Symptoms of hypoglycemia

Fatigue, insomnia, dizziness, mental confusion, heart palpitations and nervousness. Sometimes people experience changes in mood such as depression, temper tantrums, and uncontrollable crying or emotional swings. Many of my patients report craving carbs (refined or simple sugars), when they experience low blood sugars. Extreme hypoglycemia can result in fainting, coma or even death.

Treatment for hypoglycemia

The best way to treat hypoglycemia, is to prevent it with dietary and lifestyle modifications. Proper use of medications and insulin should also be evaluated on a regular basis. Work with a registered dietitian who is also a certified diabetes educator to try to avoid hypoglycemia. Your doctor will check your insulin levels, re-evaluate your medications, and evaluate your sleep and lifestyle habits.

Some tips and tricks to avoid hypoglycemia:

• Discuss blood sugar testing with your doctor
• Keep regular appointments with your physician. Provide your doctor with your blood sugar record for evaluation
• Schedule an appointment with a registered dietitian who is also a certified diabetes educator. Together you can design a meal plan to help avoid fluctuations in blood sugar. Including lean protein and high fiber foods and not skipping meals and snacks will help regulate your blood sugar levels
• Learn how to properly test blood sugars; this will reduce cost and waste of test strips and other expensive blood sugar monitoring materials
• Avoid or limit alcohol intake
• Carry fast acting glucose tablets or gels because fast acting carbohydrate can help quickly elevate blood sugar levels (food substitutes include 4 ounces fruit juice, 1 tbs honey, 4 tsp sugar or 5 pieces of hard candy)
• A family member or significant other should be instructed on how to use a life saving glucagon kit
• Check your blood sugar before exercising; if it is below 100 mg/dl, have a snack and re-test in 15 minutes
• Check your blood sugar again during extended periods of physical activity; hypoglycemia can occur 24 after exercising
• If you are sick, contact your physician; proper sick day management (including possible medication adjustment) may be needed to prevent hypoglycemia
• Wear a medical alert bracelet (the symptoms of hypoglycemia can be confused with being intoxicated)

As a CDE, I work closely with my patients and their physician to determine how often blood glucose testing is necessary. When someone is first diagnosed with diabetes, it is very important to test more frequently. I usually suggest testing first thing in the morning (fasting), 2 hours post a meal, and before bed. If morning blood sugars are not within target range, we might suggest occasionally testing at 3 AM. This is obviously very inconvenient, however it might help us determine if medications or diet should be adjusted. Hopefully, the 3AM blood sugar testing won’t have to be done very often. Many patients who are on insulin pumps also use a CGM (or continuous glucose monitor), which helps to monitor blood sugar levels.

Testing, My Story

In reality, blood sugar testing can be inconvenient, costly and at times unpleasant. Recently I had a great opportunity to visit the JJDI (Johnson and Johnson Diabetes Institute) in San Jose CA. We had a great opportunity to wear insulin pumps (of course mine had saline). We tested our blood sugars regularly over the course of a few days. As a CDE, I was able to “briefly” experience the reality of frequently blood sugar testing and carb awareness in order to regulate my blood sugar levels. It was an eye opening experience which allowed me walk in a pwd shoes (or pumps ) for a few days. Having “hands” on experience helped me understand the how important it was to learn proper blood testing techniques. It’s very important for pwd to be instructed on how to properly use test strips, lancets etc to save money and time.

Do you have any tips about preventing and treating hypoglycemia? Please let me know your thoughts and comments.

Ashley had been prescribed steroids to combat a severe sinus infection. After seeing a change in her face, the media began to question whether or not Ms. Judd had plastic surgery. While she was promoting the show “Missing”, one reporter actually asked her if she had plastic surgery. Several reports stated “Ms. Judd clearly had work done”. They even went so far as to speculate about procedures she had done! In fact, she has not had plastic surgery.

As a nutritionist in private practice, I work with women and men who have severe body image issues. I’ve been a professional member of The National Eating Disorders Association for over 15 years, and have worked with eating disorder therapists and psychiatrists to help my patients work through these devastating issues. Many women and men have unreasonable goals regarding body weight.

