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A GUIDE TO BIKING ESSENTIALS

31 OUS
DELICIIPES
REC

SUMMER GUIDE TO

Basics
25 Tips
TO MANAGE
YOUR MEDS

Be A Kid
Again!
CAMPS AND
RETREATS

WHOLE
WHEAT
BUN

MAY/JUNE 2018 / $4.99


1 jam-packed day. 29 rides.
No fingerpricks .
*

Elizabeth and Erin H.,


mom and T1D
The Dexcom G5® Continuous Glucose
Monitoring (CGM) System is the first CGM
approved by the FDA to let you make
diabetes treatment decisions without pricking
your finger.* A small sensor continuously
measures your glucose levels and sends data
to a receiver or smartphone† every 5 minutes.
And only the Dexcom G5 lets you share this
data with up to 5 followers,‡ plus set high and
low glucose alerts.

Know more. Prick less.™

DiscoverDexcom.com

*
Fingersticks required for calibration, or if symptoms or expectations do not match readings,
or when taking medications containing acetaminophen.

For a list of compatible devices, visit www.dexcom.com/compatibility ‡Separate Follow app required
BRIEF SAFETY STATEMENT The Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System (“G5”) is a glucose monitoring
system indicated for the management of diabetes in persons age 2 years and older. The G5 is designed to replace fingerstick
blood glucose testing for diabetes treatment decisions. The G5 also aids in the detection of episodes of hyperglycemia and
hypoglycemia. The G5 is intended for single patient use and requires a prescription. CONTRAINDICATIONS Do not rely on the
G5 CGM data if you have recently taken acetaminophen. Remove the G5 (sensor, transmitter, and receiver) before Magnetic
Resonance Imaging (MRI), Computed Tomography (CT) scan, or high-frequency electrical heat (diathermy) treatment. The G5 is
MR Unsafe. Do not bring any portion of the G5 into the MRI environment. WARNING CGM-based diabetes treatment decisions
are only approved with the G5, not previous generations of Dexcom CGM systems. Calibrate at least once every 12 hours using
a fingerstick. If your G5 does not display a sensor glucose reading and an arrow, or if you are getting inaccurate or inconsistent
readings, take a fingerstick. If your glucose readings and alerts do not match your symptoms or expectations, take a fingerstick to
confirm. Failure to do so may lead to hyperglycemia or hypoglycemia. The G5 is not approved for use in pregnant women, persons
on dialysis or critically ill persons. If a sensor breaks and no portion of it is visible above the skin, do not attempt to remove it. Seek
professional medical help if you have infection or infl ammation on or near the sensor insertion point. Report broken sensors to
Dexcom Technical Support. Sensor placement is not approved for sites other than under the skin of the belly (ages 2 years and
older) or upper buttocks (ages 2-17 years). To “share” data, you need an internet connection and a separate compatible smart
device running the Dexcom Follow App. Contact Dexcom Toll Free at 877-339-2664 or www.dexcom.com for detailed indications
for use and safety information. Internet connectivity required to access Dexcom Follow. © 2018 Dexcom Inc. All rights reserved.
This product is covered by U.S. patent.
LBL014743 Rev003
CONTENTS MAY/JUNE 2018

Making Your Pills


14 Work for You
Get the tools you need
to successfully manage
your medications.
By Amy Campbell, MS, RD, LDN, CDE
29
Go Back to Camp!
Diabetic
20 It’s Not Just for
Cooking
Kids Anymore
Whether you are looking to con- DEPARTMENTS
nect with other people living with
diabetes or simply looking for a
wellness retreat, you have many 5 Editor’s Letter
options to choose from.
6 News & Notes
By Alison Massey MS, RD, LDN, CDE
7 Quiz:
How Much
Do You Know
Diabetes Champion
24 Fit4D CEO David Weingard about Herbs and
By Alison Massey MS, RD, LDN, CDE Supplements?
10 Definitions
12 Resources:
Menopause + Diabetes
26 What's the Connection?
Get Walking
13 Diabetes Q&A
Learn how perimenopause
and menopause affect women 60 Supermarket Smarts
with diabetes.
Butter, Margarine
By JoAnn Stevelos
and Spreads

Cover image: Photographed by Angel Tucker; 68 Product Spotlight


food prepared by Maggie Mulvena Eucerin and DietSensor

WEIGHT SELF-MANAGEMENT PAGE 49


50 Biking for Good Health 64 Food for Thought
A guide to bike basics Kitchen and lifestyle tips
By Julia and Paul Wynn By Alison Massey,
MS, RD, LDN, CDE
56 Pack the Perfect Picnic Basket
Five easy-to-pack recipes – a complete 66 Take 5
meal under 675 calories! Balance and Stability
in Everyday Life
62 Your Weight By Laurel Dierking, M.Ed.,
Connect In Motion

Increasing Your Confidence NFPT, 200-YTT


for Weight Management
By Nicola Davies, PhD

2 May/June 2018
diaBEtes
ACTIVE

© 2018 Akorn, Inc.

Introducing A full line of health and personal care


products specifically formulated for people with diabetes.

Be

Go to TypeYou.com for a list of retailers.


CONSUMER and RETAILER: Limit (1)
coupon per purchase of specified product
and quantity stated. Not to be combined with
any other coupon(s). Limit of two (2) identical
coupons in same shopping trip. Void if expired,
$ 2 OFF
reproduced, altered, copied, sold, purchased, In the diabetic aisle
transferred, or exchanged to any person, firm,
or group prior to store redemption, or where near the pharmacy.
prohibited or restricted by law. Any other MANUFACTURER’S COUPON EXPIRES 03/01/2019
use constitutes fraud. CONSUMER: You pay
any sales tax. RETAILER: Akorn Consumer
Health will reimburse you for the face value
of this coupon plus 8¢ handling if submitted
in accordance with Akorn Consumer Health
Coupon Redemption Policy. Mail Coupons to:
Inmar Dept #58790, Akorn Consumer Health,
1 Fawcett Drive, Del Rio, TX 78840. Cash
value 1/100¢. No cash back if coupon value
Foot Care • Cough & Flu • Eye Care • Vitamins exceeds selling price. Valid only in the USA.
EXECUTIVE
Chairman & Chief Executive Officer
Jeffrey C. Wolk
Chief Operating Officer
Susan Fitzgerald
SVP, Sales & Marketing
Robin Morse EDITORIAL SALES & MARKETING
Editorial Director, Wellness Vice President, Media Solutions
Maureen McCarthy Stuart Crystal | scrystal@madavor.com
OPERATIONS Senior Digital Editor Senior Media Solutions Manager
Diane Fennell Bob Beucler | bbeucler@madavor.com
VP, Business Operations
Columnists Senior Media Solutions Manager
Courtney Whitaker
Dr. Nicola Davies Kathy Jones Rizzi | krizzi@madavor.com
Technical Product Manager Robert S. Dinsmoor Client Services
Michael Ma Joseph Gustaitis clientservices@madavor.com
Lea Ann Holzmeister, RD, CDE Marketing Director
Operations Supervisor Alison Massey, MS, RDN, LDN, CDE Andrew Yeum
Nora Frew Gary Scheiner, MS, CDE
Frieda Wiley, PharmD, CGP, RPh Marketing Associates
Human Resources Generalist Paul Wynn Michael Marzeotti, Summer Whittaker
Alicia Roach CUSTOMER SERVICE
ART & PRODUCTION
Supervisor, Client Services CustomerService@DiabetesSelf-Management.us
Art Director
Jessica Krogman (855) 367-4813
Carolyn V. Marsden
Client Services Senior Digital Designer
Cheyenne Corliss Mike Decker
Darren Cormier Senior Designer
Scott Brandsgaard
Tou Zong Her
Andrea Palli
Accounting Director
EDITORIAL BOARD
Amanda Joyce
Amy P. Campbell, William H. Polonsky, PhD, CDE Bernard P. Shagan, MD
Accounts Payable Associate MS, RD, LDN, CDE Assistant Clinical Professor, Director, Diabetes Education Center,
Tina McDermott Boston, Massachusetts. Department of Psychiatry, University Monmouth Medical Center,
of California, San Diego. Long Branch, New Jersey.
Accounts Receivable Associate David E. Goldstein, MD
Wayne Tuggle Professor Emeritus, University of Missouri L. Raymond Reynolds, Richard M. Weil, Med, CDE
Health Science Center, Columbia, Missouri MD, FACP, FACE, ECNU Exercise Physiologist and Director,
Professor Emeritus, Division of Mount Sinai St. Luke’s Weight
AUDIENCE DEVELOPMENT Lois Jovanovic, MD Endocrinology, University of Kentucky Loss Program, Mount Sinai St. Luke’s
Physician Consultant, Sansum College of Medicine, Lexington, Kentucky Hospital, New York, New York
VP, Audience Development Diabetes Research Institute,
Santa Barbara, California. Jeanne L. Rosenthal, MD Susan Weiner,
Bob Dortch Attending Surgeon, Retinal Service, MS, RDN, CDE, CDN
VP, Strategy Virginia Peragallo-Dittko, New York Eye and Ear Infirmary, Owner, Susan Weiner Nutrition, PLLC,
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.
CONTENT MARKETING Diabetes Education Service Coordinator
UK HealthCare Barnstable Brown
Strategic Content Director Diabetes Center, University of Kentucky,
Peter Madden Lexington, Kentucky
Content Marketing Associates
Anthony Buzzeo
CONTRIBUTING EDITORS
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, May/June 2018, Volume 35, reproduced or transmitted in any form or by any means, We sometimes make our list of subscribers available to
Number 3. Diabetes Self-Management (ISSN 0741-6253) electronic or mechanical, including photocopying, recording, carefully screened organizations whose products and activities
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All rights reserved. No part of this publication may be inquiries about personal health matters.

4 May/June 2018
EDITOR’S
NOTE
Twitter: I REMEMBER my first experience with diabetes.
@ManageDiabetes My cousin Billy was diagnosed with Type 1 when
Facebook: he was 16 years old. It came without warning
@DiabetesSelfManagement and no cure in sight. Faced with this life
changing challenge, Billy, a three-sport high
school athlete, took on his condition the same
way he played sports – with determination
and positivity. 
Balancing academics and athletics, he
incorporated monitoring his blood sugar
levels and insulin injections into his daily
routine. Never did he see diabetes as a set-
back. In fact, he set new goals and reached
greater heights – placing fifth in the state’s
track and field competition his senior year.
Fast-forward two decades, Billy’s positivity is as strong as ever.
Diabetes never defined him and he continues to find the good.
The role of editor-in-chief of Diabetes Self-Management is one
I am truly proud to take on. When crafting the content for this
magazine, my goal is to lead by Billy’s example:
always inspire and always find the good.
Inspired by Memorial Day, summer fun
and outdoor activities, this BBQ guide is a must-
have resource for healthy seasonal and grilled-
to-order recipes. Learn how to build the ultimate
cookout menu (pg. 30), then fire up the grill and
try new ways to prepare fish, vegan burgers, beef,
chicken and more in the “Master the Grill” section.
Add some “Savory Sides” to your menu, and top off
the meal with one of our “Summer Sparkler” beverages.
With diabetes education and alternative therapies
in mind, we offer tips and tools to help you successfully
manage your prescriptions (pg. 14). And if you think
campfires and lakeside retreats are just for kids, not so
fast. Take a look inside adult diabetes summer camps
and get the strategies you need to make the most of
the wellness retreat experience (pg. 20).
Thank you for diving in and exploring Diabetes
Grill: Shutterstock/stockcreations; Pills:Shutterstock/Mike Flippo

Self-Management. I hope you will learn something


new, find inspiration and share your inspiration
with others.

Maureen McCarthy
Editor-in-Chief

DiabetesSelfManagement.com 5
NEWS &
NOTES
A New Lyrica
any people with diabetes
M have been taking Lyrica
(generic name, pregabalin) since
it was first approved by the FDA
in 2004. Manufactured by the
pharmaceutical firm Pfizer, Lyrica
is prescribed to counter the pain of
diabetic neuropathy (nerve dam-
age). Most commonly, patients are
directed to take the medication
two or three times a day.
Recently, Pfizer announced that
the FDA has approved a new for-
mulation called Lyrica CR, which is
a longer-lasting version of Lyrica.
Unlike the previous version, Lyrica
CR is taken once a day (after the
evening meal). Lyrica CR tablets
are almond-shaped and come in
three dosages (each a different
color). Lyrica CR was also approved
for the treatment of postherpetic

A NEW DEVICE FOR FOOT ULCERS neuralgia (PHN), but not for the
management of fibromyalgia, as

T he U.S. Food and Drug Administra-


tion (FDA) recently gave the green
light to market a new device for treating
Shockwave technology has been used
in medicine for some 30 years in ortho-
pedic treatments to shatter kidney stones.
the original Lyrica was. The safety
of Lyrica CR was established in a
placebo-controlled clinical trial that
involved 800 patients. According to
diabetic foot ulcers. Known as the der- Success in these procedures suggested
James M. Rusnak, MD, chief devel-
maPACE system, it’s the first shock-wave that the technology might be effective in opment officer, Internal Medicine,
device for foot ulcers. healing wounds. This led to the develop- Pfizer Global Product Development,
ment of Pulsed Acoustic Cel- Lyrica CR was developed to offer
lular Expression (PACE). The patients an effective treatment
dermaPACE device, developed option with the convenience of
by Sanuwave, a technology once-daily dosing. “[Lyrica CR]
provides an important option for
firm based in Suwanee, Geor-
patients and health care providers
gia, is the first to employ PACE managing these often debilitating
technology for wound treat- pain conditions,” Rusnak says. †
ment. It works by using energy
pulses to stimulate wounds
and is intended for diabetes
patients aged 22 and older
who have experienced foot
ulcers for more than 30 days.
Diabetic foot ulcers are sores or The FDA approved the device after
wounds that occur on the feet of diabe- reviewing the results of two multicenter
tes patients. Ulcers are caused by damage studies. Forty-four percent of those stud-
to the nerves or blood vessels, or both, ied experienced wound closure while
when diabetes is poorly controlled. The receiving the PACE treatment.
condition occurs in about 15 percent of Technology watchers now expect that
Shutterstock/Djomas

diabetes patients. If left untreated, foot the dermaPACE breakthrough will lead
ulcers can result in reduced circulation, to a wider use of shockwave technology
infection and even amputation. in medicine. †
6 May/June 2018
NEWS &
NOTES
DIABETES INTRODUCING THE
QUIZ Questions “SUGAR SPONGE”
P eople with diabetes usually treat their disease in one
of two ways – medication or injection. Both methods,
however, have drawbacks. Injections can be painful and
confusing, while patients often forget to take their medica-
tions. Both methods can also have unwelcome side effects.
Could there be another way? Diabetes researchers in China
think there might be.
A team of scientists led by Jianzhong Du, PhD, of
Tongji University in Shanghai reported in the Journal
of the American Chemical Society on their development
of what they call a “sugar sponge.” Injected into the
bloodstream of diabetes patients, sugar sponges, also
called nanomachines, are meant to soak up glucose, or
How Much Do You Know about blood sugar, the way a kitchen sponge soaks up water.
Herbs and Supplements? Nanomachines are about 1/100th the width of a human
hair and are minuscule hollow plastic balls coated with a
More people are taking herbs, vitamins and other protein called concanavalin A. In the bloodstream, the
over-the-counter supplements than ever before. Take concanavalin A adheres to glucose, which then becomes
this quiz to see how much you know about diabetes trapped inside the plastic sphere. The hollow balls also
and supplements. work the opposite way – when glucose in the bloodstream
1. Which of the following supplements may help support becomes low, the nanomachines release it.
a healthy immune response? The researchers’ trial involved 20 mice with diabetes.
OA. Alpha lipoic acid Five of the mice were given sugar sponge injections; the oth-
OB. Lecithin ers were injected with nonabsorbent materials. The blood
OC. Vitamin B12 sugar of the mice that received
OD. Vitamin D the sponges returned to
2. Which of the following herbs lowers blood sugar? normal; the blood of
More than one answer may be correct. the others didn’t.
OA. Bitter gourd/bitter melon However, after
OB. Cassia cinnamon two days, the
OC. Ceylon cinnamon effect of the
OD. Red yeast rice sugar sponges
3. In addition to supporting blood sugar health, what are
wore off and
some other potential benefits of moringa? the blood
OA. Relieving constipation sugar levels
OB. Providing a good source of antioxidants, minerals of the five
and vitamins mice became
OC. Supporting appropriate cholesterol functioning high again. Con-
OD. Regulating blood pressure sequently, the first
Left: Shutterstock/Fecundap stock; Right: Shutterstock/Svetlana Lukienko

