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Diabetes Life Lines
Vol. 13 No. 3
Janine Freeman, RD, LD, CDEEducation Program Specialist
If you've ever experienced hypoglycemia ( low blood glucose) after your daily walk or afternoon of shopping, you know it's not a pleasant feeling. In fact, many people with diabetes would do about anything to prevent the feeling of being out of control, of feeling that they could eat everything in sight, and the fear that their blood glucose is going to fall even lower. Although exercise has many benefits for people with diabetes, including improving blood glucose control, it can result in hypoglycemia, particularly after exercise in people taking insulin.
Exercise can make your body more sensitive to insulin, increase absorption of insulin and cause a decreased need for insulin. When a person without diabetes exercises, the body turns off the pancreas's supply of insulin to keep the blood glucose levels fairly constant. People treated with insulin injections or diabetes pills that increase insulin release can develop hypoglycemia after exercise because the body has no way of turning off the supply of insulin or medication. Once you take insulin or diabetes medication, it's going to continue working whether or not you exercise. So, plan ahead to help prevent hypoglycemia.
For planned exercise it is often better to lower your insulin dosage instead of adding extra food to avoid the extra calories. If you're exercising partly to help reduce your weight or maintain your present weight, you defeat the purpose of exercise by eating extra calories. Try to be consistent with the type of exercise you do, the time of day you exercise and the amount of time you exercise. Then monitor your blood glucose levels before, during and after your usual exercise so you can see the pattern of your own body's response to your usual exercise routine. Then you can make any adjustments in medication based on your blood glucose pattern. For people taking insulin 3-4 times each day, the short acting insulin that is working during the time of exercise (either regular or lispro) may need to be lowered by 30-50 percent of the usual dose depending on the intensity of the exercise. Let's say you take 6 units of regular insulin before each meal and your usual exercise is 30 minutes of fast walking after breakfast. You usually get low blood glucose before lunch on the days you exercise. If you lower your regular insulin before breakfast by 30 percent to 4 units instead of 6 units, this can help prevent low blood glucose before lunch.
People who take the rapid-acting insulin lispro (Humalog) with each meal may want to wait until 2-3 hours after the meal to exercise when the insulin is less effective to help avoid hypoglycemia.
In many situations you will not be able to adjust insulin and therefore may need to add additional food or carbohydrate to prevent hypoglycemia or make some changes in your meal plan. If you take 1-2 injections of longer-acting insulin each day or medications like sulfonylureas that increase the body's insulin release, you may need to change your eating habits to include a snack before the time that hypoglycemia usually occurs from exercise. Changing the time of your activity is another option. Try exercising when your blood glucose tends to be the highest - - usually between 1-3 hours after eating. In this case, you may not need an extra snack.
For unplanned exercise such as the spur-of-the moment game of tennis or any unusual activity that lasts longer than 30 minutes, people who take insulin may need to add 15-30 grams of carbohydrate (4-8 ounces of juice or an apple) before the activity to prevent hypoglycemia. Be sure to test your blood glucose level before the exercise since a snack will be needed if your blood glucose level is less than 100-120 mg/dl. Remember, if you do not take insulin or the diabetes medications that increase insulin release, you will not need to worry about hypoglycemia.
In general, the benefits of exercise far outweigh the risk of hypoglycemia. Frequent blood glucose monitoring and planning ahead are the best tools to prevent hypoglycemia.
Will you always need to inject insulin? If clinical studies continue going well, the answer may be NO. At the 1998 Scientific Sessions of the American Diabetes Association, researchers reported on the preliminary results of trials of inhaled powdered insulin. These trials showed that inhaled insulin was as effective as injected insulin in lowering blood glucose levels.
A mechanical device delivers the insulin through the lungs into the body. This method was so effective that in one study 92 percent of participants who had type 2 diabetes and 80 percent of those with type 1 diabetes decided to continue the inhaled insulin after the tests ended. If the early success continues, the Food and Drug Administration may approve the inhaler within a few years.
Inhaled Therapeutics System, Inc. and Pfizer Inc., who are conducting the trials, are still seeking volunteers for additional studies. To see if you can participate, call 1-800-438-1985.
