Diabetes e-Newsletter
Issue 3: July 2010

We’re experiencing a warming trend…

Summer brings pool parties, barbecues, baseball, and other festivities.  But with all that fun in the sun, diabetes management goals can fall to the wayside.  This issue is packed with motivating tips to help you stay on track and beat the heat!

Wishing you the best of health!
Your St. Anthony’s Medical Center Diabetes Education Team

Hot Topic: Vitamin D and Diabetes: What’s the Connection?

Vitamin D deficiency has long been known as a contributing factor for osteoporosis and the risk of fractures.  But more recently, vitamin D deficiency is being linked to an increased risk for cardiovascular disease, hypertension, cancer, immune and autoimmune diseases, diabetes, and insulin resistance. 

Vitamin D is a fat-soluble vitamin found in some foods and is also synthesized when ultraviolet sun rays reach the skin’s surface.

Deficiency may be due to lack of sun exposure, inadequate vitamin consumption, impaired vitamin absorption, increased vitamin excretion, and/or aging.  Elderly Americans, which includes many patients with Type 2 diabetes, are especially at risk for developing vitamin D insufficiency.  As people age, the skin becomes less efficient at synthesizing vitamin D from sunlight.  The liver and kidney also may have decreased ability to convert vitamin D into the active form. 

Research is giving us insight into the importance of testing for vitamin D levels and addressing deficiencies with supplementation.  Adequate vitamin D levels may prevent or delay the onset of diabetes, improve blood sugar control, and reduce the serious complications for those who have already been diagnosed.

The current government recommendation for vitamin D intake in adults is 400 IU (international units) per day.  The Food and Nutrition Board of the Institute of Medicine is currently re-examining Daily Values and plans to issue revised guidelines this year.  Dietary sources of vitamin D are limited, but include the following:

Talk with your doctor about your vitamin D level.  Your dietitian can help you incorporate adequate vitamin D in your diet.  To read more, click here.

Ask the Diabetes Educator:

Top Ten Tips for Safe Summer Exercise

Question: Are there any additional guidelines I need to follow for exercise when it’s hot outside?

Answer: Now that there are more useable daylight hours, many of us are turning to outdoor activities for exercise. There are many great reasons to continue any exercise regimen, but being outdoors provides the opportunity to add something different to your routine: walking, biking, gardening, golfing, or water exercises.  However, exercise during the hot summer temperatures requires some extra attention to safety precautions, especially if you have diabetes. 

1. Start with your health care provider’s recommendations.  Maybe it’s time for that physical exam you’ve been delaying!  Your provider can give you guidance on the type of exercise that may be safest for you.

2. If you are just starting an exercise program, get a buddy!  A friend, co-worker, or family member can provide moral support or call for help if there’s a medical emergency.

3. Wear Identification, especially if you are exercising away from home.  A wallet ID card, bracelet, shoe tag, or necklace provides important information to any rescue personnel, if needed. Carry a cell phone that includes “ICE” (in case of emergency) contact phone numbers.

4. Check your blood glucose:
Before exercise, especially if you are just beginning an exercise routine.  Delay exercise if blood sugar is above 300mg/dl, less than 70mg/dl, or you have urine ketones.
After exercise to help detect if blood sugar is getting too low.  Exercise can affect blood sugars for several hours. In general, eat 15 grams of carbohydrate if you exercise longer than one hour OR if your blood glucose is less than 100mg/dl after exercise and the next scheduled meal or snack is more than an hour away.

5. Carry your meter with you!  Be prepared to confirm and treat low blood glucose (less than 70 mg/dl) with a fast-acting carbohydrate source: 3 to 4 glucose tablets, liquid glucose product, 8 ounces of a “regular sports drink”, or ¼ cup dried fruit.
  
6. Drink plenty of fluids.  Water is important before, during, and after exercise. Sports drinks (such as Gatorade) may be used to re-hydrate and provide energy in exercise that lasts longer than one hour (in general, 15 grams carb per hour of exercise is sufficient).  Choose beverages without caffeine.  

7. Timing is Key!  Exercise is preferred 1 ½ to 2 hours after a meal because that is usually when your blood glucose is the highest (but exercise at any time is better than none).  Be mindful of the peak action times of certain diabetes medications. Exercise at those peak times could cause a low blood glucose.

