December 2001/January 2002
Diabetes -The Medical Perspective
Diabetes & Neuropathy
Our nervous system operates throughout our whole body. The
nervous system controls muscle movement, sensations through
the skin, and moving food through the gastrointestinal tract,
to name just a few.
Diabetes can lead to nerve damage, although how that exactly
happens is not yet known. People with diabetes can develop
nerve problems at any time, but the longer a person has diabetes
the greater the risk of developing nerve damage. The symptoms
of diabetic neuropathy vary. Numbness and tingling in feet
are often the first sign. The symptoms may come and go. The
sensation may be dull and annoying or sharp and painful.
Diabetic neuropathy can also cause the stomach to empty too
slowly, the bladder to not empty completely, impotence, difficulty
swallowing, or even change the ability to sweat!
A simple screening test to check sensation in the feet can
be done in the doctor's office. Sometimes more extensive testing
Treatment of diabetic neuropathy aims to relieve discomfort
and prevent any additional nerve damage. What the treatment
is depends on which nerves are damaged. Pain management may
begin with the doctor suggesting non-prescription pain medication
or prescribing stronger pain therapy medication. With intense
pain, the doctor may also prescribe a therapy known as Transcutaneous
Electronic Nerve Stimulations (TENS). In this treatment, small
amounts of electricity block pain signals as they pass through
a patient's skin.
Not all people who have diabetes will develop nerve damage.
Be sure to discuss any concerns or symptoms you may have with
Diabetes and Food
Fall brings with it many flavorful recipes, but pies are
one category that many of those with diabetes have been taught
When we think of pies, most people think of the fillings
- apple, peach, pumpkin, rhubarb, just to name a few. However,
pies are high in fat and therefore calories, primarily because
of the crust!
One way to lower calories and fat is to cut smaller than
standard pieces. For instance, a standard nine-inch crust
is usually cut into eight slices. Cut the calories and fat
by half by cutting the pie into sixteenths.
Or you can use a different crust. The crust with the fewest
calories is a meringue crust, with one slice having only 30
calories and no fat (standard one-eighth of a nine-inch pie).
A meringue crust contains egg whites, cream of tartar, salt,
and a sugar replacement. It is baked separately and cooled
A cottage cheese-based pie crust slice has about 50 calories
and two grams of fat. It contains shortening, flour, and cottage
cheese and must be chilled before rolling.
A graham cracker crust slice has almost 90 calories and two
grams of fat. Variations of the traditional graham cracker
crust use only water and no margarine to lower the calories
to 70, or using ginger cookies and skim milk to reach 60 calories
A traditional flour-based pie crust slice has 140 calories
and nine grams of fat for bottom-only crusts.
Specific pie crust recipes can be found in most comprehensive
Exercise as a Part of Living
If you have neuropathy (nerve damage), you should have a
discussion with your doctor before beginning to exercise.
Some forms of neuropathy may affect your normal heart rate
which will make your heart rate a poor indicator of your exertion
level. Also, your heart may not contract as strongly as it
should during intense activity, making low-to-moderate intensity
the best exercise choice.
Neuropathy can affect the way your body uses calories and
the way insulin works on your muscle cells. You may want to
ask your doctor how long you should wait after eating or taking
insulin before you begin an activity.
Even after you talk to your doctor, make changes to your
routine gradually so your body can safely handle any changes
it needs to make.
Recipes to Try
Jamaican Chicken (Spicy)
1 teaspoongarlic powder
1 teaspoonblack pepper
1 cup finely chopped onion
1 teaspooncayenne pepper
1 cup vinegar
2 teaspoondried oregano
1 cup water
2 teaspoondried thyme
1 teaspoonbrown sugar substitute
1 lb. boneless, skinless chicken
- Combine all ingredients except chicken.
- Add chicken and marinate in the refrigerator for at least
- Transfer to a large skillet; bring to a boil, then simmer
for approximately 30 minutes. Make sure chicken does not
boil dry. Adding additional water/vinegar will decrease
spiciness. May also bake in 350E oven for approximately
||34 grams protein
|17 % calories from fat
||8 grams carbohydrate
|87 mg cholesterol
||4 grams total fat
Sweet Potato Pie Filling
6 pkts. sugar substitute
3 large eggs
1/2 cup brown sugar
1/2 cup evaporated skim milk
3 cups cooked, mashed sweet potatoes
- Combine sugars, salt, nutmeg, and eggs.
- Add milk and vanilla. Stir.
- Add sweet potatoes. Mix well.
- Pour into glass pie pan, or pie shell - See food article
||4 grams protein
|15% calories from fat
||22 grams carbohydrate
|80 mg cholesterol
||2 grams total fat
Remembering to take medication is difficult whether you have
diabetes or some other condition that requires medication.
But what do you do if you forget to take your pills that help
control your blood sugar?
The American Diabetes Association has a general rule about
whether to take your pills when you do realize you have forgotten,
if you are taking a medication in the sulfonylurea class,
such as Glucotrol, a biguanide such as Glucophage, or a thiazolidinedione
such as Actos or Advandia.
If you usually take pills twice a day, and you are within
3 hours of the dose you forgot to take, go ahead and take
your medication. If it is longer than 3 hours past the time
you should have taken your pills, wait and take them at the
next scheduled time.
If you take medication just once a day, go ahead and take
your medication if you are within 12 hours of your missed
dose. If you are not, wait until the next scheduled time.
If you are taking an acarbose such as Precose or repaglinide
such as Prandin, wait and take your medication at the next
If you have a question about your medication or medication
times, be sure to call your pharmacist or doctor. They may
have guidelines more specific to your medical condition
The following resources focus on nervous system health and
are available through the National Kidney and Urologic Diseases
Information Clearinghouse, 3 Information Way, Bethesda, MD
20892-3580, or via the internet at http://www.niddk.nih.gov/health/diabetes/
pubs/complications/nerves/nerves.htm or from the National
Diabetes Information Clearinghouse, 1 Information Way, Bethesda,
MD 20892-3560; firstname.lastname@example.org.
Single copies are generally free.
Prevent Diabetes Problems: Keep Your Nervous System
Healthy, NIH Publication.
Diabetic Neuropathy: The Nerve Damage of Diabetes,
Updated: October, 1999.
Additional general resources:
Diabetes A to Z, 4th Edition, American Diabetes
Association, 195 pages, January, 2000.
Diabetes A to Z, Spanish Edition, American Diabetes
202 pages, August, 1997.
The Uncomplicated Guide to Diabetes Complications,
Marvin E. Levin, MD & Michael A. Pfeifer, MD (Editors),
384 pages, June 1998.
Events and Local News
Free Foot Exams During November and December
During November and December, all the members of the Illinois
Podiatrist Medical Association will be providing free foot
exams to people with diabetes. Please call 1-800-323-4769
in November and December for a referral to a local podiatrist
in your area for a free foot exam.
The Centers for Disease Control and Prevention recommends
that people with diabetes should get a flu shot every year
and a pneumonia shot every six to ten years. If you have diabetes,
the flu can be more than aches and pains. It can mean a longer
illness, a trip to the hospital and even death. In fact, people
with diabetes are three times more likely to die from complications
and six times more likely to be hospitalized due to flu and/or
pneumonia. So, call your local health department or your doctor
to get a flu and pneumonia shot.
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