Protect those peepers!

Eyes are delicate and can be effected by so many different factors. Eye health is generally not thought about until there is a problem. Unfortunately, there isn't symptoms until the problem is severe. So in the face of diabetes, regular eye exams is the only way to avoid serious problems.  Interestingly, diabetes is the leading cause of blindness in adults in the United States.
The two main culprits with diabetes is blood sugar and blood pressure. Both can have the largest impact on eye health.

First, lets talk about blood sugar. Blood sugar unlike other tissues in the body, doesn't require insulin to get into the eye. The sugar can flow freely in and out of the eye. We can assume if blood sugar is elevated then its elevated in the eye as well.  Elevated sugar in the eye causes  the eye ball to change shape. It literally changes from the traditional "ball" shape to an egg shape.   Many years ago during my internship I was working in a hospital. I was speaking with gentlemen patient. He told me "My blood sugar is 600 and I don't need my glasses to see".  Wow! How do you respond to that?  My first thought was "if it stays that high you won't be able to see"
Second, is blood pressure. I like to think of blood pressure as water flowing through a garden hose. When you put your thumb on the end of the hose to increase the pressure.  This is much like the blood flowing through the blood vessels. The small delicate blood vessels found in the eye cannot take the extra pressure. It causes them to burst and bleed. The result of the blood vessel bursting is  a worsening of vision leading to blindness.
One elevated blood sugar won't cause blindness. Complications caused my diabetes don't develop over night. It takes years.

The general recommendations for eye exams is different for type1 and type 2 diabetes. 

Type 1 diabetes is associated with a fast onset of disease. A person with type 1 diabetes should have a dilated eye exam at 5 years after diagnosis and every year after that.

Type 2 diabetes generally starts and advances over 6-10 years. Type 2 diabetics should have a dilated eye exam at diagnosis and every year after that.

The best way to protect your eyes are:

1. regular eye exams

2. good blood sugar control

3.Good blood pressure

Some helpful websites are:

http://www.nei.nih.gov/health/diabetic/

 http://www.diabetes.org/living-with-diabetes/complications/eye-complications/

Holidays and Diabetes

It's getting to be that time of year again when treats are all around. It generally begins in October with "fun size" candy bars. November comes next with lots of turkey and pie. Christmas candy and treats have already started. December seems to be filled with a party every night. This is the time of year when most people gain and extra 5-10 pounds.  The following suggestions can help you "enjoy" the holidays but not put one the extra holiday pounds.

*Continue with exercise. This generally gets left out when the schedule gets busy.

*Spend your calories and carbohydrates on foods only around at holiday time. For example, M & M's and chocolate kisses come in every color. They can be purchased any day of the year.Don't spend your calories and carbohydrates on an everyday food. Make it count! Spend it on the food you love!  If your great aunt Fran makes a really yummy dish or dessert that you always look forward to don't skip it. You can spent your calories and carbohydrates on that. Then you won't feel like you are missing out. You will enjoy the yummy foods you enjoy while staying on a healthy eating plan.

*Keep portions small. It is very easy to get out of hand. Have a little and then fill up on low calorie . 

foods such as vegetables and low calorie beverage.  Alcohol is super high calories. Avoid or limit this as well.

*Bring your own dish to share.  Sometimes bringing your own snack enures you will have something at the party you can eat.

*Have a snack before the party. A small nibble of healthy protein and complex carbohydrates can prevent a binge later on.

Planning ahead is a must. A helpful website is  http://www.eatright.org/nutritiontipsheets/
This site has printable sheets.

Painless diabetic testing....Is that possible??

In all my years, I have yet to meet the person who loves to test their blood sugar. I have literally had grown men "tear up" in my office because they didn't want to poke their finger. 

Many people test and just "put up" with the pain of the finger poke. A great many avoid testing all together because of the pain.

I happen to be one of those whose doesn't like pain.  If there is any way avoid it I do.  Blood sugar monitoring is important and essential when you have diabetes. So its needs to be done. The number of test times depends on the type of medication you take to control your diabetes.

When I teach blood sugar monitoring I have a few tricks I tell patients to avoid or minimize the pain of testing.

1. Change your lancet(a fancy word for the needle)every time or every other time. The main reason for this is to always use a sharp needle and infection. Each time a needle is used it becomes more dull. A dull needle causes more pain!  Lancets are cheap especially when compared to the cost of a strip. It is worth changing the lancet every time. When I change my needle every time I can barely feel the poke if at all.

2. Location of finger poke can make a big difference. Places to avoid are the "pad" and the "tip of the finger". Several nerve endings are here for our sense of touch. So these locations are more painful. Don't test too close to the finger nail bed on the side of the finger. This is painful as well. The ideal place...outside corner of the finger on the tip. Alternating fingers makes a difference. Don't forget to do this. It gives the fingers time to heal before poking them again.You can also alternate the outside corners of each finger.

3. Don't put alcohol on the skin before testing. This toughens the skin increasing pain. Washing hands with soapy water is sufficient.

4. Alternate testing sites. Many people have chosen to use and alternate testing site. This includes the palm of the hand but more commonly the arms and legs. Arms and legs have less nerve endings than fingertips so naturally less pain.  There are two monitor brands currently approved for alternate site testing. The Freestyle and One Touch. I generally cannot get a blood sample with One Touch. I find myself using the Free Style consistently. I don't have any problems getting blood samples. Make sure to rub the testing area until its warm and red. This brings the blood to the service underneath the skin.  Alternate testing works well for for mechanics and  those spending a lot of time on computers.

