shabbos sugars a - friends with diabetes · imation, and so easy to remember.) amount: to fulfill...

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All diabetics will benefit greatly from precisecalculating of Shabbos carbs. The type 1must match insulin dosing with the

amount of carbohydrates consumed, while thenon-insulin-dependent type 2 is on a constantlookout for moderating/limiting the carbohy-drates in his/her diet. Besides discovering exactcarb contents of sometimes-hard-to-figureShabbos foods, you will learn from the follow-ing article just how much of each course youare actually required to eat (according tohalacha, Jewish law), as well as helpful hints forlowering the carb values of many Shabbosfoods.

Note: All carb values stated in this article are'effective carb counts' i.e., fiber has been sub-

tracted from the total carbohydrate content. [For more details, refer to the Tu B'Shevat article in our winter publication.] In somecases, dietary fiber values are listed separately to benefit those who are seeking to fulfill the challenging medical recommenda-tion of consuming 30 grams of fiber daily.

KIDDUSH

Grape Juice: Grape juice contains33-37 grams of carbohydrates

per cup (about 4 grams per ounce),but only the label of your particularbrand can reveal its exact carbcontent. In general, grapejuice is not recommendedbecause it is very high on theglycemic index. (It enters theblood stream very fast andraises blood sugars excessive-ly, which make it ideal fortreating a low blood sugar.) Wine: Sweet wine maycontain as many or evenmore carbohydrates thangrape juice, and a dry, low-carb wine is therefore yourbest choice. The drier the wine,the less carbohydrates it contains. When searching for a low-carb wine,please do not be fooled by advertise-ments which assert that a particularwine contains no sugar. This meansonly that there is no added sugar, butstill plenty of natural residual sugars

(halachically preferred). A leadingwine company confirmed that thesugar content in these wines is almostas great as those in grape juice. Forpeople with diabetes, 'natural' sugarsare no different than any other type ofsugar; isn't sucrose (sugar cane/tablesugar) natural as well?Because alcohol can have a bloodsugar lowering effect [refer to the

Purim article in our winter issue],many people willfind that it is bestto ignore the car-bohydrates in a

dry wine and notto cover themwith insulin.Remember that

each individual willrespond differently.

If one has a low bloodsugar at the beginning of the

meal, he should certainly substitutesome or all of the (low-carb) winewith grape juice, as the alcohol maycause his blood sugars to fall even fur-ther.

Amount: At Kiddush on Shabbosand Yom Tov, one has to drink only amelo lugmav, enough to fill one'scheek. For an average person, thiswould amount to 50-55 cc (1.69-1.85 fl. Oz.).

[To find out your exact shiur(amount), refer to our article on YomKippur, but just remember the dif-ference. On Yom Kippur we want toconsume LESS than a melo lugmav,which would be 40 cc (1.35 oz.),while for Kiddush we want to makesure to drink a FULL melo lugmav,50-55 cc.]

According to one opinion, it is possi-ble- although not preferable- todivide the melo lugmav among allparticipants. If you are being yotzeby listening to another person'sKiddush, it is enough if you drinkjust a tiny bit, and even that smallamount may be omitted, b'dieved.

The Mishnah Berurah says that oneshould use a cup that is big enoughto hold 137-150 g./4.7-5.1 oz. (this

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is the largest opinion of revi'is- theamount prescribed by our Sages forKiddush), especially for the Fridaynight Kiddush which is a d'oraisah(a biblical, as opposed to a rabbini-cal, command). The amount to drinkremains the same as mentionedabove, regardless of the size of yourcup.

Kiddush must be recited at the placewhere a meal will be eaten.Commonly, cake or cookies are usedfor that purpose, if the Shabbosmeal will be eaten at a later time ordifferent location. However, thosewith diabetes may benefit fromanother option: one may drink anextra revi'is of wine, which is 86 cc(2.9 oz.), in addition to the amounthe drinks for Kiddush (55 cc). Inother words, he should consume atotal of 141 cc (4.8 oz.). The addi-tional wine is counted as a mealaccording to halachah and it istherefore considered as the personwould have made Kiddush in con-junction with a meal.

Most wines may be mixed with 1/3water. [Refer to our Pesach issue fordetails.]

CHALLAH & MATZAH

Every ounce of challah contains 15grams of carb, with an average

slice weighing in at no less than 3ounces! Weighing your challah por-tion with a scale is highly recom-mended; it is impossible to avoiderrors otherwise.The mishna (in Trumos 4:6) states,keuavu 'ubnn jcuan ssunvu 'jcuan vbunv

i,akan jcuan — The one who countsis laudable; the one who measures iseven more commendable; theone who weighs is mostpraiseworthy of all.(Literally, the Sages arereferring to the varyinglevels of accuracy of onewho is separating tithes.)These words are very applicablehere as well: The one who counts his

carbohydrates according to exchanges(i.e. one slice=one exchange) is laud-able. The one who measures his slicefor greater accuracy (i.e. 2 inch by 2inch slice = X amount of exchanges);he is even more commendable. Butthe one who weighs the challah (30grams/1 ounce = 15 grams carb) ismost praiseworthy of all!It is preferable to use matzah, whichhas the carb count written on the boxand is always the same size. Regularmatzah has 24 grams per matzah;whole wheat contains 18 grams ofeffective carbs per matzah (22 gramsof carbohydrates, minus 4 grams offiber). It is also lower on the glycemicindex so it will cause a slower rise inblood sugars. [Once again, our TuB'Shevat article will be helpful. Seeour winter issue.]If you do use challah, remember thatits carb factor is 0.5, which meansthat half its weight is carbohydrate.For example, a slice weighing 100grams will contain 50 grams of carb.This is true also for all soft, bakedgoods. (Although not absolutelyaccurate, we feel that the rule of fifty,"Halve the weight; have your carb!" isworth using since it is a close approx-imation, and so easy to remember.)

Amount: To fulfill the obligation ofthe seudah (meal) of Shabbos, oneshould eat slightly more than akebeitzah (literally, equivalent tothe size of an egg) of challah, whichequals two k'zaysim (literally, thesize of olives). If only one kezayis isconsumed, Birchas Hamazon(blessing after the meal) can still berecited, but al netilas yadayim, theblessing after washing hands, can-

not be said, according to somehalachic authorities.

