- Do you think diabetes is on rise or decline? If on rise can you add your feedback as to why you think its on rise and if its on decline then why?
- What is the importance of diet in diabetes? What kind of dietary guidelines should people with diabetes be following?
- What sort of mistakes you think newly diagnosed people make and how can they avoid those?
1. Diana L. Malkin-Washeim
A1: YES, I believe diabetes is on the rise because there are still many people whom do not engage in activity daily; that consume sugary beverages and fried foods daily which contribute to weight gain and is a risk factor to developing type 2 diabetes. Food is expensive and when people who live on a fixed income or below the poverty threshold it becomes challenging to be able to purchase nutrient dense foods. There are many people who are health illiterate that which drives the gap of health disparity – this sub-population do not understand what the health care provider (HCP) is saying and in addition, the HCP may not understand what the needs are – hence reducing a healthy outcome. There are certain cultures that may believe or take a fatalistic approach that it is inevitable that they will develop diabetes regardless and not take a preventable approach by eating healthy, being active, and maintaining weight, when there is a strong family history of type 2 diabetes.
A2: Eating foods that contribute to the body’s’ health as well as understanding why is significant with a chronic condition such as diabetes.
One can not go wrong with consuming a plant-based meal plan and to include fresh fruits and non-starchy vegetables; to limit starchy vegetables; to include protein sources from legumes, fish, nuts and seeds and alternative protein sources such as hemp and soy; to use vegetable oils and olive oils; to avoid sugary beverages and fried foods…all along with daily activity.
A3: People who are newly diagnosed with type 2 diabetes have the preconceived notion that they cannot get off their medication. With type 2 diabetes, it is possible to get off medication if there is weight loss, consumption of healthy foods that are nutrient dense and high in fiber; daily activity; weight loss; social support and a positive attitude. These factors contribute to controlled blood sugars without medication. However this conversation needs to occur between the patient and their doctor.
Getting into the habit of only checking blood sugars once or twice per week is an error. If one is not on a sensor then checking blood sugars is key to good blood sugar control and to understand why blood sugars either elevate or drop.
2. Beverly Herman-Rivera
A1: According to the CDC website reported for 2016, the rate of newly diagnosed Diabetes in the United States has begun to fall but the numbers are still high with 29 million Americans living with diabetes and 86 million living with prediabetes. There are many undiagnosed as well as many who don’t access medical care on a regular basis for a many number of reasons including but not limited to: cost (uninsured and underinsured) , some are scared to know if they have Diabetes (it’s easier to ignore it), and many live in rural areas or inner cities where access to healthcare is difficult in a number of ways.
A2: Diet, compliance to medications as well as patients being on optimal therapies and physical activity are all key to managing Diabetes. Maintaining the proper diet seems to be one of the hardest things to do as there are so many implications such as psychological, cost, food preferences and the hunger that comes with elevated blood sugars making it difficult to match food and medications.
A3: The biggest mistake is not getting the proper information/education from a reliable source. According to A Joint Position Statement of the ADA, AADE and The Academy of Nutrition and Dietetics entitled “Diabetes Self-Management Education and Support in Type 2 Diabetes” states ”it is the position of the ADA that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter”. Obtaining proper education has been shown to reduce Hemoglobin A1C by as much as 1% in type 2 patients, has a positive effect on the psychological ,clinical and behavioral aspects of the disease as well as shown to slow down the onset of type 2 diabetes thereby reducing the risk of complications. We can partially blame this on our physicians who are not referring enough patients to these services and many patients rely on them to make recommendations for their treatment. But of course, the patients themselves should also take partial responsibility to inquire on their own about how they can get the education. For more information check http://care.diabetesjournals.org/content/early/2015/06/02/dc15-0730
3. Marianne Hutton
A1: From 1980 to 2014 the number of adults in the US age 18-79 with newly diagnosed diabetes more than tripled from 493,000 in 1980 to more than 14 million in 2014. From 1991 to 2009 the number of new cases increased sharply from 573,000 to more than 1.7 million. However from 2009 to 2014 the number of new cases decreased significantly to approximately 1.4 million.
Diabetes is steadily on the rise except where we saw it drop from 2009-2014. However the overall cases of diabetes are so many more than it was in 1990 that it is striking. We have a continuing diabetes epidemic with a slight drop in diagnosis for a time. Only time will reveal whether or not there has been a drop in new cases. We need to see the next round of numbers before we can make further assumptions on the rise or decline of diabetes. My personal thoughts based on my daily experiences out in the field working in a variety of clinics is that diabetes prevalence is on the rise.
A2: Dietary guidelines are to decrease sugar to 10 percent of caloric intake. If BMI greater than 24 decrease weight by 7-10 percent. Limit carbohydrate to no more than 45 grams per meal if you’re female and no more than 60 if you’re a male generally speaking. These guidelines should be individualized. A person can find out if they are too much carbohydrate by checking their blood sugar 2 hours after eating. Their blood sugar shouldn’t rise more that 30 to 40 points from the pre-meal blood sugar.
More fiber, whole grains and a plant based diet. Diet is extremely important. Everyone should see a Registered Dietitian at diagnosis and when any changes in their treatment plan are made.
A3: Many people begin juicing which results in taking in large amounts of carbohydrate in small volumes. Another mistake they make is not attending a diabetes self management education class. This may be because they are in denial of their diagnosis which is natural. Education is power.
4. Max Szadek
A1: I believe pre-diabetes and type 2 diabetes are on the rise. Aside from focusing on the common risk factors associated with type 2 diabetes (sedentary lifestyles, family history of diabetes and prevalence of processed foods in our diets) I think its interesting to point out how some other chronic illnesses are also linked to diabetes. I just read how new research from Medical Monitoring Project (MMP) suggests that adults with HIV are predisposed to developing diabetes.
A2: The most important dietary guideline I would recommend to people with diabetes is to aim to ‘be a better eater, not a perfect eater’. Most of us know what to do but we still don’t do it. It’s normal for slip ups to occur especially during the holidays. When that happens it important to get back on track quickly without delaying the process by beating yourself up. I like to look a my mistakes as opportunities to learn. You can only learn from a mistake after you admit you’ve made it.
A3: I feel a lot of newly diagnosed people with diabetes don’t seek professional help for coping with the emotional side of diabetes. Many people experience anger, depression and/or grief when first diagnosed. In my opinion, dealing with diabetes over the long term requires developing a range of coping skills and techniques from anger and stress management to guided meditations.
5. Francine Kerber
A1: Diabetes awareness is on the rise and I have seen an increase in people being diagnosed with insulin-resistance. I believe those being diagnosed with Diabetes is either flat or slightly falling. With the rise of DM rate over the last 20 years, families have witnessed the hardships that come with the diagnosis. As more medical professionals and celebrates vigorously promote the benefits of lifestyle changes through diet and exercise to delay or prevent the onset of Diabetes, I see motivated individuals working towards making these changes successfully.
A2: As a Registered Dietitian and Certified Diabetes Educator, the link between diet and diabetes is near to my heart. The rise of Diabetes didn’t just coordinate with people living longer or advancements in medical testing. As Americans moved further away from eating whole foods and increased their intake of packaged food-like items, health declined dramatically. Ideally, everyone not just those with Diabetes, should be eating a diet that is rich in whole unprocessed foods.
A3:If you are newly diagnosed with Diabetes, don’t miss the opportunity to attend an Accredited Diabetes Education Program within the first year of diagnosis! The diagnosis of Diabetes is often down-played for the first few years and then when complications begin to arise, patients and providers are scrambling to provide detailed education only to learn the patient may not be able to get the amount they need to be successful. Don’t try to learn how to play a game half-way through playing, read the rules first, know the risks and then play smart – knowledge is your best defense against diabetes.
6. Amy S. Gumieny
A1: Statistically diabetes is on the rise. I have seen a huge growth in gestational diabetes. We have had 30 referrals last year when normally we are lucky to get seven.
A2: Obviously, we are getting heavier and more sedimentary. As clinicians we are just as guilty. I have battled my weight since puberty. Many of us have office jobs, long commutes, do not exercise, and have a poor diet.
However, I am seeing fewer patient’s than I did 13 years ago. Our center used to have 2.5 full-time nurse educator and 2 full-time RD diabetes educators. Now, I am the only nurse and I work 20 hours a week and we have an RD that spends less than 20 hours a week on diabetes education.
I am lucky if I have 3 patients for diabetes education in a week. It may be due to lack of insurance coverage, patients declining diabetes education (they can do it on their own), lack of referrals, or more clinics having an educator on site. Diet is very important in diabetes management as well as prevention. I typically see the patient for their initial assessment. I go briefly over diet to see what they are drinking, eating, and if they skip meals. I find much of the sugar consumed is in beverages or convenience foods. Typically, I instruct patients to avoid added sugars, juices, regular soda, and limit milk to 8 oz. servings. When the dietician follows up with the patient she will assess nutrition needs and help them set up a meal plan. Patients are instructed on carbohydrate counting and reading food labels.
A3: The biggest mistake newly diagnosed patients make is trying to eliminate all carbohydrates from their diet. First, that is unrealistic and second we need carbohydrates to fuel our body. They just need to make better carbohydrate choices. Another big mistake patients make is thinking diabetes education is a one and done appointment.
It takes some people years of having diabetes before they even accept the fact they have diabetes (some never do). Once they realize it is not going away or their diabetes management worsens they come back for a “refresher”. It’s like they are getting new information when realistically I know I thought them the same thing 2 years before.
