Brushing:

1. Tilt your tooth brush at a 45-degree angle against your gum line.
2. Then gently (you don’t need to push that hard) roll the brush away from your gum line as you move over all your teeth. Make sure you touch all the surfaces of your teeth: front, back, top or bottom, and sides.
3. Give your tongue a good brushing to get rid of lingering bacteria.
4. Brush at least 2 minutes (sing a song in your head!) twice a day with toothpaste that has an antigingival/antibacterial ingredient. You can find brands that are recommended by the American Dental Association.

Flossing:

1. Use enough floss to wrap around your finger to pull the floss taut. Having enough floss makes the process faster and more efficient.
2. Gently slide the floss between each gap between teeth. Floss up and down the sides of the teeth and then gently wrap the floss around the base (where the tooth connects to your gum line) of each tooth.
3. Get rid of debris as you move by each tooth, using a clean portion of the floss. Be gentle so you do not bruise your gums.

Dentist Checkups:

1. See your dentist every 6 months or as often as your general physician or endocrinologist advises.
2. Be sure to remind your dentist and the dental hygienist that you have diabetes. It is important that they know this so they can be more vigilant about preventive care.
3. Call your dentist or hygienist if you see any of these signs or symptoms: bleeding, red, puffy, swollen, or sore gums; if your gums are pulling away from your teeth; if you notice pus or a white substance between your teeth and gums; constant bad breath.
4. Do what your dentist and hygienist recommend. They know how you can keep your teeth and gums healthy.

Actually, snoring is a sign of obstructive sleep apnea (OSA). Obstructive sleep apnea is caused by frequent stops in breathing while you sleep. Normally, the breathing is stopped because there is an obstruction of the upper airway.

This occurs most often in overweight, middle-aged and elderly individuals. Obstructive sleep apnea results in low levels of oxygen in your blood (because you are not breathing in enough air), waking up often during the night, and being very sleepy during the day.

OSA puts you at risk for (or may be a sign that you already have) type 2 diabetes, high blood pressure, heart disease, acid reflux or adult asthma.

Diabetes: Around 80% of people living with diabetes also have OSA, and untreated OSA is associated with poorer blood glucose control. OSA might cause changes in glucose metabolism, and we also know that poor sleep patterns contribute to poor glucose control.

Heart Disease: OSA causes low oxygen levels and stress to the heart from waking up frequently in the night. This makes it harder for your heart to regulate blood flow to arteries and your brain and affects the rhythm of heartbeats, increasing your risk for heart attack and stroke.

Blood Pressure: OSA can cause your hormonal system to overwork which can elevate blood pressure at nighttime when you’re body is frequently being woken from sleep. Low levels of oxygen in your blood may also contribute to hypertension.

Acid Reflux: There is no proven relationship but improved OSA generally results in improved acid reflux.

Asthma: People who are treated for OSA report fewer incidences of asthma attacks.

Obstructive sleep apnea can be easily treated with a machine call CPAP (continuous positive airway pressure). The CPAP machine provides ventilation support so you can breathe without interruption. This prevents low levels of oxygen in your blood and helps you sleep through the night without waking up. The CPAP is an easy way to help decrease your risk for the complications above and take care of that snoring problem!

A recent study compiling data and information about exercise and mortality showed that a sedentary person’s risk for dying prematurely decreased almost 20% if that person started and sustained a walking program, 30 minutes of walking 5 times a week for several years.

Those results are not noted if the individual only continues the walking program for a short period of time. So, it is very important to pick an exercise that you can continue for the rest of your life. And having different types of exercise that you like to do is beneficial too.

Here are a few different exercises to try, but remember, don’t give up. Keep working out each week. Find things you like to do so you’ll be more likely to make exercise an integral part of your life.

• Interval Training: Try walking three minutes briskly, then walk a bit slower for three minutes, and keep repeating this pattern. You can do these intervals with any type of exercise!
• Just get out and walk, move, dance, bike, run, swim, jump, whatever you like to do that keeps you moving continuously. Don’t stop moving for an extended period of time.
• Weight training or resistance training is great for your muscles and actually helps your cardiovascular fitness. Lift weights, pull bands, move soup cans, or do body weight exercises in controlled, repetitive movements. Do 12 repetitions of each exercise a total of 8 times.

