Shireen:  

So today we have Emily Tim joining us. Emily is a registered dietician and diabetes care and education specialist who holds a four 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. 

Emily: Thank you, Shireen. Thanks for having me.

Shireen: Emily, tell me a little bit about yourself. So I see that you have a keen interest in diabetes. Why? Why is that? Why specifically diabetes? 

Emily: Absolutely. So I first started in the inpatient sector, and in 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 kind of a 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 just made sense to me. 

Shireen: So you mentioned some, some stuff about your background with Cleveland Clinic. Talk to us more about that. 

Emily: Sure. So at Cleveland Clinic, I was part of an amazing team of endocrinologists and 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 prediabetes and diabetes. And during that time, I really fell in love with the Mediterranean approach to eating for people with diabetes. And through that work, I was able to then 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 helped develop the interest that I have today. So you mentioned some, some stuff about your background with Cleveland Clinic. Talk to us more about that. Sure. So at Cleveland Clinic, I was part of an amazing team of endocrinologists and 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 prediabetes and diabetes. And during that time, I really fell in love with the Mediterranean approach to eating for people with diabetes. And through that work, I was able to then 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 helped develop the interest that I have today. 

Shireen: So with that, I want to jump into the current state of affairs with COVID-19. And new the implications on people with diabetes. So I want to start out by asking, what are the statistics of how prevalent diabetes is in the United States today? 

Emily: Right? We have quite a number of people in the US with diabetes, we have 34 point 2 million people with diabetes. So that's 10.5% of the US population. And of that number 2.8% of those people do not even know they have diabetes. So that's another population that could be impacted by COVID-19. The main message is that people with diabetes do have much higher rates of serious complications and deaths from COVID-19. So without being alarmist, it does put a person with diabetes in a more vulnerable population under this current state of affairs. The good news is, is that if the diabetes is well managed, meaning there aren't a lot of fluctuations between high and low blood sugars, the risk of getting severely sick from COVID-19 is actually about the same as the general population. So this is just such good news. Because we do have a lot of time on our hands. And perhaps this time can be used to better the diabetes management and prevent serious complications. 

Shireen: Now, is there any risk between type one and type two? 

Emily: There's right now, as far as they know, there is no difference in risk between type one and type two diabetes, they are put in the same category. And again, those having highest risk would be people without good blood sugar control with a lot of fluctuations and variability in blood sugar. 

Shireen: And the risk being not so much in contracting it, because that's the same as the general population, but more so after contracting it. What does the implications look like? Correct?

Emily: Right, 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 says, Well, if somebody does have poorly controlled diabetes, there may be other metabolic conditions going on as well, perhaps high blood pressure or cardiovascular disease, or being elderly. And those things also put a person at higher risk of a more serious case of COVID-19. 

Shireen: Now the CDC and the ADA recommend 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? 

Emily: Right. So for anybody with diabetes, a sick day kit is something that we usually recommend in general. So now with the current state of affairs, having kind of a sick day kid on steroids, almost an amped up Sick Day kit would be helpful. So things to have in this kit, important phone numbers, the number of your doctor, your pharmacy, your insurance company, sources of sugar on hand if you were to experience low blood sugar during illness, so things like glucose tablets, juice, candies, also having enough insulin and medications. Right now, we're fortunate that there is not a shortage of insulin at this current time. So hopefully, if you can connect with your doctor to have multiple prescriptions filled at once, that might be a smart thing to do. And then extras like soap rubbing alcohol for cleaning skin before blood sugar testing. thermometers. glucagon if you're prescribed glucagon, ketone strips are testing ketones, with high blood sugar, canned foods and crackers and then over the counter medications like acetaminophen. And also as part of this kit would be having enough household items and groceries on hand so that you are prepared to stay home for an extended period of time.

Shireen:  

From there, I would love to talk about just being at home. Tell us more about social distancing.  

Emily: Right. So social distancing. It's kind of the buzzword right now and for good reason for vulnerable populations, like people with diabetes, and really for our entire population, social distancing is the one thing that we know can help flatten the curve, and slow the progression of the pandemics to not overwhelm our healthcare system. And a less overwhelmed healthcare system means better outcomes for patients. So that's really the goal with social distancing and staying home as much as possible. 

Shireen:  

I know for some areas, what they've done is certain grocers are now beginning to offer senior hours to where people can come in, not be as exposed to this virus hopefully. What are some of the things that you recommend in terms of some of these groceries, household items? What can they, what can they do? 

