December 2001/January 2002

Diabetes -The Medical Perspective

Diabetes & Neuropathy
(nerve damage)

Our nervous system operates throughout our whole body. The nervous system controls muscle movement, sensations through the skin, and moving food through the gastrointestinal tract, to name just a few.

Diabetes can lead to nerve damage, although how that exactly happens is not yet known. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes the greater the risk of developing nerve damage. The symptoms of diabetic neuropathy vary. Numbness and tingling in feet are often the first sign. The symptoms may come and go. The sensation may be dull and annoying or sharp and painful.

Diabetic neuropathy can also cause the stomach to empty too slowly, the bladder to not empty completely, impotence, difficulty swallowing, or even change the ability to sweat!

A simple screening test to check sensation in the feet can be done in the doctor's office. Sometimes more extensive testing is needed.

Treatment of diabetic neuropathy aims to relieve discomfort and prevent any additional nerve damage. What the treatment is depends on which nerves are damaged. Pain management may begin with the doctor suggesting non-prescription pain medication or prescribing stronger pain therapy medication. With intense pain, the doctor may also prescribe a therapy known as Transcutaneous Electronic Nerve Stimulations (TENS). In this treatment, small amounts of electricity block pain signals as they pass through a patient's skin.

Not all people who have diabetes will develop nerve damage. Be sure to discuss any concerns or symptoms you may have with your doctor.

Diabetes and Food

Fall brings with it many flavorful recipes, but pies are one category that many of those with diabetes have been taught to avoid.

When we think of pies, most people think of the fillings - apple, peach, pumpkin, rhubarb, just to name a few. However, pies are high in fat and therefore calories, primarily because of the crust!

One way to lower calories and fat is to cut smaller than standard pieces. For instance, a standard nine-inch crust is usually cut into eight slices. Cut the calories and fat by half by cutting the pie into sixteenths.

Or you can use a different crust. The crust with the fewest calories is a meringue crust, with one slice having only 30 calories and no fat (standard one-eighth of a nine-inch pie). A meringue crust contains egg whites, cream of tartar, salt, and a sugar replacement. It is baked separately and cooled before filled.

A cottage cheese-based pie crust slice has about 50 calories and two grams of fat. It contains shortening, flour, and cottage cheese and must be chilled before rolling.

A graham cracker crust slice has almost 90 calories and two grams of fat. Variations of the traditional graham cracker crust use only water and no margarine to lower the calories to 70, or using ginger cookies and skim milk to reach 60 calories per slice.

A traditional flour-based pie crust slice has 140 calories and nine grams of fat for bottom-only crusts.

Specific pie crust recipes can be found in most comprehensive cookbooks.

Exercise as a Part of Living

If you have neuropathy (nerve damage), you should have a discussion with your doctor before beginning to exercise. Some forms of neuropathy may affect your normal heart rate which will make your heart rate a poor indicator of your exertion level. Also, your heart may not contract as strongly as it should during intense activity, making low-to-moderate intensity the best exercise choice.

Neuropathy can affect the way your body uses calories and the way insulin works on your muscle cells. You may want to ask your doctor how long you should wait after eating or taking insulin before you begin an activity.

Even after you talk to your doctor, make changes to your routine gradually so your body can safely handle any changes it needs to make.

Recipes to Try

Jamaican Chicken (Spicy)

(4 Servings)

1/2 teaspooncinnamon
1/2 teaspoonsalt
1 teaspoonallspice
1 teaspoongarlic powder
1 teaspoonblack pepper
1 cup finely chopped onion
1 teaspooncayenne pepper
1 cup vinegar
2 teaspoondried oregano
1 cup water
2 teaspoondried thyme
1 teaspoonbrown sugar substitute
1 lb. boneless, skinless chicken

1. Combine all ingredients except chicken.
2. Add chicken and marinate in the refrigerator for at least 6 hours.
3. Transfer to a large skillet; bring to a boil, then simmer for approximately 30 minutes. Make sure chicken does not boil dry. Adding additional water/vinegar will decrease spiciness. May also bake in 350E oven for approximately 45 minutes.

Per serving:

Sweet Potato Pie Filling

(8 Servings)

6 pkts. sugar substitute
3 large eggs
1/2 cup brown sugar
1/2 cup evaporated skim milk
1/2 teaspoonsalt
1 teaspoonvanilla
1/2 teaspoonnutmeg
3 cups cooked, mashed sweet potatoes

1. Combine sugars, salt, nutmeg, and eggs.
   
2. Add milk and vanilla. Stir.
   
3. Add sweet potatoes. Mix well.
   
4. Pour into glass pie pan, or pie shell - See food article this issue.

Per serving:

Medication Update

Remembering to take medication is difficult whether you have diabetes or some other condition that requires medication. But what do you do if you forget to take your pills that help control your blood sugar?

The American Diabetes Association has a general rule about whether to take your pills when you do realize you have forgotten, if you are taking a medication in the sulfonylurea class, such as Glucotrol, a biguanide such as Glucophage, or a thiazolidinedione such as Actos or Advandia.

If you usually take pills twice a day, and you are within 3 hours of the dose you forgot to take, go ahead and take your medication. If it is longer than 3 hours past the time you should have taken your pills, wait and take them at the next scheduled time.

If you take medication just once a day, go ahead and take your medication if you are within 12 hours of your missed dose. If you are not, wait until the next scheduled time.

If you are taking an acarbose such as Precose or repaglinide such as Prandin, wait and take your medication at the next scheduled time.

If you have a question about your medication or medication times, be sure to call your pharmacist or doctor. They may have guidelines more specific to your medical condition

New Resources

The following resources focus on nervous system health and are available through the National Kidney and Urologic Diseases Information Clearinghouse, 3 Information Way, Bethesda, MD 20892-3580, or via the internet at http://www.niddk.nih.gov/health/diabetes/
pubs/complications/nerves/nerves.htm or from the National Diabetes Information Clearinghouse, 1 Information Way, Bethesda, MD 20892-3560; ndic@info.niddk.nih.gov.

Single copies are generally free.

Prevent Diabetes Problems: Keep Your Nervous System Healthy, NIH Publication.

Diabetic Neuropathy: The Nerve Damage of Diabetes, http://www.niddk.nih.gov/health/diabetes/pubs/neuro/neuro.htm, Updated: October, 1999.

Additional general resources:

Diabetes A to Z, 4th Edition, American Diabetes Association, 195 pages, January, 2000.

Diabetes A to Z, Spanish Edition, American Diabetes Association,
202 pages, August, 1997.

The Uncomplicated Guide to Diabetes Complications, Marvin E. Levin, MD & Michael A. Pfeifer, MD (Editors), 384 pages, June 1998.

Events and Local News

Free Foot Exams During November and December

During November and December, all the members of the Illinois Podiatrist Medical Association will be providing free foot exams to people with diabetes. Please call 1-800-323-4769 in November and December for a referral to a local podiatrist in your area for a free foot exam.

Flu Shots

The Centers for Disease Control and Prevention recommends that people with diabetes should get a flu shot every year and a pneumonia shot every six to ten years. If you have diabetes, the flu can be more than aches and pains. It can mean a longer illness, a trip to the hospital and even death. In fact, people with diabetes are three times more likely to die from complications and six times more likely to be hospitalized due to flu and/or pneumonia. So, call your local health department or your doctor to get a flu and pneumonia shot.