i fc gg introduction g your meter and strips frostbitsvision? she ended up buying new insulin at a...

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Your Meter and StripsEvery blood glucose meter has a tem-perature range within which its resultswill be valid. Some meters will notwork at all if the ambient temperatureis outside of the range, while otherswill do worse; they will work but theresults may not be accurate. The chem-ical reactions the meters perform (toread glucose levels) are affected by bothaltitude and temperature. Check your meter manual to findout what the temperature range foryour meter is. You can also refer tothe table below.Strips are even more susceptible toextreme weather. They like staying atroom temperature, out of dampness.The chemical reaction that takes placeon the strip will be slowed down incold weather, and can give a false lowreading.

During a cold-weather activity, it isadvised that you keep your meter andstrips in a pouch. You should be wear-ing several clothing layers in the cold,and the pouch should be placed in themiddle of those layers. If it's directlytouching the skin, it could get toowarm. If camping in cool weather,store your meter in your sleeping bag. If you live in an old, drafty house, tem-peratures may drop too low for propermeter function even indoors. Manymeters cannot work below 55 degreesFahrenheit, a common occurrence onwinter nights.

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Meters and Strips

BBaayyeerr

LLiiffeeSSccaann

MMeeddiiSSeennssee

RRoocchheeDDiiaaggnnoossttiiccss

OOPPEERRAATTIINNGGTTEEMMPPEERRAATTUURREESS((FFAAHHRREENNHHEEIITT))

GlucometerElite andGlucometerDEX: 50-104°,GlucometerEncore: 63-86°

One TouchBasic, OneTouch Profileand FastTake:59-95°,SureStep:50-95°

Precision QID,ExacTech,ExacTechRSG: 64-86°

All AccuChekmeters: 50-100°

RREELLAATTIIVVEEHHUUMMIIDDIITTYY

RRAANNGGEE

Elite: 20-80%,DEX: 10-80%,Encore:<85%

All: 10-90%

All: 20-80%

All: 20-80%

AALLTTIITTUUDDEERRAANNGGEE

Altitude doesnot affectmeters

All: tested upto 5,280'

Precision QID,ExacTechRSG: testedup to 7200';ExacTech nottested

All: tested upto 10,000'

SSTTOORRAAGGEETTEEMMPPEERRAATTUURREESS((FFAAHHRREENNHHEEIITT))

All: 59-86°

All: below86°; if stripsget belowfreezing, usecontrol solu-tion to test

39-86°

All: similar tometers, 50-100°

RREELLAATTIIVVEEHHUUMMIIDDIITTYY

RRAANNGGEE

Keep in foilpackets untilready for use

Keep in vialuntil ready foruse

10-90%

Keep in vialuntil ready foruse

For the Glucowatch to operate, skin temperature must be 68F-104F (20C-40C).AutoSensors should generally be stored in a refrigerator at 36F to 46F (2C-8C).AutoSensors cannot be stored in a freezer, but if needed, they may be kept at

room temperature (below 77F or 25C) for up to one month.

FrostbitsA variety of winter tidbits

IntroductionAs in our previous issues, we onceagain present a variety of diabetesrelated articles which we feel wouldbe of interest to our readers. We wishto reiterate that the ideas and sugges-tions expressed in these articles arenot "one size fits all". Experimentwith the various approaches and seewhat works best for you.

What will you learn in this issue's "InControl"?

1) Our colorful collection of wintertips and tidbits will ensure that youapproach the new season fully confi-dent and prepared.

2) Fluctuating morning blood sugarsare probably among the most con-fusing and misunderstood aspect ofBG control. You'll find a clarificationof many morning blood sugar phe-nomena, as well as suggestions foravoiding the A.M. highs.

3) A good food scale is an essentialtool for any diabetic (especially whenusing the ECF method), but youmay be overwhelmed by the numberand variety of available scales. Ourthorough and comprehensive guidewill aid you in understanding andchoosing the right scale.

In this issue, you'll also find somefascinating ways to maximize the fea-tures of the "Diet Computer Scale" asan aid in your diabetes control. You'llsurely join in the enthusiastic "Wow"that vibrated in the room when I firstintroduced this scale to our group.

4) If you are considering the lowcarb diet (and certainly if you arealready an avid follower), here aresome important points to consider.

5) Finally, we once again present ourlong awaited and much enjoyed col-umn "Friend to Friend". Thanks toall those who have shared their tipsand experiences so that others maybenefit. We are waiting to hear fromthe rest of you!

RHM-FWD

(continued on next page)

25F R I E N D S W I T H D I A B E T E S

Before you go, know your meter. Here is a guide to the operating guidelines of some popular meters.


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If you experience a seemingly strangereading while in extreme weather, a cal-ibration check should be the first step.

Keeping Active in WinterThe winter weather might have youfeeling like hibernating. But you don'thave to hang up your sneakers untilspring. With some common sense,there's usually no reason you can't exer-cise outdoors year-round. To keep yourself motivated, focus onwhat you'll gain if you keep exercisingfrom fall straight through winter. You'llcontinue to reap the short- and long-term benefits of exercise. You'll be inbetter shape come spring. Plus, exercisecan help shake those winter blues,improve your mood, increase yourenergy level and help you sleep better. Try to set aside 20 to 30 minutes a dayfor exercise. You can even count a littleon the non-strenuous activities you dodaily. Make a workout of householdcleaning or walk the stairs in yourhome. You can try joining a health clubin the neighborhood or purchasingyour own exercise equipment. You mayalso find that working out in water iseasier on your joints than otherforms of exercise.Don't be too hard onyourself if you miss aday! Just get backon schedule assoon as possible.For extra moti-vation, workout withy o u rspouse ora friend. H o ws h o u l dyou pre-p a r e

yourself for an outing on a cold, wet,and windy day? To improve your com-fort and safety while exercising in thecold, the American College of SportsMedicine recommends the following:

Layer Clothing — Several thin layersare warmer than one heavy layer.Layers are also easier to add orremove and thus, better regulateyour core temperature. The goal isto keep the body warm, minimizesweating and avoid shivering. Cover your Head and Mouth- Yourhead should be covered while exer-cising in the cold, because heat lossfrom the head and neck may be asmuch as 50 percent of the total heatbeing lost by your body. To warmthe air before you breathe it, use ascarf or mask. Stay Dry- Wet, damp clothing,whether from perspiration or precip-itation, significantly increases body-heat loss. Keep your Feet Dry- Use a fabricthat will wick perspiration awayfrom the skin. Polypropylene, woolor other fabrics that wick moistureaway from the skin and retain insu-lating properties keep the bodywarm when wet.

Stay Hydrated — Dehydrationaffects your body's ability toregulate body heat andincreases the risk of frost-bite. Fluids, especially water,

are as important in cold weath-er as in the heat. Avoid consum-ing alcohol or beverages contain-

ing caffeine, because theseitems are dehydrating.Adapted from the Mayo Clinic

Health Letter and othersources.

Mail order Insulinin Cold Weather

Insulin sent through the mail isroutinely exposed to tempera-ture conditions far exceeding

the manufacturers' recommenda-tions. Two manufacturers ofinsulin, Eli Lilly & Co. and NovoNordisk, recommend that theirinsulin be stored at temperaturesbetween 35 and 85 degreesFahrenheit. One study showed thatnearly 92 percent of the medicinesdelivered by mail are exposed toextreme temperature conditions,which can affect their potency. Oneinsulin pump trainer reports,"Unfortunately, I have had patientswhose blood sugars seem to go outof control for no apparent reason.When I have them purchasereplacement insulin at local phar-macies, often their control returns.The insulin they replace is theinsulin that comes through themail with no special packaging toprotect it. "Craig Burridge, execu-tive director of the PharmacySociety of the State of New York,relates: "We had a report of awoman in Schenectady, New York,whose insulin was left in the mail-box on a cold day. When she wentto use the insulin, she found partic-ulate matter in the vial because ithad frozen. How long would thispatient have used the vial with sub-potent insulin if she had had poorvision? She ended up buying newinsulin at a local pharmacy, sinceshe could not wait for more tocome through the mail."The coldin an outdoor mailbox on a winterday, or the heat of the metal on asummer day has the potential todecrease the potency of insulin.Buyer, Beware!!

Adapted from an articleby Marty Irons, R.Ph., CDE.

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(Frostbits — continued from previous page)


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Are you experi-encing fluctuat-ing blood sugars

during the morninghours? The first bloodsugar of the day is usu-ally the most impor-tant one for controllingthe entire day's readings. "If I wake uphigh, my whole day is shot!" is a typ-ical complaint because an early morn-ing high is often quite difficult tobring down through the day.Diabetes educators are constantlyhearing the question, "How come Iwent to sleep with an in-range BGnumber and I woke up with a muchhigher number? I didn't eat anythingin middle of the night; I didn't evendream about food!"The answer is that diabetes does notalways stick to the rules, or moreaccurately, it sticks to its own set ofrules. Once you learn these rules andhow to identify them, things will startto make sense and you will be betterable to deal with your morning bloodsugars. In this article we will attemptto show you some of these "non-rules", which will aid you in takingcontrol of your diabetes. There can bepredictable reasons for your unpre-dictable and "brittle" BGs! The secretis to learn how YOUR body reacts indifferent circumstances.As stated in our disclaimer, nevermake a change in diabetes regimenwithout prior discussion with yourhealth care provider. We are specifical-ly reiterating this warning here, as thefollowing article discusses makinginsulin changes. These tips have beencollected from individual experiences,and some may be rare exceptions tothe rule; others, however, occur veryfrequently (up to 70% of diabeticsexperience them). Remember, "If itisn't broken, don't fix it". We haveonly provided this information withthe hope that if you are among thoseexperiencing unpredictable blood sug-ars, this additional knowledge may

give you a clue of what's going on andhow to overcome it.If you do think that one of thedescribed phenomena apply to you,please do not jump to conclusionsbefore you check, double check andtriple check your blood sugars to ver-ify this. Medtronic Minimed'sContinuous Glucose Sensor, or theGlucowatch from Cygnus are excel-lent tools for tracking blood sugarpatterns, as they test BGs automatical-ly at constant intervals. Show yourrecorded logs to your health careprovider to discuss the necessarychanges. A final note about irregular morningblood sugars: Although it might seemthat reading about the various morn-ing phenomena would make it harderto pinpoint your exact problem, theopposite is true. During the day, it ismuch harder to isolate the exactsource of BG fluctuations; you maywonder if a high blood sugar is due toyour basal or last bolus. But in themorning, you know that a long timehas past since your last meal or bolus.Morning trends are much easier toidentify if you know what to look for!If you are not yet a pump user youcan enjoy this article as well. Justtranslate the word ‘bolus’ to ‘pre mealshort acting insulin’, and the word‘basal’ to ‘long acting insulin’.

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Recognizethe Signs!

Shivering is usually the firstsign of dangerous cold expo-sure, as the body is trying to

generate its own heat throughuncontrolled muscle contraction.This should be your first warningto seek shelter. The two most dan-gerous conditions that can resultfrom cold weather exposure arefrostbite and hypothermia. Frostbite describes the freezing ofsuperficial tissues of the face, ears,fingers and toes. Its symptomsinclude pain, burning, numbness,tingling, and skin which turnshard and white, blistered, or firmand shiny with a grayish tinge. Totreat, get the victim to a warm, dryplace, raise affected areas andapply warm, moist compresses tothem (but do NOT apply directheat or rub frostbitten areas).Hypothermia is a more severeresponse to cold exposure that isdefined as a significant drop inbody core temperature. Symptomsinclude goose bumps, shivering,confusion, sluggishness, lack ofcoordination, and ultimately,unconsciousness. To treat, take theperson to adry, warmplace andp r o v i d ee x t r awarmthw i t hb l a n -kets orclothing.

