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contents VOLUME-6 | ISSUE-1 | JAN-FEB 2016 related ailments 14 Diabetes affecting productivity A report on how diabetes is affecting the productive age group in India.
India’s first magazine about diabetes JAN-FEB 2016
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18 Cut the stroke risk Act before the situation turns worse.
22 Low sperm count concerns Understand the complications and the way to fight it.
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VOLUME-6 | ISSUE-1 | JAN-FEB 2016
58
78
well being
nutrition
29 Avoid mindless eating To lose weight, you need to get in tune with your eating behaviours.
30 Diabetes care in winters Winters are here after a long stint of hot days and rains. Enjoy them with our tips and best wishes.
32 Diabetic questions 19 most commonly asked questions to manage your diabetes.
58 Sesame seeds recipes Sesame seeds aid in reducing levels of blood pressure and plasma glucose in hypersensitive diabetics.
64 Wonder through science A 9 year old kid with type 1 diabetes no longer needs insulin shots. How? Paleolithic ketogenic diet did the trick for him.
fitness living 46 The mountain conquerer Maitry Pancholi, a 20 year old kid with T1D, is an inspiration for all.
50 Double check to be sure Testing your blood sugar both before and after a meal can help in better diabetes control.
54 Love thyself Quit all the self-criticism and become your own biggest supporter.
2 Diabetic Living
jan-feb 2016
66 Be a fitness jack We sat down a global fitness trainer to absorb how Metabolic Training is the real deal.
82
food 70 Winter salads Juicy citrus, bold greens, roasted vegetables, these dishes are colourful and easy.
73 Holiday recipes Make life easier this holiday season with our diabetes-friendly recipes.
78 Give the gift of cookies Show your friends and family you care about them—and their health—with yummy treats.
82 Cozy spiced desserts The warmth of spices like cinnamon, nutmeg, and ginger turns these diabetesfriendly sweets into a forkful of comfort.
INDIA
Don’t just survive winter, own it! Winter has arrived late this year and we have been seeing this trend over the last decade or so. Summers last longer and winters no longer give you the chills like they did a few years back. As children, during Dussehra, we used to wear sweaters to curb the cold, but now the New Year is here and we are still not shivering. Blame it on the rising temperature as a whole or the ozone layer depletion, but that’s the sad truth. Though the chill of yesteryears might be missing, with any dip in temperature, what rises are the chances of catching infections. And diabetics definitely need some special care when it comes to winters. From maintaining a healthy lifestyle to regular workouts, we are doing our bit to curb the menace with every issue. In this edition, we bring you story of Maitry, the mountain conquerer – a 20 year old girl with type 1 diabetes who represented India at the T1D Youth Challenge by scaling the White Mountains in Crete. She is a true inspiration for all. Hitting Them Hard focuses on the report by Metropolis Healthcare about how diabetes is affecting the productive age group of India. And the numbers are seriously horrifying. Winter and You gives you 10 tips to stay healthy, happy and in harmony with your loved ones. Diabetic care 101. Yes, with Top 19 Diabetic Questions we broke down the most commonly asked questions and the answers will help you successfully manage the epidemic. Sesame seed is your best friend. Yes really! Befriend Sesame talks about how the tiny seeds help in reducing blood pressure and glucose level in hypersensitive diabetes. Talking about food, in Science conquering metabolism, Paleolithic ketogenic diet worked wonders for a 9 year old kid who no longer needs insulin shots to control his glucose level. Next up, we sat down a global fitness trainer to understand how staying fit goes beyond pumping muscles. It all lies in metabolic training. Reebok’s global trainer, David Jack tells us how to become a fitness jack. With so many inspirational people around, there is all the more reason to stay fit and happy. Happy winters! Editorial team
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IT’S ALL GOOD INSIDE
Page 46 The mountain conquerer
Page 57 Quick guide to Iron supplement
Page 64 Science of metabolism
INDIA
Editorial advisory board The following health care professionals—all experts in diabetes management— review articles that appear in Diabetic Living ® magazine: Connie Crawley is a nutrition and health specialist for the University of Georgia Cooperative Extension Service in Athens, specialising in diabetes and weight loss. Connie is a member of the American Dietetic Association Diabetes Care and Education practice group.
Marion J. Franz has authored more than 200 publications on diabetes, nutrition, and exercise, including core-curriculum materials for diabetes educators. Marion is a member of the American Dietetic Association Diabetes Care and Education practice group.
Joanne Gallivan is executive director of the National Diabetes Education Program at the National Institutes of Health. Joanne is a member of the American Dietetic Association Diabetes Care and Education practice group.
Marty Irons practises at a community pharmacy and also served in industry and the military. Jeannette Jordan works for the Medical University of South Carolina in Charleston and consults with the Centers for Disease Control and Prevention.
Irene B. Lewis-McCormick is a fitness presenter and educator. Certified by the nation’s leading fitness organisations, she is a faculty member of the American Council on Exercise.
Chris Smith, The Diabetic Chef ® is the president of Health Range, Inc., and a professionally trained chef. He is a food consultant and cookbook author and conducts healthy-cooking classes.
Hope S. Warshaw is a writer specialising in diabetes care. She has authored several American Diabetes Association books. Hope is a member of the American Dietetic Association Diabetes Care and Education practice group.
Fred Williams practises endocrinology and specialises in diabetes. He is an active member of the American Association of Clinical Endocrinologists and serves on the board of directors.
John Zrebiec is director of Behavioural Health Services at the Joslin Diabetes Center in Boston and a lecturer in the department of psychiatry at Harvard Medical School.
4 Diabetic Living
jan-feb 2016
INDIA
Editorial advisory board, India The following health care professionals—all experts in diabetes management—review articles that appear in Diabetic Living® magazine’s India edition: Decorated with the Padma Shri and BC Roy award, Dr. Anoop Misra is Chairman, Fortis-CDOC Center of Excellence for Diabetes, Obesity, Metabolic Diseases, and Endocrinology, in New Delhi. He is also Chairman of the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and Director of the Diabetes and Metabolic Diseases, Diabetes Foundation of India. Dr. Misra has led several pioneering research studies on diabetes and published more than 300 research papers. Dr Ambrish Mithal MD, DM: (Padma Bhushan Awardee 2015) Member Governing Council, Indian Council of Medical Research (ICMR), Doctor of the year DMA 2005, cited in Limca Book of Records since 2005 - is presently the Chairman and Head of Endocrinology and Diabetes Division at Medanta, the Medicity where he has established one of India’s premier diabetes and endocrinology centres. Dr. V. Mohan is Chairman and Chief Diabetologist of Dr. Mohan’s Diabetes Specialities Centre and President & Director of Madras Diabetes Research Foundation, Chennai. He has published over 600 papers in prestigious peer reviewed journals and contributed over 100 chapters to text-books on diabetes. He has received the prestigious Dr. B.C. Roy National Award, and Fellowships from all the four Royal College of Physicians of London, Edinburgh, Glasgow and Ireland. Dr. Shashank R Joshi is a well-known endocrinologist in Mumbai. He is president of the All India Association of Advancement for Research in Obesity and vice president of the Association of Physicians of India. Padma Shri and BC Roy awardee Dr. KK Aggarwal is an eminent name in cardiology. President of the Heart Care Foundation of India and editor-in-chief of the Indian Journal of Clinical Practice, Dr. Aggarwal has a keen interest in mind-body healing. He is a regular columnist and expert for both print and television networks. Rekha Sharma is director of Clinical Nutrition and Dietetics at the Diabetes Foundation of India. This former chief dietician of the All India Institute of Medical Sciences in New Delhi has devoted several years of her life to the study of diabetes management. Madhuri Ruia is a nutritionist and fitness expert in Mumbai. A certified pilates expert from the Pilates Institute of UK, she runs Integym, a state-of-the-art centre that promises ‘intelligent fitness’ to its clients. Dr. DS Chadha is head of cardiology at the Command Hospital in Bengaluru. He has won dozens of awards, written several research papers in leading medical journals and chaired several national and international conferences on health issues. Working Committee Dr. Swati Bhardwaj is vice head at the Center for Nutrition and Metabolic Research and a nutritionist with the Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Shubhda Bhanot is a certified diabetes educator and a nutritionist with 14 years of experience in the field. A life time member of ADE (Association of Diabetes Educators), she is presently working as chief diabetes educator at Medanta, The Medicity, Gurgaon.
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Readers’ Write
New ray of hope
The article on Empagliflozin was very informative and helpful. Good to see some new and effective drugs entering the Indian market which are good for reducing cardiovascular diseases among patients. Obviously the ‘weight loss’ factor of this medicine is like the icing on cake! I hope it proves to be a positive step for my dad who is a diabetic patient for the last 18 years. Neeraj Sharma- Dehradun
Off to a healthy holiday I’ve been a type 2 diabetic patient for 9 years now. Being in the corporate world leaves no time for me to monitor my insulin level properly. For the New Year eve, my husband and I are planning to check out the Naturoville Vedic Retreat, Dehradun. The place and the diabetes management programme looks exciting to us. Yoga and Ayurveda are undoubtedly the safest and most helpful remedies. Let us experience the programme this month and we will write again sharing our progress. Thank you for introducing us to this place. Ishita Bhardwaj Kumar - Nashik
Delightful pizzas Thank you! Thank you! Thank you! For giving so many pizza recipes in your Nov-Dec issue. I made them. Tried them. It’s a big relief for me because my husband, who has diabetes, is a big fan of pizzas!!! Please give some yum pasta recipes too sometime. Tara Handa - Delhi
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Dr. Amit Bhargava Consultant, Institute of Endocrinology, Diabetes & Metabolism, Max Healthcare Inst. Ltd., New Delhi
QA +
Q1 I am not obese, but I do eat a lot of sweets and processed food. Does this mean I am vulnerable to diabetes (I am 44)? What is the best diet to prevent diabetes? Ans. Sweets, especially in the Indian context, and processed foods contain an unhealthy amount of carbohydrates, fats, salt and sugar. For example, two small gulab jamuns (depending on how they are made) can easily add around 400 calories to your diet. Asian ethnicity makes us more susceptible to developing diabetes. Therefore, we must maintain a healthy lifestyle to ensure that we do not gain weight and put ourselves at risk. The best approach is to see a nutritionist and follow a balanced diet that is tailored to you, your body and its needs.
Q2
Please talk about the role of exercise in controlling diabetes, including sugar and cholesterol levels. How much can exercise help? Ans. Aerobic exercise helps to decrease blood glucose levels, improve cholesterol, lower blood pressure and improve the body’s ability to use its own insulin. Asian guidelines recommend that we walk for 60 minutes a day. Incorporating light resistance or strength training is also very important in increasing insulin utilisation by the body. Aside from lowering the blood sugar, weight loss following exercise will lower bad cholesterol, raise good cholesterol and improve conditions like a fatty liver.
With a family history of diabetes you are at a higher risk of getting diabetes due to over sugar intake
Q + A
Q4 Please explain what statins are, how they work, and why they are so important.
Is someone considered to have diabetes forever, even if blood glucose is under control for a long time? Can the patient ever be considered to no longer have diabetes? Ans. This depends on what type of diabetes you have. For example, individuals with Type 1 diabetes mellitus need to be on lifelong insulin therapy as their body cannot produce its own insulin. If patients with Type 2 diabetes mellitus intervene with medication and lifestyle modification early enough in their disease process (i.e. before the pancreas completely burns out), they can decrease, and in some cases, even come off medications. Please consult a physician before altering any drug regimen.
Q5
I need to bring down my blood sugar level to normal and maintain it. What are the strict no-nos for me besides carbohydrates? Ans. In order to maintain good glycemic control, individuals should adhere to their medication regimen and check their blood sugars as directed. Cutting down carbohydrate intake does not mean no carbohydrates at all. Please work with a nutritionist to ensure that you follow a balanced diet that is tailored for your body. Avoid processed and fast foods, limit alcohol intake and stop smoking. Exercise and do not let yourself become a couch potato!
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Q3
Ans. Statins are cholesterol lowering drugs that work by inhibiting an enzyme called HMG-CoA reductase, in the liver. This slows down the body’s endogenous production of cholesterol and consequently, decreases one’s cholesterol level. These agents also aid the body in reabsorbing cholesterol that has accumulated in plaques in the arterial walls, thereby reducing the chance of developing a heart attack or a stroke. Whether someone needs to be on a statin depends on several factors such as existing cardiovascular disease, current lipid panel, presence of other co-morbidities like diabetes etc.
9
A S K
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E X P E R T
Q1
Dr N.K.Narayanan MRCP (Gen.Med,UK), SCE (Diab & Endo,UK), MRCP (Diab & Endo,UK), CCT - Diab & Endo,UK Consultant Diabetologist & Endocrinologist Apollo Hospitals, Chennai
QA +
tender years Our expert answers all queries that concern your little one’s wellbeing. 10 Diabetic Living
jan-feb 2016
What are the symptoms of type 1 diabetes that I should be careful about for my 12 year old?
Ans: Symptoms of type 1 diabetes include excessive thirst, frequent urination, bed wetting in children who did not have this problem before, increased appetite, unusual tiredness, unintentional weight loss, blurred vision and genital infections. The symptoms are often rapid in onset (within days to weeks) compared to type 2 diabetes. The onset of type 1 diabetes is often preceded by an acute illness.
Q2. Is there a possibility that one can outgrow type 1 diabetes? Ans: No, one cannot outgrow type 1 diabetes since it is a condition where there is complete absence of insulin in the body. Hence lifelong insulin administration is essential.
Q + A
Q3. Is it necessary to monitor the blood sugar level even if one feels fine? Ans: Yes, it is important to monitor the blood glucose levels periodically. With mild to moderate elevation in blood sugar levels, one may not always recognise the symptoms and elevated blood glucose levels can lead on to complications in the long run. Also blood glucose level beyond certain level (~ > 300) can lead on to an acute complication called diabetic ketoacidosis, a serious condition requiring hospital admission. Hence periodic monitoring is required and monitoring is especially important during illnesses (eg. infections).
Q5. What is hyperglycaemia? Ans: Hyperglycemia means elevated blood glucose levels above the normal limits. In general, a fasting glucose level less than 100 and post-meal glucose level less than 140 are considered normal.
Q4. Which insulin is best suited for a teenager for Type 1 diabetes? Ans: Two insulin regimes are common: (i) four injections per day regime. This gives flexibility to meal patterns and life style and gives better control of blood sugars (ii) twice daily mixed insulin, which is lesser injections per day but needs fixed timing of meal intake.
educate yourself and everyone around you about how to take care of diabetes and related complications
thrive
Combination Stem-cell transplant for T1D According to a new study presented at the World Diabetes Congress 2015, transplantation of cells from umbilical cords along with autologous bonemarrow stem cells may represent a new approach for treating patients with established type 1 diabetes. The study showed improvements in endogenous C-peptide, insulin levels, HbA1c, and fasting glucose. Xiumin Xu, director of China-USA Collaborative Human Cell Transplant Program at the Diabetes Research
12 Diabetic Living
jan-feb 2016
Institute at the University of Miami, Coral Gables, Florida, noted that therapeutic strategies for type 1 diabetes must address the autoreactive host immune system as well as pancreatic beta-cell repair and regeneration. The researchers used mesenchymal stromal cells extracted from umbilical cords. These cells are considered multipotent stem cells and can also be isolated from bone marrow, adipose tissue, and placenta, among other tissues, and have been shown to modulate immune responses and tissue repair. But previous works suggested that mesenchymal stromal cells alone might not be sufficient for the
type of tissue regeneration and repair needed. So the scientists used autologous bone-marrow mononuclear cells in addition. In 12 months, patients in the transplanted group showed decreased anxiety and depression symptoms and improved quality-of-life scores. Severe hypoglycaemic events were also recorded to be lower. It was a small study, but the fact that they were able to do this and show some benefit, particularly in those with type 1 diabetes for a little longer, was a step forward. More long-term and larger studies will be needed at this time in order to fully evaluate the intervention as to efficacy.
Diabetic foot, extended risks A team of researchers conducted a study with 99 diabetes patients with diabetic foot. They assessed the cognitive abilities of these patients through a series of tests conducted before and after the development of diabetic foot, and such abilities were compared with those of diabetes patients without diabetic foot. The cognitive abilities between the two groups were similar prior to developing diabetic foot, the researchers found. However, patients who developed foot complications showed reduced concentration, poorer memory, learning problems, slower cognitive and psycho-motor responses, reduced inhibition and decreased verbal fluency than those who did not develop diabetic foot. If not managed properly, diabetic foot, one of the severest complications of diabetes, may take a very complicated form. High blood sugar levels that occur with diabetes can cause nerve damage that results in loss of feeling in feet. This means that foot injuries such as cuts or blisters may go unnoticed. Such injuries can lead to ulcers and infections, and, in severe cases, amputation.
Energy drinks related to diabetes Early researches suggest that youngsters who consume a lot of caffeinated energy drinks can experience a spike in their blood insulin levels. This could make them more prone to a condition which increases their susceptibility to type 2 diabetes later in life. These drinks inhibit the body's ability to deal with a high load of sugar, which could lead to insulin resistance in which the body has to produce increasing amounts of insulin to clear blood sugar circulating in tissues. "Since caffeine persists in the system for 4 to 6 hours after consumption, continuous insulin resistance associated with regular caffeine-containing energy drink consumption in adolescents could contribute to increased metabolic risk in susceptible individuals later in life through persistent interference with their regular glucose metabolism," says Heidi Virtanen from the University of Calgary, who led the study.
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RELATED AILMENTS
14 Diabetic Living
jan-feb 2016
epidemic
HITTING THEM HARD
A report by Metropolis Healthcare on how diabetes is affecting the productive age group in India.
D
iabetes is fast gaining an epidemic status in India. According to an estimate drawn by the Indian Medical Council of Research in 2014, there are about 77.2 million people in India suffering from pre-diabetes and over 65.1 million diabetes patients. India is second only to China in the number of reported cases of diabetes. By 2030, India is estimated to become the diabetes capital of the world. Despite increasing awareness about diabetes and its life-altering complications, very few people undergo regular screening tests proactively to prevent the disease. The aetiology of diabetes in India is multifactorial and includes genetic factors coupled with environmental influences such as obesity associated with rising living standards, steady urban migration and lifestyle changes. An upsurge in the number of early-onset diabetes cases is also responsible for the development of various diabetic complications due to longer disease duration. Out of the 49,788 samples processed between the age group 20 to 80 yrs, over 10,228 samples were found to be positive for diabetes mellitus and over 10,928 samples were found to be in a prediabetic condition which constitutes a high risk group for developing diabetes. Out of the 49,788 samples, the following are the gender wise break-up: 20% of females were found to be pre-diabetic and 18% were found to be diabetic.
