THE FALLACY OF 15 WHY HYPO TREATMENT ISN’T ONE SIZE FITS ALL
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Fall Spiced
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Apples
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reductions in fasting blood glucose,
body weight, body mass index, blood 1. König D, Muser K, Berg A, Deibert P. Fuel selection and
pressure, cardiovascular risk factors, and appetite-regulating hormones after intake of a soy
requirements for diabetes medications protein-based meal replacement. Nutrition. 2012, January;
— a 20% lower need for medications 28(1):35–39
and a nearly 50% reduction in insulin
needs. These improvements were even 2. Kempf K, et al. Efficacy of the telemedical lifestyle
seen after 52 weeks of follow-up.2 intervention program TeLiPro in advanced stages of type
2 diabetes: A randomized controlled trial. Diabetes Care.
2017 Jul;40(7):863–871
••• FALL 2022 •••
Features At The Table
28 ‘Fast’ Food 44 ‘Fall’Into
Tips for quick, nourishing Healthy Habits
meals at home. This collection makes use
of all the quintessential
32 The Fallacy of 15 flavors the season’s bounty
Hypoglycemia treatment is has to offer, featuring
not one size fits all. pumpkin, apple, corn,
cranberry, squash, and
36 Return to School Brussels sprouts. These
With Success! recipes are a-maize-ing!
Tips for helping your child
with type 1 diabetes in the The Dose
classroom.
8 News & Notes
40 Snore No More 10 Quiz
Sleep apnea is a common 15 Product Spotlight
condition, but treatments 16 Ask Away
are available. 17 Curmudgeonly Athlete
Healthy Living
18 The Right Moves
20 Weighty Matters
21 Smart Smarter Smartest
22 Food for Thought
24 Susan and T’ara’s Kitchen
In Every Issue
4 Editor’s Note
63 Recipe Index
64 Final Countdown
On the cover: Spiced Baked Apples SHUTTERSTOCK
photographed by Angela Sackett. For
a list of all recipes, see page 63.
If you have type 2 diabetes
Get tested for
chronic kidney disease
Up to 40% of people with type 2 diabetes (T2D) develop
chronic kidney disease (CKD)
CKD can lead to kidney failure and dialysis and increases your risk for
heart attack and stroke. CKD often has no symptoms until it’s too late, but
when it’s caught early, there is more you can do to protect your kidneys.
Ask your doctor for a UACR (urine albumin-to-creatinine ratio) urine test
once a year. It checks for protein in the urine, one of the earliest signs of
CKD or kidney damage.
For more information, visit KidneyAlert.com
or scan code
© 2021 Bayer Pharmaceuticals, Inc. All rights reserved. BAYER and Bayer Cross
are registered trademarks of Bayer. Last Updated 1/2021 PP-UN-CAR-US-0206–1
••• EDITOR’S NOTE •••
Editorial Director,Wellness Division Food Editor
Diane Fennell Lorena Drago, MS, RDN, CDN, CDCES
ART & PRODUCTION
Senior Designer
Scott Brandsgaard
Director of Media Solutions SALES & MARKETING Marketing Associate
Ed Feldman Jaime Sweeney
Client Services
Media Solutions Manager [email protected] SEO & Content Marketing Supervisor
Cheyenne Corliss Anthony Buzzeo
Marketing Director
[email protected] Tommy Goodale
CUSTOMER SERVICE
[email protected] (855) 367-4813
Dear readers, EDITORIAL BOARD
W ho loves fall most of all? The autumn is a time of Pamela Allweiss, MD, MPH Jeanne L. Rosenthal, MD
transitions—the leaves are changing, tempera- CDC Division of DiabetesTranslation Attending Surgeon, Retinal Service,
tures are cooling down, and new fruits and vegetables NewYork Eye and Ear Infirmary, NewYork, NewYork
are coming into season. These pages on the calendar Amy P. Campbell, MS, RD, LDN, CDCES
often bring changes to routine as well, such as getting Boston, Massachusetts Gary Scheiner, MS, CDCES
back into a rhythm at work after summer vacation or Owner and Clinical Director,
returning to school. If your child with type 1 will be Shana Cunningham, Integrated Diabetes Services,
heading back to the classroom, see “Return to School MSN, RN, MLDE, BC-ADM, CDCES Wynnewood, Pennsylvania
With Success!” (page 36) for lessons on how to help Diabetes Education Service Coordinator,
them thrive this academic year. UK HealthCare Barnstable Brown Diabetes Center, Bernard P. Shagan, MD
University of Kentucky, Lexington, Kentucky Director, Diabetes Education Center,
With the busier pacing of the harvest months, Monmouth Medical Center, Long Branch, New Jersey
coming up with quick and easy meal ideas is another Robert S. Dinsmoor
common challenge. But there’s no need to resort to South Hamilton, Massachusetts Richard M. Weil, MEd, CDCES
fast food. Check out “‘Fast’ Food” (page 28) instead for Exercise Physiologist and Director,
tips from registered dietitian nutritionists for quick, David E. Goldstein, MD Mount Sinai St. Luke’sWeight Loss Program,
nourishing meals you can make at home. Professor Emeritus, University of Missouri Mount Sinai St. Luke’s Hospital,
Health Science Center, Columbia, Missouri
The biannual change of clocks is another routine NewYork, NewYork
that many anticipate (or dread!) this time of year. Jeff Plumer, Vice Chair,
And while it’s not unusual to experience some short- JDRF International Board of Directors Susan Weiner, MS, RDN, CDCES, CDN, FADCES
term sleep difficulties adjusting to the end of Daylight Owner, SusanWeiner Nutrition, PLLC,
Savings Time, sometimes sleep troubles can signal William H. Polonsky, PhD, CDCES Long Island, NewYork
something more serious. If someone has told you that Assistant Clinical Professor,
you’ve been snoring, or if you’ve been experiencing Department of Psychiatry, Stephen Z. Wolner, DDS
excessive sleepiness during the day, take heed—it NewYork, NewYork
could be a sign of sleep apnea. Visit “Snore No More” University of California, San Diego
(page 40) to learn about this common condition and
how it can be diagnosed and treated. In Memoriam Dr. Lois Jovanovic, 1947-2018
Finally, all the autumn changes in routine can make O P E R AT I O N S Accounting Director
blood glucose management more difficult than usual. Amanda Joyce
You might be familiar with the “rule of 15” for treating Senior Client Services & Operations Lead
lows, but there’s more to this principle than meets the Andrea Palli Accounts Payable Associate
eye. Learn about “The Fallacy of 15” (page 32) and find Tina McDermott
out why hypoglycemia treatment is not one size fits all. Senior Client Services & Media Analyst
Tou Zong Her Accounts Receivable Associate
Be well, “fall” into an autumn routine, and take care Wayne Tuggle
until next time! Client Services
Darren Cormier
All the best,
Audience Development Analyst DIGITAL OPERATIONS WordPress Developer
Diane Fennell Ryan Gillis David Glassman
Editorial Director, Wellness Division Senior Digital Designer
Mike Decker
4 DiabetesSelfManagement.com • Fall 2022
EXECUTIVE
Chairman & CEO Chief Operating Officer VP, Consumer Marketing Content Director
Jeffrey C. Wolk Courtney Whitaker Jason Pomerantz Matt Martinelli
In memory of Susan Fitzgerald, COO, 1966-2018
Newsstand Distribution Weekly Retail Service
Diabetes Self-Management, Fall 2022, Volume 39, Number 3. Diabetes Self-Management (ISSN 0741-6253) (USPS 003-865) SHUTTERSTOCK
is published quarterly by Madavor Media, LLC, 35 Braintree Hill Office Park, Suite 101 Braintree, MA 02184. Periodicals
postage paid at Boston, MA and at additional mailing offices. Copyright © 2022 Madavor Media, LLC. U.S.. Back issues
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Statements and opinions expressed in this publication are those of the authors and not necessarily those of the publishers
or advertisers. The purpose of this magazine is to provide readers with accurate and up-to-date medical information. It is
not intended to provide medical advice on personal health matters, which should be obtained directly from a physician.
We regret that we are unable to respond to inquiries about personal health matters.
We sometimes make our list of subscribers available to carefully screened organizations whose products and activities
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For customer service or subscription information, please call (855) 367-4813.
SJOPINEOAUKR
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PRIZES An example mnemonic for
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© 2022 Averitas Pharma, Inc. All rights reserved. M-N/A-US-07-22-0018 July 2022
••• DiabetesSelfManagement.com •••
PHYSICAL ACTIVITY
Insulin Resistance: Your Questions Answered The Health Benefits of
Walking
It’s pretty amazing what the body does to help regulate blood glucose levels
and provide fuel for bodily processes. Unfortunately, things can go awry Hippocrates said, “Walking is man’s
with this finely tuned system. If you have questions about insulin resistance, best medicine.” Indeed, walking can
this article can give you answers. provide a variety of health—and
personal—benefits. Let these words
bit.ly/3xWCLOp of wisdom inspire you to begin
walking the walk to a happier and
healthier you.
bit.ly/3MXJsEu
COMPLICATIONS HOLIDAYS RECIPE
Blood Pressure Myths Healthy Halloween Foods Spiced Apple Tea
and Facts
All Hallows’ Eve is almost here, and Full of cloves, cinnamon, and juicy
High blood pressure, also called while many revelers may be munch- apple flavor, this fragrant beverage
hypertension, affects almost half of ing on loads of sugar and chocolate, is sure to warm up the chilliest of
adults in the United States, according you can be enjoying your own Hal- evenings. Whether you drink it right
to the U.S. Centers for Disease Control loween treats that just happen to be away or make ahead and reheat,
and Prevention (CDC). How much do a little healthier for you. there’s no better way to close out
you know about high blood pressure? the day than with a steaming mug
bit.ly/3mSBRMG of this tea.
bit.ly/3tFTcfy
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INTERACT WITH US Get more news, tools, and recipes all month long! NEWSLETTER
@ManageDiabetes @DiabetesSelfManagement @diabetesrecipes Subscribe today for updates on SHUTTERSTOCK
diabetes news, research, recipes, weight
management, and more. bit.ly/2NDzTMz
6 DiabetesSelfManagement.com • Fall 2022
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••• THE DOSE ••• News & Notes
New Risk Factors
for T2D Discovered
BY JOSEPH GUSTAITIS
I n addition to the already well-known some 1 million people in the United According to lead researcher SHUTTERSTOCK
risk factors for type 2 diabetes, Kingdom. The male-to-female split of Hanieh Yaghootkar, PhD, of Brunel
researchers have identified two pre- the study group was around 50/50, University London, “People with type
viously unknown ones, according to and the average age of the subjects 2 diabetes usually have excess fat
a new report. was about 64. From the MRI scans, in their liver and pancreas, the two
the researchers were able to deter- key organs in the maintenance of
Over the years, scientists have mine the fat content and size of the the normal level of blood sugar. The
discovered nearly a dozen risk factors liver and pancreas of each subject. To genetic analysis we used in this study
for type 2 diabetes. The best known evaluate the data, the investigators is the best possible method to test
are overweight or obesity, inactivity, used what’s known as Mendelian this relationship, and we showed that
a large waist circumference, race and randomization, which is a method liver fat is causal for type 2 diabetes.”
ethnicity, family history, and age. The of using genetic variation to study The researchers did not find a link
new study, which was reported in the relationship between risk factors between the two risk factors and
the medical journal Diabetes Care, and health. type 1 diabetes.
indicates that two more can be added
to the list: 1) increased levels of liver The researchers discovered that The identification of previously
fat and 2) a smaller pancreas volume. people with a genetic formation that unknown risk factors gives hope for
Not only that, but these factors also makes them likely to store fat in the a better general comprehension of
seem to have a genetic component, liver are more prone to developing diabetes. Commenting on the new
which might mean that some people type 2 diabetes. Specifically, for every study, Lucy Chambers, PhD, head of
are “hardwired” for type 2 diabetes. 5% increase in liver fat, the risk of type research communications at Diabetes
2 diabetes goes up by 27%. In addi- UK, said it “offers new insights into
The researchers obtained data tion, the study reported that pancreas the causes of type 2 diabetes that, as
from 32,859 people who had under- volume had a direct effect on diabetes we move towards an era of personal-
gone MRI scans as part of the UK risk: the higher the pancreas volume, ized medicine, could in the future help
Biobank study, which is an exten- the lower the risk. And this relation- us to improve the way we predict,
sive biomedical database containing ship, they reported, is genetic. prevent, and treat the condition.” DSM
genetic and health information on
8 DiabetesSelfManagement.com • Fall 2022
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ďƵƐLJ ůŝĨĞ ĂŶĚ ǁĞ͛ƌĞ ĐŽŵŵŝƩĞĚ ƚŽ ŵĂŬŝŶŐ ŝƚ ĞĂƐŝĞƌ ďLJ ŽīĞƌŝŶŐ͗
Q ĨƵůů ůŝŶĞ ŽĨ ĚŝĂďĞƚĞƐ ƉƌŽĚƵĐƚƐ ŝŶĐůƵĚŝŶŐ ƚĞƐƟŶŐ Q &Ƶůů ƐĞƌǀŝĐĞ ƉŚĂƌŵĂĐLJ ĞŶĂďůĞƐ LJƌĂŵ ƚŽ
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ΞϮϬϮϮ LJƌĂŵ ,ĞĂůƚŚĐĂƌĞ ĞŶƚĞƌƐ͕ /ŶĐ͘ ůů ƌŝŐŚƚƐ ƌĞƐĞƌǀĞĚ͘
••• THE DOSE ••• News & Notes
NEW STUDY SHEDS
LIGHT ON HOW
METFORMIN WORKS
BY QUINN PHILLIPS
QUIZ M etformin has become the standard first-line medicine
for type 2 diabetes, but for such a widely prescribed
CINNAMON and studied drug, there’s still a lot that scientists don’t
know about how it works. That may be changing, though,
BY LISA CANTKIER thanks to a study recently published in the Proceedings
of the National Academy of Sciences. Researchers were
When it comes to diabetes, cinnamon has been interested in looking at how, exactly, metformin inhibits
shown in some preliminary studies (but not the release of glucose by liver. But at a deeper level,
others) to support blood sugar management and they wanted to know how metformin inhibits metabolic
provide additional health benefits. How much do processes in the mitochondria of cells in the liver. Mito-
you know about the research on this spice? Take this chondria are responsible for generating the energy in
quiz to find out! (Before making changes to your diet cells and are nicknamed the “power plant” of cells.
or treatment regimen, consult with your health care
provider to find out what is best for you, and be careful Previous research has shown that there are four differ-
to closely monitor glucose levels if using cinnamon. ent protein complexes (groups of protein chains) involved
Cinnamon is not a replacement for prescription in the release of energy through a series of chemical
medications, and high doses can be toxic, especially for reactions in mitochondria. Before the latest study, it was
people who have liver damage or disease. If taken with widely believed that metformin inhibited what’s known as
other types of supplements, cinnamon may be unsafe complex I—the largest of the energy-generating protein
or cause hypoglycemia.) complexes in mitochondria. But when researchers looked
at how metformin works on a molecular level in liver
1. Taking as little as 1 gram of cinnamon daily may cells, they found that metformin inhibits a mitochondrial
enzyme called GPD2. It does this by inhibiting not complex
help reduce certain risk factors linked with diabetes I but complex IV—the fourth protein complex involved
in the release of energy in mitochondria.
