Susan Weiner Nutrition

Huge portions, overeating and sedentary lifestyle have all led to the epidemic of  diabetes and pre-diabetes in America.  About 23.6 million Americans have diabetes and another 57 million have pre-diabetes (or pre-type 2 diabetes).  A whopping  3.7 million African Americans (or 14.7% of non-Hispanic black adults)  in our country have the disease and one quarter of all African-American women over the age of 55 have type 2 diabetes.  High blood sugar (or diabetes) can cause eye, heart disease, stroke and kidney problems if left untreated.  So much of African-American dietary practices are deeply rooted in rich history and culture.  These practices should be respected, but need to modified in order to prevent and treat the often deadly disease of diabetes.

Diabetes is a problem of high blood sugar. Your doctor will determine if you have diabetes or pre-diabetes by measuring the amount of sugar in your blood.  Type 1 diabetes (an auto immune disorder) can not be prevented, and must be treated with insulin upon diagnosis.  Pre-diabetes and type 2 diabetes (which are strongly related to your genetics as well as your environment), are often difficult to manage without proper guidance.  In the African-American community there are often feelings of denial and complex emotions which also go along with the diagnosis of diabetes.  According to Constance Brown-Riggs, a Registered Dietitian and Certified Diabetes Educator and author of “The African  American Guide To living Well with Diabetes”, July 2010, “African Americans suffer greater consequences from the complications of diabetes”.  She points out that African-Americans experience kidney failure four times more often than white Americans with diabetes, are twice as likely to suffer from diabetes-related blindness and more likely to experience amputation. It seems that many African Americans are not diagnosed with diabetes in the early stages of the disease, and often don’t receive proper nutrition and diabetes management information.

Brown-Riggs, who is an African American woman, has written this extraordinary informative guide which covers all aspects of diabetes care in a way that celebrates African-Americans. She points out that African American women are especially in need of advice on how to manage the disease.  They may not have taken diabetes seriously in the past, and are in desperate need of learning how to eat well, exercise properly and take medications as prescribed.  Basically, the black woman with diabetes should finally learn to put herself on top of the priority list and start managing her blood sugars in order to save her life!

The African American Guide To Living Well With Diabetes reminds women that living with diabetes is a life-long process.  Maintaining good health happens each and every day.  ”I”m only human.  I’m just a woman”, is a celebrated theme in the book.  Everyday is a new opportunity, so whether your diabetes is newly diagnosed, or you’ve had diabetes for several years, this guide can be very helpful.

Many diabetes books include self-care programs and work sheets, which Ms. Brown-Riggs has as part of this book targeting the African-American. However, this guide also includes a two-week sample menu of Caribbean and traditional southern meals. I’ve been a contributor to many books on diabetes, and I was so inspired on how this particular book focuses on “specifics” for the African-American community.

Since African-American women seem to have a challenging time modifying their dietary patterns due to meal rituals and ethnic identification with food, it’s really important to understand the intense importance of “food as hospitality” when modifying a food plan to reduce blood sugars. The “art” of cooking and serving delicious food doesn’t have to be a “thing of the past” when you have diabetes.

If you have a family history of diabetes, or are experiencing any of the symptoms associated with the disease (excessive thirst, frequent urination, blurred vision or fatigue), PLEASE make an appointment to see your doctor today. If you are an African-American with diabetes or pre-diabetes, there is help available! Let’s work together to eat well (lower our carbohydrate and calorie intake), exercise, take medications as needed and follow up with our health care providers. The goal is to REDUCE the incidence of obesity and diabetes in African-Americans. With some guidance, it is a very obtainable goal!

Recently I had the privilege of being a featured guest on “The Mother Love” radio broadcast on ”latalkradio”.  Mother Love and I continue to work together on the dLife TV show.  She is a co-host and I am a contributing medical producer (and member of the dLife medical advisory board).  It is a remarkable show and I am honored to be associated with people who are so passionate about finding a cure for diabetes, and offering helpful advise for those who have this challenging disease.  So when Mother Love asked me to talk about being a Certified Diabetes Educator (CDE), I was very excited to share my experiences.