DiabeticLivingOnline.in
15
RESULTS
age group (yrs)
normal
20 to 30
pre-diabetes
diabetes
9214
30 to 40
977
333
7484
1816
10524
1379
10679
In an analysis of over 49,788 samples tested for Fasting Blood Glucose* at Metropolis Healthca re Ltd, a leading chain of multi-nationa l diagnostics, the following findings were discovered
40 to 50
5063
50 to 60
2473
2433
3388
9969
60 to 70
2588
2359
3046
9022
70 to 80
2088
2184
1124
6631
Total
986
28632
853
10928
2963
10228
49788
FIGURES
gender
In a percentage analysis of overall samples, we observed an increasing trend with progression in age.
age group (yrs)
% of prediabetic samples
total
normal
pre-di-
diabetes
abetes
total
% of pre-diabetic
grand
% of diabetic
Female
17070
5416
4724
Male
27210
11562
19.90
5512
17.36
5504
22578
24.41
24.38
% of diabetic samples
age group
(yrs)
female pre-diabetes diabetes
male pre-diabetes diabetes
20 to 30
9.28
30 to 40
3.16
17.01
20 to 30
665
12.91
182
30 to 40
312
820
24.41
503
40 to 50
996
1141
876
1052
1332
1381
40 to 50
24.81
151
50 to 60
28.69
60 to 70
33.76
31.49
50 to 60
1320
32.94
1520
60 to 70
1268
1526
28.79
1001
1065
70 to 80
1087
1119
20.54
469
402
Total
517
5416
451
4724
5512
5504
70 to 80 Total
16 Diabetic Living
33.28 21.95
jan-feb 2016
Over 25% of the samples in males were found to be pre-diabetic and another 25% were diabetic which brings us to a conclusion that 1 in 2 males are either pre-diabetic or are suffering from diabetes. An increasing trend is noticed both in males and females with a progression in age. It has been observed from the data analysis that males are at a marginally higher risk of diabetes. The level of morbidity and mortality due to diabetes and its potential complications are enormous, and pose significant healthcare burdens on both families and society. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country. Screening for diabetes should begin when you hit 30 to prevent the disease.
Reference Interval American Diabetes Association, 2015, recommends fasting plasma glucose levels below 100 mg/dl. A pre-diabetic (increased risk for diabetes) condition measures 100 – 125 mg/dl and values above >= 126 mg/dl are diagnostic of diabetes. It is absolutely necessary for people to do intensive lifestyle modifications, especially in the cities & develop healthy diet habits to prevent diabetes in the population. Regular walks & exercise for adults; physical activity/ outdoor activities for children should be a part of the lifestyle modifications. Regular health checks and regular blood glucose monitoring is absolutely necessary for glycemic control and prevention of complications of diabetes.
GLOSSARY Fasting Blood Glucose Fasting blood glucose is usually the preliminary test to check for prediabetes or diabetes. Fasting of 8-12 hours is required for blood glucose testing. Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Diabetes is a serious health condition and if left untreated may damage eyes, kidneys, nerves and blood vessels.
DiabeticLivingOnline.in
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RELATED AILMENTS
strokes
cut the
RISK OF STROKE Several things may medically lead to a dire condition called stroke. But if those variables are coupled with diabetes, the situation may turn worse. Act before it’s late. by
Dr. Satnam Singh Chhabra
S
uffering from diabetes or prediabetes can lead to serious health problems. By taking insulin and keeping our glucose levels low, we can cut that risk. However, clinically there are still multiple risks attached to diabetes such as heart disease and stroke. Diabetics need to control their blood sugar level and blood pressure to maintain a normal health condition. It has to be monitored regularly to be stable at a certain level as suggested by the diabetes expert. Besides, the patients need to continuously monitor their diet, keep themselves physically active, and take prescribed medicines only.
The Stroke Clinically defined, a stroke occurs when the blood supply to the brain comes to a sudden halt. A stroke usually results in speech or vision impairment, and in severe cases can
18 Diabetic Living
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result in paralysis of the body. Strokes are also caused by blood clots which form inside the body due to fatty acids. This can further narrow or block blood vessel in the brain or the neck. Diabetics are at an increased risk for strokes as blocking of blood vessels is a direct result of diabetes. A stroke, in turn, is also a result of a bleeding blood vessel in the brain. A break in the blood vessel may also occur as a result of high blood pressure, a condition called aneurysm. It has been noted by medical experts that diabetics are at double the risk of suffering a stroke, in both the cases. Among middle-aged persons with type-2 diabetes chances of a stroke are higher. Similarly, women after menopause have higher chances of suffering from a stroke. But, in case of diabetics, women are more exposed to the risk of stroke as diabetes reduces the protective effects of a female body in reproductive years. In case of
a diabetic woman, the menstruation cycle affects blood sugar levels. One week before and during menstruation may result in a fluctuation. Likewise, diabetes management can get very complex few years before a woman hits the stage of menopause. If a diabetic has one stroke, the person carries a greater risk of suffering from a second attack. Even the risk attached after suffering from a stroke is more and in certain cases even fatal. Blood glucose levels also lead to deposits of fatty materials on the inside of the blood vessels. This may further lead to a condition of blood clogging and hardening of blood vessels. Risk of suffering from a heart disease and stroke in diabetes may increase due to a family history of heart disease. If one or more members of your family has suffered a stroke at an early age (before 55 for men or 65 for women), you may be at an increased risk.
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REDUCE THE RISK
Diabetics can take a few measured steps which can reduce the risk of suffering a stroke.
1
2
4 6
Control extra weight. High abdominal fat leads to an increased production of bad cholesterol, which saturates the blood vessels. This blood gets deposited on the inside of the blood vessels; thus leading to an increased risk of forming blood clots in the body. On the other hand, HDL (good) cholesterol works to remove deposits from your blood vessels. So, maintaining good cholesterol is important to reduce your risk of a stroke.
Follow a heart-friendly diet at home. Some simple steps at home can help you achieve this goal. Make an attempt to control your bad cholesterol with a high intake of fibre-rich foods. There are many daily consumption food items which are a rich source of fibre. Oats, whole-grain breads, including your whole-grain flours and cereals, peas, fruits, and vegetables will increase your routine dose of fibre. Take small steps to gradually increase the amount of fibre in your digestive system.
Stay fit, healthy, and hearty. Exercise regularly to pump more blood. The ideal LDL level is less than 100 mg/dl.
Say no to saturated fats. They raise your cholesterol level. Saturated fats are most commonly found in meats, butter, fatty dairy products, food cooked in coconut or palm oil. Consult a dietician to monitor your daily intake of saturated fat. Also, don’t binge on fast food as they are high in saturated and trans-fats. Also, restrict your appetite of cookies, snack foods, fried foods, baked goods and popcorn, as they are a source of increasing cholesterol level in the body.
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3
5
7
Quit smoking. Smoking can prove hazardous for people with diabetes. It leads to further clogging of arteries by narrowing down the blood vessel. Consult a doctor to help you quit smoking if you are a chain smoker.
Drink responsibly. Limit the amount of alcoholone drink per day for women and two drinks a day for men. Continuously monitor your blood pressure, and take the doctor’s advice to keep it under control if it’s high.
Regularly consult your doctor. You need to stay in touch with your doctor regularly to monitor your diet and other lifestyle aspects too. Insulin and other diabetes medications and pre-medications for a diabetic and are important to control your blood sugar levels. However, the effectiveness of these medicines hugely depends on the timing and size of the dose. A regular medical checkup is recommended to avoid any abnormality. Also, other medicines you take to treat conditions other than diabetes may affect your blood sugar level.
High blood pressure as a result of hypertension disturbs the normal functioning of the heart. The heart must work faster to pump more blood required by the other organs. This condition can in turn lead to straining of the heart, cause damage to the blood vessels, and increase your risk of stroke.
Dealing with the problem Taking prompt treatment-within the first 3 hours after you experience the initial stroke symptoms is clinically essential. Doctors prescribe a clotbuster drug called tPA for ischemic stroke. This drug treatment helps in dissolving a clog in an artery. However, there is a serious limitation for people who have had a major surgery in the previous 2 weeks for this drug intake. There are more drugs under development and consideration to reverse the brain damage caused by a stroke- if taken immediately after the event. It is medically advised to keep your heart and blood vessels in a healthy condition, to cut the high risk for heart disease and stroke.
Risk of suffering from a heart disease and stroke in diabetes may increase due to a family history of heart disease. Taking preventive medicines on the advice of your doctors is also permissible. A daily low dose of aspirin has been advised by medical experts. Diabetics can benefit from low doses of aspirin (81 mg - 325 mg a day) to maintain a stable heart condition. However, take aspirin strictly on the recommendation of your doctor, as it is not safe for everyone. For Transient Ischemic Attacks (TIAs) or mini-strokes be sure to avail prompt treatment. This form of a stroke is a strong sign to prevent a major stroke later. Symptoms of a mini-stroke may be experiencing a sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. Early treatment can only
help avoid a future disaster. Diabetics may suffer from hypertension and any kind of stress or extra pressure may lead a drastic rise in the level of your blood sugar. It also becomes difficult to follow your diabetes management routine if you are suffering from stress or that extra pressure on your mind. Similarly, simple steps to monitor blood pressure at home keep it under check. Make sure to formulate certain lifestyle changes to avoid potential stroke risk and other health disorders as a result of suffering from high blood pressure. Dr Satnam Singh Chhabra Chairman, Nuero & Spine Surgery Sir Gangaram Hospital,New Delhi
DiabeticLivingOnline.in
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RELATED AILMENTS
sperm count
LO W
O
N
C E RN
22 Diabetic Living
jan-feb 2016
UNT
Dr Khsitiz Murdia
C
by
CO
Diabetes, besides other hazards, may cause a drastic fall in the sperm count of a fertile man. Understand the intricacies of the complication and the ways to fight it.
L
ifestyle-related issues are increasingly being accounted for rising infertility among the couples. As implied in a recent report by the International Institute of Population Sciences, infertility is high in the metro cities of India. Our country has 15-20 million reported cases – a large number considering that there are about 60-80 million couples suffering with infertility in the world.
Gender Dynamics However, as opposed to the conventional perception that infertility is a women’s problem (in our society, it is usually considered to be a social stigma as well); experts have noted that one-third of the cases involving infertility concern emerging problems with men. Men should be made more aware of this fact. The society needs to come to terms with the fact that even though a woman carries the baby in her womb for nine months, fathers have an equally pivotal role to play. In this scenario, experts are now further probing reproductivity issues such as sperm quality. Many factors, including lifestyle, stress, obesity and poor diet affect the quality of sperm production. Likewise, a nutritious diet can have a positive impact on the sperm quality. A healthy diet can boost the sperm production, in terms of both quality and count.
Diabetes and Reproductive Disorder One more lifestyle factor which affects men is diabetes. It is now categorised as a serious modern lifestyle condition. The number of diabetic patients is likely to reach 70 million by 2025 (as published by the International Diabetes Federation). Most of these
numbers are affecting the young adult population in India — an age bracket for reproduction. The rise in type 2 diabetes patients in India has led to an increase in obesity and an increased chance of suffering from heart disease. Proper diet, exercise and timely dosage of insulin, keep patients in check. Defective sperm DNA also occurs as a result of type 2 diabetes. According to few medical researchers, it has been concluded that diabetic men have fragmented sperm cells. Volume of semen is clearly affected with diabetes. Mitochondria, an organelle found in large numbers in most cells, in which the biochemical processes of respiration and energy production occur, was also found to be damaged (deletions of the DNA)
in diabetics. While the damage to the DNA in the sperm may adversely affect the male fertility and thus the reproductive health condition, what’s more worrisome is the fact that even the capacity of the female egg to conceive or carry this sperm is restricted. As a result, increased fragmentation of the sperm will result in a necessary condition of embryonic failure and pregnancy loss. Fragmented or broken DNA may also lead to higher incidences of miscarriage. An early onset of diabetes obviously increases the chances of risks and chronic complications related to the disease. Also alarming is the fact that as you grow older, the complications associated with diabetes become more
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severe. A National Urban Survey in 2000 highlighted that the prevalence of diabetes in urban India in adults was 12.1 per cent. However, research is still being conducted to evidently draw a conclusion on the extent of damage to the sperm DNA as a result of diabetes,
especially in comparison to damage caused by smoking or other lifestyle factors such as stress related disorders. While diabetes is clearly one of the serious concerns which affect the DNA of the sperm, the bottom line remains that the infertility in men is measured
by the sperm count, sperm quality, and the motility of the sperm. There can be other medical reasons too which stand strong for the cause including, ejaculation of semen, genital system cancer and, as a result, exposure to chemotherapy or radiation therapy.
FINDING A SOLUTION According to medical experts, there are recognised treatments for the problem: 1. Medical treatment (hormones, multivitamins and antioxidants) 2. Surgical treatment (varicocle litigation in properly selected cases) 3. IUI (intrauterine insemination) 4. IVF (in vitro fertilisation)/ICSI (intra cytoplasmic sperm injection of eggs) • Lifestyle Solutions However, there are clinical experts who still recommend certain basic lifestyle changes to make an impact before you consult a fertility specialist. Lifestyle changes such as eating healthy can have a considerable impact on your sperm quality. Of course, we don’t discount the age factor, which affects the person’s ability of sperm to move. But, still a lot can be done to achieve the required improvement in the overall quality of the sperm. a. It is strongly recommended to follow a diet which is a source of rich antioxidants. Antioxidants possess a high level of semen reactive oxygen which can play an important role in boosting the sperm quality. Sesame, tomatoes, oranges, green leafy vegetables are super food sources of antioxidant. b. Taking regular dose of multivitamins, minerals, and antioxidants also minimise the cell damage that reduces the risk of cancer. Zinc is clinically recommended for sperm health as it is a biologically important building block of the sperm cell. c. Consuming dark chocolate, a rich source of antioxidants and amino acid, has proven to double sperm and semen volume. On the flip side, high consumption can increase the risk of putting on weight – so just be cautions. d. One or two cloves of garlic a day can also spell magic as it contains allicin, which improves blood flow to the sexual organs and protects sperm from damage, and selenium – an antioxidant that improves sperm motility. e. Have sources of Vitamin A such as red peppers, spinach, apricots, sweet potatoes and carrots, as lack of this vitamin makes your sperm count low. f. Another crucial factor to consider is not to over-exercise as this may cause the temperature of the scrotum and testicles to rise which can affect the quality of the sperm. Some experts have also advised to avoid rigorous cycling, too much saunas, hot bathtubs and even Jacuzzis. g. Even exposure to natural heat environment has to be monitored as excessive heat affects your body temperature. h. Avoid smoking hazards as even passive smoking has the potential to create abnormalities in the sperm cell, while causing damage to the sperm cell i. Avoid certain medications like steroids. j. Even excessive consumption of alcohol is considered harmful, and should be avoided. Semen is considered to be optimally fertile when it contains more than 15 million sperms per mililitre. That count can get adversely affected because of the aforementioned points such as testicles getting too hot, or when you’re stressed out. Stress, in turn, can be a killer of sperms. Stress hormones have the potential to block Leydig cells, which are tasked with regulating testosterone production. If you are too stressed out, you experience the risk of sperm production coming to a halt altogether. By adopting a healthy lifestyle you can promote the cause of improved fertility, and thus have high chances of experiencing parenthood. If after one year of unprotected sex, your partner doesn’t get pregnant, then you should consider clinical counselling and expertise.
Dr Khsitiz Murdia, Fertility Expert, Indira IVF Clinic and Test Tube Baby Centre DiabeticLivingOnline.in
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RELATED AILMENTS
heart
HELP for your HEART
A cholesterol-lowering statin medication might protect you from having a heart attack or stroke, common companions to diabetes. by
Barbara Brody |
illustrations by
Michael Mullan
I
f you have diabetes, you likely take at least one prescription medication. The American Diabetes Association (ADA) 2015 Standards of Care suggests adding another to your arsenal—a pill to keep your LDL (bad) cholesterol in check. Your health care provider might recommend it even if your cholesterol levels are OK. Surprised? Many experts say this strategy makes perfect sense. Heart disease is the No. 1 cause of death worldwide, and if you have diabetes, you’re especially vulnerable. While having high LDL cholesterol absolutely raises your risk, it’s not the only risk factor to consider. A family history of cardiovascular problems, smoking, and being overweight are all risk factors. And so is having diabetes.
The guidelines Two out of three people with diabetes will die from heart disease or stroke. Because the risk is so great, the guidelines say people with diabetes (type 1 or 2) should take a statin—a prescription pill designed to protect your heart by lowering LDL cholesterol. The quick synopsis: Unless you’re younger than 40 and don’t have any heart disease risk factors besides having diabetes, the ADA says you should be taking a statin medication. “Statins are critically important for people with diabetes because their risk of heart disease is higher than that of people without diabetes, even when they have the same LDL
Even with no heart disease risk, people age 40 and above with diabetes should consider a statin. —American Diabetes Association 2015 Standards of Care
cholesterol levels,” says Robert Ratner, M.D., chief science and medical officer for the ADA. He says the evidence showing statins work is especially compelling for those in the 40–75 age bracket. Per the 2015 guidelines, all people living with diabetes in that key age group should be taking a statin. If you have heart disease risk factors in addition to diabetes (or if you already have heart disease), then the ADA says you belong on a high-intensity statin. This type, which includes atorvastatin (Lipitor) and rosuvastatin (Crestor), usually cuts LDL levels by more than 50 percent. Don’t have any additional risk factors? The ADA recommends a moderate-intensity statin, such as pravastatin (Pravachol) or simvastatin (Zocor), which reduces LDL by an average 30–50 percent. Lipitor and Crestor also can be prescribed at lower doses, reducing them to moderate-intensity. The data proving that statins are effective in people younger than 40 and older than 75 are less clear, Ratner says. “Those are the real big question marks right now,” he says. Still, the Standards of Care suggests that all people over 75 with
diabetes take either a moderateor high-intensity statin. It also says that those under age 40 should take a moderate- or high-intensity statin if they have risk factors in addition to having diabetes. (If you already have heart disease, you need a high-intensity statin.)
How diabetes hurts your heart It’s worth noting that other major medical organisations, such as the American Heart Association and the American College of Endocrinology (ACE), have slightly different stances regarding who needs a statin; talk with your health care provider. But these groups agree that people with diabetes have a much higher-than-average risk of developing diseases of the heart and blood vessels. People with type 2 diabetes often have high blood pressure, abnormal blood fats, insufficient insulin, and insulin resistance, a condition in which the body can’t use insulin effectively, says Yehuda Handlesman, M.D., a California-based endocrinologist and president of ACE. But people who have type 1 diabetes also are at risk; they have a higher risk when DiabeticLivingOnline.in
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compared with people without diabetes. Another issue: Just like the population at large, some people with type 1 diabetes may gain weight and develop some of the components of type 2 diabetes, Handlesman says. Statins work by decreasing the amount of LDL cholesterol that your body makes, says cardiologist Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York City. Of course, statins aren’t a magic bullet. “The foundation of heart disease prevention is diet and exercise,” Goldberg says. Making healthful lifestyle changes, such as eating nutritious foods and being physically active, can lower your cholesterol about 12–15 mg/dl, but that might not be enough to avoid medication. “But if you do those things, you may be able to take a lower dose of statin, which can cut down on side effects,” she says.
What about blood sugar? You might have heard that some research has recently shown that statins raise blood glucose. So why would health care providers recommend that someone with diabetes take one? First, it’s not so clear-cut. “Some studies show they raise blood sugar, and others don’t,” Goldberg says. Handlesman explains that when statins do cause glucose to increase, it’s not a major spike: “We know how to manage glucose, and the amount statins raise it is negligible,” he says. If you already have diabetes,
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Handlesman says he wouldn’t worry too much if your glucose goes up slightly once you start taking a statin. People who should be more cautious are those with prediabetes. Adding this medication could push their numbers up enough that they can be diagnosed with diabetes (type 2 is diagnosed, in part, when blood glucose is 126 mg/dl or higher). But opting for a statin could still be a good decision. As with most things, it’s all about weighing the risks and rewards. And when it comes to helping people at risk of heart disease, Goldberg, Ratner, and Handlesman agree that the benefits of taking a statin often outweigh the risk of slightly higher blood sugar.
