December/January 2003-2004

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Diabetes -the Medical Perspective

Self-monitoring of blood glucose is an important part of management of your diabetes. Those with diabetes should be taught how to use their machines. 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.

Your health care team will discuss with you the best times for you to check your blood glucose. Those times often are before breakfast, before lunch, before supper, and before bedtime snack. Sometimes it also is a good idea to check your blood glucose an hour or two after a meal. This will give you and your health care team information about how your medication is handling the food you eat.

There are times when more frequent monitoring of your blood glucose may be wise. Those times include:

• during stressful times, like the holidays
• when you are ill, even with a cold
• when you are taking new medications, even if only temporarily
• when you suspect your blood glucose may be low.

Getting a good drop of blood is important when checking your own blood glucose. Remember to wash your hands with warm water, shake your hands below your waist, and squeeze or “milk” you finger a few times before the finger stick.

Remember, record your readings and talk to your health care team if the results don’t make sense to you.

Diabetes and Food

Holiday Eating

Many Americans face temptation this time of year as they attend parties and family gatherings for the holidays. For people living with diabetes, healthy holiday eating is necessary because weight management is very important to maintaining good health.

It is important to remember to set reasonable goals for yourself. This is usually not the time to try to lose weight. Instead, a goal could be for you to just maintain your weight. You can do this by controlling what you eat and by making wise food choices.

With a hectic holiday schedule it is wise to have healthy snacks with you to keep blood sugar levels balanced. A light snack before meals can also help you avoid overeating.

Use substitutions in your recipes to make high-fat recipes lower in fat. You will be surprised how much old-fashioned flavor is retained with clever substitutions and how much fat and calories you can cut.

If you can’t eliminate the food or make it more healthful, limit it. Put a tablespoon of high-fat gravy on the side of the plate and dip your turkey in it for taste. Cut back a little on other foods to allow for tiny indulgences. It is your total food intake that is most important.

Talk with your doctor first and make sure it is safe for you to combine alcohol with your diabetes medication. Only consume alcohol if your diabetes is under control and even then limit yourself to one drink. Stick with low-alcohol and low-sugar drinks and eat food at the same time.

Exercise as a Part of Living

Try walking a couple extra laps around the mall or renting a low-impact exercise video. If you use an exercise machine like a treadmill or stationary bike, put it in front of the TV or use a bookstand to ward off boredom. Hand weights and jump ropes can give you a good workout, and so can just walking up and down the stairs.

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

Recipes to Try

Pumpkin, Raisin, Pecan Braid
6 servings

Braid: 1 cup canned pumpkin
1/8teas. nutmeg
¼ cup brown sugar
1 egg, separated
1 teas. cinnamon
¼ cup chopped pecans
1/8 teas. ginger
¼ cup raisins
1 8-oz. can low-fat crescent rolls
non-stick cooking spray

Glaze: ¼ cup cold water
1/3 cup sugar replacement
2 teas. cornstarch
1 teas. vanilla extract
dash salt

1. Heat oven to 350º. Spray cookie sheet with non-stick cooking spray.
2. Combine pumpkin, brown sugar, spices and egg yolk. Add pecans and raisins.
3. Unroll dough onto cookie sheet, sealing perforations to form one 13x7 rectangle. Spread filling down center, to within about 2 inches of edges.
4. With scissors make cuts 1 inch apart along sides of dough. Fold these strips at an angle across filling. Beat egg white until foamy and brush over braid.
5. Bake for 25-30 minutes. Immediately remove from cookie sheet.
6. To make glaze, blend water and cornstarch. Pour into saucepan. Add salt.
7. Boil until clear and thickened. Remove from heat. Add sugar replacement and vanilla, stirring to dissolve. Pour over braid.
   

Per serving: 250 calories 4 grams protein
35 mg cholesterol 35 grams carbohydrate
10 grams total fat 37 % calories from fat

More than Potato Soup
6 1-cup servings

2 teas. margarine
2/3 cup water
3 medium potatoes, peeled, and sliced (3 cups)
28 oz. fat-free chicken broth
1 small celery root, peeled and diced (1 cup)
2 small parsnips, peeled and sliced (2 cups)
salt to taste
2 garlic cloves, chopped

1. Melt margarine in large saucepan. Add all remaining ingredients except broth. Bring to a simmer and cook 15-20 minutes until most of the water has evaporated.
2. Add the broth, bring to a simmer and cook until vegetables are tender.
3. Mash with potato masher to desired consistency.

Per serving: 138 calories 4 grams protein
28 grams carbohydrate 2 grams total fat
0 mg cholesterol 10% calories from fat

Medication Update

Glucovance ® is an oral hypoglycemic medication that combines two medications into one. Glucovance ® contains both a sulfonylureal (glyburide) and a biguanide (metformin). Combining these two medications means Glucovance ® works two ways:

• It helps the pancreas produce more insulin; and
• It helps the liver produce less glucose.

Like any medication, it cannot control your blood glucose without a program of a healthy diet and good exercise as a base. However, the combination medication has been shown to lower blood glucose more effectively than either glyburide or metformin alone.

Not everyone can take Glucovance ®. If you are over 80 years old, drink an excessive amount of alcohol, or have kidney problems, liver disease or heart failure, Glucovance ® may not be the correct medication for you.

The most common side effect of Glucovance ® is diarrhea, although hypoglycemia may occur. Talk to your doctor if you want more information on this or any other hypoglycemic medication.

New Resources

For a good comparison of the seven most widely used insulin pumps, visit www.diabetesnet.com/diabetes_technology/insulin_pump_models.php

With the holidays near, think about medical ID jewelry for those who are on your shopping list and who have diabetes. One website to visit is www.diabetesnet.com/ commonly known as the Diabetes Mall. A larger selection can be found at www.americanmedical-id.com . For teens and children, www.missbrooke.com/ may have more of what you’re looking for.

If you are interested in participating in multi-center, national studies of diabetes, visit www.niddk.nih.gov/patient for a listing of ongoing and new studies across the US.

If you have questions about your diabetes, but can’t get an appointment to see your dietitian soon, try www.dietitian.com/diabetes.html

Remember, back issues and Spanish issues of this newsletter are available at www.urbanext.uiuc.edu/diabetes/