Living Well with Diabetes
Balance and moderation are two key ingredients for a healthy life.

It’s certainly nothing to take lightly. A diabetes diagnosis—at age 13 or 63—is a serious matter. After all, diabetes is a chronic disease that can be life threatening, or can cause significant long-term complications. It can lead to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, nerve damage and more.

But there’s another thing diabetes can lead to: a better life.

Diabetes may be incurable, but with balance and moderation in exercise and food, and proper medical care, diabetes is controllable. In fact, this extra attention to balance and moderation can be a life-enhancing change for anyone—whether you have diabetes or not.

Bob Dornhecker, who has lived with diabetes for 67 years and now runs the Diabetic Support Group in Dallas, Ore., recalls a memorable comment his diabetes specialist made many years ago. “People with diabetes can live just as long, or longer, than people without,” the doctor said, “because they’ll take better care of themselves.”

The key to living well with diabetes, says Dr. Cort Garrison, medical director of Salem Hospital’s diabetes program, is “moderation in everything you do. The real challenge is understanding ‘How did I get here, and what am I going to do to change?’” he says.

“Exercise, food and medication—in that order—those are the tools we give people,” says Judy Fry, RN and Certified Diabetes Educator at Salem Hospital and an instructor of the hospital’s Diabetes Education Class. That’s because exercise and diet are the two most important factors a person with diabetes can adjust to control his or her condition. When diet and exercise alone can’t improve the condition, diabetes specialists turn to medication.

“People with diabetes must be willing to accept that they need to make lifestyle changes,” says Patti Peterson, manager of Salem Hospital’s diabetes program. “Take time for yourself. Look at diabetes as an opportunity to make changes in your life that create a better balance,” she adds.

Starr Garland, who has diabetes, saw her diagnosis as a serious wake-up call, and it inspired her to take action. Focusing intently on diet and exercise, Starr soon lost 65 pounds, reducing her weight to a level that no longer requires diabetes medication. “It’s okay to be selfish and put yourself first, because nobody else is going to do it for you,” she says.

Moderate exercise
Exercise is a critical component of diabetes management because it keeps blood sugar levels from getting too high. “Building muscle mass burns off sugar,” says Amy Schmidt, exercise specialist at Salem Hospital and an instructor of the hospital’s Diabetes Exercise Class. But, she warns, moderation is key to preventing overexertion and strain. “Sometimes blood sugar can get too low, as well, so people with diabetes need to learn their own personal patterns, and check their blood sugar before and after they exercise,” she added.

Catherine Purdy, Doctor of Podiatric Medicine at Alpine Foot Clinic of Salem and Dallas, who often helps people with diabetes manage foot problems, says that exercise, particularly walking, is also important for blood circulation. But she advises people to be careful about their shoes. “Good walking shoes are so important,” she says. “I recommend shoes made of natural materials like cloth or leather, not plastic or nylon. They should be changed daily so they can dry out and should be worn with clean, cushiony socks.”

A nutritious, moderate diet
When it comes to eating and meal planning, again “the key is balance,” says Dr. Garrison. “It takes a nutritious, moderate diet that is not overboard in any one thing.”

“People with diabetes need to pay extra attention to the level of carbohydrates in their meals,” says Denise Cedar, Registered Dietitian and Certified Diabetes Educator at Salem Hospital. “They should spread their carbs out evenly throughout their meals, control portion sizes and seek meals with balanced nutrition.” The diabetes food pyramid (above) is a good guide to a balanced diet. You may want to cut this out and put it up in a place where you are likely to see it every day.

But diabetes experts realize that eating perfectly at every meal is challenging. Schedules don’t always permit planned meals, temptations arise, and sometimes the most healthful ingredients aren’t available. So if you find yourself eating something that wasn’t in your plan, start fresh with the next meal—it’s never too late to get back on track with a balanced diet.

“You just have to make a commitment to yourself,” says Starr Garland. “I just took one meal at a time and one day at a time.”

What you can do
People with diabetes can control their own destinies to a great extent by seeking balance and moderation in their lives. If you have diabetes, try any or all of the following to take charge of your situation.

• Take a diabetes-education class—learn all about diabetes, get valuable tips for leading a great life, and enjoy the support of others with diabetes.
• Participate in an exercise class—learn safe, new exercises or refresh your workout routine.
• Join a diabetic support group—meet others with diabetes and share experiences and advice.

“I love our classes,” reports Gloria Head, who has attended Salem Hospital’s Diabetes Education and Diabetes Exercise Classes. She appreciates the supportive environment and being with others who have diabetes. “Once we start laughing and talking, we feel so much better,” Gloria says.

Exercise Your Way to Diabetes Management

One of the most critical elements of a diabetes care plan is something that everyone—whether you have diabetes or not—should be doing anyway: exercising.

Exercise is an important part of diabetes management for two reasons. First, exercise results in well-toned muscles, which require less insulin. Secondly, exercise burns blood sugar, so a person with diabetes can use exercise to regulate his or her blood sugar level.

“Exercise burns calories, and eventually fat. The more muscle and less fat you have in your body composition, the better off you are,” says Dr. Cort Garrison, medical director of Salem Hospital’s diabetes program. “The best exercise is aerobic, which protects your heart.”

