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1 Beck, RW, et al. JAMA. 2017;317(4):371-378. 2 Welsh, JB et al. Diabetes Technol Ther. 2019;21(3).
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••• NOVEMBER/DECEMBER 2020 •••
Features Healthy Holiday
Feasting
28 S. Epatha Merkerson
on Living With and 30 Keto Baked Desserts
Learning About Satisfy your cravings with
Diabetes these lower-carb treats.
The lauded actress narrates
Blood Sugar Rising, a new 54 Festive Picks for
PBS documentary about Your Holiday Feast
the disease.
At The Table
32 Tips for Navigating
the Holidays 68 A Toast to the
Holidays
36 Welcoming Old Gather your ingredients
Man Winter and enjoy the festivities!
Tips to keep the cold
weather from freezing your The Dose
diabetes management
efforts. 7 News & Notes
8 Quiz
40 Top Diabetes 14 Product Spotlight
Reads of 2020 16 Ask Away
18 Curmudgeonly Athlete
44 Making the Most
of Your Diabetes Healthy Living
Telehealth Visit
20 The Right Moves
48 Quality of Sleep 22 Weighty Matters
A vital tool for diabetes 24 Smart Smarter Smartest
self-management. 26 Food for Thought
52 Going Bananas In Every Issue
How these fruits fit into
a diabetes meal plan. 2 Editor’s Note
95 Recipe Index
96 Final Countdown
On the cover: Franklin’s Favorite
Apple Pie. For a list of all recipes in
this issue, see page 95.
SHUTTERSTOCK
November/December 2020 • DiabetesSelfManagement.com 1
••• EDITOR’S NOTE •••
Editorial Director,Wellness Division Food Editor
Diane Fennell Lorena Drago, MS, RDN, CDN, CDCES
ART & PRODUCTION
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Scott Brandsgaard
SALES & MARKETING
Senior Media Solutions Manager Marketing Director
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[email protected] (855) 367-4813
EDITORIAL BOARD
Dear Readers, Pamela Allweiss, MD, MPH Jeanne L. Rosenthal, MD
CDC Division of DiabetesTranslation Attending Surgeon, Retinal Service,
T he holidays are here! Although the celebrations NewYork Eye and Ear Infirmary, NewYork, NewYork
are likely to look different for many of us this year, Amy P. Campbell, MS, RD, LDN, CDCES
maintaining our health and sanity amid the festivities Boston, Massachusetts Gary Scheiner, MS, CDCES
is now more important than ever. If you’re feeling Owner and Clinical Director, Integrated Diabetes Services,
stressed and overwhelmed by endless to-dos, take Robert S. Dinsmoor
a deep breath to get grounded, then turn to page 32 South Hamilton, Massachusetts Wynnewood, Pennsylvania
for strategies that can boost your mood and help you
successfully navigate this time of year and enjoy the David E. Goldstein, MD Sheri Setser-Legg, MS, RD, LD, MLDE, CDCES
wonder of the season. Professor Emeritus, University of Missouri Diabetes Education Service Coordinator
Health Science Center, Columbia, Missouri
If you find dealing with the temptations of holiday UK HealthCare Barnstable Brown Diabetes Center,
desserts is a particularly tricky area, have we got a Laura Hieronymus, University of Kentucky, Lexington, Kentucky
(low-carb) treat for you! In “Keto Baked Desserts” DNP, MSEd, MLDE, BC-ADM, CDCES, FADCES
(page 30), you’ll find some of our favorite lower-carb Associate Director, Education & Quality Services, Bernard P. Shagan, MD
indulgences, including chewy Keto Chocolate Chip UK HealthCare, Barnstable Brown Diabetes Center, Director, Diabetes Education Center,
Cookies and decadent Keto Mug Cake. Keto not your Monmouth Medical Center, Long Branch, New Jersey
style? Indulge your taste buds with the more than 40 University of Kentucky, Lexington, Kentucky
recipes found in “A Toast to the Holidays” (page 68) Richard M. Weil, MEd, CDCES
and “Festive Picks for Your Holiday Feast” (page 54). Jeff Plumer, Vice Chair JDRF International Exercise Physiologist and Director, Mount Sinai St. Luke’s
Board of Directors Weight Loss Program, Mount Sinai St. Luke’s Hospital,
November doesn’t just usher in the holidays—it’s
also the annual observance of National Diabetes William H. Polonsky, PhD, CDCES NewYork, NewYork
Month and, on Nov. 14, World Diabetes Day. There Assistant Clinical Professor,
are multiple ways you can mark these occasions, Department of Psychiatry, Susan Weiner, MS, RDN, CDCES, CDN, FADCES
from knocking something off your diabetes to-do Owner, SusanWeiner Nutrition, PLLC, Long Island, NewYork
list to committing to adopt a healthy new habit for University of California, San Diego
one month to educating friends and family about the Stephen Z. Wolner, DDS
condition. (Visit bit.ly/ObserveDiabetesMonth for more NewYork, NewYork
ideas.) Learn how S. Epatha Merkerson is spreading
awareness of diabetes this month, and all year long, in In Memoriam Dr. Lois Jovanovic, 1947-2018
our chat with this former Law & Order star (page 28).
*Please note: The Certified Diabetes Educator (CDE) credential has transitioned to Certified Diabetes Care and Education
Wishing you a healthy and joyous holiday season! Specialist (CDCES).
All the best,
VP, Circulation Strategy O P E R AT I O N S Accounting Director
Diane Fennell Jason Pomerantz Amanda Joyce
Editorial Director, Wellness Division Senior Client Services & Operations Lead
Operations Director Andrea Palli Accounts Payable Associate
2 DiabetesSelfManagement.com • November/December 2020 Cheyenne Corliss Tina McDermott
Operations & Human Resources Coordinator
Toni Eunice Accounts Receivable Associate
Wayne Tuggle
Client Services
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Audience Development Analyst DIGITAL OPERATIONS WordPress Developer
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Chairman & CEO Chief Operating Officer SVP, Sales & Strategic Partnerships Content Director
Jeffrey C. Wolk Courtney Whitaker Stuart Crystal Matt Martinelli
In memory of Susan Fitzgerald, COO, 1966-2018
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••• DiabetesSelfManagement.com ••• FREE PROGRAM
HOLIDAYS, ALCOHOL AND DIABETES
Do the Three Mix? Boot
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RECIPE
10 Ways to Observe National Diabetes Self-Care in a Time Easy-As-Pie Holiday Soup
Diabetes Month of Uncertainty Think making soup is complicated?
Think again. This cozy, low-carb
November is National Diabetes During times of crisis, your day-to- holiday soup stars apples and winter
Month, and it’s a great time to day schedule and routine can get squash and rises to another level
evaluate your management. Here disrupted. If you’ve been thrown off with the addition of pumpkin pie
are some suggestions for making a bit, here are some suggestions for spice. For added flavor, include the
the most of a month devoted helping you get back on track. bit.ly/ optional garlic and ginger or mild
to diabetes awareness. bit.ly/ CovidDiabetesCare curry powder. bit.ly/EasyAsPieSoup
ObserveDiabetesMonth
INTERACT WITH US Get more news, tools and recipes all month long! NEWSLETTER
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diabetes news, research, recipes, weight
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4 DiabetesSelfManagement.com • November/December 2020
For adults with type 2 diabetes (T2D), along with diet and exercise, once-daily RYBELSUS® can help lower blood sugar
Wake Up to the Possibilities of Reaching Your A1C Goal
RYBELSUS® is proven to lower RYBELSUS® may help you RYBELSUS® does not increase
blood sugar and A1C lose some weight the risk of major cardiovascular
(CV) events such as heart attack,
In a 6-month study of people with an average While not for weight loss, in the same 6-month
starting A1C of 8%, the majority of people study, people with an average starting weight stroke, or deathb
taking RYBELSUS® reached an A1C of of 195 pounds lost up to 8 poundsa:
less than 7%a: aIn a 6-month study looking at A1C with 703 adults with T2D
• 5 pounds on 7 mg of RYBELSUS® comparing 7 mg RYBELSUS® and 14 mg RYBELSUS® with a
• Nearly 7 out of 10 people on 7 mg of RYBELSUS® • 8 pounds on 14 mg of RYBELSUS® sugar pill when both were added to diet and exercise.
• Nearly 8 out of 10 people on 14 mg of RYBELSUS® • 3 pounds on a sugar pill bIn a cardiovascular safety study, 3183 adults with T2D and
• About 3 out of 10 people on a sugar pill a high risk of CV events were treated with either 14 mg
While many people in medical studies lost weight, some RYBELSUS® or a sugar pill in addition to their usual diabetes
did gain weight. and CV medications.
If eligible, you may pay as little Textd RESULTS to 44535
as $10 for a 30-day prescriptionc to learn more about RYBELSUS®
What is Rybelsus®? Before using Rybelsus®, tell your healthcare cause low blood sugar, such as a sulfonylurea or
provider if you have any other medical insulin. Signs and symptoms of low blood
Rybelsus® (semaglutide) tablets 7 mg or 14 mg conditions, including if you: sugar may include: dizziness or lightheadedness,
is a prescription medicine for adults with type 2 blurred vision, anxiety, irritability or mood changes,
diabetes that along with diet and exercise may • have or have had problems with your pancreas or sweating, slurred speech, hunger, confusion or
improve blood sugar (glucose). kidneys drowsiness, shakiness, weakness, headache, fast
heartbeat, and feeling jittery
• Rybelsus® is not recommended as the first choice of • have a history of vision problems related to your
medicine for treating diabetes diabetes • kidney problems (kidney failure). In people
who have kidney problems, diarrhea, nausea, and
• It is not known if Rybelsus® can be used in people • are pregnant or plan to become pregnant. It is vomiting may cause a loss of fluids (dehydration),
who have had pancreatitis not known if Rybelsus® will harm your unborn which may cause kidney problems to get worse. It
baby. You should stop using Rybelsus® 2 months is important for you to drink fluids to help reduce
• Rybelsus® is not for use in people with type 1 before you plan to become pregnant. Talk to your your chance of dehydration
diabetes and people with diabetic ketoacidosis healthcare provider about the best way to control
your blood sugar if you plan to become pregnant • serious allergic reactions. Stop using Rybelsus®
• It is not known if Rybelsus® is safe and effective for or while you are pregnant and get medical help right away, if you have any
use in children under 18 years of age symptoms of a serious allergic reaction including
• are breastfeeding or plan to breastfeed. itching, rash, or difficulty breathing
Important Safety Information Breastfeeding is not recommended during
treatment with Rybelsus® The most common side effects of Rybelsus® may
What is the most important information I include nausea, stomach (abdominal) pain, diarrhea,
should know about Rybelsus®? Tell your healthcare provider about all the decreased appetite, vomiting, and constipation.
Rybelsus® may cause serious side effects, medicines you take, including prescription and Nausea, vomiting, and diarrhea are most common
including: over-the-counter medicines, vitamins, and herbal when you first start Rybelsus®.
supplements. Rybelsus® may affect the way some
• Possible thyroid tumors, including cancer. medicines work and some medicines may affect the Please see Brief Summary of Prescribing
Tell your healthcare provider if you get a lump way Rybelsus® works. Information on adjacent page.
or swelling in your neck, hoarseness, trouble
swallowing, or shortness of breath. These may be What are the possible side effects of Rybelsus®? cCommercially insured patients only. Offer valid for up to
symptoms of thyroid cancer. In studies with rodents, six 30-day fills. Eligibility and other restrictions apply.
Rybelsus® and medicines that work like Rybelsus® Rybelsus® may cause serious side effects, dMessage and data rates may apply. Check with your mobile
caused thyroid tumors, including thyroid cancer. It including: service provider. Message frequency will be based on your
is not known if Rybelsus® will cause thyroid tumors • inflammation of your pancreas (pancreatitis). selections. Text HELP to 44535 for help. Text STOP to 44535 to
or a type of thyroid cancer called medullary thyroid quit. See Terms and Conditions of Use at RYBELSUS.com.
carcinoma (MTC) in people Stop using Rybelsus® and call your healthcare
provider right away if you have severe pain in your See cost and savings info at
Do not use Rybelsus® if: stomach area (abdomen) that will not go away, RYBELSUS.com, and ask your healthcare
with or without vomiting. You may feel the pain
• you or any of your family have ever had MTC, or from your abdomen to your back provider about RYBELSUS® today.
if you have an endocrine system condition called
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• you are allergic to semaglutide or any of the
ingredients in Rybelsus® • low blood sugar (hypoglycemia). Your risk
for getting low blood sugar may be higher if you
use Rybelsus® with another medicine that can
RYBELSUS® is a registered trademark of Novo Nordisk A/S.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
© 2020 Novo Nordisk All rights reserved. US20RYB00495 September 2020
Brief Summary of information about RYBELSUS® (semaglutide) tablets How should I take RYBELSUS®?