SIDE EFFECTS: WHAT TO DO Statins generally are well-tolerated, but they can have side effects— and raising blood glucose is just one of them. The most common complaints are muscle pain and weakness, though some people also report mild memory problems. If you think you’re experiencing side effects, tell your provider, who may recommend one or more of the following steps: • Make a switch. There are eight statins approved for use in the U.S., and some people have issues with one but not others. It may take some trial and error to figure out what works best for you. • Tweak your dose. Lowering it a little could make a big difference, says cardiologist Nieca Goldberg. • Skip a day. Endocrinologist Yehuda Handlesman notes that some people experience fewer side effects by using a statin every other day instead of daily. Be sure to talk with your health care provider before skipping a day. • Take it at bedtime. You might have less muscle pain if you take your medication at night instead of in the morning, says Robert Ratner, M.D., of the American Diabetes Association. • Try coenzyme Q-10 (CoQ10). Many people with diabetes have low levels of this antioxidant, and raising your levels with a supplement may help lessen the side effects, Handlesman says. • Consider an alternative. Statins are generally believed to be the most effective drug for targeting LDL cholesterol, but if you’re really having trouble with them, your health care provider could prescribe a different type of cholesterol-lowering drug, such as Welchol or Zetia.
WELL BEING
snacking
avoid
MINDLESS
EATING
To lose weight, you need to get in tune with your eating behaviours. These three strategies will help bring them into focus.
1 2
Write down what you eat for three days
THE FIRST STEP IN PREVENTING MINDLESS EATING IS TO PUT REAL EFFORT INTO BECOMING AWARE OF HOW YOU EAT.
Study your eating environment SURROUNDINGS MAKE A DIFFERENCE! MANY OF US EAT IN STRESSFUL OR DISTRACTING AREAS, SUCH AS A WORK CUBICLE OR IN THE CAR WHILE DRIVING.
LM SPOT TIP: FIND A CA meals t to eat your Make an effor laxing place, such re a in your and snacks h or outside on as a park benc turn off the TV while e, m patio. At ho e simple changes can you eat. Thes nce in how satisfied make a differe you are finished. you are once
WN TIP: JOT IT DO e ifically for th ec sp ok Use a notebo rding every bite and co purpose of re drink for three days. d sip of food an rtion sizes, location po Include time, k, reason for eating ac of meal or sn ?), and who was with ss (Hunger? Stre r patterns and make you. Look fo you see bad habits. re changes whe
3
Monitor boredom
DISTINGUISHING TRUE HUNGER FROM “HEAD HUNGER” CAN BE A CHALLENGE, ESPECIALLY WHEN YOU HAVE TOO MUCH FREE TIME.
W HOBBY TIP: FIND A NE s ill that engage ning a new sk Consider lear ity and distracts you from your creativ g, gardening, t food. Knittin le thinking abou putting together a puzz r” or tte scrapbooking ish food and eating “cha of gu can help extin get in touch with feelings . and help you versus perceived hunger actual hunger
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WELL BEING
winter care
& YOU
Winters are here after a long stint of hot days and rains. Enjoy them with our tips and best wishes. by
Diabetics need to take special precautions in the winter season because this is the season that has the highest A1C level of the year. Stress, lack of physical activity and increased metabolism lead to higher level of glucose hence one must take certain precautions to stay healthy and safe during the winter season.
30 Diabetic Living
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Dr. Anil Chaturvedi
1
Dodge Cold and Flu
4
Exercise
7
Proper Hydration
Consume foods and supplements that help boost your immunity and make sure that you get plenty of rest. Wash your hands more often. Get the flu vaccine to stay safe.
Days are short and nights are long, making it difficult to go for a morning walk. We recommend 150 min of exercise each week, which is about half an hour of physical activity daily, five days a week. It is alright to split the activity into three 10-minute bouts of exercise.
Notwithstanding the temperature during your exercise sessions, you still lose moisture through sweating, which needs to be replenished by drinking water. Due to increased metabolism, the body needs proper hydration. It is advisable to take 8 glasses of lukewarm water every day.
2
Stay Warm
3
Eat Well
5
Cover Your Mouth
6
Healthy Heart
8
Skin Care
9
Stay Indoors
Wear warm clothes in layers, instead of a single heavy piece. It’s also very important to keep your feet warm and protected. Devices such as glucometers and insulin pens may not work properly when the temperature drops too low. Prevent this by keeping devices close to your body so that it stays warm.
Regularly huffing icy air can injure your lungs. Protect your lungs from cold, dry air by wrapping a scarf over your mouth to keep the air you breathe moist. Air can also narrow the airway, making it harder to breathe at maximum capacity and putting people with asthma at risk for attacks. During winters the skin becomes dry. Dehydrated skin tears more easily, leaving its surface open to bacteria and infections. Therefore, it is important to apply moisturising cream on the skin twice a day.
10
A healthy diet is important for diabetics. Eat more of grains, fruits and vegetables that are in season. Diabetics must take 5 servings of fresh vegetables and fruits per day. Alcohol should be taken in moderation. And if you take insulin, it’s best to have your alcoholic drinks with food and not without it.
Heart attacks are most frequent in winter becuase the heart has to work harder to pump blood due to an increased heart rate resulting from exercising in the cold. People with diabetes, heart disease and blood pressure must take extra precautions during this season.
It is better to engage oneself in indoor activities. Some of the most effective exercises, like pushups and crunches may easily be carried out inside closed doors. Turn your home into a gym. Invest in workouts DVD’s and use dumbbells, resistance bands, exercise balls or even household items such as soup cans and jugs of water to lift and move.
Winter Blues
The weather in winters can affect your moods and emotions like no other. If you’re having trouble with depression, seek help from someone such as a family member, close friend or your health care provider. Getting exercise, eating healthy and doing things with others can help your spirits up. Check your blood sugar regularly as mood swings and depression can adversely affect blood sugar.
Diabetics need to take the above precautions to stay healthy, happy and in harmony with their loved ones.
Dr. Anil Chaturvedi Senior consultant – Life Style Diseases & Preventive Health PSRI Hospital, New Delhi DiabeticLivingOnline.in
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WELL BEING
TOP
most asked
DIABETES QUESTIONS Whether you want to know the recommended blood sugar numbers or need advice on how to stay motivated, our experts have taken on the 19 most commonly asked diabetes questions so you have the answers you need to successfully manage your diabetes. by
32 Diabetic Living
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Hope Warshaw
design
Prakash Shetty
1
What should my blood sugar be when I wake up (fasting) and before meals? What about after? For most people with diabetes, the American Diabetes Association recommends a fasting or before-meals blood glucose (or blood sugar) goal of 70–130 mg/ dl. One to two hours after eating, a postprandial blood sugar reading at or under 180 mg/dl is recommended.
2 Does a diagnosis of type 2 diabetes mean I will have to go on insulin? No. People with type 2 diabetes may or may not ever need to take insulin injections, depending on several factors, including the timing of diagnosis. Research indicates that if type 2 diabetes is treated early and blood sugar is controlled initially and over the years, the pancreas is more likely to produce enough insulin longer. But a person who lives with type 2 upward of 15 years is unlikely to continue to make sufficient insulin and will need to take it via syringe, pen, or pump.
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3
I was recently diagnosed with type 2 diabetes. Do I need to see an endocrinologist? “While diabetes is an endocrine disease and falls under the specialty of an endocrinologist, there are only 3,000 of us in the U.S. who treat diabetes,” says Nicholas Argento, M.D., an endocrinologist with Maryland Endocrine near Baltimore who has type 1 diabetes. Do the math: 25 million people have diabetes; there are not nearly enough endocrinologists. “Most people with type 2 diabetes, especially in the early years, can partner with a primary care provider who takes an active interest in their diabetes,” Argento says. Make sure your doctor keeps up-to-date and provides you with care in sync with current guidelines. Be active in your care and ask questions.
4
5 Can I get rid of type 2 diabetes if I stop eating carbs and/or lose a lot of weight? No, but you can control it. If you have pre-diabetes or were just diagnosed with type 2, losing a lot of weight can put the condition into remission. Weight regain, aging, and the natural progression of type 2 diabetes can bring it back. “Not eating carbohydrate or severely restricting it is nearly impossible for any length of time. It’s also not healthy, because you won’t get essential nutrients,” says JoJo Dantone, RD, CDE, a diabetes program coordinator in New Orleans.
Why is it OK to eat fruit when it’s full of carbohydrate? Are some fruits better to eat than others? The calories in all fruits (fresh, frozen, dried, and canned without added sugar) are mainly carbohydrate with a bit of protein. People with diabetes need to eat a certain amount of carbs every day for energy and essential nutrients. Healthy sources of carbs include fruits, as well as vegetables, whole grains, legumes (beans), and low-fat dairy foods.
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6
Will insulin make me gain weight? The reason we need insulin— as a hormone made in our bodies or as a medication—is to push glucose into cells for energy. Insulin’s job is to process calories. For this reason, it can—but doesn’t have to— cause weight gain. To prevent weight gain: practice portion control. Burn extra calories with exercise. If your blood sugar has been high for a while prior to starting insulin, you’ve likely been excreting calories in your urine instead of fuelling your body. This won’t happen once your blood sugar is under control. If you experience hypoglycaemia (low blood sugar), treat it with just 15 grams of carbs.
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7
Why is weight loss so important? What’s the best way for a person with type 2 to lose weight? Weight loss is vital, particularly just after a diagnosis of type 2 or prediabetes. Weight loss increases insulin sensitivity, allowing cells to more effectively use the insulin the body continues to make. Losing just 5-10kg can accomplish a boatload of benefits. Among them are improved blood sugar, blood pressure, and cholesterol levels and possibly taking fewer medications or lower doses. To lose weight slowly and steadily, change your lifestyle. The kilos you keep off over time are the most important to living a long life.
My husband has type 2 diabetes and is a truck driver. What foods can he take on the road? “Preplanning and having healthy snacks at the ready are keys to helping you eat healthy on the road,” says Lisa Brown, RD, CDE, of BrownFox Solutions in Minneapolis and chair of the Academy of Nutrition and Dietetics Diabetes Care and Education practice group. Brown suggests fresh fruit, small containers or cans of fruit (no syrup), fat-free yogurt, part-skim cheese (sticks, slices, and cubes), sugar-free pudding cups, nuts (any type), whole wheat crackers or pretzels, peanut butter, baby carrots, and 100-calorie snack packs (buy them or create your own). Also, drink plenty of water and no-calorie drinks.
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Why do my legs hurt when I start walking and stop hurting when I sit down? You have signs of peripheral arterial disease, or PAD. “It develops when too much plaque in your arteries limits blood flow to the legs. The pain may occur while you walk because muscles need increased blood flow. The pain may stop when you sit because your muscles then require less blood flow,” says Marjorie Cypress, Ph.D., CNP, CDE, a nurse practitioner in Albuquerque and president of Health Care and Education for the American Diabetes Association. PAD increases the risk of heart attacks, strokes, and foot ulcers. Cypress suggests lowering your risks for PAD with the same advice you follow to stay healthy with diabetes.
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How can I learn to accept my diabetes? Accepting that you have diabetes is largely an act of cognition—a realignment of what you view as real and vital to your existence and how it can impact your life. Diabetes becomes an integral part of a person’s life. “While we all wish it would simply go away, this isn’t possible—yet,” says David Marrero, Ph.D., who has diabetes and is the director of the Diabetes Translational Research Center at the Indiana University School of Medicine. Marrero’s advice: Accept that diabetes will, for the rest of your life, be there. And it’s a very treatable disease, which places few restrictions on you if you follow treatment recommendations.
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11
Can I drink alcohol? Yes, adults with diabetes can drink alcohol and should follow the same guidelines as the general public—an average of up to one drink per day for women and up to two drinks per day for men, with no more than three or four drinks in any single day for women and men, respectively. “Research shows moderate alcohol consumption has minimal short – or long – term effects on glucose levels in people with type 1 or 2 diabetes,” says Marion Franz, RD, CDE, owner of Nutrition Concepts by Franz in Minneapolis. Although alcoholic drinks are made from grains or fruits (starches or sugars) through the processes of fermentation and distillation, alcohol cannot be changed into glucose, she says. Also, alcohol is the only nutrient that doesn’t require insulin to be broken down for energy; carbohydrate, protein and fat do. However, drinking more than three drinks per day over time has been shown to make glucose control a challenge. For people who take insulin or another blood glucose-lowering medication that can cause hypoglycaemia, eat some food when drinking alcohol. A cautionary note to people with type 1 diabetes: Significant alcohol intake can cause hypoglycaemia a number of hours later, so regularly check blood sugar levels when you drink.
12
Can your menstrual cycle and/or going through menopause affect glucose levels?
Yes and yes! It’s common for women to have hormone fluctuations the week before their period, and those can affect glucose control. After ovulating, estrogen and progesterone rise. “Estrogen can make women more sensitive to insulin and cause hypoglycaemia. Progesterone can do the converse,” says Natalie Strand, M.D., of the University of Southern California. Strand was the first person with diabetes to win The Amazing Race TV show. Glucose levels often return to their usual patterns after the first few days of the menstrual cycle. “Check your glucose levels and analyse your monthly fluctuations to know your patterns,” she says. Then devise a management plan for these days. Menopause also can affect blood sugar. “During perimenopause, estrogen and progesterone can fluctuate and lead to glucose swings,” Strand says. An early sign of perimenopause for women who take insulin is hypoglycaemia due to dropping progesterone.
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13
What are the best foods to eat before and after exercising? Foods that contain carbohydrate are quick and easy to digest for energy. “Eat foods like bread, crackers, pretzels, dry cereal, 100 percent fruit juice, or sports drink with calories,” says Gary Scheiner, CDE, an exercise physiologist and owner of Integrated Diabetes Services near Philadelphia. But if weight loss is a goal and you aren’t at risk of hypoglycaemia, just drink water—ditto for after exercise. Unless your workout was particularly exhausting or lasted several hours, you don’t need food. People who take insulin and are physically active should consult their health care provider about how to adjust insulin dosages.
14
Why can’t my wife and I use the same lancet if we clean it?
“The CDC strongly recommends that blood-testing devices, including lancets, should never be used by more than one person to prevent any chance of infection,” says Connie Crawley, RD, nutrition and health specialist at the University of Georgia Extension Service in Athens. “And alcohol may not sufficiently disinfect a lancet.”
15 Can I get rid of diabetes? Will it ever go away? Once you are diagnosed with type 1 or type 2 diabetes, you have it for the rest of your life. To stay healthy, keep your blood sugar, blood pressure, and cholesterol under control. To do so, eat healthy, be physically active, and take your prescribed medications. Also get the tests and checks you need to detect complications early and treat them aggressively.
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16
How often should I replace my glucose meter?
The only reason to replace your meter is if you determine it is not working correctly with its strips. To check, use the control solution that comes with your meter. “It’s an essential monitoring supply that many people don’t know about or use,” says Janine Freeman, RDN, CDE, a member of the American Association of Diabetes Educators Board of Directors. To use control solution, put a drop (similar to the amount of blood you need) on a strip and do a test. Your vial of strips gives you a glucose range in which the result should fall. If it’s in the range, your meter and strips are working correctly. If not, contact the manufacturer, which will offer advice and possibly a free replacement meter. “Use a control solution each time you open a new box of strips or any time you suspect your meter or strips aren’t working together,” says Freeman, who also suggests cleaning and disinfecting your meter at least once a week, when blood is on the meter, and before allowing anyone else to use it. Consider upgrading your meter ever five or so years because there is so much innovation, Freeman says.
17
Should I always carry glucose tablets? Your risk for hypoglycaemia depends on the category of blood glucose-lowering medication(s) you take, not your type of diabetes. Some medications can cause hypoglycaemia, including insulin; those in the sulfonylurea category, such as glyburide (Diabeta, Glynase, Micronase), glipizide (Glucotrol), and glimepiride (Amaryl); and those in the glinide category, such as repaglinide (Prandin) and nateglinide (Starlix). If you take one of these medications, always carry treatment. Most of the commonly used blood glucose-lowering medications for type 2 diabetes don’t cause hypoglycaemia.
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Is it true that complications of diabetes can be delayed and even prevented? Yes! Research shows that the earlier your diabetes is diagnosed and the sooner you start to aggressively get your blood sugar, blood pressure, and cholesterol into target ranges, the healthier you can be over the years. To stay healthy and detect any complications early, make sure your health care provider orders all the tests and checks you need. Let your provider know if you have any signs or symptoms of a potential problem. Today, diabetes complications don’t need to happen.
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Will I need to be on insulin the rest of my life? Why can’t I take pills instead?
If you have type 2 diabetes and were put on insulin, it’s likely you need it to bring your blood sugar down farther than pills could. In this case, you’ll likely need to take insulin injections the rest of your life. If, however, you started taking insulin when you had an infection, needed surgery, or were hospitalised for a medical reason, your need for insulin may be temporary. These situations raise stress, and stress can raise blood sugar levels. When the stress abates, you may be able to taper or stop taking insulin and get back to your previous medication regimen. “The big ‘if’ is whether your pancreas still makes enough insulin to get your glucose down,” says Dan Kent, Pharm.D., CDE, a specialty clinical pharmacist with Group Health in Seattle and member of the American Association of Diabetes Educators Board of Directors. “The glucose-lowering medications, other than insulin, available today (mainly pills and a few injectables) use various routes to lower glucose levels. They don’t lower glucose as much as insulin, in part because with insulin you can keep increasing the dose as needed,” Kent says.
