Improving Blood Sugar Estimates

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Diabetes occurs when your blood glucose, or blood sugar, is too high. Over time, having too much glucose in your blood can cause health problems, such as heart disease, nerve damage, eye disorders, and kidney disease. The primary test used to estimate glucose levels for diabetes management is called the A1C test. The A1C test measures the amount of glucose attached to hemoglobin, the protein in red blood cells that carries oxygen. Red blood cells are constantly forming and dying. They typically live for about 3 months. Therefore, A1C results provide an estimate of a person’s average blood glucose levels over the past 3 months. However, levels of hemoglobin with glucose attached (glycated hemoglobin) can fluctuate depending on factors other than blood glucose, making A1C testing somewhat inaccurate.

To improve the accuracy of blood sugar estimates, a team led by Dr. John Higgins at Harvard Medical School and Massachusetts General Hospital investigated individual biological differences that may affect A1C results. The research was funded in part by National Institutes of Health’s (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and an NIH Director’s New Innovator Award. Results were published in Science Translation Medicine on October 5, 2016.

The researchers analyzed data from their own hospital as well as from 3 previously published studies to assess how well the amount of glucose attached to hemoglobin reflects patients’ actual blood glucose levels. They found that the correlation was somewhat different for each patient. Using mathematical modeling, the team investigated biological differences that might contribute to the data’s variation.

Red blood cell turnover can occur on slightly different timescales for each person. Older red blood cells have more time to accumulate glycated hemoglobin than newer red blood cells. Differences in the average age of red blood cells for each patient, the researchers found, accounted for all of the variation seen between levels of glycated hemoglobin and blood glucose.

To personalize the model’s estimates, the team acquired data for more than 200 patients from 4 independent studies. The researchers determined the average red blood cell age for each person based on the relationship between continuous glucose measurements—taken using a tiny sensor inserted under the skin—and glycated hemoglobin measurements taken from a blood test. Using this information in the model, each patient’s average blood glucose levels could be calculated based on A1C tests with higher accuracy than the current standard method, reducing estimation errors by more than 50%.

“What we currently deem the gold standard for estimating average blood glucose is nowhere as precise as it should be,” says Higgins. “Our study not only pinpoints the root of the inaccuracy but also offers a way to get around it.” More research is needed to determine how long continuous glucose measurements need to be taken to give the most precise results using this model.

Adapted from: Tianna Hicklin, Ph.D.

Reference: Mechanistic modeling of hemoglobin glycation and red blood cell kinetics enables personalized diabetes monitoring. Malka R, Nathan DM, Higgins JM. Sci Transl Med. 2016 Oct 5;8(359):359ra130. PMID: 27708063.

Nutrition Tip of the Day

Learn How To Read The Labels! When you know how to read nutrition labels, shopping for healthier food gets a little easier. The Nutrition Facts table provides information on the calories and nutrients in a specific serving size of food. You can check the serving size and compare it to how much food you actually eat. The % Daily Value (% DV) on the Nutrition Facts table shows you if a food has “a little” or “a lot” of a nutrient. For example, 5% DV or less is a little of a nutrient, and 15% DV or more is a lot of a nutrient.

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U.S. Diabetes Rates Up by 40 Percent

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Diabetes rates increased in the United States from 1999 to 2012, according to a study published in Diabetes Care. Researchers examined diabetes rates and other county-level information from National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS). Overall diagnosed and undiagnosed diabetes rates rose 40 percent in this time period from about 10 percent to about 14 percent. The highest rates were among the southern states, areas along the Texas-Mexico border, and Native American reservations when compared to New England and the Midwest. These findings highlight the wide variance in diabetes awareness and ability to control this disease at the local level and should help focus public health policies to areas most in need.

Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and undiagnosed diabetes prevalence by county in the U.S., 1999-2012. Diabetes Care. 2016;39:1556-1562.

Nutrition Tip of the Day

You’ve probably heard that you should shop the outer aisles of the grocery store. It’s good advice — that’s where you’ll find vegetables and fruit, fresh lean meat, poultry, fish, eggs and milk products. But don’t avoid the inner aisles. You’ll find nutrient-rich staples such as no-salt-added canned tomatoes, dried legumes (beans, peas and lentils), whole grains, high-fiber cereals, nuts and low-sodium canned light tuna and salmon.