aim of Du’s team is to


4. Which of the following improves absorption of
curcumin, turmeric’s active ingredient?
prolong the effect of the sugar
OA. Crush the turmeric root. sponges, “one week, one month, or even longer,” he says.
OB. Juice it. If the effect could be extended to a month, the thinking
OC. Take it with black pepper. goes, it might mean that a diabetes patient could receive
OD.Boil it. a monthly injection of sugar sponges instead of a daily
injection of insulin – a considerable improvement. More
5. You don’t need to ask a medical professional before research is needed to determine effectiveness. So although
taking herbal and other over-the-counter supplements.
it will be a while, if ever, before sugar sponges routinely
OTrue
OFalse
course through human bloodstreams soaking up glucose,
it’s an encouraging development that bears watching. †
DiabetesSelfManagement.com 7
NEWS &
NOTES
DIABETES PERSPIRATION
QUIZ Answers PERSPECTIVES
R esearchers at the University of Texas announced they
have created a wearable device that can measure diabe-
tes-related compounds in tiny amounts of sweat. Regularly
collecting information on these compounds, they say, can
enable wearers who have diabetes to make smarter lifestyle
choices that can help them better manage their condition.
The wearable monitor detects amounts of cortisol, glucose
and interleukin-6 (IL-6). The necessity of measuring blood
glucose levels in people with diabetes is well-known. The
reason to measure cortisol is because cortisol increases in
moments of stress, and in such moments, glucose levels tend
1. A, B, C and D. Alpha-lipoic acid is a fatty acid and an antioxidant to rise above the normal range – a situation that can lead first
that has been shown to support healthy blood sugar levels in several to prediabetes and then to full-blown Type 2 diabetes. Rising
studies. It may also help relieve nerve pain by neutralizing free radicals. IL-6 levels are associated with cortisol secretion during psy-
Derived from soy, lecithin contains compounds called phospholipids –key
components in the cell membrane and production of the myelin sheath.
chological stress. IL-6 also increases basal glucose intake and
Evidence suggests that this may improve nerve pain in some people who can influence insulin activity, according to the researchers.
have diabetes. Vitamin B12 works along with other B vitamins to support The device requires very small amounts of sweat for test-
the transmission of healthy nerve signals. Many studies show that vitamin ing – just 1 to 3 microliters (a microliter is one-millionth of a
D deficiency contributes to many problems, including inflammation, liter) – which means that the wearer doesn’t have to produce
nerve pain and increased pain sensitivity. An animal study showed that
nerve pain decreased after restoring vitamin D levels.
much perspiration at all. Because the device is worn continu-
ally, it gives constant readings, unlike devices that test just
2. A, B and C. Studies have shown bitter melon can help lower blood
sugar. Both Ceylon and cassia cinnamon have blood sugar-lowering
once before being discarded. The developers expect that
effects, with cassia being the more potent of the two. However, consum- wearers can use it
ing large amounts of cassia cinnamon may cause liver damage. Ask your for about a week
health-care provider about how to use cinnamon and which cinnamon before replacing
product would work best for your situation before making a selection. it and intend it
3. B, C and D. Native to India, moringa contains vitamins A and C to be affordable
along with several B vitamins. It is also a good source of antioxidants, enough that it can
including quercetin, which may help support healthy blood pressure
levels. Some animal and human studies suggest the plant also may
be used in devel-
help lower cholesterol. oping countries
4. C. Turmeric’s active ingredient is curcumin, which has been shown to
where the rates
benefit diabetes in many ways, including improving insulin resistance of diabetes are
and reducing inflammation that can worsen diabetes and lead to com- climbing.
plications such as heart disease and nerve pain. The problem is the body The creators
has trouble absorbing turmeric because it does not hang around long of the tool soon
inside the body. Black pepper contains a chemical called piperine that
improves absorption. These days, more turmeric and curcumin products
expect to have an
sold also contain piperine for this reason. app that can be
5. False. While over-the-counter products are considered safe to use
installed on a cellphone. Using this app, the wearer can push
without a doctor’s supervision, many supplements and herbs may interact a button to retrieve information from the device. Accord-
with diabetes medications and alter their effects. For example, taking ing to Shalini Prasad, PhD, one of the lead designers, “If
herbs such as bitter melon and moringa may affect blood sugar levels you measure levels every hour on the hour for a full week,
and have additive effects on blood sugar if taken while taking diabetes that provides 168 hours’ worth of data on your health as it
medication. Also, some herbs, such as St. John’s wort, which is often
used for depression, may reduce the effects of other drugs, such as
changes.” This knowledge will enable wearers to analyze
birth control pills, antidepressants and blood pressure medications such how their habits and activities are influencing their health.
Shutterstock/YAKOBCHUK VIACHESLAV

as calcium channel blockers. For this and many other reasons, it never As Prasad puts it, “If I can monitor on a day-to-day basis
hurts to double check with your doctor or pharmacist before adding how my body is responding to intake and as I age, if I can
nonprescription products to your health-care regimen. † adjust my lifestyle to keep those readings where they need
Frieda Wiley, PharmD, BCGP, RPh is a pharmacist, freelance writer, and life
to be, then I can delay getting a disease, if not prevent it
enthusiast based in the Piney Woods of East Texas. entirely.” The next step for developers is to find a partner
and license the technology. †
8 May/June 2018
Discover the FreeStyle Libre system
The FreeStyle Libre system is an FDA-approved continuous glucose monitoring (CGM) system
that lets you accurately1 check your glucose with a painless2 one-second scan instead of a
YV\[PULÄUNLYZ[PJR
You can learn more at FreeStyleLibre.us.

*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.

©2018 Abbott. ADC-07061 v2.0 02/18


NEWS &
NOTES
DIABETES Victoza and
[DEFINITIONS] Heart Health
METABOLIC SURGERY
An umbrella term for a number of surgi-
cal procedures that improve blood glucose
can pass out within seconds and die if not
treated. A ventricular arrhythmia must be
treated right away with an electrical shock,
P eople with diabetes have successfully
been using the drug liraglutide (brand
name, Victoza) to control blood sugar levels
control in people with Type 2 diabetes who a treatment called defibrillation. Implantable
since the drug was approved by the U.S.
are obese. Types of metabolic surgery include cardioverter defibrillators (ICDs) are used for
people who are at high risk for ventricular Food and Drug Administration (FDA) in
adjustable gastric banding, Roux-en-Y gastric
bypass, biliopancreatic diversion and sleeve arrythmias – those who have had ventricular 2010. Recently, however, the FDA granted
gastrectomy. arrhythmias before or who have had a heart liraglutide a new indication: the product
In adjustable gastric binding, the upper attack that has damaged the heart’s electrical is now approved for reducing the risk of
part of the stomach is surrounded by an system. Doctors sometimes recommend ICDs major cardiovascular events in adults who
inflatable silicon ring that restricts the move- for people who have had prior sudden cardiac have both Type 2 diabetes and established
ment of food. In Roux-en-Y gastric bypass, arrest or are at high risk for it. The ICD has
cardiovascular disease.
a surgical stapler is used to create a small wires with electrodes on the ends that are
connected to the heart chambers. It monitors The FDA approval was based on the results
pouch in the stomach, which is then surgi-
cally attached directly to the middle of the the heart rhythm and, if it detects a ventricular of the LEADER (Liraglutide Effect and Action
small intestine. In biliopancreatic diversion arrhythmia, it delivers a low-energy electrical in Diabetes: Evaluation of Cardiovascular
and sleeve gastrectomy, the reduced stomach signal to restore the normal heart rhythm. Outcome Results) trial, which compared
is surgically attached to the end-portion of the effect of liraglutide versus a placebo
the small intestine. These procedures have
DIABETIC NEPHROPATHY
Kidney disease caused by diabetes. The
(inert) medication on over 9,300 diabetes
two things in common: they decrease the patients from 32 countries for a period of
primary function of the kidneys is to filter
absorption of calories by the gastrointestinal
waste products and excess water out of the nearly four years. The findings showed that
tract and promote weight loss. However,
researchers are studying other – and perhaps
bloodstream. Each kidney contains roughly liraglutide lowered the risk of non-fatal heart
one million glomeruli, which are tufts of attack, non-fatal stroke or cardiovascular
even more powerful – effects such as changes
tiny blood vessels called capillaries that act death by 13 percent. They also showed that
in food metabolism by bile acids, changes in
as filters. As blood flows through these
the hormones in the gut that regulate food the medication significantly reduced the risk
capillaries, small molecules such as waste
metabolism and changes in the types of of cardiovascular death by 22 percent. This
products and water pass readily through the
bacteria that live in the gastrointestinal tract. is important because cardiovascular disease
glomeruli. Other substances, such as protein
Many randomized clinical trials have
molecules and red blood cells, are too large is the leading cause of death among people
shown that these types of surgical proce-
dures achieve better blood glucose control
to pass through these filters and remain in with diabetes.
the bloodstream. Liraglutide now becomes the second diabe-
and a decrease in cardiovascular risk factors
High blood glucose levels can damage tes medication to be granted a cardiovascular
in obese Type 2 diabetes patients compared
the kidneys. People with diabetes are also
with various medical and lifestyle interven- indication. The first, in 2016, was empagliflozin
prone to hypertension (high blood pres-
tions. A joint statement issued by international (brand name, Jardiance), but Victoza is cur-
sure), which can also damage the kidneys.
diabetes organizations in 2016 recommended rently the only Type 2 diabetes treatment
Eventually, the kidneys may start to “leak”
that metabolic surgery be included among
tiny amounts of protein into the urine, a indicated to reduce the risk of three major
treatments for patients with Type 2 diabetes
and obesity.
condition known as microalbuminuria. adverse cardiovascular effects (heart attack,
If kidney disease is diagnosed early, sev- stroke and cardiovascular death).
IMPLANTABLE CARDIOVERTER eral types of treatment may keep them from Victoza, manufactured by the Danish phar-
DEFIBRILLATOR getting worse. Controlling blood glucose
maceutical firm Novo Nordisk, is delivered
A small device placed in the chest or abdomen levels and high blood pressure both help slow
down the progression of diabetic nephropa-
by injection. Patients take it once a day by
to treat dangerous types of cardiac arrhyth-
thy. Two types of blood-pressure-lowering using an injectable pen (doses are 0.6 mg, 1.2
mias (irregular heart beats).
A regular heart beat requires the coordi- medications called ACE inhibitors and ARBs mg or 1.8 mg). According to Anne Phillips,
nated contraction of the heart’s upper cham- have been found to be especially useful MD, a senior vice president at Novo Nordisk,
bers (the atria) and lower chambers (the in slowing diabetic nephropathy. Lifestyle “Physicians have come to rely on Victoza as
ventricles). The heart’s built-in electrical system changes, such as limiting alcohol and pro- an effective therapy for lowering A1C, and
coordinates the timing of these contractions. tein intake and stopping smoking, may also
with this new indication they now have the
Any disruption in this timing can cause an help. Once kidneys fail, regular dialysis may
be needed to filter the blood and, in some
option to choose a diabetes medication that
arrythmia. While most types of arrhythmias
cases, the patient may be given a kidney also reduces their patients’ cardiovascular risk.
are harmless, others can be serious. The most
dangerous types of arrythmias are ventricular transplant. † This is good news for patients and health care
arrhythmias, irregular heart beats of the lower providers that will also bring much needed
heart chambers. When they occur, the heart Robert Dinsmoor, a medical writer and editor, is a attention to the relationship between Type 2
can’t pump blood as well, and the individual contributing editor of Diabetes Self-Management. diabetes and cardiovascular disease.” †
10 May/June 2018
Giving you a hand
with diabetes
Count on us for expert advice, medications and testing supplies
from all major brands so you can perform better than ever.

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NEWS &
NOTES

DIABETES
RESOURCES

Get
Walking
I f you are looking to ease back into
regular exercise, now is the perfect
time to start a walking routine. Not
Bonus miles
Research shows that people who
want to reap health benefits from
the parking lot when you’re going to
the office or shopping at the stores.
Do walking meetings with your co-
only does walking help to lower blood walking should do it for 30 minutes workers or take short walks during
sugar levels and improve the body’s a day at least five days of the week. your lunch break.
ability to use insulin, but it also helps Keep in mind, walking for 30 min-
lower stress and helps you lose weight utes is not a must. Three 10-minute Fun walks
or maintain a desired weight. walks at a brisk pace will get the Walking day after day can become a
job done. One study by Harvard little boring, so it’s important to do
Start with a plan doctors found that women who did it with a family member or friend to
The National Heart, Lung and Blood at least 30 minutes of daily moder- help support you and get you out of
Institute developed a multi-week ate physical activity, such as brisk the house. Walking and talking will
walking plan – search for “sample walking, cut their risk of diabetes make the time go by much faster
walking program” at www.nhlbi.nih. by 30 percent. and will help motivate you to walk
gov. Begin at an easy pace with a five- brisker and longer. Another way to
minute walk and slowly add about two Squeeze in steps make walking more fun is by listen-
minutes to your walking time each If you’re having trouble finding ing to your favorite music play list,
week. By week eight, aim to walk for time to fit walking into your already new audiobooks or calling family
Shutterstock/Monkey Business Images

at least 20 minutes, and then by week hectic schedule, consider a few sim- and friends. †
12, keep walking for 30 minutes. ple ways to take more steps each
Gradually walk at a steadier pace so day. Take the stairs instead of the Paul Wynn, a writer based in Garrison, New
that you’re breathing a little harder, elevator the next time you have a York, is a regular contributor to Diabetes
but still able to have a conversation. chance. Park a little further away in Self-Management.

12 May/June 2018
NEWS &
NOTES
Q+A
Q: The meter I’ve been using for years is previously used. It’s a very good option for
being discontinued. It uses replaceable disks anyone who struggles to perform blood sugar
to hold the test strips. I can’t use meters that checks the “old fashioned” way. Ask your
require a test strip insertion because my physician for details.
hands and fingers are too arthritic. What
do you advise? Q: I had outpatient surgery on my hip
recently. Despite continuing to take my dia-
A: Sometimes “progress” doesn’t seem like betes medications (which my primary doctor
progress at all. I remember the meter you said to do), my blood sugar was quite high for
described: the test strip “disk” was certainly almost a week after the procedure. The sur-
Gary Scheiner, MS, CDE, is owner and easier to handle for people with arthritis, hand geon said this probably delayed my recovery.
clinical director of Integrated Diabetes tremors or limited vision. In the manufactur- What are your thoughts and is there anything
Services (www.integrateddiabetes. ers’ defense, the meters that have replaced it I could have done differently?
com), a private practice specializing
in intensive therapy for children and are more accurate and require a much smaller
adults. He has lived with Type 1 diabetes blood sample. Of course, that only matters if A: Asking for and following your physician’s
for 30 years; is a certified diabetes you can get the strip into the meter. advice is generally a good idea. But of course,
educator and named Diabetes Educator
of the Year 2014 by the American Here’s a bit of progress that might be able not all physicians are experts at all things.
Association of Diabetes Educators. to help. There is a new device called a “flash” Unless your primary care doctor is also an
monitor that does not require test strips or endocrinologist or an internist specializing
Have a question about diabetes?
fingersticks and provides glucose values any in diabetes, chances are he or she only has a
Send it to Gary Scheiner MS, CDE,
at gary@integrateddiabetes.com.
time you like. A 10-day glucose sensor is general understanding of diabetes care and
placed on the skin using a simple one-handed treatment. It is often worth consulting with an
inserter. After a warm-up period, you simply endocrinologist or a certified diabetes educa-
scan a handheld “reader” over the sensor to tor before a scheduled medical procedure to
see your current glucose level. The device develop a plan for managing your diabetes
does not require fingerstick calibrations, but before, during and after. A diabetes specialist
you may still need to check your blood sugar will be able to help you balance your insulin
with a meter once in a while to verify that the (or other diabetes medications) in the event
system is working properly and during the you need to fast leading up the procedure.
warmup periods. They can also coordinate with the surgeon
The flash monitor is covered by most and hospital staff in case you require IV insulin
health insurance plans, including Medicare, or glucose during and after the procedure.
and its accuracy is on par with the meter you As your surgeon pointed out, something
as important as hip surgery requires optimal
blood sugar control to allow a full, speedy
recovery and prevent infection. The same
goes for many other types of medical pro-
cedures and common illnesses. Surgery and
illness often involve several things that can
make blood sugars rise: stress, discomfort,
anti-inflammatory medications and a sharp
reduction in physical activity. To offset these
and keep the blood sugar from running
too high, it is usually necessary to increase
diabetes medication doses or temporarily
add new forms of treatment. For example,
those who do not currently take insulin may
need to take a modest dose for a short while.
Shutterstock/Click and Photo

Those who take insulin may need to ramp up


their dose. The key is to do whatever it takes
to keep your blood sugars in range so you’ll
recover as quickly as possible. †
DiabetesSelfManagement.com 13
MAKING YOUR

PILLS WORK FOR YOU


Shutterstock/Video_Creative

14 May/June 2018
By Amy Campbell, MS, RD, LDN, CDE

If you have diabetes, it’s highly likely that you


take at least one type of medicine to help you manage it. People with Type
1 diabetes must take insulin. Those with Type 2 diabetes may manage just
fine by eating healthfully and staying active. While many people with Type 2
diabetes take at least one, if not two or three, diabetes medicines, including
pills, non-insulin injectables and insulin.

