WHAT’S A NORMAL BLOOD SUGAR LEVEL? FIND OUT!

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AUGUST 2018
“Always know
your glucose
level and where
it’s heading
with just
a glance
at your
smartphone
or watch.” †

Anita V., T1D

 INTRODUCING
THE NEW DEXCOM G6.
®

NO FINGERSTICKS.
*

Smartphone compatibility† 10-day sensor wear

‡
Water-resistant wearable Alerts and alarms
Small sensor Share glucose data§
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*
If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter
to make diabetes treatment decisions.
†For a list of compatible devices, visit www.dexcom.com/compatibility. ‡The Dexcom G6 Sensor and Transmitter are water-resistant and may be submerged under eight feet
of water for up to 24 hours without failure when properly installed. §Separate Follow app required. Available by prescription only. Failure to use the Dexcom G6 Continuous
Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-
information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe
hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. If your glucose alerts and
readings from the G6 do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Seek medical advice and attention when appropriate,
including for any medical emergency.

© 2018 Dexcom Inc. All rights reserved. This product is covered by U.S. patent. LBL016049
 CONTENTS JULY/AUGUST 2018

What is a Normal Blood

14 Sugar Level?
A guide to successful
management
David Spero, BSN, RN
29
16 Insulin 101 Diabetic
Concentration, safety and more
by Laura Hieronymus, DNP,
Cooking
MSEd, MLDE, BC-ADM, CDE,
Kristen Stakelin, MD, MLDE, CDE,
and Scott Kincaid, PharmD, BCPS DEPARTMENTS
5 Editor’s Letter
Summer Day Trip
20 Planned?
6 News & Notes
7 Resources:
Read our tips Take a Hike
By Shana Cunningham MSN, RN,
MLDE, BC-ADM, CDE and
8 Quiz: How much
Laura Hieronymus DNP, MSEd, RN,
do you know about
MLDE, BC-ADM, CDE, FAADE
diabetes and stress?
12 Definitions
Protect Your Skin 13 Diabetes Q&A
24 Tips and treatments 54 Supermarket Smarts
By Amy Campbell, MS, RD, LDN, CDE Cheese
62 Product Spotlight
Diabetic Neuropathy Enlightened Ice Cream and
26 Warning signs, treatment and FRIO® Insulin Cooling Cases
prevention strategies
by Kurt Ullman CORRECTION: In our April issue,
Supermarket Smarts listed a serving size
Cover image: Photographed by Angel Tucker; of 1 cup for raisins, however, a serving size
food prepared by Maggie Mulvena is ¼ cup. We apologize for the oversight.

WEIGHT SELF-MANAGEMENT PAGE 43

44 Nuts and Bolts 56 Your Weight
of Dietary Iron Taking Control of Your Moods
Tips to find balance and Your Weight
By Amy Campbell, MS, RD, By Nicola Davies, PhD
LDN, CDE
58 Food for Thought
48 There’s an App for That!
Sauces and Marinades
Technology tools you can use By Alison Massey, MS, RD, LDN, CDE
By Alison Massey MS, RD, LDN, CDE
Shutterstock/Africa Studio

60 Take 5
50 Light Lunches
Pushing and Pulling Your Weight
Five choices for your midday By Laurel Dierking, M.Ed.,
meal—all under 250 calories! NFPT, 200-YTT

2 July/August 2018
Do you have type 2 diabetes and take multiple insulin shots each day?

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V-Go is a registered trademark of Valeritas, Inc.

ART-1024 Rev C 9/2017 ©2017 Valeritas, Inc.
 EXECUTIVE
Chairman & Chief Executive Officer
Jeffrey C. Wolk
Chief Operating Officer
Susan Fitzgerald
SVP, Sales & Marketing
Robin Morse EDITORIAL SALES & MARKETING
Editorial Director, Wellness Division Vice President, Media Solutions
Maureen McCarthy Stuart Crystal | scrystal@madavor.com
OPERATIONS
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Technical Product Manager
Robert S. Dinsmoor Client Services
Michael Ma Joseph Gustaitis clientservices@madavor.com
Operations Supervisor Lea Ann Holzmeister, RD, CDE
Marketing Director
Alison Massey, MS, RDN, LDN, CDE
Nora Frew Andrew Yeum
Gary Scheiner, MS, CDE
Operations Coordinator Frieda Wiley, PharmD, CGP, RPh Marketing Associates
Paul Wynn Michael Marzeotti, Summer Whittaker
Kianna Perry
Human Resources Generalist ART & PRODUCTION CUSTOMER SERVICE
Alicia Roach Art Director CustomerService@DiabetesSelf-Management.us
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Jessica Krogman Senior Digital Designer
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Client Services Senior Designer
Cheyenne Corliss Scott Brandsgaard
Darren Cormier
Tou Zong Her
Andrea Palli
EDITORIAL BOARD
Accounting Director
Amy P. Campbell, William H. Polonsky, PhD, CDE Bernard P. Shagan, MD
Amanda Joyce
MS, RD, LDN, CDE Assistant Clinical Professor, Director, Diabetes Education Center,
Accounts Payable Associate Boston, Massachusetts. Department of Psychiatry, University Monmouth Medical Center,
Tina McDermott of California, San Diego. Long Branch, New Jersey.
David E. Goldstein, MD
Accounts Receivable Associate Professor Emeritus, University of Missouri L. Raymond Reynolds, Richard M. Weil, Med, CDE
Wayne Tuggle Health Science Center, Columbia, Missouri MD, FACP, FACE, ECNU Exercise Physiologist and Director,
Professor Emeritus, Division of Mount Sinai St. Luke’s Weight
Lois Jovanovic, MD Endocrinology, University of Kentucky Loss Program, Mount Sinai St. Luke’s
AUDIENCE DEVELOPMENT Physician Consultant, Sansum College of Medicine, Lexington, Kentucky Hospital, New York, New York
Diabetes Research Institute,
VP, Audience Development Santa Barbara, California. Jeanne L. Rosenthal, MD Susan Weiner,
Attending Surgeon, Retinal Service, MS, RDN, CDE, CDN
Bob Dortch Virginia Peragallo-Dittko, New York Eye and Ear Infirmary, Owner, Susan Weiner Nutrition, PLLC,
VP, Strategy APRN, BC-ADM, MA, CDE, New York, New York. Long Island, New York.
Jason Pomerantz Executive Director, Diabetes and Obesity
Institute, Winthrop-University Hospital, Sheri Setser-Legg, Stephen Z. Wolner, DDS
Mineola, New York. MS, RD, LD, MLDE, CDE New York, New York.
Diabetes Education Service Coordinator
CONTENT DEVELOPMENT UK HealthCare Barnstable Brown
Strategic Content Director Diabetes Center, University of Kentucky,
Lexington, Kentucky
Peter Madden
Content Marketing Associates
CONTRIBUTING EDITORS
Anthony Buzzeo
Tim Doolan Jean Betschart Roemer, Laura Hieronymus, DNP, MSEd, RN, Nancy Cooper, RD, CDE
MSN, MN, CPNP, CDE, MLDE, BC-ADM, CDE, FAADE International Diabetes Center,
Pediatric Nurse Practitioner, Associate Director, Education & Quality Minneapolis, Minnesota.
Newsstand Distribution Children’s Hospital of Pittsburgh, Services, UK HealthCare, Barnstable
Pittsburgh, Pennsylvania. Brown Diabetes Center, University of Robert S. Dinsmoor
National Publisher Services South Hamilton, Massachusetts.
Kentucky, Lexington, Kentucky.

Diabetes Self-Management, July/August 2018, Volume 35,
Number 4. Diabetes Self-Management (ISSN 0741-6253)
(USPS 003-865) is published bimonthly by Madavor Media,
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4 July/August 2018
 EDITOR’S
NOTE
Cool, Cool Summer
ummer is in full swing, and it is truly an exciting time here at Diabetes
S
Self-Management. As a trusted source of diabetes news and information,
our goal is to fill our pages with expert advice, research news, medication
updates, and the lifestyle, nutrition and weight management tools you
need to carry you through your diabetes journey. This commitment is
also the foundation for the Diabetes Self-Management website.
I am proud to announce DiabetesSelfManagement.com
was named a 2018 Best Diabetes Blog by health information

2D0IA1BE8TEB ESGT website Healthline and medication tracker app MyTherapy. Both
S BLOEN organizations recognized DiabetesSelfManagement.com as a reliable
RE CI PI T
AWARD
and authoritative source of information for those living with diabetes.
For readers new to our website, we encourage you to dive in
and gain access to a library of nearly 900 diabetes-friendly recipes
and a wealth of educational tools including videos, expert-authored
articles, free e-books and so much more.
In addition to providing easy-to-understand content via our magazine
and website, we also understand the importance of connecting with others.
Our Facebook group is open 24/7 with over 150,000 followers just like you.

In this issue
Summer is filled with vacations, day trips and outdoor excursions. With each
adventure, preparation is critical for those managing diabetes. In this issue,
you will learn how to plan for a hike and other day trips and get helpful tips
to protect your skin this summer season.
As promised, the Diabetic Cooking section is a go-to for diabetes-friendly
recipes. The “keep it cool” theme is tailor-made for those looking appease
a craving for frozen yogurt, ice cream, sherbet and more (pg. 32).
With diabetes education in mind, we answer to the question, “What is a normal
blood sugar level?” (pg. 14), offer a diabetic neuropathy symptom checklist with
pain relief options and prevention tools (pg. 26) and share expert advice about
various insulin concentrations in “Insulin 101” (pg. 16).
Again, welcome to the summer issue of Diabetes Self-Management. I hope
you learn something new and share your learnings with others.

Kindly,
Background: Shutterstock/Lidiya Oleandra; Ribbon: Shutterstock/gusenych

Maureen McCarthy
Editor-in-Chief

Twitter:
@ManageDiabetes
Facebook:
@DiabetesSelfManagement
DiabetesSelfManagement.com 5
NEWS &
NOTES
METFORMIN FOR CHILDREN
A dults with diabetes have been suc-
cessfully using the drug metformin
to lower blood sugar for many years. But
is it suitable for children? According to a
new study from scientists at the University
of Adelaide in Australia, it just might be.
The researchers studied 90 children
ranging in age from eight to 18 who had
Type 1 diabetes. They randomly assigned
participants to one of two groups. For 12
months, the first group was given metformin
(up to one gram twice a day), and the
second group received a placebo/an
inert substance). The children tended to
be heavier than average, but most were
not overweight.
After the year was up, the children
were tested by a procedure called glyc-
eryl trinitrate‐mediated vascular dilation,
which is used to assess the health of the
blood vessels. The researchers used the
test because children with Type 1 diabetes
often have impaired vascular function.
The results showed that the metformin
6 July/August 2018
group had improved by 3.3. percentage
points, which the researchers considered
significant. The children were also given
an HbA1c test, which measures the level of
blood glucose over the preceding several
weeks, and the researchers determined
that the metformin group had lower sugar
levels than the placebo group. Finally, the
results showed the total insulin dose fell
by a mean 0.2 units per day among the
metformin group. It was noted, however,
that the children in the metformin group
experienced more gastrointestinal side
effects. Whether the children had entered
puberty did not affect the results.
The researchers were not quite ready
to recommend metformin for all children
with diabetes, saying that the results of
their study “warrant further consideration
of its use,” but they did note that metfor-
min’s “combination of improved metabolic
control and a lower insulin dose require-
ment is particularly relevant” to children
with Type 1 diabetes. †
Reversing
Diabetes through
Weight Loss
ype 2 diabetes can be reversed,
T according to a new study pub-
lished in the British medical journal
Lancet. The secret? Weight loss.
The researchers, who were
from the University of Glasgow in
Scotland, recruited 306 people with
Type 2 diabetes from various medi-
cal practices throughout the United
Kingdom. The subjects ranged in age
from 20 to 65 and had had diabetes
for no more than six years. None
were using insulin. Researchers then
assigned 149 of the participants to
follow what they called a “Coun-
terweight-Plus weight management
program." The program began with
a three-month period in which the
subjects’ daily food intake was cut by
about 800 calories. Physical activities
went unchanged. The total interven-
tion lasted one year.
After the year was up, the
researchers discovered that 46
percent of those in the dietary
intervention group were able to
achieve remission of Type 2 diabe-
tes, compared to only four percent
in the control group. And the more
weight the subjects lost, the more
impressive the results. Those who
gained weight had a zero-percent
remission rate. Those who lost
0-11 pounds had a seven percent
rate; 11-22 pounds brought a 34
percent remission rate; 22 to 33
pounds meant a 57 percent rate;
and the remission rate for those
who lost 33 pounds or more was a
whopping 86 percent.
The researchers plan to fol-
low their subjects for at least four
more years to see how they fare
in the longer term. But for now,
the results are most heartening for
those scientists seeking a “non-
pharmacological” approach to
treating diabetes. According to
Shutterstock/Sergey Novikov
Michael E. J. Lean, MD, one of the
authors, “Our findings suggest that
even if you have had Type 2 diabe-
tes for six years, putting the disease
into remission is feasible.Ӡ
 NEWS &
NOTES
DIABETES
RESOURCES
Hiking
for Health
I f you’re interested in an active sum-
mer, hiking might be just the exer-
cise for you. If you’re relatively new
to hiking, don’t be intimidated by the
image of backpackers climbing the
Rocky Mountains. The reality is that
hiking can be as mild or rigorous as
you choose – depending on the trail
and distance. Hiking is ideal exercise
for individuals with diabetes of all
ages even if you haven’t exercised
in a while.
Beneits of hiking
Besides helping to control blood
glucose levels, hiking offers numer-
ous other health benefits. Like many
aerobic exercises, hiking improves
your stamina, flexibility and muscular
fitness. Hiking also stimulates bone
strength and slows bone density loss. If
you hike on a regular basis, the health
benefits multiply by way of decreasing
bad cholesterol (LDL) and increasing
Shutterstock/varuna
good cholesterol (HDL). Hiking also
offers other important cardiovascular
benefits by expanding the arteries,
which minimizes stress on the heart.
Hiking gear
Before you set foot on your journey,
make sure you have the right equip-
ment such as sturdy hiking shoes,
light-weight backpack and hiking
pole. While a pole may seem unnec-
essary, if you’re getting back into
exercising, poles can help steady your
balance and reduce stress on your
knees, ankles and hips.
Getting ready
During your hiking preparations,
check your blood sugar level. If
your level is low, you can treat it
before you head out. Hypoglycemia
is a potential risk with any exercise,
so be sure to have snacks in case your
blood sugar drops. Raisins and glu-
cose tablets will last for long periods
in a backpack. Don’t forget to bring
plenty of water, especially during hot
summer days. Check the weather
forecast that day so you’re not caught
in sudden rain showers – or at least
be prepared with proper gear in case
conditions change.
Hike time
It’s recommended that you hike with
a family member or friend just in case
an unexpected situation occurs. If you
enjoy exercising with others, there are
hundreds of hiking clubs across the
country. The American Hiking Society
(www.americanhiking.org) includes a
list of more than 1,500 clubs. There’s
also online groups like Meetup (www.
meetup.com) that make it easy to find
local hiking groups. If you’re looking
for some truly inspiring hikes, visit
the National Park Service (www.nps.
gov), which has a treasure of hiking
options that will keep you busy for
many summers to come. †
Paul Wynn, a writer based in Garrison, New
York, is a regular contributor to Diabetes
Self-Management.
DiabetesSelfManagement.com 7
NEWS &
NOTES
DIABETES NEW GLUCOSE
QUIZ Questions MONITOR
How much
T he U.S. Food and Drug Administration (FDA) has
approved the first continuous glucose monitoring
system for use as part of an integrated system with other
compatible electronic interfaces and medical devices. Such
do you devices include automated insulin dosing systems, insulin
know about pumps, blood glucose meters and other tools used in dia-
betes care. The product is Dexcom G6 and is manufactured
diabetes by Dexcom, Inc., a California-based technology company
and stress? specializing in continuous glucose monitoring systems.
The G6, which is about the size of a quarter, is worn on
Stress is one of the
the stomach and has a small sensor that the user inserts
most important
just beneath the skin using an auto-applicator. It wirelessly
factors responsible
transmits blood sugar readings every five minutes to a small
for causing and
touch screen receiver or to a compatible smart device such
worsening a variety
as a smartphone, a smartwatch or medical device app. It
of illnesses, including
sounds an alarm when the user’s blood sugar is too high
heart disease, cancer,
or too low. The G6 improves on Dexcom’s already popular
stroke and diabetes.
G5 mobile monitoring system in several ways: it eliminates
So how does stress
the need for fingerstick calibration, it can be worn for 10
affect diabetes? Take
days instead of seven and it has an updated sensor probe.
this quiz to ind out.
The FDA’s endorsement was based on two clinical stud-
1. How does stress affect your blood sugar? ies involving 324 adults and children with diabetes. The
OA. Stress does not affect blood sugar. G6 was approved for adults and for children as young as
OB. Stress can lower blood sugar. two. According to Donald St. Pierre, acting director of the
OC. Stress can raise blood sugar. Office of In Vitro Diagnostics and Radiological Health in
OD. Stress affects blood pressure but not blood sugar.
the FDA’s Center for Devices and Radiological Health,
2. All the following are helpful ways to manage stress “The ability of this device to work with different types of
in diabetes EXCEPT: compatible devices gives patients the flexibility to tailor
OA. Exercise their diabetes management tools to best meet personal
OB. Meditation preferences.” According to the manufacturer, most insur-
OC. Laughter ance plans cover the Dexcom G6. †
OD. Self-isolation

