April /May 2003

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Diabetes -The Medical Perspective

You have to trust your doctors -- all of them -- but also take care of yourself. When your usual doctor recommends surgery, however minor, continue to trust all your doctors. But, take some precautions because YOU know more about your diabetes and your usual routine than a surgeon.

If possible, find out from the surgeon's office:

• What the cut-off time will be for when you are not allowed to eat before surgery. The medical term is "NPO."
• If they will use a general anesthetic, and if so, what their standard procedure is for checking blood sugar.
• If the anesthetic usually causes nausea or vomiting.
• If you will have an "i.v." (intravenous line) to give you dextrose (glucose), water, or insulin if you should need it.

The next step is to share this information with your usual doctor or health care team. Make sure the doctor who takes care of your diabetes is comfortable with the surgeon's procedures. Make sure you are comfortable with them. Remember, even a tooth extraction is minor surgery!

The skin is our first line of defense against infection. Whenever it is cut, there is a chance for bacteria to enter the body. Any surgery can result in an infection. Make sure you have two follow-up plans after surgery: one to prevent infection, and one to treat the infection should it occur. Remember that the stress of surgery itself can cause your blood sugar to be higher than normal. Infection will also cause a sharp rise in your blood sugar. Plan in advance and stay healthy!

Diabetes and Food

Good carbs, bad carbs? Don't eat any carbs?

If you read the newspaper or almost any magazine, you've seen a diet with low carbohydrates, or high carbohydrates, or maybe even "good" carbohydrates. What should you do?

Think about which foods are high in carbohydrates -- those in the Breads and Starches Group, those in the Milk and Dairy Group, those in the Fruit Group, and those in the Vegetable Group.

Which foods are lowest in calories and highest in fiber? Those in the Vegetable Group. Your meal plan should include 3 to 5 servings each day, depending on your calorie level.

Foods from the Fruit Group are almost all carbohydrate, but they also provide vitamins and fiber, as well as phytochemicals -- those compounds we are just learning about that help keep us healthy.

Foods from the Milk and Dairy Group also have protein and calcium. We don't want to leave these out! Remember to choose low-fat products whenever possible.

The Bread and Starch Group has many different kinds of food -- from rice to bagels to starchy vegetables like corn or potatoes. Better choices from this food group include those that are high in fiber and lower in calories and fat. This makes sense: should you choose a bagel with buttery crumbs on top that's twice the size of your fist or half of a seven-grain bagel?

We eat for many reasons but if you are trying to lower your blood glucose or lose weight, choose higher fiber, lower fat, lower calorie foods from the high carbohydrate food groups.

Exercise as a Part of Living

Spring is here, or close to here, and we can't use the snow and cold weather as an excuse for not exercising. It may become rainy or blustery, but now is the time to wake up those New Year's resolutions and think about getting up and getting outside.

Maybe the first thought we should have this spring is to stretch. Even if you're not going to run around the block, stretching is a good idea. Remember when you decided to clean the garage last spring and paid for it with your back in pain for a week afterwards? Stretch, stretch, stretch! It's not just for athletes anymore!

Recipes To Try

Carrot Cucumber Salad in Dill Dressing

1 serving = 1/2 cup; 4 servings/recipe

1 cucumber
2 cups grated carrots
1/2 cup non-fat plain yogurt
1 teaspoon dill weed
1 teaspoon lemon juice

1. Peel cucumber, leaving stripes of peel on it if more crunchiness is desired. Slice lengthwise in fourths. Gently scrape seeds out. Thinly slice each cucumber fourth.
2. Mix yogurt, dill weed, and lemon juice.
3. Add cucumber and carrots. Gently toss to coat vegetables.

Per serving:

34 calories
2 grams protein
0 mg cholesterol
7 grams carbohydrate
0 grams total fat
0% calories from fat

Tuna Rice Pie

1 9" pie = 6 servings

2 cups cooked rice
1 cup skim milk
2 tablespoons margarine
3 slices American cheese
2 tablespoons flour
1 3.5 oz. tuna packed in water

1. Press cooked rice into 9" pie pan.
2. Make a medium white sauce by melting margarine in a saucepan over medium heat, adding flour, and stirring in milk. Add one slice of cheese and stir until melted.
3. Drain tuna and spread over rice.
4. Pour medium white sauce over tuna. Cut 2 cheese slices into strips and arrange over tuna-rice pie.
5. Bake at 350° for 30 minutes, or until top is lightly browned.

Per serving:

211 calories
11 grams protein
19 mg cholesterol
22 grams carbohydrate
9 grams fat
37% calories from fat

Medication Update

If you are taking insulin, there are many things to remember -- one of which is the type of insulin you are on. Approved by the FDA in 2000, NovoLog® is relatively new to the market.

NovoLog® acts faster and has a shorter duration than regular human insulin. Because of this, NovoLog® is often prescribed along with a longer acting insulin. Know whether you are taking one or two types of insulin.

NovoLog® acts quickly, and as it acts blood glucose quickly moves into the cell. This means that glucose has to be in the blood -- in other words food should be eaten within five to ten minutes of taking NovoLog®.

As with all insulin, self-monitoring of blood glucose is often recommended. For those who are taking NovoLog®, blood glucose should be checked 90 to 120 minutes after eating. The amount of NovoLog® prescribed is based upon the amount usually eaten at each meal. If that amount changes, the insulin dose may need to be changed as well. Keeping track of your blood glucose readings will help determine the best insulin-meal combination.

If you have questions about your insulin program, be sure to talk to your doctor and/or pharmacist.

New Resources

Diabetes Digest is a web-based or hard copy magazine that contains diabetes information that is easy-to-read and understand. You can access Diabetes Digest at http://www.diabetesdigest.com/ or write to the publisher, H. Crimson, Inc., at 5 South Myrtle Ave, Spring Valley, NY 10977. Pharmacies also distribute free copies of the magazine, including Walgreen's, Cosco, and Kmart.

The National Diabetes Education Program's new campaign, Be Smart About Your Heart: Control the ABCs of Diabetes, is designed to make people with diabetes aware of their high risk for heart disease and stroke and the steps they can take to lower that risk. A new bilingual booklet Si Tiene Diabetes, Cuide Su Corazon (If You Have Diabetes, Take Care of Your Heart) is available as well as a detachable wallet card. These are available online at http://ndep.nih.gov or by calling 1-800-438-5383.

Diabetes Forecast is published monthly by the American Diabetes Association, and is exclusive to American Diabetes Association members. Membership cost is $28 per year.