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25 Tips
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 1 jam-packed day. 29 rides.
No fingerpricks .
*

Elizabeth and Erin H.,

mom and T1D
 The Dexcom G5® Continuous Glucose
Monitoring (CGM) System is the first CGM
approved by the FDA to let you make
diabetes treatment decisions without pricking
your finger.* A small sensor continuously
measures your glucose levels and sends data
to a receiver or smartphone† every 5 minutes.
And only the Dexcom G5 lets you share this
data with up to 5 followers,‡ plus set high and
low glucose alerts.

Know more. Prick less.™

DiscoverDexcom.com

*
Fingersticks required for calibration, or if symptoms or expectations do not match readings,
or when taking medications containing acetaminophen.
†
For a list of compatible devices, visit www.dexcom.com/compatibility ‡Separate Follow app required
BRIEF SAFETY STATEMENT The Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System (“G5”) is a glucose monitoring
system indicated for the management of diabetes in persons age 2 years and older. The G5 is designed to replace fingerstick
blood glucose testing for diabetes treatment decisions. The G5 also aids in the detection of episodes of hyperglycemia and
hypoglycemia. The G5 is intended for single patient use and requires a prescription. CONTRAINDICATIONS Do not rely on the
G5 CGM data if you have recently taken acetaminophen. Remove the G5 (sensor, transmitter, and receiver) before Magnetic
Resonance Imaging (MRI), Computed Tomography (CT) scan, or high-frequency electrical heat (diathermy) treatment. The G5 is
MR Unsafe. Do not bring any portion of the G5 into the MRI environment. WARNING CGM-based diabetes treatment decisions
are only approved with the G5, not previous generations of Dexcom CGM systems. Calibrate at least once every 12 hours using
a fingerstick. If your G5 does not display a sensor glucose reading and an arrow, or if you are getting inaccurate or inconsistent
readings, take a fingerstick. If your glucose readings and alerts do not match your symptoms or expectations, take a fingerstick to
confirm. Failure to do so may lead to hyperglycemia or hypoglycemia. The G5 is not approved for use in pregnant women, persons
on dialysis or critically ill persons. If a sensor breaks and no portion of it is visible above the skin, do not attempt to remove it. Seek
professional medical help if you have infection or infl ammation on or near the sensor insertion point. Report broken sensors to
Dexcom Technical Support. Sensor placement is not approved for sites other than under the skin of the belly (ages 2 years and
older) or upper buttocks (ages 2-17 years). To “share” data, you need an internet connection and a separate compatible smart
device running the Dexcom Follow App. Contact Dexcom Toll Free at 877-339-2664 or www.dexcom.com for detailed indications
for use and safety information. Internet connectivity required to access Dexcom Follow. © 2018 Dexcom Inc. All rights reserved.
This product is covered by U.S. patent.
LBL014743 Rev003
 CONTENTS MAY/JUNE 2018

Making Your Pills

14 Work for You
Get the tools you need
to successfully manage
your medications.
By Amy Campbell, MS, RD, LDN, CDE
29
Go Back to Camp!
Diabetic
20 It’s Not Just for
Cooking
Kids Anymore
Whether you are looking to con- DEPARTMENTS
nect with other people living with
diabetes or simply looking for a
wellness retreat, you have many 5 Editor’s Letter
options to choose from.
6 News & Notes
By Alison Massey MS, RD, LDN, CDE
7 Quiz:
How Much
Do You Know
Diabetes Champion
24 Fit4D CEO David Weingard about Herbs and
By Alison Massey MS, RD, LDN, CDE Supplements?
10 Definitions
12 Resources:
Menopause + Diabetes
26 What's the Connection?
Get Walking
13 Diabetes Q&A
Learn how perimenopause
and menopause affect women 60 Supermarket Smarts
with diabetes.
Butter, Margarine
By JoAnn Stevelos
and Spreads

Cover image: Photographed by Angel Tucker; 68 Product Spotlight

food prepared by Maggie Mulvena Eucerin and DietSensor

WEIGHT SELF-MANAGEMENT PAGE 49

50 Biking for Good Health 64 Food for Thought
A guide to bike basics Kitchen and lifestyle tips
By Julia and Paul Wynn By Alison Massey,
MS, RD, LDN, CDE
56 Pack the Perfect Picnic Basket
Five easy-to-pack recipes – a complete 66 Take 5
meal under 675 calories! Balance and Stability
in Everyday Life
62 Your Weight By Laurel Dierking, M.Ed.,
Connect In Motion

Increasing Your Confidence NFPT, 200-YTT

for Weight Management
By Nicola Davies, PhD

2 May/June 2018
 diaBEtes
ACTIVE

© 2018 Akorn, Inc.

Introducing A full line of health and personal care

products specifically formulated for people with diabetes.

Be

Go to TypeYou.com for a list of retailers.

Foot Care • Cough & Flu • Eye Care • Vitamins
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 EXECUTIVE
Chairman & Chief Executive Officer
Jeffrey C. Wolk
Chief Operating Officer
Susan Fitzgerald
SVP, Sales & Marketing
Robin Morse EDITORIAL SALES & MARKETING
Editorial Director, Wellness Vice President, Media Solutions
Maureen McCarthy Stuart Crystal | scrystal@madavor.com
OPERATIONS Senior Digital Editor Senior Media Solutions Manager
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VP, Business Operations
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Technical Product Manager Robert S. Dinsmoor Client Services
Michael Ma Joseph Gustaitis clientservices@madavor.com
Lea Ann Holzmeister, RD, CDE Marketing Director
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EDITORIAL BOARD
Amanda Joyce
Amy P. Campbell, William H. Polonsky, PhD, CDE Bernard P. Shagan, MD
Accounts Payable Associate MS, RD, LDN, CDE Assistant Clinical Professor, Director, Diabetes Education Center,
Tina McDermott Boston, Massachusetts. Department of Psychiatry, University Monmouth Medical Center,
of California, San Diego. Long Branch, New Jersey.
Accounts Receivable Associate David E. Goldstein, MD
Wayne Tuggle Professor Emeritus, University of Missouri L. Raymond Reynolds, Richard M. Weil, Med, CDE
Health Science Center, Columbia, Missouri MD, FACP, FACE, ECNU Exercise Physiologist and Director,
Professor Emeritus, Division of Mount Sinai St. Luke’s Weight
AUDIENCE DEVELOPMENT Lois Jovanovic, MD Endocrinology, University of Kentucky Loss Program, Mount Sinai St. Luke’s
Physician Consultant, Sansum College of Medicine, Lexington, Kentucky Hospital, New York, New York
VP, Audience Development Diabetes Research Institute,
Santa Barbara, California. Jeanne L. Rosenthal, MD Susan Weiner,
Bob Dortch Attending Surgeon, Retinal Service, MS, RDN, CDE, CDN
VP, Strategy Virginia Peragallo-Dittko, New York Eye and Ear Infirmary, Owner, Susan Weiner Nutrition, PLLC,
APRN, BC-ADM, MA, CDE, New York, New York. Long Island, New York.
Jason Pomerantz
Executive Director, Diabetes and Obesity
Institute, Winthrop-University Hospital, Sheri Setser-Legg, Stephen Z. Wolner, DDS
Mineola, New York. MS, RD, LD, MLDE, CDE New York, New York.
CONTENT MARKETING Diabetes Education Service Coordinator
UK HealthCare Barnstable Brown
Strategic Content Director Diabetes Center, University of Kentucky,
Peter Madden Lexington, Kentucky
Content Marketing Associates
Anthony Buzzeo
CONTRIBUTING EDITORS
Tim Doolan Jean Betschart Roemer, Laura Hieronymus, DNP, MSEd, RN, Nancy Cooper, RD, CDE
MSN, MN, CPNP, CDE, MLDE, BC-ADM, CDE, FAADE International Diabetes Center,
Pediatric Nurse Practitioner, Associate Director, Education & Quality Minneapolis, Minnesota.
Newsstand Distribution Children’s Hospital of Pittsburgh, Services, UK HealthCare, Barnstable
Pittsburgh, Pennsylvania. Brown Diabetes Center, University of Robert S. Dinsmoor
National Publisher Services South Hamilton, Massachusetts.
Kentucky, Lexington, Kentucky.

Diabetes Self-Management, May/June 2018, Volume 35,
Number 3. Diabetes Self-Management (ISSN 0741-6253)
(USPS 003-865) is published bimonthly by Madavor Media,
LLC, 25 Braintree Hill Ofice Park, Suite 404 Braintree,
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Photographs contained in this
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4 May/June 2018
 EDITOR’S
NOTE
Twitter: I REMEMBER my first experience with diabetes.
@ManageDiabetes My cousin Billy was diagnosed with Type 1 when
Facebook: he was 16 years old. It came without warning
@DiabetesSelfManagement and no cure in sight. Faced with this life
changing challenge, Billy, a three-sport high
school athlete, took on his condition the same
way he played sports – with determination
and positivity. 
Balancing academics and athletics, he
incorporated monitoring his blood sugar
levels and insulin injections into his daily
routine. Never did he see diabetes as a set-
back. In fact, he set new goals and reached
greater heights – placing fifth in the state’s
track and field competition his senior year.
Fast-forward two decades, Billy’s positivity is as strong as ever.
Diabetes never defined him and he continues to find the good.
The role of editor-in-chief of Diabetes Self-Management is one
I am truly proud to take on. When crafting the content for this
magazine, my goal is to lead by Billy’s example:
always inspire and always find the good.
Inspired by Memorial Day, summer fun
and outdoor activities, this BBQ guide is a must-
have resource for healthy seasonal and grilled-
to-order recipes. Learn how to build the ultimate
cookout menu (pg. 30), then fire up the grill and
try new ways to prepare fish, vegan burgers, beef,
chicken and more in the “Master the Grill” section.
Add some “Savory Sides” to your menu, and top off
the meal with one of our “Summer Sparkler” beverages.
With diabetes education and alternative therapies
in mind, we offer tips and tools to help you successfully
manage your prescriptions (pg. 14). And if you think
campfires and lakeside retreats are just for kids, not so
fast. Take a look inside adult diabetes summer camps
and get the strategies you need to make the most of
the wellness retreat experience (pg. 20).
Thank you for diving in and exploring Diabetes
Grill: Shutterstock/stockcreations; Pills:Shutterstock/Mike Flippo

Self-Management. I hope you will learn something

new, find inspiration and share your inspiration
with others.

Maureen McCarthy
Editor-in-Chief

DiabetesSelfManagement.com 5
NEWS &
NOTES
A NEW DEVICE FOR FOOT ULCERS
T he U.S. Food and Drug Administra-
tion (FDA) recently gave the green
light to market a new device for treating
diabetic foot ulcers. Known as the der-
maPACE system, it’s the first shock-wave
device for foot ulcers.
Diabetic foot ulcers are sores or
wounds that occur on the feet of diabe-
tes patients. Ulcers are caused by damage
to the nerves or blood vessels, or both,
when diabetes is poorly controlled. The
condition occurs in about 15 percent of
diabetes patients. If left untreated, foot
ulcers can result in reduced circulation,
infection and even amputation.
6 May/June 2018
Shockwave technology has been used
in medicine for some 30 years in ortho-
pedic treatments to shatter kidney stones.
Success in these procedures suggested
that the technology might be effective in
healing wounds. This led to the develop-
ment of Pulsed Acoustic Cel-
lular Expression (PACE). The
dermaPACE device, developed
by Sanuwave, a technology
firm based in Suwanee, Geor-
gia, is the first to employ PACE
technology for wound treat-
ment. It works by using energy
pulses to stimulate wounds
and is intended for diabetes
patients aged 22 and older
who have experienced foot
ulcers for more than 30 days.
The FDA approved the device after
reviewing the results of two multicenter
studies. Forty-four percent of those stud-
ied experienced wound closure while
receiving the PACE treatment.
Technology watchers now expect that
the dermaPACE breakthrough will lead
to a wider use of shockwave technology
in medicine. †
A New Lyrica
any people with diabetes
M have been taking Lyrica
(generic name, pregabalin) since
it was first approved by the FDA
in 2004. Manufactured by the
pharmaceutical firm Pfizer, Lyrica
is prescribed to counter the pain of
diabetic neuropathy (nerve dam-
age). Most commonly, patients are
directed to take the medication
two or three times a day.
Recently, Pfizer announced that
the FDA has approved a new for-
mulation called Lyrica CR, which is
a longer-lasting version of Lyrica.
Unlike the previous version, Lyrica
CR is taken once a day (after the
evening meal). Lyrica CR tablets
are almond-shaped and come in
three dosages (each a different
color). Lyrica CR was also approved
for the treatment of postherpetic
neuralgia (PHN), but not for the
management of fibromyalgia, as
the original Lyrica was. The safety
of Lyrica CR was established in a
placebo-controlled clinical trial that
involved 800 patients. According to
James M. Rusnak, MD, chief devel-
opment officer, Internal Medicine,
Pfizer Global Product Development,
Lyrica CR was developed to offer
patients an effective treatment
option with the convenience of
once-daily dosing. “[Lyrica CR]
provides an important option for
patients and health care providers
managing these often debilitating
pain conditions,” Rusnak says. †
Shutterstock/Djomas
 NEWS &
NOTES
DIABETES INTRODUCING THE
QUIZ Questions “SUGAR SPONGE”
P eople with diabetes usually treat their disease in one
of two ways – medication or injection. Both methods,
however, have drawbacks. Injections can be painful and
confusing, while patients often forget to take their medica-
tions. Both methods can also have unwelcome side effects.
Could there be another way? Diabetes researchers in China
think there might be.
A team of scientists led by Jianzhong Du, PhD, of
Tongji University in Shanghai reported in the Journal
of the American Chemical Society on their development
of what they call a “sugar sponge.” Injected into the
bloodstream of diabetes patients, sugar sponges, also
called nanomachines, are meant to soak up glucose, or
How Much Do You Know about blood sugar, the way a kitchen sponge soaks up water.
Herbs and Supplements? Nanomachines are about 1/100th the width of a human
hair and are minuscule hollow plastic balls coated with a
More people are taking herbs, vitamins and other protein called concanavalin A. In the bloodstream, the
over-the-counter supplements than ever before. Take concanavalin A adheres to glucose, which then becomes
this quiz to see how much you know about diabetes trapped inside the plastic sphere. The hollow balls also
and supplements. work the opposite way – when glucose in the bloodstream
1. Which of the following supplements may help support becomes low, the nanomachines release it.
a healthy immune response? The researchers’ trial involved 20 mice with diabetes.
OA. Alpha lipoic acid Five of the mice were given sugar sponge injections; the oth-
OB. Lecithin ers were injected with nonabsorbent materials. The blood
OC. Vitamin B12 sugar of the mice that received
OD. Vitamin D the sponges returned to
2. Which of the following herbs lowers blood sugar? normal; the blood of
More than one answer may be correct. the others didn’t.
OA. Bitter gourd/bitter melon However, after
OB. Cassia cinnamon two days, the
OC. Ceylon cinnamon effect of the
OD. Red yeast rice sugar sponges
3. In addition to supporting blood sugar health, what are
wore off and
some other potential benefits of moringa? the blood
OA. Relieving constipation sugar levels
OB. Providing a good source of antioxidants, minerals of the five
and vitamins mice became
OC. Supporting appropriate cholesterol functioning high again. Con-
OD. Regulating blood pressure sequently, the first
Left: Shutterstock/Fecundap stock; Right: Shutterstock/Svetlana Lukienko

