Category Archives: blood glucose monitoring

Now I have Type 2 diabetes what am I supposed to eat?

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It comes as no surprise that one of the first questions someone newly diagnosed with type 2 diabetes asks is “What am I supposed to eat?”.

Let’s face it you’ve probably heard over and over again that type 2 diabetes is a ‘disease of lifestyle’. And lifestyle commonly involves food. When it comes to the food choices we make there is a lot of emotional charge attached to that. For some, it may be the way that they have eaten since they were children and this is the only way they know how to eat. Food is a connecting force between us.

So, a common answer someone diagnosed with type 2 diabetes may receive about what to eat from their healthcare provider may sound something along the lines of ‘eat healthy portion sizes, increase fruits and vegetables, cut down on processed foods’. And all these answers are great recommendations.

You’d think it seems pretty easy right to go out there and, ‘eat healthy portions, increase your fruits and vegetables, and cut down on processed foods’. But we know that’s not really what happens.

A lot of people struggle with food choices. Perhaps that’s why we have such a growing epidemic of borderline diabetes and type 2 diabetes.

Over the course of my 20 plus years as a physician, I have encountered some really strange interpretations of what a ‘healthy diabetic diet’ means to different people. Let’s face it, the amount of information out there on the internet does not help either.

So when I address the topic of what to eat with anyone diagnosed with type 2 diabetes I start by helping them to normalize their experience. Take a deep breath. This is not a punishment for what you have done wrong. And yes, you can make a choice starting today to do things differently.

My invitation is to consider that diabetes eating is healthy eating.

I intend to give a TED talk with that title because it’s something I passionately believe. If everyone diagnosed with type 2 diabetes looked at this as a way their body was inviting them to eat healthier we wouldn’t have people walking around feeling victimized.

The great news is that by making these changes to how you eat, it is possible to halt the progression of borderline diabetes, type 2 diabetes and worsening metabolic health.

Change can be stressful. So I often start by advising you take simple small steps.

This will help bypass the gargantuan alarm signals to your primitive brain- the amygdala which ends up keeping you from making any change smack in the middle of your comfort zone.

So back to the question -where do you start?

The Mediterranean diet

The Mediterranean diet is a great starting point when it comes to making some healthy changes to what you eat. The traditional mediterranean diet attracted interest because people who were living on the Greek Island of Crete had less heart disease.

What makes up the Mediterranean diet

  • whole grains
  • fruits and vegetables
  • extra virgin olive oil
  • modest amounts of poultry, red meat and fish
  • nuts
  • legumes (beans, peas etc)
  • red wine

The Mediterranean diet has been extensively researched. Over 50 studies have shown that by eating this way there is an improvement in overall metabolic health parameters- reduced waist circumference, improvement in lipid profile, blood pressure, weight and blood sugar levels.

Functional Nutrition

Perhaps you want to go a step further and you want to develop an empowered relationship to food.

Food can be used as a powerful tool, to bring about healing. In functional medicine, we call this functional nutrition.

There are several food plans used in functional medicine, each targeting different results.

The cardiometabolic food plan is a step above the Mediterranean diet.

Features of the cardiometabolic food plan

  • low glycemic foods
  • personalized targeted calories
  • helps to balance blood sugars
  • high in fiber
  • low amount of simple sugars
  • a healthy balance of quality fats

One of the exciting aspects of the THRIVE group coaching program, will be working with clients on creating a personalized cardiometabolic food plan designed to optimize their metabolic health.

If you would like more information about joining the program, please send an email to info@doctoreno.com.

How managing your A1c can help you reach healthy blood sugars

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When it comes to healthy blood sugar control, the A1C is a vital measuring tool. A1c is the short name for glycosylated hemoglobin. Now, this may sound like a mouthful. It is abbreviated to the A1C to make it easier to understand.

The A1c calculated as a percentage point. Blood glucose attaches to the proteins in the red blood cells. The A1C measures the amount of sugars attached to the red blood cells. This is a normal process that occurs in both people with diabetes as well as non-diabetics.

The average red blood cell last about 120 days, the A1c can measure the blood sugar levels over the prior 6- 8 weeks.

