Sick Day Management

Colds, the flu or other illnesses can hit us at the worst of times.  When you have diabetes, it’s important to know what to do when you aren’t feeling well in terms of medications and food choices.

If you are sick, but still able to eat:

Take your diabetes medications as usual.

Eat your usual meals and snacks (if you have them) at your usual times if you can.

Test your blood sugar level more often.

If your blood sugars are running higher than normal, try to drink more sugar free fluids, like water, tea, clear broths or diet pops.  This can help to flush out some of the extra sugars in your blood.


If you cannot eat your usual meals and snacks, make sure you have one of the following every hour to reduce the risk of a having a low blood sugar, and to help with your hydration:

1/2 cup (125 mL) juice

1/2 cup (125 mL) regular pop

1/2 cup (125 mL) regular Jell-O

1 whole popsicle

You may need to test your blood sugars more often if you are unable to eat or drink.  You may need to adjust your insulin or other oral medications.


If you are sick and cannot drink enough fluids to keep yourself hydrated (especially if you have vomiting and diarrhea), call your health care provider or go to your nearest emergency room.  Also, you may want to HOLD certain medications as they can cause your kidney function to worsen or result in side effects:

Here is a list of some of the types of medications that may need to be held or adjusted during your illness:

ACE inhibitors or ARBs (ask your provider if you are not sure)

Diuretics (water pills)

Diabetes medications including: Metformin, glyburide, gliclazide (Diamicron MR)

Non-steroidal anti-inflammatory drugs (NSAIDs) (which are commonly found in pain medications like Advil or over the counter cold remedies)

You should speak to your physician, nurse practitioner or pharmacist to determine which of your medications should be stopped when you are ill.  It’s usually best to discuss a plan for your medications at your regular diabetes visit before you are ill. That way you have an individualized plan if you become ill.

If you have type 1 diabetes, check for urine ketones every 4 hours.  If your level is high, contact your health care provider or go to the nearest emergency room.

The Canadian Diabetes Association website is a great resource for information on sick day management at:

What would you do??

What types of diet changes would you be willing to do if it meant being able to avoid cholesterol-lowering or blood pressure lowering medications?

This is an article from CBC that shares a perspective about how diet changes can improve our overall health.  Vegetarian or vegan diets can be one route to support our heart health, and we need to consider our heart health when we have diabetes.  I thought I would share this article as a bit of food for thought.  You may not be willing to become vegetarian or vegan, but maybe there are aspects of these diets that you can incorporate into your daily life that would have beneficial effects on your health!  Beans and legumes more often?  One or two vegetarian meals per week?  Trying tofu instead of chicken or beef in a stir-fry?


What do you want to change?


Black Bean and Quinoa Salad–this is a tasty summer treat!



Let’s consider our portion sizes…

It’s not always the foods we choose that are the problem when it comes to managing our weight or our blood sugars.  Sometimes we are just eating too much!  Whether the calories are coming from healthy whole foods or higher calorie foods, any time we eat or drink more energy than our body needs, the extra energy will be stored as fat.

Let’s take a few minutes to consider whether we can start to reduce the amount of food we eat and I will give you a few tips and tricks to make these changes.

Our portion sizes have grown over the last 20 years, so what we believe to be a portion is often 2, 3 or even 4 times the size of an actual serving size. This can lead to an increase in our calorie, fat and sugar intake, and over time, weight gain.


Here are some things to consider when you are eating and drinking foods that are often served in large portion sizes…


What changes can we make?

1. Switch the dishes you use at home: Use smaller plates and bowls.  This will help you to serve yourself less, but it will still look like a good portion of food–it’s trickery for your eyes.

2. Measure out your portions for a few days to see what servings of food look like on your plate.  Aim for at least 1 cup of vegetables (or more if you can), 1 – 1.5 cups of starch with dinner (smaller amounts for women), 3-4 oz of protein for women and about 6 oz protein for men at dinner (3 oz = size of a small deck of cards or size of your palm, thickness of your baby finger)

3. If you are out for a meal, ask for a container to take food home in and put half of your meal in there before you eat your meal.  Yeah!  You get to have a delicious meal twice, and you save yourself cooking for a meal!

