Caldo Tlalpeño, Mexican Chicken Soup

For a break from the typical Taco Tuesday fare, here’s a savory Mexican-style soup that’s as nutritious and filling as it is flavorful. Caldo tlalpeño is a traditional dish from Mexico that typically includes chicken and chopped vegetables submerged in a chicken broth with garlic and onion, and seasoned with spicy chile peppers and lime. In this gorgeous version, radish, avocado and cilantro make a beautiful garnish, and brown rice adds a dose of heart-healthy fiber.

Caldo Tlalpeño, Mexican Chicken Soup

Caldo Tlalpeño

SERVINGS: 4   |  TOTAL TIME: 50 min


  • 6 cup(s) broth, chicken, less sodium
  • 1/2 cup(s) water
  • 1 head(s) garlic
    cloves separated and peeled
  • 8 ounce(s) chicken, breast, boneless, skinless
  • 2 teaspoon oil, canola
  • 1 medium onion(s)
  • 1 medium pepper(s), poblano chile
    or Anaheim chile, chopped
  • 1 medium pepper(s), chipotle chiles, in adobo sauce
  • 1 cup(s) rice, brown, instant
  • 4 medium radish(es)
  • 1 small avocado
  • 1/4 cup(s) cilantro, fresh
  • 1 medium lime(s)


1. Bring broth, water, garlic and chicken to a boil in a large saucepan over medium-high heat. Reduce heat to a simmer and cook, skimming any foam that rises to the top, until the garlic is tender and the chicken is cooked through, 12 to 15 minutes. Remove from the heat. Transfer the garlic with a slotted spoon to a blender and the chicken to a clean cutting board.
2. Meanwhile, heat oil in a medium skillet over medium heat. Add onion and poblano (or Anaheim) chile and cook, stirring, until beginning to brown, 8 to 10 minutes. Add to the broth.
Add 1/2 cup of the broth and chipotle pepper to the blender and process until smooth (use caution when pureeing hot liquids).
3. Pour the mixture back into the broth in the pan. Stir in rice. Bring to a boil, reduce to a simmer and cook until the rice is tender, about 10 minutes.
4. Shred the chicken and divide among 4 bowls. Ladle the broth over the chicken and top with equal portions of radish, avocado and cilantro. Serve with a wedge of lime.

Nutrition Details

per serving

Calories 318, Fat 13g, Cholesterol 39mg, Sodium 264mg, Saturated Fat 2g, Protein 22g, Fiber 6g, Carbohydrates 31g

The Best and Worst Fish For Your Health

The Best and Worst Fish For Your HealthWhat if I told you there’s a food that may be able to help keep your heart strong, brain healthy, and eyesight sharp? If you haven’t guessed by now, this multi-tasking food is fish. Although it’s is a lean yet potent source of protein, it’s not just any kind that brings on the most benefits. Fatty fish supply eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA),  long-chain omega-3s that may be the key behind the benefits associated with eating fish, more so than their shorter-chain, plant-based omega-3 counterparts: alpha-linolenic acid (ALA).

Moreover, research studies have found that EPA and DHA omega-3s can help sustain normal blood pressure levels, support healthy triglyceride levels, manage risks of heart disease, positively impact brain function and cognitive development, and play an essential role in eye health and infant visual development.

Although this information has been in and out of media headlines for years, most of us still don’t seem to eat enough fish. Americans eat about 3.5 ounces per week on average. That’s about the size of a deck of cards and a far cry from the 8 ounces per week (spread over two 4-ounce servings) recommended by The Dietary Guidelines for Americans. In fact, only 20% of Americans meet this goal.

Fish for the Best

Nearly all fish options are good for you, but some are indeed better than others when it comes to supplying EPA and DHA. Generally speaking you’ll want to choose a fatty fish, since EPA and DHA are stored in the fat of the fish. Most shellfish are not an adequate source of EPA and DHA (oysters and mussels are the exception), but the following fin fish are good options:

  • Herring
  • Salmon
  • Mackerel (not King Mackerel)
  • Tuna (wild bluefin – canned)
  • Sardines
  • Trout

Sail Past These Fish

Some, while they do supply nutrients, should be avoided. Many of these may contain harmful levels of mercury, which is especially dangerous for pregnant women and young children. These include:

