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the last of diabetes & a garden update

I know, I’m kind of on blog diabetes over-load lately. I got a great reader question, however, and I thought I’d answer it here, as well. Diabetes is a complex disease and with the Western diet we consume, I believe we are ALL at increased risk of developing insulin resistance and type 2 diabetes.

If you’re sick of diabetes, you can skip on down to my garden update. Things were a’growin’ while I was in San Jose! 😀

Heather of Get Healthy with Heather: Could you write about the different types of diabetes and ways to treat them with food and exercise? At my work diabetes is a big problem and we want to start taking steps to reduce it and help improve employee’s health. Thanks!

Prevention RD: Great question, Heather! Type 2 diabetes is the most common form of diabetes and is characterized by insulin resistance. Insulin in the hormone in the body which acts as the carrier for glucose (energy) into the cell for proper metabolic processes. When insulin resistance appears, insulin is no longer working effectively due to the cell’s decreased sensitivity to insulin or a glucose (energy) load, particularly from carbohydrates, that exceeds the capacity of the body’s needs. Muscle cells are more receptive to insulin and for this reason, insulin resistance is more common in overweight and obese individuals.

Type 2 diabetes is attributable to both genetics and lifestyle factors such as overweight and obesity, inactivity, high blood pressure, and poor diet high in total carbohydrates and/or simple carbohydrates (sugars and starches). Screening for diabetes is being performed much earlier in the US because symptoms often times take years to develop. Common symptoms of diabetes (all types) include: excessive thirst, excessive urination, fatigue, weight loss, and fruity-smelling urine.

Type 2 diabetics are twice as likely to develop cardiovascular disease. Uncontrolled diabetes can lead to other complications such as retinopathy leading to blindness, neuropathy (loss of feeling and sensation in the extremities and digits) which can lead to amputations, nephropathy leading to kidney failure and dialysis, and erectile dysfunction. Depression is also common in many diabetics.

Type 1 diabetes is an auto-immune disease which requires insulin therapy due to the pancreas’ inability to produce insulin. Type 1 diabetes is typically diagnosed in the younger years with most type 1’s being diagnosed before their 20th birthday. A strict insulin and diet regimen are required for proper health.

Gestational diabetes is commonly coined a “carbohydrate intolerance” and is first diagnosed during pregnancy. Risk factors for gestational diabetes include: obesity, family history of diabetes, non-Caucasian descent, and older maternal age. Most women resolve their carbohydrate intolerance after giving birth, but they are at increased risk for developing type 2 diabetes in the future. The baby of a gestational diabetic is more likely to become overweight or obese and have impaired glucose tolerance and/or diabetes later in life.

While there are several types of diabetes, they are all treated the same. I am an advocate of eating like a diabetic to avoid diabetes. A diabetic meal regimen focuses on regular meal times and macronutrient balance. Diabetics should be counseled on basic carbohydrate counting techniques and aim to consume a carbohydrate-controlled diet of approximately 45 grams per meal, and a 15-30 gram carbohydrate snack (plus protein) before bed. Ideally, 2-3 ounces of protein (or more) is included at each meal.

General rules of thumb for diabetics and carbohydrates:

  • Emphasize complex carbohydrates over simple carbohydrates (complex carbs include fiber)
  • Increase fruits, vegetables, and whole grains in the diet
  • If lower carbohydrate intake is good, less is not better. The brain needs glucose!
  • An evening snack should be consumed no more than 60 minutes before bed. Include protein!
  • Check labels! Look for portion size, servings per container, grams of total carbohydrate, and fiber content
  • Do not check sugar on a label! Sugar on a label cannot differentiate between lactose and sucrose, so it is not an accurate means of determining the effect on blood glucose
  • Fiber and protein help blunt the curve of the post-meal glucose spike – they are important to include at every meal.
  • If you include snacks throughout the day, aim for high-protein and healthy fat snacks (2% cheese, nuts, seeds, etc.)
  • Increase exercise! Activity helps to lower blood glucose and increase muscle mass which is more sensitive to insulin than adipose (fat)

What are some examples of balanced 45 gram meals?

  • A meat and/or 2% cheese sandwich on 2 slices of whole grain bread, a side salad with light dressing, and a piece of fruit
  • 3-4 ounces of meat with 2/3 cup rice or noodles, 1 cup of mixed vegetables, and 1 dinner roll
  • 2 chicken or beef tacos with 1/3 cup rice or ½ cup beans

45 grams gone and you’re still hungry?