They were not ready or they were just overwhelmed with all the information. It is hard enough to eat healthy. But, now we want them to exercise, take medication, monitor their blood sugars, see a diabetes educator 3-4 visits, and follow up with their provider every 3-6 months. Now they have to fit in diabetes into their daily life. Making ourselves the first priority is not always possible or realistic.
7. Joan Trute
A1: I think diabetes is on the rise. There are so many people that have pre diabetes and also diabetes. I always check the A1c of my patients and 9 out of 10 have pre diabetes or diabetes.
A2: Diet is extremely important in diabetes. That and physical activity are the two most important lifestyle changes someone can make. I use the DM plate method with people-1/2 your plate veggies, ¼ plate protein and ¼ plate carbohydrates plus a serving of fruit and a serving of yogurt or milk. Plus healthy fats of olive oil , nuts or avocado. A healthy snack of protein and a carb 1-2 times a day. Trying to eat more vegetables is a start.
A3: Ignoring it, or if they are in denial then they eat whatever they want. Start making one small change- swap sweetened beverages to water or non-sweetened beverages. Start moving more- walking, dancing etc. to get to the 30 minutes 5 days a week.
8. Lori Zanini
A1: I think the data is pretty clear that diabetes is on the rise. 1 in 11 US Adults has diabetes and 1 in 3 has pre diabetes. https://www.cdc.gov/features/diabetesfactsheet/
A2: What you eat is powerful in the self-management of blood sugar levels. Eating consistent, lower amounts of carbohydrates throughout the day will help prevent spikes in blood sugar. I recommend high fiber foods and a balance of lean protein, non-starchy vegetables, and healthy carbohydrates throughout the day. Eating a protein source at every meal and snack is beneficial.
A3: I think many individuals get overwhelmed when they first receive their diagnosis and buy into fad diets. I recommend they seek out the help of a certified diabetes educator and registered dietitian to help customize a realistic plan that will work for them.
Here is a link to my free 7 day diabetes meal plan: http://www.lorizanini.com/free7daymealplan
9. Karen Pennington
A1: According to CDC: “The rate of new cases of diagnosed diabetes in the United States has begun to fall, but the numbers are still very high. More than 29 million Americans are living with diabetes, and 86 million are living with prediabetes, a serious health condition that increases a person’s risk of type 2 diabetes and other chronic diseases.” The decline of new diabetes cases is good news, but this is taking into consideration that the word “epidemic” has recently been used to describe diabetes in the USA. I think this decline in newly diagnosed cases is due to better awareness of causes of diabetes and somewhat to the marketing about decreasing the amount of sweetened beverages that should be consumed. The continuation of poor diabetes control among those already diagnosed with diabetes is due, in part, to lack of diabetes education.
A2: The importance of diet in diabetes is twofold: First, decreasing the amount of carbs eaten at one time will decrease the amount of insulin required to process the glucose. Since high insulin levels cause increased hunger, increased fat storage and feeling sluggish after meals, eating lower carb meals will result in decreased hunger, decreased storage of body fat (as insulin is the fat storing hormone), and feeling less sleepy and sluggish after eating. Secondly, advising patients to eat more green vegetables, lean protein and moderate amounts of unsaturated fats will result in an overall lower caloric intake and greater satiety.
A3: The biggest mistake made by those with newly diagnosed diabetes is listening to friends and family member’s advice. There is much misinformation about diabetes and using reputable websites such as WedMD, diabetes.org, Eatright.org, and diabeteseducator.org can give patient good advice. Most importantly, the patient needs to request time with a CDE who can be a wealth of information and support.
10. Lawrence Labenne
A1: According to the CDC, the incidence and prevalence of diabetes has slightly trended down in recent years. However, collectively over 100 million people are living diabetes or pre-diabetes. Therefore it is still an enormous public health problem. In my practice, I see new cases of pre-diabetes or T2DM frequently emerge. I personally have not seen a new case of T1DM in a very long time.
Based on my experience, I think the high prevalence of diabetes is largely attributable to improper food choices. Pre-diabetes and T2DM is often highly preventable with: avoidance of refined carbohydrates, and reasonable sized meals comprised mostly of lean proteins and vegetables. However, many people seem eat for pleasure too often and or “stress eat” while just as many simply don’t know how to make healthy choices. More education is needed to guide people toward making food choices that are right for them.
A2: I believe that diet is the single most important modifiable factor in controlling and preventing diabetes. Although consistent carbohydrate intake (carb counting) and portion control are ideal strategies, many people become discouraged by structured dieting. In my experience, people with diabetes have better outcomes when they simply: avoid refined carbohydrates; structure their meals to consist primarily of vegetables and lean proteins; make the smallest component of their meal a complex carbohydrate; eat until nourished as opposed to eating until full.
A3: In my experience the single biggest mistake that newly diagnosed people make is not taking the initiative to learn as much as they can about their condition. I have encountered people that were struggling for years with poor glycemic control. More often than not, it turned out that they just needed to learn and apply some fundamentals of their condition.
11. Barbara Luker
A1: I think diabetes is on the rise because I see many patients convert from pre-diabetes to diabetes. Many of these patients know they have other family members with diabetes but most don’t consider the connection to be a threat until they are diagnosed. I work in an urban setting and see this population of patients develop diabetes far more often than I see them reduce their A1c once pre-diabetes has been diagnosed. I don’t believe we offer enough support to patients with pre-diabetes and doing so in the future may reduce the rise of diabetes in our patient population.
A2: Diet is the most important lifestyle change to manage diabetes, but the hardest to sustain. Patients are able to get in the habit of taking medication daily more easily that they are able to manage the amount of carbohydrates they eat in a day. Our world is not designed to support patients to make good choices on a daily basis. The American diet is laden with sweets and candy that are promoted at every holiday and so hard to avoid. I recommend the patient follow the guidelines from the American Diabetes Association, with one caveat, eat less carbohydrates whenever possible.
A3: Newly diagnosed patients should do some reading first, then find a class or have a session with a CDE or RD to help clarify their questions. Once they start living with the condition many more questions arise and they need the support to get the correct answers at this time. If they don’t, there is a chance of developing bad habits that are hard to break. I see many patients that are struggling because they didn’t get the opportunity to get a good education and support at the time of diagnosis. An educated person from the medical field needs to inform the patient that Diabetes is very manageable, but it also has serious consequences when not managed well.
12. Amanda Meadows
A1: I think on the rise. I feel that we have better/more diagnostic tools, more accessible health care (not necessary affordable; move availability), and a society that has more awareness of the signs and symptoms of diabetes resulting in more diagnoses than before. Along with the accessibility and affordability of poor nutrient foods and societal changes in environment and priorities is helping the rise.
A2: A carb controlled/carb counting diet plays an important role in controlling diabetes but is part of an overall treatment plan that includes exercise/more daily movement, blood glucose self-monitoring and medications (as needed).
A3: Not focusing on overall lifestyle changes in regards to nutrition and exercise. This can be avoided if they came to terms that “things” need to change to be healthier and that comes from the individual’s own desire for change. A provider can only education and encourage and the rest is on the individual.
13. Alison Kaplanes
A1: According to the Centers for Disease Control and Prevention (CDC) 2016 data, “The rate of new cases of diagnosed diabetes in the United States has begun to fall, but the numbers are still very high.” Over 29 million Americans are living with diabetes.Type 2 diabetes accounts for over 90% of cases of diabetes, and is often the result ofpeople being overweight and/or inactive. Another important group to focus on are people with pre-diabetes, a condition where blood sugars are higher than normal but not high enough to be diagnosed as diabetes. More than one-third of American adults have pre-diabetes, which puts them at high risk for developing type 2 diabetes and heart disease. The good news is that people with prediabetes can make relatively simple lifestyle changes to reduce their risk! I enjoy working with patients with pre-diabetes because we have solid research to show that relatively small changes in weight, diet, and activity levels can reduce the risk of developing diabetes by almost 60%!
It is important for people to see their doctors yearly so that diabetes can be diagnosed &treated early. Primary care doctors should play a major role in communicating to their patients when blood sugar levels start to rise so that patients have the opportunity to make lifestyle changes.
A2: Diet is a key factor in successfully managing diabetes. Patients often come for their first visit with me thinking that I’m going to put them on a very restrictive diet. The good news is that people with diabetes should be eating the same heart-healthy diet that is recommended for people for people without diabetes. This is truly the healthiest way to eat for the whole family! We do not use the term “diabetic diet” anymore, but rather a “heart-healthy” eating plan because people with diabetes are at increased risk for heart disease.
This healthy eating plan should include fruits, vegetables, whole grains, lean proteins, healthy fats, and low fat dairy products. Another focus of the diet is on eating a consistent amount of healthy carbohydrates throughout the day, which are foods that break down into sugar and give us energy. Too much carbohydrate or the wrong type of carbohydrate can cause high blood sugars. Healthy carbohydrates include oatmeal, whole grains, fruit, legumes, low fat yogurt and sweet potatoes. Desserts can be incorporated into the plan in small quantities on an occasional basis- which is the same recommendation that I’d give someone without diabetes.
I am sure to always help patients incorporate their favorite foods into their plan, because food is meant to be enjoyed! Regular soda and other sugar-sweetened beverages raise the blood sugars so quickly, and are packed with calories, so these are one of the few things that I say “never” too. I often hear from newly diagnosed patients that the diagnosis of diabetes was a “blessing in disguise” because it gave them the motivation to eat healthy…the way they should have been eating all along! People with diabetes should work with a Registered Dietitian that is knowledgeable in diabetes, so they can get an individualized nutrition plan. Nutrition education for diabetes is almost always covered by health insurance.
