Summertime is now in full swing and you should be enjoying the rewarding and exciting experiences of the season. Some of the favorite activities discussed by our diabetes management patients are the outdoor Grilling, BBQ or a lazy afternoon picnic at the park or beach with friends or at a family reunion. Having diabetes or another chronic condition should make you think more about proper planning. Diabetes can influence your immune system, especially when blood sugars are out of control, increasing the risk of infection. According to the CDC, “food poisoning is one of the most common maladies in the US. About 1 in 6 people get sick by consuming contaminated foods. This is about 48 million people.” Food poisoning tends to increase during the spring and summer months when more foods are taken outdoors and can be affected by the high heat and humidity with improper handling. To stay healthy, consider some of these guidelines to make your summer more carefree and outdoor friendly when you have diabetes.

Wash Hands

Always start any food preparation or eating by washing your hands – preferably with soap and warm water or a hand sanitizer high in alcohol content. This should be done prior to, during and after food preparation.

Be Really Prepared.

When cooking outdoors, carry plenty of disposable wipes, cooking gloves, hand sanitizer, paper towels, tin foil, extra paper goods, a blanket or beach towel, plastic ware and a large garbage bag. Make a checklist and keep it near your picnic basket or grilling supplies. Carry snacks such as fruit, veggies or nuts to snack on if you get hungry and the food is not ready. You do not want to set yourself up for hypoglycemia. Feelings of weakness, light headedness, sweating, fatigue and being confused can signify heat stroke or low blood sugars so test to be certain.

Food Preparation

Always thaw frozen food in the refrigerator and not on the counter top at room temperature. This can become a breeding ground for bacteria. Frozen food can be directly thawed in a microwave and should be used immediately. There is no need to wash raw meat or poultry which can splash germs into the sink. Cooking food at correct temperatures will kill the bacteria which may be present.

Marinating Foods

Barbecue RibsUsing marinades when cooking on the grill or at high temperatures should be done for several reasons. It will flavor the food nicely without a lot of calories and will make the process of grilling healthier. Grilling meats produces HCAs (heterocyclic amines) and PAHs (polycyclic aromatic hydrocarbons). HCAs and PAHs are both considered to increase the risk of cancers especially GI cancers. The longer the meat is cooked, and the higher the temperature, the more these products are formed. By using a marinade, you can reduce the formation of HCAs in half. Use an acid based marinade that includes red wine or balsamic vinegar or lemon/lime juice and skip the sugar. Add olive or sesame oil to the acid component and mix with spices and herbs for extra antioxidants. Introduce garlic, ginger, pepper, turmeric, rosemary, sage, mint and oregano to the blend. Avoid adding salt to the marinade since BBQs are often high in sodium. You should prepare 1/2 cup of marinade per pound of meat. According to The American Institute for Cancer Research, “foods should be marinated for at least 30 minutes” but can be left in marinade overnight fully covered in the refrigerator. Do not marinate at room temperature and once meat is removed from the marinade, dispose of any excess. Keep a separate, fresh marinade for basting as the original marinade can harbor bacteria accumulated from the raw meat. Never reuse the dish that held the marinade without first washing. Avoid processed meats (carcinogens) including hot dogs and sausages especially when cooking on the grill. Trim excess fat off the meat since fat will encourage more smoking and burning on the grill. Do not char the meat which also leads to carcinogenic products. Cook on a low temperature and if charring occurs, cut it off and disguard. The more well-done the meat, the more problems.

Meat Temperature

Make sure to use a thermometer to check for temperature of meat. Steaks, chops, lamb, veal and roasts should be cooked at 145 degrees with a 3-minute rest period, poultry should be cooked at 165 degrees and burgers should be cooked to 160 degrees which is medium to medium well. Not cooking to a proper temperature can increase the risk of E. coli.

Food Size

Cut foods like steaks, chops and chicken breasts into bite size kebobs to lower cooking times and temperatures. This is more healthful. Clean the grill prior to each use with soapy water and a steel brush to remove all hazardous fragments. Use steel skewers or wet bamboo skewers prior to threading food.


All salads, meats, produce and dairy should be transported in a cooler. Use a reliable cooler that is large enough for the food as well as for the ice or ice packs. A full cooler will do a better job of keeping food cold than a 1/2 full cooler. Adjust to a smaller size if it is not filled. Keep a separate cooler for drinks since this cooler will be opened much more frequently. Make sure the cooler is washed after each use with warm soapy water and carefully dried out. Keep the cooler in the car with air conditioning and not in the trunk or exposed to direct sunlight. A thermometer should be placed in the cooler and kept at 40 degrees or cooler.

Separate Foods

Keep hot and cold foods separated so they can maintain their proper temperature.

Grilling Fruits

Grilling fruit is a perfect summertime dessert treat but make sure to remove the rinds. For instance, summer fun may include soaking watermelon, honeydew or cantaloupe in vodka or rum. The rinds may harbor Listeria, so remove them. Peaches, plums and pineapple taste delicious when grilled with none of the ill effects of grilling. Grilling vegetables with a bit of olive oil are also delicious. Try grilled asparagus, corn or tomatoes.

Foods Not Influenced by Temperature

If you do not want to cook or worry about separating foods by temperature, consider bringing foods that do not require much maintenance. Bring hard cheese and whole grain crackers, popcorn, Chex-Mix, nuts, nut butters, dry cereals like Cheerios or pieces of whole fruit or canned tuna, salmon, sardines or chicken.

Mayonnaise is Not Really the Picnic Enemy

MayonnaiseEveryone is always concerned about summer chicken, egg or potato salads made with mayonnaise. Mayonnaise is not the problem since it has a high acid content. A food with high acid content may reduce the risk of pathogens. It’s the storing of the mayo-dressed salad at room temperature which causes the problem especially when left out for too long.

Throw it Out

Discard foods that have been in 90 degrees or higher more than 1 hour and discard any perishable foods under that temperature that have been left out for 2 hours. The temperature danger zone for food is above 40 degrees and under 140 degrees.

Enjoy the Outdoors

Remember to pack and use sunscreen with a SPF of 30-50. Put it on 20-30 minutes before going outdoors. Reapply the sunscreen often and wear the water-proof kind if you’re swimming. Avoid the heat of the day, typically between 11:00AM-3:00PM, if possible. Stay under a shady tree or an umbrella. Bring separate insect repellant, a wide-brimmed hat and always wear sunglasses. Bring along any medication or diabetes supplies you may need and do not store them in the car. A small separate cooler left in the shade will be helpful. Remember that insulin should not freeze or directly touch ice or the ice pack. Wrap the insulin in a wash cloth. If you use an insulin pump, you may need extra skin prep or barriers such as Skin-Tac to prevent the infusion set from slipping. Drink plenty of calorie-free fluids, especially water, to keep you well hydrated. Dehydration can lead to feeling poorly and possibly elevate blood sugars. Forget the flip flops and wear hard soled shoes and diabetes socks so your feet stay protected and comfortable. When swimming, use water shoes.

Summertime is the right time to get outdoors and enjoy your friends and family along with a delicious BBQ or picnic. Know the guidelines to keep you safe with diabetes!

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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

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.
Roberta Kleinman

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