Hello, I’m Scarlett Ramey, President and founder of Ramey Nutrition. The passion that comes from working with geniuses, which most of my patients are, is immeasurable. Witnessing the healing process they own is the primary reason I opened this clinic. My patients achieve results due to choices we make together. They are on their own timeline for long and short-term goals, and I always go at their pace, not mine.

Food issues I am faced with usually have a story behind them, and working through that story leads my patients to eating disorder recovery, weight management goals, diabetes management, and medical nutrition solutions. Trust is the “how” of what I do. Changing food in someone’s life can be highly detrimental, if not traumatic. Building trust is the key to allowing my patients to shift in ways that are dynamic to their goals.

One of my strengths that lead to my patients succeeding on their own is my own realization and belief that we live in the REAL WORLD. This means goals must be set that are not far off from what people normally do. When given medical goals, that seem undoable, it can feel futile, frustrating and hopeless, but if I can align those goals with their lifestyle, I consider it a success. Often times, just listening to my patients is the best path to success. They know more than I ever will about what the real issues are and can heal them quickly if I don’t interrupt.

If you and/or someone you love needs assistance with recovery from an eating disorder, diabetes management, weight management, or medical nutrition diagnoses, I would love to talk with you about how we can attain your goals.

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• Improving your body’s use of insulin
• Burning excess body fat, helping to decrease and control weight (decreased body fat results in improved insulin sensitivity)
• Improving muscle strength
• Increasing bone density and strength
• Lowering blood pressure
• Helping to protect against heart and blood vessel disease by lowering ‘bad’ LDL cholesterol and increasing ‘good’ HDL cholesterol
• Improving blood circulation and reducing your risk of heart disease
• Increasing energy level and enhancing work capacity
• Reducing stress, promoting relaxation, and releasing tension and anxiety

How Does Exercise Affect Blood Sugar Levels?
Normally, insulin is released from the pancreas when blood sugar increases, such as after eating. Insulin stimulates the liver and muscles to take in excess glucose. This results in a lowering of the blood sugar level.

When exercising, the body needs extra energy or fuel (sugar) for the exercising muscles. For short bursts of exercise, such as a quick sprint to catch the bus, the muscles and the liver can release stores of sugar for fuel. With continued moderate exercising, however, your muscles take up glucose at almost 20 times the normal rate. This lowers blood sugar levels throughout the day.

Intense exercise can have the opposite effect and actually increase blood sugar. The body recognizes intense exercise as a stress and releases stress hormones that tell your body to increase available blood sugar to fuel your muscles. If this happens to you, you may need to slow your intensity down or add insulin.

For a variety of reasons, after exercise, people with diabetes may have an increase or a decrease in their blood sugar levels.

What Exercises are Good for Type 2 Diabetes?
While most any exercise is healthy for people with diabetes, let’s look at some specific types of exercise and their benefits:

The latest findings show that exercise such as strength training has a profound impact on helping people manage their diabetes.

• In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in sugar control that are comparable to taking diabetes medication.
• Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and felt much more self-confident.

Aerobic Fitness and Type 2 Diabetes
Any activity that raises your heart rate and keeps it up for an extended period of time will improve your aerobic fitness. Aerobic exercise helps decrease the risk of type 2 diabetes and helps those with diabetes to better manage their blood sugar levels.

• Besides the health benefits, exercise boosts your mood. It’s hard to feel stressed when you’re walking fast on a treadmill or swimming laps in a pool.
• To reduce the risk of low or high blood sugars, follow a regular routine of exercising, eating meals, and taking your medicines at the same time each day.
• If you are participating in strenuous exercise (exercising at your maximum capacity) or prolonged exercise (lasting for several hours or more), your insulin and/or oral diabetic medicine may need to be changed. Talk to your health care provider about how to adjust your medicine.
• Be careful exercising when your medicine is reaching its peak effect.
• Exercise with someone who knows you have diabetes and knows what to do if you have a low/high blood sugar. Wear a medical identification tag (for example, MedicAlert) or carry an identification card that states you have diabetes.

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Myth:
Diabetes is not that serious of a disease

Fact:
Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Myth:
If you are overweight or obese, you will eventually develop type 2 diabetes

Fact:
Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role.

Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes.

Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight.

Myth:
Eating too much sugar causes diabetes

Fact:
No, it does not. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories, whether from sugar or from fat, can contribute to weight gain. If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.

Myth:
People with diabetes should eat special diabetic foods
 
Fact:
A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive, and can also have a laxative effect if they contain sugar alcohols.

