Diabetes Life Lines
Vol. 13 No. 2
Janine Freeman, RD, LD, CDEEducation Program Specialist
Connie Crawley, MS, RD, LD
Public Service Associate & Extension Nutrition & Health Specialist ccrawley@uga.edu
Every holiday for kids seems to center around food. Easter is no exception. While some sugary food is OK in small amounts, the candy in most Easter baskets would feed a whole room of kids with diabetes for several weeks.
What can you do instead? Look for other treats that your child will enjoy. Good basket fillers are special Easter pens or pencils and Easter stickers or rubber stamps with colorful ink pads. A nice coloring book with new crayons is also a favorite. A wonderful Easter gift is a decorative flower pot with some seeds and a colorful watering can to get your child into gardening as a lifetime activity.
Active toys for the Easter basket can include a jump rope or a new softball. Some parents even roll up a new bathing suit for the summer or provide swim goggles and a beach ball. Instead of using the traditional basket, stuff these beach items into a sand pail.
Small books or stuffed animals are popular along with entertaining videos or CD's. Some children also enjoy a gift certificate for a movie, sports event or a favorite amusement park.
Don't limit these choices to your child with diabetes. The other children in your family will like these choices, too. They last longer and give pleasure for several days and weeks without hurting their teeth. So think outside the box (or basket) and make your Easter bunny more creative this year.
You may have heard of carbohydrate counting and thought it sounds confusing or that it's just for people taking insulin. But, have you ever wondered what the amount of carbohydrate or sugar on a food label means and how much you should have at a meal? Or have you wondered why your blood glucose results are higher after certain meals than others? Today, many people can benefit from carbohydrate counting -even if you don't take medication for diabetes. And it doesn't need to be complicated.
Why should you count carbohydrate? Since carbohydrate converts almost entirely to glucose (sugar) in the body, it makes sense that the more you eat at one time, the more your blood glucose will increase after the meal. So, when you eat a meal that includes a lot of carbohydrate such as a large spaghetti dinner with several pieces of garlic bread, you're likely to have higher blood glucose results after that meal.
What foods contain carbohydrate? Carbohydrate basically includes all sugar and starch. Starchy foods include pasta, rice, bread, cereals, and all starchy vegetables like potatoes, peas, and corn. Sugars include fruit, fruit juices, milk, and desserts. You don't need to totally avoid sugar since both starch and sugar contain carbohydrate and increase blood glucose in a similar way. Therefore, you should be aware of the total amount of carbohydrate you consume.
Spacing carbohydrate throughout the day can improve your blood glucose levels. If you skip breakfast, eat a light lunch, and eat a large evening meal, most of your carbohydrate will be consumed in the evening. Your glucose levels will likely be higher in the evening and perhaps the next morning. By eating smaller, more frequent meals, you can improve your overall blood glucose levels.
How do you count carbohydrate and how much should you have? It's best to talk with a registered dietitian who can help you decide how much carbohydrate is best for you. Your doctor or nurse can help you find one who works with diabetes. You can also call The American Dietetic Association's Consumer Nutrition Hotline at 800-366-1655.
You can either count the total number of grams of carbohydrate you consume at a meal or the number of servings. A serving of carbohydrate, sometimes referred to as a "carbohydrate choice" contains 15 grams of carbohydrate and is the same as one fruit, one starch, or one milk exchange for those familiar with the food exchanges. For example, a dietitian may recommend that you have 3 carbohydrate servings at each meal and one for your bedtime snack. The total grams of carbohydrate would equal 45 per meal (15x3) and 15 for the snack. You can get the carbohydrate information from food labels, books on carbohydrate counting, or simply use an exchange booklet.
When using the information on a food label, look for the grams of "total carbohydrate" for one serving instead of sugar. It's important to note the serving size since it may be different from what you are used to. You may need to eat a smaller portion if the food contains more carbohydrate than you should have at a meal.
Carbohydrate counting can give you more variety in your meal plan since no food is excluded, but it doesn't ensure that you will have a nutritionally balanced diet. Blood glucose control is important but so is choosing healthy foods. Some high carbohydrate foods such as cookies and ice-cream can fit in your meal plan when you count carbohydrate, but they're also generally high in fat. You may not be specifically counting fat, but it is wise to use these foods less frequently if you want to avoid weight gain and higher blood fat levels. I think you'll find meal planning more exciting when you use carbohydrate counting.
I'm sure you've asked yourself on many occasions, "Why am I sticking my finger and writing down these numbers? It costs money and it certainly doesn't top my list of things that feel good. Is it really necessary?"
The answer is a strong and emphatic yes! Let's look at some of the reasons monitoring your blood glucose can help you.
Janet has type 2 diabetes and is now eating healthier food and exercising more frequently. Since she was not taking medication to control her blood glucose levels, she didn't think blood glucose monitoring was important. When she went to her regular doctor's appointment and saw that her blood glucose had gone up to 220, she was shocked. She also saw the results of her hemoglobin A1c (the test that measures blood glucose control over several months) and again was surprised at how high it was.
When Janet began monitoring her glucose levels at home several times a day, she saw where she needed to make changes. Her dinner was usually large and when she reduced the amount of starchy foods (carbohydrate) she consumed at dinner, she found her blood glucose at bedtime improved. She also noticed that on the days she walked, her numbers were always lower. Seeing the results of her efforts made Janet more motivated to continue her exercise.
Rick uses insulin in addition to eating healthy and staying active to keep his blood glucose in his target blood glucose range. He uses the results of monitoring to decide when and how much insulin to take. He knows that he has to be concerned not only with high blood glucose, but also with low blood glucose (hypoglycemia.)