Some meals are a “rip off” in terms of carbohydrate grams for portion size (ex: rice and pasta). These foods can still be consumed, but they will require smaller portions. If these portions are not enough to feel satisfied, consider increasing the amount of protein and non-starchy vegetables on your plate. There are lots of ways to add bulk to your meal without adding additional carbohydrates.

What fruits and vegetables are carbohydrates?

Technically, all of them. All fruits are carbohydrates and need to be counted. Starchy vegetables that contain significant proportions of carbohydrates include: potatoes, peas, corn, and squash. All other vegetables are very low in carbohydrates and don’t need to be counted until the portion has exceeded 3 cups (that’s a lot!). So, more or less, they’re freebees…eat more!

Heather, I recommend…

If I were you, I would create a free, anonymous survey on Survey Monkey and send it to your co-workers. Find out how much of a problem diabetes is for your co-workers and their families. Ask questions that relate to diabetes (i.e. How many fruits and vegetables do you eat each day? How many times a week do you regularly exercise? Do you have a mother, father, brother, or sister with diabetes?) to find out what needs the most attention.

Most people don’t know much about diabetes and how to prevent diabetes. More individuals than we can estimate are walking around with advancing insulin resistance and type 2 diabetes. Early intervention is extremely important! The longer diabetes goes undetected, the grimmer the future is for diabetics as far as complications and pre-mature death. Diabetes is a progressive disease and gets worse over time, requiring more to control its effects. Education is so important!

I wish you lots of luck in your endeavors to inform and help your co-workers live long, healthy, and happy lives!

Diabetes is preventable if we do something about it before it’s too late!



The squash (bottom) hadn’t even sprouted when I left on Sunday!

Critters are eating my potatoes…need to address! Any advice???

Kale! Looks like Christmas holly to me 🙂

“I was just thinking how much I missed my mommy and how I hadn’t been photographed in several days…”

And for the Lily lovers out there: Lily is feeling much better it seems! Another week to go til we find out about surgery. Thank you for all your prayers and well wishes for our baby girl! 😀

Question: Do you limit your carbohydrate intake at all? If so, why? What do YOU consider to be a low-carbohydrate diet? Do you think low-carbohydrate diets are advisable? Why or why not?

I think everyone has a different take on this, so I’m curious to hear what you guys think!

Random Question: Over dinner with Andrea the other night, we talked about how important it is to keep posts concise. I am not good at this always (see above!), but I try to be. Do you find that you enjoy blogs that are less time-consuming to keep up with? Or does length not really deter you from reading a blogger’s posts?

Have a great day!

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  1. April 22, 2010 / 6:41 am

    Considering how much of an impact diabetes is having on our country, I don’t think you could EVER post too much about it! I don’t limit my carb intake at all but then again, I also work out 6 days a week so I think I deserve it. I do limit my refined flour intake though…to rarely ever. I’m all about the whole wheat/whole grains!

    Your garden is really coming along!

    I don’t tend to get turned off by long posts as long as they are interesting and well written…especially considering how long mine usually are! (I always love yours :P)

  2. April 22, 2010 / 7:00 am

    I limit my REFINED carbohydrates as much as I can (but I am not opposed to a little bit of white flour to enhance the flavor/texture of something, etc…). I also try to limit sugars even if they’re not refined. I’m always reducing the amount of sweetener in recipes hahaha. However, I can’t stand people who call low-carb diets healthy, and a healthy way to lose weight. Uhm, no they’re not. Carbohydrates are essential and by depleting yourself of carbs you’re basically depleting yourself of necessary nutrients. However, it’s probably best that carbs be monitored because it’s really easy to go overboard on them! They’re everywhere. 😛 So I would prefer to be carb-conscious like you recommend than eat low-carb. People need carbs. It’s basic biology.

    For the critters eating your garden, I’ve heard that making an emulsion of oil and water and spraying it on the plants is a safe way to get rid of bugs. Basically the oil is supposed to suffocate them. I’m not a gardener because I kill every plant I touch but it’s worth a shot, I figure. 🙂

    If I don’t have time to read someone’s posts, I’ll usually catch up with it later. I don’t mind people who have lengthy posts. It’s their blog; they can post whatever they want! It’s usually a matter of whether or not it’s boring, which none of the blogs I read are (otherwise I wouldn’t read them, ha).
    I’m glad Lily’s doing well!