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Vegetarian Diets Reduce High Blood Pressure

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Vegetarian diets protect against hypertension, according to a study published in the Journal of Hypertension. Researchers compared hypertension rates for 4,109 participants who followed vegetarian or nonvegetarian diets. Those who followed a vegetarian diet had a 34 percent lower risk for hypertension when compared to nonvegetarians. These findings remained significant after adjusting for obesity, insulin resistance, and inflammation. Researchers call on clinicians to prescribe vegetarian diets to prevent hypertension and prehypertension. A previously published meta-analysis found that consuming vegetarian diets is associated with lower blood pressure.

Chuang SY, Chiu TH, Lee CY, et al. Vegetarian diet reduces the risk of hypertension independent of abdominal obesity and inflammation: a prospective study. J Hypertens. Published online August 10, 2016.

Nutrition Tip of the Day

Eat Eggs, and Don’t Throw Away The Yolk! Whole eggs are so nutritious that they’re often referred to as “nature’s multivitamin.” It is a myth that eggs are bad for you because of the cholesterol. Studies show that they have no effect on blood cholesterol in the majority of people. Additionally, a massive review study that included 263,938 individuals found that egg consumption had no association with the risk of heart disease. What we’re left with is one of the most nutritious foods on the planet, and the yolk is where almost all of the nutrients are found.

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The pitfalls of soda drinks if you have diabetes

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Soda pop is a product that conjures up warm, fuzzy and nostalgic emotions for many people. A wide variety of flavors, brands and types of sodas have been a part of the American culture since the introduction of soda fountains in the early-1800s and the first cola-flavored beverage in 1881. Many of us have a favorite brand. Americans drink 13 to 15 billion gallons of carbonated beverages a year — an average of 15 ounces a day. People who consume the sugary drinks regularly drink 1 to 2 cans per day, which puts them at a 26 percent greater risk of developing diabetes than people who rarely drink regular soda pop.

According to the National Soft Drink Association, soft drink consumption has doubled in the United States for females and tripled for males since the 1970s. Males between the ages of 12 to 29 average one-half gallon of sugary drinks per day. Not surprisingly, soft drink companies spend billions of dollars on advertising soft drinks and a major target is children. Just think about the big food and beverage brands that advertised during the Super Bowl.

So, what’s the problem with soda pop and sugary drinks?

  • Empty calories. Most soda has NO nutritional value and, yet, has replaced milk in many diets.
  • Tooth decay. Sugar and acid in soft drinks can dissolve tooth enamel, increasing dental decay.
  • Increased risk of obesity. Most regular soda contains up to 10 teaspoons of sugar per 12-ounce can.
  • Increased risk of developing diabetes

Other considerations include decreased water consumption, cost and regular consumption of ingredients such as high fructose corn syrup, phosphoric acid, caffeine and chemical additives.

So what can you drink?

The best answer is water. That’s right! If you think that’s boring, you’re not alone. In addition to water, you might consider:

  • Unsweetened teas
  • Coffee (ask your dietitian if concerns)
  • Diet soda (ask your dietitian if concerns)
  • Other low-calorie drinks and mixes
  • Flavoring water with a squeeze of lime or lemon juice
  • Low-fat milk (ask your dietitian for your daily requirements)

Remember, with diabetes, all calorie containing foods have a direct effect on your blood sugar and weight. If you’re overweight, any effort to reduce daily calories to your recommended level is a step in the right direction. Instead of drinking only regular soda, try mixing half regular soda and half diet soda. On a more positive note, an in USA Today indicates that Americans are now drinking more water. Since 1998, the amount of water people drink has increased 38 percent.

Adapted by: Sara J. Carlson, R.N., C.D.E. and Peggy Moreland, R.N., C.D.E.

Tip of the Day

Ask kids to become kitchen helpers! Give kids small jobs in the kitchen and praise their efforts. Children are much less likely to reject foods that they helped make.

