Driving While Diabetic

Every week, an on-line newsletter for diabetics appears in my inbox.  This newsletter tends toward the practical, the up-to-date, the amusing.  It’s well done.  I subscribe because I like to know what general information diabetic patients find helpful.  Last week I found a comprehensive list of tips for managing blood sugar while traveling. Two things occurred to me.  The first thing was that many  of the items on this list would be useful not just for those with diabetes, but for all travelers.  Tips #1 (minus the testing supplies), 5, 6, and 8 fall into this category.








The second thing I thought about was that diabetes sure makes traveling more complicated.  It doesn’t make it impossible, and it certainly doesn’t make it inadvisable.  It’s fine to drive if you’re diabetic.  As long as your blood sugars remain the normal range.  

What’s the difference between being diabetic and not being diabetic?  One thing and one thing alone.  People who are not diabetic are able to keep their blood sugars in the normal range without having to think about it.  Their bodies do it automatically.  People who are diabetic, on the other hand, have to involve their brains in the process.  They can’t keep their sugars normal anymore without thinking about it, walking the walk, and measuring and monitoring throughout the day.  That’s what it takes to keep your blood sugars in the normal range when your body can no longer do it automatically.

As long as you do what needs to be done, however, you can expect to remain healthy, with a very low risk of developing complications.

This list reminded me of the difference between being diabetic and not.  As long as you do everything you need to do to keep your blood sugars normal, you should expect to be able to do anything and everything that non-diabetics do.  Like travel.

But have you taken a look at the list yet?  It’s unbelievably detailed!  They thought of everything, and good for them.  Now here’s the rub.  If you’ve ever left home for more than a day or two, you know how complicated it can be.  You have to arrange for the animals, the newspapers, the mail, the house lights, the lawn (if you’re leaving for a while), the children (if they’re not coming with you), the job, the email account.  You have to notify the neighbors, the police (maybe), the boss, the co-workers, the paperboy, the lawn guy, the babysitter, the house cleaner.  Makes you not want to leave home.  

So why would you knowingly make choices that increase immeasurably the complexity of your arrangements?  My suggestion would be that you add these tips to your mental list of reasons that you don’t want to become diabetic (type 2).  Think of it this way:  God grant me the serenity to accept the things i cannot change, the courage to change the things I can, and the wisdom to know the difference.  

Make the choice to change the things you can!  Most cases of type 2 diabetes are preventable.

Here are the tips:
1. Pack more snacks, drinks, and blood sugar testing supplies than you think you will need, so that you are prepared in the event of travel delays.
2. If you take insulin, store it for the road trip in a cooler or insulated container.
3. Be sure to wear your medical bracelet if you have one. 
4. If you are taking a long car trip, test your blood sugar before leaving. If it is 70 mg/dL or below, eat or drink something that will raise it quickly, and wait until your blood sugar is back to normal before getting behind the wheel.
5. Research nearby restaurants and grocery stores in your travel destination so you know your healthy options for meals and snacks.
6. You can also research emergency or urgent-care clinics along your travel route. If you belong to an HMO, ask what doctors and facilities along your travel route are affiliated with your plan.
7. Test yourself at regular intervals.
8. Stop periodically to walk around, stretch your legs and give your body a break from sitting down.
9. Follow your daily dosing routine at the regular times. If you always take a medicine at 10 a.m., do so in the car at the same time.
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YOUR HEALTHY PLATE: ANOTHER GAZPACHO, THIS ONE GOLD!

I saw this recipe on a site for new blenders.  Since I expect that I’ll have a new blender by the end of the week (!), I thought it was a perfect time for this beautiful, late summer, golden gazpacho recipe.  If you can’t find yellow (acid-free) tomatoes, use red ones and the soup will be orange.



