Liver…..It’s Not Just for Dinner

May 19, 2017

By Susan Klick, MSN, RN, CNL Diabetes Educator

The Liver is one of the most important organs in our body. It weighs about three pounds in an average adult, making it the largest internal organ in the human body.  It has a central role in a number of processes, one of which is to help control glucose (sugar) balance in the blood.   Today we will take a look at the liver’s role in controlling blood sugar.

When blood sugar levels are high, the liver will absorb some of the sugar and pack it into bundles called glycogen. These glycogen bundles fill up liver cells, so the liver is like a warehouse for excess sugar.  The liver can then release the stored sugar (glycogen) when the body tells it to.   Here are some examples:

The liver responds to stress by releasing stored glycogen, (the stored form of sugar). In this situation, the release of stored sugar is part of the body’s “fight or flight” response, which prepares the body with energy to respond quickly to a threat.

When we exercise, our muscles take up sugar, and the liver responds by releasing glycogen to replace the sugar that is being taken up and used by our muscles.

Normally the liver slows down its release of sugar into the blood if blood sugar is high. But in people with Type 2 diabetes, the pancreas may be producing too much of a hormone called glucagon.  Glucagon’s job is to tell the liver to release sugar into the blood.  If too much glucagon is being produced, then the liver is releasing too much sugar, keeping blood sugar levels high after meals and overnight.

Insulin is a hormone made by the pancreas. Insulin’s job is to move sugar from the blood into the body’s cells. When you eat, a hormone in your gut tells your pancreas to start producing insulin.  When you don’t eat (i.e. skips meals) there is little insulin being produced and therefore the liver will start releasing its’ stored glucose!  The liver isn’t able to detect blood glucose levels; it only knows what insulin tells it.  If there is a shortage of insulin, the liver assumes the body needs more sugar (even if blood sugar levels are already high).  That is why some people with Type 2 diabetes will have high blood glucose levels even if they haven’t eaten, like first thing in the morning!

People with diabetes have reason to focus on liver health. Overweight people, particularly those who carry their weight around the middle, have the highest risk for liver problems.  Losing weight, eating well and exercising are recommended for helping you to control blood sugars, and what you do to help your blood sugars is good for your liver too.

 

 

Resource: The Diabetes Educator and Diabetes Forecast

The Daily Grind: Caffeine Consumption

April 5, 2017

by:  Emily Nice, RD, LD

April showers bring… slow-moving hours! Rainy days and dreary Mondays tend to hit pretty hard at times, especially if you miss out on your morning cup of coffee. Sometimes, we really need that extra boost caffeine can provide, but how much is too much?

The 2015-2020 Dietary Guidelines for Americans recommend consuming less than 400mg of caffeine daily. Average American caffeine consumption remains within this recommendation; however, it is important to note that these guidelines are reflective of adults without any serious medical conditions which may require more restrictive intakes. Approximately 95% of American adults consume caffeine, mostly coming from coffee and tea intake. The American Heart Association recommends keeping coffee intake at or below 1-2 cups daily. The amount of caffeine in a cup of coffee varies between different brands/styles, and just one 8 ounce cup of coffee may contain approximately 95-200mg of caffeine.

Depending on how you take your coffee or tea, you may be adding more empty calories to your diet than you realize as well. Additives are often unaccounted for or missed when recounting what has been consumed for the day. It is also common to pair these beverages with high calorie pastries and snacks, which may contain large amounts of both sugar and fat. These habits could negatively impact your blood sugar control and/or your efforts to lose weight.

After a long day, a warm caffeinated beverage may provide a comforting pick-me-up, but this may also influence poor sleep if consumed before bed or too late in the day. Restlessness or poor quality sleep may lead to higher blood glucose levels, making a good night’s sleep especially important in controlling your blood sugar. Pay attention to your body and make sleep a priority.

Caffeinated beverages and foods can fit into a well-balanced diet if consumed in moderation. If your daily caffeine intake is reaching or exceeding the limit, you may want to cut back. Make sure to watch your portion sizes and be sure to account for any added cream or sugar you may be enjoying. Pay attention to the types of food you choose to accommodate your drink, and be careful not to indulge too late in the day to allow time for good quality sleep at night.

