The Diabetes Action Network of the National Federation of the Blind
Diabetes Support and Information
Volume 19, Number 1, Winter Edition 2004
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Voice of the Diabetic, published quarterly, is the national news magazine of the Diabetes Action Network of the National Federation of the Blind. It is read by those interested in all aspects of blindness and diabetes. We show diabetics that they have options regardless of the ramifications they may have had. We have a positive philosophy and know that positive attitudes are contagious!
News items, change of address notices, and other magazine correspondence should be sent to: Ed Bryant, Editor, Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, Missouri 65203; Phone: (573) 875-8911; Fax: (573) 875-8902.
Find us on the World Wide Web at: (www.nfb.org). Our direct Web address is (www.NFB.org/voice.htm).
Copyright (c) 2004 Diabetes Action Network, National Federation of the Blind. ISSN 1041-8490
Note: The information and advice contained in Voice of the Diabetic are for educational purposes, and are not intended to take the place of personal instruction provided by your physician, or by your health care team. Discuss any changes in your treatment with the appropriate health professionals.
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FREE! FREE!
Voice of the Diabetic is offered absolutely free to any interested person upon request. Readers may receive the publication in standard print, on audiocassette for the blind, or in both formats. To begin receiving the Voice, please complete the subscription form (or a facsimile), found at the end, and mail it to the editorial office.
Please Note: We have a special bulk-mailing permit that we use to ship the Voice to you at low cost -- it does not allow for free re-mailing. The Post Office requires you place first class postage on any Voice you mail to others.
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Here’s the new front cover page for the Voice.
Includes photo of JoAnna Lund with the following overprinted on the photo: JoAnna Lund offers diet advice: Healthy Home Cooking.
“WHY ME” IS NOT AN OPTION
The Importance of Positive Attitude
SUGARTRAC UPDATE
New Noninvasive Glucose Monitor
MALE AND FEMALE SEXUAL DYSFUNCTION
Dealing with this Diabetes Complication
PREVENTING HYPOGLYCEMIA
Steps You Can Take
ASK THE DOCTOR
Gestational Diabetes Questions
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ADVERTISERS
Effective advertising doesn't scream at its audience. It persuades. It sells. The key to cost-effective advertising is making your voice heard where an audience is already listening. Voice of the Diabetic, circulation 329,433, offers such an outlet. Make your voice heard. For Voice of the Diabetic advertising information contact:
Eileen Rivera Ley
National Advertising Sales Manager
804 Hatherleigh Rd
Baltimore, MD 21212
Phone: (410) 296-7760 Fax: (410) 296-7645
or find us on the Web at:
http://www.nfb.org/voice.htm
For SUBSCRIPTION information, see the end of this document.
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INSIDE THIS ISSUE
HYPOGLYCEMIA PART 2: HOW TO PREVENT IT
by Ann Williams, MSN, RN, CDE .....
SUGARTRAC UPDATE .....
ASK THE DOCTOR
by Chris Corsi, MD .....
DIABETES INFORMATION
by Lois Williams .....
CARBOHYDRATE COUNTING AND THE EXCHANGE LIST
by Ann Smith, RD, CDE .....
THE FUTURE OF INSULIN: PILLS, PATCHES, AND PUFFS ARE SLOWLY COMING
by Terri Kordella .....
HEALTHY EATING AND LIFESTYLE CHANGES FOR TYPE 2 DIABETES
by Dr. Zolee Robinson .....
DIABETIC LIQUID MEAL REPLACERS
by Peter J. Nebergall, PhD .....
DIABETES AND DENTAL COMPLICATIONS
by Joseph M. Shurina III .....
BREAKTHROUGH SPARKS DIABETES HOPE .....
SOCIAL SECURITY, DISABILITY AND MEDICARE FACTS FOR 2004
by James McCarthy .....
MALE AND FEMALE SEXUAL DYSFUNCTION
by Ed Bryant .....
“WHY ME?” IS NOT AN OPTION
by Vicki Graf .....
LETTERS TO THE EDITOR .....
NEW HYPOGLYCEMIA ALARM .....
HEALTHY HOME COOKING
by JoAnna Lund .....
DO YOU WANT TO CONTINUE RECEIVING VOICE OF THE DIABETIC?
by Ed Bryant .....
RECIPE CORNER .....
BOOK REVIEWS
by Marilyn Helton .....
WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN’T KNOW WHERE TO ASK (Resource Column) .....
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HYPOGLYCEMIA PART 2: HOW TO PREVENT IT
by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people make their diabetes care fit their needs and their lives.
Last issue’s column focused on what hypoglycemia, or “low blood sugar,” is, and on how to treat it. This month’s column focuses on how to prevent hypoglycemia.
First, let’s look at what keeps blood glucose in balance. When blood glucose is normal, the factors that make the blood glucose go up and the factors that make it go down are in balance. The biggest factors that make blood glucose go up are:
1 Carbohydrates, which are starches or sugars, from food the person has eaten.
2. Stress.
3. Stored glucose being released into the blood.
The biggest factors that make blood glucose go down are:
1 Insulin.
2 Oral medications that make the body make more insulin.
3 Exercise or other physical activity.
4 Losing weight.
5 Anything else that makes the body burn glucose.
In people who do not have diabetes, these factors are naturally kept in balance
throughout the day. The blood glucose stays between 70 to 140, even when the
person has eaten a large meal with lots of carbohydrates. In people who do
have diabetes, it’s best to keep blood glucose as close to normal as
possible, through diet, exercise, and appropriate medications. Many people
who have diabetes can come close to these "normal" levels, can “achieve
euglycemia,” if they can learn the skills of avoiding too much hypoglycemia.
Preventing hypoglycemia can make the difference between good or poor blood
glucose control.
In general, if a person is having hypoglycemic events often, the hypoglycemia
can be prevented by increasing the factors that raise blood glucose, or decreasing
the factors that lower blood glucose. This is most often done by changing the
amount or timing of eating, changing the amount, timing, or type of medication,
or changing the amount or timing of exercise.
Now let’s look at some typical ways hypoglycemia can happen in people who are using insulin or oral medications. Here are three true situations, with some comments about what these individuals did to prevent hypoglycemia:
Situation 1
Rebecca takes a combination of rapid insulin and NPH insulin twice a day. She usually wakes up at 6:00 AM, takes her insulin, and has breakfast about 6:30 AM. Then she goes to work at her job as a secretary, where she sits at a desk all day. She takes a break at about 10:30 AM, and has a cup of tea. Almost every morning, she has low blood sugar at about 11:00 AM.
In this situation, Rebecca’s hypoglycemia is caused by a mismatch between her insulin and her eating schedule. At about 11:00 AM, the NPH insulin is peaking. Rebecca’s breakfast has been completely digested and absorbed, and she has not eaten anything else. So the insulin is causing her blood glucose to drop.
Rebecca spoke with a diabetes educator about ways to prevent this almost-daily hypoglycemia. She learned she had several choices. She could decrease the factors that lower her blood sugar, or increase the factors that raise her blood glucose. Specifically, the choices her diabetes educator discussed with her were:
1. Decreasing the morning insulin dose. However, this would have meant she would also have a lower dose of rapid insulin in her insulin mixture, so she would have had to eat a smaller breakfast. She likes to have a large breakfast, so this was not a good choice for her.
2. Use a different insulin regimen. What the diabetes educator suggested was a long-acting insulin without a peak (Lantus) as a background insulin, with a rapid-acting insulin at every meal. But this would mean that Rebecca would have had to carry insulin to work, and give herself an injection before lunch. She did not like this idea, so this also was not a good choice for her.
3. Increasing the factors that raise blood glucose, either by eating more at breakfast, or by eating a small snack during the mid-morning, before the time of her hypoglycemia. Rebecca realized that if she ate a larger breakfast, her blood glucose would be higher all morning, and she did not like that idea. So she chose to eat a small snack at her 10:30 AM break. She began bringing a piece of fresh fruit to work for an easy, healthy snack with some, but not too much, carbohydrate.
Situation 2
Carlos had type 2 diabetes and was using 10 mg of Glucotrol twice a day to control it. For many years, this had worked well for him. Lately, Carlos has been taking action to lose weight. He has been exercising every day for about one half hour in the late afternoon, and has cut back on how much he has been eating. He has lost about six pounds already, and would like to lose about 20 more. He has noticed that for the last week, at about 5 PM every day, he has been feeling very shaky and lightheaded. This feeling went away if he has a snack. But he has been worrying that all that snacking is going to undermine his efforts to lose weight.
The cause of Carlos’s hypoglycemia in this situation involves several factors working together. He is exercising more, eating less, and he has lost weight. The oral medication he takes, Glucotrol, works by making the pancreas put out more insulin, whether Carlos actually needs more insulin or not. Carlos now has too much insulin in his system.
Carlos talked with his doctor about his situation. His doctor congratulated him on increasing his exercise and eating less, and on his weight loss. She encouraged Carlos to continue with the weight loss. She also pointed out that both the exercise and the weight loss were helping Carlos to decrease his high blood pressure and his high cholesterol. In addition, she noted that Carlos’s exercise time, late afternoon, occurred when all the carbohydrates from his lunch had already been absorbed, so it would be easy for his blood glucose to drop.
Carlos’s doctor agreed with Carlos that having a snack before exercise would prevent hypoglycemia, but it also would make it harder for Carlos to lose more weight. So the doctor advised him to reduce his dose of Glucotrol to 5 mg twice a day. She also pointed out it would be better to exercise in the early afternoon, when he would still have plenty of carbohydrate in his system from his lunch.
Finally, Carlos’s doctor asked Carlos to be sure to let her know if he had more hypoglycemia as he lost more weight. She pointed out that it was possible, with further weight loss, that Carlos might eventually be able to have good control of his diabetes without taking any medications.
Situation 3
Marian has worked as a nurse in an intensive care unit, a very high-stress
position.
She did not get along well with her supervisors, which only increased her stress
levels. In addition, she was raising two teenagers, and one of them was having
some serious problems in school. Even though she used an insulin pump to manage
her diabetes, she often had blood glucose levels that were higher than her
goals.
As Marian grew more unhappy, she decided she needed to see a mental health counselor to help her deal with the high stress in her life. She chose to see a social worker. As she worked with the social worker, she realized that she had more choices about how she reacted to her situation than she realized. She learned how to do deep relaxation exercises, decreasing her physical and emotional response to the stress in her life. She learned better communication skills, improving her relationship with her teenagers. And she found a new job, in a lower-stress environment.
As Marian made all these changes in her life, she began having frequent episodes of hypoglycemia. Since she was eating more, to correct all that hypoglycemia, she began gaining weight. She did not like that, so she consulted the endocrinologist who had prescribed the insulin pump for her.
Marian’s endocrinologist agreed that high stress levels had increased her blood glucose. Her previous insulin doses had been based on these higher blood glucose levels. Complicating matters even more, the increase was different from one day to the next, frustratingly unpredictable. In addition, because she had been almost constantly upset, Marian hadn't had the energy to figure out the best use of her insulin pump to control her diabetes. Now that she had less stress in her life, and was handling the remaining stress better, she could take some time and energy to find out exactly how her body was reacting, and adjust her insulin pump settings to match her insulin need.
Marian’s endocrinologist asked her to see a diabetes educator, to work out better settings for her insulin pump, and achieve better control of her diabetes. The diabetes educator guided her through a series of systematic, step-by-step procedures for checking all the settings on her insulin pump. Marian checked out both the basal, or background, rates, and also the bolus rates, which are the rates at which she gave insulin after meals, or to correct high blood glucose. Although the entire series of checks took about six weeks to be completed, they were well worth the effort. After she had done this, she was able to maintain near-normal blood glucose, and she had hypoglycemia only rarely.
As you can see from these three true stories, preventing hypoglycemia is a very individualized effort. Each person, and each situation, calls for a clear analysis of the factors that raise or lower blood glucose. Furthermore, it is very important to consider what else is going on in the person’s life. In many situations in which a person has a problem with hypoglycemia, there are several possible solutions. By thinking through all the possible choices, a person has the best chance of finding a solution that prevents hypoglycemia and also fits well in his or her overall life.
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SUGARTRAC UPDATE
Last issue, Voice Volume 18, No. 4, we brought you news of the new noninvasive, talking blood glucose monitor called the SugarTrac. We told you it wasn't out quite yet, and passed on the manufacturer's estimates about availability and price. And, we promised to keep you informed.
On December 2, 2003, Voice Editor Ed Bryant conferred with Richard Peters, the inventor of the SugarTrac, who stated he now expects Food and Drug Administration (FDA) approval for the SugarTrac to come at the end of January 2004. Mr. Peters also stated he had a better handle on what the production SugarTrac would cost: About $300 for the meter and $50 for the replaceable earclip, which should last three months.
Last issue, we depicted a prototype of the SugarTrac meter and earclip. Since then, the inventor reported, the production version has been "downsized," and will fit in pocket or purse. "It will be slightly larger than a cell phone," he stated.
Asked if they are still planning to include a (built-in) voice synthesizer, he said: "Yes, version 2 of the SugarTrac will talk."
For more information, contact the manufacturer: LifeTrac, 12751 Westlinks
Drive, Fort Myers, FL 33913; telephone: (1-877-768-6978; Web site: www.sugartrac.net
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ASK THE DOCTOR
by Chris Corsi, MD
NOTE: If you have any questions for "Ask the Doctor," please send them to the Voice editorial office. The only questions Dr. Wilson (our regular writer) will be able to answer are the ones used in this column.
Christopher M. Corsi, MD, our guest writer this issue, is an endocrinologist at Western Montana Clinic, in Missoula, Montana.
Q: My wife had “gestational diabetes” when we had our first child – but the doctor says she “isn’t diabetic” now. We want to raise a family – is it safe to have more children? Will they be diabetic? Will she become a “real” diabetic? What do we need to do and watch for?
A: Gestational diabetes has become quite common. We see more of it in certain ethnic groups, in particular Black, Hispanic, and Native American women. In some communities dominated by one of these ethnic backgrounds, the frequency of gestational diabetes has been reported to be as high as 14%.
Pregnancy is diabetogenic. This means that several hormones are produced
by the placenta during pregnancy, and the presence of these hormones can lead
to insulin
resistance. Insulin resistance is the same problem that can lead to type 2
diabetes in non-pregnant individuals. Young women who develop gestational diabetes
might already be insulin resistant, and the extra insulin resistance generated
by the pregnancy brings on the diabetes. After the pregnancy is completed,
most women no longer meet the criteria for having diabetes. However, they have
a high risk (up to 50%) of developing diabetes over the next several years.
All of this is important because gestational diabetes is associated with certain problems, including macrosomia (very large babies), which can lead to problems at delivery, and increased need for caesarian section. Babies born to women with gestational diabetes are also at risk for hypoglycemia (low blood sugar) following delivery. Several other concerns make gestational diabetes an increased risk to the developing baby.
That being said, it is possible for a woman to have gestational diabetes with one pregnancy and then not develop gestational diabetes with a subsequent pregnancy. Good diet and exercise, in between the pregnancies, can often help minimize this risk, particularly if they lead to weight loss in an overweight woman. These same interventions can also lower the risk of developing diabetes in the future, but these are not universally accepted for this purpose as yet.
My best advice would be that your wife pay strict attention to diet and exercise.
If she is overweight, she should try to gradually lose weight through these
lifestyle modifications. If she is to achieve another pregnancy prior to such
interventions, she will need to be screened again for gestational diabetes
early in that pregnancy. After the two of you have completed your family, these
same lifestyle interventions will be important, in order to have your wife
avoid developing type 2 diabetes down the road. She should have regular visits
with her physician, and have her glucose checked from time to time. A fasting
glucose level each year would be the minimum.
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DIABETES INFORMATION
by Lois Williams
Includes photo of Lois Williams
Diabetes is a disease that has affected the lives of so many persons in America.
In February 2000, I bought a videotape, "Changing the Way Diabetes is Treated," from the National Diabetes Information Clearinghouse, part of the National Institutes of Health (NIH). The tape featured health professionals who met at the NIH in Washington D.C. to discuss the increase of type 2 diabetes, and it represented a major effort to wake up America about the seriousness of diabetes.
At the time the tape was made, there were an estimated 16 million diabetics, 10.6 diagnosed and an estimated 5.4 million undiagnosed. Among the Pima Indians of Arizona, more than 50 percent had overt diabetes. One in every five African American women 55 years old or older had diabetes. In the Hispanic population, 10 percent had diabetes. There were 123,000 children under the age of 19 with diabetes. And that was three years ago.
It was documented that one billion dollars were spent on this disease, each year. Every day, diabetes led to 150 amputations, 75 persons were diagnosed with kidney failure and 70 persons lost their vision, all to diabetes. These are only three of the many complications caused by sustained elevated blood sugar levels, and these numbers are climbing.
Would you believe that only 8 percent of the population at that time said they took diabetes seriously? I wonder if the number has increased with the rapid increase of new cases. I hope so.
One health professional on the video stated that, "it is better to prevent than to lament," and another stressed the importance of educating both patient and health provider. Diabetes education is not only for people who have diabetes, but also for the family, community, state, and even the country. The cost of diabetes affects everybody's "pocketbook."
I had not seen this video for over a year or so. As I write this, it is now
October 2003. Have there been any changes? Yes, the problem has gotten worse.
The Centers For Disease Control now estimates 17 million Americans have diabetes,
and 12,000 to 24,000 people will lose their sight because of it, this year.
Alabama, my home state, is now #1 in the nation for the incidence of diabetes
(according to the Huntsville Times, for January 7, 2003). More Americans are
obese, and children are developing type 2 at a younger and younger age -- which
means folks will have diabetes longer, and the risk of diabetes complications,
as well as the health care cost in dollars, goes way up. What can be done to
halt or at least slow down this epidemic? Every diabetes organization, the
news media, and many health professionals are all advising the public to eat
less
and be more active. Folks need to pay attention, and to take definite action
-- and KEEP AT IT!
Everyone can improve their health, whether they have diabetes or not, by eating to a calorie and carbohydrate budget that is realistic for them (talk to your doctor or diabetes educator, or visit your Health Department; also Voice of the Diabetic publishes food tips and diabetic recipes every issue. Whether you have diabetes or not, you can improve your health, by starting an exercise program and sticking to it. Talk to your doctor; there are programs to follow, for people with diabetes and complications. You CAN become more active. Why are we not doing these things?
I have "coined" an acronym, the Diabetic's D.I.M.E! For good diabetes control, use the D.I.M.E! D is for diet, I is for information, M is for monitoring and E is for exercise. The D.I.M.E works for me, even after my 30 years of ignorance of the seriousness of diabetes, and 30 years of uncontrolled blood sugar levels. If I had not developed diabetic retinopathy (it got my attention), if I had not learned about diabetes, if I had not made some lifestyle changes, I doubt if I would be alive today. If I had survived, I am sure I would have been a burden to my family.
I am so grateful for all the information available today. Most of it is FREE;
you just have to know where to go. Start right here, with Voice of the Diabetic.
If you have access to the Internet, look at the diabetes pages of the US Centers
for Disease Control
(www.cdc.gov/health/diabetes,htm) or the National Institutes of Health (www.niddk.nih.gov/health/diabetes/ndic.htm),
the online magazine InteliHealth (www.intelihealth.com), the International
Diabetes Center (www.parknicollet.com), or the excellent private diabetes Web
site www.mendosa.com. You can call the Centers for Disease Control, Division
of Diabetes Translation, at: (770) 488-5000. Local hospitals, doctors' offices,
and even some pharmacies have free handouts, and most of them are good quality.
Take advantage of this information. It is there for you, and using it can help prevent diabetes or slow the progression of its complications.
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CARBOHYDRATE COUNTING AND THE EXCHANGE LIST
by Ann Smith, RD, CDE
Ms. Smith, a dietitian and diabetes educator with the Diabetes Management Program
at Clark Memorial Hospital, in Jeffersonville, Indiana, gave the following
as the keynote address at the 2003 annual conference of the Diabetes Action
Network of the National Federation of the Blind. This took place on June 30,
2003, at the annual convention of the National Federation of the Blind, in
Louisville, Kentucky.
Good afternoon everyone. I'm going to hand out several items that I often use
when teaching folks with diabetes. What you’re getting is a tennis ball,
and a paper plate, and we’re going to talk about those, and about how
you can use something as simple as that -- even using your hand, and portions
of your hand, to identify food portion sizes.
