In every issue of Diabetes Self-Management magazine, we test your knowledge on a diabetes-related topic. Here's a quiz question from the July/August 2009 issue.

How much do you know about fiber?

Let’s face it: Fiber is one of those things we love to hate, and talking about it isn’t all that exciting. Going by names ranging from “roughage” to “twigs and sticks,” fiber is, to paraphrase Rodney Dangerfield, a nutrient that gets no respect. But whatever you think about it, it’s a fact that fiber has a wide variety of benefits for people with and without diabetes. And if you are like most Americans, you are not getting enough of this vital nutrient.

Fiber supplements are a good way to make sure you meet your daily fiber requirements.
TRUE or FALSE?

FALSE. While there’s nothing wrong with taking a fiber supplement, many people don’t realize that most of them are not, in fact, all that high in fiber. For example, 1 teaspoon of Metamucil Orange, Smooth Texture, Sugar Free powder contains just 3 grams of fiber. The suggested daily dose is up to 3 teaspoons per day, providing a total of 9 grams of fiber daily. Two teaspoons of Benefiber powder also provides 3 grams of fiber, with the recommended daily dose being up to 6 teaspoons, or 9 grams of fiber. Citrucel Sugar Free Orange Mix with SmartFiber provides 2 grams of fiber per tablespoon. The suggested dose is up to three servings daily, which would total 6 grams of fiber. So although fiber supplements are certainly an option, particularly if you tend to fall short of your fiber goals, you’d be better off trying to get your fiber from food sources: In addition to fiber, foods provide a variety of healthful nutrients that are not found in supplements.

In every issue of Diabetes Self-Management magazine, we test your knowledge on a diabetes-related topic. Here's a quiz question from the May/June 2009 issue.

How much do you know about indigestion?

Is there anybody out there who hasn’t experienced indigestion? (We didn’t think so.) Indigestion is an imprecise term that is used to describe any number of gastrointestinal symptoms, including frequent burping, pain in the stomach or abdomen, a bloated feeling, heartburn, nausea and vomiting, and even constipation or diarrhea. For some people, such symptoms occur infrequently and usually after eating a spicy meal or consuming particular foods or beverages. Indigestion can also be brought on by eating too much, eating too fast (especially when eating high-fat foods or feeling stressed), eating foods that are difficult to digest, or taking medicines that cause gastrointestinal side effects.

Your pancreas is part of your digestive system.
TRUE or FALSE?

TRUE. The digestive system includes a series of hollow organs that run from your mouth to your anus. In between those two points are your esophagus, stomach, small intestine, large intestine (or colon), and rectum. In addition to these hollow organs are two solid organs — the pancreas and the liver.

The pancreas, in addition to producing insulin, also produces digestive juices that travel through a duct to the small intestine. The liver makes a digestive fluid called bile, which is stored in the gallbladder until needed.

Inflammation of the pancreas, called pancreatitis, can cause symptoms of indigestion, including abdominal pain, nausea, and vomiting. Acute pancreatitis is most commonly caused by gallstones that get stuck in the pancreatic duct or by heavy alcohol use. Most cases of chronic pancreatitis are caused by long-term alcohol abuse.

To learn more about the pancreas and how diabetes can affect your digestive system, check out the following articles and blog entries:
Treating Gastroparesis
Byetta and Pancreatitis: What You Should Know
Definition: GERD
Slow Down, You Eat Too Fast!

In every issue of Diabetes Self-Management magazine, we test your knowledge on a diabetes-related topic. Here's a quiz question from the March/April 2009 issue.

How much do you know about nuts?

Once considered a fatty treat to be savored only on special occasions, nuts have had their health benefits reevaluated in recent years, and they are now taking their rightful place as part of a healthful diet. Replacing some meat in the diet with nuts has been touted as a way for people to lower their risk of diabetes and cardiovascular disease, and certain studies have even shown that nuts have the ability to lower after-meal blood glucose levels in people who have Type 2 diabetes. While nuts are still admittedly high in fat and calories, small amounts of nuts can easily fit into anyone’s meal plan (unless you happen to have a nut allergy, of course), whether you follow the guidelines of the DASH (Dietary Approaches to Stop Hypertension) diet, the Mediterranean diet, the South Beach Diet, or some other eating plan.

