Health and medical news blog

A diet for diabetes in young people should achieve these aims quite simply.

Carbohydrates are controlled carefully by a system of exchanges

We control carbohydrates because they are an immediate source of glucose and if not controlled will lead to varying glucose levels in blood. Carbohydrates are controlled by an exchange system. This system allows you to choose the carbohydrates in the meal but keep the total amount the same.

In the diabetic diet, approximately half the energy (calories or joules) should be provided by carbohydrate. The amount of carbohydrate in the diet is referred to as the number of exchanges, where one exchange is equal to a serving of food that contains 15 grams of carbohydrate.

One exchange of carbohydrate foods equals one exchange of another carbohydrate food and so they are interchangeable. It is very important that the amount of carbohydrate (or number of exchanges) stays as constant as possible each day.

You will be advised on the number of exchanges of carbohydrate for each meal, and the best balance between the various carbohydrate groups.

As the child grows or becomes more physically active, the number of exchanges per day will be gradually increased. When growth stops at the end of puberty and if the child becomes less active at that time, the number of exchanges may be reduced.

Protein and fats are taken in moderation and may be controlled

Careful measurement of protein and fats may be important in older persons with diabetes and those who are over-weight. This is because both protein and particularly fats are a major source of energy as calories or joules.

With young people it may not be important to be so precise in allowances of these foods as a rule. It is however sound nutritional advice that excess fats should be avoided as they may be bad for health. Excess protein in the diet may lead to poor diabetic control. The body does have the ability to convert the excess protein and fats into glucose and also store this energy as body fat.

Refined carbohydrates as high sugar foods should be avoided

There are many foods and drinks which have a high content of sugar. Unfortunately these are often favourite foods of children, but they are not normally suitable in the diet for a person with diabetes as they may lead to high levels of glucose in the blood. They hardly satisfy appetite well and they are not necessary from a nutritional point of view.

There are special occasions however when sugar-containing foods are helpful for a person with diabetes. This is particularly when the blood glucose falls too low or when given before extra activity to prevent hypos. They may also be helpful during illness particularly if there is vomiting when your child may not be able to take the ordinary diet.

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Where you give the injection

The upper outer surface of the thigh, the upper outer surface of the buttocks, the upper outer surface of the upper arm and the front and lower surface of the abdomen are all suitable places for injection insulin.

It is a good idea to change the site of the injection each day, so that it is not always given at the same spot. If insulin is repeatedly put in the same spot, a lump may develop which can be unsightly, and the insulin may be poorly absorbed. On the whole it is usually best to use the buttocks and thighs in young children. These areas are covered by clothing and possible marks or swellings from injections will not be noticed. Most young children seem scared of the abdomen, but this area is often preferred by older people.

Injection in the arm of young children who have very little fat can lead to unpredictable absorption of insulin, as some of the insulin may be injected into muscle which is close to the skin in slim people. Insulin is absorbed more rapidly from muscle than from fat beneath the skin, especially with exercise.

Methods of injection

How you give the injection

1. Ensure the skin is clean. In hospital it is routine to swab the skin with an alcohol swab; this is important because there is always a possibility of unusual hospital germs. At home, many people also advise cleansing the skin with cotton wool dampened with methylated spirits or an alcohol swab. This is probably not really necessary. If the skin is dirty, soap and water and thorough drying is just as good. It is not possible to sterilize the skin with alcohol swabs or methylated spirits, as most of the germs live deep in the skin.

Perhaps the best advice is; be as clean as possible in giving the injection and don’t expect the skin to be sterile – just clean.

2. Pinch up a fold of skin. Now pick up a broad fold of skin between finger and thumb and hold it firmly. This steadies the skin and makes it easier to inject.

Inject at a steep angle

3. Hold the syringe in the other hand. Now push the needle firmly at a steep angle of about 60-90 degrees through the skin into the tissues beneath it. A firm thrust of the needle is easier and hurts less than a very slow cautious insertion. There is no danger of ‘going too far’.

Draw back on the plunger

4. Let go your hold on the skin and use that hand to support the syringe. With the other hand gently pull back the plunger as if trying to withdraw it. Check that no blood enters the barrel, as this would mean the needle is in a blood vessel. If blood should enter the syringe when you pull back the plunger, immediately pull the needle out and inject into another spot.

Push the plunger in

5. Provided blood does not appear (and it probably never will) push the plunger firmly and steadily in so that all the insulin is injected. Now pull the needle straight out.