After I became a Registered Dietitian and completed my Masters of Science degree in applied physiology and nutrition at Columbia University in New York, I became intensely interested in the treatment of diabetes. Going back 20 plus years ago, diabetes was not in the news the way it is today.  There was no discussion of pre-diabetes (or “pre-type 2 diabetes).  In those days people talked about childhood or juvenile diabetes vs adult diabetes.  We now know about the pre-diabetes epidemic, gestational diabetes, as well as Type 1 and Type 2 diabetes.  When I began my private practice, I saw the need to educate people and their families on how to live with diabetes (and manage their blood sugars).  So, I decided to become a Certified Diabetes Educator!

According to the National Certification Board for Diabetes Educators (www.ncbde.org/eligibility.cfm), in order to even “apply” to take the CDE (Certified Diabetes Educator) exam, you must be licensed and registered as a health educator for a specific period of time in one of the following areas;  clinical psychology, registered nursing, occupational therapy, optometry, pharmacy, physical therapy, physician, podiatry, registered dietitian, physician’s assistant as well as a few other health professions.  Additionally, you must have two years experience in diabetes self-management education, including 1,000 hours in diabetes education!  Before taking the test you must also be currently working in the field of diabetes education at least four hours per week. In order to maintain the CDE credential, one must participate in 75 hours of continuing education (specific to the study of diabetes) every five years. These intense credentials define why a CDE is the true diabetes expert. 

I pride myself on  really listening to all of my patients’ needs. Before meeting for an initial visit, I ask a new patient to complete a “health assessment” form.  The form includes details about the individual’s medical and nutritional history, as well current medications or supplements, physical activity level and other relevant information.  People are often anxious before seeing a new health professional, and the information “intake” can be overwhelming.  I pride myself on allowing my patients to feel comfortable and relaxed when working with me.  Having this vital medical and lifestyle  information prior to meeting with a new patient allows me spend more time counseling and less time gathering data. I encourage families to become involved when appropriate. We also include the patient’s physician and other health care professionals in our care plan (as this should be a supportive team effort).

Once we start working “together”, everything about diabetes management is discussed.  My practice focuses primarily on a nutritional care and exercise plan.  We also discuss medication compliance and overall improved emotional health and well being.  Developing a nutritional care plan is a collaborative effort.  Your diet plan should not be overly restrictive and difficult to follow.  If I  told you to only eat dry fish and dark green vegetables all day, every day, you’d run out of my office!  So it’s important to work together to make “lifestyle changes” that will improve blood sugar control, while allowing  long term compliance (in the real world).  Only after I learn a little more about a person (and their lifestyle), can we start to amend and tweak what they eat.  We pay special attention to carbohydrate consumption, and eventually manage blood sugar levels.  Our goals can be somewhat varied. But basically, everyone wants to improve their blood sugars to prevent all of the long term problems that are associated with poor blood glucose management.  Sometimes goals include weight control, increased physical activity and portion control.  But everyone wants to live a long healthy life, without developing problems related to high blood sugar (such as diseases of the eyes, kidney and heart).

If you know someone who would benefit from working with a Registered Dietitian who is also a Certified Diabetes Educator, please check out the NCBDE website (www.ncbde.org). We truly are the diabetes experts!

At least twice a week I receive phone calls from potential clients with “pre-diabetes”. The conversation usually goes one of two ways. Scenario #1: ”My doctor called and told me I have borderline diabetes. He told me to call you so that I could start on a diet to lose weight and get my blood sugars under control. I”m scared! What can I do?”. Scenario #2: “My doctor and wife made me call you because my blood sugar was a little high. I don’t have diabetes yet, so I’m not sure that I need to see you. They made me call. No rush.”  I’ve been a Certified Diabetes Educator for over 15 years and I still feel the deep angst when a person with pre-diabetes contacts me who is not yet willing to make appropriate diet and exercise modifications. Pre-diabetes is an easier condition to treat than Type 2 diabetes. So early detection and treatment is essential to prevent complications.

