From mcpress.mayoclinic.org/diabetes
One in three Americans has a pre-diabetes diagnosis — and about 12 percent of the US population has some form of diabetes. What can be done to prevent it? Is it reversible? And are there any home remedies — like cinnamon?
On this episode of On Nutrition, we talk with registered dietitian and Certified Diabetes Care and Education Specialist Gina Wimmer about how people with diabetes and pre-diabetes can eat well and live well, despite their diagnosis.
Tara Schmidt: This is “On Nutrition,” a podcast from Mayo Clinic where we dig into the latest nutrition trends and research to help you understand what’s health and what’s hype. I’m Tara Schmidt, a registered dietician with Mayo Clinic in Rochester, Minnesota. In this episode, diabetes. But first we’ve got a listener question.
Leeya: Hey, Tara. My name is Leeya and I have a question about chia seeds. What are they? Why are they such a big deal? My sister had them in her pantry at her house, and the packaging looks healthy. Then I got a bag the next time I went grocery shopping, and I just put it on my yogurt and my oatmeal. But I just don’t know why. Why are they important? Are they important, and am I doing this right? Let me know. Thanks.
Tara Schmidt: Hey, Leeya. Remember Chia Pet, the terracotta pots shaped like animals or TV characters that could grow into plants with hair? Those seeds are closely related to what we’re talking about, except they’re not approved for consumption. The kind you buy at the grocery store can be added to your water smoothies, granola, oatmeal or yogurt. They’re absolutely nutritious and can add a fun texture to your dishes. A chia gel, the seeds mixed with water that they then soak up, can also be used as an egg substitute. In baking, nutritionally, they contain magnesium, fibre, Omega-3 fatty acids and even count as a complete protein. Sprinkle away and enjoy. A serving is about two tablespoons...
Now, onto the show. About 12 percent of the US population has some form of diabetes, with 1.2 million more people getting diagnosed each year. The risk of developing diabetes increases as you age too, especially combined with other elements like lifestyle and pregnancy.
What can we do to prevent it? Is it reversible? Does a diabetes diagnosis mean you need to cut out sugar? Completely. Here to explain is my colleague Gina Wimmer, a registered dietician and certified diabetes care and education specialist at Mayo Clinic in Rochester, Minnesota.
Gina counsels people with diabetes and prediabetes on how to eat well and live well, even with their diagnosis. Hi, Gina. Thank you for being with me today on the podcast.
Gina Wimmer: Thanks, Tara. I’m excited to be here.
Tara Schmidt: Well, we have lots to learn about, starting with, most people thinking that there is just Type 1 diabetes and Type 2, but there are actually quite a few types. Can you explain the differences between them?
Gina Wimmer: Like Type 2 diabetes, that’s the most common, right? Ninety to 95 percent of the population that has diabetes has Type 2. The majority of the individuals that have diabetes have Type 2 diabetes, and that pre-diabetes would lead into Type 2 diabetes. Type 1diabetes, that’s more than autoimmune.
Type 1 is going to be found in about 5 to 10 percent of the population. Now we’re seeing it more in adults and there’s another classification within that Type 1 that’s called LADA, and that stands for Latent Autoimmune Diabetes in Adults, and you might even hear that classified as Diabetes 1.5.
But that really classified under that Type 1 diabetes because eventually, they’re going to have to be on insulin completely. The other types would be gestational diabetes, so in pregnant women, they will be screened for gestational diabetes around 24 to 28 weeks.
Gestational diabetes occurs in two to 10 percent of pregnancies in the US annually. Again, much smaller, right? I’m going in descending order. The next classification is just like other diabetes. You’re going to see diabetes called monogenic diabetes syndrome, or a disease of the pancreas, or drug or chemical-induced diabetes. That’s more like one to maybe five percent.
Tara Schmidt: Let’s talk about risk, because sometimes I think with diabetes, people get blamed, like they caused it by some of their lifestyle choices. We’re absolutely going to talk about lifestyle today, I’m sure. But let’s talk about some of the risk factors in even things like genetics.
Gina Wimmer: If we start with Type 1, a first degree relative is going to put you at greater risk for developing type 1 diabetes. There’s no way for Type 1 right now, that we know of, to prevent it from happening. Type 2 is going to be genetic. If you have a family member you could be at greater risk. If you were above a certain body weight at birth, you’re going to be at greater risk.
Tara Schmidt: Even at birth, like big babies.
Gina Wimmer: Big babies. Yeah.
Tara Schmidt: Wow.
