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Diabetes demands a delicate dietary balancing act

Thursday, June 21, 2001

By Mary Miller

Wow, things have certainly changed with diabetes since we were nutrition students more than 20 yearsago. Back then, people with diabetes were called diabetics (that's no longer politically correct), sugar was always a no-no, and almost all children with diabetes had what we called "juvenile diabetes." Even that term is no longer commonly used.

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In the '80s the proper phrase was insulin-dependent diabetes and now the same condition is most often called type 1 diabetes.

The results of untreated diabetes, however, have remained the same. Impaired vision, heart and nerve disease, and kidney failure are still serious complications. Deaths related to diabetes take more lives in the U.S. every year than breast cancer and AIDS combined.

The new approach to diabetes emerged after interviews with registered dietitians and diabetes educators Rick Varner, Mary Alice Gettings and Mim Seidel, and pediatric endocrinologist Dr. Mark Sperling. They work with people with diabetes at Mercy Hospital, the Penn State Cooperative Extension, the Allegheny County Health Department and Children's Hospital of Pittsburgh.

The glycemic index

I have no problem with the changing language -- saying someone with diabetes instead of labeling him or her a diabetic. But I must admit that in the middle of a conversation, I often pause to grasp for the current correct word or phrase for a

condition or situation.

For example, is it a person with a hearing impairment, a deaf person, a hearing-impaired person, or a person who can't hear? I want to say the right thing and sometimes it's baffling.

Anyway, in 2001, a person with diabetes can often have sugar as part of a well-structured eating plan. In the early '80s, researchers developed a measurement of how certain foods affect blood sugar, which was called the glycemic index. Before the arrival of the glycemic index, dietetic students were taught that simple sugars, such as candy, made blood sugar rise more quickly than more complex carbohydrates, such as whole wheat bread and baked potatoes.

With the glycemic index, foods were ranked on a 1 to 100 scale, which related to how quickly they were absorbed as glucose into the bloodstream, with 100 being pure sucrose, or table sugar.

Because carbohydrates have the greatest effect on blood sugar, with proteins and fats not really changing blood sugar levels after meals, the foods on the list tend to be those high in carbohydrates. For me, the biggest surprise from this research was that baked potatoes had a higher ranking than table sugar.

The bottom line, however, is that table sugar has no other nutritional value other than calories, so it still should be used sparingly by those with diabetes and by everyone else.

Completely understanding the glycemic index takes time and a good teacher. Enlist the help of a health professional before making the trip to Candy-Rama for its spring clearance.

I receive many calls from family and friends who are newly diagnosed with diabetes and are panicking. They have been told that they have a chronic disease, are given some medication and handed a pre-printed diet before they leave the physician's office.

In my opinion, every newly diagnosed person should be under the care of a physician and a registered dietitian trained in diabetes management. A registered dietitian (RD) who is a certified diabetes educator (CDE) is just the ticket. Rick Varner is one such person. At Mercy Diabetes Program, he works with people with diabetes to plan eating patterns that fit into their lifestyles, all while keeping blood glucose regulated.

Private counseling and group sessions help patients and their families understand this disease.

"It is important to work with a physician and registered dietitian to develop an eating plan that works for you," stresses Varner. "Diabetes is not something to tackle on your own."

According to Act 98, Pennsylvania-based health insurance companies are required to cover diabetes education and supplies, says Mim Seidel, a registered dietitian with a master's degree in science. She is program manager of Chronic Disease Prevention at the Allegheny County Health Department.

Seeking help can be confusing and frustrating. Call your insurer (with member number handy) to inquire about what's available. The Allegheny County Health Department periodically offers classes for diabetes management. Call 412-247-7800 for more information about the next round of classes.

The Exchange Lists

Back when I was in Nutrition 422 at Penn State, The Exchange Lists for Meal Planning was the gold standard of publications for planning diabetic diets. It still is.

These lists of food groups and serving sizes are the basis for designing menus for people with diabetes. A meal plan is prepared based on calorie needs, medications and other important individual factors. The patient is instructed how to eat certain groups and amounts of foods at specific times of day to stabilize blood sugar.

Keeping blood sugars at a normal level is the goal of managing diabetes. These plans are not one-size-fits-all but are individualized.

Good nutrition, exercise and proper medications are important for keeping blood sugar levels as close to normal as possible. Eating well-balanced meals are a good idea for everyone -- whether you have diabetes or not.

Eating foods from each food group every day -- fruits and vegetables; whole grains, cereal and bread; dairy products; and meat, fish, poultry, eggs, beans and nuts -- is recommended

Which foods are unhealthful? It's the same old story -- fat in large amounts is not good for us. Too much fat in the diets of people with diabetes may further increase their risk of heart disease.