5 medium yellow tomatoes, quartered

Corn kernels stripped from 2 cobs

1/2 cucumber, peeled if thick or waxy

1/2 yellow pepper, cored and seeded

1/2 clove garlic

1 scallion, cleaned and sliced

1 1/2 tablespoons olive oil

1/2 tablespoon white vinegar

1/2 teaspoon kosher salt

1/4 teaspoon cayenne pepper



Blend the tomatoes first.  Then add in the remaining vegetables, one at a time.  Then add the oil, vinegar, salt and pepper.  Serves 4.



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Creamy Kale (No Dairy)

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You would not believe how much kale is growing in my garden.  I’ve given some away, eaten some steamed, spun some into green smoothies, and still there is more.  So here’s one more way to use it up.  Many thanks to Whole Life Nutrition Kitchen for this great recipe.  They recommend serving it with quinoa, raw vegetables, and chicken or black-eyed peas for dinner.  They also warn that 10-12 cups of chopped kale may seem like a lot, but it shrinks a lot when you cook it.

Ingredients:
10-12 cups finely chopped kale

2-3 tablespoons olive oil
1 small onion, chopped (approx. 1 heaping cup)
2 cloves garlic, chopped
1/2 cup raw cashews
2 cups water
1/2 small jalapeno pepper, seeded
1 tablespoon fresh squeezed lemon juice
2 tablespoons nutritional yeast
1 to 2 teaspoons Herbamare (an herb/seasoned salt mix–I used 1 t. salt + a mix of fresh basil and oregano)

#1  Chop the kale and set aside.
#2  Heat a large skillet over medium heat, add olive oil, then onions and garlic. Saute 5 min or until soft and turning brown at the edges.  Add to a blender with cashews, water, jalapeno pepper, lemon juice, nutritional yeast, and Herbamare. Blend until smooth and creamy. 

#3  Return sauce and chopped kale to the skillet and simmer 10-15 min until kale is soft and sauce is thick. Season to taste with salt and pepper.

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Which Eggs are Best?

Limited access to a computer today — I’m visiting family in NJ and the power isn’t back yet.  Working by generator today, so I’ll make it brief!

If you are one of the majority of Americans who purchase their eggs at a store, you may have questions about which eggs to buy, and why.  What are “free-range” and “cage-free”?  Here’s a little primer to help you understand the facts behind the labels:

FREE-RANGE chickens roam freely outdoors.  The amount and type of outdoor access are unspecified, as is the type of feed.  If you happen to be lucky enough to know who cares for these chickens, you’ll know the answers to these questions.  Beak cutting is, technically, permitted.

ORGANIC eggs with the “USDA Organic” seal come from chickens that have outdoor access, no matter how little.  The amount of outdoor time is not specified.  By the way, the USDA Organic seal is the only official, federally regulated egg label claim.  These chickens eat only organic, vegetarian, antibiotic-free feed.  Note: Chickens are not vegetarian by nature; bugs and worms are a vital part of their diet.  Beak cutting is, technically, permitted.

CAGE-FREE chickens are uncaged with unlimited access to food and water, but they have no outdoor access unless specified.  Cage-free chickens may be packed tightly into a large, unlit shed with no access to a farmyard.  Beak cutting is permitted.

CERTIFIED HUMANE chickens live in barns or warehouses without access to the outdoors unless specified.  Regulations exist to limit the population density and permit normal behaviors.  Beak cutting is, technically, permitted.

ANIMAL-WELFARE APPROVED chickens are raised by independent family farmers with flocks of up to 500 chickens.  They spend unlimited time outdoors on pesticide-free pasture.  Beak cutting is NOT permitted.  Eggs from these farms are most commonly found at specialty or health food stores, or at farmers’ markets.

UNITED EGG PRODUCERS CERTIFIED specifies only that caged hens receive food and water.  That would, naturally, be the case if hens are to remain alive and laying. 

Finally, the following terms are unregulated and have no official meaning:  Natural. Naturally Raised. No Hormones. No Antibiotics.

