Those words, stated by a person with diabetes, make me cringe! Over the past 14 years that I have been a diabetes educator I have heard those words too many times. One example is a woman with an A1c of 7.5% (that’s a 3-month average blood sugar reading of 169 ml/dL) who isn’t convinced that her blood sugar is high enough to call it diabetes or take care of her disease before it causes serious damage to her body and future health. She was set to attend an educational class but didn’t want to inconvenience herself for too many hours. There was no convincing her that she would never regret gaining knowledge over her disease and how much she would appreciate the education. I plead with anyone who questions the importance of diabetes education. Whether you have diabetes or even pre-diabetes you owe it to yourself to understand how your disease affects your body and what you can do to delay or diminish the possible complications. It is one of the few diseases that we actually have some control over. Why would anyone want to give that control up?

What do you think affects your blood glucose? Usually, the top things that come to mind are: food, activity, medication and even alcohol. Do we ever think the impact of stress or emotions has an affect on our diabetes control?
Fluctuating blood sugars can affect your moods/emotions. Our moods can swing right there besides our blood sugars. In fact, since sugar is our energy, the fluctuations of blood sugar make us feel like we’re on an energy rollercoaster! Keeping your blood sugar level helps you to feel more energized, emotionally balanced, suppresses your appetite, and will be less dangerous for your organs. Spikes in blood sugar can harm all the vessels in your body. That’s why the complications of diabetes overtime can be in the eyes, kidneys, nerves, and heart – where your vessels allow your body to receive nutrients and oxygen to function. Dips in blood sugar can harm your heart muscle, harm brain cells, and make your body run out of energy so it doesn’t operate anymore. Think about what happens to a car when it runs out of gasoline? Gasoline to a car is sugar/glucose to us! It’s the main source of fuel to keep us going. So, take a deep breath and smile…

Salt is composed of about 60% sodium and about 40% chloride and at the time of this writing – it is the worst thing to consume next to saturated fat and sugar. In America, we tend to focus on saturated fat, white table sugar and salt to flavor our foods. Why? When they are all contributors to ill health? You know, butter, cream sauces, fatty meat, whole milk or cheeses contain lots of saturated fat. Cookies, cakes, pastries and some fat-free items contain sugar – I’m not even referring to what we actually add ourselves (may I remind you that sugar turns into fat – triglycerides!) Salt is found in prepared foods, processed foods, even skim milk! The amounts we should be using of all the “disease-culprits” you ask? Saturated fat: 20 grams or less (zero is best since it is a major contributor to our high cholesterol levels), sugar: as little as possible and salt (put into sodium terms which will be most familiar to you all): sodium intake should be 1,500 mg to 2,500 mg a day. Going out to eat fast food can result in an entire day of the above three in just one meal, if not 2 or 3 times the suggested amounts.
Other countries use spices that not only DO NOT have the potential to take us down the path to diabetes, heart disease, hypertension, kidney disease and obesity but spices also offer some medicinal properties. Turmeric, an anti-inflammatory spice found in curry is one example. Inflammation occurs in most of our top diseases and so to focus more on anti-inflammatory diets (think: wholesome) would be advantageous to us all. Cinnamon’s benefits are controversial but if you add it to your cereal instead of butter – it’s reducing the saturated fat and thus artery clogging/heart disease risk somewhat while at the same time perhaps offering something worth while to our health.
So, what’s our problem? Is it a control issue? We’re too busy to think? We’re not convinced that we have a huge hand in our own demise? We don’t care? Lazy? Ignorant? Then that word comes to mind that my patients are not very fond of: moderation. It’s easy, do-able and healthy – it also keeps the stress level down because you’re reducing not omitting!

Last night I saw this tomato sauce commercial (I won’t mention any names). Sure, the commercial itself was cute but the message was that this tomato sauce can be counted as a vegetable serving. Didn’t President Reagan say that ketchup was a vegetable? Pahleeease! That’s not really something a dietitian wants to hear or see. In actuality, one vegetable serving is ½ cup which is a fraction of what is recommended for the day. If there is high fructose corn syrup in the sauce – I might look further. The sauce I buy (OK, I don’t make my own) contains no added salt (very little salt, however, tomatoes have a great taste on their own), tomatoes and some spices. It is important to learn how to incorporate vegetables – a variety of them in different colors – into your life!

Being creative with your “healthier” foods can make a huge difference on whether you will eat them or not. For example: if you don’t favor vegetables (and I’m talking about dark greens like collard greens, kale, spinach, Brussels sprouts, broccoli and cauliflower, carrots, tomatoes, onions, etc. then try to make them taste good or better with something you like. Here are some ideas I’ve come up with: I like to sauté fresh Brussels sprouts with olive oil and garlic or add one tablespoon of butter to my broccoli with a sprinkle of parmesan cheese. Perhaps use chicken or vegetable broth to steam asparagus or to make rice tastier with added vegetables in a casserole. My favorite – I think I’ll make it tonight! – is my version of mashed cauliflower (for those who don’t like to cook much and for those, like me, who like to multitask and exercise while dinner is cooking itself)! I take a bag of frozen cauliflower florets, ½ bags of frozen chopped onions and ½ bags of frozen sliced yellow squash and put them in a microwaveable dish and press cook for 20 minutes. When “mushy”, I take a fork and mush further and then add a tablespoon of butter and pepper. What a gourmet I’ve become! What about adding tomatoes with spices to your green beans? Even splurge and add low-fat shredded cheese to your broccoli. Add feta cheese to cooked spinach and onions. The most decadent vegetable recipe is to dip the broccoli, cauliflower, etc. in beaten egg or eggbeater (easier!) and then dip in breadcrumbs or panko crumbs and “bake-fry” by using spray butter under and over them. Dig in and enjoy!

