February/March 2005

[Open as PDF]

Diabetes -The Medical Perspective

Steroids are a group of medications commonly used in medicine that can have effects on blood glucose for those who have diabetes as well as for those who don’t. Steroids are also called corticostroids or glucocoticoids. While there are many, many different steroids, some of the most commonly prescribed are hydrocortisone, prednisone and dexamethasone. Steroids are often used to reduce inflammation as in asthma or arthritis, or to help lessen the symptoms of immune disorders such as Lupus.

A side effect of steroids is their impact on insulin. Steroids increase “insulin resistance” making the insulin less effective. This will cause blood glucose levels to rise if you have diabetes. If you don’t have diabetes and your pancreas is able to make additional insulin, your blood glucose will stay within a normal range. If the pancreas can’t make enough insulin to keep your blood glucose within a normal range while you are taking steroids, you have what is called “steroid-induced diabetes.”

Very often steroid-induced diabetes goes away when you quit taking the steroids. If you have to continue with steroids long-term, the diabetes may remain. Sometimes steroid-induced diabetes is an early indicator and the person will develop diabetes later in life even when not taking steroids.

Steroids are very effective medications for inflammation and immune disorders. Because of their side effects, doctors usually prescribe the lowest dose for the shortest amount of time.

Talk to your doctor if you have questions about any medications you are taking.

Diabetes and Food

It is winter again and many people are loading up on vitamin C to ward off colds. Whether that really works or not is still being debated. However, one group of scientists believes it is better to get your vitamin C from food, especially if you have diabetes and are taking vitamin C supplements on a regular basis.

Scientists at the University of Minnesota followed 2,000 postmenopausal women with diabetes for 15 years. They found that those who took a vitamin C supplement of 300mg. or more per day were more likely to develop heart disease or have a stroke than those who took less than 100 mg. of supplemental vitamin C per day or none at all.

This study does not show that supplemental vitamin C causes heart disease – just that the two were associated. The scientists agree that more research needs to be done. To be on the safe side though, they recommend getting adequate amounts of vitamin C from food.

The current recommended dietary intake for vitamin C is 90 mg. per day for men and 75 mg. per day for women. The easiest way to get this amount is to eat at least five servings of fruits and vegetables each day.

Exercise as a Part of Living

Strength or resistance training is good for muscles and bones. For this type of exercise, free weights, machines, or elastic bands can be used.

Strength training for those who have diabetes can help to reduce body fat and increase muscle mass. More muscle mass will reduce insulin resistance and improve blood glucose levels for those treating their diabetes with diet alone, with oral medications, or with insulin.

An additional benefit of strength training is the improved ability to do every day chores because of improved muscle strength. Bone mass will also be improved so the risk of osteoporosis is less. Strength training also might help lessen the risk of heart disease.

However, if you have diabetes and any type of vascular disease, retinopathy (eye disease), neuropathy (nerve disease) or high blood pressure, talk to your doctor before beginning any strength training. Avoiding heavy weights or any rapid bursts of activity may need to be included in your training program.

Recipes To Try

Cabbage and Leek Soup
about 10 1-cup servings

• 2 tablespoons olive oil
• 2 carrots, grated
• 2 small leeks, chopped
• 1 teaspoon caraway seeds
• 2 medium onions, chopped
• 2 small potatoes, peeled and diced
• 2 tablespoons minced garlic
• 6 cups chicken broth
• 4 cups shredded cabbage
• Salt and pepper to taste

1. Heat oil in large pot. Add leeks, onion and garlic. Cook and stir until tender, about five to ten minutes.
2. Stir in broth, carrots, and caraway seeds. Bring to a boil.
3. Stir in potatoes. Simmer until potatoes are cooked, about 20 minutes.
4. Stir in cabbage. Continue to simmer until cabbage is wilted, about 15 minutes. Add salt and pepper, if desired. Add water while simmering if needed to cover the vegetables.

Per serving:
Calories 118
Fat 4 grams
Protein 3 grams
Calories from fat 32%
Carbohydrate 18 grams
Cholesterol 0 grams
Fiber 2 grams

Little Cream Puffs
24 servings

• 1/2 cup water
• 2 eggs
• 3 tablespoons margarine
• 1 /2 cup lite whipped topping
• 1/8 teaspoon salt
• Non-stick cooking spray
• 1/2 cup flour

1. Preheat oven to 375°. Spray a baking sheet with non-stick spray.
2. In a medium pan, heat water, margarine and salt until boiling.
3. Remove from heat. Add flour, stirring well.
4. Add eggs, one at a time, stirring well after each.
5. Drop by teaspoonfuls on baking sheet. Bake for 25 minutes.
6. Cool on rack. Cut puffs horizontally about three-fourths of the way through. Add a teaspoonful of topping. Refrigerate.

Per serving:
Calories 32
Fat 2 grams
Protein 1 gram
Calories from fat 58%
Carbohydrate 2 grams
Cholesterol 18 grams
Fiber 0 grams

Medication Update

If you’re taking a short-acting insulin before meals, you may be interested in research about an inhaled insulin being evaluated in clinical trials.

About 300 people with diabetes took part in a research project comparing the inhaled insulin with the short-acting insulin. Researchers found that for blood glucose control the inhaled insulin before meals with a long-acting insulin injected in the evening was as effective as injected short-acting insulin before meals with the same long-acting insulin in the evening. Researchers were concerned that the inhaled insulin might not be good for the lungs. They found the lung function to be fine, but those inhaling insulin did develop a cough occasionally.

Those inhaling the insulin reported their quality of life improved. They also gained less weight than the group receiving all injected insulin.

Researchers are now conducting long-term studies to make sure that there are no effects when insulin is inhaled over longer periods of time.

New Resources

The website www.diabetic-lifestyle.com/ includes sections titled Recipes; What’s for Dinner; Entertaining; Health Updates, What’s Hot; Travel; Just for Kids; Burning Calories, and Cooking Tips. Clicking on each area will provide an archive of past articles, back to 1997. It is an internet only magazine and not available in print copy.

The National Kidney Foundation of Illinois in partnership with the Illinois Diabetes Prevention and Control Program will hold free Kidney Early Evaluation Programs (KEEP) in various locations across the state. The KEEP screening is available to individuals 18 years or older with family history of diabetes, high blood or kidney disease or diagnosed with diabetes or high blood pressure. Contact Kim Fowler at 312-321-1500.