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protein-based meal replacement. Nutrition. 2012, January;
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and a nearly 50% reduction in insulin 2. Kempf K, et al. Efficacy of the telemedical lifestyle
intervention program TeLiPro in advanced stages of type
needs. These improvements were even 2 diabetes: A randomized controlled trial. Diabetes Care.
seen after 52 weeks of follow-up.2 2017 Jul;40(7):863–871
 ••• FALL 2022 •••

At The Table
44 ‘Fall’ Into
Healthy Habits
This collection makes use

Features of all the quintessential

flavors the season’s bounty
has to offer, featuring
28 ‘Fast’ Food
Tips for quick, nourishing
pumpkin, apple, corn,
cranberry, squash, and
meals at home. Brussels sprouts. These
recipes are a-maize-ing!
32 The Fallacy of 15
Hypoglycemia treatment is
not one size fits all.

36 Return to School
With Success! The Dose
Tips for helping your child 8 News & Notes
with type 1 diabetes in the 10 Quiz
classroom. 15 Product Spotlight
16 Ask Away
40 Snore No More
Sleep apnea is a common
17 Curmudgeonly Athlete
condition, but treatments Healthy Living
are available. 18 The Right Moves
20 Weighty Matters
21 Smart Smarter Smartest
22 Food for Thought
24 Susan and T’ara’s Kitchen
In Every Issue
4 Editor’s Note
63 Recipe Index
64 Final Countdown

On the cover: Spiced Baked Apples

photographed by Angela Sackett. For
SHUTTERSTOCK

a list of all recipes, see page 63.

 If you have type 2 diabetes

Get tested for

chronlc kldneb dlsease

Up to 40% of people wlth tbpe 2 dlabetes (T2D) develop

chronlc kldneb dlsease (CKD)
CKD can lead to kidney failure and dialysis and increases your risk for
heart attack and stroke. CKD often has no symptoms until it’s too late, but
when it’s caught early, there is more you can do to protect your kidneys.

Ask bour doctor for a UAC) (urlne albu.ln-to-creatlnlne ratlo) urlne test
once a bear. It checks for protein in the urine, one of the earliest signs of
CKD or kidney damage.

For more information, visit KldnebAlert.co.

or scan code
© 2021 Bayer Pharmaceuticals, Inc. All rights reserved. BAYER and Bayer Cross
are registered trademarks of Bayer. Last Updated 1/2021 PP-UN-CAR-US-0206–1
••• EDITOR’S NOTE •••

Editorial Director, Wellness Division Food Editor

Diane Fennell Lorena Drago, MS, RDN, CDN, CDCES

ART & PRODUCTION

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CUSTOMER SERVICE
DiabetesSelf-Management@pcspublink.com (855) 367-4813

EDITORIAL BOARD
Dear readers, Pamela Allweiss, MD, MPH Jeanne L. Rosenthal, MD
CDC Division of Diabetes Translation Attending Surgeon, Retinal Service,

W ho loves fall most of all? The autumn is a time of

transitions—the leaves are changing, tempera-
tures are cooling down, and new fruits and vegetables
Amy P. Campbell, MS, RD, LDN, CDCES
Boston, Massachusetts
Shana Cunningham,
MSN, RN, MLDE, BC-ADM, CDCES
Diabetes Education Service Coordinator,
are coming into season. These pages on the calendar UK HealthCare Barnstable Brown Diabetes Center,
often bring changes to routine as well, such as getting University of Kentucky, Lexington, Kentucky
Robert S. Dinsmoor
back into a rhythm at work after summer vacation or South Hamilton, Massachusetts
returning to school. If your child with type 1 will be David E. Goldstein, MD
Professor Emeritus, University of Missouri
heading back to the classroom, see “Return to School Health Science Center, Columbia, Missouri
With Success!” (page 36) for lessons on how to help Jeff Plumer, Vice Chair,
JDRF International Board of Directors
them thrive this academic year. William H. Polonsky, PhD, CDCES
With the busier pacing of the harvest months, Assistant Clinical Professor,
Department of Psychiatry,
coming up with quick and easy meal ideas is another University of California, San Diego
New York Eye and Ear Infirmary, New York, New York
Gary Scheiner, MS, CDCES
Owner and Clinical Director,
Integrated Diabetes Services,
Wynnewood, Pennsylvania
Bernard P. Shagan, MD
Director, Diabetes Education Center,
Monmouth Medical Center, Long Branch, New Jersey
Richard M. Weil, MEd, CDCES
Exercise Physiologist and Director,
Mount Sinai St. Luke’s Weight Loss Program,
Mount Sinai St. Luke’s Hospital,
New York, New York
Susan Weiner, MS, RDN, CDCES, CDN, FADCES
Owner, Susan Weiner Nutrition, PLLC,
Long Island, New York
Stephen Z. Wolner, DDS
New York, New York

common challenge. But there’s no need to resort to In Memoriam Dr. Lois Jovanovic, 1947-2018

fast food. Check out “‘Fast’ Food” (page 28) instead for
tips from registered dietitian nutritionists for quick,
nourishing meals you can make at home.
OPERATIONS
The biannual change of clocks is another routine
Senior Client Services & Operations Lead Accounting Director
that many anticipate (or dread!) this time of year. Andrea Palli Amanda Joyce
And while it’s not unusual to experience some short- Senior Client Services & Media Analyst Accounts Payable Associate
Tou Zong Her Tina McDermott
term sleep difficulties adjusting to the end of Daylight Client Services Accounts Receivable Associate
Savings Time, sometimes sleep troubles can signal Darren Cormier Wayne Tuggle

something more serious. If someone has told you that DIGITAL OPERATIONS
you’ve been snoring, or if you’ve been experiencing Audience Development Analyst Senior Digital Designer WordPress Developer
excessive sleepiness during the day, take heed—it Ryan Gillis Mike Decker David Glassman

could be a sign of sleep apnea. Visit “Snore No More” EXECUTIVE

(page 40) to learn about this common condition and Chairman & CEO Chief Operating Officer VP, Consumer Marketing Content Director
how it can be diagnosed and treated. Jeffrey C. Wolk Courtney Whitaker Jason Pomerantz Matt Martinelli

Finally, all the autumn changes in routine can make In memory of Susan Fitzgerald, COO, 1966-2018

blood glucose management more difficult than usual.
You might be familiar with the “rule of 15” for treating
lows, but there’s more to this principle than meets the
eye. Learn about “The Fallacy of 15” (page 32) and find
out why hypoglycemia treatment is not one size fits all.
Be well, “fall” into an autumn routine, and take care
until next time!
All the best,
Newsstand Distribution Weekly Retail Service
Diabetes Self-Management, Fall 2022, Volume 39, Number 3. Diabetes Self-Management (ISSN 0741-6253) (USPS 003-865)
is published quarterly by Madavor Media, LLC, 35 Braintree Hill Office Park, Suite 101 Braintree, MA 02184. Periodicals
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4 DiabetesSelfManagement.com • Fall 2022

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 ••• DiabetesSelfManagement.com •••

PHYSICAL ACTIVITY

The Health Benefits of

Walking
Hippocrates said, “Walking is man’s
best medicine.” Indeed, walking can
provide a variety of health—and
Insulin Resistance: Your Questions Answered personal—benefits. Let these words
of wisdom inspire you to begin
It’s pretty amazing what the body does to help regulate blood glucose levels
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with this finely tuned system. If you have questions about insulin resistance, healthier you.
this article can give you answers. bit.ly/3MXJsEu
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COMPLICATIONS HOLIDAYS RECIPE

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you know about high blood pressure?
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All Hallows’ Eve is almost here, and
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of this tea.
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•••
•••THE
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DOSE•••
•••News
News&&Notes
Notes
New Risk Factors
for T2D Discovered
BY JOSEPH GUSTAITIS
I n addition to the already well-known
risk factors for type 2 diabetes,
researchers have identified two pre-
viously unknown ones, according to
a new report.
Over the years, scientists have
discovered nearly a dozen risk factors
for type 2 diabetes. The best known
are overweight or obesity, inactivity,
a large waist circumference, race and
ethnicity, family history, and age. The
new study, which was reported in
the medical journal Diabetes Care,
indicates that two more can be added
to the list: 1) increased levels of liver
fat and 2) a smaller pancreas volume.
Not only that, but these factors also
seem to have a genetic component,
which might mean that some people
are “hardwired” for type 2 diabetes.
The researchers obtained data
from 32,859 people who had under-
gone MRI scans as part of the UK
Biobank study, which is an exten-
sive biomedical database containing
genetic and health information on
8 DiabetesSelfManagement.com • Fall 2022
some 1 million people in the United
Kingdom. The male-to-female split of
the study group was around 50/50,
and the average age of the subjects
was about 64. From the MRI scans,
the researchers were able to deter-
mine the fat content and size of the
liver and pancreas of each subject. To
evaluate the data, the investigators
used what’s known as Mendelian
randomization, which is a method
of using genetic variation to study
the relationship between risk factors
and health.
The researchers discovered that
people with a genetic formation that
makes them likely to store fat in the
liver are more prone to developing
type 2 diabetes. Specifically, for every
5% increase in liver fat, the risk of type
2 diabetes goes up by 27%. In addi-
tion, the study reported that pancreas
volume had a direct effect on diabetes
risk: the higher the pancreas volume,
the lower the risk. And this relation-
ship, they reported, is genetic.
According to lead researcher
Hanieh Yaghootkar, PhD, of Brunel
University London, “People with type
2 diabetes usually have excess fat
in their liver and pancreas, the two
key organs in the maintenance of
the normal level of blood sugar. The
genetic analysis we used in this study
is the best possible method to test
this relationship, and we showed that
liver fat is causal for type 2 diabetes.”
The researchers did not find a link
between the two risk factors and
type 1 diabetes.
The identification of previously
unknown risk factors gives hope for
a better general comprehension of
diabetes. Commenting on the new
study, Lucy Chambers, PhD, head of
research communications at Diabetes
UK, said it “offers new insights into
the causes of type 2 diabetes that, as
we move towards an era of personal-
ized medicine, could in the future help
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 ••• THE DOSE ••• News & Notes

NEW STUDY SHEDS

LIGHT ON HOW
METFORMIN WORKS
BY QUINN PHILLIPS

M etformin has become the standard first-line medicine

for type 2 diabetes, but for such a widely prescribed
and studied drug, there’s still a lot that scientists don’t
QUIZ know about how it works. That may be changing, though,
thanks to a study recently published in the Proceedings
CINNAMON of the National Academy of Sciences. Researchers were
interested in looking at how, exactly, metformin inhibits
BY LISA CANTKIER
the release of glucose by liver. But at a deeper level,
they wanted to know how metformin inhibits metabolic

W hen it comes to diabetes, cinnamon has been

shown in some preliminary studies (but not
others) to support blood sugar management and
processes in the mitochondria of cells in the liver. Mito-
chondria are responsible for generating the energy in
cells and are nicknamed the “power plant” of cells.
provide additional health benefits. How much do Previous research has shown that there are four differ-
you know about the research on this spice? Take this ent protein complexes (groups of protein chains) involved
quiz to find out! (Before making changes to your diet in the release of energy through a series of chemical
or treatment regimen, consult with your health care reactions in mitochondria. Before the latest study, it was
provider to find out what is best for you, and be careful widely believed that metformin inhibited what’s known as
to closely monitor glucose levels if using cinnamon. complex I—the largest of the energy-generating protein
Cinnamon is not a replacement for prescription complexes in mitochondria. But when researchers looked
medications, and high doses can be toxic, especially for at how metformin works on a molecular level in liver
people who have liver damage or disease. If taken with cells, they found that metformin inhibits a mitochondrial
other types of supplements, cinnamon may be unsafe enzyme called GPD2. It does this by inhibiting not complex
or cause hypoglycemia.) I but complex IV—the fourth protein complex involved
1. Taking as little as 1 gram of cinnamon daily may in the release of energy in mitochondria.
help reduce certain risk factors linked with diabetes On a practical level, the most important finding of the
and cardiovascular diseases in people with type 2. latest research may be that metformin inhibits the conver-
• True •
False
2. Cinnamon has been shown to have effects on a
sion of a molecule called glycerol to glucose in the liver.
This process appears to be dysregulated in people with
variety of factors associated with metabolic syn- type 2 diabetes, leading to increased glucose production
drome, including which of the following? by the liver. Glycerol is released when fat in the body is
•• A. Insulin sensitivity and glucose levels.
B. Blood pressure and inflammation.
broken down, and the researchers found that in some
cases, 40% of a person’s blood glucose can come from the
••C. Lipids and body weight.
D. All of the above.
conversion of glycerol. So, finding new ways to block the
conversion of glycerol into glucose could form the basis
of future research into new diabetes treatments. DSM
3. Cinnamon may have which of the following
effects on blood sugar control in prediabetes?
••A. It has no effect on blood sugar control.
B. It may worsen blood sugar control.
••
C. It may improve blood sugar control.
D. It can cause prediabetes.
4. How may cinnamon affect cholesterol? NEW
••
A. It may help lower lipid (blood fat) levels.
B. It has no effect on cholesterol.
STUDY
••
C. It may increase LDL cholesterol levels.
D. It may increase triglyceride levels.
SHUTTERSTOCK

See page 12 for answers.

10 DiabetesSelfManagement.com • Fall 2022

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 ••• THE DOSE ••• News & Notes

QUIZ ANSWERS See page 10 for questions.

1. True. The results of a study with 60 participants
in Diabetes Care indicated that taking either 1, 3, or
6 grams of cinnamon per day for 40 days “reduce[d]
serum glucose, triglyceride, LDL cholesterol, and
total cholesterol in people with type 2 diabetes and
suggest that the inclusion of cinnamon in the diet of
people with type 2 diabetes will reduce risk factors
associated with diabetes and cardiovascular diseases.”
(Experts state that adults should avoid having more
than 1 teaspoon of Cassia cinnamon per day due to
potential dangers from the coumarin content.) The
researchers note that cinnamon may be beneficial for
those without type 2 to prevent and control elevated MEDITERRANEAN DIET
glucose and lipid levels. But although promising, it’s
worth noting that this study was small and short term.
BEATS LOW-FAT FOR
KIDNEY FUNCTION IN T2D
2. D. Metabolic syndrome increases a person’s
BY QUINN PHILLIPS
chances of developing diabetes, heart disease,
or stroke. According to research in the Journal of
Diabetes Science and Technology, “cinnamon and
components of cinnamon have been shown to have
beneficial effects on … factors associated with meta-
F or people with both type 2 diabetes and coronary
artery disease (CAD)—a common and dangerous form
of heart disease—a Mediterranean diet may be a better
bolic syndrome, including insulin sensitivity, glucose,
option than a low-fat diet when it comes to preserving
lipids, antioxidants, inflammation, blood pressure,
kidney function, according to a new study published in
and body weight.”“However,” the authors note, “not
the journal Clinical Nutrition.
all studies have shown positive effects of cinnamon,
For the study, 1,002 participants with coronary artery
and type and amount of cinnamon, as well as the type
disease—some of whom also had diabetes—were randomly
of subjects and drugs subjects are taking, are likely to
assigned to follow either a Mediterranean diet or a low-
affect the response to cinnamon.”
fat diet and provided guidance about how to do so. The
3. C. A small double-blind trial in the Journal of the Mediterranean diet consisted of 35% fat, including 22%
Endocrine Society investigated cinnamon supple- monounsaturated fat (the main type of fat found in olive
mentation in people with prediabetes. Fifty-four par- oil and most nuts), and less than 50% carbohydrate. The
ticipants were given either a 500-milligram cinnamon low-fat diet consisted of 28% fat, including 12% monoun-
capsule or placebo (inactive) capsule three times a day saturated fat, and greater than 55% carbohydrate. Both at
for 12 weeks. The researchers found that participants the beginning of the study and after a five-year follow-up
taking the cinnamon supplements had improved fast- period, participants had their kidney function measured—in
ing plasma glucose levels and improved glucose toler- the form of estimated glomerular filtration rate (eGFR).
ance. They suggest that longer and larger trials should Overall, participants in both diet groups saw a decline
investigate the effects of cinnamon in prediabetes. in kidney function over the follow-up period. But among
participants with type 2 diabetes, there was a smaller
4. A. A meta-analysis in the Annals of Family Medicine
decline in kidney function in the Mediterranean diet group.
indicated that cinnamon may help lower lipid levels.
In contrast, participants without type 2 diabetes tended
The authors state, “The consumption of cinnamon
to experience about the same amount of kidney function
is associated with a statistically significant decrease
loss in both diet groups. For participants with type 2 dia-
in levels of fasting plasma glucose, total cholesterol,
betes, those who started out with mildly impaired kidney
LDL-C, and triglyceride levels, and an increase in
function experienced the greatest benefit from following
HDL-C levels.” But, they add, it is not known whether
a Mediterranean diet when it came to less decline in
the results can be applied to patient care, since the
kidney function, compared with following a low-fat diet.
appropriate doses and treatment length are not clear.
“The long-term consumption of a Mediterranean diet
Lisa Cantkier is a writer and educator specializing in nutri- rich in [extra-virgin olive oil], when compared to a low-fat
tion and health. She is coauthor of the diabetes-friendly diet, may preserve kidney function, as shown by a reduced
SHUTTERSTOCK

