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Diabetes Health Line
Newsletter 3

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Medicare Now Covers Insulin Pumps •  Fakin' It •  Missing Something? •  Wristwatch-Style Glucose Monitor for Diabetics OK's • Got a Teenager or Child with Diabetes? •  Peanut Butter Cookies

Medicare Now Covers Insulin Pumps

Medicare has changed its policy and now covers insulin pumps and supplies, but only under certain conditions.

only covers insulin pumps for people who have type 1 diabetes and can prove it with a C-peptide level less than 0.5 ng/ml. (Ask your doctor for a C-peptide test if you are type 1 and can meet the criteria below.) You must also meet the conditions of either criterion A or criterion B in order to receive Medicare coverage for the insulin pump.

Criterion A:

• You have been through a diabetes education program.
• You have been taking at least three injections of insulin a day and making dose adjustments for at least 6 months.
• You have been checking your blood sugar at least four times a day and have the records to prove it.
• You have an HbA1C over 7 percent and a history of recurring low blood sugar reactions, large variations in blood sugars before meals and/or dawn phenomenon (a rise in blood sugar levels in the early morning, often over 200 mg/dl).

Criterion B:

• You were already on the pump before enrolling in Medicare and you can document checking blood sugar levels at least four times a day for the month before you enrolled.

Here's a quick list of what Medicare does and does not cover.

Medicare covers . . .

• lancets
• glucose test strips (limited to 3 per day)
• glucose meter
• insulin pump and supplies
• outpatient diabetes education

Medicare doesn't cover . . .

• diabetes pills
• insulin
• insulin syringes or pens
• jet injectors

Adapted from Diabetes Forecast, November 2000.

Fakin' It

Artificial sweeteners can be a great way to enjoy sweets without a surge in blood sugar. However, many people find cooking with artificial sweeteners difficult.

You must remember that, even though a sweetener may look like sugar, this doesn't mean that it will behave like sugar when you bake with it. Sugar not only sweetens food, it also provides structure and moistness and improves volume, texture and color. Artificial sweeteners only add sweetness. That is why some baked products don't turn out right when sugar has been replaced by a sugar substitute.

Artificial sweeteners work best in foods that rely on other ingredients for volume, moistness and texture. They work well in foods like puddings, salad dressings, sauces, pies, cheesecakes, frozen desserts and beverages. Artificial sweeteners also taste better in recipes with acidic ingredients like fruit, yogurt or buttermilk. All artificial sweeteners are sweeter when they are combined with other sweeteners. For example, one packet of saccharin and one packet of aspartame is more sweet than two packets of saccharin. Also, different forms of the same type of sweetener do not replace the same amount of sugar. For example, it takes 1/4 cup of granulated saccharin to replace 1/4 cup of sugar, but only one teaspoon of Sweet'n Low in bulk. Both are forms of saccharin.

Here are some tips for cooking with artificial sweeteners.

• Aspartame stays sweeter longer during heating if other ingredients in the recipe are acidic, like fruit.
• Sugar-free puddings and gelatins usually substitute perfectly in refrigerated desserts and congealed salads.
• Spices can mask the aftertaste of some artificial sweeteners.
• Using less of an artificial sweetener than needed to exactly substitute for sugar may also reduce aftertaste.
• Cinnamon and vanilla make food taste more sweet with less sweetener.
• Sugar makes food stay fresh longer because it helps retain moisture. You will need to cover any sugar-free baked goods well and refrigerate or freeze them to maintain freshness.
• Adding sugar-free pudding or 1/4 cup non-fat dry milk powder to a sugar-free cake may increase the volume and moistness.
• Pureed fruit can add sweetness and bulk to sugar-free cookies, cakes and quick breads.
• If you totally replace sugar in baked goods with artificial sweetener, you should reduce your dry ingredients by 25 percent and add a little fruit juice or 2 egg whites for moistness.
• Do not substitute more than 1/2 cup sugar in baked goods.

Artificial sweeteners available on the market today include saccharin, aspartame, acesulfame-K and sucralose. These sweeteners are marketed under different brand names. Be sure to read the label to determine which sweetener you want to purchase.

Missing Something?