But first, let's cover a bit of background about basic nutrition. Our topic
today is carb counting and the diabetes exchange list, and you probably are
hearing a lot about these carbs. What I’d like to do today is give you
some valid information -- some sound nutritional information you can use with
the diabetes exchange list, or if you’re a person who does carb counting
through other methods, to show you how you can do that. But let's get back
to that background in basic nutrition.
What I like to do is begin by saying your body is like a car, and in order
for that car to go anywhere, it has to have fuel. The body is like that in
that, but we have to fuel it every day, not like you might do with your car,
like I do with mine, where you go once a week to the gas station. In the body,
we need to actually fuel that "car" a few times a day.
Several things (your lifestyle, how your medications work, and whether you
sleep in the nighttime or the daytime, etc.) determine how often and how much
you need to eat. We know the energy in our food (measured in "calories")
comes from three sources. Those three nutrients are: carbohydrates, protein
and fats. The only other place that we get any caloric value at all would be
in alcohol. And alcohol I usually talk about separately, and although I can
field questions on that today, I mainly want to talk about these foods.
The carbohydrates are your first main category of nutrients. What is their
role? Carbohydrates are your body’s number one fuel base. If someone’s
telling you not to eat carbohydrates, please don’t listen to that. Please
don’t be an advocate of the Atkins diet. That is not the safest way,
or the healthiest way of getting your nutritional needs met. Carbohydrates
play a very important role for us. When we look at how they affect the blood
sugars, we can see that a carbohydrate in the food has a very quick conversion
into sugar in your bloodstream.
Two different types of carbohydrates make up most of the foods we eat. First,
the "simple" carbohydrates -- we sometimes just call these the sugars.
With these we see a very quick conversion to sugar, and all of them have a
100% conversion into glucose in the bloodstream. That isn’t bad, however,
as you need them. Remember, this is your body’s number one nutrient source
for fuel.
In planning a diabetic diet, I usually set the carbohydrate level at about
50% of your estimated caloric needs. For instance, for someone on a 1200 calorie
per day diet, with about 50% of their calories coming from carbohydrates, I’d
plan on about 150 grams of carbohydrates a day.
The other type of carbohydrates are the "complex" carbohydrates --
the ones we sometimes call the "starches." You hear all that bad
stuff in the news about starch being bad for you, that you should never eat
potatoes, you should always leave off bread, etc., but again, the starches,
the complex carbohydrates, can actually be very much a part of a well-balanced
and very nutritious diet.
But here’s where we begin to look at what would be your best types of
complex carbohydrates. Those would be the ones where you see some fiber coming
on board with them. Where do we find fiber? In cereals. What kind of cereals?
Whole grains. Where else? In fruits, and in vegetables. Does anyone in here
like beans? Yes! Beans are a very good high fiber carbohydrate.
Beans can be a very economical source of both starch and protein. When we look
at the conversion of these high-fiber complex carbohydrates into sugar, we
see these high-fiber carbohydrates are much slower than those without fiber.
This means they break down anywhere from about an hour to an hour and a half
after your meal. So, that bowl of beans gives a much slower rise in your blood
sugar than if, for instance, you'd had a bowl of fruit, a piece of candy, or
even a piece of white bread instead. That’s why the complex carbs are
the ones we like to recommend as part of any given meal.
What happens if your meal consists mostly of carbohydrates? We know even very
complex carbs will break down maybe an hour to an hour and a half after your
meal. And what’s a typical breakfast for many of us: cereal, fruit, milk,
and maybe toast? What category do all of those foods fit in? Carbohydrates.
Does anybody ever notice they’re hungry again an hour or two later --
if that’s what breakfast consisted of? Yes! And the reason that happens
-- is because such a breakfast consists of quick fuel, that is giving your
brain the fuel you’ll be needing, and giving your body a lot of essential
nutrients that come on board with those carbohydrates.
But how long does that fuel stay with you? What happens if your meal is only
carbohydrate-based foods? What would be a solution, giving us a longer-extending
fuel, one that’s not going to continue to spike our blood sugar? Protein!
If we look at the breakdown on protein, we see a much slower conversion, of
protein to glucose, than we do for carbohydrate in the body. The conversion
begins about 30 to 45 minutes after the time you actually start eating something
with protein, and at its peak, in the two-to-four hour range that protein has
only made about a 50% conversion to sugar. That conversion, that glucose level
we see, is not a level that continues to spike the blood sugar -- it’s
your ongoing fuel source. So to give you more satisfaction in a meal, and some
longer-lasting fuel that does not continue to spike the blood sugar, always
add some protein with your meal -- and typically, breakfast is the meal where
we miss that. Usually lunch and dinner are going to have some protein on board,
just because that’s usually the way we in our culture eat. But at breakfast
it is very important to put some protein on board.
The last nutrient that I want to talk about is fat. Fat often gets a very bad
label. You've heard it, like, "It makes us gain weight and causes us to
clog arteries and, you know, it’s just not the good stuff." Well,
folks, there’s some good news on the horizon about fats. There are some
very good fats to put into your daily intake of healthy foods. Some of my favorite
fats now are nuts and natural peanut butter. I eat olives, I use olive oil,
and I love avocados. Those are some of the healthiest kinds of good fat.
When we look at how fat breaks down and turns into glucose in the bloodstream,
we learn that it is a very slow-converting nutrient. Fat breaks down very slowly,
over the course of several hours. But when you look at the amount of fat that
actually turns into sugar, it’s only about 10%! So, very little of the
fat actually turns into glucose at all. The healthiest fats are nuts, avocados,
and olives, and the three best types of oils (those richer in the mono-unsaturated
type of fat) are canola, olive and peanut oils. Those are the top-of-the-line,
absolutely very best kinds of fat.
What about nuts? Any kind of nuts. We’ll talk about portion size on those
nuts in just a minute.
Remember, when we’re looking at how fat affects the blood sugar, very
little of that fat ever actually turns into sugar. So fat, by itself, does
not greatly affect your blood sugar. But it breaks down so slowly, and if we
look at the energy fat provides, one gram of fat gives you nine calories, so
we get a lot of calories with those fat grams. The newer guidelines for healthier
eating actually see a benefit of making about 30% of your calories to be from
fat grams. That is because fats actually give your meal what I call the “satiety
factor.” Any of you ever hear that word? Satiety means satisfaction.
So, even if you add a piece of really lean chicken to a meal that already has
the correct number of carbs, you may still find that you’re hungry three
to four hours later. Then ask yourself, did that last meal have some fat? Here
is where we get the combination fuel that can give you a five-hour span between
meals.
Now let’s look at how to put this fuel together, so you’re getting
the immediate energy source you need, you’re getting some protein on
board (which will not only give you a little hold-over on that fuel, but also
will give your body those building and repairing nutrients you get from protein),
and then we add some fat to that meal to give it staying power -- the satiety
factor to help you to last anywhere from five to six hours, before you need
to eat again.
The three nutrients (carbohydrates, protein, and fats), then, are your key
fuels. When we look at the Exchange List, we see our carbohydrate foods are
made up of several food groups. Fruits are one, and there is the Starch group,
the Low Carb Vegetables (the higher carbohydrate vegetables, the "starchy
vegetables," are going to be in the Starch category), and the fourth group
is Dairy, which includes only milk and yogurt. We do not include cheese or
cottage cheese in Dairy, because they contain so much protein, so they go in
the "protein" group. We see cheese and cottage cheese as "protein-based
foods, with a little carbohydrate in them."
We have the Milk/Dairy group, we have Fruits, we have Starch, and we have Vegetables.
And if you see most of the exchange book guidelines, they have another category
they call Other Carbohydrates. That’s a group with foods that don’t
fit in any of the other categories, like ice cream, angel food cake, jam, jelly,
honey, tortilla shells and Tostitos chips, even hummus. Hummus has a little
bit of protein, and some fat, but mostly complex carbs from the chickpeas used
to make it.
These, then, are the five categories we call the Carbohydrate group of foods
in the Diabetes Exchange List. Now, when you put together a meal plan, generally
your dietitian or diabetes educator will give you either a certain number of
carbs or, as I sometimes do, give you a certain number of carbohydrate choices.
For instance, on a 1200-calorie meal plan, you would generally have about three
carbohydrate choices per meal. Or if you had a 1500-calorie meal plan, you
might have four carbohydrate choices per meal, or with an 1800 calorie meal
plan, you might have four to five, depending on whether or not you have planned-in
snacks in between meals.
Why is it important to space those carbohydrates out from meal to meal, and
not do the Weight Watchers concept where it doesn’t matter when you have
them as long as you have the same number of points at the end of the day? Why
would you not want to do that with your carbohydrate foods? Why would you not
want to have them all in dinner? What’s going to happen to that blood
sugar if you have all your carbohydrates in your evening meal? It’s going
to skyrocket, and it will still be high at bedtime and more than likely it
will still be high the next day. Your doctor puts together your medication
to accommodate and treat your diabetes. Then we match that with a meal plan
to correspond to the way your medication is going to affect the timing of when
you eat, and how many carbohydrates you should have in that meal plan at that
particular meal.
That’s why it’s important for you, since you have diabetes (and
Weight Watchers wasn't set up for people with diabetes) to, more or less, have “constant
carbs.” Have any of you heard of that term? That’s where you have
a consistent, constant amount from one meal to the next. For instance, if your
educator has told you to have 50 to 60 grams of carbs, or four carb choices
per meal, then that would mean making some food choices within your carbohydrate
category. As an example, let’s put a breakfast together -- I have a few
samples of food models up here that we can do some meal planning with. Let’s
put together a breakfast with four carb choices and see how we do. Orange juice?
Well, let’s see. I forgot to bring my juice, but I brought an apple --
we will consider that our fruit. And let me tell you something, which one would
be a better choice based on what we said earlier about the fiber? Yes, the
apple, or a whole orange -- more fiber than the juice has.
And now we’re going to talk about portion size with this. You know the
tennis ball I gave you? Hold that in your hand. Hold that tennis ball and actually
cup your fingers around it. Now do you feel how that feels? That is what we
call "an average portion of fresh fruit." That would be "one
fruit choice" or "one fruit exchange," a tennis-ball-sized piece
of fruit.
One fruit choice generally has about 15 grams of carbohydrate in it. We said
our goal was to have about 60 in this meal, or four carb choices. So what else
could we have in our breakfast? Cereal, yes, how about some oatmeal? "Oatmeal
warms the heart," have you ever heard that? We know that among of the
complications of diabetes are heart disease and high cholesterol. And what
do we know about oatmeal? The soluble fiber in that oatmeal actually clinically
lowers your LDL (bad) cholesterol. So it very much "warms the heart," and
it helps keep that cholesterol down. Now I’ve got actually a bowl of
oatmeal with me, a one-cup portion. One cup of cooked oatmeal would be how
many carb choices? Two. A half-cup of cooked oatmeal is one carb choice in
the Starch category. That’s one starch -- a half a cup of cooked oatmeal.
And if you eat the whole cup of cooked oatmeal, those carbs also double.
To make oatmeal, start with a half-cup dry oats, add one cup of water, and
that makes a whole cup of cooked oatmeal. So that’s about two of your
carb choices in the starch category, and now we’ve got that partnered
with the apple we're going to eat. So we need one more carb choice, since we
have three now; how about milk? Okay, we can do milk, or you can have a light
or plain yogurt. That would be your choice in the milk category. One cup of
light or plain yogurt has about the same amount of carbs, about 15, as you
would find in an eight-ounce glass of milk. An eight-ounce glass of milk only
has about 12 grams of carbs, but in our carb choices we would still call that
one carb choice. That, then is the fourth carb choice in this breakfast meal.
Okay, so we have our carb choices, what are we missing? Protein. Remember I
said earlier that nuts are a really good type of fat, but they also have protein
in them. When we know we want some good fat in a meal and we also need some
protein, then cup your hand with those fingers closed -- and you have a small
handful of nuts. That would give you an equivalent to the amount of protein
in one egg, or one ounce of meat. So if you add nuts, either with your oatmeal
or on the side, you have now satisfied your needs both for protein and for
some of that good fat, in our sample breakfast.
Now I’ll share with you one of my favorite breakfasts. That’s two
pieces of whole grain bread, toasted, and by the way, when we look at the nutritional
information on that reduced calorie bread, we find even more fiber in the reduced
calorie bread than in the same amount of whole grain bread, and you get two
slices for the same fuel value as one slice of regular bread. Generally there
are about five grams of dietary fiber in a two-slice portion of reduced calorie
bread. So, if you use reduced calorie bread, just think, it’s a two for
one. It’s a two for one in your starch category, so you would get two
slices for one carb choice.
Now let’s go back to that breakfast -- if we do two pieces of regular
whole grain bread, that is one starch for each slice, so we have two starch
choices, and we put some natural peanut butter (the kind that has only "peanuts
and salt" on the ingredients list) onto that sandwich. Toast your bread,
put natural peanut butter on it, and you can put, in our carb counting system,
a small amount of regular jam or jelly -- as a teaspoon of regular jam or jelly
has five grams of carbohydrates.
Regular peanut butter, by the way, like Jif or Skippy or your store brand,
has a whole multitude of ingredients, including sugar, but the number-one ingredient
that’s not good for you is the hydrogenated oil. Those partially or fully
hydrogenated oils are what we know now as the worst substance in our fuel system.
And Congress is asking for more information on products containing those. So
I suggest you try to use the natural peanut butter instead.
Natural peanut butter is separated when you open the jar (the oil separates
from the solids) and here’s the trick -- you put it in your refrigerator
upside down overnight. By the next day, it will actually already have started
distributing and mixing for you. When you take it out and open the jar, take
a knife and stir it, all the way to the bottom. And remember, it has no preservatives.
When you take that hydrogenated oil out of it, it will not stay on your pantry
shelf forever, like regular peanut butter. Store it in the refrigerator to
keep it well preserved. And, if you need it to spread easier, set it out a
few minutes before you make your sandwich, so it can warm, and it will spread
much better. You have to prepare yourself for it, by saying "this isn’t
going to taste like my old peanut butter" because it’s not going
to be as smooth as shortening, and it’s not going to taste sweet. It’s
going to taste like ground up, salted peanuts, which is what it is. But I can
tell you from my own experience, once you make that switch to natural peanut
butter, you will not go back to the other. I buy the store brand, the Kroger’s
natural peanut butter -- it’s also made by Smucker’s -- but the
store brand is about a dollar cheaper per jar.
So, if we put that sandwich together, we now have two carb choices, and you
can make the other two to once again be a serving of fruit and a glass of milk.
What goes better with a peanut butter sandwich than a glass of milk? That breakfast
will stay with you a good five hours. This is one of the main breakfasts I’ve
found will stay with me through a whole morning of teaching, and my stomach
not growl. When I’m teaching people about what to eat, about how to eat,
I don’t need to have my stomach growling in the middle of it. I’ve
found the fat in the peanut butter was my satiety factor for that meal.
How many calories per gram are there in each of the different nutrients? Carbohydrates
and Protein both have four calories per gram, and fat, as I mentioned earlier,
has nine calories per gram. When you break down a nutrition label, and you
actually see the serving size on that particular food, the calories in that
serving come from the protein, the carbohydrates, and the fat. There are no
other sources of calories in that food. So you can actually do your math, and
multiply the total grams of carbohydrate and protein each by four, and the
total fat grams by nine.
One thing I would mention to you, though -- don’t get bogged down in
those percentages of daily calories -- you know, the percentage column over
to the right side. Please just ignore that. Those percentages are based on
this bogus 2,000 calorie a day diet, which is just kind of a token number they
chose to represent an average American diet.
When we’re looking at carbohydrates, the serving portion is very, very
important! Someone may tell you, "there’s only 90 calories in this," but
not if what you have on your plate is the whole can, versus the one half-cup
portion listed as the serving size. If the serving you have on your plate is
more, or less than what the serving size listed on the container, then you
do some math. If there’s 90 calories in a serving, and you have three
times that serving, your total calories would be 270. If there are 14 grams
of carbohydrate in the recommended serving, and you doubled your serving, you
now have 28 grams of your carbohydrates, or, using Exchanges, that would be
two carb exchanges. Each one of those carb choices in the categories I mentioned,
approximately 15 grams of carbohydrate. So one starch, one fruit, one milk,
and if you look at your vegetables, that actually multiplies. A serving of
a vegetable, for instance, like broccoli or green beans or a tossed salad,
has very small amounts of carbohydrate in a serving as well. I usually tell
people that unless you’re eating a whole lot of them, don’t even
consider those low carb vegetables in your meal plan. Number one, most people
aren’t going to eat more than what they really could enjoy in that meal,
and it won’t be a problem for their blood sugar. Number two, we know
there’s a lot of fiber in those vegetables, and if we actually look at
the glycemic effect of those vegetables on the blood sugar, it’s very
low. Even carrots -- even if you snack on some baby carrots, you’re not
going to get into a problem with your blood sugar. So the low carb vegetables,
they’re your freebies.
How many of you have problems with blood pressure? And blood pressure is something
that, especially with diabetes, is important to keep under good control. Another
reason those low carb vegetables are so beneficial to you is because they actually
help give you better blood pressure. The natural potassium, magnesium, and
the fiber that’s in there -- those are important natural nutrients in
our food. This information came from a really good study a few years back called
the DASH Diet. It stands for the Dietary Approaches to Stopping Hypertension.
Part of the approach was to eat lots of those vegetables and fruits every day
as part of your overall basic meal plan. They recommended five to nine servings
a day.
Now we know that you can’t have all of those five to nine servings in
fruit, because that’s going to be a whole lot of your carb choices. For
people with diabetes, I generally recommend two to three servings a day. Some
people may go as high as three to four, but the Fruit category of carbohydrates
can get some people in trouble with high blood sugars. Here we also often tend
to have problems with portion control. That’s why I gave you the tennis
ball today, as a reminder on your portion of fruit. The low carb vegetables,
then, are very very healthy -- include a lot of those in your meal plan.
With the starchy vegetables, you watch portions. Make a fist with your hand,
and that fist is like a one-cup portion of food. That would also be about the
size of a medium baked potato. A medium baked potato is about two starches,
so how many carbohydrates in that medium baked potato? Thirty. So we roughly
round it off to say it’s about 30 carbs, or two of your carb choices
in the starch category. So potatoes aren’t bad, and if you know it's
scrubbed well, eat the peeling with it because you’re getting some fiber
in that peeling. The baked potato serves well.
Your portion of meat, especially at the main meal of the day, is about three
ounces. If you hold up the palm of your hand, don't count the fingers, and
stop at the wrist, that’s about three ounces of cooked lean meat. Now
that’s just the lean portion of the meat, fat removed and with no skin
or bones. In your other meals, you can have about one to two ounces, though,
and that’s a much smaller portion. Remember meat has no carbs, unless
there has been a breading or something added to that meat or protein food,
so we do not count the meats as carb-based foods. And most of the time your
fats would not be considered carbohydrate food choices. But here’s an
exception -- some people automatically choose fat-free salad dressings, but
some of those fat-free salad dressings have a lot of sugar added to them. The
carbohydrates in those fat-free dressings may actually be as high as one of
your carb choices. They may have 15 to 16 grams of sugar, or total carbohydrates,
in maybe two tablespoons of salad dressing. So beware of those dressings. Even
if a dressing is identified as fat-free and sugar-free, look at the label!
See if there are any total carbohydrates listed. Don’t be deceived by
words like "sugar-free," "dietetic," or "no sugar
added." They are not necessarily carbohydrate free. The automatic assumption
is that because it’s "sugar-free" I can eat all I want of it.
Not true.
Dextrose, corn syrup, and fructose? These are sugars. Fructose is actually
fruit sugar in a syrup form. High fructose corn syrup is one of the more common
ingredients you will see. Sorbitol is a sugar alcohol that is something a little
bit different, actually, than your other forms of sugar. Generally, the forms
of sugar that will be in a product
will generally end in “-ose” like dextrose, sucrose, fructose,
maltose, levulose. There are also some other names like corn syrup and maltodextrin.
