June /July 2003
Diabetes -The Medical Perspective
Many people with diabetes eventually lose sensation in
their feet. The loss of sensation happens because blood glucose
has been high, and over time damages the small nerves in
Not being able to feel if you’ve stepped on a rock
or something sharp can lead to serious problems with sores
on the feet. Ulcers or sores can occur even when nothing
has been stepped on. Sometimes it is the bone itself that
causes pressure and an ulcer on the foot. Rubbing on a sock
or shoe can also cause an ulcer to develop.
Foot ulcers are usually painless and round, sometimes with
a callus around the outside edge. The top of the first
toe and the bottom of the big toe
are common places for ulcers to be found.
Treating foot ulcers before they become infected is important!
Sometimes antibiotics are needed, and sometimes special
bandages will help heal the ulcer quickly. If left untreated,
ulcer can become infected. Severe cases need to be amputated.
Preventing foot ulcers takes time and patience as well.
Proper shoes may be hard to find or expensive. Socks should
properly as well, being neither too tight so that circulation
is hindered nor so lose that the sock falls into the shoe
and makes a ridge against the foot. Take the time to find
the best-fitting socks and shoes.
Look at your feet daily for sores or tears in the skin.
Cut toenails and have any calluses treated when you visit
doctor. Ask you doctor or nurse how to care for toenails
and calluses between doctor’s visits.
We often don’t notice our feet until they hurt. Until
you have the habit of good foot care, think of a “reminder
activity” – comb your hair-check your feet, or
take a bath-check your feet.
Diabetes and Food
Lately, protein has been in the news almost as much as fat.
Where does protein fit into a meal plan for those who have
It’s a good idea for those who have diabetes to include
a protein source in each meal and snack. Protein and fat
can blunt the rise in blood glucose that is seen after eating
only carbohydrate. Protein is needed not only for muscle
maintenance but also for every other body tissue and system.
The amount of protein each person needs will depend upon
his or her meal plan that has been tailored to their overall
diabetes care plan. The Food Guide Pyramid is not a bad
starting point, though. Two to three servings each day are
by the Food Guide Pyramid.
Good sources of animal protein include beef, pork, chicken,
turkey and fish – try to choose low-fat or lean cuts.
Protein is also found in legumes, eggs and peanut butter.
All of these foods are part of the Meat, Poultry, Fish, Dry
Beans, Eggs, and Nuts Group that we usually call “the
Meat Group.” In addition to protein, these foods also
are good sources of iron, zinc, and B vitamins.
What about protein bars? Protein bars do provide protein
that can supplement many diets. However, they are also
high in calories that need to be included in any meal plan
those with diabetes. Talk to your dietitian about how protein
bars may fit into your meal plan if they are a new favorite
food for you!
Exercise as a Part of Living
Recent research confirms that regular aerobic and weight-lifting
activities not only help control blood sugar and lower blood
pressure, but also provide cardiovascular benefits. For some
people, exercise training will also help reduce total and
abdominal fat, both of which can lead to improvements in
insulin sensitivity, blood pressure and blood vessel function.
To be effective in this way, the exercise has to be part
of a structured plan – a real training program.
Remember to check with your health care provider before
increasing your activity level greatly. To read more about
this research, look at Stewart, Kerry J., "Exercise
Training and the Cardiovascular Consequences of Type 2 Diabetes and Hypertension," Journal
of the American Medical Association, Oct. 2, 2002. The Journal of
the American Medical Association is often available through your local library.
Recipes To Try
St. Kitt’s Vegetable Salad
1 serving = 1 cup
1 cup chopped tomatoes
1 banana, sliced
1 cup chopped asparagus
1/2 cup diced celery
1/2 cup chopped red onion 1-1/2 cup cooked rice
2 tablespoons reduced fat sour cream
- Combine tomatoes, asparagus, onion, banana, celery,
- Toss mixture with sour cream.
- Serve or refrigerate.
2 grams protein
2 mg cholesterol
16 grams carbohydrate
1 gram total fat
10% calories from fat
Note: 1/2 cup servings would be one half of above values
and 12 servings per recipe.
Apple Raisin Bread Pudding
4 cups “lite” white bread cubes (about 6 slices)
1/2 cup apple juice
1 medium apple, chopped
1/2 cup Splenda
12 ounces fat free evaporated skimmed milk
1 cup raisins
2 large eggs
1-1/2 teaspoons cinnamon
non-stick cooking spray
- Preheat oven to 350º. Spray an 11" x 7" baking
dish with non-stick cooking spray.
- Combine bread cubes, apple, and raisins.
- Beat eggs in a medium bowl. Stir in evaporated milk,
apple juice, Splenda, and cinnamon; mix well.
- Pour egg mixture over bread mixture, pressing bread
into egg mixture. Let stand for 10 minutes. Pour into
- Bake at 350º for 40 to 45 minutes, or until set and
4 grams protein
35 mg cholesterol
22 grams carbohydrate
1 grams fat
10% calories from fat
If you have diabetes do you have to take oral medications
or insulin to keep your blood glucose within a normal range?
Not necessarily. For some people who have Type 2 diabetes
(adult onset), losing weight, eating a balanced, moderate
diet, and exercising regularly will keep their blood glucose
normal or near-normal. For other people, this doesn’t
work well enough and medications have to be taken.
However, taking medication isn’t a substitute for a healthy diet. If you
are overweight, taking diabetes medication, following a meal plan, and exercising,
there is a possibility that your medication dose can be lowered. It may even
be stopped if you reach your goal body weight.
But isn’t it easier to just take the medication? Yes and no. It may be
easier in the short term to take medication. However, in the long run those who
have been taking medication and not following a healthy diet have blood glucose
levels that often creep up. Medication doses can be increased, but at some point
insulin may need to be included.
Eating a healthy diet is part of the overall plan for keeping
blood glucose within a healthy range. Whatever your medication,
consider your meal plan
part of that
“Learn to count carbs the right way, easy and effortlessly,
and you can simplify your life, feel better, and avoid long-term
diabetes complications.” The American Diabetes
Association Complete Guide to Carb Counting. Authors, Hope Warshaw, MMSc,
RD, CDE and Karmeen Kulkarni, MS, RD, CDE. Includes fast
food and restaurant dining choices. 192 pages. $16.95 from
My Other Checkbook by John Walsh PA, CDE, & Ruth Roberts,
MA, $12.95. Graph your blood sugar, insulin doses, oral medications
and/or exercise. Fits in your checkbook. Available from the
Diabetes Mall at http://www.diabetesnet.com/ which is owned
by the authors.
Betty Crocker’s Diabetes Cookbook: Everyday Meals,
Easy as 1-2-3, Betty Crocker Editors; Richard Bergenstal,
Diane Reader, Maureen Doran, authors, 2003; 256 pages. Available
at www.BettyCrocker.com, www.wiley.com, www.amazon.com or
local bookstores. Prices range from $17 to $25.
Diabetes | Food & Diabetes
| Medications & Diabetes
| Current Issue | Archive