December 2005 /January 2006

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Diabetes -The Medical Perspective

Foot ulcers are sores on the foot.  They are more common in people who have diabetes.  Having diabetes and not keeping blood glucose in control increases the risk of getting a foot ulcer.  Other risk factors for foot ulcers include

• nerve tissue disease in feet, legs, or fingers, with a loss of sensation (peripheral neuropathy)
• increased pressure on parts of the foot that may be caused by foot deformity or limited ankle mobility
• foot injury, either through accident or repetitive rubbing and irritation of the foot by shoes.

Those who have diabetes should have an annual foot examination that includes assessment of skin for breaks or dryness; examination of toenails and possibility of foot deformity; adequacy of blood flow in the foot; and sensation detection in the foot.

To test sensation, the doctor will usually use a very thin wire the size of plastic fishing line called a monofilament. The doctor will stick the monofilament into the bottom of the foot in four to nine spots.  It is not a sharp wire and the pressure is not enough to penetrate the skin and bleed.  However, a person with good sensation will be able to feel all of the sticks.  As neuropathy develops, a person won’t be able to feel the sticks at one or more sites. 

Other ways to test for sensation in the feet include using a tuning fork or a small vibrating device.  Whatever instruments are used, the person with diabetes should receive an exam each year and know their risk level for developing foot ulcers.

Diabetes and Food

Holiday foods are tempting.  As part of the festivities food has to be special - look better, taste better, even smell better – than everyday-type of food.  People who have diabetes should NOT pretend they wouldn’t taste special holiday foods.  The idea that if you don’t plan on eating it then it doesn’t “count” isn’t true and can lead to higher blood glucose levels that continue from one holiday to the next.  Here are some tips for planning your treats

• Choose smaller portions of extra rich foods, even if it means leaving something on your plate.
• Try to plan when and where you’ll enjoy holiday foods so that you don’t “accidentally” enjoy festival foods several times in one day.
• If the treat turns out not to be incredible – don’t finish it.  “Save”  those calories or carbohydrates for another time.
• Plan other activities at social events in addition to eating, even if that means helping to clean up, introducing yourself to new people, or starting a game of charades or cards.
  

Exercise as a Part of Living

Many fitness centers or health clubs offer personal fitness trainers, even certified personal fitness trainers.  Did you know there are many types of certification?

The American College of Sports Medicine (ACSM) certifies trainers. An ACSM certification requires a college degree in exercise physiology or related areas. Most of the training in this program is from a medical or clinic perspective and is required for any trainer wanting to work with rehabilitation of heart patients.

The American Council on Exercise (ACE) also offers certification for personal trainers, as well as group fitness, weight management trainers, and clinical exercise specialists. 

While these are the two most common organizations offering certification in training, there are certainly many more organizations offering a certification program.  If you are planning to work with a personal trainer, ask if they are certified and with whom.  Find out what areas they are specially trained to work in, and if they have worked with people who have diabetes in the past.

Recipes To Try

Cranberry Chutney   

5 ¼ cup servings

1 cup raw cranberries
½ teaspoon ground cloves
1 cup water
¼ cup finely chopped onion
2 tablespoons Splenda®
¼ cup finely chopped celery
½ teaspoon ground ginger
1 medium apple, peeled and chopped
½ teaspoon cinnamon

1. Simmer all ingredients except apple in saucepan for 15 minutes, stirring occasionally.
2. Add chopped apple and cook for an additional 5 to 10 minutes.
3. Cool. Serve as an accompaniment to turkey, fish, or pork.

Note: This is a tart chutney. To increase sweetness, add additional Splenda®.

Per serving:

Calories 30
Fat 0 grams
Protein 0.5 grams
Calories from fat 0%
Carbohydrate 8 grams
Cholesterol 0 grams
Fiber 2.5 grams
Sodium 11 mg

Two Potato Bake

8 servings

1 1/3 cup instant potato flakes
1/3 cup Parmesan cheese
1 ¼ cup water
1 tablespoon chopped garlic
2/3 cup skim milk
16 frozen potato wedges (from 24 ounce package)
1 cup no fat sour cream
non-fat cooking spray

1. Heat oven to 400º. Spray 2 quart baking dish with non-fat cooking spray.
2. Bring water to boil in saucepan. Add potato flakes and skim milk. Fluff flakes to make mashed potatoes.
3. Add sour cream, Parmesan cheese, and garlic. Mix well.
4. Place in 2 quart baking dish. Arrange potato wedges on top of mashed potato mixture in a spiral.
5. Bake 30 to 35 minutes until hot.

Per serving:

Calories 121
Fat 3 grams
Protein 5 gram
Calories from fat 20%
Carbohydrate 20 grams
Cholesterol 6 grams
Fiber 1 grams
Sodium 227 mg

Medication Update

There is a new drug that is being tested for treatment of diabetes. Liraglutide is based on a naturally occurring hormone called Glucagon-Like Peptide-1 (GLP-1). GLP-1 is released from the intestinal tract as people eat. GLP-1 works to maintain normal blood glucose levels by:

• promoting the synthesis and release of insulin from the pancreas.
• lowering blood levels of glucagon, a hormone that normally stimulates glucose production and release from the liver.
• promoting feelings of fullness by slowing stomach emptying.

The naturally occurring hormone GLP-1doesn’t stay effective for very long. Liraglutide is made to last all day. Because it also produces a feeling of fullness, Liraglutide may help prevent weight gain.

Liraglutide has been tested in animals and humans, but more testing needs to be completed before it has been demonstrated to be safe and effective.  However, you may see Liraglutide on the market in 2006.

New Resources

The U.S. Food and Drug Administration is alerting health care providers and patients of a problem with blood glucose meters made by Abbott Diabetes Care, Alameda, Calif. The meters can be switched from one unit of measurement to another, which can be confusing or dangerous to the user.  The machines can give results in both the U.S. standard, milligrams per deciliter or mg/dL, and the foreign standard, millimoles per liter or mmol/L.  These units can be accidentally switched from one measurement to the other. The switch may occur when a user is setting the time and date for the meter, or if it is dropped or after replacement of the battery.

Abbott is not telling people to return their blood glucose meters. For information on how to change the meter reading back to mg/dl, people can read their Owner’s Manual or contact Abbott Diabetes Care at 1-800-553-4105 (open 24 hrs. per day) or  AbbottDiabetesCare.com. People  who think they may have been using the wrong read-out from their meters and are worried should contact their doctors.