• •and cardiovascular diseases in people with type 2.
True False On a practical level, the most important finding of the
latest research may be that metformin inhibits the conver-
2. Cinnamon has been shown to have effects on a sion of a molecule called glycerol to glucose in the liver.
This process appears to be dysregulated in people with
variety of factors associated with metabolic syn- type 2 diabetes, leading to increased glucose production
by the liver. Glycerol is released when fat in the body is
••••drome, including which of the following? broken down, and the researchers found that in some
A. Insulin sensitivity and glucose levels. cases, 40% of a person’s blood glucose can come from the
B. Blood pressure and inflammation. conversion of glycerol. So, finding new ways to block the
C. Lipids and body weight. conversion of glycerol into glucose could form the basis
D. All of the above. of future research into new diabetes treatments. DSM
3. Cinnamon may have which of the following
NEW
••••effects on blood sugar control in prediabetes? STUDY
A. It has no effect on blood sugar control.
B. It may worsen blood sugar control.
C. It may improve blood sugar control.
D. It can cause prediabetes.
••••4. How may cinnamon affect cholesterol?
A. It may help lower lipid (blood fat) levels. SHUTTERSTOCK
B. It has no effect on cholesterol.
C. It may increase LDL cholesterol levels.
D. It may increase triglyceride levels.
See page 12 for answers.
10 DiabetesSelfManagement.com • Fall 2022
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••• THE DOSE ••• News & Notes
QUIZ ANSWERS See page 10 for questions. MEDITERRANEAN DIET SHUTTERSTOCK
BEATS LOW-FAT FOR
1. True. The results of a study with 60 participants KIDNEY FUNCTION IN T2D
in Diabetes Care indicated that taking either 1, 3, or
6 grams of cinnamon per day for 40 days “reduce[d] BY QUINN PHILLIPS
serum glucose, triglyceride, LDL cholesterol, and
total cholesterol in people with type 2 diabetes and F or people with both type 2 diabetes and coronary
suggest that the inclusion of cinnamon in the diet of artery disease (CAD)—a common and dangerous form
people with type 2 diabetes will reduce risk factors of heart disease—a Mediterranean diet may be a better
associated with diabetes and cardiovascular diseases.” option than a low-fat diet when it comes to preserving
(Experts state that adults should avoid having more kidney function, according to a new study published in
than 1 teaspoon of Cassia cinnamon per day due to the journal Clinical Nutrition.
potential dangers from the coumarin content.) The
researchers note that cinnamon may be beneficial for For the study, 1,002 participants with coronary artery
those without type 2 to prevent and control elevated disease—some of whom also had diabetes—were randomly
glucose and lipid levels. But although promising, it’s assigned to follow either a Mediterranean diet or a low-
worth noting that this study was small and short term. fat diet and provided guidance about how to do so. The
Mediterranean diet consisted of 35% fat, including 22%
2. D. Metabolic syndrome increases a person’s monounsaturated fat (the main type of fat found in olive
chances of developing diabetes, heart disease, oil and most nuts), and less than 50% carbohydrate. The
or stroke. According to research in the Journal of low-fat diet consisted of 28% fat, including 12% monoun-
Diabetes Science and Technology, “cinnamon and saturated fat, and greater than 55% carbohydrate. Both at
components of cinnamon have been shown to have the beginning of the study and after a five-year follow-up
beneficial effects on … factors associated with meta- period, participants had their kidney function measured—in
bolic syndrome, including insulin sensitivity, glucose, the form of estimated glomerular filtration rate (eGFR).
lipids, antioxidants, inflammation, blood pressure,
and body weight.”“However,” the authors note, “not Overall, participants in both diet groups saw a decline
all studies have shown positive effects of cinnamon, in kidney function over the follow-up period. But among
and type and amount of cinnamon, as well as the type participants with type 2 diabetes, there was a smaller
of subjects and drugs subjects are taking, are likely to decline in kidney function in the Mediterranean diet group.
affect the response to cinnamon.” In contrast, participants without type 2 diabetes tended
to experience about the same amount of kidney function
3. C. A small double-blind trial in the Journal of the loss in both diet groups. For participants with type 2 dia-
Endocrine Society investigated cinnamon supple- betes, those who started out with mildly impaired kidney
mentation in people with prediabetes. Fifty-four par- function experienced the greatest benefit from following
ticipants were given either a 500-milligram cinnamon a Mediterranean diet when it came to less decline in
capsule or placebo (inactive) capsule three times a day kidney function, compared with following a low-fat diet.
for 12 weeks. The researchers found that participants
taking the cinnamon supplements had improved fast- “The long-term consumption of a Mediterranean diet
ing plasma glucose levels and improved glucose toler- rich in [extra-virgin olive oil], when compared to a low-fat
ance. They suggest that longer and larger trials should diet, may preserve kidney function, as shown by a reduced
investigate the effects of cinnamon in prediabetes. decline in eGFR in [coronary artery disease] patients
with [type 2 diabetes],” the researchers concluded. DSM
4. A. A meta-analysis in the Annals of Family Medicine
indicated that cinnamon may help lower lipid levels.
The authors state, “The consumption of cinnamon
is associated with a statistically significant decrease
in levels of fasting plasma glucose, total cholesterol,
LDL-C, and triglyceride levels, and an increase in
HDL-C levels.” But, they add, it is not known whether
the results can be applied to patient care, since the
appropriate doses and treatment length are not clear.
Lisa Cantkier is a writer and educator specializing in nutri-
tion and health. She is coauthor of the diabetes-friendly
cookbook “The Paleo Diabetes Diet Solution.”
12 DiabetesSelfManagement.com • Fall 2022
Lower Magnesium
Levels Linked to Insulin
Resistance, Type 2
BY QUINN PHILLIPS
SHUTTERSTOCK H aving a lower blood level of pants developed insulin resistance they looked at magnesium levels
magnesium is linked to a higher and 429 developed type 2 diabetes. continuously, rather than comparing
risk of developing insulin resis- When the participants were divided groups of participants.
tance and type 2 diabetes, accord- into five groups of equal size (quin-
ing to a new study published in the tiles) based on their magnesium It’s important to note that the par-
journal Nutrients. level, the researchers found that ticipants in this study with lower
the middle group—with a blood magnesium levels weren’t actually
Magnesium is a mineral found magnesium level of 0.89 to 0.93 deficient in magnesium, in most
naturally in certain foods that is key mmol/L—had a 29% lower risk of cases. The range of magnesium seen
to health and well-being, but many developing insulin resistance than in participants fell almost entirely
people don’t get enough of it in their the group with the lowest magne- within the “normal” range—showing
diet. Magnesium is involved in hun- that even within this range, different
dreds of functions in the body, and sium levels, after adjusting for other magnesium levels may affect the risk
plays roles in energy metabolism and factors known to affect the risk for of developing insulin resistance and
creating proteins—two functions that insulin resistance or type 2 diabe- type 2 diabetes. But the researchers
are especially relevant if you have a tes. The researchers found similar noted that it’s unclear why there
metabolic or endocrine disorder like results—a lower risk for insulin
obesity or type 2 diabetes. resistance and type 2 diabetes at was a U-shaped rela-
moderate magnesium levels—when tionship between
For the latest study, research- magnesium lev-
ers looked at the relationship els and devel-
between blood magnesium oping insulin
levels and new cases of resistance—
insulin resistance or type with the low-
2 diabetes in 5,044 est risk seen in
adults ages 18 and participants
older in China,
who took part who fell in the middle of magnesium
in a research levels. More research is needed, they
study called the wrote, to find out why this may be
China Health and the case, and whether there is an
Nutrition Survey. optimal magnesium level to reduce
A fasting blood the risk for insulin resistance and
sample was type 2 diabetes. DSM
used to look
at magnesium, Fall 2022 • DiabetesSelfManagement.com 13
fasting blood glu-
cose, fasting insu-
lin, and A1C (a measure
of long-term blood glucose control)
at regular intervals throughout the
study. At the beginning of the study,
none of the participants had insulin
resistance or type 2 diabetes.
During an average follow-up
period of 5.8 years, 1,331 partici-
••• THE DOSE ••• News & Notes
Physical Activity May Reduce
Neuropathy Risk in Type 1
BY QUINN PHILLIPS
I n people with type 1 diabetes for their average diabetes duration was minutes per week for those who didn’t SHUTTERSTOCK
50 years or longer, greater physi- 54 years, and their average A1C level have DSPN. Greater physical activity
cal activity is linked to a lower risk of (a measure of long-term blood glucose was also linked to better outcomes
developing peripheral neuropathy— control) was 7.3%. As part of the study, on specific physical and neurological
nerve damage affecting the limbs, participants underwent a physical measures, including cooling detection
usually the legs or feet—according to exam, had their medical history taken, threshold (ability to feel a cold surface
a new study published in the Journal and reported their physical activity on the affected areas), peroneal and
of Diabetes and its Complications. during the previous 12 months. For sural amplitude, and conduction veloc-
this analysis, the researchers were ity (measurement of nerve function).
Peripheral neuropathy often devel- interested in comparing weekly physi- After adjusting for participants’ age
ops in people with diabetes as a result cal activity levels with measures of and A1C, the researchers found that
of long-term exposure to elevated diabetic neuropathy—such as nerve for every additional 30 minutes of
blood glucose levels, which can lead to conduction tests, which use electrical weekly activity, there was a predict-
nerve damage. It can cause uncomfort- impulses to measure how well nerves able improvement in two measures
able to painful symptoms, which may transmit signals. Physical signs and of nerve function—a 0.09 mv higher
include numbness, tingling, or burning reported symptoms were also used to peroneal amplitude and a 0.048 ms
sensations. Treatment guidelines for assess peripheral neuropathy. lower peroneal F-wave latency.
peripheral neuropathy mainly focus on
reducing pain, rather than addressing The average amount of weekly “In longstanding [type 1 diabe-
the underlying condition—but there is physical activity among participants tes], [physical activity] time is associ-
some evidence that certain behaviors was 156 minutes, and 65 participants ated with superior large nerve fiber
can address some of the root causes (87%) had what’s known as distal function in the lower limbs and some
of neuropathy, as well as reduce the symmetric polyneuropathy (DSPN)— better measures of small nerve fiber
risks associated with the condition. neuropathy in both feet or legs. The function,” the researchers concluded.
researchers found that participants These results, they wrote, may pro-
For the latest study, researchers with DSPN had significantly lower lev- vide a justification for studying the
looked at data from 75 participants els of physical activity than those with- effects of an exercise “prescription”
in a study called the Canadian Study out the condition—an average of 141 on neuropathy-related outcomes in
of Longevity in Type 1 Diabetes. The minutes per week, compared with 258 people with longstanding diabetes. DSM
average age of participants was 66,
14 DiabetesSelfManagement.com • Fall 2022
••• THE DOSE ••• Product Spotlight
Cool New Products to Try
BY AMY CAMPBELL, MS, RD, LDN, CDCES
Blue Cut Blue Light TheFitLife Nordic
Blocking Glasses Walking Trekking
Poles
Staring at a computer all day or night can
lead to eye strain and fatigue. But it’s not Ready to get out and do
just your computer—tablets, smartphones, some walking? Walking is
flat-screen TVs, fluorescent lights, and one of the best physical
more all emit blue light, a type of light activities around, but
that may cause tired eyes and lead to why not give yourself
dryness, irritation, and headaches. What a total body workout
to do? Get yourself a pair of Blue Cut Blue with trekking poles?
Light Blocking Glasses! These glasses are TheFitLife Nordic Walking
engineered to filter out blue light, making Trekking Poles are made
it easier for your eyes to stay focused and from sturdy, high-quality
free from strain, dryness, and fatigue. And aluminum. They’re super
if you have trouble sleeping due to being light and adjustable for
on your electronic devices before bedtime, just about any height as
these glasses will let you enjoy your well. Using these poles
favorite TV shows, video games, and more on your walks or hikes
while still getting a restful night’s sleep. will give you balance and
stability, take pressure
amzn.to/3xSiM2v off your knees and lower
back, and even increase
your speed. When you’re
done, simply collapse
them and store them
away. The poles come
with a carrying bag, plus
four interchangeable
tips for use with different
types of terrain. Choose
from five colors.
thefitlifestore.com
Harney & Sons Chamomile Herbal Tea
Chamomile tea is a go-to for many people who have trouble falling or staying
asleep. But chamomile tea has benefits that go beyond sleep—some research
shows that it may help promote a healthy heart and immune system and may
possibly protect against cancer. Harney & Sons’ Chamomile Herbal Tea sources
chamomile flower heads from Egypt, producing a quality tea with definite
body. This caffeine-free tea has a light floral scent with an undertone of apples.