A drop of fluid or blood emerging onto the surface of the skin after pulling out may be noticed, but does not matter.

Care with the needle and syringe

Now put the cap back on the needle if you intend to use the syringe a second time and store it carefully. Otherwise dispose of it safely, preferably break off the needle so that it cannot injure anyone. A rigid container such as a plastic juice container is useful.

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Treat your child as a normal person

Your approach should be one of regarding your child as normal, and helping him to feel that way too.

Do not give special consideration or favours.

Discipline him and punish him when necessary as you would your other children. Be careful and sensible with him when he gets sick with childhood illness, but do not over-treat him or ‘mollycoddle’ him.

Be optimistic – but do not promise a cure

It is right to be optimistic about the future. Diabetes cannot at present be cured, and may cause some problems in later life, but efforts in modern research are enormous and are repeatedly leading to advances in knowledge and treatment. However, do not hold out hope to yourself or your child that he may be able to stop insulin injections. The chances are he will not and constant hoping may lead ultimately to disappointment and frustration.

You will find it helpful to keep yourself informed about what is going on in research. Read articles in diabetes journals attend seminars and meetings for people with diabetes and their families. In this way, you will maintain your optimism as you hear about progress. It will also give encouragement to your family by demonstrating your active interest.

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Check for possible causes of the hypo

If a severe hypo occurs, check the following possible causes:

1. Was all the diet taken, and at the right time?

2. Was the dose of insulin measured correctly?

3. Has there been extra physical activity that day leading to the burning up of more glucose in the body?

4. Has there been some digestive upset, perhaps with diarrhea or vomiting, leading to poor absorption of the food?

Check the diet. Check sugar for activity

If any of these factors has been the cause of the reaction, then prevention of further reactions should be possible by attention to the cause. Perhaps a review of the measurement of diet is needed, and a talk with the dietitian may be helpful. If extra activity was the cause, then the child should remember to take more sugar or other carbohydrates next time he has such activity. If it was due to a digestive upset, then substitution of emergency fluid feedings for the usual diet may lead to better absorption.

Does the insulin dose need reducing?

If none of the above factors was present, then it may be the insulin dose needs reduction. Have blood tests been low recently? You should discuss this with your doctor, but at all events a reduction of 2 to 4 units of insulin at a time is usually sufficient.

An occasional mild hypo is not harmful

If you can find no reason at all for the hypo reaction (and this is quite possible) then you may wish to discuss it with your doctor, but an occasional mild reaction does have to be expected and should not be a source of worry.

Just be sure that you and your child give as much attention to the details of the treatment regimen as possible.

Remember also that hypo reactions, though unpleasant and perhaps alarming, are not dangerous if treated promptly. With growth, maturity and experience they should occur less and less and perhaps be entirely preventable.

Glucagon

Glucagon has the opposite effect to insulin; it raises the glucose level in blood. Glucagon is given by injection.

Glucagon is a hormone which, like insulin, is normally produced in the pancreas. It has the opposite effect to insulin however, and it can release glucose from stores in the liver and thus raise the blood glucose level. It can be injected under the skin like insulin with an insulin syringe and needle, or using the syringe provided.

It is therefore a very useful material, as it can be used in children who have a severe hypo reaction if they are unable to take sugar by mouth.

Within 10 to 15 minutes a person with diabetes who has been unconscious or unable to swallow will usually return to consciousness so he can then take sugar by mouth. Parents can give this injection without trouble.

Give sugar after the glucagon

It is important to give sugar by mouth as soon as the child is able to take it, giving it the same way as for any severe insulin reaction.

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A lot of useful information about the health of a child can be gained by testing for certain substances in urine. It may be helpful for you to test for glucose in the urine at times, and it is certainly important that you are able to test for ketones during illness.

Urine test for glucose

Before blood tests became generally accepted as the best method for monitoring day to day control of diabetes, urine tests were used to check the level of sugar in urine as a rough guide to the blood glucose levels.

The basis of this test was that when blood glucose values rose over approximately 10 mmol/1, glucose overflows into the urine where it can be detected. The higher the blood glucose values and the longer the period that they were too high, the more glucose is passed in the urine. Thus a rough estimate of control was based on a concentration of sugar in urine.

Clearly this test was very helpful but not really reliable. It was found that sometimes the blood test and the urine test didn’t agree. A negative urine test moreover tells you that the blood glucose value is not too high but it doesn’t tell you whether it is too low.

