blog Archives - Diabetes Counselling Online

While we’re busy making other plans..

August 7, 2014 by helwild 2 Comments

A diagnosis of diabetes brings the ‘C’ word into everyday life: Control. We get bombarded with information, instructions, advice. We’re told to ‘test’, given pieces of paper to go to a clinic or hospital for a variety of even more ‘tests’. We’re monitored, measured, & judged. For some people, this becomes more important than anything else. They become hyper vigilant, testing, checking, measuring, exercising, dieting. Almost everyone diagnosed with diabetes begins their journey like this; driven by fear, anxiety, guilt, the notion of ‘control’ becomes all consuming. For some, this is relatively short lived, and things become all too hard. Those who ‘drop the ball’ early give up, bury their head in the sand, ignore advice, feel hopeless, helpless. Their diabetes remains ‘uncontrolled’. For others, the steady mantra of ‘control’ rules their lives. No matter what they achieve, no matter how ‘good’ their diabetic ‘control’ is, they strive to be ‘better’, to be ‘perfect’. To all intents and purposes, and according to most measures, their diabetes is ‘controlled’. Yet they still feel unsuccessful.

How do we find balance?

Ive been thinking a lot about this lately. Those who have a child diagnosed with diabetes come to this with a rather different perspective. For us, the worry, anxiety, need to achieve control are driven by the primal urge to protect our child. It can be harder for us to let go of the notion of ‘control’ than for the child themselves. After all, our main role in life is to care for our child, to make life the easiest, the best, it can be. We will access the best technology and resources available to us, whether thats a new insulin, a new way of measuring, a new test, an app, a new alarm or monitor, a hypo dog. It can be hard to relinquish that ‘control’ to our child. At what age do we ‘allow’ them to make their own decisions about management? For many of us, the decision is taken out of our hands. Our child will refuse to allow us to administer insulin, conduct tests, record results. They may lie to us, and we have the moral dilemma of respecting their autonomy, their right to privacy, and reconciling that with our parental role to manage their health. In some families, difficult topics are discussed. In others, they are not spoken of, they are ignored. Either way, the hard subjects, sex, death, religion, war, family secrets, unfairness, prejudice, injustice, and overnight hypos, all exist. Our children will learn about them. We do have the right to choose whether or not to speak of them.

We tend to judge ourselves very harshly around these changes in our ‘control’. Yet in the end, the vast majority of children with diabetes grow up to manage their diabetes well, to live good, productive lives, to participate fully in other aspects of life, work, socially, and also often with a strong social conscience, a sense of advocacy and participation in supporting others with diabetes. Through struggle & difficulty many are very compassionate human beings, people to be proud of. In managing our own diabetes, although some Health Care professionals may seem, or indeed be, somewhat judgemental, in the end we are all doing the best we can at the time. There may be ‘scope for improvement’, but judging and blaming have no part in our Mental Health, nor in our Physical Health. We need to find our motivation in self love and in our sense of our own worth. We deserve kindness, and the best we can do.

I think one of the key notions that helps to make this journey survivable is to accept that it is just that- a journey. We travel our road in life, and sure, for everyone, some more than others, there are rough patches, difficulties. The destination is known, we don’t know when, but we do know that ‘all things must pass’. Looking around us while were on that journey is what makes the difference. Taking that holiday in Japan, even though we can’t get an Insurance company to fully insure our insulin pump; walking to the shops in the sunshine, or the rain; playing with our child because it’s fun, not because the exercise will be good for his blood glucose control; taking time out from achieving, controlling, managing, to just simply be. This week I went back to my Yoga class. It’s been 5 years since I saw my teacher, Balbir. In that 5 years she has grown old, but she still has the mesmerising power to transport me during relaxation time to a place of calm and serenity; and the ability to lead me through physical practice which stretches and awakens my body to Life. Taking time to focus on the breath, on Balance, Serenity, and the practice of Mindfulness. Most of all, on Resilience. Building resilience in ourselves, and importantly in our children, helps us and them to live life fully: to achieve a level of mental health that will see our journey through life as a balanced one, a life to feel gratitude for, not a life of self doubt. Yesterday I saw an almond tree in full blossom. It was growing alongside a busy highway. Clearly it had stood there for decades before the road came along, before the construction that rose around it. Yet there it was, in full blossom, old, huge, bursting with optimism and life.

