Have you ever heard of a sugar replacer? This is a new term for what usually is called a sugar alcohol. Sugar replacers contain calories and carbohydrate but are absorbed slowly by the body. They tend not to raise the blood glucose level like sugar. To metabolize them, the body does not need insulin.

What are some names for sugar replacers? Common names are sorbitol, mannitol and hydrogenated starch hydrolysate. Less common names are isomalt, lactitol and maltitol. They have about two to three calories per gram versus sugar's four calories per gram.

Unlike most sugar substitutes, sugar replacers give a food volume and texture. They stay sweet when heated and make a food less likely to spoil since they absorb less moisture. Some sugar replacers alone are less sweet than sugar. But when combined with other sweeteners, they taste sweeter.

You will find sugar replacers only as ingredients in processed foods. They are not sold for you to use in cooking. They are most commonly found in candies, frozen desserts, baked goods and chewing gum.

If these sugar replacers are so great, why are they not promoted more? First, since our intestines absorb them poorly, they can cause stomach cramps and diarrhea. This usually gets better over time. Second, foods made with them are not calorie-free. Third, many of the foods that contain them are snack foods that just add calories and little else. And finally, these foods are expensive.

On the nutrition label, sugar replacers are listed as part of the total carbohydrate. They are not listed as part of the grams of sugar. The grams of a sugar replacer may be listed separately if it is the only sweetener in the food. Usually the amount of sugar replacer is not a concern when calculating the grams of carbohydrate in a food. However, if the amount of sugar replacer in a food is five grams or more, subtract half the grams of sugar replacer from the total grams of carbohydrate. This will tell you more accurately how much carbohydrate will raise your blood glucose level.

When you have surgery, your body releases stress hormones that tend to increase your blood glucose level. Years ago you would have entered the hospital the day before to prepare for elective surgery. Then you stayed several days to recover. Now most surgery is done out-patient. Even if you stay in the hospital afterward, you generally go home quickly. This means after surgery you will be in charge of your diabetes.

Although they will have your medical records, be sure the surgical team knows about your diabetes. When you visit with them before surgery, tell them what kind of diabetes you have and how long you have had it. Describe any problems you had with your diabetes during previous surgeries. Show them all your medications you use, even over-the-counter ones. Report how often you have problems with low or high blood glucose levels and discuss any diabetic complications.

Ask the doctor how to manage your diabetes before surgery. Talk about what you should eat and drink and how to take your medication the day before and the day of surgery. Ask for a list of special medical supplies you will need at home after the surgery.

If someone is going to care for you, have them also meet with the surgical team or ask for written instructions. If you have no one to help you, ask about home health care.

Expect to have some lab work done, including blood and urine tests. They may also order an electrocardiogram and check your blood pressure.

Ask what you should eat and drink after surgery. Then have it on hand before you are admitted. Talk about signs or symptoms after surgery that may need a doctor's attention. Usually these include drainage or blood from the incision, fever, extreme pain, nausea and vomiting, high or low blood glucose levels or reduced urine output. Do not wait until after surgery to talk about these things.

Surgery is never fun. Diabetes makes planning it even more important. If you work closely with your surgical team ahead of time, your recovery will go smoothly.

Heart disease is the No. 1 killer of people with diabetes. Changes in diet can help reduce risk. Here is how to improve your diet to prevent or control heart disease:

Fat - Saturated fat, especially in the butter fat of full-fat dairy products, seems to increase blood cholesterol the most. If you are overweight, the best way to cut saturated fat is to cut intake of animal fats while keeping your carbohydrate intake the same. If you eat more high carbohydrate foods to substitute for your fat calories, you may raise your triglycerides. High triglycerides with diabetes increase risk for heart disease.

Hydrogenated oils have large amounts of trans fatty acids. Trans fatty acids seem to increase blood cholesterol levels like saturated fat. Instead of solid fats, use liquid oils in small amounts. Avoid foods that list hydrogenated oil or animal fat as one of their first ingredients. Oils high in polyunsaturated fats lower cholesterol the best. Oils high in monounsaturated fats seem to make the blood clot less, thus reducing risk for a heart attack. Keep your intake of fat to 25-30 percent of calories. Fish high in fat like salmon and mackerel are high in omega-3 fatty acids. Omega-3 fatty acids also help prevent blood clots.

Dietary cholesterol - Only animal foods have cholesterol. Dietary cholesterol raises the blood cholesterol in only about one-third of the American public. When most people eat high cholesterol foods, they adjust by making less cholesterol in their bodies. However, saturated fat raises the cholesterol level in nearly everyone. By eating moderate amounts of non-fat dairy products, lean meat, skinless poultry and fish, blood cholesterol levels should go down.

Fruits, vegetables and whole grains - Fiber and other substances called antioxidants in fruits, vegetables and whole grains may protect the body from heart disease. This effect may be unrelated to their effect on blood cholesterol and triglyceride levels. How well antioxidants protect people with diabetes is unclear.

You may have seen a new message on nutrition labels about the benefits of oat products in the diet. You would have to eat at least three servings of oat products per day to see a significant effect on lowering cholesterol. Most people cannot eat that much oat-containing food. Also you may eat less of other nutritious foods like fruits and vegetables to do so. The nutrition guidelines for diabetes recommend that we eat 25-30 grams of fiber per day from a variety of foods. You can do this with wise choices from the diabetic meal plan. People at risk for developing diabetes (like your close relatives) may be protected if they eat more unprocessed carbohydrates. They should choose whole grains and fresh fruits and vegetables either eaten raw or cooked without fat. Everyone should be getting at least six starches and five fruits and vegetables per day.

Nutritionists recommend that a fat-modified diet and exercise be tried for at least six months before taking medicine to lower cholesterol and triglycerides (lipids) levels. All medications to treat high lipid levels are expensive and have side effects. Cutting back on saturated fat, eating whole grains, fruits and vegetables, getting more exercise and losing weight will help to lower high cholesterol and triglycerides.

Corn pudding is usually not something made for one. Why deprive yourself just because you are eating alone? This recipe is quick, easy and so good! It goes great with pork or poultry. Developed by Kathleen Stanley, RD, LDE