Rosanne Rust



Nearly 24 million Americans have diabetes, and an estimated 6 million of them are unaware of the scope of the disease. With obesity on the rise, millions more are at risk for developing diabetes. November is National Diabetes Month, and while controlling diabetes is not always easy, it sure is worth the effort. Research shows that education, goal setting, and support help people with diabetes manage their diseases very well.



Most folks know that weight control is part of diabetes management. “Losing just ten percent of your weight will help your body be more sensitive to insulin” according to Carol Spicher, a registered dietitian and certified diabetes educator working in an Internal Medicine office in Lancaster. Spicher really knows first hand how to manage diabetes; she has the disease herself. Portion control is an important part of calorie control, and eating fairly consistent amounts, at consistent times helps with overall blood glucose control as well.



Local registered dietitians (RD) and Certified Diabetes Educators (CDE) have several simple goals for you to consider:

Lose weight if overweight

Never skip breakfast

Get support and show up for appointments

Incorporate exercise into your daily routine

Consider meal replacements for sustained weight loss

Once you’ve met your weight loss goal, weigh yourself daily to maintain your weight loss



Spicher recommends choosing low calorie beverages. “Other than milk, all beverages should contain five carbs or less per cup.” Christine Gerbstadt suggests trying to include more water in your diet, and trying unsweetened herbal teas over too many diet soft drinks. Gerbstadt, a registered dietitian and physician, has one simple rule: “Never skip breakfast.” She also recommends including protein at each meal. Sources of lean protein include nonfat milk, low fat cheese, an egg white omelet, skinless poultry, fish, lean beef or pork. For those with type 2 diabetes, a whey protein powder supplement has been shown to reduce blood sugar levels. You could add it to morning oatmeal or milk. Liquid meal replacements, such as Slimfast or Glucerna have also been shown to help people with diabetes maintain their weight loss program. These provide a quick, portable solution to a potential skipped meal, and provide a balance of complex carbohydrate, protein and fat in a calorie-controlled package.



Misconceptions about a “diabetic diet” abound. Some of the concerns that people have when first diagnosed include the idea that you have to prepare “special meals” aside from the family’s meals, or have to eat a perfect diet every day. According to Leslie Lawson, a registered dietitian and CDE at the Mind Body Wellness Center in Meadville, being mindful of portion size and carbohydrate is important when it comes to weight loss, and this does not always require a measuring cup or special meal plan. She recommends being mindful of hunger and fullness cues to learn what it takes to be satisfied at a meal. “Slipping up doesn’t mean you’ve completely ruined your diabetes management. If you end up eating for reasons other than hunger, embrace the opportunity in the situation to guide your future choices. Beating yourself up about the situation has the potential to generate a cycle of negativity and continued overindulging”, says Lawton. Mary Alice Gettings, a dietitian working for the Penn State Cooperative Extension in the Pittsburgh area, seconds this notion. “Pay close attention to when you are truly hungry and move away from the table when the hunger pangs just go away. Savor the flavor of your food” and eat slowly. She recommends using the Internet to look for new healthy recipes, or finding a new diabetes cookbook to inspire you.



Spicher reminds you however, not to seek perfection, but instead maintain a positive attitude toward weight loss and diabetes management. “Fill half your plate with low carb veggies. Choose calories you can chew and enjoy!” According to Dr. Dawna Mughal of Gannon University, research shows that self-efficacy (the ability and confidence to believe you can meet a challenge) is strongly related to diabetes control. “Believe in yourself - in your ability - that you can take charge of your health.”





Don't forget about exercise. Physical activity helps lower blood sugar levels and is good for your heart health as well. Spicher, CDE, recommends trying a pedometer to log steps throughout the day, working toward 50,000 steps per week. Monitor your blood glucose carefully when you add activity or change your calorie level. As Lawton points out “Checking your glucose level isn’t a punishment, it is a way for you and your diabetes management team to help make certain that your diabetes is being managed” thereby avoiding preventable complications.



Everyone agrees that you should check blood sugars pre- and post exercise as you lower your calorie intake, particularly if you have Type 1 diabetes and are insulin dependent. People with insulin dependent diabetes have some special concerns when approaching weight loss or a new exercise program. While weight loss may be an important goal in your diabetes plan, first and foremost is managing your blood sugar levels. Gerbstadt recommends that you are careful not to ever compromise your diabetes management to lose weight. First be sure you follow your physician’s and health care team’s advice, and regularly check blood glucose levels. Once you have that under control, “then you can cut back on calories and increase activity for weight loss” says Gerbstadt.



In some type 2 cases, weight loss may eliminate the need for medication, although diabetes will always continue to need to be monitored. Juliet Mancino is registered dietitian and trial interventionist with the Look AHEAD study in Pittsburgh. Look AHEAD is a clinical trial examining whether 10% weight loss and 175 minutes physical activity will decrease the incidence of cardiovascular disease in people with type 2 diabetes. According to Mancino, the number one predictor of success for participants in the lifestyle arm of the study was greater self reported exercise minutes. In other words, those who logged the most exercise were the most successful in achieving weight loss. Other important factors that contributed to successful weight loss include participation in clinic visits and use of meal replacements.



Seek the support of a Certified Diabetes Educator and your health care team so you can live a healthy, happy life with diabetes. Take control, and keep it fad-free.



Rust is a licensed, registered dietitian and nutrition coach who has a private practice in Meadville (www.rustnutrition.com), helping people learn how to eat well for good health. She is a nutrition instructor for Penn State’s World Campus and a licensed provider for Real Living Nutrition Services®. For more information about her online weight loss counseling and nutrition coaching service, visit her Web page at www.rosannerust.com or contact her at Rosanne@rustnutrition.com.



©Rosanne Rust 2009