Life is what happens to you while you’re busy making other plans- remember to Notice your Life.

Its a Long Way to go, A Hard Row to Hoe

Helen Wilde

Helen has been the parent of someone with Type 1 diabetes since 1979. She has lived with the diagnosis of Type 2 diabetes herself since 2001. She is a Senior Counsellor with Diabetes Counselling Online. If you are struggling with Control or any aspect of your diabetes you may like to contact our team at

http://www.diabetescounselling.com.au/counselling-request/

carpe diem

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Life..’More than #diabetes’ Ups & Downs

July 28, 2014 by helwild 7 Comments

How much does diabetes dominate your life? It is a health condition which, because it is related to food and exercise, can seem like the most difficult health condition you could possibly have, doesn’t it? And because the symptoms are not always obvious or noticeable, it can seem that if you ignore it, it will just go away, or not be true.That you will ‘get away with it’, if you ignore it, or make a ‘token effort’. Even people with type 1 diabetes can at times feel that they can ‘stretch’ the ‘rules’, not take their insulin, or use insulin to allow themselves to ‘indulge’ in ‘favourite’ foods; or ‘allow’ themselves to ‘run high’ to avoid hypos. The insulin pump combined with the modern blood glucose meters, cgm’s, allows such fine control, approximates more closely than anything else the action of the pancreas in releasing insulin; yet in its very existence such biotechnology is a constant reminder of life with diabetes.

As the parent of a child diagnosed with type 1 diabetes, there were times when it seemed there would never be anything else that mattered in life, other than diabetes. When my daughter grew up & left our home in a tiny rural town to go to the City to study at University, things in some ways got easier; but in other ways, things got harder. I was a young Mum, and I was only 32 years old when my beautiful healthy girl was diagnosed. I was 37 when she left home. It was hard knowing she was 250 km away, and relying on others, who were not me, as her ‘backup’ person. Every night that we slept under the same roof, I got up to sit with her through her hypos. The click of a light switch, or the click of the toaster, would wake me. This continued through her teen years; her pregnancies; her own years mothering babies; travelling with her for Diabetes related professional reasons as colleague, & as her ‘back up person’ for her diabetes management, on trips overseas & interstate ; and on family holidays. Even now, if we are sleeping under the same roof, if I’m sleeping within hearing distance, something wakes me, and I can’t lie in bed knowing she’s out of bed & feeling bad.

I do have other things in my life: work, sport, friends, family: causes to do with the environment and the earth. I have grown tree seedlings for Trees for Life, collected for the Heart foundation, travelled. I’ve volunteered at Film Festivals, Arts Festivals, tutored at the U3A. But beating away like another heartbeat is my daughter’s diabetes. I work and volunteer in Diabetes. I practice Mindfulness. Being her parent will always be a part of who I am. Of course, it is much, much more intense for her. Every minute of every day and night, no respite. I do get to take breaks, she doesn’t.

My life changed 15 years ago. My husband retired, and I got a job in the city, so we moved house. Over the past 15 years, my life has expanded to include assisting my mother in dealing with changes that came about in her life, first with my father’s diagnosis of dementia. In the beginning, I was working in a highly responsible & challenging job. My help was as practical as I could manage, also fitting in supporting both my daughters with pregnancies & babies, toddlers & growing children. With my father’s death, assisting Mum meant helping her manage her own health & living arrangements, & eventually her own dementia.

That time also came to include my own diagnosis of diabetes. Because of my daughter’s diabetes, I came to the diagnosis with a shorter period of ‘denial’ than some experience; and with very little anger. I do feel some negative emotions, of course; but I know that it’s possible to live a good life with diabetes. My fear of diabetes related complications is much less than my fear of dementia.

I hadn’t meant to write about difficult experiences in my life, but yes: they are also part of life, and many of them have nothing to do with diabetes. The past 15 years have included weddings, births, joys: wonderful family Christmases, when Mum played ‘Mother Christmas’ to our large family: visits from overseas relatives, contact through Social media with relatives, friends, strangers. Yes food is pleasure, but there are other pleasures. Exercise is pleasure. Doing things for others is pleasure. Growing things, writing, taking photos, playing with children, doing good work, talking with friends from all over the world, these are all pleasurable.