Gina Wimmer: Then you’re going to look at lifestyle too. As far as eating habits, physical activity is where the weight is. Then with gestational, that’s really age. Gestational, 25 years or older, puts you at risk.
Tara Schmidt: Oh my gosh. We’re supposed to be younger than that.
Gina Wimmer: The history of you yourself having gestational diabetes, or family members having diabetes, puts you at a little greater risk. Excessive weight, either going into pregnancy or throughout pregnancy.
You’ve gained a lot of weight during pregnancy, and then race as well has a higher risk factor, so certain races. Genetics can play a role in all types of diabetes, whereas environment is more so a factor in Type 2 and gestational. I would say it’s more of African-American, Native-American and the Asian population that tends to be at a little greater risk.
Tara Schmidt: Okay. What are the symptoms that indicate someone may be developing diabetes?
Gina Wimmer: About that frequent urination. That can go either with Type 1 or Type 2, but with Type 2 it’s going to be more, you’re getting up a few times during the night, whereas Type 1, they’re going to be possibly wetting the bed because it’s just going to be so frequent for them.
Thirst. The older we get, we start to lose that sensation of thirst, but they might find that they’re thirsty. A little bit more often. Hunger. We’re hungry more often. Again, probably a little bit more with a Type 1. I’m eating, I’m eating, I’m eating, but I’m losing weight here.
Because we see that a lot more common with Type 1, but I can still see it with Type 2s as well. Again, it depends on how long they’ve had diabetes, because that’s the thing, like with Type 2, it can go a long time without us really knowing that blurred vision, irritability, that unintentional weight loss.
All of those things can go together. Even with gestational diabetes, we really emphasize those individuals. It’s not like you woke up and you were feeling any different. Now that you have gestational diabetes, they feel no different at all.
Tara Schmidt: You already feel like crap, you’re pregnant, we don’t need any more symptoms added to the list, or you’re glowing, and I’m point in time, but then you’re just starting to get bigger. Right?
Gina Wimmer: I would say if you have any of these symptoms, you should probably have them checked out sooner rather than later.
Tara Schmidt: What about any signs or symptoms of Type 2 diabetes? Would the lay person know this without getting their blood checked?
Gina Wimmer: Again, even with them, we might see some of those signs or symptoms, but they’re much more mild than what we would see with a Type 1 diagnosis. That frequent urination, maybe some fatigue. Maybe they had a cut and it’s not healing quite like they had experienced in the past. Those might be signs and symptoms.
Tara Schmidt: There’s a lot of numbers when it comes to diabetes. Let’s start with blood sugar. What this is when someone either pricks their finger, or maybe they’re wearing a pump, they’re looking at a single point in time. What is your blood sugar right now? Is that accurate to say?
Gina Wimmer: It’s what your blood glucose, blood sugar level is at a certain point in time. Also interestingly, if you know you’re going to take an intravenous, you go to the lab and they’re going to draw your blood out. That number is going to be slightly different than a finger poke.
Tara Schmidt: I knew that. Then when we talk about A1C, we might hear A1C haemoglobin, A1C glycosylated haemoglobin. Did I say that correctly?
Gina Wimmer: Yeah.
Tara Schmidt: That is a longer term snapshot of your blood sugar averages.
Gina Wimmer: Yes, for sure. It’s going to give us a better picture of what those blood sugars have been like over the last two to three months.
Tara Schmidt: Is that how you would truly diagnose someone? We’re diagnosing people based on an A1C, not on a one-time blood sugar reading.
Gina Wimmer: Actually both. You could diagnose somebody with a one-time blood sugar. Normal blood sugar is going to be 70 to 100. If you are 100 to 125, that puts you in the pre-diabetes classification. If you’re 126 or higher, that puts you into a diabetes classification.
But oftentimes, what I see anyway is if someone has an elevated blood sugar, oftentimes the doctor is going to draw an A1C just to really get a better idea as far as what that blood sugar’s been like over the last two to three months.
Tara Schmidt: Right, it’s all about a longer-term trend. A blood sugar of 126 or higher after two separate times is going to be classified as diabetes. But before it reaches that point, let’s talk about pre-diabetes because it’s a fairly common diagnosis. It can also be pretty scary for people.
Let’s talk about pre-diabetes because I feel like it’s a fairly common diagnosis. It can also be pretty scary for people.
They hear the word diabetes in there they jump to thinking about insulin or pricking in their finger, etcetera. So how do you describe pre-diabetes to someone? Is it reversible?
Gina Wimmer: In that pre-diabetes phase it depends on how old they are. Because when we’re seeing that the older they are, we don’t have as many years maybe for that to progress. If they’re younger, then we have a lot of years for that to progress.
