Diabetic Retinopathy: Effective Treatment to Prevent and Slow This Microvascular Disease

September 2nd, 2010

Diabetic retinopathy is a disease where blood vessels in the eye tissue are damaged by diabetes. High amounts of glucose in your blood for extended periods of time or in frequent intervals can make blood vessels leak which causes the retina to swell. Also, irregular new blood vessels can develop from high blood sugars. Both of these problems contribute to blurry vision and vision loss.

It’s a scary thing but it can be prevented! The number one prevention plan is to keep your blood sugars in the normal range. But doctors have been studying other ways to prevent retinopathy or at least to slow down its progression. A study called the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study just came out with new promising results. Here are some of the highlights:

The Study Structure

  • The study had two main groups: standard blood sugar control and intensive blood sugar control
  • The standard blood sugar control group received medication to control blood sugars, lower LDL cholesterol, and lower blood pressure.
  • The intensive blood sugar control group received medication to have near normal blood sugars, lower LDL cholesterol, lower triglycerides, raise HDL cholesterol, and have near normal blood pressure.
  • We know that intensive blood sugar control slows the progression of diabetic retinopathy in people with Type 1 diabetes and newly diagnosed Type 2 diabetes.
    • The ACCORD Eye Study now shows that the same intensive control slows retinopathy in people who have had Type 2 diabetes for over 10 years.

The Results

  • The intensive control of blood sugars, triglycerides, and cholesterol decreased the progression of diabetic retinopathy by about one-third over four years.
  • The intensive control group dropped their average A1c to 6.4%
  • Taking the combination of a fibrate medication (lowers triglycerides and raises HDL) and a statin medication (lowers LDL) reduced retinopathy progression better than just taking a statin alone.
  • Intensive blood pressure (120/80) control didn’t slow down retinopathy anymore than the standard blood pressure control (140/80) did.
Bottom Line: Diabetic Retinopathy can be prevented or slowed if it already exists. Treatment should include near normal control of blood glucose and medication to lower triglycerides and LDL cholesterol as well as raise HDL cholesterol.  “The ACCORD Eye Study clearly indicates that intensive glycemic control and fibrate treatment added to statin therapy separately reduce the progression of diabetic retinopathy,” said Emily Chew, M.D., chair of the Eye Study and chief of the Clinical Trials Branch of the Division of Epidemiology and Clinical Applications at the National Eye Institute (NEI).

This treatment was proven safe for some people but it is important to know that intensive blood sugar control can increase risk of death and severe low blood sugar in some patients. You must talk with your doctor to decide if you are at risk or if you are a good candidate for this treatment to prevent or delay diabetic retinopathy.

New England Journal of Medicine (NEJM) July, 2010

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Wednesday Wellness Tip: Very Low Carbohydrate Appetizer

September 1st, 2010

Labor Day is just a few days away! This is the weekend for those outdoor parties to wish summer a bittersweet goodbye. Here is a recipe for a simple summer appetizer that won’t keep you away from your guests. Marinate these bite size shrimps a little bit before your party and then pop them on the grill as your guests arrive. They’ll be done in a snap so you have time to socialize before serving the main meal.

And you won’t need to worry about counting carbs until you eat the main meal. Plus, there is vinegar and cayenne pepper in this recipe, both ingredients that help control blood sugars and weight. This will keep you and your guests from starving but it won’t ruin your appetite.

Grilled Shrimp Poppers

Makes 10 servings

1 serving = about 3 ounces of shrimp

Ingredients

  • 3 cloves garlic, minced
  • 1/3 cup olive oil
  • 1/4 cup tomato sauce
  • 2 tablespoons red wine vinegar
  • 2 tablespoons chopped fresh basil
  • 1/2 teaspoon salt
  • 1/4 teaspoon cayenne pepper
  • 2 pounds fresh shrimp, peeled and deveined
  • skewers