cookbook “The Paleo Diabetes Diet Solution.” decline in eGFR in [coronary artery disease] patients
with [type 2 diabetes],” the researchers concluded. DSM
12 DiabetesSelfManagement.com • Fall 2022
 Lower Magnesium
Levels Linked to Insulin
Resistance, Type 2
BY QUINN PHILLIPS
H aving a lower blood level of
magnesium is linked to a higher
risk of developing insulin resis-
tance and type 2 diabetes, accord-
ing to a new study published in the
journal Nutrients.
Magnesium is a mineral found
naturally in certain foods that is key
to health and well-being, but many
people don’t get enough of it in their
diet. Magnesium is involved in hun-
dreds of functions in the body, and
plays roles in energy metabolism and
creating proteins—two functions that
are especially relevant if you have a
metabolic or endocrine disorder like
obesity or type 2 diabetes.
For the latest study, research-
ers looked at the relationship
between blood magnesium
levels and new cases of
insulin resistance or type
2 diabetes in 5,044
adults ages 18 and
older in China,
who took part
in a research
study called the
China Health and
Nutrition Survey.
A fasting blood
sample was
used to look
at magnesium,
fasting blood glu-
cose, fasting insu-
lin, and A1C (a measure
of long-term blood glucose control)
at regular intervals throughout the
study. At the beginning of the study,
none of the participants had insulin
resistance or type 2 diabetes.
SHUTTERSTOCK
During an average follow-up
period of 5.8 years, 1,331 partici-
pants developed insulin resistance
and 429 developed type 2 diabetes.
When the participants were divided
into five groups of equal size (quin-
tiles) based on their magnesium
level, the researchers found that
the middle group—with a blood
magnesium level of 0.89 to 0.93
mmol/L—had a 29% lower risk of
developing insulin resistance than
the group with the lowest magne-
sium levels, after adjusting for other
factors known to affect the risk for
insulin resistance or type 2 diabe-
tes. The researchers found similar
results—a lower risk for insulin
resistance and type 2 diabetes at
moderate magnesium levels—when
they looked at magnesium levels
continuously, rather than comparing
groups of participants.
It’s important to note that the par-
ticipants in this study with lower
magnesium levels weren’t actually
deficient in magnesium, in most
cases. The range of magnesium seen
in participants fell almost entirely
within the “normal” range—showing
that even within this range, different
magnesium levels may affect the risk
of developing insulin resistance and
type 2 diabetes. But the researchers
noted that it’s unclear why there
was a U-shaped rela-
tionship between
magnesium lev-
els and devel-
oping insulin
resistance—
with the low-
est risk seen in
participants
who fell in the middle of magnesium
levels. More research is needed, they
wrote, to find out why this may be
the case, and whether there is an
optimal magnesium level to reduce
the risk for insulin resistance and
type 2 diabetes. DSM
Fall 2022 • DiabetesSelfManagement.com 13
 ••• THE DOSE ••• News & Notes
Physical Activity May Reduce
Neuropathy Risk in Type 1
BY QUINN PHILLIPS
I n people with type 1 diabetes for
50 years or longer, greater physi-
cal activity is linked to a lower risk of
developing peripheral neuropathy—
nerve damage affecting the limbs,
usually the legs or feet—according to
a new study published in the Journal
of Diabetes and its Complications.
Peripheral neuropathy often devel-
ops in people with diabetes as a result
of long-term exposure to elevated
blood glucose levels, which can lead to
nerve damage. It can cause uncomfort-
able to painful symptoms, which may
include numbness, tingling, or burning
sensations. Treatment guidelines for
peripheral neuropathy mainly focus on
reducing pain, rather than addressing
the underlying condition—but there is
some evidence that certain behaviors
can address some of the root causes
of neuropathy, as well as reduce the
risks associated with the condition.
For the latest study, researchers
looked at data from 75 participants
in a study called the Canadian Study
of Longevity in Type 1 Diabetes. The
average age of participants was 66,
14 DiabetesSelfManagement.com • Fall 2022
their average diabetes duration was
54 years, and their average A1C level
(a measure of long-term blood glucose
control) was 7.3%. As part of the study,
participants underwent a physical
exam, had their medical history taken,
and reported their physical activity
during the previous 12 months. For
this analysis, the researchers were
interested in comparing weekly physi-
cal activity levels with measures of
diabetic neuropathy—such as nerve
conduction tests, which use electrical
impulses to measure how well nerves
transmit signals. Physical signs and
reported symptoms were also used to
assess peripheral neuropathy.
The average amount of weekly
physical activity among participants
was 156 minutes, and 65 participants
(87%) had what’s known as distal
symmetric polyneuropathy (DSPN)—
neuropathy in both feet or legs. The
researchers found that participants
with DSPN had significantly lower lev-
els of physical activity than those with-
out the condition—an average of 141
minutes per week, compared with 258
minutes per week for those who didn’t
have DSPN. Greater physical activity
was also linked to better outcomes
on specific physical and neurological
measures, including cooling detection
threshold (ability to feel a cold surface
on the affected areas), peroneal and
sural amplitude, and conduction veloc-
ity (measurement of nerve function).
After adjusting for participants’ age
and A1C, the researchers found that
for every additional 30 minutes of
weekly activity, there was a predict-
able improvement in two measures
of nerve function—a 0.09 mv higher
peroneal amplitude and a 0.048 ms
lower peroneal F-wave latency.
“In longstanding [type 1 diabe-
tes], [physical activity] time is associ-
ated with superior large nerve fiber
function in the lower limbs and some
better measures of small nerve fiber
function,” the researchers concluded.
These results, they wrote, may pro-
vide a justification for studying the
effects of an exercise “prescription”
SHUTTERSTOCK
on neuropathy-related outcomes in
people with longstanding diabetes. DSM
 ••• THE DOSE ••• Product Spotlight

Cool New Products to Try

BY AMY CAMPBELL, MS, RD, LDN, CDCES

TheFitLife Nordic
Walking Trekking
Poles
Ready to get out and do
some walking? Walking is
one of the best physical
activities around, but
why not give yourself
Blue Cut Blue Light a total body workout
Blocking Glasses with trekking poles?
Staring at a computer all day or night can TheFitLife Nordic Walking
lead to eye strain and fatigue. But it’s not Trekking Poles are made
just your computer—tablets, smartphones, from sturdy, high-quality
flat-screen TVs, fluorescent lights, and aluminum. They’re super
more all emit blue light, a type of light light and adjustable for
that may cause tired eyes and lead to just about any height as
dryness, irritation, and headaches. What well. Using these poles
to do? Get yourself a pair of Blue Cut Blue on your walks or hikes
Light Blocking Glasses! These glasses are will give you balance and
engineered to filter out blue light, making stability, take pressure
it easier for your eyes to stay focused and off your knees and lower
free from strain, dryness, and fatigue. And back, and even increase
if you have trouble sleeping due to being your speed. When you’re
on your electronic devices before bedtime, done, simply collapse
these glasses will let you enjoy your them and store them
favorite TV shows, video games, and more away. The poles come
while still getting a restful night’s sleep. with a carrying bag, plus
amzn.to/3xSiM2v four interchangeable
tips for use with different
types of terrain. Choose
from five colors.
thefitlifestore.com

Harney & Sons Chamomile Herbal Tea

Chamomile tea is a go-to for many people who have trouble falling or staying
asleep. But chamomile tea has benefits that go beyond sleep—some research
shows that it may help promote a healthy heart and immune system and may
possibly protect against cancer. Harney & Sons’ Chamomile Herbal Tea sources
chamomile flower heads from Egypt, producing a quality tea with definite
body. This caffeine-free tea has a light floral scent with an undertone of apples.
The charming tin comes with 20 sachets, and each sachet brews two cups of
tea. Treat yourself to a well-deserved tea break (minus the caffeine).
harney.com

Fall 2022 • DiabetesSelfManagement.com 15

 ••• THE DOSE ••• Ask Away
Low-Glucose Dilemmas
BY GARY SCHEINER, MS, CDCES 
Q Last week, I felt like I had
low blood glucose, but when I
checked with my meter, my glucose
level was fine—in the 120s. This has
happened to me a few times. Does
this mean my normal blood glucose
is higher than for most people?
A I had to laugh when I read your
question because I asked my doc-
tor the same thing soon after I was
first diagnosed. But no, normal blood
glucose is the same for everyone: gener-
ally, around 70-110 mg/dl.
However, hypoglycemia (low glu-
cose) symptoms can be produced
by a number of things, including a
rapid decline in blood glucose level. A
glucose that drops from, for example,
250 to 150 very quickly can “fool” the
brain into thinking blood glucose is
low, when clearly it isn’t. This can
also happen to someone who usually
spends a lot of time with elevated glu-
cose levels and then tightens up their
control. Even though the glucose is
not in a hypoglycemic range, the brain
still generates signals that cause the
usual hypoglycemia symptoms. We
call this “relative” hypoglycemia. The
good news is that after several days,
the brain readjusts to the new, lower
glucose levels and stops generating
16 DiabetesSelfManagement.com • Fall 2022
the signals that produce symptoms.
Whether caused by a rapid decline
or an overall drop, normal glucose
levels do not usually require treatment
with carbohydrate. In fact, treatment
is often discouraged because it can
cause the glucose to rise too high. It is
always a good idea to perform a finger-
stick when symptoms of hypoglycemia
occur, not only to verify that the glucose
is truly low but also for determining
how much carbohydrate is needed for
treatment. Use of a continuous glucose
monitor (CGM) can also be helpful for
determining if the symptoms are due
to a rapid decline or a true low.
Q What exactly is a low blood
glucose “rebound”?
A As a basketball player and fan, I
sometimes boast that I lead the
league in rebounds … the kind that
happen after a bout of hypoglycemia.
A rebound refers to a high blood
glucose that follows a low, assuming
the high is not caused by overtreat-
ment with food. When hypoglycemia
occurs, the body may produce stress
hormones. These hormones can cause
food to digest extra fast, insulin to not
work as well, and the liver to release
stored-up glucose into the blood-
stream. If produced in large enough
amounts, these hormones can send
the glucose level well above normal.
To compound the problem, the high
that occurs after the low can be stub-
born to come down, even with extra
insulin or exercise.
The best way to avoid rebounds
is to catch lows as early as possible
and treat them as quickly as possible
with a proper amount of very-rapid-
acting carbs. By minimizing the dura-
tion and severity of the low, you can
also minimize the stress hormone
production that causes the rebound.
Checking your glucose at the first
sign of symptoms and treating right
away is one way to accomplish this.
Another is to use a CGM with the low
alert set above your actual threshold
for hypoglycemia (for example, at 80
or 90 mg/dl), keeping an eye on how
your levels are trending and treating
as needed. DSM
Gary Scheiner, MS, CDCES, has lived
with type 1 diabetes for 30 years and
was named Diabetes Educator of the
Year 2014 by the Association of Dia-
betes Care & Education Specialists.
SHUTTERSTOCK
Have a question about diabetes?
Email gary@integrateddiabetes.com.
 ••• THE DOSE ••• Curmudgeonly Athlete
A Boatload of Ways
To Stay Fit on a Cruise
BY ROB DINSMOOR
O nly a curmudgeonly athlete would
anticipate a Caribbean cruise
with trepidation: How am I going to
work out? That was my reaction when
I climbed aboard for a family vacation.
Yet I needn’t have worried. There were
plenty of ways to get my exercise.
Workout options aplenty
Commercial cruise lines are slowly
reopening for business following a
pause due to the COVID-19 pandemic.
Many of them have fitness areas with
treadmills, elliptical machines, sta-
tionary bikes, resistance training
machines, and free weights. Some
also offer group exercise classes,
which might include yoga, tai chi,
Pilates, dancing, and sometimes
trendy stuff like Spinning or Zumba.
You can also use your cabin or a low-
traffic spot on deck as a workout space
SHUTTERSTOCK
to practice yoga and perform calisthen-
ics (strength-training exercises that use
a person’s own body weight). Consider
bringing a jump rope, which can also
offer a high-intensity cardio workout.
On deck, the railings can be excel-
lent tools for doing stretches. You can
put one leg on the railing to stretch out
your hamstrings, and you can also get
a nice stretch by grasping the railing
with both hands, leaning back, and
pushing with your feet.
If there is a swimming pool, con-
sider swimming laps.
If you’re naturally antsy, strolling
the promenade deck can be a great
way to get low-intensity cardio. (Some
cruise ships even have outdoor jogging
tracks.) If you have a pedometer or
fitness watch or any kind of walking
or running app, you can keep track
of your mileage. Strolling the deck
also helps keep claustrophobia at bay
and gives you a chance to explore
fully everything the cruise ship has to
offer. While you’re strolling, why not
Cruises in a
Post-COVID
World
The U.S. Centers for Dis-
ease Control and Preven-
tion (CDC) has lifted some
of its restrictions on cruise
ships, but there are still
guidelines in place to
help prevent the spread
of COVID. Many of them are
common-sense measures
like wearing masks indoors,
but there are far too many
to list here. For comprehen-
sive information, read the
CDC regulations online at
bit.ly/3tdkXvL and contact
your cruise ship company.
skip the elevators and take the stairs
instead? You not only get more steps
(and mileage) in, but you also add
intensity to your workout.
Abandon ship! (Sorry, I couldn’t
resist.) I simply mean you should
get off the ship whenever possible
when it docks. Most cruise ships offer
excursions. This may take the form of
walking around the town, but some-
times cruises offer more adventurous
activities like hiking, biking, kayaking,
snorkeling, and scuba diving. (One of
the highlights of my Caribbean cruise
was kayaking in the Virgin Islands.)
Forging your own path
Finally, if you’re traveling with fam-
ily, it’s OK if everyone does their own
thing from time to time. If you want
to take the hiking excursion, there’s
no reason your fellow travelers can’t
do a shopping expedition instead. Bon
voyage! DSM
Fall 2022 • DiabetesSelfManagement.com 17
 ••• HEALTHY LIVING ••• The Right Moves
‘Fall’ Into Success
Exercises to improve mobility
BY LAUREL DIERKING, MED, NASM, 700-ERYT
S ummertime is often charac-
terized by warmth, energy,
and an increase in physical pur-
suits. As we transition to autumn
and adjust to the change in sea-
sons, and perhaps the personal
obligations that accompany this
time of year, it can be easy to
lose track of our gains and “fall”
into a pattern of complacency.
Mentally preparing for this tran-
sition ahead of time can ensure
continued success in whatever it
is that you would like to maintain,
keeping up your momentum as
the calendar inevitably inches
closer to the holiday season.
When setting goals, it is impor-
tant for long-term success to antic-
ipate and prepare for expected
roadblocks in your plan. For
example, if you are attempting
to exercise four days a week,
it is important to be realistic
about your ability to maintain
this schedule while you are, say,
traveling, entertaining company,
or working overtime. In other
words, don’t let the perfect be the
enemy of the good and realize that
there will be times when things
won’t go exactly to plan. Prepar-
ing in advance for the challenges
you may face can help ensure
your continued success despite
the inevitable obstacles.
When it comes to movement
success, it is critical to expand
our perception of what it means
to be “active.” Often in Western
culture, we think of exercising as
the primary means of being active
and may consider exercise fitness
to be the only form of successful
18 DiabetesSelfManagement.com • Fall 2022
activity. However, if we can change
our idea of “exercise” to instead
be “movement,” we can give our-
selves more variety and flexibility
in what we consider to constitute
an active lifestyle.
Movement is any physical
activity outside of rest, expanding
beyond structured exercise to also
encompass the activities of daily
living—playing with children, gar-
dening, housework, and so forth.
Our bodies crave movement, and,
in fact, are designed to be mobile
in order to stay flexible, lubri-
cated, and adaptable to changing
demands. In other words, the more
often and the more ways in which
we move, the better for our entire
system! Taking the stairs instead of
the elevator, parking further from
the entrance and walking, push-
mowing the lawn, and going for a
walk while talking on the phone
are all examples of ways to add
microdoses of movement into your
daily routine.
In addition to incorporating
more of this style of activity into
your day-to-day life, try these sim-
ple movements to keep your body
supple and facilitate mobility. DSM
Laurel Dierking, MEd, NASM,
700-ERYT, is a movement special-
ist with a concentration in yoga,
strength conditioning, exercise
physiology, and postural restoration.
With 10 years of extensive experi-
ence, Dierking seeks to enhance self-
awareness by guiding individuals
through mindful movement, func-
tional training, body awareness,
and breath work.
TRIGGER POINT FOOT ROLLING
• This can be done first thing in the
morning, at your desk, or (if your balance
allows) while brushing your teeth.
• Place a lacrosse ball, tennis ball (for an
easier option), or golf ball (for a harder
option) under one foot. Working across
the entire bottom surface area of your
foot, apply a modest pressure, rolling,
squeezing, stretching, and holding
pressure in certain areas. Continue for
a minimum of 90 seconds on each side,
breathing fluidly in and out of the nose.
SUPPORTED SIDE-BODY STRETCH
• Place a circular resistance band around
your wrists (or simply pull a small hand
towel firmly in opposite directions if you
do not have a band) and reach your arms
overhead, pulling apart firmly.
• Stand with your feet hip-width apart
and alternate bending (not rotating)
side to side as you reach your arms up
actively and apart firmly. (This can also
be done seated.) Exhale slowly and
completely with each side reach and
inhale normally to return to the center
between each side bend. You should feel
a stretch in your side and a firmness in
your shoulders and core.
• Complete five slow reaches to each side.
SQUAT TO PLANK, PLANK TO SQUAT
• Lower back into a squat, with your weight
in your heels. Stay as low in your legs as
you can and reach your hands to the floor
or yoga blocks (without straightening
your knees).
• Walk your hands and body forward,
staying low to the ground, until you reach
a pushup position. Hold here for one full,
slow round of breath, in and out.
• Reverse walk your hands back to your
feet, keeping your knees bent as much
as possible. Stay low in your legs and lift
your upper body back to your original
squat position.
• This is one round. Repeat three to five
times.
AARON ASHLEY

