Blessed Assurance: Success Despite the Odds

by Jacquie Lewis-Kemp, Author & Health Coach for Living life with diabetes and organ transplants, rather than limiting life because of them.

Browsing Posts tagged living with diabetes

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The following study from the Thomas Jefferson University Hospital describes diabetes as “a self managed disease whereby the patient provides 95% of the daily care”. It continues that education is the prerequisite and ongoing contact (coaching) maintains compliance and saves lives as well as health care cost.

 

HealthWorks – Achieving Balance with Diabetes

A Diabetes Self-Management Education Program

of Thomas Jefferson University Hospital

 

Diabetes is a common, serious, and costly disease that affects an estimated 16million people in the United States. It impacts many aspects of the lives of diagnosed patients and their families, the health system, and society. People with diabetes are more likely than their non-diabetic peers to have heart attacks, strokes, amputations, kidney failure, and blindness. As a result, they have a more frequent and intensive visits within the health care system. A great number of hospitalizations are for acute problems such as foot ulcers, acute myocardial infarction, circulatory and nerve problems, and pneumonia.1 As evidenced by the Diabetes Control and Complications Trial (DCCT), many of these complications can be prevented with better glucose control.2

 

Because diabetes is a self-managed disease with the patient providing more than 95% of the daily care, patient education is the fundamental prerequisite for diabetes Self-management.3 Diabetes education is viewed by many as a “process” whereby a patient develops his/her knowledge base and improves his/her skills related to compliance with the recommended treatment plan. Modern diabetes self-management education programs emphasize patient empowerment rather than strict adherence to a regimen.4 HealthWorks at TJUH has been designed to support the current model of self-management education. In order to accomplish this, the program places emphasis not only on one’s knowledge and skill level, but most importantly on improving one’s self-confidence by helping them to:

 

• Identify and set realistic goals;

• Problem-solve

• Manage stress caused by living with diabetes;

• Identify and obtain social support; and

• Develop a plan for changing behavior

References

1. Patient-reported outcomes measurement to be featured in diabetes management

study. UHC Clinical Practice Alert. June 1997.

2. Implications of the Diabetes Control and Complications Trial. Diabetes Care 1998;21; Suppl.1:88-90.

3. Anderson RM, Fitzgerald JT, Oh MS. The relationship of diabetes-related attitudes

and patients’ self-reported adherence. Diabetes Educator 1993; 19: 287-292.

4. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient

empowerment. Diabetes Care 1995; 18(7): 943-949.

 

 

Read more of this article at http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1100&context=hpn

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The final leg of our 3 Legged stool of glucose control is diet. Our diet or the food we consume is the source of the glucose our bodies use to fuel our cells. Therefore the more we focus on the ultimate purpose for the food we eat, the more efficiently our bodies can use the fuel and function best.

According to the National Institutes of Health, “It [The diabetic diet] should take into account your weight, medicines, lifestyle, and other health problems you have.

Healthy diabetic eating includes

  • Limiting foods that are high in sugar

  • Eating smaller portions, spread out over the day

  • Being careful about when and how many carbohydrates you eat

  • Eating a variety of whole-grain foods, fruits and vegetables every day

  • Eating less fat

  • Limiting your use of alcohol

  • Using less salt

With these parameters, The American Diabetes Association recommends a “meal plan” which it describes as “a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. A good meal plan should fit in with your schedule and eating habits. Some meal planning tools include the plate method, carb counting, and glycemic index. The right meal plan will help you improve your blood glucose, blood pressure, and cholesterol numbers and also help keep your weight on track. Whether you need to lose weight or stay where you are, your meal plan can help”.

The Exchange Method

Medicinenet.com gives a detailed account of the food pyramid and how to incorporate each of the food groups into a daily meal plan. It also details the serving sizes in order to comply to the appropriate calorie limits prescribed by your doctor.

http://www.medicinenet.com/diabetic_diet/page4.htm#tocf

Carb Counting

TheJoslinDiabetesCentersuggests the following steps for Carbohydrate Counting.

1.     The first step in carb counting is to have a meal plan.  A meal plan is a guide that helps you figure out how much carb, protein and fat to eat at meals and snacks each day.  If you don’t have a meal plan, meet with a registered dietitian.

