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Stress S.O.S. – strategies for coping

Stress S.O.S. - strategies for coping
Features

By Gabrielle Bauer

Photo (above): Speaking up for people with diabetes: (From left) Helena Macario, CDA information and support services representative; Kelsey MacPherson, CDA community initiatives coordinator (Sault Ste. Marie office); Charlene Lavergne, CDA advocate; and Nickel Belt MPP France Gélinas (NDP health and long-term care critic) at a “Diabetes Day” for Ontario legislators.

Charlene Lavergne

Charlene Lavergne worries about her feet. Her church gave her a treadmill so she can exercise at home, but what if she loses a foot? She worries about her eyes. What if her vision gets worse and she cannot afford new glasses? She worries about having a heart attack. “Every time I do something, like hop on the treadmill, I worry about whether I’ll be able to do it tomorrow,” says Lavergne, 61, who lives in Oshawa, Ont. “The stress never leaves me, not even at night.”

Lavergne has lived with type 1.5 diabetes—type 2, with some features of type 1, known as LADA (Latent Autoimmune Diabetes in Adults)—since she was a teenager. Adding to her stress is the stigma of the disease in her Métis community. (She has shared her story with Ontario Members of Parliament on behalf of the Canadian Diabetes  Association/CDA.) “I can’t tell my relatives that I shouldn’t be eating a certain food,” she says. “I can’t tell them my blood sugar is high. Even my children don’t want to know.” The lack of openness compounds her stress, which “makes my blood sugar climb still higher. You can see it in my logbook.”

What kind of stress are you dealing with?

While life throws stress at just about everyone, there are some particular challenges for people with diabetes:

Michael Vallis

  • Diabetes self-management “Most people aren’t wired to pay attention to something 24/7,” says Michael Vallis, a health psychologist and associate professor at Dalhousie University in Halifax. “Even the things we enjoy, such as golf or knitting, we enjoy in spurts.” Having to think about diabetes every time you eat, exercise, or change your routine can create significant stress over time, says Vallis. “It’s not for nothing we talk about diabetes distress.”
  • Health Diabetes-related complications such as vision problems and foot ulcers can make day-to-day activities more challenging. Even if you are not dealing with complications now, they are a long-term concern.
  • Financial “Every month I worry about whether I’ll be able to afford the insulin I need,” says Lavergne, who gets a modest disability pension with a limited drug plan. When she was employed, the fear of losing her job kept her up at night. “I had a supervisor who had a problem with me injecting insulin in view of others,” she says. “I dreaded going to work and kept worrying I would get fired.”
  • Social “If you have diabetes, you’ll likely have some stress dealing with people in your social circle, particularly around food,” says Vallis. He gives the example of getting a dinner invitation, where you tell your host that you need to eat by 7 p.m. to keep your blood sugar on an even keel. “The host may say, ‘Sure, no problem,’ but then you get there and dinner isn’t ready until 8:30 p.m. That’s stressful.” Not only can the delay affect your blood sugar levels, the stress of being delayed can also worsen your physical health.

Stress: it’s not just in your head

Stress causes your body to produce cortisol and adrenalin—hormones that raise your blood sugar and give you the energy to “run from danger,” also known as the “fight or flight” response. These hormones also raise your blood pressure. If this happens just once in a while, your body can recover. But if stress becomes chronic, it can contribute to conditions such as chronic pain, digestive problems, and even heart disease. That is because high blood pressure can damage the blood vessels, causing them to form plaque that limits the flow of blood.

Norbert Schmitz

Trying to cope with chronic stress can also mean you are less likely to maintain behaviours that can help you stay healthy; that can raise your risk of developing diabetes complications over time, says Norbert Schmitz, an associate professor of psychiatry at McGill University. (Schmitz was featured in “Research Brief,” Autumn 2013.) These complications can create more stress, which can worsen your health and lead to what Schmitz calls a negative feedback loop. “Getting the stress under control can break the cycle and improve your ability to manage your diabetes effectively,” he says.