Fall 2022 • DiabetesSelfManagement.com 19

 ••• HEALTHY LIVING ••• Weighty Matters
‘Fall’ Into Weight
Management
BY DR. NICOLA DAVIES, PHD
M aintaining your healthy living
goals as you wave goodbye to the
summer can be difficult. The days are
getting cooler, comfort food is look-
ing more appealing, and the baggier
clothes are coming out of the closet.
The good news is that the outdoor
chills and the falling leaves also bring
plenty of opportunities for fitness and
weight management.
Take advantage of fall foods
Healthy fall foods include apples,
pumpkins, squash, and root vegetables.
These fruits and veggies are rich in
essential nutrients, including a vari-
ety of vitamins and minerals. Magne-
sium is a mineral found in an array of
autumn produce, such as butternut
squash and pumpkin seeds, that can
help regulate the body’s stress response
and improve sleep—both stress and
tiredness increase the risk of weight
gain. Vitamin C, which can be found in
abundance in fall foods such as Brus-
sels sprouts and cantaloupe, can help
prevent extra fat storage.
Fall root vegetables are a great
addition to soups and stews and,
thanks to their fiber content, will
20 DiabetesSelfManagement.com • Fall 2022
keep you fuller for longer. An added
bonus is that they can help improve
eye and skin health and reduce bad
(LDL) cholesterol and blood pressure.
Keep the germs away
Fall marks the beginning of increased
cases of flu and the common cold.
Managing your blood sugar may be
more difficult if you get sick, since
the body tends to release hormones
that increase blood sugar as it tries
to fight the illness. In addition, these
sicknesses often come with sudden
unintentional fluctuations in weight.
Fortunately, the preventative mea-
sures we have been taking against
COVID-19, such as frequent hand-
washing, can also help keep away
other illnesses. A side benefit of
spending time to clean and disinfect
your living space is the extra calories
you burn doing so. Why not clean the
entire house for a good workout?
Stay on track even when
you travel
Thanksgiving is a time when many
of us travel to be with our families.
Try not to stray from your weight
management goals during this time.
Your exercise regimen does not have
to hit pause if you decide to travel. If
you are in a safe environment, jog-
ging in the brisk morning air can be a
great way to start your day. If outdoor
exercise is not your style, there are
many indoor fitness activities to try.
For example, you can find and take
advantage of the local gym or follow
online fitness videos.
Other outdoor activities, such as
relaxing at a park or shopping at a
nearby farmers market, are great
ways to obtain vitamin D from sun-
light. Low vitamin D levels have been
associated with an increased risk of
depression and other mood disor-
ders, and reduced energy levels due
to poor moods can increase the risk
of weight gain. So, avoid the tempta-
tion of staying bundled up inside and
embrace that vitamin D fix before fall
is replaced with winter. DSM
Dr. Nicola Davies, PhD, health
psychology, is the author of “I Can
Beat Obesity! Finding the Motivation,
SHUTTERSTOCK
Confidence and Skills to Lose Weight
and Avoid Relapse.”
 ••• HEALTHY LIVING ••• Smart Smarter Smartest

Wraps, Buns, Tortillas,

and English Muffins
BY AMY CAMPBELL, MS, RD, LDN, CDCES

I f bread is getting too basic for you,

why not branch out and give a
wrap, bun, tortilla, or English muf-
fin a try? Yes, most of these contain
carbohydrate, but even if you’re “low
carbing” it, you’ll still find something
to fit your carb budget. When shop-
ping for wraps and the like, check
out the serving size and total carb
grams on the Nutrition Facts label.
A good goal is to aim for no more
than 30 grams of carb per serving.
But don’t stop there: check out added
sugars (if the label lists this), too.
Zero grams per serving is best, but
up to 2 grams is doable. While you’re
at it, be sure to glance at the sodium.
Surprisingly, bread and bread-like
SERVING
SIZE
products can pack a wallop when it
comes to sodium, even if they don’t
taste remotely salty. The goal here
is, ideally, no more than 240 mil-
ligrams (mg) per serving. Finally,
aim to choose whole-grain versions
whenever you can. The exception:
gluten-free products, since they are
often not made with grains. DSM
ADDED
CARBS SAT FAT PROTEIN FIBER SUGARS SODIUM
CAL (g) (g) (g) (g) (g) (mg)

SMART
Maria and Ricardo’s Whole Wheat Tortillas, Soft Taco Size 1 tortilla 140 22 0 3 4 1 300
Arnold Sandwich Thins Rolls 100% Whole Wheat 1 roll 140 28 0.5 6 4 2 280
Outer Aisle Cauliflower Sandwich Thins, Everything 2 pieces 120 5 3 10 1 0 310
Arnold Sandwich Thins Veggie Herb Made with Cauliflower 1 roll 150 28 0 7 3 1 310
Dave’s Killer Bread Killer Classic English Muffins 1 muffin 140 27 0 6 2 2 330
Stonefire Ancient Grain Mini Naan 1 naan 150 23 1 5 2 2 350
Mission Whole Wheat Original Soft Tortillas 1 tortilla 110 22 0 4 5 0 380
SMARTER
Fiber One Honey Wheat Wraps 1 wrap 80 15 0.5 6 7 0 220
Nature’s Own 100% Whole Wheat Hamburger Buns 1 bun 130 24 0.5 6 4 2 190
365 Whole Foods Market Whole Wheat English Muffins 1 muffin 120 23 0 5 4 1 230
Maria and Ricardo’s Gluten Free Quinoa Flour Tortilla, Soft Taco Size 1 tortilla 100 23 0 0 1 0 250
Joseph’s Flax, Oat Bran & Whole Wheat Pita Bread 1 pita 60 9 0 6 2 0 270
Joseph’s Flax, Oat Bran & Whole Wheat Lavash Bread 1/2 flatbread 60 8 0 6 2 0 290
Angelic Bakehouse 7 Sprouted Whole Grains Burger Buns 1 bun 140 25 0 7 5 2 290
SMARTEST
Ezekiel 4:9 Sprouted Flourless Low Sodium Tortillas 1 tortilla 140 26 0 7 5 0 0
La Tortilla Factory Organic Yellow Corn Tortillas 1 tortilla 60 12 0 1 2 1 0
Trader Joe’s Jicama Wraps 2 wraps 15 3 0 0 2 0 0
Toufayan Smart Pockets 100% Whole Wheat 1 pocket 100 17 0 5 4 0 50
Ezekiel 4:9 Sprouted Grain Burger Buns 1/2 bun 90 17 0 5 3 0 80
SHUTTERSTOCK

Tumaro’s Carb Wise Whole Wheat Wraps 1 wrap 60 12 0 5 7 0 105

Egglife Southwest Style Egg White Wraps 1 wrap 30 1 0 5 <1 0 170

Fall 2022 • DiabetesSelfManagement.com 21

••• HEALTHY LIVING ••• Food For Thought

Boosting the Nutrition

Value of Your Food
BY ALISON MASSEY, MS, RD, LDN, CDCES

SHUTTERSTOCK

22 DiabetesSelfManagement.com • Fall 2022

M any people struggle with their
relationship with food and how
to develop a well-balanced approach
to eating, a situation I’ve encountered
many times in my work as a dietitian
and diabetes educator. Often, clients
express feelings of guilt if they choose
to enjoy something they mentally
label as “bad” or deem less nutritious
than other choices. A diagnosis of dia-
betes can make this relationship even
more complex, with food choices and
their effects on blood glucose read-
ings on full display for the person to
see on their blood glucose meter or
continuous glucose monitor (CGM).
But blood glucose readings, while
informative, don’t tell the whole story.
The result on your meter doesn’t cap-
ture the moment of joy experienced
when you bite into that perfect peach or
share paella during a once-in-a-lifetime
vacation. Finding the balance between
managing health and experiencing
enjoyment through food is a tightrope
for many, but it doesn’t have to be with
support from a certified diabetes care
and education specialist (CDCES) and a
shift in mindset. While changing think-
ing patterns might, for some, require
work with a therapist, one strategy I
embrace is to focus on ways to elevate
the nutrition profile of favorite foods
versus eliminating them completely
(which some research suggests might
contribute to more cravings).
In this column, I’m sharing a few of
my preferred methods for boosting the
nutrition value of some of my favorite
foods to help you consider how you can
increase the nourishing components
of your favorite dishes. Elevating the
nutritional value of your favorite foods is
not about taking things away but rather
about boosting the flavor by adding
nutrient-dense ingredients. The best
part? That is the only “rule.” Get creative
by focusing on favorite flavors and even
using restaurant meals as inspiration to
make a “copycat” version at home. DSM
Alison Massey, MS, RD, CDCES, is
a registered dietitian and certified
diabetes care and education
specialist in Maryland. She blogs at
flourishmyhealth.com.
FAVORITE FOOD NUTRITION “BOOSTERS”
BURGER AND FRENCH FRIES
Switching to leaner ground meat and baking or air-frying french fries can be options
for nutritionally elevating your burger and fries. Why not also try boosting the nutri-
ents with some delicious toppings?
• Bruschetta topping (chopped fresh toma- • Onions
toes with garlic or onion, basil, and olive oil) Onions contain quercetin, a flavonoid
Bursting with flavor, the tomatoes, onions, (plant pigment) that acts as an anti-
and basil provide vitamin C and other inflammatory in the body.
nutrients. • Sauerkraut
• Coleslaw Some sauerkrauts contain probiotics (good
Cabbage is a great source of bacteria), which are beneficial for gut
vitamin C, vitamin K, and fiber. health.
CHEESESTEAK
A classic cheesesteak is a true delicious indulgence. If you are making it at home, con-
sider adding some additional topping options to increase the vegetable content of
your sandwich.
• Caramelized onions and a variety of other important nutrients.
Onions are a source of dietary fiber, vitamins • Red roasted peppers
C and B6, potassium, and other nutrients. Red peppers are a source of vitamins A and
• Mushrooms C and potassium.
These are a source of B vitamins, vitamin D,
PIZZA
There are so many delicious and nutritious ways to modify the classic pizza, whether
it is using different ingredients for the crust, switching the cheese, or topping with a
sauce that has less added sugars. After perfecting your pizza, consider adding some of
my favorite nutrition boosters, vegetables!
• Asparagus • Olives/olive oil
This veggie is a good source of potassium Olives are a source of heart-healthy fats.
and fiber. • Zucchini
• Arugula/spinach/kale/wedge salad Zucchini is a source of potassium and vita-
Daily salad consumption can add a variety min C.
of important nutrients to your diet.
TACOS
Tacos are a weeknight favorite for many. Try mixing it up a little by boosting your basic
tacos with some beans and lentils and topping them with sliced avocado and nutri-
tional yeast.
• Avocado • Lentils
Avocadoes contain heart-healthy fats and Like beans, their cousin in the legume family,
are a source of nearly 20 vitamins, minerals, lentils are also a source of protein and fiber.
and phytonutrients. • Nutritional yeast
• Beans Sprinkle this ingredient on for a boost of
Beans are a source of protein and fiber. extra cheesy flavor as well as added pro-
tein, vitamins, and minerals.
ICE CREAM SUNDAES
Ice cream, frozen yogurt, or “nice” cream (plant-based ice cream) tastes best with deli-
cious toppings to enhance the dessert. Try a combination of your favorite fruits, nuts,
and seeds.
• Chia seeds • Fruit
These seeds add fiber, omega-3 fatty acids, Switch up your fruit selections based on
and protein and are also a source of several seasonality to add some vitamins and min-
minerals and antioxidants. erals to your dessert.
• Flaxseed (ground) • Pistachios
Flaxseed contains omega-3 fatty acids, fiber, These nuts are a source of heart-healthy
and lignins, which provide antioxidants. monounsaturated and polyunsaturated
fats, protein, and potassium.
Fall 2022 • DiabetesSelfManagement.com 23
••• HEALTHY LIVING ••• Susan and T’ara’s Kitchen
Time to Tote Your Lunch!
Lunch boxes from around the world
BY SUSAN WEINER, MS, RDN, CDN, CDCES, FADCES, AND T’ARA SMITH, MS
A re you ready to pack a delicious,
flavorful, and easy-to-prepare
lunch? It’s time to jazz up your
midday menu with nutritious and
preportioned meals and snacks by
using a lunch box. A variety of lunch
boxes can be found across the globe,
designed to host our favorite foods.
Whether it’s a bento box in Japan,
a dosirak in Korea, a bian dang in
Taiwan or China, a tiffin in India,
or a schiscetta in Italy, it’s all about
organizing your lunch meal in a
simple and practical way.
Lunch boxes from across the globe
Susan says: Many cultures and
regions offer well-designed varia-
tions of meal containers or lunch
24 DiabetesSelfManagement.com • Fall 2022
boxes. They vary in style, material,
and size. A reusable lunch box comes
with a number of added bonuses too!
These are environmentally friendly
as compared to a throwaway bag,
simple to clean, and can keep your
lunch from getting squashed before
chow time. A well-designed lunch
box also prevents leaks and messes,
unlike a reusable or paper bag.
Let’s take a look at the types of
lunch boxes you can use to make
meal prep easier.
Bento box
Bento boxes, which originated in
Japan, are partitioned boxes that
include a “to-go” meal with an authen-
tic taste of home. Typically, foods are
portioned and neatly cut so that they
can be easily enjoyed with fingers or
chopsticks. Traditional bento boxes
are wooden, in a shokado (rectangu-
lar) or hangetsu (half-moon) shape.
They are available in Western coun-
tries in stainless and plastic materi-
als as well. In Japan, bentos can be
purchased at many convenience store
locations, takeout restaurants, and
train stations.
Dosirak
A dosirak (also known as gwakpap)
is the Korean equivalent of the Japa-
nese bento box and is comprised of
a plastic or insulated steel container,
SHUTTERSTOCK
with or without compartments. The
homemade dosirak may be packed
 From “My Indian Table: Quick & Tasty
Vegetarian Recipes” (amzn.to/3O4eTye),
by Vandana Sheth.
Curried Power
Bowl
7 SERVINGS | 1/7 OF TOTAL RECIPE
CAL 136 | FAT 3.6G | PROTEIN 6.6G |
CARBS 22.5G | SODIUM 197MG
1 tablespoon oil
1 teaspoon cumin seeds
1 large onion, chopped (about 11/3
cups)
2 serrano chilis, deseeded and
chopped (optional)
1/2 teaspoon ground red chili
1 teaspoon turmeric
1 teaspoon ground cumin
1 teaspoon ground coriander
1 teaspoon garam masala
1 teaspoon garlic
1 teaspoon ginger
8 cups cauliflower florets (about 2
pounds, or 1-11/2 large heads)
1 14-ounce can garbanzo beans
(also called chickpeas), rinsed
and drained
4 tomatoes, chopped
2-4 tablespoons chopped cilantro
(optional)
Bag of greens
1. Heat oil on medium-high setting in a
saucepan.
2. Add cumin seeds and sauté for about
1 minute, until darker brown.
3. Add onions and sauté until golden
brown.
4. Add serrano chilis, if desired, red
chili, turmeric, cumin, coriander, garam
masala, garlic, and ginger, and sauté for
1 minute.
5. Add cauliflower and mix well and
cook for about 5 minutes.
6. Add garbanzo beans and toma-
toes. Mix well, cover, and cook for 5-7
minutes.
7. Garnish with cilantro and enjoy!
Serving suggestion: Serve on a bed of
greens with a drizzle of cucumber raita
(yogurt sauce).
SHUTTERSTOCK
▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM
Want another authentic Indian recipe to try? Sheth shares a delicious
and nutritious recipe that works well with a tiffin or lunch box.
Pav Bhaji
(Spicy Mixed Vegetables and Toasted Wheat Bread)
4 SERVINGS | 1/4 OF TOTAL RECIPE
CAL 140 | FAT 5.1G | PROTEIN 3.6G | CARBS 18.2G | SODIUM 107MG
Base
1 tablespoon oil 1 14-ounce can low-sodium
11/2 teaspoons garlic, minced tomato sauce
4 cups riced vegetable 1/2 teaspoon ground coriander
medley (cauliflower, 1/2 teaspoon ground cumin
carrots, broccoli) or your 1/2 teaspoon ground red chili
choice of 4 cups cooked (optional)
vegetables (carrots, green 2-3 teaspoons garam masala
beans, bell pepper, and 1 teaspoon salt (optional)
cauliflower work well) 1 tablespoon extra-virgin
1 small potato, cooked, olive oil or 1 tablespoon
peeled, and chopped unsalted butter (optional)
1 14-ounce can low-sodium 1 tablespoon lime juice
diced tomato
Garnish
2-3 tablespoons finely chopped 1/2 cup finely chopped onions
cilantro (optional)
Pav/bread
Typically, this is a soft dinner roll that is buttered or in oil and pan
toasted. I recommend using a low-carb bread or wrap.
1. Heat oil in a kadai/wok on medium-high.
2. Add garlic and sauté for 1 minute (make sure that the garlic does not
burn).
3. Add riced vegetables or cooked vegetables, potato, diced tomatoes,
tomato sauce, coriander, cumin, red chili, garam masala, and salt.
4. Mix well, cover, and cook for 5-6 minutes, until all the vegetables are
soft and cooked.
5. Add extra-virgin olive oil or unsalted butter and mix well.
6. Turn off the stove.
7. Add lime juice, mix well, top with cilantro, and, if desired, onions, and
enjoy with low-carb bread or wrap!
“A popular street food dish that translates to bread and vegetables
(pav: bread, bhaji: vegetables). The delicious vegetables are cooked in
a tomato sauce infused with aromatic spices and enjoyed with bread,”
Sheth notes. “Traditionally, it is made with a lot of butter to offset some
of the spice level, and potatoes are the predominant vegetable used.
My version here is loaded with veggies and packed with flavor, and
lower in carbs and calories than the original version.”
Fall 2022 • DiabetesSelfManagement.com 25
••• HEALTHY LIVING ••• Susan and T’ara’s Kitchen

