1. Dining: Portion Size & Healthy Options
Around the holidays, diet patterns change and larger meals than usual are often consumed.1,3 When there are several food choices, advise patients to keep portion sizes small. “Tell them to just sample each dish, choose their favorites,” said Arévalo, and opt to freeze leftovers for a later date. In addition, having healthier food options on the table like fruits and green vegetables and substituting herbs for added salt can help patients satisfy their appetites and avoid hypertension. Although large meals eaten later in the day may be the main focus, reminding patients to eat breakfast is another strategy to prevent overeating.
Not all holidays are celebrated with vast amounts of food. Fasting for religious holidays can lead to complications in patients with diabetes — predominantly hypoglycemia. Having educational discussions with patients who choose to fast can be an effective strategy to improve self-awareness.4 Depending upon how much and when a patient is eating, it may also be important to discuss adjusting timing, type, or dosage of diabetes medications and self-monitoring to avoid severe hypoglycemia.4,5
3. Alcoholic Beverages
Recommend that patients “keep alcoholic drinks to a minimum,” stated Arévalo. Although modest alcohol intake has been associated with a reduced risk for coronary artery disease and other vascular complications associated with metabolic syndrome, results from a cross-sectional study indicated that alcohol consumption in patients with type 2 diabetes is associated with an increased prevalence of metabolic comorbidities, including increased hypertriglyceridemia and obstructive sleep apnea.6 Arévalo’s suggestion for alcohol consumption aligns with that of the American Diabetes Association: no more than 1 drink a day for women and 2 drinks a day for men.7
4. Exercise & Sleep
It’s common to neglect physical activity during holidays. Recommend that patients stay active and plan for activities other than dining. “[Suggest patients] move for 30 minutes or more every day,” said Arévalo, adding that cleaning, seasonal yardwork (raking leaves, shoveling snow), walking with family, or dancing during celebrations are all good options. In addition to physical activity, advise patients to get at least 7 to 8 hours of sleep/night to help maintain glycemic control.8
If patients plan to travel for the holidays, they should schedule an appointment with their clinician to discuss a management plan.9, 10 Provide travel letters (even if the patient is not flying) along with additional prescriptions as needed and advise patients to make photocopies in case they are lost. Recommend patients pack twice as much medication as they will require and supplies to treat hypoglycemia (glucose tablets, snack foods). In addition, patients should carry a list of medications and information for emergency contacts and doctors on hand. Foot care should also be reviewed before traveling whether or not the patient has neuropathy.10
Holidays can be a challenging time for patients with diabetes to maintain glycemic control and other aspects of their condition.1-6 Sandra Arévalo, MPH, RDN, CDE, a spokesperson for the American Association of Diabetes Educators and the Academy of Nutrition, worked with Endocrinology Advisor to compile a list of key tips for practitioners to give their patients to ensure a healthier holiday season.
Compiled by Rachael Beairsto
1. Jones AG, McDonals TJ, Hattersley AT, Shields BM. Effect of the holiday season in patients with diabetes: glycemia and lipids increase postholiday, but the effect is small and transient. Diabetes Care. 2014;37(5):e98-e99.
2. Joshi SR, Mohan V, Joshi SS, Mechanick JI, Marchetti A. Transcultural diabetes nutrition therapy algorithm: the Asian Indian application. Curr Diab Rep. 2012;12(2):204-212.
3. Sumlin LL, Brown SA. Culture and food practices of African American women with type 2 diabetes. Diabetes Educ. 2017;43(6):565-575.
4. Lee SWH, Lee JY, Tan CSS, Wong CP. Strategies to make Ramadan fasting safer in type 2 diabetics. Medicine (Baltimore). 2016;95(2):e2457.
5. Metzger M, Lederhendler L, Corcos A. Blinded continuous glucose monitoring during Yom Kippur fasting in patients with type 1 diabetes on continuous subcutaneous insulin infusion therapy. Diabetes Care. 2015;38:e34-e35.
6. Patel PJ, Smith D, Connor JP, et al. Alcohol consumption in diabetic patients with nonalcoholic fatty liver disease [published online November 1, 2017]. Can J Gastroenterol Hepatol. doi:10.1155/2017/7927685
7. Alcohol. American Diabetes Association. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html.
Updated October 16, 2017. Accessed November 9, 2018.
8. 5 healthy eating tips for the holidays. Centers for Disease Control and Prevention. https://www.cdc.gov/features/diabetesmanagement/index.html. Updated November 30, 2017. Accessed November 9, 2018.
9. 21 tips for traveling with diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/traveling-with-diabetes.html. Updated September 17, 2018. Accessed November 9, 2018.
10. Kruger D. Travel and diabetes. Endocrinology Advisor. https://www.endocrinologyadvisor.com/endocrinology-metabolism/travel-and-diabetes/article/595689/. Published December 21, 2016. Accessed November 9, 2018.