1.     The diabetic diet is planned to provide a well balanced, nutritionally balanced diet. As with any diet, it is important that there are plenty of all essential nutrients to ensure good health, satisfactory growth and development.

2.     Maintain ideal body weight for height and age. Particular emphasis is placed on the energy or calorie content of the diet to be sure that weight gain is satisfactory and obesity does not develop. There will be regular dietary reviews as your child becomes older. Sometimes, particularly in teenage girls, the energy content of the diet may need to be reduced to avoid obesity.

3.     Help maintain blood glucose levels within satisfactory limits. This requires restriction of sugar and sweetened foods, a constant intake of carbohydrate spread over the day, and regular times for meals and snacks.

The diabetic diet uses normal foods and can be enjoyed by all members of the family. There is no need for a person who has diabetes to have meals prepared separately for them. The main principles and guidelines for a diabetic diet are consistent with the Australian Dietary Guidelines for better nutrition and health for all the community. They are as follows:

1. Eat a variety of foods each day.

2. Prevent and control obesity.

3. Decrease fat intake in the diet.

4. Decrease consumption of sucrose in the diet.

5. Limit alcohol consumption.

6. Increase intake of bread, cereals, fruit and vegetables.

7. Reduce salt intake.

8. Encourage intake of water.

*24/54/5*

Here are some guide-lines that seem appropriate for most families.

1.     Be about when you are needed. Even when a teenager is being most disagreeable he still needs to feel his parents love him and are there to care for him. He may want to fly solo and fly high, but it is nice to know the ground is down there to land on later.

2.     Listen as well as advice. Teenagers have points of view which give you insights into their feelings and behaviour. This will help you understand them and will make them less frustrated that their parents don’t understand. Never mind that their ideas seem immature or misguided: sometimes the way to work things out is to talk and to work it out for yourself that way.

3.     Provide firm and sensible guidelines for behaviour. Don’t relax your own standards just to accommodate a rebellious youngster. Be prepared to discuss rules and the reasons for them and then make decisions together.

Despite teenagers rebelling against adult authority, and their many complaints to the management, they do respect firm guidelines. If you don’t set high standards, how can you achieve even minimal behaviour?

4.     Discuss with your teenager how much help with diabetes care they would like you to give and how much reminding they need from you. You will still be accused of nagging but at least you will have an agreement to work to. You may feel that it is helpful to have your child’s doctor discuss this with you both and act as an independent arbiter if there is disagreement.

5.     Trust your teenager. He will probably let you down many times, but that’s part of development. The less you trust him the more he will give you reason not to do so. Giving responsibility is a good way of developing a responsible attitude.

6.     Remind yourself of your teenager’s good points and strengths. Don’t dwell on all the bad things which may be so much in evidence.

7.     If communication isn’t going well between yourself and your teenager, involve someone you both can trust. Teenagers can still relate to some adults even if they are temporarily rejecting their parents. Perhaps your teenager’s physician can talk to him or a school counselor or youth leader or another relation.

If your teenager is giving you concern and doesn’t seem to be looking after himself, discuss it with your doctor. But take heart; this is usually a temporary phase and often the most rebellious teenager becomes a model of zealous good care within a few years.

*57/54/5*

There is no shame in diabetes

There is nothing shameful about diabetes, but still some people do feel some sense of shame. All medical conditions suggest to some people perhaps that the person is less than perfect, or has some weakness. This is largely due to ignorance, and the thing that gives the lie to this attitude is the sight of the child with diabetes in perfect health and vigour, succeeding at school and at sport and socially with friends. Naturally you, as a parent, and your child with diabetes, do not parade the fact that he has diabetes – but neither should you conceal it like a shameful thing. Anyone who ought to know for the child’s sake (such as teachers, scout master, close friends) should be told in a matter-of-fact way, without any emotional overlay, and be given information about the condition that might be useful and relevant to their day-to-day contact with your child.