A3: Without a doubt, the biggest mistake that newly diagnosed patients make is seeking information on how to manage their diabetes from the wrong sources. Many newly diagnosed patients leave their 15 minute visit with their primary care doctor with more questions than answers.Instead of turning to a diabetes expert like a Certified Diabetes Educator (who may also be a Registered Dietitian), they turn to neighbors, family members and/or the internet. The problem here is that they are often getting inaccurate information, or information that is not specific to their individual diabetes needs. Everyone thinks they are an expert on diet and diabetes these days…trust me, I’ve heard it all! Rather than feeling empowered, this “random” flow of information leaves them even more confused about how to manage their diabetes, scared about potential complications of diabetes and unnecessarily deprived of their favorite foods.
A Certified Diabetes Educator (CDE) is trained to help empower patients and help make living with diabetes easier for them. Even after the first visit with a CDE, patients will feel like they are in control of their diabetes & this is a very important quality of life issue because diabetes is a chronic condition. We teach patients all aspects of diabetes self- care to stay healthy: how to test blood sugars & what the numbers mean, how to take diabetes medications properly, what to eat, how to stay active, how to problem solve and what preventative care they should do (ex. yearly eye exam, daily foot checks). With diabetes, the more knowledge patients have, the healthier they will be.
Unfortunately, most primary care doctors do not have the time or knowledge to teach these important self-management skills; Registered Dietitians and Certified Diabetes Educators do!
How to find a Registered Dietitian in your area:
- Click on “Find and RD”
- Enter your zip code
- Make sure to seek an RD who also has a “CDE” credential or ask if they have experience with diabetes.
14. Anna Norton
A1: More and more people are being diagnosed with diabetes today than ever before. Over 29 million Americans have diabetes, and another 1 in 3 have prediabetes, with little preventative care. There could be many reasons for this rise, but I am not a scientist or clinician.
A2: Living a healthy life requires a focus on eating healthy. This can be said for people with or without diabetes. Eating natural, unprocessed foods is integral to feeling better and encouraging healthy eating habits in our youth.
A3: The newly diagnosed can feel overwhelmed upon diagnosis of diabetes. Learning about blood sugar control, treatment, insulin therapy (if needed) and the possibility of complications later in life can create a sense of insecurity and fear. The biggest mistake is not seeking peer support. There are many opportunities to meet others living well with diabetes – online and in person. Groups like this are integral in easing newly diagnosed into positive disease management and focus on the social and emotional side of diabetes management, which is often overlooked in a clinical setting.
15. Therese Franzese
A1: DM is on the rise most likely secondary to the obesity epidemic. First world challenges are usually based in overconsumption and has lead adults and children to be the fattest nation we have ever been.
Diabetics who lose even a few pounds can manage their serum glucose better and may be able to be actually become “diabetic free” if they maintain a healthy weight, exercise and eat right. I also believe that the “catch net” for DM has grown, therefore more people are finding out that they are diabetic sooner then they have in the past (some people can go their whole lives without knowing that they are diabetic).
With the evidenced based updated criteria for diagnosing DM and modernized medical methods for detecting and treating DM, most diabetic patients find out sooner than later and treat sooner. The first treatment for a type 2 DM is life style change, no drugs. Medications don’t begin until after 3 months of trying life styles changes and monitoring the serum glucose by a PCP (no specialist needed). Usually the first medication recommend is a biguenide (like Metformin).
A2: I think I answered the question about importance of diet above.
The diet should be a carbohydrate steady diet which includes all carbohydrates, complex and otherwise (cake, cookies, pasta, potatoes, are all considered carbs.). The guidelines are to try and get to, and maintain a healthy weight with using calories to maintain the weight which would include enough calories to do regular exercise and daily living, whilst maintaining your lean body mass (your strength/muscles).
Those calories (a measurement of energy) should be mixed with about 20 – 30% fats, 50 – 65 % carbohydrates and 15 – 25% proteins. Increase carbohydrates with increased activity, not protein. Increase fat for extreme workouts. Carbs, fats and proteins all carry specific micronutrients and no single nutrient should ever be taken out of the equation, since it is flat out unhealthy. All calories should try to come from good, nutrient-dense sources. (I can give you examples, if you would like)…whole grin bread vs white bread…
A3: Here are some mistakes:
Mistake #1: listening to friends and family or even other diabetics every diabetic has a different pathway to health and all patients are treated individually based on their needs (no 2 diabetics are the same).
Family and friends may have good intentions, however if they watch TV for diabetic cures and don’t at least have a 4-year degree in clinical nutrition, politely thank the and go to your Registered Dietitian or Certified Diabetes Educator. Legitimate nutrition/diet experts can help you keep the foods in your diet that you love and still reach your goals.
Mistake #2: reading unsubstantiated internet information, as you know there is a lot of “fake” info on the internet.
Mistake #3: starvation or fad diets, they don’t work and can exacerbate a problem and/or be very dangerous.
Mistake #4: herbs and other tincture cures may be very harmful and have no substantiated clinical/scientific evidence that any of these “snake oils” help and may even be dangerous. The diet industry is a billion dollar industry. American’s spend a lot of money (and frankly waste their money) on quick fixes and the manufacturers know this.
*There are still NO rules or government regulations for these ingredients, so buyer beware! Please don’t hate your money and time and just get back to basics and you should do great 🙂 Everyone can visit www.eatright.org
16. Lynn Grieger
A1: The American Diabetes Association published statistics on diabetes http://www.diabetes.org/diabetes-basics/statistics/ that show the number of people diagnosed with both diabetes and pre-diabetes continues to increase. Reasons for the increase are varied, and include obesity, lifestyle, and the increase in the US population of ethnic groups more prone to diabetes, including Hispanics.
A2: Food choices are key with every type of diabetes and pre-diabetes because food not only affects blood sugar levels, but also plays a role in body weight and cardiovascular disease. A Mediterranean-type eating style that includes plenty of vegetables, fruit, whole grains, legumes, and lean protein choices is encouraged for everyone to promote health.
A3: I often find people feel they have to immediately cut out all of their favorite foods, and then after a week or two discover they can’t continue with these drastic changes and give up making any changes in their food choices. Attending diabetes education classes and support groups is the best way for people newly diagnosed to learn as much as possible about how they can manage diabetes, and get support and encouragement making realistic changes in their habits.
17. Kathy Stone
A1: When people say that diabetes will become an epidemic, I think of diabetes as already being an epidemic. If people routinely had their HbgA1c tested yearly, I believe we would have a better handle on finding the millions of people who either already have diabetes, impaired glucose tolerance or are at great risk for it.
A2: Most of us grew up eating a large variety of processed food. Changing those eating habits back to a time where we ate food from the garden and did not need huge pantries to store crackers, chips, cereals and other highly processed foods does not match our lives of eating out and heating something to eat in minutes. It will be very difficult to reverse the trend to a growing population of people with diabetes.
A3: The biggest mistake of people newly diagnosed with diabetes as well as health care providers who see their first elevated glucose or A1c in a patient is not to take it seriously immediately. Telling someone to “watch it” without initiating medication gives the opportunity to live in denial for another several months or even years until damage has already been done and reversing the effects is too late.
18. Michelle Buelow
A1: I believe diabetes and pre-diabetes to both be on the rise. A rise in diagnosis is coming from several issues: Increase in food portions, Demanding work schedules and sedentary life styles which is causing a decrease in physical activity, Increase in Obesity, and the amount of added sugars and carbohydrates that are being incorporated into processed foods.
A2: I would not use the word diet with my patients, but rather: lifestyle change. Diabetes and having a healthy lifestyle go hand-in-hand, and having a healthy life-style is VERY important for someone who has diabetes.
In terms of dietary guidelines, I inform my patients that she should be eating NO different, then someone who is following a Healthy meal plan. I typically refer my patients to http://www.choosemyplate.gov/. Although individualized meal plans should be discussed between patients and dietitians, it is beneficial for people with diabetes to not skip meals, aim for ½ of their meal to be Fresh Vegetables or 1 serving of fruit, ¼ whole grains, ¼ protein and 1 serving of dairy per meal.
A3: I have seen this many times with my newly diagnosed diabetic patients: “I can never eat carbs again”. This issue with this is that EVERY HUMAN BODY requires carbohydrates to function properly.
I educate these patients, that while they are diabetic, they still need carbohydrates in portioned, consistent amounts throughout the day.
Another mistake I hear is “I am watching my Sugar intake on food labels”. If a patient is going to eat a consistent amount of carbohydrates, they should be reading labels for TOTAL CARBOHYDRATE GRAMS, and NOT grams of sugar, This is because our bodies break down carbohydrates into sugar- which in turn will increase our blood sugar reading. I educate these patients on where to look on food labels, so that they can better control their intake.
19. Bonnie R. Giller
A1: I believe diabetes is on the rise in the United States because of the sedentary lifestyle and poor diet of a large percentage of Americans. Their sedentary unhealthy lifestyle is mostly due to less physical activity, less home cooking and eating more fast food, convenience foods and take out. These lifestyle choices often lead to obesity, which is a major risk factor for type 2 diabetes.
A2: Diet is extremely important to best manage diabetes. The meal plan needs to be individualized to each person’s nutritional needs, lifestyle, food preferences and other medical conditions. A balanced meal plan consisting of carbohydrates, fat and protein is the best way for an individual to stabilize their blood glucose levels throughout the day and from day-to-day.
