05 Jan Living Well with Diabetes Newsletter – January 2017
Losing Holiday Weight Gain!
By: Jessica Cook MS, RD, LD, CDE
It’s a new year and time for new growth! But if the holidays caused you to grow into another dress size with wonderful desserts, cocktails, breads and chocolates, you may be wishing you had been more careful. Don’t let holiday weight gain bum you out and use these simple tips to get you back on track in 2017:
- Move. Being active is the greatest way to burn calories, prevent additional weigh gain, but also lowering blood sugars at the same time. Challenge yourself to get 10,000 steps a day or try a new fitness class with a friend and make moving more fun!
- Drink water. It is important to stay hydrated during and after the holidays especially if you’re consuming salty foods or alcohol. Water can also reduce blood sugar levels and help you feel full, so you’re less likely to reach for more food. Drink up!
- Eat veggies. Holiday parties feature many tasty treats such as breads, potatoes, cookies, pastries, but where are the vegetables? Add veggies back into your diet by purchasing a readymade vegetable platter, gourmet salad or fresh roasted vegetables to help you fill up on delicious low calorie, nutrient dense foods to keep your waist trim.
- Think before you eat. Yes, it may be tempting to go for seconds, try every cookie or indulge in buttery breads, but try thinking about it before you eat. Often we eat with our eyes, even when not physically hungry which leads to weight gain, higher blood sugars and regret. The next time you reach for a treat or yummy seconds ask yourself am I still physically hungry? Do I really need two pieces or could I be ok with just one? How will I feel after eating all this food? What will happen to my blood sugars? Sometimes taking time to stop and think will help give perspective and put you in the right frame of mind.
- Test your blood sugar. You may think ignorance is bliss, but elevated A1cs, headaches, fatigue and poor sleeping at night will let you know your blood sugars have been out of control even though you have ignored them. Testing your blood sugar levels puts you in the driver’s seat to make decisions to level your blood sugar. It also makes you aware when you have overindulged, need more water or need to increase exercise. Remember high blood sugars need more medication, so pay attention, act and test.
Thank you for taking the time to read our January 2017 Living Well with Diabetes Newsletter and Happy New Year from everyone at Palm Beach Diabetes and Endocrine Specialists!
Diabetes During Pregnancy
By: Geetanjali Kale, M.D.
What are the types of diabetes that can affect a pregnancy?
A woman with preexisting condition of either Type 1, Type 2, LADA or secondary diabetes can conceive and be referred to as ‘pregnant patient with pre-existing diabetes’ or a woman who had no prior history of diabetes can develop ‘gestational diabetes’ in second trimester of pregnancy. It is important to understand the distinction in these two conditions, since the approaches to these two kinds of patients are significantly different.
What is gestational diabetes?
Gestational diabetes is diabetes or carbohydrate intolerance first recognized during second trimester of pregnancy in women who did not have diabetes prior to pregnancy. If someone has had gestational diabetes during prior pregnancies, it is important to have testing done to confirm that, the patient does not in fact have Type 2 DM, PRIOR to conceiving the next pregnancy.
Why some women develop gestational diabetes during pregnancy?
Pregnancy is a diabetogenic state since maternal metabolism is altered to ensure appropriate supply of glucose to fetus. In the first trimester, mother’s pancreas usually prepares for future increases in demand of insulin. Occasionally, due to predisposing risk factors and genetic factors, this preparation is not adequate to control blood sugars throughout pregnancy. As the pregnancy progresses and levels of hormones such as estrogen, prolactin, HPL gradually increase, mothers become more and more insulin resistant. At times, mothers’ pancreas is unable to overcome this degree of insulin resistance and consequently mothers can suffer from gestational diabetes. For women who have pre-existing diabetes, having good control of blood glucose prior to starting pregnancy is critically important in order to overcome the phenomenon of ‘pregnancy induced insulin resistance’.
Why is it important to have optimal blood glucose control during pregnancy?
Patients with pre-existing diabetes with poor glucose control are at higher risk of pregnancy loss and congenital malformations. Poor blood glucose control during second and third trimester can cause low fetal oxygen supply, macrosomia (enlarged cell size in fetus), difficult delivery, increased risk of stillbirth and neonatal complications. These risks can be minimized with better blood glucose control through the course of pregnancy.