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WELL BEING
check
IT’S THE HOLIDAYS This time of year is full of family gatherings, sweet festivities, and longtime traditions—plus the crazy chaos of preparing for it all. Maybe you’re also missing lost loved ones or making peace between siblings—the stuff of life that goes hand in hand with the holidays. So how do you manage the highs and lows of the season and your glucose levels? In this magazine, we write a lot about taking control—of your diabetes, of your fitness, of your food choices and habits. You can’t control everything, of course. But you can pay attention to yourself and your body, limiting situations that make you feel helpless or unhealthy. We’ve found a few ideas to keep in mind this season. For keeping stress under wraps (which will help you control your blood sugar), keeping weight gain in check (even with all the holiday parties), and working ahead so the big gathering isn’t also a big ball of anxiety. Start by slowing down for a minute. Take a deep breath, pull up a chair, relax, and read on. by Lauren Grant photos by Jason
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| additional reporting by Bailey McGrath Donnelly | food styling by Dianna Nolin
Long-term stress levels increase blood glucose levels—so taming the seasonal stress monster is essential for managing diabetes. Some tips to help: • Play It Steady. “Do your best to stick with your exercise, medication, and food schedule,” says Susan Weiner, RDN, CDE, coauthor of Diabetes: 365 Tips for Living Well (Demos Health, 2015). “For most people, this is a wonderful time of year. But the holidays can mean additional pressure when you have diabetes.” Whatever you do to relax and decompress, keep it up. • Designate Elves. “Don’t overload yourself with work—delegate tasks and chores,” says Eliot LeBow, CLSW, CDE, who specializes in diabetes-focused psychotherapy and has type 1 diabetes. You don’t have to—and you shouldn’t—do everything yourself, Weiner says. “If you need help in the kitchen, recruit one of your guests, friends, or a family member to join you. Ask someone to set the table and another to clean up.” Consider hosting a potluck instead of cooking an entire meal alone. • Go Solo. If you can afford it, consider staying at a hotel while visiting family if you think you’ll need a break. Though family members might try to persuade you to stay with them, ask yourself if this is in their best interest or yours. “Sleeping in a nice hotel bed can be nicer than a
pullout couch in the middle of a living room,” LeBow says. • Treat Yourself. “Don’t forget to treat yourself gently,” LeBow says. Play music or book a massage. Get enough sleep each night—it wards off irritability and mood swings. If it helps, grab your journal and Diabetes e ducator Elio take note of the highs and lows, as t LeBow warns holid ay revelers well as what you’re thankful for. of the “Hot Zone ”–a family • Keep the Peace. Meditation and gathering, company p a arty, or any breath work may relax you. Try event that involves fo o d closing your eyes and counting and drink. “Devise a p 100 breaths or just sit quietly and lan for you r situation,” LeBow says repeat a mantra that calms you. . Maybe yo eat what o u thers are e Guided meditation apps such as ating, but in small quan tities, Mayb Headspace, Breathe2Relax, and e you grab healthy sn a ack prior to The Mindfulness App (on iPhone or stay satisfie through ho d rs d’oeuvre Android) also do the trick. hour—thin low-fat yo k gurt or che If there’s a family squabble, ese, half a whole gra in remember: Most people don’t granola bar , or a handful of nuts. deliberately try to upset others. If The social pressure to the relatives are good listeners, tell eat at parties can be huge. “I them you’re upset with an “I feel t’s natural to want to fit in and h ____ when you ____” statement. ave a piece of Au nt Ethel’s p In the end, you may have to limit ecan pie like eve ryone else contact with some individuals. ,” LeBow says. “We ar e all human Cultivating relationships that are . We all make mista ke s and strug positive is mutually rewarding. gle with managing diabetes.” “It’s always your choice to let If things do n’t go acco someone upset you or to let it rding to your Ho t Zone plan go,” LeBow says. , don’t feel guilty; just take ac • Exercise. Exercise reduces tion to correct. If you ate a p stress and helps to control iece of cake unexp ectedly, fo glucose levels, Weiner says, r example, increase yo u r insulin to so keep moving this season. cover the excess car bohydrate Try home exercise videos or o r ad just carbohydra te intake at walking. Or start a holiday a later meal. Then give yours tradition that gets everyone elf a pat on the bac k for manag moving. “Suggest a game of ing an unexpecte d situation touch football or sign up for . “Regardless of what typ a turkey trot on New Year’s e of diabetes yo u have, tom morning,” Weiner says. orrow you can start ag ain. So get At minimum, stretch often. back on th wagon and e d o your best It helps keep you mindful of , because you can’t c hange the your body and your feelings. past, but yo can work to u ward a bett er future,” LeBow says .
AVOID THE HOT ZONE
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Try these tips to avoid the postseason diet frenzy: • Keep Track. Susan Weiner suggests tracking food with a logbook or smartphone app and sticking to your blood glucose monitoring and diabetes care regimen no matter how stressful the holidays get. To keep carbs and calories in check, she says, beware the BLTs— bites, licks, and tastes of all those sweet treats out there. “If you have diabetes, that’s going to affect your blood glucose level and therefore how you’re feeling.” • Practice Moderation. Allow yourself one treat a day during the holidays, but count it toward your daily calories and carbohydrates. You may have to adjust your
remaining caloric intake or exercise routine to burn it off. Plate size can help you check portions. “When you use small plates or small bowls, you’re just setting up your environment to be more mindful about amounts,” says Elaine Magee, M.P.H., RD, author of Tell Me What to Eat If I Have Diabetes (New Page Books, 2014). We recommend a 9-inch plate. The sheer abundance of food at parties can make it easy for carb consuming to get out of control. Don’t finish food you don’t like and eat slowly. “There’s a temptation to pop a whole appetiser in your mouth because that’s how they’re constructed,” Magee says. “Take a few bites to extend the enjoyment.”
Alcohol may seem like a stress reliever, but it can pack a lot of calories and lower blood glucose levels, Weiner says. Pace yourself with a glass of water or sparkling water between alcoholic drinks. • Manage Food Police. Harassed by others who want to monitor your food choices? Weiner recommends: “Thank you for your concern. I have it under control.” Dealing with food pushers? Weiner suggests: “I appreciate it, but I can’t have that right now.” Or ask for a to-go box. If you’re the host, challenge yourself to make the healthy snack options more appealing than the junk food. If you’re a guest, bring a healthy option to share.
ing ith a visit Y B R ee chat w A ff o E c d e W x S eaceful walk or a rela rdens Test Kitchen: S TO R E V A S e m E TIM repping means more tirs frfoomr athpe Better Homes and Ga pie, and tart doughs ahedadit.of ®
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TWEAKING TRADITIONS It’s not fair to have to give up your holiday favorites. Our resident chef in the Better Homes and Gardens® Test Kitchen, Carla Christian, shares her favourite healthy updates for treasured family traditions. Replace sour cream dip served with potato chips with Greek
yogurt dip and cut veggies.
Replace mashed potatoes with mashed
cauliflower.
Replace canned cranberry sauce with
fresh cranberries minced with chopped oranges. Zesty and super fresh!
Replace eggnog with a glass of
warm apple cider.
Replace marshmallowtopped sweet potato casserole with cooked and
mashed butternut squash served with orange slices.
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LIVING
inspiration
conquering the
mountain 20 year old type 1 diabetic, Maitry Pancholi, who recently completed ‘Type 1 Diabetes Youth Challenge - White Mountains’ in Crete, is an inspiration for all. by
Siddharth M Joshi
M
aitry is a student of M.Com in Neeldeep College of Commerce in Ahmedabad. She grew up in a small family with her father, mother and a younger brother. But her life changed drastically when her father passed away and she was diagnosed with type 1 diabetes, even before she turned 12. Today, at 20, she lives a normal life. Well, as normal as it gets with diabetes. She lives with her grandmother along with her mother and a younger brother. She loves travelling and meeting people from other cultures, as also other diabetic kids and learn from their experiences. Travelling broadens her horizons. We got talking with her after she came back from her hike in Crete. Here’s an excerpt...
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Q | Congratulations on successfully scaling the White Mountains in Crete. How was the experience? A | Thank you. It was memorable, once-in-alifetime experience for me. Meeting and interacting with fellow diabetics from all over the world and learning about their individual experiences in managing diabetes was very inspirational. Together we trekked for over eight hours each day and had to manage our diabetes under tough conditions. After four days of hiking, we reached the summit of Mt. Gingilos, which is 2,080 metres above sea level. It was a long and tough hike and the sun made it extremely difficult for us to climb. Being a vegetarian, I did not have many food options. During the trek, I had to survive on health bars and fruits. I was often tired and found it difficult to continue the trek. The terrain became tougher and at one
point, we had to climb rocks without any support making it extremely difficult and risky. Some of us even had multiple cuts in our hands which were attended to by the doctors accompanying us.
Q | So, you’re satisfied with your performance? A | I am very pleased that I completed the trek successfully. My team members were very supportive and encouraged me throughout. There were moments when my legs refused to move and I was completely exhausted but their assurance and motivation kept me going. I want to share a message of hope with all the young diabetics in India. There is an exciting life waiting for them despite diabetes and beyond it. All we need to do is take our insulin medication on time and eat healthy. If we lead a disciplined lifestyle, nothing can stop us from fulfilling our dreams and living a normal, healthy life.
Q | How big was the backend team? A | An experienced medical team from SWEET centres supported us and they supervised the group throughout the trek. Four endo-pediatricians, a nurse from SWEET and two mentors also joined us, as did Delphine Arduini, founder of the World Diabetes Tour Association and Peter Nerothin, founder of Insulindependence for the T1D Challenge. Delphine and Peter had participated in the previous T1D challenges.
Q | Was there a point of crisis in the expedition? A | We didn’t face any trouble during the trek. Some of the participants had to deal with fluctuating sugar levels but our doctors were alert and took the necessary steps to normalise them.
Q | Tell us something about the ‘Type1 Diabetes Youth Challenge.’ DiabeticLivingOnline.in
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A | The ‘Type 1 Diabetes Youth Challenge’ was established by Sanofi Diabetes in partnership with SWEET and World Diabetes Tour. It was created to raise awareness, give hope to people with T1D by showing that it is possible to go beyond diabetes, make the most of every opportunity and lead a healthy active life. It sends out a positive message that young people with T1D can look beyond their condition and achieve their aspirations, provided they follow their medication routine and keep diabetes under control.
Q | You were the only Indian among the team of 11 members. How were you shortlisted? A | Sanofi contacted doctors across the country, asking them to share profiles with the SWEET team of diabetics with good glycaemic control and who were leading an active lifestyle. Dr. Saboo suggested my name and I was selected from India. The
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other 10 members were from Brazil, Canada and eight European countries.
Q | Events and programmes like these contribute a lot towards spreading awareness about diabetes. How big do you see the impact? A | I think such initiatives are very inspiring and empowering. They encourage type 1 diabetics to aspire and dream of bigger things than was possible earlier. It tells us that we can take on any physical and professional challenge in life as long as we manage our disease as advised by our doctors. Adolescents and young adults with T1D are particularly vulnerable to emotional stress. They face discrimination in many forms in life and have the extra challenge of managing their disease to ensure full glycaemic control. This puts a big toll on them. During this trek I learnt how to manage both emotional and physical stress because I was in the company of others who all had to do the same
things. Learning from each other, supporting each other were lifealtering experiences and I believe it was so for all my fellow trekkers! Therefore, initiatives such as Sanofi Diabetes, SWEET and World Diabetes Tour’s T1D YOUTH Challenge can go a long way in infusing hope in us and to demonstrate that with the right treatment plan, a good understanding of what to eat and what to avoid and a regular schedule of exercise, we can move beyond diabetes and achieve any goal that we set for ourselves in life.
Q | When were you first diagnosed with diabetes? A | I was 12 years old when both my brother and I fell sick. We had high fever and had to be hospitalized. While my brother got better, my condition deteriorated. Medicines were not having any effect on me so the doctor advised us to get my blood glucose tested. My sugar levels were over 400 mg/dL and I was told that I was having an episode of diabetic ketoacidosis,
Q | What are your hobbies? A | In my leisure time, I like watching movies and comedy TV series. Listening to music and going for long drives interest me as well. I have a lot of friends with whom I hang out with. They know about my condition and are very helpful and caring.
Q | What is your favourite cuisine? I’m sure you’ve devised some cheat for enjoying your favourite meals while still managing your diabetes. A | I eat everything but particularly enjoy Punjabi and Chinese food. Some of my favourite things are butter rotis, kadhai vegetables and hakka noodles. I also like pizza and sweets, especially kaju katli. But whenever I indulge in rich and starchy food and desserts, I check my blood glucose levels after the meal and take necessary steps in case it is high. That’s my cheat.
a recognised symptom of type 1 diabetes. That is when it was found that I had this disease.
Q | What is the first reaction of a youngster towards such diagnosis? What is the kind of support that you received from the medical fraternity back then? A | I was too young to realise all the implications when I was first diagnosed. I was just 12, very immature and scared, could not fathom what was going on. It was a very difficult time for us, for my family and for me. My father had just passed away and we were still coping with this grief and loss. The news that I had type 1 diabetes shattered our family. My mother was shocked and it was hard for us to come to terms with the situation. We knew so little about the disease and it all seemed hopeless to us. When I was told I had to take daily insulin, I cried because I did not want to take the injections every day. The
question that buzzed in my head every day was, “Why me”? But my mother was very supportive and encouraging. She took the insulin herself to eliminate my fear and to show me how it needed to be administered. Gradually, I became used to it and started taking insulin on my own. My mother and Dr. Saboo played a major role in making me accept, manage and control my diabetes. They taught me acceptance, showed me how to take my medication on time, they supervised my diet and made me exercise regularly till it all became a normal routine which I followed religiously. And life was great! Dr. Saboo has been monitoring me all these years and has taken care of my HbA1c, to make sure it always stays under control. I have always been very careful about my medication.
Q | Talking of complications, have you had any at all from diabetes? A | No.
Q | What are your personal future plans? A | I want to be a diabetes educator and spread awareness amongst families, children and in schools about type 1 diabetes. People like us require support and not sympathy. Our condition may look like a problem, but in reality, it is just another challenge to overcome and another opportunity to demonstrate strength of body and mind. It is lack of knowledge and lack of support that creates fear and confusion in the minds of children with type 1 diabetes. I want to change this and work towards ensuring a healthier future for them. I want to get into banking to support myself and my family.
Q | Are you going to continue spreading awareness about T1D? A | Yes. I am very keen on helping society and want to spread awareness amongst other kids that with proper control, nothing can stop a diabetic from achieving success. I wish to inspire other young people suffering from type 1 diabetes.
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WELL BEING
being alert
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Testing your blood sugar both before and after a meal can provide valuable insight to achieve better diabetes control. by Jill Weisenberger, RDN, CDE, photos by Jason Donnelly
FAND
O DOUBLE CHECK I
f your blood glucose meter flashes a high number—say 245—a couple hours after lunch, can you blame it on your food? Not necessarily. To learn a meal’s effect on your blood sugar, measure blood glucose before eating and again about two hours after your first bite. Pairing these readings gives you critical clues when exploring the reasons your blood sugar is out of target range, experts say. Though something’s indeed awry, a post-meal reading of 245 mg/ dl means something very different if you started lunch with a blood glucose level of 130 mg/dl versus a prelunch reading of 225 mg/dl. “If your blood glucose rose only 20 points from 225 to 245, lunch
isn’t to blame for the elevated number. Something else is the problem,” says Constance BrownRiggs, M.S.Ed., RD, CDE, CDN, author of The African American Guide to Living Well with Diabetes (Career Press, 2010). On the other hand, she says, if your blood glucose jumped more than 50 points in the two hours since that first bite, what or how much you ate may need to change. When you self-monitor blood glucose (SMBG), you can take more or fewer measurements. Though it may seem like a pain—or wasteful to use two lancets, two strips, and two drops of blood—these paired blood glucose checks help you gather useful clues that could bring better health for years to come.
BLOOD GLUCOSE MONITORING PUTS YOU IN CONTROL There are lots of reasons to self-monitor blood glucose (SMBG). You will: • Identify blood glucose levels above or below your required target ranges. • Monitor the effectiveness of your various medications. • Learn how diet, exercise, illness, and other factors affect your blood glucose levels. Bottom line: SMBG helps you understand your diabetes and make changes when you need them. Without SMBG, any change you make is just a guess. Pairing your blood glucose checks around meals and exercise is a powerful way to use SMBG. DiabeticLivingOnline.in
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PAIRED MEASUREMENTS AND EXERCISE Testing blood glucose before and after exercise is both a motivator and a safety measure, explains Gary Scheiner, CDE, clinical director of Integrated Diabetes Services LLC and author of Think Like a Pancreas (Da Capo Lifelong Books, 2012). Comparing your postexercise blood glucose level with your pre-exercise level can really show the value of making time for exercise. But if you’re taking certain medications that make you susceptible to hypoglycemia (low blood sugar), checking blood glucose before exercise is a necessity. “If blood glucose is below a safe zone, you’ll need extra carbs before you start exercising,” he says. Follow your workout with a post-exercise check to see if the extra carbohydrate did the trick—or if you need more or less. “The amount required depends on many factors, such as your body size, the nature of the workout, and the type of medical therapy,” Scheiner says. “It’s best to work with a diabetes educator to iron out the details.”
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Rhonda Comer of Bristol, Virginia, uses paired measurements through the digital diabetes management program Livongo under the guidance of registered dietitian nutritionist Toby Smithson, RDN, CDE, Livongo’s diabetes lifestyle expert. Comer, 48, who’s had type 2 diabetes for eight years, identified her “danger meals” with SMBG— pizza, pasta, and Mexican food really jack up her blood sugar. “Now if I’m having a danger meal, I cut my portions and eliminate the extras,” she says. For example, when Rhonda eats pasta, she spreads a scant cup of the pasta over the plate and adds plenty of nonstarchy veggies either to the sauce or as a generous side dish. This tweak—which she learned was necessary through paired measurements—gives her the illusion of more food and keeps her blood glucose in range. These days, Rhonda proudly reports that her A1C (average blood glucose over two to three months) recently dropped from 12.1 percent to 8.1 percent. She credits the extra monitoring as an important part of her success.
Making paired measurements work for you Here’s how it worked for Rhonda: She measured her blood glucose
levels before eating breakfast and two hours after the start of breakfast for a full week. Eventually she did the same for lunch, then she moved on to dinner. If you don’t have enough test strips to cover two measurements each day, you can gather the same valuable information by measuring every other day for two weeks. The next step is to put on your detective cap to find the meaning in all the numbers you’ve collected. It may be easier than you think. Trimming your carbohydrate intake when you sit down to the problem meal may be all it takes to improve those postmeal readings. “I use paired glucose monitoring all day, every day,” says Smithson, who has type 1 diabetes. If you’re thinking it’s too much of a hassle to test more often, compare it to the consequences of dealing with highs and lows in your blood sugar levels, Smithson says. “I truly believe it’s a reason for my success in managing my diabetes for more than 46 years,” she says. Need help making sense of all those blood glucose numbers? Make an appointment with your health care provider or a certified diabetes educator and see a registered dietitian if you have questions about the appropriate dietary changes.
BLOOD GLUCOSE GOALS FOR DIABETES MANAGEMENT Your health care provider will help you establish target blood glucose goals based on your age, health status, and a few other factors. Use these American Diabetes Association (ADA) general guidelines for adults as a starting point.
Fasting and before meals 1–2 hours after eating
80–130 mg/dl <180 mg/dl
SAMPLE BLOOD GLUCOSE LOG Jane, type 2 diabetes (Jane’s target blood glucose ranges follow the ADA general guidelines, opposite, for adults with diabetes.)
DAY
BG BEFORE MEAL (mg/dl)
BG 2 HOURS AFTER MEAL (mg/dl)
DIFFERENCE
1
108
201
93
2
113
190
77
2 pancakes, 2 Tbsp. syrup, black coffee 60 g carb
186
70
Steak, egg, and cheese on a bagel, black coffee 58 g carb
3
116
4
111
5
158
47
103
141
38
6
101
141
40
7
118
168
50
MY BREAKFAST
2 pancakes, 2 Tbsp. syrup, 4 oz. orange juice, black coffee 75 g carb
½ cup low-fat cottage cheese, ¾ cup blueberries, 1 Tbsp. almonds, 2 Tbsp. granola, 4 oz. orange juice, black coffee 42 g carb ½ cup low-fat cottage cheese, ¾ cup blueberries, 1 Tbsp. almonds, 2 Tbsp. granola, black coffee 27 g carb 1 hard-boiled egg, 1 slice whole wheat toast, 1 Tbsp. peanut butter, small apple, black coffee 34 g carb 1 hard-boiled egg, 2 slices whole wheat toast, 1 Tbsp. peanut butter, 1 cup skim milk, black coffee 46 g carb
By reviewing her log, Jane saw that her before-breakfast blood glucose level was always at goal. After eating about 60–75 g of carb, her two-hour post-breakfast blood glucose level rose above her target of 180 mg/dl. But look how eating 30–45 g carb for breakfast kept her post-meal blood glucose within range. Her SMBG tells her to aim for 45 or fewer g carb in that meal.
