Peripheral Artery Disease: Know Your Alternatives to Lower Leg Amputation

By Dr. Albert Chun, MD MBA, Managing Physician at Modern Vascular

Not long ago, a man, only 49 years old, was referred to us; he had already lost toes to amputation and just a week earlier, he was told he was also facing the amputation of his lower leg. He kept his leg, and today he is walking around, driving his car, and living his life in a way that the would have affected greatly.

This man was suffering from Peripheral Artery Disease (PAD), a circulatory ailment that affects as many as 12 million Americans; type 2 diabetes is one of the leading risk factors for PAD. This man’s story is not an isolated one; we see many just like this every month. What saved his leg was a minimally invasive outpatient procedure that is becoming a standard treatment option for PAD sufferers and their physicians to consider.

What Is PAD?

September is PAD Awareness Month, and while we have had much success saving limbs and restoring hope to hundreds of PAD sufferers, we still have work to do to raise awareness of this solution. What is PAD, specifically? It is the narrowing of peripheral arteries due to atherosclerosis (plaque buildup on arterial walls), decreasing blood flow to legs, feet, and toes. Left untreated, PAD complications include critical limb ischemia, gangrene, and amputation.

Aside from type 2 diabetes, risk factors that greatly increase the likelihood of developing PAD include increasing age, obesity, high blood pressure, high cholesterol, and smoking. In addition, PAD is more prevalent in African American and Native American populations.

Treatment: An Alternative to Amputation

While many PAD cases have traditionally resulted in amputation below the knee, new therapies are preventing that, giving patients a pathway that keeps them whole. Interventional Radiology is a minimally invasive, image-guided endoscopic procedure to treat vascular disease, down to the toe. These treatments pose minimal risk to the patient, reduce recovery time and lower costs versus Open Vascular Surgery. Who performs these procedures? Interventional Radiologists are medical doctors with 6 or 7 years of additional training following medical school. We are certified in both Diagnostic Radiology and Endovascular Procedures.

Endovascular Procedures differ from Open Vascular Surgeries in the following ways:

  • They are conducted in dedicated out-patient clinics rather than in a hospital setting
  • The procedures are minimally invasive procedures, vs open surgery performed by Vascular Surgeons
  • They tend to be shorter and have reduced recovery time, usually discharging the patient on the same day
  • They use moderate sedation or local anesthesia of patients while Open Vascular Surgeries often require general anesthesia

Both Interventional Radiologists and Vascular Surgeons have long-term patient relationships and will continue to see patients for follow-up care after treatment. Modern Vascular patients may follow up with their Interventional Radiology physician for follow up care 2-4 times per year.

Procedure Room Modern Vascular

A glance inside one of the procedure rooms | Photo credit: Dr. Albert Chun, M.D., M.B.A.

What You Should Do

For anyone at risk, particularly those with type 2 diabetes, there are a number of things you can do:

  • The ADA recommends that if you have diabetes and you are over 50, you should proactively get a screening test, such as a pulse check or ultrasound, to monitor for problems early.
  • Have periodic foot care at least once a year, to ensure you are not developing ulcers; often, people with diabetes will suffer from ulcers or other lower leg injuries without feeling them, and will not catch them until it’s too late- sometimes weeks later.
  • If PAD symptoms worsen to the point that amputation is recommended, ask your doctor about Interventional Radiology as an option.

There is a role for active surveillance for people in all risk categories, but people with type 2 diabetes, in particular, should be vigilant for symptoms. The good news is that if PAD symptoms do arise, there are real alternatives to amputation. For many, like the 49-year-old man I described above, PAD is not the end of life as they knew it – not anymore.

About the Author

Dr. Albert Chun, MD MBA, is a Vascular Interventional Radiologist and the Managing Physician at Modern Vascular in Fairfax. Dr. Chun is a board certified Vascular and Interventional Radiology specialist. He has been in practice for 15 years and previously served as Instructor of Radiology at Harvard University and Assistant Professor of Radiology and Surgery at George Washington University.

Source: diabetesdaily.com

Tackling Carbs with Tech

Many people who live with diabetes avidly avoid eating carbohydrates, as historically speaking, it has been notoriously difficult to cover carbohydrates appropriately with exogenous insulins. But with access to better, faster insulins and the uptick in the use of patient-friendly technology, things are changing, and people’s diets (and their feelings of freedom) have expanded more than ever. Here are the best tech-friendly hacks to tackle the carbohydrate conundrum.

MyNetDiary

This popular app has a searchable database with nearly a million food entries for people to access and look up carbohydrate counts on the go. The company also has a separate Diabetes app that allows users to track blood glucose levels, HbA1c results, and insulin doses, to track their progress over time. If you’re looking to lose weight, MyNetDiary can create a diet plan to meet your needs. You never have to feel restricted when eating meals with family or friends, having all your carbohydrate counting needs right at your fingertips.

Photo credit: GreaterGoods

GreaterGoods Nourish Digital Scale

This food scale is a game changer for those who cook with lots of fresh produce, where carbohydrate counts can vary quite a bit. This scale lets the user view nutrition facts for over 2,000 foods in the scale’s built-in database, and create up to 99 more custom entries. Measure individual ingredients, track full meals, and calculate daily carbohydrate intake much easier with this digital scale.

InPen

This revolutionary device is the only FDA-approved smart pen insulin system that helps prevent users from “stacking” their insulin doses and take the right amount of insulin at the right time. This device works in tandem with a phone app, where users can track insulin on board/active insulin, personalize your doses, sync with continuous glucose monitor (CGM) or glucometer data, and share reports with others. The pen itself is compatible with Humalog, Novolog, and Fiasp, and will even dose in half units. Eating carbohydrates has traditionally been much harder on multiple daily injections, but advancements such as the InPen are making strides to make life much easier for people with diabetes.