3. Which of the following are some vital nutrients that

can be helpful when managing stress? More than
one answer may be correct.
OA. Magnesium
OB. Potassium
OC. Vitamin C
OD. B vitamins

4. What are some long-term effects of stress on diabetes?

OA. Thyroid disease
OB. Infertility
OC. Weight gain
OD. Heart disease

5. Which of the following is not a symptom of stress?

OA. Grinding teeth
Shutterstock/svtdesign

OB. Inability to sweat

OC. Diarrhea
Od. Forgetfulness

8 July/August 2018
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NEWS &
NOTES
DIABETES NEW WAY TO SPOT
ADOLESCENT
QUIZ Answers OBESITY
1. D. According to the American Diabetes Association, chronic stress
can raise blood sugar. Mental stress in particular can tax the body
A study recently published in
American Medical Association
Pediatrics says that the conventional way
more than physical stress, probably because the body sees stress
as a “flight-or-fight” situation and responds by producing stress of measuring adolescent obesity is inadequate.
hormones to prepare for the battle. People enduring mental stress The United States is experiencing an obesity
may be more prone to making poor health choices when it comes to epidemic and an alarming rise in rates of
eating, substance abuse, sleep and self-care. While all these factors
can undoubtedly have poor effects on blood sugar, the increased
diabetes. Because the two phenomena are
production of stress hormones (due to long-term mental stress) can related and Type 2 diabetes has
raise blood sugar. been occurring at even younger
2. D. Exercise can ages, it’s crucial for health care
help to relieve stress, professionals to have reliable
lower blood pres- data on obesity in young people.
sure and releases The standard way of
endorphins – the
feel-good chemicals
measuring obesity has been
that make you happy. body-mass index (BMI), which
And according to the is weight in kilograms divided
American Psychologi- by height in meters squared.
cal Association, the It works quite well for adults, but not so
positive, stress-reduc-
ing effects of exercise
well for children. The authors of the study
can last several hours used three calculations to compare BMI
after a good sweat. to other ways of measuring
Many studies sug- obesity. They found that the
gest meditation and best overall body fat index to
practicing mindful-
ness help reduce stress. A good laugh can lift your mood and release
use in youngsters between eight
tension, too. Finally, meaningful social activities can help bring you and 17 is tri-ponderal mass
through the doldrums and relieve stress. index (TMI), which is weight
3. A, C, D. B vitamins help support a healthy nervous system, and divided by height cubed. They
deficiencies in B vitamins can make you feel tired, depressed and reported that adolescents
overall irritable. According to American Family Physician, magnesium are inaccurately diagnosed
supports more than 300 biological functions in the body. Unfortu- as overweight 19.4 percent of
nately, as many as 70 percent of people worldwide are deficient in
magnesium. Magnesium helps relax muscles, regulate heartbeat and
the time and that BMI is especially
support restful sleep. Stress depletes the body’s stores of vitamin C, inaccurate in boys. A main reason for
making you more prone to getting sick. the problem, the researchers said, is
4. B. Chronic stress increases your risk for many illnesses because that the math used to calculate the
it affects so many body organs and your overall health. In addition relationship between body weight
to the psychological signs and symptoms, chronic stress decreases and height is more complex in young
sperm count in men and causes menstrual irregularity in women. people than it is in adults, especially
Stress can also worsen conditions you already have such as diabetes
and thyroid disease, but it can increase your risk for developing these
during periods of rapid growth.
conditions if you don’t already have them. Because stress encourages The findings of the new study are
the release of flight-or-fight hormones such as epinephrine, elevated especially important, according to
levels of these hormones stress the heart and blood vessels and can Courtney Peterson, PhD, one of the
Left: Shutterstock/svtdesign; Right: Shutterstock/urfin

cause heart disease. authors, because “many school districts

5. B. Symptoms of stress can manifest in many ways, including some send home reports labeling adolescents
less-often signs and symptoms such as grinding teeth, stomach as overweight, and children and
problems (i.e., nausea, vomiting, diarrhea and constipation, etc.)
and memory problems. Some people sweat profusely when stressed.
adolescents tend to be more vulnerable
to weight bias and fat shaming.” †
Frieda Wiley, PharmD, BCGP, RPh is a medical writer and consultant phar-
macist based in Texas. Joseph Gustaitis is a freelance writer and editor
based in the Chicago area.
10 July/August 2018
Discover the FreeStyle Libre system
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*Fingersticks are required for treatment decisions when you see Check Blood Glucose symbol, when symptoms do not match system readings, when you suspect
readings may be inaccurate, or when you experience symptoms that may be due to high or low blood glucose.
REFERENCES: 1. FreeStyle Libre User’s Manual. 2. Data on File. Abbott Diabetes Care.
INDICATIONS AND IMPORTANT SAFETY INFORMATION
The FreeStyle Libre Flash Glucose Monitoring system is a continuous glucose monitoring (CGM) device indicated for replacing blood glucose testing and detecting trends
and tracking patterns aiding in the detection of episodes of hyperglycemia and hypoglycemia, facilitating both acute and long-term therapy adjustments in persons (age 18
and older) with diabetes. The system is intended for single patient use and requires a prescription.
CONTRAINDICATIONS: Remove the sensor before MRI, CT scan, X-ray, or diathermy treatment.
WARNINGS/LIMITATIONS: Do not ignore symptoms that may be due to low or high blood glucose, hypoglycemic unawareness, or dehydration. Check sensor glucose readings with a
blood glucose meter when Check Blood Glucose symbol appears, when symptoms do not match system readings, or when readings are suspected to be inaccurate. The FreeStyle Libre
system does not have alarms unless the sensor is scanned, and the system contains small parts that may be dangerous if swallowed. The FreeStyle Libre system is not approved for
pregnant women, persons on dialysis, or critically-ill population. Sensor placement is not approved for sites other than the back of the arm and standard precautions for transmission of
blood borne pathogens should be taken. The built-in blood glucose meter is not for use on dehydrated, hypotensive, in shock, hyperglycemic-hyperosmolar state, with or without
ketosis, neonates, critically-ill patients, or for diagnosis or screening of diabetes. Review all product information before use or contact Abbott Toll Free (855-632-8658) or visit
www.freestylelibre.us for detailed indications for use and safety information.
FreeStyle, Libre, and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. Other trademarks are the property of their respective owners.
The product images are for illustrative purposes only.
©2018 Abbott. ADC-07871 v1.0 05/18
NEWS &
NOTES
DIABETES
[DEFINITIONS]
HEMOGLOBIN A1C
An indicator of blood glucose control over the
previous three months. Hemoglobin is a protein
in red blood cells that carries oxygen throughout
the body. Glucose in the blood binds to hemo-
globin for the life of the red blood cell, and that
portion of hemoglobin with glucose bound to
it is called glycated hemoglobin or hemoglobin
A1C (HbA1c). The average life span of a red blood
cell is about four months. The higher the blood
glucose level throughout the life of the blood cell,
the higher the percentage of hemoglobin that
becomes glycated. The percentage of hemoglo-
bin that is glycated indicates the level of blood
glucose control over the previous three months.
People who don’t have diabetes typically
have an HbAlc of under six percent. Based on the
results of the Diabetes Control and Complications
Trial (DCCT), the American Diabetes Association
(ADA) recommended shooting for an HbA1c of
less than seven percent.
More recently, based on accumulating evi-
dence about the dangers of hypoglycemia (low
blood glucose), the ADA and the European
12 July/August 2018
Association for the Study of Diabetes jointly issued
a policy statement advocating more flexibility
in the selection of blood glucose goals. These
organizations suggest less stringent blood glucose
goals (such as an HbA1c of under eight percent)
for individuals having difficulty maintaining their
target blood glucose levels or with a history of
severe hypoglycemia.
EAG
An abbreviation for estimated average glucose,
a value that is derived from hemoglobin A1C
values (see “Hemoglobin A1C” on this page).
The hemoglobin A1C test shows the average
level of blood glucose control over the previous
three months, expressed as the percentage of
hemoglobin that has glucose attached to it.
However, patients with diabetes are often more
familiar with blood glucose readings, which are
expressed as the number of milligrams of glucose
in each deciliter of blood (or mg/dl).
Doctors and patients can convert a hemoglobin
A1C level to an eAG level by multiplying the A1C
value by 28.7 and then subtracting the number
46.7. For example, a hemoglobin A1C level of
less than seven percent (a target for many people
with diabetes) translates into an eAG of less than
154 mg/dl. A hemoglobin A1C level of less than
eight percent, a less stringent target, translates
into an eAG of less than 183 mg/dl. The American
Diabetes Association (www.diabetes.org) has a
calculator for translating hemoglobin A1C levels
into eAG levels and vice versa.
BELL’S PALSY
A sudden, temporary paralysis of the face caused
by damage to the facial nerves. No one knows
exactly what causes Bell’s palsy but it may result
from swelling and inflammation of the nerve that
controls the muscles on one side of the face.
These nerves control the opening and closing of
the eyes, tear glands, salivary glands and facial
expressions such as smiling or frowning. This
inflammation may be caused by a viral infection
such as herpes simplex, which causes the com-
mon cold. Bell’s palsy occurs in roughly 40,000
Americans each year and is more common in
people who have diabetes or upper respiratory
infections such as a cold or flu.
The symptoms of Bell’s palsy are diverse
and can vary from one person to another. They
include twitching, weakness and paralysis, usu-
ally on just one side of the face. There may also
be drooping of the eyelid and the corner of the
mouth, drooling, dry eyes or mouth, loss of the
taste sensation and excessive tearing in one eye.
BELL’S PALSY
Doctors can prescribe steroids such as pred-
Left: Shutterstock/Jarun Ontakrai; Right: Shutterstock/corbac40
nisone to reduce inflammation and swelling.
Drugs such as acyclovir may be used to treat
viral infections. Patients may take analgesics
such as aspirin, acetaminophen or ibuprofen to
relieve pain. Some people may need lubricating
eye drops to protect their eyes if their eyelids
are affected. †
Robert Dinsmoor, a medical writer and editor, is
a contributing editor of Diabetes Self-Management.
 NEWS &
NOTES
Gary Scheiner, MS, CDE, is owner and
clinical director of Integrated Diabetes
Services (www.integrateddiabetes.
com), a private practice specializing
in intensive therapy for children and
adults. He has lived with Type 1 diabetes
for 30 years; is a certified diabetes
educator and named Diabetes Educator
of the Year 2014 by the American
Association of Diabetes Educators.
Have a question about diabetes?
Send it to Gary Scheiner MS, CDE,
at gary@integrateddiabetes.com.
Shutterstock/onot
Q+A
Q: I have had Type 2 diabetes since 2005. My Q: Can you explain the difference between
doctor has me taking a combination of met-
formin and glibenclamide (a sulfonylurea).
Until a few weeks ago, my fasting blood sugar
was always around 100 mg/dl. Now it rises
overnight, and I wake up as high as 200mg/
dl even with nothing to eat after dinner. Why
is this happening? What can I do about it?
A: With Type 2 diabetes, the pancreas gradu-
ally loses the ability to produce insulin over
the course of time. Insulin may also start to
work less effectively, particularly in people
who gain weight, exercise less, experience
more stress or develop other health problems.
In your case, since you are not eating at
night, your blood sugar is likely rising over-
night because your liver is producing more
glucose than your pancreas can handle. You’re
just not making enough insulin on your own,
at least during the night. There are many
options for fixing this, ranging from lifestyle
changes (dietary modifications, increasing
physical activity) to adding new medical treat-
ments (oral or injectable medications) to
simple dosage adjustments.
Your health care team can make adjustments
to your diabetes treatment plan based on
specific/individual needs. See your physician
regularly and communicate between appoint-
ments if you suspect that adjustments may be
in order. Of course, it helps to have plenty of
blood sugar values to share. Without data, it
will be difficult for your health care team to
diagnose the problem and figure out the best
possible solutions.
ketosis and ketoacidosis? Are they two
entirely different processes? Can ketosis turn
into ketoacidosis if it goes on long enough?
A: With so many people resorting to low-
carb “ketogenic” diets, I knew this question
would come up eventually. Let’s see if we can
clear the air.
Ketones are acids that are produced when-
ever we burn fat for energy. It is perfectly
normal to have some ketones present all the
time. In the presence of insulin, ketones can
actually be broken down for energy. People
on very low-carbohydrate diets tend to have
modestly elevated ketones in the bloodstream
(ketosis) because they burn more fat (and less
sugar) for energy and have lower amounts of
insulin in their bloodstream. As long as they
stay reasonably well-hydrated, this state of mild
ketosis does not usually present a problem.
However, in people with Type 1 diabetes
and those with Type 2 who produce very little
of their own insulin, the presence of excess
ketones can take on a whole new meaning.
If someone who is insulin-dependent forgets
to take his or her insulin, or the insulin he
or she takes is spoiled, or there is a problem
with the delivery of the insulin (pump clog,
air in the pen/syringe, infusion set malfunc-
tion), the complete lack of insulin in the body
will cause two problems: (1) high levels of
ketones (since the body’s cells will burn fat
almost exclusively instead of sugar), and (2)
dehydration (since the blood sugar will be
very high, which causes excess urination).
The combination of high ketones and dehy-
dration is extremely dangerous and can be
life-threatening, as the body’s fluids start
to become very acidic. This is what we call
diabetic-keto-acidosis (DKA): uncontrolled
diabetes causing excess ketone production,
which leads to the blood becoming too acidic.
Being “insulin-dependent” means that you
literally depend on insulin for survival. In the
absence of insulin, what starts out as a mild
elevation in ketones (ketosis) can become
ketoacidosis in just a few hours. Those who
are insulin-dependent must always take their
insulin, stay well-hydrated, and be prepared to
check their blood or urine for ketones whenever
unusually high blood sugar levels are present. †
DiabetesSelfManagement.com 13
 What is a
NORMAL
blood sugar
level?
By David Spero, BSN, RN
THE AIM OF DIABETES TREATMENT is to bring blood
sugar (“glucose”) to as close to normal as possible. But what
is a normal blood sugar level and how can you achieve it?
Deining the differences
First, it is important to define the difference between “sugar”
and “glucose.” “Sugar” is the general name for sweet carbo-
hydrates that dissolve in water. “Carbohydrate” is a plant-
based food made only of carbon, oxygen, and hydrogen.
There are different kinds of sugars. The one our body
uses most is called “glucose.” Other sugars we eat, like
fructose from fruit or lactose from milk, are converted into
glucose in our bodies. Then we can use them for energy.
Our bodies also break down starches, which are sugars
stuck together, into glucose.
Blood sugar versus blood glucose
When people talk about “blood sugar,” they mean “blood
glucose.” The two terms mean the same thing.
In the U.S., blood sugar is normally measured in
milligrams of glucose per deciliter of blood (mg/dl).
A milligram is very small, about 0.00018 of a teaspoon. A
deciliter is about 3 1/3 ounces.
In Canada and the United Kingdom, blood sugar is
reported in millimoles/liter (mmol/L). You can convert
Canadian or Great British glucose levels to American num-
14 July/August 2018
bers if you multiply them by 18. This is useful to know if
you’re reading comments or studies from Great Britain or
Canada. If someone reports that his or her fasting blood
glucose was seven, you can multiply that by 18 and get a
U.S. glucose level of 126 mg/dl.
What are normal glucose numbers?
These numbers vary throughout the day. For someone
without diabetes, a fasting blood sugar on awakening
should be under 100 mg/dl. Before-meal normal sugars are
70-99 mg/dl. “Postprandial” sugars taken two hours after
meals should be less than 140 mg/dl.
If you have diabetes, the American Diabetes Association
(ADA) advises keeping your blood sugar levels before meals
from 80–130 mg/dl and your levels one to two hours after
meals under 180. Lower numbers require more careful
diet and more frequent monitoring to prevent lows, but
they are doable for many people.
There is also a long-term glucose test called a hemoglobin
A1C, HbA1c, or just A1C. This test measures your average
glucose control over the last two to three months. HbA1c
is measured as the percentage of red blood cells with glu-
cose attached to them. Normal measurement for a person
Shutterstock/solar22
without diabetes is below 5.7 percent. Targets for a person
with diabetes recommended by the ADA are lower than 7.0
percent, although many people achieve lower numbers,
and older, less healthy people may be given higher targets
to shoot for to avoid lows (some doctors set goals as low as NORMAL BLOOD GLUCOSE NUMBERS
6.0 percent or as high as 8.0 percent). FASTING
When glucose levels get higher than normal, they start Normal for person without diabetes 70-99 mg/dl (3.9-5.5 mmol/L)
to cause inflammation in blood vessels and nerves. This is Oficial ADA recommendation 80-130 mg/dl (4.4-7.2 mmol/L)
where all the complications of diabetes come from. Blood for someone with diabetes
glucose levels close to normal prevent complications. TWO HOURS AFTER MEALS
Low blood sugars are also a problem. If you take insulin Normal for person without diabetes Less than 140 mg/dl (7.8 mmol/L)
or a sulfonylurea or meglitinide drug, there is a risk of your Oficial ADA recommendation Less than 180 mg/dl (10.0 mmol/L)
blood sugar going too low. Low blood sugar (“hypoglyce- for someone with diabetes
mia,” pronounced high-po-gleye-SEEM-e-uh) can cause
HBA1C
dizziness, confusion, or fainting.
Normal for person without diabetes Less than 5.7 percent
Oficial ADA recommendation Less than 7.0 percent
Testing your blood sugar for someone with diabetes
You can learn what your blood glucose is at any given
moment with a fingerstick blood test, using any available health care provider. If you’re trying for tight control, you
glucose meter. It may hurt a little, and the test strips cost can test after eating different foods and doing different
money, but the test provides important information. You activities to see how they affect your glucose level. Keep
can reduce the pain and the hassle of needle sticks and careful records of your results and perhaps log what you
get more information with a continuous glucose monitor were eating and doing before your test.
(CGM). CGMs measure from a sensor inserted under the It doesn’t help much to test at the same time every day,
skin, often on the abdomen. For people taking rapid-acting which many people do on waking and before dinner. You’ll
or intermediate-acting insulin, blood sugar testing should be miss what’s happening the rest of the day. Test with a plan;
frequent. You want to take the right amount and not have when you change something like a new medicine dose or
your blood sugar go too low. a supplement, then test in the days afterward. Many moni-
For people with Type 2 diabetes who are not on insu- tors keep your result records for you or send them to your
lin, whether and how much to test is up to you and your computer or your doctor. †