From a little morning inspiration to a quick pick-me-up in the early afternoon, a reasonable caffeine fix can fit into a healthy lifestyle.

 

 

 

 

 

Resources:
2015-2020 Dietary Guidelines for Americans
American Heart Association – August 2015
Food & Nutrition – March 2017
Diabetes Forecast – July 2016

Diabetes, Websites, Apps Oh My!

February 28, 2017

If you missed our February 16th Support Group, don’t worry!  Here is a list of our recommended applications for your mobile devices and websites to help track your diabetes:

BG Monitor Diabetes: Allows you to track everything, calculate how much insulin you need, set reminders, create spreadsheets and graph your data. Organize your entries with tags.  Create a photo log of meals.

My Fitness Pal: Track food intake, exercise and weight. At the end of each day you are given an overall nutritional snapshot of your eating and an estimate of how long it will take to reach your weight loss goal based on current eating habits.  You can also log activity from an extensive list of exercises and the app will calculate calories burned.  You can also input numbers from a heart rate monitor from your treadmill for example of some other fitness tracker.

Calorie Counter PRO: This is a weight loss app that can help track your daily eating and can be useful when managing your diabetes. It allows you to chart your progress and take daily notes without being overwhelming.  It also tracks body measurements.

Glucose Buddy: Tracks food, insulin, blood sugar results and will show a graph of your glucose results. You can set an alert to remind you to check your blood glucose throughout the day.

Lose it: Used for weight management. Create a profile and use the apps recommended amount of calories for weight loss or input your own.  It has a large food database.  Input custom foods, scan bar codes or it will suggest foods based on a photo of your meal or snack.

MySugr: Track everything in one place, meals to mood. Create monthly reports.  This app does offer advanced services for a fee.

Fooducate: Offers good community support, has a scanner that gives groceries a grade. Good choice if feeling overwhelmed at the grocery store.

Diabetes Goal Tracker: This app was developed by the American Association of Diabetes Educators. Set goals to manage diabetes based on the 7 self-care behaviors we use when tracking our program participants.  Set goals for yourself and the app will send you reminders to help keep you on track and give inspiration.  The My Nutrition section allows you to scan bar codes of foods or enter foods and track calories, carbs, fat and sodium.

Diabetes.org: This is the main website for the American Diabetes Association. Under the Food and Fitness tab you will find tips for eating out, planning meals, and carbohydrate information.  Under this tab is also a link to My Food Advisor where you can find nutrition information about various foods and even create a database of your own recipes.  You will need to create an account, but it is free.

Diabetesselfmanagement.com: This site was created by the providers of Diabetes Self -Management magazine. Good resource for recipes and general information about caring for diabetes.

Nutritiondata.com: Create your own food database; use the website to analyze nutrition content of your favorite recipes

 


A “Special” Treat for Your Valentines Sweetheart

February 14, 2017

Looking for something different to do for your sweetheart for Valentine’s Day this year? Sexual problems (sexual dysfunctions) are common among both women and men with diabetes as a result of complications from the disease.  This year as a gift to your partner and to yourself, be courageous and learn about this personal issue and talk to your healthcare provider about what options are available.  Remember, it’s normal to feel embarrassed discussing intimacy, but your doctor is a professional who is there to help you, not judge you.  This is a medical problem – not a personal failure.  Here is a little background information to get your started.

Good sex requires the right circumstances so you both feel excited and safe. Feeling “aroused” requires good nerve conduction, blood flow, and the right balance of hormones.  Fluctuation in hormone and blood glucose levels, depression, and nerve damage all contribute to sexual dysfunction.  The American Diabetes Association provides a three-step approach to help alleviate fears associated with diabetes and sexual dysfunction:

  1. Start with yourself – You can lower the risk for sexual dysfunction or alleviate the condition if you already have it. Monitor blood glucose levels. Get plenty of rest. Enjoy a healthy meal plan. Incorporate physical activity throughout your day.
  2. Communicate with your partner – Communication can reduce anxiety associated with sexual dysfunction. Set time aside for honest discussion. Listen carefully.
  3. Work with your physician – Make regular visits and set personal goals. Write down questions ahead of time, and research some options before you visit. Ask about counseling or medicines or procedures that can help.

