Diabetic Neuropathies

Diabetic Neuropathies

Source: National Diabetes Information Clearinghouse (NDIC)
This fact sheet was reviewed by Peter J. Dyck, M.D., Peripheral Neuropathy Research Center, Mayo Clinic Rochester, Rochester, MN; Eva L. Feldman, M.D., Ph.D., Department of Neurology, University of Michigan, Ann Arbor, MI; and Aaron I. Vinik, M.D., The Diabetes Research Institute, Eastern Virginia Medical School, Norfolk, VA.

On this page:

• Causes

• Symptoms

• Types of Diabetic Neuropathy

• Neuropathy Affects Nerves Throughout the Body

• Peripheral Neuropathy

• Autonomic Neuropathy

• Proximal Neuropathy

• Focal Neuropathy

• Preventing Diabetic Neuropathy

• Diagnosis

• Treatment

• Points to Remember

Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, have damage to nerves throughout the body. Neuropathies lead to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.

An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years.

Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs.

Causes
The causes are probably different for different varieties of diabetic neuropathy. Researchers are studying the effect of glucose on nerves to find out exactly how prolonged exposure to high glucose causes neuropathy. Nerve damage is likely due to a combination of factors:

• metabolic factors, such as high blood glucose, long duration of diabetes, possibly low levels of insulin, and abnormal blood fat levels

• neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to the nerves

• autoimmune factors that cause inflammation in nerves
• mechanical injury to nerves, such as carpal tunnel syndrome
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors such as smoking or alcohol use

Symptoms
Symptoms depend on the type of neuropathy and which nerves are affected. Some people have no symptoms at all. For others, numbness, tingling, or pain in the feet is often the first sign. A person can experience both pain and numbness. Often, symptoms are minor at first, and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor nervous system, as well as the involuntary (autonomic) nervous system. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.

Symptoms may include:

• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in postural blood pressure
• problems with urination
• erectile dysfunction (impotence) or vaginal dryness
• weakness

In addition, the following symptoms are not due to neuropathy but nevertheless often accompany it:

• weight loss
• depression

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Types of Diabetic Neuropathy
Diabetic neuropathies can be classified as peripheral, autonomic, proximal, and focal. Each affects different parts of the body in different ways.

• Peripheral neuropathy causes either pain or loss of feeling in the toes, feet, legs, hands, and arms.
• Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy can also cause hypoglycemia (low blood sugar) unawareness, a condition in which people no longer experience the warning signs of hypoglycemia.
• Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs
• Focal neuropathy results in the sudden weakness of one nerve, or a group of nerves, causing muscle weakness or pain. Any nerve in the body may be affected.

Neuropathy Affects Nerves Throughout the Body
Peripheral Neuropathy

• toes
• feet
• legs
• hands
• arms

Autonomic Neuropathy

• heart and blood vessels
• digestive system
• urinary tract
• sex organs
• sweat glands
• eyes

Proximal Neuropathy

• thighs
• hips
• buttocks

Focal Neuropathy

• eyes
• facial muscles
• ears
• pelvis and lower back
• thighs
• abdomen

Peripheral Neuropathy
Peripheral neuropathy affects the nerves in your arms, hands, legs, and feet.
This type of neuropathy damages nerves in the arms and legs. The feet and legs are likely to be affected before the hands and arms. Many people with diabetes have signs of neuropathy upon examination but have no symptoms at all. Symptoms of peripheral neuropathy may include:

• numbness or insensitivity to pain or temperature
• a tingling, burning, or prickling sensation
• sharp pains or cramps
• extreme sensitivity to touch, even a light touch
• loss of balance and coordination

These symptoms are often worse at night.

Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in gait (walking). Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If foot injuries are not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Some experts estimate that half of all such amputations are preventable if minor problems are caught and treated in time.

Autonomic Neuropathy
Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. It also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning signs of hypoglycemia such as sweating and palpitations.

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Unawareness of Hypoglycemia
Normally, symptoms such as shakiness occur as blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia difficult to recognize.

However, other problems can also cause hypoglycemia unawareness so this does not always indicate nerve damage.

Heart and Circulatory System
The heart and circulatory system are part of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel light-headedor even to faint. Damage to the nerves that control heart rate can mean that it stays high, instead of rising and falling in response to normal body functions and exercise.

Digestive System
Nerve damage to the digestive system most commonly causes constipation. Damage can also cause the stomach to empty too slowly, a condition called gastroparesis. Severe gastroparesis can lead to persistent nausea and vomiting, bloating, and loss of appetite. Gastroparesis can make blood glucose levels fluctuate widely as well, due to abnormal food digestion.

Nerve damage to the esophagus may make swallowing difficult, while nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems with the digestive system may lead to weight loss.

Urinary Tract and Sex Organs
Autonomic neuropathy most often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely, allowing bacteria to grow in the bladder and kidneys and causing urinary tract infections. When the nerves of the bladder are damaged, urinary incontinence may result because a person may not be able to sense when the bladder is full or control the muscles that release urine.

Neuropathy can also gradually decrease sexual response in men and women, although the sex drive is unchanged. A man may be unable to have erections or may reach sexual climax without ejaculating normally. A woman may have difficulty with lubrication, arousal, or orgasm.

Sweat Glands
Autonomic neuropathy can affect the nerves that control sweating. When nerve damage prevents the sweat glands from working properly, the body cannot regulate its temperature properly. Nerve damage can also cause profuse sweating at night or while eating.

Eyes
Finally, autonomic neuropathy can affect the pupils of the eyes, making them less responsive to changes in light. As a result, a person may not be able to see well when the light is turned on in a dark room or may have trouble driving at night.

Proximal Neuropathy
Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain in either the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older people. It causes weakness in the legs, manifested by an inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage.

Focal Neuropathy
Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause

• inability to focus the eye
• double vision
• aching behind one eye
• paralysis on one side of the face (Bell's palsy)
• severe pain in the lower back or pelvis
• pain in the front of a thigh
• pain in the chest, stomach, or flank
• pain on the outside of the shin or inside the foot
• chest or abdominal pain that is sometimes mistaken for heart disease, heart attack, or appendicitis

Focal neuropathy is painful and unpredictable and occurs most often in older people. However, it tends to improve by itself over weeks or months and does not cause long-term damage.

People with diabetes also tend to develop nerve compressions, also called entrapment syndromes. One of the most common is carpal tunnel syndrome, which causes numbness and tingling of the hand and sometimes muscle weakness or pain. Other nerves susceptible to entrapment may cause pain on the outside of the shin or the inside of the foot.

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Preventing Diabetic Neuropathy
The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible. Maintaining safe blood glucose levels protects nerves throughout your body.

For additional information on preventing diabetes complications, including neuropathy, see the Prevent Diabetes Problems series, available from the National Diabetes Information Clearinghouse at 18008608747.

Diagnosis
Neuropathy is diagnosed on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch.

The doctor may also do other tests to help determine the type and extent of nerve damage.

A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine office visit. To assess protective sensation or feeling in the foot, a nylon monofilament (similar to a bristle on a hairbrush) attached to a wand is used to touch the foot. Those who cannot sense pressure from the monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly. Other tests include checking reflexes and assessing vibration perception, which is more sensitive than touch pressure.