Use Alternative Pump Boluses

If you are an insulin pump user, dosing for a high carbohydrate meal can also be difficult, especially if the meal also has a moderate amount of protein and fat (which can delay the absorption of the glucose in the meal). To handle that, try opting for a combination bolus (a.k.a. Combo Bolus or Dual Wave Bolus,  for Animas or Medtronic users, respectively; Omnipod, Tandem t:slim users will use “Extended Bolus”). This is a hybrid delivery mode: a specified portion of the total insulin bolus is delivered upfront, as a normal bolus, while the rest is delivered over a specified period of time as an extended/square wave bolus.

For example, given a 12U dose delivered as a 60/40 combination/square wave bolus over 3 hours: 60% of the total dose (7.2U) will be delivered within seconds of pressing the “deliver” button; the remaining 40% (4.8U) will be delivered equally every few minutes over the next three hours. The result is an initial dose to cover faster-digesting foods, plus an extended amount of insulin action to deal with the slower-digesting foods (which tend to be fattier or have more protein), and to prevent postprandial spikes in blood glucose. Utilizing these settings can be extremely helpful when you’re eating foods like pizza, pasta, Chinese food, Mexican food, or ice cream. Always consult with your diabetes healthcare provider before making any changes to your dosing routine.

Dexcom CLARITY Diabetes Management Software

Photo credit: Dexcom

Dexcom Clarity App

This software can be helpful for patients already using the Dexcom continuous glucose monitoring system, but are wanting to track and change problematic patterns in their blood glucose. This app lets you set target goals for your blood sugars, will track time-in-range, detects patterns of highs and lows and will alert you to them, and will even give the user a predicted HbA1c result. You can also choose to share your data with your health clinic to make changes to your insulin routine or insulin to carbohydrate ratio in real time, and to really find what will work best for you for optimal management.

Living with diabetes is never easy, but thankfully technology has made counting carbohydrates and eating easier than ever before. What apps or tech has helped you to navigate food, eating, and counting carbohydrates? What’s worked best and what hasn’t? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Healthy, Low-Carb Flaxseed Hamburger Buns

This content originally appeared on ForGoodMeasure. Republished with permission.

The obvious low-carb bun option is a crispy bed of iceberg lettuce. I’ll admit it has merit —  refreshing, crunchy & guilt-free. But sometimes you want something more — more substantial, more bread-like. Nutrient-rich, high-fiber ground flaxseed ensures this recipe’s low-carb footprint, while apple cider vinegar combines with baking soda to lend these buns the airy lift we expect from a yeast bread. A great base layer for Apple Turkey BurgersSalmon Cakes or for a lighter, vegetarian option, try a Zucchini Latke.

Print

Healthy, Low-Carb Flaxseed Hamburger Buns

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When a bed of iceberg lettuce as a replacement to a high-carb bun isn't satisfying, this is a great option.
Course Snack
Cuisine American
Keyword bread, bun
Prep Time 20 minutes
Cook Time 20 minutes
Total Time 40 minutes
Servings 6 buns
Calories 233kcal

Equipment

  • oven

Ingredients

  • 1 cup flax meal
  • 1 teaspoon baking soda
  • 1/2 teaspoon salt
  • 1/2 teaspoon caraway seeds
  • 1/8 teaspoon black pepper
  • 3 tablespoons butter
  • 3 eggs beaten
  • 2 tablespoons apple cider vinegar
  • 1/2 tablespoon maple syrup
  • 1 teaspoon sesame seeds

Instructions

  • Preheat oven to 400 degrees.
  • Line a rimmed baking sheet with parchment.
  • Mix flax meal, baking soda, salt, caraway seeds & pepper in a large mixing bowl, set aside.
  • In a separate bowl, melt butter.
  • Add eggs, apple cider vinegar & maple syrup, whisking until well combined.
  • Add egg mixture to flax mixture, stirring until well combined.
  • Let rest for 10 minutes.
  • Scoop ¼ cup portions of mixture onto the prepared baking sheet, press to flatten slightly.
  • Top with sesame seeds
  • Bake for 20 minutes, until golden.

Notes

  • Naturally low-carb & gluten-free
  • Net carbs: 2g

Nutrition

Calories: 233kcal | Carbohydrates: 9g | Protein: 8g | Fat: 19g | Cholesterol: 97mg | Sodium: 467mg | Fiber: 7g | Sugar: 2g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Healthy, Low-Carb Flaxseed Hamburger Buns Recipe

Source: diabetesdaily.com

Going Virtual: The Future of Diabetes Care

This content originally appeared on Beyond Type 1. Republished with permission.

By Todd Boudreaux

Ashlyn Mills is a physical therapy assistant in an outpatient setting in Florida, working with people with orthopedic and neurological disabilities. She was diagnosed with type 1 diabetes when she was 19 years old. Ashlyn recently started using DreaMed’s telehealth platform to see an endocrinologist, and spoke with Beyond Type 1 about the shift to virtual care.

Beyond Type 1: To start, can you tell me about your diagnosis, and how you originally managed your diabetes?

Ashlyn Mills: I had a strange diagnosis, it was caught a little bit early. I was already being followed by an endocrinologist for some other issues and we started noticing some higher blood sugars on labs. My A1c wasn’t incredibly high so they put me on a Dexcom and started monitoring my blood sugar so they could see what kind of patterns I was experiencing. My fasting blood sugars crept up higher and higher and they went ahead and added basal insulin at that point. I was insulin dependent about three months after my diagnosis.

They diagnosed me with type 1 from the start. They did say that it looked like a latent onset (LADA), but it was pretty clear that it was type 1 from the get go. I was using insulin pens at that time.

Tell me about your treatment since diagnosis.

I live in a rural area in Florida. There’s not an endocrinologist around here. I had been seeing an endocrinologist at the Mayo Clinic in Jacksonville, which is about a two and a half hour drive for me, and that was just because that’s who came recommended by my primary care physician. I was diagnosed at the Mayo Clinic and followed up with endocrinology there for the first two years after my diagnosis. The nurse practitioner that I was seeing there actually left and came to a clinic that was about an hour and a half from my home, and I had a good rapport with her. I went ahead and followed her.