A3: I find one of the most common mistakes a person newly diagnosed with diabetes makes is to avoid eating, or severely limiting, carbohydrates. It is my recommendation that anyone with diabetes, especially someone newly diagnosed, meet with a registered dietitian nutritionist, who is a certified diabetes educator, who can properly educate them on how to eat to manage their blood glucose levels, avoiding highs and lows and potential diabetes complications.
20. Bonnie Brown
A1: I believe diabetes is on the rise worldwide. Some of the negative consequences of industrialization that have effected Western cultures now for some time are now being felt in recently less developed countries, such as India and China. More fast food and processed foods, less manual, agricultural livelihoods, and ability to afford cars are some examples of factors which may be influencing a rise in rates of diabetes in the world. Not sure if rates in US and Western populations has plateaued, although it seems that rising incidents of type 2 diabetes and type 1 diabetes in children would indicated rates will continue to rise.
A2: I definitely believe diet is a major influence on rates of diabetes. I can’t say I can offer any additional pearls of dietary guidelines beyond those established by current authorities in the field. I believe a diet pattern versus any one food or “diet” is most relevant when talking about influence of diet.
However, with individual interventions it is often more useful to focus on concrete changes that may move one closer to positive diet patterns. For example, using less sugar-sweetened beverages or using whole grains in place of white. There are various “patterns” that can be beneficial for long-term health. I believe DASH, Mediterranean diet or vegetarian diet patterns can all be used as guidance.
A3: Some of the common misconceptions I have observed among those newly diagnosed with diabetes include, belief carbohydrates are bad – less is more; using insulin equates to increased disease morbidity; one has to be “fat” to get diabetes.
Other misconceptions include the need to eat a strict diet; for children the necessity to have a special, separate meal plan. Also the idea that diabetes controlled by diet or lifestyle alone, versus when medication is prescribed, is “not as bad.”
21. Judith Riddle
A1: Diabetes is definitely on the rise in the US because many Americans live sedentary lives, are overweight or obese, and eat diets high in fat, sodium, and sugar.
A2: Diet is extremely important in managing diabetes, however, there is no one-size-fits-all diet for diabetes management. Dietary patterns must be individualized according to patients’ needs, lifestyle, cultural background.
A3: Some make the mistake of not wanting to take medication and instead manage their blood sugar through diet alone. This doesn’t work because diabetes isn’t all about blood glucose management. There are other systems in the body that contribute to diabetes and must be managed/treated through medication.
22. Judy Sabzevari Yadgar
A1: Both Type 1 and Type 2 diabetes continue to rise. I have seen this when I was working as a Registered Dietitian in a hospital and even more so currently as a Certified Diabetes Educator in an endocrinology practice as the number of patients with diabetes increases. The part that is a major concern is how many people go undiagnosed or unaware of their risks. The rise can be attributed to a lifestyle of limited time for healthy habits. This leads to less physical activity, more convenience food and less time to prepare healthy meals at home.
A2: Diet has a strong influence on diabetes as well as management. People should be advised to learn about Carbohydrates. Not all carbohydrates are poor choices but the amount consumed should be the focus. Carbohydrate intake should be consistent.
Avoiding them and overcompensation at another meal is not the goal. The diet should also be balanced with lean protein with a focus on non-starchy vegetables. I have found that the “MyPlate” food model is a better tool of education for many who can’t follow a consistent Carbohydrate food plan.
A3: I have seen newly diagnosed people mistake sugar free as carbohydrate free as well as avoid non-starchy vegetables such as carrots due to wrong resources. It is very important to follow guidelines from valid resources and experts in the field. It is our job as Certified Diabetes Educators to promote healthy eating and diabetes management thought accurate information.
23. Jimmy Moore
A1: Type 2 diabetes is absolutely on the rise because the mainstream diabetes educators are still promoting decades-old thinking on how to best treat it. Eat “healthy” whole grains, lean meats, legumes, and more and simply cover the effects of these carbohydrates with insulin and medications. Can someone explain how treating a disease of excess insulin is resolved by pumping more insulin into the body? It’s literally like fighting a burning home with a blow torch. The failure to recognize the role that any carbohydrate source (not just sugar and even the much-beloved whole grains) is having on the blood sugar and insulin levels of Type 2 diabetics is the major blind spot in how we are treating the people suffering from this terrible disease. This is criminal in light of all we now know physiologically in the metabolic pathway of diabetes.
A2: Diet is the major controller of Type 2 diabetes. What you eat matters immensely because it determines whether you have a blood sugar and insulin response depending on what foods you decide to consume. Eating a banana seems innocuous until you realize that’s 29 grams of sugar and starch that needs to be dealt with by your body. And if you are insulin resistant, then that could wreak havoc on your body requiring medications and possibly insulin to deal with it.
On the other hand, you could have a 5-ounce sirloin steak with butter on top with a salad and non-starchy vegetables covered in olive oil and that will not cause a negative impact on blood sugar or insulin levels. This isn’t about calories as is commonly promoted by well-meaning, but ignorant people in the nutrition and medical fields. Instead, it’s about hormones and controlling insulin and leptin especially with the use of strategic foods. That’s why a ketogenic diet is so incredibly effective for people dealing with Type 2 diabetes.
A3: The #1 mistake I see in newly diagnosed patients with Type 2 diabetes is abdicating the responsibility for their own health to the man or woman in the white coat.
People are obviously scared when they get the diabetes diagnosis and thinks their doctor knows all the latest information on how to best treat their disease. But the truth is the medical profession is inadequately trained on how to deal with Type 2 diabetes because they have not been taught about nutrition.
I recently spoke with a student who just graduated from medical school at Duke University and asked him how much nutrition education he received during his training. His response shocked me—one three-hour seminar! And they didn’t mention insulin at all. While we have this lofty idea that doctors are all-knowing when it comes to every angle of our health, the truth is they have not been armed with enough knowledge on nutrition to give reliable information to a Type 2 diabetic. It would be like asking your plumber to fix your lawnmower.
He may know how but he hasn’t been trained to do that. And that’s exactly where doctors are today. So it is up to each and every patient given a diagnosis of Type 2 diabetes to educate themselves on all the options they have for treating their disease—including a low-carb, high-fat, ketogenic with periods of fasting—and realizing this diagnosis isn’t a death sentence. It can be improved greatly without the need for insulin, medications, or a low-fat diet!
24. Rebecca Crespi
A1: Treating children with diabetes is very challenging. Unfortunately, over the past few years, both Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM) in children have been increasing. There are numerous theories as to why diabetes is on the rise. In terms of T1DM, there are a multitude of factors (environmental and genetic) that can contribute to the increase in T1DM, but unfortunately a direct cause and reason for the increase is still being researched. However, with T2DM, the increase in childhood obesity, likely due to poor diet and sedentary lifestyle, is a profound risk factor for this increase.
A2: All children should follow a healthy diet and consume enough calories for proper growth and development. For children with T1DM, counting carbohydrates to dose insulin and eating a healthy well balanced diet is the goal. Diet restriction is not normally encouraged. In contrast, weight management to prevent and control T2DM in children can be tricky but is extremely important. Stressing the importance of exercise to help maintain or lose weight as well as to help prevent other health complications is key to diabetes management in general. In our practice, all patients with diabetes meet with a registered dietician to learn how to maintain a healthy lifestyle while continuing to grow and develop appropriately.
A3: A common mistake that many people with diabetes make is drinking fruit juice. For people with T2DM who are trying to maintain or lose weight, juice is not a healthy choice. It would be better to choose an orange or an apple instead as it has fewer calories, increased fiber and does not increase glucose levels (or sugar in the blood) in the same way. For people who take insulin, a small amount of juice, 4 oz, can be a quick and easy treatment for a low blood glucose (blood glucose <70mg/dL). A common mistake in this population is that they drink too much juice to treat a low blood glucose level. Otherwise, there is little benefit to drinking juice when a person has diabetes.
25. Antonia Pinckney
A1: Diabetes is most definitely on the rise. This is due to the overall aging of our population as our pancreases loose function, just like eyesight, as we age. Other reasons include the ethnic mix of our population, as some ethnic groups are at greater risk of diabetes than others.
A2: Diet plays an important role in both diabetes prevention and control. Avoiding weight gain, or loosing weight for those that are too heavy can prevent of delay the onset of diabetes. Those with diabetes will benefit from an individualized meal plan from a registered dietitian ( usually covered by insurance plans). Most balanced diets that promote weight loss will help any overweight person with diabetes, there is no one best diet.
A3: Some newly diagnosed patients begin diet or exercise plans that are too extreme, such as crash low carb diets or working out at the gym for hours a day. These can be harmful at worst and are not sustainable. So overall they will have no beneficial effect.
Instead, review your customary eating plan and start removing or cutting back on the most troublesome food, (for example sugary drinks). then proceed to work on a second goal, maybe choosing healthier snacks. The same goes for physical activity. Look at your typical day, scrutinize times where you can add movement. can you walk at lunchtime or do a short video workout before dinner?
26. Andrew P. Mandell
A1: Yes, I do believe diabetes is on the rise. The evidence of this is quite clear. When Defeat Diabetes Foundation (DDF) opened our doors in 1990 the numbers of diabetics in the United States, according tothe CDC (Centers for Disease Control) were 12 million – 50% of those were undiagnosed. As time went on that number continued to rise; in the year 2000 that number was 20 million Americans. Now (2016), that number is 29 million and growing, about 1/3 are undiagnosed and an additional 86 million Americans are pre-diabetic and will surely develop diabetes in the next 10-15 years unless they change their lifestyles, immediately.
