Diabetes True Confessions
They say confession is good for the soul. It’s also a good way to show others they are
not alone in their challenges. Talking about what ails you can also foster a sense of
community.
We recently asked the dLife community: What self-sabotaging habits do you have that
derail your diabetes management?
Boy, did you respond! And our dLife experts had something to say too that can help with
those challenges and make this Diabetes Awareness Month an opportunity for you to
declare, share, and move forward!
A Case of the Lazies
Confessions:
Not checking often enough. I get lazy and forget to test. Also, forgetting to bolus for
small snacks. — L.P.
I do get lazy with my testing on the weekends. I’m so much more busy and skip a few
times. Also one weakness is Tim Horton’s Iced Cappuccinos. Oh the guilt. :-D — K.W.
Getting so busy at work that I forget to check and take dose at lunch! — P.D.
Forgetting to check my blood glucose on busy days and overcoming my bad eating
habits from before my diagnosis (which was in July). Still, I am feeling a lot better than I
used to. — L.S.
Solution:
Busy bee that you are, sometimes checking those numbers can be downright
impossible. And if it’s the weekend — time to relax — then naturally you relax on your
management too, right? Well, there is an answer to this.
Testing glucose can be a hassle. Try to find a way to have some consistency and yet
give yourself permission to skip a few tests when your situation is stable. Why? A1C
correlates to self blood glucose monitoring. Type 1s who test more than 3 times a day
had an A1C on average 1 percent less than those who did not. And type 2s who test
more than once a day had an A1C on average of 0.6 percent less than those who did
not. The point is to not put the meter away for most of the day on most days.
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Page 1 Diabetes True Confessions, Continued
As for those cappuccinos, what is life without a l-i-t-t-l-e guilt? Did you know a small, 12
oz. sized milk iced cappuccino has 39 grams of carbs and 180 calories? A large 20 oz.
size has 69 grams of carbs and 320 calories? But if you go for the mocha iced cap
(large, 20 oz. chocolate milk) it has 101 grams of carbs and 500 calories! IF enough of
these “weaknesses” add up, they can certainly derail your diabetes wellness train.
Choose wisely and ditch the guilt.
— Theresa Garnero, APRN, BC-ADM, MSN, CDE
SOURCE:
Karter, A., L.M. Ackerson, J.A. Darbinian, RB D'Agostino Jr., A. Ferrara, J. Liu, J.V. Selby. 2001. Selfmonitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente
Diabetes registry. American Journal of Medicine 111(1): 1-9.
Mishandling Lows
Confession:
Gummi candies to prevent nighttime lows, which I have been having a lot of lately. —
B.S.
Solution:
It is never a bad habit to do your best to prevent nighttime lows. Using gummi bears or
candies to treat a low may work just fine (5 gummi bears have about 15 grams of carb),
but to use them to prevent lows may not be the best approach.
In order to prevent nighttime lows, consider the following;
1. Work with your healthcare provider to adjust your medication. Whether you
take insulin or diabetes pills that may contribute to low blood sugar (glucose), you
can minimize the risk for lows by taking the right kind and amount of medication.
If you have more than one low (less than 70 mg/dL) per week in the night, you
could benefit from a slight change. This includes having a plan for days you
exercise. For example, if you know you are going to have a good workout the
following day, you might take a unit or two less of Lantus or Levemir the night
before.
2. Know the early warning signs. If you know the very first inkling of a low blood
glucose, you can treat it before it goes even lower. Early recognition is important
in preventing worse lows. Some people have symptoms such as tingly lips or
mild dizziness, sweating, shakiness, etc.
3. Eat a well-balanced diet. Eating consistent, carb-balanced meals is important in
preventing lows. When people skip meals or suddenly eat less for a meal,
combined with taking insulin and certain diabetes medication, it may increase
your risk for lows.
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Page 2 Diabetes True Confessions, Continued
4. Have a bedtime snack if needed. Based on your blood glucose patterns and
recommendation from your registered dietitian or healthcare provider, a bedtime
snack may be the key to preventing lows in the night. Have a small snack that
has some protein along with carbs. Examples include a small serving of yogurt
with a sprinkling of nuts, a piece of whole-grain toast with peanut butter, a half
cup of fruit with cottage cheese, a small serving of popcorn, a glass of milk, a few
whole-grain crackers with cheese, a small protein bar.
