Janine Freeman, RD, LD, CDE
Education Program Specialist,
Department of Food and Nutrition

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Get out the bathing suit, sunglasses, sunscreen, and over-sized umbrella -- it's beach time! Swimming at the beach or in the pool can be great fun and good exercise for almost everyone. It's one type of activity that doesn't seem like exercise at all, yet it is a great way to stay fit.

Swimming and other forms of water exercises are ideal types of activities for people of any age. They're safe, even if you have arthritis or foot problems (neuropathy) because they don't put stress on joints and feet. You increase your strength by working your muscles against the resistance of the water.

Although swimming is an excellent way to stay physically fit, you don't have to know how to swim to get the benefits. If you don't have the proper breathing technique needed to swim laps, you can try water walking -- walking in waist-deep water along the bottom of the pool or in the ocean. The resistance against the water gives you a better workout than walking on land, without the impact.

Water aerobics classes are offered at many YMCAs, parks and other recreation/fitness centers. Empty milk jugs, partially filled with water, can be used to help strengthen your upper body.

You might want to use a kick board to start with if you have not been active for awhile. You can float while you kick, without using your arms.

Some precautions are necessary to prevent injury when you're at the swimming pool or the beach.

1. Foot care: Beware of hot surfaces. Wear old tennis shoes at the pool and on the beach to prevent burns from the hot surfaces or injury from stepping on sharp objects. If you have less sensitivity (neuropathy) in your feet, you may not feel the hot sand or cement before it burns your feet. Aqua socks can be worn in the ocean to protect your feet, although they are not as protective as tennis shoes. Wear some type of footwear in public showers and in the locker room to prevent athlete's foot.
2. Skin care: Be sure to use a sun screen frequently if you're outside. Use skin lotion after your shower since both sun and chlorine dry your skin.
3. Eye protection: Wear goggles in the ocean or in the pool to prevent eyes from becoming red from chlorine or salt water. Be sure to wear sunglasses outside. They can help prevent some eye problems like macular degeneration, which can cause vision loss as you get older.
4. Fluids: Don't forget to drink plenty of water when you're at the beach or pool, especially if you're in the sun. As you get older, you may not feel thirsty until you become very dehydrated. Don't wait until you feel thirsty -- get into the habit of drinking plenty of water every day.
5. Low blood glucose: Try to exercise after you have eaten. The food will help keep your blood glucose from getting too low. It's best to exercise between 1-3 hours after you eat if you take insulin. Try to avoid exercising when your insulin is peaking (when it has the most effect on your blood glucose). This will help you avoid low blood glucose. You may need to ask your doctor or health care professional for advice on how to adjust the insulin that's effective during the time you're swimming, especially if you're swimming for long periods of time. Insulin pump users can simply suspend the pump during the time they're in the water, unless they use a model designed for use in water. In that case, the basal rate can be lowered during and following the activity. All adjustments in an insulin pump should be done under the direction of your health care provider.

You're pleased with your diabetes control -- your A1c is below 7 percent, right where it should be. You shouldn't have to worry much about heart disease or any of the other complications related to diabetes -- or should you? We now know that good blood pressure is equally as important as good blood glucose control in preventing the most common complication of diabetes -- heart disease.

Diabetes doubles the risk of heart disease. If you also have high blood pressure, your risk increases to four times as great as someone without either condition. High blood pressure also increases your risk of eye and kidney disease. Because of these risks, the blood pressure goal is lower for the person with diabetes than the general public. The American Diabetes Association recommends that the goal for most people with diabetes should be a blood pressure below 130/85.

What do these blood pressure numbers represent? The top number (systolic pressure) is the peak pressure in an artery when the heart contracts and pumps blood out of the heart. The bottom number (diastolic pressure) is the pressure in an artery between heartbeats when the heart relaxes and blood flows into the heart. The higher your blood pressure, the greater your risk of heart disease, stroke, and kidney and eye disease.