RISE and Shine!Controlling Morning Blood Sugars

TTYYPPEE TTWWOOSSCCAANN DDOO IITT 22

Metformin/Glucophage XRmay be taken at dinnertimeto help improve morning BG




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F A C I N G F O R W A R DI N C O N T R O L

The Dawn PhenomenonSome 50% to 70% of people withType 1 diabetes find they need moreinsulin in the early morning hours tooffset a rise in blood sugar. This rise,called the Dawn Phenomenon, is cre-ated by a normal increase in the pro-duction and release of growth hor-mone, and to a lesser extent by corti-sol and adrenaline, which trigger theproduction and release of glucosefrom the liver. If this need is not metby an increase in insulin delivery, theblood sugar rises as daylightapproaches and is high when the per-son awakens.A typical adjustment for a personwith a Dawn Phenomenon usuallyprovides slightly more basal insulinbefore and during the early morninghours.People who have a strong DawnPhenomenon find that it's difficult tocontrol the morning blood sugar withany injected insulin regimen. On apump, however, controlling themorning blood sugar becomes a sim-ple insulin adjustment. The basal ratecan be adjusted precisely to preventthe blood sugar from rising duringthe night. Easy programming allowseach pumper to set basal rates to meetindividual needs at each hour. "I usu-ally wake up in the morning with anormal blood sugar!" is a joy sharedby many new pumpers.For instructions on testing your basalrates, refer to page 97 in the third edi-tion of "Pumping Insulin". Or, use thecharts provided in the book "TheMedtronic MiniMed Insulin PumpWorksheets". There is also a verygood web page on setting basals onthe Insulin-Pumpers website,www.insulin-pumpers.org/howto/baslr.html.For some people, adjusting basal rates

or long-acting insulin is not enough.You can experiment with the following:

Same Basal, Larger Bolus: Insteadof changing the basal rate, you mayneed a higher insulin-to-carbohy-drate ratio for breakfast. A Unit of Prevention Is Worth aPound of Correction! Anothertrick for controlling the DawnPhenomenon is to raise basal rates0.1 to 0.2 u/hr at 1 a.m., asopposed to making a larger insulinincrease at 3 a.m. or 4 a.m.

An equal or even larger percentage ofpeople with Type 2 diabetes find theirpre- breakfast reading is the hardest ofthe day to control. Even though theirproblem also occurs at dawn, thesource of the problem is differentfrom the Dawn Phenomenon. Mostpeople with Type 2 have an excess offat cells in the abdomen, referred to asan apple shape. During the night,these fat cells release fat, which ispicked up by the portal vein going tothe liver. This fat makes the liver lesssensitive to the insulin passing by.Because of this insulin resistance,more insulin is needed to do the jobof stopping the liver in its productionand release of glucose. If insulin pro-duction fails to keep up with the ris-ing need because of aging and weightgain, the liver will make more andmore unneeded glucose during thenight. For people with Type 2, aninsulin pump is often the ideal way todeliver the precise, small insulin dosesneeded to stop the liver from increas-ing glucose production. Other ideassuggested in this article can also beadapted for Type Twos.

The Wake Up PhenomenonOthers find that they experience a risein blood sugars each time they wakeup in the morning (that has nothingto do with the time of day). The solu-tion for this one would be to admin-

ister a bolus every time one wakes up.If this phenomenon appears evenupon awakening from a short nap, tryto program an extended (squarewave) bolus before napping. Or, howabout exchanging the nap for a relax-ing afternoon stroll? Again, the bestwe can do is to learn our body's indi-vidual patterns, so that we can antici-pate them and, hopefully, preventthem.

The Break-Fast PhenomenonA common occurrence is a steepincline in blood sugars following thefirst meal of the day. This phenome-non persists at all meals eaten after astretch of fasting; this can mean anearly breakfast, a midday brunch, orsupper following a Yom Kippur fast.Many people find that they cannotproperly deal with

(Rise & Shine — continued from previous page)

... thatyour dreams

could be a reflec-tion of nocturnal blood sugars? If youare having bad dreams at night andwaking up high in the morning,check it out! You may be experiencingnighttime lows and morningrebounds. Nightmares, or emotionaland involved dreams, could some-times be a symptom of low blood sug-ars. Or, it is possible that the chemi-cals involved in the dreaming processare actually causing the pattern oflows and highs. Set your alarm clockfor 2 a.m. and find out what's hap-pening with your BGs overnight!

Didyou know...

Sweet(and Sour)Dreams


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the sudden ingestion of carbohydratesif the regular insulin dose is adminis-tered.One would have to experiment withhigher insulin-to-carb ratios at thefirst meal eaten every day. Or, if thehigh blood sugars appear only after ahigh carb meal is eaten, then theamount of carbohydrates in yourbreakfast may need to be reduced.(See our "Breakfast Smarts" article formore breakfast tips.)

The Motor Start PhenomenonAn interesting trend that some peopleexperience has been informallydubbed the "Motor StartPhenomenon". This is when bloodsugars spike sharply following break-fast, no matter how many or how fewcarbs are consumed. This phenome-non tends to be inconsistent, surfac-ing and then disappearing in the sameindividual. Its’ causes are unclear, butit may be stress and hormone related.It differs from the dawn phenomenonin that it appears only after food iseaten. Many people also find that itdoes not kick in when they sleep inlonger than usual, maybe because theyare more relaxed on those days.To test for the "Motor Start"Phenomenon: Go to sleep and wakeup at your usual time, but skip break-fast. Test consistently to get a fastingmorning BG profile. On another typ-ical day, eat a protein-only breakfastand test BGs constantly. On a thirdmorning, eat a lower carb breakfastand record your blood glucose read-ings. Finally, eat a high carbohydratebreakfast and log your blood sugars.If you are experiencing the MotorStart phenomenon, you will likelyhave high blood sugars on all morn-ings that you ate any food, except onthe day you fasted.

The best method we have found fordealing with this blood sugar rise is toadminister an extra fixed amount ofinsulin, usually about 1.5 to 2 units,upon awakening or before eatingbreakfast. (It may be necessary to takethis insulin some time before eating togive the insulin a chance to beginworking before breakfast is eaten.)Just remember that as soon as yourbody's tendency changes, this extrainsulin must be eliminated.Otherwise, it can cause serious lowblood sugars.

The Rebound PhenomenonUndetected low blood sugars in mid-dle of the night followed by a re-bound (commonly called the somogyieffect) can cause stubborn highs andunpredictable blood sugars for thewhole day, especially in the morning.Checking once during the night at 2a.m. will not always catch the low, asit can be fairly brief (based on reportsfrom people who have used theCGMS). One option would be to dohourly checks spread out over severalnights. For example: the first nightyou check at 10:00, 1:00 and 4:00.Take a rest the next night, and thenyou check another night at 11:00,

2:00, and 5:00. And so on, until youcovered every hour of the night. Ifyou still can’t catch the low, talk toyour doctor about using a CGMS or aGlucoWatch biographer.

The Caffeine PhenomenonIf you are accustomed to your dailycup of morning coffee (or a few dailycups of coffee in the morning), thenhere's one more reason to break thehabit: Although caffeine has no carbs,some people have noticed that it caus-es their blood sugars to rise. This maybe due to the insulin resistance whichcaffeine triggers in some people. As with so many diabetes-relatedissues, every person is unique.Interestingly enough, some peoplehave noted that they have a "Reverse"Dawn Phenomenon, meaning thattheir sugars go low at the time ofmorning when most people areinsulin-resistant. These individualswould actually need to decrease theirbasal or long-acting insulin to com-pensate for this BG drop.

Some parts of this article are adaptedfrom "Pumping Insulin" and the InsulinPumpers mailing list.

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On the Glycemic Index…There has been much media opposition to the Glycemic index (see our

article on "Glycemic Load" in our Pesach issue). It is interesting tonote, however, that all opinions do in fact support the glycemic

index, without realizing it. For example, EVERYONE agrees that one has toeat glucose tablets or another FAST ACTING carbohydrate to treat a lowblood sugar. Why not eat a piece of chocolate to bring up the low bloodsugar? Because, when we need an immediate response in blood glucose, weneed a high GI food! [On the same topic: it is important to note that when milk is suggested fortreatment of hypoglycemia, it refers only to low fat milk which is higher onthe GI than regular milk. The fat in the regular milk slows the absorption ofthe carbs (lower GI), which makes it less recommended for treating a low.]

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Some of the following tips mightwork only for those on insulinpump therapy ☺, some will

work for those on multiple daily injec-tions and flexible insulin therapy ☺,and others might work even for thoseon the conventional regimen .Cereal is a universally favored break-fast food. There is no preparationinvolved, it is quick to serve and con-sume, many nutrients are added,and of course, many of us enjoyit! Which cereal should one selectfor a healthy breakfast, and howcan we avoid the high BG peakscaused by these rapid acting cere-als (high glycemic index)?

When it comes to choosing acereal, it would seem probable thatthe sugarcoated variety would pro-duce worse BG results. Interestinglyenough, this may not necessarily bethe case because the sugars used arecomplex and require time for the bodyto process before they can be convert-ed into glucose. The opposite is trueof the "plain" cereals, which includeproducts like Cheerios, Corn Flakes,Cream of Wheat, etc. Highly refinedgrains are convert-ed to glucose veryrapidly, much fasterthan the sweetenersused in the "sugary"stuff; therefore theyare extremely highon the glycemicindex. The solutionmight actually be tolet the kids eat junkfood!

You might alsotry squirting a littlehoney on a "plain-er" breakfast cereal.The above two tipswere shared byMichael Robinton,executive directorof Insulin Pumpers.

CAUTION: They may notwork for everyone! Somepeople do find that they reactbest to the plainer cereals.

Don't forget to count themilk; it has a lot of carbs.Milk contains 12 grams of carbohy-

drate per 8-ounce cup(1.5 grams per

oz.).

Addingalmonds tothe breakfastcereal might alsoprove beneficial. Fat slows downdigestion and lowers a food's glycemic

index (GI). Adding a protein to yourbreakfast menu would have a similaraffect, especially if you eat the proteinsfirst.

Try eating a high-fiber cereal suchas Fiber One to lower the glycemicindex of your breakfast. At the June2002 ADA conference, research was

announced showing that theglycemic load of breakfast

affects the midday mealmetabolic responses in

individuals with Type2 diabetes. In otherwords, throughchanging just yourbreakfast habits,you may see an

improvement inboth post breakfast

AND lunch blood sug-ars. Your entire day will

be brighter!Some say that cereals made from fine-ly ground whole wheat flour would

have a glycemicindex similarto that of itswhite counter-part, but oats

would have lowerGI values.

Many diabeticssubstitute breadwith rice cakes,thinking that therice cake will havea better affect ontheir blood sugars.Here are the facts:Rice cake has ahigher Glycemicindex (110) thanbread (101).

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Breakfast Smarts

Weight vs. VolumeWhen reading cereal labels,you might wonder about thevarying serving sizes. Why dosome products list 3/4 cup as a serv-ing, some record a full cup, and someeven list 1 and 1/4 cup? The reason is because the serving sizes thathave to be displayed on nutrition labels are determined by the USDAand not by the manufacturer. According to the USDA, a serving sizemust be 1 oz. in weight. Each cereal results in a different amount in cupmeasurements for the same amount in weight.Cereal measurements should always be done by weight of the dry cereal.Most cereal changes volume dramatically as the box is moved around andthe cereal settles. The investment in a good quality kitchen or food scaleis definitely a must.




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Mixed grain bread with a GI of 69, orSourdough bread which also has alower GI, would be much betterchoices. Rice cakes are also hardlylower in carbs, as one cake has at least9 grams of carb, while one small sliceof bread contains about 13 grams. Ifyou come across a brand of rice cakeswhose label states that it has just 5grams of carbohydrates per cake, youhave stumbled on an unfortunatemistake (unless it's a thinner slice thanusual)!

Although the newer, rapid actinginsulin (Humalog and Novolog)allow the freedom of injecting orbolusing right before the meal, if oneanticipates a blood sugar rise afterbreakfast then it might pay to admin-ister the insulin a little earlier. Thisgives the insulin a chance to start

working before the food kicks in. Therecommendations are to administerthe insulin between 5 and 15 minutesprior to eating, but some people haveseen greater benefits by taking theinsulin even earlier, as much as 15 -20minutes before eating breakfast. Justmake sure you don't take it too early,to avoid hypoglycemia.

