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My d-holiday in Thailand

July 7, 2014 by Sally 2 Comments

Wow! I really needed that break! I had concerns about my diabetes and coeliac disease before I left, but other than a few minor hiccups, they were fine. I prepared well, and was mindful of my activities (as much as possible) so thought I’d share some of the highlights with you.

You probably all know how I feel about routine being so important for diabetes control. I really didn’t know how I’d go with a complete break from my usual routine. I was also concerned about the impact of the high-GI foods in Thailand, and from a coeliac perspective, the availability of low-GI gluten free foods. So, I decided to be organised and ensure I took with me what I needed:

10 measured packets of my low-GI GF cereal
2 loaves of my low-GI GF bread
A few juice poppers in case of night-time hypos
Mixed unsalted nuts for snacks

And I was glad I did that as it did make a big difference! Of course I also took a spare BGL meter and loads of extra fast acting and Lantus insulin and Glucagen but fortunately didn’t need them.

The Flights

I also had to think about the plane flights, as we flew with Jetstar and they don’t provide gluten free meals. For the way over I made a frittata with lots of veggies, sweet potato and cannellini beans (for low-GI carb) which was very tasty, and my Mum (who I was travelling with) was envious as her in-flight meal was not nearly as appealing. I also took a couple of pieces of my low-GI GF bread and a jar of peanut butter, an apple, a box of nuts and a juice popper for the flight. Worked out perfectly, but I didn’t need the popper (no hypos).

On the way back we slept most of the way, but I took a baby banana (provided every day in our room as part of a fruit platter) and boiled egg from the resort and had those with bread and peanut butter for my on-board breakfast. Very satisfying – a peanut butter and banana sandwich with an egg on the side!

The Resort Food

We had breakfast included in our package which was an enormous buffet of cereals, breads, pastries, European food and Thai food as well as the usual cooked breakfast options. I missed my coffee as, although they offered coffee, it was different to the coffee we have here. Of course, I had brought my own cereal, and I indulged in a freshly made omelette most days – most delicious. I also tried some Thai breakfast options including a clear broth with pork and cabbage with a fish sauce-based chilli seasoning. Very zingy and tasty!

I found that being coeliac wasn’t much of an issue there, but was glad to have my own cereal and bread. For lunch we took a selection from the European breakfast option of cold meats/cheeses and salad to make our own sandwiches in our room.

The night time meals were pretty easy to manage other than having a higher glycemic index/load than I’m used to. Most of the seasonings were based on fish sauce, tamarind, lime juice and coconut milk, so I really only had to watch out for soy sauce. And the noodles – some were wheat based, but they’re pretty easy to spot so I just avoided those, and of course there rice and mung bean/glass noodles always available.

When we ate at the buffets in the Resort, the staff were only too happy to have the chef prepare me special meals to my liking, so I felt very spoilt and had no accidental glutenings.

Food outside the Resort

We had only one day excursion from the hotel (other than local restaurants in the evenings) and although I checked 3 times with the hotel tour operator that there would be gluten free food available on the day, when we were on the bus on the way to lunch the guide asked if anyone had any special food requirements. When I advised I needed gluten free food, he really had no idea. There were ten Australians on our bus and everyone tried to explain on my behalf (how sweet), but when we got there they’d misunderstood ‘wheat’ as ‘sweet’ lol. Suited me too, but the 3 dishes offered, one was sweet & sour pork (too sweet for my taste), one was spring rolls (not gluten free) and the third was a chicken and eggplant green curry. The restaurant made me an extra serving of the green curry very kindly, so all was good including my BGLs as the coconut milk lowered the GI of the high-GI rice they served with it!

We also went to a market one day which was fascinating to see the various vegetables available as well as the meats and even insects. We didn’t eat anything there as it was very hot and didn’t look clean, but wished we could have tried some of the fruits and vegetables on offer. In the resort the only real green vegetable dish offered was called Morning Glory that was served stir fried. Vegetables were one of the foods I missed most on this holiday, and I normally eat about 6 serves every day of fresh veggies.

