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Yoga Is the Perfect Workout for DiabetesWhat Is Your Gut Telling You?

ComPlImenTs of Your HealTH marT PHarmaCY - Please Take one

Publisher / editor-in-Chief nadia al-samarrie

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Creative Director susan Pinkerton

business Development Manager adrian al-samarrie

accounting “matt” mathewson

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mission statement Diabetes Health is the essential resource for people living with diabetes—both newly diagnosed and experienced—as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.

letters to the editor Send letters by e-mail to [email protected]. Fax a letter to us at 510-508-3843 or mail letters to: Editor, P.O. Box 1199, Woodacre, CA 94973-1199. All letters and e-mails should include the author’s full name, address, and home telephone number. Letters may be edited for clarity and length. Publication of advertisements and product profiles does not necessarily constitute endorsement of a product or service by this organization. Information in Diabetes Health is not intended to serve as medical advice. Check with your healthcare provider before modifying any aspect of your treatment.

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eNDOCrINOLOGy aDVISerSrichard k. Bernstein, mD, faCe, faCn, CWs, faCCWsDiabetes CenterMamaroneck, NY

nancy Bohannon, mD, faCP, faCeMonteagle Medical CenterSan Francisco, CA

Daniel einhorn, mD, faCeMedical Director Scripps/Whittier Diabetes Institute La Jolla, CA

allen B. king, mD, faCe, CDeMedical Director Diabetes Care Center Salinas, California

lois Jovanovic, mDDirector and Chief Scientific Officer Sansum Diabetes Research Institute Santa Barbara, California

Peter lodewick, mDMedical Director Diabetes Care CenterBirmingham, AL

alan marcus, mDSouth Orange CountyEndocrinology Laguna Hills, CA

robert J. Tanenberg, mD, faCPProfessor of Medicine, Section of EndocrinologyBrody School of Medicine, East Carolina UniversityGreenville, NC

NurSe eDuCaTOr aDVISerJane Jeffrie seley, GnP, mPH, msn, CDeDiabetes Nurse PractitionerNewYork Presbyterian Weill Cornell Medical CenterNew York, NY

NePHrOLOGy aDVISerrobert C. stanton, mDChief of NephrologyJoslin Diabetes Center, Assistant Professor, Harvard Medical School Boston, MA

NeurOPaTHy aDVISeraaron Vinik, mD, PhDDirector, Diabetes Research Institute Eastern Virginia Medical School Norfolk, VA

DIabeTeS eDuCaTION aDVISerGary arsham, mD, PhDCalifornia Pacific Medical CenterSan Francisco, CA

PubLIC HeaLTH eDuCaTION aDVISerfrederick s. mayer, rPh, mPH.President, PPSI/PCDE San Rafael, CA

PuMP THeraPy aDVISerBruce W. Bode, mDAtlanta Diabetes AssociationAtlanta, GA

PSyCHOSOCIaL aDVISerWilliam H. Polonsky, PhD, CDeClinical Professor of PsychiatryUniversity of CaliforniaSan Diego, CA

fOOT Care aDVISerneil m. scheffler, DPm, faCfasBaltimore Podiatry GroupBaltimore, MD

PHarMaCy aDVISerSr. keith Campbell, rPh, CDeProfessor, Pharmacy Dept.Washington State UniversityPullman,WA

John r. White, Jr., Pa, Pharm.D, Professor, Dept. of Pharmacotherapy, College of Pharmacy Washington State University Spokane Spokane, WA 99210-1495

eXerCISe aDVISerSkris Berg, edDProfessor, Physical Ed. Dept.University of Nebraska at OmahaOmaha, NE

sheri Colberg-ochs, PhDAssociate Professor of Exercise Science Old Dominion University Norfolk, VA

PeDIaTrIC eDuCaTOr aDVISerSJean Betschart roemer, msn, rn, CPnP, CDeChildren’s Hospital of PittsburghPittsburgh, PA

Denise richards,msn,fnP, CDeMass. General Hospital for Children Pediatric Endocrinology Boston, MA

PHarmaCIsT aCVIsorY BoarD

PubLIC HeaLTH eDuCaTION aDVISerfrederick s. mayer, rPh, mPHPresident, PPSI/PCDE, San Rafael, CA

PHarMaCy aDVISerSr. keith Campbell, rPh, CDeProfessor, Pharmacy Dept.Washington State University, Pullman,WA

nancy edgeworth, Pharm.D., CDeAssistant Professor, Department of Pharmacy Practice, University of Maryland Eastern Shore, School of Pharmacy and Health Professions

aglaia Panos, PharmDPresident of PPSI, VP Student Pharmacist Development Specialist, Pharmacy Planning Services Inc.President - Marin Pharmacy Association

evan sisson, PharmD, mHa, CDeAssociate Professor Department of Pharmacotherapy and Outcomes Science VCU School of Pharmacy