Food labels..Solving the mystery with "sugar free"

The food industry is a billion dollar business. We all buy food because everyone needs to eat.  Our decisions are based in part by the packaging. Knowing this companies try to stretch and twist the truth as much as they can so their product appears superior to the consumer.
The food label was put into place to regulate how companies represent the food products. You know to keep it honest. Generally, the food label is on the back of a food product. Some items  have the label on the bag rather than separate pieces like with fruit snacks or fun size candy.
Lets discuss the food label components. Knowing the food label is your ticket to understand what the food product contains. 
  All food labels are titled "Nutrition Facts"immediately below this you will find the serving size. Pay close attention to this as many times the entire package is several servings instead of one.  When you are reading the label you always use the "grams". The percentages on the right hand side is useless information except for "fat". When the fat percentage is 5% or less it is a heart healthy item. So using the fat percentage is a quick way to determine if an item is good for your heart. 
The next item is fat. It will always be labeled "Total Fat". There are two types of fat out there. Saturated fat and Unsaturated fat. Saturated fat is the "bad" kind that causes clogging in the blood vessels and less desirable for this purpose. Unsaturated fat is referred to as the "good fat" that helps prevent clogging. Many people are looking to eat this kind instead of saturated fat to prevent heart disease.  All fats fall into one of these two categories.
Next is "Cholesterol". I don't pay close attention to this because saturated fat causes a larger increase in ones cholesterol blood count than eating cholesterol.  "Sodium" should be watched if you are trying to follow a low sodium diet.
"Total carbohydrate" is the most important thing to watch if you have diabetes. Total carbohydrate is the whole story for carbohydrate. It is made up from dietary fiber, sugars, sugar alcohol, and other carbohydrates.  Carbohydrate is what causes a rise in the blood sugar. So this needs to be watched closely and counted accurately. "Fiber" can generally be subtracted from total carbohydrate. This is because it cannot be broken down. It passes right through the body. "Sugars" comes next. This must be counted every time. Sugar alcohol is generally found in sugar free foods. Half of the sugar alcohol is handled by the liver. The body looks at alcohol as a toxin. The other half contributes to blood sugar. Half of the sugar alcohol can be subtracted. So the carbohydrate you count is the Total carbohydrate less the dietary fiber and half of the sugar alcohol.
Some labels have claims that can be confusing. I think this is done purposely. Some you may have seen is sugar-free, net carbs, or effective carbohydrate.  Sugar -free refers to an item that has less than 5 grams of sugar per serving. This doesn't mean carbohydrate. Also, net carbs or effective carbohydrate. I have seen these used often. Let me explain. Both net carbohydrate and effective carbohydrate are "made-up terms. The food label on the back is your most accurate source of information. It is regulated by law so it can't be "made-up".
When an item is labeled sugar free it isn't always carbohydrate free.

  Examples:

***Cookies that are labeled "sugar free". If they are made with flour it is impossible for them to be carbohydrate free. They are sugar free because they are sweetened with sugar alcohol.

***Sugar free pudding actually has carbohydrate in the powder and then milk is added to make the pudding. By adding milk you add more carbohydrate.

***Sugar-free gelatin can be sugar free. There is no flour in that and milk is not used.

***Sugar free candy such as chocolate bunnies often have more carbohydrate when compared to the regular. Taste is generally not as desirable. Cost is generally much higher as well.

Try, Try and Try again: The stages of change

      Have you ever made a goal with all the best intentions but didn't succeed?  Or maybe you make the same new years resolutions over and over each year hoping this will be the time you finally achieve it. If this sounds familiar you are not alone. Millions of people fail at making the changes they hope to. And we tend to fail over and over. Just think about it. Do you know anyone who has quit smoking several times only to start up again later or the person who has lost 20 pounds 3 times.

 What makes us fall short when we have the best intentions?  Maybe its luck, stress, etc. The reasons can be endless. 

Let us consider the stages of change model developed in the late 1970s and early 1980s by James Prochaska and Carlo DiClemete at the University of Rhode Island

The stages of change describe what the mind/body goes through as one considers changing a behavior.

 Stage 1: Pre-contemplation: This stage describes a person who doesn't consider themselves to have a problem. They defend their bad habits, defensively if needed.  

Stage 2:  Contemplation:  This stage involves acknowledging that there is a problem.  But not yet ready to weigh the pros and cons. Not really sure if you want to make the change.

Stage 3: Preparation/ Determination: This stage involves getting ready to change. Generally, a commitment to change has been made. Often times gathering information and possibly making small changes are included as well.

Stage 4: Action/Will power: Changing behavior. This stage includes the actual change. The person believes they have the ability to change. Sometimes it is the shortest of all the stages. The most progress is made here.

Stage 5: Maintenance:  Maintaining the behavior change. A person successfully avoids temptations to return to the bad habit. They are able to anticipate situations where a relapse could occur and plan accordingly.

Stage 6: Relapse: Returning to old behaviors and abandoning the new changes. Many times this stage is filled with feelings of failure.

Did you see yourself in there somewhere?  The truth is most people actually go through the cycle several times before achieving a stable life style change. The case and point. Don't give up. If you fail at changing a behavior...Sit down with a pencil and paper. Make a list of what you did wrong and what you can do different next time to be successful. 

For example, lets say a person is trying to lose weight but cannot seem to stop snacking on chocolate treats between meals.  The first thing I discuss with patients is what can we substitute for a snack? 

A short list may include: sugar free gum, vegetables with fat free dip, light butter popcorn, dill pickles, sugar free beverage.

Next we consider what can be done instead of eating. Activities may include: reading, walking, getting a drink of ice water, painting, word search, calling a friend. It needs to be something you enjoy. It needs to get your attention.

These are some tips patients have found useful when trying to make a change. Whether you are trying to lose weight, quit smoking or just exercise more regularly, we all go through the same stages. Knowing the stages helps us better identify obstacles keeping us from our goal.  Good Luck!