in tiered lunch boxes and contain cally pleasing. In recent years, the Sheth shares a recipe perfect for
soup, which is kept warm by insula- practice of using a schiscetta has second-day lunch dining. She says,
tion. The dosirak may also include become more of a dining experience. “This Curried Power Bowl recipe (page
kimchi, a side dish of salted and It often includes decorative plates, 25) came about one warm summer
fermented vegetables, and shredded utensils, and napkins to brighten day when I had arrived home from
gim, or seaweed. up lunchtime. work and wanted to relax with my
family. I pulled together a few ingre-
Bian dang Tiffin dients that I thought might play well
The lunch box of choice in Taiwan Vandana Sheth, RDN, CDCES, FAND, together and cooked this in a wok on
and China is called the bian dang. registered dietitian nutritionist and our backyard stove. This dish is in
The bian dang is a polystyrene box author of “My Indian Table: Quick & honor of my husband, who loves simple
and typically has four Tasty Vegetarian one-bowl meals. For any of you looking
compartments. Recipes,” shares for an Indian-inspired meal that comes
One compartment
is designated for T’ARA’S TAKE: “The tiffin box
is a traditional
together easily, give this a try. You could
make it for dinner and have leftovers
a combination of stainless steel/ for lunch in your tiffin box!”
rice and meat,
Don’t forget your metal lunch This recipe creates a delicious
and the others diabetes supplies! box that is one-bowl meal for convenience, fla-
host sautéed or Did you know that your lunch box is compartmen- vor, and easy clean-up. Sheth says,
steamed veg- a perfect tool for staying organized talized and “The golden hue of turmeric and
etables. The bian with your diabetes supplies? Some used to take aromatics turn each bite into a flavor
dang can be pre- lunch boxes or bags are designed food to go and and textural explosion. The addition
pared at home or with added storage space, which is the Indian of garbanzo beans to this recipe
purchased locally can be used for certain diabetes equivalent of a provides a nice protein and fiber
supplies. Use the extra storage in
(and very inexpen- bento box ... I upgrade.” Sounds delicious! DSM
your lunch box to store items such
sively) throughout as a lancing device, glucose tablets, have so many
Taiwan and China. and snacks to treat low blood sugar. fond memories Susan Weiner, MS, RDN, CDCES,
(Avoid storing meters, strips, insulin of my mom FADCES, is the owner of Susan Weiner
Schiscetta or other medications in your lunch packing our tif- Nutrition, PLLC, and coauthor of “The
Italy’s version of box, as they can be affected by hot fin boxes every Complete Diabetes Organizer” and
a lunch box is the and cold food temperatures.) morning ,” she “Diabetes: 365 Tips for Living Well.”
schiscetta, which recalls. “Typi- T’ara Smith, MS, earned her master’s
was originally cally, it would degree in nutrition education and
used by people who include a flat- dedicates her professional life to helping
couldn’t afford to buy a midday meal. bread roti or herb-and-spice-infused people with diabetes thrive. Together,
Now, folks throughout Italy embrace flatbread called thepla served along they created “Susan and T’ara’s Kitchen”
the idea of packing lunches that with yogurt, some spicy pickles, and to share nutrition tips, original recipes,
delight the palate and are aestheti- a vegetable curry.” and healthy living ideas.

Can’t go to Jamaica? Bring it to you with this Jerk Chicken recipe!

What is Jamaican jerk?
When you think of Jamaican food,
chances are that “jerk chicken” is top
of mind. But do you know where the
style of cooking originated? Jamaican
jerk is a blend of delicious flavors that
describe how food is seasoned and
cooked. It consists of warm flavors such
as Scotch Bonnet pepper, pimento
(allspice), cloves, cinnamon, and much
more. Jerk provides a rich flavor that
only intensifies when cooked, espe-
cially over a grill or in a smoker.
Historically, jerk is the legacy of the
Taíno—Arawak people indigenous to
Jamaica and other Caribbean areas—
and African cultures. With the help
of the Taíno, the Maroons—enslaved
Africans who escaped to the island’s
mountains—learned to preserve meat
with various spices and techniques that
would eventually become the method
to create jerk foods.
Today, you can find jerk seasoning in
plenty of grocery stores, and because Ja-
maicans have emigrated to cities all over
the globe—especially New York and
other cities along the eastern coast of
the United States—you can be certain
to find authentic Jamaican jerk foods
in many places, primarily jerk chicken.
However, jerk seasoning can be applied
to other cuts of meat, as well as seafood.
Because of jerk seasoning’s rich
flavors, it tastes even more delicious
the next day. Prepare it for dinner and
eat a portion of leftovers for lunch the
next day to take advantage! Use this
Jerk Chicken recipe as inspiration.

26 DiabetesSelfManagement.com • Fall 2022

 T’ARA’S TAKE:
Jerk Chicken recipe tips
The star of this recipe is the jerk
marinade. It works well with any cut of
chicken or can be used with another
kind of protein, such as fish or shrimp.
Want to intensify the flavor?
Marinate the chicken, pork, or another
protein overnight in the refrigerator.
If you want to turn the marinade
into a sauce, add water to thin it to your
desired consistency and bring it to a
boil in a saucepan for at least 5 minutes
to cook (to help prevent bacterial
growth). Or, you can reserve half the
marinade or make a new batch to use
as a sauce.
Not a fan of spicy foods? Remove
the seeds of the habanero or Scotch
Bonnet pepper or omit the peppers
completely.
Portion out the chicken by putting it
in the largest section of your lunch box.
Suggested sides for this dish are rice
and beans (traditionally called peas in
Jamaica), coleslaw, steamed vegetables,
or a side salad.

Jerk Chicken
6 SERVINGS | 1/6 OF TOTAL RECIPE
▼ LC
CAL 232 | FAT 9G | PROTEIN 31G | CARBS 8G

Jerk Marinade ½ tablespoon paprika 2. Place the chicken in a bowl or a gal-

3-4 scallions
½ cup chopped onion
3-4 sprigs or 1½ tablespoons
fresh thyme
1½ tablespoons fresh ginger
7 garlic cloves
1 habanero pepper (or Scotch
Bonnet pepper)
2 tablespoons low-sodium soy
sauce
2 tablespoons white vinegar
2 tablespoons canola oil
1 tablespoon allspice
1 tablespoon ground cloves
1 tablespoon lime juice
SHUTTERSTOCK
½ tablespoon nutmeg
½ teaspoon cinnamon
½ teaspoon pepper
½ teaspoon kosher salt
(optional)
Chicken
2 pounds thin-sliced boneless,
skinless chicken breast
Fat-free cooking spray
1. Combine all of the ingredients for
the Jerk Marinade in a food processor
or blender and blend for 1-2 minutes
until the consistency is slightly thick.
lon bag and pour the marinade on the
chicken. Toss the chicken in the mari-
nade to fully coat it, and let it marinate
for at least an hour in the refrigerator.
3. Coat a skillet or grill pan with fat-
free cooking spray and heat it over
medium heat for at least 3-5 minutes.
4. Shake off excess marinade and place
the chicken onto the heated skillet.
5. Cook the chicken on both sides until
it reaches 165°F internally.
6. Serve the chicken with your favorite
sides!

▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 27

28 DiabetesSelfManagement.com • Fall 2022
 ‘Fast ’ Food
Tips for quick, nourishing meals at home
BY ALISON MASSEY, MS, RD, LDN, CDCES

N eed some “fast” food ideas? Not

the kind from the drive-thru,
mind you, but a few nourishing meals
you can easily put together at home?
Here are time-saving tips and favorite
recipes from three registered dietitian
nutritionists for no-hassle meals that
even the novice cook can handle.
TIP 1
Plan to prepare
It’s undeniable that a little advanced
planning can go a long way to save
time with meal prep. Toby Amidor,
MS, RD, CDN, FAND, an award-win-
ning nutrition expert and author of
The Wall Street Journal bestseller
“Diabetes Create Your Plate: Meal
Prep Cookbook,” suggests “planning
ahead of time what you’ll be eating,
when you’ll go food shopping, and
when you’ll prepare the meal.”
Having a plan is the first step
in making meal prep much easier
during the week. If you are over-
whelmed with the process, start with
small steps. First, assess what you
have available in your pantry and
refrigerator, using some of those
items as the basis to create ideas
for your meals. Next, write down at
least two to four different meal ideas
for the week, considering what items
you might need to purchase at the
grocery store to make those meals.
After grocery shopping, think about
setting aside some time to prepare
some of the items in advance for the
meals. For example, washing and
slicing produce, making marinades
or salad dressings, cooking grains,
and grilling or roasting protein and
vegetables can save time when it
comes to putting together meals
later in the week.
TIP 2
Balance it
Having a “formula” to put together
meals quickly can decrease the
number of decisions you need to
make about food choices. Balanced
meals can look different depending
on dietary patterns and preferences,

Toby Amidor’s Greens and Grain Bowl

TOTAL TIME: 1 HOUR, 5 MINUTES | PREPARATION TIME: 15 MINUTES | COOK TIME: 50 MINUTES
4 SERVINGS | CUP (250 ML) CHARD MIXTURE, 1/2 CUP (125 ML) BROWN RICE, 1 TABLESPOON (15 ML) CHEESE
▲ FI
CAL 323.9 | FAT 12.2G | SAT FAT 2.6G | TRANS FAT 0.0G | PROTEIN 12.1G | CARBS 44.8G | SUGARS 5.5G | CHOL 8.3MG | FIBER
7.0G | SODIUM 439.0MG | POTASSIUM 540.2MG | PHOSPHORUS 164.1MG

2/3 cup (150 ml) long-grain brown
rice
11/3 cup (325 ml) low-sodium
vegetable broth
2 tablespoons (30 ml) olive oil
1 bunch rainbow chard, center
stems removed and leaves
coarsely chopped
13/4 cans (425 ml) low-sodium
chickpeas, drained and rinsed
1 cup (250 ml) cherry tomatoes
1 teaspoon (5 ml) dried oregano
1/2 teaspoon (2 ml) garlic powder
1/8 teaspoon (0.5 ml) salt
1/8 teaspoon (0.5 ml) ground black
pepper
1/4 cup (60 ml) crumbled feta
cheese
SHUTTERSTOCK
1 lemon, cut into 4 wedges 3. To store: In each of 4 containers, add
1. In a medium saucepan, add brown 1/2 cup (125 ml) of the brown rice and
rice and vegetable broth and bring to top with 1 cup (250 ml) of the chard
a boil over high heat. Reduce heat to mixture. Sprinkle each container with 1
medium-low and simmer, covered, un- tablespoon (15 ml) of the feta cheese.
til water is absorbed and rice is tender, Add 1 lemon wedge to each container.
40 minutes. Set aside and let cool for Cover and refrigerate for up to 4 days.
10 minutes. 4. To serve: Remove the lemon and
2. In a medium saucepan, heat oil over set aside. To reheat, microwave the
medium heat. When oil is shimmering, container uncovered on high for 60 to
add chard and cook until wilted, about 90 seconds. Allow 2 minutes for the
4 minutes. Add chickpeas and cherry heat to distribute before removing
the container from the microwave.
tomatoes and toss to combine. Add
oregano, garlic powder, salt, and pep- Squeeze the lemon wedge over the
per and toss evenly to coat vegetables. top before serving.
Cook for 5 minutes to allow the flavors (Recipe from “Diabetes Create Your Plate: Meal
to combine. Prep Cookbook” by Toby Amidor. Published by
Robert Rose Books. All rights reserved.)

Fall 2022 • DiabetesSelfManagement.com 29


4 Fast Meal
Ideas That
Registered
Dietitians
Recommend
Our experts shared a few of their favor-
ite quick meals that are sure to satisfy
your taste buds and nourish your
nutrient needs.
Greens and Grain Bowl (page 29)
“This bowl is easy to make, especially
if you meal prep it on Sunday and
eat it throughout your week. You can
also opt to make it during the week,
and you can additionally use leftover
brown rice or cook up the rice the
night before, which will minimize
much of the cooking time.”
—Toby Amidor, MS, RD, CDN, FAND
(instagram.com/tobyamidor)
Veggie-Lover’s Hummus Bowl
“One of my personal favorite (and
simple!) lunch options is a Veggie-
Lover’s Hummus Bowl. I generously
smear hummus into a bowl, top with
nonstarchy veggies—often freshly
roasted or pan-grilled—sprinkle with
olive oil, lemon, and pistachios and/
or sesame seeds, then scoop up with
fluffy whole-grain pita.”
—Jackie Newgent, RDN, CDN (insta-
gram.com/jackienewgent)
Vegetable, Turkey, and Cheese
Spinach Wrap
“I am a huge fan of veggie wraps.
They’re an easy way to use up extra
produce that you may have left over in
the fridge. My favorite wrap includes
a serving of arugula, tomatoes, bell
peppers, cucumbers, cheese, and lean
turkey wrapped up in a tasty, low-carb
spinach tortilla.”
—Andrea Mathis, MA, RDN, LD (insta-
gram.com/beautifuleatsandthings)
Spinach Salad With Hard-
Cooked Egg
“This simple salad can be whipped up
in about 30 minutes. Finish the plate
by adding one medium whole-wheat
roll to your salad.”
—Toby Amidor, MS, RD, CDN, FAND
(instagram.com/tobyamidor)
30 DiabetesSelfManagement.com • Fall 2022
but many of the key components
remain the same. The U.S. Depart-
ment of Agriculture’s (USDA’s)
MyPlate was introduced in 2011 but
still serves as a good basic repre-
sentation of a balanced meal, with
half of the meal including produce
like fruits and vegetables combined
with a source of protein and a grain
choice. After the basic foundation is
in place to construct the meal, that is
when the fun can begin.
Jackie Newgent, RDN, CDN, a
plant-forward chef, nutritionist, and
author of “The Clean & Simple Dia-
betes Cookbook: Flavorful, Fuss-Free
Recipes for Everyday Meal Planning,”
suggests adding a splash of vinegar
or a squirt of lemon or lime juice to
balance taste and add some zing to
meals. She also recommends “punch-
ing up plant protein, nutrient-rich-
ness, and crunch by finishing dishes
with nuts—a diabetes superfood.”
TIP 3
Save time with repetition
Monotony is OK sometimes, especially
when it comes to planning ahead for
certain meals. Meal planning requires
a lot of decisions, and a few repeated
meals throughout the week might help
reduce decision-making fatigue.
In order to ensure that your
repeated meal choices are nourish-
ing, consider using some of these top
tips for preparing easy and nutritious
meals from Andrea Mathis, MA, RDN,
LD, owner of Beautiful Eats & Things
and author of “The Complete Book of
Smoothies: 115 Healthy Recipes to
Nourish, Heal, and Energize.”
Add a serving of lean protein to
each meal. Lean protein choices can
include foods such as chicken, turkey,
seafood, eggs, pork loin, and low-fat
dairy. Looking for plant-based protein
options? Try tofu, tempeh, beans,
legumes, nuts, and seeds.
Include more whole foods
instead of highly processed foods.
Limit foods that may be prepared with
excess sodium, sugars, and saturated
fats and instead build meals around
whole-food options like whole grains,
beans, fruits, vegetables, nuts, seeds,
meats, poultry, seafood, and eggs.
Make nonstarchy vegetables a
priority, Mathis suggests including
more of your favorite nonstarchy veg-
etables, such as broccoli, spinach, and
green beans, with your meals. These
vegetables are loaded with various
nutrients, are low in calories and car-
bohydrates, and are a source of fiber.
TIP 4
Focus on flavors
A main reason we tend to gravitate
toward certain foods is because of
their flavor. Maximizing flavor is one
of the best ways to adjust recipes to
satisfy both your health needs and
taste buds. Learning how to add more
flavor to dishes can also save time in
the long run because it may encour-
age you to enjoy more meals at home
instead of eating out.
One simple way to add flavor to
dishes is by mixing in fresh herbs,
spices, and citrus zest. Another way
to boost the flavor profile of dishes
is to recreate some of your favorites,
focusing on great flavor with a healthy
twist. For example, Mathis suggests,
“if you’re a fan of Philly cheesesteaks,
try preparing stuffed Philly chees-
esteak bell peppers instead. You’re
still getting those same great flavors
of the traditional Philly cheesesteak
but in a much healthier way.”
Deconstructing best-loved dishes
can both help make meals that are
better for your health and add a new
favorite to your repertoire.
Step by step
The keys to creating fast meals that
are both delicious and nutritious are
diligence in preparation and having a
few staple ingredients on hand. Just as
with adopting other new habits, start-
ing with small steps like building your
pantry, creating lists of your favorite
foods, or simply putting together a meal
plan for the week will go a long way
in helping you meet your goal to put
tasty meals on the table in no time. DSM
Alison Massey, MS, RD, CDCES, is
a registered dietitian and certified
diabetes care and education
SHUTTERSTOCK
specialist in Maryland. She blogs at
flourishmyhealth.com.
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32 DiabetesSelfManagement.com • Fall 2022

 The

Fallacy
15 of

Hypoglycemia treatment is not one size fits all

BY GARY SCHEINER MS, CDCES

hen I was young and restless, my Pappy often said to me,

W “Rules are rules.” Of course, this was usually preceded
by my breaking of said rules. As I got a little older and life (and
Pappy’s hair) developed more gray areas, he softened his stance
a bit. “Rules are rules, but some rules are meant to be broken.”