Diabetes in men can cause nerve and artery damage in the genital area, disrupting the blood flow necessary for an erection. Some men may experience an ejaculation which goes backward into the bladder which can make it difficult to father a child.  Over a long period of time high blood sugar levels can lead to low testosterone and may contribute to decreased sexual interest.

Diabetes in women can result in nerve damage that causes vaginal dryness making intercourse uncomfortable. Nerve damage can also lead to loss of sensation in the genital area.  Urinary infections (yeast infections) are also more common in people with diabetes, making intercourse uncomfortable.

There is a range of treatments, and any therapy will be more successful if both you and your partner are involved in the process.  Keep your sexual play interesting.  Something new may restore some freshness and improve both interest and function.  Make sure you are having fun.  Take time to connect with your partner.  Have a date night, and take time to have a relationship with each other on purpose.  Redefine sex, take your time.  You may find it helpful to meet with a mental health professional (such as a therapist) who can help you learn how to reduce stress and change behaviors and attitudes associated with impotence and lack of sexual desire.  Other Impotence treatments for men include oral medications (Viagra, Cialis, Levitra); mechanical methods (vacuum pumps and constriction rings); and surgical methods like penile implants.

Sexual issues don’t just impact you; they affect your personal relationships and create challenges of trust, intimacy, and closeness. Your partner may wonder if you are losing interest, or if you don’t want to spend time with them.  Understanding how your sexual health can be affected by diabetes can help you manage this important life issue successfully.

 

 

 

Resources: American Diabetes Association; Harvard medical School Patient Education Center; American Association of Diabetes Educators; Joslin Diabetes Center

 

 


Diabetes Support Program Presents:

February 7, 2017

Diabetes, Apps, and Websites – Oh My!

10:00 a.m.  Thursday, February 16, 2017

Hyland Education Great Room

10020 Kennerly Road

St. Louis, MO 63128

 

Presented by:

Alison Brinker, RD, LD, CDE

Susan Klick, MSN, RN CNL

Meetings are FREE to the public.

All are welcome!

 To register, call 314-ANTHONY (268-4669)

or visit stanthonysmedcenter.com/diabetes.

Come and join us for a fun and learn about the latest mobile phone apps and websites designed to help manage your diabetes better.

 


Can You Hear Me Now?

January 17, 2017

According to the American Diabetes Association, it appears there is an overlap between diabetes and hearing loss. A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease.

Hmmmm. Why could this be?  We know that high blood glucose levels cause damage to small blood vessels (for example, in the kidneys and eyes).  It is possible then that the same damage may be occurring in the ears.  Over time, when hearingexposed to high levels of blood glucose, the very tiny vessels in the inner ear may break.  The vessels of the cochlear (the spiral tube, shaped like a snail’s shell, that forms part of the internal ear, where sound vibrations are converted into nerve impulses) thicken, making blood flow to that part of the ear very difficult.   Other research has shown that when exposed to high blood glucose over a long period of time nerve damage can occur leading to hearing loss.

Symptoms of hearing loss can be hard to notice because hearing loss happens slowly. Many times, family or friends notice it before the person experiencing it.  Some signs of hearing loss include:  frequently asking others to repeat themselves; trouble following conversations that involve more than two people; thinking that others are mumbling; problems hearing in noisy places such as busy restaurants; trouble hearing the voices of women and small children; turning up the television or radio too loud for others who are nearby.

Do you think you may be experiencing hearing loss? If so, talk to your primary care doctor, or seek help from a specialist such as an audiologist.  A full hearing exam will not only teach you about your hearing loss, but you will be told what can be done to treat it.