When it comes to managing Type 2 diabetes, the A1c can is used in two ways:

To diagnose Type 2 diabetes or pre-diabetes:

  • An A1c over 6.5% on at least two separate occasions confirms a diagnosis of Type 2 diabetes mellitus
  • An A1c between 5.7- 6.4% on at least two different times is indicative of pre-diabetes
  • An A1c of less than 5.7% is normal

The A1c can also be used to measure blood sugar control:

The A1c is commonly used to monitor overall blood sugar control. It is important to know what your A1c is. I cannot tell you how many times I have been taken aback by patients who have no idea what their A1c is.

 If you are on a mission to THRIVE despite being diagnosed with Type 2 diabetes, you need to not only knowing what your A1c but also getting it under control.

What should be the target A1c in someone living with Type 2 diabetes?

About 20 years ago, there was a landmark study on people with Type 1 diabetes.  The research found that when diabetes was detected early and blood sugars well controlled, this helped to reduce the complications associated with type 2 diabetes.

To learn more about the complications associated with type 2 diabetes, and other information, you can download this free e-book, which is the first three chapters of my award-winning book.  

According to recommendations by the American Diabetes Association, the target goal for A1c should be less than 7.0%. An A1C of less than 7% correlates with sugars on average less than 140 mg/dl.

For every percentage above 7%, the blood sugars go up about 30 mg/dL. The higher the A1c, the higher the blood sugars. The higher the blood sugars, the greater the risk of complications.

So the goal for most people is to keep the A1c less than 7%

Now there may be some caveats to these recommendations-

For instance, if you over 80 years of age, then tighter blood sugar control may not be a reasonable goal. So have a discussion with your healthcare provider about what a reasonable goal should be at that point. Perhaps an A1c between 7-8% may be a more reasonable goal.

What are some factors that may affect getting the A1c to goal?

 For some suggestions on how to achieve healthy blood sugars, I recently put together a mini-course series which is a collation of prior blog articles on just that topic. To learn more click here.  

In summary, the A1c is a percentage measure of the amount of blood glucose that is attached to the red blood cells. The less the blood glucose attached to the red blood cells, the better the A1c. So we need to focus on what we need to do to achieve healthy blood sugars.

Seven Tips People Living With Diabetes Mellitus Type 2 Can Use to Make the Most of an Office Appointment with Their Healthcare Provider

Diabetes MellitusFor some people living with diabetes mellitus type 2, an appointment with their healthcare provider, particularly a doctor, can be overwhelming.

When I was in a primary care practice, I often told my patients that for the most part they had an average of four to six office appointments a year. The typical primary care visit is limited to only 15 minutes. So you need to prepare ahead of time to make the most of the appointment.
Here are seven tips you can use to make the most of your office appointment. If you use all these tips, you will get the most out of every visit to the doctor.

Tip Number 1: Take a Long Record of Your Blood Sugars

Make a habit of keeping a record of your blood sugars. Keep it simple. You do not need fancy computer software. All you need is a small notebook. You can get this at any office supply or drug store. Divide each page of the notebook into at least two columns.

The first column is for the date and time that you check your blood sugars. The second column is to a record of your blood sugar levels.

Some people do not like to prick their fingers to check their blood sugars. I’ve shared in an article some tips on how to check your sugars once a day. Over the period of a week you be able to trend of how your blood sugars are running.

By keeping a log of your blood sugars, it helps provide important feedback for you as well as your healthcare provider. For instance if your blood sugars suddenly begin to run high or low, you can pinpoint the exact time this happened. Perhaps you were sick, had started an exercise program or went on vacation and over-indulged in food. All this information can help you and your healthcare provider to make important decisions regarding your diabetes management.

Tip Number 2: Take Along Your Glucometer

When I was in an office based practice, I liked to look over the blood sugar readings on my patients’ glucometers. A number of the new generation glucometers provide a lot of valuable information. For instance some machines average the sugars over say a 14-30 day period. Others may average the blood sugars before and after meals. This is a great teaching tool for diabetic patients. It allows them to see how their blood sugars affects their overall health and wellbeing.

Tip Number 3: If Your appointment is First Thing in the Morning Do Not Eat Breakfast

Take advantage of an early morning appointment with your healthcare provider and arrive ‘fasting’. Nowadays, a lot of healthcare providers perform blood tests in their offices to check blood sugar, A1C and lipid profile. For more information on the importance of knowing your numbers, click here.

Tip Number 4: Always Carry a Snack

Has this ever happened to you? You are at the doctor’s office and the wait time is longer than you planned. But you had taken your medications earlier on in the day. Next you begin to experience the ‘bottoming out’ sensation as your sugars take a nose-dive.

