Diabetes Open Hours: Nutrition & Diabetes

0:00 [Music] welcome everyone my name is Anne besner 0:06 I work with the people affected by diabetes knowledge and connection team at diabetes Canada and I will be your 0:12 moderator for today's webinar I'd like to begin by acknowledging that I'm joining today's event from Ottawa 0:19 which is the traditional unseated territory of the Algonquin anishinaabeg people 0:25 as a health focused organization diabetes Canada recognizes that there is systemic racism within and throughout 0:32 our institutions and that we have the responsibility and power to create culturally safe and 0:37 appropriate environments of care from wherever you are tuning in I invite 0:43 you to take a moment to reflect on the land on which we live recognize the harms and mistakes of the 0:48 past and consider how we can all contribute in a meaningful way to reconciliation and collaboration 0:57 we are here to kick off a new live webinar series at diabetes Canada called diabetes open hours thank you so much 1:04 for being part of this event diabetes open hours is all about you the 1:09 person who is affected by diabetes if you have been diagnosed or are caring for someone with diabetes you're not 1:16 alone millions of Canadians are living this reality but diabetes is complex and different 1:23 people experience it differently whether diabetes is new to you or you've been living with it for a long time 1:29 you've inevitably got questions questions about risk factors complications management options 1:36 questions like why me diabetes open hours is a live virtual 1:42 agenda free hour that allows participants to interact with a feature guest in a community of individuals with 1:48 lived and professional diabetes experience this is your time to ask Customs tell 1:54 your story and share with others in a safe non-judgmental space diabetes open hours will take place 2:01 toward the end of the month every second month each one will have a different guest that will be welcoming and a different 2:08 broad theme diabetes open hours is being recorded and will be archived on the diabetes 2:13 Canada website as well as on our YouTube channel for on-demand viewing 2:19 today's theme is nutrition and we are so pleased to have with us Jenna Walsh registered dietitian and certified 2:26 diabetes educator Jenna Walsh completed her degree in human nutrition at the University of 2:32 Guelph followed by a dietetic internship through the Ottawa Hospital she has been working as a clinical 2:39 dietitian in Renfrew County since 2010 dividing her time between long-term care 2:45 inpatient and outpatient support Private Practice as well as Community nutrition 2:50 which includes developing and coordinating an initiative called kids in the kitchen and more recently a 2:56 virtual Eating Disorders Support Program she added certified diabetes educator to 3:02 her resume in 2017 and continues to support those living with diabetes in 3:07 her community by normalizing food and movement as part of their diabetes management 3:13 she loves spending time outdoors with her spouse and three daughters and in the kitchen whipping up new recipes 3:19 welcome Jenna thank you so much for being here thank you so much Anne I'm very much 3:25 looking forward to chatting with everyone today so thank you okay here's how things are going to go 3:31 over the next hour participants who are joining us for today's event can use the chat feature 3:38 to submit their diabetes related questions to Jenna we know that nutrition is a really interesting 3:43 subject it's a huge topic and one that can be a source of confusion for many because it's very Dynamic and evolving 3:51 sometimes it's hard to separate nutrition fact from fiction and challenging to identify reliable sources 3:56 of info about nutrition but not to worry Jenna is here to help us Wade through it all 4:02 as a certified diabetes educator she has a wealth of knowledge when it comes to All Things diabetes and as a registered 4:09 dietitian of course her area specialty is nutrition so we're in really good hands today with Jenna 4:15 using that chart feature please starting now and throughout the next hour type in your diabetes nutrition questions for 4:22 Jenna so you can simply click on the chat icon that's near the bottom of your screen to open the chat 4:29 you can post your question by typing it into the text box with the recipient being everyone and that way everybody 4:35 will be able to see your question we also encourage people to share their diabetes stories in the chat 4:42 we welcome supportive positive comments and emojis from the audience so feel free to be actively part of the 4:48 conversation through the chat as a moderator I'll relay the questions comments and stories to the group and 4:55 we'll do our best to get through as many as we can in the time that we have together a few quick ground rules regarding the 5:02 chat we just ask that any comments or reactions that you share be affirming 5:07 and positive and that you use this time and the chat feature as an opportunity to further 5:13 your learning engagement and curiosity and support the same for others 5:19 following this webinar we'll be sending out an evaluation to hear what you thought about open hours and how we can 5:24 better tailor it to suit your needs so with all of that Jenna are you ready 5:30 to begin good to go great let's get started 5:37 so while we are waiting for some questions to come in maybe we can just start by sort of setting the stage 5:43 Jenna can you talk to us really briefly about what the connection is between nutrition and diabetes and what rules 5:49 does healthy eating play in diabetes management um so I think I would start I mean I I 5:57 think I'm a little bit biased in terms of the the role I I feel that nutrition 6:02 plays um at the same time I really try to approach diabetes management with with 6:08 patients and clients as part of management um we all come from very different uh 6:15 socioeconomic backgrounds we all grew up with a different relationship with food some of our parents may have loved being 6:22 in the kitchen they may have included Us in the kitchen other people may have grown up not having a clue how to cook 6:28 we all have different food budgets um cultural preferences and so 6:33 nutrition is a very um individualized part of management 6:39 I think it needs to be and it should be but it can absolutely make a drastic 6:46 role and in impact on our diabetes management so even into the guidelines we see at least a one to two percent A1C 6:53 reduction potential with with nutrition I would say absolutely I've seen much higher than that with patients depending 6:59 where A1C is starting and what level of change they end up making so nutrition is a pretty big one 7:05 absolutely yeah that's very true Jenna 7:11 um now we have people joining us who are impacted by diabetes in lots of different ways 7:17 um may have nearly been diagnosed or have been living with diabetes for quite some time 