What can you do about stress?

Exercise Some research suggests that exercise increases a chemical in the brain that reduces stress and anxiety—as long as it is an exercise you enjoy. If you do not like walking on a treadmill, you might walk around a mall instead, or buy a badminton racket and find a buddy to play with.

Dr. Howard Nathan

Relaxation techniques Yoga, meditation, deep breathing, and progressive relaxation therapy (tensing and relaxing your muscles in sequence) are popular options. “Focusing on your breathing for a period of time has been shown to decrease activity in the stress centres of the brain,” says Dr. Howard Nathan, a CDA-funded scientist based at the Ottawa Hospital Research Institute. (Nathan was featured in “Research Brief,” Summer 2015.)

Mindfulness A related approach, called mindfulness-based stress reduction, involves paying attention to what is happening in your mind and body at the moment. For example, lie down and notice the sensations in your right foot—is it hot, cold, sore, tingly, or itchy?—without judging or reacting to them. “If we develop the ability to be with unpleasant sensations or emotions without reacting to them, our quality of life improves,” says Nathan, whose research has shown that mindfulness and other relaxation techniques improve physical and mental functioning as well as quality of life. There is also evidence that “mindfulness leads the body to produce less cortisol,” he adds.

Positive self-talk When Lavergne feels down about her diabetes, she reminds herself that “other people have it worse, and I’m lucky to be alive.” At other times, “I need a good cry,” she says. “The important thing is to carry on.”

Social support Research continues to find links between a strong social network and physical health. Lavergne draws strength from her weekly Bible study group. For others, friendships based on common interests may help. A word of caution from Vallis: “If your current friends don’t have time to hear about your struggles, seek out other friends.”

Doctor support According to Vallis, negative experiences with your doctor can add to your stress. If he or she never asks you how diabetes is affecting your quality of life, Vallis suggests you make the first move. “Tell the doctor how you’re feeling—including if you’re feeling judged for not being the perfect patient—and what you need.”

Mental-health support If you cannot manage your stress on your own, a psychologist, social worker, or stress-reduction program can help you identify and cope with the sources of stress in your life. Contact your doctor or a CDA branch to help you find the right support.

So where do you begin? Vallis suggests choosing one of these strategies, getting comfortable with it, and going from there. “The more sources of support you have, the better,” he says.

The last word

“Every time I do something, like hop on the treadmill, I worry about whether I’ll be able to do it tomorrow. The stress never leaves me, not even at night.” – Charlene Lavergne, person living with type 1.5 diabetes

“Getting the stress under control can break the cycle and improve your ability to manage your diabetes effectively.” – Norbert Schmitz, associate professor of psychiatry

 “Focusing on your breathing for a period of time has been shown to decrease activity in the stress centres of the brain.” – Dr. Howard Nathan, physician and researcher

“Tell the doctor how you’re feeling—including if you’re feeling judged for not being the perfect patient—and what you need.” – Michael Vallis, health psychologist and associate professor

Did You Know?

What you experience as stress is your body’s response to something you consider threatening. Read more from “Stress Management & High Blood Pressure.”




Getting to the heart of diabetes

Getting to the heart of diabetes
Research Brief

By Rosalind Stefanac

Photo (above): Kathleen MacLeod (left) and Vongai Nyamandi (right) are working to learn more about diabetic cardiomyopathy.

Growing up in Zimbabwe, Vongai Nyamandi did not really know what diabetes was. “I knew that these patients [were told they] couldn’t have sugar, but I didn’t understand why.” When she left home at the age of 18 to attend university in Cleveland, Tenn., “I did a lot of community engagement and saw so many people who were obese and/or had diabetes with accompanying complications including heart disease and hypertension.” It was the impetus she needed: Now a doctoral student living in Vancouver, Nyamandi focuses her research on type 1 and type 2 diabetes, especially as it relates to obesity and heart disease.

