How many of you have family members who love to give health advice based on the “They Say” theory.    I can recall, my mother telling me “they say blueberry tea is good for your health”.  When I was younger I always wondered, who are THEY?  As I became older, I would challenge the They Say Theory by asking, who are they, what are their credential, and show me evidence based research to substantiate this information.  No one has ever come to me with the” they say” theory ever again.

When it comes to nutrition everyone is an expert, per American Diabetes Association (ADA), Diabetics should seek the nutrition experts “Registered Dietitians” for Medical Nutrition Therapy (MNT).  When it comes to Diabetes it’s certainly more than just food and eating it’s much more involved due to the other metabolic conditions accompanying diabetes.  Never forget, food is a chemical, it is just as much of a chemical as an aspirin.  Nutrition is vital to life, however, just as you would not consume an entire bottle of aspirin knowing negative side effects will follow, you should not consume an undisclosed amount of food because there will also be side effects i.e. obesity, hypertension, hyperglycemia to name a few.

WHAT IS MEDICAL NUTRITION THERAPY:

Medical Nutrition Therapy is important in preventing diabetes, managing existing diabetes and preventing or at least slowing the rate of development of diabetes complications.  Since I am addressing the Genes I am wearing, Diabetes, I would like to discuss how MNT can at least slow the rate of diabetes complications through Diet.

Food for Thought:  Please refer to the Glucose trap: Pre-diabetes.  The key to managing diabetes is to achieve blood glucose control to normal or as near normal as possible.  Complications develop due to elevated blood glucose (sugar) levels.  Let’s use logic for a minute here, as explained the bodies main source of energy is glucose without it we can’t live, so we must consume it.  We also know that carbohydrates (carbs) turn into glucose.  Therefore, it is logical to monitor the amounts of carbs you consume, which indirectly will be monitoring the amount of glucose in your blood stream.  This is one of the key strategy in achieving glucose control to normal or as near normal as possible.

MONITORING CARBOHYDRATES:  Carbohydrates (carb) are monitored by two main processes, (a) Carbohydrate Counting and (b) Exchanges.  I currently use the system of Carbohydrate Counting at home and with my patients.  Carbohydrate Counting takes into consideration the amount of carbohydrates found in the food you eat and matching that with the amount of insulin you take or make (injected or body release) to maintain normal glucose levels.

Sample Carbohydrate Counting:

I had my mother on 45 grams of carbohydrates per meal, what did that look like:

The golden rule:  1 serving of Carbohydrate = 15 grams

Breakfast:

½ c Oatmeal    =   15 grams carb

1 sl. WW Toast =   15 grams carb

½ cup Milk        = 12 grams carb

1 Egg                =   0 grams

2 tsp. Promise   =   0 grams

TOTAL                42 grams Carbohydrate

A process called Self-Monitoring of Blood Glucose (SMBG) provided me with the necessary tools to evaluate her glycemic response to the types and amounts of food she was eating.  Based on SMBG, 42 grams of carbs plus the hypoglycemic medication she was taking maintained her levels within normal safe ranges.

2 hours after eating blood glucose levels should be in the range of 140-160 mg/dl.  A glucometer was used to measure her levels with a goal of 140-160 mg/dl.   When her levels were as high as 180 mg/dl without any other affecting factors other than food consistently I would subtract her carbohydrates by 15 grams.   Test again for a couple of days, and if the level consistently stayed within goal range, it was maintained.  Initially, I started with 60 grams per meal and had to titrate down to 45 grams which consistently gave me normal readings.  However, on the other end, if her levels fell into the range of 90-120 mg/dl two hours after her meal, I would have had to increase her carbs, to prevent hypoglycemia, 90-100 mg/dl after meals is dangerously low.

Fasting Glucose levels were monitored in the same manner.  I set her fasting goal at 90-110 mg/dl, if levels were too low, I knew she didn’t eat enough carbohydrates that evening.  I could always tell when she had her favorite night snack “ice cream” the next morning fasting levels were always in the range of 130 mg/dl or higher.

Currently my husband is on MDI (Multiple Daily Injections), with strong objections now to the insulin pump.  With MDI, prior to eating he injects 4 units of insulin per 15 grams of carbohydrates consumed. Technically this puts him at a 1:15 insulin-to- carbohydrate ratio, this regimen is perfect for him as demonstrated by his excellent A1C values and postprandial/fasting readings.

Yes, I have been exposed to Diabetes all my life and continue to live with a love one diagnosed with T2 Diabetes.  My primary goal as a clinician and wife is to prevent the development of the complications of this insidious disease.  If you have been diagnosed with diabetes, please speak with your Primary Care Physician regarding a consult with a Registered Dietitian or perhaps one that is Board Certified in Diabetes Education like myself in your local areas for assistance in managing and controlling your diabetes. 

  To me, Yes, Diabetes is personal, truly it is a Family Affair!