The First Step …. Buy the best Diabetic Cookbook!

One of the first steps new diabetics take is to seek out a good diabetic cookbook. The problem many find, however, is that there are hundreds out there. Each one states that it is the top and sells itself as the best thing since high-fibre, low-GI, sliced bread. It is important for a new diabetic, or pre-diabetic, seeking a good resource for cooking to learn their body’s reaction to certain foods and ingredients so adjustments can be made as needed.

Unless you like doing math in your head; it is equally important to make sure it’s an Australian book with our metric weights and measures and available products. With a base of 300M people, they have many more diabetic products sitting on supermarket shelves!

Low GI Eating Made Easy

[see that GI label!]

One of the first lessons everyone learns early on in the disease is that they may not react to all foods the same as other diabetics. Some diabetics can eat high fibre, low sugar foods and have no rise in blood sugar levels. Some people have no response to sugar alcohols (such as maltitol, sorbitol, or xylitol.) Part of this response has to do with the current level of pancreatic function, while medications also affect the body’s ability to handle some substances. No single diabetic cook book can take all of the variables into account but good ones allow for substitutions and adjustments for people with varying levels of carbohydrate tolerance.

When looking for a diabetic cook book, it is important to find one that explains the recipes in detail and also supplies alternative ingredients for those that may cause problems for people. Some recipes may call for the use of sugar and the recipe should offer alternatives (and proper conversion amounts) such as Equal, alternative sweeteners (sucralose, etc.), and sugar alcohol products. Some recipes even give combination alternatives such as adding cinnamon and Equal to replace sugar. A recipe that calls for flour should offer alternative suggestions for those people who react adversely to processed flour.

Offering alternatives in the diabetic cook book is important, but it is also essential to offer conversion amounts. For example Equal (and some other sugar alternatives) are much sweeter than sugar itself. Knowing this, recipes that call for a certain amount of sugar may need less Equal, however the bulk needs to be made up for with other ingredients. Some flour alternatives can only be substituted for a portion of the whole flour amount. Heavy cream can be used in place of milk but must be mixed with water, and therefore amounts need to be adjusted. A good diabetic cook book must take these adjustments into consideration.

Lastly, a good diabetic cook book must have recipes for foods that an individual would enjoy making and eating. Any nutritional plan is doomed to failure from the start if the meals selected are forced or do not offer variety. A person who ate a lot of sweet and Hi-GI food before being diagnosed with diabetes may find it difficult to adjust to a bland diet. In this case, a diabetic cookbook with recipes for low-GI, sweet snacks will be beneficial. Flip through the pages of a diabetic cook book that you are interested in and see if it holds recipes that you are interested in, and if those recipes offer alternative ingredients and adjustments it may be the right fit for you.

Pick of the Australian Diabetic Cookbooks

There are several available from the GI Team – make sure you are looking at the Australian section – including Low GI Eating - Made Easy … a beauty for new comers to the field…. The Low GI Diet – Cookbook with offerings even from the great Margaret Fulton. These have the obvious advantage of having all the GI ratings built into the recipes. Diabetes & Pre-diabetes handbook

The Low GI Diet Cookbook

Even their handbooks – this is the brand new one: Diabetes & Pre-Diabetes handbook- include good recipes and food hints – such as feeding diabetic toddlers!

From Australian Women’s Weekly and endorsed by Diabetes Australia comes The Diabetes Cookbook. It stresses menus for people with diabetes and their families! “Every delicious recipe has been selected by an expert nutritionist and is endorsed by Diabetes Australia so ALL the ingredients are on the ‘allowed’ list.”
It is a good staple and can usually be found for under $13 making it good value for money.

Women's Weekly Cookbook

A little harder to track down but worth the effort is an Australian treasure called: The Ultimate Diabetes Cookbook by Virginia Hill and Lorna Garden. Now it is important to check the author’s name as there is an American book with exactly the same name but not the same Aussie recipes! A bit of history: the first version was published as ‘Simply Delicious’ in 1996 and ‘Sweet Sensations’ in 1999 …. Just in case you spot one at the school fete.

