How I Crushed Type 2 Diabetes in Only Weeks and Completely Changed My Outlook on Life

Editor’s note: We found Rey’s remarkable story in the diabetes online community, and asked him if he would share it with us. Rey experienced extraordinary rapid success by following a precise diet and medication regimen immediately after diagnosis with type 2 diabetes. His improvement was incredible, but others making the same changes may not experience the same success. Please speak to your doctor or caregiver before enacting any major health changes of your own.

I’m Rey, and I’m a 44-year old male with a history of high blood pressure and being overweight, but until recently I had no major health issues. Only this past summer I learned that I had dangerously uncontrolled diabetes. Within the span of just a couple of months, I completely changed my diet, started and then stopped glucose-lowering medications, and got my blood sugar back into the normal, healthy range. Here’s my story.

My First Health Scare

My story is ultimately a diabetes story, but there were some bumps along the way that I think are worth including before I jump into the diabetes.

My adventure really began in the summer of 2020. After some stressful life events, I developed a rather constant state of anxiety, which seemed to be preventing me from getting good sleep. Even while using a sedative, I was up at least 4-5 times during the night, every night. I didn’t have a previous history of mental health problems, so this was all new to me. The especially challenging part was that as time passed, lying in bed became a trigger for the anxiety, which made the sleep even harder to come by. I felt like I was just going through the motions to get through life.

Fortunately, after months of stubbornness and sucking it up the best I could, I finally got to the bottom of things. I discovered it was sleep apnea, and started CPAP treatment. The result was truly life-changing, sleep returned to normal, and my anxiety went away 100%.

Life was great and I’d survived and handled my major mid-life health crisis…. or so I thought! Little did I know, but that relief would prove to be short-lived as in the coming months I started to experience a new set of symptoms.

I was at my highest weight yet and my BMI was creeping towards 30. Some reading this will scoff and think “30 is nothing, I’m well above that,” but everyone’s body is a little different and apparently 30 was my personal breaking point.

My fasting blood sugar was over 100 mg/dL, and my doctor said something about pre-diabetes, but she didn’t sound too concerned about it.

The Symptoms

I was again experiencing sleeplessness. Now I was finding that instead of sleep apnea waking me up during the night, my bladder was sure filling up and I was getting up to pee several times a night. Also, I was quite thirsty when this would happen. I did notice it was nights that I’d eat pizza or pasta for dinner that were the worst. Some combination of stubbornness and perhaps denial kept me from taking this too seriously, so I just kept on with things. Besides, this was March 2021 and you didn’t dare go into a medical clinic unless you were on your covid deathbed. Surely, this was no big deal, and getting checked out could wait.

Still, I sensed something was wrong and I reduced the amount of pizza and pasta I was eating for dinner (maybe twice a week instead of five nights a week), eating beans with rice and veggies for dinner instead. In hindsight, not great, but a minor improvement.

The next major symptom arrived in April: blurry vision. At first, I wasn’t worried. I’d gotten LASIK eye surgery done 12 years earlier, and this change seemed like a mild return of my nearsightedness. I was also in my mid-40s, which I’m told is a time where focusing becomes harder and your vision changes.

Then it got really bad: I was on a trip to Florida when I couldn’t read a menu board that was 8 feet in front of me. I had to resort to taking a picture of it with my phone and then looking at that picture to read the menu. Something was majorly wrong!

When I got back from Florida (after some real nerve-wracking and likely dangerous driving), I went in to get my vision checked and received a -2.0 diopters prescription. The optometrist was shocked that I had let my vision get that bad before getting glasses and made a comment about diabetes, but was also of the impression that my vision would change throughout the day as my blood sugar changed. That clearly wasn’t happening to me (turns out it’s more complicated than that).

The last major symptom was that I had been losing weight at a pretty decent clip (5-10 pounds a month). Obviously, this must have been due to cutting back on pizza and pasta, right? Curiously, past attempts at eating better had never been quite this effective, but why question such great progress when you’re on a roll! At this point, it was late April and the earliest I could get in for a check-up was mid-June, so why not ride out another month of weight loss and see how great my labs come back then?

My Diagnosis

A little over a week before the appointment I started researching diabetes online, since I was starting to wonder about what my doctor and optometrist had said. But surely that takes years to develop, right?

Obviously, my “diet” was working since I had now lost 25 pounds this year and weighed less than I did in my 30s. Who knew eating healthy was so easy!

After a little light reading, I quickly realized how wrong I was, that everything that had happened in the last few months was explained perfectly by diabetes, and that the weight loss might have been diabetes rather than my new diet. This was hard to process.

I picked up a blood sugar meter, and on a Friday night fumbled with the thing enough to figure out how to get a reading. I was shocked when the meter read 567 mg/dL. That can’t possibly be right! My girlfriend tried the meter and her result came in at 77 mg/dL. I tested mine again and this time it registered 596 mg/dL!

At this point, it was 11 PM on a Friday night, and my safest course of action would have been to go to the ER, but I figured if high blood sugar hadn’t killed me in the last 3-4 months, it probably wasn’t going to kill me that weekend. I decided to read more about diabetes, give myself a couple of days to get my wits about me, and go into urgent care on Monday. I also continued to test my blood sugar and it seemed to stay in the 300 to 450 mg/dL range that weekend, regardless of what I ate or whether I was eating.

At urgent care my A1c came in at 13.7%, and my fasting blood sugar was 449 mg/dL. Based on my history, I was more likely to have type 2 diabetes (and additional testing would later confirm that). I was prescribed metformin, and advised to take insulin, advice that I wasn’t ready to take.

Rey kept track of his blood sugar measurements from the moment he began testing, before he was diagnosed with diabetes. You can see his girlfriend’s healthy reading, 77 mg/dL, on the first day.

A New Diet

I now understood that the reason I had lost so much weight so quickly was my uncontrolled diabetes, at least 3 months of it!

I immediately cut most high-carb foods out of my diet and subsisted largely on a diet of full-fat cottage cheese, full-fat plain Greek yogurt, hard cheese, nuts, avocadoes, and canned beans with olive oil. I also kept some fruit and berries in my diet initially. Throughout the day I ate random combinations of these foods. I didn’t really prepare them or fancy them up at all with cooking (other than heating the beans in the microwave so they’d be warm).

I knew I had screwed things up, and if there was going to be any hope of reversing the damage I feared I had done to my body I needed to focus. Maybe I would be able to go back to eating pizza, pasta, and all those delicious carb-filled foods that I loved someday, but it was clear now wasn’t the time for that.

I’d certainly thrown in the towel on diets plenty of times before and gone back to eating like crap, but this time it felt like there was a gun held to my head, and quitting wasn’t an option. Perhaps I’m being overly dramatic about this, and perhaps it wasn’t the healthiest outlook, but it’s how I saw things and it got me through the first weeks where I was at my highest level of motivation.

I wasn’t using a particular diet system I had found on the internet or in a book, it was just me trying to think of all the foods (as a vegetarian) that I normally ate that were lower on the glycemic index, and sticking to those. Frustratingly, there seemed to be a lot of disagreement online in regards to what the “best” diet was for a diabetic, but I’ll come back to that later.

The Right Medications

With this diet and metformin, my blood sugar still ranged from about 250 to 400 mg/dL that first week. My blood sugar really needed to come down since the longer it remained elevated, the greater my risk for diabetes-related complications. Clearly, a week of my new diet and metformin wasn’t enough, and I was more open to exploring what else could be done.

When I saw my primary doctor after that week, she wanted to put me on insulin too, in order to stabilize my blood sugar. Although I knew that insulin would have rapidly brought my blood sugar down to normal levels, using it would have made it difficult for me to gauge if my dietary changes were getting the job done.