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 What’s Your
Concentration?
by Laura Hieronymus, DNP, MSEd, MLDE, BC-ADM, CDE,
Kristen Stakelin, MD, MLDE, CDE, and Scott Kincaid, PharmD, BCPS

EVERYONE needs the hormone insulin to insulin at first (you may use oral medication
keep blood glucose within a normal range. In and/or non-insulin injectables along with
people without diabetes, the pancreas makes lifestyle modifications). However, because of
insulin. When you have Type 1 diabetes, your the progressive nature of the disorder, you will
Shutterstock/Orawan Pattarawimonchai

body doesn’t make enough insulin, which likely need insulin at some point. The table
is why you must inject insulin. If you have on page 21 describes insulin use in adults
Type 2 diabetes, you may not need additional with diabetes.
16 July/August 2018
 INSULIN USE IN ADULTS WITH DIABETES
AGE RANGE (Years) INSULIN ONLY (%) INSULIN + ORAL MEDICATION (%)
18 to 39 31.3
40 to 64 13.9
65 or older 12.3
Adapted from: SOURCE: CDC/NCHS, National Health Interview Survey, 2013; NCHS Data Brief
No. 183, 2015. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db183.htm
Most children and adolescents diagnosed with diabetes
have Type 1 and use insulin. So if you have diabetes and
use insulin, you are not alone. This article reviews impor-
tant characteristics, focuses on different concentrations of
injectable insulin and provides insulin safety tips.
Insulin characteristics
You need to know three characteristics about insulin. These
characteristics will help you predict how it will work once
injected. For each type of insulin you use, you should know:
• the onset, or how long it takes insulin to get into your
bloodstream and start lowering your blood glucose;
• the peak, or time when a particular insulin has the
most impact on lowering your blood glucose; and
• the duration, or how long your insulin’s effect on
blood glucose will last.
Regardless of the type of insulin, you should know what
to expect after you inject it. The category of the insulin
describes the onset of insulin action. For example, rapid-
acting insulin starts working within 15 minutes after you
administer it, reaches maximum effect in about one hour
and lasts for two to four hours.
Regular or short-acting insulin reaches the bloodstream
9.3 within 30 minutes, has maximum effect between two and
17.3 three hours and lasts for three to six hours once injected.
14.3 Intermediate-acting insulin reaches the bloodstream two
to four hours after being injected, reaches maximum effect
between four and 12 hours and lasts for 12 to 18 hours.
Long-acting insulin slowly enters the bloodstream over
several hours and tends to lower glucose levels evenly over
a 24- or 36-hour period. Keep in mind that insulins within
each category may vary slightly. These details are based on
years of research, and listed in the package insert.
Insulin concentration
In less than five years, several different concentrations of
injectable insulin have become available. This is important
for you to know so you get not only the correct type of insu-
lin, but also the right concentration. If the concentration
is incorrect, you may not receive the right dose.
U-100 Insulin concentration. U-100 is by far the most
commonly used concentration (strength of insulin. U-100
means that each milliliter (mL) of U-100 insulin contains
100 units. That means a standard 10 mL vial of U-100 insulin
has 1000 units. Most insulin pens hold 3 mL and have 300
units of insulin. Also, be sure you know both the generic
and trade names of your insulin to be sure you have the
right product. U-100 insulin aspart injection (generic name)
now approved with two different trade names, Novolog®
Clinically proven to repair, soften & moisturize
For healthier, more beautiful feet!

INSULIN
SAFETY
In 2017, the CDC reported
that the estimated number
of people of all ages living
with diabetes is 30.3 million,
or 9.4% of the population in the United States.
Insulin is a long-standing option in diabetes
treatment, required for those with Type 1 and
essential in the treatment of many with Type 2.
Insulin is available in various concentrations
to individualize therapy for each person with
diabetes. When you inject insulin, keep in mind
the following precautions.
1. Review your insulin
prescription label. Double-
check that the name of your
insulin and the concentration
match your prescription.
2. In some cases, the name
of the insulin may be the
same, but the concentration
is different. The wrong
concentration could result in
unexpected and sometimes
severe hyperglycemia or
hypoglycemia.
3. Know the “color” of
your insulin vial or pen.
Manufacturers often
differentiate the type and
concentration of the insulin
with color.
4. If the concentration of your
insulin has changed and
you are uncertain about
how to administer your
insulin appropriately, consult
with your diabetes care
team, diabetes educator
and/or pharmacist.
5. Do not draw up your dose
from an insulin pen with a
syringe. No U-200 or U-300
syringes are available, so
if you draw up a dose from
a U-200, U-300 or U-500
insulin with a leftover U-100
syringe, severe hypoglycemia
can result.
6. If another individual in your
home uses insulin that is
a different concentration
than yours, store the insulins
in different areas to avoid
18 July/August 2018
! acting (insulin lispro [Humalog®]) and a long-acting (insulin
grabbing the wrong one and
administering the wrong dose.
7. If you take a pre-mixed
insulin (one that contains two
types of insulin), be familiar
with the characteristics and
concentration for both. For
pre-mixed medications that
contain insulin and a non-
insulin injectable, the same
holds true.
8. Never share your insulin or
delivery device with other
people. This may result in a
serious infection for one or
both of you.
9. If admitted to the hospital
and you use a different
concentration of insulin than
U-100, be sure to clarify this
with the hospital healthcare
team. Bring the pen or
syringe you use at home
to show the staff.
10. When traveling outside
of the U.S., be certain you
have an ample supply of
your insulin. Available
concentrations of insulin may
vary from country to country.
11. Each time the prescription is
filled, read the “Medication
Guide” that comes with
your insulin (also available
on the manufacturer’s
website). The guide is
approved by the U.S. Food
and Drug Administration
and is updated over time
with important safety
information.
and Fiasp®. While they are both rapid-acting insulin, they
work a little differently – be aware if you are prescribed
one of these medications.
U-200 Insulin concentration. At least two insulins – a rapid-
degludec [Tresiba®]) – are available in both U-100 and U-200
concentrations. A word of caution: the generic and trade
names are the same for both concentrations, which may cause
confusion. The U-200 concentration has 200 units of insulin
per mL, and therefore, twice as many (600) units of insulin in
a 3 mL pen as the U-100 concentration (300 units). To avoid
incorrect dosing, it is important to know the concentration
of insulin you are prescribed.
U-300 Insulin concentration. Currently, one insulin (insulin
glargine, known as Toujeo®) is available in this concentration.
This is different from other insulin glargine formulations
because the medication has 300 units per mL (compared to
the U-100 concentration with 100 units/mL or U-200 con-
centration with 200 units/mL). In other words, the U-300
concentration is three times as potent as the U-100 concentra-
tion. Once again, you should use the medication exactly as
prescribed to ensure you are getting the correct dose.
U-500 Insulin Concentration. A version of regular insulin
(Humulin® R) is available in U-100 and U-500 concentrations.
The U-500 concentration delivers five times as much insulin
in 1mL as the standard U-100 concentration. This insulin may
be prescribed to control high blood glucose in children and
adults with diabetes who need more than 200 units of insulin
a day. While this insulin comes in a pen, vials of U-500 insulin
are still available. If you take U-500 from a vial, be sure that
you use a special U-500 insulin syringe; it has a green rather
than an orange cap like the typical U 100 syringes. Make sure
you have the right tools to dose this insulin correctly.
The main takeaway is that if you are prescribed insulin in a
U-100 concentration and use U-200, U-300 or U-500 by mistake,
you will get two, three or five times, respectively, the amount of
insulin you need. Too much insulin will dramatically increase
your risk for hypoglycemia (low blood glucose). In contrast,
if you need a stronger concentration of insulin such as U-200,
U-300 or U-500 and inadvertently use the U-100 concentration,
your risk for hyperglycemia (high blood glucose) will increase.
The bottom line is make sure you have the right type
(know both the trade and the generic names) and the right
concentration of insulin.
Thinking about insulin therapy can be overwhelming.
Make sure you and your support system stay informed about
the details of your insulin treatment so you can live a long,
healthy and safe life with diabetes. †
Laura Hieronymus is a doctor of nursing practice and master
licensed diabetes educator. She is associate director at the Barnstable
Brown Diabetes Center. Kristen Stakelin is a physician and master
licensed diabetes educator. She is the medical director of the Barnstable
Shutterstock/Roman Sotola
Brown Diabetes Center. Scott Kincaid is a doctor of pharmacy and a
board-certified pharmacotherapy specialist. He is also the director of
clinical pharmacy services. All are at UK HealthCare at the University
of Kentucky in Lexington, Kentucky.
 When it Comes to
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Panorama of Grand Canyon

SUMMER
by Shana Cunningham, MSN, RN, MLDE, BC-ADM, CDE and
Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDE, FAADE

SUMMER IS AN EXCITING TIME to travel
and explore new areas. The opportunity to
travel – even for a short excursion – allows one to
expand one’s knowledge and explore the world’s
are especially fun because you get to immerse
yourself in an area for adventure, relaxation
or enjoyment with family and friends. You may
have a particular destination in mind or on your
Shutterstock/AntonioFernandez

beauty. Day trips may include a relaxing day on
the beach, hiking the Grand Canyon, walking
the National Mall in Washington, DC or visit-
ing your favorite amusement park. Day outings
20 July/August 2018
“bucket list.” Having diabetes should not stop
you from having fun and visiting new places.
However, planning and preparation are neces-
sary to safely enjoy your day trip.
 DAY TRIPS
Planning is key
The first step is deciding on a destination. After you decide
where and what you are doing for the day, do your research.
As you prepare, questions will come to mind.
• Are you going to a park, lake, ocean, beach, theme
park or museum?
• What are you going to do?
• Will you be swimming, surfing, hiking, horseback rid-
ing, exploring, or just reading and relaxing?
• What is the weather?
• Will most of your time be spent outdoors or indoors?
• If you’re planning outdoor activities, what is the area terrain
like – flat, hills, mountainous? What is the highest altitude?
• Does your destination have park rangers, lifeguards,
medical/facilities?
• What are your options for storing supplies (climate-
controlled area), food, beverages, and personal needs?
• Is food available?
Answers to these questions can help you plan your day
trip, maintain optimal blood glucose control, and recognize
how the environment might impact your blood glucose
levels and/or your diabetes medications/supplies.
General day trip traveling guidelines
• Discuss your day trip plans with your diabetes care
provider to see if changes to medication dosages or
timing are required.
• Be sure to wear your diabetes identification.
• Avoid traveling alone; know your surroundings. If you
take a cell phone, program in an emergency contact
DiabetesSelfManagement.com 21
 and directions should an emergency situation arise.
• If your day out requires strenuous activity, check with
your diabetes care provider before participating. Over-
all, it is important to remember the general principles
of diabetes self-management: healthy eating, being
active, self-monitoring, taking your medications as
directed, problem-solving and reducing the risk of
complications such as high- and low- blood glucose.
Healthy eating
Healthy eating is critical to blood glucose control. Pack healthy
foods and be aware of food options at your destination. Attempt
to stay on your usual eating schedule, and avoid missed or
delayed meals. If you take your food with you, store it properly to
avoid getting a foodborne illness. Most perishable foods should
be kept out of the “danger zone” (temperature between 40 and
140 degrees) to avoid bacterial growth. Pack foods that require
refrigeration with frozen gel packs in a cooler or insulated bag.
ON THE GO SNACK IDEAS
Cereal/Energy Bars
Trail mix
Granola
Crackers
Peanut (or another) nut butter
Canned or pouches of tuna and chicken
Dried fruits
Small pieces of fresh fruit (apple or orange)
Nuts
Pumpkin seeds
Dry cereal
Popcorn
Low sodium/low fat Turkey Jerky
22 July/August 2018
Remember to keep your food in airtight containers. Your next
best option is to pack non-perishable foods.
If you are eating out, controlling portion size is key. One way
to practice portion control is using the plate method: non-starchy
vegetables should cover half of your plate, a quarter of your
plate should be filled with a starch or grain, and the remaining
quarter of your plate should hold a protein.
Hydration is essential, so pack plenty of water for the day.
Common causes of dehydration include increased sweating,
high blood glucose related to increased urination, or visiting
an area with higher altitudes. Always drink safe, treated water,
and avoid drinking untreated water from streams, lakes and
creeks. Freeze several bottles of water, so you have cold refresh-
ing water throughout the day, or carry an empty water bottle
to refill throughout the day with clean water.
Being active
Being active is good for your health. Everyone should do some
form of daily activity. Try to avoid sitting for prolonged periods
of time, even at the beach or lake. Purposely walk around to
explore the scenery. If your trip includes a lot of activity, make
sure you have the proper footwear and clothes. Consider
wearing clothing made of moisture-wicking and quick-drying
fabrics. Listen to your body and take rest breaks when needed.
Self-monitoring
Self-monitoring is vital when you have diabetes. Bring extra
test strips and lancets with your meter. A good tip is to take
double the amount of testing strips you think you may need.
Protect your meter/strips from harmful temperatures,
extreme heat, cold or moisture by keeping them at room
temperature. For specific guidelines, check with the manu-
facturer of your meter/supplies. Make sure your meter is
fully charged before leaving home, and pack an extra battery.
Continuous glucose monitor (CGM) sensor users know
specific activities can affect CGM function. Check with your
CGM manufacturer about using your equipment during
extreme sports, altitude changes and amusement park thrill
rides. Increased sweating and water activities can affect the
adhesion of your sensor. If you plan to wear your sensor,
bring extra supplies.
If it also important to stay aware of your normal state of
being. If something does not feel right, check your blood
glucose and then ask yourself if you need to rest, eat some-
thing, drink water or seek medical attention.
Taking medications
If you need to take your oral medications during your day
trip, keep your pills in an air-tight container. Take what
you need for the day, plus one extra pill for an unexpected
travel delay. Most medication labels recommend storage
in a cool, dry place and keeping them away from excessive
heat and humidity. Remember that insulin in use does not
Shutterstock/Hannah Green
need to be refrigerated, but it is sensitive to and can ruin in
extreme temperatures. If you will be outside for an extended
period in very hot or cold weather, use an insulated cold
(not frozen) travel pack or gel pack to store your insulin.
 Take extra insulin, syringes or pens needles with you in
case your insulin gets broken or misplaced.
Insulin pump users should talk with their provider and
diabetes educator for general directions on what to do during
their day out. When people are more active than usual, they
need less insulin, so you may need temporary basal dosing.
If you plan to do any extreme activities or sports, contact
your insulin pump manufacturer for recommendations
about how to avoid damaging the pump. If in doubt, you
may want to consider disconnecting your pump and using
an alternative (prescribed) insulin delivery source for the
day. Finally, remember to take extra alcohol pads, infusion
sets, reservoirs, cartridges, pods, batteries and anything else
you need should a complete change out be necessary.