You should not ignore the "slightly high" blood pressure that many people have tended to ignore in the past. In the 10-year United Kingdom Prospective Diabetes Study (UKPDS), the group of people with diabetes who had average diastolic blood pressures of 88 showed a much lower risk of complications compared to the group with average diastolic blood pressures of 94. As you can see, a relatively small difference in blood pressure makes a big difference in the risk of complications.

What can you do to make sure your blood pressure is in good control? First of all, get it checked regularly when you have diabetes. If it's not below 130/85, take control. Don't assume that a pill is your magical answer. Here are some lifestyle changes you can make to lower your blood pressure:

1. Become more active. Many studies have shown that increasing your physical activity can lower your risk of high blood pressure and can lower the blood pressure of people who already have it.
2. Lose some weight if overweight. You'll notice that losing even a little weight can lower your blood pressure. Work with a dietitian or join a weight loss program in your community that provides group support to assist you with achieving your goals.
3. Dietary changes. Eat more grains, fruits and vegetables, and less fat to help reduce blood pressure.
4. Eat less salt.> Many people with diabetes are sodium sensitive – when they eat foods high in sodium, their blood pressure increases. Talk with a dietitian or your local County Extension Agent for ways to help lower your sodium intake to within the recommended guidelines of less than 2,400 milligrams per day if you have high blood pressure.
5. Quit smoking. Nicotine raises blood pressure by causing your blood vessels to narrow, making your heart work harder to pump blood through the vessels. Ask your doctor about products like nicotine patches, nicotine gum or medication that can help you quit smoking.
6. Drink less alcohol. Alcohol can increase blood pressure as well as provide excess calories.
7. Relax. Relaxation has been shown to lower blood pressure and to prevent high blood pressure. Relaxation techniques include walking, reading an enjoyable book, taking a warm bath, socializing and meditation.
8. Take medication if recommended. Your doctor may prescribe medication if lifestyle changes alone don't lower your blood pressure. If you've tried one type of medication and either it didn't provide adequate control or you were unable to deal with the side effects, don't give up. There are many to choose from. It may take some time to find the right one or combination of drugs, but it's worth the effort in the long run.

High blood pressure doubles the risk of complications for people with diabetes. It's up to you to take control of your blood pressure as you do your blood glucose. Make the necessary lifestyle changes to help lower your blood pressure and lower your risk of diabetes complications.

A new insulin alternative for people with type 2 diabetes has recently hit the market. If you've been using a pre-mixed insulin and dislike the inconvenience of having to wait 30-45 minutes before your meal to inject, this may be for you. This is the first pre-mixed insulin that contains the rapid-acting insulin, Humalog, that lowers blood glucose within 15 minutes of injection.

Humalog Mix75/25 is a combination of the rapid-acting insulin, Humalog, and NPL, a new type of longer-acting insulin that acts the same as NPH. The fast action of Humalog (lispro) in place of Regular insulin in the mixture helps prevent high blood glucose during and after a meal. Its shorter duration also helps prevent low blood glucose (hypoglycemia) before the next meal. Humalog Mix75/25 is available only in a pre-filled insulin pen.

More attention has recently been given to monitoring blood glucose levels after meals rather than before meals. It's important to keep both fasting and after-meal blood glucose values (post-prandial) within the goal range to achieve blood glucose control. The American Diabetes Association is expected to release guidelines for post-prandial goals in the near future. Use of a fast-acting insulin may allow better control after meals. Talk to your doctor if you take insulin and are interested in this new type of insulin.

Summer is the time of year when we think how lovely it would be to go "barefoot in the park" or on the beach or simply in the backyard. It's also the time of year when people are more likely to wear sandals or flip-flops that offer the feet little protection from injury. How quickly you can go from feeling the nice soft grass beneath your feet or the warm sand rubbing between your toes to disaster if you don't take good care of your feet.

People with diabetes need to be especially concerned about the health of their feet due to some of the long-term complications of diabetes. Neuropathy, or diabetic nerve damage, can decrease the sensation in your feet so you may not be able to feel temperature changes, pressure or pain in your feet. It can be so severe that it may prevent you from feeling a rock in your shoe, a blister or the hot sand. This loss of sensation is what causes most problems for the feet.

