Diabetes Treatments

Once you have the Diabetes list we send you, and have compared it to your local list, Review diabetes flow sheet and try to get physical exams, …

2

2 the hidden risk: diabetes
Contents of this packet Lesson 2

Lesson

objeCtives
Complete this lesson and you will be able to explain what type 2 diabetes is; list the symptoms of diabetes; estimate your personal risk of having type 2 diabetes and not knowing it; describe the different types of artificial sweeteners; decide whether you want to use artificial sweeteners

Objectives Introduction Recipe Notes Type 2 Diabetes: What Is It? Symptoms Checklist Treatment MyPyramid Who Is at a Greater Risk for Type 2 Diabetes? What Can You Do?
Information Sheet: Some Common Questions and Their Answers

introduCtion
Lesson 2 looks at non-insulin-dependent diabetes, which is called type 2 diabetes As we age, more of us will develop this disease About 7 million people have been told they have type 2 diabetes, but experts think only half of the actual cases are identified This means another 7 million adults are walking around with type 2 and dont realize it If this disease is not treated, it causes serious damage to the body Lesson 2 describes the symptoms of type 2 diabetes and who is likely to develop it See if you are at risk If so, visit your doctor for a checkup Prompt treatment
can make a difference

Sugar and diabetes; diagnosing diabetes; insulin-dependent, or type 1 diabetes mellitus; taking insulin; cows milk and type 1 diabetes; diabetic health problems
Worksheet: Are You at Risk for Type 2 Diabetes? Fact Sheet: Sweet Nothings–Are Artificial Sweeteners Safe? Recipes: Using Artificial Sweeteners

Apple-Strawberry Crisp Strawberry Shake Curried Waldorf Salad Yogurt-Cucumber Vegetable Dip

reCipe notes
The recipes in this lesson use an artificial sweetener or a sugar substitute and support the following healthful eating rule:
Choose and prepare foods and beverages with little added sugars

your WeLLness roadmap: Lesson 2

Some people use sugar substitutes to help them control their calorie intake Others find these substitutes too sweet After you have tried artificial sweeteners, you may find that foods sweetened with plain sugar taste too bland Some sweeteners can be used in baked products, others cannot They are a common ingredient in certain manufactured food products Be sure to compare the number of calories in a serving of a product made with sugar substitutes to the number of calories in the regular product Sometimes there is little difference in
calories and a big difference in price

In a person with type 2 diabetes, the body cannot handle the glucose, amino acids, and fatty acids entering the blood after a meal and during digestion Sometimes the pancreas no longer produces enough insulin Cells in the body get too little of the hormone and are unable to take in the products of digestion Sometimes the pancreas produces a lot of insulin, but the cells dont respond to it This is called insulin resistance In both cases, the levels of glucose and other nutrients do not go down as fast as they should The body dumps the excess glucose into the urine Glucose in the urine may be the first sign that something is wrong

Although debates continue about the safety of The symptoms of type 2 diabetes are artificial sweeteners, most scientists think sugar sub being very hungry all the time; stitutes will not cause harm, if used in moderation Read the fact sheet in this lesson for more information being very thirsty;

symptoms CheCkList

type 2 diabetes: What is it?
First, lets review the way a healthy body handles food Food is made of carbohydrates, proteins, and fats After a meal these substances are digested and broken down into
glucose, amino acids, and fatty acids These, in turn, are taken into the bloodstream from the intestine An organ called the pancreas makes insulin, a hormone that helps the body deal with the products of digestion

having to urinate a lot and passing a lot of

water;
blurred vision or recent changes in vision; being sleepy and tired; tingling or numbness in legs, feet, or fingers; frequent skin infections and slow healing of

cuts on hands and feet

Check off any symptoms you have See your doctor, especially if you have several of these symptoms at After a meal, the amounts of glucose and other nutri- once ents in the blood rise This signals the pancreas to release insulin When enough insulin is produced, it lowers the amounts of glucose, amino acids, and fatty acids in the blood by helping these products enter cells all over the body The cells then either use the glucose and other nutrients or store them The glucose, amino acids, and fatty acids in the blood then drop to normal levels about two hours after a meal Doctors use the drop in blood glucose levels at two hours as an indicator of normal insulin activity

