Online Health Chat with Andrea Dunn, RD, CDE

Tuesday, November 15, 2016


Description

Diabetes is becoming more common in the United States. From 1980 through 2014, the number of Americans with diagnosed diabetes has increased fourfold (from 5.5 million to 22.0 million).

Higher than normal blood glucose (sugar) levels may cause serious health problems. What you eat and how much you eat can help you keep your blood glucose levels in goal range.

Diabetes is a disease of the pancreas, an organ behind your stomach. Normally, the pancreas releases insulin into the blood. When a person has diabetes, the pancreas does not make insulin, does not make enough insulin or makes insulin that does not work properly in the body. Insulin is the helper, or the “key,” that lets sugar, or glucose, into the cells of the body, where it is stored or used for energy.

When you eat or drink, much of your food is broken down into a simple sugar called glucose. Glucose provides the energy your body needs for daily activities. Without insulin, glucose cannot get into the body's cells for use as energy. When glucose cannot get into the cells, it stays in your blood. Too much glucose in the blood is called “high blood sugar” or diabetes.

The foods that have the biggest effect on your blood glucose levels are carbohydrates. Carbohydrates are digested by the body to form glucose. For the best blood sugar control, eat consistent amounts of carbohydrates throughout the day and take your diabetes medications as directed.

Target blood glucose ranges for diabetes are:

  • 80-130 mg/dL fasting or before a meal
  • less than 180 mg/dL two hours after starting a meal
  • 100-140 mg/dL at bedtime

About the Speaker

Andrea Dunn, RD, CDE, is a registered dietitian and certified diabetes educator with the Center for Human Nutrition. She focuses patient counseling on diabetes management and prevention, weight reduction and cholesterol/blood pressure management. She takes an individual approach to each patient’s lifestyle, learning needs and readiness to change.

Andrea completed her undergraduate degree at Notre Dame College of Ohio and her internship at Miami Valley Hospital in Dayton. She volunteers with the Academy of Nutrition and Dietetics’ Diabetes Care and Education Dietetic Practice Group, serving in a chair role for the past three years. Andrea has been a certified diabetes educator for the past15 years. She is on the Editorial Board for Heart Advisor Newsletter, is an associate editor for Diabetes Spectrum journal and is on the Health Professional Board for the California Walnut Commission.


Let’s Chat About Healthy Eating With Type 2 Diabetes


Menus and Meal Planning

Molbie: I am interested in quick breakfast menu ideas, and quick and easy snacks for during the day. Also, is carb counting the best way to manage my Type 2 diabetes?

Andrea_Dunn,_RD: Let’s start with your last question first. Learning how to count carbohydrates or using another meal planning approach to quantify carbohydrate intake can help to "match" mealtime insulin to carbohydrates that you eat. Those on a fixed insulin plan or on insulin secretagogues (pills that stimulate your body to release insulin) will benefit from eating about the same amount of carbohydrate at meals and snacks and not skipping meals. Breakfast and snack ideas will depend upon your tastes, and, as you said, the time in which you want to put into them. Some breakfast choices include peanut butter on whole grain toast or waffles, cottage cheese and fruit, oatmeal sprinkled with nuts, Greek yogurt with whole grain cereal sprinkled on top, and a meal replacement shake. Snacks choices may depend on your calorie needs and how long it will be before your next meal. Some ideas include fruit, peanut butter on whole grain crackers, whole grain tortilla chips with salsa, vegetables with hummus dip, yogurt or a half sandwich. The American Diabetes Association (diabetes.org) has many resources for meal planning. Most of their books are also available through the local library system.

LKP: What kind of snacks are good, especially in the evening, for people with Type 2 diabetes. My husband has no colon and has had blockages, so he won't eat raw vegetables or apples, or much salad out of concern for causing a blockage. If he does eat those foods, they have to be cut very fine, and then he is still very cautious. To further complicate matters, I am allergic to peanuts, an airborne allergy, so he can't eat peanut-based foods when I am around.

Andrea_Dunn,_RD: It sounds like you and your husband would benefit from a visit to a registered dietitian to help with the multiple food issues you face. In general, chew all foods until they’re an applesauce-like consistency, and avoid any foods that your doctor told you to avoid or have caused problems in the past. Depending on his calorie needs, snacks may include a variety of foods. Some lower-fiber ones include: canned fruit (packed in juice, water or labeled 'lite') with cottage cheese or plain yogurt, a small serving of cereal with milk, toast with walnut or almond butter, a half sandwich or lite yogurt.

derosy: What are some snacks to eat if you have Type 2 diabetes and kidney stones. Nuts are great for diabetes but not for kidney stones. Do you have any suggestions?

Andrea_Dunn,_RD: Staying hydrated on no-calorie beverages is one of the better ways to prevent kidney stones. For snacks, it might depend on the time of day and how hungry you are. Some suggestions are fruit, yogurt, cheese and crackers, vegetables, a half sandwich and popcorn (as well as some of the items I've mentioned earlier).


