November 2012                                                                                                                    View previous issues


Stay healthier over the holidays and keep your blood sugar under control

by Sacha Uelmen, RD, CDE, Diabetes Educator and Program Director, Adult Outpatient Diabetes Education Program, U-M Comprehensive Diabetes Center, and April Pickrel, Dietetic Student, Eastern Michigan University

General Tips

  • Plan Ahead! Prepare for the temptations and make a game plan — write it down and stick to it! Think about influences you will face from family, food, and stressors.

  • Bowls filled with candy, chips or crunchy treats can be tempting. Make sure they contain non-carb snacks such as mixed nuts and vegetables or skip the snacks altogether.

  • DRINK WATER! Sure there are lots of temptations and you will be loading up on carbs with your foods. Be sure to stay hydrated and avoid the extra calories that come with other beverages. Keep a bottle or glass of water in your hand all day so when you get the urge to nibble, you can sip instead.

  • Get back on track the following day. It's okay to indulge a little on the actual holiday. The problem is weight and increased A1C stems from all those days in between. If you stick to your healthy goals 80% of the time, you can afford to indulge the other 20%.

  • Remember to regularly check your blood sugar throughout the holidays, and let those numbers help you decide how you'll eat for the day.

  • Focus on friends and family! Our food traditions bring us together, but it's the perfect time to enjoy the people you're with!

Big Meal Basics

  • Don't go hungry! Be sure to eat breakfast and avoid trying to save your carbs for a big event later in the day. Skipping meals can make it harder to control your blood sugar.

  • Are you the cook? Avoid sampling the foods where possible. Tiny tastes can add up to big calories over the course of a day in the kitchen.

  • Eat only the foods you really enjoy. Look at all your food options before you fill your plate, and skip the items that aren't a treat to you, such as mashed potatoes, bread or rolls, or other items that you can have year 'round.

  • Your fist is about the size of a 1-cup measuring cup. This can be a guide to help you estimate your portions and keep your plate reasonable.

  • artUse a smaller plate and eat slowly. Savor every bite. Think about how much work went into the meal and savor it. Make sure you only eat while sitting at the table; avoid the temptation to stand around snacking.

  • Plan to get moving! Even with the best intentions, we'll probably overeat a little bit. Get on that treadmill or stationary bike in the morning, turn on some dance music and get the whole family dancing, plan Wii games for the whole family to participate and be active, or just plan a family walk if the weather permits.

  • Save dessert for your snack a few hours later rather than immediately after dinner.

Planning for Parties

  • artEat a healthy snack before you go to the party. If you arrive too hungry, it can be easy to overindulge.

  • Try to get in your usual exercise or a walk the day of the party. Keeping to your usual healthy habits can help you feel your best.

  • Are you a guest? Offer to bring a healthy dish that you'll look forward to eating and sharing.

  • Explore all your food options before you start to fill your plate. Make room for your favorite seasonal treat, and leave the everyday foods for some other time.

  • If you try something new and you don't like it, just leave it on your plate. Don't waste the calories on something you don't enjoy.

  • artTake it easy on the alcohol. Calories from alcoholic drinks can really add up! Try to stick with the simple stuff like wine or beer and keep it to 1–2 drinks.

  • The food table can be too tempting, so find a comfortable chair and friends across the room to avoid mindless grazing.

  • Build your snack plate with healthy eating in mind. Start with fresh vegetables and fill half your plate, then try to keep chips and crackers to just a small corner.

These few extra steps can make for a successful holiday eating strategy. Take care of yourself, and enjoy!


Diabetic foot infections and limb loss are largely preventable

michael munson dpmMichael Munson, DPM
Instructor of Internal Medicine
Podiatry Services
U-M Comprehensive Diabetes Center

Did you know that foot infections account for the most total hospital days among those with diabetes? There are over 65,000 lower extremity amputations in the U.S. each year not caused by trauma (such as accidents). The majority of those amputations are due to diabetic foot infections.

Five-year death rates after amputation have been reported between 43% and 74%. This is higher than those for several types of cancer, including prostate, breast, colon, and Hodgkin's Disease.

However, up to 85% of these amputations could be prevented with education and regular checks by your podiatrist and foot care specialist. The vast majority of amputations in people with diabetes are preceded by an ulceration, or wound of the lower extremity (legs and feet). Research has shown that even small, seemingly trivial sores can become infected 58–61% of the time.

The ADA recommends daily foot inspections (for cracks, sores, calluses, red areas), daily foot care (applying lotion, drying between toes, wearing well-fitted shoes), and regular visits to your diabetes physician and podiatrist or foot care specialist.

footcare photoWhile daily inspection is extremely important, seek care from your foot care specialist immediately when inspection reveals a cut, scrape, sore, wound, or other concerning injury. Podiatrists in the Department of Metabolism, Endocrinology, and Diabetes are uniquely trained to manage persons with diabetic foot-related issues, with an emphasis on prevention, to vastly decrease the number of diabetic lower-extremity amputations.

So often, we see foot wounds that lead to partial or total limb loss that could have been treated more effectively if the patient had not waited or tried to self-treat for an extended period of time. We make an extensive effort to see our patients with diabetes who call with acute foot issues either that day, or within 24-48 hours. In an emergency, patients with concerns can go to the Emergency Department and get treated for infection and then follow up with us as soon as possible. It is the delay between recognition of a diabetic foot issue and care for that issue that needs to be shortened if we are to decrease limb loss.