Having lived with diabetes the way we treat hypoglycemia

for more than 36 years and
taught thousands of patients
through my diabetes practice,
I’ve discovered plenty of rules
that are just begging to be bro-
ken. One that truly stands out is
the “Rule of 15”—that standard
procedure for treating hypogly-
cemia (low blood sugar) with
exactly 15 grams (g) of carbohy-
drate and then waiting 15 min-
utes to see if it worked. While
this may provide a nice, easy-
to-remember starting point for
those who are recently diag-
nosed and overwhelmed with
new information, it rarely works
in real-life situations. Given the
importance of proper recovery,
needs to be customized to the
individual … and the situation.
Why is this so important?
Everyone who takes insulin or
medications that cause the pan-
creas to secrete more insulin
(sulfonylureas [e.g., glyburide,
glipizide, and glimepiride] and
meglitinides [e.g., repaglinide,
nateglinide]) is at risk of hypo-
glycemia. This includes those
who take basal (long-acting)
insulin only as well as those
who use the sophisticated new
automated insulin delivery sys-
tems (also called hybrid closed-
loop systems). It’s also worth
noting that hypoglycemia is not

Fall 2022 • DiabetesSelfManagement.com 33

limited to those with type 1 diabetes.
Approximately 50% of those with
type 2 diabetes who take insulin
also experience lows. But there is
a big difference between day-to-
day garden-variety lows (called mild
hypoglycemia) and severe lows that
may involve seizures, loss of con-
sciousness, coma, or death (severe
hypoglycemia).
What keeps a mild low from
becoming a severe low? Early detec-
tion and proper treatment. The early
detection comes from recognizing the
usual symptoms (e.g., shaking, sweat-
ing, rapid heartbeat, hunger, and, in
some cases, confusion or behavior
changes) and, nowadays, use of a
real-time continuous glucose moni-
tor (CGM) with the low alert turned
on and set above your true threshold
for hypoglycemia. For example, if
you want to keep your glucose from
going below 70 mg/dl, set your low
alert on your CGM at 80, 85, or 90
and treat it immediately when the
low alert occurs.
Proper treatment of hypoglyce-
mia requires two things: The right
type of food and the right amount.
With proper treatment, your glucose
should rise to a safe level quickly.
With improper treatment, you may
not reach a safe level, or you may
overshoot and wind up with a glucose
level that is too high. Or the treatment
may take too long to work.
An individualized approach
Treatment of hypoglycemia is some-
thing you should think about and
prepare for now—not when you’re
low and can’t think all that clearly.
Besides compromising our judgment,
hypoglycemia tends to make us really,
really, really hungry. So, do yourself
a favor. Don’t wait until a low is star-
ing you in the face to figure out what
to do. Determine the food types and
quantities now and put them where
you can access them easily.
First, let’s think in terms of quan-
tity. The amount of carbohydrate
needed to treat hypoglycemia varies
based on a number of factors, includ-
ing your body size, your usual target
glucose level, how low you are, how
34 DiabetesSelfManagement.com • Fall 2022
quickly your glucose is dropping,
and whether or not you are using an
automated insulin delivery system.
1. Body size. Every gram of carbo-
hydrate will raise your blood sugar by
a unique amount. Ten grams will raise
the blood sugar of a small child much
more than a fully grown adult. This
is due to the fact that bigger people
have more blood volume into which
the glucose will dissolve. Chemical
equations aside, suffice to say that
the bigger you are, the more car-
bohydrate it will take to raise your
blood glucose level. The chart below
summarizes our clinic’s observations
as to the amount that each gram of
carbohydrate raises a person’s blood
glucose based on their weight:
WEIGHT IN BG RISE PER GRAM OF
POUNDS (KG) CARB IN MG/DL (MMOL/L)
<60 (<27) 8-10 (.44-.55)
61-90 (27-40) 6-7 (.33-.39)
91-130 (41-59) 5 (.28)
131-180 (60-81) 4 (.22)
181-240 (82-108) 3 (.17)
241-300 (109-136) 2.5 (.14)
>300 (>136) 2 (.11)
2. The amount you want your
glucose to rise. The lower your glu-
cose, the more carbs you will need to
get back up to your usual target. And
if you define the “target” as 120 mg/
dl (6.7 mmol/l), you will need more
carb than if you define the “target”
as 100 mg/dl (5.6 mmol/l). The table
below provides guidance based on
body size, with a goal of raising the
glucose to approximately 120 (6.7).
If you’re a “math” person, another
way to determine the amount needed
is with this formula:
BLOOD GLUCOSE (MG/DL)
BLOOD GLUCOSE (MMOL/L)
WEIGHT IN POUNDS (KG):
61-90 (27-40)
91-130 (41-59)
131-180 (60-81)
181-240 (82-108)
241-300 (109-136)
>300 (>136)
(Target BG – Current BG)/BG rise
per gram of carb
For example, if your target is 110
mg/dl, your current blood glucose
(BG) is 63 mg/dl, and each gram of
carb raises you 4 mg/dl, then you
need (110 – 63)/4, or 12g carb.
3. The rate of change. This is
easily seen on a continuous glucose
monitor (CGM). If your glucose is
low and falling quickly, you will need
more than the “usual” amount of carb,
based on the chart at the bottom of
this page. If you are low and leveling
off, the standard amount should work
fine. Here is an approach you can try:
ARROWS ADJUSTMENT TO GRAMS OF
ON CGM CARB FOR TREATING LOW
No adjustment (usual treatment)
No adjustment (usual treatment)
Add 25% to the usual treatment
or Add 50% to the usual treatment
For example, if you would nor-
mally use 16g carb to treat a low but
you have one down arrow present
( ), add 16 x .25, or 4g, to your treat-
ment: 16 + 4 = 20g total carb needed
If you’re not in the mood to use a
calculator, a simpler (but less precise)
approach is to add 5g carb for each
straight-down arrow (10g per arrow
if you weight more than 200 pounds).
If you don’t have a CGM, get one.
It is the best tool for understanding
the situation. If you can’t (or won’t)
access one, consider how much insu-
lin on board you have from your last
dose of rapid-acting insulin. If you
took your last dose within the past
three hours, you are probably drop-
ping quickly; assume that you have
“down arrows.” If it has been more
than three hours, the drop is probably
70s 60s 50s 40s <40
3.9-4.4 3.3-3.8 2.8-3.2 2.2-2.7 <2.2
5g 6g 7g 8g 10g
7g 8g 10g 11g 13g
9g 11g 13g 15g 17g
11g 14g 16g 19g 21g
15g 18g 22g 25g 28g
18g 22g 26g 30g 34g
mild; don’t assume that down arrows
are present.
Besides insulin, exercise activity
is something that can cause blood
glucose levels to drop very rapidly.
If a low occurs during or right after
exercising, you are likely to need
25-50% more than the usual amount
of carb to treat the low.
Food eaten in the past couple of
hours can also affect the direction
your blood glucose is headed. If you
had a meal or snack that consisted
of slowly digesting foods (such as
high-fiber or high-fat items), there
is a very good chance that the carbs
in the food are still in the process of
digesting, and the blood glucose is
dropping at a slow rate. Not that you
should ignore the low, but the usual
amount of carb should work fine. In
some instances, less than the usual
treatment amount may suffice.
4. The impact of A.I.D. We live in
an age where technology is assisting
with many aspects of daily diabetes
management. Many people with insu-
lin-dependent diabetes use automated
insulin delivery (A.I.D.) systems that
automatically raise or lower insulin
delivery based on glucose level and
the direction it is headed. When the
glucose is projected to go below a
target threshold, basal insulin deliv-
ery is reduced or stopped completely
for a period of time. As a result, any
low glucose that occurs will be less
severe than if the system had not
made any adjustments.
What this means is that we simply
don’t need as much carbohydrate to
treat our lows when the A.I.D. system
has reduced basal insulin delivery.
Taking the usual amount of carb
will usually result in a rebound high
within the next hour or two. Consider
reducing the amount of your hypo
treatment by 25-33% when using an
A.I.D. system.
Quality matters
Once you know how much carb is
needed to deal with a low, the battle is
half over. But you still have to choose
the right type of carbs. All carbs are
not created equally. Some will raise
your blood glucose very quickly, while
others will take their sweet time (pun
intended). When hypoglycemia hits,
choose a food that will raise the glu-
cose as quickly as possible.
Dextrose is the fastest form of car-
bohydrate for raising blood sugar.
Glucose tablets and glucose gels are
made with dextrose. Several candies
are also made with dextrose, includ-
ing Smarties, SweeTARTS, Nerds,
Runts, Spree, and Pixy Stix. Check
the ingredient label on candies to
see if dextrose is the first item listed.
If you don’t have ready access to
foods containing dextrose (or you
don’t care for the taste), several ordi-
nary foods work almost as quickly.
Carbs in liquid form tend to absorb
pretty fast. Liquid options include
grape juice, sports drinks, and regu-
lar (sugar-sweetened, not diet) soda.
The next-best choices include starchy
foods that break down very easily,
such as bread, crackers, and dry
cereal. Foods that are high in fiber or
fat (such as whole fruit or chocolate)
tend to digest slower and are not
ideal for treating a low. Likewise,
dairy products like milk, yogurt, and
ice cream tend to take a long time to
raise the blood sugar. And the longer
it takes for the glucose to come up,
the more likely you are to continue
dropping or overtreat.
Right on time
Many people overtreat their lows by
continuing to eat until their symp-
toms disappear completely. It usually
takes five to 10 minutes for even the
rapidest-acting carbs to start raising
blood glucose levels and 60 to 90
minutes for them to digest completely.
So be patient! It is fine to check your
blood sugar 15 minutes after treat-
ment, but don’t be surprised if it
hasn’t risen all the way to normal. As
long as your glucose level has begun
to rise, you should be fine. If it has not
risen at all (or has dropped further),
then go ahead and treat again.
If you use a CGM, it is important
to take “lag time” into account. CGMs
tend to take a long time (sometimes
30 minutes or more) to show any
glucose rise after hypoglycemia has
been treated. In other words, don’t
count on your CGM to let you know
when (and how much) your glucose
has risen for the first 30 to 60 minutes
after treatment. Doing so can make
you think your glucose is lower than
it really is and lead to overtreatment.
Instead, use finger-stick readings to
measure your progress during recov-
ery from a low.
One other note: It is not usually
necessary to consume a “slow-digest-
ing” food (such as a fat/protein-
containing snack) during or after
treatment of a low. As long as your
insulin/medication program is set up
properly, there is no reason to think
that your glucose will drop again soon
after it has risen. If your glucose does
tend to drop a second time, it may be
time to speak with your diabetes care
team about reducing your medication
or basal insulin doses.
Make Pappy happy
None of us is perfect when it comes
to treating lows. I’ve had more than
my share of middle-of-the-night hypo-
induced chocolate binges over the
years, and some (while working out)
where I delayed treatment or failed to
wait long enough for the treatment to
take effect. Instead of a quick recovery
and return to normal activities, I felt
lingering adverse effects: continued
glucose drops, prolonged rebound
highs, sugar headaches, sluggishness,
and enough calories consumed to feed
a small army. But I’ve learned from
those events. Hypoglycemia is disrup-
tive enough. Why prolong the agony?
Treat your lows right. That’s one
rule that Pappy and I can agree on. DSM
Gary Scheiner, MS, CDCES, is Owner
and Clinical Director of Integrated
Diabetes Services (integrateddiabetes.
com), a worldwide practice specializing
in intensive insulin therapy. He is author
of several books, including “Think Like A
Pancreas: A Practical Guide to Managing
Diabetes With Insulin,” and was named
2014 Diabetes Educator of the Year by
the Association of Diabetes Care and
Education Specialists. Scheiner has lived
with type 1 diabetes for 36 years. He can
be reached at gary@integrateddiabetes.
com or (610) 642-6055.
Fall 2022 • DiabetesSelfManagement.com 35
 Return to School
With Success!
Tips for helping your child with type 1 diabetes in the classroom
BY JOANN STEVELOS, MS, MPH

Ohybrid schools, and virtual schools have upended

ver the course of the past few years, lockdowns,

families’ schedules and the critical routines that help

keep children with type 1 diabetes safe and healthy.
Establishing new school routines or re-establishing
old ones can feel overwhelming. But setting up daily
routines for your child with type 1 diabetes will pre-
vent stress and set the stage for positive interactions
with everyone involved in their care. (Remember,
to stick to routines, children will need positive rein-
forcements, a healthy dose of encouragement, loving
kindness, and celebration!) With the school year
getting under way, here are some strategies that can
help smooth your child’s transition back to school.

Helping your child make healthy food choices

at school
Food is an essential part of school culture and is
often made to be a fun, social, and enjoyable part of
your child’s school day. What your child with type 1
diabetes eats is just one of many things that affect
their blood sugar levels. Balancing their diabetes and
dietary needs with their school’s food culture can be
challenging but also rewarding. 
Whether you and your child decide to make lunch,
buy lunch, or a combination of both, getting into the
routine of choosing foods together will help your
child enjoy school and foster a sense of control in
managing their condition. 
SHUTTERSTOCK

36 DiabetesSelfManagement.com • Fall 2022

Fall 2022 • DiabetesSelfManagement.com 37
Snack and lunchtime
The best snacks and lunches for a
child with type 1 diabetes are bal-
anced with their insulin regimen.
Whether your child brings their own
snacks and lunch to school or buys
lunch there, it is vital to allow them
to help choose the foods they will eat.
In general, packing snacks and
lunches for a child with type 1 dia-
betes isn’t much different from
packing for a child without dia-
betes because the most important
thing is to have a balanced diet. One
crucial difference for a child with
type 1 diabetes, though, is that you
must be mindful of the carbohydrate
content of foods because that affects
your child’s blood glucose levels. (If
your child uses an insulin pump, it
can be easier to adjust to different
amounts of carbohydrate at meals
since the pump will have a built-in
bolus calculator to help determine
how much insulin to take for meals.)
Help your child select meals that
contain a combination of healthy
carbohydrates, fiber, healthy fats,
and protein. Planning snack and
lunch menus together can give your
child a feeling of independence.
They will be more likely to eat foods
that help manage their health and
Safe at School  your discussions to all involved.
The Safe at School campaign from
the American Diabetes Association
(ADA) can help you learn more about
ensuring your child’s needs are met:
bit.ly/3aFrAR6
blood glucose levels if they have
played a role in choosing the items.
One tool that can help with plan-
ning balanced snacks and lunches is
Japanese Bento boxes. These com-
partmentalized boxes are handy for
packing lunch for a child with type 1
diabetes because they allow for many
combinations of portion-controlled
and balanced meals and simultane-
ously present the food in a fun and
attractive way.  Research Foundation), your child’s
Bento boxes also can turn all your
child’s favorite snacks into a healthy
38 DiabetesSelfManagement.com • Fall 2022
lunch. For example, their box could
be filled with slices of cheese, whole-
grain crackers, grape leaves, crunchy
carrots with a yogurt dip, sliced ber-
ries, and sliced apple. One way to
positively reinforce and remind your
child to practice carbohydrate count-
ing is to write the number of carbohy-
drates contained in each food on the
box’s lid, along with an encouraging
message or picture for your child.
If you decide that buying a school
lunch is an option for your child, this
may help them feel more included
and not different. One way to ensure
success is to make a routine of looking
over the school menu each week with
your child and then calculating each
meal’s carbohydrate content to deter-
mine the appropriate insulin dose.
Coordinating care at school in
four steps
1. Start the conversation. Ideally, it
would be possible to set up a meet-
ing including everyone who will be
involved in your child’s care, where
you can speak with the principal, your
child’s teachers, and the school nurse,
sharing concerns, hopes, and care
protocols. Due to scheduling conflicts,
it may be challenging to accomplish
this in a single meeting, so you may
need to schedule several appoint-
ments and then send a summary of
2. Build your team. Suppose your
school staff is not familiar with type 1
diabetes. In that case, you may need
to schedule a time with a pediatrician
to provide a brief presentation on the
basics of the condition in school-age
children. Use this time to ask your
child’s school to be a partner in your
child’s care. Discuss the best way to
communicate about your child’s type
1 diabetes and their safety and health
at school.
3.  Assemble a school diabetes
emergency kit. Having a diabetes
emergency kit for your child at school
can give you peace of mind in the
event of an emergency. According to
JDRF (formerly the Juvenile Diabetes
school diabetes emergency kit should,
at minimum, include the following:  Every child with type 1 diabetes
Packing for a
Field Trip
Here is a checklist for ensuring all
the diabetes essentials are covered
on field trips. Have a school field trip
bag always packed and ready to go,
including the following (based on
the types of management devices
your child is using):
• Blood glucose meter
• Test strips
• Extra batteries for devices such as
glucose meters, CGMs, and insulin
pumps
• Insulin pump infusion sets
• Insulin pump reservoirs
• Bottle of insulin
• Two insulin syringes
• Two ketone test strips
• Glucose tablets
• Extra insulin (about a two- to
three-day supply for emergen-
cies such as hurricanes, earth-
quakes, lockdowns, etc.).
• Extra insulin pen needles,
syringes, or pump infusion sets.
• Treatments for low blood glucose.
• If your child’s management plan
calls for them, snacks like crack-
ers, energy bars, etc.
• A glucagon kit (for rapidly rais-
ing severely low blood glucose),
the use of which should be
reviewed with school personnel.
• A brief outline of your child’s
insulin regimen and meal plan.
• Anything else you can think of
that would be necessary for the
care of your child by someone
else.
The kit should be replenished from
time to time. Use these occasions as
an opportunity to revisit your child’s
school plan and check in with your
child’s school team.
4.  Learn about 504 Plans.  In
building a partnership with your
child’s school, it is essential to under-
stand 504 Plans. These legal written
documents help hold your child’s
school accountable for your child’s
health care needs while in school.
should have a 504 Plan for the teach-
ers and the school nurse. This type
of plan falls under Section 504 of the
Rehabilitation Act of 1973, part of the
federal civil rights law prohibiting
discrimination against public school
students with disabilities. A 504 Plan
outlines how a child’s specific needs
are to be met with accommodations,
modifications, and other services.
These measures “remove barriers” to
learning. Scheduling time with your
child’s teacher and the school nurse to
review the 504 Plan can prevent mis-
haps. According to JDRF, the 504 Plan
should address the specific needs of
the child and provide detailed instruc-
tions related to the following:
• Outlining times and places
for blood glucose monitoring,
including accommodations for
both monitoring and treating.
• Ensuring that staff members
are trained in checking blood
glucose levels, recognizing and
treating high and low blood glu-
cose symptoms, and administer-
ing both insulin and glucagon.
• Allowing the student to eat
whenever and wherever neces-
sary, including eating lunch at
an appropriate time and allow-
ing enough time to finish eating.
• Allowing extra trips to the bath-
room or water fountain.
• Ensuring the student’s full par-
ticipation in all sports, extracur-
ricular activities, and field trips,
with the necessary care and/or
supervision.
• Permitting extra absences for
medical appointments and sick
days when necessary, without
penalty.
• Outlining the parent’s role in the
504 process.
You and your child deserve a plan
Learn More About 504 Plans
These resources provide more information about crafting a 504 Plan for your child:
American Diabetes Association Sample Section 504 Plan
bit.ly/3mzQoww
Understood: What Is a 504 Plan?
u.org/3NF0dVX
that works for you. Collaborate with
the school as an ally looking out for
your child’s needs.
Providing education on type 1
symptoms versus behavioral
issues
Help your child, their teachers, and
school staff understand that low blood
sugar in a child with type 1 diabetes
can come on quickly and needs to be
treated right away. Ask your child’s
teacher and school nurse to help your
child remember to monitor their blood
glucose levels before lunch and before
recess to ensure they are eating enough
and not overdoing it during recess
and physical education classes. Differ-
ent children experience different low
blood glucose symptoms, so school staff
should be familiar with your child’s
specific symptoms. Sometimes type 1
diabetes symptoms may be misinter-
preted as behavioral issues. Low blood
glucose symptoms could include:
• Shakiness
• Nervousness or anxiety
• Sweating, chills, or clamminess
• Irritability or impatience
• Dizziness and difficulty concen-
trating
• Hunger or nausea
• Blurred vision
• Weakness or fatigue
• Anger, stubbornness, or sadness
The best time to discuss your
child’s type 1 diabetes with their
teacher and school nurse is before the
school year begins. Ask your child’s
teacher and school nurse for sched-
uled calls or emails about your child’s
school routine. This will help ensure
your child’s type 1 diabetes is being
managed well in school (and be sure
to offer more support to your child at
home, if needed).
T1D and COVID-19: Going back
to school during a pandemic
As children get ready to head back
to school in the midst of the ongoing
pandemic, some parents may wonder
if they should send their child back to
school in person or, if it is an option,
choose remote learning. 
Here are some things to consider
when deciding:
Local situation. Check in with
your local public health department
about the infection rates in your
region and then weigh the risk of
your child attending school. Does
your child’s school have COVID-19
prevention measures in place? 
Risk. Type 1 diabetes is an autoim-
mune condition and not an immuno-
compromised condition (the latter of
which increases the risk of COVID-
19). According to current research,
children with well-controlled type
1 diabetes face the same chance of
getting COVID-19 as children without
type 1 diabetes. 
Personal risk assessment.
Are all family members trying to
minimize possible exposure to
COVID-19 with measures such as
physical distancing, hand hygiene,
and wearing masks? 
School protocols. Does the school
have a vaccination policy for all chil-
dren and staff eligible for the COVID-
19 vaccine and boosters?
Back to school, one day at a time
Helping your child with type 1 dia-
betes navigate the changing school
environment is not for the faint of
heart. It’s challenging, demanding,
and downright tricky at times, but
creating a routine will help you man-
age different tasks. Most importantly,
routines will help your child with
type 1 diabetes be more thoughtful,
confident, and responsible while at
school. Remember, take it one day at
a time, be flexible, be kind to yourself,
and encourage your child to ask for
help when needed. DSM
JoAnn Stevelos, MS, MPH, is a public
health researcher and evaluator
who specializes in childhood obesity
prevention.
Fall 2022 • DiabetesSelfManagement.com 39
 SHUTTERSTOCK

