Sep 3, 2017 | Healthy Tips
GOOD’ HABITS TO GIVE UP FOR TYPE 2 DIABETES
You know managing type 2 diabetes isn’t just about taking medicine. So you’ve been trying to make better food and lifestyle choices. But figuring out what’s healthy and what isn’t can be confusing.
Take these habits. They may seem like they’re good for you, but they could actually be sabotaging your efforts.
- Buying “sugar-free” foods
The supermarket is full of things that appear to be diabetes-friendly because they don’t have added sugar. But many have sugar substitutes that contain carbs. That means they have the potential to send your blood sugar levels soaring.
Before you put something in your cart, check the nutrition facts to see how many grams of carbs are in each serving and how much sugar is added.
- Swapping meals for meal replacement bars
Losing weight can help, and meal replacement bars may seem like an easy way to slim down.
Many meal replacement products are aimed at athletes. So they can be high in calories. Others contain ingredients like sugar alcohols (sorbitol and mannitol, for example), which can cause stomach trouble.
Occasionally, munching on a bar for breakfast when you’re pressed for time is OK as long as you pay attention to the nutrition info. But it’s smarter to stick with real meals.
- Loading up on vitamins and supplements
A diet with lots of fruits and vegetables should give you all the nutrients you need. A multivitamin may help fill in the gaps, but it still can’t match the real thing — food.
Some people take supplements like cinnamon or chromium to try to keep their blood sugar levels stable. It’s unclear whether these work. If you choose to try them — or any supplement — tell your doctor. He can make sure it’s safe for you and won’t interact with any medication you’re taking.
- Drinking juice
Natural doesn’t always equal healthy. One cup of apple juice, for example, has 25 grams of sugar and just 0.5 grams of fibre.
An apple, on the other hand, has less sugar (19 grams) and more fibre (4.5 grams). It will satisfy you longer and help stabilize your blood sugar. What’s more, a study found that drinking juice every day increases the risk of developing diabetes. But regularly eating whole fruit lowers it.
- Downing diet soda
It may be calorie-free, carbohydrate-free, and sugar-free, but you can still overdo it. One study found that overweight people who rely on diet soda end up taking in more calories from food. Why? Diet-drink lovers may think they’re “saving” calories on drinks and can afford to splurge on food. Artificial sweeteners also confuse your body because they taste sweet but don’t provide calories.
If you’re craving a cola once in a while, it’s fine to treat yourself. But you should usually fill your glass with water and other unsweetened beverages like plain iced tea.
- Avoiding all high-fat foods
A little fat is good for you, assuming you choose the right kinds. You should limit saturated fats (found in meat and dairy products) and avoid trans fats completely. But monounsaturated and polyunsaturated fats are healthy.
In fact, certain high-fat foods seem to have benefits for people with diabetes. Eating nuts along with higher-carb foods may help prevent blood sugar levels from going up too sharply. Other studies have shown that people who eat avocados are less likely to get metabolic syndrome. That’s a cluster of symptoms that includes high blood sugar.
Just remember to keep portion sizes small. The calories can add up quickly.
- Nibbling on 100-calorie snack packs
Many people open pack after pack because each one seems so tiny. They end up eating more than if they started with a “regular” container. In one study, people who were given nine small bags of chips ended up eating almost twice as much as those who were given two large bags.
So be honest with yourself: Can you really stop after one? If not, put the box back on the shelf.
Reviewed by Michael Dansinger, MD on January 07, 2017
Sep 3, 2017 | Healthy Tips
ARE YOUR BLOOD SUGARS OUT OF CONTROL? SIGNS TO LOOK FOR
You Don’t Check Your Blood Sugar
People with type 2 diabetes can often keep their blood sugar levels under control with diet, exercise, and medicine. But unless you check your blood sugar level every day with a meter, you won’t have the most accurate results. Any person with diabetes can benefit from checking their blood sugar. And when you track your results in a log, your doctor can tell how well you’re responding to your treatment plan over time.