But when I teach carb counting, I really don’t even have you worry about
the detail of where those sugars are coming from. You simply go to the nutrition
facts label, and you see how many total carbohydrates there are in one serving
of food. Don’t even go down to the sugars -- you look at the total carbohydrates
because it is the total carbohydrates in a meal that affects what your 2-hour
blood sugar will look like. That’s why we have a more liberalized approach
to diabetes meal-planning now, and we even say you could have a teaspoon of
honey or something with regular sugar in your meal, if you have counted that
as part of the total carbohydrates in your meal. We now know it is the total
carbohydrate in your meal that matters -- it’s not that you have to avoid
all sugars, or those simple sugars -- it is the total carbohydrates. So when
you’re looking at a product, even ice cream, it can be part of your carbohydrates
within a meal -- in a portion allotted that meets your guidelines. It’s
the total carbohydrates in that meal that makes a difference on what that 2-hour
blood sugar will look like.
What about the "diet foods" that have all the fake stuff in them,
like Olestra?
Olestra is a fake fat. It doesn’t absorb as a fat, but is supposed
to make the food taste like it has fat in it. But it hasn’t been a very
popular item, because it has a very detrimental side-effect for many people,
and that side-effect is diarrhea. Personally, I choose instead to use baked
chips and baked items rather than Olestra fat-free products, like the WOW chips.
You can use baked chips (and you still count your carbohydrates in those),
but they’re baked, without having oils added to them, and they actually
have some pretty good tasting items on the market now, and you can use those
as part of your carbohydrates in a meal.
What about the sugar alcohols? Sugar alcohols are ingredients many manufacturers
use in sugar-free or no-sugar-added foods. The way they can legally say a food
is sugar-free or no-sugar-added is to simply take the sucrose out of that product,
so that opens up a whole can of worms on what that food can contain. Lots of
times they put sugar alcohols into that food, as a substitute sweetener. Let
me tell you just a little about the sugar alcohols. They are still considered
a carbohydrate, and the FDA now requires them to be so listed.
Remember I told you earlier your regular carbs have four calories per gram?
Well, your sugar alcohols have two calories per gram. If they are present in
a food (as part of the sweetening), then manufacturers must list them now under
the total carbohydrates. It should either say “so many grams of sugar
alcohol.” The FDA now requires this listing. Lots of manufacturers actually
list that actual ingredient: sorbitol, maltolol, zylitol, manitol, you hear
that -ol ending in the ingredient? Those are the sugar alcohols. If they are
in there, they will show up in the total carbohydrates of that food.
Let me give you a forewarning about sugar alcohols -- if it's in there, greater
than five grams in a serving, which it very often is in a lot of your sugar-free
desserts, your sugar-free ice creams, sugar-free cookies, sugar-free syrup,
sometimes you may see as much as 25 to 28 grams of sugar alcohol in one serving.
That sugar alcohol, like the Olestra I mentioned earlier, can have a very detrimental
side-effect, for many folks. It causes a great amount of gas, stomach distension,
and diarrhea. I have heard some very funny stories in my practice - one of
the funniest was a truck driver who was on the road, and he had diabetes, he'd
had diabetes for years, but no one ever told him about the sugar alcohols.
So he stops at this restaurant, and the waitress is taking his order, and he
finishes his meal, and she comes along and says well, would you like dessert?
And he said well I have diabetes, so I can’t really have any of that
dessert, and she’s like, oh, but we have this sugar-free pie -- you can
have that, can’t you? It’s sugar-free. And so he says, yeah I’ll
take a piece. She brings him a large piece of this sugar-free pie, and he eats
it, then gets back in his truck, and about 30 minutes down the road, it hits,
and he had to find a rest stop, and there was no rest stop to be found, and
he finally was in this little small town somewhere in middle USA, stopped at
an extension office in this little small town, and he rushed in and says to
the lady, I have to go the bathroom right now, and so he had this major case
of diarrhea, and did not know until he came to our diabetes class back several
months ago that it was the sugar-free pie that had caused his problem. He thought
it was his medicine. And his eyes got as big as golf balls when I was telling
about the sugar alcohols, and he’s like, "That’s what happened
to me that day!"
So just beware, your sugar-free gums and mints have a little bit of this in
them, but it’s usually only about two or three grams in a portion or
a serving, so it’s not a whole lot and it probably won’t affect
you, unless you eat a whole package at one time. So that’s the case of
the sugar alcohols. In small amounts they're fine; but if you’re counting
carbs, and it’s something that has 25 or 30 grams of sugar alcohol, don’t
waste your carbs, don’t spend your carbs on that stuff, spend it on something
that tastes better in a smaller amount with the real stuff in it. That’s
the beauty of counting carbs.
We talked about cereals; what about cereals other than oatmeal? Any time
you try out a new cereal, look at the portion they give you as the serving
size, whether it be a half-cup, three-fourths of a cup, one cup -- this is
a time to get your measuring cups out, get the feel for that estimated portion,
measure that serving in the bowl, to know what your serving of that cereal
would be, and how many of your carbohydrates it would account for. Here it’s
very important to look at that serving size, at how many carbohydrates are
in each serving, because your cereals can vary widely, and in some of those
cereals that really taste good, the carbs go up tremendously from the added
sugar. But even something like Raisin Bran -- one cup of raisin bran has about
43 grams of carbohydrates. Not only do you have carbohydrates in the flakes
-- the whole wheat flakes in the raisin bran -- you’ve also got raisins
in there -- and they coat those raisins with sugar, so one cup of raisin bran
would be three of your carb choices in that meal. And then your milk would
be your fourth carb choice, if you’re on 60 per meal.
If you’re making oatmeal at home in the microwave, what will make a one-cup
portion? If you’re making regular oatmeal at home, ½-cup of dry
oats mixed with one cup of water, and then microwaved, will make a one-cup
portion. That one-cup of cooked oatmeal would be two of your carbohydrate choices.
Your exchange book lists 1/2-cup of COOKED oatmeal as one carb choice, NOT
1/2-cup of dry oatmeal - that makes one cup cooked, and is two carb choices.
It will take 1/4-cup dry oatmeal to make 1/2-cup cooked, which is one carb
choice.
What about sugar substitutes? If you’re baking cookies at home, what
kind of sugar substitute can you use? There are some recipe books out there
for making cookies, and you can actually use any recipe, if it has your carbs
per serving in the nutritional breakdown. They don’t have to be sugar-free.
But when you’re using the sugar substitute, my favorite is Splenda, and
that’s what I actually use at home. It is made from sugar, and it tastes
like sugar, but it is a non-nutritive sweetener. If you buy it in the large
pourable containers, you pour it out measure for measure. It measures exactly
like sugar for a recipe. That’s my favorite, because it doesn’t
have an aftertaste. You can still use Equal or Sweet'N'Low, but I can tell
you the taste is not going to be as true, and it’s not going to be as
good, and sometimes cooking alters what happens to that sweetener -- it does
not on Splenda. There are very good studies and research on using that sweetener,
and it has stood up to the test. The price is also coming down, and we’re
finding it in more and more products. It’s a plus, because those products
taste a lot better.
How do raisins stack up as a snack? I always caution people with diabetes about
how often and what they’re having for snacks. How your meal plan is structured
will determine what those snacks can consist of. If you are using insulin,
but your insulin regimen is only covering the carbohydrates in your planned
meals, and you’re not on any additional insulin (to "reduce excursions"),
You're probably using a very quick, rapid-acting insulin, like Novolog or Humalog.
Those insulins cover and process what you’re eating anywhere from 30
minutes to about two hours. That’s the in-and-out time of that quick
form of insulin. It will cover the carbohydrates in that given meal. But if
you snack three hours later, and you add on a handful of raisins, or other
dried fruits, the portion size must go much smaller, or you'll blow your control.
A quarter cup of raisins has about the same amount of carbohydrates as that
tennis ball-sized piece of fresh fruit does -- the sugar is still there, you
just took out the water. I would suggest you be very careful about using raisins
as snacks unless you have carbohydrate snacks worked into your meal plan. And,
if you use carbohydrates for snacks, you should, test your blood sugar, two
hours after a meal. If you’re not in the really good recovery zone in
the two hours after that meal, that means the blood sugar we’re looking
for is less than 140, two hours after the meal, if you’re not below that,
and then if you’re having a carbohydrate snack in two and one half to
three hours, and your blood sugar is still 200, what’s going to happen
to that blood sugar? It's going to go way back up. So, snacks can be part of
your meal plan, but this is where you really should work with your educator
to plan those snacks appropriately in your meal plan, based on you doing some
checking of those blood sugars and seeing how many carbs you can have in your
meal, if you want to have a snack in three to four hours.
What about cashews as a snack? Cashews are wonderful, but we must remember
portion control. Remember the palmful. Any of the nuts are actually very good
combinations, some are a little higher in the mono-unsaturated fats, some a
little higher in the polyunsaturated, but any of the nuts are good. There was
an excellent study done in Salt Lake City by the Mormons, because of their
vegetarian way of eating. They did a study on the health value of nuts, and
they report any kind of nuts can be used as part of a healthy meal plan. So
cashews can be part -- but just remember the portion size, a palmful.
A good question: What size banana is one carb choice? We would say a small
banana, or half of a large banana, is one fruit choice. And a small banana
is only about five to six inches long. By the time you peel it, you’ve
got four to four and a half inches on that banana.
Some of you are hearing statements like, "there's no such thing as a diabetic
diet." I know this is confusing -- but what we mean is there are not separate
foods, rather, a person with diabetes can simply eat a healthy meal plan. A
diabetic meal should not be much different from a regular meal at a particular
occasion. You can make wise substitutions, like choosing fruit instead of the
regular dessert, or grilled chicken when others get fried chicken. In the big
scope of diabetes meal planning, I always teach people you can take any given
meal, and you can modify it to make it fit into your meal plan.
One of the other visuals I gave you was the paper plate. If you have a plate
in front of you, the choices in that meal are going to be a serving of meat,
a starch of some kind, be it potato, rice, pasta, whatever, and you’re
also likely to have some sort of a brightly colored vegetable, like green beans
or broccoli or carrots or summer squash, zucchini, greens. Those kinds of brightly
colored vegetables are generally your non-starchy vegetables. What I usually
suggest in making up that plate, is that if you want to have a healthier meal
plan, make about half of that plate be those non-starchy vegetables. About
a fourth of that plate, or a fistful, would be your starch, and then your meat
should be the other fourth of that plate. This is just the healthiest way of
eating -- that’s why we say there’s no such thing as a "diabetic
diet" any more. You're eating the same things the non-diabetics are, just
in appropriate, balanced moderation.
When people come to see me, they think I’m going to give them a diet
sheet, and the first thing I tell them is, "you are not here to get a
diet." I teach you how to eat healthier, so don’t even call what
you’re doing a "diet." You'll instead be eating healthy, in
the healthiest way for a person with diabetes, and you don’t need "special
foods" to do that. You don’t have to go out and buy all those "sugar-free
products." Our goal is healthy eating, so everyone should be broiling
and grilling and sautéing with a non-stick skillet, with a little olive
oil pan spray, stir frying with lots of vegetables and lean meats, and limiting
those starchy foods, because too many of those get us in trouble with our blood
sugar two hours later. So, more of those vegetables, less of the starch, and
then round out that meal -- if you have saved some of your carbohydrates from
that meal, kept the portions down, that will allow you to have a small portion
of that regular dessert. And that way you’re not singled out because
you have diabetes.
Some have even said that if everybody ate the “diabetic diet” nobody
would be diabetic. There’s a certain amount of truth to that (for people
with type 2 diabetes), but you’d also have to consider lifestyle. It
really is a partnership: what we eat, and how active our lifestyle. And yes,
a sensible diet would be a very good start to preventing diabetes, but in diabetes
prevention program that came out published last year, what was the key element?
It was exercise. Five times a week, thirty minutes of walking, to walk about
two miles in that 30 minutes. But exercise, five times a week prevented overt
diabetes in the folks who had the genetic predisposition for type 2. They modified
their lifestyle, and they ate healthier, so it was a partnership.
One last question; what about pizza? This is where I suggest to people that
you modify your previous thinking. Pizza is a "combination food" --
we know it has a lot of carbohydrates, from the starch in the crust, and from
the tomato sauce. And if you’re having a meat topping, you’re going
to have a lot of protein but also a lot of fat. Lots of fat partnering with
those carbs. If your pizza is the only thing you have in that meal, then your
portion is probably going to be way above what you need, in order to satisfy
your stomach for quantity of food. And what’s going to happen to that
blood sugar later? It’s going to be high. And that’s one where
people very typically report the next morning blood sugars are still very high.
Here’s part of the problem with pizza. It’s not just the amount
of carbohydrates, but also the amount of fat partnered with those carbs. I
said earlier some fat in your meal is always a good idea, but too much fat
in your meal, partnered with your carbs, will actually delay the breakdown,
the converting those carbs to sugar, and that will keep that blood sugar higher
at the two hour mark, and those sugars are on for the ride. Those are the ones
that get held over until the next morning, and they affect that A1c, so what
I would say about pizza is change your thinking about pizza a little bit. Always
have a nice big salad before you start eating the pizza. And have that salad
be with some light dressing, or just do the fork dipping on the dressing so
you’re actually not adding a lot of fat in the dressing, and then an
average up to a couple of pieces would be your max to keep you in good control.
What about using olive and lemon juice as a salad dressing? Is that good? Yes.
Lemon juice is a freebie, it’s rich in ascorbic acid, citric acid, so
that’s a freebie in the diabetes realm. Your olive oil, you’ve
got to use in very small amounts, because one teaspoon of olive oil has five
grams of fat, so here is where you’d want to use not a whole lot, max
one tablespoon of the olive oil. But when you add herbs and spices to that
olive oil, they are actually enhancing the flavor without giving any more carbs
or fats or anything. Those are free, in the realm of your meal plan. If you
add sodium, or salt, you’ll want to be very minimal with that, but use
your spices, garlic, onion, basil, thyme, all of those kinds of herbs and spices
are wonderful for enhancing the flavor -- and they do not add any more caloric
value. Vinegar is also a freebie. I think we’ve got to close. Thank you
very much.
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THE FUTURE OF INSULIN: PILLS, PATCHES, AND PUFFS ARE SLOWLY COMING
DOWN THE PIPELINE
by Terri Kordella
There are 17 million people in the United States who have diabetes. More
than a fifth of them take at least one insulin injection a day. Insulin injections
are often necessary for controlling blood sugars to decrease the risk of complications
and improve health. For those with type 1 diabetes, it’s a matter of
day-to-day survival. But type of diabetes aside, insulin shots are a fact of
life for almost four million Americans.
For now.
Several companies are working on developing new ways of taking insulin, from
pills to patches to mouth sprays to inhalers. Recent headlines in the popular
press may make it seem like these products will be available soon. But the
truth is, as FORECAST went to press, none of these products had been submitted
to the Food and Drug Administration (FDA) for approval, and there is no guarantee
any of them will pass muster. The ones furthest along in development are probably
at least two years away from becoming available, even if the FDA approves them.
The exception would be if the FDA decides to "fast-track" any of
them. When a product is "fast-tracked," it has priority review, and
the FDA may render a decision about approval in as little as six months.
That said, several new forms of insulin delivery do look promising. What could
be in store? What might the future of insulin look like?
Insulin Inhalers
More companies are working on insulin inhalers than any other insulin delivery
option. Insulin inhalers would work much like asthma inhalers. You would breathe
the insulin in through your mouth and it would be absorbed through your lungs.
The insulin, either a powder or liquid, would be fast-acting, so you would
take it at mealtime.
There are two challenges with insulin inhalers, however: the rate of absorbency
and side effects. How much insulin you actually absorb through your lungs may
be affected by your age and your respiratory shape. Side effects range from
mild cough to more serious, if rare, conditions such as scarring in the lungs.
As FORECAST went to press, the front-runner in the race for inhalable insulin
appeared to be Exubera, a combined effort of Inhale Therapeutic Systems, Inc.;
Pfizer, Inc.; and Aventis Pharma. Phase III trials had been completed, and
the companies are undertaking additional long-term studies before determining
if and when they will submit Exubera for FDA approval. Once they file, it may
take two to two and a half years for the FDA to review the trial data and make
a decision, unless Exubera is fast-tracked.
Mouth Sprays
Mouth sprays deliver insulin through an aerosol spray. They differ from inhalers,
however, because the insulin would be absorbed through the inside of your cheeks
and in the back of your mouth instead of your lungs.
Two forms of mouth spray are in development, one that is fast-acting and one
that would cover the basal rate of insulin. (The basal rate is the amount of
insulin you need throughout the day to keep blood sugars stable.) Generex Biotechnology
is developing these sprays in Canada, and is partnering with Eli Lilly and
Company in the United States.
Pills
The biggest challenge with insulin pills to date has been posed by the human
digestive system. Either the gastrointestinal tract breaks the insulin down
or the insulin passes through the system intact because it is unable to pass
through the gastrointestinal membrane. In both situations, the insulin does
not make it to the liver and then the bloodstream, which is where it needs
to go to reach the muscle cells and do its biochemical duty.
Several manufacturers are working on pills. In these pills, special molecules
attached to the insulin would help it reach its destination either by helping
to prevent the insulin from being broken down, escorting the insulin through
the gastrointestinal lining, or both.
Insulin from pills would reach its peak action about 15 minutes after you swallow
them, so pills would be considered fast-acting.
The Patch
Most of the other forms of insulin in development are fast-acting, so your
mealtime dose would be covered. But where does that leave you for a basal insulin?
The answer may be an insulin patch in pre-clinical testing at Altea Development
Corporation. Using the patch would be a two-step process. First you would use
a device that would make microscopic holes in the top layer of your skin. Then
you would apply the patch.
Although Altea is working on a 24-hour patch you would only have to apply once
a day, the patch is still in the earliest stages of development, so it may
turn out to be a 12-hour patch instead.
_____________________________________________
Terri Kordella is associate editor of DIABETES FORECAST.
Copyright © 2003 American Diabetes Association
From DIABETES FORECAST, March 2003
Reprinted with permission from The American Diabetes Association.
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HEALTHY EATING AND LIFESTYLE CHANGES FOR TYPE 2 DIABETES
by Dr. Zolee Davis-Robinson
Forget the idea of the "diabetic diet" -- a restrictive regime that
puts certain foods strictly off-limits. The healthiest diet for people with
type 2 diabetes is the same diet that’s best for everyone else.
That means eating a wide variety of foods, and including items from all the
major food groups represented on the Food Pyramid -- protein, dairy, grains,
and fruits and vegetables -- every day. It means watching your portion sizes.
It means getting enough fiber, and avoiding an overload of fat, salt, alcohol,
and sugar. (Yes, you can have dessert -- in moderation, and with a little planning!)
Following these steps will not only help control your blood sugar, but can also help you reach a healthy weight, something that’s especially important for people with diabetes.
Your Healthy Eating Plan
As with any medical condition, people with type 2 diabetes should check with their doctors before starting any diet or exercise program.
Two main tools doctors and dietitians use to help you plan healthy meals are:
* Food exchanges. This system divides foods into major categories -- starches, fruits and vegetables, dairy, proteins, and fats -- and tells you how many portions of each you should have each day.
* Carbohydrate counting. With this system, you keep track of the grams of
carbohydrate (starches and sugars) you consume, with the idea of spreading
them out through the day to help keep your blood sugar steady.
The end result should be a plan tailored to your needs: one that takes your
age, gender, lifestyle, and eating habits into account.
Putting Your Plan Into Action
While you should be able to eat most of the same things as everyone else, people with diabetes often have to limit the amounts they eat, prepare food in different ways than they may have been used to, and think about when they eat. Consider the issue of consistency: If you have diabetes, you need to eat about the same amount every day, and at about the same times. You shouldn’t skip meals, or go more than four or five hours without eating during the day.
Another important element of a healthy diet is portion control. Your health care provider, or a weight loss specialist, can help you learn to gauge correct portion sizes, which are often smaller than we’ve come to expect in the age of super-sizing. For example, one serving of meat is about the size of a deck of cards, and a serving of pasta is about the size of half a tennis ball.
But just what should those portions consist of on any given day? Here are some guidelines for various types of foods you may have questions or misconceptions about:
* Sugar: Most experts now agree that it’s OK for people with diabetes to have a little dessert now and then. Sugar is just another form of carbohydrate, so you can substitute a sweet for another starch (say, bread or pasta) in your eating plan. But keep in mind that most sugary foods have lots of calories, and few of the nutrients your body needs.
