Diabetes Everyday

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

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Sharing Toby’s Knowledge

What You Need To Know About Sleep and Diabetes

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Most people require at least 7 hours sleep – do you regularly get 7 hours or more sleep? If not, you’re missing an opportunity to improve your health (and make diabetes management easier). Check this video for some tips on how you can improve your sleeping and, at the same time, your health.

If you’ve been watching my videos, you will know that I love bringing you “aha moments.” I recently listened to researchers present interesting new findings about sleep and the big “aha moment” was their recommendation that we need to expand our definition of health to include sleep! I’ve been preaching this forever and the research keeps rolling in- sleep is a big deal…… and with diabetes it’s not always so easy. But poor or inadequate sleep – especially less than 6 hours – is clearly associated with higher blood sugar, increased insulin resistance, higher blood pressure, a significantly increased risk for heart disease, and even a poor diet linked to disruption of hunger hormones…..research shows poor sleep results in 300 additional calories per day.  A whopping 50% of people with type 2 diabetes have sleeping issues. It’s like poor sleep is perfectly designed to mess up everything about our diabetes management efforts.

But diabetes can seem perfectly designed to mess up our sleep patterns too, with blood sugar up’s and down’s, frequent urinary demands, and for some of us fantastic monitoring and insulin delivering devices pasted on our bodies and the need to respond to alarms and access our device controllers or food when we should be sleeping. So getting good sleep is a lifestyle priority, and like all diabetes management activities it’s the little things that matter.

Here’s my latest find….a new brand of stylish and innovative luxury sleepwear and loungewear for men and women designed by a person with type 1 diabetes, especially for people with diabetes, called MBK. Based on research from over 300 people with type 1, all features were designed to solve for the discomfort associated with sleeping or lounging with insulin pump and CGM’s.  These are 100% breathable Pima cotton with an extra wide waist band and drawstring to comfortably support…..wait for it…..all my the diabetes “stuff” !  All of it fits securely in the multiple, generous internal and external pockets provided just for this purpose. For me that’s my phone, my insulin pump controller, some glucose tabs or hard candy, and sometimes dog treats. The placement of the pockets on the top distributes the weight. There are also strategic openings for insulin pump tubing and a feature that is never found…but will make a huge difference in your comfort and reducing your interruptions in sleep. Comfort is one of those little things that can make a big difference, and this seems like a great gift idea…Along with these helpful reminders:

  • Work with your medical team to fine tune your medication overnight
  • Be consistent with your sleep routine: Go to sleep and wake up at the same time every day. Also set up a going to bed routine, like brushing your teeth before bed, taking a warm shower before bed and maybe not reading or watching something too stimulating of frightening
  • Take a walk before bed, not a marathon run, but a walk or engage in yoga, especially yoga nidra.
  • Keep your room cool and dark. I’ve been using an eye mask that has made a big difference. I didn’t realize I was so light sensitive.
  • Make sure to check out the MBK sleepwear and these new innovations in sleepwear as well as, evaluate the quality of your mattress or consider a weighted blanket, and
  • See a doctor if you have serious or persistent insomnia

Remember, preserving our long term health with simple and positive diabetes management behaviors pays off big time….now and for the rest of our lives. Getting quality adequate sleep must be one of the things we focus on. Sleep tight….see you next time.

The Power of Plants

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A whole-food, plant-based diet shows some pretty remarkable benefits to diabetes management. See what Toby has to say about this eating plan.

Many of you have asked me to post more information about plant -based eating, specifically, whole food plant- based eating. So, that is what we are going to talk about today. If you are ready to press the stop or pause button, don’t touch that button. It’s worth listening to a quick review of the research because it is something I know you will want to hear about. I’ll also give you some quick tips on how to incorporate plant -based eating into your eating plan.

There are many studies showing improvement in blood sugar management and even placing prediabetes and type 2 diabetes in remission. One of the studies conducted on people with type 2 diabetes compared a group who met with a dietitian for an individualized meal plan with consistent carbs, low-fat, and decreased calories for weight loss versus a second group that followed a 100% plant-based,  Low-Fat/low Oil plan, low glycemic index foods and No carb limit, no calorie limit and took a Daily multi-vitamin. The 100% plant-based group’s A1C reduced 3 times lower, lost twice as much weight and nearly (43%) half of the participants in the plant-based eating group were taken off their diabetes medications. I love those outcomes!