The Ultimate Diabetes Cookbook

Remember, it may be better to eat several small meals during the day instead of one or two big meals.

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The Stem Cell Debate …………….And a Challenge!

MouseIt’s a subject that divides the political landscape, a medical debate that flows through to the whole community. Unless you are diabetic!

Researchers have cured diabetes in mice by injecting bone marrow stem cells into the bloodstream. The stem cells seek out damaged tissue in the pancreas, where they appear to trigger the growth of new cells. If bone marrow stem cells have the same effect in humans with diabetes, they could be used to treat patients straightaway.

“This is a very significant study,” says Joel Habener of Harvard Medical School in Boston, who studies stem cells in the pancreas. “It suggests that there is something in the bone marrow that can stimulate the pancreatic stem cells to regenerate.”

It can take decades to bring a new drug to the marketplace. But bone marrow transplants have been used for years to treat a host of blood disorders, including leukaemia and sickle cell disease. They have been proven safe and would require no government approval for use as a possible diabetes treatment in humans.

There’s nothing to prevent people from trying this in humans,” says Habener. “People with diabetes have been waiting for a cure for years and years. Why not go ahead and try?”

The Current Status

That was a couple of years ago – but its back in the news again. The Prime Minister allowed a conscience vote in the parliament over whether or not that ban should be lifted. The ban was lifted last December. The Victorian Parliament votes this week.

Meanwhile, research in the US has slowed right down …   Small companies working to develop human embryonic stem cell therapies face innumerable challenges when looking for funding, according to several industry executives at the second annual Stem Cell Meeting in San Francisco on Monday.

Unlike the traditional biotechnology sector, in which government agencies provide primary funding before early-stage venture capitalists move in to invest and assume risk, the lack of support from U.S. President George W. Bush’s administration has led stem cell research to be viewed as too risky an investment, the executives said.

Last August on Channel Nine’s Sunday, Kristine Lumb talked to leading experts representing both sides of the debate.

Here is what Elizabeth Finkel said….

ELIZABETH FINKEL, BIOCHEMIST, SCIENCE WRITER, CONTRIBUTING EDITOR COSMOS MAGAZINE:

Elizabeth Finkel

“We’re not talking about copying people; we’re talking about copying their cells. if you for instance had type one diabetes what we would hope to be able to do is take one of your skin cells, and if we imaged that everyone of your cells is running a program, what is doing the programming, is like a little hard disk inside the cell called the nucleus.

We can reboot that little hard disk back to it’s original operating program where it could run all programs, so we would take that skin nucleus, and we would inject it into one of your own eggs whose own nucleus had been removed and now that the contents of your egg would reboot your skin nucleus and it would start developing as if it were a little embryo clone of you, a very primitive little embryo clone of you. It would then be used to derive embryonic stem cells and those stem cells would be coaxed to become pancreatic cells, insulin producing pancreatic cells and you would be able to have a graft of your own cells, no anti rejection drugs required.”

The International Society for Stem Cell Research

Co-sponsored by the Australian Stem Cell Centre (ASCC), this year’s ISSCR Annual Meeting will be held in the tropical city of Cairns in June.

The Biotechnology Centre of Excellence programme, the Australian Stem Cell Centre, will receive an additional $30.4 million from the Department of Industry, Tourism and Resources, and $27.5 million from the Australian Research Council (ARC). This brings the total funding from the Australian Government to $57.9 million over five years from 2006–07 to 2010–11.

Joel Habener - Harvard Medical School

The Challenge

I must be missing something – everything seems to be in place. We do have funds in Australia and the expertise.

Joel Habener of Harvard Medical School put it best….

“There’s nothing to prevent people from trying this in humans. People with diabetes have been waiting for a cure for years and years. Why not go ahead and try?”

Why not?

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Diabetes, Alcohol, and Living the Good Life

I have had diabetes long enough to take it for granted that I have to control it every day. At the same time I know that I have to make each day as good a day as it can be.

To live a good life with diabetes means first that we control our blood glucose. But it also means enjoying the good things in life.

For me living the good life with diabetes starts with enjoying the exercise that I know I Espressoneed at least every other day. Everyone likes to do different things, but the exercise that I like to do most is to walk early in the morning.

