D-thoughts on snacking

Lyndal's snacks1

Happy Australia Day! And what good timing for a blog on snacking! It must be the ‘most asked’ question I get as a dietitian: “What are the best snacks for people with diabetes?”

It’s not really a black and white question as the answer depends on your personal diabetes requirements, your personal tastes, your ability to be mindful in your choices and your knowledge of healthy eating in general. So this blog aims to help you to be mindful in making snacking decisions.

We encourage you to choose foods that are higher in nutrients to add to your overall wellbeing, rather than ‘discretionary choices’ which everybody, diabetic or not, is encouraged to limit. It’s especially the case for us with diabetes… but it doesn’t mean missing out on delicious flavours!

Priority One

Your first priority needs to be your overall diabetes goals. Are you getting all the nutrients from your diet that you need for wellbeing? Are you needing to watch your weight? Is matching your food intake to your body’s ability to process carbs an issue for you?

A perfect segue to our Australian Dietary Guidelines… Are you actually meeting the quantities recommended in the 5 main food groups across your day?

In an ideal world we would choose snacks that are included in the foods that we are recommended to enjoy each day. In these examples I’m referring to the ‘Healthy Eating for Adults’ brochure, but there’s also a Healthy Eating for Children brochure for those thinking about their children with diabetes. In both cases, the actual food group listings are on page 2.

Each of the food groups has snacking potential, so there’s always plenty to choose from.

In the ‘Vegetables and legumes/beans’ group you can always find a low-carb snack if that’s what you’re after. Whether it’s raw veg to nibble on, celery with nut butter, blanched asparagus spears when they’re in season, tasty tiny tomatoes that burst with flavour in your mouth, hummous dip with veggie sticks, or even leftover cold roasted non-starchies or ratatouille (recipe in the files section of the closed ‘Diabetes and Food – let’s celebrate it!’ Facebook group). There are always options in this group of foods if one of them will meet what you’re looking for…

salad

Next group down and a great one for those wanting something to satisfy a sweetness craving is the ‘Fruit’ group. With diabetes we are recommended to aim for about 2 serves per day, eaten at different times. However, some fruits are really low in carbohydrate, so we can have more of these without upsetting our glycemic control. Some of those include berries, passionfruit and kiwifruit. But still watch your quantities. If you want to know how much fruit will contain 15g of carbohydrate, take a look at www.calorieking.com.au , search for the fruit you are looking at, and adjust quantities to get to the 1 carb serve number.

Lyndal's snacks2

In the ‘Grain (cereal) foods’ group, it’s easy to calculate whether you’re going to meet your daily recommended amount. Often for people with diabetes this is a group that people actually tend to be low in. Instead of choosing a ‘discretionary item’, swapping in a low-GI high fibre grain snack such a piece of heavily grained toast with a topping to suit your taste can be a great option to satisfy your hunger and keep your BGLs stable. Or even a small bowl of your high-fibre cereal. Of course these options all contain carbs, but they are all much more nutritious than a cracker or sweet biscuit.

In the ‘Protein’ group, snacking options are easy to find, but it’s important to remember to try not to exceed the guidelines in terms of serve sizes and number of serves recommendations. This is because protein contains energy (or calories/kilojoules) that will cause weight gain if you have too much, although they shouldn’t upset your glycemic control. I recommend having a read of this blog on Protein : written earlier, if you’d like more info. The perfect snack from within this group for us with diabetes is really a handful of nuts, as the evidence behind inclusion of nuts in our diet is quite outstanding. Read more about nuts in this blog.

Lyndal's snacks3

And last, but not least, is the ‘Dairy and/or alternatives’ group. I wrote a couple of blogs about dairy and diabetes as it’s such an important food group for us with diabetes. Here’s a link to the first one and the second one that contain more great ideas for snacking. My favourite snacking recommendations to help meet the nutritional guidelines are a low-fat yogurt (low sugar too if you’re watching your carb intake closely) or plain low-fat greek yogurt with berries mixed in. Or a low-fat milk based smoothie made on frozen berries, with a couple of teaspoons of chia seeds added for extra fibre. Even a cup of milk based coffee can do the trick… These should work well to satisfy hunger and provide you with the nutrients this group is known for.

