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Living Well with Diabetes      Newsletter

September 2016

Palm Beach Diabetes and Endocrine Specialists

1515 N. Flagler Drive, Suite 430 West Palm Beach, FL 33401


Fall In Love with Fall Produce!

By: Director of education – Jessica Cook MS, RD, LD, CDE

Fall is officially here and you can see it everywhere even in South Florida. With the movement of eating seasonal foods, you should be aware of the sensational produce Fall brings to our local markets and their benefits!

Fall Produce:

Pumpkins – Contain high amounts of fiber, potassium, vitamin C and are delicious roasted, added to muffins or in soups. Pumpkins are not just for carving!
Winter Squashes (Butternut, Acorn, Kabocha)– High in potassium, fiber and lower in carbs then sweet potatoes. Try roasting these veggies, add to soups and mix into fresh salads.
Brussel Sprouts – High in anti-oxidants with abilities to help prevent cancer. Try these roasted with garlic or raw shredded into salads.
Pears –  High in fiber, reduce cholesterol and are high in vitamin C. Try adding to fresh salads or baking for a yummy fall treat!
Cauliflower & Broccoli – High in vitamin C, fiber, anti-oxidants, and easy to include in your diet. Try adding to stir fry, creamy soups, or raw for munching.
Swiss Chard – High in vitamin K, folate, iron and anti-oxidants. Best sautéed or add to soups or stews. Swiss chard is also delicious served in a vegetable omelet.
Hearts of Palm – High in vitamin C, iron, folate and potassium. Perfect addition to salads or raw veggie platter.
Apples – High in fiber, lowers cholesterol and is high in phytonutrients. Try baked apples with cinnamon for a perfect Fall dessert!
All of these yummy produce items not only can help you lose weight, but can reduce your risk of cancer and lower cholesterol! So get cooking and try the delectable taste of Fall!

Thank you for taking time to read our Living Well with Diabetes September 2016 Newsletter.

Risks for Developing Pre-Diabetes and Diabetes

By: Dr. Kathryn Reynolds

The term pre-diabetes refers to blood glucose levels that are higher than normal, but not high enough to meet criteria for type 2 diabetes (T2DM.) The American Diabetes Association classifies pre-diabetes according to the following categories:

Fasting plasma glucose (FPG) 100-125 mg/dL—impaired fasting glucose
2-hour post glucose (tolerance test) 140-199 mg/dL—impaired glucose tolerance
Hemoglobin A1C 5.7%-6.5%
Left untreated, pre-diabetes has a strong possibility of progressing to T2DM. This usually occurs in ten years or less. Individuals with pre-diabetes may already be at risk of developing complications, especially to the cardiovascular system.  This is important, because individuals with diabetes are at a significantly increased risk of CV disease including myocardial infarction and stroke.  The diagnosis of pre-diabetes is a “red flag” that the future development of T2DM may be likely.  Thus, a diagnosis of pre-diabetes can be an opportunity to take steps to try to improve one’s health.

Like T2DM, the exact cause of pre-diabetes is often unknown.  It is likely related to a combination of genetics, family history, and lifestyle.   There are two major physiological defects associated with T2DM.  The first is what is known as insulin resistance.  Insulin is the hormone produced by the B-islet cells of the pancreas.  Insulin is necessary for the proper movement of sugar, which is circulating in the bloodstream, into the cells in order to be utilized as an energy source.  It is clear that individuals with pre-diabetes no longer process glucose normally; insulin resistant individuals do not properly utilize the insulin that the pancreas produces.  Excess body fat (especially around the abdomen), as well as a sedentary lifestyle, are major risk factors associated with the development of insulin resistance and pre-diabetes.

The other core defect associated with T2DM is progressive B-cell failure.  This results in a progressive decrease in the ability to produce insulin.  This begins in the pre-diabetes phase and worsens over time.  In fact, it has been established that by the time a person meets criteria for T2SM, he/she has likely lost at least 50% of their B-cell function.  When food containing carbohydrates enters the system, the pancreas becomes less and less above to make enough insulin.  This is usually in the setting of insulin resistance, where the body is abnormally responsive to the insulin produced.  As a result, sugar builds up in the bloodstream and blood glucose levels begin to rise.

This concept of progressive B-cell failure helps to explain the progressive nature of the disease.  Often, individuals with pre-diabetes will progress to overt T2DM despite intensive efforts at lifestyle changes.  It explains why people with T2DM need to intensify their medication regimens with additional drugs due to rising sugar levels.  It also explains why insulin often needs to be started; if the pancreas simply cannot produce sufficient amounts of insulin, then non-insulin therapies will not be effective at mediating an insulin response necessary to control the blood glucose levels.  It is helpful for patients to understand this pathophysiology.  Requiring increasing medication is not a personal failure.  Rather, it is simply the progressive nature of the disease.

What are some of the risk factors for the development of pre-diabetes and diabetes?

