type 2 diabetes Archives - Diabetes Counselling Online

Type 2 Diabetes : Will I Ever Need To Go Onto Insulin?

March 4, 2015 by Imagine_David Leave a Comment

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Type 2 diabetes is a progressive condition with decreasing insulin production over time.

With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of glucose into your cells — or doesn’t produce enough insulin to maintain a normal glucose level.

More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There’s no cure for type 2 diabetes, but it is possible to manage the condition with a healthy eating plan, a daily dose of exercise and taking prescribed medication.

For most people with type 2 diabetes a healthy meal plan and the ideal amount of exercise still aren’t enough to manage your blood glucose levels well. Medication will be prescribed for almost all people living with type 2 diabetes.

For many insulin therapy will be needed. This need for insulin use in people living with type 2 diabetes can happen quite quickly, but more often occurs in about 50% of people within 10 years of being diagnosed.

For a very good multimedia presentation on how insulin works in your body go HERE

Pancreas Becomes Exhausted

All of the tablets your doctor prescribes need your body to be producing enough insulin to work.

Insulin: The Comes a Time — **Insulin: There Comes a Time**

When a person with diabetes is no longer making enough of their own insulin, they will probably need insulin treatment to control their blood glucose levels. (NOTE: There are other injectable forms of medication that may be prescribed for some people which is NOT insulin)

Sometimes the tablet medication is continued example: Metformin helps insulin to work, and is often used in conjunction with insulin in people living with type 2 diabetes (and in ever increasing cases of people living with type 1 diabetes).

For people with type 2 diabetes, insulin is a tool that’s better if used sooner rather than later.

Is Insulin Safe?

Insulin is very safe – so safe that is can be used in women who are pregnant and breast-feeding.

In my practice I all too often hear of other health care professionals using insulin as a threat, an “if you” thing—if you don’t lose some weight, if you don’t do some exercise, if you don’t follow the diet, then you’re going to wind up on insulin.

That’s really not how people with type 2 diabetes should view insulin—as a punishment. Insulin is a very, very safe therapy, and people should not hesitate to use it if needed.

It is a very good medication for treating people with diabetes. When used safely and effectively insulin can prevent (or at least delay) many diabetes related health problems.

NOTE: If prescribed insulin, and you feel that there are side effects happening, talk to your doctor or pharmacist.

Fear
If you’re picturing big syringes that you have to boil and sterilise ( I last saw these in the 1980’s), think again. Modern insulin needles are very thin and disposable—no sterilizing necessary. There are also insulin pens equipped with an insulin cartridge and disposable needles that are so simple even a child can use them. Either type of delivery system makes using insulin very easy and virtually painless—really. Most people report that giving insulin is less painful than testing your blood glucose level with a finger prick.

****If you have a genuine fear of needles in general, it might be a good strategy to talk with your professional counsellor or psychologist.****

How do I prevent hypoglycemia?

Hypoglycaemia is a real fear for many people living with diabetes. This occurs when you have too much insulin in the body, so blood glucose drops too low.

More information about low blood glucose level here

Types of Insulin

Rapid-acting: Usually taken before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin.
Short-acting: Usually taken about 30 minutes before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin.
Intermediate-acting: Covers the blood glucose elevations when rapid-acting insulins stop working. This type of insulin is often combined with rapid- or short-acting insulin and is usually taken twice a day.
Long-acting: This type of insulin is often combined, when needed, with rapid- or short-acting insulin. It lowers blood glucose levels when rapid-acting insulins stop working. It is taken once or twice a day. from JOSLIN

Type	Brand Name	Onset (length of time before insulin reaches bloodstream)	Peak (time period when insulin is most effective)	Duration (how long insulin works for)
Rapid-acting	Humalog Novolog Apidra	10 – 30 minutes	30 minutes – 3 hours	3 – 5 hours
Short-acting	Regular (R)	30 minutes – 1 hour	2 – 5 hours	Up to 12 hours
Intermediate- acting	NPH (N)	1.5 – 4 hours	4 – 12 hours	Up to 24 hours
Long-acting	Lantus Levemir	0.8 – 4 hours	Minimal peak	Up to 24 hours

Some are long lasting and are given once a day; some given before each meal; some are mixed insulins which allow for least flexibility in your day.

Ideally your prescribing health care professional will know your lifestyle and prescribe an insulin that fits best for you.

