June/July 2004

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Diabetes -The Medical Perspective

People who have diabetes are more likely to develop an eye condition called “retinopathy.” Retinopathy is damage to the blood vessels in the eyes. Damage to these blood vessels can result in low vision or even blindness if left untreated.

The National Eye Institute urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. For this test, the doctor will place drops in the eyes to dilate the pupils. This lets the doctor look inside the eyes more easily. There should be no pain, but sometimes the drops sting slightly. After having your eyes dilated, you must be careful to avoid bright sun until your eyes are not dilated any longer. Often your doctor will give you disposable sunglasses if you don’t have your own.

Your doctor or eye care professional can tell if you have any signs of diabetic retinopathy. Ask your doctor what tests he is performing and what the results are. Ask if you should be watchful of any particular symptoms, and what to do if you notice them.

If you don’t understand what your eye doctor tells you, ask for written information about your tests, your results, and what you can expect in the future. If you still have trouble understanding your eye doctor’s answers, ask where you can go for more information, or take the written information to your nurse or your general doctor.

Studies have shown that keeping blood glucose in control can delay retinopathy, or slow the progression of retinopathy if it is already present.

For additional information visit:
http://www.nei.nih.gov/health/diabetic/retinopathy.asp

Diabetes and Food

Using food labels to count carbohydrates is becoming more popular. What do you do with fiber? The American Diabetes Association (ADA) states that “The grams of sugar and fiber are counted as part of the grams of total carbohydrate. If a food has 5 grams or more fiber in a serving, subtract the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content.”

This recommendation is made because fiber is not digested or absorbed to the same extent that simple carbohydrates are. Studies have shown that foods high in fiber, such as fruits, vegetables, peas, beans, and whole-grain breads and cereals may help lower blood glucose.

However, it seems that a person must eat much more fiber than the average American now consumes to get this benefit. The average American eats less than 11 grams of fiber each day. The recommendation for all Americans is 20 to 35 grams per day. Researchers asked people to eat 50 grams of fiber each day in order to see an effect on blood glucose! While it seems clear that adding some fruits, vegetables, and whole grains into your diet will be healthful, to really see an effect on your blood glucose, the fiber in your diet must be quite high.

Talk to your dietitian or nutritionist about the fiber in your diet, and visit www.urbanext.uiuc.edu/diabetes/food.html. Read the Nutrition Facts on labels. Some higher fiber foods will have a health claim on the front of the label. To be able to make such a claim the food must also be a “low fat food.” If the food says “high fiber,” it must have 5 or more grams of fiber per serving. If the label claims the food is a “good source of fiber,” the food must have 2.5 to 4.9 grams of fiber per serving. And, if the label says “more or added fiber” the food must have at least 2.5 grams more fiber than a similar food without added fiber.

Exercise as a Part of Living

With the sunny, warm weather it may be the right time to consider swimming as part of your exercise routine. Unlike some other sports, swimming keeps you moving for a length of time, rather than bursts of energy followed by rest. This is important for cardiovascular (heart) fitness. Swimming is also a whole body exercise that uses both upper and lower body muscles at the same time.

When you are swimming, your body is supported by water so you are less likely to hurt yourself. If you are unsure of your swimming abilities, use a kick board or flotation device.

Swimming is fun, but it should be more than splashing in the water or standing in water to cool off. Have a goal – maybe 10 minutes of swimming, 3 times a week. Know what you can or cannot do, and do not over-do at the beginning. Remember to check with your doctor before starting a new exercise program, especially if you have any heart or circulatory condition.

Recipes to Try

Stuffed Green Peppers (6 servings)

3/4 lb. lean ground beef
1 can (10 oz.) diced tomatoes
1 small onion, chopped with green chilies, drained
1 can (15.5 oz.) red kidney beans, drained
3 large green peppers
1 can (6 oz.) tomato paste
2 tbsp. grated cheddar cheese

1. Brown ground beef in medium saucepan. Add onions and cook until tender, stirring occasionally.
2. Stir in red kidney beans, tomato paste, and diced tomatoes; heat to boiling. Reduce to low heat; simmer to blend flavors, about 10 minutes.
3. Wash green peppers and cut in half lengthwise. Remove seeds.
4. Place green peppers cut side up in large skillet. Add about ½ inch water. Heat to boiling; cover and reduce heat. Simmer about 5 minutes until crisp tender.
5. Remove peppers from water and drain on towel. Place cut side up on serving plate, and fill with ground meat/kidney bean/tomato mixture. Top with a sprinkle of cheddar cheese.

Per serving: 247 calories, 17 grams protein, 21 grams carbohydrate, 42 mg cholesterol, 11 grams total fat, 40 % calories from fat, 7 grams fiber

Almond Cranberry Muffins (18 muffins)

3 cups flour
1/3 cup skim milk
1/2 cup Splenda®
1/4 cup oil
2 teas. baking powder
1/2 teas. almond extract
1 teas. baking soda
2 eggs
1/4 teas. salt
1 cup dried cranberries
16 oz. reduced fat sour cream
1/4 cup slivered almonds

1. Preheat oven to 375°. Grease and flour muffin pans, or use paper liners.
2. Mix flour, Splenda®, baking powder, baking soda, and salt. In a separate bowl mix sour cream, milk, oil, extract, and eggs until blended.
3. Stir sour cream mixture into flour mixture until just moistened. Stir in cranberries and almonds.
4. Bake for 30 minutes until tops slightly browned.

Per serving: 182 calories, 4 grams protein, 33 mg cholesterol, 24 grams carbohydrate, 8 grams total fat, 38 % calories from fat, 1 gram fiber

Medication Update

Managing your diabetes takes a lot of work: watching your diet, exercising, and sometimes taking oral medications or insulin. Sometimes people seek alternative treatments to keep their blood glucose in control. These may seem more “natural” or easier, or may have testimonials that people are cured or their blood glucose levels are no longer a problem.

Herbal treatment for high blood glucose levels is gaining in popularity. Claims for herbal treatments should be viewed with caution. None of the herbs commonly cited to lower blood glucose have been adequately studied to know their real effects, not only on blood glucose but on other body systems as well. Animal studies are a start, but results can’t be transferred to humans – additional human studies need to be conducted.

A concern with any supplement is true with “natural” herbal treatments as well – they are unregulated. This means you can’t be sure that what you are buying contains the ingredients its label promises, or that it is in the product in the amounts that the labels says, or that it was made safely and contains no harmful ingredients.

People who take herbal treatments may say they feel better – and that’s good. However, if you are taking herbal treatments, make sure you continue to check your blood glucose level. Feeling good doesn’t equal a normal blood glucose level! Talk to your doctor about the herbals you are taking and ask if they may interact with other medication you are taking or may interfere with any other medical test(s) you may need.

New Resources

Betty Crocker and the International Diabetes Center have teamed up to create Betty Crocker's Diabetes Cookbook: Everyday Meals, Easy as 1-2-3. The cookbook contains 140 recipes in 256 pages; (February 15, 2003).

Aventis Pharmaceuticals Inc has a webpage that contains general information about diabetes; All About Diabetes; an “ask a certified diabetes educator” link; help for tracking blood glucose levels; chat rooms; and a newsletter. www.diabeteswatch.com

Two magazines for the general public concerning “how to’s” for those with diabetes are Diabetes Forecast by the American Diabetes Association ($40 cover price/ $21 through Amazon.com 12issues/yr) and Diabetes Self-Management by R.A. Rapaport Publishing, Inc ($24 cover price; $12.97 through Amazon.com 6 issues/yr).