Nerve conduction studies check the transmission of electrical current through a nerve. With this test, an image of the nerve conducting an electrical signal is projected onto a screen. Nerve impulses that seem slower or weaker than usual indicate possible damage. This test allows the doctor to assess the condition of all the nerves in the arms and legs.Electromyography (EMG) shows how well muscles respond to electrical signals transmitted by nearby nerves. The electrical activity of the muscle is displayed on a screen. A response that is slower or weaker than usual suggests damage to the nerve or muscle. This test is often done at the same time as nerve conduction studies.

Quantitative sensory testing (QST) uses the response to stimuli, such as pressure, vibration, and temperature, to check for neuropathy. QST is increasingly used to recognize sensation loss and excessive irritability of nerves.

A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture.

Ultrasound uses sound waves to produce an image of internal organs. An ultrasound of the bladder and other parts of the urinary tract, for example, can show how these organs preserve a normal structure and whether the bladder empties completely after urination.

Nerve or skin biopsy involves removing a sample of nerve or skin tissue for examination by microscope. This test is most often used in research settings.
Treatment
The first step is to bring blood glucose levels within the normal range to prevent further nerve damage. Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels. Although symptoms may get worse when blood glucose is first brought under control, over time, maintaining lower blood glucose levels helps lessen neuropathic symptoms. Importantly, good blood glucose control may also help prevent or delay the onset of further problems.

Additional treatment depends on the type of nerve problem and symptom, as described in the following sections.
Foot Care
People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.

More than half of all lower limb amputations in the United States occur in people with diabetes86,000 amputations per year. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care. Here are the steps to follow:

• Clean your feet daily, using warm-not-hot water and a mild soap. Avoid soaking your feet. Dry them with a soft towel; dry carefully between your toes.
• Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror (laying a mirror on the floor works well) or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
• Moisturize your feet with lotion, but avoid getting it between your toes. After a bath or shower, file corns and calluses gently with a pumice stone.
• Each week or when needed, cut your toenails to the shape of your toes and file the edges with an emery board.
• Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.
• Wear shoes that fit well and allow your toes to move. Break in new shoes gradually by wearing them for only an hour at a time at first.
• Before putting your shoes on, look them over carefully and feel the insides with your hand to make sure they have no tears, sharp edges, or objects in them that might injure your feet.
• If you need help taking care of your feet, make an appointment to see a foot doctor, also called a podiatrist.

For additional information on foot care, contact the National Diabetes Information Clearinghouse at 1-600-860-8747. Materials are also available at ndep.nih.gov/resources/health.htm.

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Pain Relief
To relieve pain, burning, tingling, or numbness, the doctor may suggest aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. (People with renal disease should use NSAIDs only under a doctor's supervision.) A topical cream called capsaicin is another option. Tricyclic antidepressant medications such as amitriptyline, imipramine, and nortriptyline, or anticonvulsant medications such as carbamazepine or gabapentin may relieve pain in some people. Codeine may be prescribed for a short time to relieve severe pain. Also, mexiletine, used to regulate heartbeat, has been effective in treating pain in several clinical trials.

Other pain treatments include transcutaneous electronic nerve stimulation (TENS), which uses small amounts of electricity to block pain signals, as well as hypnosis, relaxation training, biofeedback, and acupuncture. Walking regularly or using elastic stockings may also help leg pain.

Gastrointestinal Problems
To relieve mild symptoms of gastroparesisindigestion, belching, nausea, or vomitingdoctors suggest eating small, frequent meals, avoiding fats, and eating less fiber. When symptoms are severe, the doctor may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea, or other drugs to help regulate digestion or reduce stomach acid secretion.

To relieve diarrhea or other bowel problems, the doctor may prescribe an antibiotic such as tetracycline, or other medications as appropriate.

Dizziness and Weakness
Sitting or standing slowly may help prevent the light-headedness, dizziness, or fainting associated with blood pressure and circulation problems. Raising the head of the bed or wearing elastic stockings may also help. Some people may benefit from increased salt in the diet and treatment with salt-retaining hormones. Others may benefit from high blood pressure medications. Physical therapy can help when muscle weakness or loss of coordination is a problem.

Urinary and Sexual Problems
To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervals (every 3 hours, for example) since they may not be able to tell when their bladder is full.

To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy, including taking oral drugs, using a mechanical vacuum device, or injecting a drug called a vasodilator into the penis before sex. The vacuum and vasodilator raise blood flow to the penis, making it easier to have and maintain an erection. Another option is to surgically implant an inflatable or semirigid device in the penis. A constriction ring or penile sling may be helpful.

Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer the woman to a gynecologist.

Points to Remember

• Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
• Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, and sex organs.
• Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
• Foot care is another important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk if infected foot sores and amputation.
• Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage.
• Smoking significantly increases the risk of foot problems and amputation. If you smoke, ask your health care provider for help in quitting.

Hitting A Nerve

 

Hitting A Nerve

Author: Avery Hurt
Except from: Diabetic Living, Summer 2007

Think of cells as tiny power plants and glucose as the fuel that runs them. When the cells get too much fuel, they release waste that causes nerve damage or neuropathy.

Neuropathy is one of the best arguments to fight blood glucose control. It's a nerve disorder that can affect almost every system in your body. It results from bursts of high blood glucose that cause oxidative stress to the nerves.

"The mitochondrion is the power plant of the cell," says Eva L. Feldman, M.D., Ph.D., professor of neurology and director of the Neuropathy Center at the University of Michigan Health System in Ann Arbor. "Glucose is the fuel for this power station. When the power plant gets too much fuel, it exudes waste products, causing oxidative damage - much like a city's power plant causing damage by releasing waste products into rivers and streams."

From Your Toes to Your Heart

The nerve damage caused by these oxidative waste products is either peripheral or autonomic. Peripheral neuropathy can affect the toes, feet, legs, hands, and arms. Symptoms include tingling, burning, and/or numbness.

Autonomic neuropathy can affect the nerves that control blood pressure and blood glucose levels, as well as internal organs such as the heart, stomach, and bladder. Autonomic neuropathy produces a wide range of symptoms that are often mistaken for other ailments. Digestive troubles, difficulty regulating blood pressure, problems with balance, weakness, lack of bladder control, and impotence can all be signs of neuropathy.

Perhaps the most troubling fact is neuropathy in its early stages often causes no symptoms at all.

Jim Edwards, 29, of Tpsilanti, Michigan has had diabetes for 20 years. He discovered he had neuropathy of the heart during a health examination prior to joining a clinical trial. "Often you don't notice that you have peripheral neuropathy." Jim Says. "You wouldn't notice a failure to detect heat or cold, for example."

Key to Prevention

The National Institutes of Health estimates that 50 percent of people with diabetes have some type of neuropathy, even though it can be prevented. "The Diabetes Control and Complications Trial (a large, long-term, NIH-funded study) demonstrated that we can reduce autonomic damage by up to 60 percent with tight glucose control," says Aaron Vinik, M.D., Ph.D., director of the Strelitz Diabetes Research Institute at Eastern Virginia Medical School in Norfolk. "Glycemic control is crucial to preventing and limiting the damage of neuropahty."

Take Care

Neuropathy of all kinds can be subtle, so you need to take precautions. If you've lost feeling in your feet, you may not notice when you injure yourself. "Often when I examine a patient, I discover an ulcer on the bottom of the foot that the patient didn't even know was there." Feldman says, "When you visit your doctor, take off your shoes and let the doctor have a look," she says.