We were not able todetermine theexact amount ofchallah whichwould satisfy the

halachic measure-ment of k'zayis, but

Sefer K'zayis Hashaleimbrings the following examples:

— 1/9 of a bilke (5 grams in weight)

— 1/3 slice white bread (8 grams inweight)

— 1/2 of a middle-sized slice of ryebread, or ¼ of a larger-sized slice(10 grams in weight)

— 1/10 of a bagel (13 grams inweight) Note the wide variationsin weight, from 5 to 13 grams,probably due to the difference inthe consistency of each breadtype.

4/10 of a matzah (a bit less thanhalf; 15 grams in weight) would beone k'zayis. One who eats an entirematzah has certainly consumed ak'beitzah and can safely make theblessing of al netilas yadayim aswell.

FISH

Even though fish is a protein andcontains no carbohydrates (unless

it is cooked with sugar or with starchyvegetables such assweet potatoes), itis usuallymade witheither reg-ular orm a t z a hflour, whichmust be count-ed. The carbs in your fish recipe canbe calculated by adding together allthe carbohydrate grams put into thefish (i.e. the total amounts of flourand sugar) and then dividing thatnumber by the amount of portionsmade. You can also weigh the entirerecipe to figure its carb factor. [See theChanukah and Tu B'Shevat articles inour winter issue for more details.]Gefilte fish can be made without flourand sugar, using a sugar substitutesuch as Splenda. It would then be apure protein. (Wheat Bran can beused instead of flour.) Some peoplesimply rely on the fact that the littlebit of added sugar gets dispersedthroughout the broth and the entire


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pot of fish, renderingit almost negligible

in one portion. Beaware, however,that substitut-ing sweetp o t a t o e sand/or carrots

for the sugarmay not alter the

carbohydrate content per portion.A&B Famous, a popular brand offrozen gefilte fish, contains 7 grams ofcarbohydrates per slice, while its sugarfree version holds 4 grams to a slice. Acarb free version will soon be avail-able.

KNEIDLACH

The carb count will vary dependingon your recipe. Once again, you

can use the abovementioned method:Calculate the total carbohydratesincluded in the recipe and divide thatamount by the num-ber of balls yourrecipe yielded.For Example, a stan-dard recipe contains22 grams of car-b o h y d r a t e sand makes 5medium-sizedballs. Thisrecipe contains4.4 grams of carbper matzah ball.

NOODLES

Four ounces (½ cup) of noodlescontains 20 grams of carbohy-

drates; 5 grams per ounce (2 Tbsp.).Remember to pay attention to theamount of noodles you add to yoursoup, as you most likely consume lessthan ½ cup.Those on a lower carb diet can makepesach'dige "lokshen" (Passover noo-dles), which is purely fried eggs and

therefore a protein. You can include abit of soy flour and Seltzer to give theegg mixture additional substance. Or,try adding soup vegetables, such ascelery or zucchini (or even whiteradishes, turnips, andkohlrabi) to yourp o r t i o n

a n domit the noo-

dles entirely.

FARFEL

Half a cup of Farfel (4ounces) contains 15-

20 grams of carbohydrates. Note: If you cook your own Farfel,remember that the nutrition valuesstated on the packaging are for thedry (uncooked) product.

POTATO KUGEL

A 3 ounce slice, typically 2" by 2",contains 13 grams of carbohy-

drates. Using the method detailed inour Chanukah article, we can con-clude that carbs account for 15% of

potato kugel's total weight.Squash, Broccoli, Cauliflower,

mixed vegetable or Spinachkugel are some excellent

alternatives for thosewho are seeking to

limit carbohydrates.(No flour is needed either. Just addeggs, mayonnaise, and a bit of onionsoup mix for flavor.) Or, try substitut-ing Tofu for half of the potatoes in thestandard kugel recipe; Tofu's uniqueproperty is to attain the flavor ofwhatever food it is combined with.

NOODLE KUGEL

According to the book KosherCalories, a 5-ounce slice contains

19.5 grams of carbohydrates.

Understandably, the carb amount inyour kugel will vary depending on theamount of sugar, noodles, and othercarbohydrates included in the batter.(We've witnessed a chef dumping anentire 5-pound bag of sugar into oneJerusalem-style noodle kugel pan!)You can make a delicious, lower carbNoodle Kugel using spaghetti squashand sugar substitute. Use the sameingredients as in a typical NoodleKugel, but exchange the noodles forthe spaghetti squash, which containsonly 7.8 grams of carb per cup(cooked).

FLOUR KUGEL

Once again, individual recipes willdiffer. A recipe yielding 12 slices,

which calls for one pound of flour(343 grams of carb), 2/3 cup Splenda(10 grams of carb), oil, water, andspices, would contain 29 grams ofcarbohydrates per slice.

COMPOTE

It isimpor -

tant to consult the label of cannedCompote, as some contain more carbsthan others. For instance, sweetenedapplesauce has about 20-25 grams ofcarbohydrates in ½ cup, whileunsweetened contains 12-15 grams inthe same amount.If you do not know the carb content,you can usually count 15 grams ofcarb per half a cup of fruit compotewith no added sugar.


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Those on a lower carb diet canmake Compote by mixing variousberries with water and Splenda.

Type of BERRY EffectiveCarbs (per8 oz. cup)

Raspberries 5.9

Strawberries 7.2

Blackberries 10.7

Blueberries 16.6

CHOLENT

Served at the Shabbos lunch meal,cholent is a traditional stew com-

bining beans, meat, and sometimes,potatoes. Many different beans andspices can be added, and each (family)recipe will vary. We will calculate the carb content of acholent made with barley and navybeans. Cooked, pearled barley holds38.3 grams of carb per cup, whilecooked navy beans contain 36.2grams, averaging out to 37.3 gramsof carbohydrate per cup.[Just to remind you how to make anaverage, add the 2 numbers together(38.3 + 36.2 = 74.5), and divide by2 (because we have two cups), toarrive at a rounded total of 37.3grams per cup.]Should one decide to use differingamounts of various beans, the samecalculation applies. For example, ifusing 2 cups kidney beans and one

cup of lima beans, you would addtwo times the kidney beans

(2 X 29 = 58), to one cupof lima beans (26.1), for atotal of 84.1 grams of car-bohydrates. Dividing thatamount in 3 (because, in

this example, you have 3cups altogether), youarrive at 28 grams percup.

