Ask the Nutritionist Archive, Thursday, June 3, 2008

Anthony Valenza, R.Ph., graduated from Northeastern University in Boston, MA with a BS in Biology and a degree in Pharmacy. He is currently a pharmacy manager at Rite Aid in Saugus, MA. Anthony became a Certified Diabetes Manager in 2004 and is a participant in Rite Aid's Medication Therapy Management and Immunization programs.

Chiung-Huei Lui, R.Ph., is a Rite Aid pharmacist in Union City, CA. Chiung-Huei received specialized training in diabetes care through the National Institute for Pharmacist Care Outcomes (NIPCO) Diabetes Care Certificate Program and is one of Rite Aid's Diabetes Care Specialists.

Natalie Teaff, R.Ph., is a drug information specialist at the Rite Aid Drug Information Center. She received specialized training in diabetes care through the National Institute for Pharmacist Care Outcomes (NIPCO) Diabetes Care Certificate Program.

ADA_Moderator: Welcome to ADA Live. Today our guest is Stephanie A. Dunbar, MPH, RD, ADA Director of Nutrition and Clinical Affairs, It's a pleasure to have you here today Stephanie. We have a lot of questions so we're going to go ahead and get started.

tawanda2u: the only thing I can eat it seems to me is shrimp without raising my numbers Is this normal. I haven't been diagnoised that long ago (1 month today) and am trying to get the carbs and stuff down but I'm confused totally....Is there an easier way? MB
Stephanie: If the only thing you can eat is shrimp, I can see that it would be a problem. It doesn't really make a lot of sense though not to be able to eat other meats and fish without raising blood glucose levels. When blood glucose levels are high, it means you have an imbalance somewhere. To keep blood glucose levels lower, you have to match the amount of food you eat (particularly carbohydrate), with physical activity and medication if it has been prescribed by your doctor. For many people recently diagnosed with type 2 diabetes, it can also be very helpful to lose weight to lower blood glucose levels. I would suggest that you keep a food record of everything that you eat and drink for 3 days. Take the food record and any records you have for your blood glucose results in to your next appointment with your health care team. They can help you to troubleshoot what is out of balance so you can get your blood gluocse levels lower - while eating more than just shrimp!
jcasper121382: my question is i have read some labels of things that have lets say 30 carbs then underneath it it says 4 sugars then i have read things where it says 5 carbs and 5 sugars which is better for me the one with more carbs but less sugars or the ones with more sugars but less carbs
Stephanie: The first thing to know is that sugar is a type of carbohydrate. The grams of total carbohydrate on a label includes the amount of sugar. So in your example of 30 grams of carbohdyrate - 4 of them are sugar. There are 26 grams of another type of carbohydrate - starch or fiber. The second thing to know is that both starch and sugar raise blood glucose levels. The most important thing to look at on the label is the total carbohydrate because it includes both types of carb that raise blood glucose levels. That is the number that you use if you are carbohydrate counting. Back to your example: the answer depends on what you are eating. Obviously those are 2 very different foods to have one with 5 grams of carb and one with 30. Ask yourself what else you are eating? Is this for a meal or a snack? Eating the food with only 5 grams of carbohydrate will have much less impact on your blood glucose levels than the food with 30 grams of carbohydrate. But which to choose is your decision based on the questions above - as well as others such as have I been more active than usual? Am I taking any medicines that requrire me to have at least x number of grams of carb. When you are label reading, you also can compare the fat and fiber in two products before making your choice.
lep: How do for know how many carbs you are to eat each day. Is there a formula to figure this out.
Stephanie: There is no formula. It's an individualized amount based on many things including your physical activity level, weight, need for weight loss, how much carb you are currently eating, medication (if any) you are taking, age etc. Many educators recommend starting at about 45-60 grams of carbohydrate at a meal and using your blood glucose checks to help identify if it is too much or too little carbohydrate. If your blood glucose levels are consistently high or low, you need to change something about your routine whether it be physical activity, carbohydrate intake or medications. Work with your doctor or other member of your health care team to identify the right amount of carbohydate for you. You can also call 1-800-DIABETES or email askada@diabetes.org to request free materials on nutrition that can help point you in the right direction.
ad: is meat good for people with diabetes
Stephanie: By meat, I"ll assume you mean red meat. Meat can be included in a healthy diet but you do want to choose the leanest cuts you can find. Examples of lean meats are sirloin, round, flank steak, tenderloin, rump roast, t-bone steak, porterhouse and ground round. I'd also recommend that you limit how often you eat it and make sure to include fish twice a week!