The other reward I usually promise myself is to stop afterwards at my favourite coffee shop for a triple espresso. I always keep the promises that I make to myself.  We diabetics learn the value of that!

Not everyone takes it for granted that people with diabetes can enjoy the good life. If I have an alcoholic drink in a business meeting about diabetes, eyebrows are often raised.

Your doctors will probably ask you how much you drink. They will warn you about the dangers of drinking too much. But if you tell them that you don’t drink any alcohol, they may not tell you what they know about abstinence.

That’s because our response to different amounts of alcohol is quite unusual. It’s not something that could be plotted on a straight line. It is “a U-shaped curve.”

U-CurveWe now have solid evidence that abstinence is worse for you than moderate consumption. This is one of the major findings that jump out from a review of the professional, peer-reviewed literature on alcohol and diabetes in the huge Medline database.

The main problem is that a large number of us simply aren’t moderate in our consumption of alcohol. For these people the choice is between heavy use and abstinence. Doctors simply don’t want to take the chance that if you start drinking on their advice, you won’t know when to quit. Others should not consume alcohol because of the medication they take for diabetes or other conditions. Always check with your doctor or chemist.

If anything, heavy consumption of alcohol is worse for you than being a teetotaller. “The short-term risks of heavy or continuous alcohol intake include hypoglycemias, glucose intolerance, and ketone and lactate accumulation,” according to “Alcohol and the NIDDM Patient” reported in ‘Diabetes Care’.  “In the long term, heavy alcohol intake is associated with an increased prevalence of cancer, hypertension, and cirrhosis of the liver and symptomatic neuropathy.”

A recent study found that insulin resistance “is minimal in individuals with regular mild to moderate alcohol consumption and increases in both heavy drinkers and subjects without any alcohol consumption.” A comprehensive review of the literature concluded, “Compared with no alcohol use…moderate alcohol consumption is associated with…a decreased incidence of heart disease in persons with diabetes.”

In another study conducted at the University of Padova Medical School in Italy, tested insulin sensitivity by measuring tolerance to glucose while people drank the equivalent of about three drinks of beverage alcohol.

The researchers conclude that light or moderate consumption of alcohol improves insulin sensitivity and may reduce potential cardiac complications of diabetes.

Most if not all of these studies define moderate alcohol consumption as one to three drinks a day. That’s also the sweet spot on alcohol’s U-shaped curve.

Cheers!  But do have a chat with your doctor first; especially, if like me, you are on a cocktail of tablets to control your BGL.

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Pumps – Part One

As a T2, I control my diabetes well with oral medication, diet and exercise; However, I do have friends that are T1’s and have experimented with pumps. Like Jason.

His experience mirrors a lot of other users; during his first couple of weeks after a routine that had lasted some 22 years he felt uncomfortable, because the experience Insulin Pumpwas so new.

By the third week in his words: “I am very glad to report that by the third week I began to enjoy the pump and normal blood sugars regularly. I wasted no time in testing this out with a plain glazed donut. It is such a new and great feeling to be able to eat these things and never see my blood sugar go over 120. Nearly all the frustrations I had were mainly due to my emotions and attitude. It just took some time to get used to having this new ‘friend’ with me always”.

The bottom line for Jason a couple of years later is he would never go back – he emphasised one point as well as the lack of painful injections … the control is immediate and automatic … as he pigged out he didn’t see his blood sugar go over 7.8.

Here in Australia the cost of the pumps vary from $2000 - $8000 each. Pumps may be covered by some private health cover. The consumables or insulin and syringes are now covered in part by the National Diabetes Services Scheme, with outgoings of around $30 a month.

Jason had me hooked – if I ever needed insulin I would look into it –But what is a pump?

From Diabetes Australia Victoria….

    * The insulin pump is a small programmable device, about the size of a pager that holds a reservoir of insulin. The pump is programmed to deliver insulin into the body through thin plastic tubing known as the infusion set or giving set.

    * The pump is worn outside the body, in a pouch or on your belt. The infusion set has a fine needle or flexible cannula that is inserted just below the skin (usually on the abdomen) where it stays in place for two to three days.