The following chart lists thecarb contents of many commonbeans. You can also look up manymore types of beans in carb countingbooks.Before serving the cholent, you canprepare it in cups to make it a bit eas-ier to calculate the carbohydrates. (Afull cup of the above-mentionedrecipe contains 37 grams ofcarbs, so half a cupwould have 18.5grams, 5 ouncescontains 23grams, etc.)R e m e m b e r ,however, toinclude only beansand/or other carb-con-taining ingredients, andno meat, in the cups.

When removing only beans from apot of cholent, is there a possibilityof violating the prohibition of borer(separating two foodstuffs onShabbos)? After discussion with aposek, a rabbinical authority, thefollowing was concluded:

It is definitely permitted to moveaside a big piece of meat in order toreach the beans. The questionremains, however, when removingsmaller pieces of meat that getcaught in the cup. Since both foods(beans and meat) will be eaten atthe same time and the separation isonly for measuring purposes, onecan argue that there is no borer. Tobe on the safe side, one shouldleave some meat in the cup. (A smallpiece shouldn't interfere with thecarb counting.)

Lower carb dieters can try using moresoybeans and meat, or even

tofu, instead of other beanchoices or potatoes. Try

experimenting with freshpumpkins, turnips, or kohlrabiinstead of potatoes or carrots.

If your family includes mem-bers who are not on this diet,you may want to cook onelarge pot of cholent with theregular, high carb ingredi-ents, and choose just themeat for your portion.

However, as carbohydrates arevery soluble and cholent is

cooked for a long time, some ofthe carbs from the beans and pota-

toes will likely be absorbed by themeat and broth as well. An exact carbamount is hard to calculate, but dotake some carbohydrates intoaccount. (The same would be true forchicken soup, if you choose to cook itwith the vegetables and eat only thebroth.)


B E A N S C O M M O N L Y U S E D I N C H O L E N T :

Type Carbohydrates* Dietary Protein Glycemic Index ** Glycemic Load **per cup (boiled) Fiber

Kidney 29.0 11.3 15.3 28 7Lima, Large 26.1 13.2 14.7 32 10Navy 36.2 11.6 15.8 38 12Pinto 29.2 14.7 14.0 39 10Barley 38.3 5.9 3.5 25 11Soybeans, mature 6.8 10.3 28.6 18 1

* Dietary fiber was already subtracted**For explanation on GI and GL see our Tu B'Shevat and Pesach articles, respectively.

MEASURING FOODON SHABBOS

Is it permissible to measure foodon Shabbos? Normally this

would be forbidden, but b'makommitzvah (when there is a mitzvahinvolved) the act ispermitted. In our casethe mitzvah of takingcare of our health (tightlycontrolling blood sug-ars) overrides the rab-binical prohibition ofmeasuring foods.(Based on MishnaBerurah HilchosShabbos 306:36)

TIMING OF INSULIN DOSE

Since the Shabbos meal often lastsover an hour from beginning to

end, and cholent is usually servedtowards the end of the meal, it is prob-lematic to cover all the carbs withrapid acting insulin (Humalog orNovolog) at the start of the meal. Inaddition, the absorption of the carbo-hydrates is slowed by fat and dietaryfiber (especially from the cholentbeans). Some longstanding, oftenpoorly controlled, diabetics have alsodeveloped delayed stomach emptying(gastroperises), which further impedescarbohydrate absorption. For all thesereasons, it is not recommended tocover all the carbohydrates that will beingested during the Shabbos mealwith insulin prior to eating.Here are a few solutions you canexperiment with, after discussion withyour doctor:1. Pumpers can, of course, bolus as

necessary throughout the meal("bite and bolus"). An extended,square wave or dual wave bolus isalso an excellent option.

2. Split your meal shot, giving someinsulin right before or even aftereating the cholent.

3. Substitute Regular insulin for someof the Humalog/Novolog you

would normally take to cover themeal.

4. Replace some of the Humalog/Novolog with long acting insulin(such as NPH or Lente).

Depending on your prior experiences,you may or may not choose toadminister insulin for proteinas well. Most people dorequire some additionalinsulin for the Shabbos meal,when a large amount of pro-tein is consumed. [Refer toour Shavuos article.]

Example 1:CHAIM doesn't limit his

carbohydrate intake, but makessure to calculate it correctly and coverwith insulin as needed. He also shuns'diet food', disliking the taste and aim-ing not to be "different". He takes 1unit of Humalog per 15 grams ofcarbs. (Every individual's insulin-to-carb ratio will vary.)— Kiddush: He makes Kiddush on

grape juice and drinks 2 oz.= 8 grams

— Challah: His slice weighs 3ounces. (3x15=45) = 45 grams

— Fish: He eats one slice of salmon,which is a pure protein = 0 grams

— Eggs & Onions: No carbohydrateshere. (He doesn't count the smallamount of onion.) = 0 grams

— Cholent: His cup of cholent, madewith barley and navy beans,contains an average 37 grams ofcarbohydrates. = 37 grams

— Potato Kugel: He eats 1 slice,weighing 200 grams.(200 x.15=30) = 30 grams

— 1 Slice of Flour Kugel= 29 grams

Total: 149 gramsChaim will take 10 units of insulin tocover the carbs in his meal (1 unit per15 grams). He will also add 2 extraunits to cover protein. Since his mealwill last about an hour, he will split hisdose into 7 units Humalog and 5units Regular.

Example 2:DOVID is on the insulin pump. Asa type 3 diabetic (who is both a type1 [has no insulin production] and atype 2 [insulin resistant], 1+2=3), hetries to limit his carb intake, and eatsdietetic food instead of the regularversion whenever he can. He takes 1unit of Novalog per 8 grams of car-bohydrates. — Kiddush: He makes Kiddush on a

dry wine & drinks 2 oz. =0 grams·— Challah: He eats 1 whole wheat

matzah. =18 grams— Fish: He eats one slice of salmon,

which is only protein. = 0 grams— Eggs and Onions: Only protein.