The local restaurants were fantastic and I had no issues with any of their meals, other than perhaps eating too much

My diabetes control

As mentioned at the top, I had concerns about how my diabetes would cope with a complete change of routine. With the weather being in the high 30s and very high humidity, it was really too hot to exercise. My usual exercise routine helps to keep my BGLs steady across the day, and that was reflected in higher BGLs than I would usually have. I had a few up around 16mmol/l, but these were easily corrected using my insulin pump. I used more insulin than usual, but not much more.

I spent hours relaxing in the pool, just sitting or sometimes chatting with other guests. With an insulin pump, you can take it off for up to two hours at a time, but I was often there for longer than that. The solution I found was to attach my pump to my cap, which also made for a good discussion topic I just couldn’t quite stand up straight as the tubing was slightly too short to reach from the cannula on my tummy up to my cap lol.

One day, I was zoned out after a massage and went for a swim in the pool, forgetting to take my pump off. Fortunately I remembered only about a minute into the swim and jumped out in a bit of a panic thinking I’d wrecked my pump (as I’d done to a phone before that never recovered). It was fine, but certainly shocked me out of my zoned out state of mind!

I only had one minor hypo after going for a walk on the beach one day without notice, but it was only 3.6mmol/l and the juice box was cool from the mini-bar fridge so very welcome. I carried my hypo treatments and my BGL meter everywhere with me.

I went there with the idea of running my BGLs slightly higher than usual, okay since it would only be ten days away. I didn’t actually do anything to achieve that but the lack of exercise and higher GI foods naturally did it for me, and everything’s fine.

I remember the story of 90 year old, Edna who was diagnosed aged 20, so 70 years of diabetes, who said “I don’t worry about my diabetes, I just say to myself to do my testing, to get rest every day and to enjoy life and stop wasting time worrying about my health. If you look after yourself you will have a long, happy life like I have.” Wise words methinks!

The language barrier

The Thai people are so lovely and helpful, but there were occasions when language caused confusion, such as the gluten free issue on the bus ride. Also, I had taken 2 loaves of my low-GI GF bread and when we got there I asked the kitchen to put one into the freezer for me to keep it fresh until I needed it later in the visit. Two days before the end I went to collect it and found they’d only kept it in the refrigerator, so it wasn’t as fresh as it could have been, but lasted the two days and the flight home so there was no drama.

I explained to the manager how asking for something to be kept in the freezer, meant the deep freeze where ice is made, not just the refrigerator, to ensure it is kept fresh. He seemed to understand so hopefully others won’t have this issue in future.

Happy Ending

The main goal of my holiday was to completely relax and switch off, which is exactly what I did. I didn’t even get around to reading any books. We just hung by or in the pool and the beach, had massages, ate yummy food, drank a few Mojitos (with little sugar and a big garden of fresh lime and mint in the glass) and lots of water, and chatted with other guests. I’m usually an adventure holiday type of girl, but to spend this relaxing time with my Mum was definitely what the doctor ordered.

We finished off with one day of adventure on rafting down a river on bamboo rafts, and trekking with elephants to make a perfect holiday. Wishing you all the opportunity to enjoy such a holiday yourselves one day. It was a once in a lifetime experience for me, but you never know what’s ahead!

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.

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Exercise….Really?

May 20, 2014 by Imagine_David 3 Comments

Does exercise really make a difference in type 2 diabetes?

Focus on the exercise that you can do, rather than what you can't. — Focus on the exercise that you can do, rather than what you can’t.

For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years.

In a scientific paper published just last week it was found that physical activity commenced soon after the diagnosis of type 2 diabetes reduced the risk of cardio-vascular disease (heart attack and stroke). The effect of exercise was beneficial in itself in reducing the risk of health problems, even if the person had started medication to lower blood glucose levels, blood pressure and cholesterol http://jaha.ahajournals.org/content/3/3/e000828.abstract

There is also firm and consistent evidence that programs of increased physical activity and modest weight loss reduce the incidence of type 2 diabetes in individuals with Impaired Glucose Tolerance (IGT). http://care.diabetesjournals.org/content/29/6/1433.full

Boulé et al undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of more than 8 weeks duration on HbA_1c (A1C) and body mass index in people with type 2 diabetes.