I recommend purchasing eggs with increased levels of omega-3 fatty acids, gained from better quality feed, and that you buy “Animal Welfare Approved” and/or “Free Range” eggs if you can find them.  When it comes to eggs, don’t hesitate to buy the more expensive ones.  If you do the math, even the most expensive eggs at my local supermarket, at $4/dozen, still work out to only 34 cents an egg.  That’s some of the cheapest high-quality protein around. 
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YOUR HEALTHY PLATE: GAZPACHO

There were 10 large tomatoes in my CSA box today.  Here’s something wonderful to do with them, adapted from “Poor Girl Eats Well.”

Gazpacho

                                                                                                  
5 large, very ripe tomatoes                                                           
1 medium cucumber, unpeeled
1 small bell pepper, red or green as you prefer
1 small red onion
1 large carrot

1 T finely chopped hot pepper (serrano, jalapeno)  
1/2 t crushed red chili flakes                                                    
2 large garlic cloves
2 c tomato juice
1/4 c olive oil
2 T balsamic vinegar
Salt & pepper to taste

Directions:

1.  Dice and mix together the onion, bell pepper, carrot and cucumber.  Separate into two equal batches, but put one batch in a large serving bowl (or pot) and the other in a small bowl.
2.  Chop the tomatoes.  Add one cup of the chopped tomatoes to the small bowl of vegetables to use later.  Add the rest of the tomatoes to the large serving bowl filled with chopped vegetables.
3.  Add the tomato juice, olive oil, balsamic vinegar, salt, and pepper to the serving bowl, now filled with tomatoes and vegetables.  Slowly puree the mixture using a blender or hand mixer.
4.  Finally, pour the reserved vegetables (from step 1) and tomatoes (from step 2) into the serving bowl.  Adjust seasoning and refrigerate for 30-60 minutes. 
5.  Garnish with cilantro, chopped scallions, or grated carrot, as you like, and serve.
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What’s for Dinner Tonight?

I rolled out of bed this morning, threw on some old clothes and headed outside.  It was drizzling, but I couldn’t wait any more; the garden needed some serious weeding, made more serious by two Sundays in a row of commitments when it wasn’t raining, and rain when there weren’t commitments.  The crabgrass was my primary focus today.  I saw some dandelions, which I’ll leave for next week, when I’m looking forward to making another one of those amazing dandelion salads I wrote about a few weeks ago.  I saw, for the first time, a little bit of purslane, too, which I left to spread and grow.  Purslane, which is pleasantly crunchy and extraordinarily high in omega-3 fatty acids, was actually cultivated in gardens once upon a time, though most people consider it a weed these days.  It’s everywhere; if you Google its image, you’ll probably recognize it.  I saw a large patch of it growing near my office last Friday.  Let it be known that I’m planning on reviving purslane-on-purpose.  

In my garden, I sprinkled lots of lettuce seed about a month ago, so today I got to pick a huge bowl’s worth of mixed miniature lettuce leaves.  Then I picked a round purple and white striped eggplant, 2 long dark purple eggplants, a long thin red hot pepper, one tomato, a large bunch of basil, and a couple of bunches each of flat and curly parsley.  I carried everything into the kitchen and tossed the lettuce into a bowl of water to get it rinsing right away.   I cut up the eggplants and tomato.

Back outside, I grabbed the wheelbarrow.  The chicken coop was due for a change of straw today.  I filled the wheelbarrow with the old straw, and took it to the garden, where I spread the straw over the areas where the crabgrass had been thicker.  We’ll see whether that works. 

In the kitchen, meanwhile, the eggplants, tomato, and hot pepper, along with 3 cloves of garlic, an onion, olive oil, and a couple of zucchini, turned into a lovely ratatouille.  When it was done I sprinkled the top with the fresh parsley and left it to cool to room temperature.

