Amanda Wilde (Host): Learn how to live well with diabetes by developing healthy habits that support blood sugar control, reduce stress, and fit into a busy lifestyle. Teri White, Transitional Nurse Navigator and Certified Diabetic Educator at U. M. Charles Regional Medical Center, is here to share her top strategies for sustainable diabetes care.

 Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Amanda Wilde, and Teri, thank you so much for being here to share your expertise and strategies for diabetes care.

Teri White, BS, RN, CDCES: Amanda, thank you so much for having me. This is what I love to do.

Host: Well there are a large number of us, about 1 in 10 worldwide with diabetes and that number is increasing. So what are the first steps someone diagnosed with diabetes should take to start getting on top of that right away?

Teri White, BS, RN, CDCES: What I like to teach my patients as the first steps when you are actually a person with diabetes is to understand that you are not alone. This is a team sport and it's all about team support. The first thing that you should do is actually make sure that you have a provider who you can work with because they are your partner through this journey with this illness of diabetes.

By seeing your provider, they can actually make sure that you are put in touch with other providers that you want to follow up with on a regular basis. When you have diabetes, you want to follow up with a primary care doctor. It would be great if you also had an endocrinologist, which is a diabetic doctor, an ophthalmologist, which is an eye doctor, and even a podiatrist, a foot doctor.

Then comes the next challenge of making sure that you get the education that you need. So finding an education class on diabetes will help you to learn everything that you need to know about the medications and the diet and how to take care of everything. And then the last thing is what I really like to encourage is to make sure you talk with your family and your friends so that you have the support that you need and you know you're not alone.

Host: So, support plays a big role in managing diabetes as well as education, and keep that talk going with your family.

Teri White, BS, RN, CDCES: It's very important to know that you're not alone, because it can be very overwhelming. Stress comes in all different kinds of forms, and of course, when we usually talk about it or hear about it, we think of bad stress. So having a new diagnosis can be very overwhelming. So reaching out so that you have people who you can turn to that understand that you're facing something challenging is actually very helpful.

Host: Yeah, and it sounds like at this point, one of the first things you can do is start getting this team assembled around you to give you that support within the medical field. Now I want to talk about nutrition and physical activity because I know they both play a role in diabetes management, but let's discuss them separately.

First, nutrition. Are there certain general dietary guidelines that are helpful to follow?

Teri White, BS, RN, CDCES: Actually, yes, there are. The American Diabetes Association has something called a Diabetic Plate Method. Basically, what it's all about is that when you have diabetes, you need to have an understanding that food is your fuel and that your pancreas produces insulin, which allows your body to tap into being able to use the fuel.

When that system is broken, then you have diabetes, where you have an increased risk of having high blood sugars, which can lead to an increased risk of damage. And so that diabetes guideline is promoting balance. On that diabetic plate method, half of your plate should be vegetables, and we say non starchy vegetables.

We actually call them free. They're high in fiber, high in nutrients, plenty of water in there, and that should be balanced out on the plate, with a quarter of the plate being proteins, and you can do meat protein, you can do tofu, which is a plant protein, you can do nuts. All sorts of things like that, and then the last quarter of your plate is your carbohydrates.

In the class, this is where you'll learn all of the differences between all of these. Your carbohydrates are generally broken down into your fruits, your dairy products, and then your starches. And of course, I like to focus on fiber. It's all about the F word. Lastly, the biggest thing is that you want to make sure that you're avoiding sweetened beverages. You should never drink your carbohydrates. Chewing is going to help you process it slower and balance things out. So it's all about the balance.

Host: So, it's not only choosing the right amount of carbohydrates, but actually which carbohydrates you choose that will help you manage those blood sugar levels.

Teri White, BS, RN, CDCES: Yes, and one of the things that I always touch with my patients is I'll ask them, how many times have you heard, you can't have rice, you can't have bread, or things like that? And then I look at them and make sure and reassure them that is actually not true at all. When you have well controlled diabetes and you take a diabetes education class, that is what you will learn that you're allowed to have whatever you want, just in moderation. And so it's all about balancing those things because you actually have to have enough carbohydrates to have well controlled diabetes. And, not too many carbohydrates.

Host: And speaking of balance, how do you balance out the food you're putting into your body with physical activity? Are there certain physical activities that really help manage diabetes?

