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An Ounce of Prevention…
An ounce of prevention is worth a pound of cure, or so the saying goes. For people with diabetes, planning ahead is key to enjoying the holiday season. Thanks to the focus on food, children and adults with diabetes may experience great anxiety around family meals and holiday parties. However, the American Diabetes Association (ADA) emphasizes that this worry is not necessary: simple steps such as adjusting meal schedules to accommodate a large dinner at an odd hour or preparing healthy snacks to eat in lieu of high-calorie appetizers can help minimize stress and maximize enjoyment.1
Stay on Schedule
Tips from the Cleveland Clinic emphasize the importance of staying on schedule.2 Although overeating during the holidays is common, skipping later meals to "balance out" an indulgence can wreak havoc on blood sugar and encourage further overeating. Whether your holiday plans include a trip overseas or an at-home staycation, maintaining a regular schedule for eating, exercising, and taking medications can keep diabetes on track.
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Everything in Moderation
Dessert is not necessarily a no-no for people with diabetes. Although sweets can be high in calories and carbohydrates,3 strategies such as sharing, preplanned responses ("No thanks, I'm full, but dinner was delicious!"), and sensible swaps, such as choosing pumpkin instead of pecan pie,4 make guilt about indulgence a thing of the past. One "holiday hack" recommended by the Centers for Disease Control and Prevention emphasizes that "no food is on the naughty list";4 savoring a small portion of a favorite, such as stuffing or cranberry sauce, can eliminate future cravings or overindulgence.
The American Association for Diabetes Educators recommends limiting servings of starchy foods and vegetables served in creams, gravies, or butter.5 Opt instead for raw, grilled, or steamed vegetables and baked, broiled, or barbecued meats, supplemented with small servings of dip-free or crackers. If your patient is hosting a get-together, remind them that calories consumed while tasting as cooking can add up and affect blood sugar.5 Encourage patients to serve a menu that includes plenty of healthy options (fruits, vegetables, and lean meats) or to host a healthy potluck. When attending as a guest, patients can bring a dish of choice to ensure the presence of a healthy option.5
And Drink Smarter
From holiday-themed cocktails to wine and beer tastings, alcohol is ubiquitous during the holidays. Although the risk of experiencing hypoglycemia exists, the ADA confirms that people with diabetes can still sip safely.6 If a patient plans on consuming alcohol, encourage them to perform additional blood glucose checks (eg, before, during, and after indulging) and to avoid drinking on an empty stomach. In addition, the ADA encourages people with diabetes to "be sure [that] blood sugar is at a safe level — between 100 and 140 mg/dL — before you go to sleep."6 The 2015 to 2020 Dietary Guidelines for Americans7 defines moderate drinking as up to 1 drink per day for women and 2 drinks per day for men, with a drink defined as 0.6 fluid ounces (fl oz; 14 g) pure alcohol per beverage. The following reference beverage guidelines may help patients make safer decisions, especially when consuming mixed drinks: 12 fl oz regular beer (5% alcohol), 5 fl oz wine (12% alcohol), or 1.5 fl oz 80-proof distilled spirits (40% alcohol).7
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Get, and Stay, Active
A 2016 position statement published in Diabetes Care8 emphasized that although regular physical activity is critical for blood glucose management, challenges "vary with diabetes type, activity type, and presence of diabetes-related complications." Exercise recommendations should be tailored to individual patients, but physical activity should be prescribed to "all individuals with diabetes as part of management of glycemic control and overall health."8 However, patients should be sure to appropriately monitor and manage blood glucose and insulin levels during their workouts.9 Are your patients bored at the gym? Suggest some holiday-specific exercises to get them out of their rut: According to Northwestern Medicine.10 ice skating is "relatively low impact" and works groups of small stabilizer muscles, leading to improved coordination down the line.
Increase A1C Awareness
Clinicians may advise patients on the ideal number of daily blood glucose checks,11 but during the holidays, all bets are off: With more frequent, and potentially less healthy, eating and drinking, patients should incorporate more frequent blood glucose monitoring into their daily routines.5 Remind patients what normal targets look like (HbA1c, 7% or 154 mg/dL; preprandial plasma glucose, 80-130 mg/dL; postprandial plasma glucose, <180 mg/dL)12 and encourage patients to remain within range to stay on track.
