Energy drinks are everywhere you look.  They are available in grocery stores, vending machines, convenient and drug stores.  Some of my friends use them for a quick energy fix. Many cannot get through the day without having at least one. There are even sugar-free brands that are diabetes friendly.

I do know that these drinks are extremely high in caffeine. Some can have as much as 500 mg in every 8-ounce serving. To me, that is excessive, since a 5-ounce mug of coffee has between 60-150 mg. But, keep in mind; most people don’t drink just 5 oz…I think I will just stick to my coffee!  If you look at the nutrition label on a can or bottle, the caffeine amount is not even listed. Energy drinks usually contain guarana which supplies an additional amount of concentrated caffeine. This should concern some people with diabetes because too much caffeine can increase the heart rate and elevate your blood pressure. Both conditions can lead to a heart attack. Many people with type 2 diabetes already have high blood pressure and heart disease.  

In additions, these drinks may also contain herbal supplements.  Certain herbs can interfere with some of your diabetes medicines. The best message to take home, if you have diabetes, is to always speak with your doctor about these types of drinks. I strongly believe that all we need to do is to get plenty of sleep and exercise. Both can help boost our energy levels without needing any of these energy drinks.

What are your thoughts?

^{Reference: http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/UCM205286.pdf,  accessed 12/9/2011.}

^{http://www.samhsa.gov/data/2k11/WEB_DAWN_089/WEB_DAWN_089_HTML.pdf , accessed 12/9/2011.}

Most people are familiar with the medical ID bracelets.  Lately, there are other options available to help identify your diabetes.  A successful program was started in Tennessee known as the “Diabetes Alert Sticker Program”.  A sticker is placed in the rear window of a car that is driven by a person with diabetes.  If a policeman approaches a car and finds the driver showing signs of impairment, the officer is aware it may be diabetes related.  Low blood sugar symptoms are often similar to alcohol/drug use.  In order to receive the sticker, you will need a doctor’s order.  This program is becoming very popular and is being expanded throughout the United States.  In some states, diabetes can be listed on your driver’s license. This is another way to spread awareness to police officers aware that you have diabetes.  A diabetes tattoo is the latest trend.  You can have a tattoo with the Star of Life or the American Diabetes Association symbol.

What do you think your diabetes alert tattoo would say?

Recently, I read about a new concept that uses a contrast in the plate color and the food served on it.  The contrast of the plate and food can affect how we view portion sizes. 

You can perform your own experiment to see how this works.

• Place cream colored pasta on a white plate
• Serve pasta with red sauce on a white plate.

You will notice that you have a larger portion of creamed colored pasta compared to the pasta with red sauce. This shows that the less contrast between the color of food and the plate, the more you will eat.  Two-hundred people participated in a study and this is exactly what happened. It was also noted during the same study, when a white plate on a black tablecloth is used, the servings were 10% larger than a white plate on a white tablecloth. So, the opposite occurs; The higher the contrast the larger the food portions.

Try this and see if it makes a difference in controlling your food portions.  Let us know how it goes!

^{http://online.wsj.com/article/SB10001424052970204753404577066253349009674.html?KEYWORDS=heaping+plates , accessed 11/29/2011.}

I recently read an article titled, “Strategies for Insulin Injection Therapy in Diabetes Self- Management,” by the American Association of Diabetes Educators.  It stated that there is a lot of evidence showing the benefits of insulin therapy.  However, insulin continues to be under used in the United States compared to other countries.  Only 29% of adults with diabetes in the U.S. use insulin.  The results of two surveys recently completed showed that one-third of patients fail to take their insulin as ordered by the doctor and 29% skip their doses¹.  This tells us that there are many barriers to insulin use, resulting in poor blood sugar control and an increase in complications.

In spite of the importance of insulin therapy both doctors and patients try to avoid it.  Doctors tend to prescribe it as a last resort.  The Diabetes Attitudes, Wishes and Needs (DAWN) study showed that, in the U.S, insulin therapy is started later than in other countries².  The reasons were based on physician beliefs that insulin should be delayed and patient’s lack of education on insulin.

Patient barriers include:                                            

• False information on insulin

• They no longer have control

• Fear of needles and pain

• Weight gain

• Fear of hypoglycemia

• Too complicated to learn

Physician barriers include:

• Patient will not continue taking the insulin

• Patient will gain weight

• Patient resistance

• Patient lack of education

As an educator, I believe that insulin therapy should be started earlier in the treatment of newly diagnosed diabetes whether type 1 or type 2, control can be achieved sooner.  Patients can delay the onset of complications that occur too early and too frequently.   

Do you think adding insulin to your medication regimen would help you? 

^{1 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

^{2 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

Have You Made Your New Year’s Resolution?  Now is the time to start.  Look back over the past year and think about what you may want to change, fine-tune or learn. Here are some suggestions.

I will:

• test my blood glucose daily and know my target range
• keep my doctor appointments
• eat three portion controlled meals per day, no skipping or delaying
• drink more water
• check feet daily and use moisturizing lotion daily
• eat small amounts of protein with each snack
• make better choices when eating away from home
• go for a walk sometime during the day
• always take my diabetes medications
• relax and treat each day as a new day
• make an appointment with a dietitian to review meal plan (Medicare covers 2 hours of medical nutrition therapy with a physician order every calendar year following initial training)
• set one new goal every three months
• call a CDE at CCS Medical with questions regarding diabetes

I have made my diabetes New Year’s resolutions. Have you?

Have you or a loved one ever found yourself in this scenario? 