Life is Good. Life is a river, it flows. Life is truly a journey, with opportunities for rich experiences that include the difficult ones, and the easy ones: spontaneous ones and planned ones. Seize the moment, take opportunities when they arise. Life is more than diabetes: it includes things that are harder, and worse: and things that are easier, & better..Life is for the Living.

Helen Wilde

carpe diem

Helen is a Senior Counsellor with Diabetes Counselling Online. She is also the parent of someone diagnosed with diabetes in 1979. She has lived with type 2 diabetes herself since 2002.

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Blog 2 on Fats – which are the best types for us to enjoy?

July 21, 2014 by Sally 4 Comments

In today’s blog we’ll focus on which fats we should include in our diets, why this is so, and how much we should be having. Last week in the introduction to fats and d-health blog we talked about how it’s important for us, especially as people with or at risk of diabetes, to understand about the different types of fats, or fatty acids, and choosing the right fats in the right amounts can benefit our wellbeing in many ways. We explored what the different types of fats are and where they’re found, as well as how much the Australian Dietary Guidelines recommends for people with diabetes.

I need to keep this explanation relatively simple as fats and their pathways is actually quite a complex topic that, even with indepth study is tricky to explain in a short blog. I recommend that if you would like more detailed information that you go see your Accredited Practising Dietitian for personalised advice and further explanation. I also encourage you to remember that the Australian Dietary Guidelines Foundation Diet provides an excellent balance of nutrients for our wellbeing so is an excellent point of reference to know what we should be consuming for our wellbeing.

Off we go! The Mediterranean diet is currently being discussed as a very healthy way of eating, and research continues to back this up. If we just look at the fat types within that diet you’ll see a focus on monounsaturated fatty acids (being the predominant fatty acids in olive oil, canola oil, avocado and nuts) and the long chain omega-3 polyunsaturated acids (as found in deep sea fish and some plants). The research in this area is ongoing but at this stage it mostly indicates that diets higher in these types of fats help with weight maintenance as well as improving the quality of blood fats and longer term studies also showing reduced all cause mortality including cardiovascular disease.

There is also emerging evidence that demonstrates the importance of the ratio of saturated fats to anti-inflammatory fats that, being out of balance, is potentially a big cause for our Australian population’s high risk of cardiovascular disease.

Why is this important?

Recently released data through Australia’s Health 2014 that looks at the whole population and indicated that cardiovascular disease costs $7.7 billion or 10% of total expenditure and was also the leading cause of death. We also know that people with diabetes are 3 to 4 times more likely to develop cardiovascular disease (including heart attack and stroke) than those who do not have diabetes. In addition, around 75% of all people with diabetes die from cardiovascular disease, including heart attack and stroke, and people with diabetes are up to six times more likely to suffer from atherosclerosis than people without diabetes.

The National Diabetes Services Scheme website also reminds us that “People with type 2 diabetes often have ‘abnormal’ levels of blood fats (cholesterol and triglycerides). Not only are the blood fat levels different to those of a person without diabetes, the cholesterol also tends to ‘behave’ differently.” All the more reason to heed the advice provided by the Australian Heart Foundation and backed up by the Dietitians Association of Australia to avoid those saturated and trans fats.

Although I have type 1 diabetes, I’m not willing to take chances of developing heart conditions (as the rest of our healthy population should consider too) so choose foods higher in monounsaturated fats and omega 3 polyunsaturated fats whenever I can, along with the low-GI carbs which are also known to help reduce blood fats compared with high-GI carbs.

Why those particular fats?

When we look at the reason (without going into miniscule detail) that we’re advised to choose monounsaturated and omega-3 polyunsaturated fats wherever possible, it is because monounsaturated fats are shown to follow non-inflammatory pathways and omega-3s (particular from deep-sea fish) promote anti-inflammatory reactions in our bodies. Compare that with saturated fats which are recognised as being pro-inflammatory (they cause inflammation, which causes detriment to our health in several ways).