DiabetesSelfManagement.com 15
According to data from the Centers for make cells more “sensitive” to insulin
Disease Control and Prevention (CDC), and tells the liver to stop releasing too
the number of adults with diabetes who much glucose.
take insulin, pills or both greatly increased
from 1997 to 2011. The increase is due in Recommendations
part to the increase in numbers of people • When you first start taking this drug, it
in the U.S. who have diabetes. However, may cause an upset stomach, gas or diar-
thanks to newer types of diabetes medi- rhea. Lessen the chances of side effects
cines and better awareness of diabetes by taking your metformin with meals.
management among health-care provid- • Start low, go slow. Your doctor should
ers, more people are taking medicine as start you on a low dose of metformin
part of their diabetes treatment plan. and gradually increase the dose to help
lessen side effects.
TAKING DIABETES PILLS • Regular metformin is usually taken twice
There are nine classes, or types, of dia- a day; extended-release is taken once a
betes pills. There are combinations of day, usually in the evening.
these pills, too, making it easier for you • Ask your doctor to periodically check
to benefit from two types of pills. These your blood vitamin B12 level. Metformin
medications work in different ways to can affect B12 absorption in the gut,
help manage blood glucose levels. The raising the risk of B12 deficiency.
good news is that if one type of pill isn’t • Go easy with alcohol when taking met-
doing the job well enough, your doctor formin — too much alcohol can raise
can change your medicine or even add the risk for a rare but serious condition
a second or third medicine. To make called lactic acidosis.
sure you’re getting the most from your • Tell all your health care providers that
diabetes pills, consider the following tips. you take metformin, especially if you
are scheduled for a CT scan involving
SULFONYLUREAS contrast dyes.
This class of drug has been around since • Don’t panic if you see what looks like a
the 1940s. Examples include glimepiride tablet in your stools — this is the outer
(brand name Amaryl), glyburide (Dia- shell of the extended-release metfor-
Beta, Glynase, Micronase) and glipizide min. Seeing it in your stools doesn’t
(Glucotrol). Sulfonylureas signal the mean the pill hasn’t been absorbed or
pancreas to release insulin and may that it’s not working.
help your body use its own insulin better.
DPP-4 INHIBITORS
Recommendations (dipeptidyl peptidase 4 (DPP-4) are a
• Take your pill the same times each newer class of drug and include sita-
day, before meals (glipizide should gliptin (Januvia), saxagliptin (Onglyza),
be taken 30 minutes before the meal). linagliptin (Tradjenta) and alogliptin
• Because these pills can increase the (Nesina). These drugs slow stomach
chance of low blood sugar, don’t skip emptying, increase fullness and slow the
or delay meals. Be prepared and keep a release of glucose from the liver. DPP-4
treatment for low blood sugar with you inhibitors generally aren’t the first choice
at all times — glucose tablets or gel, of drug for people because in some cases,
juice or regular soda are good choices. they may not be as effective at lowering
• Sulfonylureas can increase sensitiv- A1C levels as other drugs.
ity to the sun, so be sure to protect
yourself by wearing sunscreen, a hat Recommendations
and sunglasses when you’re outdoors. • Take your DPP-4 inhibitor at the same
time each day. You don’t necessarily have
METFORMIN to take it with food. Most people take
(Glucophage, Glucophage XR, For- their pill in the morning.
Shutterstock/Shahrokost

tamet, Glumetza, Riomet) is rec- • Saxagliptin can interact with ketocon-


ommended as the first line of drug azole, a drug used to treat fungal infec-
treatment for people who are new tions, so always let your providers know
to Type 2 diabetes. This drug helps all medicines that you take.
16 May/June 2018
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• DPP-4 inhibitors are linked with pancreatitis.
Stomach pain and vomiting are symptoms of
pancreatitis. Contact your doctor if you develop
these symptoms.
• Severe joint pain is another possible side effect
of this class of drugs. The pain goes away once
the drug is stopped.

SGLT-2 INHIBITORS ARE THE NEWEST


CLASS OF DIABETES PILLS.
They lower blood sugar by causing glucose to
move from the bloodstream into the urine. They
can also help with weight loss. Canagliflozin
(Invokana), dapagliflozin (Farxiga) and empa-
gliflozin (Jardiance) are the three pills in this
class of drugs.

Recommendations
• Take your SGLT-2 inhibitor with your first meal of
the day. If you forget to take it, take it as soon as you
remember (but don’t double up on your dose).
• Keep up your fluid intake to avoid dehydration
because this drug can cause you to urinate more
than usual.
• Be aware of signs and symptoms of yeast or urinary
tract infections while taking this drug.
• Note that SGLT-2 inhibitors may cause your blood
pressure to drop too low, especially when you
stand up suddenly.

GENERAL TIPS FOR TAKING


DIABETES PILLS
• It goes without saying that your diabetes pills will
work best if you take them as prescribed — that
means taking the right dose at the right time.
• Give your medicines a chance to do their job.
But if after several weeks you don’t see any or
much of an improvement in your blood sugars,
let your doctor know.
• Check your blood sugars more than usual when-
ever you start a new diabetes medicine and/or if
the dose is changed.
• Store your medicines away from heat and humid-
ity, and pay attention to expiration dates.
• Let your doctor know if you’re having trouble
affording your medicines. He or she can likely
prescribe a lower-cost alternative. There are
also medicine-assistance programs, such as www.
needymeds.org, that can help.
• Keep up with regular doctor’s appointments and
lab tests to make sure your medicines are working
and that they are safe for you to take.
• Your pharmacist can also answer any questions
you may have about any medicines you take. He
Shutterstock/Vita Sun

or she can also help you come up with a medica-


tion schedule to make sure that you’re getting
the most out of your medicines. †
18 May/June 2018
Introducing

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power chair... The Zinger
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at the touch of a button. One-touch
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More and more Americans are reaching the age
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Lightweight Seating
from arthritis, bone density loss, knee and back
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conditions, injuries and falls or just the everyday
aches and pains that come with getting older–
getting around isn’t as easy as it used to be. You
may have tried a power chair or a scooter. Unlike Easy-Steer
bulky power chairs, the Zinger is quick and nimble, Throttle
yet it is not prone to tipping like many scooters.
Best of all, it weighs only 42 pounds and folds Inflatable
and unfolds with ease so you can take it almost Tires
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Years of work by innovative engineers have Powerful
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Just think of the places you can go:
both levers down to go forward, pulls them both
up to brake, and pushes one while pulling the • Shopping • Air Travel • Bus Tours
other to turn to either side. This enables great • Restaurants– ride right up to the table!
mobility, the ability to turn on a dime and to
pull right up to tables or desks. Best of all, no one • Around town or just around your house
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have to let mobility issues rule your life. It folds
on the steering arm so it’s simple to operate, and
in seconds without tools and is safe, reliable and
its exclusive footrest swings out of the way when
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DiabetesSelfManagement.com 19
Connect In Motion

20
May/June 2018
DIABETES
SUMMER
CAMPS?
Not Just for Kids
by Alison Massey MS, RD, LDN, CDE

DiabetesSelfManagement.com 21
Connect In Motion
CAMPFIRES, laughing with new ing for a wellness retreat, you have looking to improve diabetes man-
friends, catching fireflies on warm many options. agement and their health?
summer nights and lake swimming But before booking your trip and • adventure?
might evoke fond memories of sum- packing your bags, you might con- • improve your fitness?
mer camp for some adults. Does the sider a few things to make the most • relax and minimize stress?
magic of a summer camp experience of your experience. Some camps and retreats include
really have to end with childhood? educational lectures in which attendees
More options are now available than What kind of experience are can learn new skills, while other camps
ever for adults who want to revisit you seeking? focus more on offering activities and
the beloved summer camp getaway The first consideration is to identify experiences. There may be a combina-
or perhaps experience it for the the kind of trip you would enjoy. Are tion of these activities. Identifying the
first time. Whether you are looking you seeking to: most important features ensures you
to connect with other individuals • expand your diabetes knowledge? will achieve the type of vacation you
living with diabetes or simply look- • connect with other individuals are seeking.

“…adults taking time to retreat from the daily grind can be an important component of self-
care. Learning new skills, connecting with others and spending time in nature can be fantastic
ways to refresh and perhaps even jump-start new routines to improve diabetes management.”
22 May/June 2018
Are medical professionals
involved and/or available? ADULT SUMMER
If you are specifically looking for
information to hone diabetes self-
CAMPS AND RETREATS
Check out these options for camps and
management skills, improve culinary retreats— each designed just for adults
skills and diet or enhance fitness looking to connect with other individuals
skills, it is important to look for pro- living with diabetes or simply looking for a
grams supported by credentialed health and wellness experience geared
health care providers (either serving toward improving diabetes management.
as board members or involved in DIABETES TRAINING CAMP
supporting the program). Located in beautiful Lancaster, Pennsylvania, the
Having a licensed medical profes- Diabetes Training Camp is a multi-sports training
sional on staff is especially important if camp. They offer a weeklong camp experience
the experience involves more intense for individuals with diabetes who are either
physical activity than your typical rou- interested in improving their general fitness or in
tine and/or significant dietary modifi- improving their competitive edge for marathons,
cations. These factors can affect blood triathlons or anything in between. Professional
glucose management and in some cases coaching staff is available along with medical
staff. Workshops and seminars are included
may even require dose adjustments for
along with fitness training to enhance diabetes
medications. Generally, involvement by
self-management skills. Staff includes medical
licensed health care professionals may professionals, registered dietitians and certified
help ensure that programs are meeting diabetes educators. New program offerings in
standards of care for individuals living 2018 may also include three-day boot camp
with diabetes. It also may be beneficial experiences for individuals with Type 2 diabetes
to discuss travel and getaway plans with and prediabetes. Program fees are subsidized
your regular health care provider or by the Diabetes Training Camp Foundation.
diabetes educator to receive guidance However, scholarships are available for those in
about traveling with medications and financial need. www.diabetestrainingcamp.com
changes in physical activity and/or diet. CONNECTED IN MOTION: DIABETES
EDUCATION THROUGH ADVENTURE
How many vacation days do Designed for individuals with Type 1 diabetes,
you want to use? the Canadian-based Connected in Motion
If you are trying to find time for your- program works to build and support
self without burning through your communities of active and well-informed
adults who are engaged in their diabetes
paid time off, camp and retreat expe-
self-management. The program does this by
riences for adults are offered in vary-
offering amazing adventures and experiences
ing lengths of time. While childhood to connect individuals and provide a unique
often offers summers off, the reality is format for learning. Events range from day,
that many adults are juggling careers weekend and even 10-day experiences. Choose
and family responsibilities. Along with from a range of options from canoeing, white
weeklong experiences, many places water rafting and hiking. Not able to travel
are offering weekend retreats that are to Canada? In 2018, three programs will be
time and budget friendly. offered in Southern California and Maine.
Whether you choose a weekend http://www.connectedinmotion.ca/
away or a full two-week adventure, a SURVIVE AND THRIVE CAMP NEJEDA
retreat can be an important compo- Established in 1958, Camp Nejeda located in
nent of self-care. Learning new skills, Stillwater, New Jersey, provides all kinds of
connecting with others and spending programming for individuals living with Type
time in nature can be fantastic ways to 1 diabetes. In addition to their eight-week
refresh and perhaps even jump-start sleep-away camp for children with Type 1
diabetes, the camp offers a weekend boot camp
new routines to improve diabetes
for adults over the age of 21 with Type 1. The
management. †
boot camp provides camp goers a balance of
relaxation, fun, connection and education. Zip
Alison Massey, MS, RD, LDN and CDE, is a lining, boating and massages are just a few
registered dietitian and certified diabetes educa- activities that are available between informative
tor in Maryland. She is the owner of The Simple and interactive lectures on diabetes self-
Ingredient LLC www.thesimpleingredient.com. management. www.campnejeda.org/
24 May/June 2018
DIABETES
CHAMPION
Fit4D CEO David Weingard
By Alison Massey MS, RD, LDN, CDE

T he everyday moments that make


up our lives often do not prompt
significant change. Difficult or chal-
Weingard says the support he
received was invaluable – so much so
that he decided to seek more guidance
human touch and expertise of CDEs to
help close the gap in care and empower
individuals to improve their diabetes
lenging events are catalysts for a dif- from CDEs throughout his diabetes self-management. Fit4D partners with
ferent direction for our lives. This was journey. “Thanks to this newfound pharmaceutical companies, payers
also true for David Weingard, CEO and understanding of the complex disease, and accountable care organizations
founder of Fit4D. I was able to become productive again to improve health outcomes, with a
A successful Microsoft executive in my personal and professional life,” track record of improving adherence
and physically fit triathlete, Weingard he adds. “I figured out how to train and to branded prescriptions by 20 percent
was training five hours a day for his race Ironman Triathlons with diabetes and reducing hemoglobin A1C values.
next competitive event when he sud- and realized that I could accomplish
denly lost 20 pounds in three weeks. At anything if I had the right knowledge, Redefining diabetes education
36, the triathlete’s condition quickly support and mentality.” Currently, Fit4D has a network of over
deteriorated to the point at which he 100 CDEs who provide coaching to
was barely able to walk three blocks. The birth of Fit4D individuals with diabetes. The Fit4D
A trip to the doctor confirmed the Weingard’s medical journey coupled technology platform offers benefits
diagnosis of Type 1 diabetes. Over- with his professional experience with that traditional education often does
whelmed with this life-altering diag- next generation technology lead him not include, like multiple communi-
nosis, Weingard was surprised and to his “a-ha!” moment as an entre- cation methods and flexible sched-
frustrated that more support and edu- preneur. On his way to an Ironman uling, so individuals can work with
cation weren’t provided at the time. triathlon in Idaho, he thought to their coaches at a time that is most
Diabetes education classes at a nearby himself, “What if I could bring every- convenient to them.
hospital weren’t available for another one a ‘Cecilia’ by scaling the personal “My vision for Fit4D is that our com-
six weeks. Concerns about how to coaching aspect [of diabetes educa- pany will continue to grow, so that our
manage his diabetes and whether he tion] using technology?” This desire CDEs can reach all people living with
would be able to race again remained to expand the access to CDEs to all diabetes on Earth,” says Weingard.
unanswered. Persistent in his pursuit individuals living with diabetes was “By providing the masses with per-
for answers, education and support, the concept behind Fit4D. sonalized diabetes self-management
Weingard sought out the expertise of Making this dream a reality didn’t education and support, more people
a certified diabetes educator (CDE) come without sacrifices. Building and will be empowered to improve their
on his own. launching the company consumed lives and, by extension, the lives of
“[My diabetes educator], Cecilia, many nights and weekends. When those they love.”
went out of her way to fit me into her Fit4D partnered and finally launched You can learn more about Fit4D at
already booked schedule,” Weingard with Bayer Diabetes, Weingard left www.fit4d.com. †
recalls. “She met with me over the his corporate position with Microsoft
course of a few months and compas- to devote himself full-time to build- Alison Massey MS, RD, LDN, CDE is a registered
sionately gave me guidance on how to ing Fit4D. Fit4D’s technology-enabled dietitian and certified diabetes educator in Mary-
acclimate to my new lifestyle.” coaching now brings the personalized land. She blogs at www.thesimpleingredient.com.
DiabetesSelfManagement.com 25
Shutterstock/asife

26
May/June 2018
MENOPAUSE
+ DIABETES
What’s the Connection?
By JoAnn Stevelos

DURING THE YEARS leading up to menopause – a time


known as perimenopause – many women will say they
missed some of the signs: slow weight gain, sleepless nights,
irregular menstruation, even waking up uncomfortable or
in a sweat. Some recall experiencing difficult to manage
mood swings; a change in cholesterol levels or the horrible
crashing feeling from blood sugar fluctuation. For women
with diabetes, these symptoms can come earlier in life.