    * Only short or rapid acting insulin can be used in the pump. Whenever food is eaten, the pump is programmed to deliver a surge of insulin into the body similar to the way the pancreas does in people without diabetes. Between meals, a small and steady rate of insulin is delivered.

    * The insulin pump isn’t suitable for everyone. If you’re considering using one, you must discuss it first with your diabetes health care team.

Currently there are five pumps available in Australia. Pump companies will also send out information packs for potential purchasers. Those with Aussie websites are:
Medtronics and Deltec Cozmo ….other suppliers include Roche, Dana and Animas [Johnson & Johnson].

You need to discuss your pump requirements with your diabetes team [my GP & my wife!] and then look at the different pumps to establish which one best meets your needs.

But what about kids – they adapt so much quicker than we adults – try KidsRPumping for some really inspiring stories.

One of those five pump suppliers Medtronics have a full section on kids and pumps. Also, a cool section for teenies!

Meet some of the pumpers ….

A lady called Amy who lives just outside of Boston asked “Is it a painful or difficult procedure to get hooked up?” You should see the answers she got from a wide range of people.

Here is one with a difference – the excellent, US-based website dLife has parts of its TV show episode on pumps available online… it takes a fair bit of patience if you are on telephone dial-up, but well worth the wait.

Now here is an endocrinologist working for one of the biggest diabetes drug companies in the world still agonising over whether he should get a pump or not.

And, direct from Downtown Orlando (Mickey Mouse is close to 30 kilometres away from where real people live) comes a delightful group of bloggers known as the Orlando Pumpers.Insulin Pump

This Amy is in San Francisco – a professional writer and we join her in her first heady days of her life with the pump. Amy is definitely worth following over the forthcoming weeks.

Such an important area – we will revisit soon.

But one last point – did you know that pumps have been around for 20 odd years…

… here’s a 1984 pump from Travenol Labs alongside a current unit!

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A New Oral Drug for Type 2

In America at the moment there is a race between drug companies to bring out new and effective drugs for T2 diabetics …. breakthroughs promising to be as revolutionary as Exubera [the inhaled insulin] is for T1’s! We are, if nothing else, a major market for the drug makers.

The new agent, vildagliptin, also known by the brand name Galvus, is awaiting regulatory approval in the U.S. and Europe. The new drug class, dipeptidyl peptidase-IV (DPP-IV) inhibitors, improves cell responsiveness to glucose. laf237.jpg

This first of a new class of oral antidiabetic drugs is able to lower blood sugar (glucose) in type 2 diabetes as well as Avandia (rosiglitazone) does, but without causing weight gain, according to a report in the journal Diabetes Care – a very prestigious journal published by the august Stanford University in association with the American Diabetes Association.

Those of you who are regular readers will know that I am a T2 diagnosed well over a dozen years ago but staying healthy thanks to a mix of oral medication that also includes Rosiglitazone [marketed here in Australia as Avandia].  So news of trials in the US on a drug that works the same way is of great interest to me …. and to all you other T2’s out there … today is our day … on Monday I promise all you T1’s a special overview on the state-of-the-art of pumps!

This first of a new class of oral antidiabetic drugs is able to lower blood sugar (glucose) in type 2 diabetes as well as Avandia (rosiglitazone) does, but without causing weight gain, according to a report in the journal Diabetes Care – a very prestigious journal published by the august Stanford University in association with the American Diabetes Association.

I love my Avandia and when in China I was part of it’s expanded trials [prescribed and monitored by a University in Christchurch, NZ] but had to boost exercise and watch diet more closely to prevent that weight gain. For me, it was a matter of really watching my fat intake.

Dr. Julio Rosenstock from the Dallas Diabetes and Endocrine Centre, and colleagues compared the effectiveness and tolerability of vildagliptin versus rosiglitazone (the generic name for Avandia) in nearly 800 patients with previously untreated type 2 diabetes.

