Diabetes Education Blog

  • August 5, 2010

    Diabetes-Friendly Burgers for Summer Grilling






    These recipes can help you create more creative burgers with international flair!  (Both recipes serve two people.)

     

    Asian Fish Burgers

     

    What you’ll need:

     

    Olive oil cooking spray

    8 ounces skinless and boneless firm-flesh white fish or salmon, cubed

    1/4 cup plain panko (Japanese bread crumbs)

    2 tablespoons finely chopped green onion

    1 tablespoon slightly beaten egg white (about 1/2 of an egg white)

    2 teaspoons reduced-sodium teriyaki marinade and sauce

    1 teaspoon grated fresh ginger

    1/8 teaspoon fine sea salt

     

    Place fish, panko and green onion in food processor container. In a bowl, stir together egg white, teriyaki sauce, ginger and salt until well combined; drizzle mixture over fish and crumbs in food processor container. Cover and process with on/off turns until coarsely minced (do not overprocess; small chunks should still be visible). Form mixture into two (4-inch-round, 1/2-inch-thick) patties. If necessary, slightly wet your hands before forming patties to prevent sticking.

     

    Grilling:

     

    Preheat gas grill to medium-high for direct grilling. Lightly coat grill cooking screen with cooking spray. Lightly spray both sides of patties with cooking spray. Grill patties on grill screen, uncovered, for 3 minutes. Turn patties over; grill for 2 to 4 minutes more or until fish is opaque and cooked through (do not overcook).

     

    To serve, place patties on lettuce leaves on plate. If desired, sprinkle with toasted sesame seed.

     

    Nutrition Information

    Per Serving

    * Calories250 Calories from fat70

    * Total Fat8 g

    o Saturated Fat1 g

    o Trans Fat0 g

    * Cholesterol70 mg

    * Sodium460 mg

    * Total Carbohydrate17 g

    o Dietary Fiber1 g

    o Sugars6 g

    * Protein25 g

    * Exchanges:0.5 starch, 1 vegetable, 3 lean meat

     

    Or try these Manchego Cheese and Fig Stuffed Chicken Burgers for a burger with Spanish flair! 

     

    What you’ll need:

     

    1/4 cup light or fat-free sour cream

    1 tablespoon fresh orange juice

    1 1/2 teaspoons finely chopped dried mission figs or dark raisins

    2 tablespoons plain fine-dry bread crumbs

    1/4 teaspoon salt

    1/4 teaspoon ground coriander

    1/4 teaspoon smoked or regular/plain paprika

    1/8 teaspoon ground cumin

    Pinch ground cinnamon

    Pinch ground black pepper

    8 ounces ground fresh chicken breast

    2 tablespoons thinly sliced green onion

    2 tablespoons very finely chopped manchego or Parmesan cheese (about 1/2 ounce)

    2 large dried mission figs or 2 tablespoons dark raisins, very finely chopped

    Nonstick cooking spray

    1 (6- to 7-inch) white pita bread round with pocket, cut crosswise in half

    1/3 cup lightly packed fresh baby spinach or 2 curly leaf lettuce leaves

    1/4 cup light or fat-free sour cream

    1 tablespoon fresh orange juice

    1 1/2 teaspoons finely chopped dried mission figs or dark raisins

     

    1. In a small bowl, stir together sour cream, orange juice and 1 1/2 teaspoons chopped figs; set aside.

    2. In a medium bowl, combine bread crumbs, salt, coriander, paprika, cumin, cinnamon and pepper. Add ground chicken and green onion; mix (do not overwork poultry mixture). With damp hands, form mixture into four 1/4-inch-thick patties.

    3. Combine cheese and the 2 chopped figs; mound mixture in the center on top of 2 patties. Place the remaining patties on top and gently press edges together to seal mixture inside. Refrigerate patties for 5 to 10 minutes while preheating the grill.