  • Shark
  • Swordfish
  • Tilefish
  • King Mackerel

Don’t Like Fish? Try These Alternatives

For people who don’t like fish or who don’t eat fish because of dietary restrictions, all hope is not lost. There are other ways to get enough EPA and DHA:

  • Take fish oil pills. Supplementing with fish oils is another good solution for vegans, vegetarians, and people who simply do not or cannot eat fish. Note that the milligrams on the front of the bottle correspond to the total amount of fish oils in the supplements. To make sure you’re getting enough EPA and DHA, you should look at the “Supplement Facts” panel on the side or back of the package to make sure it contains around 250-500 mg EPA and/or DHA per serving.
  • DHA-fortified foods. You can even get some benefits of DHA through certain kitchen staples such as milk, eggs, yogurt, walnuts, bread and even some chocolates. DHA can be sourced from algae, and DHA in fortified foods cuts out the fish middle-man, which is good for non-fish-eating vegetarians. 

Get “Hooked” on Good Health

There are many factors that contribute to a healthy heart, brain, and eyes, and getting enough long-chain omega-3s is just one of those factors. In addition to an overall healthy lifestyle – one that includes getting  plenty of exercise, avoiding smoking, and drinking moderate to no alcohol – striving for at least two servings of fatty fish (or 8 oz.) per week is the goal, and if that’s not possible, fortified foods and supplements could be a great option, too.

Science aside, one of the most obvious benefits of fish is that it tastes delicious. Here’s one of my favorite recipes for my tangy mustard and horseradish sauce for salmon. It’s gluten-free and it will make you pucker up and smile at the same time. Let me know what you think!

By Bonnie Taub-Dix, RDN

Last Updated: 5/18/2015

Healthy Ways to Jump on the Soup Cleanse Bandwagon

5 healthy ways to jump on the soup cleanse bandwagonBone broth continues to be the hipster darling soup trends, but if healthy eating is one of your autumn health goals, just sipping on broth isn’t going to cut it. You’re going to need veggies — and a lot of them! Sure, salads pack in a lot of produce, but broth-based soups may be the most satisfying — and warming! — route to healthy eating this winter. If you’ve been mainlining burgers and dogs all summer, a detoxifying veggie soup is the perfect way to usher in a healthier fall, one satisfying slurp at a time. Here are five recipes that’ll give you staying power:

Many-Veggie Vegetable Soup













Many-Veggie Vegetable Soup 

We like to think of this dish from Love & Lemons as the “everything but the kitchen sink” of all soup recipes. Here at Everyday Health, we have a strict “no produce left behind” policy, and this is the perfect way to use up all of those death-row veggies in the fridge. Satiating sweet potatoes and carrots pair with lighter veggies like zucchini, tomatoes, and kale to create a hearty, stew-like dish that makes a delicious winter lunch or light supper.

Spiralized Vegan Ramen Soup With Zucchini Noodles













Spiralized Vegan Ramen Soup With Zucchini Noodles

Happiness is when two of your food obsessions (ramen and spiralizing) come together to create a healthy, guilt-free dish. Our friend Ali over at Inspiralized created the ultimate healthy substitute for when you’re jonesing for ramen. This recipe, which swaps noodles for zucchini ribbons, clocks in at 117 calories per serving, which makes it the perfect starter. Or you can make a vegan-friendly meal by adding protein-rich tofu or quinoa — or vegetarian (and a little more authentic!) by serving it with a perfect soft-boiled egg.


Spinach Soup With Rosemary Crouton













Spinach Soup With Rosemary Croutons

Here’s another “easy button” recipe that requires just a few essential ingredients that can be swapped in and out depending on what you have in the fridge. Here, cooked spinach, onion, and potatoes are blended with rosemary to create a vegetable-rich savory slurp, but you could use any green you have on hand (think: kale, arugula, mustard greens) and a variety of herbs (thyme, basil, and tarragon would all do the trick!). Eschewing bread? Just skip the croutons.

Carrot Apple Ginger Soup













Carrot Apple Ginger Soup

Check your farmers’ market, CSA box, or crisper for these fall staples: carrots, onions, apples, and ginger. This bright, sweet, and spicy soup from Joy the Baker keeps in the fridge for up to four days and freezes like a dream. Your first week of October lunch problem? Solved!