Make sure your doctor checks with a monofilament, a small tool that's like a straw from a broom. A recent study of more than 7,000 patients with type 2 diabetes found that doctors who don't check their patients' feet with a monofilament miss more than half of all neuropathy cases.

"One substance still under study that may prove to help is an antioxidant called alpha-lipoic acid." Vinik says. In fact, he says, antioxidants show a lot of promise for an eventual treatment to counter the oxidative damage that contributes to neuropathy. For people with diabetes who have nerve damage or are at risk, that's very promising news.

Hitting A Nerve

Diabetes and Neuropathy

 

Diabetes and Neuropathy

Source: Diabetes Insight, May, 2002

Nervous System Impairment (Neuropathy)

Diabetic Neuropathy can affect virtually every part of the body. Diabetic nerve damage eventually affects some 65 percent of people with diabetes.

As with other diabetes complications, poor blood glucose control lies at the root of neuropathy. As average glucose level increases, so does risk of neuropathy. However, scientists still are not sure why high blood glucose levels should interfere with the nervous system. Oddly, neuropathy does not affect the brain or spinal nerves. But it can damage the rest of the nervous system. Symptoms may include: a loss of bowel or bladder control, problems with digestion, muscle weakness, sex problems, pain or a pins-and-needles feeling in the hands or feet, or a loss of pain sensation in the extremities, which may contribute to such problems as foot ulcers.

The symptoms of neuropathy also depend on which nerves and what part of the body is affected. Neuropathy may be diffuse, affecting many parts of the body, or focal, affecting a single, specific nerve and part of the body.

The two categories of diffuse neuropathy are peripheral neuropathy affecting the feet and hands and autonomic neuropathy affecting the internal organs.

Peripheral Neuropathy
The most common type of peripheral neuropathy damages the nerves of the limbs, especially the feet. Nerves on both sides of the body are affected.

When the peripheral nerves become damaged, the result is problems in the arms and/or legs. Foot and ankle complications account for most of the hospitalizations due to neuropathy. An estimated 50 percent of diabetics eventually develop some degree of peripheral neuropathy. In addition to poor glycemic control, other risk factors include: being male, being tall, and having had diabetes for many years.

Common symptoms of this kind of neuropathy are:

• Numbness or insensitivity to pain or temperature
• Tingling, burning, or prickling
• Sharp pains or cramps
• Extreme sensitivity to touch, even light touch
• Loss of balance and co-ordination

These symptoms are often worse at night and can affect:

• Legs
• Feet
• Arms
• Hands

The damage to nerves often results in loss of reflexes and muscle weakness. The foot often becomes wider and shorter, the gait changes, and foot ulcers appear as pressure is put on parts of the foot that are less protected. Because of the loss of sensation, injuries may go unnoticed and often become infected. If ulcers or foot injuries are not treated in time, the infection may spread into the bone and because this is almost impossible to treat, the foot, or lower leg, may require amputation. However, problems caused by minor injuries can usually be controlled if they are caught in time.

Avoiding foot injury by wearing well-fitted shoes and examining the feet daily can help prevent amputations.

Autonomic Neuropathy
Autonomic neuropathy is another form of diffuse neuropathy. It affects the nerves that serve the heart and internal organs and produces changes in many processes and systems. The autonomic nervous system controls unconscious body functions, for example, digestion. Autonomic neuropathy eventually affects about 30 percent of diabetics, usually by slowing these functions down. It may affect:

• Heart
• Digestive System
• Sexual organs
• Urinary tract
• Sweat gland

The best way to prevent neuropathy is to practice tight blood glucose control. In the Diabetes Control and Complications Trial (DCCT), a 10-year study sponsored by the National Institute of Health, some of the more than 1,000 participants practiced conventional blood glucose control, while others practiced tight control. Compared with the conventional group, those who practiced tight control reduced their risk of developing neuropathy by 69 percent.

Tight control also helps prevent worsening of neuropathy in those who already have it. In the DCCT, intensive glucose control decreased progression of neuropathy by 57 percent. Other researchers report that strict control also reduces pain and improves nerve conduction.

Urination & Sexual Response

Autonomic neuropathy most often affects the organs that control urination and sexual function. Nerve damage can prevent the bladder from emptying completely, so bacteria grow more easily in the urinary tract (the outlet from the bladder).

When the nerves of the bladder are damaged, a person may have difficulty knowing when the bladder is full or controlling it, resulting in urinary incontinence.

The nerve damage and circulatory problems of diabetes can also lead to a gradual loss of sexual response in both men and women, although sex drive is unchanged. A man may be unable to have erections or may reach sexual climax without ejaculating normally.

Digestion

Autonomic neuropathy can affect digestion. Nerve damage can cause the stomach to empty too slowly, a disorder called gastric stasis. When the condition is severe (gastroparesis), a person can have persistent nausea and vomiting, bloating, and loss of appetite. Blood glucose levels tend to fluctuate greatly with this condition.

If nerves in the esophagus are involved, swallowing may be difficult. Nerve damage to the bowels can cause constipation or frequent diarrhea, especially at night. Problems with the digestive system often lead to weight loss.

Cardiovascular System

Autonomic neuropathy can affect the cardiovascular system, which controls the circulation of blood throughout the body. Damage to this system interferes with the nerve impulses from various parts of the body that signal the need to regulate blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel dizzy or light-headed, or even to faint (orthostatic hypotension).

Neuropathy that affects the cardiovascular system may also affect the perception of pain from heart disease. People may not experience angina as a warning sign of heart disease or may suffer painless heart attacks. It may also raise the risk of a heart attack during general anesthesia.

Hypoglycemia

Autonomic neuropathy can hinder the body's normal response to low blood sugar or hypoglycemia, which makes it difficult to recognize the warning signs and therefore treat an insulin reaction.

Sweating

Autonomic neuropathy can affect the nerves that control sweating. Sometimes, nerve damage interferes with the activity of the sweat glands, making it difficult for the body to regulate its temperature. Other times, the result can be profuse sweating at night or while eating (gustatory sweating).

Focal Neuropathy (including Multiplex Neuropathy)

Occasionally, diabetic neuropathy appears suddenly and affects specific nerves, most often in the torso, leg, or head. Focal neuropathy may cause:

• Pain in the front of a thigh
• Severe pain in the lower back or pelvis
• Pain in the chest, stomach, or flank
• Chest or abdominal pain sometimes mistaken for angina, heart attack, or appendicitis
• Aching behind an eye
• Inability to focus the eye
• Double vision
• Paralysis on one side of the face (Bell's palsy)
• Problems with hearing

This kind of neuropathy is unpredictable and occurs most often in older people who have mild diabetes. Although focal neuropathy can be painful, it tends to improve by itself after a period of weeks or months without causing long-term damage.

Carpal Tunnel Syndrome

People with diabetes are also prone to developing compression neuropathies. The most common form of compression neuropathy is carpal tunnel syndrome. Asymptomatic carpal tunnel syndrome occurs in 20 to 30 percent of people with diabetes, and symptomatic carpal tunnel syndrome occurs in 6 to 11 percent.

This condition is caused by nerve damage in the wrist, and causes weakness, tingling, numbness in the hands. Muscle weakness may also occur. It eventually develops in about one-third of diabetics, particularly women and those who are obese.

Numbness and tingling of the hand are the most common symptoms. Muscle weakness may also develop.