There is also some evidence that the other main type of polyunsaturated fats, omega-6s, may be seen to take the inflammatory route and compete with the omega-3s. The jury is still out on this, and the potential inflammatory effect of omega 6 can be seen as merely an “interesting theory” at this stage. Accredited Practising Dietitian Sonia Navidi recently wrote about this issue in her blog (Nourish Me Simply), and it seems at this point in time to be a sensible view towards omega-6 fatty acids. Sonia writes:

“Interesting theory, but does it play out?

Actually, no, at least as far as the latest evidence is concerned. A Science Advisory from the American Heart Association, published in the prestigious journal Circulation in 2009, gives an excellent review of the evidence. They note that while Omega-6 acts as a precursor to compounds that promote inflammation in the body, it actually also acts as a precursor to compounds that are either anti-inflammatory, or help our arteries in other ways. They note that, while the theory of Omega-6 being pro-inflammatory has been around for a while, there is no solid evidence to support it.

They also state that:

“On the basis of the intakes of omega-6 [polyunsaturated fatty acids] used in the randomized trials, metabolic studies, and nonhuman primate studies discussed below, reductions in [coronary heart disease] risk might be expected with omega-6 [polyunsaturated fatty acid] intakes of 10% to 21% of energy compared with lower intakes, with no clinical evidence for adverse events.”

* Brackets inserted where the original source gave an acronym.”

So at this point in time the main fats to avoid are saturated and trans fats found in animal products as well as palm and coconut fats. Also, trying to ensure that we have plenty of omega 3s and monounsaturated fats in our diets.

If you’re interested in reading more about coconut oil being in this ‘avoidance’ group when it seems to be claimed as healthy by some on the internet, please read this explanation by the Dietitians Association of Australia.

How do I get more healthy fats in my life?

The Australian Heart Foundation has this very handy Omega-3 meal planner to help you reach the recommended 500mg/day for the general population. People with diabetes need more than this, but you should seek individualised advice from your health professionals/Accredited Practising Dietitians to know what’s right for you.

Let’s finish up today’s blog with some recipes containing healthy fats, remembering that the quality of the carbohydrate is also important.

Atlantic salmon has the highest amount of naturally occurring omega 3s of our Australian fish. This Salmon and White Bean Mash recipe will give you the omega 3s along with the nutritious and low-GI carbs of the white beans, and only 2 carb exchanges per serve.

As a vegetarian option how about these Cashew and Brazil Nut Burgers? You can read more about nuts in my blog, but generally speaking nuts are high in monounsaturated fats. You could swap the cous cous for quinoa to make it gluten free if you need to, and of course hummous is made on olive oil – also high in monounsaturated. This one has 2.5 carb exchanges per serve of nutritious low-GI carbs.

This Avocado and Four Bean pasta recipe looks and sounds delicious with only 1.5 carbohydrate exchanges per serve. The monounsaturated fats in the avocado will help to ensure a low glycemic index and will keep your hunger satisfied for longer too.

And there are lots more where these came from. To find these ones I went to some of my favourite recipe sites including Taste.com.au, Nuts for Life and Australian Healthy Food Guide and searched terms such as ‘salmon’, ‘healthy fats’, olive oil and then looked for ones with the qualities of good fats and low-GI nutritious carbs that are so important to us with diabetes.

In Summary

The take-home message is that we should be choosing more monounsaturated fats (good sources include olive and canola oil, avocadoes and nuts) and omega-3 polyunsaturated fats (good sources include deep sea fish, walnuts, linseeds and soy products), while reducing our intake of saturated fats (from animal based products, coconut and palm oil) and trans fats (found in many processed foods).

Please share any questions you have about this blog, let me know if there’s anything else you’d like to know about fats, and of course we’d love you to share your favourite recipes that you enjoy for good health.

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.

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A fat introduction – blog 1 of a series on fats and diabetes

July 14, 2014 by Sally 2 Comments

I thought it was about time for another blog mini-series and fat is a topic that we see written about a lot so it’s easy to be misled when you’re provided with information that may be influenced by sales and marketing, and ‘fat’ is a huge topic to cover. The benefit of having such topics explained by an Accredited Practising Dietitian is that we’re not trying to sell you anything – just wanting to help you to make the best decisions for your d-health and we base our advice on the best available evidence through scientific research which is constantly being reviewed and updated where appropriate.

