High-Protein Nutrition May Help Manage Diabetes and Blood Sugar

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1. Kempf K, et al. Eﬃcacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: A randomized controlled trial. Diabetes Care. 2017 Jul;40(7):863–871.
2. Lean M, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2017;391(10120):541–551.
Groundbreaking Research Shows
How to Regain Healthy
Blood Sugar and
Lose Weight
One answer to healthy blood sugar levels is found
in high-protein low-glycemic nutrition.
People who live with diabetes want
better options for getting a handle on
their blood sugar, especially their
HbA1c levels.
The problem is that, even when we
do try to eat right and exercise, our
bodies still need extra help from our
metabolism to light the fires of our
glucose-burning furnace that’s nec-
essary for weight loss.
Knowing this, in 1985 German holis-
tic therapist Hubertus Trouillé devel-
oped a low-glycemic high-protein
formula to be used as nutritional
therapy by his patients living with di-
abetes and slow metabolism.
After following his dietary advice,
Trouillé discovered that the formula
not only helped his patients increase
metabolism but also regain glycemic
control and lose weight.
Today, his unique formula, called
Almased, has been scientifically
studied for over 30 years.
ADVERTISEMENT
Study results show the Almased
participants experienced:
Weight loss
Healthy HbA1c
Reduced
hunger
Increased
quality of life
Healthy blood
sugar
Enhanced
glucose
handling and
metabolism
Low-Glycemic High-Protein
Nutrition and Glucose Health
In a 2017 study by Kerstin Kempf and
a group of German researchers, a
12-week telemedical lifestyle inter-
vention (TeLiPro) was carried out
in patients with advanced type 2
diabetes.1
It included weekly phone calls by
trained diabetes educators who
talked about diet, exercise, and
options for overall lifestyle
changes.
For the first 12 weeks, the TeLiPro
group also received a low-glyce-
mic high-protein dietary supple-
ment — in place of three meals a
day for the first week, two meals a
day for weeks 2 to 4, then one meal
a day for weeks 5 to 12.
Time (Weeks)
Mean
Weight
Loss
(kg)
Weight Reduction
Weight Reduction
Control Group
TeLiPro Group

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* Results are not typical. Individual results may vary based on starting weight and program adherence. These statements have not been evaluated by
the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Find Almased at these fine retailers!
Made from high-quality soy,
probiotic yogurt and enzyme-
rich honey, Almased is
diabetic-friendly — 27 on the
Glycemic Index score.
Almased can help:
○ Lower HbA1c and
blood-sugar levels.*
○ Burn fat while
retaining muscle.*
○ Aid the gut microbiome in
supporting digestive and
immune health.*
○ Curb cravings and support
a healthy balance of the
hunger hormones, leptin
and ghrelin.*
○ Boost energy and
support mood.*
What makes Almased so different?
Supported by over 30 years
of scientific research.
Unique fermentation
process.
All essential amino acids.
Bioactive peptides.
Honey-derived
digestive enzymes.
Vegetarian and
gluten-free.
No artificial fillers, flavors,
sugars, preservatives
or stimulants.
The results? The HbA1c levels in
the TeLiPro group were, on average,
reduced by 1.1, from 8.4% to 7.3%.
In this group, there were also signif-
icant reductions in fasting blood glu-
cose, body weight, body mass index,
blood pressure, cardiovascular risk
factors, and requirements for diabe-
tes medications — a 20% lower need
for medications and a nearly 50% re-
duction in insulin needs.
These improvements were even seen
after 52 weeks of follow-up.
There are other lifestyle intervention
studies, with other diets, that have
had some success, such as the 2017
DiRECT study in the U.K., which sug-
gested that a very-low-calorie total
diet replacement for up to 5 months,
along with coaching by health prac-
titioners, could achieve weight loss
and reductions in HbA1c levels.2
But the U.K. study was hard to follow
(25% dropped out), had some un-
wanted side effects, and had a 2:1 ra-
tio of carbs to protein.
The Power of Almased
The German researchers chose a
formula that was high in protein
(Almased) but low in carbohy-
drates (nearly 2:1 protein to carbs),
knowing that more protein in the diet
naturally reduces insulin demand
and increases fat burning.
The takeaway from this research,
and other published studies, is that
while supporting glycemic control
can be hard, it can be easier when
our metabolism is working with us.
The high-protein, scientifically
proven, Almased Diet can help
you reduce your HbA1c and
blood sugar levels while sup-
porting glycemic control.
ADVERTISEMENT
To learn more and
to download your
free diet plan go to
almased.com/DM03E
or call us toll-free
at 1-877-256-2733
or e-mail us at
info@almased.com.

Get tested for
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If you have type 2 diabetes
DKD can lead to kidney failure and dialysis and increases your risk for
heart attack. DKD often has no symptoms until it’s too late, but when it’s
caught early, there is more you can do to protect your kidneys.
Ask your doctor for a UACR (urine albumin-to-creatinine ratio) urine test
once a year. It checks for protein in the urine, one of the earliest signs of
DKD or kidney damage.
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are registered trademarks of Bayer. Last Updated 06/2021 PP-UN-CAR-US-0310–1
For more information, visit KidneyAlert.com
or scan code
Up to 40% of people with type 2 diabetes (T2D) develop
diabetic kidney disease (DKD)

Dear Readers,
Autumn is upon us, and with it have arrived all the
changes this time of year brings: The weather is cool-
ing down, leaves are turning vibrant colors, and shorts
and tees have been exchanged for jackets and sweaters.
Eager to usher in the season with some positive changes
of your own? Read on.
Blood glucose control is the cornerstone of
diabetes management, and strategies such as regular
monitoring, following a healthful meal plan, and
getting regular physical activity are familiar steps that
can help keep it in check. But there are a variety of
other, less-well-known measures that can help, many
of which you can start implementing today. Curious?
Find out more in “Lifestyle Hacks for Better Blood
Glucose Management” (page 24).
If pain plagues your days, you may feel run-down
and hopeless. But what you may not know is that pain
and diabetes can be linked in a variety of ways, and
there are approaches that can help bring relief. Learn
about the connection between the two conditions and
get helpful tips for managing pain at home in “Pain
and Diabetes” (page 32). Remember, there is hope!
Eating: It’s something we all do, but the trick is in
knowing what and how much—often easier said than
done. Indeed, whether you’re newly diagnosed or
you’ve had diabetes for many years, this area of self-
management can be challenging. Fortunately, there
are some easy approaches that can get you on the
right dietary path. Get started with the expert tips in
“Strategies for Healthy Eating” (page 40).
No matter what area of your management routine
you choose to focus on in the coming months, you
should be proud of all the hard work you’re putting in
to stay healthy. Be well, and have a fantastic fall!
All the best,
Diane Fennell
Editorial Director, Wellness Division
••• EDITOR’S NOTE •••
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4 DiabetesSelfManagement.com • Fall 2021

E - C O U R S E
TYPE 2
WELLNESS JOURNEY
A 21-DAY E-COURSE
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Sugar: Fact or Fiction
A lot of misinformation surrounds diabetes, especially when it comes to
sugar. How do you make sense of sugar in terms of what types and how
much is“allowed”? Let’s clear up some of that confusion and set the record
straight. bit.ly/34ce3Kd
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Good-for-You Chicken
Noodle Soup
In the crisp days of fall, nothing hits
the spot better than a steaming,
hydrating bowl of chicken soup.
Using skinless chicken breasts cuts
down on the fat and calories in this
low-carb version of the classic.
bit.ly/3f5jukC
RECIPE
Hiking for Health
If you’re interested in an active
autumn, hiking might be just the
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by the image of backpackers
climbing the Rocky Mountains. The
reality is that hiking can be as mild or
rigorous as you choose. Get our tips
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Are Beans Good for Diabetes?
Beans have quietly risen to
superfood status, thanks to their
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might be wondering if and how they
can be part of your eating plan if
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NUTRITION

Fasting Glucose and
Waist Size Predict Risk of
Diabetes Complications
BY QUINN PHILLIPS
Fasting glucose level, waist cir-
cumference and age at diabetes
diagnosis are factors that help predict
who will develop diabetes compli-
cations, according to a new study
published in the Journal of Diabetes
and its Complications.
Researchers looked at a diverse,
multiethnic group of 1,587 partici-
pants, all of whom had diabetes, in
a study called the Multi-Ethnic Study
of Atherosclerosis. Participants were
divided into eight different groups
based on three factors that split par-
ticipants into two categories each.The
first factor was age at diabetes diag-
nosis, with participants divided based
on an age of 45 or younger, or older
than 45.The second factor was fasting
glucose level, with participants divided
based on a measurement of 140 mg/
dl or higher, or below this level. And
the third factor was waist circumfer-
ence, with women divided based on a
measurement of 105 centimeters (41.3
inches) or greater, or below this level,
and men divided based on a measure-
ment of 110 centimeters (43.3 inches)
or greater, or below this level.
The researchers were interested
in how each of these factors—age at
diagnosis, fasting glucose level and
waist circumference—was related
to outcomes including death from
all causes, cardiovascular disease,
chronic kidney disease, heart failure,
dementia and diabetic retinopathy
(eye disease) during a follow-up period
of about 17 years. In calculating how
these factors were related to outcomes,
the researchers adjusted for demo-
graphic differences (like age or race),
known behavioral differences, and
known differences in clinical risk fac-
tors (such as other health conditions).
They found that the group of par-
ticipants with both an early age at
diabetes diagnosis and high fasting
glucose experienced a higher risk of
death, cardiovascular disease, heart
failure, chronic kidney disease and
retinopathy. The group with both an
early age at diagnosis and a high waist
circumference experienced a higher
risk of cardiovascular disease, heart
failure, chronic kidney disease and
retinopathy. The group that had all
three higher risk factors—early age
at diagnosis, high fasting glucose and
high waist circumference—experienced
a higher risk of death, heart failure,
chronic kidney disease and retinopathy.
The researchers noted that these
results reinforce the importance of
assessing the risk for complications
among people with diabetes based on
their age at diagnosis, fasting glucose
level and waist circumference—as
well as the importance of using these
findings to communicate with patients
and to develop a strategy for prevent-
ing diabetes complications. DSM
••• THE DOSE ••• News Notes
SHUTTERSTOCK

