January 7, 2016

by Susan Klick, MSN, RN, CNL

Welcome to 2016! How many of you have come up with resolutions to better your life for the future? Why not use your resolution this year to set goals to better your diabetes management and improve your overall health? SMART goals are used to help people take steps to achieve particular outcomes. People are more likely to work towards and achieve SMART goals simply by the way they are designed. Let’s look at an example:

“This year I will be more physically active”

Striving to increase your physical activity is good….but let’s take a look at making this goal a SMART goal. A SMART goal is

  • Specific: Choose one thing you want to change, and include details
  • Measureable: How much? How will you measure your progress?
  • Achievable: Can you actually accomplish this goal? Is it within reason? Will you be able to do it?
  • Realistic: Goals should be do-able. If goals are set too high, you are less likely to achieve what you have set out to do. Ask yourself if the goal is practical and is it important to you.
  • Timely: Have a definitive timeline.

Now, let’s take a look again at our goal, except now we will make it a SMART goal:

                   “This year I will start being active by walking 20-30  minutes during my lunch hour on Monday, Wednesday and Friday for the next two weeks starting on Monday.”

Don’t forget to think about any concerns or possible roadblocks, and how you would handle it.  If you find a goal you set just isn’t working out for you, you may need to adjust it. For example, if you set a goal of trying three new recipes a week for one month, but you find you are too busy to try all that new cooking and it is stressing you out, change the goal to one new recipe each week.

Managing diabetes is not always easy. Setting SMART goals can help make managing diabetes a little easier.

Christmas is a Mixture of Things

December 22, 2015

by Susan Klick, MSN, RN, CNL

Christmas 2015

First, we at the Outpatient Diabetes and Nutrition Services office at St. Anthony’s Medical Center would like to wish each of you and your family a very Merry Christmas and a Healthy 2016!

Christmas is a mixture of many things – presents, excitement, food, drink, travel, guests, worry, stress – especially if this is your first Christmas with diabetes. Celebrating Christmas is not just a time for presents but also about food. We all eat a lot more than we should and we tend to eat more of the sort of food that is not exactly ideal for people with diabetes. You can’t really take a day off from diabetes but it is also important to remember that Christmas is a time to be enjoyed with family and friends.

Thing to Remember!

  • Stress tends to raise blood sugars
  • Eating more than usual can raise blood sugars
  • Exercise lowers blood sugars, so a walk after a big Christmas dinner will help to lower them.
  • Avoid keeping extra food around to nibble on.
  • Stay active – exercise reduces stress, burns excess calories and helps control blood sugars.
  • Pamper yourself! Whether by taking a relaxing bath or curling up with a book, make time for yourself. Get plenty of rest to prevent holiday tiredness.
  • Plan! Make sure that you have enough medication/insulin to cover the Christmas/new Year holidays.

If you take insulin or medications that can cause hypoglycemia (low blood sugar) remember the following tips:

  • Excitement tends to lower blood glucose levels (especially if you take insulin).
  • Try to keep meal times as near as possible to your usual times but if meals are later, then you need to remember to have a snack.
  • Maintain your blood glucose testing schedule as much as possible and test more often if you are eating more frequently or at irregular times.

A word (or two) about Alcohol:

  • Alcohol lowers blood glucose levels, not just while drinking, but for 24 hours afterwards!
  • Drink in moderation (good advice for all).
  • Limit yourself to 1 or 2 drinks
  • Drink alcohol with food, not by itself. Make it part of a meal.
  • Do not drive after drinking alcohol

Be safe and healthy this Christmas!





Insulin Dependent Diabetes Trust




Practice Gratitude

November 23, 2015

by Sue Klick, MSN, RN, CNL Diabetes Educator

Thursday is Thanksgiving. Many of us will be busy preparing the turkey, dressing, pies. How many of us will stop and take a moment to give thanks? How many of us regularly stop to express our gratitude for the good things in our lives? We have a tradition in our home – every Thanksgiving morning my husband, our adult sons and a couple of their close childhood friends gather around the kitchen table and everyone shares what in the past year they are most thankful for.   As these young people have grown into adulthood, their answers have also grown…from silly awkward moments, to statements of true understanding of what life means to them. Appreciation of others, appreciation of the beauty they have encountered in nature, and gratitude for the opportunities that they have been presented in life.

Being grateful is not only a good thing to do, it has been linked to increased happiness, better self-esteem, it helps to lessen stress, improves sleep quality, and improves your mood. All of these are also directly related to diabetes!  Instead of seeing diabetes as a thorn, be thankful for the challenges that it presents. It can make you more focused, more disciplined, more active. It gives you a heightened awareness of your body, and a better understanding of nutrition. Diabetes management improves your overall health.

This Thanksgiving take some time to focus on the things you are grateful for. Ways to increase gratitude include:

  1. Create a list of 5 things you are thankful for every day or every week;
  2. List experiences or events for which you are grateful;
  3. Write about someone you are grateful for;
  4. Write a gratitude letter to a living person, and give it to them;
  5. List 5 things about your body, mental capacities, emotions, etc. that you are grateful for.