• Take RYBELSUS® exactly as your healthcare provider tells you to.
Rx Only
This information is not comprehensive. • Take RYBELSUS® by mouth on an empty stomach when you first wake up.
• Talk to your healthcare provider or pharmacist
• Visit www.novo-pi.com/rybelsus.pdf to obtain the FDA-approved product labeling • Take RYBELSUS® with a sip of water (no more than 4 ounces).
• Call 1-833-GLP-PILL
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of talking to your healthcare provider about your medical condition or your treatment. RYBELSUS® works best if you eat 30 to 60 minutes after taking RYBELSUS®.
What is the most important information I should know about • If you miss a dose of RYBELSUS®, skip the missed dose and go back to your
RYBELSUS®? regular schedule.
RYBELSUS® may cause serious side effects, including:
• Possible thyroid tumors, including cancer. Tell your healthcare provider • Talk to your healthcare provider about how to prevent, recognize and manage low
blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and problems
if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or you have because of your diabetes.
shortness of breath. These may be symptoms of thyroid cancer. In studies with
rodents, RYBELSUS® and medicines that work like RYBELSUS® caused thyroid What are the possible side effects of RYBELSUS®?
tumors, including thyroid cancer. It is not known if RYBELSUS® will cause thyroid
tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in RYBELSUS® may cause serious side effects, including:
people.
• See “What is the most important information I should know about
• Do not use RYBELSUS® if you or any of your family have ever had a type of RYBELSUS®?”
thyroid cancer called medullary thyroid carcinoma (MTC), or if you have an
endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 • inflammation of your pancreas (pancreatitis). Stop using RYBELSUS®
(MEN 2). and call your healthcare provider right away if you have severe pain in your
stomach area (abdomen) that will not go away, with or without vomiting.
What is RYBELSUS®? You may feel the pain from your abdomen to your back.
RYBELSUS® is a prescription medicine used along with diet and exercise to improve
blood sugar (glucose) in adults with type 2 diabetes. • changes in vision. Tell your healthcare provider if you have changes in vision
• RYBELSUS® is not recommended as the first choice of medicine for treating during treatment with RYBELSUS®.
diabetes. • low blood sugar (hypoglycemia). Your risk for getting low blood sugar may
be higher if you use RYBELSUS® with another medicine that can cause low blood
• It is not known if RYBELSUS® can be used in people who have had pancreatitis. sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood
sugar may include:
• RYBELSUS® is not for use in patients with type 1 diabetes and people with
diabetic ketoacidosis. • dizziness or light-headedness • blurred vision
It is not known if RYBELSUS® is safe and effective for use in children under 18 years • anxiety, irritability, or mood changes • sweating
of age.
• slurred speech • hunger • confusion or drowsiness
Do not use RYBELSUS® if:
• you or any of your family have ever had a type of thyroid cancer called medullary • shakiness • weakness • headache
thyroid carcinoma (MTC) or if you have an endocrine system condition called • fast heartbeat • feeling jittery
Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• kidney problems (kidney failure). In people who have kidney problems,
• you are allergic to semaglutide or any of the ingredients in RYBELSUS®. diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which
may cause kidney problems to get worse. It is important for you to drink fluids to
Before using RYBELSUS®, tell your healthcare provider if you have any help reduce your chance of dehydration.
other medical conditions, including if you:
• have or have had problems with your pancreas or kidneys. • serious allergic reactions. Stop using RYBELSUS® and get medical help
right away, if you have any symptoms of a serious allergic reaction including
• have a history of vision problems related to your diabetes. itching, rash, or difficulty breathing.
• are pregnant or plan to become pregnant. It is not known if RYBELSUS® will The most common side effects of RYBELSUS® may include nausea,
harm your unborn baby. You should stop using RYBELSUS® 2 months before stomach (abdominal) pain, diarrhea, decreased appetite, vomiting and constipation.
you plan to become pregnant. Talk to your healthcare provider about the best Nausea, vomiting and diarrhea are most common when you first start RYBELSUS®.
way to control your blood sugar if you plan to become pregnant or while you are
pregnant. Talk to your healthcare provider about any side effect that bothers you or does not go
away. These are not all the possible side effects of RYBELSUS®.
• are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during
treatment with RYBELSUS®. Call your doctor for medical advice about side effects. You may report side effects to
FDA at 1-800-FDA-1088.
Tell your healthcare provider about all the medicines you take, including
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RYBELSUS® may affect the way some medicines work and some medicines may • Store RYBELSUS® at room temperature between 68°F and 77°F (20°C to 25°C).
affect the way RYBELSUS® works. • Store in a dry place away from moisture.
Before using RYBELSUS®, talk to your healthcare provider about low • Store tablet in the original pack.
blood sugar and how to manage it. Tell your healthcare provider if you are • Keep the tablet in the pack until you are ready to take it.
taking other medicines to treat diabetes, including insulin or sulfonylureas. • Keep RYBELSUS® and all medicines out of the reach of children.
Know the medicines you take. Keep a list of them to show your healthcare provider
and pharmacist when you get a new medicine. Revised: 01/2020
Manufactured by: Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark
RYBELSUS® is a registered trademark of Novo Nordisk A/S.
© 2020 Novo Nordisk US20RYB00078 2/2020
••• THE DOSE ••• News & Notes
Low Vitamin D Tied
to Painful Diabetic
Neuropathy
BY QUINN PHILLIPS
SHUTTERSTOCK One of the most painful poten- without diabetes or neuropathy as These dramatic results suggest
tial consequences of diabetes is a control group. Researchers took a that vitamin D may play an impor-
peripheral neuropathy—nerve dam- variety of measurements in all partici- tant role in how diabetic neuropathy
age in your extremities (arms, legs, pants to try to find factors that might develops in the body, or at least how
hands and feet) caused by elevated be associated with neuropathic pain. it is perceived. While this study didn’t
blood glucose levels. Neuropathic look at the effect of taking vitamin D
pain is widespread in people with Among the factors and measure- supplements on neuropathic pain,
diabetes, but until recently, treatment ments the researchers looked at were it references past research that has
options have been very limited and age, body-mass index (BMI, a measure done so. This research has shown
often not targeted to this specific con- of body weight that takes height into that taking vitamin D can dramatically
dition. Furthermore, some potential account), HbA1c (a measure of long- reduce pain, numbness and weakness
treatments, like anti-seizure drugs term blood glucose control), blood in people with diabetic neuropathy,
or antidepressants, carry significant lipid levels (cholesterol and triglyc- including a 50% reduction in pain
risks or side effects. erides), and blood vitamin D levels. scores in one study. So far, studies
They found that vitamin D levels were suggest that the vitamin may help limit
But there may be a cheap, widely significantly lower, overall, in par- demyelination—loss of the protective
available pill that can help reduce ticipants with painful neuropathy (an layer on the outside of nerve cells—
neuropathic pain in some people with average of 24.0 ng/ml) than in those and help nerve fibers regenerate.
diabetes, according to the results of a with painless neuropathy (34.6 ng/
recent study: vitamin D supplements, ml) or in the control group (34.1 ng/ “We demonstrate a relationship
in people who lack enough of this ml). Participants with a vitamin D level between vitamin D deficiency and
vitamin in their blood. The study, below 20 ng/ml—the threshold for painful diabetic neuropathy,” the
published in the journal Diabetes/ deficiency—were 9.8 times more likely researchers emphasize. “A well‐
Metabolism Research and Reviews, to have painful neuropathy than other constructed clinical trial of vitamin
looked at 43 people with type 1 dia- participants. Those with a vitamin D D in painful diabetic neuropathy is
betes who had neuropathy that was level below 30 ng/ml—the threshold required to assess the effectiveness
either painless (20 people) or painful for insufficiency—were 4.4 times as of a potentially simple treatment with
(23 people), along with 14 people likely to have painful neuropathy. no obvious side effects.” DSM
November/December 2020 • DiabetesSelfManagement.com 7
••• THE DOSE ••• News & Notes
QUTENZA, NEW QUIZ
CAPSAICIN PATCH FOR
DIABETIC NEUROPATHY DIABETES BY
PAIN, APPROVED THE NUMBERS
BY QUINN PHILLIPS BY LISA CANTKIER
Diabetic neuropathy—nerve damage in your extremi- Agrowing number of Americans are living
ties (arms, legs, hands and feet) caused by elevated with diabetes, and the prevalence of the
blood glucose levels—can be a frustrating condition to condition increases with age. How can you manage
treat. So the approval by the U.S. Food and Drug Admin- your diabetes or reduce your risk of developing
istration (FDA) of a new pain-relief patch to treat diabetic prediabetes? In a word: self-care. Proper nutrition,
neuropathy comes as a welcome development for many weight management, stress reduction, good sleep
doctors and patients. The patch, which is sold under the habits and exercise all play a role in managing
brand name Qutenza, contains 8% capsaicin—a chemical diabetes. Educating yourself on these topics and
compound derived from chili peppers that gives them making appropriate lifestyle changes will set you on
their “hotness.” Capsaicin has long been used in topical the right path. In observance of National Diabetes
ointments for pain relief, including sometimes for diabetic Month in November, take this quiz to see how much
neuropathy. But the new approval is the first for a patch you know about diabetes, by the numbers.
that uses this active compound to treat neuropathy, which
may offer several benefits over a cream or ointment. 1. Type 2 diabetes does not affect children.
Qutenza is the first local, non-opioid pain treatment O True O False
that delivers prescription-strength capsaicin directly to
the skin, according to a company press release. Capsaicin 2. How many Americans have diabetes?
is one of the few compounds that has been shown to offer O A. 45.0 million in 2017.
effective topical pain relief for diabetic neuropathy, but O B. 35.5 million in 2016.
many ointments contain a much lower concentration of O C. 34.2 million in 2018.
this ingredient than the new patch—making them poten- O D. 40.2 million in 2017.
tially less effective and their pain relief shorter-lasting.
3. How prevalent is diabetes in American seniors
According to the press release, Qutenza is applied
directly to the skin in a procedure in your doctor’s office. age 65 and older?
The patch can remain effective for up to three months, O A. 30.0% live with diabetes.
and there are no known drug interactions with the new O B. 26.8% live with diabetes.
treatment. Some people experienced a reaction at the O C. 25.0% live with diabetes.
application site, but in most cases, these reactions didn’t O D. 28.5% live with diabetes.
last for long and went away on their own.
4. Approximately how many of all diagnosed cases
Qutenza has already been approved and is being used
as a treatment for diabetic neuropathy in Europe. DSM in adults does type 1 diabetes account for?
8 DiabetesSelfManagement.com • November/December 2020 O A. 1% to 2% O C. 3% to 5%
O B. 10% to 15% O D. 5% to 10%
5. More than 84 million American adults age 18 years
or older (nearly 34% of adults) have prediabetes.
O True O False SHUTTERSTOCK
See page 11 for answers.
••• THE DOSE ••• News & Notes
A Diabetes Drug
for Dementia?
BY JOSEPH GUSTAITIS
According to new reports, the drug carried out at 371 sites in 24 coun- approximately five years. Cognitive SHUTTERSTOCK
dulaglutide (brand name Trulic- tries. REWIND formed the basis for decline was measured by means of
ity) appears to be a multitarget medi- the FDA’s approval of dulaglutide for two tests—the Montreal Cognitive
cation, or a drug developed for one MACE, and now the new report indi- Assessment or the Digit Symbol Sub-
purpose and then found to be effective cates dulaglutide could also reduce stitution Test.
in treating something else. Recently, cognitive impairment in adults age
dulaglutide, which is an injectable 50 and above who have established After adjusting for individual
prescription medicine for adults with or newly diagnosed type 2 diabetes standardized baseline scores, the
type 2 diabetes, was approved by along with additional cardiovascular researchers determined that the risk
the U.S. Food and Drug Administra- risk factors. of “substantive cognitive impairment”
tion (FDA) as a way of lowering the was reduced by 14% in those given
risk of major cardiovascular events The researchers looked at data dulaglutide.
