Karen Chapman Novakovski - Associate Professor of Nutrition

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April/May 2005

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In This Issue

Diabetes -The Medical Perspective

A person with diabetes is 17 times more likely to develop problems with their kidneys than those without diabetes. The kidneys’ function is to filter blood and dispose of wastes in the urine. This filtering system is composed of millions of small blood vessels. Damage can occur to these small blood vessels from high blood glucose and high blood pressure. If damage does occur the kidneys are not able to filter the body’s wastes very well leaving things (protein) in the urine. This is called nephropathy.

Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts of protein is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows. This failure, ESRD, is very serious and causes waste products to build up in the blood.

There are no early symptoms of diabetic nephropathy or chronic kidney disease, but it can be detected and treated by yearly blood and urine tests in your doctor’s office.

Tips to Detect and Prevent Diabetic Nephropathy

  1. Keep your blood glucose levels close to normal range.
  2. Lower your blood pressure, if it is high.
  3. Know your glomerular filtration rate (GFR). GFR is a measure of kidney function.
  4. Have your urine checked for protein.
  5. If you have microalbuminuria, discuss with your physician how they will treat this problem.

Diabetes and Food

Sodium intake has been linked to high blood pressure. Sodium is the main component in salt. Even if you don’t use salt at the table, your intake of sodium may be higher than it should be. Many foods have added sodium or salt as a preservative or for flavor.

Fresh foods, like fruits, vegetables, or fresh cuts of meat are usually low in sodium. Foods that have been cured, like bacon or ham, are higher in sodium. Foods that have been processed often include higher amounts of sodium. These include hot dogs and lunchmeats, canned soups, and many microwave meals or meals made from boxed ingredients such as skillet suppers.

Be sure to read the nutrition facts label and pay special attention to the percent daily value. You should aim for less than 2400 mg of sodium a day and avoid foods that contain high amounts sodium. Here are some definitions that may help you next time you are in the grocery store.

Reduced sodium: The food has three-fourths less sodium that the reference food. Make sure to read the milligrams because reducing the sodium three-fourths may not have as big of an effect as you think.

Low sodium: One serving contains 140 mg of sodium or less.

Very low sodium: One serving contains 35 mg or less. Make sure you check the serving size.

Sodium-free: The food has less than 5 mg of sodium per serving.
Making changes in our diets is not very easy. It’s important to make small changes gradually.

Exercise as a Part of Living

Excess body weight is closely linked with high blood pressure. A weight reduction program can be very beneficial for lowering blood pressure and improving the effectiveness of antihypertensive medications. Research has shown that weight reduction, even as little as 10 pounds, reduces blood pressure of overweight persons with hypertension.

If you have high blood pressure, check with your doctor before beginning a new exercise program.

Recipes To Try

Crustless Spinach Quiche - 8 servings

5 large eggs, beaten
2 tablespoons margarine
6 ounces lowfat (1%) cottage cheese
1/2 teaspoon nutmeg
4 ounces Feta cheese
10 ounce box frozen spinach, thawed, drained
1/2 cup shredded Swiss cheese
Non-stick cooking spray

  1. Preheat oven to 350°.
  2. Spray a quiche or 10-inch pie pan with cooking spray.
  3. In a large bowl combine all ingredients except spinach.
  4. Stir in spinach.
  5. Pour into pan. Bake for 35 to 45 minutes until slightly browned on top.

Per serving:
Calories 146
Fat 10 grams
Protein 11 grams
Calories from fat 59%
Carbohydrate 3 grams
Cholesterol 149 grams
Fiber 1 grams
Sodium 382 mg

Pineapple Bars - 24 servings

1 8-ounce package lowfat crescent rolls
1 tablespoon lemon juice
3 ounces nonfat cream cheese
2 eggs
1 /2 cup Splenda®
1 cup crushed pineapple, drained

  1. Preheat oven to 375°. Separate rolls into 2 strips and line a 9 x 13 pan, sealing perforations. Bake for 5-7 minutes until lightly browned. Remove from oven.
  2. Combine remaining ingredients except pineapple, mixing well. Stir in pineapple.
  3. Pour mixture over partially baked crust. Bake 25 minutes until mixture is set. If edges are brown and middle is not set, reduce heat to 350° and bake additional 5 to 10 minutes. Cool and cut into 24 bars.

Per serving:
Calories 53
Fat 2 grams
Calories from fat 33%
Protein 2 grams
Carbohydrate 7 grams
Cholesterol 18 grams
Fiber 0 grams
Sodium 108 mg

Medication Update

You may have heard of the insulin that you can take with just one shot. Lantus® is a long-acting insulin that provides 24 hour coverage with just one shot.

However, Lantus® is for basal coverage – not for covering the rise in blood glucose that occurs after meals. So, although you need only one shot for your basal coverage, you need a shot of a short acting insulin before each meal.

Lantus® can be used with oral hypoglycemic medications, or with other types of insulin. Unlike some other insulins, Lantus® cannot be mixed in the same syringe with any other type of insulin.

As with any insulin therapy, possible side effects may include blood glucose levels that are too low (hypoglycemia); injection site reactions, including changes in fat tissue at the injection site; itching and rash; and allergic reactions.

Self-monitoring of blood glucose is recommended for everyone who has diabetes. Talk to your doctor about how often you should check your blood glucose. If you are changing types of insulins or amounts of insulin or oral hypoglycemic medications, you should check your blood glucose more often than after you are in a routine.

New Resources

You can get more information about chronic kidney disease from:

National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Telephone: 1-800-622-9010 or 1-212-889-2210
Fax: 1-212-689-9261
Web site: http://www.kidney.org
E-mail: info@kidney.org

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
Web site: http://www.niddk.nih.gov

American Association of Kidney Patients
3505 East Frontage Road, Suite 315
Tampa, FL 33607
Telephone: 1-800-749-2257
Fax: 1-813-636-8122
Web site: http://www.aakp.org
E-mail: info@aakp.org

About Diabetes | Food & Diabetes | Medications & Diabetes | Current Issue | Archive | En Español

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