You were diagnosed with type 2 diabetes recently and now you have lost interest in things. The holidays are the happiest time of the year but you are sad.  You don’t understand what is going on. You may also be struggling with managing blood sugar levels and you have stopped testing altogether.

You talk with your doctor about your feelings and she performs a mental health screening. She tells you that there is a link between diabetes and depression. A 10 year study at the Harvard School of Public Health found a relationship between diabetes and depression, called a “two-way street”.  This means that diabetes puts people at risk for depression, and people with depression are at risk for type 2 diabetes.  The doctor says she will pay close attention to your mental health and the psycho-social aspect of diabetes care.  It is comforting to know that you are not alone and there is help for this problem.

Help yourself, if you have experienced any symptoms of depression, ask your doctor for a screening.  Remember, treating depression in people with diabetes can improve diabetes care. Also, people with depression can decrease their risk for type 2 diabetes. Both of these conditions can be treated and managed.

^{References: http://www.hsph.harvard.edu/news/feat}

I have two friends who have had the gastric bypass surgery.  They qualified for two reasons; Their BMI ranged between 35.0-39.9 and they have type 2 diabetes.  Both of my friends lost almost 100 pounds each!   Most importantly, they were taken off of their diabetes medicine to manage it with diet and exercise.  One of my friends actually suffered from frequent hypoglycemic episodes after this.  She was able to get it under control quickly, having known before-hand that this is a common side effect with this type of surgery.  Gastric Bypass is becoming more common for people with type 2 diabetes as an option to lose the weight.  

Gastric Bypass sounds like a quick and easy fix to dropping some serious weight, right?  What some people don’t understand is that you can gain the weight back by overeating very easily.  That is exactly what happened to both of my friends.  As a result of not following a smaller/strict diet, they both are back on their diabetes medicine and have regained the weight that was dropped from the gastric bypass surgery.

What are some other safe options for weight loss with diabetes?

Do you know anyone this has happened to?  Did they decide to have the surgery again?

I found a wonderful web page that shows how to enjoy Thanksgiving and still eat healthy.  It demonstrates exactly how to enjoy the stuffing, sweet potatoes and pumpkin pie we all love to eat on Thanksgiving Day.  The plate is divided into three portions/sections so you don’t have to measure your food.  Fill one portion with vegetables, divide the other half into two equal sections, one for stuffing and sweet potatoes and the other for the turkey. 

You will also find easy recipes to make these favorite foods with healthier ingredients.  One recipe that caught my eye was the tangerine cranberry relish which has zero grams of carbs or fat.  Also included are eleven health tips for you to use for a happy, healthy Thanksgiving!

I’m going to try to stick to calorie-free drinks throughout the day so that I can enjoy some dessert!

Also, don’t forget to sign the Healthy Holiday Eating Contract (Page 5 of the web page).  It is always helpful to set goals and list what you want to accomplish this holiday season.

Happy Thanksgiving from CCS Medical!

http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/ThanksgivingPlateResource.pdf Accessed 10/21/2011.

The holidays can be a challenge for people with diabetes and the stress can be too much with all the activities going on.  You are probably preparing for entertaining, family visits, buying gifts and parties.  Besides all of this, you are working full time, therefore, diabetes care is put on the back burner.

Here are some tips to plan for a relaxing and enjoyable holiday season:

• Plan your schedule, make a list of gifts to purchase and do some shopping online
• Always carry glucose tablets and your blood glucose meter in your car, purse or pocket
• Carry a healthy snack like nuts, a small apple with cubes of cheese or peanut butter and crackers instead of eating in the food court
• Keep your exercise schedule, it can reduce stress
• Prepare your traditional holiday food with healthier ingredients
• Bring a pre-mixed light alcoholic drink for fewer carbohydrates. Follow the American Diabetes Association alcohol guidelines for women 1 oz. and men 2 oz. per day.
• When traveling, get all prescription medication (insulin/pills) filled ahead of time. Take syringes, lancets, test strips, pump supplies and batteries

Enjoy your holiday season while effectively still managing your diabetes!

Do you have any tips for the holiday season?

Have you heard of the term “Dawn Phenomenon” or the “Somolgyi” effect? Many people with diabetes haven’t, and yet it happens quite often.

The “Dawn Phenomenon” is a sudden rise in blood sugar between 3:00am and 6:00AM. It occurs in type 1 diabetics and occasionally in people with type 2 diabetes. It is caused by the body’s reaction to hormones that are released when you sleep. The result is an increase in blood sugar due to lack of insulin in the blood stream.

The “Somolgyi” effect, also known as the “rebound” effect, is a period of low blood sugars followed by high blood sugars. It usually happens in the middle of the night. Normally this occurs as a result of taking too much insulin or an oral medication that works at the wrong time.  When the blood sugar is low the body releases hormones and stored sugar is released from the liver which also results in high blood sugars.

How do you know which one you have? This is the fun part! Your doctor will ask you to test your blood sugar between 2:00AM and 3:00 AM a few nights in a row. If the blood sugar is normal or high at this time, suspect the dawn phenomenon. However, if your blood sugar is consistently low during this time, you are experiencing the “Somolgyi” effect, caused by too much night time insulin or too small of a bedtime snack for the insulin given.

What can you do? Ask your doctor about an insulin pump to manage your diabetes.  One of the features that the pump can do well is stop the dawn phenomenon. You can set different basal rates to increase or decrease insulin according to your needs.

Feel free to share your “Dawn Phenomenon” or “Somolgyi” effect stories…what steps did you take to overcome this?