Diabetes Everyday

Living your best life with diabetes. Toby Smithson provides professional guidance with personal experience.

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The 5 Things Over 50 Years That’ve Shaped My Experience with Diabetes

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The 5 Things Over 50 Years That’ve Shaped My Experience with Diabetes

This year, November is extra special for me in my annual recognition of National Diabetes Month and celebration of World Diabetes Day on November 14th. November 2018 marks my 50-year “Diaversary”—50 years since being diagnosed with type 1 diabetes. At the time of my diagnosis, my family and I were in shock and scared of the unknown. So, after 50 years of managing this chronic condition I feel there is a cause for celebration – a time to “stop and smell the roses.” What roses? I mean all the changes over the past five decades that have made controlling diabetes more effective and, nearly as important, easier. And to celebrate five decades, here are my choices for the top five advances in diabetes management since 1968.

FOOD CHOICES:
The introduction of “carbohydrate counting” for blood sugar management has been an effective tool for people with diabetes. For the majority of my life with diabetes I followed a “Diabetes Exchange” meal planning strategy, where foods were divided into six food groups – starches, fruits, milk, meat and meat substitutes, fats and sweets plus a “free food” list. Diabetes is a family affair since lifestyle is a major component of management, and my family basically followed the same type of meal plan (although I don’t recall anyone else using the food scale to weigh portions). I’m glad I learned exchanges, but carbohydrate counting has added more flexibility in food choices and been a better tool for matching insulin doses to carbohydrate intake.

I can’t leave food choices without mentioning low calorie sweeteners like sucralose as an advancement in diabetes management. This advancement includes over 100 studies conducted over 20 years on safety of this sweetening ingredient. In a previous blog entitled, “Being More Normal – How Healthy Eating With Diabetes Has Evolved,” I discuss this in depth. But, having mentioned the Diabetes Exchange List earlier, I can illustrate my appreciation for sucralose, the no-calorie sweetening ingredient in SPLENDA® Brand Sweetener, by consulting the list and finding the “modest” portion sizes for banana nut bread as ½ ounce, lemonade as ¼ cup, and pumpkin pie as one-twelfth of a pie. Reducing the sugar and calories in these desserts and sweet drinks with low calorie sweeteners makes a significant difference in my enjoyment of sweets.

INSULIN:
Insulin is essential for people with type 1 diabetes. Fortunately for me, insulin treatment for type 1 diabetes commenced in the mid-1920’s. In my fifty-year life with diabetes, it is not so much the discovery of insulin I have experienced, but rather the improvement of insulin. At my diagnosis, insulin was “animal derived” – isolated from the pancreas of pigs and cows. Animal derived insulin caused allergic reactions in some people, and for me tended to irritate injection sites. Now, synthetic human insulin is available, manufactured by bacteria or yeast that have had the genetic “assembly instructions” spliced into their DNA (recombinant DNA).

Insulin has also been modified over the years to create different formulations having different profiles in the strength and timing of their effectiveness in reducing blood sugar levels. “Rapid acting” insulin takes effect very quickly (5-15 minutes), profoundly increases insulin levels in the bloodstream, and its action dissipates within a few hours. The action of “long acting” insulins, on the other hand, are very modest (2-4 hours), but persist for 24 hours or longer. Long-acting insulin improved insulin therapy by acting as a “basal rate” similar to natural human metabolism. Overall, improvements in insulin therapy helped people with both type 1 and type 2 diabetes manage blood glucose levels.

MEDICATIONS:
I’ve always be unsure about calling insulin a “medication” since it is the same hormone I used to produce naturally. But, my long-term health with diabetes has likely benefited from medications effective in preventing heart disease (statins) and kidney disease/ eye complications (lisinopril), all conditions for which diabetes increases the risk substantially. And, people with type 2 diabetes have a range of oral and injectable non-insulin medications that help control blood sugar levels without the risk (in most cases) for hypoglycemia (low blood sugar levels) associated with insulin.

TECHNOLOGY:
Just as technology was booming with electronic games, cell phones, the internet and improved digital TV’s, technology was also booming in the diabetes world. From my diagnosis until sometime in the 1980’s, I checked my blood glucose level by checking for excess sugar in urine, only detectable, by the way, when the level is too high. Now I work with patients whose blood glucose results are automatically uploaded to “the cloud” and will send me a text if the level is too low or too high. I now wear on my arm a “continuous glucose monitor” (CGM) the size of a quarter that can give me my level in 2 seconds. The ten-day active period for my CGM spares me as many as 100 finger sticks. I also wear an insulin pump that saves me 15 insulin injections over its three-day active span, and, more importantly, allows me to regulate my blood glucose levels much more accurately.

