Diabetes Life Lines. Peripheral Artery Disease. Have a personal history of vascular disease, heart attack or stroke. Are African American.

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1 Diabetes Life Lines A newsletter from your County Extension Office Vol. 22 No. 5 Fall 2008 Peripheral Artery Disease One in every five American over the age of 50 has Peripheral Artery Disease (P.A.D.) that increases risk for heart attack and stroke. The National Heart, Lung and Blood Institute has a campaign called Stay in Circulation: Take Steps to Learn about P.A.D. to educate consumers about the dangers, risk factors and symptoms of PAD. Who is at risk? You are at risk for P.A.D. if you Are over the age of 50. Smoke now or smoked in the past. Have diabetes. Have high blood pressure. Have high blood cholesterol. Have a personal history of vascular disease, heart attack or stroke. Are African American. What are the symptoms? Some typical symptoms include: Fatigue, heaviness, tiredness, or muscle cramps in the buttock, thigh or calf during activity that goes away with rest. Pain in legs and/or feet that disturbs sleep. Sores or wounds on toes, feet or legs that heal slowly, poorly or not at all. Color changes in the skin of the feet (paleness or blueness). Lower temperature in one leg compared to the other. Poor nail growth and decreased hair growth on toes and legs. How is it diagnosed? Your health care provider will take a medical and family history to see if you have diabetes, high blood pressure, high cholesterol or other factors that may increase risk. Your provider will also check your smoking status, your personal or family history of cardiovascular disease and whether you have any symptoms of P.A.D. The health care provider should also check Pulses in your legs and feet to be sure you have good circulation; U.G.A. Cooperative Extension College of Family and Consumer Sciences 1

2 The color, temperature and appearance of your legs and feet; and For signs of poor wound healing on your legs and feet. You may also have a test called the ankle-brachial index. This test is easy and painless and compares the blood pressure in your ankles and arms. This will tell whether you have P.A.D. However, to find the specific artery that is blocked, you will need a Doppler test. This test uses ultrasound to measure the blood flow in the veins and arteries in your arms and legs. Sometimes other tests are also done. How is P.A.D. treated? First, make one of more of the following lifestyle changes: Quit smoking. The Lung Association offers tobacco cessation classes and the Georgia Department of Human Resources offered a Tobacco Quit Line at STOP ( ). Lower your numbers. Work with your health care provider to correct any high blood pressure, high cholesterol or high glucose levels. Follow a healthy meal plan. Choose foods low in saturated fat, trans fat and cholesterol. Eat whole grains, fruits and vegetables. Get moving. Work up to at least 30 minutes of moderately intense physical activity on most, if not all, days of the week. Aim for a health weight. Work with a dietitian or other health care provider to develop a plan for weight control. A healthy weight is the stable weight that you achieve when you eat moderate amounts of a variety of healthy food and are active for at least 30 minutes five or more days a week. It may not be an ideal weight you find on a weight chart. Your health care provider may also prescribe some medicine. These medicines may Lower high blood pressure and high cholesterol and treat diabetes; Prevent formation of blood clots that could cause heart attack or stroke; Reduce leg pain when you walk or climb stairs. U.G.A. Cooperative Extension College of Family and Consumer Sciences 2

