Part 3: High blood sugar - drugs & diet tips

Having diabetes is not just a problem of having high blood sugar, it puts you at a higher risk of other diseases, such as heart attack, stroke and kidney disease. These diseases are caused by damages to the blood vessels. This is why doctors prescribe medications for diabetic patients that are not just for controlling blood sugar, but are helpful in preventing damages to the blood vessels.

For example, sometimes diabetes patients may wonder why their doctor prescribes a cholesterol medication for them but their cholesterol is not very high. According to the 2013 Canadian Diabetes Association Clinical Practice Guidelines, diabetes patients over the age of 40 should receive statin therapy (a type of drug commonly used to treat high cholesterol) for blood vessel protection. What this means is that although your cholesterol levels may not be high, diabetes patients can still benefit from taking a ‘cholesterol drug’ to prevent heart attack, stroke, legs and feet damages, and to delay the development of kidney and eye diseases.

Another drug that diabetes patients may be prescribed is a type of blood pressure medication such as, Ramipril, Telmisartan, Coversyl, etc. Diabetic patients may not have high blood pressure, however, they can still benefit from taking these drugs to prevent damages to their blood vessels, especially the blood vessels of the kidneys.

Some diabetes patients may ask us about taking Aspirin to prevent heart and blood vessel diseases.  According to the current guidelines, Aspirin therapy is recommended for patients that have ‘macrovascular’ diseases, such as  heart attack, a stroke or insufficiency in blood flow to legs or arms. Talk to your pharmacist or doctor to find out if you should be taking Aspirin for cardiovascular protection.

Some diabetes patients are now taking the newer drugs, such as Januvia, Trajenta and Onglyza.   These drugs need only to be taken once daily and they work on lowering the blood sugar after each of your meal (which is the most common time when your blood sugar is high). This also reduces the chance of lowering the blood sugar too much because the effect of the drug is activated primarily only after you eat. However, these newer drugs are not considered to be a replacement for the older drug, Metformin.  According to the current guidelines, Metformin is still a first line therapy.  The newer drugs can be chosen to be added to Metformin therapy if the blood sugar is still high.  The cost of these newer drugs are much higher than Metformin, however, they are covered under the Ontario Drug Benefit (ODB).  If you have questions about diabetes medications, Custom Care Pharmacy have Certified Diabetes Educator Pharmacists that can help answer your diabetes questions. 

Diabetes & Diet - By Rowena Leung, Registered Dietitian, CDE

*** Don't forget to register for our FREE cooking demonstration on 
Sunday, August 17th, 2014   2-4pm at Custom Care Pharmacy!***

When someone has pre-diabetes or diabetes, many individuals automatically think to control sugar intake. Sugar is definitely an area of concern; however, more importantly, it is very important for an individual living with pre-diabetes and/or diabetes to learn how to control carbohydrate intake.

Many foods contain carbohydrates including: root vegetables, grains & grain products, beans & legumes, milk & milk products as well as fruits. When cooked, tomatoes also can be a source of carbohydrates. Carbohydrate is one of the three macronutrients our body need and is made up of three components: starch, sugar and fibre. Fibre is the one component of carbohydrate which won’t be absorbed or digested by our body.  As a result, one of the functions of fibre is to help bring down blood sugar levels.

FIBRE: 

How much fibre does the average man or woman need per day? According to the Institute of Medicine, the chart below outlines the daily recommended intake of fibre for a male and female.

	Age Group	Adequate Fibre intake/day (g/day)
Male	50 years or younger	38
	51 years or older	30
Female	50 years or younger	25
	51 years or older	21

On average, a serving of fruit (e.g. a small apple/orange/pear) gives you ~2 grams of fibre. If you decide to cook a serving (i.e. 1 c) of broccoli and/or cauliflower, this will only give you 3-4 grams of fibre. If you decide to eat a plate of salad mixed with your dark green leafy vegetables, onions, cucumber, different coloured peppers and other types of vegetables mixed in, you’re getting close to 5 grams of fibre. As you can see, it is not very easy to get 21 grams of fibre/day let alone 38 grams of fibre/day.