Examples of things to consider when trying to fit an insulin into your day are:

Do you work regular hours or shift work?
Do you know (or want to learn) how to count our carbs?
How much flexibility do you want to have in when and how much to eat?
How prepared are you to find and implement best practice self acre strategies for your entire diabetes self care plan ?

Missing a Dose of Insulin

“What if I skip my insulin? Could I die?”
It depends on how often or for how long you skip your insulin. The chances of dying from one missed dose of insulin are EXTREMELY LOW for people living with type 2 diabetes. Talk to your doctor or diabetes educator about how you can plan for this situation.

I tell my clients who use insulin multiple times a day that if they miss a shot, they need to:

Measure the blood glucose level each hour.
If it is a pre meal non-mixed insulin dose, it may be safe to give the insulin within an hour after the meal.
Call for medical assistance if the blood glucose level goes over 15 mmols (especially if you are unwell)

Conclusion

Insulin use for people living with type 2 diabetes is often delayed due to fear.

If you have any fears about using insulin, talk to your diabetes educator, psychologist / counsellor and consider using the Barriers to Insulin Treatment tool: BIT validated English (USA) version 2007 1

Type 2 diabetes is like many things in life: we don’t have total control.

Our bodies and minds are very complex.

Use your team to help guide you towards the best health possible for you and your family.

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Why So High?

February 24, 2015 by Imagine_David 1 Comment

So often I hear ‘why so high’ from my clients, people living with diabetes.

So often I hear no diabetes specialised health care professionals asking ‘why so high’ when a person living with diabetes is in a bed in pain following an infection requiring a surgical procedure.

So often I hear ‘Its all too hard, Im not going to bother with this diabetes stuff, its all so confusing’ – diabetes burnout! arrrghhhh!

“Diabetes is not a death sentence, but it can feel like a life one. It can really shake up your world. After diagnosis, day-to-day activities that were once simple and straightforward such as eating, exercising, even enjoying a late night out with a few glasses of red, suddenly require greater attention, forward planning and consideration.

After a while it can feel like there is never time out from diabetes management, which like an octopus, sends its tentacles into every area of your life. Sometimes you will feel totally in control of this juggle and marvel at how well you manage. At other times, monitoring your blood glucose levels (BGLs), medication and insulin on top of the hurdles of everyday life, will become a time-sucking intrusion in your day. In particular, when you are overloaded with lots of other responsibilities and tasks, or when diabetes is not ‘playing fair’, your daily ‘must do’ diabetes management list can become an exhausting marathon. In your lowest moments, this can weigh heavily and feel an enormous burden, even a curse.” from our eBook Put the Brakes on Diabetes Burnout

Up and down we go!

So, the next tome you have a question like ‘why so high’ consider some of the things here in this chart:

Causes	Ask These Questions	Take Action
		If your answers to the questions are yes, follow these suggestions.
Food	Have you increased your portion sizes? Have you changed your eating habits or food choices? Have you eaten too many high-fat foods?	You may need to measure food more accurately to check portion control. If you think your eating pattern is changing, your medication or exercise plan may need to change.
Activity	Have you decreased or eliminated your usual activity? Are you doing too little physical activity?	Physical activity is a key to blood glucose control. Ask your healthcare team about starting a program.
Medication	Have you been taking the prescribed doses? Have you been taking the medication at the right time?Do you have “spoiled” insulin? Does your insulin look different? Was your insulin exposed to very hot or cold temperatures? Has your insulin expired?	Take the right dose at the right time. If you have any questions ask a diabetes educator. Throw away the bottle and open a new bottle. Check the expiration date on bottle.
Monitoring	Is the drop of blood too small? Are you using the correct technique? Could your meter be dirty? Have your strips expired? Have your strips been exposed to very hot or cold temperatures or not been kept in an airtight, dry, container? Is your meter calibrated to the current bottle of strips?	See a nurse educator to be sure your technique is correct and your meter is functioning the right way. Learn how to clean the meter.Throw away the strips and get a new bottle. Check the code on the strip bottle.
Illness, infection, injury and surgery	Are you feeling well? Do you have any infections?	Follow sick day rules. Contact your healthcare team for questions or help.

Some of my clients have found it helpful when visiting their health care professionals to share their knowledge about diabetes. You might find it helpful to download and complete this DIABETES KNOWLEDGE QUESTIONNAIRE (old rtf format) and take it with you to your next doctor and/or diabetes educator and/or dietitian appointment.