Directions

  1. In a large bowl, stir together the garlic, olive oil, tomato sauce, and red wine vinegar. Season with basil, salt, and cayenne pepper. Add shrimp to the bowl, and stir until evenly coated. Cover, and refrigerate for 30 minutes to 1 hour, stirring once or twice.
  2. Preheat grill for medium heat. Thread shrimp onto skewers or toss into a grill basket. Discard marinade.
  3. Lightly oil grill grate. Cook shrimp on preheated grill for 2 to 3 minutes per side, or until opaque.
Nutrition Information per One 3 oz Serving
Calories 141 Calories
Fat 6.5 g
Carbohydrates 0.6 g
Protein 19 g
Sodium 235 mg
Cholesterol 177 mg
Diabetic Exchanges 2 ½ very lean meats, 1 fat

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Helpful Health Tools: Diabetes Health Checker

August 30th, 2010

There is so much medical and health information floating around these days which can be a great help or a big hurt. Always remember that when you are browsing any website with health or medical information, it is important to keep your accuracy and reliability goggles on. (check the source of the information, the credibility of the writer, cross reference with other publications on the same topic, etc) WebMD is a huge and widely accepted source of medical information, but it is good practice to really check out the information that can potentially help or harm you.

That being said, the website offers a few really great tools for people with diabetes. Try out their Diabetes Health Checker. It is an interactive presentation that asks questions about your current diabetes condition and care. At the end of the questions, a report with tips and summaries is generated based on your answers. This tool can’t diagnose anything, but it is a good refresher on what your daily, monthly, and yearly care should look like.

And another helpful tool is the Health Assessment Tool. These questions go more in depth to cover more areas that affect your overall health and not just diabetes. A report is generated with summaries and suggestions as well. It’s a great idea to print this report and bring it to your next few doctors’ meetings and check ups. It can help your doctor see a snapshot of your life very quickly and maybe give him or her more information they didn’t know to ask about. But go ahead and tell them everything anyways; it can’t hurt to update your doctor several different ways (use words, written information, physical examinations, and however else you think you can keep your doctor up to date with your health).

Again, these tools can’t replace your doctors’ visits and in person evaluations by MDs, RNs, CDEs, and other people on your healthcare team. But they are tools to supplement and help you better manage your disease.

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Better Breakfast for Diabetes: Set the Tone for Healthy Blood Sugars

August 26th, 2010

I’m sure your dietitian, doctor, mother, and diabetes educator harp on the fact that breakfast is the most important meal of the day. It is true that studies have shown breakfast eaters eat less throughout the day and have more success in losing weight.

But is just any breakfast ok? After you were diagnosed with diabetes or prediabetes, I’ll bet y’all found out any old breakfast won’t cut it. Your body is more sensitive glucose in the morning; your blood sugars will respond differently and more quickly in the morning so not only how much but what you eat for breakfast really does matter.

Here are some quick guidelines for setting a healthy tone for your day with breakfast:

  • Start your breakfast plan knowing how many carbohydrate servings you need.
  • Get some type of lean protein into each breakfast to help slow down your sugar peak and to keep you feeling full longer.
  • Test and see how your body responds to juice and fruit in the morning. You body is more sensitive to glucose, especially in juice and fruit, in the morning so some people need to limit these foods in the AM.
  • Make a personal rule not to buy convenience breakfast foods and fast food. Just make it a habit to pass by the toaster strudels, the sausage breakfast sandwiches, and other prepackaged breakfast meals.
  • Avoid pastries like Danishes, croissants, scones, and other high sugar, high fat carb choices. For special occasions, plan ahead how much of the breakfast treat you will allow yourself. No surprises.
  • Focus on portion size.
  • Watch out for breakfasts with little extras like: brown sugar, dried fruit, extra butter, whipped cream, glazes, and syrups.
  • Make a batch of your breakfast for the week on Sunday: hardboiled eggs (store in cold water in an airtight container), a healthy breakfast casserole, quiche, homemade whole wheat breakfast bread or muffins (you can control what goes into these), whole grain waffles you can toast each morning.
  • Go for whole grains and complex carbs. Limit the refined carbohydrates.
  • Set your alarm for 10 minutes earlier so you know you have time to prepare your breakfast. Or prep your breakfast the night before.