your WeLLness roadmap: Lesson 2

treatment
Type 2 needs to be
treated If the glucose level in the blood is not reduced, it seriously damages the bodys small and large blood vessels This leads to eye damage and blindness, kidney damage and failure, and circulation problems Problems with circulation mean loss of feeling and the ability to fight off infections in the feet and legs Severe circulation difficulties can lead to amputation of feet and legs Circulation problems also affect the heart and put the person with diabetes at greater risk for heart disease and high blood pressure Treatment can include carefully regulating the amount of food eaten; timing of meals and snacks; exercise; oral medications or even insulin Surprisingly, people with type 2 can eat any food, including sweets There is no medical evidence that a person with type 2 cannot eat sweets as long as sweets are eaten as part of a meal

ing whole grains, pasta, vegetables, and fruits more often Following MyPyramid is an important part of maintaining your health; Lesson 4 talks about including MyPyramid in your wellness plan Two goals of treatment are to: keep blood glucose levels as near normal as possible, and lower blood lipid levels to the recommended range Individuals
with type 2 diabetes can learn to regulate their own blood glucose levels using finger pricks and a glucometer But lowering blood lipid levels usually requires eating less fat, less saturated and trans fats, and less cholesterol These changes in what you eat can be part of the treatment

Who is at Greater risk for type 2 diabetes?
The following people have a higher risk:
The overweight Weight gain leads to insulin resis-

tance, as we mentioned in Lesson 1 The pancreas produces insulin, but for most people, extra weight prevents cells from responding to insulin normally So glucose remains in the bloodstream longer before it moves into cells where it is used To correct this, the pancreas produces more insulin Even with an overproduction of insulin, resistance can continue to build until glucose spills into the urine and

mypyramid
Usually a person with type 2 can use MyPyramid as a guide for making food choices But people with type 2 must usually control their calorie and fat intakes and reduce their intake of saturated and trans fats This may mean making changes in the way food is prepared, choosing lean meats and low-fat dairy products, using less butter or margarine, and
eat-

your WeLLness roadmap: Lesson 2

type 2 is diagnosed You are at a greater risk if your extra pounds are on your upper body, particularly around your stomach Measure your waist and then your hips If your waist is bigger around than your hips, you have a higher risk
People with impaired glucose tolerance IGT If you

In this lesson, the information sheet provides answers to some common questions about blood glucose levels that indicate diabetes, and about insulin dependent diabetes and what causes it; the fact sheet includes information on four of the artificial sweeteners available today and what to consider in choosing one; the recipes are for desserts, salads, and dips flavored with Equal or Sugar Twin Thanks for completing this lesson

take a blood glucose test, your doctor may tell you that you dont have type 2, but that you do have impaired glucose tolerance This used to be called chemical diabetes or borderline diabetes IGT means that your body is slower than normal in clearing a glucose load from your blood Some people with IGT go on to develop diabetes Others return to a normal blood glucose response
Women who have had gestational diabetes This means

the pregnant
womans blood glucose level is higher than normal Gestational diabetes occurs in about 3 to 4 percent of pregnancies Generally a test to detect this condition is done 6 months into the pregnancy Medication or a special diet may be used to lower the mothers blood glucose to normal This protects the developing baby Sometimes women with gestational diabetes give birth to a large baby–over 9 pounds at birth Such a birth is called macrosomic That child may later have trouble with obesity Women who develop gestational diabetes are more likely to develop type 2 diabetes later in life, especially if they have a relative with diabetes

College of Agricultural Sciences Cooperative Extension

Prepared by J Lynne Brown, associate professor of food science, in cooperation with Carla Miller, Frances Shacklock, and Sheila Rye
Visit Penn States College of Agricultural Sciences on the Web: http://wwwcaspsuedu Penn State College of Agricultural Sciences research, extension, and resident education programs are funded in part by Pennsylvania counties, the Commonwealth of Pennsylvania, and the US Department of Agriculture This publication is available from the Publications Distribution Center, The
Pennsylvania State University, 112 Agricultural Administration Building, University Park, PA 16802 For information telephone 814-8656713 Where trade names appear, no discrimination is intended, and no endorsement by Penn State Cooperative Extension is implied

What Can you do?
Type 2 can be a silent disease Take the simple test in this lessons worksheet to see if you are at increased risk for undiagnosed diabetes If you are at risk, visit your doctor and ask for a blood glucose test Early treatment is best If you are not at risk include some goals in your wellness plan that will keep your risk low We will begin our discussion of those goals in Lesson 3

