Colonel Mustard and the Fundamental Difference Between Types I & II

 Comparison is often a dangerous thing.  On the one hand, it somehow makes us feel as though we are better than the subject.  On the other hand, we feel the urge to imitate the subject, or "keep up with the Jones", as the saying goes.

Diabetics do this all the time.  We see another diabetic eating cake and we cannot even begin to understand how they could do such a thing, especially after that huge meal!.....And then we secretly wish we would have saved room for cake as well.

Nine times out of ten, there are explanations for the way we behave.  And so it goes with treating diabetes.  So before we accuse Colonel Mustard of being in the kitchen with the knife, let's look at the fundamentals of diabetes.  This will help us to understand why us diabetics and our lifestyles consist of such a motley crew.   

The Pancreas - what is it, and what does it do?
Nestled behind the stomach, tucked under intestines, and just below the gallbladder lies a gland called the pancreas.  It's primary job is to secrete hormones that aid in digestion.  The mac-daddy of those hormones is insulin, which pushes glucose from the bloodstream into the body's cells for energy.

Diabetes Mellitus is hyperglycemia, or elevated blood glucose.  Essentially, there is some phenomenon that is causing the glucose in the bloodstream to remain there, and not be taken up by the body's cells.

Type I DM - immune dysfunction.
For a type I diabetic, the physiological function that has gone awry is the immune system.  It mistakenly identifies insulin-producing pancreatic tissue as alien, and then does what it's supposed to do.....attack the foreign bodies.  Quite rapidly, the pancreas goes from functioning perfectly, to never producing insulin again.  As you might imagine, the only treatment is subcutaneous insulin, which the patient must use to try to mimic the secretions of the once-robust-pancreas.     

Type II DM - metabolic dysfunction.
The pathophysiology of type II is generally more complicated.  Ultimately, there is a problem with the actual metabolism of glucose.  It typically boils down to the patient either being resistant to the action of insulin, or having decreased insulin output from the pancreas.  Because there is still likely substantial pancreatic function, subcutaneous insulin is merely one of several treatment options.  Depending on the circumstances, one may even treat type II with lifestyle changes only (no medications).  

I hope this quick overview sheds some light on this pandemic, yet grossly misunderstood, disease.  With this knowledge, let us not compare, and cast down; but share, and build up.  And then, let's be less than seven, greater than low! 

Ain't No Thing But a Chicken Wing

Linda here!  I'm Derek's proud wife and am honored that he asked me to provide a little guest post for his blog.

Often, when I provide nutrition counseling to someone who has recently been diagnosed with diabetes, he usually tells me that he was advised to avoid all white foods (sugar, white bread, cake, potatoes, chips, etc).  While this advice is OK and partially true, I find it is inadequate. I think the more knowledge one has about the different foods in his diet, the better chance he has of staying on track with managing his disease.  (They don't call diabetes a self-managed disease for nothing).

So, where does one start?

Well, I think a good starting point is to know a little bit about carbohydrate foods, that is, the foods that turn into sugar when we eat them.

Most clients/patients I talk to know that sugar, potatoes, rice, white bread, pasta, and grits are carbohydrates, but when I tell them about wheat bread, fruit, milk, and yogurt also fitting in to this category, I am met with a good deal of surprise.  Before I go on, I want to mention, carbs are not bad; they are not the enemy; they are not evil.  In fact, out of the 3 main macronutrients carb, protein, and fat, our body most readily uses carb as a source of energy.  However, since diabetes can be defined as a problem with glucose metabolism, I think it is important to achieve the appropriate balance.

OK, so what are the foods that most directly affect blood sugar (aka carbs)?

Starches - this includes (but is not limited to) rice, pasta, legumes/beans, peas, corn, potatoes, bread (even whole grain, whole wheat etc), crackers, cereal, grits, oatmeal, hummus

Fruit - ALL fresh fruit, canned fruit, dried fruit, frozen fruit.  ALL juices.

Milk/Yogurt - Milk (all types, cow's milk, almond milk, soy, rice etc), yogurt, pudding, ice cream.

