You Mean it’s Really The Carbs?

sugarWhen I think of diabetes, or pre-diabetes, I think of sugar.  Your A1C measures the percentage of blood glucose (think sugar) in you, so I just presumed that’s why it was used to determine if you have diabetes. Last week, when I was researching this test, I came across material suggesting it was carbohydrates – not the sugar I had assumed – that needs to be cut down in an effort to slow down the disease.

As usual, I’m getting a little ahead of myself.  I think I’ve discovered a formula that works when explaining… and it starts with a definition. According to Medical News Today at http://www.medicalnewstoday.com/info/diabetes/,

“Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).”

Mellitus comes from the Latin and refers to sugar sweetened. Notice that diabetes is often called Diabetes Mellitus.  Hmmmm, another reason I thought it was ingested sugar that causes the disease.  Yet, it is described as a metabolic disease; that is, a disease that deals with our metabolism – the way we process the foods we eat to gain energy.

Well then, where does insulin come in?  Just in case you forgot, insulin is “A natural hormone made by the pancreas that controls the level of the sugar glucose in the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without insulin,” accordinginsulin to MedicineNet.com at http://www.medterms.com/script/main/art.asp?articlekey=3989.

Oh, so if your body is not producing enough insulin or none at all or the cells can’t respond to the insulin produced in the usual way, the energy from the blood glucose can’t be used to provide energy for your cells.  Accepted.  But isn’t blood sugar still sugar, say from candy, cake, cookies and the like?  You know, the things we don’t eat as Chronic Kidney Disease patients.

Well… yes and no. Certainly these food items contain sugar.  That’s part of what makes them so delicious.  But they are also carbohydrates, a word I usually associate with bread and pasta. MedicineNet’s definition of carbohydrate at http://www.medterms.com/script/main/art.asp?articlekey=6553 cleared up my confusion:

“One of the three nutrient compounds, along with fat and protein, used as energy sources (calories) by the body. Carbohydrates take the form of simple sugars or of more complex forms, such as starches and fiber. Complex carbohydrates come naturally from plants. Intake of complex carbohydrates, when they are substituted for saturated fat, can lower blood cholesterol. Carbohydrates produce 4 calories of energy per gram. When eaten, all carbohydrates are broken down into the sugar glucose.” cookies

Ahh! So all carbohydrates, whether from starches or sugars break down into sugar glucose.  This is starting to sound familiar. When I brought my pre-diabetes to the nutritionist at my nephrologist’s office, she gave me quite a bit of information and a handout from DCE, a dietetic practice group of the American Dietetic Association.  Did you know that starchy vegetables, fruits, juices and milk also contain carbohydrates?  It hadn’t occurred to me.

Remember the way to measure a half cup or a whole cup when you don’t have measuring cups but want to stay on the renal diet, including portion control?  It’s the size of your palm for half a cup and the size of a clenched fist for a whole cup.  The same measurements are used to measure a portion of carbohydrates.  Good for us, one less thing to learn.  You know measuring cups are better, but to be honest, I got a little tired of dragging them around with me in only a few weeks. measuring cups

You can also buy portion control plates on the internet, but frankly, it’s just as easy to measure it (whatever it is) out once and then know what that size portion is. For example, we needed glasses so when I first used one, I measured the water it held and now know the new glasses hold 15 oz. unlike the blue ones which hold 8 oz.

When we moved in together, we had two sets of plates (Ahem, of course mine were more attractive.)Bear’s set had only large dinner plates whereas mine had both large and smaller dinner plates.  Since we were both trying to lose weight, it made sense to use the smaller ones.  Now I can see a portion on the plate without having to measure it.  I do measure periodically just to make sure I haven’t allowed my assessment of a portion to grow bigger.  Funny how that happens over time.

The Mayo Clinic has a good diet plan for diabetes at http://www.mayoclinic.com/health/diabetes-diet/DA00027/NSECTIONGROUP=2, but it won’t work for Chronic Kidney Disease patients as it is.  For example, whole wheat flour raises your blood glucose less than white flour, but has too much phosphorous for us, so we are warned to avoid it. Yoghurt, cheese, beans, and nuts are no-nos on my renal diet, but are often recommended in diabetes diets.

You need to know what you can and cannot eat on your renal diet before you look at the diabetes diet so you know what to cross out immediately.  This is what makes it easier for me to plan what I’ll be eating that day.

black breadYou also need to space out your carbohydrates.  This grand-daughter of a Jewish miller from Russia really did miss sitting down to eat a whole loaf of fresh black bread at one sitting… with butter, no less.  The diabetic diet’s not that bad, though: for me it’s 2 to 3 carbohydrate portions at breakfast, lunch and dinner with a one carbohydrate portion at three snacks – one after each meal. As I understand it, each carbohydrate portion is 15 grams. You can find a comprehensive list of these foods at http://www.diabetesdaily.com/forum/food-diet/25848-15g-carbs-snack-list/

I never told you about The Men’s And Women’s Gathering hosted by The Salt River Pima-Maricopa Indian Community and open to all tribes as well as non-tribal members.  SlowItDown’s kidney education coordinator, Annette Folmer (left), and nurse CherylVietri (right) did a great job of answering all the questions asked..  The three of us were delighted at how interactive the session was.  We had a plan, but a better one presented itself during the education.  As a result, I ended up gladly donating 15 books to visiting tribal members.  What a way to start off SlowItDown’s career of bringing free ckd education to any community that needs it! IMG_0189

Until next week,

Keep living your life!

A1C! A1C! (Sounds like a Cheer to Me!)