SUPPORT:
As the years have progressed, there has also been a huge increase in the availability of professional and peer support, and education. Certified Diabetes Educators (CDE), first credentialed in 1986, can train people to manage diabetes and help them with problem solving their diabetes. There are great resources available online, including peer support “communities.” The growth in diabetes support has allowed me not only to have a path to seek support myself, but also to provide support to others through my website, other media outlets, and as a CDE coach.

I know this may sound odd, but I’m thankful for all the challenges of living with diabetes. Those challenges have also brought opportunities to my life. Living with diabetes has taught me to be independent, a problem solver, a creative thinker and overall healthier by following a healthy eating plan and getting daily exercise starting early in life. And, it’s given me the opportunity to share what I’ve learned with others. Here’s to the next 50 years!

This blog post is sponsored by SPLENDA® Brand Sweetener. All thoughts and opinions are my own.

Being More Normal – How Healthy Eating With Diabetes Has Evolved

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Being More Normal – How Healthy Eating With Diabetes Has Evolved

This year is a milestone year for me, as it marks the 50th anniversary of my first steps on an interesting, and so far, successful journey with my own type 1 diabetes.

I have lived both professionally as a registered dietitian nutritionist (RDN) and certified diabetes educator (CDE) and personally with the evolution of diabetes treatment and self-management for many years, and I can testify that it is all about finding ways to feel normal.

One key area I have found as a person living with type 1 diabetes, and counseling others, is the role that low-calorie sweeteners can play in diabetes management, and it is far from trivial – I’ll tell you how.

The connection between diabetes and a sweetener that doesn’t add a lot of carbohydrate to our diet is somewhat obvious, and I could have written credibly about this connection simply as a professional. I didn’t have to mention the personal diabetes experience – I definitely didn’t have to mention the 50 year thing (which now makes it impossible to ever again claim that I’m 39). But sugar has been a dietary issue for so many people living with diabetes, not to mention the general population. Sugar raises blood glucose quickly, and besides calories, has no compensating nutritional value. But for many of us, a craving for sweets is hardwired into our brain, and sweets are embedded in just about every culture and social setting.

At my diagnosis, the “standard” diabetes eating plan was known as the “diabetic exchange list,” where a daily meal plan specified a certain number of choices from categories of foods – starches, fruit, milk, vegetables, meat and meat substitutes, fats, and “free” foods. The specific foods and portion sizes in each group (or subgroup, like “lean”, “medium-fat” or “high-fat” meat) contain similar calories, carbohydrate, protein and fat. Combination foods, like pizza for example, may count as 2 carbohydrates, 2 medium fat meats and 2 fats. Sweets were discouraged or outright prohibited except for vanilla wafers, graham crackers or 1/12th slice of angel food cake.

The diabetic exchange eating plan was way better than “Allen’s Starvation Diet,” the standard “treatment” to prolong life before the discovery of insulin. And, scientific studies like the Diabetes Control and Complications Trial supported the importance of lifestyle choices, like managing carbohydrate in our diet, by showing how diabetes complications of the eyes and kidneys relate directly to persistent high blood glucose levels. Over the years carbohydrate counting became accepted as a more intuitive and less complex way to manage post-meal blood glucose spikes, especially as the profile of diabetes patients has shifted dramatically to those with type 2 diabetes, who do not have insulin in their “toolbox.” Meal planning now may even include considerations of a food’s “glycemic index” or whether it contains “resistant starch.” But, the dilemma with sweets – lots of carbohydrate without compensating nutritional value – remains.

Fortunately, the evolution of diabetes eating plans has proceeded in tandem with the evolution of innovations in low calorie sweeteners like sucralose; found in the original SPLENDA® Sweeteners – better taste, more application options (like for baking), and more scientific studies to support their safety. There have been over 100 studies conducted over 20 years, showing the safety of sucralose. The SPLENDA® Brand is celebrating the 20th anniversary this year of sucralose obtaining FDA approval. The studies with sucralose show that it is safe to consume, does not cause any side effects; to include cancer, weight gain or increased appetite for sweet foods. Furthermore, sucralose does not affect gut function, as it is not metabolized in the GI tract). Last but not least, and possibly most important for us, low calorie-sweeteners do not raise blood sugar levels.

Through all of these changes in diabetes management, the availability of low calorie sweeteners, like sucralose, have given people living with diabetes, like myself, more flexibility and sense of normalcy. Nothing matters more to a person, than to feel like they have options and can live like everyone else.