Some children find blood tests too painful and prefer urine tests. Sometimes parents find that a urine test is helpful as an extra check before bed to ensure that the blood glucose is high as a reassurance that a hypo is not likely to develop. Sometimes it is useful to have a urine test as a stand-by if the blood glucose meter breaks down. Some physicians find urine glucose tests provide helpful additional information to assess control.

For all these reasons it may be helpful to know about urine tests for glucose, though it is quite possible you won’t use them.

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The idea that high cholesterol plays a role in the development of heart disease was started by the Framingham Heart Study. This study began in 1948 and monitored 5 000 healthy women and men living in Framingham, Massachusetts, USA. Researchers tried to establish which factors went on to determine if a person suffered a heart attack. High cholesterol was one factor that had some influence on who had a heart attack, but it was only one of 240 risk factors identified. Some other factors that influenced who got a heart attack included short stature, creased earlobes, male baldness, and being married to a highly educated woman!

Cholesterol was latched onto because it is a modifiable risk factor; that means there was an opportunity for drugs to be developed to lower cholesterol. There was potential to make great profits! Many scientists believe the results of the Framingham Study were misinterpreted, and cholesterol has been inappropriately focused on. The study only found an association between cholesterol and heart disease in young and middle-aged men; however over time we have all been instructed to fear cholesterol.

In the late 1950s, researchers came up with the “lipid hypothesis”, also known as the “diet-heart idea”. This claimed there is a direct relationship between the amount of saturated fat and cholesterol in the diet, and the incidence of coronary heart disease. This hypothesis has received much publicity, and is the basis for why low fat, low cholesterol diets are the hallmark of nutrition recommendations. It is also the basis of prescribing cholesterol lowering medication to anyone who has levels above the desired limit.

Since then several researchers have discovered flaws in this hypothesis. Before 1920 heart disease was rare in the United States. This is a period of time when consumption of foods such as butter, lard and dripping was much greater than now; these are all foods very high in cholesterol. Many traditional diets of native populations are very high in fat and cholesterol, yet these populations have very low rates of heart disease.

The Masai tribes of Africa consume a diet of mostly milk, blood and beef; 60 percent of calories they eat are derived from fat. However, the Masai do not have elevated cholesterol, and are free of coronary heart disease. Inuit people (Eskimos) eat an extremely high fat diet; 80 percent of their calories come from fat. These people have healthy blood vessels and there is no evidence they suffered with heart disease. The traditional Australian aboriginal diet contained large amounts of fat in the form of eggs from birds and reptiles, turtles, eels and possums. Many insects are high in fat, such as witchety grubs (67% fat), the green tree ant and bogong moths; their abdomens contain a lot of fat. The aborigines were a fit and healthy population; obesity and diabetes were almost unheard of.

Many researchers believe that it was the introduction of sugar, white flour and alcohol that has led to the explosion of diabetes, obesity and heart disease in this population.

One explanation for this contradiction is that the meat these native populations consumed was quite different in fat composition to the meat we buy from the supermarket or butcher today. Wild game meat is much lower in total fat, and particularly saturated fat than farmed meat. It is also higher in omega 3 essential fatty acids, which help your metabolism. This is why it may be a good idea to include game meat in your diet occasionally such as kangaroo, emu and rabbit. Much of the fresh fish we purchase today is farmed, and unfortunately this type offish is much lower in omega 3 fats than wild fish. This is because it is fed a type of “pet food”, vastly different from the natural diet. Whenever you purchase fish, make sure you ask if it has been farmed or caught wild.

A very interesting study was published in the American Journal of Clinical Nutrition, highlighting the difference in rates of heart disease between people living in northern and southern India. The northerners ate a lot of meat, used ghee in their cooking and had high cholesterol levels. The southerners were predominantly vegetarians, they used vegetable oil and margarine to cook with, and they had lower cholesterol. You may be shocked to know that the vegetarians had a 15 times greater incidence of heart disease than the meat and ghee eaters!

Proponents of the “lipid hypothesis” claim that when our intake of cholesterol and saturated fat is high, the saturated fat is turned into cholesterol which accumulates in the arteries. These deposits of cholesterol get thicker, form a plaque, and eventually narrow the arteries so much that blood flow is restricted. Plaques can also break off and form a blood clot in a vessel.