Since blood glucose monitoring became readily available for use at home, people with diabetes have shown marked improvement in their overall blood glucose control. Several studies have shown that close monitoring definitely improves blood glucose control which in turn helps prevent the complications of diabetes.
An important issue here is what to do with the numbers. If you simply test and record and make no changes based on your results, your blood glucose control will not improve. It's important to work with your whole diabetes team, not just your doctor, to learn how to make adjustments in your diabetes management. Diabetes is YOUR disease and you are the one person who makes the majority of decisions about what affects your blood glucose control. YOU decide what and how much you eat. YOU decide when and how much activity you get. YOU can also learn how to make adjustments in medication with advice from your diabetes care team.
How often you should monitor depends on many factors. If you have type 1 diabetes you should monitor at least before each meal and at bedtime. If you have type 2 diabetes, in general it's recommended to monitor 1-2 times per day at different times, especially if you take insulin. However, if you are in very good control and are not taking medication for your diabetes, your physician may recommend only a few times per week. Changes in your schedule, activity, illness, medication changes, poor diabetes control or pregnancy increase the need for additional monitoring. Your health care team can advise you how often to monitor your blood glucose.
It is important that you take on more of the role of decision-maker in your diabetes management. Your actions affect your life. Monitoring your blood glucose helps you take more control in making these decisions.
You may have seen ads for mail-order supplies for diabetes. Sometimes these prices seem too good to be true. Before you buy or give any information to these companies, ask the following questions:
- If Medicare or other medical insurance will not cover the price charged by the company, who will absorb the difference in cost - you or the medical supply company?
- What method is used for getting approval for an item if the initial request for payment is denied? Will the supply company contact the insurer to work things out or will they pursue you or the doctor?
- What brand of medical supplies, particularly blood glucose monitors and strips, does this company carry? If they say that they have one brand as "their primary provider', they may push you to switch to this brand even if your doctor has specified another one. Although they tell you their meter is "best', don't change without discussing it with your doctor or diabetes educator.
- Are the prices of the products really better than the same products in local stores? Often the product price is lower, but once you add shipping and handling the price may be much higher. No insurance covers shipping and handling costs. They come right out of your pocket unless the medical supplier says they cover them.
Finally, call the Better Business Bureau in the company's home town or city. While there are many honest and reliable medical supply companies, your best approach is "buyer beware.'
If exercise is scheduled, reduce the dose of insulin that will peak during the time of the exercise by one-third to one-half. If the activity is unexpected, snack on 15-30 grams of carbohydrate beforehand to help prevent hypoglycemia (low blood glucose.)
More exercise than usual increases risk for hypoglycemia (low blood glucose) for up to 12-24 hours afterward. To watch for hypoglycemia, monitor your blood glucose frequently. Extra food or a smaller insulin dose may be needed after exercise to prevent a low blood glucose reaction.
Blood glucose monitoring can help you learn how a certain amount of exercise affects you. Don't rely on the experience of others to guide you. Everyone is different and only blood glucose testing can show how you react personally to a certain activity.
Choosing the right exercise is also important. Have a doctor's exam before you start exercising and then select the exercise that best fits your physical condition. If you have nerve damage in your feet or legs, you may need non-weight bearing exercise like swimming or biking. If you have eye damage, you may need to avoid activities that increase blood pressure like weight lifting or that jar the head like football or racquet sports. Only you and your doctor can decide which activity is safest for you.
Even though there is a lot to consider, the benefits of exercise are worth the risk. A study at the University of Pittsburg found that those with type 1 diabetes who did not exercise regularly had three times the risk for premature death. Once exercise becomes routine, you will have more energy, feel less stressed, look better and enjoy life more.
| Recipe Corner |
This main dish salad is a good way to get rid of leftover ham and Easter eggs. Just be sure the eggs have been stored appropriately. If they have been at room temperature for more than 2 hours, do not eat them.
| 3 low-sodium chicken bouillon cubes | 1 medium green or red bell pepper, chopped |
| 2 1/2 cups of boiling water | 1 cup frozen corn, thawed |
| 3 cups instant brown rice | 1 cup frozen peas, thawed |
| 4 ounces lean ham, chopped | 4 green onions, chopped |
| 4 chopped hard-cooked eggs | 1 teaspoon dill weed |
| Dressing: | |
| 3 tablespoons canola oil | 1/2 teaspoon Dijon mustard |
| 1/4 cup wine vinegar | Pepper to taste |
- Dissolve the chicken broth cubes in boiling water. Add the rice. Cook rice according to package directions. Cool.
- Add ham, egg, vegetables and dill weed to cooled rice.
- Mix together dressing ingredients in separate container.
- Pour over salad ingredients. Chill. Serve on lettuce leaves or in tomato.
8 Servings
Exchanges: 2 starches, 2 vegetables, 1 medium fat meat, 1 fat
Nutrition Information:
| Calories: 309 | Carbohydrate: 39 grams | Protein: 14 grams |
| Fat: 11 grams | Sodium: 319 milligrams | Fiber: 4 grams |
| Cholesterol: 115 milligrams | ||
| Menu Item | Exchanges |
| 1 1/4 cup Easter Monday Salad* | 2 starches, 2 vegetables, 1 meat |
| 6 crackers | 1 starch |
| 1/2 cup fresh fruit salad | 1 fruit |
| Ice tea, unsweetened | Free |
| Artificial sweetener | Free |
*This month's featured recipe Note: Portions may need to be adjusted for your meal plan.