There’s no serious effort to cure diabetes – only manage it. With over $245 BILLION per year generated by diabetes, you’ll never see any interest(s) to find a cure – just a token effort to address finding a cure. Smoke & mirrors!!!
A2: Diet in diabetes care is absolutely critical. The 3 necessary components to treating diabetes Successfully are:
- Proper medical oversight. It’s a medical problem requiring a qualified diabetes specialist (endocrinologist or internal medicine specialist). No other doctor qualifies because diabetes affects ALL of your internal organs with devastating effects. It’s the leading cause of adult blindness, non-traumatic amputations, heart attacks, strokes, kidney disease, and so much more….
- Proper nutrition. Diabetes is also a metabolic disorder. What you eat will convert to the critical nourishment the body needs to properly feed the 60 trillion cells in our bodies. It’s simple, good food-good nourishment: bad food terrible nourishment and disaster for our bodies. The best way to determine the best diet for you is by consulting with a certified nutritionist/dietician. Your medical doctor will help find such a qualified professional.
- Physical fitness is equally important. It maximizes the impact of both your medical and nutrition programs. Further, it has many more beneficial gains of its own. Your doctor will coordinate ALL necessary programs!!!
A3: The first reaction by many newly diagnosed people is “denial”. In many instances they feel fine and don’t know what it truly means. To avoid the serious consequences, they need to make severe lifestyle changes and that’s no easy task. Information, education and a qualified diabetes medical specialist (see above) is the first step.
It’s also very important for the new patient to NOT be fearful. The fact is that the diabetes lifestyle is the most perfect lifestyle a human being can live:
- See your doctor regularly;
- Eat right; and,
- Exercise. Remember the words of MR. DIABETES®: “What’s worse than finding out you have diabetes?….NOT finding out!!!”
However, the times are changing and, thanks to the efforts of Defeat Diabetes Foundation and many diabetes organizations and program specialists like DDF, we are targeting children by profiling who is most likely to develop diabetes and getting them educated and on healthy lifestyle programs early. This serves to prevent diabetes, as well as minimize the destructive results of a later diagnosis if it turns out that, one day, they develop the disease. Early identification is critical.
There is no cure, but there is prevention!!! And, the good news is that diabetes Type 2 (90% of all diabetes cases) is up to 90% preventable.
www.DefeatDiabetes.org is a dedicated and totally reliable resource for complete diabetes information.
27. Debra Schonfeld
A1: Most health professionals would agree that diabetes is growing exponentially in this country.
There are those that might argue that this is in part due to the move toward greater access to healthcare in the recent years, identifying more individuals with diabetes. It may also be attributed to improved initiatives to tract and monitor disease trends.
Certainly, sedentary lifestyles, and fast foods have impacted here as well. What cannot be ignored however, is the dramatic shift in population trends that are occurring in this nation as a whole. The average person has a longer life expectancy than years past. Even more dramatic than this, is the rise in the number of people affected by diabetes due to the influx of African American, Hispanic Latino and Asian Americans migrating into this country. These groups in particular often face additional challenges in diabetic treatment, due to lack of financial resources, obesity and needs for support services.
A2: People with diabetes owe it to themselves to start becoming more aware of the foods that are available to them and the difference between. Learning to read package labels, serving size, fat and carbohydrate counting, of course are always essential. Choosing freshly prepared foods when possible over canned may be one example. Financial concerns and availability to find appropriate foods may govern food choices. This is where I always advise the patient to turn to their community for support and resources.
A3: The management of diabetes is fundamentally a self-managed disease.
Whether the patient requires the need for medications or pumps, or simply does occasional blood sugar monitoring, newly diabetic patients are very busy just carrying on their regular daily activities already. Often, the newly diagnosed patient will restrict their food intake as if they were on a reducing diet, and be very critical of themselves for a “cheat” when the carbohydrate cravings overwhelm them.
Food selection, portion control, food combining and meal timing come with time and support. Giving yourself permission to make mistakes and look at those errors critically without judgement, often lead to the best opportunities for growth. I have found, it is at these times when the patient can recruit other patients or professionals such as the diabetic educator or nutritionist, for guidance with some of the barriers that they struggle with. These barriers might be environmental triggers, emotional, cultural or financial issues that they need help with problem solving. It is always important to remember, that there are others that have passed this way before you. Keep a pad and pen around to jot down questions. It’s a process like everything else in life, and frankly you are worth the time it takes.
28. Jeff Dachis
A1: Diabetes is rapidly on the rise.
While we do not know for certain the cause of diabetes, the genetic pre-disposition for diabetes can be triggered from a variety of environmental and physiological vectors.
More and more the industrial food supply is being created with low cost high carbohydrate corn sugar products. There is more sugar in the food chain now than at any point in history and people are consuming extra added sugar and carbohydrates at an unprecedented rate. Whether in sugary beverages, or food additives, or flavor enhancers, you cannot go to a grocery store and buy virtually anything in a package without it including some form of sugar or carbohydrate additive.
Add to that the big corn lobby’s presence in falsely shifting the nations health focus to fat for decades through anti-fat and pro-sugar propaganda, paid fake research, which was all designed to mislead the public about the dangers of consuming added sugar, and you have a US and emerging market populations who are consuming radically increased diets saturated in sugar and carbohydrates.
The result of which is rapidly increasing instances of obesity, which lead to sedentary lifestyles, which can be triggers for the insulin resistance at the root of Type 2 diabetes.
We are literally poisoning ourselves with sugar and carbohydrates.
A2: Diet is a major driver in diabetes health. Each person’s diet is different and needs to be evaluated with their doctor and nutritionist, but it goes without saying that if you consume less carbohydrates of every kind, you can achieve better diabetes control with less medication.
A3: I know I probably made every rookie mistake in the book with my own diabetes, but every person is different.
I think the primary mistake people don’t make is not to get educated about how diabetes works, what impacts it – food, medication, exercise, sleep, stress – and understand how all these elements work together to create diabetes health. There is a LOT of misinformation out there – even within the medical community. You get maybe an hour a year with your doctor, so for the other 365 days and 23 hours of the year, you have to learn to be a diabaddass and that means getting smart, and getting smart fast.
29. Jennifer Smith
A1: Statistics alone show that Diabetes is on the rise. If we look at 1980 through 2014, the number of Americans with diagnosed diabetes has increased fourfold (5.5 million to 22.0 million). New statistics are here: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
The majority of those with diabetes have type 2. While major changes have been made in education to prevent diabetes, we continue to live in a society that is increasingly busy and stressful. With these lifestyle components people take less time to cook healthy real food, be active and live in a low stress environment. All of these have been shown to contribute to development of type 2 diabetes. An increase in the correct diagnosis of adults with type 1 diabetes has also been seen. Statistically there is an increase in type 1 diagnosis, but some of this may be related to more appropriate initial diagnosis while the other component to an increase has been debated as environmental reasons, etc. Since we do not have specific reason for the development of type 1 diabetes, it is hard to say why it is specifically on the rise.
Diagnostic tools have also improved over the years which has helped in the earlier diagnosis of both type 1 and type 2. Improved Clinician education has also allowed the correct diagnosis which can help the newly diagnosed person get the most optimal initial plan of care and get diagnosed earlier as well.
A2: Nutrition is a key component in management of both type 1 and type 2 diabetes (as well as Gestational DM). Since food has a major impact on blood glucose levels, it is important to consider all the macro nutrients and learn what effect they have for diabetes management. Carbohydrate is the nutrient that affects BG the most and the fastest, so, it is usually the focus of discussion when someone is diagnosed with diabetes. Unfortunately, with diabetes we become very carb centric and forget the importance of the other macro nutrients – protein and fat.
The first thing to consider is where you are starting with your personal nutrition. What does your current intake look like and how is it affecting your diabetes and health management overall. Everyone is a bit different, we all have different caloric needs and a different lifestyle (active/sedentary/heavy travel, etc.), and so evaluating what your personal needs are is paramount to what guidelines you should be given.
We do not all fit into an 1800kcal diet “mold”. An important step when setting up a nutrition plan that fits your life is to find a Certified Diabetes Educator that will work with you as an individual. Overall the simplest guidelines that can help are important for everyone, not just those with diabetes. Eat as little processed food as possible, focus on heavy intake of vegetables with ½ of your plate at lunch and dinner covered with veggies. True whole grains the kind you have to cook, such as quinoa, wild rice, old fashioned oats and limit portion to ¼ of plate. Healthy fat from plant based sources such as olive, avocado or coconut oil – with portion approximately 1-2 Tbsp. per meal.
Protein sources from lean meat, beans and legumes – Portion should be about the size of the palm of your hand or about 20-25g per meal of protein. Fruit should be 2 portions per day – 1 piece about the size of a tennis ball or cut up fruit about the size of a clenched fist. These guidelines are rough estimates and should be fine-tuned for personal need based on lifestyle. Some people also find following a lower carb diet advantageous – working with a knowledgeable educator to ensure adequate intake is important.
A3: The biggest “mistake” a person with newly diagnosed diabetes may make is often not a fault of their own. A referral or recommendation for diabetes education should always be a first step in furthering the understanding of the person who will live with diabetes.