This publication is available in alternative media on request
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University prohibits discrimination and harassment against any person because of age, ancestry, color, disability or handicap, national origin, race, religious creed, sex, sexual orientation, gender identity, or veteran status Discrimination or harassment against faculty, staff, or students will not be tolerated at The Pennsylvania State University Direct all inquiries regarding the nondiscrimination policy to the Affirmative Action Director, The Pennsylvania State University, 328 Boucke Building, University Park, PA 16802-5901; Tel 814-865-4700/V, 814-863-1150/TTY Produced by Information and Communication Technologies in the College of Agricultural Sciences The Pennsylvania State University 2006 CodeUK052 Rev4M12/06mpc 4213

Lesson

2

information sheet: Some common questions and their answers
1 does eatinG suGar Cause diabetes?
No Diabetes is caused by a lack of insulin Because there is too little insulin, the level of glucose sugar in the blood stays high and eventually spills into the urine Eating sugar raises the glucose level in blood But glucose levels will stay high only if there is too little insulin high blood glucose level of 200 mg or greater at 2 hours and one of the
other two measurements indicates diabetes
Diagnosing Diabetes
Testing conditions Nonfasting blood sample Fasting blood sample Fasting blood sample Test results 200 mg/dl or greater Less than 100 mg/dl 100125 mg/dl 126 mg/dl or greater Diabetes yes no OGTT needed yes

2 if i am experienCinG some of the symptoms of diabetes, hoW do i knoW if i have diabetes?
See your physician promptly Your doctor will discuss your symptoms with you and probably take a blood glucose measurement see table at right If you had something to eat or drink besides water up to 3 hours before seeing the doctor, a blood glucose level of 200 mg/dl or more means diabetes If you have not had anything to eat or drink are fasting, a blood glucose level of 126 mg/dl or more means diabetes Both findings must be checked by a second test the next day Some doctors do additional testing of levels under 126 mg/dl as follows: If a fasting blood sample is less than 100 mg/dl, diabetes is not the problem If the fasting blood sample is between 100 and 125 mg/dl, your doctor may ask you to take an oral glucose tolerance test OGTT This is an additional tool for determining diabetes The idea is to give a person a drink with
sugar and then test the blood glucose level 30 minutes, 1 hour, and 2 hours afterward A

Fasting blood sample
mg/dl milligrams per deciliter

3 What is insuLin-dependent diabetes meLLitus type 1?
Type 1 diabetes often appears in childhood, although sometimes it appears in an adult It occurs more frequently in whites than in other racial groups Type 1 happens suddenly with the following symptoms: extreme hunger and thirst, frequent urination, sudden weight loss, weakness, being sleepy or tired, sudden changes in eyesight, and nausea and vomiting The persons body cannot produce any insulin at all The cause is a mystery Some experts think type 1 is the result of an autoimmune disease–a condition in which the body attacks itself An infection may set it off New cases of type 1 are more common following viral infections such as mumps, measles, encephalitis, and rubella Type 1 must be treated with daily injections of insulin when food is eaten

Lesson 2: information sheet

4 Why is insuLin Given as an injeCtion instead of as a piLL?
Insulin is a protein just like the protein in meat, fish, poultry, or dairy products If insulin were taken by mouth and swallowed, it would be digested in
the stomach just as those foods are Once digested, insulin no longer works to control blood glucose It is not effective unless injected directly into the bloodstream

Not every child is at equal risk Children of a parent with diabetes are more at risk to develop type 1 diabetes Males are somewhat more likely than females to develop this disease Siblings of children with type 1 diabetes who drink more than 3 cups of milk a day appear to have a somewhat elevated risk of also developing type 1 diabetes Following recommended infant-feeding practices may decrease childrens risk of developing type 1 diabetes

6 Why do peopLe With diabetes experienCe so many other heaLth probLems?
Many of the health problems or complications of diabetes are caused by changes in blood vessels These changes are often brought about by the high glucose levels in a diabetics blood Sometimes, changes occur in the large blood vessels, like the veins and arteries The inside lining becomes thick, reducing the space in the vessel Blood has a hard time flowing through Heart disease or a stroke can result Changes can also occur in the small blood vessels, called capillaries, that distribute the blood to individual
cells Damage to the small blood vessels is often most severe in the eyes and kidneys of people with diabetes When the damaged blood vessels in the eye break open, the eye tissue is injured High blood glucose levels also damage kidney tissue Circulation in the legs and feet is also affected Sores and infections on legs and feet dont heal Severe damage often leads to loss of a toe, foot, or leg Keeping blood glucose levels close to normal helps prevent or delay such complications This is why controlling blood glucose levels is so important