But again, the more changes that we can make, the better. Certainly chatting with them about their diets or food choices. Can we improve those? Can we be a little bit more physically active? How can we push that actual diagnosis of diabetes off as long as we can?
Tara Schmidt: If I have a pre-diabetic A1C and I do my lifestyle changes. If I have excess weight, maybe I lose it. I turn my exercise up, I get my dieting gear, and my next A1C is in the normal range, I can delete pre-diabetes off of my diagnosis list, or do I always have that around?
Gina Wimmer: You probably always have that hanging over your head.
Tara Schmidt: As a risk?
Gina Wimmer: Yeah. More of a risk.
Tara Schmidt: It’s almost like a remission. Let’s talk about how the body reacts to low blood sugar, especially when someone has diabetes. What does that look like? What are their symptoms?
Gina Wimmer: A low blood sugar is going to be less than 70 milligrams per decilitre. Again, if they’re checking their blood sugar, if they have a continuous glucose monitor that they’re looking at that we do oftentimes if they have, I’m going to call that a CGM, Continuous Glucose Monitor, we’re going to ask them to do a finger poke, because that continuous glucose monitor is going to be a little more delayed than a finger poke.
Finger Pokes are going to be a little bit more real time for them. Those symptoms that individuals are initially going to experience could be sweating, shakiness, weakness, fatigue. Other more severe symptoms could be headache, hunger, slurred speech, drunken behaviour, and even unconsciousness.
Tara Schmidt: But again, we’re going to see that more with individuals that are taking insulin for their diabetes. Is there a relationship between diabetes and the brain?
Gina Wimmer: Diabetes can damage or affect those blood vessels in the brain, and so it can cause a stroke. This can lead to problems with memory and learning, mood shifts, weight gain, hormonal changes. Over time it can lead to other serious problems like Alzheimer’s disease. Both high and low blood sugars can cause these issues.
That’s why it’s important for people with diabetes to keep their blood sugar within a healthy range.
Tara Schmidt: You’re talking more about the extremes of highs and lows, not our normal daily fluctuations.
Gina Wimmer: Exactly.
Tara Schmidt: When we compare those fluctuations in people without diabetes versus people with diabetes, is it more so the risk or is it more so a wider range? How does blood sugar fluctuation differ in someone with and without diabetes?
Gina Wimmer: For everyone. Carbohydrate is that first source of energy. It’s our brain food, right? It’s going to be that first thing that turns into sugar in the bloodstream. It then moves into the cells with the help of insulin. A lot of times we talk about insulin as the key to help glucose get into your cells.
In individuals with diabetes, their body does not produce enough insulin. Like Type 1, they don’t produce any insulin. The sugar then remains in the bloodstream. That’s why we see those higher blood sugars.
Tara Schmidt: Now, one of my personal goals for our time together is to make sure that people are not fearful of carbohydrates because yes, they cause the blood sugar to rise, but we’re not talking just about candy bars and cupcakes. Some carbs, especially those that are rich in fibre, can actually help balance our blood sugar. What are some sources of healthy carbs?
Gina Wimmer: That’s unfortunately sometimes when I see patients, they’re like, “Ugh, I eat carbohydrates, and my blood sugar’s going to go up. So I’ve just stopped eating carbohydrates.” Well, we can’t survive off of not eating carbohydrates.
But yes, there’s so many healthy carbohydrates and, those good healthy carbohydrates, they’re going to have a little bit more fibre in ‘em. Things like those whole grains, even like rice. Brown rice instead of your white rice, or maybe wild rice is going to be a better choice for you.
Whole wheat pasta. Cereals. Your bran, your oats, your wheat, those are all really great. Even those black beans, pinto beans, garbanzo beans, are all really healthy. They’re a source of protein. They’re going to have some carbohydrates, but they’re also a great source of fibre that’s really good too. Those starchy vegetables.
There are those few vegetables that tend to be starchy like corn, peas, potatoes, winter squash. Again, I don’t tell people they can’t eat them. Incorporate them in smaller amounts. Eat the skin on your potato. That’s where all the fibre is. Fruit wise, any of your whole fruits I’m going to definitely encourage. A lot of times people have some misconceptions with fruit.
“Oh, I can’t eat this fruit because it’s going to affect my blood sugar.” Well, all fruit will affect your blood sugar. Again, it’s the portion size, the quantity. I’m not a huge fan of fruit juice just because there’s no fibre in there. I’d rather individuals eat the whole fruit. Then, even like milk, sometimes milk gets a bad wrap. Milk is going to have carbohydrates in its lactose.