Use Mobile Tools as Needed
Mobile health apps are more popular than ever. As of 2015, 64% of the US public owned a mobile phone, and estimates show that 90% of people across the globe will own a mobile device by 2020.13 Diabetes management apps may be a convenient option for tech-savvy patients, with the caveat that not all apps are created equal.14 Among the top-rated apps for diabetes management are Lose It!,15 a tool focused on tracking diet and exercise, and FDA-approved One Drop.16
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Although many diabetes management tips geared towards adults can apply to younger patients, the holidays pose an even greater challenge for children or teenagers with diabetes. Remind parents that, as always, a little planning goes a long way: loading up on vegetables and lean meat during Christmas dinner means it's fine to indulge in a cookie for dessert. If dessert is a central part of a family's celebration, encourage parents to substitute lighter, low-sugar recipes.17 Involving children in meal planning and cooking can help emphasize the importance of healthy choices and moderation.
One if by Air...
Flying can be nervewracking at the best of times. Flying with diabetes, during the holiday season, alongside an estimated 9.7 million other travelers,18 is enough to jingle anyone's bells. An ADA fact sheet19 recommends that travelers with diabetes travel with prescription labels for both medications and medical devices, as well as any necessary medical identification and physician contact information. For people who use insulin pumps or continuous glucose monitors, Transportation Security Administration policy20 dictates that those passengers must alert screening officers about the presence of the pump or monitor before screening begins. In addition, travelers should be aware of any contraindications to metal detector or X-ray screening for insulin pumps or continuous glucose monitoring devices.20,21
Know Your Rights
Travelers are only required to alert officers about the presence of liquid medication, which is not subject to the Transportation Security Administration 3-1-1 rule.22 Although they may be subject to additional screening, liquid medications, including insulin, in excess of 3.4 oz may be brought in a carry-on bag. Beyond Type 1, an organization focused on global type 1 diabetes education, suggests that travelers with diabetes bring twice as many supplies as patients normally need, emphasizing that supplies should be split between 2 bags in case of theft or loss.23 However, insulin should be kept in carry-on luggage because of the extreme temperatures of a plane's cargo hold.24,25
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To Grandmother's House
Logistical challenges, including insulin transportation, time zone changes, and traffic delays or layovers, are also present when traveling by car, bus, or train. The JDRF suggests packing glucose tablets or diabetes-friendly snacks to combat potential hypoglycemia during a long layover, and minimize the stress associated with being caught unprepared.26 For long car trips, the CDC recommends packing fresh fruit and raw vegetables to snack on, as these may be hard to find while on the road.27 Insulin should be packed in a cooler and stored out of direct sunlight, but should not be placed directly on an ice or gel pack.27 Last but not least, communication is key to ensure proper insulin storage at the destination.
Manage Stress and Practice Mindfulness
Several studies28-30 have examined the link between stress and type 1 and type 2 diabetes, concluding that stress likely does affect glycemic control. Increased family responsibilities, such as holiday-associated cooking, cleaning, and shopping, can render the most wonderful time of the year more stressful than ever.31 Stress reduction and mindfulness techniques (eg, setting expectations, being realistic, and taking a breather when needed32) are invaluable tools as people race toward the New Year.
From eating to drinking to being merry, the holiday season poses a unique set of challenges for people with diabetes. Endocrinology Advisor has compiled a list of top tips clinicians can share with patients of all ages to minimize concerns and maximize enjoyment right into 2018.
Compiled by Lauren Biscaldi
- Planning ahead. American Diabetes Association. www.diabetes.org/food-and-fitness/food/planning-meals/holiday-meal-planning/planning-ahead.html. Updated July 11, 2014. Accessed November 27, 2017.
- Hamaty M. 10 Holiday survival tips if you have diabetes. Cleveland Clinic. health.clevelandclinic.org/2014/12/10-holiday-survival-tips-if-you-have-diabetes-2/. Accessed November 27, 2017.
- Fitting in sweets. American Diabetes Association. www.diabetes.org/food-and-fitness/food/planning-meals/holiday-meal-planning/making-sugar-count-during-the-holidays.html. Updated October 16, 2017. Accessed November 27, 2017.
- 5 Healthy eating tips for the holidays. Centers for Disease Control and Prevention. www.cdc.gov/features/diabetesmanagement/index.html. Updated November 23, 2016. Accessed November 27, 2017.
- Holiday season eating tips for people with diabetes. American Association of Diabetes Educators. www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/general/AADE_Holiday_toolkit.pdf. Accessed November 27, 2017.
- Alcohol. American Diabetes Association. www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html. Updated October 16, 2017. Accessed November 27, 2017.
- US Department of Health and Human Services and US Department of Agriculture. 2015-2020 Dietary Guidelines for Americans, 8th Edition. December 2015. Accessed November 27, 2017.
- Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079.
- Blood glucose and exercise. American Diabetes Association. www.diabetes.org/food-and-fitness/fitness/get-started-safely/blood-glucose-control-and-exercise.html. Updated September 25, 2017. Accessed November 27, 2017.
- Family fun and fitness: ice skating. Northwestern Medicine. www.nmbreakthroughs.org/fitness/family-fun-and-fitness-ice-skating. Accessed November 27, 2017.
- Blood sugar testing: why, when and how. www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628. Published December 20, 2014. Accessed November 27, 2017.
- Checking your blood glucose. American Diabetes Association. www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html. Updated August 4, 2016. Accessed November 27, 2017.
- Carroll JK, Moorhead A, Bond R, LeBlanc WG, Petrella RJ, Fiscella K. Who uses mobile phone health apps and does use matter? A secondary data analytics approach. J Med Internet Res. 2017;19(4):e125.
- Tran J, Tran R, White Jr JR. Smartphone-based glucose monitors and applications in the management of diabetes: an overview of 10 salient “apps” and a novel smartphone-connected blood glucose monitor. Clinical Diabetes. 2012;30(4):173-178.
- Lose It! www.loseit.com/. Accessed November 27, 2017.
- OneDrop. onedrop.today/. Accessed November 27, 2017.
- Ritchie A. Tips to help your kids manage their diabetes over the holidays. Akron Children’s Hospital. inside.akronchildrens.org/2012/11/29/tips-to-help-your-kids-manage-their-diabetes-over-the-holidays/. Published November 29, 2012. Accessed November 27, 2017.
- Burns B. You’ll be good as gravy to travel after reading our 2017 Thanksgiving travel tips. Transportation Security Administration. www.tsa.gov/blog/2017/11/21/youll-be-good-gravy-travel-after-reading-our-2017-thanksgiving-travel-tips. Published November 21, 2017. Accessed November 27, 2017.
- Air travel and diabetes. American Diabetes Association. main.diabetes.org/dorg/PDFs/Advocacy/Discrimination/air-travel-and-diabetes.pdf. Accessed November 27, 2017.
- What special concerns may arise? American Diabetes Association. www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/public-accommodations/air-travel-and-diabetes/what-special-concerns-may.html. Updated January 13, 2016. Accessed November 27, 2017.
- Type 1 & TSA: What to know before taking off. Beyond Type 1. beyondtype1.org/type-1-tsa-know-taking-off/. Published May 25, 2016. Accessed November 27, 2017.
- Burns B. TSA travel tips – traveling with medication. Transportation Security Administration. www.tsa.gov/blog/2014/09/05/tsa-travel-tips-traveling-medication. Published September 5, 2017. Accessed November 27, 2017.
- Travel with T1D. Beyond Type 1. beyondtype1.org/traveling-with-t1d/. Published May 17, 2015. Accessed November 27, 2017.
- How to store insulin. Kaiser Permanente. wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=/common/healthAndWellness/conditions/diabetes/insulinStorage.html. Updated March 1, 2014. Accessed November 27, 2017.
- Air travel with type 1 diabetes. JDRF. www.jdrf.org/austin/wp-content/uploads/sites/3/2013/02/Travel_2012.pdf. Accessed November 27, 2017.
- Traveling with diabetes. JDRF. www.jdrf.org/newengland/wp-content/uploads/sites/7/2013/02/Ginny-Rich-Complete-Packet1.pdf. Accessed November 27, 2017.
- Have diabetes? Get tips for safe travels. Centers for Disease Control and Prevention. www.cdc.gov/features/diabetesandtravel/index.html. Updated June 15, 2015. Accessed November 27, 2017.
- Lloyd C, Smith J, Weinger K. Stress and diabetes: a review of the links. Diabetes Spectrum. 2005;18(2):121-127.
- Harris ML, Oldmeadow C, Hure A, Luu J, Loxton D, Attia J. Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLOS One. 2017;12(22):e0172126.
- Murdock KW, LeRoy AS, Lacourt TE, Duke DC, Heijnen CJ, Fagundes CP. Executive functioning and diabetes: the role of anxious arousal and inflammation. Psychoneuroendorcino. 2016;71:102-109.
- Tips for parents on managing holiday stress. American Psychological Association. www.apa.org/helpcenter/parents-holiday.aspx. Updated November 2016. Accessed November 27, 2017.
- Stress, depression and the holidays: tips for coping. Mayo Clinic. www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20047544. Published September 16, 2017. Accessed November 27, 2017.