The charming tin comes with 20 sachets, and each sachet brews two cups of
tea. Treat yourself to a well-deserved tea break (minus the caffeine).
harney.com
Fall 2022 • DiabetesSelfManagement.com 15
••• THE DOSE ••• Ask Away
Low-Glucose Dilemmas
BY GARY SCHEINER, MS, CDCES
Q Last week, I felt like I had the signals that produce symptoms. stream. If produced in large enough SHUTTERSTOCK
low blood glucose, but when I Whether caused by a rapid decline amounts, these hormones can send
checked with my meter, my glucose the glucose level well above normal.
level was fine—in the 120s. This has or an overall drop, normal glucose To compound the problem, the high
happened to me a few times. Does levels do not usually require treatment that occurs after the low can be stub-
this mean my normal blood glucose with carbohydrate. In fact, treatment born to come down, even with extra
is higher than for most people? is often discouraged because it can insulin or exercise.
cause the glucose to rise too high. It is
AI had to laugh when I read your always a good idea to perform a finger- The best way to avoid rebounds
question because I asked my doc- stick when symptoms of hypoglycemia is to catch lows as early as possible
tor the same thing soon after I was occur, not only to verify that the glucose and treat them as quickly as possible
first diagnosed. But no, normal blood is truly low but also for determining with a proper amount of very-rapid-
glucose is the same for everyone: gener- how much carbohydrate is needed for acting carbs. By minimizing the dura-
ally, around 70-110 mg/dl. treatment. Use of a continuous glucose tion and severity of the low, you can
monitor (CGM) can also be helpful for also minimize the stress hormone
However, hypoglycemia (low glu- determining if the symptoms are due production that causes the rebound.
cose) symptoms can be produced to a rapid decline or a true low. Checking your glucose at the first
by a number of things, including a sign of symptoms and treating right
rapid decline in blood glucose level. A Q What exactly is a low blood away is one way to accomplish this.
glucose that drops from, for example, glucose “rebound”? Another is to use a CGM with the low
250 to 150 very quickly can “fool” the alert set above your actual threshold
brain into thinking blood glucose is AAs a basketball player and fan, I for hypoglycemia (for example, at 80
low, when clearly it isn’t. This can sometimes boast that I lead the or 90 mg/dl), keeping an eye on how
also happen to someone who usually league in rebounds … the kind that your levels are trending and treating
spends a lot of time with elevated glu- happen after a bout of hypoglycemia. as needed. DSM
cose levels and then tightens up their
control. Even though the glucose is A rebound refers to a high blood Gary Scheiner, MS, CDCES, has lived
not in a hypoglycemic range, the brain glucose that follows a low, assuming with type 1 diabetes for 30 years and
still generates signals that cause the the high is not caused by overtreat- was named Diabetes Educator of the
usual hypoglycemia symptoms. We ment with food. When hypoglycemia Year 2014 by the Association of Dia-
call this “relative” hypoglycemia. The occurs, the body may produce stress betes Care & Education Specialists.
good news is that after several days, hormones. These hormones can cause
the brain readjusts to the new, lower food to digest extra fast, insulin to not Have a question about diabetes?
glucose levels and stops generating work as well, and the liver to release Email [email protected].
stored-up glucose into the blood-
16 DiabetesSelfManagement.com • Fall 2022
••• THE DOSE ••• Curmudgeonly Athlete
Cruises in a
Post-COVID
World
The U.S. Centers for Dis-
ease Control and Preven-
tion (CDC) has lifted some
of its restrictions on cruise
ships, but there are still
guidelines in place to
help prevent the spread
of COVID. Many of them are
common-sense measures
like wearing masks indoors,
but there are far too many
to list here. For comprehen-
sive information, read the
CDC regulations online at
bit.ly/3tdkXvL and contact
your cruise ship company.
A Boatload of Ways
To Stay Fit on a Cruise
BY ROB DINSMOOR
SHUTTERSTOCK Only a curmudgeonly athlete would a person’s own body weight). Consider skip the elevators and take the stairs
anticipate a Caribbean cruise bringing a jump rope, which can also instead? You not only get more steps
with trepidation: How am I going to offer a high-intensity cardio workout. (and mileage) in, but you also add
work out? That was my reaction when intensity to your workout.
I climbed aboard for a family vacation. On deck, the railings can be excel-
Yet I needn’t have worried. There were lent tools for doing stretches. You can Abandon ship! (Sorry, I couldn’t
plenty of ways to get my exercise. put one leg on the railing to stretch out resist.) I simply mean you should
your hamstrings, and you can also get get off the ship whenever possible
Workout options aplenty a nice stretch by grasping the railing when it docks. Most cruise ships offer
Commercial cruise lines are slowly with both hands, leaning back, and excursions. This may take the form of
reopening for business following a pushing with your feet. walking around the town, but some-
pause due to the COVID-19 pandemic. times cruises offer more adventurous
Many of them have fitness areas with If there is a swimming pool, con- activities like hiking, biking, kayaking,
treadmills, elliptical machines, sta- sider swimming laps. snorkeling, and scuba diving. (One of
tionary bikes, resistance training the highlights of my Caribbean cruise
machines, and free weights. Some If you’re naturally antsy, strolling was kayaking in the Virgin Islands.)
also offer group exercise classes, the promenade deck can be a great
which might include yoga, tai chi, way to get low-intensity cardio. (Some Forging your own path
Pilates, dancing, and sometimes cruise ships even have outdoor jogging Finally, if you’re traveling with fam-
trendy stuff like Spinning or Zumba. tracks.) If you have a pedometer or ily, it’s OK if everyone does their own
fitness watch or any kind of walking thing from time to time. If you want
You can also use your cabin or a low- or running app, you can keep track to take the hiking excursion, there’s
traffic spot on deck as a workout space of your mileage. Strolling the deck no reason your fellow travelers can’t
to practice yoga and perform calisthen- also helps keep claustrophobia at bay do a shopping expedition instead. Bon
ics (strength-training exercises that use and gives you a chance to explore voyage! DSM
fully everything the cruise ship has to
offer. While you’re strolling, why not
Fall 2022 • DiabetesSelfManagement.com 17
••• HEALTHY LIVING ••• The Right Moves
‘Fall’ Into Success TRIGGER POINT FOOT ROLLING
Exercises to improve mobility • This can be done first thing in the
morning, at your desk, or (if your balance
BY LAUREL DIERKING, MED, NASM, 700-ERYT allows) while brushing your teeth.
• Place a lacrosse ball, tennis ball (for an
Summertime is often charac- activity. However, if we can change easier option), or golf ball (for a harder
terized by warmth, energy, our idea of “exercise” to instead option) under one foot. Working across
and an increase in physical pur- be “movement,” we can give our- the entire bottom surface area of your
suits. As we transition to autumn selves more variety and flexibility foot, apply a modest pressure, rolling,
and adjust to the change in sea- in what we consider to constitute squeezing, stretching, and holding
sons, and perhaps the personal an active lifestyle. pressure in certain areas. Continue for
obligations that accompany this a minimum of 90 seconds on each side,
time of year, it can be easy to Movement is any physical breathing fluidly in and out of the nose.
lose track of our gains and “fall” activity outside of rest, expanding
into a pattern of complacency. beyond structured exercise to also SUPPORTED SIDE-BODY STRETCH
Mentally preparing for this tran- encompass the activities of daily
sition ahead of time can ensure living—playing with children, gar- • Place a circular resistance band around
continued success in whatever it dening, housework, and so forth. your wrists (or simply pull a small hand
is that you would like to maintain, Our bodies crave movement, and, towel firmly in opposite directions if you
keeping up your momentum as in fact, are designed to be mobile do not have a band) and reach your arms
the calendar inevitably inches in order to stay flexible, lubri- overhead, pulling apart firmly.
closer to the holiday season. cated, and adaptable to changing • Stand with your feet hip-width apart
demands. In other words, the more and alternate bending (not rotating)
When setting goals, it is impor- often and the more ways in which side to side as you reach your arms up
tant for long-term success to antic- we move, the better for our entire actively and apart firmly. (This can also
ipate and prepare for expected system! Taking the stairs instead of be done seated.) Exhale slowly and
roadblocks in your plan. For the elevator, parking further from completely with each side reach and
example, if you are attempting the entrance and walking, push- inhale normally to return to the center
to exercise four days a week, mowing the lawn, and going for a between each side bend. You should feel
it is important to be realistic walk while talking on the phone a stretch in your side and a firmness in
about your ability to maintain are all examples of ways to add your shoulders and core.
this schedule while you are, say, microdoses of movement into your • Complete five slow reaches to each side.
traveling, entertaining company, daily routine.
or working overtime. In other SQUAT TO PLANK, PLANK TO SQUAT
words, don’t let the perfect be the In addition to incorporating
enemy of the good and realize that more of this style of activity into • Lower back into a squat, with your weight
there will be times when things your day-to-day life, try these sim- in your heels. Stay as low in your legs as
won’t go exactly to plan. Prepar- ple movements to keep your body you can and reach your hands to the floor
ing in advance for the challenges supple and facilitate mobility. DSM or yoga blocks (without straightening
you may face can help ensure your knees).
your continued success despite Laurel Dierking, MEd, NASM, • Walk your hands and body forward,
the inevitable obstacles. 700-ERYT, is a movement special- staying low to the ground, until you reach
ist with a concentration in yoga, a pushup position. Hold here for one full,
When it comes to movement strength conditioning, exercise slow round of breath, in and out.
success, it is critical to expand physiology, and postural restoration. • Reverse walk your hands back to your
our perception of what it means With 10 years of extensive experi- feet, keeping your knees bent as much
to be “active.” Often in Western ence, Dierking seeks to enhance self- as possible. Stay low in your legs and lift
culture, we think of exercising as awareness by guiding individuals your upper body back to your original
the primary means of being active through mindful movement, func- squat position.
and may consider exercise fitness tional training, body awareness, • This is one round. Repeat three to five
to be the only form of successful and breath work. times.
18 DiabetesSelfManagement.com • Fall 2022
AARON ASHLEY
Fall 2022 • DiabetesSelfManagement.com 19
••• HEALTHY LIVING ••• Weighty Matters
‘Fall’ Into Weight
Management
BY DR. NICOLA DAVIES, PHD
Maintaining your healthy living keep you fuller for longer. An added management goals during this time. SHUTTERSTOCK
goals as you wave goodbye to the bonus is that they can help improve Your exercise regimen does not have
summer can be difficult. The days are eye and skin health and reduce bad to hit pause if you decide to travel. If
getting cooler, comfort food is look- (LDL) cholesterol and blood pressure. you are in a safe environment, jog-
ing more appealing, and the baggier ging in the brisk morning air can be a
clothes are coming out of the closet. Keep the germs away great way to start your day. If outdoor
Fall marks the beginning of increased exercise is not your style, there are
The good news is that the outdoor cases of flu and the common cold. many indoor fitness activities to try.
chills and the falling leaves also bring Managing your blood sugar may be For example, you can find and take
plenty of opportunities for fitness and more difficult if you get sick, since advantage of the local gym or follow
weight management. the body tends to release hormones online fitness videos.
that increase blood sugar as it tries
Take advantage of fall foods to fight the illness. In addition, these Other outdoor activities, such as
Healthy fall foods include apples, sicknesses often come with sudden relaxing at a park or shopping at a
pumpkins, squash, and root vegetables. unintentional fluctuations in weight. nearby farmers market, are great
These fruits and veggies are rich in Fortunately, the preventative mea- ways to obtain vitamin D from sun-
essential nutrients, including a vari- sures we have been taking against light. Low vitamin D levels have been
ety of vitamins and minerals. Magne- COVID-19, such as frequent hand- associated with an increased risk of
sium is a mineral found in an array of washing, can also help keep away depression and other mood disor-
autumn produce, such as butternut other illnesses. A side benefit of ders, and reduced energy levels due
squash and pumpkin seeds, that can spending time to clean and disinfect to poor moods can increase the risk
help regulate the body’s stress response your living space is the extra calories of weight gain. So, avoid the tempta-
and improve sleep—both stress and you burn doing so. Why not clean the tion of staying bundled up inside and
tiredness increase the risk of weight entire house for a good workout? embrace that vitamin D fix before fall
gain.Vitamin C, which can be found in is replaced with winter. DSM
abundance in fall foods such as Brus- Stay on track even when
sels sprouts and cantaloupe, can help you travel Dr. Nicola Davies, PhD, health
prevent extra fat storage. Thanksgiving is a time when many psychology, is the author of “I Can
of us travel to be with our families. Beat Obesity! Finding the Motivation,
Fall root vegetables are a great Try not to stray from your weight Confidence and Skills to Lose Weight
addition to soups and stews and, and Avoid Relapse.”