Amazon Bean Soup














Amazon Bean Soup With Winter Squash and Greens

If you’re looking for a vegetable-rich soup that even the most persnickety carnivore will love, look no further. The United Nations has declared 2016 the “International Year of Pulses” (pulses being beans and legumes to me and you), and for good reason: Beans are cheap, healthy, and environmentally-friendly sources of protein that are packed with fiber and nutrients. We love this wintry mix of beans, carrots, squash, and greens, finished with a squirt of lime. You can easily make this a vegan dish by swapping the butter for heart-healthy olive oil and the chicken stock for a veggie version.


No-Bone BrothNo-Bone Broth

Now that you’ve got five delicious soup ideas, you’ll need some broth. Matt Weingarten, culinary director for Dig Inn, created this No-Bone Broth recipe from kitchen scraps, like apple cores, vegetable peels, and the tops and tails of celery, to create a nutrient-rich, vegan stock that’s a perfect base for any soup recipe.

Get 5 more super-simple detox recipes. 

Tell us: What are your favorite vegetable soup recipes? 

Last Updated: 9/30/2016

Cheap and Easy Slow-Cooker Recipes

The weather is getting cooler, our busy school and work schedules are in full swing, and we’d all like to save a bit of money and eat healthier, right? All of these reasons make right now the perfect time to bust out your slow cooker.

Slow-cooker recipes are ideal for people with jam-packed schedules who want to eat home-cooked, healthy meals but have minimal time and effort to spend creating them. Just fill up your Crockpot or similar device early in the morning, and hours later your home will fill with the mouthwatering aroma of a delicious, satisfying meal that’s ready to eat. It’s fast, it’s easy, and it can even save you money — and the list of recipes you can make in a slow cooker is pretty limitless. So, on busy says, forget ordering takeout: You’ll just love coming home to any of these warm, hearty dishes waiting for you.

Cheap and Easy Slow-Cooker Recipes

Tex-Mex Chicken and Beans
: Craving tacos? Toss boneless skinless chicken breast along with beans, salsa, and a few more of your fave Mexican ingredients into a slow cooker and enjoy this zesty lunch or dinner later on.

Cheap and Easy Slow-Cooker Recipes

Indian-Spiced Eggplant and Cauliflower Stew: This vegetarian stew relies on chickpeas, tomatoes, and eggplant to fill you as well as a robust combination of Indian spices. At under 200 calories a serving, it’s a meal that’s big on flavor but light on everything else.

Cheap and Easy Slow-Cooker Recipes

Slow Cooker Korean Beef Lettuce Wraps: For a day when Chinese delivery might have been in your evening plans, avoid greasy takeout altogether and opt instead for these beef lettuce wraps from 365 Days of Crockpot that are just simmering with delicious Asian flavors.

Cheap and Easy Slow-Cooker Recipes

Sausage and Kale Cassoulet: This heart-healthy, satisfying dish came to us courtesy of Budget Bytes, and it’s a meal we know we’ll be saving in our recipe boxes. Super-low in cholesterol and high in vitamins and fiber, this cassoulet is filling and delicious while going easy on your wallet.

Cheap and Easy Slow-Cooker Recipes

Pork Tenderloin With Roasted Plums: Looking for a tasty new way to prepare pork? Combine it with vanilla and rosemary-seasoned plums and you’ll be in heaven when the aroma of this succulent meal wafts through your home.

Last Updated: 9/30/2014

Lose Weight: 130 Pounds Lost

Lose Weight

Name: Nick Guile

Age: 22

Height: 6’0”

Before: 290 lbs.

After: 160 lbs.

What was the turning point that prompted you to lose weight?

I had always been one of the bigger kids in my class. By 10th grade I started realizing just how overweight I actually was. Climbing stairs in between classes at school would leave me out of breath. My weight was causing me a lot of body image issues. I didn’t want these things to hold me back from all of the opportunities coming up, like prom and going to college, so I decided it was time to make a change.

When did you start trying to lose weight?

I began working to lose weight at the start of 2011, halfway through my sophomore year of high school. I started by changing my eating habits and incorporating exercise into my daily routine. At the beginning of high school I would do everything I could to avoid gym class because it made me feel so uncomfortable, but when I started trying to lose weight I would use gym class as an opportunity to burn calories. I also started walking every night and using games like Wii Fit to track my weight loss and help me reach my goals. I began avoiding sugary drinks like soda and cut way back on my snacking throughout the day. I also made small changes like switching from white bread and rice to healthier carbohydrates like brown rice and multigrain bread.