One of the problems for people living with diabetes of course is not FEELING the high blood glucose level. A blood glucose level of 10-15mmols is likely NOT to cause the symptoms of:

Being excessively thirsty
Need to wee more often than normal
Feeling tired and lethargic
Always feeling hungry
Having cuts that heal slowly
Itching, skin infections
Blurred vision
Gradually putting on weight
Mood swings
Headaches
Feeling dizzy
Leg cramps

However, just because you feel ok doesn’t mean that things are healthy.

Treatment of High BLOOD GLUCOSE LEVEL

For Type 1 diabetes

Plan ahead. Work with your doctor or Diabetes Educator for advice about increasing your dose of short acting insulin in this situation – before you need to.

You may need extra doses on top of your usual dose, and also you may need insulin (e.g. 2-4 units every 2 hours).

Test your blood glucose levels frequently. Measure your ketone level if the blood glucose level is over 15 mmols.

Drink extra water or low calorie fluids to keep up with fluid lost by passing more urine.

Contact your doctor or go to hospital if:

Vomiting stops you from drinking and makes eating difficult
Blood glucose levels remain high
Moderate to large ketones are present in the urine.

In type 1 diabetes, high blood glucose levels can progress to a serious condition called Ketoacidosis.

For Type 2 diabetes

Even for people NOT living with diabetes it is normal for blood glucose levels to go up and down throughout the day.

And an occasional high blood glucose level is not a problem.

However, if your blood glucose level remains high for a few days or if you are sick, enable your sick day plan and seek medical advice if unsure of what to do.

Further sick day plans can be found here:

MedlinePLus (USA)

Australian Diabetes Educators Association

Royal Australian College of General Practitioners

******* If in doubt always consult your health care professional *********

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Case Study: George Mellows (Part 4) – A visit to the Diabetes Educator

February 18, 2015 by Imagine_David 3 Comments

George Mellows is aged 55. He lives with his wife and his two teenage children, aged 15 and 19.

George works Monday to Friday 8.30 am until 4.30 pm . He works at a desk in a sedentary role, getting minimal activity in his working day. George has not played any sport for some time, but he does enjoy playing lawn bowls.

*** Previous Posts: Part 1 here ; Part 2 here ; Part 3 here ***

George has now had diabetes 3 months. He has had a consultation with his dietitian and found some healthy choices to make that not only fit with his diabetes self care plan but also things he enjoys!

This past 2 weeks George has been measuring his blood glucose level with a view of discussing the results with the diabetes educator. George feels confident that he can identify the causes of hyperglycaemia

On diagnosis, George’s doctor commenced George on Metformin 500mg in the evening with dinner. This has not changed.

The table below is his most recent blood glucose levels. George has highlighted the blood glucose levels that are over his target in red.

The Visit

“Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.” Diabetes Australia

Tools

On arrival in the consultation room George was asked by the receptionist to complete:

* The Diabetes Distress Scale (download here DDS and HERE )

* The Diabetes Knowledge Questionnaire (download here DIABETES KNOWLEDGE QUESTIONNAIRE (old rtf format) )

George felt a little uncomfortable initially using these ‘tools‘ to complete these ‘tests’. However, the diabetes educator saw George acting a little uncomfortable in the waiting room and explained that the purpose of these tools would be to individualise the visit based on the knowledge and needs of George.

George felt more comfortable with this explanation, and managed to complete both before the visit started in person. *He also felt that it might have been good to complete these at home before the visit.*

"Enjoying a good quality of life is my goal" George — **“Enjoying a good quality of life is my goal” George**

“How did you feel about completing those tools George?” the diabetes educator asked as they sat down to start the session.

” At first it was a little like being in school; but when you saw I was puzzled about them, and explained how we could use them in this session, I felt like I was going to be listened to, not just spoken at and told what I should and shouldn’t do” replied George.

The diabetes educator then used these with George to open and lead the session. George was also a little surprised at this, expecting the diabetes educator to be focussed on his blood glucose levels.

The diabetes educator started with the knowledge questionnaire, only asking George about the question he had gotten incorrect. By the end of the first 20minutes George was feeling that he was learning new things despite al of the reading and research he had been doing on the internet.

George hadn’t even considered the importance of foot-care, despite being aware that diabetes can effect the nerves and the blood supply to parts of the body.

Diabetes Distress

Diabetes may lead to specific problems and increased stress, which we often call “diabetes distress”.

