A Step by Step Guide to Getting the Support You Need to Manage your Diabetes

Diabetes Support from Family, Friends, and more

There are 29 million people living with diabetes in the United States (American Diabetes Association).  That is equal to 9.3% of the population.  Yet many people with diabetes report that they often feel alone in managing their disease.  Managing diabetes often includes making changes to one's diet, increasing physical activity, taking medications, and self-monitoring blood glucose levels.  These changes can feel overwhelming when an individual doesn't have people to lean on.

Where can people with diabetes find the social support they need?  Family/social support can help to alleviate these feelings of isolation, while also positively impacting diabetes treatment adherence.  Often the people you already spend time with everyday such as family, friends, and co-workers can be invaluable in helping out. 

When building a social support network, it is important to be clear with yourself on several matters before reaching out and asking for support. 

First, what is it that you need help with?  One suggestion is an exercise partner. It is more fun to exercise with someone than to do it alone.  Also you can help to motivate each other to exercise on days when you're not "feeling it".  Another idea is to have someone help with reminders to check blood glucose or to take medications.  Some people might like their family to keep an eye on what/how much they are eating, while others don't want to deal with the "food police.” 

Second, you have to determine who can be most helpful.  It may be your spouse when it comes to grocery shopping and cooking together.  It may be a co-worker for a daily walk during your lunch break. Then figure out how they can best support you.  Is it a text in the morning asking if you've taken your medication?  Or perhaps a hug when despite your best efforts your blood sugar is too high.

Once you've thought about the type of support you are looking for, you will need to educate your friends and family about diabetes.  There are many misconceptions out there about living a healthy life with diabetes.  It may help to have loved ones come to a diabetes class with you, or send them to a website such as www.diabetes.org (The American Diabetes Association).  Also let your loved ones know exactly how they can best help you.  And of course teach them how to give the support you need.

The two key factors to effective support from close family members are: maintain realistic expectations about blood glucose levels and avoid blame.  Family members must understand that you cannot always control blood glucose levels, even if you follow your diabetes care plan.  Blaming the person with diabetes for high or low blood glucose levels does not help and can cause hurt feelings and arguments.  The key to genuine support is to focus on problem solving.  You and your healthcare team can help to convey this important message to family members.

There are other places to find support outside of your circle of family and friends.  Check with your local hospital to see if it offers diabetes classes or support groups.  The American Diabetes Association website (www.diabetes.org) has a section where you can search, by your zip code, for events that are close to you.  Check with your physician's office to see if they have any diabetes support group meetings or ask if they are interested in starting one.

Also, today in our ever-connected world, online communities can provide a different forum for support.  There are multiple groups on Facebook that people can join.  There are groups that specialize in Type 1 diabetes and also groups for Type 2 diabetes.  The American Diabetes Association website has online support with an active message board.  People with diabetes check in with each other and post their morning blood sugars, favorite healthy recipes, and tips for staying active.

No matter where you look for support, realize that you are not alone in managing diabetes.  If the burden starts to feel like too much, you can always seek the help of a professional counselor, social worker or Certified Diabetes Educator. 

Jodi Daigler, RD, CDE

Fit4D Diabetes Health Coach

The Five Stages to Successful Behavior Change

OK, so we are a few weeks into 2016, and many of us may already be wavering from our New Year’s resolutions, if not completely forgotten them.  Why is it so hard to make changes?  James Prochaska, from the University of Rhode Island, has studied this question for more than thirty years, and has applied his theory to many health behaviors, including behaviors important in diabetes management.

Prochaska has found that people who have successfully made positive change in their lives go through five specific stages: precontemplation, contemplation, preparation, action, and maintenance.

  1. "Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware or under-aware of their problems."  Some people call this phase "denial."  

  2.  "Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action."  Many people in this stage can be described as ambivalent.  They want to improve their blood sugar, but are not yet ready to cut back on eating sweets.  

  3. The Preparation stage can be considered the information gathering and planning stage.  The preparation stage is the most important.  Fifty percent of the people who attempt behavior change and skip this stage will relapse within 21 days, according to Prochaska in his book, Changing for Good.  