Foods in Question

LKP: Are Splenda and Truvia acceptable sugar substitutes? Is it true that your body reacts to foods and drinks made with artificial sweeteners in a way that creates too much of an insulin response? If drinks such as Crystal Light are bad, what can a person with Type 2 diabetes drink besides water? (My husband has no colon, so extra hydration is critical.)

Andrea_Dunn,_RD: Seven non-nutritive sweeteners are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. They are all approved for use in the United States and determined to be safe. Splenda (sucralose) and Truvia (erythritol and stevia leaf extract) are brand names. If you find differences in blood sugar response when eating any foods with non-nutritive sweeteners, you may want to switch to another type of sweetener. There are also flavorings on the market made without any non-nutritive sweeteners that you can add to water that are very low carb (less than 1 gram per serving). The ones I have seen are lemon, orange or lime-based.

LucyintheSkies: How do I know how much fruit is a fruit serving?

Andrea_Dunn,_RD: Fruits vary in size and density. A good resource might be one found at the American Diabetes Association website: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/fruits.html or see your registered dietitian for an updated list of fruits and carb content.

MarkP: I eat a bagel from the bagel store every morning. Is that a bad thing?

Andrea_Dunn,_RD: Bagels aren’t bad, but they are a dense source of carbohydrates. Every ounce of a bagel is like a slice of bread. Some of the bagel stores have 5-ounce bagels. That would be like eating five slices of bread. If you are on medication for diabetes, you may want to be aware of the amount of carbohydrate you eat at any one meal and moderate the size of the bagel or the amount (for example, eat half).

Betty4: Why do family members keep telling me to stop eating bananas? I thought the potassium was good for me.

Andrea_Dunn,_RD: Bananas are a good source of potassium. They are also a good source of carbohydrates. A 4-inch banana is about 15 grams of carbohydrates, so a typical 8-inch banana has about 30 grams of carbs, or about the amount in two slices of bread. Are you eating the banana with cereal and milk (other carb sources)? It may be more about how much carbohydrates you are eating at one time then about whether or not you are eating a banana.

stewart: I like to drink milk. I drink milk for breakfast whether it’s with cereal or just as a drink. I also like to have a glass a milk before bed. How does milk affect blood sugar?

Andrea_Dunn,_RD: Eight ounces of milk has about 12 grams of carbohydrate. It is also a good source of protein (about 8 grams/cup) and calcium, vitamin D and potassium. What is the size of your milk glass? The amount of milk you drink at any one time (and what you drink it with) may affect your blood sugars.


Carbohydrate Concerns

SleepyinSavana: How do you eliminate carbs in your diet, slowly or cold turkey?

Andrea_Dunn,_RD: First of all, why would you want to eliminate all carbs? As we mentioned earlier, a style of eating for diabetes is a heart-healthy diet. That can include fruits, vegetables, and whole grains. To moderate your carb intake, start by taking a look at what you drink (sugared beverages) and snack on. Try to be more plant-based and less processed (candy, pastries, sugar sweet beverages).

wmchen: What carbs are better for Type 2 diabetes?

Andrea_Dunn,_RD: Plant-based carbohydrates such as fruits, vegetables, whole grains and starchy vegetables including beans/lentils. Foods with higher fiber may take longer to digest and decrease the after-meal glucose spikes.

Larkin: We like our breads, pastas and rice, and it seems like whole grains are the way to go. How much better are whole grains in the diet? Can this be measured?

Andrea_Dunn,_RD: Yes. Whole grains are often higher in vitamins, minerals, and antioxidants than their processed counterparts. Measurements: 1 slice of whole grain bread, 1/3 cup cooked whole grain pasta and rice, 1/4 cup old fashioned dry oats = 15 grams of carbohydrates.

BSH1943: If you are going to have a snack with carbs before going to bed, how soon should you have that snack before bedtime?

Andrea_Dunn,_RD: There are no set times. It may depend on when you take your last medication or when you ate dinner (and how your diabetes medication is working). Our gastroenterologists recommend to stop eating two to three hours before bedtime to avoid any reflux and indigestion.

lancet: Can I eat a no-carbohydrate meal?

Andrea_Dunn,_RD: That might depend on what medications you are taking for your diabetes. If you are on medications that may lower your blood glucose (sulfonylureas), you should include a carbohydrate source at each meal. If you are only taking metformin, you should not have a problem with a low/no carb meal (like chicken on a salad, an egg/vegetable omelet or a vegetable stir fry.


Drinking and Diabetes

Stevest12: Can you talk about alcohol consumption. I like to drink beer, maybe one to three a day, sometimes more depending on the occasion. What effects can this have on my body? What is a safe level of alcohol consumption?

Andrea_Dunn,_RD: For healthy individuals not on any medications, recommendations include no more than two alcoholic drinks/day for men, and no more than 1/day for women. Please check with your doctor or pharmacist regarding your safety if you drink alcohol and you are on any medications.

Larkin: When drinking alcohol, is one type (wine, beer, liquor) preferred or less harmful over the other?