For those of you who don’t know us personally, we do a lot of eating out during celebrations.  (Is Labor Day an eating out kind of holiday?) August is full of birthday celebrations.happy birthday

We started off by celebrating Sean’s August 20th birthday early since he and Kelly were going to be in Michigan with his family on his actual birthday.  I somehow magically found Salute Ristorante Italiano (http://www.saluteaz.com/) in Phoenix which actually had a delicious meal that required no substitutions whatsoever for me… and they didn’t know that I was coming or that I had renal disease.  Hurray for them!  It was Sean’s celebration, but I felt I was the one who’d gotten a present.

Bear’s birthday was the 23rd.  On the spur of the moment, we decided to go to Buca de Beppo’s (www.bucadibeppo.com) for a late lunch/ early dinner since I had a Landmark Worldwide class that night and we wanted to do something to celebrate.  This meal didn’t turn out so well for me.

While Bear ordered a delicious meal, I could taste the salt in the cheese ravioli with meat sauce.  The meatballs weren’t salty, but they were still red meat.  Let’s see:  cheese, red meat, and salt.  Good thing Bear also ordered a salad. Then I completely blew it by having half a chocolate chip cannoli in chocolate sauce while the wait staff sang Happy Birthday to Bear.  Amazing how fast the body lets you know you’re not doing right by it.ravioli

The next day, I’d promised to take Bear to his favorite restaurant for his favorite meal before we went to hear Greg Warren perform at Stand Up Scottsdale (http://standupscottdale.com).  While Greg Warren (www.gregwarrencomedy.com) was an excellent choice, Flo’s (www.madebyflo.com) was a renal diet disaster.  This is in no way a bad review for Flo’s, but rather a bad review for deviating from the renal diet.

Once or twice a year, I indulge myself with their scrumptious house fried rice… even though it’s fried.  But not the day after a meal that did me no good!  To make it worse, they must have changed their recipe for the Vietnamese Spring Roll. It was deeply fried with a very mushy interior. By the time, Bear’s complimentary dessert of chocolate covered wonton surrounding a slice of orange arrived, I was very happy to eat just the orange.

Ah, but we’re not done.  Grown children Abby, Lara, and Lara’s sweetheart joined us for ‘The Mortal Instruments: City of Bones’ (Eh.  Maybe I wasn’t in the mood.) and dinner at Claim Jumpers (www.claimjumper.com/) afterward.  This is a place where Bear usually shares a really tasty renal diet meal with me… but not on his birthday: ribs, mashed potatoes, roasted veggies with sour dough cheese bread and then a taste of the chocolate cake a la mode.  All I have to say is, “What the dickens is wrong with me?!?!?!?!?”

sad faceMy poor beleaguered body could not keep up with so many foods I usually do not eat and I felt physically ill.  To make matters worse, my A1C will be a mess this time around.

Oh, right, A1C.  That’s the topic of today’s blog.  Let’s start the way we usually do with a definition. I picked up Amgen’s Understanding Your Lab Values: A guide for patients with chronic kidney disease. While this is a drug company (and I don’t recommend any drugs; that’s up to your doctor), their informational guides are usually clear and straight to the point.  They define A1C as, “a test that measures your average blood glucose levels over 2 to 3 months.”  Mine is evaluated via my usual quarterly blood draw.

You’ve probably figured out that this has to do with diabetes or pre-diabetes. According to DaVita at http://www.davita.com/kidney-disease/causes/diabetes/the-a1c-test-and-patients-with-chronic-kidney-disease/e/7802, people with Chronic Kidney Disease should keep their A1C readings between 4.0 and 5.9%.  Mine has been rising steadily for the last several years and is presently at 6.1, which is considered pre-diabetic.

Okay, so your glucose levels can be tested for a two to three month average and over a certain percentage is considered pre-diabetic.  What is so important about blood glucose anyway?A1C

Our old friend MedicineNet at http://www.medterms.com/script/main/art.asp?articlekey=32858 tells us blood glucose is:

“The main sugar that the body makes from the food in the diet. Glucose is carried through the bloodstream to provide energy to all cells in the body. Cells cannot use glucose without the help of insulin.

Glucose is a simple sugar (a monosaccharide). The body produces it from protein, fat and, in largest part, carbohydrate. Ingested glucose is absorbed directly into the blood from the intestine and results in a rapid increase in blood glucose. Glucose is also known as dextrose.”

Got it!  We need blood glucose for energy.  And the cells need insulin to provide this energy from glucose. Well, how is this a problem?  Wait a minute – insulin – diabetes.  Oh, my!

I’m getting close to diabetes.  All right, then let’s look at diabetes.  What’s that? Well, we can figure out it’s the body’s inability to handle a surplus of glucose in the body, but what harm is it specifically to you (and me) as a Chronic Kidney Disease patient?

According to Diabetes.co.uk at http://www.diabetes.co.uk/how-does-diabetes-affect-the-body.html, “The kidneys are another organ that is at particular risk of damage as a result of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure and cholesterol. “

I am not liking this. I’m already being treated for hypertension [high blood pressure] and hyperlipidemia [high cholesterol].  I don’t think I can afford to add diabetes to the list.  And that’s why next week’s blog will be about diabetes.

talkingstickresortThank you for all the support you’ve shown for SlowItDown, the project to bring free CKD education by trained educators to any community that needs it. It was our pleasure to be part of The Fourth Annual Men and Women’s Gathering at Talking Stick Resort this past Thursday.  This was hosted by The Salt River Pima – Maricopa Indian Community and open to all tribes.  Non-tribal members were welcome as well.

Several medical professionals, including nephrologists, have offered to help make this an interactive blog.  Please send your questions in comment form and we will answer them as quickly as possible. I’m enjoying the change of direction for the blog.

And to think this all started when I wrote What Is It And How Did I Get It? Early Stage Chronic Kidney Disease because I needed answers.

Until next week,

Keep living your life!