Transcription:
Champion Diabetes and Nutrition Service

Cheryl Martin (Host): . Living with diabetes has its challenges, but you can manage the disease in your everyday life. Coming up, learn the importance of making lifestyle changes to improve and manage A1C and blood sugar control. Our guest is Denise Giroux, a registered dietician and certified diabetes care and education specialist with Champion Diabetes and Nutrition. Welcome to the Champions for Wellness Podcast, brought to you by Gerald Champion Regional Medical Center. We believe knowledge is the key that opens the door to a healthy life. I'm Cheryl Martin. Denise, so glad you're here to talk about a disease that affects so many Americans, 37 million. That's about 11% of the population. What about the numbers in New Mexico?

Denise Giroux: Well, thank you Cheryl, for inviting me to talk about this important, medical condition that affects so many people through the American Diabetes Association, the burden of diabetes in New Mexico. Mentioned approximately 200,558 people, which equates to 12.3% of the adult population are diagnosed with diabetes. Just to add to that, 53,000 people in New Mexico have diabetes, but they are not aware of. and then there is people in New Mexico, which comprises about 36.1% of the adult population who have pre-diabetes. which is blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as a person with type two diabetes. And just to add to that last number, every year an estimated 12,484 people in New Mexico are diagnosed with diabetes.

Cheryl Martin (Host): I am glad you're sharing all these statistics because those are touchpoints that I wanted us to cover during our time together. First of all, let's start with the fact that so many people don't know that they are diabetic, and I read that one in five Americans don't know. Why is that?

Denise Giroux: Basically, not. maybe going to their primary physician for a well checkup. They may have the signs and symptoms such as, shakiness, blurred vision, excessive thirst, and they put it off as maybe an illness. And then when they do see their primary physician and they mention what they're experiencing and maybe lab work has come back and their primary physician mentions, your blood sugars are X and your A1C is X. This puts you in a category of either, pre-diabetes or again, if the blood sugars are, higher than 1 26. Milligrams per deciliter. That gives them the diagnosis of type two diabetes.

Cheryl Martin (Host): So really a person would primarily find out by these symptoms or blood tests, specific blood tests?

Denise Giroux: Yes. So it's very important for individuals to get that well checkup, if they're noticing those signs and symptoms and they can go on the American Diabetes Association website and get, great information of what, signs and symptoms can bring on low blood sugars and also what can happen with high blood sugars.

Cheryl Martin (Host): Denise, talk about the difference between the types of diabetes.

Denise Giroux: So there is type one diabetes and there is type two diabetes. So type one usually develops early in childhood. It could also happen later in adult life, but that is a genetic condition where your pancreas, produces a hormone called insulin to help regulate your blood sugars and feed your brain, what's called glucose. And usually that is dealt with insulin. You need insulin for those individuals to survive. And a type one, your immune system is attacking or destroying the insulin producing cells in your pancreas. Type two can come on a little later on in life and your body is unable to make enough insulin, or the insulin you do make doesn't work properly.

And so medication kind of helps that process. Risk factors, currently for type one, there are really no known causes of why type one happens, but the risk factors for type two, could be excess weight or ethnicity. Symptoms with Type one, they appear more quickly with. That and type two, as I mentioned, those could be easier to miss because they appear more slowly. And then with management, as I had mentioned with type one, they have to take insulin on a regular basis to control their blood sugars. And with type two, basically, they're monitored through medication. It could be oral or. exercise is so important as well as nutrition.

So I don't use the word diet because as soon as you say the word diet, people are thinking uh oh, I have to eliminate. So, proper nutrition or better nutrition is really key. And so as a diabetes care and education specialist, we work one-on-one with patients to help them. look at that area of, nutrition. Do they understand what carbohydrates are? how do they portion their food? And above all, are they including some type of daily physical activity?

Cheryl Martin (Host): And how much physical activity at a minimum?