    4. Lightly coat cold grill rack with cooking spray. Preheat gas grill to medium for direct grilling.

    5. Grill patties, uncovered, for 8 to 10 minutes, turning them over after 4 to 5 minutes. Cook until the patties are no longer pink or until an instant-read thermometer inserted in the chicken reads 165° F.**

    6. Meanwhile, carefully open pita bread pocket. Tuck ? the spinach inside of each pocket; set aside. Drizzle sour cream mixture over spinach in pockets, place patties in bread pockets and serve.

     

    ** To take temperature of patties, insert an instant-read thermometer in chicken near cheese-fig filling, but not touching filling.

     

    Nutrition Information

    Per Serving

    * Calories370 Calories from fat130

    * Total Fat15 g

    o Saturated Fat5 g

    o Trans Fat0 g

  • August 4, 2010

    Diabetes Diet – Enjoy the Crunchy Goodness of Brown Rice

    You may have heard the news reports by now: Harvard School of Public Health (HSPH) researchers are encouraging people to switch from white rice to brown to help prevent diabetes.

    According to the HSPH study, replacing 50 grams of white rice – or about one third of a typical daily serving - with the same amount of brown rice would lower the risk of type 2 diabetes by 16%. The same replacement with other whole grains, such as whole wheat and barley, was associated with a 36% reduced risk.

    Harvard says their study is the first to examine white rice and brown rice and their relation to diabetes risk among Americans.

    Researchers say that eating five or more servings of white rice per week was associated with an increased risk of type 2 diabetes. In contrast, eating two or more servings of brown rice per week was associated with a lower risk of the disease.

    “As a general rule for healthy eating, whole grain foods are better for all of us,” says Certified Diabetes Educator Betty Ann Sirois, MSN, RN, CDE, “They provide more fiber and other valuable nutrients. An added benefit for those with diabetes is that whole grain foods tend to have a lower glycemic index and raise after-meal blood glucose levels more slowly.”

    “From a public health point of view, whole grains, rather than refined carbohydrates, such as white rice, should be recommended as the primary source of carbohydrates for the U.S. population,” said Qi Sun, who did the research while at HSPH and is now an instructor of medicine at Brigham and Women’s Hospital in Boston. “These findings could have even greater implications for Asian and other populations in which rice is a staple food.”

    Cooking brown rice is easy. Just add one cup of rice to about
    2 1/2 cups of water and bring to a boil. Lower the heat, cover and simmer for 25-45 minutes and you’ll end up with three to four cups.

    Brown rice can be more than just a side dish. Toss some into cold grain salads (just toss with chopped veggies, dressing, and anything else that suits your fancy), or add a few handfuls to some soup. You can also sauté some sliced vegetables in a little olive oil then add some pre-cooked brown rice, a few sliced almonds and “stir fry” for a few more minutes - then serve as a quick lunch or light dinner.

    And here’s a time saving shortcut to consider: cook whole grains in big batches. Brown rice will keep 3-4 days in your fridge and take just minutes to warm up with a little added water or broth. Cook once and eat twice – or even three times - for whole grain goodness!

    Do you have questions about what a “diabetes diet” is all about? Visit www.askacde.com and listen as Certified Diabetes Educator Betty Ann Sirois, MSN, RN, CDE gives you some reassuring nutrition advice.

  • July 12, 2010

    Help for a Common Diabetes Problem: Sleep Apnea

    Experts at the Joslin Diabetes Center in Boston say that while sleep apnea is on the rise for all Americans, it’s more frequent among those who have been diagnosed with type 2 diabetes.

    Sleep apnea is also linked to obesity, a risk factor for diabetes, according to Elizabeth Bashoff, M.D., Clinic Physician at Joslin. Symptoms include daytime fatigue and exhaustion as well as nighttime snoring or irregular breathing.

    There are many treatment options for sleep apnea. Lifestyle changes including weight loss and quitting smoking may be effective for mild forms of the disorder. There are also products on the market today which are helpful in the treatment of sleep apnea.

    Liberty Medical provides a wide variety of CPAP (Continuous Positive Airway Pressure) supplies. Liberty helps every customer find the right medical product.