Although both insulin analogs(Humalog by Eli Lily, and Novologby Novo Nordisk) are said to havesimilar affects, many people havenoted that switching from one brandto another, has eliminated their postmeal spikes. This benefit wasobserved in children as well as adults.Needless to say, that changing insulinbrands should only be done by therecommendation and supervision ofyour health care team. (At the time ofthis writing, Novolog is the only

rapid-acting insulin approved for usein insulin pumps.)

Keep in mind that some peoplemight require a higher insulin-to-carbratio for breakfast, due to some of thephenomena mentioned in the articleabove. For example, one's insulin-to-carb ratio might be 1:12 for break-fast, while it is 1:20 for lunch.

Alternatively, you might find thatincreasing the insulin dose specificallyfor cereal will do the trick of keepingBGs in range. You may require a dif-ferent amount of insulin for a break-fast consisting of toast, for example,than for a breakfast consisting of cere-al with the same carb content.

Recent studies have shown thattaking a walk after breakfast workedwell in avoiding the high BG spikepost breakfast.

I N C O N T R O L

(Breakfast Smarts— continued from previous page)

Quick Carb FactsCorn on the Cob: You can figure roughly4 grams of carb per ounce of corn. The definitivemethod is to strip the kernels with a knife andmeasure by volume.

The figures from USDA are:

Volume 1 ear (lg) 1 ear (avg) 1/2 cup

Weight 100 gm 77 gm 82 gm

Carbs 25.11 gm 19.34 gm 20.59 gm

Baby Carrots: 10 large baby carrots contain 12 grams of carb,while 10 small baby carrots have 8 grams ofcarbohydrates. To obtain a really accurategram count, use your gram scale! The effec-tive carb factor for carrots is 0.10.

Have you alwaysrefused to wear

traditional medicalalerts? Are you on

the lookout fora comfortable,

high-fashion, anduseful alternative?

MEDICALALERT WATCHThis good-looking watch comeswith the medical alert symbol andmedical condition indicated on itsface. A long overdue alternative totraditional alert bracelets andnecklaces! Choose from severalfashionable styles. You can orderyour Medial Alert Watch at 1-800-722-6955, or email to [email protected].

When exercising in the cold winter, the body will burn more caloriesthan in the summer, in order to maintain a stable temperature. This extra

energy is taken mainly from glucose in the blood. Therefore, whenexercising in cold temperatures, beware of falling blood sugar levels!



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Low Carb Dieting:If you do it, do it right!

We constantly hear the state-ment, "I would like to startthe Atkins diet; I heard that

it keeps blood sugars under siege."We will not enter the argument ofwhether the low carb diet is indeedthe safe and healthy way to go for thegreatest short and long-term bene-fits. But here are a few impor-tant and helpful points ondieting:

1. If you are taking oral[Type 2] diabetes pills thatstimulate the pancreas toproduce more insulin (suchas Glyburide, Glucovance,Starlix, and Prandin), you maybe asking for trouble if yousimply begin a low-carb dietwithout first reducing yourmedication dose. These medswere prescribed with theassumption that you would beeating a regular or highamount of carbohydrates andthey will cause dangerous lowblood sugars if the carbs areabsent. You will need to dis-cuss your change in diet withyour doctor and he/she willchoose to reduce, eliminate, orchange your medications. Insulin sensitizers likeGlucophage, Actos and Avandia donot usually have this blood sugarlowering effect. (Glucophage haseven been reported to aid in weightloss on a LC diet.)

2. DO NOT follow a low carbdiet on the basis of what you heardfrom a relative or friend. DO reada book describing such a dietbefore you attempt to undertake

it. We've heard this incorrect state-ment numerous times: "The LC dietis very simple; you just eat meat,foul, fish, and eggs."Wrong! Even the most stringent oflow carb advocates, such as Dr.Atkins when describing the strict"induction" diet, does not endorsethe diet as stated above. The humanbody does need some carbohydrates,and exact amounts are detailed inthose books. (The induction diet,which is very carb-limited, is only

prescribed for two weeks.) Unlessyou read up on it and you knowwhat you are doing, you might beheaded for serious disasters.A good book for those who wish tofollow this type of diet is "ProteinPower" by Dr. Eades, in companionwith his "Protein Power LifeplanGram Counter". Dr. Eades's diet is alittle more liberal than Dr. Atkins's,

and is more straight-forward, with-out the complicated calculations nec-essary for the Atkins diet. Dr. Eadesalso provides a formula in his bookfor figuring the minimum amount ofprotein one MUST eat. [Pleasenote: Dr. Eades in not a yid and hisviews on evolution should just beskipped!]

3. The large amounts of fat con-sumed on a low carb, high proteindiet raises the concern of manypeople about cholesterol and

triglycerides. The following isthe theory of low carb advo-cates: Insulin is the body's "fatbuilding hormone". Reducingthe amount of carbohydratesingested means that insulin lev-els in the body are also automat-ically lowered (as Type 1s willtestify), so the body cannotstore too much fat. It doesn'tmatter how much fat you eat; ifthere is no insulin available tostore that fat then your lipidswill indeed improve anddecrease. According to this the-ory, dietary cholesterol and fatsare not the ones that raise bloodlipids, but it is actually carbohy-drates and their insulin friendswho play the leading role. Please do not accept this theoryas fact! Make sure your lipidsare checked before you start thediet, and then again after you'vefollowed the diet for a while,and see for yourself.

Warning: If you are an "experi-enced" yo-yo dieter who is constantly onand off diets, the low carb diet may notbe safe for you. By eating a low carb,high fat diet, then taking a detour andeating foods high in carbohydrates, youwill have high fat in combination withthe high carbs present in your body, andthis could be very harmful to your

I N C O N T R O L

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The Food Pyramidfrom a Low Carb Point of View

(continued on page 34)

To join our Kosher Low-Carb discussion list visit http://groups.yahoo.com/group/Kosher-Low-Carb or simply sendand empty e-mail to [email protected] and then reply to the introductory e-mail.

Gourmet products made with soluble fiber.Sugar-free, Kosher pareve

– makes you the expert in your own kitchen.

For information, call us at 888-621-9059 or email [email protected] us on the web at www.expertfoods.com

MOUSSE

CHOCOLATE CAKE

STRAWBERRY SHAKE

PECAN-CRUSTED SALMON

HOT CEREAL

CRANBERRY SAUCE

Limit your carbs,not your Menu.

MUFFINS

CHEESECAKE

CANDIED PECANS

HOT SOUP

GRAVY

KETCHUP


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health. (Some people were able to man-age a low carb AND lower fat diet, butthey admit it's hard!)

4. Most of the LC diets includerecommended vitamin supplemen-tations. Those who oppose this diethave used this point to prove that thelow carb diet deprives the body ofessential vitamins from naturalsources. Dr. Atkins claims that thevitamins he recommends are not dueto the diet, and he would advise thateveryone take them. (According tohim, it's even more vital for the lowfat dieter to take these supplements.)We don't know which view is cor-rect, but do take those vitamins! Atthe very least, a good Multi vitaminis helpful for ANYONE, regardlessof which diet he or she follows.

5. Be aware that when starting aLC diet, you may be cutting outmost fiber-rich foods from yourmeals. This is especially true duringthe first two to three weeks of mostlow carb diets (certainly with Atkinsinduction), where you won’t even beeating enough natural fiber. Fiber isa very important nutrient for thebody, especially for the colon.However this fiber deficit lasts onlyfor that short period, and you canmend the problem rather easily. Atablespoon or two of psyllium husks,wheat bran, or ground flaxseed willhelp you meet your fiber require-ments during this time. For a morepractical and tasteful idea, buy any ofthe Expert Foods products (see ad in thisissue) and you get a whole lot of fiber inyour favorite recipes.Once you're past the induction phaseof your diet, you'll be adding in addi-

tional veggies, nuts, seeds, andberries, and you'll be getting plentyof fiber. In fact, most low carbdieters eat far MORE fiber thanthose eating the standard Americandiet (of white bread, sugar, andprocessed foods).

6. Whatever diet you choose, justdon't forget to keep on smiling!!

Low Carb Smile!

(Low Carb Dieting — cont. from page 32)

Bad Fats Butter or Margarine? The Truth about Trans FatsFor years, it was believed that saturated fats were to

be avoided at all costs. Many conscientious con-sumers began opting away from butter, loaded withsaturated fat, and choose items such as margarineinstead. However, let the truth be known: Trans fattyacids, found in a frightening number of foods, includ-ing margarine and vegetable oils, are among the worstfood choices you can make. The statistics are mindboggling, with trans fats lurking in 40% of food prod-ucts available in supermarkets. There's much confusion about the various types of fat,and which are to be avoided more than others.However, one fact is definite: trans fats are really badfor your health. They are processed fats, a product oftechnology, not of nature. Why is it bad?Careful studies show that trans fat raises LDL (bad)cholesterol and substantially lowers HDL (good) cho-lesterol. It also has other effects that lead to cloggedarteries, and more heart disease ch"v, the leading causeof death among adults in the United States.Consumption of trans fat was also associated with therisk of developing type 2 diabetes.

Who knows? It may even be possible to completelyeliminate cases of Type 2 diabetes by obliterating transfats from our diet!Where are trans fats found? Am I consuming toomuch of this deadly fat?According to the FDA statistics, trans fat can be foundin 95 percent of cookies, 80 percent of frozen break-fast foods, 75 percent of salty snacks and chips, 70percent of cake mixes, and almost half of all cereals.Among the products with the most trans fat are veg-etable shortening, doughnuts, margarine, French fries,and microwaved popcorn.How can I know if a food contains trans fats? The FDA will soon require all food manufacturers tolist trans fats on the nutrition label, just as they arerequired to list the amount of saturated fats. Untilthen, the best way to avoid trans fatty acids is tobecome a devoted label reader. Look for the words"partially hydrogenated," or "fractionated" and avoidany products that contain them.

Some parts adapted from Rick Mendosa's website at www.mendosa.com

Admin

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Choosing a FoodScale Make sure it

Measures Up!

Do I really need a Scale?Next to your meter and lancingdevice, your most important diabetestool is an accurate food scale.Whether you use the conventionalmethods of carb counting (checkingcarb amounts in gram countersand on food labels), and certain-ly if you use the effective carbfactor we have elaborated on, thebest way to accurately determinehow many carbohydrates youwill be eating is by weighingyour portion on a scale. Exceptfor certain foodstuffs such ascereals and pasta which are bestmeasured in cups, a scale is by farthe measuring tool of preference.Aside from the obvious, there aremany creative ways you can useyour scale to enhance your dia-betes control. Scales today comeequipped with advanced featuresthat make carb counting easy, nomatter where you are. Built-incalculators, computer food data-bases, memory, and compact sizeare just a few of these.A scale is especially crucial if youare very sensitive to even smallamounts of carbohydrates (asmany people are at breakfast andduring the morning hours) or arethe parent of a young child withdiabetes. A parent can weighhis/her child's portion on thescale before serving, and thenafter the child finished eating tosee how much of the food wasactually eaten. For example, one mother servedher finicky four-year-old with

diabetes a forty-gram portion ofpretzels. When he was done with hissnack, she weighed his portion againand discovered that there was still 15grams worth of food on his plate.She simply subtracted these leftoversfrom the original serving [40-15=25] and knew that her sonwould need insulin to cover 25grams of pretzels. The benefits to more precise bloodsugar control are endless and yourinvestment in a good and accurate(but not necessarily expensive) scalewill reap many dividends.