* Fat: Too much fat is bad for anyone, but especially for people with diabetes. A high-fat, high-cholesterol diet increases your risk of heart and artery disease -- and people with diabetes already are more likely to get these diseases. And, of course, eating too much fat can make you fat. So choose lean cuts of meat, or fish or skinless poultry. Switch to skim or low-fat dairy products. Cut out butter, and substitute low-fat margarine or other seasonings such as broth, herbs, and fruit juices.
* Salt: People with diabetes are at higher risk of high blood pressure, which can be affected by the sodium in your diet. To cut down on salt, limit packaged convenience foods and fast food, as well as pickles and salty condiments like mustard. Use herbs, garlic, or natural fruit juices instead of table salt.
* Fiber: Fiber is the non-digestible carbohydrate found in plant-based foods. It keeps you feeling full longer, and may also help lower blood sugar and blood fat levels. Choose whole grains and cereals, and eat lots of fruits and veggies, to help you reach a healthy goal of 25 to 35 grams of fiber per day.
* Alcohol: If your doctor approves, you may include small amounts of alcoholic beverages in your healthy eating plan. (The American Diabetes Association recommends no more than two drinks a day for men and no more than one a day for women.) If you do drink alcohol, never have it on an empty stomach. And remember that alcohol tends to be high in calories and has few nutrients. Choose light beer or dry wine, and sugar-free mixers.
* Artificial sweeteners: Unlike sugar, artificial sweeteners have no calories, don’t raise blood-sugar levels, and don’t have to be counted as a starch in your meal plan. But don’t overdo it: Many artificially sweetened foods still have plenty of calories and few vitamins and minerals.
While many, many people are living happily and healthily with type 2 diabetes, change doesn’t always come easy at first. Here are a few tips to help you get -- and stay -- with the program.
* Ask for support. Let your friends and relatives know about the changes you’ll be making, and why they’re important for your health. Ask them to help you stick with your plan.
* Plan ahead for temptation. If you’re going to a party, prepare your own healthy dish and bring it along. Or, if you’re headed to a restaurant, figure out ahead of time what you’ll order and how it fits into your eating plan.
* Educate yourself. Learning as much as you can about your condition will help you make informed decisions about it.
* Make changes gradually. For example, if your goal is to eat more veggies,
add one serving at dinner every day. Once you’re used to that change,
start sneaking in a second serving at lunch.
* Get some exercise. Not only will exercise help control your blood sugar and
boost your health in other ways, it can reduce stress and improve your outlook.
See your doctor about getting started.
Change Your Lifestyle
By making changes in your lifestyle you can help return elevated blood glucose to more normal levels, and you can delay or prevent the onset of type 2 diabetes. Modest weight loss of 5-7% of body weight and increased physical activity, such as brisk walking for 30 minutes a day, five days a week, can cut the risk of developing type 2 diabetes in a person with pre-diabetes by more than half. *Almost 90% of those newly diagnosed with type 2 diabetes are overweight.
*According to the Diabetes Prevention Program, the scientific basis for the National Diabetes Education Program (HHS/NEP).
Dr. Zolee Davis-Robinson, PhD -- the Owner of Alternative Weight Loss, has advanced degrees in Counseling and Psychology, is a Certified LifeStyle Counselor, is an Associate Member of the American Society of Bariatric Physicians and is a regular guest lecturer to both professional and lay audiences on obesity and applying the principles of behavior modification for effective weight management. Visit Alternative Weight Loss www.AlternativeWeightLossInc.com <http://www.AlternativeWeightLossInc.com> and you'll find out how she personally lost over 90 pounds and has maintained it, FREE weight loss tools and strategies, food supplements, and much more!
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DIABETIC LIQUID "MEAL REPLACERS"
by Peter J. Nebergall, PhD
Includes photo of Peter Nebergall with cat.
We're always concerned with what we can, can't, should, and should not eat. We pass by the shelf, and in big, bold letters it says "For Diabetics!" Is it? Should we add this one to our meal plan? What about that one? And so on ...
From Slimfast on down, there are a lot of liquid "meal replacers" out there. All have carb counts; some have diabetic exchanges. Strictly speaking, you can factor such a product into your meal plan. Should you?
Be careful. All of the ones I looked at: Slimfast, Ensure, Ensure Plus, Ensure Glucerna, CarboRite At Last, Diabetic Care Choice, and Enterex Diabetic, are "loaded" foods. Designed to provide a meal's nutrition, they are full of protein, carb, fat, and vitamins. If you have nothing else to eat, they can keep you alive. Used under close supervision, they'll do what they say they'll do -- help keep you slim, properly fed, and well nourished. But there's a problem -- and it's not with the products -- it's with us.
In America, we're accustomed to reaching for food because we feel like it, and eating 'til we're full. Undisciplined snacking. It's dangerous. It's why we're the fattest nation on the planet. It's the "see-food" diet.
What's wrong with treating a can of Glucerna, or a container of Diabetic Care Choice, as an impulsive snack? Lots. For starters, there's 290 calories in that can; 100 of them from fat. That's not a snack; that's your lunch! If you start chugging Slimfasts, you'll go the opposite direction, like: fatfast. If you're going to "eat 'til you're full," don't be using these -- as you can run up 500+ calories before you even notice. If you're a "nervous eater," I don't think you should keep this stuff in your house.
What should you do with them? What is their niche? All of them are carefully-formulated, medically-tested, high-quality, and generally free from trendy, untested "alternative" ingredients. Ensure and Ensure Plus are meal replacers originally formulated for people without diabetes, who need to follow a liquid diet, for sustenance. Ensure Plus has more calories, and is more "fortified." Though they are not optimal for diabetics, both are packaged with sufficient information that someone using the "carb counting" system could work them into a meal plan.
Slimfast, again not originally formulated for diabetics, was derived as a "meal replacer" for weight loss. If you read the contents, though, it's not that different from Ensure, and Slimfast is labeled for both carb counting and the older "Exchange System." Like Ensure, Slimfast comes in a variety of flavors, and generic equivalents are available in big chain stores.
Ensure Glucerna is similar, but specifically formulated with the needs of diabetics in mind. There is less sugar. But, as diabetic diet management is not the avoidance of sugar but the management of a total budget of carbohydrates and calories, the avoidance of sugar is nice, but of incremental value.
Diabetic Care Choice and Enterex Diabetic are similar to Glucerna. Diabetic Choice, from Bristol-Myers Squibb, comes in a package, not a can, and has slightly fewer calories than its competitors -- but the package is smaller. (The Diabetic Care Choice line also includes snack bars, skin creams, and excellent "diabetic socks.") The idea, according to Bristol-Myers Squibb, is to use this product as a snack replacer, rather than a meal replacer. Still, that's more a difference in use than in formulation.
CarboRite At Last, from CarboLite Foods, is a bit different, a bit more trendy. Billed as a "low carb nutrition shake," it makes use of the excellent non-sugar sweetener Splenda. Heavily vitamin-fortified, this drink contains chromium (the link between chromium and diabetes has never moved beyond "pop science") and a natural additive they are calling "insulade." Please remember science is not a religion; there is a difference between what is medically tested and what some "alternative people" choose to believe -- it's your body; be careful what you put in it.
Enterex Diabetic, by Victus, of Miami, Florida, is very low in sugar, but otherwise is, like the others, a meal-replacement drink. Like At Last, it also sweetens with Splenda, and that is commendable. Like the others, in my opinion its taste would not pass muster at the soda fountain -- but none of these is intended for dessert.
These products are not "medicine." Simply consuming them will not heal you of diabetes, or even cause you to lose weight. The "D" in the word "diet" is the same as the "D" in the word "discipline," you should remember. You have to get your eating under control, and replace something excessive with one of these instead. As part of a disciplined, medically supervised meal plan, they'll help you. I can't improve on the statement printed on every can of Glucerna, so here it is:
"Use under medical supervision as a meal replacement for dietary management of diabetes. Consult your health care provider for a weight-loss goal, calorie level and blood glucose monitoring schedule that is appropriate for your nutritional needs, blood glucose management goals, and daily activities ..."
Products:
CARBORITE AT LAST
CarboLite Foods
Evansville, IN 47715
812-485-0002
www.carbolitedirect.com
DIABETIC CARE CHOICE
Bristol-Myers Squibb
New York, NY
1-800-468-7746
www.choicedm.com
ENSURE, ENSURE PLUS, AND ENSURE GLUCERNA "Weight Loss Shake"
Ross Products Division
Abbott Laboratories
Columbus Ohio
1-800-986-8589, 1-800-986-8727
www.ensure.com
ENTEREX DIABETIC
Victus Inc.
Miami, Fl.
www.enterexdiabetic.com
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DIABETES AND DENTAL COMPLICATIONS
By Joseph M. Shurina III
Community Dental Hygienist, U.S. Public Health Service, Ft. Belknap, Montana
Within the diabetic population, there is a serious risk of dental complications.
It has long been known that having diabetes increases the risk of severe periodontal
disease. Poorly controlled type 2 diabetics are more likely to develop periodontal
disease than are well-controlled diabetics. Why?
Studies conclude that poorly-controlled diabetics respond differently to bacterial plaque at the gum line than do well-controlled diabetics and non-diabetics. Having poorly-controlled diabetes correlates with having more harmful proteins (cytokines) in their gingival tissue -- and that can cause destructive inflammation of the gums. In turn, beneficial proteins (growth factors) are reduced, which interferes with the healing response to infection.
Diabetics tend to lose collagen, a protein that supports gums, skin, tendon
cartilage, and bone, in their gum tissue, thus increasing periodontal destruction.
Diabetic vascular disorders, such as reduced circulation in tiny blood vessels
in the gums, interfere with nutrition and healing in the gum tissues. Young
people with type 1 diabetes, especially those with poor control, are very vulnerable
to early-onset periodontal disease as they reach puberty.
Current research in the September 2002 issue of DIABETES RESEARCH AND CLINICAL
PRACTICE looked at 102 patients with type 2 diabetes, average age 65. In this
Swedish study, the researchers conducted a comprehensive dental examination,
and then compared these results with the same battery of tests given to a control
group without diabetes but otherwise the same in terms of age and gender. The
results showed that diabetic subjects had more periodontal gum disease pockets
between teeth, which indicate moderate to advanced gum disease. These pockets
also tended to be deeper than in non-diabetics.
The diabetic group had more plaque on their teeth and experienced more bleeding of their gums while being examined. The 22 subjects taking insulin had more cavities than those who were controlling diabetes with diet only. Overall, the diabetic group also had problems with dry mouth, and those with poor control had worse problems.
In an article in the Journal of Periodontology, author Christopher Cutler, DDS, states: "Increased serum triglyceride levels in uncontrolled diabetics seem to be related to greater attachment loss and probing depths, which are measures of periodontal disease."
For this reason, the article stresses diabetics should work with their health care team to keep cholesterol levels and triglyceride levels normal. "Reducing ... [these two levels], preferably through diet and exercise, may be the most important changes that diabetics can make to improve their life, as well as their oral health."
How can diabetes affect your teeth and gums? We all know these problems can happen to anyone. That's why we go to the dentist on a regular basis. Plaque builds up on everybody’s teeth, but diabetic high blood glucose helps germs build up on teeth and gums, and make these problems worse, to the point it could cause tooth loss.
What does this look like, if it's happening to you? The first signs are red, sore, and bleeding gums. This can progress to periodontitis, which is an infection in the gums and the bone that holds the teeth in place. Pockets form between the teeth, and they fill with germs and pus. If the infection is allowed to get worse, your gums may pull away from your teeth, making the teeth look very long, and your teeth will loosen.
Sometimes when I write these articles, I think that diabetics are singled out for many diseases, but not here. Eighty-five percent of all adults develop it. Ten percent have lost all of their teeth to it. Diabetes just makes it worse.
It is difficult to get people to brush and floss as often as they should, and many people do not go to the dentist when their gums bleed as they brush or floss. This bleeding is not normal, and needs to be addressed. If the plaque is not brushed and flossed away, it hardens into tartar and collects under the gum line. To make matters worse, more plaque forms over the tartar, so you can imagine how this problem can escalate.
Tartar, calcified bacterial plaque, harbors soft surface bacteria, and worsens the disease below the gum-line. As this process accelerates, more and more tissue becomes diseased, and more plaque accumulates. Once the bone begins to be destroyed, you know the rest: the teeth loosen, and false teeth are around the corner.
The prospects for fighting periodontal disease are excellent, as there are many things that someone with diabetes can do to stop the process or correct the disease, once it starts. The first goal is easy.
1. Good blood glucose control
The degree to which a person exercises good diabetes control appears to have a direct relationship to the severity of periodontal disease. This is clearly a very good thing to know, especially on those mornings when you think you are running too late to brush and floss. Among poorly-controlled diabetics, bone loss from periodontal disease is particularly severe.
2. Oral hygiene
Make sure you schedule regular dental check-ups. For a diabetic this may mean every six months, or, if you have periodontal disease, more often, until you get it under control. According to many periodontists, revisiting a dental hygienist every three months (“periodontal recall,”) may ensure problems can be controlled with relatively minor procedures.
Brush and floss the proper way. If you are not sure, the hygienist, the person who regularly cleans your teeth at the dentist's office, can help show you the right way. Now that you've read this article, you know brushing and flossing are important tools to help remove bacteria before it can cause damage. If necessary, your dentist may recommend mouthwashes that use chemicals to destroy plaque-forming bacteria and neutralize their toxins.
3. Watch for warning signs.
We've gone over these in the article, but, one more time let's list them: Bleeding gums while you eat or brush and floss, abnormal changes in your mouth such as soreness, sores, bright red gums and tenderness. Also look for gums pulling away from your teeth, making your teeth look long. Also, see the dentist if you have chronic bad breath or your bite feels different.
Run -- don't walk to the dentist, if your dentures do not fit well or if you experience any of these symptoms. At the same time throw away any cigarettes you have in the house. Smoking, diabetes, and dental hygiene do not go together -- smoking escalates the severity of the periodontal disease process. White patches on your gums might indicate the presence of thrush, a fungal infection requiring treatment.
If you have to visit the dentist because of periodontal disease, you will likely receive an extended gum-line cleaning called a root plane. The dental hygienist can probe the periodontal pockets and remove plaque and tartar. Once these are removed, the inflammation of the gums should subside and the gums should re-adhere to the teeth.
Why do diabetics need to care about controlling periodontal disease? First, dental infections may worsen your diabetes by causing hyperglycemia (high blood sugar), causing mobilization of fatty acids, and ultimately leading to acidosis. As we know, all of these conditions make it very difficult to control blood glucose levels.
Proper nutrition is essential to good control of diabetes. When gums are tender, a diabetic may opt for foods that are not appropriate for a diabetic diet.
To summarize, we hope that reading this article has helped you understand the importance of caring for your teeth and gums, as well as your blood glucose levels. Most people know that when diabetes is poorly controlled, they will eventually have problems with their extremities, particularly toes and feet. But the same type of damage can occur to the salivary glands. Without those protective proteins we spoke of, diabetic people are at a higher risk for dental problems. In people with well-controlled diabetes, there really is no difference in oral health, compared to those without diabetes. But, as we have explained, those with poor control or poor oral hygiene run the risk of cavities and periodontal disease. Don’t become a statistic ... Visit Your Dental Clinic Today!
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If you or a friend would like to remember the Diabetes Action Network of the National Federation of the Blind in your will, you can do so by employing the following language:
“I give, devise, and bequeath unto the Diabetes Action Network of the National Federation of the Blind, 1800 Johnson Street, Baltimore, Maryland 21230, a District of Columbia nonprofit corporation, the sum of $_____” (or “_______ percent of my net estate” or “the following stocks and bonds:________”) to be used for its worthy purposes on behalf of blind persons.
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BREAKTHROUGH SPARKS DIABETES HOPE
(This article first appeared in the Friday, November 14, 2003 Edition of BBC News Online, copyright (c) 2003 the British Broadcasting Corporation. Reprinted with permission.)
A cure for diabetes could be a step closer after scientists found cells from the spleen can transform into insulin-producing cells. US researchers were able to halt, and even reverse, the disease in mice.
The research offers hope to people with type 1 diabetes who need insulin injections to survive. The team from Massachusetts General Hospital, whose announcement coincided with World Diabetes Day, hope to begin human trials soon.
Living with diabetes
Type 1 diabetes affects around 350,000 people in the UK. People with the condition do not produce insulin, needed to convert sugar into fuel and normally produced in the pancreas in cells called islet cells.
Their islet cells are destroyed by the body’s own immune system, leading to sugar building up dangerously in the blood.
Re-educating the immune system
The US researchers had already shown that injecting diabetic mice with spleen cells from healthy mice re-educated their immune systems so that they could accept an islet cell transplant.
But the mice unexpectedly began producing islet cells that could secrete
insulin themselves.
This latest research found this only happened if the mice had been given a
specific type of spleen cell. They can be distinguished from other spleen cells
because they lack a particular molecule called CD45. Scientists had believed
it was impossible to regenerate insulin-secreting islet cells.
To double-check their findings, researchers carried out the same treatment, giving female diabetic mice spleen cells from healthy male cells. They found that in diabetic mice that achieved long-term normal glucose metabolism, all of the new functioning islets had significant numbers of cells with Y chromosomes, showing they had come from the male donors.
In a further experiment, donor spleen cells were marked with a fluorescent green protein, and again these cells were found throughout the newly developed islets.
Rescue Hope
Denise Faustman, director of the Massachusetts General Hospital Immunobiology Laboratory who led the research, said: "It's the cells without CD45 that are the precursors for pancreatic islets. They have a distinct function that has not previously been identified for the spleen."
Dr. David Nathan, director of the hospital's Diabetes Center, added: "These exciting findings in a mouse model of type 1 diabetes suggest that patients who are developing this disease could be rescued from further destruction of their insulin-producing cells.
"In addition, patients with fully established diabetes possibly could have their diabetes reversed."
Dr. Eleanor Kennedy, research director for Diabetes UK, said, "The initial results of this research are potentially very exciting for people with diabetes. Reversing the onset of type 1 diabetes by turning adult precursor cells from the spleen into insulin-producing cells is a new approach.
"Previously research has concentrated on embryonic stem cells. This new breakthrough reopens the debate on what other types of cells are capable of. This research is in the very early stages and a lot more work still needs to be done.
"Diabetes UK will be watching the progress with interest."
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SOCIAL SECURITY, SSI, AND MEDICARE FACTS FOR 2004
by James McCarthy
Includes photo of James McCarthy
This article appeared in the Braille Monitor, December 2003 Edition, published by the National Federation of the Blind.
From the Monitor editor: Jim McCarthy is assistant director of governmental
affairs for the National Federation of the Blind. Here is his annual Social
Security summary:
With another new year come annual adjustments in Social Security programs.
The changes include new tax rates, higher exempt earnings amounts, Social Security
and SSI cost-of-living increases, and changes in deductible and co-insurance
requirements under Medicare. Here are the new facts for 2004:
FICA and Self-Employment Tax Rates: The FICA tax rate for employees and their employers remains at 7.65%. This rate includes payments to the Old Age, Survivors, and Disability Insurance (OASDI) Trust Fund of 6.2% and an additional 1.45% payment to the Hospital Insurance (HI) Trust Fund, from which payments under Medicare are made. Self-employed people continue to pay a Social Security tax of 15.3%, which includes 12.4% paid to the OASDI Trust Fund and 2.9% paid to the HI Trust Fund.
Ceiling on Earnings Subject to Tax: During 2003 the ceiling on taxable earnings for contributions to the OASDI Trust Fund was $87,000. This ceiling rises to $87,900 for 2004. All earnings are taxed for the HI Trust Fund.
Quarters of Coverage: Eligibility for retirement, survivors, and disability insurance benefits is based in large part on the number of quarters of coverage earned by any individual during periods of work. Anyone may earn up to four quarters of coverage during a single year. During 2003 a Social Security quarter of coverage was credited for earnings of $890 in any calendar quarter. Anyone who earned $3,560 for the year (regardless of when the earnings occurred during the year) was given four quarters of coverage. In 2004 a Social Security quarter of coverage will be credited for earnings of $900 during a calendar quarter. Four quarters can be earned with annual earnings of $3,600.
Trial Work Period Limit: Beginning in 2001, the SSA established a rule that changes the amount of earnings required to use a trial work month. This change is announced with the cost-of-living adjustments each year. In 2003 the amount was $570, and in 2004 it rises to $580. In cases of self-employment, a trial work month can also be used if a person works more than 80 hours, and this limit remains the same each year.