And here are some great breakfast ideas: 

  • 1 piece of whole wheat bread with 1-2 scrambled eggs on top. Add seasonings, a little mustard, or a little tub butter for flavor. (About 15 grams of carbs)
  • Pita bread with peanut butter or cottage cheese and fruit rolled up. Add a hardboiled egg for protein. (About 25-35 grams of carbs)
  • Breakfast burrito with a whole wheat tortilla, egg beaters, salsa, and sliced avocado. (15-20 grams of carbs)
  • Half whole wheat English muffin with a dollop of plain yogurt and berries on top. (30-35 grams of carbs)
  • Low calorie smoothie: ½ cup skim milk, ½ cup tofu or plain yogurt, ¾ cup fruit of your choice, ice, artificial sweetener if needed. (35-40 grams of carbs)
  • Homemade quiche made with skim milk, egg beaters, veggies, and whole wheat crust (or go crustless). (30-40 grams of carbs)
  • Steel cut oats (30 grams of carbs for ¼ cup) or regular rolled oats, not the packaged oatmeal, (15 grams of carbs for ½ cup) with peanut butter and cinnamon. Add an egg on the side.
  • Egg white omelet with tons of veggies. Have a piece of whole wheat toast on the side. (20-25 grams of carbs)
  • 1 whole grain (wheat, oatmeal, buckwheat, etc) pancake or waffle with peanut butter and berries (you don’t even need syrup!). (About 30 grams of carbs)
  • ½ cup unflavored Greek yogurt or plain yogurt with berries, almonds, flax seed. (30-35 grams of carbs)
  • Whole wheat English muffin with a slice of lean cut ham and mustard. (About 30 grams of carbs)
  • In a pinch, try a diabetes friendly shake like Glucerna.
  • Have leftovers! Repeat your healthy dinner or lunch from the day before in smaller portions.
  • Eggs any way! Scrambled, poached, cooked with pam, hardboiled. Add a piece of whole wheat toast, fruit, oatmeal, or light yogurt to get in good carbohydrates.

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Wednesday Wellness Tip: Walking Your Way to Better Health

August 25th, 2010

Manage Diabetes with an Exercise Program

Here is a walking program for beginners or expert walkers to get you moving and improving your health! Walking exercise improves glucose control and cardiovascular fitness for heart health, and it helps with weight control.

To start, just get up and go! Walk 5-10 minutes at an easy pace. As that gets easier, add 5-10 minutes each week until you are able to walk 30 minutes without stopping. Then start this program, walking each week’s target minutes at least 3-5 days a week. And remember, HAVE FUN!

Week Warm-Up Minutes (walking normally) Target Heart Rate Minutes (walking briskly) Cooldown Minutes (walking normally) Total Exercise Time
1 5 5 5 15
2 5 7 5 17
3 5 9 5 19
4 5 11 5 21
5 5 13 5 23
6 5 15 5 25
7 5 18 5 28
8 5 20 5 30
9 5 23 5 33
10 5 26 5 36
11 5 28 5 38
12 5 30 5 40

Target Heart Rate

Maximum Heart Rate (beats per minute) = 220 – your current age

Walking rate = 60-70 % of Maximum Heart Rate

Example for 50 year old: 220 – 50 years = 170 bpm (that’s your max heart rate)

60 % of 170 bpm is 102 bpm and 70% of 170 bpm is 119

So you would want your heart to beat 102-119 beats per minute during the “target heart rate/brisk walking” minutes.

How to Check Your Heart Rate:

Find your pulse with two fingers either on your inside wrist or neck.

For 1 minute, count the number of pulses you feel.

The total number of pulses in exactly 1 minute is your current heart rate.

Find more information about starting a walking program with this great presentation from dLife.

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Starting an Exercise Program: Manage Your Diabetes and Get Moving!

August 23rd, 2010

The hardest part of exercising is actually getting started! Lacing up your running shoes. Driving to the gym. Figuring out which weights to lift. Wheeling out your bike. Joining that pilates class. Those first few steps seem to get pushed back in the day or side stepped for something “more urgent.” But your health is one of the most urgent things in your life!

Exercising, along with smart nutrition, is one of the best ways to control your blood sugar. Working out causes your muscles to become more sensitive to insulin, so your blood glucose can get into your cells better. Your blood sugar level drops while you exercise but it also has been shown to stay lower after exercising. Think what a difference regularly exercising can make!

