Emily Timm, RD discusses the implications of COVID-19 on people with diabetes, what to include in a sick-day kit as recommended by the CDC and ADA, top staples, and eating habits to sustain, and recipes to maintain blood sugar levels.
About Emily Timm, RD
So today we have Emily Timm joining us. Emily is a registered dietitian, diabetes care and education specialist who holds a Board Certification in Advanced Diabetes Management.
Emily’s passion lies in her helping her patients with diabetes and related endocrine disorders achieve their goals. She specializes in weight management and the Mediterranean diet. Welcome, Emily!
Thank you, Shireen! Thanks for having me!
Emily, tell me something about yourself? So, I see that you have a keen interest in diabetes. Why is that? Why specifically in diabetes?
So… Ummm… I first started in the “Inpatient” sector and at that time I quickly realized that I loved patient education and counseling and so I then decided to move to the outpatient world and started in a diabetes clinic which was actually the Cleveland Clinic diabetes clinic. I grew and learned so much there about diabetes and also about the complexities of hormones as it relates to health and that was always a kind of personal interest for myself as well as having celiac disease and Hashimoto thyroiditis. So, both of those conditions are hormonal conditions, endocrine conditions and so diabetes made sense to me.
And… So, you mentioned some stuff about your background with the Cleveland Clinic talk to us more about that.
At Cleveland Clinic I was part of an amazing team of endocrinologists, diabetes care and education specialists and we ran a number of different programs there for patients. We had a very robust weight management program that focused on obesity management for people with diabetes and prediabetes and during that time I fell in love with the Mediterranean approach to eating, poor people with diabetes, and through that work. I was able to transfer that experience to the University of Pittsburgh Medical Center and help to grow and create a similar program at that Medical Center for those patients, so it was really a catalyst in my career and really develop the interest that I have today.
Now I am actually working on creating an online community for the Mediterranean diet and weight management. So, we will be launching group programming for the Mediterranean diet for people with prediabetes and diabetes in the very near future. So, I am really excited about that program and that stage of my life.
COVID-19 And Implications on People with Diabetes
So, with that, I want to jump to the current state of affairs with COVID-19 and know the implications on people with diabetes. I want to start out by asking, what are the statistics of how prevalent diabetes is in the United States today?
We have quite a number of people in the US with diabetes. We have 34.2 million people with diabetes that is 10.5 percent of the US population and of that number 2.8 percent of those people do not even know that they have diabetes so that is another population that can be impacted by the COVID-19. The main message is that people with diabetes do have much higher rates of serious complications and death from COVID-19.
So without being an alarmist, it does put a person with diabetes in a more vulnerable population under this current state of affairs. The good news is that if the diabetes is well managed, meaning there aren’t a lot of fluctuations between high and low blood sugar then the risk of getting severely sick from COVID-19 is actually about the same as the general population. So this is such good news because we have a lot of time on our hands and this time can be used to better the diabetes management and prevent serious complications.
Now, is there any difference between type 1 and type 2?
Right now as far as they know there is no difference in risk between type 1 and type 2 diabetes. They are more in the same category and again those having the highest risk will be people without good blood sugar control and a lot of fluctuations in blood sugar.
The risk would be the same as the general population but the risk will be more so after contracting it cause that is the same as the general population but more so after contracting it. What does the implication look like?
It has to do more so with the complications and the severity of the case that the person might experience, a lot of the time if someone does have poorly controlled diabetes, there may be other metabolic conditions going on as well perhaps high blood pressure or cardiovascular diseases or being elderly can put the person at a higher risk of COVID-19.
What to Include in A Sick-Day Kit for COVID-19?
Now the ADA recommends having extra diabetes supplies on hand to really create a sick day kit. Can you speak to us about this kit? What does it need to include?
For anybody with diabetes, a sick day kit is something that we usually recommend in general. Now with the current state of affairs having kind of a sick day kit on steroids almost, an amped-up sick day kit is helpful.
Things you need to have in the Kit:
- Phone number of your doctor,
- Insurance company’s phone number.
- Keep sources of sugar on hand if you experience low blood sugar level examples: glucose tablets, candies, juices, etc.
- Have enough insulin and medication for a couple of days.
(There is currently no shortage of insulin supply and medicines so hopefully if you connect with your doctor and have multiple prescriptions filled at once would be a smart thing to do.)