(Again, he doesn't count the smallamount of onion.) = 0 grams

— Cholent: A cholent made solelywith soybeans was a bit too bluntfor his taste, so Dovid now eats acholent of mixed beans. But, heallows himself only a half cup of it,and even that is mostly meat. (Heconsoles himself with the thoughtthat once he loses a considerableamount of weight and his insulinresistance is diminished, he will beable to eat more of his favoritecholent again!) = 15 grams

— Kugel: 1 slice of Spaghetti SquashKugel = 4 grams

Total: 37 grams

Dovid will administer 4.6 units ofinsulin to cover the carbohydrates inhis meal (1 unit per 8 grams), plus 3additional units for protein. Becausehis meal will last approximately an

hour, he will split theinsulin dose as fol-

lows: 4 units as anormal bolus atthe beginningof the meal, and4 units as asquare wave,extended over2.5 hours, taken

before thecholent.


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When Baruch entered his endocrinolo-gist's office last month, he was allsmiles. Yes, he'd finally managed it:

a neat stack of handwritten records doc-umenting his frequent blood sugarchecks, carbohydrates eaten at each meal,insulin administered… even stress andexercise were faithfully logged. Thispriceless information, he knew, was hishard-earned ticket to theland of (Almost) PerfectBlood Sugars; with his doc-tor's help, he could nowmake the precise changes inregimen to reach the diabet-ic version of Perfection.

Triumphantly, Baruchreached into his briefcaseand removed the neatly sta-pled booklet. And that'swhen he noticed his mistake:these weren't blood sugarrecords he had snatched offhis cluttered desk; instead,he stared at a report his sec-retary had just prepared,"The Varied Uses of the Modern PDA".He had a suspicion that his doctor could-n't care much, just then, to discover somelittle known functions of his Palm Pilot.

Those agonizing weeks of endless bloodglucose tests (with his trusty meter,lancets, and strips), carbohydrate calcu-lations (which entailed carb counters,calculators, food labels, and more), andtime-consuming documentation, not to

mention the endless search for pens andrecord sheets, had ended so disgracefully.Staring down at the report in his hands,he suddenly noticed its title again, andhe composed a silent wish: "Please, please,may there be one bright inventor whowill finally come up with a better alter-native to help us frazzled diabetics orga-nize our records, carbohydrate intake,blood sugars, and daily activities. My

Palm does serve so manyvaried uses; can't it help mein this area as well?"

Okay, so maybe this storynever quite happened,but you may be glad tohear that not every partof it is false. In fact, writ-ten records are vital, yettime consuming, and theendless amount of para-phernalia needed to vig-orously track diabetes indaily life may be frustrat-ing. And, yes, your trustyPDA (Personal Digital

Assistant; famous brand namesinclude Palm and Pocket PC), whichyou very likely already own for busi-ness or personal use can really help atremendous deal.

Various companies have jumped ontothe popular bandwagon of PDA soft-ware, competing to create the mostdiabetes-friendly programs withunique and helpful features. In fact,the AACN (American Association of

Critical-Care Nurses) recently pub-lished an interesting report entitled,"The Emerging Role of ElectronicDiaries in the Management ofDiabetes Mellitus". Their statementthat electronic diaries "are demon-strating promising benefits overpaper-based diaries" will surely haveyou nodding your head once you tryit out.

This article will present the distinctattributes, advantages, disadvantagesand helpful characteristics of thediverse programs available today. Ourlist of features to look out for will helpyou decide which of the diabetes ori-ented software programs will mostclosely fit your needs to make life withdiabetes just a bit easier.

Available Features:In addition to the basic features ofcharting and graphing blood glucosevalues, here are some extras you maywant your software to include.

• INSULIN CALCULATOR: Thisis among the most important quali-ties you will want your diabetessoftware program to possess. It willautomatically suggest an amount ofinsulin to administer, based on thequantity and type of food item youwill be eating, or your currentblood sugar. Some programs caneven fine-tune their dosing sugges-tions based on your specific insulinsensitivity, and a few go as far asallowing for varying insulin sensi-tivities for different meals. Onecomes preprogrammed with theunused insulin rule. The ezManagerby Animas is currently the only pro-gram on the market that calculatesinsulin for protein and subtractsfiber from final carb counts. All ofthese are phenomenal additionswhich you may want to take advan-tage of.

• A BUILT-IN FOOD DATABASEis another excellent feature whichwill save you a lot of page-turningand manual hunting through gram

M

My Palmdoes serve

so manyvaried uses;

can't ithelp me

in this areaas well?"

making yourPersonal Digital Assistant

a Personal Diabetes Assistant

counters, labels, or charts for thecarbohydrate content of your meal.One program boasts the additionalcapacity of "favorite food" mark-ings, so you can avoid searching theentire database for carb counts ofpopular foods you often consume.

• EVENT MARKINGS: Manysoftware programs give the user theability to label blood sugar resultswith a choice of titles, such as"Before meal", "After exercise", or"Hypoglycemia". Some also allowfor custom events, so you caninvent the labels that suit your par-ticular needs, i.e. "Post swimming"or "Skipped morning walk".Logbook DM will even handle thework of categorizing each entry foryou, intelligently and accurately.This not only saves time, but alsoprovides you with more useful sta-tistical information later.

• EXERCISE LOGGER: This fea-ture allows for recording the type,intensity, timing and duration of allexercise done. It is an excellent aid fortracking the effects of various typesof activity on blood glucose levels.

• DESKTOP COMPANION: Many

companies offer a desktop programwhich can be synchronized with thePDA version and is good as a back-up for people who have limitedmemory on their handheld. It alsoprovides the ability for the user toprint reports and graphs (bringingyou full circle, back to the papergeneration!)

• EXPORT FEATURE: Allows theuser to export the information toother programs, usually as a textfile. Excel is commonly used and itslayout can be customized to yourneeds.

• ELECTRONIC REMINDER:Can be programmed to remind youto reorder supplies, check bloodsugars, or change pump sites.

Diabetes Hardware for usewith your PDA:• ACCU-CHEK has two meters

available which can beam resultsdirectly to your handheld.

• ANIMAS pumps allow the user tobeam information to a PDA if youhave the ezManager Plus and the IRport. (see later on)

• FREESTYLE TRACKER: Ameter and electronic diabetes track-er in one. This excellent deviceautomatically logs all blood sugartesting results.