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LIVING
being upbeat
Quit all the self-criticism and become your own biggest supporter. Pick up some positive tips from experts. by Allison Nimlos illustrations by Rafael
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Mayani
L
iving with diabetes, you make dozens of extra decisions every day. And sometimes the outcomes don’t go as planned. Guilt, shame, and anxiety can feel like second nature, but those emotions don’t do us any good. In fact, there’s new evidence that self-criticism isn’t just counterproductive. It can be harmful to your health. Anna Friis, a health psychologist at the University of Auckland in New Zealand, says self-criticism can hinder your ability to manage diabetes. Her study in the journal Diabetic Medicine shows that people with higher levels of selfcompassion are more likely to be healthier even when they struggle with their diabetes. In other words, it’s better for both mind and body to think “I did my best” rather than “I blew it again.” It seems like a no-brainer. But think of all the chances you have every day to judge yourself harshly. I’m not testing enough. I’m too low. I’m too high. I’m not exercising enough. I’m not eating well enough. “Diabetes requires 24/7 attention. Patients have many opportunities to evaluate themselves in a negative way,” Friis says. In her work as a psychologist, she’s observed that these self-criticisms can be paralysing—some of her patients have even started avoiding necessary management practices, such as blood glucose testing or doctor’s appointments, because those added fuel to the fire of negative criticism, creating even more anxiety and stress. “They’re afraid of how badly they’d feel about themselves if their sugar levels weren’t good enough or if the nurse or doctor felt their overall management wasn’t good enough,” she says. We’re not talking depression here; depression is a clinical diagnosis in which you have an
overall negative mood that affects your entire life. This is about distress—being upset specifically about diabetes. And it’s easy to be tough on yourself if you feel that way. Most of us are compassionate when someone else is suffering. We listen, offer reassurance. We’re kind and helpful. We aren’t angry, judgmental, or annoyed. Self-compassion is practicing those same things on ourselves. We could all probably use a little more self-compassion in our lives.
Roots of Self-Criticism If self-compassion is so good for you, then why is it so tough to practice? Kristen Neff, associate professor of educational psychology at the University of Texas at Austin, says there’s a biological component to self-criticism. Our fight-or-flight response, normally triggered when we experience danger, can also switch on when we make mistakes. “Our natural tendency is to attack when we notice something we don’t like. We attack ourselves to get rid of the problem.” This is counterproductive, because people who are selfcritical often have lower self-worth and self-confidence, which means they’re less likely to think they can be successful. There’s a pretty heavy weight to the stigma surrounding diabetes. Often we feel blamed for having it. We might also see ourselves as damaged or broken. “People don’t develop diabetes just because they love chocolate or eat too much pasta,” says Janis Roszler, RD, LDN, CDE, FAND, a diabetes educator and author. “Diabetes is a complex disease that develops from numerous factors, including hereditary ones.” You are part of a community of millions of people who are also struggling with diabetes, and each member has issues—you are not
IT’S BETTER FOR BOTH MIND AND BODY TO TELL YOURSELF
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“YOU ARE PART OF A COMMUNITY OF MILLIONS OF PEOPLE WHO ARE ALSO STRUGGLING WITH DIABETES.” weird or a failure because your blood sugars seem chaotic or your weight loss has stalled, Neff says. “We have this irrational tendency to feel like our problems shouldn’t be happening,” she says. “We believe everyone else is living a normal life except us.” It might also seem selfish to have self-compassion, especially when you’re busy with life’s responsibilities. In fact, the experts say, it’s the opposite. “Self-compassion is not about doing what you want but rather what you need,” Friis says. Self-compassion helps you take care of yourself so you’re in a better position to take care of others. It’s like that in-flight announcement that reminds passengers to snap on their own oxygen mask before helping others—it’s about survival. Another factor that can trip us up is the nasty comments we hear from others. Criticisms from our health care providers and especially family and friends can cut deeply, leaving us questioning our abilities to manage diabetes. Roszler stresses the importance of putting yourself in the other person’s shoes. Family and friends care about you—they just might not know how to express themselves helpfully and with kindness. “Communication is circular,” Roszler says. “How you respond to a comment affects what your conversation partner is likely to say next, and vice versa. Communicate your needs clearly so that loved ones will be less likely to assume what you want them to do.”
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Whether it’s snide remarks from a coworker or hurried feedback from a stressed-out staffer at the clinic, we don’t always get the support and compassion we need from others. Hearing questions like Can you even eat that? or Well, what did you do wrong? can make you defensive—they sound an awful lot like attacks on your abilities. The best response isn’t “None of your business!” but rather explaining why questions like that hurt so the people who care know how to support you better. Learn how to be a better support for yourself so mean, off-handed comments (made by you or by others) don’t drag you down.
Be a Friend—to Yourself Think about what you said to yourself the last time you made a mistake. Now think about repeating those words to someone you love. See what we mean? “If you were a coach trying to motivate, what’s going to be more encouraging, saying You’re a loser or saying You can do it?” Neff asks. “Encouragement, support, and kindness are more effective
motivators to make changes than harsh criticism.” Try practicing self-care actions that nurture your physical and emotional health. Some examples: • Eat wholesome, home-cooked meals instead of fast food. Meals made with love and care are better for you on all levels. • Take a regular lunchtime walk. Get up, stretch, refresh your perspective, and notice beauty in the world around you. • Keep a journal. Sometimes just writing down a negative thought takes away its power. • Spend time with friends who truly support you. Friends make life better because they rejuvenate you when you spend time together. • Cut out the stuff that makes you feel bad or lethargic, such as surfing the Internet, eating junk food, and spending time with people who suck up all your energy and leave you feeling unhappy. • Meditate. You can start by sitting comfortably in a quiet place— morning or evening is good—and paying attention to nothing but your own breaths for a few minutes. Try it for a week and see if you notice any changes.
ADDITIONAL READING These motivational reads will help you stay mindful as you deal with diabetes and kick-start a life filled with self-compassion.
I Thought It Was Just Me (But It Isn’t): Making the Journey from “What Will People Think?” to “I Am Enough” by Brené Brown (Gotham, 2007)
Self-Compassion: The Proven Power of Being Kind to Yourself by Kristin Neff (William Morrow Paperbacks, 2015)
How to Live Well with Chronic Pain and Illness: A Mindful Guide by Toni Bernhard (Wisdom Publications, 2015)
NUTRITION
steel yourself
QUICK GUIDE TO
IR N
The human body’s requirement for iron has a sweet spot. Follow these easy guidelines to find yours. by Marsha McCulloch, RD, LD food styling by Susan Draudt
S
|
ome people find it hard to get enough iron; others absorb and store too much (that’s a hereditary disorder called hemochromatosis). But everyone should pay attention to the amount of iron per serving on Nutrition Facts labels. Iron is shown as a percentage of its Daily Value (DV), which is 18 milligrams (mg). So a food with 15 percent of your DV for iron would have 2.7 mg iron per serving (multiply 18 by 0.15). The 18 mg iron DV covers the needs of healthy, premenopausal women who aren’t pregnant. Men and postmenopausal women need 8 mg per day. People who need less iron should avoid highly iron-fortified foods (anything more than 20 percent of the DV). But if you have an iron deficiency, those foods are right up your alley. Iron comes in two forms: heme and non-heme. We absorb heme iron best. Both forms are in meat
photos by
Adam Albright
Naturally Good Sources of Non-Heme Iron (% DV Iron Per Serving)
For better absorption, pair nonheme iron foods with vitamin C and fructose-containing foods. (especially red meats), fish, and poultry. Fortified foods and plant foods contain only non-heme iron. To boost iron levels, eat nonheme sources with heme sources, such as meat. Vitamin C and fructose (fruit sugar) also increase non-heme iron absorption—a tasty reason to eat dark chocolate (supplying non-heme iron) with strawberries (containing fructose and vitamin C). Not enough iron can make you feel tired and unfocused because iron (as hemoglobin) helps transport oxygen to your body’s cells. But too much iron, especially from heme iron, can cause bodily inflammation and may increase risk of type 2 and gestational diabetes. Animal studies suggest excess iron—more likely if you consume a lot of heme iron—may decrease how well your insulin works and damage insulin-producing cells. Just one more reason to eat red meats in moderation.
Dark chocolate, 70%−85% cacao, 28 g
18%
Lentils, cooked, ½ cup
18%
Tofu, firm, raw, ½ cup
18%
Tomatoes, stewed, canned, 1 cup
18%
Spinach, cooked, drained, ½ cup
17%
Cashews, 28 g (18 nuts)..11% Kidney beans, cooked, ½ cup
11%
Baked potato with skin, medium (170 g)
10%
Dried apricots, ¼ cup
10%
Pumpkin seeds, ¼ cup
10%
NUTRITION
recipe
Befrien
d
SESA ME
Sesa m press e seeds diab ure and p aid in red e the w tics. Use lasma gl ucing lev ucos these onde e in els of blo by G r s c s itanj r e hy u o eds i ali G urba nto y mptious persens d xani it recip our d es to ive iet. inclu de
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S
esame seeds may be tiny but they have huge health benefits. These seeds are especially rich in mono unsaturated fatty acids, oleic acid, which compromises up to 50% fatty acids in them. Oleic acid helps lower LDL or ‘bad cholesterol’ and increase HDL or ‘good cholesterol,’ in the blood. They are a good source of B-complex vitamins such as niacin, folic acid, thiamine (Vitamin B1), pyridoxine (Vitamin B6) and riboflavin. These seeds have a delicate nutty flavour, which indeed becomes more pronounced once they are gently roasted under low flame for a few minutes. “Sesame seeds are also rich in calcium, iron, manganese, zinc, magnesium, selenium and copper. Many of these minerals have a vital role in bone mineralisation, red blood cell production, enzyme synthesis, hormone production, as well as regulation of cardiac and skeletal muscle activities. It also has a cholesterol-lowering effect. The well suited characteristics and appropriate composition of fatty acids, particularly linoleic acid and high polyunsaturated/ saturated fatty acid ratio, high level of
lignans, fibre and tocopherol in sesame seeds may have favourable effects in reducing the risk of coronary heart disease and in particular, in high risk conditions such as diabetes. However, well designed research studies are needed to prove this,” says Dr.Anoop Misra, Director and Head, Department of Diabetes& Metabolic Diseases, Fortis Hospitals, New Delhi. He further points out that sesame seeds are calorie dense and therefore need to be consumed in moderation. One levelled teaspoon (tsp) contains nearly 3 grams of sesame seeds and provides approximately 17 kcal, 0.5g protein and 1.5 g fat, 0.7g carbohydrate (0.3g fibre). Although sesame seeds have a low glycaemic index (GI: 35) and can be incorporated in a well balanced diet in form of salads or consumed as part of roasted snacks. However, one needs to take care of the total calories (according to one’s BMI and pathological condition) being consumed. Further, it is advised that diabetics, specifically those with renal (kidney) problems, should consult their diabetologist before incorporating it in their diets.
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METHOD
BROCCOLI TOFU AND SESAME SEED STIR FRY SERVES 4 INGREDIENTS REQUIRED
1 tbsp Oil 250 g Tofu, cut into small cubes 2 Cloves, garlic, finely cut 1 tsp Ginger, grated ¼ tsp Red chilli powder 200 g Broccoli florets 2 ½ tbsp Soya sauce 2 tbsp Sesame seeds
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1. Heat oil in a pan. 2. When hot, add in garlic and ginger. 3. Sauté for a minute. Add in the broccoli. 4. Simmer and cook for 12-15 minutes or till the broccoli is almost cooked. 5. Add in the tofu pieces, red chilli powder and soya sauce. 6. Gently mix it up. 7. Stir in the sesame seeds, mix well and take it off the flame. 8. Serve hot.
Wholewheat Sesame Seed Cookie INGREDIENTS REQUIRED :
½ cup ½ cup ½ tsp
Refined wheat flour Whole wheat flour Baking powder Pinch of salt ¼ cup Unsalted butter, softened 1 tsp Vanilla essence 3 – 4 tbsp Milk, lukewarm 1 cup Sesame seeds, roasted ½ tsp Baking soda 10 tsp Sweetwell METHOD
1. Sieve together the refined wheat flour, whole wheat flour, salt, baking powder, baking soda and sweet well in a large bowl. 2. Add to it the softened butter. 3. Using an electric hand beater, mix this on medium speed till well blended. 4. Add in the vanilla essence and little milk as required to make a soft biscuit dough. 5. Divide this dough into 8-10 equal size portions. 6. Shape each into a round ball and gently flatten them with the tip of your fingers. 7. Place this disk over the sesame seeds and coat it on both sides of the cookies. 8. Place them on a well greased baking tray. 9. Bake in a pre-heated oven at 190°C for 12-15 minutes or until golden brown in colour. 10. Cool completely and store in an air tight container.
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MULTI GRAIN BREAD WITH SESAME SEEDS MAKES 1 LOAF INGREDIENTS REQUIRED
3 Cups 2 Cup 1 tbsp 1 tbsp 1 ½ tsp 2 ½ tbsp
Multigrain flour Refined wheat flour Oil Demerara sugar Salt Sesame seeds
Water 10 g
as required Fresh yeast
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METHOD
1. Sieve together the refined wheat flour, multigrain flour and salt in a large bowl. 2. In a separate bowl, mix together the yeast and salt. Mix this well with your finger tips. 3. Add a little flour, alternately with water, till all of it is used up to make a soft dough. 4. Place the oil over it and knead the dough for 5 minutes till it’s well kneaded. 5. Cover it with a damp cloth and set aside in a warm room for 30 minutes.
6. Now punch it down and shape it into an oblong shape. 7. Spread the sesame seeds on the surface and coat one side of the bread with it fully. 8. Mark slits across the bread, if desired. 9. Set it aside for 2 hours in a warm room to rise. 10. Bake in a pre-heated oven at 220°C for 15-20 minutes or till it’s golden brown in colour. 11. Let it cool completely, then slice and serve fresh.
GRILLED ASPARAGUS AND ROASTED SESAME SEEDS IN SOYA SAUCE SERVES 4 INGREDIENTS REQUIRED
450 g 1 tsp 2 ½ tbsp. 2 tbsp 2 tbsp ½ tsp
Asparagus Garlic, finely cut Soya sauce Sesame seeds Oil Black pepper powder
METHOD
1. Soak the asparagus in cold water for one hour. 2. Drain and cut off the ends. 3. Lightly grease a baking tray. 4. In a bowl, mix together the soya sauce, garlic, oil and black pepper powder. 5. Line the asparagus 1 inch apart and coat it evenly with this mixture. 6. Place the tray in a grill and cook it till it’s light brown in colour. 7. Sprinkle sesame seeds over it. 8. Serve hot.
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NUTRITION
metabolism
SCIENCE conquering
METABOLISM A 9 year old kid with type 1 diabetes no longer needs insulin shots. How? Paleolithic ketogenic diet did the trick for him. Here’s how... by
Siddharth M Joshi
A
Hungarian study conducted at the University of Pecs, on a nine year old kid, who had recently been diagnosed with type 1 diabetes, showed that following a Paleolithic ketogenic diet significantly brings the blood glucose levels to the desired normal state. The child had been on insulin therapy for six weeks and was on a high carbohydrate diet. The researchers put him on a modified version of a paleolithic ketogenic diet and fed him three meals a day with only animal meat, fat, offals and eggs. His blood glucose levels had been fluctuating when he was only on insulin, but the diet brought a change. The researchers observed sustained ketosis, which is when the body has a high burning rate. And he had normal blood sugar before and after meals. His insulin therapy was discontinued.
Sample of a ketogenic diet Brea
8 o tm cup oconu 1/2 c p 1 oil cu 1/3 ed with conut o k c Coo poon es l b a t
Dinner
Snack
10-12 amia macad nuts
141 g porterhou se steak with 1/8” fat Cooked in 1 ta blespoon tallow
After 19 months, the child is still on the Paleolithic ketogenic diet, and the researchers report it can ensure normoglycemia without the use of external insulin. No side effects or complications were observed, and the researchers stress the diet is sustainable in the long-term. The researchers wrote, "We opine that the Paleolithic ketogenic diet ensures normal glucose levels and can be maintained on the long-term in those patients with newly diagnosed T1DM with residual insulin secretion. It is important to emphasise, however, that in those patients with longstanding T1DM beta cells might have exhausted and therefore there may be a need for insulin replacement. In these cases, however, the Paleolithic ketogenic diet may be used as an adjunct in an attempt to likely prevent diabetic complications."
*Source: www.paleoplan.com
ch ed Lun salmon s sauté n ilk 5g nio
4 sli kfast ce 1 eg s baco n g 2 ta bles p bac on g oons ex tra reas e
Nutritional Breakdown
– 2013 Calories – 13.8 ) (g Carbs – 186 ) (g Fat – 79.1 ) (g ein ot Pr – 2.7% Carbs – 83.2% Fat – 15.7% Protein
What is ketosis? Ketosis is a metabolic process that happens when body needs energy to keep working. When the body doesn’t have enough carbohydrates it starts burning fat instead. As a part of this
process, it creates ‘ketones’. Your body doesn’t make ketones if you eat balanced diet. But when you cut back on your calories or carbs way too much your body switches to ketosis for energy. It is a sign of not using enough insulin for people with uncontrolled diabetes. This diet may also be used by those who wish to lose weight and maintain muscle. But it must be taken under strict supervision of a doctor who knows your medical history. There’s not much room for vegetables in this diet plan except some onions. So, vegetables must be well compensated with meat. If you eat organs, bone broth, and the muscle meat from grass-fed/pasture raised animals and yolks from pastured hens, then you’re getting heaps of nutrients. But if you don’t, you’d really need to supplement on this diet.
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FITNESS
workout
66 Diabetic Living
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be a
FITNESS
JACK
Staying fit goes beyond pumping muscles in the gym and gulping down protein shakes. We sat down a global fitness trainer to absorb how Metabolic Training is the real deal. by
I
DIET
“Eat more ‘one ingredient’ foods, like fish, broccoli, eggs, carrots, and anything else that is one ingredient. You also need to reduce the amount of liquid calories you drink.”
The right kind of fish Halibut, Oysters, Wild Salmon, Scallops, Light Canned Tuna and Pacific Cod.
Siddharth M Joshi
n countries like India that are growing, where people have greater opportunities to work, the exercise time seems to be getting scarce. So, obviously fitness takes a back seat on their scale of priorities. Extremely conscious of my own state of fitness, I make a desperate attempt to tuck my extra flab under the belt and meet the Reebok Global Master Trainer, David Jack. On a strict 8-days multi-city tour to India to introduce the concept of metabolic training to fitness coaches, David highlights the irony in my opening statement, “What else are we working for? If at 42 you have a heart attack and you are not here anymore, what does it matter how many hours you chased your work for, or how much money you earned? You will not be with your family to enjoy it.” Just to put things into perspective, I am far from being 42 but the example still sounds scary. So, what’s the way to get that extra bounce for your ounce? I ask, now wary to pour the content of
that open sugar sachet in my lemon tea. “As a backward rationale you need to realise that all you have is yourself, to enjoy this life. Still the reality is that people say they don’t have an hour to work out. So, we needed to harness a way to be able to give them an opportunity to get fitness in shorter amounts of time that actually was able to do something for them. Enter metabolic training as a potential solution. One should expect to get stronger, get more cardiovascular fitness and burn body fat. It is not necessarily weight loss; weight loss is good but it’s body fat that we want to get rid of, and create more lean muscle. Because lean muscle is what provides our body more energy, protects our joints and bones, and gives us structural and postural health. On further coaxing Davis spills that it is all about understanding how the human body functions in its most natural state. While doing the simplest exercises there are only certain
Broccoli, the rich fibre veggie High in Vitamin C, Vitamin A and Calcium, it also reduces blood pressure and helps you stay in shape.