Myth:
If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta

Fact:
Starchy foods are part of a healthy meal plan. What is important is the portion size. Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks. The key is portion control. For most people with diabetes, having 3-4 servings of carbohydrate-containing foods is about right. Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.

Myth:
People with diabetes can’t eat sweets or chocolate

Fact:
If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten in moderation by people with diabetes. They are no more “off limits” to people with diabetes than they are to people without diabetes.

Myth:
You can catch diabetes from someone else

Fact:
No. Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious. It can’t be caught like a cold or flu. There seems to be some genetic link in diabetes, particularly type 2 diabetes. Lifestyle factors also play a part.

Myth:
People with diabetes are more likely to get colds and other illnesses

Fact:
You are no more likely to get a cold or another illness if you have diabetes. However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to control, and people with diabetes who do get the flu are more likely than others to go on to develop serious complications.

Myth:
If you have type 2 diabetes and your doctor says you need to start using insulin, it means you’re failing to take care of your diabetes properly

Fact:
For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.

Myth:
Fruit is a healthy food; therefore, it is ok to eat as much of it as you wish.

Fact:
Fruit is a healthy food. It contains fiber and lots of vitamins and minerals. Because fruits contain carbohydrates, they need to be included in your meal plan. Talk to your dietitian about the amount, frequency and types of fruits you should eat.

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Consequently, when receptors on body cells become resistant to insulin’s transfer, the body’s only response is to produce more insulin, again not used entirely due to the receptors not accepting it. Insulin in the blood stream along with high sugar cannot do anything to lower it because again, it can only transfer it. Your Goal is to maintain normal blood glucose levels.

Dangers of Low Blood Sugar
Usually we think of low blood sugars as a sign that type 2 is going well, however, blood sugar can go too low and become just as detrimental as having high blood sugars. This is medically called hypoglycemia The symptoms of lower blood sugar levels need to be treated immediately due to the possibly of fainting and slipping into a coma.

Low blood sugar can be due to the following:

• Skipping meals and snacks
• Not eating enough food at a meal or snack exercising longer or harder than usual without eating something extra
• Getting too much insulin if taken, or not timing the insulin doses properly with meals, snacks, & exercise
• Taking a long bath or shower right after an insulin shot

Symptoms of low blood sugar:

• Trembling
• Clammy skin
• Pounding or fast heart rate
• Anxiety
• Sweating
• Hunger
• Irritability
• Difficulty thinking

When blood sugar is really low, symptoms can also include confusion, headaches, seizure and possible coma.

Unless you are eating a meal right away, the best treatment for lows is a combination of simple and complex carbohydrates plus some protein. Quickly treating lows lessens stress hormone release and lowers the chance of the blood sugar going high after a reaction. You’ll feel better if the body is quickly resupplied with the fuel it needs. Your brain, muscles and other cells will thank you for not prolonging their misery.

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Type 2 Diabetes Short Term Complications
High Blood Sugar (hyperglycemia) – Blood sugar can rise for many reasons, including eating too much in one sitting, being sick, stressed, or not taking enough glucose-lowering medication.

Low Blood Sugar (hypoglycemia) – If your blood sugar level drops below your target range, it’s known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal.

However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you’re receiving insulin therapy.

Diabetic Ketoacidosis – As blood sugar goes up, the body tries to flush it out through the urine. When glucose is lost in urine it pulls fluid out with it. When these fluids are lost, the first danger is dehydration.

• Meanwhile, body cells are starved for sugar due to a lack of insulin then fat and protein from muscle tissue in order to maintain energy.
• The body normally prefers carbohydrate (sugar) for maintenance, but because there isn’t enough insulin in the body to transfer it to cells, the body starts burning fat in an unhealthy way. The liver is involved in fat-burning, and the by-product of this burning is ketones.
• Ketones build up and your blood becomes acidic, which prompts the body to shift electrolytes around to neutralize the acid and the result is the body retaining sodium and losing potassium.
• An imbalance of potassium affects the brain and heart rhythm. Potassium is needed for the electrical system to keep your heart beating, and the brain needs glucose and electrolytes to be fueled and for electric transfer of information, respectively. Without sugar or electrolytes the brain becomes at high risk for coma.

Type 2 Diabetes Long Term Complications
Cardiovascular disease – This complication is caused by decreased blood flow to the heart. As this happens, the heart can no longer pump blood throughout the body. Blood flow is cut off due to high levels of sugar in the blood deteriorating blood vessel walls.