John r. White, Jr., Pa, PharmD Professor, Dept. of Pharmacotherapy, College of Pharmacy,Washington State University Spokane, Spokane, WA

Papatya Tankut, rPhVice President, Pharmacy Professional Services CVS Caremark Corporation, Woonsocket, RI

Bill remak, BsmT, BsPH, sGna, aHCJChairman, California Hepatitis C Task Force Steering & Communications Committee Member, California Chronic Care Coalition: Chair, National Association of Hepatitis Task Forces Secretary of the Board of Directors, FAIR Foundation (Fair Allocations In Research) Co-founder, Dream of Life Coalition, Petaluma, CA

C.e. aDVISerTerry Baker, PharmDEditor, The Rx Consultant, Martinez, CA

ADVISORY BOARD

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I n v e s t I g a t e . I n F O R M . I n s P I R e .

February 2017 • Issue 223 • Volume 26 • Number 1

®

2620

In This Issue

C O V E R S T O R Y

6 Yoga Is the Perfect Workout for Diabetes

• Yoga has many benefits to support anyone living with chronic disease...

F E A T U R E S10 What Is Your Gut Telling You?

• Figuring out what’s going on when you have stomach discomfort or digestive issues can be difficult for anyone, but this is especially true for people with diabetes. Diabetes can affect every system in your body, including the gastrointestinal (gI) tract.

26 Taking the Bite out of Dental Problems from High Blood sugars

• It comes as no surprise to a person with diabetes that having high blood sugar can have a huge impact on your entire body and how you feel.

C O L U M N S

making a Difference

5 letter from the Publisher • some great tips for Living With

Diabetes

20 ask nadia • How Many Carbs a Day for

Diabetics?

H E A L T H Y L I V I N G

14 living With Type 2 • How Phil Lost 200 Pounds and got

off His type 2 Diabetes Medication

18 living With Type 1 • these simple tips Helped Me

Lose Weight

R E S E A R C H R E p O R T S

23 • not enough Diabetes Patients Receiving statins

• anti-Diabetes Prescriptions Outpacing anti-Obesity Drugs

28 • FDa expands Coverage for Lilly, Boehringer Diabetes Drug

• Congenital Heart Disease Increases adult type 2 Diabetes Risk

D I A b E T E S C R O S S w O R D p U z z L E

29 Crosssword Puzzle • test your knowledge to see how

well you understand diabetic problems.

30 Crosssword solution

F O O D F O R T H O U G H T

22 Crunchy Herbed Guacamole

C A R T O O N S

31 a1 Chuckles

6


Making a Difference

Nadia Al-Samarrie was not only born into a family with diabetes, but also married into one.

She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview–now Diabetes Health magazine.

Nadia’s leadership has spanned 25 years, establishing the magazine as a preeminent consumer and professional resource.

With our profound Web presence, Diabetes Health leads the way with an informative blend of content and technology, delivering Nadia’s enduring vision to investigate, inform, and inspire.

sOMe gReat tIPs FOR Living With Diabetes

For people with diabetes, their condition is always at the back of

their minds. they have to "manage" an often hard-to-control progressive disease that really doesn't give them a break.

Fortunately, there are things people with diabetes can do that not only make them exercise greater control over their disease but can concretely affect their numbers—and in some cases of type 2, wean a patient off of diabetes drugs.

this issue profiLes some of those empoWering activities:· Our cover story, "Yoga Is the Perfect

Workout for Diabetes" by Rachel Zinman (page 6), discusses how a venerable ancient art can help people with diabetes both physically and psychologically.

· In "What Is Your gut telling You?" (page

10), tanya Caylor looks at symptoms and possible problems with the gastro-intestinal tract, and the ways diabetes physicians and patients can address and relieve them.

· One of the unwelcome side effects of

diabetes is damage to teeth and gums. "taking a Bite Out of Dental Problems from High Blood sugars" by shoshana Davis (page 26) examines the consequences of high blood sugars on dental health and ways to mitigate them.

· Our type 1 and type 2 columns ("Living

With type 2 on page 14 and "Living With

type 1" on page 18) profile the successful efforts by two people with diabetes to control their weight and enjoy the benefits from losing a substantial number of pounds.

One of the most important questions people with diabetes ask themselves is, "How many carbohydrates should I consume per day?" In light of the recent scientific skepticism about trading fats and proteins for carbohydrates as an important way to avoid cardiovascular disease, this question is more important than ever. I answer it in "ask nadia: How Many Carbs a Day for Diabetics?" on page 20.

(One thing to keep in mind about diabetes is that while it's the name of the disease that now affects millions of americans, each case of it is different. some people with diabetes metabolize carbohydrates better than others. Determining what amount of carbs works best with each individual requires keeping track of carbohydrate consumption and comparing it to a record of blood glucose readings to see if there's a pattern of cause and effect.)

"Research Reports" (pages 23 and 28) are brief reports on current research and new drugs in the diabetes world. Please take a look.

to better management and control!

