Holiday Eating Strategies for Diabetics

The holidays have officially begun. In the weeks ahead, Christmas, New Year’s, and finally the Super Bowl in January will offer us numerous opportunities to gorge on special holiday foods. Not surprisingly, most people will gain weight. Many diabetics look ahead to the holiday season with mixed feelings, so much great food, but so many diet restrictions.

Between mid-November and early January, average-weight adults typically gain 1 pound, while overweight adults gain 5 pounds. During the rest of the year, most people will maintain this new weight, slowly gaining weight every subsequent year. These unwanted pounds can increase high blood sugar levels and lead to real health problems.

Food-oriented gatherings make maintaining a disciplined eating plan difficult. With all the sugary and carbohydrate-laden foods, diabetics often find this time of year particularly challenging. The best way to dodge the eating pitfalls of the holidays and avoid gaining weight is to adopt a good eating strategy.

How can a diabetic enjoy special holiday foods without gaining weight? Use these tips to eat, drink, and be merry. You will be glad you did. By keeping your blood sugars controlled, you will keep your energy level up for all the holiday festivities!

Holiday survival guide for diabetics

Select and savor festive foods
This is the time of year for special foods. To ensure you enjoy this time, selectively eat foods that you do not usually eat during the rest of the year, like your grandmother's secret recipe for stollen. Eat slowly to savor the experience and make every bite count - you will be less likely to mindlessly eat something without noticing. It is easier to control your eating habits when you truly experience the food.

Plan ahead - overeating is spontaneous, not planned
Before going to a party, visualize yourself eating a single serving of each special food, and not going back for seconds. Remind yourself that you do not have to taste everything that is being served. Pick the most incredible foods and savor every bite! Overeating is not planned behavior, it is spontaneous. By removing spontaneity, you will be able to enjoy the holidays without binging.

Having diabetes shouldn't stop you from enjoying holiday celebrations. Planning now, before the holidays arrive can help you to commit to a healthy season while you enjoy the season packed full of cheer and holiday parties.

Revamp holiday recipes for you
Celebrate the holidays by making delicious and nutritious recipes that fit into your diabetic meal plan. The recipe below is so tasty, colorful, and healthy that it will become one of your holiday favorites.

Broccoli Garden Salad
4 servings
¼ teaspoon ground cinnamon
1 cup nonfat light vanilla yogurt
½ cup roasted chopped peanuts
1 cup chopped apples
3 cups broccoli florets
1 cup grated carrots
1 cup sliced cauliflower
½ cup sliced green onions
Toss all ingredients together in a large mixing bowl. Refrigerate until ready to serve.
1 cup is equal to 1 carbohydrate exchange (15 gm carbs)

How to survive a holiday party……..

Plan ahead - do not skip meals beforehand
First, go prepared. Do not save calories all day long by skipping meals or snacks. If you arrive famished, it will be difficult to stop eating once you start. Be good to yourself. Eat a sensible breakfast. For lunch, have something like a lean turkey sandwich, salad, and fruit. Before the event, have a light snack. The idea is to save calories by eating low-calorie, low-carbohydrate foods that are filling, not by skipping meals.

Consciously think about what you eat
Be mindful of what you eat. During these situations, people tend to eat unconsciously. To break this cycle, avoid munching on the mints, nuts, and hors d'oeuvres when you first arrive. Instead, ask for a no-calorie, low-carb beverage like sparkling water. When you have socialized for a while and are ready to eat, take a few moments to assess the food options. Categorize them into:
• High-calorie foods - fried foods, desserts, cheeses, dips
• Low-calorie/Low-carb foods - fruits, vegetables, non-fried foods.

Select 1 or 2 high-calorie foods and then fill the rest of your plate with low-calorie, low-carbohydrate options. Be sure to sit down and enjoy your food. Order another calorie-free beverage and socialize. If you are still hungry later, repeat the process.

Opt for activity instead of additional eating
Also, engaging in an activity like taking a stroll around the neighborhood or simply standing during the party is another good choice. If people are dancing, join in! By keeping your body moving, blood sugar levels will stay down. Being prepared and mindful of what you eat in social situations will not only allow you to feel better about your choices, but it will also keep your blood sugar levels and weight down.