DiabetesSelfManagement.com 27
Perimenopause, usually lasts their schedules to accommodate
HELP FOR HOT FLASHES
• If your breathing is hurried, slow it down
about four years until menopause things like checking their blood
and take deep breaths. begins. Women enter menopause sugar levels more often during the
• Use a cold cloth on your face and the back when their ovaries have completely day and occasionally during the
of your neck. stopped releasing eggs and they have night. Or you may need to visit the
• Drink cold or icy water. not had a period for 12 months. doctor more often to adjust medica-
• Wear loose, light clothing and dress in
layers so you can remove and add them
tions – especially if you are gaining
according to your body temperature. How do perimenopause and weight. And the sleepless nights
• Don’t use memory foam mattress and menopause affect women experienced by many women during
pillows because they have a greater with diabetes? this phase requires making time to
tendency to trap heat. When you have your period, your rest or fit in a nap as part of your
• Use a bedside fan.
• Turn down the thermostat at night. estrogen and progesterone hor- daily routine.
mones are fluctuating and can
affect how your body responds to How do you know if
COPING WITH WEIGHT GAIN insulin. During perimenopause, menopause or diabetes is
• Eat small meals regularly to reduce the many women experience periods causing your symptoms?
chance of fat storage. that are heavier or lighter, longer or It can be confusing to determine
• Choose whole grain foods, fruits and shorter than usual. This is caused by whether menopause symptoms or
vegetables over processed food.
• Read the labels.
the imbalance of progesterone and diabetes is causing sweating, dizziness
• Use healthy oils that are high in omega-3 estrogen. For women with diabetes, or mood swings. It is very common to
like olive oil. the higher levels of estrogen can mistake hot flashes for low blood sugar.
• Choose foods with complex carbohydrates improve insulin sensitivity. However, Not being able to distinguish between
like fruit and beans over simple higher levels of progesterone can the two conditions can be frustrating.
carbohydrates like soda and candy.
• Stay active by doing things like walking, cause insulin resistance. When your but you can take a few actions.
yoga, gardening, swimming and biking. menstrual cycle is less predictable,
• Exercise with other people – it keeps you you can expect your diabetes to be Check your blood glucose
motivated and accountable. less stable on some days than others. levels more often, especially
• Use an app like Noom, Weight Watchers or It is no surprise to most women while experiencing
MyFitnessPal to keep track of your activity.
• Establish small achievable goals. Add or that whenever your hormone balance symptoms.
delete one thing at a time. changes, your weight can change as Be sure to eliminate unhealthy factors
well. So it is especially important to that may cause similar symptoms, like
keep track of weight changes dur- caffeine or sleeping in a warm room.
BE KIND TO YOURSELF ing perimenopause and menopause Discuss the changes in your body
• Splurge on loose fitting stylish clothing because too much weight gain puts with your doctor. A doctor can help
that will accommodate weigh fluctuations. women at a higher risk of developing identify the best treatments for you.
Choose neutral colors, like grays and
whites that you can mix and match easily.
Type 2 diabetes. For example, if you are experiencing
• Create a routine to give yourself some Women who have diabetes who vaginal dryness, decreased sexual
sense of certainty and that will help you gain weight during perimenopause response, hot flashes or other symp-
with time management.  and menopause may need to work toms, the doctor may recommend a
• Take a “well day” or “mental health day” with their doctor to manage their vaginal lubricant to restore moisture
to just unwind, rest and relax. 
• Try something new. New experiences
diabetes and may need to increase or vaginal estrogen therapy to correct
will help you learn more about yourself the dosage of insulin or oral meds. thinning and inflammation of the
and give you new things to think and Identifying and understanding the vaginal walls.
talk about. body’s signals during perimeno- Be compassionate and gentle with
• Try a meditation app like HeadSpace or pause and menopause and those yourself. These are big changes and
Stop, Breathe & Think.
• Choose water over other drinks. Staying related to diabetes can be quite can be overwhelming. Ask for sup-
hydrated is essential to feeling good. challenging. Staying in control of port from family and friends.
• Meet up with a friend just to catch up.  your diabetes is manageable with When you are unsure of what is
• Claim some space. Find a place where you some focused attention. Maintain- causing your discomfort, be proactive
can go to have a quiet moment to read a ing a lifestyle that is active and in listening to your body, and seek
book, or meditate or cry – somewhere you
can get some peace and privacy. mindful of choosing healthy meal medical advice. Just as you need an
• Get outside for some fresh air every day – options is important. individualized plan for diabetes, you
even for a few minutes or a walk around Another challenge may be that will need one for coping with meno-
the block. Breathe the fresh air. Stand you will need to improve your time pause. With some patience, trial and
under a tree.  management skills. Women with error and support from your doctor,
• Make sleep a priority. Everything is more
difficult when you’re tired. diabetes who are in perimenopause family and friends, you will create a
or menopause will need to adjust plan that is right for you. †
28 May/June 2018
BUILD THE
PERFECT
Celebrating BBQ PORK
18+ Years SANDWICH
TRUSTED AND
APPROVED PAGE 36
by Registered
Dietitians
DARE TO DIP
PAGE 40

BE A GRILL
MASTER
PAGE 44
Shutterstock/Arina P Habich

SUPERMARKET SMARTS
BUTTER, MARGARINE
AND SPREADS PAGE 60
DiabetesSelfManagement.com 29
THIRST QUENCHERS BBQ FAVORITES SUMMER SIDES
35 Strawberry-Basil Sparklers 33 BBQ Pork Sandwiches 33 Grilled Corn on the Cob
with Slaw with Buttery Citrus Spread
35 Mint-Green Tea Coolers
41 Grilled Oriental Shrimp Kabobs 33 Spicy Baked Sweet Potato Chips
35 Iced Pomegranate Tea
41 Grilled Salsa Turkey Burger 45 Low-Fat Macaroni and Cheese
BBQ BEGINNINGS 41 Grilled Summer 45 Garden Pasta Salad
37 Asian Vegetable Rolls with Vegetable Sandwiches
46 Grilled Sesame Asparagus
Soy-Lime Dipping Sauce 42 Spiced Chicken Skewers
46 Coleslaw With Snow Peas and Corn
37 Southern Crab Cakes with with Yogurt-Tahini Sauce
Rémoulade Dipping Sauce 46 Gazpacho Pasta Salad
42 Chipotle Orange BBQ Drumsticks
38 Chunky Veggie Dip 43 Grilled Swordish á l’Orange
JUST DESSERTS
38 Roasted Garlic Hummus
47 Brown Sugar Strawberry Shortcakes
39 Roasted Red Pepper Dip
48 Very Berry Yogurt Parfaits
39 Harvest Sticks with Vegetable Dip
48 Almond Berry Parfaits

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 May/June 2018
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THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE.
BBQ
FAVORITES

IF YOU ARE LOOKING for summer


cookout ideas, your search is over.
Break out the hickory smoked
barbecue sauce and build this savory
pork sandwich with homemade
coleslaw. Add some spicy sweet potato
chips and the buttery goodness of
grilled corn on the cob to create a
meal light on calories (under 525)
and heavy on deliciousness.

Photographed by Angel Tucker; food prepared by Maggie Mulvena

32 May/June 2018
BBQ Pork Sandwiches
with Slaw
MAKES 4 SERVINGS (1 BUN, 4 SLICES PORK
AND GENEROUS 1/3 CUP SLAW)

Nutrients per Serving: Calories 338,


Grilled Corn on the Cob
Total Fat 6g, Saturated Fat 1g, Protein 28g,
Carbohydrates 43g, Cholesterol 74mg,
with Buttery Citrus Spread
Dietary Fiber 6g, Sodium 731mg MAKES 4 SERVINGS
SERVING SIZE: 1 EAR OF CORN AND
Dietary Exchange: 2 Bread/Starch, ½ Fruit, 2 TEASPOONS SPREAD
3 Meat

1 pound lean pork tenderloin


Nutrients per Serving: Calories 84, Total Fat 3g,
¼ teaspoon plus 1/8 teaspoon salt, Saturated Fat 1g, Protein 2g, Carbohydrates 15g,
divided Cholesterol 0mg, Dietary Fiber 2g, Sodium 189mg
¼ teaspoon black pepper Dietary Exchange: 1 Bread/Starch, ½ Fat
6 tablespoons hickory smoked
barbecue sauce, divided 4 medium ears corn, husks ¼ teaspoon salt
and silks removed
1½ cups thinly sliced green cabbage
Nonstick cooking spray 1. Preheat grill to medium
or cole slaw mix
2 tablespoons reduced-fat heat. Coat corn with nonstick
1 medium Granny Smith apple, cooking spray. Grill, covered,
peeled and coarsely grated margarine
18 to 20 minutes or until gold-
¼ cup sliced green onions 1 tablespoon inely
en brown, turning frequently.
chopped parsley
1 tablespoon reduced-fat
mayonnaise 1 teaspoon grated lemon 2. Meanwhile, combine
peel remaining ingredients in small
½ teaspoon apple cider vinegar
½ teaspoon black pepper bowl.
4 whole wheat sandwich buns,
toasted ¼ teaspoon paprika 3. Serve corn with spread.

1. Preheat oven to 400°F.


Spicy Baked Sweet Potato Chips
2. Sprinkle pork with ¼ teaspoon MAKES 4 SERVINGS
salt and pepper. Brush pork with 2
tablespoons barbecue sauce. Place in
roasting pan; bake 25 to 30 minutes, Nutrients per Serving: Calories 102, Total Fat 5g, Saturated Fat 1g, Protein 1g,
turning once during baking. Let stand 5 Carbohydrates 14g, Cholesterol 0mg, Dietary Fiber 2g, Sodium 181mg
minutes; cut into 16 (¼-inch) slices. Dietary Exchange: 1 Bread/Starch, 1 Fat
3. Meanwhile, combine cabbage, apple,
1 teaspoon granulated sugar 2. Cut sweet potatoes crosswise
green onions, mayonnaise, vinegar and
½ teaspoon smoked paprika into very thin slices, about 1/16 inch
remaining 1/8 teaspoon salt in medium
¼ teaspoon salt thick. Place on prepared baking
bowl; mix well.
sheet. Drizzle with oil; toss to coat.
¼ teaspoon ground red pepper
4. Place remaining 4 tablespoons Arrange in single layer.
2 medium sweet potatoes
barbecue sauce in small microwavable
4 teaspoons vegetable oil 3. Bake 10 minutes. Turn chips
bowl; cover and microwave on HIGH 30
over; sprinkle with seasoning mix.
seconds or until sauce is heated.
1. Preheat oven to 400°F. Spray Bake 10 to 15 minutes or until
Shutterstock/All for you friend

5. To serve, divide pork among buns. baking sheet with nonstick cook- chips are lightly browned and crisp,
Spread 1 tablespoon barbecue sauce ing spray. Combine sugar, paprika, stirring frequently. Spread on paper
over pork on each sandwich. Top evenly salt and ground red pepper in small towels to cool completely.
with slaw. Serve immediately. bowl; set aside.
DiabetesSelfManagement.com 33
THIRST
QUENCHERS

NOTHING KICKS OFF A COOKOUT


like an ice-cold sparkler! If you fancy
the cool flavors of strawberry and basil,
try our ruby red-flavored sparkler. If
teas are your go-to, wet your whistle
with the Mint-Green or Iced
Pomegranate variety.

34 May/June 2018
Strawberry- Iced Pomegranate
Basil Tea
Sparklers MAKES 4 (1-CUP) SERVINGS
MAKES 8 (8-OUNCE)
SERVINGS
Nutrients per Serving: Calories
36, Total Fat 0g, Saturated Fat 0g,
Protein 0g, Carbohydrates 10g,
Nutrients per Serving: Cholesterol 0mg, Dietary Fiber 0g,
Calories 89, Total Fat 0g, Sodium 8mg
Saturated Fat 0g, Protein
1g, Carbohydrates 22g, Dietary Exchange: ½ Fruit
Cholesterol 0mg, Dietary
Fiber 2g, Sodium 54mg 3 cups water, divided
Dietary Exchange: 1½ Fruit 2 spiced chai tea bags
3 to 4 tablespoons sugar
Basil Simple syrup substitute
(recipe follows)
2 tablespoons lemon juice
4 cups strawberries,
plus additional for 1 cup blueberry pomegran-
garnish ate juice
Ice cubes
1. Bring 1 cup water to a boil in
2 liters club soda small saucepan over high heat.
Fresh basil leaves Remove from heat. Add tea
(optional) bags. Steep 3 minutes. Discard
tea bags.
1. Prepare Basil Simple
Syrup. 2. Pour remaining ingredients
into pitcher. Mix well. Add
2. Combine 4 cups straw- brewed tea; stir. Serve immedi-
berries and Basil Simple ately over ice, or cover and chill.
Syrup in blender; blend Mint-Green Tea Coolers Variation: Also may be served
until smooth.
MAKES 2 SERVINGS
hot.
3. Fill eight glasses with
ice. Divide strawberry mix-
Nutrients per Serving: Calories 3, Total Fat 1g,
ture among glasses; pour
Saturated Fat 1g, Protein 1g, Carbohydrates 1g,
in club soda. Garnish with Cholesterol 0mg, Dietary Fiber 1g, Sodium 1mg
additional strawberries
and basil.
2 bags green tea
Basil Simple Syrup 4 thin slices fresh ginger (about 1 inch)
1 cup fresh basil
7 or 8 large fresh mint leaves, roughly
leaves
torn
2
/3 cup sugar
2 cups boiling water
2
/3 cup water
2 cups crushed ice
Combine all ingredients
1. Place tea bags, ginger and mint leaves in
in small saucepan; cook
teapot or 2-cup heatproof measuring cup.
and stir over medium heat
Add boiling water; steep 4 minutes. Remove
until sugar is dissolved.
tea bags, ginger and mint leaves; discard.
Remove from heat; cool
Cool tea to room temperature.
completely. Pour through
ine-mesh sieve; discard 2. Pour 1 cup crushed ice into each of two
basil. Store in refrigerator tall glasses. Divide tea between glasses.
up to 1 week.
Tip: Squeeze a lime wedge (about 1/8 of a
lime) into each cooler before serving.
DiabetesSelfManagement.com 35
BBQ
BEGINNINGS

BUILD THE PERFECT BARBECUE APPETIZER! Whether your group is gathered


poolside or lounging on the deck, these easy-to-prepare recipes will energize the
taste buds. From Asian Veggie Rolls to Roasted Garlic Hummus to Southern Crab
Cakes with Rémoulade Dipping Sauce, these tasty starters will be crowd pleasers.

