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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How to stand up to the fear of diabetes

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I was thinking the other day that if someone could just come up with a way to check blood glucose that does not require turning your fingers into blackened stubs, where multiple areas bleed when you squeeze for one blood test, and they could eliminate hypos, I would be ok with having diabetes.

There are many parts of it I dislike, but these are two of my most hated. In fact the hypos thing is probably the biggest fear for me. And that is the bottom line toughest part of life with diabetes when we break it all down isn’t it, the fear.

It is not that you have to eat healthy, be active, get your rest, plenty of sunshine, check your feet, visit more doctors than usual and reduce your stress. These are all good for you. It is not that you have to take medications or have multiple daily injections or lived attached to a machine, even though that is annoying and sometimes frustrating. It is not even the fact you have a chronic disease that can’t be cured. It is the cold hard fear.

It’s waking up in the morning with a high blood glucose level and having to decide whether to eat breakfast or wait, worrying about whether you are going to end up higher and feel like crap, or dive into a hypo from your correction dose of insulin, and feel like crap….It is sitting up late at night when everyone else is in bed, waiting to see if your levels are going to settle as they have been too high or too low. It’s managing the swings and ups and downs, often alone and not knowing when it will stop.

It is going out on a run, to the gym, dancing, drinking, on holidays, hiking, skiing, having sex, even a walk around the block – and not knowing if you might end up low or high. It is the fear of the unknown. And the fear of the known. The fear that gets drilled into you when you get diagnosed and reminded to you every time you look at a national diabetes week, or world diabetes day poster. It’s sleeping, waking, eating, fasting, sitting, standing, lying, existing – with FEAR.

It’s exhaustion. Which makes fear worse.

It’s all those things that can go wrong, break, stop working, fall off or be chopped off. It is blindness and dialysis and horrible feet. It’s not having babies, or having babies and then trying not to breathe the entire time you are pregnant in case it messes up your blood sugar and harms your precious baby.

It’s working hard in your career and your life dreams and not knowing if your diabetes will cause a problem you don’t want your colleagues to find out about. It’s failing exams because your levels were so high you couldn’t think straight. The stress of losing your license when your job is driving trucks. Losing your ability to make love. Losing your partner. Losing your grip.

Yes indeed, diabetes is a whole lot about fear and a whole lot less about the mechanics of it all, a whole lot less about the actual act of caring for your diabetes. People will tell you that you are “non compliant”, not managing well, not getting it. That is bullshit. You are probably scared. You are probably confused. You are probably exhausted.

Fear creeps up on you, takes hold of you, hangs around in dark corners, jumps out at you from under the bed.

Fear is a bitch.

And if someone could only take away that fear for me, I would be pretty ok with having diabetes, it is not the worst thing to have. The truth is, nobody is going to do that for you but YOU. If you are like me, and fear has a grip on your life with diabetes at times, the only way we can stand up to that fear is together, and alone.

We must take time to notice these fears, to pull them out from under the covers. We must take time to shine a light on them, share them – please don’t suffer fear in silence. Learn how to be more mindful, how to manage fears, how to be more centered, more peaceful. You don’t need to learn how to be more brave – people with diabetes are some of the bravest people I have ever had the pleasure of knowing – and trust me over 15 years working in diabetes I have known many thousands.http://www.dreamstime.com/royalty-free-stock-photo-fear-concept-choice-acronym-bravery-life-image44534735

By sharing these fears we reduce them. We feel safer, as there is safety in numbers. Fear will always be part of life with diabetes. It is scary. But we can reduce how much it impacts on our daily lives by setting up networks of support, help when we need it, talking about it and facing it head on. And in those moments when you are scared shitless, just remember we are all here holding your hand. We have your back and you CAN do it.

What do you fear most about life with diabetes – please share and get these things out into the spotlight

Helen

xx

Helen Edwards has lived with type 1 diabetes since 1979. She is Mum to 3 sons, the founder of Diabetes Counselling Online, a diabetes educator, social worker and PhD Candidate studying diabetes distress in pregnancy for women with type 1 diabetes. She is also a successful Interiors Blogger and Stylist at www.recycledinteriors.org and runs creative workshops, an online store and studio in Adelaide – just for a life outside of diabetes.

 

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Christmas kindness and mindfulness

Christmas: season of abundance
Christmas: season of abundance
Christmas: season of abundance

Christmas can be a tricky time for people with diabetes. As the dietitian for Diabetes Counselling Online I’d like to remind you all to be kind to yourself over the Christmas period and remember that diabetes is not a game of perfect – it’s what you do most of the time that makes the difference, especially as we’re doing it for the rest of our lives. In today’s blog I’d like to share some ideas by other dietitians and offer a few tips that will hopefully help you to be mindful of your wellbeing this Christmas/New Year period.

As we all have different types of diabetes, using different or no medications, and with so many variations in our day to day lives, I encourage you to check with your health professional before making any changes to your usual routine. These tips are meant as a guideline, so please use good sense in applying them.

