Diabetes and Drinking

You are at a holiday party. Everyone around you is drinking, but you have diabetes. Is it safe for you to consume alcohol? The danger is not what most people think - high blood sugar. Instead, alcohol mixed with diabetes medication, either insulin or certain pills, can lead to dangerously low blood sugar

levels (hypoglycemia). Since low blood sugar produces symptoms similar to intoxication, you may be fooled into thinking you are slightly drunk when in fact you may be headed for a severely low blood-sugar reaction.

But it is OK for someone with diabetes to have a drink or two at a party if they take proper precautions. The American Diabetes Association suggests not more than one "serving" per day for women, and two for men. A "serving" is one beer, 4 ounces of wine, or 1.5 ounces of distilled spirits. So what happens if you have diabetes and you drink? Normally, your liver produces a steady supply of glucose, especially at night, when you are not eating. If you have diabetes, you take insulin and/or oral medications to lower the sugar levels in your blood. So there is a balance: The liver produces glucose and the medication keeps it at a safely low level.

But when the liver senses alcohol, it shifts function and attempts to detoxify your body by removing the alcohol from the bloodstream. Meanwhile, it is not producing sugar. So if you are taking medication to reduce your glucose levels while the liver is not producing any, you may reach dangerously low levels.

The liver can work from eight to 12 hours ridding your body of alcohol. Since these hours normally are the ones following an evening affair, your blood sugar may drop very low while you are asleep. You would recognize and treat the symptoms if you were awake, but perhaps the symptoms would not wake you, particularly after a long, tiring party at which you've had a drink or two.

Here are some rules to improve your chances of safe drinking:

First, at a party, always make sure someone is aware that you have diabetes and knows how to recognize hypoglycemia and help you treat it by giving you carbohydrates. Tell them not to assume you are a bit drunk, but rather know that you are having a low blood-sugar reaction. They must be told that if you appear ill or begin vomiting, you will need medical help. If you become unconscious, they should not try to feed you. Instead, they should seek medical help immediately.

Never drink on an empty stomach. Take your drink with a meal, or with snacks containing carbohydrates, such as pretzels or crackers. Prepare your own drinks, if possible, so you know how much alcohol you're getting. Most important, drink slowly!

Avoid sweet liqueurs, drink mixes, juices or regular soda. Instead, mix drinks with diet soda, club soda or vegetable juice. But locate fruit juice and regular soda so you can reach it quickly if you need a quick carbohydrate boost.

Choose light beers over regular beer. Drink water or a non-caloric beverage between alcoholic beverages. Carry a quick-acting carbohydrate, such as three glucose tablets or candy.

Monitor your blood sugar every few hours, especially if the party includes increased physical activity, such as dancing, playing sports or swimming, that can further lower your blood sugar. Remember that even one drink may affect you differently than people without diabetes, so always have a designated driver lined up.

Have a snack before getting into bed, even if your blood sugar is slightly high. Set the alarm clock to ring halfway through the night, or have a family member wake you, to check your blood sugar. Eat a carbohydrate-containing snack if blood sugar is below 100mg/dl.

Zulia Hernandez-Escobar is a Registered Dietitian at the Diabetes Care Center, South Miami Hospital.

Baptist Health South Florida is the largest faith-based, not-for-profit health care organization in the region, with an outstanding reputation for medical and service excellence. It's network of services extends throughout Miami-Dade and Monroe Counties with Baptist, Baptist Children's, South Miami, Homestead, Mariners and Doctors Hospitals, and Baptist Cardiac & Vascular Institute.

What to Expect From the Doctor If You Have Diabetes

Diabetes is a complex disease involving many organs and systems. Taking good care of diabetes is often best obtained when you work with a team of doctors and other healthcare professionals. It's common today for a person with diabetes to be seen not only by our Diabetes Care Center staff, but also a range of specialist physicians who might include an endocrinologist, cardiologist, nephrologist, ophthalmologist and podiatrist to help with the various complications of the illness. It is also common that the family physician directs the care of a diabetes patient. It's important for the patient to know what to expect from the doctor and when to ask for additional expert help.