 

 

Sources:
American Diabetes Association
AADE In Practice Sept 2014

Carbohydrate Counting Tips for the New Year

January 3, 2017

By Alison Brinker, RD, LD, CDE

Research shows that counting carbohydrates is important for good glucose control.   However, it can get a little tricky at times………pizza, salads, casseroles.  All those combination foods can be difficult.  Following are some tips that may help make counting your carbs a bit easier.

Hot dishes made with pasta or grains such as tuna noodle casserole or lasagna have about 30 grams of carbohydrate per cup. Using a measuring cup is most accurate, but if you can’t measure a cup is about the size of a woman’s fist.  Stews or Asian-style meals that are a mix of meat and vegetables in a savory sauce are about 15 grams of carb per cup.  Keep in mind that measuring foods at home will help you better estimate portion sizes when eating out.

Broth-based soups and cream soups made with water are about 15 grams of carb per cup. If it is a hearty soup you could eat with a fork or if it is loaded with noodles or beans estimate about 30 grams of carb for one cup.

If you are at a potluck think about the size of the serving spoon. Four level tablespoons is about ¼ cup.  This amount of baked beans, for example is about 15 grams of carbohydrate.  Baked beans are a starchy vegetable and most likely have molasses or brown sugar as an ingredient.  A larger serving spoon is about ¼ cup per scoop.  Two of these larger spoonfuls of corn or another starchy vegetable will be about a ½ cup or 15 grams of carb.

Not all salads are created equal when it comes to carbs. One cup of a leafy green salad has only 2-5 grams of carb compared to creamy coleslaw that has 15 grams carb for a ½ cup portion.  Potato salads and pasta salads often have sugar in the dressing so count those as 30 grams of carb for a ½ cup portion.

Think of pizza in terms of the crust. Thin crust is going to have much lower carb content than hand tossed or pan pizza.  1/8 of a 12 inch thin crust pizza has about 15 grams of carb.  You should add about 5-10 grams of carb per slice if you have a hand tossed crust or pan pizza.

Be careful with the items offered free to the table at some restaurants. Most rolls, bread slices and bread sticks are 15 grams of carb per serving.  Twelve tortilla chips are also about 15 grams of carb.  Even though the salsa is a free item and is very low in carbs, the chips can add up quickly.

Fruit smoothies, although they sound healthy, can have just as much carbohydrate as a can of regular soda. Some smoothies average 45 grams of carb in a 12 oz. portion which is just as much as a regular soda.  If you choose a smoothie as a quick breakfast option measure your ingredients separately as you add to the blender to ensure your carb count is accurate.

I hope you find these tips helpful. Below is a chicken chili recipe for the crockpot.  It is easy to prepare, great for a cold winter night and about 30 grams of carb for a 1 cup portion.  Carbohydrate is found in the white beans which are also a wonderful source of fiber.  Top your chili with diced avocado to add some healthy monounsaturated fat.  Enjoy!

 

Slow Cooker White Chili with Chicken

1 ½ pounds boneless, skinless chicken breast

1 Tablespoon minced garlic

1 Tablespoon ground cumin

1 teaspoon salt (optional)

1 teaspoon chili powder

½ teaspoon oregano

½ teaspoon cayenne pepper

½ pound dried Great Northern Beans

3 cups low sodium chicken broth

1 cup chopped onion

2 4-ounce cans chopped green chiles, undrained

Chopped fresh cilantro, chopped avocado, chopped tomato (optional for serving)

The evening before you plan to make the chili soak beans in a large container covered with water for at least 8 hours or overnight. Place beans along with chicken, onion, broth, chopped chiles and seasonings into the crockpot.  Stir to mix the ingredients.  Cook on high 4-6 hours or on low 8-10 hours.  Remove chicken from the crockpot and using 2 forks shred the chicken, return chicken to the crockpot and mix well.   Serve chili topped with cilantro, avocado and tomato if desired.

30 grams carbohydrate per 1 cup portion

 

Source: Diabeticlivingonline.com.  The recipe was modified using the White Chicken Chili on the Everyday Essential Great Northern Bean package and Slow Cooker White Chili with Chicken on allrecipes.com

 


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