Aging and Adapting

As we age, our body changes.  We must continue to eat well, exercise and get adequate sleep in order to maintain (or achieve) good health (and prevent chronic disease). However, how we look at 20 years old, is simply not how we look at 50 years of age. Wisdom comes with age. So do a few wrinkles around our eyes and a couple of pounds around our mid-sections. Ms. Judd is in her mid-40′s and is surely entitled to look different from when she was in her 20′s.

Mothers who have battled weight for most of their lives often become critical of their daughters bodies. I work with many families where a young girl (with an overweight mother) tends to either eat large amounts of food in private, or  starve themselves to achieve an unrealistic weight goal. Has anyone ever commented on your weight? Have you reacted in a negative way  such as severely restricting your food intake or binging? This behavior is a common occurrence which needs to be addressed both in the media and at our dinner tables.

When a Size 6 is considered “fat”

Even with proper diet and routine physical activity most of us will not obtain the perfect bodies that we lust after. Most of us will never be a size 2 while maintaining good health. Ashley Judd went from a size 2/4 (about 13 years ago) to a size 6 (during a period when she admits to being physically inactive).  By Hollywood standards, a size 6 is considered fat. Judd was taken back by comments such as “you better watch out that your husband doesn’t start looking for a second wife” Or “you’re a cow”. On that note, I’d love to hear your thoughts and comments on this subject.

Unfortunately, I’ve been to my share of shiva calls and sat shiva for my father. (“Sitting shiva” means “participating in the shiva process”.) Friends, relatives, neighbors and even business associates show respect for the mourners by visiting the shiva home and bringing in food, or sending in “platters of food”. It is customary for the door of the shiva home to remain unlocked, so visitors can arrive without fanfare, and visit with the mourners. Food is brought into the home, so that the mourners don’t have to prepare food. Mourners are not supposed to serve food, or even offer food to guests. Food is usually put out in the kitchen and often platters of food are set up throughout the home for visitors. 

Guidelines for supplying food for shiva:

If the mourners are Kosher, order food in from a Kosher caterer

Even if you don’t know anything about being kosher, it is very easy to contact a kosher caterer and order a meal for the mourners. Kosher establishments will graciously guide you through the process. Kosher food can be costly, so consider sharing the cost with another person in the community. The caterer will usually deliver it to the shiva home.

Take food directly into the kitchen

Since the door to the house is usually unlocked, quietly enter and bring the food directly into the kitchen. Shiva is a time for respect, and therefore it’s not necessary to announce your arrival or bring attention to the food that you kindly brought into the home of the mourners. Friends and relatives who are helping to set up the food may ask for your assistance in terms of setting up a meal or putting out some sweets.

Consider bringing a vegetable or fruit platter

Many people who come to a shiva house bring cookies, candy or pastries. If you have ever attended shiva, you know that the amount of sweets in the home is often more than could ever possibly be eaten. Vegetable, fruit or nut platters are a great healthy addition to a shiva gathering. Remember that people eating shiva are in mourning, and need nourishment as well as comfort. Healthy food is always appreciated in a shiva house.

If you are invited to eat with the mourners, please join them

Although you should NEVER expect to join the mourners for meals, they may invite you to join them for a meal. Remember to be considerate and moderate in your consumption of food. Typically, visiting guests don’t eat meals with the mourners, but then again, they might be invited to eat with the family.

When we sat shiva for my father, the food ranged from homemade to store-prepared to gourmet catering. There were so many dinners ordered from a local caterer, that they called me after shiva to offer me a gift certificate in lieu of sending food that they knew we wouldn’t be able to eat (or store) during the week-long mourning period. My mother felt it was “bad luck” to give away food from a shiva home, so much of it was thrown away. Now when I go to a shiva home, I call other people to coordinate food efforts. Most importantly, I do things other than provide food. I help set up meals, clean up the kitchen, take out the trash, walk and feed dogs or other pets. Most importantly, I listen to stories about the departed and offer my deepest condolences. Please share your thoughts and comments on shiva.