5 Can drinkinG CoWs miLk Cause type 1 diabetes?
This question continues to be investigated A theory that a particular type of milk protein, A1 beta casein, could cause an immune response that could lead to type 1 diabetes has not found good support However, recent research from Europe suggests that several infant-feeding practices may increase some childrens risk of developing type 1 diabetes These practices include breastfeeding for less than 2 months, introduction of cows milk formula for feeding earlier than 6 months, and introducing gluten-containing cereal-basedfood before 3 months of age

Lesson

2

Worksheet: Are you at risk for type 2
diabetes?
The effects of type 2 can start 9 to12 years before you or your doctor realize you have it When type 2 is finally diagnosed, eye, kidney, and nerve damage may already be present Early detection and treatment can reduce the complications of this disease Take the following test to see if you are at risk Select the group that corresponds to your current age Then answer all the questions for that age-group

I am 65 or more years of age
My weight is equal to or above that listed in the chart Choose the column for your sex and then find your height Compare your weight to the weight listed yes ___ no ___ My mother, father, sister, or brother had diabetes yes ___ no ___ I have given birth to a baby weighing more than 9 pounds yes ___ no ___ If you answered yes to any question, you are at risk Do your answers indicate that you are at risk? Ask your doctor about a blood glucose test Guard your health
Source: W H Herman, P J Smith, T J Thompson, M M Engelgau, and R E Aubert 1995 A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes Diabetes Care 183, 382-387

I am 2044 years of age
My weight is equal to or above that listed in the chart shown
at right Choose the column for your sex and then find your height Compare your weight to the weight listed yes ___ no ___ I get little or no exercise during a usual day yes ___ no ___ If you answered yes to both questions, you are at risk

I am 4564 years of age
My weight is equal to or above that listed in the chart Choose the column for your sex and then find your height Compare your weight to the weight listed yes ___ no ___ I get little or no exercise during a usual day yes ___ no ____ If you answered yes to either question, you are at risk

Women Height Feet and inches 4 ft 9 inches 4 ft 10 4 ft 11 5 ft 0 5 ft 1 5 ft 2 5 ft 3 5 ft 4 5 ft 5 5 ft 6 5 ft 7 5 ft 8 5 ft 9 5 ft 10 5 ft 11

Weight Pounds 134 137 140 143 146 150 154 157 161 164 168 172 175 179 182

Men Height Feet and inches 5 ft 1 inch 5 ft 2 5 ft 3 5 ft 4 5 ft 5 5 ft 6 5 ft 7 5 ft 8 5 ft 9 5 ft 10 5 ft 11 6 ft 0 6 ft 1 6 ft 2 6 ft 3

Weight Pounds 157 160 162 165 168 172 175 179 182 186 190 194 199 203 209

Height is without shoes and weight is without clothes

This chart shows weights that are 20 percent heavier than what is recommended for women and men with a medium frame If your weight is above the amount shown
for your height, you may be at risk for developing diabetes

Lesson

2

faCt sheet: Sweet nothings– are artificial sweeteners safe?
We are born with a desire for sweet foods Newborns dont learn to like sugar; they just naturally like it Perhaps this explains why the average person eats about 43 pounds of sugar a year Sugar contains calories, however Many people want the sweet taste, but not the calories Supermarkets now offer many low-calorie or nocalorie foods made with artificial sweeteners It is possible to buy no-calorie soft drinks that have the same sweetness as the original formula Can we really enjoy this gift from food science, or is there a hidden cost? Lets review the sweeteners and the evidence for their safety it increased bladder cancer in rats Because of the intense public outcry against the ban, Congress postponed the ban but required that a warning statement be placed on labels of foods containing saccharin In 1991 the FDA withdrew the proposal to ban saccharin The consumer warning remains on the food label if saccharin is used in the food product Saccharin is approved for use in more than 90 countries The FDA considers it safe for the general public at current
levels of intake Most public health officials feel that using saccharin poses only a small risk They recommend that children eat no more than 500 mg/day of saccharin and that adults eat no more than 1,000 mg/day See table that follows on acceptable daily intakes Currently, most adults and children consume much less saccharin, partly because of the availability of other artificial sweeteners Saccharin can affect a baby during pregnancy While there is no evidence that saccharin can harm a fetus, it is wise to avoid using much of it if you are pregnant

