New Year, New Diabetes Questions

It’s a new year and hopefully you are actively setting up new and realistic goals concerning your diabetes. Diabetes self-management can be challenging, but it is the only way to make sure you reduce your future complications and live a healthier life. Diabetes remains a “life-long disease”, yet diabetes self-management classes are still not considered mandatory when you are initially diagnosed. Accurate information keeps you motivated. Own your diabetes and own your knowledge. Although you can find answers to many of your diabetes questions on our website, continue to consult your physician about your best day to day diabetes care and treatment.

It’s a New Year – What Can’t I Eat?

The bottom line with diabetes is that there is nothing completely off limits in your diabetes eating plan. With that said, there are certainly some easy tips and better choices that can set you on the path to healthier eating. These foods will help reduce your blood sugars and keep them more stable. Certain food selections can assist in weight loss, which is always a major win with diabetes. You can eat and enjoy a wide variety of foods but still continue to manage your diabetes effectively. The trick is to create a delicate balance. Complete deprivation of your favorite foods may lead to mental anguish and anxiety, which may easily backfire later on. This can lead to blood sugar imbalances and weight gain. It is in your best interest for improved diabetes control to eat:

Nutrient dense foods. Eat seasonal fruits in moderation. When in season, the fruit will taste juicier and sweeter which may offset cravings. If out of season, choose plain bagged frozen fruits with no syrups or added sugars. Great selections (with a lower glycemic index) include berries (blackberries, blueberries, strawberries and raspberries), kiwis, melons, and a variety of apples. That does not mean you can’t eat peaches, grapes or bananas. It just means you need to watch the portion size. One huge peach is not the same as one small peach in terms of carbohydrates or calories. Understand that a serving may be half a banana or 10-12 grapes. Another excellent choice of nutrient dense foods are non-starchy vegetables. Non-starchy vegetables are full of vitamins and minerals, contain lots of water, are low in calories and are very filling. Bell peppers (green, red, yellow, or orange), radishes, green zucchini, yellow squash, cucumbers, celery and tomatoes are just a few examples. Again, potatoes and corn are not off limits – they need to be eaten in smaller quantities with lean protein and non-starchy vegetables to keep blood sugars balanced.
High fiber foods. High fiber foods are preferred since they help maintain blood sugars. Small to moderate amounts of brown or wild rice, barley, amaranth, 100% whole wheat, steel cut oats, quinoa, and bulgur taste delicious and do not raise blood sugars like white pasta, white bread, processed foods or simple sweets. You may yearn for a sweet (cookie, candy, dessert) now and again, just remember that simple sugars should be limited as much as possible for better diabetes control. Learn to count carbohydrates to understand portion amounts and how you can trade foods.
Lean protein. Blood sugars are not affected by protein unless you eat very large quantities. Stick to fish, shellfish, skinless chicken or turkey, and lean, grass-fed beef. Plant-based proteins such as nuts, seeds and legumes are fine, too. Nuts and seeds are high in calories, so be careful.
Less sodium. Watch out for salt added to your foods as well as condiments, sauces and dressings. Eat less processed foods since they tend to be full of salt and sugar. Use more spices, citrus, flavored vinegars, and herbs for flavor. Try to limit or eliminate flavored sweetened milks, yogurt with added sugars and full fat dairy.
Low fat dairy. Have 2-3 servings a day. Dairy is presently being studied “as a food that may lower your risk of developing diabetes”.

A Few More Good Tips To Remember

It is best to work with a dietitian or diabetes educator for specific guidelines. They can decide and offer you personal suggestions based on your current weight, age and activity level. Personalized nutrition is not far off in 2021.
Know what you put on your plate. Eat food instead of drinking fruit smoothies or bars.
Include healthy fats (heart health) in moderation due to calorie content: nuts, seeds, olives, olive oil, and avocados.
Drink water and calorie-free beverages. Water dilutes your blood sugar. Hydration is important and most adults are slightly dehydrated daily. Limit or eliminate alcohol. Alcohol provides extra calories and may affect your blood sugar in a negative manner.
Snacks are allowed but not needed if you are not hungry. They add extra calories and eventually increase your weight. Snacks may be more important if you are on insulin or suffer with hypoglycemia.
You may make an allowance for an occasional treat – especially when you blood sugars are well controlled.