Denise Giroux: Well, the American Diabetes Association recommends that most adults accrue a minimum of 150 minutes of physical activity a week, which breaks down to 30 minutes, at least five days a week. And Cheryl, the nice thing about that is, you can break that up into six, five minute sessions. You can break that up into three 10 minute session. And also you can break that up in two 15 minute sessions because we're wanting an accumulation of 30 minutes. So, parking farther away at the grocery store or going to the mall and walking inside the mall. that is a great way. YouTube has videos of silver sneakers where they can do armchair aerobics.

If their endurance isn't up to par, they can sit in the chair and march in place and move their arms. they also have great exercise videos for Tai Chi, for flexibility and also weight strength training. So we're trying to increase one's activity and decrease one's inactivity. So sedentary.

Cheryl Martin (Host): And I love the fact that you talked about nutrition versus diet, but specifically what food groups are you telling diabetics to embrace and which ones to resist or to have less of?

Denise Giroux: Well, that's the nice thing, Cheryl, about being a registered dietician. All foods fit, so you have to get away from that. Bad food versus good food is basically the portions. So we really mention about, food scale or measuring cups, looking at the food label, the nutrition facts label, and look at the serving size. So if it says one cup, one cup is the serving, and especially if it's a carbohydrate, you want to look at the nutrition fax label and look at what says the total carbohydrate. And a lot of people wanna look at total sugars and total sugars are part of that total carbohydrate. But with the nutrition label, the newest addition is called includes added sugars and it gives you a number, like 10 grams.

And so what that is telling us is what is being added into that food item to give you that includes, Added sugar and the goal is to try to look at the percentage, which is we are trying to get 20% or less of intake, because you have to add that added sugar into the total carbohydrate. So for example, if an item says 37 grams of carbohydrate for two thirds cup. And it says includes 10 grams of added sugar. Well now you have to add that 10 grams to the 37 grams of total carbohydrate and you get a total of 47 grams of carbohydrate Does that kind of make sense?

Cheryl Martin (Host): Yes. So at what point is it too many carbs? That number is too high and we should resist that?

Denise Giroux: Well not resist. You just have to look at the nutrition labels. So sometimes, you bought something that may say 28% or 30%, that's okay. It fits. just look at the nutrition portion size of the serving to know, okay, this is what I'm getting and it's, something that I'm not gonna have all the time, but I'm going to add other foods into my intake. And so we try to say, eat the rainbow. Women should strive between 30 to 45 grams of carbohydrates and that equals Two to three carbohydrate choices, and I'll get to choices in a second. And then we try to strive for 45 to 60 grams of carbohydrates per meal, each meal. And so 45 grams is three carbohydrate choices.

60 grams is four carbohydrate choices. And so a carbohydrate could be your dairy. So milk, doesn't matter what type of milk you're drinking, whole, 2%, 1% fat free. It's a carbohydrate, it is just the calories deals with how much fat is in that milk. Your fruits are a carbohydrate. They can be fresh. Frozen, dried or canned. You have your cereals and grains like oatmeal, cream of wheat, your regular cereals. You have pasta, rice. You have your starchy vegetables, which could be baked beans. Your regular beans like kidney beans, Lima Navy pinto red beans, corn on the cob. Peas. Okay. Baked potato. winter squash such as a corn or butternut.

Same with yams, which are your sweet potatoes. And then you have your breads. So your bagel, your regular breads, English muffin, a hotdog bun, a hamburger bun, taco shells, tortillas, waffles. And then lastly, also, you have crackers and snacks like animal crackers, graham crackers, Ritz crackers, saltines, oyster crackers, pretzels, popcorn, rice cakes. And then you know, you have your fat free or baked potato chips, pita chips or tortillas and so forth. And so what we look at is those carbohydrate foods. There is a guide that lets you know that a serving, so you're looking at the serving side on that nutrition label.

We're saying that those foods that are a carbohydrate. One carbohydrate choice is 15 grams. And so when you're looking at your bread and it says 18 grams of carbohydrate, well, we know that is a carbohydrate. If you wanna do a really down and dirty calculation. You take that total carbohydrate and you divide by 15, and that gives you your total number of carb choices.

