Cooking for friends with diabetes

Q: Hello Ginny,

I have a girlfriend and I like her a lot. When we started dating she told me that she has diabetes type II. She is so kind and she has cooked dinner a few times for me and I love it, but I’d like to cook for her more often, however I need to be conscious about her Carbs intake. She told me that she is allowed 45g of Carbs per meal and I was wondering if you have recipes that I can cook that would be within that amount of allowable Carbs intake per meal, or at least point to what direction I should go in order to abtain such recipes.

Please let me know. Thanks.

A: How lovely that you want to cook a dinner for your friend!

Most people with diabetes watch their carbohydrate intake carefully. You said your friend is having 45 grams of carbohydrates per meal. What are carbohydrates? They are all the starches (bread, pasta, rice, cereal, potatoes, corn, beans and lentils), fruits (fresh, frozen, dried and juice) and milk products (milk, yogurt, ice cream) that we eat. Each general serving is approximately 15 grams. A serving is about 1/2 cup.

Your friend is trying to have 3 carbohydrate servings per meal. What would a dinner for her look like? A big salad; a serving of fish, chicken or beef (spices are great but be careful with sauces); and vegetables (broccoli, cauliflower, zuchinni, spinach ect.). So far we don't have many carbohydrates in the meal. Some patients are tracking very intensively and count salad and vegetables. If these are in servings dishes, your friend could help herself and either count them or not. Now, if you wanted to add carbohydrates like potatoes and dinner rolls, place these in serving dishes as well. If there are choices for people with diabetes, that is such a plus. Your friend can put the amounts on her plate that fit in with her personal plan and what she chooses to have at the meal.

There are great cookbooks that you can check out too: Betty Crocker's "Diabetes Cookbook", "1,001 Delicious Recipes for People with Diabetes" by Sue Spitler and "The Everything Diabetic Cookbook" by Pamela Hahn.

I am also sending your note to my friends, Lisa and Ann, to see if they have more information to add.

Happy cooking, ginny

Carbohydrates, Calories or Medication

Q: Dear Ginny,

I have a Brother-in-law who is at least 300 pounds that he's Diabetic. His Doctor told him to have 75 carbs per meal, and because of that he's gained 15 pounds in a short time.'

I also have a brother who also is Diabetic and although he wasn't that heavy, his Doctor told him to have 35 carbs per meal, he's lost about 40 pounds and is doing well.

I believe my Son-in-law is eating too many Carbs. Am I right or do you think this is correct?

Thank you

L.

A: L., It is so very hard to give specific advice when I have not seen your son-in-law.

If he has gained 15 pounds in a very short time, he wants to be sure and check in with his physician and make sure that the weight gain is not a side effect of any medication he is taking. If the weight gain is not caused by medication, overall calorie intake may be the cause. He may be eating more food than his body needs.

Blood sugar levels are most often affected by carbohydrate intake. If blood sugars are high, we usually ask patients to look very closely at the number and kinds of carbohydrates they are eating. When patients begin to decrease very processed carbohydrates in favor of whole grains, they decrease fat and salt intake as well. This often begins to make a difference with their weight.

I will ask a friend of the Ask Ginny site, Lisa Loertscher, a dietician, to look at your letter and see if she has additional information to add.

-ginny

D-Tips: Who Do You Know That Is Resilient?

Dr. Terri Flint has volunteered to join "Ask Ginny & Friends" to help answer your questions about diabetes.

Terri is the Director of Intermountain Employee Health Services, including Employee Health and the Employee Assistance Program. She has worked in this role for over 10 years and has worked for Intermountain Healthcare for 19 years. Dr. Flint has a PhD in Social Work and has been a clinical Social Worker for 29 years. Her areas of expertise are change management, communication and building resilience.

Terri also writes "D-Tips for Healthy Living," sponsored by the American Diabetes Association. D-Tips are periodic emails to help individuals cope with the psychological issues created by having diabetes. I know you will find D-Tips interesting, informative and that your family will benefit in your quest for better physical and mental health!

