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Diabetes Life Lines

Vol. 13 No. 5

Janine Freeman, RD, LD, CDE
Education Program Specialist  

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Infections in the mouth occur more often and usually to a greater extent in people with diabetes, especially if the blood glucose levels are not well controlled. Therefore, it's critical to take good care of your mouth, teeth and gums when you have diabetes. Infections can cause blood glucose levels to greatly increase, making it difficult to maintain your usual blood glucose control. In addition, if mouth pain prevents you from eating, that can present another hurdle in your attempt at good control.

Gum disease is also known as periodontal disease. Bacteria can grow in the space between your gums and teeth. When this gets out of control, you have gum disease.

Symptoms of gingivitis (the earliest stage of gum disease) include red, swollen gums that may bleed easily when flossing or when brushing your teeth. Plaque and tartar can be seen along the surface of the teeth and below the gum line. Mouth infections can also cause an unpleasant odor in the mouth, due to the bacteria and the trapped food particles. As gum disease gets more severe, the gum line recedes, exposing the roots of your teeth. The bone holding your teeth can eventually erode, causing your teeth to become loose and fall out.

If you notice any of the symptoms of gum disease, see your dentist right away. Your dentist may be able to treat it with routine dental cleanings. If it's more severe, your dentist may refer you to a gum specialist, known as a periodontist.

You can help avoid the risk of infection, gum disease, and other problems of the mouth in several ways:

1. First of all, practice good oral health by brushing your teeth after every meal and before bedtime, and flossing daily. This helps to keep plaque and tartar from building up on your teeth.
2. Avoid frequent use of sugared or chewy candies, raisins or other dried fruits, fruit roll-ups, or glucose tablets.
3. See your dentist every three to six months for a thorough cleaning and check-up. Early stages of gum disease are easier to treat. Make sure you tell your dentist that you have diabetes.
4. Keep your blood glucose levels under good control. High blood glucose levels increase the glucose in your saliva, making it easier for bacteria to grow. In addition, any kind of infection heals more slowly when your diabetes is not well controlled. Testing your blood glucose levels regularly, visiting your doctor and diabetes team on a routine basis, and following a healthy lifestyle can help you keep a handle on your diabetes control.

Remember that with diabetes, prevention is control. You're in charge, so take control of your dental health. Look diabetes in the mouth and take action.

How often do you come home from work to see your child snacking in front of the television, and find out he's been there for three hours? You tell him to go outside and play until you get dinner ready, but he complains. He comes up with a million excuses not to go outside. "It's too hot." "It's too cold." "There's nobody to play with." "There's nothing to do outside." Sound familiar? Unfortunately, many children in America today do not get enough exercise.

Physical activity is important for everyone, including children with diabetes. If regular exercise is a part of your child's life, he or she is much more likely to continue exercising as an adult. Exercise helps build and maintain healthy bones and muscles, improves strength and endurance, helps control weight and boosts self-confidence. It may also improve blood glucose and cholesterol levels. For children with diabetes, exercise adds to the blood glucose-lowering effects of injected insulin. So children who get regular exercise usually have lower insulin needs than those who do not exercise.

Children should get at least 30 minutes of moderate physical activity almost every day. If your child plays sports, walks a good distance to school or a bus stop, or takes dance classes, he may already be getting enough activity. However, if your child is driven to school, and prefers quiet activities like reading and playing computer games, he may not be getting enough exercise. As children grow up, some lose interest in physical activity. They may have failed and been embarrassed while attempting an organized sport. Some children adapt to an inactive lifestyle and don't have the desire to change. Here are several tips you can use to help get your child moving.

1. First, pay attention to the physical activities your child enjoys and encourage him to continue. If your child can't seem to find an activity he likes, introduce him to many different ones. You can get a list of activities offered by your local activity/recreation center or YMCA and review it with your child to find an activity of interest.
2. Applaud your child's efforts. Whether he scores five goals at a basketball game or fouled out, praise him. If you show interest in what your child is doing, he is a lot more likely to continue to do it.
3. Set an example for your child. If you live a very inactive life, your child probably will, too. Children tend to be like their parents, and getting them to be more active may mean you need to be more active. Your attitude about exercise also affects the way a child feels about it. Join in the fun; exercise is always more fun with two people. Consider organizing family activities such as biking or taking a hike together. Everyone should exercise, so do something the whole family can enjoy.
4. Encourage your child to participate in activities with friends. They might enjoy gymnastics or dance classes, and your child may find it easier to get involved if a friend goes along.