That natural sugar that we find in milk is good for you. Trying to choose low fat versus the whole milk though again, the fat content is what’s different. Then we think about your yogurt. That’s Greek yogurt. It’s going to have some protein, some healthy carbohydrates in it. Again, trying to be mindful about that fibre that we find in those foods. A lot of those carbohydrate-rich foods are really good and healthy for us.
Tara Schmidt: Pairing those carbohydrate-rich foods with sources of other nutrients like protein, or with a little fat, or with fibre like you’ve mentioned, and not just having a bowl of cereal.
Gina Wimmer: Right? Exactly.
Tara Schmidt: Let’s talk about how fibre plays a role. When I’m eating a carbohydrate with or one without fiber, how would that change the impact on my blood sugar?
Gina Wimmer: Foods that have a higher fibre content take longer to digest. You’re going to see more of a gradual rise in the blood sugar than a food item that has no fibre in it. You might see a really sharp peak with that. Thinking like rice, right?
A lot of times people are like “white rice.” It just shoots my blood sugars right up there and yeah, it can. Because it’s very low in dietary fibre.
Tara Schmidt: ‘Carbs, especially the ones that aren’t as rich in nutrients, can increase blood sugar levels. Do other macronutrients like protein or fat also cause the blood sugar to rise?
Gina Wimmer: Yeah. It is mainly that carbohydrate. It’s not to say that protein doesn’t affect blood sugars because yeah, there’s probably about 40 to 50, maybe even 60 percent of that turns into sugar in the digestion process, but it takes a lot longer.
When we think about fats, a high fat diet, fats don’t turn into sugar, but fats slow that digestion process down. That’s why for some individuals, especially if they’re taking insulin, trying to match that insulin with their rise in carbohydrates sometimes can be very challenging if they’re eating a high fat diet.
Tara Schmidt: I’m hearing this is a simple factor of time right after a meal, your blood sugar will gradually get back into the normal range. I’m hearing this may be a factor of insulin that you’ve given yourself or insulin that your own pancreas is making. The other one I thought of was exercise, can exercise help to decrease your blood sugar?
Gina Wimmer: Yeah, definitely, definitely. Exercise can be as impactful or helpful for the blood sugars as a medication. But individuals that take insulin or other medications that can lower their blood sugar, they might want to be a little bit more mindful about what they’re doing.
Again, if it’s a planned activity, we can take steps prior to that to prevent that low from happening. But if it’s an unexpected one, then we might need to eat a little carbohydrate so we don’t have that low.
Tara Schmidt: There are multiple kinds of diabetes, and Type 2 is the most common. It’s when the body cells resist the normally effective insulin that your pancreas makes causing a build-up of glucose or blood sugar. Then there’s Type 1, which is an autoimmune disease that’s usually identified in childhood though a small number of people have a form called LADA, Latent Autoimmune Diabetes in adults or Type 1.5.
Gestational Diabetes can happen during pregnancy and can develop into Type 2 later in life. Then there’s Pre-Diabetes, a diagnosis, which can also lead to Type 2. While lifestyle and environment are a factor, a lot of it’s just due to genetics.
What is in your control? Your blood sugar is indicated by your A1C levels. That’s a snapshot of the last two to three months. Carbs cause blood sugar to rise, but fiber can slow the rise and balance it out. Fibre-rich carbohydrates are your best friends. Try to target whole grains, fruits, vegetables, and beans, and exercise can be just as effective as medication at lowering blood sugar.
Why does blood sugar matter for people with diabetes in the short term, having a low episode can cause shakiness, sweating and fatigue, but long-term, big fluctuations in blood sugar can lead to stroke, memory loss, and Alzheimer’s disease. Now let’s talk about managing blood sugar and the nuances of living with a diabetes diagnosis. Gina, will you play true or false with me?
Gina Wimmer: Definitely.
Tara Schmidt: Let’s do it. Okay. Number one, eating too many sweets can eventually cause diabetes.
Gina Wimmer: False. Eating too many sweets does not cause diabetes, although eating too many sweets could cause weight gain and weight gain could lead to pre-diabetes to Type 2 diabetes. They don’t need to avoid sugar, but they need to be mindful about quantity and portion size.
Tara Schmidt: Maybe limit is the more appropriate word than avoid. Okay. People with diabetes cannot drink alcohol.
Gina Wimmer: False. They can drink alcohol. With a Type 1 they are a little greater risk of having a low blood sugar with alcohol. The perfect storm would be, “Oh, I had lunch and now it’s five O’clock. Dinner’s not ‘til seven. I’m going to have a few drinks.” That alcohol could cause the liver, which is always producing a little bit of sugar, to stop doing that, and that’s where that dip and blood sugar could happen.