5. Exercise moderately early in the morning before breakfast. In the morning,
your body is most insulin resistant. Since lows are most likely within 4 hours after
exercise, you can reduce your risk of nighttime lows by exercising earlier in the
day.
6. Test your blood sugar regularly. This will help you identify patterns that can
reveal your risk for lows. You can also set your alarm for the middle of the night
on a couple of occasions (3 a.m.) to make sure you are not going low. Some
people sleep through their lows, so this is important information to bring back to
your provider. Be sure to keep quick-acting sugar (like a small box of juice or
glucose tablets) at your bedside.
7. Limit alcohol, especially on an empty stomach. Alcohol can cause low blood
glucose, especially the following morning. Best to have with food, and have a
plan in place regarding medications on the nights that you do drink (your doctor
may suggest a little less long-acting insulin, for example).
— Theresa Garnero, APRN, BC-ADM, MSN, CDE
Incorrect Correcting
Confessions:
When I just want my little girl to feel “normal” around her friends and not have to wait to
eat something that might take me forever to figure out the carb count I have a tendency
to make a quick guess and correct my mistake later. — A.C.
Under-counting carbs when blousing and then correcting two hours later. — C.B.
Solution:
The best way to feel comfortable about controlling your diabetes is to become familiar
with the carbohydrate content of foods you are commonly eating on a day-to-day basis.
Foods that contain carbs (starches and sugars) tend to raise blood sugar levels. Rather
than having to constantly correct a high or low blood sugar, it's very important to figure
out the right amount of carbs for you (or your child) to eat throughout the day. Daily
activities don't always go according to plan, but if you familiarize yourself with the carb
content of various foods that you enjoy and eat most often, you will be less like to have
to correct your blood sugar.
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Page 3 Diabetes True Confessions, Continued
Becoming comfortable with reading food labels, and understanding portion sizes can
help you carb count more easily. (If you double up on a serving, you're consuming twice
the amount of carbs!) If a food doesn't have a food label (for example fresh fruit and
produce), you can approximate the amount of carbs in the food.
More ideas to prevent frequent blood sugar correction:
Know your schedule, so you can adjust your meal plan accordingly. If your child has an
unexpected play date, offer to bring the snacks (for all the kids), so that you are in
control of the carb content.
Use measuring tools (at least initially). If you are constantly guessing and correcting
insulin dosages, chances are you are not familiar with correct portion sizes as it relates
to your carb intake. You won’t have to measure forever! Measure proportions for a little
while, until you are seeing an improvement in your target blood sugar levels. This will
show you visually what 15g of carbs look like (for example, ½ cup of oatmeal).
Use an online tool, smartphone app, or poket-sized carb-counter book to quickly look up
the arb content of “sometimes” foods that you might not have been prepared to eat.
That way there will be less guesswork involved in medication coverage.
Keep a journal, make an appointment with a registered dietitian and certified diabetes
educator to help you figure out the best way to navigate your meals and snacks.
Working with a professional who is well-versed in diabetes meal planning will help you
make sure that you are eating an overall balanced and nutritious diet.
— Susan Weiner, R.D., M.S., C.D.E., C.D.N
Irregular Exercise
Confessions:
Not exercising regularly. — M.W.
Well I just found out I was diabetic in July so I am still learning but so far I have not
started exercising and I have not stopped McDonald’s fries, although I have reduced the
amount. I do try to carb count. — J.R.S.
Solution:
The best thing to do is stop thinking about exercise and start moving more daily. Just
being active all day long — standing, taking steps, moving whenever and wherever you
can — will help build your fitness and keep your blood sugar under better control.
Consider getting an inexpensive pedometer (step counter) and setting daily goals, too.
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Page 4 Diabetes True Confessions, Continued
Dis-proportion
Confessions:
The food that usually sabotages my sugars is pizza. — L.D.
Low carb pizz. Who can stop at just one slice? — R.W.S.
Peanut butter is my big downfall. I’ll sit down with the jar and go to town. — L.D.
Solution:
The common denominator here is portion control — or lack of it. Pizza and savory
snack foods are some of the hardest to eat in moderation. What can you do?
