April /May 2002
Diabetes -The Medical Perspective
Most everyone knows that hypertension, or high blood pressure,
can be dangerous to health, but what exactly is it? Your veins
don’t burst with high blood pressure the way water pipes
might under a lot of pressure.
What does happen is that the veins and arteries become less
"stretchy," so that they are more stiff and less
flexible when blood flows through. This causes the pressure
in the veins and arteries to increase. If the pressure gets
very high, some of the pressure will be relieved by "backing
up" to the heart or kidneys. This causes damages to these
organs, and then they don’t function well. Sometimes
the damage is permanent, and sometimes it can be reversed.
However, sometimes these organs–the heart and kidneys–quit
Hypertension is sometimes called the "silent killer,"
because people can’t feel high blood pressure. Although
there are some signs or symptoms of hypertension, they are
non-specific and easily overlooked.
If you have diabetes you are at a higher risk for heart
disease and stroke, and having uncontrolled hypertension will
increase this risk. Have your blood pressure checked at every
doctor’s visit. The target range for those who have
diabetes is below 130/80. The top number, the 130, is the
systolic blood pressure. Systolic blood pressure represents
the pressure in the heart during contraction. Diastolic blood
pressure, the bottom number - 80, represents the pressure
in the heart while it is relaxed.
Remember that your blood pressure can vary from day to day,
and even according to the time of day. Several blood pressure
readings per year are recommended - more often if your blood
pressure tends to be high, you have a couple of high readings,
or you have recently begun treatment for hypertension.
Diabetes and Food
If you have high blood pressure, there are two nutrition-related
goals you and your health care team may set: maintaining or
achieving a desirable weight; and reducing the amount of sodium
(salt) in your diet. However, a more comprehensive dietary
plan is called DASH, which stands for Dietary Approaches to
The DASH diet can be incorporated into any diet for those
with diabetes. It emphasizes an eating plan that is low in
saturated fat, cholesterol, and total fat and higher in fruits,
vegetables, and low-fat dairy foods. It also is lower in sodium
than many dietary patterns.
The DASH diet recommends no more than 2,400 mg of sodium
each day. This is a big reduction in dietary sodium for most
people. To eat a diet this low in sodium, you need to do more
than just avoid adding salt to your food. Many high sodium
foods need to be avoided or eaten infrequently.
Tips to lower the sodium in your diet include:
- Buying fresh, plain frozen, or canned vegetables without
- Choosing ready-to-eat cereals that are lower in sodium;
- Use fresh poultry, fish, and lean meat instead of smoked
or processed, such as hot dogs, ham, sausage, or luncheon
- Choose convenience foods that are lower in sodium;
- Avoid salty snack foods and crackers
Exercise as a Part of Living
Even low-to moderate intensity activity can help lower your
risk of heart disease. The National Heart, Lung, and Blood
Institute/American Heart Association has a sample walking
program that starts gradually and builds to 40 minutes of
walking, at least three days per week.
Their plan always starts with 5 minutes of walking normally
and 5 minutes of walking normally for the "cool down"
period. In the first week, these experts recommend walking
briskly for 5 minutes in between the "warm up" and
"cool down" periods. The brisk walking period is
then increased by 2-3 minutes each week in their 12 week program.
This way you go slowly, and build up gradually!
Remember to consult your doctor before you start or increase
your physical activity if you:
- have heart trouble or have had a heart attack;
- are taking medicine for high blood pressure or a heart
- are over 50 and not used to much activity;
- have a family history of heart disease.
Recipes to Try
2 pkgs. (10 oz. each) frozen chopped spinach
1/2 teas. salt
1 lb. whitefish fillets, about 1/2 inch thick
1 c. roasted red bell peppers
4 teas. dried basil
2 tbls. skim milk
- Thaw spinach. Squeeze to drain.
- Spread spinach evenly in ungreased 11 x 7" pan.
- Blend in blender or food processor red pepper, basil,
- Spread 1/2 of pepper mixture over spinach.
- Arrange fillets next in pan. Top with remaining pepper
- Cover and bake at 400° for 25 to 30 minutes, until
fish flakes easily with fork.
Per serving :
||26 grams protein
|68 mg cholesterol
||6 grams carbohydrate
|7 grams total fat
||31 % calories from fat
1 cup low-fat cottage cheese
1 tbsp. sugar
1 tbsp. Splenda®
1/2 cup flour
2 teas. poppy seeds
1 teas. vanilla
c teas. cream of tartar
2 teas. lemon juice
2 egg whites
4 drops yellow food coloring
1 tbsp. aspartame
3 tbsp. boiling water
- Blend cottage cheese until smooth in food processor or
blender. Add egg, flour, vanilla, lemon juice, sugar, Spenda®,
poppy seed, and food coloring. Process until well blended.
- Beat egg whites with mixer until they hold peaks. Add
cream of tartar and continue mixing until soft.
- Fold egg whites into cheese mixture. Pour into muffin
pan which has been sprayed with non-stick cooking spray.
- Bake at 300° for 20 minutes.
- Combine aspartame with boiling water. Drizzle over muffins
||4 grams protein
|4 grams carbohydrate
||1 gram total fat
|19 mg cholesterol
||19 % calories from fat
For those who are taking insulin as part of their therapy
for diabetes, three important concepts are:
- peak, and
- duration of action.
"Onset" refers to how long it takes before your
insulin starts really working. It isn’t instantaneous.
Rapid-onset insulin starts lowering blood glucose 5 minutes
after it is injected. Regular or short-acting insulin starts
working about 30 minutes after it is injected. Intermediate-acting
insulin reaches the bloodstream and starts being effective
in about 2-4 hours. Finally, long-acting insulin begins to
be effective 6-10 hours after injection.
"Peak" refers to when the insulin has its maximum
strength in lowering blood glucose. Generally, you want your
insulin to "peak" about 15-30 minutes after a meal
because that is when your blood glucose will be highest. Rapid-acting
insulin peaks in about an hour, so people generally take it
before a meal. Regular insulin peaks in about 2-3 hours, intermediate
in about 4-12 hours, and long-acting provides nearly continuous
coverage after it becomes effective.
"Duration of coverage" refers to how long the
insulin will remain active, even after its peak effectiveness.
Rapid-acting works for only 2-4 hours, regular for 3-6 hours,
intermediate for 12-18 hours, and long-acting for 18-28 hours.
There are many different types of insulin, so your regular
schedule can be accommodated. Talk to your health care team,
know your types of insulin and how they work, and discuss
any changes in your normal routine.
Facts About the DASH Diet are available online at http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm
National Heart, Lung, and Blood Institute Health Information
P.O. Box 30105, Bethesda, MD 20824-0105. Single copies are
An organization called the Medicine Program offers help
in finding and applying for free medicines supplied by pharmaceutical
companies. To request assistance, obtain an application form,
available on its website or through the mail, and list the
medicines you need. Send the application back with a $5 processing
fee for each medicine listed (e.g., $20 when requesting four
medicines). If the Medicine Program fails to qualify you to
receive the medicine, your processing fee will be returned.
The Medicine Program
P.O. Box 515
Doniphan, MO 63935-0515
Phone: (573) 996-7300
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