Too Many Older Adults May
Be Taking Daily Aspirin
BY QUINN PHILLIPS
Two commonly recommended or
prescribed drugs—daily aspirin
and the cholesterol-lowering drugs
statins—may not be taken by the right
proportion of older adults, according
to a new study published in the Jour-
nal of the American Geriatrics Society.
Both daily aspirin and statins have
been shown to reduce the risk of car-
diovascular events in some people, but
they’re not recommended universally.
Aspirin is generally recommended for
adults with a moderate to high risk
of developing atherosclerotic cardio-
vascular disease (fatty deposits in the
arteries) who have a remaining life
expectancy of at least 10 years and are
willing to take aspirin daily for at least
10 years. This means aspirin is most
likely to be recommended for adults
ages 50-59, with less evidence to sup-
port its benefits for people ages 60-69.
People under 50 or at least 70 are
generally not considered candidates
for daily aspirin without a history of
cardiovascular disease (CVD).
Statins, on the other hand, are gen-
erally recommended at low to moder-
ate doses for adults ages 40-75 who
don’t have a history of CVD but who
have one or more cardiovascular risk
factors (such as diabetes, high blood
pressure or abnormal cholesterol or
triglyceride levels) and a moderate to
high risk of developing atherosclerotic
CVD.There isn’t enough high-quality
evidence, the researchers write, to
recommend that most adults over
age 75 take either aspirin or a statin
daily to help prevent CVD.
Using data from the U.S. National
Health and Nutrition Examination
Survey (NHANES) between 2011 and
2018,the researchers looked at the use
of both aspirin and statins in adults age
50 and older.They found that daily use
of aspirin—mostly at low doses, as is
recommended for preventive benefits—
tended to increase with age and was
quite similar across the range of years
in the study.In 2017 and 2018,rates of
daily aspirin use, almost always at the
recommendation of a doctor, ranged
from 20.0% in adults ages 50-54 to
49.6% in adults ages 70-74 to 53.7%
in those age 75 and older.
Daily use of statins also tended to
increase with age,ranging in 2017 and
2018 from 17.8% in adults ages 50-54
to 47.7% in adults ages 70-74 to 52.3%
in those age 75 and older.While these
numbers are broadly similar to those
for daily aspirin, the different clinical
recommendations for each drug mean
it’s likely that more older adults could
benefit from taking statins than cur-
rently take them—while it’s likely that
too many older adults are taking daily
aspirin and may be at higher risk for
adverse effects like bleeding as a result.
“Education...regarding the com-
pelling benefits of using statins
for the secondary prevention of
CVD is important,” the research-
ers wrote. Additionally, they note,
“Healthcare providers should
inform their older patients about
the appropriate aspirin use.” DSM
SHUTTERSTOCK

Groundbreaking New
Weight-Loss Drug Approved
BY QUINN PHILLIPS
The U.S. Food and Drug Admin-
istration (FDA) has approved
Novo Nordisk’s application to
market a new formulation of the
drugmaker’s type 2 diabetes drug
Ozempic (semaglutide) as a once-
weekly injection for weight loss.
Sold under the brand name
Wegovy, the new formulation for
weight loss is a higher-dose ver-
sion of Ozempic, a treatment to
improve blood sugar levels that
was approved by the FDA in 2017.
Wegovy is intended to be com-
bined with a reduced-calorie diet
and increased physical activity to
achieve weight loss in people who
are overweight or obese, and who
have medical problems related to
their excess body weight.
The new FDA approval is based
on the results of a clinical trial called
STEP (Semaglutide Treatment Effect
in People with Obesity) that included
about 4,500 participants. Trial par-
ticipants who received Wegovy lost
an average of 14.9% of their body
weight over the course of 68 weeks,
compared with 2.4% for participants
who received a placebo (inactive treat-
ment).What’s more, 83.5% of partici-
pants in the Wegovy group lost at least
5% of their body weight, compared
with just 31.1% who lost this much
body weight in the placebo group.
“This is the first time we have
seen this magnitude of weight
loss with a medicine,” said Rob-
ert F. Kushner, MD, a professor of
medicine and medical education at
Northwestern Medicine’s Feinberg
School of Medicine in Chicago.
Wegovy should not be taken with
any other products that contain
semaglutide—such as Ozempic or
Rybelsus—or any other drug in the
GLP-1 receptor agonist family, which
includes Trulicity (dulaglutide),
Byetta and Bydureon (exenatide),
Victoza (liraglutide), and Adlyxin
(lixisenatide). Like many other drugs
in this family, digestive upset is
the most common category of side
effects for Wegovy. DSM
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TYPE 1 DIABETES LINKED
TO MUSCULOSKELETAL
CONDITIONS
BY QUINN PHILLIPS
Type 1 diabetes is linked to a higher risk of developing
musculoskeletal problems, including conditions like
frozen shoulder and carpal tunnel syndrome, according to
new research presented at the Diabetes UK Professional
Conference (DUKPC) 2021.
Researchers at the University of Exeter in England
based their findings on an analysis of data from the UK
Biobank—one of the largest general health studies in the
world—and from FinnGen, a similar large study based in
Finland. The researchers used both genetic information
and health data to find out whether people with type 1
are at higher risk for a wide range of health conditions.
They found that type 1 was likely to play a causal role
in developing a range of musculoskeletal conditions,
including frozen shoulder, carpal tunnel syndrome, trig-
ger finger and Dupuytren’s contracture. Each of these
conditions is marked by pain and reduced mobility in
the shoulder, wrist, hand or fingers.They also found that
type 1 was unlikely to play a causal role in developing
osteoarthritis (the most common form of arthritis, in
which joints degenerate).
This study is the first large-scale analysis to show that
type 1 diabetes is responsible for a higher risk of develop-
ing musculoskeletal problems. Now that this connection
is known, the researchers noted, people with type 1 and
their doctors can be on the lookout for musculoskeletal
problems that may develop as a result of diabetes.
More research is needed, the researchers pointed
out, to learn how diabetes and elevated blood glucose
may contribute to the development of musculoskeletal
problems. DSM
PORTION CONTROL
BY LISA CANTKIER
Portion sizes matter when it comes to a healthy
diet, particularly if you have diabetes. With
obesity rates at an all-time high in the United States
and around the world, we need to examine not only
what we eat but also how much we eat. Odds are,
your portion sizes may be larger than they should
be. Find out what your portions should look like
and how to truly take charge of your plate by taking
this quiz. (Everyone is different, so be sure to ask
your healthcare provider about your diet and meal
portions to determine what is best for you.)
1.True/False:The“plate method”is a strategy that
can help you achieve portion control.
O
OTrue O
OFalse
2. Controlling the portions on your plate can:
O
OA. Result in healthy weight loss.
O
OB. Lead to a decrease in diabetes medication.
O
OC. Improve blood glucose control.
O
OD. All of the above.
3.Weight loss in people with diabetes who are over-
weight is associated with which of the following?
O
OA. Decreased muscle tone.
O
OB. Normalized blood glucose levels and a reduced
risk of other health problems.
O
OC. Increased LDL (“bad”) cholesterol.
O
OD. An increased risk of hypertension (high blood
pressure).
4. Howcanyouestimateportionsizesforyourplate?
O
OA. Use measuring cups and measuring spoons.
O
OB. Use food scales.
O
OC. Use the palm of your hand, fist, fingers and thumb.
O
OD. Eyeball it.
5.True/False: Using a smaller plate size does not
help control meal portions.
O
OTrue O
OFalse
QUIZ
See page 14 for answers.
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FOR ONE NIGHT. WE STAND TOGETHER.

REDUCED-CARBOHYDRATE,
HIGH-PROTEIN DIET SHOWS
BENEFITS IN TYPE 2
BY QUINN PHILLIPS
Following a reduced-carbohydrate, high-protein diet
may provide a variety of benefits to people with type
2 diabetes, including better glucose control and reduced
hunger, according to a small study published in theAmeri-
can Journal of Physiology-Endocrinology and Metabolism.
The study’s participants were 28 adults with type 2
diabetes, who were randomly assigned to follow either a
reduced-carbohydrate, high-protein diet or a conventional
diabetes diet for six weeks.The reduced-carbohydrate diet
got 30% of its calories from carbohydrate,30% from protein
and 40% from fat, while the conventional diabetes diet got
50% from carbohydrate,17% from protein and 33% from fat.
The researchers found that following a reduced-car-
bohydrate, high-protein diet resulted in total after-meal
glucose elevation (“area under the curve”) that was 60%
lower on average, as well as 24-hour glucose levels that
were 13% lower, compared with the conventional diabetes
diet. Participants’ after-meal insulin secretion rate was
also 24% lower, while pancreatic beta cell sensitivity to
insulin increased by 45% on this diet. Stomach empty-
ing was delayed by an average of 15 minutes, while
self-reported fullness between meals increased by 18%.
These results show dramatic benefits, and no sig-
nificant disadvantages or risks, linked to following a
reduced-carbohydrate, high-protein diet in a small group
of people with type 2 diabetes. “It is noteworthy that
these results were achieved in a setting that aimed at
body weight maintenance,” rather than weight loss, the
researchers wrote—suggesting that the difference in diet
composition, rather than a reduction in overall calories,
was responsible for the benefits observed.
Based on these results, the researchers concluded,
many people with type 2 diabetes may benefit from a
modest shift in their diet composition away from carbo-
hydrate and toward protein. DSM
SHUTTERSTOCK
1.True. According to the American Diabetes Associa-
tion, the“plate method”can help you create“perfectly
portioned meals with a healthy balance of vegetables,
protein and carbohydrates without any counting,
calculating, weighing or measuring…all you need
is a plate.”This method suggests you fill one-quarter
of your plate with protein, one-quarter with whole
grains or other whole-food carbohydrates, and half
with colorful nonstarchy vegetables.The recom-
mended beverage of choice for the plate method is
filtered water. Avoid processed foods.
2. D. Portion size is an important determinant of
energy intake. In people with type 2 diabetes, weight
reduction improves blood glucose control. According
to research, portion control tools are effective in lead-
ing to weight loss and enable people with diabetes
to decrease their blood glucose medications without
sacrificing glycemic control.
3. B. According to Diabetes Canada,“Portion size is an
important part of weight loss. If you’re overweight or
obese, weight loss is the most important and effec-
tive way to help normalize blood sugar levels and
reduce your risk of other health problems.”DC says
you should fill half your plate with vegetables and
fruits.The organization also notes that“Low-glycemic-
index foods such as legumes, whole grains, and fruits
and vegetables can help control blood sugar...and can
make you feel full longer to help with losing weight.”
4. A, B, C. Measuring cups and spoons and food scales
are useful tools for determining portion size.The Cen-
ters for Disease Control and Prevention teaches people
how to estimate portion size using their hands when
these tools aren’t available. For example, 3 ounces of
meat, fish or poultry = the palm of the hand (no fin-
gers), 1 cup or 1 medium fruit = a fist, 1 tablespoon =
a thumb tip (tip to first joint), 1 teaspoon = a fingertip
(tip to first joint).
5. False. The results of a study in the journal BMC
Obesity showed that using a plate smaller than a tra-
ditional dinner plate resulted in participants consum-
ing smaller food portions.This is an effective strategy
you can try to help manage your portions. (Just be
mindful that portion control plates have the potential
to reduce portion sizes of important items—if you try
this, don’t skimp on your nonstarchy veggies!) DSM
LisaCantkierisawriterandeducatorspecializinginnutri-
tion and health. She is coauthor of the diabetes-friendly
cookbook The Paleo Diabetes Diet Solution.
QUIZ ANSWERS See page 12 for questions.

