June /July 2002

Diabetes -The Medical Perspective

Urinary tract infections affect millions of people each year, but occur more often in those who have diabetes. This may happen because:

• there is a difference in the way those with diabetes are able to fight infections;
• there is incomplete bladder emptying which occurs when the nerves around the bladder have been affected by diabetes;
• or there is a high urine glucose concentration that accompanies poor blood glucose control. The high urine glucose concentration can be "food" for microorganisms.

Normally urine is sterile, and contains fluid, salts, and waste products, but no bacteria or viruses. An infection occurs when bacteria cling to the urethra, multiply, and move up the urinary tract system to the bladder, and possibly to the kidneys. Most often, the outward flow of urine will wash away the bacteria. Sometimes it doesn’t and an infection will occur.

Not everyone with a urinary tract infection has symptoms. However, those who have diabetes may have a higher blood glucose reading than usual because infections usually raise blood glucose. Other symptoms of a urinary tract infection include a frequent urge to urinate; pain or a burning feeling in the lower abdomen; milky or cloudy urine; and a shaky, washed out feeling.

To avoid an infection:

• drink plenty of water;
• drinking cranberry juice may help, although the calories and carbohydrates need to be included in the overall meal plan or diet;
• take showers instead of baths.

Talk to your health care provider for more information about urinary tract infections, especially if you have any symptoms, have a history of urinary tract infections, have unexplained fevers, or have an unexplained high blood glucose level.

Diabetes and Food

Those who have diabetes know that planning meals will help them

• keep their blood glucose in the normal range;
• keep their blood cholesterol in the normal range;
• keep their weight in the normal range;
• and prevent or delay health complications related to diabetes.

Keeping a food diary may help you become more aware of how you eat. Keeping a food diary will also help your dietitian when she/he is assessing your eating patterns in relation to your blood glucose readings. A food diary might also help you notice a specific change you may want to make in the amount you eat, or the kinds of food you eat, or even the time of day you eat.

Foods with similar nutritional value have always been sorted into similar food groups. Breads and starches, fruit, and milk are the food groups high in carbohydrates. Some carbohydrates are also found in vegetables. Foods that include ingredients from these food groups will also contain carbohydrates.

Casseroles with noodles, stews with potatoes, pizza (crust and tomato sauce), and French fries all have fairly high amounts of carbohydrates. Of course, so do desserts, such as cookies, pies, and candy, as well as alcoholic beverages, such as beer or wine, and "fat-free" foods. "Fat-free" foods may be lower in fat but even higher in calories than its "normal fat" counterpart. Fat-free foods are usually higher in carbohydrates than their normal fat counterparts.

Try keeping a food diary and highlighting those foods that are high in carbohydrates. Check your portions and the time of day you normally eat the most carbohydrates. Talk to your dietitian or health care provider about the amount of calories and/or carbohydrates that is best for you.

Exercise as a Part of Living

Want to lose weight and keep it off? If you do, make sure that an exercise program and meal plan are both included in your long-term program. Research has shown that the most effective weight loss programs are those that include modifying diet and exercise habits – for the long-term. Both physical activities and eating patterns have to become a habit,- a life-long habit.

The types of physical activity that seem to be most effective are those of low intensity and long duration, such as walking, bicycling, or swimming.

Recipes to Try

Easy Pepper Steak

(4 servings)

1 lb. cut-up beef, fat removed
1 medium bell pepper, cut into 1/2 inch squares
1 medium onion, sliced
1/2 cup hoisin sauce

1. Place beef in non-stick skillet over medium to high heat. Add water or stock to braise. Do not allow to dry out, but use minimum liquid. Cook until all sides are brown.
2. Add pepper and onion; cook about 1 minute until vegetables are crisp-tender.
3. Stir in hoisin sauce; cook and stir about 1 minute or until hot.
4. May serve over noodles or rice.

Per serving:

Orange Mocha

(6 servings)

1 package sugar-free orange gelatin
2 tbsp. unsweetened cocoa
1 cup hot coffee
4 tbsp. Splenda®
1 cup cold coffee
1/2 cup Cool Whip Free®

1. Combine gelatin, cocoa, and Splenda® in a bowl.
2. Add hot coffee, stirring until dissolved.
3. Add cold coffee. Refrigerate until thick.
4. Stir in Cool Whip Free® until blended. Refrigerate until set.

Note: May use decaffeinated coffee, or increase or decrease coffee strength as desired.

Per serving:

Medication Update

A new long-acting insulin, glargine, is now available under the brand name of "Lantus." Lantus is different from other insulins in that it does not "peak."

"Peak" refers to when the insulin has its maximum strength in lowering blood glucose. Generally, you want your insulin to "peak" after a meal because that is when your blood glucose will be highest. While long-acting insulins provide nearly continuous coverage, all of them except Lantus peak between 8 and 16 hours after injection. Because it does not peak, Lantus is more of a "background" or "basal" insulin. It is often prescribed with oral medications or fast-acting insulins.

Lantus had been evaluated in many clinical trials before the FDA approved its use in April, 2000. In one trial with people who had type 2 diabetes, they found lower blood glucose levels after dinner and less night-time hypoglycemia (low blood glucose) than was found in people taking another kind of insulin.

If you are taking insulin, and in good control, there is no advantage to including Lantus in your medication routine. However if you are taking insulin or oral medications, and your blood glucose is too high despite your best efforts to control it, you may want to talk to your health care providers about Lantus. Anytime you change medications, you should be prepared to check you blood glucose more often to see how well the new routine is working for you.

New Resources

The Joslin Diabetes Online Learning Center offers short classes that you can take at home whenever it suits your schedule. Each class will take less than 20 minutes to complete. When you finish, you’ll be able to print out a certificate showing that you took the class.

To take the classes, you have to register as a Joslin Diabetes Online Learing Center member, but membership is free. The class topics include Assessing Your Diabetes Actions, Assessing Your Diabetes Beliefs, Assessing Your Diabetes Knowledge, An Overview of Diabetes, and Treating Type 2 Diabetes with Oral Medications.

Visit the website http://www.joslin.org/ape/default.asp to learn more about the courses.