the United Kingdom and lasted 11 years. The researchers found:

• Eating more fruits and vegetables (about six servings a day) was associated with a 21 percent lower risk of developing type 2 diabetes compared with eating just two servings a day.

• People who ate a wide variety of fruits and vegetables — averaging 16 different types over the course of a week — were about 40 percent less likely to develop diabetes than those who averaged just eight different types.

It’s important to note that the study doesn’t necessarily prove cause and effect. But it is one more good reason why you might want to incorporate a wider variety of fruits and vegetables into your diet. Here are some ideas to do so:

• Even if you don’t normally pack your lunch, pack a snack to have mid-morning or mid-afternoon. It can be one of the standards: an apple, orange, banana, grapes, baby carrots, celery strips or red pepper strips, or something totally new. Shop the produce section with a fresh eye to see what you might want to try.

• Buy large containers of vanilla or plain yogurt and, as you prepare individual servings, top with one-quarter to one-half cup of fresh or frozen berries.

• Add variety to salads by including spinach with the lettuce and topping with fresh blueberries or strawberries.

For more on the benefits of fruits and vegetables and ideas to include more in your diet, see the Fruits and Veggies Matter website, a partnership of the Centers for Disease Control and Prevention and the Produce for Better Health Foundation, at http://www.fruitsandveggiesmatter.gov.

Chow Line is a service of Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH, 43210-1044, or filipic.3@osu.edu.