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Contents
JANUARY/FEBRUARY 2018

12 The Prescription
for Dry Winter Skin
It’s the dry, itchy skin and
chapped lips time of the year—
winter in Diabetes Land. Use
23
these tips to keep dry skin in
check and learn when you
Diabetic
need to see your doctor. Cooking
By Wil Dubois, BS, AAS, PWD, CPT, TPT
MEDITERRANEAN

16 Obesity+Diabetes
the Link DEPARTMENTS
With Type 2 diabetes and
obesity both becoming
4 Editor’s Letter
global epidemics, it’s time
to investigate the connection 6 News & Notes
between these two conditions 7 Quiz:
By Nicola Davies, PhD How Much
Do You Know
about Diabetes
20 Ditching New Year’s
Resolutions
and Energy?
7 Resources:
This year, instead of relying on Practice Good
willpower to completely overhaul Oral Health
your lifestyle, try focusing on 9 Definitions
smaller steps and developing
the skills that will help you 9 Diabetes Q&A
achieve your goals. The key is
being S.M.A.R.T. 42 Supermarket Smarts
By Alison Massey, MS, RD, LDN, CDE Bread

Cover image: Photographed by Angel Tucker; 64 Product Spotlight

food prepared by Maggie Mulvena FiberPasta

WEIGHT SELF-MANAGEMENT PAGE 45

46 Dance Your Way to Health 56 A Cozy Night In
By Susan Weiner and Erin Palinski-Wade Five dishes to warm you
50 Fitness in the from the inside—for a
Palm of Your Hand total of 699 calories!
Sheri Setser-Legg, MS, RD, LD,
MLDE, CDE 60 Your Weight
Laura Hieronymus, DNP, MSEd, RN, Overcoming Triggers
MLDE, BD-ADM, CDE, FAADE to Overeating
By Nicola Davies
54 Take 5
Shutterstock/Sea Wave

Workday Pick-Me-Up 62 Food for Thought

By Laurel Dierking, M.Ed., New column!
NFPT, 200-YTT By Alison Massey,
MS, RD, LDN, CDE
2 January/February 2018
Do you have type 2 diabetes and take multiple insulin shots each day?

Rediscover a life without pens, syringes, or pumps

Simplify with V-Go

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Insulin delivery that’s worn like a patch*

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Lœœ`ÃÕ}>ÀVœ˜ÌÀœ >`>Þ insulin needed *>ÀÌ>˜`“œÃÌ

œ““iÀVˆ>˜ÃÕÀ>˜Vi

Ask your diabetes health care professional

about switching to V-Go.
Visit VGOSTART.com or call 1-800-694-4410 for more information.
*Adhesive pad not shown
Important Risk Information
vÀi}Տ>À>`ÕÃ̓i˜ÌÃœÀ“œ`ˆwV>̈œ˜Ã̜̅iL>Ã>À>Ìiœvˆ˜ÃՏˆ˜>ÀiÀiµÕˆÀi`ˆ˜>Ó{‡…œÕÀ«iÀˆœ`]œÀˆv̅i>“œÕ˜Ìœvˆ˜ÃՏˆ˜
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V-Go is a registered trademark of Valeritas, Inc.

ART-1024 Rev C 9/2017 ©2017 Valeritas, Inc.
Editor’s Note

HAPPY NEW YEAR! Now that it’s time to settle into 2018, this issue of Diabetes Self-
While Management offers advice for feeling as healthy, wealthy and wise as possible in the
coming year. But this January, let’s not talk about resolutions. Instead, as Alison
staying Massey, MS, RD, LDN, CDE, suggests, let’s take a different approach to making
active is positive lifestyle changes by making it a no-resolution New Year (page 20). Use the
article’s advice to set goals and improve your health each day for results that are not
crucial, you only attainable, but sustainable.
Now, let’s face it, whether or not you make a formal resolution, exercising more is a
also need typical goal of many people at this time of year. The key to sticking with physical activity,
as with any activity we choose to do in our free time, isn’t complicated—simply, you
to stay on need to enjoy it. Exercise doesn’t have to entail weights, fancy machines or even going
to the gym. As long as you are moving, you’re sustaining health benefits. If you’re like
top of other me, a good beat is all it takes to get you moving—so why not dance your way to health
(page 46)? Dancing improving insulin sensitivity, builds muscle mass, aids weight loss,
aspects of boosts fitness—and you can get grooving regardless of age, fitness or skill level.
While staying active is crucial, you also need to stay on top of other aspects of your
your health. health. With the cold weather starting to bear down on us, vigilant skin care needs to
be a part of your daily regimen. Dry skin can be dangerous for people with diabetes
because it increases the likelihood of cracks, which in turn leave the body vulnerable to
infection. “The Prescription for Dry Winter Skin” (page 12) provides ways to prevent
dry skin, treatment options, the truth about diabetes-specific skin care products and
advice on when to call your doctor. Another part of your body that you shouldn’t
neglect is your mouth, with one in five cases of tooth loss linked to diabetes. Don’t take
those pearly whites for granted. Follow the simple steps in “Practice Good Oral Health”
(page 7) to keep your teeth and gums in tip-top shape.
Speaking of your mouth, the scrumptious recipes in this edition of Diabetic Cooking
are sure to keep it happy during these cold winter months. From fresh, nutritious and
delicious Mediterranean dishes (page 34) and hearty roasted vegetables (page 26) to
perfect potato plates (page 30) and luscious game-day desserts (page 38), we have the
recipes you need to satisfy your comfort food cravings.
No matter your goals for 2018, we here at Diabetes Self-Management will provide the
advice, tips and information you need to make this a successful and healthful year.
Yours truly,

Joan Edgett
Editor
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NEW DEVICE COULD
END FINGER STICKS
M any people with diabetes want to test
their blood sugar levels regularly but
don’t. The reason that most of them give is
that they just don’t want to go through the
unpleasant business of sticking their fin-
ger to draw blood. However, the U.S. Food
and Drug Administration (FDA) has just
approved a new technology that its manu-
facturer advertises as a breakthrough that
“eliminates the need for routine finger sticks.”
The device is called the FreeStyle Libre
Flash Glucose Monitoring System (FreeStyle
Libre for short), and it’s the creation of
Abbott, a global health-care company based
in Illinois. The system checks blood glucose
levels through a sensor that’s about the size
of two stacked quarters. The user applies the
waterproof sensor to the back of the upper
arm. One it’s in place, the user is able to
scan it with a small handheld reader. The
scan is painless and takes about a second.
Because the scanner can make readings
through clothing, the wearer doesn’t have to
uncover the upper arm to get a reading. The
6 January/February 2018
NEWS&
NOTES
scan identifies glucose levels as high, low, or
stable and provides an eight-hour history of
fluctuations—in other words, the FreeStyle
Libre device essentially works as a continuous
glucose monitor (CGM). The manufacturer
says that the FreeStyle Libre device is cali-
brated at the factory and therefore doesn’t
require daily calibration by the user through
finger sticks, as some other CGM devices do.
The device is especially recommended for
patients being treated with insulin because
these are the ones who require the most
careful and frequent monitoring.
Although the device has just been
approved in the United States, it has already
been used by more than 400,000 people in
about 40 countries. The manufacturer says
that reports indicate that users test their
glucose levels at an average of at least 15
times a day, a frequency that leads to bet-
ter overall glucose control. Abbott expects
that it will be available at U.S. pharmacies
before the end of the year. To get one, a
user will need a doctor’s prescription. †
IBM Jumps In
T he technology company
IBM has long been a major
player in the field of informa-
tion technology. Now IBM has
announced that it is bringing
its expertise and experience to
another area—the investigation
of Type 1 diabetes. IBM will part-
ner with the New York-based
Juvenile Diabetes Research
Foundation (JDRF), which for
nearly half a century has been
a leading global organization
dedicated to funding research
on Type 1 diabetes.
The amount of data that
researchers have collected on
Type 1 diabetes is huge, which
is why IBM’s capabilities should
prove so valuable. IBM will apply
its machine learning techniques
to this accumulation of research
to learn what causes Type 1 dia-
betes in children and to explore
ways in which the disease could
be treated or even prevented.
Specifically, IBM plans to exam-
ine three separate data sets
and compare them to previ-
ously collected data. The plan is
that by scrutinizing the specific
areas of genetics, familial vari-
ables, and autoantibodies, the
researchers will be able to find
a group of characteristics com-
mon to all the data sets. Once
those are known, they hope
to determine the top risk
factors for Type 1 diabetes.
According to Jessica Dunne,
director of the JDRF’s Prevention
Program, “With IBM’s technol-
ogy and analysis, we are opening
up the possibility of developing
personalized approaches for pre-
vention and, ultimately, curing
Type 1 diabetes.”
The pilot program is sched-
uled to run until the end of
2018, when the initial results
should be in. If everything
Shutterstock/Click and Photo
works out, IBM and the JDRF
hope to forge a lasting partner-
ship in pursuit of an ambitious
goal—the eradication of Type 1
diabetes. †
 NEWS&
NOTES
DIABETES QUIZ
How Much Do You
Know about Diabetes
and Energy?
Diabetes can affect many parts of the body
and lead to other illnesses, but the condition
can zap your energy, too. Take this quiz to
see how much you know about keeping your
energy level up when you have diabetes.
1. How does mental health affect fatigue
in people with diabetes?
A. Mood does not affect energy.
B. Poor mental health may increase fatigue.
C. Good mental health has no effect on
fatigue.
D. Mental health alters blood sugar.
2. How do infections affect fatigue in
those with diabetes? More than one
answer may be correct.
A. Infections have no effect on fatigue.
B. Infections make it more difficult to treat
fatigue.
C. The treatment plan may often cause or
worsen fatigue.
D. Infections lower the risk for fatigue.
3. True or false: Fatigue is a symptom of
both hypoglycemia and hyperglycemia.
4. Which of the following are conditions
that also cause fatigue and are com-
monly seen in people who have dia-
betes? More than one answer may be
correct.
A. Being overweight
B. Sleep apnea
C. Peripheral vascular disease
D. Low blood sugar levels
5. What are some ways you can help man-
age fatigue when you have diabetes?
More than one answer may be correct.
A. Exercise
B. Monitor blood sugar
C. Eat a healthy diet
D. Adhere to a sleep regimen
DIABETES RESOURCES
Practice Good Oral Health
W hen diabetes goes
untreated, it takes a toll
on your mouth. One in five
cases of tooth loss is linked to
diabetes. Periodontal disease,
the most common dental dis-
ease, affects nearly a quarter of
those diagnosed with diabetes.
Why are people with diabe-
tes more prone to gum disease?
The mouth is populated by
millions of bacteria, and a high-
sugar environment is an ideal
place for bacteria to thrive. If
they camp out in your mouth,
the bacteria can cause peri-
odontal disease. This chronic
inflammatory condition can
destroy your gums, all the tis-
sues holding your teeth and
can even eat into your bones.
Individuals with diabetes
are more susceptible to infec-
tions inside the mouth. Like all
infections, serious gum disease
may cause blood sugar to rise.
This makes diabetes harder
to control because you are
less able to fight the bacteria
attacking the gums, which can
become inflamed, bleed and
lead to gingivitis.
Visit your dentist
Did you know dentists are
often the first to diagnose dia-
betes? A recent study discov-
ered that one in five people
with severe gum disease had
developed Type 2 diabetes
and hadn’t even been aware.
It’s important to visit your
dentist at least twice a year
for regular cleanings and
checkups. Studies show that
treating gum disease can help
improve blood sugar control
in patients living with diabetes,
decreasing the progression
of the condition. Practicing
good oral hygiene and hav-
ing regular professional clean-
ings can help lower your A1C.
Depending on the health of
your gums, your dentist may
have you come back more
often for cleanings.
Healthy routines
The American Dental Asso-
ciation recommends brushing
twice a day for two minutes,
using toothpaste with fluo-
ride. While the dental associa-
tion doesn’t recommend one
toothbrush over another, many
experts recommend powered
toothbrushes. While they are
more expensive than manual
toothbrushes, they offer several
advantages. These toothbrushes
often include a timer feature to
help remind people to continue
brushing for two full minutes.
Some even feature a pressure
indicator light to let patients
know when they’re brushing
too hard and possibly damaging
their gums.
Dentists also recommend
that people floss once a day
to remove food and plaque
in between the teeth and
along the gums. If you don’t
like floss, try an interdental
device—a tiny brush to get
at crevices that are hard to
reach with toothbrushes. To
fight off bacterial buildup,
rinse your mouth with anti-
bacterial mouthwash. Swish
the mouthwash for about 30
seconds and even gargle for
a few seconds to help remove
more bacteria. †
Paul Wynn, a writer based in
Garrison, New York, has covered
health-care trends for more than
20 years.
DiabetesSelfManagement.com 7

1.B. Mental health plays an important role in
many aspects of health because it affects not
only your ability to understand health-related
concepts, but it also has a significant impact on
your ability to engage in self-care. This includes
important activities such as bathing, preparing
meals and eating, checking your blood sugar,
and checking your feet for infections, diabetic
ulcers and foot fungus. Some people who have
diabetes experience a phenomenon known as
“diabetic distress,” a condition in which a person
feels overwhelmed and burned out from living
with and managing his or her diabetes (for more
on dealing with diabetes burnout, see page XX).
Researchers found that the stress of living with
and managing diabetes affected fatigue in 23
percent, or nearly one-fourth, of people who have
diabetes. Also, people with diabetes are twice as
likely to have depression as the general population.
2. B & C. While not all infections in people with
diabetes may cause fatigue, the treatment plans
used to fight these infections may increase the
risk for or worsen fatigue. This is especially true
when the infections involve the lower limbs of
the body (i.e., the feet, ankles and lower legs).
Treating lower limb infections and ulcers often
requires the patient to reduce or avoid putting
weight on the area and decrease activity. While
this aspect of the treatment plan helps the leg
heal, decreased physical activity and the toll taken
by the infection increase the likelihood of fatigue,
according to a review article.
3. True. In one in-depth analysis, tiredness was
ranked fifth of the 16 most commonly reported
symptoms of hyperglycemia. One study examining
the effects of diabetes on a variety of symptoms in
188 Dutch patients found a slight but statistically
significant correlation between HbA1c and fatigue.
NEWS&
NOTES
ANSWERS
Another study evaluated the effects of a night-
time episode of hypoglycemia in adults with Type
1 diabetes. When subjects’ blood glucose levels
were lowered to hypoglycemic levels (42-59 mg/dl)
during an overnight visit and sustained in a higher
range (90-216 mg/dl) during a second overnight
visit, they reported more fatigue symptoms and
decreased well-being and were more likely to
fatigue faster during exercise than when blood
glucose levels remained within the higher range.
According to the authors of a review of studies
evaluating diabetes and fatigue, “the successful
self-management of diabetes requires physical,
psychological and cognitive tasks (e.g., exercise
participation, management of hypoglycemia and
hyperglycemia, and calculation of insulin doses)
that are likely to be affected by fatigue. Fatigue
in diabetes is likely caused from the interplay of
physiological, psychological and lifestyle-related
factors. Fatigue is also likely to be both a cause
and a result of poor diabetes self-management.”
4. A, B, C, D. According to the Diabetes Council,
being overweight and having conditions such
as sleep apnea, peripheral vascular disease or
low blood sugar all can affect your energy level.
Sleep apnea is a condition in which a sleeping
person suddenly stops breathing. The National
Institutes of Health states that the disruption in
sleep can last for several seconds and may happen
as many as 30 times in one hour. People with this
condition may snore or make grunting sounds,
and even if they sleep continuously all night, they
often wake up tired. In some cases, a condition
known as peripheral vascular disease (PVD) may
cause damage to blood vessels of the feet, ankles
and calves. When this occurs, these parts of the
body do not receive adequate blood. PVD often
occurs along with peripheral neuropathy, causes
aches and pains and may contribute to fatigue.
As for low blood sugar, glucose is the brain’s
primary fuel source and plays an important role
in energy production for bodily cells. When the
body lacks enough blood glucose to meet these
demands, energy plummets. Finally, being over-
weight stresses the body because it has more
weight to carry around than what is efficient for
functioning. Therefore, it takes more energy to
move, exercise and carry out normal daily tasks.
5. A, B, C, D. A growing body of evidence shows
that people who exercise are less likely to feel tired,
and these findings hold true not only in healthy
people but also in people who have cancer and
chronic conditions such as rheumatoid arthritis
and high blood pressure as well as diabetes. While
scientists have yet to elucidate the exact correla-
tion between exercise and fatigue, the fact that
exercise boosts the “feel-good” hormones called
endorphins and helps with weight management
may play a role. Fatigue is very common among
people with Type 2 diabetes who have a high body
mass index. And as always, exercise also helps
you to keep your blood sugar under control. As
is the case with diabetes and its many potential
challenges, healthy blood sugar levels are very
important to staying healthy, feeling your best
and taking control of your health. A healthy,
diabetes-friendly diet will supply your body with
many vital nutrients it needs to function and will
help increase energy. Establishing a regular sleep
pattern can not only shorten the time it takes to
fall asleep, but also improve the quality of sleep,
leading to more energy throughout the day.
Frieda Wiley, PharmD, BCGP, RPh, is a freelance medi-
cal writer and consultant pharmacist based in the Piney
Woods of East Texas.