Do you still eat out weekly, not caring about the consequences of your food choices? Or have you reverted to eating at home, scared to face a large menu with confusing choices? (Is it healthy? How will it affect my blood sugar? How many calories are in that?)

Of course it is important to make the best food choices under any circumstance, but dining out can be very difficult. Being tempted by foods and desserts that you know are not in your meal plan for the day can be a big challenge. Or navigating a menu from an ethnic restaurant where you’re not sure how the menu items are prepared can thwart your good intentions.

Even though it might be difficult, diabetes does not need to prevent you from dining out occasionally or with friends for special occasions. Planning and preparing will equip you to make the best choices possible. Here are a few ideas and red flags to watch out for.

• Just because eating out is a special occasion or because the food is so much better than what you eat at home does not mean you have a license to splurge and overeat.
• Take a look around to see the dishes on the tables around you. Does something look good? Do you see that the chef has a tendency to drown the food in butter and sauces?
• Decide how much you’ll eat before the meal comes. Cut out your portion and ask for a carry out bag for the rest right away.
• Be aware of which foods contain carbs on your plate. Portion out the right amount of each food for your total carb intake. Pasta, bread, rice, dairy, fruit, starchy veggies, etc.
• Don’t forget about your vegetables and fruits. It is easy to get lost in the main entrée options, but choose healthy sides or ask what comes with your entrée.
• Order water. Drink 1 glass of water for every other beverage serving. Be smart about your beverage choices accounting for added sugar and calories.
• Don’t be scared to ask for specifics. The chef will be willing to accommodate your needs if they know you have a medical condition.
• Eat slowly and stop when you’re full. Really. You’ll enjoy yourself more, save the extra calories you’re not hungry for, and have tasty leftovers for tomorrow.

Use these cues to make the best decisions for yourself when eating these types of cuisine.

• Mexican or Tex-Mex
  • Red Flags: sour cream, crispy, stuffed, chorizo, fried, refried beans, cream sauce, extra cheese
  • Green Lights: lettuce, tomato, pico de gallo, black beans, soft corn tortillas, fajitas, grilled
• Italian
  • Red Flags: focaccia, pancetta, prosciutto, salami, alfredo, stuffed with cheese, cream sauce, breaded, white bread
  • Green Lights: whole wheat pasta, vegetables, lightly sautéed, tomato-based, herbs and spices, primavera, piccata, vinegar
• Chinese
  • Red Flags: Chinese noodles, fried, battered, breaded, crispy, sweet and sour, white rice, sweet sauce, glaze, wonton
  • Green Lights: vegetables, steamed, brown rice, light, simmered, lightly stir fry, chicken, hot and sour
• Thai
  • Red Flags: peanut sauce, coconut milk, fried, golden brown, crispy, curry sauce, mee-krob
  • Green Lights: lemon grass, lime juice, curry paste, napa cabbage, mixed vegetables, broth soup, lime sauce, sautéed
• Japanese
  • Red Flags: fried, tempura, battered, breaded, agemono, katsu, white rice
  • Green Lights: clear broth, vinegered, miso, steamed, with vegetables, grilled, on skewers, boiled
• Indian
  • Red Flags: ghee, molee (coconut), coconut milk, fritters, fried, battered, korma (cream sauce), stuffed, cream curry, basmati rice, chutney
  • Green Lights: skinless chicken, matta (peas), Indian spices, vegetables, lentils (dahl), tandoori

Take a look at this post and this post about preventing foot sores and keep reading here to learn about taking care of wounds that you do get.

1. Make sure that the wound is getting good blood flow. Circulating blood will bring antibodies to fight infection and help generate new cells for healing and closing of the wound. Propping your legs up or gently massaging the area around the wound will help blood get to your lower extremities if you have poor circulation.
2. Keep the wound clean and dry to prevent infection. Cover the wound with clean bandages and clean away visible dirt or debris with warm water and a soap or antibacterial ointment approved by your doctor. Preventing infection is crucial because your wound, however small, will not heal if it is infected.
3. Take away any pressure on the wound or the area around the wound. Place bandages so that they are not pressing on the wound or stretching the skin around the wound. Be careful to wear loose clothing or padded socks so there is not extra pressure or contact.

Your healthcare team should know about your wounds, cuts, scrapes, etc. even if you don’t think they look too serious. Your doctor can track the healing time and let you know if circulation tests are needed, if the wound needs to be thoroughly cleansed or debrided, or if antibiotics are needed before the wound gets serious.