As with you as a parent, so it is true with members of the community; the most important thing to avoid is pity. No child wants to be pitied, and it does not help him to regain his self-confidence in himself, and self-esteem as a healthy individual.

Be prepared to talk about diabetes

You will want to be aware of his problems, be prepared to talk about diabetes when he wants to do so, and give help with adjustment to the treatment when needed. Try to avoid giving the impression you are worried about him or sorry for him. You will feel sorry for him at times of course, and perhaps worry about him often. But to show this will be upsetting for him, and will stop him feeling like a normal child.

*49/54/5*

Examples of what to give for a hypo reaction

On first sign of a hypo, give at once one of the following:

150ml Orange Juice

3 level teaspoons Sugar or 3 Sugar cubes

15g Barley sugar – i.e. 3 pieces

150ml Lemonade or other ordinary soft drink (not low calorie soft drink)

5 level teaspoons Glucose Powder e.g. Glucodin

3 level teaspoons Honey – may be especially useful for young children as it can be placed in the mouth and is difficult to refuse.

If the hypo did not occur just before a meal or snack it is sometimes a good idea to give an extra exchange of more complex carbohydrate, e.g. bread, biscuits, as well as the sugar. Otherwise the usual meal or snack should be taken promptly to prevent a recurrence of the hypo. The sugar you gave was an extra – don’t deduct an exchange from the usual diet allowance.

If the hypo is not improving in 10 minutes or so, or if it appears to be becoming worse, give further sugar as above.

An early or mild hypo reaction

The early signs (including the warning signs) of insulin hypoglycemic reaction may include one or more of the following:

Paleness, sweating, tremulousness

Dizziness and vagueness

Headache

Odd behaviour, bad temper, misery, crying

Trembling, twitching

Drowsiness

The things to do are:

1. Give sugar quickly: 3 teaspoonful or equivalent.

2. Make a note on the test record of the hypo.

A late or severe hypo reaction

The late signs of an insulin reaction may include:

Intense sleepiness, uncooperative behaviour.

Loss of consciousness or ‘coma’.

Convulsion.

The things to do are:

1. Give sugar if you can: 6-8 teaspoonful or equivalent.

IF NOT:

2. Give a glucagon injection.

3. When he responds, give the sugar at once.

4. If no response, call your doctor at once.

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Older children should do their own tests

As soon as your child is old enough to do the test (perhaps at the age of 5 or 6) he should be encouraged to do it himself. This will give him a greater sense of responsibility and will help him to accept blood testing as part of his daily routine. Some supervision will be needed.

Some children object to tests

It is common for children, as they become adolescent, to object to doing their tests. This is part of the general resentment of ‘being different’ that is common and natural at this age. Also if they do not appreciate the reason for doing the tests, they will be less inclined to do them.

Also the teenager is starting to have a busier social life, school work is getting more demanding or sport more important, and it is harder to get up in time in the mornings. For these and other reasons many tests may be left undone, and the parent may wonder how much to push the child, and how much to do the tests herself.

Your child may want privacy when doing the test, and this should be respected. A child needs some discipline at this age, but also a lot of understanding. Each child presents a different problem for himself and for those who are trying to help him. Usually it is best to allow your child’s doctor to help with the solution of this problem, if it should arise, rather than allow it to be a continuing battle between parent and child.

*32/54/5*

Ruined sex life: Cholesterol is the building block for several hormones, including those made by the adrenal glands, as well as sex hormones. This means that taking cholesterol lowering drugs can lower testosterone levels in men and women, reducing libido, physical and mental drive, and energy. As well as a loss of sex drive, several studies have shown that cholesterol lowering drugs can affect sexual performance in men, leading to erectile dysfunction. This is the case for both statins and fibrates (another type of cholesterol lowering drug). Cells in the testes are capable of producing cholesterol, as it is required in high amounts to produce testosterone. Statin drugs do reach the testes, and they can inhibit cholesterol production there, as well as in the liver. Sexual dysfunction symptoms vanish when the medications are discontinued.

