February /March 2003

Diabetes - The Medical Perspective

Many people gain a little weight as they get older. We may need to get rid of a few clothes that are snug and buy new clothes a size or two larger. We don’t have to look like fashion models anyway!

The problem is that if every year we put on a few pounds, in ten years we have put on many more than a few.

If you have pre-diabetes and are even modestly overweight, experts recommend that you reduce your weight by 5-10% and do some kind of modest physical activity for 30 minutes each day. So if you weigh 170 pounds and were overweight, that would mean a weight loss of 8.5 to 17 pounds. How much you should lose depends on the best weight for your height. Talk to your health care provider to find out what your best weight may be. (Pre-diabetes is the term used when a person’s blood glucose is higher than normal, but not high enough to be called diabetes. It is also called Impaired Glucose Tolerance (IGT) – the fasting blood glucose level is between 110 and 126 mg/dl.)

If you have diabetes you should work extra hard at preventing those extra pounds from adding up. If those pounds have already been put on, pay extra attention to getting them off. But don’t feel alone; almost 90% of those diagnosed with type 2 diabetes are overweight.

New diets are published each week and some include a bizarre combination of foods. Healthful eating should be balanced and shouldn’t result in drastic loss of weight. Losing one-half to one pound per week is a good goal. This equals eating about 250 to 500 calories less each day than you usually do.

Be sure to talk to you doctor about your weight and any weight loss plan you may want to pursue. Losing weight is great! – and it may mean you’ll need less medication as the pounds come off.

Diabetes and Food

Trying to cut back on your calories and get back on your usual meal pattern after the holidays? For most people this is a little hard. We get used to treats and we like them! Going without feels like we are giving up the fun and excitement of the holiday season.

Most people don’t pay a lot of attention to why they are eating, or overeating. Overeating is a habit that is especially hard to break because you can’t give up on eating altogether. A habit is automatic. The first step to changing that habit is to become aware of it. Even if you don’t think you are overeating, making a check on your eating habits every once in awhile can help prevent overeating from becoming a habit.

A food diary is a good way to start. It may sound like hard work, but the payoff is big! Make a late New Year’s resolution to pick a couple days each month when you write down everything you eat. And how much! If you find yourself eating differently than if you had not been writing the food down, this suggests that you may need to break a bad eating habit.

If you find you have been overeating, think about when you overeat and why. If there are a lot of excuses for overeating, find help to be realistic with yourself. Talk to your dietitian for suggestions to change any bad habits.

Exercise as a Part of Living

Exercise plays an important role in both losing weight and maintaining a healthy weight. Not only does daily exercise burn extra calories, in the long run being fit can help you burn more calories even when resting!

Exercise can also help you develop new interests, and give you a burst of psychological energy while you are trying to lose weight.

Once you’ve reached your desired weight, exercise is still important. Exercise will help maintain flexibility and balance so that you are less likely to fall and hurt yourself. It helps keep your heart and circulation running at their best. It can also give you that healthy glow so you know you look your best, too.

If you’ve had an exercise routine and given it up over the holidays, now is the time to get back in the swing of things. Don’t feel badly because you didn’t stick to last year’s routine. Start fresh and start again!

If your exercise routine has become boring, ask a friend to join you, or join a walking group. Many times your health care provider can refer you to safe and successful programs right in your own neighborhood.

Recipes to Try

Chicken Finger Manicotti

1 package manicotti shells (14 shells)
1 jar (30 ounces) spaghetti sauce
1 teaspoon garlic powder
24 ounces (1-1/2 lbs.) chicken tenders
1 1/2 cups light shredded mozzarella

1. Cook manicotti shells according to directions.

2. Heat oven to 350º.

3. Spread a small amount of spaghetti sauce over the bottom of a
13 x 9 inch baking pan.

4. Sprinkle garlic powder on chicken. Put chicken tender into manicotti shell. Place stuffed shells in baking pan.

5. Pour remaining sauce over shells. Sprinkle with cheese.

6. Cover baking pan with foil. Bake for 1 hour.

Per serving:

471 calories
27 grams protein
35 mg cholesterol
66 grams carbohydrate
10 grams total fat
20% calories from fat

Filled Squares

1 cup margarine, softened
2 cups flour
1/2 teaspoon baking powder
1 package (8 ounces) fat free cream cheese
1 jar sugar free light preserves, any flavor
1/2 cup chopped pecans

1. Mix first 4 ingredients together. Form a ball and chill for 3 hours.

2. To make filling, mix jam and nuts together.

3. Roll one-fourth of dough out and cut into 2-inch squares. (You should have 15 squares per one-fourth of dough to come up with total of 30 cookies of 2 squares each- if you have fewer, calories per serving may be higher.)

4. Place a spoonful of filling on square, top with another square and seal by pinching edges. Repeat until all of dough is used.

5. Bake at 375º for 15 to 20 minutes.

Per serving:

111 calories
2 grams protein
1 mg cholesterol
10 grams carbohydrate
7 grams fat
60% calories from fat

Medication Update

One of the most expensive parts of diabetes care can be medications. And when we think of medications and expense, we think about insurance coverage.

If you are over 65 years of age, usually Medicare is your insurance coverage. Medicare offers no prescription drug coverage at this point. Medicare supplement plans H, I and J offer prescription drug benefits. The basic drug benefit, offered in plans H and I, has a $250 annual deductible and requires a 50% co-payment. Plans H and I pay up to a maximum benefit of $1,250 per year. The extended drug benefit, offered in plan J, also has a $250 yearly deductible and a 50% co-payment. However, plan J pays up to a maximum benefit of $3,000 per year.

Does all this sound confusing? It is!

The Senior Health Insurance Program (SHIP) is a free insurance counseling service for Medicare beneficiaries and their caregivers. SHIP is sponsored by the Illinois Department of Insurance. This service, offered statewide, is available to Medicare beneficiaries of all ages. They do not sell insurance, but can help answer your Medicare questions.

Senior Health Insurance Program
Illinois Department of Insurance
320 W. Washington Street
Springfield, IL 62767-0001
1-800-548-9034 or 217-524-4872 (TDD) or visit their website at http://www.ins.state.il.us/ or e-mail them at SHIP@ins.state.il.us

New Resources

Want a little humor in your life? Try Confessions of a couch potato: If I’m so skinny, why do I feel like flounder?, by Stephen Furst who lost 150 pounds and has kept it off. Contains lots of tips and anecdotes as well as recipes. Available from the American Diabetes Association bookstore at http://store.diabetes.org/adabooks/ or through amazon.com, in paperback, 136 pages.

On a more serious note, there is Counting carbs made easy for people with diabetes, by Marie McCarren, which is also available through the ADA webstore. The 60 page, pocket-sized book has lots of tips for counting carbohydrates in everyday life.

One book that has been put on tape by ADA is Diabetes burnout –what to do when you can’t take it anymore!, by William Polonsky. The book (386 pages) without the audiotape is available at http://www.diabetesnet.com/burnout.php