October /November 2002

Diabetes -The Medical Perspective

• Do you often feel full after eating a small amount?
• Do you often feel bloated after eating?
• Do you usually feel nauseated after meals or in the morning?
• Do you have unexplained vomiting of undigested food?
• Do you have stomach cramping or pain?
• Do you often have diarrhea or constipation?
• Do you talk to your doctor or health care provider about these "stomach" problems?

You should! Gastrointestinal problems like those above could be a symptom of gastropathy. Gastropathy is the condition that occurs when the stomach empties too slowly.

The first sign of a problem with slow emptying of the stomach may be blood sugar levels that seem out of control and unpredictable ­ even when you are doing everything right! The reason is that if food doesn't leave the stomach and get absorbed as blood glucose, there may be a mismatch in timing between your insulin or oral diabetes medicine and your blood sugar level following meals.

In addition, if you take oral medication, it may not get fully absorbed. If it doesn't get fully absorbed, it won't be effective. Your blood sugar could either be low because food isn't absorbed, or high because your medication is not absorbed. Either of these conditions could occur in the same person, at different times.

Talk to your doctor if you think you might have gastropathy. Medications can often help lessen the symptoms.

Flu and Pneumonia Shot
If you have diabetes, a flu shot could save your life. During flu season, many people with diabetes are hospitalized and could die from flu and pneumonia complications. Call your doctor or county health department to schedule an appointment today!

Foot Care Awareness Program
Do not lose a foot or leg due to diabetes. Call 1-800-323-4769
during November and December to get a referral to a local foot doctor who can provide a free foot exam (statewide).

Diabetes and Food

Gastropathy, the condition that occurs when the stomach empties too slowly, can sometimes be helped by a change in diet. Many people who have the bloating, early feelings of fullness, blood sugar fluctuations, and changes in bowel habits that accompany gastropathy find that they have less trouble with the condition when they follow these dietary guidelines:

• Eat a low-fat diet (fat slows down gastric emptying).
• Eat a low-fiber diet (some fiber can collect in the stomach and not be passed through to the intestine easily).
• Eat small, frequent meals.
• Switch to liquids, such as fruit juices, broth or clear soups when having a lot of difficulty with gastric emptying.

Avoiding fiber may mean avoiding most fruits and vegetables, at least for awhile. However, vegetable and fruit juices, baby food fruits and vegetables, applesauce, and bananas may be tolerated when other fruits and vegetables are not. Although it is easy to get frustrated, pay attention to your symptoms, and go slowly. Your stomach may change from day to day, so have a plan in mind to switch to and try to keep your blood sugar as normal as possible.

Exercise as a Part of Living

Water aerobics is not just splashing around in the pool but can be just as fun. It is an effective way to build strength and aerobic capacity. And, you don't even have to know how to swim!

Water aerobics is also suitable for most people because it's a non-weight-bearing exercise -- your feet and legs do not support all your body weight while you exercise. The water supports most of your weight! This water support makes water aerobics ideal for people with nerve damage, arthritis, or old injuries that are aggravated by high-impact exercise.

To ensure your safety, talk to your doctor before starting any exercise regimen. Also, wear an ID bracelet or necklace so that people around you will be aware that you have diabetes if anything should go wrong.

Recipes to Try

Sweet Potato Salad

2 pounds sweet potatoes
1/2 cup non-fat yogurt, plain
1/2 cup low-fat mayonnaise
1 tablespoon curry powder
1 teaspoon ginger
1/2 cup golden raisins
6 1/2 cup servings

1. Simmer potatoes in water until tender, about 10 minutes. Peel and dice.
   
2. Combine yogurt, mayonnaise, curry powder, and ginger in a medium bowl.
   
3. Add potatoes and raisins. Toss to coat.

Per serving:

Note:

1/2 cup servings will yield 12 servings per recipe,
and above nutrients are halved (e.g. 123 calories).

Soda Bread

2 cups unsifted flour
1/2 teaspoon baking soda
1 1/2 teaspoon baking powder
1/2 teaspoon salt
1 cup low-fat buttermilk
non-fat cooking spray

1. Pre-heat oven to 350º. Spray a 9" round pan with non-fat cooking spray.
   
2. Mix dry ingredients.
   
3. Add buttermilk and stir to make a soft dough.
   
4. Knead dough on lightly floured board for about 1 minute. Shape into a round loaf and place loaf in pan.
5. Bake for 40 minutes or until sounds hollow when tapped.

Per serving:

Medication Update

Oral hypoglycemic medications may have side effects. Know the type of oral hypoglycemic medication(s) you are taking and the dose(s). Discuss any side effects with your doctor.

If you are taking:

• Sulfonylureas - common side effects include weight gain, mild gastrointestinal disturbances, alcohol intolerance, mild skin irritations and hypoglycemia or low blood glucose levels.
  
• Biguanides - common side effects may include nausea, diarrhea or mild gastrointestinal disturbances and loss of appetite.
  
• Glucosidase inhibitors - common side effects include nausea, diarrhea, mild gastrointestinal disturbances, bloating and gas.
  
• Thiazolidinediones - side effects vary among the brands available, and can include adverse effects to the liver. Your doctor should run blood tests to check how well your liver is working every month for the first eight months of therapy.
  
• Meglitinindes - there is a chance for low blood sugar, or hypoglycemia.

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New Resources

Diabetes Self-Management is a bimonthly magazine established in 1983. They don’t publish personal experiences, personality profiles, or "breakthroughs." Instead, they give people up-to-date, practical "how-to" information on nutrition, exercise, new drugs, medical advances, self-help, and the many other topics people need to know about to maximize their health. Yearly (six issues) subscription is $15.97. You can subscribe on the web at www.diabetesselfmanagement.com

or you can also call toll-free 1-800-234-0923 Monday to Friday 8:00 - 11:00 and Saturday 9:30 - 6:00 Eastern Time. Or, if you prefer, write to:

DIABETES SELF-MANAGEMENT
Subscription Services
PO Box 52890
Boulder, CO 80322