Lyndal's cup of coffee2

Priority Two

Your second priority, also a very important one, is to ask yourself what do you actually feel like eating and why? Sometimes snacking can become a habit. People say “I have a sweet tooth and NEED a biscuit or cake”. (or whatever) This is important too, because if you deprive yourself of what you really want (or feel you need) all the time, then your craving will only grow bigger and you’ll end up overdoing it and regretting it later. Not a good thing, but happens all too often. If you can enjoy a small amount of what you feel you “need”, being mindful of enjoying every mouthful, savouring the textures and flavours that you’ve wanted so badly, then you’re in a better place to return to your ‘healthier’ options on a regular basis.

Do I really need to snack?

If you’re medicated for your diabetes, and are putting yourself at risk of a hypo if you don’t snack, then you should snack as you’ve been advised by your medical diabetes team. If in this case you’d rather not be snacking as you’re just not hungry, then you should talk to your d-team and arrange to have the medication adjusted so that you don’t need to snack.

For those of you where snacking has just become a habit, it’s worth thinking twice to see if you really are hungry before you just head for a snack. Is it out of habit or because you’re bored? Sometimes a drink of water will satisfy that ‘hunger’ feeling, which may actually be your body telling you that you’re dehydrated. If you’re bored, take the opportunity to go for a walk, call a friend, do something off your household chores list, read a book, or engage in your hobby.

If you are constantly actually hungry, it may be worth your while to visit an Accredited Practising Dietitian to see how your meal plan can be adjusted to help avoid that happening. Being hungry is not good or necessary for you to manage your diabetes and weight well.

More ideas?

In the Diabetes Counselling Online closed Facebook groups ‘Diabetes and Food – let’s celebrate it!’ and ‘Diabetes Weight Matters’ we’ve asked the members what their favourite snacks are and have created a document up in the files section of the groups. I think I still need to finalise the weight matters file, but it’ll be there soon. These are member ideas, not necessarily dietitian approved, so please use this blog as a thought process in helping to make your snacking decisions right for you.

Also in the current issue (February 2015) of the Australian Healthy Food Guide they’re running a feature relevant to this blog that you may find helpful. It’s entitled “Your Treat Foods Toolkit” and explains “why those ‘naughty’ treat foods are discretionary, and how they can fit into a healthy diet.” It’s written by an Accredited Practicing Dietitian, Brooke Longfield and can be found on page 34. Although not related specifically to diabetes, you’ll find it helpful for portion sizes and understanding more about ‘discretionary’ foods.

Happy snacking! Sally :)

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

 

 

 

 

 

 

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Guest post from Georgia: Fresh as a daisy!

flowers on country fence

Sharing a guest blog from Georgia today

xx

Helen

I have got motivated this week, it is 2015 – a fresh start, my fresh start. After a long (needed) break it was go time, 2015 hit me with full force of determination; I was going to make this year mine.
I started with the compulsory booking of appointments, at first hair & nails, then the medical side of things: Endocrinologist (a new one, for a new start); Podiatrist (my annual care plan appointment); Eye test (my biannually care plan appointment); blood test for my 3 monthly Hba1c and an appointment with my GP to get my referral for my new Endo.

I have a feeling, after a messy 2014 this year is going to deliver the goods, a year to achieve and work towards my goals and get my Fashion Blog well and truly off the ground and get everything (diabetes wise) in the best shape possible.

Not that it is in a bad place at the moment, I feel great but there’s always room for improvement, like my quote of the week “Always be a work in progress”, you can never stop bettering yourself.

A new Endo means a chance to have someone understand me more and to hear my side of things before looking at levels, a new set of eyes to provide me with help and support. It took a while for me to agree to find a new Endo, I was adamant that I could handle everything myself (I’m still confident I could), but it doesn’t hurt and who knows my stubborn self may learn a thing or two. I am going in to this with no qualms what so ever. After my last experience I hold no expectations to my new doctor, but hope that this time round it doesn’t end in guilty tears.

On another note, I am all about challenges – I get stressed when I have so much to do, but I never feel satisfied until my diary is full of commitments. I like being busy and I love challenging myself and investing myself in new tasks.

This year I am focusing on:
1. Getting fitter than ever
2. Having more adventures
3. Possibly undertaking an external course
4. Doing a first Aid Course
5. Expanding my/our Fashion Blog.

I advise you all to make this year your year! I turn 22 this year and I read this great article saying how your 20’s are your selfish years and your 30’s are your years to plan for the rest of your life, me being me I want to make my 20’s both of those things.

But most importantly, I am focusing on me, investing my time on those who I truly care about and who truly care about me. High school was years ago and I am feeling myself grow up and change from the person I was 3 years ago – I am still the same child who dances to One Direction around my room, and my values haven’t changed, but I have and so has my attitude – all for the better of course.

2015 baby!