    With Liberty you:

    • Choose from a wide selection of CPAP masks and supplies.
    • Get supplies delivered right to your home with free shipping.
    • Pay no up-front costs.**
    • Rest assured with a No-Risk Guarantee.*
    • Receive personalized service, including a Medicare-coordinated replacement schedule and friendly reorder reminders.

    Avoid hassles — Liberty fills out your Medicare claim forms for you.

    For more information on CPAP products, visit www.libertymedical.com/sleep-apnea/CPAP-supplies.

    Up to 90 days from shipment (a longer period may apply based on law or regulation). Some restrictions apply. We are unable to accept returns of properly filled prescriptions.
    ** Co-payments, deductibles and some restrictions apply.
     

  • June 18, 2010

    Sweet Alternative for Diabetes

    The modern American diet has become increasingly dominated by processed foods and fast foods.  Most of these products are made with refined sweeteners like granulated sugar and high fructose corn syrup and therefore have a high glycemic index…they raise blood sugar quickly. 

    But there are some sweeteners that have a lower glycemic load and can actually be sweeter than sugar.  In North America, we’re familiar with maple syrup and honey as alternatives to refined sugar.  But another sweetener that is gaining in popularity is the syrup of a cactus-like Mexican plant called agave.

    Agave is perhaps best known as the source of tequila.  However, from the time of the Aztec Empire when it was known as a gift from the gods, Mexicans have used it to sweeten their food and drinks. Its nectar is known as aguamiel, or "honey water."

     

  • June 15, 2010

    The Diabetes Diary

    Healthy eating and weight management is important for everyone but even more critical when you have diabetes. Registered Dietician and Liberty Certified Diabetes Educator Beth Anderson says there’s a critical first step to take if you want to change what you’re eating – write it down!  

    The best way to understand your current eating habits — what you eat, when and why - is by keeping a daily log or diary of everything you eat and drink for a week. “The more detailed your diary is, the better,” says Anderson. “On paper you will be able to see exactly what you’ve eaten and what triggers your thoughts behind your food choices.” 

    To create a food diary, you may want to keep several sheets in a loose-leaf binder or have a small notebook that you can carry with you. Anderson recommends including the following columns for recording your information: 

    • Time of day • Who you’re with
    • Food  • Hunger level (ranging from 0 for "stuffed” to 5 for  “famished”) 
    • Amount  • Mood 
    • Location   

    You may also want to record the amount and type of exercise you do each day. After keeping a diary for a week, you and your health care professional or registered dietitian will be able to evaluate your habits to identify possible problem areas that are keeping you from losing weight. 

    Your food diary will allow you to tally how many calories you are now taking in and what adjustments may be needed to help you to reach your target or “healthy” weight. A healthy weight should be one that will help you to keep your blood glucose, blood pressure and cholesterol in control and also to help you to lower your risk of heart disease or other weight-related conditions. To determine a patient’s healthy weight, many health care professionals use body mass index (BMI) and waist circumference. BMI is a measure of weight relative to height. It is calculated by multiplying your weight in pounds by 703, then dividing by your height in inches and dividing again by your height in inches. A BMI score above 30.0 is considered to be obese, a score between 25.0 and 29.0 is considered overweight, and below 18.5 is underweight. 

    Portion control is one of the challenges for dieting Americans, who are surrounded by restaurants who encourage them to “supersize” their meals.  But when you cook at home, you’re in control and here are some tricks to consider: 

    You may want to switch to a smaller dinner plate and bowl, and use a teaspoon rather than a soupspoon when eating soup, stew or cereal. “It’s also a good idea to measure your portions until you learn portion sizes,” says Anderson. 

    Also, remember to read labels carefully. A product labeled “low-fat” may actually be high in calories and carbohydrate. Don’t forget to include high-fiber foods, such as whole grains and fresh fruits and vegetables, in your diet. They’ll help you feel fuller longer.

  • June 11, 2010

    Diabetic Hypoglycemia – the Warnings to Heed

    Do you know the warning signs of low blood glucose?  Some of the symptoms may surprise you!

    There are many different signs of low blood sugar and your symptoms might be very different from someone else.  Once you learn what your own early warning signs are, you should share them with others who might be able to help you notice them – and do something about them – right away!