Next thing you know it you’re being carted into a waiting ambulance to the emergency room!

I advise people living with diabetes to always carry around a piece of ‘hard candy’. I also recommend meal replacement bars such as glucerna. So always be sure to take a snack along with you wherever you go.

Tip Number 5: Keep a Journal and Take This Along to Your Visit

Living powerfully with diabetes requires that you do things a little differently than the crowd. Keeping a journal or a diary is one of those things. A lot of times, a journal is for your personal use. However at times it may help your healthcare provider to detect why your sugars may be running high or low.

There are several ways you can choose to journal. For instance, you can keep a food journal. If you keep a record of what you eat, you may notice there are certain foods that make your blood sugars go up.

This gives you a good idea of knowing what foods to reduce or what to take out of your diet completely.
You may find out that stress affects your blood sugars. Some people may prefer to journal and record their blood sugars in the same book. Decide what works for you and just do it.

Tip Number 6: Be Prepared to Take Off Your Shoes and Socks

Foot care is a very important aspect of diabetes care. Inspecting the feet helps to prevent or detect early foot infections, which could lead to other complications. I always insisted on looking at the feet of all my diabetic patients at least every 2-3 months.

It is also important to make sure that you have sensation on the bottom of your feet.

Your physician can perform a very simple test called a fine filament test on your feet. This is a simple instrument and as there name suggests a thin filament. If you do not feel the filament being pressed on the bottom of your feet, you may be developing a complication called diabetic neuropathy. This is when the nerves are damaged and you can no longer feel your feet. The danger is that you could step on a nail for instance and not know because you could not feel it.

Diabetic neuropathy is one of the leading causes of amputations in people living with diabetes mellitus. So make sure that your doctor performs this test on your feet every three months.

Tip Number 7: Be Prepared for Change

In diabetes type 2 is a disease that has the potential to change over time. Regimens that worked earlier on may not work so well as the disease advances. As time goes on it may get harder to control your blood sugars. So be prepared for change.

For example you may have been on a medication for a long time and your blood sugars had been well controlled. All of a sudden your blood sugars start running high. Your doctor may decide to add another medication or even insulin. Always believe that your healthcare provider has your best interest at heart.

I know that there are a lot of skeptics out there about the pharmaceutical industry. Research is being conducted to develop new drugs, which may help preserve the function of the pancreas.
To reduce the potential complications of type 2 diabetes follow your doctor’s advice. In the first three chapters of my upcoming book, “Dr Eno’s A-Z Guide to Living Powerfully with Type 2 Diabetes” I address three strategies that are important in order to embrace change. To download a free copy of my e-book that covers this, click here.

As always I welcome your comments and suggestions about more topics you would like to learn about.
To your health & wellbeing,

How fiber can help reach healthy blood sugar levels in type 2 diabetes

type 2 diabetesA friend of mine was recently sharing me how frustrated her husband was with his blood sugar levels. They seemed to fluctuate widely from high blood sugar levels to low blood sugar levels. He did not know how to react to this and had decided that he was not going to take his medications any longer. Naturally she was at her wits end when she reached out to me. How could she convince her husband that stopping his medications was not the way to deal with fluctuating blood sugars?

Fluctuating blood sugars are not unusual in type 2 diabetes. Whether you are a woman living with diabetes or you know someone living with diabetes, this can be very frustrating .

Let me start by normalizing this for you. You are not alone. There are many reasons why the blood sugars fluctuate. I will cover this topic in more detail in an upcoming article.  In addition to scheduling an appointment to see your healthcare provider, you may also need to make sensible lifestyle changes- to your diet and exercise regimen.

One of the ways things to tweak in diet to increase the amount of fiber. Fiber is a form of carbohydrate. Contrary to popular belief, not all carbohydrates are bad for you!

There are two kinds of fiber-soluble fiber and insoluble fiber. Insoluble fiber does not get absorbed from the intestinal tract. This kind of fiber helps to reduce constipation. Soluble fiber has many proven benefits. Soluble fiber gets absorbed into the bloodstream and so can help regulate blood sugars. It also helps to control cholesterol levels.

Soluble fiber can help to reduce the risk of stroke and heart disease by up to 50%. This is especially important for someone living with type 2 diabetes, where the risk of stroke and heart attacks is increased.

Another benefit of soluble fiber is that it help reduce hunger by maintaining a sense of fullness. This can be useful in weight management. When you feel full you tend to eat less. 