People with diabetes are two to three times more likely to develop heart disease than people who do not have diabetes. In one of the most prevalent conditions, diabetic cardiomyopathy, the heart muscle cells do not function properly and as a result the heart does not beat normally. Currently, Nyamandi is studying under Kathleen MacLeod, a professor and researcher at the University of British Columbia who has conducted research on diabetic cardiomyopathy. “Kathleen drives me as a researcher to come up with ideas and how to implement them,” says Nyamandi.

One of those ideas is Nyamandi’s latest research project, funded by the Canadian Diabetes Association (CDA). She is using mice with diabetes to look at a pathway that chemical signals take in heart cells; these signals (called RhoA-ROCK) are overactive in individuals with diabetes. She is hoping to discover why this pathway causes an irregular heartbeat, which will then allow researchers to develop ways to treat diabetic cardiomyopathy. Nyamandi is aiming to have the results completed by this August.

“Vongai’s research project is very exciting, because it shows for the first time that reducing the over-activity of RhoA improves heart function in diabetes,” says MacLeod. “We are very grateful for the support of the Canadian Diabetes Association.”

Dr. Jan Hux, chief scientific officer with the CDA, says heart failure robs many people with diabetes of both quality of life and length of life. “Novel insights into the unique aspects of heart failure in diabetes from this work could lead to important new treatments for a common complication,” she says.

Nyamandi also puts her expertise to good use in Zimbabwe: She makes a point of going home every few years to educate the community there about high blood pressure and diabetes, and would like to get even more involved in using research findings to affect changes in government policy. “We need to do more on educating people, especially children, on how to lead healthier lives so they’re not facing these diseases later on.”

Vongai Nyamandi at a glance

  • Awarded the Canadian Diabetes Association Doctoral Student Research Award (2014)
  • Completes Master of Science, Biomedical Engineering, University of Calgary (2012)
  • Completes Bachelor of Sciences (Honors), Biochemistry, Lee University (2009)
  • Receives Dean’s Academic Scholarship, Lee University (2005)

Did You Know?

High blood glucose (sugar), high blood pressure, an inactive lifestyle, and being overweight are all risk factors for heart attack or stroke. People with diabetes can lower their risk by maintaining a healthy lifestyle. Learn more about “Heart Disease & Stroke”.

Visit diabetes.ca/research to read about the 97 research projects and awards funded by the Canadian Diabetes Association.

How can you help us fund research that changes lives? Donate now!




5 ways to enjoy tomatoes

5 ways to enjoy tomatoes
Nutrition

By Rosie Schwartz, RD

It is finally that time of year when we can start to enjoy the pleasure of homegrown tomatoes. But these summer favourites are not just a tasty treat—they are also packed with nutrients. Thankfully, we have gotten past the late 18th century, when tomatoes were wrongly feared as poisonous because they are a member of the nightshade family (other members include eggplants and potatoes).

In fact, tomatoes are packed with vitamins A, C, and E; folate; and potassium, fibre, and phytochemicals (disease-fighting compounds found in plant foods) such as lycopene, lutein, and isoprenoids, which are now at the centre of much research. Lycopene (the pigment that gives red tomatoes their colour) is also an antioxidant, which protects cells against damage and may protect you against a variety of diseases, including heart disease, stroke, and certain cancers. And tomatoes’ healthful qualities come in a rainbow of colours besides red thanks to the availability of heirloom tomatoes (where the seeds have been passed down through the generations) as well as newer varieties. If you like tomatoes with a purple hue, for example, that colour comes from pigments called anthocyanins, which are also antioxidants.

Tomatoes are healthy in other ways: For example, the gel around the seeds contains substances that may help to decrease the risk of developing blood clots, which may lead to heart attacks and strokes. They also provide potassium—the mineral that gives bananas their reputation as a smart choice for regulating blood pressure.