If you have the intestinal condition known as diverticulosis, you can safely eat nuts.
TRUE or FALSE?

TRUE. This is good news for anyone who has diverticulosis, a condition in which pouches form in the large intestine. In a serious and painful condition known as diverticulitis, inflammation of these pouches sets in. Historically, people prone to diverticulitis were told to avoid certain foods, such as nuts, seeds, and popcorn, that were believed to get “trapped” in the pouches. However, a study published in The Journal of the American Medical Association in the summer of 2008 debunked this belief. In this study, which involved over 47,000 men ages 40–75 years, the men who ate nuts at least twice a week had a 20% lower chance of getting diverticulitis compared with men who ate nuts less than once a month. So, after decades of being blamed for causing diverticulitis, nuts may actually help prevent this condition.

To learn more about nuts, check out the following blog entries and recipes:
“A” is for Almonds
Recipe: Hot and spicy nuts
Recipe: Banana peanut butter bread

Here's a quiz question from the January/February 2009 issue.

How much do you know about the common cold?

The common cold sounds simple enough: a viral infection of the nose and throat. Americans get an estimated 1 billion colds each year. The Centers for Disease Control and Prevention says that 22 million school days are lost each year because of colds (it doesn’t give figures for lost workdays). An article in the February 24, 2003, edition of the journal Archives of Internal Medicine puts the cost of the common cold at $40 billion per year in the United States, with missed workdays making up half of that cost.

Most of the time, a cold is harmless. When you have diabetes, however, the stress of even a simple cold can wreak havoc on blood glucose control.

Echinacea has been shown to be a safe and effective herbal cold remedy.
TRUE or FALSE?

UNCLEAR. Some studies suggest that echinacea may have beneficial effects, while others suggest that it doesn’t. A 2007 meta-analysis, which combined the results of 14 studies, concluded that echinacea reduced the chance of getting a cold by 58%. However, this immediately followed the publication of a study that found no helpful effect from echinacea.

One possible explanation for the conflicting results of studies is variability in what was tested. There are nine different species of echinacea, with echinacea purpurea believed to be the most potent, according to the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM). It is not clear, however, whether the root, leaf, stem, or seed is the most effective part of the plant to take. Furthermore, there is uncertainty about how much to take and when to take it. Some studies suggest that taking echinacea regularly does not prevent colds, but that taking it at the first sign of a cold or respiratory infection may help reduce symptoms.

While many people consider “natural” remedies to be harmless, this is not always the case. After all, prescription drugs often are derived from the same plants and other substances found in nature as herbal preparations. Herbal supplements, in fact, may have all the risks of drugs without the accompanying standards of effectiveness, safety, and consistency. In the case of echinacea, some sources warn that people with autoimmune disorders should avoid taking the herb. Allergic reactions are also possible, including rash, asthma, and anaphylaxis (a rare but life-threatening condition). Stomach and intestinal upset is the most common side effect of echinacea; rare side effects include hepatitis, kidney failure, and atrial fibrillation (an irregular heartbeat). Be sure to talk with your doctor before using any herbal or dietary supplement.

The NCCAM has compiled fact sheets on numerous supplements, including echinacea, that can be accessed here.

To learn more about supplements and your health, check out the following blog entries and articles:
Do You CAM?
FDA Issues New Supplement Rules
Choosing a Multivitamin
Antioxidants: Should You Supplement?

Here's a quiz question from the November/December 2008 issue.

How much do you know about athlete's foot?

People who have diabetes are told to check their feet every day for anything unusual, which might include redness, swelling, warmth, coolness, blisters or other signs of rubbing, dry skin, thick calluses, breaks in the skin, etc. While there are many potential causes for such symptoms, one fairly common cause of some of these is athlete’s foot, which, despite its name, is not confined to athletes. The most common symptom of athlete’s foot is cracked, flaking, peeling skin between the toes, but it can also cause itching, burning, and stinging, as well as blisters, oozing, or crusting. Athlete’s foot is most common among men and among people with weakened immune systems, which include those with uncontrolled diabetes.

All I need to do to prevent athlete’s foot is to wear shoes in public areas.
TRUE or FALSE?

FALSE. Wearing shoes in public areas is certainly one way to lower your risk of getting athlete’s foot, but it’s not the only way. Keeping your feet dry is important as well, along with doing all you can to prevent the fungus from reaching your feet.

Keeping your feet dry entails drying your feet thoroughly — especially between the toes — after bathing or swimming. It also entails changing your socks at least once a day, and wearing socks that are made either from natural materials, such as cotton or wool, or synthetic materials that wick moisture away from your skin. If you are prone to heavy sweating, change your socks twice a day. Look for natural materials when you choose shoes, too. Plastic, rubber, vinyl, or vinyl-lined shoes hold in moisture and can raise your risk of getting athlete’s foot. Alternate pairs of shoes to give them time to dry between wearings.

If you’re prone to athlete’s foot, ask your doctor about sprinkling your feet and/or shoes regularly with an antifungal powder.

If you go to a nail salon, make sure it uses disposable instruments or practices a sterile environment. If you’re unsure, take your own instruments, and clean them between uses.

If you currently have athlete’s foot, avoid spreading the fungus to other areas of your body by using a separate towel to dry your feet. In addition, put your socks on before putting on your underwear. Washing your clothes, towels, and sheets in hot water and bleach increases the likelihood of killing the fungi that may be clinging to them.

To learn more about keeping your feet healthy, check out the following blog entries and articles:
Love Your Feet
Taking Steps Toward Healthy Feet
How to Choose Footwear
Foot Care: Drugstore Do's and Don't's

Here's a quiz question from the September/October 2008 issue.

How well do you know your diabetes vocabulary?

Hypoglycemia. HbA1c. Ketoacidosis. Diabetes has its own set of vocabulary words, many of which are completely unfamiliar to most people who don't have diabetes. Even when you have diabetes, it can be difficult to keep them all straight, especially since some terms go out of favor and others are added over the years, as discoveries are made and new products are developed. But the more terms you're familiar with, the more you will know about how diabetes—and treating it—works. Even though not every smidgen of vocabulary will seem relevant to you, increasing your general knowledge can help you understand more quickly what you hear or read and may help you communicate more easily with your doctor or other medical professionals.

Every form of diabetes can be classified as either Type 1 or Type 2.
TRUE or FALSE?

FALSE. While Type 1 and Type 2 diabetes are the most common forms of diabetes, others exist. Gestational diabetes, in which elevated blood glucose levels occur during the course of a pregnancy, affects about 4% of pregnant women in the United States. Latent autoimmune diabetes of adults, or LADA, occurs when the insulin-producing pancreatic beta cells are attacked by the immune system, just as in Type 1 diabetes. However, LADA begins in adults under 50, who may or may not also exhibit insulin resistance, a chief characteristic of Type 2 diabetes. LADA is often misdiagnosed as Type 2 diabetes. Maturity-onset diabetes of the young, or MODY, is a group of genetic forms of diabetes in which the pancreas produces less insulin than the body needs, but usually doesn't completely lose the ability to make insulin. MODY usually develops between puberty and age 25, but in some cases it may begin later in life. While some people with MODY take insulin, others are able to control their diabetes through meal planning and/or oral diabetes drugs.

To learn more about LADA, MODY, and gestational diabetes, check out the following blog entries and definitions:
Is it Type 2 or is it LADA?
What We're Reading: Halle Berry's Diabetes
Type 1.5 Diabetes
Gestational Diabetes

Here's a quiz question from the May/June 2008 issue.

How much do you know about triglycerides?

Most of the fat found in our bodies, as well as in our food, is in the form of triglycerides. Just as with cholesterol, though, the relationship between triglycerides in the diet and blood triglyceride levels is not a direct one. Triglycerides in the body are stored in fat cells and also circulate in the blood. They are needed to provide energy, but high levels in the blood can be dangerous.

The National Cholesterol Education Program's Adult Treatment Panel III (ATP III) report contains numerous guidelines for evaluating cardiovascular disease risk, and it identifies high triglycerides in the blood—called hypertriglyceridemia—as one factor that increases the likelihood of heart disease. High triglycerides are a common feature of the metabolic syndrome (also characterized by unhealthy cholesterol levels, high blood pressure, and abdominal obesity), which affects around 80% of people with Type 2 diabetes.

Consuming omega-3 fatty acids helps to lower blood triglyceride levels.
TRUE or FALSE?

TRUE. Numerous studies have shown that consuming the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) lowers triglyceride levels. Studies examining the intake of omega-3 fatty acids in healthy people have consistently shown a 20% to 50% reduction in triglyceride levels from consuming 2–3 grams of omega-3 fatty acids each day. This effect is even greater in people with elevated triglycerides, including those with either Type 1 or Type 2 diabetes. Fish oil is a good source of omega-3 fatty acids. Randomized controlled clinical trials—the gold standard for research in medicine—have demonstrated that fish oil is the only lipid-lowering substance other than statins that can decrease the risk of death in people with existing heart disease. Be aware of dose size, though, when selecting fish oil supplements; many varieties would require a daily intake of a dozen pills to reach 2–3 grams of omega-3 fatty acids.

For people who are not trying to significantly lower their triglyceride levels, eating more fish (especially fatty varieties such as salmon, tuna, and mackerel) is also a good way to take in more omega-3 fatty acids. Two servings a week is considered a desirable intake for most healthy people (not pregnant or nursing women), providing health benefits without the risk of unsafe levels of mercury.

To learn more about triglycerides and omega-3 fatty acids, check out the following articles and blog entries:
Studies Find Benefits for Fish and Omega-3 Consumption
Troublesome Triglycerides (Part 1)
Troublesome Triglycerides (Part 2)
Fabulous Fish Oil Findings: Part 1
Fabulous Fish Oil Findings: Part 2
Fabulous Fish Oil Findings: Part 3

Here's a quiz question from the January/February 2008 issue.

How much do you know about vitamin D?

Vitamin D has been in the spotlight lately thanks to studies linking adequate intake of it to a reduced risk of certain types of cancer. Two recent studies have also found that getting enough vitamin D may help prevent Type 2 diabetes. Other research shows that it may reduce the risk of Type 1 diabetes when given to infants, and that it can improve insulin sensitivity among adults, including those with Type 2 diabetes.

Taking cod liver oil is a good way to increase vitamin D intake.
TRUE or FALSE?

FALSE. Although cod liver oil has a high level of vitamin D, it is also very high in retinol, a type of vitamin A. Too much retinol has been found to increase the risk of hip fractures among postmenopausal women, so cod liver oil, despite its vitamin D, is not likely to contribute toward overall bone strength. Other sources of vitamin D (fortified milk, oily fish, supplements, and sunlight) represent safer choices. (For vitamin A, beta-carotene appears to be a better choice than retinol. Beta-carotene can be found in sweet potatoes, carrots, squash, and many green, leafy vegetables, as well as supplements.)

To learn more about vitamin D, check out the following articles and blog entries:
Boning Up on Bone Health
Nutrition and Dental Health
Top 10 Health Tips for Women Over 65
Vegetarianism and Diabetes: Do the Two Mix? (Part 3)

Here's a quiz question from the November/December 2007 issue.

How much do you know about fish?

Fish is often promoted as a heart-healthy food for people with and without diabetes alike. And indeed, fatty fish such as salmon, mackerel, sardines, and albacore tuna is an excellent source of healthful omega-3 fatty acids, which have been shown to improve heart health. This quality of fish can be especially beneficial to people who have diabetes, which increases the risk of heart disease and stroke. Preparing fatty and other types of fish using low-fat cooking methods such as poaching, baking, or steaming is a healthful way to add nutrition and variety to your meal plan.

Eating fish is a proven way to boost mental functioning.
TRUE or FALSE?

FALSE. Omega-3 fatty acids are suspected to improve mental functioning, but more research is needed before health organizations like the American Diabetes Association can take any official positions on the issue. Additionally, careful review of the current research on mental functioning and omega-3 consumption is needed because studies published so far have measured omega-3 fatty acid intake in different ways: Some studies used food intake as reported by the study participants to estimate the amount of omega-3 fatty acids consumed, while others measured blood levels of the different types of omega-3 fatty acids. So the amount of omega-3 fatty acids necessary to affect mental functioning is not clear.

To learn more check out the following blog entries:
Studies Find Benefits for Fish and Omega-3 Consumption
Fabulous Fish Oil Findings: Part 1
Fabulous Fish Oil Findings: Part 2
Fabulous Fish Oil Findings: Part 3