(MACE) in adults with type 2 diabetes from 8,828 patients who were part
who have established cardiovascular of the REWIND trial. The patients Dulaglutide is what’s known as
disease or multiple cardiovascular had an average age of 65.5, and the a glucagon-like peptide-1 (GLP-1)
risk factors. Now a new study has male-female split was about 50/50. receptor agonist, a class of drugs
reported another possible use for the They had an HbA1c (measure of glu- that helps diabetes patients achieve
medicine—to lower cognitive decline cose control over the previous two blood sugar control. This raises the
and prevent dementia in people with to three months) of 9.5% or less and possibility that these drugs might also
type 2. This is an important finding were taking no more than two blood- have a beneficial effect on dementia
because type 2 diabetes is a known sugar-lowering agents. The patients and cognitive decline. In an editorial
risk factor for cognitive impairment also had histories of heart attack, accompanying the study, Geert Jan
and dementia stroke, chest pain and the like. They Biessels, MD, of the UMC Brain Cen-
were randomly divided into groups: ter at the University Medical Center
The new study, which was pub- one was given weekly doses of dula- Utrecht, wrote, “If some classes of
lished in the medical journal Lan- glutide, and the other was given a anti-diabetic drugs are superior than
cet Neurology, was based on what’s placebo (an inactive substance). The others in preventing dementia, this
known as the REWIND (Researching patients were given cardiovascular finding has clinical implications… The
Cardiovascular Events with a Weekly follow-ups every six months. The effect of this drug class on dementia
Incretin in Diabetes) study, which was trial lasted two years (2011 to 2013), and related diseases in people with
a randomized, double-blind study and the subjects were followed up for diabetes and those without diabetes
urgently needs to be studied.” DSM
10 DiabetesSelfManagement.com • November/December 2020
QUIZ ANSWERS See page 8 for questions. Stay Healthy
1. False. Previously known as adult-onset diabetes, At Home
type 2 diabetes (a condition characterized by high
blood sugar, insulin resistance and insufficient insulin OVER
production) is affecting children more frequently. Per
statistics from the Centers for Disease Control and 500,000 USERS
Prevention (CDC), in the United States, approximately
210,000 children and adolescents under the age of 20 Smooth elliptical gliding motion works more
had diagnosed diabetes in 2018, including roughly than 50% of your body’s muscle groups for
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children and adolescents 10 to 19 years of age were
newly diagnosed with type 2 diabetes that year. sitting on the couch or favorite chair.
2. C. If you’re living with diabetes, you are not alone. Keep Fit While You Sit – burn calo-
According to the American Diabetes Association, 34.2 ries, improve circulation, strengthen
million Americans, or 10.5% of the population, had dia- muscles and boost energy.
betes in 2018. Of this number, nearly 1.6 million Ameri-
cans have type 1 diabetes, including about 187,000 Stay Moving at Any Age – for
children and adolescents. Of the 34.2 million adults with better mobility, flexibility and
diabetes, an estimated 7.3 million were undiagnosed. balance.
According to the CDC, one in five Americans who have
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and undiagnosed).”
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1 diabetes can also be diagnosed in adults. According
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5. True. Prediabetes rates are high in the United States. energy than just sitting.
According to the National Institute of Diabetes and Keep active while you
Digestive and Kidney Diseases (NIDDK), an estimated work, read or watch TV.
84.1 million American adults age 18 years or older have
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fulcommunications.com.
••• THE DOSE ••• News & Notes
Double Diagnosis Statement of Ownership, Management and Circulation
1. Title of Publication: DIABETES SELF-MANAGEMENT;
Type 1 diabetes and celiac disease 2. Publication No. 0741-6253 3. Filing Date: October 1,
2020 4. Issue Frequency: Bi-Monthly 5. No. of issues
BY JOSEPH GUSTAITIS published annually: 6 6. Annual Subscription Price:
$29.94 7. Complete Mailing Address of Known Office
In a recently concluded trial, Farid on a gluten-free diet for a year and a of Publication: 35 Braintree Hill Office Park, Suite 101; SHUTTERSTOCK
Mahmud, MD, of the Hospital for second that continued on a regular Braintree, MA 02184 Contact: Andrea Palli, Telephone:
Sick Children at the University of diet for the same time period. The (617) 279-0191 8. Complete Mailing Address of Head-
Toronto, described, along with his col- subjects’ HbA1c levels were measured quarters or General Business Office of Publisher: 35
leagues, an emerging “double diagno- at the beginning of the study and again Braintree Hill Office Park, Suite 101 Braintree, MA
sis” of type 1 diabetes (T1D) and celiac after six and 12 months. Blood sugar 02184; 9. Full Names and Complete Mailing Addresses
disease (CD) and concluded that celiac levels after meals were determined of Publisher, Editor and Managing Editor: Publisher,
disease is “frequently” asymptomatic by continuous glucose monitoring. Courtney Whitaker, 35 Braintree Hill Office Park, Suite
and undiagnosed in people with T1D. Any participant in the regular-diet 101 Braintree, MA 02184; Editor, Diane Fennell, 35
They also reported the surprising group who developed symptoms of Braintree Hill Office Park, Suite 101 Braintree, MA
finding that T1D patients who switch celiac disease during the trial was 02184. 10. Owner: Madavor Media, LLC, 35 Braintree
to a gluten-free diet might experience transferred to the gluten-free group. Hill Office Park, Suite 101 Braintree, MA 02184 11.
blood sugar spikes after meals. Known Bondholders, Mortgagees and Other Security
The researchers found that asymp- Holders Owning or Holding 1 Percent or More of Total
Celiac disease is, like T1D, an tomatic celiac disease was 1½ times Amount of Bonds, Mortgages or Other Securities: None
autoimmune disease. People who more common in the adults than in the 12. Does not apply 13. Publication Name: DIABETES
are genetically predisposed to celiac children, a finding they called “surpris- SELF-MANAGEMENT 14. Issue Date for Circulation
disease suffer damage in the small ing” and probably because the adults Data Below: 08/04/2020 15. Extent and Nature of
intestine when they ingest gluten, had had “lower rates of prior screening Circulation: A. Total no. copies (net press run): Average
which is a protein found in wheat, overall.”They added,“This may reflect no. copies each issue during preceding 12 months:
rye, barley and certain other grains. a misperception of celiac disease as a 232,551; Actual No. Copies Single Issue published
Celiac disease is estimated to affect condition exclusively seen during the nearest to filing date: 150,457; B. Paid Circulation: 1.
about 1% of the world’s population, pediatric period.”The most unexpected Mailed Outside- County Paid Subscriptions Stated on
and it commonly goes undiagnosed. finding was that subjects who were on PS Form 3541: Average no. copies each issue during
the gluten-free diet experienced note- preceding 12 months: 155,774; Actual no. copies
The study was called the Celiac worthy increases in blood sugar levels single issue published nearest to filing date: 132,469;
Disease and Diabetes-Dietary Inter- after meals—more than those on the 2. Mailed In- County Paid Subscriptions Stated on PS
vention and Evaluation Trial. The regular diet.And over the 12 months of 3541: Average no. copies each issue during preceding
researchers screened 1,298 adults the study, there was a 0.3% increase in 12 months: 0; Actual no. copies single issue published
and 1,089 children with T1D for celiac HbA1c levels in the gluten-free group. nearest to filing date: 0 3. Paid Distribution Outside
disease—at the onset of the trial, none the Mails Including Sales Through Dealers and Car-
of the subjects showed any symptoms The researchers concluded that riers, Street Vendors, Counter Sales, and Other Paid
of CD. After identifying 51 participants “clinical vigilance” is necessary for Distribution Outside USPS: Average no. copies each
with asymptomatic celiac disease, the T1D patients who adopt a gluten-free issue during preceding 12 months: 18,772; Actual no.
researchers randomly assigned them diet because such a diet “may impact copies single issue published nearest to filing date:
to one of two groups: one that went short-term glycemic variability.” DSM 16,606 4. Paid Distribution by Other Classes of Mail
Through the USPS: Average no. copies each issue dur-
ing preceding 12 months: 0; Actual no. copies single
issue published nearest to filing date: 0; C. Total Paid
Distribution: Average no. copies each issue during
preceding 12 months: 174,546; Actual no. copies
single issue published nearest to filing date: 149,075;
D. Free Distribution or Nominal Rate Distribution (By
Mail and Outside the Mail): 1. Free or Nominal Rate
Outside-County Copies included on PS Form 3541:
Average no. copies each issue during preceding 12
months: 57,588; Actual no. copies single issue published
nearest to filing date: 903 2. Free or Nominal Rate
In-County Copies Included on PS Form 3541: Average
no. copies each issue during preceding 12 months:
0; Actual no. copies single issue published nearest to
filing date: 0 3. Free or Nominal Rate Copies Mailed at
Other Classes Through the USPS: Average no. copies
each issue during preceding 12 months: 0; Actual no.
copies single issue published nearest to filing date: 0;
4. Free or Nominal Rate Distribution Outside the Mail:
Average no. copies each issue during preceding 12
months: 92; Actual no. copies single issue published
nearest to filing date: 100; E. Total Free or Nominal
Rate Distribution: Average no. copies each issue dur-
ing preceding 12 months: 57,680; Actual no. copies
single issue published nearest to filing date: 1,003; F.
Total Distribution: Average no. copies each issue dur-
ing preceding 12 months: 232,226,; Actual no. copies
single issue published nearest to filing date: 150,078;
G. Copies not distributed: Average no. copies each issue
during preceding 12 months: 326; Actual no. copies
each issue published nearest to filing date: 379; H.
Total: Average no. copies each issue during preceding
12 months: 232,552; Actual no. copies single issue
published nearest to filing date: 150,457; I. Percent
Paid: Average no. copies each issue during preceding
12 months: 75.16%; Actual no. copies single issue
published nearest to filing date: 99.33%.16. Electronic
Copy Circulation; A. Paid Electronic Copies: Average
no. copies each issue during preceding 12 months:
55,362; Actual no. copies single issue published nearest
to filing date: 40,184; B. Total Paid Print Copies + Paid
Electronic Copies: Average no. copies each issue during
preceding 12 months: 229,908; Actual no. copies single
issue published nearest to filing date: 189,259; C. Total
Print Distribution + Paid Electronic Copies: Average
no. copies each issue during preceding 12 months:
287,588; Actual no. copies single issue published
nearest to filing date: 190,262; D. Percent Paid (Both
Print & Electronic Copies): Average no. copies each
issue during preceding 12 months: 79.94%; Actual
no. copies single issue published nearest to filing date:
99.47% 17. This Statement of Ownership will be printed
in the 10/06/2020 issue of this publication. 18. I certify
that all information furnished on this form is true and
complete. I understand that anyone who furnishes
false or misleading information on this form or who
omits material or information requested on the form
may be subject to criminal sanctions (including fines
and imprisonment) and/or civil sanctions (including
multiple damages and civil penalties). (signed) Courtney
Whitaker, Chief Operating Officer, October 1, 2020.