Problem-solving and
reducing risks
Increased activity, heat, sweating and dehydration can all
impact your blood glucose control. When a person is more
active, hot and sweating, that person’s blood glucose level
can often drop, causing hypoglycemia or low blood glu-
cose levels. Be ready to treat hypoglycemia with a source of
glucose. Glucose tablets or gels are ideal treatment options
and are stable in extreme temperatures. Four to five glucose
tablets (15 to 20 grams of carbohydrate) are appropriate
treatment for hypoglycemia. Take your glucagon kit and
make sure one of your travel companions knows how to
administer it. Pack urine ketone strips in case you have
high blood glucose readings or become ill.
You also need to protect your skin and feet. Take proper
fitting shoes that are broken in. Wearing a new pair of
shoes is not ideal during a day trip because they may create
blisters or sores. Always wear shoes during your trip and
change into a new pair of dry shoes if necessary. Protect
your skin from extreme sun, heat and chilly weather. Apply
sunblock every two hours, after swimming or sweating, and
use insect repellant.

Speciic destination considerations

Beach/Water Activities During the planning stage, you may find it helpful to make
• Use sun block as directed. a list of items you might need during a day trip. You can
• Avoid direct sunlight, especially during peak hours; customize it to your diabetes treatment plan and needs as
limit your hours in the sun; wear a wide-brimmed hat well as to various destinations.
and sunglasses.
• Stay hydrated. Enjoy yourself
• Wear water shoes; avoid walking barefoot on the sand. When you have diabetes, it pays to be well prepared when
Hiking you take a trip, even if just for a day. A little planning can
• Hike with at least one companion. go a long way toward reducing travel-related stress. That
• Stay on the path and tell others where you’re planning way, you can focus on enjoying yourself and having terrific
to go. day trip adventure. †
• Wear hiking boots or shoes.
Amusement Parks Shana Cunningham is a registered nurse and master licensed
• Call ahead to Guest Services to see if the park has any diabetes educator. She is a Diabetes Education Service Coordinator.
Shutterstock/Ahmet Misirligul

special accommodations for children with diabetes.
• Research food options before your visit.
• Find the First Aid Stations and restrooms when you
first arrive.
Laura Hieronymus is a doctor of nursing practice and master licensed
diabetes educator. She is the associate director of education and
quality services. They are at the Barnstable Brown Diabetes Center at
University of Kentucky in Lexington, Kentucky.
DiabetesSelfManagement.com 23
Protect
Your
Skin
Tips and
Treatments
By Amy Campbell,
MS, RD, LDN, CDE
Shutterstock/goodluz

24 July/August 2018
 DIABETES CAN AFFECT just about any organ in the body, known as azoles. More severe or persistent infections may
and the skin is no exception. With summer underway, it’s require injections or IV medication.
important to pay close attention to your diabetes control and
take extra steps to keep your skin healthy. Tips to prevent fungal infections
• Try to keep your blood sugars in your • Dry off thoroughly after a swim,
SUNBURN target range. shower or bath, including between
• Keep your skin as dry as possible, your toes.
Having a sunburn looks as painful as it feels. Sunburn, which especially under the arms, under the • Always wear shoes or sandals,
can occur in less than 15 minutes, is a result of overexposure to breasts, and in the groin area. especially around swimming pools
ultraviolet rays from the sun. Sunburned skin is red and painful, • Change socks, underwear and other and in locker rooms.
and may swell or develop blisters if the burn is severe. Besides clothing regularly.
being a risk for skin cancer and skin damage, sunburn puts a
major stress on the body and can lead to high blood sugars. THE THREE Ps: POISON IVY, POISON OAK AND
POISON SUMAC
Tips to avoid sun overexposure If your idea of a fabulous summer involves hiking, camping
• Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30. or gardening, go ahead and enjoy – but look out for poison
Reapply at least every two hours and more often if you’re swimming or sweating. ivy, oak and sumac. These plants can cause a maddening itch
Also, don’t forget to apply sunscreen on cloudy days. and blistering rash. If you are exposed, these non-contagious
• Avoid/limit sun exposure between the 10 a.m. and 4 p.m., when the sun’s rays
are the strongest. rashes can appear in a number of hours or days.
• Wear a broad-brimmed hat and cover up as much as possible. If you are
outdoors frequently, invest in clothing that provides sun protection. Symptoms of the “Three Ps,” according to the
• Wear sunglasses that have a high UV-protection rating. American Academy of Dermatology:
• itchy skin • hives • small or large blisters
What should you do if you get sunburned? • redness • swelling • crusting skin
• Get out of the sun!
• Drink plenty of sugar-free fluids. Treatment of poison ivy, oak or sumac
• Take a cool shower or bath to help soothe the burn. • Rinse your skin with warm, soapy • Apply calamine or hydrocortisone
• Apply a product that contains aloe or vitamin E to help reduce water immediately after exposure. ointment to the affected areas.
inflammation. Ask your doctor if a cortisone cream might help. • Wash your clothing right away. • Apply cool compresses to the skin.
• If you need to take something for the pain, consider taking ibuprofen or • Take a short, lukewarm bath with • Consider taking an antihistamine
acetaminophen, but again, check with your doctor. If your pain is severe, either baking soda or colloidal oatmeal (check with your doctor first).
call your doctor or head to an urgent care clinic or the ER. (available at a drugstore).
• If you have severe blistering or swelling of your face, neck, hands, or feet,
head to the nearest ER.
Poison Ivy: SHutterstock/Stuart Monk; Poison Oak:Shutterstock/Sundry Photography; Poison Sumac: Robert H. Mohlenbrock @ USDA-NRCS PLANTS Database / USDA SCS. 1991

If your rash is severe, your doctor may recommend a

corticosteroid, such as prednisone. Be aware that cortico-
FUNGAL INFECTIONS
steroids can increase blood sugar levels. It’s important to
Having diabetes also increases the risk for a fungal infection,
check your blood sugars regularly and report high readings
as does taking certain medications, such as corticosteroids,
to your doctor; you may temporarily need to increase your
antibiotics, and birth control pills. Fungus loves warm, moist
diabetes medicine dose or possibly even take insulin. If you
environments, so it’s not surprising that fungal infections
have fever, pus, pain, or swelling, you may have an infection
are prevalent during the summer months.
and may need to take an antibiotic.
Symptoms of a fungal infection:
• Itchy rash • Red or white lesions • Peeling, redness, Head to the ER right away if:
• Cracked skin in the mouth itching, and burning, • you have trouble breathing • you have swelling, especially
• Tiny blisters • Red skin in the case of athlete’s or swallowing on your face; and/or
and scales foot • the rash is all over your body • the rash is on your face or genitals.

Treatment of fungal infections To avoid sunburn and other seasonal skin irritants or infec-
Treatment of fungal infections may include the use of an tions, limit sun exposure and wear a hat, long pants, a shirt with
antifungal ointment or cream and possibly oral medications long sleeves and protective footwear. Your skin will thank you. †

Poison Ivy Poison Oak Poison Sumac

DiabetesSelfManagement.com 25
 Diabetic Neuropathy
Everything you need to know about the condition, from symptoms
and causes to pain-relief options and prevention
By Kurt Ullman
UP TO 60 PERCENT OF PEOPLE WITH DIABETES
will complain of numbness, tingling or pain in their toes
or hands. These are symptoms of nerve damage known as
diabetic neuropathy (DN).
“Diabetic neuropathies are the most common form of
non-traumatic neuropathies in industrialized nations,” said
Dianna Quan, M.D., professor of neurology at the University
of Colorado School of Medicine in Denver. “Things that
sometimes go with diabetes such as smoking, high blood
pressure, increased triglycerides and cholesterol are also
bad for nerves.”
The nerves
There are three broad types of nerves: motor, autonomic
and sensory. Sensory nerves carry information about sen-
sations from various parts of the body. This includes pain,
texture or temperature. Sensory nerves are the most com-
monly affected by DN.
The nerves of the autonomic nervous system control the
“housekeeping” functions of the body such as activities of
the stomach, heart, intestine and bladder.
Motor nerves tell the muscles what to do when you move.
Peripheral nerves send sensory information from the
body back to the brain and spinal cord. They also can carry
signals from the brain and spine to the muscles, telling
them to move. Like static on your phone, neuropathies
distort and interrupt these messages, resulting in numb-
ness, tingling, weakness or pain.
“Diabetic neuropathies are injuries to the peripheral
[outside of the brain or spinal cord] nerves that are sec-
ondary to the condition of diabetes,” said Eva Feldman,
Shutterstock/metamorworks
M.D., Ph.D., Russell N. DeJong, professor of neurology at
the University of Michigan Medical School in Ann Arbor.
“The classic type starts in the nerves in the tips of your toes
and then slowly moves up the body.”
This makes sense from a physical standpoint because
the nerves in your toes or fingers are the farthest from
their beginnings in the spinal cord. Think of them as long
extension cords that might be cut or stretched.
Control is key
Neuropathies in diabetes are most often linked to lack of
good control of blood sugars. The longer you have diabetes
and the consistently higher your hemoglobin A1c (HbA1c)
is, the more likely you will get DN and the worse it will be.
While good control is important in both types of dia-
betes, the effect it will have on neuropathies may change
if you have Type 2 disease. In Type 1, the person is usually
insulin deficient when the pancreas stops making insulin.
In Type 2, you are insulin resistant, so your body responds
by pumping out more and more insulin, but your muscles
and fat cells still can’t take in enough glucose and fats.
“Clearly in Type 1 patients, the DN is more closely cor-
related to glucose control,” said Dr. Feldman. “There are
well-controlled studies showing that if you control glucose
in Type 1, you are less likely to have neuropathies and might
even improve any preexisting damage. In Type 2, even with
good control, the nerve damage can continue over time.”
In Type 2, there may be a problem getting the correct
fuel into the nerve cells. Think of nerve cells as little power
plants. You need to get something in to generate the power
while also removing waste products. If you try to use diesel
fuel when the plant is set up for regular gasoline, your plant
won’t work as efficiently, and sludge will start to build up
that eventually shuts the plant down.
Data show that controlling glucose in Type 1 diabetes can
reduce the incidence of DN by 60 percent and can often
slow progression. On the other hand, among those with
Type 2, at least 50 percent will show indications of diabetic
neuropathies even with good control.
DiabetesSelfManagement.com 27
 “With Type 2 diabetes, the pathology of nerve damage
is probably more multifactorial,” said Feldman. “In addi-
tion to glucose, lipids, obesity and high blood pressure
run parallel with this kind of diabetes. You need to treat
dyslipidemia, control weight and work with the hyperten-
sion to see a beneficial impact in Type 2.”
While most experts and guidelines set HbA1c goals
of 6.5 to 7.5 percent, that is not always the case. Indeed,
some forms of DN may actually make that goal dangerous
to certain people.
One of the body’s natural defenses against hypoglycemia
or low blood sugar is the release of adrenalin from the
adrenal gland. If DN has affected the nerve that serves this
gland, then the hormone isn’t released.
“This hypoglycemic unawareness, or inability to sense
low blood sugars, may mean you have to tolerate higher
glucose levels to avoid frequent incidents of low blood
sugar,” said Lyle Mitzner, M.D., a staff physician at the Joslin
Diabetes Center in Boston. “The body is wired for a specific
response in the case of low blood sugars. If nerve damage
means that it doesn’t work, the glucose will continue to
drop, and we want to avoid that.”
An ounce of prevention
The best way to avoid diabetic neuropathies is to never
get diabetes.
“From the standpoint of prevention, diabetes doesn’t
happen overnight,” said Quan. “There is a period of pre-
diabetes or impaired glucose metabolism that is a transition
between healthy blood sugar levels and frank diabetes. In
that twilight zone, there is an opportunity to avoid Type 2
diabetes in the first place.”
Early symptoms of diabetic neuropathy include:
• burning sensation in the toes or fingers
• pricking pain
• tingling
• electric-shock feelings
• hypersensitive to touch
• muscle weakness
• loss of reflexes
• loss of balance and coordination
As the neuropathy gets worse, you may lose feeling in
your extremities. This can be the most dangerous part of
the process.
“When you have nerve damage to the point you can’t
feel your feet, you are at a much higher risk for developing
ulcerations,” says Dr. Mitzner. “If you don’t feel a cut or
scratch on your foot, you don’t know to treat it. This can
lead to ulcerations, infections and possibly even amputa-
tion of the foot or toes.”
This is why your diabetes health care team stresses check-
ing your feet often. The injuries can be hard to see, but fur-
ther problems can be prevented when they are caught early.
Diagnosis of diabetes-related nerve damage often occurs
in the diabetologist’s office. An important part of the assess-
28 July/August 2018
ment is a good history and physical examination. After all,
just because you have diabetes doesn’t mean you can’t have
another neurological condition.
Your health care provider will often use a tuning fork to
test for sensitivity to vibrations and a safety pin to look for
deficits in pain perception. He or she may have you push
against his or her hands or grip his or her fingers to assess
your strength and whether it is the same on both your right
and left sides. In some cases, nerve conduction studies might
be used to see if the nerve messages are getting through.
“I look at what my patient is telling me about their
symptoms and see if they are consistent with what we see
in diabetic neuropathies,” said Mitzner. “Not everyone will
need to see a neurologist unless I see something indicating
some other possible medical concern.”
Pain-relief picks
There are no treatments or magic pills that will reverse any
damage already done to the nerves. If the symptoms are
mainly things like tingling or electric shock, there is little
that can be done. When there is pain, medications can help.
Currently, only two medications have been approved
by the U.S. Food and Drug Administration (FDA) for use
in the treatment of neuropathic pain in diabetes. These
include the anti-seizure medication pregabalin (Lyrica)
and the antidepressant duloxetine (Cymbalta).
Although they have not gone through the process of
getting official FDA approval for such use, many other
kinds of medications have been shown in comprehensive
studies to help with pain relief. This so-called “off-label”
use is accepted by many physicians and should not alarm
you if prescribed. Most of these have cheaper generic ver-
sions available.
These groups include: other anti-seizure medications
such as gabapentin and carbamazepine; and tricyclic
antidepressants such as amitriptyline, desipramine and
imipramine.
If these do not relieve the pain, more powerful medi-
cations may be used. Opioid narcotics are available if the
pain is refractory after other medications have been used.
“We can treat pain if the symptoms impact your ability to
function or limit your quality of life,” said Mitzner. “Medica-
tions have side effects that can be more bothersome than
the symptoms themselves. Others are already on a lot of
medications and don’t want to have another. Pain treatment
is very individualized.”
The key message from all three experts is don’t wait
until you have diabetic neuropathy. The earlier you think
about it, the better off you will be.
“From my standpoint, the minute you are diagnosed with
diabetes, you should be talking with your doctors about what
you need to do to prevent or lessen problems for yourself
in the long run,” said Quan. “And this conversation should
be about more than just nerve damage.” †
 
Kurt Ullman, RN, is an Indiana-based medical writer whose career
spans 30 years.
 KEEP IT
COOL!
Froyo, Sherbet
and Ice Cream
Celebrating
18+ Years PAGE 32
TRUSTED AND
APPROVED
by Registered
Dietitians SEASONAL
SIPPERS
PAGE 34

CHOCOLATE
CRAVINGS?
6 Diabetes-friendly recipes
PAGE 36

FRUITY
DESSERTS
PAGE 40
Photographed by Angel Tucker; food prepared by Maggie Mulvena

FROZEN
YOGURT

DiabetesSelfManagement.com 29
 COOL DOWN!
32 Frozen Berry Ice Cream
32 Pineapple Frozen Yogurt
32 Chocolate Chip Frozen Yogurt
COOL BEVERAGES
35 Frozen Blackberry Lemonade
35 Frozen Fizz
35 Frozen Watermelon Whip
SWEET TOOTH
36 Frozen Pineapple Fudge
37 Ice Cream Cake
38 Frozen Chocolate Cheesecake Pie
38 Chocolate-Drizzled Frozen Grapes
39 Frozen Chocolate Banana Pops
39 Frozen Fudge Pops
“BERRY” DELICIOUS
41 Double Berry Pops
41 Cool & Creamy Lemon-Apple Dessert
41 Sweet Leaf® Raspberry Sherbet
42 Summer Cherry Sundaes
42 Watermelon Granita
Font: Shutterock/Anastasia Barre; Photo: Shutterstock/Africa Studio; Hand Icon: Shutterstock/justden

Understanding Our Symbols LOW-FAT RECIPE

Contains 3 grams or fewer of fat per serving
Like everyone, you’re busy – and we kept that in
mind when we selected recipes for this issue. Many LOW-SODIUM RECIPE
of the recipes in Diabetic Cooking can be prepared Contains 140 milligrams or fewer of sodium
in 30 minutes or less. Others require short preparation per serving
times followed by long cooking times. LOW-CARBOHYDRATE RECIPE
Contains 15 grams or fewer of carbohydrate
We’ve also included symbols to help you more easily per serving
find those recipes especially low in fat, sodium, and
carbohydrates, and high in fiber. HIGH-FIBER RECIPE
Contains 5 grams or more of fiber per serving

30 July/August 2018
 Make One Sweet Change to
these Family Favorites
By switching from sugars to better-for-you, plant-based SweetLeaf® Stevia
products, you can reduce calories, carbs, and sugars while still keeping great
SweetLeaf® Chocolate
taste in your food and drinks, without artificial ingredients.
Peanut Butter Smoothie

Find recipes for these family favorites and

more you’ll love at SweetLeaf.com.
CERTIFIED CERTIFI
ED
PALEO PALEO
NO SUGARS
ZERO CALORIES
NO ARTIFICIAL
INGREDIENTS
NON-GMO
NON-GLYCEMIC
RESPONSE INGREDIENTS:
• 5 drops SweetLeaf®
50ml Liquid Stevia
Caramel Sweet Drops™
SweetLeaf® Baked Beans • 1 cup almond milk,
unsweetened
INGREDIENTS: • 1/3 cup almond milk,
• 1 3/4 cup water unsweetened, frozen
• 1/2 tsp. + 1/8 tsp. SweetLeaf®
• 2 Tbsp. apple cider vinegar into cubes
Liquid Stevia SteviaClear®
• 2 garlic cloves, minced • 1 banana
Sweet Drops™
• 1 1/4 tsp. chili powder • 1 Tbsp. powdered
• 6 cups cooked pinto beans
• 1/2 tsp. onion powder peanut butter
• 1 can (15 oz.) no salt added
• Salt and pepper to taste • 2 tsp. cocoa powder
tomato sauce
Place all ingredients in crockpot, stir, and cook on high for 7 hours (or until beans are Combine ingredients in a blender
and blend until smooth. Serves 1.
soft and sauce has thickened). Let sit for one more hour with heat turned off and lid
on. Serve and enjoy! NUTRITION PER SERVING:
CALORIES 183, CARBS 31g, TOTAL FAT 5g,
NUTRITION PER 1/2 CUP: CALORIES 49, FATS 0g, SODIUM 60mg, CARBS 15g, SUGARS 3g DIETARY FIBER 5g, PROTEIN 7g,
(tomato sauce), PROTEIN 4g SUGARS 1g

Buy SweetLeaf® delicious products at SweetLeaf.com,

health food and grocery stores, or online retailers.