A small head of broccoli from last week’s CSA was cut into florets, steamed until bright green, and then sprinkled with French Thyme.  I cut the woody part of the stems from five gorgeous artichokes, and then steamed them, too, along with two cut up limes, until the leaves separated easily.  I baked a few potatoes.  The lettuce went through a great many water changes until it looked quite clean and all the specks of dirt had been rinsed away.

In the afternoon, my husband left for the supermarket to pick up a few pieces of tilapia.  

I stripped the basil leaves (approx 30) from the stalks, and mixed them with olive oil (approx 1/2 c.) and salt (approx 1/2 t.) in a 2-cup pitcher.  Then I blended the mix with an immersion blender until it was smooth and bright green.  This should be amazingly good(!!) anywhere you decide to put it: on the salad, baked potatoes, broccoli, or fish.  Or all of them, as I plan to do.  Maybe the ratatouille, too.  I’ll bet the artichoke leaves will taste delicious dipped in basil-olive oil.

Dinner should be ready soon and, given the number of dishes we prepared, there should be plenty of leftovers.  I am looking forward to eating them for lunch this week.  I am also looking forward to a new batch of vegetables from our CSA on Tuesday.  
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YOUR HEALTHY PLATE: POTLUCK BEAN SALAD

Running out of ideas for what to take to summer potlucks?  Run no more…

16 oz can red beans
16 oz can black beans
16 oz can garbanzo beans
16 oz can corn, drained (or 2 cobs worth)
Rinse and drain.

2 large stalks celery, sliced very thinly
1 medium red onion, diced small
1 large tomato, diced small-medium
1 c spicy salsa (or 1/4 cup tomato paste + 1 small jalapeno, diced fine)
1/4 c olive oil
1/4 c lime juice (approx 4 limes)
1 tsp salt
1/2 tsp cumin
1 tsp chili powder

Mix spices with lime juice at the bottom of a beautiful, wide pottery bowl, and then add in the olive oil and salsa.
Mix in corn and all the beans. Add all but 1/4 cup of the celery, diced onion and diced tomato.  Mix them together, and then pile the small mixture in the middle on top as a garnish.  Let sit 1/2-1 hour, and then take to a pot luck.  Delicious!
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Scoop at the Coop 3: Why We Raise Our Own Chickens

This past spring, what with the unceasing rain, one of our hens caught a cold and never recovered.  It was a bit sad, but there was a good side:  I figured out how to keep the pen drier so the girls wouldn’t get soaked to the skin every time it rained.  They could easily stay inside the coop whenever it rained, but they were apparently eager, no matter what the weather, to spend time out of doors.  I bought a piece of roofing to cover the open pen; and then, since most of our weather comes from the north/northwest, I fixed a large tarp across the back of the north side of the pen.  It made a big difference, and I was no longer greeted on rainy days by drippy hens.

The girls seem healthier now than ever before.  They are laying large numbers of eggs, and their combs are full and red.  In fact, after a long, dry patch that lasted at least a year, we have seen Nora’s pale pink, wizened comb turn soft, red and fertile again.  She’s laying eggs now at least every other day.  Dora’s comb has grown so big that it covers almost her entire head and makes her look like she’s wearing a red baseball cap.  Nora and Dora are black-and-white Hamburgs, and they lay creamy white, angular, medium-sized eggs.  The five Golden Buffs, Daisy, Maizey, Maggie, Goldie and Glorie, lay extra-large, extra-round, brown eggs.  The two lighter-colored Golden Buffs, Maizey and Maggie, are probably the ones whose eggs are slightly chalky in appearance.

What do our hens eat?  They get approximately 5 cups daily of an organic, grain-based feed that my father obtains from an outfit in Hillsborough, NJ.  Besides that, they get major amounts of leftovers from the cutting board.  On any given day, these might include apple cores, beet greens, stale sunflower seeds, leftover salmon skin (from special dinners), watermelon rinds, the seed mass from inside cantaloupes and honeydews, tops and seeds from sweet peppers, or cucumber ends.  I toss in things like stale bread and moldy muffins.  After Passover this past spring, they ate all the leftover matzah.

