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.




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

Breakfast – How Important is it?

September 25, 2015

by Susan Klick, MSN, RN, CNL

Mom was right – you shouldn’t skip breakfast. This is especially true with diabetes. When you wake up in the morning, you’ve gone many hours without eating and your body needs fuel. You wouldn’t pull your car out of the garage and drive to work without fuel in it, and your body isn’t any different.   Your body needs fuel! If you don’t give it any, it will create its own in the form of stored blood sugar from the liver. The liver may make too much sugar, and your blood sugar gets too high. Studies show people with type 2 diabetes who skip breakfast and fast until noon may have continued blood sugar spikes throughout the day. Skipping breakfast has also been linked to less efficient processing of glucose by the body, or a reduced ability to convert blood sugar into energy.

Research has shown there truly is a negative effect on how the body uses glucose when a diabetic simply skips breakfast. This means that even if you don’t eat as many carbohydrates at lunch and dinner, it will have little or no effect on reducing elevated glucose levels when you have skipped breakfast. This is because skipping breakfast may make it difficult for the pancreas to produce the right amount of insulin to properly control blood sugar. Normally, beta cells in the pancreas release insulin in response to elevated levels of sugar in the blood. But when you skip breakfast, it may cause the beta cells to delay the release of insulin and allow blood sugar levels to remain high for longer periods of time after lunch and dinner.

Remember, when you wake up in the morning, your body is in a fasting state. When you don’t give it any energy (food), your body slows down to conserve the energy it has left. Your metabolism slows down. The trick is to keep your metabolism going at a steady rate all day. One simple solution is to always eat a good, healthy breakfast.

Here’s one healthy breakfast tip: Don’t fly on a sugar high! Avoid stopping at the donut shop. Breakfast should contain a healthy amount of carbohydrates and a small amount of lean protein. The carbohydrates will give your body energy, and the protein provides staying power as well as makes you feel fuller.



Sources:  Diabetes Care, July 2015; Everyday Health

Cellulitis (not Cellulite) can cause problems with Diabetes

September 1, 2015

If you have diabetes, be extra careful of your skin. Infections are more common and when blood glucose is high, it can potentially feed the infection. Cellulitis is an infection found in skin and tissues that are found directly under the skin. It can be caused by many types of bacteria including streptoccus, staphylococcus and methicillin-resistant staphylococcus aureus (MRSA). People that have diabetes are at a higher risk of developing cellulitis, which can spread rapidly.

Some people confuse cellulite with cellulitis. Cellulite is composed of fat that pushes up against connective tissue making the skin pucker. It is not harmful. Cellulitis is different; it is an infection that can be very harmful.

Any infection causes an increase in blood glucose in everyone.  The extra glucose is released to help fight the infection.  In non-diabetics, the body will also release extra insulin to handle the extra glucose. When a person has diabetes, this extra rise in the glucose can cause problems. Diabetes can also cause the skin to be susceptible to bacteria by slowing blood flow.

What are the signs and symptoms of cellulitis?

The most identifiable signs of cellulitis are pain and tenderness, swelling, redness and warmth over an area of skin. The number of white blood cells increase to help fight the infection. The area becomes swollen. Fever and chills may also develop. The skin may develop blisters (but not always).

In adults, cellulitis develops most often in the legs and feet. In children it is frequently seen on the head and neck. It can develop anywhere on the body but frequently at the site of wounds, burns, insect or animal bites or a surgical incisions. It can occur anywhere that the skin has been punctured or injured. This can include an injury that may form from fungal infections such as “athletes’ feet”. Cellulitis usually is only on one side of the body (example one leg).

How does cellulitis develop?

Bacteria usually enters the body through the break in the skin. This break can be of any size. In some cases of cellulitis, the break in the skin cannot be found. Sometimes in cases where athlete’s foot is present, the break may be from the fungus in the foot. The cellulitis may develop from the bacteria that enters the break in the skin at the foot level which may travel to the lower leg. The area has infection present and can spread very rapidly.

What can I do to prevent cellulitis?

  • Take care of your skin and take precautions to prevent cuts and wounds.
  • Inspect your feet and other problem areas daily.
  • See a podiatrist or other qualified foot care professional for recommendations and help to acquire shoes and footwear that fit. Ask what you should wear at the beach or pool, etc.

What should I do if I suspect I have cellulitis?

Call your doctor or healthcare professional immediately who will examine the area to determine the extent of the cellulitis and decide on the best treatment.  he doctor may order antibiotics medications that you  take by mouth. Many cases of cellulitis need intravenous antibiotics. A person may need to be admitted to the hospital for this. In the hospital, the doctor would have access to other experts for consultation.




Get every new post delivered to your Inbox.

Join 155 other followers

%d bloggers like this: