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  • Preparing for and managing diabetes in a disaster

    Information Regarding Insulin Storage and Switching
    between Products in an Emergency

    INSULIN STORAGE AND POTENCY
    Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. According to the product labels from all three U.S. insulin manufacturers, it is recommended that insulin be stored in a refrigerator at approximately 35 to 46 degrees F. Unopened and stored in this manner, these products maintain potency until the expiration date on the package. However, all of the available insulin products may be left unrefrigerated (between 59 and 86 degrees F) for up to 28 days and still maintain potency.

    As a general rule, insulin loses its potency according to the temperature it is exposed to and length of that exposure. Under emergency conditions, you might still need to use insulin that has been stored above 86 degrees F. Such extreme temperatures may cause insulin to lose potency, which could result in loss of blood glucose control over time.

    In any case, you should try to keep insulin as cool as possible. Try to keep insulin away from direct heat and out of direct sunlight, but if you are using ice, also avoid freezing the insulin.
    When properly stored insulin again becomes available, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced. If patients or healthcare providers have specific questions about the suitability of their insulin, they may call the respective manufacturer at the following numbers:
    Lilly: 1-800-545-5979
    Aventis: 1-800-633-1610
    Novo Nordisk: 1-800-727-6500
    INSULIN SWITCHING
    Switching insulin should always be done in consultation with a physician. If this is not possible under emergency conditions, the following recommendations may be considered:
    Short-acting and rapid-acting insulins
    One brand of regular insulin (e.g. Humulin R, Novolin R) may be substituted for another brand of regular insulin and for rapid-acting insulins (e.g., Humalog, NovoLog), and vice versa, on a unit-per-unit basis.
    Intermediate and long-acting insulins
    One intermediate-acting insulin product (e.g., Humulin N, Novolin N, Lente insulin) may be substituted for another intermediate-acting insulin product on a unit-per-unit basis. Likewise, these insulins may also be substituted for long-acting insulins (such as Lantus and Ultralente) on a unit-per-unit basis, or vice versa. IMPORTANTLY, half of the NPH (or Lente) insulin dose should be given in the morning and half given in the evening.
    Insulin mixes
    Patients using pre-mixed insulin products (e.g., Humulin 70/30, Humalog Mix75/25, Novolin 70/30, NovoLog Mix 70/30) have two options to consider:
    • One insulin mix product may be substituted for another on a unit-per-unit basis.
    • If no other insulin mix is available, patients should first substitute an intermediate- or long-acting insulin on a unit-per-unit basis relative to the intermediate-acting component of the mix (e.g., in the examples above, approximately ? of the total unit dose of the mix), always making sure that the total dose of NPH (or Lente) insulin is split between morning and evening doses.
    • If regular or rapid-acting insulins are also available, they may be used before major meals along with the intermediate- or long-acting insulin (dosed as above) in doses equivalent to approximately ? of the total dose of pre-mixed insulin usually taken before that meal.
    Insulin pumps
    • Patients using insulin pumps who must switch to injected insulin may substitute an intermediate or long-acting insulin for the 24-hour total basal dose of infused insulin on a unit-per-unit basis, always making sure that the total dose of NPH (or Lente) insulin is split between morning and evening doses.
    • If regular or rapid acting insulin is also available, patients should administer mealtime insulin according to their previous system for calculating their bolus insulin doses.
    http://www.fda.gov/cder/emergency/insulin.htm

  • #2
    Re: Preparing for and managing diabetes in a disaster

    Diet rich in beans, lentils helps control diabetes

    CHICAGO -- A diet rich in nuts, beans and lentils beat a high cereal-fiber diet in controlling symptoms of diabetes and heart disease, Canadian researchers said on Tuesday.

    They said the study was aimed at settling the question of which diet could help diabetics gain better control over their disease, but it could be helpful for others as well. Dr. David Jenkins of St. Michael?s Hospital and the University of Toronto and colleagues studied 210 people with type 2 diabetes randomly selected to try one of two diets for six months. All were also treated with medications to control their blood sugar and had monthly blood tests.