Too much salt can increase blood pressure in some people. Again, because people with diabetes have an increased risk of heart disease, it is wise to reduce sodium in the diet. Not a bad idea for all of us, diabetic (oops) or not.

People with diabetes should also eat less sugar. Some foods high in sugar include candy, sugary cereals, table sugar, honey, soft drinks and syrups.

If this information sounds vaguely familiar, it's because it's basically the same information the government puts out in the U.S. Dietary Guidelines for Americans.

Change in labels

Just as juvenile diabetes is now called type 1, what we once knew as adult-onset diabetes is now type 2. Why the name changes? It might be partly because the number of children diagnosed with this once adult form of diabetes is skyrocketing. With about 20 percent of new type 2 cases being children, that label no longer fits.

For those new to the language of diabetes, type 1 is an autoimmune disease where the body doesn't make enough insulin. When you have type 1, insulin injections are required, along with diet and other lifestyle adaptations to control progression of the disease.

In type 2, insulin is made, but for some reason the body is less sensitive to it. It is usually controlled by diet, medication or a combination and often aided by weight loss. Chances of getting type 2 diabetes are increased if you are overweight. The majority of kids being diagnosed with type 2 are overweight.

What is it about fat that kicks diabetes into action? As young dietitians, we were taught that excess fat didn't do much metabolically. It caused strain on your heart and on your joints, but we didn't think of fat as an active part of the body. We now know differently.

Recently, studies have shown that fat tissue actually produces a hormone called resisitin, which plays a role in regulating insulin, and might be the link to obesity and diabetes.

Keeping children from becoming overweight could delay the onset of type 2 diabetes. We can't do anything about our genes, but we can make some lifestyle changes to make the best of what we've been born with.

"It takes an effort from home, school and community," says Mary Alice Gettings, a certified diabetes educator and a nutritionist with Penn State Cooperative Extension in Beaver County. "Inactive lifestyle and excess weight put your child at risk."

Parents are the primary role models for children, at least until they enter school. They also are in charge of purchasing the food. Try to make wise choices. As a parent, you can't do much about what your child trades his sandwich, fruit and carrot for at lunch (possibly a bag of chips and a chocolate bar?) but you can control the food served in your home.

Besides keeping yourself and your children in good physical shape and providing healthful foods, what else can you do?

A lot of people are walking around with diabetes -- up to 50 percent are undiagnosed -- and they don't have any idea that this disease may already be attacking their bodies.

"If you have a family history of the disease, get tested," says Varner.

Don't wait for symptoms we're familiar with -- excess thirst, excess urination -- to occur. "Sometimes the symptoms aren't even noticed -- maybe just fatigue or slow healing of wounds," he says.

The key to prevention and treatment is awareness. To get more Americans conscious of the risk factors for diabetes, the U.S. Postal System has released a Diabetes Awareness Stamp. Use the stamps as a reminder to yourself to get tested, even if you're at low risk.

Mary Miller, a registered dietitian and free-lance writer, lives in Fox Chapel. She writes the "Simply . . . Entertaining" column for the Post-Gazette.

Tokyo Toss

1/4 cup peanut oil
2 tablespoons white vinegar
2 tablespoons water
1 tablespoon soy sauce
1 teaspoon lemon juice
1 tablespoon ketchup
1 teaspoon ground ginger
1 teaspoon sugar
1/4 teaspoon black pepper
1/4 cup chopped onions
1 package (10 ounces) fresh spinach, trimmed
1 package (8 ounces) fresh sliced mushrooms

In a blender or food processor, combine all the ingredients except the spinach and mushrooms; blend until smooth. In a large salad bowl, combine the spinach, mushrooms and dressing mixture; toss well and serve. Serves 6.

Exchanges per serving: Fat exchange, 2; Vegetable exchange, 1;

"Mr. Food's Quick & Easy Diabetic Cooking'

Cream of Carrot Soup

2 tablespoons low-calorie margarine
1/4 cup minced shallots
2 tablespoons unbleached white flour
2 cups evaporated fat-free milk, hot
2 cups pureed cooked carrots
2 cups low-fat, low-sodium chicken broth
2 teaspoons cinnamon
1 tablespoon chopped fresh parsley

Melt the margarine in a stockpot over medium-high heat. Add the shallots and saute for 3 minutes. Sprinkle with flour and cook for 2 minutes. Add remaining ingredients and simmer on low for 20 minutes, Garnish with chopped parsley to serve. Makes 6 1-cup servings.

Exchanges per serving: Starch exchange, 1; Low-Fat Milk exchange, 1/2

"More Diabetic Meals in 30 Minutes -- Or Less!"

Thursday, June 21, 2001

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