    Here are a few things you might feel as your blood sugar drops:

    • Shakiness
    • Dizziness
    • Sweating
    • Hunger
    • Headache
    • Pale skin color
    • Sudden moodiness or behavior changes, such as crying for no apparent reason
    • Clumsy or jerky movements
    • Seizure
    • Difficulty paying attention, or confusion
    • Tingling sensations around the mouth

    If you have symptoms, you should check your blood glucose.  However, if you aren’t able to check, it’s always a good idea to go ahead and treat.

    Causes of Low Blood Sugar 

    There are many causes of hypoglycemia, including taking too much diabetes medicine, a delayed meal, skipping a snack, exercising more than usual, eating too few carbohydrates, or drinking alcohol on an empty stomach.   

    To treat low blood glucose, you should always have an emergency source of sugar with you.  Some convenient things to carry are a box of raisins, graham crackers, a box of fruit juice or glucose tablets.

    If you take insulin, get a glucagon emergency kit, which can be prescribed by your doctor.  Glucagon is a hormone that’s made in the pancreas and allows the liver to release stored glucose into the bloodstream.  You’ll need to keep the kit with you and teach family friends and co-workers how to use it in case of an emergency. 

  • June 9, 2010

    The Psychology of Diabetes – Dr. Wendy is On Call

    Being diagnosed with diabetes is an emotional event, for the patient as well as for the patient’s family members.

     “Grief and loss over the healthy self is a part of adaptation to living with chronic illness. Appreciate that family members grieve differently by nature of personality and gender; don't interpret not talking or being busy as not caring. Give yourself permission to be angry for a while.”

    This is the advice of Dr. Wendy Satin Rapaport, a social worker and psychologist who has been specializing in the psychology of diabetes for twenty-eight years.  She has a private practice in Boca Raton, Florida and is the author of the book “When Diabetes Hits Home: The Whole Family’s Guide to Emotional Health”  (American Diabetes Association, 1998).

    Dr. Rapaport practices individual, family and group therapy, always focusing on the emotional and behavioral aspects of diabetes care.

    “Diabetes is a loss of a healthy self that everyone grieves,” she says. “But it takes more work for some than others.”

    Dr. Rapaport was a hospital social worker when she met the patient who sparked her interest in the psychological component of diabetes care. “He was a 16-year-old whose mother had died, who would repeatedly stop taking his insulin and end up in the hospital,” she says.

     Rapaport suspected that the hospital had become a haven for the teenager, who also struggled with depression. “Everyone loved him there, and he would get a lot of attention and special care,” she says, adding that at the time the emotional aspects of diabetes were not widely recognized. Therapy and antidepressants eventually helped get the young man back on track — and put Rapaport on the path to becoming a psychologist.

     Dr. Rapaport currently works with the Diabetes Research Institute as an adjunct professor and consultant, most recently training and mentoring participants in its Parents Empowering Parents program.

     “We train mothers of kids with diabetes to become mentors to newly diagnosed children or children going through developmental changes, such as going to college or entering adolescence,” Rapaport says. “The idea is to bring support and competence to families coping with diabetes, whether it’s in person or by phone and e-mail.”

  • June 7, 2010

    Diabetes? Go for the Greens

     “Eat more leafy green vegetables!”  We’ve all heard that common nutrition tip, but did you ever wonder why these veggies are so good for you?  And what are the best leafy greens to choose?

    “For many Americans, the only leafy green vegetable they may eat is iceberg lettuce, and then only once or twice a week,” says Liberty Medical Certified Diabetes Educator Beth Anderson, RD, CDE. “They are cheating themselves of an excellent source of nutrients.”

    Some of the most nutritious leafy greens are spinach, Swiss chard, romaine lettuce, collards and kale. For one serving, plan on 1 cup raw or 1/2 cup cooked. Toss raw, tender greens into salads or tuck them into sandwiches. Sturdier greens can be steamed or braised in a small amount of liquid and flavored with lemon or lean smoked meats. They’re also a delicious addition to soups and scrambled eggs.