HEALTHY AND HOMEMADE: Does the summer heat have you hankering for the cool,
refreshing taste of frozen yogurt or ice cream? Whether you favor a scoop of chocolate
chip froyo (14 grams of carbohydrates per serving) or the sweet fruity flavor of berry
ice cream (69 calories per serving), this collection of delectable low-calorie, low-fat, low-
sodium recipes will surely delight!
Frozen Berry Ice Cream
MAKES 8 (½-CUP) SERVINGS
Nutrients per Serving: Calories 69, Total
Fat 1g, Saturated Fat 1g, Protein 3g,
Carbohydrates 15g, Cholesterol 0mg,
Dietary Fiber 1g, Sodium 23mg
Dietary Exchange: 1 Bread/Starch
8 ounces frozen unsweetened
strawberries, partially thawed
8 ounces frozen unsweetened
peaches, partially thawed
4 ounces frozen unsweetened
blueberries, partially thawed
6 packets sugar substitute
2 teaspoons vanilla
2 cups sugar-free, low-fat vanilla ice
cream
16 blueberries (optional)
4 small strawberries, halved
(optional)
8 peach slices (optional)
1. Combine partially thawed strawberries,
peaches, blueberries, sugar substitute
and vanilla in food processor. Process
until coarsely chopped.
2. Add ice cream; process until
well blended.
3. Serve immediately for semi-soft
texture or freeze until ready to serve.
(If frozen, let stand 10 minutes to
soften slightly.)
32 July/August 2018
COOL
DOWN!
Pineapple Frozen Yogurt
MAKES 4 SERVINGS (1 PINT)
Nutrients per Serving: Calories 130, Total Fat 1g, Saturated Fat 1g, Protein 5g,
Carbohydrates 25g, Cholesterol 59mg, Dietary Fiber 1g, Sodium 79mg
Dietary Exchange: 1½ Bread/Starch, ½ Fat
¼ cup pasteurized or cream colored. Add half-and- half,
cholesterol-free egg yogurt and pineapple; mix well. Re-
substitute frigerate mixture completely before
¼ cup sugar adding to ice cream maker.
½ cup fat-free half-and-half
2. Follow manufacturer’s directions
½ cup plain reduced-fat for ice cream maker, or pour mix-
yogurt ture into shallow glass baking dish
¾ cup crushed pineapple and place in freezer. Stir and scrape
in juice mixture with rubber spatula every
10 minutes for about 1 hour or
1. Beat egg substitute and sugar until it reaches desired consistency.
in medium bowl until thick and
Chocolate Chip Frozen Yogurt
MAKES 6 (1/3-CUP) SERVINGS
Nutrients per Serving: Calories 87, Total Fat 2g, Saturated Fat 1g, Protein 3g,
Carbohydrates 14g, Cholesterol 4mg, Dietary Fiber 1g, Sodium 52mg
Dietary Exchange: 1 Bread/Starch, ½ Fat
1 cup plain nonfat yogurt 1. Stir yogurt, half-and-half, sugar
½ cup fat-free half-and-half and vanilla in medium bowl until
well blended.
2 tablespoons sugar
¼ teaspoon vanilla 2. Freeze yogurt mixture in ice
¼ cup mini semisweet cream maker according to manu-
chocolate chips facturer’s directions until soft. Add
chocolate chips; freeze until irm.
 69 CALORIES
1 GRAM
OF FAT*

FROZEN
YOGURT
Photographed by Angel Tucker; food prepared by Maggie Mulvena

*Per serving
DiabetesSelfManagement.com 33
 COOL
BEVERAGES

BREAK OUT THE BLENDER!

Watermelon, blackberries and
strawberries make up this frosty list
of nonalcoholic frozen beverages.
Serve these easy-to-make coolers
and let the sipping begin!

34 July/August 2018
Frozen Blackberry
Lemonade
MAKES 4 (1-CUP) SERVINGS

Nutrients per Serving: Calories 152, Total Fat

0g, Saturated Fat 0g, Protein 1g, Carbohydrates
38g, Cholesterol 0mg, Dietary Fiber 4g, Sodium
5mg
Dietary Exchange: 2½ Fruit

2 cups fresh or frozen blackberries

1 cup water
½ cup frozen lemonade concentrate
¼ cup sugar
Grated peel and juice of 1 lemon
Ice cubes
Grated lemon peel twists
(optional)

1. Combine all ingredients in blender or

food processor; blend until smooth.

2. Pour into 4 glasses. Serve immediately.

Frozen Fizz
MAKES 4 SERVINGS
(ABOUT 1 CUP PER SERVING)

Nutrients per Serving: Calories 21, Total Fat

0g, Saturated Fat 0g, Protein 0g, Carbohydrates
7g, Cholesterol 0mg, Dietary Fiber 1g, Sodium
61mg
Dietary Exchange: ½ Fruit

2 cups (16 ounces) diet ginger ale,

divided
8 ounces frozen unsweetened
strawberries
2 tablespoons sugar substitute*
2 tablespoons fresh lime juice
Lime wedges (optional)
1. Combine 1½ cups ginger ale, straw-
berries, sugar substitute and lime juice in
blender; blend until smooth.
2. Pour into four glasses. Top with remain-
ing ½ cup ginger ale. Garnish with lime
wedges, if desired.
Note *This recipe was tested using
sucralose-based sugar substitute.
Frozen Watermelon Whip
MAKES 2 SERVINGS
Nutrients per Serving: Calories 24,
Total Fat 1g, Saturated Fat 1g, Protein
1g, Carbohydrates 6g, Cholesterol 0mg,
Dietary Fiber 1g, Sodium 2mg
Dietary Exchange: ½ Fruit
1¾ cups ice
1 cup coarsely chopped
seedless watermelon
1 cup brewed lemon-lavored
herbal tea, at room
temperature
Lime slices (optional)
1. Combine ice, watermelon and
tea in blender or food processor;
blend until smooth, pulsing to
break up ice.
2. Pour into two tall glasses. Gar-
nish with lime. Serve immediately.
DiabetesSelfManagement.com 35
 SWEET
TOOTH

LEAVE THE GUILT BEHIND!

If you have a passion for all
things chocolate, this heavenly
ensemble of creamy, fudgy
decadence will satisfy the
strongest of cravings!

Frozen Pineapple
Fudge
MAKES 4 (¼-CUP) SERVINGS

Nutrients per Serving: Calories 83,

Total Fat 1g, Saturated Fat 1g, Protein 5g,
Carbohydrates 17g, Cholesterol 2mg,
Dietary Fiber 1g, Sodium 65mg
Dietary Exchange: 1 Bread/Starch

2 3
/ cup nonfat dry milk powder
4 teaspoons unsweetened
cocoa powder
4 teaspoons sugar substitute
1 cup unsweetened crushed
canned pineapple

Combine milk powder, cocoa and

sugar substitute in medium bowl. Stir
in pineapple until well combined. Pour
into custard cups or ice cube trays and
freeze 3 hours or until irm.

36 July/August 2018
Ice Cream Cake
MAKES 16 SERVINGS
Nutrients per Serving: Calories 118, Total Fat 5g, Saturated Fat 4g, Protein 2g,
Carbohydrates 15g, Cholesterol 11mg, Dietary Fiber 1g, Sodium 35mg
Dietary Exchange: 1 Bread/Starch, 1 Fat
5 crushed sugar cones
3 tablespoons unsalted butter,
melted
2 pints (4 cups) no-sugar-added
light ice cream, softened at
room temperature, divided
1 container (8 ounces) reduced-
fat whipped topping, thawed
3 tablespoons sugar-free hot fudge
sauce, warmed (optional)
1. Spray 10-inch springform pan
or deep-dish pie pan with nonstick
cooking spray.
2. Place sugar cone crumbs in small
bowl. Stir in butter until crumbs are
evenly moistened. Press crumbs onto
bottom and partially up side of pre-
pared pan. Refrigerate 20 minutes.
3. Spread one pint of ice cream into
crust with rubber spatula. Freeze 30
minutes or until irm. Spread remain-
ing pint of ice cream over irst layer.
Freeze 30 minutes or until irm.
Spread whipped topping over ice
cream; freeze 2 hours or until irm.
If desired, drizzle with fudge sauce
after 30 minutes.
4. Let soften in refrigerator 15 to 30
minutes; slice into wedges to serve.
Tip: To inely crush sugar cones,
place in resealable plastic bag. Re-
move excess air from bag; seal. Press
rolling pin on top of cones to break
into pieces. Continue pressing until
evenly crushed.

Frozen Chocolate Cheesecake Pie
MAKES 10 SERVINGS
Nutrients per Serving: Calories 150, Total Fat 5g, Saturated Fat 3g, Protein 3g,
Carbohydrates 21g, Cholesterol 0mg, Dietary Fiber 1g, Sodium 360mg
Dietary Exchange: 1½ Bread/Starch, 1 Fat
1¼ cups chocolate graham
cracker crumbs (about 15
squares)
1 tablespoon cocoa powder
¼ cup sugar substitute*
2 tablespoons margarine,
melted
1 egg white, beaten
1 package (4-serving size)
chocolate sugar-free instant
pudding
1 package (4-serving size)
cheesecake sugar-free
instant pudding
1½ cups low-fat (1%) milk
1 8
/ teaspoon almond extract
2 cups reduced-fat whipped
topping, thawed
Dark chocolate curls for
garnish (optional)
38 July/August 2018
SWEET
TOOTH
1. Preheat oven to 350°F. Lightly coat
9-inch pie pan with cooking spray.
2. Combine graham cracker crumbs,
cocoa powder and sugar substitute
in small bowl or food processor. Add
margarine and egg white and mix
well. Pour crumbs into pie pan and
press into pan with ingers to form
crust. Bake crust 8 to 10 minutes,
remove from oven and cool.
3. In medium bowl place pudding
mixes, milk and almond extract
and beat with electric mixer until
smooth (mixture will be thick). Fold
in whipped topping and spoon illing
into crust. Freeze 2 hours or until irm.
Remove pie from freezer 15 to 20
minutes before slicing and serving.
Top with chocolate curls, if desired.
Note *This recipe was tested using
sucralose-based sugar substitute.
Chocolate-Drizzled
Frozen Grapes
MAKES 2 SERVINGS
SERVING SIZE: ½ TOTAL RECIPE
Nutrients per Serving: Calories 81,
Total Fat 2g, Saturated Fat 1g, Protein 1g,
Carbohydrates 18g, Cholesterol 0mg,
Dietary Fiber 1g, Sodium 3mg
Dietary Exchange: ½ Fat, 1 Fruit
1 cup seedless grapes (green
and red)
1 tablespoon semisweet
chocolate chips
1 teaspoon fat-free (skim)
milk
½ teaspoon powdered sugar
Fresh mint (optional)
1. Wash grapes; remove from
stems. Dry completely with paper
towel. Place in single layer on bak-
ing sheet. Freeze 2 hours or up to
48 hours.
2. About 5 minutes before serving,
place chocolate chips and milk in
small microwavable cup. Micro-
wave on HIGH 20 seconds; stir until
chocolate is melted. Microwave in
10-second intervals, if necessary, un-
til chocolate is melted and smooth.
3. Remove grapes from freezer. Divide
evenly into two small dessert dishes.
Sprinkle with powdered sugar. Drizzle
melted chocolate over grapes. Garnish
with mint. Serve immediately.
Note: To drizzle chocolate, place
melted chocolate mixture in resealable
food storage bag. Snip corner of bag
and squeeze chocolate over grapes.
Frozen Chocolate Banana Pops
MAKES 6 SERVINGS
Nutrients per Serving: Calories 132, Total Fat 6g, Saturated Fat 3g, Protein 1g,
Carbohydrates 23g, Cholesterol 0mg, Dietary Fiber 2g, Sodium 2mg
Dietary Exchange: 1 Fat, 1½ Fruit
3 bananas,* peeled
6 ice cream sticks or wooden
skewers
½ cup semisweet chocolate
chips
1½ teaspoons vegetable oil
¼ cup sprinkles, coconut,
chopped peanuts or
crushed cookies (optional)
1. Line baking sheet with waxed
paper or foil; set aside. Cut each
banana in half. Insert ice cream
stick halfway into each banana.
Place on prepared baking sheet;
freeze 1 hour.
Frozen Fudge Pops
MAKES 8 POPS
SERVING SIZE: 1 FROZEN POP
Nutrients per Serving: Calories 92,
Total Fat 1g, Saturated Fat 1g, Protein 5g,
Carbohydrates 17g, Cholesterol 2mg,
Dietary Fiber 0g, Sodium 70mg
Dietary Exchange: 1 Milk
½ cup nonfat sweetened
condensed milk
¼ cup unsweetened cocoa
powder
2. Stir chocolate chips and oil in small
saucepan over low heat until melted
and smooth. Place toppings on indi-
vidual plate, if using; set aside.
3. Remove pops from freezer. Spoon
chocolate over each banana while
holding over saucepan. Roll in top-
pings. Return to freezer to harden,
about 1 hour. Store in airtight
container or resealable freezer food
storage bag.
Notes *You may substitute 6 baby
bananas. If desired, bananas can be
cut into 1-inch pieces, frozen, then
dipped in chocolate for individual bites.
1¼ cups evaporated skimmed
milk
1 teaspoon vanilla
1. Beat sweetened condensed milk
and cocoa in medium bowl until
blended. Add evaporated milk and
vanilla; beat until smooth.
2. Pour mixture into 8 small paper
cups or 8 popsicle molds. Freeze
about 2 hours or until almost irm. In-
sert wooden popsicle stick into center
of each cup; freeze until solid.
 “BERRY”
DELICIOUS

FROZEN FRUIT TREATS

always hit the spot! Each of
these frosty goodies blends
the sweet taste of seasonal
fruit with the coolness
of gelatin or the creamy
deliciousness of yogurt or
fat-free, low-sugar vanilla ice
cream. Try one today!