Research has proven that simply losing 10% of your body weight helps to prevent borderline diabetes from becoming full blown type 2 diabetes. Some examples of soluble fiber include psyllium, pectin and wheat dextrin and oat products.

So exactly how much fiber is enough?

 Women should eat about 25 g of fiber and men up to 38 g of fiber a day. With the ‘standard American diet’ we consume an average of 17 g fiber per day.   A study in the New England Journal of Medicine found that by increasing daily fiber up to 50 g, a person living with diabetes was able to achieve healthier blood sugar and cholesterol control.

Some ways that you can start to increase your fiber intake? 

 I usually recommend gradually increasing fiber in your diet. Remember this is a long-term change you are making to your lifestyle.  If you rapidly increase fiber, it may cause gas and abdominal bloating. Too much fiber could also cause constipation if you do not drink enough water.

 So here are some suggestions on ways to increase your fiber intake: 

  1. Create a list of fiber rich foods.  You can do research this online. Click on this link to research a variety of food sources that have high fiber content.
  2. Try experimenting with some new sources of fiber every day.
  3. Gradually increase your fiber intake by 5 g per day until you reach the goal.
  4. As you increase fiber intake also make sure to increase your water intake to reduce bloating and constipation.

Remember to be kind and patient with yourself. There is no quick fix to diabetes. Your goal is to achieve healthy blood sugars so that you reduce the complications associated with diabetes. Increasing the amount of fiber in your diet can be one of your most powerful tools in achieving healthy blood sugars. So start today to take simple small steps each and every day and don’t give up.

To your health and wellbeing,

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Seven Tips On How to Maintain Healthy Blood Sugars During The Holiday Season

holiday-feast

I recall a number of years ago, when a patient left my office based practice and sent me a very nasty note three months later. She expressed how disappointed she was that I was not a person of my word. I had assured her that due to the fact that her blood sugars were well controlled and her A1C was less than 7% that I would attempt to wean her off some, if not all her medications.

The catch was that at the time that this discussion was going on, the holiday season was also upon us. I had made a mental note to address this in the New Year, as I hate to see anyone fail due to no fault of his or her own.
I should have educated my patient on what it was that I intended to accomplish and my reasoning.

For people living with type 2 diabetes, this is one of the more challenging times of the year. Blood sugar levels may gradually begin to rise with each holiday party. And with that, the A1C rises.

By following these seven simple steps, you can survive the holiday season and come out a winner ready to embrace 2017 as you live powerfully!

Tip number 1- Plan your meals

In order to keep blood sugars within a normal range, planning your meals is very important at this time of the year.

Here’s a simple tip-If you know that you are going to be out at a holiday party later on in the day, consider having a light snack just before leaving home. That way you are less hungry and less likely to go for the sweets that will cause your sugars to rise.

Also consider cutting down on the portion sizes of your earlier meals. Be careful if you are on insulin or an oral hypoglycemic agent not to cut down too low so that you do not experience hypoglycemia.

Tip number 2- Increase your amount of fiber intake

Fiber is a complex carbohydrate. The average American diet contains a low level of fiber. Most nutritionists recommend a daily fiber intake of up to 35G.

Studies have shown that by increasing the amount of fiber in the diet can help control blood glucose levels. This is especially if it is soluble fiber. An example of soluble fiber is oatmeal.

Fruits and vegetables are all good sources of fiber. By making a conscious choice to increase the amount of fiber rich foods in your diet will get you to your goal of maintaining a normal blood sugar range throughout the holiday season and beyond.

Tip number three- Plan to incorporate physical activity

The Winter & Holiday season is traditionally the time when the average American gains between 7-10 lbs. Studies have shown that people living with type 2 diabetes can achieve normal blood sugar range by increasing physical activity. During the winter months make an effort to maintain some form of physical activity. Choose an exercise regimen that is easy to follow.  As always be sure to see your physician before starting out on an exercise program. So if you have not already scheduled your annual physical, now is a great time to go ahead and do so.

Tip number four- Drink enough water

There are a myriad of benefits to drinking water. The important thing in a type 2 diabetic is to maintain good kidney function. Drinking water may also keeps you feeling full and so help with weight loss. The traditional recommendation has always been 8 glasses of water a day. However something else to consider is drinking half of your body weight in ounces. So if you weigh 170 lbs. that equals 85 ounces of water a day.