3 If blood flow to one of your legs is totally or almost totally blocked, you may benefit from a medical procedure or surgery as well. Procedures like angioplasty and bypass graft surgery will not cure P.A.D., but will improve circulation to your legs and help you walk better. If you believe you are at risk for P.A.D., talk to your health care provider. You need to find out NOW how to lower your risk and whether you need to be tested. What Really Works for Weight Control: How Much Activity is Enough? To control your weight and diabetes, you need physical activity. In both cases, being active is like taking an anti-diabetes or anti-obesity pill. You would not skip a day of your medicine, so you should not skip a day of physical activity. As long as your medical team says it is OK, you should work up to being active five or more days a week. The National Weight Control Registry has studied people who have kept at least 30 pounds off for at least a year. They found that those who maintained their weight loss tended to be active at least 60 minutes a day. This activity included both structured physical activity like swimming and biking and normal daily activity like walking to do errands and climbing stairs. Most of the people on the Registry walked regularly as their main type of exercise. The U.S. Dietary Guidelines also say that to lose weight, most people need 60 minutes a day of moderate physical activity on most days of the week, and that to maintain weight loss, minutes may be needed. Even greater health benefits may be seen if a person does more vigorous activity for longer periods of time. So hiking up hills may improve your health more than walking on a flat sidewalk. Don t be overwhelmed by this amount of activity. It doesn t have to be done all at once. Just short 10 minute physical activity breaks several times a day work just as well. If you are totally inactive, begin with a 5-10 minute walk around the house, mall or track and add about 5 minutes a week until you hit your goal. You may also need strength training to really see changes in your appearance. Using free weights or exercise machines that build muscle will tone you faster than aerobic activity alone. Your balance, joint pain and endurance will also improve. Stronger muscles can prevent falls U.G.A. Cooperative Extension College of Family and Consumer Sciences 3

4 and keep you independent as you get older. Start with the lowest weight that feels good and add weight slowly. Pulling a muscle or hurting a joint because you did too much, too soon will just slow you down. Don t train the same muscle group more than 2-3 days a week. Your muscles need to rest and repair between sessions. Without rest days you will not get stronger and may get hurt. Stretching is also important to prevent injuries. To stretch safely, always stretch muscles that have been warmed up by other physical activity first. If you are on diabetes medicine, check your blood glucose more often during and after any increase in activity to be sure it stays in the range your doctor wants. Exercise can drop blood glucose quite a bit so you may need less diabetes medicine if you do it regularly. Keep written records of your activity, food intake, and medicine doses so you can see patterns and work with your doctor to make adjustments. If you take diabetes medicine, you may also need a snack or glucose tablets with grams of carbohydrate on hand while you work out to treat any low blood glucose reactions. However, once you know the right amount of medicine for your new routine, you may not need that extra carbohydrate or calories. Will Cutting Out the Salt Really Help Your Hypertension? Eating between 2,000 and 3,000 mg of sodium per day, and a healthy diet like the DASH diet, can greatly reduce your blood pressure. Look at the nutrition label on packaged foods, and read the amount of sodium per serving. Add up these numbers from all the food you eat to see how much sodium you consume each day. To lower the sodium in your diet: 1. Flavor your food with herbs and spices. Use only a couple of herbs and/or spices for each food. To enhance the flavors of herbs and spices, add them at the end when making soups or stews and at the beginning when making salad dressings or marinades. If you are buying an herb-spice blend, check the ingredient list to see if it contains sodium. There are many salt-free blends available that taste very good. 2. Don t add salt to your food. This includes salting at the table and while cooking. Instead, use lemon juice or a small amount of table wine. Do not use cooking wine. It contains salt! If you can t cut the salt totally, try only half the amount in the recipe. That may be enough. Only use a salt substitute if your doctor says it is OK. U.G.A. Cooperative Extension College of Family and Consumer Sciences 4