Through my research, I had become convinced that SGLT2 inhibitors were the only class of drugs that made any sense for a person with new uncontrolled type 2 diabetes to take (in addition to metformin). Normally in uncontrolled diabetes, your kidneys excrete sugar to your urine as a means of keeping your blood sugar from getting dangerously high, but that effect doesn’t really kick in until your blood sugar levels are way up there. With an SGLT2 inhibitor, your kidneys are just doing that all the time, keeping your blood sugar down in the process. The real beauty of this is instead of insulin, which causes your body to store that excess sugar (only delaying the problem), once you pee out the excess sugar, it’s gone forever.

I asked my doctor for a referral to an endocrinologist and a prescription for an SGLT2 inhibitor instead. She didn’t have much experience with SGLT2s and started talking about other drugs, but she could see I had a pile of notes with me on different drug classes, the research I had done on them. I think she also realized that although she was the one to write the prescription, that I was ready to argue my case.

As soon as I started taking the SGLT2 inhibitor my blood sugar came down almost immediately.

On Farxiga, within days my blood sugar dropped to the 100 to 150 mg/dL range. I had to pee a little more at first too, which suggested the drug was doing exactly what it was supposed to. After a few days, I found I wasn’t peeing any more than normal, which was probably due to my fairly low-carb diet.

[Editor’s note: Rey had an incredibly positive experience with SGLT2 inhibitors, but they are not for everyone, and do carry side effects and risks, especially when combined with low-carbohydrate diets. Please speak to your doctor about changing your medication.]

This was a great improvement over where I was before, but like every newly-minted diabetic I had dreams of reversing my diabetes and getting my blood sugar back to “normal.” I obviously wasn’t there yet and just because you want something doesn’t mean it’s possible or realistic, but I was holding onto that dream.

Remission is a very controversial topic. Most ADA and official-looking literature I found said that diabetes was a progressive disease. As time passes, more drugs are required to maintain the same degree of control, and some pretty awful complications occur as it gets worse and worse. That was a rather depressing outlook. If it all falls apart in the end, why not just go back to enjoying all those carb-rich foods that I love and enjoy whatever time I’ve got left? Fortunately, I didn’t fall into that trap, but I have to imagine many do.

Intermittent Fasting

I was aware of internet doctors out there on the fringes saying type 2 diabetes can be reversed and people can manage through diet alone, without drugs. Are they selling false hope, similar to new-age healers selling energy crystals to cure cancer? Most of them are talking about low-carb and “keto,” which I’d previously assumed to be just another random fad diet. “They’re obviously quacks,” I thought. I figured that American Diabetes Association was most certainly correct about diabetes being progressive, just giving me the cold hard truth. But just for the sake of argument, I decided to hear the quacks out first.

Of the doctors on Youtube, the first to really suck me in was Dr. Jason Fung, a Canadian nephrologist. He had a very intuitive model for explaining type 2 diabetes, and used research on treating the condition with gastric bypass surgery (which has been highly successful) as a starting point. He suggested a low-carb diet combined with fasting in various forms. Hey, I’m already doing the low-carb thing and it seems to be helping. Maybe fasting would be the next nudge I needed.

I started with 3 set meals a day (eating between 7:30 AM and 7:30 PM, and then fasting from 7:30 PM until 7:30 AM the next morning). Around the time I started Farxiga, I moved into the next phase of fasting, which was to skip breakfast and then eat only lunch and dinner (eat at 12 PM and then 8 PM). To my surprise, I no longer felt hunger when I wasn’t eating. I now know that’s a common benefit to the keto diet, but if someone had tried to tell me about that a year earlier, I would have thought they were crazy. Also, I didn’t really know I was doing keto. I was just doing a tighter version of the diet I’d explained earlier, with less fruit and no beans.

I completed my first full-day fast the weekend after starting Farxiga. I didn’t eat anything at all starting Friday after dinner until around 1 PM on Sunday, for a 40+ hour fast. Again, Farxiga had gotten my blood sugar down to under 150 mg/dL on a regular basis, but this was the kick that finally got me back under 100 mg/dL. Throughout Friday it was testing 130 to 150 mg/dL, Saturday morning I was at 144 mg/dL, but as Saturday dragged on and my fast continued I started getting multiple readings under 100 mg/dL. My Sunday morning fasting result was 96 mg/dL and, it got as low as 79 mg/dL on Sunday afternoon before I finally broke my fast. To my surprise, breaking my fast only bumped me to 119 mg/dL and 5 hours later my blood sugar was back down to 82 mg/dL. Seeing this progress felt truly amazing and it was only 16 days after finding out I had diabetes!

Maintenance

Rey’s blood sugars improved rapidly and remarkably with the right combination of diet and medication.

Of course, you don’t eat your way to diabetes in two weeks and you don’t undo your diabetes in two weeks either. I was taking 2,000 mg of metformin a day as well as the SGLT2 inhibitor. The week after my big fast, my fasting blood sugar readings would go back over 100 mg/dL, but I kept plugging away, only eating two larger meals a day during a narrow set of eating hours. I also tested the high-carb waters with a 6-inch Subway sandwich – it spiked my blood sugar to 190 mg/dL, which is much higher than a non-diabetic would likely hit from that meal. That helped knock me back down a peg and remind me that I still had diabetes, after all.

The next weekend I noticed that my blood sugar numbers were starting to come down to under 100 mg/dL without extended fasting. I also noticed that foods that previously spiked my blood sugar a great deal were now spiking it much less. On June 28th (day 24 of knowing I had diabetes and 13 days after starting my SGLT2) I decided to stop taking Farxiga and see what effect it would have. This was not a responsible decision, as you should always consult with your doctor before discontinuing medication, but with my improved blood sugar levels, I questioned if Farxiga was still doing anything for me. It turned out my guess was correct. There was no significant change in fasting or post-meal blood sugar readings in the days that followed, and my type 2 diabetes was now well-controlled via just diet and metformin!

About a week later I started wearing a Freestyle Libre 2 to get a broader picture of my blood sugar trends, and for convenience. My readings were still in the 80-90 mg/dL range throughout the day, with small bumps up over 100 mg/dL after a meal. When I finally was due for my appointment with an endocrinologist to discuss my diabetes treatment, the feel of the visit could best be summed up as “why are you here?” My data showed that my average blood sugar in the previous 10 days had been 95 mg/dL, which would extrapolate to a 4.9% A1C (compared to the 13.7% result when first tested). This is, of course, only an estimate. And my blood sugar had only been well controlled for 2-3 weeks at this point.

Blood sugar wasn’t the only improvement either over last year’s numbers: total cholesterol dropped from 238 mg/dL to 172 mg/dL, with HDL (“good cholesterol”) fairly steady from 64 to 62 mg/dL. LDL (calculated) dropped from 141 to 90 mg/dL. Triglycerides dropped from 165 to 102 mg/dL. The endocrinologist agreed that I no longer needed Farxiga and indicated there really wasn’t a reason for me to see her again, but that I was free to set up another appointment if things changed.

My Best Path Forward

Since then, I’ve done more reading on the keto diet and feel that’s my best path forward to continue to maintain my health, both in terms of diabetes and beyond. I’ve improved enough that I no longer wear a CGM or perform finger sticks to check blood sugar on a regular basis, only checking maybe once a week “just to be sure.” Although I’ve tested out eating some of my old high-carb favorites and been impressed by how much less they spike my blood sugar now, I’m no longer interested in eating them on a regular basis, which is surprising to me. I’ve also found I can sleep through the night just fine without my CPAP machine due to the 35 pounds of weight I have lost from my peak of 215 lbs. The sleep apnea isn’t completely gone, so I still wear the mask most nights, but it appears to be dialed back from severe to mild.