— nadia al-samarrie founder, publisher, and editor-in-chief


In spite of my diagnosis, I didn’t give up on yoga. I truly believe yoga saved my life. Yoga not only works on the physical body to increase our strength and stamina it also supports us to let go of accumulated stress and tension. this is crucial when managing our health. How many times have you noticed your own moods shift and change with unpredictable blood sugars? Having solid tools in place to deal with stress can be just as powerful as getting the perfect a1c.

so Why is yoga so beneficiaL? It’s a physical activity.

Findings suggest that when you participate in regular physical activity blood glucose control improves and type 2 diabetes can be prevented or delayed. More

My passion for Yoga started in

my teens. While everyone else was signing up for track I was in the gym breathing and stretching and gazing at my navel. I’m not quite sure why yoga caught my attention but I am absolutely glad it did. eight years ago I was diagnosed with type 1 LaDa diabetes, almost 22 years into my life as a yoga practitioner and teacher. the

diagnosis floored me.

Before my diagnosis I taught and shared yoga worldwide and was adamant that yoga had the potential to cure any disease.

after my diagnosis? a cure was questionable at best.

Yoga has many benefits to support anyone living with chronic disease, but nothing can replace a life saving medication like Insulin, especially if you live with type 1 diabetes.

in spite of my diagnosis, i didn’t give up on yoga. i truly believe yoga

saved my life. yoga not only works on

the physical body to increase our strength

and stamina it also supports us to let go

of accumulated stress and tension.

Yoga is the Perfect Workout for DiabetesRachel Zinman

Cover Story


Cover Story

to keep the body weight at its optimum. But what about Yoga exercises? according to a study held in India which recruited people not only with type 2 diabetes but with a family history of type 2 for an 8-week program. the results indicated that yoga is a feasible intervention strategy and may help reduce weight, BMI and waist circumference, three important factors in the risk of type 2 diabetes.

yoga improves sLeep anD immune system functionsomething that’s not talked about much in the management of diabetes is how much our sleep suffers. For those of us with type 1 we can be up at all hours of the night with fluctuating levels. With type 2 the fear of complications can be so overwhelming that we suffer

the autonomic nervous system governs automatic functions in the body like heart rate, breathing, digestion etc. reducing stress is key because due to mental and emotional stress around unpredictable lows and highs, we spend way more time in the fight or flight response.

specifically, Yoga, due to the engagement of the musculo-skeletal system, hugging muscles to bones and moving isometrically, improves Insulin resistance which in turn enables those of us with either type of diabetes to uptake the insulin more efficiently.

it improves your nervous system function thereby reDucing stress the autonomic nervous system governs automatic functions in the body like heart rate, breathing, digestion etc. Reducing stress is key because due to mental and emotional stress around unpredictable lows and highs, we spend way more time in the fight or flight response. a human being is designed to spend about 80% of the time in the relaxed nervous system and 20% in the fight or flight response, but that’s not what happens with diabetes. every incident in managing the disease increases stress so our time spent in the fight or flight mode is more like 80% while the relaxed part gets the 20%.

yoga may heLp promote Weight Loss. Regular physical exercise has been known to improve anyone’s health and wellbeing and


from anxiety and depression. When we don’t spend enough time in the deep sleep state our immune system suffers. Ideally a good nights sleep equals a healthy immune system. so how does Yoga help?

specific restorative postures support the body and mind to be comfortable in a state of deep rest while specific breathing

ratios to increase the length of the exhalation enable the mind to relax and slow down. also the sister science of yoga, ayurveda offers specific lifestyle guidelines which includes a daily self massage with sesame oil (called abhyanga) which penetrates the layers of the skin to relax the nervous system.

In my personal experience yoga over many years of practice

has also increased my physical strength, flexibility, concentration and improved my overall wellbeing.

But, to be honest when there are so many factors involved in managing my diabetes on a daily basis, it takes discipline to step onto my mat every day.

What gets me there, more than knowing the benefits, is the overall feeling I get from my daily practice. It’s in those last few moments after opening my eyes and gazing out at the world that I know why yoga works.

the world always feels brighter, I feel calm and rejuvenated and ready to face the day exactly as it is.

Rachel Zinman is a senior yoga teacher with over 30 years’ experience teaching internationally. at 42 she was diagnosed with type 1 LaDa diabetes. Passionate about the benefits of yoga for diabetes, Rachel writes diabetes publications. Find out more about Rachel on her blog http://www.yogafordiabetesblog.com

What gets me there, more than knowing

the benefits, is the overall feeling i

get from my daily practice. it’s in those

last few moments after opening my eyes

and gazing out at the world that i know why

yoga works.

Cover Story


gastro-esophageal reflux disease (gerD): chronic

heartburn that isn’t easily explained by late night

spicy foods may mean that something else is going on.

gerD is a condition in which stomach acids regularly

overflow into the esophagus, irritating the lining of the

tube that links your mouth to your stomach.