thanks to their fiber content, will
20 DiabetesSelfManagement.com • Fall 2022
••• HEALTHY LIVING ••• Smart Smarter Smartest
Wraps, Buns, Tortillas,
and English Muffins
BY AMY CAMPBELL, MS, RD, LDN, CDCES
If bread is getting too basic for you, grams on the Nutrition Facts label. products can pack a wallop when it
why not branch out and give a A good goal is to aim for no more comes to sodium, even if they don’t
wrap, bun, tortilla, or English muf- than 30 grams of carb per serving. taste remotely salty. The goal here
fin a try? Yes, most of these contain But don’t stop there: check out added is, ideally, no more than 240 mil-
carbohydrate, but even if you’re “low sugars (if the label lists this), too. ligrams (mg) per serving. Finally,
carbing” it, you’ll still find something Zero grams per serving is best, but aim to choose whole-grain versions
to fit your carb budget. When shop- up to 2 grams is doable. While you’re whenever you can. The exception:
ping for wraps and the like, check at it, be sure to glance at the sodium. gluten-free products, since they are
out the serving size and total carb Surprisingly, bread and bread-like often not made with grains. DSM
SERVING ADDED
SIZE CARBS SAT FAT PROTEIN FIBER SUGARS SODIUM
CAL (g) (g) (g) (g) (g) (mg)
SMART 1 tortilla 140 22 0 3 4 1 300
4 2 280
Maria and Ricardo’s Whole Wheat Tortillas, Soft Taco Size 1 roll 140 28 0.5 6 1 0 310
Arnold Sandwich Thins Rolls 100% Whole Wheat 3 1 310
Outer Aisle Cauliflower Sandwich Thins, Everything 2 pieces 120 5 3 10 2 2 330
Arnold Sandwich Thins Veggie Herb Made with Cauliflower 2 2 350
Dave’s Killer Bread Killer Classic English Muffins 1 roll 150 28 0 7 5 0 380
Stonefire Ancient Grain Mini Naan
Mission Whole Wheat Original Soft Tortillas 1 muffin 140 27 0 6
SMARTER 1 naan 150 23 1 5
Fiber One Honey Wheat Wraps 1 tortilla 110 22 0 4
Nature’s Own 100% Whole Wheat Hamburger Buns
365 Whole Foods Market Whole Wheat English Muffins 1 wrap 80 15 0.5 6 7 0 220
Maria and Ricardo’s Gluten Free Quinoa Flour Tortilla, Soft Taco Size 1 bun 130 24 0.5 6 4 2 190
Joseph’s Flax, Oat Bran & Whole Wheat Pita Bread 1 muffin 120 23 0 5 4 1 230
Joseph’s Flax, Oat Bran & Whole Wheat Lavash Bread 1 tortilla 100 23 0 0 1 0 250
Angelic Bakehouse 7 Sprouted Whole Grains Burger Buns 1 pita 60 9 0 6 2 0 270
½ flatbread 60 8 0 6 2 0 290
SMARTEST 1 bun 140 25 0 7 5 2 290
Ezekiel 4:9 Sprouted Flourless Low Sodium Tortillas 1 tortilla 140 26 0 7 5 0 0
La Tortilla Factory Organic Yellow Corn Tortillas
Trader Joe’s Jicama Wraps 1 tortilla 60 12 0 1 2 1 0
Toufayan Smart Pockets 100% Whole Wheat
Ezekiel 4:9 Sprouted Grain Burger Buns 2 wraps 15 3 0 0 2 0 0
Tumaro’s Carb Wise Whole Wheat Wraps
Egglife Southwest Style Egg White Wraps 1 pocket 100 17 0 5 4 0 50
SHUTTERSTOCK ½ bun 90 17 0 5 3 0 80
1 wrap 60 12 0 5 7 0 105
1 wrap 30 1 0 5 <1 0 170
Fall 2022 • DiabetesSelfManagement.com 21
••• HEALTHY LIVING ••• Food For Thought SHUTTERSTOCK
Boosting the Nutrition
Value of Your Food
BY ALISON MASSEY, MS, RD, LDN, CDCES
22 DiabetesSelfManagement.com • Fall 2022
Many people struggle with their FAVORITE FOOD NUTRITION “BOOSTERS”
relationship with food and how
to develop a well-balanced approach BURGER AND FRENCH FRIES
to eating, a situation I’ve encountered
many times in my work as a dietitian Switching to leaner ground meat and baking or air-frying french fries can be options
and diabetes educator. Often, clients for nutritionally elevating your burger and fries. Why not also try boosting the nutri-
express feelings of guilt if they choose ents with some delicious toppings?
to enjoy something they mentally
label as “bad” or deem less nutritious • Bruschetta topping (chopped fresh toma- • Onions
than other choices. A diagnosis of dia- Onions contain quercetin, a flavonoid
betes can make this relationship even toes with garlic or onion, basil, and olive oil) (plant pigment) that acts as an anti-
more complex, with food choices and inflammatory in the body.
their effects on blood glucose read- Bursting with flavor, the tomatoes, onions, • Sauerkraut
ings on full display for the person to and basil provide vitamin C and other Some sauerkrauts contain probiotics (good
see on their blood glucose meter or nutrients. bacteria), which are beneficial for gut
continuous glucose monitor (CGM). • Coleslaw health.
Cabbage is a great source of
But blood glucose readings, while vitamin C, vitamin K, and fiber.
informative, don’t tell the whole story.
The result on your meter doesn’t cap- CHEESESTEAK
ture the moment of joy experienced
when you bite into that perfect peach or A classic cheesesteak is a true delicious indulgence. If you are making it at home, con-
share paella during a once-in-a-lifetime sider adding some additional topping options to increase the vegetable content of
vacation. Finding the balance between your sandwich.
managing health and experiencing
enjoyment through food is a tightrope • Caramelized onions and a variety of other important nutrients.
for many, but it doesn’t have to be with Onions are a source of dietary fiber, vitamins • Red roasted peppers
support from a certified diabetes care C and B6, potassium, and other nutrients. Red peppers are a source of vitamins A and
and education specialist (CDCES) and a • Mushrooms C and potassium.
shift in mindset. While changing think- These are a source of B vitamins, vitamin D,
ing patterns might, for some, require
work with a therapist, one strategy I PIZZA
embrace is to focus on ways to elevate
the nutrition profile of favorite foods There are so many delicious and nutritious ways to modify the classic pizza, whether
versus eliminating them completely it is using different ingredients for the crust, switching the cheese, or topping with a
(which some research suggests might sauce that has less added sugars. After perfecting your pizza, consider adding some of
contribute to more cravings). my favorite nutrition boosters, vegetables!
In this column, I’m sharing a few of • Asparagus • Olives/olive oil
my preferred methods for boosting the This veggie is a good source of potassium Olives are a source of heart-healthy fats.
nutrition value of some of my favorite and fiber. • Zucchini
foods to help you consider how you can • Arugula/spinach/kale/wedge salad Zucchini is a source of potassium and vita-
increase the nourishing components Daily salad consumption can add a variety min C.
of your favorite dishes. Elevating the of important nutrients to your diet.
nutritional value of your favorite foods is
not about taking things away but rather TACOS
about boosting the flavor by adding
nutrient-dense ingredients. The best Tacos are a weeknight favorite for many. Try mixing it up a little by boosting your basic
part? That is the only “rule.”Get creative tacos with some beans and lentils and topping them with sliced avocado and nutri-
by focusing on favorite flavors and even tional yeast.
using restaurant meals as inspiration to
make a “copycat”version at home. DSM • Avocado • Lentils
Avocadoes contain heart-healthy fats and Like beans, their cousin in the legume family,
Alison Massey, MS, RD, CDCES, is are a source of nearly 20 vitamins, minerals, lentils are also a source of protein and fiber.
a registered dietitian and certified and phytonutrients. • Nutritional yeast
diabetes care and education • Beans Sprinkle this ingredient on for a boost of
specialist in Maryland. She blogs at Beans are a source of protein and fiber. extra cheesy flavor as well as added pro-
flourishmyhealth.com. tein, vitamins, and minerals.
ICE CREAM SUNDAES
Ice cream, frozen yogurt, or “nice” cream (plant-based ice cream) tastes best with deli-
cious toppings to enhance the dessert. Try a combination of your favorite fruits, nuts,
and seeds.
• Chia seeds • Fruit
These seeds add fiber, omega-3 fatty acids, Switch up your fruit selections based on
and protein and are also a source of several seasonality to add some vitamins and min-
minerals and antioxidants. erals to your dessert.
• Flaxseed (ground) • Pistachios
Flaxseed contains omega-3 fatty acids, fiber, These nuts are a source of heart-healthy
and lignins, which provide antioxidants. monounsaturated and polyunsaturated
fats, protein, and potassium.
Fall 2022 • DiabetesSelfManagement.com 23
••• HEALTHY LIVING ••• Susan and T’ara’s Kitchen
Time to Tote Your Lunch!
Lunch boxes from around the world
BY SUSAN WEINER, MS, RDN, CDN, CDCES, FADCES, AND T’ARA SMITH, MS
Are you ready to pack a delicious, boxes. They vary in style, material, portioned and neatly cut so that they SHUTTERSTOCK
flavorful, and easy-to-prepare and size. A reusable lunch box comes can be easily enjoyed with fingers or
lunch? It’s time to jazz up your with a number of added bonuses too! chopsticks. Traditional bento boxes
midday menu with nutritious and These are environmentally friendly are wooden, in a shokado (rectangu-
preportioned meals and snacks by as compared to a throwaway bag, lar) or hangetsu (half-moon) shape.
using a lunch box. A variety of lunch simple to clean, and can keep your They are available in Western coun-
boxes can be found across the globe, lunch from getting squashed before tries in stainless and plastic materi-
designed to host our favorite foods. chow time. A well-designed lunch als as well. In Japan, bentos can be
Whether it’s a bento box in Japan, box also prevents leaks and messes, purchased at many convenience store
a dosirak in Korea, a bian dang in unlike a reusable or paper bag. locations, takeout restaurants, and
Taiwan or China, a tiffin in India, train stations.
or a schiscetta in Italy, it’s all about Let’s take a look at the types of
organizing your lunch meal in a lunch boxes you can use to make Dosirak
simple and practical way. meal prep easier. A dosirak (also known as gwakpap)
is the Korean equivalent of the Japa-
Lunch boxes from across the globe Bento box nese bento box and is comprised of
Susan says: Many cultures and Bento boxes, which originated in a plastic or insulated steel container,
regions offer well-designed varia- Japan, are partitioned boxes that with or without compartments. The
tions of meal containers or lunch include a “to-go” meal with an authen- homemade dosirak may be packed
tic taste of home. Typically, foods are
24 DiabetesSelfManagement.com • Fall 2022
From “My Indian Table: Quick & Tasty Want another authentic Indian recipe to try? Sheth shares a delicious
Vegetarian Recipes” (amzn.to/3O4eTye), and nutritious recipe that works well with a tiffin or lunch box.
by Vandana Sheth.
Pav Bhaji
Curried Power
Bowl (Spicy Mixed Vegetables and Toasted Wheat Bread)
7 SERVINGS | 1⁄7 OF TOTAL RECIPE 4 SERVINGS | ¼ OF TOTAL RECIPE
CAL 140 | FAT 5.1G | PROTEIN 3.6G | CARBS 18.2G | SODIUM 107MG
CAL 136 | FAT 3.6G | PROTEIN 6.6G |
CARBS 22.5G | SODIUM 197MG Base
1 tablespoon oil 1 tablespoon oil 1 14-ounce can low-sodium
1 teaspoon cumin seeds
1 large onion, chopped (about 11⁄3 1½ teaspoons garlic, minced tomato sauce
cups) 4 cups riced vegetable ½ teaspoon ground coriander
2 serrano chilis, deseeded and
medley (cauliflower, ½ teaspoon ground cumin
chopped (optional)
½ teaspoon ground red chili carrots, broccoli) or your ½ teaspoon ground red chili
1 teaspoon turmeric
1 teaspoon ground cumin choice of 4 cups cooked (optional)
1 teaspoon ground coriander
1 teaspoon garam masala vegetables (carrots, green 2-3 teaspoons garam masala
1 teaspoon garlic
1 teaspoon ginger beans, bell pepper, and 1 teaspoon salt (optional)
8 cups cauliflower florets (about 2
cauliflower work well) 1 tablespoon extra-virgin
pounds, or 1-1½ large heads)
1 14-ounce can garbanzo beans 1 small potato, cooked, olive oil or 1 tablespoon
(also called chickpeas), rinsed peeled, and chopped unsalted butter (optional)
and drained
4 tomatoes, chopped 1 14-ounce can low-sodium 1 tablespoon lime juice
2-4 tablespoons chopped cilantro
(optional) diced tomato
Bag of greens
Garnish
1. Heat oil on medium-high setting in a
saucepan. 2-3 tablespoons finely chopped ½ cup finely chopped onions
2. Add cumin seeds and sauté for about cilantro (optional)
1 minute, until darker brown.
Pav/bread
3. Add onions and sauté until golden
brown. Typically, this is a soft dinner roll that is buttered or in oil and pan
toasted. I recommend using a low-carb bread or wrap.
4. Add serrano chilis, if desired, red
chili, turmeric, cumin, coriander, garam 1. Heat oil in a kadai/wok on medium-high.
masala, garlic, and ginger, and sauté for
1 minute. 2. Add garlic and sauté for 1 minute (make sure that the garlic does not
burn).
5. Add cauliflower and mix well and
cook for about 5 minutes. 3. Add riced vegetables or cooked vegetables, potato, diced tomatoes,
tomato sauce, coriander, cumin, red chili, garam masala, and salt.
6. Add garbanzo beans and toma-
toes. Mix well, cover, and cook for 5-7 4. Mix well, cover, and cook for 5-6 minutes, until all the vegetables are
minutes. soft and cooked.
7. Garnish with cilantro and enjoy! 5. Add extra-virgin olive oil or unsalted butter and mix well.
Serving suggestion: Serve on a bed of 6. Turn off the stove.
greens with a drizzle of cucumber raita
(yogurt sauce). 7. Add lime juice, mix well, top with cilantro, and, if desired, onions, and
enjoy with low-carb bread or wrap!
“A popular street food dish that translates to bread and vegetables
(pav: bread, bhaji: vegetables). The delicious vegetables are cooked in
a tomato sauce infused with aromatic spices and enjoyed with bread,”
Sheth notes. “Traditionally, it is made with a lot of butter to offset some
of the spice level, and potatoes are the predominant vegetable used.
My version here is loaded with veggies and packed with flavor, and
lower in carbs and calories than the original version.”