Program Reviews:In this assessment of diabetes soft-ware programs for your handheld PC,information is applicable in each caseup to the version indicated. A truly in-depth evaluation of the many pro-grams available would have beenalmost impossible, so we mentiononly the most prominent or interest-ing features. Besides the distinct prosand cons of each program, manyattributes are simply a matter of pref-erence. Remember that most compa-nies offer a free trial version, so youcan insure your full satisfaction andmake an educated decision beforepurchasing the software. Friends WithDiabetes has compiled a very usefulCD which includes trial versions ofmany excellent diabetes software pro-grams, giving you the unique oppor-tunity to compare and contrastamong the various programs beforemaking your decision.

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ezManager

Latest version: 3.0

Company or developer: AnimasCorp.

Purchasing information: Availableat Animas eStore website.

Price: $99.00, or $69.00 forAnimas pumpers

Trial version: 32 days after freeregistration (6 days prior to reg-istering)

Charts: Only logs are available onthe handheld, but many chartsand graphs can be viewed onthe desktop companion.

Pros: The most advanced and pol-ished of all diabetes-orientedPDA software to date, the

ezManager boasts many exclu-sive features. It is currently theonly program that recordsextended boluses and automati-cally calculates protein coverage(for those who need it). The pro-gram is very easy to use; no dropdown menus. Make a list offavorite foods, so you don't needto search the whole food data-base for commonly used foods.You can even save entire foodmenus (carbohydrate values plusactual food items), and differentinsulin-to-carb ratios can be setfor different meals and snacks(for example, you may find that 1unit insulin per 6 grams carbohy-drate works best to cover break-fast, while a ratio of 1:10 is ade-quate for lunch, and at dinner

you respond best to a 1:8.). Youcan also enter a food in any serv-ing size and the carb values areautomatically adjusted.

Cons: Exiting the program can onlybe done from the main screenwhich may cause a delay of sev-eral seconds. Blood glucose val-ues can be entered only byscrolling and not by the use ofgraffiti.

ezManager Plus Price: $129, or $99 for

Animas customers.

In most ways the same as theezManager, this program has theadditional capabilities to down-

load information from the Animaspump as well as a variety ofmeters. The comprehensive datacan then be used to produce beau-tiful, professional, and wide-rang-ing reports.

Logbook DM

Latest version: 2.2

Company or developer: Copyrightby Ryan J. Bruner

Purchasing information:www.PalmGear.com orwww.handango.com Search forLogbook DM.

Price: $15.00

Trial version: 40 entries

Pros: Logbook DM (DM =Diabetes Management) providesthe easiest and fastest way tolog blood glucose levels, carbo-hydrate intake, insulin, lowblood glucose, exercise, ketones,and other notes. The developerof Logbook DM is himself apumper and uses the programdaily, so it is extremely practicaland contains almost every con-ceivable feature that may be ofhelp.

Most commonly-used featuresare accessible from a singleentry screen. And, using QuickDM, you can enter informationwith the touch of a finger...nostylus necessary! Logbook DMcan be configured to provideautomated reminders for check-ing blood glucose (either atspecified times or in response tomeals, boluses, or low bloodsugars), appointments, orderingsupplies, etc.

The "Interpolated Average" fieldprovides a time-weighted aver-age of blood sugars. Meaning, itdoesn't just calculate actual glu-cose values, but also factors inhow long that particular sugar

level was maintained in thebody. (Supposing your bloodglucose was 150 for an hour,and 250 for three-hour's dura-tion, your average blood sugarwill not be a simple 200.)

Cons: Does not have an integratedfood database, but you can cre-ate your own "quick carbs"- acustomized list of the foods youoften eat and their carb values.

FreeStyle Tracker(This is a meter that slidesinto a Handspring Visor andcomes with FS Tracker software.)

Latest version: 1.24

Company or developer: FreeStyle

Purchasing information: 888-522-5226 or: www.therasense.com

Price: $109 after $40 mail inrebate. With Visor: $194

Trial version: There is an onlinedemonstration available. (Notrial version.)

Charts: A 'logbook' showing twodays at once, diary, 3 screens forstatistics.

Graphs: Line, Pie, model day.

Pros: Blood glucose meter auto-matically logs testing results.Smallest blood volume requiredfor testing (0.3 microliters),alternate site testing available,glucose results in an average of15 seconds, with 2,500 eventmemory (1.7 years of data atfour tests per day)! You can entera comment with each readingand also note how much timeelapsed since you last ate.

FS Tracker allows for sophisticat-ed filtering and displaying ofdata. If you test with more thanone meter, blood glucose read-ings can be manually added intothe Tracker application on theVisor. The software even stores

temporary basal adjustmentsand has a food database of2,500 foods. In addition, theTracker is incredibly discreet. Asquoted in Diabetes Positive, "Wechose not to even put our brandname on the Tracker module...There's absolutely nothing togive away its function. No onewill know it's a blood glucosemeter unless you tell them."

Cons: Will generate a sliding scalebased on your insulin sensitivity,but will not automatically calcu-late insulin doses based on cur-rent blood sugars. The fooddatabase is also not integrated,meaning that after you look upfood values in the database youhave to enter the carbohydratecontent manually. (You may pre-fer downloading the USDA list of6,000 foods, available for free).Nutrition information is also stat-ed based on specific servingsizes, which may not be theamounts you need. For example,the database lists the carbohy-drate value for a serving of 17grapes, but if you ate 30 grapes,you have to adapt the valuesyourself.

Accu-ChekPocket Compass

Latest version: 1.0

Company or developer: RocheDiagnostics

Purchasing info.: 800-428-5076

Trial version: Not Available

Charts: Overall statistics, targetgraph, average day graph, aver-age day statistics, hypoglycemiastatistics, carbohydrates graph,logbook, average week graph,average week statistics, trend,timeblock trend, insulin log,insulin graph, HbA1c graph,blood pressure graph.

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Pros: Downloads blood glucosevalues from Accu-Chek Compactand Accu-Chek Active meters; thedata is beamed directly fromyour meter to your Palm. You cancustomize your personal "time-blocks" so that blood glucoseresults are stored in the correctlylabeled time slots. This feature isof aid when making reports.