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Are late-night snacks a no-no for people who have diabetes?

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If you have diabetes, late-night snacks aren’t necessarily off-limits but it’s important to make wise choices. Late-night snacks add extra calories, which can lead to weight gain. Additionally, if you snack after your evening meal, especially if the foods contain carbohydrates, you may wake up the next morning with a high blood sugar level. If you’re hungry after dinner, choose a “free” food, such as:

  • One sugar-free frozen cream pop
  • Five baby carrots
  • One cup of light popcorn
  • A small handful of goldfish-style crackers
  • A can of diet soda

You can also swap the snack for a piece of gum or small hard candy. These “free” foods have few, if any, carbohydrates and calories, so they won’t contribute to weight gain or increased blood sugar. If you take insulin or other diabetes medications and feel that you must snack before bedtime to prevent low blood sugar (hypoglycemia) during the night, talk to your doctor. He or she may recommend adjusting the dose of your medications to prevent the need for a late-night snack.

Adapted from: M. Regina Castro, M.D.

Tip of the Day

Looking for a quick and easy dinner option? Combine lean protein, lots of veggies, plus flavorful herbs and spices in a large skillet for a quick one-pot meal that’s ready in 30 minutes or less.

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Can I use artificial sweeteners if I have diabetes?

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You can use most sugar substitutes if you have diabetes, including:

  • Saccharin (Sweet’N Low)
  • Aspartame (NutraSweet, Equal)
  • Acesulfame potassium (Sunett)
  • Sucralose (Splenda)
  • Stevia (Pure Via, Truvia)

Artificial sweeteners, also called sugar substitutes, offer the sweetness of sugar without the calories. Artificial sweeteners are many times sweeter than sugar, so it takes a smaller amount to sweeten foods. This is why foods made with artificial sweeteners may have fewer calories than those made with sugar. Sugar substitutes don’t affect your blood sugar level. In fact, most artificial sweeteners are considered “free foods” — foods containing less than 20 calories and 5 grams or less of carbohydrates because they don’t count as calories or carbohydrates on a diabetes exchange. Remember, however, other ingredients in foods containing artificial sweeteners can still affect your blood sugar level.

More research is needed, but more studies are finding that the benefits of substituting sugar-sweetened food and beverages with those that have been sweetened artificially may not be as clear as once thought, particularly when consumed in large amounts. One reason may be a “rebound” effect, where some people end up consuming more of an unhealthy type of food because of the misperception that because it’s sugar-free it’s healthy. Also, be cautious with sugar alcohols including mannitol, sorbitol and xylitol. Sugar alcohols can increase your blood sugar level and for some people, sugar alcohols may cause diarrhea.

Adapted from: M. Regina Castro, M.D.

Tip of the Day

Eat a variety of vegetables to get vitamins and minerals your body needs. How can you include two different vegetable subgroups into the same meal? Try to eat a red and orange vegetable like red bell peppers or carrots and a dark leafy green like spinach, collard greens, or kale.

Daily Inspiration 

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Maternal Obesity and Diabetes Increase Risk for Autism

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Maternal obesity and diabetes increase the risk of having a child born with autism, according to a study published in Pediatrics. Researchers analyzed 2,734 mother-child pairs between 1998 and 2014, analyzing the mothers’ pre-pregnancy weight and whether the mothers had diabetes before getting pregnant or whether they developed gestational diabetes during pregnancy. The combination of maternal obesity and diabetes was associated with greater risk of the child developing autism or other intellectual disabilities than either obesity or diabetes alone. This study is among the first to assess the effects of maternal obesity and diabetes together. Researchers suspect the increased risk for disorders due to inflammation and hyperglycemia brought on by these two conditions.

Li M, Daniele Fallin M, Riley A, et al. The association of maternal obesity and diabetes with autism and other developmental disabilities. Pediatrics. 2016;137: e2 0152206

Tip of the Day

Dining out? Start off with a veggie-packed salad, it can help you feel satisfied sooner. Remember to ask for dressing on the side and use a small amount of it.

Daily Inspiration 

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