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Vol 11. No. 1
Connie Crawley, MS, RD, LD |
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After meals many people with Type II diabetes have very high blood glucose levels. A new medication called acarbose (trade name PrecoseŽ) slows carbohydrate digestion and smooths out blood glucose levels.
Your doctor will start you on a small dose and slowly increase it. Since digestion of starches and some sugars are delayed, bacteria has time to digest some of the carbohydrate. This can result in stomach cramps, gas and diarrhea. Taking a small dose at first reduces the risk of these side effects. Even if the side effects do occur, they usually go away in a few weeks. How do you know if you might benefit from acarbose? Test your blood sugars before and two hours after meals. If your blood glucose is higher two hours after a meal than the target value you and your doctor want, acarbose may help. Only frequent blood glucose monitoring can tell you if acarbose is right for you. Acarbose alone does not cause blood glucose levels to get too low (hypoglycemia). However when it is combined with insulin, some diabetes pills and other drugs, the risk for hypoglycemia increases. Acarbose does not replace good nutrition and exercise. It will not allow you to eat anything you want. It is just another way to help you control your diabetes when good nutrition and activity are not enough.
Lydia has felt strange lately. Whenever she stands up after lying down, the room spins and she feels weak. She almost falls and there seems to be a white cloud before her eyes. She recovers by supporting herself on a table or chair and hanging her head down for a few minutes. Slowly her vision clears and she regains her strength. This is very frightening since she lives alone and, if she falls, no one would find her for hours. Lydia visits her doctor and tells him about her dizziness. After he examines her, he tells her that she probably has orthostatic hypotension. He believes this problem is due to some diabetic nerve damage (neuropathy). Lydia is very concerned. The doctor reassures her that there are things she can do to control it. If they do not work, there are some drugs that may help. First, the doctor recommends that Lydia use more than one pillow under her head whenever she lies down. He also recommends that Lydia get up slowly and stoop a little to help the blood return to her head better. Second, he advises her to add some salt to her food or eat more food processed with salt. While many people with diabetes have high blood pressure and need less salt, Lydia needs more sodium to keep her blood pressure up. Next he wants her to consume more fiber and fluid so she will not get constipated and strain when she goes to the bathroom. He also encourages her to eat more frequent, small meals. Larger meals divert blood to her stomach and intestines so less blood is available to her brain. Finally, he recommends support hose. Support hose will return the blood better from her legs to her heart and brain. After three weeks, Lydia visits her doctor again. She has tried all his suggestions and has felt dizzy only once or twice. The doctor is very pleased and asks Lydia to return in six months for a check-up if she has no other problems. Note: If you have this problem, or think you do, talk to your doctor before implementing these suggestions.
In 25 centers throughout the United States, researchers are studying whether Type II non-insulin-dependent diabetes can be prevented. The centers will recruit a total of 4,000 volunteers who are at high risk for developing diabetes. These volunteers will have Impaired Glucose Tolerance (IGT). People with IGT have blood glucose levels higher than normal but not high enough to be true diabetes. From 1 to 5 percent of these individuals develop diabetes every year. The researchers will study whether life style changes or two different drugs can prevent diabetes in this high risk group. How is IGT diagnosed? A three-hour glucose tolerance test is necessary. The volunteer has a fasting blood glucose drawn and then drinks a very sugary drink. Then over a three-hour period, the blood glucose is tested three more times. The person has IGT if the values are higher than normal but not as high as diabetic levels. The study will divide the 4,000 volunteers into four groups. One group will eat a healthy diet and begin exercising regularly. The second group will take metformin, a drug that lowers the amount of glucose the liver produces and helps glucose get into the cell. A third group will take troglitazone, a drug that makes the body more sensitive to insulin and lowers certain types of fat in the blood. A final group will take a placebo that has no effect on the body. The volunteers will be tested for diabetes regularly over a six-year period. Researchers hope to find that one or more of the treatments reduces the number of cases of people who develop diabetes. Unfortunately none of the research centers are in Georgia. The closest ones are in Miami, Baton Rouge and Memphis. However if you have family in other parts of the country and they are over 25 and overweight, they may wish to be tested. Also individuals from various minority groups like Native Americans, Hispanic-Americans and African-Americans are more at risk. To find out if a center is nearby, interested volunteers can call (888)377-5646.
Shepherd's Pie is often made with lamb but this version uses lean ground turkey breast. It is a perfect one-dish meal for two on a cold winter's night. If you don't have someone to share with, the leftover portion is even more flavorful the next day.
2. Microwave the milk in small container on high for 30 seconds. In a small bowl, mash potatoes with the milk until smooth. Set aside. 3. In a small, pyrex baking dish, cook the ground turkey covered on high for approximately 4 minutes. Add the carrots, green beans, onions and commercial herb mixture. Cook an additional 4 minutes, stirring occasionally. 4. Add the undiluted soup and pepper. Cook 5 minutes more. 5. Remove the cover, top with mashed potatoes, sprinkle with cheese, paprika and chili powder. Broil in conventional oven until brown.
Exchanges: 3 starches, 3 very lean meats, 1 vegetable
Note: Portions may need to be modified to fit your meal pattern.
Print copies of Diabetes Life Lines are available 6 times per year free to
Georgia residents by calling the local county extension office.
Reprinted with permission from the University of Georgia.
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How does acarbose work? Acarbose is taken with the first bite of a
meal. It inhibits the enzymes that help the body break down the
carbohydrates we eat. By delaying digestion, the blood glucose level does
not get so high. This may help diabetes control.