7:23 um maybe we can just kind of go back to basics um and this is useful for for anybody 7:29 um who's living with diabetes can you take a second to just talk to us a little bit about carbohydrates so 7:36 um what are carbohydrates and uh what impact do they have generally on blood 7:41 sugar yeah absolutely and and I'm glad you bring that up because more often than not when I'm speaking to people I'd say 7:49 at least half will pause me and say you know what which foods are carbohydrates um so there's a few different categories 7:56 that we start to talk about when we talk about carbohydrates but essentially it's think of them as a like a chain I like 8:02 people to think of food kind of like Lego blocks that make sense for people and then once we eat carbohydrates they 8:08 essentially are broken down to simple sugars in our in our body so even if something is sugar-free they can still 8:14 have carbohydrates meaning they will still impact your blood sugar once we ingest them so the big one that most 8:20 people know about are starch-based foods so any grain based um think your wheat your oats your 8:27 barley um all of those grains are carbohydrates 8:32 and any of the foods that they end up making we also then have our starchy veggies that's where potatoes fall into 8:37 as well and then our fruit they all naturally that's where we get their delicious sweetness from is from sugars 8:45 right it's natural and dairy as well so oftentimes people forget that Dairy 8:51 especially milk has lactose and lactose is simply a sugar or a carbohydrate so I 8:58 like people to think not so much as like does it have sugar but thinking in terms of carbohydrates and that makes label 9:04 reading a lot easier as well now with respect to diabetes though in blood sugar management just because 9:10 carbohydrates affect our blood sugar it doesn't mean we can't eat them 9:16 the most important piece I ask people to pay attention to is how much can each 9:22 person's own body handle or tolerate at a meal or an eating period and blood 9:28 sugar stay within target range so that's again where our nutrition becomes very individualized because a 9:35 what carbohydrates do you like eating right which one still give you enjoyment 9:40 with your meals and allow you to continue to eat that way how much of it do you need to feel satisfied from that 9:46 meal and then on top of that you know does it keep your blood sugars within a within a safe range 9:54 that's really helpful Jenna just a reminder to everybody that if you have questions please go to that chat feature 10:01 and put them right in we're happy to answer any questions you have related to diabetes nutrition 10:06 if you're more comfortable coming off mute you can certainly pose your question as well out loud 10:13 um I see here from a comment in the chat that Kathy is having a bit of difficulty understanding with with an echo so we'll 10:20 work on that Kathy apologies for that um but you can come off mute anybody if 10:26 you'd like to ask a question or feel free to put that in the chat and while we're waiting for some more of those questions to come in Jenna 10:33 um wondering if you could talk a little bit more about um some some different foods and their effects on blood sugar so what about 10:40 vegetables you mentioned that potatoes are a starchy vegetable but what about other veggies what what impact do those 10:45 have on um blood sugar yeah um so we we try to divide Foods up into 10:53 sort of those starchy and then non-starchy right so non-starchy typically being 10:58 um things like your dark leafy greens things like zucchini and cucumbers and celery whereas some other ones where 11:06 that might have more sugar in them may have a bigger impact unless people are on multiple daily 11:13 injections of insulin I try not to get them too focused on the exact number of carbohydrates in 11:20 Foods versus focusing on eating more vegetables in general checking blood 11:26 sugars two hours after and just seeing how that meal has affected them because the one really neat thing that 11:33 some Studies have shown us is within each person right so the individual 11:39 person not larger populations we will see repetitive similar responses to food 11:45 so one person might say their blood sugars go through the roof after having you know some bran flakes and a banana 11:53 and it might be you know whatever maybe they've had 45 grams worth of carbohydrates at that meal the person 11:58 next to them might not it might be pretty modest we can expect for that person where that blood sugar has spiked 12:04 with that specific food we can expect that to repeat so it's it's simple 12:09 enough simple it's still a lot of tedious work and learning but we can start to learn our own patterns and 12:15 which foods our body does well with versus what foods our body struggles a little bit more with and so absolutely 12:23 some of those squashes the sweet potatoes potatoes the ones that really when we think about it have a little bit 12:28 more of that sweeter taste tend to have more complex carbohydrates and and some sugars in them and they may 12:36 they may affect your blood sugars more there's a more complex part to that in terms of what we know to be the glycemic 12:43 index in terms of how much a particular food will spike a blood sugar so that part's important as well 12:51 all really important points and and we can see some questions now coming in through the chat which is terrific keep 12:57 those coming everybody um so Kathy asked a really excellent question here 13:02 um thanks Kathy how do carbs impact type 1 diabetes versus type 2 diabetes versus 13:09 pre-diabetes so maybe you can kind of unpack that a little bit for us great question 13:16 um so I want you to think about type 1 diabetes uh so let's back up a little bit with diabetes when we eat those 13:22 carbohydrates our body breaks them down into those very simple carbohydrates and then asks 13:28 the pancreas for insulin so the pancreas is that organ that we have and in those 13:33 beta cells that we have in the pancreas it secretes insulin insulin is just a hormone its job is to hook onto that 13:39 Sugar bring it to our muscle and brain cells and convince them to open up and 13:45 let that sugar in now sometimes with diabetes the insulin comes takes it cells don't 13:52 open up that's foreign resistance with other people we may it may be more 13:57 genetic in terms of type 1 diabetes sometimes it's a viral infection or something that damages those beta cells 14:04 and they no longer are making insulin people with type 1 diabetes are not 14:10 making any insulin okay so we pay a little bit more attention to you know specifically how 14:18 many grams of carbohydrates we're getting in a meal because we have to then give ourselves the exact amount of 14:25 insulin to keep blood sugars in range with type 2 diabetes we have a little 14:30 bit more flexibility sometimes because we still have some insulin being made so the body is still taking care of some