  4. "Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy."   During the action stage, one implements the plans developed and information gathered in the preparation stage.

  5. "Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action."

Most people I work with, who have diabetes, could be categorized in the contemplation stage. They are seriously thinking about life changes, but have not yet made a commitment to take action.  Therefore, I think it valuable to further explore this stage.

Within each stage, specific actions called, "processes of change," help someone mentally move through each stage successfully.  In the contemplation stage, the processes of change are “consciousness raising” and “self-reevaluation.”  

Consciousness raising is the process of actively becoming more aware, mindful or conscious of the current situation.  Some activities include, keeping a food diary to learn more about how much I am eating, monitoring blood sugar to learn how well or if my treatment plan is working, or reading food labels to learn about how much carbohydrate is in different foods.

Self-reevaluation flows naturally from consciousness raising.  Self-reevaluation means taking stock or appraisal of the behavior that needs to be changed, and reveals how your values conflict with the problem behaviors.  

An activity which will help clarify your values, or "why" you want to change is called “decisional balance”.   The decisional balance takes into consideration the pros and cons of behavior change.  Understanding pros and cons helps one acknowledge that behavior change has good consequences, but requires sacrifice.  

Take a piece of paper.  Divide the paper into two columns.  Label one "pros" and the other column "cons".  Under each column answer each question: ·        What will be the consequences of my behavior change be for me?  

  • What will the consequences of my behavior change be for others (family, friends, coworkers)?  
  • What will my reactions be to my new self?  
  • What will the reactions of others (family, friends, coworkers) be to my new self?
  • If the pros of change outweigh the cons, then one is ready to move into the preparations stage! This sets the foundation for the preparation, action and maintenance stages.    

I once heard a radio interview with James Prochaska.  He said that making a behavior change should be approached as if you were getting ready for a major surgery.  How much pre-planning would you do?  How much support would you solicit from friends and family? How much mental attention would you put towards it?  It would be your number one priority, and you would choose a time when there would be nothing else within your control that would take precedence.  You would not choose a time when you are making a marital change, job change, major vacation, getting ready to move to a new house, etc.  Healthy behavior change is that difficult, and it is that important.

 

By: Donna Webb, RD, LD, CDE

Fit4D Diabetes Health Coach  

 

Cancer Prevention Research Center. University of Rhode Island, 2016. Web. 10 Jan. 2016. <http://web.uri.edu/cprc/about-ttm/>

Prochaska, J. O. and W. F. Velicer (in press). “The transtheoretical model of health behavior change.” American Journal of Health Promotion.

Prochaska, PH.D., James O., John C. Norcross, PH.D., and Carlo C. Diclemente, PH.D. Changing For Good. New York, NY: Harperollins Publishers, 1994. Print.

 

New Year Resolutions - Managing Your Diabetes Effectively

 

It's the beginning of the New Year - the perfect time to review what you are already doing to take care of your diabetes and what changes you can make to manage it better. Most Year Year's resolutions begin with a great start, but often fail due to lack of motivation or burnout issues. Managing diabetes is not easy, especially with the many roadblocks that one may face. When trying to make a lifestyle change, one of the biggest challenges of individuals with diabetes is not knowing how to set appropriate goals. Here are some tips to help you be successful in implementing lifestyle changes: 

1) Set up a goal: As you work on setting your goals, it is important to set specific and realistic goals. A specific goal has a greater chance of being accomplished than a general goal because you know the behavior you would like to change and the estimated time-frame needed to achieve the goal. Goals such as, "I will eat three servings of vegetables at least 6 days a week," are more specific and realistic than, "I will eat more vegetables every day." Another example might be, "five days a week I will walk for 20 minutes after dinner," rather than saying "I will walk everyday."

It always helps to have the goal written down as a visual reminder. This means you could write it on a sticky-note and place it somewhere you can see it multiple times a day; or you can set reminders on your phone, tablet, or daily personal calendar.  

Once you have set a goal and have been successful in its implementation, you can advance the goal. You can now say, "I will eat four servings of vegetables everyday," or, "five days a week, I will walk for 30 minutes after dinner."