Here are some pointers:

Neither you nor your doctor should underestimate diabetes. It is a serious disease that can cause serious complications.

How much work are you willing to do with diet, exercise, blood sugar testing and medications? You and your doctor, together, should decide on the treatment goals. Are you interested in following conventional therapy, or more aggressive intensive therapy that will help keep blood sugar levels closer to normal range and reduce the risk of diabetes complications?

Take written records of your blood sugar readings to every appointment so you can discuss your progress. Your doctor should also monitor your A1C level, a blood test that shows diabetes control and the risk of developing complications, every three to six months. Discuss what the results mean in relation to your goals.

Your needs will change with time, so your physician should offer ongoing education by a competent diabetes team.

Does your doctor screen for and treat complications? Aggressive blood pressure, cholesterol and triglyceride treatment is essential. In addition to routine blood tests, your doctor should examine your feet at every visit, run urine tests every year or as needed, and order a thallium stress test as needed. He or she should offer to you the pneumonia vaccine once and flu vaccine annually, refer you for a dilated eye exam annually or as needed, and remind you to have regular dental cleanings.

Whenever your family physician orders a new medication or a medical procedure or surgery, he or she should discuss the risks and benefits with you. What impact will this have on the diabetes, and what complications may arise because of the disease? Remind your doctor about your diabetes and the medications that you take so that he or she can adjust any treatment as needed.

Finally, don't be afraid to ask for a referral to an endocrinologist if your family physician cannot control your blood sugar or diabetes complications. That's what specialists are for!

Maria Gough is a Nurse Manager at the Diabetes Care Center, Baptist Hospital.

Baptist Health South Florida is the largest faith-based, not-for-profit health care organization in the region, with an outstanding reputation for medical and service excellence. Its network of services extends throughout Miami-Dade and Monroe Counties with Baptist, Baptist Children's, South Miami, Homestead, Mariners and Doctors Hospitals, and Baptist Cardiac & Vascular Institute.

Controlling Cholesterol Levels With Diabetes

The evidence continues to mount that controlling cholesterol is important for people with diabetes, even if they show no signs of heart disease. Having diabetes increases your risk for many diseases, including heart disease and stroke. If you have diabetes, the recommended target cholesterol levels are stricter than for those without diabetes. An adult with diabetes should have an LDL (low-density lipoprotein) cholesterol level of less than 100 mg/dl, and an HDL (or high-density lipoprotein) level of more than 40 mg/dl for men and 50 mg/dl for women. Recommended level for triglycerides is less than 150 mg/dl. In case you are unfamiliar with those terms, cholesterol is basically divided into two types, one "good" and the other "bad." LDL is often called the "bad" cholesterol because it builds up in the inside walls of arteries, causing hard lumps or plaque, the main cause of heart attacks and strokes. HDL, the "good" cholesterol, carries excess fats from your arteries and reduces this plaque buildup. So the goal is to reduce the LDL cholesterol and increase the HDL cholesterol in your blood.

If your cholesterol results are outside the recommended parameters, your doctor likely will recommend diet and exercise as a first step. If that doesn't work, the doctor may prescribe medication. One of the most important diet recommendations is to cut back on the total fat intake, especially the intake of saturated fats (found mostly in meat, milk and eggs) and trans fats (found in shortening, packaged foods and many brands of margarine).

Intake of daily cholesterol from diet should be less than 200 mg. Another important diet recommendation is to increase total fiber intake to at least 20-30 grams per day, especially soluble fiber (such as that found in oats, peas, beans, and some fruits and vegetables). Exercise can raise HDL cholesterol, as well as lower LDL cholesterol and triglycerides. In addition, exercise has cardiovascular benefits and reduces stress. However, always talk with your doctor before starting any exercise program. As for medication, a recent study in the United Kingdom found "highly significant reductions" of about 25 percent in heart attacks when people were treated with a cholesterol-reducing medication. This benefit existed in people with diabetes over the age of 40 even if their cholesterol levels were otherwise normal.

