April /May 2001

Diabetes - The Medical Perspective

Diabetes & Your Feet

People who have diabetes are more likely than others to have difficulty with their feet. Diabetes effects both the nerves and the blood vessels.

When your diabetes effect the nerves in your feet, you may feel like there are pins and needles in your feet or they might "fall asleep" easily.

When your diabetes effects the blood vessels, the blood vessels become more narrow and limit circulation. Poor circulation makes it hard to get blood to your feet.

You may have poor circulation if:

Your legs or feet often hurt while walking or resting;
Your legs or feet hurt even at night when you are sleeping;
Your feet are usually cold, bluish, or puffy;
Cuts or sores on your feet don’t heal well;
Your feet are usually dry with cracks in the skin.

If you have any of these problems, make sure you talk to your nurse or doctor about them.

To help prevent problems with your feet, make sure you:

Wash your feet every day with warm (not hot) water and soap;
Dry your feet carefully, especially around the toes;
Check for sores, cracks, or cuts on your feet;
Make sure your toenails are kept trimmed, and always cut them straight across the nail;
Use lotion on your feet to help keep the skin smooth, but don’t put lotion between your toes or on cuts or cracks;
Always wear shoes that fit your feet well.

Make sure the foot specialist is part of your health care team, or that your doctor checks your feet at least once a year.

Diabetes and Food

Controlling your diet is an important part of your diabetes care. To help you eat a healthy diet while controlling your blood sugar and weight, many different food plans can be used. Some of the most common are the Food Guide Pyramid, the Food Exchange Lists, and Carbohydrate Counting.

Food Guide Pyramid

The Food Guide Pyramid is an eating plan that was designed for everybody - not just those with diabetes! You have probably seen the Food Guide Pyramid on food labels. The Food Guide Pyramid has six food groups: the Bread, Cereal, Rice, and Pasta Group; the Fruit Group; the Vegetable Group; the Milk, Yogurt, and Cheese Group; the Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group; and the Fats, Oils, and Sweets Group. The Food Guide Pyramid then suggests a certain number of servings from each group to be eaten each day.

Food Exchange Lists

The Food Exchange Lists also divide foods into groups. The serving sizes might be different from the Food Guide Pyramid’s suggestions because of the calorie or carbohydrate content or the food. For instance, the Food Guide Pyramid sets a serving size for juice at 3/4 cup but the Food Exchange List sets the serving size at 1/2 cup for certain juices like orange juice. The Food Exchange lists vegetables, so often include cheese in with the Meat Group because of the protein in cheese, whereas the Food Guide Pyramid includes cheese in the Milk Group only.

Carbohydrate Counting

Carbohydrate counting is a system in which only foods that contain carbohydrates are "counted." Serving sizes of food are given so that each food contains 15 grams of carbohydrate, or a multiple of 15 (30, 45, 60 grams).

If you are not sure which food plan to use, or want to try a different plan, talk to your doctor, dietitian, or nutritionist.

Exercise as a Part of Living

Physical activity, or exercise, does not have to mean being on your feet, if foot problems are already part of your life. Many exercise routines can be done while sitting.

Aerobic exercise is the kind that is best for your heart. Although aerobic-type exercise usually means being on your feet, swimming is also aerobic. Bicycling is less hard on your feet, whether using a stationary or regular bike.

Muscle strengthening exercises or flexibility exercises can also be done while sitting. Weights can add resistance, but even lifting arms and legs without weights is activity.

Remember to check with your doctor before starting any new exercise routine, especially if you have a history of heart conditions.

Recipes to Try

Southwest Chicken

(4 Servings)

2 tablespoons margarine
2 tablespoons water
2- 6 oz. Chicken breasts, halved & skinned
1/2 teaspoon
Tabasco pepper sauce
1/2 teaspoon tarragon dash of pepper
2 tablespoons lime juice

1. Melt margarine in skillet. Place chicken in skillet. Season with pepper & tarragon.
2. Brown chicken over medium heat- about 10 minutes. Turn, season, & brown other side.
3. Mix lime juice, water, & pepper sauce; pour on chicken. Cover & simmer until tender, about 10 minutes.
4. Suggested to be served with rice.

Per serving:

Cranberry Ice

(4 Servings)

1can (8 oz.) Jellied cranberry sauce
1 to 2 drops red food coloring
1/2 cup diet carbonated lemon-lime beverage

1. Beat cranberry sauce & food coloring in small mixer bowl until smooth.
2. Mix in lemon-lime beverage gradually on low speed.
3. Pour into refrigerator tray; cover & freeze until firm.
4. Remove from freezer; break into chunks in small mixer bowl. Beat until fluffy & smooth.
5. Return to refrigerator tray; cover & freeze until firm.

Per serving:

Medication Update

Pills to treat type 2 diabetes: sulfonylureas

There are three kinds of diabetes pills sold today in the US. They work in different ways to lower blood sugar. This column will focus on sulfonylureas, which stimulates the beta cells of the pancreas to release more insulin. Names of sulfonylurea drugs include: Chlorpropamide (brand name Diabinese); glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). All sulfonylurea drugs have similar effects on blood sugar levels, but they differ in side effects, how often they are taken, and interactions with other drugs.

Alcohol and diabetes pills may not mix, especially chlorpropamide, and more rarely other sulfonylureas. They can interact with alcohol to cause vomiting and flushing.

Generic versions of some sulfonylureas are available, are generally reliable, & cost less than the brand-name products. Ask your doctor to prescribe the largest tablet strength suitable for the dose you need. One 500-mg tablet, for example, often costs much less than two 250-mg tablets.

At some point, a sulfonylurea may stop working as well as it used to, and your blood sugar level will go up. This doesn’t mean you have done anything wrong, or not followed your diet. Instead of taking more of this medicine, your doctor may change you to another kind of sulfonylurea, or a different medication altogether.

If you are taking a sulfonylurea medicines, tell your doctor if you ever have any unusual or allergic reaction. Sulfonylureas are rarely used during pregnancy, so tell your doctor if you become pregnant or are thinking about breast-feeding. Some elderly patients may be more sensitive than younger adults to the effects of sulfonylureas, and may have an increased chance of developing low blood sugar. Elderly patients who take chlorpropamide are more likely to hold too much body water as well.

When you are taking sulfonylurea drugs, it is very important to tell your doctor if you are taking any other medication. Drug-drug interactions could occur & cause dangerous or unpleasant side effects.

New Resources

The following are resources focusing on foot care:

Action Plan for persons with Diabetes: Prevent Foot Ulcers & Amputations! Eli Lilly & Co. and Boehringer Mannheim Corp.,(1997) 207-7648-0197, Global Diabetes Care, Indianapolis, IN 46285 fax: 317-277-9337,or at
www.diabetesresource.com

Self-Testing for Sensation in Your Feet. Eli Lilly & Co. and Boehringer Mannheim Corp.,(1997) 207-7648-0197, Global Diabetes Care, Indianapolis, IN 46285 fax: 317-277-9337,or at www.diabetesresource.com

Becton Dickenson Consumers Products: Foot Care Do’s and Don’t; low literacy, English or Spanish, 800-237-4554. Up to 25 copies/month available to health educators free.