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••• HEALTHY LIVING ••• Susan and T’ara’s Kitchen
in tiered lunch boxes and contain cally pleasing. In recent years, the Sheth shares a recipe perfect for
soup, which is kept warm by insula- practice of using a schiscetta has second-day lunch dining. She says,
tion. The dosirak may also include become more of a dining experience. “This Curried Power Bowl recipe (page
kimchi, a side dish of salted and It often includes decorative plates, 25) came about one warm summer
fermented vegetables, and shredded utensils, and napkins to brighten day when I had arrived home from
gim, or seaweed. up lunchtime. work and wanted to relax with my
family. I pulled together a few ingre-
Bian dang Tiffin dients that I thought might play well
together and cooked this in a wok on
The lunch box of choice in Taiwan Vandana Sheth, RDN, CDCES, FAND, our backyard stove. This dish is in
honor of my husband, who loves simple
and China is called the bian dang. registered dietitian nutritionist and one-bowl meals. For any of you looking
for an Indian-inspired meal that comes
The bian dang is a polystyrene box author of “My Indian Table: Quick & together easily, give this a try.You could
make it for dinner and have leftovers
and typically has four Tasty Vegetarian for lunch in your tiffin box!”
compartments. Recipes,” shares This recipe creates a delicious
one-bowl meal for convenience, fla-
One compartment “The tiffin box vor, and easy clean-up. Sheth says,
is a traditional “The golden hue of turmeric and
T’ARA’S TAKE:is designated for aromatics turn each bite into a flavor
and textural explosion. The addition
a combination of Don’t forget your stainless steel/ of garbanzo beans to this recipe
rice and meat, diabetes supplies! metal lunch provides a nice protein and fiber
and the others box that is upgrade.” Sounds delicious! DSM
host sautéed or Did you know that your lunch box is compartmen- Susan Weiner, MS, RDN, CDCES,
FADCES, is the owner of Susan Weiner
steamed veg- a perfect tool for staying organized talized and Nutrition, PLLC, and coauthor of “The
Complete Diabetes Organizer” and
etables. The bian with your diabetes supplies? Some used to take “Diabetes: 365 Tips for Living Well.”
T’ara Smith, MS, earned her master’s
dang can be pre- lunch boxes or bags are designed food to go and degree in nutrition education and
pared at home or with added storage space, which is the Indian dedicates her professional life to helping
purchased locally can be used for certain diabetes equivalent of a people with diabetes thrive. Together,
(and very inexpen- supplies. Use the extra storage in bento box ... I they created“Susan and T’ara’s Kitchen”
sively) throughout your lunch box to store items such have so many to share nutrition tips, original recipes,
Taiwan and China. as a lancing device, glucose tablets, fond memories and healthy living ideas.
and snacks to treat low blood sugar. of my mom
Schiscetta (Avoid storing meters, strips, insulin packing our tif-
Italy’s version of or other medications in your lunch fin boxes every
box, as they can be affected by hot
a lunch box is the and cold food temperatures.) morning ,” she
schiscetta, which recalls. “Typi-
was originally cally, it would
used by people who include a flat-
couldn’t afford to buy a midday meal. bread roti or herb-and-spice-infused
Now, folks throughout Italy embrace flatbread called thepla served along
the idea of packing lunches that with yogurt, some spicy pickles, and
delight the palate and are aestheti- a vegetable curry.”
Can’t go to Jamaica? Bring it to you with this Jerk Chicken recipe!
What is Jamaican jerk? Historically, jerk is the legacy of the the globe—especially New York and
When you think of Jamaican food, Taíno—Arawak people indigenous to other cities along the eastern coast of
Jamaica and other Caribbean areas— the United States—you can be certain
chances are that “jerk chicken” is top and African cultures. With the help to find authentic Jamaican jerk foods
of mind. But do you know where the of the Taíno, the Maroons—enslaved in many places, primarily jerk chicken.
style of cooking originated? Jamaican Africans who escaped to the island’s However, jerk seasoning can be applied
jerk is a blend of delicious flavors that mountains—learned to preserve meat to other cuts of meat, as well as seafood.
describe how food is seasoned and with various spices and techniques that
cooked. It consists of warm flavors such would eventually become the method Because of jerk seasoning’s rich
as Scotch Bonnet pepper, pimento to create jerk foods. flavors, it tastes even more delicious
(allspice), cloves, cinnamon, and much the next day. Prepare it for dinner and
more. Jerk provides a rich flavor that Today, you can find jerk seasoning in eat a portion of leftovers for lunch the
only intensifies when cooked, espe- plenty of grocery stores, and because Ja- next day to take advantage! Use this
cially over a grill or in a smoker. maicans have emigrated to cities all over Jerk Chicken recipe as inspiration.
26 DiabetesSelfManagement.com • Fall 2022
T’ARA’S TAKE:
Jerk Chicken recipe tips
The star of this recipe is the jerk
marinade. It works well with any cut of
chicken or can be used with another
kind of protein, such as fish or shrimp.
Want to intensify the flavor?
Marinate the chicken, pork, or another
protein overnight in the refrigerator.
If you want to turn the marinade
into a sauce, add water to thin it to your
desired consistency and bring it to a
boil in a saucepan for at least 5 minutes
to cook (to help prevent bacterial
growth). Or, you can reserve half the
marinade or make a new batch to use
as a sauce.
Not a fan of spicy foods? Remove
the seeds of the habanero or Scotch
Bonnet pepper or omit the peppers
completely.
Portion out the chicken by putting it
in the largest section of your lunch box.
Suggested sides for this dish are rice
and beans (traditionally called peas in
Jamaica), coleslaw, steamed vegetables,
or a side salad.
Jerk Chicken
6 SERVINGS | 1⁄6 OF TOTAL RECIPE
W LC
CAL 232 | FAT 9G | PROTEIN 31G | CARBS 8G
Jerk Marinade ½ tablespoon paprika 2. Place the chicken in a bowl or a gal-
3-4 scallions ½ tablespoon nutmeg lon bag and pour the marinade on the
½ cup chopped onion ½ teaspoon cinnamon chicken. Toss the chicken in the mari-
3-4 sprigs or 1½ tablespoons ½ teaspoon pepper nade to fully coat it, and let it marinate
fresh thyme ½ teaspoon kosher salt for at least an hour in the refrigerator.
1½ tablespoons fresh ginger (optional) 3. Coat a skillet or grill pan with fat-
7 garlic cloves free cooking spray and heat it over
1 habanero pepper (or Scotch Chicken medium heat for at least 3-5 minutes.
2 pounds thin-sliced boneless,
2 Bonnet pepper) skinless chicken breast 4. Shake off excess marinade and place
tablespoons low-sodium soy Fat-free cooking spray the chicken onto the heated skillet.
sauce
2 tablespoons white vinegar 1. Combine all of the ingredients for 5. Cook the chicken on both sides until
2 tablespoons canola oil the Jerk Marinade in a food processor it reaches 165°F internally.
1 tablespoon allspice or blender and blend for 1-2 minutes
1 tablespoon ground cloves until the consistency is slightly thick. 6. Serve the chicken with your favorite
1 tablespoon lime juice sides!
SHUTTERSTOCK
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28 DiabetesSelfManagement.com • Fall 2022
‘Fast’ Food
Tips for quick, nourishing meals at home
BY ALISON MASSEY, MS, RD, LDN, CDCES
Need some “fast”food ideas? Not Prep Cookbook,” suggests “planning setting aside some time to prepare
the kind from the drive-thru, ahead of time what you’ll be eating, some of the items in advance for the
mind you, but a few nourishing meals when you’ll go food shopping, and meals. For example, washing and
you can easily put together at home? when you’ll prepare the meal.” slicing produce, making marinades
Here are time-saving tips and favorite or salad dressings, cooking grains,
recipes from three registered dietitian Having a plan is the first step and grilling or roasting protein and
nutritionists for no-hassle meals that in making meal prep much easier vegetables can save time when it
even the novice cook can handle. during the week. If you are over- comes to putting together meals
whelmed with the process, start with later in the week.
TIP 1 small steps. First, assess what you
Plan to prepare have available in your pantry and TIP 2
It’s undeniable that a little advanced refrigerator, using some of those Balance it
planning can go a long way to save items as the basis to create ideas Having a “formula” to put together
time with meal prep. Toby Amidor, for your meals. Next, write down at meals quickly can decrease the
MS, RD, CDN, FAND, an award-win- least two to four different meal ideas number of decisions you need to
ning nutrition expert and author of for the week, considering what items make about food choices. Balanced
The Wall Street Journal bestseller you might need to purchase at the meals can look different depending
“Diabetes Create Your Plate: Meal grocery store to make those meals. on dietary patterns and preferences,
After grocery shopping, think about
Toby Amidor’s Greens and Grain Bowl
TOTAL TIME: 1 HOUR, 5 MINUTES | PREPARATION TIME: 15 MINUTES | COOK TIME: 50 MINUTES
4 SERVINGS | CUP (250 ML) CHARD MIXTURE, ½ CUP (125 ML) BROWN RICE, 1 TABLESPOON (15 ML) CHEESE
V FI
CAL 323.9 | FAT 12.2G | SAT FAT 2.6G | TRANS FAT 0.0G | PROTEIN 12.1G | CARBS 44.8G | SUGARS 5.5G | CHOL 8.3MG | FIBER
7.0G | SODIUM 439.0MG | POTASSIUM 540.2MG | PHOSPHORUS 164.1MG
2⁄3 cup (150 ml) long-grain brown 1 lemon, cut into 4 wedges 3. To store: In each of 4 containers, add
rice ½ cup (125 ml) of the brown rice and
1. In a medium saucepan, add brown top with 1 cup (250 ml) of the chard
11⁄3 cup (325 ml) low-sodium rice and vegetable broth and bring to mixture. Sprinkle each container with 1
vegetable broth a boil over high heat. Reduce heat to tablespoon (15 ml) of the feta cheese.
medium-low and simmer, covered, un- Add 1 lemon wedge to each container.
2 tablespoons (30 ml) olive oil til water is absorbed and rice is tender, Cover and refrigerate for up to 4 days.
1 bunch rainbow chard, center 40 minutes. Set aside and let cool for
10 minutes. 4. To serve: Remove the lemon and
stems removed and leaves set aside. To reheat, microwave the
coarsely chopped 2. In a medium saucepan, heat oil over container uncovered on high for 60 to
1¾ cans (425 ml) low-sodium medium heat. When oil is shimmering, 90 seconds. Allow 2 minutes for the
chickpeas, drained and rinsed add chard and cook until wilted, about heat to distribute before removing
1 cup (250 ml) cherry tomatoes 4 minutes. Add chickpeas and cherry the container from the microwave.
1 teaspoon (5 ml) dried oregano tomatoes and toss to combine. Add Squeeze the lemon wedge over the
½ teaspoon (2 ml) garlic powder oregano, garlic powder, salt, and pep- top before serving.
1⁄8 teaspoon (0.5 ml) salt per and toss evenly to coat vegetables.
1⁄8 teaspoon (0.5 ml) ground black Cook for 5 minutes to allow the flavors (Recipe from “Diabetes Create Your Plate: Meal
pepper to combine.
¼ cup (60 ml) crumbled feta Prep Cookbook” by Toby Amidor. Published by
cheese
Robert Rose Books. All rights reserved.)
SHUTTERSTOCK
Fall 2022 • DiabetesSelfManagement.com 29
4 Fast Meal but many of the key components Make nonstarchy vegetables a SHUTTERSTOCK
Ideas That remain the same. The U.S. Depart- priority, Mathis suggests including
Registered ment of Agriculture’s (USDA’s) more of your favorite nonstarchy veg-
Dietitians MyPlate was introduced in 2011 but etables, such as broccoli, spinach, and
Recommend still serves as a good basic repre- green beans, with your meals. These
sentation of a balanced meal, with vegetables are loaded with various
Our experts shared a few of their favor- half of the meal including produce nutrients, are low in calories and car-
ite quick meals that are sure to satisfy like fruits and vegetables combined bohydrates, and are a source of fiber.
your taste buds and nourish your with a source of protein and a grain
nutrient needs. choice. After the basic foundation is TIP 4
in place to construct the meal, that is Focus on flavors
Greens and Grain Bowl (page 29) when the fun can begin. A main reason we tend to gravitate
“This bowl is easy to make, especially toward certain foods is because of
if you meal prep it on Sunday and Jackie Newgent, RDN, CDN, a their flavor. Maximizing flavor is one
eat it throughout your week. You can plant-forward chef, nutritionist, and of the best ways to adjust recipes to
also opt to make it during the week, author of “The Clean & Simple Dia- satisfy both your health needs and
and you can additionally use leftover betes Cookbook: Flavorful, Fuss-Free taste buds. Learning how to add more
brown rice or cook up the rice the Recipes for Everyday Meal Planning,” flavor to dishes can also save time in
night before, which will minimize suggests adding a splash of vinegar the long run because it may encour-
much of the cooking time.” or a squirt of lemon or lime juice to age you to enjoy more meals at home
—Toby Amidor, MS, RD, CDN, FAND balance taste and add some zing to instead of eating out.
(instagram.com/tobyamidor) meals. She also recommends “punch-
ing up plant protein, nutrient-rich- One simple way to add flavor to
Veggie-Lover’s Hummus Bowl ness, and crunch by finishing dishes dishes is by mixing in fresh herbs,
“One of my personal favorite (and with nuts—a diabetes superfood.” spices, and citrus zest. Another way
simple!) lunch options is a Veggie- to boost the flavor profile of dishes
Lover’s Hummus Bowl. I generously TIP 3 is to recreate some of your favorites,
smear hummus into a bowl, top with focusing on great flavor with a healthy
nonstarchy veggies—often freshly Save time with repetition twist. For example, Mathis suggests,
roasted or pan-grilled—sprinkle with Monotony is OK sometimes, especially “if you’re a fan of Philly cheesesteaks,
olive oil, lemon, and pistachios and/ when it comes to planning ahead for try preparing stuffed Philly chees-
or sesame seeds, then scoop up with certain meals. Meal planning requires esteak bell peppers instead. You’re
fluffy whole-grain pita.” a lot of decisions, and a few repeated still getting those same great flavors
—Jackie Newgent, RDN, CDN (insta- meals throughout the week might help of the traditional Philly cheesesteak
gram.com/jackienewgent) reduce decision-making fatigue. but in a much healthier way.”
