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Diabetes Self-Management (March - April 2020)

Diabetes Self-Management magazine offers up-to-date, instructive and practical “how-to” information that has immediate application on nutrition, exercise, new drugs, medical advances, self-help for people with diabetes. It has also many other topics people need to know about to stay healthy.

Articles focus on exercise and fitness, nutrition and diet, and the techniques, products, and strategies that

help readers take charge of their well-being and live happier, healthier lives.

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Features


26
Save Money on
Your Medicines
Strategies to reduce costs
at the pharmacy counter
At The Table
When Two
29
Celebrate Spring!
Disorders Meet 48
Diabetes and thyroid The spring season is a time
disease frequently coexist, to explore and renew. Just
and a coordinated as physical and mental
strategy is required to well-being are important
manage both conditions components of healthy
successfully living with diabetes, so is
eating deliciously well.
34 Managing Diabetic
Kidney Disease
Steps to prevent, slow
and reverse this common
complication The Dose
6 News & Notes

38 Living With a 9 Quiz
Type 1 Diagnosis 12 Product Spotlight
Four tips to get 14 Ask Away
you started 16 Curmudgeonly Athlete

42 Staying Healthy Healthy Living
on a Budget
18 The Right Moves
How to safely save 20 Weighty Matters
money on your diabetes
care and supplies 21 Smart Smarter Smartest
22 Getting There
44 Eating Out 24 Food for Thought
With Diabetes
Making the best In Every Issue
menu choices 2 Editor’s Note
63 Recipe Index
64 Final Countdown






On the cover: Selection of fresh
foods photographed by Angela
Sackett. For a list of all recipes in
this issue, see page 63.
SHUTTERSTOCK/ANNE LEVEN





Mar/Apr 2020 • DiabetesSelfManagement.com 1

••• EDITOR’S NOTE •••








Editorial Director, Wellness Division Associate Editor Food Editor
Diane Fennell Matthew Bernat Lorena Drago, MS, RDN, CDN, CDE

ART & PRODUCTION
Art Director Senior Designer
Carolyn V. Marsden Scott Brandsgaard

SALES & MARKETING
Senior Media Solutions Manager Social Media & Marketing & Media
Bob Beucler | [email protected] Marketing Manager Solutions Associate
Senior Media Solutions Manager Tim Doolan Shawn Daniel
Kathy Jones Rizzi | [email protected] Senior Marketing Associate Content Marketing Supervisor
Client Services | [email protected] Tommy Goodale Anthony Buzzeo
Content Marketing Associate
Sarah MacDougall

CUSTOMER SERVICE
[email protected] (855) 367-4813

EDITORIAL BOARD
Pamela Allweiss, MD, MPH William H. Polonsky, PhD, CDE
CDC Division of Diabetes Translation Assistant Clinical Professor,
Amy P. Campbell, MS, RD, LDN, CDE Department of Psychiatry, University of California, San Diego
Boston, Massachusetts Jeanne L. Rosenthal, MD
Attending Surgeon, Retinal Service,
Dear Readers, South Hamilton, Massachusetts New York Eye and Ear Infirmary, New York, New York
Robert S. Dinsmoor
ax time is looming, which means decisions about David E. Goldstein, MD Sheri Setser-Legg, MS, RD, LD, MLDE, CDE
Professor Emeritus, University of Missouri Diabetes Education Service Coordinator
Tfinances are front and center for many people. Health Science Center, Columbia, Missouri UK HealthCare Barnstable Brown Diabetes Center,
University of Kentucky, Lexington, Kentucky
And if you’re living with diabetes, you know the Laura Hieronymus, Bernard P. Shagan, MD
DNP, MSEd, RN, MLDE, BC-ADM, CDE, FAADE
impact the condition can have on your wallet. Between Associate Director, Education & Quality Services, Director, Diabetes Education Center,
UK HealthCare, Barnstable Brown Diabetes Center, Monmouth Medical Center, Long Branch, New Jersey
prescriptions, medical equipment and supplies, University of Kentucky, Lexington, Kentucky Richard M. Weil, MEd, CDE
co-pays for doctor visits, healthy food and more, it can Virginia Peragallo-Dittko, Exercise Physiologist and Director, Mount Sinai St. Luke’s
RN, BC-ADM, CDE, FAADE, FAAN Weight Loss Program, Mount Sinai St. Luke’s Hospital,
really add up. Fortunately, there are strategies you Executive Director, Diabetes and Obesity Institute, New York, New York
Winthrop-University Hospital, Mineola, New York Susan Weiner, MS, RDN, CDE, CDN, FAADE
can use to trim your budget while maintaining your Owner, Susan Weiner Nutrition, PLLC, Long Island, New York
Jeff Plumer, Vice Chair JDRF International
health. Whether you’re looking for ways to save at the Board of Directors Stephen Z. Wolner, DDS
New York, New York
pharmacy counter (page 26), tips to reduce your outlay In Memoriam Dr. Lois Jovanovic, 1947-2018
for common supplies and nutritious foods (page 42), or
approaches to spend less for fitness (page 16), there’s
something here for you. OPERATIONS
Beyond monetary considerations, avoiding VP, Circulation Strategy Client Services and Human Resources Manager Accounting Director
Jason Pomerantz Circulation Supervisor Alicia Roach Amanda Joyce
complications—or effectively managing them if they Operations Director Andrea Palli Senior Client Services Associate Accounts Payable Associate
occur—is another top concern. In “Managing Diabetic Cheyenne Corliss Operations and Tou Zong Her Tina McDermott
Front Desk Coordinator Client Services Accounts Receivable Associate
Kidney Disease” (page 34), learn about steps that Toni Eunice Darren Cormier Wayne Tuggle
can help you prevent, slow and reverse this common
complication and keep your kidneys in top shape. And DIGITAL OPERATIONS
read about how thyroid disorder and diabetes are Director of Digital Audience Development Analyst Senior Digital Designer WordPress Developer
Mike Decker
David Glassman
Leza Olmer
Ryan Gillis
related—and how thyroid conditions can potentially
EXECUTIVE
affect blood glucose control—in “When Two Endocrine Chairman & CEO Chief Operating Officer SVP, Sales & Strategic Partnerships Content Director
Disorders Meet” (page 29). Jeffrey C. Wolk Courtney Whitaker Stuart Crystal Matt Martinelli
Finally, you may have picked up this issue because In memory of Susan Fitzgerald, COO, 1966-2018
you or a loved one was recently diagnosed with type 1 Newsstand Distribution Weekly Retail Service
diabetes. You may be frightened and overwhelmed, but
Diabetes Self-Management, March/April 2020, Volume 37, Number 2. Diabetes Self-Management (ISSN 0741-6253) (USPS
living well with the condition is definitely doable. The 003-865) is published bimonthly by Madavor Media, LLC, 25 Braintree Hill Office Park, Suite 404 Braintree, MA 02184.
Periodicals postage paid at Boston, MA and at additional mailing offices. Copyright © 2020 Madavor Media, LLC. U.S.
subscriptions $29.94 per year. Postmaster: Please send changes of address to Diabetes Self-Management, P.O. Box 8507,
four expert tips on page 38 from Certified Diabetes Big Sandy, TX 75755-8507. For customer service or subscription information, please call (855) 367-4813. Advertising
Sales: Madavor Media, LLC (800) 437-5828.
Educator and Registered Dietitian Amy Campbell can All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, elec-
tronic or mechanical, including photocopying, recording, or any other means, without the prior written permission
help you get started. of Madavor Media, LLC.
Here’s to better physical and financial health! Statements and opinions expressed in this publication are those of the authors and not necessarily those of the publishers
or advertisers. The purpose of this magazine is to provide readers with accurate and up-to-date medical information. It is
not intended to provide medical advice on personal health matters, which should be obtained directly from a physician.
All the best, We regret that we are unable to respond to inquiries about personal health matters.
We sometimes make our list of subscribers available to carefully screened organi-
zations whose products and activities may interest you. While many subscribers
find this type of information valuable, some prefer not to receive unsolicited mail.
Please contact our customer service department at (855) 367-4813 if you do not
wish to receive such mailings.
Diane Fennell Photographs contained in this magazine are for illustration purposes only. SHUTTERSTOCK/YRABOTA
Editorial Director, Wellness Division For customer service or subscription information, please call (855) 367-4813.

2 DiabetesSelfManagement.com • Mar/Apr 2020



••• DiabetesSelfManagement.com •••





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••• THE DOSE ••• News & Notes



















































How Sleep Can Affect




Diabetes: Study





BY JOSEPH GUSTAITIS




e all know that getting a good and subjective quality of sleep. Sleep of sleep and inconsistent sleep dura-

Wnight’s sleep is important to efficiency is defined as the ratio of the tion, but not all of these variables had
our health, and that includes the total time spent asleep compared to an equal effect. The factor with the
health of people with diabetes. But the total time spent in bed (people greatest effect was sleep variability
exactly what does “a good night’s who are asleep nearly all the time (short and long), followed by, in order,
sleep” mean? Recently, researchers in they are in bed are said to be sleeping total sleep duration, subjective sleep
the Netherlands investigated that very more efficiently). Sleep variability is a quality, variability in midsleep time
question and published the results in measure of how differently a person and sleep efficiency. Interestingly, the
the journal Diabetes Care. might sleep from night to night, and researchers did not find an associa-
The researchers collected data midsleep time is a way of evaluat- tion between HbA1c and insomnia.
on 172 patients with type 2 diabetes ing how late a person goes to sleep One benefit of their research,
(T2D) who were receiving care from and wakes up. Subjective quality of the investigators concluded, is
the Amsterdam University Medical sleep refers to how a person rates the the realization that sleep patterns
Center. The researchers’ goal was to quality of his or her night’s sleep (a can, through various therapies, be
learn how different sleep measures person can sleep less than usual but changed and adjusted, which might
affected the subjects’ HbA1c, which still wake up feeling great). make it possible to affect the way
is a measure of a person’s average The researchers found that the sleep influences HbA1c. As they put
blood glucose (sugar) levels over the different measures of sleep did, in it, “Sleep in general may be a modifi-
previous two to three months. fact, have diverse effects on HbA1c. able factor of importance for patients
The investigators looked not only Higher HbA1c levels were seen in with T2D. The prevention of sleep

at how long the patients slept but also people with lower sleep efficiency, curtailment may serve as a primary
at other sleep measures—sleep effi- higher variability in sleep and mid- focus in the sleep-centered manage- SHUTTERSTOCK/TOMMASO79
ciency, sleep variability, midsleep time sleep time, worse subjective quality ment of T2D.” DSM

6 DiabetesSelfManagement.com • Mar/Apr 2020

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••• THE DOSE ••• News & Notes












