Exempt Earnings: The monthly earnings exemption for blind people who receive disability insurance benefits was $1,330 of gross earned income during 2003. In 2004 earnings of $1,350 or more per month, before taxes, for a blind SSDI beneficiary will show substantial gainful activity after subtracting any unearned (or subsidy) income and applying any deductions for impairment-related work expenses.
Social Security Benefit Amounts: All Social Security benefits are increased by 2.1% beginning with the checks received in January 2004. The exact dollar increase for any individual will depend upon the amount being paid.
Standard SSI Benefit Increase: Beginning January 2004, the federal payment amounts for SSI individuals and couples are as follows: individuals, $564 per month; couples, $846 per month. These amounts are increased from individuals, $552 per month, and couples, $829 per month.
Student Earned Income Exclusion: the Student Earned Income Exclusion is adjusted each year. Last year the monthly amount was $1,340, and the maximum yearly amount was $5,410. In 2004 these amounts increase to $1,370 per month and $5,520 per year.
Medicare Deductibles and Co-insurance: Medicare Part A coverage provides hospital insurance to most Social Security beneficiaries. The co-insurance payment is the charge the hospital makes to a Medicare beneficiary for any hospital stay. Medicare then pays the hospital charges above the beneficiary's co-insurance amount.
The Part A co-insurance amount charged for hospital services within a benefit period of not longer than 60 days was $840 during 2003 and is increased to $876 during 2004. From the sixty-first day through the ninetieth day there is a daily co-insurance amount of $219 per day, up from $210 in 2003. Each Medicare beneficiary has 60 lifetime reserve days, which may be used after a 90-day benefit period has ended. Once used, after any benefit period, these reserve days are no longer available. The co-insurance amount to be paid during each reserve day used in 2004 is $438, up from $420 in 2003.
Part A of Medicare pays all covered charges for services in a skilled nursing facility for the first 20 days within a benefit period. From the twenty-first day through the one-hundredth day in a benefit period, the Part A co-insurance amount for services received in a skilled nursing facility is $109.50 per day, up from $105 per day in 2003.
For most beneficiaries there is no monthly premium charge for Medicare Part A coverage. Those who become ineligible for Social Security Disability Insurance cash benefits can continue to receive Medicare Part A coverage premium-free for 93 months after the end of a trial work period. After that time the individual may purchase Part A coverage. The premium rate for this coverage during 2004 is $343 per month. This is reduced to $189 for individuals who have earned at least 30 quarters of coverage under Social Security covered employment.
The Medicare Part B (medical insurance) deductible remains at $100 in 2004. This is an annual deductible amount. The Medicare Part B basic monthly premium rate charged to each beneficiary for the year 2004 is $66.60. (The 2003 premium rate was $58.) This premium payment is deducted from Social Security benefit checks. Individuals who remain eligible for Medicare, but are not receiving Social Security benefits because of working, pay this premium directly.
Programs Which Help with Medicare Deductibles and Premiums: Low-income Medicare beneficiaries may qualify for help with payments. Assistance is available through two programs--QMB (Qualified Medicare Beneficiary program) and SLMB (Specified Low-Income Medicare Beneficiary program).
Under the QMB program states are required to pay the Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) premiums, deductibles, and coinsurance expenses for Medicare beneficiaries who meet the program's income and resource requirements. Under the SLMB program states pay only the full Medicare Part B monthly premium ($66.60 in 2004). Eligibility for the SLMB program may be retroactive for up to three calendar months.
Both programs are administered by the Centers for Medicare and Medicaid Services (CMS) in conjunction with the states. In order to qualify, the income of an individual or couple must be less than the poverty guidelines currently in effect. The guidelines are revised annually and were last announced in February of 2003. New guidelines will be issued in February or March of 2004. The rules vary from state to state, but in general the following can be said:
A person may qualify for the QMB program if his or her income is less than $769 per month for an individual and $1,030 per month for a couple. These amounts apply for residents of 48 of the 50 states and the District of Columbia. In Alaska, the income threshold used to define poverty is less than $955 per month for an individual and $1,282 per month for couples. In Hawaii, income must be less than $881 per month for an individual and $1,182 per month for couples.
For the SLMB program the income of an individual cannot exceed $918 per month or $1,232 for a couple in 48 of the 50 states and the District of Columbia. In Alaska, the income amount is $1,141 for an individual and $1,534 for couples. An individual in Hawaii qualifies if his or her income is less than $1,053 per month; for couples the amount is $1,414.
Resources--such as bank accounts or stocks--may not exceed $4,000 for one person or $6,000 for a family of two. (Resources generally are things you own. However, not everything is counted. The house you live in, for example, doesn't count, and in some circumstances your car may not count either.)
If you qualify for assistance under the QMB program, you will not have to pay:
* Medicare's hospital deductible amount, which is $876 per benefit period in 2004;
*The daily co-insurance charges for extended hospital and skilled nursing facility stays;
*The Medicare Medical Insurance (Part B) premium, which is $66.60 per month in 2004;
*The $100 annual Part B deductible;
*The 20 percent co-insurance for services covered by Medicare Part B, depending on which doctor you go to.
If you qualify for assistance under the SLMB program, you will not have to pay the $66.60 monthly Part B premium.
If you think you qualify but you have not filed for Medicare Part A, contact Social Security to find out if you need to file an application. Further information about filing for Medicare is available from your local Social Security office or Social Security's toll-free number, (800) 772-1213.
Remember, only your state can decide if you are eligible for help from the QMB or SLMB program. So, if you are elderly or disabled, have low income and very limited assets, and are a Medicare beneficiary, contact your state or local welfare or social service agency to apply. For more information about either program, call CMS’s toll-free telephone number, (800) 633-4227.
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MALE AND FEMALE SEXUAL DYSFUNCTION
by Ed Bryant
Includes photo of Ed Bryant
The principal symptom of diabetes, type 1 or type 2, is high blood sugar. In time, excess glucose in the blood can cause damage to the eyes, kidneys, nerves, and circulatory system. As human sexual response involves so many systems at the same time, it is not unusual to find a person with long-term diabetes experiencing sexual difficulties: ranging from diminished interest, slow response, discomfort, pain, and, for men, outright impotence. Though these problems express differently in men and women, and sexuality is the sum of many different factors, having diabetes is a major predictor of sexual difficulties, for both men and women.
Female Sexual Dysfunction
Having diabetes can interfere with a woman's participation in and enjoyment of the sex act. Diabetic complications can make sex painful and unpleasant -- and reluctance to participate can be understandable. But the culture throws negative labels around, and, traditionally, women’s sexual issues have not been addressed to the same depth as men’s issues -- so many medical professionals are less than fully "up to speed" on this subject, so less likely to ask their female patients, and only recently has the medical profession acknowledged any "female sexual dysfunction" at all -- so there is a shortage of professional expertise here. Some doctors have real difficulty separating diabetogenic (caused by diabetes) difficulties from unrelated issues. More studies, especially of women with diabetes, are urgently needed. Too many assumptions are derived from the study of diabetic men, and need to be tested.
Diabetic women, many of retirement age, were, many of them, raised in a time when "nice girls didn't talk about such things." There can be real reluctance to bring up the subject of sexual difficulties, diabetogenic or otherwise. Anna Sarkadi, MD, and Urban Rosenqvist, MD, PhD, in their paper: "Intimacy and Women with Type 2 Diabetes," published in The Diabetes Educator (2003), stress that both the patient and the clinician need to push for more openness and discussion.
In their book, For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life (2001 Edition), sisters Jennifer Berman, MD, and Laura Berman, PhD, quote a survey published in the Journal of the American Medical Association, stating that “43% of American women, young and old suffer from some sexual dysfunction (JAMA,1999)" They continue: " And yet for most of this century doctors have dismissed women’s sexual complaints as either psychological or emotional.”
The Bermans go on to state: “Many of the same health problems that cause erectile dysfunction in men, such as diabetes, high blood pressure, and high cholesterol, as well as many medications used to treat these conditions, can cause sexual dysfunction in women.” Female sexual disorders (according to the Bermans) are classified into four categories: 1) Hypoactive sexual desire disorder, 2) Female sexual arousal disorder, 3) Orgasmic disorder, and 4) Sexual pain disorders. Each disorder has different treatments (Brassil, D.F. and Lewis, J.H., 2003). Sarkadi and Rosenqvist (2003) point out that although "female orgasmic disorder" does not correlate with diabetes, #4, sexual pain often does, and it is vital for both patients and providers to overcome old reluctance, and raise the subject with each other.
Just as with men, female sexual dysfunction can result from physiological, hormonal, neurogenic or psychological causes, or a mix of the above -- and physical discomfort can engender psychological issues. Some physical causes include: pelvic surgery or trauma, blood flow problems such as coronary heart disease, high blood pressure, high cholesterol, smoking, spinal cord injury, and even (for both men and women) excessive bicycle riding. Hormonal causes can include menopause, endocrine disorders, postpartum hormone deficiencies, and diabetes.
In their article: "Sex, Intimacy, and the Kidney Patient" (in Kidney Beginnings magazine), Donna Brassil, RN, MA, CURN, and Jean Lewis, BSN, RN, CNP, caution that although kidney failure (diabetic or otherwise) itself imposes no limitation on sexual activity, sexual function is impaired in many individuals with chronic kidney disease. "A kidney transplant may cause improvement," they report, "although sexual function rarely returns to the pre-illness state." This applies to both men and women.
Certain medications have also been shown to adversely affect female sexual response. Some of them might have been prescribed for diabetes complications. The culprits are the same as for the men: anti-hypertensive agents, anti-depressants, sedatives, neuroleptics, anti-convulsants, anti-ulcer drugs, anti-cancer drugs, and many illegal "recreationals." Be sure to discuss medication options with a physician or nurse.
Psychological issues must also be evaluated for their possible relationship to sexual disorders. Many disorders, not just diabetes, have been shown to impact sexual response. These will need to be "ruled out." Sarkadi and Rosenqvist caution that too many have been "taught to accept" bad "folk explanations" (that are not in fact explanations at all, but value judgments) for their difficulties, like "because you're too old, or too fat, or too lazy ..." and their resulting guilt and self-blame exacerbate the problems. As when you think you have the answer (however incorrect you may be!), you're not likely to bring up the question, self-blame's consequences range from unpleasant, to dangerous, to outright lethal.
How does diabetes cause female sexual difficulties? Neuropathy, nerve damage, can interfere with the ability to feel, to detect touch, and can cause both pain and numbness. Diabetic small vessel circulatory damage can cause dryness, cracking, and impaired lubrication of skin and mucous membranes. Sarkadi and Rosenqvist (2003) state: "women with diabetes had double the rate of disturbed (inadequate) lubrication as their non-diabetic peers." These ramifications can seriously interfere with satisfaction, and with the willingness to participate in sexual activity.
Diabetic high blood sugars greatly increase the odds of a woman having a vaginal infection, most commonly a yeast infection. Diana Guthrie, past Professor at University of Kansas School of Medicine--Wichita, warns such infections can dry and irritate the skin, cause terrible itching, and produce severe pain during intercourse. Good diabetes control cuts the odds of such infections, and effective topical treatments for yeast infection are available. “For diabetics, such infections are generally not sexually transmitted,” warns Professor Guthrie, “but safe sex must be practiced if you or your partner have such an infection.”
In one study, where participants' average age was over 60, 18% of the women with type 1 diabetes reported sexual difficulties, but the figure was 42%, for those women with type 2. It was a small study, but the point is valid -- type 2 diabetes produces a lot of sexual difficulties!
Berman and Berman advise there is no single “cure-all” for female sexual dysfunction, and options for treatment vary as much as the symptoms. They further advise that, although medications may play a role in treatment, sexual dysfunction disorders may persist if accompanying emotional issues remain unaddressed. As a result, they recommend treatment on both a physiological and psychological level. They stated, “Diagnosis and treatment should ideally combine the mind and body in order to attend to all the components of a woman’s sexual life.”
Their suggestions are just as valid for men facing sexual difficulties.
Medicinal treatments for women increasingly include prescriptions for Viagra (sildenafil). Similar to its effects for men, Viagra increases blood flow to the vagina, clitoris, and labia, causing engorgement of these tissues, enhanced sensation, and increased vaginal lubrication. It is recommended that sildenafil be taken on an empty stomach, about an hour before intercourse, without alcohol. In addition, a woman must have the desire to engage in sexual relations, and be sexually stimulated enough for it to have an effect. Discuss with your doctor or nurse whether such use is appropriate for you. Note, as other new therapies for men come on to the market, some of them may prove effective for women as well. Talk to your health care team about new therapies.
Hormone replacement therapy (HRT) is currently the only drug treatment that has been approved by the FDA for women with complaints of sexual problems associated with the drop in hormone levels brought on by menopause. Talk to your doctor about whether or not such therapy is appropriate for you.
The Eros-CDT (clitoral therapy device), by Urometrics, Inc., of Anoka, Minnesota, became the first treatment for female sexual dysfunction approved by the FDA in May, 2000. The CDT is in essence a small pump with a tiny plastic cup attachment that fits over the clitoris and surrounding tissue. It provides gentle suction and stimulating blood flow to the area. The CTD can cause orgasm in women, and it may help to prevent the fibrosis (collagen deposits) in women that can build up in the arteries leading to the clitoris. Consult your physician for more information on this device. Because no drugs are administered, diabetes contraindications are less likely.
Sexual dysfunction's symptoms should be taken seriously. Talk to your doctor. It is not a "moral issue." Get it checked out -- as something undetected (like kidney disease) can cause sexual difficulties -- then you can start dealing with it, and getting on with your life. A recent Mayo Clinic heart disease study stated people with sexual difficulties had a greatly increased likelihood of undiagnosed heart problems. So Just don't ignore it. Act!
The best prevention is the same as for diabetic men: Tight control. Diabetes per se does not cause these ramifications -- they follow long periods of elevated blood glucose, and your best insurance is to keep those numbers down. The better you do, the less the risk. Smoking increases the odds and severity of diabetic complications; it should be stopped. Alcohol use needs to be limited.
Male Sexual Dysfunction
Of all the complications of diabetes, this one, male impotence (the inability to achieve and sustain an erection sufficient for sexual intercourse), may be most feared, but it is also one of the most treatable. More than 50% of diabetic men may experience erectile dysfunction, but over 95% of cases can be successfully treated. With proven treatment available, and new treatments appearing, a diabetic man experiencing this problem does have options. It isn't something he--or any man--or his partner--should have to live with.
Many men do not feel difficulties with their sexual performance are a fit subject to discuss with their partners -- or anyone else; they fear they will be ridiculed or condemned for having such. They couldn't be more wrong -- for they make things worse by "suffering in silence." Men, all of them, need to move beyond the old idea that the sex act is something the male provides. He is part of a relationship, and what interferes with one affects both. A man's partner is equally involved.
Achieving and sustaining an erection requires interaction between the neurological, arterial, hormonal, and psychological functions of the body. Simply, a lot of different parts have to work right. Proper hormonal balance, normal sex drive and emotional make–up, functioning nerves and blood vessels, and healthy penile tissue are all required. Both Libido, the interest in sexual activity, and potency, the ability to perform, must be present. Several different sets of nerves are involved, and neuropathy, nerve damage, to any of them can impair the sex act. Erection is a function of the parasympathetic nervous system, but orgasm and ejaculation are controlled by a different set of nerves: the sympathetic system.
"Erection is a hydraulic phenomenon, that occurs involuntarily," says Arturo Rolla, MD, of Harvard University School of Medicine. "Nobody can will an erection!" Anything that limits or impairs blood flow can interfere with the ability to achieve an erection, no matter how hard a man tries, or how much he wants to achieve one.
Although sexual vigor generally declines with age, a man who is healthy, physically and emotionally, is able to produce erections, and enjoy sexual relations, regardless of his age. Impotence is not an inevitable part of the aging process.
On occasion any man may experience the inability to achieve or sustain an erection. Such transient episodes are common and may be attributed to illness, fatigue, stress, relationship problems, depression, etc. The occasional inability to perform, however traumatic to both partners, is normal.
Repeated inability to achieve and sustain an adequate erection can be caused by anything that affects a man, psychologically or physically. Psychological, or "psychogenic," impotence can follow major life changes, unrelated medical treatments or conditions, stressful events, relationship difficulties, or even the fear of becoming impotent. The physiological changes associated with fear can themselves cause erectile dysfunction! When a diabetic discovers the source of his difficulties is not physical -- that it is due simply to his fear of the ramifications -- sexual function is usually restored. But to tell the difference between physical and psychogenic impotence, and to make any progress against it, requires that you TALK about this sensitive issue -- with your partner, your physician, and, ideally, with a urologist specializing in male sexual difficulties.
Sexual dysfunction can contribute to psychological problems such as feelings of inadequacy, frustration, loss of self-esteem, and despair. Strained relationships with partners may well result. It is important for people to discuss the problem with their partners, and to promptly seek medical attention. Many men may find counseling helpful.
Diabetic impotence is not a sign of diminishing sexual interest! It is generally a result of the blockage of or damage to blood vessels responsible for erection, damage to the nerves that dilate those blood vessels, or a mixture of the two. In some cases, re-establishing good glycemic control may decrease the problem, though permanent damage to nerves and small blood vessels may not be reversible. Such blockage may be an indicator of previously undiagnosed heart disease.
A diabetic man can decrease his risk of impotence (and many other complications) by carefully controlling his diabetes. Poorly controlled diabetes, and high cholesterol, increase the chances of vascular complications, which may lead to erectile dysfunction or other circulatory problems.
End Stage Renal Disease (ESRD), a common diabetes complication, imposes its own stresses on the body, and can lead to impairment of sexual function. Short of a kidney transplant, the best treatment is to do whatever possible to keep your kidneys healthy.
Exercise regularly, and avoid nicotine and alcohol. Smoking causes constriction of the blood vessels, and greatly increases the odds of diabetic circulatory damage. Good health practices, and tight blood glucose control, help men prevent impotence, just as they ward off the other major complications of neuropathy, nephropathy, and retinopathy.
Impotence, the chronic inability to have and sustain an erection adequate for sexual intercourse, may well be a symptom of more serious disorder, such as previously undiagnosed heart complications. Seek prompt medical help for sexual dysfunction -- as it can lead to early diagnosis of other problems -- for which prompt intervention might save your life. Identification of the source of impotence can point the way to the prevention of strokes, heart attacks, and other life-threatening illnesses.
Whatever the cause, if a man does not have or cannot sustain erections adequate for vaginal penetration, and the problem continues over a period of four to five weeks, he should recognize a problem exists, and seek medical help. Don't delay -- erectile dysfunction doesn't "just go away!"
In treatment of impotence, the choice of doctors is most important -- all are not equally qualified to diagnose or treat such a condition. Among the best choices are those practicing at centers specializing in erectile dysfunction, urologists who subspecialize in the treatment of impotence, and other physicians specifically trained in this field. Most people's first contact is with their family doctor. Ask that primary care physician for a referral to a medical professional who is particularly familiar with this disorder. Local hospital referral services may keep lists of such experts in practice nearby.
With an interview and physical exam, the doctor should be able to determine whether the erectile dysfunction is psychological or physical in nature. Where diabetes is present, a vast majority of instances of erectile dysfunction have a partly or completely physical cause. But based on examination and interview, the doctor may determine the cause to be psychological, and if so, refer the man to a qualified health professional specializing in psychologically-induced erectile dysfunction. This may be a psychiatrist, psychologist, sex therapist, or marital counselor. Please, do not see such a diagnosis as an insult, or as a defeat -- to do nothing, to choose inaction, would be the real defeat.
Troy A. Burns, MD, of PropartnersMD in Overland Park, Kansas (who was formerly
Medical Director of the Diagnostic Center for Men), reports that an old at-home
test for erectile activity during sleep (the lack of which would suggest physically-caused
impotence) was the postage-stamp test. The patient was instructed to wrap several
stamps snugly around his penis at bedtime. If the stamps had perforated by
the time he awakened, some penile tumescence probably occurred! Of course more
sophisticated tests are used today.
Impotence is sometimes a side effect of medications prescribed for other disorders.
Such medications can include: some antihypertensives (diuretics and beta blockers),
some ulcer medications, the heart medication Digoxin, antihistamines used for
allergy control, antipsychotics, commonly used tranquilizers such as Diazepam,
certain antianxiety drugs, certain narcotics, anticholinergics, tricyclic antidepressants,
and many illegal drugs. Elavil and other tricyclic antidepressants, sometimes
used to treat the pain of neuropathy, can cause, trigger, or aggravate impotence.