D-Tip: Who Do You Know That Is Resilient?

There are great examples of resilient people around us. Corrie Ten Boom was a survivor of Jewish war camps and her book The Hiding Place is a remarkable story of how her faith, forgiveness and sense of humor helped her survive. Michael J. Fox, the actor struck with Parkinson's Disease, has continued to make people laugh and inspire others to increase funding for the study of this disease. In his book Always Looking Up, Michael writes that for everything this disease has taken, something with greater value has been given. Take a look around. Who do you know that is resilient? What do they do differently?

The American Diabetes Association would like to hear from you. Contact Dr. Terri Flint at d-tips@diabetes.org to have your questions addressed in one of the upcoming D-Tips. Come hear Dr. Terri Flint talk about Coping with Diabetes at the 2010 American Diabetes Association Expo on February 27, at South Towne Expo Center. Visit http://diabetes.org/saltlakecityexpo regularly for Expo updates.

Nutrition & Diabetes

Q: I am a 50 yr old male and I have had type 2 for about 2 yrs.

I would like to know if there are classes locally that discuss diet. Specifically guidelines, portion size shortcuts to help me get the suggested amounts of vegetables fruits etc.

I really want to be able to ask questions about my personal situation because I have some other health concerns as well, so the online stuff is kind of frustrating because it all seems to be so general in nature. I live in the Millcreek area. Any info would be greatly appreciated.

Thanks, D

A: D….You bet there is. I am going to suggest seeing a dietician one-on-one so you can ask all the questions that you need to ask first.

Classes will certainly give you a lot of information and you will probably want to take a class too, but because you are frustrated and have many specific questions, I think a one-on-one appointment would be the place to start.

In the Millcreek area, there are several sites that may work for an appointment with a dietician: St. Mark's Hospital, University of Utah Diabetes Center and Memorial Clinic. Check with your insurance carrier to see which site would be covered. You will learn so much that will help you.

good luck, ginny

Get Active with Diabetes (video)

Who to turn to for diabetes information

Q: Hi Ginny,

I am looking for a diabetes educator and also wondering if I should choose a doctor that's more specialized in diabetic care than my family doctor. I live in Springville and have heard about a doctor in American Fork - not remembering his name at this moment....

I have recently lost 8 pounds and I'm interested in eating according to the LDS word of wisdom. I have just looked at a Doctor Richard Bernstein book and thought I'd rather die than follow his eating plan - He said he hadn't eaten any fruit for over 25 years!

I could be pretty close to needing insulin. I don't have insurance and had to stop using Byetta because it was too expensive. I did see the ad with the info about getting an A1c test at the health department, but it looks like old info from last November. Is that being offered this month..of June.

I'm also wondering if there's anyone - like you - who could explain to me the differences in ways to deal with my diabetes. I see a lot of different choices and wonder if there's anyone who can help me find my best choices.

Sorry about all the questions. I'd be very glad to hear from you and look forward to your advice.

Thanks so much, Carol

A: I think the person you thought about seeing in American Fork is Dr. Von Welch. Please call his office and make an appointment and fill out financial assistance paperwork.

Dr. Welch will be able to direct your care to the educators in the hospital, Jill and Elise, and to the Diabetes Center in Provo if you need to go there. Dr. Welch's clinic should be able to help you with medication assistance as well as a A1c test.

There are many different dietary plans you can follow, but being consistent in your carbohydrate intake is very important. Most dietary plans for people who have diabetes have patients lower their intake of refined, processed carbohydrates and use whole grain high fiber carbohydrates for their charbohydrate choices.

Dr. Welch and the educators in the hospital will be able to help you find a dietary plan that you will feel comfortable using.

Good luck to you, ginny

Diabetes Diet and Insurance Issues

Q: Ginny,

My name is Jennifer, and I'm pretty sure I have Type II Diabetes. My HgA1C was last checked two years ago, and it was 5.9. My doctor told me I'd be diagnosed at 6.0, so I haven't had it rechecked because I don't have insurance and if I'm diagnosed, I'll never have insurance. My husband's employer doesn't offer group insurance.