saCCharin
Saccharin is the grandfather of all artificial sweeteners It was first made in 1879 for use as an antiseptic However, scientists soon discovered its ability to provide sweetness Food processors use it as a sugar substitute in canned foods and beverages Saccharin is 300 to 400 times sweeter than table sugar or sucrose Today it is sold as Sweet N Low, Sugar Twin, or Sweetmate and appears in a wide variety of food products Saccharin is not broken down by the digestive system, so it is calorie free It is stable in heat and can be used in cooking It sometimes gives food a bitter aftertaste In 1977 the Food and Drug Administration
FDA proposed a ban on saccharin after studies found

Lesson 2: faCt sheet

aspartame
Aspartame was first approved in 1981 Equal, Equal Spoonful, and NatraTaste are tabletop sweeteners that contain aspartame Aspartame is made of two amino acids, phenylalanine and aspartic acid, linked to methanol, a natural alcohol The body digests aspartame like a protein and provides 20 calories per teaspoon Because aspartame is 200 times sweeter than sugar see sugar substitutes and equivalents table, very little is needed to produce the desired sweetness The sweetener is used in lower-calorie versions of traditional sweet foods It appears in carbonated beverages, fruit juice, milk beverages, frozen desserts, puddings, yogurt products, and in packets for home use Because aspartame is broken down by heat, it cannot be used in baking But it may be added to foods after they are cooked The products of aspartame digestion–phenylalanine, aspartic acid, and methanol–occur naturally in many foods Studies of humans who used aspartame in large doses 200 mg/kg of body weight or over 60 cans of diet soda for a 120-pound woman for months or several years did not show any significant bad effects People with
phenylketonuria PKU should not use aspartame because it may affect the levels of phenylalanine in their blood Breast-feeding women who use aspartame at levels recommended for healthy adults no more than 50 mg/kg of body weight appear to bring no risk to their child But scientists continue to investigate the safety of aspartame for use by children and by pregnant or breastfeeding women A recent study suggested aspartame use might be associated with an increased risk of brain cancer FDA examined the National Cancer Institute database on cancer occurrence and found no evidence of such an association Moderate use of aspartame is unlikely to be harmful Ninety percent of the people who use aspartame eat a very small amount of it per day

aCesuLfame-k
This sweetener was discovered in 1967 in Frankfurt, Germany Hoechst, a German company, introduced it in the United States in 1989 under the name of Sunette Acesulfame-K is the major ingredient in two tabletop sweeteners, Sweet One and Swiss Sweet It is 200 times sweeter than sugar If used alone at high concentrations in certain food products, it may produce a slightly bitter aftertaste, similar to that produced by saccharin Acesulfame-K is
not broken down by the bodys digestive system Thus, it is calorie free Some consumer groups have asked if large doses of this sweetener might cause cancer The FDA has stated that a detailed analysis of all the research data showed that any tumors found in animals were not caused by feeding the animals acesulfame-K In the United States, acesulfame-K has been approved for use in chewing gum, powdered beverages, gelatins, puddings, instant coffees, and nondairy creamers Unlike aspartame, it is heat stable and

Lesson 2: faCt sheet

can be used in baking It can be combined with other sweeteners to produce an even sweeter taste, a practice common in other countries It has been approved for use in over 40 countries

Acceptable Daily Intakes ADI Sugarsubstitute ADI Saccharin Children: 500 mg/day Adults: 1,000 mg/day Aspartame 50 mg/kg body weight For 50-lb 23 kg child: For 150-lb 68 kg adult: Acesulfame-K 15 mg/kg body weight For 50-lb 23 kg child For 150-lb 68 kg adult 5 mg/kg body weight For 50-lb 23 kg child For 150-lb 68 kg adult