Figuring out what’s going on when you have

stomach discomfort or digestive issues can be difficult for anyone, but this is especially true for people with diabetes. Diabetes can affect every system in your body, including the gastrointestinal (gI) tract.

this shouldn’t be surprising when you consider that moving food from the mouth to the stomach and then through nearly 30 feet of plumbing in the intestines is a complex maneuver involving countless nerves that control the speed and efficiency of all the built-in switches and

trap doors along the way. Much as malfunctioning nerves can cause foot problems in peripheral neuropathy, diabetes can disrupt the nerves governing the digestive process. Recognizing the problem and seeking treatment as soon as possible can make a difference in controlling symptoms and helping to prevent long-term damage.

Here are some problems in both the upper and lower

portions of the gI tract to watch out for:

gastro-esophageaL reflux disease (geRD): Chronic heartburn that isn’t easily explained by late night spicy foods may mean that something else is going on. geRD is a condition in which stomach acids regularly overflow into the esophagus, irritating the lining of the tube that links your mouth to your stomach. Over time, this condition can lead to more serious problems such as asthma, dysphagia (difficulty swallowing), scar-tissue buildup that can cause narrowing of the esophagus and even esophageal cancer. In milder cases, antacids such as tums or Rolaids may do the trick. Histamine-blocking anti-reflux drugs such as Pepcid or Zantac can also help. Proton-pump inhibitors such as Prilosec and Prevacid, which are designed to reduce the production and pumping of stomach acid, may also provide relief. In advanced cases, surgery may be needed.

Feature

What is your gut teLLIng YOu?tanya Caylor


Feature

enteropathy: Bouts of constipation alternating with diarrhea are the most common symptoms of enteropathy, which is more likely to affect people with poorly controlled diabetes who have peripheral neuropathy as well as autonomic neuropathy (damage to the nerves that control everyday bodily functions). In some cases, acute hyperglycemia can affect anal sphincter function, potentially increasing the risk of fecal incontinence, especially at night. an ultrasound or endoscopic examination is often used to rule out other causes such as pancreatic insufficiency, bile salt malabsorption or an intolerance to metformin. treatment is usually geared toward symptom relief, especially if dehydration is a factor. Long term, the best treatment is aiming for better glycemic control through a combination of drugs and lifestyle modifications.

Diabetic gastroparesis: If you’ve been experiencing nausea, vomiting, bloating, upper abdominal pain and frequently feel full much sooner than usual, you may have gastroparesis, a condition in which there is a delay in how long it takes food to move out of the stomach and into your digestive tract. gastroparesis affects

people with type 1 diabetes more than type 2, but it’s pretty rare in both cases, affecting about 5 percent of the former and 1 percent of the latter. In both cases, it’s not typically something you get unless you’ve had diabetes for 10 years or more. If you suspect this is your problem, ask your doctor to perform a test called gastric emptying scintigraphy. treatment includes dietary modifications such as eating smaller but more frequent meals and staying away from fatty or high-fiber foods. Medications may be used to stimulate the stomach muscles, though side effects can be a problem. Drugs such as Benadryl and Zofran may help with nausea and vomiting. In extreme cases, a feeding tube may be surgically implanted.

esophageaL DysmotiLity DisorDers: this is a broad category of problems involving swallowing,

Diabetic gastroparesis: if you’ve been experiencing nausea, vomiting, bloating, upper abdominal pain and frequently feel full much sooner than usual, you may have gastroparesis, a condition in which there is a delay in how long it takes food to move out of the stomach and into your digestive tract.


nonalcoholic fatty liver disease (nafLD): this

condition has been linked to obesity and a sedentary lifestyle.

according to one study, up to 69 percent of people with type 2

diabetes have nafLD.

regurgitating food and spasms in the upper gI tract. some studies suggest that up to 63 percent of people with diabetes struggle with some form of this problem, which can affect both type 1 and type 2

diabetes. However, it is most common among those who have had diabetes for several years and has been linked to retinopathy. anti-reflux drugs and muscle relaxants such as nitrates and calcium channel blockers are often used to treat the problem, but in more advanced cases surgery may be required.

gLycogenic hepatopathy: this is a condition that can occur in people with type 1 diabetes who have a long-term history of poor blood sugar control. a buildup of glycogen in the liver causes elevated enzyme levels, which can reflect an enlargement of the liver due to infection or tumors. symptoms can range from vomiting, abdominal pain, jaundice, fatigue

and muscle aches to no symptoms at all. It is typically managed by prompt insulin treatment.

nonaLcohoLic fatty Liver Disease (nafLD): this condition has been linked to obesity and a sedentary lifestyle. according to one study, up to 69 percent of people with type 2 diabetes have naFLD. You may not notice any symptoms, and early cases may be benign. But over time, fatty liver disease can progress to a more serious condition that may cause inflammation, cellular degeneration, cirrhosis and even a form of liver cancer. a liver biopsy offers the most definitive diagnosis, but cost and risk factors inherent in the procedure must be weighed against the possible benefit. Chances are, if you are obese, sedentary and have diabetes, you have fat in your liver. What can you do about it? the same thing that your doctor advises for managing your diabetes in general: Improve your diet and get more exercise. Despite what you might think, low blood sugar is more important in controlling a fatty liver than a low-fat diet. antioxidants such as selenium and vitamin e may also be helpful.