It’s a very weird feeling: when I first found out I had diabetes I wanted nothing more than to continue eating the foods I loved and found comfort in. I felt like something had been stolen from me and feared that my body was permanently broken. Why should other people be able to eat what they want to, and I can’t? It felt very unfair and I really wanted there to be a drug or a treatment that would let me eat how I wanted to. Now that I’ve immersed myself in a better understanding of just how bad those foods were for me, I view things very differently.

I share my story not to lord my results over you if you’ve been less successful with your diabetes. I got really lucky, finding good dietary advice quickly after my diagnosis. Sadly, much of the official guidance out there seems sure to fail. I was also lucky with my uncontrolled diabetes “helping” with the first 25-30 pounds of weight loss.

I no longer have aches and pains when I get up out of bed or have to roll a certain way to avoid them, my memory has improved quite a bit and I’m no longer struggling to recall things I was just told, as I did with high blood sugar levels. I have so much more energy and stamina rather than feeling lethargic or struggling to complete physical activities. It’s like I’m in my 20s all over again (except for a little gray hair)! The downside is I now know if I go back to a lifestyle of enjoying carbohydrate-rich foods, things will go poorly for me, but as long as I don’t, I get to enjoy life so much more than I had before. And there are plenty of delicious foods that aren’t packed with carbs that I’m free to enjoy.

I think diabetes has been a net positive for me, as strange as that sounds. The me of today is very different than the me of a year ago.

Source: diabetesdaily.com

How Community Health Workers Impact Diabetes Care

This content originally appeared on diaTribe. Republished with permission.

By Andrew Briskin

Andrew Briskin joined the diaTribe Foundation in 2021 after graduating from the University of Pennsylvania with a degree in Health and Societies. Briskin is an Editor for diaTribe Learn.

Two major factors that lead to poor outcomes for people with diabetes are food insecurity and a lack of social support. Community health workers can address these issues, connecting people with diabetes to the resources they need.

Community health workers (CHWs) play a crucial role in addressing public health, particularly in communities with lower socioeconomic status and higher rates of chronic diseases, such as heart disease or diabetes. Two of the most significant social determinants of health impacting these communities – food insecurity and social support – can have a profound effect on the ability of people with diabetes to manage their condition. CHWs can play a direct role in addressing these factors by connecting people with resources to access healthy foods, helping them advocate for themselves, providing nutrition education, and connecting with and supporting individuals on a personal and community-wide level.

CHWs are typically members of the communities they serve, who are sometimes in a paid position and other times work as volunteers. Because of how important it is for CHWs to identify and communicate with the people in their community, they typically share the same background, ethnicity, and language. CHWs work in many locations throughout the community, which can include health clinics, government facilities, churches, food banks, other community centers/events, or traveling throughout the area.

Food insecurity is an economic and social condition of limited or uncertain access to adequate food, according to the US Department of Agriculture. People who deal with food insecurity are often only able to afford low-quality foods that lack nutritional value, have access to only a limited food variety, or have disrupted eating patterns (where you aren’t able to eat multiple balanced meals each day). For people with diabetes, these eating habits can be especially harmful when trying to manage things like weight and blood sugar.

Food insecurity, which is a growing problem throughout the United States, has been further exacerbated by the COVID-19 pandemic. Estimates for 2020 indicate that over 50 million people (or one in every six people) dealt with food insecurity in the United States, an increase of 4.1% since 2018. Rates of food insecurity among people with diabetes are also higher than the national average, with estimates suggesting that one in five people with diabetes face food insecurity during any given year, even without the COVID-19 pandemic adding additional stress.

At the ADCES 2021 conference last month, Dr. Anjulyn Ballard, a research and evaluation fellow at the CDC involved in advancing work of CHWs, said, “By CHWs addressing food insecurity and social support, health disparities can decrease significantly within communities.”

Dr. Betsy Rodriguez, senior public health advisor at the CDC Division of Diabetes who trains CHWs, focusing on reaching ethnic minorities and bilingual health communities, joined Dr. Ballard in the presentation. She said of CHWs, “Their advocacy can impact many healthcare-related issues such as improving health while lowering healthcare costs, improving access to primary care, and increasing screening for major conditions such as diabetes, just to name a few.”

Together, they outlined a few of the ways CHWs play an important role in addressing food insecurity and social support in the populations they serve. These roles include:

  • Advocating for individuals and communities. This involves connecting people with helpful resources while also encouraging people to advocate on their own behalf.
  • Conducting outreach. It’s important for CHWs to establish trust through regular communication with individuals in the community.
  • Coordinating access to healthcare. This includes making referrals to healthcare providers, ensuring that people make it to their appointments, and serving as a liaison between the clinics and the individuals assuring as many people as possible get the care they need.
  • Providing coaching and general social support. CHWs should be able to inform people on where to find community forums or others in the community that can provide social support.
  • Providing culturally appropriate health education. This means helping people understand the guidance they receive from their healthcare provider (for example if there are language or education barriers) and providing advice that considers the food, language, and traditions of the specific community they serve.
  • Addressing financial hardship and environmental needs. This involves encouraging people to apply for benefits such as SNAP and assisting them in the application process.

diaTribe recently spoke with Quisha Umemba, founder of Umemba Health, an organization that recruits and trains CHWs in Texas. A certified CHW instructor and diabetes care and education specialist, Umemba discussed how CHWs can support community members in addressing food insecurity and social support.

“CHWs can help people with diabetes advocate for better nutrition and food choices in their community,” Umemba said. “Often, people don’t know they can approach store managers or owners and request a different selection of foods. They also may not know how to approach their local representation in government or how to start a community petition to address issues like food insecurity.”

CHWs can also connect people with diabetes to their local food bank or farmer’s market to get the food they need. “They can provide nutrition education as well,” Umemba added. “Sometimes clients might have access to healthier foods but they don’t always know how to cook them.”

Not sure where to start? At findhelp.org you can enter your zip code and be immediately connected with food assistance, help paying bills, legal aid, and other free or reduced cost programs.

Increasing CHW engagement that focuses on specific interventions can help promote health equity. Unfortunately, there is still a great need for additional funding and resources for CHWs, especially during the pandemic.

Drs. Ballard and Rodriguez said the pandemic has negatively impacted the ability of CHWs to perform their roles. COVID-19 presented the challenge of providing specific pandemic-related support to communities without the necessary funding or virtual resources, they said. Plus, the economic hardships caused by COVID-19 led to an increased number of people requesting assistance from their CHWs with food, transportation, and financial issues.

Umemba agreed. “So much of what CHWs do revolves around establishing a trusted relationship with their clients,” she said. “It was difficult at the onset of the pandemic, but I believe for the most part that CHWs now see that personal interactions don’t just have to occur ‘in-person.’”

Drs. Ballard and Rodriguez also recommended specific interventions to better combat food insecurity and social support on the community level, such as developing standardized training and increasing funding for CHWs across the board. Umemba supported these interventions, lamenting the lack of federal regulations to support standardized training.

“There is no standardized training program for CHWs at the national level, as it is mostly governed by different states,” she said. “When I think about standardized training as it relates to food insecurity, first we need to make sure that CHWs know how to screen for it as well as the other social determinants of health. Also, we need to make sure resources are provided before the patient leaves the clinic, and that appropriate follow-up takes places. CHWs can be trained to screen, assemble and provide the appropriate resources and then follow-up as needed.”

In general, getting support from a community health worker in your area can be an extremely helpful resource not only for general guidance, but to improve your health and diabetes management.

Towards the end of the conversation, Umemba discussed her start in the field, making new observations on the interactions between people with diabetes and various members of the healthcare team such as fitness trainers, dieticians, nurses, and CHWs. Noting how each of these experts was able to connect with people with diabetes, Umemba observed that “year after year, virtually every single biometric including BMI, weight, blood pressure, cholesterol, etc., was better in the group taught by CHWs.”

She concluded that “the more charismatic and identifiable the instructor was, the better the participants did. There are plenty of people taking care of a person’s medical needs but not nearly enough people taking care of a person’s social needs. That’s why I’m such a big cheerleader for CHWs.”

If you need assistance related to food, shelter, healthcare, or financial resources, visit our “Affording Diabetes” resource page. On the right sidebar, you can find a helpful tool that allows you to enter your zip code and connect with a variety of resources in your area.

Source: diabetesdaily.com

10 Diabetes-Friendly and Affordable Finds at Trader Joe’s

Trader Joe’s is a great resource for people looking for convenient and affordable food that is diabetes-friendly and healthy.

The first Trader Joe’s was opened in 1967, and the business has grown to over 500 stores across the United States. They are known for their affordable branded products and offer great customer service, with a full refund guarantee if you are not satisfied with your purchase. The atmosphere is light and friendly with store managers referred to as “captains” and employees are “crew members”. Their Hawaiian shirts and friendly service make this a place you want to go back to.

I have a Trader Joe’s in walking distance from my house but do not take advantage of it enough. There are delicious frozen meals, fresh fruit galore, and tasty desserts all that won’t put you over budget. They also offer great wine and fresh flowers, making this a great place to run in and accomplish more than just picking up dinner.

I reached out to the diabetes online community and the Diabetes Daily forum members to get their recommendations on what to try next. Here are some healthy and affordable options to check out on your next visit.

1. Turkey Burgers

These turkey burgers are made with a combination of white and dark meat, rosemary, and salt, and contain 0 carbs and a whopping 22 grams of protein. They are also extremely convenient as you can cook them without defrosting them. These burgers come in a pack of 4 (think ahead, make two and throw the second over salad for lunch) and cost only $3.29, which makes for a few cheap meals. Be sure to check out their salmon and shrimp burgers too!

2. Mexican Style Riced Cauliflower

This flavorful spicy riced cauliflower makes for a great side dish next to your favorite protein or a great base for a burrito bowl. You can get creative and add grilled shrimp and have a delicious and healthy dinner that only contains 5 grams of carbs!

Cauliflower Gnocchi

Photo credit: Trader Joe’s

3. Cauliflower Gnocchi

Don’t be fooled by the fact it is made with 75% cauliflower. This delicious entree is made for Trader Joe’s in Italy, giving it a little more clout. For 16 net carbs, you can enjoy an authentic tasting pasta-like dish.

4. Oven-Baked Cheese Bites with Summer Truffle

I debated including this one because it is a seasonal item, but keep this on your radar for next year. With only 1 carb, this delicious snack packs a great amount of flavor, with a rare hint of ultra-gourmet truffles, and can be used to make a creative and healthy snack at your next celebration. The recipe attached suggests turning this into a luxe snack mix by adding nuts and pretzels.

5. Butternut Squash Mac N’ Cheese Bites

These bites are made from butternut squash, macaroni, a blend of cheddar and gouda cheese, and some seasonal spices. They are fried and make for a delicious appetizer or side. Coming in at only 18 carbs, this is a unique treat you can definitely sink your teeth into.

6. Egg Frittata with Swiss Cheese and Cauliflower

This is one of my favorite recommendations, to which a store employee agreed, as she excitedly told me she eats them 2-3 times a day!  Coming in at only 10 grams of carbs and 25 grams of protein for 2, this is a great low-carb, high-protein way to start your day that will keep you satiated until your lunch break.

Chewy Chocolate & Peanut Butter Protein Bars

Photo credit: Trader Joe’s

7. Chewy Chocolate and Peanut Butter Protein Bars

With only 12 net carbs, this Trader Joe’s protein bar rivals its competitors in taste and in price too. It can be tough to find good (and affordable) lower-carb snacks to eat on the go. This great snack on the go packs 10 grams of protein, making it a worthwhile snack to keep on hand.

8. Organic Freeze-Dried Berry Medley

If you are looking for something sweet without a ton of sugar to add to your smoothies, shakes, yogurts, and such, look no further. One entire bag only contains 29 carbs (along with 9 grams of protein), so you can feel free to use this sparingly to add some sweet flavor and healthy goodness to any of your favorite protein-filled snacks.

9. Jicama Sticks

This raw root vegetable is ready-prepared for you into small sticks so you can throw over a salad, or get creative and turn it into jicama french fries. Simply sprinkle with olive oil and any seasoning of your choosing and roast or air fry for about 10 minutes at 425 degrees (just double the time if you are using a conventional oven) for a crispy, tasty alternative to french fries.

10. Cauliflower Pizza Crust

This low-carb, high-fiber alternative to the real thing will keep your blood sugars stable and is quite tasty. Top this base with any of your favorite pizza toppings to make a delicious meal for you or your family.

This list just scratches the surface of what healthy finds Trader Joe’s has to offer. Please keep in mind that their offerings do change seasonally and while some of these are not linked to their website, I spoke with a manager who confirmed they are all still offered. Please be sure to also check out their dips, cheese spreads, and fresh produce.

Have you found any healthy good finds at Trader Joe’s? Be sure to share and comment below!

Source: diabetesdaily.com

Quiche the Crust Goodbye

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.

This light veggie quiche is made without a traditional quiche crust in order to keep the carbs down. You can tailor it to your tastes with your favorite veggies and cheese, and pair it with these Cauliflower Hash Browns for breakfast, lunch, or dinner.

Quiche the Crust Goodbye

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Quiche the Crust Goodbye

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This easy, cheesy, fluffy egg casserole ditched the crust but kept the flavor so you’ll be eggcited to dish it up with your favorite fixins.
Course Breakfast
Cuisine French
Keyword quiche
Servings 4 servings
Calories 326kcal

Ingredients

  • 8 eggs
  • 1 cup milk or milk alternative. I used hemp milk, purchased from Trader Joe’s
  • 1-2 tablespoons seasoning I used Green Goddess Seasoning from Trader Joe’s
  • 1 cup cheese shredded. I used a Swiss/Gruyere blend
  • 1 cup sautéed veggies of choice I used chopped asparagus, mushrooms, and white onion
  • 3 tablespoons green onions finely chopped, plus 2 tablespoons for garnish
  • salt to taste
  • pepper to taste
  • ¼ cup goat cheese 1-2 oz, crumbled

Instructions

  • Preheat oven to 350 degrees.
  • Chop and sauté veggies in a large skillet over medium heat.
  • Crack eggs into a large mixing bowl and whisk.
  • Add seasoning, milk, and cheese to eggs, and whisk again until combined.
  • Add sautéed veggies and freshly chopped green onion, and whisk together.
  • Spray a 9×9 glass baking dish (or 9″ glass pie dish) with nonstick cooking spray and pour egg mixture into dish.
  • Bake for 40-45 minutes, or until set in the middle.
  • Garnish with more fresh green onion, crumbled goat cheese, and salt and pepper, if desired.

Nutrition

Calories: 326kcal | Carbohydrates: 7g | Protein: 23g | Fat: 23g | Saturated Fat: 12g | Polyunsaturated Fat: 2g | Monounsaturated Fat: 7g | Trans Fat: 1g | Cholesterol: 370mg | Sodium: 380mg | Potassium: 292mg | Fiber: 2g | Sugar: 4g | Vitamin A: 1111IU | Vitamin C: 1mg | Calcium: 404mg | Iron: 3mg


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.