After the program of exercise the HbA1C was significantly lower, even if the BMI (weight) had not been lowered. http://care.diabetesjournals.org/content/29/6/1433.full

Never to old to ride a bike. Do it safely, have a medical checkup before you start a new exercise program. — Never too old to ride a bike. Do it safely, have a medical checkup before you start a new exercise program.

Aerobic exercise

The amount and intensity recommended for aerobic exercise vary according to goals.

The evidence is strong that to improve glycemic control, assist with weight maintenance, and reduce risk of Cardio Vascular Disease (heart attack, stroke), it is recommend that at least 150 minutes per week of moderate-intensity aerobic physical activity and/or at least 90 min/week of vigorous aerobic exercise.

This exercise would be best prescribed by an exercise physiologist, available on the Medicare plans through your GP.

The physical activity should be distributed over at least 3 days/week and with no more than 2 consecutive days without physical activity.

Performing more than 4 hours per week of moderate to vigorous aerobic and/or resistance exercise physical activity is associated with greater CVD risk reduction compared with lower volumes of activity.

For long-term maintenance of major weight loss (≥13.6 kg/30 lb), larger volumes of exercise (7 h/week of moderate or vigorous aerobic physical activity) may be helpful.

With the help and guidance of an exercise physiologist you can find some exercise that will give you health benefits safely

Resistance exercise

In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance exercise three times a week, targeting all major muscle groups, progressing to three sets of 8–10 repetitions at a weight that cannot be lifted more than 8–10 times (8–10 RM).

To ensure resistance exercises are performed correctly, maximize health benefits, and minimize the risk of injury, it is recommend that initial supervision and periodic reassessments are undertaken by a qualified exercise physiologist, as was done in the clinical trials.

Barriers to Exercise

Table 1— Barriers to physical activity among low-income patients with type 2 diabetes from http://care.diabetesjournals.org/content/28/5/1209.full#T1

Barrier
I have health problems that keep me from exercising	2.78 ± 2.10
I do not have anyone to exercise with	2.77 ± 2.10
I have trouble getting back to exercise after a break in my routine	2.69 ± 1.99
I have joint pain that keeps me from exercising	2.57 ± 1.85
My leg pain is too bad to exercise	2.52 ± 1.86
Exercise is physically painful	2.48 ± 1.86
I do not have enough time at home to exercise	2.42 ± 1.68
I do not have the right equipment to exercise	2.18 ± 1.75
I do not have enough time during or after work to exercise	2.16 ± 1.47
There is not enough time in my schedule to exercise	1.97 ± 1.46

Accessing an Exercise Physiologist

“Patients who have both a GP Management Plan (GPMP) and Team Care Arrangements (TCAs) have access to allied health individual services on the Medicare Benefits Schedule. Eligible patients can claim a maximum of five (5) allied health services per calendar year. The five allied health services can be made up of one type of service (e.g. five exercise physiologist services) or a combination of different types of services.

In addition, patients with a GPMP and type 2 diabetes can also access Medicare rebates for up to eight (8) allied health group services per calendar year. Group programs do not have to be limited to type 2 diabetes groups only.

Relevant group programs for type 2 diabetes patients may include:

Fitness or weight management group services; or
Blood glucose monitoring services. (From http://exerciseismedicine.org.au/wp-content/uploads/2011/09/Referrals-to-AEPs-under-Medicare.pdf )

What Are Your Barriers?

You might like to download and compete this Exercise Benefits/Barriers Scale and discuss it with your GP.

Be Safe, Ask Questions.

