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Keep Blood Sugars Under Control During a Cookout!

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

Summer time calls for grilling outdoors, cook outs, and BBQ’s, but whatever you choose to call your get together, it screams lots of outdoor fun. Unfortunately, this could also mean high carbohydrate foods such as potato salad, macaroni salad, lemonade, hot dog or hamburger buns, baked beans and everyone’s favorite ice cream! If you have diabetes and you are trying to reduce carbohydrate foods in your diet to help reduce blood sugar spikes or lose weight, this could be challenging. But eating healthy at an outdoor grilling event can be easy if you follow these easy tricks:

• Bring veggies! When attending a cook out event offer to bring fresh veggies. Try bringing a delicious salad, vegetable kebobs for the grill or raw crudités and a healthy dip such as hummus. Yum!
• Use lettuce wraps versus a bun. Use a huge head of iceberg lettuce or romaine lettuce wedges to create lettuce buns for sausages, hot dogs or hamburgers versus a traditional bun to reduce your carbohydrate intake.
• Stay hydrated. Watch out for high calorie beverages at outdoor parties such as lemonade, sweet tea, sodas, fruit punch and alcoholic beverages. Not only can these drinks leave you with elevated blood sugars, they do not help you to stay hydrated during the Summer heat. Don’t forget to drink water to help stay hydrated, keep blood sugars down and cool off.
• Try fresh fruit for dessert. Instead of choosing cake, cookies or ice cream for dessert stick with fresh fruit to help satisfy your sweet tooth without adding all those extra calories!
• Don’t come to the party hungry. Showing up to a get together when you’re starving can be very dangerous when there are many high calorie, high carbohydrate treats around. Try eating a high protein meal with lots of vegetables to fill up before heading to the cook out, so you can make level headed decisions.
Try these tips to stay safe and smart this Summer! Thank you for taking time to read our Living Well with Diabetes July 2016 Newsletter.

Diabetes and Thyroid Conditions

By: Paul Casanova-Romero, MD
Thyroid dysfunction is common in people with diabetes and can produce significant metabolic disturbances. Patients with Type 1 diabetes have a higher prevalence of thyroid disorders compared with the normal population. Because patients with one organ-specific autoimmune disease are at risk of developing other autoimmune disorders, and thyroid disorders are more common in females, it is not surprising that up to 36% of female type 1 diabetic patients have thyroid disease. The rate of postpartum thyroiditis in diabetic patients (11% prevalence) is three times that in normal women. A number of reports have also indicated a higher than normal prevalence of thyroid disorders in type 2 diabetic patients, with hypothyroidism being the most common disorder.

Hypothyroidism (low thyroid hormone level and function) is by far the most common thyroid disorder in the adult population and is more common in women above 55 year old (6.6% of the general population). It is usually autoimmune in origin, presenting as either primary atrophic hypothyroidism or Hashimoto’s thyroiditis. Thyroid failure secondary to radioactive iodine therapy or thyroid surgery is also common. Rarely, pituitary or hypothalamic disorders can result in secondary hypothyroidism. Approximately more than 6 million people in the United States are hypothyroid and receive thyroxine replacement therapy.

Although wide-ranging changes in glucose metabolism are seen in hypothyroidism, clinical manifestation of these abnormalities is seldom conspicuous. However, the reduced rate of insulin degradation may lower the exogenous insulin requirement. The presence of hypoglycemia is uncommon in isolated thyroid hormone deficiency and should raise the possibility of hypopituitarism in a hypothyroid patient.

More importantly, hypothyroidism is accompanied by a variety of abnormalities in plasma lipid metabolism, including elevated triglyceride and low-density lipoprotein (LDL) cholesterol concentrations. Even subclinical hypothyroidism can exacerbate the coexisting dyslipidemia commonly found in type 2 diabetes and further increase the risk of cardiovascular diseases. Adequate thyroxine replacement will reverse the lipid abnormalities.

Hyperthyroidism (Elevated thyroid hormone level and function) is much less common. Graves’ disease is the most common cause and affects primarily young adults. Toxic multi-nodular goiters tend to affect the older age-groups. There is a 12% prevalence of hyperthyroidism in patient with history of diabetes.
Hyperthyroidism is typically associated with worsening “glucose” control and increased insulin requirements. Indeed, thyrotoxicosis (elevated thyroid hormones causing clinical symptoms) may unmask latent diabetes. In practice, there are several implications for patients with both diabetes and hyperthyroidism. First, in hyperthyroid patients, the diagnosis of glucose intolerance (Pre-diabetes) needs to be considered cautiously, since the “elevated glucose” may improve with treatment of thyrotoxicosis. Second, underlying hyperthyroidism should be considered in diabetic patients with unexplained worsening hyperglycemia. Third, in diabetic patients with hyperthyroidism, physicians need to anticipate possible deterioration in glycemic control and adjust treatment accordingly. Restoration of euthyroidism (optimal TSH and T4 and T3 levels) will lower blood glucose level.