2) Have a Plan: Now that you have set goals to work on, set a time frame for implementing them. You also want to think about barriers that may prevent you from accomplishing your goals. Barriers may include something like not having the time to prepare recipes that include more vegetables. You could work around that by buying more frozen vegetables or salads and you can revamp your traditional recipes to make them easier and quicker to prepare. 

3) Implement your Plan: Have a daily log that helps you track changes you have already implemented. 

Remember that in spite of your best possible efforts, there may be days when you are not able to follow through on your goals. That's OK, as long as you don't lose sight of the bigger picture. 

Now that you have set some realistic, achievable goals and have actually implemented them, it's time to reward your accomplishments. It is important that the goal is relevant to you and that you have a reward and recognition system in place. You want to reward yourself with something that is appropriate to what you have accomplished. It needs to be affordable, available soon enough after successful implementation, and valuable and meaningful to you. 

In addition to specific goals you may want to implement, here are some general goals to help keep your diabetes under check:

  • Follow-up with your Healthcare Provider 3-4 times per year and more often if situations arise
  • Check your blood sugars daily
  • Take your medications as prescribed
  • Check your feet daily
  • Schedule an appointment with the dentist twice a year and an annual comprehensive eye exam

References:

1) www.joslin.org (Joslin Diabetes Institute)

2) www.diabetes.org (American Diabetes Association

Vidya Sharma, MA, RD, LD, CDE

Fit4D CDE

True or False: Foods that People Think are Healthy, but are they Really?

Gluten-Free, Fat-Free, Cholesterol-Free, Sugar-Free Foods

Why people think they’re healthy: “Free” implies that bad things are removed from foods, so it would seem these foods would then be healthy and therefore there is no need to limit portions.

Why that’s not necessarily so: People with celiac disease cannot process gluten (found in wheat, rye, barley, bulgur, graham, and spelt) however most people can. Someone may experience a benefit from cutting gluten from their diets only because they are cutting down on carbohydrates, but this often can go too far. Someone who goes “gluten free” has to become really conscious of including whole grains in the diet (such as rice [especially brown], corn, quinoa, millet, buckwheat, gluten-free oats) because of their nutritional contributions and importance to overall health. Carbohydrates should provide 45 - 65% of total calories daily per the Dietary Guidelines for Americans. Many foods made without fat or sugar will have more of the other in order to make them taste better, which still renders them to be unhealthful. The manufacturers are going to put something in to make sure people like their products! Calorie balance always comes into play with portions, as well.

Health Drinks and Health Bars

Why people think they’re healthy: Popular electrolyte-replacement drinks replace fluids and provide “energy”; protein bars are formulated to have protein and “energy”.

Why that’s not necessarily so: The “energy” from these foods is provided by carbohydrates (mostly sweeteners) and some vitamin-containing “waters”; plus they often provide caffeine. Electrolyte drinks provide fluids and energy for vigorous workouts, however they are not healthy for casual drinking when compared to plain water, 100% fruit juices, or milk. “Health bars” are often candy bars with added oatmeal or other grains, and nuts. Advise people to read labels to see the sugar and fat content of these heavily marketed products. Suggest they consider a switch to making smoothies which contain whole fruits, vegetables and milk or yogurt for a healthy drink or snack.

Vegetarianism

Why people think it’s healthy: Aren’t we supposed to eat more vegetables?

Why it’s not necessarily so: The problem for many people is that being a vegetarian is more about giving up “meat” and less about eating enough volume or variety of vegetables and fruits. A diet based on pasta and cheese or nuts and soy can be quite unhealthful due to its limited nature. Vegans in particular are at risk of not getting enough protein and calcium, and should take B-12 supplements because this nutrient can only be found in animal proteins such as meat, dairy, eggs, and fish. Further, vegetarians still need to focus on getting a balanced diet—fresh fruits, vegetables, and whole grains, and encouraged to consume low fat dairy as well.

