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Diabetics must regulate their blood sugar. A tiny pump can be used to inject insulin through a catheter into an individual’s abdomen up to seven times an hour, as displayed by 53-year-old Bob Russell.

Diabetes—Are you at Risk?
By Mary Lou Baker
Plus: "I Survived the CIA"

Your body may be keeping an important secret from you.

Of the approximately 21 million people in the United States who have diabetes, only one-third know it. And, according to the American Diabetes Association, 41 million Americans ages 40–74 have blood sugar levels that are above normal but below the diabetic range—a condition called prediabetes.

Neal Love was one of those who had no idea he had a disease whose complications can be life threatening. Love, a local resident and the president of a nationally known special events company, enjoyed entertaining clients and friends at fine restaurants and elaborate parties. A connoisseur of fine food and wine, he took it pretty hard when his primary care physician gave him the news at age 61.

The endocrinologist to whom his primary care physician referred him pulled no punches. Love would have to drastically change his dietary habits and start to exercise regularly. For a man whose business involved a high level of stress as well as a demanding travel schedule, this was no easy assignment. “I was shocked to hear the news—and determined to take control of my life,” says Love, who had watched his diabetic stepbrother’s health deteriorate over the years as a result of ignoring his doctor’s advice.

With the support of his wife, Vickie, Love has taken dramatic steps to lose weight and incorporate exercise into his regular routine. He swims daily for an hour in the 89° salt ph-balanced therapeutic pool at a fitness club, rides a three-speed tricycle (to which he switched after back surgery), and sticks to a healthy diet. “I have learned that diet and exercise are the two keys to keeping my diabetes—and my weight—under control,” says Neil, who has gone from 350 to 250 pounds over a period of five years. “It hasn’t been easy—and we keep reminding ourselves that this is a process, not perfection,” he says.

Dr. Mitch Swartz urges people who have a risk for being diabetic to see a doctor to be screened.

Vicky enjoys telling the story of their recent “boot camp” experience at the prestigious Culinary Institute of America (CIA) in Hyde Park, New York. As a Christmas present to her husband, she enrolled them both in the CIA’s intensive 4-day Techniques of Healthy Cooking Boot Camp. Calling it “a life-changing experience,” she recommends it to anyone who needs a jump start on the journey to healthy eating.

“The CIA experience was sensational—and, above all, healthy!” says her husband, a former bon vivant whose sole remnant of his former lifestyle is a 4-ounce glass of red wine a day and whole-grain pasta every once in awhile.

Marjorie Armstrong, a registered dietitian and assistant professor at the CIA, says that about 75 percent of the students in the school’s boot camp program come because of health reasons. Most must get serious about changing their diets to combat the consequences of diabetes, heart disease, or high cholesterol. Armstrong says that many come with their partners, although a recent class was made up entirely of men whose wives had enrolled them en masse as a way to convince them that fruit, nuts, and grains are not just for sissies. “They had a lot of fun—and learned that cooking with healthy ingredients is anything but boring,” says Armstrong.

In classes ranging from thirteen to twenty participants, students start their days by donning an authentic chef’s uniform before convening for Armstrong’s 7 a.m. lecture on how carbohydrates, fats, and proteins affect the body. Then it is time for serious business, as the group breaks up into teams and starts chopping, measuring, and cooking under the direction of CIA chefs Mark Ainsworth and Mike Garnero.

“They threw us right into the fire,” recalls Vickie Love. “We prepared a complete meal with a deadline of noon, when our classmates and the teachers critiqued each team’s plates on the basis of taste, appearance, and calorie count. The Loves learned to make meat an accent rather than the main event on a dinner plate given eye appeal with the rainbow colors of broccoli, beets, carrots, squash, and beans. And they were taught the techniques of braising, roasting, and grilling foods to bring out their natural flavors. To satisfy her husband’s love of pasta, Vickie now substitutes spaghetti squash for the real thing and makes paella using brown rice. “No white food has become our mantra,” says Neal.

The Loves are doing all the right things for Neal’s condition, according to Pat Burnett, a registered nurse and certified diabetes educator who works with diabetic inpatients and outpatients at Anne Arundel Medical Center (AAMC). “Education is the best treatment in managing diabetes,” says Burnett. “The more the patient understands about his or her condition, the more willing they are to make use of the means that control blood sugar—and this means both diet and exercise.”

AAMC cardiologist Mitch Schwartz, M.D., is on high alert for diabetes symptoms in his patients and is vehement in his advocacy of diabetes screening. “If you have a risk for being diabetic, go to your doctor and ask to be screened,” he advises. “Finding out you have diabetes and doing something about it can dramatically extend life expectancy,” says Dr. Schwartz. He defines people at high risk for diabetes as those who are overweight, have a sister, brother or parent with diabetes; get little or no exercise, are over the age of 45 and are of African-American descent.

Burnett says that approximately sixty people a month are referred to AAMC’s Diabetes Center for treatment after they are diagnosed. Burnett, a registered dietitian with special training in diabetes, and a pharmacist team up to provide nutritional counseling as well as information on what each patient should do to avoid the unpleasant complications and consequences of diabetes that gets out of control.