aim of Du’s team is to

4. Which of the following improves absorption of
curcumin, turmeric’s active ingredient?
OA. Crush the turmeric root.
OB. Juice it.
OC. Take it with black pepper.
OD.Boil it.
5. You don’t need to ask a medical professional before
taking herbal and other over-the-counter supplements.
OTrue
OFalse
prolong the effect of the sugar
sponges, “one week, one month, or even longer,” he says.
If the effect could be extended to a month, the thinking
goes, it might mean that a diabetes patient could receive
a monthly injection of sugar sponges instead of a daily
injection of insulin – a considerable improvement. More
research is needed to determine effectiveness. So although
it will be a while, if ever, before sugar sponges routinely
course through human bloodstreams soaking up glucose,
it’s an encouraging development that bears watching. †
DiabetesSelfManagement.com 7
NEWS &
NOTES
DIABETES
QUIZ Answers
1. A, B, C and D. Alpha-lipoic acid is a fatty acid and an antioxidant
that has been shown to support healthy blood sugar levels in several
studies. It may also help relieve nerve pain by neutralizing free radicals.
Derived from soy, lecithin contains compounds called phospholipids –key
components in the cell membrane and production of the myelin sheath.
Evidence suggests that this may improve nerve pain in some people who
have diabetes. Vitamin B12 works along with other B vitamins to support
the transmission of healthy nerve signals. Many studies show that vitamin
D deficiency contributes to many problems, including inflammation,
nerve pain and increased pain sensitivity. An animal study showed that
nerve pain decreased after restoring vitamin D levels.
2. A, B and C. Studies have shown bitter melon can help lower blood
sugar. Both Ceylon and cassia cinnamon have blood sugar-lowering
effects, with cassia being the more potent of the two. However, consum-
ing large amounts of cassia cinnamon may cause liver damage. Ask your
health-care provider about how to use cinnamon and which cinnamon
product would work best for your situation before making a selection.
3. B, C and D. Native to India, moringa contains vitamins A and C
along with several B vitamins. It is also a good source of antioxidants,
including quercetin, which may help support healthy blood pressure
levels. Some animal and human studies suggest the plant also may
help lower cholesterol.
4. C. Turmeric’s active ingredient is curcumin, which has been shown to
benefit diabetes in many ways, including improving insulin resistance
and reducing inflammation that can worsen diabetes and lead to com-
plications such as heart disease and nerve pain. The problem is the body
has trouble absorbing turmeric because it does not hang around long
inside the body. Black pepper contains a chemical called piperine that
improves absorption. These days, more turmeric and curcumin products
sold also contain piperine for this reason.
5. False. While over-the-counter products are considered safe to use
without a doctor’s supervision, many supplements and herbs may interact
with diabetes medications and alter their effects. For example, taking
herbs such as bitter melon and moringa may affect blood sugar levels
and have additive effects on blood sugar if taken while taking diabetes
medication. Also, some herbs, such as St. John’s wort, which is often
used for depression, may reduce the effects of other drugs, such as
birth control pills, antidepressants and blood pressure medications such
as calcium channel blockers. For this and many other reasons, it never
hurts to double check with your doctor or pharmacist before adding
nonprescription products to your health-care regimen. †
Frieda Wiley, PharmD, BCGP, RPh is a pharmacist, freelance writer, and life
enthusiast based in the Piney Woods of East Texas.
8 May/June 2018
PERSPIRATION
PERSPECTIVES
R esearchers at the University of Texas announced they
have created a wearable device that can measure diabe-
tes-related compounds in tiny amounts of sweat. Regularly
collecting information on these compounds, they say, can
enable wearers who have diabetes to make smarter lifestyle
choices that can help them better manage their condition.
The wearable monitor detects amounts of cortisol, glucose
and interleukin-6 (IL-6). The necessity of measuring blood
glucose levels in people with diabetes is well-known. The
reason to measure cortisol is because cortisol increases in
moments of stress, and in such moments, glucose levels tend
to rise above the normal range – a situation that can lead first
to prediabetes and then to full-blown Type 2 diabetes. Rising
IL-6 levels are associated with cortisol secretion during psy-
chological stress. IL-6 also increases basal glucose intake and
can influence insulin activity, according to the researchers.
The device requires very small amounts of sweat for test-
ing – just 1 to 3 microliters (a microliter is one-millionth of a
liter) – which means that the wearer doesn’t have to produce
much perspiration at all. Because the device is worn continu-
ally, it gives constant readings, unlike devices that test just
once before being discarded. The developers expect that
wearers can use it
for about a week
before replacing
it and intend it
to be affordable
enough that it can
be used in devel-
oping countries
where the rates
of diabetes are
climbing.
The creators
of the tool soon
expect to have an
app that can be
installed on a cellphone. Using this app, the wearer can push
a button to retrieve information from the device. Accord-
ing to Shalini Prasad, PhD, one of the lead designers, “If
you measure levels every hour on the hour for a full week,
that provides 168 hours’ worth of data on your health as it
changes.” This knowledge will enable wearers to analyze
how their habits and activities are influencing their health.
Shutterstock/YAKOBCHUK VIACHESLAV
As Prasad puts it, “If I can monitor on a day-to-day basis
how my body is responding to intake and as I age, if I can
adjust my lifestyle to keep those readings where they need
to be, then I can delay getting a disease, if not prevent it
entirely.” The next step for developers is to find a partner
and license the technology. †
Discover the FreeStyle Libre system
The FreeStyle Libre system is an FDA-approved continuous glucose monitoring (CGM) system
that lets you accurately1 check your glucose with a painless2 one-second scan instead of a
YV\[PULÄUNLYZ[PJR
You can learn more at FreeStyleLibre.us.

*Fingersticks are required for treatment decisions when you see Check Blood Glucose symbol, when symptoms do not match system readings, when you suspect
readings may be inaccurate, or when you experience symptoms that may be due to high or low blood glucose.
REFERENCES: 1. FreeStyle Libre User’s Manual. 2. Data on File. Abbott Diabetes Care.
INDICATIONS AND IMPORTANT SAFETY INFORMATION
The FreeStyle Libre Flash Glucose Monitoring system is a continuous glucose monitoring (CGM) device indicated for replacing blood glucose testing and detecting trends
and tracking patterns aiding in the detection of episodes of hyperglycemia and hypoglycemia, facilitating both acute and long-term therapy adjustments in persons (age 18
and older) with diabetes. The system is intended for single patient use and requires a prescription.
CONTRAINDICATIONS: Remove the sensor before MRI, CT scan, X-ray, or diathermy treatment.
WARNINGS/LIMITATIONS: Do not ignore symptoms that may be due to low or high blood glucose, hypoglycemic unawareness, or dehydration. Check sensor glucose readings with a
blood glucose meter when Check Blood Glucose symbol appears, when symptoms do not match system readings, or when readings are suspected to be inaccurate. The FreeStyle Libre
system does not have alarms unless the sensor is scanned, and the system contains small parts that may be dangerous if swallowed. The FreeStyle Libre system is not approved for
pregnant women, persons on dialysis, or critically-ill population. Sensor placement is not approved for sites other than the back of the arm and standard precautions for transmission of
blood borne pathogens should be taken. The built-in blood glucose meter is not for use on dehydrated, hypotensive, in shock, hyperglycemic-hyperosmolar state, with or without
ketosis, neonates, critically-ill patients, or for diagnosis or screening of diabetes. Review all product information before use or contact Abbott Toll Free (855-632-8658) or visit
www.freestylelibre.us for detailed indications for use and safety information.
FreeStyle, Libre and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions.

©2018 Abbott. ADC-07061 v2.0 02/18

NEWS &
NOTES
DIABETES
[DEFINITIONS]
METABOLIC SURGERY
An umbrella term for a number of surgi-
cal procedures that improve blood glucose
control in people with Type 2 diabetes who
are obese. Types of metabolic surgery include
adjustable gastric banding, Roux-en-Y gastric
bypass, biliopancreatic diversion and sleeve
gastrectomy.
In adjustable gastric binding, the upper
part of the stomach is surrounded by an
inflatable silicon ring that restricts the move-
ment of food. In Roux-en-Y gastric bypass,
a surgical stapler is used to create a small
pouch in the stomach, which is then surgi-
cally attached directly to the middle of the
small intestine. In biliopancreatic diversion
and sleeve gastrectomy, the reduced stomach
is surgically attached to the end-portion of
the small intestine. These procedures have
two things in common: they decrease the
absorption of calories by the gastrointestinal
tract and promote weight loss. However,
researchers are studying other – and perhaps
even more powerful – effects such as changes
in food metabolism by bile acids, changes in
the hormones in the gut that regulate food
metabolism and changes in the types of
bacteria that live in the gastrointestinal tract.
Many randomized clinical trials have
shown that these types of surgical proce-
dures achieve better blood glucose control
and a decrease in cardiovascular risk factors
in obese Type 2 diabetes patients compared
with various medical and lifestyle interven-
tions. A joint statement issued by international
diabetes organizations in 2016 recommended
that metabolic surgery be included among
treatments for patients with Type 2 diabetes
and obesity.
IMPLANTABLE CARDIOVERTER
DEFIBRILLATOR
A small device placed in the chest or abdomen
to treat dangerous types of cardiac arrhyth-
mias (irregular heart beats).
A regular heart beat requires the coordi-
nated contraction of the heart’s upper cham-
bers (the atria) and lower chambers (the
ventricles). The heart’s built-in electrical system
coordinates the timing of these contractions.
Any disruption in this timing can cause an
arrythmia. While most types of arrhythmias
are harmless, others can be serious. The most
dangerous types of arrythmias are ventricular
arrhythmias, irregular heart beats of the lower
heart chambers. When they occur, the heart
can’t pump blood as well, and the individual
10 May/June 2018
can pass out within seconds and die if not
treated. A ventricular arrhythmia must be
treated right away with an electrical shock,
a treatment called defibrillation. Implantable
cardioverter defibrillators (ICDs) are used for
people who are at high risk for ventricular
arrythmias – those who have had ventricular
arrhythmias before or who have had a heart
attack that has damaged the heart’s electrical
system. Doctors sometimes recommend ICDs
for people who have had prior sudden cardiac
arrest or are at high risk for it. The ICD has
wires with electrodes on the ends that are
connected to the heart chambers. It monitors
the heart rhythm and, if it detects a ventricular
arrhythmia, it delivers a low-energy electrical
signal to restore the normal heart rhythm.
DIABETIC NEPHROPATHY
Kidney disease caused by diabetes. The
primary function of the kidneys is to filter
waste products and excess water out of the
bloodstream. Each kidney contains roughly
one million glomeruli, which are tufts of
tiny blood vessels called capillaries that act
as filters. As blood flows through these
capillaries, small molecules such as waste
products and water pass readily through the
glomeruli. Other substances, such as protein
molecules and red blood cells, are too large
to pass through these filters and remain in
the bloodstream.
High blood glucose levels can damage
the kidneys. People with diabetes are also
prone to hypertension (high blood pres-
sure), which can also damage the kidneys.
Eventually, the kidneys may start to “leak”
tiny amounts of protein into the urine, a
condition known as microalbuminuria.
If kidney disease is diagnosed early, sev-
eral types of treatment may keep them from
getting worse. Controlling blood glucose
levels and high blood pressure both help slow
down the progression of diabetic nephropa-
thy. Two types of blood-pressure-lowering
medications called ACE inhibitors and ARBs
have been found to be especially useful
in slowing diabetic nephropathy. Lifestyle
changes, such as limiting alcohol and pro-
tein intake and stopping smoking, may also
help. Once kidneys fail, regular dialysis may
be needed to filter the blood and, in some
cases, the patient may be given a kidney
transplant. †
Robert Dinsmoor, a medical writer and editor, is a
contributing editor of Diabetes Self-Management.
Victoza and
Heart Health
P eople with diabetes have successfully
been using the drug liraglutide (brand
name, Victoza) to control blood sugar levels
since the drug was approved by the U.S.
Food and Drug Administration (FDA) in
2010. Recently, however, the FDA granted
liraglutide a new indication: the product
is now approved for reducing the risk of
major cardiovascular events in adults who
have both Type 2 diabetes and established
cardiovascular disease.
The FDA approval was based on the results
of the LEADER (Liraglutide Effect and Action
in Diabetes: Evaluation of Cardiovascular
Outcome Results) trial, which compared
the effect of liraglutide versus a placebo
(inert) medication on over 9,300 diabetes
patients from 32 countries for a period of
nearly four years. The findings showed that
liraglutide lowered the risk of non-fatal heart
attack, non-fatal stroke or cardiovascular
death by 13 percent. They also showed that
the medication significantly reduced the risk
of cardiovascular death by 22 percent. This
is important because cardiovascular disease
is the leading cause of death among people
with diabetes.
Liraglutide now becomes the second diabe-
tes medication to be granted a cardiovascular
indication. The first, in 2016, was empagliflozin
(brand name, Jardiance), but Victoza is cur-
rently the only Type 2 diabetes treatment
indicated to reduce the risk of three major
adverse cardiovascular effects (heart attack,
stroke and cardiovascular death).
Victoza, manufactured by the Danish phar-
maceutical firm Novo Nordisk, is delivered
by injection. Patients take it once a day by
using an injectable pen (doses are 0.6 mg, 1.2
mg or 1.8 mg). According to Anne Phillips,
MD, a senior vice president at Novo Nordisk,
“Physicians have come to rely on Victoza as
an effective therapy for lowering A1C, and
with this new indication they now have the
option to choose a diabetes medication that
also reduces their patients’ cardiovascular risk.
This is good news for patients and health care
providers that will also bring much needed
attention to the relationship between Type 2
diabetes and cardiovascular disease.” †
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NEWS &
NOTES
DIABETES
RESOURCES
Get
Walking
I f you are looking to ease back into
regular exercise, now is the perfect
time to start a walking routine. Not
only does walking help to lower blood
sugar levels and improve the body’s
ability to use insulin, but it also helps
lower stress and helps you lose weight
or maintain a desired weight.
Start with a plan
The National Heart, Lung and Blood
Institute developed a multi-week
walking plan – search for “sample
walking program” at www.nhlbi.nih.
gov. Begin at an easy pace with a five-
minute walk and slowly add about two
minutes to your walking time each
week. By week eight, aim to walk for
at least 20 minutes, and then by week
12, keep walking for 30 minutes.
Gradually walk at a steadier pace so
that you’re breathing a little harder,
but still able to have a conversation.
12 May/June 2018
Bonus miles
Research shows that people who
want to reap health benefits from
walking should do it for 30 minutes
a day at least five days of the week.
Keep in mind, walking for 30 min-
utes is not a must. Three 10-minute
walks at a brisk pace will get the
job done. One study by Harvard
doctors found that women who did
at least 30 minutes of daily moder-
ate physical activity, such as brisk
walking, cut their risk of diabetes
by 30 percent.
Squeeze in steps
If you’re having trouble finding
time to fit walking into your already
hectic schedule, consider a few sim-
ple ways to take more steps each
day. Take the stairs instead of the
elevator the next time you have a
chance. Park a little further away in
the parking lot when you’re going to
the office or shopping at the stores.
Do walking meetings with your co-
workers or take short walks during
your lunch break.
Fun walks
Walking day after day can become a
little boring, so it’s important to do
it with a family member or friend to
help support you and get you out of
the house. Walking and talking will
make the time go by much faster
and will help motivate you to walk
brisker and longer. Another way to
make walking more fun is by listen-
ing to your favorite music play list,
new audiobooks or calling family
Shutterstock/Monkey Business Images
and friends. †
Paul Wynn, a writer based in Garrison, New
York, is a regular contributor to Diabetes
Self-Management.
 NEWS &
NOTES
Gary Scheiner, MS, CDE, is owner and
clinical director of Integrated Diabetes
Services (www.integrateddiabetes.
com), a private practice specializing
in intensive therapy for children and
adults. He has lived with Type 1 diabetes
for 30 years; is a certified diabetes
educator and named Diabetes Educator
of the Year 2014 by the American
Association of Diabetes Educators.
Have a question about diabetes?
Send it to Gary Scheiner MS, CDE,
at gary@integrateddiabetes.com.
Shutterstock/Click and Photo
Q+A
Q: The meter I’ve been using for years is previously used. It’s a very good option for
being discontinued. It uses replaceable disks
to hold the test strips. I can’t use meters that
require a test strip insertion because my
hands and fingers are too arthritic. What
do you advise?
A: Sometimes “progress” doesn’t seem like
progress at all. I remember the meter you
described: the test strip “disk” was certainly
easier to handle for people with arthritis, hand
tremors or limited vision. In the manufactur-
ers’ defense, the meters that have replaced it
are more accurate and require a much smaller
blood sample. Of course, that only matters if
you can get the strip into the meter.
Here’s a bit of progress that might be able
to help. There is a new device called a “flash”
monitor that does not require test strips or
fingersticks and provides glucose values any
time you like. A 10-day glucose sensor is
placed on the skin using a simple one-handed
inserter. After a warm-up period, you simply
scan a handheld “reader” over the sensor to
see your current glucose level. The device
does not require fingerstick calibrations, but
you may still need to check your blood sugar
with a meter once in a while to verify that the
system is working properly and during the
warmup periods.
The flash monitor is covered by most
health insurance plans, including Medicare,
and its accuracy is on par with the meter you
anyone who struggles to perform blood sugar
checks the “old fashioned” way. Ask your
physician for details.
Q: I had outpatient surgery on my hip
recently. Despite continuing to take my dia-
betes medications (which my primary doctor
said to do), my blood sugar was quite high for
almost a week after the procedure. The sur-
geon said this probably delayed my recovery.
What are your thoughts and is there anything
I could have done differently?
A: Asking for and following your physician’s
advice is generally a good idea. But of course,
not all physicians are experts at all things.
Unless your primary care doctor is also an
endocrinologist or an internist specializing
in diabetes, chances are he or she only has a
general understanding of diabetes care and
treatment. It is often worth consulting with an
endocrinologist or a certified diabetes educa-
tor before a scheduled medical procedure to
develop a plan for managing your diabetes
before, during and after. A diabetes specialist
will be able to help you balance your insulin
(or other diabetes medications) in the event
you need to fast leading up the procedure.
They can also coordinate with the surgeon
and hospital staff in case you require IV insulin
or glucose during and after the procedure.
As your surgeon pointed out, something
as important as hip surgery requires optimal
blood sugar control to allow a full, speedy
recovery and prevent infection. The same
goes for many other types of medical pro-
cedures and common illnesses. Surgery and
illness often involve several things that can
make blood sugars rise: stress, discomfort,
anti-inflammatory medications and a sharp
reduction in physical activity. To offset these
and keep the blood sugar from running
too high, it is usually necessary to increase
diabetes medication doses or temporarily
add new forms of treatment. For example,
those who do not currently take insulin may
need to take a modest dose for a short while.
Those who take insulin may need to ramp up
their dose. The key is to do whatever it takes
to keep your blood sugars in range so you’ll
recover as quickly as possible. †
DiabetesSelfManagement.com 13
 MAKING YOUR

PILLS WORK FOR YOU

Shutterstock/Video_Creative

14 May/June 2018
 By Amy Campbell, MS, RD, LDN, CDE

If you have diabetes, it’s highly likely that you

take at least one type of medicine to help you manage it. People with Type
1 diabetes must take insulin. Those with Type 2 diabetes may manage just
fine by eating healthfully and staying active. While many people with Type 2
diabetes take at least one, if not two or three, diabetes medicines, including
pills, non-insulin injectables and insulin.