This is a 24/7 chronic condition, one that the person with diabetes has to consider for some many reasons in day to day life. It’s important that real education is provided in order to ensure they learn how to navigate their own health management. Education should cover at least the basic physiology of diabetes (especially the difference in types), BG monitoring, medication and how it works/difference in medication and education on the medicine that is specific to what they are personally using.
BG monitoring and how/when/why to check BG so it is valuable information that they can learn from and make beneficial changes to their plan of care. Nutrition education should be given that is specific to their needs and lifestyle – there are many plans that can work, and educators should take the time and effort to learn what the person with diabetes is doing, how to make changes that will make a difference in their management and how to meet the person’s goals (weight loss or gain or maintenance, versus performance (athletes), or management of BG/cholesterol/BP, etc.
Another mistake that seems to be most common is taking the advice of a friend or co-worker, or looking at information from non-reputable sources online. A friend with diabetes may have some good suggestions, but initial information should come from an educator who can cater the information to the individual. This allows the person to make a good “call” about the advice they hear from a friend or media.
30. Joy Cornthwaite
A1: Researchers suggest that the number of diagnosed diabetics will increase in the coming years for reasonsbeyond an absolute increase in the number of total people who develop the disease. Recentstudies, like that of the population health status in Houstona, the nation’s 5th largest city, found that a staggering 1 in 4 persons living in the city have diabetes and do not know it. Thus, in a city of 5.5 million, increased identification of diabetes alone will influence, quite significantly, the increased prevalence of type 2 diabetes.
And while it is true that obesity is one of the primary drivers of growth in the prevalence of type 2 diabetes, and that over 35% the U.S. population is obese, the trend in obesity seen increasing over the past 15 years for adults and youth, did not show a significant growth in the most recent 3 yearsb.
Becoming a diabetic does not have to be inevitable. Efforts to impact this national and global epidemic are already underway. Research is driving collaborative projects like Cities Changing Diabetesc, to understand the diversity of challenges facing communities, cities and nations, and driving the movement to change the face of diabetes, now and in the future.
Texas: Institute for Health Policy, The University of Texas Health Science Center at Houston School of Public Health. Health of Houston Survey. HHS 2010 A First Look. Houston. 2011.
Ogden, CL, Carroll, MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015. http://www.citieschangingdiabetes.com/about/overview.html
A2: Nutrition behaviors and lifestyle modification are the foundation of diabetic care. Our food behaviors inform gene expression, impact weight management, and may reduce the likelihood or delay the development of disease and illness. Meal planning prior to and within diagnosis of diabetes,together with glucose monitoring and/or medication adherence, informs and shapes medical treatment plans. These bring about better health outcomes.Diabetics who control weight and glucose values via diet and exercise can improve insulin sensitivity, decrease glucose intolerance, and impact medications needed for treatment.
In my practice, I find it critical to focus on the concept of meal planning using the plate method, versus “diet”. Initially, it appears on the surface to be a question of semantics, but let me explain. Diets do not last. Many people think of the idea of a diet as an approach to eating that will be brief and short-lived. A diet is a promise to oneself that after a certain amount of time, this way of eating will be gone. You will be able to return to your eating behaviors as they were. Diabetes is a progressive disease. It will need monitoring and self-care to maintain wellness, health and quality of life.
Keeping this in mind, let’s return to meal planning via the plate method. This concept encourages a person to approach diabetes and nutrition in a more mindful way. Food decisions are made to include rather than exclude items. Nutrition knowledge forms the basis of nutrition therapy. Receiving evidence-based education on the function, role,and sources of macronutrients: complex carbs, fruit, vegetables, lean proteins, and combining this knowledge with techniques allowing for appropriate portions, patterning (combinations of nutrient dense food sources),and meal timing,is critical to both self-efficacy and adherence. Meanwhile, food preferences, cultural influences, lifestyle, and food preparation skills, shape personalized selections.
The result is more mindful, more frequently healthy food choices. And therefore, a sustainable, lifelong meal plan.
A3: An unfocused, unmonitored Google-search is certainly not advised. Blogs, group chats, and social media sitesmay all provide unsolicited and erroneous misinformation about a diabetes diagnosis. A well-meaning family member, coworker, or friend may also provide information that is confusing. Every person’s diabetic journey is personal and unique as that individual.
Ask your provider for references and referrals to a specialist regarding self-management of your diabetes. Seek professionals who can lead you to reputable and evidence-based resources for education and developing a self-care plan. I really like the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) websites for general patient-centered education materials, as well as contact information for credentialed certified diabetes educators and registered dietitians in your area. The Cornerstones4Care program and website provide an excellent platform for support through health advisors and meal plans that you can personalize.
Also, don’t forget to use your insurance provider as a resource. They can alert you and direct use of available coverage, per your plan coverage, for self-management providers and programs in your area. They will give you a list of in-network providers. Don’t be afraid to contact your potential provider and conduct a mini pre-visit interview. Personalized care should feel comfortable.
31. Daphna Bottcher
A1 & A2: No comment.
A3: Please note that these things aren’t necessarily ‘mistakes’, but more of a reaction to the emotional distress that families are under at the difficult time of diagnosis. Our hearts go out to all newly diagnosed families!
Setting a tone of Courage and Strength: As parents, we play a vital role in building self confidence and character in our children. They look to us as their chief role models. We must have positive attitudes. We must face the challenges with courage and emotional strength. This will pave the way for our children to learn to live well with the disease on their own. It also will help keep stress and, therefore, blood sugar levels in a healthy range. Your emotional health will have a lasting effect on your child and will give her or him powerful tools to live a long and healthy life. You only have a few days to set the tone for how your family is going to handle this diagnosis.
Say Good-Bye to Guilt: It seems there is no end to the things for which parents feel guilty. Every parent has guilt over one thing or another. But, when your child is diagnosed with a serious illness, guilt can quickly swell. Many parents feel guilty for not seeing the symptoms sooner. Some feel guilty that this dreaded disease was passed down from one of their family members. Just in case your child’s medical team didn’t tell you, please rest assured: There is nothing you did or your child did to cause this awful disease. Because the majority of people with diabetes have Type 2, it is often thought to be controllable, or even avoidable. Type 1 diabetes is neither. Once your child’s immune system decided to wreak havoc on their insulin producing cells, no one – not you, not your child, not even your doctor-could have stopped it from happening. Of course we all wish we could have, but being unable to stop something bad from happening is not the same as causing it. Let the guilt go! Guilt is not going to help you or your child manage this disease.
‘Getting a Grip’ on Your Fears: Type 1 diabetes is a serious and scary disease. There are daily fears regarding lows and highs. Then there are long range fears about your child’s growing independence, future and the serious complications people with Type 1 can develop. Some parents are facing multiple health conditions to manage and balance – not just Type 1. A whole range of fears are normal and common for us as parents. It is important to remember that your child has many fears of their own and will be further unsettled by your fear. Getting a grip on your fears will help you help your child live a full life.
- Fight fear with knowledge!
- Know the real odds.
- Stay informed.
- Be in charge. Stay in charge.
- Don’t keep your fears to yourself.
32. Amy Campbell
A1: Statistics show that diabetes is on the rise, and as a dietitian and certified diabetes educator, I definitely believe this. Genetics certainly play a role, but I also believe that our lifestyles and environment play a big role in this increase, as well. Being sedentary, eating large portions and not-so-healthy foods, stress, and lack of sufficient, quality sleep are also big contributors.
A2: Diet plays a key role, although it’s not the only factor: physical activity (or lack thereof), stress, other medical conditions, and poor quality sleep are factors, as well. As important as diet is, it’s really hard to pinpoint any one “diet” or eating plan that will work for everyone. Nutrition recommendations from the ADA recognize many different eating patterns that can help a person with diabetes better manage his/her condition. To expect most people to give up carbs, for example, or to drink a meal replacement shake doesn’t work. Plus, any kind of diet needs to fit within the context of a person’s culture and lifestyle. However, in general, an eating plan that emphasizes whole foods (and fewer processed foods), plenty of plant foods, and healthy fats seems doable for most people – along with reasonable portions!
A3: Because newly dx’d are often scared and don’t know what to eat, they often listen to their friend or co-worker who has tried some faddish-type diet, and they try to follow something that is unrealistic and often, unhealthy. Or, they search the internet and get taken in by unqualified people who tout special supplements or diets (usually at a cost) that, again, seem promising but that don’t deliver.
In addition, someone new to diabetes may try to make changes on their own, such as cutting out food groups, overly restricting portions, or overdoing physical activity in an attempt to manage blood sugars (and possibly avoid having to go on medication/insulin). Newly dx’d people need access to qualified healthcare professionals – preferably those who have training in diabetes – for education, advice and support, along with credible resources – ADA, AADE, Diabetes Self-Management, etc. They also need to realize that having diabetes does require some adjustments, but that it’s manageable.
33. Lindsay Gillon
A1: On the rise – according to the CDC, the percentage of Americans diagnosed with diabetes has nearly doubled since the late 1990’s. Based on recent data I do think that the rise in diabetes may have slowed but is still not declining yet. Focusing on prevention is a great opportunity to affect the future trend of diabetes. An estimated 86 million Americans have pre-diabetes, 90% of them are unaware that they have it or what the risks are, and 15-30% will develop diabetes within 5 years. Until we do more to effect those numbers, I don’t think that we will see the diabetes trend declining.
A2: Diet is an essential part of managing diabetes. What and how much a person eats have a direct impact on their blood glucose level. Generally, people underestimate the number of calories, and carbohydrates they are consuming. They should focus on eating quality sources of carbohydrates, those that come with fiber and other nutrients, and eating portions that are appropriate for them.