Vegetable, Turkey, and Cheese In order to ensure that your Deconstructing best-loved dishes
Spinach Wrap repeated meal choices are nourish- can both help make meals that are
“I am a huge fan of veggie wraps. ing, consider using some of these top better for your health and add a new
They’re an easy way to use up extra tips for preparing easy and nutritious favorite to your repertoire.
produce that you may have left over in meals from Andrea Mathis, MA, RDN,
the fridge. My favorite wrap includes LD, owner of Beautiful Eats & Things Step by step
a serving of arugula, tomatoes, bell and author of “The Complete Book of The keys to creating fast meals that
peppers, cucumbers, cheese, and lean Smoothies: 115 Healthy Recipes to are both delicious and nutritious are
turkey wrapped up in a tasty, low-carb Nourish, Heal, and Energize.” diligence in preparation and having a
spinach tortilla.” few staple ingredients on hand. Just as
—Andrea Mathis, MA, RDN, LD (insta- Add a serving of lean protein to with adopting other new habits, start-
gram.com/beautifuleatsandthings) each meal. Lean protein choices can ing with small steps like building your
include foods such as chicken, turkey, pantry, creating lists of your favorite
Spinach Salad With Hard- seafood, eggs, pork loin, and low-fat foods, or simply putting together a meal
Cooked Egg dairy. Looking for plant-based protein plan for the week will go a long way
“This simple salad can be whipped up options? Try tofu, tempeh, beans, in helping you meet your goal to put
in about 30 minutes. Finish the plate legumes, nuts, and seeds. tasty meals on the table in no time. DSM
by adding one medium whole-wheat
roll to your salad.” Include more whole foods Alison Massey, MS, RD, CDCES, is
—Toby Amidor, MS, RD, CDN, FAND instead of highly processed foods. a registered dietitian and certified
(instagram.com/tobyamidor) Limit foods that may be prepared with diabetes care and education
excess sodium, sugars, and saturated specialist in Maryland. She blogs at
30 DiabetesSelfManagement.com • Fall 2022 fats and instead build meals around flourishmyhealth.com.
whole-food options like whole grains,
beans, fruits, vegetables, nuts, seeds,
meats, poultry, seafood, and eggs.
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32 DiabetesSelfManagement.com • Fall 2022
The
Fallacy
15of
Hypoglycemia treatment is not one size fits all
BY GARY SCHEINER MS, CDCES
When I was young and restless, my Pappy often said to me,
“Rules are rules.” Of course, this was usually preceded
by my breaking of said rules. As I got a little older and life (and
Pappy’s hair) developed more gray areas, he softened his stance
a bit. “Rules are rules, but some rules are meant to be broken.”
Having lived with diabetes the way we treat hypoglycemia
for more than 36 years and needs to be customized to the
taught thousands of patients individual … and the situation.
through my diabetes practice,
I’ve discovered plenty of rules Why is this so important?
that are just begging to be bro- Everyone who takes insulin or
ken. One that truly stands out is medications that cause the pan-
the “Rule of 15”—that standard creas to secrete more insulin
procedure for treating hypogly- (sulfonylureas [e.g., glyburide,
cemia (low blood sugar) with glipizide, and glimepiride] and
exactly 15 grams (g) of carbohy- meglitinides [e.g., repaglinide,
drate and then waiting 15 min- nateglinide]) is at risk of hypo-
utes to see if it worked. While glycemia. This includes those
this may provide a nice, easy- who take basal (long-acting)
to-remember starting point for insulin only as well as those
those who are recently diag- who use the sophisticated new
nosed and overwhelmed with automated insulin delivery sys-
new information, it rarely works tems (also called hybrid closed-
in real-life situations. Given the loop systems). It’s also worth
importance of proper recovery, noting that hypoglycemia is not
Fall 2022 • DiabetesSelfManagement.com 33
limited to those with type 1 diabetes. quickly your glucose is dropping, (Target BG – Current BG)/BG rise
Approximately 50% of those with and whether or not you are using an per gram of carb
type 2 diabetes who take insulin automated insulin delivery system.
also experience lows. But there is For example, if your target is 110
a big difference between day-to- 1. Body size. Every gram of carbo- mg/dl, your current blood glucose
day garden-variety lows (called mild hydrate will raise your blood sugar by (BG) is 63 mg/dl, and each gram of
hypoglycemia) and severe lows that a unique amount. Ten grams will raise carb raises you 4 mg/dl, then you
may involve seizures, loss of con- the blood sugar of a small child much need (110 – 63)/4, or 12g carb.
sciousness, coma, or death (severe more than a fully grown adult. This
hypoglycemia). is due to the fact that bigger people 3. The rate of change. This is
have more blood volume into which easily seen on a continuous glucose
What keeps a mild low from the glucose will dissolve. Chemical monitor (CGM). If your glucose is
becoming a severe low? Early detec- equations aside, suffice to say that low and falling quickly, you will need
tion and proper treatment. The early the bigger you are, the more car- more than the “usual” amount of carb,
detection comes from recognizing the bohydrate it will take to raise your based on the chart at the bottom of
usual symptoms (e.g., shaking, sweat- blood glucose level. The chart below this page. If you are low and leveling
ing, rapid heartbeat, hunger, and, in summarizes our clinic’s observations off, the standard amount should work
some cases, confusion or behavior as to the amount that each gram of fine. Here is an approach you can try:
changes) and, nowadays, use of a carbohydrate raises a person’s blood
real-time continuous glucose moni- glucose based on their weight: ARROWS ADJUSTMENT TO GRAMS OF
tor (CGM) with the low alert turned ON CGM CARB FOR TREATING LOW
on and set above your true threshold WEIGHT IN BG RISE PER GRAM OF
for hypoglycemia. For example, if POUNDS (KG) CARB IN MG/DL(MMOL/L) No adjustment (usual treatment)
you want to keep your glucose from No adjustment (usual treatment)
going below 70 mg/dl, set your low <60 (<27) 8-10 (.44-.55) Add 25% to the usual treatment
alert on your CGM at 80, 85, or 90 or Add 50% to the usual treatment
and treat it immediately when the 61-90 (27-40) 6-7 (.33-.39)
low alert occurs. For example, if you would nor-
91-130 (41-59) 5 (.28) mally use 16g carb to treat a low but
Proper treatment of hypoglyce- you have one down arrow present
mia requires two things: The right 131-180 (60-81) 4 (.22) ( ), add 16 x .25, or 4g, to your treat-
type of food and the right amount. ment: 16 + 4 = 20g total carb needed
With proper treatment, your glucose 181-240 (82-108) 3 (.17)
should rise to a safe level quickly. If you’re not in the mood to use a
With improper treatment, you may 241-300 (109-136) 2.5 (.14) calculator, a simpler (but less precise)
not reach a safe level, or you may approach is to add 5g carb for each
overshoot and wind up with a glucose >300 (>136) 2 (.11) straight-down arrow (10g per arrow
level that is too high. Or the treatment if you weight more than 200 pounds).
may take too long to work. 2. The amount you want your
glucose to rise. The lower your glu- If you don’t have a CGM, get one.
An individualized approach cose, the more carbs you will need to It is the best tool for understanding
Treatment of hypoglycemia is some- get back up to your usual target. And the situation. If you can’t (or won’t)
thing you should think about and if you define the “target” as 120 mg/ access one, consider how much insu-
prepare for now—not when you’re dl (6.7 mmol/l), you will need more lin on board you have from your last
low and can’t think all that clearly. carb than if you define the “target” dose of rapid-acting insulin. If you
Besides compromising our judgment, as 100 mg/dl (5.6 mmol/l). The table took your last dose within the past
hypoglycemia tends to make us really, below provides guidance based on three hours, you are probably drop-
really, really hungry. So, do yourself body size, with a goal of raising the ping quickly; assume that you have
a favor. Don’t wait until a low is star- glucose to approximately 120 (6.7). “down arrows.” If it has been more
ing you in the face to figure out what than three hours, the drop is probably
to do. Determine the food types and If you’re a “math” person, another
quantities now and put them where way to determine the amount needed
you can access them easily. is with this formula:
First, let’s think in terms of quan- BLOOD GLUCOSE (MG/DL) 70s 60s 50s 40s <40
tity. The amount of carbohydrate BLOOD GLUCOSE (MMOL/L) 3.9-4.4 3.3-3.8 2.8-3.2 2.2-2.7 <2.2
needed to treat hypoglycemia varies WEIGHT IN POUNDS (KG):
based on a number of factors, includ- 61-90 (27-40) 5g 6g 7g 8g 10g
ing your body size, your usual target 91-130 (41-59) 7g 8g 10g 11g 13g
glucose level, how low you are, how 131-180 (60-81) 9g 11g 13g 15g 17g
181-240 (82-108) 11g 14g 16g 19g 21g
241-300 (109-136) 15g 18g 22g 25g 28g
>300 (>136) 18g 22g 26g 30g 34g
34 DiabetesSelfManagement.com • Fall 2022
mild; don’t assume that down arrows others will take their sweet time (pun count on your CGM to let you know
are present. intended). When hypoglycemia hits, when (and how much) your glucose
choose a food that will raise the glu- has risen for the first 30 to 60 minutes
Besides insulin, exercise activity cose as quickly as possible. after treatment. Doing so can make
is something that can cause blood you think your glucose is lower than
glucose levels to drop very rapidly. Dextrose is the fastest form of car- it really is and lead to overtreatment.
If a low occurs during or right after bohydrate for raising blood sugar. Instead, use finger-stick readings to
exercising, you are likely to need Glucose tablets and glucose gels are measure your progress during recov-
25-50% more than the usual amount made with dextrose. Several candies ery from a low.
of carb to treat the low. are also made with dextrose, includ-
ing Smarties, SweeTARTS, Nerds, One other note: It is not usually
Food eaten in the past couple of Runts, Spree, and Pixy Stix. Check necessary to consume a “slow-digest-
hours can also affect the direction the ingredient label on candies to ing” food (such as a fat/protein-
your blood glucose is headed. If you see if dextrose is the first item listed. containing snack) during or after
had a meal or snack that consisted treatment of a low. As long as your
of slowly digesting foods (such as If you don’t have ready access to insulin/medication program is set up
high-fiber or high-fat items), there foods containing dextrose (or you properly, there is no reason to think
is a very good chance that the carbs don’t care for the taste), several ordi- that your glucose will drop again soon
in the food are still in the process of nary foods work almost as quickly. after it has risen. If your glucose does
digesting, and the blood glucose is Carbs in liquid form tend to absorb tend to drop a second time, it may be
dropping at a slow rate. Not that you pretty fast. Liquid options include time to speak with your diabetes care
should ignore the low, but the usual grape juice, sports drinks, and regu- team about reducing your medication
amount of carb should work fine. In lar (sugar-sweetened, not diet) soda. or basal insulin doses.
some instances, less than the usual The next-best choices include starchy
treatment amount may suffice. foods that break down very easily, Make Pappy happy
such as bread, crackers, and dry None of us is perfect when it comes
4. The impact of A.I.D. We live in cereal. Foods that are high in fiber or to treating lows. I’ve had more than
an age where technology is assisting fat (such as whole fruit or chocolate) my share of middle-of-the-night hypo-
with many aspects of daily diabetes tend to digest slower and are not induced chocolate binges over the
management. Many people with insu- ideal for treating a low. Likewise, years, and some (while working out)
lin-dependent diabetes use automated dairy products like milk, yogurt, and where I delayed treatment or failed to
insulin delivery (A.I.D.) systems that ice cream tend to take a long time to wait long enough for the treatment to
automatically raise or lower insulin raise the blood sugar. And the longer take effect. Instead of a quick recovery
delivery based on glucose level and it takes for the glucose to come up, and return to normal activities, I felt
the direction it is headed. When the the more likely you are to continue lingering adverse effects: continued
glucose is projected to go below a dropping or overtreat. glucose drops, prolonged rebound
target threshold, basal insulin deliv- highs, sugar headaches, sluggishness,
ery is reduced or stopped completely Right on time and enough calories consumed to feed
for a period of time. As a result, any Many people overtreat their lows by a small army. But I’ve learned from
low glucose that occurs will be less continuing to eat until their symp- those events. Hypoglycemia is disrup-
severe than if the system had not toms disappear completely. It usually tive enough. Why prolong the agony?
made any adjustments. takes five to 10 minutes for even the
rapidest-acting carbs to start raising Treat your lows right. That’s one
What this means is that we simply blood glucose levels and 60 to 90 rule that Pappy and I can agree on. DSM
don’t need as much carbohydrate to minutes for them to digest completely.
treat our lows when the A.I.D. system So be patient! It is fine to check your Gary Scheiner, MS, CDCES, is Owner
has reduced basal insulin delivery. blood sugar 15 minutes after treat- and Clinical Director of Integrated
Taking the usual amount of carb ment, but don’t be surprised if it Diabetes Services (integrateddiabetes.
will usually result in a rebound high hasn’t risen all the way to normal. As com), a worldwide practice specializing
within the next hour or two. Consider long as your glucose level has begun in intensive insulin therapy. He is author
reducing the amount of your hypo to rise, you should be fine. If it has not of several books, including “Think Like A
treatment by 25-33% when using an risen at all (or has dropped further), Pancreas: A Practical Guide to Managing
A.I.D. system. then go ahead and treat again. Diabetes With Insulin,” and was named
2014 Diabetes Educator of the Year by
Quality matters If you use a CGM, it is important the Association of Diabetes Care and
Once you know how much carb is to take “lag time” into account. CGMs Education Specialists. Scheiner has lived
needed to deal with a low, the battle is tend to take a long time (sometimes with type 1 diabetes for 36 years. He can
half over. But you still have to choose 30 minutes or more) to show any be reached at gary@integrateddiabetes.
the right type of carbs. All carbs are glucose rise after hypoglycemia has com or (610) 642-6055.
not created equally. Some will raise been treated. In other words, don’t
your blood glucose very quickly, while
Fall 2022 • DiabetesSelfManagement.com 35
Return to School SHUTTERSTOCK
With Success!
