Category Archives: prescription drug

fall means roast in the crock pot to me…you?

It’s rare I go to the grocery store and purchase a several pound piece of meat (i.e. beef, pork, whole chicken, etc.) — it intimidates me. And call me crazy, but I’ve never been a huge fan of touching raw meat…it kinda takes away from my enjoying the final product. But, I like meat and sometimes that means buying and handling large hunks of meat. And I don’t know about you, but something about fall makes me want a roast in the crock pot all day long getting nice and tender. Which lead me to this recipe, and it did not disappoint!

Slow Cooker Char Siu Pork Roast from Cooking Light

1/4 cup low-sodium soy sauce
1/4 cup hoisin sauce
3 Tbsp ketchup
3 Tbsp honey
2 tsp bottled minced garlic
2 tsp grated peeled fresh ginger
1 tsp dark sesame oil
1/2 tsp five-spice powder
2  pounds boneless Boston butt pork roast, trimmed
1/2 cup  fat-free, less-sodium chicken broth

Directions:

Combine first 8 ingredients in a small bowl, stirring well with a whisk. Place in a large zip-top plastic bag. Add pork to bag; seal. Marinate in refrigerator at least 2 hours, turning occasionally.

Place pork and marinade in an electric slow cooker. Cover and cook on low for 8-12 hours.

Remove pork from slow cooker using a slotted spoon; place on a cutting board or work surface. Cover with aluminum foil; keep warm.

Add broth to sauce in slow cooker. Cover and cook on low for 30 minutes or until sauce thickens. Shred pork with 2 forks; serve with sauce. Yield: 8 servings (serving size: 3 ounces pork and 1/4 cup sauce).

Nutrition Information (per serving): 227 calories; 73 mg. cholesterol; 561 mg. sodium; 9.5 g. fat; 12.7 g. carbohydrate; 0.4 g. fiber; 21.6 g. protein

Result: This recipe was easy and delicious! The recipe called for 8 hours of  cooking on low, but I was gone at least 12 hours today and the roast was just fine. It literally FELL apart, no shredding required. I struggled with what to serve with the pork and I landed on fresh bread and an arugula salad…a very simple, flavorful, and easy fall meal. 😀 Mr. P really liked this recipe, too. He compared it to BBQ pulled pork (silly man…) and proceeded to slather about 1/2 cup of BBQ sauce on his meat, but whatever. I found it to be juicy and PLENTY moist and flavorful. Mr. P tends to ruin any flavor with condiments, but I try to refrain from stopping him! I am just glad it wasn’t buffalo wing sauce *eye roll*

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Thank you for all of your kind words about my migraine. I forgot to mention how I called the Walgreens pharmacist MY HERO as he handed over my migraine medicine. Ends up, I didn’t have a script to refill and he found an “emergency dose script” in an old order (???). I’ve never heard of this before, but I wasn’t going to questing anything with that debilitating migraine…it was everything in me not to beg, plead, and cry for the meds. And if I’m being truthful, there were tears…it was THAT bad. BUT, alas, I was a new woman yesterday morning…and I feel great! For anyone who suffers from migraines, you all the empathy in the world coming from me!

My first upper body strength workout went well…but slightly torturous, not going to lie. It was tough, but in a good way. I hope I can keep it up! And in response to a few emails, I am still candy-free!  Thanks for keeping me motivated, folks! 😀

Question: What was your best ever Halloween costume?

I think mine was as a bee in college. I remember “stinging” quite a few young men and having a lot of fun!

P.S. Keep your eyes peeled for some information on my private practice nutrition company! We got some exciting news today and I’m anxious to share…just waiting for our website to launch and then I’ll spill all!! 😀

Have a spoooky day,

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Filed under challenge, condiments, Cooking Light, crock pot, dietitians, dinner, doctors, exercise, healthy cooking, low-carb, physical activity, prescription drug, protein, recipe, salad, work

The Gila Monster

As I’ve battled with insulin resistance and the side effects experienced while taking the diabetic drug, Metformin, I’ve become increasingly interested in the other glucose lowering agents on the market (outside the ones I’m most familiar with in my clinic — Metformin, glyburide, glipizide, Actos, novolog, and Levemir). One drug in particular, Byetta, has piqued my interest.

