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Special foods for people with diabetes

Ideally, people with diabetes eat ordinary foods with their family or friends, omitting only the foods unsuitable because of a concentrated sugar content.

There may be times, however, when they will miss some of the high sugar content foods, particularly as relishes or spreads or sweets. Fortunately, there are many alternatives which have been specially manufactured for persons with diabetes and people who want to lose weight by reducing sugar intake.

Examples of such special foods are tomato sauce, jams, pickles, jellies, soft drinks, chocolate, preserved fruits and some sweets. To be acceptable, they must be clearly labeled on the package, stating their carbohydrate content. In some cases they are not ‘free’ to take but must be measured or taken in moderation. In some cases they contain sorbitol, and if this is taken in excess it may cause abdominal discomfort and diarrhea.

There are some products on the market labeled ‘Suitable for Diabetics’ which are not recommended by dietitians and may be unsuitable for your child. It is always wise to check with your dietitian about any product before buying it.

The main place for special products for persons with diabetes in the diet is as additions to add variety, rather than as the main foods.

It is not really necessary to buy any special diabetic products. It is certainly not necessary to spend a lot of money on diabetic products. Fortunately many of these are available for a similar price to sugar containing products.

The co-operation of other relatives and friends

Relatives and friends may need to be told about the diet

Although you will be familiar with details of your child’s diet, and understand the reason for restrictions on certain foods, you will realize that sometimes other people may not be so well informed, or understand the need for the diet. Occasionally friends or neighbors may, with the best intentions, offer your child food, or perhaps a grandparent may not agree with the diet system.

It may be useful to tell some neighbors and friends that your child is not allowed extra foods and sweets, and this may save them embarrassment and your child disappointment. It will certainly be important to explain as fully as possible the need for the diet to relatives who have close contact with your child.

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Bruising

Bruises sometimes develop when an injection is given. Don’t worry. They don’t matter and won’t affect the insulin. They are more likely to occur if your child tenses up during the injection. Try to have him relax.

The plunger gets stuck

Occasionally the plunger gets stuck as you are giving the insulin before it is all injected.

This can happen but it is rare. It is more likely to happen if you give the injection of insulin too slowly. Try rotating the plunger in the barrel of the syringe and then pressing further. Try withdrawing a little and then pressing further. If you put pressure on the plunger and force the insulin, be sure to steady the needle on the syringe if it is a type of syringe that does not have the needle set into the hub.

You may have to take the needle out and push the rest of the insulin into another spot.

A broken needle

The needle breaks off while injecting. Do not panic. It is not so very serious.

Keep your child still, not moving the part you injected. If a small bit of the needle is poking out of the skin, grasp it with forceps and pull it out.

If you fail, put an antiseptic on the skin, make a mark where the needle is and note the direction it was pointing when you were injecting.

Contact your doctor. He may decide to leave it, as there are some places when a small particle of needle does not matter. However if you marked where the needle is and the direction it was pointing it will be easier for him to find it.

Soreness

A tender red lump develops during the day following the injection.

This means there is inflammation, possibly due to infection. Put an antiseptic on the area, and avoid injecting there for a few days. If it does not settle down in the next day, contact your doctor.

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Meals should not be too rigid

At this age precise adherence to diet will probably be impossible, so it’s better to be flexible. Remember also the inevitable loss of appetite with infections. It’s not fair to make a child eat when she is feeling sick and it can provoke vomiting.

On the other hand your child won’t understand why you say ‘no’ when she wants more to eat, even though she has had all her exchanges. If you feel that she does need a little more on this occasion, it probably won’t hurt to give her a small amount of the exchange though you will tend to rely on low energy foods in this situation. Some extra food may make for peace without adversely affecting the diabetes.

Be prepared to adjust exchanges in consultation with your doctor and dietitian as your child’s appetite changes.

If all else fails and meals develop into a battle, discuss it with your doctor and dietitian. It may be better to go through a few days of reducing exchanges and lowering the insulin dose so your child gets hungry – then she will eat all her food and demand more. When this happens the battle is largely over.

Insulin injections and blood tests

Most toddlers accept needles as part of their lot in life. Some even like to help with their needles or are impatient to have the needle done so they can have breakfast.