Tips for helping your child with type 1 diabetes in the classroom
BY JOANN STEVELOS, MS, MPH
Over the course of the past few years, lockdowns,
hybrid schools, and virtual schools have upended
families’ schedules and the critical routines that help
keep children with type 1 diabetes safe and healthy.
Establishing new school routines or re-establishing
old ones can feel overwhelming. But setting up daily
routines for your child with type 1 diabetes will pre-
vent stress and set the stage for positive interactions
with everyone involved in their care. (Remember,
to stick to routines, children will need positive rein-
forcements, a healthy dose of encouragement, loving
kindness, and celebration!) With the school year
getting under way, here are some strategies that can
help smooth your child’s transition back to school.
Helping your child make healthy food choices
at school
Food is an essential part of school culture and is
often made to be a fun, social, and enjoyable part of
your child’s school day. What your child with type 1
diabetes eats is just one of many things that affect
their blood sugar levels. Balancing their diabetes and
dietary needs with their school’s food culture can be
challenging but also rewarding.
Whether you and your child decide to make lunch,
buy lunch, or a combination of both, getting into the
routine of choosing foods together will help your
child enjoy school and foster a sense of control in
managing their condition.
36 DiabetesSelfManagement.com • Fall 2022
Fall 2022 • DiabetesSelfManagement.com 37
Snack and lunchtime lunch. For example, their box could Packing for a
The best snacks and lunches for a be filled with slices of cheese, whole- Field Trip
child with type 1 diabetes are bal- grain crackers, grape leaves, crunchy
anced with their insulin regimen. carrots with a yogurt dip, sliced ber- Here is a checklist for ensuring all
Whether your child brings their own ries, and sliced apple. One way to the diabetes essentials are covered
snacks and lunch to school or buys positively reinforce and remind your on field trips. Have a school field trip
lunch there, it is vital to allow them child to practice carbohydrate count- bag always packed and ready to go,
to help choose the foods they will eat. ing is to write the number of carbohy- including the following (based on
drates contained in each food on the the types of management devices
In general, packing snacks and box’s lid, along with an encouraging your child is using):
lunches for a child with type 1 dia- message or picture for your child. • Blood glucose meter
betes isn’t much different from • Test strips
packing for a child without dia- If you decide that buying a school • Extra batteries for devices such as
betes because the most important lunch is an option for your child, this glucose meters, CGMs, and insulin
thing is to have a balanced diet. One may help them feel more included pumps
crucial difference for a child with and not different. One way to ensure • Insulin pump infusion sets
type 1 diabetes, though, is that you success is to make a routine of looking • Insulin pump reservoirs
must be mindful of the carbohydrate over the school menu each week with • Bottle of insulin
content of foods because that affects your child and then calculating each • Two insulin syringes
your child’s blood glucose levels. (If meal’s carbohydrate content to deter- • Two ketone test strips
your child uses an insulin pump, it mine the appropriate insulin dose. • Glucose tablets
can be easier to adjust to different
amounts of carbohydrate at meals Coordinating care at school in • Extra insulin (about a two- to
since the pump will have a built-in three-day supply for emergen-
bolus calculator to help determine four steps cies such as hurricanes, earth-
how much insulin to take for meals.) 1. Start the conversation. Ideally, it quakes, lockdowns, etc.).
Help your child select meals that would be possible to set up a meet-
contain a combination of healthy ing including everyone who will be • Extra insulin pen needles,
carbohydrates, fiber, healthy fats, involved in your child’s care, where syringes, or pump infusion sets.
and protein. Planning snack and you can speak with the principal, your
lunch menus together can give your child’s teachers, and the school nurse, • Treatments for low blood glucose.
child a feeling of independence. sharing concerns, hopes, and care • If your child’s management plan
They will be more likely to eat foods protocols. Due to scheduling conflicts,
that help manage their health and it may be challenging to accomplish calls for them, snacks like crack-
this in a single meeting, so you may ers, energy bars, etc.
Safe at School need to schedule several appoint- • A glucagon kit (for rapidly rais-
ments and then send a summary of ing severely low blood glucose),
The Safe at School campaign from your discussions to all involved. the use of which should be
the American Diabetes Association reviewed with school personnel.
(ADA) can help you learn more about 2. Build your team. Suppose your • A brief outline of your child’s
ensuring your child’s needs are met: school staff is not familiar with type 1 insulin regimen and meal plan.
bit.ly/3aFrAR6 diabetes. In that case, you may need • Anything else you can think of
to schedule a time with a pediatrician that would be necessary for the
blood glucose levels if they have to provide a brief presentation on the care of your child by someone
played a role in choosing the items. basics of the condition in school-age else.
children. Use this time to ask your The kit should be replenished from
One tool that can help with plan- child’s school to be a partner in your time to time. Use these occasions as
ning balanced snacks and lunches is child’s care. Discuss the best way to an opportunity to revisit your child’s
Japanese Bento boxes. These com- communicate about your child’s type school plan and check in with your
partmentalized boxes are handy for 1 diabetes and their safety and health child’s school team.
packing lunch for a child with type 1 at school. 4. Learn about 504 Plans. In
diabetes because they allow for many building a partnership with your
combinations of portion-controlled 3. Assemble a school diabetes child’s school, it is essential to under-
and balanced meals and simultane- emergency kit. Having a diabetes stand 504 Plans. These legal written
ously present the food in a fun and emergency kit for your child at school documents help hold your child’s
attractive way. can give you peace of mind in the school accountable for your child’s
event of an emergency. According to health care needs while in school.
Bento boxes also can turn all your JDRF (formerly the Juvenile Diabetes Every child with type 1 diabetes
child’s favorite snacks into a healthy Research Foundation), your child’s
school diabetes emergency kit should,
at minimum, include the following:
38 DiabetesSelfManagement.com • Fall 2022
should have a 504 Plan for the teach- that works for you. Collaborate with T1D and COVID-19: Going back
ers and the school nurse. This type the school as an ally looking out for
of plan falls under Section 504 of the your child’s needs. to school during a pandemic
Rehabilitation Act of 1973, part of the As children get ready to head back
federal civil rights law prohibiting Providing education on type 1 to school in the midst of the ongoing
discrimination against public school symptoms versus behavioral pandemic, some parents may wonder
students with disabilities. A 504 Plan issues if they should send their child back to
outlines how a child’s specific needs Help your child, their teachers, and school in person or, if it is an option,
are to be met with accommodations, school staff understand that low blood choose remote learning.
modifications, and other services. sugar in a child with type 1 diabetes
These measures “remove barriers” to can come on quickly and needs to be Here are some things to consider
learning. Scheduling time with your treated right away. Ask your child’s when deciding:
child’s teacher and the school nurse to teacher and school nurse to help your
review the 504 Plan can prevent mis- child remember to monitor their blood Local situation. Check in with
haps. According to JDRF, the 504 Plan glucose levels before lunch and before your local public health department
should address the specific needs of recess to ensure they are eating enough about the infection rates in your
the child and provide detailed instruc- and not overdoing it during recess region and then weigh the risk of
tions related to the following: and physical education classes. Differ- your child attending school. Does
ent children experience different low your child’s school have COVID-19
• Outlining times and places blood glucose symptoms, so school staff prevention measures in place?
for blood glucose monitoring, should be familiar with your child’s
including accommodations for specific symptoms. Sometimes type 1 Risk. Type 1 diabetes is an autoim-
both monitoring and treating. diabetes symptoms may be misinter- mune condition and not an immuno-
preted as behavioral issues. Low blood compromised condition (the latter of
• Ensuring that staff members glucose symptoms could include: which increases the risk of COVID-
are trained in checking blood 19). According to current research,
glucose levels, recognizing and • Shakiness children with well-controlled type
treating high and low blood glu- • Nervousness or anxiety 1 diabetes face the same chance of
cose symptoms, and administer- • Sweating, chills, or clamminess getting COVID-19 as children without
ing both insulin and glucagon. • Irritability or impatience type 1 diabetes.
• Dizziness and difficulty concen-
• Allowing the student to eat Personal risk assessment.
whenever and wherever neces- trating Are all family members trying to
sary, including eating lunch at • Hunger or nausea minimize possible exposure to
an appropriate time and allow- • Blurred vision COVID-19 with measures such as
ing enough time to finish eating. • Weakness or fatigue physical distancing, hand hygiene,
• Anger, stubbornness, or sadness and wearing masks?
• Allowing extra trips to the bath-
room or water fountain. The best time to discuss your School protocols. Does the school
child’s type 1 diabetes with their have a vaccination policy for all chil-
• Ensuring the student’s full par- teacher and school nurse is before the dren and staff eligible for the COVID-
ticipation in all sports, extracur- school year begins. Ask your child’s 19 vaccine and boosters?
ricular activities, and field trips, teacher and school nurse for sched-
with the necessary care and/or uled calls or emails about your child’s Back to school, one day at a time
supervision. school routine. This will help ensure Helping your child with type 1 dia-
your child’s type 1 diabetes is being betes navigate the changing school
• Permitting extra absences for managed well in school (and be sure environment is not for the faint of
medical appointments and sick to offer more support to your child at heart. It’s challenging, demanding,
days when necessary, without home, if needed). and downright tricky at times, but
penalty. creating a routine will help you man-
age different tasks. Most importantly,
• Outlining the parent’s role in the routines will help your child with
504 process. type 1 diabetes be more thoughtful,
You and your child deserve a plan confident, and responsible while at
school. Remember, take it one day at
Learn More About 504 Plans a time, be flexible, be kind to yourself,
and encourage your child to ask for
These resources provide more information about crafting a 504 Plan for your child: help when needed. DSM
American Diabetes Association Sample Section 504 Plan JoAnn Stevelos, MS, MPH, is a public
bit.ly/3mzQoww health researcher and evaluator
who specializes in childhood obesity
Understood: What Is a 504 Plan? prevention.
u.org/3NF0dVX
Fall 2022 • DiabetesSelfManagement.com 39
SHUTTERSTOCK
40 DiabetesSelfManagement.com • Fall 2022
Snore
No
More
Sleep apnea is a common condition,
but treatments are available
BY ROBERT S. DINSMOOR
Snoring can be more than just an inconve-
nience for you or whoever is sharing your
bed. It can be a sign of sleep apnea—shallow
breathing or pauses in breathing during sleep.
Sleep apnea can cause excessive sleepiness
during the day, difficulty concentrating or stay-
ing alert, and irritability. It can also be directly
hazardous to your health, raising your blood
pressure and making your diabetes more dif-
ficult to control, among other potential issues.
Here’s how to find out whether you have it and
what you can do about it.
Fall 2022 • DiabetesSelfManagement.com 41
Causes and risk factors the risk of other disorders. One of
There are two basic types of sleep the biggest concerns, especially for
apnea: obstructive sleep apnea (OSA) people with diabetes, is an increased
and central sleep apnea (CSA). By far risk of heart disease and heart failure.
the most common type of sleep apnea When sleep apnea causes the level
is obstructive sleep apnea, in which of oxygen in the blood to drop, this
the airway collapses or becomes can trigger the body’s “fight-or-flight”
blocked during sleep. Central sleep response, increasing the heart rate
apnea, which affects fewer than 10% and blood pressure. These responses
of people referred to sleep clinics, can increase the risk of atherosclero-
occurs when, for whatever reason, sis, the buildup of plaque on the walls
the area of the brain that controls of blood vessels. Atherosclerosis sets
breathing during sleep fails to send the stage for heart attack and stroke.
the right signals to the muscles In people with diabetes, sleep apnea
involved in breathing. can also increase blood glucose levels.
There are many risk factors
for developing sleep apnea. Being
male, over the age
of 40, or obese
Getting the Most can increase Certain
Out of CPAP your risk of
the condi-
While CPAP is a proven treatment for
sleep apnea, its effectiveness is limited tion. Other habits can
when it isn’t used correctly—or isn’t things that
used at all. The Mayo Clinic offers a may pre-
number of suggestions about possible
problems with CPAP and ways to get dispose
around them.
people to increase
Masks come in all shapes, sizes, sleep apnea
and designs. For example, some are having a
masks cover both the nose and the
mouth. These are more effective for large neck circum- the risk
people who prefer to breathe through ference, an enlarged
their mouth during sleep, but some tongue or tonsils, a nar-
people feel “claustrophobic.” Other
masks deliver air just through the nose row upper jaw, or an of sleep
and cover less of the face. Work with undersized or reced-
your doctor and your mask supplier ing lower jaw or chin.
to ensure that you have the style best
suited to you and a properly fitting People with allergies, apnea.
mask. nasal congestion, or
gastroesophageal reflux
CPAP definitely takes getting used
to. The Mayo Clinic suggests that you disease (GERD, the most
first wear just the CPAP mask for short
periods of time while you’re awake. common symptom of
Then try the mask with it hooked up to
the machine while it runs. Eventually, which is heartburn) are also
you can try sleeping with the mask in
place and the machine running. at increased risk.
Some people experience a dry, Certain habits can increase the
stuffy nose with CPAP. Fortunately,
some CPAP units come with a heated risk of sleep apnea. Drinking alcohol Diagnosis
humidifier, and applying a saline solu-
tion to the nose at bedtime may also can relax the muscles in the mouth If you think you might have sleep
help.
and throat, narrowing the upper air- apnea, see your doctor. They may ask
SOURCE: MAYO CLINIC
way and leading to obstructive sleep you about your symptoms, possible
42 DiabetesSelfManagement.com • Fall 2022
apnea. It can also depress the activity risk factors, and any family history of
of the muscles used for breathing. sleep apnea or other sleep disorders.