Other helpful tips for Healthy Holiday Eating include:
Keep Counting Carbs
Carb (carbohydrate) counting can be a great way to control blood glucose levels and weight.  If you’re going to attend a holiday dinner offer to bring a dish, such as dessert, that you know the carbohydrate content.

Make One Trip to the Buffet Table 
Make only one trip to the buffet table and remember to load up on salad and vegetables first.  Avoid creamy dressings, foods with breading and condiments that are high calories and fat.

Socialize Away from the Table 
The most popular socialization area is usually in the kitchen or near the food table. Many times people talk and eat, without realizing what they are consuming. This is a dangerous behavior that can lead to overeating and surprisingly high blood glucose levels.

Bring your own beverage
Bring your own carbohydrate-free beverage if you don't want to have plain water and aren't sure whether diet or sugar-free drinks will be offered.

Limit or avoid alcohol
Studies have shown that alcohol stimulates food intake and can also increase feelings of hunger. Having your judgment impaired and stimulating your appetite is a recipe for failure if you are trying to follow a diabetic diet or weight-loss plan.

Continue Exercise and Record Keeping 
Exercise is important especially during the holidays. Find a way to work physical activity into your schedule, whether it is with a quick exercise video, mall walking, or a trip to the gym. This will really help keep your blood glucose levels controlled and decrease weight gain.

Join a support group 
Many people find it helpful to talk to other people with diabetes to find out what they do when they have a problem. You can find out, for example, what others do to make better food choices during the holidays or how they fit exercise into a busy day.

Below are two delicious recipes anyone with diabetes can enjoy!

PUMPKIN CHEESECAKE
Yield: 12 to 14 slices
Source: "1,001 Delicious Desserts for People with Diabetes"

INGREDIENTS
-  3/4 cup ground reduced-fat graham crackers
-  3/4 cup ground gingersnap cookies
-  8-1/4 teaspoons Equal for Recipes
   or 27 packets Equal sweetener, divided
-  4-5 tablespoons margarine, melted
-  2 packages (8 ounces each) fat-free cream cheese
-  1 cup canned pumpkin
-  2 eggs
-  2 egg whites
-  2 teaspoons ground cinnamon
-  1 teaspoon ground cloves
-  1 teaspoon ground ginger
-  2 tablespoons cornstarch
-  1 cup light whipped topping
-  Chopped toasted pecans, as garnish

DIRECTIONS
Mix graham cracker and gingersnap crumbs, 1 teaspoon Equal for Recipes, and melted margarine in bottom of 9-inch springform pan; reserve 2 tablespoons crumb mixture Pat
remaining mixture evenly on bottom and 1/2 inch up side of pan. Bake at 350 degrees F. until lightly browned, about 8 minutes. Cool on wire rack.

Beat cream cheese until smooth in large bowl; beat in pumpkin, eggs, and egg whites. Mix in remaining 7-1/4 teaspoons Equal for Recipes, spices, and cornstarch. Pour mixture into springform pan.

Bake at 300 degrees F. just until set in the center, 45 to 60 minutes; sprinkle with reserved crumbs and return to oven. Turn oven off and let cheesecake cool in oven with door ajar for 3 hours.

Refrigerate 8 hours or overnight.

Nutritional Information Per Serving (1/12 of recipe):
Calories: 213, Fat: 9.8 g, Saturated Fat: 4.3 g, Cholesterol: 47.2 g,
Sodium: 444 mg, Protein: 12.1 g, Carbohydrate: 18.2 g

CAESAR SALAD
Yield: 1 cup
Source: "Mr. Food Every Day's a Holiday Diabetic Cookbook"

INGREDIENTS
-  1/2 cup light mayonnaise
-  1/3 cup low-fat (1%) milk
-  1-1/2 teaspoons Dijon-style mustard
-  1 tablespoon lemon juice
-  1/4 cup grated Parmesan cheese
-  1/4 teaspoon garlic powder
-  1/4 teaspoon salt
-  1/4 teaspoon black pepper
-  1 large head romaine lettuce, washed and torn into bite-sized pieces

DIRECTIONS
In a medium bowl, combine all the ingredients except the romaine; whisk until smooth and creamy.

Place the romaine in a large salad bowl and toss with the dressing. Serve immediately.