Exercise is safe for children with diabetes if some precautions are taken to avoid low blood glucose reactions (hypoglycemia). First, check your child's blood glucose before and after exercise to see how the specific activity affects your child's blood glucose level. If the activity will last more than 30 minutes, the child should check his glucose 30 minutes into the activity. Keep a record of blood glucose values to show your doctor or other health care professional, and to help you plan physical activities. To prevent low blood glucose, the safest time to exercise is one to three hours after a meal or snack. Your child may also need to eat a carbohydrate snack during and after the activity.

Your child should carry some form of fast-acting carbohydrate (such as glucose tablets) when exercising. Children should always drink plenty of water before, during and after exercise. Make sure your child's doctor is aware of your child's activity levels. Depending on the level of activity, insulin dosages may need to be changed.

Once your child becomes more active, here are a few tips to stay active. Set realistic goals for your child. Exercising 30 minutes, seven days a week may not be something your child can or is willing to do. Make exercise fun, not a chore. Reward your child with things he likes, like a toy or some kind of clothing. Finally, keep trying new activities. Even a child's favorite activity can get old after several months. You can help make exercise a fun and important part of your child's life and your life.

- Tracy Chason, Intern

You already know that diabetes can affect your kidneys, blood vessels and eyes. But did you know that diabetes can also affect your bones? Your body is constantly removing old bone and replacing it with new, fresh bone. As children and young adults, this process of bone remodeling is in balance. As a result, young people often have strong, sturdy bones. But, as people get older, the body tends to break down bone faster than it makes new bone. So bones tend to get weaker as we age. Some of us will get a bone disease called osteoporosis where bones become so soft that they easily break. A minor fall or even a cough can break a bone. The bone then heals very slowly.

Some people are more likely to have weak bones and get osteoporosis than others. Those at higher risk include:

• Pregnant women
• Post-menopausal women (women who have stopped having menstrual periods)
• Small-boned people
• White people (Caucasion)
• People whose hair turns at least partially gray before age 40
• People who have taken steroid drugs for a long time
• People who are inactive

Diabetes can affect your bones and how well they heal. Poor control of your diabetes can change the way your body uses vitamin D and calcium, which are very important in building strong bones. Diabetes can cause nerve damage, which makes it easier to fall and break a fragile bone. High blood glucose levels can slow the healing process. If you have type 2 diabetes, you have an added concern. Eating a low-fat diet and losing weight are part of the treatment plan for most people with type 2 diabetes. However, many foods high in calcium are also high in fat.

There are lots of things you can do to keep your bones from becoming weak. Everyone, especially women, should eat a diet high in calcium. Some low-fat sources of calcium include:

• Skim milk
• Nonfat yogurt
• Low-fat cottage cheese
• Nonfat cheeses
• Collards, turnip greens, mustard greens and other greens
• Broccoli
• Spinach
• Peas and beans

How much calcium you need each day depends on your body. Current recommendations for people between the ages of 19 and 50 years are 1,000 milligrams of calcium per day. Recommended amounts of calcium for people over 50 years are 1,200 milligrams of calcium per day.

Another concern for women is that estrogen slows bone loss. If you have gone through menopause, your body makes much less estrogen than before menopause. You should talk with your doctor about the benefits and risks of estrogen replacement therapy.

In addition to all the other benefits you've been hearing about from exercise, it can also help make your bones stronger at any age. Exercises like walking, jogging or weight lifting --weight-bearing exercises -- cause the body to add more bone. Remember to always consult your doctor before starting an exercise program.

Despite having diabetes, you can help keep your bones strong and healthy throughout your lifetime by choosing more foods high in calcium, getting more exercise and keeping your blood glucose levels in good control

For people with diabetes, influenza ("the flu") can mean more than aches and pains. The flu can cause some people to become very ill, requiring hospitalization. People with diabetes are almost three times more likely to die with complications of flu and pneumonia. "People with diabetes may be unaware that the disease can make their immune system more vulnerable to severe cases or even death from the flu," said Dr. Frank Vinicor, director of the Division of Diabetes Translation at The Centers for Disease Control and Prevention (CDC). About 80 percent of deaths from the flu could be prevented with a flu shot.