Wine

Why people think it’s healthy: Many studies tout that wine is healthy and beneficial, showing that wine’s alcohol and polyphenols, especially resveratrol from grapes, appear to reduce LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol. Wine also provides antioxidants which can be helpful in preventing some diseases.

Why it’s not necessarily so: Many of the studies on wine have been conducted on animals, or look at correlations, and are not necessarily true for humans. Plus, some of the benefits of wine can be found in grapes themselves, and in other fruits and vegetables. The recommended daily limit of one glass for a woman, two for a man is not often followed in real life. Moderation is the key. Other research has also demonstrated that wine is unhealthy. Too much can lead to high blood pressure, increased triglycerides, and cancer. Wine is also not recommended during pregnancy.

 

Foods People Often Think Are An Indulgence, But May Be Good For You

Coffee

Why people think it’s an indulgence: It’s “addictive”, it interferes with sleep, and people love it so much it must be bad.

Why it’s pretty healthful: True, overindulgence can create problems for some such as affecting blood pressure or interfering with sleep. Current research continues to provide evidence for new ways that caffeine is beneficial to health. Contributing to the major reasons coffee was deemed unhealthy in past decades was that people who smoked, exercised little, ate unhealthy diets, and also drank coffee resulted in coffee being blamed for years for high cholesterol, obesity and other problems when in fact the accompanying habits were the culprits. Coffee seems to be protective against Parkinson’s disease, Type 2 diabetes, and liver disease including liver cancer (Mayo Clinic). Neurologists have determined that coffee has a role in improving cognitive function and decreasing the risk of depression. The key again is moderation, as well as moderating the added cream and sugar.

 

Eggs

Why people think they are an indulgence: Eggs contain cholesterol, and for many years cardiologists pinpointed eggs as being especially detrimental to heart health.

Why they’re pretty healthful: Eggs do contain cholesterol, however even people with high cholesterol do not have to avoid them completely or even limit themselves to the whites. Eggs are an excellent source of protein, and the yolks offer minerals (zinc, iron) as well as choline, vitamin A, and B-vitamins which are essential to normal cell processes in the body.

 

Chewing Gum and Mints

Why people think they are an indulgence: Aren’t they essentially candy?

Why they’re pretty healthful: The sugar alcohol Xylitol in some sugarless gums and mints is actually beneficial to the teeth. Xylitol prevents cavity-causing bacteria from adhering to teeth and can help build enamel. Xylitol should be listed in the first three ingredients for gum or mints. It can be beneficial to take the gum or mints after eating sugary or acidic foods at times when you don’t brush your teeth.

Resources:

Academy of Nutrition and Dietetics. www.eatright.org. Accessed December 3, 2015.

Emmie Olivas

Fit4D CDE

Managing Blood Sugars During the Holidays

With the holidays right around the corner, keeping blood sugars in control can be somewhat of a challenge. Whether you’ve “fallen off the bandwagon” in the past or done a relatively good job eating healthy, the following suggestions may help you get through the holidays without cramping your lifestyle.

  • Always take your medications. Be sure to stay on a schedule with your medications and don’t forget them if you are traveling away from home. Don’t be embarrassed about having to take medications in front of family or friends. You can always excuse yourself and go to another room to check blood sugars and take medications. Most people will understand or won’t even notice.

  • Keep checking blood sugars as instructed by your doctor. When eating different foods and doing different activities you may find that managing blood sugars can be a bit more challenging. Continuing to check blood sugars is critical to staying in control.

  • Carry glucose tabs or another form of fast-acting sugar with you. As mentioned above, by doing other activities you may be more likely to have unexplained high or low blood sugars. Have a form of fast-acting sugar on hand in case of a low (e.g., glucose tabs).

  • Get some form of physical activity every day. Go for a walk after dinner, play with the kids, go dancing, etc. The holidays can bring many opportunities for activity with loved ones.

  • Eat a healthy snack before going to a party to avoid overeating unhealthy foods. When you are hungry you are much more likely to make unhealthy food decisions and temptations can be harder to resist. If you show up not hungry you are much more likely to resist those yummy temptations.