Be careful of interactions between your medications and any “alternative” herbal
supplements too -- tell your doctor what you're taking. Non-prescription treatments
for a person's unrelated disorders may contribute to the problem, as over-the-counter
medications, including certain eye drops and nose drops, have been associated
with erectile dysfunction.
If you experience erectile dysfunction, and you are using other medication(s), discuss it with your doctor. By adjusting the dosage of current medication(s) or by switching to valid alternates, erectile dysfunction may be alleviated. Ask your doctor or pharmacist for information about side effects, and be sure to read the package insert in the container. Consult a physician before discontinuing any medications.
Much is now known about the causes and treatments of erectile dysfunction, and impotent men should be aware of their various treatment options. Although surgery is one choice, 95% of cases are resolved by nonsurgical means, and the National Institutes of Health recommends trying nonsurgical treatments before more invasive methods. All options should be considered, but the man's personal preferences -- and those of his partner -- are vital in the choice of treatment. For purpose of discussion I've divided treatments into three categories: medications, external mechanical devices, and surgery.
Medications
Topical "Vasodilators" May Improve Blood Flow: When diagnosis indicates a problem in the vascular system, particularly arterial insufficiency, externally-applied vasodilators (example: nitroglycerine ointment) can be used to dilate arteries, improving blood flow into the penis. Commonly used in treatment of high blood pressure and associated heart disease, such ointment is applied to the penis to increase penile arterial flow and improve erections. The most notable side effect of nitroglycerine ointment is that it may give the female partner headaches, as it is absorbed into her bloodstream through the vagina. To prevent this, the man should use a condom. Note: some men are "intolerant" of nitroglycerine as well, and cannot use such a product. Talk to your health care team.
Another topically applied vasodilator, Minoxidil, was found to have fewer side effects and be more effective than nitroglycerine cream. Although some cases of erectile dysfunction respond well to this kind of therapy, the effectiveness of topical vasodilator products for this purpose has not yet been determined by the scientific community. Research continues.
Yohimbine Therapy Shows Promise: Yohimbine medication comes from the bark
of a tree that grows in Africa and India. The extract, long used as an aphrodisiac
and folk remedy for impotence, has proved effective in some impotence cases,
and has an FDA approval for use as an aphrodisiac. It is not known exactly
how the medication works. Note that desire is not ability -- and an aphrodisiac, "folk" or
FDA-approved, does not address the circulatory difficulties central to diabetogenic
impotence. Some "alternative" medications, sold on the Internet as "sex-life
enhancers," contain yohimbine as one component.
The few side effects of yohimbine tablets can be easily alleviated. Many doctors
prescribe this therapy for cases of very mild, physically caused dysfunction
or for psychological impotence. This therapy does have merit and should be
considered.
Alprox-TD, a topical cream containing alprostadil, has completed several Phase III clinicals. Manufactured by NexMed (from Robbinsville, New Jersey), it appears to produce a statistically significant improvement in impotence symptoms, and "demonstrated significant efficacy in double-blind, placebo-controlled, take-home studies in a broad patient population." Many of the test population also had cardiac complications, and the medication appeared safe for them as well. "The use of Alprox-TD is not contraindicated in patients using nitrate medication for cardiovascular disease or any other type of medication," says NexMed. This medication (already available in Asia) is not yet FDA approved, but the company expects U.S. marketing clearance shortly. This is NOT "alternative," but carefully-researched medication, and the manufacturer is making sure the product is safe and effective.
Oral Medications:
Viagra, Pfizer, Inc.'s oral medication for the treatment of male erectile dysfunction (impotence) was approved by the U.S. Food and Drug administration in March of 1998. Viagra is a simple pill, priced about $7 per dose, and appears to successfully treat a wide percentages of cases. Although sometimes contraindicated where circulatory disease is present (talk to your doctor first!), for some, it may be the most convenient treatment of all.
Levitra, from Bayer and GlaxoSmithKline, won approval late in 2003, and is now available. Its pattern of action is similar to that of Viagra. Another Viagra competitor, Cialis, sold on many overseas Web sites as "Super Viagra," won FDA approval in November of 2003.
Uprima, manufactured by TAP Pharmaceuticals, is said to work in a similar manner, but where Viagra acts directly on the circulatory system, Uprima "stimulates the appropriate neurotransmitters in the human brain." It is sold on the Internet, billed as an "orgasm enhancer." It might work for some, as might its foreign competitors and generic equivalents: Vig-Rx and Asotas -- but these are not "mainstream," and caution is advised. Be extremely cautious with all such overseas "gray-market" medications; your health care team may be unfamiliar with their consequences and contraindications, and familiar labels may be dishonest.
Vasomax, by Zonagen Pharmaceuticals, was another anti-impotence oral medication. An oral form of the proven anti-impotence injectable medication phentolamine, approved in Mexico, it failed its final clinical tests in the U.S., and was withdrawn from the market before it could incur the stigma of "banned by the FDA."
Penile Injection Therapy: Many sources report that penile injection therapy
has an estimated 80% rate of success. Injected directly into the penis, the
medication alprostadil produces erection by relaxing certain muscles, increasing
blood flow into the penis and restricting outflow. The therapy has disadvantages,
such as risks of infection, pain, and scarring--fibrosis--in the penis, and
it may create "priapism," a prolonged, painful erection lasting six
hours or more (although reversible with prompt medical attention). A popular
version of this medication is Upjohn Corporation's Caverject, the first to
be approved for such use by the FDA. Note: The MUSE system, described below,
administers the same medication, without needles, and (if and when FDA approved),
NexMed’s Alprox-TD will offer it in a cream.
Drug Combination Injection Therapy: Therapies using combinations of drugs have
been developed and are proving to be a good "fallback" for individuals
who experience difficulties with Caverject alone. "About 15% of all individuals
who try therapy with Caverject experience significant pain at the injection
site," says Troy A. Burns, MD. "For these 15%, a combination of Caverject,
Papaverine, and Phentolamine produces less or no pain."
Alternatives
The MUSE System, by VIVUS, is a noninvasive alternative to penile injection. The user dispenses his medication (a pellet of alprostadil/Caverject) with an eye-dropper-like applicator, directly into the urethra. No needles are required. Both the drug and the delivery system have been approved by the Food and Drug Administration for this use. For many impotent men, the MUSE may be the therapy of choice.
"Rejoyn" is an inexpensive, nonprescription alternative to the many vacuum-actuated devices described below. Described by its manufacturer as a "support sleeve," it does not "cause" an erection, but rather supports the flaccid penis as if it were erect (one wears it under a condom).
External Mechanical Devices
This category of treatments for erectile dysfunction includes external vacuum therapies; noninvasive external mechanical devices that produce painless erections by causing blood to flow into the penis while constricting outflow of blood. Such devices imitate a natural erection, and do not interfere with orgasmic experience. External vacuum therapy mechanisms are approximately 95% successful in causing and sustaining an adequate erection. All are portable, and costs range between $200-$500, covered under most insurance plans, and Medicare Part B.
The vacuum constriction device consists of a vacuum cylinder, various sizes of tension rings, and a vacuum pump, either hand-operated or electric. The penis is placed in a cylinder to which a tension ring is attached. Air is evacuated from the cylinder by means of the pump, creating a vacuum, which produces the erection. The cylinder is removed, leaving the tension ring at the base of the penis to maintain the erection.
Vacuum therapy devices have a few minor disadvantages. One must interrupt foreplay to use them. THE TENSION RING MUST BE REMOVED AFTER SUSTAINING THE ERECTION FOR 30 MINUTES, TO PREVENT PENILE BRUISING. You must use the correct-size tension ring. Although considered to be basically pain free, initial use may produce some soreness. Such devices may be unsuitable for men with certain disorders related to blood clotting. In general, vacuum constriction devices are successful in management of long-term impotence, and they enjoy wide physician acceptance. They are relatively inexpensive, and they work on simple principles, so they are easy for patients to understand.
Widely available, they are now offered in mass-market catalogs like "Dr. Leonards," and, as long as the user follows the instructions, and is in otherwise good physical condition, they usually work well. As no medication needs to be consumed or injected, these devices are good for many men.
Surgical Treatments
There are many less-invasive and less-expensive options, and surgery should
be considered only after all others have proved unsatisfactory. Of the two
kinds of surgery performed, one involves implantation of a penile prosthesis;
the other attempts vascular reconstruction. Less than 5% of impotent men
may benefit from vascular surgery. Expert opinion about surgical implants
has changed during recent years; today, surgery is no longer so widely recommended.
Even though it is 90% effective (on an appropriate subject), surgery is expensive
in both monetary and human terms, but it is one available option for impotent
men. The decision to have or not have surgery is one that should be made
by the man and his sexual partner, after medical consultation.
Companies that market surgically-implanted prosthetic devices sell only to hospitals and physicians and will not provide the selling price to consumers. Some years ago, I checked prices, and found that the malleable prostheses cost about $1,400, and inflatable devices cost about $4,000 -- just for parts. If the man elected to undergo the surgery, and fees were totaled (surgical, operating room, and the markup on the prosthesis), the cost would be thousands more.
The main risk associated with penile surgery is infection. Although every attempt is made during the procedure itself to prevent infection, it can develop, and may force removal of the prosthesis. As with all invasive procedures, there may be some pain, bleeding, and scarring. If for some reason the prosthesis or parts become damaged or dislocated, surgical removal may be necessary. With a general success rate of about 90%, any of the devices will restore erections, but they will not affect sexual desire, ejaculation, or orgasm.
Prostheses: Many different types of penile prostheses are available, in three categories: rods, inflatable prostheses, and self-contained prostheses. Semi-rigid or malleable rods are the simplest and least expensive of all. Their main disadvantage is that the penis remains constantly erect, which may cause problems with concealment.
Inflatable prostheses are complex mechanical devices that imitate the natural process of erection. Parts are inserted surgically into the penis and scrotum, and activated by squeezing. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid. Disadvantages include risk of mechanical breakdown or leakage. Fully inflatable devices are the most expensive of the three categories, because of the complicated surgery necessary to implant the parts.
Self-contained single-unit prostheses are similar to the inflatable types, but more compact. The entire device is implanted into the penis. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used. Some of the mechanical types have been known to fail during intercourse; the inflatable device can sometimes be difficult to operate.
All penile implants will produce erections suitable for intercourse. When
decisions are being made regarding the kind of surgery, other factors should
be considered. According to Bruce A. MacKenzie in Impotence Worldwide (Volume
7, No.2), purpose is only one of several elements considered when selecting
an implant. MacKenzie said, "To those who wish to simulate nature to the
furthest extent--then a fully inflatable would be their choice; for those who
wanted something relatively simple, ready to use, lower cost, one day less
in the hospital--their choice would be the hinged or malleable; to those who
wanted a compromise between the two--a hybrid--they would choose a self-contained;
and for those who wanted the least expensive (low end of the line)--the semi-rigid
would fit the bill."
Vascular Reconstructive Surgery for Impotence uses highly sophisticated techniques
and equipment to physically correct the underlying causes of impotence in the
penis. The surgeon may attempt reconstruction of the arterial blood supply,
or remove veins when the cause is due to leakage. Less than 5% of men with
erectile dysfunction have such surgically treatable impotence!
Conclusion
When your quality of life is affected by sexual dysfunction, diabetogenic or otherwise, you should seek a physician’s help, preferably that of a carefully chosen specialist. Don’t wait for your doctor to ask you about sexual function -- talk about it! Nothing is cured by silence. Talk about it with your partner/spouse, too, as he/she is equally affected by this condition. Remember, you’re both involved, so your partner is integral to the relationship and deserves complete honesty. Relationships are solid only when couples consider each other’s feelings, so COMMUNICATE WITH YOUR PARTNER. Remember, man or woman, you are not alone; others have faced these difficulties. You do have options!
COMPANIES THAT MARKET IMPOTENCE THERAPY SYSTEMS
American Medical Systems, 10700 Bren Road West, Minnetonka, MN 55343; telephone: 1-800-328-3881; Web site: (www.visitams.com). They offer prosthetic devices.
Encore, Inc., 7696 15th Street East, Sarasota FL 34243; telephone: 1-800-221-6603. They offer vacuum constriction devices.
Mentor Corp., 501 Mentor Drive, Santa Barbara, CA 93111; telephone: 1-800-235-5731; Web site: (www.mentorcorp.com). They offer prosthetic devices.
Mission Pharmacal Co., 10999 IH-10 West Suite 1000, San Antonio, TX 78230; telephone: 1-800-531-3333; Web site: (www.missionpharmacal.com). They offer the VED line of vacuum constriction devices.
Soma Blue Corp., PO Box 10026, Augusta, GA 30903; telephone: 1-800-827-8382;
Web site: (www.somablue.com). They offer vacuum constriction devices.
Pfizer, Inc., 235 East 42nd Street, New York, NY 10017; Web site: (www.viagra.com). They offer the oral impotence medication Viagra.
Pos-T-Vac, 1701 N. 14th Street, PO Box 1436, Dodge City, KS 67801; telephone: 1-800-627-7434 or 1-800-279-7434; Web site: (www.postvac.com). They offer vacuum constriction devices and the “Rejoyn” support sleeve. See also www.rejoyn.com
TIMM Medical, PO Box 5679, Hopkins, MN 55343; telephone: 1-800-438-8592; Web site: (www.timmmedical.com). Successor to Osbon Medical Systems, they offer both vacuum constriction and prosthetic devices.
UROMETRICS, Inc., 2022 Ferry Road, Suite 3125, Anoka, MN 55303; telephone: 1-763-323-1968; fax: 1-763-323-1988; Web site: www.urometrics.com They offer the EROS-CTD device.
VIVUS, Inc., 605 E, Fairchild Drive, Mountain View, CA 94043; telephone: 1-650-934-5200; Web site: (www.vivus.com). They offer their noninvasive MUSE delivery system for the drug alprostadil (Caverject).
RESOURCE LIST OF INFORMATION AND SERVICES
Diabetes Action Network of the National Federation of the Blind, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911; Web site: (www.nfb.org/voice.htm). They offer other information pertinent to diabetes and its ramifications.
The Erectile Dysfunction Institute, 10949 Bren Road East, Minnetonka, MN 55343; telephone: (952) 852-5559 and (866) 563-2432; Web site: (www.cure-ed.com). They offer information, advice, and the location of trained specialists. Much useful information on their Web site.
National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: (www.nfb.org). Hours: 8:00 a.m. to 5:00 p.m. They offer advice about blindness, and a free book-length publication of this and other articles about ramifications of diabetes, in large print, or on 4-track audiocassette, titled: Diabetes Action Network Articles.
National Kidney and Urological Diseases Information Clearinghouse, #3 Information Way, Bethesda, MD 20892-3580; telephone: (301) 654-4415; Web site: (www.niddk.nih.gov/nkudic.htm). Part of the National Institutes of Health, they publish an “Impotence Fact Sheet,” free upon request.
Bibliography
Berman, Jennifer B. and Laura Berman. For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. New York: Henry Holt and Company, 2001.
Brassil, Donna F. and Jean H. Lewis. “Sex, Intimacy and the Kidney Patient.” Kidney Beginnings, June/July (2003): 6-8 and 26.
Diabetes UK: "Let's Talk About Sex." Balance Magazine (www.diabetes.org.uk/balance) #196, November/December 2003.
Laumann, E.O., A. Paik, and R.C. Rosen. “Sexual Dysfunction in the United States: Prevalence and Predictors.” Journal of the American Medical Association 281 (1999): 537-44.
Sarkadi, Anna, and Urban Rosenqvist. "Intimacy and Women With Type 2 Diabetes: An Exploratory Study Using Focus Group Interviews." The Diabetes Educator, Vol. 29, No. 4, July/August (2003): 641-652.
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“WHY ME?” IS NOT AN OPTION
by Vicki Graf
Includes photo of Vicki Graf
“Why not you? What makes you more special than anyone else, that you should be spared pain and suffering?” As the pastor spoke, his message shocked some members of the congregation. Many had never heard such words. The missive changed some lives forever. It was my good fortune to be a member of the congregation that Sunday morning. His straightforward, unforgettable message has served me well.
Diagnosed with type 1 in 1957, my clearest memory is of wailing, while running through a hospital hall. As the other pediatric patients celebrated one child’s birthday, the nurses denied me the delight of a scoop of chocolate ice cream. No matter what the situation, “No” is difficult for any four year old to accept. Denial of treats at a birthday party feels just plain wrong in a child’s eyes. I don’t remember what happened once I reached the comfort of my bed, but I’m sure I must have thought, why me?
It was another 28 years before the pastor’s wise words reached out to me. In the meantime, I was diagnosed with diabetic retinopathy, had a heart attack, and underwent quadruple coronary bypass surgery. “Why me?” was most certainly on my mind, as I faced blindness and heart disease before the age of 30. But the pastor’s message helped me realize that I’m no different than anyone else. Everyone is faced with adversity of some sort. The key to our survival is how we choose to react to our circumstances. It’s a matter of attitude.
Wallowing in self-pity gets us nowhere. Oh, sure, it feels good at first -- then what? Our physical health is affected by our mental condition, and before we know it, our overall health has deteriorated, tossing us into the eye of a downward spiral. Conversely, by choosing to confront our plight, we develop coping skills and, in the end, gain strength and confidence to face future health issues. At least that’s the theory while life is flowing smoothly. But do we lose this lesson when the pressure is on?
My reality, end-stage renal disease and dialysis, soon put me to the test. I will admit to a period of denial. In the beginning, I wanted nothing to do with any part of dialysis. I was confident a renal transplant was forthcoming. However, I quickly realized the hopelessness of that approach. After adding my name to the lengthy transplant waiting list at UCSD Medical Center in San Diego, Calif., I waited.
With time, I accepted my circumstance. I took as much control of my body as possible, and began complying with the rules and regs of dialysis--proper nutrition, fluid regulation, and exercise. The support I received from the medical staff and from my family and friends was invaluable.
I lived the reality of the pastor’s words. Never one to join diabetes support groups, I had lived a diabetic’s life alone. Suddenly, I found myself surrounded by people with similar health concerns, many struggling with more serious issues than my own. A “why me?” mindset would have been self-centered. The experience taught me compassion, leaving me grateful for having heard the pastor’s message.
Once I learned that valuable lesson, I was put to the test again. The wait was finally over. UCSD Transplant Center called me at 7:00 a.m., December 2, 1996. By 8 o’clock that evening, I was on my way to the operating room. Through warped time and fuzzy mind, I heard someone tell me the kidney was not functioning. Still, the doctors were optimistic. More than a test of my attitude, this had become the final exam of my fortitude. I almost failed.
After three and a half months of immunosuppressants, dialysis, biopsies, and an intense course of antibiotics for cyto-megalo virus, the kidney struck liquid gold. That may have been the happiest day of my life.
Seven years after that joyful experience, the kidney is still functioning, but the tests continue. Through cataract surgery -- one successful, one not -- and amputation of the toes on my left foot, I have seen no point in saying, “why me?”
From each health crisis, I emerge, equipped with stronger coping skills. By avoiding the “why me?” mindset, I rapidly recover from crises that, at their onset, seemed irreparable. That good attitude is one of the most valuable coping skills in my medicine cabinet. It has allowed me to move forward toward a more fulfilling life, to realize dreams I previously thought impossible.
Give serious thought to your options. Choose an attitude that is health-promoting in the long run. Whether you have many or few options, avoid the “why me?” mindset. Ultimately, if you strive to prevail, “why me?” at is not an option.
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LETTERS TO THE EDITOR
Includes art work: fancy writing pen
July 12, 2003
It is with great pleasure that I send this donation to you. I always look forward to reading each issue; very informative, upbeat interviews of success stories, and many other aspects of the publication bring me great enjoyment. Keep up the good work!
If someone would contact me, I’d like to help distributing in my area.
Sincerely,
Joan Granuzzo
Long Island, NY
*****************
July 14, 2003
I enjoy reading the Voice of the Diabetic. This latest issue’s article on “caring for your feet” was most informative. I pass the extra copies to Sisters here who have diabetes and I take the rest of the copies to our Diabetic Support Group that meets monthly. Thank you very much.