LOW-DOSE ASPIRIN FOR WOMEN

W omen who have Type 2 diabetes have a higher risk of
developing breast cancer than women who don’t have
diabetes. This is especially true of postmenopausal women;
studies have found that women with diabetes are up to 20
percent more likely to develop breast cancer after menopause.
Some researchers suspect that both conditions might be tied to
overweight or obesity, but they also think it’s possible that Type
2 diabetes somehow directly affects the risk of breast cancer.
A new study from Taiwan indicates that low-dose aspirin
might reduce the risk of breast cancer in women with Type
2 diabetes. The study, which used data retrieved from the
National Health Insurance Database in Taiwan, involved
148,739 women with diabetes (mean age 63.3 years), of
8 January/February 2018
whom 24,378 were taking aspirin. It covered a 14-year period
(January 1, 1998 to December 31, 2011). The researchers
determined that overall, the use of aspirin in patients with
diabetes lowered the risk of breast cancer by 18 percent. The
optimal effect of aspirin was found to occur when the daily
dosage was more than 88.9 milligrams.
The study appeared in the Journal of Women’s Health.
When it was published, Susan G. Kornstein, MD, editor-in-chief
of the journal, commented, “Women with Type 2 diabetes have
an increased risk of breast cancer, and these results suggest that
the same low-dose aspirin that many of these women take to
prevent cardiovascular disease may also help reduce their risk
of breast cancer.” †

Diabetes
[definitions]
DEEP VEIN THROMBOSIS
A blood clot that forms deep within the body.
Deep vein thrombosis (DVT) most commonly
occurs in the lower leg, but may also develop
in other parts of the body. A clot is more likely
to form following surgery, injury or periods of
inactivity, such as during travel or while recov-
ering from surgery. It is also more common in
people who are overweight or obese or who
smoke. Symptoms of DVT include swelling
of the leg or along a vein in the leg, pain or
tenderness in the leg, increased warmth in the
area of the leg that is swollen or painful and
red or discolored skin on the leg. DVT is treated
with anticoagulants or “blood thinners” such
as warfarin and heparin.
A clot in a deep vein can travel through
the bloodstream to an artery in the lungs and
can block blood flow, a life-threatening condi-
tion called a pulmonary embolism (PE). A PE
can damage the lungs and other organs and
may be fatal. The symptoms of a PE are unex-
plained shortness of breath, pain with deep
breathing, and coughing up blood. Anyone
with symptoms of a PE should seek medical
attention immediately.
There are steps people can take to lower
their risk of DVT. Get out of bed and move as
soon as possible after surgery. Get up and walk
during long trips—or, at the very least, move
your legs and stretch your feet.
STRESS TEST
A test using exercise (or sometimes drug stimu-
lation) to measure the heart’s ability to handle
physical stress. Doctors typically use stress test-
ing to help diagnose coronary heart disease
(CHD) and determine its severity.
CHD is a condition in which plaque builds
up in the coronary arteries, the arteries that
supply oxygen-rich blood to the heart muscle.
Plaque narrows these arteries, restricting blood
flow to the heart, and makes blood clots more
likely to occur. Blood clots can block blood flow
through the artery, causing angina (chest pain)
or a heart attack.
The signs and symptoms of CHD may not
show up during rest, but may show up during
exercise, when the heart works harder and
needs more blood and oxygen. A stress test
Shutterstock/Photographee.eu
may detect abnormal changes in the heart
rate and blood pressure, shortness of breath
or chest pain or abnormal changes in the
heart’s rhythm or electrical activity.
During exercise stress testing, the patient
NEWS&
NOTES
walks on a treadmill or pedals a stationary
bicycle while hooked up to an electrocardio-
graph (EKG) to record the heart’s electrical
activity. Various types of imaging such as
echocardiograpy, myocardial perfusion imaging
using a radioactive dye or positron emission
tomography (PET) scanning may be used to
see how hard the heart is working.
For people who are unable to exercise safely,
various drugs may be used to dilate coronary
vessels to provide some of the same information
as exercise stress testing.
GLYCOGENOLYSIS
The breakdown of glycogen, the stored form
of energy found in muscle and liver tissue,
into glucose, which the body can readily use.
Glycogenolysis plays an important role in the
regulation of glucose in the blood. For example,
as part of the body’s “fight or flight” reac-
tion to stressors, the adrenal glands release
the hormone epinephrine, which stimulates
glycogenolysis to provide immediate energy
for muscle activity.
Glycogenolysis is also important for blood
glucose regulation in people with diabetes.
When blood glucose levels drop too low, the
release of epinephrine and another hormone,
glucagon, stimulates glycogenolysis to restore
blood glucose levels to normal. People with
Type 1 diabetes may eventually lose the ability
to secrete glucagon and epinephrine, set-
ting the stage for severe hypoglycemia. The
symptoms of mild-to-moderate hypoglycemia
typically include shaking, sweating, hunger and
headache, alerting the person for the need
to consume carbohydrate. However, people
suffering from severe hypoglycemia may be
unable to eat or drink, may have seizures
and may lose consciousness, so consuming
carbohydrates may not be an option.
Friends and family members of people who
are prone to severe hypoglycemia should learn
how to use a glucagon emergency kit. Injecting
glucagon stimulates glycogenolysis and raises
blood glucose levels. †
Eating, Stress,
and Sleep
C an stress make you fat? It seems so. A
new study published in the Journal of
Applied Psychology is one of the first to
examine the ways in which work-related
psychological experiences can affect how
we eat. It found that stress on the job leads
not only to overeating but also to unhealthy
food choices.
The research involved two studies
that looked at a total of 235 workers in
China. One study was on information-
technology employees who had heavy
workloads; the other was on workers in
a call center who often had to deal with
unpleasant customers.
According to co-author Chu-Hsiang
“Daisy” Chang, Ph.D., of Michigan State
University, the researchers concluded that
“Employees who have a stressful work-
day tend to bring their negative feelings
from the workplace to the dinner table,
as manifested in eating more than usual
and opting for more junk food instead
of healthy food.”
But the study also discovered a possible
way to break the link between job stress and
bad eating. A good night’s sleep. As Dr.
Chang went on to report, “Sleep helped
people deal with their stressful eating after
work. When workers slept better the night
before, they tended to eat better when they
experienced stress the next day.”
Although the study is relevant to just
about anyone who goes to work, the authors
directed their recommendations more to
employers. Employers, they suggested,
should accentuate the importance of health
management for their workers. They should
also consider offering sleep-awareness train-
ing and flexible work schedules. Finally, they
might want to reconsider offering food as a
job perk. As Dr. Chang put it, “Food-related
perks may only serve as temporary mood-
altering remedies for stressed employees,
and failure to address the sources of the
work stress may have potential long-term
detrimental effects on employee health.” †
Joseph Gustaitis is a freelance writer and editor
based in the Chicago area.
DiabetesSelfManagement.com 9

Our Expert
Gary Scheiner MS, CDE, is owner
and clinical director of Integrated
Diabetes Services (www.integrat-
eddiabetes.com, 610-642-6055),
a private practice specializing
in intensive insulin therapy for
children and adults. He and his
team of Certified Diabetes Educa-
tors work with clients throughout
the world via phone and internet.
Gary has lived with Type 1 diabe-
tes for 30 years and was named
Diabetes Educator of the Year in
2014 by the American Association
of Diabetes Educators. He has
written six books, including Think
Like A Pancreas.
«Have a question about diabetes? Send it to Gary Scheiner MS, CDE, at gary@integrateddiabetes.com.
10 January/February 2018
Q NEWS&
NOTES
Q: Does a bedtime snack help or hurt the
wake-up blood sugar reading?
A: Like most things having to do with diabe-
tes, it depends. If you are not taking insulin,
bedtime snacks can either cause your wake-up
reading to be elevated or force your pancreas
to produce extra insulin during the night to
offset the effects of the snack—neither of
which is a good thing.
If you take insulin, a bedtime snack may
be needed if your blood sugar tends to drop
overnight.  This is often a sign that your basal
insulin dose (via injection or a pump) is a bit
too high. Basal insulin’s job is to keep your
blood sugar steady overnight. So if you’re
dropping, you may be getting too much
basal insulin. In this case, without a snack,
you might wind up with low blood sugar in
the middle of the night. And if you overeat
or “rebound” from the low, your wake-up
reading could wind up too high. So with
basal insulin doses that are a bit too high, a
snack at night may be necessary. However, it
would be better to get the basal insulin dose
set properly.
If your basal insulin dose is correct and
your blood sugar holds steady through the
night without a snack, a bedtime snack
will make your blood sugar rise. A dose of
rapid-acting insulin would likely be needed
to offset the effects of the carbohydrates in
the snack.
While we sleep, the body produces a hor-
mone called leptin that curbs appetite. So if
you’re trying to shed some body fat, a bedtime
snack may be counterproductive. And since
excess body fat leads to insulin resistance, all
those extra bedtime snacks can lead to higher-
than-desired blood sugars in the morning
that persist around the clock.
Q: I have had Type 1 diabetes for 40 years.
Recently I’ve been noticing low blood sugar
feelings (glazed, unable to concentrate) even
when my blood sugar levels are normal or
high. Sometimes I even have ketones when this
happens. Is this what’s causing my symptoms?
A: Symptoms of low blood glucose (hypo-
glycemia) tend to change over time. Most
people who have had diabetes as long as you
have lose the early warning signs (shaking,
sweating, rapid heartbeat) and only experi-
ence cognitive (mental) symptoms, such as
the ones you described.
Interestingly, these types of symptoms can
occur in different situations. Unusually high
blood glucose, particularly when you don’t
spend a lot of time in a high range, can tem-
porarily impair mental function and lead to
tiredness, confusion and mood changes. It is
easy to confuse these with symptoms of hypo-
glycemia, so it is important to check your blood
glucose whenever symptoms occur. You don’t
want to start popping glucose tablets when your
blood glucose is 300 mg/dl (16.7 mmol/l).
Another situation that can cause hypogly-
cemic symptoms is a rapid decline in blood
glucose, such as falling from 300 (16.7) to
130 (7.2) within an hour. This may happen
during intense exercise or when rapid-acting
insulin is peaking. The rapid drop fools the
brain into thinking that the blood glucose is
low simply because it is coming down so fast.
Since you mentioned ketones in your
question, it is worth noting that the pres-
ence of ketones, with or without elevated
glucose levels, can indicate a lack of insulin
in the body, a lack of dietary carbohydrates
or an infection that is causing intense insulin
resistance. Regardless of the cause, ketones
reflect a conversion from carbohydrate to fat
metabolism, which can also create some of
the symptoms you described. The solution,
as you can probably guess, is to make sure
you’re taking enough insulin (and that the
insulin you’re taking hasn’t spoiled), consume
reasonable amounts of carbohydrate and see
your physician to rule out an infection. †
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 THE PRESCRIPTION
FOR DRY WINTER SKIN
By Wil Dubois, BS, AAS, PWD, CPT, TPT

T he air outside is cold and dry. Inside, fires and furnaces bake away what little moisture is left in
Shutterstock/Ternavskaia Olga Alibec

the atmosphere. Break out the lip balm and hand lotion. It’s the dry, itchy skin and chapped lips
time of the year—winter in Diabetes Land. What can you do to keep dry skin in check this time of
year? How bad does dry skin have to get before you need to see your doctor? And why do we seem
to have more problems with dry skin than everyone else?
12 January/February 2018
 D EAT GREAT & LOSE WEIGHT!

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Is dry skin caused by diabetes or high
blood sugar?
John Anthony, MD, a dermatologist for the Cleveland Clinic,
thinks that there’s something lurking in the skin or DNA
of people with diabetes that makes them prone to dry skin.
According to him, research shows that fully 26 percent of
people with diabetes suffer various “problems with dry
skin,” although he states, “I don’t think we understand
why,” adding, “it’s a bit of a mystery.”
But to Lauren Levy, MD, of the Yale School of Medi-
cine, an expert on skin conditions related to diabetes, it’s
no mystery at all. For her, it’s simple. She thinks dry skin
is 100 percent caused by hyperglycemia—elevated blood
sugar in uncontrolled diabetes—saying matter-of-factly, “It
dehydrates the skin.”
Meanwhile, in the trenches, certified diabetes educator
(CDE) Erin Kelly, who works for Harvard’s Joslin Diabetes
Center, isn’t so sure. She says, “We see dry skin across the
board with all patients. Rarely would I assert that the dry
skin is caused by hyperglycemia; it’s too hard to correlate
in the presence of other factors.”
So take your pick, but regardless of the cause of the
dry, itchy hands and cracked lips, you need to fix the
problem, both for comfort and, because left alone, dry
skin can become a dangerous ticking time bomb for
people with diabetes.
Preventing dry skin
While there doesn’t seem to be much agreement on the
causes of dry skin in people with diabetes, the experts we
talked to are in universal agreement on how to stay ahead of
it. Their number one recommendation is to use fragrance-
free skin care products. In Levy’s words, “Use Dove instead of
Irish Spring. Irish Spring may smell great, but it dries out the
skin.” Of course, Levy emphasizes the importance of getting
and keeping blood sugar in control as the first step toward
preventing dry skin issues, but after that, she advises avoiding
hot showers, another point that all our experts agree on.
Anthony says patients should also avoid what he calls
“over-bathing,” noting that many people with dry skin
will bathe two to three times a day, partly because it
“feels good,” and partly because many people assume
this will help moisturize the skin. But, in fact, frequent
bathing actually dries out the skin more, according to
Anthony. He also advises patients not to scrub too hard
when bathing, to blot dry, and then to apply cream or
lotion to damp skin.
When it comes to creams and moisturizers, Anthony
recommends products with dimethicone to lock moisture
in, ceramide fats to help restore the barrier function of
skin and humectants to draw moisture up into the skin
from lower tissue levels. His prescription for preventing
dry skin is to use creams twice a day, adding that there’s a
lot of benefit to applying a cream “right after a shower.” In
the shower, he prefers his patients to use liquid bath gels
rather than traditional soap because “a pure soap may not
be gentle on the skin.”
14 January/February 2018
In addition to direct skin treatments, Kelly recommends
that people with diabetes consider using a humidifier in
their homes during the winter months “to add some mois-
ture back into the air while the heat is on.”
What about all those diabetes-specific skin
products?
All of our experts agree: There’s nothing wrong with the
“diabetes-branded” skin products, but they aren’t necessary.
Over-the-counter products are just as effective as long as
they are fragrance-free.
Levy says that diabetes-branded products aren’t supe-
rior, but “if the price is right, go for it.” Like Anthony, she
advises patients to look for products with ceramides. She
also notes that dry skin isn’t just a winter issue, and that
people with diabetes need to be proactive year-round to
take care of their skin. “I give this advice 100 times a day
with patients,” she says.
Dry skin can be dangerous
Skin is an important barrier that protects the body from
infection. Anthony says that people with diabetes “really
can’t afford to have breaks in the skin. Having an intact
barrier is really important.” Kelly says, “We think about dry
skin and diabetes because dry skin can create openings in
skin integrity that are a potential source of infection. With
diabetes, the sugar in your blood could act as food for the
infection and make it harder to heal.”
What are the warning signs that your dry skin is about
to turn from bad to worse?
When to call your doctor
Kelly tells her patients to see a dermatologist or podiatrist
“if you have severe cracks in your skin.” She also urges her
patients to check their skin daily for “signs of infections,
irritation, skin breakdown or worsening of skin condition.”
Levy says that if dry skin doesn’t respond to simple
treatments, “seek a consultation with a dermatologist, as
inflammatory diseases is a risk.” She also urges expert help
if a rash erupts.
“At some point, dry skin leads to inflammation, which
can lead to breaks, then infection,” Anthony warns.
Special considerations for gear heads
Suzanne Ghiloni, CDE, who works with Kelly at Harvard,
says, “My patients who wear devices—pumps and continuous
glucose monitors—seem to have a special need to avoid dry or
irritated skin because it impacts the adherence and comfort
of the adhesive on their skin. This is always more of a problem
in the winter.” Her recipe nicely sums up the advice of all of
our experts: “I ask them to practice good skin hygiene, that
is, warm—not hot—water for baths and showers, gentle soaps
like Dove or Cetaphil, and regularly moisturizing the skin with
non-medicated, non-perfumed lotions.” †
Wil Dubois is a health columnist and author who has published over 325
articles and four award-winning diabetes books. He has type 1 diabetes.
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 Obesity+Diabetes
THE LINK
By Nicola Davies, PhD

W hy is Type 2 diabetes becoming a global

epidemic, and is it just a coincidence
that its rise is joined by another global epi-
demic—obesity? Could it be that the two are
linked in some way, and if so, how? Dr. Nicola
Davies, author of I Can Beat Obesity! Finding
the Motivation, Confidence and Skills to Lose
Weight and Avoid Relapse, investigates.