However, there is no standard diet or number of carbohydrates because every person is different. A Registered Dietitian can help create an individualized plan that meets a person’s specific needs. However, as important as diet is, diet is not the only thing that affects blood sugar and diet alone is not always enough to control blood sugar. Other aspects of diabetes management are important, such as monitoring of blood sugar, medication/ insulin needs, stress management, etc.
A3: I think it is common for people newly diagnosed to either underestimate the severity of the disease, or really over restrict their diet.
Some people think that because they feel alright physically that they are “not that bad”, or they were told that their sugar is a little high so they think they are just “borderline” and don’t really have diabetes.
On the opposite side of the spectrum, some people are determined to control their blood sugar, so they try to completely remove all carbohydrate containing foods from their diet. They end up following this very restrictive diet for a few weeks but then get discouraged and frustrated.
It is important for people who are newly diagnosed to remember that this is something they have to live with the rest of their lives, so making small changes can help them create a diet that is realistic for them. Part of the responsibility to correct these mistakes also falls on healthcare providers, making sure that they are taking the time to have an open discussion with their patients about the disease process and what their blood sugar should be.
34. Elizabeth Ebner
A1: Yes, diabetes is on the rise. I believe the greater consumption overall of calories as well as inactivity is exacerbating an ever-increasing population of diabetic patients.
A2: Diet is essential in the management of diabetes. Through carbohydrate counting and portion control, we can help patients control their blood glucose. Also, having the patient maintain a food and blood glucose log helps the patient and the healthcare provider examine reasons for erratic and unexpected blood glucose changes as well as reinforcing good outcomes.
A3: Patients sometimes feel very overwhelmed at the onset of diagnosis. It is important for us, as educators, to remember how much information they are given, either from friends, physicians, family, etc. Very clear guidelines as to the diet, medication, blood glucose testing and exercise have to be given. It is helpful to have the patient verbalize the instructions provided back to the educator to ensure understanding. Compliance is also improved when the patient knows we are here to support them.
35. Rohit Moghe
A1: Type 1 diabetes is stable; type 2 diabetes (T2DM) is on the rise, as is gestational (GDM). The reason for why T2DM and GDM are on the rise is multi-factorial, however, it’s trending along the lines of the rising (global) obesity epidemic So we have to look at why obesity rates are rising. T2DM is strictly lifestyle disease; the reason why many women have GDM is also related to lifestyle, but the burden of pregnancy exacerbates it further. Therefore it is LIFESTYLE. Lifestyle related to the food we eat, our general activity levels, daily conveniences, coping with stress, and public policies.
- Nutrition is highly correlated in lifestyle – we eat more processed foods; less whole foods; less fresh vegetables & fruits, whole grains, beans, legumes, nuts/seeds; more meat consumption (especially in the developing world); high fat intake (especially from meat); and in general increased calories. People are also eating out more than 50 years ago and cooking less at home compared to more than 50 years ago.
- Activity – in the western world, we’re more sedentary than we’ve been; sitting jobs; sitting and watching TV or playing video games, or surfing the internet, and less activity overall. Also due to suburban sprawl, we drive places on highways and do less walking and other human-powered modes of transportation (e.g. biking); bus stops at every corner insead of every 4-5 blocks.
- Daily conveniences – instead of walking/biking to the grocery store, we an order our grocery online and it gets delivered to our house; we spend more time indoors than outdoors.
- Stress – we’re working longer hours; high degree of demands and stressors at work and in personal lives with NO capacity to cope and lacking the resources to cultivate strong coping skills; lack of sleep; multi-tasking and multiple (and in some cases competing) priorities.
- Public policies – farming subsidies for growing certain types of crops for animal feed instead of encouraging biodiversity in farming; factory farming; nutrition guidelines from USDA for school lunches; unhealthy food (meat) is inexpensive, healthy foods (plant-based) are expensive; poor urban and suburban planning to make more walk/bike friendly; unsafe neighborhoods that prevent outside activity
A2: Importance of diet in diabetes – PARAMOUNT!
In fact all the medications approved by the FDA for diabetes are an “…adjunct to diet and exercise…” I interpret this as the drug is in addition to diet and exercise, i.e. diet and activity are primary and drug is secondary.
I’d also like to also add that stress management (sleep, coping skills, meditation, arts/crafts, hobbies, etc.) and strong social support are a piece of the pie, unfortunately the FDA cannot comment on that.
In regards to dietary lifestyle, I believe that for most T2DM patients, a low fat, whole-foods plant-based dietary pattern that naturally contains good fats is the best, most sustainable option. Cultivating this approach in individuals is challenging due to the fact the most people, including health care practitioners (physicians, nurses, etc.) are not well versed in nutrition, and if the health practitioner doesn’t know, how will they communicate good habits to cultivate to the patient, let alone practice it for themselves.
My initial step is to use the Harvard Plate Method that focuses on predominantly plant-based diet (~75% or greater) with low fat dairy (no more than 2 servings per day), whole grains, healthy fats, and no red meat, processed meat, etc.
My ultimate plate, which is what I use for myself and my family, is the one designed by the Physicians Committee for Responsible Medicine, called the PowerPlate. It is whole-food plant-based diet that is naturally low in fat because the fat is coming not from oils, but from nuts/seeds, certain fruits/vegetables (avocados, coconuts, etc), and focuses on rainbow of colors through vegetables & fruits for phytonutrients, fiber through whole grains and beans/legumes. It leaves NO room for dairy, meat, and eggs. This is along the lines of what Dr. Dean Ornish uses in his program, as well as part of the curriculum on lifestyle medicine with the American Colleges of Lifestyle Medicine and Preventive Medicine. (ACLM & ACPM).
In the end, wise words by Michael Pollan, author of The Omnivore’s Dilemma and producer of the documentary Food, Inc, ” Eat Food, Mostly Plants, Not Too Much” The longest surviving people with least amount of medical conditions in the Blue Zones are at least 85% plant-based; eat real whole-food, with minimal processing, and eat within reason, when hungry (i.e. portion control).
A3: Mistakes people make when first starting out are focused on “quick fixes” and not being realistic. They want what’s quickest.
We all know that the tortoise always beats the hare!. They don’t plan smart, and don’t track their plans, and as a result, get frustrated because they’re not seeing results quick enough. They also don’t know where to start because they hear many different dietary plans that are quick fixes in health & wellness sections of the bookstores, but no strong long-term results through peer-reviewed published studies.
Examples are ketogenic, paleo, Atkins, South Beach, etc. The litany of information that people have access to is confusing, which is right, which is wrong, etc. There is a lot of misinformation out there, and social media and blog posts can perpetuate falsehoods even further. The answers are simple, but execution is challenging. To sum, reliance on wrong social networks for support; too much information and mis-information and falsehoods; and expecting rapid results sabotage people’s plans.
36. Sharon Newman-Kemp
A1: Diabetes is definitely on the rise secondary to inactivity, poor eating habits, and barriers to care. People are busy working and taking care of their families. Most of the population is overweight or obese and not taking time to exercise. The American adult eats fast food 3-5 times a week. Fast food is high in calories and sodium.
A2: Diet is definitely important. People with diabetes should follow a consistent carbohydrate meal plan that is low fat, low sodium, includes whole grains, vegetables, fruits, and high in fiber.
A3: The most common mistakes made by newly diagnosed people with diabetes is they do not attend a Diabetes Education Class.
They assume they can handle it on their own. Education and support makes a HUGE difference. Barriers to care are important to acknowledge, it is expensive to each healthy, accredited diabetes education classes are expensive, may programs are closed, and self-care is not included on most employee health plans. People need diabetes education and ongoing support. More employers should offer free diabetes education to employees, assistance with medication, and an onsite or gym supported exercise program. This will assist with education and ongoing support to help self-manage the disease. Diabetes does not go away but must be managed daily.
37. Catherine Parkhurst
A1: Definitely feel it is on the rise. I attribute this to improved screening, aging population, increased awareness, and the ongoing issues with obesity in our population.
A2: Following a healthy eating plan is a vital part of diabetes management and control but should be addressed in our non-diabetic population as well.
Dietary guidelines should be individualized to meet individual patient needs, disease states, and preferences but should be a well-balanced healthy eating plan that incorporates vegetables and fresh fruits, lean protein sources and controlled high quality carbohydrate foods. Decreasing processed foods and those with little nutritional value is important. Calorie control is important for those wanting to see weight reduction.
A3: I see a lot of medication mistakes-timing and dosing of medications. Often Patients will discontinue meds without notifying their physician if they feel they are having side effects or if the medication is too costly.
Often many of these problems can be addressed and resolved. Another problem I see is infrequent follow-up with their diabetes provider especially for the patients who have not reached target for control of their blood glucose, blood pressure, or lipids. These are all important in long term cardiovascular risk reduction and need to be followed more closely than at an annual visit.
38. Elisamuel Sanchez
A1: I strongly believe Diabetes is on the rise and statistically speaking, the numbers support it. Some of the reason for this are lack of time to exercise, poor eating habits, poor lifestyles choices, spending too much time watching TV, playing videos (mostly children) or spending too much time socializing through social networks such as Facebook, Instagram, etc.
But I also believe failure to perform early screening on people who are high risk has had a major impact on those statistics. I think prevention will go along way in halting the development of Diabetes by simply screening people early.