  • Find out what will be served before going to a party to plan it into your meal plan. There is no need to feel shy about asking the host of a party what will be served before showing up. When you know what will be served you can decide beforehand what you will eat and won’t have to make a decision in the moment (as it may be harder to make a healthy one).

  • Bring a healthy dish to a party to share with others! You can always bring something you can eat, and others will most likely appreciate it as well. With 1 in 11 Americans having Type 2 diabetes, and more than 1 in 3 having Pre-Diabetes (2), you aren’t alone!

  • While socializing, go to a room where the food isn’t being served to avoid snacking. Get yourself out of temptation’s way. If after a while of being away from it for a while and you want to eat, you can go back and consciously eat.

  • Choose low or no carb drinks such as sparkling water, unsweetened tea, or diet beverages. An easy way to avoid too many carbs is by avoiding sugary drinks. High sugar drinks can quickly put you over your carb limit.

  • Make the focus of your festivities people and activities instead of food. The holidays aren’t just about food. Enjoy the relationships you have and don’t be scared to strengthen them during the holidays.

  • When eating, focus on vegetables and protein before carbs. When loading up your plate, be aware of what has carbs and what doesn’t, to avoid setting yourself up for failure.

  • Don’t overeat. You’ll thank yourself later

  • Plan ahead if you will be traveling. Keep in mind different time zones, availability of a refrigerator and medications. Talk to your health care provider with more specifics if you are concerned.

  • Be wary of treats brought over by friends and neighbors. The holidays can be a time for baked sweets and sharing them. Graciously thank others for their thoughtfulness but don’t allow yourself to lose control. Plan treats into your meal plan if possible, and give the rest to someone who may want them.

Remember, the holidays are for enjoying and growing closer to others and not just about the food. By having good control of your Diabetes during the holidays, you will feel better and have better BGs without any regret (3).

References:

1. “Managing Your Diabetes During the Holidays.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 Nov. 2014. Web. 14 Nov. 2015.

2. “2014 National Diabetes Statistics Report.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 May 2015. Web. 14 Nov. 2015.

3. “The Importance of Controlling Blood Sugar.” The Importance of Controlling Blood Sugar. N.p., n.d. Web. 14 Nov. 2015.

Annette Valle, RN, CDE

Fit4D CDE

Exercise and Diabetes

girl-running-stock-photo.jpg

Everyone knows that getting regular physical activity is good for you, but it can be particularly beneficial for people with diabetes. Physical activity can help control blood sugar as well as relieve stress, improve heart health, strengthen the muscles and bones, and improve mood.  For a person with diabetes, activity helps the body become more sensitive to insulin to help improve a blood sugar control (1).

Despite these benefits, today’s world is full of barriers to actually doing exercise.  Time constraints, family obligations, a dislike for exercise, lack of gym funds, or not even knowing how to begin are some obstacles that can get in the way of starting an exercise routine.  While it can be easy to get stuck on the obstacles, thinking through and planning ahead can help you incorporate physical activity into your daily routine.

Here are some tips for making exercise part of your regular routine:

  • Schedule it in. Make exercise an appointment and stick to it!
  • Make it fun. If exercise is enjoyable, you are much more likely to do it. If you like to walk, try a beautiful park.  If you like to dance, turn on the radio and jam. If you like to be outside, join a community garden and sign up for gardening hours. If you like to be around others, join your local gym or city recreation center and take a class (any centers have free or low cost options). The opportunities are endless – find the ideal activity for you and mix it up!
  • Find a buddy to exercise with: Getting support for regular physical activity can help you to actually do it!
  • Sneaking in “incidental” activity: Take the stairs instead of the elevator or parking in the back of the parking lot instead of in front are additional ways to add activity into your daily routine.
  • Set up goals and rewards. You can’t get to where you are going if you don’t know your intended destination.  Try setting a time-oriented, realistic goal, and make it specific using the SMART acronym:
  • Specific: What will you do? Who will you do it with? When will you do it?
  • Measurable: How will you know when you achieve it? (e.g., walked a half a mile)
  • Achievable: Can you reasonably do it? (e.g., if you are just starting to exercise, setting a goal of running 10 miles isn’t realistic but starting with a half mile is)
  • Relevant: Is this something you can and want to do? (If you don’t like running choose another activity)
  • Timely: When will you do it?