You’re Thirsty, and You Have to Go
Thirst and frequent urination are two classic diabetes signs caused by too much sugar in your blood. As your kidneys work harder to filter out the sugar, they also pull more fluids from your tissues, which is why you have to go to the bathroom more often than usual. Thirst is your body’s way of telling you it needs to replenish the liquids it’s losing. If you don’t drink more fluids, you can dehydrate
You’re Wiped Out
Fatigue is another signal that your blood sugar isn’t under control. When sugar is staying in your bloodstream instead of being diverted to your body’s cells, your muscles don’t get enough fuel to use for energy. You might feel only a little tired, or your fatigue might be so bad that you need a nap. Sometimes people with diabetes feel especially tired after eating a big meal.
The Room Is Spinning
Feeling dizzy or shaky can be a sign of low blood sugar or hypoglycaemia. Because your brain needs glucose to function, a drop in blood sugar can be dangerous — even life-threatening — if you don’t address it. A glass of fruit juice can bring up your blood sugar in the short term. But if you’re regularly feeling shaky, talk to your doctor. You may need to adjust your medications or diet.
Your Hands and Feet Swell
If you have high blood pressure as well as diabetes, the two conditions can damage the kidneys’ ability to filter wastes and fluid over time. As water builds up in your body, your hands and feet may swell — a warning sign that you may have kidney disease. You can preserve the kidney function you have by taking your diabetes and blood pressure medicines as prescribed. Diet changes may help. Work with a nutritionist to keep your blood sugar under control.
You Have Numbness or Tingling
Nerve damage (called peripheral neuropathy) can be another sign of chronically elevated blood sugars. It results in numbness or tingling in your hands and feet, or inability to feel pain or temperature changes. See your podiatrist for regular foot exams. People with neuropathy may not realize they have been injured from a cut or that a wound is becoming infected. Or they may be oversensitive to pain. They might experience severe and constant pain from otherwise painless stimulation.
You Have Stomach Trouble
Diabetes also damages the nerve that helps your stomach empty and move food smoothly through your digestive tract. When your stomach can’t empty quickly enough, a condition called gastroparesis, you may deal with unpleasant abdominal problems like diarrhoea, constipation, or incontinence. Many people also have problems eating or swallowing. Gastroparesis also can make it harder to control your diabetes.
You’re Losing Your Sight
High blood sugar and high blood pressure both can damage the sensitive structures in your eyes and threaten your vision. Diabetic retinopathy — caused by damage to the blood vessels in the eye — is the biggest cause of blindness in adults. Blurred vision, spots, lines, or flashing lights are signs that it’s time to see your eye doctor. Get your eyes checked now before your vision has a chance to deteriorate.
You’re Losing Weight
Losing unwanted pounds is always a good idea to manage type 2 diabetes. But if you’re losing weight quickly, without trying, or without doing anything different, it may be a sign that your blood sugar is too high. When your glucose is high, it gets flushed out of the body in urine, taking the calories and fluids you consume with it
You Have Recurring Infections
Frequent or recurring infections are sometimes a sign of high blood sugar. You might experience gum disease, urinary tract infections, bacterial or fungal infections of the skin, or if you’re a woman, yeast infections. Other infections might include pneumonia and respiratory infections, kidney and gallbladder infections, and severe bacterial middle ear and fungal sinus infections.
Cuts and Bruises Won’t Heal
If your blood sugar isn’t well controlled, you might find that cuts and bruises are slow to heal. Tending to injuries, however small, is important because it reduces the risk of infections in people with diabetes. Infections themselves can also worsen blood sugars, which makes it even harder for your immune system to fight off the infection.
Keep Control
Don’t panic about diabetes complications — try to avoid them by carefully following your doctor’s treatment plan. Take your medicine, eat a healthy diet, and exercise to keep your blood sugar levels in check. Use your meter to test your blood sugar so you know that it’s staying in the recommended range. An A1C test at least twice a year will give you a good snapshot of your blood sugar control over time.
When to Call Your Doctor
Any new or unusual symptoms are worth making a call to your doctor. Call if you feel dizzy or your blood sugar drops, or if you have severe symptoms like uncontrolled vomiting, dizziness, numbness or tingling, or blurred or double vision that doesn’t go away. Also, call if you’re having trouble controlling your blood pressure on your own.
Sep 3, 2017 | Healthy Tips
12 TIPS TO AVOID DIABETES COMPLICATIONS
Choose Carbs Carefully
Diabetes doesn’t mean you have to cut carbs completely. Choose carbohydrates that break down in the body slowly, providing steady energy. Reach for whole grains, beans, nuts, and fresh vegetables and fruits. Yes, you can eat fruit even though it’s sweet. It’s about eating the right amounts of carbohydrates at each meal. A registered dietitian can help you learn how much is right for you.
