What to do when you're falling into old, bad habits? Fit4D CDE and RDN, Erin Spitzberg recommends keeping a journal to identify and overcome hurdles and achieve optimum diabetes control!
Fit4D CDE and RD, Rita Bush shares strategies for beating diabetes burnout.
Fit4D CDE, Elise Swenson, writes about how patients can get the support they need by using their pharmacist as a diabetes educator.
Fit4D CDE, Cami Morgan, shares a personal story about comforting friends and family at the point of diagnosis.
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
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.
"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."
"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.
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.
"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.
"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.
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.
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
1) www.joslin.org (Joslin Diabetes Institute)
2) www.diabetes.org (American Diabetes Association
Vidya Sharma, MA, RD, LD, CDE
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.
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.
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
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.
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.
Academy of Nutrition and Dietetics. www.eatright.org. Accessed December 3, 2015.
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).
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.