Gratefully,
Sister Marie Gangwish
Cincinnati, OH
*****************
July 14, 2003
The Voice of the Diabetic quarterly newspaper is easy to read, sensible and newsworthy. I appreciate receiving it -- every page is read!
Thank you so very much for this great and useful source.
Sincerely yours,
Prudence A. Mueller
Cayuga, NY
*****************
August 6, 2003
I get the magazine and enjoy it very much. I’m 82 years old and live alone. Thanks so much for the magazine. I read it all.
Lena Russell
Moravian Falls, NC
*****************
August 12, 2003
Please keep up the great work!
Sincerely,
James Birkett
Oshkosh, WI
*****************
August 15, 2003
Today I came across your publication quite by accident and I must say I am very impressed! In our facility we serve many diabetic amputees and those with foot wear/care needs, and I am very excited to offer your publication in our waiting room. Thank you for the opportunity to provide an excellent venue for information to our patients.
Jessica
McCall’s OTP Laboratory
St. Petersburg, FL
*****************
August 18, 2003
Thank you so much for the tapes. I really enjoyed them, there is so much information. Looking forward to more.
I would also like to continue to receive the print paper as I will let my family read it and then pass it on.
Thank you again.
Billie Jean McKenna
Parma, OH
*****************
August 18, 2003
I’m Warren and have really enjoyed reading and listening to Voice of the Diabetic. I’ve been diabetic for over 20 years, take my blood count and insulin about four or five times a day. I think it would be O.K. to help you distribute the Voice. Please consider that and call me anytime.
Thank you.
Warren Britain
Lakeland, FL
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NEW HYPOGLYCEMIA ALARM
Diabetes brings with it the risk of hypoglycemia, low blood sugar. Most often the result of imbalance between food, exercise, and medications, a "hypo," a low blood sugar reaction, can cause disorientation, unconsciousness, and sometimes, death. We're all at risk; those who use insulin are at greatest risk of a "low."
Sometimes a diabetic can miss the signals, for whatever reason, and can drop so low as to become incapable of taking any corrective action. The ambulance can become necessary -- assuming someone is there to call for it.
The trick is to never get that low.
Some of us need some help. There is a condition called "hypoglycemia unawareness," in which a diabetic loses the ability to tell that he or she is going down -- and the next sound you hear may be a siren.
What many of us need is an alarm, a device to warn us we're going low, when we cannot tell for ourselves. There is now such a device -- FDA approved.
Diabetes Sentry Products, from Bellingham, Washington, offers the Sleep Sentry, a wrist watch-sized device that sounds an audible warning whenever the wearer’s blood sugar drops too low. Not a blood glucose monitor, this noninvasive device meters changes in body temperature and sweat consistent with hypoglycemia, and sounds a warning in time for you to take action. It's like an "idiot light" for your body instead of your car.
The Sleep Sentry is completely noninvasive and continuous. There are no needles, wires or patches, and the only thing you'll need to replace is the battery, every few months or so.
The Sleep Sentry costs $399, shipping included, and may be ordered from: Diabetes Sentry Products Inc., 1200 Dupont St., Suite #1D, Bellingham, WA 98225; telephone: 1-866-270-5675; Web site: www.sleepsentry.com
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HEALTHY HOME COOKING
by JoAnna M. Lund
Hi, I’m JoAnna Lund and I specialize in creating what I fondly call “common folk” healthy recipes, intended for people with diabetes, heart/cholesterol concerns and anyone following just about any reputable eating plan. Best of all, everyone sitting at the table (even if they don’t have any health concerns) will love my creations because they taste so good! You may have enjoyed some of my recipes in the Recipe Corner of this fine publication or in my many cookbooks, including The Diabetic’s Healthy Exchanges Cookbook or The Diabetic’s Dessert Cookbook.
Each visit, during the coming year, I will be sharing several easy cooking tips to help you revise your own family favorites into healthier versions. I’ll also be revising one or two of your family favorites -- that is if you send them to me! While space won’t permit sharing the original recipe, I’ll compare my revised version to the original in nutrients. Also, I promise not to share your name or city, only your initials and state. So you don’t have to worry that your letters and notes to me will be made public.
In my cooking tips and recipes, I will be naming brands -- that is, what I consider to be those products that deliver the most flavor for the least amount of fats, sugars, sodium and cost that are easily available in my small town! If I don’t call for a specific brand, then any will do. I don’t have a relationship with these manufacturers and the brands are only intended as suggestions. If you choose to use another brand, that’s fine with me. Just remember that the final nutritional analysis could be different, especially if I call for Blue Bunny sugar- and fat-free ice cream and you use Ben & Jerry’s Premium instead!!!
First, though, let’s start with some easy cooking tips to help you keep your new year’s resolution to cook and eat healthier in 2004.
First, winter is normally a time to enjoy many casserole and soup dishes. How about an ultra-easy mix that’s ideal for substituting for canned creamed soups? To make JO’s Dry Casserole Soup Mix, all you need to do is combine 2 cups Carnation Nonfat Dry Milk Powder, 1 cup cornstarch, ½ cup dry bouillon (your choice of flavor), 5 teaspoons dry onion flakes, 1 tablespoon dry thyme, 1 tablespoon dry basil and 1 tablespoon black pepper. Store this in a covered container in a cool place. Anytime you want to use this instead of a (10-3/4 ounce) can of purchased cream soup, all you have to do is combine 1/3 cup of soup mixture and 1 cup of water. You’ll save both money and salt!
Second, to make your own sugar-and fat-free lemon yogurt, simply combine one small tub of Crystal Light Lemonade Mix and a 32-ounce container of plain non-fat yogurt. Mix well and store in the yogurt container. Use in any recipe that calls for lemon yogurt OR scoop ¾ cup of it into a dessert dish and enjoy! It only counts as 1 Fat Free Milk and there’s NO added sugar!
Third, you can make diet salad dressings taste more like the “real thing” by adding a small amount of fat-free mayonnaise and a pinch of sugar substitute to the diet dressing. Here’s a good starting point: Stir 1 teaspoon fat-free mayo and 1/2 teaspoon Splenda Granular into 2 tablespoons of purchased fat-free salad dressing. Drizzle this over your salad of choice and your taste buds will appreciate it from the very first bite!
Fourth, if you’d like to bake cookies or desserts like your mother did, but haven’t because her recipes called for sweetened condensed milk, I have a sugar-free version that will work just fine. In a 2 cup glass measuring cup, combine ½ cup water and 1 1/3 cups Carnation Nonfat Dry Milk Powder until it makes a smooth paste. Cover and microwave on HIGH (100% power) for 45 to 60 seconds or just until mixture is very hot but not to the boiling point. Stir in ½ cup Splenda Granular. Cover and refrigerate for at least two hours before using. This will keep for two weeks in your refrigerator. Use in any recipe that calls for sweetened condensed milk. It makes the equivalent of one (12-fluid-ounce) can of commercial brand.
Fifth, if you want to use a recipe that calls for ¼ cup of chopped nuts or less and you are reluctant to use it because you don’t want to bother getting the food processor, blender or nut chopper out (because you don’t want to take them apart later to wash them), then I have an ultra easy solution for you. Simply use Grandma’s food processor -- a biscuit cutter! Put the nuts in a small sturdy plastic bowl (even a Cool Whip container works great) and chop away with the biscuit cutter. When you are through chopping to the consistency you want, all you have to do is toss the biscuit cutter into the sink and it practically washes itself!
Sixth, if a recipe calls for fat-free cream cheese, do NOT ever use an electric mixer to soften it! Fat-free cream cheese is made with water and if you stir it too vigorously, you will release the water and whatever you’re making will end up a soupy mess. Instead, put the fat-free cream cheese (either tubs or bricks) in a large bowl, get out a sturdy plastic mixing spoon and stir for 30 to 45 seconds -- 30 for the tubs and 45 for the bricks. Now, add whatever other ingredients the recipe calls for. Your finished product will look as good as it tastes. If you’ve purchased fat-free cream cheese in the past and used an electric mixer, then blamed the cream cheese for turning soupy, now you know it wasn’t the cheese, it was the cook that caused the problem!
Now for our recipe makeovers.
JR of Texas sent me a cheesecake to “lighten up” because she has
diabetes and her husband has high cholesterol. They both wanted to be able
to enjoy their favorite dessert without guilt. By the time I was through, my
version was less than half the calories but still had all the flavor!
Cherries Ahoy Cheesecake
Ingredients:
2 (8-ounce) packages Philadelphia fat-free cream cheese
1 (4-serving) package JELL-O sugar-free instant vanilla pudding mix
2/3 cup Carnation Nonfat Dry Milk Powder
1 cup water
1 cup Cool Whip Lite
1 (6-ounce) Keebler chocolate pie crust
1 (20-ounce) can Lucky Leaf No Sugar Added Cherry Pie Filling
1 teaspoon almond extract
2 tablespoons slivered almonds
1 tablespoon mini chocolate chips
Instructions:
In a large bowl, stir cream cheese with a sturdy spoon until soft. Add dry pudding mix, dry milk powder, and water. Mix well using a wire whisk. Blend in ¼ cup Cool Whip Lite. Spread mixture into pie crust. Refrigerate while preparing topping. In a medium bowl, combine cherry pie filling and almond extract. Evenly spoon pie filling mixture over set filling. Drop remaining Cool Whip Lite by tablespoonful to form eight mounds. Evenly sprinkle almonds and chocolate chips over top. Refrigerate for at least 30 minutes. Cut into eight servings.
Each serving equals:
238 Calories, 7 gm fat, 12 gm protein, 33 gm carbo., 575 mg sodium, 2 gm fiber; Diabetic Exchanges: 1 Starch/Carbo., 1 Fruit, 1 Meat, 1 Fat
Let’s Compare: The original recipe was 538 calories, 31 gm fat, and 54 gm carbohydrate. Quite a difference. Now you can enjoy without guilt!
SM of Oklahoma sent me a main dish recipe to revise. He says he does the cooking in his family and he likes his recipes easy and filling. Well, they don’t get much easier than this and my husband Cliff said it was a very filling meal. That’s two for two!!
Hamburger Hot Dish
Ingredients:
16 ounces ground extra-lean sirloin beef or turkey breast
1 (10-¾ ounce) can Healthy Request Tomato Soup
1 1/2 cups frozen whole-kernel corn, thawed
1 1/2 cups frozen green beans, thawed
1 cup diced cooked potatoes
1/2 cup shredded Kraft reduced-fat Cheddar cheese
Instructions:
Preheat oven to 350 degrees. Spray an 8-by-12-inch baking dish with butter-flavored cooking spray. In a large skillet sprayed with butter-flavored cooking spray, brown meat. Stir in tomato soup. Add corn, green beans and potatoes. Mix well to combine. Spread mixture into prepared baking dish. Evenly sprinkle Cheddar cheese over top. Bake for 25 to 30 minutes. Divide into six servings. Freezes well.
Each serving equals:
238 calories, 6 gm fat, 20 gm protein, 26 gm carbo., 324 mg sodium, 2 gm fiber; Diabetic Exchanges: 2 Meat, 1 Starch, 1/2 Vegetable
Let’s Compare: The original recipe was 364 calories, 18gm fat, and 28gm carbo. That’s a savings of well over 100 calories and 12 grams of fat. Perfect for all those meat & potato guys who thought they couldn’t enjoy dishes like this anymore!
I hope you enjoyed our time together in the kitchen. Remember, if you’d like me to revise one of your family favorites so that it’s healthier, send your request to: JoAnna Lund, c/o Voice of the Diabetic, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203. Also, be sure to visit my Web site at www.healthyexchanges.com for more “common folk” healthy recipes to try. See you next time!
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RECIPE CORNER
Includes drawing of fruits and vegetables
This issue, all the recipes are from The Diabetic’s Healthy Exchanges Cookbook, by JoAnna M. Lund, published by Perigee. Reprinted with permission. Contact Healthy Exchanges at telephone: (319) 659-8234; Web site: www.healthyexchanges.com
Super Salad Bowl
This one is so filling you could serve it with pride to the hungriest couch potato quarterback you know ... even during Super Bowl halftime!
Ingredients:
2 cups chopped fresh broccoli
2 cups chopped fresh cauliflower
1 cup sliced carrots
1 cup sliced celery
1/2 cup chopped green bell pepper
2 cups cherry tomatoes
1-1/2 cups sliced fresh mushrooms
1 cup Kraft Fat-Free Italian Dressing
1/4 cup Hormel Bacon Bits
2 tablespoons grated Kraft Fat-Free Parmesan Cheese
Instructions:
In a large bowl, combine broccoli, cauliflower, carrots, celery, green pepper, cherry tomatoes, and mushrooms. In a small bowl, combine Italian dressing, bacon bits, and Parmesan cheese. Add dressing mixture to vegetable mixture. Mix gently to combine. Cover and refrigerate at least 30 minutes. Gently stir again, just before serving. Makes 8 one-cup servings.
Each serving equals:
Exchanges: 2-1/2 Vegetable.
85 calories. 1 gm Fat. 4 gm Protein. 15 gm Carbohydrate. 501 mg Sodium. 2 gm Fiber.
Corn-Veggie Chowder
Ingredients:
2 cups (10 ounces) diced raw potatoes
1 cup diced carrots
1 cup diced celery
1/2 cup chopped onion
2 cups (one 16-ounce can) Healthy Request Chicken Broth
1/2 cup (one 2.5-ounce jar) sliced mushrooms, drained
2 cups (one 16-ounce can) cream-style corn
1-1/2 cups (one 12-fluid-ounce can) Carnation Evaporated Skin Milk
3/4 cup (3 ounces) shredded Kraft Reduced-Fat Cheddar Cheese
1/8 teaspoon black pepper
2 tablespoons Hormel Bacon Bits
Instructions:
In a medium saucepan, combine potatoes, carrots, celery, onion, and chicken broth. Cook over medium heat 15 minutes or until vegetables are tender. Lower heat. Stir in mushrooms, corn, evaporated skim milk, Cheddar cheese, and black pepper. Continue cooking five minutes or until cheese melts, stirring often. Just before serving, stir in bacon bits. Makes six 1-1/3 cup servings.
Each serving equals:
Exchanges: 1-1/2 Starch. 1/2 Vegetable. 1/2 Meat. 1/2 Skim Milk.
236 Calories. 4 gm Fat. 14 gm Protein. 36 gm Carbohydrate. 710 mg Sodium. 2 gm Fiber.
Hot Spiced Cider
Ingredients:
4 cups unsweetened apple juice
1/4 cup Brown Sugar Twin
1 cup water
1 teaspoon apple pie sauce
Instructions:
In a medium saucepan, combine apple juice, Brown Sugar Twin, and water. Bring mixture to a boil. Stir in apple pie spice. Lower heat and simmer 30 minutes. Makes eight half-cup servings.
Each serving equals:
Exchanges: 1 Fruit.
60 Calories. 0 gm Fat. 0 gm Protein. 15 gm Carbohydrate. 7 mg Sodium. 0 gm
Fiber.
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DO YOU WANT TO CONTINUE RECEIVING VOICE OF THE DIABETIC?
By Ed Bryant, Editor
The Voice offers support and information, free of charge, to more than 325,000 people interested in diabetes and its complications. We cover all aspects of diabetes in the Voice, and we show folks they do have options and are not alone. We give it away, because we know you need it -- and we need to make sure the money YOU donate is used wisely. Tell us -- do you want to continue receiving Voice of the Diabetic?
If you want to continue receiving the Voice, free of charge, or to start subscribing, please respond to the coupon below, by mail, fax, or email. We need to hear from YOU.
----------------------------------------------------------------------------------------------------
YES! I want to continue receiving Voice of the Diabetic. _____
Name ______________________________________________
Address ____________________________________________
Address ____________________________________________
City _________________________ State _____ Zip _________
telephone ___________________________________________
Please return this form to: Ed Bryant
VOICE OF THE DIABETIC
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
Email: [email protected]
Email: [email protected]
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BOOK REVIEWS
by Marilyn Helton
Greetings and welcome to 2004! Beginning with this issue, you'll notice some changes in the format and number of book reviews you'll be seeing in each issue. The good news is, you'll be seeing more reviews in each issue; the not-so-good news is they will be somewhat shorter in length. We have quite a backlog of excellent books to share with you, so this new format should help to bring us up to date.
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You're probably among those lamenting a 7 to 10 pound average holiday weight gain. Don't waste any more time chastising yourself for it, just get down to the business of taking care of it! Some good starting points for weight loss can be found in 101 Weight Loss Tips for Preventing and Controlling Diabetes, by Amy Daly, MS, RD, CDE, Linda Delahanty, MS, RD, LD, and Judith Wylie-Rosett, EdD, RD.
With so many weight loss programs for sale these days, it's becoming an art to maneuver yourself through the madness of the tricky diet maze. If you're ready for a simple plan to support good health for the rest of your life, you'll find most of the answers in this book, written by three experts in the fields of nutrition and diabetes.
101 Weight Loss Tips also covers topics such as: how to evaluate a weight loss program, identifying your high risk stages of life, whether weight loss drugs or surgery are right for you, how your emotions figure in the "food triangle" and other roadblocks to weight loss, why exercise may be the magic key, and more. Presented in a simple question-answer format, this American Diabetes Association publication is easy to digest and a great start on the road to your weight loss success. Softcover, 114 pages.
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They don't call it "middle-age spread" for nothing, and if you're in the 50+ age group, you'll probably be interested in 101 Tips for Aging Well with Diabetes, another book in the best-selling series of self-care books published by the American Diabetes Association.
Written by David B. Kelley, MD, Aging Well with Diabetes was written to give maturing people with diabetes guidance to improve their lifestyles. Topics such as glucose levels, medications, exercise, risks and complications, foot care, neuropathy, nephropathy, menopause, Syndrome X, diminishing appetite, alcohol consumption, family support and more are addressed in a way that is easy to understand and follow. Aging well and staying healthy are challenges for everyone, and even more challenging when you have diabetes.
Answers to questions such as: "Am I alone with my diabetes? What factors affect my glucose levels? How do diabetes pills work? Why would I learn to count carbs? Am I too old to exercise? How do I manage diabetes when I'm sick?, and why did my spouse's personality really change after the diagnosis of diabetes?" are among those explored in detail. Published in softcover; 128 pages.
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No journey would be complete without a good overall tips book, like 101 Tips for Coping with Diabetes. Written by a dynamite team of experts, this book covers stress management, anger, depression, emergencies, emotional issues, healthy habits for busy schedules, and more. Authors Gary M. Arsham, MD, PhD, Catherine Feste, BA, David Marrero, PhD, Richard R. Rubin, PhD, CDE, and Stefan H. Rubin contribute more than 200 years of combined experience with diabetes to this publication. Four of the authors have diabetes, and the fifth has lived for more than 40 years with diabetes in the family.
Did you know that the stress of living with a chronic disease (such as diabetes) can actually cause out-of-control blood sugar levels? By increasing your diabetes knowledge and building emotional coping skills, you'll be better able to steer clear of dangerous "coping" habits such as drinking, smoking, or eating too much. In 101 Tips for Coping with Diabetes, you'll learn how to replace these addictive habits with healthier ways to deal with your issues, which is bound to improve every aspect of your life.
Having type 2 diabetes myself, I readily identified with several common issues which affect my control, such as: "I worry that I'll go low while exercising; how do I adjust my insulin so this doesn't happen?" Or, "How can I keep from getting really scared every time my blood sugar goes too low?" And, "How can I avoid overeating when I am low?"
This tips book, one of the best in this self-care series, gives straightforward answers to the most common questions and lets you know it's possible to cope well with the scheduled and unscheduled demands of your disease. Published by the American Diabetes Association, in softcover; 120 pages. Highly recommended.
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While you're on your weight-loss journey, you'll need to pack a couple of good recipe sources, so I've tucked a couple of cookbooks into this review mix. Here are two brand new releases you're destined to love.
If you've finally graduated from diabetic exchanges to counting carbs, you'll be happy with Quick and Easy Low-Carb Cooking for People with Diabetes, by Nancy S. Hughes.
With hectic schedules and little time to cook (holidays or otherwise), it can be difficult to find the time and energy to do the food math required by low-carb "diets" (don't you just hate that four-letter word, d-i-e-t?) Being a great fan of Nancy Hughes' recipes, I'm always thrilled to see another new cookbook from her. Once again, she's come to the rescue with a new publication chock-full of tasty choices for low-carb eaters and people with diabetes. Says Hughes, "These recipes are geared for the real (that is busy) lives that we all lead. You can throw your calculator in a drawer because, I've done the homework for you!" She continues, "I've kept the ingredient lists short and the prep time even shorter."