Pre-Diabetes should not be taken lightly! It’s now estimated that 57 million Americans have pre-diabetes. Pre-diabetes is actually “Pre-Type 2 Diabetes”. If  it is not properly treated, it has the potential to progress to Type 2 diabetes. If your fasting  blood sugar (after 8 hours of not eating, usually overnight)  is between 100 mg/dl and 125 mg/dl then you have pre-diabetes. A fasting blood sugar of 126 mg/dl puts you in the Type 2 diabetes category. Remember that pre-diabetes has nothing to do with Type 1 diabetes, which is an autoimmune disorder. (We must continue to support research to find a  cure for Type 1 diabetes).  Brett Michaels and Nick Jonas are examples of people who have Type 1 diabetes.

According to Dr. Gary Trager, the director of the Center for Diabetes and Endocrinology and Metabolism in Huntington New York, “The risk of heart attack and stroke triples to quadruples when you have the diagnosis of pre-diabetes”. Pre-diabetes can also increase the risk of retinopathy and neuropathy.  Many people are walking around undiagnosed with pre-diabetes (as there are often no overt symptoms). In a recent study in the American Journal of Preventative Medicine, about half of those diagnosed with pre-diabetes don’t even try to lose weight or alter their lifestyle habits. I suppose either people are scared and want to prevent Type 2 diabetes, or they are not motivated to change their diet and physical activity habits until they actually develop full blown diabetes! Anywhere from 33%-70% of people who have pre-diabetes will develop Type 2 diabetes. Since it is much easier to control than Type 2, I continue to reach out to those with pre-diabetes in order to help them properly manage their blood sugars.

A study called the Diabetes Prevention Program (DPP) found that losing 5-7 % of body weight (by reducing caloric intake and increasing physical exercise) can prevent (or substantially delay) Type 2 diabetes from developing. Carrying weight in your belly is very dangerous, and can significantly impact your blood sugar levels. People who are “apple shaped” are at high risk for being insulin resistant. A woman with a waist measurement of more than 35 inches is at high risk for developing blood sugar problems. And a  man with a waist circumference of more than 40 inches is in the  high risk category.

Don’t delay! Get started today! If your not sure how to manage your carbohydrate and calorie intake, contact a registered dietitian and certified diabetes educator to develop a meal plan that will fit into your lifestyle and control your blood sugars. Start moving! Exercise is a key component to blood sugar management. Talk to your doctor about possible blood glucose monitoring and medications changes. Do whatever you can to prevent pre-diabetes from developing into Type 2 diabetes.

You finally agreed to go for your annual all inclusive physical. A few days later your doctor calls  with those bone chilling words “your blood sugar is elevated, you have diabetes”. And there is always this dreaded scenario…your child has lost a lot of weight, is experiencing extreme thirst and is always tired. One morning she is unable to wake up for school and you rush her to the emergency room. After a blood test the doctor emerges and announces ”your child has diabetes”. Diabetes is a scary word. So I thought I’d go back to basics and discuss the difference between Type 1, Type 2 and Pre-Diabetes.

Diabetes is a serious problem which will require medical attention and lifestyle adjustment. As a Certified Diabetes Educator, I want to increase awareness about the different types of diabetes. Type 1 diabetes (also known as juvenille diabetes, insulin-dependent diabetes mellitus or sometimes childhood diabetes) accounts for about 5- 10% of the diabetes in the United States. Although it is usually diagnosed in childhood, it can develop in adults as well.  At this point in time there is no cure for Type 1 diabetes and it   CAN NOT be prevented. It is an autoimmune disorder that occurs because the beta cells in the pancreas do not produce ANY insulin. Insulin is a hormone (chemical messenger) that helps the body’s cells use glucose for energy. Without insulin, glucose builds up in the blood and over time can cause excessive high blood sugar levels. If diabetes is uncontrolled it will cause major problems in every organ of the body. Serious complications of diabetes can include blindness, heart disease, kidney disease and stroke. All people with Type 1 diabetes must take insulin. Some people use injectable insulin and others use insulin pumps.