As far as everyone else, it’s going to be the same recommendation that we would give to anyone, so no more than one drink per day for women and no more than one drink per day for men after the age of 65, and no more than two drinks prior to that.
Tara Schmidt: Let’s talk about why alcohol is an issue for people with Type 1. Because when your liver’s metabolizing the alcohol, it’s focused on, “Hey, we have a toxin here. We have to do something about that.” It’s not really doing its normal side job of helping you to manage your blood sugar. Blood sugar could go down.
That’s even more confusing because some of the symptoms of having an extremely low or even extremely high blood sugar can look similar to symptoms of intoxication.
Gina Wimmer: Right. It’s probably more of that low, I would say more often than not. I often tell individuals, “Okay, if you’re going to go out for drinks, make sure who you are with knows that you have diabetes.”
Tara Schmidt: Yes, and eat. Eat a piece of pizza before.
Gina Wimmer: Yes.
Tara Schmidt: Go get a burrito like a normal college kid. True or false? Type 2 diabetes…
Gina Wimmer: Is reversible. There is no cure for Type 2 diabetes, but individuals can have remission of diabetes by managing lifestyle, losing weight. But this is very individualized, so I can’t say everybody can go into remission. I would say it’s less common than common.
Tara Schmidt: Okay. But with pre-diabetes…
Gina Wimmer: There’s a little bit more of a chance there.
Tara Schmidt: True or false. We might have answered this one. Increasing fibre intake can.
Gina Wimmer: Definitely. It can. It takes longer for that fibre to digest, as I mentioned before. Fibre can help to balance those blood sugars. The recommended amount of fibre is 14 grams for every thousand calories. If you’re consuming a 2,000 calorie diet, then you need 28 grams.
Tara Schmidt: Yes, everyone needs more fibre. Even a cup of oatmeal with three fourth cups of raspberries can make a difference. Alright, and last one, true or false? People with diabetes should stay away from white food like potatoes or rice.
Gina Wimmer: No. That is false.
Tara Schmidt: No mushrooms, you guys? Come on!
Gina Wimmer: Avoiding certain food types will not control your blood sugar. Many foods have carbohydrates. Chances are that you’ll eat some of those during your typical day, some type of carbohydrate, This is okay. Regardless of the type of carbohydrate, when you choose healthy foods and eat them in proper serving sizes at consistent times, you’re doing the best to control your blood sugars.
There are many healthy foods as you mentioned, mushrooms, cauliflower, parsnips, tofu, yogurt. Oversimplifying recommendations with restraints like colour is just not a really good idea.
Tara Schmidt: Yeah. It’s oversimplifying it, just like you said, we have an argument for all of the oversimplifications of the nutrition world. Let’s talk about the rule of 15. This is something that I have taught people to use to treat a low blood sugar or to treat hypoglycaemia. Do you want to walk us through it?
Gina Wimmer: Sure, sure. The ‘Rule of 15” is you check your blood sugar, you’re low, so you’re going to treat it with 15 grams of carbohydrates. What that would look like is four ounces of juice. This is one time I’m a proponent of juice.
Tara Schmidt: We’re okay with juice right now. You’re low.
Gina Wimmer: Or it might be 15 of those little teeny tiny jelly beans or Skittles. But that’s a lot to chew. Our preferred method is glucose tablets. You can buy those at the drugstore. You don’t need a prescription to buy them, but one tablet is only four grams of carbohydrates, so you really need four of them to treat low blood sugar.
You’re going to wait 15 minutes and then check blood sugars again. We want to see those blood sugars coming up. They’re not in your goal range. Then we might have you treat again and again, do the whole treatment of 15 minutes, wait and check.
Tara Schmidt: What I describe to people is like a stare motion of we’re treating, we’re waiting and checking, we’re treating, we’re waiting, and we’re checking. Because sometimes people panic, and it absolutely is understandable to do this, if I feel like crap, or I believe that my blood sugar is low.
Let me eat a sandwich. Let me chug a soda. Again with the right intentions. But now we’ve gone from too low to too high, and then when things do start to kick in, we’re crashing back down again. Now instead of this nice, “I’m walking up the stairs,” we’ve had, “I’ve gone up the mountain and now I’m sliding back out.”
Gina Wimmer: I will always tell people, “don’t treat with a candy bar. There’s too much fat in that. It’s going to take too long for those blood sugars to come up.” But we also talk about if that low blood sugar is happening in the middle of the night, we might say double treat.