Cheryl Martin (Host): So you really teach those who come to you that it's so important to look at these labels and know what the numbers mean. So if necessary, you can modify and have more of a balanced meal?

Denise Giroux: Correct. And when we balance that, we balance that with half our plate with non-starchy vegetables. A quarter of that plate is your protein source, and then that quarter of the other part of your plate, that's where you get your carbohydrate choices. For females, 30 to 45 grams for males, 45 to 60 grams each meal, not for the day. A lot of people think that's how much I can only have for the entire day, and we're saying no. That is about each food. So if you are a female and you have 45 gram. For breakfast luncheon dinner, you're eating about 135 grams of carbohydrates. Now, if you did 30 and you times that by three, you're going to be eating 90 grams.

So for men, Again, 45 times three is that top 1 35, and if you did 60 times three meals, you're at 180 grams of carbohydrates. And so when you take that total number of grams and you divide it by 15, that is telling you how many servings of carbohydrates you can have at each meal. So, if I can do an experiment, if you want, at the top end of 60 carbohydrates at each meal for a male, which is 180 and you divide by 15, because we're saying one carb choice is 15 grams, they're getting 12 carbohydrates for that day.

And if you are dividing it by three, that gives you four carbohydrates at each meal. But let's say you. Four meals because you're having a snack. That means you would get three carbohydrates at each meal for that whole day,

Cheryl Martin (Host): So, Denise, let me ask you, so these lifestyle changes in terms of nutrition and weight management can actually improve and manage your A1C and blood sugar control?

Denise Giroux: Yes. So basically what we're saying, if you go to the lower end of the carbohydrates per meal, so that would be 30 for a female. 45 for males that will help with weight loss, that will help with better glucose management. also helps with weight. And when they do see us for their appointment, I actually have a plate with food models and I help them build a plate showing them this is what your meal would look like. And nine times out of 10 people are very surprised to say, wow, that's a lot of food on that plate. A lot of people think that they're gonna starve.

And when they actually visually see that and they can say, well, you know what? I wanna take something away. And I say, okay, what do you wanna take away? And they take a food item away. And they still look at what is left over on their plate. They're still amazed at there's a lot of food that it's, they're not going to quote unquote, starve to death.

Cheryl Martin (Host): what other services and classes are available for diabetics through the Champion Diabetes and Nutrition Clinic?

Denise Giroux: Well for people with diabetes and we try to stay away from the term diabetic cuz we are trying to, address the person with their condition. so it would be a person with diabetes. We offer what's called diabetes self-management and training, which are group classes, held four sessions and they are two hours. Basically it is a service of the patient if they have not rendered a diabetes education in the past, they are allowed to have 10 hours of diabetes education in their lifetime. But if somebody took diabetes education, let's say in 2015, and they're wanting to take another class, they only get two hours of education.

And that's where we can ask them, okay, what are you needing to focus on? And we have classes, healthy eating and being active. We talk about monitoring and taking medications. We also do problem solving and reducing risks, and then healthy coping. This follows the ADCS seven healthcare behaviors that focus on people with diabetes and how they can manage. and be more engaged in understanding what their blood sugars are and how they can keep that under control.

Cheryl Martin (Host): So once someone has diabetes, can they actually get out of that range?

Denise Giroux: You mean reverse?

Cheryl Martin (Host): Yes.

Denise Giroux: So there has been research for reversing, but I'm on the fence with that. I don't see a reversal, but I can see a slowing down of complications such as blindness, amputation, heart attack, kidney diseas e with dialysis. And, there are some individuals who can, and That has been proven. I have not visually seen it. I know plant-based is very, very popular, but we do have to be careful. Plant-based is carbohydrates, but you are not eating processed meats and so forth. You're eating more plant-based, which it is gonna be higher fiber, higher nutrients than, if you're adding meat, into one's diet.

Cheryl Martin (Host): And so once again, those that you've seen who have prevented complications, it's because they took the measures that we're talking about?