of 14:36 that naturally right so we we have a little bit of wiggle room to say it also depends too if we're on any 14:45 other medications so with type 2 diabetes we would also potentially be on some oral medications or pills that 14:52 address different parts of blood sugar management so they may work at the cell level to reduce that insulin resistance 15:00 we talked about convince those cells to open up and let the sugar in some medications work at the liver so while 15:06 we're not eating the liver also slowly release the sugar back into our bloodstream so that the levels are 15:12 consistent some medications work at the kidneys so the kidneys also filter out sugar 15:19 um and and also keeps them in our blood so some medications try to convince the kidneys to pee more sugar out so those 15:26 carbohydrates are important in all three stages so pre-diabetes type 2 and type 1 15:32 were a little bit more specific with the amounts 15:38 uh with type 1 because we're giving insulin for every gram of carbohydrate 15:43 essentially type 2 if we're on insulin so sometimes we're still in insulin we are again 15:49 being a little bit more specific we're paying attention to you know if I have 45 grams of carbohydrates how much extra 15:57 insulin do I need right so we're still paying attention we may not be as specific with those 16:03 starchy versus non-starchy veggies because you start to learn yourself how your body does 16:08 with pre-diabetes think of pre-diabetes kind of as that yellow warning flag that 16:13 things are starting to go awry we need to be more specific and more pay a 16:19 little bit more attention to how our body's doing with meals now guidelines still don't really 16:25 suggest that we have to be testing our blood sugars in the pre-diabetes stage I am a very vocal advocate for testing our 16:33 blood sugars at this stage because of what we just talked about you can eat 16:38 your normal meals and check your blood sugars two hours after to see how your body is coping with what you're eating 16:46 um and I find even with people if we can get a you know continuous or floss glucose monitor on in the pre-diabetes 16:53 stage for that two weeks we see such better outcomes because they 16:58 can make small tweaks without being overly restrictive and they can maintain those changes for 17:05 a long time and so little things Kathy like for 17:10 example I often hear people when they're diagnosed with pre-diabetes being terrified if things even like carrots 17:15 where as I would rather you eat carrots because they're nutritious and they're so valuable with lots of nutrition and 17:22 let's just check and see how your body does and what are you eating with the carrots in terms of protein and other 17:29 nutrients to see how that impacts it I hope that answered your question 17:37 that's a really good point Jenna um certainly when we're eating we're not just consuming carbohydrates right so 17:45 what else would make up our plate in terms of foods or nutrients and what 17:50 kind of an impact would those things have on blood sugar and then how can we kind of incorporate 17:57 all things to eat in a in a really well balanced way would you say 18:02 yeah um I mean ideally we I try to focus um more on a plate method right where 18:09 we're really trying to get Back to Basics around eating enough food first I 18:15 I really don't find that anyone does well when we try to impose restriction and taking things away as opposed to 18:23 First focusing on you know are you eating enough vegetables at every meal because they're high in fiber and 18:28 they're typically low on carbohydrates are you eating enough protein a to maintain muscle mass 18:34 um fantastic in terms of Just Energy and also satiety keeping us full longer and 18:39 then those carbohydrates which also give us all the you know vitamins and minerals and fiber having all of those 18:44 together again if I go back to that Lego analogy for people it's like having a really intricate Lego block that your 18:51 body has to work really hard to pull all of those pieces apart it takes longer for the body to access those 18:57 carbohydrates and so we don't see this massive Spike of blood sugars but you know hopefully more Rolling Hills 19:04 and so for a lot of patients where we start is okay what are you currently doing when are you eating what are you 19:11 eating how much are you eating and is there room to add so far you know typically having say you 19:18 know toast and jam and a coffee for breakfast great but we're just having carbohydrates and 19:24 carbohydrates can we add some veggies can we add some protein it might be adding some peanut butter and um sliced tomatoes on the side or 19:31 something right a veggie omelet and one piece of toast try a whole bunch of different varieties a to see how their 19:38 individual body tolerates I think that's really helpful 19:44 um we've got another question coming in here from Jennifer uh Jennifer works at diabetes Canada and has lived with type 19:51 1 diabetes for a long time and also happens to be a dietitian so I'm very knowledgeable when it comes to food and 19:57 nutrition but she says in spite of all of this eating out for her can be an ongoing challenge so what's your advice on 20:04 eating out for people who are living with diabetes um perhaps for for people with type 1 but also for people with type 2. 20:12 um and how how would you go about sort of estimating um carb amounts of things like sauces 20:17 which which may be a little bit trickier to figure out um and then working to kind of maintain 20:22 those blood sugar targets yeah absolutely and I mean um eating out in in general is can be a 20:30 challenge um for anyone living with diabetes in terms of knowing how much and also how it then 20:37 impacts their blood sugars right so uh especially for type 1 whether they're MDI or whether they're pumping there's a 20:43 few things I'm a big fan of first of all is be part of a group so any sort of 20:50 diabetes online support groups Facebook has a ton of them but there's more outside of Facebook I really truly find 20:56 that people living the experience have more inside scoop and knowledge of the 21:02 best places to eat where they're serving consistent amounts right so most of the 21:09 food chains that that we frequent have their nutrition information available 21:14 but the sauces and all the little pieces really come down to are they following the amounts that that standard recipe 21:20 suggests that they're putting on when it comes to sauces right versus are they just doing a big old squirt 21:26 um easy enough we can ask for those things on the side that's always the safest 21:31 it's sometimes annoying for sure but safest in terms of if we're if we're dosing specific amounts or bolusing 21:39 the second piece too is what you may do especially if you're eating out often is 21:45 you may have some of your own staple foods for a meal and just be getting a portion that's takeout so I've had some 21:52 patients have success