••• THE DOSE ••• Product Spotlight
Philips SmartSleep Sleep Wake-Up Light
If the longer nights have you yearning for more time in bed,
maybe it’s time to treat yourself to the gift of healthy sleep.
The Philips SmartSleep Sleep Wake-Up Light is a sound
investment in your health.You can customize your nighttime
and morning routines with sunset and sunrise simulation,
which allows you to wake up more naturally using a
combination of light and sound.This device also provides an
FM radio, a reading lamp with 10 brightness settings and a
tap snooze in case you want to sleep a bit longer. Fall asleep
faster and wake up feeling energized.
usa.philips.com
Cool New Products to Try
BY AMY CAMPBELL, MS, RD, LDN, CDCES
Tea Forte Single Steeps Tea Chest Sampler
There are so many reasons to enjoy a hot cup of tea. Some are
health-related, including a lower risk of heart disease, type 2 diabetes
and some types of cancer, and less depression and anxiety. Drinking
a cup of tea can also help you unwind from a busy day or let you
catch up with a good friend. Whatever your reasons are, you’ll be
sure to appreciateTea Forte’s Single SteepsTea Chest Sampler.You’ll
get to experience a wide range of different teas (28, to be exact)
from around the world. Fix yourself the perfect cup of tea anytime,
anywhere withTea Forte’s single-serve pouches.
teaforte.com
Quility Weighted Blanket
For people with diabetes, constant stress and lack of sleep can make
it harder to manage blood sugars. A quick and easy way to improve
your sleep and banish stress is to use a weighted blanket. Weighted
blankets, such as the Quility Weighted Blanket, provide the right
amount of pressure on your body—much like getting a good hug.
This blanket is made from high-quality, durable materials, including
microglass beads and a removable, breathable duvet cover.You’ll
feel comforted and relaxed, and you’ll finally get a good night’s sleep
without getting overheated.
quilityblankets.com
Fall 2021 • DiabetesSelfManagement.com 15

Diabetes Freedom – What is it all about?
A large amount of the population today suffers from the deadly disease called diabetes;
especially Type-2 diabetes is becoming a common problem among the population.
A large number of diabetic patients get their legs amputated. Many times, diabetic patients are
left helpless because there seems to be no cure for their condition.
They can only survive if they take their medications on time. Their bodies get so used to the
support from these tablets that the body’s ability to function on its own is diminished.
For years people have been dealing with type-2 diabetes, but no permanent cure still exists for
the condition.
Or is the world being fooled by all the big drug companies and manufacturers? There are
natural ways through which one can bring under control one’s blood sugar level.

Hypoglycemia Defined,
Hidden Carbs
BY GARY SCHEINER, MS, CDCES
••• THE DOSE ••• Ask Away
SHUTTERSTOCK
QMy lab work says that a blood
glucose level in the 60s mg/
dl is normal, but I’ve always been
told that anything below 70 mg/dl
is too low. Which is correct?
AThere is a great deal of debate
in the medical/scientific world
about the true definition of hypogly-
cemia (low blood glucose). For anyone
at risk of hypoglycemia, including
those who take insulin or medications
that increase insulin production, the
general rule has always been that
anything below 70 mg/dl is considered
too low and should be avoided. Glu-
cose levels below 70 mg/dl will usually
cause the body to produce adrenaline,
which leads to the classic symptoms
of hypoglycemia (e.g., shaking, sweat-
ing, rapid heartbeat, intense hunger).
While these symptoms can be
unpleasant and disruptive, they are
not necessarily dangerous. Research
has shown that, for most people, the
mind and body can still function rea-
sonably well even with glucose levels
in the 60s. However, once glucose
dips below 55 mg/dl, things change
dramatically. At this point, the brain
lacks the energy to function prop-
erly. Confusion can set in, and it may
become difficult or impossible to eat
or drink something to treat the low.
And some people experience this at
levels higher than 55 mg/dl.
Given how quickly glucose can
drop, most people aim to keep their
levels from going below 70 mg/dl.
Think of glucose levels in the 60s as
a guardrail that keeps you from fall-
ing over a cliff. You’re safe as long as
you stay behind the guardrail, but if
you push against it too hard or lean
too far over it, you can easily wind
up falling into a pit of doom. Best to
have a discussion with your diabetes
care team to determine precisely how
low is too low for you.
QThe other day, all I had for
lunch was a salad with some
cashews. Within a few hours, my
blood glucose had risen almost 100
mg/dl! Why would it rise so much if
I didn’t have any sugar or starch?
AWelcome to the world of “hidden”
carbohydrates. Many people
think the only sources of blood-
glucose-raising carbs are obvious
foods such as bread, potatoes, fruit
and sweets. But there are carbs in
almost everything we eat. Salads, for
example, contain an average of about
4 to 5 grams of carbohydrate per cup.
And cooked nonstarchy vegetables,
such as steamed broccoli, contain 8
to 10 grams per cup. A handful of
cashews contains about 10 grams
of carbohydrate, and a handful of
peanuts contains roughly 6 grams (of
course, handful sizes may vary!). Milk
is another source of carbs—about
12 grams per cup. And that doesn’t
even touch on sauces, dressings and
condiments. A single tablespoon of
barbecue sauce can contain 5 to 10
grams of carbohydrate!
There are a few exceptions. Most
meats, eggs and cheeses are com-
pletely carb-free. But carbs may be
added during food preparation. It
pays to look up the contents of your
common meals and snacks to make
sure your carb counts match what
you actually consume. DSM
Gary Scheiner, MS, CDCES, has lived
with type 1 diabetes for 30 years and
was named Diabetes Educator of the
Year 2014 by the Association of Dia-
betes Care Education Specialists.
Have a question about diabetes?
Email gary@integrateddiabetes.com.

Take a Hike!
BY ROB DINSMOOR
I’ve always enjoyed hiking, but I
especially came to love it during
the pandemic because it gave me an
excuse to leave my house, breathe
fresh air, and enjoy the scenery. If
you haven’t hiked before, it’s never
too late to begin. Hiking can increase
stamina, improve bone density,
strengthen leg muscles, strengthen
your core, and improve your bal-
ance. It can also help you control
your weight, improve blood pressure,
lower blood glucose levels, and gener-
ally reduce the risk of heart disease.
A wide variety of fancy gear is
marketed to hikers, but all you really
need to start out is a lightweight back-
pack and sturdy, durable hiking boots
that fit well. (I remember hiking in
old boots that seemed to be made of
lead, but there are many lightweight
yet durable options available today.)
Hiking poles are also recommended,
especially on hills, because they help
you keep your balance, particularly
going downhill, and take some of the
stress off knees and hips.
What do you put in your backpack?
Water is the most important item,
since hiking inevitably builds a thirst,
and there are usually no water foun-
tains or convenience stores in the wild.
It’s also prudent to carry blood glucose
monitoring supplies and snacks and/
or glucose tablets in case of hypogly-
cemia (low blood glucose). If there’s
any chance of being out after dark,
definitely pack a flashlight.
All geared up with nowhere to
go? Members of the Appalachian
Mountain Club (outdoors.org) have
access to organized hiking trips and
related events. The Hiking Project
(hikingproject.com) offers maps for
hiking trails all over the world and
allows you to search for trails near
you. Meetup.com has regional hiking
groups that provide group hikes, most
of which are free to members. Most if
not all states have hiker-friendly state
parks and forests, often with large
trail maps on display and smaller
trail maps that you can carry. The
U.S. Forest Service (fs.usda.gov) has
a searchable database of forests and
grasslands in various states.
For people who prefer flat sur-
faces, consider abandoned railroad
tracks that have been converted to
hiking and biking trails, offering natu-
ral scenery you can’t usually see from
the road. Over 22,000 miles of trails
in the U.S. alone have been converted
by the Rails-to-Trails Conservancy
(railstotrails.org), which can give you
information about converted rails in
your state. I also enjoy walking on
nearby beaches, some of which go
on for miles—and if I want a more
intense workout, I hike up and down
the dunes.
Safety is particularly important
when you’re starting out. It’s a very
good idea to hike with a friend, so you
can help each other if one of you gets
hurt. You should also stay on marked
paths and trails. Check the weather
forecast so you can dress accordingly,
especially if there is likely to be cold
weather or rain.
Above all, have fun! DSM
••• THE DOSE ••• Curmudgeonly Athlete
SHUTTERSTOCK