Anyway, I am about 40-50 lbs. overweight, and I have the basic knowledge of what I should be eating, but I don't want to. I have no desire for healthy food whatsoever. I not only have no desire for it, it sometimes makes me feel sick. I know it's backwards, and I really need to get a handle on my cravings, but they've been out of hand for about eight years and I've never been able to beat them.

I cannot do moderation. I try and I end up eating 1 lb. of chocolate or more. Chocolate is the main problem. I know I'm not healthy and I know that I need to be conscious of my eating not only for weight control, but to control my diabetes.

Can you recommend a dietician who has had experience with addictions and might not charge too much for consultations? I need to do something. Thanks.

Jennifer

A: You are right that you need to do something. Can you go to a clinic and get a blood test? There are low cost or free clinics that may be able to test you.

Check with the

• University of Utah Med Center at 801-581-2121;
• Maliheh clinic at 415 East 3900 South at 801-266-3700; or
• Sorenson Clinic at 855 California Avenue at 801-977-0502.

If your physician is in a clinic and you want to continue to see him/her, please apply for financial assistance. You need some information about what is happening to your body so you will know where to begin.

Sometimes when blood sugar levels are high, people become very hungry and describe the same symptoms you have described in your letter. The best place to start, I think, is to see if you have diabetes and what your blood sugar readings are. Anyone who can help you with a diagnosis will be able to direct you to a dietician.

Find out if you have diabetes first, o.k.? Remember, knowledge is power!!!

Good luck to you, Ginny

Diabetes and Burning Feet

Q: Ginny,

My husband has trouble with his feet, not horrible trouble though. He complains of them being like they are on fire on the top of them. He also says that they feel like the circulation is weird. He has a family history of diabetes, his dad takes medication for his and so does his sister. Do we need to be concerned about this problem? His shoes bother him because of the heat. Usually rubbing and massaging them helps but he is always complaining about this.

A: Yes, please be concerned about your husband's feet.

His physician can test his fasting glucose to see if his fasting glucose is 126 or higher and diabetes can be diagnosed. If the test is normal, his physician may ask him to complete a glucose tolerance test; a test that will watch what your husband's body does with 75 grams of glucose. Does your husband see a podiatrist, a specialist who deals with feet? Between your husband's physician and a poditrist hopefully some treatment will begin soon and be successful. ginny

Ginny

Foot problems and diabetes

Q: My husband is 37 years old. He has lost a significant amount of weight lately. He refuses to go to a doctor (because he said he needs to find a good one).

He finally went to a dermatologist for his feet because he couldn’t hardly walk. They are “Really” sensitive/red dry and cracked, and can never seem to get them just right. He asked the dermatologist if it was a sign of diabetes… The doctor said NO.

He works with a lady that has had diabetes since she was 3 and tells him it is, and can be related. I also have heard it can be.

Do you think it is a sign of diabetes? She has also tested him while at work before, because she has to do hers several times, and he has scared her before with his results. Do you think you can give me a referral (recommended doctor) that takes BC/BS insurance? I am just really concerned for him. Cancer and Diabetes run in his family.

Thanks.

A: Your husband needs a primary care physician. Please call Blue Cross Blue Shield (BXBS) and get the names of physicians who are on your plan. You want to have him see someone who is trained to deal with diabetes. Problems with feet often occur as the glucose levels rise. Other symptoms are urinating more frequently (especially at night), feeling very hungry, losing weight, feeling very tired, having pain or numbness in your feet and feeling very thirsty.

Please make an appointment for him to be evaluated and tested.

If he is diagnosed with diabetes, a fasting glucose level 126 or higher, he may need to follow up with a specialist. Since he has BXBS he may want to call the University of Utah Diabetes Center. They will work with his Primary Care Physician to take care of your husband. Please have his glucose levels tested so he can determine what his next step should be.