with that especially if they're on the road a lot say you're a busy um you know parent with sports and 21:59 you're on the road a lot or um with work if you're traveling with work having some of those Staples where 22:04 you're boosting fiber you're boosting protein um that can be easy as well to know the 22:10 specific amounts that you're getting or vice versa you're bringing your carbohydrate amounts and what you're 22:15 ordering might be like you know a salad with chicken to get extra 22:22 it's a super question from Jennifer thanks so much and just as a reminder to everybody keep 22:28 those questions coming recall that open hours is all about you so ask anything that's on your mind about diabetes and 22:35 nutrition feel free to use the chat feature or you can come off mute and ask your question in person 22:42 uh Jenna we've heard a lot about low carb diets so maybe we could talk a 22:48 little bit about about that um what is your perspective on low carb 22:53 diets um are they a fud are they helpful for people with diabetes 22:58 um give us the lowdown yes so this is still a really big topic 23:06 and still a very controversial one and controversial even I find in in terms of my own head 23:12 um because it's only effective if it's effective 23:18 and realistic for the patient long term and so when we look at eating patterns 23:24 for people whether it's ketogenic meaning less than five percent of the diet is carbohydrates versus low carb 23:30 which is typically under 20 percent of total calories coming from carbohydrates 23:35 um it's effective we can eat well nutritionally balanced if it fits their 23:41 budget they enjoy the foods they're eating they're eating enough nutrition and they're still managing their 23:46 diabetes Well right so we can still be eating that 20 percent have very low carb very low carb 23:52 and a higher carb meal without any medications and blood sugar still you know increase after that one meal so 23:59 there's still some education there's still some learning there's still self-monitoring of blood glucose even in 24:05 those contexts um is it necessary I would say no 24:11 we can still manage our diabetes very well with a you know standard Mediterranean style of eating or a more 24:18 flexible carbohydrates which I find for most people again I 24:24 work a lot with eating disorders so I'm very sensitive to restriction and what 24:29 long-term impacts that can have um if we can make sure that carbohydrates don't feel like a bad food 24:35 for patients I'm all for that so yes it can be 24:40 effective for patients if they're interested in addressing or trying a lower 24:46 carbohydrate diet I definitely suggest that they chat with an RD or with someone who has experience just to make 24:52 sure they're getting enough food they're never feeling restricted and they're still managing well 24:58 in your experience what are some of the risks of somebody following a low carbohydrate diet particularly if if 25:04 somebody maybe isn't um doing it alongside a registered dietitian or or hasn't 25:10 um consulted with a healthcare provider about that so if someone's living with diabetes are are their risks 25:22 yeah um absolutely um I think I think the biggest thing 25:27 that we really want to look at right is um the reason that they're choosing 25:32 right so it might naturally already be the way that they prefer to eat one of 25:38 the key things that we really want to look at is you know what medications are they on some of them are not safe to 25:45 continue taking and so we really want to look at you know where is insulin at and the sglt2s some of the sulfonurias 25:53 certain medications we really should look at stopping so that's one thing 25:58 that we definitely want to start with if there's any history of Eating Disorders or disordered eating 26:04 that big red flag for me and it's something I I really dig deeply in with with people 26:12 um risk factors too is really a cost right if they have a fairly low uh budget for 26:20 food High veggies and high protein is really expensive 26:25 so my my concern is actually more in terms of how are they managing to eat 26:30 enough nutrition following a low carb diet uh that's a 26:35 that's a big one that I think is overlooked way too often um I mean outside of that those are the 26:42 biggest factors so the medications you know the disordered eating and then is it reasonable for that for that 26:48 patient it's helpful to think about the benefits and the risks and making decisions about 26:55 eating patterns um so and speaking of eating patterns you mentioned the Mediterranean diet 27:02 so just wondering if you can describe what that eating pattern is like for people who aren't familiar with the 27:08 Mediterranean diet yeah so I think it's great to think of it more as a as a lifestyle that's 27:14 really the way that we know there's more benefit we're we're focusing on lots of plant Foods 27:21 um lots of plant-based fats and proteins nuts and seeds you know olive oils avocados 27:27 um less red meat so it's not gone but it's definitely less frequent like a few 27:33 times a month as opposed to a few times a week more fatty fish like trout and and tuna sardines 27:39 Etc um the lifestyle Factor too comes in in terms of focusing on taking time to eat 27:47 right we're not scarfing food down in five minutes and going on a better day is making time to 27:54 cook trying to cook more meals at home trying to sit socially together to eat 27:59 we actually see much better outcomes and much more satisfaction from food when 28:04 we're able to do that digestively too we tend to actually have better Digestive Health when we actually 28:10 sit you know kind of that 30 45 minutes that we would all ideally have for three meals a day 28:16 is important as well so it's not so much a diet in today's sense of the word but a way of eating 28:25 now you mentioned with the Mediterranean way of eating that that it heavily features vegetables 28:32 um I think uh one thing that a lot of people are wondering about uh when they're diagnosed with diabetes or 28:38 they've been living with it for a while is is there any benefit to adopting a vegetarian diet so cutting out animal 28:45 products all together and and you know whether it's a vegetarian diet or a vegan diet or any sort of variation can 28:52 you talk to us a little bit about that is it necessary to be vegetarian when you have diabetes 28:57 yeah so definitely not necessary um the interesting thing with the evidence that we have with uh vegetarian 29:03 Lifestyles is that we also see a fairly significant reduction in heart disease for those who do follow more of a 29:10 plant-based diet so less elevated cholesterol less elevated blood pressure 29:15 which we know risk factors for both right when we have diabetes and heart disease is is high so we see 29:22 improvements there um we also because I I got a lot of questions when people are asking to eat 29:28 more plant-based and we're encouraging them to eat more pulses