Daily life and general stress levels can affect your diabetes control. How well your diabetes is going can in turn affect your general stress levels – so it is a bit of a chicken and egg. It is very important to get the general stress in your life under control, as this will assist with your diabetes management. Likewise, feeling settled with your diabetes management will decrease your overall stress.

If you are struggling with stress at work, or in your personal life, it can be harder to manage diabetes and it suffers. We all experience stress and life would be boring without some stress! People say they would rather not have stress in their lives, but in fact we need a balance between just enough stress and not too much, to keep us alive and active. Not all stress is bad believe it or not.

Some of the things that can lead to diabetes distress are:

Worry about food changes
Management of blood glucose levels
Weight management
Going onto insulin/medication
Hypos (low BGL)
Depression & mood swings – have been shown to be higher in people with diabetes
Relationship & sexual problems
Work stress, discrimination in relation to your diabetes
Disclosure – wondering if you should tell people about your diabetes
Lack of understanding or support from family/friends
Guilt, fear, worry, panic & anxiety about diabetes and your future
Risk of Complications
Feeling alone and isolated
Seeing or hearing about all the things that can go wrong
Feeling out of control
Other mental health problems such as an eating disorder
Feeling overwhelmed and exhausted
Lack of information

Blood Glucose Levels

Towards the end of the session the diabetes educator and George decided to take a careful look at the blood glucose levels that George had been measuring.

The diabetes educator asked “George, why do you test your blood glucose level?”

George was a little taken aback by this question. He thought that everybody just had to, that it was a part of having diabetes.

After a moment he said: ” To determine if my diabetes self care plan is working well, or if there needs to be some changes to my meal planning, or my exercise, or to my diabetes medication.”

George identified clearly the things that would impact on his blood glucose level, and also identified that weekdays at lunchtimes when he didn’t move very much was a problem for him.

Future Planning

The plan at the end of the session was to make an appointment with an exercise physiologist and a podiatrist, and then return to the diabetes educator in 6 months (unless he felt the need to return sooner).

George also had a plan to talk with his manager to have 60 minutes for lunch and go for a 20 minute walk each working day after he had eaten. This meant that he would have to work back an extra 30 minutes. But he also felt it was well worth it if it meant having a better quality of life, and potentially a longer working life (by minimising the risks to his health caused by high blood glucose levels).

George felt that he had achieved quite a lot in his first few months of living with diabetes, but was also aware that this was only the beginning of a lifelong journey.

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D-thoughts on bread

February 9, 2015 by Sally 5 Comments

Bread has become a staple food in our modern diet but can be problematic for those of us with diabetes, especially if it has a high glycemic index, we eat too much of it, or it contains too much of nutrients such as sodium and saturated fat which can affect our heart health and longer term insulin resistance. Today’s blog aims to help to you make better choices by understanding where it fits in the Australian Dietary Guidelines and find a bread that you can enjoy while maximising your glycemic control.

And for those of us who avoid wheat/rye bread due to the gluten content (coeliac disease, wheat intolerance or a FODMAP intolerance) we can take a look at some of those options too.

Probably a good place to start is a look at where bread fits in the Australian Dietary Guidelines, then we’ll go on to a reminder on label reading, which will lead in nicely to a look at some of the better bread choices on the market for people with diabetes based on a comparison table put together by student dietitian Stacey Beech for Dietitian Connection.

Australian Dietary Guidelines

Of course bread fits into the grains and cereals food group in the Australian Dietary Guidelines, and we encourage breads that are full of whole grains which provide extra nutrients and fibre in the bread you’re choosing. This is beneficial for your general health, as well as your diabetes health. And the more whole grains there are, the lower the glycemic index will be to help you avoid those spikes which can be associated with breads for some people.

Click on the image if you need it to be larger

You can read more about grains in this blog on grains prepared earlier for Diabetes Counselling Online. And the recent blog on snacks highlights that a piece of grainy bread can work well as a snack (with a topping) if you haven’t used your suggested serves for the day.

Label reading on bread packs

It’s important not just to think about the amount of carbohydrate in the bread you’re choosing, because often if the carb is low they’ve had to manipulate fat and sodium to make up for it.

As with most products we should be aiming for lower total fat (breads are usually quite low at around 2-6g/100g), lower saturated fat (well under 2g/100g) and lower sodium (less than 400mg/100g). Fibre should be as high as possible, and protein can be higher too (to contribute to lowering the GI).