Please do this right away, Ginny

Possible cure for Type 1 using cancer drugs?

Q: What's the latest in the possible cure for Type 1 using the 2 already approved cancer drugs? Are there any local studies?

A: I think the two cancer drugs you are talking about are the drugs Imatinib (Gleevec) and Sunitnib (Sutent). These are drugs that block an enzyme that is believed to be a factor in autoimmune diseases. The studies looking at these drugs is being done at the University of California with mice. There is no study calling for patient participation yet that I know of.

Harvard University has been studying how to activate genes that tell cells how to transform themselves and begin working another way. They are studying how to change cells in the pancreas that make gut enzymes that help digest food and have them make insulin instead. This has also been done in mice but they think it is at least two to five years from being tried in humans.

There may be other studies, but two clinical trials that I know of who are accepting patients are:

• A drug called Otelixizumab is under investigation in the DEFEND trial. This study is looking at how the beta cells in the pancreas are destroyed by the body itself and they wonder if the drug can stop or slow down the destruction process. This study is under way in phase 3 clinical trials and they are accepting volunteers. You must be a Type 1 and have been diagnosed with Type 1 in the last 90 days. Check defend@tolerx.com or call 1-877-515-6672.


• At Massachusetts General Hospital there is a study under way by Denise Faustman, in phase 1 clinical trials, studying the Bacillus Calmette-Guerin (the TB vaccine) which seems to decrease the abnormal immune cells that attack and destroy the beta cells. Since the BCG vaccine has been used safely for about 80 years, they are busy trying to determine the doses that are needed and the possible side effects. They are accepting volunteers for future clinical trials. Look up DiabetesTrial@partners.org to email this study group for more information. Scientists are getting closer and closer to finding a solution for Type 1.

Stay healthy until there is a cure for us!

Ginny Burns RN MEd CDE

Diabetes progression and prevention

Q: Ginny,

I have read several obits lately indicating people have died from complications of type 2 diabetes, which I have had for a little over a year. I have my A1c level down to 5.8 and have lost 35 lbs. If I continue to eat sensibly and keep my Alc level in acceptable range will I avoid those complications? Or will my condition worsen?

Thank you for your info,
Judy

A: Judy, You have done a great job! Remember, the leading cause of complications (blindness, end-stage renal disease, and non-tramatic amputations) is not diabetes. The leading cause is UNCONTROLLED diabetes.

We do not know if your body will need more assistance, with more or different medications as time goes on, but your meter will help you. As you test your blood sugar levels you will be able to track whether the numbers continue to be safe. If the numbers become unsafe, you and your physician will be able to decide what the next step for you should be.

Ginny

What Is Type 3 Diabetes?

Q: What is Type 3 diabetes and how serious is it?

Pat

A: Type 3 is a fairly new term. It generally means a type of diabetes that is mixture of Type 1 and Type 2 (the old term was Type 1.5).

Patients who have Type 1 diabetes no longer make insulin. This type of diabetes generally is considered an auto immune disease where the body destroys its own cells in the pancreas that make insulin.

Type 2 diabetes occurs when the body becomes unable to process insulin properly and becomes resistant to it's own insulin. Over 95% of the people who have diabetes, have Type 2 diabetes.

Type 3 patients are often adults or children who have Type 1 diabetes, gain weight, and develop the signs of insulin resistance, which can also include high blood pressure and abnormal cholesterol.

A report from the Children's Hospital in Pittsburgh stated about 25% of children who were diagnosed with Type 1 diabetes also had symptoms of insulin resistance. Tests can be done to determine if a patient falls more in line with autoimmune distruction or insulin resistance. Sometimes patients fall in the middle. Medications are looked at carefully to decide which would work the best. Most physicians will use the medications that will lower the glucose readings first.

Regardless of the Type of diabetes, glucose levels need to be controlled. All abnormal glucose readings can damage a body: Type 1, Type 2 and Type 3.