High levels of HDL “good” cholesterol protect us from heart disease by transporting excess cholesterol away from the arteries to the liver for removal. A high level of LDL “bad” cholesterol means that a lot of cholesterol must be depositing itself on the lining of our arteries, increasing our risk of heart attacks and strokes. This is true to a large extent, but is a very simplistic view of atherosclerosis (formation of fat plaques in the arteries). We now know there are many other factors involved.

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Conception is a complex process that depends on everything working properly at a number of stages.

Firstly, your hormone balance must be correct so that the egg develops normally. Secondly, you must be ovulating so that the egg is released. Thirdly, you must have sex at the right time in your cycle (there may be only two or three days a month when you are fertile). In addition, your partner must have a good sperm count and possess healthy sperm, which are capable of penetrating your cervical mucus to reach the egg. Then the egg has to be captured by the fallopian tube and be fertilised. Finally, once the egg has been fertilised, the embryo has to implant securely in the lining of the womb, which needs the right levels of the hormone progesterone to maintain the pregnancy. No wonder they talk about the miracle of life!

It’s daunting to think about the number of things that can go wrong. But, as we have seen, there are many simple ways in which you can dramatically improve your chances of getting pregnant.

There are different factors that can undermine your fertility. The list may seem long but it is important to identify the particular combination of factors that may be undermining your and your partner’s health and wellbeing.

Nutrition

You are what you eat. Or, to put it another way, if you put poor-quality petrol in a high-performance car, like a Rolls-Royce or a Porsche, it may run for a while but eventually it will become less productive and less efficient. It is exactly the same with the human body. You need top-grade ‘fuel’ to function properly, and to produce healthy eggs or sperm. To a very large extent, your fertility depends on what you eat.

One of the problems is that nowadays we eat a lot of convenience and refined foods that have been stripped of essential nutrients during manufacturing. For example, 80 per cent of zinc is removed from wheat during the milling process to ensure that a loaf of bread has a longer shelf life.

The soil our food is grown on is so lacking in nutrients due to overuse and commercial farming methods, that even what we regard as ‘healthy’ foods – vegetables, for instance – may not contain the amounts of minerals we expect to get from them. If you have been dieting for a number of years (either restricting your food intake or trying different diet drinks or pills), you could well be deficient in a number of vitamins and minerals.

The well-balanced diet is a myth. We simply do not get all the nutrients we need from our food. This was confirmed by a National Food Survey conducted in 1995 which found that the average person in Britain was grossly deficient in six out of the eight vitamins and minerals surveyed. Fewer than one in ten people received the RDA (Recommended Daily Allowance) for zinc, which is the most important mineral for both male and female fertility.

Put this lack of nutrients together with all the additives, preservatives and pesticides in your food and you can see that your fertility may well be compromised on a daily basis. Chemicals like pesticides are known to affect fertility, others will affect your general health, and this in turn can reduce your ability to conceive. Scientists may know the toxic effects of one particular chemical but what they don’t and can’t know for certain is the effect of being exposed to a cocktail of these substances.

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Want to live forever? Get religion.

The world’s major religions promise eternal life. They don’t all agree, though, on exactly how we get from here to eternity. But in a nice little cosmic twist, it turns out that spiritual beliefs may well delay our journey to the unknown, allowing us to shuffle along on this mortal coil longer. Numerous studies have suggested that aspects of spirituality contribute to better health, better quality of life, and yes, even longer years.

Just what is this spirituality thing? It is not the same as religiosity. True, religious people are spiritual, but spiritual people are not all religious, notes Krista Kurth, Ph.D., a management consultant in Potomac, Maryland, who specializes in spirituality in the workplace.

Dr. Kurth’s preferred definition of spirituality is “the Divine influence working in the human heart.” That’s “Divine” with a capital D. For those uncomfortable with the concept of “the Divine,” she offers this definition: “the sense that there is something more than us out there that connects us all.” Spirituality, she says, is “our recognition of our connection with the Divine,” or with that something greater, be it greater consciousness or greater sense of being.

Let’s say that you cultivate a sense of connectedness with the Divine. What is it going to do for you? Scientists who’ve tried to isolate God in the laboratory do have some answers.

Science Weighs In

Religiously active members of the Church of Jesus Christ of Latter-Day Saints (also known as the Mormons) live longer and have half the death rate from heart disease, cancer, and other debilitating diseases compared to the general population, says James Enstrom, Ph.D., associate research professor in the School of Public Health at the University of California, Los Angeles. Dr. Enstrom knows. He has tracked 10,000 active Mormons for 14 years in order to relate their mortality patterns to their lifestyle. Active Mormons do not smoke, do not drink, and attend church regularly. Sure, abstaining from alcohol and tobacco helps. But it’s not the whole story.