    When it comes to selecting leaf vegetables, the darker green the better. And with this food, the more, the merrier!

    That’s because greens are low in calories and fat and high in dietary fiber, making them an ideal choice for weight management. What’s more, they have a low glycemic index so you can eat more without quickly raising your blood sugar.

    Dark leafy greens are rich in minerals, including iron, calcium, potassium and magnesium, and vitamins K, C, E and folic acid. Just one cup of cooked greens provides almost nine times the minimum intake of vitamin K — a vitamin that most of us don’t get enough of. Vitamin K, along with vitamin C and calcium, is important for protecting bones from osteoporosis. It also helps with regulating blood clotting and and warding off inflammatory diseases such as arthritis.  If you are on blood thinning agents, check with your health care provider before including these foods in your diet.

    But the importance of including these nutrient-rich vegetables in your diet goes one step further. They contain a host of phytochemicals, including beta-carotene, lutein and zeaxanthin, for protecting against cataracts and age-related macular degeneration — a major cause of blindness in the elderly.

  • June 4, 2010

    Got Diabetes? Get Moving!

    When someone tells you that you need to get more exercise, do you groan inside and picture yourself spending hours on a treadmill in the gym?  That scenario might work for some people, but if it doesn’t appeal to you, don’t worry.  There are lots of other ways to get moving!

    Perhaps the most convenient, cheapest and one of the most effective forms of exercise is walking.  Walking briskly for 30 minutes a day may be all it takes to keep you fit. If it’s more convenient, you may decide to break up the 30 minutes to three 10 minute sessions.

    Experts say that as we age, walking a different route each day lays down new pathways in the brain and keep us sharp as well.  You can go solo and meditate on the beauties of nature.  Or you can walk with a friend and share some social time together.
    In addition to walking, you can go out dancing, work in the garden, ride your bike, take a swim or try water aerobics.  Some everyday activities count as exercise as well – using the stairs instead of taking an elevator, parking away from the store and walking to it, playing ball with your children or grandchildren, and of course, walking the dog!

    When you have diabetes, being physically active has many benefits.  Exercise can:

    • lower your blood glucose
    • help make your heart stronger
    • lower your blood pressure
    • help lower your cholesterol level
    • relieve stress and anxiety
    • lift your spirits

    If you haven’t been active, check with your health care provider before you start any exercise plan.  While your goal should be to raise your heartbeat and work your muscles for about 30 minutes total a day, don't worry if you can't do it all at once. Many people start out with 5-10 minutes a day and work their way up. Some people do three 10-minute sessions of activity a day to get their 30 minutes in. Do what works for you.

    When you fit daily exercise into your routine, you can make a difference for your family members as well as for yourself.

  • March 22, 2010

    Less Pain, More Gain

    Joseph Stock, 67, of Waterford, Wis., learned he had diabetes in the mid-1990s. Since then, he's been careful to keep his blood sugar under control and watch for signs of any complications. "Being diabetic, I checked my feet regularly," he says. "I had not noticed anything when all of a sudden the nail on the big toe of my right foot fell off. I might have noticed the problem had it not been underneath the nail."

    An emergency room doctor determined that the toe was seriously infected and couldn't be saved. It was amputated the next day, but doctors worried that if they didn't get Stock's infection under control quickly he would lose his leg below the knee.

    Stock consulted a wound care specialist, who recognized that because Stock had good blood flow to the area, there was a chance to save the leg. He remained in the hospital, visiting the hyperbaric oxygen chamber almost daily and following up those sessions with additional wound care treatments.

    After eight weeks, Stock was ready to go home. He had a new graft material placed over the wound site so it could continue to heal. Next came a medicinal-grade honey treatment, and finally a skin graft to the wound using healthy skin taken from his thigh.

    "Within weeks I was completely healed and I was being fitted for a new pair of shoes," he says. "Now I can go walking, do activities around the house and even dance with my wife."
    Control glucose, control complications

    Diabetic neuropathy, which describes a variety of nerve problems and diseases, isn't inevitable. While neuropathy is more common in people who have had diabetes for a long time, keeping diabetes in good control can lower your risk of developing nerve problems or delay the onset of symptoms. Even if you've started to notice pain or discomfort in your extremities, especially in your feet, getting tight control of your blood sugars can help. Following a healthy lifestyle and taking medications, if needed, can keep nerve damage from progressing, and can even help reverse it.