The Role of Insulin Resistance

in the Obesity-diabetes Link
Understanding insulin resistance is funda-
mental to answering the obesity-diabetes
link question. The pancreas pro-
duces insulin, which helps the
sugar we eat become fuel
for cells in the muscles,
fat and liver to use
for energy. Insulin
resistance, however,
reduces the ability
of these cells to use
the sugar for energy.
This is more likely to
occur in people who
are overweight or obese
since excess fat makes the
cells less responsive to insu-
lin, causing insulin resistance.
Shutterstock/Kittichai

There is also scientific evidence

showing that fat cells are more insulin-
resistant than muscle cells. In other words,
16 January/February 2018
insulin is less effective in people who are overweight or
obese, causing glucose in the bloodstream to remain high.
There are several contributing factors to insulin resis-
tance, not all of which are weight-related. Some can be
controlled, while others cannot. Genetics, age and ethnicity
all play a part. Medications like steroids can interfere with
the insulin mechanism. Lifestyle factors such as alcohol
intake, smoking, exercise level and stress also play a key role,
and there’s a cardiovascular connection too; individuals
with high blood pressure and cholesterol are more prone
to diabetes.
Yet the one overarching indicator that outshines all
other factors in terms of whether you’ll develop insulin
resistance is your body weight. Nearly one-third of all
American adults are obese, and the number of obese
children has tripled in the last four decades. Indeed,
obesity is the single best predictor of whether a person will
develop Type 2 diabetes. If you are overweight or obese
(characterized by a body mass index [BMI] greater than
30), you have an exponentially higher risk of developing
diabetes during your lifetime. In fact, almost 90 percent
of people with Type 2 diabetes are overweight or obese.
How Obesity Contributes to Diabetes
People with a BMI above 30 are 80 times more likely to
develop Type 2 diabetes than people with a BMI under
22. Why is this? If we look more closely, it isn’t necessarily
the weight itself that contributes to diabetes, but where it
is stored in the body. Body fat can be classified according
to two locations—visceral or subcutaneous.
• Visceral fat is stored inside the belly area and wraps
around the walls of internal organs, which means it
can’t easily be removed by typical diets or exercise.
• Subcutaneous fat is found right beneath the skin and
is what you can physically measure when taking your
waist circumference—the so-called “love handles.’”
Visceral fat is the type that increases the risk of developing
serious health problems such as diabetes. While subcutane-
ous fat isn’t as dangerous in general, when it comes to the
belly area, both types of fat are present, so a growing belly
can be a sign that one or both types of fat are increasing in
the stomach region, raising your risk for diabetes.
Ultimately, the weight around the midsection is the type
we need to watch when it comes to preventing or controlling
diabetes. People with excess abdominal fat (see table) are
much more prone to developing Type 2 diabetes because
abdominal fat cells release inflammatory chemicals that
reduce the body’s ability to incorporate and utilize insulin.
It isn’t just where body fat (also known as adipose) is
stored, but also the type of fat being stored. There are two
kinds of adipose (fat) tissues.
DIABETES RISK BY WAIST CIRCUMFERENCE (INCHES)
DIABETES RISK LOW HIGH VERY HIGH
Men Less than 37 37 – 40 Greater than 40
Women Less than 31.5 31.5 – 35 Greater than 35
• Brown adipose tissues are, as you might expect, dark
brown in color. They are linked with many blood vessels
and associated with calorie burning, heat production
and energy balance.
• White adipose, on the other hand, is responsible
for storing energy and accumulates excessively in
obesity. In a healthy body, muscles, fat tissue and the
liver absorb glucose from the bloodstream. White
adipose supports this process of glucose regula-
tion, which in turn helps reduce the risk of obe-
sity and diabetes. However, when white adipose
becomes excessively thick, its ability to help regulate
glucose levels is disrupted.
Understanding fat and how it is stored in the body can
be useful if you are embarking on a weight-management
regimen to prevent or control diabetes.
The Obesity-diabetes Link Starts Young
The risk of developing Type 2 diabetes by age 25 qua-
druples in obese children. One large study in the United
Kingdom examined electronic health records from 1994
to 2013 for nearly 370,000 children ages 2 to 15 for high
BMI values indicative of childhood obesity. Researchers
then looked at the diagnoses of either Type 1 or Type 2
diabetes up to age 25 in those same people. Obese children
had four times the risk of developing Type 2 diabetes by
age 25 compared to those children with a normal BMI
during childhood.
Historically, Type 2 diabetes had been considered an
adult disease, but currently, Type 2 diabetes in children is
being diagnosed at an alarming rate, with doctors attrib-
uting it to obesity, unhealthy diets and lack of physical
activity. Obesity is also an indicator of childhood Type 1
diabetes. Although Type 1 is an autoimmune disorder,
factors such as obesity and insulin resistance further
complicate the condition. In one study comprised of
nearly 100,000 children who were monitored for weight
changes during the first year of life, overweight and obese
babies had a positive correlation with increased Type 1
diabetes incidence. The heavier the child, the younger
the age of diabetes diagnosis. Although insulin resistance
is not the main driver for Type 1 diabetes, this study shows
that obesity does play a role and could explain why more
children are developing both types of diabetes.
The Sleep Connection
The link between obesity and diabetes isn’t straightforward
because other factors can exacerbate the link. Sleep is
one area where this is particularly the case. Sleep is vital
to so many of the body’s core functions, including insulin
regulation. Untreated sleep issues like sleep apnea, which
is more common in overweight people, can increase the
risk of developing obesity, which in turn increases the risk
for insulin resistance and Type 2 diabetes.
Abdominal fat and overall obesity are the two biggest risk
factors for developing sleep apnea because the excess fat in
the pharynx (the part of the throat behind the mouth and
DiabetesSelfManagement.com 17
nasal cavity) is more likely to block the airways. A cascade
effect occurs in that obese people are more likely to develop
obstructive sleep apnea, with even moderate sleep apnea
disrupting metabolic processes and increasing the risk of
developing diabetes.
Endocrinologists point out that poor sleep negatively
affects blood sugar levels and also disrupts many other
bodily processes like cholesterol and blood pressure.
These problems are much worse in obese individuals.
Unfortunately, many people with Type 2 diabetes do suf-
fer from poor sleep. Both the quantity of sleep as well as
the quality matter in this equation. People who get too
little sleep (less than six hours) or too much (more than
nine hours) are more prone to Type 2 diabetes. Indeed, a
British study of approximately 4,500 children showed that
insufficient sleep was associated with three risk factors for
Type 2 diabetes: higher BMI, increased insulin resistance
and elevated glucose readings.
Prediabetes and Metabolic Syndrome
Researchers have another theory that obesity leads to
prediabetes, a condition characterized by elevated blood
glucose levels that are not high enough to make a dia-
betes diagnosis. The number of people with prediabetes
is rising sharply—at least 84 million people in the U.S.
had it in 2015. Over time, prediabetes causes the body’s
cells to start losing the ability to uptake insulin. In fact,
most people with prediabetes end up developing Type 2
diabetes within 10 years.
Metabolic syndrome, a related condition, is a com-
OBESITY: FACT FROM FICTION
Q Overweight is the same as obesity
Being overweight is not the same as being obese. Overweight may
simply be a result of having heavy bones or muscle mass, or even
high body water content, but not necessarily fat. Obesity, on the
other hand, refers only to having too much adipose tissue or fat
in the body. Both conditions, however, refer to having weight or
fat that is in excess of what is considered healthy for your height.
Q An ideal weight is a healthy weight
Some people assume that they are unhealthy or “too fat” when their
weight doesn’t fall in the ideal range. A healthy weight is computed
based on your height, weight and other factors. On the other hand,
your ideal weight is often based on your personal preference and
how you want your physique to appear. For obese people, losing five
or 10 percent of their weight can already be healthy (or healthier)
because it can reduce the risk of developing certain health problems.
So, always try to aim for a healthy weight, rather than your ideal
weight—they aren’t necessarily the same thing.
Q Obesity is detected through shrinking clothes
and extra pounds
Some people assume they are overweight or obese when their clothes
feel tighter, the scale shows they’ve gained weight or their waist
feels wider than before. Although these signs show that you have
gained some weight, they do not automatically mean you are obese.
18 January/February 2018
INTERESTING FACT:
The Obesity-Diabetes-Memory Link
Type 2 diabetes has been linked to memory loss, and researchers now
believe this could be related to increased weight in many people
with Type 2 diabetes. People who are overweight or obese have
been found to develop thinner grey matter in parts of the brain
related to memory. Not only could weight management help with
your diabetes, but it could also improve your memory.
plex set of risk factors including excess abdominal fat,
high blood pressure, elevated triglycerides, low HDL or
“good” cholesterol and high blood sugar levels. Many
obese people suffer from this condition, which dramati-
cally raises their chances of developing diabetes, among
many other illnesses. In fact, having multiple metabolic
syndrome risk factors leads to a five-fold increase in your
risk for diabetes.
Metabolic syndrome, also called Syndrome X or obesity
syndrome, is hereditary, and as you get older, the risk gets
higher. It’s very common among Native Americans, Afri-
can Americans, Hispanics and Asians—some of the same
ethnicities that are more prone to diabetes. Doctors aren’t
sure exactly why metabolic syndrome develops, but two of
the biggest indicators are obesity (particularly abdominal
fat) and insulin resistance.
What Can I Do?
Obesity is the single biggest predictor of Type 2 diabetes,
but fortunately, even small weight-related changes are
very effective. Losing as little as five to 10 percent of your
weight has been found to result in drastic improvements
in overall health and well-being, which in turn reduce
diabetes risk. If you weigh 200 pounds, lose 10 and see
what happens. Diet interventions to reduce carbohydrates
can be very effective. Get moving too—moderate walk-
ing for as little as 20 minutes per day can rev up your
metabolism. Studies in which people employed these
measures showed as much as a 60 percent reduction in
the development of diabetes.
If you already have prediabetes or full-blown Type 2
diabetes, stay focused and stay positive. You can make
many lifestyle changes to your diet and exercise routine
to prevent the situation from getting any worse. The same
measures mentioned above will work even if you’ve already
been diagnosed. Indeed, increasing evidence shows that
weight loss can actually reverse Type 2 diabetes.
The fact that weight and diabetes are so intertwined is
a good thing, even if it might not seem so. It gives many
of us some control over how we can avoid or manage
diabetes. Indeed, the more we learn about how the link
between these two conditions, the more empowered we
are to tackle them head-on in pursuit of better health
and well-being. †
Nicola Davies, PhD, is a health psychologist and author of I Can Beat
Obesity! Finding the Motivation, Confidence and Skills to Lose Weight and
Avoid Relapse.
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 DITCHING
NEW YEAR’S
RESOLUTIONS

By Alison Massey, MS, RD, LDN, CDE

IT’S DECEMBER 31ST, the clock strikes midnight and it’s all of a sudden a new
year. This year, big changes are going to be made. We have all been there or at
least know someone who has. In fact, according to one survey, about 41 percent
of Americans make resolutions, but fewer than 10 percent of those individuals
reported that they were successful in keeping their resolution. Yet, goals for self-
improvement with a focus on healthier lifestyle choices don’t need to be made
only once a year or in vain. In fact, some studies and experts agree that perhaps
Shutterstock/oatawa

focusing more on smaller steps and developing the skills to achieve your goals
might be a better approach than depending on willpower.
20 January/February 2018
 According to Merriam-Webster, willpower is “the abil-
ity to control yourself: a strong determination that allows
you to do something difficult.” Willpower is often what
people cite they are lacking when goals or resolutions are
derailed. But what if self-control isn’t the key? What if merely
embracing small steps toward a larger goal that result in
behavior change over time is the best strategy? What if
thinking about each day as a marker for a fresh start is a
better approach than focusing on a new year? Initiating
self-improvement and healthy lifestyle goals doesn’t have
to be overwhelming if you decide to take it one day at a
time. So, this year, ditch the New Year’s resolution and use
these eight tips for setting goals and improving your health
each day for more sustainable results and a positive change
in your health habits.
Be S.M.A.R.T about your choices
When selecting goals, regardless of whether they are short-
term or long-term, remember to make them S.M.A.R.T.
The acronym “S.M.A.R.T.” stands for specific, measurable,
attainable, results-focused and time-sensitive. When setting
daily and weekly goals, think about—and perhaps even
write down—the details regarding what you would like to
achieve, keeping the S.M.A.R.T. principles in mind. Break-
ing down the specific goal or task into detailed steps with
a definite deadline provides clarity and actionable steps
toward completing the goal. For example, if the goal is to
try to drink more water throughout the day, perhaps you
outline the goal like this: aim to drink eight 8-ounce glasses
of water today from 9 a.m. until one hour before bedtime
at 10 p.m. Remember, each small step can lead you toward
accomplishing larger goals.
Don’t do it all at once
The “taking it one day at a time” approach or, at minimum,
breaking down your larger objectives into smaller, more
achievable goals is one strategy that works well for some
individuals. Mercy Medical Center registered dietitian
and certified diabetes educator Leigh Tracy, RD, CDE,
LDN, doesn’t worry about making New Year’s resolutions.
Instead, Tracy focuses on smaller goals initiated at different
times throughout the year. “I don’t make New Year resolu-
tions,” says Tracy. “Instead of starting all my goals at once,
I like to make smaller goals throughout the year. It’s not as
overwhelming and I’m more likely to follow through with
accomplishing my goals.” Taking the small steps approach
is one way to break down larger and perhaps more daunt-
ing goals into something that appears more doable. It also
helps minimize the “all or nothing” attitude that one is
either on board with healthy changes or not, since goals
are spread out over time versus implemented all at once.
Schedule it
Consistency is key when it comes to implementing actions
to improve lifestyle. Texas-based nurse practitioner Travis
Maule, MSN, APRN, FNP-C, emphasizes consistency with
his patients as one of the most important elements toward
making lasting changes. “Small lifestyle modifications that
are implemented on a daily basis are significantly more
likely to have a lasting and profound effect,” says Maule.
“Extreme and abrupt lifestyle changes oftentimes cause
burnout, resulting in patients diverting back to old habits.”
So, how can you be more consistent in sticking with goals?
Scheduling the goal or task like any other appointment is
a practical and simple way to ensure you have time allotted
to accomplish the task.
Focus on the positives
The glass-is-half-full mindset is a good one and can also
be utilized when considering goals and lifestyle changes.
Instead of focusing on what should be avoided or eliminated
to achieve what you are trying to accomplish, focus instead
on the positive aspects of the change. For example, when
overhauling your diet, think about all the delicious foods
you might start adding to your meal plan. Change can be
difficult enough, so replace negative thoughts with positive
ones to better embrace the change.
Self-monitor
Self-monitoring has long been recognized as one strategy
to help individuals with accountability on goal progress.
Goals can be self-monitored in various ways, such as on
a calendar, in a journal or using an app. Self-monitoring
is especially important for lifestyle and behavior change
that will occur over longer periods of time. So, identify
the self-monitoring method that is best suited for you and
implement it daily to help with long-term success.
SMALL STEPS TOWARD
IMPROVING HEALTH
Nurse practitioner Travis Maule, MSN, APRN, FNP-C, doesn’t want his
patients to wait until there’s a medical emergency to make healthy lifestyle
changes—although sometimes that is the catalyst for change. “One of
the harsh realities of life is that many people are unwilling to change until
something catastrophic happens, such as stroke or heart attack,” he says.
“But it doesn’t necessarily have to be this way. Lifestyle modifications
don’t have to be drastic or cumbersome.” Here are Maule’s top five simple
lifestyle tips that you can start doing today.
Start with 20. Find a good compromise with your health-care provider
on goals for physical activity. Any amount of exercise is better than zero
minutes. Try starting with 20 minutes of cardiovascular exercise daily.
Save it. As a general rule of thumb, your body will let you know when
it doesn’t need any more food, so don’t push it. Overeating is a bad habit
that often has a snowball effect. If you start to feel full, don’t continue to
eat the remainder of your meal because it is available and tastes good. Save
it for later!
Recognize before you reach. Recognize “emotional eating” habits
before reaching for a snack. Develop other healthy non-food-related habits
to handle emotional eating.
Change your routine. Something as simple as regularly taking the
stairs rather than the elevator or parking at the far end of the parking lot at
the grocery store are steps toward improving health status.
Enjoy smaller portions. Abrupt cessation of your favorite foods is
not exactly the aim, but rather practicing moderation of these foods.
DiabetesSelfManagement.com 21
MEAL PREP MADE EASY
Is improving meal preparation a habit that you’d like to start? Try this healthy
protein- and vegetable-filled dish created by registered dietitian Leigh Tracy,
RD, CDE, LDN. She focuses on preparing simple and nutritious meals during
the week and recommends that her patients develop the same healthy
habit. Tracy says, “My favorite breakfast items to make are egg muffins, egg
casseroles and egg quesadillas—I load them with a variety of vegetables to
add a splash of color, flavor and fiber to my morning. My secret ingredient
to my egg creations is sautéed sweet potato. It adds a sweetness to the dish
that is unique compared to using a white potato.”
Leigh’s Sweet Potato
and Egg Casserole
1 medium sweet potato, diced 1 cup frozen tri-colored sweet
1 tablespoon olive oil peppers, defrosted and
12 whole eggs chopped, if desired
¾ cup 1% milk ½ cup low-fat cheddar cheese
¾ cup grape tomatoes, halved Dash of paprika, cumin and
2 handfuls baby spinach, chopped black pepper
1. Preheat oven to 350°F. Spray a 9x13 casserole dish
with nonstick cooking spray.
2. Wash and dice sweet potato into 1-inch cubes.*
3. Heat a skillet on medium and add the olive oil. Once
the oil is hot, add the diced sweet potatoes, stirring
occasionally until you can easily put a fork through the
potatoes. Set aside.
4. In a large mixing bowl, crack the eggs and stir in the
milk. Add grape tomatoes, spinach, peppers, cheese and
cooked sweet potatoes to the egg mixture.
5. Pour egg mixture into dish and place in oven for
20 minutes or until the middle is firm.
6. Once the dish has cooled, cut square portions and
place slices into individual freezer bags.**
Tips: *Leave the skin on the potatoes for added fiber.
**Place 1 to 2 egg portions into freezer bag and defrost
in fridge the night before to make it faster to heat up in
the morning OR make egg muffins by simply pouring
sweet potato egg casserole mixture into a muffin tin for
the perfect portion and easy grab-and-go breakfast.
22 January/February 2018
Collaborate with others
Have you ever considered working more with your
health-care provider on attaining your healthy lifestyle
goals? Especially for individuals dealing with various
medical issues, it can be helpful not only to have your
health-care provider serve as an accountability partner
at checkups but also provide guidance and customized
goals. He or she may even recommend other specialists
who might be better able to help you reach your goals,
such as a registered dietitian, physical therapist or certi-
fied diabetes educator. Maule emphasizes, “It’s important
that lifestyle modifications and goals are tailored to the
individual, as certain medical conditions and underly-
ing factors can influence [what goals an individual may
want to set]”. He suggests that patients write down a list
of concerns and potential goals ahead of time. This can
serve not only as a reminder during appointments, but
also helps create a more structured conversation with
the provider regarding health and lifestyle goals that
are important to you.
Commit to the process, not the goal
Improving our lifestyle behaviors is a process without
a set endpoint. Achieving a healthy lifestyle requires
dedication to behaviors that occur on a regular basis.
Embracing the journey or the process is a much better
strategy than focusing on the end-goal alone. New habits
or lifestyle behaviors likely need to be continued—the
need for them doesn’t stop when the goal is reached.
This is why developing a dedication to the process is
much more important than commitment to the goal.
This, in part, explains why many diets are largely unsuc-
cessful—because individuals haven’t truly adopted modi-
fications in food choices or eating behaviors. Diets are
started and stopped, whereas healthy eating habits are
implemented daily.
Develop perseverance for long-term success
Change can be difficult, especially when there are set-
backs or roadblocks to achieving our short-term and
long-term goals. Developing the tenacity to stick with
goals despite these setbacks is an important skill that can
be beneficial in many different areas of life. Sometimes
roadblocks are completely out of our control but what
remains in our control, is the ability to refocus, develop
a new plan and continue with the steadfastness required
for long-term success.
This year, rethink New Year’s resolutions and instead
resolve to treat each day as an opportunity to improve your
health and life. A healthy lifestyle is built day by day on small
choices. It’s important to remember that over time, small
changes can make a big difference. After all, slow change
is still change. †
Shutterstock/marekuliasz
Alison Massey, MS, RD, LDN, CDE, is a registered dietitian and certified
diabetes educator in Maryland. She is the owner of The Simple Ingredient LLC
www.thesimpleingredient.com.
 ROASTED
VEGGIE DISHES
PAGE 26
PERFECT
POTATOES
PAGE 30
A TASTE OF THE
MEDITERRANEAN
PAGE 34

ng GAME-DAY
Celebrati DESSERTS
17TR+USYTEeD aANrDs PAGE 38
ED
APPROV d
tere
by Regis ans
Dietiti
Shutterstock/Liliya Kandrashevich

