Diabetes control at the holidays: It's not about perfection

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Making healthy choices during the winter holidays can be challenging for anyone. For people with diabetes, it can be even harder.

Disruptions brought on by travel, stress and food-filled celebrations can "really wreak havoc on people's self-management of their diabetes," said Dr. Cecilia Low Wang, a professor of medicine at the University of Colorado Anschutz Medical Campus School of Medicine in Aurora.

Handling the season starts with being realistic, said Melissa Magwire, program director at the Cardiometabolic Center Alliance in Kansas City, Missouri. While your choices matter, "you can do everything within your control, and still, your body's reaction to the food you've eaten or the stress you might be under can be different from day to day," said Magwire, a certified diabetes education and care specialist.

Which is why, when asked for advice about how to manage diabetes during the holidays, she and Low Wang both emphasized that it isn't about being perfect. "I think the one way to lose control is to assume that you can control everything when you're living with diabetes," Magwire said.

Here's what they did recommend.

Have a plan

Diabetes is personal, Magwire said. If she were advising four patients, "All four could eat the exact same meal, and they would react differently to it."

If you know you're going to encounter certain holiday foods, and you know how they affect you, plan for that, she said. Ask yourself, "Are there ways that I can adapt my diet for that day so that I can have the foods that I enjoy but still have glycemic levels that are safe and healthy?"

If you're expecting to be served a carbohydrate-filled dinner, plan to eat low-fat proteins at lunch, Magwire said. You also can ask your care team about how to adjust your insulin before bigger meals.

You also need a plan for travel, she said. Pack your own snacks to ensure you'll have healthy options.

Low Wang, who specializes in endocrinology and diabetes management, also advised making sure you have enough medications to get you through an extended stay if flights are canceled.

Don't starve yourself

Skipping meals to save up for a big one should not be part of your plan, Magwire said.

"No. 1, you're more likely to overindulge at that meal if you haven't eaten all day long," she said. No. 2, not eating could interfere with your medications, which may have been calculated to meet the needs of average-sized meals.

Starving and then stuffing yourself also could lead to a huge swing in blood sugar, and "you're going to pay the price," Magwire said.

Watch the alcohol

"You really need to be careful," Low Wang said. Depending on the drink, alcohol can either raise or lower blood sugar levels: Beer and sweetened mixed drinks are full of carbohydrates that raise it, but alcohol stops the liver from producing blood sugar, or glucose. The effects can show up hours later.

The symptoms of low blood sugar, or hypoglycemia, can be mistaken for the effects of alcohol, Magwire said. "In layman's terms, being tipsy can feel a lot like being low."

Magwire suggests testing your blood glucose before drinking, during and for several hours after – and letting those around you know that you have diabetes. If you start acting strangely, she said, "it may be not that you're drunk or tipsy – it could be that you're hypoglycemic."

Try these holiday buffet tactics

Use a smaller plate so you're less tempted to load it up. "I know that sounds simplistic," Magwire said. But patients tell her it really works.

Alternatively, commit to taking portions no larger than your fist. Emphasize the proteins and leafy green vegetables, and add the starches and sweets to your plate last. "I'm not saying you can't have those, but fill up on the more nutritional aspects before you add those extra sweets," Magwire said.

Also remember, just because it's on your plate does not mean you have to finish it. "When you're full, you're full," she said. "Listen to your body."

Don't skimp on sleep

Diabetes health goes beyond diet, and "during the holidays, there are also many, many situations where sleep is disrupted," Low Wang said.

Make a plan for coping with that, she said. Make sure the room you sleep in is cool, dark and quiet. Stick to your sleep schedule, and get the recommended seven to nine hours per night for adults. Research has shown that even one night of disrupted sleep can increase insulin resistance.

Find ways to face stress

Stress can affect diabetes management directly and indirectly, Low Wang said.

Directly, stress boosts levels of hormones such as adrenaline and cortisol that counteract the effect of insulin and raise blood sugar, she said.

Indirectly, stress also can interfere with sleep or lead to overeating.

Setting realistic expectations for the season can help, Magwire said. "I think we trip ourselves up by expecting perfection through the holidays."

Get up and move

If you spend eight hours in a car going over the river and through the woods to Grandma's house only to immediately dive into a heavy meal, "you probably ought to try to take a walk afterward," or find some other way to be physically active, Magwire said.

In her family, that has meant everything from taking a stroll to having a video game bowling tournament. "I don't care if you stand in the middle of the room and flap your arms," she said. "That counts as some activity."

Unlink 'holidays' from 'food'

Celebrations often emphasize eating. They don't have to, Low Wang said.

Making your season about seeing other people, more so than food and drink, will make diabetes management easier, she said. "Really focus on the first part, not so much the second."

Understand that things might go wrong

Low Wang tells her patients that healthy choices are important and that the rewards include feeling better.

But when something goes amiss, "not beating yourself up over it is important," she said. And it's OK to "enjoy everything else about the holidays. Even though long-term effects of out-of-control glucose are important, too much worry can impact how you're feeling without helping how the diabetes is doing."

Magwire said people living with diabetes "tend to be fairly hard on themselves. And they look at it as 'I did something wrong.'" But second-guessing shouldn't overwhelm time with loved ones.

So, while preparation is wise, obsessing about challenges isn't, she said. "Just enjoy the time, and enjoy the moment."