Emily: Right, and the best thing to do is to try to limit the number of trips to the store as much as you can. Because the more times we leave our homes, the more touch points we have with other people, which can mean higher rates of transmission. So especially for somebody who has diabetes and is at higher risk of more serious complications from COVID-19. If you are able to enlist the help of a family member or a friend to run to the store 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 kind of plan ahead so that you have a little more leeway in your schedule to receive those groceries that can be a really nice option. And yes, some stores if you're able to call ahead to your store, or look online, some stores are offering these awesome hours for more vulnerable populations to do their shopping away from the crowds. 

Shireen: Now, let's say we get the groceries home. Right now we've got the groceries, what are some eating patterns? And what are some suggestions that you would, that you would recommend for people with diabetes? 

Emily: Yes. So I think it's a, it's a good idea to talk about what our healthful ways for people with diabetes to eat, and then go into the context of how do we implement those in this, in this pandemic. So just kind of to review, the American Diabetes Association does recognize that there's no one best pattern of eating for people with diabetes. So that's really reassuring at a time like now, because there's lots of flexibility and there's lots of gray area to individualize your plan, to your person and to your environment. And the top three eating patterns recognized by the American Diabetes Association, for people with diabetes are one, a Mediterranean style of eating. So 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's a great healthy eating pattern for people with diabetes. Another healthy healthy eating pattern would be a plant based style of eating. So this is similar to a Mediterranean style of eating, but more more so fall under vegetarian or vegan styles of eating. And then the third would be a low carb style of eating, which is now recognized as a healthy eating pattern for somebody with diabetes, which basically limits the number of carbohydrates consumed in the day. For the low carb plan, I do think it's important to note that there is no one number of carbohydrates that's, that is considered low carb. So this is again very individualized. So moving into 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 really requires being creative, and thinking a little bit differently and using those pantry items in more interesting ways. And at the end of the day, the thing that we're trying to do with any diabetes, eating pattern, and under these circumstances as well, is 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. So it doesn't have to be super complicated. As long as you're trying to do these three things and optimize with what you have. That's wonderful. 

Shireen: So let's talk through some of the diet, right, so tell me more about the amount of protein and the kind of proteins and carbs. You know, just generally walk me through all the different types of things that we need to focus on. 

Emily: Yeah, so I mean, I think I'll just kind of share some of the items that we stocked up on as a family, because these eating patterns are really appropriate for the entire family just because you might have diabetes in your family. And, and your kids don't and your husband doesn't or your partner doesn't, it can be appropriate for the entire family. So the things that we stocked up on that I know a lot of people are stocking up on sources of protein, frozen meats, canned chicken and canned fish. Canned and dried beans can be great sources of protein and fiber. And then thinking also about things that have a longer shelf life. So tofu has a longer shelf life, and eggs have a longer shelf like cheese has a longer shelf life. So those types of things can be good sources of protein as well. As far as the carbohydrates. Whole grain breads are easy to have on hand and easy to freeze. Being based and whole grain pastas are great to have on hand. They're super versatile, and they can be a meal in, in, in themselves. And then bulk grains bulk grains as well like brown rice Keane, while bulgur, those are awesome things to have on hand. As far as healthy sources of fats, going along with the plant based in the Mediterranean style of eating for diabetes, olive oil is a great source of healthy fat to have on hand. nut butters, nuts and seeds. Even things like ground flaxseed and chia seeds, which can sound a little different. But those items are awesome because you can kind of add them to things that you're already eating to just make them that much more nutrient dense. As far as fruits and vegetables, I do think it's important to just dispel the myth that canned and frozen vegetables and fruits are less healthy. That is not true. They are extremely healthy options. And they are awesome at a time like now when we're trying to have these things on hand. So frozen berries, canned vegetables, like canned green beans, canned stewed tomatoes, canned artichokes, all of those things are awesome to have on hand. And then some other items that you might not think about immediately boxed milks like nut milks, almond milk, walnut milk, oat milk, balsamic vinegar for salads, and cooking, and broths for making easy soups. So those are some pantry ideas.  Right. Yeah, I think that's a great question, Shireen because, well, there are many people who maybe don't cook on a regular basis. So this might be a little bit new having to cook every single day. Even for those of us that love cooking, it's, it can be a little overwhelming. All the cooking and everybody being home. So for breakfast, a couple of ideas, one, taking whole grain bread and toasting it, having some nut butter on it. Breakfast, you're done. So that breakfast is easy. It's filled with fiber, healthy fat, protein, it's filling. It's a great staple. You can also do something a little more creative. Maybe you want to have something a bit fresher. A smoothie in the morning can be a nice meal replacement. So one smoothie that I like to make utilizes one cup of frozen berries. So frozen blueberries would work. handful of fresh or frozen spinach, a couple of tablespoons of nut butter and then eight ounces of milk of choice, so maybe unsweetened almond milk and a dash of cinnamon blended all together. Perfect, delicious breakfast. So those are some breakfast suggestions. As far as thinking about lunch and dinner, I think it can be really helpful to make something in a batch that you can use for multiple meals to kind of minimize the amount of cooking that you are doing. One thing that I think a lot of people are doing right now that I think is a great idea is making a large batch of chili. Chili can be adapted to many different eating patterns and it's super fun to play around with. The other day I made a chili which used a pound a pound of meat, you can use ground beef, you can use ground turkey, you can use vegan frozen meat, you can omit the meat, a can of chili beans and onion, one and a half cups of broth a can of diced tomatoes, a can of green beans, some chili powder, cumin, salt and pepper can put it in your slow cooker and you have dinner for a few days. So that's another great idea. 