What does that mean for you? If you have diabetes, even with no signs of heart disease, cholesterol- lowering therapy may be beneficial for you. Patients should discuss this with their physicians.

Alice Pereira is a Diabetes Team Nutritionist at the South Miami Hospital, Baptist Hospital. Baptist Health South Florida is the largest faith-based, not-for-profit health care organization in the region, with an outstanding reputation for medical and service excellence. Its network of services extends throughout Miami-Dade and Monroe Counties with Baptist, Baptist Children's, South Miami, Homestead, Mariners and Doctors Hospitals, and Baptist Cardiac & Vascular Institute.

In the Face of Bad Publicity Long Term Christian Missionaries Quietly Serve Haitians

On January 31, ten missionaries from the Central Baptist Church in Meridian, Idaho and the East Side Baptist Church in Twin Falls, Idaho were arrested at the Haitian-Dominican Republic border for attempting to smuggle 33 Haitian children out of the country. Both churches are members of the Southern Baptist Convention, which runs relief programs worldwide and is America's largest Protestant denomination.

The spokeswoman for the missionaries said they were "just trying to do the right thing."

Some do say their actions can be understood in light of Haiti's tragic situation. Even before the earthquake, roughly 15 percent of the children were orphaned or abandoned, many living in institutions or on the streets. It was a country whose poverty would shock most Americans. The earthquake, which some call the most cataclysmic event in generations made an already wretched situation worse. More Haitians than ever live in squalor and more children than ever are orphaned or homeless. It's hard to imagine how a child could grow up in bleaker circumstances, with a bleaker future.

It takes considerable tact and sensitivity to negotiate the racial, linguistic, religious, and cultural divide that exists between foreign missionaries and Haitians. The Idaho missionaries failed.

Sadly, this incident casts a cloud over other Christian missionaries in Haiti. There are many Christian groups there with long track records of working cohesively with the Haitian people. Let's take a brief look at five of them.

Haitian Christian Outreach

Haitian Christian Outreach (HCO), of Mahomet, Illinois, has uplifted the spiritual lives of Haitians since 1989. Its first and foremost task has been to build a number of Emmanuel Churches. But it has also prioritized health care, establishing roving medical clinics that scour the country to provide free medical and dental care for Haitians who cannot afford to see a doctor or a dentist. It also runs fixed medical and dental clinics.

The Children's Ministry of HCO partners with Haitian Christians to spread the Gospel. HCO partners with the staff of Emmanuel Christian School to provide quality K-9 education, biblical training, and physical nourishment. The Haitian Christian Outreach Children's Fund provides food, education, uniforms, and health care to more than 1,200 students in three schools.

HCO has been in the forefront of efforts to help the Haitian people recover from the mammoth earthquake of January 12. It has responded to the fear people have of sleeping inside buildings -- because of the continuing aftershocks -- by providing tarp, tents, and mosquito nets to make sleeping outside agreeable.

It has provided food to more than 500 families, distributed potable water, and brought in sea containers and prepackaged meals.

Northwest Haiti Christian Mission

Northwest Haiti Christian Mission (NWHCM), from Versailles, Kentucky, has served the Haitian people for 30 years. It focuses its efforts in northwest Haiti where poverty is at its worst in the poverty-stricken nation. NWHCM's record of service to northwest Haitians is long. It has worked with indigenous Haitian Christian churches to lift people out of spiritual, physical, and social poverty.

NWHCM benefits thousands of people "regardless of age, gender, religion" through various programs: primary schools, feeding projects, orphanages, medical clinics, church planting, a Bible College, and agricultural development. It is the largest employer in northwest Haiti and among the biggest ministries in the country.