  3. April 22, 2010 / 7:22 am

    I definitely prefer posts that are short and concise, but then again, if a post is really long, but full of good information, I don’t mind at all!

    Love seeing your garden grow!

  4. April 22, 2010 / 7:23 am

    I do not eat a low carb diet because I don’t limit carbs but I do limit the amount of grains that I eat. I try to only eat a serving of grains once or twice per day. If I eat too many, I become lethargic, get inflammation in my joints and digestive issues. I think it is because I am gluten intolerant. Most of the people I know that are gluten intolerant have to limit grains.

  5. April 22, 2010 / 7:28 am

    I definitely prefer shorter, more consise posts, but if it is a blog I love, longer posts wouldn’t stop me from reading once in a while!

  6. April 22, 2010 / 7:45 am

    I love reading your recaps on your diabetes conference!

    I prefer shorter posts… but if someone has something really interesting to say… the longer post doesn’t bother me 🙂

  7. April 22, 2010 / 7:47 am

    This was a great post. I think so many times you hear all about this diabetes epidemic and no one really differentiates between type 1 and 2. Just to add: There’s LADA (latent autoimmune diabetes in adults), sometimes called type 1.5, which is like type 1 with components of type 2 but diagnosed in adults.

    And there’s also pre-diabetes, which is a stage of reduced insulin resistance, but not enough to warrant a type 2 diagnosis. If you’re diagnosed with pre-diabetes, you can often make the necessary lifestyle changes (eating right, exercising, losing weight) to possibly avoid type 2. Sure, it’s not guaranteed and many people with pre-diabetes—including those who do change their habits—still go on to have type 2. But I’ve interviewed plenty of people who were diagnosed with pre-diabetes and haven’t been diagnosed with type 2. Also, just to underscore how important diet changes are, I’ve interviewed many people with type 2 who have gone off their oral meds because they changed their diet and can manage their diabetes with it. (You can’t do that for type 1, though.)

    To answer Samantha’s question, you can’t have more than one type at a time.

  8. April 22, 2010 / 8:00 am

    I am always so surprised when I watch shows like the Biggest Loser and they have contestants who don’t know that they are diabetic. The more information that is out there about diabetes the better!

    For my carb intake – I don’t really pay that much attention to the amount of carbs I eat. I eat a ton of fruit and I think that helps me not overeat on bread. I have been eating sprouted grain bread and tortillas now for extra fiber and protein.

    For long/short blog post – I love long posts if it keeps attention and has a lot of useful information. I always learn a lot from your post and I like reading them. But I am not a fan of long posts that are more like rants and complaints than useful info.

  9. April 22, 2010 / 8:01 am

    I don’t try to eat low carbs, but a lot of times it happens accidentally. Being gluten free, I can’t just run out and grab a bagel or a sandwich (as much as I’d like to!) I try to get my carbs from tons of veggies 🙂

  10. April 22, 2010 / 8:14 am

    Long posts don’t bother me if if grabs my attention. Sometimes though I’ll just skim through if it doesn’t.

    I don’t limit my carbs like I did 7 years ago when I was on Atkins. Then I kept it to like 20-40g a day. Now I just get my macros right and wherever my carbs end up they end up. I seem to end up between 170-240.

  11. April 22, 2010 / 8:17 am

    I love seeing the garden pics! I cannot wait until we get to plant in ours.

    I prefer concise. I skim if it is too long imo (like this, I just skipped to the garden update, like you said). And I totally skip all the food pics on those “this is what I ate today” blogs.

  12. April 22, 2010 / 8:45 am

    I love all this info – you should publish this as a diabetes education pamphlet! I especially like how you included real examples of balanced meals – many of my patents say they know they are suppose to have so many grams of this or that, but they have trouble understanding what this means in terms of an actual meal…

    I’m so glad to hear adorable Lilly is feeling better!! Please continue to keep us posted on how she’s doing…

    Your garden looks amazing! The kale is so pretty!!