The girls are let out of the coop (with its attached pen) every afternoon for 2-3 hours, and that’s when they get their fill of bugs, grubs, greens, weeds, and worms.  They hang around when I garden to grab any worms I unearth in the process of digging and turning the soil.

What do they seem to like best?  The same thing as human beings, oddly enough.  Or not.  They love the sweet stuff.  They fight over strawberry tops and melons, and they look amusingly ghoulish as they cannibalize melons and race away to enjoy their bounty, the long, ragged strings of seeds and fruit dripping from their mouths.  They vie with each other for an ideal spot when grain is being tossed into the pen.  Sometimes somebody gets pecked and lets out a big squawk, but usually they behave well enough.

They are also partial to protein.  They fight with one another to be the lucky recipient of fish skin, and they have behaved similarly on the rare occasions that I have brought them leftover hamburger.  We have a family policy never to feed them leftover chicken, the reasons for which seem obvious.

I know that they need greens, and I’ve seen them eating them, but never with relish.  Maybe greens are an acquired taste, or maybe they just aren’t as delicious as protein or sweet.  All I know is, it reminds me of people.  A friend of mine recently shared that she requires her children to eat their vegetable course (served first) before the rest of the meal.  Her kids are beautiful, healthy and slender.  I’m just saying…  Anyway, sometimes I toss grain on the crabgrass growing around the edges of my fenced garden.  Then the chickens get their greens, and I get some help with the weeding.  They also get plenty of greens from the kitchen in the form of outer lettuce leaves, wilted salads, and fading cole slaw, but they always eat it last.

This brings me to Dr. Niva Shapira, from Tel Aviv University, whose recently published article in the Journal of Agricultural and Food Chemistry explains how a hen’s feed affects the quality of her eggs.  Dr. Shapira’s research indicates that hens fed a diet high in wheat, barley and sorghum (another grain) produce eggs much lower in omega-6’s and with much larger amounts of anti-oxidants than hens fed a cheaper diet consisting mainly of soy- and corn-based products.

Dr. Shapira showed that daily consumption of two standard, commercial eggs increased LDL cholesterol oxidation by 40 percent over eating eggs from hens eating the better quality feed.  In North America (but not in Europe by the way), corn- and soy-based chicken feed usually make up the bulk of commercial hens’ diets.  Looks like your health is on your hen’s plate, too.

For now, many of us are limited to what’s available at the supermarket.  But when you do buy eggs, pick the expensive “high omega-3” eggs.   Even if they cost more than the standard, commercial eggs, they are still some of the cheapest high-quality protein available.  And worth every extra penny.  If you don’t spend it on food now, you’ll spend it on medicine later.


YOUR HEALTHY PLATE: Tuna with a Bite

Some of the young people in my home have their own way of preparing tuna fish and I thought they might inspire you to think about other ways of making tuna than with the standard mayonnaise and celery. 

When I mentioned this to a co-worker, she shared that her favorite way to eat tuna is to mix in a tablespoon of olive oil.  That sounds delicious.  I like to cover a tray with lettuce leaves and then turn over a can of tuna in the center, surrounding it with piles of green beans, olives, new potatoes, carrots, and radishes.  All different colors.

1) Here’s a recipe for “tuna with a bite”:

1 large can of tuna (water pack)
1-2 teaspoons tabasco sauce
4-5 tablespoons mayonnaise
1 large sour pickle, diced
1 tablespoon of barbecue sauce (optional)

2) and here’s a recipe for “tuna with a bit less bite”:

1 large can of tuna (water pack)
4-5 tablespoons mayonnaise
3 banana peppers, chopped into small pieces
2 tablespoons mustard

Mix and serve.  Bon appetit.
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Hardening of the Arteries

Last week’s blog post was all about your heart.  If you think of the heart as having electricity, carpentry and plumbing, then heart attacks are a plumbing problem, i.e., a blockage in the pipes.  The pipes, of course, are the blood vessels of the heart, and the blockage is called a clot.  If blood can’t pass through a vessel, then all the cells past the blockage quickly become starved for oxygen, and then they die.  That’s a heart attack.  