In the early days after the earthquake it provided roving medical aid. It has since gone on to work with the government of Saint Louis du Nord to provide food, physical therapy and rehabilitation, and orthopedic surgery, including hand surgery for the many in need.

Haitian Christian Mission

Haitian Christian Mission (HCM), of Indianapolis, Indiana, has served in Haiti for 34 years. It exists "to save souls for the Kingdom of Christ." Its educational, medical care, and nutrition centers advance its mission and give children a future.

HCM has established schools to teach reading, writing, arithmetic, and basic French. Its objective is to build a school to go with every one of its churches.

Haiti is a medically-deprived nation, having only one doctor for every 4.000 people. Endeavoring to turn the tide, HCM recently began collaborating with Project Haiti Heart to establish an OB-GYN next to its two hospitals in Fonds Parisiens, giving 80,000 people access to quality health care.

HCM nutrition centers serve roughly 7,480 meals to children every day, focusing on those who suffer from second and third degree malnutrition.

HCM also has a sponsorship program, wherein persons and groups in the United States donate $30 a month to provide food and education to the neediest Haitian children.

The ministry brought in a volunteer medical team after the earthquake. The team and the staff at Fonds Parisiens hospitals have treated hundreds of victims -- people with broken arms and legs, back and head injuries...

Missions of Love

Missions of Love (MOL), based in Hartford, Kentucky, began as a medical mission nearly 30 years ago in Jolivert. Innovation has been one of its features. One example is its Mamba blend (made of powdered milk, sugar, oil, and vitamins mixed with peanut butter). Mamba treats moderately and severely malnourished children between the ages of one and five.

Through the years MOL has taken on many other programs, some in partnership with other organizations. The Adult Literacy program helps adult Haitians learn to read and write. The Ear and Eye Clinic offers low cost or free eye exams and eye wear to Haiti's poor. The clinic also diagnoses and treats ear disease.

MOL works with the nonprofit Feed My Starving Children to provide food for needy children and nourishment for their souls. And it works with an Ohio family to provide medical supplies including dressings, syringes, rubber gloves, and surgical instruments to clinics and hospitals.

MOL outreach clinics enable children in remote villages and mountainous areas to get medical treatment...children who would otherwise go without the critical service.

The organization's Planting New Churches program feeds nutritious meals daily to children. Its Safe Drinking Water program reduces typhoid, dysentery, and parasitism.

MOL's Micro Finance program helps women in Haiti pay off loans and expands their businesses.

The Tents-4-Haiti program has been especially useful after the earthquake. It's made it possible for a population that is without housing or is reluctant to sleep with a roof over its head (because of the continuing threat of aftershocks) to sleep comfortably outside. MOL has provided other earthquake aid including medical teams, food, and water purification.

Haiti Christian Mission

Haiti Christian Mission, from Waco, Kentucky, provides discipleship training and enhances economic and educational opportunities for the community of Galette and surrounding areas.

The mission started in 1983 to support Ed & Pam Hardy from Irvine, Kentucky who worked 2 years helping with building church and other buildings for the Christianville Mission in Haiti. In 1984 they began to support Choubert Remy in securing an education and returning to Haiti in Christian service. HCM missionaries provide meals, clothes, dental, and medical care.

The Russell Christian School has been HCM's main contribution to Haitian society. Choubert and his wife Bernadette established the school in 1995. In that time it has grown from 30 K-6 students to 250. These students would go without education were it not for this school. They learn basic reading, writing, arithmetic, and science, in addition to learning Christian principles and the Gospel.

HCM has played an important role in disaster relief since the earthquake, providing food, water, and medical supplies to Galette and surrounding communities.

These five Christian Missions have served in Haiti for decades. They are staffed by mostly native Haitians and the Americans that are in service have taken the time and attention to learn the culture and ethnic nuances of the people. These missions do not deserve to be lumped with the Idaho missionaries. These missions deserve your prayers and support so they can continue the good work they perform.

