April /May 2001
Diabetes - The Medical Perspective
Diabetes & Your Feet
People who have diabetes are more likely than others to have
difficulty with their feet. Diabetes effects both the nerves
and the blood vessels.
When your diabetes effect the nerves in your feet, you may
feel like there are pins and needles in your feet or they
might "fall asleep" easily.
When your diabetes effects the blood vessels, the blood vessels
become more narrow and limit circulation. Poor circulation
makes it hard to get blood to your feet.
You may have poor circulation if:
Your legs or feet often hurt while walking or resting;
Your legs or feet hurt even at night when you are sleeping;
Your feet are usually cold, bluish, or puffy;
Cuts or sores on your feet dont heal well;
Your feet are usually dry with cracks in the skin.
If you have any of these problems, make sure you talk to
your nurse or doctor about them.
To help prevent problems with your feet, make sure you:
Wash your feet every day with warm (not hot) water and
Dry your feet carefully, especially around the toes;
Check for sores, cracks, or cuts on your feet;
Make sure your toenails are kept trimmed, and always cut
them straight across the nail;
Use lotion on your feet to help keep the skin smooth, but
dont put lotion between your toes or on cuts or cracks;
Always wear shoes that fit your feet well.
Make sure the foot specialist is part of your health care
team, or that your doctor checks your feet at least once a
Diabetes and Food
Controlling your diet is an important part of your diabetes
care. To help you eat a healthy diet while controlling your
blood sugar and weight, many different food plans can be used.
Some of the most common are the Food Guide Pyramid, the Food
Exchange Lists, and Carbohydrate Counting.
Food Guide Pyramid
The Food Guide Pyramid is an eating plan that was designed
for everybody - not just those with diabetes! You have probably
seen the Food Guide Pyramid on food labels. The Food Guide
Pyramid has six food groups: the Bread, Cereal, Rice, and
Pasta Group; the Fruit Group; the Vegetable Group; the Milk,
Yogurt, and Cheese Group; the Meat, Poultry, Fish, Dry Beans,
Eggs, and Nuts Group; and the Fats, Oils, and Sweets Group.
The Food Guide Pyramid then suggests a certain number of servings
from each group to be eaten each day.
Food Exchange Lists
The Food Exchange Lists also divide foods into groups. The
serving sizes might be different from the Food Guide Pyramids
suggestions because of the calorie or carbohydrate content
or the food. For instance, the Food Guide Pyramid sets a serving
size for juice at 3/4 cup but the Food Exchange List sets
the serving size at 1/2 cup for certain juices like orange
juice. The Food Exchange lists vegetables, so often include
cheese in with the Meat Group because of the protein in cheese,
whereas the Food Guide Pyramid includes cheese in the Milk
Carbohydrate counting is a system in which only foods that
contain carbohydrates are "counted." Serving sizes
of food are given so that each food contains 15 grams of carbohydrate,
or a multiple of 15 (30, 45, 60 grams).
If you are not sure which food plan to use, or want to try
a different plan, talk to your doctor, dietitian, or nutritionist.
Exercise as a Part of Living
Physical activity, or exercise, does not have to mean being
on your feet, if foot problems are already part of your life.
Many exercise routines can be done while sitting.
Aerobic exercise is the kind that is best for your heart.
Although aerobic-type exercise usually means being on your
feet, swimming is also aerobic. Bicycling is less hard on
your feet, whether using a stationary or regular bike.
Muscle strengthening exercises or flexibility exercises can
also be done while sitting. Weights can add resistance, but
even lifting arms and legs without weights is activity.
Remember to check with your doctor before starting any new
exercise routine, especially if you have a history of heart
Recipes to Try
2 tablespoons margarine
2 tablespoons water
2- 6 oz. Chicken breasts, halved & skinned
Tabasco pepper sauce
1/2 teaspoon tarragon dash of pepper
2 tablespoons lime juice
- Melt margarine in skillet. Place chicken in skillet. Season
with pepper & tarragon.
- Brown chicken over medium heat- about 10 minutes. Turn,
season, & brown other side.
- Mix lime juice, water, & pepper sauce; pour on chicken.
Cover & simmer until tender, about 10 minutes.
- Suggested to be served with rice.
||27 grams protein (without rice)
|40 % calories from fat
||1 gram carbohydrate
|72 mg cholesterol
||9 grams total fat
1can (8 oz.) Jellied cranberry sauce
1 to 2 drops red food coloring
1/2 cup diet carbonated lemon-lime beverage
- Beat cranberry sauce & food coloring in small mixer
bowl until smooth.
- Mix in lemon-lime beverage gradually on low speed.
- Pour into refrigerator tray; cover & freeze until
- Remove from freezer; break into chunks in small mixer
bowl. Beat until fluffy & smooth.
- Return to refrigerator tray; cover & freeze until
||0 gram protein
|0% calories from fat
||22 grams carbohydrate
|0 mg cholesterol
||0 grams total fat
Pills to treat type 2 diabetes: sulfonylureas
There are three kinds of diabetes pills sold today in the
US. They work in different ways to lower blood sugar. This
column will focus on sulfonylureas, which stimulates the beta
cells of the pancreas to release more insulin. Names of sulfonylurea
drugs include: Chlorpropamide (brand name Diabinese); glipizide
(Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase,
and Diabeta), and glimepiride (Amaryl). All sulfonylurea drugs
have similar effects on blood sugar levels, but they differ
in side effects, how often they are taken, and interactions
with other drugs.
Alcohol and diabetes pills may not mix, especially chlorpropamide,
and more rarely other sulfonylureas. They can interact with
alcohol to cause vomiting and flushing.
Generic versions of some sulfonylureas are available, are
generally reliable, & cost less than the brand-name products.
Ask your doctor to prescribe the largest tablet strength suitable
for the dose you need. One 500-mg tablet, for example, often
costs much less than two 250-mg tablets.
At some point, a sulfonylurea may stop working as well as
it used to, and your blood sugar level will go up. This doesnt
mean you have done anything wrong, or not followed your diet.
Instead of taking more of this medicine, your doctor may change
you to another kind of sulfonylurea, or a different medication
If you are taking a sulfonylurea medicines, tell your doctor
if you ever have any unusual or allergic reaction. Sulfonylureas
are rarely used during pregnancy, so tell your doctor if you
become pregnant or are thinking about breast-feeding. Some
elderly patients may be more sensitive than younger adults
to the effects of sulfonylureas, and may have an increased
chance of developing low blood sugar. Elderly patients who
take chlorpropamide are more likely to hold too much body
water as well.
When you are taking sulfonylurea drugs, 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.
The following are resources focusing on foot care:
Action Plan for persons with Diabetes: Prevent Foot
Ulcers & Amputations! Eli Lilly & Co. and Boehringer
Mannheim Corp.,(1997) 207-7648-0197, Global Diabetes Care,
Indianapolis, IN 46285 fax: 317-277-9337,or at
Self-Testing for Sensation in Your Feet. Eli Lilly
& Co. and Boehringer Mannheim Corp.,(1997) 207-7648-0197,
Global Diabetes Care, Indianapolis, IN 46285 fax: 317-277-9337,or
Becton Dickenson Consumers Products: Foot Care Dos
and Dont; low literacy, English or Spanish, 800-237-4554.
Up to 25 copies/month available to health educators free.
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