Feature


When The Wall Street Journal quoted a major public figure who called Diabetes Health the best weapon against diabetes, what did he say? Former Chrysler Motors President Lee Iacocca said: “Diabetes Health magazine provides the best, most unbiased information to the diabetes community. I highly recommend it.”

What makes Diabetes Health different from any other publication out there? Diabetes Health magazine is a lifestyle publication for those living with diabetes or the people who care for them. Whether newly diagnosed or experienced with diabetes, readers are delighted and impressed by the articles written by people living with type 1 and type 2 diabetes.

Other contributors include family members who care for those with diabetes. In fact, our founder and publisher, Nadia Al-Samarrie, was not only born into a family with diabetes, but also married into one. Nadia’s articles are published nationally online by many news outlets. She has also been featured on ABC, CBS, NBC, and Fox television on “America’s Premiere Experts.”

Nadia was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview—now Diabetes Health magazine.

With Nadia’s leadership, Diabetes Health magazine was nominated for “Best in Health” by the Western Publishers Association in 2004 and 2014.

Subscribe Now and Stay Motivated With A Publication That is Dedicated to make Your Life Easier - You Deserve the Gift of Diabetes HealthStarting with your first issue you can expect to: ~ Get inspired by everyday heroes and celebrities living with diabetes~ Gain a new perspective on living with type 1 and type 2 diabetes~ Learn about the latest in medical devices, medication options, and products and stay on top of the latest research on diabetes~ Try making one of our yummy recipes~ Giggle reading one of our cartoons or test your knowledge on diabetes in one of our crossword puzzles.

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How did Phillip Brenneman lose 200 pounds

and get off insulin, metformin and his cholesterol and blood pressure meds?

the garrett, Ind., man says he did it literally one step at a time. and in the beginning,

even that was more than he could manage.

Brenneman’s first attempts at exercise took place in his chair at home. arm circles and leg lifts were all he could handle when he decided, the morning after a super Bowl party in 2015, that he had to make changes or risk missing his daughter grow up.

at 400 pounds, what people noticed was his weight. But

phillip brenneman lost 200 pounds and

got off his diabetes medications by

gradually improving his diet and exercise

habits. in october 2016 he finished his first

half marathon and in november 2016 he

placed third in his age group in a 5K race.

while that was the most obvious part of his misery, he knew his type 2 diabetes was the real danger. He had watched his mother die from complications from that disease. now in his mid-40s, he was on the that same path, and just a few years from the age at which she died.

Brenneman never went on a diet, per se. But he did start reading labels and buying healthier food. Instead of picking up dinner at the drivethrough, he began preparing veggies and lean grilled meats at home. the only processed foods in his diet were low-calorie products like Lean Cuisine frozen dinners and skinny Cow treats. eventually he cut those out as well, preferring natural, organic fare he cooks himself.

after he lost 40 pounds or so, Brenneman joined the local YMCa. He started on the elliptical machine, eventually adding walking and jogging to his regimen. By the time he saw his doctor in October 2015, he’d lost 120 pounds. His lab tests were

Healthy Living

Life With type 2 Diabetes:How Phil Lost 200 pounds and got off his type 2 Diabetes medication Tanya Caylor


normal. His doctor, stunned at the change, agreed to take him off his medications, provided he continue to monitor his blood sugar.

Brenneman eventually lost 200 pounds. His methods aren’t the quick fix people want to hear. But because he simply began to eliminate unhealthy behaviors and consistently worked to slowly improve his diet and exercise habits along the way, he now finds himself doing things that feel both comfortable and sustainable.

Having gotten used to the way premium foods fuel his body, treats that used to captivate him no longer seem so alluring. For thanksgiving, he mashed cauliflower instead of potatoes. His family is on board with his lifestyle changes. His wife has lost 60 pounds and his daughter, now 5, is learning to love exercise. “We don’t even plan on desserts,” he says.

Brenneman, who has appeared on Cnn and nBC’s “today” show, now says he checks his blood sugar more regularly than he did when he was overweight, generally at least once a day and whenever he feels “off.”

“If I overload on carbs, I can feel it,” he says. “It’s never going to go away.”

But he’s been able to control his blood sugar and maintain his weight loss by eating sensibly and exercising regularly. He completed his first half marathon in October 2016. the following month he placed third in his age group in a 5K turkey trot. though he’s sometimes tired when his alarm goes off for his morning workout, he reminds himself “that’s just a mindset.” He’s learned that his body will respond once he begins working out.