Amountofproduct togiveADI 13 packets Sweet N Low 25 packets Sweet N Low

suCraLose
Since its approval in 1998, sucralose has become the most popular sugar
substitute It is sold under the brand name Splenda and can be found in thousands of food and beverage products around the world It is about 600 times sweeter than sugar A patented process is used to create sucralose from cane sugar The process involves replacing three hydrogen-oxygen groups on the sugar molecule with three chlorine atoms Chlorine is found naturally in many foods and beverages such as tomatoes, peanut butter, and table salt In this case, the addition of chlorine is what converts sugar into sucralose The body does not recognize this sweetener as sugar or a carbohydrate Thus, it is not metabolized by the body and does not provide any calories Sucralose can be used in cooking and baking Unlike some other artificial sweeteners, it maintains its sweetness when heated and does not produce a bitter aftertaste More than 100 scientific studies have been conducted over a 20-year period on the safety of this product Based on the results of these studies, the FDA and other health authorities have concluded that sucralose can be safely consumed by everyone, including pregnant and nursing women Products containing sucralose are not required to carry any warning labels or safety
information

32 packets of Equal or 7 12-oz cans of diet soda 97 packets of Equal or 20 12-oz cans of diet soda

7 packets of Sweet One 20 packets of SweetOne

Sucralose

9 packets of Splenda 28 packets of Splenda

Note: To determine your weight in kilograms, divide your weight in pounds by 22 Example: 150 pounds divided by 22 68 kilograms mg milligrams Sugar and Equivalents of Sugar Substitute Sugar Equal SweetNLow SweetOne Splenda 2 teaspoons 1 packet 1/5 teaspoon 1 packet 1 packet

1 tablespoon 1 1/2 packets 1/3 teaspoon 1/4 cup 1/3 cup 1/2 cup 1 cup 6 packets 8 packets 12 packets 24 packets 3 packets 4 packets 6 packets 12 packets

1 1/4 packets 1 1/2 packets 3 packets 4 packets 6 packets 12 packets 6 packets 8 packets 12 packets 24 packets

Lesson 2: faCt sheet

seLeCtinG a suGar substitute
Choosing a sugar substitute is no longer easy Which sweetener tastes best? How much should you eat in a day? To learn which sweetener you like best, try a variety of food products that contain different sweeteners Some sweeteners taste better in baked products, others better in beverages Review the recipes in this lesson to learn how to cook with them Think about the risks and benefits of
sweeteners Look at diet soft drinks, for example The benefit of drinking artificially sweetened drinks is that you take in fewer calories How many can you drink in a day and still avoid any risks? To help you, the FDA has established an acceptable daily intake ADI for each sweetener This is the amount that humans can eat over a lifetime and still be considered safe by one hundredfold In other words, this is 1/100th of the amount shown to have no toxic effects on test animals The ADI is reported as an amount per kilogram of body weight One kilogram is 22 pounds If you decide to use sweeteners, limit your daily intake to less than the levels given in the ADI table on the opposite page If you wish to use sweeteners during pregnancy, aspartame and sucralose are the best choices Avoid saccharin

seLeCtinG a LoW-CaLorie food produCt
Labels of food products that contain artificial sweeteners may say sugar free, calorie free, or reduced calories A sugar-free food has less than 05 gram of sugar per serving A calorie-free food has less than 5 calories per serving A reduced-calorie food has at least one-quarter or 25 percent fewer calories than the original food These statements on the front
of the package are the first sign of a lowcalorie product

Not all sugar-free or reduced-calorie foods are low in calories, however The food may contain fat, which provides calories Sometimes a sugar-free food doesnt save you many calories, compared with the food it is replacing Be sure to examine the Nutrition Facts panel on all low-calorie food products to be informed of what you are really getting Use artificially sweetened foods in moderation and they can be part of your wellness plan

suGar aLCohoLs
Sugar alcohols are also called polyols They include sorbitol, mannitol, xylitol, maltitol, maltitol syrup, lactitol, isomalt, and hydrogenated starch hydrolysates Most of these are half as sweet as table sugar Maltitol and xylitol are about as sweet as table sugar

Lesson 2: faCt sheet

Manufacturers use sugar alcohols to sweeten some foods and often combine them with other sweeteners like acesulfame-K or saccharin Sugar alcohols do not lose their sweetness when heated and can be used to sweeten hot drinks and cooked foods They are not used in baked goods because they do not give foods the desired brown color These compounds provide fewer calories than table sugar In Europe they
are given an average caloric value of 24 calories per gram They are not easily passed from the intestine to the bloodstream When taken into the blood, they are converted to energy by a process that does not involve insulin Sugar alcohols passing through the intestine are broken down by bacteria If eaten in large amounts, they can cause gas and act like a laxative Unlike sugars they do not cause tooth decay If a food contains sugar alcohols, they must be listed in the ingredient list A food manufacturer may list the grams of sugar alcohol in a serving on the Nutrition Facts panel This is voluntary unless a nutrient content claim like sugar free is made on the label If such a claim is made, the sugar alcohol content must be listed If only one sugar alcohol is used, it may be listed by specific name If several are used, the manufacturer may simply call them sugar alcohol