which is you know they're high fiber 29:35 um beans and legumes and higher in carbohydrates and there's that moment of 29:40 confusion of what I thought I had to watch my carbohydrates we don't see as much of an impact with a 29:46 lot of those pulses when they're Incorporated with other plant proteins as well in high fiber grains because 29:52 there is more protein in fiber so we see some benefits there as well 29:57 from a higher intake of fiber when we're following more plant-based proteins 30:02 because things like um you know almonds and walnuts and black beans and lentils they do they 30:09 have protein but they also have a ton of fiber that helps to reduce cholesterol and 30:15 also Keeps Us full longer and is lower on that glycemic index we talked about 30:21 so we definitely see good at in outcomes sorry with respect to diabetes 30:26 I would argue it's potentially cheaper meat is still through the roof right now since covid so budget wise we can really 30:33 stretch that dollar with more plant-based I find for people it's more of a lifestyle switch we're very much 30:39 still a meat potatoes veggie way of eating and so it can be more of a switch that way 30:45 I find that's helpful for people to pick say one meal a day to start in terms of 30:52 trying to transition to more plant proteins so they may have a salad or a soup and 30:57 instead of putting meat on it putting again even canned black beans or canned lentils in that pot of soup or you know 31:04 a quarter of a cup even to start on their salad or if they're having a wrap you know mashing some chickpeas and and 31:11 using that as the protein instead of leftover chicken or ham or something along those lines necessary no but 31:18 there's definitely benefits that's great I was actually going to ask you if you could provide some 31:24 suggestions for how people can incorporate more plant-based proteins in their diet so 31:29 um good to get those ideas for people who maybe are not accustomed to eating a lot of plant-based proteins but want to 31:35 want to start um so we're about halfway through open hours now everybody the time is just 31:42 flying by thanks again so much for joining us uh we're here with Jenna Walsh registered dietitian and certified 31:48 diabetes educator she's here to answer all of your nutrition related questions so use that chat feature to ask anything 31:56 about diabetes and nutrition you can certainly also share your story about how you're affected by diabetes talk a 32:03 little bit about how diabetes is impacting your life um and and we'll just keep going 32:09 um Jenna you were talking before a little bit about um 32:15 different types of carbohydrates and wondered if you could just provide a little information about simple versus 32:22 complex carbs so people may have heard those terms before and there may be a little bit of confusion about what those 32:27 are so tell us about simple and complex cards 32:33 yeah so think of your simple carbohydrates basically as your sugars 32:38 there are one unit doesn't take your body much ever to break down it's going to be things like 32:44 your honey your maple syrup um you know juice really is is 32:49 everything's been broken down and removed as well they're they're very easy for the body to use right away now 32:56 most people when I say that say okay so they're about they're not bad but if we're having them 33:01 we want to have them with again going back to that protein and the fiber to help again reduce that Spike where 33:08 they're beneficial is when people are having a low so when blood sugars fall under that 33:14 four or three point eight we actually want to be reaching for those simple sugars 33:19 tablespoon of honey you know a half a cup of juice a half a cup of regular pop because that's what's actually going to 33:26 take little time for your body to bring those sugars back up to a safe level now on the flip side of that your complex 33:32 carbohydrates I want you to think of a whole bunch of sugars tied together like a chain 33:39 um they're complex they've got some hydrogen and oxygen as well and you know potentially different fiber molecules 33:45 some protein all of those good things again that really complex Lego block right 33:51 takes more effort for the body to break it down uh and to absorb it into the 33:56 bloodstream so from a meal in day to day into we want 34:02 to focus on more complex carbohydrate and yeah try to build most of our meals around 34:09 those on the flip side of that if we're having a low these are not the ones we want to 34:14 grab we don't want um you know a half a cup of lentils with whatever mixed in 34:20 veggies mixed in it's going to take too long for the body to bring those sugars up so complex exactly as they sound they're 34:27 complicated for the body to break down simple super easy very quick for the blood sugar to spike 34:36 okay that makes sense um now related to that concept and also something you mentioned before I'm just 34:43 wondering if you can expand a little bit on this whole concept of carb Counting what is it 34:49 who needs to do it how do you do it why is it important yeah 34:55 I um with type 2 diabetes I I avoid getting too in depth with carb counting 35:03 because I try not to have food become numbers for people with insulin use we do get into carb 35:11 counting not necessarily right away we start with kind of that plate method again but we're very much looking at a food 35:18 label or measuring food we have different lists for foods that let us know how many grams of carbohydrate per 35:26 weight of food so then we would be essentially weighing that food using that calculation to 35:32 figure out in what we're about to eat how many grams of carbohydrates 35:38 that with insulin we figure out a ratio of how many units of insulin we need at 35:44 a meal per grams of carbohydrate so that's pretty complex and detailed 35:51 for for today there may be some people out there any of our type ones especially or any of our type twos on 35:57 MDI who maybe have already you know been dabbling in that or experts in it that 36:03 is the simplest way to look at it if we are for example looking at a food product 36:09 and it says you know there's 48 grams of carbohydrates we also use an exchange 36:15 system to simplify that where roughly 15 grams of carbohydrate would be one 36:21 carbohydrate so for example we have some great resources that sort of already list the 36:27 carbohydrates in foods and what portion would equal one and the simplest way is 36:33 typically one piece of bread one cup of milk and one medium sized fruit are all roughly equal to 15 grams or one serving 36:41 so there's a difference depending where a patient is at with their their diabetes or what type and what 36:48 medications or insulins they're using that determines whether we get into that in depth 36:54 discussion around carbohydrates because it it even goes beyond that rate it also depends on the amount of fiber subtract 37:00 fiber from the total carbohydrate