The drug simvastatin (Zocor, Lipex) is able to directly inhibit testosterone production independently of its cholesterol lowering action, via a different mechanism. In some men statin drugs have caused them to develop gynaecomastia; this is the growth of breast tissue in men. The Australian Adverse Drug Reaction Advisory Committee has eleven reports of gynaecomastia connected to simvastatin use. The UK Committee on Safety of Medicines lists “a few cases” of gynaecomastia linked with the use of cholesterol lowering drugs.

Be aware that the risk factors for coronary heart disease, such as obesity, diabetes and smoking are also risk factors for erectile dysfunction. If you do suffer with erectile dysfunction, it could be an early warning sign that you also have clogged arteries and are at risk of a heart attack or stroke.

Cataracts: Taking statin drugs can cause irreversible damage to the lens of the eye. Taking the antibiotic erythromycin in combination with a statin increases the chances of developing cataracts. A study published in the Archives of Internal Medicine found that a single course of an antibiotic, typically lasting ten days doubled the risk of cataracts when taken with a statin. Two or more courses of antibiotics tripled the risk.

*25/53/5*

Calendar method

Using the onset of bleeding as day 1 and the day prior to the onset of bleeding as the last day of the cycle, map out your cycles for eight months. Find the longest and shortest and work out the times of ovulation in both cycles. This occurs fourteen days before the first day of bleeding in any one cycle. So if your cycle is 28-32 days long you will ovulate at some point on days 14-18 in any one month. Allow four days either side for safety. This means (continuing the example-the days will differ for different individuals) that you are unsafe from day 10 to day 21 in any month. Outside this time span you are probably safe.

Advantages

•     Costs nothing.

•     Gets around religious prohibitions on using ‘artificial’ methods of birth control.

•     No medical side-effects.

•     Makes couples more aware of the woman’s reproductive cycle and the functioning of her body.

•     Leads to couples finding alternatives to penis-in-vagina sex.

Disadvantages

•     Very unreliable.

•     Needs constant checking of cycle lengths to be sure that they are not changing.

•     Rules out penis-in-vagina sex for twelve days a month unless you are absolutely regular. Couples who don’t like making love during the woman’s period will add at least four days during menstruation to this, making half the month either unsafe or unsuitable.

•     Constant worry about timing can be unpleasant for both partners and probably leads to less sex overall.

Sympto-thermal method

A method which combines the taking of the woman’s daily body temperature and an awareness of the state of her fertility cycle through charting her cervical mucus condition. The method is complicated to do well and needs practice. In principle it works as follows:

When the cervical mucus is relatively thick and cloudy in the early days of a cycle it may be safe to have sex unless your cycle is very short.

As the mucus becomes slippery, thin and clear, ovulation is about to occur. As soon as the mucus appears to stop being thick and cloudy stop having unprotected sex. Avoid intercourse until three full days after the ‘peak’ of slippery mucus. Obviously, this takes some experience at judging.

The safest time for sex using this method is from the fourth day after the peak slippery mucus day until the first day of a period.

Advantages

•     Costs nothing.

•     Good for religious groups for whom contraception is prohibited.

•     No medical side-effects.

•     Makes a woman (and her partner) much more aware of her reproductive cycle and the functioning of her body.

•     Encourages the use of methods of love-making other than penis-in-vagina intercourse.

Disadvantages

•     Unsafe. Studies have shown that in the best hands the reliability can be near to that of the diaphragm but this can only be achieved by restricting sex to a relatively few days of the month.

•     As with the calendar method, travel, illness, drugs, stress infections and so on can all affect cycle length and so throw off the calculations. Women with irregular cycles find such methods tricky too.

•     As with the calendar method, many days every month are unsafe, and others may be regarded as unsuitable because of menstruation. This can suit the couple with a low sex drive very well but for others it means using alternative methods of love-making, many or all of which are unacceptable to some.

