November is National Diabetes Month. For 2018, organizations like the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) are focusing on gestational diabetes, a type of diabetes that is developed during pregnancy. Typically, gestational diabetes will go away after giving birth, but about half of women who develop gestational diabetes go on to develop type 2 diabetes. Mothers who have had gestational diabetes also need to know their child has an increased risk of obesity and developing type 2 diabetes.Equiscript's Certified Diabetes Educator, Donna Maria LaBrasca has put together a list of thirty tips to help manage diabetes. You can visit the NIDDK for more information on National Diabetes Month and how you can get involved in your community.
National Diabetes Month Tips
- About 50% of women who have had gestational diabetes go on to develop Type 2 diabetes. Gestational diabetes is a type of diabetes that occurs only during pregnancy. Gestational diabetes can cause health problems in both mother and baby. Managing your diabetes can help protect you and your baby. (NIDDK Gestational Diabetes)
- Gestational diabetes often has no symptoms, or they may be mild, such as being thirstier than normal or having to urinate more often. Gestational diabetes is sometimes related to the hormonal changes of pregnancy that make your body less able to use insulin. Genes and extra weight may also play a role. (NIDDK Symptoms & Causes of Gestational Diabetes)
- Managing gestational diabetes includes following a healthy eating plan and being physically active. If your eating plan and physical activity aren’t enough to keep your blood glucose in your target range, you may need insulin. (NIDDK Managing & Treating Gestational Diabetes)
- You can lower your chance of getting gestational diabetes by losing extra weight before you get pregnant if you are overweight. Being physically active before and during pregnancy also may help prevent gestational diabetes. (NIDDK Preventing Gestational Diabetes)
- If you had gestational diabetes, you are more likely to develop type 2 diabetes. Your child is more likely to become obese or develop type 2 diabetes. You may be able to lower your and your child’s chances of developing these problems by reaching a healthy weight, making healthy food choices, and being physically active. (NIDDK After Your Baby is Born)
- Has adhering to your diabetes medication been an issue due to pharmacy access, forgetting to pick up your prescriptions, etc? Evaluate your pharmacy options. A study published in the American Journal of Managed Care studied the adherence rates of more than 293,000 patients with diabetes, hypertension and high blood cholesterol over two years, and they found that patients with these conditions who had their medications delivered were 18 percent more adherent, overall, than patients who didn’t have delivery. (AJMC Dispensing Channel and Medication Adherence)
- If you've been intending to “do better” on your diabetes self-care but are just too overwhelmed by all the options, try this: at your next office visit, ask your provider to help you identify one change in your daily habits that could get you on the road to more effective diabetes management. “What should I be doing that I’m not doing now? What should I not be doing? What do I need to understand that I don’t know now?” Seeing a positive impact in one area will give you the confidence to make other changes.
- Not convinced that particular food & beverage choices, or activities such as adding an after-meal walk to your day, will make any real difference to your blood sugars? Be your own science experiment! Check out the Accu-Check Testing in Pairs info and videos to find out. Change one thing for a week, check your blood sugar before and after the food, beverage, or activity you decide to focus on, and see for yourself what effect it has on your blood sugar readings. Enlightening! It’s instant feedback you can use to fine-tune your diabetes plan.
- Know which foods and beverages raise blood sugar. (Hint: it’s anything that contains carbohydrate - carbs. Not just sugars, but any carbohydrate, whether it’s sweet or not.) Next step - do you know which foods that don’t come with a label contain carbohydrate? How about apples? Blueberries? Potatoes? How about sweet potatoes? Baked chicken? How about fried chicken? Point is, if you aren’t sure, you’ve got a lot of company. But it will be a frustrating endeavor to hope for blood sugars in the “safe” range if you’re unsure about which food and drinks contain carbs and which don’t. Remember that carbs aren’t the enemy - we need the glucose from carbohydrate breakdown for energy. Search websites that end in .org or .gov for evidence-based information you can trust about which carbs to include in your diet and which to enjoy as occasional treats only.
- Want to start making better food choices but know in your heart that you’re not going to put a lot of effort into finding out what that means? Two tips that carry a lot of impact: (1) fill up half of your plate with low-carb vegetables, and the rest with protein and starch, and (2) switch to calorie-free beverages. Easy peasy! And by the way, peas are a starch, but don’t hate on them for that.
- If you’re going to cook anyway, double the amount and freeze meal-sized portions for later. You’ll need to cook less often, and workday lunches will be ready to go.
- Beware of packaged foods that make health claims and market themselves as having an “aura of health.” Terms such as “Lean,” “Smart,” “Fit,” “no added sugar,” and “fat free” are designed to nudge you to purchase that item and are not necessarily nutritious. To make that assessment, you’ll have to read the food label.
- How can you tell if that packaged item you want to toss into your grocery cart is a good fiber choice? Look for the Dietary Fiber number on the Nutrition Facts label. Three grams (“3g”) or more is a wise fiber choice. Fiber can help you feel full longer and can dampen the blood sugar spikes that one can experience with low-fiber foods.
- Not checking your blood sugars as often as your doctor wants you to because you have no idea what the numbers mean? You’re in good company! Ask your provider to write down for you what times of day it’s best for you to take a reading (before breakfast? 1-2 hours after your largest meal of the day? At bedtime?) and what is the “safe range” for you to be in at those times. Blood sugar goals should be individualized to suit your own medical situation.
- You check your blood sugar as ordered, but are you using that information? Look for patterns. Maybe your readings are usually fine at bedtime but too high when you wake up in the morning. Maybe your fasting readings in the morning are good, but you’re in the 300s by lunchtime. Or you wake up with a low blood sugar a couple of times each week. Look for reasons that may explain a pattern, then address the reasons. Your provider will want to know if you’ve detected a pattern, and may need to make a medication adjustment.