Here are the 6 basic things you’ll focus on when you follow a whole food plant-based plan:

  1. Avoid all animal products-so this means no dairy, fish poultry, and meats. Just plant-based foods.
  2. Go low fat. The goal is to keep any food you are eating to be under 3 grams of total fat per serving. The amount of fat grams for the whole day is limited to 20-30 grams. The reason being that we want to reduce the intralipid fat in the cells- the fat that is within our cells and increases insulin resistance.

To keep the fat lower, we need to reduce the amount of oil, nuts, avocado (even though these items are plant based). Use cooking methods of steaming, stir-fry, bake, grill, or braising. Use

Cookware likeNonstick pans and parchment paper on baking sheets. Ways you can substitute for oil include Sauté with water or vegetable stock; Use apple sauce instead of oil in baking or Use fat-free dressings and condiments

  • Fill up on fiber. Filling up on fiber is where you will make the biggest change in feeling full. Fiber is an indigestible carbohydrate, and it helps keep blood sugar steady. That’s super important for us and Soluble fiber helps lower cholesterol. The goal is to consume 40 grams or more of fiber per day.  Add fiber slowly and make sure to drink plenty of water.
  • Choose WHOLE plant foods. Apples instead of apple juice or wild rice or brown rice instead of white rice.
  •  Choose low glycemic index foods. Those are foods that have a slower rise in blood sugar. For instance, sugar will spike your blood sugar whereas fresh fruit will give you a slower rise.
  • And Take vitamin B12 supplement. If you are following a plant-based eating plan since we get Vitamin B12 from animal sources…fish, meat, poultry, eggs, milk, and milk products.  And research has found that people with diabetes, both type 1 and type 2, tend to be deficient in vitamin b 12. Taking the medication, Metformin, increases your risk for being deficient in B12. I have more details about vitamin B12 in my video titled what you need to know about vitamin B12.      

Please keep in mind, whenever you make any changes to your diet, you may need to:

  • Check your blood sugar more often. Changing your eating habits is a lifestyle change and we know food affects blood sugar levels. It’s good to watch for any new patterns of your blood sugar.
  • Work with your diabetes educator or doctor to adjust your dose of medications that lower blood sugar. Those medications may need to be lowered whether you have been diagnosed with type 1 or type 2 diabetes.
  • Make sure to also Monitor your blood pressure as there can be changes with lowering your blood pressure when following a Whole food plant-based eating plan.
  • And compare your cholesterol levels before following a whole food plant-based eating plan and during because you also may need to have your doctor Lower your cholesterol medications, if you are on any statins now.

I have more resources on plant based eating right here on my channel- Eat more plants for diabetes health video; How do I get adequate plant-based protein? Video and what about plant-based milks video. Until next time, Cheers to your health.

Stinkin’ Thinkin’ vs Awesome Thinking About Diabetes

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Self-talk can have a remarkable effect on how we deal with diabetes management. Frankly, we’re often too hard on ourselves which, consequently, increases stress making diabetes management even more challenging.

Here are some lessons from a talk Toby did with clinical psychologist and fellow person-with-diabetes Dr. Beverly Adler. See if any (or how many) of Dr. Adler’s “cognitive distortions apply to you. Spoiler alert, most of these apply to us all now and then.

What Are the Best Supplements for Diabetes?

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Americans spend billions of dollars on dietary supplements but the truth is that not only can we get most of what we need from food, but food sources are often more effective. Still, there are a few nutrients where supplementation may be useful of even necessary. See what Toby has to say.

Welcome back to DiabetesEveryDay. I’m registered dietitian nutritionist and certified diabetes care and education specialist, Toby Smithson.  If you haven’t already, make sure to subscribe to my channel and log onto my DiabetesEveryDay.com website to sign up for my newsletter.

I know this is always a hot topic. A topic that is on people’s mind….. should I or shouldn’t I take this or that vitamin supplement? I have a couple videos on some specific supplements that people with diabetes need to consider. In today’s video, I’m going to try to give a rundown of supplements in general of what you should look for and present the science- based findings of which supplements are appropriate for people with diabetes and the reason why.