Kind Regards,

David – Diabetes Educator @ Diabetes Counselling Online

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Cruising with diabetes

May 12, 2014 by Sally 1 Comment

Sometimes going on holiday with diabetes can be a worry when you don’t know what to expect food-wise. As requested by the Diabetes Counselling Online closed Facebook group ‘Men living with diabetes’, today’s blog will look at how you can prepare for your wonderful cruising holiday and how to make the most of it while avoiding the rollercoasters of glycemic control.

It’s important to remember, and especially when you’re on holiday, that diabetes isn’t a game of perfect so aim to relax your control a little for the duration of your cruise to allow yourself a chance to recharge and relax. You’re there to enjoy yourself!

A little planning goes a long way

My dietitian colleague, Jemma O’Hanlon wrote a blog on managing your weight when on cruising holidays, and one of my favourite quotes from her blog is:

“Failing to plan = planning to fail” – Jemma reminds us that “Not having a plan is a recipe for disaster, as peer pressure and ‘living in the moment’ can often lead to poor decisions being made.”

Cruise Lines International Association (CLIA) Australasia offered us this advice: “Cruise lines should ask you to identify any dietary requirements at the time of booking, either through your agent or online, and your needs can then be discussed with relevant staff once onboard – generally the maître’d or food and beverage manager.”

They also remind us that “cruise ships offer an enormous variety of food and their chefs are very well versed in dealing with all sorts of medical conditions and dietary needs,” so you can feel confident that you won’t need to worry about having the right types of food to help with your glycemic control.

When you get on board, make one of your first actions to meet with the person in charge of food. If you take a letter from your doctor with you that outlines your dietary requirements and medications it can only help.

Be mindful with your choices where possible

APD, Jemma O’Hanlon says, “My number 2 rule is to keep in mind that going on holidays is not an excuse to eat more or give up all of your healthy eating habits”.

My Ten Top Tips that I share with my clients include:

1) Start each day with a healthy breakfast – you know the low-GI cereals are a great option, but also enjoy poached eggs or omelettes with plenty of vegetables and grainy toast for some variety.

2) Choose quality low-glycemic index carbohydrates – dairy, wholegrain cereals and breads, sweet potato/corn and try to include your two pieces of fruit per day. Avoid higher-glycemic index carbohydrates where possible (sweets/desserts/sweet drinks), but as you’re on holiday if you really want something then have it and enjoy every morsel.

3) Choose grilled rather than fried foods (and uncoated foods – avoiding crumbs and batter).

4) Choose fresh foods rather than processed foods. This is a perfect opportunity to enjoy quality rather than quantity.

5) Portion sizes – aim for small plate size of food, and don’t feel obliged to finish what’s on your plate if you’ve had enough.

6) Aim for half your plate to be salad or non-starchy vegies

7) Consider if you *really* want dessert – knowing you wouldn’t at home and that it will upset your glycemic control and weight management, is it really worth it?

8) Avoid snacks between meals – if you need a snack try to choose fresh fruit, yogurt, or nuts and seeds.

9) Minimise your alcoholic beverages – this doesn’t mean abstaining altogether, but there are risks associated with alcohol and diabetes, and of course they’re full of empty calories just like softdrink.

10) Engage in physical activity every day – walking in the swimming pool, around the deck, and participate in other offered activities.

Other diabetes matters to consider

If you are insulin dependent or on other insulin stimulating drugs, CLIA Australasia advises, “Most cruise lines also offer room service and would certainly organise to have a particular type of food available if there was a medical requirement”. Personally I would ensure that I had several hypo treatments available in my room to be on the safe side.

For day trips off the ships, check with your on-board contact about taking a picnic lunch so that you’re not caught short in a place that you’re unfamiliar with. Remember to carry your hypo treatments with you if you’re at risk.

Some useful travel websites for people with diabetes are:

Diabetes Counselling Online – diabetes and travel page

The Joslin Diabetes Center – ten tips for a safe trip which includes some helpful tips including remembering to test your BGLs!

VoyageMD, a website all about travel with diabetes put together by a UK doctor who has many years experience in diabetes care, to provide up-to-date and practical help for people with diabetes intending to travel anywhere in the world.