Some people decide not to get flu vaccines because they fear becoming ill from a flu shot. However, "flu shots do not contain a live virus so they cannot cause the flu," says Tamara Kicera of the CDC. Flu shots only offer protection for one season. Therefore, you need to get a flu shot every year just before the flu season. October is an ideal time because the flu season begins in November.

The CDC also recommends that people with diabetes receive a pneumonia vaccine to protect against the most common form of pneumonia because they are at greater risk for complications resulting from pneumonia. For most people one dose of the pneumonia vaccine provides lasting protection, so you will probably only need to get it one time.

Call your doctor today to ask about getting a flu shot and pneumonia vaccine.

What can help you control weight, lower cholesterol, and prevent disease without costing big bucks? No, it's not a new magical pill - it's fiber! Fiber increases the bulk of your meal, so you feel full with less food. This can help you control your weight. Fiber speeds the elimination of wastes from your body, which can help prevent constipation and some diseases of the colon. Fiber can also help lower cholesterol by interfering with its absorption in the body.

Fiber in food is made up of two types: insoluble fiber (vegetables and whole-grain products), and soluble fiber (fruits, oats, barley, and beans). Insoluble fiber can help treat or prevent constipation by helping food pass easily through the body. Soluble fiber can help lower your blood cholesterol level. It has also been shown to help lower the rise in blood glucose after a meal. However, the amount of soluble fiber needed to affect blood glucose is difficult for most people to consume in a typical diet. People with diabetes should consume the amount of fiber suggested for all adults. The recommended daily intake of fiber is 20 to 35 grams per day. Unfortunately, most Americans eat only 8-10 grams of fiber per day. A few examples of high fiber foods include: " cup cooked beans (7 grams fiber),1/3 cup dry oat bran (4 grams fiber),1 small orange (3 grams fiber), and 1/3 cup dry oatmeal (3 grams fiber.) The Nutrition Facts label on the food product will tell you how many grams of dietary fiber are in one serving.

Beans are an excellent source of fiber. They digest slowly, resulting in only a small increase in blood glucose and insulin levels. Eating 1-3 cups of cooked beans daily can lower cholesterol between 5-19%. Beans are packed with protein, fiber, vitamins and minerals, and are low in fat, cholesterol, and sodium. Beans can be used in salads, soups, or main dishes. Canned beans are quicker and easier and have the same beneficial effects as dried beans. However, if you are following a low sodium diet, you should be careful with the amount of canned foods you eat, since these are often high in sodium. Researchers at Tufts University recommend eating beans instead of meat as a main dish twice a week.

For the most benefit, you should consume high-fiber foods throughout the day. Other foods that are high in fiber include whole-grain breads and cereals. Look for breads that contain 2-4 grams of fiber per serving. A high-fiber cereal for breakfast such as Raisin Bran, Wheaties, or All-Bran with some fresh fruit will start your day off with plenty of fiber. Be sure to include whole fruits and add lots of vegetables throughout the day.

If you are used to eating a diet that is low in fiber, it is best to increase your fiber intake slowly. Adding one to two high-fiber foods per week until you reach between 20 and 35 grams per day is a good plan to follow. If large amounts of fiber are added too quickly to the diet, it may cause painful gas and discomfort. Eat the amount of fiber that is right for you. Thirty-five grams may be more than your body can comfortably handle.

Remember to increase your fluid intake as you eat more fiber. Liquids will keep the bulky fiber moisturized to help in elimination of waste. You should drink 6-8 glasses of water each day, whether you are thirsty or not. Without sufficient water intake, a high-fiber diet could lead to constipation.

To get all these benefits of fiber, you'll have to start eating more fiber. You'll also be eating foods that provide you with lots of healthy nutrients in addition to the fiber - and with very little fat. How can you lose?

Recipe Corner

Green Beans and New Potatoes

1. Add all ingredients to a large stockpot and cover with water. Bring to a boil, then reduce heat.
2. Cook until the green beans and new potatoes are tender, about 20 minutes.

6 Servings
Serving Size: 1 cup
Exchanges: 2 vegetables, 1 starch

Nutrition Information:
Calories: 117
Carbohydrate: 23 gram
Protein: 7 grams
Fat: 1 gram
Cholesterol: 9 mg
Sodium: 242 mg
Fiber: 5 grams
mg = milligrams

Reprinted with permission from The New Soul Food Cookbook for People with Diabetes.. The American Diabetes Association, 1999.

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