New Gene Regions Linked



to Diabetic Kidney Disease




in Type 1





BY QUINN PHILLIPS




t’s well known that having poorly there are wide individual differences ease, the strongest link was found in a
Icontrolled or longstanding diabetes in who develops diabetic kidney dis- gene variant that affects the structure

increases the risk of developing com- ease, since some people with excellent of certain membranes in your kid-
plications, including diabetic kidney blood glucose control will eventually neys by making a form of collagen, a
disease (DKD)—a leading cause of develop it, while others with less-ideal protein. Other identified gene regions
disability in people with diabetes control won’t. So researchers at UCD, were also associated with collagen
that can end in organ failure. That’s in cooperation with teams at other production or with inflammation or
because elevated blood glucose levels universities in Europe and North immunity. The researchers hope that
cause damage to blood vessels over America, looked at 19,406 people identifying these gene regions is the
time, and the tiny blood vessels in with type 1 diabetes—with and with- first step toward developing therapies
your kidneys are especially prone to out kidney disease—to try to find to protect vulnerable people from
this type of damage. out what genetic factors might help diabetic kidney disease.
But blood glucose control and explain differences in risk. “Despite our best efforts, the rates
duration of diabetes aren’t the only As described in a UCD press of diabetes and associated vascular
factors in developing diabetic kidney release, participants received kid- complications remain unacceptably
disease. In a new study—the largest ney function tests and urine tests high,” says lead researcher Catherine
ever to look at the genetic factors to look for indicators of kidney dis- Godson, a professor at the UCD School
behind this complication—research- ease. They also had their genomes of Medicine, in the press release.
ers at University College Dublin (UCD) scanned, and researchers looked “There is an urgent need to predict
in Ireland have identified 16 areas of for links between gene regions and those individuals with diabetes who
the human genome that contribute to kidney-related outcomes. are at risk of developing complica-

diabetic kidney disease risk in people Out of the 16 areas of the human tions such as DKD and to develop
with type 1 diabetes. genome that the researchers identi- effective drugs to treat the disease SHUTTERSTOCK/SWEET MANGO
Scientists have long known that fied as related to diabetic kidney dis- in susceptible people.” DSM

8 DiabetesSelfManagement.com • Mar/Apr 2020

FDA TESTING METFORMIN

FOR CARCINOGEN



BY QUINN PHILLIPS




ince its approval for marketing in the United States
Sin 1994, metformin has become the first-line drug for
treating type 2 diabetes. It’s no exaggeration to say that this

medicine has revolutionized how type 2 is treated, since
it lowers blood glucose levels without the significant risk
of hypoglycemia (low blood glucose) associated with older
classes of drugs for type 2. It also appears to have a range of
QUIZ secondary benefits, from weight loss to better heart health

to improved cognition to reduced anxiety.
CUTTING COSTS FOR But in the wake of warnings from the Food and Drug
Administration (FDA) that low levels of the potentially
DIABETES CARE cancer-causing contaminant N-nitrosodimethylamine

BY HELENE ENGLER, PHD (NDMA) were found in the acid reflux drug Zantac (raniti-
dine), the agency has confirmed that it is testing samples
of metformin for the same substance, according to a report
ood health is your wealth. But if you have from Bloomberg. The agency indicated that it was looking
Gdiabetes, you know that the rising prices of at metformin made by various manufacturers and that it
medications, supplies and co-payments can deplete would take appropriate action—including recalls if nec-
your bank account. How familiar are you with money- essary—if unacceptably high levels of NDMA are found.
saving tips for cutting the costs of diabetes care? Test “The agency is in the beginning stages of testing met-
yourself with this quiz. formin,” reads an emailed statement from FDA spokesman
Jeremy Kahn, per the Bloomberg report. “However, the
1. On average, people with diagnosed diabetes
agency has not confirmed if NDMA in metformin is above
spend over four times more on their healthcare
the acceptable daily intake (ADI) limit of 96 nanograms
than those without diabetes.
in the U.S.”
O O True O O False
The statement emphasizes that no one should stop tak-
2. Drugstore prices for identical medications can ing metformin without first talking to their doctor. If any
vary. contamination is eventually detected, it will most likely be
O O True O O False possible to switch to another brand of metformin safely if
your brand is recalled.
3. In comparing insurance plans, which of the fol- NDMA can be accidentally created through various
lowing options should you consider to make cost- industrial processes, including those used in drug-making.
effective choices? The risk of its presence in metformin isn’t just hypotheti-
O O A Coverage for prescription medicines. cal, since Singapore recently announced the recall of three
O O B Co-payments and deductibles. different formulations of metformin out of 46 that are sold
O O C Coverage for medical supplies and devices. in the country. None of these three versions of metformin

O O D All of the above. is sold in the United States. DSM

4. Which of the following is NOT a safe strategy to
help you save money on diabetes care?
SHUTTERSTOCK/RETROROCKET; METFORMIN: SHUTTERSTOCK/SHERRY YATES YOUNG O O B Looking for doctors in your insurance provider’s
O O A Comparing prices of diabetes supplies and buy-
ing in bulk.


network.
O O C Sharing supplies such as insulin pens with family
members.
O O D Comparing pharmacy prices of medicines and
asking your doctor about lower-priced medicines.
See page 10 for answers.



Mar/Apr 2020 • DiabetesSelfManagement.com 9

••• THE DOSE ••• News & Notes





QUIZ ANSWERS
See page 9 for questions.

1. False. According to research released in March of
2018 by the American Diabetes Association (ADA),
people with diagnosed diabetes spend 2.3 times
more than those without the condition each year.
The average medical expenditures for people with
diagnosed diabetes is $16,752 per year, with approxi-
mately $9,601 directly due to diabetes.

2. True. Medicine prices vary quite a bit for the same

drugs. According to a report by the U.S. Public Interest
Research Group, the price of the same prescription
drug can vary by thousands of dollars depending on
where you buy it. The study surveyed hundreds of
BIONIC PANCREAS drugstores and found significant differences in price

RECEIVES FDA for identical drugs. You could save $100 to $5,400 a
year just by shopping around, based on the report. So
BREAKTHROUGH DEVICE spend a little time bargain shopping to protect your

DESIGNATION health—and your wallet!

3. D. Diabetes management can be pricey, and most
BY QUINN PHILLIPS people need help paying for their care. Shop around,
because health insurance companies are not allowed
to refuse to cover you or charge you more if you have
he goal of developing a closed-loop artificial pancreas— diabetes when your new health coverage begins. While
Ta device or system of devices that regulates a person’s evaluating different plans, consider asking the follow-
blood glucose levels completely automatically—has inspired ing questions: Is your preferred doctor in the plan’s
efforts from many different companies in recent years. network? Does the plan cover all the medications,
One contestant in that race is Beta Bionics, Inc., which supplies, lab tests and devices that you need to be
recently announced in a press release that it has received healthy? What percentage of the costs does a plan pay?
the U.S. Food and Drug Administration (FDA)’s Break- Does the plan cover any potential specialists you might
through Device designation for its iLet bionic pancreas need? Finally, be sure to ask for a Summary of Benefits
system. This designation gives the company priority and Coverage.

review in future steps of the FDA’s approval process.
According to the press release, the iLet is “a pocket- 4. C. While you can safely reuse some of your own
sized, wearable” device that’s similar in form to an insulin supplies, it is NOT safe to reuse or share any supplies
pump. Still in its investigational stages, the device requires that puncture your skin, such as insulin pens or finger-
users to enter only their body weight in order to begin stick devices. This could put you at risk for dangerous
regulating blood glucose levels. By reading the user’s infections. The Centers for Disease Control and Pre-
blood glucose levels continuously, the device is designed vention (CDC) offers many safe ways to save money.
to perform all calculations needed to deliver the right Call different pharmacies to find the least-expensive
amount of insulin at any given time. What’s more, the medication, and ask your doctor about cost-saving
device can be configured to deliver insulin only, glucagon approaches such as using a generic medication, get-
only (a hormone that prompts the release of glucose from ting a prescription for a higher dose of a medication
a person’s liver) or both hormones. and cutting the pills in half, or getting combination
The algorithms used by the iLet were developed at a pills. Compare prices for medical supplies and be sure
Boston University lab led by Ed Damiano, president and to use reward programs and buy in bulk. Your doctor
CEO of Beta Bionics, and refined based on clinical trials may also have samples of supplies to give you. Use
involving both children and adults with type 1 diabetes. doctors in your network and medications covered by
“We believe the iLet Bionic Pancreas System represents your insurance provider. If you do not have insurance,
a true breakthrough therapy for the management of gly- there are options such as online drug discount pro-
cemia, particularly in type 1 diabetes,” says Damiano in grams and free or reduced-cost clinics. DSM

the press release. “The iLet may be able to provide safer
Helene Engler, PhD, is a scientist, lecturer, science writer
and more effective therapy in far more people than cur-
and editor, and educational consultant in Austin, Texas.
rent therapies due to its simplicity of use.” DSM

10 DiabetesSelfManagement.com • Mar/Apr 2020

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••• THE DOSE ••• Product Spotlight





Cool New Products to Try




BY AMY CAMPBELL, MS, RD, LDN, CDE










Aculief
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Most people experience headaches every now and then.
Aculief is a small, wearable device that uses acupressure (not
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culation throughout the body. Take it with you while traveling,
going to work or doing your favorite activities. One size fits all!
aculief.com


















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goodness without worrying that your
blood sugar will climb sky high later.
cocotopia.com

















Tree Hut * Disclosure: Tate & Lyle sent this product for review. Views/opinions are solely my own. #DDPGDigitalInfluencer
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When you exfoliate, you are removing dead cells
from your skin’s surface. Made with organic shea
butter, sugar and an array of natural oils, this scrub
gently softens, smooths and moisturizes your skin
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12 DiabetesSelfManagement.com • Mar/Apr 2020

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••• THE DOSE ••• Ask Away


































Pumps on a Plane




Plus, post-meal blood sugar spikes


BY GARY SCHEINER, MS, CDE




I am traveling to the United you’re prepared. Have backup with seeing two hours after meals could
Q States soon and will be asked you: injectable long-acting (basal) and actually be a direct result of your
to go through full-body scanning short-acting (bolus) insulin. It will be healthy lifestyle. Foods that are rich
equipment at airports. I use an insu- necessary to take an injection of long- in fiber and slowly digesting (low-gly-
lin pump and have been advised by acting insulin right away—and every 24 cemic-index) carbs, such as legumes,
the pump company not to wear my hours until you receive a replacement— dairy products and fresh vegetables,
pump through the scanner. The if your pump stops working. Ask your tend to cause a gradual/delayed rise in
last time I flew, the airport security healthcare provider for specific doses. blood sugar. Instead of seeing a rapid
staff said it was OK. Are you able to spike, your blood sugar rises modestly
provide any advice on this? I am a 58-year-old woman who a few hours after you eat.
Q as had type 2 diabetes for two Exercising right after eating can
h
Pumps on a plane. Sounds like years. I am a vegetarian and walk also contribute to a delayed blood
A he title for a good action-thriller. regularly after meals. Last year, my sugar rise. During physical activity,
t
Everyone who wears a pump must doctor put me on metformin, which blood flow to the stomach and intes-
choose between the inconvenience lowered my HbA1c (a measure of tines is reduced. Nutrients, including
of removing the pump while passing blood sugar control over the previous sugar, absorb into the bloodstream
through security checkpoints and the two to three months) from 9.4% to more slowly. The combination of
guaranteed safety of following the 6.4%. Now I have a peculiar problem: slowly digesting food and physical
manufacturer’s recommendations. My blood sugar is normal an hour activity is likely what is pushing your
From a purely practical standpoint, after eating but seems to rise to 130 post-meal blood sugar rise back to
consider this: Air travel is already a to 140 mg/dl an hour later before the two-hour point. As your doctor
major hassle. Why add to it? Wearing coming back down. I have searched indicated, since your blood sugar is not
your pump through the scanner may the internet for answers and remain peaking excessively high and returns
require nothing more than a quick mystified. My doctor doesn’t seem to normal soon afterward, you prob-
10-second “dusting” by security per- concerned, but I was hoping you ably don’t need to worry about it. DSM
sonnel (checking for explosive resi- could shed some light on this.
due) once you’ve passed through. Over Gary Scheiner, MS, CDE, has lived
the years, insulin pumps have been First of all, congrats on get- with type 1 diabetes for 30 years and
i
t
worn through airport security check- A ng your HbA1c into a healthy was named Diabetes Educator of the
points millions of times with hardly range. Exercise and a nutritious Year 2014 by the American Associa-

any problems reported. In the unlikely diet remain the cornerstones of tion of Diabetes Educators. SHUTTERSTOCK/PROSTOCKSTUDIO
event that something goes wrong with diabetes management. Have a question about diabetes?
your pump while traveling, make sure The delayed blood sugar rise you’re E-mail [email protected]

