August /September 2002

Diabetes -The Medical Perspective

"Pre-diabetes" is the term used when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Doctors sometimes also call this state of high blood glucose "Impaired Glucose Tolerance" or "Impaired Fasting Glucose," or maybe even just talk about "borderline diabetes."

Doctors can use either the fasting plasma glucose test or the oral glucose tolerance test to detect pre-diabetes. Both require a person to fast overnight.

Who should be tested for pre-diabetes?

• If you are overweight and aged 45 or older
• If your weight is normal and you're over age 45, you should ask your doctor if testing is appropriate.

For adults younger than 45 and overweight, you may request testing if you have any other risk factors for diabetes or pre-diabetes. These include high blood pressure, low high density lipoprotein cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes, such as African American or Hispanic.

Research has shown that if you take action to control your blood glucose when you have pre-diabetes, you may delay or prevent type 2 diabetes from ever developing.

How can you take control of your blood glucose? Treatment usually includes losing a modest amount of weight through diet and moderate exercise. But don't worry if you can't get to your ideal body weight, a loss of just 10 to 15 pounds can make a huge difference!

Diabetes and Food

Eating out is entertainment as well as just a meal. During the summer months we often eat out more often—either because we’re on vacation, or have more activities, or because it’s too hot to cook.

Staying within your meal plan when eating out may seem to put a damper on the entertainment part of eating out. Try to remember that the long-term goal is to be as healthy as you can be. It may not be as fun to plan ahead, but it can still be fun!

Some tips for eating out:

• Think about how food is cooked: breading, frying, and adding sauces will add many calories. Chicken and fish may be good choices, but not if they are breaded and fried or have added sauce.
• Avoid "super" sizes. Although they may be good value money-wise, they are not good value calorie-wise.
• For Mexican food, pile on lettuce, salsa, and tomatoes. Go easy on cheese, sour cream, and guacomole. Avoid beans refried in lard, deep-fried taco shells, or dishes where the tortilla is filled and then fried.
• For Oriental eating, choose plenty of vegetables, preferably steamed. Avoid deep-fried wontons, and keep an eye on portion sizes.

Exercise as a Part of Living

The four basic parts to a total fitness program are aerobic endurance, muscle strength and endurance, flexibility, and body composition. The best fitness programs offer these parts in balance with each other.

Aerobic exercise is activity that puts an increased demand on the body to deliver oxygen to the muscles. Aerobic means "with oxygen." Although everything we do, we do "with oxygen," aerobic exercise or activity uses more oxygen than normal.

Aerobic exercises benefit the cardiovascular system. The cardiovascular system includes the heart (cardio) and all the blood vessels (vascular). Aerobic exercises include jogging, dancing, and bicycling.

There are several ways to test cardiovascular fitness. One way is with a "stress test" where the heart and blood pressure are monitored while the person increases his/her level of exercise, such as on a treadmill or stationary bike. An easier way is to measure a person’s heart rate. The stronger the heart, the more efficient it is at pumping. A normal heart rate is about 72 beats/minute. A trained athlete may have a heart rate in the 60’s or 50’s, or even lower. You can calculate your heart rate from your radial pulse (wrist) or carotid pulse (neck).

Recipes to Try

Blueberry Pie with Cottage Cheese Pie Crust

(8 or 10 servings)

Pie Crust
1 cup flour
1/2 tsp. salt
3 tbls. butter flavored shortening
1/2 cup low-fat cottage cheese

1. Combine flour and salt.
2. Cut shortening into flour until mixture resembles coarse meal.
3. Mix in cottage cheese until it forms a soft dough. May use immediately or chill.
4. Roll dough between sheets of wax paper.
5. Fit into 9 inch pie pan.
6. Bake at 475° 6-8 minutes, until lightly browned.

Per serving (1/10th pie or 1/8th):

Blueberry Filling

2 12-ounce pkgs. frozen unsweetened blueberries
1/2 cup Splenda®
3 tbsp. cornstarch dissolved in 4 tbls. water
1 tsp. vanilla
1 tbls. lemon juice

1. Partially defrost blueberries.
2. Combine all other ingredients in a saucepan.
3. Add blueberries and heat over medium heat, stirring constantly, until blueberries are completely thawed and mixture thickens.
4. Pour into pie shell.

Per serving without shell (1/10th pie or 1/8th):

Medication Update

There are many choices of oral hypoglycemic medications for the person who has type 2 diabetes.

• Sulfonylureas stimulate the beta cells of the pancreas to secrete more insulin. Common sulfonylureas include Glimepiride (Amaryl), Glipizide (Glucotrol), Glipizide-GITS (Glucotrol XL, which is a controlled release medication), Glyburide (Micronase, DiaBeta), and Glyburide micronized (Glynase).
  
• Biguanides improve the body’s own insulin action at the liver and decrease liver glucose production. A common biguanide is Metformin (Glucophage).
  
• Glucosidase inhibitors act at the intestine and slow carbohydrate digestion and glucose absorption. Common glucosidase inhibitors are Acarbose (Precose) and Miglitol (Glyset).
  
• Thiazolidinediones enhance tissue sensitivity to the body’s own insulin in the muscle. Common thiazolidinediones are Rosigliazone (Avandia) and Pioglitazone (Actos).
  
• Meglitinindes stimulate the beta cells of the pancreas to secrete more insulin. Common Meglitinindes include Repaglinide (Prandin) and Nateglinide (Starlix).

Knowing the type of oral hypoglycemic medication that you have been prescribed, and the dose, can be a great help when you are talking to health care providers who may not have your entire record available.

New Resources

MEDLINEplus.gov is a free consumer health education resource which is consistently rated number one. The website is authoritative and up-to-date, using the National Institutes of Health and other reputable sources as references for information concerning over 500 diseases and conditions. There are also lists of hospitals and physicians, and information on prescription and over-the-counter medications.

The Discovery Health Channel will join with the American Diabetes Association to produce a night of programming to coincide with November’s Diabetes Awareness Month. Watch for public service announcements of this broadcast.