Her and I had come to the understanding that it was difficult for me to see her every three months, so instead I saw her every six months. It became a little bit of an issue for me being able to talk with someone in between if I had issues, which is how I found DreaMed. I could find somebody to bridge the gap between those six months that I’m going without seeing a doctor in person. Now, I’m able to communicate with someone whenever I want to.

How have you been keeping up with your job as a healthcare worker living with T1D during the pandemic?

Florida did a stay at home order back in March. About mid April my employer decided, “We’re going to send everybody who is high-risk home.” I worked from home for about two months and then the numbers started looking better and they sent me back to work. Now, I’m working in the clinic every day and it is nerve wracking. I’m still working but I’m quarantining from my family right now because I was exposed at work.

I go through phases where I feel like I would be fine if I got it but then I have bad blood sugar days and I’m like, “This is it. If I get COVID I’m doomed because my blood sugar was over 200 mg/dL all day today.” Overall, I think I would be okay but I do worry about being hospitalized. I think that’s my biggest fear with the whole entire thing is ending up in the hospital with no family there to be with me. I pray every day that I stay well but I am working and the numbers in our county are rising quickly

How did you find out about DreaMed and what was that process like getting started?

When I was sent home and started doing telehealth with my patients I realized this is easy, there shouldn’t be any reason why I can’t do this.

At the time my endocrinologist’s office was not offering telehealth appointments, even in the midst of COVID-19. I started doing a little bit of research and found DreaMed. I went on the website and signed up for more information. My experience as a provider doing telemedicine is what led me to push to try to find someone that could do the same with me as a patient.

How does DreaMed work?

They asked me what state I lived in and they connected me with an endocrinologist here in Florida, Dr. Kava. I set a telemedicine appointment with her and she spent about an hour with me on that first call. I think you can view it as a replacement service for your current endocrinologist or just an add-on to your current care.

Was it surprising your appointment lasted for an hour?

Dr. Kava would have spent as long as I wanted her to with me. My normal appointments in the clinic, I drive about two hours to be seen for maybe 10 minutes. Most of the time there’s not too much to discuss at those appointments you just make a few changes, but she asked all about my personal life, including my mental health during the pandemic. She really seemed invested in me as a person, too, not just diabetes.

She nitpicked my data because I told her I’m a little bit of a control freak. She said, “If you want tight control I’ll help you.” She spent a long time combing through all of my graphs and figuring out what we could do to get things even tighter than they already were.

Has any diabetes provider before Dr. Kava asked about your mental health?

That’s the first time I recall that happening. When I was first diagnosed I had a diabetes educator talk with me about mental health and diabetes to prepare me for what may be to come with my mental health. They assume if your control is good you’re doing okay with your mental health, but that’s not always the case. I don’t necessarily quit caring for myself when I feel burned out but that doesn’t mean I’m not struggling mentally with it.

It was Dr. Kava spent a good bit of time talking with me about mental health and diabetes and how my mental health was doing with COVID-19 and all of that so I was very impressed with that.

Were there any other specific suggestions that stuck out to you?

Most adult endocrinologists seem stuck in the stone ages a little bit. Dr. Kava looked at my data and she said, “You’re on a closed loop system. The system is going to suspend you if you’re going to go low. If you want to stay below 140 or if you want to stay below 120 I can help you get your settings there.” That was the first time that I had ever had someone be willing to be that aggressive with my care, but I felt like she was totally game for whatever I wanted her to help me do.

Do you think that you’ll continue using DreaMed?

Yeah, ideally I would like something to bridge the gap right now. Although my endocrinologist has started offering telemedicine I’d like somebody that I can talk with through DreaMed and not feel like I’m bothering. When you’re bothering your endocrinologist a lot of times you’ll get an unexpected bill; it would be nice to pay the monthly fee and have somebody at my fingertips whenever I need them. If my endocrinologist quit offering telemedicine I would love for DreaMed to replace my current endocrinologist. As much as I love her it’d be nice to do telemedicine and not have to drive two hours to be seen by someone.

Do you have any advice for someone living with type 1 who doesn’t currently have access to a local endocrinologist?

I just think if anyone’s trying to figure out what to do in the time of pandemic or just tired of driving to see an endocrinologist as frequently as they do, I would suggest looking into DreaMed. They’re currently offering a three-month trial. I have no dog in the fight, I’m not being compensated to say anything about them. You have nothing to lose. They are very honest and I think it’s worth giving a try.

Source: diabetesdaily.com

Research Trends: A Focus on Nutrition and the Diabetes-Cancer Connection

Dr. Maria Muccioli, Ph.D., holds degrees in Biochemistry and Molecular and Cell Biology, with over a decade of research experience. She is a biology professor at Stratford University and a science writer at Diabetes Daily and has been living well with type 1 diabetes since 2008.

In this recurring article series, Dr. Maria presents some snapshots of recent diabetes research, especially interesting studies and reviews that may fly under the mainstream media radar.

***

In Support of the Ketogenic Diet

A comprehensive literature review by expert obesity and nutrition researchers from Spain was recently published in Reviews in Endocrine and Metabolic Disorders. The narrative suggests that overall, research on very-low-carbohydrate (ketogenic) diets points to favorable health outcomes for many patients with type 2 diabetes. Various health parameters, including weight loss and glycemic management, can be effectively improved when following a very low-carb approach. These outcomes are now supported by a sizable and growing body of peer-reviewed literature. Importantly, adverse health effects appear to be “of mild intensity and transient,” the experts summarized. Dr. Felipe Casanueva and his colleagues even went as far as to call this dietary approach a “potential game-changer in the management of type 2 diabetes.”

Diabetes and Cancer Risk

The complex interplay between diabetes and cancer continues to be investigated in the research world. At this year’s American Association for Cancer Research (AACR) annual meeting, researchers from the Washington University School of Medicine in St. Louis, MO reported on a link between type 2 diabetes and colorectal cancer (CRC) risk. The scientists evaluated data from almost 6,000 patients with colorectal cancer and found that the cancer patients were significantly more likely to have type 2 diabetes as compared to the healthy control group. The association remained after adjusting for the potential confounding variables, with an increased odds ratio of 1.4 (7.2% of CRC patients also had type 2 diabetes as compared to only 4.3% of the controls).