Sweets/Sugar - this seems like a no brainer, but this is a good time to mention that honey, agave nectar, brown sugar, sugar-in-the-raw, evaporated cane juice, and maple syrup are all considered forms of sugar, and they all affect blood sugar.

and lastly, a little something I like to call.....

Sneaky Carbs - these are the foods that many people think contain very little or no carbohydrate, but then are left with a big surprise when they check their blood sugar a couple hours later.

• Chicken wings, those delicious little bite sized treats, what are they covered in?  Some form of sauce that probably contains sugar (BBQ sauce, tangy sauce, sweet and sour, siracha glazed, bourbon maple, you get the idea).
• Other sauces - gravy, spaghetti/marinara, sweet and sour, teryaki 
• Salad dressings - while not all contain carb, think about honey mustard dressing and certain fruit based vinaigrettes.
• Carrots and other sneaky veggies - Vegetables are so good for you.  Most of us should eat more of them, but certain ones do contain significant carbohydrate.  
• Fried chicken/meat - the meat contains NO carb, but the breading does.  Bummer.
• Peanut butter/nuts - most will say these are very low carb foods, but if you eat a nice sized portion, and eat them often, they can be contributing to those higher blood sugar readings.

So, knowing the foods that affect blood sugar is the first step.  The next is knowing how to read the label and decipher how much to have.  But, not to worry, we'll have more on that another time.  Thanks Derek for asking me to blog this week.  I am happy to be your wife and little diabetes nerd/guru.  Aren't you glad you married a dietitian?! HA!

I tried to keep this post short and concise, however, I plan on elaborating more in future posts. Please feel free to ask questions in the comments.  Peace.   

          

Reinventing the Wheel: Resources Diabetics Should Know

Have you ever finished up a long, frustrating project, only to learn of a better, more efficient way of accomplishing the work you just completed?  Thankfully, this happens to me less and less as I have learned to simply Google it, or YouTube it.  As the old saying goes, there's nothing new under the sun. 

This approach, however, doesn't always work with diabetes.  How can we be sure that the information we receive is legit?  Furthermore, many times we get flustered with insurance rules on preferred medications, co-payments, and the list goes on.  Perhaps we are faced with a new situation concerning diabetes, and we simply want to speak with someone who shares a similar experience.

Wouldn't it be nice to have some support outside the doctor's office to provide guidance, discussion, and maybe even assistance with affording medications?  My friends, let's not reinvent the wheel.  There are great resources out there that are largely underutilized.  Here are a few of my favorites:
  

• JDRF (formerly Juvenile Diabetes Research Foundation) is the worldwide leader in funding research for type I diabetes.  Their website is excellent for staying up-to-date on current treatment options, devices, and research.  In addition, JDRF has organized local chapters that provide support and activities for children and adults with type I. 

• Type One Nation is JDRF's online social network where type I's, or friends and relatives of type I's, can create a free account that provides tons of professional and peer-to-peer blogs, forums, and groups.

• The American Diabetes Association (ADA) is an endless resource for news, diet, current trends, and education.  Membership includes a subscription to their top magazine, Diabetes Forecast.  The ADA also provides local support groups and events.  

• Diabetic Connect is a free online community of people living with diabetes (type I or II).  It's a great tool for connecting and conversing with countless diabetics of all types and ages.

• Cornerstones 4 Care is a service of the pharmaceutical company, Novo Nordisk.  It is a free online tool that allows patients to create an action plan for managing diabetes.  If you're someone who thrives on planning and structure, this site is for you.

• Lilly Tru Assist is a patient assistance program offered by the pharmaceutical company, Eli Lilly.  Most drug companies have a similar program.  Even if your medications are affordable, you may be missing out on coupons that could save you money.  It's worth your time to check into offers from the companies that make your meds and devices. 

Stick with the above mentioned, and you can't go wrong.  These are awesome resources for education, community, and support.  Don't get caught outside the loop.  Thanks for reading; and, as always, let's be less than seven, greater than low!

