Diabetes Everyday

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

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My Profile in “Diabetic Living”

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Several months ago I wrote a profile for Diabetic Living. They wanted my take on what it’s like to be a CDE with diabetes. I’ve done a number of interviews with this magazine, but this is my first writing assignment- a pretty easy assignment to write about something I know so well.

I’m sure many of our members already get Diabetic Living, but for those who may not, I highly recommend it. Subscribers probably already have their copy, but it goes on sale Monday- which, interestingly, happens to be my birthday. By the way- there’s a typo in the heading- I was diagnosed in 1968 at the age of 8. I can’t let them add 8 years to my age without pointing it out. For a sneak peak at my article click here.Several months ago I wrote a profile for Diabetic Living. They wanted my take on what it’s like to be a CDE with diabetes. I’ve done a number of interviews with this magazine, but this is my first writing assignment- a pretty easy assignment to write about something I know so well.

I’m sure many of our members already get Diabetic Living, but for those who may not, I highly recommend it. Subscribers probably already have their copy, but it goes on sale Monday- which, interestingly, happens to be my birthday. By the way- there’s a typo in the heading- I was diagnosed in 1968 at the age of 8. I can’t let them add 8 years to my age without pointing it out. For a sneak peak at my article click here.

Watch “The Weight of the Nation” HBO Documentary, Part I; Consequences

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This 4 part HBO series is a “must see” for all Americans, and you can watch it online here. I’m re-posting the first episode, but you can find all 4 parts under my blog link.

The obesity epidemic is literally becoming an issue of national security, with the health of our workforce compromised and the cost of obesity related illness racing toward overwhelming. Worse, our children are almost certainly going to be less healthy than our current adult population.

Part I explores the systemic effects of extra weight, including, of course, type 2 diabetes. This will be a difficult “watch” for some- obesity and obesity related disease is complicated physically and emotionally. But, this episode in particular confronts my first essential commitment to diabetes self-management- reality.  I suggest you watch it with all of your attention no matter how uncomfortable you find it. Before we confront this challenge personally we must feel the urgency intensely.

We’ll post episode II next week, and episode III and IV after. If you want to watch it in one dose click here to visit HBO.
This 4 part HBO series is a “must see” for all Americans, and you can watch it online here.

The obesity epidemic is literally becoming an issue of national security, with the health of our workforce compromised and the cost of obesity related illness racing toward overwhelming. Worse, our children are almost certainly going to be less healthy than our current adult population.

Part I explores the systemic effects of extra weight, including, of course, type 2 diabetes. This will be a difficult “watch” for some- obesity and obesity related disease is complicated physically and emotionally. But, this episode in particular confronts my first essential commitment to diabetes self-management- reality.  I suggest you watch it with all of your attention no matter how uncomfortable you find it. Before we confront this challenge personally we must feel the urgency intensely.

We’ll post episode II next week, and episode III and IV after. If you want to watch it in one dose click here to visit HBO.

This Was Hard!!!

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The book is complete- well, the first draft is complete. And, most importantly, it looks like there may be a few days rest before the editorial inquiries start. But, there can’t be too much rest since the release date is set for October 28th – we all know how time flies.

I am really pleased with the result, and I have an even greater appreciation for the work that my friends – including the authors of the many cookbooks you enjoy through DiabetesEveryDay- put into their work. I only thought that I understood before this undertaking – now I REALLY understand how challenging this book writing process is.

So, before I duck back into my cave to begin the final polishing I’ll just express a wish that this work helps people take control of their own diabetes. My co-author and I were on the same page, literally and figuratively, the whole way, and I appreciate the credibility that Dr. Alan Rubin brings to the subject of diabetes and food. This post is more or less just a big exhale, but I will look forward to sharing the ideas we covered, and a few new recipes from Chef Lindsey Singleton, as we approach Diabetes Awareness Month this November.

Now, it’s back to work!!

 The book is complete- well, the first draft is complete. And, most importantly, it looks like there may be a few days rest before the editorial inquiries start. But, there can’t be too much rest since the release date is set for October 28th – we all know how time flies.