    I actually really like long posts, as long as they are well-written like yours always are… 🙂 I really enjoy settling in with a cup of tea to read a nice long post, the way I would settle in to read an article or a book chapter! 🙂

  13. April 22, 2010 / 9:18 am

    Gosh I just love Lily 🙂 Great post on the different types of diabetes, what a great refresher. I like short post, but in all honestly, it doesn’t really bother me, as long as they have great pictures to look at, then I am suckered in! Have a great day Nicole!

  14. April 22, 2010 / 9:25 am

    Another great picture of Lily.

    Re: blog posts, I think that more and more people have short attention spans but, if the post is engaging, readers will stick with you until the end…

  15. April 22, 2010 / 9:26 am

    Great post. I’m learning a lot about diabetes in my health psych and nutrition classes. I’m definitely not a low-carb person and really do not believe in any of those kind of diets. Grains make up such a large portion of what I eat…no way could I cut them out! I do like posts when they are more concise, but then again I have trouble doing this as well…so many topics just contain so much to say about them!

  16. April 22, 2010 / 9:45 am

    Such a great post!! Loved all the information and especially the examples of 45g meals! 🙂

  17. April 22, 2010 / 10:03 am

    Thanks Nicole that’s even more info than I was hoping for! Survey monkey’s a good idea, we’ve used it before, I just have to get the okay from the powers above first. Educating staff about diabetes would be a great first step I think. To bad you live so far away or else I’d want you to educate them!

    Since I exercise a lot I know that my body needs carbohydrates to keep me going so I definitely do not follow a low carb diet. I just always ensure I have a good balance of carbs, protein and fat.

  18. April 22, 2010 / 10:19 am

    I do not limit my carbohydrates, but I do emphasize fats and proteins. I find these more nutritious, filling, and beneficial for me, though I’m sure it varies person to person.

  19. April 22, 2010 / 10:51 am

    Good summary of diabetes. I think you forgot to mention beans as carb-containing foods in your vegetable sections.

    Great garden. I wish I am more committed to a project like that.

    I prefer short blogs, but as everyone else was saying, if interesting, I keep reading. Oh, and I don’t recommend low carb diets. Carbs are not bad, but it’s a matter of moderation and spreading through out the day. I do limit sugar and refined/processed foods as much as possible, but I also like to enjoy my food. Balance is key.

  20. April 22, 2010 / 11:12 am

    The one thing too that I always remind patients diagnosed with gestational diabetes, especially with overweight/obese patients and those with DM in their families, is that they need to be tested after they deliver (2-6 mos) because gestational is diabetes diagnosed for the first time in pregnancy. There is nothing that says the person did not have diabetes before and only knows now because they are “forced” to have the glucose tolerance test and then comes the diagnosis. Real gestational diabetes will go away after delivery, but if this is type 2 that was only caught during pregnancy then it will not go away, and I always fear for these women because the doctors always say that it will go away after they have the baby, so they do not follow up with this. I therefore reminded all of my patients of this, and that no matter what they are at increased risk for developing diabetes later on. That is where doctors drive me mad, all they would say is the diabetes will go away after you deliver. How could they be so sure without following up? Yes, I covered the L/D and maternal infant unit and all patients followed for gestational DM. The hardest to deal with is a type 1 who is pregnant because they think they know it all and they do not realize the effects that hormones have in their everyday glucose management.

  21. April 22, 2010 / 11:23 am

    I will read a long post if it is informative and has information relative to me. I don’t care to read extremely lengthy posts about every detail of someone’s day though. I do like knowing what is going on with them, but don’t need to read a paragraph to know why they chose to drink two cups of coffee instead of one type of things.

    I also think that if the post is lengthy and discusses more than one topic, the post should be split into two. It is easier to read that way.

  22. April 22, 2010 / 12:19 pm

    I wish I didn’t live in the desert so I could grow a garden! I tried last year and it was a complete bust! I do have a potted tomato plant that is budding so hope she makes it this year!

    I think it depends on the writer of the blog and the content. Sometimes I don’t mind reading long post if they are full of content but sometimes my mind just does not want to concentrate and I’ll skim through.

  23. April 22, 2010 / 12:20 pm

    Very nice info abt diabetes…useful …and your garden looks beautiful nicole

  24. April 22, 2010 / 1:25 pm

    YAY I am so happy lily is doing better!!!! she is/was def in my prayers! There is a bulldog puppy near the park that I run at and I always consider kidnapping her lol ::sssshhhhh::

  25. April 22, 2010 / 1:53 pm

    Post length won’t deter me from a good blog, especially one with a lot of information vs people’s daily lives.