It is easy to get caught up in the
widespread mentality that we
should move in only certain ways.
Some advocates for specific types of
exercise—yoga, strength training,
running, you name it—will encour-
age you to “just do this, it’s the only
workout you need!”You can be sure
this is a marketing gimmick, and
unfortunately, it gives a false impres-
sion of what our bodies actually need.
So, what should we be doing, then?
Our bodies are dynamic, versatile and
always adapting to what we do often
(even if we don’t do it well). In other
words, we should move in all the ways
available to us (or, as the popular
meme goes, do ALL the things).
If you were to step into a yoga
class, your instructor might suggest
you position your body in particular
ways to “accomplish”different poses.
What they may not tell you is that
each body on each mat should look
different. This is the same for gener-
ally all types of movement: We each
have a unique skeleton that directly
influences our ability (or inability)
to move, shift and bend. (That does
not mean, however, that maintaining
proper alignment is not important.)
There are fundamental movement
patterns that most people’s skeletons
are generally able to achieve. Skeletal
variations such as where your hip
socket sits in your pelvis (which varies
greatly from person to person) and
many other structural differences
determine how you are able to move
and how you will be able to optimize a
particular movement. Exploring new
movements can help you learn what
is best for your unique body.
In Western society, there is a det-
rimental and often dangerous fixa-
tion on the way things look. We are
obsessed with symmetry, which is
ironic considering that our bodies
are built asymmetrically (e.g., we
have a heart on one side, a liver on
one side, and so on).This asymmetry
alone creates a cascade of structural
“misalignments” from the ribcage to
the pelvis and to the joints beyond.
With all that being the case, why
then should we move in just one way?
The answer is, we shouldn’t. Our bod-
ies are built for and crave a variety of
types of movement, and there is not a
single “magic” way to train that is for
everyone. Exploring new patterns of
movement and incorporating variety
into your routine can help reduce
your risk of overuse injuries from
repeating the same things over and
over (even sitting can cause overuse
injuries).
Try these simple and fun move-
ments to notice your own imbalances
and add some diversity to your physi-
cal activity regimen. DSM
Laurel Dierking, MEd, NASM, 700-
ERYT, is a movement specialist with
a concentration in yoga, strength con-
ditioning, exercise physiology and
postural restoration. With 10 years of
extensive experience, Dierking seeks
to enhance self-awareness by guiding
individuals through mindful movement,
functional training,body awareness and
breath work.
Move In All
the Ways
BY LAUREL DIERKING, MED, NASM, 700-ERYT
••• HEALTHY LIVING ••• The Right Moves
SINGLE LEG CHAIR TO STAND
• Sit in a secure chair with your
spine tall and your heels under
your knees.
• Extend one leg off the floor (for
more support, extend the leg
while keeping the heel on the
floor).
• Without using your hands
(unless you have to), come up to a
standing position using just your
one leg.
• Slowly, with control, return back
to your seat, still with just the one
leg.
• Repeat five to 10 repetitions on
each leg.
ARMS OVER HEAD AND SHAKE
• Set a timer for 1 minute.
• Stand with your feet hip-width
apart or wider, reaching your arms
overhead.
• Begin to gently bounce in
your legs and shake your arms
vigorously overhead.
• Breathe steadily as you shake
and bounce your limbs.
• After 1 minute, gently bring
your arms down beside you and
relax your posture, returning your
breathing to normal (in and out
through the nose).
SINGLE LEG REACHES
• Stand on one leg next to a desk
or a wall in case you need support
(perform this exercise with no
support for a challenge, but have
support nearby).
• Keep your knee straight (but not
locked) and hinge (on an exhale),
folding from your waist to reach
as far forward in front of you
toward an object as you can. Keep
your back leg reaching back.
• Inhale and come right back up
to standing. Repeat 10 times on
each leg.

AARON
ASHLEY

••• HEALTHY LIVING ••• Weighty Matters
SHUTTERSTOCK
4 Ways to Healthy Habits
BY DR. NICOLA DAVIES, PHD
Fall conjures up images of moun-
tains of roasted turkey, fresh-
baked pumpkin pie and bright candy
apples—none of which are ideal for
weight management! Fortunately,
though, the season has many redeem-
ing features that can help you get
closer to your health goals. Indeed,
the good news for people with diabe-
tes is that studies show blood glucose
levels are typically lower during the
autumn months.
Here are a few tips for embracing
the fall to accelerate your healthy
habits.
Recognize and manage
mood dips. Experts recog-
nize that, with less daylight
and the stress of the looming holiday
season, fall can cause mood dips.
Being on a strict diet can worsen
these dips, making you feel con-
stantly “hangry.” One tried-and-
tested weight-management strategy
that can help avoid low moods is
being mindful of what you are eat-
ing. Don’t deny yourself food—sim-
ply replace empty calories with
healthier options. Replace chips with
baked crackers or plain popcorn, for
example. If you crave bread, go for a
whole-grain, low-glycemic version.
Keep track of your intake using an
app. Above all, slow down and enjoy
your food.
Harness the power of
healthy fall foods. The
autumn harvest is perfectly
suited for those looking to embrace
a healthy diet. You can use pump-
kin, broccoli and butternut squash
to make warming, hearty soups that
are low in calories. Fresh apples
and pears can satisfy sweet crav-
ings. Other filling fall produce, such
as cauliflower and Brussels sprouts,
can be included in your meal plan to
help you keep the weight off without
feeling hungry. (Read “Making the
Most of Autumn” [page 22] for some
more inspiration.)
Gear your exercise rou-
tine to the fall weather. Fall
weather motivates people to
get moving.The chillier temperatures
and colorful outdoors can make exer-
cising a pleasure. Take advantage of
this by planning hikes along scenic
trails or jogging through your local
park. Fall is also a great time to get
into sports with family and friends—
lacrosse, baseball or football are just
a few ideas.
Stay active indoors. Yes,
sometimes the air may be
just too chilly for you to
enjoy the outdoors. However, staying
indoors doesn’t mean you need to give
up your exercise routine. There are
a variety of ways to bring your exer-
cise inside—consider yoga, aerobics
or even dancing. There are plenty
of fitness apps and videos available
online to help you stay fit without
leaving the house.
In it for the long haul
Weight management needs to be a
long-term lifestyle change rather than
something that comes and goes like
the seasons. Tweaking your usual
habits this fall may help you avoid
“holiday weight” altogether. DSM
Dr. Nicola Davies, PhD, health
psychology, is the author of I Can
Beat Obesity! Finding the Motivation,
Confidence and Skills to Lose Weight
and Avoid Relapse.
2
3
4
1

SMART
Tabatchnick Balsamic Tomato Rice Soup 1 pouch 100 530 0 20 4 4 3
Amy’s Black Bean Vegetable Soup 1 cup 210 540 0 35 7 4 9
Pacific Foods Organic Cashew Carrot Ginger Bisque 1 cup 140 570 3.5 22 4 11 2
Bar Harbor Rhode Island Style Clam Chowder 1 cup 140 570 1 19 0 1 9
Pacific Foods Organic Chicken Wild Rice Soup 1 cup 120 610 1 16 2 2 5
Campbell’s Well Yes! Garden Vegetable With Pasta, Lightly Salted 1 cup 90 640 0 18 3 5 3
Campbell’s Well Yes! Chicken Noodle Soup 1 cup 110 640 0.5 13 2 2 8
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Healthy Choice Vegetable Beef 1 cup 120 400 0.5 20 3 4 7
Campbell’s Chunky Healthy Request Split Pea Ham Soup 1 cup 150 410 0.5 24 5 3 12
Pacific Foods Organic White Bean Kale Millet Soup Made With Chicken Bone Broth 1 cup 130 430 1 18 3 1 10
Pacific Foods Organic Creamy Golden Cauliflower Soup 1 cup 120 450 3 13 2 5 4
Progresso Light Beef Pot Roast Soup 1 cup 70 470 0 9 1 2 5
Healthy Choice Chicken With Rice Soup Made With Chicken Bone Broth 1 can 110 480 0 12 2 1 11
Progresso Reduced Sodium Hearty Minestrone Soup 1 cup 120 480 0 21 4 4 5
SMARTEST
Tabatchnick Split Pea Soup, Low Sodium 1 pouch 180 35 0 33 13 5 12
Health Valley Organic Minestrone Soup 1 cup 100 45 0 18 3 5 4
Health Valley Organic Chicken Noodle Soup, No Salt Added 1 cup 80 130 0 13 1 1 5
Imagine Butternut Squash Creamy Soup, Light in Sodium 1 cup 100 230 0 21 2 7 1
Amy’s Organic Minestrone Soup, Light in Sodium 1 cup 120 270 0 18 4 4 4
Dr. McDougall’s Right Foods French Lentil Soup, Lower Sodium 1 cup 130 280 0 24 9 3 8
Amy’s Organic Fire Roasted Southwestern Vegetable Soup, Light in Sodium 1 cup 140 340 0.5 20 4 4 4
RECOMMENDED
SERVING CAL SODIUM
SAT FAT
(g)
CARBS
(g)
FIBER
(g)
SUGAR
(g)
PROTEIN
(g)
Soup
BY AMY CAMPBELL, MS, RD, LDN, CDCES
Chosen wisely, soup is a great way
to sneak in some vegetables,
whole grains and even an ounce or
two of protein. Homemade soup is
generally your best nutritional option,
but the reality is that store-bought
soups are a mainstay for many of
us—they’re quick, convenient and
easy to prepare. The downside of
store-bought soups? Sodium, and lots
of it. Excess sodium contributes to
high blood pressure, stroke and heart
attack. Luckily, there’s a decent assort-
ment of store-bought soups that are
reasonable (and even low) in sodium
and that are tasty, too! Choose soups
with less than 480 milligrams (mg) of
sodium, less than 5 mg of saturated
fat, and at least 3 grams (g) of fiber per
serving. If possible, look for at least
7 g of protein per serving, too. As for
higher-sodium soups? Enjoy them in
moderation and limit your portion
(go for a cup rather than a bowl). DSM
SHUTTERSTOCK
••• HEALTHY LIVING ••• Smart Smarter Smartest