By the end of my senior year of high school I had lost 90 pounds. I continued to lose weight throughout my freshman year of college and I dropped an additional 40 pounds.

What was your biggest challenge?

My biggest challenge was not throwing off my diet with junk food. I really enjoy sugary, fattening treats like cupcakes and cookies, so even having them in the house when I was trying to lose weight was a challenge for me. You don’t necessarily have to cut these out of your diet completely while losing weight, but you certainly can’t be enjoying them every day either.

Were there any times when you wanted to quit or give up? How did you stay motivated?

There were a few times when I would get frustrated with my progress and not want to do my workout for the day. When this happened, I would allow myself to skip a day, but it meant I’d have to work even harder the next day.

If you reached a weight loss plateau, how did you break out of the rut?

There were a few times when I hit a plateau and was not losing as much weight as I had expected. When this happened I would use high intensity interval training (HIIT) during cardio, and after a few days I would start seeing results again. I also found it helpful to not weigh myself too often (no more than once a week) to avoid getting caught up on the number on the scale.

What’s your current exercise routine?

When the weather is nice, I still like to walk a few miles each night. During the winter I play dance games on Nintendo Wii for a fun workout and do Insanity DVDs whenever possible.

What’s your daily diet look like?

I’m less strict with my diet now compared to when I was trying to lose weight, but for breakfast I’ll normally have something like oatmeal or Greek yogurt. For lunch I’ll have half of a turkey sandwich with baby carrots or sautéed spinach, and one of my favorite things to do for dinner is a salad with grilled chicken breast.

What’s your favorite healthy snack and meal?

A chocolate peanut butter protein shake! I blend ice with ½ cup of water, ½ cup of skim milk, a scoop of chocolate whey protein powder, and just a little bit of peanut butter. I also like to snack on baby carrots with a little bit of hot sauce…is that weird?

How has losing weight changed your life?

Losing weight was one of the best decisions I have ever made. Simple things like walking up a flight of stairs no longer leave me out of breath. I have increased self-esteem and more confidence than I did in high school, and I feel better than ever before.

Do you have any advice for those trying to lose weight?

Make exercise a part of your daily routine. Like I said earlier, I took advantage of my gym class at school to help me work toward my weight loss goals. I also made my walk each night part of my daily routine. When exercise becomes a part of your schedule, it makes it much more enjoyable and it is easier to lose the weight.

Fish Sandwich With Pineapple Slaw

This scrumptious sandwich is reminiscent of a fish sandwich at your favorite seafood joint, but with far less calories and fat!

A fish sandwich doesn’t have to be deep-fried and doesn’t have to be off your list of “healthy” foods. Try our version with a tangy, zesty pineapple slaw.

It’s worth taking the extra minute to chop pineapple slices instead of using crushed pineapple — the crushed is too small and disappears into the slaw.

Reduced-fat mayo and fat-free yogurt help slim down the refreshing and easy pineapple slaw, which has just a touch of sweetness to offset the tart, crunchy coleslaw.

Cajun seasoning helps add loads of zesty, calorie-free flavor to the fish – try using Pacific cod or haddock – which is then dusted lightly in cornmeal and cooked in a skillet in just a few minutes on each side.

The combination of mouthwatering flavors here is exceptional; it’s a summery seafood recipe your family will be begging you to repeat! We like serving it with a side arugula salad, grilled veggies, or steamed corn on the cob.

Fish Sandwich With Pineapple Slaw

Crispy Fish Sandwich With Pineapple Slaw


•2 tablespoon mayonnaise, reduced-fat

•2 tablespoon yogurt, fat-free plain

•2 teaspoon vinegar, rice

•1/8 teaspoon pepper, red, crushed, or up to 1/4 tsp for taste

•8 ounce(s) pineapple ring(s), drained and coarsely chopped

•2 cup(s) coleslaw mix, packaged

•1/4 cup(s) cornmeal

•1 1/4 pounds fish, haddock fillets, skinned and cut into 4 portions, or Pacific cod

•1/2 teaspoon Cajun seasoning

•1/4 teaspoon salt

•4 teaspoon oil, canola, divided

•8 slice(s) bread, 100% whole-wheat, toasted


1. Whisk mayonnaise, yogurt, vinegar and crushed red pepper to taste in a medium bowl. Add pineapple and coleslaw mix and stir to combine.