Terry_C_: Where can I find a food pyramid that can be printed out?
Stephanie: You can contact our National Call Center and request the brochure, First Step in Diabetes Meal PLanning which has a food pyramid in it. It's free - call 1-800-DIABETES. There are also other booklets on nutrition that cover different types of meal planning such as carbohydrate counting, " create your plate" and the glycemic index.
Sam: I want my dad who has diabetes, type 2 to get in the habit of no less than moderate excersise. Do you have a chart that shows health benifits on a scale that will at least demonstrate how a little goes an extremely long way and how a lot goes very far. He can walk the golf course, but I would like him to get in the habit of regular swimming for this summer because it is something he and my mom like and I know how far this type of excersise goes .
Stephanie: I don't have any type of chart, but if your father is able to walk the golf course, then that definately counts. If he's actually carrying the clubs, even better. The best advice I can give is encouraging him to get exercise most days of the week and gradually increase the duration. Swimming is definately a great form of exercise if he chooses to do it. Remember, it will be more helpful if you encourage him. Try not to get in the role of nagging because it is up to him to make these changes to his lifestyle and improve his health. Good luck.
Rick: I am a diabetic and my blood sugar keeps dropping very low (35-40) What does that mean?
Stephanie: It means you have too much insulin in your blood stream for the amount of carbohydrate you are eating. This can happen when you don't eat as much as usual, you exercise more than usual or you are taking too much medication. You should contact your doctor to have a change in your management plan if you blood sugar drops low about the same time. He or she can help you troubleshoot how to avoid low blood glucose levels.
Tara: I am a Type 2 Diabetic for almost nine years now... Is it okay to drink wine and if so, red or white?
Stephanie: If your blood glucose levels are well-managed and you don't have any contraindications (severe neuropathy, history of alcoholism, etc.), it is ok to have a small glass of wine. A couple of rules of thumb: 1.) keep it to 1 (5 oz wine)drink for a woman and 2 drinks for a man per day; 2.) don't drink on an empty stomach. It's your choice of white or red - both have similar heart protective effects.
Luvbug: What is the 1800 Calorie Diet for the ADA??
Stephanie: Many years ago, well over 10 now, the American Diabetes Association used to have "the ADA diet." This was a predetermined meal pattern based on calorie levels. Everyone with diabetes was given the same sheet of paper. If you didn't like tuna, it didn't matter - that was lunch on tuesday. Obviously, this didn't work for many people!! Having a guide of what to eat is important, but having to stick to a predetermined set of meals that doesn't account for your food prferences, doesn't work. Managing diabetes is a lifelong challenge. You will be eating for the rest of your life, and you need to be able to include the foods that you enjoy or else it will be extremly difficult to stick to your plan. So the ADA doesn't have those sheets any longer. Instead, we recommend that everyone have an individulized plan based on their personal needs. For example, do you have high blood pressure? high cholesterol? need to lose weight? need to lower blood glucose levels? All of these things need to be considered in developing a meal plan. Instead of "diet sheets," ADA now has a 32 page booklet to offer. It includes information on carbohydrate, fat, carbohydrate counting, glyemic index, and has 2 sample menus in the back. You can get a free copy by calling 1-800-DIABETES or sending an email to askada@diabetes.org
Greta: Dear Stephanie, I was at a health fair last week. I chose to have my blood glucose checked even though I had eaten lunch about 40 minutes before. My results were 137 and I am worried that I may have pre-diabetes. What do you think? Thank you.
Stephanie: Diagnosis for pre-diabetes is a blood glucose of between 140-199 two hours after eating. The test needs to be repeated on a second day. Only a doctor can diagnose diabetes or pre-diabetes and the setting at a health fair is not controlled enough to know if the number is accurate. That being said, based on that one test, your blood glucose level may be creeping up. Next time you are at your doctor's office, tell them about the result and your concern and asked to be tested for diabetes. In the mean time, you can take action. The best way to prevent pre-diabetes or diabetes is to lose weight if you are overweight. Losing 15-20 pounds can reduce your risk. Becoming more active by getting at least 30 minutes of aerobic exercise every day will also help.
oldylox: What can I eat for breakfast besides eggs that are not carbohydrates??
Stephanie: You can try reduced-fat, light fat or non-fat cheese. Nuts or nut butters work well for breakfast on an apple or bananna or a slice of toast. Lean ham, canadian bacon, or other lean breakfast meats. There are a lot of soy breakfast options available. They do contain some carbohydrate but also contain fiber and protein. Instead of eating the whole egg, try making an egg white omelet with sauteed vegetables like red peppers, onion, olives and mushrooms.