How Can I Quickly Lower my Blood Sugar?

You may test your blood sugar and find it to be higher than you want or expect. Blood sugars do vary during the day for many reasons including food intake, activity level, diabetes medication, stress or illness. Even a bad sunburn can lead to elevated sugars. Sometimes it is difficult to figure out the exact reason for the high blood sugar. If your blood sugar goes up, or you have diabetes symptoms and you are not sure what to do, always contact your physician. You may need to go to the ER.

Some simple things you may try to lower blood sugars include:

Drink water. A 2017 study noted that “low water intake led to high blood sugar”. By drinking more water, you can flush out excess blood sugar through the kidneys. Hydration is important since it really dilutes blood sugars.
Don’t get overheated. High body temperature can elevate sugars. Get cooled off with cool water and a tepid shower. Wear a hat for head protection. Do not overdress – especially when exercising. Skip the hottest hours of the day outside, normally from 10AM-3PM.
Go for a 15-30-minute walk. Try to walk at a quick pace. Evidence shows that just a simple walk after a meal can help blood sugars from jumping up too high. Exercise makes you more sensitive to insulin. The glucose goes to the muscles for energy and blood sugars go down. If you are on insulin and have a blood sugar of 240mg/dl, check for urine ketones. Do not exercise if you have urine ketones. Make sure you have taken your correct insulin dose and report ketones to your health care provider.
Eat fewer carbohydrates at your next meal. Space out carbohydrate intake. Eat carbohydrates high in fiber which will take longer to get into your blood stream. Avoid simple sugars. Eat non-starchy carbohydrates. Make ½ your plate non-starchy vegetables, like a salad.
Eat protein. This may help stabilize blood sugars. A slice of turkey, a hard-boiled egg or a piece of chicken may help.
Monitor your blood sugars. Look for patterns in your blood sugars.
Do not over-medicate. Do not take more diabetes medication unless you are on a sliding scale insulin regimen. Too much medication may cause hypoglycemia.
Ingest adequate magnesium and chromium. Sources of magnesium in foods are nuts, avocados, seeds, and fatty fish which are all low in carbohydrates. Sources of chromium in food depends on the soil they are grown in. Foods to include for chromium are nuts, mushrooms, and vegetable oils.
Chill out. Stress pushes out cortisol which can quickly raise blood sugars. Deep breathing or meditation could help. Whatever takes away the mental stress and anxiety can help bring down your blood sugars.

Tips if you are trying to lower blood sugars gradually:

Spread meals out.
Wait at least 4-5 hours between meals.
No skipping meals and no fasting.
Don’t save carbohydrates for later in the day. Spread them out with each meal.
Eat resistance starch. Resistant starch skips the stomach and small intestine and enters the colon with friendly gut bacteria. It has a positive effect on the number and type of gut bacteria. Resistant starch functions like soluble fiber. It can improve insulin sensitivity, lower blood sugars after meals, decrease your appetite, may help in weight loss and aid in digestion. Resistant starch can reduce gut inflammation, lower PH, lower colon cancer risk and increase mineral absorption. It is best to cook the food and then let it cool. Foods high in resistant starch are white or sweet potatoes (cooked and cooled), green bananas, peas, lentils, white or kidney beans, oatmeal, and cashews.
Eat breakfast. The body needs food in the morning to shut off the liver from producing glucose.
Lose weight if needed or maintain your current weight if it is acceptable. Get your weight circumference and BMI measured.
Adequate sleep and exercise complete the picture.
Glutamine supplements. Glutamine is an amino acid which helps with immunity and intestinal health. It is currently being studied to see “if it makes your insulin more effective”. Small studies suggest “it may help in weight loss in overweight people and may stimulate insulin production in the obese”. According to some studies, people with type 2 diabetes are low in glutamine. It can be taken in capsules or powder packets, up to 30 grams a day. Glutamine is also found in cabbage, beets, beef, chicken, fish, milk, and dairy products. Always check with your health care provider before starting any new supplement.