Which one do I Buy?Gram increments… tare feature…auto-off… capacity and dimen-sions… There are so many things tolook out for when buying a foodscale! Just as you can not buy a car ifyou are not aware of the variousparts and features you need to lookout for, so too with scales. This arti-cle was designed to clarify someunfamiliar terms and help guide youin deciding which of the many scales

I N C O N T R O L

Scale SafetyAvoid lengthy exposure to extreme heat or cold. Your scale works best when operatedand stored at normal room temperature. Allow sufficient warm up time. Turn the scale on and wait several seconds to give theinternal components a chance to stabilize before weighing. Avoid shaking, dropping or otherwise shocking the scale. It is a precision instrumentand must be handled with extreme care. Gently apply all items to be weighed onto thetray top. Although a good scale is designed to be quite durable, try to avoid rough treat-ment as this may permanently damage the internal sensor and void your warranty.When turning the scale upside down, such as during battery replacement, do not useexcessive force and don't press on the tray.Remember: You can permanently damage the scale by overloading it! Check howmany grams your scale can hold and never exceed this maximum weight.Only operate the scale on a stable, vibration free surface. Do not operate your scale near cell phones, radios, computers, or any other electronicdevice. These devices emit RF and can cause unstable scale readings. If your scale everperforms poorly, try moving the scale to a different room or location. Your scale may need to be recalibrated every once in a while (to ensure that themeasurements it is giving are accurate). To check if it is still weighing accurately, place20 nickels onto the weighing tray. These should weigh exactly 100 grams.Save your purchase receipt in case you'll need to make use of the warranty.Remove the batteries if you plan to store the scale for more than ten days.



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F A C I N G F O R W A R DsWxc

S C A L E SNNAAMMEE//MMOODDEELL

Diet-Health

ComputerScale

MX-200

Proscale500

H 250

Penscale100g

Nutri-BalanceNutrition

Scale

1475T

TouchScale

6001

ex3

Palmscale

MMAANNUU-FFAACCTTUURREERR

Soehnle

MyWeigh

MyWeigh

MyWeigh

MyWeigh

Tanita

MyWeigh

MyWeigh

Royal

MyWeigh

PPRRIICCEE

$125.95*

$34.95

$64.90

$11.95

$9.95

$69

$80

$87.95

$45.95

$29.95

$59.90

CCAAPPAACCIITTYY

2,000g(4.5 Ib)

200g(7.05oz)

500g(17.635oz)

250g(8.5oz)

100g

2,200grams

or 4 Ibs.135/8oz

1200g

200g

6050g

1400g(3.1Ib)

200g

INCREMENTS

1-2g(1/0oz)

0.1g(0.01oz)

0.1(0.005oz)

2g(1/8oz)

2g

1 gramor 1/8oz

1g

0.1g

1.0g

1.0g(0.1oz)

0.1g

DIMENSION

8''x11''x2''

4.7''x3.1''x0.8''

5.2''x2.9''x<1''

2.75'', 3''4.5'' tall

size of alargepen

10½''x8''x2¼

5¾''x31/2''x5/8''

4.9''x3.2''x 0.8

6.2''x7.2''x1.6''

5.8''x1.4''x 7.4''

4.7''x3.3''x 0.8''

PPLLAATTFFOORRMMDIMENSION

7''

3.1''x4.7''open-ended

wighingplatform(cover)

5.2''x2.9''x<1''

RemovablePlatform

is6.24''x4.

25''

Clip

DDIIGGIITTAALL

3

3

3

8

8

3

3

3

3

3

3

TTAARREE

3

3

3

8

8

3

3

3

3

3

TTRRAAYY

Stainless steel

3

3

8

3

3

3

FFOOOODDDDAATTAABBAASSEE

425

8

8

8

8

413

8

Makeyourown

data-base of4 items

8

8

AAUUTTOO OOFFFF

3

60seconds

3

8

8

3minutes

3

3

BBAATTTTEERRYY

3Vincluded

3 AAAincluded

2 AAAincluded

8

8

3 pcs.xLR44

alkalinebattery

included3 3-V

included

9-Vincluded

9-voltbattery

(notincluded)

WWAARRRRAANNTTYY

1 Year

5 Year

180days

2 year

5 year

NNOOTTEESS

Programyour own

foods! Plus,has a port toconnect it to

your comput-er (softwareand cable

not included).

Low batteryindicator;

black or blue;sliding coverthat doublesas a weigh-

ing tray.MX-120 is

only $38.95

Black or clear

In black,red, white,

marble; maybe hard to

find since it’sa discontin-ued item.

Pen Shape,the Penscale50 weighs in

1g incr.

Foods cannot be

added to thedatabae.

Handy traydoubles asprotective

cover.GRAMS ONLY

Built in touchcalculator

Good kitchenscale. Holdsthe weighteven after

food isremoved. The

3001 is$39.95 andcomes in

many colors

HOLDfunction;Even a

Fold-up stand

Opens withthe touch of

a button

S C A L E S

*at Diabetes Mall (800) 988-4772 www.diabetesnet.com

We would like to thank Joshua Kesselman from My Weigh Scale Co. (www.myweigh.com)for donating scales for this review.

I N C O N T R O L


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American Weigh Scales1836 Ashley River Rd Suite 320Charleston, SC 29407Phone - 843-991-5066Fax - 815-301-8926Email - [email protected] portable digital pocket gram scales to dietary kitchen scales Bringing you the best scales at the lowest prices. User friendlyproducts and the latest technology.American Weigh accepts ALL types of payments, Credit Cards,PayPal, COD, Checks & Money Orders by mail. Phone ordersalso accepted.

Pocket and Mini Scales Medium and Large Scales Digital Scales Pocket Scales Shipping / Postal Scales Diet / Food Scales Body Fat Scale Hand ScalesAnd much more…

Palmscale

Tanita kd160Pocket and Mini ScalesMedium and Large ScalesDigital ScalesPocket Gram ScalesShipping/Postal ScalesDiet/Food ScalesBody Fat ScaleHand ScalesAnd much more . . .

American Weigh accepts ALL typesof payments, Credit Cards, PayPal,COD, Checks & Money. Orders by mail.Phone orders alos accepted.

American Weigh Scales1836 Ashley River Rd, Suite 3120, Charleston, SC 29407

Phone 843-991-5066 • Fax 815-301-8926e-mail: [email protected]

from portable digital pocket gram scales

to dietary kitchen scales!

Bringingyou the

best scalesat the lowestprices.

Userfriendly

productsand the

latesttechnology.

Palmscale

Tanita kd160

1scale2000



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out there would be the right choicefor you. Be an educated consumer!

What to Look Out ForWhen Buying a Scale:INCREMENTS: First off, make

sure the scale you are planning tobuy measures in grams (the stan-dard when weighing food andusing effective carb factors) and notjust in ounces. You will also want ascale that is accurate and precise;one that weighs in 10 gram incre-ments will not fit the bill. On theother hand, you don't necessarilyneed a super-precise scale thatweighs in a tenth of gram incre-ments either.

CAPACITY: An important point toconsider is the maximum weight ascale can handle. Remember that100 g. might not always beenough; one typical bilkele weighsmore. If your scale has a very smallcapacity, you may need to divide afood item into smaller pieces inorder to weigh it.

WEIGHT: Yes! A scale can also beweighed! And you don't want onethat will be too heavy and inconve-nient to use.

SIZE DIMENSIONS: If you arelooking for a food scale to keep anduse in the house, then size is notsuch a major consideration(although you don't want some-thing that will be excessively bigand bulky). However, what aboutweighing your food while you areaway from home? Wouldn't youenjoy the convenience of a scalethat slides into your pocket? Manypocket and travel scales are availabletoday, in handy compact sizes.

PRICE: Before you decide on ascale, check out the price to make

sure it is within your budget. Scalescan vary from the very inexpensive,under-twenty-dollar range, to any-thing above one hundred dollars.Try to get the most and best fea-tures for your money. Rememberalso that there can be quite a dis-crepancy in price from one scaleretailer to the next. Do some shop-ping around before you settle on aprice.

WARRANTY: Does the scale comewith a manufacturer's warranty orguarantee? How long does it last?

DIGITAL: We live in a digital worldtoday, the world of clear-display andeasy-to-use gadgets. Why not takeadvantage and buy a digital kitchenscale? Don't forget, however, aboutShabbos and Yom Tov, when manyhalachic authorities rule that digitalscales can not be used. While youpurchase a digital scale for usethroughout the week, do look intoan "old-fashioned", inexpensive

food scale as well.Note: While there are many pocket-sized digital scales available today,the non-digital scales are usually larg-er. (The pen scale, described in ourchart, is an exception.)

BATTERIES: Are the batteries thescale uses easily accessible? Are theyincluded with scale purchase?

TRAY: Does the scale comeequipped with its own tray, or willyou constantly be faced with thetask of finding something to placeyour portion on before it can beweighed? Lack of a protective trayalso means that the scale platform ism o re l i ke l y t o b e c o m e d i r t y a n ds c r a t c h e d .

AUTO-OFF: The auto-off is a bat-tery-saving feature built into somescales. It means that when left onwith no activity for a certainamount of time, your scale willautomatically turn off to conservebattery power.

TARE FEATURE: This is animportant and useful feature thatmany scales are equipped with. Thetare feature allows the scale to"zero-set", or return to zero afteryou placed something on it. Thismeans that you can place a contain-er on your scale and press tare. Thedisplay will reset to 0.0. You canthen place any food inside the con-tainer and get an accurate measure-ment of just the food; the weight ofthe holder will not be included inthe reading. [Note that any taredvalue will be displayed as a negativenumber once all weight is removedfrom the unit. Depress tare toreturn the unit to zero.]

Even if the food is already in its con-tainer, you can place an identicalempty container on the scale, presstare and remove it. Now place thefood with its container on the scaleand the weight of the holder will not

(Choosing a Food Scale — cont. from previous page)

What do you say to anexcellent programthat will helpyou track yourblood sugars inthe palm ofyour hand?Get a complete, easy-to-usediabetes care system whichtakes the place of traditionallogbooks and also records meal details, medica-tions, exercise, and other notes. Some can evenestimate your insulin requirements based onmeal content, while it aids the user in findingtrends in blood sugars. FWD will be conducting a‘review’ on some of the popular and sophisticat-ed diabetes management software products forthe PDA user such as: ez Manager by Animascorp., Freestyle Tracker by Therasense, DiabetesPilot 2.0, Logbook DM, Diabetes Now, GlucoPilot.

For more details on these programsvisit our web page

www.friendswithdiabetes.org/files/Links_Palm.htm

I N C O N T R O L



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Adding New Foodsto the Soehnle ScaleYou baked your favorite cake. You fig-ured out the carb amounts of eachingredient, weighed the finished prod-uct, and discovered the cake's carb fac-tor. Now, there is even a way you canadd this food to your Soehnle dietcomputer scale. Whenever you feel likehaving a slice of the cake, you will beable to cut any portion size, enter thecorrect code number onto your scale,weigh it, and know instantly howmany carbohydrate grams the slicecontains.

Instructions:Note: The words that appear in italicsare from the scale's manual. Our com-ments and examples follow.

If you wish to change the foods pro-grammed into the diet computer, first ofall enter the code number of the food to bechanged. You will have to choose anexisting number of the scale's database;you can not add new code numbers.Choose the code number of a food younever eat, one that isn't kosher, or onethat contains only protein and fat, as itis not necessary for us to know thenutrition values of these foods. Thiswill now become your personal codenumber for this particular cake.For example, you might choose to usethe meat section of the Soehnle data-base. Since meats contain no carbohy-

drates, you can change all code num-bers for meat to reflect the nutritionvalues of your own homemade recipes.A time-efficient idea is to find the codenumber of a food you don't eat that hasa carbohydrate value which is the sameor similar to the food you would like toadd. Simply write down the code num-ber and use it for the homemade food.For example, potato latkes have anECF of 0.15. You will find that code#089, potato salad with mayonnaisedressing, also has a carb factor of 0.15.You can simply weigh your potatolatkes and enter code #089 for anaccurate reading of its carbohydratecontent. (It is true that any other nutri-tional values for the latkes, such as itsprotein and cholesterol content, proba-bly differ greatly from those of thepotato salad. But that's okay, since weare only concerned that the carbohy-drate reading be accurate.)As you add more and more homemadefoods to your scale's database, don'tforget to list in a safe place all the foodsyou have added and their correspond-ing code numbers.