curser7: I like to ride my bike as a work out. I'm going to be doing a 40mile ride (a long distance for me). What concern should I have with drinking energy drinks
Stephanie: When you are exercising for more than 30-60 minutes, it can be important to have a source of carbohydrate to keep your blood glucose levels from dropping. Remember that physical activity lowers blood glucose. You may need about 30-50 grams of carbohydrate for each hour of the ride. Sports drinks are a way of replacing fluid as well as easily getting the carbohydrate. If you are not used to riding this distance, you should try it out beforehand so you know what to expect with your blood glucose levels and can have the appropriate supplies (snacks, gels, glucose tablets) with you.
blackie: What does sugar alcohol mean as compared to sugar free. Is sugar alcohol dangerous to a diabetic???
Stephanie: Sugar alcohol is a type of carbohydrate. It is not made from alcohol. Sugar alcohols are "reduced calorie sweeteners" that provide on average, half the calories of sugar. It is not dangerous to use them; however, some people are sensitive to them and they can cause gastric symptoms such as gloating, gas and diarrhea if you eat too much of them.
Bobbi: What is the purpose os sugar substitutes? Are they necessary? Can a diabetic eat sugar vs a sugar substitute?
Stephanie: Sugar substitutes are used to sweeten foods without adding calories or carbohydrates. You do not have to use sugar substitutes. You can choose to eat regular sugar, but you need to be cautious how much you eat. There is about 4 grams of carbohydrate in a teaspoon of sugar. So if you add 1 teaspoon to your coffee, you won't see much of an effect on blood glucose levels. . . but if you drink coffee with sugar in it all day, it will have an impact. It's a personal choice whether to use them. Either way, most of your diet should focus on non-starchy vegetables, lean protein sources, beans, fruit, whole grain and non-fat dairy products. A little bit of sugar can be worked into your meal plan.
destinokee: I have just been diagnosed with diabetes T2 and now I am looking into the food labels closely. My question is to determine the amount of carbs. There are two parts to the Nutrition FActs label. I have noticed that the dietary fiber is listed on the top portion of the label and the bottom portion. Which of the two "dietary fiber" do I need to use to determine the amount of carb? I have realized that the more fiber I eat the fully I feel. But I also want to be carefull with the total carbohydrate. Thanks, destinokee
Stephanie: You look at the dietary fiber on the top part. This is the amount of dietary fiber in one serving of a food. The information at the bottom tells you the goals for a whole day - but does not provide you information about the actual food you are eating.
Doug: How long after eating should I check my blood levels? Should they be elevated above 140 after I eat?
Stephanie: The American Diabetes Association recommends that blood glucose levels be under 180, two hours after eating. This is a general target and your goal may be different. Check with your health care team for their recommendation for your target number.
Ange: In short, I am asking about sodium intake in the diet of a person with Type II Diabetes. People with Diabetes must watch sodium and fat intakes closely as well, right?
Stephanie: Carbohydrate, sodium, fats, fiber . . . the list goes on of things to either increase or decrease when you have diabetes. Carbohydrate is the most important factor for managing blood glucose levels. This is true. The other truth is that the most common diabetes complication is heart disease. The two diseases are very closely linked - so it's important to cut back on saturated fat, trans fat and sodium to lower your risk of heart disease.
meachie: does diabetes atomaticly result in kidney failure?
Stephanie: No, it does not. One of the possible complications of diabetes is kidney problems. Having diabetes does not doom you to have kidney failure or any other complication. Keeping your blood glucose, blood pressure and cholesterol numbers near your goal will lower your risk of developing diabetes complications. Specifically for kidney problems, keeping your blood glucose and blood pressure at your goal will reduce your risk.
Kolenko: What is the best diabetic cookbook for someone who has had a heart transplant?
Stephanie: The ADA has many cookbooks. All of our cookbooks provide the nutrition information for the recipes so you can see how much carbohydrate, protein, saturated fat, and sodium are in the recipe. Because all of our cookbooks provide healthy recipes, it's really your choice based on the types of foods and cooking techniques you prefer. To see our whole line of cookbooks go to diabetes.org/store. On the left-hand column, click on cookbooks.
ADA_Moderator: That is all we have time for today. Thanks so much for taking the time to be here Stephanie. Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.
ADA_Moderator: Keep up to date with all the ADA Live events and reference the archives here. We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, June 5, 2008. See you then.