April/May 2004

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Diabetes -The Medical Perspective

We know that hearing loss occurs more frequently in older adults than in younger adults. We know that diabetes occurs more often in older adults than in younger adults. Several recent studies have suggested that those with diabetes may suffer hearing loss more often than those of a similar age who do not have diabetes.

Researchers speculate that the same processes that occur during diabetes that damage nerve tissue as well as organs like the eye and kidneys may also damage the ear. At this point, no one has proof, but scientists and doctors think it sounds reasonable.

Another study found that certain hearing structures may be damaged in those who have diabetes, and that this damage is present even before any problem can be diagnosed by clinical tests of hearing sensitivity. The nerve impulses going from the ear to the brain may move more slowly in those who have diabetes than in others. This suggests that those who have diabetes may have difficulty understanding speech even if they have little or no hearing loss.

The best approach is to have your hearing checked during your regular appointment, or ask your doctor to refer you to an audiologist. If you’ve never been to an audiologist, ask your doctor or nurse about what they can do for you. Audiologists have special training in the prevention, diagnosis and treatment of hearing disorders. Think of it as your spring tune-up!

If you can’t find an audiologist, try the American Academy of Audiologist’s website at www.audiology.org.

Diabetes and Food

"Sugar free" doesn't mean "free food." Most sugar-free foods are desserts and sweets - cookies, jam, jellies, candy. Remember that the American Diabetes Association says that it is the total amount of carbohydrate and calories that are eaten that is important, not just sugar. In fact, people with diabetes can have foods with sugar in them as long as they eat those foods with a meal and include those calories or carbohydrates as part of their meal plan.

Consider these sugar-free oatmeal cookies:

Serving size - four cookies (26g)
Calories 100
Total fat 5g
Total carbohydrates 15g
Dietary fiber 0g, Sugars 0g, Maltitol 6g, Protein 2g.

A regular oatmeal cookie is about 15 grams, but can be as little as 12 grams but up to 50 grams per cookie! Size will make the biggest difference in calories or carbohydrates.

What about the total carbohydrates? Fifteen grams equals one carb unit if you are carbohydrate counting. If you are using Exchange Lists, this is one starch exchange and one fat exchange. If you use the Food Guide Pyramid, these cookies will be a serving from the Breads and Starches group.

Maltitol is a sugar alcohol, also called a polyol. Can you subtract those carbohydrates from the total? The rule of thumb for carbohydrate counting is that if polyols are just one of the sources of carbohydrates, divide the grams of polyols in half and subtract that amount from the total carbohydrate. In this case it would be 6 divided by 2 = 3. Fifteen total carbohydrates minus 3 = 12.

In cases where polyols are the only carbohydrate, if there are 10 or more grams of polyols - sorbitol, mannitol, or xylitol - then divide the grams by 2 and subtract. Also, remember not to eat more than three servings of polyol-containing foods each day. If the total carbohydrate in the food comes from polyols and there is less than 10 grams per serving, the carbohydrates do not need to be counted if three or fewer servings are eaten in a day.

Exercise as a Part of Living

Have you heard of T'ai Ch'i (pronounced tie chee)? Many leisure and sports organizations are adding T'ai Ch'i to their programs. T'ai Ch'i is a traditional Chinese martial art, but it is also practiced for exercise benefits. One of the principles of T'ai Ch'i is an emphasis on relaxation of tension, both physical and mental, leading to the development of internal strength.

There are different spellings of T'ai Ch'i and different types of T'ai Ch'i classes. T'ai Chi Chuan is one of the most famous and widespread of all Chinese health enhancing exercise systems. It includes 108 movements in the long form or between 20 and 40 movements in the short forms.

As always, search for the right exercise program for you, and see your doctor before starting anything new.

Recipes to Try

Cauliflower Potato Soup 14 servings (1 cup each)

2 tablespoons margarine
1 teaspoon caraway seeds
1 cup chopped onion
6 cups fat-free chicken broth
4½ cups chopped cauliflower
½ teaspoon salt
4 cups peeled, diced potato
Pepper to taste
¾ cup shredded carrot

1. Melt margarine in large saucepan; add onion. Cook until lightly browned.
2. Add cauliflower, potato, carrot, and caraway seeds, stirring constantly for 4-5 minutes.
3. Add remaining ingredients and bring to a boil. Reduce heat, cover and simmer about 15 minutes or until vegetables are tender. Remove lid, and lightly mash vegetables until chunky, pureed mixture.
4. Replace lid and simmer another 20-30 minutes.

Per serving: 91 calories, 3.5 gram protein, 15 grams carbohydrate, 2 mg cholesterol, 2.6 grams fat, 24% calories from fat

Peach Raisin Tart (8 servings)

1 cup raisins
1 16-ounce bag frozen, unsweetened peaches, thawed
1/3 cup Splenda®
2 tablespoons flour
½ teaspoon cinnamon
1 tablespoon lemon juice
¼ teaspoon salt
1 9-inch unbaked pie shell

1. Preheat oven to 425°.
2. Combine raisins, Spenda®, flour, cinnamon, and salt.
3. Combine peaches and lemon juice. Toss peaches with raisins/flour mixture.
4. Put peach mixture in middle of pie shell. Fold edges toward center of pie and crimp together.
5. Bake for 10 minutes. Reduce heat to 350° and bake 20 to 25 minutes more until crust is golden brown.

Per serving: 167 calories, 2 grams protein, 30 grams carbohydrate, 0 mg cholesterol, 5 grams fat, 29% calories from fat

Medication Update

Metformin (Glucophage) is a biguanide that works by improving the body’s own insulin action by the liver and decrease liver glucose production. There are two kinds of metformin, regular and extended release.

Metformin is also combined with other medications. Glucovance is a combination of glyburide and metformin. Avandamet is a combination of rosiglitazone and metformin. Metaclip is a combination of glupizide and metformin.

These combination drugs for treating diabetes are similar to cold medication that has more than one drug in it. For instance, a cold medication might have a decongestant and an antihistamine. The decongestant and the antihistamine have different ways of lessening the effects of a cold. The same is true for the combination diabetes medications. Each part has a different way of treating high blood glucose levels.

If a single ingredient type of oral hypoglycaemic is not keeping your blood glucose in your goal range, talk to your doctor. Ask if a medication that has two approaches to treating high blood glucose would be helpful for you, or at least worth a trial. Remember to check your blood glucose often until you and your doctor are comfortable with a new medication.

New Resources

A study by the Health and Human Services' Centers for Disease Control and Prevention shows that deaths due to poor diet and physical inactivity rose by 33 percent over the past ten years. The study was published in the Journal of the American Medical Association and suggests that interventions to prevent and increase cessation of smoking, improve diet, and increase physical activity must become much higher priorities in the public health and health care systems.

The report is titled Actual causes of death in the United States, 2000 and was published in the March 10, 2004 issue of JAMA. Many public libraries carry this journal.

A Nutrition Notes article discusses pedometers, that have become a favorite way to increase activity and keep track of how well you’re doing. Pedometers: Do They Make a Difference? Device Can Bring Benefits if Used Correctly by Karen Collins, R.D. is available at www.msnbc.msn.com/id/4099157/. Nutrition Notes are press releases by Karen Collins for the American Institute for Cancer Research, but often apply to those without cancer as well.