Quiche the Crust Goodbye Recipe

Source: diabetesdaily.com

Matcha Latte Bombs: Low-Carb, Dairy-Free & Satisfying

This content originally appeared here. Republished with permission.

These keto-friendly green tea Matcha Latte Bombs are a fun take on the Tik Tok recipe trend, just like my Bulletproof Coffee Bombs! So if you’re looking for a little extra and want to have some fun, make these matcha latte bombs! There are a few simple steps to take to get them just right, so keep reading.

Sure, you could take these ingredients and make a regular matcha latte (and it would be fabulous!), but think it’s worth the extra effort to make the bombs because they have a super satisfying melt and pop.

Take it from a former barista, matcha lattes are even better than espresso!

Keto Matcha Latte Bombs

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Keto Matcha Latte Bombs

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Make the best ever bulletproof Keto Matcha Latte, and level it up with these fun melting bombs!
Course Drinks
Cuisine American
Keyword matcha
Prep Time 20 minutes
Cook Time 5 minutes
Total Time 25 minutes
Servings 1 serving
Calories 117kcal

Equipment

  • milk frother

Ingredients

Keto Matcha Latte

  • 1 cup almond milk unsweetened
  • 1 teaspoon matcha powder
  • 1.5 – 2 teaspoons monk fruit sweetener or erythritol
  • 2 teaspoons coconut oil

Optional Ingredients

  • 1 tablespoon whipped cream sugar-free
  • 1/8 teaspoon vanilla extract

Instructions

Make the Matcha Latte Bombs

  • Spoon about one teaspoon of softened room temperature coconut oil into each half sphere of your silicone mold, two half spheres for each bomb you plan to make. Pay extra attention to coat the sides, all the way up to the edges. Set the mold in the freezer for about 15 minutes, until hardened.
  • Use your hands to carefully remove the hardened half spheres, and set them on a chilled plate. Fill half of the pieces with matcha and sweetener.

    One at a time, rub the unfilled spheres face down in a warmed skillet, just for about 5 seconds. This will melt and flatten the edge, then use your fingers to close over one of the filled half spheres, smoothing and sealing the edges. If necessary, take a little more room temperature coconut oil and fill any gaps.

  • Set the filled bombs in the freezer for another 5 minutes, then sprinkle lightly with a little more matcha powder. Last, transfer the finished matcha bombs to an airtight container and store in the freezer until you’re ready to make your latte!

Make the Latte

  • Heat the almond milk in a small sauce pan until it starts to simmer, then transfer to a mug. Use a spoon to gently drop the the matcha bomb into the mug and wait for it to melt. Use a milk frother to fully combine and froth.

Notes

To store: Set in an airtight container and store in the freezer until you’re ready to use them!

Nutrition

Calories: 117kcal | Carbohydrates: 1g | Protein: 3g | Fat: 11g | Saturated Fat: 7g | Sodium: 325mg | Potassium: 1mg | Fiber: 1g | Sugar: 1g | Vitamin A: 200IU | Calcium: 300mg | 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.

Keto Matcha Latte Bombs Recipe

Source: diabetesdaily.com

10 Fruits with 10 Net Carbs or Less

Fruits are high in vitamins and minerals and have several health benefits, including reducing the risk of obesity, heart attack, and stroke. However, all fruit contains sugar, and this can be challenging for those of us living with type 1 or type 2 diabetes. The fruit mentioned below all have a carbohydrate count of 10 carbs and are low GI foods which means they won’t spike you as quickly. These fruits are also loaded with fiber, which can help keep you fuller longer, promote good digestion, and help your overall blood sugar management.

Be mindful of the carb count of the fruit you’re eating: it will help you enjoy this healthy and delicious food without spiking your blood sugar. And please note that fresh fruit and frozen fruit are always better choices than fruit that comes in a can or jar. Also, avoid processed fruits and dried fruits that contain extra sugar.

Here are 10 fruits that contain 10 carbs or less per serving:

Tomatoes

Surprise! The tomato is a fruit, and I find it to be one of the most versatile fruits to work with. You can eat tomatoes over a salad, serve them with fresh mozzarella and a drizzle of balsamic vinegar, roast them, or turn them into a sauce and add it to any of your favorite proteins. Tomatoes contain a slew of vitamins, minerals and antioxidants and only contain 4.8 grams of net carbs for an average-sized tomato (about 123 grams/4.3 punches).

avocado

Avocados

Containing only 1.7 grams of net carbs per 3.5 ounces/100 grams of avocados, this is a great choice that is full of healthy fats and antioxidants. It is also high in fiber, contains potassium, Vitamin K, Vitamin C, and folate. Adding some avocado to a salad is a flavorful way to get in some good nutrients without spiking your blood sugar. You can also turn this into guacamole and serve it with your favorite crudite.

Strawberries

This personal favorite of mine contains only 8 net grams of carbs per cup. This fruit is high in vitamins, fiber, and antioxidants, along with many other nutritional benefits. You can do so much with strawberries and don’t have to worry too much about your blood sugars. Make a smoothie, toss on your favorite summer salad, or dice them up and add to greek yogurt. Add a drizzle of sugar-free chocolate syrup for a decadent and healthy snack.

Lemon and Lime

While most people don’t actually eat whole lemons and limes, either is a great addition to water to make it more palatable. It is also great to mix with your favorite alcohol for a low-sugar tasty drink. Lemon and lime both only contain 7 net carbs per serving, so feel free to use them generously in your drinks and to season meals as well.

Blackberries

Out of all the really fruity fruits, berries contain the lowest amount of carbs, only 8 net carbs per cup. (Blueberries, by contrast, contain 17 net carbs per 1 cup serving). They are packed with vitamins and high in fiber, making them a great choice.

kiwi

Photo credit: Pranjall Kumar (Unsplash)

Kiwi

Unbeknownst to many, kiwis are berries, and like most other berries they have minimal sugar, coming in at 8 net carbs per kiwi. The health benefits of kiwis are plentiful, they are packed with vitamins, antioxidants and are high in fiber, which will help aid digestion. When it comes to using kiwi, the options are endless- smoothies, puddings, desserts, even bread. Check out these recipes for more ideas on how to use this super fruit.

Plums

This fruit only contains 7.5 net carbs per average-sized plum and is packed with nutrition. Plums have also been found to reduce blood sugar thanks to a hormone, adiponectin, which helps regular blood sugars.  The fiber will also help avoid a quick spike in your blood glucose levels.

Rhubarb

Coming it at only 1 net carb per cup, this fruit is worth the effort. You can eat it on its own (only the stalk; the leaves are poisonous), but most people use it to bake with. This superfruit is packed with vitamins and antioxidants and has numerous health benefits, such as aiding collagen production and fighting inflammation, to name a few.

Watermelon

With only 8 grams of carbs per 100 grams/3.5 ounces of watermelon, this is a delicious refreshing fruit you can enjoy any time of year. Not just high in vitamins and antioxidants, watermelon also contains lycopene, which has has been found to lower blood pressure and cholesterol, reduce inflammation, and benefit brain health.

Cantaloupe

Like watermelon, cantaloupe only contains 8 grams of carbs per 100 grams/3.5 ounces. It is full of vitamin A, C, and potassium. You can get pretty creative with this succulent fruit by turning it into sorbet, cantaloupe chia pudding, or even this refreshing drink

Do you try to stick to low-carb fruits? What are some of your favorites and how do they impact your blood sugar levels? Share and comment below!

Source: diabetesdaily.com

Your Brain and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Brett Goerl and Matthew Garza

Recent studies have shown a link between brain diseases like Alzheimer’s and Parkinson’s and diabetes.  Unfortunately, these conditions are becoming more common as our population grows older. Find out more and ways to improve brain health.