What are the targets of blood glucose control during pregnancy?
Throughout pregnancy, optimal glycemic goals are as follows:
Premeal, bedtime, and overnight glucose 60–99 mg/dl,
Peak postprandial glucose 100–129 mg/dl, ( at 2 hrs after eating a meal)
Mean daily glucose <110 mg/dl, and A1C <6.0.
What treatment options are available for management of diabetes in pregnancy?
The approach has to be individualized based on when diabetes was diagnosed with relation to pregnancy. There are a lot of medications a person with pre-existing diabetes might be taking prior to conception that are contraindicated in pregnancy. Some patients managed on medications may have to switch to insulin during pregnancy. It is important to have a preconception planning visit with your endocrinologist and OBGYN for all patients with diabetes planning a pregnancy. For those patients, diagnosed with gestational diabetes during second or third trimester of pregnancy, usually an approach of lifestyle modification is initially attempted to assess improvement in blood sugar levels. However, the therapy is eventually individualized and women with gestational diabetes may need to use insulin until delivery of the baby.
Are there any follow up recommendations?
It is recommended that ALL patients experiencing any form of diabetes during pregnancy have a follow up with their provider within 6-8 weeks of delivery. This is done to re-evaluate status of their diabetes in order to modify treatment as deemed appropriate.
Managing Your A1c
By: Rosemarie Steinsapir MS, RD, LD, CDE
There was a time not long ago when we watched the complications of diabetes wreak havoc in patients’ lives. And yet, we could not say to a patient with diabetes that the complications of this disease were a direct result of blood sugar control.
Then 1992 changed the world of diabetes forever. Through the United Kingdom Study, completed that year, the link between the actual numbers involved in a patient’s blood sugars clearly demonstrated the relationship between those numbers and a patient’s predicable outcome for complications.
It starts with the red blood cells. Their life span is 120 days. After a blood draw from your vein, the blood is spun and the sugar coating on the red blood cells is released and measured. This is called the Hemoglobin A1c. The normal range is between 4.0 to about 5.5 (without diabetes). Because the red blood cell has 120 day life span, the sugar coating it becomes a look into your blood sugar history for about the past 60-90 days.
An A1c level above normal, indicates daily sugar levels are trending up past normal as well. The UK study demonstrated that the risk of complications could be directly linked with the movement of the A1c. For healthy individual patients, the higher the A1c, the greater the risk of complications. The A1c is a link (think of it as an intermediary number) between your daily glucose numbers and your risk for complications. For example, for an A1c of 6.5 or less, the risk could be reduced by as much as 76% for retinopathy (eye disease/blindness), 60% for neuropathy (nerve disease or amputations), and 35% for nephropathy (kidney disease and dialysis). Your physician and you will determine your A1C goal. Your physician will determine your goal based upon your age, presence or absence of diabetic complications, evidence of present heart disease, your history of severe hypoglycemia. Thus, your A1C goal must be individualized.
Learning to manage daily blood sugars is very difficult for most patients. Management of an A1c level is really about managing diabetes (and blood sugar levels) day to day, meal to meal. Each day is a new day and each meal is a new opportunity. The A1c is not managed by the month(s); it is managed by the day!
Many people understand the concept of choosing your professional clothes the night before you planned to wear them. At least for women, this allowed a lot more freedom when you needed it most. No need to try things on in the morning to see if everything worked together. If you can get into the habit of thinking about blood sugars and meals as choices, this think-ahead method may work for you too.
Start by acknowledging that meals and food preparation are work. For working people feeding families, meals are important, never-ending work. If you know the day before, or 2 days ahead, what you plan to prepare/eat at each meal, you gain incredible power over your blood sugars (hence power over your A1c and the complications of diabetes).
Knowing before you walk into the kitchen to prepare a meal, exactly what that meal will be and how much of it you will eat, means you have made the choices at a time when you are not overwhelmed by appetite, pressed for time, or too tired to think of anything but restaurant food. Control is now in your court.
Need a Boost to Lose Weight and Reduce Blood Sugars?
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