DiabetesSelfManagement.com 15
 According to data from the Centers for
Disease Control and Prevention (CDC),
the number of adults with diabetes who
take insulin, pills or both greatly increased
from 1997 to 2011. The increase is due in
part to the increase in numbers of people
in the U.S. who have diabetes. However,
thanks to newer types of diabetes medi-
cines and better awareness of diabetes
management among health-care provid-
ers, more people are taking medicine as
part of their diabetes treatment plan.
TAKING DIABETES PILLS
There are nine classes, or types, of dia-
betes pills. There are combinations of
these pills, too, making it easier for you
to benefit from two types of pills. These
medications work in different ways to
help manage blood glucose levels. The
good news is that if one type of pill isn’t
doing the job well enough, your doctor
can change your medicine or even add
a second or third medicine. To make
sure you’re getting the most from your
diabetes pills, consider the following tips.
SULFONYLUREAS
This class of drug has been around since
the 1940s. Examples include glimepiride
(brand name Amaryl), glyburide (Dia-
Beta, Glynase, Micronase) and glipizide
(Glucotrol). Sulfonylureas signal the
pancreas to release insulin and may
help your body use its own insulin better.
Recommendations
• Take your pill the same times each
day, before meals (glipizide should
be taken 30 minutes before the meal).
• Because these pills can increase the
chance of low blood sugar, don’t skip
or delay meals. Be prepared and keep a
treatment for low blood sugar with you
at all times — glucose tablets or gel,
juice or regular soda are good choices.
• Sulfonylureas can increase sensitiv-
ity to the sun, so be sure to protect
yourself by wearing sunscreen, a hat
and sunglasses when you’re outdoors.
METFORMIN
(Glucophage, Glucophage XR, For-
tamet, Glumetza, Riomet) is rec-
ommended as the first line of drug
treatment for people who are new
to Type 2 diabetes. This drug helps
16 May/June 2018
make cells more “sensitive” to insulin
and tells the liver to stop releasing too
much glucose.
Recommendations
• When you first start taking this drug, it
may cause an upset stomach, gas or diar-
rhea. Lessen the chances of side effects
by taking your metformin with meals.
• Start low, go slow. Your doctor should
start you on a low dose of metformin
and gradually increase the dose to help
lessen side effects.
• Regular metformin is usually taken twice
a day; extended-release is taken once a
day, usually in the evening.
• Ask your doctor to periodically check
your blood vitamin B12 level. Metformin
can affect B12 absorption in the gut,
raising the risk of B12 deficiency.
• Go easy with alcohol when taking met-
formin — too much alcohol can raise
the risk for a rare but serious condition
called lactic acidosis.
• Tell all your health care providers that
you take metformin, especially if you
are scheduled for a CT scan involving
contrast dyes.
• Don’t panic if you see what looks like a
tablet in your stools — this is the outer
shell of the extended-release metfor-
min. Seeing it in your stools doesn’t
mean the pill hasn’t been absorbed or
that it’s not working.
DPP-4 INHIBITORS
(dipeptidyl peptidase 4 (DPP-4) are a
newer class of drug and include sita-
gliptin (Januvia), saxagliptin (Onglyza),
linagliptin (Tradjenta) and alogliptin
(Nesina). These drugs slow stomach
emptying, increase fullness and slow the
release of glucose from the liver. DPP-4
inhibitors generally aren’t the first choice
of drug for people because in some cases,
they may not be as effective at lowering
A1C levels as other drugs.
Recommendations
• Take your DPP-4 inhibitor at the same
time each day. You don’t necessarily have
to take it with food. Most people take
their pill in the morning.
Shutterstock/Shahrokost
• Saxagliptin can interact with ketocon-
azole, a drug used to treat fungal infec-
tions, so always let your providers know
all medicines that you take.
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 • DPP-4 inhibitors are linked with pancreatitis.
Stomach pain and vomiting are symptoms of
pancreatitis. Contact your doctor if you develop
these symptoms.
• Severe joint pain is another possible side effect
of this class of drugs. The pain goes away once
the drug is stopped.

SGLT-2 INHIBITORS ARE THE NEWEST

CLASS OF DIABETES PILLS.
They lower blood sugar by causing glucose to
move from the bloodstream into the urine. They
can also help with weight loss. Canagliflozin
(Invokana), dapagliflozin (Farxiga) and empa-
gliflozin (Jardiance) are the three pills in this
class of drugs.

Recommendations
• Take your SGLT-2 inhibitor with your first meal of
the day. If you forget to take it, take it as soon as you
remember (but don’t double up on your dose).
• Keep up your fluid intake to avoid dehydration
because this drug can cause you to urinate more
than usual.
• Be aware of signs and symptoms of yeast or urinary
tract infections while taking this drug.
• Note that SGLT-2 inhibitors may cause your blood
pressure to drop too low, especially when you
stand up suddenly.

GENERAL TIPS FOR TAKING

DIABETES PILLS
• It goes without saying that your diabetes pills will
work best if you take them as prescribed — that
means taking the right dose at the right time.
• Give your medicines a chance to do their job.
But if after several weeks you don’t see any or
much of an improvement in your blood sugars,
let your doctor know.
• Check your blood sugars more than usual when-
ever you start a new diabetes medicine and/or if
the dose is changed.
• Store your medicines away from heat and humid-
ity, and pay attention to expiration dates.
• Let your doctor know if you’re having trouble
affording your medicines. He or she can likely
prescribe a lower-cost alternative. There are
also medicine-assistance programs, such as www.
needymeds.org, that can help.
• Keep up with regular doctor’s appointments and
lab tests to make sure your medicines are working
and that they are safe for you to take.
• Your pharmacist can also answer any questions
you may have about any medicines you take. He
Shutterstock/Vita Sun

or she can also help you come up with a medica-

tion schedule to make sure that you’re getting
the most out of your medicines. †
18 May/June 2018
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DiabetesSelfManagement.com 19
 Connect In Motion

20
May/June 2018
 DIABETES
SUMMER
CAMPS?
Not Just for Kids
by Alison Massey MS, RD, LDN, CDE

DiabetesSelfManagement.com 21

CAMPFIRES, laughing with new
friends, catching fireflies on warm
summer nights and lake swimming
might evoke fond memories of sum-
mer camp for some adults. Does the
magic of a summer camp experience
really have to end with childhood?
More options are now available than
ever for adults who want to revisit
the beloved summer camp getaway
or perhaps experience it for the
first time. Whether you are looking
to connect with other individuals
living with diabetes or simply look-
ing for a wellness retreat, you have
many options.
But before booking your trip and
packing your bags, you might con-
sider a few things to make the most
of your experience.
What kind of experience are
you seeking?
The first consideration is to identify
the kind of trip you would enjoy. Are
you seeking to:
• expand your diabetes knowledge?
• connect with other individuals
Connect In Motion
looking to improve diabetes man-
agement and their health?
• adventure?
• improve your fitness?
• relax and minimize stress?
Some camps and retreats include
educational lectures in which attendees
can learn new skills, while other camps
focus more on offering activities and
experiences. There may be a combina-
tion of these activities. Identifying the
most important features ensures you
will achieve the type of vacation you
are seeking.

“…adults taking time to retreat from the daily grind can be an important component of self-
care. Learning new skills, connecting with others and spending time in nature can be fantastic
ways to refresh and perhaps even jump-start new routines to improve diabetes management.”
22 May/June 2018
Are medical professionals
involved and/or available?
If you are specifically looking for
information to hone diabetes self-
management skills, improve culinary
skills and diet or enhance fitness
skills, it is important to look for pro-
grams supported by credentialed
health care providers (either serving
as board members or involved in
supporting the program).
Having a licensed medical profes-
sional on staff is especially important if
the experience involves more intense
physical activity than your typical rou-
tine and/or significant dietary modifi-
cations. These factors can affect blood
glucose management and in some cases
may even require dose adjustments for
medications. Generally, involvement by
licensed health care professionals may
help ensure that programs are meeting
standards of care for individuals living
with diabetes. It also may be beneficial
to discuss travel and getaway plans with
your regular health care provider or
diabetes educator to receive guidance
about traveling with medications and
changes in physical activity and/or diet.
How many vacation days do
you want to use?
If you are trying to find time for your-
self without burning through your
paid time off, camp and retreat expe-
riences for adults are offered in vary-
ing lengths of time. While childhood
often offers summers off, the reality is
that many adults are juggling careers
and family responsibilities. Along with
weeklong experiences, many places
are offering weekend retreats that are
time and budget friendly.
Whether you choose a weekend
away or a full two-week adventure, a
retreat can be an important compo-
nent of self-care. Learning new skills,
connecting with others and spending
time in nature can be fantastic ways to
refresh and perhaps even jump-start
new routines to improve diabetes
management. †
Alison Massey, MS, RD, LDN and CDE, is a
registered dietitian and certified diabetes educa-
tor in Maryland. She is the owner of The Simple
Ingredient LLC www.thesimpleingredient.com.
ADULT SUMMER
CAMPS AND RETREATS
Check out these options for camps and
retreats— each designed just for adults
looking to connect with other individuals
living with diabetes or simply looking for a
health and wellness experience geared
toward improving diabetes management.
DIABETES TRAINING CAMP
Located in beautiful Lancaster, Pennsylvania, the
Diabetes Training Camp is a multi-sports training
camp. They offer a weeklong camp experience
for individuals with diabetes who are either
interested in improving their general fitness or in
improving their competitive edge for marathons,
triathlons or anything in between. Professional
coaching staff is available along with medical
staff. Workshops and seminars are included
along with fitness training to enhance diabetes
self-management skills. Staff includes medical
professionals, registered dietitians and certified
diabetes educators. New program offerings in
2018 may also include three-day boot camp
experiences for individuals with Type 2 diabetes
and prediabetes. Program fees are subsidized
by the Diabetes Training Camp Foundation.
However, scholarships are available for those in
financial need. www.diabetestrainingcamp.com
CONNECTED IN MOTION: DIABETES
EDUCATION THROUGH ADVENTURE
Designed for individuals with Type 1 diabetes,
the Canadian-based Connected in Motion
program works to build and support
communities of active and well-informed
adults who are engaged in their diabetes
self-management. The program does this by
offering amazing adventures and experiences
to connect individuals and provide a unique
format for learning. Events range from day,
weekend and even 10-day experiences. Choose
from a range of options from canoeing, white
water rafting and hiking. Not able to travel
to Canada? In 2018, three programs will be
offered in Southern California and Maine.
http://www.connectedinmotion.ca/
SURVIVE AND THRIVE CAMP NEJEDA
Established in 1958, Camp Nejeda located in
Stillwater, New Jersey, provides all kinds of
programming for individuals living with Type
1 diabetes. In addition to their eight-week
sleep-away camp for children with Type 1
diabetes, the camp offers a weekend boot camp
for adults over the age of 21 with Type 1. The
boot camp provides camp goers a balance of
relaxation, fun, connection and education. Zip
lining, boating and massages are just a few
activities that are available between informative
and interactive lectures on diabetes self-
management. www.campnejeda.org/
24 May/June 2018
 DIABETES
CHAMPION
Fit4D CEO David Weingard
By Alison Massey MS, RD, LDN, CDE
T he everyday moments that make
up our lives often do not prompt
significant change. Difficult or chal-
lenging events are catalysts for a dif-
ferent direction for our lives. This was
also true for David Weingard, CEO and
founder of Fit4D.
A successful Microsoft executive
and physically fit triathlete, Weingard
was training five hours a day for his
next competitive event when he sud-
denly lost 20 pounds in three weeks. At
36, the triathlete’s condition quickly
deteriorated to the point at which he
was barely able to walk three blocks.
A trip to the doctor confirmed the
diagnosis of Type 1 diabetes. Over-
whelmed with this life-altering diag-
nosis, Weingard was surprised and
frustrated that more support and edu-
cation weren’t provided at the time.
Diabetes education classes at a nearby
hospital weren’t available for another
six weeks. Concerns about how to
manage his diabetes and whether he
would be able to race again remained
unanswered. Persistent in his pursuit
for answers, education and support,
Weingard sought out the expertise of
a certified diabetes educator (CDE)
on his own.
“[My diabetes educator], Cecilia,
went out of her way to fit me into her
already booked schedule,” Weingard
recalls. “She met with me over the
course of a few months and compas-
sionately gave me guidance on how to
acclimate to my new lifestyle.”
Weingard says the support he
received was invaluable – so much so
that he decided to seek more guidance
from CDEs throughout his diabetes
journey. “Thanks to this newfound
understanding of the complex disease,
I was able to become productive again
in my personal and professional life,”
he adds. “I figured out how to train and
race Ironman Triathlons with diabetes
and realized that I could accomplish
anything if I had the right knowledge,
support and mentality.”
The birth of Fit4D
Weingard’s medical journey coupled
with his professional experience with
next generation technology lead him
to his “a-ha!” moment as an entre-
preneur. On his way to an Ironman
triathlon in Idaho, he thought to
himself, “What if I could bring every-
one a ‘Cecilia’ by scaling the personal
coaching aspect [of diabetes educa-
tion] using technology?” This desire
to expand the access to CDEs to all
individuals living with diabetes was
the concept behind Fit4D.
Making this dream a reality didn’t
come without sacrifices. Building and
launching the company consumed
many nights and weekends. When
Fit4D partnered and finally launched
with Bayer Diabetes, Weingard left
his corporate position with Microsoft
to devote himself full-time to build-
ing Fit4D. Fit4D’s technology-enabled
coaching now brings the personalized
human touch and expertise of CDEs to
help close the gap in care and empower
individuals to improve their diabetes
self-management. Fit4D partners with
pharmaceutical companies, payers
and accountable care organizations
to improve health outcomes, with a
track record of improving adherence
to branded prescriptions by 20 percent
and reducing hemoglobin A1C values.
Redefining diabetes education
Currently, Fit4D has a network of over
100 CDEs who provide coaching to
individuals with diabetes. The Fit4D
technology platform offers benefits
that traditional education often does
not include, like multiple communi-
cation methods and flexible sched-
uling, so individuals can work with
their coaches at a time that is most
convenient to them.
“My vision for Fit4D is that our com-
pany will continue to grow, so that our
CDEs can reach all people living with
diabetes on Earth,” says Weingard.
“By providing the masses with per-
sonalized diabetes self-management
education and support, more people
will be empowered to improve their
lives and, by extension, the lives of
those they love.”
You can learn more about Fit4D at
www.fit4d.com. †
Alison Massey MS, RD, LDN, CDE is a registered
dietitian and certified diabetes educator in Mary-
land. She blogs at www.thesimpleingredient.com.
DiabetesSelfManagement.com 25
 Shutterstock/asife

26
May/June 2018
MENOPAUSE
+ DIABETES
What’s the Connection?
By JoAnn Stevelos

DURING THE YEARS leading up to menopause – a time

known as perimenopause – many women will say they
missed some of the signs: slow weight gain, sleepless nights,
irregular menstruation, even waking up uncomfortable or
in a sweat. Some recall experiencing difficult to manage
mood swings; a change in cholesterol levels or the horrible
crashing feeling from blood sugar fluctuation. For women
with diabetes, these symptoms can come earlier in life.