Diabetes and Neuropathy

Diabetic Neuropathy - Nerve Pain and Numbness

 

Diabetic Neuropathy - Nerve Pain and Numbness

Author: Milton Hammerly, M.D.
Source: The New Integrative Approach to Diabetes

An estimated 60 percent of all people with diabetes have some form of diabetic neuropathy, the nerve damage caused by long-term effects of diabetes. Symptoms can include numbness, tingling, prickling, and sometimes pain (burning, cramping, or extreme sensitivity to touch). These symptoms usually start in the feet or legs, but sometimes also affect the hands or other body parts. Only about half of affected individuals will be aware of symptoms due to decreased sensitivity of the affected nerves. On the other hand, sometimes neuropathy may cause both pain and insensitivity to pain in the same individual.

Scientists are not entirely sure what causes the nerve damage, but there are probably several contributing factors. These may include impaired oxygen supply to the nerves due to damage to the small blood vessels, as well as chemical changes that impair the ability of the nerves to transmit signals. Researchers are focusing on whether glucose inhibits the nitric oxide supply (nitric oxide dilates blood vessels), which would, in turn, limit the supply of blood to the nerves. Nerve damage may occur when glucose attaches to and alters the structure of proteins, which affects vascular (blood vessel) function.

Diabetic Neuropathy - Nerve Pain and Numbness

All The Nerve

 

All The Nerve

Author: John McIntosh
Source: Healthy Living, October-December 2005

The Surprising Link Between Diabetes And Nerve Damage

One of the most common long-term repercussions of high blood glucose levels is diabetic neuropathy, or nerve damage. According to the National Institutes of Health (NIH), about two-thirds of those with diabetes have some form of this complication.

The Symptoms

Neuropathy may not produce any obvious symptoms in its beginning stages, but eventually most people find that they experience numbness, tingling or pain in their feet. Other symptoms include:

• Numbness in the legs, hands, arms and fingers, and a weakening of the muscles of the feet or hands

• Indigestion, nausea or vomiting and/or diarrhea or constipation

• Dizziness or faintness due to a drop in blood pressure

• Sexual dysfunction and/or problems urinating

These symptoms arise when high blood sugar causes damage to nerve converings and to blood vessels that bring essential oxygen to the nerves. The damage may make nerves send messages too slowly or at the wrong times, or it may prevent them from transmitting anything. As neuropathy becomes more severe, it may cause chronic pain, loss of motion and injuries that can lead to amputation.

Though the challenges of nerve damage may seem daunting, progress is being made every day.

The Diabetes Control and Complications Trial, a major NIH study, found that people who kept their blood glucose levels close to normal could lower their risk of nerve damage by as much as 60 percent.

5 Ways To Help

1. Keep blood sugar levels as close to normal as possible.
2. Limit alcohol intake.
3. Take good care of your feet and have your doctor check them regularly.
4. Tell your doctor about problems you have with your feet, legs, stomach, bowels or bladder.
5. Tell your doctor if you are experiencing sexual dysfunction, cannot tell when your blood sugar is to low or feel dizzy when going from lying down to sitting or standing up.

"Though we can't always prevent neuropathy, we can reduce the risk", says Strelitz Diabetes Institutes' Dr. Vinik. "People with diabetes and their doctors need to work together to use the most effective ways to control blood sugar

All The Nerve

Diabetic Recipes - Salads

 

Diabetic Recipes - Salads

Source: The Diabetes Snack, Munch, Nibble, Nosh 2nd Edition Book, American Diabetes Association
Author: Ruth Glick

Bean, Corn, and Rice Salad

Ingredients:

3/4 c mild low-sodium or regular salsa
1 tbsp olive oil
1/2 tsp dried oregano leaves
1/4 tsp salt, or to taste (optional)
1 15 oz. can low sodium or regular kidney beans, rinsed and well drained
1 c frozen corn kernels, cooked according to package directions
1 c cooked brown rice
1 large celery stalks, diced

Directions:

In a medium bowl, combine the salsa, oil, oregano, and salt (if desired). Stir to mix well. Stir in the kidney beans, corn, rice, and celery. Mix well. Serve at once or cover and refrigerate. Leftover salad will keep in the refrigerator 3 to 4 days.

Makes 9 Servings.

Dietary Exchanges: 1 Starch, 1/2 Mono-unsaturated Fat

Nutrients Per Serving:
104 Calories
2 g Total Fat
0 g Saturated Fat
18 Calories from Fat
18 g Carbohydrate
4 g Dietary Fiber
3 g Sugars
4 g Protein
0 mg Cholesterol
64 mg Sodium

****************************************

Marinated Potato Salad

Ingredients:

5 medium (about 1 1/2 lb) red-skinned potatoes, cut into 1/2-inch cubes
3 tbsp fat-free, low-sodium or regular chicken broth
2 tbsp olive oil
1 1/2 tbsp plus 1 tsp balsamic vinegar
1 large celery stalk, thinly sliced
3 tbsp chopped red onion or other sweet onion
1 1/2 tsp Dijon-style mustard
3/4 tsp basil
3/4 tsp dried thyme leaves
1/4 tsp salt, or to taste (optional)
2-3 drops hot pepper sauce

Directions:

Combine the potatoes and enough water to cover in a large saucepan. Cover the pot and bring to a boil over high heat. Reduce the heat and simmer 6 to 11 minutes, until the potatoes are tender but not soft when pierced with a fork. Cool under cold running water. Drain well in a colander. While the potatoes are cooking, in a large bowl or serving dish, combine the broth, oil, and vinegar. Stir to mix. Add the celery, onion, mustard, basil, thyme, salt (if desired), and hot pepper sauce. Stir to mix well. To assemble the salad, add the potatoes, carefully stirring with a large spoon to coat them with the dressing mixture. Be careful not to break up the potatoes. Cover and refrigerate several hours, stirring occasionally, to allow flavors to blend. Leftover salad will keep for 3 to 4 days in the refrigerator.

Makes 10 Servings.

Dietary Exchanges: 1 Starch

Nutrients Per Serving:
81 Calories
3 g Total Fat
1 g Saturated Fat
25 Calories from Fat
13 g Carbohydrate
2 g Dietary Fiber
2 g Sugars
2 g Protein
0 mg Cholesterol
31 mg Sodium

****************************************

Curried Turkey Salad

Ingredients:

1/2 c juice-packed crushed pineapple, well drained
1/4 c fat-free sour cream
2 tbsp reduced-fat mayonnaise
1 tsp mild curry powder
1/4 tsp salt, or to taste (optional)
1 c (5 oz) cubed turkey breast meat
1 8-oz can sliced water chestnuts, well drained
1 small celery stalk, chopped
2 tbsp chopped chives or sliced green onion tops

Directions:

In a medium bowl, stir together the pineapple, sour cream, mayonnaise, curry powder, and salt (if desired). Stir in the turkey, water chestnuts, celery and chives. Serve at once or cover and refrigerate several hours or up to 24 hours. Leftover salad will keep in the refrigerator for 2 to 3 days.

Makes 5 Servings.

