One of my patients came for a follow up visit this week one month after her initial diagnosis of type 2 diabetes. The first session included an overview of the diabetes process, physiology and complications along with an hour of specialized nutritional information and guidelines.
Since I knew her next visit was between the Thanksgiving and Christmas holidays my pearl of wisdom was “maintain – do not gain.” She thought that was fair since she has spent most of her adult life on a weight roller coaster. She admitted to having tried almost every popular diet program (including HCG shots), all prior to being diagnosed with diabetes. She also freely admitted that her life revolved around food. She is an emotional eater, a comfort eater and a stress eater. It did not matter if she was happy, sad, content, bored, anxious, stressed and restless, excited or down, her way of coping was always reaching for food.
We talked about how food and emotion have been tied together in most cultures. As a parent the first thing done when the baby cries is to feed them. Small children are often rewarded with a treat for good grades, good behavior or for doing a chore. Sweets and desserts are often taken away when the child misbehaves. When we get hurt, physically or mentally, many of us grab something to put in our mouths to reduce the hurt, fear or pain. Weddings, funerals, holidays and social gatherings surround us with buffet tables. The list goes on between the food and emotional connection.
I was able to convince her that food is just a temporary fix to a much bigger problem that has been with her for years. Since my credentials are RN/CDE, I did refer her to a therapist who actually specializes in addictions, including food addiction. She understood that habits are difficult to change since they did not develop overnight; they definitely take time, patience and determination to change. I was able to get her focused on what needed to be done right now, especially during this time of the year. She learned that one of the gold standards of diabetes management is healthy food choices, no meal skipping with small portions throughout the day.
At her follow up visit she was thrilled because instead of “maintain – do not gain”, our original plan, she was 5 pounds lighter. She had not been on a scale at home but was using a mirror, a tape measure and her clothes as indicators of progress. I did remind her that now she was exercising with weights and doing aerobic activity – she may have gained muscle mass which can weigh more than fat. Scales do not differentiate between fat, muscle or water weight – which can be discouraging. She saw the shape of her body change slightly with her clothes hanging differently on her frame and she was truly grateful for her hard work. Some tips we shared to be used for the holiday season and later are:
- Plan before and downsize when you get there. There is NO saving up carbohydrates for one meal. Sugar will flood the blood stream if you eat like that; complications come from repeated attacks of sugar on the nerve endings. Nothing is off limits with diabetes if you take time to plan it out and be satisfied with a taste, small portion or even just a bite. Aunt Martha’s cheese cake is a special treat one time a year – so go for it!
- Chew sugarless gum and carry sugar free mints. Sometimes having something in your mouth that releases flavor will do the trick.
- Increase sleep – too much sleep (more than 9) or too little sleep (less than 6) changes hormone levels which can have a huge impact on your appetite; it can change your perceived hunger or feelings of fullness.
- Consider mobile apps which can help you with on the spot information on different food choices and calorie amounts per portion.
- Have someone you know and trust make you a plate when your willpower is low; give them an idea of what you may really want to be included.
- Stand on the opposite side of the room from the buffet table. Sit outside if the party over flows there as well.
- Carry a club soda with fresh lemon or lime during the gathering and sip constantly. We tend to be dehydrated during this season which may be confused with hunger. It also takes the edge off hunger. Plain water with cucumber slices is double hydrating due to the high water content of cucumbers.
- Remember – no calories / carbohydrates in drinks. Soda, mixers and fruit juice raise the blood sugar quickly and do not offer any benefit. Eggnog is full of calories and fat. Choose plain drinks with diet soda or diet tonic water. One alcoholic beverage for women or two for men under 65 is the limit. Have food with alcohol to help prevent hypoglycemia.
- Try to choose low fat options like shrimp or crab meat cocktail instead of cheesy fondue, fried mushrooms or pigs in a blanket (watch the cocktail sauce which has added sugar). Choose cheeses like Feta, Mozzarella or other low fat varieties and skip the Brie, Boursin or Blue cheese.
- Reach for air popped popcorn – up to 3 cups is a serving size. Another good choice is a dark chocolate kiss which has 20 calories and 8 grams of carbohydrate and is wonderfully satisfying with heart benefits.
- Think about low fat dips like Walden Farms and use veggies instead of salty chips. Try hummus spread made from chick peas which are full of protein and fiber with Wasa crackers.
- Stick to fresh fruit over dried fruit if you have the choice. Two tablespoons of dried raisins or cranberries equals a cup of fresh strawberries or raspberries.
- Dressings, gravies and sauces stay on the side. Use them to lightly dip, but not smother, your food.
- Skip the accoutrements for the baked potato and eat the skin. Bacon, cheese, butter and sour cream are heavy fat and laden with calories. Use salsa and chives for great flavor.
- Find the nut bowl – but only a handful. Nuts can improve the inner lining of the arteries, are 80% fat which keeps you satiated, contain Omega-3 fatty acids, fiber, Vitamin E and L-arginine.
The holidays will soon be over and a New Year begins. Enjoy your time with family and friends but do not forget your health, which is the biggest gift we have!
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.