It might be worth having a browse through these as part of your trip preparation, so you’ll be ready to relax once you’re on board. Many of my clients come back from a cruising holiday much fitter and healthier than when they left due to enjoyment of such a variety of wonderful activities and fresh foods.

When you get home, take a few moments to reflect on your holiday, remembering how much you’ve enjoyed your cruise, and try to incorporate the activity and the fresh foods into your everyday life. Then everyday can a little bit of your holiday in it.

Most of all enjoy every moment while you’re there! Wishing you everything you’re hoping for in your cruising holiday. Sally

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Wanderlust, Georgia’s Blog

May 9, 2014 by Helen-Edwards Leave a Comment

Maybe it’s because it’s getting to winter and I’m getting ‘middle of the year’ syndrome when I need something happening, to excite me. Otherwise every day seems to go so much slower.

I have always wondered if it’s just me. It’s not that I’m not content with everything, I just crave so much more. I dream of travelling, picking up my passport and just going. This could be because I’ve watched a numerous amount of movies and think anything is possible, not that this is a bad thing. I love that I want to do everything, however it can get depressing when I realise I can’t.

I don’t know when it happened, when I started thinking about my life and where I want to go and who I want to be, and seeing the world from a young age I got a taste for how much more there is. So I make promises to myself, create bucket lists and make plans. I know life doesn’t always go accordingly, believe me I do, but whenever things start drifting from the path I know that it isn’t always a bad thing. Sometimes it leads me to better destinations and other times I just have to spend a little extra effort rebuilding the path to get back on it.

For the meantime, I do have something to look forward to – I’m turning 21 and although I didn’t want to do anything, I found out my mum and friends have planned something for me. They are so great. I even cried when they told me because it was so unexpected and now I have this night to look forward to.

Turning 21 comes with great maturity and responsibility (in my eyes anyway) and a whole lot of celebrating. Having a 21^st means a lot more preparation, i.e. guest lists and the perfect birthday dress, which is extremely important haha.

Having a big party isn’t the only thing I have to look forward to. I have great jobs (yes, plural), passion for what I want and great people around me who continuously support me in my life, and having them with me on my life journey is something very exciting to look forward to, not everyone has that privilege.

Although there is a long road ahead, I am proud of how far I have come, there’s been a lot of hurdles in my life, some sad, some hard and some amazing and it’s crazy looking back how big the little things were and how little the big things were.

Life is about moments and thank god I have a zest for life to create extraordinary moments that I will one day, far, far in to the future get to share with my kids, like my parents have with me and inspire them to keep dreaming. I know not everything is possible but it’s only a small box of things you can’t do and endless opportunities out there that are waiting for you to grab them.

You never know where you’re going to end up and things change all the time, but a quote I live by that’s from my favourite movie of all time ‘Titanic’; “I figure life’s a gift and I don’t intend on wasting it. You don’t know what hand you’re going to get dealt next. You learn to take life as it comes at you. To make each day count”

Until next time, keep looking forward!

Georgia

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Flourishing & Happiness, decorating your home with happy

April 23, 2014 by Helen-Edwards 2 Comments

I was feeling tired last night, a little virusey, but also incredibly happy as I munched on a carrot while simultaneously cooking dinner and balancing on a chair looking in the medicine cupboard for some cold and flu Echinacea and Horseradish tablets, basked in the late afternoon Autumn sun shining in through the window, when I stopped and thought, I am so damn happy!

This makes me happy

And this

and this

And this

and this

Do you know what I mean? Such an innocuous moment, yet a sense of happiness washed over me. I know that this feeling is happy for a fact because in my past I have felt, well, so damn sad. My years of depression and anxiety, of that black dog running things, have taught me how to avoid him and he no longer frequents my life. But I give thanks to that black dog, for it is him that has taught me happiness.

Sometimes I think that we have to experience the uncomfortable feelings, the ones nobody wants to play with, the ones that get picked last for the sports team, never get asked to dance at the school disco and always seem to turn up wearing the “wrong” clothes. The ones that keep you in bed, lock you in the house, stop you from seeing your friends and family, from venturing out into the light, from talking, from being.