- Soap and rubbing alcohol for cleaning skin before a blood sugar test.
- Thermometers, glucagons, ketone strips
- Canned food and crackers
- Over the counter medications like – acetaminophen
- Also, have enough groceries and home food to stay at home for extended periods of time.
I would like to talk about being at home. Tell us more about social distancing.
So social distancing is the buzzword right now and it is for a good reason. For vulnerable populations like people with diabetes and really for our entire population. Social distancing is the one thing that we know will help to flatten the curve and slow the progression of the pandemics and will not overwhelm our healthcare system and a less overwhelmed health care system means better outcomes for patients. So that really is the goal with social distancing and staying home as much as possible.
Top Staples and Groceries to Have on Hand
For some areas what they have done is certain grocers are now beginning to offer senior hours to their people. So, they can come in and not be as exposed to this virus hopefully. What are some of the things that you recommend in terms of groceries, household items? What can they do?
The best thing to do is to try and limit the number of trips to the grocery stores as much as you can. The more times we leave our homes, the more touchpoints we have with other people which means higher rates for transmission. So especially for somebody who has diabetes and is at a higher risk of more serious complications from COVID -19.
If you are able to enlist the help of a friend or a family member to go for you that would be great. Grocery delivery is another wonderful option. There are some higher wait times right now for grocery delivery, but if you can plan ahead and if you have some leeway in your schedule to receive those groceries than that could be a really nice option. Some stores if you are able to call ahead to your store or look online some stores are offering these awesome hours to more vulnerable populations to do their shopping away from the crowds.
Eating Habits for People with Diabetes
Let’s say we got our groceries home, what are the eating patterns you would recommend for people with diabetes?
So I think it is a good idea to talk about what are helpful ways for people with diabetes to eat and then go into the context of how we implement these pandemics. So just kind of to review, the American Diabetic has recognized that there is no one specific pattern of eating for people with diabetes and this is really reassuring at a time like now cause there is a lot of flexibility and there is a lot of grey area to individualize the plan to your person and to your environment. The top 3 eating patterns recognized by the American Diabetes Association for people with diabetes are:
- A Mediterranean style of eating – this style of eating focuses on whole grains, vegetables, fruits, beans, healthy fats like olive oil and nuts, and the majority of animal protein coming from fish sources so that is a great healthy eating pattern for people with diabetes.
- Plant-based style of eating- similar to the Mediterranean style of eating but it will fall under vegetarian and vegan styles of eating.
- Low carb style of eating- is a healthy eating pattern for someone with diabetes. It limits the number of carbohydrates consumed in the day. There is no set limit to what is low carb so this is again individualized.
How do you implement healthy eating under these circumstances when you might not have access to the fresh foods that you have on a regular basis and I think that requires being creative and thinking a little differently and using those pantry items in more interesting ways. At the end of the day, the thing that we are trying to do with any diabetes eating pattern and under these circumstances as well as to facilitate a higher intake of non-starchy vegetables, to reduce the intake of processed food and to minimize our intake of refined grains and added sugar. It is not supposed to be complicated unless you are trying to do these three things and optimize with what you have that’s wonderful.
Let’s talk about some of the diets. So.. tell me more about the number of proteins and the kind of proteins and carbs. Generally, walk me through all the different types of things that we need to focus on.
I will just share some of the items we stuffed as a family. These eating patterns are appropriate for the entire family just because you might have diabetes in your family, your kids don’t or your husband doesn’t. It can be appropriate for your entire family.
We stocked up as well as a lot of people are stocking up on frozen meat, canned chicken, and canned fish. Canned and dried beans can be great sources of fiber and also think about things that have a longer shelf life: tofu, eggs, cheese, and these things can be good sources of protein as well. For carbohydrates, whole-grain bread is easy to have and is easy to freeze. Bean base and whole-grain pasta are super versatile and they can be a meal by themselves. Also bulk grains like Brown rice, quinoa are awesome things to have on hand.
Sources of fats; going upon the plant-based and the Mediterranean style of eating for diabetes like olive oil, nut butter, nuts and seeds, chia seeds, and brown flax seeds are good sources of healthy fats. You can add these items to the foods that you are eating to make them a little more nutrient-dense.