Nutritional Information Per Serving (1 cup):
Calories: 55, Fat: 4 g, Cholesterol: 6 mg, Sodium: 193 mg,
Carbohydrate: 2 g, Dietary Fiber: 0 g, Sugars: 1 g, Protein: 2 g

PUMPKIN SOUP
Yield: 5 servings (1 cup each)
Source: The New Family Cookbook for People with Diabetes Book I

INGREDIENTS
- 2 teaspoons margarine
- 3/4 cup chopped onion
- One 16-ounce can pumpkin puree (not pumpkin pie filling)
- 2 cups Homemade Chicken Broth OR canned reduced-sodium chicken broth
- 2 teaspoons sugar
- 1/2 teaspoon salt
- 1/8 teaspoon ground cloves or ground nutmeg
- 1 cup fat-free milk

DIRECTIONS
Melt the margarine in a medium saucepan.
Saute the onion until softened, about 5 minutes.

Add the pumpkin, broth, sugar, salt, and cloves; stir to mix well. Bring to a boil; reduce the heat and simmer for 15 minutes.

Puree until smooth in a blender or food processor.
Return to the saucepan. Add the milk; heat thoroughly but do not boil. Serve at once.

Nutritional Information Per Serving:
Calories: 89; Protein: 4 g; Carbohydrates: 15 g;
Cholesterol: 1 g; Sodium: 318 mg; Fat: 3g

Great success can happen when you have the support from family, friends and from other people with diabetes.

Grace C. Eaton, LPN
PHMG Patient Centered Nursing Team
Diabetes Self-Management Support
Certified Smoking Cessation Instructor
PinnacleHealth FamilyCare of Lower Paxton

Diabetes and Smoking: A Deadly Combination

Smoking is bad news. It is the leading cause of avoidable death in the United States, accounting for nearly half a million deaths each year. Smoking increases your risk of incurring a number of Diabetes complications.

The Effects of Smoking
Everyone knows smoking causes lung cancer, and more people die of lung cancer each year in the U.S. than any other type of cancer. But did you know that smoking can affect the health of your heart, kidneys, eyes, nerves, muscles and joints, and more?

Those with Diabetes are three times more likely to die of cardiovascular disease, such as heart attack or stroke, but add in smoking and that risk multiplies.

That's because smoking….

• Decreases the amount of oxygen reaching tissues 
• Increases cholesterol levels and the levels of some other fats in your blood 
• Damages and constricts blood vessels 
• Increases blood pressure 
• Smoking increases your blood sugar levels and decreases your body's ability to use insulin, making it more difficult to control your Diabetes. 

When blood vessels are constricted, the amount of blood circulating in arteries and veins is limited. This can lead to peripheral vascular disease, which can worsen foot ulcers and contribute to leg and foot infections.

In addition, smokers with Diabetes are at increased risk of developing nerve damage (diabetic neuropathy), kidney disease (diabetic nephropathy) and eye disease (diabetic retinopathy).

But wait, the bad news doesn't end yet!  

In addition to lung cancer, smoking may also contribute to mouth, throat and bladder cancer.

Those who smoke are more susceptible to colds and respiratory infections.

Smoking increases muscle and joint pain.

Smoking can cause impotence in men and miscarriage or stillbirth in pregnant women.

Quit Smoking
If you are a smoker, you know you should quit. The good news is, no matter how long you've smoked, your health will improve after you quit. Fortunately, there are many new medications and successful programs out there to help you quit smoking. If you smoke and you're ready to quit, ask your friends and family members who have quit for advice or ask your doctor to refer you to one of these programs for help.

Why is it so hard to quit?
Simply put, nicotine is among the most addictive drugs. Smoking is not a habit or a lifestyle choice. It’s an addiction that over time, changes brain chemistry. Nicotine has its effect by attaching to certain receptors in the brain, and when you become a smoker these receptors increase in number. If not regularly stimulated with nicotine, the increased receptors begin to make a person feel very unpleasant, a phenomenon known as withdrawal. Both withdrawal and the craving it causes are tied to changes in brain chemistry.

Quitting smoking is one of the most important things individuals living with diabetes can do to help prevent or delay the onset of complications.

How can I quit?
The first critical step is to make the decision to quit. It may help to set a firm, short-term quit date. In the meantime, get as much information as you can from your doctor or pharmacist about options to help you quit, including medications that can increase your chances of success by three to four times. Similar to the day-to-day process of managing your diabetes through diet, exercise and regular blood glucose testing, managing to quit smoking is something that is best approached by incorporating it into your daily routine.