Once you’ve set your SMART goal, find a buddy (friend or family member) to hold you to it and reward yourself when you reach your goal.  For example: “By Friday I will walk around the track 2 times after dinner on Monday, Wednesday, and Friday and then I will go see the new movie on Saturday as my reward.”

Before starting any new exercise program, it’s important to talk with your healthcare provider. People with conditions involving the heart, eyes, kidney, and nerves may have limitations in the type and intensity of exercises they do. For a person with diabetes, it’s also important to make sure to be prepared for a possible low blood sugar.

Here are some tips for exercising with diabetes:

  • Know what low blood sugar is. Hypoglycemia is when blood sugar drops below 70 mg/dl.
  • Know the symptoms of low blood sugar. These may include feeling dizzy, shaky, light headed, irritable, and less coordinated.
  • Prepare and prevent hypoglycemia. Check blood sugar before exercising. If it’s below 100 mg/dl, have a snack of 15 grams carbohydrate, such as a piece of fruit.
  • Carry your glucometer with you to measure your blood glucose as needed.
  • Bring glucose tabs or gel in a pocket as emergency quick carb.
  • Use caution with high blood sugar. If your blood sugar is 300 or higher, or 250 with ketones, exercise is not advisable and it is recommended to seek medical care. Stay hydrated with water. Consider testing blood sugar after exercise, especially if it was a long and/or intense session.
  • Check feet every day and wear comfortable shoes.
  • Consider wearing a medical ID and keeping a phone in your pocket.
  • Always carry water to stay adequately hydrated.

A simple rule of thumb: if you don’t feel well, don’t exercise. Once you feel better and you have talked to your doctor about exercise, incorporating more activity into your life can have numerous benefits- so get moving and enjoy!

 

SOURCES:

  1. Bartlett R, Gratton C, Rolf CG eds. Encyclopedia of International Sports Studies. New York, NY: Routledge; 2010:1367-1368.
  2. Coleman E. Diet, Exercise & Fitness. 8th Edition. Falls Church, VA: Nutrition Dimensions; 2011.

Nicole Anziani, RD, CDE

Fit4D Coach

Patterns

Understanding patterns can steer you in the right direction

Keeping records and downloading reports from your meter, pump or continuous glucose monitor (CGM) can help you see the big picture.  You can use these records or reports to see patterns in your blood glucose levels.  Sometimes it is not always easy to see a pattern so your healthcare provider can educate you on how to best analyze your particular readings.  It’s recommended that you check your blood glucose for 3 or more consecutive days, prior to each meal and before bedtime, so that you can gain a complete view of your particular patterns.

Breakfast            Lunch                    Dinner                   Bedtime

100                        88                         220                          160

But if you have several days of blood glucose numbers then you are able to see if there is a pattern.

Breakfast            Lunch                    Dinner                   Bedtime

100                         88                          220                         160

85                           220                         60                           260

98                           127                         140                         267

77                           130                         102                         202

It’s helpful to circle or color code the numbers that are out of your target range then ask yourself do you see a pattern?  If there is a non-desirable pattern you might want to figure out if there is a cause.  Write down everything you can that may have an influence on your blood glucose.  For example doses and times of your diabetes medicine, times of your blood sugar numbers and foods you ate.

Please talk to your diabetes educator or healthcare provider and ask for suggestions on changes to keep your blood glucose closer to your target range.

When using 3 or 4 days for pattern management it would be a good idea to not include blood glucose numbers collected during an illness or major emotional stress, at the start of a menstrual cycle or after a low blood sugar.

The American Diabetes Association suggest the following blood glucose targets for most non-pregnant adults with diabetes:

  • 80-130 mg/dl before a meal
  • <180 mg/dl 1-2 hours after a meal

Just remember this takes time.  It’s not a judgment of you as a person, but rather an adjustment in your diabetes treatment plan.