Dietary Exchanges: 1/2 Fruit, 1 Vegetable, 1 Very Lean Meat

Nutrients Per Serving:
97 Calories
2 g Total Fat
0 g Saturated Fat
19 Calories from Fat
10 g Carbohydrate
1 g Dietary Fiber
6 g Sugar
10 g Protein
25 mg Cholesterol
89 mg Sodium

****************************************

Pasta, Bean and Salmon Salad

Ingredients:

3 tbsp catsup
2 tbsp cider vinegar
1 tbsp olive oil
1 garlic clove, minced
1 tsp Italian seasoning
1/8 tsp salt, or to taste (optional)
1 c uncooked penne or similarly shaped pasta
1 14.5 oz can low-sodium cut green beans, well drained
2 tbsp chopped red onion or other sweet onion
1 6-oz can boneless, skinless pink salmon, well drained

Directions:

In a large serving bowl, combine the catsup and vinegar. Stir to mix well. Stir in the oil, garlic, Italian seasoning, and salt (if desired). Set aside. Cook the pasta according to the package directions. Transfer to a colander and rinse under cold running water. Drain. Meanwhile, add the green beans and onion to the bowl with the dressing. Stir to mix well. Stir in the pasta and salmon. Serve immediately, or cover and refrigerate 1 hour or up to 36 hours before serving. Stir before serving. Leftover salad will keep in the refrigerator 3 to 4 days.

Makes 8 Servings.

Dietary Exchanges: 1/2 Starch, 1 Lean Meat

Nutrients Per Serving:
100 Calories
3 g Total Fat
0 g Saturated Fat
28 Calories from Fat
12 g Carbohydrate
1 g Dietary Fiber
2 g Sugar
6 g Protein
12 mg Cholesterol
190 mg Sodium

Diabetic Recipes - Salads

Diabetic Recipes - Holiday Main Dish

 

Diabetic Recipes - Holiday Main Dish

Southwestern Turkey Shepherd's Pie

Source: Diabetic Cooking, January/February 2004

Ingredients:

Nonstick vegetable cooking spray
1 lb ground turkey
1 1/2 c chunky fat-free salsa, medium or spicy, well drained
1/2 tsp ready to use crushed garlic
4 servings instant mashed potatoes prepared according to package directions (see note) 1/4 tsp chili seasoning powder (optional)
Additional salsa, optional garnish

Directions:

Preheat oven to 400°F.  Lightly coat 9 1/2-inch round glass baking dish with cooking spray. Place turkey in dish. Add salsa and mix thoroughly with turkey. Add garlic to prepared potatoes and mix well. Spoon potatoes onto turkey-salsa mixture in 6 mounds. Spread potatoes to cover surface completely. Score potatoes in a crosshatch  pattern using tines of a fork. Spray top lightly with cooking spray. Bake for 30 minutes. Remove from oven and let rest for 5 minutes. To serve, sprinkle casserole with chili seasoning powder. Cut into 6 wedges. Garnish with additional salsa.

Makes 6 (1-cup) Servings.

Serving Suggestion: Serve with a leafy green salad and reduced-fat or fat-free salad dressing or steamed vegetables such as broccoli and cauliflower.

Note: Substitute 1 tablespoon olive oil for the butter or margarine specified on the box, and substitute skim milk or unsweetened soymilk for the milk specified. Be sure to read the nutritional label and choose instant potatoes without added fat, especially hydrogenated fats.

Dietary Exchanges: 1 Starch, 2 Meat, 1 Fat

Nutrients Per Serving:
225 Calories
39 Calories from Fat
10g Total Fat
2 g Saturated Fat
17 g Carbohydrate
17 g Protein
60 mg Cholesterol
642 mg Sodium 
2 g Fiber

*************************************************

Chicken Pot Pie

Source: Diabetic Cooking, January/February 2004

Ingredients:

2 tsp olive oil
1/2 c plus 2 tablespoons fat-free reduced-sodium chicken broth, divided
2 c sliced mushrooms
1 c diced red bell pepper
1/2 c chopped onion
1/2 c chopped celery
2 tbsp all-purpose flour
1/2 c fat-free half-and-half
2 c cubed cooked chicken tenders
1 tsp minced, fresh dill
1/2 tsp salt
1/4 tsp black pepper
2 reduced-fat refrigerated crescent rolls

Directions:

Heat oil and 2 tablespoons chicken broth in medium saucepan. Add mushrooms, bell pepper, onion and celery. Cook 5 to 7 minutes or until vegetables are tender, stirring frequently. Stir in flour; cook 1 minute. Stir in remaining 1/2 cup chicken broth; cook and stir until liquid thickens. Reduce heat and stir in half-and-half. Add cooked chicken, dill, salt and pepper. Preheat oven to 375°F. Spoon mixture into greased 1-quart casserole. Roll out crescent rolls and place on top of chicken mixture. Bake pot pie 15 to 20 minutes or until topping is golden and filling is bubbly. Serve with leafy green salad, if desired.

Makes 4 (1-cup) Servings.

Note: To make 2 cups cubed cooked chicken, simmer 1 pound chicken tenders in 2 cups fat-free reduced-sodium chicken broth about 15 minutes or until meat is no longer pink in center. Cool and cut into cubes.

Dietary Exchanges: 1 Starch, 3 Lean Meat, 2 Vegetable

Nutrients Per Serving:
286 Calories
27% Calories from Fat
8 g Total Fat
2 g Saturated Fat
25 g Carbohydrate
26 g Protein
54 mg Cholesterol
740 mg Sodium
2 g Fiber

*************************************************

Goulash Casserole

Ingredients:

vegetable cooking spray
1 lb ground beef eye of round
2 medium onions, chopped
1 green bell pepper, chopped
1 red bell pepper, chopped
2 cloves garlic, minced
1 tbsp flour
2 tsp paprika
1 tsp crushed caraway seeds
1/2 - 3/4 cup water
1 can (14 ounces) sauerkraut, rinsed, drained
1 large tomato, coarsely chopped
1 c fat-free sour cream
Salt and pepper, to taste
Minced parsley, as garnish

Directions:

Spray large skillet with cooking spray; heat over medium heat until hot. Add ground beef and cook until browned; add onions, bell peppers, and garlic and cook until tender, 8 to 10 minutes. Stir in flour, paprika, and caraway seeds; cook 1 to 2 minutes longer. Stir in water, sauerkraut, tomato, and sour cream; season to taste with salt and pepper. Spoon mixture into 11x7-inch baking dish or 2-quart casserole. Bake, covered, at 350 degrees until hot through, 20 to 30 minutes. Sprinkle with parsley before serving.

Makes 6 (1/3 Cup) Servings.