Call your doctor immediately and maybe schedule a visit if you have one of these types of wounds on your foot, leg, hand, arm or anywhere on your body:

• Athlete's foot
• Cracking between the toes
• Sores or wounds on your feet
• Ingrown toenails
• Increasing numbness or pain
• Calluses
• Redness
• Blackening of skin
• Bunions
• Infection
• Hammer or mallet toes (when the middle joints of toes are permanently bent downward)

They put extra effort into each day than the average person and come out with more satisfaction knowing they are conquering more than the average person.

You probably know that managing diabetes can be complicated, but there are a few changes you can make with major impact.

Controlling your blood sugar is the biggest improvement you can make but a lot goes into controlling your blood sugar:

• controlling carbohydrate intake;
• possibly taking medication or insulin;
• exercising;
• checking your blood sugar regularly;
• reducing stress;
• and the list goes on.

The following simple changes will help lead to better blood sugar control along with your other treatments, but making all these changes together will give you the biggest impact on preventing complications.

Weigh Your Food for One Day Out of Every Week: This will keep you sharp in sticking with portion control, help you control your carb intake, and aid in getting to or staying at a healthy weight.

Join a Gym or Find an Exercise Accountability Partner: The financial cost of joining a gym will be motivation to get the most out of your investment and there are trainers at gyms that can help you maximize your work outs. Having someone to exercise with or who will kindly remind to workout is a great motivator and makes exercising more fun.

Test Your Blood Sugar after fasting, before eating a meal, and 2 hours after eating a meal: Knowing what your blood sugar level is at different times during the day will cause you to react, either to work to get a high reading down, a low reading up, or to congratulate yourself on a great reading in your target range. The more you check, the better you refine your habits to control your blood sugar.

Keep Up to Date with Your Doctors Visits and Tests: Schedule your regular visits to your doctor, specialists, dietitian, dentist, and anyone else that is part of your care team. Also, make sure you are up to date with your tests like A1c, kidney tests, heart check ups and more. It is important to track your progress and give your care team as much information as possible to refine your treatment plan as time goes on.

Find Out How Many Calories You Should be Eating Each Day: This might sound complicated but knowing how much energy your body needs will help you to lose weight and then maintain your healthy weight once you’re there. If you don’t know how many Calories your body needs, how do you know if you are eating too much? Knowing this number is a simple way to keep on target. (Talk with your dietitian or doctor to find out your individual Calorie goals)

Learn Which Foods are Good for Your Heart, Cholesterol, and Diabetes: There are tons of resources available for you to do a little self study or meet with a dietitian or CDE to learn which foods are better for you to choose. A little knowledge goes a long way to better health.

Drink Water: Drinking water seems like a no-brainer but many Americans do not get enough pure water each day. Choosing water over sugary drinks like cokes and sports drinks will save you calories, lower your blood sugar, and improve your overall health.

Quit Smoking: This is a big change for some people but it has one of the biggest impacts on improving your health for your diabetes, heart, circulation, lungs, and other organs.

Set Goals: New Years is not the only time to set goals. Think about areas in your life that you want to improve, not just having to do with diabetes, and write SMART goals down. This simple act will give you something specific to work towards instead of being overwhelmed with the million things you need to improve.

Be Realistic: The longer you have diabetes, the more likely you are to develop complications not because of your failure but because of the progressive nature of the disease. Don’t beat yourself up, but do everything you can to manage the disease so you don’t have any regrets.

A new Dutch study published in Diabetes Care might give you a sigh of relief to know that you can still get fairly accurate results when you are not able to be the most vigilant with your finger pricking cleanliness.

The study watched people with diabetes test their blood sugar under different circumstances: washing and drying hands; no hand washing; after touching fruit and not washing hands; after touching fruit and then washing hands.

You can make an educated guess with common sense that washing your hands gives the most accurate blood sugar results, which it does. But they found the second drop of blood was more accurate than the first drop for the people that did not wash their hands. Not washing your hands will give some error, but they found less error with the second drop.

And common sense tells you also that testing your blood sugar with visibly dirty hands will give you inaccurate results, which it does. So always wash your hands before pricking your finger if you are able. But, if you are not able to wash your hands, wipe away the first drop of blood and then use the second drop to wick on the test strip.