Did I cause my diabetes by eating too much sugar?

Eating too much sugar is only one piece of the puzzle when it comes to causing type 2 diabetes. Your overall diet, age, lifestyle, and genetics play a bigger role in the development of type 2 diabetes. Type 1 is an autoimmune disease where there is a complete lack of insulin while type 2 is insulin resistance or insulin that does not work properly. Even without diabetes you should not continue to eat as much sugar as you want.

The average American eats 17 teaspoons of sugar daily.
The recommended amount for adult women is 6 teaspoons daily.
The recommended amount for adult men is 9 teaspoons daily.
Eating a sugary treat occasionally is not the problem.
“Sugar can be as dangerous as tobacco” since it is addicting. It has an ability to produce morphine like chemicals, dopamine, in the brain. This produces “the gotta have it” or the natural high making it hard for us to resist.

How can too much sugar affect the rest of my body?

Arteries. Excess sugar can affect the arteries all over the body. It causes arteries to grow thicker, stiffen and get inflamed, leading to heart disease.
Brain. Too much sugar may lead to depression and addiction.
Teeth. Bacteria love to eat the sugar that remains on your teeth and in your mouth after eating a sweet. This leads to tooth decay and gum disease.
Joints. Extra sugar leads to joint inflammation and possible rheumatoid arthritis.
Skin. Sugar damages collagen and elastin production causing wrinkles plus sagging and aging skin.
Liver. Added sugar, and especially high fructose corn syrup, leads to fat build up in and around the liver causing disease, both NASH and NAFLD, in the liver which can be serious.

What Can You Do?

Take small steps to reduce or eliminate your sugar intake. You may notice headache withdrawal.
Eliminate all sugary beverages. A 12 ounce can of soda has 40 grams of sugar. Skip energy drinks with sugar, sport drinks with sugar, fruit juice drinks and 100% fruit juice.
Do not be tricked by natural sugar. Maple syrup, brown sugar, carob syrup, honey, Agave and other sources of natural sugar are all broken down into glucose in the body and raises blood sugars.
Opt for a no-sugar/low-sugar version. When buying nut milks such as almond, coconut, or cashew, select the unsweetened variety. Purchase plain, unflavored yogurts not those with added sugars. Use regular milk or cream for coffee or tea and avoid flavored (full of sugar) creamers. Eat dark chocolate (72% or higher), not milk chocolate which contains added sugar. Look for protein or snack bars that only have fruit and nuts not added syrups, sweeteners or sugar. Choose 100% whole grain cereals instead of honey nut clusters or sugar-coated flakes.

Do blood sugar numbers affect my brain function?

Diabetes does hasten the aging process and mental decline occurs earlier in those with diabetes. Signs of decreased brain function may not be obvious early on. Blood sugar swings and changes can result in fatigue, anxiety and depression as well as having trouble thinking clearly. These symptoms can affect your daily function and quality of life. Both chronic low blood sugars and high blood sugars may have an impact on your brain function.

Chronic low blood sugars. When blood sugars are low, usually 70 mg/dl, you may experience fuzzy thinking and confusion. If low blood sugars go untreated you may develop seizures or loss of consciousness. Older adults with hypoglycemia get more “cognitive symptoms” like slower thinking, confusion and difficulty speaking as compared to “autonomic symptoms” such as sweating, shaking or blurry vision seen in younger patients. Elderly people with repeated episodes of low blood sugar are more at risk for dementia and Alzheimer’s. It is more difficult for the elderly to alter brain cell pathways. Going too low frequently can lead to a condition called hypoglycemic unawareness where your brain and body do not recognize the symptoms and sensations of low blood sugars. Up to 40% of people with type 1 diabetes have hypoglycemic unawareness. Recent use of continuous glucose monitors or CGMs are extremely helpful in identifying lows before they happen by tracking blood sugar trends.
Chronic high blood sugars. Chronic high blood sugars have serious consequences on multiple systems in your body including your blood vessels, heart, nerve endings and eyes. We also know that chronic elevated blood sugars can affect thinking and memory function. Usually, this is paired with high LDL’s, high triglycerides and high blood pressure which also affect brain function negatively. When A1C levels remain above 8% for a long period, thinking skills and memory grows progressively worse. Vascular dementia or small artery damage in the brain affects the brain’s white matter. Insulin resistance can damage brain communication pathways. Even more amyloid plaques have developed as in Alzheimer’s with high uncontrolled blood sugars. People with type 2 diabetes are at a 73% increased risk of getting dementia, and “twice as likely” to get Alzheimer’s compared to those without diabetes.
Control. The best way to prevent brain function abnormalities with diabetes is to keep blood sugars controlled. Practice a proper lifestyle with diet, exercise, stress management and diabetes medication.