Dietary Exchanges: 2 Meat, 3 Vegetable

Nutrients Per Serving:
174 Calories
2.8 g Fat
18.1 g Carbohydrate
17.6 g Protein
36.6 mg Cholesterol
530 mg Sodium

*************************************************

Brunswick Stew

Ingredients:

1 3½-lb frying chicken or 2 boneless skinless breasts and 2 hindquarters
1 tspnon-aromatic olive oil, divided
1 large sweet onion, cut in 1" dice (generous 2 cups)
3 ribs celery cut in ¼" slices (1 ½ cups)
3 oz Canadian bacon cut the same size as the celery
1 red bell pepper cut the same
2 c canned, crushed tomatoes
1 c low sodium chicken stock
1 tsp Worcestershire sauce
¼ tsp cayenne pepper
1 c frozen corn kernels
1 c frozen baby lima beans
1 tbsp arrowroot mixed with 2 tablespoons stock or water (slurry)
¼ c chopped fresh parsley
¼ c chopped fresh basil

Directions:

If you are using a whole chicken, cut off the legs with the thighs and the breasts. Use the carcass and wings for stock. Remove the skin from all the pieces. Separate the legs from the thighs and bone the thigh, leaving the bone in the leg. Remove the skin and bone from the breast pieces. Bones, fat and skin will all help to make a flavorful stock. Cut the meat into 1½ " chunks. Heat ½ teaspoon of the oil in a 10½ " chef's pan on medium high. Sauté the onion 3 minutes or until it starts to turn translucent. Add the celery, Canadian bacon, and red bell pepper and cook 3 more minutes. Remove to a plate and without washing the pan, add the remaining ½ teaspoon oil and heat. When the pan is nice and hot, toss in the thigh meat and legs to brown 2 minutes. Add the breast meat and brown 1 to 2 minutes more. Pour in the tomatoes, stock, and Worcestershire sauce. Add the cooked vegetables and cayenne. Bring to a boil, reduce the heat, cover and simmer 35 minutes or until the chicken is tender. Add the lima beans and corn and cook 12 minutes more or until the beans are tender. Stir in the slurry and heat to thicken. Add the parsley and basil and you are ready to serve.

Makes 6 Servings.

Nutrients Per Serving:
260 calories
6 g Fat
2 g Saturated Fat
7% Calories From Saturated Fat
21 g Carbohydrate
3 g Fiber
362 mg Sodium

*************************************************

Beef Stroganoff

Ingredients:
1 lb steak, sirloin or tenderloin 
2 tbsp flour, all purpose 
2 oz sour cream 
2 oz cottage cheese, creamed 
1/2 c water 
2 tbsp margarine 
2 tsp beef bouillon granules 
1 1/2 c mushrooms, fresh sliced 
1/4 tsp salt 
1 tsp garlic, minced 
1/4 tsp black pepper 
1/2 c hot noodles or rice 

Directions:

Partly freeze beef. Thinly slice across grain into bite-size strips. Combine flour, pureed cottage cheese and 5 ounces of water. Stir in bouillon, sour cream, 1/2 cup water, salt and pepper. Set aside. In a large skillet, stir half of meat in margarine on high heat until done. Remove. Add rest of meat, mushrooms, onions and garlic. Cook and stir till meat is done and onions are tender. Return all meat to skillet. Add sour cream-cottage cheese mixture. Cook and stir over medium heat until bubbly. Cook on reduced heat with stirring for 5 minutes more. Serve over rice or noodles.

Dietary Exchanges: 1 1/2 servings Meat and 1/2 of a Mixed Serving of Dairy and Vegetable. (A half cup of rice would add a third serving, this one of grain.)

*************************************************

Mexican Lasagna

Ingredients:

1 lb boneless, skinless chicken breasts, cut into strips
1 large onion, halved and cut into thin wedges
1 large clove garlic, minced
2 c (16 oz) fat-free ricotta cheese
1 c (8 oz) reduced-fat sour cream
1 jar (4 oz) chopped green chiles
1/2 c chopped fresh cilantro (optional)
2 tsp ground cumin
1/8 tsp salt
6 plum tomatoes, chopped
8 corn tortillas (6" diameter), cut in half
1 1/4 c (5 oz) shredded low-fat Monterey Jack cheese

Directions:

Preheat the oven to 350 degrees. Coat a 13" x 9" baking dish with cooking spray. Coat a large nonstick skillet with cooking spray. Add the chicken.  Cook over medium heat, turning several times, for 5 minutes, or until no longer pink. Transfer to a medium bowl. Wipe the skillet with a paper towel and coat with cooking spray. Add the onion and garlic. Cover and cook over medium heat, stirring occasionally, for 7 to 8 minutes, or until lightly browned. Add to the chicken in the bowl. In another medium bowl, combine the ricotta, sour cream, chiles, cilantro (if using), cumin and salt. Spread 1 cup of the tomatoes in the prepared baking dish. Arrange half of the tortillas evenly on top. Spread half of the ricotta mixture over the tortillas. Top with half of the chicken mixture. Top with 1 cup of the remaining tomatoes and 1/2 cup of the cheese. Repeat with the remaining tortillas, ricotta mixture and chicken mixture. Sprinkle with the remaining 1 cup tomatoes and 1/4 cup cheese. Bake for 30 minutes, or until heated through. Loosely cover with foil if the cheese browns too quickly.

Makes 8 Servings.

Dietary Exchanges: 1 Carb (1 Bread/Starch), 3 Meat

Nutrients Per Serving:
259 Calories
28 g Protein
23 g Carbohydrates
2 g Dietary Fiber
5 g Total Fat
3 g Saturated Fat
62 mg Cholesterol
333 mg Sodium

Diabetic Recipes - Holiday Main Dish

The Diabetic Diet

 

The Diabetic Diet

Source: The American Diabetes Association and the American Dietetic Association.

Diet is a vital component in your overall diabetes control program. Your diabetes educator, dietitian, and doctor will develop a personal meal plan to help you attain appropriate blood sugar (glucose) and blood fat (cholesterol and triglyceride) levels.

If you have non-insulin dependent diabetes, sticking to your meal plan helps you achieve and maintain your correct weight, and balances the foods you eat with the insulin your body produces.

If you have insulin dependent diabetes, you must stick to your meal plan to insure a balance between injected insulin and the foods you eat.

Your diabetic diet is a well-balanced meal plan tailored to your individual needs, tastes, activity level and life style. Meal times and types and amounts of foods are planned and adjusted just for you. You may need to learn more about foods, and you may have to make some changes in your eating habits. The better you understand your diet, the more flexibility you can enjoy.

Your dietitian is there to get you started on your way to good nutrition and better health. He or she can help you tailor favorite recipes to fit your prescribed meal plan. Your dietary needs are not like anyone else's. That's why your dietitian's help is so important. Once you understand your dietary needs, you'll be able to design your own menus and make safe judgments about your diet.

Attention Vegetarians!

Ask your dietitian about vegetarian options, and check your book store for Vegetarian Cooking for Diabetics by Patricia Mozzar (published by The Book Publishing Company).

Basic Nutrition for People with Diabetes

Although foods contain many nutrients, it is easiest to categorize them in three groups: carbohydrates, proteins, and fats.

• Carbohydrate foods include bread, potatoes, rice, crackers, cookies, sugar, fruit, vegetables, and pasta. When digested, carbohydrates provide fuel for energy. 
• Protein foods include meat, poultry, fish, eggs, cheese, dried beans, and legumes. When digested, protein is used to build and repair your body. Some protein may also be used as fuel for energy. 
• Fat foods include butter, margarine, cooking oil, cream, bacon, and nuts. When digested, fats are stored as fat cells or later used as fuel for energy.
  Your meal plan will include carbohydrates, proteins and fats in amounts that will promote good diabetes control while providing adequate fuel for energy and building and repairing your body.

Calories

A calorie is a unit of heat used to express the energy-producing content of foods. Your dietitian will determine how many calories you need every day, and how they should be divided among types of food, by considering your height, weight, age, activity level, growth needs, metabolism, and general life style. For example, an active young person of normal weight needs more calories than an inactive older person or an overweight person.

Remember, if you eat more calories than you need to produce energy, the excess calories are stored as body fat.