14 DiabetesSelfManagement.com • Mar/Apr 2020

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••• THE DOSE ••• Curmudgeonly Athlete
















































Saving Money On Exercise




BY ROBERT S. DINSMOOR




n the media, exercise sometimes table and shockingly intense workout, YOGA
Iseems to be portrayed as an extrava- try a jump rope. You might be sur- Yoga can improve your functional
gance for the rich, what with personal prised how winded you get in a very strength, flexibility, balance and
trainers, fancy gear and expensive short amount of time. peace of mind. You don’t have to
health club memberships. But it pay nearly $70 for a yoga mat at
doesn’t have to be that way! All you STRENGTH Lululemon—you can actually buy

really need to exercise is a willingness Strength training doesn’t have to be durable and attractive mats at many
to do it. Here are ways to stay fit and expensive either. You don’t necessar- department stores and sporting goods
lose weight without losing your shirt. ily need a fitness center or a home stores for about $20. Likewise, yoga
fitness machine. clothing need only be comfortable—
CARDIO Exercises using your own body not expensive. Many people show up

Most people can walk, and it doesn’t weight, such as squats, lunges, push- to class in gym shorts and T-shirts.
require instruction, expensive gear or ups and situps, are excellent for Pricey mats and clothes don’t make
a health club. A decent pair of sneak- functional fitness and don’t require you “serious” about yoga—regularly
ers is all you need to get started. You equipment. Books and DVDs from the practicing yoga does.
can walk on sidewalks, quiet roads library can help you do them correctly. Nor do you have to go to a “bou-
and trails. When it’s rainy or cold, You can use inexpensive strength tique-y” yoga studio. If you can forgo
many people find shopping malls a equipment. Dumbbells can be used the incense and the attitude, you can
convenient place to walk. for a variety of exercises with differ- find much less expensive classes at
Running needn’t be expensive ent body parts, and you can buy them your local YMCA, community center
either. Wear comfortable, supportive pretty cheaply at many department or senior center. (At the YMCA where
footwear and clothing that’s appropri- stores. Resistance bands, generally I teach and practice yoga, yoga is free
ate to the season, and you’re good to running under $20, can strengthen with your basic membership.) Also,
go. Some people think fancy, expen- and tone multiple parts of the body most public libraries have DVDs on
sive shoes make them a “serious run- and are easy to pack in a gym bag or various workouts, including yoga.

ner.” No, running a lot makes you a suitcase. Exercise balls, which can be Bottom line: If you can spare the
serious runner. had for as little as $20, are great for attitude, you can spare a good wad SHUTTERSTOCK/MAREKULIASZ
For an inexpensive, extremely por- building core strength. of cash. DSM

16 DiabetesSelfManagement.com • Mar/Apr 2020

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my mom




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••• HEALTHY LIVING ••• The Right Moves










Minimalist Training




Doing more with less



BY LAUREL DIERKING, MED, NASM, 700-ERYT





etween the trendy aspects of the initiative one day at a time, one Reverse Lunges
Bexercise (brand-name workout opportunity at a time, you can build • Standing upright, shift your
clothing and fitness watches and a powerful practice of self-care, one weight to your right leg and
other tech gadgets being just a few decision at a time. step your left leg about 2 feet
examples) and the social pressures Try these simple bodyweight behind you toward a short
to join a gym, the $30 billion fitness movements to get five extra minutes lunge position.
industry is booming, and we are of daily activity. Try performing at • Keeping your right knee
willingly forking over gobs of money least two rounds of each exercise centered over the ankle, drop
to the cause. According to a study by with little rest in between each your left knee towards the
the Statistic Brain Research Institute, movement to increase your heart floor without actually touching
the average gym membership in the rate and heighten mental clarity and the floor.
U.S. costs $58 per month ($696 per focus throughout your day. DSM • Shift your weight forward to
year). For a portion of the 62 million your right leg and step your left
people who purchased memberships Laurel Dierking, MEd, NASM, 700- leg up to the starting position.
in 2018, their time and money has ERYT, is a movement specialist, with • Repeat 10 times on your
been well invested, but nearly half a concentration in yoga, strength- right leg, and follow with 10
have been throwing their money conditioning, exercise physiology and repetitions on your left leg.
away and not setting foot in the gym. postural restoration. With 10 years
Fortunately, there are unlimited of extensive experience, Dierking
methods of training and ways to seeks to enhance self-awareness by
obtain public exercise information that guiding individuals through mindful
require nothing more than a motivated movement, functional training, body

mindset, a few spare minutes and awareness and breath work.
occasional access to Wi-Fi. If you
are self-motivated (or have been
encouraged by your doctor to take Bodyweight Squats
action toward lowering your blood to Single Leg
pressure or improving other aspects of • With your feet no more than
your health) and are willing to explore hip-width distance apart, keep
your body’s abilities, you can have a your chest lifted and squat back
phenomenal workout for free. into the heels as if you are sitting
In fact, becoming more fit does in a chair.
not necessarily mean spending • At the bottom of the squat, shift
more time in the gym but rather your weight into the right leg as
making continuous and consistent you come back up to standing
adjustments to your daily routine. and lift your left leg up so that
Kick that “New Year’s” mindset back you are standing on just your
into gear and tune into an inspiring right leg.
YouTube video, pick up one less pastry • Bring your left leg back down
at the office, schedule a meeting with as you come back into a squat
a friend to go for a walk during lunch, position, and repeat on the left.

take the stairs or park your car at • Repeat for five repetitions on
AARON ASHLEY
the back of the parking lot. By taking each side.



18 DiabetesSelfManagement.com • Mar/Apr 2020

Forearm Plank Rotations
• Begin in a plank position on your forearms. Keep your
knees lifted, or lower the knees for a modified version
of the exercise.
• Shift your weight to your right arm and side of your
right foot, then raise your left arm toward the ceiling.
Pause and breathe in.
• Exhale, lower your left forearm back to the floor, then
shift your weight left and lift your right arm up toward
the ceiling.

• Repeat for five repetitions on each side.






































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••• HEALTHY LIVING ••• Weighty Matters









you can use your leftovers to create
Managing more meals and avoid waste.

Try incorporating a couple of meat-
free days into your week. Meat is often
Your Weight the most expensive item on your shop-

ping list and you can easily substitute
for it with other healthy sources of
on a Budget protein, such as beans and lentils.



KEEPING FIT ON A BUDGET
BY DR. NICOLA DAVIES, PHD Keeping fit doesn’t have to cost you a

fortune and there are plenty of ways
to get up and moving without spend-
ticking to a healthy eating plan Avoid taking a shopping trip when ing a penny!
Scan be hard when living on a you are feeling hungry. One of the easiest and cheapest ways
tight budget. The good news is, with Typically, the most nutritious food to grab some exercise and fresh air is to
a little careful planning and prepara- within a store is located around the go for a walk. Take your dog, friends or
tion, budget-friendly weight manage- perimeter. This usually includes family along for some company.
ment is achievable. fresh produce such as Use your body weight to do some
bread, dairy, meats simple muscle-toning exercises in
PLANNING A BUDGET-FRIENDLY and fish. the comfort of your own home.
DIET Some examples include jump-
Careful advance planning of your ing jacks, squats, lunges and
weekly meals will help avoid waste push-ups.
and stop you from being tempted by Swimming is a great all-
unhealthy and costly items. There over body workout that
are plenty of meal-planning web- shouldn’t cost a lot if you
sites and apps available online find a local pool.
to help you with this. Taking There are plenty of free
the time to write a shopping list workout videos available
before heading to the grocery online. A search on You-

store will also help you make Tube will bring up many
smarter and healthier choices options so you can find
when you are there. one that is right for you.
You can even substi-
SMART GROCERY SHOPPING tute items readily available

TIPS in your home for gym equip-
Smart shopping ensures you find ment. Climbing stairs can get
the most budget- and waistline- your blood pumping while toning
friendly foods. and strengthening your legs. Use
Choose fruit and vegetables that COOKING AFFORDABLE RECIPES cans or bottles as hand weights.
are in season to help keep costs down. Cooking homemade meals instead of Get creative!
Frozen and canned fruit can offer buying processed and convenience Even though your budget may be
the same nutritional value as fresh, foods is a great way to ensure you restricted, you don’t need to sacrifice
with a much lower price tag. eat healthily on budget. Making healthy living. It will take a bit of plan-
Pulses such as beans, peas and healthy meals in bulk and freezing ning and organization, but your health
lentils are a healthy choice as they some for later can help save both and well-being are worth it. DSM
can help maintain blood sugar levels. time and money.
The good news is that they are also A useful tip is to keep your stor- Dr. Nicola Davies, PhD, health
cheap and easy to cook. age cupboard stocked up with lots psychology, is author of I Can Beat

Consider buying store-branded of healthy essentials and then plan Obesity! Finding the Motivation, Con-
products as an alternative to expen- your meals around these. There are fidence and Skills to Lose Weight and SHUTTERSTOCK/COSMAA
sive brands. many interesting and exciting ways Avoid Relapse.