Clinical Trial: Metformin in Cancer Treatment

A clinical trial at the University of Milan is investigating the utility of Metfomin in preventing high blood sugar in cancer patients treated with glucocorticoids. While high-dose steroids can be an effective treatment for many cancers, they often cause the undesirable side effect of increasing blood glucose levels. The trial will include over one hundred patients undergoing treatment for various types of cancer, including skin, lung, and breast cancers. The researchers hope that by mitigating the hyperglycemic effects of high-dose steroids used in treatment will improve patient outcomes.

Prenatal and Childhood Nutrition Affects Metabolic Disease Later in Life

A large literature review conducted by endocrinology experts in China examined how early nutritional patterns (before birth, i.e., mother’s diet and eating patterns during childhood) may affect metabolic disease, like type 2 diabetes, later in life. The review article was recently published in The Chinese Medical Journal. The key takeaways were as follows: 1) Both maternal “overnutrition and undernutrition” during pregnancy resulted in higher risk for metabolic disorders in their children; 2) These predispositions may be mitigated through specific nutritional patterns in early childhood. This is not surprising, as tissue plasticity is highest during early development, and so many predispositions may be affected by environmental factors. Some studies have pointed to the importance of “dietary bioactive compounds,” including resveratrol, and genistein, among others, in this process.

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Please share your thoughts with us and stay tuned for more recent research updates!

Source: diabetesdaily.com

Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile

This content originally appeared on diaTribe. Republished with permission.

By Cindy Takigawa and Frida Velcani

What’s an AGP report, and what does it show? Why does my AGP matter? How can I use an AGP report to improve my blood glucose levels and time in range?

Having diabetes is a full-time job: you have to simultaneously monitor your diet, activity, stress, and even sleep. On top of that, you need to calculate and manage the number of carbs you consume in each meal, and keep careful tabs on your blood sugar levels. The Ambulatory Glucose Profile (AGP) report, developed by the International Diabetes Center, is a tool that provides a simplified way to look at data on your blood glucose patterns and trends. It has been recognized as a standard of care for reporting continuous glucose monitor (CGM) data by the American Diabetes Association. In this article, we explain what an AGP report is and how you can use the information to help you navigate your diabetes management.

CGM App

Image source: diaTribe

What is an ambulatory glucose profile report?

An AGP report is a standardized, single-page report that includes glucose statistics like time in range, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on at least seven days of CGM data, with 14 days of data (or more) considered ideal. Currently, many CGMs include a version of the AGP report in their devices and reporting software.

An AGP report that summarizes data provided by self-monitoring of blood glucose (SMBG) is currently being developed. This article focuses on CGM AGP reports.

Why does my ambulatory glucose profile matter?

The AGP report is the same no matter what device you use – it allows your healthcare team to assess blood glucose levels and trends in a standard way for everyone they see. Below you’ll find sample AGP reports from Abbott, Dexcom, and Senseonics.

The AGP report shows patterns in a user-friendly way so that people with diabetes can easily identify the times of day when glucose levels are consistently low, high, or fluctuating. The general goal for people with diabetes is to have their glucose levels stay within the target range of 70 to 180 mg/dL for at least 70% of the day, spending less than 4% of their time in hypoglycemia (under 70 mg/dL). The information from an AGP report can help you have a discussion with your healthcare team about goals for your diabetes management and ways you can achieve them. The data offered by this report can help make your care far more precise and effective.

What exactly does your AGP show?

The standard AGP (designed by the International Diabetes Center and shown above) will show your data like this:

  • Glucose Statistics and Targets: This section displays metrics including average glucose, glucose variability, and Glucose Management Indicator (GMI), which can be thought of as your predicted A1C. It also includes the dates and number of days in the report, as well as the percent of time that the CGM was used to collect data. While time in range goals can be individualized, the expert-defined goals for various groups of people with diabetes can be found in this section. You can read more about time in range targets here.
  • Time in Ranges: This color-coded bar chart helps you visualize the percentage of time spent above and below your target range.
  • Ambulatory Glucose Profile: This graph combines all of your glucose readings over time to display your trends across a 24-hour period. At the end of this article you can find examples of what this will look like for your specific CGM.
    • Black line: the median of all the readings. Half of your glucose values are above the middle black line and half are below.
    • Green lines: this is your target glucose range.
    • Dark blue area: 50% of glucose values lie in this area.
    • Light blue area: 90% of glucose values lie in this area. This percentage may differ between AGP reports. The International Diabetes Center report includes 90% of glucose values, while the Eversense report shows 80% of glucose values.
    • Dotted blue lines: 5% of the highest and lowest glucose values are above and below this line, respectively.
  • Daily Glucose Profiles: Each box shows your glucose pattern from a single day.
    • Yellow area: instances of high glucose (hyperglycemia).
    • Red area: instances of low glucose (hypoglycemia).

How can I interpret an ambulatory glucose profile report?

An AGP report combines several days of blood glucose readings into one snapshot. Once you have identified daily patterns, you can work with your healthcare team to adjust your medications and insulin dosing to spend more time in range. You may also discuss timing of food or physical activity, what you are eating, or ways to reduce stress. Here are some steps you can take to understand your data:

1.     Look at your time in range. The goal is to shift the numbers into the 70 – 180 mg/dl target range while having fewer lows and extreme highs. Each AGP report includes a bar chart of your time in range; one way to see this goal in action is to aim for more “green” and less “red” on the bar chart.

2.    Keep track of the usual times you wake up, go to sleep, eat meals and snacks, and are physically active. Food, activity, medication doses, and dozens of other factors can affect your blood glucose levels. Recording these activities and their timing will help you understand your AGP report and the patterns you see.

3.    Identify times when your glucose levels are lowest and highest, and look for times of more variability. Speak with your healthcare professional about what factors may be causing highs, lows, and variability in your AGP and how you can reduce them. The wider the shaded blue areas on your report, the more variability there is in your glucose levels.

4.    If you can, compare your current and past AGP reports, and create an action plan with your healthcare team. What strategies did you use previously to make changes? Identify a few steps to improve your glucose patterns moving forward.