What are neurodegenerative diseases?

The term “neurodegenerative diseases” refers to a range of diseases in which the cells in our brains break down and can no longer perform their designated functions associated with movement or mental ability, according to the EU Joint Programme – Neurodegenerative Disease Research. The most common neurodegenerative diseases that affect people with diabetes are mild cognitive impairment (MCI) and dementia, which includes Alzheimer’s disease.

As we age, it is completely normal for our memory, thinking, and judgment to slightly decline. However, MCI occurs when our mental abilities decline faster than expected and begin to interfere with our daily lives. Age is by far the biggest risk factor for MCI, but diabetes, smoking, high blood pressure and cholesterol, obesity, and depression can further increase a person’s risk of developing MCI.

In around 10-15% of cases each year, the mental decline seen in MCI may progress further, making it difficult for us to carry out a healthy and happy life. When this happens, it is called dementia. The two most common types of dementia that affect people with diabetes are Alzheimer’s disease (AD) and vascular dementia.

While the symptoms of AD and vascular dementia are similar, they are caused by two different processes that occur in our brains. AD is thought to be caused by the abnormal build-up of proteins in the brain. One protein is “amyloid,” which clumps together in spaces around brain cells. The other protein is “tau,” which get tangled up inside brain cells. Vascular dementia, on the other hand, occurs when the blood vessels in our brain become narrow or start to bleed. This reduces the brain’s ability to get the oxygen it needs to keep brain cells healthy and for the brain to function properly. In both cases, brain cells become damaged, leading to a wide range of problems such as memory loss, worsened judgment, and personality changes.

AD is the most common form of dementia in the US, making up 60-70% of dementia cases. In the US, an estimated 5.4 million people of all ages are affected by AD, and one in eight people 65 years and older suffer from it. Considering the 14.3 million adults aged 65 and older in the U.S. who have diabetes, and it is easy to see why Alzheimer’s disease and diabetes are two of the most common diseases of aging. And recent research has suggested that they may be linked in various ways.

How do neurodegenerative diseases like Alzheimer’s and vascular dementia relate to diabetes? 

We often think of diabetes as a problem with our metabolism since the lack of insulin (in type 1 diabetes) or insulin resistance (in type 2 diabetes) affects our body’s ability to maintain normal blood glucose levels. However, our brain consumes the most glucose compared to any other organ in our body. While the brain accounts for roughly 2% of our body weight, it uses almost 20% of the sugars we eat or release from our body’s stores.

An increasing amount of research shows that people with AD and other forms of dementia experience insulin resistance in the CNS (central nervous system, which includes the brain and the spinal cord), similar to what people with type 2 diabetes experience in other areas of the body, such as the muscles, the liver, and the fat. Scientists have yet to determine exactly what the relationship between diabetes and AD or other forms of dementia may be caused by, but there are a few theories that have been proposed.

  • One of these theories focuses on brain insulin resistance, which is when brain cells stop responding normally to insulin, leading to problems related to the ways our brain cells communicate, use energy, and fight infection.
    • Insulin receptors can be found in many areas of the brain, where they are involved with brain cell growth, communication, and survival. While insulin levels are lower in the brain than in the bloodstream, all the insulin that makes its way to the brain comes from the same insulin produced in the pancreas – it crosses over what is known as the blood-brain barrier (or BBB). This barrier prevents unwanted things from the bloodstream from entering the brain. However, injected insulin does not cross the BBB. The reduced transport of insulin across the BBB may be why brain insulin levels are lower when the body experiences insulin resistance (such as in pre-diabetes and type 2 diabetes) and in diseases such as AD.
    • Insulin in the brain is known to help control our metabolism in certain other organs of the body, like the liver and fat tissue. The hypothalamus, the part of our brain that controls hunger, thirst, and emotions, is highly sensitive to levels of insulin in the brain. The association between type 2 diabetes and brain health may be due to problems with insulin’s actions in the hypothalamus, increasing a person’s likelihood of developing whole-body insulin resistance.
  • Diabetes also increases the risk for damaged blood vessels, leading to heart disease and stroke. Damaged blood vessels can starve the brain of oxygen, leading to cognitive decline and vascular dementia.
  • Diabetes disrupts how our bodies produce amylin, a hormone related to insulin that helps our bodies digest food. People with obesity and pre-diabetes often have high amounts of amylin, some of which can circulate and cross into the brain. Studies have shown that amylin can interact with the same protein deposits in the brain known to cause AD.
  • Experiencing hyperglycemia for long periods of time can degrade the myelin sheath (a protective layer that surrounds your neurons). This leads to issues in how your nerves send and receive signals to your body. It can also lead to your brain cells dying.

Type 1 diabetes could be a risk factor for dementia for many of the same reasons as type 2 diabetes. In particular, the cardiovascular complications such as heart disease and stroke that are associated with type 1 diabetes could provide an explanation for its relationship with vascular dementia. Additionally, higher rates of cognitive dysfunction for those with type 1 diabetes could be related to frequent cases of hyperglycemia and hypoglycemia. Indeed, severe hypoglycemic and hypoglycemic events are associated with increased dementia risk for older adults with type 1 diabetes.

Is diabetes a risk factor for developing neurodegenerative disease? 

On average, people with diabetes experience slightly more cognitive difficulties associated with MCI across their lifespan, but experiencing cognitive difficulty does not mean you will eventually get diagnosed with dementia or AD. The prevalence of type 2 diabetes and neurodegenerative diseases, however, both increase with age, meaning it is more common for older people (65+ years) with type 2 diabetes to get diagnosed with vascular dementia or AD.

Data suggests that people with diabetes have a 73% increase in the risk of developing any type of dementia and 56% increase in the risk of developing AD compared to people who do not have diabetes. This makes diabetes one of the strongest risk factors for getting dementia aside from aging. Health measures like A1C, cholesterolhigh blood pressure(or hypertension), and eGFR are negatively impacted by diabetes and may also be associated with cognitive performance and neurodegenerative diseases.

  • In the ACCORD-MIND trial, the largest and most rigorous study on diabetes and the brain to date, higher A1C levels were associated with lower cognitive function in people with diabetes. Similarly, another study found that the risk for dementia increased as a person’s A1C level increased, regardless of whether or not the person had type 2 diabetes.
  • A recent analysis of over 100 studies found that higher levels of LDL cholesterol (known as “bad cholesterol”) was an independent risk factor for the development of AD.
  • High blood pressure in middle-aged people has been linked to future cognitive decline and dementia, and in particular, vascular dementia. This may be due to high blood pressure in the brain causing damage to blood vessels, such as small blockages and bleeding.
  • In a study on kidney health and dementia recently published recently, researchers found that lower rates of kidney filtration (as measured by eGFR) were associated with higher risk of onset of both vascular dementia and AD.

What about Parkinson’s Disease?

Parkinson’s Disease (PD) is another neurodegenerative disease associated with aging. In PD, the cells in your brain deteriorate and begins to affect a person’s ability to perform daily activities associated with movement. Symptoms can include tremors (rhythmic shaking), muscle stiffness and rigidity, and PD can even slow your movement in a process called bradykinesia. It can also lead to other symptoms not associated with movement such as disrupting sleep, constipation, anxiety, depression, and fatigue.

As with other neurodegenerative diseases, research has been conducted to identify if there is a link between diabetes and PD. In particular, one study from 2018 showed an association between the two conditions. The researchers looked at the English National Hospital Episode Statistics and Mortality Data from 1999-2011 and divided the data into two cohorts, those with type 2 diabetes (2,017,115 people) at the time of hospital admission and those without (6,173,208 people). It was found that those with diabetes had a 30% higher chance of developing PD than those without, and the younger a person was with diagnosed type 2 diabetes, the more likely their chance of developing PD.