    "High glucose levels are toxic to the nerve. The nerve needs normal levels to use for energy, but it can't handle high levels and converts the glucose into other, irritating substances," explains Dr. Richard M. Bergenstal, president-elect, medicine and science, of the American Diabetes Association, and executive director of the International Diabetes Center at Park Nicollet in Minnesota. He suggests that you shouldn't worry about one high blood sugar reading here or there — the important point is to keep overall levels low.

    Take care to bring your blood sugar down gradually, though. "When it rockets down very fast it can irritate the nerves temporarily," Bergenstal says. Talk to your doctor about the right blend of diet, exercise and medication to help stabilize your blood sugar.

    Keeping diabetes in good control can lower the risk of developing nerve problems, but diligent foot care can prevent some severe complications.

    Because the blood flow nourishes your nerves, keeping your vascular system healthy can also relieve some nerve pain. Bringing your blood pressure and cholesterol levels into normal ranges can help by improving your circulation and preventing plaque from building up in your arteries.

    Some people with diabetic nerve problems have trouble with swelling in their legs, which can impair blood flow, notes Dr. Robert Gerwin, an attending physician at the Johns Hopkins Pain Treatment Center in Baltimore. In these cases, elevating the legs at night and using massage or pumps to alleviate the swelling can help improve circulation.

    "Controlling swelling and edema in the legs may be as important as anything in treating leg ulcers and some foot ulcers," says Dr. Greg Catalano, a podiatric surgeon at Emerson Hospital 
in Concord, Mass.

    Watch your step

    Sally Matson, a certified wound, ostomy and continence nurse at Orlando Regional Healthcare in Florida, says three factors often combine to make healing challenging for people with diabetic neuropathy.

    First, there's the lack of sensation. When the nerves aren't firing properly, it's hard to notice problems that would cry for attention with normal pain signals. Second, people with diabetes are prone to muscle wasting and bone deformities that can cause the foot to fall out of balance. Finally, impaired sweat and oil gland functions can lead to dry, scaly skin that can develop cracks and fissures where infectious germs can creep in.

    It's easy to ignore preventive foot care, especially when you don't notice any discomfort. But slow-healing wounds and infections can lead to gangrene and may even require amputation. To avoid these problems, follow these tips:

    * Wear good shoes, and wear them all the time (even in your home) to prevent injury. Shoes that don't fit properly can cause pressure ulcers. Closed-toe shoes with a wide toe box are ideal.
    * Inspect your shoes before you put them on for anything that might be lodged inside that could harm your foot.
    * After you've worn a new pair of shoes for an hour or two, inspect your feet for signs of a poor fit.
    * Watch where you're walking, and keep an eye out for anything that might injure your foot.
    * Look at your feet every day, checking for thick calluses, ulcers, athlete's foot, sores, ingrown toenails, corns, swelling, skin color changes or cracked skin. Make sure to check between your toes. Use a mirror to check the bottoms of your feet, or ask a friend to take a look if vision problems or obesity make it tough to check your feet on your own. "Nails have to be managed well and calluses have to be buffed down. A good podiatrist is crucial," Matson says. "A callus that's discolored or bleeding underneath is often a sign of a pre-ulcer."
    * Don't trim your nails or treat calluses, warts or bunions at home, because it may result in injury. With diabetes, even small injuries can be very serious if an infection sets in.
    * Wash your feet with lukewarm water daily, but don't soak your feet — soaking removes oil.
    * Moisturize your feet with a cream or oil designed for diabetic foot care, but don't spread it between the toes.

    Stay on top of it

    If you do develop a foot ulcer, see your doctor, a podiatrist or a diabetic foot care specialist right away. "People need to get those wounds looked at quickly so they don't become chronic situations," says Catalano. Your doctor will develop a treatment plan, starting with a look at your diabetes control and other health conditions that can affect healing, such as high blood pressure and peripheral vascular disease. "You don't want to just focus on the wound. You need to look at the whole person," 
he adds.