um the complexity of that meal again we 37:05 talked about you know how much protein is in there and fat so 37:12 but you can see why nutrition is such an interesting topic to people because it's it's complex and 37:20 um one question kind of leads into the next um so so happy to have you here to help 37:26 us um figure this all out um let's talk about carbs a little longer 37:33 and then maybe we'll shift away and again just encouraging people to bring up anything that they're wondering about 37:38 related to diabetes nutrition in the chat or you can come off mute to ask your question to Jenna 37:44 we welcome story sharing as well and reactions in the in the chat feature 37:51 um you mentioned uh recently um in one of your responses the glycemic 37:57 index um so walk us through that for people who don't know what the glycemic index 38:03 is tell us about how you use it and kind of what it's all 38:09 about yeah so um the easiest way to do it is there's 38:15 been different studies and evaluations on different foods on how quickly they 38:20 raise our blood sugar so from there then um 38:26 Foods were categorized using basically a light system so like green yellow red 38:32 into being low glycemic index meaning they had minimal impact or less impact 38:37 things like you know really um higher fiber higher protein really is 38:43 the easiest way to simplify it greens and cereals versus as they get more into 38:49 the red they're typically more refined with less protein and fiber right so 38:54 like really dense 12 grain bread being low versus like a low fiber low protein 39:02 white bread now since then though I mean if you look in 39:07 the bread aisle right there's 200 varieties of bread we also now have white bread that has added fiber and 39:12 protein and so it's different so we can't just simplify it that way um but we use it as a really good 39:17 starting point in education piece for patients um I don't know if I can share my screen 39:22 in but I did have it open in case anybody asked me amazing thank you you shared it perfect 39:29 I I figured that would come up it comes up a lot so it is one of those things I always say to people you know what use 39:35 it as a guide as a starting point and then little things right like I I brought up before 39:40 in terms of bananas for some people because that's a big one but even something like barley is low on 39:46 the glycemic index for some people they might have barley and it might still impact their blood 39:52 sugars fairly significantly we can also take a high glycemic index food 40:00 like instant white rice and add protein 40:06 canned tuna chicken lentils and veggies Frozen fresh canned 40:13 whatever you know fits your budget or makes you happy and make that high glycemic index 40:19 food a low glycemic index meal so again I never like people to feel stuck 40:27 with Foods or deterred based on their budget or their ability to cook certain foods we 40:34 can still eat really well on any of those budgets and also with any of the foods that we're used to 40:39 eating so again use it as a guide but keep in mind when we talk glycemic index and blood sugar spiking 40:47 we still have that ability to to reduce the glycemic load of a meal by adding protein and fiber and fat 40:56 I see a question in the chat here from Maria thanks Maria um so Maria is wondering about 41:01 incorporating glycemic variability into patient education and Maria's wondering 41:07 how you personally use this concept in your practice it's a it's a super 41:13 question Maria thank you yeah absolutely and um I think for some people so I think what 41:20 you're meaning is you know some people will stay fairly low carbohydrate and then you know occasionally have higher 41:26 carbohydrate meals um and or choosing right from some of those lower glycemic index foods and and 41:32 higher and trying to pair them and so both are always fine 41:38 right like having variety and variability in Foods is normal it's 41:43 natural that's an intuitive way of eating for a lot of people the most 41:48 important piece I always say or encourage people is just check your blood sugars 41:54 right so if most of the time you're eating fairly low glycemic index or low carbohydrate or whatever and blood 42:01 sugars are typically within Target and you do have something that's higher glycemic index or you do go out for 42:07 higher carbohydrate meal or you have one at home it's fine just check and see where your blood 42:13 sugars are at later because if we stay suddenly out of nowhere have um you know a lasagna or a spaghetti or 42:19 pizza and that's all we eat we have some room that even if blood sugars are high later again we can reduce that glycemic 42:26 load by adding some veggies with the next time around having more protein 42:31 right so maybe having less pasta have more sauce have a salad on the side so you can always have that variability 42:38 and that variety we always encourage that I'm hoping most people who are doing education are encouraging that as 42:45 well because it's not realistic for us to assume living with diabetes these are 42:50 the only Foods we're allowed to eat for the rest of our our time here we need to have variety 42:58 yeah that's that's a really terrific question from Maria um and just want to direct everybody's 43:04 attention to the chat where I put in the link to diabetes Canada's resource about the glycemic index food guide so 43:11 you can access that it's a PDF on the diabetes Canada website 43:17 um so wondering a little bit about sweeteners Jenna if you can talk to us a 43:22 bit about sugars and sweeteners so artificial sweeteners and then sort of natural sources of sugar 43:29 um and and starting with the whole idea of like are all sugar is created equal so brown sugar white sugar honey 43:37 molasses maple syrup are those all the same or are some better than others hmm 43:46 yeah it's such a big topic um sugar is sugar so when we're talking in a diabetes World 43:53 um all of the the sugars right whether it's agave syrup which again is like 43:58 this trendy sugar um lactose honey glucose all of it maple 44:05 syrup molasses it's all gonna give us you know those four grams of carbohydrates 44:11 um so in a diabetes world they're all the same some people will argue you know natural maple syrup has more 44:17 micronutrients the amount of sugar that we would have to eat to get any valuable 44:23 nutrition from them blood sugars would be through the roof so it's not a source of micronutrients 44:29 when we when we look at it and so the biggest thing is always if you're having sugar 44:35 or maple syrup or honey eat the one that you enjoy that's the most important piece when we 44:41 start to get into sweeteners right so everyone also has their own personal belief in view on sweeteners 44:48 that they're either okay or they're not good for us 44:54 from an Evidence point of view which is where we practice from is we look at you know what is the the 45:01 safety level that's been tested it