Let’s Start Counting!

Managing diabetes requires a toolbox of strategies. Taking your medications as prescribed, getting screening tests done in a timely fashion, monitoring blood sugar levels on a daily basis, are a few of these tools. Another tool to add to your box is carbohydrate counting.

Carbohydrate counting helps keep your blood glucose levels under control whether you take oral medications like metformin or use insulin. A study done at the University of Texas School of Allied Health Sciences in Galveston found that eating the same amount of carbohydrates each day gave people with Type II diabetes improved glucose control. They dropped their average blood glucose reading 55 mg/dl and their hemoglobin A1c by almost 2 points.

In order to start counting carbs, you need to know what a carbohydrate is. Carbohydrates includes sugars and starches. The source does not matter because both raise blood sugar levels. What is important is the total carbohydrate content of a food.

The nuts and bolts of carb counting:

Reading Labels

All packaged foods have food labels. Look for the total carbohydrate content of the food you are looking at. The total carbohydrate includes everything in the food that is carbohydrate, sugar, fiber, starches. Now look at the serving size listed on the package. The total amount of carbohydrate amount is based on that serving size. So if you eat more or less than that serving size you need to adjust your carb number.

For example: if a serving size is half a cup and you are going to eat a full cup, you will need to double your carb amount. There are two adjustments that you can make for fiber and sugar alcohols like mannitol, sorbitol, and xylitol. If the package lists fiber grams, subtract the number from the total carb amount. Subtract ½ the grams of sugar alcohols from the total carb content. For example : a food contains 4 grams of mannitol, subtract 2 grams from the total carb content.

Check nutrition listings

Get carbohydrate content information for unpackaged or restaurant food by carrying a printed or electronic database. There are many available some you can download onto your phone for easy access.

Learn to estimate portion sizes

An easy and quick way to count carbohydrates is called portion conversion. Portion conversion is when you compare a serving of food to a common object such as a ball or a deck of cards. Then take that amount and convert into a carbohydrate count based on the typical carbohydrate content for a a known amount of that food.

For example: one cup of cooked pasta has about 40 grams of carbohydrate. You estimate the servings on your plate to be 1 and ½ cups because a 12 ounce can of soda is approximately equal to the serving on your plate. So 1 and ½ cups of pasta has 60 carbs in it. You will need to have a list of standard food portions and their carb content.

Some common “measuring” devices:

adult fist = 1 cup

baseball = 1 cup

deck of cards =1/3 cup

12 ounce soda can =1 ½ cups

The best way to improve your skills is to practice. Estimate the volume of a food item and then compare it the food label or measure it out manually.

Carb counting may seem difficult at first but with practice you can get better. And the result will be better blood sugar control overall.

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Diabetes and Diet

Eating right for diabetes comes down to three things:  

  • What you eat. Your diet makes a huge difference!! You should eat mostly plant foods, cut back on refined carbs and sugary drinks, and choose healthy fats over unhealthy fats.

Refined carbs and sugary drinks create a quick spike in your blood sugar and may cause an over secretion of insulin with resulting hypoglycemia in Type 2 Diabetics.  This results in eating more to overcome the low sugars which results in weight gain as increasing insulin levels also results in increased fat storage.  This results in increase insulin insensitivity which worsens the diabetes.  Dizzy yet!

  • When you eat.Diet is part of it, but keeping regular meal and snack times also affects your blood sugar levels and will help to keep them more constant.

Spacing small frequent meals regularly helps level out insulin levels and decreases weight gain.

  • How much you eat. Portion sizes matter. Even if you eat very healthy meals, if you eat too much you will gain weight, which is a factor in diabetes.

Focus on SMALL frequent meals.  Unfortunately, small and American don’t coincide!  But we must change our way of thinking about food.  We don’t need all you can eat to get our money’s worth.  We don’t need to have it our way.  Split a meal with your spouse or friend.  You’ll be surprised how satisying it is.  We do need to be healthy!

You do not need to eat special foods, but instead simply emphasize vegetables, fruits, and whole grains. A diabetes diet is simply a healthy eating plan that is high in nutrients, low in fat, and moderate in calories. It is a healthy diet for anyone!

Source : http://www.helpguide.org/life/healthy_diet_diabetes.htm

Live long and prosper,

Dr. Ray

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Hyperglycemia linked to low water intake

A recent artical in Diabetes Care showed a link between low water intake and hyperglycemia.  Please discuss your appropriate water intake with your health care provider as your requirements may not be standard due to associated heart or kidney disease.

  Original artical by Ronan Roussel, Léopold Fezeu, Nadine Bouby, Beverley Balkau, Olivier Lantieri, François Alhenc-Gelas, Michel Marre, Lise Bankir, and for the D.E.S.I.R. Study Group

Low Water Intake and Risk for New-Onset Hyperglycemia Diabetes Care published ahead of print October 12, 2011, doi:10.2337/dc11-0652

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Insulin Use in Diabetes

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy, such as with glyburide, metformin, and actos as examples. Insulin therapy may be initiated as an addition to oral medications, starting at 0.3 unit per kg (kg=pounds/2.2), or as replacement to oral medications, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner.  Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications.

Thanks for reading!

Dr. Ray

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Gender Difference

New research suggests that men develop type 2 diabetes at a lower BMI (body mass index) than women.  Let’s get exercising guys!

Dr. Ray

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Hypoglycemia Underreported

A recent article on our Medical News page reported that 1/3rd of diabetic patients did not report symptoms of hypoglycemia due to not understanding what the symptoms are.  I want to make sure you know!  Please report to your provider if you’re having any of the below symptoms.

Hypoglycemia (or low blood sugar), happens when the level of glucose in the blood drops too low for what the body requires. It can occur among individuals with type 2 diabetes and is connected with certain medications for type 2 diabetes. Symptoms include, sweating, hunger, anxiety, palpitations, tremors and behavioral changes.

Sometimes when first being treated for diabetes and getting your sugars to normal you may also experience these symptoms.  When you do experience these symptoms, please record your glucose, as well as time of day and relation to time you’ve eaten, and report them to your provider.

If you’re experiencing these symptoms associated with a low blood sugar (less than 70 on your meter) more than once a week, call and move your appointment up so you can discuss this with your provider.

Treatment of  hypoglycemia involves the rapid delivery of a source of easily absorbed sugar. Regular soda, juice, lifesavers, table sugar, and the like are good options. In general, 15 grams of glucose is the dose that is given, followed by an assessment of symptoms and a blood glucose check if possible. If after 10 minutes there is no improvement, another 10-15 grams should be given. This can be repeated up to three times. At that point, you should be considered as not responding to the therapy and an ambulance should be called.

The equivalency of 10-15 grams of glucose (approximate servings) are:

  • Four lifesavers
  • 4 teaspoons of sugar
  • 1/2 can of regular soda or juice

TAKE CARE!

Dr. Ray

 

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Blog About Diabetes

This blog is about anything to do with diabetes!  We’re excited to have this forum with you. We look forward to keeping the topic lively and getting your feedback on what you want to know from us! Posts from the blog will be by Marie Miesel, APN and Lori Ray, MD.

 

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