8. Pay attention to your feet. Wear comfortable, well-fitting shoes and socks.  Check your feet before and after exercise for reddened or open areas. Open-toed shoes, sandals, and flip flops are not recommended for exercise.  Pool/water shoes protect your feet during any water activities.

9. Check the weather!  If temperatures are over 80 degrees and the humidity is over 70%, you may need to decrease the intensity or length of time of exercise.  You may need to move indoors for temps over 90 degrees and humidity over 76%.  Consider mall-walking or indoor classes.  See the Recommended Resources section for more information.  

10.  What you wear matters!  Wear layers of light-colored clothing.  Stay cool with cotton or other breathable fabrics, which allow sweat to evaporate.  Avoid spandex, rubber, or plastic fabrics.    

Check here for additional information on exercise and diabetes.

Do you have a question about diabetes?  Send it to us!  If your question is selected, we will send you a diabetes cookbook!  Your question, along with the expert’s answer, will be published in our next newsletter.  Please send your question to elizabeth.glantz@samcstl.org or Diabetes Education, Ask the Expert, 12700 Southfork Rd., Suite 225, St. Louis, MO 63128.  Deadline September 1, 2010.

Eat This Instead

Summer barbecues

Summer barbeques can dish up many healthy options, but some may worsen blood glucose and heart health.  But you can enjoy the food and fun with a few smart choices!

To meet your health goals while enjoying the festivities, try choosing…  

• Diet or sugar-free beverages instead of regular soda, lemonade, and punch
  This is an easy way to reduce “empty” calories and carbohydrates. 

• Fresh vegetables instead of potato chips
  Vegetables still give you that crunch, but without the fat and calories (and carbs too).  Try two tablespoons of low-fat salad dressing for dipping.

• Salad instead of coleslaw
  Coleslaw contains mayonnaise or oil and often sugar, which means more fat, carbohydrate, and calories.  Check the Cook’s Corner for a fresh twist on a summer salad.

• Three-bean salad instead of baked beans
  Traditional baked beans contain sugar and bacon.  Three-bean salad is a healthier alternative.  Try this simple recipe.  Substitute the sugar with an artificial sweetener, like Splenda® for less carbohydrate.

• Baked potato instead of potato salad
  Potatoes are a source of carbohydrate – but they shouldn’t be eliminated from your diet.  However, we can do without the excess mayonnaise in potato salad!  When you choose a baked potato, you can decide how much fat is added.

• Barbecue or grilled chicken instead of barbecue ribs or pork steak
  By choosing a lean cut of meat, you eliminate artery-clogging saturated fat and calories.

• Angel food cake with fresh berries instead of pie
  Angel food cake with fruit still contains carbohydrate, but is much lower in fat and calories than pie (even if the pie is sugar-free).  Want to limit carbohydrate further?  One cup of berries contains only 15 grams of carbohydrate.

Whenever dining out, try your best to make a healthy food choice.  Even if you’re not in charge of party-planning, you may consider bringing a healthy dish along!  If few options are available, limiting portion sizes can help you control carbohydrate, fat, and calories.  For more ideas on making over your picnic click here.

Cook's Corner

Judy‘s Summer Spinach Salad

Tired of the same old salad?  Try this fresh twist by incorporating one of summer’s sweetest treats: strawberries.  Not to mention, you’re getting a vitamin-packed side dish by using spinach, another one of nature’s most antioxidant-rich foods.

Ingredients and Instructions:
In a large bowl, toss together:
1 pound baby spinach  
1 quart strawberries, sliced

In a separate bowl, whisk together: 
1/3 cup canola oil
1/4 cup red wine vinegar
1/4 teaspoon paprika
2 tablespoons sesame seeds
1 tablespoon poppy seeds
Sweeten to taste with sucralose (Splenda®)

Pour dressing mixture over the spinach and strawberries and toss to coat.
Sprinkle the following over the top and serve immediately: 
¼ cup walnuts or pine nuts
¼ cup light feta cheese

Makes 8 servings.

Tip:  Serve as a refreshing appetizer or try a larger portion topped with grilled chicken as a healthy entrée.