2. Place cornmeal in a shallow dish. Sprinkle both sides of fish with Cajun seasoning and salt. Dredge the fish in the cornmeal.

3. Heat 2 teaspoons oil in a large nonstick skillet over medium-high heat. Add half the fish and cook until golden, about 2 minutes per side.

4. Transfer to a plate and repeat with the remaining 2 teaspoons oil and fish, adjusting heat as necessary to prevent burning.

5. Top toasted bread with the fish and pineapple slaw to make sandwiches. Serve immediately.

Nutrition Details:

per servingCalories 425, Fat 9g, Cholesterol 105mg, Sodium 684mg, Saturated Fat 1g, Protein 44g, Fiber 7g, Carbohydrates 42g

Jumbo Prawns and Balsamic-Orange Onions

Jumbo Prawns and Balsamic-Orange Onions

Slowly roasted orange-scented sweet onions are a delicious foil for shrimp. A small amount of prep yields a luscious entree. Serve with tortillas or rice.

Shrimp is the more general term throughout North America, particularly in the United States, where it is used for almost all species.

The term prawn is less commonly used in the United States, being applied mainly to larger shrimps and those living in fresh water.

It’s a prawn, it’s a shrimp, it’s a delicious crustacean! We’re happy when either lands on our plate, but if you truly need to know the difference, we can point you in the right direction. For the record: you’d be hard-pressed to tell them apart by taste-test alone.

Inspect a specimen with its shell intact (otherwise you may never know). Does it have claws on two or three of its five pairs of legs? Two means shrimp, three means prawn.

And no legs means you bought your prawns or shrimp pre-shelled and have much less prep work to do. Other ways to tell, keeping in mind that in many parts of the world, especially in the Commonwealth, “prawn” and “shrimp” are interchangeable: prawns are typically harvested from fresh water and shrimp from salt, and prawns will usually be larger than shrimp — think tiger prawns, although both shrimp and prawns come in a huge variety of sizes and shapes.

If you find yourself caring way too much whether the fishmonger is trying to pull a fast one on you, remember: it literally doesn’t matter whether you have shrimp or prawns, as long as you don’t overcook either. Maybe re-focus your energies on finding really great olive oil or the perfect skewer for a shrimp/prawn

SERVINGS: 4   |  TOTAL TIME: 2 hr 25 min


  • 2 large onion(s), sweet sliced
  • 2 tablespoon oil, olive, extra-virgin
  • 1 teaspoon salt, Kosher
  • 1 teaspoon orange peel (zest), grated
  • 1 medium orange(s) juice of
  • 2 tablespoon vinegar, balsamic
  • 1 teaspoon rosemary, fresh finely chopped
  • 1 pinch pepper, red, crushed
  • 12 large shrimp, raw (6-8 per pound), peeled and deveined
  • 1/4 cup(s) scallion(s) (green onions)sliced


1. Preheat oven to 400°F.

2. Toss onions, oil and salt in a 9-by-13-inch baking pan until coated. Cover with foil. Bake until softened and juicy, about 45 minutes.

3. Remove foil, stir and continue baking, uncovered, until the onions around the edges of the pan are lightly golden, 25 to 30 minutes.
4. Stir in orange zest, orange juice, vinegar, rosemary and crushed red pepper. Bake until most of the liquid has evaporated, about 30 minutes.
5. Stir in shrimp and bake until cooked through, 20 to 25 minutes. Stir in scallion greens and serve.

Nutrition Details

per servingCalories 314, Fat 10g, Cholesterol 259mg, Sodium 550mg, Saturated Fat 2g, Protein 36g, Fiber 2g, Carbohydrates18g

Trends in Diabetes Tools

Trends in Diabetes Tools

Kelly Rawlings is editorial director of Diabetes Forecast magazine, the healthy living magazine published by the American Diabetes Association. She’s lived with diabetes since 1973. She is really glad that—among many other improvements in diabetes tools and care—blood glucose meters have replaced the color-changing Clinitest tablets used once-upon-a-time to test urine for glucose. Yeah, like that did any good.