40 July/August 2018
Double
Berry Pops
MAKES 6 POPS
SERVING SIZE: 1 POP
Nutrients per Serving:
Calories 90, Total Fat 0g,
Saturated Fat 0g, Protein 7g,
Carbohydrates 15g, Cholesterol
0mg, Dietary Fiber 1g, Sodium
30mg
Dietary Exchange: ½ Bread/
Starch, ½ Fruit, ½ Meat
2 cups plain nonfat
Greek yogurt,
divided
1 cup blueberries
3 tablespoons sugar,
divided
6 (5-ounce) paper or
plastic cups or pop
molds
1 cup sliced
strawberries
6 pop sticks
1. Combine 1 cup yogurt,
blueberries and 1½ table-
spoons sugar in blender or
food processor; blend until
smooth.
2. Pour mixture into cups.
Freeze 2 hours.
3. Combine strawberries,
remaining 1 cup yogurt and
1½ tablespoons sugar in
blender or food processor;
blend until smooth.
4. Pour mixture over blue-
berry layer in cups. Cover
top of each cup with small
piece of foil. Freeze
2 hours.
5. Insert sticks through cen-
ter of foil. Freeze 4 hours or
until irm.
6. To serve, remove foil and
peel away paper cups or
gently twist frozen pops out
of plastic cups.
Cool & Creamy
Lemon-Apple Dessert
MAKES 6 SERVINGS
SERVING SIZE: 1 WEDGE
Nutrients per Serving: Calories 64, Total Fat 1g,
Saturated Fat 0g, Protein 1g, Carbohydrates 11g,
Cholesterol 0mg, Dietary Fiber 1g, Sodium 89mg
Dietary Exchange: ½ Fruit
2 cups water
2 packages (4-serving size each) sugar-
free lemon-lavored gelatin
1 teaspoon vegetable oil
1½ cups thawed frozen fat-free
whipped topping
1 very firm Granny smith apple,
peeled and diced
Fresh mint leaves (optional)
1. Bring water to a boil in large saucepan.
Add gelatin; stir until gelatin is completely dis-
RECIPE AND
solved. Cover and refrigerate 1 hour. NUTRITION INFO
PROVIDED BY
2. Meanwhile, brush 1-quart gelatin mold or SWEETLEAF®
glass bowl with oil.
3. Stir whipped topping into gelatin. Fold in
apple. Spread into prepared mold. Cover and Raspberry Sherbet
refrigerate 4 hours.
MAKES 6 SERVINGS
SERVING SIZE: ½ CUP
4. To unmold, run small metal spatula or
Nutrients per serving:
pointed knife around edge of mold. Dip bot- Calories 120, Total Fat: 1g, Saturated
tom of mold briefly into warm water. Place Fat: ½g , Protein 4g, Carbohydrates 23g,
serving plate on top of mold. Invert mold Cholesterol <5mg, Total Dietary Fiber <1g,
and plate and shake to loosen gelatin. Gently Sodium 55mg
remove mold. To serve, slice into 6 wedges.
Garnish with mint.
3 packets SweetLeaf® Organic
Stevia Sweetener
2 cups yogurt
¼ cup milk
½ cup raspberry juice
1 tablespoon orange juice
1 teaspoon vanilla
1 banana, cut up
Ice cream cones optional
In a large bowl, blend together all
ingredients. Once blended, pour the
mixture into an ice cream maker and
churn until thick, about 30-40 min-
utes. Serve in ice cream cones or small
bowls, and enjoy.
DiabetesSelfManagement.com 41
 “BERRY”
DELICIOUS
Summer
Cherry
Sundaes Watermelon Granita
MAKES 4 SERVINGS MAKES 8 SERVINGS 1. Process watermelon in food proces-
SERVING SIZE: ABOUT ½ CUP sor until nearly smooth. (You should have
about 31/3 cups.)
Nutrients per Serving:
Calories 159, Total Fat 3g, Nutrients per Serving: Calories 88, Total Fat 2. Combine sugar and gelatin in small
Saturated Fat 1g, Protein 0g, Saturated Fat 0g, Protein 1g, Carbohydrates saucepan. Gradually stir in juice. Cook
4g, Carbohydrates 30g, 22g, Cholesterol 0mg, Dietary Fiber 1g, Sodium and stir over low heat until gelatin dis-
Cholesterol 3mg, Dietary 5mg solves. Add to watermelon purée in food
Fiber 2g, Sodium 35mg Dietary Exchange: ½ Bread/Starch, 1 Fruit processor; process until combined. Pour
Dietary Exchange: 2 into 8-inch square baking dish. Cover and
Bread/Starch, ½ Fat freeze about 5 hours or until irm.
5 cups cubed seeded watermelon
½ cup sugar 3. Break watermelon mixture into chunks
1 teaspoon unsalted
butter 1 envelope unlavored gelatin in baking dish. Freeze about 3 hours or
½ cup cranberry juice cocktail until irm. To serve, stir and scrape granita
10 ounces (2 cups)
with fork to create icy texture. Spoon into
fresh cherries,
dessert dishes.
pitted
1 tablespoon
packed light
brown sugar
1 tablespoon water
1 8
/ teaspoon almond
extract
11/3 cups fat-free, low-
sugar vanilla ice
cream
2 tablespoons sliced
almonds, toasted
2 tablespoons (¼
ounce) grated
semisweet or
bittersweet
chocolate

1. Melt butter in me-

dium nonstick skillet over
medium-high heat. Add
cherries, brown sugar
and water; cover and
cook, stirring often, until
cherries are slightly soft-
ened, about 5 minutes.
Remove from heat and
stir in almond extract.

2. Scoop 1/3 cup ice cream

into each of 4 serving
bowls. Spoon warm cher-
ry sauce over ice cream;
sprinkle evenly with al-
monds and chocolate and
serve immediately.
42 July/August 2018
 NUTS &
BOLTS OF
DIETARY
IRON
LIGHT LUNCH
OPTIONS
UNDER 250
CALORIES
PER SERVING!

GET THE
SKINNY
On Sauces
and Marinades

SUPERMARKET SMARTS
CHEESE PAGE 54
Shutterstock/ffolas

DiabetesSelfManagement.com 43
 NUTS & BOLTS
OF DIETARY IRON
Too little or too much? How to find the right balance
By Amy Campbell, MS, RD, LDN, CDE
IRON is a mineral used to make red blood cells, hemoglobin
(the protein in red blood cells that carries oxygen) and myo-
globin (the protein that carries oxygen in muscle). It plays
a role in metabolism, collagen formation, immune system
function and the production of neurotransmitters (brain
chemicals) such as serotonin and dopamine.
Despite iron’s many roles, the amount of iron in the body
only adds up to roughly one teaspoon. We get iron from foods
or supplements, and on average, we lose about one milligram
of iron each day through intestinal blood loss, sweat and urine.
Premenopausal women lose more iron than others through
menstruation.
Food sources of iron
Iron from foods comes in two forms: heme and non-heme.
Heme iron is found in animal foods, such as meat, poul-
try, fish and eggs. Non-heme iron is found in plant foods,
including dark green, leafy vegetables, nuts, seeds, legumes,
iron-enriched grains and dried fruits. Pasta, white rice and
many types of bread are enriched with iron because naturally
occurring iron is often lost during processing. Many cereals
are fortified with 100 percent of the Recommended Dietary
Allowance (RDA) for iron.
The body absorbs anywhere from 15 to 35 percent of heme
iron, compared to one to seven percent of non-heme iron.
However, how much iron you absorb depends on several fac-
tors. If iron storage is low, the body increases iron absorption
from food. Likewise, if iron storage is high, absorption will
normally decrease. Iron absorption increases during a child’s
growth spurt and also during pregnancy. Certain substances
in food such as calcium, caffeine, tannins (found in tea) and
phytates (found in plant foods) can decrease iron absorption.
On the other hand, vitamin C greatly increases iron absorp-
tion from foods with non-heme iron. Following expert recom-
mendations to eat five to nine servings of fruits and vegetables
a day can help maximize iron absorption. Another way to
increase iron in your diet is to cook foods in iron pots and
pans. Small amounts of iron from the cookware can leach
into foods.
Iron and Type 2 diabetes
Research has linked high iron levels and the development
of Type 2 diabetes. A key study from the Harvard School of
Public Health looked at data from 33,000 healthy women in
the ongoing Nurses’ Health Study. After 10 years of follow-up,
about 700 of these women developed Type 2 diabetes. These
women also had significantly higher iron stores compared to
a control group of about 700 women who did not develop
diabetes, and they were almost three times as likely to develop
diabetes than women with low iron stores.
Another study looking at 33,000 men in the Health Profes-
sionals’ Follow-up study found that men whose iron intake
came primarily from red meat were at higher risk of Type 2
diabetes compared to men who got their iron from non-red
meat or plant sources.
How much iron do you need?
Iron requirements depend on several factors, including
sex and age. For example, adult men and postmenopausal
women need less iron compared to children, adolescents
and women of childbearing age. Infants need very little iron
(they are born with iron storage that can last for up to six
months), while pregnant women need substantially more
than non-pregnant women.
Iron-deiciency anemia
Iron-deficiency anemia can occur when there is not enough
hemoglobin in the blood. The World Health Organization
DiabetesSelfManagement.com 45
reports that iron deficiency is the most common nutritional are the richest sources of absorbable dietary iron. However,
disorder in the world, and it’s estimated that more than 30 anemia can be easily prevented in vegetarians with an eating
percent of the world’s population is affected. In the United plan rich in fruits and vegetables high in vitamin C. Further-
States, approximately five percent of women and two percent more, there’s evidence that vegetarians actually adapt to a lower
of men have iron-deficiency anemia. iron intake by increasing iron absorption and decreasing iron
Insufficient iron in the body will eventually lead to iron- losses. Anyone who has problems with malabsorption because
deficiency anemia. The body will draw iron from the liver, of celiac disease, Crohn’s disease or ulcerative colitis or who
spleen and bone marrow if iron is lacking in the diet. However, has had a portion of his or her intestines removed is at high
when iron stores in the bone marrow and becomes low, the risk for developing anemia, as well.
marrow cannot make enough hemoglobin for red blood cells.
The resulting red blood cells are small and carry too little Iron supplements
oxygen for organs and tissues, causing anemia. It can be tempting to take an iron supplement to prevent
Symptoms. See your health care provider if you experi- anemia. However, too much iron can lead to iron overload,
ence any of the following, because they can be signs that you a condition in which excess iron
are anemic: is stored in the heart
• fatigue • rapid heartbeat • difficulty concentrating and liver, some-
• weakness • shortness of breath • brittle nails times damaging
• lightheadedness or • headaches • cracked lips those organs.
dizziness • irritability • smooth, sore tongue Only take an
• ringing in the ears • paleness iron supple-
Causes. Low iron levels can result from an inadequate ment under
intake of dietary iron, poor absorption, internal bleeding due the guid-
to ulcers or cancer, heavy menstrual periods, pregnancy, the ance of your
demands of the growing bodies of children and adolescents health care
or an increased loss of iron during endurance sports. provider. Taking
People who are on kidney dialysis often become ane- an iron supplement
mic. Damaged kidneys can’t make enough of a hormone on your own to self-treat what
called erythropoietin, which is needed to make red blood you suspect is anemia may also delay the diagnosis of a more
cells. Erythropoietin and iron are also lost during dialysis. serious problem, such as a bleeding ulcer or colon cancer.
Therefore, people on dialysis typically need supplements of In general, most healthy people do not need to take an iron
iron and erythropoietin to prevent anemia. supplement. However, women with heavy menstrual periods
Pregnant women who are anemic may exhibit unusual and pregnant women are typically prescribed iron. Also, people
conditions called pica and pacophagia. Pica is the consumption with the following conditions may need supplemental iron:
of nonedible items such as dirt, clay or paper. A person with • bleeding problems • stomach problems • removal of stomach or
pacophagia constantly craves ice. Anemia during pregnancy • burns • hemodialysis intestines
raises the risk of premature delivery, a low birth weight baby • intestinal diseases
and complications in the mother. Iron supplements are sold over the counter at drugstores
If your health care provider suspects you have anemia, you and come in several forms, including capsules, tablets and
will likely have a physical exam and special blood tests, which liquids. Iron is also available by injection (given by a health
include a complete blood count, iron tests (to determine the care provider) or infusion and may be given to people who
type and severity of anemia) and a ferritin level test to deter- have difficulty absorbing iron from food or supplements or
mine the level of iron stores in the body. Sometimes a portion who have stomach problems.
of the bone marrow is also obtained to better determine the Possible side effects from iron supplements include:
cause of anemia. If your physician suspects bleeding in the • upset stomach • constipation • leg cramps
digestive tract, you’ll likely need a fecal occult blood test, a • heartburn • diarrhea • stained teeth (from
colonoscopy, an endoscopy and/or an upper GI series (x-rays • nausea • dark-colored stools liquid supplements)
of the upper gastrointestinal tract). • vomiting • dark-colored urine
People at risk. Because older infants, toddlers, adolescents, Taking iron with food or right after eating can help lessen
women of childbearing age and pregnant women have higher stomach upset, and increasing fiber and fluid intake may help
iron needs, they are more likely to not get enough iron. Women prevent constipation. Dark green or black stools are normal and
who have heavy menstrual periods often need more iron, as occur due to unabsorbed iron. (However, call your health care
well. Women in minority groups and women from low-income provider if your stools are dark with a sticky consistency, if you
backgrounds are more likely to not meet the RDA for iron. see red streaks, or if you have any abdominal cramping or pain
Shutterstock/Victor Josan

Others at risk for anemia include endurance athletes such
as long-distance runners, who can have increased iron losses
from sweating and high red blood cell turnover. Vegetarians
are also at risk because they limit or avoid animal foods that
46 July/August 2018
because these can indicate serious gastrointestinal bleeding.)
Unless you have a chronic condition that impairs iron
absorption, iron supplements are not meant to be taken
indefinitely, so follow your health care provider’s instructions
about how long to take your supplement. If you are anemic,
you may need to take an iron supplement for up to six months.
Supplement safety
Iron supplements may interfere with the absorption and
action of some medicines and can affect other medical condi-
tions, such as kidney disease, heart disease, asthma, intestinal
disorders and stomach ulcers. Once again, it’s important to
discuss taking iron supplements with your health care provider,
especially if you have any concerns.
Certain foods (dairy foods, eggs, spinach, whole-grain
foods, tea and coffee) decrease iron absorption when taken
with an iron supplement. Take your iron one hour before
or two hours after eating these foods. Don’t take your iron
with calcium supplements and antacids. (Remember, to
increase iron absorption from food and supplements, eat
a food high in vitamin C with your meal, such as an orange,
tomato, strawberries or green pepper.)
Store iron supplements away from heat and light, and
discard any expired supplements. Always keep iron out of
the reach of children because an iron overdose can be fatal.
If you take a multivitamin supplement or eat a fortified
cereal (such as Total), be sure to check the label for the
amount of iron it contains. A multivitamin supplement
that contains 18 mg of iron (or a cereal that contains 100
percent of the daily value for iron, which is also 18 mg),
for example, is fine for most women under 50. However,
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this is too much iron for men and postmenopausal women,
who should choose a supplement with no more than 8 or
9 mg of iron.
Iron overload
Iron overload, in which excess iron in the blood is stored in
vital organs such as the liver and heart, can be caused by get-
ting too much iron from a supplement. A common genetic
condition called hemochromatosis can also cause the body
to absorb too much iron. Over time, iron builds up in organs,
leading to problems such as cirrhosis (damage to the liver)
and heart failure. Hemochromatosis may be linked with
diabetes, as well.
Hemochromatosis occurs in about one out of 250 people of
Northern European descent and is less common in other ethnic
groups. It is often not diagnosed until signs of organ damage
occur, which is another reason why men and postmenopausal
women who are not iron-deficient should not take iron supple-
ments unless prescribed by their health-care providers.
Everyday iron
It’s easy to underestimate the importance of a substance that
we need so little of, but iron is important for health. In the
United States, most peoples’ diets ensure that they get the
right amount of iron, but if you fall into an at-risk group or if
you have any questions, a registered dietitian can help make
sure your eating plan is “iron clad.” †
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 There’s an
APP
for that!
By Alison Massey, MS, RD, LDN, CDE
NEARLY 70 PERCENT of Americans own a
smartphone, and for individuals with dia-
betes, these devices – specifically phone
apps – have become an integral part of
their everyday lives because they house
tools to help stay on a healthy
diabetic track.
“We usually see patients quar-
terly for appointments, which
means the other 361 days
of the year, they’re on their
own,” says endocrinolo-
gist Amber Champion,
MD, at Great Plains
Health in North Platte,
Nebraska. “They need
to have the knowledge
and tools to take care
of themselves. Diabetes-
related apps can be useful to
help keep track of all the data and
see it visually. They can also help edu-
cate and teach patients to spot trends
and keep their data organized.”
When it comes to apps, which
ones are the best to help you get
started and manage your diabetes
self-care? Here is a list of apps to
consider.
48 July/August 2018
DIABETES
MANAGEMENT APPS
mySugr App: This
app, named one of
the top diabetes apps
by Healthline from 2015 to 2017,
offers two options: basic and pro.
The basic app function is designed to
help manage blood glucose patterns for
individuals with Type 1 and Type 2 diabe-
tes. There is a section to enter data regarding
diet, medications and blood glucose levels.
The upgraded pro version provides features like
blood glucose reminders, multi-device syncing,
basal rates for pump users and priority support.
MySugr coaching is one of the newest features
by which users can receive personalized advice
from certified diabetes educators.
Extra Features Available: There is also a mySugr
bundle program for $39.99 per month that pro-
vides users with an AccuCheck Guide glucometer
with Bluetooth technology, which automatically
integrates with the mySugr app test strips and the
mySugr coach feature.
Devices: Compatible with iOS devices
Shutterstock/blackzheep
Diabetes:M: An award-winning diabetes
logbook app, Diabetes:M allows users to enter
glucose readings, insulin injections and car-
bohydrates consumed at meals. There is a bolus calculator
as well as a food database for looking up and tracking vari-
ous foods. Detailed graphs, analytical charts and the ability
to generate reports to share with health care providers are
some of the additional features.
Extra Features Available: Premium subscription features provide
synchronization from multiple devices. Diabetes:M can analyze
data imported from various glucometers and insulin pumps.
Devices: Compatible with iOS devices and Android
MyTherapy App is a personal medication tracker.
Never forget a dose again! This app allows users to
setup personal alerts for medications, as well as track
other health components like weight and blood pressure. Fam-
ily sharing is available for this app, if extra support is needed.
Devices: Compatible with iOS devices
Glucose Buddy Diabetes Tracker: A top-rated
diabetes app, Glucose Buddy allows users to track
trends in blood glucose, medication, weight, blood
pressure and A1C. Data can be exported to create easy-to-read
and printable reports to share with health care providers. This
app integrates with the Apple Health App.
Extra Features Available: A premium subscription provides
additional features like an A1C calculator, advanced graphs for
viewing trends and custom tags for logging data.
Devices: Compatible with iOS and Android devices
One Drop Diabetes Management: This app
syncs with popular glucometers and insulin pumps
and can track patterns in blood glucose, food, medica-
tion and physical activity. Users are able to set up and schedule
daily reminders for medication and blood glucose monitoring.
Extra Features Available: The One Drop Chrome glucometer is
a Bluetooth technology meter that automatically integrates with
the One Drop App. Users can select plans that provide 50, 100
or unlimited test strips each month from $19.95-$44.95/month.
Devices: Compatible with iOS and Android devices
HEALTHY EATING AND MEAL PLANNING APPS
Figwee Portion Explorer: Figwee provides users with a
visual representation of portions of various food items
with corresponding nutrition data. It allows users to
manually adjust the portions to larger or smaller, which
provides insight on how portion size impacts the nutritional
composition of the food.
Devices: Compatible with iOS devices
Simple Feast: This app provides seasonal recipes customized
to your own personal weight loss and athletic perfor-
mance goals. Create grocery shopping lists based on the
recipes you’ve selected for the week or watch culinary
videos to improve your skills in the kitchen.
Extra Features Available: Premium upgrade provides the Nutri-
tion Coach feature that selects recipes to best support your goals
based on information you provide in a profile.
Devices: Compatible with iOS devices
MyNetDiary Pro: If you need to understand the
nutrient composition of your food and keep track of
your choices, this app does double-duty, providing both
nutrition data and meal planning guidance. It also syncs with
fitness trackers and makes suggestions for additional activities
and exercises.
Extra Features Available: Some features of the app are sub-
scription options only, available via a monthly or annual
payment feature.
Devices: Compatible with iOS devices and Android
Myfitness pal: This app is still one of the most
popular free calorie counter, nutrition and exercise
journals available. Individuals who need to learn to
count carbohydrates will likely be able to find what they are
looking for in the database of over 294,474,000 foods.
Devices: Compatible with iOS and Android devices
PHYSICAL ACTIVITY APPS
Couch to 5K: This app provides the training plan
to help beginner runners train for their first 5k. The
plan is set up for a nine-week plan that gets you mov-
ing toward meeting your goals. Features track both pace and
distance and provide a virtual coach to keep you motivated
throughout the training process.
Devices: Compatible with iOS devices
Sworkit: This app provides workout plans for every
fitness level and any schedule, with some workouts as
short as five minutes.
Devices: Compatible with iOS devices and Android devices
PHYSICAL ACTIVITY TRACKERS INTEGRATED
WITH DIABETES TECHNOLOGY
Other technology devices, like physical activity
trackers, are being integrated with some continu-
ous glucose monitor (CGM) systems to help dem-
onstrate how activity impacts blood glucose levels. In the
fall of 2017, Fitbit partnered with Dexcom to bring CGM
data to Fitbit Ionic. Some health-care programs, like UHC
Medicare Advantage plans, are even providing piloting
programs in which participants who use CGM technology,
like Dexcom, are receiving Fitbit activity trackers.
Devices: Compatible with iOS devices
With so many technologies in the marketplace, selecting
the right app can be overwhelming. Remember that apps
are tools designed to create accountability, track data and
help users discover patterns and change behaviors. Trying
several apps allows you to experiment with features to find
the best fit for your lifestyle and needs. Focus on using app
technologies that ease the burden of diabetes management
instead of complicating it. †
Alison Massey, MS, RD, LDN, CDE, is a registered dietitian and Certified
Diabetes Educator in Maryland. She is the owner of The Simple Ingredient
LLC, www.thesimpleingredient.com.
DiabetesSelfManagement.com 49
NEVER A DULL LUNCH AGAIN! Whether you are preparing lunch for home,
the office or the beach, this scrumptious lunchtime line-up will add spice to your
noontime menu. Try a new recipe each day and savor the variety of salads, proteins
and seasonal vegetables. All under 250 calories per serving!