To get started, I have three key points about supplements. 

Point number one. Food first. As a dietitian, I always recommend food first. If you have found that you are deficient in a certain vitamin or mineral the science still recommends to first look to the food sources to get the best absorption of the nutrient and remember these foods will also provide other important nutrients like possibly fiber or protective compounds called antioxidants which may not be provided in the supplement. Did you know that the fat- soluble vitamins (A, D, E and K) can’t be absorbed without the presence of fat like nuts, olive oil or avocado? This is a great example of why getting nutrition from food first can be beneficial beyond the supplement you may be taking.

Point number two: Be careful on the brand of the supplement you are purchasing. My go to brand is Nature Made. Their vitamins are made in the US and follow the FDA standards in a certified facility. And they have the USP label on their supplements. USP stands for United States Pharmacopeia verification. Nature Made products are also easily found at your local grocery stores or pharmacies.

And point three: Let your doctor know if you are taking any over the counter supplements and follow the dosage as recommended by your doctor. Supplements are not to be used in place of diabetes medications.

Now let’s talk about some of the supplements directly related to diabetes… There have been studies done looking at the prevention or treatment of type 2 diabetes using alpha lipoic acid, chromium, herbal supplements, magnesium, omega 3s, selenium, vitamins C and D.

The results of the studies have not shown an absolute benefit. For instance, studies have found that chromium might help with blood sugar management, and alpha-lipoic acid (which is also found in spinach, broccoli, and tomatoes) might be helpful for diabetic neuropathy (nerve problems).

But, for the majority of supplements, there isn’t enough positive outcome science -based evidence to make a recommendation to take this or that supplement.

Chromium is an essential trace mineral that can help our body use glucose efficiently. The research findings showed improvement for people with type 2 diabetes who had poor management of their blood sugar levels. As a safety note: these supplements can cause stomach bloating, kidney damage, muscular problems and even skin reactions, so you need to be cautious about long term use of a chromium supplement.

The next supplement on the list is herbals and unfortunately there is not reliable evidence that herbal supplements can manage diabetes or prevent complications. More solid science- based studies are needed.

Magnesium is another supplement. Make sure to check out my video on Magnesium. Just an added note here. Consuming large doses of this supplement can cause stomach cramping and diarrhea. Keep this in mind if you choose to take any supplement. Too much can backfire on your health.

You may be familiar from recommendations to take Omega 3s for heart health. There has been a review of the research and there is conflicting evidence showing some improvement in heart and diabetes health and then other research showing that omega 3s increased risk of diabetes. More research is needed.

The research on Selenium looked at prevention of diabetes and the review of 4 studies with more than 200,000 participants revealed that use of a selenium supplement did not reduce the likelihood of developing type 2 diabetes.

Vitamin C and D are also on the supplement list and there is a study that found vitamin c supplement helped blood sugar in people with type 2 diabetes. Vitamin D has been studied because it was found that people who have low levels of vitamin D are at increased risk for developing type 2 diabetes and low levels are on the theory list for development of type 1 diabetes. Vitamin D is important to be combined with calcium for bone health but the studies on diabetes prevention or management don’t show to be helpful.

And don’t forget to check out my video on vitamin B12. This is a nutrient of concern for people with diabetes taking metformin, older adults and those who follow a vegetarian eating plan.

Remember to look carefully at any potential side effects. Some supplements can affect our kidneys, and we don’t want to increase our risk for kidney disease. Consuming too much of a supplement can also cause stomach issues. And to repeat the most important points – get your nutrients from food first and talk to you doctor before adding any supplements to your daily routine. Simple lab tests can determine if you actually need supplementation. Until next time, cheers to your health.

What’s New in Diabetes Management?

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The Association of Diabetes Care and Education Specialists Annual Conference occurs every August. This conference offers diabetes educators the latest and greatest information about diabetes management. As a certified diabetes care and education specialist and a person who’s been managing my own diabetes for many decades, I sought out topics that would be really interesting to us as people living with diabetes. Here are my highlights from the conference:

The New Data: Time In Range

You’re probably familiar with the lab work called hemoglobin A1C (A1C for short). Your healthcare provider may order an A1C once, twice, or three times a year to evaluate your average blood sugars over the past two to three months. It’s been the gold standard for assessing diabetes management, but we’ve long been aware of some limitations. A1C represents a “weighted” average.