 

Hollie Breedlove, MS, RD, CDE

Fit4D Coach

Protecting Your Diabetes Supplies during the Summer Months

For many people, summertime means time at the pool, days at the beach, backyard barbecues, and outside fun with family and friends!  During the hot summer months, you want to make sure you protect your diabetes supplies and equipment.  Heat can have negative impacts on your oral medication, insulin, blood glucose meter, and test strips.  Let’s take a look at some tips to keep your diabetes supplies safe during the hot summer months!

Insulin

Insulin can become damaged and ineffective in extreme heat.  Be sure to keep insulin pens and insulin vials refrigerated. . If you don’t have access to a refrigerator, it is perfectly fine to carry these supplies with you during the day unrefrigerated, just as long as you’re careful to keep them out of direct sunlight, and in a cool environment.  On the other hand, never store insulin next to a frozen ice pack—freezing will ruin the insulin.  Be sure to look at the medication insert for specific information on temperature thresholds for your specific insulin.

Oral Medications

Heat can also harm the effectiveness of oral diabetes medications.  Most oral medications have a therapeutic temperature range above which they don’t work as well.  Look at the medication insert for specific information on heat thresholds for you oral diabetes medications.

Blood Glucose Meter

Your blood glucose meter plays an important role in caring for your diabetes, so you want to be sure to take good care of it.  That means you should never expose it to extreme temperatures, whether that may be freezing cold, or intense heat. During the hot summer months, you don’t want to keep your meter in your car since cars can get extremely hot.  Always keep it in a cool dry place.

Test Strips

Test strips are another important tool in caring for diabetes, and we know how costly they are too.  You need protect your investment and never expose test strips to heat, which can leave the test strips working incorrectly.  Never leave your strips exposed to extreme temperatures, and always close the cap on a canister of test strips. Keeping the lid closed at all times will protect the integrity of the strips, and also keep out moisture.

 

Whitney Roberts, RD, CDE

Fit4D CDE

Diabetes doesn’t take Vacation

Yeah, Vacation!

In a recent TIME magazine I read that 96% of Americans recognize the importance of taking vacation, yet we are taking fewer days off than in the past and leaving unused vacation days at year’s end.

Vacation is a time to de-stress, to break away from our everyday life and daily grind whether it be through a ‘stay-cation’ or by exploring new surroundings or making an annual trek to our favorite location. Having time away can help with peace of mind, and help us reconnect with family or to interests not fully explored with the demands of work and everyday life. I know I focus better, perform more effectively and work harder when allowed time to break away and rejuvenate both physically and mentally.

This may come from a week-long vacation or simply a long weekend without work vying for my attention.

For those that need reminders I encourage you to do the same. Carve out some vacation time in any manner you will find pleasurable and doable.

Use the tips given by Gabrielle Kemble, Fit4D Health Coach, who recently wrote about how to plan for summer travel, and frankly, travel at any time of the year.

What I would like you to think about is this…while I extoll the virtues of vacation remember that diabetes doesn’t take a vacation. It goes where you go. Taking a break is vital, taking a break from the daily grind of diabetes self-management is also refreshing. However, to take a complete break from lifestyle habits or your medication regimen may impact your diabetes not only for the time away but into the days and weeks following your time off. It may be difficult to reign in the excess of vacation, just as it can be difficult after the holidays. Remember your A1C is a 2-3 month average of your blood sugar which includes what might be a weeklong break from healthy eating along with any change in activity level. So, to have it both ways, vacation with diabetes control I encourage you to plan ahead and get the best for your diabetes management and get the most out of your vacation.

Consider This

Consider how you may include occasional special treats while not over doing it. An increase in activity may help balance extra calories but wedon’t burn as much as our mind assumes. And excess calories and carbohydrates can cause the hyperglycemia you’re trying to avoid. Pack snacks, and easy foods to prepare when you have kitchen facilities to reduce frequency of dining out – and you’ll save money, too! Indulge with conscious thought to do so but in a controlled manner. Share a dessert and if you plan to do this, skip the appetizer. Or, if you plan to stop at the creamery for a frozen dessert, pick something light for dinner and not the pasta special. Enjoy the sights and take an additional walk after your meal. Manage alcoholic beverages and limit snacking. Why stock the camper, fridge or car with a multitude of snacks we wouldn’t ordinarily have at home? Don’t use vacation as an excuse to eat junk food, fast food or too much of any food. Keep snacks out of reach while driving so as not to eat out of boredom.