Neuropathy – Excess sugar deteriorates blood vessel walls that nourish nerves, especially in the legs and can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, all sense of feeling in affected limbs could be lost. Damage to digestion specific nerves can cause problems with nausea, vomiting, diarrhea or constipation.
For men, it may lead to problems with erectile dysfunction.

Kidney Damage – Kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from blood. Diabetes can deteriorate this delicate filtering system which can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.

Eye Damage – Diabetes can damage blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.

Foot Damage – Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications.
Left untreated, cuts and blisters can become serious infections, and severe damage might require toe, foot or even leg amputation.

Skin and Mouth Conditions – Because blood sugar levels run so high, people with diabetes are more susceptible to skin problems, including bacterial infections, fungal infections and itching.

Gum infections also may be a concern, especially if you have a history of poor dental hygiene.

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When type 2 diabetics realize they have power over sugar, and they need to play the game right, then it becomes a responsibility rather than “I can’t eat sugar, I’m diabetic.” This causes the diabetic to go from powerless to powerful when diabetes originally was a detriment and a life sentence.

Some people make the choice to stay off sugar and say “I can’t, I’m a diabetic” This choice could be attention getting or it could be easier than figuring out how to manage sugar. Part of the process is to determine feelings about food and emotional ties to sugar, where they lie, and where it’s going to be a challenge. It requires effort to take on the challenge and make a powerful decision to have power over diabetes instead of being in a submissive role to diabetes. Sometimes it’s easier to not take on this challenge. Some people just don’t want to deal with it. However, the truth is once it’s dealt with it is very simple.

The second biggest challenge is the stigma attached to diabetes. What does it mean if you have diabetes? Do you want to tell people you have diabetes? Not really, because there is judgment from people. People make statements such as “You must be out of control” or “You ate too much sugar”. A lot of people still think that if a person has diabetes they ate too much sugar. There are jokes such as “Oh you’re so sweet, you’re giving me diabetes.”

The third challenge a person faces with type 2 diabetes is the family feeling responsible for the diabetic’s health. They feel the need to remind and point out things they think the person with diabetes is not seeing, when the person with diabetes knows what is going on.

All of these challenges can be dealt with in a group sessions as practiced in Beyond Type 2. Group supports people with type 2 because they are with other people who physically, mentally, spiritually, and socially understand everything that goes with diabetes. People can read books and books, but if you don’t have diabetes you will never understand diabetes at a physical level.

To feel support from people who know is highly life changing. Not feeling alone is primal and feeling connection; support and being supported by people with diabetes makes it easier to change together rather than alone. The motivation is much more real than it would be with a dietician or a coach. The connection with like minded people is very strong.

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The benefits of Gentle Yoga include:

• Stress relief
• Increased flexibility
• Increased strength
• Calmness
• Improved focus

Cost: $10.00
Mats provided
Dress in comfortable clothes
Bring water

All you have to do is show up. We look forward to seeing you there.

Because exercise and hard core athletics lowers blood sugar dramatically, constant testing needs to occur at least once an hour while exercising to determine if the athlete needs another 15 grams of carbohydrates. The athlete doesn’t need it while running around on the field but if blood sugars are too low a break to eat a granola bar is required.

If blood sugars are high, the athlete can exercise for a lot longer but headaches occur and when exercising on a very high blood sugar, there is no energy and the athlete becomes lethargic. It’s best to keep blood sugar in the range between 100-140 to keep the blood sugar going; not too high and definitely not too low. In athletes, high blood sugar is less dangerous than low because in a high blood sugar, exercising can stop and probably will due to fatigue. A low can throw the athlete into a coma. For an athlete the danger is more on the low end.

Athletes test more frequently and eat more frequently than non-athlete diabetics. They don’t play a three hour game and eat oranges afterwards. Athletes play an hour, come out and test sugar, eat the appropriate amount, drink water and get back into the game. This same routine applies to practices as well. When the athlete is off the field, a return to a normal routine occurs.

Athletes have to eat before athletics, sometimes during and after athletics which consists of protein and carbohydrate before, pure carbohydrate in the middle and protein, carbohydrate and fat at the end. This is the pattern generally followed but will vary by individual. Being an athlete with type 2 diabetes requires a lot of work because of the regiment they have to follow but it’s not impossible as many athletes have proven.

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You don’t know what you’ll run into in an airport, on planes, in gas stations or in cars or on trains. Sometimes you hit the jackpot and find really great meals but the trick is to not count on that happening, actually count on it not happening. For the length of travel, plan for the worst case scenario. If travel is for nine hours you need food for nine hours, which is more than you think when you’re just sitting. Travel is an active life activity and you don’t realize it because you are concentrating on trying to get to another gate. You are lifting and hefting suitcases, you’re checking in, and your stress level is high. You need more food when traveling than lying around on the couch all day.