12 DiabetesSelfManagement.com • November/December 2020
••• THE DOSE ••• News & Notes
Promising New Treatment
for Neuropathy Pain
BY JOSEPH GUSTAITIS
High-frequency spinal cord stimu- spine, the device emits pulses that researchers also conducted sensory
lation appears to be a promising reduce pain signals to the brain. The assessments of the targeted limbs
and effective treatment for the pain study reported on results from 216 after three months. They found a
associated with diabetic neuropathy diabetes patients who were randomly 72% improvement in the SCS group
(nerve damage in the arms, legs, assigned to one of two groups: one and just a 7% improvement in the
hands and feet), according to a new receiving CMM (103 patients) and CMM group. Finally, study author
report. one receiving HF10 SCS in addition Erika Petersen, MD, explained that
to CMM (113 patients). while neuropathy pain often causes
The report was based on a study difficulty in falling asleep and awak-
known as SENZA-PDN. This study After a three-month test period, ening caused by pain, the researchers
compared Conventional Medical the reported results were striking. reported improvements in both areas
Management (CMM) to HF10 ther- Of the patients who had the SCS in the SCS group after three months.
apy, which is a type of spinal cord implantation, nearly eight out of 10 She summed up the results by saying,
stimulation, or SCS. HF10 therapy (79%) reported a response of 50% “My overall takeaway here is that
works by means of a small device or greater pain relief. Of those who these initial three-month results are
implanted under the skin. Connected received CMM only, a mere 5% of very promising.” DSM
to thin wires positioned near the patients reported similar results. The
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••• THE DOSE ••• Product Spotlight
Cool new products to try
BY AMY CAMPBELL, MS, RD, LDN, CDCES
Splenda Diabetes Care Shakes
If you’re looking for a meal replacement or an option for healthy snacks, look no
further than Splenda Diabetes Care Shakes. These shakes contain a unique blend of
16 grams of quality protein, carbohydrates and healthy fat in each 8-ounce serving,
which can help you manage your blood sugar—and help reduce blood sugar spikes,
too. These shakes are sweetened with sucralose (Splenda) as well as allulose, a low-
calorie sweetener that has 70% of the sweetness of regular sugar with little or no
effect on blood sugar levels. Available in French Vanilla, Milk Chocolate and Strawberry
Banana flavors. Give all of these tasty, no-sugar-added flavors a try. So delicious, you’ll
forget it’s good for you!
Splenda.com Disclosure: Views/opinions are my own and do not reflect the views or opinions
of the DCE DPG or Academy of Nutrition and Dietetics. #DDPGDigitalInfluencer
Gloves In A Bottle Shielding Lotion
Frequent hand washing or using drying soaps or hand gels can wreak havoc on your
hands. Give them some tender loving care with Gloves In A Bottle Shielding Lotion.
This long-lasting lotion bonds with the outer layer of your skin cells (just like an invis-
ible glove), enhancing the outer layer to repel irritants and prevent moisture loss while
improving skin elasticity and minimizing irritation—and doesn’t wash off. Unlike conven-
tional hand creams and lotions that coat your skin, this lets your skin breathe, protecting
it from environmental toxins, irritants found in cleaning products, and frequent hand
washing. Gloves In A Bottle is hypoallergenic, vegan, cruelty-free and is made in the USA.
GlovesInABottle.com
Linenspa Memory Foam Mattress Topper
Tired of waking up feeling tired and sore? Need a new
mattress but can’t spring for one just yet? If so, you might
benefit from a mattress topper. But don’t choose just any
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14 DiabetesSelfManagement.com • November/December 2020
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••• THE DOSE ••• Ask Away
Metformin Recall,
Hidden Carbs
BY GARY SCHEINER, MS, CDCES
QI take metformin twice daily, high levels of exposure over extended ACarbohydrates can be sneaky. SHUTTERSTOCK
but I heard that it was recalled periods of time have been linked to They find their way into our
due to a cancer risk. Should I stop an increased risk of some cancers diets unexpectedly. Most vegetables,
taking it? and liver/spleen damage. for example, are low in carbs but
not carb-free. Salad veggies aver-
A Metformin is the most widely Check to see what company pro- age about 5 grams per cup, and that
used medication for treat- duced your metformin. Unless it was doesn’t include add-ons like dressings
ing diabetes. It helps to reduce the manufactured by one of the compa- and croutons. Breading on meats and
body’s natural production of glucose, nies listed earlier, there is no need for vegetables also add carbs, as do most
decrease the absorption of glucose concern. The manufacturer is typi- sauces and condiments. Even a palm-
into the bloodstream, and improve cally listed in the “fine print” under sized portion of nuts can contain 5 to
the way insulin functions, all with the medication brand name with the 10 grams of carbohydrate. All of these
very few side effects. Earlier this year, prefix MFG or MFR. On some bottles, “hidden” carbs can add up.
the U.S. Food and Drug Administra- it may be on the side panel with the
tion (FDA) recommended a recall safety warnings and storage informa- It is important to additionally note
of extended-release (ER) versions tion. If your medication was manufac- that carbohydrate is not the only thing
of metformin from several specific tured by one of the companies listed in our food that raises blood sugar.
manufacturers—as of mid-Septem- earlier, reach out to your pharmacy Protein can also cause the blood sugar
ber, these included Amneal, Apotex, to request a new stock of medicine to rise—particularly when consumed
AvKARE (repackager for Amneal), from a different manufacturer. as part of a low-carb diet. Research
Bayshore Pharmaceuticals, Granules has shown that approximately half of
Pharmaceuticals, Lupin Pharmaceuti- In the meantime, do not stop tak- the protein in a very-low-carb meal
cals, Marksans (labeled as Time-Cap), ing your medication. The immediate can eventually turn into glucose, so if
PD-Rx Pharmaceuticals (repackager health risks associated with high you choose to go low-carb, it may be
for Amneal and Marksans), Preferred blood sugar and diabetes compli- necessary to start considering protein
Pharmaceuticals (repackager for cations are far greater than those grams as well. DSM
Marksans), Teva (labeled as Acta- from possible short-term exposure to
vis), and The Harvard Drug Group NDMA. Speak with your doctor if you Gary Scheiner, MS, CDCES, has lived
(repackager for Apotex)—because have any doubts about what to do. with type 1 diabetes for 30 years and
they were found to contain unac- was named Diabetes Educator of the
ceptably high levels of a chemical QI have type 1 diabetes and eat a Year 2014 by the Association of Dia-
called NDMA. At low levels, NDMA whole-food, plant-based diet. It betes Care & Education Specialists.
is not harmful. However, according surprises me to see my blood sugar
to the World Health Organization, spike when I have low-carb foods such Have a question about diabetes?
as zucchini or cashews. What causes Email [email protected].
this to happen?
16 DiabetesSelfManagement.com • November/December 2020
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••• THE DOSE ••• Curmudgeonly Athlete
Warm to Winter Exercise
BY ROBERT S. DINSMOOR
Iwon’t say I hate winter, but it’s my HIKING TIPS FOR STAYING SAFE SHUTTERSTOCK
least-favorite time of the year. Yet I When hiking in the winter, the best • Start small. If you’re new to winter
started to mind the season much less footwear starts with waterproof hik- activity, you may underestimate the
once I took up cross-country skiing. ing boots. If you’ll be walking or hik- effort involved.
Give the following activities a try, and ing on ice or snow, it’s a good idea to
you may also find yourself warming have additional footgear to prevent • Start early. Make hay while the
up to winter, too. slipping. Microspikes are devices that sun is shining! It’s no fun getting stuck
slip around boots and have small out in the cold after dark.
CROSS-COUNTRY SKIING spikes at the bottom to provide trac-
Cross-country skiing is an excellent tion. Crampons are devices with • Carry—and drink—plenty of
form of cardiovascular exercise that bigger spikes to really dig into the water. Even if you don’t notice you’re
works the entire body, including the ice, making them especially useful thirsty, you could become dehydrated,
core, and allows you to enjoy the for scaling icy slopes. which increases your risk of hypo-
beauty and quiet of nature. While thermia.
there are groomed ski trails specifi- COLD-WEATHER WORKOUT
cally for cross-country skiers, you can • Bring plenty of food. The ideal
cross-country ski virtually anywhere CLOTHING food would be small snacks you can
there’s enough snow. Proper clothing is essential for munch on without stopping your
staying warm and dry. A hat, activity.
SNOWSHOEING moisture-wicking gloves, and
Flat and wide, snowshoes are moisture-wicking socks are best, • Carry or wear a medical ID or
designed to spread your weight over but people with diabetes should medical alert jewelry that identifies
the snow so that you don’t sink in, avoid electric foot warmers, which you as someone with diabetes.
which makes them very handy for could burn their feet without their
getting across expanses of deep even knowing it. In general, it’s a • Be sure to check your blood glu-
snow. Snowshoeing is easier to learn good idea to dress in layers. The cose levels before, during and after
than cross-country skiing, and snow- innermost layer should be moisture- your workout and bring hypoglycemia
shoes are generally inexpensive and wicking thermal underwear. On the (low blood glucose) treatment, such
lightweight. And snowshoeing is upper body, the next layer could be as glucose tabs, along for the trip.
safer and easier on rugged terrain a fleece, followed by a water-proof
and deep snow than cross-country winter coat. On the lower body, the MAKING THE MOST OF THE
skiing is. outer layer could be ski pants or
other water-proof pants. WINTER
So what are you waiting for? Pick an
activity that sounds like fun, get the
OK from your doctor, and get started.
There’s a whole winter wonderland
to enjoy! DSM
18 DiabetesSelfManagement.com • November/December 2020
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••• HEALTHY LIVING ••• The Right Moves
Sweet Success
Stay fit through the holidays
BY LAUREL DIERKING, MED, NASM, 700-ERYT
Lifestyle changes related to the as possible. Once you have deter- SQUAT TO CHAIR
COVID-19 pandemic may have mined the “what,” take the next steps
already challenged your eating and and determine the “when” and “how.” • Begin seated at the edge of your
movement routines enough to leave For example, if your goal is to lose 15 chair with your feet flat on the
you feeling off-kilter, but this can be pounds, determine the date by which floor and your spine held tall.
used as motivation to overcome the you’d like to be at your target weight. • Exhale as you press firmly into
challenges you know you’ll face with For the “how,” outline the realistic your heels and big toes to stand.
the sweet temptations of the holidays. steps you can take to move yourself • Inhale and slowly lower back and
One way to approach the allure that toward that accomplishment. In this down into the chair.
typically awaits us at this time of year case, that might include measures • Repeat 10 to 15 times without
is to have a plan ahead of time. No such as committing to exercise twice a stopping.
matter whether your goals are related week, not eating out for three weeks,
to fitness, weight loss, nutrition, or avoiding soda, limiting yourself to STANDING SINGLE-LEG
health more generally, anticipating two glasses of wine per week, bring- BALANCE
the potential setbacks and having a ing a healthy appetizer to a holiday
plan in place can help you navigate party, or all of the above. Every goal • Stand on one leg, with the knee
the seasonal celebrations and start off should have a plan for how it will be slightly bent, about 2 feet or more
the new year on the right foot. achieved, and this plan should include away from a desk or counter.
room for error and ideas for how to • Inhale and bend at your waist,
Author and businesswoman Ari- bounce back from missteps. reaching the opposite arm to tap
anna Huffington reminds us that “fail- the counter or desk lightly.
ure is not the opposite of success, it is Our response to setbacks deter- • Exhale and stand back up to the
part of the success.” All too often, we mines our outlook moving forward, starting position.
tend to throw in the towel when we and ultimately, our mindset is often the • Repeat 10 times before switching
feel we have strayed off our path to deciding factor in whether we succeed. to the other leg.
progress with just one mistake or set- Pledge to create a plan for how you will
back. This mindset can cause a much attain your goals this holiday season INCLINE PUSH UP
greater impact on our success than and stick to it! You can begin with these
the original issue itself. It is critical to simple exercises.Take just five minutes • Stand with your arms
understand that these setbacks can and help yourself stay on track with outstretched and your hands on a
be reinforcements that ultimately help your daily movement goals. DSM desk, wall, table or counter. Walk
propel us forward toward our goals, your feet back so that your calves
and the disappointment we may feel Laurel Dierking, MEd, NASM, 700- are stretched, and your body is
when we encounter a snag communi- ERYT, is a movement specialist with angled from the surface.
cates to us that we desire a different a concentration in yoga, strength • Inhale and lower your chest to the
outcome and are on the right path. All conditioning, exercise physiology space between your hands.
the better to factor those setbacks into and postural restoration. With 10 • Exhale and immediately push
the initial equation so that, when they years of extensive experience, Dierk- yourself all the way back up to
inevitably do occur, the reaction isn’t ing seeks to enhance self-awareness straight arms.
out of proportion to the event. by guiding individuals through mind- • Do 10 to 15 repetitions.
ful movement, functional training,
No matter what your end goal is, it body awareness and breath work.
is especially helpful to be as specific
20 DiabetesSelfManagement.com • November/December 2020
AARON ASHLEY
November/December 2020 • DiabetesSelfManagement.com 21
••• HEALTHY LIVING ••• Weighty Matters
Weight Management
What does the latest research say?