Tip number five- be consistent with monitoring your blood sugars

This is not the time of the year to slack off testing your blood sugar levels.  It is not the time to stick your head in the sand and rationalize that your blood sugar levels are going to be high and there’s nothing you can  do about it anyway. Your mindset is very important. If you have not been checking your blood sugar levels regularly, this is the time to start. By regularly checking your blood sugar levels,  you get instant feedback. Living powerfully with diabetes, requires that you have an awareness attached to action. High blood sugar levels just do not happen to you. You can make the necessary adjustments in your lifestyle in order to control your blood sugars.

Tip number six- Keep all scheduled appointments with your healthcare providers

This is the time to make your healthcare provider aware of any challenges that you may be encountering during the holiday season. That way you both can explore ways to better control your blood sugar levels.

Depending on your A1C, your healthcare provider may decide to adjust your medications. This is a much better option than starting out the New Year with high A1c levels and blood sugar levels out of control. Sometimes it can take more than 6 months to normalize the blood sugars.

Tip number seven- Enlist the support of family and friends

I have written in a previous article about the importance of a support network. Now more than ever is the time of the year to enlist the support of family and friends. Want to get started in an exercise program? Call up a workout buddy. Not sure how to handle ‘Aunt Martha’s’ three layer chocolate cake? Have a family member share a portion with you. It takes teamwork to make the dream work. Do not be afraid to ask for support. Sometimes just knowing there is someone else looking out for you is what makes the world of difference.

I’d love to read your comments and any other strategies that you may have in place to ensure that you keep your diabetes type 2 sugar levels normal this holiday season and beyond.

Until next week,

Here’s to your Health & Wellbeing,

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Blood Glucose Monitoring-Some Strategies to Check Blood Sugar Levels Once a Day

blood glucose monitoringWelcome back! Over the last few weeks I shared some of the lows and highs of living with type 2 diabetes. Namely hypoglycemia and hyperglycemia.

According to American Diabetes Association guidelines, normal fasting blood sugar levels range between 80-130 mg/dL. Blood sugars should also be checked after eating. This is called postprandial blood sugars. The best time to check postprandial blood sugars is  two hours after a meal. Normal postprandial blood sugar levels should be below 180 mg/dL. In order to reduce diabetes complications, it is important to try and keep blood sugars within this range.

Sometimes it may be necessary to check blood sugars several times a day in order to make the necessary adjustments to get blood sugars in the healthy range. This is usually where I would encounter a lot of resistance from my patients. They complain that testing their blood sugars several times a day is painful. Test strips cost a lot of money. Or it may be that because of their work schedule they just don’t have the time.

I found that the more I argued with my patients about monitoring their blood sugars more than once a day, the more resistant some patients became. In fact some even stopped coming in as scheduled. They would stretch out their appointments. For instance, instead of coming in every three months, they made it twice a year.

Now that can be harmful as it is a surefire way to develop complications related to diabetes!

So I had to get creative with that segment of my patients that just were not going to check their blood sugars consistently.

Well here are some strategies that I came up with. For the most part they ended up being about compromise, which I think is something that is very important if you are committed to living powerfully.

Strategy number 1-alternate checking fasting blood sugar levels with post prandial blood sugar levels

This is by far my favorite strategy. This is how it works:

On a calendar, divide the month into odd numbered and even numbered days.

On odd numbered days of the month, check your fasting blood sugar levels.

On even numbered days, check your postprandial sugar levels.  Try to vary the times that you check your postprandial levels. For instance on one day check the levels after breakfast, the next time after lunch. At another time after dinner.

This is a great way to get a general view of how your sugars run during different times of the day and not test more than once a day.

Remember to make a note of the times that you check your sugars so that your doctor can understand the trend. Some blood glucose monitors allow labeling the blood sugars also. Check your glucose monitor to see whether you can do this.

Strategy number 2- check postprandial sugars over the weekend

Here is when I would recommend this strategy:

If a patient cannot check their postprandial levels during the week due to their work schedule, then I encourage them to check the fasting levels during the week and then over the weekend, just to focus on checking their postprandial levels.

They can do this by alternating postprandial levels between breakfast, lunch and dinner over the weekend

Strategy number 3- check your blood sugars for two weeks before you see your healthcare provider

I only bring out this strategy when I am pushed to the wall. Literally I am begging a patient to work with me so that I can help them reach their blood sugar goals.