If you have type 2 diabetes and have been unable to control your blood glucose levels adequately by eating healthy foods and increasing your activity, your doctor has a lot more choices today about what medications to treat your diabetes with than he would have had 5 or 10 years ago. Years ago the choices were diabetes pills and insulin. If the pills stopped working, you automatically began insulin treatment. In the past few years many new diabetes medications have become available. If one does not work well enough alone, you can use a combination of two or three diabetes medications because they work in different ways in the body.
- The sulfonylureas ( a class of diabetes drugs) used most frequently include glyburide (brand names Diabeta, Micronase, Glynase,) glipizide (Glucotrol) and glimepiride (Amaryl). These types of drugs work mainly by causing the pancreas to produce more insulin. Use caution because these drugs can cause hypoglycemia (low blood glucose.)
- Repaglinide (Prandin) also stimulates the pancreas to produce insulin. It works very quickly but for a short time. Therefore, it is best taken at meal time to prevent the blood glucose from increasing too much after the meal. Take care because it also can cause hypoglycemia.
- Meformin (Glucophage) works mainly to prevent the liver from making so much glucose, a major problem in type 2 diabetes. It is not likely to cause hypoglycemia.
- Acarbose (Precose) slows the absorption of carbohydrate after you eat and is also very short-acting. This medication also works best taken with meals. Since it does not increase insulin production, it will not cause hypoglycemia unless it is used with insulin or Prandin.
- Troglitazone (Rezulin) increases insulin sensitivity, another major problem for people with type 2 diabetes. It is not likely to cause hypoglycemia by itself. This medication requires frequent blood tests to monitor liver function.
These oral medications may also be used with insulin to keep the blood glucose in control without having to take as high a dosage of insulin. In some cases you may take the oral medication throughout the day and take insulin before bedtime.
Not all of these diabetes medications are safe for everyone. Your physician will determine which ones you should use. Since the main goal is to keep your blood glucose level as close to normal as possible, you and your physician can work together with the results of your blood glucose monitoring, a healthy way of eating, and an active lifestyle to see which combination works best for you.
Your great-grandmother would turn over in her grave if she knew the choices in foods available today to someone with diabetes. Not only do we have aspartame (Nutrasweet, Equal), acesulfame-K (Sweet-One) and saccharin (Sweet'n Low), we now have a fourth non-nutritive sweetener. Sucralose, the only non-caloric sweetener made from sugar, was approved last year and is now making its way to supermarket shelves under the brand name Splenda.
By making a few changes in the sugar molecule, Sucralose was born. It tastes like sugar, but does not get absorbed in the body. Therefore, it doesn't have calories and does not raise blood glucose levels. With its intense sweetness (it's about 600 times sweeter than sugar), you need very little of it to sweeten foods or beverages. And not only that, if it's combined with another sweetener like acesulfame-K or aspartame, you can use a lot less to get the same sweetness.
Some other major advantages of Sucralose include stability with heat and storage and its safety. To date, no adverse side effects have been detected. It's now being used in more than 30 countries.
Sucralose is expected to be available for manufacturers to use in new categories of foods like reduced-calorie cookies, cakes, ice cream toppings, and fruit and pie fillings in addition to soft drinks, jams and jellies, and gum. Today it can be found in some low-calorie fruit drinks and diet sodas.
The food choices for someone with diabetes today are remarkable. Not only can people with diabetes learn how to include some high carbohydrate foods in the meal plan without compromising good blood glucose control, they have lots of choices of foods that taste good without the sugar or fat. You no longer have to feel deprived like great-grandmother did.
Do you find yourself constantly dieting in an attempt to find your "ideal body weight"? Your blood glucose would improve dramatically if you could only lose the weight. Right? Well, relax. Stop feeling guilty for not getting down to the size 6 that no woman in your family for generations has worn since the age of 11! It's time to get realistic.
You can control your diabetes without getting down to your 7th grade weight. The major goals for type 2 diabetes are to keep your blood glucose as close to normal as possible and to keep your blood fats ( cholesterol and triglycerides) in good control. Good eating habits and regular activity will help you achieve both of these goals.