Though researchers do not yet understand the exact way that diabetes and PD are related, they do have a few hypotheses. Namely, there is the chance that certain genetic abnormalities that lead to diabetes may also lead to PD; even if one of these conditions does not directly cause the other, people who have one may be more likely to also have the other. In addition, when diabetes and PD coexist in a person, they may create a more hostile environment in the brain, leading the neurodegenerative processes underway in PD to speed up and be more severe.

What are strategies to reduce the risk of developing a neurodegenerative disease?

There is evidence that leading a healthy lifestyle can reduce your risk of developing diabetes-related complications like dementia or PD. For example, heart attacks and stroke can increase the risk of developing vascular dementia; therefore, lifestyle modifications that help you maintain an ideal blood pressure and levels of cholesterol for your age and health status are important. This can be accomplished by exercising regularly and consuming a diet low in saturated fat, salt, and sugar.

Below are some other tips for improving brain health, which can go a long way in reducing the risk of neurodegenerative diseases like AD. The good news is that many of these strategies are also recommended for managing diabetes.

  • Take control of your blood glucose levels by aiming for a greater time-in-range (TIR). To learn more about time-in-range goals, click here.
  • Smoking is associated with higher rates of dementia. In a recent review, smokers were 40% more likely to develop AD than non-smokers. Given that people with diabetes are at an increased risk of developing dementia, smoking is likely to increase this risk further. If you smoke or experience nicotine addiction, talk to your healthcare professional about a plan to quit or cut back.
  • Keep blood pressure at the target discussed with your health care provider (which might be 130/80 mmHg or less, if you are at high risk of cardiovascular disease) by exercising regularly and eating a diet low in salt (aim for less than 2,300 mg of sodium each day)
  • Take your diabetes medications consistently and as directed by your healthcare team. Some early evidence shows that certain diabetes drugs, like GLP-1 receptor agonists, may be beneficial for brain health. In fact, exenatide, a GLP-1 receptor agonist, is currently in clinical trials for treating PD.
  • A very active area of research focuses on the dementia-preventing effects of having an active and stimulating mental life and rich social networks. Working to maintain an active and socially rich lifestyle could help prevent some of the effects of diabetes on dementia risk.

If you are 65 years of age or older and have memory concerns or other cognitive complaints (i.e., brain fog, depression, personality change), talk to your healthcare provider about getting a cognitive assessment. Learn more here.

Source: diabetesdaily.com

Remission, Not Reversal: Experts Agree to Define Ultimate Type 2 Diabetes Success

Type 2 diabetes can be considered “in remission” if patients can maintain non-diabetic blood glucose levels (<6.5% A1c) for 3 months without medication, according to an international panel of experts.

On August 30, the American Diabetes Association joined the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK in co-authoring a consensus statement on “the definition and interpretation of remission in type 2 diabetes.” Here’s a press release, and here’s the full statement.

Remission is Becoming More Common

Type 2 diabetes remission has always been rare – a 2014 survey concluded that fewer than 2% of adults with diabetes experienced any level of remission without bariatric surgery – but in recent years, it has become more common.

The increasing prevalence of diabetes reversal owes partially to the rise in bariatric surgery, but is also likely due to the proliferation of new weight loss and diabetes management techniques. Although diabetes rates continue to rise unabated throughout the world, experience and understanding of the disease have led to superior treatment strategies, allowing a minority of patients to return their blood glucose levels to non-diabetic levels.

Now there are even companies, such as Virta Health, that have based their entire business strategy on the belief that diabetes “reversal” is within the reach of millions of adults with the condition.

With so much attention paid to diabetes remission, the world’s major diabetes authorities decided that the phenomenon of diabetes remission or reversal needed to be properly addressed, named, and described. The consensus statement should help guide study of the phenomenon, and give doctors and patients a framework for understanding just what remission really means.

What’s in a Name?

The experts seem to have given very careful consideration to what word doctors should use to refer to the achievement of regaining non-diabetic blood sugar levels. Many in the diabetes world use words like “reverse” or “correct” or even “cure” to refer to this phenomenon, each of which has its own implications. To speak of a “cure,” for example, is to imply that the disease has left and will never return; in the case of a patient that needs to keep up with dramatic lifestyle adjustments to keep their blood sugar at non-diabetic levels, this is a plainly inaccurate label. “Reversal” and “resolved” likewise suggest similar shades of meaning.

The panel decided,

that diabetes remission is the most appropriate term. It strikes an appropriate balance, noting that diabetes may not always be active and progressive yet implying that a notable improvement may not be permanent.

The term also accounts for the fact that while patients with diabetes may have achieved normal glycemic levels, they may still suffer from insulin resistance and/or deficiency, factors that may mean that they need to continue keeping a careful watch on their blood sugar management.

An earlier statement from the American Diabetes Association on type 2 remission categorized patients into different types of remission – partial, complete, and prolonged. These categories have been discarded as unhelpful.

Diagnosing Remission

Type 2 diabetes remission is now defined “as a return of HbA1c  to < 6.5% (<48 mmol/mol) that occurs spontaneously or following an intervention and that persists for at least 3 months” without the use of insulin or glucose-lowering medications. (The statement also allows for some other manners of diagnosing remission, such as using fasting blood glucose, in cases where HbA1c may be unreliable.)

The 3- month time parameter helps weed out both fluke A1c results and the lingering effect of medication, which can last for months after it’s been discontinued. Lifestyle interventions (changes to diet and exercise) and surgery (especially gastric bypass) can precipitate diabetes remission.

At the moment, the experts advise that patients in remission should have their A1c, as well as any potential diabetic complications, checked annually.

By definition, patients with type 1 diabetes cannot achieve remission (except under perhaps under unique and extraordinary circumstances), given their lifelong reliance on exogenous insulin

How to Achieve Remission

The most reliable way of creating type 2 diabetes remission is through bariatric surgery: nearly half of the patients in a Swedish cohort experienced lasting remission.

Bariatric surgery, however, is a very intense and expensive operation, and it comes with its own risks and complications; most patients with type 2 diabetes will not be considered good candidates. For the rest, weight loss, however it may be achieved, appears to be the best path to remission. Experts additionally debate the efficacy of specialized eating patterns, such as low-carbohydrate diets and therapeutic fasting.

Remission may not be a realistic goal for everyone, and researchers don’t yet have a solid understanding of why some patients are better able to reset their metabolic health than others.

We have an entire article on diabetes remission – originally published using terminology that is now officially out of step with mainstream practice: What You Need to Know About Reversing Type 2 Diabetes.

Going Forward

There’s an awful lot we still don’t know about remission. To date, diabetes remission has not attracted much attention from researchers, possibly because it was considered such a rarity. But with that changing, the diabetes authorities behind the consensus statement recognized a need to guide the questions of researchers.

The statement includes a laundry list of areas where future study is required, including:

  • How often patients in remission need to be re-evaluated
  • Whether or not patients in remission could still benefit from metformin and other drugs
  • Whether other metabolic parameters (such as cholesterol levels) need to be monitored
  • How long remission can be expected to last
  • What impact remission has on longterm health outcomes

Having finally named and described the phenomenon, the panel hopes to spur research into the reality of the condition so that it may be better understood.

 

Source: diabetesdaily.com

Lemon-Herb Halibut with Caprese Topping

This content originally appeared on ForGoodMeasure. Republished with permission.

While Insalata Caprese was created post WW1 as a patriotic Italian tribute, Caprese salad also plays homage to summer’s colorful bounty. Juicy tomatoes, aromatic basil, refreshing mozzarella & fruity olive oil, paired with a lemon-herb halibut and a drizzle of pesto. Squisito! Simple, yet layered, this recipe is the perfect ending to a sun-kissed day.