Those feelings are not the popular ones but so many of us experience them. I am not just talking about everyday sadness – we all experience every range of emotions all the time and that is wonderful and being human. But many of us experience far deeper feelings of darkness than the odd sad day or moment.

And, we all seek this intangible, popular girl thing called happiness, but what is it?

My take on it, after nearly 47 years of life, a teenagehood filled with angst, living with type 1 diabetes since I was 12, living with depression on and off even longer, studying Social Work for 4 years and then working in it for 26 years, is that the reason we can’t really define happiness, can’t write it up truly and completely like a Hallmark Card, sign it off and post it, is because it is ever changing.

What made you happy when you were 5 years old, does not necessarily make you happy now – although I do think there are lots of things from childhood we need to do more often as adults, such as days where nothing is planned, jumping on the bed, eating in a very messy manner or rolling in muddy puddles. (I am working still on the unplanned days thing as I am total CRAP at it). It can also change from day to day and moment to moment. Happiness is not a constant. It can be in the background however while other feelings layer upon it. Some days I can be happy as a little bird and then something happens to bring in anger, frustration or sadness, but the happy is still there, sitting in the back seat to catch me when I fall back down from these jumpy, sneaky emotions that are fed by my busy mind and chattering head.

Seeking, finding and then knowing what makes you happy can be truly empowering.

I know that things that make me happy go a bit like this (not in any order of priority):

my children and family
my friends
my cats
waking up in the morning
the sunrise
the sunset
the ocean
the sky
running
music
trees and flowers
animals
writing
styling, design and pretty things
rust, wood, fabric, paints & paper
other people
Instagram and all the wonderful creatives I have met
opportunities
possibilities
creating
the feeling I get when I contribute to or help another human being in their life

And that is just a start. What does your list look like?

I once heard at the Happiness Conference which I have attended twice, partly due to the presence of the great Dalai Lama, the wonderful Marty Seligman talking about “flourishing” as being what happiness is all about. He says that happiness is the centerpiece of positive psychology.” It is a real thing that is defined by the measurement of life satisfaction and that Happiness has three aspects: positive emotion, engagement, and meaning, each of which feeds into life satisfaction and is measured entirely by subjective report”. That meaning it is different for all of us.

Seligman identifies five aspects which he says are vital to human flourishing — positive emotion, engagement, good relationships, meaning and purpose in life, and accomplishment, cumulatively called PERMA.

“The content itself — happiness, flow, meaning, love, gratitude, accomplishment, growth, better relationships — constitutes human flourishing. Learning that you can have more of these things is life changing. Glimpsing the vision of a flourishing human future is life changing.” ~ Martin Seligman

Having a purpose and contributing to the world is just as important as all the other aspects which is why people can become depressed if they suddenly don’t have this anymore, such as when they retire. I also totally get the part about flow – when I am in the flow of anything – faffing about at home, painting furniture, studying, blogging, singing, pottering, anything really – I feel so happy. Do you experience that too?

Having an environment which reflects all of these things is also to me what happiness is all about and why it is so important to design and decorate your home and working spaces in ways that create these things for you – positive emotion, engagement with the world, good relationships, meaning and purpose in life and accomplishment – through displaying things that remind you of your experiences, what matters, why you get out of bed each day, the places you have been, the people you love – these things all make a happier home and are reflected in the design and decoration.

Having colours, textures, shapes, images that fill your mind and heart, these things give your home a heart and encourage you and your loved ones to flourish. It does not matter what style or trend you are into – if minimalism, or boho, or coastal, or rustic, or whatever it is that rocks your boat reflects your passions and lifestyle, then this is what will make it a happy home. A home which is devoid of the personality of those who live within it, just does not have the same effect on the people who live there.

What things do you decorate your home with that make you happy?

Helen

Helen Edwards – founder Diabetes Counselling Online, type 1 diabetic since 1979, Mum of 3, Interior Stylist & Blogger at Recycled Interiors

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