At the beginning of the study, the patients’ average haemoglobin A1c level (HbA1c), a measure of long-term glucose control, was 8.7 percent. (Normal HbA1c levels are less than 7 percent). It decreased by 1.1 percent with vildagliptin treatment, with most of the decrease occurring within the first 12 weeks, the investigators report. Patients treated with rosiglitazone had a 1.3 percent decrease in HbA1c, with maximum reduction occurring at week 16.

Patients who were not obese (body mass index below 30) fared better than heavier patients with vildagliptin, the team found.

Vildagliptin treatment was associated with stable body weight during treatment and a significant decrease in the “bad” cholesterol, including triglycerides, LDL, and non-HDL cholesterol, compared with rosiglitazone treatment, the researchers note. Patients taking rosiglitazone experienced a significant average increase in weight of about 3.5 pounds [1.6 kilos].

Vidlagliptin and rosiglitazone are both effective in reducing blood glucose levels in type 2 diabetes patients who have not received prior anti-diabetic drug treatment, the investigators conclude. Along with being well-tolerated, vildagliptin does not cause weight gain, which is an important consideration in selecting the first drug to treat type 2 diabetes patients.

Next week I will be reviewing all the new T2 drugs that are sitting in the pipeline over in the States  – the stages of their clinical trials and just how they are meant to work …. wait till you hear about sitagliptin!

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Inulin …. The Search for Sweeteners (not Spelling) Goes On!

InulinInulins are a group of naturally occurring oligosaccharides (several simple sugars linked together) produced by many types of plants. They belong to a class of carbohydrates known as fructans. Inulin is used by some plants as a means of storing energy and is typically found in roots or rhizomes. Most plants which synthesize and store inulin do not store other materials, such as starch.

Inulin is one more natural sweetener having such an impact on our diabetic food and cooking market. However, it is not that well known in Australia.

Yet, Inulin is used increasingly in foods overseas, because it has excellent nutritional and functional characteristics. It ranges from completely bland to subtly sweet and can be used to replace sugar, fat, and flour. This is particularly advantageous because inulin contains one-third to one-fourth the food energy of sugar or other carbohydrates and one-sixth to one-ninth the food energy of fat. It also increases calcium absorption and possibly magnesium absorption, while promoting intestinal bacteria.

Nutritionally, it is considered a form of soluble fiber, and it is important to note that consuming large quantities (particularly for sensitive and/or unaccustomed individuals) can lead to gas and bloating. Inulin has a minimal impact on blood sugar, making it generally considered suitable for diabetics and potentially helpful in managing blood sugar-related illnesses.

Plants that contain high concentrations of inulin include:
Dandelion (Taraxacum officinale)
Wild Yam (Dioscorea spp.)
Jerusalem artichokes (Helianthus tuberosus)
Chicory (Cichorium intybus)
Jicama (Pachyrhizus erosus)
Burdock (Arctium lappa)
Onion (Allium cepa)
Garlic (Allium sativum)
Agave (Agave spp.) …….. onions and garlic … but it tastes so sweet!

When I worked in LaLaLand (aka Hollywood), on my way to the Studio I would drive past one of Trader Joe’s outlets; a neighbourhood food store that is just so totally different to anything we have here … all the odd and exotic foodstuffs from all over the world dumped into huge bins.  For my lunch, while penning the adventures of the inhabitants of Star Trek –Deep Space Nine at Paramount, I would pick up a Stonyfield Farm yoghurt sweetened with Inulin. Just great!

(Keep an eye out for our new feature Showbizzy, - coming soon - which will give you the inside on diabetes in Hollywood)

The only Inulin product that I know in Australia so far, (keep an eye on this, it is going toDarrell Lea take off) is the imported range of Cavalier chocolates from Belgium. All of their range is sweetened with Inulin. I learned my chocolore at the feet of the fabulous immigrant brothers responsible for Darell Lea back in the ‘70’s. That whole story is one for the future!

It was accepted that the best chocolate in the world was Belgian and the best example of that confectioner’s art were the Sea Shells.

At last, Belgian chocolate Sea Shells are available from our friends at the Sugar Free Zone in Adelaide and Xlear Australia in Brisbane.