Traveling outside of the country adds additional complexities. After arriving at the hotel and checking in, go on a walking tour. Ask the concierge for directions to the closest place for food, not a restaurant but snack type food or a grocery store. Buy a variety of different foods that will keep in your hotel room. Often a miniature refrigerator is available to store food and if not, there are other options. Hotels have ice available to use to store cream cheese or milk for cereal in the morning. String cheeses and yogurt can be kept on ice. You can buy bread for toast or peanut butter, fresh fruit, and snack foods such as baby carrots that are easy to eat.

Maintaining a lower stress level is part of traveling with type 2 diabetes. Travel is highly stressful and it’s important to include methods to lower the stress hormones as best you can. While sitting, try meditating, praying, breathing exercises or any activity that works for you. Stress alone can increase blood sugar to the 500s. For a non-diabetic person, getting in a car crash can raise blood sugar to the 500- 600 range. A diabetic is much more sensitive and as a result relaxation techniques are required. When traveling with type 2 diabetes, drink plenty of water, not the vitamin or sugar waters, but sugar free or very low calorie and caffeine free. Do not consume alcohol because it will either spike or lower blood sugar levels dramatically depending on your own body.

When traveling, it’s a good idea to test your blood sugar levels. Sometimes you’re going to be hungry and you’re not going to know it because the air pressure is different. On long car trips you might eat too much because there’s nothing else to do. Using a blood sugar monitor is a good double-check. First test your body and then test with a blood sugar monitor.

Traveling with type 2 diabetes requires preparation and awareness about your food needs. Don’t let type 2 diabetes stop you from enjoying travel.

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Since the information presented to the patient is new it creates a huge learning curve and they are expected to learn in all in one day. The class is multi-faceted including exercise, medication, food, insulin if needed, sleep, foot care, and what can happen if you don’t control your diabetes. Often times scare tactics are used, which are definitely motivators but not the way it should happen the day after the patient is diagnosed.

My comprehensive program Beyond Type 2 Diabetes is eight weeks long and covers the psychology, education, and exercise components.

I start out with an entire day on the psychology of the diagnosis. I ask these questions:

• When did you get diagnosed?
• What was your reaction?
• How has your reaction changed today?
• Where do think you’ll be ten years from now?
• What are your biggest worries?
• What are your biggest woes?

I don’t teach about diabetes because no one would be interested. The program is about the patients’ experiences and supporting each other in the process. My focus is always on the patient and their experience.

Every day that we have class, there is a check-in. I ask questions such as:

• How did you do this week?
• How did you feel this week?
• Was it a good week or a bad week?
• What are you coming up against psychologically?

The classes have a component of education to determine what people know and if there is any discord with that information and veering off into “I know I can’t eat sugar”, then I will gently bring them back to the research studies that have taken place that allow sugar in the diabetic diet. I take a very scientific approach. For example, I teach about what the pancreas is doing in a diabetic, which enables understanding exactly what the body is doing with food when food is eaten.

Most programs do not have the psychology component and they don’t combine the psychology portion with fitness. The combination of psychology with fitness works well because the patient is doing it. They understand the science of it and actually perform with the knowledge of what is actually going on with their bodies. Psychologically there’s a huge release of energy through the exercise and the huge release of the psyche and stress through the group. The patient is not only losing weight, but losing mental weight as well and in the process becoming more and more empowered.

A Typical Beyond Type 2 Evening
Group Setting – snacks and water are provided. In the group room, check-in occurs to see how things are going. The first week is spent on psychology, who are you with this diagnosis, who are you without this diagnosis, and who will you be with this diagnosis.

Workbook Exercises – this is about your own process, struggles, and successes throughout diabetes and beyond type 2. The goal is to figure out where you are with this diagnosis, where do you want to be, and what your goals are.
Group Closing – the group session closes.
Before Exercise – check blood sugar and weigh in. Confidentiality is kept and the numbers are not revealed.
Change into exercise clothes and exercise – gentle and motivating, fun, music, and camaraderie
Snack before driving home
Check blood sugar again

Other times you come in for exercise, group, or one-on-one sessions. Support group is offered once a week. One-on-one is every other week and is based on each patient’s struggles and successes as individuals and how they are doing with the group. The goal is to lower A1C and go beyond type 2 diabetes.

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