In young women with type 1 diabetes, there is a high incidence of autoimmune thyroid disorders. Transient thyroid dysfunction is common in the postpartum period and warrants routine screening with serum thyroid-stimulating hormone (TSH) 6 to 8 weeks after delivery. Glucose control may fluctuate during the transient hyperthyroidism followed by hypothyroidism typical of the postpartum thyroiditis. It is important to monitor thyroid function tests in these women since approximately 30% will not recover from the hypothyroid phase and will require thyroxine replacement. Recurrent thyroiditis with subsequent pregnancies is common.

The diagnosis of thyroid dysfunction in diabetic patients based solely on clinical manifestations can be difficult. Poor glucose control can produce features similar to hyperthyroidism, such as weight loss despite increased appetite and fatigue. On the other hand, severe diabetic nephropathy can be mistaken for hypothyroidism because patients with this condition may have edema, fatigue, pallor, and weight gain.

To further complicate the diagnostic process, poorly controlled diabetes, with or without its complications, may produce changes in thyroid function tests that occur in nonthyroidal illnesses. Typical changes include a low serum T3 due to impaired extrathyroidal T4-to-T3 conversion, a low serum T4 due to decreased protein binding, and an inappropriately low serum TSH concentration.

The availability of the highly sensitive immunoassay for serum TSH as we are using in PBDES (with detection limit of Thyroid dysfunction is common in diabetic patients and can produce significant metabolic disturbances. Therefore, regular screening for thyroid abnormalities in all diabetic patients will allow early treatment of subclinical thyroid dysfunction. A sensitive serum TSH assay is the screening test of choice. In type 1 diabetic patients, it is helpful to determine whether anti-TPO antibodies are present. If these are present, then annual TSH screening is warranted. Otherwise, a TSH assay should be done every 2 to 3 years. In type 2 diabetic patients, a TSH assay should be done at diagnosis and then repeated at least every 5 years.


By: Gail Starr LCSW, CDE

July is a great month. It represents summer in all its glory. It is the month when people go on vacation, when kids are out of school, when flowers are in total bloom, when hopefully people feel more relaxed, and when we celebrate the 4th of July, our Independence Day.

Freedom!!!! Freedom from tyranny! Freedom from being ruled!

That is what we all want. Personal freedom. And that is what I wish you. I wish you freedom from being ruled by cravings, freedom from the need to eat to push down feelings, freedom from joint and muscle pain, freedom from anxiety, freedom from the fear of Diabetes, and freedom from denial. I wish you the freedom to choose to focus on making a few changes in order to have a better quality of life.

• Do you know that the more carbs you eat, the more you want?
• Do you know that the more people eat to push down cravings, the more guilt they feel?
• Do you know that being overweight can cause joint and muscle pain as well as more difficulty in sleeping, breathing, and in life in general. Weight also plays a major role in having higher blood sugars.
• Do you know that if people focus and plan on an objective it has a better chance of being accomplished than if they just say they want to do it?
• Do you know that anxiety and stress can raise blood sugars?
• Do you know that you needn’t fear Diabetes? It is high blood sugars that cause the problems.
Be mindul. Be aware. Make a plan. Take one day at a time.

Helpful Hints:

1. Every morning, wake up and choose to say your gratitudes. Talk out loud and remind yourself of all the things in your life for which you are grateful.

2. Choose to make it a habit to focus on your plan for the day. A good plan might be to eat only ½ the portion of carbs usually eaten.

3. Choose to do meditation, hobbies, talk to friends, read, punch a pillow, go to church, or walk on the beach to manage feelings. If food has to play a role, choose carrots, celery, radishes and other crunchy vegetables with a small amount of low fat dip.

4. Choose to make your best effort to move every day. The more you sit, the more your joints and muscles ache. Choose to get up and walk (not eat) during TV commercials.

Unfortunately, there is no freedom from the diagnosis of diabetes yet. But doing these suggestions may help you reduce your body size and free you from the anxiety about diabetes and blood sugars. It’s worth doing them because it is your body and it is your life!!!

Please come join us for our Healthy Meal Planning for Diabetes Workshop!

2 hour class – patients may bring one guest for free!

• Includes: healthy meal planning, planning healthy snacks, grocery shopping list, foods to avoid, healthy dining out & healthy alternatives when cooking,
• Refresher on glucose monitoring, exercise and weight loss.
• Patients will receive a recipe booklet including carbohydrate counting guides and snack lists.
• A Healthy snack will be prepared and provided for patients to try!

We have 3 convenient locations to attend this workshop:

Jupiter: Wednesday August 10th 5:30pm-7:30pm
Abacoa Professional Center
550 Heritage Drive, Suite 150
Jupiter FL, 33458

West Palm Beach: Tuesday August 9th 10am-12pm
Temple Israel
1901 N. Flagler Drive
West Palm Beach, FL 33401

Boynton Beach: Wednesday August 17th 10am-12pm
Brookdale Senior Living
8220 Jog Road
Boynton Beach, FL 33472

Call 561-659-6336 Ext. 8012 for reservations Today!

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