In other words, instead of 15, take 30 grams because it’s just going to get you to that point quicker so you’re not up for an hour treating a little more.
Tara Schmidt: Mm-hmm. But again, these are people who have verified with a glucometer or by testing their blood sugar that they are truly low. They’re not just going by feeling necessarily, unless you’re a seasoned person with diabetes.
Gina Wimmer: Even that, the longer you’ve had diabetes and the longer you’ve had low blood sugar, your sensitivity decreases over time.
Tara Schmidt: Hmm. Okay. Let’s talk about some non-nutritional factors and the impact on blood sugar. ‘Cause I think we talk a lot about carbs, and of course we talk about exercise, but I also hear about things like illness and stress. How might that impact?
Gina Wimmer: Stress, heat, and humidity. Our sleep, if we’re not sleeping well, hydration, illness, infections can all affect the blood sugars. However, they do not affect everyone the same way and are harder to predict an individual’s response. It’s not like we say, “Oh, for stress you need to do this.”
Or if you’re outside in the heat and humidity, you need to do that. You have to figure yourself out and treat each instance separately.
Tara Schmidt: Who is it most important to have really tight control of blood sugar, pregnant women? I don’t know if I would’ve said that. Excellent. Tell us how that uncontrolled blood sugar may impact both mom and foetus.
Gina Wimmer: With individuals with diabetes, either if they have diabetes they have Type 1 and they get pregnant, we’re pretty picky about where we want those blood sugars to be. We want those blood sugars in the goal range. An individual with Type 1 wants 70 to a hundred.
We want them normal, with gestational we’re going to say we want fasting below 95 and then two hours after they eat one 20 or below. Our concerns are that the baby is going to get too big. Having blood sugars not in control can also cause hypertension in pregnancy and a greater risk for individuals that have had gestational diabetes in the future, to have another pregnancy with gestational diabetes, but also for later in life to potentially have the diagnosis of Type 2 diabetes.
Maybe a preterm birth, so the baby might be delivered earlier. There’s certainly concerns, but when we talk to individuals with gestational diabetes in particular, we’re just talking about, let’s just try to get those blood sugars in control as much as possible.
They’re going to be contacting their OB very often with what those blood sugars are. If they’re out of range, then we might have to add some medication and most likely that’s going to be insulin.
Tara Schmidt: There’s no one more motivated than a pregnant person because they’re in control of their health, but also their new little human’s health. We find those patients to say, “I’ll do whatever you tell me.” They’re awesome patients. The risk of developing Type 2 diabetes increases with age. Once we hit 45 and older, is there a bump there?
Gina Wimmer: Yeah. Actually the diabetes standards of care, they come out every year. The 2025 ones.
Tara Schmidt: Oh gosh, I feel old. We’re supposed to have babies before we’re 25. I’m at risk of diabetes. I’m 35. My life is over.
Gina Wimmer: No, Tara, it’s not.
Tara Schmidt: What scares people a lot with uncontrolled diabetes is the risk of complications, and I start to think of loss of eyesight and nerve damage in your feet. How do those complications happen?
Gina Wimmer: When we think about those complications that can happen, you’re totally right. You know, we think about those major organs, so we think about our eyes, we think about our heart, we think about our kidneys, we think about our feet. That can affect that for individuals having high blood sugars over a longer period of time and put them more at risk.
Again, it’s that macro and microvascular. The vessels in our bodies, higher blood sugars can affect those.
Tara Schmidt: Continuous or extended high blood sugar is damaging the blood vessels. How can we prevent the worst case scenario?
Gina Wimmer: Things that we can do to help with that is certainly managing those blood sugars as best we can. Again, long-term health. Thinking about tracking blood sugars can be helpful. Taking medications if they’re prescribed. Think about eating a healthy diet, trying to achieve or maintain a healthy body weight, getting that regular physical activity, stop smoking if you’re a smoker and see that provider on a regular basis.
Tara Schmidt: Cardiologist, go see that person and you’re doing foot checks.
Gina Wimmer: Definitely.
Tara Schmidt: Diabetes is on the list of what are the leading causes of death in the US, but I’m not sure we see it the same as if you died from a heart attack or you unfortunately died from a motor vehicle accident. What’s the correlation there? Why is diabetes on the list?
Gina Wimmer: It’s often due to that uncontrolled diabetes that we just talked about. Because of the damage it can do to those blood vessels. Because that increases our risk for cardiovascular disease, stroke, and kidney disease.