40 DiabetesSelfManagement.com • Fall 2022

Snore
No
More
Sleep apnea is a common condition,
but treatments are available
BY ROBERT S. DINSMOOR

S
noring can be more than just an inconve-
nience for you or whoever is sharing your
bed. It can be a sign of sleep apnea—shallow
breathing or pauses in breathing during sleep.
Sleep apnea can cause excessive sleepiness
during the day, difficulty concentrating or stay-
ing alert, and irritability. It can also be directly
hazardous to your health, raising your blood
pressure and making your diabetes more dif-
ficult to control, among other potential issues.
Here’s how to find out whether you have it and
what you can do about it.

Fall 2022 • DiabetesSelfManagement.com 41

 Causes and risk factors
There are two basic types of sleep
apnea: obstructive sleep apnea (OSA)
and central sleep apnea (CSA). By far
the most common type of sleep apnea
is obstructive sleep apnea, in which
the airway collapses or becomes
blocked during sleep. Central sleep
apnea, which affects fewer than 10%
of people referred to sleep clinics,
occurs when, for whatever reason,
the area of the brain that controls
breathing during sleep fails to send
the right signals to the muscles
involved in breathing.
There are many risk factors
for developing sleep apnea. Being
male, over the age
of 40, or obese
Getting the Most can increase
the risk of other disorders. One of
the biggest concerns, especially for
people with diabetes, is an increased
risk of heart disease and heart failure.
When sleep apnea causes the level
of oxygen in the blood to drop, this
can trigger the body’s “fight-or-flight”
response, increasing the heart rate
and blood pressure. These responses
can increase the risk of atherosclero-
sis, the buildup of plaque on the walls
of blood vessels. Atherosclerosis sets
the stage for heart attack and stroke.
In people with diabetes, sleep apnea
can also increase blood glucose levels.

Out of CPAP
While CPAP is a proven treatment for
sleep apnea, its effectiveness is limited
when it isn’t used correctly—or isn’t
used at all. The Mayo Clinic offers a
number of suggestions about possible
problems with CPAP and ways to get
around them.
Masks come in all shapes, sizes,
and designs. For example, some
masks cover both the nose and the
mouth. These are more effective for
people who prefer to breathe through
their mouth during sleep, but some
people feel “claustrophobic.” Other
masks deliver air just through the nose
and cover less of the face. Work with
your doctor and your mask supplier
to ensure that you have the style best
suited to you and a properly fitting
mask.
CPAP definitely takes getting used
to. The Mayo Clinic suggests that you
first wear just the CPAP mask for short
periods of time while you’re awake.
Then try the mask with it hooked up to
the machine while it runs. Eventually,
you can try sleeping with the mask in
place and the machine running.
Some people experience a dry,
stuffy nose with CPAP. Fortunately,
some CPAP units come with a heated
humidifier, and applying a saline solu-
tion to the nose at bedtime may also
your risk of
the condi-
tion. Other
Certain
habits can
things that
may pre-
dispose
increase
people to
sleep apnea
are having a
large neck circum-
ference, an enlarged
tongue or tonsils, a nar-
the risk
row upper jaw, or an
undersized or reced-
ing lower jaw or chin.
People with allergies,
of sleep
nasal congestion, or
gastroesophageal reflux
disease (GERD, the most
apnea.
common symptom of
which is heartburn) are also
at increased risk.
Certain habits can increase the
risk of sleep apnea. Drinking alcohol Diagnosis
can relax the muscles in the mouth If you think you might have sleep
and throat, narrowing the upper air- apnea, see your doctor. They may ask
way and leading to obstructive sleep you about your symptoms, possible
apnea. It can also depress the activity risk factors, and any family history of
of the muscles used for breathing. sleep apnea or other sleep disorders.
Smoking can promote inflammation During the physical examination, the
in the upper airway, and it, too, can doctor will search for signs of physical
affect the muscles that control breath- conditions that may increase the risk
ing. Poor diet, especially in combina- for sleep apnea, such as obesity, large
tion with inactivity, can cause weight tonsils, narrowing of the upper air-
gain and thus promote obstructive way, a large neck, or a large tongue.
SHUTTERSTOCK

help. sleep apnea. In some cases, the doctor may refer

SOURCE: MAYO CLINIC Sleep apnea may, in turn, increase you to a sleep center or sleep special-
42 DiabetesSelfManagement.com • Fall 2022
 ist. A sleep study may be performed
at home or at a special sleep center.
It can uncover disorders that aren’t
otherwise apparent, such as pauses
or slowdowns in breathing, high or
low activity in the muscles that con-
trol breathing, low oxygen levels in
the blood during sleep, and unusual
brain or heart activity during sleep.
Treatment
As with most disorders, doctors gen-
erally begin treating sleep apnea with
the gentlest, least-invasive measures
first. The first line of therapy is life-
style changes, such as eating a healthy
diet and limiting alcohol intake, espe-
cially right before bedtime. Stopping
smoking can also lower the risk of
sleep apnea, as well as a host of other
conditions, including heart disease.
For people who have overweight or
obesity, losing weight can help allevi-
ate sleep apnea.
Regular aerobic exercise
can also help. The U.S.
Department of Health and
Human Services (HHS)
recommends getting
at least 150 minutes of
moderate aerobic activity
every week (plus two days
of “muscle-strengthening
activity”), which might take
the form of, say, walking for 30
minutes five times a week. Aerobic
exercise directly helps the lungs,
decreases stress, lowers blood pres-
sure, lowers the risk of heart disease,
and even lowers the risk of type
2 diabetes. In addition to directly
reducing sleep apnea, exercise also
helps manage weight.
Your doctor may also prescribe
some type of breathing device. One
of the most commonly used devices
is a CPAP (continuous positive airway
pressure) machine. CPAP treatment
basically involves wearing a mask
strapped over your nose or both your
nose and mouth. The mask is con-
nected via a tube to the machine,
which forces air through the tube
to keep your airways open. For the
treatment to work, patients must use
SHUTTERSTOCK
the CPAP machine every time they
sleep or nap, whether at home or
while traveling. CPAP takes patience
(see “Getting the Most Out of CPAP”
on the facing page), and your doc-
tor should work with you to find a
comfortable-fitting mask, the type of
CPAP apparatus you should use, and,
if necessary, a humidifier chamber.
Some people immediately notice
improvements from CPAP, such as
mg/dL
better sleep quality, less snoring, and
less sleepiness in the daytime. In
addition, CPAP treatment can help
lower blood pressure, lower the risk
of stroke, improve cognitive function,
and possibly reduce blood glucose
levels (see “Can CPAP Lower Blood
Glucose Levels?”). If you experience
side effects such as congestion, runny
nose, dry mouth, or nosebleeds, speak
with your doctor about ways you can
reduce them or adjust to them.
Another option is oral appliances,
which serve to keep the airways open
while you’re asleep. One type of appli- Can CPAP Lower
ance is a mandibular advancement
or mandibular repositioning device,
Blood Glucose
which is typically molded to the teeth Levels?
and holds the lower jaw forward to We know that sleep apnea can raise
help keep the upper airway open. blood glucose levels in people with
Another type of appliance, a tongue- diabetes. Is the converse true—in
stabilizing device, holds the tongue other words, can successfully treat-
forward to prevent it from blocking ing sleep apnea with CPAP lower blood
the upper airway. glucose levels? Preliminary evidence
Some cases of sleep apnea may not suggests that it can. Probably the most
respond well to CPAP, such as those compelling evidence comes from a
caused by a visible obstruction of the study reported in the journal Diabetes,
upper airway, like large tonsils. These Obesity, and Metabolism in 2020. The
may require surgery. Types of surgery researchers pooled and analyzed the
include tonsillectomy (the removal of data from seven previous clinical tri-
the tonsils), bimaxillary advancement als, which randomly assigned a total
or double-jaw surgery (surgery to of 691 people with sleep apnea and
move the upper jaw and lower jaw type 2 diabetes to CPAP, sham CPAP
forward to enlarge the upper airway), (using a machine that didn’t actu-
and tracheotomy (surgery to create ally aid breathing), or no treatment
a hole in the windpipe and insert a at all. (Randomized studies, in which
breathing tube, or “trach tube,” to participants are randomly assigned
help the patient breathe). to different treatment groups without
knowing what group they’re in, are
Taking the first step considered the most reliable studies
There is a range of treatments for of the effectiveness of various forms
sleep apnea. The first step to better of treatment.) The researchers found
health is getting it diagnosed. that, compared with either sham CPAP
treatment or no treatment at all, CPAP
Robert S. Dinsmoor is an award- lowered the participants’ hemoglobin
winning medical journalist who has A1C levels (a measure of long-term
written hundreds of articles on health blood glucose control) by an average
and medicine. of 0.32%.
Fall 2022 • DiabetesSelfManagement.com 43
 ••• AT THE TABLE •••
‘FALL’ INTO
Healthy
Habits
OUR RECIPES
Like everyone, you’re busy—
and we keep that in mind
when we select recipes. Many
of them can be prepared in
44 DiabetesSelfManagement.com • Fall 2022
30 minutes or less. Others require short
preparation times followed by long
cooking times. We’ve also included
symbols to help you more easily find
those recipes especially high in fiber,
low in fat, carbohydrates, and sodium.
BY LORENA DRAGO, MS,
RDN, CDN, CDCES
F eeling a pep in your
step with the arrival of
crisp autumn air and colorful
leaves? Why not take the
opportunity to “fall” into some
healthier dietary habits! This
collection makes use of all
the quintessential flavors the
season’s bounty has to offer,
featuring pumpkin, apple,
corn, cranberry, squash,
and Brussels sprouts. These
recipes are a-maize-ing!
▲ FI HIGH-FIBER RECIPE ▼ LC LOW-CARB RECIPE
5g or more of fiber per serving 15g or less of carbs per serving
▼ LF LOW-FAT RECIPE ▼ LS LOW-SODIUM RECIPE
SHUTTERSTOCK
3g or less of fat per serving 140mg or less of sodium per serving
••• AT THE TABLE ••• Pumpkin Yums
Pumpkin Spice Muffins
12 MUFFINS | 1 MUFFIN
CAL 191 | FAT 6G | SAT FAT 1G | PROTEIN 5G | CARBS 29G | CHOL 1MG | FIBER 3G | SODIUM 417MG
DIETARY EXCHANGE: 2 BREAD/STARCH, 1 FAT
12 pleated paper muffin cups or
nonstick cooking spray
33/4 cups Better Baking Mix (recipe
on page 50)
1/4 cup sugar
1 teaspoon pumpkin pie spice mix
or cinnamon
1/4 cup trans-fat-free margarine,
butter and canola oil blend,*
or canola oil
11/4 cups cold fat-free milk, low-fat
buttermilk, or soy milk
1/2 cup pumpkin purée
1/4 cup chopped walnuts
1. Preheat oven to 400°F. Prepare
muffin pan with paper muffin cups or
lightly coat with nonstick cooking spray.
(Muffin cups should be 3 inches across
at top and contain 1/4 cup of batter
when filled 3/4 full.)
2. Combine baking mix, sugar, and
spice mix in large mixing bowl with
wire whisk. Cut in margarine, butter
blend, or oil with pastry knife or two
knives until mixture resembles coarse
meal. Make a well in center of mixture
and add milk and pumpkin. Gently and
lightly stir together just until moist-
ened. Do not overmix. Gently fold in
walnuts with rubber spatula.
3. Using 1/4-cup measure or 2-inch ice
cream scoop, fill prepared muffin pan
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cups 3/4 full. (Dipping the cup or scoop
in water between scoops helps the bat-
ter release easier onto the muffin pan.)
Bake 10 to 15 minutes, rotating pan
once during baking, or until muffins
are golden on tops and bottoms and
toothpick inserted in centers comes out
clean. Remove from oven. Transfer muf-
fins to wire rack to cool.
*Note: Butter and canola oil blends are
available in the refrigerated dairy sec-
tion of your supermarket. You can easily
make your own by combining equal
parts room-temperature butter and
canola oil in the bowl of a food proces-
sor. Pack the mixture into a plastic tub
with a lid and refrigerate.
Fall 2022 • DiabetesSelfManagement.com 45
 ••• AT THE TABLE ••• Pumpkin Yums
TIP Don’t throw out
the pumpkin seeds!
They have protein, fiber, iron,
copper, magnesium, and
other minerals. They also
contain healthy fats. You can
toast your own seeds and add
them to yogurt and cereals.
Pumpkin Spice Mug Cake
1 SERVING | 1 MUG CAKE
▼ LF
CAL 146 | FAT 2G | SAT FAT NA | PROTEIN 3G | CARBS 31G | CHOL 0MG | FIBER 1G |
SODIUM 284MG
DIETARY EXCHANGE: 2 BREAD/STARCH
1/4 cup angel food cake mix
3 tablespoons water
2 teaspoons canned solid-pack
pumpkin
1 teaspoon finely chopped pecans
1/4 teaspoon pumpkin pie spice
1. Combine cake mix, water, pumpkin,
46 DiabetesSelfManagement.com • Fall 2022
Fresh
Pumpkin
or Squash
Purée
3-4 CUPS OF PURÉE (FOR
RECIPES) | 1 CUP
▲ FI | ▼ LF | ▼ LS
CAL 101 | FAT 1G | SAT FAT
0G | PROTEIN 2G | CARBS
21G | CHOL 0MG | FIBER
7G | SODIUM 5MG
DIETARY EXCHANGE: 1½
STARCH; CARBOHYDRATE
CHOICES: 1½
Small pumpkin or
medium squash
(butternut, acorn, or
Hubbard), 4-6 pounds
1. Preheat oven to 350°F.
Carefully cut off the stem
and a few inches of the
top of the pumpkin or
squash with a sharp
knife. Cut into halves.
Remove stringy flesh and
seeds, then cut again into
quarters.
2. Bake 50 to 60 minutes
until soft. Allow to cool,
then scoop the flesh
from the skin into a food
processor and purée until
smooth. For a smoother
consistency, push the
purée through a strainer.
3. Freeze any unused pu-
rée in a freezer-approved
plastic container, marking
the container with the
amount it contains. Purée
pecans, and pumpkin pie spice in large can be stored for up to six
ceramic* microwavable mug. months. Try substituting
2. Microwave on high 2 minutes. Let up to a cup of purée for
stand 1 to 2 minutes before serving. shortening in recipes for
baked goods.
*Note: This cake will only work in a
ceramic mug, as the material allows for
more even cooking than glass.
TIP Squash can be
difficult to cut. If
you use squash frequently,
consider buying a designated
small hand saw to help you
cut through the thick skin.
Label this saw so that it does
SHUTTERSTOCK
not get used for materials
other than food.
 Savory Pumpkin Hummus
11/2 CUPS (ABOUT 12 SERVINGS) | 2 TABLESPOONS
▼ LF | ▼ LC | ▼ LS
CAL 38 | FAT 2G | SAT FAT 0G | PROTEIN 1G | CARBS 4G | CHOL 0MG
| FIBER 1G | SODIUM 101MG
DIETARY EXCHANGE: ½ FAT, 1 VEGETABLE

1 can (15 ounces) solid-pack pumpkin

3 tablespoons chopped fresh parsley, plus additional for
garnish
3 tablespoons tahini
3 tablespoons fresh lemon juice
3 cloves garlic
1 teaspoon ground cumin
1/2 teaspoon salt
1/8 teaspoon black pepper
1/8 teaspoon ground red pepper, plus additional for garnish
Assorted vegetable sticks

1. Combine pumpkin, 3 tablespoons parsley, tahini, lemon juice,

garlic, cumin, salt, black pepper, and 1/8 teaspoon ground red pep-
per in food processor or blender; process until smooth. Cover and
refrigerate at least 2 hours to allow flavors to develop.
2. Sprinkle with additional ground red pepper, if desired. Garnish
with additional parsley. Serve with assorted vegetable sticks.