These are tips to manage food intake and reduce hyperglycemia. On the other hand, for those who are more active on vacation, you’ll want to plan ahead to prevent the hypoglycemia that can come with an increase in physical activity.

Medications

Everyone’s needs and desires are different just as medications are. So, think about how your medications work, and discuss with your Certified Diabetes Educator (CDE) or Health Care Provider (HCP) your vacation plans before leaving. They can help you learn how to make necessary adjustments with considerations for your medication regimen while on vacation to accommodate any change in sleep pattern, activity level, or food habits.

If you travel with a plan you are more apt to stick with it and be healthier for it, mind, body and spirit. Upon returning home you will feel better and ease into your routine more easily as well. I wish you all a fun, restful and healthy vacation!

 

Lori Muller RD, LD,

CDE Fit4D Diabetes Health Coach

Summer Travel & Diabetes

Summer is upon us, and for many people that means travel plans!  Diabetes shouldn’t hold anyone back from getting out and enjoying the fun!  The important thing to focus on, is taking your care routine with you.

The Essentials

Packing double the amount of medication and supplies you usually use is a great idea, incase of delays in traveling or other unexpected events.  Think about packing medication, test strips, lancets, batteries for your meter, and ketone strips.  Always take copies of prescriptions with you, should you need to get refills on the road.   Keep your health insurance card and emergency contacts in an easy to find place for emergencies; wear your medical ID bracelet or necklace.  If on insulin, be sure to bring a glucagon kit, as well as plenty of syringes or other insulin delivery devices.  It is also a good idea to check out where to get medical care near your travel destination as well.  Better to be prepared and not need it then want it and not have it.

Bring a note with you from your doctor explaining that you have diabetes and what medications you need.  If traveling to a location where a different language is spoken, consider having the note translated into the appropriate language(s).  Medications and other diabetic supplies should be packed in your carry on bag, rather than in checked luggage so that there is no risk of losing it.  Keep time zone changes in mind as you go, and be sure to take your medication at your usual times.

If you utilize an insulin pump, there are a few extra things to consider.  Request a private screening at the airport, rather than going through the body scanner.  Make sure you have extras of all your supplies – reservoirs, infusion sets, inserters if you need one, extra batteries for your pump, glucose tablets, non-perishable snacks and insulin.

 

Move!

With driving, or flying, there is always a risk of blood clots when you sit still for awhile.  Try to move around every hour or two if you are at risk for these.  Insulin that is open and in use, needs to be kept at room temperature.  If you will be in a hot car or other area, remember to pack your insulin with a cooling ice pack, putting a towel between the ice and medication to prevent it from accidentally freezing.  If you are in an area that will be excessively cold, keep your open insulin close to your body to keep it the appropriate temperature.   Unopened insulin should always be kept at refrigerator temperature, so this should be wrapped in a towel and placed with an ice pack as well.

 

Prepare for Lows

Pack plenty of pure sugar items that you can use in case of a low blood sugar.  Healthy snacks like fruit, raw veggies and bottled water are a good idea too as these are not always readily available on the road or in the air.  Make sure you have access to nutrition information.  If the places you will be eating at don’t have carbohydrate information readily available, download a nutrition database app such as Calorie King or Nutrition Data, or get a hard copy of their pocket guide versions.

Once you arrive at your travel destination, try to maintain your usual activity level to keep blood sugars in check.  And above all else, test your blood sugar!  Even more than usual, since changes in routine, eating and exercise habits can drastically affect blood sugar levels.  The more you check, the more chances you have to improve the results.  It can be difficult to balance your diabetes with changes in routine, but it if you plan ahead you can fully enjoy your summer vacation!

 

Gabrielle Kemble, RD, CDE

Fit4D CDE & Clinical Manager