I am really pleased with the result, and I have an even greater appreciation for the work that my friends – including the authors of the many cookbooks you enjoy through DiabetesEveryDay- put into their work. I only thought that I understood before this undertaking – now I REALLY understand how challenging this book writing process is.

So, before I duck back into my cave to begin the final polishing I’ll just express a wish that this work helps people take control of their own diabetes. My co-author and I were on the same page, literally and figuratively, the whole way, and I appreciate the credibility that Dr. Alan Rubin brings to the subject of diabetes and food. This post is more or less just a big exhale, but I will look forward to sharing the ideas we covered, and a few new recipes from Chef Lindsey Singleton, as we approach Diabetes Awareness Month this November.

Now, it’s back to work!!

 

Are You Wearing the “Healthy Halo”?

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There’s an interesting tendency among people who are not nutrition professionals to make certain assumptions based upon the general quality of a particular food, like salads, for instance – salads are healthy. Taking that a step further, one can declare to oneself that if I eat salads often, I am eating a healthy diet. Nutrition professionals know better.

The issue is that salads aren’t necessarily healthy- it all depends upon what you put into your salad. We call the blanket assumption that eating a food with a healthy reputation means one is eating a healthy diet the “healthy halo.”

To demonstrate, I asked my husband Tony to visit the salad bar at a local restaurant for demonstration purposes, and his salad is the image you see. I can assure you that this salad includes healthy foods – lettuce, spinach, and peppers, to name a few, but let’s look at what’s showing (if you can make it out beneath the sesame ginger dressing). There are eggs, a healthy protein, but that’s a lot of eggs. I recognize bacon bits and sesame seeds, one not so healthy, but both high in fat (meaning calories). I see a number of olives….healthy, but fat and calories to spare…..and some Mandarin oranges. At the top of the photo you may recognize oil packed anchovies, and in the five o’clock position you’ll recognize avocados. Frankly, this is more like the typical salad Americans eat.

Here’s the point, even the healthier add-on’s….oranges, avocados, sunflower seeds, eggs, fish, and olives….bring lots of calories and fat (remember, fat packs more than twice the calories of protein or carbohydrate). So, a 300 calorie salad of nonstarchy vegetables can easily become a 1200 or 1500, high fat meal that approaches your daily recommended calorie intake.

Don’t wear the healthy halo. Make the decision to actually learn about the food you’re eating, rather than making unfounded assumptions and generalizations. You might be surprised, and even disappointed, to learn how your salad fixin’s add up, but in the end you’ll get the results you want.There’s an interesting tendency among people who are not nutrition professionals to make certain assumptions based upon the general quality of a particular food, like salads, for instance – salads are healthy. Taking that a step further, one can declare to oneself that if I eat salads often, I am eating a healthy diet. Nutrition professionals know better.

The issue is that salads aren’t necessarily healthy- it all depends upon what you put into your salad. We call the blanket assumption that eating a food with a healthy reputation means one is eating a healthy diet the “healthy halo.”

To demonstrate, I asked my husband Tony to visit the salad bar at a local restaurant for demonstration purposes, and his salad is the image you see. I can assure you that this salad includes healthy foods – lettuce, spinach, and peppers, to name a few, but let’s look at what’s showing (if you can make it out beneath the sesame ginger dressing). There are eggs, a healthy protein, but that’s a lot of eggs. I recognize bacon bits and sesame seeds, one not so healthy, but both high in fat (meaning calories). I see a number of olives….healthy, but fat and calories to spare…..and some Mandarin oranges. At the top of the photo you may recognize oil packed anchovies, and in the five o’clock position you’ll recognize avocados. Frankly, this is more like the typical salad Americans eat.

Here’s the point, even the healthier add-on’s….oranges, avocados, sunflower seeds, eggs, fish, and olives….bring lots of calories and fat (remember, fat packs more than twice the calories of protein or carbohydrate). So, a 300 calorie salad of nonstarchy vegetables can easily become a 1200 or 1500, high fat meal that approaches your daily recommended calorie intake.

Don’t wear the healthy halo. Make the decision to actually learn about the food you’re eating, rather than making unfounded assumptions and generalizations. You might be surprised, and even disappointed, to learn how your salad fixin’s add up, but in the end you’ll get the results you want.