BY DR. NICOLA DAVIES, PHD
The importance of maintaining a by the intestines, and increases insulin with participants losing an average of
healthy weight when you have sensitivity, resulting in better control 4.4 kilograms (roughly 9.7 pounds) in
diabetes is well known, but as with of blood glucose levels. In addition, a four weeks. Participants were also pro-
anything, there is always more to lot of people have reported significant vided with healthy eating advice from
learn. So, what are the most recent weight loss when taking the medicine. a dietitian alongside their treatment.
research advances concerning diabe-
tes and weight management? Learn Until recently, we didn’t under- ARE GROUP INTERVENTIONS THE
about some of the latest significant stand exactly how metformin helps WAY FORWARD?
findings in this roundup. with weight loss. This changed last The results of a recent randomized
year, when researchers found that clinical trial suggest that combin-
COULD WEIGHT LOSS HOLD THE mice treated with the drug showed an ing group medical visits with inten-
KEY TO TYPE 2 REMISSION? increase in the level of a protein coding sive weight-management strategies,
This has been a hot topic for several gene known as growth/differentiation including a low-carbohydrate diet,
years, but in 2019 a study confirmed factor 15 (GDF15), which is known to can improve weight loss, reduce the
that this very well could be the case. suppress the appetite and reduce body use of diabetes medications, and sig-
Researchers found that a weight loss of weight. The study showed that mice nificantly decrease the occurrence of
10% or more in people recently diag- lacking this gene did not lose weight hypoglycemic events.
nosed with type 2 diabetes doubles when treated with metformin, thus
their chances of going into remission establishing a connection between Group medical visits can help
when compared to those who maintain GDF15 and the weight-loss benefits empower people with diabetes while
the same weight. A weight loss of 10% of the medicine. improving access to healthcare ser-
is both modest and achievable, offering vices. Attending group settings can
a realistic goal for the management DISCOVERY OF A WEIGHT-LOSS also help provide people with the sup-
of diabetes. port they need to follow weight-loss
HORMONE INJECTION. plans effectively.
MECHANISM OF METFORMIN’S An innovative injection to help people
WEIGHT-REDUCTION BENEFITS with both diabetes and obesity lose A FOCUS FOR THE FUTURE.
REVEALED. weight has recently been developed The impact that our gut bacteria, or
The oral medication metformin is the by a team of researchers based at microbiome, has on our health has
Imperial College London, UK. This been well established over the past
most widely prescribed treat- injection is made up of three different decade. In fact, the bacteria residing
ment for type 2 diabetes. It hormones (glucagon-like peptide 1 in our gut have been linked to many
[GLP-1], oxyntomodulin and peptide chronic conditions, including diabetes.
decreases glucose produc- YY), a mixture of which is referred to Researchers are now keen to dis-
tion by the liver, as “GOP,” for short. cover whether targeting this bacterial
decreases population could help improve weight
glucose GOP hormones originate from the control in people with diabetes. The
absorp- bowels, and it is claimed that treat- results may offer another method
tion ment with the GOP injection results for better managing both weight and
in changes similar to those seen after diabetes. Stay tuned! DSM
gastric bypass surgery. GOP is gener- SHUTTERSTOCK
ally well tolerated, causing no signifi- Dr. Nicola Davies, PhD, health
cant side effects. psychology, is author of I Can Beat
Obesity! Finding the Motivation,
The results of a small trial showed Confidence and Skills to Lose Weight
that GOP infusion improves and Avoid Relapse.
blood glucose levels and
reduces body
weight,
22 DiabetesSelfManagement.com • November/December 2020
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••• HEALTHY LIVING ••• Smart Smarter Smartest
Butter and Spreads
BY LEA ANN HOLZMEISTER, RD, CDCES
Butter and spreads can contribute large amounts of fat, spreads and are also incorporating healthier ingredients,
saturated fat and calories to your diet. The good news such as canola oil, olive oil, omega-3, flaxseed oil, sea
is that spreads no longer contain trans fat due to a 2015 salt, calcium and vitamin D, into their offerings.
Food and Drug Administration (FDA) ruling that banned
artificial trans fats from foods in the United States. It’s To keep saturated fat from these products low, choose
worth noting that regular butter, though, contains almost a butter or spread with less than 2 grams of saturated
half a gram of naturally occurring trans fat per tablespoon. fat per tablespoon. Those watching their weight should
note that butter and spreads labeled “light” contain 50%
Almost any spread is a better pick than butter because fewer calories and fat than regular products: One table-
spreads contain more healthy unsaturated fat and, as spoon of traditional butter contains roughly 110 calories
mentioned above, no trans fat. To make their products and 7 grams of saturated fat, while a tablespoon of light
stand out from the crowd, some companies are adding butter or spread contains 50 calories and 3 grams of
healthier unsaturated oils to their butter and non-butter saturated fat. DSM
SERVING FAT SAT FAT TRANS FAT CHOL SODIUM
CALORIES (g) (g) (g) (mg) (mg)
1 Tbsp
SMART 1 Tbsp 65 7 3 0 0 90
1 Tbsp 0 5 90
Olivio Coconut 1 Tbsp 50 5.5 2 0 0 80
Challenge Spreadable Lite Butter 1 Tbsp 0 0 100
Land O’ Lakes Fresh Buttery Taste Spread 1 Tbsp 70 8 2 0 0 90
Olivio Original 1 Tbsp 0 0 35
I Can’t Believe It’s Not Butter! The Original 80 9 2.5 0 0 90
Fleischmann’s Original 1 Tbsp
Parkay Original 1 Tbsp 60 6 2
1 Tbsp
SMARTER 1 Tbsp 60 7 1
1 Tbsp
Pure Blends Avocado Oil Plant-Based Butter 1 Tbsp 60 6 1.5
I Can’t Believe It’s Not Butter! With Olive Oil 1 Tbsp
Benecol Original 60 6 2 0 0 90
Promise Buttery 1 Tbsp
Land O’ Lakes Light Butter With Canola Oil 1 Tbsp 60 6 2 0 0 90
Country Crock Original 1 Tbsp
Parkay Light 1 Tbsp 70 8 1 0 0 105
1 Tbsp
SMARTEST 1 Tbsp 60 6 2 0 0 85
1 Tbsp
I Can’t Believe It’s Not Butter! The Light One 50 6 2 0 10 90
Promise Light
Benecol Light 50 6 1.5 0 0 100
Olivio Light
Country Crock Light 50 6 1 0 0 110
Brummel & Brown Original Made With Real Yogurt
Blue Bonnet Light Spread 35 4 1 0 0 85
45 5 1.5 0 0 90
50 5 1 0 0 95
50 5 1.5 0 0 95
35 4 1 0 0 90 SHUTTERSTOCK
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40 4 1 0 0 95
24 DiabetesSelfManagement.com • November/December 2020
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••• HEALTHY LIVING ••• Food For Thought
Healthy and Joyful Holidays
Tips to make the most of the season
BY ALISON MASSEY, MS, RD, LDN, CDCES
As we enter the 2020 holiday Zoom gathering where everyone can ingredients to really enhance the
season, many people may be enjoy a hot beverage and cookie from quality of your favorite baked goods.
celebrating differently because of the comfort of their own home and
ongoing COVID concerns and social share a recipe and good cheer with I won’t be hosting a large family
distancing guidelines. Festive meals, other attendees. holiday meal, and it has me
parties and events may be smaller feeling a bit down. What are your
or postponed, but it doesn’t mean Freeze cookie dough and bake suggestions for making the most
the situation has to put a damper on small batches. If it’s just not the of the holiday dinner when there
your entire holiday season. Here are a holidays in your household without are empty seats around the table?
few suggestions for creating intimate, certain baked treats, try preparing
healthy and joyful holidays. and freezing the dough and then only Unfortunately, 2020 has been a year
baking half a dozen cookies at a time. where many special events have had
This year I won’t be hosting my This allows you to enjoy a variety of to be canceled or postponed. Here
cookie exchange party. I love fresh, hot treats right out of the oven are a few suggestions to make the
holiday baking—how can I still without a constant overabundance most of your holiday celebrations on
make the most of the season? of desserts. a smaller scale.
Host a virtual cookie exchange Focus on quality versus quantity. Change the menu. Hosting fewer SHUTTERSTOCK
party. If you are avoiding hosting or We all tend to have treats that are people for a holiday meal may provide
attending annual cookie exchange favorites and other things we enjoy a bit more money in the budget to
parties, you can still enjoy the social but can pass up. Focus on choosing spend on quality ingredients. It may be
aspect of gathering with your favor- a few of your very favorite holiday the perfect time to actually modify the
ite cookie-loving friends and family recipes to prepare during the season menu and do something completely
by hosting a virtual cookie exchange versus every single recipe that is new or serve a favorite that is a bit too
party. Send invitations for a group typically on your list. Use top-notch expensive to feed a crowd.
26 DiabetesSelfManagement.com • November/December 2020
Create a beautiful tablescape. benefits of a low-key holiday season Here are a few of my favorite fes-
Set the mood by creating a beautiful with perhaps fewer engagements to tive snack ideas to try during the
tablescape to enjoy throughout the attend but more time to be at home holiday season:
holiday season. There are so many and rest and relax. There might be
benefits to taking time to sit down fewer shared holiday meals but • Seasonal herbal tea paired with
and enjoy a nice meal, so make more time to catch up with loved two small tea sandwiches
sure it is a pleasurable experience. ones in other ways. A forced slower
Play your favorite music, light a pace and home quarantine aren’t • One cup of popcorn mixed with
candle, and consider putting a few of ideal, but with those circumstances two tablespoons of seasoned
your favorite pictures of family and come less pressure to constantly nuts
friends in the area where you eat. If be on the go (and, let’s be honest,
you live alone, consider setting up fewer dishes to wash at the end of • One cup of homemade veg-
virtual dinner or lunch dates with the meal isn’t always a bad thing). etable soup
cherished friends and family. There
is no reason you can’t enjoy each I’m struggling with stress- • One cup of homemade hot choc-
other’s company even if you aren’t snacking this holiday season. olate made with almond milk
eating the same meal. Do you have any healthy ideas
for seasonal snacks? • Fresh orange sliced and
Consider the benefits of a low- sprinkled with cinnamon and
key holiday dinner. It’s easy to Holidays can be stressful for a vari- a pinch of nutmeg
focus on the negative aspects of ety of reasons, but it is actually OK
canceled holiday plans, but even to snack. Smart snacking can help • Sautéed apples topped with a
in unfortunate circumstances like provide us with energy to tackle the pinch of cinnamon and apple
a global health pandemic, there are to-do list and contribute to stabilizing pie spice
some silver linings. Think about the blood glucose levels.
Wishing everyone health and hap-
piness this holiday season. DSM
Alison Massey, MS, RD, LDN, CDCES,
is a registered dietitian and certified
diabetes care and education specialist
in Maryland.
November/December 2020 • DiabetesSelfManagement.com 27
S. Epatha Merkerson
on Living With and Learning
About Diabetes
The lauded actress narrates Blood Sugar Rising, a new PBS documentary about the disease
BY TONI FITZGERALD
Tony- and Emmy-nominated has lived with type 2 diabetes for no-nonsense Lt. Anita Van Buren on COURTESY OF NBCUNIVERSAL
actress S. Epatha Merkerson is more than a decade. “It’s a struggle, NYC-set drama Law & Order, a role
just like the rest of us. She’s human but fortunately, I’ve been able to keep she played for 17 years, and now
this time of year. “I’m not going to tell my A1C below 7%, I’ve lost weight, appearing as a hospital executive
you that I don’t falter when it comes to and I’ve changed my diet, and for on NBC drama Chicago Med (which,
staying on track during the holidays,” exercise, I like to walk,” she says. like Law & Order, is produced by
she admits, “but I’ve learned not to “New York and Chicago are great Dick Wolf).
beat myself up.” cities for walking!”