Press the 'INP' key. Pressing this keymeans that you have entered INPUTmode. You can now add or change val-ues in the scale's computer.

Press the key for the nutritional valueconcerned. The respective value flashes andcan now be overwritten. Key in the value

I N C O N T R O L

Smart Scale TricksThe Soehnle Diet Computer Scale can do much more than justweigh your food. It can, when the correct food code is entered, giveyou an instant reading of the amount of carbohydrates in your spe-cific meal. But if you use your own brain and FWD's tips, this cleverscale can be a really spectacular tool. Let's explore some of the waysyou can take advantage of your scale.


be included in the scale's reading.Note that this feature is not exclusiveto digital scales. However, you willneed to tare a non-digital scale man-ually, usually by turning a screw.

HOLD FUNCTION: Some scalesoffer a convenient "Hold" feature.When the "Hold" button is pressed,the scale will keep the reading of theitem being weighed even after it isremoved from the weighing plat-form. This is particularly usefulwhen weighing large items thatcover up the scale's display.

BUILT-IN CALCULATOR: Anew and delightful feature we havediscovered on some scales is a built-in calculator. The calculator is veryuseful for figuring effective carbfactors, insulin-to-carb ratios, oradding up the carb contents of ameal. The built-in calculator savesyou the hassle of carrying two gad-gets around.

COMPUTER DATABASE: Thecomputer database is an advancedand very useful feature that only aselect amount of scales comeequipped with. These computerscales are preprogrammed with thecarb contents and other nutritionalvalues of many common foods youmight eat. All you have to do isweigh the foodstuff, enter an appro-priate food code, and you willimmediately receive a reading of theamount of carbohydrates containedin your portion! (Keep in mind thatas these amounts are averages, theyare not always so accurate.However, you can change the valuesstored in your scales computer! Seeour instructions in this issue.) TheSoehnle computer scale can alsomemorize what you've eaten duringthe day and give a readout of yourentire day's intake of carbohydratesand other nutritional values.

(Choosing a Food Scale — cont. from previous page)



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I N C O N T R O L

per 100 g of weight or liquid density. Theonly nutritional value we wish to enterfor this new food is its carbohydratecontent. In fact, we have not even fig-ured any other values for this recipe, aswe are concentrating only on carbohy-drates. So, if you wanted to enter thecarbohydrate content of the Yom Tovcake we baked, press the carbohydratekey (represented by a stalk of wheat onthe scale) and enter the number 35. A word of explanation is in order here:Carb factors are a percentage, whichmeans that they represent the amountof carbs a food contains per 100 grams.Any slice of this cake will contain35% (or 0.35) carbohydrates, but a100 gram slice will containEXACTLY 35 grams. Since weare told to enter the carb amountper 100 grams, we will put in 35without the decimal. [Note thatIsraeli foods are labeled with nutritionfacts figured per 100 grams. So youcan enter into your scale the exactamount of carbohydrates stated on thefood's packaging.]Please take care to enter all of the digitswhen making manual entries, includingdigits after the decimal point.Carbohydrates must be entered as 3-digitvalues excluding the decimal point. Forexample, if 100 grams of a food contains 3grams of carbohydrate, enter "3.00".(Remember that this is true for carbo-hydrates. You might need to enter dif-ferent numbers of digits for othernutritional values.)

Pressing the key once more will con-firm the nutritional value in the display.The entered value stops flashing and istransferred into the food memory. Onceyou have entered the number 35, pressthe carbohydrate key again. This valueis now stored in your computer scale.

If you do not know the nutritionalvalue for a particular component of a food,press the 'MR' key until five horizontaldashes appear in the display. The scale hasthe capacity to store five nutritional

values for each food entered:Carbohydrates (represented by a stalkof wheat), fat (represented by an oildrop), protein (pictured as a crackedegg), cholesterol and kilocalories. Wehave put in the amount of carbohy-drates contained in this cake, but whathappens with the other four values?Since we don't know them, we will fol-low the instructions given: press anutritional value key, press the 'MR' keyuntil five dashes appear, and then pressthe same nutritional key again. Repeatthis procedure for all four nutritional

keys.

Afterentering all of the nutritional values,the required food is programmed. Inthis way you can edit the values for thepre-programmed foods in the dietcomputer to suit your requirements.By pressing the 'INP' key you can endthe input mode at any time. If nothingis entered within 10 seconds, the scalealso reverts to normal weighing mode.The changed values have now beenstored. The next time you feel like tasting apiece of your home baked cake, justplace your slice on the scale, enter thecode number you had decided on, andthen press the carbohydrate key for aninstant reading of the amount of carbscontained in your serving!

If you wish to receive instructions inYIDDISH on adding foods to theSoehnle database, please contactFWD at (845) 352-7532.

When figuring the carbcontents of a homemaderecipe:Note that your scale can even be of aidwhen you are in the process of figuringthe carb contents of a recipe. YourSoehnle scale comes equipped with anaccumulator. This memory feature lit-erally accumulates your food intake ofthe entire day. You can adapt this fea-ture and use it to add up the totalsum of carbohydrates in a recipe. Asyou figure the carb amounts in each

ingredient, enter that numberinto the accumulator. When

you are done, the scalewill give you a read-

out of the entireamount of carbo-

hydrates in therecipe. (Of course, a

standard calculator willoffer similar performance!)

A Trick with Food CodeNumbers:This idea is an original twist on thebasic functions of the Soehnle scale. Itwill require some time to install, butafterwards, it should prove to be atimesaver. You will never need to lookup a code number again, and there willalso be no need to program new foodsinto your scale's database. Best of all,your scale will now have the ability togive nutrition values for much morethan the 425 foods it is programmedto contain. The instructions are easy, but a bittedious. (Warning: If you don't enjoymath, this technical trick may not befor you!)

(Smart Scale Tricks — cont. from previous page)




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Following the directions detailedabove, change the carbohydrate valuesfor ALL code numbers in your scale'sdatabase. You will be entering all possi-ble ECFs, from 0.01 to 0.99 in order,using their corresponding code num-bers. Don't forget, however, that youwill not program actual ECFs, as youwill be entering the amount of carbsper 100 grams of food.Do as follows: For code number 001,enter a carb value of 1.00 (representingan ECF of 0.01), for #010, you wouldenter the number 10.0 (representingan ECF of 0.10), for #050 you wouldprogram a value of 50.0, #085 wouldhave a programmed carb value of 85.0,and so on…

Whenever you want to eat some-thing, just look up that item's ECF (or,in the case of a homemade item, figureout the ECF yourself). Then, there isno need to find out or program itscode number. If you know the food'sECF, you will instantly know its codenumber, and your scale will give accu-rate carbohydrate readings. For example: When looking at our TuB'Shevat fruit chart, you may noticethat scale code numbers are given foronly a few of the fruits. What if youwant to eat a pomegranate, which doesnot come programmed into the scale?This tip would eliminate such occur-rences, as you now have every possiblefood programmed into your scale! Yo uwould simply enter code #017 (as theECF of pomegranates are 0.17) anddiscover the exact carbohydrate con-tent of your portion.Another example: Potatoes are beingserved for supper. Normally, youwould need to look up its code num-ber and enter the meaningless #082.But now, you would enter #015- thecode number which reflects the ECF ofpotatoes, 0.15. The numbers shouldbe much easier to remember, as theynow carry substantial significance andrepresent the actual effective carb fac-tors of the food you will be eating.

A shortcut would be to programonly 20 new entries, putting in thecarb factors in increments of five. Soyou would change the carbohydratevalues for #001, #005, #010, and soon… When you want to eat some-thing, round that food item's ECF, andpress the appropriate code number. If you wanted to eat fresh figs with anECF of 0.16, you would round thatnumber to approximately 0.15, andenter code #015.Later, if the opportunity arises, you cantake the time to enter all the code num-bers so that your readings will be moreprecise.

Instant Insulin Dosing!How would you like to press one more"magic" button on your scale so youknow not only the amount of carbsyour portion contains, but also exactlyhow much insulin you need to admin-ister to cover them adequately? Of course, the magic won't work with-out education! The first step is to knowyour personal insulin-to-carb ratio. Youwill program this ratio into the scaleusing the 'BE'- Bolus Equivalent key,and it will automatically do the mathfor you. Turn living with diabetes intosome high-tech fun![Note that the makers of the Soehnlescale really created the 'BE' key to givedieters the Bread Equivalents of thefoods they consume. One slice of breadwas programmed to equal 10 grams ofcarbohydrates, so if a dieter was eatinga cupcake containing 30 grams of car-bohydrate, s/he could press the 'BE'key and find that this treat would countas 3 breads in his/her diet plan. FWDhas adapted this feature to aid ininsulin dosing, thus the new initials,"Bolus Equivalent". Of course, usingthe 'BE' key in this manner is not guar-anteed by the scale manufacturers, asthey had a complete different use inmind. However, common sense tells usthat this should work.]

Keep in mind that for the 'BolusEquivalent' feature, your insulin-to-carb ratio will need to be entered as afour-digit decimal. If you thought ele-mentary school math was boring andunimportant, here's how to do it.Think: how many grams of carbohy-drate can you cover with one unit ofinsulin? Just divide the number one (1)by that number to turn it into a deci-mal.For example: You can cover 15 gramsof carb with one unit of insulin. Youwill calculate 1 divided by 15 and seethat 15 is expressed as a rounded deci-mal of 0.067. Enter this number intothe Soehnle computer scale.Likewise, if your ratio is 1:20, dividethe number 1 by 20, and enter the dec-imal 0.050.Instructions:

If you are using an insulin-to-carbratio of 1 unit of insulin for every 10grams of carbohydrate, then you donot need to change anything pro-grammed into your scale. Simplyweigh your portion of food and pressthe 'BE' key. You now know exactlyhow many units of fast-acting insulinto administer to cover the portion youweighed!However, if you use a ratio other than1:10, you will need to change the fac-tory settings of your Soehnle scale.

Turn your scale on and enterINPUT mode by pressing the 'INP'key. Then press the 'BE' key.

Enter the amount of carbs you cancover with one unit of insulin.Remember to convert the whole num-ber to a decimal of four digits!

Confirm your entry by pressing thecarbohydrate (stalk of wheat) key.

Now press the 'INP' key once againand you are back to the regular weigh-ing mode.

I N C O N T R O L

(Smart Scale Tricks — cont. from previous page)

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Friend to Friend

For the Forgetful PumperParents of very young children with dia-betes are often advised to bolus for ameal after it is eaten. Sometimes this isrecommended even for adults, especial-ly when eating a high-fat meal, or forthose suffering from gastroparesis(delayed stomach emptying). The prob-lem that often arises in such cases is thatpeople forget to administer the bolus.This can have dangerous consequences,especially if it occurs a bit too frequent-ly. Even if there wasn't such a large doseof missed insulin, many people willneed an even greater bolus to make upfor the missed amount. It seems thatwhen insulin is administered in antici-pation of a BG rise, it is more affectivethan when taken later, when blood sug-ars are already high. (To quote the well-known wisdom, "An ounce of preven-tion is worth a pound of cure.") If youfind that you or your child is forgettingto bolus after eating, try the following:

Remove your pump from yourpocket, belt, etc., and leave it on thetable as long as you are eating. Havingthe pump in front of your eyes through-out the meal will surely serve as areminder to administer the necessaryinsulin.

Alternatively, you can try keepingyour log book or even an attractive-looking notebook on the table whileyou eat. Don't put it away until youhave jotted down your meal, its carbcontent, and the amount of coverage itrequires. This trick is also useful for theforgetful BG logger!

There are several watches availablewith multiple alarms that can be presetto sound at the times you usually eat ameal. Some computerized watches can

even be programmed to read"BOLUS". One example is the Ironmanwatch by Timex that can be bought atmajor department stores for under $50.