Lemon-Herb Halibut with Caprese Topping

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Lemon-Herb Halibut with Caprese Topping

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Simple, yet layered, this recipe is the perfect ending to a sun-kissed day.
Course Dinner
Cuisine Italian
Keyword fish
Servings 4 servings
Calories 248kcal

Ingredients

  • 3 tablespoons olive oil divided
  • 1 tablespoon lemon juice
  • 1 tablespoon parsley minced
  • 1 teaspoon basil
  • 1 teaspoon garlic minced
  • 1 teaspoon sea salt divided
  • 1/4 teaspoon black pepper divided
  • 4 four-ounce halibut fillets
  • 1 cup cherry tomatoes halved
  • ½ cup mozzarella pearls halved
  • ¼ cup basil leaves

Instructions

  • In a small bowl, combine 2 tablespoons olive oil, lemon juice, parsley, basil, garlic, ½ teaspoon sea salt & ⅛ teaspoon pepper.
  • Set aside.
  • In a shallow dish, place halibut fillets in a single layer.
  • Pour olive oil mixture over halibut, refrigerating for one hour.
  • Meanwhile, in a small bowl, toss cherry tomatoes in remaining 1 tablespoon olive oil.
  • Add mozzarella pearls, seasoning with remaining ½ teaspoon sea salt.
  • Set aside for 30 minutes.
  • Line a shallow baking dish with parchment.
  • Preheat oven to 450 degrees.
  • Place marinated halibut in prepared baking dish.
  • Bake until internal temperature reaches 145 degrees, or desired doneness.
  • While baking, add basil and remaining ⅛ teaspoon black pepper to tomato mixture.
  • Top baked fillets with Caprese mixture.
  • Serve alongside basil pesto, if desired.

Nutrition

Serving: 4ounce | Calories: 248kcal | Carbohydrates: 3g | Protein: 25g | Fat: 15g | Cholesterol: 67mg | Sodium: 751mg | Fiber: 1g | Sugar: 1g


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.

Lemon-Herb Halibut with Caprese Topping Recipe

Source: diabetesdaily.com

How Do We Measure Successful Diabetes Care?

This content originally appeared on diaTribe. Republished with permission.

By Arvind Sommi, Andrew Briskin

Quality measures are tools to evaluate the effectiveness and quality of healthcare. Measures such as A1C, blood pressure, and cholesterol are used to understand health at the population level to ensure people with diabetes are getting the best care possible. At The diaTribe Foundation, we believe that Time in Range would be a valuable addition to the quality measures for diabetes care.

During a routine office visit, your healthcare provider may check certain health measures such as your A1C, blood pressure, and cholesterol. These tests are primarily used to assess your individual health and the effectiveness of your diabetes treatment plan. They are also used to evaluate the overall quality of care provided when these results are combined across all patients in a healthcare professional’s office, healthcare system, or health plan.

Recent advances in glucose monitoring, and the increasing use of continuous glucose monitors (CGM), has led to wider use of the metric Time in Range (TIR), which is a helpful supplement to A1C in assessing your glucose management. Because of this, TIR could be a valuable addition to the quality measures for diabetes care if it became a more widespread metric – a feat that is challenged by barriers to accessing CGM and integrating it into electronic health records.

What is a quality measure?

Quality measures can encompass many things but generally include different types of measurement domains, as outlined below.

Diabetes care

Source: diaTribe

Some tests, such as A1C screening or blood pressure monitoring, can serve as both a healthcare process and an outcome measure.

At the population level, outcome measures evaluate whether certain established goals are reached for a group of people. For example, this might be the percentage of patients in a healthcare practice with an A1C greater than or less than 9.0%. Quality measures, in this way, are used by insurance providers, people with diabetes looking for the best healthcare professionals to use, researchers, employers, and reporting agencies to better understand the effectiveness of diabetes treatments and evaluate how effective healthcare professionals or health systems are.

How are quality measures used in diabetes care?

Quality measures are important in diabetes care because achieving these goals can decrease the risk of diabetes complications and lead to improved health outcomes for everyone. There are several quality measures in diabetes care, many of which you may be familiar with through routine office visits with your healthcare team, such as:

Primarily, the combined data from these tests across many people with diabetes is used to determine if certain treatment methods are effective for the entire population. The data can also be used to reinforce or dispute established standards of diabetes care and respond to new care innovations (such as the latest technology or treatments).

Along with their use in evaluating treatments and standards of care, quality measures can also be used to evaluate healthcare professionals. In some cases, healthcare provider reimbursements from Medicare or other insurance providers may be tied to results, particularly under a value-based care model (learn more about value-based care here). For example, A1C screenings might be reimbursed only if enough patients meet A1C targets below certain thresholds.

Why might including Time in Range in quality measures be helpful to you?

While A1C is the current quality measure used to assess glucose management in people with diabetes, A1C has limitations. The accuracy of A1C measurements can vary based on factors such as race/ethnicity or chronic kidney disease. A1C tests are also generally limited to every two to three months and only represent an average blood glucose level over that time, which means daily highs and lows are not explicitly captured. Additionally, while low blood sugar may lower your A1C, it can also increase your risk of severe hypoglycemia – meaning a lower A1C may be dangerous if you experience frequent low blood sugars or mild hypoglycemia.

Time in Range is a glucose metric typically measured by a CGM. It is the amount of time you spend in the target range – generally between 70 and 180 mg/dL. The goal for most people with diabetes is to have at least 70% of your glucose readings within this range. Understanding your TIR as well as your time above and below range can help you and your healthcare provider assess how your body responds to medications, food choices, daily activities, stress, and a variety of other factors that affect your glucose. The increased use of TIR could help equip people with diabetes and their healthcare team with the information they need to make vital healthcare decisions and experience better diabetes care.

Time in Range allows for quick, actionable steps to improve diabetes management and corresponding health outcomes,” said Dr. Diana Isaacs, a diabetes care and education specialist from the Cleveland Clinic. “Time in Range can be assessed more frequently and provides more actionable insight into glucose management. Making it a quality measure would increase the utilization of this powerful tool. It has the potential to revolutionize how we take care of people with diabetes.”

Increases in TIR have been associated with a reduced risk of microvascular complications such as eye (retinopathy) and nerve disease (neuropathy), with similar evidence emerging for other macrovascular complications such as heart disease. Plus, the use of CGM has increased dramatically over the last few years (for example in people with type 1 diabetes in the T1D Exchange registry, this number rose from 6% in 2011 to 38% in 2018), allowing more people with diabetes to use TIR data on a regular basis.

However, there are still barriers to integrating TIR as a quality measure for diabetes care. One major challenge is the many barriers to using a CGM. For instance, most insurers cover CGM only for a limited number of people with diabetes (for example, those with type 1 diabetes who take insulin). Until access is substantially expanded and more people are able to use CGM who wish to, TIR adoption into the standard quality measures will be difficult.

An additional challenge is that TIR data is not integrated into most electronic health records (EHR) used by clinicians, making it difficult for providers to analyze TIR data for all patients and to assess TIR at the community level. Efforts are currently underway to change these systems so that TIR can be integrated into her systems, similar to metrics like A1C and blood pressure; at the ADA Scientific Sessions this year Dr. Amy Criego spoke to the success that the International Diabetes Center in Minnesota has had with integrating Abbott LibreView data into their EHR.

Through the efforts of the Time in Range Coalition, diaTribe is working to increase awareness and hopefully the eventual adoption of TIR as a meaningful quality measure in diabetes care.

Source: diabetesdaily.com

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