What can help me quit smoking?
Nicotine replacement therapy 
The first line of treatment is nicotine replacement therapy, whether in the form of a gum, patch or inhaler, to help ease withdrawal symptoms. Nicotine replacement therapy is now available without a prescription in pharmacies. It is very safe, even for people with heart disease, pregnant women or teenagers, and it’s important when using it to know that you can use as much as is necessary to stem your particular cravings.

Oral medications 
There is a prescription medication that can dramatically decrease smoking cravings. It works by stimulating the same areas in the brain that are stimulated by nicotine. This drug can’t be used by everyone (eg., people with epilepsy or a history of seizures), and might interfere with other medications if you are already taking an anti-depressant or other psychiatric medication.

Another prescription drug acts by stimulating the receptors in the brain responsible for initiating and maintaining nicotine addiction, so that people feel they have smoked a cigarette without actually having done so. If they do smoke, it doesn’t have the same positive effect. Like any prescription drug, though, it has side effects, including nausea and in some, psychiatric symptoms, and so may not be right for everyone.

Lifestyle changes 
Smoking often is associated with strong cues, so as you move toward a quit date, get a sense of where and when you smoke, and identify some strategies to bypass those situations. If you typically smoke after dinner, take a walk instead. Any setting where alcohol is involved, such as a wedding or a party, will probably be a hazard zone….. just as you may plan to adjust your food intake or insulin dosage, consider in advance how you will handle these situations.

Enlist your family and friends in the effort. Make sure they understand how important it is for you to quit smoking and how hard it may be, and ask for their support. For some people, joining a support group along with others who are also trying to quit is helpful. Your doctor may have some information on groups in your community. Your doctor may have some information on groups in your community, along with smoking cessation classes available.

Never quit quitting! 
Making the transition from smoker to nonsmoker is not easy, and you may have a lapse. If you do, give yourself a break. Don’t focus on the one cigarette you just had, but remember the hundreds you haven’t had since you quit. Manage your quitting plan much like you manage your diabetes – take it one day at a time.

The fact is, successful quitters generally make at least two or three unsuccessful attempts before they finally kick the habit, so never quit quitting!


Grace C. Eaton, LPN
PHMG Patient Centered Nursing Team
Diabetes Self-Management Support
Certified Smoking Cessation Instructor
PinnacleHealth FamilyCare of Lower Paxton

Trouble Shooting Your Glucose Meter

When people with diabetes can control their blood sugar (glucose), they are more likely to stay healthy. People with diabetes can use a number of tools to help them better manage their diabetes.  One of these tools is a home glucose meter.

Glucose meters help people with diabetes check their blood sugar at home, school, work, and play. Other blood and urine tests reveal trends in diabetes management and help identify diabetes complications.  We are going to discuss the glucose meter (glucometer) and how it can help you control your diabetes.

Self-Monitoring of Blood Glucose
The process of monitoring one's own blood glucose with a glucose meter is often referred to as self-monitoring of blood glucose or "SMBG."

To test for glucose with a typical glucose meter, place a small sample of blood on a disposable "test strip" and place the strip in the meter. The test strips are coated with chemicals that combine with glucose in blood.
The meter measures how much glucose is present. Meters do this in different ways. Some measure the amount of electricity that can pass through the sample. Others measure how much light reflects from it. The meter displays the glucose level as a number. Several new models can record and store a number of test results. Some models can connect to personal computers to store test results or print them out.

Choosing a Glucose Meter
At least 25 different meters are commercially available.  

They differ in several ways including:

• Amount of blood needed for each test 
• Alternate testing sites (for example, using the forearm instead of a finger)
• Testing speed 
• Overall meter size 
• Ability to store test results in memory 
• Cost of the meter 
• Cost of the test strips used  (Insurance companies will often cover the cost of testing strips for certain meters….contact your insurance for the best coverage.) 

Newer meters often have features that make them easier to use than older models. Some meters allow you to get blood from places other than your fingertip (Alternative Site Testing). Some new models have automatic timing, error codes and signals, or barcode readers to help with calibration. Some meters have a large display screen or spoken instructions for people with visual impairments.