    It's important to keep pressure off the wound so it can heal. Matson says options range from special boots and half-shoes to crutches, wheelchairs and bed rest, depending on the severity and location of the wound.

    Most diabetic wounds extend beneath the top skin layer, into fat, muscle and even bone. "You're going to have dead tissue there, and one of the key elements in dealing with these wounds is they need to be debrided," Matson says. "We want to get that cleaned up quickly because dead tissue has a greater chance for bacterial buildup." Debridement means removing the outer dead tissue from a wound in order to prevent infection and provide oxygen to the site to help in healing. Products with antimicrobial properties can help clean dead tissue from wound sites, though sometimes surgery is needed. Intravenous, oral or topical antibiotics and antifungal medications can help fight infection as well.

    Once the wound is clean, your doctor will recommend dressings that promote healing. Wounds need to be kept moist, but not wet; various products can help depending on whether your wound is too wet 
or too dry.

    Wounds tend to change over time. A wound may start out wet and draining, but as it heals it may become drier, so treatment may need to change to reflect the wound's progress.

    "It's all about establishing a good balance in the wound so the body can heal itself using its own natural growth factors," Catalano says. For some people, like Joseph Stock, hyperbaric oxygen treatment can help the body heal.

    Be sure to talk to your doctor at the first sign of any diabetic nerve trouble, injury or ulcer, so you can get prompt attention and increase your chances for a speedy recovery. An ounce of prevention is worth a pound of cure.

    Breathing in relief

    Hyperbaric oxygen therapy may be prescribed to help patients dealing with wound healing. During treatment, patients spend about 90 minutes every weekday for four to six weeks in a special chamber, breathing in 100 percent oxygen, nearly five times the level found in air, at two times normal atmospheric pressure. The therapy can help speed healing by:

    * Helping antibiotics and anti­microbes fight off germs
    * Stimulating white blood cells to battle infections
    * Promoting new blood vessel growth
    * Encouraging fibroblasts to heal wounds
    * The walls of the chamber are acrylic so patients can see out, and they can converse with the staff. Typically patients can pass the time watching TV.

    Treating the Pain

    Getting pain under control frees you to enjoy your life. But glucose control alone may not be enough to thwart diabetes-related nerve pain. Moreover, the pain can be unpredictable — it may worsen at first as the nerve heals, or it may lessen if the nerve further deteriorates and no longer responds to pain. You can start treating the pain with common over-the-counter pain relievers such as acetaminophen (Tylenol®) and ibuprofen (Advil®). Your primary care doctor, endocrinologist or neurologist may prescribe other medications or treatments to help alleviate the pain. For example:

    * Pregabalin (Lyrica®) and duloxetine (Cymbalta®) are approved, and several other tricyclic antidepressants are effective (though not formally approved) for this type of pain. The serotonin and norepinephrine levels that are regulated to control depression also help suppress the brain's pain response, so the same medications that help with depression may help with nerve pain. Anti-seizure medications may also be helpful.
    * Many drugs that are used for other types of nerve pain also work to treat diabetic neuropathy, since the conditions trigger pain in similar ways.
    * Some creams can bring relief. Capsaicin cream (such as Capzasin-P® or Zostrix®), which is derived from chili peppers and depletes some of the pain transmitters, can work on small spots but isn't practical for larger applications. Lidocaine cream can help numb the peripheral nerves. Homeopathic topical ointments such as Neuragen® have also provided pain relief for some people.
    * Some weaker opioids such as tramadol can be helpful, and while stronger narcotics can be effective against the pain, their side effects can cause problems and they have the potential for abuse.
    * Spinal cord stimulation, while not approved for diabetic neuropathy, may also be suggested. In this treatment, doctors place a small electrode in the epidural space — the same spot used to treat the pain of childbirth. The electrode activates a signal that replaces the pain with a pleasant tingling feeling.

    By Stephanie Thurrott. Photo by John Hubbard.