Embrace the egg whites Eggs are a very good source of inexpensive, high quality protein.
Stay hydrated Water is important not only for the cellular mechanisms, but also to recover.
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muscles of the body that come under strain. So, instead of the traditional strength training, which he insists still has its place, you might rest for 30 seconds and then do an exercise for a different group of muscles. This way, your heart rate stays elevated because you’re working, say, your legs and your muscles burn. Your legs are tired, but the back is fresh, and you switch muscle groups. You are still metabolically working to perform, to create energy and to respond to stimulus. And most importantly you save time.
The Universe of Movement There are infinite ways that a body can move by the way of different exercises and movements that a body can perform. David illustrates, “You can take a squat – just stand up and sit down. Now add dumbbells or bars or kettlebells or a sand bag when you do it. Next, you could reach to the left or to the right, up or down. Throw and catch a ball in between the squats. Slightly splitting out your feet, go down slow, come up fast, or go down fast and come up slow... We can manipulate that exercise in infinite patterns, and it’s still a squat.” So, you can stack two movements and geometrically double your exercise.
Risks and Gym Fixes Sometimes common sense escapes us, because it’s exciting and everyone else is doing it... it’s called the gym
DO IT DAVID’S WAY
“Go find a hill and power-walk a hill, come down, do some push-ups, do some weight squats, again go power-walk the hill, come back and repeat all that. Set a clock for 15 minutes. 10 push-ups, 10 squats, up the hill, then down. See how many rounds you can manage. Don’t start the push-ups when you haven’t rested enough and are sure that you’re in good form, same thing with the squats. You need to choose what pace you walk with, when to rest and when you want to go again. It doesn’t matter what time you finish in, but that you finish it well. Next time you can try to beat it by doing it in 12 minutes, or by increasing the numbers of push-ups and squats.”
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fix. We get in there and we know we shouldn’t do a certain exercise, but the hormones inside, the energy around you, the camaraderie, the cheering, all combined make you change your mind. And the next thing you know is you go, “Oh yeah, I can do that.” And maybe you can for a session or two. But ultimately, what happens is you hit a threshold where your body can’t do it anymore. Metabolic training is high on intensity and is fast paced. Because fatigue is alleviated, if you don’t own the movements and aren’t conscious about your form and quality when you’re tired, that’s when those exercises turn into something they were never designed to be. David warns that you shouldn’t have pain and injury, but these are the most common risks involved “Fitness should always make you feel better, and in the end buy you vitality. You should feel better from where you started. It’s going to be challenging and you’re going to sweat. You should sweat and smile and should feel the burn because that’s where growth comes from, but ultimately it should be sustainable. And if you’re doing something today that you couldn’t do two or three years from now you’ve got be careful. Risks still need to be calculated.”
Trainer Selection People need to be empowered to know what to look for in a metabolic training environment. How long has the coach been training? Do they have experience in metabolic training? Do they assess you? Do they ask you about your goals? Do they make you do an exercise that you’re uncomfortable doing? Observe a class. And if you see there are people all over the place, everybody’s form looks different and it doesn’t look safe, then it’s probably not safe. The coach needs to take time to teach, educate, listen and ask questions. You must feel like you matter there and that the trainer cares.
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FOOD
salads
winter for salads 2 Juicy citrus, bold greens, roasted vegetables—fresh flavours don’t hibernate for the season. These main dishes are colourful and easy. recipes by Lauren Grant | photos by Adam Albright food styling by Charlie Worthington
Kale, Grapefruit, and Pomegranate Salad
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Kale, Grapefruit, and Pomegranate Salad 2 (2 cups each) 25 g PREP 30 minutes STAND 5 minutes SERVINGS
Indian-Spiced Cauliflower and Chickpea Salad
CARB. PER SERVING
1 red grapefruit or blood orange 1 226 g skinless, boneless chicken breast half 1 Tbsp. olive oil 2 tsp. honey 1⁄ 2 tsp. black pepper 3 cups torn fresh kale 1⁄ 4 tsp. salt Nonstick cooking spray 1⁄ 4 cup pomegranate seeds 1⁄ 4 cup halved and very thinly sliced red onion 1. Remove zest from grapefruit. Peel and section grapefruit; squeeze remaining juice from membranes. 2. Place chicken in a resealable plastic bag set in a shallow dish. For marinade, combine 2 teaspoons of the grapefruit zest, 2 teaspoons of the grapefruit juice, and 1 teaspoon of the oil. Pour marinade over chicken. Seal bag; turn to coat chicken. Marinate in the refrigerator until needed. 3. For dressing, whisk together honey, pepper, and the remaining grapefruit juice; set aside. 4. In a large bowl combine kale, salt, and the remaining 2 teaspoons oil. Using your hands, massage oil mixture into kale for 1 to 2 minutes or until kale begins to soften. 5. Drain chicken, discarding marinade. Coat a large nonstick skillet or grill pan with cooking spray; heat over medium-high heat. Add chicken; cook 6 to 8 minutes or until done (74°C), turning once. Remove from heat and let stand for 5 minutes. Thinly slice the chicken. 6. To serve, add grapefruit sections, chicken, dressing, pomegranate seeds, and onion to kale; toss gently to combine. PER SERVING: 312 cal., 11 g total fat
(2 g sat. fat), 83 mg chol., 382 mg sodium, 25 g carb. (4 g fibre, 14 g sugars), 31 g pro.
Indian-Spiced Cauliflower and Chickpea Salad 2 (21⁄2 cups each) CARB. PER SERVING 33 g PREP 20 minutes ROAST 20 minutes SERVINGS
1 Tbsp. curry powder 1 Tbsp. olive oil 1⁄ 4 tsp. salt 11⁄2 cups cauliflower florets 1 cup canned no-salt-added garbanzo beans (chickpeas), rinsed and drained 3⁄ 1 4 cup ⁄ 2-inch carrot slices 1⁄ 4 cup plain fat-free yogurt 1 Tbsp. lime juice 1⁄ 2 tsp. black pepper 1⁄ 2 tsp. grated fresh ginger or 1⁄ 4 tsp. ground ginger 1⁄ 2 tsp. minced fresh jalapeño chilli pepper (optional)* 1 to 2 Tbsp. fat-free milk (optional) 2 cups torn red-tip leaf lettuce 1 cup packed fresh Italian parsley
1⁄ 4
cup thinly sliced red onion
1. Preheat oven to 232°C. In a medium bowl combine the first three ingredients (through salt). Add the next three ingredients (through carrot); toss to coat. Spread mixture in a 15×10-inch baking pan. Roast for 20 to 25 minutes or until vegetables are tender, stirring once. 2. Meanwhile, for dressing, in a small bowl stir together the next four ingredients (through ginger) and, if desired, jalapeño pepper. If needed, thin with milk to desired consistency. 3. In a large bowl combine roasted vegetables, lettuce, parsley, and onion. Add dressing; toss to coat. *TEST KITCHEN TIP: Chilli peppers contain oils that can irritate your skin and eyes. Wear plastic or rubber gloves when working with them. PER SERVING: 241 cal., 9 g total fat
(1 g sat. fat), 1 mg chol., 405 mg sodium, 33 g carb. (10 g fibre, 8 g sugars), 11 g pro.
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Pork and Squash Salad 2 (2 cups each) CARB. PER SERVING 31 g PREP 25 minutes ROAST 24 minutes STAND 3 minutes SERVINGS
1 Tbsp. balsamic vinegar 2 tsp. olive oil 1⁄ 4 tsp. salt 1⁄ 4 tsp. ground cinnamon 1⁄ 4 tsp. black pepper 3⁄ 3 4 cup ⁄4-inch pieces butternut squash 1⁄ 4 cup chopped onion 1 226 g boneless pork loin chop, cut 1 inch thick and trimmed of fat 1 Tbsp. pure maple syrup 1 Tbsp. chopped pecans (optional) 3 cups mixed baby greens 1⁄ 4 cup dried cranberries
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1. Place a 9-inch cast-iron skillet in the oven. Preheat oven to 218°C. 2. Meanwhile, whisk together the first five ingredients (through pepper). In a small bowl toss squash and onion with 2 teaspoons of the vinegar mixture. Carefully arrange squash mixture around edges of hot skillet. Roast for 5 minutes. 3. Brush both sides of the pork chop with 1 teaspoon of the vinegar mixture. Place chop in center of hot skillet. Roast 18 to 20 minutes or until squash is tender and browned, turning chop and stirring vegetables once. 4. Drizzle maple syrup over chop and vegetables. If using, sprinkle pecans over vegetables. Roast 1 to 2 minutes more or until a thermometer inserted in chop
registers 62°C and pecans are toasted. Remove from oven and let stand for 3 minutes. Thinly slice the chop. 5. To serve, in a medium bowl toss together salad greens, cranberries, meat, vegetables, and the remaining vinegar mixture. PER SERVING: 306 cal.,
9 g total fat (2 g sat. fat), 75 mg chol., 363 mg sodium, 31 g carb. (4 g fiber, 19 g sugars), 27 g pro.
FOOD
e k a m ead ah
get prepped
h y es b
p reci
Roasted Salmon with White Bean Ragout recipe on page 77
Carla
s y a d i l o t brigh m Al raudt a d A D by usan tos by S pho
C
ian, hrist
D| ing RD, Lfood styl
Make life easier this holiday season with these diabetesfriendly recipes. Each uses advance prep so you can relax more with family and friends.
Get Ahead
CHOP AND COOK THE WHITE BEAN RAGOUT UP TO THREE DAYS BEFORE YOUR MEAL. TO SERVE, BROIL THE SALMON AND HEAT THE RAGOUT. IT'S THAT EASY!
Get Ahead
THIS POMEGRANATE-CRANBERRY TOPPER HOLDS UP TO THREE DAYS IN THE REFRIGERATOR. AT PARTY TIME, BAKE THE BREAD AND CHEESE, THEN SPOON ON TOPPER.
Pomegranate, Cranberry, and Brie Bruschetta 16 (1 bruschetta each) 8g 30 minutes CHILL up to 3 days 12 minutes
SERVINGS
CARB. PER SERVING PREP BAKE
3⁄ 4 1⁄ 2
cup pomegranate seeds cup fresh or frozen chopped cranberries, thawed 2 Tbsp. sugar* 1 tsp. finely shredded orange zest Dash of salt 170 g baguette-style French bread, cut diagonally into 16 slices Nonstick cooking spray 1⁄ 8 tsp. black pepper 1 170 g log Brie cheese, such as Canzona brand, cut diagonally into 16 slices 1 Tbsp. finely snipped fresh basil 1. In a small bowl combine the first five ingredients (through salt). Cover and chill for up to 3 days. 2. To serve, preheat oven to 176°C Place bread slices in a 15×10-inch baking pan. Lightly coat both sides of bread with cooking spray; sprinkle with pepper. Bake for 8 minutes, turning once. Top with cheese. Bake for 4 minutes more or until cheese is softened. 3. Stir basil into pomegranate mixture; spoon onto bread. Serve warm. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use product amount equivalent to 2 tablespoons of sugar. PER SERVING: 77 cal., 3 g total fat
(2 g sat. fat), 8 mg chol., 114 mg sodium, 8 g carb. (0 g fibre, 2 g sugars), 2 g pro. PER SERVING WITH SUBSTITUTE: Same as above, except 75 cal.
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Pomegranate, Cranberry, and Brie Bruschetta
Cherry Chicken Salad Bites
Get Ahead
THIS IS PERFECT FOR BUSY TIMES! BAKE AND FREEZE THE PUFF PASTRY UP TO A MONTH IN ADVANCE. CHILL THE CHICKEN FILLING UP TO THREE DAYS.
Get Ahead
MIX THE DRY AND WET INGREDIENTS SEPARATELY UP TO THREE DAYS IN ADVANCE. BEFORE THE MEAL, STIR THEM TOGETHER AND POP IN THE OVEN. YOU'LL SERVE WARM MUFFINS WITH NO HASSLE.
Savoury Holiday Corn Bread Muffins
Savoury Holiday Corn Bread Muffins 8 (1 muffin each) 16 g PREP 20 minutes CHILL up to 3 days BAKE 15 minutes COOL 5 minutes SERVINGS
CARB. PER SERVING
1⁄
2 1⁄ 4
1 11⁄4 2 1⁄
1⁄
Cherry-Chicken Salad Bites
vigorously. Cook and stir until mixture
16 (1 puff each) CARB. PER SERVING 5 g PREP 30 minutes BAKE 28 minutes
Remove from heat; cool for 5 minutes.
SERVINGS
1⁄
2 cup water
6 Tbsp. light butter with canola oil 8 tsp. salt 1⁄ 2 cup all-purpose flour 1⁄ 4 cup white whole wheat flour 2 eggs, lightly beaten 3 Tbsp. finely chopped fennel (reserve leaves) 1⁄ 2 cup finely chopped cooked chicken breast 3 Tbsp. snipped dried cherries and/ or dried apricots 2 Tbsp. plain fat-free Greek yogurt 2 Tbsp. chopped toasted pecans 1 Tbsp. buttermilk Salt and black pepper
1⁄
forms a ball that doesn’t separate. 2. Transfer mixture to a large bowl. Add eggs, one at a time, beating with a mixer after each addition until smooth. Pipe dough in 16 mounds 2 inches apart onto prepared baking sheet. 3. Bake for 10 minutes. Reduce oven temperature to 176°C. Bake for 18 to 20 minutes more or until golden and firm. Poke each puff with a toothpick to allow steam to escape. Cool completely. Place in an airtight container and freeze up to 1 month. 4. For filling, snip 2 teaspoons of the fennel leaves. In a medium bowl combine snipped fennel leaves, chopped fennel, and the remaining ingredients. Cover and chill for up to 3 days. 5. To serve, cut tops from puffs. Spoon
1. Preheat oven to 218°C. Line a large baking sheet with parchment paper. In a small saucepan combine the water, butter, and 1 ⁄ 8 teaspoon salt. Bring to boiling. Add both flours all at once; stir
about 1 tablespoon filling onto the bottom of each puff. Replace tops. PER SERVING: 66 cal., 3 g total fat
(1 g sat. fat), 29 mg chol., 94 mg sodium, 5 g carb. (0 g fibre, 1 g sugars), 3 g pro.
2 3
1⁄ 4 1⁄ 4
3 4
cup all-purpose flour cup yellow cornmeal Tbsp. sugar* tsp. baking powder eggs, lightly beaten cup low-fat milk cup refrigerated cooked turkey sausage crumbles, such as Jimmy Dean brand cup shredded Gruyère cheese cup snipped dried cranberries Tbsp. vegetable oil tsp. light pancake syrup or honey
1. In a bowl combine the first four ingredients (through baking powder). Cover; store at room temperature for up to 3 days. In a small bowl combine the next six ingredients (through oil). Cover and chill for up to 3 days. 2. To serve, preheat oven to 190°C. Line eight 21 ⁄ 2-inch muffin cups with paper bake cups; coat with nonstick cooking spray. Add milk mixture all at once to flour mixture. Stir just until moistened. Spoon into prepared muffin cups. 3. Bake for 15 to 17 minutes or until a toothpick comes out clean. Cool in muffin cups on a wire rack for 5 minutes. Remove and brush tops with syrup. Serve warm. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use product amount equivalent to 1 tablespoon sugar. PER SERVING: 161 cal., 8 g total fat
(2 g sat. fat), 55 mg chol., 179 mg sodium, 16 g carb. (1 g fibre, 6 g sugars), 5 g pro. PER SERVING WITH SUBSTITUTE: Same as above, except 159 cal., 5 g sugars. DiabeticLivingOnline.in
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Ham and Broccoli Breakfast Casserole
Get Ahead
ASSEMBLE AND CHILL THIS EGG CASSEROLE THE NIGHT BEFORE. IT'S READY TO BAKE AND SERVE FOR BREAKFAST OR BRUNCH THE NEXT DAY.
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Ham and Broccoli Breakfast Casserole 8 (1 portion each) 20 g PREP 20 minutes CHILL overnight BAKE 50 minutes SERVINGS
CARB. PER SERVING
2 cups broccoli florets 4 cups refrigerated shredded hash brown potatoes 2 Tbsp. coarsely snipped fresh chives 170 g thinly sliced lowersodium cooked honey ham, chopped 1 cup shredded reduced-fat cheddar cheese 8 eggs, lightly beaten 1⁄ 2 cup fat-free milk 1⁄ 2 tsp. salt 1⁄ 2 tsp. black pepper 1⁄ 4 tsp. garlic powder 1. In a medium saucepan cook broccoli in boiling lightly salted water for 3 minutes; drain. Rinse with cold water; drain again. 2. Coat a 1.8 litre rectangular baking dish with nonstick cooking spray. Add potatoes and chives to prepared dish; toss to combine. Top with broccoli, ham, and cheese. 3. In a medium bowl combine the remaining ingredients. Pour egg mixture over potato mixture. Cover and chill overnight. 4. To serve, preheat oven to 176°C. Bake, uncovered, for 50 to 55 minutes or until eggs are set (71°C). If necessary to prevent overbrowning, cover with foil for the last 10 minutes. PER SERVING: 219 cal.,
9 g total fat (4 g sat. fat), 206 mg chol., 550 mg sodium, 20 g carb. (2 g fibre, 2 g sugars), 15 g pro.
Roasted Salmon with White Bean Ragout
Get Ahead
PROBABLY ONE OF THE EASIEST FISH DISHES YOU WILL COME ACROSS, IT’S FRESH AND SIMPLE TO PREPARE. GUESTS WILL BE SURPRISED WHEN YOU WHIP THIS UP IN JUST 30 MINUTES.
Roasted Salmon with White Bean Ragout SERVINGS 2⁄
8 (1 salmon fillet +
3 cup bean mixture each)
18 g 30 minutes BROIL 4 minutes per 2-inch thickness of fish
CARB. PER SERVING PREP 1⁄
2 Tbsp. olive oil cup chopped onion
3⁄ 4 3⁄ 4
cup chopped red sweet pepper 3 Tbsp. tomato paste 1 tsp. salt 3⁄ 4 tsp. black pepper 2 cups coarsely chopped Swiss chard 2 425 g no-salt-added cannellini beans (white kidney beans), rinsed and drained 1⁄ 2 cup reduced-sodium chicken broth or vegetable broth Nonstick cooking spray 8 113 g fresh or frozen skinless salmon fillets, thawed 2 cups halved cherry tomatoes 8 tsp. grated Pecorino Romano cheese
1. In an extra-large nonstick skillet heat 1 tablespoon of the oil over medium heat. Add onion and sweet pepper; cook for 5 minutes or until tender, stirring occasionally. Stir in tomato paste, 1 ⁄ 2 teaspoon of the salt, and 1 ⁄4 teaspoon of the black pepper; cook and stir for 2 minutes. Stir in Swiss chard. Cook and stir for 1 minute or until chard is wilted. Stir in beans and broth; cool. Cover and chill for up to 3 days. 2. To serve, preheat broiler. Line a baking sheet with foil and coat with cooking spray. 3. Rinse fish; pat dry. Measure thickness of fish. Place on prepared baking sheet. Brush with the remaining 1 tablespoon oil and sprinkle with the remaining 1⁄ 1 2 teaspoon salt and ⁄ 2 teaspoon black pepper. Broil 4 inches from the heat for 4 to 6 minutes per 1 ⁄ 2-inch thickness or until fish flakes easily (if fish is 1 inch or more thick, turn once). 4. Meanwhile, in a large nonstick skillet cook bean mixture over medium heat for 5 minutes or until heated through, stirring occasionally. If needed, thin with up to 1 ⁄ 2 cup water to desired consistency. Stir in tomatoes. 5. Arrange fish on top of bean mixture. Sprinkle with cheese and additional black pepper. PER SERVING: 299 cal., 12 g total fat
(2 g sat. fat), 64 mg chol., 501 mg sodium, 18 g carb. (5 g fibre, 3 g sugars), 29 g pro.