Using Your Glucose Meter
Diabetes care should be designed for each individual patient. Some patients may need to test (monitor) more often than others do. How often you use your glucose meter should be based on the recommendation of your health care provider. Self-monitoring of blood glucose (SMBG) is recommended for many people with diabetes, but especially for those who take insulin. The role of SMBG has not been defined for people with stable type 2 diabetes treated only with diet.

Often, self-monitoring plans direct you to test your blood sugar before meals, 2 hours after meals, at bedtime, and anytime you experience signs or symptoms. You should test more often when you change medications, when you have unusual stress or illness, or in other unusual circumstance.

Please discuss the your testing frequency with your personal provider or access the American Diabetes Association website at www.diabetes.org.

Learning to Use Your Glucose Meter
Not all glucose meters work the same way. Since you need to know how to use your glucose meter and interpret its results, you should get training from a diabetes educator. The educator should watch you test your glucose to make sure you can use your meter correctly. This training is better if it is part of an overall diabetes education program.

Instructions for Using Glucose Meters
The following are the general instructions for using a glucose meter:
1. Wash hands with soap and warm water and dry completely or clean the area with   alcohol and dry completely.
2. Prick the fingertip (or alternative site if your meter that allows that) with a lancet.
3. Hold the hand down and hold the finger until a small drop of blood appears; catch the blood with the test strip.
4. Follow the instructions for inserting the test strip and using the SMBG meter.
5. Record the test result.

You should carefully read the instructions for both the meter and its test strips. Meter instructions are found in the user manual. Keep this manual to help you solve any problems that may arise. Many meters use "error codes" when there is a problem with the meter, the test strip, or the blood sample on the strip. You will need the manual to interpret these error codes and fix the problem.

You can get information about your meter and test strips from several different sources.

Your user manual should include a toll free number in case you have questions or problems. If you have a problem and can't get a response from this number, contact your healthcare provider or a local emergency room for advice. Also, the manufacturer of your meter should have a website. Check this website regularly to see if it lists any issues with the function of your meter.

Measurement Range
Most glucose meters are able to read glucose levels over a broad range of values from as low as 0 to as high as 600 mg/dL. Since the range is different among meters, interpret very high or low values carefully.  Refer to the package insert of your glucose meter for the blood sugar range your meter will record.

Factors That Affect Glucose Meter Performance
The accuracy of your test results depends partly on the quality of your meter and test strips and your training. Other factors can also make a difference in the accuracy of your results. Some factors that can impact accuracy include the following:

• Blood counts (hematocrit)
• Vitamins and mineral supplements
• Altitude, temperature and humidity
• Generic or third party test strips

Refer to the package insert of your meter for specific instructions regarding these factors.

Making Sure Your Meter Works Properly
You should perform quality-control checks to make sure that your home glucose testing is accurate and reliable. Several things can reduce the accuracy of your meter reading even if it appears to still work. For instance, the meter may have been dropped or its electrical components may have worn out. Humidity or heat may damage test strips. It is even possible that your testing technique may have changed slightly. Quality control checks should be done on a regular basis according to the meter manufacturer's instructions. There are two kinds of quality control checks:

Check Using "Test Quality Control Solutions" or "Electronic Controls"
Test quality control solutions and electronic controls are both used to check the operation of your meter. Test quality control solutions check the accuracy of the meter and test strip. They may also give an indication of how well you use your system. Electronic controls only check that the meter is working properly.

Take Your Meter with You to The Health Care Provider's Office.
This way you can test your glucose while your health care provider watches your technique to make sure you are using the meter correctly. Your healthcare provider will also take a sample of blood and evaluate it using a routine laboratory method. If values obtained on the glucose meter match the laboratory method, you and your healthcare provider will see that your meter is working well and that you are using good technique. If results do not match the laboratory method results, then results you get from your meter may be inaccurate and you should discuss the issue with your healthcare provider and contact the manufacturer if necessary.

New Technologies: Alternative Site Testing
Some glucose meters allow testing blood from alternative sites, such as the upper arm, forearm, base of the thumb, and thigh.  Sampling blood from alternative sites may be desirable, but it may have some limitations. Blood in the fingertips show changes in glucose levels more quickly than blood in other parts of the body. This means that alternative site test results may be different from fingertip test results not because of the meter's ability to test accurately, but because the actual glucose concentration can be different. Glucose levels at the alternative site appear to change more slowly than in the fingertips.  Alternative site results may be different than the fingertip when glucose levels are changing rapidly (e.g. after a meal, taking insulin or during or after exercise).