Type 2 diabetes also known sometimes as adult onset diabetes is more common than Type 1. Since many obese children have developed Type 2 diabetes, it should no longer be referred to as adult onset diabetes!  Having a sedentary lifestyle, being overweight and having a family history of Type 2 diabetes are all factors that will increase the risk of developing Type 2 diabetes.  Certain ethnic groups such as African Americans and American Indians also have a higher incidence of Type 2 diabetes. Most people with Type 2 diabetes can still produce some insulin. Unfortunately there is a problem with the  insulin receptors and therefore glucose continues to build up in the blood. The pancreas will continue to produce insulin in order  to keep up with the high blood sugar levels, but due to the problem with insulin receptors, blood glucose remains high and continues to cause problems. So although people with Type 2 may start out with insulin resistance, eventually they will develop insulin deficiency. In order to control Type 2 diabetes, it is important to modify carbohydrate and calorie intake while increasing physical activity in order to promote weight loss. Weight reduction can help reduce the excess “belly fat”  which increases the risk of insulin resistance. You must eat right, reduce your carbohydrate consumption and for goodness sake start moving! In addition to proper diet and exercise, many people with Type 2 also take oral medications. It is also important to realize that many people with Type 2 diabetes also eventually require insulin. Insulin may therefore be a necessary part of your treatment plan if you have Type 2 diabetes.

1 in 4 Americans over the age of 20 (about 57 million people) have Pre-Diabetes. Pre-Diabetes is a condition in which your blood sugar levels are elevated, but you are not yet diagnosed with diabetes. The important point to remember is that Pre-Diabetes is Pre-Type 2 diabetes. If you lose weight, control your belly fat and increase your physical activity you can control your blood sugars and prevent Pre-Diabetes from turning into Type 2 diabetes!

Diabetes is a serious and complex metabolic disorder. As a Registered Dietitian and Certified Diabetes Educator, I truly want to educate as many people as possible on the ways to treat the disease. If you have a child with Type 1 diabetes (or suffer from the disease yourself), please know that I support research in finding a cure. If you have Pre-Diabetes or Type 2 diabetes start to modify your lifestyle today! Many of my future articles/blogs will be about ways to improve living with diabetes!

November 14th is World Diabetes Day! Diabetes advocates everywhere (patients, educators, family members and friends) will be focusing on disease awareness. Diabetes will be acknowledged by the United Nations and is supported by the International Diabetes Federation (IDF) and the World Health Organization (WHO). World Diabetes Day began in 1991 and has brought a great deal of attention to the disease. The exciting part this year is the beginning of a five year push for diabetes education and prevention programs. I couldn’t be prouder or more energized to do my part as a certified diabetes educator!

Let’s bring it down to the trenches…what can we do fight this disease? What can I do as a diabetes educator to prevent the complications of both Type 1 and Type 2 diabetes? How do I reach more people with pre-diabetes in order to prevent or delay the onset of Type 2 diabetes?  How can we come together to find a cure for diabetes? These are questions I ask myself each and every day.

I’ve been a certified diabetes educator for over 10 years. During that time I’ve been involved in educating my wonderful clients on the importance of self diabetes care and education. I constantly stress the importance of improved blood sugar control, healthy dietary habits and increased physical activity. Staying motivated is a very difficult part of diabetes management. My goal is to encourage my patients to identify risk factors associated with diabetes and support them (always) in their quest to improve their physical and emotional health. Whether it’s just listening to the daily trials of diabetes management or dealing with the progession of the disease, I will continue to offer my complete support.

Diabetes has many possible critical complications such as heart, kidney and eye disease as well as increased incidence of stroke. It’s not as if one day you wake up and the pancreas will start actively producing insulin. So we have to work together to “fight” the disease. Together let’s work on getting our diabetes under control and band together to find a cure.