Obesity

If you are overweight, losing weight is your primary goal. You can lose weight by eating fewer calories than your body needs for your usual activity level and by increasing your exercise.

A pound of fat is equal to 3,500 calories. To lose a pound in a week, you'd have to cut your calorie intake by 500 calories a day (500 calories x 7 days = 3,500 calories, or one pound). If that sounds like a lot of dieting for very little weight loss, remember a pound a week is 52 pounds a year. But you have to stick with it.

To achieve your ideal weight you have to develop good eating habits, and to maintain that weight you must continue those habits.

Be realistic. Making a big change in your life takes time. It might help to keep a record of your weight each week, so you know when you're making progress, and when you're not. And don't worry about occasional relapses. Don't be harsh with yourself if you overeat once or twice, or regain a pound or two you thought you'd lost forever. But do try to identify the causes of your relapses, so that you can avoid them in the future.

Guidelines for Healthier Eating

There are some very simple things you can do every day to make sticking to your diet easier:

• Plan your meals so that you eat healthy food, not just whatever is easiest 
• Think before you eat instead of raiding the refrigerator every time you feel hungry. 
• Use a smaller plate, so that you can't heap on much more than you really want or need. 
• Chew slowly and completely, savoring every mouthful, instead of packing in as much as you can as quickly as you can.

The following guidelines are a little more complicated, but well worth the effort:

EAT LESS FAT

Cut down on meat. Eat more fish and poultry instead. When you do eat red meat, choose the leanest cuts.
Roast, bake, or broil instead of frying. Trim the fat off meat and the skin off poultry, and avoid adding fat in cooking. Beware of sauces and gravies. They often contain lots of fat.
Eliminate or cut down on high-fat foods like cold cuts, bacon, sausage, hot dogs, butter, margarine, nuts, salad dressings, lard, and shortening.
Eat less ice cream, cheese, sour cream, cream, and other high-fat dairy products. Check for low-fat versions; they're increasingly available in grocery stores. And drink skim or
low-fat milk instead of whole milk.

Know Your Fats

• Cholesterol is a fatty substance found in animal foods (meat, poultry, egg yolks, whole milk, cheese, ice cream, butter). Have your cholesterol level tested; your goal is a level under 200 mg/dl. 
• High-density lipoprotein (HDL) is a type of cholesterol that may protect against heart disease (good cholesterol). 
• Low-density lipoprotein (LDL) is a harmful type of cholesterol that deposits on artery walls and increases the risk of heart disease (bad cholesterol). 
• Monounsaturated fat is a type of unsaturated fat that lowers blood cholesterol. It is found in olive oil and peanut oil. 
• Polyunsaturated fat is a vegetable fat that lowers total blood cholesterol. It is found in cottonseed, soybean, sunflower, and safflower oils. 
• Saturated fat is an animal fat that raises total blood cholesterol. It is found in hydrogenated vegetable fats, coconut and palm oils, cocoa butter, meat fat, whole milk, butter cream, and fatty cheeses. 
• Triglycerides are fats in the blood that may increase the risk of heart disease.

INCREASE FIBER

• Switch to whole-grain breads, cereals and crackers. 
• Eat more vegetables -- raw and cooked. Instead of fruit juice, eat fresh, whole fruit. 
• Sample high-fiber foods that may be new to you, like bran, barley, bulgur, brown and wild rice, and dried beans, peas, and lentils.

What is Fiber?

Also known as roughage, fiber is the part of plant food your body cannot digest.
Fiber relieves constipation, lowers blood cholesterol levels, and apparently slows down the rate of carbohydrate digestion, reducing carbohydrate-induced elevations of blood sugar.

Fiber also causes gas if you eat too much too quickly.

REDUCE SODIUM

Don't add salt in cooking, and try not to put salt on your food at the table.
Cut down on high-salt foods like canned soups, ham, sauerkraut, hot dogs, and pickles. Food that tastes salty probably is salty.
Eat fewer convenience foods and try to avoid fast-food restaurants. Even when they don't taste salty, these foods are often loaded with sodium.

REDUCE SUGAR

• Don't eat table sugar. If you're used to adding sugar to food beverage, substitute an artificial sweetener that has no calories, like saccharin or aspartame (Nutrasweet).
• Avoid honey, syrup, jam, jelly, candy, sweet rolls, regular gelatin, cake with icing, and pie. Instead of fruit canned in syrup, choose fresh fruit, or fruit canned in natural juice or water. 
• Drink diet soft drinks. One twelve-ounce can of regular cola contains nine teaspoons of sugar!

Exchange Lists

Your dietitian may use exchange lists to help you plan meals and snacks. Exchange lists are groups of foods that contain roughly the same mix of carbohydrates, protein, fat, and calories. There are six exchange lists:

1. Starches and Breads
2. Meats and Meat Substitutes
3. Vegetables
4. Fruits
5. Milk
6. Fats

You need foods from all six lists for complete nutrition. Foods on the exchange lists are familiar, everyday items you can buy at the supermarket. The Exchange Lists are the basis of a meal planning system designed by a committee of the American Diabetes Association and the American Dietetic Association. While designed primarily for people with diabetes and others who must follow special diets, the Exchange Lists are based on principles of good nutrition that apply to everyone.

The Diabetic Diet

Vitamin D May Prevent Diabetes And Helps Reduce Heart Disease Risk if You're Diabetic

 

Vitamin D May Prevent Diabetes And Helps Reduce Heart Disease Risk if You're Diabetic

Author: Dr. Joseph Mercola, April 30, 2011

Vitamin D is also an important factor in diabetes. First, having lower levels of vitamin D has been linked to an increased risk of developing type 2 diabetes. After following more than 5,000 people for five years, the Australian research team found that those with lower than average vitamin D levels had a 57 percent increased risk of developing diabetes, compared to those within the recommended range. According to lead researcher Dr. Claudia Gagnon:

"Studies like ours have suggested that blood levels of vitamin D higher than what is recommended for bone health may be necessary to reduce the risk of developing type 2 diabetes."

Low levels of vitamin D are also known to nearly double your risk of cardiovascular disease if you already have diabetes. A 2009 study shed light on why vitamin D has such a significant impact on diabetics' heart health.

Diabetics who are deficient in vitamin D cannot process cholesterol normally, so it builds up in their blood vessels, hence increasing the risk of heart attack and stroke. Vitamin D inhibits the uptake of cholesterol by cells called macrophages. Macrophages are dispatched by your immune system in response to inflammation and are often activated by diseases such as diabetes.

When you're deficient in vitamin D, your macrophage cells absorb more cholesterol, and can't get rid of it. The macrophages then get clogged with cholesterol and become what scientists call "foam cells," which are one of the earliest markers of atherosclerosis.

So, if you're diabetic it's even more important to maintain therapeutic levels of vitamin D.

Vitamin D May Prevent Diabetes And Helps Reduce Heart Disease Risk if You're Diabetic

6 Factors That Influence Our Food Choices | eHow.com

 

6 Factors That Influence Our Food Choices

X

Michael Brent

Michael Brent is an experienced magazine writer and editor who has written for various publications. He holds a Bachelor of Arts from the University of Winnipeg and has studied journalism at Ryerson University.

By Michael Brent, eHow Contributor

updated August 01, 2011

• Print this article

People often don't think about why they choose some foods over others.