Denise Giroux: Yes, So I do have quite a few people who are interested in, plant-based, and they've brought in their cookbooks and we've gone through, the main thing is people want us as dieticians to write a menu, and we don't do that because we don't live with that patient. So what we do is what are your likes? What are your dislikes? Look at your pantry, look at your refrigerator, write things down, see what fits. And then you can make your own menu. So basically we try to encourage an engaged person, what do you like and what do you not like?

And so that will be most beneficial to help those individuals to say, yeah, you know what? I can make a and B, and then Put that together and then put C and D together and do that, and then A and D and B and C, and so that they can create the meals that they like, and then just watch the portions. That's the main thing is just watching the portion. So either a food scale or measuring utensils would be the best option that they have so they can visually see what that portion looks like.

Cheryl Martin (Host): Now, is this the same advice you would give for those who are in that pre-diabetic range to keep them from moving into diabetes?

Denise Giroux: Yes. So pre-diabetes is 5.7 to 6.4% for that A1C. They can follow the same thing portion control. Cannot say enough for exercise. And then if they are able to lose five to 10% of their current weight as well, that can help them, manage their blood sugars and prevent them from stepping up to becoming type two.

Cheryl Martin (Host): Denise, why is it so important to you that your clients feel engaged and empowered as they understand the importance of making these lifestyle changes?

Denise Giroux: They have to be engaged and empowered because diabetes does not take a vacation. It's 365 days, seven days a week. They don't punch a clock to say, oh, I'm gonna start at eight o'clock and I'm gonna punch out at five o'clock. So when they understand what they're able to do, and it's only small increments. When they see us, my main thing is I tell them by the time that they leave the appointment, we are going to work together to develop a smart goal. S M A R T. And so when they develop a smart goal, the S means specific.

What do you want to work on? It's not me. I'm here to guide you and give you some information and you need to figure out, Hmm, is that what I wanna work on? The M is motivate. How is that specific goal gonna motivate you? Because I like anyone else, I don't like to exercise, but I know I see the results, so that's my motivation. The A is attainable or achievable. Can that goal that you're making, can you attain it? if it's not farfetched, the R means realistic. So the A and the R kind of go together, is the goal realistic to attain and is it attainable because it's realistic? And then the T means how do you track it? Do you have a calendar that you wanna circle?

Are you really smartphone savvy that you can put in the, time on a specific date that you wanna, do this goal? And we try to. Elicit the goal for a two week period because you're trying to engage in a healthier behavior, trying to take away, not so healthy behavior and put in a healthier behavior. And it takes about two weeks to get into the process. And so when they come back to see us in two to three weeks, we kind of go over. Okay. How was your smart goal? What percentage do you think you achieved it? What were your barriers? And then when they tell us the barriers, go back.

Okay. What plan A, plan B would you be able to put into its place to make sure that you would be able to accomplish that goal. And then, okay, two weeks becomes four weeks, becomes six weeks become eight weeks. And now that behavior is becoming more and more ingrained into your everyday process. It's like putting on pants, after a while you can put on your pants pretty quick, but at first it's kind of like uh oh, can I, get them on and get them. buttoned and so forth. So I look at that. So when they make their smart goal, that's how they become empowered and that's how they become engaged.

Cheryl Martin (Host): Denise Giroux, thanks so much for educating us on the role good nutrition and other healthy habits play in managing diabetes. Thank you.

Denise Giroux: Well, thank you Cheryl. Very nice to have spoken with you. And, if I can plug, if individuals are interested in education from a dietician and diabetes educator, please Speak with your primary care physician and we'll be more than happy to, get you scheduled and speak with us and get you on the road to a healthier you.

Cheryl Martin (Host): And let me add for more information about Champion Diabetes and nutrition service, call 575-446-5085. That's 575-446-5085. If you found this podcast helpful, please share it on your social channels. And thank you for listening to Champions for Wellness, local Caregivers, educating our community. And if you missed one of our podcasts, just go to GC MCR.org/podcast.