20 DiabetesSelfManagement.com • Mar/Apr 2020

••• HEALTHY LIVING ••• Smart Smarter Smartest




































Beans, Peas and Lentils





BY LEA ANN HOLZMEISTER, RD, CDE




eans, peas and lentils—all members of a class of with animal protein. One half-cup of cooked or canned
Bvegetables known as legumes—are nutrition legumes provides 6 to 8 grams of protein and 5 to 11
powerhouses, packed full of protein, fiber, phytochemicals grams of fiber, which accounts for roughly one-fifth to
and folate. A vegetable and a plant-based protein source, nearly one-half of the Daily Value for fiber (25 grams per
beans contain nutrients found in both food groups, making day based on a 2,000-calorie diet). If selecting canned
them one of the most versatile and nutritionally complete legumes, choose no-added-salt or reduced- or low-sodium
foods. And unlike meat-based proteins, beans are naturally varieties. To decrease the undesirable intestinal side
low in fat and free of saturated fat, trans fat and cholesterol. effects of beans, make sure they are thoroughly cooked
With today’s escalating food prices, legumes (especially and rinsed. For canned beans, drain and rinse thoroughly

dry beans) are an economical protein source compared to reduce sodium. DSM

SAT TRANS
FAT FAT FAT CHOL SODIUM CARBS SUGAR FIBER PROTEIN
SERVING CAL (g) (g) (g) (mg) (mg) (g) (g) (g) (g)
SMART
Bush’s Baked Beans, 25% Less Sugar & Sodium ½ cup 140 1 0 0 0 390 29 11 5 7
Bush’s Garbanzos, Reduced Sodium ½ cup 120 2 0 0 0 240 20 3 4 6
Bush’s Garbanzos ½ cup 120 1 0 0 0 380 22 <1 6 6
Bush’s Pinto Beans, Reduced Sodium ½ cup 100 0 0 0 0 220 18 0 7 6
Ranch Style Brand Black Beans ½ cup 110 1 0 0 0 390 19 <1 7 6
Trader Joe’s Cannellini White Kidney Beans ½ cup 120 0 0 0 0 260 21 <1 10 8
Trader Joe’s Cuban Style Black Beans ½ cup 100 1 0 0 0 370 19 1 6 6
Bush’s Black Beans, Reduced Sodium 1/2 cup 120 1 0 0 0 240 23 1 6 7
SMARTER
Bush’s Red Chili Beans, Low Sodium ½ cup 130 1 0 0 0 130 24 2 9 6
Bush’s Pinto Chili Beans, Low Sodium ½ cup 120 1 0 0 0 135 21 1 5 7
Bush’s Cannellini Beans, Reduced Sodium ½ cup 100 0 0 0 0 130 19 0 6 7
S&W Garbanzos, 50% Less Sodium ½ cup 120 2 0 0 0 140 20 1 6 7
S&W Kidney Beans, 50% Less Sodium ½ cup 110 0 0 0 0 140 20 1 8 7
Trader Joe’s Organic Black Beans ½ cup 100 0 0 0 0 140 19 <1 4 7
Trader Joe’s Organic Pinto Beans ½ cup 110 0 0 0 0 140 21 <1 8 6
SMARTEST
Black Beans, Cooked (No Salt Or Fat Added) ½ cup 99 0 0 0 0 9 18 0 4 6
Black-Eyed Peas, Cooked (No Salt Or Fat Added) ½ cup 148 0 0 0 0 3 17 0 5 6
97
SHUTTERSTOCK/LUIGI GIORDANO Kidney Beans, Cooked (No Salt Or Fat Added) ½ cup 108 0 0 0 0 10 19 0 6 7
0
8
2
0
7
6
25
0
0
½ cup
Garbanzo Beans/Chickpeas, Cooked (No Salt Or Fat Added)
2
0
0
8
19
0
2
Lentils, Cooked (No Salt Or Fat Added)
½ cup
0
0
110
9
99
6
0
0
18
0
½ cup
0
4
Pinto Beans, Cooked (No Salt Or Fat Added)
0
6
0
8
0
0
121
White Beans, Cooked (No Salt Or Fat Added)
½ cup
5
22
0
0
Mar/Apr 2020 • DiabetesSelfManagement.com 21

••• HEALTHY LIVING ••• Getting There








































Yellowstone







Welcome to geyser country



BY JULIA BELLROSE WYNN












ur national parks house some of In 2018, Yellowstone had more the eruption time is always within
Othe most beautiful landscapes than 4 million visitors, mainly from 60 to 110 minutes (plus or minus 10

in the country, but few are as majes- June through September. If you are minutes) from the time posted on Yel-
tic as Yellowstone. Spread across going to one of the more popular lowstone’s website under the “Current
Wyoming, Idaho and Montana, Yel- destinations, avoid the peak crowd Geyser Activity” section. Be sure to get
lowstone is most known for geysers times of 12 p.m. to 6 p.m. Also, leave a seat on the surrounding benches
like Old Faithful, but it also plays ample room in your itinerary for well beforehand, as they fill up quickly
host to diverse adventures including driving, as traffic jams are common, and you don’t want to be in the back.
river rafting, animal watching, fossil especially when bison are crossing If you are interested in learning
hunting and learning about Native the road. Before your trip, consult more about geysers, check out the
American culture. the National Park Service’s website Old Faithful Visitor Education Cen-
Founded in 1872 as the world’s first (nps.gov) for information on road ter. Across from the center is the Old
park, Yellowstone has five entrances to conditions, attraction closings and Faithful Inn, a favorite place to stay
begin your journey—North, Northeast, construction around the park. with several rooms overlooking Old
East, South and West. Each entrance Faithful. The 300 rooms book fast, so
leads you to different sites and scen- OLD FAITHFUL plan your reservation early.
ery that showcases different aspects The major attraction in Yellowstone is The Old Faithful Inn features a large
of the 2.2 million acres of parkland. Old Faithful—the best known of Yel- dining room with hearty meals and
Looking on a map does not prepare lowstone’s nearly 500 geysers. Located buffet options. There are several other
you for the vastness of Yellowstone nor between the West and South Entrance, places to eat around the park—from
the amount of time you’ll spend in the Old Faithful erupts, on average, about sit-down restaurants to snack shops

car. Do your best to group activities 20 times a day. For tourists trying to and convenience stores—but count
together based on how close they are plan a day around seeing Old Faith- on at least some unforeseen circum- SHUTTERSTOCK/HAVESEEN
to each other. ful in action, it’s helpful to know that stances or long lines at the restaurants.

22 DiabetesSelfManagement.com • Mar/Apr 2020

Tips to stay healthy

during your visit

• Yellowstone has different altitudes,
mostly above 5,000 feet, which can
lead to altitude sickness among
young and old. Altitude sickness is
caused by lower oxygen levels in the
air, resulting in headaches, dizziness,

appetite loss and fatigue. To combat
altitude sickness, move to lower
grounds, eat light meals, drink plenty
of water and avoid caffeinated drinks.

• When traveling to Yellowstone,
planning your menu in advance is
key, as you can’t just drop into the
local supermarket to pick up food
HOTTEST SPRINGS also showcases the incredible Lower and supplies, especially within the
There is so much to see in Yellowstone Falls, the biggest waterfall in the park, park. It’s a must to bring nutrient-
dense, high-protein prepackaged
that it’s difficult to narrow down the with a 308-foot drop. From South Rim
snacks to help you feel full longer
list of destinations. One attraction Drive, it is just a short walk on a paved
that deserves particular attention trail to see the spectacular falls. When and minimize the effects on your
blood sugar levels. There will always
is the Grand Prismatic Hot Springs. you reach the end of the trail, there is
be something unexpected, and you’ll
Closest to the West Entrance, the an overlook with incredible views of
springs can be enjoyed various ways, the canyon between Inspiration Point want to give yourself the freedom
to handle it without worrying about
but to get the best view, hike up the and Grand View Point.
Grand Prismatic Overlook Trail. The Looking like topography from missing your next meal and risking
low blood sugar levels.
.6-mile trail gradually climbs 105 another planet is Mammoth Hot
feet, showcasing not only the Grand Springs. It is just south of the North • Anytime you travel, consulting with
Prismatic, but also giving a great view Entrance near Gardiner, Montana. your doctor beforehand is a good
of the Midway Geyser Basin. At the The Upper and Lower boardwalks precaution. He or she can tell you
Grand Prismatic Hot Springs, there cover about 1.75 miles, with about exactly what extra supplies you will
are long boardwalk sections that help 50 hot springs. The specific geother- need to bring as well as give you a
you get safely near the hot springs for mal activity of the area makes the letter or prescription to keep handy
the best photo moments. hot springs unlike anything else in in the event you need extra insulin or
Easily accessible from the North, the park.DSM diabetes medication over the course
West or East Entrances is Yellow- of your travels. Wearing a medical
stone’s Grand Canyon. The vibrant Julia Bellrose Wynn is a writer bracelet is also always a good
SHUTTERSTOCK/EZAKIELL yellow, pink and orange rock of Grand from Garrison, NY, who would spend precaution. With smart planning and

enthusiasm, Yellowstone can be an
Canyon’s Artist Point is one of the most all of her free time in national
unforgettable adventure.
famous views in the park. Artist’s Point parks if she could.
Mar/Apr 2020 • DiabetesSelfManagement.com 23

••• HEALTHY LIVING ••• Food For Thought











Trimming Your Food Budget







BY ALISON MASSEY, MS, RD, LDN, CDE






hen it comes to figuring out a Curbside pickup and/or grocery Do you have any meal ideas for
Wmeal plan for the week, most delivery: Even with a grocery list in feeding my family for less than
of us are trying to save both time and hand, the entire experience of gro- $5.00 a serving?
money. This column explores ways to cery shopping, including the drive Quiche and side salad: Eggs are
maximize convenience items, create to and from the store, can easily take cost-effective, high in protein and can
budget-friendly meals and develop a anywhere from one to two hours. If be used in so many different ways.
delicious and cost-effective meal for that is time you would rather spend Create a quiche that includes your
blood glucose management. cooking or doing something else, it favorite vegetables and cheese and
might be worth investing in curbside serve with a simple side salad.
What are the best convenience pickup or grocery delivery services. Chili and cornbread: Canned goods
options to help with meal plan- Grocery stores often offer curbside are great pantry staples and can be
ning for the week? pickup services for no additional or used to create cost-effective meals.
The best convenience options to minimal additional cost. Simply place Select no-salt-added or low-sodium
help with meal preparation will vary your grocery order online and sched- varieties of canned beans, tomato sauce
depending on your budget and prefer- ule the time you would like to pick up and diced tomatoes to create a simple
ences. You should consider how you the groceries from the store. Grocery and quick chili. Pair with a simple corn-
want to spend both your time and delivery services are often offered bread or a few whole-grain crackers.
money when it comes to preparing directly through specific stores or use Chicken stir-fry: Use a rotisserie
meals for your family. a service like Instacart, which for a chicken, frozen stir-fry vegetables, low-
monthly fee provides you with access sodium soy sauce and a quick-cooking
Best meal-preparation to a personal grocery shopper. brown rice for a simple but filling meal.
timesavers

If you are tight on time or would Best convenience food items Carbohydrates are satisfying and
rather spend your time on actual Rotisserie chicken: The price point, cost-effective. How can I reduce
cooking, consider the following convenience and versatility of rotis- the starch at my meals without
options to help you save an hour or serie chicken makes it one of my go-to increasing my grocery bill?
two each week on grocery prepara- items for saving time in the kitchen. Carbohydrates like potatoes, pasta and
tion and shopping. Use rotisserie chicken in soups, cas- rice are staples in diets around the
Grocery store apps: Does your seroles, quesadillas, to top entrée world, and they are typically inexpen-
grocery store have an app? It might salads or in a stir-fry. Dinner can be sive and delicious. But when it comes to
be worth downloading and using it to prepared in under 30 minutes and blood glucose management, the portion
help you save time and money. Most at a price point that is well under a of carbohydrates matters. My suggestion
grocery store apps offer the tradi- takeout dinner for a family of four. is to focus on increasing the nonstarchy
tional grocery list feature and often Bean and lentil-based pasta: vegetable component of the meal. Using
also integrate other helpful features to Bean and lentil-based pastas typically frozen, canned and seasonal fresh veg-
improve the grocery shopping experi- cost more than traditional pastas, but etables is the most cost-effective way
ence. Additional features grocery apps they also provide more nutritional to ensure that changing the portions
may offer include: value: They are higher in both fiber on your plate won’t negatively impact
• Coupons and weekly sales and protein and provide a tasty and your grocery budget. DSM
• A product location identifier, convenient way to increase bean and
indicating the aisle in which lentil consumption in the diet. A ver- Alison Massey, MS, RD, LDN, CDE,

the item can be found satile option, these products can be is a registered dietitian and certified SHUTTERSTOCK/ARINA P HABICH
• A recipe index for meal used in traditional pasta dishes or diabetes educator in Maryland. She
inspiration added to soups, casseroles or salads. blogs at alisonmasseyrd.com.