doesn't necessarily mean Beyond there it's not safe it means that's the level 45:07 at which they've tested and there's been no adverse effects right so with each 45:13 sweetener that's out there um so there's sugar alcohols for example sugar alcohols are also naturally found 45:21 in in foods right so like sorbitol Mannitol all of these are are natural 45:27 sugars and same with Xylitol in Foods um there's no issue with them they they 45:34 don't boost our blood sugar like regular sugar does 45:39 the difference being with sugar alcohols is if you're having too much typically Beyond 10 grams a day you might have 45:45 digestive side effects because they pull fluid into the gut okay so any of those ones typically that end in ol 45:51 are those sugar alcohols outside of that there's there's a bunch 45:57 of of sugar-free substitutes available out there the one I typically like to 46:02 highlight to people where they potentially could be eating beyond that suggested safe limit is the cyclamate 46:09 which is like the sugar twin or the Sweet and Low the ADI which is that acceptable daily amount is really around 46:17 um just under that 600 milligrams and one of those pockets would be close to 270 milligrams so for people if they're 46:23 constantly eating Sweet and Low um that's the only one that you know to kind of just be cautious with outside of 46:30 that things like sucralose which is you know your Splenda again great you'd have to eat a lot of Splenda I think it's 46:37 close to two cups in a day to even come close to that um ADI uh Stevia again same thing you 46:45 can buy the actual Stevia plants and plant them if you really like it um 46:50 the levels are there it would take a lot for people to get close to that ADI and 46:55 again that tested level doesn't necessarily mean there's adverse effects Beyond it 47:01 um it's just more that that's the level they've been tested at again the bigger thing to look at that I 47:08 say to people you know if they're baking and all of a sudden they're feeling like okay well I'm gonna have to buy a Splenda or Stevia and start baking if 47:15 you're making cookies that have oats and flour and spending more money to add Stevia or 47:22 splenda that you don't like there's still carbohydrates in those cookies from the flower and the oats so 47:29 removing the sugar doesn't remove the carbohydrates it absolutely can decrease it but there's a balance between 47:36 the satisfaction from food and how much you need to be satisfied and enjoy versus 47:42 um just feeling restricted by a lot of Foods right so that's a balance if 47:50 you're having coffee and you're just as happy with stevia or splenda or whatever in your coffee amazing that makes a big 47:55 difference because some people will end up with a tablespoon or more um but in terms of baking and cooking again just be mindful in terms of 48:02 there's still going to be carbohydrates likely in a lot of those Foods 48:07 there's also a great resource and sorry and I can remove some of that as well yes I just popped into the chat a link 48:14 to the diabetes Canada resource on sugars and sweeteners again it's a PDF that people can access that has good 48:21 general information about sugars that affect blood glucose and 48:26 um sugars and sweeteners that don't so much so that's there for people to take a look at 48:32 um so we've got about 10 minutes left in our time here 48:38 um I can't believe how quickly this hour is going now is your chance everybody to put those questions into the chat come 48:44 off mute if you'd like to share your story or to talk to us a little bit about how diabetes impacts your life and 48:51 what you're wondering about nutrition uh maybe we can shift away a little bit 48:56 from um carbs and talk a bit about some other 49:01 things that we find in our food so alcohol and caffeine so what is the deal 49:07 with these for somebody living with diabetes do they have to avoid them are there special things that they should 49:12 know about intake of alcohol and caffeine what what do you tell people 49:18 yeah so um caffeine in general right so caffeine is 49:23 is going to constrict blood vessels and just the way that it affects the body is going to increase blood sugars and so we 49:30 know that even if it's black uh it doesn't mean don't drink it again biggest thing of awareness right if you get up in the morning and you have a 49:36 coffee and test your blood sugars two hours after and you know it's eight or ten or whatever and you haven't eaten 49:41 anything it's just be mindful that it's probably the coffee which is okay if you're you know hitting 49:48 Tim's for a triple triple there's a lot of added sugar in your coffee so I find it's not so much just 49:53 the caffeine sometimes it's what we're adding to it to be mindful that it can be impacting your blood sugar 50:00 um with alcohol the same is true in a few ways it's a bit more complex 50:05 right so alcohol in itself if we're just having liquor with no added carbohydrates is 50:12 going to divert the liver from releasing sugar while it breaks down the alcohol so we sometimes actually see blood 50:18 sugars dip a little bit now it gets a bit more complicated depending how much we have and also what 50:24 medications we're on because if we're on medications that can cause our blood sugars to go low 50:30 we run the risk of going low right I also find that if people are 50:35 having things like beer or alcohol as well like any of the coolers that do 50:41 have carbohydrates or even wine we get kind of just more erratic blood 50:46 sugars where you might see a dip but then you might see them Spike one way or the other because it also then depends 50:52 on how we're eating and behaving while we're having those drinks so 50:58 typically I mean people with pre-diabetes and type 2 if they're not on insulin it's not as much of a concern 51:05 from a safety perspective the other thing that alcohol does is it increases our triglycerides or it can which is a 51:13 blood fat which again it's just more that we kind of see that increased double risk of heart disease with diabetes 51:20 um there were just recently updated guidelines around the alcohol suggested 51:25 alcohol limits they're quite strict I don't know if people have already seen them and sort of what their thoughts on 51:31 on them are but it's really suggesting less than two drinks a week um and that's more from a heart health 51:38 perspective chronic disease perspective and and also cancer so 51:44 um you don't have to cut it out again it comes back to management right I mean if you're going to have a few 51:49 glasses of wine help them enjoy them but check your blood sugars that's all 51:55 yeah I think those those alcohol guidelines that you were talking about Jenna that were recently released are from the um Canadian Center on substance 52:03 use and addiction so people can check those out online 52:08 um and and you know good to consider the impact of both alcohol and caffeine on 52:14 blood sugars um so