This year on Thanksgiving morning, we will again gather around the kitchen table.  And I am thankful for the lessons in physics I will learn from Scott, the stories of the beauty of nature Kori will share, talking hockey and music with Graham, discussing medicine with Eric, learning new computer technology from Bryan, and the insightful discussions on diabetes I will have with Shauna. Most of all, I am thankful for having a wonderful husband to share it all with. We are truly blessed. From our family to yours, have a Happy and Healthy Thanksgiving.




Sources: Diabetes Self Management and Diabetes Action.Org

Flu Season is Here

November 4, 2015

by:  Susan Klick, MSN, RN, CNL


The flu can make existing health conditions worse and is especially dangers for people with chronic health conditions, like diabetes. People with diabetes both (Type 1 and 2), even when well-managed, are at high risk of serious flu complications, often resulting in hospitalization and sometimes even death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications.

Illness can make it harder to control your blood sugars. The illness might raise your sugar but sometimes people don’t feel like eating when they are sick, and this can cause blood sugar levels to fall. It is important to follow sick day rules.


Vaccination is the best protection against the flu, and flu shots are approved for use in people with diabetes as it has a long, established safety record in people with diabetes. Therefore, the CDC recommends that both Type 1 and Type 2 diabetics, who are 6 months of age and older, receive a flu vaccine.  Check with your physician regarding the nasal spray vaccine as  the safety of the nasal spray vaccine in people with diabetes and some other high risk conditions has not been established.

Your physician may also recommend a pneumonia vaccine if you have Type 1 or Type 2 diabetes.


Contact your doctor’s office immediately if you experience flu-like symptoms.  Anti-viral medications may be prescribed if you test positive for the flu that can make your symptoms less severe and make you feel better faster. Antiviral drugs fight influenza viruses in your body. They are different from antibiotics, which fight against bacterial infections. Antiviral medications may help people with conditions that increase the risk of complications from flu (like diabetes) if given within the first 48 hours after symptoms start.

Sick Day Rules:

  • Continue taking your diabetes pills or insulin
  • Test your blood glucose every four hours and track your results
  • Drink lots of calorie-free liquids to stay hydrated
  • Try to eat as you would normally
  • Weigh yourself every day. Losing weight without trying is a sign of high blood glucose

Contact your health care provider or go to an emergency room immediately if you:

  • Are unable to eat normally
  • Go six hours without being able to keep food down
  • Have severe diarrhea
  • Lose five pounds or more
  • Have a temperature over 101o Fahrenheit
  • Get a blood glucose reading lower than 60 mg/dL or more than 300 mg/dL
  • Have trouble breathing
  • Feel sleepy or can’t think clearly
American Diabetes Association

It’s Halloween! Candy is Everywhere & Chocolate is Good for Me, Right?

October 27, 2015

by Alison Brinker, RD, LD

The media often provides information about how some foods we generally think are not good choices may actually be good for us, such as chocolate and red wine.   Be aware, too much of anything is not a good idea. I will try to clarify the benefits of chocolate and wine and how to work these into a meal plan.

Flavanols are found in foods such as chocolate, red wine, grape juice, red grapes and tea. Flavanols are thought to help limit damage to the cells in our body from environmental contaminants such as pollution, pesticides and cigarette smoke. Flavanols may also play a part in reducing inflammation in the body, reduce the likelihood of platelets adhering and/or clotting in our blood vessels and improve blood flow.

The flavanols in red grapes, red wine, red grape juice may help increase levels of HDL (high density lipoprotein or “good” cholesterol) and consequently decrease the risk of heart disease. One 5-ounce glass of wine per day is all that is recommended for any potential benefit without increasing the risk of problems associated with too much alcohol consumption. If choosing red wine, a dry wine will have less impact on glucose levels than a sweet wine. It is also important to remember that a serving of fresh red grapes (about 17 grapes = 15 grams carbohydrate) or a serving of 100% juice red grape juice (4 ounce = 15 grams carb) can offer the same flavanols and benefits as the red wine. You are also getting fiber from the fresh grapes that is not found in juice or wine. Sometimes alcohol is not recommended because of certain medications.

Tea (unsweetened) is a free beverage that is also a source of flavanols. It is thought that 2 cups per day may reduce total cholesterol, LDL cholesterol (low-density lipoproteins or “bad” cholesterol) and reduce risk of heart disease and stroke. Iced tea is lower in flavanols that hot tea. Steeping tea as long as possible increases the flavanol content. Green or black tea has higher flavanol content than other types of tea.

Chocolate also contains flavanols and may help improve blood flow and lower blood pressure. However, like grape juice and fresh grapes it can impact glucose numbers significantly. The greatest amounts of flavanols are found in nonfat cocoa solids. Dutch cocoa is actually significantly lower in flavanol content. The best sources are natural or unsweetened cocoa powder. Add a tablespoon to unsweetened vanilla yogurt as part of a healthy snack. Unsweetened baking chocolate is also a good source as well as dark or semisweet chocolate. As with any food, check the label for serving size and carbohydrate content to determine the amount that will fit into your meal plan.