Lose Weight If You Need To
Start small. If you are overweight, shedding just a few pounds can improve the body’s ability to use insulin. It’ll help lower your blood sugar and improve your blood pressure and blood fats. You’ll also have more energy. Ready? Aim to burn more calories than you eat. To start, try cutting excess fat, sugar, and calories from your diet.
Get Enough Sleep
Getting too much or too little sleep can increase your appetite and cravings for high-carb foods. That can lead to weight gain, increasing your risk for complications such as heart disease. So shoot for seven or eight hours of sleep a night. If you have sleep apnea, treating it can improve your sleep and lower your blood sugar levels.
Be Active: Exercise and Diabetes
Pick something you like — walking, dancing, biking, or just marching in place while you’re on the phone. Do it a half-hour a day; work up to that if you need to. Exercise can help you lower your cardiovascular risks, cholesterol, and blood pressure levels, and keep your weight down. Exercise also relieves stress and may help you cut back on diabetes medication.
Monitor Your Blood Sugar Daily
You know you’re supposed to check it. And actually checking your blood glucose levels can help you avoid diabetes complications, like nerve pain, or keep them from getting worse. Checking it can also help you see how foods and activities affect you, and if your treatment plan is working. Your doctor can help you set a target glucose level range. The closer you get to your target, the better you’ll feel.
Manage Stress
When you have diabetes, stress can cause your blood glucose levels to rise. Get rid of whatever physical or mental stresses you can. Learn coping techniques to deal with others. Relaxation techniques such as breathing exercises, yoga, and meditation may be especially effective if you have type 2 diabetes.
Say No to Salt
Reduce the salt in your diet. It may help lower blood pressure and protect your kidneys. Not salting the food on your plate may not be enough. Most of the salt in Americans’ diets comes from processed foods. Avoid convenience foods and use fresh ingredients when you can. Season with herbs and spices instead of salt when you cook.
Adults age 51 and older, and individuals with high blood pressure, diabetes, or chronic kidney disease should talk with their doctor about how much to reduce their sodium intake. In general, people with diabetes should decrease to less than 2,300 mg per day, however, your doctor may recommend lower amounts.
Heart Disease Risk and Diabetes
Heart disease can be a serious diabetes complication. Keep an eye on your risk by getting these ABCs checked:
A1C level. This is a measure of your average blood sugar control for the last 2-3 months. You may need it checked two or more times a year. Talk to your doctor about setting a goal.
Blood pressure. Goal: below 140/80 mm Hg.
Cholesterol. Goal: LDL to 100 mg/d or less; HDL above 40 mg/dl in men and greater than 50 in women; and triglycerides below 150 mg/dl.
Take Care of Bumps and Bruises
Diabetes raises your risk of infection and slows healing, so treat even simple cuts and scrapes quickly. Properly clean your wound and use an antibiotic cream and sterile bandage. See a doctor if it’s not better in a few days. Check your feet every day for blisters, cuts, sores, redness, or swelling. Moisturize them to prevent cracks.
Break Your Smoking Habit
People with diabetes who smoke are two times more likely to die prematurely than those who don’t. Quitting helps your heart and lungs. It lowers your blood pressure and risk of stroke, heart attack, nerve damage, and kidney disease. Ask your doctor about help for quitting tobacco.
Pick Super Foods, Don’t Supersize
There’s no single diabetes diet. But here are basics to keep in mind: Enjoy super foods like berries, sweet potatoes, fish with omega-3 fatty acids, and dark green, leafy vegetables. Look at food labels and avoid saturated fat and trans fats. Instead, opt for mono and polyunsaturated fats like olive oil. A registered dietitian can give you personalized advice.
Set Up Doctor Visits
Expect to see your doctor two to four times a year. If you take insulin or need help balancing your blood sugar levels, you may need to visit more often. Also get a yearly physical and eye exam. You should be screened for eye, nerve, and kidney damage, and other complications. See a dentist twice a year. And be sure to tell all health care providers that you have diabetes.
Aug 26, 2017 | Healthy Tips
DIABETES COMPLICATIONS: WHAT YOU CAN DO
When diabetes gets out of control, it can take a toll on your body. Too much sugar in your blood can damage nerves and blood vessels, which can lead to many different types of problems.
