February/March 2001

Diabetes - The Medical Perspective

Diabetes & Stress

Stress is so many things it is sometimes hard to define exactly. Stress can be physical, like injury or illness. Stress can also be mental or emotional, like problems in family or friend relationships, problems with your job or money, or feelings of frustration or anxiety.

When you are stressed, your body gears up to take action. Levels of many hormones increase to make stored energy–glucose and fat – available to cells. However, the cells still need insulin for the glucose to get in. For those with diabetes, this may mean that blood glucose levels increase when they are stressed, either physically or emotionally.

In addition, people who are stressed often do not take good care of themselves.

They might exercise less than they normally would, or miss meals. They might drink more alcohol or forget to check their blood sugar levels.

Just having diabetes and working on changing lifetime behaviors may be stressful! It is clear that some stress will always be in your life. Some stress won’t always make your blood sugar too high. However, many stressful things can be "too much."

If you feel that way, the stress level might be effecting your blood sugar. Talk to your health care provider so that he/she knows your blood sugar might be too high because of too much stress. Ask about support groups. Even if you don’t like sharing your problems, knowing other people in your same situation can help. You might also learn some tips that work for other people!

Diabetes and Food

Sugar substitutes have been on the grocery store shelves for more than 30 years. As the years go by, the number of sugar substitutes increase.

Are they all the same? While many sugar substitutes can be used in similar ways, they are not all the same.

The labeling laws of the Food and Drug Administration (FDA) explain that if one serving of a sugar substitute has less than 5 calories, it can be labeled as zero calories. Many sugar substitutes are labeled that way, but really have about 4 calories per serving. This can add up if large amounts are used in cooking or baking, or consumed in beverages.

Those sugar substitutes that are considered to be non-nutritive, or zero in calories, include those made with aspartame, saccharin, acesulfame-potassium or acesultame K, and sucralose. Aspartame is sold under the names of Equal® , NutraSweet® , and NatraTaste®, and will probably also be on your grocery shelf as a generic or store brand. Saccharin is sold under the name of Sweet ‘n Low ®, Sweetmate®, and Sweet Twin®. Acesulfame-potassium or acesulfame K is sold under the names Sweet One® and Swiss Sweet®. Sucralose is sold under the name Splenda®.

All of these can be used in hot or cold beverages. Sugar substitutes will work best in products where sugar is used mostly for sweetening, such as in pie fillings, sauces, or custards. All can also be used in cooking or baking, although they don’t all result in a high-quality product all the time. In recipes where texture and structure is needed, such as in cakes or breads, sugar substitutes may not all work as well as sugar. If the sugar was used in the recipe to also caramelize or brown the product, like in cookies, sugar substitutes may not all work as well as sugar. Consider adding a dark ingredient such as molasses, or cocoa. Products may also bake more quickly with a sugar substitute than with sugar. Check your cookies and cakes for doneness a few minutes earlier.

Exercise as a Part of Living

As spring looms around the corner, many of us are in the yard or garden more often. Most of us wouldn’t think of gardening as exercise, and yet it is physical activity.

Because the activities of gardening vary, and you might do a lot one day and not the next, it may be hard to regulate your blood glucose, or balance your eating, activity, and insulin. If you are taking insulin, think of gardening as a new exercise program and remember to check your blood sugar before and after working in the yard

Recipes to Try

Topped Blueberries

(4 Servings)

1 pint fresh blueberries
1/8 teaspoonfinely grated orange rind
2/3 cup non-fat plain yogurt
1/4 teaspoonvanilla
1/3 fat-free sour cream
1/8 teaspoonalmond extract
4 pkts. (1 gram each) aspartame sweetener

1. Wash berries and pat dry.
2. Sprinkle berries with 2 pkts. aspartame. Set aside.
3. In a small bowl combine yogurt, sour cream, sweetener, orange rind, vanilla and almond extracts.
4. Spoon berries into 4 goblets or dessert bowls.
5. Top with yogurt mixture.

Per serving:

95 calories
4 grams protein
0 calories from fat
19 grams carbohydrate
1 mg cholesterol
0 grams total fat

Red Apple Spinach Salad

6 servings

1 lb. fresh spinach, trimmed and cleaned
1/4 c. frozen unsweetened orange juice concentrate, thawed
1 unpeeled red apple
3 slices bacon, fried crisp, crumbled
1/3 c. light mayonnaise

1. Dice apple.
2. Mix orange juice and mayonnaise.
3. Mix apple and spinach.
4. Pour dressing over salad and top with crumbled bacon.

Per serving:

98 calories
3 gram protein
54% calories from fat
10 grams carbohydrate
7 mg cholesterol
6 grams total fat

Medication Update

Pills to treat type 2 diabetes: Meglitinide, biguanides, & glitazones

There are three kinds of diabetes pills sold today in the US. They work in different ways to lower blood sugar. The previous issue focused on sulfonylureas, which stimulates the beta cells of the pancreas to release more insulin. Similar to the sulfonylureas is another medication which also stimulates the beta cells of the pancreas to secrete more insulin. The type of medication is a meglitinide and it is sold under the name of Prandin or may be called Repaglinide. This drug can produce hypoglycemia or low blood sugar.

The second type of oral hypoglycemic medication are those that sensitize the body to the insulin that is already present. Within this category are two general kinds of medications: biguanides and glitazones.

Biguanides are sold as Metformin (brand name Glucophage) and lowers blood sugar by helping insulin work better. It is often taken two times a day.

Glitazones are sold as rosiglitazone (Avandia), and pioglitazone (Actose). They help insulin work better in muscle and fat. Glitazones are often taken once or twice a day with food.

The biguanides and glitazones won’t cause hypoglycemia (low blood sugar) unless they are taken with sulfonylurea or meglitinide oral medications, or in combination with insulin.

When you are taking drugs to control your blood sugar, it is very important to tell your doctor if you are taking any other medication. Drug-drug interactions could occur & cause dangerous or unpleasant side effects. This includes any over-the-counter medications or nutritional supplement.

New Resources

Single copies of the following are free from the National Diabetes Information Clearinghouse,1 Diabetes Way, Bethesda, MD 20892-3600 (Please use 9-digit ZIP code).

Control Your Diabetes. For Life. Tips for Feeling Better and Staying Healthy (NDEP-8) This booklet provides an action plan for diabetes control that includes tips on knowing blood sugar levels, reaching blood sugar goals, and maintaining blood sugar control ( 8/98).

Expanded Coverage for Diabetes— Medicare and You (NDEP-19) Available on the web:

http://ndep.nih.gov/materials/pubs/medicare-and-you/
expanded-coverage.htm

If You Have Diabetes, Know Your Blood Sugar Numbers
(NDEP-10)

This brochure provides information on measuring blood sugar levels using the hemoglobin A1c test and the finger-stick test (published 8/98, updated 3/00).