Others have difficulty in accepting needles and get angry and try to fight you off. Explanations aren’t much use at this age – an upset toddler isn’t very susceptible to rational argument. It’s always of course important to explain what you are going to do and also to explain why in simple terms. It’s usually best, if your child is carrying on, to be firm and get the needle over with quickly. If she sees you get upset it tends to make her own feelings worse.

It may be helpful to let your child inject a doll or teddy to make it better, using an old syringe without its needle. Give them lots of opportunities to re-enact the injection scene with toys and play. Give time for reassurance and a cuddle after the injection is over even if your child did behave rather badly.

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Good control means good health

We try to keep diabetes in good control for a number of reasons. The most important ones are as follows:

1.     With good control of diabetes a person feels well and can enjoy life to the full.

2.     With good control a child grows normally and puts on weight appropriately, neither becoming fat nor getting thin.

3.     With good control the body overcomes infections quickly, wounds and sores heal well and certain other infections are avoided.

4.     With good control a child can do any sport and succeed as well as if she didn’t have diabetes.

5.     With good control a person can have a driving license.

6.     With good control a person can carry out almost any career and hold almost any job with confidence.

7.     Good control minimizes – perhaps prevents – the chance of late complications of diabetes.

This last reason is perhaps the most important reason to attempt good control of diabetes. It is often possible to feel well and to grow adequately and lead a full life as a young person even though diabetic control is not perfect. It seems that for the prevention of the long-term medical problems of diabetes control has to be really quite good.

Good control can be difficult at times

Sometimes good control is very hard to achieve, even with the best advice and the best intention on everyone’s part. Some children are more unstable than others through no fault of their own. Some children find it almost impossible to keep to all the restrictions of a regimen for diabetes. Emotional and social upsets will upset diabetic control, and for some children these upsets may make stable control quite unattainable for a long while.

Most people however can keep good control. For others it may take time but will happen eventually. It is always worth trying, and you shouldn’t become discouraged and give up. Situations change and a new adjustment to the diabetic regimen may be all that is needed.

Your doctor will evaluate the quality of control

We can tell whether diabetic control is satisfactory in a number of ways, all of which contribute to an assessment. This is one of the objects of a consultation with a physician.

Perhaps the first consideration is how your child feels and whether she has any symptoms of diabetes. The next is how growth in height and weight is progressing. Then there are a number of observations the doctor can make on examination.

Your record of blood tests at home will be helpful in evaluating overall control, but you will realize that blood tests can only tell you what is happening at certain times of the day and not at others.

There are a number of laboratory tests that may be helpful, such as the levels of fats in the blood. The most useful test of all however is a test called the glycosylated hemoglobin test.

As a result of all these observations and tests the physician will probably be able to reassure you that control is satisfactory. If not he will be able to let you know and discuss ways to improve control.

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At times the body may make chemical substances called ketones. These are derived from fat, which is an important source of energy for the body but which also requires insulin. If the fats are not burnt up properly they produce ketones which are a kind of toxic by-product from the inefficient burning up of fat.

Ketones may be made in large amounts when diabetes is untreated or if there is insufficient insulin. They may also occur during illness and vomiting when the insulin may not work properly. Occasionally ketones may develop when not enough carbohydrate is eaten and the body is forced to burn up fat.

When ketones are formed in large amounts they circulate in the blood and spill out in the urine. There they can be detected. They may also be smelt on the breath.

Ketones should be tested during illness

It is important to test urine for ketones when your child’s blood glucose levels are very high during illness. It is particularly important to test during a vomiting illness. Ketones may themselves make the child feel ill and vomit.

There are two common tests for ketones in urine: Ketostix and Ketur-Test. Both work on the same principle as the urine glucose tests, using a plastic strip with a reagent block at one end. When the strip is dipped in urine, a purple colour develops if ketones are present.

Some tests have glucose and ketones on the same stick

It is often helpful to be able to test glucose and ketones at the same time. These tests are Ketodiastix which is a combination of Ketostix and Diastix, and the Keto-Diabur-Test 5000 which is a combination of Ketur-test and Diabur test-500.

The tests on each of these are just the same as the two tests that are present on the strip and are read in the same way.