Pizza usually causes a delayed blood sugar rise, which can wreak havoc with your
management. It’s the big dose of carbs from the crust combined with the blood-sugar
moderating fat in the cheese. The best strategy with pizza is to allow yourself to eat the
first few bites of the thin part of the pizza and then use a fork to scrape off the rest and
leave the big, thick part of the crust right on your plate (or better yet, throw it away so
you don’t start nibbling on it without thinking). Eat slowly, too, to give your body time to
get the message up to your brain that you’re satisfied.
And here’s one piece of good news about the peanut butter: Two tablespoons of peanut
butter (the popular brands, with added sugar) contain just 7 grams of carbs, and 2 of
those grams are beneficial fiber. It’s calorie-dense but delivers healthy fats,
antioxidants, vitamins, and minerals.
Here’s what I do to help me not overate snacks: Buy some mini ramekins or other
condiment-size containers that you like (I have little wooden bowls in different shapes
that I love. At snack time, get into the habit of always pulling out your mini-size dishes
and never eating out of a jar or package.
— Lynn Prowitt-Smith
dLife Food & Nutrition Editor
Celebration Time!
Confession:
After you get a glowing report from your doctor that your tests have improved, you
suddenly feel invincible. So you decide to celebrate by eating a HUGE meal! — J.M.
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Page 5 Diabetes True Confessions, Continued
Solution:
Getting a glowing report from your doctor deserves a huge celebration. However, it’s not
necessary to celebrate with a HUGE meal. It’s true that we often feel that a “positive”
accomplishment deserves a treat. But why does that treat need to be sugar coated? If
you celebrate your accomplishment of improved health with something else that also
makes you feel good, then you will feel even more accomplished.
Here are some carb- and calorie-free ways to celebrate:
Look in the mirror and repeat your accomplishment out loud. You’ll smile when you see
and hear yourself saying “your blood sugar is in good control.”
Take some time off and read a book or see a movie. It’s a guilty pleasure that you
typically wouldn’t do on a random weekday.
Go for a long walk. If you live near a beach, go to the boardwalk.
Send yourself flowers or take a walk through a botanical garden (that you’ve been
meaning to visit). The lovely sights and smells will make you remember why you are
eating well and taking care of yourself.
Sit in a bubble bath, schedule a massage, or treat yourself to a nice body lotion.
You deserve another good blood test in three months. Rather than eat foods that you
might regret later, treat yourself to activities which will make you happy and healthy.
— Susan Weiner, R.D., M.S., C.D.E., C.D.N
Good Intentions Gone Bad
Confessions:
Chocolate. Every time I decide it’s time to eat more fruits and veggies, I eat more junk.
— K.L.
For the last couple of months I’ve been a good girl… and I think just NOT allowing
myself things is what generally sabotages me. It makes me obsess and fantasize about
foods in unhealthy ways, and then I’ll end up bingeing. Man, I went through a major
pepperoni binge for a while, and gained some serious weight from it. This denial,
deprivation, binge, and denial again cycle is an eating disorder… don’t feed into it. 
— L.C.
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Page 6 Diabetes True Confessions, Continued
Solution:
These problems sound like the all-too-common “deprivation backlash.” You say to
yourself, “I need to eat more fruits and veggies and less chocolate and junk” or “I am
being so good, I haven’t had a binge in months…”
The most compelling human needs are water, oxygen, and anything we’re told we can’t
have. My solution to this problem is to adopt a healthy eating plan that involves adding
foods to your diet rather than taking things away.
1. Let the good crowd out the bad. Every week, add at least one new source of protein,
one new vegetable, and one new fruit to your shopping cart.
2. Focus on low carb fruits and vegetables and high-fiber foods. Learn more about
superfoods like greens.
3. Don’t give up chocolate. Just switch to plain, dark chocolate (if you don’t like it at
first, take little pieces and suck on them from time to time; soon enough, you’ll like it
more than milk chocolate).
4. Meet with a dietitian who specializes in diabetes. As registered dietitian and certified
diabetes educator Janis Roszler says, “You don’t have to avoid all of your favorite
foods, just learn how to eat them in healthier amounts.”
— Lynn Prowitt-Smith
dLife Food & Nutrition Editor
Temptation, You Temptress!
Confession:
Being tempted by others and giving in to it instead of standing up for myself and
resisting. For instance… regardless of what junk my hubby brings home and sets in
front of me, I don’t have to choose to eat it. I just wish he were “on my side.” — J.G.