Family history—genetics may play a strong role
Weight—being overweight or obese is a major risk factor due to the association with
insulin resistance

Age—the risk increases with age, likely related to gradual weight gain and reduced
physical activity

History of gestational diabetes
Polycystic ovary syndrome—associated with insulin resistance and metabolic syndrome
Associated conditions include obesity, hypertension, dyslipidemia, and cardiovascular disease
For individuals diagnosed with pre-diabetes, it is important to take steps to try to either bring the glucose levels back into the normal range, or at least try to keep from progressing onward to T2DM.  Some of the following recommendations include:

Diet—eat foods low in sugar and high in fiber.  Consultation with a registered dietician is recommended
Weight loss—losing 5-10% of body weight if overweight/obese can reduce the risk of developing diabetes
Medication—often the diabetes drug metformin is recommended early on.  This is an insulin-sensitizing drug that has been shown to reduce the progression to diabetes.
Treating concomitant conditions—medications to control blood pressure and cholesterol

Diabetes and Inflammation

By: Ines Cobo RN, CDE, CPT

People with Type 2 Diabetes don’t produce enough insulin or their bodies do not use the insulin effectively. Insulin is a hormone that is made by cells in the pancreas. It helps to control the amount of sugar in the blood.

Insulin may also have an impact on tissues in the body. Insulin’s effects on tissues are influenced by many factors, including obesity with the accumulation of fat around the belly and the major organs in the abdomen. The fat cells can produce chemicals that lead to inflammation.

Scientists are only beginning to understand the role of internal inflammation may play the development in chronic diseases like Diabetes.

Decades ago, researchers identified higher levels of inflammation in the bodies of people with type 2 diabetes. The levels of certain inflammatory chemicals called cytokines are often higher in people with type 2 diabetes compared to people without diabetes. Researchers discovered that in people with type 2 diabetes, cytokine levels are elevated inside fat tissue. They have concluded that excess body fat, especially in the abdomen, causes continuous low levels of abnormal inflammation that alters insulin’s action and contributes to the disease. Obesity and inactivity have been known to be the most important risk factors for type 2 diabetes.

As type 2 diabetes starts to develop, the body becomes less sensitive to insulin and the resulting insulin resistance also leads to inflammation. Blood sugar levels creep higher and higher, eventually resulting in type 2 diabetes. Emotional stress can also increase levels of the chemicals of inflammation.

Exercise to Fight diabetes and Inflammation

Walking 30 minutes daily has been proven to be the best way to prevent type 2 diabetes for people at high risk. Diabetes prevention may come from its anti-inflammatory effects. Physical activity releases anti-inflammatory chemicals into the body. Exercise also causes the body’s cells, especially muscle cells to increase their sensitivity to insulin. The increased insulin sensitivity from exercise also helps reduce chronic inflammation. The benefits are seen even with moderate exercise, like regular walking.

Anti Inflammatory Diet

Diet can also contribute to chronic inflammation. And some foods have anti-inflammatory properties. An anti-inflammatory diet by itself is not effective at preventing diabetes unless it leads to weight loss. Weight loss and increased physical activity can have strong anti-inflammatory effects and both are important for reducing the risk of type 2 diabetes.

Foods with anti-inflammatory properties include:

Healthy fats like omega-3 fatty acids: olive oil, flaxseed oil and canola oil
Avocados & olives
Walnuts, chia seeds and flaxseed
Most fruits and vegetables: oranges, tomatoes, beets and leafy greens.
Plain green tea
Fish – Salmon, Tuna, Sardines, etc.
Tumeric (curcumin) and ginger
Foods that tend to increase inflammation in the body include unhealthy fats:

Trans-fatty acids – partially hydrogenated oils
Vegetable shortening
High fat cuts of Beef & Pork such as bacon, salami, sausage, pepperoni, hot dogs, liverwurst, bratwurst, corned beef, etc.
Added sugar and white flours such as cakes, cookies, white bread, white pasta, ice cream, pies, chocolates
Too much sodium in the diet – Monosodium glutamate (MSG)
Looking for New Information on Foods to Help Manage Your Diabetes?

Then come join our Healthy Meal Planning Workshop!

Available in 3 locations:

Brookdale 8220 Jog Road Boynton Beach, FL 33472

Temple Israel 1901 N. Flagler Drive West Palm Beach, FL 33401

Jupiter office location: 550 Heritage Drive, Suite 150 Jupiter, FL 33458

Will provide Healthy Snacks!

We discuss healthy meal planning for diabetes, planning healthy snacks, grocery shopping list, foods to avoid, healthy dining out, healthy alternatives when cooking, glucose monitoring, exercise and weight loss.
Patients will receive a recipe booklet including carbohydrate counting guides and snack lists.
**May bring one guest free of charge!

If interested attending this program please contact our scheduling department at (561) 659-6336 Extension 8001 today!

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