“Weighted” means that more recent blood glucose levels contribute more heavily to the A1C value than blood glucose levels last week or, especially, two or three months ago. “Average” could reflect many above-target readings and many below-target readings. For example, readings of 120 and 160 and readings of 50 and 230 both average 140. The American Diabetes Association’s recommended range for A1C is less than 7%, equivalent (more or less) to a 154 mg/dl average.

This year’s conference included a lot of focus on a newer way of seeing how your body is handling the management of your blood sugar. It’s called time in range (TIR). TIR captures the amount of time your blood sugar is in the range between 70 mg/dl and 180 mg/dl. Studies show that this is the ideal range to keep our blood sugar to achieve the best health outcomes. We want our blood sugar to be in that ideal range of 70–180 at least 70% of each day.

TIR information is more actionable than A1C readings. As I mentioned, A1C gives us an average, but TIR will tell us exactly the time of day or night that our blood sugar is above or below the ideal range. We can think of TIR as our GPS for diabetes management. The information helps us navigate the best routes. For instance, if we’re seeing that our blood sugar is dropping too low before lunch, we may want to look at our breakfast meal choices and add more protein and/or fiber to the meal to help keep our blood sugar steady until lunch, or we may need to discuss our medication regimen with our healthcare provider.

How do you find out what your TIR is? TIR is easiest to calculate if you wear a continuous glucose monitor (CGM) because a CGM captures an almost continuous stream of data. But you can also gather the BGM approximation of TIR, called Points in Range, by tracking your blood glucose readings at different times of the day for two weeks. And remember, your POGO Automatic® can help you get the data you need without the hassle of having to carry test strips and lancets, since they’re integrated into 10-test cartridges that you just pop into the monitor. It’s simple to use and it’s discreet, which makes it easy to check your blood sugar anywhere you choose. And your Patterns® app will help you get the data you need in one location. Note: The more readings you have, the more precise the TIR calculation will be —and the more precise your decisions will be, too.

Keep in mind that at least forty-two factors affect blood sugar readings. (It’s not just food, medication, and physical activity.) Knowing the time period when your blood sugar levels are going out of range helps us individualize your diabetes management and is super helpful when it comes to making changes in our diabetes management. I like to refer to this as making informed decisions.

Food Slant: Eating Plants

More and more studies are showing that plant-based eating offers improvements in diabetes management results. There is evidence that if you follow a low-fat vegan eating plan, you may be able to put prediabetes or type 2 diabetes into remission. The focus is on what you eat, not how much you eat.

For people with type 2 diabetes, cells (such as muscle cells) are really stubborn about responding to the natural output of insulin from the pancreas that’s intended to move excess glucose out of blood and into cells. This is often referred to as insulin resistance. Visually, you can think of insulin as the key that opens the lock to get glucose into the muscle—but with insulin resistance, the lock is blocked. Researchers have also found that people with type 2 diabetes have more fat droplets in their cells. Following a low-fat vegan plan will help reduce calories and unclog the cells that contain fat.

The whole-foods, plant-based eating plan is 100% plant based (no animal products) and low in fat and oils, and it uses lower-glycemic-index foods. No carb counting is required, nor is portion control as long as you’re choosing whole, plant-based foods. We suggest that you try this eating plan for three weeks to see how you feel and how your blood sugar levels respond.

If this sounds like too big of a change in your eating habits, start small by eating one meal a week that’s plant based and then gradually increase the number of plant-based meals you eat. As a guideline, choose a minimum of three servings a day from the four plant-based food groups: fruits, vegetables, grains, and beans/peas. Here are some tips on how to get started:

  • Add items to your grocery list from each of the four food groups in the whole-foods, plant-based eating plan (fruits, vegetables, grains, and beans/peas).
  • Fill up on fiber—make sure you’re choosing the high-fiber food choices within each of the food groups. Fiber helps us feel fuller and slows down the absorption of carbohydrate into our bloodstream, resulting in our blood sugar level rising more slowly.
  • Swap animal protein food choices with plant-based ones. For example, at breakfast, have oatmeal with raisins or blueberries and coffee with soy milk instead of bacon and eggs. For lunch, eat a bean burrito and steamed broccoli instead of a lunch meat sandwich. For dinner, try minestrone soup, whole wheat bread, and steamed vegetables in vegetable stock served over barley.

