Diabetes - The Medical Perspective
Diabetes & Stress
Stress is so many things it is sometimes hard to define
exactly. Stress can be physical, like injury or illness. Stress
can also be mental or emotional, like problems in family or
friend relationships, problems with your job or money, or
feelings of frustration or anxiety.
When you are stressed, your body gears up to take action.
Levels of many hormones increase to make stored energyglucose
and fat available to cells. However, the cells still
need insulin for the glucose to get in. For those with diabetes,
this may mean that blood glucose levels increase when they
are stressed, either physically or emotionally.
In addition, people who are stressed often do not take
good care of themselves.
They might exercise less than they normally would, or miss
meals. They might drink more alcohol or forget to check their
blood sugar levels.
Just having diabetes and working on changing lifetime
behaviors may be stressful! It is clear that some stress will
always be in your life. Some stress wont always make
your blood sugar too high. However, many stressful things
can be "too much."
If you feel that way, the stress level might be effecting
your blood sugar. Talk to your health care provider so that
he/she knows your blood sugar might be too high because of
too much stress. Ask about support groups. Even if you dont
like sharing your problems, knowing other people in your same
situation can help. You might also learn some tips that work
for other people!
Diabetes and Food
Sugar substitutes have been on the grocery store shelves
for more than 30 years. As the years go by, the number of
sugar substitutes increase.
Are they all the same? While many sugar substitutes can be
used in similar ways, they are not all the same.
The labeling laws of the Food and Drug Administration (FDA)
explain that if one serving of a sugar substitute has less
than 5 calories, it can be labeled as zero calories. Many
sugar substitutes are labeled that way, but really have about
4 calories per serving. This can add up if large amounts are
used in cooking or baking, or consumed in beverages.
Those sugar substitutes that are considered to be non-nutritive,
or zero in calories, include those made with aspartame, saccharin,
acesulfame-potassium or acesultame K, and sucralose. Aspartame
is sold under the names of Equal® , NutraSweet® ,
and NatraTaste®, and will probably also be on your grocery
shelf as a generic or store brand. Saccharin is sold
under the name of Sweet n Low ®, Sweetmate®,
and Sweet Twin®. Acesulfame-potassium or acesulfame
K is sold under the names Sweet One® and Swiss Sweet®.
Sucralose is sold under the name Splenda®.
All of these can be used in hot or cold beverages. Sugar
substitutes will work best in products where sugar is used
mostly for sweetening, such as in pie fillings, sauces, or
custards. All can also be used in cooking or baking,
although they dont all result in a high-quality product
all the time. In recipes where texture and structure is needed,
such as in cakes or breads, sugar substitutes may not all
work as well as sugar. If the sugar was used in the recipe
to also caramelize or brown the product, like in cookies,
sugar substitutes may not all work as well as sugar. Consider
adding a dark ingredient such as molasses, or cocoa. Products
may also bake more quickly with a sugar substitute than with
sugar. Check your cookies and cakes for doneness a few minutes
Exercise as a Part of Living
As spring looms around the corner, many of us are in the
yard or garden more often. Most of us wouldnt think
of gardening as exercise, and yet it is physical activity.
Because the activities of gardening vary, and you might
do a lot one day and not the next, it may be hard to regulate
your blood glucose, or balance your eating, activity, and
insulin. If you are taking insulin, think of gardening as
a new exercise program and remember to check your blood sugar
before and after working in the yard
Recipes to Try
1 pint fresh blueberries
1/8 teaspoonfinely grated orange rind
2/3 cup non-fat plain yogurt
1/3 fat-free sour cream
1/8 teaspoonalmond extract
4 pkts. (1 gram each) aspartame sweetener
- Wash berries and pat dry.
- Sprinkle berries with 2 pkts. aspartame. Set aside.
- In a small bowl combine yogurt, sour cream, sweetener,
orange rind, vanilla and almond extracts.
- Spoon berries into 4 goblets or dessert bowls.
- Top with yogurt mixture.
4 grams protein
0 calories from fat
19 grams carbohydrate
1 mg cholesterol
0 grams total fat
Red Apple Spinach Salad
1 lb. fresh spinach, trimmed and cleaned
1/4 c. frozen unsweetened orange juice concentrate, thawed
1 unpeeled red apple
3 slices bacon, fried crisp, crumbled
1/3 c. light mayonnaise
- Dice apple.
- Mix orange juice and mayonnaise.
- Mix apple and spinach.
- Pour dressing over salad and top with crumbled bacon.
3 gram protein
54% calories from fat
10 grams carbohydrate
7 mg cholesterol
6 grams total fat
Pills to treat type 2 diabetes: Meglitinide, biguanides,
There are three kinds of diabetes pills sold today in
the US. They work in different ways to lower blood sugar.
The previous issue focused on sulfonylureas, which stimulates
the beta cells of the pancreas to release more insulin. Similar
to the sulfonylureas is another medication which also stimulates
the beta cells of the pancreas to secrete more insulin. The
type of medication is a meglitinide and it is sold under the
name of Prandin or may be called Repaglinide. This drug can
produce hypoglycemia or low blood sugar.
The second type of oral hypoglycemic medication are those
that sensitize the body to the insulin that is already present.
Within this category are two general kinds of medications:
biguanides and glitazones.
Biguanides are sold as Metformin (brand name Glucophage)
and lowers blood sugar by helping insulin work better. It
is often taken two times a day.
Glitazones are sold as rosiglitazone (Avandia), and pioglitazone
(Actose). They help insulin work better in muscle and fat.
Glitazones are often taken once or twice a day with food.
The biguanides and glitazones wont cause hypoglycemia
(low blood sugar) unless they are taken with sulfonylurea
or meglitinide oral medications, or in combination with insulin.
When you are taking drugs to control your blood sugar, it
is very important to tell your doctor if you are taking any
other medication. Drug-drug interactions could occur &
cause dangerous or unpleasant side effects. This includes
any over-the-counter medications or nutritional supplement.
Single copies of the following are free from the National
Diabetes Information Clearinghouse,1 Diabetes Way, Bethesda,
MD 20892-3600 (Please use 9-digit ZIP code).
Control Your Diabetes. For Life. Tips for Feeling
Better and Staying Healthy (NDEP-8) This booklet provides
an action plan for diabetes control that includes tips on
knowing blood sugar levels, reaching blood sugar goals, and
maintaining blood sugar control ( 8/98).
Expanded Coverage for Diabetes Medicare and You
(NDEP-19) Available on the web:
If You Have Diabetes, Know Your Blood Sugar Numbers
This brochure provides information on measuring blood sugar
levels using the hemoglobin A1c test and the finger-stick
test (published 8/98, updated 3/00).
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