November is American Diabetes Month... And the start of the holiday season for many of us!

According to the American Diabetes Association:

• Nearly 30 million children and adults in the United States have diabetes.
• Another 86 million Americans have pre-diabetes and are at risk for developing type 2 diabetes.
• The total national cost of diagnosed diabetes in the United States is $245 billion.

For more info visit: http://www.diabetes.org

Don't forget we at VMG are here for diabetes education, nutrition, and medical services through the holiday season! Please let us know how we can help.

In the meantime, holiday meals and treats don't have to get you off track if you plan ahead. If it's important to you to savor a special holiday dessert this season, try these strategies for fitting it into your plan:

Here are some "Sweet Tips" for the holidays:

• Choose what special treat to eat ahead of time, and stick to your plan 
• Choose a small serving size 
• Decrease the other carbohydrates in your meal to keep your total within goal 
• Try replacing up to half the sugar with a sugar substitute when baking 
• Or, try cutting down on sugar and increasing cinnamon, nutmeg, or vanilla instead 
• For sweet cravings at home, try frozen grapes or baked apples 
• Savor your serving slowly, and then send the leftovers home with someone else! 

Do you have other strategies that help you enjoy the holidays in moderation? Please share in the comments section below!

New FREE Support Group! (Plus Halloween Carb Counting)

The Diabetes Team at Valley Medical Group is excited to announce a new FREE Diabetes Support Group in our Northampton (Florence) office. 

The group will meet on the 2nd Wednesday of every month starting November 11th, from 5:30 -7 pm. 

The group is open to anyone - no need to sign up.

 Our first support group will feature a food demonstration to prepare you for the holidays!!

 We are looking forward to offering support and connections with you, your family and our community. If you have any questions or concerns you are welcome to contact Bonnie Grenier at 413-262-2838 or bgrenier@vmgma.com

And to get you started thinking about your strategy for navigating the holiday season, let's start with Halloween! Here are the nutrition facts for some of the most popular Halloween candies you might encounter this week, thanks to Diabetes Forecast Magazine: 

Candy	Calories	Fat (g)	Carbs (g)
Snickers, fun size	80	4	10.5
Snickers, mini	43	1.6	4.4
3 Musketeers, fun size	63	2	11
3 Musketeers, mini	24	0.7	5
Skittles Original, fun size mini	60	0.5	14
Butterfinger, fun size	100	4	15
Butterfinger, mini	45	2	7.25
Candy Corn, 1 oz.	100	0	25.6
Milky Way, fun size	80	3	12
Milky Way, mini	38	1.6	6
Almond Joy, snack size	80	4.5	10
Almond Joy, mini	67	3.6	8
Hershey's Kiss, 3 pieces	67	4	8.3
Kit Kat, snack size	70	3.6	9
Kit Kat, mini	18	2	5.6
Reese's Peanut Butter Pumpkin	170	10	18
Twix, fun size	80	4	10
Twix, mini	50	2.6	6.6
Peanut M&M's, fun size	90	5	10.5
M&M's, fun size	73	3.3	10.6
York Peppermint Patty	140	2.5	31
York Peppermint Patty, mini	50	1	11
Tootsie Roll	23	0	4.6
Charms Blow Po	60	0	17
Jolly Rancher	23	0	5.6
Smarties roll	25	0	6

Nutrition information is shown per piece of candy or per bag for appropriate items (such as M&M's).

Source: http://www.diabetesforecast.org/2010/oct/carb-counts-for-halloween-candy.html

Good News for Fidgeters

By now, I'm guessing you've heard about the health effects of sitting. Those of us logging hours in front of computers, TV's, and sitting in cars on long commutes have an increased risk of:

• heart disease
• diabetes
• cancer
• anxiety
• death (!)

Sitting has been said to increase your risk of heart disease just as much as smoking! And in the research I've seen, this is even if you exercise for an hour at the gym before you go home.

But I have some encouraging news for you: it seems that even small efforts to move more can make a big difference.

For example, as this article explains, there is research to show that some of these health risks are lower in people who fidget.

And this one shows that even a two minute walk each hour can offset these drawbacks.

Encouraging, right? You don't need to start running races to undo all that time in your chair. Here are some more suggestions to stay moving throughout the day:

• If you have a laptop or other portable device, put a shelf or a small table on top of your desk so you have the option to alternate sitting and standing throughout the day
• Walk down the hall to speak to a coworker, rather than sending an email
• Get up to refill your water bottle (two goals in one!)
• Go the long way around to the copier or to the bathroom - bonus points if you can go up one set of stairs and down another on your way
• When tidying up the house, make a trip up or down the stairs for each item you put away
• Stand up, walk in place, or do simple stretches during each commercial break
• Pace or walk in place while on the phone, brushing your teeth, or waiting for the microwave

What other suggestions do you have for fitting a little bit more movement into your day? Let us know in the comments section below!

VMG is now on Social Media!

Did you know VMG is now on social media?

You can now find (and "like"!) Valley Medical Group at:

Facebook - https://www.facebook.com/valleymedgroup

Twitter- https://twitter.com/valleymedgroup

Thanks,

From the VMG Diabetes Team

Back to School with Diabetes

Are you caring for a child with diabetes?

Here are some things to think about while getting ready for the first day of school:

1. Communicate clearly with teachers.

Joslin posted their advice last week, advising that you discuss symptoms of hyper- and hypo-glycemia, and when the child should go to the nurse's office. You may also want to clearly outline what the child needs to be allowed to do in the classroom, such as checking blood sugars or carrying snacks.