Were you one of those kids who put your spinach or Brussel sprouts under the table table for the family pet? Or did you offer to send it via snail mail to less fortunate children? The bottom line is green foods have remarkable health benefits, and are delicious. As parents, we have to learn not to “push” green foods as a punishment. If they are cooked and presented in a tasty way, your family will gobble them up.

Healthy, Heart-y and Happy

Green foods are immune boosters, good for your heart, and can improve your mood. Although green beer on St. Patrick’s day may temporarily improve your emotional outlook, green veggies and (naturally green) foods have a long lasting positive effect on your overall health and well-being.

Here are some tips on how to make your diet “greener”:

• Eat more raw green vegetablesKeep cut up green peppers, broccoli and edamame in the refrigerator. After a busy day you can reach in and munch on some delicious and crunchy snacks. Try dipping these delightful veggies into fresh hummus, salsa or Greek yogurt.
• Drink Green TeaGreen tea is rich in cancer fighting anti-oxidants as well as antiviral properties. If you want to reduce your caffeine intake, try decaf green tea. It’s a great substitute for carb laden drinks and tastes great!
• Have a “green” based saladSalads should be colorful and tasty. Try making the base of your salad a bowl of green. Use fresh spinach (washed well), kale, and dark green romaine lettuce. Top off your salad with some avocado (which is rich in vitamins K, E and B as well as fiber). Finally, build up your salad with some colorful red peppers and tomato. Doesn’t that sound perfect?
• Cut up some cucumber into your waterI’m always looking for ways to increase my water intake. I enjoy fresh lemon and lime in water, and recently tried sliced cucumber in ice cold water. Cucumber gives water a fresh and crisp taste. After you’re done, be sure to put the chilled cucumber on your eye lids – to help reduce eye puffiness!

If you want some fun tips on Healthy Green eating and activities for the kids on St Patrick’s day, please check out St Patrick’s Day – Nourish Interactive. These free, printable St Patrick’s Day activities help kids make a positive association with eating green vegetables and fruits.

Above all, have a wonderful, happy and safe St. Patrick’s day. Everyone has a little bit of Irish in them. It’s time to improve our health by eating green all year long. What are you doing for St. Patrick’s day? Please share your thoughts and comments.

Eating a low carb meal plan as part of a nutritious diet is essential for good diabetes management .  Planning meals and snacks which should include lean  protein (such as fish, eggs, poultry, and lean meat), along with adequate fiber (from whole grains and veggies) can help improve your blood sugars. Here are a few suggestions on how to lower the carb content of your “side dishes”:

Make a “Switch”

• to whole grains such as brown rice or quinoa
• add low carb vegetables to your recipes
• to spaghetti squash instead of pasta
• try substituting bean sprouts for noodles

Measure out your portions

Use a food scale as well as measuring cups and spoons to help you control your carb servings. After a while, you’ll become familiar with proper serving sizes.

“Redefine” your side dish

Enjoy broiled tomatoes or grilled eggplant with garlic and basil or mashed cauliflower topped with cheese. All are delicious and much lower in carbs than traditional pasta or potato dishes.

In a pinch, cut cherry or grape tomatoes in half, toss with pepper and oregano. Heat for 20 seconds in the microwave and use as a topping on scrambled eggs.

Check out http://www.dlife.com/diabetes/diabetic-recipes for some fantastic and delicious low carb recipes and side dishes. You may be surprised at the variety of ingredients and recipes on this site.

Spice up your side dishes

Use fresh seasonings to make them interesting and satisfying. Start your meal off with a colorful fresh salad, dressed with olive oil and vinegar. Over the winter, try some fresh vegetable soup. These low calorie, low carb appetizers can help curb your appetite for starches during the meal.

Remember to keep moving

Regular exercise can help control your blood sugars as well as your stress level.

Do you have any low carb recipes that you’d like to “dish out”? Please share your thoughts and comments.