Smoking can promote inflammation During the physical examination, the
in the upper airway, and it, too, can doctor will search for signs of physical
affect the muscles that control breath- conditions that may increase the risk
ing. Poor diet, especially in combina- for sleep apnea, such as obesity, large
tion with inactivity, can cause weight tonsils, narrowing of the upper air-
gain and thus promote obstructive way, a large neck, or a large tongue.
sleep apnea. In some cases, the doctor may refer SHUTTERSTOCK
Sleep apnea may, in turn, increase you to a sleep center or sleep special-
SHUTTERSTOCK ist. A sleep study may be performed while traveling. CPAP takes patience mg/dL
at home or at a special sleep center. (see “Getting the Most Out of CPAP”
It can uncover disorders that aren’t on the facing page), and your doc- Can CPAP Lower
otherwise apparent, such as pauses tor should work with you to find a Blood Glucose
or slowdowns in breathing, high or comfortable-fitting mask, the type of Levels?
low activity in the muscles that con- CPAP apparatus you should use, and,
trol breathing, low oxygen levels in if necessary, a humidifier chamber. We know that sleep apnea can raise
the blood during sleep, and unusual blood glucose levels in people with
brain or heart activity during sleep. Some people immediately notice diabetes. Is the converse true—in
improvements from CPAP, such as other words, can successfully treat-
Treatment better sleep quality, less snoring, and ing sleep apnea with CPAP lower blood
As with most disorders, doctors gen- less sleepiness in the daytime. In glucose levels? Preliminary evidence
erally begin treating sleep apnea with addition, CPAP treatment can help suggests that it can. Probably the most
the gentlest, least-invasive measures lower blood pressure, lower the risk compelling evidence comes from a
first. The first line of therapy is life- of stroke, improve cognitive function, study reported in the journal Diabetes,
style changes, such as eating a healthy and possibly reduce blood glucose Obesity, and Metabolism in 2020. The
diet and limiting alcohol intake, espe- levels (see “Can CPAP Lower Blood researchers pooled and analyzed the
cially right before bedtime. Stopping Glucose Levels?”). If you experience data from seven previous clinical tri-
smoking can also lower the risk of side effects such as congestion, runny als, which randomly assigned a total
sleep apnea, as well as a host of other nose, dry mouth, or nosebleeds, speak of 691 people with sleep apnea and
conditions, including heart disease. with your doctor about ways you can type 2 diabetes to CPAP, sham CPAP
For people who have overweight or reduce them or adjust to them. (using a machine that didn’t actu-
obesity, losing weight can help allevi- ally aid breathing), or no treatment
Another option is oral appliances, at all. (Randomized studies, in which
ate sleep apnea. which serve to keep the airways open participants are randomly assigned
Regular aerobic exercise while you’re asleep. One type of appli- to different treatment groups without
can also help. The U.S. ance is a mandibular advancement knowing what group they’re in, are
Department of Health and or mandibular repositioning device, considered the most reliable studies
Human Services (HHS) which is typically molded to the teeth of the effectiveness of various forms
recommends getting and holds the lower jaw forward to of treatment.) The researchers found
at least 150 minutes of help keep the upper airway open. that, compared with either sham CPAP
moderate aerobic activity Another type of appliance, a tongue- treatment or no treatment at all, CPAP
every week (plus two days stabilizing device, holds the tongue lowered the participants’hemoglobin
of “muscle-strengthening forward to prevent it from blocking A1C levels (a measure of long-term
the upper airway. blood glucose control) by an average
activity”), which might take of 0.32%.
the form of, say, walking for 30 Some cases of sleep apnea may not
minutes five times a week. Aerobic respond well to CPAP, such as those Fall 2022 • DiabetesSelfManagement.com 43
exercise directly helps the lungs, caused by a visible obstruction of the
decreases stress, lowers blood pres- upper airway, like large tonsils. These
sure, lowers the risk of heart disease, may require surgery. Types of surgery
and even lowers the risk of type include tonsillectomy (the removal of
2 diabetes. In addition to directly the tonsils), bimaxillary advancement
reducing sleep apnea, exercise also or double-jaw surgery (surgery to
helps manage weight. move the upper jaw and lower jaw
Your doctor may also prescribe forward to enlarge the upper airway),
some type of breathing device. One and tracheotomy (surgery to create
of the most commonly used devices a hole in the windpipe and insert a
is a CPAP (continuous positive airway breathing tube, or “trach tube,” to
pressure) machine. CPAP treatment help the patient breathe).
basically involves wearing a mask
strapped over your nose or both your Taking the first step
nose and mouth. The mask is con- There is a range of treatments for
nected via a tube to the machine, sleep apnea. The first step to better
which forces air through the tube health is getting it diagnosed.
to keep your airways open. For the
treatment to work, patients must use Robert S. Dinsmoor is an award-
the CPAP machine every time they winning medical journalist who has
sleep or nap, whether at home or written hundreds of articles on health
and medicine.
••• AT THE TABLE •••
‘FALL’ INTO BY LORENA DRAGO, MS,
RDN, CDN, CDCES
Healthy
Habits F eeling a pep in your
step with the arrival of
crisp autumn air and colorful
leaves? Why not take the
opportunity to“fall”into some
healthier dietary habits! This
collection makes use of all
the quintessential flavors the
season’s bounty has to offer,
featuring pumpkin, apple,
corn, cranberry, squash,
and Brussels sprouts. These
recipes are a-maize-ing!
OUR RECIPES 30 minutes or less. Others require short V FI HIGH-FIBER RECIPE W LC LOW-CARB RECIPE SHUTTERSTOCK
preparation times followed by long 5g or more of fiber per serving 15g or less of carbs per serving
Like everyone, you’re busy— cooking times. We’ve also included
and we keep that in mind symbols to help you more easily find W LF LOW-FAT RECIPE W LS LOW-SODIUM RECIPE
when we select recipes. Many those recipes especially high in fiber, 3g or less of fat per serving 140mg or less of sodium per serving
of them can be prepared in low in fat, carbohydrates, and sodium.
44 DiabetesSelfManagement.com • Fall 2022
••• AT THE TABLE ••• Pumpkin Yums
Pumpkin Spice Muffins
12 MUFFINS | 1 MUFFIN
CAL 191 | FAT 6G | SAT FAT 1G | PROTEIN 5G | CARBS 29G | CHOL 1MG | FIBER 3G | SODIUM 417MG
DIETARY EXCHANGE: 2 BREAD/STARCH, 1 FAT
12 pleated paper muffin cups or lightly coat with nonstick cooking spray. cups ¾ full. (Dipping the cup or scoop
nonstick cooking spray (Muffin cups should be 3 inches across in water between scoops helps the bat-
at top and contain ¼ cup of batter ter release easier onto the muffin pan.)
3¾ cups Better Baking Mix (recipe when filled ¾ full.) Bake 10 to 15 minutes, rotating pan
on page 50) once during baking, or until muffins
2. Combine baking mix, sugar, and are golden on tops and bottoms and
¼ cup sugar spice mix in large mixing bowl with toothpick inserted in centers comes out
1 teaspoon pumpkin pie spice mix wire whisk. Cut in margarine, butter clean. Remove from oven. Transfer muf-
blend, or oil with pastry knife or two fins to wire rack to cool.
or cinnamon knives until mixture resembles coarse
¼ cup trans-fat-free margarine, meal. Make a well in center of mixture *Note: Butter and canola oil blends are
and add milk and pumpkin. Gently and available in the refrigerated dairy sec-
butter and canola oil blend,* lightly stir together just until moist- tion of your supermarket. You can easily
or canola oil ened. Do not overmix. Gently fold in make your own by combining equal
1¼ cups cold fat-free milk, low-fat walnuts with rubber spatula. parts room-temperature butter and
buttermilk, or soy milk canola oil in the bowl of a food proces-
½ cup pumpkin purée 3. Using ¼-cup measure or 2-inch ice sor. Pack the mixture into a plastic tub
¼ cup chopped walnuts cream scoop, fill prepared muffin pan with a lid and refrigerate.
1. Preheat oven to 400°F. Prepare
muffin pan with paper muffin cups or
Get more delicious diabetes-friendly recipes at
DiabetesSelfManagement.com/recipes
Fall 2022 • DiabetesSelfManagement.com 45
••• AT THE TABLE ••• Pumpkin Yums
TIP Don’t throw out Fresh
the pumpkin seeds! Pumpkin
or Squash
They have protein, fiber, iron, Purée
copper, magnesium, and 3-4 CUPS OF PURÉE (FOR
RECIPES) | 1 CUP
other minerals. They also
V FI | W LF | W LS
contain healthy fats. You can
CAL 101 | FAT 1G | SAT FAT
toast your own seeds and add 0G | PROTEIN 2G | CARBS
21G | CHOL 0MG | FIBER
them to yogurt and cereals. 7G | SODIUM 5MG
Pumpkin Spice Mug Cake DIETARY EXCHANGE: 1½
STARCH; CARBOHYDRATE
1 SERVING | 1 MUG CAKE CHOICES: 1½
W LF Small pumpkin or
medium squash
CAL 146 | FAT 2G | SAT FAT NA | PROTEIN 3G | CARBS 31G | CHOL 0MG | FIBER 1G | (butternut, acorn, or
SODIUM 284MG Hubbard), 4-6 pounds
DIETARY EXCHANGE: 2 BREAD/STARCH
1. Preheat oven to 350°F.
¼ cup angel food cake mix pecans, and pumpkin pie spice in large Carefully cut off the stem
3 tablespoons water ceramic* microwavable mug. and a few inches of the
2 teaspoons canned solid-pack top of the pumpkin or
2. Microwave on high 2 minutes. Let squash with a sharp
pumpkin stand 1 to 2 minutes before serving. knife. Cut into halves.
1 teaspoon finely chopped pecans Remove stringy flesh and
¼ teaspoon pumpkin pie spice *Note: This cake will only work in a seeds, then cut again into
ceramic mug, as the material allows for quarters.
1. Combine cake mix, water, pumpkin, more even cooking than glass.
2. Bake 50 to 60 minutes
until soft. Allow to cool,
then scoop the flesh
from the skin into a food
processor and purée until
smooth. For a smoother
consistency, push the
purée through a strainer.
3. Freeze any unused pu-
rée in a freezer-approved
plastic container, marking
the container with the
amount it contains. Purée
can be stored for up to six
months. Try substituting
up to a cup of purée for
shortening in recipes for
baked goods.
TIP Squash can be
difficult to cut. If
you use squash frequently,
consider buying a designated
small hand saw to help you
cut through the thick skin.
Label this saw so that it does SHUTTERSTOCK
not get used for materials
other than food.
46 DiabetesSelfManagement.com • Fall 2022
Savory Pumpkin Hummus
1½ CUPS (ABOUT 12 SERVINGS) | 2 TABLESPOONS
W LF | W LC | W LS
CAL 38 | FAT 2G | SAT FAT 0G | PROTEIN 1G | CARBS 4G | CHOL 0MG
| FIBER 1G | SODIUM 101MG
DIETARY EXCHANGE: ½ FAT, 1 VEGETABLE
1 can (15 ounces) solid-pack pumpkin
3 tablespoons chopped fresh parsley, plus additional for
garnish
3 tablespoons tahini
3 tablespoons fresh lemon juice
3 cloves garlic
1 teaspoon ground cumin
½ teaspoon salt
1⁄8 teaspoon black pepper
1⁄8 teaspoon ground red pepper, plus additional for garnish
Assorted vegetable sticks
1. Combine pumpkin, 3 tablespoons parsley, tahini, lemon juice,
garlic, cumin, salt, black pepper, and 1⁄8 teaspoon ground red pep-
per in food processor or blender; process until smooth. Cover and
refrigerate at least 2 hours to allow flavors to develop.
2. Sprinkle with additional ground red pepper, if desired. Garnish
with additional parsley. Serve with assorted vegetable sticks.
TIP Ready for some fun trivia? Did you know that, botanically, pumpkin is
a fruit, not a vegetable? The bright orange color in pumpkin is a telltale
sign that it is rich in beta-carotene, an antioxidant that is converted into vitamin
A. Vitamin A helps to preserve vision, maintain healthy bones and skin, prevent
infections, and regulate cell growth. One cup of pumpkin is low in calories and
carbohydrate, and it is also an excellent source of potassium, which helps maintain
normal blood pressure.
V FI HIGH-FIBER | W LF LOW-FAT | W LC LOW-CARBOHYDRATE | W LS LOW-SODIUM Get more delicious diabetes-friendly recipes at
DiabetesSelfManagement.com/recipes
Fall 2022 • DiabetesSelfManagement.com 47
••• AT THE TABLE ••• Pumpkin Yums
Wholesome
Chocolate-Chip
Pumpkin Bars
24 SERVINGS | 1 SQUARE
W LC
CAL 110 | FAT 4G | SAT FAT 1G | PROTEIN
3G | CARBS 15G | CHOL 20MG | FIBER 2G |
SODIUM 170MG
DIETARY EXCHANGE: 1 BREAD/STARCH,
½ FAT
Nonstick baking spray
1 cup white whole-wheat flour
1 cup all-purpose flour
¾ cup sugar substitute*
1½ teaspoons baking powder
1 teaspoon baking soda
1½ teaspoons ground cinnamon
½ teaspoon ground nutmeg
½ teaspoon ground ginger
1 can (15 ounces) solid packed
pumpkin
2 large eggs
¼ cup canola oil
1 container (2½ ounces) puréed
baby food prunes
2 tablespoons molasses
2 tablespoons packed brown sugar
4 ounces reduced-fat cream cheese
4 ounces nonfat cream cheese
2 tablespoons sugar substitute*
½ cup reduced-fat whipped topping
6 tablespoons mini chocolate chips
1. Preheat oven to 350°F. Coat 13x9-inch
pan with nonstick baking spray.
2. In medium bowl, mix together flours,
¾ cup sugar substitute, baking powder,
baking soda, and spices.
3. In large bowl stir together pumpkin,
eggs, oil, prune purée, molasses, and
brown sugar. Mix in flour mixture and
stir just until combined.
4. Spoon into pan, smooth, and bake 20
to 25 minutes, or until toothpick inserted
in center comes out clean. Cool on rack.
5. In small bowl, beat together cream
cheeses and 2 tablespoons sugar substi-
tute. Beat in whipped topping. Spread
frosting onto cooled cake and top with
chocolate chips. Cut into 24 squares.
*Note: This recipe was tested using
sucralose-based sugar substitute.
48 DiabetesSelfManagement.com • Fall 2022
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