Warning about Supplements

A new study on supplements has revealed that 4 out of 5 supplements sold at stores like Walmart, Target, or GNC contained none of the herb listed on the label. Can you believe that? NONE. 

We already knew that supplements are not as carefully regulated as prescription drugs and are not tested for efficacy by the FDA. 

But most of these supplements contained mainly fillers like rice and houseplants!!

Read full articles describing the study: here and here.

Hopefully this will help improve supplement regulation - but in the meantime, maybe just stay out of the supplement aisle altogether!

Bottom line: don't waste your money, and don't risk your health. 

Update from the Diabetes Support Group

Hi all! Today Margie Sobil, our nutritionist in Greenfield, has an update about the Diabetes Support Group. Also below - a quick easy alternative to sugary grocery store fruit-flavored yogurts!

The diabetes support group is in its 3rd year now! We continue to combine a mixture of activities at the meetings:

•          member sharing and support
•           Tips, skills building and new ideas
•           Recipes and food demos

At some of our recent meetings, we all got a chance to practice a variety of chair exercises thanks to Ann Marie (great for many of us who feel confined to home during this time of year of being snow-bound) and we looked at the Diabetes Blog on the Valley Medical Group website- where we got to see our favorite VMG volunteer (from our support group)- Ann Marie.

 Some comments from participants about the group: 

“What I like about this group is the sharing of ideas and having a place to talk about what is working, and the challenges.  I get help for myself, and sometimes it just feels good to offer some  ideas and help someone else.” 

“I like the food samplings and new recipe ideas- it helps me to know I can expand my food options and know that I am eating something that is healthy for me without overdoing the carbs”

AND, we have been learning creative/tasty tips for lower carb food items  that are simple to prepare. 
Zucchini and summer squash spaghetti spirals,  sautéed and combined with whole wheat pasta, to create a low carb spaghetti that everyone loved.  We also learned that 2 oz dry pasta on the box (40-45 grams of carbs) is about 1 cup cooked- something everyone had to admit has always been a mystery to figure out.

But today I want to share this easy way to make a healthy alternative to grocery store fruit-flavored yogurts. After looking at a variety of yogurt containers, we learned that there are only about 6-7 grams of carbs in a container of plain yogurt.  Many people in the group eat flavored Greek yogurt- the “light” Greek style yogurt has only about 9 grams of carbs, while the sweetened yogurt has about 20 grams.  Once we figured out the difference between sweetened yogurt (20 grams) and the plain (6 grams) = 12 grams, we learned that 12 grams sugar is equal to 3 teaspoons of added sugar.  

Instead try this, for almost 2x as much food as fruit flavored cups, without all the sugar: 

• 1 cup frozen berries (strawberries, blueberries and blackberries) thawed in microwaveable bowl
• Pulse with small blender or chopper
• mix berry mixture. 3/4 cup plain Greek style yogurt and 1 packet stevia or Splenda. 
• Mix and enjoy. 
• Carb count: approx 20 grams carbs

At 22 grams of carbs (minus a few grams of fiber from the fruit)- we got a serving of yogurt and real fruit for roughly the same amount of carbs as a sugar sweetened yogurt.  Not only that- but everyone, even the most skeptical members of the group- had to admit that it was DELICIOUS!!!!

So, if you haven’t been to the group for a while, or if you would like to give it a try- come any month- 2^nd Tuesday.  Our next meeting is Tuesday March 10, 5:30-7:00 p.m.  Feel free to call Margie with any questions at (413) 992-7392.

Guest Post: Are You Ready For an Emergency?

After yesterday's storm, Dr. Stuart Chipkin has a few reminders for you all about being prepared for an emergency. Thanks Dr. Chipkin!

Whenever the snow starts falling or the electricity fails, I can count on several phone calls from patients who “all of a sudden” realize they don’t have glucose test strips or other supplies to help with their diabetes.  It’s completely understandable- we all think “Oh, I’ll run out and get those tomorrow”, or “the weather will only be bad for a day or so- I won’t have a problem”.  But any weather that can limit your ability to travel or suddenly put you without electricity can “snowball” (OK- maybe I intended that pun) into a much bigger problem. 

And I recommend all patients have a Medical ID (bracelet, necklace, even a tattoo!) in case they are unable to respond when initially found (again, independent of weather- could be in a car accident or brought into an Emergency room).

Listed below are some things you should think about to make sure that you are prepared for having diabetes during severe weather:

•  A week’s worth of medication
• Glucose tablets or gel if you are at any risk for having low blood sugars.  If you have had reactions without symptoms, you should find out about having a Glucagon emergency kit as long as someone at home will learn how to use it.
• For those on an insulin pump- have extra supplies including:
• Cartridges, infusion sets, prep wipes and batteries
• Extra sensors (if appropriate) and chargers
• Non-pump insulin options (see #4) in case of a pump failure;
• If you are on insulin injections, make sure and have enough:
• Insulin pens and pen needles OR insulin vials and syringes- both short and long acting
• Extra alcohol wipes;
• Consider having something in which to discard insulin syringes, needles and lancets (e.g., an empty hard plastic detergent bottle with cap)
• Glucose measurement supplies including:
• Extra meter
•  Lancet device and lancets
• Alcohol wipes
• Test strips and batteries
• For patients with type 1 diabetes, I encourage you to have urine ketone test strips (independent of bad weather)-  these are good to have if you have several high blood sugars to see if you are getting to the point that you need to consider going to the Emergency room;
• Other general information to have:
• Copy of your recent medical records including current medications and doses

You should think about having something to put all these things in- a container (maybe even waterproof) that may also have a place for a cold pack for insulin.