Recent studies have told us two new things about starting exercise. The first: individuals that are able to internally motivate themselves to start exercising and to put effort into their workouts have the best exercise and weight loss/weight maintenance results up to three years later. The second: Most people need a specific plan or structured program to start exercising and to keep exercising. Knowing this, you can equip yourself to start the best exercise program for you that will give you the best health results!

Here are some words of encouragement to help you get over that exercise hump and just get going. Check out this previous blog post about checking your blood sugar before, during, and after exercising. You have to get moving, but you also need to be smart about it. 

  • Pick activities that are simple and action-oriented. You don’t need to buy an expensive gym membership or a pricey treadmill. Start with easy activities like walking in your neighborhood, running at the local high school track, exercise videos, pilates at home, swimming at the YMCA, and so many more options.

 

  • Internalize your desire to be healthy and get revved up. If you know the healthy results and benefits of exercising and your health is important to you, getting going will be easier. You will have extreme motivation!

 

  • Focus on exercise as a constructive thing. It really is a great activity for your heart, your mind, your health. Exercise is not the bad guy lurking in the dark to make you miserable. So flip flop how you think about physical activity, so it becomes upbeat and positive.

 

  • Track your exercise and progress. This is a great way to hold yourself accountable and to motivate yourself. You’ll see progress like being able to walk your normal neighborhood route faster than you did a month ago. You’ll know when you are ready to increase the weights that you are lifting. And you’ll see that your efforts are paying off.

 

  • Make exercise meaningful. Associate your daily exercise with valuable time or memories. This can be a walk with your sister every weekend to catch up. A yoga class every morning to collect your thoughts. A run through the park that your kids played in. Listen to an audio book while you exercise.

 

  • Set specific and measurable goals. It is easier to work at something when you know what you are trying to achieve. Start a walking program with the goal to be able to walk two miles in under 20 minutes. Lift weights with the goal of doing 10 push ups without stopping. Start with goals you know you can accomplish and write them down.

 

  • Treat your workouts like appointments and put them on your calendar. You wouldn’t miss a meeting with your boss or a lunch date with your best friend would you?!

 

  • Invest in the right gear. Get comfy, padded running shoes that fit correctly. Buy a helmet if you plan to bike outside or a pedometer if you plan to walk. Invest in a tennis racket and tennis balls if you live close to a court. If you put money into something, you’ll be more likely to do it.

 

  • Create a workout group or make a pact with a workout buddy. You’ll have other people to motivate you and push you. Some people prefer to workout with a friend because talking keeps their mind off of the exercise. But if having a friend with you distracts you so you end up not working, try to workout solo.

 

  • Have fun and recognize your accomplishments. If you absolutely hate running, don’t try it! Start slowly with activities that you actually enjoy: dancing, walking, bicycle riding, ice skating, snow shoeing, team sports, water aerobics…the options are endless so you can surely find an activity that gets you excited. And don’t forget to pat yourself on the back when you reach a goal or workout 5 times a week. It is a huge accomplishment and you should fee very good about yourself.

The most important thing to remember is that you have to get started. Thinking about it and making plans are necessary. But if you don’t actually start moving, you won’t get the benefits. Talk with your doctor before you start exercising for the first time in awhile. He or she will also have great suggestions to help you get moving and to move safely.

You can do it! Get up and get moving. Your health is worth it!

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Reading Food Labels Leads to Healthy Choices Which Leads to Weight Management

August 19th, 2010

There is a study called the National Health and Nutrition Examination Survey (NHANES) that is performed each year. Along with many health and disease parameters, the study generates data about what, how  much, when, and why Americans eat what we do. NHANES 2005-2066 and two studies published in the Journal of the American Dietetic Assocation were just completed and here is some information they found:

  • People that read food labels, on average, consume less calories, less total fat, less saturated fat, less cholesterol, less sodium, less sugar, and more dietary fiber.
  • 61.6% of respondents to NHANES said they read the nutrition facts panels, 51.6% examine the list of ingredients, 47.2% read the serving size and 43.8% review health claims at least sometimes when deciding whether to buy a food product.
  • Food packaging labeled with healthful nutrition labels has potential to increase purchase of healthy foods versus less healthy food choices.
  • Reading food labels is associated with improved dietary factors and healthful eating patterns.