Merkerson also recently narrated
It’s a refreshingly real perspective She’s best known for her ties to a documentary that aired on PBS.
from someone in the public eye who those two cities—first, portraying With a family history of diabetes and
28 DiabetesSelfManagement.com • November/December 2020
COURTESY OF NBCUNIVERSAL a desire to assist others in learn- With over 30 million Americans I never really understood what
ing more about it, the actress was suffering from diabetes, Blood Sugar a “touch of sugar” meant, but I saw
thrilled at the chance to highlight Rising is important and timely. the results. Now, we have healthy
people living with the disease and discussions about A1C, dietary issues
confront the often ugly stigmas that DSM: How did you get involved and exercise.
can accompany a diabetes diagnosis. with this film? What about it spoke
to you and made you want to be part Fans who know that I am diabetic
The film, titled Blood Sugar Rising, of it? will ask questions or share stories
examines the “rapid rise” in diabetes about their struggle or about a fam-
diagnoses and explores why, despite Merkerson: Being diabetic, I have ily member dealing with the disease.
the severity of the epidemic, the con- a keen interest in the subject matter,
dition often doesn’t get a lot of media and I have a significant track record DSM: Do you feel a stigma from
attention. It challenges viewers to in the advocacy of diabetes education living with diabetes? Why or why not,
“rethink the environments we live in and prevention. and if so, how do you deal with it?
that fuel diabetes’ growth.”
DSM: What did you learn from Merkerson: I don’t personally feel
Shortly after Rising debuted, narrating this film? a stigma, but I understand that there
Merkerson spoke to Diabetes Self- is the idea that those of us who suf-
Management about self-care during Merkerson: With all the work that fer from the disease are somehow at
quarantine, how she monitors her I’ve done with diabetes education, I fault and could’ve prevented it. Poor
diabetes, and her family’s history must admit I’d never heard the term diet, lack of exercise and being over-
with the condition. “dead in bed syndrome” [which refers weight can lead to diabetes, but there
to sudden deaths of young people with
Diabetes Self-Man- are other variables that
agement: Why is it type 1 diabetes]. It may be that I have can [increase risk of the
important for people to always had to deal with issues of high condition], like genetics,
learn more about the blood sugars. I was also pleased to environment and access
severity of the diabetes learn more about the history of the to decent health care.
epidemic? disease.
DSM: How do you
S. Epatha Merker- DSM: Do you talk about your dia- manage your diabetes
son: The answer is actu- betes a lot in your day-to-day life? Is (i.e., do you have a CGM,
ally built into in your it something you discuss with family/ do you use other technol-
question by the use of the friends, and does it come up when ogy, etc.)?
word “epidemic.”The sta- fans approach you?
tistics show that diabetes Merkerson: I use a
affects a large number of Merkerson: Diabetes has affected blood glucose meter twice
our population, upwards members on both sides of my fam- a day.
of 30 million Americans, ily. My father died at 57 from com-
and that number is said to be rising. plications of type 2. My maternal DSM: How do you
grandmother lost her sight as a monitor your diabetes on
DSM: What role does awareness result of the disease; an uncle had the set of Chicago Med?
play in fighting the diabetes epidemic, lower-extremity amputations due to Merkerson: There are so many
especially among African-American uncontrolled glucose levels. One of pitfalls on a set. With a constant flow
communities? my brothers suffers from type 2, and of food and snacks, I don’t always
yet there was never any conversation succeed, but the caterers know that
Merkerson: My mother used to in our family aside from the phrase I’m diabetic, so they are extremely
say to all of us (I’m the last of five), “a touch of sugar.” helpful, providing food that won’t
“When you know better, you can do spike my blood sugar levels.
better.” DSM: We’re speaking a couple of
months into the COVID-19 pandemic.
Blood Sugar Rising is a compre- Has anything changed with your dia-
hensive look at diabetes. It covers betes during this social distancing/
the history and the statistics. There quarantine period?
is an illustration of exactly what hap- Merkerson: No, I still finger-prick
pens to the pancreas and the kidneys. twice a day, and we’ve been good
It explains the difference between about trying to maintain scheduled
type 1 and type 2. There are testi- meals. I have listened to the direc-
monies from people who are living tives, and I realize that people with
with the disease. You hear from phy- diabetes are at risk. I am also over
sicians at the forefront of diagnosis 65, so I’ve made masks for us, and
and research, doctors and research- since the quarantine, I have only been
ers speaking on the issues and the out of the house twice, for medication
advances that have been made. and for groceries. DSM
November/December 2020 • DiabetesSelfManagement.com 29
Keto Baked Desserts
Satisfy your cravings with these lower-carb treats
BY LISA CANTKIER
If you follow a ketogenic (also pressure and blood glucose levels, as lunchboxes.And fortunately, low-carb SHUTTERSTOCK
known as a “keto”) diet, finding well as reduced appetite and weight. products are growing in popular-
desserts that meet your needs and ity and availability. Combine these
satisfy your cravings can be tricky. Many higher-carbohydrate foods options with a little at-home baking,
Originally used to treat epilepsy in are refined, processed and contain and it’s entirely possible to avoid
children, the keto diet is a low-carb, added sugar, additives and preser- traditional baked desserts altogether.
high-fat, moderate-protein style of vatives that aren’t good for anyone.
eating that is seeing increasing popu- This doesn’t change the fact, how- Interested in giving keto treats a
larity among those looking to lose ever, that it can be challenging to try? Here are a few quick and simple
weight or manage blood glucose give up certain enjoyable high-carb nutritious lower-carb desserts that
levels through reduced carb intake. foods, such as baked desserts. For you can bake at home! DSM
When done correctly and carefully this dilemma, lower-carb baked des-
under the guidance of a healthcare serts are the answer. Lisa Cantkier is an educator, writer
professional, following a low-carb and coach specializing in nutrition
diet like this can offer a variety of Keto desserts are a great way to and health. She also helps individuals
possible health benefits, including help adults and kids alike satisfy their with diabetes and digestive disorders
improvements in blood fat, blood cravings and can be offered either manage special diets. You can email her
as alternatives for traditional after- at [email protected].
dinner treats or as snacks in school
30 DiabetesSelfManagement.com • November/December 2020
Chocolate Blueberry Mug Cake Macaroons
Chip Cookies Muffins
2 SERVINGS | ½ MUG CAKE 12 SERVINGS | 1
12 SERVINGS | 1 COOKIE 12 SERVINGS | 1 MUFFIN MACAROON
CAL 161 | FAT 13G | CARBS
CAL 86 | FAT 8G | CARBS 7G | CAL 194 | FAT 17G | CARBS 12G | SODIUM 186MG CAL 142 | FAT 13G | CARBS
SODIUM 32MG 14G | SODIUM 37MG 21G | SODIUM 33MG
2 tablespoons and 2
1 cup almond flour 2¼ cups almond flour teaspoons almond ¾ cup powdered
4 tablespoons sugar-free ½ cup powdered flour erythritol, or
equivalent of
chocolate chips, such erythritol, or 1 tablespoon stevia
as Lily’s brand equivalent of powdered
2 tablespoons powdered stevia erythritol, or 2½ cups unsweetened
erythritol, or 1½ teaspoons baking equivalent of shredded coconut
equivalent of stevia powder stevia
1⁄8 teaspoon baking Pinch of salt Pinch of salt ½ cup unsweetened
powder 1⁄3 cup solid butter chocolate chips,
Pinch of salt or coconut oil ¼ teaspoon baking such as Lily’s brand
2 tablespoons butter, (melted) powder (optional)
melted (or melted 1⁄3 cup unsweetened Pinch of salt
coconut oil) almond milk 1 tablespoon raw
1 teaspoon pure vanilla 3 large eggs cacao or cocoa 1½ teaspoons pure
extract 1 teaspoon pure powder vanilla extract
3 teaspoons whole milk vanilla extract
(or nondairy milk) 1 cup blueberries 1 tablespoon 2 large egg whites
mayonnaise
1. Preheat oven to 325°F. 1. Preheat oven to 350°F. 1. Preheat oven to 350°F.
1 large egg yolk Line a baking sheet with
2. Stir dry ingredients in a large 2. Line a 12-serving muffin 1 teaspoon water parchment paper. In a large
bowl. pan with muffin liners. bowl, combine all ingredi-
1. Combine dry ingredients ents well by mixing with
3. Add in wet ingredients to 3. In a large bowl, stir dry minus cocoa into a coffee your hands.
form a dough. ingredients together. mug and mix very well with
a fork. Sift in the cocoa to 2. Wet your hands and then
4. Shape into 1-inch balls. 4. Mix in wet ingredients reduce its bitterness. place 1½ tablespoons of
and fold in blueberries. macaroon mixture on the
5. Place cookie balls on a cookie 2. Add wet ingredients and baking sheet. Repeat this
tray and bake on center rack for 5. Pour batter equally into stir well throughout. step with the remaining
10 to 12 minutes. muffin cups. Bake for 22 to mixture, spacing macaroons
25 minutes, until the tops 3. Allow batter to rest for 2 about an inch apart.
6. Allow cookies to cool and are golden brown. to 3 minutes.
firm up for 8 to 10 minutes. 3. Bake macaroons until
4. Microwave batter for 45 golden brown, 18 to 20
to 50 seconds. minutes. Allow to cool.
November/December 2020 • DiabetesSelfManagement.com 31
Former Miss America Nicole
Johnson, DrPH, MPH, MA,
and her daughter.
TIPS FOR COURTESY OF NICOLE JOHNSON
Navigating
the Holidays
BY SUSAN WEINER, MS, RDN, CDCES, FADCES
32 DiabetesSelfManagement.com • November/December 2020
T he most wonderful time of the But not to worry—there are ways might already be slightly dehydrated.
year is finally here! Because to navigate the festivities while main- Try some sparkling water instead
food and celebrations are plentiful, taining your health and sanity. Try of champagne. It looks festive and
holiday time may wreak havoc with these tips and strategies to boost can be substituted for extra glasses
your usual schedule and potentially your mood and guide you through of alcohol.
affect your daily diabetes manage- the holiday season. BONUS TIP: Traveling to a friend’s
ment. Social gatherings (both online or family holiday celebration? Freeze
or in-person), shopping, gift giving Ground yourself with gratitude. water bottles the night before you
and traditional holiday fare are a lot Shelby Kinnaird, host of Cook & leave. If you plan to travel by car, a
to juggle. From Halloween to New Chat With Shelby, has been thriv- frozen water bottle will help keep
Year’s Day, we seem to have endless ing with type 2 diabetes for over 21 perishables cold and give you ample
to-do lists added to our typical daily years. Kinnaird shares, “As a busy liquids while traveling.
activities. If you feel overwhelmed person, I find it’s extremely helpful
or disorganized during the holiday to ground myself with gratitude. Be prepared for the diabetes
season, you’re not alone. Every morning, I partake in a five-
minute grateful journal [exercise]. I food police.
write down three things I’m grate- Have you been harassed by a friend
ful for and three ideas for an awe- or relative who acts like the “diabetes
some day ahead. Before bed, I write food monitor” (aka the “food police”)
down three memorable moments of at a holiday gathering? These are
that day. Try it! It will help keep you folks who feel the need to comment
focused, motivated and positive amid on or question your food choices.
the chaos of the holidays.” Aunt Edna might announce that she
also has diabetes and her doctor told
Get organized. her only to eat white meat turkey and
Even the most organized person may plain green beans over the holiday.
feel disorganized during the holidays. She might even make this statement
Have you tried making a master holi- while glaring in your direction.
day to-do list? Create a list of every-
thing you need to do and want to get While some may turn this encoun-
done for the holidays. Whether you ter into an educational moment about
write your task list in a notebook, diabetes management, actor and
on your smartphone or on a bulletin comedian Jim Turner, who has been
board in the kitchen or home office, living with type 1 diabetes for over
make sure your list is in one place and 50 years, shares his own experience
easily accessible. Use a calendar to and advice: “I’ve been very lucky.
create deadlines. Once you have your My family and most of my friends
main list of must-do tasks, break them know not to poke their nose where it
into smaller tasks and place deadlines doesn’t belong. However, there is the
for each on your calendar. occasional nosy poker in the world of
BONUS TIP: Write down every- food police and diabetes police and
thing in a paper calendar (or on your other cultural police. My response
phone) to help keep track of appoint- is always the same. I listen politely,
ments and events. You can even fit in and I say, ‘Thank you so much. I
physical activity or workouts. Make appreciate that. I hadn’t thought of
appointments with yourself. This will that. I’ll try it your way. Thank you.’
give you peace of mind and a plan Then I change the conversation. If
during this busy time of year. the conversation persists, I politely
and quickly change company.”