DiabetesSelfManagement.com 27

HELP FOR HOT FLASHES
• If your breathing is hurried, slow it down
and take deep breaths.
• Use a cold cloth on your face and the back
of your neck.
• Drink cold or icy water.
• Wear loose, light clothing and dress in
layers so you can remove and add them
according to your body temperature.
• Don’t use memory foam mattress and
pillows because they have a greater
tendency to trap heat.
• Use a bedside fan.
• Turn down the thermostat at night.
COPING WITH WEIGHT GAIN
• Eat small meals regularly to reduce the
chance of fat storage.
• Choose whole grain foods, fruits and
vegetables over processed food.
• Read the labels.
• Use healthy oils that are high in omega-3
like olive oil.
• Choose foods with complex carbohydrates
like fruit and beans over simple
carbohydrates like soda and candy.
• Stay active by doing things like walking,
yoga, gardening, swimming and biking.
• Exercise with other people – it keeps you
motivated and accountable.
• Use an app like Noom, Weight Watchers or
MyFitnessPal to keep track of your activity.
• Establish small achievable goals. Add or
delete one thing at a time.
BE KIND TO YOURSELF
• Splurge on loose fitting stylish clothing
that will accommodate weigh fluctuations.
Choose neutral colors, like grays and
whites that you can mix and match easily.
• Create a routine to give yourself some
sense of certainty and that will help you
with time management.  and menopause may need to work
• Take a “well day” or “mental health day”
to just unwind, rest and relax. 
• Try something new. New experiences
will help you learn more about yourself
and give you new things to think and
talk about.
• Try a meditation app like HeadSpace or
Stop, Breathe & Think.
• Choose water over other drinks. Staying
hydrated is essential to feeling good.
• Meet up with a friend just to catch up.  your diabetes is manageable with
• Claim some space. Find a place where you
can go to have a quiet moment to read a
book, or meditate or cry – somewhere you
can get some peace and privacy.
• Get outside for some fresh air every day –
even for a few minutes or a walk around
the block. Breathe the fresh air. Stand
under a tree.  management skills. Women with
• Make sleep a priority. Everything is more
difficult when you’re tired.
28 May/June 2018
Perimenopause, usually lasts
about four years until menopause
begins. Women enter menopause
when their ovaries have completely
stopped releasing eggs and they have
not had a period for 12 months.
How do perimenopause and
menopause affect women
with diabetes?
When you have your period, your
estrogen and progesterone hor-
mones are fluctuating and can
affect how your body responds to
insulin. During perimenopause,
many women experience periods
that are heavier or lighter, longer or
shorter than usual. This is caused by
the imbalance of progesterone and
estrogen. For women with diabetes,
the higher levels of estrogen can
improve insulin sensitivity. However,
higher levels of progesterone can
cause insulin resistance. When your
menstrual cycle is less predictable,
you can expect your diabetes to be
less stable on some days than others.
It is no surprise to most women
that whenever your hormone balance
changes, your weight can change as
well. So it is especially important to
keep track of weight changes dur-
ing perimenopause and menopause
because too much weight gain puts
women at a higher risk of developing
Type 2 diabetes.
Women who have diabetes who
gain weight during perimenopause
with their doctor to manage their
diabetes and may need to increase
the dosage of insulin or oral meds.
Identifying and understanding the
body’s signals during perimeno-
pause and menopause and those
related to diabetes can be quite
challenging. Staying in control of
some focused attention. Maintain-
ing a lifestyle that is active and
mindful of choosing healthy meal
options is important.
Another challenge may be that
you will need to improve your time
diabetes who are in perimenopause
or menopause will need to adjust
their schedules to accommodate
things like checking their blood
sugar levels more often during the
day and occasionally during the
night. Or you may need to visit the
doctor more often to adjust medica-
tions – especially if you are gaining
weight. And the sleepless nights
experienced by many women during
this phase requires making time to
rest or fit in a nap as part of your
daily routine.
How do you know if
menopause or diabetes is
causing your symptoms?
It can be confusing to determine
whether menopause symptoms or
diabetes is causing sweating, dizziness
or mood swings. It is very common to
mistake hot flashes for low blood sugar.
Not being able to distinguish between
the two conditions can be frustrating.
but you can take a few actions.
Check your blood glucose
levels more often, especially
while experiencing
symptoms.
Be sure to eliminate unhealthy factors
that may cause similar symptoms, like
caffeine or sleeping in a warm room.
Discuss the changes in your body
with your doctor. A doctor can help
identify the best treatments for you.
For example, if you are experiencing
vaginal dryness, decreased sexual
response, hot flashes or other symp-
toms, the doctor may recommend a
vaginal lubricant to restore moisture
or vaginal estrogen therapy to correct
thinning and inflammation of the
vaginal walls.
Be compassionate and gentle with
yourself. These are big changes and
can be overwhelming. Ask for sup-
port from family and friends.
When you are unsure of what is
causing your discomfort, be proactive
in listening to your body, and seek
medical advice. Just as you need an
individualized plan for diabetes, you
will need one for coping with meno-
pause. With some patience, trial and
error and support from your doctor,
family and friends, you will create a
plan that is right for you. †
 BUILD THE
PERFECT
Celebrating BBQ PORK
18+ Years SANDWICH
TRUSTED AND
APPROVED PAGE 36
by Registered
Dietitians
DARE TO DIP
PAGE 40

BE A GRILL
MASTER
PAGE 44
Shutterstock/Arina P Habich

SUPERMARKET SMARTS
BUTTER, MARGARINE
AND SPREADS PAGE 60
DiabetesSelfManagement.com 29
 THIRST QUENCHERS
35 Strawberry-Basil Sparklers
35 Mint-Green Tea Coolers
35 Iced Pomegranate Tea
BBQ BEGINNINGS
37 Asian Vegetable Rolls with
Soy-Lime Dipping Sauce
37 Southern Crab Cakes with
Rémoulade Dipping Sauce
38 Chunky Veggie Dip
38 Roasted Garlic Hummus
39 Roasted Red Pepper Dip
39 Harvest Sticks with Vegetable Dip
BBQ FAVORITES
33 BBQ Pork Sandwiches
with Slaw
41 Grilled Oriental Shrimp Kabobs
41 Grilled Salsa Turkey Burger
41 Grilled Summer
Vegetable Sandwiches
42 Spiced Chicken Skewers
with Yogurt-Tahini Sauce
42 Chipotle Orange BBQ Drumsticks
43 Grilled Swordish á l’Orange
SUMMER SIDES
33 Grilled Corn on the Cob
with Buttery Citrus Spread
33 Spicy Baked Sweet Potato Chips
45 Low-Fat Macaroni and Cheese
45 Garden Pasta Salad
46 Grilled Sesame Asparagus
46 Coleslaw With Snow Peas and Corn
46 Gazpacho Pasta Salad
JUST DESSERTS
47 Brown Sugar Strawberry Shortcakes
48 Very Berry Yogurt Parfaits
48 Almond Berry Parfaits

Understanding Our Symbols LOW-FAT RECIPE

Contains 3 grams or fewer of fat per serving
Like everyone, you’re busy – and we kept that in
mind when we selected recipes for this issue. Many LOW-SODIUM RECIPE
of the recipes in Diabetic Cooking can be prepared Contains 140 milligrams or fewer of sodium
in 30 minutes or less. Others require short preparation per serving
times followed by long cooking times. LOW-CARBOHYDRATE RECIPE
Contains 15 grams or fewer of carbohydrate
We’ve also included symbols to help you more easily per serving
find those recipes especially low in fat, sodium, and
carbohydrates, and high in fiber. HIGH-FIBER RECIPE
Contains 5 grams or more of fiber per serving

30 May/June 2018
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THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE.
 BBQ
FAVORITES

IF YOU ARE LOOKING for summer

cookout ideas, your search is over.
Break out the hickory smoked
barbecue sauce and build this savory
pork sandwich with homemade
coleslaw. Add some spicy sweet potato
chips and the buttery goodness of
grilled corn on the cob to create a
meal light on calories (under 525)
and heavy on deliciousness.

Photographed by Angel Tucker; food prepared by Maggie Mulvena

32 May/June 2018
 BBQ Pork Sandwiches
with Slaw
MAKES 4 SERVINGS (1 BUN, 4 SLICES PORK
AND GENEROUS 1/3 CUP SLAW)
Nutrients per Serving: Calories 338,
Total Fat 6g, Saturated Fat 1g, Protein 28g,
Carbohydrates 43g, Cholesterol 74mg,
Dietary Fiber 6g, Sodium 731mg
Dietary Exchange: 2 Bread/Starch, ½ Fruit,
3 Meat
1 pound lean pork tenderloin
¼ teaspoon plus 1/8 teaspoon salt,
divided
¼ teaspoon black pepper
6 tablespoons hickory smoked
barbecue sauce, divided
1½ cups thinly sliced green cabbage
or cole slaw mix
1 medium Granny Smith apple,
peeled and coarsely grated
¼ cup sliced green onions
1 tablespoon reduced-fat
mayonnaise
½ teaspoon apple cider vinegar
4 whole wheat sandwich buns,
toasted
1. Preheat oven to 400°F.
2. Sprinkle pork with ¼ teaspoon
salt and pepper. Brush pork with 2
tablespoons barbecue sauce. Place in
roasting pan; bake 25 to 30 minutes,
turning once during baking. Let stand 5
minutes; cut into 16 (¼-inch) slices.
3. Meanwhile, combine cabbage, apple,
green onions, mayonnaise, vinegar and
remaining 1/8 teaspoon salt in medium
bowl; mix well.
4. Place remaining 4 tablespoons
barbecue sauce in small microwavable
bowl; cover and microwave on HIGH 30
seconds or until sauce is heated.
Shutterstock/All for you friend
5. To serve, divide pork among buns.
Spread 1 tablespoon barbecue sauce
over pork on each sandwich. Top evenly
with slaw. Serve immediately.
Grilled Corn on the Cob
with Buttery Citrus Spread
MAKES 4 SERVINGS
SERVING SIZE: 1 EAR OF CORN AND
2 TEASPOONS SPREAD
Nutrients per Serving: Calories 84, Total Fat 3g,
Saturated Fat 1g, Protein 2g, Carbohydrates 15g,
Cholesterol 0mg, Dietary Fiber 2g, Sodium 189mg
Dietary Exchange: 1 Bread/Starch, ½ Fat
4 medium ears corn, husks ¼ teaspoon salt
and silks removed
Nonstick cooking spray 1. Preheat grill to medium
2 tablespoons reduced-fat heat. Coat corn with nonstick
cooking spray. Grill, covered,
margarine
18 to 20 minutes or until gold-
1 tablespoon inely
en brown, turning frequently.
chopped parsley
1 teaspoon grated lemon 2. Meanwhile, combine
peel remaining ingredients in small
½ teaspoon black pepper bowl.
¼ teaspoon paprika 3. Serve corn with spread.
Spicy Baked Sweet Potato Chips
MAKES 4 SERVINGS
Nutrients per Serving: Calories 102, Total Fat 5g, Saturated Fat 1g, Protein 1g,
Carbohydrates 14g, Cholesterol 0mg, Dietary Fiber 2g, Sodium 181mg
Dietary Exchange: 1 Bread/Starch, 1 Fat
1 teaspoon granulated sugar 2. Cut sweet potatoes crosswise
½ teaspoon smoked paprika into very thin slices, about 1/16 inch
¼ teaspoon salt thick. Place on prepared baking
sheet. Drizzle with oil; toss to coat.
¼ teaspoon ground red pepper
Arrange in single layer.
2 medium sweet potatoes
4 teaspoons vegetable oil 3. Bake 10 minutes. Turn chips
over; sprinkle with seasoning mix.
1. Preheat oven to 400°F. Spray Bake 10 to 15 minutes or until
baking sheet with nonstick cook- chips are lightly browned and crisp,
ing spray. Combine sugar, paprika, stirring frequently. Spread on paper
salt and ground red pepper in small towels to cool completely.
bowl; set aside.
DiabetesSelfManagement.com 33
 THIRST
QUENCHERS

NOTHING KICKS OFF A COOKOUT

like an ice-cold sparkler! If you fancy
the cool flavors of strawberry and basil,
try our ruby red-flavored sparkler. If
teas are your go-to, wet your whistle
with the Mint-Green or Iced
Pomegranate variety.

34 May/June 2018
Strawberry-
Basil
Sparklers
MAKES 8 (8-OUNCE)
SERVINGS
Nutrients per Serving:
Calories 89, Total Fat 0g,
Saturated Fat 0g, Protein
1g, Carbohydrates 22g,
Cholesterol 0mg, Dietary
Fiber 2g, Sodium 54mg
Dietary Exchange: 1½ Fruit
Basil Simple syrup
(recipe follows)
4 cups strawberries,
plus additional for
garnish
Ice cubes
2 liters club soda
Fresh basil leaves
(optional)
1. Prepare Basil Simple
Syrup.
2. Combine 4 cups straw-
berries and Basil Simple
Syrup in blender; blend
until smooth.
3. Fill eight glasses with
ice. Divide strawberry mix-
ture among glasses; pour
in club soda. Garnish with
additional strawberries
and basil.
Basil Simple Syrup
1 cup fresh basil
leaves
2
/3 cup sugar
2
/3 cup water
Combine all ingredients
in small saucepan; cook
and stir over medium heat
until sugar is dissolved.
Remove from heat; cool
completely. Pour through
ine-mesh sieve; discard
basil. Store in refrigerator
up to 1 week.
Iced Pomegranate
Tea
MAKES 4 (1-CUP) SERVINGS
Nutrients per Serving: Calories
36, Total Fat 0g, Saturated Fat 0g,
Protein 0g, Carbohydrates 10g,
Cholesterol 0mg, Dietary Fiber 0g,
Sodium 8mg
Dietary Exchange: ½ Fruit
3 cups water, divided
2 spiced chai tea bags
3 to 4 tablespoons sugar
substitute
2 tablespoons lemon juice
1 cup blueberry pomegran-
ate juice
1. Bring 1 cup water to a boil in
small saucepan over high heat.
Remove from heat. Add tea
bags. Steep 3 minutes. Discard
tea bags.
2. Pour remaining ingredients
into pitcher. Mix well. Add
brewed tea; stir. Serve immedi-
ately over ice, or cover and chill.
Mint-Green Tea Coolers Variation: Also may be served
MAKES 2 SERVINGS
hot.
Nutrients per Serving: Calories 3, Total Fat 1g,
Saturated Fat 1g, Protein 1g, Carbohydrates 1g,
Cholesterol 0mg, Dietary Fiber 1g, Sodium 1mg
2 bags green tea
4 thin slices fresh ginger (about 1 inch)
7 or 8 large fresh mint leaves, roughly
torn
2 cups boiling water
2 cups crushed ice
1. Place tea bags, ginger and mint leaves in
teapot or 2-cup heatproof measuring cup.
Add boiling water; steep 4 minutes. Remove
tea bags, ginger and mint leaves; discard.
Cool tea to room temperature.
2. Pour 1 cup crushed ice into each of two
tall glasses. Divide tea between glasses.
Tip: Squeeze a lime wedge (about 1/8 of a
lime) into each cooler before serving.
DiabetesSelfManagement.com 35
 BBQ
BEGINNINGS

BUILD THE PERFECT BARBECUE APPETIZER! Whether your group is gathered

poolside or lounging on the deck, these easy-to-prepare recipes will energize the
taste buds. From Asian Veggie Rolls to Roasted Garlic Hummus to Southern Crab
Cakes with Rémoulade Dipping Sauce, these tasty starters will be crowd pleasers.