SUPERMARKET
SMARTS
BREAD
PAGE 42
 ROASTED PERFECT OLD WORLD GAME-DAY
VEGETABLES POTATO DELIGHTS DESSERT

27 Roasted Balsamic 31 Tomato, Potato 35 Caprese Salad 39 Dessert Nachos

Asparagus and Basil Skillet
35 Mediterranean 39 Quick Chocolate Chip
27 Roasted Cauliflower 31 Mashed Potato Puffs Roasted Tomatoes Cookie Cakes
27 Roasted Tomato, 31 Cauliflower Potato 35 Mediterranean 39 Donut Spice Cakes
Artichoke and White Pancakes Chicken Salad
40 Chocolate Peanut
Bean Crostini
32 Broccoli & Potato 36 Mediterranean Orzo Butter Truffles
28 Bite-You-Back Chowder and Vegetable Pilaf
40 Dreamy Orange
Roasted Edamame
32 Chili-Topped 36 Mediterranean Tuna Cheesecake Dip
28 Roasted Butternut Baked Potato Sandwiches
40 PM Snack Bars
Squash
32 Ginger Sweet 36 Deviled Eggs
28 Roasted Parsnips, Potato Cake
Carrots and Red Onion

LOW-FAT RECIPE
Understanding Our Symbols Contains 3 grams or fewer of fat per serving
Like everyone, you’re busy – and we kept that in
mind when we selected recipes for this issue. Many LOW-SODIUM RECIPE
Lettering: Shutterstock/Ana Babii; Image: Shutterstock/SergeyIT

of the recipes in Diabetic Cooking can be prepared Contains 140 milligrams or fewer of sodium
in 30 minutes or less. Others require short preparation per serving
times followed by long cooking times. LOW-CARBOHYDRATE RECIPE
Contains 15 grams or fewer of carbohydrate
We’ve also included symbols to help you more easily per serving
find those recipes especially low in fat, sodium, and
carbohydrates, and high in fiber. HIGH-FIBER RECIPE
Contains 5 grams or more of fiber per serving

24 January/February 2018
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 ROASTED
VEGETABLES

WE ALL KNOW we should eat our vegetables, those nutrient-filled powerhouses, but eating
the same old veggies prepared in the same old way gets boring. That’s why these roasted
vegetable dishes are just the thing to get you eating healthily and happily in the new year. And
these aren’t just side dishes—we’ve included yummy, good-for-you snacks with our Bite-You-
Back Roasted Edamame and Roasted Tomato, Artichoke and White Bean Crostini recipes.
Eating well never tasted so good!

26 January/February 2018
Roasted Roasted Tomato, Artichoke
Balsamic and White Bean Crostini
Asparagus MAKES 24 SERVINGS
SERVING SIZE: 1 CROSTINI
MAKES 6 SERVINGS

Nutrients per Serving: Calories 96, Total Fat 3g, Saturated

Nutrients per Serving:
Calories 57, Total Fat 3g,
Saturated Fat 1g, Protein
3g, Carbohydrates 4g,
Cholesterol 3mg, Dietary
Fiber 2g, Sodium 53mg
Dietary Exchange: 1 Fat,
1 Vegetable
1 pound fresh
asparagus
1 tablespoon olive
oil
½ teaspoon salt
(optional)
¼ teaspoon black
pepper
1 tablespoon
balsamic glaze*
¼ cup finely
shredded or
grated Parmesan
cheese
1. Preheat oven to 375°F.
2. Arrange asparagus in
single layer in shallow
11x7-inch baking dish.
Drizzle asparagus with
oil; gently toss to coat
evenly. Sprinklewith salt,
if desired, and pepper.
3. Bake 14 to 16 min-
utes or until crisp-tender.
Drizzle balsamic glaze
over asparagus; roll again
with tongs to coat. Top
with cheese.
Note: *Balsamic glaze
can be found in the
condiment section of the
supermarket or can be
prepared by simmering
2 tablespoons balsamic
vinegar until reduced by
about half.
Fat 1g, Protein 4g, Carbohydrates 14g, Cholesterol 0mg,
Dietary Fiber 2g, Sodium 202mg
Dietary Exchange: 1 Bread/Starch, ½ Fat
Roasted
Cauliflower
MAKES 4 SERVINGS
(ABOUT ¾ CUP PER SERVING)
Nutrients per Serving:
Calories 62, Total Fat 4g,
Saturated Fat 1g, Protein 2g,
Carbohydrates 7g, Cholesterol
0mg, Dietary Fiber 2g, Sodium
38mg
Dietary Exchange: ½ Fat,
1 Vegetable
5 cups cauliflower
florets
1 tablespoon extra
virgin olive oil
¾ teaspoon Italian
seasoning
½ teaspoon garlic
powder
¼ teaspoon salt
(optional)
1
/8 teaspoon black
pepper
1. Preheat oven to 425°F.
Spray baking sheet with
nonstick cooking spray.
2. Place cauliflower on bak-
ing sheet. Drizzle with oil.
Sprinkle with Italian season-
ing, garlic powder, salt, if
desired, and pepper. Gently
toss; arrange in single layer.
3. Bake 20 minutes, turn-
ing once, or until tender.
1 pint grape tomatoes 1. Preheat oven to 450°F.
2 cloves garlic, Place tomatoes and 1 clove
garlic in 8-inch square
crushed and
divided baking dish. Drizzle with
¼ cup olive oil, divided 1 teaspoon oil and vinegar;
1 teaspoon balsamic
toss to coat evenly. Bake
25 minutes.
vinegar
1 can (about 15 2. Combine beans, cheese,
ounces) cannellini lemon juice, 1 clove garlic,
beans, rinsed and 2 tablespoons oil and salt in
drained
food processor or blender;
2 tablespoons grated process using on/off pulses
Parmesan cheese until combined. Fold in
artichokes.
2 tablespoons fresh
lemon juice
3. Arrange bread in single
¼ teaspoon salt layer on baking sheet;
1 can (14 ounces) brush lightly with remain-
quartered ing oil. Spread 1 table-
artichoke hearts, spoon bean mixture over
drained each bread slice.
1 loaf (about 1 pound)
4. Remove tomatoes from
French bread,
ends removed oven.Reduce oven tempera-
and sliced into ture to 350°F. Bake crostinis
24 (½-inch-thick) 10 to 12 minutes or until
slices bread is crisp and edges
¼ cup chopped fresh begin to brown. Top evenly
basil with tomatoes and basil.
DiabetesSelfManagement.com 27

Bite-You-Back
Roasted Edamame
MAKES 4 TO 6 SERVINGS
SERVING SIZE: ½ CUP
Nutrients per Serving: Calories
78, Total Fat 4g, Saturated Fat
1g, Protein 4g, Carbohydrates 7g,
Cholesterol 0mg, Dietary Fiber 1g,
Sodium 7mg
Dietary Exchange: ½ Bread/Starch,
1 Meat
2 teaspoons vegetable oil
2 teaspoons honey
¼ teaspoon wasabi
powder*
1 package (10 ounces)
shelled edamame,
thawed if frozen
Kosher salt (optional)
1. Preheat oven to 375°F.
2. Combine oil, honey and wasabi
powder in large bowl; mix well.
Add edamame; toss to coat.
Spread on baking sheet in single
layer.
3. Bake 12 to 15 minutes or until
golden brown, stirring once. Im-
mediately remove from baking
sheet to large bowl; sprinkle gen-
erously with salt, if desired. Cool
completely before serving. Store in
airtight container.
Note: *This can be found in the
Asian section of most supermar-
kets and Asian specialty markets.
28 January/February 2018
ROASTED
VEGETABLES
Roasted
Butternut
Squash
MAKES 5 (1-CUP) SERVINGS
Nutrients per Serving:
Calories 143, Total Fat 3g,
Saturated Fat 2g, Protein
3g, Carbohydrates 30g,
Cholesterol 7mg, Dietary
Fiber 8g, Sodium 167mg
Dietary Exchange:
1½ Bread/Starch, ½ Fat,
1 Vegetable
Nonstick cooking
spray
1 pound butternut
squash, peeled, cut
into 1-inch cubes
(about 4 cups)
2 medium onions,
coarsely chopped
8 ounces carrots,
peeled and cut
into ½-inch
diagonal slices
(about 2 cups)
1 tablespoon dark
brown sugar
¼ teaspoon salt
Black pepper
(optional)
1 tablespoon butter or
margarine, melted
1. Preheat oven to 400°F.
Line large baking sheet
with foil and spray with
nonstick cooking spray.
2. Arrange vegetables in
single layer on prepared
baking sheet; spray with
cooking spray. Sprinkle
with brown sugar, salt and
pepper, if desired.
3. Bake 30 minutes. Gently
stir; bake 10 to 15 minutes
or until tender. Drizzle with
butter; toss to coat.
Roasted Parsnips, Carrots
and Red Onion
MAKES 4 SERVINGS (ABOUT ¾ CUP PER SERVING)
Nutrients per Serving: Calories 107, Total Fat 3g,
Saturated Fat 0g, Protein 2g, Carbohydrates 21g,
Cholesterol 0mg, Dietary Fiber 5g, Sodium 197mg
Dietary Exchange: 1 Bread/Starch, ½ Fat,
1 Vegetable
2 carrots (9 onion (1/4-
ounces), cut inch slices)
into 2-inch-
long pieces
1 tablespoon
balsamic
2 parsnips (9 vinegar
ounces), cut
2 teaspoons extra
into 2-inch- virgin olive oil
long pieces
¼ teaspoon salt
¾ cup vertically 1
/8 teaspoon black
sliced red
pepper
1. Preheat oven to 425°F. Line large baking
sheet with foil or spray with nonstick cooking
spray.
2. Combine carrots, parsnips, onion, vinegar,
oil, salt and pepper in large bowl; toss to coat.
Spread in single layer on prepared baking sheet.
3. Roast 25 minutes or until vegetables are
tender, stirring occasionally.
Note: Parsnips are a pale white root veg-
etable similar to the carrot in shape. The
parsnip, however, is broader at the top and
has a smoother skin. The longer it stays in
the ground, the sweeter it becomes. Choose
parsnips that are firm, unblemished, and small
or medium in size (about 8 inches long). Rinse
and scrub parsnips with a vegetable brush to
remove embedded soil. Peel parsnips with a
swivel-bladed vegetable peeler or paring knife.
Trim off ends and discard. For even cooking,
parsnips are best chopped, cubed, sliced or cut
into strips before cooking.
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 PERFECT
POTATO

MASHED, BAKED, FRIED—POTATOES are endlessly versatile, and these recipes show you
all the wonderful ways you can use the terrific tubers. From Cauliflower Potato Pancakes to
Ginger Sweet Potato Cake, we’ve got every meal—and in-between bites—covered with these
scrumptious spud-centered dishes.

30 January/February 2018
Tomato, Potato
and Basil Skillet
MAKES 4 SERVINGS
SERVING SIZE: 1 WEDGE
Nutrients per Serving: Calories
260, Total Fat 7g, Saturated Fat
1g, Protein 9g, Carbohydrates
42g, Cholesterol 106mg, Dietary
Fiber 4g, Sodium 394mg
Dietary Exchange: 2 Bread/
Starch, ½ Fat, 2 Vegetable
1 tablespoon olive oil,
divided
3 cups sliced potatoes
1
/3 cup minced fresh basil
2 whole eggs
2 egg whites
2 tablespoons fat-free
(skim) milk
1 tablespoon Dijon
mustard
1 teaspoon dry mustard
½ teaspoon salt
¼ teaspoon black
pepper
2 cups sliced plum
tomatoes
1. Heat 1½ teaspoons oil in
medium nonstick skillet over
medium heat until hot. Layer
half of potato slices in skillet.
Cover and cook 3 minutes or
until lightly browned. Turn
potatoes and cook, covered,
3 minutes or until lightly
browned. Remove potatoes
from skillet. Repeat with
remaining 1½ teaspoons oil
and potatoes.
2. Arrange all potatoes in
skillet. Sprinkle with basil.
Whisk together eggs, egg
whites, milk, mustards,
salt and pepper in small
bowl. Pour over potatoes.
Arrange tomatoes over
potato mixture. Reduce heat
to low. Cover and cook 10
minutes or until eggs are set.
Cut into 4 wedges to serve.
Mashed Potato Puffs
MAKES 18 PUFFS (ABOUT 6 SERVINGS)
Nutrients per Serving: Calories 63, Total Fat 2g,
Saturated Fat 1g, Protein 32g, Carbohydrates 8g,
Cholesterol 2mg, Dietary Fiber 1g, Sodium 99mg
Dietary Exchange: ½ Fat, 1 Vegetable
1 cup prepared mashed potatoes
½ cup finely chopped broccoli or
spinach
2 egg whites
4 tablespoons shredded Parmesan
cheese, divided
1. Preheat oven to 400°F. Spray 18 mini (1¾-
inch) muffin cups with nonstick cooking spray.
2. Combine mashed potatoes, broccoli, egg
whites and 2 tablespoons cheese in large
bowl; mix well. Spoon evenly into prepared
muffin cups. Top evenly with remaining 2
tablespoons cheese.
3. Bake 20 to 23 minutes or until golden
brown. To remove, gently run knife around
edges and lift out with fork. Serve warm.
Cauliflower
Potato Pancakes
MAKES 12 PANCAKES
(ABOUT 6 SERVINGS)
Nutrients per Serving: Calories
89, Total Fat 4g, Saturated Fat 1g,
Protein 4g, Carbohydrates 14g,
Cholesterol 31mg, Dietary Fiber 2g,
Sodium 313mg
Dietary Exchange: ½ Bread/
Starch, ½ Fat, 1 Vegetable
1½ cups cubed Yukon Gold
potatoes
3 cups roughly chopped
cauliflower
1
/ cup whole wheat flour
3
1 egg, lightly beaten
1 egg white
1 tablespoon chopped fresh
chives, plus additional
for garnish
1 teaspoon baking powder
½ teaspoon salt
3 teaspoons vegetable oil,
divided
Light sour cream
(optional)
1. Bring large saucepan of water
to a boil. Add potatoes and
cauliflower; reduce heat. Simmer
10 minutes or until fork-tender.
Drain potatoes and cauliflower.
Let stand 5 to 10 minutes or
until cool enough to handle.
2. Gently mash potatoes and
cauliflower in large bowl. Add
flour, egg, egg white, 1 table-
spoon chives, baking powder
and salt; mix well.
3. Heat 1 teaspoon oil in large
nonstick skillet over medium heat.
Drop ¼ cupfuls potato mixture
into skillet; flatten slightly. Cook
5 to 7 minutes per side or until
golden brown. Repeat with re-
maining oil and potato mixture.
4. Serve with sour cream, if
desired. Garnish with chives.
DiabetesSelfManagement.com 31

Broccoli & Potato
Chowder
MAKES 2 SERVINGS
SERVING SIZE: 2 CUPS CHOWDER
Nutrients per Serving: Calories 280,
Total Fat 1g, Saturated Fat 1g, Protein
19g, Carbohydrates 51g, Cholesterol
3mg, Dietary Fiber 5g, Sodium 311mg
Dietary Exchange: 2 Bread/Starch,
3 Vegetable, ½ Milk
1 can (about 14 ounces)
fat-free reduced-sodium
chicken broth
1 cup sliced leeks
½ cup cubed peeled potato
1
/3 cup fresh or frozen corn
1 can (about 4 ounces) diced
mild green chiles
¾ teaspoon paprika
1½ cups broccoli florets
¾ cup evaporated skimmed
milk
2 tablespoons all-purpose flour
Jalapeño pepper sauce
(optional)
1. In medium saucepan combine
broth, leeks, potato, corn, chiles
and paprika. Bring to a boil. Reduce
heat and simmer, covered, 10 to 15
minutes or until vegetables are tender.
Add broccoli; simmer 3 minutes.
2. Whisk milk into flour. Stir into
vegetable mixture. Cook, stirring
constantly, until soup comes to a boil
and thickens slightly. Season to taste
with pepper sauce, if desired.
32 January/February 2018
PERFECT
POTATO
Ginger Sweet
Potato Cake
MAKES 18 SERVINGS
Chili-Topped Nutrients per Serving: Calories
Baked Potato 174, Total Fat 4g, Saturated Fat
1g, Protein 2g, Carbohydrates 31g,
SERVES 4 (½ POTATO AND Cholesterol 0mg, Dietary Fiber 1g,
1 CUP CHILI PER SERVING) Sodium 217mg
Dietary Exchange: 2 Bread/Starch,
½ Fat
Nutrients per Serving: Calories 280,
Total Fat 6g, Saturated Fat 2g, Protein 1 package (about 18
11g, Carbohydrates 49g, Cholesterol
ounces) spice cake mix
5mg, Dietary Fiber 7g, Sodium 230mg
11/3 cups water
Dietary Exchange: 2 Bread/Starch, 1 Fat
1 cup mashed sweet
potatoes (see Note)
2 Russet potatoes
6 egg whites or ¾ cup egg
1 tablespoon vegetable oil
substitute
2 cloves garlic, finely chopped
2 tablespoons canola oil
1½ cups thinly sliced fresh
1 tablespoon grated fresh
mushrooms
ginger
2
/3 cup chopped red onion
1 container (8 ounces) fat-
2
/3 cup chopped red bell pepper free whipped topping
¼ teaspoon ground cumin
1
/8 teaspoon ground red 1. Preheat oven to 350°F. Coat
pepper 13x9-inch baking pan with non-
1
/8 teaspoon dried oregano stick cooking spray.
1 can (28 ounces) whole
2. Combine all ingredients except
tomatoes, peeled, unsalted whipped topping in large bowl;
and undrained mix according to package direc-
½ cup Great Northern beans, tions. Pour batter into prepared
rinsed and drained baking pan. Bake 30 minutes or
2 green onions, sliced until toothpick inserted into center
¼ cup shredded reduced-fat comes out clean. Cool completely
Cheddar cheese in pan on wire rack.
3. Frost with whipped topping.
1. Preheat oven to 450°F. Pierce pota-
Cover and refrigerate until serving.
toes several times with fork. Place in
shallow baking pan. Bake 45 minutes Note: 1 can (15 ounces) sweet
or until soft. potatoes in syrup, drained and
mashed, equals about 1 cup.
2. For chili, heat oil in large nonstick
saucepan over medium-high heat
until hot. Add garlic; cook and stir 1
minute. Add mushrooms, onion and
bell pepper. Cook 5 minutes, stirring
occasionally. Add cumin, ground red
pepper and oregano. Cook and stir
1 minute. Add tomatoes and beans.
Reduce heat to medium-low. Simmer
15 minutes, stirring occasionally.
3. Slice potatoes in half lengthwise.
Spoon chili on top and sprinkle evenly
with green onions and cheese.
+++++++++ I N T R O D U C I N G +++++++++

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$ 99
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re

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everything you need to live a happy, healthy life.
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+ + + + + ++ + + BENEFITS OF MEMBERSHIP* + + + + + + + +

For three decades, Diabetes Self-Management has helped, encouraged and guided a growing population
of people living with diabetes. In response to customer feedback, and in an effort to meet the daily needs
and high expectations of you, our audience, we have created Diabetes Self-Management Care & Connect.
This comprehensive program provides you with tools and connects you with additional resources
for virtually everything you need to live a happy, healthy life.

