3 Tips on Eating Out With Diabetes

When you have diabetes, managing your diet can be strenuous. Managing your diet when you're diabetic and eating away from home is even more challenging. When restaurants and fast food are the only options, how do you know what to choose? Certainly eating nothing is not an option, since that's dangerous to any diabetic. But what's the best choice with limited options? Here are a few tips to follow when eating out on a diabetic diet:

1. Ask What. Whenever you're compelled to eat from a menu that you're unfamiliar with, ask yourself what the true content of the food is. Consider what the carbohydrates are: are they complex, do they contain any fiber and if so to what extent? Fruits and veggies are the best type of carbs, but you do need to include whole grains for their unique nutritional value. Next, what type of fat is in the food you're looking at? What oils have been used to cook this food, and how much has been used? Some oils have a higher caloric impact, while others are more processed and may be absorbed into your system more quickly. Finally, ask what type of protein is involved in what you're eating. You want to eat lean meats, and if eating vegetarian, consider that beans, legumes, and so on aren't complete proteins in and of themselves. Food combining becomes very important when you're eating vegetarian to ensure that you get the right amino acids, i.e. the building blocks of protein. Eat legumes with grains, nuts or seeds, grains with legumes or dairy, and nuts and seeds with legumes.

2. Ask When. How often to eat is an essential element to eating with diabetes. When eating out, it becomes more difficult, especially if you manage your diabetes with insulin. First of all, do not take your insulin at home and then go out to a restaurant – you can't control delays in your food delivery when you're out, so take your medication with you. Secondly, consider portion sizes with the frequency of your meals. Try to avoid eating too much at one time, and instead take some food home with you when appropriate. You will often not know truly how big the meal you're ordering is until it's in front of you, so be prepared to ask for a doggie bag to avoid throwing your blood glucose levels out of whack.

3. Ask Who. Whoever's food you're eating, i.e. what type of cuisine it is, can present certain challenges for you if you're diabetic. For example, Italian food often involves pasta, sauce, and occasionally free bread. Always opt for whole grain pasta, limit your bread intake to one serving, and try to order sauces that are free of fattening things like dairy, or bacon. With Tex-Mex food, it often comes loaded with cheese and/or sour cream, so be careful how much you consume. Plus, those tasty dishes can often be deep fried, so make sure you're aware of how they've been prepared. Asian food is much more popular these days, but alas this cuisine has become more westernized. All-you-can-eat-buffets are common, and more and more things are being deep fried. Plus, those delicious Asian sauces often contain tons of hidden sugar.

The bottom line is simply to think before you eat. Luckily, eating out is still an option – just get educated about what you're going to ingest, when you're going to do it, and where some of the hidden calories might come from. You never know, you might help out some friends with your new-found knowledge!

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

3 Tips on Helping Your Teen with Diabetes

Having a teenager is tough enough trying to balance an urge to care for them constantly, with wanting to give them their space and show them trust. When your teen has diabetes, it becomes that much more difficult – how can you leave them alone and trust that they'll take proper care of themselves? Especially when their self-care is that much more important than that of their peers? With a few key tips, you can learn to let go, while at the same time know that the ones you love are safe and prepared.

1. Let them be seen. Especially in the early teen years, your teenager will place a great deal of importance on body image and will seek more reassurance from their peers than from you. This is a good reason to promote healthy diet and exercise plans for the whole family rather than mentioning weight issues and body changes in your teen. Keep an eye out for potentially risky behaviour: some teens can be tempted to reduce or skip meals, or even their insulin injections in an effort to lose weight.

2. Let them be free. Try to give positive encouragement to your teen about their diabetes management. Even using terms like 'good' or 'bad' can come across as judgemental, so try to praise them freely and at the same time focus on a plan. This won't be easy, because being a teen also means being spontaneous, and diabetes can certainly discourage a lot of that spirit-freeing need. When there's a next step to plan for, the current results tend to be less important, so try to encourage them to think about 'what's next' regarding their diabetes management. With a plan in place, they can learn to follow it without much thought to it, so they can still go out and be spontaneous.