Blood Sugar Testing Ineffective- Now I’m Mad!!

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Here’s a story that made me really mad!!

Uriëll L. Malanda of the VU University Medical Center in Amsterdam and colleagues reviewed about a dozen studies to look at the effectiveness of blood sugar self-monitoring, based upon improvements in HbA1C levels and upon patient “satisfaction”, “general well being” and health-related “quality of life”.  A1C estimates average blood glucose levels over a three to four month period, and lower values would represent clinical improvements in blood glucose control. The study looked at more than 3,000 subjects who do not use insulin, and was reported in The Cochrane Library.

The results– blood glucose self-monitoring showed only modest improvements in A1C at six months, which vanished at twelve months, and no effect on patient perceptions. Moreover, one study compared costs to urine testing for hyperglycemia and found blood monitoring twelve times more costly.

This is absurd, and information like this will eventually threaten patient compensation for blood glucose monitoring supplies, certainly for patients not treated with insulin. But it isn’t the information I can blame, of course—that would be the old “kill the messenger” strategy. The question is– why are patients not benefiting from this incredibly useful information? Dr. Mayer Davidson who authored one of the studies in the Malanda review was quoted in the Cochrane article saying, “patients aren’t using these numbers to do anything clinically significant.”

So, who can I blame? I need to vent somewhere because it may well be that self-monitoring blood glucose does not benefit Type 2 patients, but self-monitoring CAN and SHOULD improve both clinical outcomes and patient perception.

  • Physicians focus, naturally I suppose, on the “medical management” of diabetes. But often, in my experience, doctors will instruct patients to test blood sugar once or twice each day at set times, like upon waking, that have no relationship to lifestyle behaviors. Self-monitoring is most valuable in identifying patterns, positive or negative, related to food or physical activity. Identifying blood glucose patterns allows the patient to “manage” those things that have a positive or negative influence on glycemic control. On the other hand, sticking one’s finger first thing in the morning only to see virtually the same result each day would not lead patients to feel more satisfied or to actively modify things that could improve A1C over time. Observing how a couple slices of pizza sends one’s blood glucose level to 380 mg/dl, however, could eventually lead one to modify behavior. Diabetes management is an “activity”, not a “circumstance”.
  • Insurance providers do not place sufficient priority on lifestyle support. Reimbursement for educational and motivational sessions with Registered Dietitians or Certified Diabetes Educators is often limited by both dollar amount and frequency allowed. While the tide is slowly changing, insurance providers sometimes seem more willing to reimburse kidney dialysis than wellness sessions.
  • Patients do not take diabetes seriously, or, more correctly, do not take their responsibility for self-management by daily lifestyle choices seriously. I could deflect the “blame” onto those who should be informing and guiding the patient or reimbursing instruction, I suppose, but no matter how I can slice it too many people with diabetes simply don’t commit to the lifestyle issues. And in the same way that a focus on diet and physical activity represent dedication to self care, so too does thoughtful blood glucose monitoring. It has to do with being actively engaged with one’s responsibility to manage hyperglycemia, and just as too many ignore diet and exercise so too does blood glucose monitoring become a useless task.

So what makes me so mad? That the message still isn’t getting to, or sticking with, people with diabetes—YOU can have a remarkable impact on the ultimate effect of this condition upon YOUR health. Purposeful blood glucose monitoring allows one to take action, and provides instant feedback about our own behavior. It is an incredible tool for cause and effect identification and intervention.

Those who see diabetes self-management as a “spectator sport”, no matter who’s really to blame, do a disservice to their own long term health and to the rest of us too. Eventually, those of us who do take self-management seriously will be “out of pocket” for testing supplies and equipment, and that is one giant step backwards.Here’s a story that made me really mad!!

Uriëll L. Malanda of the VU University Medical Center in Amsterdam and colleagues reviewed about a dozen studies to look at the effectiveness of blood sugar self-monitoring, based upon improvements in HbA1C levels and upon patient “satisfaction”, “general well being” and health-related “quality of life”.  A1C estimates average blood glucose levels over a three to four month period, and lower values would represent clinical improvements in blood glucose control. The study looked at more than 3,000 subjects who did not use insulin, and was reported in The Cochrane Library.

