December 2005 /January 2006
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
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
- 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.
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
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?
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
The American Council on Exercise (ACE) also offers
certification for personal trainers, as well as group fitness,
weight management trainers, and clinical exercise specialists.
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
Recipes To Try
5 ¼ cup servings
1 cup raw cranberries
½ teaspoon ground cloves
¼ cup finely chopped onion
¼ cup finely chopped celery
1 medium apple, peeled and chopped
- Simmer all ingredients except apple in saucepan for
15 minutes, stirring occasionally.
- Add chopped apple and
cook for an additional 5 to 10 minutes.
- Cool. Serve as
an accompaniment to turkey, fish, or pork.
Note: This is
a tart chutney. To increase sweetness, add additional Splenda®.
Fat 0 grams
Protein 0.5 grams
from fat 0%
Carbohydrate 8 grams
Cholesterol 0 grams
Fiber 2.5 grams
Sodium 11 mg
Two Potato Bake
1 1/3 cup instant potato flakes
1/3 cup Parmesan cheese
1 ¼ cup water
tablespoon chopped garlic
16 frozen potato wedges
(from 24 ounce package)
1 cup no fat sour cream
- Heat oven to 400º. Spray 2 quart baking dish with
non-fat cooking spray.
- Bring water to boil in saucepan.
Add potato flakes and skim milk. Fluff flakes to make mashed
- Add sour cream, Parmesan cheese, and garlic.
- Place in 2 quart baking dish. Arrange potato
wedges on top of mashed potato mixture in a spiral.
30 to 35 minutes until hot.
Fat 3 grams
Protein 5 gram
from fat 20%
Carbohydrate 20 grams
Cholesterol 6 grams
Fiber 1 grams
Sodium 227 mg
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
- 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
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
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.
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.
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.
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