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Diabetes Life Lines

Vol. 12 No. 5

Connie Crawley, MS, RD, LD
Public Service Associate & Extension Nutrition & Health Specialist   ccrawley@uga.edu

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Get Those Flu Shots! Having the flu may not sound too serious, but if you have diabetes it can be fatal. People with diabetes are three times more likely to die from the complications of flu and pneumonia. That can mean 30,000 deaths a year. During a flu epidemic, someone with diabetes is six times more likely to be hospitalized. The risk is even greater if a person is over the age 65 or has other health problems such as heart disease. About 80 percent of the deaths from flu and pneumonia could be prevented by getting the flu and pneumonia vaccines.

"People with diabetes may be unaware that the disease can make their immune system more vulnerable to severe cases and even death from flu," said Dr. Frank Vinicor, director of the Division of Diabetes Translation at Centers for Disease Control. "A flu shot is an easy, safe, preventive measure that people with diabetes should take to protect themselves from the risks associated with the flu.'

More than half of the people who have diabetes don't get a flu shot. Many say they don't because they think it might make them more likely to get the flu. This not true. The flu vaccine does not use the live flu virus to produce immunity, so getting the flu from the shot is impossible. A few people get a cold coincidentally after taking the shot, but this is not caused by the vaccine. They just catch a cold by chance at about the same time.

Different flu viruses appear each year, so even if you got a flu shot last year, you will need a new one this year. The flu season usually runs from November to March. Ideally you should get the shot before the flu season begins, but most clinics give the shots for a few weeks after the season starts.

Always check with your doctor before you get a flu or pneumonia shot. Since everyone is different, only you and your doctor can decide if these vaccines are right for you.

Breast-feeding and Type 1 Diabetes Blood glucose monitoring, diet and activity are very important when a mother with Type 1 diabetes breast-feeds. New breast-feeding mothers tend to have unpredictable blood sugars. If the blood sugar is too high, a woman may have less breast milk and more breast infections. If the blood sugar is too low, she may not care for herself and the baby properly.

Kathy Fagen, a dietitian working with breast-feeding women in California, says taking some precautions can increase breast-feeding success.

First, the woman should choose a hospital and medical staff who are breast-feeding experts. Ideally they will instruct her about her special needs before the baby arrives. If the baby has a problem after delivery that delays breast-feeding, they should encourage her to pump her breasts. This milk can be offered to the baby by medicine dropper instead of by bottle. Then feeding from the breast should be started as soon as possible. A new baby who gets a bottle may resist taking the breast. A mother may also need support if her breast milk does not come in as quickly as other mothers' do. This is common in women with Type 1 diabetes.

Second, a woman with diabetes should monitor her blood glucose very frequently after delivery. At first, insulin needs will be very low, but they will gradually go up to about half the dose needed during pregnancy. Only close blood glucose monitoring and good food and activity records can determine the proper insulin dose.

Third, the woman should check her blood sugars before breast-feeding and before taking a nap. She may need a light snack to prevent hypoglycemia unless she has eaten within one to two hours. Good snacks to choose are 4-8 ounces of milk, a piece of fruit or a few crackers (about 15 grams of carbohydrate).

Fourth, a breast-feeding woman will need about 500 extra calories per day. A dietitian can help plan quick meals that meet the mother's calorie and schedule needs. Anyone who has had a baby knows how little time there is to prepare food and eat. An hour visit with a dietitian may save hours of frustration due to poor milk supply and unstable blood glucose levels.

Acesulfame K Approved for Beverages Acesulfame potassium (trade name Sunette) has been approved by the Food and Drug Administration for use in liquid beverages. Acesulfame potassium is an artificial sweetener that has been used since 1988 in table top sweeteners, baked goods, candies, dry beverage mixes, desserts, dairy product mixes and chewing gum. It is also called acesulfame K because the letter K is the chemical symbol for potassium.

In liquid beverages, acesulfame K will be mixed with other sweeteners. This produces a taste more like table sugar without an unpleasant aftertaste. Unlike aspartame, which is widely used in diet drinks now, acesulfame K is more heat stable. Drinks sweetened with aspartame tend to lose their sweet flavor over time, especially if they were stored at high temperatures. That is why most diet drinks have an expiration date.

The World Health Organization has found acesulfame K to be safe. In Canada, acesulfame K is in 70 percent of the diet beverages. It is approved for use in 90 other countries and is found in 4,000 foods worldwide.

This is just one more option for people trying to control their carbohydrate and calorie intake. It will be especially welcome to those individuals who may have found the current diet drinks a poor substitute for the "real thing."