4. Avoid having serving dishes of food on the table where you are eating–otherwise known as the See-Food diet.  When it is in front of us, we are much more likely to go for seconds because of the constant reminder that it is there.  If we have to get up for seconds, we may be less likely to do so.  Keep extras away from where you are eating, or even put extras away into the fridge right away to avoid picking at the leftovers after the meal.

5. Along those same lines–avoid going for seconds, or WAIT 10-15 minutes before deciding whether you need seconds.  Give your body some time to register the food you have eaten.  When going for seconds, go for more vegetables first.

6. Eat SLOWLY!  Put your fork down between bites.  Take sips of water between bites.  Use chopsticks.  Enjoy good dinnertime conversations.  Pacing your eating means you are giving your body time to register your fullness.

7. Pre-portion your snacks–put chips, popcorn, candies, chocolates, ice cream etc. into small bowls or ramekins.

8. Limit your food choices–have you ever noticed how much more we eat at a buffet or potluck compared to when there are fewer choices for food?  When we want to try a lot of different foods, the more that is available, the more we will eat, so, have less variety available, avoid buffets, stick with one protein, one starch and 2-3 vegetable options at a meal.  If going to a potluck, bring a healthy food that you want to eat that is packed with vegetables!

Last thing. At meal times, always aim to have half of your plate as vegetables, a quarter of your plate as starch and the other quarter as your protein!!

Make your plate look like this! Keeping in mind that this plate is 9 inches in diameter, compared to most of our plates that are 12 inches or more!!

Now it’s time for you to set a goal.  What is one thing that you are going to do to try to reduce your portion sizes???  Who is brave enough in the group to share their goal and be the first to post a comment on the blog???

Andrea, RD



New Study shows marked improvement in diabetes related complications.

New Study shows marked improvement in diabetes related complications.
I came across this article and it was featured on several new casts in April. It looked at the change in diabetes related complications from 1990 to 2010. The article itself is a hard read for a lay person but I’ll try to summarize.
Over two decades, the study observed an amazing reduction in diabetes related complications. Specifically there was a two thirds (67%) reduction in the chance of having a heart attack and the risk of stoke and amputation decreased by about 50%. There was also a 28% reduction in the progression to severe kidney disease (ie. requiring dialysis).
There are probably may factors that account for the improvement in outcomes of patients with diabetes. The authors and many healthcare professionals feel that a great deal of the improvement is related to better diabetes care and advances in medicines over those twenty years. I certainly have seen vast improvements in my own practice outcomes over the twenty years. Better blood sugar control, better blood pressure control, smoking cessation and statins (cholesterol lowering medicines) have all likely contributed to these advances.
I think this sort of data really reinforces what we are trying to accomplish with our diabetes program at the Markham FHT. Helping our patients to achieve their targets, quit smoking, stay active and eat healthier are major thrusts of our programs. This kind of data explains why we stress the importance of controlling your blood sugars, blood pressure and cholesterol.
Not specifically address in this study but another important thing to remember is the data that shows the huge positive impact of staying physically active. Here are just a few examples:
  • Reduced blood pressure
  • Reduced weight
  • Better blood sugar control
  • Improved cholesterol profile
  • Improved cardiovascular outcomes
  • Reduced cancer risk
  • Improved sense of well-being and mental health measures
It’s not just about medications. There is so much we all can do to improve our health by staying active and eating right.
One final message – don’t forget to access the resources at the Markham Family Health Team to help you achieve your health goals. You can access the help of our clinical diabetes educator, dietitian, pharmacist, chiropodist and family physicians to address your concerns related to diabetes.
Here is a link to the article if you’re interested:
Dr. Bill

So you want to make changes to your diet…

I have been trying to figure out where to start with blog posts about diet changes that will help with blood sugar management and achieving a weight that is healthy for you.  I have finally decided to start with some basics and then will take other various topics and go into more depth about them.  I would love some feedback on areas that you struggle with so I know that the information is applicable to you.  Remember–if you have questions about something specific, it is common that others are thinking the same thing and may be too shy to ask, so ask away!!!