Autumn is upon us! What are the
best ways to incorporate fall har-
vest fruits and vegetables into a healthy
meal plan for managing diabetes?
One way to create natural variety
in your eating pattern is to change
your produce selection based on the
season. What is seasonally available
will vary somewhat regionally,but this
roundup includes commonly available
fall produce, along with tasty ways to
add these items to your diet.
(Each person with diabetes needs
to decide how to incorporate various
types of produce into their meal plan
and recognize that while nothing is
completely off-limits,portions and pro-
duce choices may impact blood glucose
levels in different ways.The way foods
are paired with fats and proteins can
slow digestion and also minimize a
postmeal rise in blood glucose in some
cases.Speak with a registered dietitian
about the best produce picks and pair-
ings for your meal plan.)
APPLES
NUTRITION FACTS:
MEDIUM: CALORIES: 104,
FAT: 0.0 G, PROTEIN: 0.5 G,
CARBOHYDRATE: 28.0 G,
FIBER: 4.8 G
Baked Apples. Bake apples with
cinnamon, walnuts and raisins.
Breakfast Apple Quesadilla.
Spread your favorite nut butter on a
low-carbohydrate wrap and add thinly
sliced apples.
SavoryApple Coleslaw/Salad.Add
sliced apples to coleslaw and salads.
Butternut Squash and Apples.
Bake butternut squash and apples with
your favorite fall spices or combine for
a savory-and-sweet soup.
Homemade Applesauce. Use your
favorite recipe for homemade apple-
sauce to add to pancakes and muffins,
or simply enjoy with a sprinkle of cin-
namon for a snack.
BEETS
NUTRITION FACTS: 1
CUP: CALORIES: 77, FAT:
0.0 G, PROTEIN: 2.8 G,
FIBER: 5.0 G
Berry Beet Smoothie.
Combine frozen berries,½ cup of pine-
apple or banana, cooked beets and
yogurt (or a nondairy option) for a
simple refreshing smoothie.
Roasted Beet Side Salad. Roast
fresh beets and drizzle with balsamic
vinegar and top with 1 ounce of feta or
crumbled goat cheese.
Strawberry and Beet Ice Pops.
Combine frozen strawberries, ½
cup of cooked beets, nondairy milk,
pure vanilla extract and sweetener
to taste. Put mixture in a popsicle
mold and freeze for two to three
hours, until frozen.
Pickled Beets. Look for a no-sugar
pickled beet recipe or reduce the sugar
in your favorite recipe for a tangy treat
to top salads or eat as a simple side
dish.
Raw Beet Salad. Grate raw beets
and add shredded carrots, onions and
your favorite vinaigrette.
COLLARD GREENS
NUTRITION FACTS: 1 CUP,
COOKED: CALORIES: 44, FAT: 0.8 G,
PROTEIN: 4.0 G, CARBOHYDRATE:
8.0 G, FIBER: 5.5 G
Braised Collard Greens. Use veg-
etable or chicken stock and water to
cook collard greens over low heat in
a covered pot. Add red pepper flakes,
garlic,or lemon juice and zest for flavor.
Collard Slaw. Thinly slice collard
greens, purple cabbage, carrots, red
onion or any vegetables of choice to
create a custom collard slaw to treat
your taste buds.Dress with your favor-
ite creamy slaw dressing.
Shredded Collard Green Salad
With Roasted Vegetables. Remove
stems and thinly shred collard greens
for the salad base.Top with your favor-
ite fall roasted vegetables,such as sweet
potatoes or butternut squash. Add 1
ounce of goat cheese and lightly salted
nuts or seeds for added texture, flavor
and protein.
Skillet Greens With Ham. Pan-fry
collard greens with onion, garlic, and
Canadian bacon or ham.
CRANBERRIES
NUTRITION FACTS: 1
CUP, RAW: CALORIES: 46,
FIBER: 3.6 G
Cranberry and Orange Relish.Try
making a no-sugar-added cranberry
sauce by combining fresh cranberries,
1 navel orange, fresh orange zest and
sweetener of choice (to taste) in a food
processor. Pulse until the mixture is
chunky but without large pieces.
Fresh Cranberry Chutney and
PorkTenderloin.Combine fresh cran-
berries, apples or pears, and spices to
create a fragrant and flavorful chutney
to use with pork tenderloin or turkey.
Cranberry and Orange Parfaits.
Layer low-fat yogurt with 2 tablespoons
of fresh cranberry sauce and sliced
oranges and top with 1 to 2 table-
MakingtheMostofAutumn
Meal and snack ideas
BY ALISON MASSEY, MS, RD, LDN, CDCES
••• HEALTHY LIVING ••• Food For Thought
SHUTTERSTOCK

spoons of chopped nuts for a quick
snack or breakfast.
Cranberry Applesauce. Consider
adding some fresh cranberries to your
next batch of homemade applesauce
for a tangy-sweet combination.
GRAPES
FRESH: CALORIES: 104,
FIBER: 1.3 G
Roasted Grapes and Brussels
Sprouts. Toss Brussels sprouts in
olive oil and sprinkle with salt and
pepper. Bake in a preheated oven at
450°F for about 20 to 30 minutes. In
a saucepan, add grapes, thyme and 1
to 2 tablespoons of butter. Cook until
grapes are glazed. Pour mixture over
prepared Brussels sprouts.
Pecan Chicken and Grape Salad.
Prepare chicken salad as usual and
add toasted chopped pecans and fresh
sliced grapes.
Jell-O Frozen Grapes.Wash grapes
(don’t dry).Empty a sachet of sugar-free
Jell-O powder into a bowl. Roll grapes
in the Jell-O powder until coated.Place
the Jell-O-covered grapes in a single
layer in a freezer-safe container and
freeze for at least 1 to 2 hours.
Balsamic Grape Crostini. Toss
grapes in 1 to 2 tablespoons of olive oil
to coat and bake in a preheated oven at
375°F for about 15 minutes.Use warm
grape topping on pre-prepared warm
French baguette slices and drizzle with
balsamic vinegar.
PARSNIPS
COOKED: CALORIES: 146, FAT: 4.5 G,
PROTEIN: 2.0 G, CARBOHYDRATE:
26.0 G, FIBER: 5.6 G
Roasted Parsnip “Fries.” Wash
and peel parsnips. Slice lengthwise
into strips and coat with olive oil,finely
chopped rosemary and a sprinkle of
salt and pepper. Bake in a 450°F pre-
heated oven for about 20 minutes,
or until the parsnips are tender and
slightly browned.
Mashed Parsnips and Carrots.
Wash and peel parsnips and carrots.
Steam for about 15 to 20 minutes, or
until the vegetables are tender. Place
the carrots and parsnips into a food
processer and add ½ tablespoon of
olive oil, orange zest, salt and pepper.
Process until the vegetables reach a
creamy texture.
Parsnip“Rice.”Wash and peel pars-
nips.Slice into large cubes and add to a
food processor.Pulse until the parsnips
reach a rice-like size. Sauté the riced
parsnips over medium heat for about
8 minutes when ready to use.
PEARS
Baked Pears With Walnuts. Pre-
heat oven to 350°F. Cut pears in half
and place on a baking sheet. Use a
melon baller and scoop out the seeds.
Sprinkle each ½ pear with walnuts,
cinnamon and a drizzle of maple syrup
or honey. Bake for about 30 minutes.
Ricotta Toast With Sliced Pears.
Combine ricotta, orange zest and 1
teaspoon of maple syrup or sweet-
ener of choice. Spread ricotta mixture
on toast. Top with ½ ripe sliced pear
and sprinkle with toasted almonds or
walnuts.
RUTABAGAS
COOKED: CALORIES: 72,
CARBOHYDRATE: 16.0 G, FIBER:
4.0 G
Mashed Rutabagas.Boil rutabagas
and then mash with butter or olive oil
as you would potatoes.
Rutabaga Oven “Fries.” Wash and
peel rutabaga and slice into strips.
Coat in olive oil and toss with your
favorite seasonings, such as cayenne,
salt, pepper or garlic powder. Roast in
a preheated oven at 425°F for about
30 minutes.
Raw Rutabaga Salad. Shave or
grate rutabaga and carrots and add
sliced scallions. Toss in your favorite
vinaigrette dressing.
TURNIPS
COOKED: CALORIES: 34,
CARBOHYDRATE: 8.0 G, FIBER:
3.0 G
Parmesan Turnip Chips. Using a
mandolin, slice turnips as thinly as
possible. Toss turnip slices in olive
oil and sprinkle with salt. Lay turnip
slices on a baking sheet and bake in a
preheated oven at 425°F for about 30 to
35 minutes, until the chips are cooked
evenly. Sprinkle the baked chips with
grated parmesan cheese.
Turnip-Potato Mash. Place peeled
and chunked turnips and potatoes into
boiling water. Cook for about 20 min-
utes, or until the potatoes and turnips
are easily pierced with a fork.Drain the
turnips and potatoes in a colander and
return to the pot.Blend the turnips and
potatoes with an immersion blender
until they are a creamy consistency
(add milk or nondairy milk and butter,
as you would during the preparation
of mashed potatoes).
WINTER SQUASH
(ACORN)
NUTRITION FACTS: 1
CUP, CUBED: CALORIES:
115, FAT: 0.0 G, PROTEIN:
2.0 G, CARBOHYDRATE:
30.0 G, FIBER: 9.0 G
Baked Acorn Squash. Bake acorn
squash and use to top salads or a win-
ter slaw.
Acorn Squash Purée.Bake or steam
acorn squash and then purée and add
a pinch of cinnamon or nutmeg.Add to
your pasta sauce or soups for a boost
of extra nutrition.
Casseroles/Vegetable Lasagna.
Add baked or roasted acorn squash to
any of your favorite casseroles or even
a vegetable lasagna. DSM
Alison Massey, MS, RD, CDCES, is a
registered dietitian and certified diabetes
educator in Maryland. She blogs at
amassey.com.
NUTRITION FACTS: 1
CUP, FRESH: CALORIES: 71,
FAT: 0.0 G , PROTEIN: 0.0 G,
FIBER: 3.8 G
Poached Pears. Bosc pears are the
best choice for poaching. Pears can
be poached in a liquid of choice, such
as apple cider or red wine. Look for a
recipe that suits your tastes and adjust
any added sugars to best fit your goals
for your eating plan.

Diabetes Freedom Worth Buying? Reviews –
Can George Reilly James Freeman’s Main
Manual control your blood sugar level
naturally?