It’s almost interrelated there. Individuals with diabetes are twice as likely to have a stroke as someone that doesn’t.
Tara Schmidt: Okay, so they’re leading to some of the causes of death that are higher up on the list potentially. Let’s clear the air. You don’t need to avoid sugar to avoid diabetes, though eating a lot of sweets can lead to weight gain, which is a factor in pre-diabetes and Type 2.
People with diabetes can drink alcohol, though it could cause a dip in blood sugar for people with Type 1. The best practice for people with Type 1 is to eat beforehand and tell your drinking buddies what to look for if you have low blood sugar.
Unfortunately, Type 2 diabetes is not reversible, but it is possible for some people to go into remission with weight loss, diet and exercise. Contrary to popular belief, white food is not the enemy. People with diabetes can eat plenty of quote unquote white foods like mushrooms, yogurt, and parsnips.
But of course, processed foods like white bread and foods with added sugar should probably be swapped out for something more nutrient-dense.
Again, the most important factor is blood sugar. If you have diabetes and experience low blood sugar, apply the rule of 15, 15 grams of carbs like juice, glucose tabs, or some easy to eat candy and check again after 15 minutes. If it’s nighttime, eat 30 grams of carbs so you don’t have to keep waking up to check.
Because higher blood sugar damages blood vessels. Uncontrolled diabetes can lead to complications like loss of eyesight and nerve damage. It can also be linked to cardiovascular disease, stroke and kidney disease, but you can prevent those extreme scenarios by not smoking, taking your medications, and seeing your provider regularly.
Remember, diabetes is not a death sentence. There are plenty of medications and treatment pathways out there. Let’s get into how to live a lovely life despite a diagnosis.
When someone enters your office with a new diagnosis of diabetes, what are some of the pieces of advice you give them about living with diabetes?
Gina Wimmer: Well, sometimes, firstly I say I’m not the enemy. I’m not the food police.
Tara Schmidt: I’m your friend. I’m your friendly neighborhood dietician.
Gina Wimmer: That education, the sooner the better, we can provide that. Sometimes people feel like, “Oh, I’m doing something wrong.” They’re sending me to the dietician. It’s like, “Oh no, it’s so not that. We’re going to really just talk about them, how the food that they’re eating can impact their life and their lifestyle, and take a stepped approach. I’m going to start more with the plate method, thinking about how we put our food on our plate. Half of our plate is those non-starchy vegetables. We want lots of those guys, a quarter of the plate to be that protein. Whether it’s fish or chicken, beef or pork, cheese, eggs, that’s your protein source.
Then, a quarter of your plate to be that starch or that grain component, the beans — they can fit into that category.
Certainly I can have some fresh fruit, some milk. Again, that’s what we paint that picture and give them visuals, and help them with quantity or portion size.
Like I said, if we have to take teeny, tiny baby steps, but if we can do that over time it can make a big impact.
Tara Schmidt: Are there foods that you feel like people need to avoid or foods that are beneficial that we haven’t talked about yet?
Gina Wimmer: I’m probably never going to say there’s a food to avoid. I would probably say, yeah, maybe regularly sweetened items like sodas just because there’s so much sugar in that quantity and your portion size. Let’s see if we can make just some healthier food choices throughout the day. As far as, is there any magic bullet food that’s going to help your blood sugar? No, not really.
We see in the media, maybe cinnamon. Well, a lot of times I look at that and go, “Oh, well cinnamon’s not going to hurt you unless you’re taking spoonfuls and you choke on it, so sure.” Have more cinnamon. The studies aren’t backing it up that it’s really going to impact blood sugars a ton.
Tara Schmidt: There can be a bit of a social stigma associated with a diabetes diagnosis. How can patients combat that?
Gina Wimmer: There certainly is. It’s a full-time job to have diabetes, the most important thing is. Education, right? For those individuals, it’s hard to say. You need to educate everyone else.
We as a society need to educate more about what diabetes is because individuals feel judged. We have to just be so careful with our words when we speak with them.
In terms of thinking about, just that support and again, empathy and trying to understand a little bit where they are. I don’t really watch a whole lot of TV, but I caught this ad a couple weeks ago, and it was this individual that had the diagnosis of diabetes Type 2, and he went to his doctor and the doctor said “We’re not meeting your goals.”
He got this little post-it note put on him, right on. Not meeting goals. Then he goes home and he’s sitting at the dinner table with his wife and family, and she’s like, “Did you check your blood sugars, check blood sugars,” And then the next thing is this guy with these post-it notes all over him.I’m just like, yeah, it’s a lot of work. It’s a lot to think about. Diabetes is tough.