Andrea_Dunn,_RD: The new 2015-2020 Dietary Guidelines for Americans address alcohol equivalents: https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf. Twelve fluid ounces of beer (five percent alcohol) is considered one drink equivalent. So is 5 ounces of wine (12 percent alcohol) or 1.5 ounces 80 proof distilled spirits. The higher the alcohol content, the more potent the beverage. For example: 12 ounces of beer with 9 percent alcohol content is like 1.8 drinks. Also, consider if you have the distilled spirits (for example, vodka, whiskey) over ice or with a sugar sweet beverage. A margarita may have 40 or more grams of carbohydrate depending on how it is made.


Baffled by Blood Sugar

gatorfrog: For the most part, I can control my blood sugar levels; however, sometimes they have been high, and when they are high (after steroid shots especially), I don't know how to lower them. Can you tell me how to do that? Also, I think that I get odd results occasionally after meals that I would consider “good,” ones with protein and not many carbs, if any. Or I will have a meal that I know should bring bad results, and the results will be good. Is that just part of the machine's occasional misstep? Thank you.

Andrea_Dunn,_RD: It sounds like you are already aware of what goal blood sugars should be and what personally throws them off. For the benefit of the others in this web chat, let's review what goal range blood sugars are: pre-meal: 80-130 mg/dL; post-meal (two hours after starting meal): less than 180 mg/dL; bedtime: 100-140 mg/dL. The goal is more than 50 percent of these values within target range. Talk with your doctor for what your goals might be following steroid shots. If your after-meal blood sugars are high, take a look at how much carbohydrate you had at that meal. Moderating the amount of carbohydrate will help keep the blood sugars in goal range. If after-meal blood sugars are higher than goal range, try some exercise. Light walking may help. Your last question is about your meter. Make sure you cap your strips after taking them out of the container. They can absorb moisture in the air and then be inaccurate. Also, make sure your hands are clean from lotions. Finally, don't use outdated monitoring strips.

gr1919: I have an issue with high morning, fasting blood sugars. I find that eating before going to bed tends to keep them lower. Have you any recommendations for the best things to eat? I normally try to eat protein but would something more balanced be better?

Andrea_Dunn,_RD: People respond in different ways. You may find that 15 to 30 grams of carbohydrates as a night snack might work for you, depending on your calorie needs. Try different foods, and try to be consistent with exercise (so that is not a variable). Note the difference between blood sugars from day to day.

Dillard: Why is it that blood sugars are highest in the morning (130-135), late PM (115-120)? Is this a problem for me?

Andrea_Dunn,_RD: Gluconeogenesis – the big name for your liver making glucose and putting it into the bloodstream – is probably the biggest reason for morning blood sugars being elevated. Losing weight, if you are overweight, and regularly exercising may prevent this from happening. If your morning blood sugars continue to be out of goal range, talk to your doctor.


Topics in Treatment

Stevest12: Do you think all people with Type 2 diabetes should make nutrition therapy a part of their treatment plan?

Andrea_Dunn,_RD: What we eat does affect how we feel, including the energy we have for the day. And what we eat can make a difference in our health. So lifestyle changes, such as what you eat (nutrition), can definitely help people manage Type 2 diabetes.

Larkin: Can exercise help in the process of having glucose absorbed into the body cells?

Andrea_Dunn,_RD: Yes! Exercise has been described as being effective as one medication for helping to manage Type 2 diabetes.

Dillard: Is there any proof that exercise lowers blood sugar?

Andrea_Dunn,_RD: Yes. Many studies support exercise as a lifestyle change to help manage blood sugars. But why not experiment on yourself, Track your blood sugars over the next month on days you exercise and days you don't, and look at the trends.


Closing

Moderator: That is all the time we have for questions today. Thank you, Andrea, for taking time to educate us about managing diet with diabetes.

Andrea_Dunn,_RD: In closing, keep in mind, there is no one diet for diabetes. If you want help with your meal planning or want to learn more about diabetes and what you eat, please make an appointment with a registered dietitian/nutritionist.

Dillard: Thank you Andrea!

Moderator: On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.


For Appointments

To make an appointment with Andrea Dunn, RD, LD, CDE, or any of the other specialists in our Digestive Disease Institute, Center for Human Nutrition at Cleveland Clinic, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at www.clevelandclinic.org/nutrition.

For More Information

Cleveland Clinic

Cleveland Clinic’s Digestive Disease Institute (DDI) offers patients the most advanced, safest and proven medical and surgical treatments primarily focused on disorders related to the gastrointestinal tract.

Part of the DDI, the Center for Human Nutrition provides evaluation, education and treatment to people who have disease-related nutrition problems. Additionally, the Center is involved with a multitude of programs to promote health and wellness. Both of these efforts are driven by a dedicated team of registered dietitians, dietetic technicians, nurses, pharmacists, physicians and surgeons who work together to provide comprehensive support for patients with specialized nutrition needs.

The Digestive Disease Institute has been ranked second in the nation by U.S. News & World Report’s Best Hospitals Survey since 2003 and first in Ohio since 1990.

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