What does this have to do with diabetes and obesity?  Everything.  High blood sugars cause stiffening of the blood vessel walls.  The higher your blood sugars, the faster the blood vessels harden.  The longer your blood sugars remain high, the faster the hardening occurs.  So the worse your diabetes, and the longer you have it, the harder your arteries become and the worse your circulation gets.

We’`re not just talking here about the arteries in your heart.  Once your arteries start to harden, it’s a problem everywhere.  Each of these complications has its own name.  Blockages in the
heart cause heart attacks.  Blockages in the brain cause strokes. 
Blockages in the legs cause peripheral vascular disease, and then
amputations.  Blockages in the kidney cause renal insufficiency, and
then “end stage renal disease.“   Blockages in the back of the eye, or
retina, cause diabetic retinopathy.  And so on. 

These aren’t all separate diseases.  The fact of the matter is that they
are all caused by the same underlying problem.  If you’ve been reading
this blog for a while, along the way you`ve learned that this problem is
caused by high insulin levels, or “hyperinsulinemia.”

Hyperinsulinemia
is also known as metabolic syndrome.  It`s a pre-diabetic state, and it
is the underlying cause not just of diabetes, but also of high blood
pressure, high triglycerides and low HDL, polycystic ovarian syndrome
(PCOS, a cause of infertility in young women), and obesity.  High
insulin levels stiffen blood vessels, too.

Long before people are diagnosed with diabetes, their bodies try to
cope with the occasional (at first) and then frequent (later) high blood
sugars by releasing loads of extra insulin to catch all the extra blood
sugar.  But the high blood sugar itself causes resistance to the
insulin, and so bodies respond by releasing even more insulin. 
Unfortunately, it’s never enough; the amount of circulating insulin
continues to rise.   When the day finally arrives on which the person can no longer make enough insulin to manage their ever-rising high blood sugars, those blood sugars begin to rise even higher and faster.

Diabetes increases the likelihood of having a stroke (brain arteries), an amputation (leg arteries), kidney disease and dialysis (renal arteries), blindness (retinal arteries), dementia (due to “small vessel ischemic disease“, which means “hardening of the small blood vessels“), and difficulty having an erection (penile arteries).  In case you’ve ever wondered, yes, hardening of the arteries causes erectile dysfunction, too.  That’s why we call erectile dysfunction a “proxy” for heart disease.  Hardening of the arteries anywhere increases the risk of hardening of the arteries everywhere. 

Remember that blood sugar problems start years, even decades, before people are diagnosed with diabetes. For a long time, their blood sugars have been spiking after they eat, and then taking too long to return to normal.  For all that time, damage has been slowly accruing.  That’s why people who are diagnosed with diabetes already have 10 years worth of damage to their blood vessels at the time of their actual diagnosis.  What does that tell you?  It tells me that we diagnose diabetes 10 years after it really starts.  I’d like to change the paradigm so that doctors recognize diabetes before the damage begins.  Even better, I`d like to identify those people who are entering that 10-year period and stop it before it even begins.  We need to start diagnosing people at the beginning of that 10-year period instead of at the end.  It would save patients 10 years of damage to their blood vessels. 

All the while, as the years go by, arteries continue to harden throughout the body.  So if you are ready to decrease your chances of developing hardening of the arteries, I`d like to suggest that you start today by decreasing your consumption of refined carbohydrates, and shifting your diet in the direction of foods that you absorb slowly:  Eat more fruits and vegetables, more healthy oils, more high-quality protein, and less white flour and sugar.   
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