36 May/June 2018
Asian Vegetable
Rolls with Soy-
Lime Dipping
Sauce
MAKES 6 SERVINGS
SERVING SIZE: 3 ROLLS WITH 1
TABLESPOON DIPPING SAUCE

Nutrients per Serving: Calories


25, Total Fat 1g, Saturated Fat
1g, Protein 1g, Carbohydrates
5g, Cholesterol 0mg, Dietary
Fiber 1g, Sodium 343mg
Dietary Exchange: Free Free

¼ cup reduced-sodium
soy sauce
2 tablespoons lime juice
1 clove garlic, crushed
1 teaspoon honey
½ teaspoon inely
chopped fresh ginger
¼ teaspoon dark sesame
oil
1
/8 to ¼ teaspoon red Southern Crab Cakes
pepper flakes with Rémoulade Dipping Sauce
½ cup grated cucumber MAKES 8 SERVINGS
1 SERVING SIZE: 1 CRAB CAKE WITH 1½ TEASPOONS SAUCE
/3 cup grated carrot
¼ cup sliced yellow bell
pepper (1 inch long) Nutrients per Serving: Calories 81, Total Fat 2g, Saturated Fat 1g, Protein 7g,
2 tablespoons thinly Carbohydrates 8g, Cholesterol 30mg, Dietary Fiber 1g, Sodium 376mg
sliced green onion Dietary Exchange: ½ Bread/Starch, 1 Meat
18 small lettuce leaves
Sesame seeds 10 ounces fresh lump crabmeat white, 1 tablespoon mustard and ½ tea-
(optional) 1½ cups fresh white or sourdough spoon hot pepper sauce; mix well. Using
bread crumbs, divided ¼ cup mixture per cake, shape into 8
1. Combine soy sauce, lime ¼ cup chopped green onions (½-inch-thick) cakes. Roll crab cakes
juice, garlic, honey, ginger, lightly in remaining ¾ cup bread crumbs.
½ cup fat-free or reduced-fat
oil and red pepper lakes in mayonnaise, divided 2. Heat large nonstick skillet over me-
small bowl.
1 egg white, lightly beaten dium heat; add 1 teaspoon oil. Add 4
2. Combine cucumber, carrot, 2 tablespoons coarse-grained or crab cakes; cook 4 to 5 minutes per side
bell pepper and green onion spicy brown mustard, divided or until golden brown. Transfer to serv-
in medium bowl. Stir in 1 ¾ teaspoon hot pepper sauce, ing platter; keep warm in oven. Repeat
tablespoon soy sauce mixture. divided with remaining 1 teaspoon oil and crab
cakes.
2 teaspoons olive oil, divided
3. Place about 1 tablespoon
vegetable mixture on each Lemon wedges (optional) 3. For dipping sauce, combine remaining
lettuce leaf. Roll up leaves; ¼ cup mayonnaise, 1 tablespoon mus-
sprinkle with sesame seeds, if 1. Preheat oven to 200°F. Pick out and tard and ¼ teaspoon hot pepper sauce
desired. Serve with remaining discard any shell or cartilage from crab- in small bowl; mix well.
sauce for dipping. meat. Combine crabmeat, ¾ cup bread
crumbs and green onions in medium 4. Serve crab cakes warm with dipping
bowl. Add ¼ cup mayonnaise, egg sauce and lemon wedges, if desired.
DiabetesSelfManagement.com 37
BBQ
BEGINNINGS
Chunky Veggie Dip
MAKES 12 (¼-CUP) SERVINGS
SERVING SIZE: ¼ CUP DIP

Nutrients per Serving: Calories 47, Total Fat 3g,


Saturated Fat 2g, Protein 3g, Carbohydrates 3g,
Cholesterol 9mg, Dietary Fiber 1g, Sodium 254mg
Dietary Exchange: ½ Fat, 1 Vegetable

1
medium red bell pepper, chopped
1
large green bell pepper, chopped
½ medium onion, inely chopped
1
celery stalk, chopped
2
tablespoons water
1
/8
teaspoon red pepper flakes
¼ cup fat-free (skim) milk
¾ teaspoon cornstarch
1
cup (4 ounces) shredded reduced-fat
sharp Cheddar cheese
2 ounces reduced-fat cream cheese
1 jar (4 ounces) diced pimientos
¾ teaspoon salt
Baked corn tortilla chips
Roasted Garlic Hummus
1. Coat slow cooker with nonstick cooking MAKES 6 SERVINGS
spray. Add red and green peppers, onion, cel- SERVING SIZE: ¼ CUP HUMMUS
ery, water and red pepper lakes. Cover; cook
on LOW 3 hours or until celery is tender.
Nutrients per Serving: Calories 85, Total Fat 1g, Saturated Fat 1g, Protein
2. Combine milk and cornstarch in small 4g, Carbohydrates 15g, Cholesterol 0mg, Dietary Fiber 4g, Sodium 303mg
bowl, stirring until cornstarch dissolves. Add Dietary Exchange: 1 Bread/Starch
to pepper mixture with Cheddar cheese and
cream cheese. Press down on cream cheese 2 tablespoons Roasted powder, sesame oil and hot
with rubber spatula until well blended. Stir Garlic (recipe follows) pepper sauce, if desired, in food
in pimientos and salt. Cover; cook 15 min- 1 can (about 15 ounces) processor or blender. Cover;
utes or until thickened. Serve with tortilla chickpeas, rinsed and process until smooth.
chips, if desired. drained
3. Serve with pita wedges and
¼ cup fresh parsley sprigs
Variation: Use soft corn tortillas instead of vegetables, if desired.
chips. Cut each tortilla into 6 wedges and 2 tablespoons water
bake in a single layer on a baking sheet at 2 tablespoons lemon juice Roasted Garlic: Cut off top
350°F for 10 minutes. Cool completely be- ½ teaspoon curry powder third of 1 large garlic head (not
fore serving. Chips will irm as they cool. 1
the root end) to expose cloves;
/8 teaspoon dark sesame oil discard top. Place head of garlic,
Dash hot pepper sauce trimmed end up, on 10-inch
(optional) square of foil. Rub garlic gener-
Pita bread wedges ously with olive oil and sprinkle
and fresh vegetables with salt. Gather foil ends
(optional) together and close tightly. Roast
in preheated 350°F oven 45 min-
1. Prepare Roasted Garlic. utes or until cloves are golden
and soft. When cool enough to
2. Place chickpeas, parsley, 2 handle, squeeze roasted garlic
tablespoons Roasted Garlic, cloves from skins-; discard skins.
water, lemon juice, curry
38 May/June 2018
Roasted Red
Pepper Dip
MAKES 2 CUPS (ABOUT 16 SERVINGS)
SERVING SIZE: 2 TABLESPOONS

Nutrients per Serving: Calories 35,


Total Fat 0g, Saturated Fat 0g, Protein 2g,
Carbohydrates 4g, Cholesterol 2mg, Dietary
Fiber 0g, Sodium 189mg
Dietary Exchange: 1 Vegetable

2 jars (12 ounces each) roasted red


peppers in water, drained
1 cup crumbled fat-free feta
cheese
¼ cup chopped fresh basil
¼ cup light sour cream
3 tablespoons Worcestershire
sauce
4 cloves garlic
Assorted vegetable sticks

1. Place roasted red peppers in food Harvest Sticks with Vegetable Dip
processor or blender; process until MAKES ABOUT 2 CUPS DIP
coarsely chopped. Add cheese, basil, SERVING SIZE: 2 TABLESPOONS
sour cream, Worcestershire sauce and
garlic; process until smooth and well
blended. Cover and refrigerate at least Nutrients per Serving: Calories 50, Total Fat 2g, Saturated Fat 2g, Protein 3g,
2 hours or until chilled. Carbohydrates 5g, Cholesterol 5mg, Dietary Fiber 1g, Sodium 135mg
Dietary Exchange: ½ Fat, 1 Vegetable
2. Serve with assorted vegetable sticks.
1 container (8 ounces) light until smooth and well blended. Stir
cream cheese with chives in cucumber, parsley, onion, garlic
spread, softened , curry powder, if desired, and salt.
1 cup plain nonfat Greek Spoon into small serving bowl;
yogurt cover and refrigerate 1 hour or until
1
/3 cup inely chopped ready to serve.
cucumber
2. Cut carrots lengthwise into thin
2 tablespoons chopped fresh strips; gather into bundles. Tie rafia
parsley around bundles to hold in place, if
2 tablespoons dry minced desired. Repeat with zucchini. Serve
onion or 1/4 cup inely with dip.
chopped fresh onion
1 clove garlic, minced Note: The vegetable bundles
can be made ahead of time. Cut
½ teaspoon curry powder
(optional) vegetables as directed. Place carrots
in medium bowl; cover with cold
¼ tevaspoon salt water and refrigerate until ready to
6 large carrots, peeled use. Place zucchini sticks in small
3 medium zucchini resealable plastic food storage bag
Rafia (optional) and refrigerate until ready to use.
Just before serving, gather vegeta-
1. Beat cream cheese in small bowl bles into bundles and tie with rafia
until light and luffy; stir in yogurt as directed.
DiabetesSelfManagement.com 39
BBQ
FAVORITES

GET OUT AND GRILL! If you crave the flavor of gently


marinated shrimp kabobs seasoned to perfection, succulent
grilled chicken or spicy salsa-inspired turkey burgers, it’s
time to fire up the grill and show off your skills!

40 May/June 2018
Grilled Oriental Grilled Summer
Shrimp Kabobs Vegetable
MAKES 4 SERVINGS Sandwiches
SERVING SIZE:1 KABOB (WITHOUT MAKES 4 SERVINGS (1
FRIED RICE AND PINEAPPLE SPEARS) SANDWICH PER SERVING)
Nutrients per Serving: Calories
240, Total Fat 7g, Saturated Fat
Nutrients per Serving: Calories 129, 3g, Protein 11g, Carbohydrates
Total Fat 4g, Saturated Fat 1g, Protein 35g, Cholesterol 10mg, Dietary
20g, Carbohydrates 1g, Cholesterol Fiber 3g, Sodium 570mg
173mg, Dietary Fiber 1g, Sodium
596mg Dietary Exchange: 2 Bread/
Grilled Salsa Starch, 1 Fat, 1 Vegetable,
Dietary Exchange: 2½ Meat
Turkey Burger ½ Meat

3 tablespoons reduced-sodium MAKES 1 SERVING 2 tablespoons light


soy sauce or regular soy SERVING SIZE: 1 SANDWICH (WITHOUT CHEESE) balsamic vinaigrette
sauce Nutrients per Serving: Calories 302, Total dressing
1 tablespoon regular or Fat 11g, Saturated Fat 3g, Protein 22g, ½ teaspoon minced garlic
seasoned rice vinegar Carbohydrates 29g, Cholesterol 63mg, Dietary
Fiber 2g, Sodium 494mg ¼ teaspoon salt
1 tablespoon dark sesame oil 1
/8 teaspoon black pepper
Dietary Exchange: 2 Bread/Starch, 1 Fat,
2 cloves garlic, minced 2 Meat Lean 1 small zucchini, cut
¼ teaspoon dried red pepper lengthwise into
flakes 3 ounces 93% lean ground turkey ¼-inch-thick slices
1 pound uncooked large 1 tablespoon mild or medium salsa 1 medium yellow squash,
shrimp, peeled and 1 tablespoon crushed baked tortilla cut lengthwise into
deveined chips ¼-inch-thick slices
1 slice (1 ounce) reduced-fat Monterey 1 medium red onion,
1. For marinade, combine soy sauce, Jack cheese (optional) cut into ¼-inch-thick
vinegar, oil, garlic and pepper lakes slices
1 whole wheat hamburger bun, split
in small bowl; mix well. Cover; re-
Green leaf lettuce 1 large red bell pepper,
frigerate 1 hour or overnight.
quartered
Additional salsa (optional)
2. To complete recipe, combine 4 teaspoons reduced-fat
marinade and shrimp in large 1. Lightly spray grid with nonstick cooking chipotle mayonnaise
resealable food storage bag. Seal spray. Prepare grill for direct cooking. ½ pound Italian bread,
bag securely. Refrigerate at least 30 cut into 4 slices
minutes or up to 2 hours, turning 2. Combine turkey, chips and 1 tablespoon 4 thin slices provolone
bag once. salsa in small bowl; mix lightly. Shape into cheese
patty.
3. Spray barbecue grid with non- ¼ cup shredded fresh
stick cooking spray. Prepare barbe- 3. Grill burger over medium-high heat about basil
cue grill for direct cooking. 6 minutes per side or until cooked through
(165°F). Top with cheese, if desired, during 1. Prepare grill for direct
4. Drain shrimp, reserving marinade. last 2 minutes of grilling. Toast bun on grill, cooking. Combine dressing,
Thread shrimp onto 4 (12-inch-long) cut sides down, during last 2 minutes of grill- garlic, salt and pepper in
skewers. Place skewers on prepared ing. large bowl. Add vegetables;
grid; brush with half of reserved toss to coat.
marinade. 4. Place lettuce on bottom half of bun; top
with burger, additional salsa, if desired, and 2. Grill vegetables over
5. Grill skewers on covered grill over top half of bun. medium-high heat about
medium coals 5 minutes. Turn skew- 4 minutes per side or until
ers over; brush with remaining half Note: To broil, preheat broiler. Broil burger 4 tender.
of marinade. Grill 3 to 5 minutes to 6 inches from heat 6 minutes per side or
more or until shrimp are opaque. until cooked through (165°F). 3. Cut bread slices in half.
Spread 1 teaspoon mayon-
Serving Suggestion: Serve with Tip: This dish tastes even better when naise on each of four halves.
fried rice and fresh pineapple spears, served alongside a cool and refreshing glass Top with cheese, vegetables,
if desired. of COCA-COLA®. basil and remaining bread.
DiabetesSelfManagement.com 41
BBQ
FAVORITES
Spiced Chicken Skewers
with Yogurt-Tahini Sauce
8 SERVINGS
SERVING SIZE:1 SKEWER WITH ABOUT
2 TABLESPOONS SAUCE

Nutrients per Serving: Calories 145, Total Fat 7g,


Saturated Fat 1g, Protein 16g, Carbohydrates 4g,
Cholesterol 38mg, Dietary Fiber 0g, Sodium 285mg
Dietary Exchange: 1 Fat, 2 Meat

1 cup plain nonfat 3. Combine oil, garam


Greek yogurt masala and remaining
¼ cup chopped fresh ½ teaspoon salt in me-
parsley, plus dium bowl. Add chicken;
additional for toss to coat evenly. Thread
garnish chicken on 8 (6-inch)
¼ cup tahini* metal or wooden skewers.
2 tablespoons lemon 4. Grill chicken skewers
juice over medium-high heat 5
1 clove garlic minutes per side or until
¾ teaspoon salt, chicken is no longer pink. Chipotle Orange BBQ Drumsticks
divided Serve with yogurt-tahini MAKES 8 SERVINGS (1 DRUMSTICK PER SERVING)
2 teaspoons garam sauce. Garnish with ad-
masala** ditional parsley.
1 pound boneless Nutrients per Serving: Calories 150, Total Fat 4g, Saturated
Notes *Tahini, a thick Fat 1g, Protein 24g, Carbohydrates 2g, Cholesterol 87mg,
skinless chicken paste made from ground Dietary Fiber 1g, Sodium 221mg
breasts, cut into
sesame seeds, is available in Dietary Exchange: 3 Meat
1-inch pieces
the international foods sec-
tion of major supermarkets, ½ cup barbecue sauce, orange peel
1. Spray grid with nonstick
Middle Eastern markets or preferably mesquite 8 chicken drumsticks (7
cooking spray. Prepare grill
health food stores. or hickory smoked to 8 ounces each),
for direct cooking.
1 to 2 tablespoons skin removed,
**Garam masala is a
2. For yogurt-tahini sauce, minced canned rinsed and patted
blend of Indian spices
combine yogurt, ¼ cup chipotle peppers in dry
available in the spice aisle adobo sauce
parsley, tahini, lemon 1 teaspoon ground
of many supermarkets. If
juice, garlic and ¼ tea- 1 teaspoon grated cumin
garam masala is unavail-
spoon salt in food proces-
able, substitute 1 tea-
sor or blender; process 1. Spray grill grid with nonstick cooking spray. Prepare
spoon each ground cumin
until combined. Set aside. grill for direct cooking.
and ground coriander.
2. For sauce, combine barbecue sauce, chipotle peppers
and orange peel in small bowl. Set aside.

3. Sprinkle drumsticks evenly with cumin.

4. Grill chicken, covered, over medium-high heat 30 to


35 minutes or until cooked through (165°F), turning fre-
quently. Baste with sauce during last 5 minutes, turning
and basting until all of sauce is used.

Serving suggestion: Serve with 4-ounce microwaved


potatoes topped with fat-free or light sour cream and
mixed greens and green pepper salad with fat-free or
light balsamic vinaigrette.
42 May/June 2018
Grilled Swordfish á l’Orange
MAKES 4 SERVINGS Thanks to
Nutrients per Serving: Calories 276, Total Fat 10g,
BetterWOMAN, I’m
Saturated Fat 2g, Protein 35g, Carbohydrates 12g,
Cholesterol 65mg, Dietary Fiber 2g, Sodium 412mg winning the battle for
Dietary Exchange: 1 Fruit, 4 Meat

4 swordish, halibut orange juice mixture. Place


Bladder Control.
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2. Prepare grill for direct for years, I struggled with bladder control
1 tablespoon lemon cooking. problems. After trying expensive medications
juice with horrible side effects, ineffective exercises
1 tablespoon dark 3. Place remaining half and uncomfortable liners and pads, I was
sesame oil of orange juice mixture ready to resign myself to a life of bladder leaks,
in small saucepan. Stir in isolation and depression. But then I tried BetterWOMAN.
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SUMMER
SIDES

GRILLED VEGETABLES, pasta salad, coleslaw and more are dreamy


additions to any main dish. Try our veggie-rich Garden Pasta Salad
or an easy-bake, Low-Fat Macaroni and Cheese. This collection of
scrumptious summer sides will add zip to any barbecue menu!