Diabetes Is Challenging

“Mindfulness is awareness that arises through paying attention on purpose, in the present moment, non-judgmentally, in the service of self-understanding and wisdom.” – Jon Kabat Zinn-

The many opportunities for people with diabetes to have a quick reaction to a situation like an above- or below-target blood sugar reading can increase our stress and anxiety. Blood sugar management can be very distracting and interfere with life. Honestly, there are times we may not trust our body or feel safe in our body with all the ups and downs of blood sugar readings. Living with diabetes can be scary. Diabetes is challenging. This is where mindfulness can be very helpful. It’s a skill that gets easier with practice. Start by acknowledging that diabetes is challenging, be accepting that you have diabetes, be present in the moment, and understand that you’ll be okay. Make sure you don’t have unrealistic expectations of yourself concerning your blood sugar readings. Know that you aren’t alone in this journey and that problem solving happens many times throughout the day and night when you’re managing diabetes.

The presenters at the conference offered great suggestions for dealing with diabetes challenges. When you’re feeling lifestyle restrictions or any impact from the restrictions diabetes presents, use the mindfulness practice of accepting the present moment as it is. If diabetes is giving you discomfort from finger sticks or putting an insulin pump on your body, practice mindfulness by observing experiences without judgment. And if you’re feeling that diabetes management is setting you up for impossible expectations, use mindfulness to let go of expectations.

Mindfulness and meditation come in many forms: breathwork, compassion/self-compassion, loving kindness, gratitude, and yoga. My take-home message is to try to include meditation work in your daily life to help you feel balanced, centered, and calm. Namaste

What Does High Blood Sugar Feel Like?

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Having higher than “normal” blood sugar levels literally defines diabetes. In practice that means that after eating foods containing carbohydrate blood sugar levels do not come back down as quickly as they should (or even at all). Over time, higher than normal blood glucose levels cause damage – to blood vessels to nerves – and that damage can build up to cause serious “complications” like heart attack, stroke, kidney failure, blindness, unresponsive infections and others. But, can we tell when our blood sugar levels are high by how we feel?

How does it feel when your blood sugar is high or I like to say “blood sugar is above target”. The medical terminology, by the way, is Hyperglycemia.

For some of you, it may feel like a “normal” feeling. This may be because your readings have been above target for a while, so it feels “normal”. Our bodies don’t always give us straight up signs that our blood sugar is above target and the only way to know for sure is to check.

The typical symptoms or feelings are:

  1. You feel very thirsty
  2. You need to go to the bathroom to urinate more than usual….that’s because your body can eliminate excess blood glucose this way, but it’s a slow process.
  3. Sometimes you may have a headache or feel lethargic or sleepy. It can go as far as having some altered mental status
  4. If your breath is smelling fruity, this can be a warning indicator that you are experiencing diabetes ketoacidosis. And with that you can experience nausea, vomiting, and abdominal pain. Being in a state of Diabetic ketoacidosis is dangerous. You can check your urine with keto sticks and call your doctor immediately. This is rarely an issue with type 2 diabetes although a similar dangerous condition can occur, especially if you’re ill already.

I can hear your next question…What can cause an above target reading? If you are taking insulin, you may have not taken enough insulin; if you have type 2 diabetes, your body’s insulin may not being as effective; if you ate more carbohydrate than you had planned or exercised less than you had planned- it’s all a matter of balance with eating and body movement; or you are experiencing stress-whether it’s stress from having a cold or illness or emotional stress. These all can be causes of an above target reading.

Bottom line is that if your blood sugar readings are above target, you won’t feel as well as you would if your readings are in target range.  Check out my other videos related to this topic- How to bring your blood sugar down fast; 3 foods that spike blood sugar; or everything you need to know about blood sugar a couple of videos.  Until next time, cheers to your health.