It Is Complicated!


It Is Complicated!

Contributor: Vandana Sheth, RDN, CDE, FAND

Living with diabetes can be challenging and significantly affect our risk for many other health conditions. Besides our food choices, portions, and meal timing, stress, physical activity and medications all play an important role in good blood sugar control. So, when we think about diabetes management, we have to pay attention to many other factors, and that makes it complex. I typically encourage my clients to keep their ABCDs in mind. A stands for your Hemoglobin A1C, B stands for Blood Pressure, C stands for Cholesterol, D stands for Depression, and S for Smoking.

Blood Sugar Management
Consistently high blood sugar levels can cause damage to our blood vessels contributing to higher blood pressure and also negatively affect lipid levels. Working with your health care team to better understand your food choices, portions, and meal timings is an important step. Incorporating regular activity can improve your insulin sensitivity and help your body process sugars better. Exercise will also positively impact your blood pressure and promote weight loss or management. Try a 10-15 minute walk after each meal, and before you know it, you would have gotten 30-45 minutes of activity that will help your blood sugar and blood pressure.

Blood Pressure
Blood pressure can be an independent risk factor for heart disease. But people with diabetes who also have high blood pressure are at almost double the risk for heart disease. Maintain your blood pressure with a preferable goal of 130/80. Cut back on sodium in your diet by enjoying herbs and spices instead to enhance flavor. Enjoy more foods naturally higher in potassium, magnesium, and fiber such as apples, broccoli, carrots, kale, spinach, tangerines, tomatoes, and sweet potatoes.

According to the Centers for Disease Control (CDC), a majority of those with diabetes also have unhealthy lipids (fats) levels in their blood. This can add to the circulation problems often experienced by people with diabetes. It is important to improve your lipid panels, especially your total cholesterol, LDL “bad” cholesterol, and HDL - “good” cholesterol. Enjoying more vegetables, fiber-rich foods, whole grains, beans and lentils, chia seeds, salmon, and nuts can help.

Depression and Stress
People with diabetes have a higher risk of depression compared to those without diabetes. Women with diabetes are at double the risk of being depressed compared to men. Hormones can significantly contribute to this increased rate of depression. Also, women often have more on their plate in terms of responsibilities at home and work, being primary caregivers for their family. Being diagnosed and living with diabetes can feel overwhelming and be a tremendous stress factor. We know that stress can negatively affect your blood sugars and overall health. It is very important to get the support you need to address your emotional and mental health. Identify positive ways to cope with your stress. Women often feel guilty when they take time to focus on themselves, but this is essential for their self-care and wellbeing. Consider using “apps” to help you become more mindful and relaxed.

If you have diabetes and smoke, you are at a much higher risk for developing heart disease, kidney disease, retinopathy, peripheral neuropathy, and other complications. Reach out for support and get some help through community resources such as a formal smoking cessation program.

With a good diabetes management plan, consistent action towards your goal, and support from your health care team and loved ones, you can thrive and minimize complications.

Contributor: Vandana Sheth, RDN, CDE, FAND is on a mission to help people with diabetes Eat Well Your Way For Life, and thrive with diabetes. She received her BS in Nutritional Science and Coordinated Dietetics and became a registered dietician nutritionist in 1997, and has been a certified diabetes educator since 2008. She is an active member of the American Association of Diabetes Educators (AADE), the California Dietetic Association (CDA), and is currently a spokeswoman for the Academy of Nutrition and Dietetics. Learn more about her at