3. Let them be a boss. Have them be involved in the decision making process: when they have worked with you and their diabetes team, together you've all decided on the right goals. These goals include safe glucose levels, the right diet plan, and the right medication plan, and so then reminding them about what they helped to decide means a lot. It certainly has more impact than telling them what you think or what the doctor told them – giving them a say in their own health and then holding them to their word will go a long way.

Ultimately, there's going to come a point where you just have to let go – you can't be around your teen every minute of every day, and you have to accept that the disease really is their disease, and not yours. Sometimes being a good parent means being there for your child, and sometimes it means just being there in case they need you. Keep the lines of communication open, and when they do approach you, be supportive.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

Case Study: Acupuncture and TCM for Diabetes and Double Vision

A 62 year-old woman presented with a main complaint of double-vision, especially at night, for two months. She was no longer able to drive, and was very concerned with getting her driver's license back. She had been diagnosed with diabetes 7 years previous.

Other symptoms included night sweats, some low-back pain, and frequent urination. She also experienced some occasional weakness in her right knee, and had dry skin and itchiness on her forearms and lower legs.

Her tongue was red with very little coating, and her pulse was quite thin and rapid.

Diagnosis: Kidney Yin Deficiency affecting the Liver, and hence the eyes.

Treatment Principle: Nourish Yin and Liver Blood to correct the vision issues.

Acupuncture Points Used: BL 17, BL 23, GB 25, RN 4, RN 6, KD 2, KD 3, KD 9, SP 6, LR 8

Herbal Formula Used: Qi Ju Dihuang Wan (Lycium Chrysanthemum Rehmannia Pill) to nourish the Yin and benefit the eyes.

After 10 treatments over the course of six weeks, the patient reported no more incidents of blurred vision at night. Her doctor's testing confirmed that she was indeed seeing properly, and could get her driver's license back. She also experienced some relief of her night sweats.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

Case Study: Acupuncture for Diabetes and High Blood Pressure

A 59 year-old man had been suffering from diabetes for the previous 11 years. He was diagnosed with borderline high blood pressure 2 months ago. The diabetes presented with excessive thirst, with dry mouth and tongue. The patient also complained of frequent urination, including at least two times during the night, when he was woken by the urge. He also had dry and cracked lips, and apparently had suffered from constipation since his teenage years. Blood pressure was reported as 140/85.

His general health was good, although he was prone to getting a cold or flu every three months. His tongue was red, with a dry-yellow coating. His pulse was very full and rapid.

Diagnosis: Lung and Stomach Heat. It was believed that Stomach Heat had reached his Lungs, depleting Lung Yin and Lung Qi as well.

Treatment Principle: Clear Heat from his Stomach organ system, and also nourish Yin and Lung Qi.

Acupuncture Points Used: LI 4, LR 3, LI 11, ST 44, SP 6, KD 6, LU 7

After two treatments per week for 4 weeks, the patient reported that his blood pressure had dropped to safer levels. He continued treatment once a week for two more weeks, and then returned periodically for routine maintenance.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

5 Tips About Your Ageing Parent and Diabetes

With the growing epidemic of diabetes in our society, it's no wonder that many people are finding they have an ageing parent with the disease. If you're one of this burgeoning group of people, you may be discovering that this parent who once took such good care of you is now not taking very good care of themselves. And with a diagnosis of diabetes, them taking care of themselves is an even greater concern for you. No diagnosis yet? Here are the signs to look for that might indicate your parent is diabetic:

• extreme thirst
• extreme hunger
• frequent need to urinate
• nausea
• blurred vision
• shaking or tremors
• anxiety or irritability
• fatigue
• dizziness and/or confusion
• irregular or fast heart beat

Once you're sure that your parent needs your help, there's no going back. But don't feel overwhelmed just yet – there are a lot of ways that you can help them, and a lot of resources out there to help support you in your efforts. Here are some tips:

1. Get educated. Knowing about the risks, the warning signs, and treatment options for diabetes can go a long way to helping you be prepared. And being prepared will help give you a better feeling of control and reassurance that everything is going to be okay with your loved one.