Lifestyle Hacks
for Better Blood
Glucose Management
BY GILLES BEAUDIN, CSEP-CEP, MSc
SHUTTERSTOCK

Many health conditions are mul-
tifactorial, meaning that there’s
usually more than one cause, and
diabetes is no exception.
Most people with type 2 diabe-
tes know how important regulating
their carbohydrate intake and getting
enough exercise are for managing
their diabetes. Recent research has
found that other lifestyle modifications
can also have a positive influence on
blood glucose levels.These modifica-
tions involve:
• EXERCISE INTENSITY
• EXERCISETIMING
• SLEEP
• COLD EXPOSURE
• GUT BACTERIA
What’s more, the impacts of these
lifestyle hacks are not limited to glu-
cose control. They will benefit many
aspects of your life. If you are curi-
ous, read on. You will discover how
you can incorporate them into your
daily routine.
EXERCISE INTENSITY
Work a little harder, sometimes.
You hopefully have a regular exercise
routine. If you don’t, you may have the
same reason as most nonexercisers:
lack of time.But recent research shows
that you can get a lot of benefits from
short training sessions. The secret?
Work a little harder, in intervals.
In studies, increasing the intensity
of exercise has resulted in similar
or better metabolic improvements
than longer, less-intense routines
for people with type 2 diabetes, all
in a fraction of the time. Part of the
reason is that higher intensities use
more muscle fibers, which in turn use
more glucose.
In fact, your muscles are respon-
sible for clearing the majority of the
glucose from your blood. To make
them more sensitive to insulin,you just
need to reduce their glucose stores.
Because higher-intensity exercise
requires more muscle fibers to be
used, this reduces the glucose stores
in more fibers.
A review article published in
2015 reported that interval walking
(alternating intervals of fast- and
slow-paced walking) better improves
glycemic control in people with type
2 diabetes than consistently paced
walking that uses a similar amount
of energy. This indicates that how
many calories you burn matters less
than how you burn them. If more of
those calories come from glucose,
it will have a bigger effect on blood
glucose control.
How to up your intensity. Evi-
dence shows that interval training
is generally safe and has metabolic
benefits for those with type 2 diabetes.
After getting the go-ahead from your
doctor,it is important to progress grad-
ually and ease into higher-intensity
intervals.As you get better, you can go
a little harder. Just give your body a
chance to adapt. If you exercise a few
times a week, only try higher-intensity
intervals twice a week to start. It’s not
necessary to incorporate them into
every exercise session.
The intensity of your intervals will
depend on your level of fitness and tol-
erance. If you are a beginner, walking
faster for 30 to 60 seconds during a
stroll may be a good place to start.This
is equivalent to what fitness expert
Covert Bailey called wind sprints:
small modifications in intensity that
will challenge your wind.
One word of caution: Before your
exercise session, check your blood
glucose. If it is over 240 mg/dl, check
your urine for ketones. If you have
ketones, do not exercise, as this could
make your glucose go even higher.
EXERCISETIMING
When you exercise. Now that we
have established that it matters how
hard you exercise, the question is:
Does it matter when you exercise to
improve your glucose control and/or
insulin sensitivity?
Studies have shown that the peak
in blood glucose happens around
90 minutes after the start of a meal.
Making storage space for glucose
in your muscles by being physically
active is the best way to reduce that
peak, and exercising within 30 min-
utes of a meal is the best way to
maximize the effects of your training
session. That goes for any type of
exercise. Also, it has been reported
that exercising after meals is more
effective than exercising once a day
for blood glucose control in people
with type 2 diabetes.
How to time exercise. Glucose
from a meal starts to trickle into your
blood roughly 15 minutes after you
start to eat. Exercise will open up
space in your muscle fibers, making
them more responsive to the effects
of insulin. If you can change the tim-
ing of your exercise sessions, give it
a try. Here’s my rule of thumb: Try to
exercise 30 minutes before or after
a meal. If your preference is shorter,
higher-intensity workouts, I would
suggest you exercise before your meal.
High-intensity activities after eating
may disturb your digestion. But there’s
nothing wrong with a brisk walk after
a meal.
SLEEP ON IT
Researchers are learning more about
the effects of not getting enough restful
sleep.And that’s a good thing: Sleep is
one aspect of wellness that doesn’t get
its fair share of attention.The Centers
for Disease Control and Prevention
(CDC) call insufficient sleep a public
health epidemic. Experts generally
recommend that healthy adults sleep
seven to nine hours a night, but about
35% of Americans report typically
sleeping less than seven.
Sleep deprivation has been linked
to a variety of metabolic dysfunctions,
including reduced insulin sensitivity.
Even one night of four hours’ sleep
can decrease insulin sensitivity. Six
nights at this rate will drop your insu-
lin sensitivity by 24%.And don’t think
that you can compensate for it on
the weekend: Running a sleep deficit
during the week and sleeping in on
the weekend will not readjust your
insulin sensitivity.
Do you find it hard to resist your
cravings?Your willpower may not be
to blame. Sleep deprivation will also
disturb certain appetite hormones,
which will make you hungrier. How’s
that for a double whammy?
How to get more sleep. When
it comes to the influence of sleep on
blood glucose control, recent evidence
suggests that lifestyle modifications

are better than relying on medica-
tion in order to regulate appetite and
glucose metabolism. Get into a sleep
routine: Go to bed and wake up at the
same time each day. Also be aware
that light sends the message that it is
time to get up. Dim the lights and stay
away from screens at least 30 minutes
before bed, and use light-blocking
shades to make your room as dark as
possible, so you don’t get woken early
by the sunrise.
Here’s an extra trick—you can boost
melatonin naturally by practicing deep
breathing. Researchers reported a
reduction in stress hormones and
an increase in melatonin from deep
diaphragmatic breathing. Doing this
before bed will help improve the qual-
ity of your sleep.
Try this: Lie down on your back,
knees bent and feet flat on the floor.
Put one hand on your chest and the
other on your belly, below the ribs.
Take a deep breath and make the
hand on your belly move up.The one
on your chest should stay stable.Take
three to four seconds to breathe in
and six to eight seconds to breathe
out. You want to feel your lower ribs
expand. That rib expansion is from
the contraction of your diaphragm.
Practice this until it becomes a smooth
flow in and out.
COLD EXPOSURE
Turn on your furnace. Your body
always aims for a state of homeostasis,
or balance.That includes maintaining
a certain body temperature.When the
environmental temperature drops,
your body has mechanisms in place to
maintain its own temperature. One of
those is activating a type of fat that is
known as brown adipose tissue (BAT).
This tissue is like a mini furnace, using
energy to create heat. In people used
to living in temperature-controlled
environments, it gets activated less,
just like an unused muscle.
Research shows that by exposing
your body to a colder environment,
you will get BAT to take up glucose
and fatty acids to crank up the heat.
A review article published in 2016
concluded that mild cold exposure is
a good strategy for the prevention and
treatment of type 2 diabetes.
How to master cold exposure.
One word of caution: Cold exposure is
like exercise for your blood vessels. It
makes them contract. Check with your
doctor before trying this, particularly
if you have a heart condition. Also,
if you are a beginner, don’t push too
hard. Your body is adaptable, but it
needs time to make adaptations, so
go at it easily.
If you live in a part of the world
that gets cold winters, you can drop
the thermostat a few degrees. You
can also slowly get used to taking a
shower with colder water. Start your
shower as usual.After washing your-
self, gradually lower the temperature
of the water. Get used to colder water
every week, just for one to two min-
utes. You will eventually “train” your
BAT to become more active.
GUT BACTERIA
Trust your gut. This is fairly new
knowledge, and we don’t know all
the details, but the evidence is too
strong to ignore. The gut is often
referred to as the second brain. Its
nervous system is very complex, and
it secretes certain substances that
have influences on other body tis-
sues. The data in humans are still
scarce, but an article published in
2019 reported that certain bacteria
that populate your gut could influence
insulin resistance.
In fact, the link between the two
appeared very strong, and it was
shown that people with type 2 diabe-
tes have a lower count of certain gut
bacteria. Is this just a link, or does one
cause the other? That remains to be
determined.
How to adjust your gut. Fortu-
nately, there’s no need to wait for the
answer.A healthy gut is important to
your overall health. It has been shown
that certain pesticides can reduce
your good gut bacteria, and the use of
antibiotics can ravage your intestinal
flora.To rebuild it, eating foods rich in
prebiotics (food for your gut’s healthy
bacteria)—such as onions, garlic and
leeks—and probiotics (health-pro-
moting bacteria and yeasts)—such
as those found in yogurt, kefir and
sauerkraut—can be helpful.
Also, eat a variety of fresh foods,
favor high-fiber vegetables and fruits,
and eat organic when you can. And
as much as possible, stay away from
processed products. (Sound familiar?
Healthy eating has many benefits.)
Take the first step
As Albert Einstein wisely said, “The
definition of insanity is doing the same
thing over and over again but expect-
ing different results.” That applies to
your social circle, your family life, your
financial position and your health. If
you want to see a change, you need
to change your habits.
In most cases, lifestyle modifica-
tions work well. They are not always
easy because they involve changes to
the way you live, and they tend not to
work as quickly as medications. But
they are always the right thing to do.
Give your body what it needs, and you
will see results. DSM
Gilles Beaudin, CSEP-CEP, MSc,
is a clinical exercise physiologist at
Cleveland Clinic Canada.
Sleep
deprivation
has been
linked to a
variety of
metabolic
dysfunctions,
including
reduced
insulin
sensitivity.