Custom Diabetes Care Report: A custom Diabetes E-Connect: Quarterly Coupon Pack: Quarterly mailings of coupons
curated report prepared for you by our E-workshops on important to help you SAVE BIG on diabetes‚ and other
certified diabetes educator. Value $75 diabetes topics. Value $100 health-related products. Value $100

Diabetes Log & Learn: A blood
sugar logbook to track your
numbers for a full year, plus helpful
information and practical tips on
blood sugar monitoring. Value $15
Diabetes Self-Management Recipe Ring: Get
delicious, diabetes-friendly recipes for every meal,
plus snacks‚ and, of course, desserts! — delivered
to you quarterly. These can be conveniently
collected on our handy ring. Value $50
Annual subscriptions/renewals
to the print version of
Diabetes Self-Management and
Pain-Free Living. Value $60

Ready to get connected?

*Diabetes Self-Management Care & Join now at www.bit.ly/dsmcare
Connect is only available in the US.
 OLD WORLD
DELIGHTS

THE MEDITERRANEAN DIET

has been shown to not only
improve blood sugar control,
cholesterol, triglyceride levels
and weight in people with Type 2
diabetes, it’s also linked to slower
progression of diabetes and a
decrease in the development
of diabetes-related eye disease.
And better yet, it’s chock full of
delicious food! Start your new
year with these meals that are so
mouthwatering you’ll forget how
healthy you’re eating.

Photographed by Angel Tucker; food prepared by Maggie Mulvena

34 January/February 2018
Caprese Mediterranean
Salad Chicken Salad
MAKES 4 SERVINGS MAKES 1 SALAD

Nutrients per Serving: Nutrients per Serving: Calories 187,

Calories 73, Total Fat 5g, Total Fat 3g, Saturated Fat 1g, Protein 23g,
Saturated Fat 2g, Protein Carbohydrates 14g, Cholesterol 56mg, Dietary
4g, Carbohydrates Fiber 3g, Sodium 587mg
9g, Cholesterol 9mg,
Dietary Exchange: ½ Bread/Starch,
Dietary Fiber 1g, Sodium
165mg 1 Vegetable, 2 Meat

Dietary Exchange:
½ Fat, 1 Vegetable, 2 cups spring salad greens or
½ Meat mesclun
½ cup diced or shredded cooked
3 medium chicken breast
tomatoes (¾ 1 plum tomato, sliced
pound total), ¼ cup fat-free croutons
cut into 8 slices
2 tablespoons chopped fresh basil
2 (1-ounce) slices
2 tablespoons reduced-fat reduced-
part-skim
sodium Italian salad dressing
mozzarella
cheese, each Black pepper (optional)
cut into strips
(24 strips total) Mediterranean 1. Combine greens, chicken, tomato,
1
/8 teaspoon salt Roasted Tomatoes croutons, basil and dressing in large bowl;
toss well.
Pinch black MAKES 4 SERVINGS
pepper SERVING SIZE: 1 TOMATO HALF 2. Transfer mixture to plate. Season with
2 teaspoons extra- pepper, if desired.
virgin olive oil
¼ cup thinly sliced Nutrients per Serving: Calories 34,
fresh basil Total Fat 2g, Saturated Fat 1g, Protein 2g,
Carbohydrates 3g, Cholesterol 4mg, Dietary
leaves
Fiber 1g, Sodium 162mg

Arrange tomatoes Dietary Exchange: ½ Fat, 1 Vegetable

and cheese alternately
on plate; overlapping 2 medium beefsteak tomatoes, cut
slightly. Sprinkle with in half crosswise
salt and pepper and 4 fresh basil leaves
drizzle with oil. Scatter 2 tablespoons finely chopped
basil on top. pitted kalamata olives
Note: Caprese is a 2 tablespoons shredded reduced-
simple salad from fat mozzarella cheese
the Italian region of 2 tablespoons grated Parmesan
Campania, tradition- cheese
ally including sliced
fresh mozzarella 1. Preheat toaster oven or oven to broil.
cheese, plum toma- Place tomato halves on rack of toaster
toes, and basil. It’s oven tray or broiler pan. Top each tomato
seasoned with salt, half with 1 fresh basil leaf and one fourth
black pepper, and of olives and cheeses.
olive oil.
2. Broil 2 minutes or until cheese melts
and begins to brown. Let cool slightly
before serving.
DiabetesSelfManagement.com 35
 OLD WORLD
DELIGHTS

Mediterranean
Tuna Sandwiches
MAKES 4 SERVINGS
SERVING SIZE: 1 SANDWICH
Nutrients per Serving: Calories
332, Total Fat 12g, Saturated Fat
2g, Protein 29g, Carbohydrates
27g, Cholesterol 31mg, Dietary
Fiber 4g, Sodium 483mg
Dietary Exchange: 1½ Bread/
Starch, ½ Vegetable, 3½ Meat Lean

1 can (12 ounces) solid Deviled Eggs

Mediterranean Orzo
and Vegetable Pilaf
MAKES 6, ½ CUP SERVINGS
Nutrients per Serving: Calories 168, Total Fat 7g, Saturated
Fat 2g, Protein 7g, Carbohydrates 23g, Cholesterol 11mg,
Dietary Fiber 3g, Sodium 516mg
Dietary Exchange: 1 Bread/Starch, 1 Fat, 1½ Vegetable,
½ Meat
½ cup plus 2 tablespoons
(4 ounces) uncooked
orzo pasta
2 teaspoons olive oil
1 small onion, diced
2 cloves garlic, minced
1 small zucchini, diced
½ cup fat-free reduced-
sodium chicken
broth
1 can (about 14
ounces) artichoke
hearts, drained and
quartered
1 medium tomato,
chopped
½ teaspoon dried
oregano
½ teaspoon salt
¼ teaspoon black
pepper
½ cup crumbled feta
cheese
Sliced black olives
(optional)
36 January/February 2018
1. Cook orzo according to
package directions, omitting
salt and fat. Drain.
2. Heat oil in large nonstick
skillet over medium heat.
Add onion; cook and stir 5
minutes or until translucent.
Add garlic; cook and stir 1
minute. Reduce heat to low.
Add zucchini and broth;
simmer 5 minutes or until
zucchini is crisp-tender.
3. Add cooked orzo, arti-
chokes, tomato, oregano,
salt and pepper; cook and
stir 1 minute or until heated
through. Top with cheese
and olives, if desired.
Note: This makes a nice
side dish to any plain grilled
or roasted chicken or fish.
Tip: To reduce the sodium in
this recipe, omit the salt. With
all the different fresh flavors,
you will not miss the extra salt.
white tuna packed in
water, drained
8 slices whole wheat
bread
¼ cup finely chopped red
onion
¼ cup fat-free or reduced-
fat mayonnaise
3 tablespoons chopped
black olives, drained
1 tablespoon plus 1
teaspoon lemon juice
1 tablespoon chopped
fresh mint (optional)
1 tablespoon olive oil
¼ teaspoon black pepper
1
/8 teaspoon garlic powder
(optional)
4 thin slices tomato
4 pieces romaine lettuce
1. Combine tuna, onion, mayon-
naise, olives, lemon juice, mint,
if desired, olive oil, pepper and
garlic powder, if desired, in large
bowl until blended.
2. Top each of 4 slices bread
with tomato slice and lettuce
leaf. Spoon 2/3 cup tuna mixture
over each tomato slice. Top with
remaining bread slices. Cut sand-
wiches in half to serve.
MAKES 12 APPETIZERS
(ABOUT 6 SERVINGS)
Nutrients per Serving:
Calories 49, Total Fat 3g,
Saturated Fat 0g, Protein
4g, Carbohydrates 3g,
Cholesterol 0mg, Dietary
Fiber 1g, Sodium 157mg
Dietary Exchange: 1 Meat
¼ cup finely diced
cucumber
¼ cup finely diced
tomato
2 teaspoons fresh
lemon juice
1
/8 teaspoon salt
6 hard-cooked eggs,
peeled and sliced
in half lengthwise
1
/3 cup roasted garlic
or any flavor
hummus
Chopped fresh
parsley (optional)
1. Combine cucumber, to-
mato, lemon juice and salt
in small bowl; gently mix.
2. Remove yolks from
eggs; discard. Spoon 1
heaping teaspoon hum-
mus into each egg half.
Top with ½ teaspoon
cucumber-tomato mixture
and parsley, if desired.
Serve immediately.
  Clip this offer and please call today!

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AFN44167_0113
 GAME-DAY
DESSERTS

JANUARY—AND THAT FIRST WEEKEND IN FEBRUARY—is prime football party time,

but desserts are often overlooked when planning the menu. Not anymore! These crowd-
pleasing sweet treats are sure to put the perfect finishing touch on any gridiron get-together.
But be warned—if anyone spots these dishes chilling in the fridge, they might not make it to
the buffet table.

38 January/February 2018
Dessert Nachos
MAKES 4 SERVINGS
SERVING SIZE: 6 TORTILLA
WEDGES WITH ½ CUP BERRIES,
¼ CUP YOGURT MIXTURE AND
1 TEASPOON CHOCOLATE CHIPS
Nutrients per Serving: Calories
160, Total Fat 3g, Saturated Fat
1g, Protein 4g, Carbohydrates
28g, Cholesterol 2mg, Dietary
Fiber 3g, Sodium 146mg
Dietary Exchange: 1 Bread/
Starch, ½ Fat, 1 Fruit
3 (6- to 7-inch) flour
tortillas
Nonstick cooking spray
1 tablespoon sugar
1 Carbohydrates 13g, Cholesterol 1mg, Dietary Fiber 1g, Sodium 74mg
/8 teaspoon ground
cinnamon
Dash ground allspice
1 container (6 ounces)
nonfat vanilla yogurt
1 teaspoon grated
orange peel
1½ cups fresh strawberries,
stemmed and cut
into quarters
½ cup fresh blueberries
4 teaspoons mini
semisweet chocolate
chips
1. Preheat oven to 375°F.
2. Cut each tortilla into 8
wedges. Place on ungreased
baking sheet. Generously
spray tortilla wedges with
cooking spray. Combine sugar,
cinnamon and allspice in small
bowl. Sprinkle over tortilla
wedges. Bake 7 to 9 minutes
or until lightly browned; cool
completely.
3. Meanwhile, combine yogurt
and orange peel in small bowl.
4. Place 6 tortilla wedges on
each of 4 small plates. Top
with strawberries and blueber-
ries. Drizzle with yogurt mix-
ture; sprinkle with chocolate
chips. Serve immediately.
Quick Chocolate Chip Cookie Cakes
MAKES 4 DOZEN COOKIES
SERVING SIZE: 1 COOKIE CAKE
Nutrients per Serving: Calories 79, Total Fat 3g, Saturated Fat 1g, Protein 1g,
Dietary Exchange: 1 Bread/Starch
1 package (about 18 ounces) 1. Preheat oven to 350°F. Spray cookie
reduced-fat yellow cake sheets with nonstick cooking spray.
mix
2. Combine cake mix, egg substitute,
½ cup cholesterol-free egg
substitute oil and sour cream in medium bowl;
mix well. Stir in oats and chocolate
¼ cup vegetable oil chips. Drop dough by teaspoonfuls
¼ cup reduced-fat sour cream onto prepared cookie sheets.
2 cups old-fashioned oats
3. Bake 12 minutes or until lightly
½ cup semisweet chocolate
browned. Remove to wire racks; cool
chips
completely.
Donut Spice Cakes
MAKES 10, 1 CAKE, SERVINGS
Nutrients per Serving: Calories 127, Total Fat 4g, Saturated Fat 1g, Protein 2g,
Carbohydrates 21g, Cholesterol 43mg, Dietary Fiber 1g, Sodium 182mg
Dietary Exchange: 1½ Bread/Starch, ½ Fat
1 package (9 ounces) namon and nutmeg in medium bowl
yellow cake mix with electric mixer at high speed, 4
½ cup water minutes or until well blended. Spoon
¼ cup batter into each bundt cup.
2 eggs
½ teaspoon ground cinnamon 3. Bake 13 minutes or until toothpick
¼ teaspoon ground nutmeg inserted near centers comes out clean
and cakes spring back when lightly
2 teaspoons powdered sugar
touched.
1. Preheat oven to 350°F. Grease and
4. Cool in pans 5 minutes. Remove
flour 10 mini (½-cup) bundt pan cups.
cakes from pans. Serve warm or at
room temperature. Sprinkle with
2. Beat cake mix, water, eggs, cin-
powdered sugar just before serving.
DiabetesSelfManagement.com 39

Chocolate Peanut
Butter Truffles
MAKES 20 TRUFFLES (4 TRUFFLES PER SERVING)
Nutrients per Serving: Calories 220,
Total Fat 12g, Saturated Fat 3g, Protein 8g,
Carbohydrates 25g, Cholesterol 0mg, Dietary
Fiber 3g, Sodium 229mg
Dietary Exchange: 1½ Bread/Starch, 2 Fat
½ cup reduced-fat chunky peanut
butter
3 tablespoons sugar substitute*
1 cup crisp rice cereal
3 tablespoons unsweetened cocoa
powder
¼ cup mini semisweet chocolate chips
1. Place peanut butter in small microwavable
bowl. Microwave on HIGH 10 seconds. Stir
in sugar substitute with wooden spoon until
smooth. Stir in cereal; mix well.
2. Line large plate with waxed paper. Spray
hands with nonstick cooking spray and
shape peanut butter mixture into 1-inch
balls, pressing firmly. Place balls on prepared
plate and freeze 15 minutes or up to 1 hour.
3. Spread cocoa on small plate. Roll each
truffle in cocoa; return to large plate.
4. Place chocolate chips in small resealable
food storage bag. Microwave on HIGH 10
seconds; knead bag. Repeat until chocolate
is melted and smooth.
5. Press melted chocolate into one corner
of bag; cut very small hole in corner. Drizzle
chocolate over truffles. Let chocolate set
before serving. Truffles can be refrigerated
in airtight container up to 3 days.
Note *This recipe was tested using
sucralose-based sugar substitute.
40 January/February 2018
GAME-DAY
DESSERT
Dreamy Orange
Cheesecake Dip
MAKES 12 SERVINGS
SERVING SIZE: 2 TABLESPOONS
DIP WITH ½ CUP FRUIT MIX
Nutrients per Serving: Calories
102, Total Fat 4g, Saturated Fat
2g, Protein 3g, Carbohydrates
18g, Cholesterol 7mg, Dietary
Fiber 2g, Sodium 111mg
Dietary Exchange: ½ Fat,
1 Fruit, ½ Meat
1 package (8 ounces)
reduced-fat cream
cheese, softened
½ cup orange marmalade
½ teaspoon vanilla
Grated orange peel
(optional)
Mint leaves (optional)
2 cups whole
strawberries
2 cups cantaloupe
chunks
2 cups apple slices
1. Combine cream cheese,
marmalade and vanilla in small
bowl; mix well. Garnish with
orange peel and mint leaves,
if desired.
2. Serve with strawberries,
cantaloupe and apples for
dipping.
Note: Dip can be prepared
ahead of time. Store, covered,
in refrigerator up to 2 days.
PM Snack Bars
MAKES 16 SERVINGS
SERVING SIZE: 1 (2¼-INCH) SQUARE BAR
Nutrients per Serving: Calories 91,
Total Fat 4g, Saturated Fat 1g, Protein
3g, Carbohydrates 11g, Cholesterol 1mg,
Dietary Fiber 1g, Sodium 24mg
Dietary Exchange: ½ Bread/Starch, 1 Fat
3 tablespoons creamy peanut
butter
2 tablespoons molasses
2 egg whites
2 tablespoons ground flaxseeds
4 cups crisp rice cereal
½ cup sliced almonds
1 ounce bittersweet chocolate,
melted
1. Spray 9-inch square baking pan
with nonstick cooking spray. Preheat
oven to 350°F. Place peanut butter in
small microwavable bowl; microwave
on LOW (30%) 30 seconds or until
peanut butter is melted. Stir in molas-
ses; cool.
2. Place egg whites and flax seeds in
blender; blend until foamy. Pour into
large bowl. Add peanut butter mixture;
stir until smooth. Stir in cereal and
almonds until cereal is evenly coated.
Press cereal mixture into prepared pan.
3. Bake 20 to 25 minutes or until
lightly browned. Cool completely in
pan on wire rack. Cut into 16 bars.
Drizzle melted chocolate over bars.
Tip: You can buy flax seeds and grind
them in a coffee mill or blender. Flax
seeds are an excellent source of Ome-
ga-3 fatty acids, which may reduce the
risk of heart disease. If you can’t find
flax seeds at the supermarket, look for
them in a health food store.
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 SUPERMARKET
SMARTS
By Lea Ann Holzmeister, RD, CDE
N
o matter how you slice it, bread has been a dietary
staple for thousands of years. Almost every culture has
its own type of bread in a variety of textures, shapes
and flavors. Bread is included in the grains group of the
U.S. Department of Agriculture’s (USDA’s) MyPlate tool
for healthy eating, a group from which adults should eat
six to eight servings each day, depending on age, gender
and amount of physical activity. While most do consume
the right amount of grains, few consume the right kind—
whole grains, which should constitute at least half of all
grains eaten.
According to the Whole Grains Council, “whole grains
or foods made from them contain all the essential parts
and naturally occurring nutrients of the entire grain seed
in their original proportions. If the grain has been pro-
cessed (e.g., cracked, crushed, rolled, extruded and/or
cooked), the food product should deliver the same rich
balance of nutrients that are found in the original grain
seed.” Whole grains contain more protein, fiber, vitamins
and minerals than enriched refined grains. They also confer
many health benefits, including lowering heart disease risk
and providing essential nutrients such as fiber, several B
vitamins and minerals.
A 1-ounce slice of bread is one grain serving and contains
an average of 80 calories and 15 grams of carbohydrate
(equal to one carbohydrate choice in a diabetes meal
plan). However, bread slice sizes vary by brand and some
manufacturers indicate two to three slices of bread as one
serving. Check Nutrition Facts panels on bread packaging to
determine the calorie and carbohydrate content in one slice.
The fat content of bread is typically 1 to 2 grams per
serving, with zero to less than 1 gram of saturated fat in one
slice. Bread has about 3 grams of protein per slice, which
is a little less than half the amount found in a 1-ounce
serving of meat.
Whole wheat bread contains 2 to 4 grams of fiber per
slice, while white bread contains zero to 1 grams per slice.
Consuming one to three servings per day of whole wheat
varieties significantly increases fiber intake.
Salt is an essential ingredient in bread-making, and most
bread contains about 100 to 300 milligrams of sodium per
slice. However, the sodium content of a whole sandwich
adds up quickly if the bread alone contains more than 400
milligrams of sodium. Sodium-free bread is available for
those looking to limit their sodium intake.
42 January/February 2018
It’s important to note that there is no required amount
of whole grains for a product to display labels such as “good
source of whole grains” or “rich in whole grains” on the
package. In fact, breads can be made from mixtures of
whole grains and refined grains, which means that breads
“made with whole grains” contain varying amounts of
whole grain. And be wary of labels such as “natural whole
grain goodness” or “made with natural whole grain,” which
do not necessarily mean that the product provides large
amounts of whole grains.
If the first ingredient listed on the ingredient list contains
the word “whole,” there is a better chance that the product
will contain mostly whole grains. If the ingredients list con-
tains two grain ingredients but only the second is a whole
grain, the bread contains between 1 and 49 percent whole
grain. Select bread that list “100% whole wheat flour” or
“100% whole grain flour” as the first ingredient.
Breads labeled “multigrain” contain more than one type
of grain, such as wheat, oats or rye, and can include either
refined or whole grains. White wheat is a variety in which
the bran portion of the grain is lighter in color and milder
in flavor, making it more appealing to those accustomed to
refined wheat. Whole wheat white grain and whole wheat
grain do not differ nutritionally. The ingredients of bread
made with whole white wheat will list either “whole white
wheat flour” or “whole wheat flour.”
Breads labeled an “excellent source of fiber” contain at
least 5 grams of fiber per serving. However, the fiber may not
derive from whole grains but rather from the isolated fiber
sources inulin, polydextrose, cellulose or other processed
fibers. Isolated fibers may help prevent constipation, but
they may not contain the nutrients and phytochemicals
found in whole grain fiber or help lower the risk of heart
disease or diabetes.
Light breads are lower in calories, typically 40 to 50
calories per slice. Manufacturers cut calories by making
their slices smaller (thin sliced), adding fiber or both.
The added fiber adds bulk and thickness to bread without
any calories.
Because most Americans include bread in their diet
every day, it makes sense to select a product that contains
Shutterstock/Bon Appetit
whole grains to gain all the health benefits. Read the ingre-
dients on bread packaging and select breads with “whole
wheat flour” or “whole grain flour” listed first, and check
the Nutrition Facts panel to determine its fiber content. †
 SATURATED FAT (g)

