June /July 2002
Diabetes -The Medical Perspective
Urinary tract infections affect millions of people each year,
but occur more often in those who have diabetes. This may
- there is a difference in the way those with diabetes
are able to fight infections;
- there is incomplete bladder emptying which occurs when
the nerves around the bladder have been affected by diabetes;
- or there is a high urine glucose concentration that accompanies
poor blood glucose control. The high urine glucose concentration
can be "food" for microorganisms.
Normally urine is sterile, and contains fluid, salts, and
waste products, but no bacteria or viruses. An infection occurs
when bacteria cling to the urethra, multiply, and move up
the urinary tract system to the bladder, and possibly to the
kidneys. Most often, the outward flow of urine will wash away
the bacteria. Sometimes it doesn’t and an infection
Not everyone with a urinary tract infection has symptoms.
However, those who have diabetes may have a higher blood glucose
reading than usual because infections usually raise blood
glucose. Other symptoms of a urinary tract infection include
a frequent urge to urinate; pain or a burning feeling in the
lower abdomen; milky or cloudy urine; and a shaky, washed
To avoid an infection:
- drink plenty of water;
- drinking cranberry juice may help, although the calories
and carbohydrates need to be included in the overall meal
plan or diet;
- take showers instead of baths.
Talk to your health care provider for more information about
urinary tract infections, especially if you have any symptoms,
have a history of urinary tract infections, have unexplained
fevers, or have an unexplained high blood glucose level.
Diabetes and Food
Those who have diabetes know that planning meals will help
- keep their blood glucose in the normal range;
- keep their blood cholesterol in the normal range;
- keep their weight in the normal range;
- and prevent or delay health complications related to
Keeping a food diary may help you become more aware of how
you eat. Keeping a food diary will also help your dietitian
when she/he is assessing your eating patterns in relation
to your blood glucose readings. A food diary might also help
you notice a specific change you may want to make in the amount
you eat, or the kinds of food you eat, or even the time of
day you eat.
Foods with similar nutritional value have always been sorted
into similar food groups. Breads and starches, fruit, and
milk are the food groups high in carbohydrates. Some carbohydrates
are also found in vegetables. Foods that include ingredients
from these food groups will also contain carbohydrates.
Casseroles with noodles, stews with potatoes, pizza (crust
and tomato sauce), and French fries all have fairly high amounts
of carbohydrates. Of course, so do desserts, such as cookies,
pies, and candy, as well as alcoholic beverages, such as beer
or wine, and "fat-free" foods. "Fat-free"
foods may be lower in fat but even higher in calories than
its "normal fat" counterpart. Fat-free foods are
usually higher in carbohydrates than their normal fat counterparts.
Try keeping a food diary and highlighting those foods that
are high in carbohydrates. Check your portions and the time
of day you normally eat the most carbohydrates. Talk to your
dietitian or health care provider about the amount of calories
and/or carbohydrates that is best for you.
Exercise as a Part of Living
Want to lose weight and keep it off? If you do, make sure
that an exercise program and meal plan are both included in
your long-term program. Research has shown that the most effective
weight loss programs are those that include modifying diet
and exercise habits – for the long-term. Both physical
activities and eating patterns have to become a habit,- a
The types of physical activity that seem to be most effective
are those of low intensity and long duration, such as walking,
bicycling, or swimming.
Recipes to Try
Easy Pepper Steak
1 lb. cut-up beef, fat removed
1 medium bell pepper, cut into 1/2 inch squares
1 medium onion, sliced
1/2 cup hoisin sauce
- Place beef in non-stick skillet over medium to high heat.
Add water or stock to braise. Do not allow to dry out, but
use minimum liquid. Cook until all sides are brown.
- Add pepper and onion; cook about 1 minute until vegetables
- Stir in hoisin sauce; cook and stir about 1 minute or
- May serve over noodles or rice.
||26 grams protein
|66 mg cholesterol
||12 grams carbohydrate
|6 grams total fat
||26% calories from fat
1 package sugar-free orange gelatin
2 tbsp. unsweetened cocoa
1 cup hot coffee
4 tbsp. Splenda®
1 cup cold coffee
1/2 cup Cool Whip Free®
- Combine gelatin, cocoa, and Splenda® in a bowl.
- Add hot coffee, stirring until dissolved.
- Add cold coffee. Refrigerate until thick.
- Stir in Cool Whip Free® until blended. Refrigerate
Note: May use decaffeinated coffee, or increase or decrease
coffee strength as desired.
||1 gram protein
|5 grams carbohydrate
||0.2 gram total fat
|0 mg cholesterol
||7% calories from fat
A new long-acting insulin, glargine, is now available under
the brand name of "Lantus." Lantus is different
from other insulins in that it does not "peak."
"Peak" refers to when the insulin has its maximum
strength in lowering blood glucose. Generally, you want your
insulin to "peak" after a meal because that is when
your blood glucose will be highest. While long-acting insulins
provide nearly continuous coverage, all of them except Lantus
peak between 8 and 16 hours after injection. Because it does
not peak, Lantus is more of a "background" or "basal"
insulin. It is often prescribed with oral medications or fast-acting
Lantus had been evaluated in many clinical trials before
the FDA approved its use in April, 2000. In one trial with
people who had type 2 diabetes, they found lower blood glucose
levels after dinner and less night-time hypoglycemia (low
blood glucose) than was found in people taking another kind
If you are taking insulin, and in good control, there is
no advantage to including Lantus in your medication routine.
However if you are taking insulin or oral medications, and
your blood glucose is too high despite your best efforts to
control it, you may want to talk to your health care providers
about Lantus. Anytime you change medications, you should be
prepared to check you blood glucose more often to see how
well the new routine is working for you.
The Joslin Diabetes Online Learning Center offers short
classes that you can take at home whenever it suits your schedule.
Each class will take less than 20 minutes to complete. When
you finish, you’ll be able to print out a certificate
showing that you took the class.
To take the classes, you have to register as a Joslin Diabetes
Online Learing Center member, but membership is free. The
class topics include Assessing Your Diabetes Actions, Assessing
Your Diabetes Beliefs, Assessing Your Diabetes Knowledge,
An Overview of Diabetes, and Treating Type 2 Diabetes with
Visit the website http://www.joslin.org/ape/default.asp
to learn more about the courses.
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