    I’m glad Lily is feeling better.

    Do you know what is eating your potatoes? can you send me a close up of a leaf? You can try insecticidal soap, there are lots of good brands out there or you can make your own

    1 to 2 tablespoons liquid soap
    1 quart water
    Combine ingredients in a bucket, mix, then transfer to a spray
    bottle as needed. You can also add strong smelling herbs and spices as a deterrant, I add cayenne.
    If it is snails or slugs you can use copper tape around the edge of your raised bed, they don’t like to cross it, or a small container filled with beer they tend to fall in and die as happy drunks…
    You can also take a leaf to a good local gardening center they should know what is eating your potatoes and help with remedies.

    Good luck. (sorry for the long response :P)

  26. April 22, 2010 / 2:28 pm

    If a post is interesting, it doesn’t really matter the length for me.

    Thanks for sharing all this information with us, really interesting.

    Also Lily is super cute!

  27. April 22, 2010 / 2:32 pm

    At first I was going to say that I love carbs and never limit them, but after reading the other commenters, I do limit refined carbs. But never the complex kind 😉

  28. April 22, 2010 / 3:10 pm

    Loads of great info on diabetes!! I find it all to be so helpful and very interesting. I am fearful that I will develop gestational diabetes. Do you know if there’s anything women can do to prevent it? And also, if they to develop it, are they put on a low carb diet? I can’t imagine a low carb diet could be healthy for a growing baby.

  29. April 22, 2010 / 5:06 pm

    Thanks for stopping by my little blog. I have been reading yours for some time (mostly lurking I guess.) I am an RD, and CDE, so I loved reading the recap of your diabetes conference!

  30. April 22, 2010 / 5:40 pm

    Thanks for the great info on diabetes. I had always wondered about gestational diabetes. Great rules of thumb too! My favorite is “If lower carbohydrate intake is good, less is not better. The brain needs glucose!” So many people tell me they’re cutting out carbs to lose weight…I’m going to refer them to this post! 🙂 I’m glad Lily is feeling better!

  31. April 22, 2010 / 8:14 pm

    Yay, I’m so glad that Lily is doing better 🙂 I’m continuing to think of her (and Maddies is, too!).

    Thanks for all the fantastic info on DM, Nicole. It’s incredible how prevalent it is in the world now, even in areas of the world where it was previously unheard of! And with all the complications and co-morbidities that result from DM … we need to do the best we can to reduce the risk. I think the idea of eating like a diabetic to avoid diabetes is a great one. Spacing out carbs is important for everyone.

    Have a great day!

  32. April 22, 2010 / 11:22 pm

    I like short posts, but I like long posts too. If theyre really long I tend to skim them, and then I wind up wondering what I missed, and read the whole thing anyhow.

    I dont limit my intake of anything. However, I dont keep refined carbs in my house, and so I only eat them on a very rare basis. So I guess I just called myself a liar eh? Clearly I DO limit my intake of carbs – but only the refined ones! lol

    SO glad Lily is feeling better. I just love her face, and no one with a face that cute should ever be hurting!

  33. April 23, 2010 / 6:44 am

    I am SO JEALOUS of your garden!! nick and I have decided that will be one of the first areas we really work on in our new home, because it’s almost too late to start one! I want to plant kale SO BAD. It’s expensive at the store and the other day I bought some that had gone bad 🙁 I may need to e-mail you for some gardening questions throughout our process!

    Diabetes question for you: I am working with a guy who has diabetes (type II) and he really likes to snack A LOT at night. I know it’s important to have protein in a late night snack (and you mentioned this above) but how many carbs should he have? How much is too much? I want his blood sugar BELOW 150 in the am! It was over 200, now it’s about 150-160.

  34. April 23, 2010 / 7:30 am

    I love your Diabetes updates. My mom has type 2, and my best friend has type 1 – she was diagnosed when we were 4 years old. So, I appreciate all that you do to help people. Which you know because I say that in like all my comments… lol!

    Your garden looks fab-oo. Makes me want one… maybe when we get a house of our own I will give it a shot!

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