CHOLESTEROL (mg)

TOTAL CARBS (g)

FAT CALORIES

TRANS FAT (g)

SERVING SIZE

SODIUM (mg)

PROTEIN (g)
SUGAR (g)
CALORIES

FIBER (g)
FAT (g)
BIMBO
DOUBLE FIBER TOASTED 1 SLICE 75 1.5 15 1 0 0 120 13 2 3 2
DAVE’S KILLER BREAD
100% WHOLE WHEAT 1 SLICE 100 1 10 0 0 0 160 22 4 3 4
POWERSEED 1 SLICE 100 2 20 0 0 0 140 17 1 5 5
DAVE’S KILLER BREAD, THIN SLICED
21 WHOLE GRAINS AND SEEDS 1 SLICE 60 1 15 0 0 0 100 12 3 3 3
100% WHOLE WHEAT 1 SLICE 70 1 10 0 0 0 105 14 2 2 2
GOOD SEED 1 SLICE 70 2 15 0 0 0 115 13 2 3 3
POWERSEED 1 SLICE 60 1.5 10 0 0 0 95 11 1 4 3
FOOD FOR LIFE
EZEKIEL 4:9 SPROUTED WHOLE GRAIN 1 SLICE 80 0.5 5 0 0 0 75 15 0 3 4
EZEKIEL 4:9 LOW SODIUM SPROUTED WHOLE GRAIN 1 SLICE 80 0.5 5 0 0 0 0 15 0 3 4
FLAX SPROUTED WHOLE GRAIN 1 SLICE 80 1 10 0 0 0 70 14 0 4 5
HOME PRIDE
BUTTER TOP WHITE 1 SLICE 70 1 10 0 0 0 130 14 2 0 2
NATURE’S OWN
100% WHOLE WHEAT 1 SLICE 60 0.5 5 0 0 0 110 11 1 2 4
BUTTERBREAD 1 SLICE 70 0.5 5 0 0 0 95 12 1 <1 3
HONEY OAT 1 SLICE 70 1 10 0 0 0 110 13 2 <1 3
HONEY WHEAT 1 SLICE 70 1 5 0 0 0 125 13 2 <1 3
LIFE 100% WHOLE GRAIN 1 SLICE 50 1 10 0 0 0 125 9 0 1 4
LIFE WHEAT & PROTEIN 1 SLICE 90 2 20 0 0 0 150 9 2 2 8
NATURE’S HARVEST
LIGHT 100% WHOLE WHEAT 2 SLICES 80 0.5 5 0 0 0 170 17 1 6 6
OROWEAT
12 GRAIN 1 SLICE 100 2.5 25 0 0 0 170 17 2 3 4
100% WHOLE WHEAT 1 SLICE 90 1 10 0 0 0 135 16 3 2 4
COUNTRY BUTTERMILK 1 SLICE 100 1 10 0 0 0 135 20 3 <1 3
COUNTRY POTATO 1 SLICE 100 1 10 0 0 0 135 19 2 <1 3
COUNTRY SOURDOUGH 1 SLICE 110 1.5 10 0 0 0 180 20 <1 <1 3
COUNTRY SWEET HAWAIIN 1 SLICE 110 2 15 0 0 0 150 20 5 <1 3
COUNTRY WHITE 1 SLICE 100 1.5 15 0 0 0 140 19 2 <1 3
DARK RYE 1 SLICE 80 1 10 0 0 0 210 15 <1 1 3
DOUBLE FIBER 1 SLICE 80 1.5 10 0 0 0 130 17 2 5 4
JEWISH RYE 1 SLICE 90 1.5 15 0 0 0 180 16 1 1 3
OATNUT 1 SLICE 110 2 20 0 0 0 130 19 3 2 4
PEPPERIDGE FARM WHOLE GRAIN BREADS
15 GRAIN 1 SLICE 110 2 20 0.5 0 0 115 20 3 3 5
100% WHOLE WHEAT 1 SLICE 110 2 15 0.5 0 0 105 20 3 3 5
GERMAN DARK WHEAT 1 SLICE 100 1.5 15 0.5 0 0 150 20 2 3 5
HONEY WHEAT 1 SLICE 110 2 15 0.5 0 0 110 20 4 3 5
OATMEAL 1 SLICE 110 1.5 15 0.5 0 0 120 20 4 3 5
PEPPERIDGE FARM FARMHOUSE BREADS
POTATO 1 SLICE 100 1 10 0 0 0 170 20 4 1 4
WHOLE GRAIN WHITE 1 SLICE 110 1 10 0 0 0 160 20 3 3 3
PEPPERIDGE FARM RYE AND PUMPERNICKEL BREADS
JEWISH PUMPERNICKEL - DARK PUMP 1 SLICE 80 1 10 0 0 0 230 20 1 2 3
JEWISH RYE - SEEDED 1 SLICE 80 1 10 0 0 0 200 20 1 2 3
JEWISH RYE - SEEDLESS 1 SLICE 80 1 10 0 0 0 170 20 1 1 3
RYE & PUMPERNICKEL - DELI SWIRL 1 SLICE 80 1 10 0 0 0 200 20 1 1 3
PEPPERIDGE FARM VERY THIN BREADS
100% WHOLE WHEAT 3 SLICES 110 2 20 0.5 0 0 180 20 2 3 5
SARA LEE
100% WHOLE WHEAT 1 SLICE 60 1 10 0 0 0 120 12 1 2 3
ARTESANO 1 SLICE 100 1 10 0 0 0 190 20 2 <1 3
BUTTER BREAD 1 SLICE 70 0.5 5 0 0 0 105 13 2 <1 2
DELIGHTFUL HEALTHY MULTI-GRAIN 2 SLICES 90 1 10 0 0 0 170 18 1 5 6
HONEY WHEAT 1 SLICE 70 0.5 5 0 0 0 110 13 2 <1 2
SWEET HAWAIIAN 1 SLICE 100 1.5 15 1 0 <5 170 18 3 <1 4

DiabetesSelfManagement.com 43
 YOUR SHOPPING LIST
All the Ingredients for the Recipes in this Issue
We’re making it easier for you to stay on track! As you find recipes
you’d like to try, simply check off the ingredients on this list,
clip it out and take it along on your next grocery trip.

BAKED GOODS/BREAD CONDIMENTS (CONTINUED) VEGETABLES (CONTINUED)

Flour tortillas Olive oil Parsnips
French baguette Olive oil, extra virgin Potatoes
French bread Vegetable oil Potatoes, Russet
Whole wheat bread DAIRY/FRIDGE Potatoes, Yukon Gold
BAKING PRODUCTS Radishes
Butter
Shallots
Active dry yeast Cream cheese, reduced-fat
Spinach
Baking powder Eggs
Spring salad greens
Bittersweet chocolate Egg substitute
Sweet potatoes
Cocoa powder, unsweetened Egg substitute, cholesterol-free
Zucchini
Dark brown sugar Egg whites
Flour, all-purpose Low-fat (1%) milk SNACKS/NUTS
Flour, whole wheat Margarine Almonds, sliced
Molasses Skim milk SPICES & HERBS
Powdered sugar Sour cream, light
Allspice, ground
Semisweet chocolate chips Sour cream, reduced-fat
Basil, dried
Semisweet chocolate chips, mini Whipped topping, fat-free
Basil, fresh
Spice cake mix Yogurt, vanilla, nonfat
Black pepper
Sugar FROZEN Chervil, dried
Sugar substitute
Sweet peppers, tri-colored Chicken bouillon granules
Yellow cake mix
FRUIT Chives, fresh
Yellow cake mix, reduced-fat
Cinnamon, ground
CANNED FOODS Apples
Cumin
Beefsteak tomatoes
Artichoke hearts Dry mustard
Blueberries
Cannellini beans Garlic cloves
Butternut squash
Chicken broth, fat-free, reduced-sodium Garlic powder
Cantaloupe
Evaporated milk, skimmed Ginger, fresh, grated
Delicata squash
Great Northern beans Italian seasoning
Grape tomatoes
Kosher salt Mint, fresh
Lemons/juice
Mild green chiles Nutmeg, ground
Olives, black
Sweet potatoes in syrup Oregano, dried
Olives, kalamata
Tomatoes, whole, no-salt-added Paprika
Orange peel
Tuna, solid white, packed in water Parsley, dried
Plum tomatoes
Vegetable broth, reduced-sodium Parsley, fresh
Strawberries
CHEESE Red pepper, ground
Tomatoes
Rosemary, fresh
Cheddar cheese, low-fat MEAT Salt
Cheddar cheese, reduced-fat, shredded
Chicken breast, ½ cup Thyme, dried
Feta cheese, crumbled
VEGETABLES Vanilla
Mozzarella, part-skim, sliced
Wasabi powder
Mozzarella, reduced-fat, shredded Asparagus
Parmesan, grated Baby spinach MISC. GROCERIES
Parmesan, shredded Bell peppers, red Arborio rice
Romano, grated Broccoli Baby lima beans, dried
CONDIMENTS Carrots Chocolate ice cream topping, sugar-free
Cauliflower Crisp rice cereal
Balsamic glaze
Celery Croutons, fat-free
Balsamic vinegar
Corn Edamame, shelled
Canola oil
Cucumbers Flaxseeds, ground
Dijon mustard
Escarole Hummus, roasted garlic or any flavor
Honey
Leeks Maraschino cherries with stems
Italian salad dressing, reduced-fat,
Lettuce, romaine Oats, old-fashioned
reduced-sodium
Lettuce, torn leaf Orange marmalade
Jalapeño pepper sauce
Mesclun Orzo
Lemon juice
Mushrooms Peanut butter, chunky, reduced-fat
Mayonnaise, fat-free
Onions Peanut butter, creamy
Mayonnaise, reduced-fat
Onions, green Sun-dried tomato halves
Nonstick cooking spray
Onions, red Wine, white, dry