2.      Step two involves learning which foods contain carbohydrate. Most people know that starchy foods, such as bread, pasta and cereal contain carbs.  But other food   groups, such as fruit, milk and desserts and sweets, have carbs, too.
There are three main ways to learn about carbs in foods:

o       Ask for a food choice list from your dietitian.

o       Learn how to read the Nutrition Facts Label

o       Purchase a food counts book that provides the number of grams of carb in various foods.

3.      Measuring tools.  In order to accurately count carbs, you’ll need to be accurate with the portion sizes of foods that you eat.  Invest in a food scale to weigh foods such as fruit and bread.  Use measuring cups to measure cereal, pasta and rice, and use liquid measuring cups for carb-containing beverages such as milk, juice and energy drinks.

The Glycemic Index

Web MD defines,  “The glycemic index is a ranking that attempts to measure the influence that each particular food has on blood sugar levels. It takes into account the type of carbohydrates in a meal and its effect on blood sugar.

Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. People who eat a lot of low glycemic index foods tend to have lower total body fat levels. High glycemic index foods generally make blood sugar levels higher. People who eat a lot of high glycemic index foods often have higher levels of body fat, as measured by the body mass index (BMI).

Talk to your doctor, a registered dietitian, or a diabetes educator and ask if the glycemic index might work to help gain better control of your blood sugar levels”.

The Plating Method

Here’s a quick video from the American Diabetes Association on how the Plating Method works.

Ask your doctor to prescribe or refer you to a dietician to prescribe a meal plan or daily calorie count, and also ask which diet method is best for you.

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Stephen R. Kemp, II

Stephen Kemp, II spoke to a community group at the Farwell Middle School in Detroit about the prevalence of diabetes among African Americans.  His presentation included diabetes education as well as tips for living with diabetes.

No, Stephen is not diabetic himself, however he has lived and been around diabetes all of his life.  His mother Jacquie, a Type 1 diabetic, spent an hour every Monday and Wednesday of her pregnancy in her high risk obstetrician’s office from the time she was 11 weeks pregnant until she delivered a blood sugar normal baby at 36 weeks. She also carried her insulin and a meal to work and kept necessary diabetic supplies in the car so that she could make the treck from work to Stephen’s after school soccer, football or lacrosse. Stephen learned early how to cure an insulin reaction with orange juice.His Type II maternal grandmother picked him up from school many days when his parents were at work.  She taught him the importance of snacks–and lots of snacking they did together.  It was their relationship and his understanding of her diabetes that at the tender age of 6 made him insist that his dad not drive off when his grandmother didn’t come to the door when Stephen rang the doorbell one morning.  When she didn’t answer, he ran to the location of the secret key, opened the door and disarmed the alarm.  Stephen ran to her bedroom where he found his grandmother lying on the bedroom floor.  He yelled to his father who followed behind him, to call 9-1-1.  Paramedics were able to give her instant glucose and arouse her from a bad insulin reaction.  This heroic moment was recognized not only by family, but the American Red Cross. Stephen received an An Everyday Hero medal at an awards banquet from the American Red Cross.

Stephen’s Type II paternal grandfather now depends on him to program cell phones and pick out new cars.Stephen explained to the community group the importance of glucose control and how he watches his diabetic family members do well to manage blood sugars as well as problems they’ve run into.  His presentation also included handouts from the American Diabetes Association and  included a healthy meal that followed. The group organizer asked Stephen to ask God’s blessings upon the meal.

NOW WITH LOTS OF REASONS TO BE PROUD!

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It amazes me to listen to people argue that the Affordable Health Care act should be repealed and that they believed it was unconstitutional.  I don’t understand how people don’t get that in order to ensure life, liberty and the pursuit of happiness, in today’s terms, that means we must have affordable health care.

I get that in order to pay for a comprehensive health care plan, we (America) have got to be able to afford to do it. Again, while I get, providing for the common defense, I don’t get becoming the world’s police. Without being a member of the Congressional Budget Office, I intuitively believe that we can afford a comprehensive health plan if we back up on policing the world and better focus our efforts on domestic issues.