For more information, visit either:

http://www.diabetesforecast.org/2012/aug/how-to-stockpile-for-emergencies.html

http://www.nj.gov/health/fhs/documents/diabetes_disaster_guidelines.pdf

Guest Post: A Reluctant Diabetic

Hi everybody! Today I am thrilled to share a story from a VMG patient. Anne Marie Meltzer has been an amazing volunteer for our diabetes program, including helping with diabetes support groups at our GHC office. Thanks, Anne Marie!!

Annual Physical February 2012.  I complained of tingling and numbness in my fingers, toes and nose.  I thought it was due to weakness resulting from a small stroke I had in 2009.  I also gained 25 pounds but thought that was also due to the stroke and inactivity.  My MD, Ross Midler, decided to do and A1C to rule out Diabetes.  It came back high – Type II Diabetes. I was put on a 500mg of Metformin.

This hit me hard, as it was not expected.  When I was young, I lost a friend to kidney failure resulting from Diabetes and I knew this disease as a killer.  I withdrew into a deep sadness.  When my MD recommended Diabetes Education, I rolled my eyes and reluctantly attended the sessions.  I am highly independent and I don’t like to be told how to live my life.  I got angry and decided to take control – I wasn’t going to let this disease take away my life. 

How I eat is a challenge. I adjusted the regimen of carbs to even out my food intake over six small meals a day.  I keep low carb snacks in my car and purse, and I have learned to order wisely in restaurants.

I cook my foods from scratch, sometimes including bread, and eat no processed foods because I am allergic to a preservative used in pre-made food.  Under these circumstances, counting carbohydrates can be difficult. I also have intermittent attacks of Gastroparesis, my stomach does not empty and bloats. I change what I eat when this flares up - low residue foods, liquids, and very little or no fiber.  The two diets are not compatible and my blood glucose fluctuates.

I began to exercise again and trained to be certified to teach strength and balance classes to older people.  This keeps me in shape – I cannot say that I am too tired to exercise because I am teaching the classes.

My A1C now remains between 6.1 and 6.5 and I have lost 22 pounds.  I have learned to listen to what my body is telling me, although I admit I sometimes cheat.

Guest Post: "I Know Better"

Today I have a quick holiday greeting for you (and a laugh!) from our friend Seth, a VMG patient with type 1 diabetes.

This year I've got 10 New Year's Resolutions:

1. Exercise

2. Exercise

3. Exercise

4. Exercise

5. Exercise

6. Exercise

7. Exercise

8. Exercise

9. Exercise

10. Exercise

And I figure I'll be able to keep some of these.

Happy Holidays!

Recipe of the Week - Pumpkin Cranberry Applesauce!

I hope you all had a nice Thanksgiving weekend!

I love the seasonal flavors of fall - apples, spices, pumpkin... but I am already getting sick of rich holiday food. 

I made up this recipe this weekend just to use up some apples, but I think it has already become a new favorite dessert in my house! And it uses no sweetener at all - just the natural sugar in the apples.

PUMPKIN CRANBERRY APPLESAUCE

Ingredients: 

8-10 apples (macintosh or cortland type work best)

1 bag of fresh or frozen cranberries

1 sugar pumpkin

Spices: cinnamon, nutmeg, cloves, pumpkin pie spice, ginger...

First, I microwaved the pumpkin to soften it and make it easier to chop up. In my microwave, this took about 5 minutes on high. 

Slice the pumpkin in half and scoop out the seeds. Slice off the outer rind and dice the pumpkin flesh up into big chunks. 

Core and slice the apples and add them and the diced pumpkin all to one large stock pot. Add cranberries. Cook on medium heat until juices are released and the whole mixture starts to bubble, then cover and let simmer on low until everything starts to soften and blend together when you stir it. 

Options: This recipe is super flexible. Instead of a pumpkin, you could use a butternut squash, some leftover sweet potato puree from thanksgiving dinner, or a can of prepared pumpkin. Be creative and use what you have! 

This recipe is nice and tart the way I like it - but if you have more of a sweet tooth, I think adding some stevia would sweeten this up nicely. When I made it for company, I put a tablespoon of butter in the bottom of the pan before I added the apples. 

Feel free to experiment - and enjoy!

Thoughts from a Doc: Why do my sugars DO that?!? (Part 3)

Today's post comes from Dr. Stuart Chipkin, Valley Medical Group's Endocrinologist and Diabetes Program Director

This is Part 3 of 3 of this series from Dr. Chipkin. So far we have heard his thoughts on exercise, food, insulin, and counter-insulin hormones. This week - his thoughts on a few remaining factors that can  influence your numbers. 

 Insulin-sensitizing hormones: these are sometimes called “incretins” because they increase the action of insulin.  There are now medications based on these incretin hormones which help to lower blood glucose levels and also have modest benefits on weight loss.  Examples are exenatide [Byetta] and liraglutide [Victoza].  Other medications inhibit the enzymes that break down the body’s own incretin hormones- these medications generally don’t help with weight loss- they include sitagliptin [Januvia], saxagliptin [Onglyza] and linagliptin [Tradjenta]

 Factors x, y, and z:  These are the wild cards that sometimes make it really hard to either predict or understand why glucose values do what they do.  Most of these won’t change blood glucose values by large amounts but can contribute to not having them be exactly on target.  Examples can include: hormonal changes during phases of the menstrual cycle, the efficiency or inefficiency of how food is absorbed from the intestines, emotional stresses, antibodies that some people make against insulin, etc. 

With all these different factors, and the ways that each of these factors can change blood sugar values, it’s pretty impressive we every get things close to being on target!!   This is where each individual has to learn their own personal diabetes and some of the “quirks” of how their body responds.