This week, during diabetes education management sessions, I addressed some important topics concerning a patient which I think will be of interest to you. The first patient of the day was a 43-year old woman who presented with a 15-year history of diabetes type 2. She stated that she weighed 140 lbs (5’4″) at age 23 prior to trying to become pregnant. After 3 miscarriages she was placed on Progesterone, a hormone which would increase the likelihood of her carrying the baby to full term. The problem is she was placed on this hormone for her next 2 babies as well and ended up weighing over 250 pounds after her 3 children were finally born. We discussed that some of the tremendous weight gain was certainly related to the hormone medication needed to hold the pregnancies, but much of it was due to her stress during that time period and her poor eating habits. She admitted that she spent years ‘escaping to food’ to relieve her frustrations and disappointments. After each child’s delivery, she held on to a large amount of weight and started a new diet program ranging from “The Grapefruit Diet” to “The Cookie Diet”. These were followed by HCG shots, diet pills and pre-packaged meal plans. She lost 20-30 lbs with each diet attempt and ended up weighing approximately 240 when she returned to her ‘normal eating’ pattern. Her other big concern was that she was always ‘catching everything that was floating around the house’ from her family and that she would remain sick longer than anyone else. She noted that her immune system was failing, the more her blood sugars were out of control. After years of personal despair and the beginnings of diabetes complications including neuropathy, she finally made a decision to learn about diabetes self management. We reviewed the concepts of balanced eating, medication, exercise and other critical lifestyle skills. She also decided that mental health counseling with a professional would help complete her desire for more effective and long term change.
Here is some of the basic information we discussed:
- Forget about all the diet programs once and for all and start on a healthy, livable and realistic plan that you will be able to follow for life. We discussed using the “Plate Method” of eating since she was not interested in weighing or measuring her food. I recommended a portion plate or specially designed containers that have distinct sections to fill with different types of foods.
- 1/2 the plate with non-starchy vegetables which are considered ‘free food’. She enjoyed crunchy foods so this might help fill her desire for chips. According to the latest USDA guidelines, women should eat 7 servings of vegetables and fruits daily. With diabetes, fruit portions need to be reduced but not eliminated since they are carbohydrates and will turn into sugar. We reviewed how fiber would not only help her feel more satiated but it would also help with blood sugar control. She was not a vegetable eater so we explored options. We talked about using lettuce leaves or collard greens in place of bagels or doughy French bread for sandwich options. Adding vegetables including lettuce, tomato, onions, olive slices and avocado would bulk up a sandwich as well. We talked about shredding carrots, celery and onions and adding to casseroles and sauces to bulk up a meal. Purchasing pre- cut vegetables, although more expensive, was the way to go since she had so much going on during meal time.
- 1/4 of the plate would be for complex carbohydrates including whole grains, starchy vegetables including corn, peas, beans and potatoes or fruit. She mentioned that she had already eliminated white starchy foods and was happy replacing them with whole grains that offer more fiber.
- 1/4 of the plate should be lean protein including fish, shellfish, poultry, lamb, lean beef or pork. She could substitute beans, nuts, tofu or legumes as the protein source. She could include low fat dairy products including cheese, yogurt or milk for calcium content and limit to 2-3 cups daily.
After our discussion she knew she had to make quite a few changes to work on improved diabetes control and good overall health, but she was excited to have a plan. She realizes that if all the lifestyle changes do not achieve better numbers, then her medication will become part of the equation as well. We will meet again in a month to monitor her progress. She stated that she was ready to feel stronger and forge ahead so she could play with her grandchildren, this time with more energy and ability to get down on the floor to play. You can do it too!
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
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