Do not test at an alternative site, but use samples taken from the fingertip, if …

• you think your blood sugar is low, 
• you are not aware of symptoms when you become hypoglycemic, or 
• the site results do not agree with the way you feel. 

Below are a few contact numbers for a few meters if you are having trouble with your meter, please use the toll free number in your handbook or one of the ones below if you have one of these meters.

FREEDOM METERS	(888) 522-5226
BAYER METERS	(800) 348-8100
PRODIGY METERS	(800) 243-2636
PRESTIQUE/TRU TRACK METERS	(800) 342-7226
WAVESENSE	(866) 906-4197
ONE TOUCH METERS	(800) 227-8862
ACCU-CHECK	(800) 858-8072

Grace C. Eaton, LPN

Nurse Panel Manager

PHMG Patient Centered Nursing Team

Diabetes Self-Management Support

Certified Smoking Cessation Instructor

PinnacleHealth FamilyCare of Lower Paxton

Diabetes 101

In recognition of Diabetes Awareness Month, here are the basics of Diabetes.

What is Diabetes?

• Diabetes affects the way your body uses food for energy.  
• When you eat food, your body changes it into sugar.  
• Your body also makes insulin.  
• Insulin helps move the sugar from your blood into your body’s cells to be used for energy.
• Your body normally keeps blood sugar and insulin in balance.
• When you have diabetes, your body isn’t getting the energy it needs.

When your pancreas no longer produces insulin and the sugar cannot move in to the cells to become energy, you have TYPE 1 DIABETES. This type of Diabetes only affects 5-10% of people who have diabetes.

When your pancreas doesn’t produce enough insulin and/or cannot use it well enough to get the blood sugar into the body’s cells for energy, you have TYPE 2 DIABETES.

In both situations, blood glucose builds up in your body and can lead to serious health problems and premature death.

Risk factors for Type 2 Diabetes include:

• Older Age
• Obesity
• Family History of diabetes
• History of gestational diabetes
• Impaired glucose tolerance
• Physical inactivity
• Race/ethnicity
• African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for Type 2 Diabetes.

Pre-Diabetes
Pre-diabetes is the stage that occurs before a person gets Type 2 Diabetes.  Blood sugar levels are higher than normal, but not high enough to be diagnosed with diabetes. Over 79 million people have pre-diabetes (www.diabetes.org/diabetes-basics/diabetes-statistics).

How do you know if you have diabetes?
The common signs of diabetes are:

• Feeling Tired
• Urinating often
• Being very thirsty
• Feeling very hungry
• Having blurry vision
• Having an infection that does not go away
• Having wounds or sores that do not heal well
• Possible weight loss

How will the doctor diagnose diabetes?
If your health care provider thinks you may have diabetes, there are some blood tests available to find out for sure.

1. FASTING BLOOD SUGAR—prior to this test, you should not eat for 8-10 hours. A person without diabetes will have a fasting blood sugar between 70-99mg/dl.  A person with pre-diabetes will have a fasting blood sugar between 100-125 mg/dl.  A person with diabetes will have a fasting blood sugar of 126 mg/dl or greater. 
2. ORAL GLUCOSE TOLERANCE TEST-- This test measures your body’s response to sugar.  You are given a drink with a very high amount of sugar.  Then your blood sugar levels are tested every 60 minutes for up to three hours.  The 2 hour reading is often used to diagnose diabetes.  
3. HEMOGLOBIN A1C—This is a non-fasting blood test that measures the average blood sugar levels over a period of up to 3 months.

Why is it important to know if I have diabetes or not?  
If you have diabetes and do not control it, there are many complications that could become very serious.

• Cardiac problems—Heart Attack
• Kidney problems—Nephropathy
• Nerve problems—Nerve Damage
• Vision problems--Retinopathy
• Circulatory problems—Heart Attack, Stroke
• Amputations—Peripheral Arterial Disease
• Stroke
• Mouth and Gums—Gingivitis
• Depression
• Erectile Dysfunction 
• Death

Diabetes affects the entire body. In order to control diabetes, you need to work on having a healthy lifestyle.  This may mean changing the way you eat and exercise.  Do not think of it as a "diet" but a lifestyle change.  Talk with your doctor to develop a care plan that is specifically for you.