There is nothing more frustrating than not having an idea about how the blood sugars of a patient are running in between scheduled office visits. It is like shooting in the dark. You get a blood test result that is high, but you have no idea how to go about correcting it.

As I tell my type 2 diabetes patients, on average they get to see their healthcare provider between three to four times per year for routine diabetes care. What happens the remaining 361 days is left in their hands.

With blood sugars taken consistently for even two weeks before an office visit, when combined with the hemoglobin A1C most times it is much easier to spot the problem.

Why is it important to check both the fasting and postprandial blood sugar levels?

In an earlier article I shared some important numbers that a person living with diabetes needs to know. One of those numbers is the A1C also known as the glycosylated hemoglobin. The target range for the A1c is less than 6.5- 7%.  In order to achieve that goal, the fasting blood sugars are within the target range of 70-130 mg/dL. The postprandial levels also have to be consistently less than 140 mg/dL two hours after a meal.

If your A1C is high, then by keeping a log of the blood sugars, you will be able to pinpoint the problem.

For instance if the fasting blood sugar levels are within normal range, but the post prandial levels are high, then perhaps you need to adjust portion sizes.

If the fasting levels are running high, it may be that the evening medications need to be adjusted or that a late night snack needs to be cut out. Sometimes this may even mean that the nighttime medications may need to be cut down. But your physician needs to see your glucose log so that they can target the problem and create a customized plan for you.

Start today to check your blood sugars

Perhaps you are a newly diagnosed diabetic or even if you have had diabetes for some time but just never thought it important to check your blood sugars. Let’s start out fresh.

Review the instructions of your glucometer. If you do not understand how to use it then check to see whether your local pharmacist can help you. If not call your doctor’s office and schedule a visit with the nurse. Most times they can help you. Most times the machines work the same way. A few have extra ‘bells and whistles’ attached to them.

Just as I share in my upcoming book, “Dr Eno’s A-Z Guide to Living Powerfully with Type 2 diabetes”,  two of the hallmarks of living a powerful life with diabetes is being committed and persistent. If you do that you will go a long way to living free of diabetes complications.

I welcome your comments or questions so please leave them here. I’d also love to hear some of the issues that you have as a type 2 diabetic. Come over to my Facebook page and share some of your thoughts with me. It just may be a topic for an upcoming article.

Until next week Here’s to your Health and Wellbeing,

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The ABC’s of Knowing Your Diabetes Numbers

I was once admitting a patient to the hospital. He had been living with type 2 diabetes for over 15 years. Unfortunately he had developed kidney failure and so now had to be on hemodialysis.

He seemed to know how his blood sugars were doing. He even recognized that a recent infection was the reason that his blood sugars were high.

I was impressed and excited. Then I asked him this, ‘So what’s your A1C?’  ‘What’s that?’ he replied with a blank stare. I was taken aback at his response, ‘You know your glyco hemoglobin?’ I ventured again. Another blank stare. ‘Never heard of that’ he responded off offhandedly.

Here was a man who by all intents and purposes seemed actively engaged in managing his diabetes. And yet he had NEVER heard of the A1C!

So this week, I will discuss getting to know your diabetes numbers.

One of the keys to Living powerfully with diabetes is to know your numbers.

I love acronyms. They help to make learning easier. For instance in my soon to be released book, Dr. Eno’s  A-Z Guide to Living Powerfully with Diabetes’ I use the letters of the alphabet to cover different topics related to  type 2 diabetes.

I am going to use the simple acronym ABCs to show how to remember some diabetes numbers. The uppercase letter will be for what I’ll call actual numbers. The smaller ‘a’ will go with some of the lifestyle adjustments that need to be made as a person living with type 2 diabetes.

So here goes:

  • A – A1C
    • activity
  • B – Blood sugar
    • bmi
  • C – Cholesterol
    • calories

A1C

A1C is a short name for glycosylated hemoglobin. That may sound like a mouthful, so it’s been abbreviated it to the A1C. The A1c is calculated as a percentage point. The A1C measures the average of the blood sugar levels over the prior 6- 8 weeks. The A1C measures the amount of sugars that attached to the red blood cells.

The higher the blood sugars, the higher the A1C. Typically the red blood cells live for about 120 days before they die off.

The goal is to keep the A1C less than 7%. An A1C less than 7% correlates with sugars on average less than 140 mg/dl.