Calorie KingDiabetes Log

Latest version: 1.3

Company or developer: CalorieKing

Purchasing information:www.calorieking.com/handheld

Price: $14.95 (Diet diary $19.95)15% discount with mention ofFWD.

Trial version: 14 days

Pros: Warnings and color-codedentries indicate blood glucoselevels outside your target range.(Colored PDA needed)

Cons: Food database is not inte-grated. The exercise list is verylimited with no option of addingto it. Glucose values must beentered by scrolling just one-tenth of a point with each click.

Diabetes PilotDiabetes Pilot

Latest version: 2.0

Company or developer: DigitalAltitudes, LLC

Purchasing information:www.diabetespilot.com

Price: $24.00. Desktop compan-ion: $39.00

Trial version: 15-day trial versionavailable.

Charts: Averages, range, showdata by category. No graphs.

Pros: Allows for "Favorite food"

marking. You can customize themain screen to show any or all ofthe following: glucose, food,medication, exercise, notes. Thisprogram can filter data byevents, or to include only "today"or "yesterday", past 7 days, orany selected date or range ofdays. Your can also create yourown list of exercises.

GlucoPi lo t

Latest version: 1.6

Company or developer:HealtheTech Inc.

Purchasing information:www.healthetech.com

Price: $29.00

Trial version: 30-day trial versionavailable.

Charts: Pie, line, modal, his-tograms, reports.

Pros: Users can add defined cate-gories. Charts and reports can befiltered by category (events). Youcan choose one statistic (e.g.today's glucose average, glucoseminimum, insulin sum, or carbsum) to be displayed on the mainscreen at all times.

Cons: Not yet compatible withPalm OS 5.

GlucoTools 2.oThis is a free softwarewhich aids in calculating meal orhigh blood sugar insulin doses. Itwill compute meal boluses basedon different insulin-to-carb ratiosfor varying times of the day. Allyou do is enter the number of car-bohydrates you wish to eat, andan insulin dosage for that specifictime of day is automatically given.

This software computes correctionboluses based on different bloodglucose targets and insulin-to-blood glucose ratios for differenttimes of the day. It even calculates"negative correction boluses"when blood sugars are below thetarget range.

GlucoTools has many more excel-lent features. Check it out athttp://glucotools.sourceforg

e.net/Glycemic Index

Rick Mendosa has a very popularand useful table listing hundredsof foods with their glycemic indexand load.

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43overwhelmed?

Do you own a desktop computer and aPDA, and would love to have a diabetessoftware program, but you simply don'tknow where to start choosing?

Friends With Diabetes has compiled awonderful CD containing trial versionsof many of the available programs. Wesave you the headache of ordering eachsample from its respective manufactur-er, and then deciding which amongthem you like best. Here, all the choicesare in one compact CD.

TO ORDER: CALL: (845) 352-7532 EMAIL: [email protected]: Friends With Diabetes, 31 Herrick Avenue, Spring Valley, NY, 10977

Other programs that weren't listed(but will be iy"h in a future update)

DIABETES NOW $10.95www.clothesrack.net/palm/diabetes/diabetesnow.htm

HEALTHENGAGE DIABETES 3.0.1 $70www.healthengage.com/

FUTUREWARE PERSONAL DIABETESTRACKING PRODUCTS $29-$49www.futurewaredc.com/diabetes/

DIABETES MANAGEMENT SOFTWARE$14.99 http://tinyurl.com/ls9i

GLUCO TRAK 3.0 $9.99http://store.yahoo.com/bsoftware/glucotrak10.html

GLUCOBASE $17.96www.glucobase.com/

GLUCOCONTROL (for PDA's based onPocket PC) Free softwarewww.glucocontrol.org/eng/

GLUCO-LOG 3.1 $10.00http://tinyurl.com/ls92

BLOOD GLUCOSE LOG 1.0 - Freehttp://tinyurl.com/lscx

GLUCOSE DIARY 1.4B $10.00http://tinyurl.com/lsde

GLUCOSE LOG BOOK 1.0 - Freehttp://tinyurl.com/lscu

GLUCOSE LOG 01 $9.99http://tinyurl.com/lsd0

INSULIN+ $30.00http://tinyurl.com/lsd8

MY BLOOD GLUCOSE LOG 1.8.2 $10http://tinyurl.com/lsd3

We will also be running another sucharticle on PDA programs to assistwith nutrition/Diet, carb/caloriecounting.

For all these programs visit our webpage www.friendswithdiabetes.org/r_PDA.html

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Chart 1: LOGS

BloodGlucose Insulin Basal Food Activity Notes Events

ezManagerLogbook DM

Pocket Compass

Diabetes LogDiabetes Pilot

GlucoPilotFS Tracker

Chart 2: FEATURES

Food Database

separate

Bolus Calculator

see notes

Desktop Companion Export Feature Reminders

ezManagerLogbook DM

Pocket Compass

Diabetes LogDiabetes Pilot

GlucoPilotFS Tracker

The greatestdiscovery of anygeneration is thata human being

can alter his lifeby alteringhis attitude.

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

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Friend to Friend

Bubble Trouble Here’s a scientific solution for

those problematic air bubbles that manyof us cannot seem to get rid of, despiteour best efforts when filling an insulinpump cartridge. These persistent littleair pockets are often born after a newcartridge has been safely installed, andmay be due to the discrepancy in airtemperature between the inside of thetubing (about 76 degrees) and the out-side world (around 90-95 degrees).A suggestion that really seems to work isto first lubricate the reservoir, then injectas much air into the insulin vial as theamount of insulin you plan on with-drawing. Next, fill the cartridge withinsulin and allow it to stand upright(with the cartridge syringe covered) forat least one half hour. This allows theinsulin to acclimate to outside tempera-tures and causes air bubbles to form. Youcan then tap the reservoir to bring bub-bles to the top, and push them out.Even after the tubing is connected, youshould have no more trouble from thosebubbles!