*13/72/5*

Most of us are infinitely more familiar with the symptoms of a Big Mac attack than a brain attack, also known as a stroke. In fact, one study found that 27 percent of the general public didn’t know a single warning sign of stroke, whereas the craving for beef, though hard to describe, often ends with a visit to your favorite grease pit.

If you want to be a card-carrying death defter, it’s imperative that you bone up your knowledge about stroke – the nation’s third leading killer. The brain cells and life you save could be your own. “The majority of stroke sufferers do not get to the hospital within the three-hour time frame we need to help them,” says Fletcher McDowell, M.D., professor of neurology at Cornell University Medical College in New York City and president of the Burke Medical Research Group in White Plains, New York. “If you get treatment within that time period, medication may reverse the stroke process or limit its extent.”

Part of the problem is that some consider stroke an old person’s disease. Guess again. While most stroke victims are over age 65, nearly 30 percent are under 65. “It can happen at any age,” says LaRoy Penix, M.D., assistant professor of neurology at the University Of Kentucky College Of Medicine in Lexington, and faculty associate at the Sanders-Brown stroke program, also at the university. “We have a child here now who had a stroke at the age of 12.”

The brain of a stroke victim tells the story. In the most common scenario, an ischemic stroke, an artery leading to the brain has been blocked by a blood clot. Whether blood flow is blocked by a clot or fatty plaque-the same mixture of cholesterol and other debris that can cause heart attacks-the result is the same. Starved of blood, oxygen, and other vital nutrients for even a few minutes, brain cells begin to die, Dr. McDowell says.

When this occurs you’re likely to get some signs that something is seriously wrong: sudden loss of vision in one eye; weakness, numbness, or tingling on one side of the body; difficulty speaking or understanding what people are saying; trouble walking; severe dizziness; or unsteadiness. It’s a list you’ll want to remember: One study found that 52 percent of stroke patients were unaware they were experiencing a stroke.

“These may be warning signs that the circulation in the brain is not working right and you are at risk for stroke and should seek medical attention,” says Dr. Ralph Sacco of the National Stroke Association.

The sooner you seek it, the better. Statistics show that most stroke victims don’t report to an emergency room until more than 24 hours after their first symptoms-many hours too late for the best possible treatment. Make it in time and chances are good that the doctors will give you what’s called a clot-buster to try to dissolve the blockage and get the blood flowing again, Dr. Sacco says.

If blood flow isn’t restored, entire regions of your brain can die. And since these different regions are responsible for various bodily functions- memory, vision, and so on-the shutdown results in familiar forms of disability. Someone who suffers a small stroke, for example, might temporarily lose the use of the muscles in one side of his face. More widespread damage to a key area of the brain can have even more devastating results. “If the area controlling motor function is damaged, for example, that can cause paralysis. Or if that area controls vision, then there’s vision loss,” Dr. Sacco says.

What, you may ask, are the main culprits in this debilitating, and often deadly, scenario? In addition to plaque buildup or clots, often it’s years of high blood pressure-literally the pressure caused by blood on arterial walls-that cause “hardening of the arteries to the brain, small-vessel clogging, or particles blocking arteries,” Dr. Sacco says. In fact, high blood pressure is the single most important controllable stroke risk factor. And, of course, anything that helps keep your arteries and blood vessels clear-such as eating less saturated fat and more fiber, losing weight, and lowering your cholesterol-will go a long way in helping you avoid not only stroke but heart disease as well. In fact, reducing your risk for heart disease will also reduce your likelihood of a stroke.

*89/36/5*

Before adolescence, the life of an anorexic-to-be seems pretty smooth. These people are often described as “model children”: compliant, obedient, and well-behaved. They carry out their duties at home cheerfully and willingly. At school, they are good students who are devoted to their work and usually get good grades.

In short, these people seem happy with their role as children. The demands made on them are easily met. They succeed at a level that fits their position in life, and thus feel good about themselves.