How to get tested for the A1C:

You do not have to fast overnight before getting tested for the A1C. Most healthcare providers can do this test in their office; otherwise it can be done in the laboratory.

activity

I encourage everyone to try to adapt some form of physical activity. Research has shown that prolonged sitting and a sedentary lifestyle increases your risk of heart disease, cancer and diabetes by up to 40%. Research also shows that increased physical activity helps to control blood sugars.

A lot of people use the excuse of lack of time for not getting enough physical activity. Here are some creative ways to incorporate physical activity into your daily life:

  • Purchase a fitness tracker so that you can track your movement. When you track any activity you become more aware of that and this makes you want to do more of what you track.
  • Encourage your friends and colleagues to purchase fitness trackers. Have them join you in a fitness tracking challenge. A good idea would be to check with your health insurance company to see if fitness trackers are a covered benefit.
  • Instead of looking for a 30-45 minute block of time, how about creating three to four 10-15 minute blocks of time throughout the day?
  • Rather than taking the elevators, look for every opportunity to take the stairs.
  • Get to work 15 minutes earlier park further away and get a brisk walk.
  • Get up several times during your workday and do squats at your desk.
  • Do leg raises when you are sitting down
  • Spend time during your lunch break walking outdoors.
  • Instead of delegating that task of walking the dog to your kids, get a long leash and walk it!

Blood Sugar

It is important to keep your blood sugars within a healthy range. Depending on the treatment goals that your healthcare provider sets, you may have to check your blood sugars at home. This is known as self-monitoring of blood glucose. I’m often surprised to find patients who do not want to check their blood sugars. Perhaps they feel it is painful or they are scared stick themselves.

A healthcare provider only gets to see their patients on average 4-5 times a year. That’s every 3-4 months! Knowing your blood sugar levels gives you instant feedback as to how well you are managing your diabetes. It alerts you to a problem and you can work with your healthcare provider to make corrections.

Knowing your blood sugars is key to living powerfully with diabetes. 

bmi

Currently there are more than two third of adult Americans are overweight or obese.

BMI correlates with body fat and is relatively unaffected by height. It is calculated from the weight and square of the height as follows:

BMI   = body weight (in kg) ÷ stature (height, in meters) squared

Know your BMI

The definition of overweight and obesity varies by race.

According to the WHO and NHBLI guidelines, overweight for Caucasians, Hispanics and blacks is a BMI between 25 and 29.9 kg/m2.

Obesity is when the BMI of 30 kg/m2 or more.

For Asians, overweight is a BMI between 23 and 29.9 kg/m2. Obesity a BMI >30 kg/m2.

There are several apps that can help to calculate your BMI once you enter in your weight and height. You can also check with your healthcare provider on a routine visit.

Cholesterol

Cholesterol is produced in the liver. It gets transported from the liver to the cells of the body where it performs a variety of functions. If the cholesterol levels run high then there is a risk for heart disease.

It is important to know your cholesterol numbers.

You should get a fasting lipid panel as part of your routine diabetes care.

The fasting lipid panel is made up of several parts:

  • HDL (High Density Lipoprotein) I call it the ‘happy cholesterol’ This level should be more than 40 mg/dl. More than 60 mg/dl is excellent.
  • LDL (Low Density Lipoprotein) I call it the ‘lousy cholesterol’. You want to keep this as LOW as possible. The current guidelines are to get the LDL as low as 70 mg/dl.
  • Triglycerides – These are all the fatty substances in your blood. The goal is to keep the triglycerides less than 150 mg/dl.

calories

The amount and quality of calories that you eat plays a crucial role in how well controlled your blood sugars are going. Calories are also tied directly to how much weight you gain or lose. It’s a very simple equation.

Calories in more than calories out = gain in weight (high BMI + High blood sugars + high A1C)

Calories in less than calories out = weight loss (lower BMI + normal blood sugars + normal A1C)

Ways to monitor your calories:

  • A simple way to start of is to simply watch your portion sizes.
  • Don’t fill your plate or use a smaller plate.
  • Eat only till you are about 80% full. This is a principle that the Okinawans in japan use. They live into their 100s.
  • Increase your intake of fruits and vegetables.
  • Drink at least half your body weight in ounces of water per day. This helps to keep you full.
  • Increase the intake of fiber. This also helps control your blood sugars.

So there you have it. Know your ABCs.

As always I welcome your questions and comments.

Here’s to your Health & Wellbeing,