24 DiabetesSelfManagement.com • Mar/Apr 2020

Mar/Apr 2020 • DiabetesSelfManagement.com 25

Save Money on









Strategies to reduce costs at the pharmacy counter



BY KRISTINA NASEMAN, PHARMD, MPH, MLDE, BCACP, CDE,
AND LAURA HIERONYMUS, DNP, MSED, RN, MLDE, BC-ADM, CDE, FAADE





he soaring cost of medications is difficult to afford the medications you had to ask their healthcare provider for
Tnot news to people with diabetes. need to manage your diabetes. And a lower-cost medication for diabetes.
But did you know that a number of it can be challenging to prioritize the Here are some ways you can work
factors can influence the price you pay high costs of necessary medications with your diabetes care provider and
for your diabetes drugs? The price of when other expenses arise. pharmacy to help lower the price you
a medication can be extremely high Recent data from the National pay for your diabetes medications.
and variable from one pharmacy to Health Interview Survey of Americans
another, especially if you don’t have found that 15% of people with diabetes Patient assistance programs

prescription insurance. Even if you did not take their diabetes medication These are programs sponsored by SHUTTERSTOCK/ANDRII ZASTROZHNOV
have insurance, co-pays, deductibles as prescribed due to the cost. Among pharmaceutical manufacturers to help
and coverage gaps can still make it this same survey group, almost 25% those who cannot afford their medica-

26 DiabetesSelfManagement.com • Mar/Apr 2020

Your Medicines









tions. Many companies offer assistance if you are a candidate for a patient for the maximum amount the card
with the medications they produce, assistance program. will cover, the expiration date and the
but it is important to note that each number of times you will be able to
company establishes its own rules Manufacturer co-pay cards use the card. If you have government
and guidelines. For example, which Co-pay cards are provided by the man- insurance, you may be excluded from
medications are available and what ufacturers of medications to either using a co-pay card.
requirements must be met to qual- decrease the co-pay of a medication
ify for assistance will vary between or provide a free initial prescription so Pharmacy medication discount
programs. There is often an income you can try out the medication. Your programs
qualification, and the program may healthcare providers may have the Many pharmacies offer discounted
only be available to those without cards in their office and can provide prices on certain generic medications,
insurance or with high out-of-pocket them based on medications they have which can include medications for
medication costs. All programs require prescribed. Many co-pay cards are diabetes, cholesterol disorders and
paperwork to be submitted from both also available online, where you can high blood pressure. These discounts
the patient and the prescribing health- sign up and print out a card to take can be very helpful for reining in how

care provider. Talk with your provider, to your pharmacy when the prescrip- much you spend at the pharmacy each
pharmacist and/or diabetes educator, tion is filled. Keep in mind that it is month. Programs may vary at different
who may be able to help you identify important to read the fine print. Look pharmacies, so you may have to do

Mar/Apr 2020 • DiabetesSelfManagement.com 27

some research to see what your local better understand what medications Affordable alternatives
pharmacies offer. It is best to fill all of your insurance prefers or, if possible, If the cost of your medications is more
your prescriptions at one pharmacy even choose a new insurance plan. than you can afford, have a conversa-
so that the pharmacist can check for Look into your prescription insur- tion with your healthcare provider.
drug interactions, but if you are using ance plan’s medication formulary, Changing the types of medications you
multiple pharmacies to get discounts, which will tell you what medications are on, or considering a combination
you can provide the pharmacist with (both generic and brand name) are medication to decrease the number
a list of all of your medications so he available at the lowest cost. You may of co-pays you have to pay, may be
or she can safely fill your prescription. be able to find an alternative medica- other good options. Many times, the
tion that will work just as well for a person prescribing your medication
Understanding your insurance lower price. Additionally, many insur- doesn’t actually know how much the

options ance plans offer lower costs if patients medication will cost you at the phar-
Sometimes, the best way to save fill prescriptions for a 90-day (three- macy. Doing your homework to see if
money on your medications is to month) supply or through the pre- there are more affordable medication
scription insurance plan’s mail-order options to treat your diabetes may help
pharmacy. It is often difficult for your you save some money and still meet
Medication healthcare providers to access insur- your diabetes health goals.
ance formularies, so if you bring this
Assistance information to your provider appoint- Local resources

ment, it can help you make better If you are going through a challenging
Resources decisions for your care and perhaps time and are unable to afford your

your wallet as well. medications, looking into resources in
NeedyMeds
needymeds.org Understanding what insurance your area may be one of the best ways
Offers resources to help find affordable plans are available to you can also to help you get what you need. Health
medications, including patient assis- help you better spend your healthcare system patient assistance programs
tance programs and drug discount cards dollars. This could include working at local hospitals may be one option
with your human resources depart- to help you get access to healthcare
RxAssist Patient Assistance
ment to understand your insurance providers and medications. Many
Program Center
rxassist.org plan options at work. Looking into cities have charitable pharmacies
Database of patient assistance programs options like a Health Savings Account and/or free clinics that provide care
(HSA) or a Flexible Spending Account and medications to those in need.
Medicine Assistance Tool (FSA) may make your healthcare Local religious organizations, health
medicineassistancetool.org
money go further. departments and other charitable
Search engine that connects users to
available resources through PhRMA If you have Medicare, be sure to organizations may also be able to
compare the various Medicare Part help meet your diabetes health needs
American Association of Diabetes
D plans to find out which best covers when money is tight.
Educators Access & Affordability the medications you need. Each year Don’t be shy—utilizing the avail-
Resources
diabeteseducator.org/living-with-diabetes/ during the Medicare open enrollment able resources, as well as having
window—usually toward the end of frequent and honest conversations
Tools-and-Resources/affordability-resources
List and links to tools to help with the year—you should review your with your healthcare provider, are
savings for diabetes therapy plan to make sure it is still right for important steps to help you get access
you. Those who have limited income to the medications you need to stay
Affordable Insulin Project
on Medicare may also qualify for a healthy with diabetes. DSM
affordableinsulinproject.org
program called Low Income Subsidy,
Provides resources to help you talk
about the importance of being able to also called “Extra Help,” which lowers Kristina Naseman is a doctor
afford insulin the cost of Medicare prescription drug of pharmacy and master licensed
coverage. See the online application diabetes educator at UK HealthCare
Health Insurance Marketplace
healthcare.gov form at https://secure.ssa.gov/i1020/ for the inpatient diabetes service team,
Connects people who need health start to determine if you may qualify. Barnstable Brown Diabetes Center
insurance with options in their area If you don’t currently have insur- and Maternal-Fetal Medicine. Laura
ance, looking into options through Hieronymus is a doctor of nursing
Social Security: Extra Help With
the health insurance marketplace will practice, master licensed diabetes
Medicare Prescription Drug Plan
Costs (Low-Income Subsidy) help you determine if there is a good educator, and the associate director of
https://secure.ssa.gov/i1020/start insurance option for you. This will education and quality services at the UK
Qualifications and application for those allow you to compare plans available HealthCare Barnstable Brown Diabetes
needing extra help with their Medicare and can also help you to determine if Center. Both are at the University of
drug costs you qualify for Medicaid in your state. Kentucky in Lexington, Kentucky.

28 DiabetesSelfManagement.com • Mar/Apr 2020

When Two Endocrine Disorders Meet






Diabetes and thyroid disease frequently coexist, and a coordinated

strategy is required to manage both conditions successfully



BY PAUL WYNN




he underappreciated but very that person is also dealing with thy- have a significant impact on the over-
Timportant endocrine system is roid problems, often manifesting as all management of diabetes,” said
critical to regulating a number of vital low amounts of thyroid hormone, Noah Bloomgarden, MD, assistant
organs, such as the pancreas and resulting changes in insulin levels and professor of medicine in the depart-
overall changes in energy metabolism ment of endocrinology, diabetes and
thyroid gland. When a person’s endo-
SHUTTERSTOCK/FEDRUNOVAN crine system malfunctions and the can make blood glucose control even metabolism at Albert Einstein College

of Medicine in New York City. “Thyroid
pancreas fails to produce adequate (or more challenging.
“Unmanaged thyroid disease can disorders make it harder to manage
any) insulin, diabetes occurs. When
Mar/Apr 2020 • DiabetesSelfManagement.com 29

your glucose levels if you already and constipation appear, that may
have diabetes.” indicate the thyroid gland is not
An estimated 7% of the general functioning properly. That means it’s
population lives with some form of time to see a doctor and get tested
thyroid disease, which is second for thyroid disease.
only to diabetes as the most com- According to the American Thyroid
mon disorder of the endocrine sys- Association, the most common test
tem. Thyroid disorders are known is the thyroid-stimulating hormone
to increase with age and are more test (TSH). This is the most sensi-
common among women and those tive laboratory test to determine the
with other autoimmune disorders, presence of hypothyroidism or hyper-

explained Veronica Brady, PhD, MSN,
CDE, assistant professor at the Uni-
versity of Texas Cizik School of Nurs-
ing in Houston. “People with a family The prevalence
history of thyroid disease are also at
higher risk of developing problems of thyroid
Two Thyroid with the thyroid gland.” diseases among
The prevalence of thyroid diseases
Conditions among those with diabetes is two those with
to three times higher than in those
to Know without diabetes. People with type 1 diabetes is two
diabetes have a greater risk of devel-
Hypothyroidism occurs oping autoimmune thyroid disorders
1 when the thyroid does not and especially Hashimoto’s thyroid- to three times
produce enough hormone itis, which causes inflammation of higher than in
to keep the body running the thyroid gland (a butterfly-shaped
smoothly. The most common organ located in the lower neck). those without
cause of hypothyroidism is an The association between type 2 dia-
autoimmune disorder called betes and thyroid conditions is less diabetes.
Hashimoto’s thyroiditis (also common and not well understood,
known as chronic lymphocytic since type 2 diabetes is not a known

thyroiditis), which is autoimmune disease. “Both type 2
inflammation of the thyroid diabetes and thyroid disease are com- thyroidism. The test, considered the
gland. The most common mon disorders, but the specific rela- most reliable and sensitive available,
symptoms of hypothyroidism tionship between them is less clear,” allows for both of these conditions
include fatigue, weight gain, explained Melissa Young, PharmD, to be diagnosed with certainty by
constipation, increased CDE, a clinical pharmacy special- measuring how much of the main thy-
sensitivity to cold, dry skin, ist with the Department of Veterans roid hormone, known as thyroxine,
depression and muscle aches. Affairs office in Salt Lake City, Utah. is being made by the thyroid gland.
Hypothyroidism, the most com- If the test comes back with abnor-
Hyperthyroidism occurs
2 when the thyroid is mon form of thyroid disease among mal results, your doctor may order
those with diabetes, occurs when the another test—called T4—to deter-
overactive and produces
thyroid gland doesn’t make enough mine the underlying cause or problem
too much of a hormone
called thyroxine. Too much hormone to help keep the body func- affecting your thyroid gland. “This is
tioning normally. Hyperthyroidism, an important test to assess thyroid
thyroxine in the system
or levels of thyroid that are too high, function prior to starting any medica-
can accelerate metabolism,
causing unintentional weight “may be hard to distinguish from low tions,” stated Young.
blood glucose because both can cause The standard of care for treating
loss, along with heartbeat
irregularities, nervousness and sweating, tremors and irritability,” hypothyroidism is a synthetic version
added Young. of T4 called levothyroxine, which is
tremors. The most common
typically used as the first treatment.
cause is Graves’ disease, an
autoimmune disorder in Testing and treating This thyroid-replacement hormone is
When signs and symptoms such available in brand-name (Synthroid)
which antibodies stimulate
as fatigue, weakness, weight gain and generic versions.
the thyroid to produce too SHUTTERSTOCK/FEDRUNOVAN
much thyroxine. or weight loss, dry hair, dry skin, Adding a thyroid replacement
sensitivity to cold, muscle cramps medication, such as levothyroxine,