I think it is a good idea to make available a pool of money by requiring people to carry health insurance instead of them being treated for common or chronic illnesses in the emergency room. Insurance can then be affordable and more effective if the costs are lower because of the relative costs of doctor’s offices versus emergency rooms.  Many of the people who continue to oppose this matter, don’t have chronic illness and believe that they will end up having to pay for insurance and will never use it.  But like any insurance (homeowners, car, possibly even life), we find value in paying for “just in case”. Why wouldn’t we want to pay for “just in case there is an accident or illness”?  For those who find requiring Americans to carry health insurance an infringement on their freedom, perhaps we should go ahead, let them opt out. However make the penalty of opting out, an ability for emergency rooms and other medical professionals to “opt out” by refusing care–excuse physicians of their Hippocratic Oath, for this circumstance only.

These arguments against the Affordable Health Care Act are ones typically held by people with health insurance and who are healthy. I consider myself in that category—with health insurance and reasonably healthy. And although I am able to afford health insurance in today’s market, I wouldn’t want to deny anyone who was unable to afford health insurance as if it were a luxury and not what should be a civil right. I am keenly aware of the type of intense medical care diabetes, kidney disease, asthma and heart disease require. Trying to manage these conditions without health insurance would even shorten, if not end immediately, the life of a financially wealthy person.

So why would people oppose something that will be good for all of us, including the “least of these”?

The first answer is an easy one—selfish ignorance. Selfish: “I’ve got it and you should find a way to get it”. And ignorant because they don’t understand how they really live (as my father used to say) with one foot on the ground and the other foot firmly planted on a banana peel. It doesn’t take much for today’s insurance caps to be met and the onus for payment for medical care to be placed on the patient. A serious illness or accident could bankrupt a person.

The second answer is a sad reality responsible for more than opposition to Affordable Health Care, and that is deep seeded generational racism. Affordable Health Care is a policy created, promoted and passed by a black President of the United States along with people who recognize their own vulnerability as it relates to health care, and also care for people less fortunate than them. Even though Affordable Health Care benefits us all and there are ways to make choices so that the policy doesn’t bankrupt the country as some would suggest, they still oppose not just the idea, but the President. Rather than support the President, they would allow their young adult children looking for their first job out of college to suffer a gap in health insurance. They would rather their loved ones with chronic illness be denied health care coverage, rather than admit that what this black president has lead our country to do, protects their life and liberty.

I don’t suspect that people who question the President’s birth certificate, his policies and his patriotism would call themselves racist. They wouldn’t call themselves racist because the people they call racist were their grandparents and parents. They openly disagreed with a black person because of the color of his skin. What is happening now, I liken to Pavlov’s Dogs. The Russian psychologist, Pavlov is responsible for the study of classical conditioning whereby a conditioned stimulus would elicit an unconditioned response. Pavlov was able to evoke salivation from dogs simply by ringing a bell, after conditioning them to expect food after hearing the bell ring.

People who oppose the Affordable Health Care Act react much like the dogs. Unlike generations before them, they have been conditioned and don’t even make the connection that the reason they oppose the act is because the President is black, but instead give an unconditioned response (like the dogs) and oppose the policies because they have been conditioned that if the policy was lead by a black man, it cannot be right.

It appears that sounder minds have prevailed thus far, however I would encourage anyone who opposes affordable health care insurance for most (not even all) Americans, would search their souls and find that this argument is not “Zero Sum”. In other words, giving someone else a benefit does not take from your pot of benefits.

 

 

 

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When a child is diagnosed with diabetes, the parents’ natural response is to imagine the worse scenarios–insulin shots, limitations, and long term complications. It is ok to briefly consider those possible realities as long as you the parent and coach don’t dwell in that valley. Imagine for a minute that you are coaching a youth baseball team, and you began your season with the focus, “Well, we can possibly lose all of our games this season and be plagued with injuries, making us the worst team in the league”. It probably wouldn’t encourage the team to do their best now would it? It is the same with parenting a child with diabetes.

The Reality

Life with diabetes is complicated. And the reality is that children with Type 1 and many with Type 2 diabetes have to take insulin, whether they are Pumpers or Shooters (via insulin pump or insulin injections). They also have to monitor their blood glucose and remain in touch with changes in their body.

The Outlook

A child who believes that diabetes management is not an obstacle, but a step necessary for success will flourish. One of the most important things that my parents provided for me is a positive outlook about my diabetes. In all that we did, they reinforced the fact that I could do anything that I wanted to do as long as I was willing to do the work.