Teri White, BS, RN, CDCES: All of them, and yes, I love this topic. I have a lot of experience as an exercise physiologist before I was a nurse, and when it comes to diabetes, you want to shoot for about 150 minutes minimum of exercise in a week. And the benefit of that is that when you exercise regularly, you'll have a decrease in blood sugars for about 24 hours, increases and benefits of your heart health, decreases in your blood pressure and things like cholesterol. You can decrease your weight, increase your energy, decrease your stress, and increase your sleep. And you can actually do the different categories of exercise. For example, your cardiovascular, which is like your biking or your walking or your swimming. Strength training, and that could be using your body as resistance or using hand weights. Or any other kind of equipment that you see out there, but you don't have to join a gym. And then the last category is flexibility. You want to make sure once again, that you're balanced and very equal with all of your fitness stuff to try to keep your body as healthy as possible.

And all of these help your body to become more efficient with utilizing the fuel and controlling your blood sugars.

Host: So, we've talked about diet and activity. What about sleep?

Teri White, BS, RN, CDCES: Sleep is very important, and most people don't realize this. When we're not getting enough sleep, it actually increases something called insulin resistance. Type 2 diabetes is all about insulin resistance, which actually causes your blood sugars to be elevated. So what happens is, is when you can sleep deeply, it helps to increase your blood sugar control.

If you don't get enough sleep, it actually imbalances your hormones that regulate your appetite and so that can actually make it very difficult to get better control over your blood sugars. Sleep hygiene is something I love to talk about and it's basically how to prep for a good night's sleep and this includes but is not limited to, having a quiet environment, making sure you don't have too much light.

Make sure you have the right temperature. Cooler is actually a little bit better, around 68 degrees. Having a regular schedule so you're not going to bed around different times and making sure you're waking up at the same time or around the same time is most helpful. You want to avoid substances that can actually affect your sleep. For example, alcohol disrupts sleep and people don't realize that. If you have too much caffeine, it can actually make it more difficult to actually have a good night's sleep. The other thing is exercise is really good at helping somebody get a good night's sleep. The problem you're going to run into is if you exercise too close to bedtime, you always want to make sure you're exercising at least two hours away from when your head is ready to hit your pillow.

And lastly, the thing that can actually cause a problem is you want to try to omit naps. Napping's not really good for you hormonally, and you'll actually find that you'll sleep better if you just get on a good schedule.

Host: Oh, that's so interesting because some people swear by naps and then other people absolutely never nap. So that's always been a question of mine. So it sounds like the regular physical activity combined with proper sleep and nutrition are all working together, really, to manage blood sugar levels.

I do want to ask, though, if you have tips for managing blood sugar levels. Even if you're doing those things, we do run across these very stressful times, whether it's personal or community oriented, there's a lot of stress in the world. And do you have tips for managing blood sugar, specifically addressing stress?

Teri White, BS, RN, CDCES: Yes, I do. So the first thing that I like to try to encourage people to do, because it's all about making sure that we empower people to understand that they can have and make big changes with their blood sugars and the control of the blood sugars. So the first thing that I teach is pre planning. Everybody has periods of time where things do not go the way that you expect them to. So I try to teach my patients that if you plan everything that you're going to eat tomorrow, tonight before you go to bed; that can really help you avoid surprises and be able to make sure that you have the things that you need to make good, healthy food choices.

Number two, take frequent breaks. Meditate. If that works for you, doesn't work for everybody. For me, going for walks. Anytime my stress level is up, I go for a walk. And when you do that, it actually physically eats the cortisol in your body, which is a stress hormone. So that really is very helpful. The third thing that I like to teach is deep breathing.

Every time you take a deep breath, it actually can lower your heart rate and your blood pressure and it teaches your mind to be more calm. So if you find that you're going through a very acute, it's happening right now, stressful period, try to take deep breaths. Breathe through it. Number four, we've already talked about, it's sleep.

And then number five is to try to not adopt any new habits. You want to limit your alcohol. You want to limit smoking or cut it out if you can. And those things, lastly, are really helpful at helping your body to be resilient with stress. The healthier your baseline body is. The better your body will handle stress, therefore you'll actually have better controlled blood sugars.

Host: So, it works on every single level, really. There are medications for diabetes. What should people know about the medication options?