[source]

Byetta helps the pancreas produce insulin more efficiently in type 2 diabetics. Byetta’s major drawback for consumers is the fact that it is an injectable. Most interestingly, Byetta is derived from the saliva of the gila monster. This poisonous lizard is native to desert regions of Utah, Nevada, New Mexico, California, Arizona, and Mexico. Byetta is FDA-approved and becomingly an increasingly popular glucose control agent in diabetics, for those willing to go the injectable route.

I find this amazing…anyone else? If an endocrinologist recommended I go on Byetta, I would do so. I’ve over-come the fear of giving myself an injection, so why not?

Question: Do you know of any “alternative” medicine treatments, drugs, or cures (i.e. cinnamon for blood sugar control or ginger for nausea)??

Heading back to Tulsa tonight! Busy, busy, busy!!

Amazed by science,

21 Comments

Filed under complimentary and alternative nutrition, diabetes, dietitians, prescription drug, supplements, travel, work

Not so private push-ups

So I had my medication check-up yesterday. For the past month, I have been taking 500 milligrams of Metformin twice daily to help control my insulin resistance from PCOS. Sadly, I have noted little to no change in my blood glucose or my weight (1 pound down – woot! *eye roll*)…

Quick embarrassing story: While I was waiting for the doc to come into the exam room yesterday, I decided to get my push ups out of the way for Heather’s 100 Push-Up Challenge. Yes, doctor’s offices are germ-laden, but I work in a health clinic…nothing there I’m not already exposed to day-in and day-out. As I was on the floor doing my push-ups, my doc walked in. With a medical student. No knock to warn they were entering.They both had a puzzled look on their face and as I climbed up to my feet, blushing, I explained that I was doing push-ups. They thought I was quite committed to be utilizing my wait time so effectively! 😉

Anyway, my doc doubled my dose and I am now prescribed 1,000 milligrams twice daily. While I’m bummed, I understand that I have to do what it takes…and that also means not giving up on weight loss and giving more attention to my eating habits and exercise regimen. What was a tad VERY depressing was the fact that I will likely be on Metformin for the rest of my life. Did I mention I hate taking pills? 😦

On that note, I have FINALLY started my page on PCOS and Insulin Resistance. Check it out! After reading A Patient’s Guide to PCOS, I feel assured that I’m doing so much right…and that I am NOT alone. There are so many PCOS sufferers out there, and I feel so much better about the situation when I tackle it head-on versus throwing pity parties for myself. So yep, check out the info on PCOS. I put a lot of thought into it and hope that it can help other women and PCOS sufferers find answers and comfort.

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And in honor of my hosting BSI this week…another recipe featuring PAPRIKA! This one, I swear, was a surprise! Cooking Light and I were on the same page with paprika this week, apparently!

Smoky Spanish-Style Pan Roast from Cooking Light June 2010

1  pound small red new potatoes, halved
2  tablespoons  olive oil
3/4  teaspoon  salt, divided
1/2  teaspoon  freshly ground black pepper, divided
3/4  pound  unpeeled large shrimp
1/4  pound  Spanish chorizo, thinly sliced
1  pound  green beans, trimmed
4  garlic cloves, chopped
1/2  cup  pilsner beer
1/2  teaspoon  Spanish smoked paprika
2  red bell peppers, cut into thin strips
1/4  cup  fresh flat-leaf parsley leaves

Directions:Preheat oven to 400° F.

Combine potatoes, oil, 1/2 teaspoon salt, and 1/4 teaspoon black pepper in a large roasting pan, tossing well to coat potatoes. Arrange potatoes in a single layer, cut side down, in pan. Bake at 400° for 15 minutes or until potatoes are lightly browned.