54
CALO
RIES
PER S
ERVIN
G

50 July/August 2018

Greens and
Broccoli
Saladwith 2 4 2 IES
CALO
Peppy
Vinaigrette
MAKES 4
SERVINGS
Nutrients per Serving:
Calories 54, Total Fat 2g,
Saturated Fat 1g, Protein
3g, Carbohydrates 9g,
Cholesterol 0mg, Dietary
Fiber 2g, Sodium 79mg
Dietary Exchange:
2 Vegetable
4 sun-dried tomato
halves (not packed
in oil)
3 cups torn leaf lettuce
1½ cups broccoli florets
1 cup sliced mushrooms
1 3
/ cup sliced radishes
2 tablespoons water
1 tablespoon balsamic
vinegar
1 teaspoon vegetable oil
¼ teaspoon chicken
bouillon granules
¼ teaspoon dried chervil
or dried parsley
¼ teaspoon dry mustard
1 8
/ teaspoon ground red
pepper
1. Pour boiling water
over tomatoes in small
bowl to cover. Let
stand 5 minutes; drain.
2. Chop tomatoes.
Combine toma-
toes, lettuce, broc-
coli, mushrooms and
radishes in large salad
bowl.
3. Combine 2 table-
spoons water, vinegar,
oil, bouillon granules,
chervil, mustard and
red pepper in jar with
tight-itting lid; shake
well. Add to salad;
toss gently.
POTATO
Asian Chicken
MAKES 10 SERVINGS
R
PER S
ERVIN
G
Nutrients per Serving: Calories 178,
Total Fat 3g, Saturated Fat 1g, Protein
32g, Carbohydrates 4g, Cholesterol
78mg, Dietary Fiber 1g, Sodium
475mg
Dietary Exchange: 4 Meat
3 pounds boneless skinless chicken
breasts
½ cup reduced-sodium soy sauce
¼ cup fresh lemon juice
1 tablespoon honey
2 teaspoons sesame oil
Cheddar Stuffed Beef Burger 1 teaspoon dry mustard
MAKES 4 SERVINGS 1 teaspoon grated fresh ginger or ½
teaspoon powdered ginger
1 teaspoon minced garlic
¼ teaspoon red pepper flakes
Nutrients per Serving: Calories 242, Total Fat 3g,
Saturated Fat 1g, Protein 26g, Carbohydrates 26g,
1. Place soy sauce, juice, honey,
Cholesterol 40mg, Dietary Fiber 3g, Sodium 369mg oil, mustard, ginger, garlic, and
red pepper flakes in gallon-size
Dietary Exchange: 2 Bread/Starch, 2 Meat resealable food storage bag. Add
chicken. Seal bag. Turn to coat
Nonstick cooking spray evenly. Place bag in pan. Chill in
2 large baking potatoes, washed and dried refrigerator 1 hour or overnight.
12 ounces extra-lean ground sirloin
½ teaspoon dried thyme 2. Preheat oven to 350°F. Line
4 slices fat-free sharp Cheddar cheese roasting pan with foil. Remove
1 8
/ cup water chicken from bag and place in pan.
4 slices beefsteak tomato (Discard unused marinade.) Bake
4 romaine lettuce leaves chicken breasts 30 minutes or until
no longer pink in center.
1. Preheat oven to 450°F. Lightly coat a baking
sheet with cooking spray. Cut each potato cross-
wise into 8 round slices. Place slices on baking
sheet. Bake for 25 to 30 minutes or until lightly
browned.
178
CALO
RIE
PER S
ERVIN S
2. Mix together the ground sirloin and thyme in G
a mixing bowl. Form into 8 balls.
3. Fold each slice of cheese in half 4 times,
forming a cube.
4. Press cheese cube in between 2 ground
sirloin balls, sealing cheese inside. Form into a
patty by flattening to approximately 1½-inch
thick. Repeat for 3 more patties.
5. Lightly coat a deep skillet with cooking spray.
Heat skillet over medium-high heat. Add stuffed
patties and cook for 3 minutes on each side.
Add water; cover and cook for 6 minutes.
6. Place each burger on a slice of potato. Top
with tomato slice, lettuce leaf and another slice
of potato.
DiabetesSelfManagement.com 51
 Brown Rice,Asparagus
1 7 5
R IES
and Tomato Salad
CAL O ERVIN
G MAKES 4 (¾-CUP) SERVINGS
PER S

Nutrients per Serving: Calories 130, Total Fat 3g,

Saturated Fat 1g, Protein 4g, Carbohydrates 22g,
Cholesterol 0mg, Dietary Fiber 3g, Sodium 97mg

Dietary Exchange: 1½ Diabetic Carb Count, 1½

Bread/Starch

1 cup instant brown rice

12 medium spears asparagus, cooked and cut into 1-inch
pieces
2 medium tomatoes
2½ teaspoons lemon juice
2 teaspoons olive oil
1 8
/ teaspoon salt
1 8
/ teaspoon black pepper
¼ cup minced fresh chives or green onions
2 teaspoons minced fresh dill
1. Bring 1 cup water to a boil in medium sauce-
pan. Stir in rice. Bring water to a boil again. Re-
duce heat to low; cover and simmer 5 minutes.
Remove from heat. Stir rice; cover again. Let
stand 5 minutes or until water is absorbed and
rice is tender. Fluff with fork; set aside.
South-of-the-Border Lunch Express 2. Meanwhile, place asparagus in large bowl.
MAKES 2 SERVINGS Core tomatoes over a separate bowl to catch
juice. Dice tomatoes, reserving juice. Add
tomatoes to asparagus. Whisk 1½ tablespoons
reserved tomato juice, lemon juice, oil, salt and
Nutrients per Serving: Calories 175, Total Fat 2g, Saturated Fat 0g, pepper in small bowl until well blended. Stir in
Protein 5g, Carbohydrates 35g, Cholesterol 0mg, Dietary Fiber 5g,
chives and dill.
Sodium 244mg
3. Add rice to salad bowl. Pour in dressing; toss
Dietary Exchange: 2 Bread/Starch, ½ Vegetable lightly to coat.
Variation: To turn this salad into a heart-
½ cup chopped seeded tomato
¼ cup chunky salsa
ier main dish, add 1 cup chopped cooked
¼ cup rinsed and drained canned black beans chicken breast.
¼ cup frozen corn, thawed
1 teaspoon chopped fresh cilantro
¼ teaspoon chopped garlic
Dash ground red pepper
1 cup cooked brown rice 1 3 0
R IES
CAL O ERVIN
G
Shredded reduced-fat Cheddar cheese (optional) PER S
1. Combine tomato, salsa, beans, corn, cilantro, garlic and ground
red pepper in 1-quart microwavable bowl. Cover with vented
plastic wrap. Microwave on HIGH 1 to 1½ minutes or until heated
through; stir.
2. Microwave rice in separate 1-quart microwavable dish on HIGH
1 to 1½ minutes or until heated through. Top with tomato mixture
and cheese, if desired.
Variation: To make this vegetarian dish even more satisfying,
add pinto beans.
52 July/August 2018
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 SUPERMARKET
SMARTS
CHEESE
By Lea Ann Holzmeister, RD, CDE
lmost everyone loves some type of cheese, whether
A it’s an aged, robust, hard cheese such as Romano
or a crumbly, pungent cheese like Gorgonzola.
One fact is for sure: with more than one-third of all milk
produced each year being used to manufacture over 300
varieties of cheese sold in the United States, cheese has
become a staple food in the American cuisine.
Cheese is primarily made from cow, goat or sheep’s
milk and therefore has a nutritional profile similar to
milk. Cheese is also a good source of nutrients because
it contains calcium, protein and phosphorus, but it also
has considerably more fat per serving than milk.
Serving size
The serving size of cheese varies with the variety and type
of the cheese. Shredded cheese has a serving portion of
one-fourth cup; grated cheese may list a serving size as
small as two teaspoons. Block cheese or cheese that is not
sliced indicates a serving portion of one ounce. The serv-
ing size of sliced cheese varies according to the size of the
slice. Some come in skinny or slim slices (usually three
slices per serving) or one ordinary-sized slice. Cheeses that
come sliced may look lower in calories, saturated fat and
sodium because their labels often list a smaller portion
size than block cheese. Check the Nutrition Facts panel
to determine the serving portion of the cheese you select.
Nutrients in cheese
Cheese packs a lot of calories and fat in a small serving
size. The calorie content of cheese varies according to
the type and the fat content of the cheese. One ounce of
cheddar cheese contains about 115 calories, while one
ounce of low-fat cheddar cheese contains about 50 calories.
People with diabetes are advised to limit saturated fat
to less than 10 percent of calories (those with elevated
LDL cholesterol levels may be advised to limit saturated
fat to less than seven percent of calories) and avoid trans
fat (cheese does not contain trans fat). For an individual
on a 1500-calorie meal plan, 10 percent of the calories
from saturated fat would be less than less than 17 grams
daily. For the individual limiting his or her saturated fat
to less than seven percent of total calories, the amount
54 July/August 2018
would be less than 12 grams of saturated fat per day.
Over two-thirds of the fat in milk is saturated fat.
Therefore, cheese made from full fat or whole milk con-
tains significant amounts of saturated fat. One ounce of
a full fat cheese contains five to six grams of saturated fat,
supplying over 30 percent of a day’s worth of saturated
fat. Therefore, it becomes important to find strategies to
select lower fat cheeses, consume cheese less frequently
and limit portion sizes to one-ounce portions or less.
Positive choices
Choose cheeses that do not have more than three grams
of saturated fat per serving, about half of what full-fat
cheese contains. Choose cheese labeled “lite,” “two percent
milk,” “50 percent less fat,” “reduced fat” or “part-skim.”
Reduced fat or two percent cheese is made from milk that
contains two percent milk fat. Reduced fat cheese contains
at least 25 percent less fat than regular full-fat cheese. Low
fat cheese is made from milk with one percent milk fat
and must contain less than three grams of fat per serving.
Cheese is a good source of protein, calcium and phos-
phorus. A one-ounce serving of most cheeses provides seven
to eight grams of protein. Cheese is also a good source of
calcium and phosphorus. Calcium is important to maintain
bone mass and decrease risk of osteoporosis, and phosphorus
helps strengthen bones and generate energy in cells. One
ounce of cheese contains 15-20 percent of the daily recom-
mended intake for calcium or about 270 milligrams and up to
15 percent of the daily recommended intake for phosphorus.
The sodium connection
Salt is a standard ingredient in cheese-making, but it
may also be added at varying amounts, depending on the
variety. Natural cheese contains approximately 100-300
milligrams of sodium per ounce, with some varieties such
as Roquefort containing over 500 milligrams per ounce.
Processed cheese typically contains a high sodium content
with 300-500 milligrams per ounce. Low sodium cheese
must contain less than 140 milligrams of sodium per serv-
Shutterstock/Ted PAGEL
ing. Reduced sodium cheese must contain 25 percent less
sodium per serving than regular cheese. Select cheeses
with less than 300 milligrams of sodium per serving. †
 SATURATED FAT (g)

CHOLESTEROL (mg)

TOTAL CARBS (g)

FAT CALORIES
SERVING SIZE

SODIUM (mg)