To learn more about how people with diabetes and healthcare professionals can use AGP, click here. For more resources on time in range, check out diaTribe’s comprehensive library here.

Abbott AGP

CGM App

Image source: diaTribe

Dexcom AGP

Dexcom

Image source: diaTribe

Eversense AGP

AGP

Image source: diaTribe

Source: diabetesdaily.com

Top 20 Healthy and Affordable Walmart Food Finds

Walmart, America’s most popular retail chain, has been increasing its options of healthy foods, with plenty of plant-based, vegan, paleo, gluten-free, and keto-friendly options at affordable prices. They also have a private-label organic line, Great Value Organic, which offers quality tasting organic products that are more affordable than its brand name competitors.

Here is a list of healthy and affordable Walmart finds that not only taste great but won’t break the bank.

1. Walmart’s Great Value Organic Frozen Fruit Line

I love fresh fruit but I don’t eat it quick enough and usually wind up having to throw most out. With Walmart’s own line of frozen fruit, I can buy affordable frozen fruit in bulk. Fruit is a great source of fiber and antioxidants and I love adding them to a protein smoothie or mixing into my favorite Greek yogurt.  You can’t go wrong with the $8.47  price tag for 32 ounces, especially because none will go to waste.

2. Great Value Pesto Spirals

These tasty frozen pesto spirals made from zucchini and carrot noodles are only 5 grams of carbs per ¾ cup serving and low-calorie too. They can be used as a simple side dish or turned into a restaurant-quality cuisine. Try adding grilled chicken or shrimp, and your favorite sauce! They are only $2.98 per a 12-ounce package and the options are unlimited!

3. CauliPower Baked Chicken Tenders

This is one of my favorite finds because it is something that my whole family can enjoy. These baked chicken fingers are gluten-free, coated in cauliflower and only 10 grams net carbs per serving (about two chicken fingers). My kids love it as is and I like to get creative with it and turn it into salads and entrees with healthy spices and sauce. It is affordable to feed the whole family with a price of $5.98 for a 16 oz package.

4. Jimmy Dean’s Delights Broccoli and Cheese Egg’wich

This high-protein, low-carb breakfast option is made with egg frittata flavored with broccoli as the “wich” with chicken sausage and cheese layered in between. This great on-the-go meal is packed with 14 grams of protein and only 8 grams of carb, making this a perfect, low-carb choice to start your day.

5. Pb2 Peanut Butter Powder

This is an item I was reluctant to try for quite some time. Once I tried it, I wish I had sooner since there are so many ways to use this product. You can either mix with water or almond milk to use like peanut butter (I enjoy it with a few Bake Believe chocolate chips) or simply add the powder to any desserts or shakes for an added punch of peanut butter flavor. With only 5 grams of carb, 45 calories and 1.5 grams of fat per serving, this is definitely an item worth considering. It costs $8.47 for a 16-ounce jar and will last you for quite some time.

6. Deebee’s Organics Superfruit Freezie

This product is such a great find. I first became familiar with these ice pops at a friend’s house and all the children devoured them. The mom specifically purchases these because they are free from the top 8 allergens, including peanuts, tree nuts, milk, egg, fish and shellfish, soy and wheat, making this a safe choice for her 7-year-old daughter who has multiple allergies. They have no artificial flavors, colors or preservatives and come in at only 7 grams of sugar per ice pop, making this the perfect treat when your kid is already operating on a sugar high. Each box comes with three delicious flavors–Strawberry Lemon, Mango Orange and Blueberry Pomegranate and costs 3.98 for 10 bars making it an affordable dessert when having guests.

7. Bake Believe Keto-Friendly Chocolate Chips

I reviewed this product last year and have been buying it ever since. Unlike their competitors, their price is affordable and it tastes great too. This is still a best-kept secret so make sure to scoop these up if your store has them in stock. With only 60 calories, 4.5 grams of fat and 1 gram net carb per serving you can indulge without worrying about your nutrition goals or your blood sugar. Bake Believe chocolate chips cost just a fraction of the other brands, with a price tag of only $3.98 for a 9-ounce bag, making this one of my favorites on this list!

8. Badia Organic Chia, Flax and Hemp Seeds

This variety of seeds is a great plant-based source of omega-3 fatty acids, proteins, and minerals such as magnesium, zinc and iron. They come in a handy container that you can put right into your fridge or freezer to give it the longest shelf life. The chia seeds are extremely affordable at $19.44 for an enormous 5.5 lb container that will last you a long time and won’t spoil.

9. Great Value Coconut and Almond Flour

I love baking my own low-carb alternatives to some of my favorite desserts but it is very expensive to do so. In a regular retail grocery store, almond flour can cost around $10 dollars for a 1-lb bag. For two pounds, Great Value’s organic coconut and almond flour are considerably less than my normal go-to brands with a price of $4.98 for coconut and $12.98 for almond flour.

10. Whisps Cheese Crisps

This gluten-free and keto-friendly snack comes in individual portions, perfect for back to school, for both you and your children. With only 1 gram carb, 110 calories and 6 grams of protein, this is a great choice that will not spike your blood sugars. At Walmart this product costs $3.47, the lowest of anywhere I’ve ever purchased. I will be sure to pick some up on my next visit!

11. Kale

For just $1, you can get a 1-lb bag of frozen kale — plenty of health benefits and the cooking options are limitless. This one is a no brainer to add to your shopping cart.

12. Great Value Deluxe Mixed Nuts

As with many other items, Great Value boasts some of the lowest prices for nuts that I’ve ever seen. This one is a particular favorite of mine; make sure to get the lightly-salted version. A large container weighing 15.25 ounces will only cost you $7.98! Store the nuts in the fridge for longest shelf life.

13. Great Value Oils

The selection of oils at Walmart is impressive and there is no doubt you’ll find what you are looking for. I prefer to use avocado oil for my grilling due to its ability to withstand high heat. And I use a lot of coconut oil when I’m baking. Both of these oils cost less than in my local grocery store, with coconut oil costing $4.62 for 14 ounces and avocado oil $ 7.47 for a 25.5-ounce bottle.