5 Salt substitutes can harm you if you have kidney problems. 3. Taste your food first. The food may taste fine without adding anything extra. Enjoy its natural flavor! Some spray butters have very low amounts of sodium but can greatly improve the flavor of vegetables, pasta, and even waffles! 4. Eat low-sodium meats. Bacon, sausage, and deli meats have lots of sodium added to them. Instead, buy fresh chicken or turkey, and cook them at home. You can slice or chop the leftovers to make sandwiches or salads. 5. Check food labels for sodium content. Look for products with less than 400 mg of sodium per serving for a single food and less than 800 mg of sodium for a frozen dinner. 6. Cook more at home. Meals at restaurants are packed with sodium. Cook more often at home where you can control the amount of sodium you are getting. 7. Limit condiments. Condiments and sauces like soy sauce, ketchup and salsa can add a lot of sodium to your meals. Use very little or buy the reduced and low-sodium versions at the store. 8. Eat fresh. Use fewer processed foods like chips, crackers, baked goods, soups, lunch meats, and canned goods. Buy low-sodium versions if possible. Make your own soups from dried beans, fresh or frozen vegetables, and low-sodium packaged or homemade broths with no added salt. 9. Rinse canned vegetables with fresh water. Wash canned vegetables with water for one minute. Then cook them in fresh water instead of the liquid from the can. This removes about half the sodium. Even better, buy fresh or frozen vegetables without added salt or sauce. Also, wash canned tuna fish for one minute with water to remove about 75% of the sodium. 10. Follow the DASH diet if your doctor or dietitian approves. This diet is the only meal plan proven to lower blood pressure. It limits high sodium foods and includes 5-9 servings of fruits and vegetables, 2-4 servings of low-fat dairy products, whole grains and nuts. Check out this website for DASH diet recipes: Contributors: Connie Crawley, MS, RD, LD, Extension Nutrition and Health Specialist, Writer and Editor Editorial Board: Jenny Grimm, RN, MSN, CDE, Medical College of Georgia Ian C. Herskowitz, MD, CDE, FACE, Medical College of Georgia U.G.A. Cooperative Extension College of Family and Consumer Sciences 5

6 Recipe Corner Pumpkin Roll CAKE INGREDIENTS FILLING ¾ cup egg substitute 4 ounces reduced fat cream cheese, 1 cup granulated artificial sweetener softened 1 cup canned pumpkin 1 ½ cup frozen, light whipped 1 teaspoon lemon juice topping, thawed 1 cup self-rising flour 2 tablespoon granulated artificial 2 teaspoons ground cinnamon sweetener 1 teaspoon ground nutmeg 1. Preheat oven to 350 degrees. 2. For cake, beat egg sub and 1 cup granulated artificial sweetener for 5 minutes in mixing bowl on medium speed of mixer. 3. Stir in pumpkin and lemon juice. 4. Blend in flour and spices until well combined. 5. Line jelly roll pan or small cookie sheet with waxed paper. Spread batter evenly in pan. Bake in oven for 5-8 minute or until wooden pick comes out clean. Cool 3 minutes in pan and turn out onto clean cloth and roll up from the narrow end. 6. Chill in refrigerator until completely cool. 7. For filling, beat cream cheese, whipped topping and 2 tablespoons of granulated artificial sweetener in mixing bowl on medium speed until smooth and spreadable. 8. Unroll pumpkin roll and remove from cloth. Spread with filling and re-roll. Cover and refrigerate until ready to serve. Slice into pinwheels. Adapted from a recipe on Calories: 148 Carbohydrates: 22 grams Fat: 5 grams Protein: 6 grams Sodium: 284 milligrams Fiber: 1 gram Cholesterol: 8 milligrams Exchanges: 1 ½ starches, 1 fat 8 Servings U.G.A. Cooperative Extension College of Family and Consumer Sciences 6

7 The University of Georgia Cooperative Extension College of Agricultural and Environmental Sciences / Athens, Georgia Dear Friend, Diabetes Life Lines is a bi-monthly publication sent to you by your local county Extension agent. It is written by Food and Nutrition Specialists at the University of Georgia, College of Family and Consumer Sciences. This newsletter brings you the latest information on diabetes, nutrition, the diabetic exchange system, recipes, and important events. If you would like more information, please contact your local county Extension office. Yours truly, Connie Crawley, Principal Writer County Extension Agent The University of Georgia and Ft. Valley State College, the U.S. Department of Agriculture and counties of the state cooperating. The Cooperative Extension Service offers educational programs, assistance and materials to all people without regard to race, color, national origin, sex or disability. An equal opportunity/affirmative action organization committed to a diverse workforce. Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, The University of Georgia College of Agricultural and Environmental Sciences and the U.S. Department of Agriculture cooperating. Scott Angle, Dean and Director Cooperative Extension U.S. Department of Agriculture The University of Georgia College of Agricultural and Environmental Sciences Athens, GA Official Business Diabetes Life Lines: Your current issue enclosed U.G.A. Cooperative Extension College of Family and Consumer Sciences 7