Avandia is Going Down!

Avandia hit the market, a triumph in blood sugar control.  It helped with insulin resistance and it helped make the pancreas to produce more insulin.  I took it and it worked better than anything else.  I had my first hypoglycemic incident taking Avandia.  My blood sugar hit a severe and dangerous low.  It scared me enough to make me as vigilant about my lows as I am about my highs. 

There was a piece of news that made me stop taking Avandia.  Data had been released that 30% of patients treated with Avandia had heart attacks.  I told Dr. Melvin, no more Avandia for me.  He and I decided to go straight to insulin.

Now, the news comes out that Avandia will be removed from the market.  It's a victory for T2D patients.

The history of oral medications is filled with stories of damaging, even deadly, side effects.  

It Says "'Sugar Free"

Some sugar substitutes will raise blood sugar!  Read the label on your sweetener packet.  Not the part that sells the product.  All you will read is what you want to hear.  Packaging is design to get people to believe they are buying what they want.  Read the part of the label that lists nutritive information and ingredients.  That will tell you what you need to know. 

Here's how to use the information:

1.  No calories, no carbohydrates, no rise in blood sugar.  Simple.

2.  Ingredients lists a word ending in  ...itol, like sorbitol or erythritol.  These are sugar alcohols, not the booze-type alcohol, but a sweet tasting compound having a molecular structure that chemists named, "alcohol."  Sugar alcohols have a carbohydrate count.  They raise blood sugar more slowly than sucrose (table sugar), fructose (the sugar in fruit), or carbohydrates from starch.  To calculate the actual carb impact on your blood sugar, The American Diabetes Association recommends dividing the carb contribution of the sugar alcohol in half, then subtracting that from the total carb count.  That way you can track your carbs and know what to expect to happen to your blood sugar.

3.  Lactose, sugar in dairy products, is the sugar in "Sugar-Free" or "No Sugar Added" ice cream.  As tempting as it is to believe you can eat all you want, sadly, it is not so.  Read the label, you will see.  Sorry for the bad news.

Food and Love

All of us feel better when we eat.  There's the biology of eating:  our bodies crave nourishment and fuel.  Eating gives our body the substances it needs to function.  We need calories for energy; protein to repair and build tissue; fiber, minerals and vitamins for the myriad of biological processes that go on in our bodies.  When our bodies have what they need, we feel good.

There's the other feeling good domain, the psychology of eating.  For all of us, eating carries meaning far greater than  biological health.  To some degree, more for some and less for other, eating means taking in love.

Charlene Loves Red Beans and Rice

Charlene's doctor cautioned her to be careful about her blood sugar, to be careful about the carbohydrates and calories she consumes.  She had been accustomed to eating whatever she wanted.  Like most people who live in Louisiana, she loves her Red Beans and Rice.  She grew up among generations of people accustomed to a meal of Red Beans and Rice once a week.

Traditional Red Beans and Rice appears on every one's table in New Orleans at some time or another.  The dish has loads of flavor, along with a deep heritage in family life.

It also has loads of carbohydrates and fat.  The red beans are big, red kidney beans boiled with some kind of seasoning meat, like smoked ham hocks or smoked sausage.  different cooks have their own ways of seasoning the beans with onions, spices and herbs.  The rice is always white, long or medium grain, refined rice, cooked separately.  At serving time, you dish up a bowl of beans and add a big scoop of rice to each bowl, along with a substantial piece of smoked sausage on the side.  The carbohydrate count in a meal sized serving runs around 120 grams, enough to send blood sugar skyrocketing.

When Charlene heard the news, she was shocked with disbelief, "What?!  Red Beans and Rice are bad for you?"  To Charlene, Red Beans and Rice is a nutritious, satisfying meal.  To be fair to the dish, it does contain good protein, vitamins, minerals and fiber.  The calories and carbohydrate make it dangerous to someone living with Type 2 Diabetes.

Charlene hung her head and put her hands over her eyes.  She couldn't help but feel dragged down, "Another thing I can't eat."

Adapting to healthy diabetic eating challenge everyone.  There's something we all must do:  give up some of our favorite foods or reduce our portions.

For those of us living with T2D, a safe portion of Red beans and Rice is a small side dish of about 1/2 cup of red beans with cut up sausage and a tablespoon of rice, yielding about 30 grams of carbohydrate.  That small a serving cannot satisfy Charlene's love for Red Beans and Rice.  That small a serving also violates her lifelong custom, a custom going back generations, of making Red Beans and Rice the meal.  It would leave her feeling deprived.  Charlean would be left yearning for more and the yearning would be painfully hard to resist.  For most people, the yearning overwhelms them and they give in to it.  Even people who can resist their cravings most of the time, will give in sometimes (see Do As I Say No As I Do, below). We humans are like that.