While potatoes cook, peel shrimp, leaving tails intact. Devein shrimp, if desired. Set shrimp aside.

Stir chorizo, green beans, garlic, remaining 1/4 teaspoon salt, and remaining 1/4 teaspoon black pepper into pan. Bake at 400° for 10 minutes. Add beer, paprika, and bell pepper, scraping pan to loosen browned bits. Nestle shrimp into vegetable mixture. Bake at 400° for 10 minutes or until potatoes and green beans are tender and shrimp are done. Sprinkle with fresh parsley leaves. Serves 4 (approx. 1 1/2 cups per serving).

Nutrition Information (per serving): 392 calories; 15.5 g. fat (3.8 g. saturated, 8.5 g. monounsaturated, 2.4 g. polyunsaturated);
28 g. protein; 36.6 g. carbohydrate; 7.7 g. fiber; 129 mg. cholesterol; 590 mg. sodium

Result: Again, easy and delicious! I planned this recipe to use the leftover chorizo from last night’s Grilled Salmon with Chorizo and Fingerlings. I will definitely be making it again. The dish was light with a huge punch of beer and paprika flavor…right up my alley!

Don’t Forget!!

I’ve already received several paprika recipes for the Blogger Secret Ingredient Contest! You have until Sunday at 5PM Central Time to submit yours!

Random questoin: What’s something you know a lot about, or would consider yourself an “expert” in? What topic do you wish you knew more about? Doesn’t have to be nutrition, fitness, or health-related at all…just curious!

Have a wonderful day!


41 Comments

Filed under beer, blood glucose, book, carb-controlled, challenge, chronic disease, Cooking Light, diabetes, diet, dietitians, doctors, exercise, healthy cooking, hormones, MUFAs and PUFAs, PCOS, physical activity, physicians, prescription drug, recipe, weight loss

A Day in the Life of an RD

I recieved a lovely email from a reader this week who wanted me to write up a little something on a “Day in the Life of an RD”…so, I did! I get a lot of emails about people pursuing a career in dietetics, or a career change to dietetics, and various questions about the educational and career paths for dietitians…and I am always happy to help! I am passionate about what I do and truly, whole-heartedly LOVE my work. It’s not work if you love what you do, right? 😉

As a little background, I work as a dietitian in an out-patient clinic in a rural community outside of Tulsa. For patient safety and to remain compliant with HIPPA laws, I cannot disclose identifiable information on patients or my place of work. We do have several physicians on staff as well as 8 nurses, 4 pharmacists and pharmacy technicians, 2 dietitians, ultrasound technician, radiology technician, physiologists, ophthalmologists and optometrists, phlebotomists (and a laboratory), as well as per diem podiatrists, endocrinologists, pediatricians, etc. Basically, we are one-stop shop for health care and accept all major medical coverage and insurance.

I work Monday through Thursday, 7am to 5:30pm and for the most part schedule my own patients. If a referral is made for the dietitian, a receptionist books a patient in for a 1-hour appointment. I see primarily diabetic and bariatric patients, as well as those needing diet assistance to manage other conditions such as hyperlipidemia, hypertension, anemia, non-alcoholic fatty liver, metabolic syndrome, gout, renal insufficiency, pre-natal nutrition, and digestive health (i.e. Crohn’s, Celiac disease, etc.). But it is fair to say 80% or more of my time is spent on diabetes and bariatrics. I work on 30-minute slots and bill for medical nutrition therapy in 15-minute increments.

Let me set the scene…

Currently, I am pursuing the Certified Diabetes Educator (CDE) credential. I currently have 445 hours and need 1,000 to sit for the exam. Logging my hours:

This is (part of) the form RD’s use to chart in my clinic. We are making the switch the Electronic Health Records (EHR) in the coming months.