Solution:
Temptation is tantalizing, but it doesn’t have to always win and you don’t always have to
avoid it. To deal with temptation:
1. Treat yourself to a small taste of the tempting food;
2. Make your home a “junk free” zone (which is healthy for all);
3. Keep a healthy alternative snack in your purse.
As for that unsupportive spouse? See the next confession!
— Janis Roszler, RD, CDE, LD/N
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Page 7 Diabetes True Confessions, Continued
Diabetes Police
Confession:
… I just wish he were “on my side.” — J.G.
Solution:
It can be difficult for the spouse who doesn’t have diabetes to know what to do or when.
To encourage your husband to be on your side:
1. Bring him to a session with a dietitian or diabetes class to learn more about your
needs.
2. Invite him to read The Secrets of Living and Loving With Diabetes — a great book
that helps spouses and partners learn how to support one another.
— Janis Roszler, RD, CDE, LD/N
Handling Stress
Confession:
I drink booze; margaritas, especially after a stressful day at work. — J.L.
Solution:
If you are taking medication to control your diabetes (insulin or oral pills), please be
aware that alcohol can lower your blood sugar (i.e., cause hypoglycemia) for up to 12
hours after drinking. Alcohol should not be consumed on an empty stomach, as the
effects of the alcohol will be exaggerated. The symptoms of being intoxicated and
having a low blood sugar are very similar (slurred speech, unsteady gait, or dizziness)
and therefore the two can be easily confused. Mixed drinks (which often contain fruit
juice or sugary additives) provide additional carbohydrates, which are not accounted for
when meal planning. Because alcohol reduces your ability to make good decisions,
meal planning may be an issue if you drink too much on a regular basis.
Here are some tips to de-stress and drink a bit less:
1. ALWAYS test your blood sugar before consuming any alcohol. If your blood sugar is
out of range, cut up some lemons and limes and add them to a glass of sparkling
seltzer. Sip on this refreshing beverage while listening to some soothing music in the
background.
2. Have your food waiting for you when you get home. Try not to stray from your
nutritious meal plan. You will feel satisfied after you eat and able to reduce your
alcohol intake.
3. If you do have an acoholic beverage, sip it. Put a lot of ice in the drink. One drink
equals 4 ounces of wine or a 12-ounce beer.
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Page 8 Diabetes True Confessions, Continued
4. Have a calorie-free beverage waiting for you in the refrigerator. Sit outside if possible
and unwind before coming into the house.
— Susan Weiner, R.D., M.S., C.D.E., C.D.N
Bedtime Carbs
Confession:
It’s the carbs before bed that do me in. — H.E.
Solution:
Nighttime eating is perhaps the most common way people sabotage their healthy eating
efforts. Research shows that people who eat more in the morning eat less, over the
course of a whole day, than people who eat more in the evening. The research also
shows that food consumed in the morning actually satisfies us more than the food we
eat at night. Of course, at night you’re tired, you’re sitting around, there’s nothing you
have to be doing. And you’ve got all those snacks in the kitchen.
What’s the easiest fix? Get those easy grabbable snacks out of the kitchen. You’re less
likely to engage in mindless eating in front of the TV or the computer if the only food
available needs to be chopped or cooked.
Other ideas: Change your nighttime routines.
1. Take a yoga class or attend a lecture series at your local library. Anything that gets
you out of the house cuts some of your nighttime snacking hours.
2. Take a therapeutic bath once a week (find a spa-type bath product you love — salts,
bubbles, oatmeal, etc.) The bathtub is one relaxing place where it’s very
inconvenient to eat.
3. Change your nighttime snacks to odd foods that you’re unlikely to overeat: briney
foods like pickles, olives, or veggies dipped in vinaigrette; slow-eating things like
beef jerky, or spicy foods like a hot chili or stuffed hot cherry peppers.
— Lynn Prowit-Smith
dLife Food & Nutrition Editor
SOURCE:
Castro, John M. 2004. The Time of Day of Food Intake Influences Overall Intake in Humans. Journal of
Nutrition. 134: 104-111.
So as you can see, no one is perfect. Even the most experienced person with diabetes
has their good days and their bad. The challenge is being willing to admit these slips
can happen so that you can find solutions or, at the very least, cut yourself some slack!
Any time is a good time to assess your diabetes management and make a positive step
forward. Need some help? dLife is a great first step!
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