Let’s start with a couple of previous Diabetes Counselling Online blogs I’ve written on food for Christmas.

A fresh look at the Christmas meal reminds us that we can choose to provide foods that although Christmassy, do not need to be laden with fat, salt and sugar.

Colours of Christmas – enjoying the festive foods with no regrets helps us to understand about shopping for Christmas treats, and a whole lot more including these great Christmassy food comparisons that help make your choices more mindful.

Did you know that:

  • A cupful of halved fresh apricots (155g) has only 10g carb (half a serve) and 265kJ/64 calories.
  • A cupful of cherries without seeds (145g) has 15.8g carb (one serve) and 363kJ/87 calories.
  • A cupful of strawberries with no stems (150g) has only 6g carb (possibly not worth counting!) and 162kJ/39 calories.
  • A scoop of low-fat vanilla icecream (50g) has 11.4g of low-GI carb and 258kJ/62 calories.

Compared with:

  • 1 small slice of a Christmas fruit pudding (50g) has 30.4g carb (2 serves) and 785jK/188 calories (plus loads of saturated fat and sodium)
  • 1 small fruit mince pie (40g) has 26.8g carb (2 serves) and 802kJ/192 calories (plus loads of fat and sodium too)

Dietitian Christmas articles

Speaking of being mindful, these next few blogs are written by Accredited Practising Dietitians (APDs) that focus on choices (not diabetes choices, but healthier choices) and there are some great tips in them that I’d like to share with you.

First up, I love these mantras by APD Deb Blakley from this article in The Scoop on Nutrition. Deb reminds us that we should enjoy ourselves at Christmas. Deb says it’s all about good food and good company. Her mantras are very sensible to ensure that we remain kind to ourselves and to others.

The Australian Healthy Food Guide magazine has also shared a few Christmassy articles to help us to maintain our health while we enjoy the Christmas celebrations. This one by APD Caitlin Reid provides 21 tips to stay healthy over the festive season. That’s a lot of tips! Have a read as even if only one or two mean something to you, then you’ll be in a better place.

This one by APD Zoe Wilson is entitled ‘Surviving the Silly Season’. In it Zoe offers 3 quick tips to help you make it through to the New Year without regrets.

And the last of the Australian Healthy Food Guide blogs is by APD Brooke Longfield who talks about managing alcoholic intake which we know adds empty calories as well as disrupting our diabetes management. Brooke has some very helpful ideas here.

Last but not least is a blog by APD Megan McClintock. I have to say this is my favourite one because its focus is on kindness and mindfulness which is something that can be so powerful when we’re managing a chronic health condition such as diabetes. Megan shows us which questions we should be asking ourselves and reminds us that there’s no point feeling guilt or being negative with our thoughts about food. She also provides 6 very practical tips to help.

Wow! That was a BIG read. I hope you found some tips in there that mean something to you and will help you to be kind to yourself and others. In summary it’s about choosing what you have at home and enjoying it mindfully without beating yourself up, and balancing your extra food enjoyment at Christmas with plenty of activity which has benefits of it’s own. Our main focus should be being kind to ourselves and others, enjoying the social aspects of being with family and friends and using any time off to recharge our batteries for a good start to the new year.

Wishing you and your families a wonderfully happy Christmas filled with love and laughter. 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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A fresh look at The Christmas Meal

xmas table

My family celebrated Christmas Day a month early this year because we’ll all be in different parts of the world on 25th December, and we value our annual family get together. I thought it was a good opportunity to remind you how easy it is to provide a delicious and nutritious lunch, especially for us in Australia with the hot weather, that won’t disrupt your usual diabetes routine too much whilst still enjoying your Christmas celebrations. I’ve also included a few of our family recipes for your enjoyment. :)

Ours was held at my brother’s home in Sydney. We had 20 family members expected, including 7 children under the age of 14. Our Christmas foods tradition follows a Red, White and Green theme to look Christmassy. My Mum is the organiser and she delegates one dish to each of the family groups, so not all the preparation and cooking is left to one person (although you’ll notice that she does more than her own fair share!). Sharing that load really does minimise the stress often associated with these large family gatherings.

Xmas 2014 table decorations

The basic idea is to include more plant-based foods, and provide a treat or two that you save for these such special occasions.

We arrived to bowls of pistachio nuts – perfect as each nut must be opened first, thereby minimising overeating potential – and olives. Perfect with a glass of bubbly to get us all in the mood for our Christmas feast ahead! :)

First course are the cold green and red soups.

I made the green zucchini soup which is so easy (6 zucchini, 1 onion lightly sautéed. Add 1 litre chicken stock, one chopped potato and some fresh dried tarragon with salt and pepper to taste. Simmer for 15 mins or until potato is cooked through. Allow to cool. Blend and refrigerate).

zucchini soup cooking

One of my Sister-in-laws made the red tomato gazpacho which is just pureed tomatoes with an onion/ lemon juice flavour added, plus diced cucumber and ham (from the main event).