44 January/February 2018
GROOVE YOUR NEW COLUMN!
FOOD FOR
WAY TO GOOD THOUGHT
HEALTH

5 RECIPES
FOR A COZY
NIGHT IN
699 CALORIES
DiabetesSelfManagement.com 45
 Dance
Your Way to Health
By Susan Weiner and Erin Palinski-Wade
N eed a new workout routine but don’t want to join a
gym? We’ve got the answer! It’s time to boogie to the
beat of your favorite tune. Dance will keep you moving
and grooving, boost fitness, improve insulin sensitivity and
help manage blood glucose levels. It can even help you slim
down while building metabolism-boosting muscle mass. If
you enjoy music and moving to the rhythm, dancing is the
workout for you.
Health benefits of dance
Whether you dance with a partner, in a class or in your own
bedroom, moving to music can offer impressive health
46 January/February 2018
benefits. “Any form of dance may help to reduce insulin
resistance and improve blood glucose management,” says
Rachel Portnof, RD, of To The Pointe Nutrition (pointe-
nutrition.com). “In addition, dance elevates mood and
energy levels.” The benefits of dance extend far beyond
enhancing daily diabetes self-care. Dance counts as weight-
bearing exercise, which may also build muscle strength
and bone density.
Shutterstock/Rawpixel.com
Type 1 and Type 2 diabetes have been associated with
an increased risk of osteoporosis and bone fractures. A
review of diabetes and bone health published in the journal
Diabetes/Metabolism Research and Reviews found that
people with diabetes were more likely to
suffer fractures of the hip, foot and spine
than individuals without diabetes. Weight-
bearing activities such as dance help
improve bone health and fight bone loss.
By strengthening bone through regular
exercise, osteoporosis may be delayed or
prevented. A study published in Nutrición
Hospitalaria found that physical activity
based on rhythmic and choreographic
activities in overweight individuals may
prevent bone loss. There are so many
reasons for you to give dancing a whirl—
and a twirl!
In addition to strengthening the body,
dance may also boost the mind. A recent
study found that elderly individuals with
mild cognitive impairment who began
ballroom dancing on a regular basis not
only experienced slower cognitive decline
but improved mental functioning. Emily
Coles (EmilyColesDanceSF.com), a com-
petitive ballroom dance teacher who has
Type 1 diabetes, agrees that dance benefits
both the body and the mind and has seen
it in her own students. “I worked with a
student who began ballroom dancing as
part of treatment for a head injury and
used partner dancing as a form of com-
munication.” Emily was excited to share
that her student’s ability to communicate
improved dramatically as she continued to
dance with various partners. She points out
that the cognitive benefit may not come
entirely from the physical aspect of dance
either. “In dancing, specifically in partner
dancing, there is a large social compo-
nent,” says Coles. “You are practicing how
to communicate with another person, how
to relate to music and how to express your
emotions through movement.” This social
connection may positively affect stress
and mood while also helping you think of
dance as more of a social event rather than
exercise, which may just make it easier to
stick with long-term.
Start at any age or fitness level
Think you are too old or unfit to get
started? Nothing could be further from
the truth. “Dance is for all ages and all
fitness levels,” says Billy Blanks Jr., found-
er of Dance It Out (danceitout.com),
who points out that the oldest student
in his studio is 94 years young. “Dance
is one of the best forms of exercise be-
cause you don’t feel like you are exercis-
ing. You are simply having a good time,
focusing on the steps and enjoying life.”
Dancing for fitness may be even more
effective than hitting the gym at times.
”I see many people come to dance after
becoming bored at the gym or frustrat-
ed from the lack of results,” Blanks ex-
plains. “If you are trying to work out, but
don’t feel like you are seeing the benefits
and are at risk of burnout, it may be time
to consider a new form of exercise, such
as dance.”
Thanks to reality shows such as Dancing
with The Stars and So You Think You Can
Dance becoming mainstream media hits,
more individuals are starting to consider
learning to dance as a new way to enhance
fitness and health. If you have been tun-
ing into your favorite dance show but feel
intimidated by their fancy footwork and
fit physiques, don’t let that hold you back.
“Going to the gym or starting a new fitness
regimen may feel intimidating,” Blanks
says, “but with dance, you can come in
with what you are comfortable with.” At
Dance It Out, which has locations world-
wide, he stresses that dance is for all levels
and you don’t have to know technique to
have a great time and benefit from the
exercise. “Don’t be hard on yourself. If you
start and you are not yet jumping like the
other dancers or picking up the steps, so
what,” states Blanks. “I always tell people
to go at your own pace. If you only get one
step today, that’s progress. It’s about feel-
ing comfortable, connecting with those
around you and having a good time.”
Melissa’s story
Whether you want to start dancing just
for fun or with the goal of performing
one day, the practice can offer some-
thing for everyone. For those with dia-
betes, beyond the fun of learning a new
form of movement, dance can have a
life-changing impact. Melissa Vitti, a
28-year-old teacher from New York, re-
members the day she was diagnosed with
prediabetes vividly. “I was very young,
only 24 years old, and at my annual phys-
ical I was told I had prediabetes. It was
very nerve-wracking as both my father
and maternal grandparents had diabe-
tes as well.” At 460 pounds, Melissa knew
she wanted to get on track and prevent
a diagnosis of Type 2 diabetes, but she
struggled to get active. “I found the gym
ALWAYS TAKE
PRECAUTIONS
Although dance is a wonderful
form of exercise for individuals
with diabetes, like any form of
exercise, it can pose risks. Foot
care is extremely important for
everyone with diabetes, but for
dancers who are at a greater
risk of developing blisters and
foot wounds, monitoring the feet
regularly is essential. Sharing
your diabetes diagnosis with
your dance teacher is a personal
decision, but if you are prone
to hypoglycemia or are taking
insulin, you should notify those
who exercise around you about
the signs of hypoglycemia
and the treatment protocol to
prevent potential issues.
POST-PERFORMANCE
DANCE SNACKS
These filling snacks, which contain
both complex carbohydrates and
protein, can be a great way to
refuel after a dance workout. Feel
free to adjust the portions to meet
your needs.
2 tablespoons of classic
hummus and 1 whole sliced
red bell pepper: 100 calories,
11.3 grams carbs
Rolled-up thin-sliced turkey
with avocado and tomato:
109 calories, 7.2 carbs
Cottage cheese topped
with walnuts: 166 calories,
4.8 grams carbs
4 whole grain or quinoa
crackers with 1 tablespoon
natural almond butter: 175
calories, 15 grams carbs
1 ounce (1 slice) cheddar
cheese and 1 small Red
Delicious apple: 202 calories,
21.6 grams carbs
4 ounces plain low-fat Greek
yogurt with ¼ cup sliced
almonds: 240 calories,
10.5 grams carbs
DiabetesSelfManagement.com 47
boring. It wasn’t a sustainable form of exercise for me,”
Vitti says. “I had been following Dancing with The Stars
for years and come from a musical background. Danc-
ing made sense for me—it was something I knew I could
enjoy and stick with.” Now 180 pounds lighter and an
award-winning competitive ballroom dancer, Melissa is
far more confident in herself, her blood glucose is offi-
cially in the normal range and she is no longer classified
as having prediabetes. “Dance has given me so much. It
has brought out the best parts of me and has pushed me
past the limitations I have put on myself.”
Susan’s story
Susan Innes, 66, of Stonewall, Manitoba, shares a simi-
lar story. “I discovered I had Type 2 diabetes by accident.
I was asked to complete a physical and get blood work
before joining a wellness center, and found out my A1C
was 15%!” Her physician instructed her to lose weight
and begin exercising to better manage her blood glu-
cose levels. “I hate exercising with machines,” says Innes,
who weighed 225 pounds when she was diagnosed. “As
a child, I used to dance to the radio with my brothers
for entertainment. Dancing always made me happy. It
lifts your mood and your spirits.” Her love of music and
dance led to her join a water aerobics dance group at her
wellness center. She had osteoarthritis, so dancing in the
water provided an effective workout while placing less
strain on her joints. To date, dance, along with dietary
changes, has helped her lose 75 pounds and reduce her
A1C to 5.3%. She now enjoys dancing in the pool with
her granddaughter. “I let her play aerobics instructor and
we get the whole family involved.”
The first steps
Ready to get moving? It can be incredibly simple to get
started with dance. “If you have never danced before and
don’t know what style of dance you want to try, start by
thinking about what type of music you love to listen to
and then figure out what dance it is,” says Coles, who
points out that for those new to exercise and dance, con-
necting with a qualified instructor is key. “Consider work-
ing with a qualified professional dance teacher one-on-
CALORIES BURNED DURING DANCE
The following estimates are based on a 150-pound person
after 30 minutes of dancing.
Aerobics Moderate-intensity dancing
low impact disco, ballroom, square
205 calories 205 calories
Low-intensity dancing High-intensity dancing
slow, waltz, foxtrot fast, ballet, twist
112 calories 223 calories
Source: Harvard Health Publications, March 2017: https://www.health.
harvard.edu/diet-and-weight-loss/calories-burned-in-30-minutes-of-leisure-
and-routine-activities
48 January/February 2018
one first before jumping into a group. Instruction from
a dance teacher individually can show you how to move
safely and stretch correctly to reduce injury risk.”
Warming up and cooling down before and after every
dance workout is essential to prevent injury and reduce
muscle soreness. If you are new to exercise, increased muscle
soreness after exercise may deter you from being consistent
with your new workout routine. But don’t try to forgo the
warmup or the cooldown to save time. Warming up your
muscles before jumping into a dance routine and taking
a few minutes at the end of dance to allow your body to
cool back down may help ward off muscle soreness, prevent
injury and keep you dancing on a regular basis.
Balancing your blood glucose
Dancing for exercise can be an effective strategy for man-
aging blood glucose levels, but learning to fuel your new
workout is key. Eating too little before dancing or not eat-
ing enough afterward can put you at risk for hypoglyce-
mia. On the other hand, if you become too hungry after
exercise, you may overeat and run the risk of spiking your
blood glucose levels.
“Eating smaller frequent meals and snacks throughout
the day may be better than choosing three large meals
as this allows you to fuel your body both before and after
your dance workout,” Portnof says. Including a variety of
complex carbohydrates, such as whole grain bread, whole
fruit and Greek yogurt, balanced with lean protein and
plant-based fats at each meal and snack may best promote
optimal glucose levels. “Always keep a snack on hand in
your bag in case of emergencies,” Portnof advises. If you
are taking medications to lower your blood glucose levels
or use insulin, keeping a fast-acting carbohydrate on hand
in case of low blood glucose levels is essential. Options such
as a juice box, hard candy or glucose tablets make excellent
choice because they have a long shelf-life and do not need
to be refrigerated.
When starting any new form of exercise, make sure to
check your blood glucose levels often, especially if you are
prone to hypoglycemic episodes. You can experience post-
exercise–induced hypoglycemia for as long as 24 hours after
exercise, so regular testing can help you understand your
body’s response to exercise and determine the best times
for you to eat your meals and snacks. Before starting any
exercise routine, make sure your physician has cleared you
for exercise and discuss your pre- and post-exercise glucose
level goals with your diabetes care team. Keep your team
informed of changes in your glucose levels as you begin
to exercise. You may find that as you exercise more, your
need for certain medications may be reduced as well. †
Susan Weiner, MS, RDN, CDE, CDN is the 2015 AADE Diabetes
Educator of the year and the co-author of The Complete Diabetes
Organizer and Diabetes: 365 Tips for Living Well. susanweinernutrition.
com. Erin Palinski-Wade, RD, CDE, author of the 2-Day Diabetes
Diet, is a nutrition communications consultant and speaker based
in Franklin, NJ. erinpalinski.com.
 ST
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50 January/February 2018
Fitness in the
Palm of Your Hand
Sheri Setser-Legg, MS, RD, LD, MLDE, CDE
Laura Hieronymus, DNP, MSEd, RN, MLDE, BD-ADM, CDE, FAADE

I t’s that time of year—when all thoughts turn toward health, when you dust off your treadmill and
dig your running shoes out of the back of your closet. Maybe you are even one of the zealous ones
who buys a gym membership to really kick off the New Year right. Starting each year with the goal
of a healthier lifestyle is one of the most common New Year’s resolutions. Getting more physically
active is one of the biggest steps that you can take toward a healthier lifestyle.
But what happens after those first few weeks or months of already have Type 2 diabetes, and the positive benefits of
motivation pass? Life becomes busy, as it always does, and your weight loss and regular physical activity have long been estab-
dedication to physical fitness falters. You don’t feel you have the lished for this population as well.
time, energy or, in some cases, finances to maintain this new There are multiple exercise and physical activity benefits for
commitment. So, yet again, your treadmill starts collecting dust, those with prediabetes and Type 2 diabetes. The most important
the gym membership goes unused and your running shoes get is obviously that exercise improves insulin sensitivity and makes
pushed back to the dark corners of your closet. it easier to control blood glucose levels. Whether a person’s
So the question is, how do you combat what seems like the elevated glucose is a result of insufficient insulin production or
inevitable end to your new and improved lifestyle? What can the inability to use insulin effectively (insulin resistance), physical
you do to ensure you are just as committed to your exercise activity will help lower blood glucose levels. In addition to the
in June or November as you were in January? There are some glucose-lowering effects, regular physical activity has long-term
important and useful tips and resources that you can utilize benefits in that it decreases the risk for chronic complications for
to stay laser-focused on physical activity and also improve those with Type 2 diabetes. It helps maintain good cholesterol
your overall health. The newest resource for the New Year is levels (high-density lipoproteins, or HDL), protects your heart
literally in the palm of your hand—your smartphone or other and lowers blood pressure. Last, but certainly not least, regular
device. This is the age of technology for people with diabetes exercise is essential to weight loss. Weight loss is directly related
to use these resources for physical fitness, and overall health is to a reduction in insulin resistance.
improving every day.
Getting Started
Benefits of Exercise The American Diabetes Association (ADA) recommends
It is no secret that physical activity is vital for overall health daily exercise or, at the very least, no more than two elapsed
but, particularly, for people with prediabetes and Type 2 dia- days between exercise sessions. Ideally, people with Type 2 di-
betes. Recent Centers for Disease Control and Prevention abetes should perform both aerobic and resistance exercise
reports indicate that 84.1 million people have prediabetes, training for optimal glycemic and health outcomes, accord-
which is one out of every three American adults. And in fact, ing to the ADA. Based on the DPP, individuals with prediabe-
nine out of 10 individuals with prediabetes don’t even know tes or at high risk for developing Type 2 diabetes should get
that they have it. The Diabetes Prevention Program (DPP) at least 150 minutes per week of physical activity.
clinical study demonstrated that people with prediabetes or So you know about the important role exercise plays in the
at risk for Type 2 diabetes could reduce their risk of develop- prevention of Type 2 diabetes as well as improved glycemic con-
ing diabetes by 58 percent by participating in a structured trol in individuals with Type 2 diabetes. Now we need to translate
lifestyle change program incorporating weight loss and that knowledge into practice—better yet, a practice that you
regular physical activity. An additional 30 million U.S. adults maintain indefinitely. There are several keys to developing and
DiabetesSelfManagement.com 51

FIND THE APP THAT’S
RIGHT FOR YOU
Searching for the fitness app that works for you can be overwhelming. More
than 100,000 apps are available for fitness, nutrition and overall health, so how
can you decide which one will work for you? Below are a few popular apps that
could help you get started.
MY FITNESS PAL is a free mobile CHARITY MILES is a free app that
app and online food and exercise tracker. allows you to donate to charity at the
It is fairly easy to use and allows you to same time you are burning those excess
track both the calories you consume as calories. It tracks workouts, such as runs,
well as the calories you expend each walks and bicycle rides and donates a
day. My Fitness Pal is compatible with few cents to the charities of your choice
a number of fitness trackers, including for every mile you complete. Corporate
Fitbit and Garmin Connect. So this app sponsors such as Johnson and Johnson
can estimate how many calories you burn and Chobani make these donations on
by automatically pulling in your activity your behalf to charities such as Feeding
data from your personal tracker. An added America and Habitat for Humanity.
bonus is its extensive food database Although these small amounts may not
and bar code scanner to make counting seem like much, when a lot of people
calories easier. Finally, through My Fitness use Charity Miles, those small amounts
Pal, you can connect with friends and join really add up. So if you need a little
the large community to celebrate victories extra incentive to lace up your walking
and help motivate and inspire one another. shoes, this charitable benefit might be
just what you need.
LOSE IT! is another free app and
website designed for both logging exercise MAPMYFITNESS is a fitness tracking
and counting calories. Lose It! is compatible app that enables you to use the built-in
with a multitude of other fitness trackers GPS of your mobile device to track all
and apps, including Fitbit, Nike + Fuelband your fitness activities. You can record
and Map My Fitness, which allow you to your workout details, including duration,
import your data into the Lose It! app. This distance, pace and speed. You can track
app helps you set weight loss and exercise calories burned and route traveled using
goals and track your progress. Like My an interactive map. Through this feature,
Fitness Pal, Lose It! has a large, interactive you can clearly see how much you are
community that is a constant source of improving, and since it saves all your
motivation and inspiration. workouts, you can look back at where you
started and see how far you have come.
You can also connect with friends and
create challenges together.
SWORK IT is a fitness app that helps
you find a workout that’s just right for
your fitness level. This app allows you
to choose from a variety of workout
options, including yoga, cardio, strength
training or stretching, or a combination
for a more varied exercise routine.
The app comes with a timer from 5
to 60 minutes and demonstrates all
exercise so even the truest beginner can
gain confidence before diving into an
exercise program.
52 January/February 2018
sustaining a successful exercise program.
The first step toward your com-
mitment to physical activity is setting
specific goals and having reasonable
expectations. Too often, we set lofty
but unachievable goals for exercise and
are discouraged when we cannot meet
them. The American Council on Exer-
cise (ACE) outlines the SMART guide
to goal setting for your new exercise
program (see sidebar). With the SMART
method, your goals should be clearly
defined: S=specific; M=measurable;
A=attainable; R=relevant; T=timebound.
The goals should be important to you
and achievable. Finally, your exercise
goals should have specific timeframes
that will motivate you and give you a
sense of accomplishment. For example,
a SMART fitness goal might be, “I will
walk at least 10 minutes three times per
week for the next three weeks.” This
may not seem like a very ambitious goal
to some, but for an individual new to
exercise, this is usually a very realistic
and achievable goal.
With regard to being specific about
your exercise goal, using the FITT prin-
ciple to design your exercise program
can be extremely helpful. Many people
do not feel they have the knowledge to
design a fitness program, and the FITT
principle is a reasonable guide. FITT
stands for frequency, intensity, time and
type. All of these components are equally
important to create exercises that fit your
goals and fitness levels and can help keep
your goals reasonable for you.
Frequency: How often will you exer-
cise? Frequency depends on a variety
of factors, including your fitness level,
exercise goals and type of physical activity.
Intensity: How hard will you work
during exercise? For beginners, it is best
to start with a low-intensity program.
Using a heartrate monitor is a great way
to monitor your intensity.
Time: How long will you exercise? The
duration of your activity will again depend
on your fitness level. It may be easier to
complete smaller, more frequent exercise
bouts than one longer duration activity.
As time passes, you can slowly increase
how long you exercise.
Type: What kind of activity are you
going to do? It could be a cardio activity
such as walking, some type of resistance
training or a combination of both.
Talk with your diabetes care team,
especially your diabetes educator, to deter-
mine the right fitness goals for you.
The Role of Technology in Your
Exercise Program
Mobile fitness applications or “apps”
can be great assistants in meeting your
health, fitness and weight loss goals.
They are always with you and can be
personalized to fit your specific needs.
Staying motivated in your fitness goals
requires daily attention to your eating
habits and exercise routine, and fitness
apps can provide that extra support to
move you in the right direction. Some
fitness apps function more as trackers
to help you log your exercise and track
your progress while others provide
actual workouts and exercise plans.
Alhough these apps can vary in the
tools they provide, they share a com-
mon goal: to promote physical activity
and improve your fitness level and over-
all health.
Using a fitness app to help you achieve
your physical activity goals can be a great
motivator. However, the fitness app is only
an aid. Personal accountability is key for
any fitness program or lifestyle change.
Here are a few tips to get the most out of
whatever fitness app you choose.
1. Make it visible. Your fitness app
should be on the home page of your
phone or electronic device. If it is buried
on the third or fourth page, you are less
likely to use it. After all, the apps you see
on the first page of your device are typi-
cally the ones you use the most. If you see
it each time you power on your device, it is
likely to trigger a subconscious reminder
to make it happen.
2. Log it! Most apps include a logging
feature as part of their design. Immedi-
ately after a workout, get in the habit of
logging it. This benefits you because you
can constantly track your progress, and
that, in itself, is a great incentive to keep
up the good work. Better yet, plan your
day of exercise and log it ahead of time
so you are more likely to find time for
it. Schedule your physical activity just as
you would that important meeting. On
most apps, you can manually input your
workout and it will help calculate calories
burned.
3. It’s a virtual personal trainer. Some
apps include workouts that can be per-
sonalized to meet your fitness level
and goals. It is easy to shy away from
exercise simply because you lack con-
fidence. With detailed instructions and
examples, these apps can be great for
beginners and allow people to work at
their own pace. Since they can be done
virtually anywhere, apps can eliminate
the typical excuses that you don’t have
time to go to the gym.
4. Use your app daily and track your
progress. A large majority of fitness app
users stop using their app within the
first week because they aren’t using the
app consistently every day. That means
that only a small portion of users stay
on track with their app and exercise
routine. Fitness apps only really work if
you use them every day. Furthermore,
most apps offer graphing features to
visualize your progress and see if you
are on track with your goals. Quite
simply, seeing your progress is a fool-
proof way to keep you moving in the
right direction.
The bottom line is: Embrace tech-
nology and let it work for you in the
new year. With individualized workouts,
progress tracking capabilities and inspi-
rational virtual communities, fitness
apps can motivate you and turn exercise
into a fun and rewarding experience.
Choose a fitness app that can work with
your lifestyle, and use these tips to stick
with the program. Keep in mind that
using a fitness app does not replace the
professional advice of your health-care
provider or trained fitness professional.
Always check with your health-care pro-
vider before beginning any exercise pro-
gram. Talk with your diabetes educator
to see what plan may be right for you. Be
SMART, set a realistic goal. Now, what are
you waiting for? Grab that smart device
and get started! †
Sheri Setser-Legg is a registered dietitian
nutritionist and master licensed diabetes educa-
tor. She is a Diabetes Education Service Coordi-
nator. Laura Hieronymus is a doctor of nursing
practice and master licensed diabetes educator.
She is the associate director of education and
quality services. They are at the UK HealthCare
Barnstable Brown Diabetes Center at University
of Kentucky in Lexington, Kentucky.
 Take
ke
Office Yoga: Seated Salutations
By Laurel Dierking, MEd, NFPT, 200-YTT
IN A 2013 GALLUP SURVEY, more than 70 percent of
americans agreed that chronic stress caused them to become
disengaged in the workplace. While stress stems from numer-
ous environmental settings other than the office, the work-
place is among the most common causes of perceived stress
in Americans, costing businesses more than $300 billion
annually in lack of productivity, sick leave and other losses,
according to the World Health Organization (WHO).
To combat this “health epidemic of the 21st century”
as the WHO has called it, businesses should incorporate
top-down wellness initiatives into day-to-day routines.
Encouraging employees to take time out of their work day
for lunch, utilize onsite fitness facilities, conduct meetings
while standing—or even walking—and offering classes
on stress reduction and mindfulness techniques benefits
long-term employee health and satisfaction. However,
many workers around the country don’t have access to
these progressive amenities, leaving it up to each individual
to make optimizing his or her own stress levels a priority.
54 January/February 2018
Fortunately, techniques abound that anyone can adjsut to
fit just about any setting.
Yoga, for example, can be modified for any person,
location and time constraint. Research shows that yoga
helps improve blood pressure, perceived stress, anxiety
and sleep deprivation. The practice is increasingly popular
in the workplace and is so versatile that you do not have to
get up from your desk chair. Try this workplace yoga flow
of seated salutations at your desk to help improve focus,
increase self-awareness and ease accumulated physical
tension from sitting. †
Laurel Dierking, MEd, NFPT, 200-YTT, is a health and fitness
professional and yoga instructor with seven years of experience who
tailors her training to individual clients’ needs. She has an extensive
hands-on background in exercise physiology, yoga and individualized
wellness training, with a focus on improving the mind and body con-
nection by guiding individuals through mindful movement, functional
training, body awareness and breath work.
 TRY IT! PART 1

+ PART 1
Begin seated upright with your
back against the chair and your feet
firmly on the floor. Close your eyes
(or find a fixed focal point in front
of you) and begin to direct your
attention onto your breathing, in
and out through the nose. Observe
the quality of your breath and gently
begin to lengthen the inhales,
filling the belly, and smoothing
the exhales, controlling the rate at
which you let the air out. Take five
slow inhales and smooth exhales.