The results– blood glucose self-monitoring showed only modest improvements in A1C at six months, which vanished at twelve months, and no effect on patient perceptions. Moreover, one study compared costs to urine testing for hyperglycemia and found blood monitoring twelve times more costly.

This is absurd, and information like this will eventually threaten patient compensation for blood glucose monitoring supplies, certainly for patients not treated with insulin. But it isn’t the information I can blame, of course—that would be the old “kill the messenger” strategy. The question is– why are patients not benefiting from this incredibly useful information? Dr. Mayer Davidson who authored one of the studies in the Malanda review was quoted in the Cochrane article saying, “patients aren’t using these numbers to do anything clinically significant.”

So, who can I blame? I need to vent somewhere because it may well be that self-monitoring blood glucose does not benefit Type 2 patients, but self-monitoring CAN and SHOULD improve both clinical outcomes and patient perception.

  • Physicians focus, naturally I suppose, on the “medical management” of diabetes. But often, in my experience, doctors will instruct patients to test blood sugar once or twice each day at set times, like upon waking, that have no relationship to lifestyle behaviors. Self-monitoring is most valuable in identifying patterns, positive or negative, related to food or physical activity. Identifying blood glucose patterns allows the patient to “manage” those things that have a positive or negative influence on glycemic control. On the other hand, sticking one’s finger first thing in the morning only to see virtually the same result each day would not lead patients to feel more satisfied or to actively modify things that could improve A1C over time. Observing how a couple slices of pizza sends one’s blood glucose level to 380 mg/dl, however, could eventually lead one to modify behavior. Diabetes management is an “activity”, not a “circumstance”.
  • Insurance providers do not place sufficient priority on lifestyle support. Reimbursement for educational and motivational sessions with Registered Dietitians or Certified Diabetes Educators is often limited by both dollar amount and frequency allowed. While the tide is slowly changing, insurance providers sometimes seem more willing to reimburse kidney dialysis than wellness sessions.
  • Patients do not take diabetes seriously, or, more correctly, do not take their responsibility for self-management by daily lifestyle choices seriously. I could deflect the “blame” onto those who should be informing and guiding the patient or reimbursing instruction, I suppose, but no matter how I can slice it too many people with diabetes simply don’t commit to the lifestyle issues. And in the same way that a focus on diet and physical activity represent dedication to self care, so too does thoughtful blood glucose monitoring. It has to do with being actively engaged with one’s responsibility to manage hyperglycemia, and just as too many ignore diet and exercise so too does blood glucose monitoring become a useless task.

So what makes me so mad? That the message still isn’t getting to, or sticking with, people with diabetes—YOU can have a remarkable impact on the ultimate effect of this condition upon YOUR health. Purposeful blood glucose monitoring allows one to take action, and provides instant feedback about our own behavior. It is an incredible tool for cause and effect identification and intervention.

Those who see diabetes self-management as a “spectator sport”, no matter who’s really to blame, do a disservice to their own long term health and to the rest of us too. Eventually, those of us who do take self-management seriously will be “out of pocket” for testing supplies and equipment, and that is one giant step backwards.

My Diabetes Partner

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My husband Tony and I have an anniversary next week, so it seems like a good time to post this interview our friends Joan and Tony (Skerbec) did with my partner and me about supporting a loved one with diabetes. You’ll hear stories of insulin forgotten, wild guava for hypoglycemia, and real advice on diabetes-management in partnership. Happy Anniversary to us!
[audio:https://diabeteseveryday.com/wp-content/uploads/Caregivers-TS5.mp3|titles=Caregivers-TS]My husband Tony and I have an anniversary next week, so it seems like a good time to post this interview our friends Joan and Tony (Skerbec) did with my partner and me about supporting a loved one with diabetes. You’ll hear stories of insulin forgotten, wild guava for hypoglycemia, and real advice on diabetes-management in partnership. Happy Anniversary!

[audio:https://diabeteseveryday.com/wp-content/uploads/Caregivers-TS6.mp3|titles=Caregivers-TS]