Move more
Exercise can be an intimidating concept. But it doesn’t necessarily require a gym membership and buckets of sweat.

“The most important thing a person can do is simply move more,” says Judy Fry, RN and Certified Diabetes Educator at Salem Hospital.

By moving more, your body will use more energy and keep blood sugar levels down.

Try these quick tips for moving more:

• Park at the far end of the parking lot—Get 40 extra yards of walking in every time you go shopping or run errands.
• Forget the elevator—Take the stairs whenever possible.
• Wash dishes by hand—Get your upper body moving by scrubbing and drying.

Exercise classes
Another option is to participate in a regularly scheduled exercise class. A structured program can teach people—new or experienced exercisers—healthy techniques they can later use on their own.

The best part of an exercise class “is the regular routine, and having other people who are on your same level,” notes Roger Philippi, who participates in Salem Hospital’s Diabetes Exercise Class. “Plus, it’s a great way to break into exercise, and meet others with diabetes.”

Exercise safely
It’s critically important to exercise carefully, especially at first. Amy Schmidt, exercise specialist and instructor of Salem Hospital’s Diabetes Exercise Class, offers these tips for people with diabetes:

• Check your blood sugar before and after exercise.
• Start slowly and don’t get burned out. Diabetes is a lifetime condition—the exercise needs to be sustainable.
• Try multiple exercises. Add resistance training and stretching to aerobic exercise.
• Check with your physician before starting an exercise program.

Move more and discover exercise—it’s a powerful way to prevent and manage diabetes.

Learn More
Salem Hospital offers two types of diabetes exercise classes. Call 503-561-6990 for details.

American Diabetes Association
See the “Weight Loss & Exercise” section

Visit the Health Source reference library for more information on diabetes.

In the world of weight-loss and diet fads, the effect of carbohydrates on the body may continue to be a hotly debated topic. But in the world of diabetes, there’s no debate: carbohydrates play a critical role in meeting the body’s nutritional and dietary needs. And, as with most healthful life choices, balance and moderation are the keys to a successful diabetic diet.

The diabetes food pyramid
Most people are familiar with the traditional food pyramid and its recommendations for a healthy diet. There is a food pyramid for people with diabetes, too. While it is similar to the traditional food pyramid, the diabetes pyramid is different in one key way: beans, corn and potatoes are considered starches to those with diabetes.

The diabetes food pyramid has six food groups, each varying in size based upon the recommended daily servings of each (see illustration at right). From largest to smallest, the diabetes food groups are:

• Breads, grains, and starchy vegetables (including beans, corn, and potatoes)
• Vegetables
• Fruits
• Meats and other proteins
• Milk
• Fats, oils, sweets, and alcohol

For people with diabetes, consuming the right proportions of each food group is doubly important. While the exact number of servings depends on individual goals, calorie and nutrition needs, lifestyle, and food preferences, everyone should eat servings from each food group every day—make sure to limit sweets, though. To develop a healthful meal plan, anyone with diabetes should partner with a registered dietitian who has diabetes-management expertise.

The role of carbs
Because carbohydrates are converted directly to blood sugar, paying attention to carb consumption is particularly important for people with diabetes. Too many carbs can easily lead to high blood sugar, and too few carbs can keep blood sugar too low.

This means no crash diets that eliminate all carbohydrates. “Atkins-type diets are discouraged by diabetes-nutrition experts,” says Denise Cedar, Registered Dietitian and Certified Diabetes Educator at Salem Hospital. “Many people need to lower their carbs, but not omit them.”

To maintain consistent blood sugar, people with diabetes should be sure to eat the appropriate number of carbs each day and to distribute those carbs evenly across all meals. A registered dietitian can help you determine the appropriate number of carbs for you.

Healthy eating tips
“The way people with diabetes need to eat is the way all of us should be eating,” says Denise Cedar. There’s no need for families with a member who has diabetes to prepare separate meals. In fact, the nutritional balance of a diabetic diet may improve the health of the entire family.

The American Diabetes Association offers these tips for making healthful food choices:

• Eat a wide variety of foods every day to provide balanced nutrition.
• Consume less sugar. Soft drinks, sweets, and other sugary foods offer many calories with no nutritional value.
• Consume less salt and sodium. Avoid the salt shaker, and enjoy more fresh and unprocessed foods.
• Eat more healthful starches. Whole grains, beans, and starchy vegetables such as peas, corn, potatoes (when they are not deep fried), and winter squash are healthy because they have very little fat, saturated fat, or cholesterol. Avoid such fat-laden starches as French fries and chips.
• Eat more vegetables. Vegetables are nutritious, full of vitamins, and naturally low in calories. Plus, they offer much-needed fiber.

By following these basic guidelines, and always striving for dietary balance and moderation, people with diabetes can easily control their carbohydrate intake and effectively manage their blood sugar levels.

Diabetes is a chronic, incurable disease that affects nearly 17 million Americans. If not controlled it can be life threatening or can lead to long-term complications, from blindness to kidney failure and more. Diabetes is the sixth-leading cause of death in the United States.
But there’s great news: With careful attention to diet, exercise, and medical care, diabetes can be successfully managed.