So, reading the full nutrition label, the ingredients list, and the health claims on the packaging of foods you buy and eat can help you develop healthy eating habits. This will hold you accountable to what you know you should eat, so you will buy and eat foods that are better for you. Compare products in the grocery store by holding the food labels of two packages side by side. By paying attention to the numbers on food labels, you’ll also keep better tabs on the total calories, fat, cholesterol, and sodium you are eating.

Now, just reading food labels alone is not going to magically make you change your eating habits and behaviors. But it can help improve your health day to day by improving the nutrition that you eat. And long term, it can help you lose weight along with exercise, portion control, and healthier choices throughout each day.

Stay well informed and know what you are putting into your body. You don’t need to be preoccupied and worried about the labels, but reading and paying attention will naturally help you make better choices. And this will increase the nutrients you eat, help you lose extra weight and maintain your healthy weight.

Here’s a question for you! Let us know your ideas on how to improve food labels. What information would you like to see added or taken away? What can be clarified on the labels to make more sense to you? Do you think you would purchase healthier foods if the prices were lower than the less healthy versions?

Let us know what you think!

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Wednesday Wellness Tip: Carrying Diabetes Identification Can Save You

August 18th, 2010

A friend I spoke with recently told me that she has different ID bracelets to match her outfits. She doesn’t want to broadcast that she lives with diabetes, but she does want to have a bracelet that will quickly and easily alert someone that she has diabetes. Do some of y’all feel this same way? Have you found other ways to carry identification and health information without feeling like a billboard? There are many ways to wear a clearly visible ID that is stylish and not cumbersome. Please share your ideas with us and take a look at a few of these options.

  • ID bracelet
  • Ankle ID bracelet
  • ID card for wallet (if you always carry your wallet)
  • Jewelry that is engraved or has discreet writing
  • Stickers on your car windshield
  • Tags for your shoes, purse, or other items you carry all the time
  • Belt with ID info
  • Watch bands with ID info
  • Wallpaper of your cell phone
  • Key chains
  • Sweat bands for when you exercise outdoors
  • Cards that slide under shoelaces
  • Embroidered glucose meter kits
  • Broaches or pendants with writing
  • Tags for your bicycle or other sports equipment

No matter what methods you choose, it is absolutely crucial that you have some type of easily found identification on your body to indicate that you have diabetes. It can protect you, save you, and ensure that you get appropriate medical care. You can have multiple places where your medical information is identified though. You’ll be prepared for any of those situations we hope never happen: car accident, hypoglycemic coma, fire, or any emergencies where you are unable to speak for yourself.

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Agave Nectar: Is It a Safe Natural Sweetener Option for People with Diabetes

August 16th, 2010

In the late 1990s, the American Diabetes Association finally gave the thumbs up to sugar. Although a cautious thumbs up, the ADA and diabetes health professionals as a whole agreed that sugar in small amounts is an OK option for people with diabetes. But there are still so many different sweeteners on the market. It is hard to determine which is better: sugar, sugar alternatives, natural sweeteners? If you control the amount and frequency of eating pure sugar, you can maintain good glucose control and have your cake and eat it too. However, there is more to consider with some sweeteners than just the sugar content.

Let’s take a look at a natural sweetener that is getting a lot of attention.

Agave Nectar: The Good

  • The plant was used by the Aztecs for medicinal properties
  • Agave results from the aquamiel, “honey water,” in the core of the plant being processed into a syrup or nectar
  • Sold as light colored agave (similar to maple syrup or honey), dark and amber agave nectar (similar to caramel), and raw agave
  • Contains about 60 calories in 1 tablespoon compared to 40 calories in 1 tablespoon of table sugar
  • Is 1½  times sweeter than table sugar so it requires less for the same sweetness
  • You can lower the number of calories by using less with a sweet result
  • Agave has a very small amount of antioxidant properties: less than honey but more than table sugar
  • It does contain very small amounts of calcium, potassium, magnesium, vitamin A, and folate
  • Glycemic Index of agave nectar is below
Food Name Glycemic Index Serving (grams) Carb/Serving (grams) Glycemic Load
Organic Agave Cactus Nectar, light, 90% fructose (Western Commerce Corp., City of Industry, CA, USA) 11 10 8 1
Organic Agave Cactus Nectar, light, 97% fructose (Western Commerce Corp., USA) 10 10 8 1
Premium Agave nectar (Sweet Cactus Farms, USA) 19 10 8 2

Bottom Line: Agave is sweeter than table sugar so you can use a smaller amount and consume less calories. Agave also has a low glycemic index.

