June /July 2001

Diabetes - The Medical Perspective

Diabetes & Your Eyes

People with diabetes are more likely than others to suffer from glaucoma and cataracts. Glaucoma is increased pressure inside the eye that damages the eye. Cataracts are a loss of transparency on the lens of the eye.
Having high blood sugar is a risk factor for both of these conditions. People with diabetes who smoke are more likely to get retinopathy. When your blood sugar gets too high, it can damage the blood vessels in your eyes - retinopathy. Your retina is the nerve layer that lines the inside of your eye and converts light into nerve signals that your brain can interpret.

How To Avoid Eye Problems

1. Keep your blood sugar under good control.
2. If you have high blood pressure, bring it closer to normal. High blood pressure can make eye problems worse.
3. Get a dilated eye exam by an eye doctor every year. Your eye doctor will use drops to enlarge your pupils to look inside your eyes.
4. Make a special appointment with your doctor or eye doctor if:

   Your vision is blurry.
   You see double.
   You see spots or floaters
   One or both eyes hurt.
   You feel pressure in your eye.
   You can't see things at the sides like you used to.
   You have trouble reading.

Other Eye Problems

Macular degeneration is more common in older people. Symptoms include:

blurry or fuzzy vision
straight lines appear wavy
a dark or empty area appears in the center of vision.

If you have vision problems, ask your eye doctor for a low-vision
evaluation.

Diabetes and Food

Can Your Diet Effect Your Vision?

Whether your diet can effect your vision or not depends somewhat on what is causing your vision problems.

High Blood Pressure

Those with high blood pressure, or hypertension, often experience problems with seeing well. Controlling blood pressure may include achieving or maintaining a healthy weight; taking medication; and/or following a diet low in sodium (salt = sodium + chloride).

Diabetes

Those with diabetes also may experience problems with vision. Keeping the blood glucose normal is the best way to keep vision normal. Follow your diet plan, exercise, and see your dietitian and physician on a regular basis.

Macular Degeneration

There are two types of macular degeneration - wet and dry. Although controversial, some believe there is a link between diet and macular degeneration (MD). In fact, a large National Eye Institute research study is now in progress.

Lutein is the nutrient most often talked about in relation to MD. Lutein can be found in many fruits and vegetables, so following the Dietary Guidelines to eat 2-4 servings of fruit and 3-5 servings of vegetable is a smart move!

Very often those with MD also have cardiovascular disease. Some researchers suggest that following a low-fat diet is a healthy move, especially if your blood cholesterol is high.

Exercise as a Part of Living

Physical activity can make you feel better in more than one way. Regular physical activity can reduce anxiety, reduce symptoms of depression, and promote feelings of well-being.

People who are physically active report they sleep better at night, and have more energy during the day. Feeling more capable is another positive feeling often reported.

Physical activity, or exercise, does not have to mean joining a gym or organized club. However, walking clubs are a great way to visit with new and old friends while exercising.

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

Recipes to Try

Spinach Orange Salad

(4 Servings)

4 cups fresh spinach, washed & torn into bite-size pieces
1 orange, peeled & cut into sections OR 3/4 cup Mandarin orange slices, drained
1/2 cup sliced water chestnuts
1/2 cup croutons
Favorite no-fat or low-fat salad dressing

1. Toss spinach, oranges, water chestnuts, and croutons.
2. Serve salad dressing on the side.
   without dressing, with fresh oranges:

   Per serving:

without dressing, with mandarin oranges:

Per serving:

Braised Cabbage

(8 - 1/2 cup Servings)

1 tablespoon margarine
1 tablespoon chicken broth
1 pound green cabbage( 1/2 medium head), cut into 1/4 inch strips
1/4 teaspoon crushed thyme
11 tablespoons minced fresh parsley leaves
salt/pepper to taste

1. Melt margarine in large skillet over medium heat.
2. Add broth, then cabbage and thyme.
3. Bring to a simmer; cover and continue simmering, stirring occasionally until cabbage is wilted but still bright green, about 7 to 9 minutes.
4. Sprinkle with parsley and season to taste with salt and pepper.

Per serving:

Medication Update

On March 21, 2000, Rezulin, an oral medication for the treatment of type 2 diabetes, was withdrawn from the U.S. market in response to a request made by the Food and Drug Administration (FDA). The FDA requested Rezulin be withdrawn from sale due to concerns regarding the drug’s safety, specifically, in relation to liver failure.

If you had been taking Rezulin you should have contacted your health care provider to discuss other treatment options.

Rezulin is part of a class of diabetes drugs called sometimes referred to as the "glitazones" or "insulin sensitizers." Currently, there are two other drugs in this class: Avandia® (generic name: rosiglitazone) and Actos® (generic name: pioglitazone hydrochloride). Whether you switch to one of these drugs, or to another medication, is a decision that should be made in with your health care provider.

The American Diabetes Association continues to believe that the class of drugs to which Avandia and Actos belong can be very beneficial and has a unique way of reducing blood glucose levels in people with type 2 diabetes.

For people taking Avandia or Actos, the FDA recommends a liver function test before beginning the drug, every two months during the first year of therapy, and periodically thereafter. Anyone who has unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine, and/or jaundice - yellowing of the skin- should contact their health care provider for a liver function test.

New Resources

The following are resources available from the American Diabetes Association. Contact them at http://store.diabetes.org/ or call 1-(800) DIABETES or 1- (800) 342-2383. For questions about book content,
contact: ADABookInformation@diabetes.org.

Diabetes Burnout, by William H. Polonsky, PhD, CDE. Published by the American Diabetes Association. $18.95. 350 pages.

12 Things You Must Know About Diabetes Care Right Now by Irl B. Hirsch, MD. Published by the American Diabetes Association. $14.95. 180 pages.

Express Lane Diabetic Cooking by Robyn Webb . Published by the American Diabetes Association. $16.95. 200 pages.

16 Myths of a Diabetic Diet by Karen Hanson Chalmers, MS, RD, CDE & Amy E. Peterson, MS, RD, CDE. Published by the American Diabetes Association. $14.95. 240 pages