Here is how insulin pens work:

Breakfast at my desk:

My work station:

Lunch at my desk:

Employee Taste Test Sign-Up!

Tuesday went something like this…

7-8am: Check my schedule (no 7:30am appointment – woo!), catch up on emails, eat breakfast at my desk, and finish any charting left from the previous day

8am: New onset type 2 diabetic wanting to control blood glucose through diet and exercise. Full diabetes diet and glucometer education completed. Discussed the role of oral agents to help control diabetes (45 minutes)

9am: Weight management follow-up – patient is trying to lose 40 lbs for her 50th birthday in 5 months – down 9 lbs in 3 months so far (60 minutes)

10:30am: Uncontrolled diabetic on insulin – discussed recommitting after “falling off the wagon” (45 minutes)

11:20am: Uncontrolled type 1 diabetic following up regarding carbohydrate to insulin ratio. Food journals and insulin regimens reviewed, glucometer downloaded to analyze. Recommended no changes in insulin dosing as fasting and post-prandial blood glucose goals were being met (45 minutes)

12:30pm: Surprise appointment! I went out to my car to get my water bottle and a patient asked me in the street to download his glucometer and give him more testing strips. The patient is a controlled type 2 diabetic who I have worked closely with over the course of 9 months to get his blood glucose levels within normal limits. He now journals all of his intake and checks his blood glucose up to 6x a day (45 minutes)

1:15pm: QUICK 5 minute lunch at my desk

1:20pm: Weight management follow-up. Patient lost 4.3 lbs in 2 weeks on a 1,800 calorie diet. Patient is considering bariatric surgery through our clinic (30 minutes)

2pm: Weight management follow-up. Patient lost 3.5 lbs in 2 weeks. Young, disruptive child present at session. Patient goals include meal planning and making food stamps last longer throughout the month (45 minutes)

2:45pm: Patient was rescheduled – he did not bring his glucometer or food journals/pattern management to meeting and therefore no insulin adjustments could be made.

3pm: Follow-up with uncontrolled type 2 diabetic on insulin and strict pattern management. Called patient’s physician and recommended a change in Levemir (long-acting insulin) – verbal order given over the phone (30 minutes)

3:45pm: Follow-up weight management and uncontrolled hypertension; 0.8 lb weight gain in 2 weeks. Patient was seeking advice on diet pills and how to manage “dieting” with unsupportive friends, co-workers, and husband (45 minutes)

4:30pm: Weight management follow-up – I have been seeing this patient for 9 months without significant weight loss, yet she attends all of our appointments and wants to continue coming to RD meetings (30 minutes)

5-5:30pm: Catch-up on charting, returns urgent emails and phone calls, and head home!

WHEW!

There were 14 appointments scheduled on this day – 2 called to cancel, 2 no-showed, and I had 1 walk-in patient.

Likes and Dislikes

I love the critical thinking and intense patient-provider interaction involved in diabetes care. Plus, I do have some of the best patients :). And most of you know I am passionate about diabetes, I love working in diabetes. I hate the early hours…mornings are rough…and the fact that most blogs are blocked at work 😦 And…I can always want more money, right? 😉

There you have it…a Day in the Life of an RD!

Question: What is your current profession? What do you love and hate most about YOUR current role?

Work hard 😉 ,

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Filed under blog topic request, blood glucose, breakfast, chronic disease, diabetes, diet, dietitians, healthy cooking, hypertension, lunch, physicians, prescription drug, Uncategorized, US health care, weight gain, weight loss, weight maintentance, work

A dose of diabetic reality

If you’ve missed my last few posts, I am currently in San Jose, California attending a diabetes conference at the Johnson & Johnson Diabetes Institute.

Today was jam-packed full of new diabetes knowledge encompassing everything from reimbursement guidelines to pharmaceuticals to motivational interviewing to GIVING MYSELF INJECTIONS!!