The range of good sweetener alternatives is rapidly increasing – we have a feature coming up where we will examine each of the new ones and where they are being used in Australia … you still have that sweet tooth? … stay tuned!

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Food Pyramids …and Diabetes

Last year saw a minor skirmish between the United States Department of Agriculture [the American healthy food gods] and the American Diabetes Association [the other god on what we should eat if we are diabetic].

Now, my American cousins have always loved their food pyramids: I remember playing with one when I was at school [and that’s pre-TV!].  But the USDA has dropped the pyramid and replaced it with an interactive guide and renamed it mypyramid! This step upset the American Diabetes Association!

So, what’s at the heart of this dispute by America’s two top good food guys; here is the pyramid the ADA would prefer to use …..

Food Pyramid

 And they say….

The Diabetes Food Pyramid divides food into six groups.  These groups or sections on the pyramid vary in size.  The largest group — grains, beans, and starchy vegetables — is on the bottom.  This means that you should eat more servings of grains, beans, and starchy vegetables than of any of the other foods.  The smallest group — fats, sweets, and alcohol — is at the top of the pyramid. This tells you to eat very few servings from these food groups.

The Diabetes Pyramid gives a range of servings. If you follow the minimum number of servings in each group, you would eat about 1600 calories and if you eat at the upper end of the range, it would be about 2800 calories.  Most women, would eat at the lower end of the range and many men would eat in the middle to high end of the range if they are very active.

The exact number of servings you need depends on your diabetes goals, calorie and nutrition needs, your lifestyle, and the foods you like to eat.  Divide the number of servings you should eat among the meals and snacks you eat each day.

The Diabetes Food Pyramid is a little different than the USDA Food Guide Pyramid because it groups foods based on their carbohydrate and protein content instead of their classification as a food. To have about the same carbohydrate content in each serving, the portion sizes are a little different too.

For example:  you will find potatoes and other starchy vegetables in the grains, beans and starchy vegetables group instead of the vegetables group.  Cheese is in the meat group instead of the milk group.  A serving of pasta or rice is 1/3 cup in the Diabetes Food Pyramid and ½ cup in the USDA pyramid.  Fruit juice is ½ cup in the Diabetes Food Pyramid and ¾ cup in the USDA pyramid.  This difference is to make the carbohydrate about the same in all the servings listed.  

Following is a description of each group and the recommended range of servings of each group.

Grains and Starches

At the base of the pyramid are bread, cereal, rice, and pasta. These foods contain mostly carbohydrates. The foods in this group are made mostly of grains, such as wheat, rye, and oats. Starchy vegetables like potatoes, peas, and corn also belong to this group, along with dry beans such as black eyed peas and pinto beans.

Starchy vegetables and beans are in this group because they have about as much carbohydrate in one serving as a slice of bread. So, you should count them as carbohydrates for your meal plan.
Choose 6-11 servings per day. Remember, not many people would eat the maximum number of servings.  Most people are toward the lower end of the range. 

Vegetables

All vegetables are naturally low in fat and good choices to include often in your meals or have them as a low calorie snack.  Vegetables are full of vitamins, minerals and fibre.  This group includes spinach, chicory, sorrel, Swiss chard, broccoli, cabbage, bok choy, brussels sprouts, cauliflower, and kale, carrots, tomatoes, cucumbers, and lettuce.  Starchy vegetables such as potatoes, corn, peas, and lima beans are counted in the starch and grain group for diabetes meal planning.

Fruit

The next layer of the pyramid is fruits, which also contain carbohydrates. They have plenty of vitamins, minerals, and fibre.  This group includes blackberries, cantaloupe, strawberries, oranges, apples, bananas, peaches, pears, apricots, and grapes.
Choose 2-4 servings per day.

Milk

Milk products contain a lot of protein and calcium as well as many other vitamins.  Choose non-fat or low-fat dairy products for the great taste and nutrition without the saturated fat.
Choose 2-3 servings per day

Meat and Meat Substitutes

The meat group includes beef, chicken, turkey, fish, eggs, tofu, dried beans, cheese, cottage cheese and peanut butter.  Meat and meat substitutes are great sources of protein and many vitamins and minerals.