Come adolescence, however, the child is expected to function in new ways. Now an adolescent’s identity derives more from relating to her peer group than from simply meeting the expectations of adults. An adolescent who has trouble with these new demands begins to feel inadequate, although she may not be able to put her feelings into words. Even the rewards for “good behavior” that the adolescent might once have expected from adults are now less tangible and less frequent. A twelve-year-old doesn’t get a gold star for brushing her teeth every night; such behavior is now expected of her.

Feelings of inadequacy sometimes relate to the bodily changes puberty, as the hormonal onslaught triggers a flood of new emotions. The onset of menstruation forces a girl to think about herself as a maturing woman, a sexual being. For some, the sudden awareness of sexuality may be more than they can bear. Many of my patients appear to weather the storm of puberty for some time, accepting menstruation as a natural part of their development. Often, however, it turns out that they have just been putting up a brave front. Deep down, they are terrified of what’s happening to their bodies.

The fragile personalities these girls develop can be shattered by some devastating event. Such events take many forms, but they usually relate to a loss or a sense of failure.

For example, some anorexics have suffered the death of a parent or a particularly beloved grandparent. Sometimes the loss involves the breakup of the first (and most intense) romance. Some patients, about to enter college, are frightened by the thought of leaving the family or by the pressure to succeed. Divorce, relocation, marriage of a sibling, illness-any of these can shake her sense of security, challenge her ability to meet the expectations placed on her, and rob her of self-esteem.

Of course, the same can be said of anyone. The potential anorexic, however, lacks the inner strength necessary to handle loss, rejection, or change. She has aged, but she has not grown up. She has spent so much emotional energy pleasing others that she has none left to invest in understanding her own feelings. She has never learned to recognize the signals coming from her growing body, her brain, and, for want of a more scientific term, her soul.

Even if she does recognize these signals, she can’t respond to them. Instead she has a vague sense that “something is wrong with me.” She begins to mistrust not just herself but everyone around her. In such a state she can’t make new friends or keep old friendships going. She withdraws further into herself.

Soon her insecurity, lack of trust, and inability to recognize feelings affect her perception. She can’t even see what her own body looks like with any degree of accuracy.

Eventually, though, a kind of transformation takes place in her thinking. She gropes for an anchor to keep her from drifting into an emotional whirlpool. The notion that “there is something wrong with me” becomes “there is something wrong with my body-it’s too fat.”

*20/35/5*

Angela Banks turned to meditation to help her cope with stress and negative emotions. She never imagined that it would also help her lose 50 pounds.

For years, Angela used food to block out memories of her painful, | rri unhappy childhood. Eating made her feel warm and fuzzy inside. It was her way of showing herself kindness and love. But it came at a price: By the time she reached her twenties, she weighed 188 pounds.

All the while, Angela’s emotional pain continued to fester inside her. It finally came to a head in an explosive confrontation with her husband. At that moment, Angela realized that she could no longer ignore what had happened to her as a child. It was not only driving her to overeat, it was also undermining her spiritual well-being as a mother, wife, and business owner.

Angela immediately sought professional help. She learned an array of coping skills, including meditation. Now, instead of running to the refrigerator when she feels bad, she heads for a quiet room. For a few minutes, she tunes out the outside world and tunes in to her innermost thoughts and emotions. She tries to identify what is really bothering her, then figures out how to deal with the real problem without turning to food.

Today, at age 34, Angela runs a nonprofit organization that provides personal counseling and career support for sexually abused women. She credits a combination of meditation and prayer with helping her turn her life around. It also helped her slim down: She maintains a healthy weight of 138 pounds.

WINNING ACTION

Use your mind, not food, to mellow your mood. Daily meditation can help you relax, so you’ll be less inclined to plunge into a stress-induced binge. To try meditation, go to a room in your home where you won’t be disturbed. Sit in a comfortable position, then begin breathing slowly and deeply. Concentrate on your breathing. As thoughts enter your mind, acknowledge them, but don’t dwell on them. Continue for 20 minutes. You’ll feel the stress melt away.

*74\89\8*