To get you started, here are some things to ask yourself:

1) Am I eating breakfast every day, within an hour or so of waking up?

Breakfast eaters tend to have more success with achieving and maintaining a healthy weight.  It is important to get the metabolism going in the morning, to help give you energy through the day, to reduce cravings and over eating later in the day, and to make sure you get important vitamins and minerals in your diet.  Many people who tend to skip breakfast tell me they are not hungry in the morning.  This could be because they have eaten too much in the evening, leaving them somewhat full in the morning, or it could be that their body is just not used to eating in the morning and they have lost those hunger signals.  We can retrain our body to be hungry in the morning by feeding it daily at that time.  Start with something small, like a yogurt or piece of whole grain toast with peanut butter or a small apple or berries.  Slowly build it up to have a balanced breakfast that includes some fibre, lean protein and that is low in added sugars.


3/4 cup cooked oatmeal (not instant) with 1 tbsp peanut butter (melted on top or mixed in…delicious), cinnamon, 1/2 banana, 1 cup low fat milk

3/4 cup plain yogurt, 1 cup mixed berries (you can use frozen and they will flavour the yogurt nicely!!), 3/4 cup high fibre cereal (look for something that has at least 4 g fibre and 8 g of sugar or less per 30 g serving).  Men may need to add a slice of whole grain toast (aim for 15 g carbohydrate per slice) with peanut butter or a boiled egg.

Breakfast on the go could be 1-2 slices of whole grain toast with low fat cheese or peanut butter, 15 grapes and a cup of milk or 100 g yogurt.


2) How often are you snacking?  What are you snacking on?  Are you HUNGRY when you are snacking or are you eating because you are: bored, frustrated, upset, influenced by others eating, used to eating at that time?

Snacking can be important, especially if we are going longer than 4-6 hours without eating a main meal.  Snacking can help us reduce our portions sizes at meal times by managing our hunger between meals.  It can help keep our blood sugars more stable over the day, to avoid those highs and lows.  It can be an important source of good nutrients and it can be an enjoyable part of our day.

Unfortunately, snacking can also lead to excess calorie intake, excess intake of things like sugars and fats which may not be good for our diabetes or our heart or our health.

Instead of the word snack, think of it as a ‘mini-meal’.  This can sometimes help us make better choices, as often snacking brings up images of chips, chocolate bars and the like.  These are okay to have in moderation, but if we can include healthy snacks at least 80% of the time, then we’re on the right track.

Plan your snacks out and have foods available for when you may need them.  Try to include some protein in the snack to help keep you satisfied longer.  Some options may include:

100 g yogurt cup with 10-12 almonds

1 small (size of tennis ball) apple with 1 oz cheese  (think individually wrapped Babybel cheeses or a cheese string)

1/2 whole grain pita with 2 tbsp hummus

100 g container cottage cheese (plain) mixed with 3/4 cup berries

2-4 whole grain crackers (e.g. Mary’s Crackers, Finn Crisp, Ryvita) with a tbsp of peanut butter or 2 tbsp hummus (maybe some sliced tomato or cucumber on top!)

1/2 cup whole grain cereal with 1/2 cup milk

Do you have any great snack suggestions???

Before you have your snack, ask yourself a few questions.

1) Am I physically hungry (is my stomach growling? does my body need food?)?  Or am I eating because I am bored, or sad, or because the commercial I was just watching showed a great picture of….

2) How long is it until my next meal? (If it will be 4-6 hours or more between meals, then yes, eat something.  If your meal is less than an hour away and your blood sugar is not low, maybe you can wait for the meal)

If you are not physically hungry and the answer to question 2 is not within the parameters, try to distract yourself by calling a friend, going for a walk, doing a hobby instead of eating.  Otherwise, our snacking calories will add up to more than we need.