44 May/June 2018
Low-Fat Macaroni Garden Pasta Salad
and Cheese MAKES 8 SERVINGS
MAKES 4 SERVINGS SERVING SIZE: 1¼ CUPS SALAD
SERVING SIZE: 11/8 CUPS MACARONI
Nutrients per Serving: Calories 286, Total Fat 10g,
AND CHEESE
Saturated Fat 2g, Protein 18g, Carbohydrates 33g,
Nutrients per Serving: Calories Cholesterol 36mg, Dietary Fiber 3g, Sodium 886mg
398, Total Fat 8g, Saturated Fat 4g,
Dietary Exchange: 2 Bread/Starch, ½ Fat, 2 Meat
Protein 28g, Carbohydrates 54g,
Cholesterol 33mg, Dietary Fiber 0g,
Sodium 788mg 6 cups (about 12 ounces) cooked penne pasta
Dietary Exchange: 3½ Bread/Starch, 2 cups shredded cooked boneless skinless
2½ Meat chicken breasts
¾ cup chopped red onion
8 ounces (2 cups) uncooked ¾ cup chopped red or green bell pepper
macaroni
¾ cup sliced zucchini
1 cup fat-free reduced-
sodium chicken broth 1 can (4 ounces) sliced black olives, drained
1 shallot, inely minced 1 teaspoon red pepper flakes
1 tablespoon all-purpose 1 teaspoon salt (optional)
flour 1 can (10¾ ounces) condensed reduced-fat
½ teaspoon dry mustard reduced-sodium cream of chicken soup,
1
undiluted
/8 teaspoon white pepper
½ cup lemon juice
2 tablespoons water
½ cup grated Parmesan cheese
1¾ cups (7 ounces) shredded
reduced-fat mild ½ cup chopped fresh basil (optional)
Cheddar cheese, divided ¼ cup chopped fresh parsley (optional)
1 cup fat-free ricotta cheese
1. Combine pasta, chicken, onion, bell pepper, zuc-
1 tablespoon minced fresh
chini, olives, red pepper lakes and salt in large bowl;
parsley (optional)
toss lightly.
1. Cook macaroni according to 2. Combine soup and lemon juice in small bowl; mix
package directions, omitting salt. well. Pour soup mixture over pasta salad; mix well.
Drain; set aside.
3. Sprinkle with Parmesan cheese, basil and parsley.
2. Combine chicken broth and
shallot in medium saucepan;
bring to a boil over high heat.
Cover; reduce heat to low and
simmer 5 minutes. Meanwhile,
combine lour, mustard, pep-
per and water in small bowl; stir
mixture into saucepan. Bring to
a boil; cook and stir 2 minutes
or until slightly thickened. Add
pepper, 1 cup Cheddar cheese
and ricotta cheese. Continue stir-
ring until cheeses are completely
melted. Stir in cooked pasta; mix
well.

3. Remove pasta mixture from


heat; stir in remaining ¾ cup
Cheddar cheese and parsley, if
desired. Garnish with fresh pars-
ley sprigs. Serve immediately.

DiabetesSelfManagement.com 45
SUMMER
SIDES
Grilled Sesame Gazpacho Pasta
Asparagus Salad
MAKES 4 SERVINGS MAKES 5 SERVINGS
SERVING SIZE: 5 MEDIUM SPEARS (1 CUP PER SERVING)

Nutrients per Serving: Calories 42, Nutrients per Serving: Calories 91,
Total Fat 1.5g, Saturated Fat 0g, Protein Total Fat 2g, Saturated Fat 1g, Protein
3g, Carbohydrates 6g, Cholesterol 0mg, 3g, Carbohydrates 17g, Cholesterol
Dietary Fiber 3g, Sodium 147mg 0mg, Dietary Fiber 3g, Sodium
248mg
Dietary Exchange: ½ Fat, 1 Vegetable
Dietary Exchange: 1 Bread/Starch,
Nonstick cooking spray ½ Fat
1 pound medium asparagus
11/3 cups cooked whole wheat
spears (about 20), trimmed
penne pasta or rotini
1 tablespoon sesame seeds
½ cup chopped red onion
2 to 3 teaspoons balsamic
1 small cucumber, peeled
vinegar
and diced
¼ teaspoon salt
1 medium green bell pepper,
¼ teaspoon black pepper seeded and chopped
2 cups grape or cherry
1. Spray grid with cooking spray;
tomatoes, halved
prepare grill for direct cooking. Coleslaw With
1 tablespoon tomato juice
2. Place asparagus on baking sheet;
Snow Peas and Corn
1 tablespoon red wine
MAKES 4 SERVINGS
spray lightly with cooking spray. vinegar
(ABOUT ¾ CUP PER SERVING)
Sprinkle with the sesame seeds, roll- 1½ teaspoons olive oil
ing to coat.
¼ teaspoon crushed dried
3. Place asparagus on grid. Grill, un- Nutrients per Serving: Calories 85, oregano
Total Fat 1g, Saturated Fat 1g, Protein
covered, 4 to 6 minutes or until the ½ teaspoon salt
3g, Carbohydrates 17g, Cholesterol 3mg,
asparagus begins to brown, turning Dietary Fiber 2g, Sodium 175mg ¼ teaspoon pepper
once. Dietary Exchange: 3 Vegetable ¼ cup chopped fresh basil
leaves
4. Transfer asparagus to serving
4 cups (about 8 ounces)
dish. Sprinkle with vinegar, salt and coleslaw mix 1. Combine penne, onion, cu-
pepper.
½ cup trimmed vertically sliced cumber, bell pepper and toma-
Cook’s Tip: Be sure to use the snow peas toes in large bowl.
entire amount of pepper—it really ½ cup whole kernel corn (frozen
2. Combine tomato juice, vinegar,
brings out the lavors of this dish. or fresh)
oil, oregano, salt and pepper in
¼ cup low-fat mayonnaise cup. Stir well. Pour over salad and
¼ cup fat-free sour cream mix well. Sprinkle with basil.
¼ cup nonfat buttermilk
1 tablespoon cider vinegar
2 teaspoons sugar
¼ teaspoon celery seed

1. Combine coleslaw, snow peas and


corn in large bowl.

2. Meanwhile, whisk mayonnaise,


sour cream, buttermilk, vinegar, sugar
and celery seed in medium bowl.
Add to coleslaw mixture and mix to
combine.
46 May/June 2018
JUST
DESSERTS

COOL AND FRUITY! The sweet


taste of strawberries, blueberries,
and rasberries are a perfect ending
to any meal. Try these refreshing,
easy-to-make recipes and and let
your taste buds soar!

Brown Sugar
Strawberry Shortcakes
MAKES 6 SERVINGS
Nutrients per Serving: Calories 190,
Total Fat 5g, Saturated Fat 1g, Protein
4g, Carbohydrates 37g, Cholesterol 1mg,
Dietary Fiber 1g, Sodium 572mg 
Dietary Exchange: 1½ Bread/Starch,
1 Fat, ½ Fruit

2 cups fresh sliced strawberries


¼ cup sugar substitute,* divided
2 cups reduced-fat biscuit baking
mix
½ teaspoon baking powder
1
/3 cup low-fat (1%) buttermilk
2 teaspoons margarine or butter,
melted
2 tablespoons packed brown and stir gently with spoon until half on dessert plates, cover with 1/3
sugar dough comes together. Remove cup berries, 1 tablespoon whipped
6 tablespoons reduced-fat dough from bowl, place on lightly topping and cake tops.
whipped topping loured surface, and pat into a ¾- to
1-inch-thick circle. Note *This recipe was tested using
1. Preheat oven to 400°F. Spray baking sucralose-based sugar substitute.
Photographed by Angel Tucker; food prepared by Maggie Mulvena

sheet with nonstick cooking spray. 4. Cut dough into 6 portions.


Round each piece into a circle and Tip: Strawberries can be refriger-
2. In medium bowl toss strawberries place on baking sheet. Brush with ated, unwashed, for up to 3 days. Or,
and 2 tablespoons sugar substitute. melted margarine and sprinkle 1 they may be frozen. To freeze straw-
Set aside. teaspoon brown sugar over each berries, hull them and arrange them
shortcake. Bake 12 to 15 minutes. in a single layer on a jelly-roll pan.
3. In another medium bowl combine Transfer to rack and let cool slightly. Place them in the freezer until they
baking mix, remaining 2 tablespoons are frozen solid and then transfer
sugar substitute and baking powder. 5. To assemble shortcakes: Split them to storage containers. They will
Pour buttermilk over dry ingredients each shortcake in half. Place bottom keep for up to 9 months.
DiabetesSelfManagement.com 47
JUST
DESSERTS
Very Berry Yogurt Parfaits
MAKES 4 SERVINGS
SERVING SIZE: 1 PARFAIT

Nutrients per Serving: Calories 179, Total Fat 3g, Saturated


Fat 1g, Protein 10g, Carbohydrates 33g, Cholesterol 4mg,
Dietary Fiber 3g, Sodium 104mg
Dietary Exchange: 1½ Fruit, 1 Milk

3 cups plain nonfat yogurt


2 tablespoons sugar-free berry preserves
1 packet sugar substitute*
½ teaspoon vanilla
2 cups sliced fresh strawberries
1 cup fresh blueberries
4 tablespoons sliced toasted almonds
Almond Berry Parfaits
1. Combine yogurt, preserves, sugar substitute and va- MAKES 2 SERVINGS
nilla in medium bowl. SERVING SIZE: ½ CUP YOGURT, 1 CUP BERRIES

2. Layer ½ cup yogurt mixture, ¼ cup strawberries, ¼ cup


blueberries and ¼ cup yogurt mixture in each of four des- Nutrients per Serving: Calories 220, Total Fat 6g,
sert dishes. Top each parfait with remaining ¼ cup straw- Saturated Fat 1g, Protein 9g, Carbohydrates 30g,
berries and 1 tablespoon almonds. Serve immediately. Cholesterol 7mg, Dietary Fiber 6g, Sodium 84mg
Dietary Exchange: 1 Fat, 1½ Fruit, 1 Milk
Notes *This recipe was tested with sucralose-based
sugar substitute.
1 container (8 ounces) plain low-fat yogurt
These parfaits would also be delicious topped with 1 cup sliced strawberries
low-fat granola. Or, try another lavor of preserves for a ½ cup raspberries
simple variation.
½ cup blueberries
1
/8 teaspoon almond extract
1 tablespoon plus 2 teaspoons pourable sugar
substitute,* divided
2 tablespoons slivered or sliced almonds,
toasted

1. Line strainer with coffee ilter or 2 sheets paper


towel; place over bowl. Place yogurt in strainer; refrig-
erate at least 2 hours or up to 24 hours to drain.

2. In medium bowl, combine strawberries, raspberries


and blueberries. Add extract and 2 teaspoons sugar
substitute; toss lightly. Chill at least 30 minutes or up
to 2 hours.

3. Transfer drained yogurt to small bowl, stir in re-


maining 1 tablespoon sugar substitute. Spoon 1/3 cup
berry mixture into each of 2 wine or parfait glasses.
Spoon half of yogurt mixture over berries. Repeat lay-
ering with half of remaining berries, remaining yogurt
and remaining berries. Top with almonds.

Note *This recipe was tested using sucralose-based


sugar substitute
48 May/June 2018
PACK THE PERFECT

PICNIC
BASKET
671 CALORIES

A GUIDE TO
BIKING
BASICS

BOOST YOUR
WEIGHT MANAGEMENT
CONFIDENCE
Shutterstock/S_Photo

DiabetesSelfManagement.com 49
Shutterstock/lightpoet; Border:Shutterstock/LongQuattro

50
May/June 2018
A guide to bike basics
By Marie Spano, MS, RD

Are you tired of pedaling a stationary bike or an elliptical machine?


Are you in search of a little adventure? If so, maybe you’re ready to get
outside and try real biking. Although the fundamentals of bicycling
haven’t changed since you owned a 10-speed, great strides have
been made in many aspects of this activity, making it both
more accessible and more enjoyable.

DiabetesSelfManagement.com 51
Technology has greatly enhanced biking works the muscles in your may make for more enjoyable and
bicycles, helmets and even apparel. legs and arms, increases your lung safer bike riding. If you intend to
Biking clubs across the U.S. make it capacity, and helps you maintain a ride on roads, you will want either
easier to find others to ride with. And healthy heart. In addition, all forms a road bike with fairly thin tires and
many communities are becoming of aerobic exercise, including biking, a lightweight frame or a somewhat
more bike-friendly by, for example, help improve your body’s response heavier “city bike.” If you plan to
creating bike lanes or separate bike to insulin and lower blood glucose commute on your bike, you might
paths, providing bicycle parking levels. even consider getting a foldable bike
areas, and installing racks on trains Even if you regularly do some for easier storage at your home and
and buses so that bikes can be trans- other type of aerobic exercise, varying workplace.
ported with their riders. your routine with an occasional bike If you prefer biking on trails, you’ll
So if you haven’t touched your ride will challenge you physically and probably need a mountain bike.
bike in years, now’s the time to get stimulate you mentally. Cross-training Mountain bikes have fat, knobby
it out, dust it off, take it to your local of any type works your muscles a little tires and a thick frame, making them
bike shop for a tune-up (very impor- differently, may help prevent overuse both sturdier and heavier than road
tant) and assess whether you need injuries and keeps you from getting bikes. They are also much slower on
any gear, such as a helmet, lock, bored with your exercise routine. roads than road bikes.
gloves or even a new bike. If you think you may be riding
Trails or roads? on both roads and fairly flat trails,
Why cycle? If you already have a bike and don’t a hybrid bicycle might be right for
Biking is an enjoyable activity that wish to buy a new one, the style of you. This style combines features
you can do alone or with others. It your bike will probably determine from both mountain bikes and road
can be a good way to explore new where you will ride it. If you’re in the bikes, with a mid-weight frame and
places or enjoy old favorites. The market for a new bike, however, you tires that are thicker than those of a
experience of riding down a bike may want to think first about where road bike but thinner than those of a
path or a trail feeling the breeze on you intend to bike—on trails or on mountain bike. Hybrid bikes cannot
your face and the sun on your back roads—before buying one. be used for very rugged trails.
is like nothing else. People who ride Biking on roads is convenient
a bike to work or to run errands also since you can usually just hop on Finding a good fit
have the satisfaction of knowing and go. However, sharing the road Once you have decided which type
they’re getting some exercise and with cars can be challenging and of bike, go to your local bike shop
not polluting the air. even dangerous. Seeking out quieter and try some on for size. Most shops,
Besides being a pleasant activity, streets, back roads and bike paths especially those that aren’t part of a