Choose from lean meats, poultry and fish and cut all the visible fat off meat.  Keep your portion sizes small.  Three ounces is about the size of a deck of cards.  You only need 4-6 ounces for the whole day
Choose 4-6 oz per day divided between meals

Fats, Sweets, and Alcohol

Things like potato chips, candy, cookies, cakes, crackers, and fried foods contain a lot of fat or sugar. They aren’t as nutritious as vegetables or grains.  Keep your servings small and save them for a special treat!

A lot of this is extracted and Adapted from the book Diabetes Meal Planning Made Easy. Written by Hope S. Warshaw, MMSc, RD, CDE, a nationally recognized expert on healthy eating and diabetes.

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Diabetes and Travelling - Part 2

A Collection of Tips…Part Two

Continuing an overview of good things to do as a diabetic traveller…. If you would like to read the first five tips, start here….

6.  Check Your BGL Frequently – I know there are plenty of you out there testing 8, 12, 16+ times a day, so to you I give a thumbs up :-) .

But for others I would suggest, especially if travelling more than 3 time zones to test glucose levels more frequently….  And from Australia, we tend to do that all the time. We all get in the habit of keeping a mental note of what effects certain foods have on our blood sugars (at least I do). But being in a different time zone and eating different foods can have a much greater effect on your blood sugar than you think.

For example, I fly between Sydney and the West coast of the U.S. regularly and notice drastic changes once I reach each side. My blood sugars get extremely low even when eating the same foods. It’s almost as if my insulin starts working 50% more within my body for the next few days after arrival and I have to make constant adjustments. This is something that would be good to consider.

The effects of Jet Lag can be worse for diabetics. However, there are things you can do.

7.  Discuss it with the Doc –When you are going on a rather long trip, it is a good idea to get checked out by your doctor a few weeks before going.

Consult with him or her and explain the length and extent of the trip. You could even talk about the cultural and culinary differences between your home and where you’re going and how it might affect your blood sugar. Also make sure you’ve brought more medical supplies than you think you’ll need. This includes extra insulin/pills, syringes, fast acting glucose tablets, fast acting insulin for emergency highs … always carry a copy of your prescriptions … particularly since 9/11.

How you pack your meds is also important. When I first started my trips to China, the only real diabetic drugs available were Glibenclamide… and as a T2; I was using a mix of tablets.

8. Bottled Water, Drink it! – Hydration is very important, but just as important is the quality of your hydration source. Especially if you’re in a foreign country where the water quality is debatable then pick up a few bottles of drinking water. Trust me; even in locations within the U.S. the water quality is far from optimal. Better safe than sorry.

9. Check Out Travel Insurance – Especially when staying on longer trips and even after extensive packing there is still a chance for things to go wrong. What happens when your luggage with your 5 weeks worth of medication gets lost at the airport?  Contact your insurance company and see what they can cover in case you aren’t already covered. It also might not hurt to inquire about international travel insurance if you plan on going abroad.

As part of your travel planning visit Diabetes Australia and download their handy guide.

10.  Watch the Alcohol – Ah yes, temptation again. You may feel like “letting loose” with a few too many martinis at the coconut bar on your island get away but try to resist. People with diabetes can enjoy alcohol just like everyone else but the key is moderation (Just like everyone else). Some tips involve being selective about what you drink, the sugars and calories in those mixers add up very quickly.

Also, eat something before drinking, drinking on an empty stomach is never a good idea whether you have diabetes or not. I’m sure (hopefully) you’re “celebrating” with other people and just not getting drunk by yourself, if so make sure they know your situation in case of emergency and even to support you in not over doing it.

As an insulin dependent Type 1, read a special article on travelling in the young diabetic website Reality Check… a great place to visit even if you’re a certified oldie like me.

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Blood Sugar Targets

It is interesting that different people will give you different BGL targets. I am 65, a Type 2 and my GP is happy if my fasting is around 7.5 while others tell me that’s terrible (particularly my super-healthy brother –another Type 2). However age is a factor for target scores  … I can usually hit the 6’s … but what do the pro’s say?

