1. Take Charge of Your Diabetes During the Holidays

2. The holidays can present special challenges for those with diabetes . . .
Busy schedules
Extra stress
Family gatherings
Eating out
Foods rich in carbohydrates, fats, and sodium
Foods high in calories
Ask: What challenges do you face during the holidays?
Ask: What is one way you have learned to manage these challenges? (Take examples from 2-3 people)

3. Why worry about diabetes management during the holidays?
The holiday season goes from Halloween to New Year’s = 2 months
With busier schedules, there is less time for exercise
Researchers have found that weight gained during the holidays usually doesn’t come off later in the year
Increased weight leads to increased difficulty managing your diabetes
Towards the end of the year, we really do celebrate a holiday “season” because we have holidays occurring right in a row from October to January. Many of the holidays that take place at the end of the year have a heavy focus on food – especially foods that are high in sugar, sodium, fat, and calories. Holidays also bring many extra gatherings, social events, and shopping, which leave us with even less time for healthy lifestyle habits like exercise.
Since research shows that weight gained during the holidays doesn’t usually come off later in the year, it is important to focus on “weight maintenance” through quality diets and physical activity during the holidays. This not only helps our waistlines, but also helps us to manage other health conditions like diabetes and heart disease.

4. You have the power to manage your diabetes
and
Enjoy the holiday season!
Provide encouragement to participants.
The holidays can be challenging, but managing their diabetes will go a long way in staying happy and healthy the entire year through.

5. Cut stress and stay active
Stress effects your diabetes
The “fight or flight” effect
Continued high stress can lead to difficulty managing your glucose
Staying active can help you manage your diabetes
Plan activity into your day
Train for and participate in a local holiday run/walk event
Incorporate activity into time with friends and family
Go for a walk after eating a holiday meal
Clear the table after a meal – this will get you active and prevent mindless munching
Stress causes our bodies to stay in a constant state of “fight or flight”. In response, our bodies release hormones that effect the way our bodies release and use glucose. This can cause blood glucose (or blood sugar) levels to remain high and be more difficult to manage.
Option: Ask participants to tell you about some of the holiday stresses they face.
Activity suggestion: Blow up balloons. As participants list holiday stresses, write each on a balloon. Ask for a volunteer to try to keep all of the balloons in the air. This is a difficult task! Ask others to join him/her in keeping the balloons in the air. Ask the participant how they felt trying to keep all of the balloons in the air. Take away – when we try to do EVERYTHING during the holidays and do it by ourselves, it is very stressful. Decide what is important and ask for help; it makes a task more fun just like it made keeping the balloons in the air more fun.
Physical activity helps reduce stress and helps our bodies control blood glucose.
This slide lists some fun ways to stay active during the holiday season.
Option: Ask “What are some ways you and your family can be more active during the holidays?”

6. Stay on track - plan ahead
Your schedule
Think about your holiday gatherings, travel, and events
Try to maintain balance – medication, healthy foods, physical activity
Your meals
Stick to your healthy meal plan
Plan menus in advance so you are not putting meals together at the last minute
Take diabetes-friendly foods to gatherings
While the holidays can be hectic, planning ahead helps to keep aspects of your diabetes care in balance. Remembering to take medications, eat healthy, and be physically active will help you to stay healthy and manage your diabetes.

7. Try these holiday meal tips
Slow down
Focus on friends and family
Enjoy the foods you are eating
Remember to keep your carbohydrates consistent
Try to have the same amount of carbohydrate you normally would
Don’t skip meals or snacks earlier in the day to “save” carbs for later. This will make your blood glucose more difficult to control.
Keep desserts in check
Share
Take desserts you have modified to be healthier
Politely decline when you know you have reached your limit

8. Watch your portions 2 stacked dominoes = 1 oz of cheese
Deck of cards = 3 oz. of meat
Baseball = medium potato or fruit, 1 cup cold cereal
Compact disk = pancake
Computer mouse = ½ cup pasta
Diameter of a yo-yo = small cookie
Consider using a portion kit to help participants visualize portion sizes.

9. Holiday foods can be high in sugar, fat and calories
Ask: Think about your holiday traditions and meals. What foods come to mind when you think about the holidays?
Most of the foods we look forward to having as part of a holiday meal or family tradition are rich in flavors and sweetness. Looking at the foods in these pictures, you can probably tell that their “richness” comes from extra fat and sugar from ingredients like lard, butter, whipped cream, chocolate, sugar, etc. Unfortunately, this “richness” also brings extra calories to our diet during this 2 month on-going holiday season.