Tape Allergies If you’ve tried everything- from

skin preps to various types of tapes onthe market- and still suffer irritatingallergy symptoms, perhaps this surpris-ingly simple advice (courtesy ofMedtronic MiniMed) will help: Tryabstaining from any kind of soap, alco-hol, or cleansing agents at all. Theseproducts will only remove your natural-ly protective skin oils. (Alcohol, or anyalcohol-based skin prep, is particularlynotorious for drying out the skin.) Evena mild soap will remove the skin’s pro-tective layer, essentially allowing irritat-ing tape agents to penetrate the skin.Sometimes, the plain and simple stillworks best!

At an Angle It pays to spend an extra minute to

master this frustration-free technique forhandling FreeStyle strips. If you examinethe strip, you will find very tiny holes(situated on the edge of a blue semi cir-cle) which suck up blood samples usingcapillary action. Only one of these holesneeds to be filled in order to receive anaccurate blood glucose reading. To pre-vent their blockage, place the semi circleat a 45 degree angle to your blood sam-ple. Then, let the strip do the work!

Save Your (Sore) Fingers You can use the following system

to ensure that none of your fingers areoverused as testing sites:Look down at your hands with yourpalms face up. Number your fingers

from left to right (your left thumb willbe #1 and your right thumb will be#10). Then look at today’s date; if thelast digit of the date is 1 (i.e., it’s the 1st,11th, 21st, or 31st of the month), useyour finger numbered ‘1’ for all tests onthat day. On days that end in ‘2’, useyour finger numbered ‘2’ and so on. Theonly time that you’ll end up using thesame finger two days in a row is inmonths that have 31 days (you’ll useyour left thumb both on the 31st and onthe following day which is the 1st of thenew month). Hope this helps save yourfingertips!”As appeared in BD Update, Fall, ‘02

This tip works even better when theJewish calendar is followed, as we onlyhave 29-30 days in a month. (But willour fingers be sorer during a leap yearwhen we have an extra month?

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

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Making TechnologyUser-FRIENDLY

ezManager Gets EZer We love the ezManager PDA soft-

ware, but find just one aspect a bit cum-bersome: The user is required to enter aspecific food eaten, and the food’s carbvalue is then automatically calculated.There is no faster option of mechanicallyentering a carb value for a food you ofteneat and whose carb content you alreadyknow. So we took advantage of the‘favorites’ feature and added an itemcalled ‘10 gram’. This stands for 10grams of carbohydrates as one serving.We usually know the amount of carbs weare consuming and want the software’shelp just for figuring insulin dosages. Ifwe consume 38 grams of carbohydrates,for example, that would be 3.8 servingsof ‘10 gram’. The program will then cal-culate an insulin dose based on the infor-mation previously entered in ‘settings’. Itpays to remember one additional trick: Ifyou enter an extra spacebar before typingthe name of an item to be added to yourfavorites, this item will always be at thetop of the list. (The empty space at thebeginning prevents the item from beinglisted alphabetically.)

Faster FreeStyle When testing blood sugars using the

Freestyle Tracker, many button pressesand clicks are normally required before ablood sample can be applied.Here is a little trick to save a few key-strokes. Click on the “Prefs” icon andthen select ‘buttons’ from the drop downmenu. You can program the Visor toopen to any specific program with thepress of one of the four buttons. Forexample, you can set the Visor to opento the FreeStyle program whenever theright (memo pad) button is pressed. Youwon’t have to turn on the meter with theON/OFF button. Just click on the pre-determined key and FreeStyle will openup. Afterwards, the only click you willneed to do is pressing OK to confirm thecode number.Just remember that there are two iconapplications associated with freestyle, soyou won’t get confused between thetwo. ‘FS tracker’ opens the software and‘Freestyle’ allows for blood sugar checks.

(For more information onthe software programsmentioned, see our PDAarticle in this issue.)

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SWEET SUCCESSS

ince mastering the use of carb fac-tors (with guidance from FWD’sTu B’Shevat article),

Shabbos became the hardestday of the week for Shimon*.By now, carefully weighingeach food item he wished toeat, and then multiplying itseffective carb factor (ECF) bythat weight, was an easy partof his routine. He was gratefulfor his impeccably controlledblood sugars and the whole-some sense of pride that camewith it. But on Shabbos, hefound his efforts frustrated.Although he continued toweigh his food and look upeach item’s carb factor, howcould he reach an accuratefinal carb count without theuse of a calculator? Shimon isno math wizard,and he found themental multiplica-tion of 0.13 (the

carb factor of an apple) by 176 (thatapple’s weight in grams), just a bittoo maddening.

“Necessity,” they say, “is the motherof invention.” Determined to restorethe serenity of our precious seventh

day, Shimon arrived at an ingenioussolution, which was also surprisinglysimple. He invented fast factors™.

Nowadays, when Shimon wants toeat a banana on Shabbos, he makesan easy calculation. Bananas have an

ECF of 0.20, so Shimonsimply drops all complicateddecimals and zeroes, and heremains with the plain num-ber 2. He thinks to himselfas follows: A banana weigh-ing 10 grams contains 2grams of carbohydrates. Ofcourse, if his banana weighed20 grams, he would just dou-ble the number of carbs aswell, and so on.

To make these calculationseven more effortless, we havedevised a chart depicting thefast factors of many foods.The following is only a par-tial listing, but the complete

table can beretrieved atwww.FriendsWithDiabetes.org.

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

Note: You will notice some discrepancy between the fast Factors and regular ECF; fast factors are slightly less accurate,because they involve rounding carb factors and weight grams to the nearest tenth for greater simplicity. However, it isan excellent shortcut for days like Shabbos and Yom Tov, or when you do not have access to a calculator. Certainly, fast

Factors are many times more precise than eyeballing or estimating can ever be!

Carb Factors Made EasyFast Factor Food ECF

Apples 0.13

Grapes 0.14

Horseradish 0.10

Oatmeal 0.10

Potato Salad 0.13

Almonds 0.19

Beans 0.21

Ice Cream 0.21

Plums 0.18

Rice, cooked 0.24

Fast Factor Food ECF

Cashews 0.26

French Fries 0.34

Pizza 0.28

Sherbert 0.32

Spaghetti 0.26

Cheerios 0.70

Dates, dried 0.67

Jam 0.70

Saltines 0.70

Toast 0.70

33 ggrraamm ccaarrbb ppeerr1100 wweeiigghhtt ggrraammss..

6 g. carb per 20 g.

9 g. carb per 30 g.