A multidisciplinary approach including regular follow-up with your primary care provider or endocrinologist and foot care expert can greatly decrease your chance of diabetic foot infection and limb loss. You can make an appointment with the foot care specialists in Podiatry, which is located at Domino's Farms, Lobby C in the Department of Metabolism, Endocrinology, and Diabetes, by calling 734-647-5871 or toll-free at 866-266-5221.


wdd logo6th Annual U-M Diabetes Health Fair sets records!

For the past six years, the U-M Comprehensive Diabetes Center has hosted a Diabetes Health Fair to commemorate the United Nations' World Diabetes Day (WDD) and the American Diabetes Association's Diabetes Awareness Month. Each year, the event gets larger and more features are added. This year was no exception. Here is a summary of the 2012 U-M WDD Health Fair, which took place on Saturday, November 10 at the Sheraton Ann Arbor Hotel:


wdd screenings photoAttendance:1000–1200
Number of lectures: 3 (consecutive)
Number of volunteers: 45 (NOT counting the exhibitors)

UM Health System exhibit tables: 15
Non-profit organization exhibit tables: 10
Diabetes medical supply exhibit tables: 16
Total exhibit tables: 41 (NOT counting the screenings)

Number of free screening stations: 7
18 people had foot screenings by Podiatry Service, U-M Comprehensive Diabetes Center
35 people had eye screenings for diabetic retinopathy by U-M Ophthalmology (NEW this year)
96 people had kidney screenings by the National Kidney Foundation of MI
110 people had cholesterol screenings by U-M MHealthy Corporate Wellness
174 people had blood sugar and A1c screenings by U-M Pathology

Once again, the University of Michigan's MedEquip Division was our main sponsor. Patients can order their diabetes supplies, wheelchairs, and much more from MedEquip by calling toll-free: 800-530-0714. We would also like to thank Dexcom and the Eli LIlly Co. for their extra support!


We are looking for feedback on this year's U-M Diabetes Health Fair before we start planning the 2013 fair. Please send comments to Amy Garber at


How do diabetes complications develop? We're looking for volunteers with type 1 diabetes to help us find out!

Diabetes changes how our bodies use fats, carbohydrates (sugars), and proteins for fuel and these changes may contribute to the serious complications that can result from diabetes. These complications include retinopathy (a type of damage to the eye that may lead to blindness), nephropathy (kidney disease), and neuropathy (nerve damage that can cause pain, loss of sensation, and even lead to amputations).

pop-busui photoTo better understand how changes in a body's use of fat, carbohydrate, and protein contributes to complications of diabetes, renowned U-M diabetes researcher Dr. Rodica Pop-Busui and her colleagues are conducting a study called "Tissue-Specific Metabolic Reprogramming in Diabetic Complications." In the study, volunteers will have blood tests done during a time when their blood sugar is held at different, but steady, levels.

Some of the tests will be done with the blood sugar in the normal range, and some of the tests will be when the blood sugar is kept higher than normal. Doing these tests will help the researchers learn more about how high blood sugars affect metabolism — how our bodies use different fuels like fat, sugar, and protein.

The study will include four groups of people. In all, 40 people will be needed to make the study a success.

Specifically, the four groups needed are:

  • 10 people with type 1 diabetes who have no diabetes complications

  • 10 people with type 1 diabetes who also have early signs of kidney disease

  • 10 people with type 1 diabetes who have multiple diabetes complications, such as retinopathy (eye damage) plus neuropathy (nerve damage), or neuropathy plus nephropathy (kidney disease)

  • 10 people who do not have diabetes and who are in good general health

test tubes photoComparing the results from these four different groups will help the researchers learn how changes in metabolism lead to development of diabetes complications. Learning more about how complications develop may help to devise ways to prevent complications from happening.

If you are interested in being in this study, please contact the Study Coordinator to review all the entry criteria for the study. For people with type 1 diabetes, this includes having had type 1 diabetes for at least 5 years, and having an A1c level of under 7.5% for the past 6 months (A1c is a measure of diabetes control). All participants have to be willing to stay overnight in the hospital for one night, and then spend most of the day in the hospital for the testing.

To learn more about this study, please contact the Study Coordinator, Cynthia Plunkett, RNC, CCRC, at 734-936-8065 or via email at


A day in the life of diabetes: Post your photo for the ADA!

ADDA graphicThe American Diabetes Association (ADA) designates each November as "American Diabetes Month." This year, the theme of American Diabetes Month is “A Day in the Life of Diabetes” — and it's being depicted by thousands of photos on an ADA page on Facebook.

The ADA is asking people to "Send us a photo of a moment that captures what living with diabetes every day means to you. Tell us about the extraordinary effort that goes into living an ordinary day. Your picture and comments will help build a mosaic that shows the true picture of diabetes."

CVS Pharmacy is donating to the ADA $1 for every photo or image uploaded through November, up to $25,000.

To view the photos or upload your own, visit:

Adult Diabetes Education  ~  Pediatric (Child) Diabetes Education
Adult Diabetes Support Groups

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