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Over time, their insulin becomes less and less effective. Insulin levels have been so high for so long, that the cells of the body (particularly muscle and fat cells) start to ignore it. It’s like if someone continually talks and talks and talks; eventually you stop listening! So we can say the cells of the body have become resistant to insulin.

Initially, after a rise in blood glucose levels, the cells do not respond to the insulin that is released. The body responds by pumping out more and more insulin. Some hours later, when the insulin finally does work, there is a too rapid drop in blood sugar levels. This can make you suffer with hypoglycemia.

These are some common symptoms of hypoglycemia:

• Fatigue and feeling sleepy

• Mental fogginess

• Depression or anxiety

• Strong cravings for carbohydrates or sugar

• Hunger, even soon after a meal

• Feeling shaky or dizzy

• Sleep disturbances

All of these symptoms can make you want to reach for more carbohydrate, and hence the vicious cycle continues. This is why carbohydrates and sugar are often described as addictive! The desire to eat more carbohydrate can be overwhelming. It is usually the comfort foods people reach for to self medicate themselves when experiencing the symptoms of hypoglycemia, especially depression.

If Syndrome X is left to progress, you are at greatly increased risk of developing type 2 diabetes. As insulin becomes less and less effective, it has poorer control of our blood sugar; thus the blood sugar level becomes elevated. Diabetics have a much higher rate of heart disease than the general population.

Syndrome X and diabetes are the biggest risk factors for heart disease.

In Australia the health and economic costs of cardiovascular disease are greater than for any other disease.

You may remember that the enzyme in the liver that manufactures cholesterol is called HMG-CoA reductase. This is the enzyme that cholesterol lowering drugs called statins inhibit. Interestingly enough the hormone insulin stimulates the activity of HMG CoA reductase, causing it to manufacture more cholesterol. So now you see that the more sugar and carbohydrate you eat, the more insulin you secrete, and the more cholesterol your liver manufactures. Rather than taking cholesterol lowering drugs with potential side effects, wouldn’t it just be easier to lower the amount of carbohydrate you have in your diet! You can have a blood test to measure your levels of insulin.

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There is so much information available nowadays about the risks of lung cancer, emphysema and other life-threatening conditions and most people are aware of the detrimental effects of smoking when pregnant. I know how shocked many of us feel when we see a heavily pregnant woman standing with a cigarette in her hand. Yet most people are not aware of the impact smoking can have on a couple’s fertility. It’s not surprising that tobacco has such an effect – it contains more than 4,000 compounds, including carbon monoxide, oxide of nitrogen, ammonia, aromatic hydrocarbons, hydrogen cyanide, vinyl chloride, nicotine, lead and cadmium.

Although many women smokers resolve to give up when they get pregnant, they don’t realize that by smoking they are reducing their chances of getting pregnant in the first place. Not only that but you don’t usually know that you are pregnant for the first couple of weeks and the baby will be taking in all that tobacco smoke in the meantime.

The man’s fertility is also affected by smoking – it decreases his sperm count, makes his sperm more sluggish, increases the number of abnormal sperm and reduces his testosterone levels.

In addition, smoking reduces the level of vitamin Ñ in the bloodstream. Lack of vitamin Ñ encourages sperm to clump together (a process known as agglutination) instead of moving forward to fertilise the egg. One study showed how male fertility was improved by giving men 500mg of vitamin Ñ twice a day.

Smoking has definitely been linked with infertility in women. It can even bring on an early menopause, which is an especially important consideration for older women trying to conceive who may be racing against time. If you are a smoker, you should ask yourself why you are taking something into your body that is bringing you nearer to the menopause – and infertility?

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Vitamins may be the most convoluted health story of the century. First we discover that without them, we die, slowly and painfully from deficiency diseases like scurvy and beriberi. Then we figure that, if a little is good, more is even better. And folks go haywire, popping more pills than Jimi Hendrix on a bad day. Before long we find out that you really can get too much of a good thing, as people succumb to the side effects of vitamin overdose-like liver damage from too much vitamin D. And now, nearly 100 years after we first heard about vitamins, we’re still searching for middle ground.