As the old adage goes, you are what you eat. This is especially true when it comes to the food choices people make, which are are influenced by a wide variety of internal and external factors that may actually have little to do with the food itself. Consciously or unconsciously, individuals choose particular foods over others. Six factors in particular influence these choices.

1. Taste

   • The most obvious factor that makes you choose one food over another is its taste. Food that tastes good is understandably appealing, although what is considered tasty may vary widely from individual to individual. Caviar, for example, is considered a rich, delicious delicacy to those who enjoy it, while a child would probably turn up his nose. People often tend to feel hungry for -- and thus seek out -- foods which they subjectively find appealing.

   Marketing and Advertising

   • A TV commercial extolling the virtues of a mouth-watering brand of frozen pizza may make you want to rush out and buy one, which is exactly the hope of most advertising executives. In fact, many food choices are heavily influenced by advertising and media marketing specifically designed to make customers choose one food or brand of food over another. Children, for example, are influenced by factors such as toys that come with fast-food meals and cartoon characters promoting breakfast cereal.

   Culture

   • Your ethnic and cultural background can play a key role in influencing your food choices. A Mexican-American, for example, is likely to choose very different foods than a Chinese-American would, for purely cultural reasons. Many people will gravitate toward food they find comforting or familiar, which can differ widely from culture to culture.

   Health

   • Concerns over health and fitness can also influence food choices. An overweight person trying to lose weight by dieting will usually choose different foods than someone whose metabolism allows her to eat whatever she wants without concerns of weight gain. Taste is still a factor in these decisions, but often comes second to caloric value and fat content.

   Emotion

   • Many people have an emotional connection with food, which is often tapped as a source of comfort in times of sadness and distress. As a result, emotions often influence food choices. Conditions such as depression, stress and anxiety can cause people to make choices about food that they might not make in a different emotional state. Most of the time, this leads to impulse eating, often involving unhealthy usually leading toward less-healthy "junk" foods.

   Economic Status

   • Your income and monetary status will heavily influence which food you decide to eat. A person on a small fixed income is likely to look for the most inexpensive food possible. Budget shoppers often try to make multiple recipes with the same basic family of ingredients, and purchase less expensive prepared and canned foods. Someone for whom money is no object is more likely to indulge in more expensive dishes or impulse buys.

6 Factors That Influence Our Food Choices | eHow.com

The Food Staycation | eHow.com

 

The Food Staycation

Turn Your Vacation at Home Into an International Adventure -- With Food

• Print this article

Make your retreat a culinary excursion.(photo: Joao Canziani/Digital Vision/Getty Images)

The best way is to get on a plane and go, but you can still learn a lot by getting out your pans!

— Brock Kuhlman, chef and "food scientist"

If you dream of sampling the cuisine and the beaches of the Riviera but find yourself grilling chicken and sunbathing in your own backyard, you are not alone.

The "staycation," or stay-at-home-vacation, has become an increasingly popular money-saving trend during the past few years as Americans opt to explore their own cities rather than more exotic locales.

However, you can still get a taste of your dream vacation destination, right in your own kitchen.

Planning Your Culinary Expedition

Start your culinary "travels" by choosing a cuisine. Maybe you've always wanted to check out Burmese street food or Nigerian chin-chin. Or, if you're feeling really adventurous, just stick a pin in a map.

"Part of the adventure of travel is the planning phase: buying tickets, exploring destinations and deciding on itineraries," said Brock Kuhlman, an American chef and food scientist living in Thailand. Planning a menu -- or a week of menus -- is a similar process.

"If you are new to a cuisine, before your 'trip' it's a good idea to read some blogs about the food culture of your target and get some good cookbooks," he advised.

For instance, if you decide to spend a virtual week on the French island of Corsica, stock up on clementines, hazelnuts and mussels, and maybe even go online to order the famed Corsican brush honey to put on your breakfast toast.

Next, head to your local library or bookstore to browse cookbooks that will provide details about ingredients and techniques. Travel and food writer Maggie Hall, a British expatriate living in the United States, likes to talk with other "foreigners" living in her area about their favorite foods.

"All cities and towns, often even the smallest of communities, have a range of residents who have either just settled here or whose grandparents arrived decades ago. Invariably the traditional recipes came with them," said Hall, who finds that vendors at her local farmers' market in Washington, D.C., hail from Greece, Poland, South Korea and Central America and are eager to share their recipes.

"They're always happy to discuss how they treat food and guide you on doing it their way," she noted. "Frequently it's not different ingredients in the recipes but different methods of use."

Global Cuisine in Pop Culture

You can get a real taste of food culture both at home and abroad through movies and books that celebrate food. Here are a few tried-and-true favorites to whet your appetite:

Movies:

"Big Night"

"Eat Drink Man Woman"

"Julie and Julia"

"Tampopo"

"Babette's Feast"

"Tortilla Soup"

"Mostly Martha"

"Like Water for Chocolate"

Books:

"A Year in Provence"

"My Life in France"

"The Lost Ravioli Recipes of Hoboken: A Search for Food and Family"

"The Art of Eating"

"The Tummy Trilogy"

"Apple Pie: An American Story"

"Shark's Fin and Sichuan Pepper: A Sweet-Sour Memoir of Eating in China"

Around the World in Seven Days

Seven continents in a week -- why not? Because the land masses are geographically large and culturally diverse, the challenge would be to choose recipes knowing that no single meal can represent an entire continent. Look for foods you haven't tried before: If you already cook a lot of Italian food, for example, make something Hungarian on the day when Europe is the featured continent. Admittedly, Antarctica could be a little tricky, but use your imagination!

To better understand the food of a certain region, immerse yourself in the culture as much as possible. "A large part of understanding a country's food ways is bigger than just recipes," Kuhlman said.

"How it's served, when it's served, what place it holds in the collective imagination of a country -- that can't be transmitted by a plate of food. It's complex, as complex as our relationships with each other, but it's interesting to use literature, pop culture and movies to understand the context of how a culture eats."

If you are interested in trying out a cuisine that is new to you, look for ethnic grocery stores in your area, said Kuhlman and Hall. "Virtually all cities and big towns are going to have a variety," Hall said, "and they'll even give you tips for cooking."

Closer to Home

If you don't have a yen for more exotic fare, another staycation food option is to dig deep into the traditional recipes of your own area, many of which we often forget to celebrate in a world where we can eat asparagus and bananas any time of year. The locally grown or raised ingredients in a 100-mile radius of your home may range from oysters and venison to fiddlehead ferns and gooseberries, some of which you may never have tried. Now is your chance to explore!

Nearly every state in the United States has its official state foods, from chokecherries to chanterelles. If you hail from Maryland, give Smith Island Cake a try. If you're a northern Louisiana native, whip up a Natchitoches meat pie.

Visit some pick-your-own farms and bring home the freshest local ingredients to celebrate the down-home food culture of your own turf. Every region has culinary idiosyncrasies, and it can be fun to try them out.

Hall waxed poetic about the tasty traditions of her native Yorkshire in the United Kingdom: "Special -- or peculiar -- eating habits are apple pie with a slice of strong Cheddar cheese, black pepper sprinkled on strawberries about an hour before serving, and sliced tomatoes with a sprinkling of sugar."

You don't need a passport to go to the grocery store, so pack up your curiosity and travel the world from your kitchen. "The best way is to get on a plane and go," Kuhlman said, "but you can still learn a lot by getting out your pans!"

The Food Staycation | eHow.com