The Plan

Successful diabetes management is not something that can be done haphazardly. It requires organization and consistency. Medication, diet and exercise should be planned in concert with the objective to maintain blood sugars within (or as close to) the normal range of 70-120.

 

The Tools

With any task, it is easy to adhere to the plan with the right tools in the right place. What that means for a child with diabetes is that the plan has to include where meals will come from (ie: packing a snack or lunch to eat at the prescribed time), carrying a glucose monitor to check levels throughout the day (and understanding school rules), having insulin handy and stored properly (not in a car that may be too hot or too cold and may denature the insulin. Regularly scheduled exercise and an emergency plan developed with your child and school officials.

The Benefit of Diabetes

Yes, after all of that work, there are benefits! For the novice, all of this seems like a whole lot of work—and it is. It is a mindset, and equipping a plan to manage diabetes. While it may seem like a lot, particularly for a young child, it prepares them for more of the same in life. The road to successful academic achievement is a mindset (GPA 3.5) and a well equipped plan (study between classes at the library and redo all homework prior to tests). The road to a successful career is a mindset (make partner within 5 years) and a well equipped plan (keep schedule on iPad and always be well prepared for presentations).

Said another way, diabetes can provide practice for success in life.

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Managing a chronic illness like diabetes is more an issue of behavioral change than it is a medical treatment. Sure for insulin dependent diabetics, management requires not only learning to administer the injection, but how to manipulate the doses. But the majority of diabetes management involves understanding how various foods and exercise affects blood sugar levels, and learning to orchestrate a routine that keeps a relative flat line of glucose levels within the normal range

The same is true of living on dialysis or transplant living. Other than being compliant with the doctor’s orders, most of the activity while on dialysis or maintaining a healthy transplant, involves a behavioral change.

Many times, dietary restrictions like low sodium, low fat, low glycemic, means that people need to learn to eat and cook differently. Often times this means a change not only for the person afflicted with the chronic condition, but the entire family. For instance, my husband has a condition unrelated to diabetes or transplant that requires him to eat a low sodium diet. Since I prepare about 99.99% of the meals in our house, that means that after a life of no sugar and low carbohydrate diets, I now add to our meals, low sodium! But it doesn’t work if I prepare his meals separately. In a world of processed foods with lots of added salt, eating low sodium is healthy for everyone.

Since a lot of chronic conditions are aided and best managed by lifestyle changes and establishing a routine, I’ve started a health coaching practice which works is concert with your doctor’s care plan. Once your doctor has prescribed the necessary activities, I work with the patient to develop a regimen that makes those changes fall in concert with your current life.

Perhaps the busiest and most difficult to manage time in my life was when I was a dialysis patient. I was CEO of a manufacturing company, married with a son in elementary school. My job was an hour away from my son’s school. He played soccer and went Kumon twice a week after school. Peritoneal dialysis required that I did one midday exchange and connected to a Cycler at night to perform the dialysis as I slept. My diabetes required glucose monitoring four times a day and insulin injections twice a day. Because dialysis can cause the blood pressure to fluctuate to dangerous levels, I also needed to monitor my weight daily and blood pressure several times a day.  At that time I was sodium restricted as well as on a diabetic diet, and so the best way to control sodium and sugar was to prepare meals myself. As a busy wife, mother and CEO, that was more than a notion, but necessary and therefore not impossible.

All of those requirements—medical, occupational and familial could be summarized like this:

  • Eating out had to be a rare treat

  • I needed diabetic and dialysis medication and testing supplies handy at home and at work

  • In order to cook healthy meals and eat at reasonable times, I had to have them prepped to the point of spending an hour to finalize them for dinner.

  • In order to attend my son’s sporting events and participate in the snack schedule or take him to Kumon even when I would normally work late, meant I had to have business resources at home (computer, fax, printer, binding equipment, presentation folders, etc.).

When I finally got my Ultimate Multitasking Routine in swing, this is how it ran…typically.

  • My workday began at 5:30 am in order to disconnect from my cycler, do all of my testing (weight, glucose, blood pressure), take my insulin plan and prep dinner, prepare lunches for everyone to take to school or work, prepare a light breakfast, and if necessary complete any last minute items for work.

