December 2004/ January 2005

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Diabetes -The Medical Perspective

Diabetes is a lifelong condition that affects many aspects of day-to-day living. Everyone who has diabetes has thoughts or feelings about it. These feelings may vary from day to day or season to season. Some clinicians believe that people with any chronic condition go through stages: denial, anger, depression, and adaptation. People may go back and forth through these stages as medications change or other life events occur.

Your feelings and stress levels may affect your blood glucose levels. Or your blood glucose levels may be the source of additional stress if you don't feel you can manage to keep them at your target level. It can be a vicious circle! It is important to acknowledge your feelings about your diabetes. They won't just go away and feelings aren't just problems that need to be solved. Sometimes saying that you feel (identify the feeling) because of (reason) will help sort out very mixed emotions.

Friends and family members can be a great support to anyone who has a chronic condition. However family members may feel guilty (they don't help enough), or they somehow feel jealous of extra attention the person with diabetes gets. Everyone may worry about long-term complications.

If the support systems need support, your doctor is a good first place to turn. Your doctor may be able to help sort out feelings, or suggest another professional who can help. Local support groups can help the person who has diabetes feel less lonely - or even be a group to share special achievements with.

Not everyone likes to talk about feelings, especially negative ones. Sometimes keeping a journal or writing to a friend can help. Several diabetes-related websites have “chat rooms” and most local hospitals will have support groups. Watch your local newspaper for weekly events to find out when and where they meet. Living with diabetes is difficult and often frustrating. Take action to get the support you need!

Diabetes and Food

Nutrition bars are becoming more popular as a quick snack or meal replacement. Are they "okay" for those with diabetes? Although almost any food can fit into the meal plan with careful planning, nutrition bars are a special challenge.

There are many different kinds of nutrition bars - some are energy bars, some protein bars, some meal replacements, there are even high carb and low carb bars. Because nutrition bars have fairly high levels of vitamin and minerals added, they are considered a supplement, not a food.

What this means to the general public is that they are not regulated the same way as food. A few years ago an independent laboratory found that many of the nutrition bars on the market did not contain what their labels claimed. Half of the bars tested contained more carbohydrate than their labels claimed. Often this was because the manufacturers excluded certain compounds from "counting" as carbohydrate. The FDA has sent warning letters to the companies stating that they were wrong and that all of the excluded compounds indeed "counted" as carbohydrate. However, because there is no regulatory process, the manufacturers may not (and do not have to) change their labels.

This makes it very difficult for those with diabetes to use nutrition bars in their meal plans. Low carb bars may not be a good choice since they may really be high carb bars. Checking blood glucose levels two hours after eating may be the best plan.

Exercise as a Part of Living

How hard you exercise and how long you exercise can have different effects on your blood glucose.

Light exercise doesn't affect your breathing but your pulse may increase somewhat. Light exercise for less than about 10 minutes will not affect your blood glucose. Light exercise for longer than 10 minutes can lower blood glucose.

Moderate exercise does affect both breathing and pulse. Pulse will increase to between 100 and 125 beats per minute. Moderate exercise for less than 10 minutes may raise blood glucose - the liver will release stored glucose for short-term needs. However, moderate exercise for longer than 10 minutes will usually lower blood glucose.

Strenuous exercise affects breathing and pulse more intensely. Breathing will be rapid and pulse rates will be between 125 and 160 beats per minute. Like moderate exercise, blood glucose levels may increase if the exercise lasts less than about 10 minutes. Strenuous exercise for longer than 10 minutes may lower blood glucose for a longer time than moderate exercise can.

The effects of exercise can vary among people because of training, age, medication, and how well controlled their blood glucose usually is. Check your blood glucose level before exercise and afterwards to avoid high or low blood glucose swings.

Recipes to Try

Holiday Fruit Salad

21 servings, 1/3 cup each
(14 servings, 1/2 cup each)

• 1 can (20 oz.) crushed pineapple
• 1 can (16 oz.) whole berry
• 2 pkgs. (4 servings each) sugar-free cranberry sauce
• cranberry gelatin
• 1 medium apple, chopped

1. Drain pineapple, reserving juice. Add enough water to juice to make 2 cups and bring to a boil in microwave or on stove.
2. Add boiling liquid to gelatin in mixing bowl. Stir until dissolved.
3. Add cranberry sauce and stir until blended.
4. Add crushed pineapple and blend. Stir in chopped apple.
5. Refrigerate until firm.

Per serving:
58 (88) calories 0 (1) gram protein 14 (21) grams carbohydrate 0 (0) gram total fat 0 (0) % calories from fat 0 (0) mg cholesterol 1 (1) gram fiber

Sugar-free Banana Bread

14 servings

• 2 cups flour
• 2 eggs
• 1/2 teas. baking soda
• 3 ripe bananas, mashed
• 1/2 teas. salt
• 1/3 cup non-fat plain yogurt
• 1 cup Splenda®
• 1 teas. vanilla
• 1/4 cup margarine
• softened cooking spray

1. Preheat oven to 350°. Spray loaf pan with cooking spray.
2. Combine flour, soda, and salt.
3. Cream Splenda® and margarine with a mixer until well blended. Add eggs, one at a time, mixing after each addition. Add banana, yogurt, and vanilla, mixing well. Add flour mixture, beating at low speed just until moist.
4. Spoon batter into loaf pan. Bake 1 hour or until toothpick inserted in middle comes out clean.

Per serving: 145 calories 3 grams protein 24 grams carbohydrate 4 grams total fat 27% calories from fat 30 mg cholesterol 1 gram fiber

Medication Update

If you’ve just started taking insulin, or if it has been awhile since you received instructions, it may be worthwhile to review a few facts on the storage and use of insulin.

• The insulin bottle being used can be kept at room temperature if the room is less than 86°F.
• If it is hot or very humid, store the bottle you are using the refrigerator.
• You may warm the insulin to room temperature before using it. Usually this will cause less irritation than chilled insulin does.
• Insulin will be fine to use for 28 days after opening even when kept at room temperature.
• Extra bottles of insulin should be kept in the refrigerator.
• Insulin should never be frozen. Extremes of temperature can cause insulin to lose its potency.
• Always check the bottle for off color or “stringiness.” If the color is unusual or if the insulin doesn’t mix well, don’t use it.
• Clear insulin does not need to be mixed.
• Longer acting insulins are often cloudy and need to be mixed by rolling or shaking gently.
• Check the expiration date on the bottle or box. If it is past the expiration date, don’t use it.
• Calculate how many doses you can get from a bottle so the insulin doesn’t expire before you use it. If you are not sure how many doses you should be able to get from a bottle, ask your pharmacist.

Whenever you have a question about your medication, call your pharmacist or ask your doctor. Ask that the information be written so that you can refer to it again later. Write the name and dose of the medication on the instructions because instructions may change when medications change.

New Resources

Although not “new,” the book 'Psyching Out Diabetes: A Positive Approach to Negative Emotions' by Dr. Richard Rubin may be a good place to start if you or a friend or relative needs some extra support. The book is 269 pages and has chapters dealing with denial, obsession, anger, depression, grief, fear, frustration, guilt, embarrassment, psychological help, and positive framing.

Published by NTC Contemporary Publishing, Chicago, 1997. Paperback and hardback. $12 –22. Available through amazon.com, diabetes.com and many local bookstores.