NorthShore Diabetes Care Team
Dr. Billings and RD Lynn Tucker: Both exercise and diet are very important for a person with diabetes. Exercise is important for improving blood glucose control, increase metabolic rate, weight maintenance, and heart health. Diet is extremely impactful on lowering blood glucose levels particularly when carbohydrate amounts are monitored carefully and not in excess. High-quality diets contribute to overall health. A healthy diet, carb controlled/calorically restricted is important for weight loss. Weight loss improves glucose control in people with diabetes.

NorthShore Diabetes Care Team
Great question, Phillip! A1c is a shortened term for Hemoglobin A1c. This number provides an estimate of the average glucose level over the last 90 days. For example, an A1c of 7.0% would indicate that a person has had an average blood glucose ~150 over the last 90 days. Normal A1c is less than 5.7%. Pre-diabetes range is 5.7%-6.4%. Diabetes range is 6.5% and above. Generally, our goal of treatment in diabetes is an A1c less than 7%, but this can be a personalized goal per person in communication with your doctor.

NorthShore Diabetes Care Team
Lynn says: Sugar-free foods can have carbohydrates and be high in calories. For example, diet soda has no calories or carbohydrates. A sugar-free cookie has calories and carbohydrates. The best way to decide on which products to buy would be to look at the nutrition label and note the total calories per serving and total carbohydrate per serving when choosing something that fits into your meal plan. Of note, sugar substitutes like sugar alcohols (like sorbitol) can cause diarrhea and gastrointestinal upset in higher quantities. Also, there isn't clear evidence that eating sugar-free foods helps with weight loss.

NorthShore Diabetes Care Team
Dr. Billings: Type 2 Diabetes is caused by genetic risk as well as environmental risk. For example, if a person has a parent or parents with diabetes, they have an increased risk genetically of getting diabetes. The risk is increased with poor diet and weight gain and a sedentary lifestyle in developing diabetes. Fortunately, the genetic risk can be countered by regular exercise and healthy diet. This has been shown in the Diabetes Prevention Program where people with a high genetic risk for type 2 diabetes lowered their risk when they participated in an intensive lifestyle program including at least 150 minutes of aerobic exercise per week, 7-10% weight loss, and healthy diet.

NorthShore Diabetes Care Team
Dr. Billings: Having diabetes increases the risk of heart disease (for example heart attack or coronary artery blockages) and stroke. This risk can be lowered by discussing preventative medications with your doctor. Elevated blood glucose (A1c greater than 7.0%) puts people at risk of having eye, kidney, or nerve damage. Keeping blood glucose in good control (A1c less than 7.0%) decreases this risk significantly. The main takeaway is that diabetes can cause a higher risk of other diseases, but a person with diabetes can have the power through good blood glucose control, a healthy lifestyle, and the right medication to lower this risk.

NorthShore Diabetes Care Team
Lynn: Yes, there are certain general rules for replacements that can help diabetes management. For example, replace refined grains (like white rice) with 100% whole grain options like brown rice or quinoa. That being said, whole grains still have carbohydrates and quantities need to be monitored. Replacing high saturated fats (like butter, coconut oil) with healthy fats like olive oil, avocado, peanut oil, or unsweetened nut butters. Replace red meat with fish and seafood, eggs, and soy protein. Try to replace high carb starches with lower-carb vegetables. For example, rice cauliflower instead of rice OR spaghetti squash instead of pasta OR winter squash instead of potato.

NorthShore Diabetes Care Team
Lynn: I recommend picking your one very favorite holiday treat and eating a small portion (less than 3 bites) only on the special occasion. Chew slowly, focus on enjoying while eating it. Also spreading out dessert/treat from the meal gives your body a chance to have blood glucose come down after dinner before increase with a dessert/treat. Also, limit the starches and other carbohydrates with the meal if you plan on having dessert after. Dr. Billings: Please keep in mind, if your blood glucose is generally not controlled (glucose >180) yet, you should avoid high carbohydrate foods and sugar until the blood glucose is in a safer range. Once in a safer range, it may be alright to reintroduce small amounts of "treats" in the diet for special occasions. If you feel that you cannot control the portion of a sweet food, then avoid it.

NorthShore Diabetes Care Team
Lynn: Sweetened beverages like soda, juice, sweetened teas, egg nog, high sugar coffee drinks should generally never be on the menu for someone with diabetes. You may use sweetened beverages (soda or juice) to treat a low blood glucose as instructed by your doctor. In general, look at your holiday menu. Determine which foods are your favorites that are higher carbohydrate and take small portions. A good rule of thumb is to limit starchy foods (like potato, stuffing) to 1 cup combined.

NorthShore Diabetes Care Team
Dr. Billings: Symptoms of very high blood glucose could be unexplained weight loss, increased thirst, increase hunger, more frequent urination, or blurry vision. Often diabetes does not have symptoms. Your doctor should provide yearly screening with an A1c and fasting glucose level if you are overweight and over the age of 35, or yearly over the age of 40, or have a history of gestational diabetes, or if you have other medical conditions that might increase your risk. One tool to assess risk is provided by the American Diabetes Association: https://www.diabetes.org/diabetes-risk. The American Diabetes Association also has other resources that are helpful.

NorthShore Diabetes Care Team
We have diabetes educators, endocrinologists, registered dieticians, and specialized advanced nurse practitioners. We have class series through the diabetes educators for medicare patients. Other resources: American Diabetes Association Juvenile Diabetes Research Foundation Diatribe Some apps include: Glucose Buddy Myfitnesspal LoseIt CalorieKing

NorthShore Diabetes Care Team
Dr. Billings: The field of diabetes is very fast-moving. 10 years ago, we had very few medications that we could use for type 2 diabetes, whereas now we have several options. The newest medications available in the type 2 diabetes treatment are SLGT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) and GLP1-Receptor Agonists (semaglutide, dulaglutide, liraglutide, exenatide, lixisenatide). The advantage of these newer therapies is that in addition to blood glucose-lowering they can also promote weight loss and protect for heart disease and kidney disease in certain patients. As far as technologies, we now have continuous glucose monitors that can be used in both type 1 and type 2 diabetes to help monitor blood glucose levels without needing fingersticks. Additionally, we now have insulin pumps that integrate with continuous glucose monitoring, and the insulin dose is modified by the glucose level helping glucose control and less low blood glucose