10. Extra calories can sneak in during the holidays
Extra calories can sneak in during the holidays And they don’t always come in LARGE portions
Chocolate cake, iced 650 calories per 2x2 inch slice
Pecan pie 500 calories per 1/8 pie
Egg nog 342 calories per 8 oz.
Pumpkin pie 290 calories per 1/8 pie
Holiday cookies 150 calories per 2 cookies
The 2010 Dietary Guidelines from Americans, suggests a 2,000 calorie per day diet for most adults in the general population. This calorie recommendation varies among adults based on factors such as age, height, weight, gender, and activity level. Some people may only need 1,600 calories per day while others may need 2,200 calories per day.
Regardless of your calorie needs, you can see that eating a slice of chocolate cake with icing would consume a large majority of your calories for the day.
Healthy Americans as well as those with diabetes should consume a well balanced diet that consists of fruits, vegetables, whole grains, lean protein, and low-fat or fat-free dairy. That’s not always an easy task during the holidays. However, a few smart choices and recipe modifications can make this an easier task.

11. Making your holiday favorites healthier
Reduce the sugar:
Use less
Replace with non-nutritive sweetener
Reduce the fat:
Ingredient substitution
Portion control
Reduce the sodium:
Increase fiber:
Add fruits, vegetables, and whole grains
Handout: Modifying Recipes to be Healthier, OSU Extension Fact Sheet
Although some of your favorite foods could be laden with extra fat, sugar, or sodium, there are some modifications you can make to recipes to make your holiday favorites healthier.
Here are some examples:
Reducing sugar: use less sugar, replace sugar with non-nutritive sweeteners (particularly in items that will not be baked/cooked), increase seasonings such as vanilla and cinnamon
Reducing fat: use less (particularly for box mixes), substitute fruit purees, low-fat or non-fat yogurt, and heart-healthy oils such as canola and olive oil
Reducing sodium: use less, use herbs and spices in place of salt
Increasing fiber: add fruits, vegetables, and whole grains
In the following slides, we will go through some ways to improve specific holiday foods.

12. Dining with Diabetes Holiday Meal Make-Over
On the Menu
Roasted Turkey Breast
Apple Stuffing
Skinny Gravy
Sweet Potato Puffs
Green Beans, Cranberries, and Nuts
Double Layer Pumpkin Pie
I am going to show you how to prepare a healthier holiday meal. Today we will prepare and sample ______ .

13. Let’s Talk Turkey
Turkey is a healthy, low-fat meat, if you choose the right part
Selection (3.5 oz) Fat (g)
Turkey skin 39
Roast beef 15
Turkey wing with skin 12.3
Turkey leg with skin 11.5
Roasted ham 9
Turkey breast with skin 7.3
Turkey leg without skin 7.1
Turkey breast without skin 0.7
Source: USDA database
Turkey is typically thought of as a healthy choice, but truly it depends on what part of the turkey you are consuming and how it is prepared.

14. Make healthy modifications Holiday Apple Stuffing:
Use a lower-sodium broth and stuffing mix
Add fruits and vegetables to increase flavor, color, and fiber content
Add whole grains like brown rice, barley, and wheat berries
These are suggested tips for healthier variations of traditional dishes. Include Apple Stuffing recipe in the participant recipe packet and consider demonstrating this recipe.

15. Compare ½ Cup stuffing Calories Carbs Fat Sodium Fiber
Home-made
Box mix
Apple Stuffing
Fitness Connection:
You would need to walk . . .
60 minutes to work off the home-made stuffing
50 minutes to work off the box-mix stuffing
24 minutes to work off the apple stuffing

16. “Skinny” gravy Use fat free broth or de-fatted drippings as a base
Skim the fat of meat drippings from the meat
Use cornstarch in place of a higher fat “roux” made from flour and fat
These are suggested tips for healthier variations of traditional dishes. Include Skinny Gravy recipe in the participant recipe packet and consider demonstrating this recipe.
Demonstration idea: skimming the fat from drippings and discussing the significant calorie decrease.
De-fatting drippings significantly reduces the fat and calories in the gravy. Drippings can be de-fatted in several ways: allowing it to cool and separate, and then pouring or skimming off the top fat layer as shown in the picture above or causing separate by cooling with ice-cubes which are placed in the drippings. Fat free broth can also be used as a starter base.