  • Our routine was that my husband usually took my son to school and I usually picked him up from school. As they left, I dressed and left for work. My commute was about 45 minutes which allowed me time to clear voicemail and not walk into any surprises.

  • I kept a three drawer plastic storage cabinet under my desk to store a glucometer, testing supplies, dialysis fluid, blood pressure cuff and supplies, an extra pair of pantyhose and nail polish remover—for other emergencies. The key to being compliant with doctor’s orders is to make the process easy to do and have all of the necessary items available. So at midday, I was ready to test and do my midday dialysis exchange. I kept my stock of dialysis fluid replenished by loading up the car on Sunday night and bringing it into the office each Monday morning.

  • If my son had an after school activity, I would also load up the car the night before with the team snack or whatever was necessary so that I could leave work, pick him up from school and be ready with whatever supplies.

  • Because dinner had been prepped that morning, it was usually within an hour of being done, if not crock pot ready. While completing dinner, I supervised my son while doing homework and was available for questions.

  • In the evening, I completed bedtime testing, took medications, and finished any job related work and prepared for the next day.

 

While of course, things didn’t always work out this smoothly, it was my home base, and when things like illness or other family functions got in the way of this routine, I knew where to return.

I would like to help others with chronic conditions to develop the routine that works best for them to be compliant to their doctors orders and live healthy lives without making overwhelming changes to their current lifestyle.

FOR MORE INFORMATION ON HEALTH COACHING, click on the Health Coaching Tab above.

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Americans with Disabilities Act

Published January 23, 2012
Written by Linda Hepler, RN | Reviewed by George Krucik, MD
Reprinted from Healthline.com
Many health experts consider diabetes to be the biggest public health problem of the 21st century. Consider these sobering statistics from the National Diabetes Information Clearinghouse:
  • 18.8 million people in the United States have been diagnosed with diabetes.
  • It’s estimated that an additional 7 million people have the disease, but don’t know it.
Diabetes is the 7th leading cause of death in this country.
  • Diabetes is a major cause of heart disease and stroke and a leading cause of kidney failure, non-traumatic lower limb amputations, and new cases of blindness.
  • At any given age, a person with diabetes’ overall risk of death is twice that of those people of the same age without diabetes.
  • Why the grim statistics for a disease that can be controlled or even prevented? According to the International Diabetes Federation (IDF), an umbrella organization of over 200 national diabetes associations around the world, a major problem is lack of public attention to the early diagnosis and management of this disease—and to people’s fundamental human rights to life and health. As hard as it is to believe in a country as wealthy as the U.S., there are millions of Americans with diabetes that go undiagnosed until complications arise, lack access to affordable health care, medicines, and needed equipment, and are denied opportunities to manage their diabetes properly in schools and workplaces.
    The IDF strongly believes that those with diabetes can play an essential part in confronting this silent killer by knowing their rights, so they developed an International Charter of Rights and Responsibilities of People With Diabetes (see the document at http://www.idf.org/advocacy/charter-of-rights).
    Do you know your rights and responsibilities as a person with diabetes? In a nutshell:
    Your Diabetes Rights
    1. You have the right to care.
    Good healthcare is essential for diabetics. You deserve access to affordable and quality healthcare at all stages of your life. When receiving diabetic services, you should expect to be treated with respect and dignity and allowed to make complaints about any aspect of your healthcare without it affecting your treatment.
    2. You have the right to information and education.
    Knowledge is power! You should expect your healthcare providers to give you sufficient education about managing your disease, and information about where to access additional resources for learning. You should be allowed to be involved in planning your own healthcare and setting your health goals. You should be given the names, dosages, actions, and possible side effects of any medications your healthcare provider wants you to take. You should have access to your own medical records, as well as the right to share that information with others only as you deem necessary.
    3. You have the right to social justice.
    You have the right to be treated fairly in the workplace, at school, and in other public settings. You must be allowed time and privacy as well as a clean and safe place for blood sugar monitoring and medication administration, as well as sufficient time off for medical appointments. You should also have access to affordable medications and monitoring technologies.
    Are all of these rights legally enforceable? Many of them are. While you may have to champion your own cause when it comes to insisting upon adequate diabetic education at your doctor’s office, you can get legal help to end discrimination at school, work, and other settings where you are being treated unfairly because of your diabetes. One place to start is by talking to a legal advocate through the American Diabetes Association. By calling 1-800-DIABETES, you’ll be put in touch with someone who can help you to understand your legal rights and help you to take action.
    Responsibilities
    Along with rights come responsibilities. The IDF lays out some major responsibilities for those with diabetes. These include:
    • Being honest with your healthcare providers about all aspects of your life that may influence your diabetic care, such as your lifestyle behavior, the medications you take, and your allergies.
    • Carrying through with the agreed-upon treatment plan for your diabetes, such as blood sugar monitoring, medications, and healthy lifestyle behaviors.
    • Sharing any problems you’re having with your diabetes management with your healthcare providers so the plan can be revised.
    • Telling others in your life about your diabetes if this knowledge can help them to support you, such as those at home, in the workplace, and at school.
    Article Sources:
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    Soul Food has been the blame for Type 2 diabetes and uncontrolled Type 1 diabetes for years.  One of the reasons that it has not been quickly eliminated from the diet of African Americans is because of the social role these foods have played throughout history.  Much like the movie “Soul Food”, the Sunday Diner and family contribution to its preparation is what has historically kept families together.  Therefore for the sake of the African American family, we must find a way to uphold this ritual and at the same time reverse the effects it has on diabetes and heart disease.