14. Fairlife Chocolate Milk

With 50% less sugar than regular chocolate milk and 9 essential nutrients, Fairlife chocolate milk is what I give my kids to make sure they are getting a healthy source of vitamins and minerals. It is also packed with protein coming in at 13 grams per cup. I personally use Fairlife to treat my low blood sugar. It has just enough sugar to raise my sugar and some fat and protein to keep it stable. It also happens to be delicious! At Walmart, you can find Fairlife for $3.18 for 52 fluid ounces.

15. Good Food Made Simple Egg White Patties

I think my mouth dropped to the floor when I found this gem. These patties are already cooked and can become a part of your favorite breakfast sandwich or wrap, or eaten on their own, with some bacon and avocado on the side!  This is an easy and protein-packed food to put on your shopping list and only costs $3.98 for 6 patties!

16. CauliPOWER Margherita Pizza

It can be difficult to find a store-bought, plant-based pizza option without it costing a small fortune. These delicious cauliflower-based, gluten-free pizzas have 30% less sugar than other leading pizza brands and only cost $6.48 for a personal pie.

17. LaCroix Sparkling Water

LaCroix sparkling water is a delicious alternative to high-sugar soda and a nice change of pace from plain water. With no calories, sugar or sodium, you can feel good about keeping this stocked in your fridge. LaCroix comes in an assortment of flavors and can also be great as a mixer with your favorite adult beverage. And you can’t beat the price of $11.99 for 24 cans.

18. Oscar Meyer P3 Chicken, Monterey, and Cashews Portable Protein Pack

This is an incredible option for those who are carb-conscious and looking to get in some protein, too. Each individually-sized pack comes with seasoned rotisserie chicken, cashew pieces and Monterey Jack cheese. It contains 12 grams of protein, making it very macro-friendly. If your children like it, this is a great and affordable option to bring to school at just $1.50 each.

19. Great Value Pasta Sauce

This sauce has a full serving of veggies and contains only 9 grams net of carb in each ½ cup serving. There are also other options, like Marinara sauce, that are even lower in carbohydrate and equally as delicious! This sauce is also gluten-free and contains no saturated or trans fat. It’s taste rivals that of its brand name competitors but its price of just $0.88 cents cannot be beaten!

20. Green Giant Riced Vegetables Cauliflower Risotto Medley

Green Giant used to just mean soggy string beans or corn niblets in a can. Now you have an assortment of vegetables turned into “rice” with a fraction of the calories and carbs. The Cauliflower Risotto Medley tastes rich and creamy but only has 20 calories and 4 grams carb per serving. This is a favorite of mine and is very affordable coming in at just $2.48 for a 10-oz bag.

Walmart is a one-stop-shop for many of us and saves us from running a ton of errands. Now, with Walmart offering all of these delicious and affordable options, we can save time and money while also looking after our own and our family’s health!

Have you found any delicious, healthy and affordable foods at Walmart? Share and comment below!

Source: diabetesdaily.com

Low-Carb Keto Granola

This content originally appeared on Low Carb Yum. Republished with permission.

If you’re familiar with traditional granola, you know that rolled oats are the main ingredient. It also includes a sweetener, like honey or brown sugar.

Unfortunately, these ingredients aren’t very keto-friendly.

So to make this low-carb granola, we use nuts, seeds, and a delicious sugar-free honey flavored syrup instead!

I love the sweet, candy-like coating we get from baking the honey into the granola. It isn’t overly sweet, it’s just the right balance.

The combination of the nuts, seeds, and baked honey coating gives each bite that satisfying crunch we want from granola.

It has a rich, honey nut taste that goes well in almond milk or yogurt. But you can also enjoy it all by itself!

Print

Low-Carb Keto Granola

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Made from seeds and nuts, this low-carb granola goes well with almond milk or yogurt for your tasty breakfast or snacks.
Course Breakfast, Snack
Cuisine American
Keyword nuts, seeds
Prep Time 10 minutes
Cook Time 15 minutes
Total Time 25 minutes
Servings 10 people
Calories 186kcal

Ingredients

  • 3/4 cup walnuts chopped
  • 3/4 cup pecan chips
  • 1/4 cup sunflower seeds
  • 1/2 cup pumpkin seeds
  • 1/4 cup chia seeds
  • 3 tablespoons Pyure organic harmless hunny
  • 1 teaspoon cinnamon
  • 1 teaspoon vanilla extract

Instructions

  • Preheat the oven to 350 degrees.
  • Add all of the ingredients to a mixing bowl, and toss to coat well.
  • Spread the mixture evenly in a single layer on a well greased or parchment lined baking sheet.
  • Bake for 12-15 minutes until toasted.
  • Let the granola sit and cool to room temperature.
  • Break the granola up and serve. Keep uneaten granola in an airtight container in the fridge.

Notes

  • For a maple walnut flavor, the honey flavor syrup can be replaced with maple-flavored syrup.
  • Different variations of nuts and seeds can be used depending on what you have on hand.

Nutrition

Serving: 0.33cup | Calories: 186kcal | Carbohydrates: 10g | Protein: 5g | Fat: 16g | Saturated Fat: 2g | Sodium: 2mg | Potassium: 141mg | Fiber: 7g | Sugar: 1g | Vitamin C: 1mg | Calcium: 57mg | Iron: 1mg


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Low-Carb Keto Granola Recipe

Source: diabetesdaily.com

A Parent’s Concern: COVID-19 and the School Year

This content originally appeared on Beyond Type 1. Republished with permission.

By Eugenia Araiza/Mariana Gomez

COVID-19 has brought many challenges and struggles to our daily lives. From the beginning we have adopted new habits in order to adapt to this new normal and this new dynamic and way of life certainly includes our environment and our children.

In the case of children with diabetes, the school environment alone already entails interesting challenges that, although they can be solved through teamwork and diabetes education, are scenarios that require some preparation to face.

The new normal includes concerns the caregivers have about going back to school and, although we look forward to that day, we also analyze the risks that it could represent in a population that a lot of the literature considers “vulnerable”.