TIP Ready for some fun trivia? Did you know that, botanically, pumpkin is
a fruit, not a vegetable? The bright orange color in pumpkin is a telltale
sign that it is rich in beta-carotene, an antioxidant that is converted into vitamin
A. Vitamin A helps to preserve vision, maintain healthy bones and skin, prevent
infections, and regulate cell growth. One cup of pumpkin is low in calories and
carbohydrate, and it is also an excellent source of potassium, which helps maintain
normal blood pressure.
Get more delicious diabetes-friendly recipes at
DiabetesSelfManagement.com/recipes

▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 47

 ••• AT THE TABLE ••• Pumpkin Yums

Wholesome
Chocolate-Chip
Pumpkin Bars
24 SERVINGS | 1 SQUARE
▼ LC
CAL 110 | FAT 4G | SAT FAT 1G | PROTEIN
3G | CARBS 15G | CHOL 20MG | FIBER 2G |
SODIUM 170MG
DIETARY EXCHANGE: 1 BREAD/STARCH,
½ FAT

Nonstick baking spray

1 cup white whole-wheat flour
1 cup all-purpose flour
3/4 cup sugar substitute*
11/2 teaspoons baking powder
1 teaspoon baking soda
11/2 teaspoons ground cinnamon
1/2 teaspoon ground nutmeg
1/2 teaspoon ground ginger
1 can (15 ounces) solid packed
pumpkin
2 large eggs
1/4 cup canola oil
1 container (21/2 ounces) puréed
baby food prunes
2 tablespoons molasses
2 tablespoons packed brown sugar
4 ounces reduced-fat cream cheese
4 ounces nonfat cream cheese
2 tablespoons sugar substitute*
1/2 cup reduced-fat whipped topping
6 tablespoons mini chocolate chips

1. Preheat oven to 350°F. Coat 13x9-inch

pan with nonstick baking spray.
2. In medium bowl, mix together flours,
3/4 cup sugar substitute, baking powder,
baking soda, and spices.
3. In large bowl stir together pumpkin,
eggs, oil, prune purée, molasses, and
brown sugar. Mix in flour mixture and
stir just until combined.
4. Spoon into pan, smooth, and bake 20
to 25 minutes, or until toothpick inserted
in center comes out clean. Cool on rack.
5. In small bowl, beat together cream
cheeses and 2 tablespoons sugar substi-
tute. Beat in whipped topping. Spread
frosting onto cooled cake and top with
chocolate chips. Cut into 24 squares.
*Note: This recipe was tested using
sucralose-based sugar substitute.

48 DiabetesSelfManagement.com • Fall 2022

Pumpkin Bread Pudding
2 SERVINGS | ½ OF TOTAL RECIPE
▲ FI | ▼ LF
CAL 141 | FAT 1G | SAT FAT 1G | PROTEIN 6G | CARBS 28G | CHOL 0MG | FIBER 5G | SODIUM 177MG
DIETARY EXCHANGE: 2 BREAD/STARCH

Nonstick cooking spray
2 slices whole-wheat bread
1 cup canned pumpkin
3 tablespoons egg substitute
2 tablespoons sucralose-based
sugar substitute
1 teaspoon vanilla
½ teaspoon ground cinnamon
1 tablespoon raisins
Fat-free whipped topping
(optional)
1. Preheat oven to 375°F. Lightly
spray 2 ovenproof custard cups or ra-
mekins with nonstick cooking spray.
Toast bread; cut into 1-inch cubes.
2. Beat pumpkin, egg substitute,
sugar substitute, vanilla, and cin-
namon in medium bowl with electric
mixer at medium speed 1 minute, or
until well blended. Fold in toast cubes
and raisins. Divide mixture evenly
between prepared cups.
3. Bake 30 minutes. Serve warm with
whipped topping, if desired.

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DiabetesSelfManagement.com/recipes

▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 49

 ••• AT THE TABLE ••• Appealing Apples
Apple Galette
6 SERVINGS | 1/6 OF TOTAL RECIPE
CAL 190 | FAT 8G | SAT FAT 2G | PROTEIN 3G | CARBS 28G | CHOL 0MG |
FIBER 2G | SODIUM 210MG
DIETARY EXCHANGE: 1 BREAD/STARCH, 1 FRUIT
3/4 cup all-purpose flour
1/4 cup whole-wheat flour
1 teaspoon baking powder
1/8 teaspoon salt
1/4 cup (1/2 stick) cold trans-fat-
free margarine
3 tablespoons plus 1
teaspoon cold fat-free
(skim) milk, divided
3 cups thinly sliced peeled
baking apples
2 tablespoons sugar
1 teaspoon ground cinnamon
1. Preheat oven to 375°F.
2. Combine all-purpose flour,
whole-wheat flour, baking powder,
and salt in medium bowl; mix
well. Cut in margarine with pastry
blender or two knives until mixture
resembles coarse crumbs. Add 3
tablespoons milk, 1 tablespoon
at a time, mixing with fork until
dough is moistened. (Dough will
50 DiabetesSelfManagement.com • Fall 2022
be crumbly.)
3. Turn dough out on lightly
floured surface; knead 6 to 8 times,
or just until dough clings together.
Shape into ball; roll into 12-inch
circle on heavy-duty foil. Transfer
dough with foil to large baking
sheet.
4. Combine apples, sugar, and
cinnamon in medium bowl; toss to
coat evenly. Mound apple mixture
in center of dough, leaving 2-inch
border. Fold border up over filling.
Brush top and side of crust with
remaining 1 teaspoon milk. Cover
edge of crust with foil.
5. Bake 15 minutes; remove foil.
Bake 25 minutes, or until crust is
golden and apples are tender. Cool
on baking sheet 10 minutes. Re-
move to wire rack; cool 20 minutes.
Serve warm.
Better Baking Mix
8 CUPS BAKING MIX
21/4 cups unbleached all-purpose
flour
21/4 cups whole-wheat flour
21/4 cups oat flour*
11/4 cups nonfat dry milk
3 tablespoons baking powder
11/2 teaspoons salt
1 teaspoon baking soda
1. Combine flours, milk powder, bak-
ing powder, salt, and soda in 1-gal-
lon freezer resealable plastic food
storage bag. Stir mixture with wire
whisk to blend. Seal bag and shake
upside down to mix ingredients in
corners. Alternatively, mix ingredients
together in a large mixing bowl with
a wire whisk and spoon into an 8-cup
container with a tight-fitting lid.
2. Seal container. Label and date
contents. Store in freezer. Use within
six months.
*Note: Oat flour is available at many
supermarkets, natural foods stores,
and online. Oat flour can easily be
made at home by pulsing old-
fashioned oats in a blender or food
processor until a flourlike consistency
is reached.
TIP For best results, spoon
flours and milk powder into
measuring cups and level with the
edge of a straight spatula. This is the
most accurate way to measure dry
ingredients, and it helps aerate and
lighten the flour mixture. Dipping
the measuring cup into the flour bag
compacts the flour, making it denser;
which can lead to inaccurate measuring
and less air in the mixture. For easy
cleanup, spoon flour into measuring
cups over a sheet of waxed paper. The
flour left over from leveling can be
poured back into the flour sack using
the waxed paper as a funnel.
TIP Freezing is suggested for
the baking mix because
whole-wheat and oat flours are made
with whole grains, meaning they still
contain the bran, the germ, and the
endosperm of the grain. Whole grains
contain more beneficial fats and fiber
SHUTTERSTOCK
than refined grains and should be
frozen for longer shelf life.
Apple-Cinnamon Pancakes
4 SERVINGS | 3 (4-INCH) PANCAKES
CAL 231 | FAT 6G | SAT FAT 1G | PROTEIN 8G | CARBS 37G | CHOL 54MG | FIBER 4G | SODIUM 545MG
DIETARY EXCHANGE: 2½ BREAD/STARCH, 1 FAT

1¾ cups Better Baking Mix (recipe
on opposite page)
¼ teaspoon ground cinnamon
1 cup water or fat-free (skim) milk
½ cup no-sugar-added applesauce
1 egg, lightly beaten, or 2 egg
whites
1 tablespoon canola oil
Nonstick cooking spray
Nonfat, plain yogurt (optional)
Additional ground cinnamon
(optional)
Sugar substitute (optional)
1. Combine baking mix and cinnamon
in large bowl. Make a well in center; add
water, applesauce, egg, and oil. Stir with
wire whisk just until blended.
2. Spray griddle or skillet with nonstick
cooking spray; heat over medium heat.
3. Using 1/4-cup measure or ladle, pour
batter onto griddle. Cook pancakes on
griddle until golden brown, turning
once.
4. Serve with yogurt and cinnamon
mixed with sugar substitute.

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▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 51

 ••• AT THE TABLE ••• Appealing Apples

Spiced Baked
Apples
4 APPLES | ½ APPLE
▼ LF | ▼ LS
CAL 96 | FAT 0G | SAT FAT 0G
| PROTEIN 0G | CARBS 24G |
CHOL NA | FIBER 4G | SODIUM
0MG
DIETARY EXCHANGE: 1½ FRUIT
CARBOHYDRATE CHOICES: 1½

4 large baking apples

(approximately 9
ounces each)
2 tablespoons sweetened
dried cranberries
2 tablespoons raisins
¾ cup unsweetened apple
juice
½ teaspoon allspice

1. Preheat oven to 375°F.

Remove the core of each apple,
leaving 1/2-inch flesh at bottom.
Place cored apples in an 8x8-
inch baking dish.
2. Fill each apple with 1/2
tablespoon cranberries and 1/2
tablespoon raisins. Fill apples
half full of apple juice and pour
remaining juice around them in
the pan. Sprinkle apples evenly
with allspice.
3. Cover and bake for 45
minutes, or until tender when
pierced with a fork. Spoon re-
maining baking juices over the
apples and serve hot or chilled.
ANGELA SACKETT

52 DiabetesSelfManagement.com • Fall 2022

 ••• AT THE TABLE ••• Cool Corn

Squash and Corn

4 CUPS | ½ CUP
▼ LC
CAL 65 | FAT 1G | SAT FAT <1G | PROTEIN 3G | CARBS 11G | CHOL <1MG | FIBER 2G | SODIUM 91MG
DIETARY EXCHANGE: ½ STARCH, 1 NONSTARCHY VEGETABLE
CARBOHYDRATE CHOICES: 1

1 pound zucchini, sliced
lengthwise
3 roasted green chilies, peeled
and seeded (banana
peppers were used in
testing; alternatively, half
a 41/2-ounce can of roasted,
diced chilies can be used)
Nonstick cooking spray
1 teaspoon corn oil
1 small onion, finely chopped
ANGELA SACKETT
1 teaspoon real bacon bits
2 cups frozen corn, thawed
(fresh corn cut from the cob
can also be used)
1/4 cup water
1/4 teaspoon salt
1. Dice zucchini into 1/2-inch pieces.
Thinly slice chilies.
2. Coat a large nonstick skillet with
cooking spray, add oil, and warm over
medium-high heat. Add onion and
cook, stirring frequently, until trans-
lucent, about 3-4 minutes. Add bacon
bits and corn and cook 2-3 minutes
more, stirring frequently. Add water,
squash, chilies, and salt; stir to mix.
3. Cover pan, reduce heat to medium,
and simmer 10-15 minutes, or until
corn and zucchini are tender; stir oc-
casionally.

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▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 53

 ••• AT THE TABLE ••• Cool Corn

Herb-Roasted Chicken and Cornbread Dressing

6 SERVINGS | 3 OUNCES CHICKEN AND ¾ CUP DRESSING
▼ LC
CAL 280 | FAT 10G | SAT FAT 3G | PROTEIN 31G | CARBS 11G | CHOL 195MG | FIBER 1G | SODIUM 576MG
DIETARY EXCHANGE: 1 BREAD/STARCH, 1½ FAT, 3 MEAT

1/4 cup chopped fresh parsley
2 tablespoons lemon juice
2 teaspoons grated lemon peel
1 teaspoon dried thyme
3/4 teaspoon dried sage
1/2 teaspoon dried rosemary
1/2 teaspoon salt
1/4 teaspoon black pepper
1 whole chicken (31/2 to 4 pounds)
1 cup water
Nonstick cooking spray
4 ounces reduced-fat bulk
breakfast sausage
1 cup finely chopped onion
2 medium stalks celery with
leaves, thinly sliced
1 medium red bell pepper, diced
1 can (about 14 ounces) low-
sodium chicken broth
2 cups cornbread stuffing mix
1/2 teaspoon poultry seasoning
1. Adjust oven rack to lowest position.
Preheat oven to 450°F. Combine parsley,
lemon juice, lemon peel, thyme, sage,
rosemary, salt, and pepper in small
bowl; mix well.
2. Separate chicken skin from meat by
sliding fingers under skin. Spread pars-
ley mixture evenly over chicken; cover
with skin. (If skin tears, use toothpicks
to hold skin together.) Place on rack in
roasting pan, breast side up.
3. Roast chicken 20 minutes. Add water
to pan; roast 40 minutes, or until meat
thermometer inserted into thickest
part of thigh registers 165°F. Remove
from oven; let stand 15 minutes before
slicing.
4. Meanwhile, coat large nonstick skillet
with nonstick cooking spray. Heat over
medium-high heat. Add sausage; cook
3 minutes, or until browned, stirring to
break up meat. Drain off excess fat; set
aside.
5. Add onion, celery, and bell pepper
to skillet; spray with nonstick cooking
spray. Cook and stir over medium heat
7 minutes, or until celery is tender. Stir
in broth; bring to a boil. Remove from
heat. Add sausage, stuffing mix, and
poultry seasoning; mix well. Serve with
chicken.
Variation: Add 1 clove garlic, minced,
to parsley mixture.

TIP To reduce calories,

fat, and saturated
fat, remove and discard
chicken skin before serving.
This will reduce calories to
about 270, fat grams to about
9, and saturated fat to about 2
grams per serving.

54 DiabetesSelfManagement.com • Fall 2022

 Fresh Corn Sauté
4 SERVINGS | ½ CUP
▼ LS
CAL 115 | FAT 4G | SAT FAT 1G | PROTEIN 4G | CARBS 20G | CHOL 0MG | FIBER 3G |
SODIUM 64MG
DIETARY EXCHANGE: 1 BREAD/STARCH, 1 FAT
2 teaspoons canola or olive oil
½ cup chopped sweet or yellow
onion
½ cup chopped red bell pepper
2 cups fresh corn kernels (3-4 ears
corn)* or 1 package (10 ounces)
frozen corn kernels, thawed
¼ teaspoon salt (optional)
2 tablespoons imitation bacon bits
1. Heat oil in medium saucepan over
medium heat. Add onion and bell pep-
▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM
per; cook and stir 4 minutes.
2. Add corn and salt, if desired; cook and
stir 2 minutes, or until vegetables are
crisp-tender. Stir in bacon bits.
*Note: For extra flavor, grill or broil the
shucked corn briefly using high heat
until it begins to brown. Cool. Cut corn
kernels from ears. If fresh corn is out of
season, substitute 1 10-ounce package
frozen corn kernels, thawed.
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Fall 2022 • DiabetesSelfManagement.com 55
 ••• AT THE TABLE ••• Scrumptious Cranberries

Cranberry Chutney
18 SERVINGS | 2 TABLESPOONS
▼ LF | ▼ LC | ▼ LS
CAL 52 | FAT 1G | SAT FAT 1G | PROTEIN 1G | CARBS 12G | CHOL 0MG | FIBER 1G |
Mulled
SODIUM 4MG
DIETARY EXCHANGE: 1 FRUIT
Cranberry
1 teaspoon canola oil 1. Heat oil in medium saucepan over
Cider
1 clove garlic, finely minced medium-low heat. Add garlic and ginger; 8 SERVINGS | 1 CUP
1 (1-inch) piece fresh ginger, peeled cook and stir 1 minute, or until fragrant. ▼ LF | ▼ LC | ▼ LS
and finely minced (Do not brown.) Add apple and pumpkin CAL 32 | FAT 1G | SAT FAT
1 cup unpeeled, diced green apple pie spice, stirring to coat evenly. Add 1G | PROTEIN 1G | CARBS
8G | CHOL 0MG | FIBER 1G |
1 teaspoon pumpkin pie spice water; cover and simmer 10 minutes,
SODIUM 60MG
1/4 cup water or apple juice or until apples are tender and water is
DIETARY EXCHANGE: ½
1 can (16 ounces) whole-berry evaporated. Drain any remaining liquid. FRUIT
cranberry sauce 2. Stir in cranberry sauce and vinegar until
1 tablespoon cider vinegar well combined. Cook until heated through. 8 cups (1/2 gallon)
Serve warm or at room temperature. low-calorie
cran-raspberry or
cran-apple juice
cocktail
3 cinnamon sticks
10 whole cloves
1 cup rum or brandy
(optional)

1. Pour juice cocktail into

slow cooker. Tie cinna-
mon sticks and cloves in
cheesecloth. Add spice
bundle to slow cooker.
Cover and cook on high 2
hours or on low 4 hours,
or until hot. (May be kept
warm on low up to 3
hours.)
2. Discard cheesecloth
bag. If desired, stir in rum
or brandy just before
serving in mugs. Garnish
with additional cinnamon
sticks, if desired.