- Not checking your blood sugars as often as your doctor wants because you don’t like the numbers you’re getting? Take a little pressure off yourself! Instead of seeing your reading as a failing grade or as a judgment on you as a person with diabetes, look at it as…just a number. A number you can use as information about what’s been going on with your activity level, food and beverage choices, and perhaps stress level over the last several hours. Use those readings you aren’t happy with to decide what needs adjustment over the next several hours in order to get you back in your “safe” zone.
- Get moving. Think of movement as medicine. All movement is helpful for your overall health. Build activity into your day. Park on the far side of the grocery store lot rather than looking for the closest space. Return your cart to the cart corral one or two rows away from your car. Bring one grocery bag at a time in from your car. You get the idea.
- Let the people in your life know clearly what you need from them regarding your diabetes. Let them know what’s helpful and what isn’t. Even people who love you, work with you, or know you well won’t “just know” what’s helpful or what is hurtful unless you share that with them.
- Use teachable moments that come your way. With all that’s involved in diabetes self-management, you’ve earned the right to. Next time someone says “Should you be eating that?” (which is really them saying “You shouldn't be eating that.”), kindly explain that, yes, people with diabetes can eat dessert, rice, pizza, etc. and help them understand why that’s true.
- We’re learning that sleep quantity and quality have a significant impact on blood sugar levels and overall health. Let your provider know if you don’t sleep well, if you snore, if you wake up tired, if you have trouble staying awake during the day, so you can plan how to address your sleep needs.
- The language we use to talk to ourselves matters. Instead of “testing” your blood sugar, “check” it instead. No one wants to fail a “test,” but you can use the blood sugar reading as info to course correct over the next several hours. And instead of striving to “control” your diabetes, take some heat off and be persistent in “managing” it instead.
- Every night before you turn out the lights, give yourself credit for what you did well that day, to manage your diabetes effectively. You remembered BOTH your morning and nighttime medications! You checked your blood sugar when you got up! You woke up late & skipped breakfast, and went off the rails at that lunch buffet, but got back on track at supper and took a walk before the sun went down! Be as emotionally kind to yourself as you are with your friends. Every day, every choice presents a fresh opportunity to do better.
- Hope for the best, but plan for the worst. Know how to plan for and deal with diabetes during a disaster.
- Put technology to work for you. Check out your blood glucose meter’s website for apps that will automatically upload your blood sugar readings to your phone. Most apps will alert you to patterns in your readings, and some allow you to set alerts (blood sugar too low, too high, time to take a reading, medication, etc.) Look on the back of your meter for the web address, or call the 800# on the back of the meter. The Customer Service person will be happy to point you in the right direction. Or just go to your app store and type in the name of your meter.
- If you’re really ready to lose weight and keep it off - only 10% of people who lose weight are successful in keeping it off, typically because they don’t have a plan for that - there’s a great online tool that can help. And it’s free!
- National Institutes of Health (NIH) research tells us that loss of body fat slows after a ketogenic diet, and that low-carb diets are nearly identical to low-fat diets in terms of fat burning. Low-carb diets impair glucose tolerance - once a person gives up on the low-carb diet and goes back to eating as they did before, their bodies are less able to keep blood sugars in the non-diabetic range. Yet again, our grandmothers were right - eat a balanced diet.
- Did you know that artificial sweeteners increase the pH - the acidity level - in the colon, which can adversely affect one’s microbiome - the intestinal environment? This matters because the condition of our gut lining (which has the surface area of a tennis court!) affects nutrient absorption and our immune system. We hear a lot about “probiotics” these days, yet there’s almost no evidence that probiotic supplements will give us a healthier gut. Feed the beneficial microbes in your gut by eating lots of plants that are as minimally processed as possible. Variety in the diet feeds the diversity of one’s microbiome.
- “I know what to do, but I can’t get myself to do it!” Try this - change your outcome goals (lose ten pounds by the Christmas party; lower my A1c by 1 point before my next office visit) to process goals (walk for 20-30 minutes after dinner at least five days each week; sweeten my iced tea with stevia instead of sugar). Break the process goal into mini-goals: “I’m going to walk at least five days this week for 5-10 minutes.” Focus on behaviors, not numbers. You’ve got this!
- The most important factor in a person’s A1c number is their adherence to their medication regimen. If your meds are too expensive, too inconvenient, too frequent, tell your provider! They want you to feel and be successful in managing your diabetes. Medication routines can be personalized to your needs and preferences, but you’ll need to let your doctor know what’s getting in the way of you taking what was prescribed.
- Chronic diseases such as diabetes (Type 2), heart disease, and high blood pressure are on the rise along with overweight and obesity. Approximately 40% of American adults are currently obese, with another 30% being overweight. The average American man is 5’9”, 196 pounds, 15 pounds more than twenty years ago. The average woman is 5’3.75”, 169 pounds, which is 20 pounds more than 20 years ago. Find out where you are by checking out the CDC Adult BMI calculator.
We hope you found this helpful. Feel free to leave your tips for managing diabetes in the comments below!
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Donna LaBrasca, M. Ed., CDE
Quality Assurance and Training Coordinator
Donna LaBrasca is the Quality Assurance and Training Coordinator at Equiscript. She spent her undergraduate years studying Psychology at Clemson University, then received a Master's degree in Counseling from The Citadel. Donna has been a Certified Diabetes Educator since 1989 and enjoys keeping up to date with new research. Reading, cooking, and BBC dramas are hobbies of Donna's. She has also been a Master Gardener almost three decades and even xeriscaped her yard!