Research in people with type 2 diabetes—who are at high risk of developing heart disease—found that eating tomatoes on a daily basis resulted in lower blood pressure readings as well as favourable effects on levels of “good” HDL-cholesterol in the blood. Other studies show that tomatoes provide these same benefits for people who do not have diabetes. And tomatoes do not have a high carbohydrate count, making them a great choice for people living with diabetes, says Joanne Lewis, diabetes education manager for the Canadian Diabetes Association (CDA).

For Your Eating Pleasure

Now that you know why tomatoes are so good for you, here are five different ways to enjoy them.

Raw There is nothing quite like a sliced summer tomato. Lewis loves hers in a Caprese salad with grape tomatoes, mini bocconcini, some olive oil, and basil.

Grilled Thicker slices can be cooked right on the grill for a few minutes for a more intense flavour. Cherry tomatoes are delicious on skewers, either with a combination of other vegetables plus meat, chicken, or fish, or on their own.

Oven dried If you have a lot of tomatoes from your garden or from a farmers’ market, oven dry them. This method is also a good way to enjoy winter tomatoes. (See the Linguine With Oven-Dried Tomatoes and Roasted Garlic recipe). Not only is the flavour intensified, but the lycopene is better absorbed when tomatoes are either cooked or canned.

Canned Whether homemade or store-bought, “canned tomatoes are a quick go-to if you want to make a healthy sauce,” Lewis says. But if you are buying from stores, “look for low-sodium or no-added-salt products to avoid high sodium.”

Soups Raw or cooked tomatoes can add body and taste to soups without adding significant amounts of carbohydrates that can affect your blood glucose (sugar).

Here are three delicious ways to include tomatoes on our menu. They are easy enough for every day but are also tasty offerings for entertaining.

Linguine with Oven-Dried Tomatoes and Roasted Garlic

Roasting tomatoes in the oven provides an intense hit of flavour and boosts lycopene absorption, especially when combined with extra virgin olive oil. You can use this preparation to oven dry any type of tomato and use tomatoes that are not very flavourful. Shorten cooking times if the tomatoes are small.

2 lb. (1 kg) plum tomatoes
3 tbsp (45 mL) extra virgin olive oil
3 large cloves garlic
¾ lb. (375 g) linguine, preferably whole wheat
2 oz. (50 g) fresh mozzarella cheese, diced
2 tbsp (25 mL) chopped fresh basil
2 tbsp (25 mL) freshly grated Parmesan cheese

Preheat oven to 325°F/160°C. Line a baking sheet with parchment paper.

Cut tomatoes into wedges (quarters for small tomatoes and sixths for larger ones) and place on the baking sheet, skin side down. Drizzle 1 tbsp (15 mL) olive oil over tomatoes, and season to taste with salt and pepper.

Bake for 1½ to 2 hours, or until tomatoes are slightly dried but still soft to touch. Do not over dry.

To prepare garlic, cut ¼ inch (0.5 cm) off the top of the cloves. Drizzle with 1 tsp (5 mL) olive oil and wrap in double-thickness aluminum foil. Place in oven alongside tomatoes and bake for about 30 minutes. Remove from oven and allow to cool. Squeeze roasted garlic into a small bowl. Using a fork, mash it together with 2 tsp (10 mL) olive oil.

Remove tomatoes from oven and allow to cool; cut into ½-inch (1 cm) pieces. Set aside.

Cook pasta according to package directions; drain.

In a large skillet, over medium heat, add garlic-oil mixture; add dried tomatoes and toss to coat. Heat until mixture is warmed through. Add cooked linguine and toss. Remove from heat. Add mozzarella and basil, being careful to distribute pieces evenly. Drizzle remaining 1 tbsp (15 mL) of olive oil over pasta. Season to taste with salt and pepper. Serve garnished with Parmesan.