Stay hydrated.
Drink plenty of water to keep yourself Get physical.
well-hydrated. Continue to drink Exercise can be a great mood booster
water when the weather turns frosty and may reduce stress. If you are not
or when you are extremely busy. keen on going to the gym, check out
Thirst is not always a great indicator the plentiful YouTube and Instagram
of when to take a drink. As a matter exercise videos and workouts avail-
of fact, by the time you’re thirsty, you able for every fitness level. Take a
walk with a friend, co-worker or your
adoring dog. Try a new online dance
November/December 2020 • DiabetesSelfManagement.com 33
class or yoga session. while jumping rope in the garage. If If you drink alcohol, do so SHUTTERSTOCK
Write your scheduled exercise you ditch the excuses, there’s always
a way to stay active no matter what in moderation.
time in your planner, jot it down the season.” Alcohol can significantly affect
on your calendar or load it on your your blood glucose. For one
smartphone. Physical activity is one Plan ahead and check your thing, it may impact the ability
appointment that shouldn’t be post- of your liver to regulate blood
poned or taken off the calendar. blood sugar. glucose levels. In addition,
Vieira acknowledges the importance of it can interfere with medi-
On Thanksgiving morning, con- potential medication adjustments and
sider participating in a fun run or frequent blood sugar checks. Accord- cations you may have been
walk. Many communities host Turkey ing to her, “On the specific day of a prescribed for diabetes man-
Trots for charity, and there are lots holiday, like Thanksgiving, I increase agement and other health
of virtual options available this year. my background (basal) insulin dose by conditions. Be sure not to
You’ll cross the finish line and be a unit or two to help compensate for drink on an empty stomach,
home in time to eat your festive meal. the extra calories and more indulgent as alcohol can also impair
meals. Before that day and before decision-making as well
Author, speaker and athlete Gin- that holiday meal, I really try to stick
ger Vieira was diagnosed with type to the basics: Get plenty of exercise as reduce your ability to
1 diabetes and celiac disease over every day and eat mostly very healthy make informed decisions
20 years ago. While working from food, so there’s room for indulging in about food choices and por-
home, she balances her work, caring yummy holiday treats. I also check tions. And remember that
for her young children and an ever- my blood sugar more after those the calories and carbohy-
changing exercise program, even meals. Also, keep in mind how slowly drate content (especially
during the holidays. Vieira says, “In that big holiday meal might digest. for fruity cocktails) can
the winter, the kids and I run around If you take your entire meal dose vary significantly among
in the snow. There’s no easier way to at the time of eating, you’ll likely go beverages. Recommenda-
get your heart pumping in the winter low. On Thanksgiving, for example, I tions for alcohol are no more
than trudging through snow in your spread a huge meal bolus out over the than one drink per day for women and
snow pants. I bundle up from head course of four or five hours because no more than two per day for men.
to toe even for dog walks to ensure the high-fat, high-protein, and high- (An example of one drink is 12 ounces
the cold temperatures don’t get in carbohydrate goodies are going to of beer, 5 ounces of wine, or 1 ounce
the way of exercising. I’ll also put digest very slowly.” of distilled spirits.) Speak with your
on a jacket and gloves to stay warm healthcare professional for individual
guidance on alcohol consumption.
BONUS TIP: Take a liquid measur-
ing cup and a wine glass out of your
cabinet at home. Measure out 5 ounces
of water (which is the recommended
serving of wine) and pour it into the
wine glass. Now you will have a visual
awareness of what a serving of wine
is supposed to look like. Remember,
you can decide when to say “stop” if
a friend or relative is pouring a glass
of wine for you at a holiday gathering.
Get enough shut-eye.
A good night’s sleep is one of the keys
to good health. If you don’t get enough
sleep, you simply may not feel your
best. Have you ever confused fatigue
with hunger and eaten more food
when sleep-deprived? Overindulging
in food rather than getting enough
sleep may lead to unwanted weight
gain and fluctuating blood sugar levels.
If possible, try to keep to a regu-
lar bedtime routine. Go to sleep and
wake up at approximately the same
34 DiabetesSelfManagement.com • November/December 2020
time every day. While this can be needs some time to recharge, espe- KEEP CONNECTED
challenging during the holidays, it cially during the holidays, so claim DURING THE
can help improve your slumber. Try an afternoon to treat yourself to spa HOLIDAYS
to avoid excess alcohol and caffeine time…even in your own bathroom!
and turn off all technology (including Take a bath. Light a candle (I like Janis Rozner, PhD, RDN, LMFT,
your smartphone and social media) the ones with the wooden wicks that CDCES, and board-certified sex
at least an hour before bedtime. This sound like a fireplace). Turn on spa therapist, reminds us to nurture
will reduce your stress and hopefully music, the kind with whales, birds romantic and social connections
help you get a restful night’s sleep. or ocean sounds. I treat myself to a during the holidays. Rozner suggests
BONUS TIP: Keep your room dark. facial mask while soaking in the tub. that we partake in at least one type
Make sure the shades are drawn and Then I step back into the real world, of intimacy (see below) every day to
the lights are off. Cover the lights on but that world has taken on a softer maintain a close connection with our
the cable box or computer if neces- hue, and I can manage it much better.” partner, even when times are hectic.
sary. If any remaining lights bother
you, try wearing an eye mask. Keep a Focus on friends and family. Affection (not sexual): Say,“I love
flashlight on your nightstand (or next to Nicole Johnson, DrPh, MPH, MA, and you.”Say,“Thank you.”Give a peck
your bed), so you can check your blood Miss America 1999, reminds us of the on the cheek, hold hands or enjoy a
glucose or continuous glucose monitor importance of focusing on family and quick hug.
(CGM) as necessary during the night. friends, especially during the holiday
season. Johnson, who was diagnosed Emotional: Share your feelings. Use
Treat yourself to mini-spa time. with type 1 diabetes 27 years ago, “I”language:“I feel ____ when ____.
Recharge your battery by scheduling says, “2020 has taught us all to slow What I need is ____.”
some alone time. Enjoy a massage, down and appreciate the little things.
nature walk, manicure/pedicure, or This year, I have developed habits that Social: Go out on a double date or
funny TV show or movie. Begin your I didn’t know I needed. I take walks Zoom with others.
day with some deep breathing exer- twice a day—this is for my diabetes
cises and a cup of delicious herbal tea. management and for my relation- Aesthetic: View something of
ships—and I will continue to do so beauty together, like a sunset or a
Jo Jo Dantone, MS, RDN, LDN, throughout the holiday season. In the painting.
ADCES, FAND, is an award-winning evening, the walk is with my daughter
registered dietitian/nutritionist who and becomes a time of no distrac- Intellectual: Discuss different
lives life to the fullest with type 1 tion and complete connection. The issues or topics. Steer clear of politics
diabetes. Dantone shares, “Quiet time health benefits of this small change if you are on opposite sides of the
with yourself is underrated. Everyone are enormous. I can truly say I am issue. The goal is to connect, not to
move further apart.
SHUTTERSTOCK happier than I have
ever been because Spiritual: Meditate at the same
of the strength time.
of connections.
I have grown to Physical (not sexual): Go for a
cherish my time of walk or ride bikes together.
focus on my family.
When I’m off from Sexual: Fit in sexual activity at a
work, even though I time that works well for you and your
partner.
work from home, my
time off is a sacred from taking photos of flowers to plant-
respite spent with ing in my yard to watching sunsets.
my daughter and This behavior fills my soul with joy
family.” and that helps me recharge.” DSM
“During the holi- Susan Weiner, MS, RDN, CDCES,
days, I take time to FADCES, is the owner of Susan
cherish something in Weiner Nutrition, PLLC, and was
nature. I find that by the 2015 AADE Diabetes Educator
investing in and appre- of the Year. You can reach her at
ciating the beauty of [email protected].
the world around me,
I am more grounded.
This means everything
November/December 2020 • DiabetesSelfManagement.com 35
Welcoming
Old Man Winter
Tips to keep the cold weather from freezing your diabetes management efforts
BY AMY CAMPBELL, MS, RD, LDN, CDCES
Winter is upon us. Depending festivities and a sense of hibernation weather.That’s because cold air makes
on where you live, you may can make your diabetes a little more it easier for viruses to stick around
have already started shoveling, snow challenging to deal with. However, longer. And some viruses, such as the
blowing and driving on slippery roads all things are possible—it’s a matter rhinovirus, thrive more in cold tem-
of adapting and maybe having a few peratures. In addition, when the ther-
with blinding snow—all hall- hacks up your sleeve. mometer takes a nosedive, you might
marks of wintery weather. be spending more time indoors, where
As the seasons change, so Stay healthy you’re surrounded by people who are
can managing your diabe- Well, yeah! That’s obvious. Avoiding also sick. So how do you stay healthy?
tes. Cold weather, holiday COVID-19, along with other common
cold-weather illnesses, is a key worry • Get your flu shot and talk with
on everyone’s minds lately. Of course, your healthcare provider about getting
you got your flu shot, right? If not, it’s a pneumonia vaccine if you haven’t
not too late. While getting a flu shot had one yet (a pneumonia vaccine is
is extremely important for everyone, recommended for anyone with diabetes
especially for those with diabetes, to age 2 and older).
reduce the risk of illness, it’s not a guar-
• Wash your hands often for at least
antee that you won’t get the flu. Plus, 20 seconds and avoid touching your
we’re all more likely to “catch” eyes, nose and mouth. If soap and
the common cold or pick water aren’t handy, use hand sanitizer
up other viruses that contains at least 60% alcohol.
during the
cold • Wear a mask over your mouth and
nose when around others who are not
from your household and maintain at
least 6 feet of physical distance.
SHUTTERSTOCK
36 DiabetesSelfManagement.com • November/December 2020
November/December 2020 • DiabetesSelfManagement.com 37
your feet every day for cuts, sores or
areas of redness or warmth. Signs of
frostbite include whitish or bluish-gray
skin, combined with numbness, and
possible blisters. Call your healthcare
provider right away if you have any of
these symptoms.
• Keep your feet clean and moistur-
ized (not between your toes, though) to
prevent dryness and cracking.
• Clean and disinfect frequently from freezing. Be active SHUTTERSTOCK
touched surfaces and objects each day. • CGMs, meters, test strips and con- Try not to let the cold, snowy weather
prevent you from moving! Remember
• If you get sick, follow your sick-day trol solution can be impacted by the that the goal is to fit in at least 150
plan. No sick-day plan? Talk with your cold as well, so take care to keep them minutes of physical activity every week.
doctor or diabetes educator about get- at room temperature. Your warm-weather physical activities
ting one in place before you get sick. may no longer work when the tempera-
Protect your feet ture is below freezing, so think about
Guard your diabetes supplies Cold, dry weather can dry out the skin other options to help you meet your
If you’re out and about in the cold anywhere on your body; your feet are activity goals during the winter months.
weather and you take insulin or non- especially vulnerable as they can crack,
insulin injectable medicine, such as a making you more susceptible to devel- • Skiing, snowshoeing and ice skat-
GLP-1 agonist (e.g. Trulicity, Victoza, oping infections. In addition, if you ing are ways to enjoy the outdoors and
Ozempic, Byetta/Bydureon, Adlyxin), have loss of sensation in your feet from stay active (make sure to dress warmly
protect it at all costs. Like other liq- neuropathy and/or poor circulation, and keep your hands and feet dry).
uids, insulin and GLP-1 agonists can you may not realize that your feet are
freeze, causing them to become inef- cold, putting you at risk for developing • If venturing outdoors in frigid
fective. Your diabetes equipment can frostbite, which can cause significant temperatures isn’t your thing, choose
be affected by cold temperatures, too. damage. indoor activities such as working out
with exercise videos or participating in
• Don’t leave your insulin or GLP-1 • Wear appropriate waterproof virtual group exercise classes.
agonist in a cold car. Depending on footwear in the cold weather. If you’re
how cold it gets where you live, your exercising outdoors, choose sneakers • Bring along snacks and treatment
injectable medication could be affected that are geared toward winter weather, for low blood sugars if you take insulin
even by keeping it in your purse or such as trail running shoes. or diabetes pills that raise the risk of
coat pocket. Keep your vials or pens hypoglycemia, and always wear or
in an insulated case, such as the FRÍO • Use sweat-wicking socks that carry some form of medical ID.
insulin case. keep your feet dry. If needed, wear
another layer over them, but avoid • Stay hydrated! Just because it’s
• If you use an insulin pump, wear socks that are too thick to fit into your cold out and you don’t feel thirsty
it close to your body and throw on shoes or boots. doesn’t mean you can’t become dehy-
an extra layer of clothing to keep it drated. Make sure to drink plenty of
• Be extra diligent about checking non-caloric fluids; better yet, keep a
water bottle with you to remind you
to drink.