Shireen: So I'm 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 can whip up with these ingredients.  Now let me tell you this all this is making me hungry. You should have bought food to this thing. Okay, well, thanks for sharing that. One of the other things I'm sort of curious about with people staying indoors, not leaving the house that much. You know, we start hearing about how do I stay active? I can't go to the gym. You know, I can't go to my favorite classes, so forth. What can they do to stay active at home? What tips do you have for that? 

Emily: Yes, staying active is so key. I think it's so key for anybody during this time for mental health and just, you know, remaining calm and taking time for yourself. But for people with diabetes, it can be very key, because even small amounts of activities throughout the day can have dramatic reductions in blood glucose or blood sugar. So yes, in terms of remaining active and how do you do that, you can go outside, it's okay to go outside, it's encouraged to go outside for some fresh air walk around the block. Unfortunately, on these walks, if you do see a neighbor you want to talk to, when you are having a conversation, just stay about six, three to six feet apart from that individual to prevent any contact. But yeah, you can go outside, you can get a nice walk in a lot of online. gyms are offering free memberships to their fitness classes. So that's a nice thing to take advantage of, as well as a lot of YouTube channels and videos that we've already had for home workouts for free. And just being mindful about the activity throughout the day, going for a 10 minute walk after a meal can lower your blood sugar by 10 to 20 points. So just getting up and moving after meals, doing household chores, all of those things are going to help you to keep active and keep busy during this time at home. 

Shireen: There's a lot of stress out there, sort of off your game, you're not doing the usual things you do. There's a lot of change, staying indoors, like I mentioned earlier. So what do you recommend in terms of resources that people can utilize? while they're sort of dealing with all of this? 

Emily: Yeah, I just I think that's such a key point. Because we've never done this before. There's no handbook for 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. If you don't want to, that's fine too. So I think the most important thing is just to go easy on yourself. Take it one day at a time and do the best you can. And as far as thinking about self care and stress management because those things are super important for blood sugar control. There are many things you can do. Making sure to stay in contact with friends and family. Even like, through video I think can be more effective and spending time with your pets or you know walking your dog looking into free meditation apps, listening to music, just taking some time for self care because we have the extra time. So we should 

Shireen: What about resources for food and nutrition? 

Emily: Yeah, there, there are some great resources as your, you might be looking for new ideas at this time. The American Diabetes Association on their website, which is diabetes.org. They do have a diabetes food hub, which offers a number of different recipes for different eating patterns. So that's a great resource. There's also a free app and website called fooducate. And this app is great for comparing pantry items that you might find at the store. It grades the items from A through F. So you don't have to get lost in the food label and you can still get a sense of how healthy a product is. 

Shireen: And then any other resources that you recommend? 

Emily: I think at this time really just staying up to date with the CDC recommendations and checking in with the American Diabetes Association. As things evolve and change because the situation is changing every day, new information is coming out. And another resource would just be looking online, or calling your doctor to figure out where testing sites are in your area, so that you're aware of that should you need to get tested for COVID-19. 

Shireen: So we're wrapping up the end of the episode here, Emily and I wanted to get folks to connect with you to have questions or they just want to learn more about work. So how can folks do that? 

Emily: Yes, I would love to connect with you. I do have an Instagram community, the endocrine nutritionist. I'd love for you to join me there. I'll be posting information soon about upcoming programs. And if you have specific questions and you don't have Instagram, feel free to email me at Emily Tim. Ti m m nutrition@gmail.com. 

Shireen: Again, this was Emily Timm. She is with Emily Tim nutrition Registered Dietitian. Thank you again. 

Emily: Thank you, Shireen. This was so fun. I hope to talk to you soon.

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Resources Mentioned: 

Yumlish 

Fooducate

American Diabetes Association 

World Health Organization – Coronavirus Disease 

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