17. Compare ¼ Cup Gravy Calories Carbs Fat Sodium Home-made 82.5 5 6 340
Commercial
“Skinny” Gravy
Fitness Connection:
You would need to clean . . .
24 minutes to work off the home-made gravy
12 minutes to work off the commercial
2 minutes to work off the skinny gravy

18. Sweet Potato Options Use orange juice or apple juice
Add spices, such as cinnamon, cloves, nutmeg, or ginger
Omit sugar and butter
Use half the amount of marshmallows or use raisins instead
Mash and bake to make sweet potato puffs
These are suggested tips for healthier variations of traditional dishes. Include Sweet Potato Puff recipe in the participant recipe packet and consider demonstrating this recipe.

19. Compare ½ Cup Calories Carbs Fat Sodium Fiber Regular 253 46 7.4 240 2
Sweet Potato
Puffs
Fitness Connection:
You would need to bike . . .
40 minutes to work off the regular sweet potato casserole
20 minutes to work off the sweet potato puffs

20. Green Beans with a Twist
Use fat free half & half in place of cream soup
Add colorful fruits, like cranberries, or veggies, like carrots or corn, to add color and give a fiber boost
Top with minced onion and parmesan cheese instead of fried onion rings
Add nuts and seasoning
These are suggested tips for healthier variations of traditional dishes. Include Green Beans, Cranberries and Nuts recipe in the participant recipe packet and consider demonstrating this recipe.

21. Compare ½ Cup Calories Carbs Fat Sodium Fiber Regular 125 12.5 7 495 2
Green Beans
Cranberries, and Nuts
Fitness Connection:
You would need to jog . . .
20 minutes to work off the regular green
bean casserole
12 minutes to work off the green beans,
cranberries, and nuts

22. Tips to Make a Delicious, Better for You Pie
Omit the bottom crust for fruit pies
Use ground ginger snaps in place of traditional pie crust
Use a ready-made pie crust – it is thinner than homemade versions, thus typically contains fewer calories, less fat, and fewer carbohydrates
Use egg whites in place of whole eggs
Use evaporated skim milk
Cut into 10 servings
Top with fat-free whipped cream

23. Crust comparisons 1/8th Crust Calories Fat Gingersnap 60 1
Graham
Ready-made 120 8
Homemade

24. Try our Double Layer Pumpkin Pie
Use less sugar
Add sugar-free pudding mix to add volume without calories
Spice it up – add cinnamon, ginger, cloves, or try a prepared pumpkin pie spice
These are suggested tips for healthier variations of traditional dishes. Include Double Layer Pumpkin Pie recipe in the participant recipe packet and consider demonstrating this recipe.

25. Compare 1/10th Calories Carbs Fat Homemade Pie 168 24 7
Commercial Pie
Double Layer
Pumpkin Pie
Fitness Connection:
You would need to rake leaves . . .
35 minutes to work off the home made or commercial pie
19 minutes to work off the double layer pumpkin pie

26. Cookie Considerations
Make them smaller
Make fewer varieties
Serve cookies with fresh fruit
Cutting fat doesn’t really save on calories if it is replaced with sugar and flour – these add carbs!

27. Compare Calories Carbs Fat Traditional Holiday Dinner 983.5 109.5 40.7
Modified Holiday Dinner
You Saved:
482.5 Calories
47.1g Carbohydrates
26.3g Fat

28. Celebrate the happiness that friends are always giving, make every day a holiday and celebrate just living!
~ Amanda Bradley

29. Credits
Developed by the Ohio State University Extension Diabetes Education Team
Christine Kendle, OSU Extension Tuscarawas County
Shari Gallup, OSU Extension Licking County
Amy Habig, OSU Extension Adams, Brown, and Highland Counties
Kate Shumaker, OSU Extension Holmes County
2013
Resources:
American Diabetes Association,
Brinkman P, Syracuse C. Modifying a Recipe to be Healthier. Ohio State University Extension
Center for Disease Control and Prevention,
Henneman A. Tiny Tastes can add up to Big Calories During the Holidays. University of Nebraska Lincoln Extension.
Mayo Clinic,