Charlene might do better with a substitute for her traditional Red Beans and Rice than to tantalized, or tormented, be a tiny portion.  The question to answer:  "What would have the same taste satisfaction and carry the cultural satisfaction, while still being safe for a diabetic to enjoy?

Here are some ways to change this high carb dish into something more T2E friendly:

1.  Increase the vegetables cooked with the beans.
Many cooks add chopped onion and bell peppers for flavor when they cook the beans.  Increasing the amounts of these vegetables will help lower the carb count in a serving.  Other vegetables to add that are flavorful and taste good with the beans are eggplant, zucchini, celery, and  tomatoes.  Substituting vegetables for most of the beans can give you a hearty, tasty carb safe meal.

2.  Change the traditional smoked sausage to low fat turkey smoked sausage.
Smoked turkey sausage tastes great and lowers fat quite a lot.

3. Use brown rice instead of refined white rice.
The higher fiber content in brown rice helps prevent blood sugar spikes.  Have one serving of rice, about 1/2 cup. 

Hypoglycemia: Quick Fix Food

If you're feeling jittery, blurry minded, sweating, test your blood sugar.  You may be hypoglycemic.  You can have the symptoms with blood sugar at any level.  You need to measure for to be sure.  You might get the symptoms like those of hypoglycemia if you're blood sugar is getting closer to normal after having been high, hyperglycemic, for a while.  As your blood sugar gets closer to normal, your body and brain are adjusting to a new level.  The sensation may tempt you to eat some carbs, which will defeat the adjustment you are needing to make in glucose levels. Only your meter will tell you for sure if your sugar is too low.  If your meter displays a number under 70 mg/dl, your blood sugar is low enough to be called hypoglycemic.

You need about 15 gms of carbohydrate, or one starch exchange.  Here are some foods that will bring your glucose back to normal:

5-6 hard candies
4 oz, 1/2 can, of sugared soda
1 Tablespoon of peanut butter
some peanut butter crackers, an amount giving you 15 gm of carbohydrate 

 

Why?

Sheila thinks the foods she eats gives her diabetes.  Ron thinks it's genetic, occurring only in certain families.  Both are partly right and wrong.  Type II Diabetes is a very different disease from Juvenile Diabetes or Type I Diabetes.  Juvenile Diabetes and Type I Diabetes are illnesses of the pancreas.  The pancreas cannot produce enough insulin to keep blood glucose within normal range.  In some cases, the pancreas has shut down completely, producing zero insulin.  People with Type II Diabetes eventually wear out their pancreas, causing a shut down in insulin production, making the person insulin dependent.

How does someone get Type II Diabetes?  T2D is a disease of insulin resistance.  Genetics plays a big role.  When both parents have T2D, their children will develop it.   Body fat increases insulin resistance in everyone.  Yes, everyone.  An overweight person with T2D in the family will develop T2D early in life.  A lean person with T2D in the family will develop it later.  Obesity, all alone, is a big risk factor for T2D.

Do As I Say, Not As I Do

Lynn and I had dinner together recently.  Lynn is adapting to pre-diabetes changes in her metabolism and she's doing a great job.  She's doing everything right.  She counts her carbs.  She lost weight.  She walks nearly every day.   We went to an Ethiopian restaurant.  I love  Ethiopian food, but it cannot be found in many cities in the US.  I hadn't has it in years.  Lynn, being the considerate person she is, agreed to indulge me.

Ethiopian food had some T2D friendly choices:  kitfo, a spicy beef dish; vegetable choices, like collard greens; and an assortment of stews.  The foods are served on injera, a spongy pancake made from teff flour.  Teff is an ancient grain that is ground and used like wheat with injera on the side.  Injera is also your eating utensil.  You break off a piece of injera, and use it to pick up mouthfuls of food.  So good.

Lynn did the smart thing.  She asked for a fork.  I did the dumb thing and ate with injera.  Lots of it.   Afterward, we went for a walk, stop in at a coffee shop where I measured my blood sugar.  It was shockingly high, high enough that we sat, drank coffee and water and talked a good long time with me injecting fast acting insulin to bring my blood sugar down.

I should have asked for a fork.  I ordered kitfo and collard greens.  Excellent choices.  I can pat myself on the back there.  My hot desire for injera overwhelmed my good judgement.  Next time, I will ask for a fork.