36 May/June 2018
Asian Vegetable
Rolls with Soy-
Lime Dipping
Sauce
MAKES 6 SERVINGS
SERVING SIZE: 3 ROLLS WITH 1
TABLESPOON DIPPING SAUCE

Nutrients per Serving: Calories

25, Total Fat 1g, Saturated Fat
1g, Protein 1g, Carbohydrates
5g, Cholesterol 0mg, Dietary
Fiber 1g, Sodium 343mg
Dietary Exchange: Free Free

¼ cup reduced-sodium
soy sauce
2 tablespoons lime juice
1 clove garlic, crushed
1 teaspoon honey
½ teaspoon inely
chopped fresh ginger
¼ teaspoon dark sesame
oil
1
/8 to ¼ teaspoon red
pepper flakes
½ cup grated cucumber
1 SERVING SIZE: 1 CRAB CAKE WITH 1½ TEASPOONS SAUCE
/3 cup grated carrot
¼ cup sliced yellow bell
pepper (1 inch long)
2 tablespoons thinly
sliced green onion
18 small lettuce leaves
Sesame seeds
(optional)
1. Combine soy sauce, lime
juice, garlic, honey, ginger,
oil and red pepper lakes in
small bowl.
2. Combine cucumber, carrot,
bell pepper and green onion
in medium bowl. Stir in 1
tablespoon soy sauce mixture.
3. Place about 1 tablespoon
vegetable mixture on each
lettuce leaf. Roll up leaves;
sprinkle with sesame seeds, if
desired. Serve with remaining
sauce for dipping.
Southern Crab Cakes
with Rémoulade Dipping Sauce
MAKES 8 SERVINGS
Nutrients per Serving: Calories 81, Total Fat 2g, Saturated Fat 1g, Protein 7g,
Carbohydrates 8g, Cholesterol 30mg, Dietary Fiber 1g, Sodium 376mg
Dietary Exchange: ½ Bread/Starch, 1 Meat
10 ounces fresh lump crabmeat
1½ cups fresh white or sourdough
bread crumbs, divided
¼ cup chopped green onions
½ cup fat-free or reduced-fat
mayonnaise, divided
1 egg white, lightly beaten
2 tablespoons coarse-grained or
spicy brown mustard, divided
¾ teaspoon hot pepper sauce,
divided
2 teaspoons olive oil, divided
Lemon wedges (optional)
1. Preheat oven to 200°F. Pick out and
discard any shell or cartilage from crab-
meat. Combine crabmeat, ¾ cup bread
crumbs and green onions in medium
bowl. Add ¼ cup mayonnaise, egg
white, 1 tablespoon mustard and ½ tea-
spoon hot pepper sauce; mix well. Using
¼ cup mixture per cake, shape into 8
(½-inch-thick) cakes. Roll crab cakes
lightly in remaining ¾ cup bread crumbs.
2. Heat large nonstick skillet over me-
dium heat; add 1 teaspoon oil. Add 4
crab cakes; cook 4 to 5 minutes per side
or until golden brown. Transfer to serv-
ing platter; keep warm in oven. Repeat
with remaining 1 teaspoon oil and crab
cakes.
3. For dipping sauce, combine remaining
¼ cup mayonnaise, 1 tablespoon mus-
tard and ¼ teaspoon hot pepper sauce
in small bowl; mix well.
4. Serve crab cakes warm with dipping
sauce and lemon wedges, if desired.
DiabetesSelfManagement.com 37
 BBQ
BEGINNINGS
Chunky Veggie Dip
MAKES 12 (¼-CUP) SERVINGS
SERVING SIZE: ¼ CUP DIP

Nutrients per Serving: Calories 47, Total Fat 3g,

Saturated Fat 2g, Protein 3g, Carbohydrates 3g,
Cholesterol 9mg, Dietary Fiber 1g, Sodium 254mg
Dietary Exchange: ½ Fat, 1 Vegetable

1
medium red bell pepper, chopped
1
large green bell pepper, chopped
½ medium onion, inely chopped
1
celery stalk, chopped
2
tablespoons water
1
/8
teaspoon red pepper flakes
¼ cup fat-free (skim) milk
¾ teaspoon cornstarch
1
cup (4 ounces) shredded reduced-fat
sharp Cheddar cheese
2 ounces reduced-fat cream cheese
1 jar (4 ounces) diced pimientos
¾ teaspoon salt
Baked corn tortilla chips
Roasted Garlic Hummus
1. Coat slow cooker with nonstick cooking MAKES 6 SERVINGS
spray. Add red and green peppers, onion, cel- SERVING SIZE: ¼ CUP HUMMUS
ery, water and red pepper lakes. Cover; cook
on LOW 3 hours or until celery is tender.
Nutrients per Serving: Calories 85, Total Fat 1g, Saturated Fat 1g, Protein
2. Combine milk and cornstarch in small 4g, Carbohydrates 15g, Cholesterol 0mg, Dietary Fiber 4g, Sodium 303mg
bowl, stirring until cornstarch dissolves. Add Dietary Exchange: 1 Bread/Starch
to pepper mixture with Cheddar cheese and
cream cheese. Press down on cream cheese 2 tablespoons Roasted powder, sesame oil and hot
with rubber spatula until well blended. Stir Garlic (recipe follows) pepper sauce, if desired, in food
in pimientos and salt. Cover; cook 15 min- 1 can (about 15 ounces) processor or blender. Cover;
utes or until thickened. Serve with tortilla chickpeas, rinsed and process until smooth.
chips, if desired. drained
3. Serve with pita wedges and
¼ cup fresh parsley sprigs
Variation: Use soft corn tortillas instead of vegetables, if desired.
chips. Cut each tortilla into 6 wedges and 2 tablespoons water
bake in a single layer on a baking sheet at 2 tablespoons lemon juice Roasted Garlic: Cut off top
350°F for 10 minutes. Cool completely be- ½ teaspoon curry powder third of 1 large garlic head (not
fore serving. Chips will irm as they cool. 1
the root end) to expose cloves;
/8 teaspoon dark sesame oil discard top. Place head of garlic,
Dash hot pepper sauce trimmed end up, on 10-inch
(optional) square of foil. Rub garlic gener-
Pita bread wedges ously with olive oil and sprinkle
and fresh vegetables with salt. Gather foil ends
(optional) together and close tightly. Roast
in preheated 350°F oven 45 min-
1. Prepare Roasted Garlic. utes or until cloves are golden
and soft. When cool enough to
2. Place chickpeas, parsley, 2 handle, squeeze roasted garlic
tablespoons Roasted Garlic, cloves from skins-; discard skins.
water, lemon juice, curry
38 May/June 2018
Roasted Red
Pepper Dip
MAKES 2 CUPS (ABOUT 16 SERVINGS)
SERVING SIZE: 2 TABLESPOONS
Nutrients per Serving: Calories 35,
Total Fat 0g, Saturated Fat 0g, Protein 2g,
Carbohydrates 4g, Cholesterol 2mg, Dietary
Fiber 0g, Sodium 189mg
Dietary Exchange: 1 Vegetable
2 jars (12 ounces each) roasted red
peppers in water, drained
1 cup crumbled fat-free feta
cheese
¼ cup chopped fresh basil
¼ cup light sour cream
3 tablespoons Worcestershire
sauce
4 cloves garlic
Assorted vegetable sticks
1. Place roasted red peppers in food
processor or blender; process until
coarsely chopped. Add cheese, basil,
sour cream, Worcestershire sauce and
garlic; process until smooth and well
blended. Cover and refrigerate at least
2 hours or until chilled.
2. Serve with assorted vegetable sticks.
Harvest Sticks with Vegetable Dip
MAKES ABOUT 2 CUPS DIP
SERVING SIZE: 2 TABLESPOONS
Nutrients per Serving: Calories 50, Total Fat 2g, Saturated Fat 2g, Protein 3g,
Carbohydrates 5g, Cholesterol 5mg, Dietary Fiber 1g, Sodium 135mg
Dietary Exchange: ½ Fat, 1 Vegetable
1 container (8 ounces) light
cream cheese with chives
spread, softened
1 cup plain nonfat Greek
yogurt
1
/3 cup inely chopped
cucumber
2 tablespoons chopped fresh
parsley
2 tablespoons dry minced
onion or 1/4 cup inely
chopped fresh onion
1 clove garlic, minced
½ teaspoon curry powder
(optional)
¼ tevaspoon salt
6 large carrots, peeled
3 medium zucchini
Rafia (optional)
1. Beat cream cheese in small bowl
until light and luffy; stir in yogurt
until smooth and well blended. Stir
in cucumber, parsley, onion, garlic
, curry powder, if desired, and salt.
Spoon into small serving bowl;
cover and refrigerate 1 hour or until
ready to serve.
2. Cut carrots lengthwise into thin
strips; gather into bundles. Tie rafia
around bundles to hold in place, if
desired. Repeat with zucchini. Serve
with dip.
Note: The vegetable bundles
can be made ahead of time. Cut
vegetables as directed. Place carrots
in medium bowl; cover with cold
water and refrigerate until ready to
use. Place zucchini sticks in small
resealable plastic food storage bag
and refrigerate until ready to use.
Just before serving, gather vegeta-
bles into bundles and tie with rafia
as directed.
DiabetesSelfManagement.com 39
 BBQ
FAVORITES

GET OUT AND GRILL! If you crave the flavor of gently

marinated shrimp kabobs seasoned to perfection, succulent
grilled chicken or spicy salsa-inspired turkey burgers, it’s
time to fire up the grill and show off your skills!

40 May/June 2018
Grilled Oriental
Shrimp Kabobs
MAKES 4 SERVINGS
SERVING SIZE:1 KABOB (WITHOUT
FRIED RICE AND PINEAPPLE SPEARS)
Nutrients per Serving: Calories 129,
Total Fat 4g, Saturated Fat 1g, Protein
20g, Carbohydrates 1g, Cholesterol
173mg, Dietary Fiber 1g, Sodium
596mg
Dietary Exchange: 2½ Meat
3 tablespoons reduced-sodium
soy sauce or regular soy
sauce
1 tablespoon regular or
seasoned rice vinegar
1 tablespoon dark sesame oil
2 cloves garlic, minced
¼ teaspoon dried red pepper
flakes
1 pound uncooked large
shrimp, peeled and
deveined
1. For marinade, combine soy sauce,
vinegar, oil, garlic and pepper lakes
in small bowl; mix well. Cover; re-
frigerate 1 hour or overnight.
2. To complete recipe, combine
marinade and shrimp in large
resealable food storage bag. Seal
bag securely. Refrigerate at least 30
minutes or up to 2 hours, turning
bag once.
3. Spray barbecue grid with non-
stick cooking spray. Prepare barbe-
cue grill for direct cooking.
4. Drain shrimp, reserving marinade.
Thread shrimp onto 4 (12-inch-long)
skewers. Place skewers on prepared
grid; brush with half of reserved
marinade.
5. Grill skewers on covered grill over
medium coals 5 minutes. Turn skew-
ers over; brush with remaining half
of marinade. Grill 3 to 5 minutes
more or until shrimp are opaque.
Serving Suggestion: Serve with
fried rice and fresh pineapple spears,
if desired.
Grilled Summer
Vegetable
Sandwiches
MAKES 4 SERVINGS (1
SANDWICH PER SERVING)
Nutrients per Serving: Calories
240, Total Fat 7g, Saturated Fat
3g, Protein 11g, Carbohydrates
35g, Cholesterol 10mg, Dietary
Fiber 3g, Sodium 570mg
Dietary Exchange: 2 Bread/
Grilled Salsa Starch, 1 Fat, 1 Vegetable,
Turkey Burger ½ Meat
MAKES 1 SERVING 2 tablespoons light
SERVING SIZE: 1 SANDWICH (WITHOUT CHEESE) balsamic vinaigrette
Nutrients per Serving: Calories 302, Total dressing
Fat 11g, Saturated Fat 3g, Protein 22g, ½ teaspoon minced garlic
Carbohydrates 29g, Cholesterol 63mg, Dietary
Fiber 2g, Sodium 494mg ¼ teaspoon salt
1
/8 teaspoon black pepper
Dietary Exchange: 2 Bread/Starch, 1 Fat,
2 Meat Lean 1 small zucchini, cut
lengthwise into
3 ounces 93% lean ground turkey ¼-inch-thick slices
1 tablespoon mild or medium salsa 1 medium yellow squash,
1 tablespoon crushed baked tortilla cut lengthwise into
chips ¼-inch-thick slices
1 slice (1 ounce) reduced-fat Monterey 1 medium red onion,
Jack cheese (optional) cut into ¼-inch-thick
slices
1 whole wheat hamburger bun, split
Green leaf lettuce 1 large red bell pepper,
quartered
Additional salsa (optional)
4 teaspoons reduced-fat
1. Lightly spray grid with nonstick cooking chipotle mayonnaise
spray. Prepare grill for direct cooking. ½ pound Italian bread,
cut into 4 slices
2. Combine turkey, chips and 1 tablespoon 4 thin slices provolone
salsa in small bowl; mix lightly. Shape into cheese
patty.
¼ cup shredded fresh
3. Grill burger over medium-high heat about basil
6 minutes per side or until cooked through
(165°F). Top with cheese, if desired, during 1. Prepare grill for direct
last 2 minutes of grilling. Toast bun on grill, cooking. Combine dressing,
cut sides down, during last 2 minutes of grill- garlic, salt and pepper in
ing. large bowl. Add vegetables;
toss to coat.
4. Place lettuce on bottom half of bun; top
with burger, additional salsa, if desired, and 2. Grill vegetables over
top half of bun. medium-high heat about
4 minutes per side or until
Note: To broil, preheat broiler. Broil burger 4 tender.
to 6 inches from heat 6 minutes per side or
until cooked through (165°F). 3. Cut bread slices in half.
Spread 1 teaspoon mayon-
Tip: This dish tastes even better when naise on each of four halves.
served alongside a cool and refreshing glass Top with cheese, vegetables,
of COCA-COLA®. basil and remaining bread.
DiabetesSelfManagement.com 41
 BBQ
FAVORITES
Spiced Chicken Skewers
with Yogurt-Tahini Sauce
8 SERVINGS
SERVING SIZE:1 SKEWER WITH ABOUT
2 TABLESPOONS SAUCE

Nutrients per Serving: Calories 145, Total Fat 7g,

Saturated Fat 1g, Protein 16g, Carbohydrates 4g,
Cholesterol 38mg, Dietary Fiber 0g, Sodium 285mg
Dietary Exchange: 1 Fat, 2 Meat

1 cup plain nonfat 3. Combine oil, garam

Greek yogurt masala and remaining
¼ cup chopped fresh ½ teaspoon salt in me-
parsley, plus dium bowl. Add chicken;
additional for toss to coat evenly. Thread
garnish chicken on 8 (6-inch)
¼ cup tahini* metal or wooden skewers.
2 tablespoons lemon 4. Grill chicken skewers
juice over medium-high heat 5
1 clove garlic minutes per side or until
¾ teaspoon salt, chicken is no longer pink. Chipotle Orange BBQ Drumsticks
divided Serve with yogurt-tahini MAKES 8 SERVINGS (1 DRUMSTICK PER SERVING)
2 teaspoons garam sauce. Garnish with ad-
masala** ditional parsley.
1 pound boneless Nutrients per Serving: Calories 150, Total Fat 4g, Saturated
Notes *Tahini, a thick Fat 1g, Protein 24g, Carbohydrates 2g, Cholesterol 87mg,
skinless chicken paste made from ground Dietary Fiber 1g, Sodium 221mg
breasts, cut into
sesame seeds, is available in Dietary Exchange: 3 Meat
1-inch pieces
the international foods sec-
tion of major supermarkets, ½ cup barbecue sauce, orange peel
1. Spray grid with nonstick
Middle Eastern markets or preferably mesquite 8 chicken drumsticks (7
cooking spray. Prepare grill
health food stores. or hickory smoked to 8 ounces each),
for direct cooking.
1 to 2 tablespoons skin removed,
**Garam masala is a
2. For yogurt-tahini sauce, minced canned rinsed and patted
blend of Indian spices
combine yogurt, ¼ cup chipotle peppers in dry
available in the spice aisle adobo sauce
parsley, tahini, lemon 1 teaspoon ground
of many supermarkets. If
juice, garlic and ¼ tea- 1 teaspoon grated cumin
garam masala is unavail-
spoon salt in food proces-
able, substitute 1 tea-
sor or blender; process 1. Spray grill grid with nonstick cooking spray. Prepare
spoon each ground cumin
until combined. Set aside. grill for direct cooking.
and ground coriander.
2. For sauce, combine barbecue sauce, chipotle peppers
and orange peel in small bowl. Set aside.

3. Sprinkle drumsticks evenly with cumin.

4. Grill chicken, covered, over medium-high heat 30 to

35 minutes or until cooked through (165°F), turning fre-
quently. Baste with sauce during last 5 minutes, turning
and basting until all of sauce is used.

Serving suggestion: Serve with 4-ounce microwaved

potatoes topped with fat-free or light sour cream and
mixed greens and green pepper salad with fat-free or
light balsamic vinaigrette.
42 May/June 2018
Grilled Swordfish á l’Orange
MAKES 4 SERVINGS
Nutrients per Serving: Calories 276, Total Fat 10g,
Saturated Fat 2g, Protein 35g, Carbohydrates 12g,
Cholesterol 65mg, Dietary Fiber 2g, Sodium 412mg
Dietary Exchange: 1 Fruit, 4 Meat
4 swordish, halibut
or shark steaks
(about 1½ pounds)
1 orange
¾ cup orange juice
1 tablespoon lemon
juice
1 tablespoon dark
sesame oil
1 tablespoon soy
sauce
1 teaspoon cornstarch
Salt and black
pepper to taste
(optional)
1. Rinse swordish and pat
dry with paper towels. Grate
enough orange peel to mea-
sure 1 teaspoon; set aside.
Peel orange and cut into
sections; set aside. Combine
orange juice, lemon juice,
oil and soy sauce in small
bowl. Pour half of orange
juice mixture into shallow
glass dish. Add ½ teaspoon
grated orange peel to
orange juice mixture. Place
ish in dish; turn to coat in
mixture. Cover; marinate in
refrigerator up to 1 hour.
2. Prepare grill for direct
cooking.
3. Place remaining half
of orange juice mixture
in small saucepan. Stir in
cornstarch and remaining
½ teaspoon orange peel.
Heat over medium-high
heat, stirring constantly, 3
to 5 minutes or until sauce
thickens; set aside.
4. Remove ish from mari-
nade; discard remaining
marinade. Lightly sprinkle
ish with salt and pepper, if
desired. Grill over medium
coals 3 to 4 minutes per
side or until ish is opaque
and lakes easily when
tested with fork. Top with
reserved orange sections
and orange sauce. Serve
immediately.
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 SUMMER
SIDES

GRILLED VEGETABLES, pasta salad, coleslaw and more are dreamy

additions to any main dish. Try our veggie-rich Garden Pasta Salad
or an easy-bake, Low-Fat Macaroni and Cheese. This collection of
scrumptious summer sides will add zip to any barbecue menu!