Agave Nectar: The Bad

  • Nutritional content of agave products sold depends on the plant species and the vendor/manufacturer
  • Agave nectar sold in bottles in the U.S. is slightly processed and contains a high amount of concentrated fructose
  • Researchers just published a study in Physiological Behavior about fructose and blood lipids in April of 2010 concluding:
    • “We conclude that even moderate consumption of fructose-containing liquids (including agave) may lead to the onset of unfavorable changes in the plasma lipid profile and one marker of liver health, independent of significant effects of sweetener consumption on body weight.”
  • Research is indicating that eating too much fructose or high fructose containing foods can not only raise cholesterol and triglycerides, but it might decrease insulin sensitivity.

Bottom Line: Although there is no definitive research, eating agave nectar in small amounts might be a good sweetener alternative for people with diabetes. But it should be consumed in small amounts less frequently.  

This is the same concept that applies to all sweeteners and simple sugars such as sucrose, honey, maple syrup, table sugar, brown sugar, etc. Small amounts of simple sugars (simple carbohydrates) are acceptable for people with diabetes, but remember that your healthy diet will focus on complex carbohydrates and use sweeteners sparingly.

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Diabetes, Aspirin, and Heart Disease: Keeping Your Heart Healthy

August 12th, 2010

Aspirin has been the go to anti-inflammatory pill to ease all aches, pains, fevers, and problems. People at risk for stroke and heart attack, including people with diabetes, have been told to take a baby aspirin each day to thin blood just enough to prevent these acute heart problems from occurring. Well, the prevention benefits from aspirin still exist, but doctors are being more careful about recommending this tiny pill.

Below is a statement from the American Heart Association. Bottom Line: Doctors are recommending baby aspirin only  to men aged 50 years or older and women aged 60 and older with significant cardiovascular disease.

———————————————————————————————————————–

American Diabetes Association Statement: “Low–dose aspirin therapy is recommended to prevent a first myocardial infarction (heart attack) or stroke in diabetes patients at high risk of cardiovascular disease, according to a joint statement released by the American Diabetes Association‚ American College of Cardiology‚ and American Heart Association.

The guideline includes men with diabetes aged 50 years or older and women with diabetes aged 60 or older who have additional cardiovascular risk factors and no excess bleeding risk. “Because the relative risk reduction (of heart attack and stroke) appears to be modest‚ the panel felt that we are on strongest ground recommending aspirin for those at increased CVD risk, defined by the age categories and risk factors mentioned or by a calculation of CVD risk‚” said Dr. Michael Pignone‚ chief of the general medicine division and professor of medicine at the University of North Carolina‚ Chapel Hill. “We felt that the benefits were likely to exceed the downsides‚ such as gastrointestinal bleeding‚ for the groups mentioned. There will be some younger people with sufficient risk to warrant aspirin‚ but many who are not at sufficient risk.” The statement is published in the Journal of the American College of Cardiology‚ Diabetes Care‚ and Circulation: Journal of the American Heart Association.”

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In the past, the ADA, along with most doctors, recommended aspirin for heart attack and stroke prevention to people with diabetes over the age of 40. The new research study shows that daily aspirin is beneficial, but mainly for people at a very high risk of heart disease. Even though people with diabetes have three times the risk for heart disease than non-diabetics, the affects of aspirin don’t outweigh the negative results until people with high risk are over the age of 50 (males) and 60 (females).

An increased risk for heart disease in these age groups include: smoking, hypertension, high cholesterol, or family history of cardiovascular disease. And the negative affects from aspirin are internal bleeding in the head, stroke from bleeding, and stomach and intestinal bleeding. So you can see how it makes sense for doctors to determine which risk is higher for each patient.

If you have diabetes, have an increased risk for heart disease, or currently take baby aspirin, talk with your doctor to see if you should start, continue, or discontinue taking aspirin to prevent heart attack and stroke. Aspirin can be just one aspect of your diabetes and heart disease management, but make sure it is right for you.

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