February/March 2013

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Diabetes - The Medical Perspective

Celiac disease is an autoimmune disorder. An individual with celiac disease cannot tolerate gluten, a protein found in wheat, rye, and barley. Type 1 Diabetes, like celiac disease, is also an autoimmune disease.

According to the American Diabetes Association, the overall incidence of celiac disease worldwide is estimated to be 1 person in 250, but as high as 1 in 20 for people with type 1 diabetes. As with most autoimmune diseases, including type 1 diabetes, something needs to “trigger” the onset of celiac. Examples of “triggers” are illness or infection, stress, surgery, and pregnancy.

Symptoms of Celiac Disease

• Diarrhea
• Abdominal pain
• Bloating
• Vomiting
• Lack of appetite
• Failure to thrive (in children)

Less Common Symptoms

• Anemia
• Osteopenia (low bone density)
• Fatty liver
• Recurrent miscarriages
• Short stature (in children)
• Skin rash
• Unexplained hypoglycemia (in people with diabetes)

There is no pharmaceutical treatment for celiac disease. The only way to avoid symptoms is by following a strictly gluten-free diet. Wheat, barley, and rye are all foods that contain gluten. Gluten is a protein in the starch. It is what gives elasticity to dough, helping it rise and keep its shape and often gives the final product a chewy texture.

People who need to avoid gluten also avoid oats because they are often processed on the same equipment or in the same facility as starches that contain gluten. Corn, potatoes, rice and tapioca are all starches that can be eaten while on a gluten-free diet. While gluten-free diets can be healthy, they are not necessary for people who do not have celiac disease, whether they have diabetes or not. Wheat, barley, and rye products contain vitamins, minerals, and fiber and are part of a healthy, well balanced diet

Medication Update

Corticosteroids are often prescribed to treat arthritis, allergic reactions, and autoimmune conditions among many other uses. Corticosteroids such as Prednisone are also called “glucocorticoids” because of their effects on glucose metabolism. Blood glucose levels will rise in individuals with diabetes while they are taking steroids.

People with diabetes who are prescribed to corticosteroids should talk to their doctors to see if changes need to be made with their diabetes medication while they are taking the corticosteroids. If you take insulin, you may need to increase the dose. A common increase is about 20%, often referred to as a “sick-day booster.”

If you take pills, you may need to increase the dose, add another type of pill, or possibly even take insulin temporarily. Changes to your medications will depend on how your glucose levels are affected by the corticosteroids.

While taking corticosteroids, you will need to check your blood sugar regularly. You may need to check it more often than usual. Four or more times a day is common.

Some oral drugs take as long as four to six weeks to have effects on lowering blood glucose, so faster-acting medication to lower blood sugar, such as insulin, is commonly prescribed.

Typically, steroids are only taken for a short period of time. After a person stops taking steroids, their blood sugars will return back to values that are normal for them.

Recipes To Try

Tortellini Toss
4 servings per recipe

• 1 package frozen tortellini
• 6-8 plum tomatoes, chopped
• 3-4 medium zucchini, chopped
• ½ teaspoon garlic salt
• ½ teaspoon basil
• ½ teaspoon oregano
• ¼ cup shredded Parmesan cheese

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

Nutrition facts per serving:

Fruited Slaw
makes 8- 1 cup servings

• 1 can (20-ounce) pineapple tidbits
• 1 tablespoon lemon juice
• 1 medium banana, sliced
• 3 cups shredded cabbage
• 1 can (15-ounce) mandarin oranges, drained
• ½ cup chopped walnuts
• ½ cup raisins
• ½ teaspoon salt
• 6 ounces low-fat tropical yogurt

1. Drain pineapple, reserving 2 tablespoons juice.
2. Stir lemon juice into reserved pineapple juice. Add banana slices.
3. In large salad bowl, combine cabbage, oranges, walnuts, raisins, salt, and juice mixture.
4. Add yogurt. Toss to coat. Chill until serving.

Nutrition facts per serving

Menu Suggestions

† recipes from Diabetes Lifelines or Recipes for Diabetes or Fiesta of Flavors at at http://urbanext.illinois.edu/diabetesrecipes/intro.cfm

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