CARBOHYDRATES:
Individuals living with diabetes and/or pre-diabetes don’t have to avoid any foods. Portions for carbohydrate containing foods may change; however, all foods can still be enjoyed. For example, for the general healthy individual, ½ c of cooked rice is one serving of carbohydrate containing food; however, when someone has diabetes, 1/3 c of cooked rice is one serving of carbohydrate containing food.  When reading the food label, it is very important to remember that 1 portion of carbohydrate containing food (e.g. 1 slice of bread, ½ c cooked pasta, 1/3 c rice) is equal to 15 grams of carbohydrate.

As you can see on the label to the left, the word carbohydrate is bolded. Underneath, the components of carbohydrates are listed including fibre & sugar. Starch is typically not listed but it is to be understood that once you subtract the fibre & the sugar from the total amount of carbohydrates, what is left over is the starch amount.

What is of importance now is to pay attention to the carbohydrate to fibre ratio. Because fibre is not absorbed or digested by our body, we can subtract the fibre from the total amount of carbohydrate. To know that you are eating an item that is a high source of fibre, it must have at least 4 grams of fibre/serving or 15% or more of your % daily value (%DV).  Once you subtract the fibre from the total amount of carbohydrate, you would like to end up with 15-45 grams (i.e. 1-3 servings of carbohydrate containing food).  **

**1 serving of carbohydrate containing food= snack 
   2 servings of carbohydrate containing food= reflective of a female appetite @ a meal
   3 servings of carbohydrate containing food= reflective of a male appetite @ a meal

SUGAR: 

As mentioned before, sugar is an area of concern as well. As always, sugar intake is always recommended to keep to a minimum. The newest recommendation for sugar intake/day is as follows:

Women are allowed 6 added teaspoons of sugar/day.

Men are allowed up to 9 added teaspoons of sugar/day.

Please keep in mind that 1 teaspoon of sugar is equal to 4 grams of carbohydrate.

Do you really enjoy eating vermicelli and/or rice noodles? Unfortunately, both these items are not very good for someone living with diabetes because both products are made of refined sugar and not very high in fibre. Eating these items will make blood sugar levels rise very quickly. Don’t worry, you can still enjoy a similar item but not have to worry about the carbohydrate intake! Curious as to what this item is? It is Shirataki noodles!

Shirataki noodles are made from a Japanese yam called Konjac yam. If you eat the whole package of Shirataki noodles, you’re only getting 3 grams of net carbohydrates. This is the equivalent of eat 1/5 of a standard piece of bread. The nice thing about shirataki noodles is that it’s already pre-cooked so all you have to do is warm the noodles up and enjoy!

Do you really enjoy eating pasta? Did you know that 1 c cooked pasta is like eating two pieces of bread? Most individuals cannot be full after only eat 1 c of cooked pasta. This is why you can enjoy spaghetti squash, another low-carbohydrate, but spaghetti-like option.

For every ½ c of cooked spaghetti squash, you only absorb 4 grams of carbohydrate which is the equivalent of eating ~1/3 of a piece of bread. This is much better than ½ c of pasta which is equivalent to eat 15 grams of net carbohydrate. Spaghetti squash is easy to prepare as it only takes ~40 minutes to bake or ~20 minutes if you choose to steam the squash. Once the squash is cooled down, take a fork and peel out the strings of spaghetti! Spaghetti squash has a very mild flavor; therefore, treat it like regular pasta but you don’t have to worry about it being as high in carbohydrate content.

On Sunday, August 17th, 2014, we will be doing a live demonstration on cooking with Shirataki noodles and Spaghetti Squash. Please register at Custom Care Pharmacy in store or by calling us at 905-305-0111!