Do you know how much fiber you get every day? Most Americans get less than 20 grams of fiber in a day. Fiber is an important part of your diet that helps prevent many health problems. In many cases, the more fiber you eat, the better your blood glucose control. The American Diabetes Association recommends that people with diabetes eat 20 to 35 grams of fiber every day. You don't have to stop at 35 grams, though. One study found that people had better glucose control when they ate 50 grams of fiber a day than they did when they ate 24 grams of fiber a day.

When adding fiber to your diet, do it slowly. Adding a lot of fiber all at once could cause some gas and discomfort.

Here's how you can add more fiber to your diet.

• Eat cereal with at least 5 grams of fiber per serving for breakfasts and snacks.
• Make whole-grain pancakes and waffles.
• Top cereal, pancakes and waffles with fresh or dried fruits.
• Grab some fruit (either whole or in single-serving cans) on your way out the door.
• Have a salad with dinner and add carrots, cooked beans and spinach leaves.
• Have a whole-grain roll with dinner.
• Make pizzas with whole-wheat crust and top with vegetables.
• When baking, substitute whole-wheat flour for a quarter or half the white flour.
• Buy whole-grain crackers.
• Make sandwiches with whole-wheat bread and add vegetables like red peppers, lettuce, sprouts, tomatoes and cucumbers.
• When making meatloaf or meatballs, replace some of the meat with cooked bulgur or brown rice.
• Keep baby carrots, celery sticks and other vegetables in your refrigerator so they are ready to eat when you want a quick snack.
• Plan a meatless main dish at least once a week.
• Choose main courses that have beans in them, like tacos, chili, bean soup and bean salads.
• Choose whole-grain noodles and brown rice over regular noodles and white rice. Use these whole-grain products in dishes such as barley soup, rice casserole and stir fry.
• Eat popcorn for snacks.
• Have fruit for dessert.
• When you make soup, add brown rice, barley or cooked beans.
• Try vegetable sticks and dip instead of chips and dip.

Wristwatch-Style Glucose Monitor for Diabetics OK'd

FDA has approved a wristwatch-like device to help diabetics manage their disease. The GlucoWatch, which is to be used along with finger-prick blood tests, measures blood glucose by sending out tiny electric currents to extract fluid through the skin. It sounds an alarm if the glucose reaches dangerous levels. For more information, see the U.S. Food and Drug Administration new release.

Source: FDA News Digest, March 26, 2001.

Got a Teenager or Child with Diabetes?

Then you could probably use Getting a Grip on Diabetes. Published by the American Diabetes Association, this book has medical advice and straight talk from other teens on how to handle the pressure and stress that comes with just being a kid, teenager or young adult with diabetes. To purchase Getting a Grip on Diabetes, just call 1-800-232-6733 or order online.

Recipe Corner - Peanut Butter Cookies
2 dozen cookies

You'll Need:

3/4 cup margarine, softened

1 cup creamy style peanut butter

1/4 cup egg substitute or egg whites

2 tbsp. honey

1/2 tsp. vanilla

1 cup of sucralose granules (like Splenda)

1 1/2 cups all-purpose flour

1/2 tsp. baking soda

1/2 tsp. salt

1. Preheat oven to 350°F.
2. In a large bowl, beat margarine and peanut butter with an electric mixer until creamy, approximately one minute.
3. Add egg substitute, honey and vanilla. Beat on high speed until well blended, approximately 30 seconds.
4. Add sucralose and beat on medium speed until well blended, approximately 30 seconds.
5. In small bowl, combine flour, baking soda and salt. Slowly add flour mixture to peanut butter mixture, beating on low speed until well blended, about 1 1/2 minutes. Mixture may be crumbly.
6. Roll level teaspoons of dough into balls and drop onto a lined sheet pan, about 2 inches apart. Flatten each ball with a fork, pressing a crisscross pattern into each cookie. Bake 7-9 minutes or until light brown around the edges. Cool on wire rack. Serving Size: 2 cookies

Calories: 140 Carbohydrates: 9 g Protein: 3 g Dietary Fiber: 1 g
Total Fat: 11 g Saturated Fat: 2 g Cholesterol: 0 mg Sodium: 2 g
Diabetic Exchanges: 1/2 starch, 2 fat