44 May/June 2018
Low-Fat Macaroni Garden Pasta Salad
and Cheese MAKES 8 SERVINGS
MAKES 4 SERVINGS SERVING SIZE: 1¼ CUPS SALAD
SERVING SIZE: 11/8 CUPS MACARONI
Nutrients per Serving: Calories 286, Total Fat 10g,
AND CHEESE
Saturated Fat 2g, Protein 18g, Carbohydrates 33g,
Nutrients per Serving: Calories Cholesterol 36mg, Dietary Fiber 3g, Sodium 886mg
398, Total Fat 8g, Saturated Fat 4g,
Dietary Exchange: 2 Bread/Starch, ½ Fat, 2 Meat
Protein 28g, Carbohydrates 54g,
Cholesterol 33mg, Dietary Fiber 0g,
Sodium 788mg 6 cups (about 12 ounces) cooked penne pasta
Dietary Exchange: 3½ Bread/Starch, 2 cups shredded cooked boneless skinless
2½ Meat chicken breasts
¾ cup chopped red onion
8 ounces (2 cups) uncooked ¾ cup chopped red or green bell pepper
macaroni
¾ cup sliced zucchini
1 cup fat-free reduced-
sodium chicken broth 1 can (4 ounces) sliced black olives, drained
1 shallot, inely minced 1 teaspoon red pepper flakes
1 tablespoon all-purpose 1 teaspoon salt (optional)
flour 1 can (10¾ ounces) condensed reduced-fat
½ teaspoon dry mustard reduced-sodium cream of chicken soup,
1
undiluted
/8 teaspoon white pepper
½ cup lemon juice
2 tablespoons water
½ cup grated Parmesan cheese
1¾ cups (7 ounces) shredded
reduced-fat mild ½ cup chopped fresh basil (optional)
Cheddar cheese, divided ¼ cup chopped fresh parsley (optional)
1 cup fat-free ricotta cheese
1. Combine pasta, chicken, onion, bell pepper, zuc-
1 tablespoon minced fresh
chini, olives, red pepper lakes and salt in large bowl;
parsley (optional)
toss lightly.
1. Cook macaroni according to 2. Combine soup and lemon juice in small bowl; mix
package directions, omitting salt. well. Pour soup mixture over pasta salad; mix well.
Drain; set aside.
3. Sprinkle with Parmesan cheese, basil and parsley.
2. Combine chicken broth and
shallot in medium saucepan;
bring to a boil over high heat.
Cover; reduce heat to low and
simmer 5 minutes. Meanwhile,
combine lour, mustard, pep-
per and water in small bowl; stir
mixture into saucepan. Bring to
a boil; cook and stir 2 minutes
or until slightly thickened. Add
pepper, 1 cup Cheddar cheese
and ricotta cheese. Continue stir-
ring until cheeses are completely
melted. Stir in cooked pasta; mix
well.

3. Remove pasta mixture from

heat; stir in remaining ¾ cup
Cheddar cheese and parsley, if
desired. Garnish with fresh pars-
ley sprigs. Serve immediately.

DiabetesSelfManagement.com 45

Grilled Sesame
Asparagus
MAKES 4 SERVINGS
SERVING SIZE: 5 MEDIUM SPEARS
Nutrients per Serving: Calories 42,
Total Fat 1.5g, Saturated Fat 0g, Protein
3g, Carbohydrates 6g, Cholesterol 0mg,
Dietary Fiber 3g, Sodium 147mg
Dietary Exchange: ½ Fat, 1 Vegetable
Nonstick cooking spray
1 pound medium asparagus
spears (about 20), trimmed
1 tablespoon sesame seeds
2 to 3 teaspoons balsamic
vinegar
¼ teaspoon salt
¼ teaspoon black pepper
1. Spray grid with cooking spray;
prepare grill for direct cooking.
2. Place asparagus on baking sheet;
spray lightly with cooking spray.
Sprinkle with the sesame seeds, roll-
ing to coat.
3. Place asparagus on grid. Grill, un-
covered, 4 to 6 minutes or until the
asparagus begins to brown, turning
once.
4. Transfer asparagus to serving
dish. Sprinkle with vinegar, salt and
pepper.
Cook’s Tip: Be sure to use the
entire amount of pepper—it really
brings out the lavors of this dish.
46 May/June 2018
SUMMER
SIDES
Coleslaw With
Snow Peas and Corn
MAKES 4 SERVINGS
(ABOUT ¾ CUP PER SERVING)
Nutrients per Serving: Calories 85,
Total Fat 1g, Saturated Fat 1g, Protein
3g, Carbohydrates 17g, Cholesterol 3mg,
Dietary Fiber 2g, Sodium 175mg
Dietary Exchange: 3 Vegetable
4 cups (about 8 ounces)
coleslaw mix
½ cup trimmed vertically sliced
snow peas
½ cup whole kernel corn (frozen
or fresh)
¼ cup low-fat mayonnaise
¼ cup fat-free sour cream
¼ cup nonfat buttermilk
1 tablespoon cider vinegar
2 teaspoons sugar
¼ teaspoon celery seed
1. Combine coleslaw, snow peas and
corn in large bowl.
2. Meanwhile, whisk mayonnaise,
sour cream, buttermilk, vinegar, sugar
and celery seed in medium bowl.
Add to coleslaw mixture and mix to
combine.
Gazpacho Pasta
Salad
MAKES 5 SERVINGS
(1 CUP PER SERVING)
Nutrients per Serving: Calories 91,
Total Fat 2g, Saturated Fat 1g, Protein
3g, Carbohydrates 17g, Cholesterol
0mg, Dietary Fiber 3g, Sodium
248mg
Dietary Exchange: 1 Bread/Starch,
½ Fat
11/3 cups cooked whole wheat
penne pasta or rotini
½ cup chopped red onion
1 small cucumber, peeled
and diced
1 medium green bell pepper,
seeded and chopped
2 cups grape or cherry
tomatoes, halved
1 tablespoon tomato juice
1 tablespoon red wine
vinegar
1½ teaspoons olive oil
¼ teaspoon crushed dried
oregano
½ teaspoon salt
¼ teaspoon pepper
¼ cup chopped fresh basil
leaves
1. Combine penne, onion, cu-
cumber, bell pepper and toma-
toes in large bowl.
2. Combine tomato juice, vinegar,
oil, oregano, salt and pepper in
cup. Stir well. Pour over salad and
mix well. Sprinkle with basil.
 JUST
DESSERTS

COOL AND FRUITY! The sweet

taste of strawberries, blueberries,
and rasberries are a perfect ending
to any meal. Try these refreshing,
easy-to-make recipes and and let
your taste buds soar!

Brown Sugar
Strawberry Shortcakes
MAKES 6 SERVINGS
Nutrients per Serving: Calories 190,
Total Fat 5g, Saturated Fat 1g, Protein
4g, Carbohydrates 37g, Cholesterol 1mg,
Dietary Fiber 1g, Sodium 572mg 
Dietary Exchange: 1½ Bread/Starch,
1 Fat, ½ Fruit

2 cups fresh sliced strawberries

¼ cup sugar substitute,* divided
2 cups reduced-fat biscuit baking
mix
½ teaspoon baking powder
1
/3 cup low-fat (1%) buttermilk
2 teaspoons margarine or butter,
melted
2 tablespoons packed brown and stir gently with spoon until half on dessert plates, cover with 1/3
sugar dough comes together. Remove cup berries, 1 tablespoon whipped
6 tablespoons reduced-fat dough from bowl, place on lightly topping and cake tops.
whipped topping loured surface, and pat into a ¾- to
1-inch-thick circle. Note *This recipe was tested using
1. Preheat oven to 400°F. Spray baking sucralose-based sugar substitute.
Photographed by Angel Tucker; food prepared by Maggie Mulvena

sheet with nonstick cooking spray. 4. Cut dough into 6 portions.

2. In medium bowl toss strawberries
and 2 tablespoons sugar substitute.
Set aside.
3. In another medium bowl combine Transfer to rack and let cool slightly.
baking mix, remaining 2 tablespoons
sugar substitute and baking powder.
Pour buttermilk over dry ingredients
Round each piece into a circle and
place on baking sheet. Brush with
melted margarine and sprinkle 1
teaspoon brown sugar over each
shortcake. Bake 12 to 15 minutes.
5. To assemble shortcakes: Split
each shortcake in half. Place bottom
Tip: Strawberries can be refriger-
ated, unwashed, for up to 3 days. Or,
they may be frozen. To freeze straw-
berries, hull them and arrange them
in a single layer on a jelly-roll pan.
Place them in the freezer until they
are frozen solid and then transfer
them to storage containers. They will
keep for up to 9 months.
DiabetesSelfManagement.com 47
 JUST
DESSERTS
Very Berry Yogurt Parfaits
MAKES 4 SERVINGS
SERVING SIZE: 1 PARFAIT
Nutrients per Serving: Calories 179, Total Fat 3g, Saturated
Fat 1g, Protein 10g, Carbohydrates 33g, Cholesterol 4mg,
Dietary Fiber 3g, Sodium 104mg
Dietary Exchange: 1½ Fruit, 1 Milk
3 cups plain nonfat yogurt
2 tablespoons sugar-free berry preserves
1 packet sugar substitute*
½ teaspoon vanilla
2 cups sliced fresh strawberries
1 cup fresh blueberries
4 tablespoons sliced toasted almonds
1. Combine yogurt, preserves, sugar substitute and va-
nilla in medium bowl.
2. Layer ½ cup yogurt mixture, ¼ cup strawberries, ¼ cup
blueberries and ¼ cup yogurt mixture in each of four des-
sert dishes. Top each parfait with remaining ¼ cup straw-
berries and 1 tablespoon almonds. Serve immediately.
Notes *This recipe was tested with sucralose-based
sugar substitute.
These parfaits would also be delicious topped with
low-fat granola. Or, try another lavor of preserves for a
simple variation.
48 May/June 2018
Almond Berry Parfaits
MAKES 2 SERVINGS
SERVING SIZE: ½ CUP YOGURT, 1 CUP BERRIES
Nutrients per Serving: Calories 220, Total Fat 6g,
Saturated Fat 1g, Protein 9g, Carbohydrates 30g,
Cholesterol 7mg, Dietary Fiber 6g, Sodium 84mg
Dietary Exchange: 1 Fat, 1½ Fruit, 1 Milk
1 container (8 ounces) plain low-fat yogurt
1 cup sliced strawberries
½ cup raspberries
½ cup blueberries
1
/8 teaspoon almond extract
1 tablespoon plus 2 teaspoons pourable sugar
substitute,* divided
2 tablespoons slivered or sliced almonds,
toasted
1. Line strainer with coffee ilter or 2 sheets paper
towel; place over bowl. Place yogurt in strainer; refrig-
erate at least 2 hours or up to 24 hours to drain.
2. In medium bowl, combine strawberries, raspberries
and blueberries. Add extract and 2 teaspoons sugar
substitute; toss lightly. Chill at least 30 minutes or up
to 2 hours.
3. Transfer drained yogurt to small bowl, stir in re-
maining 1 tablespoon sugar substitute. Spoon 1/3 cup
berry mixture into each of 2 wine or parfait glasses.
Spoon half of yogurt mixture over berries. Repeat lay-
ering with half of remaining berries, remaining yogurt
and remaining berries. Top with almonds.
Note *This recipe was tested using sucralose-based
sugar substitute
PACK THE PERFECT

PICNIC
BASKET
671 CALORIES

A GUIDE TO
BIKING
BASICS

BOOST YOUR
WEIGHT MANAGEMENT
CONFIDENCE
Shutterstock/S_Photo

DiabetesSelfManagement.com 49
 Shutterstock/lightpoet; Border:Shutterstock/LongQuattro

50
May/June 2018
 A guide to bike basics
By Marie Spano, MS, RD

Are you tired of pedaling a stationary bike or an elliptical machine?

Are you in search of a little adventure? If so, maybe you’re ready to get
outside and try real biking. Although the fundamentals of bicycling
haven’t changed since you owned a 10-speed, great strides have
been made in many aspects of this activity, making it both
more accessible and more enjoyable.

DiabetesSelfManagement.com 51
 Technology has greatly enhanced
bicycles, helmets and even apparel.
Biking clubs across the U.S. make it
easier to find others to ride with. And
many communities are becoming
more bike-friendly by, for example,
creating bike lanes or separate bike
paths, providing bicycle parking
areas, and installing racks on trains
and buses so that bikes can be trans-
ported with their riders.
So if you haven’t touched your
bike in years, now’s the time to get
it out, dust it off, take it to your local
bike shop for a tune-up (very impor-
tant) and assess whether you need
any gear, such as a helmet, lock,
gloves or even a new bike.
Why cycle?
Biking is an enjoyable activity that
you can do alone or with others. It
can be a good way to explore new
places or enjoy old favorites. The
experience of riding down a bike
path or a trail feeling the breeze on
your face and the sun on your back
is like nothing else. People who ride
a bike to work or to run errands also
have the satisfaction of knowing
they’re getting some exercise and
not polluting the air.
Besides being a pleasant activity,
52 May/June 2018
biking works the muscles in your
legs and arms, increases your lung
capacity, and helps you maintain a
healthy heart. In addition, all forms
of aerobic exercise, including biking,
help improve your body’s response
to insulin and lower blood glucose
levels.
Even if you regularly do some
other type of aerobic exercise, varying
your routine with an occasional bike
ride will challenge you physically and
stimulate you mentally. Cross-training
of any type works your muscles a little
differently, may help prevent overuse
injuries and keeps you from getting
bored with your exercise routine.
Trails or roads?
If you already have a bike and don’t
wish to buy a new one, the style of
your bike will probably determine
where you will ride it. If you’re in the
market for a new bike, however, you
may want to think first about where
you intend to bike—on trails or on
roads—before buying one.
Biking on roads is convenient
since you can usually just hop on
and go. However, sharing the road
with cars can be challenging and
even dangerous. Seeking out quieter
streets, back roads and bike paths
may make for more enjoyable and
safer bike riding. If you intend to
ride on roads, you will want either
a road bike with fairly thin tires and
a lightweight frame or a somewhat
heavier “city bike.” If you plan to
commute on your bike, you might
even consider getting a foldable bike
for easier storage at your home and
workplace.
If you prefer biking on trails, you’ll
probably need a mountain bike.
Mountain bikes have fat, knobby
tires and a thick frame, making them
both sturdier and heavier than road
bikes. They are also much slower on
roads than road bikes.
If you think you may be riding
on both roads and fairly flat trails,
a hybrid bicycle might be right for
you. This style combines features
from both mountain bikes and road
bikes, with a mid-weight frame and
tires that are thicker than those of a
road bike but thinner than those of a
mountain bike. Hybrid bikes cannot
be used for very rugged trails.
Finding a good fit
Once you have decided which type
of bike, go to your local bike shop
and try some on for size. Most shops,
especially those that aren’t part of a
Shutterstock/Africa Studio
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 national chain, are run and staffed by
active cyclists who have great enthusi-
asm for the sport and desire to help
others. They are usually more than
willing to help you get started, and
find the right equipment.
If mountain biking is in your
future, you will need to choose
between a full-suspension or hard-
tail bike. Full-suspension models
have both front and rear suspension,
which allows for a more comfortable
ride, but they’re also more expensive.
Hardtails have only front suspension.
They are lighter and cheaper than
full-suspension bikes, and they ride
better on smooth surfaces, but they
are not as comfortable on rough ter-
rain. Some full-suspension bikes have
a “lock out” feature that lets you turn
BIKE MAINTENANCE
Before every ride, it is important to perform a quick inspection. Here are some things
to check.
• Check that the brakes are working
properly, the tires have plenty of air
and are not worn, and the wheels are
secure (lift your bike so one tire is on
the ground and shake the other tire in
the air from side to side).
• The rims and spokes should have no
bulges, dents or dings in them.
• The levers on your quick-release hubs
(if you have them) should be in the
closed position.
54 May/June 2018
off the front and/or rear suspension
when riding on flat surfaces.
Before test-riding any bike, have
the sales clerk help you pick the
right frame size for your body and
also show you how to adjust the seat
and handlebars. A properly adjusted
bike will maximize both your safety
and comfort. To check frame size,
straddle the bike with both feet on
the ground. You should have 2–4
inches of clearance between the
top of the tube and your crotch for
mountain bikes and hybrids and 1–2
inches of clearance for a road bike.
If the bike has a sloping top tube,
which is typical of women’s bikes,
measure your clearance from an
imaginary top tube.
In addition to examining the
• Your chain should be well lubricated
without any kinks or gunk in the links.
• The pedals should be securely attached
to the bike yet move freely.
• The seat should be secure.
• If your bike is muddy after riding, clean
it with soap and water (preferably
gentle soap made for bikes) and
dry it off right away. Dirt and mud
are abrasive and can destroy bike
components.
height of the top tube, consider
its length, which determines how
far you have to bend over to reach
the handlebars. You should not be
stretched all the way out to reach
the handlebars. Instead, your elbows
should be slightly bent and your back
bent from the waist at an approxi-
mately 45-degree angle. Riding on a
bike with either too much or too little
distance between seat and handlebars
will make it difficult to maneuver.
Bikes designed especially for women
often fit them better because they
take into consideration women’s lon-
ger legs and shorter torsos.
Adjust the bike’s seat so that when
you are sitting on it with one foot on
the pedal close to the lowest posi-
tion, your knee is bent slightly. With
experience, you may decide to raise
or lower the seat to suit your riding
style. Mountain bikers, for example,
typically lower the seat for greater
maneuverability.
Next, adjust the handlebars to the
appropriate height. You may need to
ride your bike several times to find
the right handlebar height for you.
In general, handlebars typically range
from 2-3 inches below the top of the
seat to 2-3 inches above it. Your goal
is to find a height that is comfortable
and allows you to easily use the brakes
and shift gears.
Bike pedals come in several styles.
Flat, “platform” pedals are best for
novices or those who are doing easy
riding on fairly flat surfaces. With
flat pedals, you can stop your bike
and immediately put your feet on
the ground without any problem.
Pedals with toe straps or cages secure
the foot to the pedal and allow
cyclists to go faster since they can
use their hip flexors to apply power
on the upstroke (as well as pressing
down on the downstroke). “Clip-
less” pedals have no straps or cages
but require special cycling shoes
with cleats on the bottom that lock
into the pedals. They, too, allow the
cyclist to go faster by applying pres-
Shutterstock/Simon Kadula
sure to the pedal for its full rotation.
Because clipless pedals take some
getting used to, only experienced
cyclists should use them.