Depending on the child's age, you may need to emphasize that your child may not be able to tell the teacher when he or she is having a low.

2. Do your homework.

Work with your child's doctor to update your Diabetes Medical Management Plan (DMMP). You can use the DMMP to draft an Individualized Education Plan (IEP) with the school, clearly outlining the school's responsibilities and who should be trained - this includes the teacher, the school nurse, and depending on the age of the child, possibly other staff such as the bus driver.

http://www.cdc.gov/features/diabetesinschool/

3. Be prepared.

The CDC offers this list of suggestions for packing a diabetes kit for your child's backpack:

• Blood glucose (sugar) meter, testing strips, lancets, and extra batteries for the meter.
• Ketone testing supplies.
• Insulin and syringes/pens.
• Antiseptic wipes.
• Water.
• For children who wear an insulin pump, backup insulin and syringes/pens in case of pump failure,
• All children on insulin need glucose tablets or other fast-acting glucose snacks (a carbohydrate that will raise blood sugar levels relatively quickly when eaten). Here are examples of fast-acting snacks that provide about 10 to 15 grams of carbohydrate:
• 3-5 pieces of hard candy.
• 4-6 ounces of regular (non-diet) soda.
• 4-6 ounces of orange juice.
• 2 tablespoons of raisins.
• 8 ounces of nonfat or low-fat milk.

http://www.cdc.gov/features/diabetesinschool/

4. Stay healthy and active as a family 

The back-to-school season can be a stressful time, but it's important to keep up with all your family's healthy habits, including:

• Packing or encouraging healthy balanced breakfasts, lunches, and snacks
• 60 minutes of physical activity per day - especially if you can do activities together, such as walking or bike riding together after school
• Limiting screen time
• Staying up to date on doctor appointments and vaccinations

Is there anything else you have learned from experience about getting ready for this fall? Please let us know in the comments section below!

For more information, check out:
http://www.cdc.gov/features/diabetesinschool/
http://blog.joslin.org/2013/08/back-to-school-tips-for-diabetes-management-teacher-edition/

Two News Items

Good Morning! 
Two news items were brought to my attention by VMG Diabetes team members recently that I thought I should share with you. It's kind of a good news/bad news situation. 

Let's do the bad news first: the FDA has issued a drug warning for the diabetes medications Invokana (canagliflozin), Farxiga (dapagliflozin), and Jardiance (empagliflozin). These are a group of medications called SGLT2 inhibitors. 

The warning is being issued because 20 patients being treated with these medications were hospitalized with Diabetic Ketoacidosis (DKA). You might have heard of DKA happening to people with type I diabetes, and being associated with very high blood sugars. These cases were unusual because these were people with Type 2 diabetes, with relatively normal blood sugars. 

If you are taking one of these medications, you are not advised to stop taking it without speaking to your provider, but do be on the lookout for the symptoms of DKA, which the FDA lists as: difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. You can read the full FDA warning here. 

photo from Weill Cornell Medical College's article

Today's good news? Changing the order in which you eat your meal may help improve blood sugar control! A recent study out of Weill Cornell Medical College found that eating protein and vegetables before carbohydrates resulted in lower post-meal blood sugars and insulin levels in people with type 2 diabetes on oral medications. 

They emphasize that more research is needed to confirm the finding and to explain why exactly this works, but I don't think it can hurt to try it out for yourself!

Any other big diabetes news you've noticed in the past couple weeks? Let us know in the comments section below!

Looking for Weight Loss Inspiration?

For those of you who may be trying to lose weight, I want to share some of my favorite online resources for inspiration, information, and support.

If you are a smartphone user, you probably already know there are many apps available to help you on your weight loss journey - maybe too many. These are the ones that I have seen the most people succeed with:

• Fooducate or Shopwell: Scan barcodes while shopping – these apps will help you make healthy choices.
• Myfitnesspal or LoseIt: Track your intake to meet daily calorie or nutrient goals
• HealthyOut Healthy Meal Finder: Search for the healthiest restaurant or takeout food options

If you are looking for trustworthy information, recipes, or community, these are some websites that you might want to try:

• CalorieKing.com: Find the facts on almost any food!
• Sparkpeople.com: A combination of an online food diary, informative articles, and a supportive online community.
• Mayo Clinic Recipes: Large database of healthy recipes from a trustworthy source
• Oldways: Not strictly for weight loss, this collection of Mediterranean Diet recipes may help you include more heart-healthy choices in your weight loss meal plan

My favorite weight loss resources of all, however, have always been first-person accounts of real life experiences. I think these blogs are inspiring, funny, and very helpful. If you have all the information you need, but could use a boost from a real person's story, check out these blogs: 

• Authentically Emmie: Cheerful and positive, documents the author’s journey down from 455 pounds.
• Prior Fat Girl: Honest advice from a writer who has maintained her weight loss
• Does this Blog Make Us Look Fat: Very funny take on weight loss, with some very good advice
• Can You Stay for Dinner?: Heartfelt personal story of weight loss and the author’s struggle with emotional eating and body image. Also includes many wonderful recipes!
• Cranky Fitness: This blogger doesn’t like to exercise either, but does it anyway.
• Roni’s Weigh: Inspirational story of weight loss, with lots of helpful tips.

Do you have any favorite online resources to share? Let us know in the comments section below!