Keep an eye on the scale
If your idea of getting through the long
winter months means curling up on
the couch and binge-watching your
favorite series, take extra precautions
to make sure the pounds don’t pile on.
Extra snacking, hearty comfort meals
and a lack of physical activity can lead
to weight gain. Come up with a plan so
that this doesn’t happen.
• Reach for lower-calorie, lower-carb
snacks such as cut-up raw veggies, pop-
corn or hard-boiled eggs. Pre-portioned
snack bags of whole-grain crackers,
38 DiabetesSelfManagement.com • November/December 2020
baked tortilla chips or nuts are good About 5% of people are affected by Keep on checking
choices, too. SAD, according to the American Psy- Illness, cold weather, holidays and a
chiatric Association, and it’s more change in food choices can all impact
• Make a habit of sipping on sugar- common in women than in men. your blood glucose and A1C levels
free beverages when watching TV. Try Symptoms include feeling anxious, (a measure of glucose control over
water infused with lemon, mint leaves being irritable, difficulty concen- the previous two to three months).
or berries; unsweetened hot or cold trating, feeling fatigued and losing Be prepared that your blood sugars
tea or coffee; or flavored seltzer water. interest in doing usual activities. may be very different in the winter
David Spero, RN, a contributor to compared to the summer.
• Keep track of your food intake. Diabetes Self-Management, adds
Doing so can help you be more aware that “depression interferes with dia- • Keep up with regular blood
of what you’re putting in your mouth. betes management.” sugar checks or what your CGM
There are plenty of food-tracking apps is telling you, and pay attention to
out there, including Lose It!, MyFitness- • If you think you might have SAD, trends (e.g., higher fasting or bed-
Pal and MyNetDiary. talk with your healthcare provider. time blood sugars).
Treatment includes lightbox therapy
• Schedule time for exercise. You (phototherapy) and possibly medication • Let your healthcare team know
don’t have to hit the gym. Climbing and counseling. if your glucose levels are consistently
stairs, using hand weights or march- outside of your target range—apart
ing in place while you watch TV are • Stay active, both physically and from food and activity, you may need
easy ways to stay on the move and socially. Exercising and connecting with a medication adjustment.
burn calories. family and friends can improve your
mood and reduce stress and anxiety. Befriending Jack Frost
Manage your mood Your diabetes self-care plan will
Some people find winter to literally • Focus on making healthy food likely need some adjusting when the
be a depressing time of year. Sea- choices rather than reaching for high- winter winds are blowing, but don’t
sonal affective disorder (SAD) is a carb, high-fat comfort foods. let the cold weather stop you in your
type of depression that can emerge tracks. And remember that summer
during the winter due to shorter • Get plenty of sleep—but not too is just around the corner! DSM
days and a lack of sufficient sunlight. much. Aim for about eight hours of
sleep each night.
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BY ALISON MASSEY, MS, RD, LDN, CDCES
Amid all the hustle and bustle of lished this year to help people living recipe and meal prep inspiration, there SHUTTERSTOCK
the holidays, it’s important to take with diabetes improve their self-care. is a book that has your needs covered.
some time to relax and perhaps sit Regardless of whether you‘re looking As a registered dietitian and certified
back with some good reading material. for a title specifically about diabetes diabetes care and education specialist,
Several fantastic books have been pub- management or are seeking some new here are some of my top picks.
40 DiabetesSelfManagement.com • November/December 2020
BEST DIABETES BOOKS OF 2020
THINK LIKE A PANCREAS
A Practical Guide to Managing
Diabetes With Insulin
Third Edition
May 2020
Gary Scheiner, MS, CDCES
An updated and revised third edition
of this book is a must-have resource
for anyone who takes insulin. Full
of practical guidance on how to suc-
cessfully match insulin to the body’s
changing needs, this updated version
also focuses on both new medications
and technologies that aid in diabetes
management.
WHAT DO I EAT NOW?
A Guide to Eating Well With
Diabetes or Prediabetes
Third Edition
April 2020
Tami A. Ross, RDN, LD, CDCES, MLDE
This new revised and updated edition
provides the latest information on dia-
betes management and healthy eating
and meal planning. A beginner’s guide
on vital concepts of diabetes nutrition,
this book includes overviews of topics
such as macronutrients, eating pat-
terns, reading nutrition labels, and
shopping and cooking techniques, as
well as guidance for eating at special
occasions.
BEST DIABETES MEAL PREP AND COOKBOOKS OF 2020
THE CLEAN & SIMPLE
DIABETES COOKBOOK
Flavorful, Fuss-Free Recipes for
Everyday Meal Planning
January 2020
Jackie Newgent, RDN, CDN
This cookbook focuses on flavorful
food based on simple recipes that are
made with minimal ingredients. The
best part? Most recipes require 15
minutes or less of preparation time,
which makes healthy eating attainable
for everyone—even the most amateur
of home cooks. Basic tips on managing
diabetes and grocery shopping guides, as well as menu ideas and meal plans,
are included in the book.
November/December 2020 • DiabetesSelfManagement.com 41
THE CREATE-YOUR-PLATE DIABETES COOKBOOK
A Plate Method Approach to Simple, Complete Meals
March 2020
Toby Amidor, MS, RD, CDN, FAND
This guide comes complete with 125 mix-and-match recipes that will help
you plan balanced and perfectly portioned meals using the Diabetes Plate
Method. Each recipe is designed to follow the American Diabetes Association
nutrition guidelines. The book provides photographs of sample plates to
provide a visual guide to meal planning, as well as a one-week meal
plan and plenty of tips for using the Diabetes Plate Method. DSM
Alison Massey, MS, RD, LDN, CDCES, is a registered dietitian
and certified diabetes care and education specialist in Maryland.
A CHAT WITH AUTHOR
TOBY AMIDOR
Toby Amidor, MS, RD, CDN, FAND, Association to write a cookbook based know how to
is an award-winning nutrition on their Diabetes Plate Method. I was make, such
expert and Wall Street Journal best- thrilled because this method was so as a green
selling author. We recently spoke with much simpler than other methods I salad, a piece
her about her latest book, The Create- have seen. I was so happy that the of grilled
Your-Plate Diabetes Cookbook: A Plate Diabetes Plate Method could help so chicken and
Method Approach to Simple, Complete many folks who have diabetes easily whole-wheat
Meals. She provides her best tip for create a meal without counting, mea- pasta. Then
preparing delicious and healthy meals suring, tracking or calculating. find a simple
at home and gives a sneak peek into recipe that you
her book, sharing one of her favorite DSM: What kind of recipes and can include on
recipes. flavors can readers expect from your the plate, like a
cookbook? simple Sautéed
Diabetes Self-Management: Mushroom Med-
What inspired you to develop this Amidor: The cookbook is filled ley or Weeknight
cookbook? with all types of recipes, meals and Vegetable Stir-Fry.
flavors. I am from a Mediterranean The recipes in The
Toby Amidor: My first job as a background, so you will certainly see C r e a t e - Yo u r- P l a t e
registered dietitian was at a hospital dishes like Spinach and Feta Stuffed Diabetes Cookbook are
in Brooklyn, New York, where part Mushrooms and Greek-Style Salad made for beginners, with
of my job was to educate those who With Tuna and Farro, but I also made ingredients that are easy to
needed to better understand nutrition sure to include flavors from all types find and simple instructions.
[to help manage their] health condi- of cultures and cuisines. Some of my
tion. Much of my nutrition education favorites are Slow Cooker Mexican DSM: What are some of your
was geared toward patients who had Chicken Soup, Southwest-Style Turkey favorite recipes from this book?
diabetes—and [providing them with Meatloaf, Lamb and Chickpea Curry,
all the necessary information] was no and Pork Stir-Fry With Orange Sauce. Amidor: I love barbecues, and
easy feat.A diabetic-friendly meal plan one of my favorite plates in the cook-
consists of all the food groups, carefully DSM: What is your top tip for those book is Grilled Chicken and Vegetable
balanced [between] carbohydrates, who might be intimidated by cooking Skewers With Kale Apple Slaw. I make
proteins and fats. It took me a lot of or putting together meals? it regularly for my family over bar-
time to explain a diabetic-friendly meal becue season. I also love my Ruby
plan to people with diabetes, especially Amidor: Start simple. The Dia- Red Ice Pops, which are perfect as a
when there was calorie counting or betes Plate Method is very simple, snack on a hot day.
measuring involved. as there is no measuring or count-
ing involved—all you need is a plate To try Amidor’s Ruby Red Ice Pops
Fast-forward 18 years, I was and to follow a few easy steps. Start and her other delicious recipes, visit
approached by the American Diabetes by filling your plate according to the TobyAmidorNutrition.com. DSM
Method with simple foods that you
42 DiabetesSelfManagement.com • November/December 2020
Roasted Salmon With
Chimichurri Sauce
Amidor shares her drool-worthy Roasted
Salmon With Chimichurri Sauce recipe from
The Create-Your-Plate Diabetes Cookbook.
4 SERVINGS | 1 5-OUNCE PIECE OF SALMON
AND 2 TABLESPOONS OF SAUCE
DIETARY EXCHANGE: 4 LEAN PROTEIN, 2 FAT
TOTAL TIME 15 MINUTES PLUS 10 MINUTES’
COOLING TIME PREP TIME 3 MINUTES COOK
TIME 12 MINUTES
Roasted Salmon
CAL 280 | CAL FROM FAT 150 | FAT 17G | SAT
FAT 3G | TRANS FAT 0G | PROTEIN 28G | CARBS
2G | SUGARS 0G | ADDED SUGARS 0G | CHOL
75MG | FIBER 1G | SODIUM 240MG | POTASSIUM
580MG | PHOSPHORUS 375MG
Nonstick cooking spray
4 5-ounce salmon fillets
½ cup Chimichurri Sauce (recipe below)
1. Preheat oven to 400°F.
2. Coat a medium ovenproof pan with nonstick
cooking spray and heat over medium heat.
When the pan is hot, add the salmon and cook
for 1 minute, then turn and cook the other side
for an additional minute.
3. Using an oven mitt, carefully place the pan
into the oven and continue cooking the salmon
about 10 minutes, until a thermometer inserted
into the thickest part of the fillet reads 145°F.
4. Carefully remove the hot pan and place on
the stove to cool for about 10 minutes. Serve
each piece of salmon with 2 tablespoons of the
Chimichurri Sauce.
Chimichurri Sauce
4 SERVINGS | 2 TABLESPOONS
DIETARY EXCHANGE 1½ FAT
TOTAL TIME 5 MINUTES PREP TIME 5 MINUTES
COOK TIME 0 MINUTES
CAL 70 | CAL FROM FAT 60 | FAT 7G | SAT FAT
1G | TRANS FAT 0G | PROTEIN 0G | CARBS 2G |
SUGARS 0G | ADDED SUGARS 0G | CHOL 0MG |
FIBER 1G | SODIUM 150MG | POTASSIUM 80MG |
PHOSPHORUS 10MG
¼ cup water
2 tablespoons olive oil
2 tablespoons white wine vinegar
¾ cup fresh parsley, roughly chopped
2 cloves garlic, minced
2 teaspoons dried oregano
¼ teaspoon salt
1⁄8 teaspoon red pepper flakes
Add all the ingredients into a blender and blend
until smooth.
November/December 2020 • DiabetesSelfManagement.com 43
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2020-11-01 Diabetes Self-Management
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