[Source]

That’s right, I gave myself a saline injection just as a diabetic would do if requiring insulin. I know how to teach injections, but I’ve never given myself one before! RD’s traditionally hold a HANDS-OFF role in health care, but this is rapidly changing. The role of the dietitian is quickly broadening to include much more of what I consider to be the “fun stuff”! 😉

[Fact: Some RD’s in progressive teaching hospitals are inserting naso-gastric tubes in patients — a tube inserted up the nose and down through the esophagus and into the stomach for feeding. How cool!]

If you are an RD or RD-to-be, embrace this increasing span of care. These new responsibilities as medical providers ensure you are a top-notch provider and create more autonomy for your profession! Hello, job security and better reimbursement rates!

Anyways, I digress.

We learned a method of injection called the “Daniel Method”. Basically, you gently place the tip of the needle on the cleaned and sanitized entrance site. You take a deep breath and then look down. More times than not, the needle slides right in. If not, a very light pressure will insert the needle. I was telling my husband about this exercise and for those outside the medical world, it is a little bizzare to think about….30 some medical professionals of all shapes and sizes, lifting their shirts/dresses and injecting themselves with…nothing. It’s amazing to me how many nurses, Nurse Practitioners, and Physician Assistants had never injected themselves! I was not alone! Did it hurt? Not a bit! I didn’t even know the needle went in!

THEN we move on to insulin pumps. Insulin pumps are a great tool for insulin-dependent diabetics (type 1 or 2), most commonly seen in type 1 diabetics (usually appearing in young children when diagnosed). The pump entrance is injected and then adhered to the body with a strong tape. There is very small tubing that leads from the entrance site to a small pump that looks just like a beeper, worn traditionally on the waist band of pants and skirts.

I am the first to admit I know very little about insulin pumps as most of the diabetics I work with are 1) type 2 and avoiding insulin at all costs and 2) poor. Insulin pumps are SPENDY! The one you see in these pictures retails for over $6,000!!!

I thought inserting the insulin pump would be painful. Hello, another needle into my fluffy belly!! Again, wrong. Didn’t feel a thing. It’s hanging out down there and other than carrying the pump with me, I have no reminder of it being there. I worked out with the pump, showered with the pump (water-proof!), and slept with the pump. A change, for sure.

Here is my pale, fluffy tummy and my insulin pump insertion site

When I first inserted the pump, I was mad. Why and how will I be wearing this? Mind you, for the next 24 hours. Can you imagine having one inserted to be with you FOREVER?

Talk about empathy. Empathy I would’ve never felt had I not come to this conference and had this experience. In that moment, I truly understood denial of the disease. And as I type this with sore fingers from testing my blood glucose just 5 times yesterday, I empathize with my patients who test 7 times a day…every day. Because it’s what’s best for their disease management.

Wow, just wow. What an eye-opening, humbling dose of diabetic reality.

And I won’t forget the food… 🙂

The food is all prepared from a diabetic cookbook! Chicken, cucumber and strawberry salad with an orange and cilantro salsa (interesting!), mixed vegetables, and whole grain rice

We also went to a really nice seafood restaurant for dinner in downtown San Jose (Scott’s, for those in the area). The view of the city was BEAUTIFUL and so was the food! Too bad that in this fine establishment we tested our blood glucose at the table…all 30 of us, and then proceeded to carb-count our meals and enter it in to our pump. You know, so we were sure to get enough saline 😉

I need to head off to day #2…and tonight is dinner with Andrea!

Question: Knowing what I just shared, do you think you could give yourself an injection? Or have you given yourself an injection before?

Sugar love,

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Filed under blog, blood glucose, challenge, chronic disease, diabetes, diet, dietitians, dining out, dinner, exercise, low-carb, physicians, prescription drug, self-control, travel, work

Green Monster Success!