Shutterstock/Africa Studio

52 May/June 2018
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be deducted from your monthly rate plan balance equal to the length of the call and any call connected by the Personal Operator. Jitterbug, GreatCall and 5Star are registered trademarks of GreatCall, Inc.
Copyright ©2018 GreatCall, Inc. ©2018 firstSTREET for Boomers and Beyond, Inc.
national chain, are run and staffed by off the front and/or rear suspension height of the top tube, consider
active cyclists who have great enthusi- when riding on flat surfaces. its length, which determines how
asm for the sport and desire to help Before test-riding any bike, have far you have to bend over to reach
others. They are usually more than the sales clerk help you pick the the handlebars. You should not be
willing to help you get started, and right frame size for your body and stretched all the way out to reach
find the right equipment. also show you how to adjust the seat the handlebars. Instead, your elbows
If mountain biking is in your and handlebars. A properly adjusted should be slightly bent and your back
future, you will need to choose bike will maximize both your safety bent from the waist at an approxi-
between a full-suspension or hard- and comfort. To check frame size, mately 45-degree angle. Riding on a
tail bike. Full-suspension models straddle the bike with both feet on bike with either too much or too little
have both front and rear suspension, the ground. You should have 2–4 distance between seat and handlebars
which allows for a more comfortable inches of clearance between the will make it difficult to maneuver.
ride, but they’re also more expensive. top of the tube and your crotch for Bikes designed especially for women
Hardtails have only front suspension. mountain bikes and hybrids and 1–2 often fit them better because they
They are lighter and cheaper than inches of clearance for a road bike. take into consideration women’s lon-
full-suspension bikes, and they ride If the bike has a sloping top tube, ger legs and shorter torsos.
better on smooth surfaces, but they which is typical of women’s bikes, Adjust the bike’s seat so that when
are not as comfortable on rough ter- measure your clearance from an you are sitting on it with one foot on
rain. Some full-suspension bikes have imaginary top tube. the pedal close to the lowest posi-
a “lock out” feature that lets you turn In addition to examining the tion, your knee is bent slightly. With
experience, you may decide to raise
or lower the seat to suit your riding
style. Mountain bikers, for example,
typically lower the seat for greater
maneuverability.
Next, adjust the handlebars to the
appropriate height. You may need to
ride your bike several times to find
the right handlebar height for you.
In general, handlebars typically range
from 2-3 inches below the top of the
seat to 2-3 inches above it. Your goal
is to find a height that is comfortable
and allows you to easily use the brakes
and shift gears.
Bike pedals come in several styles.
Flat, “platform” pedals are best for
novices or those who are doing easy
riding on fairly flat surfaces. With
flat pedals, you can stop your bike
and immediately put your feet on
the ground without any problem.
Pedals with toe straps or cages secure
the foot to the pedal and allow
BIKE MAINTENANCE cyclists to go faster since they can
Before every ride, it is important to perform a quick inspection. Here are some things use their hip flexors to apply power
to check. on the upstroke (as well as pressing
• Check that the brakes are working • Your chain should be well lubricated down on the downstroke). “Clip-
properly, the tires have plenty of air without any kinks or gunk in the links. less” pedals have no straps or cages
and are not worn, and the wheels are • The pedals should be securely attached
but require special cycling shoes
secure (lift your bike so one tire is on to the bike yet move freely.
the ground and shake the other tire in • The seat should be secure.
with cleats on the bottom that lock
the air from side to side). • If your bike is muddy after riding, clean into the pedals. They, too, allow the
• The rims and spokes should have no it with soap and water (preferably cyclist to go faster by applying pres-
Shutterstock/Simon Kadula

bulges, dents or dings in them. gentle soap made for bikes) and sure to the pedal for its full rotation.
• The levers on your quick-release hubs dry it off right away. Dirt and mud Because clipless pedals take some
(if you have them) should be in the are abrasive and can destroy bike getting used to, only experienced
closed position. components. cyclists should use them.
54 May/June 2018
bicycling will probably lower your
blood glucose level, so you may need
to stop for a snack or adjust your
diabetes regimen in some other
way to account for bicycling’s blood-
glucose-lowering effect. Here are
some things to remember before
you head out.
If you have a cellphone, bring
it with you.
Always tell someone where you
are going and when you plan on
coming back, especially if you are
cycling by yourself. In general,
however, biking with other people
is safer.
Always carry some food with
you. Energy bars are easy to carry
Other equipment after dark, a white headlight and a (although in warm weather, avoid
A properly fitting helmet is essential flashing red rear light are neces- bars with chocolate or yogurt coat-
for bicycling and should be worn at sary to make you more visible to ings, which will melt in the heat).
all times, even on a leisurely ride. In motorists. Reflectors on your bike Energy gels are another option.
addition to a helmet, you may want will also make you more visible on They are essentially pure carbo-
to consider bike gloves, which give city streets. hydrate and can provide a quick
your palms some padding while pick-me-up when you need one.
leaving your fingers uncovered. On longer rides, carry your
Although special biking clothes are blood glucose monitoring supplies
not strictly necessary, many people with you.
find bike shorts with a gel pad in Rain can be particularly hazard-
the seat area to be comfortable, and ous for cyclists. When it rains, the
moisture-wicking shirts (generally ground gets slippery, your bicycle’s
made of synthetic material) can brakes may not work as well, and vis-
keep you drier than 100 percent ibility—both yours and that of motor-
cotton tops. Wearing clothing, such ists—decreases. If you get caught in
as a vest, made of reflective material the rain, ride conservatively: Use your
is a good idea if you will be biking at Choosing a route bike lights, avoid roads with heavy
dawn or dusk or after dark; it makes Bike shops are usually a good source traffic, yield to cars at intersections
you much more visible to motorists. for local route and trail information. and start slowing down before you
Biking is an aerobic exercise, so They often have maps and books turn to avoid skidding in the turn.
you will want a way to carry some that contain detailed information If you are on a low-traffic street or
water with you to drink as you ride. such as mileage, difficulty level and a bike path, ride in the center of
If your bike has a bottle cage, carry terrain. Participating in a group ride the lane and not on the side, where
a water bottle in it. Another alter- organized by a bike club is another puddles and wet leaves may collect.
native is to wear a small backpack good way to discover places to ride. “Dragging” your brakes, or putting
with a refillable bladder in it that Shops also can help you find a bike a little pressure on them as you ride,
attaches to a hose with a mouth- club in your area. can help to remove water from your
piece that reaches over your shoul- As you would with any new tire rims, making it easier to stop with
Hlemets:Shutterstock/wizdata; Sign:Shutterstock/Christophe Testi

der. The backpack can also be used sport or physical activity, start with your brakes when needed.
to carry food, extra clothing and a route that you can cover easily, Lastly, if you ever feel unable
other supplies. then build up your distance and to control your bike because of
To carry bike wrenches and extra difficulty gradually. weather conditions, stop and get
tubes in case of a flat tire, you may off. You may be later (that’s why you
want to buy a small pouch that Safety first brought your cellphone) or wetter
attaches right below your seat. Also Bicycling is great exercise and it’s than you otherwise would have got-
helpful for dealing with flat tires fun, but accidents, delays or simply ten, but you will be alive and able
is a small travel bike pump, which the unexpected can happen, so it’s to take another bike ride when
attaches to your bike. If you are out best to be prepared. In addition, conditions are more favorable. †
DiabetesSelfManagement.com 55
SUNNY DAYS AND WARM TEMPERATURES are the essential
TOTALIES ingredients for a picnic! Choose your destination and fill your
CALOR basket with a zesty snack, hearty turkey sandwich, a salad bursting

671
with seasonal color and nutrients, and be sure to include a
delicious, fruit-inspired dessert. All this for 671 calories!

262
CALO
PER S RIES
ERVIN
G

56 March/April 2018
Turkey
Sandwiches
with Roasted 71 RIES
CALSOERVING
Bell Peppers PER

MAKES 4 SERVINGS
SERVING SIZE:
1 SANDWICH

Nutrients per Serving:


Calories 262, Total Fat 5g,
Saturated Fat 1g, Protein
22g, Carbohydrates
34g, Cholesterol 52mg,
Dietary Fiber 11g,
Sodium 301mg

Dietary Exchange:
2 Bread/Starch,
1 Vegetable, 2 Meat

2 large red bell peppers


8 slices whole grain or
millet bread
¼ cup reduced-fat
mayonnaise
8 spinach leaves
or
4 romaine lettuce leaves
8 thin slices red onion
½ pound thinly sliced
skinless roasted
turkey breast
8 large fresh basil leaves
(optional)
1. Preheat broiler.
Cut bell peppers into
quarters; discard stems,
membranes and seeds.
Place peppers, skin side
up, on foil-lined bak- Easy Greek Salad ½
1
/3
cup sliced red onion
cup crumbled feta cheese
ing sheet. Broil 3 inches MAKES 6 SERVINGS 2 tablespoons extra virgin olive oil
from heat 10 minutes or
2 tablespoons lemon juice
until skin is blackened. 1 teaspoon dried oregano
Wrap peppers in foil ½ teaspoon salt
from baking sheet; let Nutrients per Serving: Calories 71,
stand 10 minutes. Peel 1. Combine lettuce, cucumber, tomato,
Total Fat 6g, Saturated Fat 1g, Protein 1g,
off skin and discard. onion and cheese in large serving bowl.
Carbohydrates 5g, Cholesterol 4mg,
2. Spread 4 bread slices Dietary Fiber 1g, Sodium 249mg 2. Whisk together oil, lemon juice,
with mayonnaise. Top oregano and salt in small bowl. Pour
with spinach, onion, tur- Dietary Exchange: 1 Fat, 1 Vegetable over lettuce mixture; toss until coated.
key, peppers and basil, if Serve immediately.
6 romaine lettuce leaves, torn into
desired. Top with remain- Serving Suggestion: This simple but
1½-inch pieces
ing bread slices. 1 medium cucumber, peeled and sliced delicious salad makes a great accompani-
1 medium tomato, chopped ment for grilled steaks or chicken.

DiabetesSelfManagement.com 57
Summertime
112 RIES
CALSOERVING
Fruit Medley
MAKES 8 SERVINGS
PER

Nutrients per Serving:


Calories 112, Total
Fat 1g, Saturated
Fat 1g, Protein 1g,
Carbohydrates 24g,
Cholesterol 0mg, Dietary
Fiber 2g, Sodium 8mg

Dietary Exchange:
2 Fruit

2 large ripe peaches,


a peeled and sliced
2 large ripe nectarines,
sliced
1 large ripe mango,
peeled and cut into
1-inch chunks
1 cup fresh blueberries
2 cups orange juice
¼ cup amaretto or
½ teaspoon almond
extract
2 tablespoons sugar or
3 packets sugar substitute
Fresh mint (optional)
1. Combine peaches,
nectarines, mango and
blueberries in large bowl.
2. Whisk orange juice,
amaretto and sugar in
small bowl until sugar
is dissolved. Pour over
fruit mixture; toss to
coat. Marinate 1 hour
at room temperature,
gently stirring occa-
sionally. Garnish with
fresh mint.

Tangy Blue Cheese Potato Salad


MAKES 6 SERVINGS
116
CALO
PER S RIES 1. Boil potatoes until tender,
(ABOUT ¾ CUP PER SERVING) ERVIN
G drain and cool. Cut into 1-inch
chunks; set aside.
1 pound red new potatoes 2. Meanwhile, combine
Nutrients per Serving: Calories 116, Total Fat 5g, ¼ cup light mayonnaise mayonnaise, sour cream, garlic
Saturated Fat 2g, Protein 3g, Carbohydrates 14g, ¼ cup light sour cream powder, vinegar avnd blue
1
Cholesterol 10mg, Dietary Fiber 2g, Sodium 84mg /8 teaspoon garlic powder cheese in medium bowl.
1 tablespoon cider vinegar
1
/3 cup reduced-fat crumbled blue cheese 3. Fold in potatoes and celery
Dietary Exchange: 1 Bread/Starch, 1 Fat ½ cup chopped celery and mix to combine.

58 March/April 2018
Garlic-Parmesan Popcorn
MAKES 12 CUPS POPCORN
(ABOUT 6 SERVINGS)
110
PER
RIES
CALSOERVING

Nutrients per Serving: Calories 110, Total Fat 5g,


Saturated Fat 1g, Protein 4g, Carbohydrates 13g,
Cholesterol 4mg, Dietary Fiber 2g, Sodium 83mg

Dietary Exchange: 1 Bread/Starch, 1 Fat

1 tablespoon olive oil


1 clove garlic, finely minced
1 tablespoon light butter-and-oil spread, melted
12 cups plain popped popcorn
1
/3 cup finely grated Parmesan cheese
½ teaspoon dried basil
½ teaspoon dried oregano
Stir oil and garlic into spread in small bowl until
well blended. Pour over popcorn in large bowl;
toss to coat. Sprinkle with cheese, basil anvd
oregano.
Tip: One regular-size microwavable package of
popcorn yields about 10 to 12 cups of popped
popcorn.

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SMARTS

By Lea Ann Holzmeister, RD, CDE


ood companies have developed a wide variety of spreads to claim they are “trans fat free” even if they contain up to

F and butter blends to appeal to a range of taste prefer-


ences and nutritional needs. Companies are adding
healthier unsaturated oils to butter, and non-butter spreads
0.5 grams per serving. For those limiting their trans fat to
two grams or less per day, one serving would provide almost
one-fourth of a day’s limit.
have healthier ingredients such as canola oil, olive oil, flax-
seed oil, sea salt, calcium and vitamin D to make them stand Types of butter, margarine and spreads
out. Spreads and butter also come in forms such as sticks, Butter contains about 110 calories, 12 grams of fat and 30
spreads, squeeze bottles or sprays, and many, also come in milligrams of cholesterol per tablespoon. Eight of the 12
lower fat varieties. grams of fat are saturated fat. Unsalted butter is an alternative
for those limiting sodium intake. Regular butter contains
Fat in butter, margarine and spreads about 85 milligrams of sodium per tablespoon, and unsalted
Full fat butter, margarine and spreads contain 100 percent butter contains no sodium.
of their calories from fat. People with diabetes are advised Whipped butter has less saturated fat and fewer calories
to limit the type of fat in foods to include less than 10 per- because it has more air. One tablespoon of whipped butter
cent of calories from saturated fat (those with elevated LDL contains 50-70 calories and 3.5-5 grams of saturated fat.
cholesterol levels may be advised to limit saturated fat to Due to the lower fat content, whipped butter would not be
less than 7 percent of calories) and to avoid trans fat. For appropriate for cooking, baking or frying.
an individual on a 1500-calorie meal plan, 10 percent of the Butter blended with unsaturated oil (canola, olive, soybean
calories from saturated fat would be less than less than 17 and/or flaxseed) contains less saturated fat than regular
grams daily. For the individual limiting saturated fat to less butter, which contains around 3.5-4.5 grams of saturated
than 7 percent of total calories, this would be fewer than 12 fat and around 100 calories per tablespoon. Some butter-oil
grams of saturated fat per day. blend sticks, such as Land O Lakes Butter with Olive Oil &
Butter and spreads are a mixture of different types of Sea Salt Sticks, contain generous amounts of saturated fat,
fatty acids. Fats high in saturated fat include lard, butter about 6 grams per tablespoon.
and tropical oils. The more solid a margarine is at room Light butter or non-butter spreads are lower calorie and
temperature, the more saturated fat it contains. A tablespoon fat alternatives to regular full-fat butter or margarine. Butter
of regular butter has 7 grams of fat, about 30-40 percent of and spreads labeled “light” contain 50 percent fewer calories
a day’s worth. To keep saturated fat intake low, try to choose and fat than regular products. One tablespoon of light butter
butter and non-butter spreads with less than 2 grams of or spread contains 50 calories and 3 grams of saturated fat.
saturated fat per serving. Light butter blended with oils contains added unsaturated
Trans fat is found naturally in foods such as butter and in oils and water, which decreases the saturated fat to about
processed vegetable oil spreads that contain partially hydro- 2 grams per tablespoon and decreases calories to about
genated oil. Spreads that contain hydrogenated and fully 50. Land O Lakes Light Butter with Canola Oil and Smart
hydrogenated oil have no trans fat. A tablespoon of regular Balance Light Butter & Canola Oil Blend are light blended
butter contains 0.5 grams of naturally occurring trans fat. butter spreads.
The trans fatty acid content of butter and spread products Butter and spreads can contribute large amounts of fat,
is not always included on the Nutrition Facts panel on prod- saturated fat and calories to your diet. To keep saturated fat
Shutterstock/ImagePixel

uct labels. The Food and Drug Administration (FDA) allows and trans fat low, choose products with less than 2 grams of
food labels to list 0 grams of trans fat if a food has less than saturated fat per tablespoon and do not contain partially
0.5 grams of trans fat per serving. This allows food products hydrogenated oil. †
60 May/June 2018
SATURATED FAT (g)

CHOLESTEROL (mg)

TOTAL CARBS (g)


FAT CALORIES

TRANS FAT (g)


SERVING SIZE

SODIUM (mg)