If you have eaten a meal with anunusually high fat or protein content,you may require additional insulin sev-eral hours after eating. (Or, you can usea square wave bolus. See "Extendingyour Bolus" below.) You can use yourpump as an "alarm clock" to remind youto bolus. All the pumps have an auto-off feature, meaning that the pumpshuts off after a preset amount of timeduring which no buttons are pressed.The pump will alarm at that time. So,if you will want to take additionalinsulin two hours after eating a meal,you can program the auto-off to beepafter two hours, as a reminder to bolus.Keep in mind, however, that if thisalarm is not turned off in time, thepump will go into suspend and you willbe missing not just boluses, but basalrates too.

If you don't like any of the aboveideas, there's still hope! The newCozmo pump by Deltec which is nowin the making features alarms to remindpumpers to bolus.

Missed Insulin Do you think you missed some infusedinsulin while taking a shower, etc.?When disconnecting from the pump,you can check the daily total before andafter disconnecting, and program abolus for any amount missed. Many people also feel more confident ifthey bolus an extra 0.3 units beforereconnecting, and see the drop ofinsulin come out.

Suspending SilentlyMany pumps, such as those producedby Disetronic and Animas, alarm con-tinuously while the pump is in sus-pend/STOP mode. How can you elim-inate these beeps?

For the Animas R-1000: Instead

of using the pump's suspend mode, oneshould use a Temporary Basal set atOFF. If you scroll far enough down thenegative numbers, you'll see the OFFoption. Be sure to use GO to insure thatthe pump is using that TEMP basal.Note that this will work for up to 12hours. If you need to stop insulin deliv-ery for a longer period of time, justremove the pump batteries. (TheAnimas pump will save all your settingsand basal rates even without the batter-ies.)Alternatively, just go to the basal setupand set the basal to deliver zerounits/hour. If you have a profile thatyou have not yet set or played with, itshould be at zero. This profile will nowbe your suspend/STOP mode. Just pickthat basal profile and GO with it.

For the D-Tron: To switch off theSTOP (suspend) warning, hold downthe "check" button for 3 seconds. Ateach change to the RUN mode, theSTOP warning is automatically reacti-vated. In other words, you will get thealarm again the next time you STOPyour pump, but you can easily switch itoff again by pressing the "check" button.

Extending your BolusAlthough you may initially be over-whelmed by the various bolus optionson your pump, bear in mind that theymay be very useful. As many pumpersrelate, the square wave bolus is particu-larly helpful for covering foods such aspizza and macaroni and cheese that con-tain large amounts of fat and protein.When munching on nuts, for example,you might program a square wave ofone unit over an hour. The square waveis also indispensable when you are eat-ing a heavy meal. Some people haveeven found that snacking on popcornrequires a square or dual wave bolus. Itpays to experiment! The only price youwill pay is better BG control!

NovoLog CartridgesSome people have found that NovoLog

F R I E N D T O F R I E N D


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F R I E N D T O F R I E N D

helps control their blood sugars betterthan any other rapid acting insulin.Many pumpers have therefore usedNovoLog cartridges in the D-Tron withno problems reported. However, dobear in mind that the company does notendorse such use, as the cartridges arenot sized precisely for fitting this pump.

Your Sites Can Stick LongerAre your sites coming off too early andtoo easily? Do standard brands of tapeirritate your skin? I first discoveredTincture of Benzoin when my doctorused it to hold steri strips and tape onmy skin following surgery. This verysticky spray or liquid is a non-expensivesubstance, available in many local phar-macies. You will need to get"Compound" Tincture of Benzoin,which is stocked in some pharmaciesunder the name of "Friars Balsalm". Iapply it under my site tape and my sitesnow hold for much longer periods oftime. An additional bonus is that I nolonger develop the rashes I used to getunder the tape. I did find that Goo-Gone is sometimes necessary to help meremove those sticky sites.

If you are on the GlucoWatchSome friendly tips from GlucoWatchusers:

I usually wear the watch so thecontact pads are not in the center of myarm where they could stimulate thesuperficial radial cutaneous nerve. Thiswould cause tingling in the back of thehand and wrist.

I have discovered that the skin irri-tation from the autoSensor is worse ifyou remove it according to the manualinstructions. The way I did it is toremove the autoSenser from theGlucoWatch first and only then did Iremove the sensor from the skin, withthe help of Goo-Gone. It came offmuch easier.

The GlucoWatch can not be wornon a hairy section of the arm as thisinterferes with the watch's readings. You

can do as I have done and wear thewatch on the bottom, smoother side ofthe arm.

I wore the GlucoWatch higher upon my arm so that it didn't become wetwhen I washed my hands for netilasyadaim, leading to a malfunction. Also,as mentioned in the manual, that area ofthe arm is usually less sweaty, and there-fore does not cause the watch to skipreadings.

Low Carb BakingFor those who normally use sugar sub-stitutes when cooking and baking, thereare times when you will be tempted touse real sugar for reasons other than itssweetening properties. For example,sugar gives cakes their fluffy texture andprevents ice cream from freezing to asolid rock. In these instances, artificialsweeteners simply will not measure up.We have found a product calledDiabeteSweet which is a mix of Isomalt(a modified sugar alcohol) and ace-k. Itis great for baking, browning, and mak-ing syrups and ice cream. Just remem-ber that it does contain some carbohy-drates, about ¼ the amount containedin sugar. It is also a sugar alcohol, whichmeans that it can have unpleasant affectswhen used in quantity.

Pre-meal DosingMany of us have been advised by ourdoctors not to eat until our pre-mealblood sugars are within an acceptablerange. We are told to check before eat-ing, administer additional insulin if BGsare high, and then wait until they havefallen considerably. I frequently findmyself just sitting in front of the food,mouth watering, and waiting for myBG to crawl into range before finallyallowing myself to partake of the meal.I recently came up with a solution: Iregularly check my blood sugars a halfhour before meal time. (With today'sfast and convenient meters, this causesno interruption in my work.) If my BGsare high, I administer the proper cor-

rection bolus. By the time I am ready toeat, my blood sugars are back in thenormal range and I can bolus for thefood and eat!

RHM comments: We have seen cases(especially in children) in which a cor-rection bolus given right before eatingwas only HALF as affective as a patch-up administered not at meal time. Inother words, you might need doublethe amount of insulin to bring down ablood sugar right before eating. It paysto bolus in advance!

A Change in Place, a Change in Luck…Our sages already divulged to us that"meshaneh makom meshaneh mazel" -changing the place [usually of one'shome] may affect a change in one's lot.For us diabetics, this saying may havean interesting application… For the past few months, my blood sug-ars were running at a constant high.Despite my numerous attempts atchanging pump sites and sets, acquiringcompletely new vials of insulin, payingprecise attention to what I ate, and allthose endless insulin patch-ups… therewas absolutely nothing I could do toget those numbers into the normalrange. Understandably, I was gettingincreasingly baffled and frustrated, andmy medical team began suggesting thatI might need to take an insulin sensitiz-er (such as Avandia or Actos) or per-haps I would need to cut back oninsulin dosing to upgrade my insulinreceptors. As a last-ditch attempt, mydoctor advised changing my pump sitesto a completely different area of mybody. Wonder of wonders, it worked!! If you are having unexplained highblood sugars over a period of time thatdo not respond to site or insulinchanges, it may be that the skin at yourusual injection area has lost some of itsabsorption power. You might need toexperiment with a different place… andimprove your lot!


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FromParent

toParent

A letter from the parents ofa diabetic teenager:

Our son was diagnosed at age 101/2 over three years ago. Itseems almost like yesterday…

He was in the sixth grade, but seemedto be lethargic and lazy; it was as ifsummer vacation had never quite lefthis system. On Shabbos Shuva, wewere arguing. We told him he neededto remain focused on the material wewere reviewing, and he agreed. Not fiveminutes later, he asked to use the bath-room again. We refused to let him go

until he finished the particular Rashi wewere discussing. He was done in recordtime, and then took off like a jackrabbitto the bathroom.

Eventually, we suspected diabetes. AType Two neighbor, just to reassure us,offered to check our son's blood sugars.He was sure the meter had malfunc-tioned when it displayed a whopping540!

We remember the conversation we hadabout going to the hospital… aboutwhat we suspected. We rememberholding back our own tears and fearswhile trying to calm a screaming child.We both felt as if we were handed a sen-tence of cancer, CH"V. B"H our neigh-bor, who is also a social worker, wasable to calm our son and show him thatdiabetes is chronic, but not terminal;treatable, though not comfortable.

He went on the pump oneyear after diagnosis. Ourson is to the skinny side,has B"H never had a severelow, and his A1cs have con-sistently been in the normalrange.

We have never limited hissugar or carbohydrateintake at all; the only thing

he does not have is regular soda andjuice. As far as we are concerned he caneat what he wants, when he wants, aslong as he tests and boluses for what heeats to the best of his ability. We feelthat this keeps things very honest andabove board. We try pointing out tohim the foods he really doesn’t do verywell on and the ones he does better on.Right now we are leaving the choicesbasically up to him. We find that hedoesn't go higher from sugar or noshwhen he boluses properly.

A good tip we have learned is to treatlows with Winkies only. This keeps ourson from trying to go low in order tobe able to eat sugary junk.

We insist he does everything his peersare doing. He goes to camp, away forShabbosim etc. On Purim he hasalways been more or less under control.(We haven't had to deal with alcohol orsmoking yet, but guess we will crossthat bridge when we get there.) Heunderstands that he must wear medicalID and carry a test-kit, Winkies, a smallvial of insulin and a syringe wherever hegoes. He also leaves a test kit in Shuland anyplace he will be eating or sleep-ing on Shabbos.

Our son has matured and grown, bothdespite and because of his illness. Wehope that, as he matures further, he willrealize the importance of avoiding cer-tain foods that he would be better offwithout. We would wish that no oneever have to deal with such a conditionin the future. Meanwhile, we bask inthe Nachas of a son who is such amentch!

S. and I. S.

Special forParents

Only special parentsare blessed with special children

with diabetes!This section is dedicated to all

those indispensable, irreplaceableparents of diabetic children…

S P E C I A L F O R P A R E N T S

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A multipack of 5 fashioned stickers of your

choiceis available by Animas for just $9.95.

See our full ad on page 6

S P E C I A L F O R P A R E N T S


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Excerpts from lettersof encouragement writtento parents of a newlydiagnosed diabetic child:

I am a frum Yid with Type 1 dia-betes for the past 16 years (diagnosed atage 11), I fully empathize and sympa-thize with your fears and concerns nowthat your young son has been diagnosedwith diabetes. Being told that yourchild now has a chronic condition,which he will have for life, is very scary.But at the same time, the knowledgethat you can control his diabetes andgive him an almost perfectly normal lifeshould be very reassuring. I am sure youare well aware that having diabetes doesnot stand in the way of anything hecould ever want to do, and from per-sonal experience I can assure you thatthis is true. I've never had a real problemwith managing my diabetes even duringthose most trying work days.This will be a big period of adjustmentfor you and your family, but I'm certainthat all will go well. Hatzlocha rabba!

A.W.

My son, now 7 years old, has haddiabetes since he was 4 and half. He isdoing wonderfully, B"H. You are luckythat you discovered FWD so quickly, asit will be a great source of informationand support to you. More good news isthat your doctor may be willing to giveyou a pump right away. Although youmight be overwhelmed at the thoughtof a pump, you are being offered thevery best standard of care. (You willhave to learn how to give injections any-way, so why not just learn how to use apump right away?) We are seriouslyconsidering a pump for our son, asevery pumper we know is ecstatic overthe change. Im Yirtzeh Hashem, it willget easier, and may your son have manyyears of health and happiness until 120.

C.L.

You know you’re the parentof a diabetic child when…

You grab the meter after cutting YOURSELF —that big drop of blood's just too perfect to waste!

