Category: health

Jovina Cooks Italian: Marsala mushroom sauce

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mushrooms

 

Once again Jovina shows us how little additions of garlic, herbs and wine can bring a little touch of Italy into your life, wherever that is. 

Garlicky Marsala Mushroom Sauce

This sauce can be  folded into an omelet or served with pan-fried chicken breasts or over pork chops.

Ingredients

  • 5 tablespoons extra-virgin olive oil, divided
  • 1 pound white mushrooms, caps quartered
  • 1 pound shiitake mushrooms, stems discarded, caps quartered
  • Salt and freshly ground pepper
  • 4 large garlic cloves, 2 thinly sliced and 2 minced
  • 1 medium shallot, thinly sliced
  • 1 1/2 teaspoons minced rosemary
  • 1/2 cup dry Marsala wine
  • 3 tablespoons balsamic vinegar
  • 6 Kalamata olives, pitted and coarsely chopped
  • 2 tablespoons minced chives

Directions

In a very large skillet, heat 2 tablespoons of the olive oil. Add the white and shiitake mushrooms, season with salt and pepper, cover and cook over moderately high heat for 5 minutes, stirring once. Uncover and cook over high heat, stirring once, until the mushrooms are browned all over, about 3 minutes.

Add the sliced garlic, the shallot and rosemary and cook, stirring, until fragrant, about 2 minutes. Add the Marsala and cook until evaporated, about 30 seconds. Add the vinegar and cook, stirring, for 30 seconds. Stir in the minced garlic, chives, olives and the remaining 3 tablespoons of olive oil and season with salt and pepper. Cover and keep warm.

From Cooking The Italian Provinces – Trapani | jovinacooksitalian

Can supplements help diabetes related visual problems?

kaitiscotland6 Comments

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Are supplements a waste of money? This article from Diabetes in Control describes and experiment to find out…..
 Do Supplements Help Diabetes Vision?

June 26th, 2015

 

This was a 6-month randomized, controlled clinical trial of patients with type 1 and type 2 diabetes with no retinopathy or mild to moderate non-proliferative retinopathy assigned to twice-daily consumption of placebo or a novel, multi-component formula containing xanthophyll pigments, antioxidants and selected botanical extracts.

Measurement of contrast sensitivity, macular pigment optical density, color discrimination, 5-2 macular threshold perimetry, Diabetic Peripheral Neuropathy Symptoms, foveal and retinal nerve fiber layer thickness, glycohemoglobin (HbA1c), serum lipids, 25-OH-vitamin D, tumor necrosis factor α (TNF-α) and high-sensitivity C reactive protein (hsCRP) were taken at baseline and 6 months. Outcomes were assessed by differences between and within groups at baseline and at study conclusion using mean ± SDs and t tests (p<0.05) for continuous variables.



The results showed that there were no significant intergroup differences at baseline. At 6 months, subjects on active supplement compared with placebo had significantly better visual function on all measures (p values ranging from 0.008 to <0.0001), significant improvements in most serum lipids (p values ranging from 0.01 to 0.0004), hsCRP (p=0.01) and diabetic peripheral neuropathy (Fisher’s exact test, p=0.0024). No significant changes in retinal thickness, HbA1c, total cholesterol or TNF-α were found between the groups.
The researchers concluded that this study provides strong evidence of clinically meaningful improvements in visual function, hsCRP and peripheral neuropathy in patients with diabetes, both with and without retinopathy, and without affecting glycemic control.

A. Paul Chous. The Diabetes Visual Function Supplement Study (DiVFuSS). Br J Ophthalmol doi:10.1136/bjophthalmol-2014-306534.

Leoni at Low Carb Store: Blueberry and Lemon Loaf

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lemon-181650_960_720This recipe is from Low Carb Store and was invented by Leoni, their resident dietician.

