August / September 2003

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Diabetes -The Medical Perspective

The American Diabetes Association has guidelines for the management of those with diabetes. These guidelines, or standards of care, were developed for clinicians, patients, and researchers to use as a basis for quality diabetes health care.

These standards of care state that the person with diabetes is best cared for by a health care team. The team should include a doctor, nurse, dietitian, pharmacist, and mental health professionals with a background in diabetes.

Treatment goals, such as blood glucose target levels, weight, or blood lipids, should be discussed with the team and patient. Everyone is different and the treatment goals need to consider that. Self-monitoring of blood glucose is an important part of management. Those with diabetes should be taught how to use their machines, and a schedule for blood glucose checks should be agreeable to both the health care team and the patient. The health care team will check periodically to be sure that the person with diabetes continues to use the machine correctly, and that the machine is still accurate.

A hemoglobin A1c test is a blood test that can assess how well a person’s blood glucose has been controlled over the past 2-3 months. A hemoglobin A1c test should be taken at least twice a year for those who are meeting their treatment goals, maybe more often for those who are having difficulty with goals.

Remember to talk to your health care team if the tests or the goals don’t make sense to you. They can write instructions or explanations out for you so you don’t forget.

Diabetes and Food

Whether you have diabetes or not, summer is the time to grill and cook out. Nobody wants to spoil a wonderful picnic by getting sick, so keep food safe! The following list offers some quick tips for safe food preparation:

• Take meat and poultry home immediately from the store and refrigerate.
• Marinate foods in the refrigerator, not on the kitchen counter or outside.
• Don't re-use marinade.
• Pre-cook food only if it will go immediately on to the grill.
• Do not partially grill extra hamburgers to use later. Once you begin cooking hamburgers by any method, cook them until completely done to assure that bacteria are destroyed.
• Don't use the same platter and utensils for raw and cooked meats. Raw meat juices can contain bacteria that could cross-contaminate safely cooked foods.
• Keep cold foods cold and hot foods hot. Keep the cooked meats hot by setting them to the side of the grill rack, not directly over the coals where they would eventually overcook.
• In hot weather (90°F and above), food should never sit out for more than one hour.

Exercise as a Part of Living

Summer is also the time for sports that swing! Golf, baseball, softball, and tennis. While everyone wants to hit it out of the ballpark, or land on the green, most of us are weekend warriors at best! Although exercise is important and necessary for our health, we don’t want to hurt ourselves in pursuit of the best swing.

Experts suggest the following tips to keep you swinging your best:

• Strengthen and tone your upper body before you hit the courts, field, or course.
• Find your balance. Practice balance exercises to keep you on your feet.
• Don’t forget to exercise your legs so that balance becomes easier.
• Keeping stomach and back muscles in shape will help with balance and with your swing. Stomach and back muscles provide support for the upper body.
• Any cardiovascular or aerobic exercise will help your stamina – how long you can last in the field, on the course, or on the court!
• Don’t forget to stretch – both before and after your game.

Remember - talk to your doctor before beginning any exercise program!

Recipes To Try

Sunset Orange Cake

12 servings

1 pkg. yellow cake mix
1 cup hot water
1 pkg. sugar-free orange gelatin
lite whipped topping (2 tablespoons per serving)
1/3 cup water
6 ounces no-fat orange yogurt
1 small can mandarin oranges
3 eggs
non-stick cooking spray

1. Preheat oven to 350º.
2. Spray a 13 x 9” pan with non-stick cooking spray.
3. Combine cake mix, 1 teaspoon gelatin, 1/3 cup water, yogurt, and eggs. Beat at low speed until moistened, then at high speed for 2 minutes. Pour into prepared pan.
4. Bake at 350º for 30 to 40 minutes. Cool cake in pan for 15 minutes.
5. Combine hot water and remaining gelatin. Prick cake with a fork at half-inch intervals. Pour gelatin evenly over cake. Chill.
6. Serve with 2 tablespoons whipped topping and two slices of mandarin oranges.

Per serving:

209 calories
4 grams protein
53 mg cholesterol
38 grams carbohydrate
4 grams total fat
16 % calories from fat

Zucchini Tortellini Toss

4 servings

1 pkg. frozen tortellini
1/2 teaspoon basil
6 to 8 roma (plum) tomatoes, chopped
1/2 teaspoon oregano
3 to 4 medium zucchini
1/2 cup shredded Parmesan cheese
1/2 teaspoon garlic salt

1. Cook tortellini as directed on package.
2. Heat tomatoes, zucchini, garlic salt, basil, and oregano in a medium skillet 3 to 5 minutes until zucchini is tender.
3. Stir in tortellini, cooking 2 to 3 minutes.
4. Serve topped with Parmesan cheese.

Per serving:

352 calories
17 grams protein
54 grams carbohydrate
8 grams total fat
50 mg cholesterol
22% calories from fat

Medication Update

Self-monitoring of blood glucose (SMBG) is a term that means people test their glucose themselves several times each day or each week. The test usually involves pricking a finger to obtain a small blood sample, applying a drop of blood on a reagent strip, and determining the glucose concentration by inserting the strip into a meter for a blood glucose reading. Blood glucose results are then recorded in a logbook. People with diabetes use their SMBG results to change their diet or medication, or talk to their health care team.

There are at least seven manufacturers and more than 20 types of SMBG meters on the market. For most, some kind of reagent strip is needed but for some no strip is required. For some, it is important to wipe away any excess blood before reading, and for others this is not important. Almost all take less than one minute to show a test result.

What should you do if you get a reading that is really out of line for you? The same thing the regular laboratories do – repeat the test. If your results are still very much out of your range, call your health care team.

New Resources

For additional information about blood glucose monitors go to http://www.diabetes.org/ main/ community/ forecast/ ResourceGuide2003/BloodGlucose.jsp

“Link for Life” is an interactive program on diabetes and heart disease which is part of an initiative of the American Diabetes Association and the American College of Cardiology, and is sponsored by a pharmaceutical company Glaxco Kline Smith. Go to http://www.diabetes.org/main/info/link.jsp to access the educational material,

“Help! My Underwear is Shrinking!” by Jo Ann Hattner, MPH, RD; Ann M. Colston, MS, RD; Mike Goodkind, BA offers an easier way to control carbohydrates and plan meals, as well as some motivation to do it! Published in 2003 by McGraw Hill, 137 pages.