The Seasons of Gratitude and Giving Can Come with Dietary Challenges, Especially for Those with Diabetes
Elkin Nunez, MD, director of endocrinology at Atlantic Health System’s Morristown Medical Center, joined a Community Conversation on November 12, 2020, to recognize World Diabetes Day and answer some common questions as well as sharing important tips to help those with diabetes make healthy holiday decisions.
What's the difference between type 1 and type 2 diabetes?
Dr. Nunez explained that type 1 diabetes is when your pancreas does not produce any insulin. Most diabetes patients however, about 95%, have type 2 diabetes. For those with type 2 diabetes, the body makes insulin, just not enough of it. People with type 2 diabetes don't respond to insulin as well as they should.
What is prediabetes?
There are 23 million people in the United States with prediabetes. This is a condition where a person's blood sugar level is higher than normal, between 100 and 125 milligrams per deciliter, Dr. Nunez explained. Normal blood sugar levels should be under 99. Another measure is an individual’s A1C, which is the average blood sugar level over a three-month period. Normal A1C, when you don't have diabetes, is less than 5.6. When you have pre-diabetes, it’s between 5.7 and 6.4. A level over 6.5 means a person has diabetes.
If a person is prediabetic, does that mean they will develop diabetes?
"No, and that’s the key." Dr. Nunez responded. “That’s why it’s so vital to identify these patients and know (their condition). If you incorporate lifestyle changes – medical nutrition therapy, exercise, and some weight loss – we can prevent diabetes by as much as 58%.” He noted that it is important to address any prediabetic indicators early to mitigate the onset of full diabetes. Patients don’t have to radically alter their diet to prevent diabetes. Moderation is the goal.
Are people with diabetes more vulnerable to COVID-19?
Dr. Nunez answered, “Absolutely. We don’t know specifically why the mortality rate in people with diabetes is so high, but we know that COVID-19 induces an inflammatory response throughout the whole body.”
For people with diabetes, that response gets heightened and causes more problems, he said. People with diabetes tend to be in the ICU longer, have a longer length of stay in the hospital and are more likely to have serious complications.
How are the holidays a challenge for those who are prediabetic and for those who have diabetes?
The holidays of fall and winter, including Halloween, Thanksgiving, Christmas, Hanukkah, Kwanzaa and New Year’s Eve, are times to gather with family and friends to celebrate, often with food. “Everywhere you go, there’s food…and so you end up gaining five to ten pounds, sometimes even more,” Nunez said.
You need to put yourself and your health at the top of this year’s list, he said, and concentrate on keeping your diabetes under control for you and for your family.
What are some ways to help loved ones make good decisions to stay healthy through the holiday season?
It is important to limit the number of free carbs and simple sugars in foods such as cakes, pies and candy. Dr. Nunez explained, “Even though it’s Thanksgiving … we love apple pie and all, but you’ve got to limit those things.”
Nunez usually tells patients to look in the room where they’re going to eat. Look at the food, if it’s already out, and scout. Make a mental plan: what am I going to consume? What should I consume? And then stick to that plan.
“We tend to walk around and start picking … grazing, and you want to limit that grazing, because the calories add up," he advised.
Where can people find information about making healthy choices about food?
If you’re someone who lives with diabetes, it is important to see a diabetes education professional. The educator will work with you to establish goals for your A1C and blood glucose levels and help you manage your food intake and medications. Your primary care provider at Atlantic Health System can coordinate and connect you with diabetes education resources as part of your overall health and wellness plan.
What else should people with diabetes do to prepare for the holidays?
Dr. Nunez noted that it is important to make a plan in case you fall ill during the holidays. If you use insulin, have a conversation with your provider or your educator and tap into their vast wealth of knowledge. Make a plan to check your blood sugar, understand your medications and manage your food intake.
Where can I find more information and resources about living with diabetes?