More products, more choices are two trends in the diabetes tools, product and device industry. Consider blood glucose meters: we counted 93 as we gathered product information and specs for the Diabetes Forecast 2016 Consumer Guide. The annual issue features medical devices and other tools designed to help people take care of their diabetes day in, day out.

The Consumer Guide also takes a look at what’s trending in the product development pipeline and how such innovations may be able to help people with diabetes. Here are some notable trends in not-yet-available products. Some you may be able to buy before the end of the year; others may require months more of rigorous testing and FDA regulatory clearance.

1. Patch “pumps” for people with type 2 diabetes who use insulin. There’s one product on the U.S. market currently, the V-Go, and the Imperium patch pump is in testing. These disposable insulin delivery devices release a pre-set basal rate throughout the day and allow the user to type in bolus amounts for mealtimes. The idea is that a steady stream of insulin may more closely mimic what the body needs rather than giving large doses by injection (which sometimes aren’t absorbed well).

2. Infusion set improvements. Infusion sets are needed to get the insulin in a pump from the cartridge to just under the skin, where the insulin can be absorbed into the blood stream. Current infusion sets are indicated for no more than three days of wear and can clog and/or irritate the skin—which means insulin may not be absorbed as well as it should and can be an infection risk. One new developmental product by BD has an opening at the end of the cannula that stays under the skin and on the side—offering two outlets for the insulin and thus the hope of fewer clogs or insulin interruptions.

3. User-friendly delivery methods for glucagon. This rescue medication is used by someone else to treat a severe low in a person with diabetes who is unconscious or otherwise unable to eat or drink something containing glucose. Currently, glucagon powder has to be mixed with a sterile solution and injected—without training and in the middle of an emergency situation, this can be difficult. New forms of investigational glucagon are a Lilly intranasal version delivered by a puff into the nose (where the medication is rapidly absorbed into the bloodstream) or a peel-and-stick patch by Zosano Pharma.

4. Insulin pen memory aids. Insulin pens with memory features that show when the last dose was delivered have come and gone. People who use pens love that feature (yes, in my injection days, before using a pump, I would sometimes give a dose and later not be sure if I really had delivered the insulin). Now, clip-on memory devices as well as app-enabled pens like that being developed by InPen are in the works to help users keep track of the timing and size of their doses.

5. Fashion and function. People with diabetes have long wondered why their meters, pumps, and other devices aren’t as attractive and functional as their smartphones. I won’t get into all the challenges, but I can report that meter makers are designing app-enabled devices that look more like cosmetic accessories than medical devices. Goodbye clunky plastic “bricks,” hello rose gold OneDrop meter and its companion lancing device, which looks as sleek and shiny as a high-end lipstick!

More products, more choices are a good thing for people with diabetes. Of course, here’s hoping that manufacturers are listening to empowered patients when it comes to designing product features that consumers like best.
By Kelly Rawlings, Editorial Director, Diabetes Forecast magazine

Exercising With Diabetes

Exercising With Diabetes

Jennifer Okemah is a Certified Diabetes Educator and Certified Sports Specialist in dietetics. She is the director of four diabetes centers in the Seattle area.



Although her centers see all patients with all types of diabetes, she specializes in technology devices related to diabetes (pumps, meters, CGMs). Jennifer is an avid participant in many JDRF Ride to Cure 100-mile destination rides, is a certified Stand Up Paddleboard instructor, and has completed her 200-hour yoga teacher training.



In this post she’ll discuss dealing with the highs and lows of exercising with diabetes.

So you wanna exercise, but every time you start your lofty goals, you have a low blood sugar. Or, a high blood sugar. What gives?

Nerd alert: exercise, in general, can be a potent blood-glucose-lowering tool by nature of skeletal muscle burning glucose independent of insulin being present. To be precise, that means your little Glut4 transporters are opening up like daffodils in the spring, letting glucose into the cells and burning the fuel.

Usually, insulin is required to open up the transporter to let glucose in, but not for these little bad boys when you exercise. This is the very nature of the benefits of exercise with or without diabetes.

However, when you just gave yourself a full-on bolus with your meal before your workout, you now have two to three factors on board that are working hard to lower your blood sugar: bolus from your meal, basal insulin, and added exercise. This explains acute exercise-induced hypoglycemia.