“Most people know what they’re doing wrong,” he said. “You’ve got to own up to it. I’m the one who put all that unhealthy stuff in my body.”

now he’s taking responsibility for his health, one step at a time.

Healthy Living

brenneman never went on a diet, perse. but he did start reading labels and buying healthier food. instead of picking up dinner at the drive through, he began preparing veggies and lean grilled meats at home. the only processed foods in his diet were low-calorie products like Lean cuisine frozen dinners and skinny cow treats. eventually he cut those out as well, preferring natural, organic fare he cooks himself.




We plan our meals. every week before going

grocery shopping, we decide what we’ll eat.

some weeks, especially when i have to work on the weekend, we

take it easy and thaw something from the

freezer that we made previously so that it will

be an easy week.

People keep asking me

questions about my weight. “Whose diet are you doing?” my co-workers inquired. “Wow, you lost weight. I really like the new you” said a customer at work. “You look great. I

don’t think you need to lose any more weight” remarked a sweet friend. It seems that people have noticed my 22lb weight loss, and they all want to know how I did it. there isn’t a big juicy secret, but there are some simple tips that help keep me on the right track.

the first thing is exercise. I’d be lying if I said it was possible for me to lose weight without exercise. I work hard to be healthy. I have lived with type 1 diabetes for

the past 21 years. I figured walking would be great for my circulation, heart, and blood sugars. I have gotten up at 5:30 in the morning since late January to get onto my treadmill before work. I keep doing it, despite my desire to stay in my soft sheets every morning when the alarm sounds. I make sure to walk at least 30 – 45 minutes, almost every day of the week.

I don’t go out to eat. My husband and I used to eat out at least three times a week. We decided to give it up to save money and our waistlines. We will treat ourselves to a special dinner at a restaurant for a birthday, but other than that, it is a rare occasion. It’s funny, now that I’ve been exercising and doing so well, I find myself choosing a healthier entrée when we do treat ourselves. a “cheat meal” isn’t so much of a cheat. I feel like I’d be cheating myself out of good health if I go too overboard.

Healthy Living

Life With type 1 Diabetes:these simple tips helped me Lose Weight Meagan Esler


We plan our meals. every week before going grocery shopping, we decide what we’ll eat. some weeks, especially when I have to work on the weekend, we take it easy and thaw something from the freezer that we made previously so that it will be an easy week. Many of our meals and snacks are low in carbohydrates. I also make sure to keep my portions on the smaller side. Our shopping list usually contains lots of fresh produce, cheese, eggs, nuts, unsweetened almond milk, and meat. We get low-carb tortillas for late night quesadilla cravings and a loaf of low-carb bread in case we find ourselves running out of meals, and we need to prepare a simple sandwich for dinner. these things save us from steering toward a drive-thru restaurant since they are quick and easy and guarantee that we always have something we can quickly prepare.

If I decide to eat carbs, I try to make sure it isn’t a high fat, high-carb item. Occasionally I will have a Weight Watchers or skinny Cow ice cream bar. these bars are not low in carbohydrates, but they are small, low in fat and calories, and a nice change of pace. they don’t seem to upset my blood sugars with the right insulin dose, and they keep me from straying too far towards a cheat.

I bring snacks wherever I go, and not just because of my blood sugars. I don’t want to find myself hungry while I’m out and about. I know I’ll buy something I’ll regret later to scarf down. I also always want to be prepared for my lows, so I usually have some regular crackers or juice boxes handy.

if i decide to eat carbs, i try to make sure it isn’t a high fat, high-carb item. occasionally i will have a Weight Watchers or skinny cow ice cream bar. these bars are not low in carbohydrates, but they are small, low in fat and calories, and a nice change of pace.

Healthy Living

Losing weight with diabetes is possible. It’s not easy for anyone to lose weight though it seems incredibly easy to gain at a scary rate. I found myself at my all-time highest weight the last few years, unable to budge. I knew I had to try something different. If you want to lose weight, I hope you’ll try some of the simple tips that helped me. It takes some work and dedication, but I feel so much better than I did, and I am so much happier being healthier.


Dear Nadia,How many carbs should be eaten by a diabetic in one day?—Narendra K

Dear narendra:there are no simple answers to your question.

It goes without saying that carbohydrates are the one food source that can be the most dangerous to people living with diabetes. How dangerous depends on the type and quantity of carbs you consume.

Ironically, people with diabetes have been far ahead of the curve when it comes to questioning the conventional wisdom that focusing on carbs and avoiding fat and protein are the best ways to protect themselves from cardiovascular disease.

In hindsight it’s ironic when americans joined the low fat cult in the 1990’s, the rate of new diabetes cases skyrocketed.

should people with diabetes still consume carbohydrates? Definitely

yes. But that “yes” has some important considerations attached to it and needs to be discussed with your healthcare professional.

the number of gramsWhat range of daily grams of carb consumption is “good” or “bad?” the american Diabetes association recommends daily consumption of up to 130 to 160 grams of carbs, spread over three or more meals.