Tara Schmidt: That’s a great analogy. It’s a full-time job.
Gina Wimmer: Yes. When I work with our diabetes nurse educators and we teach some of our classes, they have a really great picture. It’s like a circle, and it’s got this little teeny tiny sliver and it tells individuals that little sliver is how much time you spend with your healthcare providers.
Tara Schmidt: Mm-hmm.
Gina Wimmer: The rest of the time is all you.
Tara Schmidt: I have a feeling people ask you about keto though. So high fat, low carbs. Is this a good option for people with diabetes?
Gina Wimmer: No, that’s my personal opinion. There is a risk for, again, that oversimplification of “Let me just take carbohydrates out.” Really a true keto approach, initially, it was designed to help individuals with seizures.
Keto, in my eyes, it’s not sustainable. Certainly individuals can lose weight with Keto. Again, because it’s not sustainable. Oftentimes they’re going to go back to old habits and the weight’s going to come back on, the blood sugars are going to go up again, it’s really not a healthy diet.
It’s a lot of fat and it should be more unsaturated fat, but for a lot of individuals it’s more saturated fat, so not going to be heart healthy for them. Again, for people with diabetes, we really want to think long term, what changes can you make and live with.
Tara Schmidt: Let’s get into the spectrum of treatment options for people with diabetes. In obesity we start with lifestyle and then we may go to a medication, perhaps a procedure, and maybe a surgery at the end. With diabetes, I’m thinking fairly similarly, but I’m more going from lifestyle to oral agent, to insulin to pump.
Gina Wimmer: It depends on the type of diabetes that they have, right? If it’s Type 2, then yes, lifestyle. It really depends. Sometimes an individual will get diagnosed with Type 2 and their A1C will be super high and then they might start them on insulin right away.
That might just be a temporary thing, wake that pancreas back up, give it a chance to start producing that insulin maybe a little bit more. Then, oftentimes maybe some of those different oral agents help with that. But yes, in a slow progression, diet and exercise, oral medications, or now we have those GLP ones and that might be an option for individuals.
It’s really up to the individual and their provider as far as what’s going to be the best route to go with that. Some individuals are on several types of oral medications. It really just depends. If they’re Type 1, it’s going to be insulin from the get go. Ideally probably more of an MDI at first so that they know how that works and then to a pump if they want a pump. But people feel pumps are very intrusive too.
Tara Schmidt: Okay. I’m hearing with Type 2 diabetes, it may be a little bit more fluid among that spectrum, right? That you can’t go back from having bariatric surgery, but with diabetes, you may be able to go back from being on insulin.
Gina Wimmer: Potentially. It really depends.
Tara Schmidt: Let’s talk a little bit more about the impact that exercise can have on blood sugar. It lowers blood sugar, which is why if you’re at risk of having a low blood sugar, like someone in cardiac rehab, we actually make them check their blood sugar before they exercise if they have diabetes, and especially if they’re on insulin.
Are there some exercises that are better than others? There’s a study that said doing 100 squats throughout the day could be better for your blood sugar than taking a 30 minute walk.
Gina Wimmer: I saw that study. What’s interesting is this study was conducted in a very small sample of individuals, 18 participants. The important guidance is to choose an activity that you enjoy and you can do it on a routine basis. Just get moving.
Tara Schmidt: We’ve said it a hundred times, everyone. I don’t care what you do. Just do something that you don’t hate.
Gina Wimmer: If we look at the recommendations by the American Diabetes Association, they suggest 150 minutes of moderate to vigorous aerobic activity spread out throughout the week, right? Sometimes I tell individuals, even if you can do a 10, 15-minute, and do that a couple times a day that’s going to get you up there.
Then also strength and resistance training two to three times a week is going to be helpful for those blood sugars.
Tara Schmidt: Perfect. Gina, thank you so much for bringing all of your knowledge on a topic that has always made me a bit nervous, because I feel like there’s so much going on here. I very much appreciate your stopping by.
Gina Wimmer: You are welcome. It was fun to spend the time with you, Tara. I just never get to see you.
Tara Schmidt: It’s wonderful to see you.
If you get a diabetes diagnosis, the key is being aware that there’s no real magic bullet like cinnamon to cure your condition. As usual, it comes down to a balanced diet and a lifestyle that involves regular exercise.
In addition, there are plenty of resources like registered dieticians, medications and devices to help you manage for the long haul.
It takes a lot of energy to manage a chronic illness like diabetes, but there’s nothing to be scared of. If you’re cognizant of your carbs and fuelling with fibre, diabetes should be scared of you.
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