Having the option to add sweetness to food without all the carbohydrate of sugar is priceless, and helps me and my patients with diabetes feel more normal and less restricted. Every morning I look forward to adding SPLENDA® Sweetener along with a sprinkle of cinnamon and some almonds to my oatmeal-delicious! And for holiday celebrations, I love that I now have the option to bake desserts with a low-calorie sweetener like SPLENDA® Sweetener. This allows me to confidently enjoy some sweetness knowing the carbohydrate and caloric content of my dessert, and to determine how it will fit into my meal plan.

For decades, managing diabetes “by the book” meant completely avoiding sugar. This is no longer the case as long as moderation is used. But, when sweetness comes without all the calories or carbohydrates of sugar or other full-calorie sweeteners, it’s a different life – it’s a more “normal” life.

I have partnered with the SPLENDA® Brand and have been compensated for this blog post. However, my opinions are my own and I have not been paid to publish positive comments.

Emergency Evacuations and Diabetes Management

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Emergency Evacuations and Diabetes Management

 It was a 2017 replay of Hurricane Matthew with Hurricane Irma, this year, triggering our Governor’s order of a mandatory evacuation for our area of South Carolina. Planning is always important for effective diabetes management, and when facing a potential emergency it is absolutely essential. And, experience is golden.

We had, for instance, fueled our cars at the first hint the storm’s track may involve us. We plotted our timing and a route to our Atlanta refuge to avoid the mass exodus on Interstates 95 and 75. We knew where our important papers were stashed, and which clothes to pack. And, I am always prepared to gather my diabetes supplies on a moment’s notice.

perfect pairing snack

Most importantly, this time I knew that food availability could be unpredictable. There’s very early morning and very late evening travel on secondary roads, the potential for storm-related travel delays, and the reality that returning home can be more challenging than being evacuated – power outages following Hurricane Matthew had left our hometown groceries unable to open for business.

The perfect fit for me this time was a stash of NuGo Slim bars . The NuGo Slim bar was a perfect combination of nutrients (protein, carbohydrate, fiber, and fat) to use as a meal replacement or snack, relieving hunger and keeping blood sugar steady. Plus, it has only 2-3g sugar from Real Dark Chocolate and chicory root fiber, no maltitol or artificial sweeteners.

These bars served as my “go to nutrition bar” for breakfast that morning we evacuated. And even though we were lucky to have no damage at home this time, those NuGo Slim bars kept my huger at bay and my blood sugars in sync by candlelight during an 18 hour power outage caused by tropical storm Irma, who followed us all the way to Atlanta. You can never be too prepared.

Find very low glycemic NuGo Slim at your local store. Use code TOBYSLM for 15% off NuGo Slim online through 3/5/2018. My favorite flavors are Chocolate Mint and Brownie Crunch but I also like Roasted Peanut too – it’s hard to pick just one.

Thoughts About Blood Sugar Monitoring

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I read a great article recently that included blood glucose testing, but parts of the article really bother me.  While the article was essentially about whether health tracking is useful with all of the new apps available for users, one angle of the article was about how unsuccessful home blood sugar monitoring has been over a 3o year period. The author called people with diabetes “early adopters” of health tracking, and pointed out that most hate it.

First, a 2001 study found only 5% of people with diabetes actually do daily testing, 65% admitting to testing less than once a month.  More concerning to me, the reason people don’t test is that they see testing as an enemy – out to remind them how poorly they’re doing. Add to this a move in some circles to stop reimbursements for testing supplies based in large part on evidence that people with diabetes don’t use testing to change behavior, and a big problem is brewing. There is a terrible disconnect within our medical system.

I know how incredibly valuable testing is….with type 1 diabetes it’s simply impossible to work things out by guessing. But, testing can be valuable for type 2 diabetes too if you use the tool to get relevant information, and to make changes. Here’s an example. My friend Mike often tests after meal just to see how a certain food has affected his blood sugar. His behavior changes aren’t major – if his blood sugar goes too high he knows that particular food doesn’t fit his metabolism well. This is how blood sugar testing can serve to improve control over time, and improved control means better health.

Contrast this to another friend who has been prescribed one test each day, first thing in the morning. Essentially, a fasting glucose 365 times a year. Guess what? Her blood sugar is virtually the same every day. There is no data upon which to make changes, and there’s no data that could possibly be any more valuable than an A1C every 3 to 6 months. This is a waste of resources and a burden on my friend, but I can’t convince her to stop because this is what her general practitioner has told her to do. She hates it, of course.