Lesson

2

reCipes: Using artificial sweeteners
appLe-straWberry Crisp
Makes4servings One serving 1/4 of crisp contains: 191 calories 20 g carbohydrate 2 g protein 12 g fat 135 mg sodium 0 mg cholesterol 2 g dietary fiber Ingredients: Nonstick vegetable spray 1/4 cup margarine 1/4 cup quick-cooking oats 1/4 cup flour
1/4 tsp brown sugar substitute 1/2 pint fresh strawberries 1 large tart cooking apple, peeled and cut into 1/4-inch slices 2 tsp lemon juice 1/2 tsp cinnamon 1/2 tsp lemon peel, grated 1/2 tsp vanilla
If Sugar Twin or another brown sugar substitute cannot be found, use regular brown sugar

Procedure: Preheat oven to 400F Spray 8-inch round baking dish with nonstick vegetable spray Combine margarine, oats, flour, and brown sugar substitute in small bowl until crumbly and set aside Combine remaining ingredients to coat fruit Pour into prepared dish Top with oat mixture Bake for 1520 minutes or until slightly browned
Adapted from The American Diabetes Association and the American Dietetic Association Family Cookbook, Vol III New York: Prentice Hall Press, 1987

Microwavetip: Pour fruit mixture into unsprayed, 8-inch microwave-safe dish Top with oats mixture Cook on high power for 68 minutes, rotating dish halfway through cooking time Let stand for 45 minutes before serving Serve warm with low-calorie whipped topping, if desired

straWberry shake
Makes1serving1cup One serving contains: 88 calories 11 g carbohydrate 7 g protein 2 g fat 92 mg sodium 75 mg cholesterol 0 g dietary fiber
Ingredients: 1/2 cup plain low-fat yogurt 1/4 cup sugar-free, strawberry-flavored carbonated beverage 1/2 packet Equal brand sweetener 2 Tbsp unsweetened frozen strawberries, slightly thawed Procedure: Blend all ingredients in blender Pour into chilled glass Store leftovers in the refrigerator Time-savingtip: Make a couple hours ahead and keep in refrigerator until serving
Reprinted, with permission, from The Joy of Snacks 1991 International Diabetes Center, Minneapolis All rights reserved

Lesson 2: reCipes

Curried WaLdorf saLad
Makes4servings One serving 3/4 cup contains: 198 calories 8 g carbohydrate 17 g protein 11 g fat 226 mg sodium 48 mg cholesterol 1 g dietary fiber Ingredients: 8 oz 1 1/2 cups cubed skinned smoked turkey 1 cup cubed apple 1/2 cup sliced celery 1/2 cup low-calorie mayonnaise 1/2 tsp curry powder 2 packets Equal brand sweetener Procedure: Combine turkey, apple, and celery in a large bowl In a separate bowl, blend together mayonnaise, curry powder, and Equal Toss turkey mixture with dressing Chill Serve on lettuce leaves Store leftovers in the refrigerator

yoGurt-CuCumber veGetabLe dip
Makes11/2cupsor24tablespoons One serving 1 Tbsp contains: 9 calories 1
g carbohydrate 1 g protein 0 g fat 52 mg sodium 1 mg cholesterol 0 g dietary fiber Ingredients: 1 cup pared, shredded cucumber, drained 1/2 tsp onion powder 1 cup plain low-fat yogurt 3 packets Equal brand sweetener 1/2 tsp salt 1/8 tsp pepper 1 tsp garlic powder 1 Tbsp lemon juice Procedure: Shred peeled cucumber with grater Press cucumber with paper towels to remove as much moisture as possible Combine cucumber and onion in a bowl Combine remaining ingredients and mix with cucumber Blend thoroughly Cover and chill Serve with fresh vegetables Best if used within one week
Reprinted, with permission, from The Joy of Snacks 1991 International Diabetes Center, Minneapolis All rights reserved

Source:st-joseph.org