By SARA ARTHURS
Being diagnosed with diabetes can feel overwhelming, and may generate an “array of emotions” including depression and denial. Julie Russell has seen it. She wants to help people instead feel empowered to take control of their own health.
Russell, outpatient dietitian and certified diabetes educator at Blanchard Valley Health System, was one of the presenters at a recent OSU Extension “Dining With Diabetes” class held at Blanchard Valley Hospital. The session included speakers on nutrition, exercise, cooking and even a little gardening.
At the end, participants sampled a meal prepared by Peg Meents, OSU Extension Program Coordinator for Family and Consumer Sciences. It included cod coated in Parmesan cheese and Dijon mustard, green beans with toasted pecans and cranberries, breadsticks with Italian seasoning, a raspberry-filled cookie with Splenda as a sweetener and a white chocolate orange pudding.
Russell, in an interview with The Courier ahead of the class, said the point of any diabetes education is to help control blood sugars.
Uncontrolled diabetes can lead to complications which affect many parts of the body. The key message Russell emphasizes: “This is something you — the patient — can do. You can prevent these complications.” People may feel that lowering or stabilizing blood sugar is something “only the medicine can do” but that isn’t true, she said. What you eat and how active you are also makes a difference.
She said half the plate should include nonstarchy vegetables. The recommendation for carbs is 45 to 60 grams per meal for a woman, or 60 to 75 grams for a man.
Russell explained that with clean arteries, the blood flows more easily, and saturated fat and trans fat can cause plaque to form.
“We do need to have some fat in our diet,” Russell said, but she encouraged focusing on “good” fats rather than “bad” ones. Healthy fats include any kind of nuts as well as olive oil, canola oil or peanut oil. Fats to avoid include lard, bacon, butter and stick margarine — tub margarine is preferred, Russell said.
“Good fats” do not raise cholesterol, Russell said. But fat still has the same amount of calories. (Fat has 9 calories per gram, compared to 4 for carbohydrates and protein.) So if you are watching your weight, be careful about the portion size, she said.
The goal for sodium is to stay within 1,500 mg for the entire day, Russell said. One teaspoon of salt contains 2,300 mg of sodium.
Anything processed tends to be high in sodium, and fresh or frozen vegetables are better than canned for this reason, she said. A lot of products do have a low-sodium version, although you might have to hunt for it. Canned soups are high in sodium, so Russell recommends making your own.
Salt substitutes usually contain potassium, which could be dangerous depending on the medications a person is taking. So Russell recommended instead using something like pepper,
Mrs. Dash, garlic powder or onion powder. If you buy seasoning blends in the grocery store, be aware that they may contain hidden salt, so look at the ingredient list and check the labels. And remember, “It all starts with you,” Russell said. Russell said sometimes people assume they cannot eat carbs as it will raise their blood sugar. But avoiding them altogether is actually one of the worst things to do, as “We do need carbs for energy.”
The key is choosing healthier, “better carbs,” such as whole grains. Russell also recommended eating carbs in smaller amounts throughout the day, balanced with lean protein like chicken, fish, low-fat cheese, eggs or nuts.
At the class, exercise physiologist Bridget Hammer gave a presentation on exercise, focusing on strength training.
If you have diabetes, keep a source of quick-acting carbohydrates available, in case of sudden low blood sugar, she said. Stay hydrated, and practice good foot care including wearing proper shoes and socks so you do not get blisters. (Diabetes can lead to foot problems if cuts or sores become infected, potentially leading to amputations.) Hammer said people should check their blood sugar before and after exercise, especially if they are new to exercise, to see how it affects their body.
She encouraged people to exercise every day to keep blood sugar stable, but said to add to it gradually, perhaps 10 minutes at a time.
Dining With Diabetes has existed in Ohio for some time, but a national curriculum has recently been revised and these classes are being taught throughout the country.
Meents said every week, an entire meal is prepared and has 45 to 60 grams of carbohydrates total. It includes a plate that is half nonstarchy vegetables, one-quarter protein and one-quarter starch or bread.
One attendee, James Reichman, said he came to the class because his blood sugar has been “out of control.” He said the classes have been helpful, and “the cooks are good.”