Please take care, Ginny

Future with Type 2 Diabetes

Q: Thanks for giving us this opportunity to ask questions!

My husband (age 57) has had Type II diabetes for about 3 years. He does everything right, monitoring all his levels, lotions his feet every day, exercises regularly, goes to the doctor every 6 months. We are improving our diet (although slowly). My question is: If he continues to maintain this schedule, what will life be like in 10 or 20 years with diabetes?

P

A: Dear P,

Your husband is doing everything right: keeping track of his blood sugar levels and his HgbA1c levels. The studies tell us that people who keep their levels in a normal range have fewer complications. For people who have Type 2 diabetes, the big three areas he needs to watch (with the help of his physician and you) are his glucose levels, blood pressure and cholesterol. Eating well and exercising will help with all three.

Remember, complications do not generally come from diabetes, they come from UNCONTROLLED diabetes.

Good luck to you both! Ginny

Heart disease and high blood sugar readings

Q: My husband has been diabetic for 14 years now. Recently he had a 6 by pass surgery, since then he has not been able to control his levels. We have tried different medications. But he remains high like over 400-500 maybe higher, our machine only goes to 500 then it says high. Then also he drops very low and I had to get the paremedics here to revive him. I dont know what to do.

A: Please follow up with your husband's family practice or internal medicine doctor, his cardiologist and the diabetes educators that you may have met while your husband was in the hospital.

The medications are used to lower the blood sugars---they match up with everything that makes the blood sugars go up---illness, stress and carbohydrates. If at times he is very high and then drops very low, there isn't a good match. Please meet with his doctors and the diabetes educators to learn more about what the medications are doing and how you can make better matches with the food he is eating.

Is there a diabetes clinic close to you? Please call for an appointment right away.

Please let me know how everything turns out. We want to make sure the blood sugars become lower and much steadier.

Ginny Burns

I have gestational diabetes

Q: Hello Ginny,

I am 8 months of pregnancy. They found Gestational diabetes I have. Could you please let me know about special diet what I should use during last 9th month?

Thank you very much!

A:What did your doctor tell you to do? Did they want you to see a dietician? Did they want you to test your blood sugar levels?

It is best to see a registered dietician to help you design a diet that will help the higher than normal blood sugars that you are having but still provide your growing baby with the calories and nutrients that he/she needs. The dietician will also recomend the correct number of calories for you. It usually turns out to be about 2,200 to 2,500 calories a day if you are of average weight. If you are overweight the dietician may ask you to lower the amount of calories.

The dietician will teach you how to balance your diet. Diets are very individual but usually about 10-20% of the calories come from protein (meat, eggs, cheese, fish); less than 30% of the calories come from fat and the rest of the calories come from carbohydrates (bread, rice, fruit, milk, cereals ect). The dietician will teach you how to choose the healthiest carbohydrates.

In addition to the diet, your doctor may ask you to exercise 3-5 times each week to help control your blood sugar levels too.

To make sure the diet and exercise are working, your doctor may ask you to test your blood sugar at the clinic or use a blood sugar meter at home. It is important to know what these blood sugar numbers are! If the numbers remain high even after you change your diet and add exercise, your doctor may ask you to take insulin. Not many women need to take insulin but the blood sugar levels must be normal in order for you to have a healthy baby. Your doctor may need to monitor you and your baby more closely during these last few weeks. They may do ultrsounds, non-stress testing and/or other fetal movement charting. The doctor will be checking to see if the baby is growing normally. Most women are able to have a normal labor and vaginal delivery but some doctors will deliver the baby earlier or may suggest a cesarean section if the baby becomes too large.

After delivery, your doctor will also check to make sure your blood sugar level have returned to normal. It will be important to check again at the baby's six week check up and every 1-3 years to make sure your blood sugar levels are still normal.

Please contact your doctor right away and ask: Do I need to see a dietician? Should I exercise? Should I test my blood sugar? It will be important for the health of your baby!

Good luck, Ginny