Here’s the problem. Medical policy makers in government programs and with private insurers do not provide adequate coverage for education and support time with diabetes educators.  More time with educators could result in a better understanding of testing, and less anxiety about doing it because a purpose could be defined. Some of the responsibility is with patients. But, most people want to do better with self management, and this complex condition does require active participation by those of us who stand to benefit the most – patients. I hope our members at DiabetesEveryDay will share their thoughts about testing with me. I am concerned about this marvelous tool being so misunderstood by those who could gain so much.

 

It’s Diabetes Awareness Day – March 22, 2016

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With more than 21 million people diagnosed with diabetes, most likely you know someone who has diabetes. The CDC reports fourteen adults are diagnosed with diabetes every 5 minutes. But, you also may have a relative, friend, or acquaintance that falls into the pocket of the estimated 8 million people who have diabetes that is not yet diagnosed or the 86 million with prediabetes. Walking around without the diagnosis or treatment can put them (or you) at higher risk for complications from diabetes much earlier than if you were managing your blood glucose levels already.

The unknown is usually scary, but in the case of diabetes it is critical to know (get diagnosed). And, if you are diagnosed with diabetes it is important to manage your blood glucose readings daily. Diabetes management can certainly be overwhelming, but if we take some small steps we can achieve huge health rewards.
Here are a few doable small steps for a great start:

1) Plan a week of menus including all your meals and snacks and use this menu as your grocery list.

2) Add movement that fits into your regular routine such as standing on one foot as you brush your teeth in the morning and evening.

3) Add a low carb vegetable (bell peppers, green beans, broccoli or cauliflower) to lunch and dinner every day.

4) Check your blood glucose levels at different times of the day (before meals, two hours after meals, before and after exercise, before bed). These time slots can let you know if your blood glucose levels are staying in range (80-130 before meals, 180 or less two hours after eating)

Diabetes awareness is the first step followed by diabetes management. A great starting point is to take the type 2 diabetes risk test today http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/?loc=alertday

Two Thumbs Up for “The Complete Diabetes Organizer”

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As I hope you’ve noticed, I’ve managed to keep DiabetesEveryDay.com free of advertising, the idea being that whenever I endorse or recommend a product you’ll know it’s coming straight from me without any financial influence. And, having the dual personality- person with diabetes and person who counsels people who have diabetes – I can’t help but look at anything diabetes-related from both angles. So, when I tell you that a new book, The Complete Diabetes Organizer, is something you should read and keep handy for frequent reference, you can believe it. I’m certainly keeping it handy.

The book is written by fellow Registered Dietitian, Certified Diabetes Educator and my friend Susan Weiner, and co-authored by Leslie Josel, an authority on “chronic disorganization.” Now, I should say that people with diabetes are not chronically disorganized by default, so don’t think the book will only be helpful if you happen to fall into that category. The real issue, and what makes this book so valuable for anyone with diabetes, is that we can all greatly reduce the stress of diabetes self-management if we are greatly organized. In fact, one of the things I like most about the book is the admission right up front that managing diabetes effectively is a huge pain in the butt.

Not surprisingly, the book is well organized, even to the extent of having a built-in bookmark. And, the authors also offer ideas from many other diabetes experts who understand the challenges best- they all have diabetes. I’ll just encourage you to grab a copy for yourself, and see if the tips and guidance don’t make your diabetes management activities more efficient, and more successful.As I hope you’ve noticed, I’ve managed to keep DiabetesEveryDay.com free of advertising, the idea being that whenever I endorse or recommend a product you’ll know it’s coming straight from me without any financial influence. And, having the dual personality- person with diabetes and person who counsels people who have diabetes – I can’t help but look at anything diabetes-related from both angles. So, when I tell you that a new book, The Complete Diabetes Organizer, is something you should read and keep handy for frequent reference, you can believe it. I’m certainly keeping it handy.

The book is written by fellow Registered Dietitian, Certified Diabetes Educator and my friend Susan Weiner, and co-authored by Leslie Josel, an authority on “chronic disorganization.” Now, I should say that people with diabetes are not chronically disorganized by default, so don’t think the book will only be helpful if you happen to fall into that category. The real issue, and what makes this book so valuable for anyone with diabetes, is that we can all greatly reduce the stress of diabetes self-management if we are greatly organized. In fact, one of the things I like most about the book is the admission right up front that managing diabetes effectively is a huge pain in the butt.

Not surprisingly, the book is well organized, even to the extent of having a built-in bookmark. And, the authors also offer ideas from many other diabetes experts who understand the challenges best- they all have diabetes. I’ll just encourage you to grab a copy for yourself, and see if the tips and guidance don’t make your diabetes management activities more efficient, and more successful.