In our groups and communities in Latin America, we have a similar opinion and we are pleased to see that the community has gotten to work and has quickly become familiarized with #BigLittleChanges that will help slow the spread of the virus. We know as a fact that social distancing, among other things, is one of the key pillars, but… what will happen when school begins?

We approached members of the type 1 Diabetes Community from Spanish-speaking families to ask their opinion. This is what we found.

About Going Back to School in August

“August seems too soon for in-person classes, it honestly scares me!” Esther shared with us, who thinks the same as Francisco who added “in my opinion, I do not think it can be possible because we are at a very critical point in the pandemic.”

In countries like Mexico, the rules will depend on the school system (public or private) and even on the state and region. In some schools there will be three options for returning to school: in-person, online or hybrid methodology that involves separating the groups to avoid having several children in a classroom alternating the days of in-person and online education.

Viridiana, Zuri’s mother said, “As Zuri’s mother, who lives with type 1 diabetes, I still do not feel it is safe for her to go back to school and I think that many moms are going through the same thing, the uncertainty of not knowing what will happen in the upcoming school year.”

The British Society of Pediatric Endocrinology and Diabetes States:

  1. Clinically extremely vulnerable children are to remain shielded and not to return to school, even if their year group has.
  2. Clinically vulnerable children who are only under the care of primary care are overwhelmingly likely to benefit from returning to school when their year group does.
  3. Clinically vulnerable children, who are under secondary or specialist care for an underlying health condition are, on the balance of probabilities, more likely to benefit from returning to school when their year group does so. These families may need a conversation with their medical teams to balance the potential risks and any anxiety among family members.
  4. All other children should attend school when their year group returns.

The New Normal and School

Among concerned parents, there has been talk about three options for returning to school: in-person, online or hybrid methodology that involves separating the groups to avoid having several children in a classroom alternating the days of in-person and online education.

Marcela told us “we still have not heard anything about when school will begin, personally I am stressed out about my son returning to school and whether they will take the necessary measures to avoid infections, hopefully, some students will attend some days and others online to be incorporated gradually like some people are saying.”

Others like Cloe have been preparing a little ahead of time and have talked with the principals and those in charge of the schools to let them know the family’s concerns regarding their child’s diabetes, the care and risks that it would involve, to which the teacher responded “This is a situation in which many of us agree because the most important thing is the health of our little ones. The authorities have mentioned that we will be able to make exceptions when school starts. Do not worry, when the time comes, we can explore options, you have my full support.”

In Mexico, the Aprende en Casa program used five means for teaching, among them, free textbooks in digital and printed format, which include the basis of all the expected learning and programs disseminated in several digital outlets, including free-to-air and cable television channels, radio and printed and digital materials.

The Parents’ Conditions

When asked about the requirements they have as parents to send their children to school, Yahaira said “I do not have any because at this moment I think that if it is in-person, my child will not go to school” while Mónica said “I would require them to supervise the students so they have no contact with each other, and they should be very clear about social distance”.

Apparently, all this causes great uncertainty because of a lack of assertive communication in many of our countries by the educational authorities and, as Adriana says “I would like to know all the measures that would be taken when school starts, but so far there is nothing clear enough so that parents and also children and teenagers with diabetes can sit, think, and make clear decisions so they can all feel safe and calm.”

Gaby, like many other participants, told us that she would prefer a hybrid system since “personally, I think my daughter would be affected if she stays at home any longer, she is at an age in which she tends to get depressed, and to stay up late talking to friends she has not seen in months. Now she has to start at a new school, it would be good for her not to spend so much time at home and go back to school with the appropriate care.”

The Opinion of Children and Teenagers Living With Diabetes on Going Back to School

Fer tells us that she wants to return and that “she would always have to have her face mask on, carry hand sanitizer, she would not hug her friends and keep her distance”. Ian cannot wait to go back, and it is very difficult for Mónica, his mother, not to send him. The same happens with Damián who wants to go back to school and see his friends. However, Matteo knows for sure that he does not want to return.

Zuri, who is 10 years old, tells us “I am very afraid of catching it and having complications with my diabetes.” 11-year-old Pablo says: “I will not go back until there is a vaccine.” Mali, who is 13 years old, is the one who shows the most concern on the subject and says just the thought of being surrounded by children and teachers scares her.

The Official Positions

Sadly, up to the date this article was published, we have not found any information from school authorities or medical societies for our countries in Latin America.

However, on May 20th the Official Position of the Association of Children’s Diabetes Clinicians (ADC) was published, emphasizing the lack of evidence to suggest that children with diabetes are more vulnerable to get the virus than other children, and parents of children with diabetes are called upon to reinforce safety measures such as hand washing and social distancing.

At the beginning of the statement, it says children with diabetes can return to the school environment as long as protective measures are taken. According to the documents, parents should consider whether the children will be able to keep their distance from their classmates, and if someone at home has a greater risk of contracting the virus. In addition, there are other factors that should be considered. Are parents capable of providing quality education from home? Will this distancing have any negative consequences on their development and emotional well-being?

Here are some safety protocols that will be implemented in different countries that you may be able to discuss with your educational authorities if you are a caregiver to a child with diabetes

  • Placement of students by age group: students will attend school in groups or age groups.
  • Students will not interact with other students outside of their age group.
  • A temperature check will be conducted each day before students enter the premises.
  • All staff will wear face shields.
  • Students will have many opportunities to wash their hands daily.
  • Handwashing stations will be created around the premises.
  • Students will not share supplies and materials.
  • Students will be seated at a safe distance from each other.
  • Teachers will be provided with safe cleaning supplies for students to use throughout the day.

Some Conclusions

Viridiana García, Zuri’s mother, perhaps represented what many of us thought and could not put into words “I think that, at the moment, there is nothing more important than the health of our children, and if we weigh the health of our children against their education, their health seems more important. We should remember that nothing is forever, and these moments of crisis will sooner or later pass and we will have time to recover in all aspects.”

While all this goes through the minds of the parents, a question arises, how long are we going to be able to keep the children out of the new normal?