Nutrition Information (per side-size serving):
135 calories
10 g carbohydrate
3 g protein
10 g fat

Recommended Resources

Get motivated for exercise!

Routine exercise may be one of the most difficult habits to form.  Even the most dedicated exerciser can lose her motivation when a lot is going on.  We’ve compiled some fun resources to help you stay motivated for exercise!

Gym and fitness classes
Group classes are an easy way to get involved, especially if you are motivated by being around others and held accountable by a class schedule!  Community centers and gyms offer a variety for all fitness levels.  Check the most recent issue of St. Anthony’s Your Health Today for the fitness class schedule or visit www.stanthonysmedcenter.com and click the link for Classes and Programs at the top of the page.

Local walking/Walking groups
Joining a walking group is a fun way to get motivated and help motivate others!  To find a walking group:

• Check your community newsletter, church, mall, or local school for walking facilities or groups.
• Click here for mall walking information (available times and length of walk).
• For a walking clubs directory, click here and scroll to Missouri.  The site lists groups state-wide.
• Trouble finding a babysitter?  Try the Mom’s Like Me walking group.
• If you have a walking buddy and are looking for new outdoor walks, try Trails.com.  The site lists walking trails in the area, terrain, and length.
• Ten Toe Express Walking Tours offers a weekly walking schedule beginning at alternating MetroLink stations.  Registration is free and includes a walking kit and a guide for more than 80 suggested walking tours.  Runs mid-April through July. Call 314-231-7272 or details.

Mp3 players
If you’re just starting out with technology, try an mp3 player.  Just transfer music from your computer to the device, then put on the headphones for entertainment while you exercise. Try www.fitmusic.com for free downloads of mixes.

Map My Run www.mapmyrun.com
If you have a smartphone, download the app and the GPS on your phone will track your progress as you walk or run.  Not so technologically advanced?  Don’t worry; you can still use the website to track how far you went or to log your exercise.

Nike nikerunning.nike.com
If you’re into gadgets, try the Nike+ program.  A sensor in your shoe (about $20) syncs with your iPhone, iPod, or sport band to track how far you have walked/run, time, and calories burned.  Visit the website to watch a video of how it works.

Upcoming Opportunities

Featured Opportunities:

July Pre-Diabetes Class
If you or someone you know has been diagnosed with pre-diabetes, told that your blood sugar is "a little high,” or are just interested in prevention, please join our class, Small Steps to a Healthy Tomorrow: Preventing Type 2 Diabetes.  July 19 and 21 from 1-3 p.m. (you attend both sessions).  Call 314-ANTHONY (268-4669) to register.  Cost is $25.

Let’s Get to the Heart of It
Having high cholesterol and/or high blood pressure increases your risk for heart attack and stroke.  Whether or not you have diabetes, if you are interested in learning more about cholesterol levels and heart healthy dining, this class is for you.  July 23 from 1-3 p.m.  Call 314-525-4508 and press option 2 to register.  Cost is $20 (includes materials and resources).

Meal Planning for Everyday Living
This class is intended for those who have had previous diabetes education, but need to brush up on carbohydrate counting skills and learn practical meal-planning tips.  The class includes topics such as dining out, adding variety, and handling holidays and parties.  August 12 from 4-6 p.m.  Call 314-525-4508 and press option 2 for more information and to register.

Click here for information on other educational opportunities offered by the Diabetes Education Program including our monthly Diabetes Support Group.

Our patients' comments

I was treated with utmost respect and concern and given all the help possible.  Thank you all.  I will definitely recommend your services.

The nurse helped me to learn how to use my glucose meter as well as how to give myself Byetta shots.  She was wonderful!  Very knowledgeable, patient, understanding, and greatly concerned for my health.  A diabetes diagnosis is scary, but she made me feel more comfortable with my entire situation.  She deserves to be recognized for her efforts.

From Day 1 of classes, all persons involved in training, education, etc were kind and understanding.  [They] made it all easier to get through with a positive outlook.  All questions, and I had many, were answered very professionally.

Contact us

phone: 314.525.4508    fax: 314.525.4260
e-newsletter editor: elizabeth.glantz@samcstl.org