The Holidaze

Over the past month…

Really the last three months, it’s been ALL about studying.  I recently took my CDE exam (certified diabetes educator) and PASSED!!  I will start off by saying that an exam doesn’t make me a CDE, however, I now have the credentials showing that I am.  I have been at the Diabetes Research Institute, DRI, for almost two years now.  When I first started there I set out a lot of goals that I wanted to achieve and becoming a CDE was definitely on the list.  During the first year I  was learning a lot and had to slow down on what I thought I’d accomplish in my first year (the master’s is still on the list, there was/is  a period of adjustment that had to happen) and I’ll be honest, my type A personality kind of took over thinking I could do it all.  Diabetes is a complicated disease – Type 1 and Type 2.  There are many myths associated with the disease and one being that if you’re overweight you’ll get diabetes (Type 2).  Not true.  Not every overweight person has diabetes.  Does it increase your risks?  Absolutely.  But diabetes is more complicated than that.  Take a look at this picture of your organs affected by diabetes.  It’s not just your pancreas!

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So when we’re treating someone with diabetes it takes a lot of teaching to help people understand what all is functioning/not functioning in their body.  People with diabetes many times don’t have the sensation of feeling full – their gut hormone is not functioning 100%.  If there is at least this understanding, this allows me to teach my patients at least better ways to put together meals that will help to make them feel full.  First and foremost, everyone should eat as if they had diabetes.  The problem is that people don’t.  We are a society on carbohydrate overload and we need to start cutting back.  Just look at breakfast as an example.  Cereal.  Maybe the worst food ever created (yep I said it).  1 cup of regular Cheerios has 20 grams of carbohydrate.  A real serving size might be more like 3 cups worth (or more depending on the individual, let’s be honest).  3 cups = 60 grams of carbohydrate and that’s not including the milk that is added.  An average meal for a female should consist of just 45 grams of carbohydrates and men up to 60 grams.  The problem with cereal is that being that it’s almost all carbohydrate and virtually no protein (Cheerios did just get in trouble for their claim that their “protein” cereal had more protein than the regular Cheerios) you’re hungry all over again in just under an hour!

In the world of digestion protein keeps you fuller longer, so you need protein at each meal AND we need to lessen the load of carbs at each meal if you have diabetes or don’t have diabetes.  And just for the record, I picked what is believed to be a cereal that is “healthier” than others.  I have another cereal in my office to use as an example that in it’s one cup serving has 39 grams of carbs.  That’s ludicrous.  Just saying.  (If you had 3 cups worth along with a cup of milk that totals ~130 grams of carbs, what is the total grams of carbs needed for some people in a WHOLE day!)

Back to studying for the CDE.  The hardest part for me was learning all of the drugs and their mechanism of action.  I typically have an hour with a patient and obviously as a dietitian I need to educate them on the food as that’s a critical component in diabetes self-management.  I realized when I started studying the only way I was going to learn the drugs would be to include them in my counseling.  So as a patient came in, I knew what medications they were on and then would ask if they wanted to know why they were on what they were on.  ½ did, ½ didn’t.  But that was my in.  If they did want to know I explained to them exactly why they were on the medicine they were on.  The repetition helps, but in all honesty that’s they only way I was able to learn and commit to memory the medications.  It then would allow me to segway in to teaching the patients about food and how it’s all interrelated. 

I really do aim to teach patients as they come in on what their needs are for that day.  I had a patient come in the other day with an insulin pump.  She had her settings in the pump but had no idea what they were or how to navigate her pump to see what they were.  I explained to her that an insulin pump is great, but she’s the brains behind the pump and in order to obtain better blood sugar control she needed to understand her settings.  She was only testing her blood sugar two times per day and we focused on increasing the frequency of her checks as that too allows her to make sure she’s correcting an elevated blood sugar and not just staying high all day.  In that hour, sure I talked a little bit about food (it always returns to the food!) but we spent the majority of our session focusing on the barriers of why she wasn’t testing and what we could do to help her bolus 15 minutes prior to her meals – something so simple but so critical in helping her to have better blood sugar control.  I’m supposed to talk with her tomorrow and see how her weekend went with checking her blood sugar levels as well as if her current settings are working at the ratios they are set & if she’s been able to bolus ahead of meals.  

The definition of a CDE, “is a health professional who possesses comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention.”  I’m proud to say I passed the test and am a CDE; however, knowledge goes beyond test taking.  There were many questions that I could’ve added an answer “E” to because there wasn’t really a “best answer”.  I’m in a place where not a day goes by that I don’t learn something knew or see something knew…all making me an even better CDE.

So as I was studying my days and nights away, Thanksgiving happened and now Christmas is just 5 days away!!  So it’s that time of year again when we gather with friends and family to celebrate the holidays.  The holidays are filled with lots of tasty food, seasonal goodies, and cheer that can/may result in a few extra pounds that can wrap around your middle. 

Dangerous pounds!  Research shows that most adults will gain a few pounds over the holidays.  Not only will they gain a few pounds but they’ll also lose one or two of those added pounds, and then usually hold onto at least one pound each year.  This slow and steady weight gain creeps up on us over the years and can lead to adults becoming overweight by middle age.

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You can take pleasure in the holidays and enjoy delicious foods.  The holidays shouldn’t be a time of deprivation; no one wants to face Thanksgiving, Christmas, Hanukkah, or any holiday party without being able to enjoy their favorite foods.  The key is having a plan so that you can avoid the annual trap of gaining weight.  Here are a few tips that will help you this holiday season:

  • Keep up your regular physical activity.  Make sure to get in a good workout on the day of the party or event.  NO excuses! 

  •   Eat a small, nutritious snack before leaving for the party.  Sometimes we show up to the party famished.  A small snack will help take the edge off of your appetite and allow you to resist the hors d’oeuvres, saving your calories for the meal.

  •   Watch your alcohol calories – they add up fast!  Alternate alcoholic beverages with non-calorie beverages such as sparkling water.

  •   Look over all the food offerings before you decide what you are going to eat.  If there are foods that you love but know are decadently rich, just sample a tasting portion.

  •   Eat slowly and savor every bite.

  •   Don’t linger around the food table!  Move to another location that is less tempting.

  •   Portion control and moderation are the keys to success (our eyes are always bigger than our stomachs!)

Remember that social gatherings during the holidays are a time to embrace and give thanks for our family and friends.  Spend less time focused on food and more time enjoying the camaraderie of your loved ones.  Holiday time does not need to be synonymous with weight gain.  Make this your year not to gain those few extra pounds that you adamantly proclaim to lose on New Year’s Day.  Happy Holidays!

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