30 DiabetesSelfManagement.com • Mar/Apr 2020

may lead to changes in a person’s roid gland or radioactive iodine are doctor for regular monitoring. “These
blood glucose control. “As thyroid other treatment options. If the gland medications can be life-saving, but
hormone is supplemented, metabo- is surgically removed, patients must sometimes medications have side
lism increases, which can include take thyroid replacement hormone effects, so you have to share any
metabolism of blood-sugar-lowering daily on an empty stomach at doses changes in your health status with
medications such as insulin,” said needed to maintain normal thyroid your doctors,” said Bloomgarden.
Young. “If this happens, it can be function. Ann-Marie Kloogh, who lives “One of the biggest mistakes is to
managed with blood glucose moni- with type 2 diabetes in Salt Lake City, think that doctors will not listen or
toring and medication adjustments, had her thyroid removed in 2018. “I care. We want to hear about any
especially during the time when thy- take my thyroid replacement medi- changes so we can adjust medica-
roid medications are first initiated.” cation daily and have felt a lot better tions and help you better manage

Hyperthyroidism is often treated since the surgery.” your disease.” DSM
with a medication called methima- Between diabetes and thyroid
zole, which works by making it harder medications, it can be a lot to keep Paul Wynn, a writer based in Garri-
for the body to make thyroid hor- track of, but it’s important to take son, New York, has covered healthcare
mones. Surgical removal of the thy- them as directed and to see your trends for more than 20 years.





Contributing Factors of Thyroid Disease


• Sex (women are seven to eight • Presence of other autoimmune • Exposure of the neck to radiation
times more likely than men to diseases (type 1 diabetes,
• Certain medications (e.g. lithium,
have the condition) rheumatoid arthritis, lupus, amiodarone, interferon alpha,
celiac disease, etc.)
• Age (it can occur even in children, interleukin-2)
but the risk is increased in those • Previous thyroid surgery • Damage to the pituitary gland
over 50)
• Too much or too little iodine
SOURCE: AMERICAN THYROID ASSOCIATION
• Genes (i.e. if family members

have Hashimoto’s or other
thyroid diseases)















































SHUTTERSTOCK/FEDRUNOVAN







Mar/Apr 2020 • DiabetesSelfManagement.com 31

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34 DiabetesSelfManagement.com • Mar/Apr 2020

Managing








Diabetic








Kidney









Disease







Steps to prevent, slow and reverse

this common complication



BY DAVID SPERO, BSN, RN






iabetic kidney disease (DKD) is a com-

Dmon and serious complication of diabetes.
Kidney failure can cause death or contribute

to death from heart disease or stroke. Along

with high blood pressure, diabetes is the lead-

ing cause of kidney disease, with 20% to 40% of
people with diabetes having some level of DKD.

But like all complications, DKD can be pre-

vented, slowed or reversed with good treatment

and self-management.

Kidneys are miracles
The kidneys are among the greatest miracles of the human
body. These bean-shaped organs, each about 4 inches (11
centimeters) long in adults, constantly take waste prod-
ucts and extra water out of the blood and excrete them
in the urine. Without working kidneys, toxins and water
would build up in the blood and rapidly kill us. According
to the National Kidney Foundation, “Your kidneys filter
about 200 quarts of blood each day to make about 1 to
2 quarts of urine.” An average adult human has about 5
quarts of blood, so most blood goes through the kidneys

about 40 times each day.





Mar/Apr 2020 • DiabetesSelfManagement.com 35

Kidneys do their magic with about
a million mini-organs called neph-
rons (NEFF-ronz). That’s why kid-
ney doctors are called nephrologists.
Each nephron contains a tuft of tiny
blood vessels called a glomerulus
(glow-MARE-you-liss), an amazing fil-
tering system that pushes out poisons
like ammonia and keeps important
body proteins in. Then a second set of
filters called the renal tubules reclaim

escaped proteins and glucose.
Like all blood vessels, nephrons
are easily damaged by high levels of
glucose (sugar) in the blood. Sugar
inflames blood vessels and causes
swelling and scarring. When a glom-
erulus is damaged, it will excrete
proteins that the body needs to keep.
In later stages, some nephrons shut
down completely and excess water
cannot be excreted.


Symptoms of DKD processing urine. A normal range is Stage 3: The eGFR is 30 to 59.
Like diabetes, kidney disease is a 90 milliliters per minute or above. This is where patients may start
silent killer. “Those with kidney dis- Kidney function is also monitored to feel sick with symptoms such as
ease tend not to experience symptoms with tests for blood urea nitrogen swelling or back pain, and they may
until the very late stages,” says Joseph (BUN). Normal BUN ranges are 8 mg/ develop anemia and/or high blood
Vassalotti, MD, chief medical officer dl to 24 mg/dl for men and 6 mg/dl pressure. In stage 3, treatment and
at the National Kidney Foundation. to 21 mg/dl for women. For an eGFR, self-management recommendations
“Only 10% of people with chronic kid- higher is better, but for creatinine change. Doctors will advise eating less
ney disease know that they have it.” and BUN, higher is a sign of damage. protein, because protein breakdown
There are a few symptoms. Dr. Vas- Urine tests are also used to check products are hard on the kidneys.
salotti cites fatigue; difficulty sleeping; for albumin (alb-YOU-min), one of the They may prescribe blood pressure
dry, itchy skin; blood in the urine; proteins the kidneys are supposed medications to prevent heart failure.

bubbly urine; swelling around the to keep in the blood, not excrete. A Stage 4: The eGFR is 15 to 29,
eyes, ankles or feet; poor appetite; microalbumin test can check for small meaning the kidneys are severely
and muscle cramps as possible warn- (micro) amounts of albumin in your damaged. At this stage, doctors will
ing signs. The Mayo Clinic adds nau- urine, which indicate kidney damage. advise patients to start thinking about
sea, vomiting and decreased mental These tests are usually done once a dialysis or a kidney transplant. (Some
sharpness to this list. But since all year for monitoring, or more often if people may have a close relative will-
those symptoms can result from a DKD is progressing. ing to donate a kidney.)
variety of conditions, it’s hard to tell Stage 5: The eGFR is less than 15,
much about the kidneys from symp- Stages of kidney disease meaning a person has kidney failure.
toms alone in the early stages. People with kidney disease are placed At this point, patients will need to go
in stages 1 to 5, based on their eGFR on dialysis or receive a kidney trans-
Lab tests for kidney disease results and clinical signs such as plant. Both treatment options change a
Because it can be difficult to distin- blood in the urine, swelling (edema) patient’s life and diabetes management.
guish DKD from other conditions in or damage visible on scans. Usually, progression through
the early stages, experts advise people Stage 1: The eGFR is 90 or greater, the stages of DKD can be slowed
with diabetes to have their kidneys a normal level, but there are other or stopped by controlling glucose
tested regularly. A blood test for cre- signs of DKD, such as microalbumin and blood pressure through lifestyle
atinine, a waste product our bodies in the urine. changes and medical management.
constantly produce and excrete, can Stage 2: The eGFR is 60 to 89,

be used to calculate an estimated glo- but there are usually no physical Managing DKD: Diet SHUTTERSTOCK/PROSTOCKSTUDIO
merular filtration rate (eGFR), which symptoms. (For those with DKD, this From the self-management point of
indicates how fast the kidneys are is where you want to keep it.) view, DKD could almost be consid-

36 DiabetesSelfManagement.com • Mar/Apr 2020

protein to protect their kidneys from (ACE) inhibitor class or the angioten-
breakdown products. They also must sin receptor blocker (ARB) class for
reduce potassium and phosphorous and people with chronic kidney disease.
limit fluids, which sometimes means A few additional items to note
limiting fiber to avoid constipation. regarding medications in people with
Stage 5: Those on dialysis should kidney disease:
eat lots of protein but tightly limit • According to DaVita Kidney Care,
potassium, phosphorous and flu- patients on dialysis often receive the
ids (which should be kept below 32 blood-building drug erythropoietin,
ounces per day). along with iron, to prevent anemia.
Post-transplant: Food choices are They may also take phosphate bind-

less restricted, but be careful of weight ers with every meal to keep phospho-
gain from medicines and diet and of rous levels down, along with a variety
infection because immune systems of vitamins.
are weakened by transplant drugs. Be • The Cleveland Clinic transplant
sure to wash everything well. center says that after a kidney trans-
plant, patients need to take drugs
Managing DKD: Medicines such as steroids to protect the new
For people with type 2 diabetes and kidney. These drugs can potentially
chronic kidney disease, the American affect diabetes management by
Diabetes Association’s Standards increasing insulin resistance.
of Medical Care in Diabetes—2019 • Because kidneys play a major
recommends providers consider pre- part in removing drugs from the body,
ered as three separate conditions. scribing drugs in the SGLT2 class (e.g. kidney damage means drugs stay in
Diets and medications are different Invokana, Farxiga, Jardiance) or the the system longer. This means that
in stages 3 to 4, on dialysis and after GLP-1 inhibitor class (e.g. Trulicity, doses of almost all medications will
transplant. Here are some guidelines: Victoza, Bydureon, Byetta, Lyxumia, need to be adjusted by a physician for
Stages 1 to 2: Focus on lowering Tanzeum). (People with type 1 dia- people with kidney disease.
glucose and blood pressure. Less car- betes require insulin to keep blood • People with kidney failure, and
bohydrate and more protein and fiber glucose levels in target range.) Some especially those on dialysis, may have
may be recommended. Patients also recent research suggests that metfor- increased risk of hypoglycemia, or low
need to limit salt and sodium intake. min may be safe for certain people blood glucose episodes that can have
The National Kidney Foundation recom- with mild kidney disease. serious consequences. Patients should
mends the DASH (Dietary Approaches to The American Association of Fam- monitor glucose closely, using a con-
Stop Hypertension) diet or a plant-based ily Physicians advises physicians to tinuous glucose monitor if possible.

diet as the best options. prescribe blood pressure drugs in • Patients with advanced DKD may
Stages 3 to 4: Patients must reduce the angiotensin-converting enzyme not have much energy for exercise, but
any gentle activity they can do will
help with circulation and diabetes
management. Walking, stretching and
strengthening exercises are all good.
• Smoking damages blood vessels,
so smoking with diabetes isn’t just a
double whammy for kidneys—it’s the
whammy squared. If you need help
quitting smoking, visit Smokefree.gov.