We know for certain that in the proper amounts vitamins and their sidekick minerals can dramatically improve our health. What we’re finally realizing is that vitamins and minerals alone are not the sole makings for good nutrition. We also need substances known as phytochemicals, such as the flavonoids in red wine that fight heart disease and the carotenoids like lycopene in tomatoes that fight prostate cancer. We need fiber, which keeps us regular, lowers cholesterol, and cuts our risk for colorectal cancer. And we likely need countless other compounds that scientists don’t even know about yet. The only way to get all that is from food.

The question then is: should we take supplements at all? The answer is yes, according to Katherine Tucker, Ph.D., associate professor of nutrition at Tufts University in Boston. For two reasons: First, we’re imperfect. Try though we may, most of us still don’t eat well enough to get the Daily Values of all the nutrients we need all of the time, especially as we get older, says Dr. Tucker. Second, there are a few nutrients that can provide us extra protection from conditions like heart disease if we take them in doses higher than what we can get from food. Today, most respected nutritionists and experts in the field recommend loading up on fruits and vegetables and taking a multivitamin/mineral supplement to pick up any slack. Obviously, for the best protection, you should take a multi that has enough of the nutrients you need.

E-normous Benefits

If you supplement nothing else, supplement vitamin E, advises Dr. Tucker. You’ve heard by now that vitamin E is an antioxidant. But you likely have no idea just how good this free-radical-fighting nutrient really is. Even researchers have just begun to scratch the surface.

For a quick review, free radicals are simply oxygen molecules just like the ones you’re breathing in right now, only they’ve been damaged-meaning that they lost an electron-by sunlight, pollution, or even your own metabolism. To repair themselves, they steal electrons from your body’s healthy molecules, which not only damage your cells but also create more free radicals. Antioxidants stop this molecular chain of destruction by stepping in and offering their own electrons instead.

Antioxidant action may be most helpful inside your arteries. Scientists have found that it’s free-radical damage to your unhealthy low-density lipoprotein cholesterol that makes the stuff stick to your artery walls and eventually clogs them up. Vitamin E is so effective in the fight against hardening of the arteries that when British researchers gave more than 2,000 people with partially blocked coronary arteries either 400 or 800 international units (IU) of vitamin E a day for 18 months, these coronary candidates (of either dose) lowered their risk for nonfatal heart attack by 75 percent.

“The benefits of vitamin E against heart disease are pretty well established,” says Dr. Ichiro Kawachi of the Harvard School of Public Health. The Daily Value for vitamin E is only 30 IU, a standard that leading health experts consider far below what you need for disease protection. The problem is that it’s practically impossible to get higher, protective amounts of vitamin E from food alone since it’s mostly found in fatty oils. You certainly don’t want to drink the eight cups of corn oil that it would take to get 400 IU, so Dr. Kawachi recommends taking a supplement of 200 to 400 IU a day instead.

As a bonus, it may make you better in bed. Vitamin E prevents testosterone from breaking down, which keeps your libido up. And it may keep your memory sharp to boot. Though researchers have used only astronomical doses so far (a lot more than anyone should take without a doctor’s supervision), vitamin E was able to delay the progression of severe dementia in a group of 341 people with moderately severe Alzheimer’s disease, according to a study from Rush Alzheimer’s Disease Center in Chicago.

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“It’s so strange,” said one mother. “Melissa turned into a vegetarian overnight. Now she won’t eat any of the foods she always loved.”

A father remarked: “Lisa seems to live at McDonald’s. All that junk can’t be good for her-can it?”

“Cookies! I think that girl exists on Oreos! What should I do?”

“I swear, she starts a different diet every week.”

“She eats nothing all day, and then gets ravenous just before bedtime. Is this just a teenage phase? Or should I worry?”

“I can’t understand it. Every day she eats exactly the same thing. The same foods, in the same order, every meal. Even breakfast. Is something wrong?”

Adolescence: Spell it T-U-R-M-O-I-L. Hormones surge. Emotions run amok. Bodies change so fast that their owners don’t recognize themselves in the mirror.

The physical transformation alone is hard enough to handle. But a teen’s whole world is in upheaval. Socially speaking, the pressure’s on. Suddenly a person whose age has barely reached double digits has to cope with enormous changes and choices. Sexuality. Dating. Demanding teachers. Those twin temptations, drugs and alcohol. New roles and responsibilities.