 

Ingredients

  • 125g almond flour
  • 3 eggs
  • 75g inulin
  • 100g blueberries
  • Zest of 1 lemon
  • 45g butter
  • 2 tsp vanilla extract
  • 1 tsp baking powder

Nutrition Per Slice

Recipe makes 10 slices

 

Net (Total) Carbs 2.3g
Fat 8.5g
Protein 4.9g
Fibre 7g
Calories 122kcal

 

Create It

 

Pre-heat your oven to 180°c then grease and line your loaf tin (we used a 12cm x 28cm). In a mixing bowl combine the almond flour, eggs, baking powder, vanilla and butter. Next gently fold in the berries, lemon zest and inulin using a spoon. Pour into your prepared tin and bake for about 25 minutes, until your kitchen fills with a delicious aroma and the loaf is golden brown. Devour hot and buttered!

 

Options – keep a few berries back and add to the top of the loaf before popping in the oven. You could also try adding some dark chocolate chunks if your carbs allow or some cinnamon for a hit of autumnal spice! Get creative and make it your own.

Margaret Coles: Invite this Physiotherapist into your home

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At  www.movingtherapy.co.uk. you can find Margaret Cole’s free educational resource to help your health and well being.

home-physio

Margaret worked as a community physiotherapist and when she retired she decided to put her knowledge and experience to good use. She produced videos covering a lot of different situations that you can face regarding your physical and mental states and has put them on the site. She also gives advice on how to lose weight.   People from all over the world have visited the site since 2011.

NHSinform Scotland and her local authority also promote the site.

 

 

Jovina Cooks Italian: Fruit with Mascarpone and Marsala

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strawberries

Strawberries are traditionally used in this Italian dessert from Trapani Italy, but given our seasonal constraints, feel free to use any fruit that appeals. This would make a nice treat for Valentine’s day.

Strawberry, Mascarpone, and Marsala Budini

Budini is Italian for puddings or parfaits.

Makes 6 servings

Ingredients

1 8-ounce container mascarpone cheese

  • 6 tablespoons sweet Marsala (preferably imported)
  • 3 tablespoons whipping cream
  • 3 cups sliced hulled strawberries (about 15 ounces)
  • 2 1/4 cups coarsely crumbled amaretti cookies (Italian macaroons; about 4 1/2 ounces)

Directions

Combine mascarpone, 3 tablespoons Marsala, and cream  in medium bowl. Stir gently until well blended.

Combine strawberries, remaining 3 tablespoons Marsala in another medium bowl; toss to blend. Cover mascarpone and berry mixtures; refrigerate 30 minutes.

Place 2 tablespoons crumbled cookies in each of 6 champagne goblets. Divide strawberry mixture with juices among the goblets.

Top berries with mascarpone mixture, then remaining cookies. Cover and chill at least 30 minutes and up to 2 hours.

Do you take a pair of “old faithfuls” on holiday?

kaitiscotland2 Comments

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 Many of us bring our best and newest footwear on holiday. But is it a good idea? This article from Diabetes in Control discusses the matter.

A Lot to Learn from Your Patients

I teach patients how to care for their feet, how to prevent foot problems, and how to treat them if they should have problems.

I have had so many patients return from vacation with foot wounds due to the particular shoes they were wearing. Some didn’t bring enough shoes or bought and wore brand new shoes, while some wore the type of shoes we don’t recommend and some didn’t wear shoes at all.

As I write this, I am on vacation. Before leaving, I thought about the above. I needed new shoes for the trip, so I bought 2 pair of the same shoes, one normal width and one wide. I didn’t have much time before leaving, but I did practice wearing them before leaving. “Something” told me to also bring a pair of old faithfuls…shoes I have worn a lot and had no problem with.

I’m so glad I heeded my own teaching. The first day, in one of the new pair of shoes, it went pretty well, no pain or redness. After wearing them all daytime, I changed to old faithful that evening. The next morning I noted a little redness and soreness on an area of my foot. I took no chances. I wore the pair with the wide width that day. No problems.

I thought about the wisdom we teach our patients. Glad to have feeling and sight to prevent a problem I’m sure would have occurred…more personal ammunition to teach my patients.