Worth the effort
Protecting your kidneys requires
work, but it’s worth the effort. Regu-
lar screening, some lifestyle changes
and medications, if necessary, can
all ensure these organs stay in the
SHUTTERSTOCK/PROSTOCKSTUDIO for Disease Control and Prevention
best shape possible. As the Centers


(CDC) says, take care of your kidneys,
and they will take care of you. DSM

Mar/Apr 2020 • DiabetesSelfManagement.com 37

Living

WITH A










Type 1



DIAGNOSIS






Four tips to get you started



BY AMY CAMPBELL, MS, RD, LDN, CDE



























































SHUTTERSTOCK/ANDREW ANGELOV








38 DiabetesSelfManagement.com • Mar/Apr 2020

ave you recently been
Hdiagnosed with type 1

diabetes? If so, you might
feel a lot of different emo-

tions right now. And you
might wonder what having

type 1 diabetes means for

you—how are you going to
handle taking insulin, prick-

ing your fingers or counting
carbohydrates? Can you

play sports? Can you travel?
Can you ever eat ice cream

again? How will having
diabetes affect your life at

work, school or home? Can
you have children? Why did

you get this condition in the

first place? And will it ever
go away?

There are so many questions
that pop up when you are hit with
a diagnosis like this, and it can
be really hard knowing where to
turn. Yes, your life as you know it
will change—and not necessarily

in a bad way. Fortunately, there
is a lot of support out there. And
you might take some comfort in
knowing that you have company:
1.25 million Americans, to be exact.
Some famous folks also have type
1 diabetes, including Nick Jonas,
Sonia Sotomayor, Kris Freeman, Jay
Cutler, Gary Hall, Jr., Scott Verplank,
Bret Michaels and Nicole Johnson.
They all lead very active lives, and
they haven’t let their diabetes slow
them down. It hasn’t always been
easy for them, and it won’t always
be easy for you, either. But thanks
to research, innovation and a strong
type 1 community, living with type
1 diabetes is most definitely doable.
These four tips can help.





Mar/Apr 2020 • DiabetesSelfManagement.com 39

1 FEEL THOSE FEELINGS


Confusion, fear, grief, despair, anger,
shame…these are all very common
feelings that you may experience.
In fact, being diagnosed with type
1 diabetes means you’re very likely
to go through the stages of grief as

developed and defined by Elisabeth
Kübler-Ross:
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
Your own path to accepting and
coping with your new diagnosis may
be very different than someone else’s—
and that’s OK. As hard as it can be to
face your emotions head on, try to let
yourself feel them and get through
them. You may need some help doing
this. For some people, talking to a
friend or family member helps. For
others, joining a support group or an
online community helps them deal cializes in treating diseases of the have a dentist. If not, find one soon,
with the myriad emotions and ques- endocrine system, including diabetes. as people with diabetes are more
tions that they’re facing (check out Not everyone with diabetes sees an likely to have periodontal disease
TuDiabetes.org, BeyondType1.org and “endo,” but if you have type 1, it’s and other oral health issues.
DiabetesDaily.com). You might even highly recommended. These members are the core of
decide to talk with a mental health Certified diabetes educator your team. Depending on certain
professional (in fact, this person may (CDE): This person may be a nurse, factors such as your age, other health

very likely be on your diabetes care dietitian, pharmacist or other pro- conditions and your lifestyle, you
team—more on that in a moment). fessional who has special training might have a podiatrist (foot doc-
in working with people who have tor), physical therapist or exercise
diabetes. You might even have more physiologist, cardiologist, nephrolo-
than one CDE on your team! gist (kidney specialist), social worker
Dietitian (RD): A dietitian may and/or mental health counselor.
2 ASSEMBLE YOUR TEAM also be a CDE and has training in
nutrition, especially as it relates to
Team? What team? Your diabetes managing diabetes. Your PCP can
care team! Your primary-care pro- provide you with a referral to an RD in LEARN AND LEARN
vider, whether that be a doctor, nurse your community. Many RDs are found 3
SOME MORE
practitioner or physician’s assistant, in endocrinologist offices, as well.
is your gatekeeper, but he or she can’t Pharmacist: Your pharmacist can Finding out that you have diabetes
do it alone. You need a team that has be an invaluable resource when it can be a shock to the system, and it
your back. Here’s who to consider comes to managing and understand- can definitely take a while to process
having on your team: ing your medications. everything. But as best you can, be
Primary-care provider (PCP): Eye care specialist: Make sure an open to learning about your condition
Sometimes called a PCP, he or she ophthalmologist or optometrist is on and how to manage it. There’s no cure
takes care of your overall health your team, as at least once a year, you (yet) for type 1 diabetes, and it’s not

needs and can refer you to specialists will need a dilated eye exam to check something that can easily be fixed by, SHUTTERSTOCK/GENERATIONCLASH
and other services that you may need. for diabetic retinopathy. say, taking a pill or having surgery.
Endocrinologist: This doctor spe- Dentist: Hopefully you already Learning how to manage diabetes

40 DiabetesSelfManagement.com • Mar/Apr 2020

(aka “diabetes self-management”) is symptoms of hypoglycemia and how
the best way to keep living your life they can help you if they occur.
and stay healthy at the same time. Where do you learn all of this? YOUR DIABETES NUMBERS
ARE INFORMATION
So, what will you need to learn? For Start with your diabetes care team. 4
starters, you’ll need to learn how to: You’ll need to have at least a few ses-
• Inject insulin sions with your CDE and/or dietitian. As you start managing your diabetes,
• Prevent and treat hypoglycemia Ideally, attend a diabetes program you’ll be faced with a lot of “numbers,”

(low blood sugars) in your community. You’ll learn a lot meaning blood sugar results, A1C
• Check your blood sugar not only from the instructors but also levels, blood pressure, cholesterol,
• Understand and make sense of from others in the program as well. kidney function tests… It’s very easy
your blood sugar readings Ask your doctor, check your local to get caught up in these numbers—
• Check for ketones hospital or call your local office of after all, they’ll help guide how you
• Count carbs and balance your the American Diabetes Association and your healthcare team manage
carb intake with your insulin for a diabetes program nearby. And your diabetes treatment plan. It won’t
• Check your feet don’t forget that there is plenty of always be easy, but try not to let these
• Manage your diabetes when information online. Start with Diabe- numbers define who you are as a per-
you’re sick or under a lot of stress tesSelfManagement.com, and check son. You’re not a “bad” person if your
• Prevent complications related out others, too, including: blood sugar is too high, for example.
to diabetes • diaTribe (diaTribe.org) Instead, use your numbers as a
Down the road a bit, you might • American Diabetes Association tool so that you can see what’s work-
decide to use an insulin pump and/ (Diabetes.org) ing and what isn’t. Maybe you need
or try CGM (continuous glucose • Centers for Disease Control and more (or less) insulin before dinner.
monitoring). You’ll also likely need Prevention (CDC.gov) Maybe you could eat a small snack
to teach others about your diabetes You can’t learn all of this in a before you go for a walk. Maybe you
so that they can help you, if needed. day or a week. And there are new could benefit from taking a medicine
For example, you may want to teach research findings, treatments and to help bring your cholesterol down.

someone close to you—a spouse, fam- technologies coming out all the time. Be open to trying different things to
ily member, roommate, friend or co- Expect to continue to learn for as long find out what works best for you…and
worker—how to recognize signs and as you have diabetes! try not to be too hard on yourself! DSM

Mar/Apr 2020 • DiabetesSelfManagement.com 41

Staying Healthy







on a Budget







How to safely save money on your diabetes care and supplies


BY LISA CANTKIER





re the costs associated with dia- inexpensive solutions or substitutes cost of diabetes supplies. Researchers
Abetes management weighing you to help bring down the high costs, but at the University of Chicago Medi-
down? If so, you are not alone. A study improperly cutting corners can lead to cal Center conducted a cost-analysis
published by the American Diabetes ineffective diabetes management and study that found significant benefits
Association found that the total cost potential health problems. Here are for diabetes patients who had per-
of diagnosed diabetes in the United some safe and effective ways for you sonalized their blood sugar goals.
States during 2012 was $245 billion, to save money on diabetes supplies Published in 2017, the study found
with average annual medical expen- without risking harm to your health.  that treatment plans that had been
ditures for people with the condition tailored to the patient’s age and health
totaling almost $14,000. Costs for Personalize your blood history were far more cost effective
diabetes essentials such as test strips, sugar goals when compared to national standard
glucose monitors, insulin, syringes, Working with your provider to per- treatment plans. In fact, people with

lancets and healthy diabetes-friendly sonalize your blood sugar goals is one individualized plans had a lifetime
snacks can quickly add up. way to help save money on medical average savings of $13,546 in health- SHUTTERSTOCK/AFRICA STUDIO
Often, people with diabetes look for treatments, healthcare costs and the care costs. Review your goals with