TIP Did you know that the cranberry became official state
berry of Massachusetts in 1994? And that the cranberry is
uniquely American? Fresh cranberries only have one season, and
that is in the fall. The nutrient power of cranberries is largely in their
polyphenol antioxidants. These antioxidants are found in many
fruits and vegetables and help prevent or stop cell damage that can
SHUTTERSTOCK

contribute to diseases such as cancer.

56 DiabetesSelfManagement.com • Fall 2022

 ••• AT THE TABLE ••• Posh Squash

Roasted Butternut Squash

and Sweet Onion
4 SERVINGS | ¾ CUP
CAL 128 | FAT 4G | SAT FAT 1G | PROTEIN NA | CARBS 24G | CHOL 0MG | FIBER 4G |
SODIUM 154MG
DIETARY EXCHANGE: 1½ BREAD/STARCH, ½ FAT

Nonstick cooking spray 1. Preheat oven to 425°F. Spray jelly-roll

4 cups bite-size peeled butternut
squash chunks
1 sweet onion (about 3/4 pound)
peeled and cut into 12 wedges
1 tablespoon extra-virgin olive oil
1 teaspoon dried sage
1/8 teaspoon black pepper
1/4 teaspoon salt
ANGELA SACKETT
pan with nonstick cooking spray.
2. Combine squash, onion, oil, sage, and
pepper in large bowl. Spread vegetables
in prepared pan. Bake 25 minutes, or
until browned and tender, stirring once.
Sprinkle with salt.

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▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 57

 ••• AT THE TABLE ••• Posh Squash

Butternut Squash Soup

4 SERVINGS | 1½ CUPS
CAL 152 | FAT 3G | SAT FAT 1G | PROTEIN 6G | CARBS 28G | CHOL 13MG | FIBER 3G | SODIUM 155MG
DIETARY EXCHANGE: 2 BREAD/STARCH, ½ FAT

2 teaspoons olive oil
1 large sweet onion, chopped
1 medium red bell pepper,
chopped
2 packages (10 ounces each)
frozen puréed butternut
squash, thawed
1 can (103/4 ounces) condensed
reduced-sodium chicken broth,
undiluted
1/4 teaspoon ground nutmeg
1/8 teaspoon white pepper
1/2 cup fat-free half-and-half, plus
more to thin
1. Heat oil in large saucepan over
medium-high heat. Add onion and bell
pepper; cook 5 minutes, stirring oc-
casionally. Add squash, broth, nutmeg,
and white pepper; bring to a boil over
high heat. Reduce heat; cover and sim-
mer 15 minutes, or until vegetables are
very tender.
2. Purée soup in saucepan with hand-
held immersion blender or in batches in
food processor or blender. Return soup
to saucepan.
3. Stir in half-and-half; heat through.
Add additional half-and-half, if neces-
sary, to thin soup to desired consis-
tency.
Serving suggestion: Garnish with a
swirl of fat-free half-and-half or a sprin-
kling of fresh parsley.

TIP Butternut squash is a

type of winter squash
and is an excellent source of
beta-carotene. It’s also a very
good source of vitamin C,
potassium, and dietary fiber.

58 DiabetesSelfManagement.com • Fall 2022

 Winter Squash Soup
4 SERVINGS | 1 CUP
▼ LF | ▼ LS
CAL 116 | FAT 2G | SAT FAT 1G | PROTEIN 5G | CARBS
22G | CHOL 1MG | FIBER 2G | SODIUM 135MG
DIETARY EXCHANGE: ½ FAT, 4 VEGETABLE

1 tablespoon low-fat vegetable oil spread

1 tablespoon minced shallot or onion
2 cloves garlic, minced
3 fresh thyme sprigs
Pinch dried rosemary
2 packages (10 ounces each) frozen
butternut squash, thawed
1 cup fat-free reduced-sodium chicken broth
3 tablespoons fat-free (skim) milk
Fat-free sour cream (optional)

1. Melt vegetable oil spread in medium saucepan

over medium heat. Add shallot, garlic, thyme, and
rosemary; cook and stir 2 to 3 minutes, or until shal-
lot is tender. Add squash and broth; bring to a boil.
Add milk; stir until blended.
2. Remove and discard thyme. Working in batches,
process soup in blender or food processor until
smooth. (Add additional broth or water to make
soup thinner, if desired.) Top each serving with dol-
lop of sour cream, if desired.

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▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 59

 ••• AT THE TABLE ••• Posh Squash
Apple-Stuffed Acorn Squash
8 SERVINGS | 1/8 OF TOTAL RECIPE
▼ LF | ▼ LS
CAL 87 | FAT 2G | SAT FAT 1G | PROTEIN 1G | CARBS 20G | CHOL 4MG | FIBER 3G | SODIUM 28MG
DIETARY EXCHANGE: 1 BREAD/STARCH, ½ FRUIT
1/4 cup raisins
Warm water
2 acorn squash (about 4 inches in diameter)
Butter-flavored cooking spray
2 tablespoons sucralose no-calorie sweetener
1/4 teaspoon ground cinnamon
2 medium Fuji apples
2 tablespoons light butter
1. Cover raisins with warm water and soak 20 min-
utes. Preheat oven to 375°F.
2. Cut squash into quarters; remove seeds. Place
60 DiabetesSelfManagement.com • Fall 2022
squash on baking sheet. Spray inside of each squash
quarter with cooking spray. Combine sweetener and
cinnamon in small bowl; sprinkle squash quarters
with half of cinnamon mixture. Bake 10 minutes.
3. Meanwhile, cut apples into quarters; remove
cores. Chop apples into 1/2-inch pieces. Drain raisins.
Melt butter in medium saucepan over medium
heat. Add apples, raisins, and remaining cinnamon
mixture; cook and stir 1 minute. Top partially baked
squash with equal amounts apple mixture. Bake 30
to 35 minutes, or until apples and squash are tender.
Serve warm.
 Marvelous Marinara Over Spaghetti Squash
6 SERVINGS | 1/6 OF TOTAL RECIPE
▼ LC | ▼ LS
CAL 101 | FAT 4G | SAT FAT 1G | PROTEIN 2G | CARBS 10G | CHOL 0MG | FIBER 2G | SODIUM 107MG
DIETARY EXCHANGE: 1 FAT, 2 VEGETABLE

2 tablespoons olive oil 1. Heat 2 tablespoons olive oil and garlic in large saucepan
3 cloves garlic, minced over low heat; cook and stir 2 minutes. Add tomatoes,
2 cans (28 ounces each) low-sodium, diced oregano, basil, parsley, vinegar, broth, salt, if desired, and
tomatoes with juice pepper. Simmer, uncovered, 20 minutes, or until sauce
1 teaspoon chopped fresh oregano or dried thickens.
oregano 2. Cut squash in half. Remove seeds. Cut halves into
1 teaspoon chopped fresh basil or dried basil 2 pieces. Place in large saucepan with about 1 inch
1 teaspoon chopped fresh parsley of water, or place in vegetable steamer basket over
2 tablespoons balsamic vinegar saucepan of simmering water. Cook 15 to 20 minutes, or
1/4 cup vegetable broth until squash softens. Remove to large platter until cool
1/8 teaspoon salt (optional) enough to handle. Over large bowl, scrape squash with
1/8 teaspoon black pepper fork; squash will fall into spaghetti-like strands. Add salt,
1 medium spaghetti squash if desired, and 1/4 teaspoon olive oil and toss. Serve with
1/4 teaspoon olive oil marinara.
ANGELA SACKETT

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▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM Fall 2022 • DiabetesSelfManagement.com 61

 ••• AT THE TABLE ••• Bountiful Brussels Sprouts

Beef Tenderloin With Roasted

Vegetables
10 SERVINGS | 1/10 OF TOTAL RECIPE (WITHOUT GRAVY)
CAL 326 | FAT 10G | SAT FAT 3G | PROTEIN 34G | CARBS 24G | CHOL 71MG | FIBER 1G |
Creamy SODIUM 546MG
DIETARY EXCHANGE: 1 BREAD/STARCH, 1½ VEGETABLE, 4 MEAT
Brussels 1 beef tenderloin roast (about 3 baking pan with nonstick cooking spray.
Sprouts pounds), trimmed of fat Place potatoes, Brussels sprouts, and car-
½ cup chardonnay or other dry white rots in pan. Remove roast from marinade.
2 CUPS | 1/3 CUP
wine Pour marinade over vegetables; toss to
CAL 39 | FAT 1G | SAT
FAT 0G | PROTEIN 2G | ½ cup reduced-sodium soy sauce coat. Cover vegetables with foil; roast 30
CARBS 7G | CHOL NA 2 cloves garlic, sliced minutes. Stir.
| FIBER 1G | SODIUM 1 tablespoon fresh rosemary leaves 3. Place tenderloin on vegetables. Roast,
39MG 1 tablespoon Dijon mustard
DIETARY EXCHANGE: ½
uncovered, 35 to 45 minutes, or until inter-
1 teaspoon dry mustard nal temperature of roast reaches 135°F for
STARCH
CARBOHYDRATE
Nonstick cooking spray medium-rare to 150°F for medium when
CHOICES: ½ 1 pound small red or white potatoes, tested with meat thermometer inserted
cut into 1-inch pieces into thickest part of tenderloin.
2 cups fresh or frozen 1 pound Brussels sprouts
Brussels sprouts 1 package (12 ounces) baby carrots 4. Transfer tenderloin to cutting board;
½ cup fat-free sour tent with foil. Let stand 10 to 15 minutes
cream 1. Place roast in large resealable food stor- before carving. (Internal temperature will
½ teaspoon hot sauce age bag. Combine wine, soy sauce, garlic, continue to rise 5°F to 10°F during stand
1 teaspoon rosemary, Dijon mustard, and dry mustard time.) Reserve drippings from roasting pan
Worcestershire in small bowl. Pour over roast. Seal bag; to make gravy, if desired.
sauce turn to coat. Marinate in refrigerator 4 to 12 5. Stir vegetables; continue roasting if not
½ teaspoon black hours, turning several times. tender. Slice tenderloin; arrange on serving
pepper 2. Preheat oven to 425°F. Spray 13x9-inch platter with roasted vegetables.
1. Place Brussels sprouts
in a saucepan and cover
with water. Place on
medium heat and cover
with lid. Boil for approxi-
mately 10 minutes until
tender yet firm.
2. Meanwhile, mix
fat-free sour cream, hot
sauce, Worcestershire
sauce, and black pepper
in a small mixing bowl.
When Brussels sprouts
are cooked, drain water,
and return pan to low
heat.
3. Add sour cream mix-
ture and stir an addition-
al 2 minutes until the
sauce is heated through. TIP Despite having Brussels in its name, this vegetable did not, in fact, originate
in Belgium. This small cabbage lookalike is thought to have actually
Serve immediately.
originated in Rome, becoming popular in Belgium in the 16th century. French settlers
brought Brussels sprouts to the state of Louisiana, and the rest is history. Although not
everyone’s favorite, Brussel sprouts have plenty of benefits, including being high in
dietary fiber, vitamin C, and vitamin K. (If you are taking blood thinners, you need to
be mindful when you increase or decrease your vitamin K intake.) Brussels sprouts are
Get more delicious diabetes-friendly recipes at also good sources of a variety of other vitamins and minerals, including vitamin B6,
DiabetesSelfManagement.com/recipes potassium, phosphorus, and anti-inflammatory omega-3 fatty acids.

62 DiabetesSelfManagement.com • Fall 2022


Warm Brussels Sprouts Salad
With Mustard Vinaigrette
4 SERVINGS | ¼ OF TOTAL RECIPE
▼ LC
CAL 177 | FAT 12G | SAT FAT 3G | PROTEIN 6G | CARBS 15G | CHOL
4MG | FIBER 4G | SODIUM 312MG
DIETARY EXCHANGE: 2½ FAT, 3 VEGETABLE
3 cups Brussels sprouts, cut
into quarters
1 pint (2 cups) grape
tomatoes
½ cup sliced red onion
3 tablespoons olive oil,
divided
2 tablespoons balsamic
vinegar, divided
¼ teaspoon salt
1 tablespoon water
2 teaspoons Dijon mustard
1 teaspoon honey
4 cups chopped butter
lettuce
¼ cup shaved parmesan
cheese
1. Preheat oven to 375°F.
▲ FI HIGH-FIBER | ▼ LF LOW-FAT | ▼ LC LOW-CARBOHYDRATE | ▼ LS LOW-SODIUM
2. Combine Brussels sprouts,
tomatoes, and red onion in large
bowl. Add 1 tablespoon oil, 1
tablespoon vinegar, and salt; toss
to coat evenly. Arrange in single
layer on baking sheet.
3. Bake 20 minutes, stirring once.
Let stand 10 minutes to cool
slightly.
4. Meanwhile, whisk remaining
2 tablespoons oil, 1 tablespoon
vinegar, water, mustard, and
honey in large bowl until smooth
and well blended. Add vegeta-
bles; toss to coat evenly.
5. Arrange lettuce on 4 plates.
Spoon vegetables evenly over
lettuce. Top evenly with cheese.
recipe index
SUSAN AND T’ARA’S KITCHEN
25 Curried Power Bowl
25 Pav Bhaji
27 Jerk Chicken ▼ LC
‘FAST’ FOOD
29 Toby Amidor’s Greens and Grain Bowl
PUMPKIN YUMS
45 Pumpkin Spice Muffins
46 Pumpkin Spice Mug Cake ▼ LF
46 Fresh Pumpkin or Squash Purée
▼ LF | ▼ LC | ▼ LS
47 Savory Pumpkin Hummus
▼ LF | ▼ LC | ▼ LS
48 Wholesome Chocolate-Chip
Pumpkin Bars ▼ LC
49 Pumpkin Bread Pudding ▲ FI | ▼ LF
APPEALING APPLES
50 Apple Galette
50 Better Baking Mix
51 Apple-Cinnamon Pancakes
52 Spiced Baked Apples ▼ LF | ▼ LS
COOL CORN
53 Squash and Corn ▼ LC
54 Herb-Roasted Chicken and Cornbread
Dressing ▼ LC
55 Fresh Corn Sauté ▼ LS
SCRUMPTIOUS CRANBERRIES
56 Cranberry Chutney ▼ LF | ▼ LC | ▼ LS
56 Mulled Cranberry Cider ▼ LF | ▼ LC | ▼ LS
POSH SQUASH
5 7 Roasted Butternut Squash
and Sweet Onion
58 Butternut Squash Soup
59 Winter Squash Soup ▼ LF | ▼ LS
60 Apple-Stuffed Acorn Squash ▼ LF | ▼ LS
61 Marvelous Marinara Over Spaghetti
Squash ▼ LC | ▼ LS
BOUNTIFUL BRUSSELS SPROUTS
6 2 Creamy Brussels Sprouts
62 Beef Tenderloin With Roasted
Vegetables
63 Warm Brussels Sprouts Salad With
Mustard Vinaigrette ▼ LC
Fall 2022 • DiabetesSelfManagement.com 63
 ••• FINAL COUNTDOWN •••

As a Matter of Fact
BY DIANE FENNELL

5
Roughly 49.4 million students attended public elementary and secondary
schools in fall 2020, according to the National Center for Education
Statistics. In 2019, there were 3.2 million teachers in public schools and 0.5
million teachers in private schools. Do you have a child with type 1 diabetes
entering or returning to school this academic year? Check out the lessons in
“Return to School With Success!” (page 36) to help them get a leg up.

4
According to The Food Institute, 85% of Americans plan to cook
more at home this year. Approximately 36% of people in the
United States cook at home each day. Statistics indicate that home
cooking can be up to five times cheaper than eating out. Curious
about some quick and nourishing meals you can prepare at
home? See the ideas in “‘Fast’ Food” (page 28).

3
Obstructive sleep apnea (OSA) is the most common type of sleep
apnea and is estimated to affect 10% to 30% of adults in the United
States. Men are twice as likely as women to have sleep apnea. Roughly
80% of people with moderate and severe OSA are undiagnosed.
Wondering if your daytime sleepiness or snoring could be a sign of
sleep apnea? Head to “Snore No More” (page 40) for information on this
common condition.

2
In 2018, roughly 242,000 adults (9.6 per 1,000 adults with diabetes)
visited the emergency room due to hypoglycemia (low blood
glucose), according to the U.S. Centers for Disease Control and
Prevention (CDC). Symptoms of hypoglycemia can include shaking,
sweating, irritability or confusion, nervousness, fast heartbeat,
and hunger. Although the “rule of 15” is a common hypoglycemia
treatment guideline, it is not one size fits all. Learn more in “The
Fallacy of 15” (page 32).

1
In some countries, lunch is the most significant meal of the day. According
to the website Just Fun Facts, the word “lunch” comes from the Northern
English word “luncheon,” which is itself derived from the Anglo-Saxon
“nuncheon,” meaning “noon drink.” Want to see more fun lunch facts and
discover some new recipes to bring in your brown bag? Check out “Time to
SHUTTERSTOCK

Tote Your Lunch!” (page 24) to learn about lunches from around the world.

64 DiabetesSelfManagement.com • Fall 2022

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