One other good finger stick habit is to not squeeze too hard. If you have to force blood to come out of your finger, it can actually change the blood sugar reading. So…

• Let your hand hang to your side to get blood flowing to your fingers.
• Set your lancing device depth to the best setting for your skin thickness (those calluses can get tough!).
• Wash your hands well with warm water and soap. (Carry hand sanitizer with you everywhere just in case there is not a sink nearby)
• Dry your hands very thoroughly.
• Go ahead and test your blood sugar, making sure not to squeeze too hard.

So make your dietitian proud today and choose one of these healthy lunch options to stay on target with your blood sugar and healthy weight.

Tasty and Healthy Lunch Ideas:

Open faced sandwich: Whether you packed your lunch today or you’re heading over to the corner deli, open up your sandwich by taking off the top piece of bread or bun. You’ll still have all the great flavor and texture but half the carbs.

Be picky about your salad: Salad is always a great option but it is so easy to sabotage your good intentions with high carb/high fat croutons, too much creamy dressings, tons of cheese, and other toppings. Choose darker leafy greens, top with some healthy veggies like broccoli or bell peppers, add 4-6 ounces of lean proteins like fish or chicken, and leave the dressing on the side. Dip your fork into an oil based dressing like a vinaigrette before getting a forkful.

Soup for you: A nice warm cup of soup can be comforting, filling, and calorie friendly. Watch out for cream based, cheesy soups and pasta soups because these high fat soups with hidden carbs might cause a delayed blood sugar spike while packing in too many calories. Broth or tomato based soups and chilis are a great options, especially with non-starchy veggies, lean protein, and high fiber grains like bulgur, quinoa, or brown rice.

Breakfast or Dinner for lunch: Healthy dinner leftovers are fast and better options than fast food drive thru. Turn your pot roast dinner into an open faced sandwich or toss your stir fry chicken and veggies into a Tupperware for lunch. Or turn back the clock to breakfast and have a lean egg white omelet with veggies or an egg salad pita. You can control the portion size and how many carbs you pack.

Scrutinize that menu: If you opt to dine out for lunch with friends, coworkers, or clients, see the menu as a challenge to order most healthy and satisfying thing on the menu. Don’t hesitate to ask the waiter if the cook can prepare a dish a particular way or leave a dressing on the side. Look to fill half your plate with non starchy vegetables, ¼ of your plate with a lean protein, and the last ¼ with a high fiber, whole grain carbohydrate.

Slowly cutting back and replacing your sugary drinks with better alternatives can be such a smooth transition, you won’t even notice!

Follow this step by step guide to slash out that liquid candy that you know is hurting your body and you’ll start to notice several benefits: much better blood sugar control; losing weight from cutting out those liquid calories; improved energy; better teeth and gum health; and a feeling of accomplishment for doing something healthy for your body.

1. Recognize all the sweetened beverages that you drink. Everything from Mountain Dew to Capri Sun to smoothies.
2. Choose better alternatives. You’ll need to do a little research here to find drinks that you like and that are not packed with sugar. But there are great options out there.
3. Start now! Don’t put it off and tell yourself you will start when you run out of the 12 pack you just bought. Most likely you won’t, so make your decision to change now!
4. Depending on how fixed you are on a particular drink, cut back on the total amount by at least half. So, if you normally drink 2 cans of Coke in a day, limit yourself to 1. If you can, cut back more.
5. Here’s the key. You’ll go crazy if you don’t have something to drink in the morning or if you feel doomed to drinking water only the rest of your life. Replace the amount of liquid that you cut out with the same amount of the better alternative you’ve chosen.
6. As you get used to your new drink or your caffeine headache starts to go away, cut back on the leftover sugar drink even more. Replace the liquid like you did before until you are totally sugar drink free!
7. You might find that you don’t even need the replacement anymore.

A few things to keep in mind:

• Your craving for something sweet will go away. Replacing the drink will help with this.
• You might find that your need for sweetened drinks isn’t even a craving but a need to do something. Drinking, sipping or sucking through a straw can be a habit in itself.
• The first few days of cutting back or cutting out these drinks might be painful, literally. You might have a caffeine headache from drinking less caffeine, you might feel like you have less energy for a few days, and you might feel moody. These are all temporary and show you just how much you need to get away from those drinks.