Ways to control and prevent complications of diabetes include:

• Eating healthy
• Weight loss
• Exercise
• Taking care of your feet and eyes
• Quitting tobacco
• Regular visits with your healthcare provider
• Relieve stress
• Accept that you have diabetes
• Set goals

Know your target numbers, keep your doctor appointments, learn what you can do to help manage your diabetes.



Grace C. Eaton, LPN
Nurse Panel Manager
PHMG Patient Centered Nursing Team
Diabetes Self-Management Support
Certified Smoking Cessation Instructor
PinnacleHealth FamilyCare of Lower Paxton

Cold versus Flu

OK, we’re knee-deep in cold and flu season. As I sit here contemplating the difference between cold and flu, it strikes me that flu season has yet to hit us. So, if you’ve been sick so far this year, you’ve probably had the cold.

What is the “common cold”?  Well, it’s a viral infection, generally rhinovirus. Rhino…like the nose, not the animal (although the animal derives its name from the Greek word for nose due to the large nose-like proboscis on its head). So that can help you understand that the primary symptoms of colds are nasal symptoms. The first few days you feel tired and run-down.  Your throat starts to hurt. Then the nose starts to run and you sneeze. The nose then also becomes stuffy and congested.  It’s the stuffy and runny combination that if you really think about it is rather odd. How can something both be stuffed and running? That is more than I can say for Uncle Pat after Thanksgiving dinner! The interesting thing is that influenza (flu) also does that. The difference between the two is the intensity of symptoms.  Flu is a much more intense version of the cold.  Often, the mucous that is causing the congestion and runny nose causes a cough. I’d say easily, the cough is what brings people to the office when dealing with a cold.  It comes later in the course of illness and lasts beyond the time when you feel “sick."  You feel like the cold is gone but the cough can linger for weeks (yes, I said WEEKS).

One thing you may have noticed is that I did not mention fever. That’s because the cold doesn’t cause a fever. That’s not to say it won’t raise your body temperature, because it will. You just won’t have a fever.  So here’s a little tip. A temperature greater than 98.6 is NOT a fever. We refer to them as low-grade fevers but really they are not fevers. A fever starts when the temperature reaches 100.4. That seems like an odd number. It’s because scientific and global measurements are done with Centigrade temperatures. So that corresponds to 38C. Normal body temperature on that scale is 37. That one degree Celsius separates normal from febrile. So from 98.6 to 100.4 is not a fever. Why does it raise your temperature? Well, that’s because in fighting off this virus, your immune system gets activated. The T cells notice the virus and deploy a search-and-destroy call to other T cells.

Other symptoms include cough, congestion, fever (that one is almost a deal-breaker and without it, the flu is not really a consideration—so be sure to check your temperature…with a thermometer!), body aches, sore throat, and sometimes diarrhea. To remind you, the cold has those symptoms as well. The major difference is the sudden onset of the flu (all/most symptoms hit you at once, generally within 12 hours of each other) and the fever over 100.4. The colds all have the same basic symptoms but are generally more gradual in their onset (starts with a tickle in the throat for a day, then runny nose for a day, then cough…and lingers 10 days or more), are much less intense and often without that higher fever.

If you realize you have the flu and it’s been more than 48 hours of symptoms, available treatments aren’t going to work anymore. Even if we do treat these flu episodes, the medication has only been shown to shorten the length of time you’re sick by 1 day. So unless you have major medical conditions, specifically lung disease, we don’t automatically treat the flu with the anti-viral medicines because the side effects (on you, the patient) and the virus (it can make the virus mutate faster) aren’t always worth that 1 day of symptom improvement. We mostly focus our efforts on making you more comfortable while you are fighting this virus off. Once we know flu is in our area, we don’t typically test for it and treat you based on symptoms alone.

The good news is you don’t have to face this alone! Your healthcare provider at your PinnacleHealth Medical Group primary care office has you covered. If you feel you are sick and not sure if it’s the cold or the flu, ask one of the pros. It’s why we’re here, after all! Be well and stay well!!

Sandra R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group