Quick and Easy Low-Carb Cooking is divided into five sections (breakfasts, lunches, dinners, desserts and snacks), and is based on the "carb choice" exchange system. All recipes have the carbs calculated per serving and in addition to a complete nutritional analysis, traditional diabetic exchanges are also available, for those who have not adopted "carb-counting." As a time-pressured cook myself, I appreciate the "try it with" section which suggests possible sides with each meal. My salivary juices start flowing with recipe titles like Rustic Cajun Chicken and Sausage Rice, Creamy Baked Chicken with Crunchy Corn Bread Topping, Sticky Maple Pecan Pull-Aparts, Weekend Morning Bacon-Potato Casserole Cheddary Vegetables au Gratin, and Lemon Zest Pound Cake with Apricot Topping. Where's my apron?
Published by the American Diabetes Association, Quick and Easy Low-Carb Cooking by Nancy Hughes is another sure keeper.
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Speaking of carb-counting, the new Better Homes and Gardens Carb Counters Diabetic Cookbook is another winner. With an introduction by Hope S. Warshaw, MMSc, RD, CDE, co-author of the American Diabetes Association's Complete Guide to Carb Counting and The Diabetes Food and Nutrition Bible, carb-counting is made easy.
The Carb Counters Diabetic Cookbook begins with Warshaw's introduction to the basics of counting carbohydrates. Written in a question-answer format, Warshaw's explanation of carb-counting is thorough and easy to understand. Carbohydrates are found in all foods (starches, fruits, vegetables, and milk) except meats. The book contains a handy chart on the number of carbohydrates your body needs each day. This chart is a great visual aid to help you understanding how the carb-counting system works. Sample menus for a full week of breakfast, lunch, and dinners, based on 1,600 to 1,800 calories per day, are suggested at the end of the section. For more information, you'll find several Internet and other resources, as well.
Each recipe includes a complete carb count, nutritional analysis, and diabetic exchanges. There is a definite drawback, however, a difficulty reading the nutritional information, as it is printed in a lime-green color, and in very small print. It's a real problem for visually-impaired readers.
If you can live with carb counts at a glance for each analysis, the recipes are worth it! And, if you've visited the Cinnamon Hearts Web site in recent months, you'll see how much we like this cookbook. More than a few of these delicious recipes have starred in several of our recent food features. Better Homes and Gardens Carb Counters Diabetic Cookbook, (c)2003, is published by the Meredith Corporation, Des Moines, IA.
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What if you just don't have time to cook, and have to eat out? You'll need a reliable guide to healthier restaurant eating. Here's the ticket: Eat Out, Eat Right! by Hope S. Warshaw, MMSc, RD, CDE.
Having spent the last 20 years advising clients on navigating the pleasures and pitfalls of restaurant menus, Hope S. Warshaw is a nationally-recognized expert on diabetes and healthy eating out. In Eat Out, Eat Right!, published by Surrey Books, she has managed to condense her knowledge of what's good and what's not good for you into one compact resource.
Covering the 14 most popular kinds of restaurants (including Mexican, Italian, Chinese, American, breakfast/brunch, fast food and seafood), Eat Out, Eat Right! gives you basic strategies and specific food choices for controlling calories, carbs, fat, cholesterol, and sodium amounts in restaurant foods. Each chapter familiarizes the diner with the nutrition traits and pitfalls of a particular style of cooking. "Pre-planning is key," says Warshaw. "Do you go to your favorite Mexican restaurant and order chimichangas or enchiladas? Do you go to the ballpark ready for a jumbo hot dog, chips, and ice cream or will popcorn and a slice of pizza do?"
One of book's best assets is its Menu Profile, a basic description of each cuisine, its healthy points and hazardous pitfalls, along with a run-through of what to order (and not to order), from soup to dessert. Following the detailed description of the cuisine's typical fare, author Warshaw gives the reader a "Nutrition Snapshot" which is a quick look at some of the nutrition numbers for a cuisine's typical dishes. You'll also find green flag (good) words, such as "lightly sautéed," and red flag (bad) words, such as "fried," about each cuisine, along with "special requests to make to the waiter," which are designed to help you make the healthiest choices.
With Eat Out, Eat Right! you can plan ahead by "studying-up" on a specific cuisine before you go to the restaurant, or slip this compact book into your purse or the glove box of your car for no-excuses dining out.
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That's a wrap for this issue, folks! I can't wait to bring more exciting reading your way in the Spring issue -- A great time to turn to more thoughts on new beginnings. In the meantime, stay focused and in the moment; it's the best place to be!
Marilyn Helton, diabetic since 1993, is the publisher of Cinnamon Hearts: The Art of Living a Winning Diabetic Lifestyle, a positive-power E-zine for diabetics and their families. Visit the Cinnamon Hearts Web site: www.cinnamonhearts.com.
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WHAT YOU ALWAYS WANTED TO KNOW BUT DIDN'T KNOW WHERE TO ASK
(Resource Column)
Includes Art: Hand removing book from shelf.
Inclusion of materials in this publication is for information only and does not imply endorsement by the Diabetes Action Network of the NFB.
New Email Diabetes List
Our Diabetes Action Network now offers its own listserv: [email protected]. Although its primary focus is on blindness and diabetes, any and all discussions concerning diabetes are welcome. We welcome topics like: diet, devices, healthcare, diabetes control, and how to improve the Voice of the Diabetic. Remember, please do not give any direct medical advice, unless you are a medical professional. Membership is free.
There are two ways to sign up. You can go to the following Web site: www.nfbnet.org/mailman.listinfo/diabetes-talk or you can sign up by email, by sending a message to: [email protected] and putting “subscribe” in the subject line.
Tax Help
For assistance with completing your year 2003 tax forms, you can telephone the Internal Revenue Service, toll-free: 1-800-829-1040; Web site: www.irs.ustreas.gov/prod/forms_pubs
Large Print Books
Many people keep up with the latest bestsellers through book clubs. They’re bargains. The problem has been all the books came in standard print, and some of us need something bigger. Doubleday, a major book publisher, has come to the rescue. Check out the Doubleday Large Print Book Club. All text is 14 point or larger, and the books are up to 30% cheaper than publisher’s list price. Get your bestsellers in a font you can read more easily. Contact: Doubleday Large Print Book Club, PO Box 6338, Camp Hill, PA 17001-9058; Web site: www.joinDLP.com
Adaptive Computing Equipment
Freedom Scientific is a powerhouse adaptive equipment maker for the blind and visually impaired computer user. A union of Arkenstone, Blazie Engineering, and Henter-Joyce, Freedom Scientific offers screen magnifiers (including MAGic 9 software, which both magnifies up to 16x and speaks the words on the screen), talking attachments (voice synthesizers) for your computer, Braille printers and much more. Whether you need adaptive software or hardware, check them out: Freedom Scientific; telephone: 1-800-444-4443; Web site: www.freedomscientific.com
Full Service Diabetes Supplier
Access Diabetic Supply promises free delivery, no paperwork, and free in-home training in the use of blood glucose testing devices. Your private insurance is welcome, and they accept Medicare, too. They offer free blood glucose monitors to folks who sign up. Check them out on line: www.diabeticsupply.com or call: 1-800-713-7062.
HEAR YE, HEAR YE, A RAFFLE
The Diabetes Action Network of the National Federation of the Blind reaches out and provides support and information to thousands of people. Because it costs to operate this valuable network and to produce the Voice of the Diabetic, we must generate funds to help cover these expenses. Our Diabetes Action Network has elected to hold a raffle.
THE GRAND PRIZE WILL BE $500! The winning ticket will be drawn, and the winner's name announced, on July 4, 2004, at the banquet held during the annual convention of the National Federation of the Blind.
Raffle tickets cost $1 each, or a book of six may be purchased for $5. Tickets may be purchased from state representatives of our Diabetes Action Network or by contacting the Voice Editorial Office, 1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911. Anyone interested in selling tickets should also contact the Voice Editorial Office. Tickets are available now! Names of persons who sell 50 tickets or more will be announced in the Voice.
Please make checks payable to the National Federation of the Blind. Money and sold raffle ticket stubs must be mailed to the Voice office no later than June 10, 2004, or they can be personally delivered to Voice Editor Ed Bryant, at this year's NFB convention in Atlanta, Georgia. This raffle is open to anyone age 18 or older, and the holder of the lucky raffle ticket need not be present to win. Each ticket sold is a donation, helping keep our Diabetes Action Network moving forward.
Relief
Many diabetics suffer from dry feet. It "goes with the territory." They hurt, they itch, they dry out and crack, and you need to do something about it. Sometimes neuropathy, nerve inflammation, in your feet can really drive you 'round the bend. But Steuart Laboratories offers help. Steuart's Foot Cream, with melalenca oil, is excellent for dry diabetic feet. Steuart's CNS Liposomes offers relief from neuropathy; also good for back, muscle, and joint pain. Prices (2 oz. jar): $9.25 plus shipping for the Foot Cream; $19.80 for the CNS Liposomes. Contact: Steuart Laboratories, PO Box 297, Harmony, MN 55939; telephone: 1-800-210-9665; Web site: www.steuartlabs.com
Healthy Cookbooks
JoAnna Lund writes healthy cookbooks. They are simple, “common folks” recipes, and all contain both complete nutrient counts and diabetic exchanges. There are three titles: Fast, Cheap, and Easy; Grandma Jo’s Soup Kettle; and Fresh From the Hearth. Price is $10 each, or $25 for all three. There is no shipping charge. Contact: Healthy Exchanges, PO Box 80, DeWitt, IA 52742; telephone: 1-800-766-8961; Web site: www.healthyexchanges.com
New Diabetes Resource List
The Diabetes Action Network of the National Federation of the Blind will
shortly offer the 2004-2005 edition of Diabetes Resources: Equipment, Services
and Information, our comprehensive list of resources for diabetics. Diabetes
Resources is our compilation of companies and individuals offering products
and/or information to help diabetics, especially those who are blind or are
losing vision, self-manage their diabetes. The list contains many subject categories,
including: Insulin Measurement Devices, Insulin Syringe Magnifiers, Insulin
Injection Systems, Diabetic Foot Care, Blood Glucose Monitoring Systems, Insulin
Pumps, Products for the Blind, Food and Diet, Literature and Information, Distributors
of Diabetes Equipment and Supplies, and Medication Assistance.
Blind diabetics can and do accurately draw up insulin, monitor blood glucose,
and perform the other tasks of independent self-management. By using alternative
techniques and products, they can continue being independent, and control their
diabetes as efficiently as do their sighted peers. Limitations are usually
self-imposed--often all that is needed to overcome negative thinking is simply
to know where to go for information.
Diabetes Resources: Equipment, Services, and Information (2004-2005 Edition)
will cost $5 per copy, and will be available in Braille, large print, and audiocassette
(recorded at 15/16 IPS for the blind), after February 1, or you can access
it on the NFB Web site: www.nfb.org/diabres
Please order from: National Federation of the Blind, Materials Center, 1800
Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. Note: the NFB
Materials Center is open weekdays 8 am to 5 pm Eastern time.
Diabetes Supplies
American Diabetic Supply, Inc., will ship your diabetes supplies to your door. They handle all insurance claims and provide free delivery. Folks with Medicare and/or private insurance (no HMOs) may receive supplies with no further cost. For information, contact: American Diabetic Supply, Inc., 400 S. Atlantic Ave., Suite 108, Ormond Beach, FL 32176; telephone: 1-800-453-9033; Web site: www.americandiabeticsupply.com.
Treat Male Impotence
Diabetes can produce male sexual dysfunction/impotence, but very often this condition is treatable. For many men, vacuum therapy may be the best choice -- and it requires no drugs or medications. Augusta Medical Systems offers SomaTherapy-ED, effective, drug-free, and lifetime guaranteed. They’ll send you a free patient information kit. For information, telephone: 1-800-827-8382.
Free Diabetes Literature
The National Federation of the Blind maintains an extensive literature collection, with free materials on many subjects available in a variety of formats. Twenty-three articles on aspects of diabetes, all previously published in the Voice, regularly updated, have been assembled into a single volume, available in large print and four-track audiocassette, titled: “Diabetes Action Network Articles.” Both formats are free of charge. To order, or to request a complete NFB literature catalog, contact: NFB Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. You may also order by email: [email protected] The Materials Center is open 8:00 pm to 5 pm, EST, weekdays.
Full Service Diabetes Supplier
DS Medical Supply is a full-service supplier with a catalog of more than 55,000 items, dealing with diabetes, its complications, and many other medical supplies, delivered to your home. Diabetes products range from glucose monitors by Bayer and LifeScan, and the AccuChek VoiceMate talking glucose monitor, strips, lancets and other supplies, to diabetic orthotics/foot care items, and much more. They accept Medicare, private insurance, some HMOs, and, in most states, direct or crossover Medicaid. Contact: DS Medical, 2105 Newport Place, Suite 600, Lawrenceville, GA 30043-5561; telephone: 1-888-724-4357, Web site: www.dsmedical.com
Keynote Address
Every year, during the first week of July, our Diabetes Action Network holds its national seminar and business meeting, during the annual convention of the National Federation of the Blind. Every year, we seek an individual prominent in diabetes to address our seminar. This year, 2004, we will meet in Atlanta, Georgia, which, incidentally, is home to the U.S. Centers for Disease Control (CDC). Dr. Frank Vinicor heads the CDC’s Division of Diabetes Translation, and he will present the keynote address, on the future of diabetes control. He will be accompanied by ophthalmologist Dr. Jinan Saaddine. Join us, at the Atlanta Marriott Marquis, 265 Peachtree Center Avenue, Atlanta, GA 30303; telephone: (404) 521-0000.
Voice Formats
Voice of the Diabetic is offered in two formats: standard print, and 15/16 IPS audiocassette, "talking book" speed. Anyone who is currently receiving the Voice in print and having difficulty reading it, may receive it on cassette at no charge. Voice tapes require the special tape player available free to the legally blind from Regional Libraries for the Blind and Physically Handicapped, which can be obtained by telephoning the National Library Service at: 1-800-424-8567. Note: Attempting to play Voice tapes (or any other tapes recorded in NLS format) on a conventional music-speed tape player will yield incomprehensible "chipmunk sounds."
The Voice is also available by email, distributed quarterly. Go to: www.nfbcal.org/listserv-signup.html to sign up.
Periodically we receive requests for the Voice in Braille or large print. It is not available in either of those formats at this time.
All a subscriber needs to do, to switch from standard print to tape, or to receive both formats, free of charge, is contact us at the Voice of the Diabetic Editorial Office.
Diabetic Supplies Online
Pharmacist Bryan Luna, Rph, offers diabetes supplies, including glucose monitors, online at www.diabeticsupplies.com. This convenient Web site is simply laid out, and can be accessed in large print, too. For those without the internet, telephone: 1-877-787-7543. They will file your Medicare, Medicaid, and private insurance forms. Free product catalog; 30-day money-back guarantee.
To Our Readers
To hold down costs, both the Voice and many of our divisional mailings are sent via "bulk mail." When we have your current address, this works very well, but when we don't, the Post Office throws the Voice away, or returns it to us with a hefty "postage due" attached. They do NOT automatically forward bulk mail!
If you move, please let us know promptly. If the Voice doesn't follow you to your new address, we may not have your new address. Don't miss a single issue.
Diabetic Foot Information on Tape
Podiatrist Kenneth B. Rehm, DPM, limits his practice to the diabetic foot, and he has a great deal of useful information to impart. On July 6, 2002, he addressed the Diabetes Action Network’s annual meeting, and we recorded his speech. Titled: “Diabetes, Neuropathy, and The Feet,” it is now available, on normal-speed audiocassette, for $2 per copy, from: National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org
New Diabetic Exchange List
The “exchange system” has been around for years. A generation of diabetics, blind and sighted, grew up using the American Diabetes Association’s (ADA) Exchange List for Meal Planning. The National Federation of the Blind offered the ADA Exchange List in accessible format, Braille and 4-track audiocassette.
The ADA Exchange List has been revised and enlarged. The new 2003 version now deals with carbohydrate counting, with fast foods, and with substitutions. The meal planning lists have been reworked, and there are new categories.
For a copy of the Exchange List for Meal Planning, 2003, in standard print, contact the ADA: telephone: 1-800-232-3472; Web site: www.diabetes.org/health/nutrition/exchangelist.jsp. For a copy in alternative format (Braille, $10, or 4-track audiocassette, $2), contact the National Federation of the Blind, Materials Center, 1800 Johnson Street, Baltimore MD 21230; telephone: (410) 659-9314; Web site: www.nfb.org
Diabetes Supplies
Do you get tired of having to "shop around" for your various diabetes items? "Go to this place for these; to that place for those ..." Do something about it. Check out diabetesstore.com, the leading online source for discount diabetes products. Contact them by telephone: 1-800-891-9399; or Web site: www.diabetesstore.com
Easy Diabetic Cookbook
If you want to prepare healthy diabetic meals, but find most cookbooks just too complicated, you need Linda Coffee and Emily Cale's new and improved Diabetic 4 Ingredient Cookbook. There are almost twice as many recipes as before, 350, in all food categories, with complete nutritional and exchange information, each one using four ingredients. The book costs $19.95 (+$3.50 shipping), from: Coffee and Cale, PO Box 2121, Kerrville, TX 78029; telephone: 1-800-757-0838; www.fouringredientcookbook.com
Articles Needed
If you have diabetes, are a family member or friend of a diabetic, or a health professional with an interest in diabetes, we invite you to submit an article for publication in the Voice of the Diabetic.
Our philosophy regarding diabetes is positive. Do you have an inspiring, enlightening story? We, the Diabetes Action Network of the National Federation of the Blind, seek to show people they are not alone, and do have options, regardless of diabetic complications. If you have experienced ramifications, others, who may be facing the same side-effects, could benefit from what you have to say.
Perhaps you have not experienced complications--your unique insight, coping
strategies, and lifestyle can still inspire others. Are you a relative, a friend,
or a health professional? More than 329,433 Voice readers could benefit from
your story.
For information and article submission guidelines, contact: Voice of the Diabetic,
1412 I-70 Drive SW, Suite C, Columbia, MO 65203; telephone: (573) 875-8911.
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SUBSCRIPTION/DONATION FORM
The Voice of the Diabetic is a quarterly magazine published by the Diabetes Action Network of the National Federation of the Blind (NFB) for anyone interested in diabetes, especially diabetics who are blind or are losing vision. An outreach publication, it emphasizes good diabetes control, diet, and independence.
Donations are gladly accepted and appreciated. Contributions are not only tax deductible but are needed to keep the Voice and the Diabetes Action Network moving forward to help people with all aspects of diabetes.
Members of the NFB Diabetes Action Network enjoy priority services and unique benefits such as a continuous free subscription to the Voice, automatic access to committees covering all aspects of diabetes, free counseling concerning all facets of blindness and diabetes, as well as access to diabetics who have experienced complications.
The Voice is free to any interested person upon request. Each subscription costs the Diabetes Action Network approximately $20.00 per year. To help defray publication expenses, members are invited, and nonmembers are encouraged, to cover the subscription cost.
To begin receiving the Voice, please check one:
[ ] I would like to become a member of the NFB Diabetes Action Network and receive the Voice of the Diabetic. (Members are entitled to special benefits.)
[ ] I would like to receive the Voice of the Diabetic as a nonmember. (Nonmembers are encouraged to pay the institutional rate of $20/one year; $35/two years; $50/three years.)
Send the Voice in (check one):
[ ] print [ ] cassette tape for the blind [ ] both
and physically handicapped
(recorded at slower-than-
standard speed of 15/16 IPS)
Optionally check this box:
[ ] I would like to make (or add) a tax-deductible contribution of $__________ to the Diabetes Action Network of the National Federation of the Blind.
PLEASE PRINT CLEARLY
Name:_____________________________________________________
Address:__________________________________________________
__________________________________________________
City:_______________________ State:______ Zip:__________
Telephone: ( )________________________
Send this form or a facsimile to:
Voice of the Diabetic
1412 I-70 Drive SW, Suite C
Columbia, MO 65203
Telephone: (573) 875-8911
Fax: (573) 875-8902
Please make all checks payable to:
NATIONAL FEDERATION OF THE BLIND
(V19#1)
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