(We would like to thank Viridiana García, Zuri’s mother, for sharing the protocols of her school with us)

About the Authors

Eugenia Araiza Eugenia has a Degree in Nutrition specialized in Diabetes and she is a Diabetes Educator. She was diagnosed with type 1 diabetes 25 years ago, she is the creator of Healthy Diabetes. She really enjoys studying and helping others in managing their different types of diabetes. She loves studying, managing type 1 diabetes, and nutrition. She especially enjoys writing about the impact diabetes has in her life. She lives surrounded by the love of her family, Luis Felipe, who lives with LADA type diabetes and her teenage son, Indigo.

Mariana Gómez Mariana is a Psychologist and Diabetes Educator. She was diagnosed with type 1 diabetes in the summer of 1985. In 2008, Mariana started a blog where she shares her life experience and topics related to living with diabetes and emotional health with others. Mariana worked with the Mexican Diabetes Federation until 2012 and today she is Director of Emerging Markets for Beyond Type 1. She is the mother of a teenager.

For more information on what you can do to protect yourself and others, visit coronavirusdiabetes.org and share the #BigLittleChanges you are making.

Source: diabetesdaily.com

Advocating for Better Care in the Hospital

Most everyone knows that landing yourself in the hospital with diabetes can mean trouble for your diabetes management. A recent study by the NHS showed that patients with type 1 diabetes are 3.5 times more likely to die from COVID-19, and people with type 2 diabetes are twice as likely to die from COVID-19 in the hospital as compared to people who don’t have diabetes.

Patients with diabetes have complained about the quality of care they receive in the hospital setting for a long time, and improvements are slow to reach the bedside. So, what gives? And how can you better advocate for yourself should you find yourself being admitted to the hospital any time soon?

Know Your Rights

Even though you’re in the hospital, you still have rights that doctors need to abide by. If you’re willing and able, some hospitals will let you sign a waiver allowing you to manage your insulin intake and test your own blood sugars while in-patient. If you’re on a continuous glucose monitor (CGM) and/or insulin pump, make sure you ask the nursing staff if you can stay on your technology for the duration of your stay.

Note: Staff will still come into your room and manually check your blood sugar with a hospital-grade meter every few hours, even if you have your CGM on. The more control you can have over your insulin intake and blood sugar management, the better.

John, who lives with type 1 and is from Iowa, says,

“About five years ago I had an overnight stay at the hospital for surgery, and the nurse told me that I had to remove my pump for the stay. I explained I would feel more comfortable with my own settings and control. She finally relented, but made me fill out a sheet every time I bolused or checked my blood sugar, and I was yelled at several times when I forgot to fill out the form… I was happy when her shift ended.”

Ginger, who lives with type 1 diabetes, recalls her experience in labor and delivery with her baby,

“They withheld insulin from me, and I had to take secret injections in the bathroom to keep my blood sugar at an even 90 mg/dL for the sake of my soon-to-be-born child.”

Managing in a New Setting

Managing diabetes in the hospital setting is extremely different from everyday life: your exercise and physical activity levels are way lower, you don’t have control over much of your diet, and things like infections and stress levels can leave your blood sugar sky-high. Keep in mind that you may need to increase basal rates or doses during this time, especially if you’re dealing with illness or infection on top of environmental change. Some ways to improve your management while in the hospital include:

  • If able, walk laps around the floor to get some steps in
  • Don’t request the “diabetic meal”- these meals are extremely high in carbohydrate, and are just fixed at a certain number of carbohydrates per meal. They are not low-carb. Instead, opt for ordering menu items “a la carte” where you can choose a few different protein options and low-starch vegetables as a side
  • Increase your basal rates or doses accordingly (do not just continually bolus, as this can cause your blood glucose levels to crash)
  • If you’re on an IV drip for hydration, make sure it is NOT a dextrose drip (this is the most common kind and will quickly send you into DKA)
  • Make sure the hospital staff allows you to dose for meals before you eat! (due to liability issues, many will try and force patients to dose after they’ve eaten).
  • Try mindful meditation or gentle chair yoga to calm the mind
  • Remind  yourself that your stay is only temporary

Amy, who lives with type 1, expresses her frustration over the meal options that hospitals often provide for their patients,

“Although the doctors were wonderful, I found that they, unfortunately, do not get involved with a type 1 diabetic’s diet. So my first night there (before surgery) I was given a very high-carb meal. Pasta, bread, fruit, and dessert. The nutritionist told me that this was the ‘recommended diet’ since it was pre-carb counted.”

Allie from Brooklyn agreed that getting adequate care in the hospital setting was almost impossible,

“a hospital I was in once denied me insulin for a full 24 hours because they couldn’t get an endocrinologist on call to come consult…”

Advocate for Yourself

When all else fails, you must advocate for yourself. Being in a hospital can be lonely and scary, but if you’re well enough to advocate for better care, you must. Many hospitals and providers are not up to date on the latest diabetes technology and care, so arm yourself appropriately. Some helpful information to have on hand:

  • Contact information for your endocrinologist and primary care physician
  • A printed out diabetes medical management plan detailing how you manage your diabetes to provide to the hospital staff
  • A printed list of all your prescriptions
  • Contact information for your pharmacy and pharmacist
  • An emergency contact’s information

Judy, a type 1 from Georgia, laments,

“…after the hospital began hydrating me (with a dextrose drip), I continued to get worse. They ended up not even putting me on an insulin drip, and removed by insulin pump so during that time I had no insulin on board whatsoever. Eventually, I was transferred to the ICU until an endocrinologist finally realized what was going on…”

Advocating and standing up for yourself can sometimes be the best guarantee that you will receive the treatment you need and deserve when in the hospital setting.

Diabetes is a multifaceted condition affecting major organs and entire body systems. It requires close, quality care and fine attention to detail. As diabetes can affect everyone differently, one must work with their healthcare team to create and follow a care plan based on one’s individual needs. Making sure that patients get this quality care in the hospital setting is crucially important, both for acute and long-term health outcomes.

Source: diabetesdaily.com

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