After five breaths, INHALE and

stretch your arms high above your
head still pressing down through
your feet, filling up the belly and
lungs completely.

EXHALE and fold your upper body

over your legs reaching your hands
towards the floor. Know that you
are free to widen your legs in your
seat to allow for more room for the
front side of your body (but keep
your feet pressed firmly on the
ground).

On your next INHALE raise your

upper body up half way, parallel
to the floor, with your hands on
PART 2
your shins. Imagine creating the
longest spine you can as you reach
forwards with the top of your head.

EXHALE and fold forward again,

relaxing the arms, shoulders, and
hands.

PART 2
INHALE to come all the way back
upright to a tall supported posture,
while bringing one knee up towards
the chest, hugging your thigh close
to your body. Breath here for two to
three breaths, then switch legs.

FINAL NOTE
Repeat the entire sequence three
times, then return to the starting
position for another round of
Aaron Ashley

five long, smooth breaths.

DiabetesSelfManagement.com 55
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TOTALIES out into the cold for dinner? Our Cozy Night In features five scrumptious
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56 January/February 2018
White Bean and
Escarole Soup
MAKES 6 SERVINGS
SERVING SIZE: 1½ CUPS
SOUP
Nutrients per Serving: Calories 196,
Total Fat 2g, Saturated Fat 0g, Protein 12g,
Carbohydrates 35g, Cholesterol 0mg, Dietary
Fiber 5g, Sodium 33mg
Dietary Exchange: 2 Bread/Starch,
2 Vegetable
1½ cups dried baby lima beans, rinsed
and sorted
1 teaspoon olive oil
½ cup chopped celery
1 109mg  /3 cup sliced radishes
/3  cup coarsely chopped onion
2 cloves garlic, minced
2 cans (about 14 ounces each) no-salt-
added whole tomatoes, undrained
and chopped
½ cup chopped fresh parsley
2 tablespoons chopped fresh rosemary
¼ teaspoon black pepper
3 cups shredded fresh escarole
1. Place dried lima beans in large
glass bowl; cover completely with
water. Soak 6 to 8 hours or over-
night. Drain beans; place in large
saucepan or Dutch oven. Cover
beans with about 3 cups water;
bring to a boil over high heat.
Reduce heat to low. Cover and
simmer about 1 hour or until soft.
Drain; set aside.
2. Heat oil in small skillet over
medium heat. Add celery, onion
and garlic; cook and stir 5 minutes
or until onion is tender. Remove
from heat.
3. Add celery mixture and toma-
toes to beans. Stir in parsley, rose-
mary and pepper. Simmer, covered,
over low heat 15 minutes. Add
escarole; simmer 5 minutes.
Tip: Store dried lima beans (also
known as butter beans) in an air-
tight container in a cool, dry place
for up to 1 year. When soaking, do
not allow beans to soak for longer
than 12 hours or they may start to
ferment.
90
CALO
P RIES
Greens and Broccoli
Saladwith Peppy
ER SE
RVING
Vinaigrette
MAKES 4 SERVINGS
Nutrients per Serving: Calories 54,
Total Fat 2g, Saturated Fat 1g, Protein 3g,
WholeWheat Herb Bread Carbohydrates 9g, Cholesterol 0mg, Dietary
Fiber 2g, Sodium 79mg 
MAKES 24 SERVINGS (4 ROUND
LOAVES, 6 SLICES PER LOAF)
Dietary Exchange: 2 Vegetable
4 sun-dried tomato halves
(not packed in oil)
Nutrients per Serving: Calories 90, Total Fat 3 cups torn leaf lettuce
2g Saturated Fat 1g, Protein 4g, Carbohydrates 1½ cups broccoli florets
17g, Cholesterol 1mg, Dietary Fiber 3g, Sodium 1 cup sliced mushrooms
1
2 tablespoons water
Dietary Exchange: 1 Bread/Starch 1 tablespoon balsamic vinegar
1 teaspoon vegetable oil
2
/3 cup water ¼ teaspoon chicken bouillon granules
2
/3 cup fat-free (skim) milk ¼ teaspoon dried chervil or dried parsley
2 teaspoons sugar ¼ teaspoon dry mustard
1
2 packages active dry yeast /8 teaspoon ground red pepper
3 egg whites, lightly beaten 1. Pour boiling water over tomatoes
3 tablespoons olive oil
in small bowl to cover. Let stand 5
1 teaspoon salt
½ teaspoon dried basil
minutes; drain.
½ teaspoon dried oregano leaves 2. Chop tomatoes. Combine toma-
4 to 4½ cups whole wheat flour, divided toes, lettuce, broccoli, mushrooms
1. Bring water to a boil in small sauce- and radishes in large salad bowl.
pan. Remove from heat; stir in milk and 3. Combine 2 tablespoons water,
sugar. When mixture cools to warm vinegar, oil, bouillon granules,
(110° to 115°F), add yeast. Mix well; let chervil, mustard and red pepper in
stand 10 minutes or until bubbly. jar with tight-fitting lid; shake well.
Add to salad; toss gently.
2. Blend egg whites, oil, salt, basil
and oregano in large bowl. Add yeast
mixture; mix well. Add 4 cups flour, ½
cup at a time, mixing well after each
addition, until dough is no longer
sticky. Turn out onto lightly floured sur-
54 RIES
CALSOERVING
PER
face. Knead about 5 minutes, adding
enough of remaining flour to make a
smooth and elastic dough. Form into a
ball. Cover; let rise in warm place about
1 hour or until doubled in bulk.
3. Preheat oven to 350°F. Spray bak-
ing sheet with nonstick cooking spray.
Punch down dough and place on
lightly floured surface. Divide into 4
pieces and roll each piece into a ball;
place on prepared baking sheet. Bake
30 to 35 minutes or until golden brown
and loaves sound hollow when tapped.
DiabetesSelfManagement.com 57
Winter Squash Risotto
MAKES 4 TO 6 SERVINGS

Nutrients per Serving: Calories 228, Total Fat 7g, Saturated Fat 2g,
131 RIES
CALSOERVING
PER
Protein 8g, Carbohydrates 35g, Cholesterol 6mg, Dietary Fiber 4g,
Sodium 573mg 

Dietary Exchange: 2 Diabetic Carb Count, 2 Bread/Starch

2 tablespoons olive oil

1 small butternut squash or medium delicata squash, peeled and
cut into 1-inch pieces (about 2 cups)
1 large shallot or small onion, finely chopped
½ teaspoon paprika
¼ teaspoon dried thyme
¼ teaspoon salt
¼ teaspoon black pepper
1 cup uncooked arborio rice
¼ cup dry white wine (optional)
4 to 5 cups hot reduced-sodium vegetable broth
½ cup grated Parmesan or Romano cheese
1. Heat oil in large nonstick skillet over medium heat. Add
squash; cook and stir 3 minutes. Add shallot; cook and
stir 3 to 4 minutes or until squash is almost tender. Stir in
paprika, thyme, salt and pepper. Add rice; stir to coat.
2. Add wine, if desired; cook and stir until wine is ab- Chocolate Orange
sorbed. Add broth, ½ cup at a time, stirring frequently un- Bread Pudding
til broth is absorbed before adding next ½ cup. Continue
MAKES 8 SERVINGS (¾ CUP PER SERVING)
adding broth and stirring until rice is tender and mixture is
creamy, about 20 to 25 minutes.
3. Sprinkle with cheese just before serving.
Note: Gluten-free dairy-free egg-free nut-free: Omit Nutrients per Serving: Calories 131, Total Fat 2g, Saturated
Parmesan cheese, or replace it with a dairy-free version. Fat 1g, Protein 6g, Carbohydrates 23g, Cholesterol 80mg, Dietary
Fiber 1g, Sodium 131mg 

Dietary Exchange: 1½ Bread/Starch

¼ cup sugar

278PER
RIES
CALSOERVING
1½
3

3
tablespoons unsweetened cocoa powder
cups fat-free (skim) milk
eggs, lightly beaten
1 to 2 teaspoons grated orange peel
1 teaspoon vanilla
¾ teaspoon ground cinnamon
4 ounces (4 cups) cubed French baguette
¼ cup sugar-free chocolate ice cream topping
8 maraschino cherries with stems (optional)
1. Preheat oven to 350°F. Combine sugar and cocoa
in medium bowl; stir in milk, eggs, orange peel,
vanilla and cinnamon until well blended.
2. Place bread cubes in ungreased 8-inch square
baking dish. Pour milk mixture evenly over bread
cubes.
3. Bake about 35 minutes or until a knife inserted
near center comes out clean. Cool 5 to 10 minutes.
4. Spoon warm pudding into dessert dishes. Drizzle
with ice cream topping and garnish with a cherry.
58 January/February 2018
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 Your Weight
By Nicola Davies
Overcoming Triggers to Overeating
In previous columns, we have discussed
the causes and consequences of being
overweight. It’s now time to explore
the practical aspects to weight manage-
ment, starting with how to handle trig-
gers of overeating. Do you recognize
any of these triggers? If so, try some of
these strategies to gain control.
TRIGGER: Social connection
This common psychological trigger
is about attempting to connect with
others and gain a sense of safety. As
an example, research has shown that
if we are at a restaurant with someone
who orders or consumes large portions,
we tend to follow suit. We also eat for
traditional and cultural reasons to
connect with those we love.
STRATEGY: A shift in focus
Shift your focus from food to social
interaction—strike up conversations,
take photos of the event, amuse young
children. Eat foods that others recom-
mend and compliment their recipes,
but keep portion control in mind.
TRIGGER: Ease frustration or fear
Many people who overeat tend to hide
rather than voice their frustrations
and fears. Often, pushing frustration
down with food is also an effort to avoid
the guilt that comes after you have
expressed frustration toward someone.
STRATEGY: Release your emotions
In the short-term, release the adrena-
line associated with these feelings by
screaming into a pillow, riding your
bike, taking a walk, lifting weights or
even rearranging the furniture. You
60 January/February 2018
can’t overeat while you are being active.
Once you feel a little calmer, write
about your frustration or fear. Acknowl-
edge its presence and ask what you
need to feel better. Your emotions are
there for a reason, and overeating to
push them down will not help address
the reason for their presence.
TRIGGER: Craving comfort
This happens when we feel life has
disappointed us in some way. Instead
of confronting our feelings, we choose
to deal with the unresolved loss, fear
or trauma through comfort eating.
STRATEGY: Be kind to yourself
Be compassionate with yourself. Under-
stand that you are hurting and reach
out to a friend, family, support group or
counselor. Indulge in rhythmic activi-
ties to soothe yourself, like yoga, dance,
walking, or even a bubble bath.
TRIGGER: Sugar addiction
More research is showing just how
addictive sugar is. As with any other
addiction, there is the initial high of
the sugar rush, followed by guilt, and
then you swear never to be controlled
by the substance again—but you soon
find yourself back in the vicious cycle.
STRATEGY: Seek support
Professional input in the form of a sup-
port group or therapist may be needed
if your trigger is due to addiction. Cog-
nitive behavioral therapy, in particular,
has been found to help change addic-
tive patterns. If you choose to tackle
this trigger alone, replace the sugar
with a healthy food or physical activity.
TRIGGER: Self-punishment
Overeating can be a way to punish our-
selves if we feel ashamed or guilty, or
simply because we lack self-esteem and
do not like ourselves.
STRATEGY: Self-care
See the desire to punish yourself as a trig-
ger to do the opposite. If you are reaching
for chocolate because you know you will
feel bad after eating it, select a kinder
option for your body’s needs instead. If
you feel like isolating yourself for a food
binge, plan a healthy meal out with a
friend. Every time you do the opposite
of self-punishment, you strengthen a
new pathway in your brain—one that
encourages self-care.
TRIGGER: You are “hangry”
A common trigger to overeating is when
you become “hangry”—bad-tempered
because you are hungry.
STRATEGY: Don’t go hungry
Fuel your body regularly and any time it is
signaling to you that it needs food. If you
are following a diet that leaves you hungry,
stop it straightaway and find one that
respects your body’s need for sustenance.
At the core of defeating each of these
triggers is simply being kind to yourself dur-
ing those times when the urge to overeat
is strong. With self-compassion, the urge
will subside, and you will come out the
other side stronger. †
Dr. Nicola Davies is a health psychologist and
Shutterstock/Alhovik
author of I Can Beat Obesity! Finding the Motiva-
tion, Confidence and Skills to Lose Weight and
Avoid Relapse.
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GRAB AT THE GROCERY STORE
Craving something sweet in
the morning?
Breakfast pastries aren’t typically rec-
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but new products on the market pro-
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grams of protein, 5 to 6 grams of fiber
and a patented probiotic blend. They
are available in six tasty flavors: double
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Need a grab-and-go breakfast
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RXBARS are made from simple ingredi-
ents including fruit, nuts and egg whites,
which provide a better-for-you quick grab-
and-go breakfast or snack option. They
come in 10 flavors, including the new
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about 210 calories, 12 grams of protein
and 5 to 6 grams of fiber. Want something
with fewer calories for a snack? Try the
new RXKIDS bars, which come in three
fun flavors and contain 140 calories, 7
grams of protein and 3 grams of fiber.
For more information, visit rxbar.com.
PRODUCE TO TRY THIS MONTH
Parsnips
Sweet and earthy, parsnips can be used
in the kitchen much like carrots. Rich
in vitamins and minerals, particularly
62 January/February 2018
F Thought
for
d
By Alison Massey, MS, RD, LDN, CDE
potassium, parsnips are a great low-
calorie and fiber-rich vegetable to add
to your next meal. Try incorporating
parsnips in your stews and soups or
trying mashing cooked parsnips with
carrots for a colorful side dish.
Pomegranates
The lovely deep red pomegranate arils
are delicious with a sweet-tart taste. Full
of good-for-you nutrients—specifically
vitamin C, potassium and fiber—pome-
granate packs in a lot of nutritional
value per serving. Try pomegranate arils
on top of salads or bruschetta or even
add them to salad dressings and drinks.
KEEP IT IN THE KITCHEN
Love those winter vegetables but don’t
like how long it takes to cook them?
Try spiralizing butternut squash, beets,
carrots and turnips for a fun, fast and
quick way to eat veggies. Or try spiral-
izing apples and pears and sautéing
them with cinnamon or other favorite
spices for a low-calorie and healthy
dessert. Learn more at oxo.com.
Tired of having multiple kitchen
devices? Streamline this year with the
Instant Pot® 7-in-1 multi-use program-
mable cooker. A pressure cooker, slow
cooker, rice cooker, steamer, sauté pot,
yogurt maker and warmer, this device
can multitask and help prepare all
kinds of dishes for individuals with
busy lifestyles. For more information,
go to instantpot.com.
WHAT’S NEW IN RESEARCH
It’s best to keep an eye on the food labels
and not necessarily the food claims when
purchasing items at the grocery store.
According to one study published in
the September issue of the Journal of the
Academy of Nutrition and Dietetics, food
items with nutrient claims (i.e., low fat,
no sugar added, etc.) did not necessar-
ily offer better nutritional profiles than
comparable products without nutrient
claims on the labels. The bottom line:
Always compare the nutrition facts por-
tions of the label to make sure that you
are making the best choice.
Q&A WITH THE RD
Q: I’m working on losing weight in
the new year. What are a few diet
strategies to help me get started?
A: The best advice is to eliminate
the “diet” mentality and focus on
developing healthy eating habits
that you can stick with throughout
the year. Diets fail because they are
a temporary fix and something that
individuals often start and then stop.
Instead of starting a “diet,” think
about simple strategies to improve
your food and beverage choices, like
adding more fruit and vegetables,
choosing drinks with little added
sugar and learning the appropriate
portion size for items at a meal.
Consider working with a registered
dietitian on developing personalized
goals to improve your eating habits.
Do you have any questions you want
answered by the registered dietitian? Send
an email to them at communications@
diabetesselfmanagement.com. †
Alison Massey, MS, RD, LDN, CDE,
Shutterstock/Sudowoodo
is a registered dietitian and certified dia-
betes educator in Maryland. She is the
owner of The Simple Ingredient LLC
www.thesimpleingredient.com.
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 PRODUCT
SPOTLIGHT
FiberPasta
FORGET EVERYTHING YOU KNOW
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64 January/February 2018
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