    Many of the foods are in fact healthy and nutrient filled at the start.  It is often the preparation styles that rid the foods of their cancer fighting and sometimes blood pressure lowering nutrients.  Adding excess salt and fat also cause some dishes to be unhealthy. With a few slight changes, soul food can become not just good to you, but good for you.

    Low-Sodium Selections

    Traditional soul food is high in sodium or salt. Replace
    table salt with sea salt. This type of salt has a strong flavor, and you won’t
    need to use too much of it to get the flavor you desire. Select foods that say
    “reduced” or “low-sodium” on the labels. Include dried or fresh herbs and spices
    in your favorite soul food recipes to add flavor without adding
    salt.

     

    Low-Fat Diet Options

    Traditional soul foods can be high in unhealthy fat,
    such as saturated and trans fat. Soulfoodandsoutherncooking.com suggests
    replacing traditional soul food ham hock with smoked turkey and using turkey
    bacon instead of pork bacon. Breading and frying meat and poultry are typical
    soul food preparations. Select a lean cut of beef or skinless chicken breast,
    which are low in saturated fat. Coat the protein with flour, egg wash and
    crushed-up corn-flake cereal. You can add your favorite seasonings such as sea
    salt or dried herbs. Spray a cookie sheet with a nonstick spray and bake the
    meat until done. This cooking method cuts out the fat from battering and
    frying.

    Balanced Carbohydrate and Veggie Options

    Soul foods include starchy vegetables such as corn,
    potatoes and peas. You can still enjoy these foods while having diabetes, but
    you need to balance them with some nonstarchy vegetables. Enjoy steamed green
    leafy vegetables alongside your starchy veggies. Prepare collard greens, spinach
    or kale in a hot saute pan with a splash of red wine vinegar. Drizzle the cooked
    greens with heart-healthy olive oil, and sprinkle with sea salt to finish.
    Black-eyed peas are a staple of soul food. Pair these simple carbohydrates with
    complex carbohydrates such as brown or wild rice. Simple carbs break down
    quickly and may cause a spike in your blood sugar. Pairing them with complex
    carbs may help to stabilize your blood sugar since foods with complex carbs take
    longer to break down.

    Replacements in Baked Goods

    When baking biscuits or cornbread, replace fatty
    buttermilk with a reduced-fat milk. Whipped cream is a delicious addition to
    homemade apple pie. Replace half the heavy whipping cream with reduced-fat milk
    to shave some fat. Use 1 percent or skim milk in recipes that traditionally call
    for whole milk.

    Different Fats and Oils

    Fill your diet with heart-healthy fats, such as
    monounsaturated, polyunsaturated and omega fatty acids. Use healthy oils such as
    olive, vegetable and corn oil in your cooking. Replace butter with margarine.
    Include some nuts that are high in monounsaturated fats, such as almonds,
    cashews and walnuts.

    Read more: http://www.livestrong.com/article/328360-soul-food-diet-for-diabetics/#ixzz1lf3mTmIx

     

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