Fruits and vegetables: Dispel the myths that canned and frozen fruits and vegetables are not healthy they are an extremely healthy option. They are awesome at a time like now when we are trying to have these things on hand. Canned peas, artichokes, stewed tomatoes are awesome to have on hand. Other items like boxed milk – nut milk, almond milk, walnut milk, oat milk. Things like balsamic vinegar for cooking and broths for making easy soups. Those are some pantry ideas.
Recipes to Maintain Blood Sugar Levels
I am going to put you on the spot here. Now getting all these ingredients delivered I have them now, give me some quick and easy breakfast and dinner ideas that I Whip up with these ingredients.
This is a great question! There are many people who don’t cook on a regular basis so this might be a bit new. Having to cook every day and even for some people who cook every day; it might be overwhelming cooking every day at home.
- Taking some whole wheat bread and having it with nut butter. Fiber + healthy fats + protein and it is filling.
- A little bit fresher? – have a smoothie in the morning and it is a great meal replacement
Smoothie – 1 cup of berries, 1 cup of spinach, couple of tablespoons of nut butter and 8 ounces of milk of choice; a dash of cinnamon and blend it all together
Lunch and Dinner:
- Make large batches of food so that you don’t have to cook very often.
- A great idea is to make a large batch of chili as it can be adapted to a large number of eating patterns; it is super fun to play around with.
- You can use it with a pound of meat, ground beef/turkey, or you can omit the meat and eat a can of chili beans and onion.
- 1/ 2 cups of broth and canned tomato, a can of green beans, some chili powder, cumin, salt, and pepper. Put it in a slow cooker and you can have dinner for a few days.
All this is making me hungry.
EMILY: Me too.
Thanks for sharing that. One of the other things that I am curious about is; with people staying indoors, not leaving the house as much. Do they keep asking how do I stay active? I can’t go to the gym; I can’t go to my favorite classes. What do we do to stay active at home?
Yes, staying active is so key for anybody during this time with mental health and remaining calm; and taking time for yourself. But people with diabetes will be very key because small activities throughout the day can have a dramatic drop in the levels of blood glucose. So in terms of remaining active and how do you do that?
You can go outside; it is okay to go outside. In fact, it is encouraged to go outside and take a walk around the block. But, unfortunately, if you see a neighbor you want to talk to stay 3-6 feet apart from that individual to prevent any contact. You can go outside you can get a nice walk in you can also go online and get free memberships to their fitness classes. And that is a nice thing to take advantage of and also a lot of YouTube channels for home workouts.
If you have diabetes be mindful of your activities. Going for a 10-minute walk just after a meal can reduce your blood sugar level by 10- 20 percent. Doing household chores, moving after meals all of these things will keep you active and busy during this time at home.
There is a lot of stress out there, you are sort of off your game because you are not able to do the usual things that you do. There is a lot of change, staying indoors as I mentioned earlier. So, what do you recommend in terms of sources that people can utilize while they are dealing with all this?
I think that is such a key point. We have never done this before, there is no handbook of how to survive the pandemic and what your daily schedule should look like. There are a lot of schedules floating around on the internet. It’s great to use a schedule if you want to. But it’s also fine not to use one. The most important thing is to go easy on yourself one day at a time and do the best that you can. As far stress management goes as they are super important for blood sugar control. There are many things that you can do like making sure to stay in contact with friends and family through video and it will be more effective.
Spending time with your pets or your dog, looking into free meditation apps, listening to music and taking some time for self-care because you have the extra time so you should.
What about resources for food and nutrition?
There are some great resources that you might be looking for ideas at this time. The American Diabetes Association on their website www.diabetes.org. They do have a diabetes food hub that offers a number of different recipes for different eating patterns. There is also a free website and app called www.fooducate.com which is great for comparing pantry Items that you might find at the store. It grades the food items from A- F so you will not be lost in the food labels and shows how healthy a product is.
Any other reading sources that you recommend?
Till this time just stay up to date with the CDC recommendations and checking in with the American diabetes association and as things evolve the situations are changing every day. Another resource would be just looking online and calling your doctor to figure out where testing sites are in your area so that you are aware that you need to get tested for COVID-19.
How can listeners connect to you and learn more about your work? So how would folks do that?
EMILY: I have an Instagram community called Endocrine Nutritionist.
Email:- email@example.com – contact for any questions.