PROTEIN (g)
SUGAR (g)
CALORIES

FIBER (g)
FAT (g)
ALPINE LACE
CHEDDAR, REDUCED FAT 1 OZ. 70 6 50 3.5 15 150 0 0 0 6
AMERICAN, REDUCED FAT 1 OZ. 90 6 60 4 20 300 2 2 0 6
MUENSTER, REDUCED-SODIUM 1 OZ. 100 9 80 5 20 135 0 0 0 7
PROVOLONE, REDUCED FAT 1 OZ. 80 6 50 3.5 15 160 1 0 0 7
SWISS, REDUCED FAT 1 OZ. 90 6 50 3.5 20 115 1 1 0 8
ATHENOS
BLUE CHEESE 1 OZ. 100 8 70 5 20 380 1 0 1 6
FAT FREE FETA 1 OZ. 30 0 0 0 5 430 1 0 0 7
GORGONZOLA 1 OZ. 100 8 70 5 20 380 1 0 1 6
TRADITIONAL FETA 1 OZ. 70 6 50 3.5 20 330 1 0 1 5
BABYBEL
GOUDA OR WHITE CHEDDAR 1 PIECE 70 6 50 4 20 140-160 0 0 0 4-5
MINI BABYBEL LIGHT 1 PIECE 50 3 25 2 10 160 0 0 0 6
MOZZARELLA STYLE 1 PIECE 50 3.5 30 2.5 10 160 0 0 0 6
HORIZON ORGANIC
AMERICAN SINGLES 1 SINGLE 60 5 45 3 15 230 2 1 0 3
CHEDDAR CHEESE SLICES 1 SLICE 80 7 60 4 20 135 0 0 0 5
MONTEREY JACK SHREDS ¼ CUP 100 8 70 5 25 170 0 0 0 6
KRAFT
AMERICAN, BIG SLICE 1 SLICE 90 8 70 4.5 20 160 0 0 0 5
CHEDDAR, NATURAL, BIG SLICE 1 SLICE 90 8 70 5 25 140 0 0 0 5
CHEDDAR, SHREDDED ¼ CUP 110 9 90 6 25 170 1 0 0 6
COLBY JACK, NATURAL, BIG SLICE 1 SLICE 90 7 60 4.5 25 150 0 0 0 5
COLBY & MONTEREY JACK, SHREDDED ¼ CUP 110 8 80 5 25 180 1 0 1 6
HAVARTI, NATURAL, SLICED 1 SLICE 80 7 60 4 20 135 0 0 0 4
MEXICAN STYLE FOUR CHEESE, SHREDDED ¼ CUP 100 8 70 5 25 180 1 0 1 6
MOZZARELLA, PART-SKIM, NATURAL, SLIM SLICE 3 SLICES 100 7 60 4 20 180 0 0 0 9
MOZZARELLA, PART-SKIM, SHREDDED ¼ CUP 90 6 50 3.5 15 150 1 0 1 7
MOZZARELLA STRING CHEESE 1 STICK 70 4.5 40 2.5 5 150 0 0 0 6
PEPPER JACK, NATURAL, BIG SLICE 1 SLICE 90 7 70 4.5 25 140 0 0 0 5
PARMESAN, FINELY SHREDDED ¼ CUP 110 8 70 4.5 25 430 1 0 0 9
PARMESAN, GRATED 2 TSP 20 1.5 15 1 <5 75 0 0 0 2
SINGLES, 2% MILK AMERICAN 1 SLICE 45 2.5 20 1.5 10 230 2 2 0 4
SINGLES AMERICAN CHEESE 1 SLICE 70 4.5 40 3 5 220 1 1 0 4
SINGLES, DELI DELUXE SWISS 1 SLICE 60 5 40 2.5 15 280 2 2 0 4
SWISS, AGED, NATURAL, BIG SLICE 1 SLICE 90 7 60 4.5 25 40 0 0 0 6
VELVEETA PROCESSED CHEESE LOAF 1 OZ 80 5 50 3.5 7 410 1 2 0 4
VELVEETA SLICES, ORIGINAL 1 SLICE 40 2 15 1 10 320 3 2 0 3
LAUGHING COW
CREAMY SPICY PEPPER JACK 1 WEDGE 35 1.5 15 1 5 180 1 1 0 2
CREAMY SWISS, LIGHT 1 WEDGE 35 1 15 1 5 180 1 1 0 2
CREAMY SWISS, ORIGINAL 1 WEDGE 50 4 35 2.5 10 190 1 1 0 2
LIFETIME
CHEDDAR, FAT-FREE 1 OZ. 40 0 0 0 3 220 1 1 0 9
CHEDDAR, W/ PLANT STEROL 1 OZ. 47 1.7 15 0.5 3.5 200 1 <1 1 7
PRESIDENT
BRIE 1 OZ 100 9 80 5 30 140 1 0 0 5
PUB CHEESE, SHARP CHEDDAR, SPREADABLE 2 TBSP 70 5 45 3.5 15 150 3 1 0 3
RONDELE, ARTICHOKE & GARLIC, SPREADABLE CHEESE 2 TBSP 70 6 60 4 25 160 2 1 0 1
SARGENTO BISTRO BLENDS
4 CHEESE ITALIAN, SHREDDED, REDUCED FAT ¼ CUP 80 4.5 45 3 15 210 1 0 0 8
CHEDDAR, MEDIUM, REDUCED FAT, SLICED 1 SLICE 60 4 35 2.5 15 125 0 0 0 6
CHEDDAR, SHARP, SLICED 1 SLICE 80 7 60 4 20 130 0 0 0 5
MOZARELLA NATURAL STRING CHEESE 1 PIECE 80 6 50 3.5 15 210 1 0 0 8
MOZZARELLA NATURAL LIGHT STRING CHEESE 1 PIECE 50 2.5 25 1.5 10 160 1 0 0 6
SWISS, SLICED REDUCED FAT 1 SLICE 60 4 35 2 15 30 1 0 0 5
SWISS, ULTRA THIN SLICED 3 SLICES 120 9 80 5 30 65 1 0 0 9
TRADER JOE'S
SLICED LITE CHEDDAR 1 SLICE 70 4.5 40 3 15 170 <1 0 0 8
SLICED SWISS 1 SLICE 110 8 70 5 30 60 1 0 0 9
LITE SHREDDED 3 CHEESE BLEND ¼ CUP 80 4 40 3 15 135 1 0 0 8
FANCY SHREDDED LITE MEXICAN BLEND ¼ CUP 80 4.5 40 3 15 170 1 0 0 9
LITE HAVARTI 1 SLICE 80 4 45 3 15 210 0 0 0 8
LITE SHREDDED MOZZARELLA 1 OZ 45 3 30 1 10 190 0 0 0 5

DiabetesSelfManagement.com 55
 Your Weight
By Nicola Davies, PhD
Taking Control of Your Moods and Your Weight
EMOTIONAL HEALTH AND WEIGHT
can become so intertwined that it is dif-
ficult to separate the two. People often
use food as a compensatory measure
when they feel unhappy, bored or angry,
since sugar-rich foods release the brain’s
feel-good chemical, dopamine. However,
the effects are short-lived and only act
to disrupt normal hunger-related brain
signals, leading to over-eating and weight
gain. If this sounds like you, here are
some tools to help you break this cycle.
Keep a mood diary
The first step is to examine your emo-
tions honestly via a mood diary. This can
help you chart your most prominent
emotions, the time of day they occur
and their impact on your eating and
vice versa. Once you are aware of criti-
cal times when emotions may get the
better of you, it will be easier to manage
moods and stop yourself from reverting
to old habits. Free online mood diaries
are available including MedHelp, Mood
Tracker and MoodPanda. If you want
to build your own mood diary, here are
some tips to get you started.
• Decide on the moods you will use as headings
– anxiety, general mood, depression, stress
and irritability, for example. Choose only as
many as you can realistically monitor.
• Decide on the number of times you will record
moods – once daily, twice daily or only when
you have a strong emotion.
• Create a rating system appropriate for each
item. For example, you can rate irritability on a
scale from one to five, where one is extremely
low irritability and five is extremely high.
56 July/August 2018
• Include a comments area for notes on particu-
lar thoughts regarding an emotion. For exam-
ple, you may be affected by the anniversary of
a traumatic event.
• Summarize your moods and compare them
weekly to monitor progress. Your journey to
emotional health should be reflected in changes
you start to see in your mood diary over time.
Keep a reflective journal
Journaling allows you to reflect and
assess why certain events trigger intense
emotions. It provides a chance to con-
sider what you could do to react in
a more positive way the next time.
Through writing, you can clarify your
thoughts and emotions, as well as how
they might be linked to your eating
habits. Journaling has been scientifi-
cally proven to help process emotions,
and studies suggest that those who keep
journals are more successful at manag-
ing their weight than those who do not.
Some questions to kick-start
your journaling
• How happy am I with my current life?
• What changes could I make to improve
my future?
• If I could talk to my younger self, what advice
would I give?
• What are my aspirations?
• What do I hope to get out of journaling?
Be mindful
Many of the benefits that come from
keeping a mood diary or reflective
journal are the result of grounding
yourself in the present moment. They
help you be mindful and to examine
your breathing, body, thoughts and
experiences in a non-judgmental man-
ner. Acceptance is part of the process,
so there should be no conscious efforts
to reject or change your mood.
Try this
Next time you feel overwhelmed by an
emotion and want to reach for dopa-
mine-releasing food, lie flat on your
back, arms by your side, palms upward
and feet relaxed outward. Close your
eyes and bring your attention to your
breathing. Breathe in and out, trying
to inhale for a count of four and exhale
for a count of six. Visualize the fresh
breath entering your body and revital-
izing every part with oxygen. Become
aware of your thoughts and of that
strong emotion you were experiencing.
Do not pursue it – simply let it float
through your brain while concentrat-
ing on your breathing and releasing it
as you exhale.
Take charge
Regulating your emotions is a choice
you can make, and once you are in
control of your feelings, you can work
on using positive energy to help bet-
ter manage your weight. These tools
will help you on your journey to gain
greater awareness of your emotions
and ultimately allow you to recover
ownership of your body. †
Nicola Davies, PhD, is a health psychologist
Shutterstock/Alhovik
and author of I Can Beat Obesity! Finding
the Motivation, Confidence and Skills to Lose
Weight and Avoid Relapse.
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These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Better-for-you Sauces and Marinades
LOVE CONDIMENTS? Worried about
the sodium, sugar or calorie content
busting your diet and health goals? Condi-
ment lovers don’t need to despair. With
the variety of choices on the market, there
is no need to sacrifice taste. After all, a
condiment can often make an average
dish spectacular, and food companies are
paying attention to consumers’ health
needs. Whether it is low-sodium, gluten-
free, cholesterol-free or organic, there is
something for everyone. But it is impor-
tant to pay attention to the nutrition facts.
Low sodium options
Mr. Spice makes nine, flavorful, salt-free
sauces and marinades. These sauces are
organic, gluten-free, low in carbohydrates
and cholesterol free and range from
sweet and savory to spicy. Currently, the
sauces are only sold in retail stores in
Canada but are available for purchase
online at www.mrspice.com or via phone
at 1-800-SAUCE-IT.
Mrs. Dash has been a staple for many
looking for low-sodium seasoning options,
but the company also offers four low-
sodium marinades Lime Garlic, Garlic
Herb, Lemon Pepper and Sweet Teriyaki.
Mrs. Dash marinades do not include high-
fructose corn syrup and instead rely on
brown sugar and honey to add sweetness.
www.mrsdash.com
Woeber’s is an Ohio-based company
that produces condiments like mustards,
mayonnaise, garlic and horseradish sauce,
vinegar, dips and lemon juice. Their low-
sodium condiment options include Sand-
DIfferent types of condiments.
58 July/August 2018
F Thought
for
d
By Alison Massey, MS, RD, LDN, CDE
wich Pals Smoky Horseradish Sauce and
unique mustard options like the Sandwich
Pals Jalapeno Mustard. Note: reading
labels is key, as all products are not low-
sodium options. www.woebermustard.com
Low sugar options
Westbrae Natural Line offers one of the
lowest sugar-added ketchups on the
market. In fact, their Unsweetened Un-
ketchup contains no added sugar and
is also low in sodium. www.westbrae.com
Sir Kensington’s Special Sauce and
Dijonnaise are flavorful options that
are low in added sugars and sodium
and a tasty way to top a sandwich or
burger. Sir Kensington’s also offers a
classic and spicy ketchup made with
less sugar and non-GMO ingredients.
www.sirkensingtons.com
Primal Kitchen vinaigrette and mari-
nades use avocado oil as the base and
are sugar-free, dairy-free and gluten-free.
They offer six flavorful options including
lemon turmeric, sesame ginger and honey
mustard. www.primalkitchen.com
Looking for organic marinades,
sauces and dressings?
Tessemae’s, a Maryland-based com-
pany, produces organic dressings, sauces
and condiments that fit many dietary
needs. Whether it is gluten-free, dairy-
free, no-sugar added or vegan products,
Tessemae’s offers dozens of products,
including their organic slow-roasted garlic
spread, organic BBQ sauce and more.
www.tessemaes.com
Drew’s Organics in Vermont offer
products that are gluten-free, vegan
and no-sugar added. There are over a
dozen dressing and marinade flavors to
choose from, including more unique
flavor-profile options like Shiitake Gin-
ger, Thai Coconut Sesame and Tahini
Goddess. www.drewsorganics.com
Annie’s Naturals offers a line of
organic food products, but it’s their
horseradish mustard that stands out
as a winner that is low in added sug-
ars, sodium and calories. Made with
simple ingredients, it is a flavorful way
to add a kick to any sandwich or dish.
www.annies.com
Do you have questions for a Registered
Dietitian? Email communications@
diabetesselfmanagement.com. †
Alison Massey, MS, RD, LDN, CDE is a regis-
tered dietitian and Certified Diabetes Educator
Top: Shutterstock/Sudowoodo; Bottom: Shutterstock/Daxiao Productions
in Maryland. www.thesimpleingredient.com.
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AFN44167_0113
 Pushing and Pulling Your Weight
By Laurel Dierking, MEd
THERE ARE TIMES in life where we are called to ‘pull our
weight’ in order to accomplish a task or meet requirements
demanded of us. Other times it may be necessary to ‘push
our weight’ around to command respect and be more on
the assertive side. Psychologically these times come and go
and are a part of the natural order of our external environ-
ment. Interestingly, what happens outside of ourselves is not
always so far from the happenings of our very own internal
environment. The same qualities of ‘pushing’ and ‘pulling’
are required of our physical body, and quite importantly so.
The act of pushing and pulling each require unique,
and opposing sets of muscle groups that may not be active
while performing one or the other. The completion of these
two movements is vital in the balance of our physiological
structure, however, it is not uncommon that one set of
motions are neglected more than the other. Life causes
us to acclimate ourselves into rigid patterns and modes of
operation that without a conscious and deliberate effort
we may never remove ourselves from. Physically, mentally,
at work and at home, we become so stuck in our patterns
that any deviation can oftentimes create discomfort.
Our physical body needs variety in order to remain bal-
anced, stable, and safe in our everyday functional movement.
Pushing and pulling are two modalities that can offer a fresh
60 July/August 2018
take on providing a range of different movement types. The
muscles that are activated while pushing are then the ‘sup-
porters’ while performing a pulling motion. Both support and
strengthen various muscle groups and activate dormant areas
of the body that often become weak due to sedentary lifestyles,
long periods of time sitting, as well as non-varied exercise.
Pushing and pulling are considered to be fundamen-
tal pieces of ‘functional’ movement; actions performed
frequently in day-to-day living situations. Consider for a
moment how frequently we may ‘pull’ an object towards
us — picking up a box or opening a door — and on the
contrary, how often we ‘push’ a shopping cart and even
performing a squat. When we neglect one motion over
the other, imbalance occurs which leads to weakness and
increases our risk of injury. It is important to remain bal-
anced within these two systems. Try these movements to
strengthen your ‘pulling’ and ‘pushing’ mechanics.
Laurel Dierking, MEd, NFPT, 500-YTT, is a health and fitness special-
ist, with a concentration in Yoga, individualized strength conditioning,
exercise physiology, and alignment-based movement. With eight years
of extensive hands-on experience, Laurel seeks to help enhance the mind
and body connection by guiding individuals through mindful movement,
functional training, body awareness and breath work.
 TRY IT!
1
Bodyweight PUSH ups: Stand
facing a desk, table, or couch end
with your palms on the edge of the
desk at shoulder width apart and
walk your feet back so that you are
at an angle towards the desk (your
heels can be lifted from the floor).
Create an angle so that you have
more body-weight in your hands.
With your arms straight, contract
your abdominal muscles by slightly
lifting the belly up and in. Inhale
through the nose and begin to bend
the elbows wide, lowering your
chest to the desk, keeping your spine
straight and abdomen engaged.
On your exhale begin to push your
bodyweight back up to the starting
position. This is one repetition.
Complete 10-15 repetitions two to
three times, at the rate of one breath
per movement.

2
Single arm bodyweight PULL:
Stand facing the edge of an open
door to one side. Grip the edge of
the door with the same side hand
and walk your feet forward slightly
so that you are at an inverted angle
to the door with your arm stretched
out long. Inhale through the nose
and begin to pull your body forward
towards the door, keeping your
elbow bent close to the side of your
body. Exhale and slowly re-lengthen
out the same arm. Maintain squared
shoulders and hips throughout the
movement. Complete eight to 10
repetitions on each side for two to
three sets between the push ups.
Aaron Ashley

DiabetesSelfManagement.com 61
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Containing just 60-100 calories per serving,
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For more information and to download a
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FRIO® Insulin Cooling Cases

YOU MAY BE LOOKING FORWARD to long, lazy
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you’re out and about.
That’s where FRIO® Insulin Cooling Cases can help.
Requiring no icepacks or any other components that
need refrigeration, the cases’ cooling properties come
from the evaporation of water that is soaked into the
products’ unique gel. To use, the case needs only to be
soaked in cold water for five-10 minutes, after which it
will keep its contents at a room temperature range of
77-79 degrees for a minimum of 45 hours per immersion.
The packs are reusable and TSA-friendly, perfect for
keeping insulin safe when you’re on the road.
Available in a variety of shapes, sizes and colors, the
cases are designed to fit all types of insulin pumps,
insulin pens, insulin vials and standard refill cartridges.
To learn more, and to order, visit www.FRIOCase.com.
—Diane Fennell

62 July/August 2018
Giving you a hand
with diabetes
Count on us for expert advice,
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Talk to our pharmacist today.

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