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FOOD
crumbly nuggets
V I G
E GIFT H T E O
cookies
F
Show friends and family you care about them— and their health—with these yummy treats they'll never guess are carb-smart, too! recipes by
Katie Shields, M.S., RD | photos by Adam Albright food styling by Charlie Worthington
Honey Lemon Almond Shortbread recipe on page 80
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SNIC
KERD
OODL ES
T NU ISSES A E P RK TE UT
B
SPICED PUM WALNUT C PKIN OOKIES
ARK D E ATE UBL DO OCOL WITH CH KIES OW O CO INT SN M DiabeticLivingOnline.in
79
HONEY LEMON ALMOND SHORTBREAD 12 (1 cookie each) 19 g PREP 20 minutes FREEZE 5 minutes BAKE 10 minutes
sweet e packag To keep temptation out of the kitchen, gift these cookies to friends and family. You can feel good about giving them away, too— they're all under 150 calories and 22 grams of carb. per serving. Now that's sweet. To package the treats, choose from cookie tins, cellophane bags, or cardstock boxes. For more gift-wrapping ideas visit DiabeticLivingOnline.com/ giftbox Before packaging, layer the cookies between waxed paper. This prevents them from sticking together and keeps the cookies crisp. If you'd rather keep the whole batch (and why not?—you did all the work!), layer the cookies between waxed paper in an airtight container. Unless otherwise stated, store cookies at room temperature for up to 2 days or freeze up to 1 month.
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SPICED PUMPKIN WALNUT COOKIES 12 (1 cookie each) 21 g PREP 15 minutes FREEZE 10 minutes BAKE 12 minutes
SERVINGS
SERVINGS
CARB. PER SERVING
CARB. PER SERVING
5 Tbsp. butter, melted cup honey 2 Tbsp. pure maple syrup 1 Tbsp. lemon zest 1⁄ 2 tsp. almond extract 11⁄ 3 cups all-purpose flour 3⁄ 4 tsp. sea salt 1⁄ 4 cup sliced almonds 1⁄ 4
1. Preheat oven to 176°C. Line a cookie sheet with a silicone baking mat or parchment paper. In a medium bowl combine the first five ingredients (through almond extract). 2. In a small bowl stir together flour and salt. Add flour mixture to honey mixture; stir until combined. Cover and freeze for 5 minutes. 3. Shape dough into 12 balls; place on prepared cookie sheet. Press balls into 3×2-inch rectangles. Top with almonds. 4. Bake for 10 minutes or just until edges are golden. Cool on cookie sheet for 5 minutes. Remove; cool on a wire rack. If desired, sprinkle with additional lemon zest. PER SERVING: 135 cal., 6 g total fat
(3 g sat. fat), 13 mg chol., 139 mg sodium, 19 g carb. (1 g fibre, 8 g sugars), 2 g pro.
6 Tbsp. packed brown sugar* 6 Tbsp. canned pumpkin 3 Tbsp. refrigerated or frozen egg product, thawed 2 Tbsp. olive oil 2 Tbsp. mild-flavour molasses 1 cup white whole wheat flour 11⁄2 tsp. pumpkin pie spice 3⁄ 4 tsp. baking soda 1⁄ 2 tsp. sea salt 6 Tbsp. raisins 1⁄ 4 cup chopped walnuts 1. Line a cookie sheet with a silicone baking mat or parchment paper. In a medium bowl combine the first five ingredients (through molasses). 2. In a small bowl stir together the next four ingredients (through salt). Add flour mixture to egg mixture; stir until combined. Stir in raisins and walnuts. Cover and freeze for 10 minutes. 3. Preheat oven to 176°C. Drop dough into 12 mounds (about 2 tablespoons each) onto prepared cookie sheet. Flatten slightly. 4. Bake for 12 to 14 minutes or until edges are set. Cool on cookie sheet for 5 minutes. Remove; cool on a wire rack. *SUGAR SUBSTITUTE: We do not recommend using a sugar substitute for this recipe. PER SERVING: 124 cal., 4 g total fat
(0 g sat. fat), 0 mg chol., 182 mg sodium, 21 g carb. (1 g fibre, 12 g sugars), 2 g pro.
PEANUT BUTTER KISSES 12 (1 cookie each) 12 g or 9 g PREP 15 minutes BAKE 10 minutes
SNICKERDOODLES 12 (1 cookie each) 22 g or 15 g PREP 15 minutes FREEZE 10 minutes BAKE 10 minutes
DOUBLE DARK CHOCOLATE COOKIES WITH MINT SNOW 12 (1 cookie each) 18 g PREP 15 minutes FREEZE 10 minutes BAKE 10 minutes
SERVINGS
SERVINGS
SERVINGS
CARB. PER SERVING
CARB. PER SERVING
CARB. PER SERVING
1⁄
2 cup creamy peanut butter 2 Tbsp. refrigerated or frozen egg product, thawed 1⁄ 4 cup sugar* 1⁄ 2 tsp. baking powder 1⁄ 4 tsp. vanilla 1⁄ 8 tsp. salt 2 Tbsp. sugar** 12 dark chocolate candy kisses
1. Preheat oven to 176°C. Line a cookie sheet with a silicone baking mat or parchment paper. In a bowl combine peanut butter and egg. Stir in the next four ingredients (through salt). 2. Shape dough into 12 balls. Roll balls in the 2 tablespoons sugar; place on prepared cookie sheet. Flatten until 1 ⁄ 2 inch thick by making crisscross marks with a fork. 3. Bake for 10 to 13 minutes or just until centers are set. Immediately press a chocolate kiss into each cookie’s centre. Cool on cookie sheet for 3 minutes. Remove; cool on a wire rack. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use product amount 1 equivalent to ⁄4 cup sugar. **SUGAR SUBSTITUTE: We do not recommend using a sugar substitute for the 2 tablespoons sugar. TO STORE: Layer cookies between waxed paper in an airtight container. Store at room temperature for up to 3 days or freeze up to 1 month. PER SERVING: 110 cal., 7 g total fat
(2 g sat. fat), 0 mg chol., 97 mg sodium, 12 g carb. (1 g fibre , 10 G SUGARS), 3 G PRO. PER SERVING WITH SUBSTITUTE: Same
as above, except 104 cal., 9 g carb. (8 g sugars).
3⁄ 4
6 2 11⁄2 1 3⁄ 4 3⁄ 4
1 11⁄2
cup sugar* Tbsp. unsalted butter, softened Tbsp. refrigerated or frozen egg product, thawed tsp. vanilla cup all-purpose flour tsp. baking powder tsp. sea salt Tbsp. sugar** tsp. ground cinnamon
1. Line a cookie sheet with a silicone baking mat or parchment paper. In a bowl combine the first four ingredients (through vanilla). 2. In a bowl combine the next three ingredients (through salt). Add flour mixture to egg mixture; stir to combine. Cover; freeze for 10 minutes. 3. Preheat oven to 176°C. In a bowl combine the 1 tablespoon sugar and cinnamon. Shape dough into 12 balls. Roll in cinnamon-sugar; place on prepared cookie sheet. 4. Bake for 10 minutes or until edges are brown. Cool on cookie sheet for 5 minutes. Remove; cool on a wire rack. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use product amount 3 equivalent to ⁄4 cup sugar. If dough stiffens, omit freezing. Lightly press dough balls on cookie sheet. **SUGAR SUBSTITUTE: We do not recommend using a sugar substitute for the 1 tablespoon sugar. PER SERVING: 145 cal., 6 g total fat
(4 g sat. fat), 15 mg chol., 174 mg sodium, 22 g carb. (0 g fibre, 14 g sugars), 1 g pro. PER SERVING WITH SUBSTITUTE: Same
as above, except 127 cal., 15 g carb. (7 g sugars).
11⁄4 cups white whole wheat flour 2 Tbsp. unsweetened cocoa powder 3⁄ 4 tsp. sea salt 1⁄ 2 tsp. baking soda 1⁄ 4 cup unsalted butter, softened 3 Tbsp. sugar* 1⁄ 4 tsp. peppermint extract 1⁄ 3 cup unsweetened almond milk 3 Tbsp. chopped dark chocolate pieces 3 Tbsp. crushed regular or sugar-free peppermint candies (about 8 candies) 1. Line a cookie sheet with a silicone baking mat or parchment paper. In a bowl stir together the first four ingredients (through baking soda). 2. In a bowl beat the next three ingredients (through peppermint extract) with a mixer on medium until combined. Beat in almond milk. Beat in flour mixture just until combined. Stir in chocolate. 3. Shape dough into 12 balls; place on prepared cookie sheet. Cover and freeze for 10 minutes. 4. Preheat oven to 176°C. Press balls into 3-inch rounds. Bake for 10 to 12 minutes or until set. Immediately top with crushed candies. Cool on cookie sheet for 5 minutes. Remove; cool on a wire rack. This cookie is best enjoyed the day it is baked. *SUGAR SUBSTITUTE: We do not recommend using a sugar substitute. PER SERVING: 122 cal., 5 g total fat
(3 g sat. fat), 10 mg chol., 198 mg sodium, 18 g carb. (2 g fibre, 7 g sugars), 2 g pro. DiabeticLivingOnline.in
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FOOD
sweet tooth
The warmth of spices like cinnamon, nutmeg, and ginger turns these diabetesfriendly sweets into a forkful of comfort.
photos by Jason Donnelly food styling by Dianna Nolin
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Cin nam on-Ba nana Cake with Choc Ganache olate
recipe on page 90
DiabeticLivingOnline.in
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Bananas Foster Mini Pies
Bananas Foster Mini Pies 12 (1 mini pie each) 20 g or 19 g 30 minutes CHILL 1 hour 15 minutes per batch
SERVINGS
CARB. PER SERVING PREP BAKE
1⁄
3 cup butter, softened 1 Tbsp. granulated sugar* 1⁄ 4 tsp. salt 1 egg 2 Tbsp. cold water
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11⁄2 cups all-purpose flour 3⁄ 4 cup chopped banana (1 medium) 1⁄ 4 cup chopped pecans, toasted 1⁄ 4 cup sugar-free caramelflavour ice cream topping 1 Tbsp. bourbon 1⁄ 4 tsp. ground cinnamon 1 Tbsp. butter, melted 2 tsp. powdered sugar
1. Line two baking sheets with parchment paper. In a medium bowl beat 1 ⁄ 3 cup butter with a mixer on medium for 30 seconds. Add granulated sugar and salt; beat on medium for 3 minutes. Beat in egg and the water. Beat in flour. Cover and chill until dough is easy to handle (about 1 hour). 2. Preheat oven to 204°C. For filling, in a bowl combine the next five ingredients (through cinnamon). 3. On a lightly floured surface, roll dough until 1 ⁄ 8 inch thick. Using a 4-inch round cutter, cut out dough, rerolling scraps as needed. Place about 1 tablespoon of the filling in centre of each pastry circle. Brush edges of circles with a little water. Fold each circle in half over the filling; press edges with a fork to seal. Prick tops. Place pies on prepared baking sheets. Brush with 1 tablespoon melted butter. 4. Bake for 15 minutes or until light brown. Cool slightly. Sprinkle with powdered sugar and additional cinnamon. Serve warm. *SUGAR SUBSTITUTES: Choose Sugar Free Gold packets. Follow package directions to use product amount equivalent to 1 tablespoon granulated sugar. PER SERVING: 165 cal., 8 g total fat
(4 g sat. fat), 32 mg chol., 118 mg sodium, 20 g carb. (1 g fibre, 3 g sugars), 3 g pro. PER SERVING WITH SUBSTITUTE: Same
as above, except 161 cal., 19 g carb. (2 g sugars), 3 g pro.
ea h rbr ars Ginge M
recipe on page 90
dC upc ma akes llow with Fros ting
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n g a e r O C h r o e colate g n i G Tar t
recipe on page 90
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Almond Cannoli with Spiced Ricotta Cream Filling recipe on page 91
Spice Cake Roll with Cream Cheese Filling 12 (1 slice each) CARB. PER SERVING 27 g PREP 35 minutes CHILL 4 hours BAKE 12 minutes SERVINGS
1 recipe Cream Cheese Filling 3 cup all-purpose flour 1⁄ 4 cup whole wheat pastry flour or whole wheat flour 11⁄2 tsp. pumpkin pie spice 1 tsp. baking powder 1⁄ 4 tsp. salt 1⁄ 4 tsp. ground cloves 4 eggs, room temperature 1 tsp. vanilla 1⁄
1⁄
1⁄
2 cup full-flavour molasses
3 cup granulated sugar* Powdered sugar* (optional)
1. Prepare Cream Cheese Filling; chill as directed. 2. Meanwhile, preheat oven to 190°C. Grease a 15×10-inch baking pan. Line bottom of pan with waxed paper or parchment paper; grease paper. In a bowl stir together the next six ingredients (through cloves).
Spice Cake Roll with Cream Cheese Filling
3. Separate eggs. In a medium bowl beat egg yolks and vanilla with a mixer on high for about 5 minutes or until thick and lemon-coloured. Beat in molasses just until combined. 4. Thoroughly wash beaters. In a large bowl beat egg whites on medium until soft peaks form (tips curl). Gradually add granulated sugar, beating on high until stiff peaks form (tips stand straight). Fold yolk mixture into beaten egg whites. Sprinkle with flour mixture; fold in gently just until combined. Spread batter in prepared baking pan. 5. Bake for 12 to 15 minutes or until cake springs back when lightly touched. Immediately loosen cake edges from pan and turn cake out onto a towel sprinkled with powdered sugar; peel off paper. Roll towel and cake into a spiral, starting from a short side of the cake. Cool on a wire rack. 6. To assemble, unroll cake; remove towel. Spread cake with filling to within 1 inch of the edges. Roll up cake; trim ends. Cover and chill up to 6 hours. If desired, sprinkle with powdered sugar before serving.
CREAM CHEESE FILLING: In a heavy
medium saucepan stir together 1⁄ 4 cup granulated sugar* and 1 tablespoon cornstarch. Gradually stir in 1 cup fat-free milk. Cook and stir over medium heat until thickened and bubbly. Cook and stir 1 minute more. Gradually stir about half of the hot mixture into 2 lightly beaten egg yolks. Return yolk mixture to remaining hot mixture in saucepan. Bring just to boiling; reduce heat. Cook and stir 2 minutes. Remove from heat. Add 170gm reduced-fat cream cheese (Neufchâtel), cut up and softened, and 1 teaspoon vanilla. Let stand for 5 minutes. Stir until smooth. Place bowl with filling in a larger bowl of ice water; let stand 5 minutes, stirring occasionally. Cover surface with plastic wrap; chill for at least 4 hours. *SUGAR SUBSTITUTES: We do not recommend using sugar substitutes for this recipe. PER SERVING: 180 cal., 6 g total fat
(3 g sat. fat), 104 mg chol., 175 mg sodium, 27 g carb. (0 g fibre, 21 g sugars), 5 g pro.
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Cinnamon-Orange Pumpkin Bread Pudding 8 (2⁄3 cup each) CARB. PER SERVING 23 g or 21 g PREP 25 minutes BAKE 50 minutes STAND 15 minutes SERVINGS
5 cups 1⁄2-inch cubes light oatmeal or whole wheat bread (about 7 slices) Nonstick cooking spray 1 orange 2 cups fat-free milk 1 cup canned pumpkin 3⁄ 4 cup refrigerated or frozen egg product, thawed, or 3 eggs, lightly beaten 3 Tbsp. granulated sugar* 1 tsp. ground cinnamon 1⁄ 3 cup light cream cheese spread, softened 1 Tbsp. light stick butter (not margarine), softened 3 Tbsp. powdered sugar*
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1. Preheat oven to 148°C. Arrange bread cubes in a single layer in a shallow baking pan. Bake for 10 to 15 minutes or until dry, stirring once or twice. Cool (cubes will continue to dry as they cool). 2. Increase oven temperature to 176°C. Coat a 1.8 litre shallow baking dish with cooking spray. Arrange dry bread cubes in prepared dish. 3. Remove 1 teaspoon zest and squeeze 2 tablespoons juice from orange. In a large bowl combine orange zest and the next five ingredients (through cinnamon); pour over bread cubes. Gently press bread down into liquid to moisten. Let stand for 15 minutes. 4. Bake for 40 to 45 minutes or until a knife comes out clean. Cool slightly on a wire rack.
5. Meanwhile, in a small bowl beat cream cheese and butter with a mixer on medium until smooth. Gradually beat in powdered sugar and enough of the orange juice to reach drizzling consistency. Drizzle over warm bread pudding. *SUGAR SUBSTITUTES: Choose Sugar Free Gold. Follow package directions to use product amount equivalent to 3 tablespoons granulated sugar. We do not recommend a substitute for the powdered sugar. PER SERVING: 142 cal., 3 g total fat
(2 g sat. fat), 8 mg chol., 211 mg sodium, 23 g carb. (1 g fibre, 13 g sugars), 7 g pro. PER SERVING WITH SUBSTITUTE: Same
as above, except 135 cal., 21 g carb, (10 g sugars).
Date Coo e l p a M Cinnam kies with on-E spresso rosting F recipe on page 91
COZY SPICED DESSERTS Continued from page 83
Cinnamon-Banana Cake with Chocolate Ganache 16 (1 slice each) 34 g or 27 g PREP 15 minutes BAKE 45 minutes COOL 10 minutes SERVINGS
CARB. PER SERVING
2 cups all-purpose flour 1⁄ 2 cup whole wheat pastry flour 1⁄ 2 cup granulated sugar* 1⁄ 2 cup packed brown sugar* 11 ⁄4 tsp. baking powder 1 tsp. ground cinnamon 1⁄ 2 tsp. baking soda 1⁄ 2 tsp. salt 3⁄ 4 cup fat-free milk 2⁄ 3 cup mashed bananas (2 medium) 1⁄ 2 cup refrigerated or frozen egg product, thawed, or 2 eggs, lightly beaten 1⁄ 4 cup canola oil 1 tsp. vanilla 85 g dark chocolate, chopped 1⁄ 4 cup fat-free half-and-half 1. Preheat oven to 162°C. Generously grease and flour a 10-inch fluted tube pan. In a large bowl stir together the first eight ingredients (through salt). 2. In a medium bowl combine the next five ingredients (through vanilla). Add egg mixture all at once to flour mixture. Beat with a mixer on medium to high for 2 minutes. Spread batter in prepared pan. 3. Bake for 45 to 55 minutes or until a toothpick comes out clean. Cool in pan for 10 minutes. Remove; cool on a wire rack. 4. For ganache, in a small bowl microwave chocolate and half-and-half on 50% power (medium) for 1 minute. Let stand for 5 minutes. Stir until smooth. Let stand until slightly thickened. Spoon over cake. *SUGAR SUBSTITUTES: Choose Sugar Free Gold to substitute for the granulated sugar and Organic Tattva Brown Sugar to substitute for the brown sugar. Follow package directions to use product amounts 1 equivalent to ⁄2 cup each granulated sugar
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and brown sugar. PER SERVING: 197 cal., 5 g total fat (1 g sat. fat),
1 mg chol., 177 mg sodium, 34 g carb. (2 g fibre, 17 g sugars), 4 g pro.