The American Association of Clinical Endocrinologists (AACE) recommends the following general blood glucose testing goals for adults with type 1 and type 2 diabetes:

Preprandial* (fasting, or before a meal) - 6.1 mmol/l [100 in USA]

Two hours postprandial (after the start of a meal) - 7.8 mmol/l [140 in USA].

Our own NSW branch of Diabetes Australia push a far higher threshold on a whole page on BGL and are supporting an innovative thing called a self-test scratchie… a great gift for those friends who think they may have diabetes and want to use your monitor.

They say….

• If your BGL reading is less than 5.5 Diabetes is unlikely.
It is recommended that you retest your BGL in three years.

• If your BGL is between 5.5 - 6.9
The results require further investigation. An Oral Glucose Tolerance test (OGTT) should be taken …. Who still remembers their first free glass of orange juice?

Down South they are a little tougher ….

From Diabetes Australia – Victoria… the following recommendations…

Targets For Glycaemic Control:

Risk of hypoglycaemia (low blood glucose) - Less than 3.5 mmol/L if insulin or certain types of tablets are used, but this does not apply to other tablets or where glucose is controlled by meal plans alone.

Normal levels 4-6 mmol/L before meals
4-8 mmol/L after meals*

Ideal levels 4-6 mmol/L before meals
Up to 8 mmol/L after meals*

Moderate levels 6-7 mmol/L before meals
Up to 11 mmol/L after meals*

High levels More than 7 mmol/L before meals
More than 11 mmol/L after meals*
* Two hours after starting the meal

While The American Diabetes Association also lowers the bar considerably ….
Time of Test                                         Goal Plasma Glucose

Before meals                               90-130 mg/dL (milligrams per deciliter) [ 5.0 to 7.2]*
Before bedtime snack                   (1-2 hours after a meal/postprandial)
                                                      less than 180mg/dL [10.0]*

                                                  * Official Diabetes Blog conversions.

However, most discussion centres on the lower thresholds for diagnosis … if you are reading American blogs and you want to do the conversions [I like doing them in my head – like metric vs. imperial] there’s a cool converter here.

At what point do you find you get a hypo? I get that dizzy feeling around 3.5 and have taught myself to recognise it – my briefcase is always stocked with muesli bars :)

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History of Insulin and its Future

Traditionally, clinicians have used oral agents for as long as possible before reverting to insulin. However, we are now moving towards a culture in which insulin is being advocated earlier in the disease process; particulalry in Europe.

This is particularly true in type 2 diabetes where intensive treatment is not associated with the same risk of hypoglycaemia often seen in type 1 diabetes. In addition, recent developments with insulin analogues have made insulin a far more versatile management tool than has been the case in the past.

Looking back at the first-generation insulins in the 1920s, there were problems with supply, impurity and inconsistency of potency. Despite Hagedorn’s discovery of NPH [early 20’s and Novo Nordisk the Danish company was founded on it … the H in the name is actually his!] –the first protracted insulin to be made available–there remained problems of instability combined with injection pain.

Little progress was made until the 1950s and 60s when NPH and Lente insulins provided more tolerable intermediate action. The mid-1960s saw Novo’s first mono-component insulin which was:

  • Highly purified
  • Had no animal proteins
  • Contained no contaminants
  • Possessed a specification higher than had previously been achieved.

Following the Nobel prize-winning work of Dorothy Hodgkins on the structure of insulin in the early 1960s, the potential of interfering with the biokinetics of insulin pointed to the potential for designer products in the future. However, the first short-acting analogues did not appear until the 1990s.

The most recent development has been the 2004 introduction of Levemir® (insulin detemir), the long-acting insulin analogue which has a more predictable glucose-lowering effect than both NPH insulin and insulin glargine (the first long-acting insulin analogue, which appeared in 2002) in patients with type 1 diabetes as well as producing fewer nocturnal hypoglycaemic events than NPH.

Last year both Levemir and Lantus [another analaogue from sanofi-aventus, USA] were approved for use in Australia and as part of the PBS – thanks Diabetes Australia for a great lobbying effort! Quick note: it is not yet approved here for Type 2 pateients except on private script.

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