What is diabetes?
“Diabetes is an elevated sugar level—outside the normal range of 70 to 140 before or after eating, above 200 when randomly sampled, or above 126 when fasting,” explains Dr. Cort Garrison, medical director of Salem Hospital’s diabetes program.

People with diabetes can’t produce enough insulin—which converts blood sugar to energy. Without insulin, high levels of blood sugar accumulate, leading to complications. There are three types of diabetes:

• Type 1—The body produces little or no insulin, requiring daily supplements.
• Type 2—The body cannot produce or properly use enough insulin, requiring a careful diet, exercise, weight loss, and possibly medication.
• Gestational—A pregnant woman who cannot use the insulin her body produces. It may be controlled with diet, exercise, and weight management, and usually disappears after delivery.

Several risk factors contribute to diabetes, including genetic background, impaired glucose tolerance (above-normal blood sugar), hyperinsulinemia (above-normal insulin levels) and insulin resistance. However, two of the greatest risk factors are completely manageable: obesity and physical inactivity.

What you can do about it
“Diabetes prevention involves things we should all be doing anyway,” says Patti Peterson, manager of Salem Hospital’s diabetes program. To help prevent diabetes and other health problems, make it a habit to:

• Manage obesity—Maintain a healthy weight through proper diet and exercise. (Check out the Health Source section of our Web site to learn your healthy weight.)
• Get regular exercise—Activity keeps your blood sugar level in check and your muscles well toned.
• Eat right—Eat meals that are nutritious and low in carbohydrate content. Limit portion sizes.

As Peterson says, “There are so many risk factors you can’t control—do something about the ones you can.”

Diabetes Tips and Tricks

A Diabetic diet means making manageable lifestyle adjustments. Denise Cedar, Certified Diabetes Educator at Salem Hospital, offers the following practical tips:

• When eating out, ask for a take-out container when the food is delivered. Because most restaurants provide twice as much food as the body needs, you can put half of the food into the container right away and still have plenty to eat. You’ll get two meals for the price of one!
• Try to avoid eating one gigantic meal and under-eating the rest of the day. Uneven meal sizes result in changing blood-sugar levels.
• Avoid regular soda and other sweetened drinks. Instead, choose water, tea, diet soda, or artificially sweetened drinks.

With Valentine’s Day right around the corner, candies and chocolates will soon be floating around the office and home. So, how will you handle it? Will you cave in to every temptation and hate yourself later? Or resist every morsel and feel like you’re being deprived?

Fortunately, you don’t have to choose between such extremes. Whether you’re pursuing weight-loss goals, managing diabetes, or just working to maintain general health, the best choice is moderation. Here are some tips for enjoying those heart-shaped treats without derailing your health program:

• Slow Down—Sweets are meant to be tasted, not scarfed. If you eat slower and savor every bite, it won’t take as much to satisfy your craving.
• Moderate Portion Size—If a giant slab of chocolate cake lands on your plate, you don’t have to eat the whole thing.
• Avoid Sugar—It doesn’t take a load of sugar to make a tasty treat. Keep an eye out for reduced-sugar, sugar-free, or artificially sweetened options, such as apple-sweetened brownies…

Apple-Sweetened Brownies
Preparation time: 20 minutes

1/3 cup vegetable oil
1/2 cup unsweetened applesauce
1/2 cup unsweetened cocoa powder
1/2 cup sugar
1 cup all-purpose flour
1 tsp baking powder
1/2 tsp baking soda
2 large eggs
1 tsp vanilla extract
1/4 cup chopped nuts

Directions

1. Preheat oven to 375° F.
2. Combine oil, applesauce, and cocoa. Add sugar and stir until dissolved. Add eggs and vanilla. Mix dry ingredients together and stir into the mixture.
3. Pour the batter into a greased and floured (or wax-paper-lined and sprayed) 9-inch square pan. Sprinkle on nuts (optional).
4. Bake about 20 to 30 minutes or until top is set but edges are not dried out. Toothpick will come out clean. Cut into 16 squares.

Yield: 16 brownies

Nutritional analysis per brownie: 123 calories, 15 gm carbohydrate, 1 gm fiber, 7 gm fat (with nuts), 163 mg sodium.

Print This Recipe: Apple-Sweetend Brownies

Diabetes Day

Mark your calendar for Diabetes Awareness Day, Saturday, March 19, from 9 a.m. to noon. We will be offering fasting blood sugar testing, exhibits and educational sessions designed to enhance your knowledge of diabetes management.
Call 503-561-5639 for details.

Diabetes Resources

Salem Hospital’s Diabetes Education Class
8:30 a.m. to noon, Monday through Thursday for one week. Individual and evening classes are also available. Call 503-561-6990 for details.

Salem Hospital’s Diabetes Exercise Class
4:15–5:15 p.m., Mondays and Wednesdays. Class requires doctor’s approval. Call 503-561-6990 for details.

Dallas Diabetic Support Group
Fourth Monday evening, every month, 7–8 p.m. in the West Valley Hospital conference room.