Dr. Richard K. Bernstein, a type 1 and guru in the diabetes industry, has been able to keep his blood glucose down around 83—the statistical norm for non-diabetic people—by severely restricting his carb consumption. He advises his patients to eat no more than 30 grams of carbohydrates daily.

that’s quite a large spread between two well known sources. But given what we now know about carbs, it would appear following Dr. Bernstein’s advice, keeping carb intake as low as possible, 30 grams of carbs per day is difficult for most people.

the types of carbs are importanteven before researchers realized that increased carb consumption could be directly linked to cardiovascular problems, some of them realized that there was a big difference between Cheetos and oatmeal. this led to the creation of the “glycemic Index,” which rated carbohydrates on a scale, indicating how slowly the body metabolized their intake.

ask nadia: How Many Carbs a Day for Diabetics?

What range of daily grams of carb

consumption is “good” or “bad?”

the american Diabetes association

recommends daily consumption of up

to 130 to 160 grams of carbs, spread over three or more meals.

Ask Nadia


even before researchers realized that increased carb consumption could be directly linked to cardiovascular problems, some of them realized that there was a big difference between cheetos and oatmeal. this led to the creation of the “glycemic index,” which rated carbohydrates on a scale, indicating how slowly the body metabolized their intake.

the lower the glycemic number, the better the carb in the diabetic scheme of things. see the footnote below for a link to the glycemic Index. that said, I can’t recommend the grams of carbohydrates you should consume daily because this is a discussion you need to have with your healthcare professional. the daily medication and dosage you take to manage your diabetes needs to be factored in with your diet- to achieved the best possible blood sugars.

—nadia

Sources: ADA Glycemic Index l Disclaimer:Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professionals’ therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

About Nadia:Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

Nadia has received 14 nominations for her work as a diabetes advocate. She has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.

Ask Nadia

nutritional information:(1 cup): 367.53 calories; 4.54 g protein; 17.22 g carbohydrates; 34.84 g total fat; 0 mg cholesterol; 351.68 mg sodium; 11.41 g total dietary fiber.

crunchy herbed guacamoleRecipes courtesy of IMUSA. View additional recipes and IMUSA cookware at www.imusausa.com.

ingreDients2 Ripened avocados, halved and pitted3 small red radishes, diced¼ Cup finely chopped cilantro¼ Cup snipped fresh chivesKosher salt or table salt, to taste Juice of ½ limeBottled Chipotle Hot Pepper sauce (optional)

preparationscoop avocado flesh inside an IMusa Mol-cajete and add the cilantro, chopped chives, lime juice, and chipotle hot pepper sauce. gently mash with the pestle until the desired consistency is reached. Fold in diced radishes and season with salt to taste.

Food for Thought



https://www.diabeteshealth.com/diabetes-health-news-podcast-6/

almost all middle-aged diabetes patients should be using statins, but a recent study has found that cardiologists are only prescribing them to about three in every five patients. this finding came after analyzing the records of over 215,000 diabetes patients ages 40-75. each had visited a cardiologist from 2008-2013 but had no overt cardiovascular disease.

the study found that only 61.6% of patients had been prescribed a statin. those that were prescribed the medications were more likely to exhibit cardiovascular risk factors, and they were more likely to receive non-statin cholesterol-lowering therapy. the individuals that received statins also had lower LDL cholesterol than patients who did not receive the medication.

these findings were published in the Journal of the American College of Cardiology on september 20, 2016.

https://www.diabeteshealth.com/diabetes-health-news-podcast-4/

a new study published in the journal of Obesity has found that anti-diabetes drug prescriptions are far outweighing the number of prescriptions for anti-obesity drugs. In fact, there are 15 times more anti-diabetic medications (excluding insulin) dispensed compared to anti-obesity drugs. the adoption of new medications to combat obesity is also much slower than the adoption of a new anti-diabetes medication.

One of the greatest barriers to prescribing anti-obesity drugs is the lack of insurance coverage, although questions about long-term safety and unrealistic weight-loss expectations are also problematic. the researchers responsible for the study also believe that a reluctance to recognize obesity as a chronic medical condition or disease that requires medical care may also impact the number of prescriptions.

these findings were reported in the Obesity journal on august 29, 2016.

almost all middle-aged diabetes patients should be using statins, but a recent study has found that cardiologists are only prescribing them to about three in every five patients.

not enough Diabetes patients receiving statins

anti-Diabetes prescriptions outpacing anti-obesity Drugs

Research Report


brought to you by trividia health, inc., the makers of the true brand.

trividia Health, Inc. introduces the Meet Lance™ campaign, featuring the character Lance as the unassuming face of the newly diagnosed patient

with diabetes.