As an introduction I’ll remind you that fats are an important part of our diets, as are carbohydrates and proteins (these 3 being the major macronutrients that produce energy) and every cell in our body needs quality fats to protect it, help it communicate with other cells and to allow important biological processes to occur in our bodies. It’s important for us, especially as people with or at risk of diabetes, to understand about the different types of fats, or fatty acids, and choosing the right fats in the right amounts can benefit our wellbeing in many ways. In this blog I’ll explain what the different types of fats are and where they’re found, as well as how much the Australian Dietary Guidelines recommends for people with diabetes.

From a healthy weight perspective, the Australian Dietary Guidelines reminds us that, “When eaten in large amounts, all fats, including healthy fats, can contribute to weight gain. Fat is higher in energy (kilojoules) than any other nutrient and so eating less fat overall is likely to help with weight loss.” So again, it’s all about balance!

Something I found enlightening when learning about foods applies particularly with fats, in that they’re not black and white in the varying types, but more like differing shades of grey. To demonstrate my point, nuts are a perfect example. If you refer to page 2 of this tree nut ready reckoner you can see that every nut has a different amount of all the different types of fat within it. I make this point to reinforce that, as with most things in diabetes, it’s about making healthy choices whenever you can but not worrying too much about small amounts of things that we know we’re better without (such as saturated and trans fats).

Which is a perfect segway to talk about Types of Fats

I think the most straightforward explanation of the different types of fats is found on the Dietitian’s Association of Australia website where they explain:

“There are two main types of fats: saturated fats and unsaturated fats.

Saturated fats

Saturated fats are ‘unhealthy’ fats, and eating greater amounts of saturated fat is linked with an increased risk of heart disease and high blood cholesterol levels. These fats are solid at room temperature and are found in:

Animal-based products:

Dairy foods – such as butter, cream, full fat milk and cheese
Meat – such as fatty cuts of beef, pork and lamb, processed meats like salami, and chicken (especially chicken skin)

Some plant-derived products:

Palm oil
Coconut
Coconut milk and cream
Cooking margarine

Saturated fats are also commonly found in many manufactured and packaged foods such as:

Fatty snack foods
Deep fried take away foods
Cakes
Pastries and pies
Biscuits

Unsaturated fats

Unsaturated fats are ‘healthy’ fats and are an important part of a healthy diet. These fats help reduce the risk of heart disease and lower cholesterol levels (among other health benefits) when they replace saturated fats in the diet.

There are two main types of unsaturated fats: polyunsaturated fats and monounsaturated fats.

Polyunsaturated fats:

omega-3 fats which are found in fish
omega-6 fats which are found in some oils such as safflower and soybean oil, along with some nuts, including brazil nuts.

Monounsaturated fats:

found in olive and canola oil, avocados and some nuts, such as cashews and almonds.

Trans fats

Trans fats are unsaturated fats that have been processed and as a result, behave like saturated fats. Consumption of trans fats increase the levels of ‘bad’ cholesterol and decrease the levels of ‘good’ cholesterol in the body which is a major risk factor for heart disease. It is important to lower the amounts of trans fats you eat to help improve your health.

Trans fats are found in many processed foods, also in butter and some margarines. When buying these products check the labels and choose the varieties that are lower in saturated and trans fats and higher in poly and monounsaturated fats.”

In summary, we should aim to have most of our fat intake from mono- and poly-unsaturated fats.

How much should we have?

You may remember from my blog on label reading that on nutrition information panels we should aim for less than 10g/100g total fat, and less than 2g/100g saturated fats. This is because people with diabetes tend to have higher rates of bad cholesterol, and reducing amounts of saturated fats (and poor quality carbohydrates) is one of the most effective ways of reducing that bad cholesterol.

The Australian Dietary Guidelines advises that in addition to the serves outlined for the five food groups, “an allowance for unsaturated spreads and oils for cooking, or nuts and seeds can be included in the following quantities: 28-40g per day for men less than 70 years of age, and 14-20g per day for women and older men.”

That’s probably enough info for this first blog. If you have specific fat-related questions that you’d like answered in the rest of the fat-series, just comment below and I’ll do my best to answer them for you.

Also remember to see your Accredited Practising Dietitian if you think some personalised advice could be useful, or arrange for an e-consultation with our e-dietitian at Diabetes Counselling Online.