As you are probably aware, diabe-
tes is best managed with a team
approach. Your team includes your
diabetes medical providers (physi-
cians, nurse practitioners and physi-
cian assistants), diabetes care and
education specialists, dietitians, exer-
cise experts, nurses, pharmacists,
mental health professionals and, most
importantly, you! But did you know
that your team should also include
dental specialists? It is important to
establish an ongoing relationship with
a dental hygienist and dentist for your
oral health care.Your dental hygienist
will conduct a professional cleaning
and provide instruction on routine
home care and cleaning to maintain
or reestablish oral health, while your
dentist will perform an oral examina-
tion and diagnose conditions such as
cavities, gum disease, and yeast and/
or fungal infections. As part of your
care, you should also receive an oral
cancer screening during a dental visit.
In fact, taking care of your mouth
and teeth is a big part of your diabetes
health. It is very important to make
every effort to ensure you keep up
your daily oral hygiene practices and
schedule regular visits with your den-
tist and dental hygienist for cleanings
and oral health checkups.
Your dental toolkit
A healthy mouth begins with proper
maintenance. Always keep a tooth-
brush and toothpaste on hand. Brush
your teeth at least twice a day, in the
morning and evening, ideally after
meals and snacks. Soft-bristled tooth-
brushes are best to clean the teeth
and along the gum line. Hard or firm
bristles can irritate your gums and
cause them to recede (or pull away
from the teeth) over time. Make sure
your toothbrush is in good condition,
with bristles that are not bent or frayed.
Be certain to replace your toothbrush
about every three months.Your tooth-
brush should be a comfortable size for
your mouth. A toothbrush that is too
big can make it hard to reach all tooth
surfaces and limit your range of move-
ment—the ability to move the tooth-
brush around—while brushing.
Whether to use a manual or an
electric toothbrush is up to you. How-
ever, your dentist or dental hygienist
might suggest an electric toothbrush
if they see you are having trouble
cleaning thoroughly with a manual
brush. If you start to use an electric
brush, you will likely be asked to
bring it to one of your office visits so
the hygienist can show you how to
use it based on the design.
To use a manual brush, you should
hold the toothbrush at an angle
and brush your teeth with short circu-
lar strokes, being sure to cover all sur-
faces of the teeth, including the gum
line. When using an electric brush,
most of the movement is done for you,
but you’ll still want to work with your
dentist and hygienist to make sure
you’re getting the best possible results.
Remember, the goal of brushing is to
remove food debris and the “sticky”
plaque that can be easily missed along
the gum line. Brushing all of your teeth
should take about two minutes.
Flossing and cleaning between your
teeth is especially important and is
recommended as a daily practice.Your
dentist or hygienist will help determine
what type of floss or flossing device
is best to clean these hard-to-reach
areas. Flossing is a learned skill, and
the selection of the best interdental
cleaner should be recommended by
the dentist or hygienist, with one-on-
one instruction provided for how to
use it. While dental floss is the best
choice for many people, other tools,
such as preloaded floss on a dental
pick, interdental brushes or Stim-
U-Dents, might work better for you.
These tools help break up and remove
plaque and trapped food that the
toothbrush can’t reach. Your dentist
or hygienist can help you learn how
to floss or show you how to use one
of the other interdental cleaning tools
to make it easier if you have arthritis
or difficulty moving your hands. You
should practice good dental care on
a daily basis and schedule a visit with
your dentist and hygienist at least
twice a year for a cleaning and oral
health checkup.
Diabetes and dental disease
People with diabetes are at higher
risk for dental complications. These
include gum disease, tooth loss and
dry mouth that could cause thrush or
other infections.TheAmerican Dental
Association says that one out of five
cases of tooth loss is connected to
diabetes, and that 22% of people with
diabetes have gum disease. If you have
diabetes and are a smoker, the risk for
gum disease is 20 times higher.
Hyperglycemia and your mouth
Hyperglycemia (high blood glucose)
can make dental problems much
worse.When blood glucose levels are
consistently high, the glucose in your
saliva also increases, which provides
“food”to the harmful bacteria in your
mouth, helping it grow. In addition,
consuming foods high in sugars and
starches can make your saliva thick
and add to the growth of bacteria,
which increases the amount of plaque.
Plaque is a soft, sticky film that can be
found most commonly at the gum line.
If plaque is not removed by proper
brushing and flossing, it can turn into
DentalDefinitions
Gingivitis: Red, swollen and bleeding gums caused by
inflammation from plaque.
Periodontitis: Gum disease caused by infection in the
gums, which can lead to irreversible damage to the
teeth, bone and tissues.
Plaque: Sticky film along the gums containing bacteria.
Tartar: Hardened plaque that has not been removed.
Thrush: A naturally occurring fungus that grows
uncontrollably, causing white patches in the mouth that
may progress to open sores. Also known as candidiasis.
Xerostomia: Lack of saliva in the mouth, or“dry mouth,”
which can lead to pain, cracked lips and mouth sores.

tartar, which is hard and can’t be
removed with routine brushing and
flossing. Tartar can only be removed
by your dentist or dental hygienist.
Plaque and tartar buildup that is not
removed can lead to swollen, inflamed
gums that become tender, red and
bleed easily. This condition is called
gingivitis, and 50% to 90% of people
worldwide have it, but it is reversible.
However, a condition called peri-
odontitis is not reversible, and it can
develop if your gingivitis is not treated.
Periodontitis is a chronic gum disease
that causes the gums to pull away from
the teeth and form spaces, or “pock-
ets,” around the teeth. These pockets
collect food debris and bacteria and
limit your ability to clean your teeth at
home.Without proper cleaning, these
pockets can become infected.As these
infections spread between teeth and
under the gum line, they can begin
to damage the bone and gum tissues
that support the teeth. This can lead
to loose teeth, difficulty chewing and
eventual tooth loss. Periodontal dis-
ease is a risk associated with diabetes.
Some studies have shown that screen-
ing for diabetes in dental offices has
resulted in up to 30% of individuals
being diagnosed with prediabetes or
diabetes when referred back to their
primary care provider.
Bleeding and inflamed gums can
be a window into what is happen-
ing to the rest of the body. Bacteria
from infected gums can move into the
bloodstream with normal activities like
eating, flossing or brushing your teeth.
Once these bacteria enter the blood-
stream, they can start a chain reaction
in the body’s defense system, which
can trigger problems in the mouth and
throughout the rest of the body. This
increase in the defense system can
have harmful effects and lead to more
inflammation,which could cause blood
glucose levels to climb even higher by
making your body more resistant to
insulin. In addition, the higher blood
glucose can delay healing of wounds
and infections, which can increase
your risk for gum swelling and bleed-
ing gums, increased pockets and bone
damage, and certain infections.
Hyperglycemia can also increase
your risk for dry mouth and an oral
fungal infection called thrush (also
known as candidiasis).Hyperglycemia
can cause dry mouth by decreasing the
production of saliva,which is one of the
body’s natural weapons to protect your
oral health. Saliva washes away food
debris and it also dilutes the harmful
acids from food and bacteria.Without
enough saliva, bacteria and acids can
build up and lead to tooth problems
and gum disease. Thrush is caused
when a fungus that normally occurs in
the mouth begins to grow uncontrol-
lably.Sore white or red patches can be
found on the roof of the mouth, gums,
tongue and cheeks, causing pain and
discomfort, especially with eating and
drinking.Medication can be prescribed
by your dentist or diabetes care pro-
vider to treat thrush.Your toothbrush
(as well as anything that touched your
mouth during the outbreak) should be
replaced.
Good news
Research shows that thorough, rou-
tine dental cleaning at home and
regular dental checkups can ensure
optimal oral health by reducing
inflammation of the teeth and gums
and actually improving blood glucose
levels in people with type 2 diabetes.
Treatment of severe gum disease
in people with type 2 diabetes has
been shown to lower A1C levels (a
long-term measure of glucose con-
trol), with the benefit being about the
same as you might experience if your
diabetes care provider added another
diabetes medication. Now that is
something to smile about! DSM
Korinne Callihan is a doctor of nursing
practice student at the University of
Kentucky College of Nursing.
Dawn Dawson is a registered dental
hygienist and certified clinical
research coordinator at the University
of Kentucky College of Dentistry.
Laura Hieronymus is a doctor of nursing
practice, master licensed diabetes
educator, and the associate director of
education and quality services at the
UK Barnstable Brown Diabetes Center.
StayonTrack
You can do many things to limit
your risk of dental problems.
If you have diabetes and are
concerned about your oral health,
consider these tips to keep you on
the right track:
• Stay connected with your diabetes
care provider and diabetes care
and education specialist for
optimal blood glucose control.
• Keep your gums as healthy as
possible at home by using good
dental care practices.
• Check your mouth often for any
signs of red, swollen or bleeding
gums.
• Be sure to visit your dentist at least
twice a year and ask the hygienist
to discuss the measures they take
to check your gums for pockets
and any signs of damage.
• Plan for your visit! Contact the
dental office ahead of your
appointment to discuss your
medications and how long the
visit will take, so you can plan
around meals.
•Take your diabetes medicine and
eat your meals on your regular
schedule. If your medicine can
cause hypoglycemia (low
blood glucose) or if the visit will
interfere with your mealtime,
plan to bring a snack or source of
treatment to the office with you.
• Have your blood glucose monitor
on hand to check your levels
before the dental visit and while
you are there, if necessary.
•Talk to your diabetes care
provider and your dentist about
the best way to prepare for your
appointment.
• Finally, if you smoke, work with
your diabetes care provider to
make a plan to quit. Smoking
increases your risk for gum
disease, oral and throat cancers,
and fungal infections in the mouth
like thrush. Smoking also raises
your risk for many other diabetes-
related complications.

Pain and
Diabetes
What’s the connection,
and how to get relief
BY ALICIA DOWNS, RN, MSN, CDCES
Diabetes is a chronic, lifelong condition, so it’s not sur-
prising that it both impacts and is impacted by so many
areas of our lives. It can also be associated with its share of stigma,
and people living with diabetes may hear things like “Just do what your
doctor says, and it will get better” or “You can change it if you really want to.”These
messages can wear us down and leave us feeling hopeless. Similarly, pain can be a chronic,
lifelong condition. For some, pain comes and goes, but for others, it is a part of every day. As with
diabetes, pain conditions can impact many areas of our lives and can also be associated with stigma.