We discussed this comparison a while ago in the Diabetes and Food – let’s celebrate it! closed Facebook group and the main point made was that although the Helgas low carb seeded loaf is indeed lower in carb with 27.7g/100g compared with 44.5g/100g in the ‘usual’ one, there’s over 10% more energy (kilojoules) meaning it won’t help with weight management because the fat is 10.9g/100g in the low carb version, compared with 2.8 in the grainy one. If you’re not trying to lose weight then it’ll be fine, but it’s worth bearing this in mind as we know that extra body weight contributes to poorer glycemic control.

It’s also worth checking comparison tables (summary of one below) as I noticed there’s a bread called ‘Well Being Lower Carb Bread’ that actually has the same level of carbs as many of the wholegrain varieties – just a reminder to not always believe what it says on the pack!

Helgas low carb 5 seeds bread NIP — Helga’s low carb 5 seeds bread NIP

Helgas mixed grain bread NIP — Helga’s mixed grain bread NIP

Good bread options from the Dietitian Connection bread comparison table by Stacey Beech

This is a mini-table with content taken from Stacey’s more comprehensive table, to show you some of the better bread choices on the market. All values are per 100g.

By no means am I suggesting these are the best breads, but by showing you this comparison I hope to help you to recognise which breads will be better choices for you. I’ve only chosen the ‘mainline’ brands to compare. And I’ve only covered wheat breads here, where rye breads are also a good option.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Burgen Wholegrain & Oats Bread	964	10.7	9.1	0.6	31.9	6.4	280
Helga’s Traditional Wholemeal Grain Bread	1010	9.9	4.0	<1.0	38.0	7.3	400
Coles Smart Buy Multigrain Sandwich	990	8.8	2.4	0.4	47.0	4.3	400
Well Being Lower Carb Bread	952	10.4	2.1	0.6	36.8	8.8	349
Tip Top 9 Grain Wholemeal	1040	12.4	6.4	0.7	30.6	8.7	370

And here are some of the gluten free comparisons if you have an interest here.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Helga’s Sunflower and Red Quinoa GF Bread	1100	6.3	8.0	<1.0	40.1	4.2	400
Coles GF Chia & Seed Bread	1130	7.3	7.5	1.5	41.2	3.7	280
Country Life Gluten & Dairy Free Lower GI	1030	6.0	7.2	<1.0	37.2	4.2	400
Pure Bred Multigrain Farmhouse (added Iron)	717	5.1	2.3	0.3	32.6	9.7	534
Burgen GF Sunflower and Chia Bread	1190	7.0	9.7	1.4	39.7	4.2	400

I included a variety of breads here for you consider what type of bread will suit your personal needs, but of course you should consider how you personally enjoy the taste of the bread you’ve chosen. Trying a few different varieties is often a good idea in that respect to find what works for you, for taste, glycemic control and long term health.

Sourdough and Wraps

These types of breads can be beneficial for people with diabetes, especially for those who really don’t like the grainer options.

With sourdough it’s important to check that it is ‘real’ sourdough as the term ‘sourdough’ is often misused as a marketing word on some breads. If it’s real sourdough, then the glycemic index should be lower (due to the fermentation process involved).

Wraps

There are a few good wraps around, although there aren’t many actually listed in the Low GI Shoppers Guide 2014 with a low-GI. The only one I could spot was the Diego’s low-carb wraps which have 11.g carb per serve. But I’d be checking the fat and sodium levels on that label before buying them…

One of our often discussed favourites in the Diabetes and Food – Let’s celebrate it! Facebook group is the Goodness SuperFoods Barley Max wrap which does tick all the boxes, so is a great one to try if you haven’t already.

I don’t want bread!

Of course no-one is suggesting that we *have to* eat bread. Many people I know choose to avoid it for various reasons, and that’s what suits you, then it’s easy to meet your grain serve guidelines in other foods.

It’s also worth mentioning that everyone is different as to how different carbs affect your BGLs, so a little self-experimenting with testing your BGLs before and 2 hours after meals can go a long way with various foods so you can have a better feel as to how those foods effect you personally.

I hope you’ve found this blog on bread helpful in making your choices best for your diabetes and general wellbeing. 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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D-thoughts on snacking

January 26, 2015 by Sally Leave a Comment

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…

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.

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.

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.

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

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