Other equipment
A properly fitting helmet is essential
for bicycling and should be worn at
all times, even on a leisurely ride. In
addition to a helmet, you may want
to consider bike gloves, which give
your palms some padding while
leaving your fingers uncovered.
Although special biking clothes are
not strictly necessary, many people
find bike shorts with a gel pad in
the seat area to be comfortable, and
moisture-wicking shirts (generally
made of synthetic material) can
keep you drier than 100 percent
cotton tops. Wearing clothing, such
as a vest, made of reflective material
is a good idea if you will be biking at
dawn or dusk or after dark; it makes
you much more visible to motorists.
Biking is an aerobic exercise, so
you will want a way to carry some
water with you to drink as you ride.
If your bike has a bottle cage, carry
a water bottle in it. Another alter-
native is to wear a small backpack
with a refillable bladder in it that
attaches to a hose with a mouth-
piece that reaches over your shoul-
Hlemets:Shutterstock/wizdata; Sign:Shutterstock/Christophe Testi
der. The backpack can also be used
to carry food, extra clothing and
other supplies.
To carry bike wrenches and extra
tubes in case of a flat tire, you may
want to buy a small pouch that
attaches right below your seat. Also
helpful for dealing with flat tires
is a small travel bike pump, which
attaches to your bike. If you are out
after dark, a white headlight and a
flashing red rear light are neces-
sary to make you more visible to
motorists. Reflectors on your bike
will also make you more visible on
city streets.
Choosing a route
Bike shops are usually a good source
for local route and trail information.
They often have maps and books
that contain detailed information
such as mileage, difficulty level and
terrain. Participating in a group ride
organized by a bike club is another
good way to discover places to ride.
Shops also can help you find a bike
club in your area.
As you would with any new
sport or physical activity, start with
a route that you can cover easily,
then build up your distance and
difficulty gradually.
Safety first
Bicycling is great exercise and it’s
fun, but accidents, delays or simply
the unexpected can happen, so it’s
best to be prepared. In addition,
bicycling will probably lower your
blood glucose level, so you may need
to stop for a snack or adjust your
diabetes regimen in some other
way to account for bicycling’s blood-
glucose-lowering effect. Here are
some things to remember before
you head out.
If you have a cellphone, bring
it with you.
Always tell someone where you
are going and when you plan on
coming back, especially if you are
cycling by yourself. In general,
however, biking with other people
is safer.
Always carry some food with
you. Energy bars are easy to carry
(although in warm weather, avoid
bars with chocolate or yogurt coat-
ings, which will melt in the heat).
Energy gels are another option.
They are essentially pure carbo-
hydrate and can provide a quick
pick-me-up when you need one.
On longer rides, carry your
blood glucose monitoring supplies
with you.
Rain can be particularly hazard-
ous for cyclists. When it rains, the
ground gets slippery, your bicycle’s
brakes may not work as well, and vis-
ibility—both yours and that of motor-
ists—decreases. If you get caught in
the rain, ride conservatively: Use your
bike lights, avoid roads with heavy
traffic, yield to cars at intersections
and start slowing down before you
turn to avoid skidding in the turn.
If you are on a low-traffic street or
a bike path, ride in the center of
the lane and not on the side, where
puddles and wet leaves may collect.
“Dragging” your brakes, or putting
a little pressure on them as you ride,
can help to remove water from your
tire rims, making it easier to stop with
your brakes when needed.
Lastly, if you ever feel unable
to control your bike because of
weather conditions, stop and get
off. You may be later (that’s why you
brought your cellphone) or wetter
than you otherwise would have got-
ten, but you will be alive and able
to take another bike ride when
conditions are more favorable. †
DiabetesSelfManagement.com 55
 SUNNY DAYS AND WARM TEMPERATURES are the essential
TOTALIES ingredients for a picnic! Choose your destination and fill your
CALOR basket with a zesty snack, hearty turkey sandwich, a salad bursting

671
with seasonal color and nutrients, and be sure to include a
delicious, fruit-inspired dessert. All this for 671 calories!

262
CALO
PER S RIES
ERVIN
G

56 March/April 2018
Turkey
Sandwiches
with Roasted 71 RIES
CALSOERVING
Bell Peppers PER

MAKES 4 SERVINGS
SERVING SIZE:
1 SANDWICH

Nutrients per Serving:

Calories 262, Total Fat 5g,
Saturated Fat 1g, Protein
22g, Carbohydrates
34g, Cholesterol 52mg,
Dietary Fiber 11g,
Sodium 301mg

Dietary Exchange:
2 Bread/Starch,
1 Vegetable, 2 Meat

2 large red bell peppers

8 slices whole grain or
millet bread
¼ cup reduced-fat
mayonnaise
8 spinach leaves
or
4 romaine lettuce leaves
8 thin slices red onion
½ pound thinly sliced
skinless roasted
turkey breast
8 large fresh basil leaves
(optional)
1. Preheat broiler.
Cut bell peppers into
quarters; discard stems,
membranes and seeds.
Place peppers, skin side
up, on foil-lined bak- Easy Greek Salad ½
1
/3
cup sliced red onion
cup crumbled feta cheese
ing sheet. Broil 3 inches MAKES 6 SERVINGS 2 tablespoons extra virgin olive oil
from heat 10 minutes or
2 tablespoons lemon juice
until skin is blackened. 1 teaspoon dried oregano
Wrap peppers in foil ½ teaspoon salt
from baking sheet; let Nutrients per Serving: Calories 71,
stand 10 minutes. Peel 1. Combine lettuce, cucumber, tomato,
Total Fat 6g, Saturated Fat 1g, Protein 1g,
off skin and discard. onion and cheese in large serving bowl.
Carbohydrates 5g, Cholesterol 4mg,
2. Spread 4 bread slices Dietary Fiber 1g, Sodium 249mg 2. Whisk together oil, lemon juice,
with mayonnaise. Top oregano and salt in small bowl. Pour
with spinach, onion, tur- Dietary Exchange: 1 Fat, 1 Vegetable over lettuce mixture; toss until coated.
key, peppers and basil, if Serve immediately.
6 romaine lettuce leaves, torn into
desired. Top with remain- Serving Suggestion: This simple but
1½-inch pieces
ing bread slices. 1 medium cucumber, peeled and sliced delicious salad makes a great accompani-
1 medium tomato, chopped ment for grilled steaks or chicken.

DiabetesSelfManagement.com 57
 Summertime
112 RIES
CALSOERVING
Fruit Medley
MAKES 8 SERVINGS
PER

Nutrients per Serving:

Calories 112, Total
Fat 1g, Saturated
Fat 1g, Protein 1g,
Carbohydrates 24g,
Cholesterol 0mg, Dietary
Fiber 2g, Sodium 8mg

Dietary Exchange:
2 Fruit

2 large ripe peaches,

a peeled and sliced
2 large ripe nectarines,
sliced
1 large ripe mango,
peeled and cut into
1-inch chunks
1 cup fresh blueberries
2 cups orange juice
¼ cup amaretto or
½ teaspoon almond
extract
2 tablespoons sugar or
3 packets sugar substitute
Fresh mint (optional)
1. Combine peaches,
nectarines, mango and
blueberries in large bowl.
2. Whisk orange juice,
amaretto and sugar in
small bowl until sugar
is dissolved. Pour over
fruit mixture; toss to
coat. Marinate 1 hour
at room temperature,
gently stirring occa-
sionally. Garnish with
fresh mint.

Tangy Blue Cheese Potato Salad

MAKES 6 SERVINGS
116
CALO
PER S RIES 1. Boil potatoes until tender,
(ABOUT ¾ CUP PER SERVING) ERVIN
G drain and cool. Cut into 1-inch
chunks; set aside.
1 pound red new potatoes 2. Meanwhile, combine
Nutrients per Serving: Calories 116, Total Fat 5g, ¼ cup light mayonnaise mayonnaise, sour cream, garlic
Saturated Fat 2g, Protein 3g, Carbohydrates 14g, ¼ cup light sour cream powder, vinegar avnd blue
1
Cholesterol 10mg, Dietary Fiber 2g, Sodium 84mg /8 teaspoon garlic powder cheese in medium bowl.
1 tablespoon cider vinegar
1
/3 cup reduced-fat crumbled blue cheese 3. Fold in potatoes and celery
Dietary Exchange: 1 Bread/Starch, 1 Fat ½ cup chopped celery and mix to combine.

58 March/April 2018
Garlic-Parmesan Popcorn
MAKES 12 CUPS POPCORN
(ABOUT 6 SERVINGS)
110
PER
RIES
CALSOERVING

Nutrients per Serving: Calories 110, Total Fat 5g,

Saturated Fat 1g, Protein 4g, Carbohydrates 13g,
Cholesterol 4mg, Dietary Fiber 2g, Sodium 83mg

Dietary Exchange: 1 Bread/Starch, 1 Fat

1 tablespoon olive oil

1 clove garlic, finely minced
1 tablespoon light butter-and-oil spread, melted
12 cups plain popped popcorn
1
/3 cup finely grated Parmesan cheese
½ teaspoon dried basil
½ teaspoon dried oregano
Stir oil and garlic into spread in small bowl until
well blended. Pour over popcorn in large bowl;
toss to coat. Sprinkle with cheese, basil anvd
oregano.
Tip: One regular-size microwavable package of
popcorn yields about 10 to 12 cups of popped
popcorn.

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 SUPERMARKET
SMARTS
By Lea Ann Holzmeister, RD, CDE
ood companies have developed a wide variety of spreads
F and butter blends to appeal to a range of taste prefer-
ences and nutritional needs. Companies are adding
healthier unsaturated oils to butter, and non-butter spreads
have healthier ingredients such as canola oil, olive oil, flax-
seed oil, sea salt, calcium and vitamin D to make them stand
out. Spreads and butter also come in forms such as sticks,
spreads, squeeze bottles or sprays, and many, also come in
lower fat varieties.
Fat in butter, margarine and spreads
Full fat butter, margarine and spreads contain 100 percent
of their calories from fat. People with diabetes are advised
to limit the type of fat in foods to include less than 10 per-
cent of calories from saturated fat (those with elevated LDL
cholesterol levels may be advised to limit saturated fat to
less than 7 percent of calories) and to avoid trans fat. For
an individual on a 1500-calorie meal plan, 10 percent of the
calories from saturated fat would be less than less than 17
grams daily. For the individual limiting saturated fat to less
than 7 percent of total calories, this would be fewer than 12
grams of saturated fat per day.
Butter and spreads are a mixture of different types of
fatty acids. Fats high in saturated fat include lard, butter
and tropical oils. The more solid a margarine is at room
temperature, the more saturated fat it contains. A tablespoon
of regular butter has 7 grams of fat, about 30-40 percent of
a day’s worth. To keep saturated fat intake low, try to choose
butter and non-butter spreads with less than 2 grams of
saturated fat per serving.
Trans fat is found naturally in foods such as butter and in
processed vegetable oil spreads that contain partially hydro-
genated oil. Spreads that contain hydrogenated and fully
hydrogenated oil have no trans fat. A tablespoon of regular
butter contains 0.5 grams of naturally occurring trans fat.
The trans fatty acid content of butter and spread products
is not always included on the Nutrition Facts panel on prod-
uct labels. The Food and Drug Administration (FDA) allows
food labels to list 0 grams of trans fat if a food has less than
0.5 grams of trans fat per serving. This allows food products
60 May/June 2018
to claim they are “trans fat free” even if they contain up to
0.5 grams per serving. For those limiting their trans fat to
two grams or less per day, one serving would provide almost
one-fourth of a day’s limit.
Types of butter, margarine and spreads
Butter contains about 110 calories, 12 grams of fat and 30
milligrams of cholesterol per tablespoon. Eight of the 12
grams of fat are saturated fat. Unsalted butter is an alternative
for those limiting sodium intake. Regular butter contains
about 85 milligrams of sodium per tablespoon, and unsalted
butter contains no sodium.
Whipped butter has less saturated fat and fewer calories
because it has more air. One tablespoon of whipped butter
contains 50-70 calories and 3.5-5 grams of saturated fat.
Due to the lower fat content, whipped butter would not be
appropriate for cooking, baking or frying.
Butter blended with unsaturated oil (canola, olive, soybean
and/or flaxseed) contains less saturated fat than regular
butter, which contains around 3.5-4.5 grams of saturated
fat and around 100 calories per tablespoon. Some butter-oil
blend sticks, such as Land O Lakes Butter with Olive Oil &
Sea Salt Sticks, contain generous amounts of saturated fat,
about 6 grams per tablespoon.
Light butter or non-butter spreads are lower calorie and
fat alternatives to regular full-fat butter or margarine. Butter
and spreads labeled “light” contain 50 percent fewer calories
and fat than regular products. One tablespoon of light butter
or spread contains 50 calories and 3 grams of saturated fat.
Light butter blended with oils contains added unsaturated
oils and water, which decreases the saturated fat to about
2 grams per tablespoon and decreases calories to about
50. Land O Lakes Light Butter with Canola Oil and Smart
Balance Light Butter & Canola Oil Blend are light blended
butter spreads.
Butter and spreads can contribute large amounts of fat,
saturated fat and calories to your diet. To keep saturated fat
Shutterstock/ImagePixel
and trans fat low, choose products with less than 2 grams of
saturated fat per tablespoon and do not contain partially
hydrogenated oil. †
 SATURATED FAT (g)

CHOLESTEROL (mg)

TOTAL CARBS (g)

FAT CALORIES

TRANS FAT (g)

SERVING SIZE

SODIUM (mg)