😀 TGIF! 😀

I am pouting for a moment because I have to go in for a meeting today! Boo…!!!! 😦

Most of you know I do bi-weekly taste tests for the employees at my work. Employees pay $1 to help cover the expense of groceries and I prepare a healthy recipe to taste along with a copy of the recipe to try at home. I went out on a limb this week and decided to make GREEN MONSTERS! Not gunna lie, I didn’t know how these would go over with our staff…

I used the Designer Whey Protein Powder I won from Heather’s giveaway!

Into the blender went:

pineapple
papaya
banana
blueberries
strawberries
spinach
honey
vanilla whey protein powder (good stuff!)
skim milk

Rainbow of delicious nutrition!

Green Monsters to taste!

Feedback from taste testers:

I had 2 that weren’t fans, but the other 14 were all pleasantly surprised! I think people REALLY enjoyed the green monsters and I think some will even go on to make them at home. I strongly encouraged employees to give the smoothies a shot, despite their “look” and I am really happy with their willingness to step outside the box!

Taste Test…………………….Success! 😀

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Today’s NNM Topic: Nonalcholic Fatty Liver (NAFL)

Simply put, nonalcholic fatty liver disease is the accumulation of fat in the liver in individuals who consume little to no alcohol. Excessive fat accumulation can cause scarring in the liver and lead to liver damage and cirrhosis. There are usually NO signs or symptoms of nonalcoholic fatty liver disease, but fatigue, weight loss, and abdominal pain may present. There are several risk factors for NAFL including obesity, gastric bypass, rapid weight loss, high cholesterol, certain medications, malnutrition, metabolic syndrome, pesticides, type 2 diabetes, malnutrition, and Wilson’s disease. As you can, NAFL is HIGHLY correlated to proper nutrition.

Ways to treat nonalcoholic fatty liver through nutrition include lowering carbohydrate intake (simple carbohydrates, specifically), limiting fats in the diet, specifically saturated and trans fat, weight loss, and a high plant intake including fruits, vegetables, and legumes.

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And lastly….my new favorite snack!!! I RARELY post my daily eats, so you must understand how FABULOUS this snack is!!

They look like roaches or chocolate turtles, don’t they!?

The large date is a Medjool and the smaller dates are Barhi — they are so sweet and creamy!! I’ve heard that they taste like caramel if you freeze them. Must try! So to snack on, just remove the pit and shove a walnut right in! YUMMM!

Question #1: What’s the last snack you ate? Don’t fib!! 🙂

Question #2: Do you like dates? How do you like to eat them? Any favorite varieties?

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Filed under carbohydrates, cholesterol, diabetes, diet, dietitians, fiber, fruits and vegetables, Giveaway, Green Monster, healthy cooking, low-carb, meat consumption, Metabolic Syndrome, MUFAs and PUFAs, National Nutrition Month, prescription drug, protein, recipe, saturated fat, snack, supplements, trans fat, weight loss, work

Oh, the irony! …and a Q&A

John asked a question last week on my Q&A regarding Arborio rice and it’s nutritional benefits. Or lack thereof. Oops. You know, like a kid told not to touch an open flame, I went and made an Arborio recipe (because 24 1/2 years was too long to go without this treat). But I blame Kerstin for this…her recipes are all too enticing! Behold:

Gruyere Risotto with Asparagus and Mushrooms adapted from Cake, Batter, and Bowl

1 tablespoon olive oil
1 1/2 cups 1 large bunch asparagus, chopped
2 cups mushrooms
1 tablespoon butter Smart Balance Light
1 yellow onion, 3 small shallots, chopped (I didn’t have an onion! The shallots were awesome!)
4 garlic cloves, minced
1 cup Arborio rice, dry
4 cups low-sodium chicken stock
1 1/2 cups shredded Gruyere cheese (approx. 7 ounces)
2 tablespoons 1/4 cup lemon juice (juice from one lemon)
1 1/2 teaspoon salt
1/4 cup freshly grated Parmesan cheese

Directions:

Heat olive oil over medium high heat in a large pan and sauté asparagus and mushrooms until tender, about 8 to 10 minutes. Remove from heat.