There is a whole lot going on here. Sometimes my clients try to out-smart this process and turn their insulin pumps off during exercise. “That’ll teach that basal rate to stop causing my lows.” This is not usually a smart idea, as I can almost guarantee a rebound hyperglycemic excursion.

An exception to this would be a very conditioned athlete during an endurance event. Their muscle cells are like a million little furnaces burning glucose, usually with very little insulin usage.

However, in normal human subjects, such as us non-professional athletes with diabetes, we must remember that our “linebacker” liver (not the brightest, but works the hardest) is constantly spilling out glucose to keep us alive, and it works harder when blood glucose is low-ish.

Glucagon controls this, and glucagon can be wonky in diabetes. This is why you can actually have a high blood sugar after exercising. And this is why turning off your pump is probably not a good idea unless you are already bottoming out.

Fuel plan (hint: it involves carbs)

One of the key aspects I counsel clients on is to not fuel up to their insulin. You are an athlete, or at least you play one on TV. Regardless, you need fuel. Eat or drink your fuel as any other athlete, but don’t “carb load,” as your liver and muscle capacity to store glycogen is finite and the liver is already leaky.

Any left-over glucose will be reported on your meter as a higher than necessary number and require a correction. (Please don’t do a FULL correction when exercising. I whispered that, but I hope you heard it.) Therefore, eat your usual carbs you need for fuel.

And for the love of human physiology, you NEED carbs. Make them good quality ones, keep the quantity of grams in check, and keep the fat low so carb absorption is accessible when you need it. Consider a lower bolus than usual so you have a buffer to burn excessive glucose without a consequence of a low.

Don’t forget to fuel during your workout or event. If it lasts more than 30 to 45 minutes, you may benefit from a small carb source to continue to fuel you. This is the time to keep the carbs in small doses and more simple, so you can continue to burn the fuel.

Think of your fuel and hydration plan with exercise like a throttle set to “purr.” Don’t rev your engine by entering into exercise with a marginal blood glucose and then hitting the gym like Captain America.

Most athletes (I’m counting you too, you weekend warriors), like to enter into a workout with a blood glucose of 150 to 250 mg/dL depending on the type of exercise and the duration.

Do what is comfortable, but don’t accept negative consequences as “this is my diabetes.” There are a myriad of factors involved in that number on the meter.

But now I’m high…

Post-exercise highs, if not due to full suspension of insulin delivery, can be due to overindulging in carbs and not bolusing at all, or it could be counter-regulatory hormones kicking in.

This generally happens with newly incorporated exercise plans or high-intensity exercise in short durations. Essentially, this means that whatever you are doing, your body is registering it as stress—similar to our Homo sapien relatives being chased by a T. rex. Wait. They didn’t live at the same time, did they? Well, you get the picture.

Fuel and hydration in the presence of diabetes and exercise can be tricky. Good thing we have science and logic to help us through most of it. I can’t wait to hear how you all are doing it and the questions you may ponder and ask.
By Jennifer Okemah, CDE, CSS for

The Cost of Diabetes Care

For a person with diabetes, medical care costs can be more than double. Learn how to create a diabetes budget you can live with.

The Cost of Diabetes Care

Diabetes can be a costly condition to manage. According to the American Diabetes Association (ADA), the cost of diabetes in the United States is more than $245 billion a year, which includes direct medical costs and the cost of reduced productivity. For a person living with diabetes, medical expenses are about 2.3 times higher than those for the average person without diabetes. People with diabetes accrue about $7,900 in diabetes-related healthcare costs annually and about $5,800 because of other health problems.

One bright spot, according to the ADA, is the Affordable Care Act, which President Obama signed into law in 2010 and which has helped people with diabetes keep their insurance coverage and has broadened healthcare options to help manage costs.

Whether you get your coverage through private health insurance, Medicare, Medicaid, your employer, or the Affordable Care Act, it’s important to read the fine print on your policy so you understand all the costs, including deductibles, copays, and prescription costs.

Breaking Down the Costs of Diabetes

Researchers with the ADA crunched data from national surveys and health databases and determined that the bulk of diabetes costs occur in these categories:

  • 43 percent for hospital inpatient care.
  • 18 percent for prescription medications.
  • 12 percent for anti-diabetic agents and supplies.
  • 9 percent for physician office visits.
  • 8 percent for residential care facilities.

The data were published in the April 2013 issue of Diabetes Care.