Sugar-coating Diabetes

Let's frolick through a meadow holding hands singing Kumbaya, while the forest burns behind us.  This is the image I get when people insist on using inclusive, or politically correct language.  I call to mind this image, because I read an article last week in one of the major diabetes magazines that advised against using the term "diabetic" to describe people with diabetes.  The article stated that this type of labeling diminishes a person's individuality, and it can be harmful to his or her self-image.

Folks, I'm here to tell you that this line of thinking is completely off the mark.  It is related to a "modern logic" that is infiltrating our global culture under the guise of inclusion and social justice.  It twists truth ever so slightly, then demands that everyone else do the same. 

However, for the sake of discussion, let's suppose that there is a kernel of truth to the statement.  Let's suppose that calling me a diabetic does indeed offend me.  Why is that so?  Why is it that I look like a duck, walk like a duck, quack like a duck; but you ought not call me a duck, because I may forget that I'm a mallard?

There are several answers that come to mind; but as a diabetic, only one jumps out as a game-changer.  One reason we may be offended at the term "diabetic" is because of the negative public image that it arouses.  I've mentioned before that we don't exactly have the best reputation.  When most people hear that someone they know is diabetic, it is tempting to assume that they must not take care of themselves.  They must not have any discipline or self-control.  That's certainly not a category that I want to be lumped into.

So how did we get this image?..........It comes through a long history of not taking care of ourselves, having no discipline, and having no self-control.  Essentially, we've shown up late to work for the past 50 years, and now we're getting mad at the world for calling us tardy.  There's only one thing we can do to change it now.......start showing up on time.  It's up to a new generation of diabetics to turn this word into respectful terminology.  And if you are reading this post, that means you and me.

The fight is not against the terminology itself.  It's against the meaning of that terminology.  So for those of you who are offended at being called "diabetic", I'm offended that you're offended.  Diabetes has taught me numerous invaluable lessons about life and love, and I am honored to be labeled diabetic.  It puts me in a community of people who are forced to either embrace or reject the struggle daily.  I don't like diabetes, and I don't wish it on my worst enemy.  But I'm here now, and I'm going to make the best of it.

I'd like to end with a quote from Theodore Roosevelt in his speech, "Citizenship in a Republic."  It has become my personal MO in the last couple of years, and I think it goes well with my rant.  Thanks for reading; and let's be less than seven, greater than low!

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Breaking Down those Adult Beverages

"Do you drink?"........The question stumps me every time.  No doubt the answer is yes; but for an over-thinker such as myself, I know in south Louisiana the real question is, "Do you enjoy getting wasted every now and then?"  To this, the answer is no.  Now you see my dilemma. 

This tricky question is a good lead-in to the topic of alcohol and diabetes, a tricky combination.  Most resources will say that alcohol in moderation is okay for diabetics, but be aware that it can cause hypoglycemia.  That's certainly good to know, but it still leaves much to be desired. 

While it will take some individual trial and error, I want to offer some perspective for you by establishing two cardinal rules: (A) just as in all things, moderation is indeed king.  (B) alcohol can lower blood sugar, but what else is in the drink?

Intoxication and hypoglycemia have many of the same characteristics.  Practically speaking, that is why (A) is important.  On the other hand, we must remember that not all drinks will cause hypoglycemia.  In fact, many drinks will cause a spike in blood sugar because of other ingredients.  It's important to know what's in your drink before taking that first sip.  Here are a few general guidelines for common beverages:

1.  Beer.  Contains carbohydrates that will increase blood sugar.  Be mindful, however, that they tend to be digested slowly, like a complex carb or fat.

2.  Wine.  Little to no carb.  There is a good chance that it could cause hypoglycemia, even hours later!  It is wise to keep wine-drinking with meals.  See study.

3.  Hard liquor & mixed drinks.  For blood sugar purposes, liquor by itself can be treated as wine.  Mixed drinks, however, usually contain juices or other ingredients that can be packed with sugar.  These will spike the blood sugar very quickly.

Happy drinking; and let's be less than seven, greater than low! 

Nutrition facts & tips