Meanwhile, melt butter over medium high heat in a large stockpot. Sauté the onion for 5 to 7 minutes or until tender; add garlic and sauté for an additional minute. Add the rice and stir until well-coated and translucent. Reduce heat to medium and stir in 1 cup of chicken stock. Simmer, stirring occasionally, until the stock has been absorbed; add another cup and continue in this way until all the chicken stock has been absorbed, for about 30 minutes. Stir in gruyere cheese, lemon juice, and salt and simmer an additional 5 minutes or until desired consistency is reached. Stir in asparagus and mushrooms. Scoop into bowls and sprinkle Parmesan cheese on top. Makes 5 servings.

Nutrition Information (1/5th of recipe): 382 calories, 18 g. fat, 40 mg. cholesterol; 610 mg. sodium; 33 g. carbohydrate; 1.4 g. fiber, 19.2 g. protein per serving

Ok, sure…not the best stats, but this recipe is a W-O-W recipe! You know, the kind you make for a special someone you’re trying to impress…or when your in-laws come to town (my in-laws read my blog AND they’re amazing, so this doesn’t apply to me, of course!). At least it has vegetables!? But yeah, Gruyere doesn’t come in a low-fat version to my knowledge 😉 But MAN, it is GOOD! My husband was so sweet to me tonight. I got a, “Thanks for making dinner, babe! It tastes really Italian.”

::blink blink:: Thumbs upppppppppp!

And on to the brief (but good!) Q&A for the week…

…Or possible known as the once-a-week, really long, exhaustively detailed posts!

Biz of Biggest Diabetic Loser: If I know I am going to have a hard workout, I tend to give myself a bit less insulin at breakfast so my blood sugar doesn’t crash and burn. Take today for instance – I was 180 before working out, and when I got back it was a perfect 102.  I then took the right amount of insulin for my lunch. Do you think having that “temporary” high will hurt me in the long run? My blood sugar numbers on average for 30 days are between 116 and 125.

Prevention RD: For those of you who don’t know Biz, she is a type 1 diabetic and author of the wonderful blog, Biggest Diabetic Loser. I feel comfortable answering this because I know your HbA1c is just below 7.0% — my answer would vary for someone with a higher HbA1c. I think that if this is working for you, you’re fine to continue with this regimen (especially if you’re on an insulin pump, which I’m not sure if you are or not…). The one option you have is to take a ligher dose of insulin with breakfast – bolus for maybe half the carbs you consume with whatever carb:insulin ratio you use and exercise with a G2/water or water/juice mix and drink that throughout your workout. This would have you starting your workout closer to a 120-140 mg/dl reading (I wouldn’t recommend below 120 to start in case you don’t intake enough and risk bottoming out) and fueling your blood glucose as the exercise works to decrease the glucose, hypothetically keeping you right in the 100-130 range throughout the duration of your exercise. If you decide to take this approach, I would certainly have your monitor nearby and come prepared – glucose tabs, honey or whatever agent you use in emergency hypoglycemic instances. I do feel there could be some benefit in your HbA1c if you’re able to prevention missing any insulin doses in light of working out. It may take some trial and error to work out any kinks, but it can be done! The key with type 1 diabetes and exercise is consistency. I say it all the time – diabetics know their bodies better than ANYONE else…even the best of doctors and endocrinologists out there. I hope this makes sense and keep me posted – I want to know what you decide to try out, if anything! Awesome make-Nicole-think question! P.S. I ran this past both our Diabetes Nurse and one of the doctors on staff today, and they agreed! 🙂

Molly: I’ve been meaning to ask this question for quite some time.  I’d say I live a healthy life style; working out regularly and watching what I eat.  I try to eat  as balanced of a diet as I can, getting the right amount of good fats, proteins and carbohydrates.  But one thing that will ALWAYS be hard for me to control is my love for salt.  I definitely love salty over sweet and almost always salt my food (even if it doesn’t need it).  What I try and do to compensate for my love of salt is drink A LOT of water…I mean a lot.  I feel as though this will some how help or “reverse” the effects.  Is it crazy for me to think that or is there actually some logic behind it?

