February /March 2002

Diabetes -The Medical Perspective

Ketosis is the condition of having too many ketones in the blood. Ketones are waste products made when your body is forced to burn body fat, instead of glucose, for energy. Your body gets rid of ketones by emptying them into your urine.

Your body will use body fat instead of glucose when any of the following situations occur:

• You have a high blood glucose (hyperglycemia) caused by too much food and/or too little insulin. Without the right amount of insulin, your body burns fat for energy.
  
• You have a low blood glucose (hypoglycemia) caused by too much insulin and/or too little food. When your body does not have enough glucose to be used for energy, it uses fat instead.
  
• Using a lot of energy as in exercise, stress, or illness.

How do I know if I have ketones in my urine? If you have high blood glucose and/or have some symptoms from the list below you may have a high level of ketones. If you have high blood glucose levels, and your ketones are high for long periods of time, you could develop ketoacidosis. Signs of ketoacidosis or ketones in your urine, include...

• dry mouth/great thirst
• fruity breath
• loss of appetite
• nausea/vomiting
• dry, flushed skin/fever
• fatigue/drowsiness
• frequent urination
• labored breathing.

If you have these symptoms, or have a blood glucose level over 240 mg/dL, you should test your urine using a ketone test kit. If you have large amounts of ketones in your urine, you should call your diabetes team or health care provider immediately. If you have a "trace" or "small" amount of ketones in your urine you should drink a glass of water every hour and test your blood glucose every three hours. If blood glucose and ketone levels are not going down after two tests, call your diabetes team.

Diabetes and Food

Fruits and vegetables are low in calories, high in fiber, and packed with vitamins and minerals! They are low in fat, low in sodium, and may have other beneficial components - phytochemicals!

Unfortunately these wonderful foods are often thought to be boring, hard to fix, or expensive. While they could be all three of these, they can also be exciting, easy to prepare, and low cost.

How many servings of fruits and vegetables you should eat each day depends on your diabetic diet plan. If you are searching for some new ideas to plan your fruit and vegetable servings, try:

• Waking up to fruit. Drinking juice or adding fruit to cereal is a light touch to breakfast!
• Thinking "grate"! Add grated or shredded vegetables such as zucchini, carrots, or cabbage to mixed meat or pasta dishes, or even top a sandwich with some "grate" vegetables!
• Just "stuffing it"! Stuff pitas, omelette, tortillas with chopped or grated vegetables. Keep a handy supply of grated vegetables to make additions easy.
• Being saucy! Puree berries, apples, pears, or peaches to be added to grilled or broiled chicken, pork, or seafood.
• Turning smooth. Many recipes for fruit smoothies are low calorie and delicious!

Exercise as a Part of Living

Forget something? Maybe you should take a walk! A study of older adults conducted at the University of Illinois found that those who walked about 45 minutes, three times per week for six months performed substantially better on several mental tasks than those who did stretching or strengthening exercises. All of the 124 study subjects had been previously sedentary.

That is one of the nice results of the study: a person who has not been physically active during his or her younger years still can benefit from walking.

However, remember to walk safely - wear correct shoes, use an uncluttered path or walkway, make sure the lighting is good.

This may be especially important to those who do not have their blood glucose in good control. A study of 379 Finnish men and women reported that the proportion of female subjects with good balance tended to decrease along with those who had poor glucose control. There was also a trend that disturbances in gait (such as walking speed and step length among the women) increased along with the deterioration of glucose control.

Remember - talk to your doctor before beginning any exercise program!

Recipes to Try

Pineapple Whipped Salad

(8 servings)

1 pkg. (3 oz.) sugar-free lime gelatin
1/2 cup low-fat cottage cheese
1 cup boiling water
1 cup no-fat whipped topping
1 can (20 oz.) crushed pineapple in its own juice

1. Dissolve gelatin in boiling water.
2. Drain pineapple, reserving 1/2 cup. Add this 1/2 cup of pineapple juice to gelatin.
3. Chill until very thick.
4. Fold in pineapple, cottage cheese, and whipped topping. Chill until firm.

Per serving (1/2 cup serving):

Strawberry Smoothie

(1 - 8 oz. serving)

4 oz fat-free, no sugar added strawberry yogurt, frozen
2 strawberries
6 oz. Crystal Light lemonade

1. Combine all ingredients in blender.
2. Blend until smooth.

Per serving:

Medication Update

Taking medication all the time AND at the right time may be hard to remember, especially if you have many activities in your life, or different routines from time to time.

There are many innovative devices on the market to help you remember when to take your oral medication or your insulin.

One device is vibrating watches. There are many types, but most have up to six alarm times for up to six times in a day to take medication. There is even a talking watch for the visually impaired!

A little less technical are the various medication organizers, with divisions for each day, and slots for each time. Some of these organizers are sophisticated and also have alarms and clocks built into them. One even provides a choice of light, sound, or vibration as a reminder!

If you are using insulin, you can adapt these by putting "marker" pills or pebbles that you take out whenever you give yourself insulin. The drawback is if you give yourself insulin and forget to remove the "marker!"

For those who are taking insulin, a fanny pack-type organizer will keep insulin cold for up to 12 hours, and also has room for two vials of insulin and syringes.

New Resources

For information about medication alert watches or containers visit
http://www.medose.com/ or call 800-549-0095 or (781) 239-8255 or write to e-pill, LLC 70 Walnut Street, Wellesley, MA 02481-2175, USA.

Other similar products are available http://www.healthaccessories.com/ or write to Health Accessories at Bluff City, 5991 Daybreak Drive , Bartlett, TN 38135-5134.

The Diabetes Food and Nutrition Bible by Hope S. Warshaw, Robyn Webb, Graham Kerr.
Included in the book are meal planning approaches; portion control; how to buy, store, and handle foods; two weeks of menus using the recipes; and how to find a dietitian. Paperback, 320 pages, about $13 to $19 depending on where you purchase. Available from amazon.com at $13 and the American Diabetes Association at ADABookOrders@pbd.com; or call the Order Fulfillment Department at 1-800-232-6733 at $19.