Lessons Learned:

  • When helping your patients prepare for travel, always teach to take more than one pair of shoes. If they are taking new shoes, this is especially important. And…always take a pair of “old faithfuls.”
  • Whether traveling or not, teach your patients to “listen” to any sign of redness, soreness, or pain that is telling them to wear different shoes.
  • Always teach the importance of looking at feet at least daily for changes and treat them early.
  • Remember, what’s good for people who have diabetes is most likely good for everyone.
  • Heed your own knowledge and practice what you teach.

Joy Pape, FNP-C, CDE, CFCN, FAADE
Associate Editor, DiabetesInControl

(My comment: personally I always bring Compeed Plasters on holiday and I put them on at the first sign of skin irritation. If you wait till the end of a walk its too late! I’ve become very fond of Sketcher’s Go Walk 2 shoes as well)

 

Rick: What Mary Tyler Moore meant to my mother

kaitiscotland4 Comments

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For me, Mary Tyler Moore represented what it meant to be both successful and a person with Type 1 diabetes.   My parents and I watched her program each week and I can recall my mother saying she has type 1 diabetes like I do.  Meaning like my mom did.  Her apparent health gave me hope and by extension the belief that my mom might be OK.  I can recall when I was diagnosed with diabetes that my mom said, you can do anything and Mom used Mary Tyler Moore as an example of a successful person with diabetes.

American feminism defined

Mary Tyler Moore represented American feminism in the 1970’s as America’s most successful middle aged working woman on TV who was not married.  The Mary Tyler Moore Show was about adults facing adult issues, in an adult and humorous way.  We often forget that the Mary Tyler Moore Show was about women making it in the world without a man to guide them and doing so successfully.  It was as much a revelation in sitcoms as was All in the Family, That Girl or the Jefferson’s to name a few.

Mary Tyler Moore was diagnosed with diabetes at age 33 and she embraced being a person with type 1 diabetes during her career.  For me, when I was diagnosed in 1974 I learned something about how to say I have diabetes from Mary Tyler Moore.  I can say that when I saw such a successful person with type 1 diabetes I related to her career and causes.

In later years I followed Mary Tyler Moore’s struggle with retinopathy and I always marveled at what a remarkable figure she was both for the diabetes community and as a woman who never let diabetes get in her way as an actress or human being.

More than diabetes

But she was about more than just diabetes.  She embraced animal rights organizations and commented that she wished to be remembered as an animal rights activist.  Most of us are content to be remembered for one thing, let alone two major causes.

Most of my readers know that my mother was very ill with complications from type 1 diabetes beginning in the 1960’s until 1986 when she passed at age 46.  When I was 13 and heard Mary Tyler Moore had diabetes it gave me hope that my mother might be ok, hope for my mother’s health was in short supply then.  When I heard that Mary Tyler Moore had retinopathy and was using laser treatments like my mother she gave me a belief that my mother might one day see again.    When my mother died, Mary Tyler Moore’s advocacy for diabetes causes gave me an example of what I, as a person with type 1 diabetes, should do for my community.    When Mary Tyler Moore died last week I cried and said thank you for her 50+ years of service to my community.

I know we have lost a friend of our community, but like many of us who loved her advocacy I feel like I have lost a friend of the family.

Rick Phillips.

Jovina Cooks Italian: Sage meatballs with Marsala wine sauce

kaitiscotland1 Comment

real-sage-115351_640 From Cooking The Italian Provinces – Trapani | jovinacooksitalian

Sage Meatballs with Marsala Wine Sauce

4 servings

Ingredients

  • 1 pound ground beef
  • 2 tablespoons freshly grated Parmigiano-Reggiano cheese
  • 1/4 cup soft unsalted butter, divided
  • 1 1/2 tablespoons fresh sage leaves (about 20 leaves), very finely chopped
  • Salt to taste
  • All-purpose flour for dredging
  • 1/4 cup sweet Marsala wine

Directions

In a large bowl, combine the meat, Parmigiano, half the butter, the sage and salt until they are very well blended, using your hands. Form small meatballs about 1 1/2 inches in diameter using cold wet hands to keep the meat from sticking. Roll the meatballs in the flour and set aside.