12 g. carb per 40 g

15 g. carb per 50 g.




28 g. carb per 40 g



2 g. carb per 20 g.

3 g. carb per 30 g.

4 g. carb per 40 g

5 g. carb per 50 g.


4 g. carb per 20 g.

6 g. carb per 30 g.

8 g. carb per 40 g


*name has been changed

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


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It’s really easy to use fast factors on your own, even without the help of ourchart. We will illustrate with the example of a banana, mentioned above.

1. Look up the food’s carb factorand round it the nearest tenth.

2. Simply delete all zeroes anddecimals. This is the numberof carbohydrate grams yourfood item contains per 10grams of weight.

3. All that is left for you to dois to weight the food you’dlike to eat. To keep thingsuncomplicated, round thatnumber to the nearest ten aswell.

4. Think: How many timesdoes 10 go into the numberof weight grams?

5. Before you bite in, just mul-tiply the fast factor by youranswer to instruction #4.

Banana is easy, since its carb factor is0.20. No rounding is needed.

We arrive at the whole number 2. Thisis the fast factor for bananas.

Shimon’s banana weighs 136 grams.He rounds this to 140.

In this case, 140 divided by 10 is, ofcourse, 14.

We answered “14” to instruction num-ber 4, so we will multiply 2 by 14.Another easy calculation! This bananacontains 28 grams of carbohydrates.

If Shimon feels like eating a snack ofpretzels on Shabbos afternoon, heuses the same five steps:

1. The carb factor for pretzels is 0.75,rounded to 0.80

2. Erasing zeroes and decimals,Shimon arrives at thenumber 8. Pretzelshave 8 grams ofcarbohydrate per10 grams inweight.

3. Shimonweighs hisportion; 44grams. Herounds thisnumber to40.

4. 40 divided by10 is 4.

5. He multiplies 4 by the fast factor of8. His portion contains approxi-mately 32 grams of carbohydrate.

If you are more mathematicallyinclined and wouldn’t mind a greaterchallenge, try rounding the number

of weight grams to thenearest five, for

increased accuracy.For example:

Shimon mightround hisbanana’sweight (136grams) to135,

instead of 140.He would then

multiply thebanana’s fast factorof 2 by 13 and-a-half weight grams.

Successlies incansnot incannot!

Somebody said it couldn’t be doneBut he with a chuckle repliedThat “maybe it couldn’t,” but he would be oneWho wouldn’t say so until he had tried.So he buckled right in with the trace of a grinOn his face. If he worried he did it.He started to sing as he tackled the thingThat couldn’t be done, and he did it.

Somebody scoffed: “Oh, you’ll never do that;At least no one ever has done it:”And the first thing he knew he’d begun it.With a lift of his chin and a bit of a grin,Without any doubt or quitting,He started to sing as he tackled the thingThat couldn’t be done, and he did it.

There are thousands to tell you it cannot be done;There are thousands to prophesy failure;There are thousands to point out to you, one by one,The dangers that wait to assail you.But just buckle in with a bit of a grinJust take off your coat and go to it;Just start to sing as you tackle the thingThat “cannot be done,” and you’ll do it!

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


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Latest Updates:

HalachaTidbits

J U S T C H E C K I N G I NA father posed the following question: His young (under bar mitzvah-aged) son iscapable of checking his own blood sugars and therefore performs his own tests onShabbos, without parental help. He is usually awokened during the night to checkhis blood glucose, but would it perhaps advisable to skip this extra nighttime testjust on Shabbos?

The decision of Rav Weissmandl shlit"a may come as a surprise to many of us. Heruled that it is absolutely more preferable for the child to perform this additionaltest on Shabbos, than to skip it even on this one day.

(What a sobering thought... and worth remembering when laziness tempts us toomit that extra glucose check!)

Y O U R M E T E R M A T T E R SWe have previously published several halachic rulings regarding the use of specif-ic meters on Shabbos. Here's an update on two of the newer meters:

• The One Touch Ultra Smart is permitted for use on Shabbos, despite its require-ment of a code number confirmation for every 25th test.

• However, one should avoid using the FreeStyle Tracker which entails severaladditional steps per glucose check, which other meters do not require.

L I F E S A V E R SThe following is a quote from "The Fifth Commandment", by Rabbi Moshe Leiber:

"If a sick parent asks his child to give him something to eat or drink which doctorshave determined to be unhealthy for the parent, the child should refuse to honorthe parent's request. Chida submits that only if the requested item is life threaten-ing must the child refuse, but if it is only damaging to the parents' health, theparental request should be honored. Thus, according to all opinions, if a diabeticparent requests sweets from a child, the child should not comply."

Note: Obviously, the above refers to a parent with type 2 diabetes, who needs tolimit the carbohydrates in his diet. If covered appropriately with insulin, sweetspose no danger to the type 1.

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A laugh a day ... To keep your 'low' moods away ...A Bulgarian court was forced to postpone a court case asthe 50 year old man was too fat to travel to the courtroom.He is unable to leave his house as he weighs 675 poundsand can hardly walk anymore. The court has been postponing the fraud case against him for six years, but has nowordered him to lose weight. He will be charged with contempt of court unless he loses enough weight to attendcourt. Don’t wait till this happens to you!

22

Little Rikky was going to a birthday party and mom wantedher to be sure to eat the right size of cake. She drilled heron the size so she’d have it in her mind. When she gothome she talked about the games and prizes, etc., butmom insisted on asking about the size of the cake. She said,“Yes, it was the right size - after I rolled it into a little ball.”

A Dr. was talking to a group of children with diabetes. He explained to them that Debbie was the only one whohad all her tests written down, and since she could do it,

they could too. Debbie beamed and said, “I have nextmonth’s too, you want to see it?”22

I recently decided to live year round on the St. LaurenceRiver. To do this I had to get a new home, have a well

drilled, and get a water pump to go with it. The well is 236feet deep. At a party a woman that I had not seen in quite

a while came to my table. She is from Canada and has adiabetic son and has always been interested in my insulinpump. When she sat down she asked me, “How is your

pump working?” Of course I replied, “Great, 30 gallons aminute!” You should have seen the look on her face.

shabbos sugars a - friends with diabetes · imation, and so easy to remember.) amount: to fulfill...

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