Neuropathy can also damage the nerves in your feet that control moisture. Skin then becomes very dry and often cracks. The cracks allow bacteria to enter and can cause an infection.

Changes in the muscles and shape of your feet can cause deformities like hammer toes and calluses. Ill-fitting shoes can put pressure on these areas, causing sores or ulcers.

Poor circulation to your feet occurs when the blood vessels to your feet are damaged or clogged. The decreased supply of blood to your feet results in fewer nutrients and oxygen to your feet, causing injuries or sores to heal more slowly.

The combination of neuropathy, poor circulation to the feet, and poor care and protection of your feet can eventually lead to amputation. You need to be serious about protecting and caring for your feet. Here are some steps you can take to help protect your feet.

1. Inspect your feet daily. Look for swollen areas, blisters or signs of infection. Areas that are red or streaked with red or areas that are warm to the touch might be signs of infection. Call your doctor with any signs of a wound or infection.
2. Wear comfortable shoes that fit well. Since feet expand as you get older, you may need to get a larger size than you used to wear. Insoles and specially made shoes may be needed to help prevent foot problems and can be obtained through a foot specialist.
3. Choose socks carefully. Avoid mended socks, socks with holes or seams. Avoid tight socks or garters that might cut off blood flow to your feet.
4. Wash feet in warm, soapy water and dry well, especially between the toes.
5. Use lotion on your feet. Lotion or cream can help prevent cracking. Avoid using it between the toes since that area tends to stay moist.
6. Never go barefoot. Old tennis shoes are good for walking on the beach and boating. Aqua socks can be worn while swimming.
7. Avoid "bathroom surgery." Let a podiatrist trim corns, calluses and treat ingrown toenails.
8. Take care when trimming toenails. Have a professional trim nails that are thick or curved or if you have limited vision.
9. Have your feet checked every time you visit your health care professional. Your feet should be tested for loss of sensation. Remove your socks as a reminder if your doctor or health care provider doesn't remember to check your feet.

You can now use saccharin in your coffee or tea without worrying about the warning label on the package. The government recently removed saccharin from a list of cancer-causing substances because many experts now believe that saccharin does not cause cancer in humans.

Saccharin, the oldest sugar substitute in the U.S. food supply, has been used for more than 100 years in the United States. In 1981 it was added to the list of cancer-causing substances because of a study that linked saccharin use in rats to bladder cancer. In the study, rats were fed very large doses of saccharin, equal to a person drinking more than 800 cans of diet soda each day. Later Congress passed a law requiring that all products that contain saccharin include a warning label that saccharin causes cancer in laboratory animals.

A clearer understanding of science now shows that the link between saccharin use and bladder tumors in rats does not apply to humans. More than 30 human studies have not shown saccharin to cause bladder cancer in humans. It is expected that Congress will soon drop the warning label requirement. Saccharin has received a clean bill of health from such groups as the American Diabetes Association, the American Dietetic Association and the American Cancer Society.

For decades saccharin was the only sugar substitute available to sweeten foods and beverages following the ban of cyclamates. During World Wars I and II, saccharin use increased due to sugar rationing. The use increased in the 1950s when sugar-free foods and beverages became popular. Now, in addition to saccharin, we can choose from a variety of non-caloric sweeteners. These include aspartame (Equal, NutraSweet), acesulfame K (Sweet-One) and sucralose (Splenda). The Food and Drug Administration maintains that all these sweeteners are safe to use.

Combining sugar substitutes makes a food or beverage sweeter than using only one type of sweetener. Less total sweetener is then needed to sweeten a product. Since less of any one sweetener will be consumed, it reduces any possible risks posed by a particular sweetener and limits the aftertaste of any one sweetener.

Non-caloric (artificial) sweeteners can give you more options in sweets or desserts without raising your blood glucose if used correctly. Remember that sweeteners like saccharin don't raise blood glucose by themselves, but when they're used in a dessert, other ingredients will raise your blood glucose. Blood glucose monitoring can help you see the effect these foods have on your blood glucose. The use of these foods within a healthy food plan and lifestyle can allow you to maintain control of your diabetes.