In a large skillet, melt the remaining butter over medium heat, then cook the meatballs until brown, 7 to 8 minutes. Shake the skillet often so they don’t stick.

Remove the excess fat from the skillet with a spoon and discard. Once the meatballs are brown, pour in the Marsala wine and continue cooking until it is almost evaporated, about 2 minutes. Serve immediately.

Continuous glucose monitors may need human back up

kaitiscotland1 Comment

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This story from Diabetes in Control Disasters Averted series describes why it is a good idea to check a finger prick sample of blood if there is a discrepancy between your recorded results and how you feel.

CGM? Still Perform the Fingerstick!

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College student, type 1 diabetes, wears a pump and CGM. She has good family support. Several of her family members get her CGM readings on their phone. She received a call from her mother about 2:45 am waking her up. She told her to treat her low blood glucose, which patient reported to be 41. (UK 2.2)

Patient states her alarm had gone off, but she did not hear it. She performed a fingerstick because she didn’t feel like she was low. It was 149. (UK  8.2) (See report.) The CGM recalibrated. She did not treat because she did not need to.

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She was always taught to check a fingerstick before treating. She was glad she was taught that. Had she not checked she may have had to deal with a high glucose level later.

Lessons Learned:

  • Technology helps, but it needs human input.
  • CGM’s accuracy may have proved to be accurate enough to treat from, but experience tells us each person responds differently, and accuracy can vary from person to person.
  • If symptoms don’t match readings, perform a fingerstick.
  • My recommendation is to continue to perform a fingerstick before treating, even though some say one does not have to.

Double diabetes: watch out for ketoacidosis with some drug combinations

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The use of adjuvant drugs for obese, insulin resistant type ones is increasing. What can you expect from therapy with some of the newer add on drugs? This article in Diabetes in Control tells you.

Type I Diabetes Mellitus: A Triple Therapy Approach

Diabetes management strategies have evolved since the discovery of newer oral agents that provide glycemic control through various pathways. Type 1 diabetes mellitus treatment has changed from traditional insulin regimens to incorporating other agents for improving glycemic control.

Maintaining adequate glycemic control and preventing end-organ damage is of utmost importance when managing diabetes. Uncontrolled blood glucose levels can lead to retinopathy, neuropathy, and nephropathy, which affects overall quality of life in our patients.

Due to these effects and the increased rate of uncontrolled A1c levels in patients with type 1 diabetes, various researchers have devised various treatment approaches for these patients. Recent research efforts have looked into the benefits of SGLT-2 inhibitors and their effect on cardiovascular events and mortality.

Matteo Monami et al., have looked into the benefits of these agents in patients with type 2 diabetes in the EMPAREG OUTCOME study. The findings from this research study highlight the benefit from SGLT-2 inhibitor use.  Their use in T2DM was found to reduce the risk of all-cause mortality, cardiovascular mortality, and myocardial infarction, but there was no increase in the risk of stroke. These findings can also provide similar benefits in type 1 diabetes patients; however, more studies are needed to provide stronger evidence.

Previous studies with other SGLT-2 inhibitors (i.e. canagliflozin) showed an increased incidence of diabetic ketoacidosis (DKA) in T1D patients. The incidence of DKA is thought to be associated with an increase in glucagon and free fatty acids that induces insulin resistance, which can also predispose to renal complications.

Conversely, a recent study showed improvements in renal functions in patients taking dapagliflozin through reductions in ischemia and hypoperfusion. These findings are not seen in patients taking liraglutide due to suppression of ketogenesis.

Recently, Nitesh Kuhadiya and colleagues expanded on the use of SGLT-2 inhibitors in type 1 diabetes patients. In this randomized clinical trial, researchers looked at the reduction in glycemia and body weight when adding dapagliflozin to an insulin and liraglutide regimen. Researchers hypothesized that the addition of dapagliflozin to an insulin and liraglutide regimen would provide improvements in glycemia without leading to increased concentrations of glucagon and other ketosis mediators.