While chocolate can provide health benefits, tea, red grapes and grape products can too reinforcing that variety is one of the most important aspects of staying healthy.


Source: Nutrition411.com


Cereal…..It’s Not Just for Breakfast

October 12, 2015

by Alison Brinker, RD, LD

Cereal can be a great breakfast choice with so many varieties to choose from and also a good snack packed with vitamins, minerals and fiber. It can be eaten dry, with milk or stirred into yogurt.   However, it is important to know what to look for when choosing a cereal, because many claim to be healthier than they really are.

A healthy cereal will contain:

  • About 100 calories per serving or 15 grams of carbohydrate per serving
  • 2 or more grams of protein
  • At least 3 grams of fiber, 5 grams or more is ideal
  • Less than 3 grams of total fat and no trans fat or hydrogenated oils
  • 8 grams or less of sugar per serving
  • A whole grain as the first ingredient (or look for the whole grain stamp)

Be sure to check serving sizes when comparing cereal labels. Serving size needs to be the same between the two brands you are comparing or it is not a fair comparison. Some manufacturers will make the serving size smaller so all the other numbers such as calories, carbs, fat, and sugar look better.

Beware of cereals that claim to contain yogurt and be high in calcium. This “yogurt” is usually a combination of sugar, palm kernel oil (a saturated fat) and dried non-fat yogurt. The calcium does not come from the yogurt, but is added to the cereal.

Check the ingredient list for the source of fiber. Isolated fibers such as inulin, maltodextrin, soy fiber, modified wheat starch, sugarcane fiber and polydextrose only improve regularity and do not offer the other benefits of fiber such as decreased cholesterol and improved glucose control like natural, intact fiber does. Natural, intact fiber will not be part of the ingredient list as it occurs naturally in a cereal made with whole grains.


Breakfast Tips

October 5, 2015

By Susan Klick, MSN, RN, CNL

Last time we talked about the important reasons to EAT breakfast.  So here are some tips on what makes the perfect breakfast:

A perfect breakfast has three to four components:

  • One serving of a whole grain carbohydrate
  • One serving of a dairy or high-calcium food
  • One serving of fruit
  • One serving of protein (if desired)

Choose these toppings for your whole wheat bagel, English muffin or toast:

  • Two tablespoons nonfat cottage cheese sprinkled with flaxseed
  • One slice low-fat cheese melted over a slices of mango
  • Two tablespoons of peanut butter or nut butter with a sliced banana
  • One slice of baked ham and one slice of tomato
  • One slice of low-fat mozzarella cheese melted over a slice of tomato

Quick Breakfast Preps:

  • Make brown rice, barley or quinoa. Cook the grain the night before. In the morning put it in a bowl with 2 tablespoons of raisins, a cut up apple and a sprinkle of cinnamon and artificial sweetener.
  • Make a fruit smoothie. Put ½ cup of fruit (strawberries, banana, kiwi, berries), ½ cup unsweetened orange juice and 1 cup of plain yogurt in the blender. Add a scoop of protein powder and a cup of crushed ice and you’ve got a healthy, on-the-go breakfast.
  • Sprinkle a whole wheat burrito with 2 ounces of grated, low fat cheddar cheese and broil until the cheese is melted. While it is cooking eat a piece of fruit.
  • Breakfast burrito—scrambled egg, egg substitute or tofu, chopped tomatoes, onion, peppers and a little grated reduced fat cheese, wrapped in a whole wheat tortilla.
  • Trail Mix. Mix ½ cup Wheat Chex or Mini Wheats, dried fruit, mixed nuts in a snack size baggie and eat on the way to work with a thermos cup of skim or 1% milk.
  • Have lunch for breakfast. Have whole wheat toast topped with 2 tablespoons tuna made with low fat mayo, or canned or smoked salmon. Have a bowl of soup too.

The possibilities are endless!  Choose one item from each column below for a balanced breakfast:

Whole Grain Carb Low Fat Dairy Fruit Protein
½ cup cooked oatmeal 1 cup skim milk 1 piece of fresh fruit 2 egg whites or one whole egg (limit to 3 yolks per week)
¾ cup whole grain cereal 1 cup 1% milk ½ cup canned fruit packed in its own juice 1 tablespoon peanut butter
½ whole wheat English Muffin, bagel or pita 6oz. low fat yogurt ¾ cup berries 1 tablespoon almond, cashew or soy nut butter
1 slice whole wheat bread or a whole grain toaster waffle ¼ cup dried fruit ¼ cup low fat or fat free cottage cheese or 1 oz low fat cheese stick
Granola bar or muffin (less than 200 calories, less than 5g fat, less than 2 gm saturated fat ½ cup 100% fruit juice 1 oz low fat turkey sausage or bacon
1 whole grain tortilla 1 oz ham or turkey


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