Connie Crawley, MS, RD, LD
Public Service Associate & Extension Nutrition & Health Specialist,
Department of Food and Nutrition

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People with uncontrolled diabetes have more problems with their teeth and gums than people who have good control. In fact, poor dental health may be one of the first signs that you have diabetes. When the blood glucose is high, mouth tissue is also bathed with too much glucose. Since glucose is a sugar, it can promote gum infection and dental decay. If you answer yes to any of these questions, you need to see a dentist:

1. Does your mouth hurt sometimes?
2. Do your gums bleed?
3. Are your teeth spaced farther apart now?
4. Are your gums swollen and tender?
5. Are your gums pulled away from your teeth?
6. Do you often have bad breath?
7. Is there pus between your teeth and gums?
8. Does your bite seem different when you chew?
9. If you have partial dentures, do they fit differently?

Diabetes is the major cause of kidney failure in the United States. With the help of a dietitian, changes in protein intake may delay it. When even small amounts of protein appear in your urine, your doctor may ask you to eat less protein. You may have to cut your intake by a third or more. For example, instead of eating 80 grams of protein a day, you may be asked to eat 55 grams. The actual amount will depend on your weight, age and severity of your kidney problem.

The type of protein may be important. Studies show that protein from vegetable sources like beans may slow damage to the kidney. Even protein from dairy products like milk may put less stress on the kidney than meat, fish and poultry.

To make the changes, you will need to work closely with a dietitian. She will make sure you get the right amount of protein and calories while controlling your sodium, phosphorus and potassium, if needed.

Have your urine tested each year for micro-albumin (protein). Changing your diet early and taking special medication to protect your kidneys will help you stay healthy as long as possible.

An insulin pump can provide more flexibility and better blood glucose control than insulin shots. Learning how to use the pump is not easy. It requires blood glucose monitoring at least four times a day and careful insulin adjustment. You will need education from a dedicated medical team experienced in insulin pumps. Someone with skill in pump management must be available to you 24 hours a day to help with any problems.

Along with learning how to run the pump, you will learn to adjust insulin doses for diet changes, exercise and sick days. You will also learn to deal with unexpected high or low blood glucose readings. Since the pump only uses fast-acting insulin, problems with the pump can result in dramatic blood glucose changes. That is why not checking the blood glucose frequently can be dangerous.

You will also learn how to keep the infusion site clean and changed regularly. If the site is not managed well, infection is possible or the infusion system may clog or become detached.

You will also learn to handle the pump during showering, swimming, sexual contact, sleep and strenuous exercise. No two people handle these activities the same, so your medical team will give you several options and have you practice at home.

Just because you have a pump doesn't mean that you will totally abandon syringes. You will need a back-up supply of insulin and syringes for when the pump is not working properly or when wearing it is not feasible. Especially when traveling, even for just a day trip, always carry a supply of syringes and a bottle of insulin.

A pump is great but it is more expensive than using syringes. Insurance companies vary on their coverage. Often your doctor will need to send a special letter to the health insurance company to explain your need for the pump. Before buying your pump, make sure you have a letter from your insurance company stating that they will pay for it.

The pump is great for many people, but it is not for everyone. Talk to your medical team and other pump users to decide if it is right for you.

For years we have known that hormone replacement therapy for women after menopause helps reduce risk for heart attack and osteoporosis. Now there is evidence that hormone replacement in women with Type 2 diabetes improves blood glucose levels.

Twenty-five women with Type 2 diabetes who had gone through menopause received hormone replacement therapy. The researchers tested their blood glucose and cholesterol levels before and two months after the treatment. After the hormone treatment, the blood glucose levels improved and the bad LDL-cholesterol decreased while the good HDL-cholesterol went up. Other measurements of blood glucose control also improved.

While hormone replacement is not risk free, these results indicate that this therapy is something that every woman needs to discuss with her doctor when she enters menopause. Then she can make an informed decision about whether it is right for her.

Here is a quick and tasty recipe for a low fat beef stew. It is the perfect dish for a cold winter's night in front of the fire.

1. Preheat skillet over medium heat and spray with non-stick spray. Peel and cube the potato and cube the beef. Saute both with onion and garlic until lightly brown.

2. Add tomatoes and frozen vegetables. Bring to a boil. Reduce heat and add the spices. Simmer for approximately 45 minutes or until meat is tender.

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