that people with diabetes are really aware when they're consuming 52:19 different things what effect it might have no speaking of beverages 52:25 um we know we hear from a lot of places a lot of sources that water is really important for our health 52:32 um but some people just are not crazy about water it can be maybe boring or 52:37 Bland so even though we know we should probably drink a fair bit of water in the day 52:43 um maybe we're less inclined so so what tips or tricks do you have for people to increase their intake of water 52:51 yeah uh first starting point I always suggest is whatever else you're having 52:57 at ice cubes it's an easy starting point tons and tons of ice every time you're having something else add ice 53:04 um outside of that is there's a little bit of mind over matter 53:09 too sometimes right like sometimes I find it's habit if we're always grabbing for something sweet it's because we've also trained our brain that this is what 53:16 I enjoy water tastes gross I hear sometimes because we're actually expecting the sweetness there's there's 53:23 some gradual transition that we see when people actually just actually start increasing their water so we we can 53:29 actually just start there versus also adding frozen fruit you can buy Frozen sliced 53:36 lemons and limes which are Super convenient to add into even a full jug of water and leave it in the fridge some 53:41 people really just like cold water so actually getting a really nice decanter or something that fits in your fridge 53:48 um to leave it in there so it's nice and cold the other thing that I ask is depending on your water 53:55 um you might not like the taste of it so some water is really high in iron or or 54:01 other minerals it might be worth investing in like a Culligan system right just even the ones where you can 54:07 get the filled up jugs so those are options you can also get now like the 54:12 carbonated um like the PC waters for the bubblies they're sugar-free they're really just 54:19 flavored carbonated waters um those are nice sometimes they're also a really nice alternative if you're 54:25 looking for that drink in the afternoon or in the evening there's something that's just a little bit different right 54:32 um yeah I'm a big fan of adding the frozen fruit sometimes even veggies like adding 54:37 mint and cucumber is lovely um and you can sometimes even just save 54:42 the tips of your cucumber and throw them in as in a tupperware or baggie in the freezer 54:48 and then throw them in your jug of water so that's super easy to do as well 54:55 outside of that I sometimes too if people are drinking coffee all day is even just start with before you fill up 55:01 another cup fill your mug with water and just down it 55:07 an easy way to start yeah that's a really good tips 55:12 um just on a couple minutes left here and welcoming any last questions comments stories anything in the chat or 55:20 you can come off mute to share um Jenna 55:26 um you've talked a couple times about cost and we we know right now that we're dealing with Rising food costs 55:32 um and that healthy eating can be quite expensive and sometimes people feel like 55:39 prohibitively so so what are what are some tips that you have 55:46 um really I mean for anybody but but specifically for people who are living with diabetes about 55:51 um eating well on a budget yeah um first thing and I think most people 55:56 who are on a budget know this is don't buy into the name brand um the No Name you know the the store 56:04 brand are typically as new nutritious for a fraction of the cost I'm a huge 56:11 fan of frozen veggies and fruit they're as nutritious you know they're picked up 56:17 Prime flash frozen for the most part and they last longer they're not going to spoil on us and now the lovely thing is 56:23 you know you can buy frozen spinach and frozen kale and Frozen edamame beans and you know pretty much every veggie Frozen 56:31 butternut squash all of those things that give you a ton of variety they give 56:37 you a lot of options for your meals and they're they're less expensive 56:42 I definitely don't recommend you know buying things out of season like strawberries and berries this time of 56:48 year are astronomical um there is some value sometimes also in 56:54 the points programs so different grocery stores like independent for example will do the PC 57:01 points you can surprisingly actually build up quite a bit of money to then get free groceries right so 57:09 people if you think of kind of some of those like coupon clipping behaviors if 57:14 you're mindful of what foods points are available for and you're 57:19 buying more of those things in bulk those weeks especially if they're frozen or canned items you can build up a lot 57:25 of return income for that outside of that canned and bagged beans so again 57:31 going back to the vegetarian it's like a dollar 25 to buy a bag of dried beans 57:37 um there's tons of YouTube videos on how to cook them what to add them to you can add them to anything 57:42 they're fantastic for protein and fiber balanced nutritionally right when we 57:49 really get down to it in terms of those two nutrients alone and so then adding even just 57:55 um whether it's rice or whether it's some frozen veggies and you have a nutritionally balanced meal for really 58:00 under a dollar fifty or two bucks compared to if we're trying to buy fresh veggies and meat and whatever else so it 58:07 makes a big difference that's a great practical note to leave things on 58:14 um Jenna I just want to thank you so much for being with us today on Diabetes open hours it was a pleasure and I 58:20 learned a lot from you I I hope that our our viewers did as well 58:25 um and and just as a final message to everybody we want to thank you the participants for joining us today and for being part of this very first 58:32 diabetes open hours um there will be an evaluation coming to you so please let us know what you 58:38 thought about this format and uh we are looking for ways to um to really tailor 58:43 this to suit you the the participants so please share your feedback with us to learn more and to stay up to date on 58:50 Diabetes Canada work and resources you can also visit our website diabetes.ca or check out our social 58:56 media channels we're on Facebook Twitter Instagram LinkedIn you can also call our 59:01 information team at 1 800 Banting so b-a-n-t-i-n-g or email us at info 59:08 diabetes.ca with Customs join us in April for our next diabetes open hours 59:13 and please stay tuned to our social channels and to the diabetes Canada webinar page if you Google diabetes 59:19 Canada upcoming webinars you'll find that page and there will be information there posted shortly about our next open 59:25 hours what the date will be and the topic as well as the registration information we hope you found this 59:31 webinar helpful for you and we look forward to hearing your feedback and to seeing you back again soon thanks so much 59:38 foreign [Music]