    People on the low-glycemic index diet ate an abundance of beans, peas, lentils, nuts and pasta. People in the high fiber group ate a largely ?brown? diet: whole grain breads and cereals, brown rice, potatoes with skins and whole wheat bread, crackers and cereals. At the end of the six months, people on the low-glycemic diet lost slightly more weight, had significantly better control of their blood sugar and had higher levels of high density lipoprotein or HDL, the so-called good cholesterol.


    http://www.chinapost.com.tw/health/d.../Diet-rich.htm

    ---------------------------------------------------------------------------------------------------------------


    Effect of a Low?Glycemic Index or a High?Cereal Fiber Diet on Type 2 Diabetes


    A Randomized Trial

    David J. A. Jenkins, MD; Cyril W. C. Kendall, PhD; Gail McKeown-Eyssen, PhD; Robert G. Josse, MB, BS; Jay Silverberg, MD; Gillian L. Booth, MD; Edward Vidgen, BSc; Andrea R. Josse, MSc; Tri H. Nguyen, MSc; Sorcha Corrigan, BSc; Monica S. Banach, BSc; Sophie Ares, MA, RD, CDE; Sandy Mitchell, BASc, RD; Azadeh Emam, MSc; Livia S. A. Augustin, MSc; Tina L. Parker, BASc, RD; Lawrence A. Leiter, MD

    JAMA. 2008;300(23):2742-2753.

    Context Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low?glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations.

    Objective To test the effects of low?glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes.

    Design, Setting, and Participants A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007.

    Intervention High?cereal fiber or low?glycemic index dietary advice.

    Main Outcome Measures Absolute change in glycated hemoglobin A1c (HbA1c), with fasting blood glucose and cardiovascular disease risk factors as secondary measures.

    Results In the intention-to-treat analysis, HbA1c decreased by ?0.18% absolute HbA1c units (95% confidence interval [CI], ?0.29% to ?0.07%) in the high?cereal fiber diet compared with ?0.50% absolute HbA1c units (95% CI, ?0.61% to ?0.39%) in the low?glycemic index diet (P < .001).

    There was also an increase of high-density lipoprotein cholesterol in the low?glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by ?0.2 mg/dL (95% CI, ?0.9 to 0.5 mg/dL) in the high?cereal fiber diet (P = .005).

    The reduction in dietary glycemic index related positively to the reduction in HbA1c concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = ?0.19, P = .009).

    Conclusion In patients with type 2 diabetes, 6-month treatment with a low?glycemic index diet resulted in moderately lower HbA1c levels compared with a high?cereal fiber diet.

    Trial Registration clinicaltrials.gov identifier: NCT00438698


    Author Affiliations: Clinical Nutrition and Risk Factor Modification Center (Drs Jenkins, Kendall, R. Josse, and Leiter, and Messrs Vidgen and Nguyen, and Mss Corrigan, Banach, Ares, Mitchell, Emam, Augustin, and Parker) and Division of Endocrinology and Metabolism (Drs Jenkins, R. Josse, and Leiter), St Michael's Hospital, Toronto, Ontario; Dalla Lana School of Public Health (Dr McKeown-Eyssen), Department of Nutritional Sciences (Drs Jenkins, Kendall, McKeown-Eyssen, R. Josse, and Leiter, and Messrs Vidgen and Nguyen, and Mss A. Josse, Banach, Emam, and Augustin), and Department of Medicine (Drs Jenkins, R. Josse, Silverberg, Booth, and Leiter), University of Toronto, Toronto, Ontario; Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario (Dr Silverberg); and College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan (Dr Kendall), Canada.



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    Factors that influence the GI of food:

    ♦ type of starch present,

    ♦ the physical form of the food, ie particle size, ripeness (the larger the particle size the more slowly the
    food is absorbed and the riper the fruit the more quickly it is absorbed),

    ♦ the amount of cooking and processing -usually speeds up absorption,

    ♦ amount of water-soluble fibre present (slows down absorption),

    ♦ the type of sugar (fruit sugar is more slowly broken down than sucrose),

    ♦ fat and protein content (delays absorption),

    ♦ the acidity of food- eg adding lemon juice to food, delays its absorption


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