42 DiabetesSelfManagement.com • Mar/Apr 2020

your doctor to ensure that you are More importantly, PharmacyChecker a lot cheaper than the brand name
receiving the best possible treatment provides online verification of all products. (These companies also have
with your individual needs in mind.  savings to ensure you are only given loyalty cards that earn points with
information on deals for medications each purchase, which you can even-
Diabetes medication  that are accurate and safe. Pharmacy- tually use toward future purchases.) 
The first step in combating high costs Checker has a team of experts that you Glucose meters: Glucose meters
for essential medications is to survey can interact with online if you need help can be quite expensive, especially
the prices at different pharmacies. finding affordable medication. All three those produced by specialty compa-
Often, local pharmacies or pharmacies websites have been accredited by the nies and brand names, but there are
located within doctors’ offices may Better Business Bureau.  a number of options to reduce the cost
have higher rates for essential drugs of purchasing a glucose meter. Online

like metformin. A study from Harvard Diabetes supplies promotions through companies such
Medical School found that the cost Test strips: Test strips can be pricey, as Accu-Chek (accu-chek.com), One-
of medicine was a factor in whether but there are a number of ways to Touch (onetouch.com) and FreeStyle
seniors received effective medical bring down the cost. First, compari- (freestyleusa.com) offer free glucose
treatment for a host of conditions, son shop on various websites and meters. All three sites provide options
including diabetes. The researchers in stores. Amazon can often provide to subscribe and purchase test strips
found it common for patients, espe- brand-name products at cheaper to receive a free meter. Amazon also
cially seniors, to neglect taking pills to prices, sometimes with discounts provides many options, with detailed
make their supply last longer. included. For example, a box of 50 reviews of inexpensive monitors. For
One possible solution is to visit web- or 100 strips can easily be found for in-store options, Walmart’s ReliOn
sites that can help you find the lowest between $30 and $40 on Amazon. brand offers various glucose moni-
prices and best deals for medication. toring systems for affordable prices.
The Medicine Assistance Tool at MAT. Other supplies and snacks: Sup-
org is a search engine designed to The first step in plies like syringes, lancets, sharps con-
help find medication and assistance tainers, blood sugar logbooks and even
through various pharmaceutical pro- combating high healthy snacks can really add up each
grams. Websites such as GoodRx.com, time you find yourself running low on
WellRx.com and PharmacyChecker. costs for essential these essentials. To combat high costs,
com compare prices, potentially offer- medications is you can use companies like Retail-
ing huge savings when compared to MeNot.com that provide coupons for
local pharmacies, and you can receive to survey the sites such as TotalDiabetesSupply.com
free coupons through text or email and ADWDiabetes.com and products
straight to your mobile device. GoodRx prices at different like Glucerna. Diabetic snacks can also
additionally provides a mobile app that pharmacies. be purchased online. A great option is

can send you reminders and updates to visit sites like Amazon or Diabet-
on deals on your specific medications, icPromotions.com, where companies
along with information on where to find will often sell snacks in bulk for cheaper
them. The website promises to help you Companies like One Drop can provide rates than at grocery or specialty stores.
save up to 80% on most prescription huge savings through their mem- Additionally, there are many websites
drugs across the United States and can bership programs. On the website like JustFreebies.com where you can
provide coupons within the app that OneDrop.today, you can sign up for a sign up for coupons, free samples and
can be used at any pharmacy. variety of subscription packages, from giveaways of diabetic-friendly snacks
WellRx is another company that 100 test strips every three months for and other supplies. Also try buying
promotes easy access to essential medi- $39.95 total to unlimited test strips in bulk (keeping an eye on expiration
cation at a reduced rate by searching every three months for $149.95 total. dates) to save over the long-term at
for the best deals in your location. The A One Drop membership also includes stores like Costco.
WellRx savings card is accepted at access to its mobile app, with the Last but certainly not least, consider
65,000 chains and retail pharmacies option to order various test supplies, spending more time in the kitchen
across the country and can provide you track blood glucose and find personal each week cooking your meals and
with price alerts in your area. coaching and education. Stores like preparing your snacks from scratch.
Finally, PharmacyChecker is another Costco can also provide great deals, Doing so will save you money, pro-
great site that provides updates and as buying strips in bulk can save you vide added nourishment and help
alerts on savings in your area. It prom- money in the long term. Additionally, you avoid unwanted ingredients and

ises savings of up to 90% on prescrip- stores like Walgreens, CVS, Target and processed foods. Check out our latest
tion medications through their price Walmart all sell their own brands of and greatest recipes at DiabetesSelf-
comparison feature and savings card. diabetes test strips, which often are Management.com/Recipes. DSM

Mar/Apr 2020 • DiabetesSelfManagement.com 43

Eating






With Diabetes
















44 DiabetesSelfManagement.com • Mar/Apr 2020

Out

Making the best menu choices


BY AMY CAMPBELL, MS, RD, LDN, CDE

















Mar/Apr 2020 • DiabetesSelfManagement.com 45

mericans like—make that TIPS FOR TOP MENU CHOICES
A love—to go out to eat, so much Every restaurant is different, and that
so that, on average, we eat out 4.9 means that foods may be prepared in
times per week, according to a Zagat any number of ways. Your best bet is
dining trends survey. And while to ask questions of your waitstaff so
many people dine out because of the that you know what you’re getting.
convenience or due to hectic work However, in general, the following tips
schedules, the reality is that eating can boost the chances of you making
out is enjoyable. the best choices possible:
But what if you have diabetes?
Does dining out have to become a Starters and appetizers
thing of the past? Not necessarily. • Go for a bowl of broth-based soup,
You can definitely dine at an infinite such as chicken, vegetable or hot and
number of restaurants and still keep sour soup. Skip creamy or fatty soups

your blood sugars well-managed. like chowders and French onion soup.
Timing of meals, remembering to • Nibble on raw vegetables or cru-
take your diabetes medication, and dité with a vinaigrette dressing or
portion control are key factors to pay some hummus.
attention to when eating away from • Shrimp cocktail is a low-calorie,
home. In addition, using the healthy low-carb starter.
plate method is a simple but helpful • Vegetable salads are generally
way to keep you on track with making a good choice, but ask for dressing
better choices. Here’s how it works: on the side so that you control how
• Aim for half of your plate to be much is added. And bypass fatty,
filled with low-calorie, non-starchy high-calorie extras such as bacon,
vegetables or salad. cheese and fried noodles.
• Have a quarter of your plate • Caprese salad (fresh mozzarella
filled with a lean protein food, such with tomato and basil) is a delicious,
as chicken, seafood or lean meat. high-protein starter.
• Have the other quarter of your • Indulge in a few tortilla chips with
plate filled with a healthy carb, such salsa, but then ask that the chips be
as brown rice, quinoa, sweet potato removed from the table.
or peas.

• Use heart-healthy fats, including Main courses
olive oil, canola oil, avocado, nuts • Get your omega-3 fatty acid fix by SHUTTERSTOCK/RAWPIXEL.COM
or seeds. ordering broiled poached salmon,

46 DiabetesSelfManagement.com • Mar/Apr 2020

halibut or tuna. Other healthy fish Sides
include cod or scrod, haddock and • Roasted or steamed vegetables are
mackerel. Pass up fried or breaded good choices, especially if they’re
seafood dishes. cooked without fat or with a drizzle
• Go ahead and treat yourself to of olive or peanut oil.
crab or lobster—eat it plain with • Baked potatoes and sweet pota-
lemon juice and maybe a touch of toes are healthy choices, but because
butter. Skip baked stuffed versions, they contain carb, eat just half if the
as they can be loaded with calories potato is on the large side. Go easy
and carbs. with butter and sour cream; try a
• Baked, grilled or broiled chicken squirt of lemon juice, instead.

is generally a good choice. Peel off the • If you’d rather forgo a starchy
skin before you eat the chicken. side dish, ask to swap out a potato or
• Grilled or roasted lean beef is a fries for a second vegetable.
good choice. If you can spring for it, • Whole grains provide impor-
order a filet or tenderloin cut to mini- tant nutrients and fiber, so look for
mize saturated fat. And steer clear of quinoa, brown rice, farro, bulgur
oversized or super-fatty cuts of meat, or barley.
such as prime rib.
• Burgers can be a good choice, Dessert
whether you choose beef, turkey or • A dish of fresh berries with a drizzle
bison. Shave off carbs by removing of balsamic vinegar is an elegant and
the top half of the bun, and ask for healthy way to satisfy a sweet tooth.
yours with vegetable toppings (minus • A small dish of ice cream or sor-
the cheese). bet can also tame the craving for
• In terms of Chinese food main something sweet.
courses, chicken with broccoli, • If you’re wanting something a
tofu-based dishes, moo goo gai pan bit more decadent, go ahead and
(chicken and vegetables) and steamed order the triple chocolate cake or
shrimp and veggies are decent options. tiramisu—but share it with the table
• If you’re at a Mexican restaurant, and take just a few bites.
try a fajita with chicken, shrimp or
beef. You can lower the calories by ADDITIONAL POINTERS
skipping the rice; or go with a fajita For the most part, restaurants try to be
bowl and ask for yours on a bed of accommodating as much as possible

lettuce. Ask for a side of beans for a because they want your business.
dose of fiber. Don’t be afraid to ask questions about
• Try fish tacos—but make sure how your food is prepared, as well as
the fish isn’t fried. Also, go with corn about easy substitutions.
tortillas instead of flour tortillas. Since restaurant meals tend to be
• Pasta dishes will be high in car- overly generous in size, see if you can
bohydrate, for sure; however, if it’s order a smaller size or share a meal
noodles that you crave, lower the carb with your dining companion. Or, eat
count by ordering a pasta primavera half of your meal and bring the rest
(pasta and vegetables) or pasta with home for the next day. Don’t forget to
marinara sauce. Since portions of check your blood sugar before your
pasta can be large, split a dish with meal and then try to check it a couple
your spouse or friend and be sure to of hours later to see the impact of
have a salad on the side. And if the res- that meal on your blood sugar (the
taurant happens to offer whole-grain goal for an after-meal blood sugar
or vegetable noodles, even better! is less than 180 mg/dl). If you’ve
• If it’s pizza you’re craving, go overindulged, try to do some activ-
BACKGROUND: -SHUTTERSTOCK/LENA PAN flower crust pizza is an option, even help lower your blood sugar.
with a thin-crust pizza (and if cauli-
ity, such as going for a short walk, to

better!). Top it with plenty of veggies
With these tips and a bit of plan-
and chicken, and if possible, ask the ning on your part, eating out doesn’t
chef to go easy on the cheese.
have to be a thing of the past! DSM
Mar/Apr 2020 • DiabetesSelfManagement.com 47

••• AT THE TABLE ••• Delicious Side Dishes















Celebrate











Spring!






he spring season is a time to explore and renew. Just as
Tphysical and mental well-being are important components

of healthy living with diabetes, so is eating deliciously well. If
available in your area, your local farmers’ market or community-

supported agriculture (CSA) program make excellent places to
purchase foods fresh and in season and talk with the farmers.





Roasted Parsnips,

Carrots and Red Onion


4 SERVINGS | ABOUT ¾ CUP
V FI | W LF
CAL 107 | FAT 3G | SAT FAT 0G | PROTEIN 2G | CARBS 21G | CHOL 0MG |
FIBER 5G | SODIUM 197MG
DIETARY EXCHANGE 1 BREAD/STARCH, 1/2 FAT, 1 VEGETABLE

2 carrots (9 ounces), cut into 3. Roast 25 minutes, or until
2-inch-long pieces vegetables are tender, stirring
2 parsnips (9 ounces), cut into occasionally.
2-inch-long pieces Note: Parsnips are a pale white
¾ cup vertically sliced red root vegetable similar to the carrot
onion (¼-inch slices) in shape. The parsnip, however,
1 tablespoon balsamic vinegar is broader at the top and has a
2 teaspoons extra-virgin smoother skin. The longer it stays in
olive oil the ground, the sweeter it becomes.
¼ teaspoon salt Choose parsnips that are firm,
1⁄8 teaspoon black pepper
unblemished and small or medium
in size (about 8 inches long). Rinse
1. Preheat oven to 425°F. Line large
baking sheet with foil or spray with and scrub parsnips with a vegetable
nonstick cooking spray. brush to remove embedded soil.
Peel parsnips with a swivel-bladed
2. Combine carrots, parsnips, onion, vegetable peeler or paring knife.
vinegar, oil, salt and pepper in large Trim off ends and discard. For even
bowl; toss to coat. Spread in single cooking, parsnips are best chopped,
layer on prepared baking sheet. cubed, sliced or cut into strips.




Get more delicious diabetes-friendly recipes at
DiabetesSelfManagement.com/recipes ANGELA SACKETT



48 DiabetesSelfManagement.com • Mar/Apr 2020


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