Eligible patients were enrolled based on the following characteristics: 18-75 years of age with type 1 diabetes, fasting C-peptide of <0.1nmol/L, on any insulin regimen for more than 12 months with or without history of DKA. All patients had an A1c of <9.2% and were knowledgeable on carbohydrate counting. Additionally, patients needed to be on liraglutide therapy for at least 6 months prior to the start of the trial. 30 patients were assigned in a 2:1 ratio to receive either dapagliflozin 10 mg or placebo for 12 weeks. Consistency of carbohydrate content was documented by a dietitian.

The primary end-point of the study was a change in mean A1c after 12 weeks of dapagliflozin. Each patient’s body weight, systolic blood pressure, carbohydrate intake, and ketosis mediators were measured throughout the study as secondary endpoints. 26 patients completed the study, out of which only 17 were part of the intervention group. Those in the intervention group received dapagliflozin 5 mg daily for one week followed by 10 mg daily for 11 weeks. All insulin doses were targeted to 3.8-8.8 mmol/L.

At the end of the study it was found that triple therapy with liraglutide, insulin, and dapagliflozin decreased A1c by 0.66% when compared to placebo (~0.1%) (p <0.01 vs placebo). No severe hypoglycemic episodes were reported even when weekly glucose concentrations fell by 0.83 + 0.33 mmol/L in patients receiving triple therapy; no significant changes observed in the placebo group (P< 0.05 vs baseline; P=0.07 vs placebo).

When looking at the effects of this regimen and body weight, it was observed that body weight fell by 1.9 + 0.54 kg in the triple therapy group (P<0.05 vs placebo). Furthermore, there was a significant increase in ketosis mediators. It was also seen that total cholesterol and LDL-C level increased by 6% and 8%, respectively. Blood pressure readings remained unchanged in both groups.

In conclusion, a significant decrease in A1c and weight can be obtained by incorporating dapagliflozin for type 1 into an insulin and liraglutide regimen. However, special consideration should be taken when utilizing this approach due to an increase in ketosis mediators that can predispose patients to develop DKA.

Practice Pearls:

  • Triple therapy with dapagliflozin, insulin, and liraglutide reduces blood glucose levels without increasing the risk of hypoglycemia.
  • Weight reduction and A1c reduction can be obtained in type 1 diabetes patients while providing cardiovascular and renal protection properties, however closer monitoring is warranted due to increases in cholesterol and LDL-C.
  • Frequent monitoring should be implemented when utilizing this triple therapy approach due to an increase in glucagon, free fatty acids, and other mediators of ketosis predisposing to DKA.

Researched and prepared by Pablo A. Marrero-Núñez – USF College of Pharmacy Student Delegate – Doctor of Pharmacy Candidate 2017, reviewed by Dave Joffe, BSPharm, CDE

References:

Chang, Yoon-Kyung, Hyunsu Choi, Jin Young Jeong, Ki-Ryang Na, Kang Wook Lee, Beom Jin Lim, and Dae Eun Choi. “Dapagliflozin, SGLT2 Inhibitor, Attenuates Renal Ischemia-Reperfusion Injury.” PLOS ONE PLoS ONE 11.7 (2016). Web

Kuhadiya, Nitesh D., Husam Ghanim, Aditya Mehta, Manisha Garg, Salman Khan, Jeanne Hejna, Barrett Torre, Antoine Makdissi, Ajay Chaudhuri, Manav Batra, and Paresh Dandona. “Dapagliflozin as Additional Treatment to Liraglutide and Insulin in Patients With Type 1 Diabetes.” The Journal of Clinical Endocrinology & Metabolism (2016). Web.

Monami, Matteo, Ilaria Dicembrini, and Edoardo Mannucci. “Effects of SGLT-2 Inhibitors on Mortality and Cardiovascular Events: A Comprehensive Meta-analysis of Randomized Controlled Trials.” Acta Diabetol Acta Diabetologica (2016). Web.