Eating the Healthy Chinese Way Some people get in a rut by eating the same food all the time. To spice up your menus, try some ethnic foods. Many ethnic foods are nutritious, but some recipes can be high in fat, sugar and sodium. If you prepare them at home from fresh ingredients, you will have more control over how they are made.

Chinese food is a mealtime favorite. It is quick and inexpensive to fix. Depending on how you prepare it, it can be low in fat, sugar and sodium. To prepare healthy Chinese food:

1. Make recipes with more vegetables and less meat, poultry and fish. Skinless poultry and fish will be lower in saturated fat than fatty meats.
2. Switch to reduced-sodium soy sauce. Reduced-sodium soy sauce is still not a low sodium food, but it is better than regular soy sauce. To cut the sodium even more, replace half the soy sauce in the recipe with wine. Only use regular wine because cooking wine contains salt.
3. If a recipe calls for sugar, use an artificial sweetener or cut the sugar in half.
4. Fix brown rice instead of white rice. Brown rice adds more fiber and a nutty flavor without adding almonds or peanuts.
5. If you are stir-frying, use a non-stick pan and very little peanut or canola oil. Steaming the food or microwaving it without added fat is even better.
6. When a recipe needs broth, use low sodium bouillon or homemade broth with little or no added salt.
7. To thicken any sauce, use less cornstarch or skip it entirely.
8. Have fruit for dessert instead of a fortune cookie.

If you eat at a Chinese restaurant, you can still make healthy choices. Choose dishes made with lots of vegetables. If you know a entree has few vegetables, order a vegetarian dish as well and share both with a friend. Stay away from sweet and sour dishes. They are too high in fat, sugar and sodium.

Ask that the MSG (monosodium glutamate) be left out of the food. It is high in sodium. If you are really serious about cutting sodium, skip the soup and other appetizers.

Request that no cornstarch be added to the sauce and definitely ask that all fried wontons be removed from the table.

Don't be tempted by large servings. Ask for a take-home bag before you eat. Portion out the amount that is right for you and eat the rest at another meal.

Chinese food prepared at home can be a regular treat, but buying it out should only be for special occasions if you are really trying to control your sodium, fat and sugar intake.

Blood Glucose Supplies Now Covered by Medicare Medicare now covers blood glucose monitors, testing strips, and lancets for all Medicare Part B and Medicare managed care enrollees with diabetes. Previously, only insulin-using patients qualified for this coverage.

To get coverage, your doctor must prescribe blood glucose testing supplies and write on the prescription:

1. The number of test strips to be dispensed,
2. Whether or not you use insulin,
3. How often you should test.

All applicable Medicare deductibles and co-payments apply.

Recipe Corner

Here is a delicious Chinese recipe that comes from a cookbook available from the American Diabetes Association entitled Quick and Easy Diabetic Recipes for One. To order, call 1-800-232-6733.

Wall of China Stir-Fry
4 ounces firm tofu	1/2 teaspoon canola or peanut oil
1 1/2 teaspoons lite soy sauce	1/4 cup diced celery
1 1/2 teaspoons dry sherry	1/2 cup frozen chopped broccoli
1/4 teaspoon sesame oil	1/4 cup sliced onion
1 glove minced garlic	1/4 large red or green bell pepper, sliced
3-6 drops hot sauce	2/3 cup cooked brown rice
non-stick vegetable spray

1. Cut tofu into small, rectangular pieces.
2. In a small plastic storage container with a lid, mix the soy sauce, sherry, sesame oil, garlic and hot sauce. Gently stir in tofu. Cover and refrigerate at least 4 hours.
3. When ready to cook, spray a non-stick skillet with non-stick vegetable spray. Heat over medium-high heat, add canola or peanut oil.
4. Stir in celery and broccoli. Cook, stirring constantly for 3-4 minutes. Add the onion and bell pepper and continue stir-frying an additional 5 minutes. Finally add the tofu, along with the soy marinade. Cook, stirring gently for approximately 3 minutes more or until tofu is heated through. Serve immediately over 2/3 cup cooked rice.

1 serving

Nutrition information:

Calories: 333	Carbohydrate: 46 grams	Protein: 17 grams
Fat: 11 grams	Sodium: 366 milligrams	Cholesterol: 0 milligrams

Suggested Menu
Menu Item	Exchanges
Wall of China Stir-fry	3 starches, 1 medium fat meat, " fat
1 cup spinach salad	1 vegetable
with 1 tablespoon of soy bacon bits	free food
1 tablespoon fat free dressing	free food
3/4 cup fresh pineapple	1 fruit
Hot tea	free
Artificial sweetener	free

Portions may need to be adjusted for your meal plan.