Prevention RD: Hey Molly! Good question! I have to put in my plug on the importance of a low-sodium diet. Salt is a hard habit to kick, so don’t wait until you’re any more set in your ways to change! The majority of the salt we ingest is present in our food through the processing it undergoes, so any additional salt to our diet is likely too much. Excessive salt intake can cause serious electrolyte imbalances, water retention, and hypertension – also known as “the silent killer”. Having high blood pressure puts undue strain on every vessel in our bodies and over time, this can cause serious internal damage and lead to strokes and cardiovascular disease. While I am catastrophizing (not a word…) some, it is a serious matter. Make sure you get your blood pressure checked regularly and exercise is definitely a huge help! How much water are you drinking? Large loads of sodium can off-set the sodium balance of the body and thirst does increase when this balance is off. If your high water intake is habitual that sounds fine, but if your thirst seems excessive, this could indicate a sodium in balance in the body. If this is the case, I would look to decrease your salt usage even more so. Another thing to consider is increasing your intake of potassium; potassium and sodium work together in the body to carry impulses through the body which are vital for proper health. Using less processed foods and cooking from scratch can help lower the salt in your diet without changing the content too much. But as far as water actually flushing out all the sodium, this isn’t really the case. Water can help ease the effects of bloating, but it doesn’t reverse salt intake. Sorry! Great question!!

Anonymous: I’ve read a lot about agave nectar being just as bad as sugar – is this true?

Prevention RD: I’m sure you’ve seen this claim a lot – it’s all over right now! Agave is the natural sweetener that comes from the same Mexican plant used to make tequila! Agave has similar calorie and carbohydrate content to sugar, however agave is three times sweeter and thus requires less to achieve the same sweetness. Agave can be up to 90% fructose – the natural sugar found in fruits which has a lower glycemic index than sugar itself. While agave nectar is a tasty, all-natural sweetener, it is still a high-calorie sweetener that should be used in moderation. Until we find a 100% all-natural, organic, calorie-free, perfectly safe sweetener, we will be able to find a problem with any other sweetener for one reason or another! People hear that something is “good” or “healthy” and they take that to mean more is better, and that’s just not the case. Really great question!

Alison of Waisting Duxie: I am trying to conceive. Can I get too much folic acid? Most supplements are 800 mcg, the supplement that I am taking to lengthen my luteal phase (gotta love pre-menopausal in my mid 30s) has 200 mg and I’m supposed to take it 3 times a day, BUT I often forget.  Is it better to take the 800 one in the morning when I know I won’t forget and then maybe get 400 more over the day? How much does a typical diet high in dark leafy green veggies add and ultimately is this one of those vitamins you can overdo.

Prevention RD: The “tolerable upper limit” for folate is 1000 micrograms a day, though risk for toxicity is low. Because so many foods in the US food supply are fortified and enriched, most Americans meet the 400 mcg recommended daily value. What I am unable to locate is any folic acid recommendations to lengthening of your luteal phase. Best as I can tell and rationalize, you shouldn’t need additional folic acid and 800 mcg’s should be more than sufficient. I would not recommend taking over 1,000 mcg’s a day as this exceeds the upper limit. Check with your doctor regarding the 3 doses a day. Other than better chances of absorption, I don’t know of any other rationale for the frequent dosing, but I’m not a MD! I hope this helps – really interesting question! And congrats to you in starting a family! 😀

Happppppppppy Hump Day! Half way there, folks!

Question #1: What vitamins, minerals, or other supplements do you take?

Question #2: What’s your take on agave nectar? Like? Dislike? Healthy? Not-so-healthy?

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