PROTEIN (g)
SUGAR (g)
CALORIES

FIBER (g)
FAT (g)
BALADE
LIGHT BUTTER W/SEA SALT 1 TBSP 54 6 50 3 0 5 70 0 0 0 0
BENECOL SPREAD
ORIGINAL 1 TBSP 70 8 70 1.5 0 0 110 0 0 0 0
LIGHT 1 TBSP 50 5 50 1 0 0 80 0 0 0 0
BLUE BONNET MARGARINE
LACTOSE FREE STICK 1 TBSP 70 7 70 3 0 0 125 0 0 0 0
LIGHT STICK 1 TBSP 50 5 50 1 1 0 80 <1 0 0 0
ORIGINAL STICK 1 TBSP 70 7 60 2.5 0 0 130 0 0 0 0
LIGHT SOFT SPREAD 1 TBSP 40 4 35 1 0 0 95 <1 0 0 0
CALCIUM SOFT SPREAD 1 TBSP 45 5 45 1 0 0 130 0 0 0 0
ORIGINAL SOFT SPREAD 1 TBSP 50 6 55 1.5 0 0 120 <1 0 0 0
BRUMMEL & BROWN MARGARINE SPREAD WITH YOGURT
ORIGINAL SPREAD 1 TBSP 45 5 45 1.5 0 0 90 0 0 0 0
BUTTER BUDS
DRY SPRINKLES 1 TSP 10 0 0 0 0 0 60 2 0 0 0
FLEISCHMANNS MARGARINE
SOFT SPREAD 1 TBSP 60 6 55 1 0 0 35 0 0 0 0
OLIVE OIL SPREAD 1 TBSP 60 6 55 1 0 0 45 <1 0 0 0
ORIGINAL STICK 1 TBSP 80 9 80 3.5 0 0 105 0 0 0 0
UNSALTED SPREAD 1 TBSP 60 7 60 1.5 0 0 0 0 0 0 0
GOLD 'N SOFT
LIGHT SPREAD 39% OLIVE OIL 1 TBSP 50 5 50 1.5 0 0 120 0 0 0 0
I CAN'T BELIEVE IT'S NOT BUTTER
LIGHT SPREAD 1 TBSP 40 4 40 1 0 0 85 0 0 0 0
ORIGINAL SOFT SPREAD 1 TBSP 60 6 60 2 0 0 90 0 0 0 0
VEGAN SPREAD 1 TBSP 60 6 60 2 0 0 90 0 0 0 0
OLIVE OIL SOFT SPREAD 1 TBSP 60 6 2 0 0 0 90 0 0 0 0
ORIGINAL SPRAY 5 SPRAYS 0 0 0 0 0 0 0 0 0 0 0
IMPERIAL
REGULAR STICK 1 TBSP 70 7 70 2.5 0 0 105 0 0 0 0
REGULAR SPREAD 1 TBSP 50 5 45 1 0 0 90 0 0 0 0
LAND O LAKES
CINNAMON SUGAR BUTTER SPREAD 1 TBSP 70 6 60 2.5 0 10 30 3 3 0 0
SPREADABLE LIGHT BUTTER W/CANOLA OIL 1 TBSP 50 6 50 2 0 10 90 0 0 0 0
GARLIC & HERB BUTTER SPREAD 1 TBSP 70 8 70 3 0 10 100 1 0 0 0
HONEY BUTTER SPREAD 1 TBSP 70 6 60 2.5 0 10 50 4 4 0 0
LIGHT BUTTER STICK 1 TBSP 50 6 50 3.5 0 15 95 0 0 0 0
FRESH BUTTERY TASTE SOFT SPREAD 1 TBSP 70 8 70 2 0 0 80 0 0 0 0
UNSALTED WHIPPED BUTTER 1 TBSP 50 6 55 3.5 0 15 0 0 0 0 0
WHIPPED SALTED BUTTER TUB 45% LESS FAT 1 TBSP 50 6 50 3.5 0 15 50 0 0 0 0
OLIVIO
LIGHT SPREAD 1 TBSP 50 5 50 1 0 0 90 0 0 0 0
COCONUT SPREAD 1 TBSP 65 7 65 3 0 0 90 0 0 0 0
ORIGINAL SPRAY 5 SPRAYS 0 0 0 0 0 0 15 0 0 0 0
PARKAY
LIGHT SPREAD 1 TBSP 50 6 55 1 0 0 110 0 0 0 0
ORIGINAL SPREAD 1 TBSP 60 6 55 1.5 0 0 90 <1 0 0 0
ORIGINAL STICK 1 TBSP 70 8 55 3 0 0 130 <1 0 0 0
LIGHT STICK 1 TBSP 50 5 50 2 0 0 80 0 0 0 0
SQUEEZE 1 TBSP 70 8 70 1.5 0 0 110 0 0 0 0
PROMISE
ACTIV LIGHT SPREAD 1 TBSP 45 5 45 0.5 0 <5 85 0 0 0 0
LIGHT SPREAD 1 TBSP 45 5 45 1 0 0 85 0 0 0 0
SHEDD'S SPREAD COUNTRY CROCK
CALCIUM PLUS VITAMIN D SPREAD 1 TBSP 45 5 45 1.5 0 0 100 0 0 0 0
CHURN STYLE SPREAD 1 TBSP 50 6 50 1.5 0 0 100 0 0 0 0
HONEY SPREAD 1 TBSP 70 6 50 1.5 0 0 45 3 3 0 0
LIGHT SPREAD` 1 TBSP 35 4 35 1 0 0 90 0 0 0 0
ORIGINAL SPREAD 1 TBSP 50 6 50 1.5 0 0 100 0 0 0 0
SMART BALANCE
EXTRA VIRGIN OLIVE OIL BUTTERY SPREAD 1 TBSP 60 7 60 2 0 0 70 0 0 0 0
EXTRA VIRGIN OLIVE OIL LIGHT BUTTERY SPREAD 1 TBSP 50 5 50 1.5 0 0 70 0 0 0 0
LIGHT BUTTER & CANOLA OIL SPREAD 1 TBSP 50 5 50 2 0 0 90 0 0 0 0
LIGHT SPREAD W/ FLAX SEED OIL 1 TBSP 50 5 50 1.5 0 0 90 0 0 0 0
LOW SODIUM BUTTERY SPREAD 1 TBSP 70 8 70 2 0 0 30 0 0 0 0
OMEGA-3 LIGHT BUTTERY SPREAD 1 TBSP 50 5 50 1.5 0 0 80 0 0 0 0

DiabetesSelfManagement.com 61
Your Weight
By Nicola Davies, PhD

Increasing Your Confidence for Weight Management


YOU NEED TO BE in the right head- success; only then do they increase the your circle who is willing to be your
space before you can effectively tackle complexity of the training regimen. cheerleader and provide support and
the task of initial weight loss. Although No one starts as an expert, so build on encouragement.
we tend to think a person develops con- small successes and then push yourself
fidence through mastering an ability – a little further. As an example, you may Exude confidence
whether it be athletics, painting or losing want to work on flexibility. If one day Fatigue and stress can affect your
weight – researchers have found that it is you can reach your knees in a forward mood, lowering confidence levels.
the other way around: confident people fold, then push a little harder each Sometimes just seeing someone who
tend to achieve success. day until you can touch your ankles, has been critical or demeaning in the
The Confidence Ruler presented then the floor, until you are finally past can send confidence plummeting.
below will help you rate your weight flexible enough to get your palms flat Although success or failure is perceived
management confidence. Take a few on the floor. differently depending on your state
minutes to answer the following ques- of mind, simply altering your body
tions using the ruler to guide you. Take a team approach position can increase confidence. Psy-
For each of the statements, write Inspiration comes from those who chologists call this “embodied cogni-
down the factors that may be prevent- reached the goals you are hoping tion” – if you stand taller, widen your
ing you from scoring a 10. These are the to achieve. People who have already chest, and put your chin up, you are
areas in need of improvement. achieved success can provide firsthand decreasing production of the stress
insights and tips on how they dealt hormone cortisol and boosting the
Tips for increasing your confidence with various challenges. Weight man- feel-good hormones.
Increasing your confidence can boost agement groups are often success- Self-efficacy – another term for
your performance. However, weight con- ful because people achieve mastery self-confidence – will rise as you mas-
trol can be as hard as giving up smoking through observing and modeling oth- ter each small challenge along your
or another vice because it is easy to slip ers. Belonging to a team of people with journey. So, if you lack confidence
back into old habits. While you may have the same goal can help build the will to now, don’t be disheartened – it is
the skills and self-confidence to achieve win. If joining a group is not practical there to be nurtured and to grow
weight loss, you need clear performance for you, then find a mentor who suc- with each step you take toward your
incentives to achieve success. Here are cessfully manages his or her weight. desired weight. †
four tips to increasing your confidence.
Find a cheerleader Nicola Davies, PhD, is a health psychologist
Building on successes Charismatic friends or mentors can and author of I Can Beat Obesity! Finding
Sports coaches build confidence by challenge and inspire us to achieve the Motivation, Confidence and Skills to Lose
making sure everyone achieves initial our goals. Find a person within Weight and Avoid Relapse.

THE CONFIDENCE RULER


1. I can make the necessary changes to manage my weight.
Source: Digate Muth, 2015

2. I can eat healthier.


3. I can increase my physical activity.
4. Not only can I make changes to better manage my
weight, but I can also maintain those changes. 1 = No confidence 10 = Great confidence

62 May/June 2018
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Our Perfect Sleep Chair® is just the chair to do it it, inspect it, test it, position it, and even carry the
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F Thought
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d
By Alison Massey, MS, RD, LDN, CDE

GROCERY STORE: GRAB-AND-GO PRODUCE TO TRY THIS MONTH Want an environ-


Want to make a quick, healthy and Asparagus ment friendly
delicious Mexican meal at home? Composed of over 90 percent water, alternative to
Admittedly, some pre-packaged taco asparagus is low in calories and sodium disposable, plas-
shells are bland, flavorless and a bit and is a good source of fiber, vitamins tic sandwich and
tough. Then Garden of Eatin’ created C, E and K and potassium. Asparagus snack bags? Try Reuseit reusable sand-
their taco shells. Available in yellow can be either green or white, and peak wich and snack bags. Dishwasher and
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you want extremely tender asparagus, PVC, latex and phthalates. For more
look for thinner stalks. information, visit www.reuseit.com.

Rhubarb Q&A WITH THE RD:


Although technically a vegetable and Q: Is the ketogenic diet right
not a fruit, rhubarb is often prepared for me?
like a fruit and used in jams, pies, muf- A: The ketogenic diet was introduced
fins and other desserts. The color of in the 1920s to treat epilepsy and was
rhubarb stalks varies from light pink to widely used for about two decades to
light green. It is typically available from help manage this condition. Recently,
early April to June. Try using rhubarb the ketogenic diet’s popularity has
crispy and made with organic stone- as part of a compote or sauce made resurged as a strategy to lose weight
ground corn. Two taco shells have with a sugar-substitute like stevia for a quickly. The diet is a very high fat
only 140 calories, 7g of fat, 17g of total lower calorie option. and extremely low in carbohydrates
carbohydrates, 1g of fiber and 2g of with the purpose of putting the body
protein. Find more information at into ketosis to use fat as fuel. This
www.gardenofeatin.com. approach is not balanced and isn’t a
healthy meal pattern for individuals
Need a better-for-you frozen meal? with diabetes and may not be advised
Luvo steam-in-pouch meals are loaded for others dealing with various
with vegetables, whole grains and pro- medical conditions.
tein and all have less than 400 calories
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rently, there are eight delicious steam- and focus on developing lifelong
in-pouch meal options. Learn more at mindful eating practices.
www.luvoinc.com.
Do you have questions for a Registered
Dietitian? Email communications@
KEEP IT IN THE KITCHEN diabetesselfmanagement.com. †
Need help with portion control but
don’t want to measure every snack? Try Alison Massey MS, RD, LDN, CDE is a registered
Shutterstock/Sudowoodo

purchasing a set of beautiful ceramic dietitian and Certified Diabetes Educator in


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available at www.amazon.com.
64 May/June 2018
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AFN44167_0113
Balance and Stability in Everyday Life
By Laurel Dierking, MEd

MAINTAINING A SENSE of physical balance and stability There are many creative ways to practice maintaining
is invaluable to feeling grounded and supported. Physical and improving your balance and stability. For instance,
balance is what allows you to move safely from one place to while you’re doing the dishes, stand on one leg for one
another or to stand without feeling you are going to teeter dish, then on the other leg for the next dish. This chal-
over. Stability is the amount of structural engagement (the lenges both your balance and your stability. It is a simple
“structure” being your body) within each movement or, in and great way to improve the strength of the standing hip,
a stationary position, required to stand firmly. knee and ankle joints. Doing this simple task naturally
Age, repetitively sedentary lifestyles and lack of practice causes you to engage and activate your core muscles. The
can result in the dwindling capacities of these daily func- stronger your core, typically the better your balance and
tions. Fortunately, we have the opportunity to practice stability, and vice versa.
improving these very important elements of safety and Here are some ways you can incorporate balance and
wellness during even the most unassuming times. For stability work into your daily life at home or at work.
example, when you walk at home, you can test your bal-
ance by walking in a straight line, heel-to-toe from one Laurel Dierking, MEd, NFPT, 500YTT, is a health and fitness special-
end of the room to the other, looking straight ahead. ist with a concentration in yoga, individualized strength conditioning,
How did you do? exercise physiology and alignment-based movement.
66 May/June 2018
TRY IT!

1
Single-Leg Standing with Progression Level 2 Standing in the same position as in Level 1, you
can add a bit of movement in the lifted leg to further
Level 1 Stand on one foot at your desk, behind a chair
challenge your balance and strengthen your stability. Do
or next to a wall. Make sure to keep a small bend in the
this by extending the lifted leg directly out to your side,
standing knee. Stand for one minute, or 10 slow breaths,
pressing irmly through your heel, then contracting. Repeat
then switch to the other leg. Repeat this as many times as
10 to 15 times on each leg.
you can throughout the day.

2
Single-Leg Standing
Forward Reach
Stand on your right leg 2 to
3 feet in front of your chair
or desk. Keep a bend in the
standing knee throughout the
movement while also keeping
the lifted leg irm and engaged,
pressing through the heel, lexing
the leg. Put your right hand on
your hip. Stand up tall and on
an EXHALE, begin to bend at
the waist and reach your left
hand toward your chair or desk
and lightly touch the edge. With
control, INHALE to bring yourself
back up to your original single-
leg standing position. Repeat 10
to 15 times on each leg.

TIPS
1. Press into the heels of BOTH legs to stand up tall. 2. To bend forward, hinge from the waist and keep your
Maintain this throughout the movement. spine as long as possible, as opposed to rounding your back
Aaron Ashley

to reach down.

DiabetesSelfManagement.com 67
PRODUCT
SPOTLIGHT
Eucerin
IN THE SUMMER, skin-care hazards are everywhere, mind as a complication of diabetes, high blood sugar
from bright sunshine to chlorinated pool water to can in fact lead to a number of skin issues, some of
poison ivy. While skin problems don’t always come to them serious. To help stop skin troubles before they
start, Eucerin offers creams, lotions, sunscreens and
cleansers designed to moisturize, protect and heal.
Founded more than 100 years ago by German
pharmacist Paul C. Beiersdorf, the company,
headquartered in Hamburg, Germany, uses a research-
based approach, working with pharmacists and
dermatologists to test and refine its products.
Eucerin products are designed for many skin
types and needs, such as soothing dry and itchy skin;
protecting against UV rays; and relieving eczema.
Whether you’re trying to repair damage or keep
healthy skin in good shape, Eucerin has an option that
can help.
For more information, visit www.eucerinus.com.

DietSensor
WHEN DIAGNOSED WITH DIABETES, the first
question many people ask is, “What am I going to eat?”
Food plays a central role in managing the condition, and
knowing what options are best is vital.
If you don’t know where to start, DietSensor, an
innovative tracking app, can help. Developed by the
parents of a child with Type 1 diabetes, the free version
of the nutrition and meal planning app includes access
to a nutrient database of more than 600,000 foods,
carb counting, real-time portion size coaching and
the ability to add a food via barcode scanning. For an
additional $1.50 per week, users have the added benefits
of nutrition education programs and coaching for Type
1 and Type 2 diabetes and weight loss. SCiO – a pocket-
sized food scanner – and a digital scale for weighing
food can be purchased separately to make food logging
automatic, with no guesswork.
“Whether users plan to use DietSensor to monitor
diabetes, lose weight, improve general fitness or are
simply curious to know what exactly they are putting into
their body, we expect the simple and intuitive technology
to quickly become part of their daily regimen,” says
company co-founder and CEO Remy Bonnasse.
To learn more, visit www.dietsensor.com.
—Diane Fennell

68 May/June 2018
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V-Go is a registered trademark of Valeritas, Inc.


ART-1024 Rev C 9/2017 ©2017 Valeritas, Inc.