Makes 6 servings

Nutritional breakdown per serving 47 g carbohydrate, 12 g protein, 11 g total fat, 3 g saturated fat, 9 g fibre, 166 mg sodium, 329 calories

© Rosie Schwartz

Gazpacho

Gazpacho originated in the region of Andalusia, in southern Spain. During the summer, I always keep some of this refreshing soup in my refrigerator, to snack on but also to serve at meals. This dish is served cold, making it the perfect thing for a hot summer's day.

2 cloves garlic, chopped
1 medium onion, cut into eighths
1/3 cup (75 mL) chopped cilantro
¼ cup (50 mL) chopped fresh flat leaf parsley
2 tbsp (25 mL) extra virgin olive oil
3 tbsp (45 mL) red wine vinegar, or to taste
4 large ripe, red tomatoes (about 1 kg/2 lb.), cut into eighths
2 red peppers, cored, seeded, and cut into eighths
1 English cucumber, cut into 2-inch (5 cm) pieces
Salt and freshly ground black pepper, to taste

Place garlic, onion, ¼ cup (50 mL) cilantro, 3 tbsp (45 mL) parsley, the olive oil, vinegar, and half of the tomatoes, red peppers, and cucumber in a food processor; process to a smooth purée. Place in a large bowl. Process remaining tomatoes, red peppers, and cucumber until smooth. Add to bowl and mix together. Season with salt, pepper, and more vinegar, if desired, to taste.

Refrigerate at least one hour or overnight. Serve garnished with remaining cilantro and parsley.

Makes 6 servings

Nutritional breakdown per serving 12 g carbohydrate, 2 g protein, 5 g total fat, 1 g saturated fat, 3 g fibre, 220 mg sodium, 97 calories

© Rosie Schwartz

Shakshuka

Middle Eastern food has become extremely popular lately. Here is an Israeli specialty, similar to huevos rancheros, that makes eggs irresistible. It is an adaptation from chef Moshe Basson of Eucalyptus Restaurant in Jerusalem.

2 tsp (10 mL) extra virgin olive oil
1 cup (250 mL) chopped onion
1 red pepper, diced
2 cups (500 mL) diced plum tomatoes (about 500 g/1 lb.)
¼ tsp (1 mL) ground cumin
Salt and freshly ground pepper, to taste
4 eggs

Heat oil in a saucepan over medium-high heat; add onion and sauté for 5 minutes or until soft. Add red pepper and continue to sauté for another 5 minutes. Add tomatoes and cumin; stir to mix. Reduce heat to medium-low and cook, covered, for 20 minutes, stirring occasionally. Season with salt and pepper to taste. Crack eggs onto mixture, spacing them evenly in the mixture, and continue to cook, covered, until eggs are set, or for about 4 minutes. Serve immediately.

Makes 2 servings

Nutritional breakdown per serving: 263 g carbohydrate, 13 g protein, 12 g total fat, 3 g saturated fat, 4 g fibre, 180 mg sodium, 263 calories

Did You Know?

While fruits and vegetables offer an abundance of good-for-you compounds, some are better for your diabetes diet than others. For example, did you know that two cups of strawberries have less sugar than a whole mango?) Read more from 10 Things You Need to Know About Fruits and Vegetables now.




Group walking has big benefits

Group walking has big benefits
Fit Tip

By Barb Gormley

Photo (above): You don't need to be part of a formal group, like this Walk N’ Talk Diabetes group from B.C. Simply call up a friend or two, and get going!

Walking is good for you wherever you do it—around the neighbourhood with the dog, at the mall, or on a treadmill. It is a simple activity that can have a dramatic effect on your blood glucose (sugar), blood pressure, blood lipids (fats found in your blood, such as cholesterol), cardiovascular health, and overall quality of life.

Chella Percy

“For most people, walking is the ideal way to exercise,” says Chella Percy, a registered nurse and educator from Kelowna, B.C. “It’s easy, effective, and free.”

“And the only equipment required is a pair of supportive shoes,” adds Glenna Armstrong, BC Interior regional coordinator for the Canadian Diabetes Association (CDA).