2. Manage the team. You, your parent, and the doctor(s) involved are a team now. Make sure that you're involved in communicating with your parent and their medical professionals so you can not only see that all the bases are being covered, but so that you can have some peace of mind about it too.

3. Get active. If your parent is not very active, invite him/her out on outings with you, even that just means a walk after dinner. Try to get them involved in activities that they might enjoy as well. Some examples are gardening, mall-walking, art classes, Tai Chi or light yoga. Even spending more time with the rest of their family doing things can help them move those muscles more. Click here for more tips about exercising with diabetes.

4. Get cooking. Help your parent plan meals by cooking for them and showing them how delicious healthy food can be! It's one thing to tell them what to eat – it's another to show them. Click here for more tips on eating with diabetes.

5. Find support. Join a support group that will help you cope – you're not alone and there are tons of people online and in person who want to show you just that. Being proactive and discovering that you have someone there when you need them can make you that much more helpful to that parent who loves you.

Switching roles and becoming the care-giver can be a scary process. Sometimes it's gradual, while other times it comes along quite quickly. Try to be patient with yourself and your parent through this process: avoid using words like 'good' or 'bad' with the both of you. You're both learning and growing, so adapting to diabetes doesn't have to be a torturous ordeal. It can simply be something that you do together.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

These links may also be helpful:

Massage Therapy as a Treatment for Diabetes

Treating Diabetes with Acupuncture

Diabetes and the Link to Kidney Disease

The complications of diabetes can lead to a variety of issues, one of which is the possible threat of kidney trouble. If you've been diagnosed with diabetes, or even prediabetes, there are certain steps that you can take to help prevent the onset of kidney disease, aka nephropathy. Nephropathy caused by diabetes is known as diabetic nephropathy.

Diabetes is indeed the leading cause of kidney failure today, and is more prevalent in African Americans, aboriginal Americans, and Latin Americans. Unfortunately, the precise interplay between diabetes and kidney disease is not well known, and there is not yet a cure for diabetic nephropathy. Essentially, it is believed that over years with high blood pressure and high blood glucose levels, your kidneys become damaged, thus preventing them from working properly, or even failing altogether. Luckily, proper management of diabetes can prevent or delay any serious damage to your kidneys.

Your kidneys help to filter your blood, excreting waste through your urine. Your kidneys also help to regulate the fluids and salt content in your body, an important factor in controlling your blood pressure. Each of your two kidneys has approximately one million tiny filtration units, called nephrons. And each nephron has a small filter called a glomerulus, which is attached to a tubule. It is through this tubule that waste and water pass through. When breakdown occurs, it is at this point, where the glomeruli work together with the tubules.

As was said above, it is unclear why high blood sugars and high blood pressure should damage your glomeruli, although it is likely related to your kidneys working so much harder to compensate for increased blood pressure. Because high blood sugar levels damage your blood cells, this further stresses your kidneys as the glomeruli are essentially a network of blood cells.

The following are some of the early signs of kidney disease in people with diabetes:

1. Albumin/protein in your urine.
2. High blood pressure.
3. Swelling in your legs, feet or face.
4. Going to the bathroom more frequently.
5. High levels of nitrogen and creatinine in your blood.
6. Less need for diabetic medicines, such as insulin.
7. Nausea and/or vomiting.
8. Headaches.
9. Fatigue.
10. Itchiness.

If you are diagnosed with kidney disease, you will likely be treated as part of a comprehensive approach to treating your diabetes. Some conventional medical options for treatment include medication such as ACE inhibitors, as well as dialysis, or even kidney transplant.