Both these soups are very popular across the whole family. The children tend to love the zucchini soup the best. I like to indulge in a small bowl of both so I can enjoy both yummy flavours.

Buffet in the kitchen.

Our centre piece is a whole ham that my Mum makes a glaze for and bakes. It’s served at room temperature as there usually no room in the fridge, and that’s where the salt comes into its own as a preservative until there’s room to get it into the refrigerator.

whole glazed ham

Of course, the ham in your meal could be replaced with any protein source that you and your family enjoy including the traditional favourites of turkey and seafood.

Traditionally we’ve had cold baby potatoes tossed in fresh herbs and olive oil for our carb salad (excellent for resistant starch and glycemic management), however this year Mum found a recipe for a quinoa and cannellini bean salad that was also full of fresh herbs. It was very delicious, but also more work than the potatoes.

Quinoa and canellini bean salad

Then the non-starchy salads – we have a tomato salad, a green avocado salad and asparagus with parmesan, so there are plenty of plant foods to fill up on.

avocado green saladasparagus and parmesan

tomato christmas salad

This year Mum found an unusual tomato recipe that had pomegranate seeds and lots of fresh herbs. Again it was very delicious but I think she underestimated how long it would take to dice up all those coloured tomatoes. It was flavoured with lots of chopped garlic, fresh herbs and olive oil. Usually we do sliced beefsteak tomatoes with mozzarella cheese and fresh basil leaves on top, drizzled with extra virgin olive oil. I don’t think you can beat that one for simplicity and flavour!

Desserts

We don’t really enjoy the richness of the traditional Christmas desserts in our family. This year another of my Sister-in-laws and one of my Aunts were asked to bring a dessert with no guidelines so we ended up with a pavlova topped with lovely fresh fruit, and a light lemon ricotta cheesecake that my Sister-in-Law found on a blog called ‘Marley & Lockyer’ with you as it’s so easy and suitable for us with diabetes.

Source: Marley & Lockyer blog
Source: Marley & Lockyer blog

We served ours with low-fat icecream, but you could also use low-fat Greek yogurt rather than cream.

For those of you who really enjoy the Christmas puddings and mince pies, the December 2014 issue of Australian Healthy Food Guide magazine included a feature called ’10 of the best Christmas treats – enjoy your favourite sweets for fewer kJs!’ which I encourage you to read. In there they rate the ‘Best Mince Pie’ as a bite-size Woolworths Free From Gluten Fruit Mince Bit as a ‘real taste of Christmas’ for only 522kJ (125cal).

Reminders

I hope you found some healthy inspirations here for your Christmas main meal. I’d remind you to have a read of the blog I wrote for Diabetes Counselling Online entitled ‘Five tips for managing diabetes at events where food choices are likely to be poor’ and remember these tips when you’re at your own Christmas food celebration.

Healthy Eating Plate

I’d also encourage others of you to share your own healthy and special favourite Christmas dishes in the comments below please!

Wishing you all compliments of the season with a reminder about enjoying everything in moderation, except the love and goodwill that we can all enjoy in excess across the Christmas season. 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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Those cloudy days with diabetes

to the clouds

Yesterday it rained.

It’s the time of the year where we should be stripping off, not layering on, but every rule has it’s exception. It’s the middle of November and it’s raining.

It reminds me of having diabetes, you get a streak of good BGL (Blood Glucose Level) readings then BAM out of nowhere and for no good reason a storm hits, sometimes it’s just a light drizzle in the morning or a few clouds in the afternoon yet others, as they say ‘when it rains, it pours’ and those sunny days seem long gone.

At least with the weather, it’s forecasted. There’s no such luck with having Diabetes, you can do everything right, administer the right amount of insulin that you worked out by doing the BGL:Carbohydrate ratio and still have a gust of wind blow you off track.

As much as Diabetes is about science, without being hooked up to a machine 24/7 there is no formula that can work every time – it’s forever changes and like science there are unaccounted factors that come in to play, except instead of being in a lab hovering over a microscope you’re at school, or your day job and have to juggle everything all at once.

Sometimes it feels like I’m working two jobs.

However you do get the opposite happen, and lately my days have been a bit cloudy – it’s the typical no matter how hard you try, everything and anything that can go wrong – will go wrong, good old Murphy and his laws!

At the moment, the sun is shining for me (not at the moment – I’m watching the rain drizzle down my window) but I’m having one of those lucky days, where my diabetes is cooperating with me.

Not many people understand the ongoing frustration of juggling everything to get your levels right – only those who share the pain (literally) of injection after injection and test after test. So when those sunny days come – embrace them. And when those rainy days come – dance in the rain because you are doing as much as you can do – before you know it a sunny day is just around the corner (well it’s stuck behind a cloud).

No matter what the weather, stand tall and we can get through this together!

Until next time
Georgia

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