Percy and Armstrong run Walk N’ Talk Diabetes, a free 60-minute walking program, at five different parks in Kelowna, B.C. The program is a collaboration between the University of British Columbia Okanagan and the CDA. Approximately 50 people—some with type 1 or type 2 diabetes and their friends and families, as well as people interested in preventing type 2 diabetes— meet once per week with university staff and students, and CDA volunteer walking leaders.

Both women strongly encourage group walking for people with type 1 or type 2 diabetes—whether as an organized group or as an informal gathering of friends— because it offers three advantages.

1. It is fun and social

“Overwhelmingly, people tell us that meeting other people and making new friends is their number one reason for coming out each week,” says Percy. “Some of our participants are new to town, and they find Walk N’ Talk is a great way to get socially connected while being active and learning about new locations for walking.”

2. It is motivating

“In our programs everyone moves at their own pace, but they also set a personal goal,” says Percy. “An example of a walking goal would be to measure how many steps you can comfortably walk today, and by the end of a 10-week program have increased it by 1,000 steps.” Hearing about what other group members are aiming for can encourage you to set—and work toward—your own goal.

3. You are more likely to stick with it

“A group provides positive peer pressure that gives you an extra little push to show up for each walk,” says Armstrong. "People notice when you’re not there.”

Want to get the most from a group walk?

1. Get engaged

Walk, run, or hike in international and Canadian events—and help people living with diabetes or prediabetes. Sign up for the CDA’s Team Diabetes (diabetes.ca/teamdiabetes). You can also contact your local CDA office to find out if there is a walking group in your area. If you are part of a group that invites experts to speak, “listen attentively to the guest speakers, and ask questions,” says Armstrong. “We encourage our participants to talk about the topic of the day and to share information as they walk.”

2. Make a commitment

“To realize all the benefits of walking, it’s important to walk regularly,” says Armstrong. “If your walking group disbands or your program finishes, let walking remain an everyday part of your life.”

Did You Know?

As you progress with your walking, you may want to challenge yourself to walk further, faster, or both. The best approach is to gradually increase your walking level over several weeks. Read more from Advanced Aerobic Plan now.

Do you have a story about the difference physical activity has made for you and your health? Please let us know at dialogue@diabetes.ca.

Contact your local CDA office to find out whether there is a walking group in your area.




Can weight loss & healthy living reverse type 2 diabetes?

Can weight loss & healthy living reverse type 2 diabetes?
News

By Elizabeth McCammon

Reaching a healthy body weight is very important in controlling type 2 diabetes, but could losing weight actually reverse the disease? 

Recently, a team of U.K. scientists at Newcastle University followed 30 people with type 2 diabetes who ate a very low-calorie diet (just 600 to 700 calories per day). As the participants lost weight, they experienced a return to normal insulin production. In other words, their diabetes was reversed.

Participants who lost some weight but remained overweight or obese also reversed their type 2 diabetes. The researchers think this is because these participants had lost enough weight to decrease the amount of fat in their pancreas. Too much fat in the pancreas limits insulin production. How much fat is too much? That will be different for each person, say the researchers.

This study published in Diabetes Care gives hope to people who have lived with type 2 diabetes for a long time, as it shows that they can see real benefits if they commit to taking an active role in improving their health.

Our expert opinion: “Although lifestyle changes can improve blood sugar control, I think saying ‘reversal of diabetes’ could be misleading. Weight loss might delay the onset of diabetes or offer short-term prevention for some, but we still can’t be certain it prevents or reverses diabetes forever,” says Kathryn Arcudi, dietitian and certified diabetes educator at Montreal West Island Integrated University Health and Social Services Center, and Lakeshore General Hospital Diabetes Clinic in Montreal. “The bottom line is that all people with diabetes who are overweight can benefit from weight-loss strategies to help improve their body’s ability to use insulin.”




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