Here are some key ideas on preventing kidney disease:

• Strictly control your blood sugar levels by eating properly, and monitoring your levels within the target range specified by your doctor.
• Ensure that your blood pressure and blood cholesterol levels are well controlled.
• Avoid NSAIDS (non-steroidal anti-inflammatory drugs), e.g. aspirin or ibuprofen, which have been linked to some issues with kidney function.
• Don't smoke cigarettes or consume nicotine in any form.
• Treat urinary tract infections immediately with antibiotics.
• Drink plenty of water and avoid sugary drinks and alcohol.
• Avoid medical tests that may damage your kidneys, including x-rays that require the injection of contrast dyes.
• Take your prescribed medications and get regular tests to determine the health of your kidneys.
• Get regular exercise.
• Follow a healthy meal plan.

Furthermore, getting regular acupuncture can help you to balance your hormonal levels, your blood sugar levels, and your blood pressure as well. Acupuncture does not interfere with medication, and so is completely safe to administer alongside your other treatments. Ensure that whoever is treating you with acupuncture is well trained in Traditional Chinese Medicine, so that you will be diagnosed properly.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner

4 Tips on Dieting with Diabetes

If you have diabetes, you may be finding that, well, it's a lot of work! And if you've been diagnosed with prediabetes, you're going to want to know what the consequences of the full-blown illness are. You'll have to monitor your blood sugar levels, time your meals, maybe take insulin, definitely exercise, and generally be aware of everything that you're doing (and about to do!) at any given time of day. That can add up to a lot of time spent doing things that the average person doesn't need to do. And with diabetes on the rise, you won't be alone for much longer when it comes to needing a plan to get everything done. Here are some important food points to focus on:

1. Cut out the refined. No, I don't mean the refined people – you guys can still be friends. But stay away from those refined carbohydrates (aka 'sugars') that are everywhere, like in white breads, pastas, cereals, rice and even white potatoes. Instead, focus on whole-grains in your breads, etc., and eat starchy foods like potatoes in moderation. The more refined the carbohydrate, the quicker it's broken down, and thus the higher your blood glucose (once again, aka 'sugar') levels will rise, since your cells can use insulin receptors only so well. And with diabetes, that's serious! Whole-grains will also help to make sure that you get enough fiber, and consequently help to reduce your risk of heart disease, which is closely linked to diabetes.

2. Shrink it and spread it. No, this isn't your tummy I'm talking about here! (Although, you do want to try and rid yourself of any abdominal fat that you might have accumulated – it will help lower your risk of heart disease - see the reference to fiber, above). I'm talking about your meals: smaller meals that are consumed throughout the day at more frequent intervals will help keep your blood sugar levels in check. Try to take in the same amount of food that you'd normally eat, say in three meals, and then split it in half and eat six smaller meals instead.

3. Get fat. Good fat, that is! Avoid saturated fats, not because of potential heart issues (that's right, overwhelming evidence shows that sat-fats are not directly linked to ticker trouble), but because these fats are high in calories. Limit your intake of fatty beef, hot dogs, sausage, bacon... you see where I'm going with this. But don't fret – you can still eat that stuff, just do it in moderation! Most of the time, swap these foods for others like avocados and nuts, which have the good fats. And eat fish or take fish oil supplements, as these are your best sources for omega fatty acids.

4. Watch the sugar. That's a no-brainer when it comes to diabetes, but be aware of the fact that there's a lot of sugar in alcohol (click here to read more), and pretty much anything that you drink that isn't water, even when it says it's 'made with real juice'. Read the nutrition labels and look at caloric content as well as the amount of sugar in what you're consuming. And when you crave something sweet, go for things like fruit, nuts, yogurt, ricotta cheese, and other things that don't have sugar added to them. If you really need that piece of cake, try just half a slice, and eat it slowly, savouring every bite. That little trick makes your mind feel like it's getting the whole thing!

If you follow this advice about eating well, and get some exercise (click here for some tips on exercising with diabetes), you should be able to lead a relatively normal life.  So do the little extra that it takes to manage or prevent this potentially deadly illness, and you'll still live a long, healthy and happy life.

By Richard Lobbenberg, Acupuncturist and TCM Practitioner