PROTEIN (g)
SUGAR (g)
CALORIES

FIBER (g)
FAT (g)
BALADE
LIGHT BUTTER W/SEA SALT 1 TBSP 54 6 50 3 0 5 70 0 0 0 0
BENECOL SPREAD
ORIGINAL 1 TBSP 70 8 70 1.5 0 0 110 0 0 0 0
LIGHT 1 TBSP 50 5 50 1 0 0 80 0 0 0 0
BLUE BONNET MARGARINE
LACTOSE FREE STICK 1 TBSP 70 7 70 3 0 0 125 0 0 0 0
LIGHT STICK 1 TBSP 50 5 50 1 1 0 80 <1 0 0 0
ORIGINAL STICK 1 TBSP 70 7 60 2.5 0 0 130 0 0 0 0
LIGHT SOFT SPREAD 1 TBSP 40 4 35 1 0 0 95 <1 0 0 0
CALCIUM SOFT SPREAD 1 TBSP 45 5 45 1 0 0 130 0 0 0 0
ORIGINAL SOFT SPREAD 1 TBSP 50 6 55 1.5 0 0 120 <1 0 0 0
BRUMMEL & BROWN MARGARINE SPREAD WITH YOGURT
ORIGINAL SPREAD 1 TBSP 45 5 45 1.5 0 0 90 0 0 0 0
BUTTER BUDS
DRY SPRINKLES 1 TSP 10 0 0 0 0 0 60 2 0 0 0
FLEISCHMANNS MARGARINE
SOFT SPREAD 1 TBSP 60 6 55 1 0 0 35 0 0 0 0
OLIVE OIL SPREAD 1 TBSP 60 6 55 1 0 0 45 <1 0 0 0
ORIGINAL STICK 1 TBSP 80 9 80 3.5 0 0 105 0 0 0 0
UNSALTED SPREAD 1 TBSP 60 7 60 1.5 0 0 0 0 0 0 0
GOLD 'N SOFT
LIGHT SPREAD 39% OLIVE OIL 1 TBSP 50 5 50 1.5 0 0 120 0 0 0 0
I CAN'T BELIEVE IT'S NOT BUTTER
LIGHT SPREAD 1 TBSP 40 4 40 1 0 0 85 0 0 0 0
ORIGINAL SOFT SPREAD 1 TBSP 60 6 60 2 0 0 90 0 0 0 0
VEGAN SPREAD 1 TBSP 60 6 60 2 0 0 90 0 0 0 0
OLIVE OIL SOFT SPREAD 1 TBSP 60 6 2 0 0 0 90 0 0 0 0
ORIGINAL SPRAY 5 SPRAYS 0 0 0 0 0 0 0 0 0 0 0
IMPERIAL
REGULAR STICK 1 TBSP 70 7 70 2.5 0 0 105 0 0 0 0
REGULAR SPREAD 1 TBSP 50 5 45 1 0 0 90 0 0 0 0
LAND O LAKES
CINNAMON SUGAR BUTTER SPREAD 1 TBSP 70 6 60 2.5 0 10 30 3 3 0 0
SPREADABLE LIGHT BUTTER W/CANOLA OIL 1 TBSP 50 6 50 2 0 10 90 0 0 0 0
GARLIC & HERB BUTTER SPREAD 1 TBSP 70 8 70 3 0 10 100 1 0 0 0
HONEY BUTTER SPREAD 1 TBSP 70 6 60 2.5 0 10 50 4 4 0 0
LIGHT BUTTER STICK 1 TBSP 50 6 50 3.5 0 15 95 0 0 0 0
FRESH BUTTERY TASTE SOFT SPREAD 1 TBSP 70 8 70 2 0 0 80 0 0 0 0
UNSALTED WHIPPED BUTTER 1 TBSP 50 6 55 3.5 0 15 0 0 0 0 0
WHIPPED SALTED BUTTER TUB 45% LESS FAT 1 TBSP 50 6 50 3.5 0 15 50 0 0 0 0
OLIVIO
LIGHT SPREAD 1 TBSP 50 5 50 1 0 0 90 0 0 0 0
COCONUT SPREAD 1 TBSP 65 7 65 3 0 0 90 0 0 0 0
ORIGINAL SPRAY 5 SPRAYS 0 0 0 0 0 0 15 0 0 0 0
PARKAY
LIGHT SPREAD 1 TBSP 50 6 55 1 0 0 110 0 0 0 0
ORIGINAL SPREAD 1 TBSP 60 6 55 1.5 0 0 90 <1 0 0 0
ORIGINAL STICK 1 TBSP 70 8 55 3 0 0 130 <1 0 0 0
LIGHT STICK 1 TBSP 50 5 50 2 0 0 80 0 0 0 0
SQUEEZE 1 TBSP 70 8 70 1.5 0 0 110 0 0 0 0
PROMISE
ACTIV LIGHT SPREAD 1 TBSP 45 5 45 0.5 0 <5 85 0 0 0 0
LIGHT SPREAD 1 TBSP 45 5 45 1 0 0 85 0 0 0 0
SHEDD'S SPREAD COUNTRY CROCK
CALCIUM PLUS VITAMIN D SPREAD 1 TBSP 45 5 45 1.5 0 0 100 0 0 0 0
CHURN STYLE SPREAD 1 TBSP 50 6 50 1.5 0 0 100 0 0 0 0
HONEY SPREAD 1 TBSP 70 6 50 1.5 0 0 45 3 3 0 0
LIGHT SPREAD` 1 TBSP 35 4 35 1 0 0 90 0 0 0 0
ORIGINAL SPREAD 1 TBSP 50 6 50 1.5 0 0 100 0 0 0 0
SMART BALANCE
EXTRA VIRGIN OLIVE OIL BUTTERY SPREAD 1 TBSP 60 7 60 2 0 0 70 0 0 0 0
EXTRA VIRGIN OLIVE OIL LIGHT BUTTERY SPREAD 1 TBSP 50 5 50 1.5 0 0 70 0 0 0 0
LIGHT BUTTER & CANOLA OIL SPREAD 1 TBSP 50 5 50 2 0 0 90 0 0 0 0
LIGHT SPREAD W/ FLAX SEED OIL 1 TBSP 50 5 50 1.5 0 0 90 0 0 0 0
LOW SODIUM BUTTERY SPREAD 1 TBSP 70 8 70 2 0 0 30 0 0 0 0
OMEGA-3 LIGHT BUTTERY SPREAD 1 TBSP 50 5 50 1.5 0 0 80 0 0 0 0

DiabetesSelfManagement.com 61
 Your Weight
By Nicola Davies, PhD

Increasing Your Confidence for Weight Management

YOU NEED TO BE in the right head-
space before you can effectively tackle
the task of initial weight loss. Although
we tend to think a person develops con-
fidence through mastering an ability –
whether it be athletics, painting or losing
weight – researchers have found that it is
the other way around: confident people
tend to achieve success.
The Confidence Ruler presented
below will help you rate your weight
management confidence. Take a few
minutes to answer the following ques-
tions using the ruler to guide you.
For each of the statements, write
down the factors that may be prevent-
ing you from scoring a 10. These are the
areas in need of improvement.
Tips for increasing your confidence
Increasing your confidence can boost
your performance. However, weight con-
trol can be as hard as giving up smoking
or another vice because it is easy to slip
back into old habits. While you may have
the skills and self-confidence to achieve
weight loss, you need clear performance
incentives to achieve success. Here are
four tips to increasing your confidence.
Building on successes
Sports coaches build confidence by
making sure everyone achieves initial
success; only then do they increase the
complexity of the training regimen.
No one starts as an expert, so build on
small successes and then push yourself
a little further. As an example, you may
want to work on flexibility. If one day
you can reach your knees in a forward
fold, then push a little harder each
day until you can touch your ankles,
then the floor, until you are finally
flexible enough to get your palms flat
on the floor.
Take a team approach
Inspiration comes from those who
reached the goals you are hoping
to achieve. People who have already
achieved success can provide firsthand
insights and tips on how they dealt
with various challenges. Weight man-
agement groups are often success-
ful because people achieve mastery
through observing and modeling oth-
ers. Belonging to a team of people with
the same goal can help build the will to
win. If joining a group is not practical
for you, then find a mentor who suc-
cessfully manages his or her weight.
Find a cheerleader
Charismatic friends or mentors can
challenge and inspire us to achieve
our goals. Find a person within
your circle who is willing to be your
cheerleader and provide support and
encouragement.
Exude confidence
Fatigue and stress can affect your
mood, lowering confidence levels.
Sometimes just seeing someone who
has been critical or demeaning in the
past can send confidence plummeting.
Although success or failure is perceived
differently depending on your state
of mind, simply altering your body
position can increase confidence. Psy-
chologists call this “embodied cogni-
tion” – if you stand taller, widen your
chest, and put your chin up, you are
decreasing production of the stress
hormone cortisol and boosting the
feel-good hormones.
Self-efficacy – another term for
self-confidence – will rise as you mas-
ter each small challenge along your
journey. So, if you lack confidence
now, don’t be disheartened – it is
there to be nurtured and to grow
with each step you take toward your
desired weight. †
Nicola Davies, PhD, is a health psychologist
and author of I Can Beat Obesity! Finding
the Motivation, Confidence and Skills to Lose
Weight and Avoid Relapse.

THE CONFIDENCE RULER

1. I can make the necessary changes to manage my weight.
Source: Digate Muth, 2015

2. I can eat healthier.

3. I can increase my physical activity.
4. Not only can I make changes to better manage my
weight, but I can also maintain those changes. 1 = No confidence 10 = Great confidence

62 May/June 2018
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GROCERY STORE: GRAB-AND-GO
Want to make a quick, healthy and
delicious Mexican meal at home?
Admittedly, some pre-packaged taco
shells are bland, flavorless and a bit
tough. Then Garden of Eatin’ created
their taco shells. Available in yellow
and blue corn, these shells are light,
crispy and made with organic stone-
ground corn. Two taco shells have
only 140 calories, 7g of fat, 17g of total
carbohydrates, 1g of fiber and 2g of
protein. Find more information at
www.gardenofeatin.com.
Need a better-for-you frozen meal?
Luvo steam-in-pouch meals are loaded
with vegetables, whole grains and pro-
tein and all have less than 400 calories
and 500 mg in sodium serving. Cur-
rently, there are eight delicious steam-
in-pouch meal options. Learn more at
www.luvoinc.com.
64 May/June 2018
F Thought
for
d
By Alison Massey, MS, RD, LDN, CDE
PRODUCE TO TRY THIS MONTH
Asparagus
Composed of over 90 percent water,
asparagus is low in calories and sodium
and is a good source of fiber, vitamins
C, E and K and potassium. Asparagus
can be either green or white, and peak
season is typically April through June. If
you want extremely tender asparagus,
look for thinner stalks.
Rhubarb
Although technically a vegetable and
not a fruit, rhubarb is often prepared
like a fruit and used in jams, pies, muf-
fins and other desserts. The color of
rhubarb stalks varies from light pink to
light green. It is typically available from
early April to June. Try using rhubarb
as part of a compote or sauce made
with a sugar-substitute like stevia for a
lower calorie option.
KEEP IT IN THE KITCHEN
Need help with portion control but
don’t want to measure every snack? Try
purchasing a set of beautiful ceramic
measuring bowls. Try the Pioneer
Woman’s Flea Market four-piece set,
available at www.amazon.com.
Want an environ-
ment friendly
alternative to
disposable, plas-
tic sandwich and
snack bags? Try Reuseit reusable sand-
wich and snack bags. Dishwasher and
freezer safe, these bags are free of BPA,
PVC, latex and phthalates. For more
information, visit www.reuseit.com.
Q&A WITH THE RD:
Q: Is the ketogenic diet right
for me?
A: The ketogenic diet was introduced
in the 1920s to treat epilepsy and was
widely used for about two decades to
help manage this condition. Recently,
the ketogenic diet’s popularity has
resurged as a strategy to lose weight
quickly. The diet is a very high fat
and extremely low in carbohydrates
with the purpose of putting the body
into ketosis to use fat as fuel. This
approach is not balanced and isn’t a
healthy meal pattern for individuals
with diabetes and may not be advised
for others dealing with various
medical conditions.
Bottom-line: Break up with “dieting”
and focus on developing lifelong
mindful eating practices.
Do you have questions for a Registered
Dietitian? Email communications@
diabetesselfmanagement.com. †
Alison Massey MS, RD, LDN, CDE is a registered
Shutterstock/Sudowoodo
dietitian and Certified Diabetes Educator in
Maryland. She is the owner of The Simple
Ingredient LLC www.thesimpleingredient.com.
  Clip this offer and please call today!

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AFN44167_0113
 Balance and Stability in Everyday Life
By Laurel Dierking, MEd
MAINTAINING A SENSE of physical balance and stability
is invaluable to feeling grounded and supported. Physical
balance is what allows you to move safely from one place to
another or to stand without feeling you are going to teeter
over. Stability is the amount of structural engagement (the
“structure” being your body) within each movement or, in
a stationary position, required to stand firmly.
Age, repetitively sedentary lifestyles and lack of practice
can result in the dwindling capacities of these daily func-
tions. Fortunately, we have the opportunity to practice
improving these very important elements of safety and
wellness during even the most unassuming times. For
example, when you walk at home, you can test your bal-
ance by walking in a straight line, heel-to-toe from one
end of the room to the other, looking straight ahead.
How did you do?
66 May/June 2018
There are many creative ways to practice maintaining
and improving your balance and stability. For instance,
while you’re doing the dishes, stand on one leg for one
dish, then on the other leg for the next dish. This chal-
lenges both your balance and your stability. It is a simple
and great way to improve the strength of the standing hip,
knee and ankle joints. Doing this simple task naturally
causes you to engage and activate your core muscles. The
stronger your core, typically the better your balance and
stability, and vice versa.
Here are some ways you can incorporate balance and
stability work into your daily life at home or at work.
Laurel Dierking, MEd, NFPT, 500YTT, is a health and fitness special-
ist with a concentration in yoga, individualized strength conditioning,
exercise physiology and alignment-based movement.
 TRY IT!

1
Single-Leg Standing with Progression Level 2 Standing in the same position as in Level 1, you
can add a bit of movement in the lifted leg to further
Level 1 Stand on one foot at your desk, behind a chair
challenge your balance and strengthen your stability. Do
or next to a wall. Make sure to keep a small bend in the
this by extending the lifted leg directly out to your side,
standing knee. Stand for one minute, or 10 slow breaths,
pressing irmly through your heel, then contracting. Repeat
then switch to the other leg. Repeat this as many times as
10 to 15 times on each leg.
you can throughout the day.

2
Single-Leg Standing
Forward Reach
Stand on your right leg 2 to
3 feet in front of your chair
or desk. Keep a bend in the
standing knee throughout the
movement while also keeping
the lifted leg irm and engaged,
pressing through the heel, lexing
the leg. Put your right hand on
your hip. Stand up tall and on
an EXHALE, begin to bend at
the waist and reach your left
hand toward your chair or desk
and lightly touch the edge. With
control, INHALE to bring yourself
back up to your original single-
leg standing position. Repeat 10
to 15 times on each leg.

TIPS
1. Press into the heels of BOTH legs to stand up tall. 2. To bend forward, hinge from the waist and keep your
Maintain this throughout the movement. spine as long as possible, as opposed to rounding your back
Aaron Ashley

to reach down.

DiabetesSelfManagement.com 67
 PRODUCT
SPOTLIGHT
Eucerin
IN THE SUMMER, skin-care hazards are everywhere, mind as a complication of diabetes, high blood sugar
from bright sunshine to chlorinated pool water to can in fact lead to a number of skin issues, some of
poison ivy. While skin problems don’t always come to them serious. To help stop skin troubles before they
start, Eucerin offers creams, lotions, sunscreens and
cleansers designed to moisturize, protect and heal.
Founded more than 100 years ago by German
pharmacist Paul C. Beiersdorf, the company,
headquartered in Hamburg, Germany, uses a research-
based approach, working with pharmacists and
dermatologists to test and refine its products.
Eucerin products are designed for many skin
types and needs, such as soothing dry and itchy skin;
protecting against UV rays; and relieving eczema.
Whether you’re trying to repair damage or keep
healthy skin in good shape, Eucerin has an option that
can help.
For more information, visit www.eucerinus.com.

DietSensor
WHEN DIAGNOSED WITH DIABETES, the first
question many people ask is, “What am I going to eat?”
Food plays a central role in managing the condition, and
knowing what options are best is vital.
If you don’t know where to start, DietSensor, an
innovative tracking app, can help. Developed by the
parents of a child with Type 1 diabetes, the free version
of the nutrition and meal planning app includes access
to a nutrient database of more than 600,000 foods,
carb counting, real-time portion size coaching and
the ability to add a food via barcode scanning. For an
additional $1.50 per week, users have the added benefits
of nutrition education programs and coaching for Type
1 and Type 2 diabetes and weight loss. SCiO – a pocket-
sized food scanner – and a digital scale for weighing
food can be purchased separately to make food logging
automatic, with no guesswork.
“Whether users plan to use DietSensor to monitor
diabetes, lose weight, improve general fitness or are
simply curious to know what exactly they are putting into
their body, we expect the simple and intuitive technology
to quickly become part of their daily regimen,” says
company co-founder and CEO Remy Bonnasse.
To learn more, visit www.dietsensor.com.
—Diane Fennell

68 May/June 2018
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Do you have type 2 diabetes and take multiple insulin shots each day?

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V-Go is a registered trademark of Valeritas, Inc.

ART-1024 Rev C 9/2017 ©2017 Valeritas, Inc.