Shannon Knapp, RN, a diabetes educator at the Cleveland Clinic in Ohio, suggests looking at the following elements when calculating the cost of your diabetes care:

  • Diabetes medications. These include oral medications, insulin, and other injectable medication for diabetes. “Some of the newer and better medications don’t yet have generics and aren’t covered by insurance,” Knapp says. “One option is to contact drug companies directly for assistance.” Sometimes drug manufacturers can offer discount coupons or rebates so you can afford to continue taking your medications. The ADA offers a list ofprescription assistance resources. Also, when shopping for prescription drug coverage, choose the plan with affordable copays for the drugs you use, recommends the AARP.
  • Testing supplies. Blood testing meters are a limited cost for people with diabetes, but lancets and testing strips are an ongoing expense. “Meters are usually covered, or they may be free from your doctor’s office,” Knapp says. “Lancets are cheap, but testing strips are expensive.” And, she adds, your preferred type of strips may not be covered if your insurance pays for only a certain type of meter that uses different strips.
  • Injection supplies. Beyond the medication itself, be sure to factor in alcohol swabs, syringes, pen needles, and anything else you use for insulin injection.
  • Insulin pump. Pumps and the supplies you need to keep them going are usually covered by insurance, but you may have a copay. “For someone without insurance, it can cost more than $7,000 just to get a pump set up,” Knapp says. “Even with insurance coverage, copays can add up to around $2,000 to get a pump started.”
  • Continuous glucose monitoring. “Continuous blood sugar monitoring isn’t as widely covered as an insulin pump, but coverage is improving,” Knapp notes. “You need to include the initial cost and the cost of regular supply shipments.”
  • Doctor visits. Calculations should include the cost of seeing your primary care doctor as well as any specialists. You may have different copays to factor in. It’s not uncommon for a person with diabetes to also see a diabetes specialist (endocrinologist), an eye doctor (ophthalmologist), a kidney specialist (nephrologist), a foot doctor (podiatrist), and a heart specialist (cardiologist), according to the ADA.
  • Healthy food. “People with diabetes should shop for fresh, unprocessed foods,” Knapp says. Work with a diabetes educator to learn how to read nutrition labels and shop for diet-friendly bargains. Reading the weekly circular from your local grocery store might help.
  • Weight loss/fitness program. “Weight loss is important for people with diabetes who are also overweight, and many people rely on weight loss programs like Weight Watchers or a gym membership to stay fit,” Knapp says. Factor in these costs as well.

Health Insurance for Diabetes

According to the ADA, the average person living with diabetes has more than $13,000 a year in healthcare expenses — much of which should be covered by health insurance.

“It’s impossible to predict what any one individual’s out-of-pocket expenses will be because it depends on the type of insurance he or she has, what kind of aid he or she qualifies for, and what state he or she lives in,” Knapp says. “But it’s safe to say that anyone living with diabetes will have some uncovered healthcare costs.”

If you’re struggling to find insurance for diabetes or need help for the uncovered costs of diabetes, check out the following resources for information about financial support:

Create a Budget for Diabetes Costs

Having a budget is important for everyone, but it’s essential when you’re managing diabetes, especially during hard financial times.

The Federal Trade Commission has a worksheet you can use to outline your household budget, covering such fixed expenses as housing and utilities. The worksheet also includes health expenses, so you can track your diabetes and healthcare costs over time.

If you’re struggling to keep up with out-of-pocket costs, help is available. If uncovered diabetes medications are taking a big chunk out of your budget, contact prescription assistance programs. If you can save money by switching to a generic drug, ask your doctor to change your prescriptions and shop around to get the lowest price at drugstores. If paying for diabetes supplies is depleting your budget, ask your doctor whether his or her office can provide these supplies at a discount price, or get ideas from others who also struggle with this. Local diabetes organizations and a diabetes support group can also be good resources.

Finally, don’t be afraid to ask your doctor for help. Never skip needed medications or alter your treatment plan on your own because of cost — if finances are preventing you from getting the treatment you need, your doctor needs to know. Covering the cost of diabetes is challenging for many people, but your doctor can direct you to the best support and most useful resources. Don’t let the cost of diabetes get in the way of caring for yourself.

By , Reviewed by Judy Mouchawar, MD, MSPH


— Additional reporting by Madeline Vann, MPH

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