It’s the new year and many of us seem to be ready to LOSE WEIGHT!  The guilt is piling up from all the extra food and snacks we had over the holidays and now we MUST get down to business. 

Please try not to set yourself up for failure!  Don’t put too much pressure on yourself for immediate results.  Simply: THINK BEFORE YOU EAT!  If you do this, you won’t be on a “short-lived” diet, filled with so many, too many, restrictions.  Rather, you will be allowing yourself satisfaction with better food/beverage choices for the long-term.  Just spread less butter when having butter.  Replace chips with fruit and take a smaller handful of nuts.  Remember how oil adds up in calories: 1 tablespoon is already 120 calories!  Non-starchy veggies like salad, broccoli, green beans and carrots don’t add up to many calories so emphasize these foods instead of the starches.  Keep this information in a safe spot in back of your head so you pause before over-indulging.  You’ll be fine!  Try to enjoy your food and not let it hurt you….

I met Steve a year or so ago at different diabetes venues: various support groups, advocate lunches, etc. Unlike most of my retired patients, Steve was only 52 years old. Unlike my other patients, Steve already had diabetes, Type 2 for several years, and was on insulin. He also suffered from the many diabetes complications. Steve was quite a character! He became my loyal attendee and always added humor and spice. I feel very close to many of my patients, especially the ones who I get to see not only in my office but at various events. Steve was like family and I will miss him.

I wouldn’t say that I’m “on a diet”, however, in the past 3-4 months I have gained 7 pounds. OMG! I think – and say! How could I let THAT happen? Well, maybe because I’m human just like you? I like food, I talk about it all day long, and although I know how to control my weight sometimes I just don’t feel like it! So, my decision to not care, not think about my food choices and allow life to overwhelm me, resulted in SEVEN POUNDS! With a little thinking, I realized exactly why this happened. As easy as it has been to add 7, I am just as easily subtracting it! After all, I deserve it and more importantly, I feel so much better without it! The small snacks I was adding to my evening hours have gotten even smaller in size and I am thinking more before I grab something I don’t even want or need to eat. It’s a challenge I always like to win. It makes me feel proud of myself! Simple! Don’t you think?

Sometimes I feel that I am a sales person. Although I was trained to educate my patients about controlling diabetes, I find myself using every possible tactic to sell them good health.
Yesterday, I saw a woman for the second time. She has uncontrolled diabetes and is morbidly obese. She stated at the first visit that she realizes that if her poor eating habits continue it might “kill her”. She is fearful, however, at the same time, like an alcoholic, she just can’t stop.

Sure, I suggested low-calorie, healthy and well-balanced food choices so she could replace the higher-calorie and higher-sugar/fat cookies, ice cream and cake but there was more to it. I had to SELL her good health. I had to convince her to save herself. I had to use every ounce of my psychological skills to motivate her.

From the first visit to her second visit, yesterday, she had made changes. I was happy with her progress. My sales-pitch worked! Now we are focusing more on the 8-11:00 pm “trouble-time.”  I am hopeful. With my continued support and her compliance – we’ll seal the deal!

I often wonder what to say to my patients who have a legitimate story about why they won’t, can’t or shouldn’t follow health advice.  One example was a man who was a holocaust survivor.  When I was recommending to him to curtail his portions he looked at me and said, “I was starved almost to death in the Holocaust and then I had no money to eat and now FINALLY I have enough money to give myself whatever my heart desires.  But you’re telling me I can’t or shouldn’t have an abundance of carbohydrates.  I’m 80 years old, what do I care”.  So, my fellow readers, what would YOU say to that?  He obviously has a valid argument.  I simple tell him what I would tell anyone else: do not omit just modify.  Why open yourself up to a slow demise, complications that make you miserable instead of giving yourself all you want – IN  MODERATION!

Another woman came with uncontrolled diabetes and looking to lose about 100 or more pounds.  “I will not diet or cut out my favorite foods and I have trouble saying no to a food when it is in my house”.  I gave her options:  she can have bariatric surgery to physically/surgically make her stomach smaller or she can MODIFY (there’s that dirty word again).  Her husband was sitting next to her, nice and thin and in shape.  “Do you need those foods in your house to tempt her?”, I asked.  “No”, he said.  He turned to his wife of 50 years and said, “I will work with you.  We will only bring foods into this house that can help you reach your goals”.

The couple left and I made sure my patient knew I was there for her by phone, email, or next appointment and her husband would support her too.  That’s how we succeed.

Some quotes from patients on whether or not they have the “D” word: “My doctor has told me I have pre-diabetes for the past 25 years.  My A1c is 6.6% and I’ve been on Metformin twice a day”.  OK?, I think to myself.  An abnormally high 3-month blood sugar average (A1c) plus she’s on 2 doses of medication – but still the “D” word won’t be admitted, only the “PD” word.  Yesterday, I had a patient that admitted that she had the “D” word but her doctor didn’t!  Her A1c is 7% (non-diabetic range is under 6%), she’s on Metformin and she has been testing her blood sugar for months or has it been years.  Anyway, with this diabetes epidemic and obesity epidemic maybe using the words with their true meanings will be more motivating to put an end to this killer.  At least maybe more patients will take this devastating disease seriously.