When newly diagnosed with diabetes, it is important to understand how diabetes can cause other serious, but preventable, health complications.

tips on topics ranging from how to get a proper blood sample to the importance

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of fiber are covered in a simple-to-read narrative. Both newly diagnosed patients and patients who have been managing diabetes for many years will benefit from the reliable and relevant information provided through Lance’s experience.

trividia Health and it’s partner, Health Mart systems, Inc., understand that managing diabetes can be costly, which is why trividia Health, through Health Mart pharmacy, offers a multitude of money-saving coupons on a wide range of products ideal for people with diabetes.

Look for Meet Lance™ patient education in each Health Mart Diabetes Health publication!

Meet Lance.™


It comes as no surprise

to a person with diabetes that having high blood sugar can have a huge impact on your entire body and how you feel. But did you know it can also cause many problems in your mouth? Your teeth and gums are heavily affected by the excess

glucose in your system, and without proper preventative care, people with either type 1 or type 2 diabetes can experience serious long-term damage to their mouths.

Here are some ways having diabetes can harm your mouth and what you can do to prevent these problems:

thrush: this fancy six-letter word describes essentially a yeast infection in your mouth.

there can be many reasons for it to occur, such as using a steroid-based inhaler. In people with diabetes, unfortunately, it’s a condition that’s very likely to pop up.

the high sugar levels in people with diabetes provide much better conditions for yeast to grow than in people without the disease. additionally, the dry mouth common in people with diabetes, combined with the higher amount of glucose in their systems, make for a perfect environment for thrush to thrive.

to help prevent thrush from developing, it’s crucial to have good dental habits, such as brushing, flossing, and using mouth wash twice a day. If you begin to notice sores or white spots, check with your dental team immediately for treatment.

taking the bite Out of Dental Problems from high blood sugarsShoshana Davis

your teeth and gums are heavily

affected by the excess glucose in your

system, and without proper preventative

care, people with either type 1 or

type 2 diabetes can experience serious

long-term damage to their mouths.

Feature

gingivitis and Periodontitis: gingivitis is the first stage of gum disease, in which plaque and tarter begin to form on your teeth and push your gums down. You’ll notice that your gums will begin to bleed and that you will have some discomfort. If gingivitis goes untreated, it can lead to periodontitis. this advanced gum disease can destroy the bone and soft tissues that hold your teeth up.

Dry mouth: everyone gets a little dry mouth here and there, but in people with diabetes it’s much more frequent. Dry mouth is essentially what the description says, a lack of saliva in your mouth. In addition to the excess sugar in your body, dry mouth can lead to all other types of problems, so it’s important to keep your saliva moving. One easy suggestion is to chew sugar-free gum, which helps your body produce saliva.

(Check with your doctor first since some people with diabetes have issues with gum. also, if necessary, your physician

can prescribe medications to help the condition.)

since having diabetes increases the amount of sugar in your system, it can be very easy to develop an excess build up of it if you don’t keep your mouth clean. It’s important to practice good dental habits as well as visit your dentist regularly for a deep cleaning.

Make sure to let your dental team know that you have diabetes, so that it can help you keep your teeth clean and prevent complications.

Shoshana Davis freelances for Top Dentists (www.topdentists.com), a dental health resource and consumer site.

since having diabetes increases the amount of sugar in your system, it can be very easy to develop an excess build up of it if you don’t keep your mouth clean. it’s important to practice good dental habits as well as visit your dentist regularly for a deep cleaning.



https://www.diabeteshealth.com/diabetes-health-news-2/

the Food and Drug administration (FDa) has recently approved an expanded form for synjardy, a drug produced by Boehringer Ingelheim and eli Lilly. also known as empagliflozin/metformin hydrochloride, synardy is now approved for use as an adjunctive treatment. When used along

with exercise and an improved diet, it is believed that the drug can improve glycemic control in adults with type 2 diabetes who haven’t received prior treatment.

While a recent double-blind study assessed the safety and efficacy of synjardy when treating type 2 diabetes, patients should still be aware of the potential side effects. the most common include runny

or stuffy nose, urinary tract infections, sore throat, headache, and diarrhea. serious side effects are rare, but can include dehydration, kidney problems, hypoglycemia, and lactic acidosis.

these findings were published in Endocrinology Today

https://www.diabeteshealth.com/diabetes-health-te-news/

Researchers have recently found that patients over 30 years old with congenital heart disease are at an increased risk for developing type 2 diabetes. this Danish study analyzed roughly 5,150 individuals born from 1963-1980 who lived with congenital heart disease up to 30 years of age.

Findings from this study showed that adults with heart disease, in particular, cyanotic congenital heart disease, were at a higher risk for developing type 2 diabetes than adults with acyanotic congenital heart disease. However, both groups had a higher risk of developing type 2 diabetes overall when compared to the general population.

these findings were published in the Journal of the American Heart Association

Research Report

researchers have recently found that

patients over 30 years old with congenital heart disease are at

an increased risk for developing type 2

diabetes.

fDa expands coverage for Lilly, boehringer Diabetes Drug congenital

heart Disease increases adult type 2 Diabetes risk


© Diabetes Health 2017

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