More to come….am looking forward to your feedback and questions!

Andrea, RD

What’s In A Name?

Figuring out what medications you are on can be confusing, especially when they can go by either brand or generic name. Here is a list of some common oral diabetes medications and the names they can go by. Keep in mind “googling” can sometimes be confusing as the american brand names can also be different. When in doubt speak to a member of your healthcare team.

*generic – lowercase italics, brand name – uppercase BOLD

metformin (GLUCOPHAGE), long acting metformin (GLUMETZA)

gliclazide (DIAMICRON, DIAMICRON MR) (note: MR = modified release, which means the long acting form)

glyburide (DIABETA)

pioglitazone (ACTOS)

repaglinide (GLUCONORM)

sitagliptin (JANUVIA)

sitagliptin + metformin (JANUMET)

saxagliptin (ONGLYZA)

linagliptin (TRAJENTA)

linagliptin + metformin (JENTADUETO)

Sheetal Desai (Pharmacist and Diabetes Educator)

How to reduce your salt intake without sacrificing flavour!

Leslie Beck, a registered dietitian and regular columnist in the Globe and Mail wrote a great article about how to use different herbs and spices to flavour foods, while minimizing the amount of salt needed. Check out the article here:

With diabetes, it is important to aim for a healthy blood pressure, so our heart and our kidney’s don’t have to work as hard. Reducing your salt (sodium) intake is one way to do this.

The recommendation for sodium intake is 1500-2300mg per day. One teaspoon of salt = 2300mg of sodium! Most Canadians eat at least double the recommended amount of sodium in the day, and most of this comes from processed foods, not what we add to our foods.

To help reduce your sodium intake, choose unprocessed fruits, vegetables, grains, meats and dairy products more often. Also, review food labels before you buy. Choose foods that have 10% DV (daily value) or less of sodium, or the lowest % DV if you are comparing between products.

What foods have more sodium in them than you thought? Any surprises? Any good low sodium finds? Share them with the group!


Welcome to the Markham FHT Group Diabetes Visit Blog!

I’d like to take this opportunity to welcome everyone to our blog and discussion space on WordPress. If your reading this you’ve already figured out how to navigate to the posts. Andrea and I and the rest of our team at Markham Family Health Team (FHT) are really excited about our group visit project and hope you will get a lot out of the experience. The goal is to optimize the health outcomes of all of our participants and help to facilitate the self management of your diabetes. We are going use this project to try out some innovative ways of accomplishing this goal. We hope to learn how to better manage diabetes together but we really hope that participants can learn from each other and not just from the professionals.

About the blog. We hope that this will become a forum for us to share useful information around diabetes. We also hope it will be a place where you can post your questions and we will all pitch in to find the best answers. Keep in mind that because of obvious privacy issues, the posts should be of a general nature and not about a specific individual. First names only please.
From the Markham FHT we will have the following professionals who may be posting their comments: Myself – your trusty family doctor, Andrea-our registered dietitian/clinical diabetes educator, Paula-our registered nurse, Janey-our administrative support, Sheetal-our pharmacist, Sheri-our nurse practitioner, Shirley – our chiropodist, Tony – our IT support and Lisa-our clinical program manager. Depending on the expertise we require to respond to a posting, we may pull in the services of other professional services as needed. Andrea and I will do our best to moderate the posts. Please keep them courteous and respectful at all times.
We welcome your feedback along the way. We want to know what your needs around diabetes are so please let us know. If you have any difficulty with the WordPress site/blog please contact Janey, our admin support, for assistance.
Dr. Bill

Ontario Diabetes Passport

Here is a copy of the Ontario Diabetes Passport to record important information about your diabetes.

Diabetes Passport

23 and 1/2 hours

This is a great video to get us all motivated to be more active, a key component in diabetes self-management. Enjoy.