A2: I think healthy eating (don’t quite like the word diet) is quite important in the overall care of people with Diabetes. Basic guidelines I would recommend to my patients is, first of all eat what you like and enjoy it, but choose foods low in calories, fat, sugar and salt. Be cognizant of your meal times and try to eat your main meals 4 to 5 hours apart and if that is not possible eat small meals throughout the day. Make sure to eat balanced meals comprising of a source from each the food groups: carbohydrate, protein, vegetables, fruit and dairy products.
A3: Just to name a few:
A) Not asking questions: What Type Do I have? Is it manageable? Can exercise help in controlling my blood sugars? What do I need to know about ordered medications?
B) Ignoring the diagnosis/disease: I believe getting a diagnosis of Diabetes might come as a shock to many and thinking that ignoring it, it would go away, but the reality is that it won’t go away. You need to confront it and learn as much as your can about it.
Enrolling in a Diabetes Self-Management Education Program can provide patients with the tools they need to tackle their disease. Keeping up appointments with their care providers and coming to those appointments prepared, meaning bring your glucose meter, blood sugar logs and your medications are all very helpful things to do. Ask questions, take charge of that visit. Become a fully-activated patient in your own care.
39. Dora Jaramillo
A1: In my opinion diabetes is on the rise because of several factors; Too many fast food restaurants with high fat, high sugar meals. Too much social media leading to a sedentary lifestyle. Lack of exercise especially in the schools.
A2: Some tips:
- following a meal plan is very important, not a diet because the word diet is a word they don’t want to hear. Meal planning is more attainable and helping the patient understand the importance of planning a meal is very important. Knowledge is power.
- healthy meals that include plenty of green leafy vegetables, fruits, food high in fiber, low fat, low carbs.
- smaller portions (portion control).
A3: In my opinion:
- The most common mistake is denial. “They don’t have diabetes”. Failure to accept the diagnosis leads to not complying with doctors advise.
- How do they avoid this….not sure; however, they need to talk to their doctor and ask questions. Talking to the diabetes team…CDEs.
40. Gowardhan Doddi
A1: Diabetes is on rise for sure, As on 2011, it is estimated that 61.3 million people in Indian were Diabetic and the most alarming thing is 77.2 million people in India are said to have prediabetes as of 2013.
A2 & A3: It is emphasized that Diet impacts 65% in managing patients blood sugar levels, My recommendation about diet will always be to cook as much as possible at home, avoid ready to foods and packed foods like biscuits, cakes, chips etc. I generally dont recommend counting carbs etc. because that seems to me like we are eating mechanically, I believe eating should be enjoyable.
Though Glycemic index can provide with a guideline of what foods to eat what to avoid, One should always watch out if the other nutrients in that food can make me healthier.
Also as we don’t eat most of the foods by themselves, we generally make some dishes and we add number of ingredients in them, so we need to focus more on glycemic index.
Let us see an example: Egg fried rice – Diabetics think they cannot eat Egg fried rice, but you can see Rice – carbs , Egg- Protien and Oil- fat , it is a balanced meal. Also the famous Indian breakfast Dosa is a good example of glycemic load, Dosa is combo of rice, urad dal and coconut chutney- fat in the coconut chutney lowers the glycemic index of rice used in Dosa. So any food combination which was passed on by our ancestors had a lot of science behind them, we should not over look, For me healthy cooking is Grandma’s Cooking.
41. Valerie Goldstein
A1: I believe diabetes, pre-diabetes and all blood sugar related medical conditions are on the rise. According to diabetes.org:
- 1.4 million Americans are diagnosed with diabetes every year.
- In 2012, 86 million Americans age 20 and older had prediabetes; this is up from 79 million in 2010.
This is a complex question but I think there is not just a sole reason for the increase in the diabetes epidemic.
Here are a few, I can elaborate if needed:
- Marketing and industry’s greed over health concern.
- Poor health care coverage for adequate health care.
- Lack of continuity of care amongst health care professionals.
- Mixed or incorrect messages relating to the best diet options for blood sugar treatment.
A2: Diet is THE most important aspect of diabetes care. It is the key to quality of life; especially mood stabilization, successful mental and physical daily life functioning and avoiding diabetes complications. Minimize carbs and mostly get them from natural sources like non starchy vegetables and low glycemic fruits or dairy. I explain this in my book, The Stubborn Fat Fix.
A3: Mistakes yes but the bigger issue is denial and fear. These are the biggest road blocks in diabetes self management. As a diabetes educator, I take the time to educate clients on BELIEVING that the diagnosis is an opportunity to start caring for oneself daily. Diabetes can be managed and controlled. Living a long healthy productive life as if there were no diagnosis is attainable. Knowledge and practice is power. Making small lifestyle steps and avoiding overwhelming unrealistic goals will get you normal blood sugar levels.
42. Susan Schussler
A1: It seems there are more young people with pre-diabetes and type 2 diabetes. Young people of today seem to weigh more & exercise less than previous generations.
A2: A healthy diet is important for everyone. People with diabetes should be choosing nutrient-dense carbohydrates & limiting saturated & trans fats. Reducing portion sizes is important especially if weight loss is needed.
A3: The biggest mistake I encounter with people newly diagnosed with diabetes is that their doctor is not encouraging them to get education. I hear that they get a prescription for a glucometer & are never given guidelines for target blood glucose goals. Or I hear they are told to not eat anything white. Many are lost as to how to help themselves and rely solely on prescription medication to control their diabetes.
43. Ashlea Hill
A1: Yes, diabetes is on the rise. We live in an instant world today where we become aggravated if our social media page doesn’t refresh within seconds and sadly people expect health to be a quick fix too. There isn’t an immediate fix to our health, it’s a process and proper nutrition is essential for all, no matter what type of diabetes.
A2: With Type 1’s, of course we may allow more carbohydrates to be consumed but they should also know the importance not consuming a high carb meal if their blood sugar is already elevated. Type 2’s do have more dietary restrictions and all should NOT follow a preset 60 grams of carbs per meal and 15gm snacks! The plan should be individualized for each person and most likely need considerably less than what is being consumed.
Diabetes is not a one size fit all disease; each person should know their plan including trigger foods. Learning this comes from proper education which is the key to managing this disease. In today’s time, people are busy and do not eat all meals at home and that’s okay because making proper food choices can still be accomplished.
A3: A common mistake is eating sugar free and thinking that is a healthy step and not realizing it has carbs. It’s important to remember that small changes matter; set a goal and reach it!
44. Johanna Burani
A1: Diabetes is definitely on the rise. According to the Centers for Disease Control and Prevention (CDC), the most recent statistics (2014) indicate that 29 million people, or 9% of the US population, have diabetes. In 2010, that number was 26 million. One reason for this noted increase is better diagnostic testing and awareness, which is the good news. The CDC has also identified 86 million other Americans (1 in 3) who have pre-diabetes. These are the people who, if they do not all make the small yet effective lifestyle changes that help to thwart the natural progression of the pre-diabetic state to diabetes, drive the statistics up. And that’s the bad news.
A2: The triad of diabetes treatment includes diet, exercise and medication, with diet as the foundation of all treatment. A healthful diet can take on a variety of sizes and shapes to blend with individual needs, lifestyles and food preferences. However, all healthful diet plans will be rich in low glycemic, high fibrous foods like fresh fruit, vegetables and wholesome, unprocessed whole grains. Protein and fat choices are ideally plant-based, lean and/or good sources of omega 3 fats. All food portions should be appropriate for age, sex and level of physical activity.
A3: Abstaining from entire food categories is a common mistake. Over 28 years of counseling, I have heard too many times: “I’ve stopped eating all carbs.” or “No more pasta or ice cream for me anymore.” Embracing a balanced diet with appropriate portion sizes is the best way to improve blood glucose control. Most patients know what they should do: perhaps replace 50% of regular soda consumption with water, or include 2-3 fruit servings/day, or measure and weigh current meat and starch portions and decrease them by 25%. Small, sustainable changes lead a person to think, “I can do this!”
45. Jessica Schirmer
A1: The incidence of diabetes seems to be remaining consistent in our local region in the Midwest, however, I primarily practice in Pediatric diabetes and I think on a national and global level the incidence of type 1 diabetes has steadily increased. This is even more so, I believe, for type 2 diabetes. The rise in incidence for type 2 seems self-explanatory, until we can see a large change in behavior and lifestyle, and decrease in obesity, increase in physical activity, and improvement in the quality of our nutrition, this will most likely continue to be on the rise. Pertaining to the incidence of type 1, however, I feel an increase may be more related to environmental influences that we are unaware of or do not yet fully understand.
A2: Nutrition in diabetes is vitally important. In order to balance insulin and glucose levels, one needs to be aware of and often times moderate the amount of carbohydrate consumed, as well as ensure a balance of other vital nutrients. If this is not done, often times the result is hyperglycemia or hypoglycemia which can be dangerous in the short and long term scheme of things for people with diabetes. When newly diagnosed with diabetes, it is very easy to be overwhelmed, nervous, angry, scared, etc. I think it is important for people to try and keep things simple initially, and take everything step by step and day by day.
A3: Mistakes can happen when details are overthought and patients should always reach out to their providers if they have questions or concerns about their medications, dietary regimens, or blood glucose monitoring, especially when newly diagnosed with diabetes. Diabetes is very complex, but taking care of it can be manageable and mastered over time. It is all about balance, and keeping your expectations realistic. Do not try for perfection, but strive to meet realistic goals! This is the key and a certain foundation for success!
Disclaimer: The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of TheDiabetesCouncil.com.