You don't care about the nutritional content of the food you'rebuying, just about the amount of carbs per serving! You've forgotten what the phrase "good night's sleep" means. You glance at the digital thermostat, which reads 68, and imme-diately run for glucose tabs. You look at all children's wrists to see if anyone else is wearing amedic alert bracelet. You base your entire self-worth on your kid's last A1C! Your husband's beeper goes off and the first thing you check isthe insulin pump. New diabetes-related technology (GlucoWatch, etc.) is moreexciting than a new car or kitchen gadget. Your non-diabetic child complains of a low in order to get somecandy.The top shelf in the refrigerator door is reserved for bottles ofinsulin instead of eggs.You reach for measuring cups as serving spoons, even when thechild with diabetes isn't home.You find yourself arguing with your daughter because sheWON'T eat her ice cream before she goes to bed! Your child learns to count backwards before learning to countforward — by watching his/her meter countdown. When asked by someone if they can borrow a pen, you reply, "Hor NPH?" "An apple a day" is not to keep the doctor away, but to offset theinsulin peaking.You clean the lint trap of your clothes dryer and find a bunch oftest strips.You're up at 2:00 a.m., trying to coax your child into drinkingsome juice to treat a low, and you immediately wonder howmany other FWD parents are up doing the very same thing.

©Copyright 1995-2002 Children With Diabetes (www.childrenwithdiabetes.com). Used by permission.


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H A L A C H A T I D B I T S

Halachah TidbitsHalachah TidbitsëCarryingí on Shabbos

There are instances when a Jewish diabetic may- and should - carry certain items outdoorson shabbos, even in areas without an eiruv where carrying would normally be forbidden. The following are some clarifications on the subject:

Surplus InsulinMoshe asked an interesting question: Rabbanim have ruled that one is allowed to wear the pump out-side on Shabbos, even in a neighborhood that does not have an eiruv. However, he wondered, wouldone be allowed to carry the pump if his reservoir is filled with more insulin than he would need onShabbos?

Our Rabbanim ruled that this would not be an issue, and one would be allowed to carry the extra insulin,provided that he does not do it with the specific intention that he will use the insulin after Shabbos.

The same would apply for those who find it necessary to carry an insulin vial outdoors on Shabbos. Anysize vial or cartridge, containing any amount of insulin, may be carried, regardless of the amount ofinsulin actually needed on Shabbos.

Syringe or Insulin Pen?To minimize the prohibition of 'carrying', would it be preferable to carry an insulin pen with the needleattached (1 item) as opposed to separate insulin vial and syringe (2 items)?Rabbi Weissmandl ruled that the insulin pen would be the better option, if possible and practical.

For PumpersA pump's remote control may be used on shabbos the same way one is permitted to use the pump.However, it is not permissible to carry the remote outdoors on shabbos, even with a shinui.

More about Meters on Shabbos The Freestyle MeterClaims have been made on the media to the affect that the Freestyle meter would be the preferred optionon Shabbos. Our Rabbanim have researched the matter and concluded that the Freestyle would in facthave no apparent advantage for use on Shabbos.

Advantage or DisadvantageNote that the AccuCheck Advantage meter has a distinct drawback on Shabbos, as it does not turn off byitself. Since this meter requires the user to turn it off manually, it would be advised to refrain from usingthis particular meter on Shabbos.


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vynkn cagu cag kf lk iht 'arsnc

ksd uk rnutu u,ut vfna gherc kzn uk ihta

The Midrash says;Each and every blade of grass is struck by a

heavenly messenger who commands it "grow!"

Growing PainsBy B. Gertner

Stands a field awash in green,A lively, vivid, luscious scene,This dancing, swaying, vibrant mass,Of young and carefree strings of grass.

Cautiously, unsure at first,They struggled through the earth and dirt,And now, at last, the rays and streaks,Of friendly sunshine warm their cheeks.

The darkness comes, it seems, too fast,And fear blankets the blades of grass.Shivering, they now behold,Brilliant angels bathed in gold.Wings arch out, inflicting dread,And firmly hit each frail head.

How innocent, these blades so new!Their tears emerge like pearls of dew,Pained and fearful, voices bleating,"Do we deserve this heavy beating?"

But, says the Midrash, there and then,The angels whisper a command of Hashem,Stronger than hail, gentler than snow,"Grow my little seedling, grow!"And comes the early morning dawn,Growth has touched this tired lawn.

The scene takes place in time and space,That earthly eyes can't penetrate,But still, I think, it's surely true,The angels' words can reach us too.

Though times are hard, the pain is strong,Our Master says: "You see it wrong!You're hurt and scared and weak, but knowThat now, my child, you can grow!The hardships will not last too long,You'll greet the dawn yet, tall and strong!"

S H O R T A N D S W E E T

As you travelthrough thestreets and highwaysof lifewe are oftenbaffledat the interesting sightsyou are lefta passengerwondering aboutthe places youobservethe phenomenayou witnesssometimeswhen the streetsturn expectedlywhen the trafficis heavywhen the signsare passed too quicklyto read and understandwhen the road symbolsare too difficultto decipheryour trusting heartpounds with questionsand you sigheven cryfor you so wishyou could put thispuzzle together.

Roads seem to twistwithoutrhyme or reasonbut passengers don'tquestionsometimes they evenfall peacefully asleepfor we knowwithout doubtthat the driveris a fatherour fatherand none otherthan he alonehas made all thehighwaysand roadsand signsand signalsandonly heunderstandshis planfor only he aloneis perfect indeedand is ever socarefullydriving us allto a beautiful and suredestination!Have a safe journey!

S.L.

I THINK I CAN! Think big and you'll grow,

Think small and you'll fall behind,Think that you can and you will,

It's all in the state of mind,Life's battles don't always go,

With the strongest or fastest man,But sooner or later,The man who wins,

Is the fellow who thinks he can!

sWxc

Everyone has one - a well-inten-tioned friend or family mem-ber who is a master of misin-

formation. The neighbor who gasps,"You're eating that?!?" or the cousinwho confides, "At least you don'thave the serious kind of diabetes." Next time, make the occasion anopportunity for education ratherthan frustration. Pass along the mostcommon diabetes myths and the realstory behind them.

1) Eating too much sugar causes dia-betes.There is absolutely nolink between sugar con-sumption and diabetesdiagnosis. Obesity is arisk factor for type 2 dia-betes and insulin resis-tance, and overweightindividuals may bestereotyped as big "sweet"eaters, which could beone way this myth is per-petuated.

2) People with diabetescan never eat any sugar!According to ADAguidelines, refined andnatural sugars can beenjoyed by people withdiabetes as long as thecarbohydrates they con-tain are calculated intothe total allowance ofcarb grams for the day.Many people are sur-prised to find that a 1/2cup of potatoes will makeblood sugar levels riseabout 3 times higher thana teaspoon of refinedsugar.

3) People with type 2diabetes don't have totake insulin.Sometimes, even with thebest efforts, diet, exercise,and/or medication fail tokeep blood glucose levels

in an acceptable range in people withtype 2 diabetes. Insulin injections givethese people the control they need toenjoy a healthy and more enjoyablelife.

4) Kids only get type 1 diabetes.Unfortunately, rising rates of child-hood obesity have resulted in anincrease in the incidence of type 2 dia-betes in children, once considered an

"adults only" disease.On the flip side,someone may bediagnosed with type 1diabetes in adulthood.

5) Type 2 diabetes isnot as serious as type1 diabetes.Both type 1 and type2 diabetes can lead tothe same array of dia-betic complicationsch"v, if not treatedproperly. Diabetes ofany type is control-lable and livable, butmust be cared for seri-ously.

6) You can be curedof diabetes if you'reable to go off medica-tion. Or, if you havejuvenile (type 1) dia-betes, you'll outgrowit anyways as youmature!The only current"cure" for diabetes is apancreas or islet celltransplant. If some-one is able to managediabetes through dietand exercise and with-out medication orinsulin, s/he is stilldiabetic. And, unfor-tunately, while type 1

Top10 Myths & MisconceptionsA B O U T D I A B E T E S

7SimpleSteps

for losingyour

FRIENDSWITH

DIABETES(Also works great

for parents,siblings, etc.)

1. Frequently lecture them on how tomanage diabetes properly.Example: "Should you be eating that?"2. Dismiss any negative emotions asmere signs of changes in blood sugarlevels.Example: "You seem upset. Maybe youshould check your blood sugar."3.Find ways to treat your friend as if heor she was fragile or stupid.Example: While eating dinner away fromhome, announce that your friend has dia-betes and s/he must eat now. In otherwords, treat your friend as if he or she is achild, without considering his/her desires.4.Blame your friend for all high or lowblood sugar readings.Example: "Why are your sugars so highnow? What did you do this time?"5. Undercut all attempts to effective selfmanagement by being a helpful saboteur.Example: "You deserve some time off yourregimen. Have a piece of pie."6. Offer meaningless encouragementwhich is less than helpful.Example: "I know exactly how you feel."Example: "It's going to be better soon."Example: "You're not that bad comparedto…"7. Dismiss any concern your friend mayhave.Example: "It could be worse; you couldhave severe ailments ch"v."Example: "Diabetes is not that difficult.All that is necessary is to take insulin."

1.2.

3.

4.

5.

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7.

10S H O R T A N D S W E E T


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It's a calm winter morning, the house is almostsilent, and the clock is calmly ticking in thekitchen. And then the phone rings.

It's your endo's secretary on the line, but hervoice sounds strangely unreal and half hysterical with excitement. In onebreath, she exclaims, "Hello?

CAN YOU COME DOWN TO SCHEDULE ANAPPOINTMENT FOR YOUR CURE?"

What would be your reaction?

A similar question was asked at asurvey conducted several years ago.

Here are some of the answers:

Wow! What a question! I'dcall up all of my diabetic

friends and have a huge party. I'dmake sure that everyone ate and ateand didn't worry about their bloodsugars, but, I wouldn't just servejunk food, since that is bad for evennon-diabetics! Honestly though, Ithink I'd miss diabetes a little bit.I've been diabetic since I was sevenyears old. I don't remember notbeing diabetic. It is a part of my lifenow. It has taught me a lot ofresponsibility. I'd be a totally differ-ent person if I had never been diag-nosed."

diabetes often develops in very youngpatients, it is there to stay until the curewill be discovered.

7) Borderline diabetes or "a littlesugar" is nothing to worry about.With diabetes, it's either all or nothing.The term borderline diabetes actuallyrefers to impaired glucose tolerance(IGT), a precursor condition to type 2diabetes. Today, the medical communi-ty avoids using this as a diagnosticterm, in part because it understates theimportance and risk of IGT.

8) It's dangerous for people with dia-betes to exercise.Exercise is a basic cornerstone of dia-betes management. While strenuousphysical activity can drive blood sugarslower, and there are certain precautionssomeone with diabetes should takebefore exercising, exercise is critical tolong-term blood glucose control and ahealthy body, mind, and spirit.

9) Having diabetes means a strict"diabetic diet."There is no such animal as a "diabeticdiet." People with diabetes are encour-aged to eat the same variety of healthyfoods as the rest of the world. (Or, toput it another way, the rest of theworld should be getting just as muchencouragement as people with diabetesdo, to eat healthy foods.) They do needto pay close attention to food labelsand amounts in order to keep theirtotal daily intake of carbohydrates at anappropriate level. However, as long ascarbohydrates are properly balancedwith insulin, there is no need to restrictcarb intake.

10) Women with diabetes shouldn'thave children.A woman who maintains good bloodglucose control can enjoy a normal andhealthy pregnancy and give birth to acompletely healthy baby. Nursing isalso a viable option for a diabeticmother.

“I will try to help those whocan't afford diabetic sup-

plies and/or afford to be cured fromthis sometimes annoying condition."

“I will probably go out andget a whole load of sugar

and eat it until I'm sick. Then I'llstay clear of it for a while."

“Us at FWD will have

just one little technicality to arrange: We'll have to change the organization'sname to Friends Without Diabetes!!

“

THE CURE

For all diabetics out there who have an incurable sweet tooth: Beware! There are times… When Ice Cream Isn't Everything

In the days when an ice cream sundae cost much less, a ten-year-old entereda hotel coffee shop and sat at a table. A waitress put a glass of water in frontof her. "How much is an ice cream sundae?" she asked.