I know the Common Symptoms of Diabetes, are there any different ones?

The common signs and symptoms of diabetes may include:

Extreme thirst
Extreme hunger
Frequent urination
Blurry vision
Nausea
Cuts or sores that are slow to heal

There are some different diabetes symptoms which may be found by accident by you or your physician:

Inflamed or bleeding gums. You may go for your regular dental cleaning where the dentist notices thick, puffy or bleeding gums. Your saliva contains more sugar and diabetes reduces blood supply to your gums. Your dentist can detect signs and symptoms of diabetes and may send you for a fasting blood sugar or A1C blood test for a possible diabetes diagnosis.
Strange sensations in your feet. Peripheral neuropathy or nerve damage is not an initial sign or symptom of diabetes. It feels like pins and needles, numbness, burning or lack of sensation in your feet or toes. You may think it is from standing in high heels or wearing shoes that pinch your toes and feet. You may need to stand in place for long periods of time for your job, such as a teacher, surgeon or cashier. If these symptoms do not disappear after you make some adjustments, you should follow-up to see if it could be diabetes. There are many other causes of peripheral neuropathy.
Persistent fatigue and constant napping. When glucose remains in the blood stream instead of getting into the cells, due to lack of insulin or insulin resistance, you will not have any energy. Being tired is different than having persistent fatigue. Resting should alleviate being tired whereas constant fatigue with resting may indicate diabetes. This is from high blood sugars. Check with your physician for a diabetes blood test.
Skin discoloration and other skin conditions. High blood sugars can create multiple skin conditions without you knowing you have diabetes.
Acanthosis nigricans. Patches of tan or brown velvety, raised skin on the sides of your neck, under your armpits, or in your groin area. It is more common in obesity and diabetes.
Diabetic dermopathy. Changes in small blood vessels which present as light brown, scaly patches usually found on your shins. These are harmless and usually disappear when blood sugars are controlled.
Infection. Bacterial infections, genital infections, chronic urinary tract infections, fungal infections, Athlete’s Foot and chronic itchy dry skin will not resolve themselves. These symptoms should alert you and your physician to check for diabetes.
Diabetes blisters may disappear when blood sugars are controlled.
Digital sclerosis. Tight, thick, and waxy skin on the back of the hands. Your joints may become stiff and this is unrelated to arthritis.
Hearing loss. Twice as many people with diabetes have hearing loss compared to those without diabetes. Even people with pre-diabetes have a 30% higher risk of hearing loss compared to those with normal blood sugars. High blood sugars damage the 8th cranial nerve which can cause tinnitus (ringing in the ears) and affect your balance. High blood sugars affect small blood vessels in the inner ear as well as the hair cells in the ear; the hair cells are needed for translating noise. Elevated blood sugars impair blood flow and circulation; this slows or eliminates reproduction of hair cells needed for hearing.
Vision loss. A regular symptom of diabetes is blurry vision but when diabetes is not immediately diagnosed you may have more visual problems and disturbances. Cataracts and glaucoma are more common when you have diabetes, and you may end up being diagnosed with diabetes by your eye doctor. They are often able to diagnose high blood pressure as well as high sugar, just by looking at the blood vessels in your eyes.

Pay attention to any unusual symptoms and always go for your regular checkups. Maintain blood sugars as best as possible with help from your physician and your own knowledge. Always ask questions if you are not sure. Diabetes is a very controllable chronic disease. Take control!