Meents has heard from participants that the class shows them how to make changes and put them in action.
Understanding the science and the signs of diabetes
By SARA ARTHURS
Diabetes is an illness which affects the levels of blood sugar in the body, potentially causing serious complications.
Diabetes occurs when blood glucose, also called blood sugar, is too high, according to the National Institute of Diabetes and Digestive and Kidney Diseases website. Over time, having too much glucose in your blood can cause health problems such as heart disease, nerve damage, eye problems and kidney disease, the agency’s website states.
Blood glucose is the body’s main source of energy and comes from the food you eat, the website states. Your pancreas makes a hormone called insulin, which helps glucose from food get into your cells to be used for energy.
However, sometimes a person’s body does not make insulin, does not make enough, or doesn’t use it well, meaning glucose stays in the blood.
The agency reports that 29.1 million people in the United States, or 9.3 percent of the population, have diabetes. One in four people with diabetes don’t know they have the disease.
In Type 1 diabetes, previously called juvenile diabetes, the pancreas does not make insulin, or not enough, said Julie Russell, outpatient dietitian and certified diabetes educator at Blanchard Valley Health System.
People with Type 1 diabetes must take insulin every day. Russell said when the pancreas works properly, there is a drip of insulin throughout the day and night, then a surge released after a meal. So, diabetics often take shots of different types of insulin, one to keep a stable level and the other after a meal.
“What they’re trying to mimic is what the pancreas does,” she said.
Type 1 diabetes is often genetic, although some people with no family history do develop it, Russell said.
In type 2 diabetes, the body does not make or use insulin well. It’s more common, and occurs most often in middle-aged and older people, but can occur at any age.
Type 2 diabetes may start with prediabetes, in which blood glucose levels or A1C levels (which reflect average blood glucose levels) are higher than normal but not high enough for a diagnosis of diabetes, according to the NIDDK website. It affects an estimated 86 million Americans age 20 or older, according to the institute.
Insulin is in essence a key which “unlocks the cell” so that sugar can get in, Russell said. So if a person doesn’t have enough insulin, the sugar stays in the blood.
In prediabetes, the sugar does get into the cells, but it might take more and more insulin to get the job done. If the pancreas doesn’t keep up, and the sugar stays in the blood, it can lead to nerve, kidney and heart damage.
Sugar is “sticky,” so the sugar molecules can stick behind your eyes, or affect how your kidneys function, Russell said. She said someone who has diabetes is very much at increased risk of heart problems for the same reason.
Russell said it’s much more common than it used to be that people with insulin resistance are recognized while it is still prediabetes, before it has progressed to diabetes.
Here, too, there is a genetic component. But “lifestyle has a lot to do with it,” she said. People who are overweight are more likely to be insulin resistant, meaning the insulin does not get the sugar out of the blood into the cells efficiently.
She said it’s like a machine that must work harder to get the job done. If the insulin is getting the sugar into the cells, but if it requires double or triple the amount of insulin to get the job done, that’s insulin resistance or prediabetes, she said. The person’s body must work harder.
In the prediabetes range, a doctor can educate their patient and talk about changing diet and becoming more active, which can keep the insulin resistance from progressing into diabetes.
But Russell said there are a lot of people who have prediabetes and don’t even know they have it.
There aren’t any symptoms. She said those aware of a family history of diabetes may want to consider getting tested.
Once a person starts actually having symptoms of diabetes, sugar levels are pretty high.
Symptoms may include blurred vision and increased thirst or urination, but if sugars are that high it is likely already affecting the nerves and other parts of the body.
Russell said years ago, by the time someone was diagnosed with diabetes, they were often already at the point where there were major complications.
What’s likely to cause complications is if the sugars are running high, and are uncontrolled, for long periods of time. If this persists for months or years, it puts a person at high risk.
Russell said there simply isn’t much education about what diabetes actually is. She wants to help patients understand that “This is something that you have control of making better.”
She said it’s about “balance” and there are many pieces to the puzzle. Besides exercise, food and medication, blood sugar can be affected by other factors like stress or infection. And, she said, exercise lowers blood sugar. Insulin and exercise “work together,” so the exercise means less insulin is being used, Russell said.