June 2006/ July 2006

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Diabetes - The Medical Perspective

Planning a surgery or need to plan a surgery? Talk to your health care team, sign up for a diabetes refresher course, or re-read all your previous materials on self-management. Studies clearly show that good blood glucose control before and after surgery is associated with fewer infections and better outcomes.

A recent study of patients at a Veterans Affairs Healthcare System found that well managed pre-operative blood glucose was associated with better outcomes in a variety of non-cardiac surgeries. The measure used for good blood glucose control was the blood hemoglobin A1c level.

Most people with diabetes should be monitoring their blood glucose at home. How often they monitor their blood will depend on many things, such as the type of diabetes they have (type 1 or type 2), the kind of medication they are taking, if any, and how well they have been managing their blood glucose.

A hemoglobin A1c blood level will also give the individual and the health care team a look at how well the person’s blood glucose level has been managed for the previous three months. When you talk about elective surgery with your doctor, ask what your blood hemoglobin A1c level is, and what it should be. The American Diabetes Association recommends that hemoglobin A1c blood values be less than 7 percent but your health care team may have other target values for your hemoglobin A1c level.

Diabetes and Food

“Carbohydrates” is a word we see so often, like in the newspaper, in the diet book, and on the food label. But what is a carbohydrate anyway?

A carbohydrate is a macronutrient, meaning it is a nutrient found in large quantities in food. The name carbohydrate comes from its chemical make-up. “Carbo” means carbon, “hydrate” means water, which is hydrogen and oxygen.

A carbohydrate can be simple or complex. These categories are based on how easily they are digested. Either way, carbohydrates are your body’s main source of energy.

Most foods have at least some carbohydrates. Foods with large amounts of carbohydrate include foods from the bread and starch group, fruits and fruit juices, and many foods from the dairy group, like milk, yogurt, and ice cream.

It is important for those with diabetes to know which foods have carbohydrates in them, because carbohydrates have a big influence on blood glucose levels. Check your plate the next time you eat and compare the foods containing carbohydrate with your meal plan.

Exercise as a Part of Living

There are several strategies that can help people with diabetes maintain an exercise program, including:

• Using the right equipment and getting trained on using it to avoid injury.
• Progressing at an easy pace to make your exercise longer and harder than when you began.
• Having goals that you want to reach related to the exercise - not body weight.
• Knowing how to recognize and treat hypoglycemia (low blood glucose).
• Working to have an exercise schedule. It will then more easily become a habit.
• Having a training partner, an exercise buddy, or personal trainer to help you keep goals and schedules.
• Encouraging yourself to achieve goals with nonfood rewards like a new book, a movie, or a new plant.
• Accepting “off-days” as a temporary situation not as a failure.

Recipes To Try

Rainbow Gelatin Salad
14 1/2-cup servings

• 1 package (0.32 ounce) sugar-free orange gelatin
• 1-1/2 cup boiling water
• 1 can (20 ounce) pineapple tidbits
• 2 teaspoons lime juice
• 1 cup combination of shredded carrot, broccoli, red cabbage, cauliflower (ready-to-serve package may need additional chopping)
• 1/4 cup slivered almonds

1. Dissolve gelatin in boiling water.
2. Add undrained pineapple and lime juice.
3. Fold in vegetable shreds and almonds. Chill until firm

Per serving:

• Calories 38 Fat 1 gram
• Protein 1 gram Calories from fat 29%
• Carbohydrate 6 grams Cholesterol 0 gram
• Fiber 1 gram Sodium 24 mg

Asparagus Frittata
3 servings

• 1-1/2 cup egg substitute (6 egg equivalents) 2 scallions, chopped
• 1/3 cup Parmesan cheese 2 tablespoons olive oil
• 24 asparagus spears, trimmed 1 teaspoon dried mint

1. Slice trimmed asparagus into 1-inch diagonal pieces. Heat oil in a 10-inch nonstick skillet and sauté asparagus and scallions about five minutes.
2. Blend egg substitute, cheese and mint. Pour over asparagus and scallions in skillet and cook on medium heat, gently pulling sides back from skillet to cook egg substitute throughout. Cover skillet with lid once egg mixture is half-cooked. Use a spatula to divide into thirds, and turn once.

Per serving:

• Calories 258 Fat 16 grams
• Protein 23 grams Calories from fat 57%
• Carbohydrate 6 grams Cholesterol 9 grams
• Fiber 3 grams Sodium 415 mg
  

Medication Update

Byetta (exenatide) is a new type of medication for people with type 2 diabetes. It is approved by the US Food and Drug Administration and became available in June 2005.

Byetta is injected like insulin, and is given before morning and evening meals. Byetta has a number of complex mechanisms but it seems to increase insulin secretion only when blood glucose is high. Byetta may be used when oral medications and careful meal planning have failed to achieve the target blood glucose range. Byetta can be used with the other oral medications or by itself.

The most frequent side effect of Byetta is nausea. However, the side effect of weight loss and reduced food intake are often seen not as a negative effect, but another positive outcome. Nevertheless, Byetta is not approved as a weight loss medication. Byetta cannot be used as a substitute for insulin or in combination with insulin.

News & Resources

Fix it and Forget It Diabetic Cookbook. PP Good and the American Diabetic Association. Intercourse, PA: Good Books, 2005. 284 pages, about $15.95

200 Healthy Recipes in 30 Minutes or Less. R. Webb. Alexandria, VA: Small Steps Press, 2005. 268 pages, about $16.95.

The American Dietetics Association Guide to Gestational Diabetes Mellitus. AM Thomas, YM Gutierrez. American Dietetic Association, 2005. 178 pages. About $35 for American Dietetic Association members; about $45 for non-members.