Jeffrey J. Rodman is a Certified Fund Raising Executive (CFRE) and a Certified Grants Specialist (CGS). He is an experienced grantwriter, fundraiser, nonprofit executive, and public speaker who operates Here-4-You Consulting and Grant Writing providing consultation for grant writing and funding development to Christian ministries and Churches worldwide.

Jeffrey has supervised a team of writers, researchers, editors, and administrative staff in providing consultation for grant proposal writing, nonprofit development, and fundraising in almost every state and a dozen foreign countries and has worked on proposals to Federal, State, and Local government as well as to Foundations, Civic groups, and many others.

Jeffrey received his BS and his M.Ed. from George Mason University. He has written 100's proposals, secured millions of dollars in funding, and maintains a funding rate of nearly 80%. He has successfully managed over 25 different grants as a grant administrator and has also served as a grant reviewer on a state, federal, and local level as well as on foundation review panels. Jeffrey is an experienced speaker and is a Certified National Trainer for programs in Ohio, Indiana, Georgia, Pennsylvania, and Florida.

Miami Hospital System Pulls Plug on Dialysis For the Poor

A hospital system that provides affordable healthcare or complimentary medical services to the poor and uninsured in Miami-Dade County has announced it will cut dialysis treatments for nearly 200 patients with progressive kidney diseases and renal failure.

Jackson Health System, a quasi-government and privately funded consortium of primary care clinics, mental health facilities hospitals in the region made the decision as a direct result of rising medical costs and funding cuts from local and federal governments. Jackson estimates it will save about $4 million per year by eliminating the dialysis program.

"This decision was not taken lightly," Eneida Roldan, chief executive of Jackson, tells the Miami Herald. Roldan explained that Jackson is trying to reduce a projected loss of $168 million for fiscal 2010. She said patients can still get treated in the emergency room.

According to the National Kidney Foundation, some 26 million Americans are living with kidney disease. About 300,000 of them suffer from End Stage Renal Failure (ESRF), a non-reversible disorder that eliminates the body's ability to filter waste products from the blood. Without dialysis --- a mechanical process whereby a machine essentially "washes" the patient's blood three times per week for about three hours on an outpatient basis --- the patient requires a kidney transplant in order to survive.

Other medical facilities in the Miami area have offered to come to Jackson's aid in an effort to provide care for its indigent dialysis patients. Jackson estimates about a third of them are undocumented immigrants. Although the federal government does provide guaranteed Medicaid coverage for dialysis treatment, the process for applying for benefits takes about a year and does not pay claims for illegal citizens. What's more, the federal government requires that beneficiaries must have "paid into" the Medicare program for a certain period of time through payroll deductions before they can receive coverage.

So far, all but about 40 of Jackson's dialysis patients have successfully located alternative sources of care for dialysis treatments. In addition, nearby Baptist Health South Florida (a private, for-profit healthcare company) has called for a charitable medical partnership to create a new, ongoing safety net for the patients who require dialysis.

"These people are going to seek treatment," Keeley tells the Herald. "They're going to migrate to the nearest emergency room," after they become sick, meaning care will be more expensive. Such a scenario is "very inappropriate" when they could be kept well at outpatient dialysis centers, he said.

Under the healthcare reform proposals now before Congress, the emphasis is on getting cheaper basic care for an additional 30 million Americans to reduce emergency room care for those people without a primary care physician or health insurance.

Gerard Kaiser, Jackson's chief medical officer, justifies the decision to end dialysis treatment at its facilities because various government programs pay for inpatient dialysis but don't pay for outpatient treatment. He also explains that the savings Jackson will receive will come at the cost of shifting care to other facilities in the community, since they may end up at ERs other than Jackson's.

The National Kidney Foundation counters such an argument on its Web site, where the organization is calling for higher reimbursement rates for dialysis from Medicare. The NKF also fears that healthcare reforms under consideration by Congress could unintentionally threaten patient access to dialysis facilities, since they depend on the cross-subsidization of private insurance plans to allow them to continue operating.