Karen Chapman Novakovski - Associate Professor of Nutrition

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June/July 2005

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In This Issue

Diabetes -The Medical Perspective

People who have diabetes often also have cardiovascular disease. Doctors don’t know why this is exactly, but it is believed to be related to higher blood glucose levels affecting the linings of the blood vessels.

The cardiovascular system includes the heart and arteries and veins. When your doctor evaluates your cardiovascular system, he will check your blood pressure, heart rate, pulse in your legs and feet, and your blood levels of cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), very low density lipoproteins (VLDL) and triglycerides.

People with type 2 diabetes don’t always have higher blood LDL or cholesterol levels than people without diabetes. Often the VLDL and triglycerides are higher than they should be, and the HDL is lower. When this happens, the person has a higher risk for cardiovascular disease even if the blood cholesterol and LDL are normal or only moderately high.

The American Diabetes Association recommends that the LDL level be below 100 mg/dl, the HDL be above 40 mg/dl for men and above 50 mg/dl for women, and that triglycerides be below 150 mg/dl. Talk to your doctor about what your blood levels are. If they fall within these recommendations, keep doing what you have been doing. If any of the blood values don’t meet these recommended levels, ask your health care team what you can do to bring them back within the normal range. This may reduce your risk of developing cardiovascular disease.

Diabetes and Food

Recently the United States Department of Agriculture (USDA) released a new food guidance system replacing the former Food Guide Pyramid.  The new system, called "MyPyramid," provides a set of tools based on caloric requirements to help Americans make healthy food choices. The goal of the new MyPyramid is to help the consumer match the calories they eat with the calories they need and to maintain or reach an optimal weight.

These are goals for people who have diabetes as well. As with the previous Food Guide Pyramid, serving sizes may differ between one’s diabetic meal plan and the new MyPyramid serving sizes. The starchy vegetables are still in the vegetable choices of the MyPyramid whereas these vegetables are usually counted as a starchy serving in the Cereals group for those with diabetes.

A dietitian or certified diabetes educator can help develop a meal plan that fits the person’s lifestyle and caloric needs, as well as work towards goals in body weight, blood glucose, and blood cholesterol, LDL, HDL, and triglycerides.

Exercise as a Part of Living

Very large people may feel uncomfortable about exercise or physical activity. Not looking “great” in spandex or a swimsuit often makes people avoid public physical activity. However, not having the group interaction and support makes it more difficult to be motivated.

If you are one of these people, or know someone who fits the description, you should read Active at Any Size by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The website and booklet helps very large people meet the challenges of increasing physical activity.

The NIDDK emphasizes starting slowly, appreciating yourself, and having fun. Suggested activities include weight bearing, non-weight bearing, and lifestyle activities. Although national recommendations set physical activity goals fairly high, the NIDDK states that even a few minutes a day will start a person on the path towards fitness.

The website is http://win.niddk.nih.gov/publications/active.htm, or write to Weight-control Information Network, 1 WIN Way, Bethesda, MD 20892–3665, or call Toll free: 1-877-946-4627

Recipes To Try

Lemon Meringue Pie
8 servings

1/3 cup cornstarch
1/2 tablespoon margarine
1/8 teaspoon salt
1/2 cup lemon juice
1 cup Splenda ®, divided
1/4 teaspoon cream of tartar
1-1/2 cups water
1 ready-to bake 9-inch pie shell that has 90 calories/serving or less.
4 eggs, separated

  1. Bake pie shell as directed. Cool.
  2. In medium saucepan, stir together cornstarch, salt, and 3/4 cup Splenda ®. Add water, stirring until Splenda ® and cornstarch are dissolved. Cook on medium heat until mixture thickens and comes to a boil, stirring constantly.
  3. Beat egg yolks in small bowl. Add about 1/3 cup of the cornstarch mixture and stir. Transfer this mixture to cornstarch mixture in saucepan, stirring rapidly. Cook on medium heat until very thick, about 5 minutes.
  4. Remove from heat and whisk in margarine and lemon juice. Pour into pie shell.
  5. Preheat oven to 400°.
  6. In medium bowl beat egg whites on high speed until foamy. Add cream of tartar and beat until soft peaks form. Add remaining 1/4 cup Splenda ® and beat until stiff peaks form.
  7. Spread meringue over pie filling, sealing with crust edge. Bake 10 minutes or until meringue is golden.
  8. Remove from oven and cool 1 hour. Refrigerate for 3 hours before serving.

Per serving:
Calories 167
Fat 8 grams
Protein 4 grams
Calories from fat 44%
Carbohydrate 20 grams
Cholesterol 110 grams
Fiber 0 grams
Sodium 164 mg

Note: Pie crusts vary from 80 to 150 calories per serving. Read the label to choose one lower in calories. The above calculations were based on a pie crust with 90 calories per 1/8 of a pie.

Medication Update

Glucovance ® is an oral medication that contains two types of medication to lower blood glucose: a sulfonylurea (glyburide ®) and a biguanide (metformin ®). Your doctor may start you on Glucovance ® if you have been taking both of these medications separately. It is more convenient to take one pill than two.

Your doctor may also start you on Glucovance ® if you’ve been taking one or the other of these medications and have not met your blood glucose goals.

A possible side effect of Glucovance ® is hypoglycemia or low blood glucose. If this occurs, your doctor may take you off Glucovance ® and try Metformin ® by itself. Your doctor may also discontinue Glucovance ® if you develop problems with your kidneys or liver, if you have a surgery scheduled, or if you have an illness like the flu where you are losing a lot of body fluids by vomiting or diarrhea.

Talk to your doctor any time your medication changes. Do not change your dosage yourself or discontinue a medication without talking to your doctor. Remember to check your blood glucose so you and your health care team can check how effective your medication is.

New Resources

You can get more information about the new food pyramid at

www.mypyramid.gov

or write to: USDA Center for Nutrition Policy and Promotion
3101 Park Center Drive
Room 1034
Alexandria, VA 22302-1594

The American Diabetes Association has a Message Board service on its website. These Message Boards allow people with the same concerns or type of diabetes to “talk” to people with the same concerns. The ADA does not monitor the message boards and advises everyone to talk to their health care providers to be sure the information is correct. Anyone can read posted messages, but to post a message or reply, you need to register (free). Visit www.diabetes.org and click on Message Boards in the yellow top border.

 

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