Au Revoir
Georgia.
georgia new year

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Making Rice Nice for Diabetes

dreamstime_m_5280572 (2)

Rice is one of those grains that can be problematic for people with diabetes, so I thought it might help if we explain a little of why that is, why different rices have varying effects on our BGLs and ways to make rice more diabetes friendly.

You may know that, generally speaking, a quarter of a cup of cooked rice is one carb serve. You can see that in this snip from CalorieKing showing that half a cup of boiled rice = 28.8g carb (or 2 carb serves).

2 serves boiled rice

And this photo shows you what half a cup of cooked rice (2 carb serves) looks like on a plate.

half a cup of cooked basmati rice

You may also know that, particularly for us with diabetes, we’re better having rice that breaks down more slowly to glucose in our bloodstream, or low-GI rice. The main types in Australia of low GI rices are long grain rices including Basmati and Doongara. Even when choosing brown rice for the extra fibre, we’re best to choose brown Basmati or Doongara.

This mini-table gives you a feel for the glycemic indexes of various rice products.

Source: Low GI Diet Shoppers Guide 2014

Rice type Glycemic Index Glycemic Index rating
Aborio/risotto rice, boiled, SunRice 69 Medium
Basmati white rice, boiled, SunRice 59 Medium
Basmati white rice, SunRice, microwave pouch 52 Low
Calrose rice, brown, medium-grain, boiled 76 High
Calrose rice, white, medium-grain, boiled 87 High
Japanese style sushi rice, SunRice 89 High
Jasmine fragrant rice, SunRice 73 High
Long-grain rice, white, boiled 15 mins, Mahatma 50 Low
Low-GI Long-Grain rice, Brown, SunRice 54 Low

This is only a snapshot, but it indicates that there’s quite a difference in how quickly the different rice types break down to glucose in our bloodstream. It’s also worth bearing in mind that the longer you cook any rice the higher it’s GI rating will become, so try to keep it tender, not mushy.

What makes these rices different in GI is the type of starches they contain combined with the shape of the grains. The two main starches found in rice varieties are amylose and amylopectin. Wikipedia explains that high-amylose varieties of rice, the less sticky long-grain rice, have a much lower glycemic load. It’s to do with the chemical structure of the starches.

Nutritionally rice is mostly starch (80-90%). This snip from Wikipedia shows the nutritional content of Rice, white, long-grain, raw, and demonstrates that it doesn’t add a whole lot of nutrients to our meals other than carbohydrate.

nutritional content of rice

By keeping your portion sizes reasonable, consuming protein foods and vegetables with your rice meal will add nutrients and lower the overall GI of the meal.

chicken curry and cabbage

And dishes that you’ve previously always used rice in can be nutritionally enhanced by swapping in other forms of more nutritious grains such as barley, quinoa and cracked wheat. Why not do an experiment and try some swaps out for yourself? One of my dietitian colleagues makes her sushi with quinoa, and barley risotto is amazing! Here’s a recipe from Taste.com.au for it.

barley risotto snip

One trick with rice is to combine it with other grains for added fibre and nutrients and to further lower the glycemic index and improve that nutritional profile.

Fortunately more and more options are available to us.

The Australian company, SunRice, has a great range of ‘Health & Wellbeing’ rices and rice blends that you may like to consider trying.

And Coles also has recently launched some similar products that are all high in fibre and have a low glycemic index too. The varieties available are:

  • Brown Rice and Quinoa
  • Brown Rice and Chia seeds
  • 7 Ancient Grains – a combination of brown rice, green lentils, millet, quinoa, sorghum, amaranth and chia seeds (the highest fibre variety).

Capture

These microwaveable packs usually contain 2 serves per pack. You should check the Total Carb per Serve column to check how many carb serves a ‘serve’ contains. It’s usually about two. They’re very convenient quality carb options to keep in your pantry.

Resistant starch

Just a reminder while we’re on the subject of starches, that cooked and cooled starches develop a crystalline structure which makes them resistant to digestion (hence their name) which lowers their glycemic index. So adding cooked and cooled rice to your salads is a great way of adding a serve or two of low-GI carbs to your meal to help manage your blood glucose levels and provide the many benefits associated with including low-GI carbs in each meal. The theory of resistant starch goes that if the starch resists digestion it will end up in the large bowel to feed the good bacteria which in turn improve our immunity and overall wellbeing. You can read more in the blog on fibre if you’re interested.

So I hope you learned how to make rice work better for you. Please let us know if you have any questions. Sally :)

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. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

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Diabetic Nerve Damage: Neuropathy

Diabetic Nerve Damage: Neuropathy

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood glucose can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood glucose management, and a healthy lifestyle.

