Recipe of the Week: Carrots Marsala

This side dish is perfect paired with an Italian main dish.

Serves 6, Serving Size 1/2 cup

10 carrots (about 1 lb.), peeled and diagonally sliced

1/4 cup Marsala wine
1/4 cup water
1Tbsp. olive oil
Fresh ground pepper
1 Tbsp. fresh parsley

1. In a large saucepan, combine carrots, wine, water, oil, and pepper.
2. Bring to a boil, cover, reduce the heat, and simmer for about 10 minutes, basting occasionally.
3. Transfer to a serving dish, spoon juices on top, and sprinkle with parsley.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Foot Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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Life With Diabetes: Interview With Paula Deen

From Cooking With Paula Deen, May/June 2012
Q: What first went through your mind when you were diagnosed, and why did you wait so long to announce it to your fans?
A: Any diagnosis from a doctor takes a while to set in. You know, you have to learn how to live with it. I had agoraphobia for 20 years until I was able to overcome it, so I felt pretty good that it only took 2 1/2 years to deal with this new diagnosis. I talked with Michael, Jamie, Bobby, my doctor, and those close to me first. But for my fans, I wanted to bring them a solution, not just walk out and say, "Hey y'all, I have diabetes." When I got to know the folks at Novo Nordisk and we developed Diabetes in a New Light, I knew that I had a great solution to share with my fans.
Q: So many have accused you of being of a hypocrite because you promote "over-the-top" recipes. What would you like to say to those critics?

A: I don't have anything to my critics, just to my fans, who have been amazing. To them I say, "I love y'all so much." My "over-the-top" recipes have never been meant to be eaten every day, and for the most I talk about how they should be enjoyed at special occasions or in moderation. After all, when Jamie was little and allergic to peanuts, I wouldn't send him over to a friend's house and tell the parent that their kid couldn't eat peanuts. We all have to measure what we eat for our own diet because every one of us is different.
Q: How are the recipes in your magazine going to change?
A: I am going to continue the Southern cooking traditions that my family has passed down to me and still cook that comfort food that we all love. But I am going to add versions of the recipes so those who need something a little different can still enjoy them. Look at the great versions of my recipes that Bobby has created in his magazine column, Bobby Lightens It Up, and is sharing on his show, Not My Mama's Meals. Here's the thing, I've always encouraged moderation. And for those special events like holiday parties or family reunions when you want a showstopping recipe, Cooking With Paula Deen will give you plenty of options for the occasion.
Q: You have had such a positive attitude in the midst of the press storm. What has been most disappointing or bothersome since your diagnosis?
A: I've lived my life overcoming challenges and have seen how that has inspired my boys, Michael, and my fans. I'm really not disappointed, but actually happy that I have lived long enough to deal with issues like my health and similar challenges, which millions of Americans face daily. I hope I can inspire these folks to move their lives forward.
Q: How have you changed your lifestyle since your diagnosis?
A: My lifestyle, like everyone else's changes constantly, and I work with my doctor to ensure that I stay healthy. I have always eaten in moderation, but you know, people see me on TV two or three times a day cooking all these wonderfully Southern, fattening dishes. In reality, that's only 30 days out of 365, and it's for entertainment. People have to responsible for themselves.
Q: Since you'll still offer readers decadent recipes for entertaining and special occasions, where in the magazine are readers likely to find recipes more wholesome and light?
A: You'll find my lighter recipes throughout the magazine. The column Bobby Lightens It Up shares satisfying healthier versions of traditional dishes, while sections like Paula's Weekly Five and Jamie's Family Table offer wholesome recipes for ordinary days, when it's important to eat good food that tastes great, too.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Foot Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

Why Do My Feet Tingle? Diabetic Peripheral Neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs, and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.
Three groups of nerves can be affected by diabetic neuropathy:

• Sensory nerves, which enable people to feel pain, temperature, and other sensations
• Motor nerves, which control the muscles and give them their strength and tone
• Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating.

Diabetic peripheral neuropathy doesn't emerge overnight. Instead, it usually  develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy.
The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even life.
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can develop diabetic peripheral neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.
As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers. For example:

• Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a sore. The numbness caused by sensory neuropathy can make the patient unaware that this is happening. 
• Because of numbness, a patient may not realize that he or she has stepped on a small object and cut the skin.
• Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy's numbness and problems associated with motor neuropathy can lead to developing a sore. 

Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.
For sensory neuropathy:

• Numbness or tingling in the foot
• Pain or discomfort in the feet or legs, including prickly, sharp pain, or burning feet

For motor neuropathy:

• Muscle weakness and loss of muscle tone in the feet and lower legs
• Loss of balance
• Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:

• Dry feet
• Cracked skin

To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient's history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient's reflexes, ability to feel light touch, and ability to feel vibration. In some cases, additional neurologic tests may be ordered.
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient's blood sugar level. In addition, various options are used to treat the painful symptoms.
Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.
In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:

• Keep blood sugar levels under control. 
• Wear well-fitting shoes to avoid getting sores.
• Inspect your feet everyday. If you notice any cuts, redness, blisters, or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse. 
• Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
• Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes. 