Teri White, BS, RN, CDCES: The medication options, I teach it as three different categories. You've got pills, you've got injectables, and then you have combination therapies. Pills are often given to people when they're first diagnosed, but this is the caveat. You have to make sure that your blood sugars aren't too high.

There is a magical number called an A1C. It's actually a blood test that the doctors will get, and that's a percentage of your blood that's covered in these sticky blood sugars. When you're over 10, you're kind of stuck. The pills don't work as well, and you really need to use the injectables, which are your insulins.

But if you can control your blood sugar, then you can actually use the pills. Pills like metformin or glipizide are fantastic at helping to control blood sugars, and they all work just a little differently. Whereas your insulins, it's the oldest diabetic medication that was ever made and it's very effective, but you have some tricks you need to learn to make sure that you're doing right.

The last one, the combination therapies. I see a lot of my patients inside the hospital that are actually on both or sometimes they're on these alternative medications. A lot of them are on different ones that all work together in different ways throughout the body to try to help to control the blood sugars.

Host: Do you find, as you're dealing with patients who are in the process of trying to control diabetes that there are any common misconceptions about diabetes and diabetes management?

Teri White, BS, RN, CDCES: Yes, misconceptions, I love talking about these because you hear about them all the time. The first one is, it's not just about the sugar. I taught a class yesterday, and when I pulled up a nutrition facts label, I actually had them look at it. And I said, the first thing that you look at is the serving size.

But then the next thing, and I asked them, what is the most important thing on this nutrition facts label? And one person got it right. It's actually carbohydrates. It's not just the sugars. So that's a huge misconception. The second one, and I'm going to tell you right now, it's probably the most common error that I see made.

Patients think that if they skip meals, it's actually going to help control their blood sugar. It actually does the opposite. You actually need to make sure that you're eating breakfast within an hour. You want to shoot for three to four meals a day and a bedtime snack. And truly, if you're ever going more than four to five hours between meals, you want to have another snack in between.

If you've ever heard that phrase, you want to eat four to five small meals a day. That's the way to go. And skipping meals actually hurts the problem and doesn't help it. Another misconception is that diabetes is mild. It's not. It may be new to you right now, but there's a slew of complications that happen when you have diabetes and it's uncontrolled. So I like to tell people diabetes and high blood sugars when it's uncontrolled; it'll hurt you and it can even take your life. It'll take a while but you're going to be very sick until that happens. The next one is that diabetes can be prevented. And that's what I love to go over with people because that's not always true.

Sometimes it's genetic. I actually have a friend who got really sick and her body doesn't produce insulin anymore. She didn't do anything wrong and now she has to live as a person with diabetes. And that's okay as long as you have and tap into all the resources available. Another misconception is that insulin is bad. When you have diabetes, it is a progressive disease and some people, no matter what they do, may eventually end up on insulin. And as I mentioned before, insulin is a very effective medication and we primarily use it here in the hospital because that's the fact.

And then the last misconception. This goes along with that whole people think it's okay to skip meals is that they like to have a low carb diet. That is not true. When you're opting and shooting for controlling your blood sugars, the best way to go is to eat enough carbs and not too many. Cutting out your carbs, your body actually interprets as skipping a meal. So all those fad diets out there are not necessarily very helpful.

Host: So, let's sum up some key takeaways here. I'm hearing a lot of things in this conversation. One, it's all about keeping things in balance and just like whether or not you have diabetes, balancing exercise, and your food habits and your sleep will help you have a healthier baseline to start from. And then, how to space your meals sounds really important and not to skip meals and to use all your resources. There are resources available to you. You mentioned classes and just starting with your primary care physician and from there, assembling a team around you to help you. Well, I guess we'll end as we started. You're really not alone.

Teri White, BS, RN, CDCES: Yes, ma'am. The takeaways are that you're not alone and my favorite words are balance and fiber and that not being alone you understand that you actually have to create a team. Your providers are your partners. And then don't forget your education classes. That is really where all the magic happens. Those diabetes education classes will save your life. They will teach you everything that you need to know.

Host: And since diabetes is on the increase, this knowledge is really more important than ever. Thank you so much for sharing your expertise and strategies today.

Teri White, BS, RN, CDCES: Thank you so much for having me, Amanda.

Amanda Wilde (Host): Teri White is a Transitional Nurse Navigator and Certified Diabetic Educator at U. M. Charles Regional Medical Center. Find more shows just like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System.

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