Spouses and other family members are encouraged to attend educational sessions at the Diabetes Center as well as the monthly support group held on the fourth Wednesday of each month. “It is important that the patient’s spouse understand the condition and how critical it is to follow a consistent program of diet and exercise,” says Burnett. “They have to be aware of the carbs and fats in food and get in the habit of reading product labels. With diabetes, it’s not just a matter of taking a pill—it’s up to the patient to make lifestyle changes that will prevent serious complications.”

Complications of diabetes can involve stroke, heart disease, kidney problems, ruptured blood vessels in the eyes, and slow healing of sores on the body. Burnett recommends that patients get yearly exams of their feet as well as their eyes. “When they go to their primary care physician for an exam, and take their shoes off to weigh in, they should leave those shoes off and have their feet checked.” Burnett says she found her niche while working with diabetes patients at Georgetown Hospital before she joined AAMC. “We are passionate about what we do here,” she says.

Kashif Munir, MD, is the lead endocrinologist at the Joslin Diabetes Center at Baltimore Washington Medical Center in Glen Burnie. The center has just moved to its own building near the hospital and sees as many as 120 new patients a month. “Patient education is a huge component of our program,” says Munir. The center has three endocrinologists as well as a registered dietitian and a diabetes nurse educator who work with patients.

Munir cites obesity as the major risk factor for diabetes, noting the nationwide statistics showing the majority of people in the United States are overweight. To simplify their understanding of diabetes, he tells patients to remember that if they take in more energy (food) than they use (exercise), they are putting themselves at risk.

Munir is impressed with the technological strides that make it easier to monitor and control a patient’s insulin level. A real-time sensor on a patient’s stomach can now graph out the patient’s blood sugar levels and be easily read on a screen attached to the sensor. This kind of sophisticated monitoring is a far cry from the old days, when frequent urination was often the only symptom of diabetes—and without the efficiency of the tests now available sugar in urine could be detected only by actually tasting the patient’s urine.

But despite the strides in detection, the most sensible approach to controlling diabetes is to “stay active and eat right,” says Munir. He and his fellow endocrinologists Nanette Steinle, MD, and Kathleen Prendergast, MD, work as a team with certified diabetes nurse educators and registered dietitians to provide a multidisciplinary approach that helps patients control their blood sugar level, optimize their quality of life, and prevent or minimize the complications of diabetes.

With diabetes, medical intervention is not the answer. Self-discipline and determination on the part of the patient seem to be the keys to controlling a disease that has become the “evil twin” of obesity. Francine R. Kaufman, MD, head of the Center for Diabetes and Endocrinology at Children’s Hospital in Los Angeles, calls the phenomenon “diabesity” and believes that dramatic changes must be made in schools, workplaces and communities to control the epidemic. “In this way, we can live and grow old with a normal weight, a normal blood sugar, and the chance to be healthy.”

Neal and Vicky Love made a decision to take that path—with no detours in sight.

I Survived the CIA Boot Camp By Mary Lou Baker Chef Michael Garnero and Chef David Karmen instruct students Intrigued by the description of Neal and Vicky Love’s lifestyle-changing experience at the Culinary Institute of America’s (CIA’s) Techniques of Healthy Cooking Boot Camp, I traveled to the CIA campus in Hyde Park, New York, to get an inside look. As one of twelve students, from California, Texas, Ohio, Massachusetts, and New York, I participated in an intensive 4-day quest for the scoop on preparing foods that promote better health for people with diabetes, obesity issues, and heart conditions—and everyone else. Registered dietitian Marjorie Armstrong shared her broad knowledge of nutrition in daily lectures and chef Michael Gardero guided us through the preparation of full-course meals chosen specifically for their healthy attributes. It was there that I first met a Daikon radish, made buckwheat polenta, experimented with a variety of grains, and discovered that a strict high-protein diet can leach calcium from your bones. We also learned to do these things: Think of meat, poultry and fish as a garnish “Remember the rainbow”: use a variety of vegetables to create an appealing plate Avoid artificially colored farm-raised salmon and go for the wild Stick to the perimeter of the supermarket; that’s where the healthy foods are Become an avid reader of labels to check the sodium, sugar, carb, and fat content of a product Invest in a good sauté pan with sloping sides; use a minimum of olive oil (a spray will do) to coat the bottom for cooking just about anything; and deglaze the pan with wine, stock, or water to make a sauce. Boot Camp class in CIA's Continuing Education department Since returning to the comfort of my own stove (those at the CIA were huge), I have had e-mail from several fellow boot campers. “Am throwing my first post-Boot Camp dinner party. Menu includes tangerine spinach salad, prosciutto and figs, watermelon/feta/mint salad and roasted pork loin with either mustard or blueberry sauce.” A reformed New Yorker says “I am no longer such a big carnivore . . . making quinoa, brown rice, Cuban style beans and other whole grains with stock and exotic seasonings.” For more information on the CIA Healthy Cooking Techniques Boot Camp, go to www.ciachef.edu or call Jay Blotcher at (845) 905-4419. Celebrating the 60th anniversary of its founding, the CIA, the nation’s premier culinary college, is located in Hyde Park, New York, a little more than 5 hours from Annapolis.

Mary Lou Baker is a freelance writer who writes frequently for What’s Up Annapolis about health issues.