Everything is Possible
Everything is Possible

Clinical context

Pain and paraesthesia are common peripheral neuropathic symptoms, and if the autonomic nervous system is involved, gastrointestinal, bladder and sexual problems arise.

Diabetic neuropathic complications increase the burden of self-care and overall management.

The clinical focus is on prevention via good glycaemic control, and early recognition facilitated by good history and routine sensory testing.

New modalities are arriving to assist in the management of diabetic neuropathies.

Before any treatment is instigated, exclusion of non-diabetic causes of neuropathy is suggested. This includes assessment for vitamin B12 deficiency, hypothyroidism, renal disease and review of neurotoxic drugs including excessive alcohol consumption.

Autonomic neuropathy

Autonomic neuropathy may result in:

  • orthostatic hypotension (also called postural hypotension, is a form of low blood pressure that can cause dizziness. It happens when the blood vessels do not constrict (tighten) as you stand up, which makes you feel dizzy) with >20 mmHg drop
  • impaired and unpredictable gastric emptying (gastroparesis), which can cause a person’s blood glucose levels to be erratic and difficult to control. Pro-kinetic agents such as metoclopramide, domperidone or erythromycin may improve symptoms
  • diarrhoea
  • delayed/incomplete bladder emptying
  • erectile dysfunction and retrograde ejaculation in males
  • reduced vaginal lubrication with arousal in women
  • loss of cardiac pain, ‘silent’ ischaemia or infarction
  • sudden, unexpected cardiorespiratory arrest especially under anaesthetic or treatment with respiratory depressant medications
  • difficulty recognising hypoglycaemia
  • unexplained ankle oedema.

Cardiovascular autonomic neuropathy should be suspected by resting tachycardia (>100 bpm) or orthostatic reduction in BP (a fall in SBP >20 mmHg on standing without an appropriate heart rate response). This applies to people not currently on antihypertensive agents that may cause variations in BP responsiveness such as beta blockers. It is associated with increased cardiac event rates.

Diagnosis

The diagnosis of diabetic neuropathy may include:

  • taking a medical history for symptoms typical of neuropathy
  • checking your feet and legs for responses to stimuli such as temperature, light touch, pain, movement and vibration
  • checking the reflexes at your ankles and knees
  • tests to exclude other possible causes of neuropathy (such as low vitamin B1 or thiamine levels).

Treatment

Damaged nerves cannot be repaired. However, the risk of further complications in the feet can be reduced by:

  • vigilance – regular inspection of the feet for early signs of trouble or potential problem areas (such as breaks in skin, signs of infection or deformity
  • getting help at the first sign of trouble – early treatment of foot ulcers gives the best chance that they will heal
  • good foot and nail hygiene
  • choosing appropriate socks and shoes properly fitted to the shape of your foot
  • avoiding activities that may injure the feet. Check shoes for stones, sticks and other foreign objects that might hurt your feet every time before putting your shoes on.

A referral to a podiatrist may be appropriate for assessment and ongoing preventive management of foot complications.

Treatment for painful neuropathy

Appropriate pain management can significantly improve the lives of people with diabetes and painful neuropathy. A number of different medications are available, which produce comparable effects.

Most people would begin with one of either:

  • serotonin-norepinephrine reuptake inhibitors (such as venlafaxine, duloxetine)
  • tricyclics antidepressants (such as amityptiline)
  • anti-epileptics (such as gabapentin, pregabalin).

If one type fails to provide the response required, it is usual to switch to or add another. If all three agents alone or in combination fail, then opioid analgesics and tramadol may be used as second-line treatments.

Prevention of diabetic neuropathy

Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:

  • Maintain blood glucose levels within the target ranges.
  • Exercise regularly.
  • Maintain a healthy weight for your height.
  • Stop smoking.
  • Reduce your blood pressure and lipid (fat) levels through diet and lifestyle changes, and medication where appropriate
  • Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
  • Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.

DSCN2553

Although, potential health complications due to diabetes may happen; don not live in fear, by watching the amount and types of food you eat, exercising, and taking any necessary medications, you may be able to prevent short and long-term diabetes complications.

  • Keeping blood glucose close to normal can help prevent the long-term complications of diabetes.
  • Manage high blood pressure.
  • Monitor your blood sugar level and A1c.
  • Have regular reviews with your diabetes care team.

Talk to your health care professional team: ask questions and get answers that you understand….. prevention is better than a decreased quality of life.

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