"Fifty cents," replied the waitress.The little girl pulled her hand out of her pocket and studied a number of coinsin it. "How much is a dish of plain ice cream?" she inquired.Some people were now waiting for a table and the waitress wasa bit impatient. "Thirty-five cents," she said brusquely.The little girl again counted the coins. "I'll have the plain icecream," she said.The waitress brought the ice cream, put the bill on the table,and walked away. The girl finished the ice cream, paid thecashier and departed. When the waitress came back, she beganwiping down the table and then swallowed hard at what shesaw. There placed neatly beside the empty dish, were two nick-els and five pennies — her tip!

S H O R T A N D S W E E T


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Sweet SuccessAt home, Yisroel is very proficient

at carb counting. He uses hisreliable tools — eyes, scale, mea-

suring cups and spoons — to figure theamount of carbs in his meals.However, Yeshivah poses a problem.Since Yisroel did not want to bringmeasuring tools into the lunch room,how could he accurately figure howmany carbs his lunch contained? Resourcefully, Yisroel came up with asolution to his dilemma. Instead ofusing measuring cups, he estimatedfood amounts by pouring his portioninto regular plastic cups. This simple and unobtrusivemethod will surely come inhandy for many of us, in varioussituations. If you know theamount of carbs contained in an8 ounce serving of a food, youcan measure your portion in anysized cup.Do the following simple calcula-tion: Look up the carb amountof that food per 8 oz. serving.Divide this number by 8 toderive the amount of carbs inevery ounce of that food. Then

multiply by the amount of ounces inyour portion.FOR EXAMPLE: 8 ounces of cornflakes contains 24 grams of carb. 24divided by 8 would be 3. So we knowthat one ounce of corn flakes has 3grams of carb. We can now figure 15grams for 5 ounces, 21 grams for 7ounces, and 18 grams for 6 ounces. Ifyour portion of corn flakes fills a 7ounce plastic cup to the top, then youwill be eating 21 grams of the cereal.Yisroel would routinely scoop up hisportion of food using paper cupsinstead of the serving spoons provided.Alternatively, he used a soup ladle,which has a half cup capacity, toremove his serving of food. He devised the following chart foreasy reference in Yeshivah:

We have come up with a formula thatcan be used in a program such asMicrosoft Excel. If you know howmany carbs a food contains in 8ounces, use the following calculation:

A = amt. of carbs per 8 oz. cupB = Formula (see below)A / B = carbs

FORMULAS:For 5 oz cup: 1.6For 7 oz cup: 1.142For 9 oz cup: 0.888

FOR EXAMPLE: Howcan Yisroel calculate thecarb amount in a 7 oz.

serving of rice? We know that an 8oz. cup of ricecontains 45

grams of carb.(This is A.)The formulafor a 7 oz.

cup is 1.142.(This is B.)

Yisroel woulddivide 45 by 1.142, to reach thecorrect number of 39. He nowknows that a 7oz. serving of ricecontains 39 grams of carb.

S W E E T S U C C E S S

Ialways knew in the back of mymind that my family had a histo-ry of diabetes. I also knew that I

was a bit on the heavy side… alright,grossly overweight, and that obesitycould lead to diabetes. But, I hadalways thought I was as healthy as ahorse. A forty year old, very obesehorse. A forty year old, very obesehorse with high blood pressure, cho-lesterol problems, asthma, and now,diabetes. It was time to face it; mosthorses in my condition are sold in lit-tle bottles labeled Elmer's.Other problems started appearing.My vision got so bad that I couldhave been classified as legally blind. Ialways had joint aches and pains, and

my fingers and toeswould tingle andfreeze. Combinethis with the factthat I was rushingto the restroomevery twenty min-utes, and I couldn't go anywherewithout a bottle of water by my side.I knew I had to see the doctor.The doctor's visit confirmed my sus-picions. My blood glucose was 640mg/dl and my HbA1c was 17%. Myblood pressure was 165/105 and myHDL, the "good cholesterol" whichprotects the heart, was only 21. Thesingle piece of good news was that Iweighed in at 230 pounds - down

from 270. Apparently, I had lost 40pounds due to my diabetes. For thefirst time in my life, I had to face upto the fact that I was physically very,very ill.My health today is a study in con-trast. My HbA1c is 4.9%. My weightis down to 170 pounds and my HDLis up at 61. My blood pressure aver-ages around 120/75 and my resting


FOO

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OUNCES

Going Forward 2 SuccessBy D. Weintraub

8 5 7 9

Milk 12 8 11 14Orange Juice 27 17 24 30Corn Flakes 24 15 21 27Ferfel 40 25 35 45Noodles 35 21 24 39Potatoes 36 22 31 40


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pulse rate is 53 beats per minute. Ina certain sense, getting diagnosedwith diabetes was one of the bestthings that could have happened tome. The diagnosis woke me up. Itmade me realize how dangerously illI had become.

This tremendous changeover in mylife did not occur because I possesssuperhuman strength. I had vowedthousands of times before that Iwould start exercising, but never fol-lowed through. I made constant res-olutions to lose weight, but thoseintentions always lost out to the nextorder of burger and fries. After awhile, I just accepted that I am whoI am, and if people didn't like mebecause I was overweight, that wastheir problem.This time, things were different. Isuddenly had a clear vision of myfuture, and it wasn't pretty. Failurewas no longer an option, and maybethis provided me with the incentive Ineeded to stick to my plan, but it alsomeant that I actually had to have aplan. For the first time in my life, Isat down and analyzed my situation.I asked myself why my previousattempts to lose weight had failed,and what I have to do to succeed.

I can't say I came up with a magicdiet plan that will guarantee weightloss, nor did I discover a way to exer-cise while lying on the couch duringa Shabbos nap. There will be difficultsituations you will have to gothrough, and there will be sacrificesto make; there will be times whenyou will fall, and you will have to bedetermined to pick yourself up andcontinue. But that's just part of life,and you've done that before. Beloware some tips that I discovered on myway to better health. Maybe they willhelp you too. • You are going to be on a diet forthe rest of your life.Sounds scary,doesn't it?Before Iadopted thisattitude, dietsfor me werejust a tempo-rary means tolose weight, so Icould go back todevouring all thefood withinreach. Now, Iunderstoodthat Iwould haveto change myentire way ofeating and find a diet that I couldstick to. My actual diet is a mixture oflow calorie, low fat, and a moremoderate carbohydrate intake. • I began reading nutrition labelsand I quickly found that many so-called "healthy items" were muchhigher in calories and carbohydratesthan we thought. I stopped eatingthat "healthy" 12 grain bread I liked,but which contained over 26 gramsof carbohydrates per slice. In fact, Ifound that I needed to forget aboutspecialized diet food altogether. Mostof the time, manufacturers simplyreplace the fat in diet products withexcess carbohydrates. Besides, I

wanted to learn a new way of eating,to get to the point where a syrupysweet drink is not even tempting. Ilearned to enjoy the naturally bittertang of tea and coffee and to associ-ate good flavor with foods that arenaturally high in nutrition. • Everyone in your life is going onthe same diet. For years, whenever Iwas dieting my wife would have tofix me diet food while everyone elsein the house ate regular food. I wasleft feeling constantly deprived. Thistime, I was determined to change notonly the way I lived, but also every-one else's life. I stressed to my familythat we weren't going on a weightloss diet or a diabetes diet. We

would be eating a healthydiet. Treats would

become just that: treats,and not a constitutional right.

I stressed to the kidsthat if they wanted

snacks, there wouldbe plenty of fruit,

cereal, ands a n d -w i c h e s

to eat. What really

changed wasour attitude

towards our veg-etable friends. Non-

starchy vegetable side dishes wouldno longer be an afterthought, butwould become a necessary compo-nent of the meal. We found goodvegetable cookbooks and startedexperimenting with new, exotic pro-duce: Chard, mustard greens, broc-collini, and others. We learned newways of cooking vegetables beyondsteaming and boiling. To our pleas-ant surprise, we learned that our kidsactually liked vegetables.• Exercise, exercise, exercise! In hisbook, Eat, Drink, and Be Healthy,Dr. Walter Willet takes on the food


(Going Forward 2. . . — cont. from previous page)

“In a certainsense, gettingdiagnosed withdiabetes was

one of the bestthings that couldhave happened

to me.”


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pyramid. One of the biggest modifi-cations Dr. Willet makes is puttingexercise right on the base of hisHealthy Eating Pyramid. Reducingyour caloric intake without increasingyour physical activity will merely putyour body into starvation mode.You will be constantlyhungry and you willprobably metabolizemuscle you want tokeep and not fat youwant to lose. Whileexercise does NOT replacea healthy diet, it is an essen-tial addition.Of course, exercise hasmany other benefitstoo. Aerobic exercisebuilds muscle andreduces fat. Since fatincreases insulinresistance and mus-cle reduces insulinresistance, the resultis better diabeticcontrol. After just acouple of monthsof exercise, I no longerneeded any diabetic medication. I found that in order to really benefitfrom exercise, it must become aningrained habit. When I first startedout, I was too embarrassed by mybulk to work out in a gym, and I cer-tainly wasn't going to jog through thestreets. Walking was the obvious solu-tion. A brisk walk can be an excellentcardio-vascular workout, it is gentleon the knees, and most important ofall, I could pretend that I was justwalking and not really exercising. Youcan do your walking anywhere:Around the neighborhood, in a shop-ping mall, at a park, or walking to andfrom Shul. When I first started out, Icould barely walk a mile in 20 min-utes, but after a few months, I couldcover a mile and a half in that amountof time.

I took at least two walks per day: oneright after breakfast and the other fol-lowing lunch. I decided on this pat-tern because I figured that I couldfind the time to do two 20 minutewalks per day, but squeezing in a 30minute walk (30 minutes is the rec-ommended minimum of exercise per

day.) wouldbe much hard-

er. Besides, Ialso discovered

that walking couldlower my blood glu-cose reading by asmuch as 60 points,and a good walkwould keep my post-prandial readingsbelow 120 mg/dl.Since my blood glu-

cose was thehighest right

after break-fast and

lunch, it was anexcellent time to

exercise. Sometimes,when the weather was

good, I would also take anevening walk to help maintain my

blood glucose level.• Use your glucose meter. My glucosemeter became more than a means oftesting my blood glucose; it is ameans of keeping my entire lifestyleon track. I started testing my bloodglucose between eight to ten timesper day. A high blood glucose readingwould make me trim the amount ofcarbohydrates I would eat at my meal,or encourage me to put a little moreoomph into my walk. It might evenencourage me to take a third walk orto go a bit longer than my usual 20minutes.I found the meter a great encourage-ment for exercising since I couldimmediately see the results. I couldwatch a pre-exercise reading of 119mg/dl become a post-exercise readingof 82 mg/dl. The meter reading made

me feel good and gave me the feelingthat I was in control of my diabetes.My life has pretty much changed sincemy diagnosis. I eat more than I first

did when I started my diet because Ino longer want to lose weight and Iam a lot more active now. However,my diet is still more or less the sameas it originally was. In addition, Iexercise more intensely nowadays. Irun for 25 to 30 minutes and I do around of weights once per day to helpkeep my insulin resistance low. I sim-ply don't feel that my day is completeunless I've run at least six miles.Instead of a Shabbos nap, I'd rathertake a nice long walk. If invited to asimcha, I no longer make a bee line tothe buffet and dessert tables, butspend my time dancing with thecrowd. Most of all, I am happy with my newlife. I have more energy and spendmore time playing with my kids. Mybody doesn't suffer from constantaches and pains that I assumed werejust signs of getting old. I no longerfeel embarrassed of the way I look.Best of all, I am teaching my childrengood living habits. G-d willing, theywill keep on living a healthy lifestyle,and they won't have to go through thedistress and pain of getting diagnosedwith diabetes in their mid-forties. I'mglad I discovered that I had every-thing I needed to get my life backunder control. All it takes is some rea-sonable planning and the desire totake that first step ForWarD.

(Going Forward 2. . . — cont. from previous page)

“After just acouple of monthsof exercise, I nolonger needed any diabetic medication.”

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