Let's start by changing your way of thinking. Stop saying you're "on a diet." What happens when you're "off the diet"? Instead, think of making some positive lifestyle changes that will become life-long habits.
- Focus on eating healthier foods. Try making a point of eating five servings of fruits and vegetables every day. Include fish at least twice each week. Think of ways to prepare foods with less fat such as using a non-stick cooking spray instead of frying your foods. Eat at home more often. Studies show we eat more fat when we eat out. Don't be unrealistic and stop eating in restaurants entirely. Learn to choose healthier foods when you do eat out.
- Space your food throughout the day. If you now skip breakfast, eat a very light lunch, and eat most of your calories at night, simply divide your food into three or four fairly equal meals to help improve your blood glucose levels. Since foods that contain carbohydrate (sugars and starches) increase your blood glucose the most, try to space the carbohydrate fairly evenly throughout the day.
- Eat smaller portions. Try to make a habit of eating only one portion of each food and not going back for seconds. To make seconds less tempting, put extra food back in the refrigerator before you sit down for a meal or prepare only enough for the meal.
- Snack less often. When you do snack, try to eat a healthy snack like fruit, carrot sticks or low-fat crackers.
- Walk at least five days a week. Gradually work up to 30-45 minutes each day. Many people with type 2 diabetes find their blood glucose levels improve a lot with regular activities like walking and biking. Talk with your doctor or other health care professional for other suggested activities if you are unable to walk.
- Monitor blood glucose levels. This not only gives you and your health care professionals valuable information on how and when to make changes in your treatment, but it also can help motivate you to keep up the good work. When you see lower blood glucose results after you've walked or higher results when you've eaten too much carbohydrate at the Italian restaurant, it helps reinforce that what you do makes a difference in your blood glucose control.
If you make some of these changes now, soon they will become life-long habits. Along with many of these healthy habits you may find that you'll lose some weight. If losing weight is a priority for you, be realistic in setting your weight goals. Consider your genetics and what your lowest weight has been as an adult. Set short-term goals that you can reach with not more than 1-2 lbs of weight loss per week. Despite the temptation, avoid fad diets. They are often very unhealthy and can be harmful to your body. There are no magic bullets to help you lose weight. With healthy eating, good lifestyle habits and well-controlled blood glucose, you'll be as healthy as you can be.
| Recipe Corner |
This classic Southern salad is lighter than the original with the old-fashioned good taste. Serve it as a main dish for a brunch, luncheon or supper meal.
| 3 cups chopped, cooked chicken (skin removed) | 1/3 cup light mayonnaise |
| 1 cup seedless grapes (about 1/2 lb) | 1/3 cup plain low-fat yogurt |
| 1/2 cup chopped celery | 1 Tbsp. lemon juice |
| 1/3 cup slivered almonds, toasted | 1/4 cup raisins or currants |
| 1/8 tsp. pepper | |
| Lettuce leaves | |
| Curry powder |
- In a large bowl, combine the chicken, grapes, celery, and almonds. Whisk together the remaining ingredients except the lettuce leaves and curry powder.
- Add the dressing to the chicken mixture and toss well. Cover and chill. Spoon onto lettuce leaves and garnish with curry powder to serve.
6 Servings
Serving size: 1 cup
Exchanges: 1 fruit, 3 lean meat, 1 fat
Nutrition Information:
| Calories: 273 | Carbohydrate: 16 grams | Protein: 23 grams |
| Fat: 13 grams | Sodium: 181 milligrams | Fiber: 2 grams |
| Cholesterol: 69 milligrams | ||
Reprinted with permission from Southern-Style Diabetic Cooking. The American Diabetes Association, 1996.
| Menu Item | Exchanges | Carbohydrates |
| 1 cup Southern Chicken Salad* | 1 fruit, 3 lean meat, 1 fat | 15g |
| Tossed green salad | Free | |
| 1 Tbs. fat-free vinagrette dressing | Free | |
| 1 dinner roll | 1 Starch | 15g |
| " cup sliced peaches | 1 Fruit | 15g |
| Iced tea, unsweetened | Free |
*This month's featured recipe