A few healthier alternatives:

• Water: Water is a no brainer but many Americans do not get enough each day. It might be difficult to go straight to water, but do try to increase your water intake as you cut back on other drinks.
• Unsweetened tea: Hot or cold, tea is packed with antioxidants and has no calories! There are so many different kinds and flavors, and you truly don’t need to add anything for flavor.
• Coffee: Recent research is showing that coffee actually has health benefits. Drink in moderation of course, 1-3 cups per day, and be careful not to add tons of sugar yourself. That would defeat the whole purpose!
• Infused water: Add lemon wedges, cucumber, frozen blueberries or raspberries, or other flavor enhancers to a pitcher of water. The water will have a subtle flavor and still no calories.
• Diluted 100% fruit juice or vegetable juice: By adding water to fruit juice or vegetable juice, you cut back on the amount of sugar, sodium and calories per serving. Both contain vitamins and minerals so it is healthy alternative if you limit the sugar. It might take awhile to determine the right ratios but you’ll be pleasantly surprised by the taste when you get used to it.
• Whole fruit or vegetables: If the fruit and vegetable juices have nutrition, think how much more the actual fruit or vegetable has! And you’ll be surprised that eating 1 piece has less calories and carbs than drinking the juice.
• Skim milk or soy milk: This is not something to sip throughout the day, but a cup with lunch or with a midday snack is a great alternative. You’ll get more calcium, vitamin D, protein, and other nutrients from milk, but remember that 1 cup has 15 grams of carbs and 80 calories.
• Non-Caloric, Artificially-Sweetened Beverages: This includes diet soda, diet drinks, and artificially-sweetened drinks. A better option than the high sugar, high calorie drinks, but these drinks should not make up the bulk of your fluid intake either.

Well that didn’t help at all did it?! This is a disease that causes your arteries to become hard and narrowed (that process is called arteriosclerosis) with fatty deposit (atheromatous deposits) and extra tough tissue (fibrosis)  in the artery walls.

Arteries can even become completely blocked in atherosclerosis. Your arteries are blood vessels that carry blood from your heart to the rest of your body, so atherosclerosis, blocking arteries, can lead to heart disease.

Well, that doesn’t sound good. How does it start you ask? Several problems lead to the fatty deposits and tough fiber tissue in your arteries:

• High blood pressure
• High cholesterol
• Diabetes
• Overweight or obesity
• Smoking and tobacco use
• Unhealthy diet
• Lack of exercise
• Family history of heart disease

With these conditions that lead to the junk in your arteries, your body kicks into protection mode and actually sends more “good gunk” to the damaged area. These good intentions actually just cause more plaque, which you’ve probably heard of. This plaque leads to more narrowing and hardening of the arteries.

When damage occurs, your body tries to repair your arteries.

So what can I do to stop atherosclerosis and plaque buildup from happening? You guessed it, “lifestyle changes.” Just like the foods you eat, how much you exercise, and other healthy habits you do or don’t do affect your blood sugar control; these same lifestyle habits will affect your heart and arteries.

The main goals are to get to a healthy weight, keep your LDL cholesterol below 100 mg/dL, get your HDL cholesterol over 50 mg/dL, keep triglycerides under 150 mg/dL, keep your blood pressure under at least 120/80, and control your blood sugar with an A1c of 7.0%.

Here are some tips on how to accomplish all this. (And by the way, doing all these things will also help you manage your diabetes and prevent other complications.)

Pick at least 5 days to exercise each week: Choose 3 days for cardiovascular exercise like walking, dancing, jogging, running on an elliptical or biking and choose 2 days to work your muscles with resistance training, weight lifting or doing body weight exercises.

Educate yourself on healthier foods for your heart and for your blood sugar. (Come on, you know you know this!): Hold yourself accountable to start choosing these foods more often over the foods you know are not as good for your heart and diabetes. Choosing the right carbs is crucial too. Check out this link from the Mayo Clinic for more information.

Cut out smoking and tobacco completely. This is a must.

Work some of these extra heart boosting choices into your daily and weekly routine: Eat fish 2 times a week. Take an omega-3 fatty acids supplement, 1000mg/day. Choose tub butters with plant stanols and sterols instead of regular butter or shortening. Get at least 38grams of fiber (for men) and 25 grams of fiber (for women) each day. Cut back and lower your sodium intake.

Take time each day to relax and lower your stress level: This doesn’t mean plopping down in front of the TV (studies show this actually hurts your health). Try something active or calmly sitting to quiet your mind and calm your nerves.