The combination of having to man-
age pain and having to manage diabe-
tes can feel overwhelming, and some
may react by avoiding dealing with
either one. You may be surprised to
learn, though, that your diabetes and
your pain may be linked in a number
of ways, and improving your care and
management in one area can improve
the other. Let’s dive into how diabetes
and pain are linked and learn about
some ways to get relief.
The link between diabetes
and pain
Diabetes can directly affect our experi-
ence of pain. Studies have shown that
elevated blood glucose levels reduce
our body’s pain suppression mecha-
nisms. In other words, the chemical,
neurological and hormonal processes
that should reduce our experience of
pain are inhibited. There is also evi-
dence that when blood glucose levels
are elevated, pain medications may be
less effective.People with diabetes may
therefore need additional assistance
with pain management.
Muscles and joints. Diabetes can
also cause changes in our bodies that
are painful.The muscles and joints are
two of the most commonly affected
areas. These issues often start with
postural or movement injuries that
lead to loss of flexibility. This loss of
flexibility leads to tension, stress on
joints, and pressure on nerves, which
can be very painful.This pain, in turn,
then leads to less movement and less
flexibility. Eventually, muscles can
shorten or even atrophy (waste away),
and the cycle is very hard to break.
Did you know that elevated blood
glucose levels also cause loss of flex-
ibility? When there is excess glucose
in our blood, the connective tissues
(tendons and ligaments) that hold
our muscles and bones together and
keep our joints in alignment get gly-
cated (linked with sugar molecules).
As a result, they become more rigid
and less flexible, which adds pain to
everyday tasks and can make being
active less enjoyable.
Nerves. Another pain condition
experienced by many people with dia-
betes is a long-term complication called
neuropathy (nerve damage). Damage
from high blood glucose levels to the
small blood vessels leads to reduced
circulation to nerve fibers. Without
sufficient oxygen and nutrients, these
nerves begin to die. Nerve damage
can cause numbness, and it can also
be extremely painful. (Anyone who’s
had a hand or foot“fall asleep”and felt
the pins and needles of nerves briefly
deprived of oxygen flow has an inkling
of the pain potential of nerve damage.)
PAD. People with diabetes are also
at higher risk of developing periph-
eral arterial disease (PAD), a condition
in which arteries become blocked and
circulation is reduced. When PAD
affects the legs, symptoms can include
TipsandTechniquesforManagingPain
What can we do to help manage pain? Prescription
medication options can be effective, but they also
carry risks and the potential for side effects. Before
we look to steroids, opiates, nerve blocks and other
medicines and procedures, what can we do to help
reduce and manage our pain issues at home? Here
are a few suggestions. (Be aware that, because pain
can increase blood glucose levels, starting pain
management can result in low blood glucose, or
hypoglycemia. A reduction in insulin or other blood-
glucose-lowering medications may be needed at the
start of treatment, so work with your healthcare team
to have a plan in place.)
Avoid injury. Maintain a healthy weight, since
carrying extra weight increases the risk of joint and
back injury and pain.
Also adopt a stretching routine. Maintaining
flexibility reduces strain on joints and nerve pressure,
so stretch daily. Be sure to stretch both before and after
exercise to avoid muscle and joint injuries.
Consider hot and cold therapy. Talk to your doctor
about the use of hot and cold therapy to relieve pain,
particularly muscle pain. From heating pads and hot
water bottles to cold compresses and cooling sprays,
these therapies can reduce inflammation, improve
circulation, reduce swelling and increase comfort.
Try physical therapy/chiropractic care. Don’t
think of these as another appointment; think of them as
a personal trainer your insurance will pay for! Physical
therapy can help you increase range of motion and
flexibility. Your therapist can give you exercises to
strengthen muscles and reduce the burden on painful
joints. They can even help you find patterns of misuse
that have been leading to your pain in the first place.
Physical therapy is available and covered by insurance
for nearly any cause of pain, and coverage is often
continued until the issue is resolved.
These professionals can also guide you in the use of
stimulation therapy.This involves using a device that
emits a low electrical impulse, which can help block pain
receptors if worn long-term. Some versions can even
be implanted for pain management. In shorter-term
use, this treatment creates tiny micromovements in the
muscles that can help them release tension and increase
circulation to reduce pain and nerve impingement.
Get moving to stay moving. It may hurt to get
moving at first, but the more we move, the less it will hurt.
So, while an injury may have us briefly sidelined while
healing, it should never stop us from moving entirely. As
we move, circulation increases, helping muscles to receive
oxygen and nutrients and heal better, reducing fluid in
joints that causes painful stiffness, and allowing muscles

pain in the calves, thighs and hips,
which typically occurs with activity
and goes away with rest.
Blood glucose and pain
The risk of developing these painful
complications can be reduced by
keeping blood glucose levels in tar-
get range and taking steps to avoid
erratic blood glucose swings. This
can be complicated, however, since
not only does diabetes impact pain,
but pain can impact blood glucose.
Why is this? For one thing, when
we are in pain, it is hard to maintain
regular physical activity, which in
turn makes it harder to keep blood
glucose levels stable and in target
range. Experiencing pain can also
raise our levels of stress hormones,
which increase insulin resistance
and elevate blood glucose levels.
Inflammation from a chronic injury
can also cause persistent low-level
elevation in blood glucose. In these
cases, diabetes medications may
need to be increased to keep blood
glucose levels well-managed.
Additionally, people who live with
chronic pain are also far more likely
to self-medicate with food—rates of
food addiction and binge eating dis-
orders are much higher in those who
report chronic pain—and to deal with
depression. People in pain are also
more likely to miss or cancel health-
care appointments, which leads to a
general reduction in overall wellness.
If we struggle due to the burdens
presented by a pain condition, our
diabetes may take a back seat.
So, as we can see, managing pain
is not just important for quality of
life—it can actually be a critical com-
ponent of diabetes management, too
See the tips and techniques below to
help you get started.
There is hope
I live with chronic pain, and I live
with diabetes. Managing both of
these conditions together is key
to staying healthy and active and
enjoying life. Just as it is for you,
it is important that I work with my
entire medical team to achieve my
goals and to ensure they under-
stand how my pain control and
blood glucose management are
equally important and depend on
one another. With good communica-
tion and a collaborative approach,
you can feel better. DSM
Alicia Downs, RN, MSN, CDCES, is
the director of patient care and
education at Integrated Diabetes
Services in Wynnewood, Pennsylvania.
After an initial diagnosis of type 2
diabetes,she was diagnosed with LADA
(latent autoimmune diabetes in adults)
and uses her personal experience
and diverse nursing background to
coach people with diabetes. Visit
integrateddiabetes.com to learn more.
to strengthen and stabilize injured areas. It may ache to
get started, but remember that the more we move, the
less we hurt.Work with your doctor on a plan to manage
that initial pain and ensure you can get moving without
further injury. Stretching is a fantastic place to start!
Investigate topical options. Topical pain relievers
can be effective for muscle pain and short-term relief.
Options include menthol gels, magnesium oil sprays,
lidocaine and numbing creams.These great options are
available over the counter, cheaply and without sedative
or digestive side effects (be aware, though, that too much
magnesium can cause loose stools) or the potential for
addiction.Topical pain relievers are of minimal assistance
for more severe nerve pain or joint pain, but they can
provide temporary relief to assist in mobility.
Look into over-the-counter medications. Speak
with your provider about the use of over-the-counter
medications.While these options can be highly effective,
using them long-term can pose some potential health
risks (such as liver function issues from acetaminophen
or blood pressure and digestive impacts from long-term
NSAID use).They may also interact with other medications
you take. However, these medicines can be highly
effective for treating pain. A recent study even showed
that alternating acetaminophen and ibuprofen every four
hours resulted in pain control comparable to opioid pain
management.Talk with your prescriber about appropriate
use, timing and dosages to meet your needs.

HowAm
I Going to
Remember
to Do That?
8 strategies to manage your daily diabetes regimen
BY SUSAN WEINER, MS, RDN, CDCES, FADCES, AND LESLIE JOSEL
D
o you feel pressure trying to remember everything
you need to do to manage both your busy life and
your diabetes? You are not alone! Juggling your daily dia-
betes to-do list along with home and family responsibili-
ties, plus school and work, can overwhelm even the most
organized person. Although life is filled with unexpected
distractions, we believe you can create systems and strate-
gies that can help streamline your diabetes management.
SHUTTERSTOCK

Here are eight surefire tips and
tools to help get you started.
1.WHAT’S YOUR STYLE?
Recognize how you prefer to remem-
ber to do things and tap into the prac-
tices that work for you. For example,
perhaps you like your reminders fun
and visual, so leaving yourself col-
orful notes on your bathroom mir-
ror (e.g., to remember to check your
blood sugar or pack your lunch) might
work for you. If you are comfortable
and familiar with technology and
find the alarms and alerts from an
insulin pump or continuous glucose
monitor (CGM) useful, then timers and
smartwatches that also use alarms
as reminders may be the way to go.
It doesn’t matter what your personal
style is, as long as it helps to get those
memory juices flowing.
PROTIP: If you spend a good part
of your day in front of your computer,
set alerts for to-dos on your desktop
calendar. Notifications will pop up
on your screen without making any
noise, so your work or virtual meetups
won’t be disrupted.
2. ROUTINE, RITUAL, REPEAT.
The beauty of routines or rituals
is that they take away the need to
“remember to remember.” Think of
a routine as something that needs to
be planned only once. It provides the
ability to move through your tasks
without thinking about what’s next.
Think about the routines and ritu-
als you already have in place that are
working for you. Perhaps you always
charge your phone in the kitchen and
never forget it since you pass through
that room often. Or you leave your
diabetes supply bag by the front door,
so you literally must step over it to
leave your home. If you have a system
or routine that is already working for
you, pairing it with another task you
want to remember may be an easy
way to adopt an additional routine.For
example, if you never miss your morn-
ing brew, place your oral medications
or pill box in your“coffee drawer,”and
voilà! Every morning you will be pre-
sented with a gentle visual reminder
to take your medication.
PROTIP: One of our favorite apps
for habit building is The Habit Hub.
It’s customizable and encourages you
to create daily habits by reminding
you to perform your tasks and track-
ing when you complete them. The
app creates a visual “chain” when
tasks are completed; as the chain gets
longer, it serves as an incentive for
you to keep at the task so you don’t
break the chain.
3. PUT THE ITEM FRONT AND
CENTER!
If you are prescribed oral medications
(or routinely take vitamin and mineral
supplements), you can use the bottles
or containers as a visual reminder.
ALERTSAND
REMINDERSFOR
PEOPLEWHO
AREHEARING
IMPAIRED
• For iOS, turn on the“LED Flash for
Alerts”feature. Go to Settings
Accessibility Hearing Audio/
Visual. The phone will flash with
a bright light when you have a
notification (such as a programmed
CGM alert).
• For Android, turn on the“Flash
Notification.”Go to Settings
General Accessibility Hearing.
• While sleeping (or when you may not
be able to look at your device), wear
your smartphone on an armband
and enable the vibration feature.
SHUTTERSTOCK

High-Protein Nutrition May Help Manage Diabetes and Blood Sugar

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