PER SERVING WITH SUBSTITUTE: Same as
above, except 177 cal., 27 g carb, (10 g sugars).
Gingerbread Cupcakes with Marshmallow Frosting 15 (1 cupcake each) 26 g or 24 g 15 minutes 15 minutes COOL 5 minutes
SERVINGS
CARB. PER SERVING PREP BAKE
Nonstick spray for baking cup butter, softened 2 Tbsp. light stick butter (not margarine), softened 1⁄ 4 cup sugar* 2 tsp. pumpkin pie spice 11 ⁄2 tsp. baking powder 1⁄ 4 tsp. baking soda 1⁄ 2 cup refrigerated or frozen egg product, thawed, or 2 eggs, lightly beaten 1 cup water 1⁄ 2 cup mild-flavor molasses 3⁄ 1 4 cups all-purpose flour 85 g reduced-fat cream cheese (Neufchâtel), softened 2 Tbsp. butter, softened 1⁄ 2 cup marshmallow creme
cups for 5 minutes. Remove; cool on a wire rack. 5. For frosting, in a medium bowl beat cream cheese and the 2 tablespoons butter until smooth. Stir in marshmallow creme. Spread on top of cupcakes. Sprinkle with additional pumpkin pie spice. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use 1 product amount equivalent to ⁄4 cup sugar. PER SERVING: 174 cal., 7 g total fat (4 g sat. fat),
18 mg chol., 150 mg sodium, 26 g carb. (1 g fibre, 12 g sugars), 3 g pro.
PER SERVING WITH SUBSTITUTE: Same as
above, except 169 cal., 24 g carb, (10 g sugars).
1⁄ 4
1. Preheat oven to 176°C. Line fifteen 21 ⁄2-inch muffin cups with paper bake cups; lightly coat bake cups with nonstick spray. 2. In a large bowl beat the 1 ⁄4 cup butter and the light butter with a mixer on medium for 30 seconds. Add the next four ingredients (through baking soda). Beat until combined, scraping bowl occasionally. Beat in egg. 3. In a medium bowl combine the water and molasses. Add flour and molasses mixture alternately to butter mixture, beating on low after each addition just until combined. Spoon batter into prepared muffin cups, filling about two-thirds full. 4. Bake for 15 to 20 minutes or until a toothpick comes out clean. Cool in muffin
Ginger-Orange Chocolate Tart 12 (1 slice each) 27 g or 23 g 30 minutes 10 minutes CHILL overnight
SERVINGS
CARB. PER SERVING PREP BAKE
11 ⁄4 cups finely crushed reduced-fat cake crumb squares (about 18) 3 Tbsp. sugar* 1⁄ 2 tsp. ground ginger 3 Tbsp. butter, melted 1 egg white 6 Tbsp. sugar* 1⁄ 4 cup unsweetened cocoa powder 1⁄ 8 tsp. salt 3⁄ 4 cup fat-free half-and-half 4 egg yolks, lightly beaten 1 Tbsp. butter 1⁄ 2 tsp. vanilla 4 medium Cara Cara, navel, and/or blood oranges, peeled and sliced 6 fresh kumquats, thinly sliced (optional) 2 Tbsp. sugar-free orange marmalade, melted 28 g dark chocolate curls 1. Preheat oven to 176°C. For crust, in a medium bowl combine the first three ingredients (through ginger). Combine melted butter and egg white; stir into crumb mixture. Press onto bottom and sides of an 8-inch tart pan with a
removable bottom. Bake for 10 minutes; cool on a wire rack. 2. For filling, in a small heavy saucepan combine the next three ingredients (through salt). Stir in half-and-half. Bring just to simmering over medium heat, stirring constantly. Gradually stir about 1 ⁄2 cup of the hot mixture into egg yolks. Return yolk mixture to remaining hot mixture in saucepan. Bring to a gentle boil, stirring constantly. Remove from heat. Stir in the 1 tablespoon butter and the vanilla. Pour filling into crust-lined pan. Cover surface with plastic wrap and chill overnight. 3. Before serving, arrange orange slices and, if desired, kumquat slices on tart and brush with melted marmalade. Top with chocolate curls. Remove sides from pan. *SUGAR SUBSTITUTE: Choose Sugar Free Gold. Follow package directions to use product amounts equivalent to 3 tablespoons and 6 tablespoons sugar. PER SERVING: 182 cal., 8 g total fat (4 g sat. fat),
72 mg chol., 131 mg sodium, 27 g carb. (2 g fibre, 19 g sugars), 3 g pro.
PER SERVING WITH SUBSTITUTE: Same as
above, except 168 cal., 23 g carb, (14 g sugars).
Almond Cannoli with Spiced Ricotta Cream Filling 12 (1 filled cannoli each) 15 g 45 minutes 5 minutes per batch
SERVINGS
CARB. PER SERVING PREP BAKE
2 egg whites 3 cup sugar* 3 Tbsp. all-purpose flour 3 Tbsp. ground almonds 1⁄ 8 tsp. salt 2 Tbsp. olive oil or almond oil 1⁄ 2 tsp. vanilla 226 g fat-free cream cheese, softened 113 g reduced-fat cream cheese (Neufchâtel), softened 3 Tbsp. honey 1⁄ 2 tsp. apple pie spice 11 ⁄4 cups light or part-skim ricotta cheese 2 Tbsp. chopped almonds, toasted 1⁄
1. Preheat oven to 190°C. Line a large baking sheet with parchment paper. In a
medium bowl beat egg whites with a mixer on medium to high for about 20 seconds or until foamy. Add sugar; beat 1 minute. Sprinkle with the next three ingredients (through salt); fold in gently. Drizzle with oil and vanilla; fold in gently. 2. Drop batter in 11 ⁄2-tablespoon portions about 6 inches apart onto prepared baking sheet; spread to 4-inch circles. Bake for 5 to 7 minutes or until bottoms are light brown. 3. Immediately loosen cannoli from baking sheet. Turn over and wrap around metal cannoli cones or the straight metal handle of a whisk or honing steel; cool slightly. (If the cannoli becomes too stiff to roll, return briefly to oven to soften.) While still warm, remove from cones and cool, seam sides down, on a wire rack. 4. For filling, in another medium bowl beat cream cheese on medium until smooth. Beat in honey and apple pie spice. Gently fold in ricotta. Cover and chill until needed. 5. To serve, pipe or spoon filling into cannoli shells. Sprinkle ends with chopped almonds. Serve immediately. NOTE: If you prefer, substitute 12 full-size or 24 miniature purchased cannoli shells for homemade shells. Prepare filling and fill as directed. *SUGAR SUBSTITUTE: We do not recommend using a sugar substitute for this recipe. TO MAKE AHEAD: Prepare cannoli shells and filling as directed. Place shells in an airtight container and store at room temperature for up to 3 days. Place filling in an airtight container and chill for up to 3 days. To serve, let the filling stand at room temperature for 30 minutes to soften slightly. Fill shells as directed. PER SERVING: 150 cal., 7 g total fat (2 g sat. fat),
16 mg chol., 209 mg sodium, 15 g carb. (0 g fibre, 12 g sugars), 7 g pro.
Maple-Date Cookies with Cinnamon-Espresso Frosting 28 (1 cookie each) 23 g or 21 g 30 minutes 8 minutes per batch
SERVINGS
CARB. PER SERVING PREP BAKE
1⁄ 2 1⁄ 2
cup butter, softened cup packed brown sugar*
1⁄ 2
tsp. baking soda Dash of salt 1⁄ 3 cup pure maple syrup 2 Tbsp. refrigerated or frozen egg product, thawed 1⁄ 2 tsp. vanilla 12 ⁄3 cups all-purpose flour 1⁄ 3 cup whole wheat pastry flour 1⁄ 3 cup finely snipped pitted whole dates 1 recipe Cinnamon-Espresso Frosting 1. Preheat oven to 176°C. Lightly grease a cookie sheet. In a medium bowl beat butter with a mixer on medium for 30 seconds. Add the next three ingredients (through salt). Beat until combined, scraping bowl as needed. Beat in the next three ingredients (through vanilla). Beat in both flours. Stir in dates. 2. Drop dough by teaspoons 2 inches apart onto prepared cookie sheet; flatten slightly. Bake for 8 to 10 minutes or until edges are light brown. Remove; cool on a wire rack. 3. Spread cookies with CinnamonEspresso Frosting. If desired, sprinkle with additional cinnamon and/or coffee powder. CINNAMON-ESPRESSO FROSTING: In a medium bowl stir together 2 teaspoons hot water and 1 teaspoon instant espresso coffee powder until powder is dissolved. 1 Add ⁄4 cup butter, cut up and softened; 1 1 cup powdered sugar;* and ⁄4 teaspoon ground cinnamon. Beat with a mixer until smooth. Beat in 1 cup additional powdered sugar.* Beat in additional 1 water, ⁄2 teaspoon at a time, to reach spreading consistency. *SUGAR SUBSTITUTE: Choose Organic Tattva Brown Sugar to substitute for the brown sugar. Follow package directions to use 1 product amount equivalent to ⁄2 cup brown sugar. We do not recommend using a substitute for the powdered sugar. PER SERVING: 141 cal., 5 g total fat (3 g sat. fat),
13 mg chol., 73 mg sodium, 23 g carb. (1 g fibre, 16 g sugars), 1 g pro. PER SERVING WITH SUBSTITUTE: Same as
above, except 135 cal., 21 g carb, (14 g sugars). DiabeticLivingOnline.in
91
PREDICTION
tarot
Tarot forecast for Jan-Feb 2016
ARIES
TAURUS
GEMINI
Card of the Period: Strength
Card of the Period: The Hermit
Card of the Period: The Chariot
This is a time for making yourself feel comfortable. If there is something on your mind that you need to unload, ask a friend to lend an ear. If you have an ailment that needs to be taken care of, make the doctor’s appointment at the earliest. If you feel that you need more aerobic exercise than you’ve been giving yourself, make time now to get your first good long run or yoga class and feel the benefit of those deep breaths balancing out your body’s energy. Since Arians are demanding, energetic, and busy, they wish a proportionate diet to preserve body fitness and vigour for work.
You are bound to gain attention in its varying forms, but you are not always sensitive to it. To counteract the reactions that may catch you off guard, be aware of your diet this time. You are advised not to skip meals. Eat balanced, nutritious meals that get along with your taste buds and your internal organs. Plenty of water will help keep you grounded and at the same time make you feel fresh. Be aware of intake of processed sugar. Avoid snacking or other unconscious behaviours which in turn can create chaos. Taureans should avoid heavy and rich food.
You often make statements that are more profound than you are aware of, leading people to expect more from you than you realise. If you feel a little out of touch with yourself, invite yourself for an evening at home. Make yourself the healthiest dinner you know how. Draw a hot bath and get to bed early with your favourite reading material. This will help you to know where you stand, and to re-establish the bond with yourself - thus making you more self-aware. Gemini people tend to eat on the run and are infamous junk food buffs. Avoid junk food more often.
CANCER
LEO
VIRGO
Card of the Period: The Fool
Card of the Period: Justice
Card of the Period: The Lovers
When you feel unbalanced it’s a little more upsetting for yourself than it is for others. For instance, when you break the routine in your exercise practice you tend to feel the effects quite strongly affecting you badly. You can use this sensitivity constructively. If you need to start on a health routine again and are facing trouble getting motivated, all you need to do is start and the energy rush you will get will make you complete your goals right away. Use this momentum to build a health regimen. Fresh vegetables, fresh fruit, and lean protein are necessary for the Cancerian.
92 Diabetic Living
jan-feb 2016
This is the right time to move away from consuming sweets so as to maintain your health. You will get excited by what you ingest but try to be calm and patient. Sugar and preservatives are among the greatest triggers for you so the high alert has already started. Your stars dominate the emotional territory so it is best to stay at a respectful distance from all that ‘winds you up.’ On the other hand, what releases pent up energy is highly recommended now. Exercise, meditation, sound sleep, Yoga - choose your source of relaxation to gain momentum!
The stars really favour the sensually oriented ones. Your body is your temple, and it’s great to worship it! Try to prepare your food as ‘Sattvik’ as it can be : include more of fresh fruits, oats, almonds, lemons, whole grains, adding your favourite flavours, oranges and bananas. Your body is a sacred ornament, polish it within as well as outside with exercise. Yoga massages your internal organs and soothes you mentally as well. You may also try some exfoliating baths like those with oats and chopped pear is a great mixture to bring into the water and see the effects.
Manisha Koushik (Astrologer, Tarot Card Reader, Numerologist, Vastu & Fengshui Consultant) Email:
[email protected] Url: http://www.askmanisha.com Contact: +91-11-26449898, 26489899
LIBRA
SCORPIO
SAGITTARIUS
Card of the Period: Death
Card of the Period: The Hanged Man
Card of the Period: The Devil
The cards create a tension that you might feel in your stomach area. This does not necessarily mean a stomach ache but it is more of a sign like a weakening of the will to eat everything right and crave for junk. This aspect can present itself in a variety of ways: over-sleeping, over-eating or ‘forgetting’ to express your emotional truth to those who matter. To counter these detrimental forces, concentrate on sticking to healthy habits like drinking plenty of water and detoxifying your body with a fruit and salad diet over the next few weeks.
Generally remember that you sleep well! We must not forget to adjust our sleeping habits consciously so that we are insured of good rest as well keeping health in concern. If needed, change your bed or mattress or quilt or maybe, a pillow! Whatever it may be to bring you that new feeling of lightness. Strive hard to perfect your sleeping area as guided. Everything must be according to as you like it. This is one area of life that should not be economised and you can’t compromise on. For food, Scorpions should indulge in calcium and protein-rich food.
This is going to be a period of accomplishments where you may inevitably see the pattern of ending up where you started but with greater selfawareness along with great confidence. Caring for yourself and your body is a way of constantly adapting to change while greeting ‘the new’ optimistically. Our diet is our best prevention against disease and staying fit; exercise is our best weapon against depression and laziness; and good sleep is our best way to feel truly self-centred. Concentrate on developing these skills to the fullest as much as you can.
CAPRICORN
AQUARIUS
PISCES
Card of the Period: The Tower
Card of the Period: Eight of Pentacles
Card of the Period: Four of Cups
The card for this period brings a lot of energy and shows you that you need to engage your mind to manage your body accordingly. Focus is what is required the most to win any challenge. Discipline is the next ingredient. If you learn to use the combination of both you can excel in anything you do. Use your mind to convince yourself to get your running shoes on, to prepare a healthy regime, or to get up and refill your water glass to start a fresh and healthy day. Capricorns are known for their durability!
It’s never too late to make the things going wrong to work in the right directions. The cards in this period, lights up the path you have been waiting for to inspire you to make way for new opportunities of life. Indeed, your inner voice will tell you something and it is in your best interest to listen to it carefully. Calming and relaxing exercises will help you perform better. Yoga, Pilates, stretching, lifting weights - whatever you do makes you feel better. Hot baths can also be the punch to the health regime for you.
Quite often you get confused about not knowing which voice to listen to. There is no ‘right’ or ‘wrong’, so be confident in whatever you do. Kick off the uncertainties in your life and learn to bring consensus to what you wish to choose. To help yourself in acquiring security in this insecure world, it is important to ground yourself in a consistent exercise regimen. This will help you psychologically as well as physically. Consistency and discipline will set you free from all such hurdles coming in your way!
DiabeticLivingOnline.in
93
INDIA
INDIA’S FIRST MAGAZINE ABOUT DIABETES
India’s first magazine about diabetes JAN-FEB 2016
diabeticlivingonline.in
`100
Winter
proof yourself this season CHOCOLATE
TART more
7 Roasted Salmon &
for your sweet tooth
with white bean ragout
TOP 19 QUESTIONS for every diabetic & their concrete answers
reader survey
?
how can we help you
thrive with diabetes?
Please take a few minutes to tell us what you think about this magazine. Then fold the survey, place it in an envelope, and mail (address on opposite side). Your comments will help us meet your needs as you live with diabetes.
1
2
Where did you get this issue of Diabetic Living magazine? At home A store Friend or family member Doctor’s office or clinic Other _____________________ Why are you interested in reading about diabetes? Please check all that apply. I have type 2 diabetes For how long?_________ I have type 1 diabetes For how long?_________ I have pre-diabetes (elevated blood glucose) My child has diabetes I am the caregiver for an adult with diabetes Diabetes runs in my family I am a medical professional
name address city
state
pin
e-mail
3
Where else do you find diabetes education/support? Please check all that apply. Diabetes education class(es) Registered dietitian Family doctor Endocrinologist In-person support group Online support group/community Magazines/books Videos/DVDs Online Other ________________________
6
How often do you look for diabetes or other health information online? Daily Weekly Monthly Less than once a month I have never looked online for diabetes information (please go to question 9).
7
Please list the top three diabetes or health websites you visit. 1.
4
What information do you feel has been missing from your diabetes education?
5
Where do you access the Internet? Please check all that apply. At home At work Through a mobile device At the public library I do not have Internet access (please go to question 9).
2. 3.
8
Which of the following would you like to read most in Diabetic Living? high interest
low/no interest
moderate interest
Diabetes medical news and research Everyday recipes 30-minute (or less) recipes Low-carb recipes Low-sodium recipes Special-occasion recipes Holiday recipes Recipes for two Dessert recipes What/how much to eat Getting started (newly diagnosed) Medication and treatments Diabetes procedures and tests Weight loss Easy exercises Reducing blood glucose and/or A1C Pain management How to avoid complications Mentally coping with diabetes Reducing stress Diabetes products and services Inspiration from people with diabetes Other
9
Is there anything else you’d like to tell us?
Yes, the editors of Diabetic Living magazine may contact me for more information.
Please indicate your level of agreement with the following statements that describe your feelings about Diabetic Living. agree neither agree disagree disagree agree completely
somewhat
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The magazine is well-organised Articles do not give me enough information Articles are colorful and attractive The text size is too small to read The text size is easy to see and to read Stories inform and educate me Stories inspire me to take self-care actions Stories encourage me to talk to my doctor or health care provider I can get the same information elsewhere The magazine keeps me up-to-date on the newest information about diabetes The articles are difficult to understand The stories are realistic for someone with diabetes The magazine shows/describes people I can relate to
Thank you! We appreciate your feedback.
Fold and mail this survey in an envelope addressed to:
Diabetic Living Survey TCG Media Limited, 101, Arunachal Building, 19 Barakhamba Road, New Delhi-110001
completely
India’s first magazine about diabetes JAN-FEB 2016
diabeticlivingonline.in
`100
Winter
proof yourself this season CHOCOLATE
TART more
7 Roasted Salmon &
for your sweet tooth
with white bean ragout
TOP 19 QUESTIONS for every diabetic & their concrete answers
Subscribe to the online version of diabetic living tcg.media/subscribe
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