Some of this confusion and fear is bound to rub off onto the parents. They watch their sweet, obedient child transmute into an anxious, volatile creature from another world.

Everything in the kid’s life is changing, and eating patterns are no exception. Unusual diets, strange menus, or just plain bad food habits do not always mean that an eating disorder has struck. Switching to vegetarianism or an occasional food binge represents nothing unusual.

Sometimes, though, there is cause for concern. Those habits may not be a phase, but a sign that something is wrong. The body could be changing so fast that it can’t keep up with itself. Emotions may spin out of control. The pressure gets to be too much. For a lot of people, eating-or the discipline of not eating-provides relief, comfort, or just plain distraction.

You may think (or know) that something is wrong with the way your child is eating. Or you may be worried about a close friend or relative-or yourself. You may have witnessed bizarre behavior-for example, wolfing down a dozen bananas or six hot dogs in a row-that makes you suspicious. Maybe your daughter takes forever at the dinner table, picking at her food, eating nothing. Or she disappears into the bathroom two or three times during a meal. Or perhaps another person’s casual remark-“Barbara’s losing an awful lot of weight, isn’t she?”-sets off an alarm in your head.

When does a “diet” become a disorder? What exactly are eating disorders, anyway? Why do they strike, and how do they affect the people who have them? This chapter will help you find out. To start, look over this list of warning signs that indicate something is wrong.

The warning signs of eating disorders

Severe weight loss

Preoccupation with being thin and /or an intense fear of being overweight

Severe diets or odd behaviors about food

Signs and symptoms of depression

Loss of menstrual periods

Hyperactivity, compulsive exercising

Distorted body image

Unexplained medical problems

Hair loss

Slow pulse (bradycardia)

Intolerance to cold (shivering, blueness of the skin and fingers, etc.)

Edema (swelling of the ankles)

Low blood pressure

Low body temperature (hypothermia)

Dental damage (due to vomiting)

Weakness

Sleep disturbance

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In 1994, Melonie Heaton weighed 225 pounds. She had no energy, could barely muster the stamina to climb the stairs at home, and had no desire to socialize with her friends.

Today, Melonie weighs in at a svelte 135 pounds. She slimmed down, she says, by learning to identify the emotional sources of her physical hunger. –

Melonie, a 38-year-old Seattle resident, had been overweight for as long as she could remember. “I’d been on the weight-loss roller coaster, trying every diet on the planet to slim down,” she says.

Then Melonie started walking for just a few minutes, a few days a week. “I was so physically out of shape that walking was the only thing that I thought I could tolerate,” she explains. “I’ll never forget my first walk. I was out of breath in 3 minutes. I had to be very patient with myself.”

Her patience paid off. Those 3-minute, 3-days-a-week walks gradually got longer and faster, and Melonie started dropping pounds. As a bonus, her energy level soared.

Inspired, she began looking for ways to improve her eating habits, too. Through what she calls a journey of self-exploration, she soon realized that she had fallen into a pattern of eating even when her body didn’t really want food. “I was misinterpreting feelings of fatigue, loneliness, dissatisfaction, or low motivation as hunger,” she recalls. “I discovered that in order to remodel myself outside, I first had to remodel myself inside.”

Melonie learned how to face her feelings head-on and how to remedy them without food. Now, whenever she has the urge to eat, she asks herself what she really needs. Is her hunger genuinely physical? Or are her emotions calling out for sustenance? “If I realize that

I’m bored, I get out a craft project or go shopping or find some g other constructive way to occupy my time,” she says. By learning to distinguish between physical and emotional Q 1 hunger, Melonie stopped eating for the wrong reasons. In 2 years, she lost 90 pounds. Now, even 3 years later, she can proudly say, “I no longer have a weight problem.”

WINNING ACTION

Feed your hunger, not your mood. This has been such an important lesson for me! I constantly found myself thinking about food or even rummaging through the kitchen for something to eat—all because I was really feeling sad, scared, lonely, or just plain bored. The next time you find yourself searching for something to eat, stop and ask yourself, “What do I really need right now?” You may realize that you don’t need food at all and that you’re really hungry for a chat with a good friend.

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