Wishing you a great week! Sally

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Fibre is our d-friend

June 16, 2014 by Sally Leave a Comment

I’m sure you’ve all heard about the importance of including good levels of fibre for good digestive health, so I thought it worthwhile to talk through the different types of fibres and how they benefit us as well as what the evidence says about fibre in relation to diabetes and how much we need topped off with some ideas of how you can increase the fibre in your diet for your improved wellbeing. Many of my previous Diabetes Counselling Online blogs have referred to fibre, so I’ll remind you of those along the way and you might like to bookmark them for a re-read.

It’s important to remember from the start that when following a high fibre diet that you drink plenty of fluids (preferably water) and are physically active to help you gain the greatest benefits.

Fibre and Diabetes

Starting with the glycemic index, we should know that including foods higher in fibre will contribute to lowering the glycemic index of the carbohydrates in the meal. You can read more about this topic here and here.

There’s also lots of evidence that you can read about in the Australian Dietary Guidelines about how fibre reduces fat absorption and reduces risk of cardiovascular disease and bowel cancers. All of these are important issues for us with diabetes to consider.

And, of course, if you’re watching your weight, fibre has a lower energy density as it resists digestion so will keep you feeling satisfied for longer too.

Types of Fibre and their roles

Dr Alan Barclay of the Glycemic Index Foundation explains that “dietary fibres come mostly (but not exclusively) from plants and that they are the poorly digested portions that pass through into the large intestine (bowel) and provide much of the bulk in our stools (along with water and bacteria, amongst a few other things).”

There are three main types of dietary fibre: soluble, insoluble and resistant starch. We need a combination of these for good health as they play separate roles.

Soluble fibres attract water and are totally broken down in the large intestine (colon) by good bacteria. They include foods such as whole grains, legumes, psyllium, some fruits, vegetables, nuts and seeds. You can read more here.

Insoluble fibres are the ‘bulking’ fibres that aid regular bowel movements. They are also found in similar foods as the soluble fibres, but wheat bran is also a contributor.

Resistant starch is like fibre in that it is starch that resists digestion in the small intestine and travels through to feed the good bacteria in the colon. Research is indicating how beneficial it is for colon health! It’s found primarily in legumes, pearl barley and brown rice as well as cooked and cooled starches (the process forms a crystalline structure around the starches, causing them to resist digestion) such as potato, pasta and rice. The CSIRO has developed a type of this starch which can be found in some specially formulated breads and cereals (including the BarleyMax range by Goodness Superfoods).

How much do we need?

I usually advise clients to read labels (most labels in Australia include fibre these days) and look for the highest fibre level when you’re comparing products. You can read more about label reading in a previous blog here.

As a guide, breads should be greater than 5g/100g at a minimum.

In total we’re aiming for 28g per day for women and 38g per day for men.

How do we get it?

If you aim to include fibre-rich foods such as wholegrains, legumes, nuts, vegetables and fruit in each of your main meals, and follow the Australian Dietary Guidelines, especially in those 3 food groups, you should easily reach your target. Leaving the edible skins on your fruit and vegetables is also an awesome idea.

I couldn’t do better than share this table from the Grains & Legumes Council website with you to demonstrate how to include more fibre…

(Just click on the picture to enlarge it if it’s too small for you to see clearly)

High fibre recipe ideas

The most basic idea is to modify existing recipes by adding products like legumes and whole grains and nuts and seeds, but here are some high-fibre recipe links that might inspire you to increase your fibre intake.

Cinnamon Chicken with Bean Salad

Apple and Bran Muffins

Mushroom and Lentil Burger

There’s loads more this like this on the Taste.com.au website, as well as my other favourite internet recipe sites including Allrecipes.com.au, the Grains & Legumes Nutrition Council website and the Nuts For Life website.

Some other helpful links for more info on fibre

Dietitians Association of Australia

Grains & Legumes Council

The Better Health Channel, Victoria

Catherine Saxelby’s Foodwatch website

The Australian Healthy Food Guide by dietitian Caitlin Reid

Hoping that’s given you inspiration, understanding and some helpful ideas to include more fibre in you day.

We’d love to hear how you personally get enough in your day, so please share in the comments below.

Wishing you a great day! Sally

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