Richard E. Ehle, DPM
Diabetic Foot Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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Recipe of the Week: California Chopped Salad

8 servings
Serving Size: 1 cup
Preparation Time: 20 minutes

Salad
1 medium cucumber, peeled, halved, seeded, and diced
1 medium red pepper, diced
1 medium yellow pepper, diced
2 medium carrots
5 medium plum tomatoes, diced
2 scallions, thinly sliced
4 cups fresh spinach leaves or other greens
Salt and pepper to taste

Dressing
1 Tbsp. lemon juice
1 Tbsp. white vinegar
2 tsp. Dijon mustard
1 garlic clove, minced
3 Tbsp. olive oil

1. In a large bowl, combine the cucumber, red pepper, yellow pepper, carrots, plum tomatoes, and scallions. On a serving platter or in a serving bowl, place the spinach leaves or other desired greens. Set aside.
2. Whisk together the lemon juice, white vinegar, Dijon mustard, and garlic. Slowly add the oil, salt, and pepper and whisk well. Pour over the chopped vegetables and then turn out the chopped salad onto lettuce leaves and serve.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Foot Doctor in CT
Podiatrist in Bristol
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

What Is Charcot Foot?

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.
Charcot foot is a very serious condition that can lead to severe deformity, disability, and even amputation. Because of its seriousness, it is important that patients with diabetes- a disease often associated with neuropathy- take preventive measures and seek immediate care if signs or symptoms appear.

Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain, or trauma. Because of diminished sensation, the patient may continue to walk- making the injury worse.
People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.
The symptoms of Charcot foot may include:

• Warmth to the touch (the affected foot feels warmer than the other).
• Redness in the foot.
• Swelling in the area.
• Pain or soreness.

Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.
Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.
It is extremely important to follow the surgeon's treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.
Non-surgical treatment for Charcot foot consists of:

• Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot, or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.
• Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities- as well as help prevent recurrence of Charcot foot, development of ulcers, and possibly amputation. In cases with significant deformity, bracing is also required. 
• Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Foot Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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Randy Jackson and Taking Diabetes to Heart

When Randy Jackson was diagnosed with Type 2 diabetes in 2003, "My doctors told me that people with Type 2 diabetes have an increased risk of heart disease and stroke. This was all I needed to know to take my diabetes to heart. I made changes to my lifestyle and worked with my doctors to set goals for my blood sugar, blood pressure, and cholesterol," says Jackson. 
Adults with Type 2 diabetes are 2 to 4 times more likely to die from heart disease than adults without diabetes. The risk for stroke for those with diabetes is also 2 to 4 times more likely than those without diabetes. 
Jackson is working with Take Diabetes to Heart to stress early and effective management using the ABCs of diabetes: A1C or blood sugar, Blood pressure, and Cholesterol. Managing diabetes and cardiovascular disease go hand in hand since heart disease and stroke are complications of diabetes. By lowering cholesterol levels you can reduce your risk of those complications. You should talk with your endocrinologist about goals for your blood sugar, blood pressure, and cholesterol. 
Taking Diabetes to Heart is an educational program developed by Merck to help people suffering with Type 2 diabetes understand the disease and the serious complications, including heart disease or stroke. The program aims to empower adults with Type 2 diabetes to take their diabetes to heart by managing their blood sugar, blood pressure and cholesterol to help lower their risk for heart disease. 
Jackson is encouraging those with diabetes to pledge to better manage their disease. Those who make the pledge will have access to Jackson's personal tips and example questions to ask their doctors about ways to help manage diabetes. 

Richard E. Ehle, DPM
Diabetic Foot Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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Diabetes and Depression

It's not surprising that people who have diabetes are twice as likely to suffer from depression as those who don't. Just think of all the responsibilities that go with the disease- the monitoring, the medications, and the constant self-control. John Anderson, M.D., president-elect of medicine and science at the American Diabetes Association says, "It's a 24 hour disease. Anything that puts that type of burden on a person can increase the risk for depression."
However, it goes both ways. People who suffer from depression are 60 percent more likely to develop type 2 diabetes. A recent study from the University of Washington also found that those who have both conditions are twice as likely to develop dementia as people with just diabetes. Exact causes were undetermined, but experts guess that inflammation brought on by high levels of stress hormones may lead to insulin resistance, and in turn that damage to tiny blood vessels caused by high blood sugar might affect the brain.
So if you have diabetes and think you may be depressed, what should you do? Step one is to recognize the signs: feeling overwhelmed by daily tasks (including your diabetes care), appetite changes, unexplained ailments like back pain or headaches, and feeling sad or down.
If you're feeling depressed, be sure to see your health care provider immediately. They will give you a quick screening questionnaire and go through treatment options with you, which may including counseling, life-style modifications like exercise, or therapeutic drugs. Treating both conditions together can result in a better outcome for your blood sugar and mood.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Diabetic Doctor in CT
Podiatrist in Bristol, CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter. 

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