Church attendance also appears to be a positive health factor. Dr. Enstrom is not sure how church attendance works its magic. However, he says, Mormon or not, people who attend church regularly generally are healthier than those who do not attend church. Dr. Enstrom is pretty sure because he also followed a large general population sample of nonsmoking people (in an effort to replicate the Mormon lifestyle in a non-Mormon population). What happened? “The nonsmoker who attended church regularly was healthier than the nonsmoker who didn’t attend church regularly,” he says. Research by other investigators has supported these findings.

But what of the spiritual folks who don’t attend church? Do they enjoy better health and a better sense of well-being?

Yes, according to the latest research. The “relaxation response” linked with meditation – a practice with multifarious spiritual origins – provides a plethora of health benefits, says Herbert Benson, M.D., associate professor of medicine at Harvard Medical School and the Beth Israel Deaconess Hospital in Boston and author of Timeless Healing. Spirituality also advocates a healthier lifestyle and increases social support, which helps you deal with stress and improves your coping skills.

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“Why am I so fat?”

“Who made me such a pig?”

“Why is my child starving herself?”

“Why am I so disgusting?”

“How come I’m such a loser?”

“Where did I fail as a parent?”

“What did I do?”

“What didn’t I do?”

If an eating disorder has shattered your life, questions like these constantly bewilder you. All of these questions derive from one dominating issue:

“Whose fault is it, anyway?”

The question is simple. The answer, however, is complex. We all want to know who’s responsible. For every problem, there must be an identifiable cause, or someone to take the blame. At the end of our favorite television shows, guilty criminals always blurt out: “Yes, your honor, I did it! I killed the man!” Simple, tidy endings that resolve all the riddles and tie up all the loose ends make us feel better.

Eating disorder victims want desperately to solve the mystery of their illness. The urge to place blame is so strong that a bulimic often “confesses” to a crime she didn’t even commit: “It’s all my fault,” she thinks. “If I were stronger, I’d be more in control. I’d be thin.”

Others sometimes step forward to share the guilt. When a child develops an eating disorder, family members search frantically for information about it. They talk to friends, scan magazines at the checkout counter, or listen to health experts on radio and television talk shows.

Unfortunately, they often wind up with wrong information. They might read, for example, that children starve themselves because their parents give them too little attention, or too much attention, or the wrong kind of attention. Given such conflicting signals, who wouldn’t be confused? The parent thinks, “It’s all my fault. If I were a better mother [or father], I wouldn’t have caused my child to act this way.”

Or they might hear that children are more prone to develop an eating disorder if their families have a history of psychiatric disorders, such as depression or substance abuse. Parents naturally conclude that their child’s illness results from their own troubled situation. They torture themselves by thinking, “It’s all our fault – we should never have had children.”

Round up the suspects, book ‘em, and throw away the key. Let me assure you: Self-blame is wrong, dead wrong. Such mistaken thinking only contributes to the severity of an eating disorder. Even worse, such attitudes can actually interfere with therapy, making it more difficult for a patient to seek, receive, and respond to treatment.

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When Maria Padron moved from Venezuela to Indianapolis in 1993, eating became a whole new experience. So was the weight gain that eventually followed.

“Food was everywhere,” Maria recalls. “Fast food at every corner. Snacks anytime you wanted them. It was great.”

What Maria got hooked on was not burgers, however. It was soft drinks. She drank 10 cans of sugar-laden cola a day. She went from a trim 130 pounds to 162 pounds in a year. Then, she discovered that her cola habit was costing her 150 calories a can. At 10 sodas a day, that was 1,500 calories a day, or 10,500 calories a week!

Maria quit the colas cold turkey, trading them for calorie-free water. She also cut back on fried foods and started eating more fresh foods, especially fruits and vegetables, just like she used to do in

Venezuela. And she took a full-time job as a nanny for triplets, which gave her plenty of exercise.

In 2 years, she was back to her former weight.

“I still’drink at least eight glasses of water every day,” says Maria, now 28. “Soda doesn’t cross my lips.”

W INNING A C T I O N

Can the soda pop. One of the easiest ways to reduce your calorie intake is to substitute water or flavored water for sodas and sugary fruit juices. What about diet sodas? Researchers at the Centre for Human Nutrition in Sheffield, England, found that people who drink beverages loaded with artificial sweeteners such as aspartame actually eat more food.

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