But those complications aren’t set in stone for everyone with diabetes — there’s a lot you can do to avoid them. Along with treatment, good health habits can help you keep your disease under control and keep other troubles at bay.
What Diabetes Can Do
High blood sugar can impact different parts of your body:
Eyes. Diabetes raises your odds of having vision problems, including blindness. It can cause:
• Cataracts. The lens of your eye gets cloudy.
• Glaucoma. This damage to the nerve that connects your eye to your brain keeps you from seeing well.
• Retinopathy. This involves changes to the retina in the back of your eyes.
Heart. Years of high blood sugar may harm your body’s blood vessels. That raises your chance of having heart disease, which can cause heart attacks or strokes later on. High blood pressure and high cholesterol make the problems even more likely.
Kidneys. Diabetes can affect blood vessels in your kidneys, too, so they may not work as well. After many years of trouble, they might stop working.
Feet. High blood sugar can harm blood flow and damage nerves, and that may cause cuts, scrapes, or sores to heal slowly. You may lose some feeling in your feet, which keeps you from noticing injuries that can get infected. If an infection gets serious, it might mean you need to have a foot removed.
Nerves. If high blood sugar damages your nerves, called diabetic neuropathy, you might feel pain, tingling, or numbness, especially in your feet.
Skin. Diabetes may make you more likely to have yeast infections, itching, or brown or scaly patches.
Erection problems. Men with diabetes may be at risk for sexual problems because high blood sugar can harm blood flow and damage nerves that the body needs to get and keep an erection.
Aug 26, 2017 | Healthy Tips
4 WAYS TO ENGAGE HYPERTENSIVE PATIENTS
Jerry Penso, MD, MBA – Chief Quality and Medical Officer at the American Medical Group Association
Medical professionals have known about the risks of poorly controlled hypertension for over a century and effective treatments have been available for more than 50 years. Yet according to the Centres for Disease Control and Prevention, less than half of the 68 million American adults with hypertension have their condition under control, and nearly 20 percent are unaware they have it.
Blood pressure control has been challenging mainly because it is a “silent” condition in terms of physical symptoms. For this reason, patients may not adhere to recommended medication or lifestyle regimens, physicians may not treat hypertension as an urgent issue, and the disease may not get the public attention that other diseases receive.
Our current health system is also primarily designed to address acute medical problems, not chronic conditions that require team-based, longitudinal care with advanced information technology and patient-centred care.
To address hypertension and other pressing chronic conditions, the American Medical Group Foundation (the non-profit research arm of the American Medical Group Association) has launched a multi-year initiative, the Chronic Care Challenge. This program leverages best practices in disease management and population health. Measure Up/Pressure Down, the program’s first campaign brings together nearly 150 medical groups and health systems to achieve a goal of 80 percent of patients in control of their high blood pressure by 2016.
Groups across the nation, including Cleveland Clinic, Geisinger Health System, Kaiser Permanente and Mayo Clinic, are implementing up to eight evidence-based care processes that were developed by the campaign to achieve this aim. These processes have been proven to work in healthcare settings and have resulted in successful improvement rates among groups.
Medical practices and health systems of all sizes can easily implement these campaign strategies to identify and engage hypertensive patients. Following are some of the methods that Measure Up/Pressure Down’s participating medical groups around the country are using to improve control rates among their patients:
1. Retrain direct care staff in accurate blood pressure measurements
Studies show that every day, hundreds of patients with hypertension visit their doctor’s office and leave without having the disease diagnosed or addressed. To properly identify hypertensive patients, direct care staff must be trained in accurate blood pressure measurement. This training, as well as annual certifications, should cover techniques for patient positioning, selection of cuff size, obtaining a valid blood pressure measurement, recording it accurately and reporting abnormal results. For example, Cornerstone Health Care in North Carolina has developed two training videos to demonstrate the differences between accurate and inaccurate techniques for its team members. Additional topics to address during training sessions may include knowledge of proper techniques and different types of observer biases, processes to properly maintain and calibrate equipment, and interpretation of measurements including an understanding of the variability of blood pressure depending on the time of day, exercise and timing of medications.
2. Keep track and reach the patients most in need of care
Effective care for chronic illness is virtually impossible without information systems that ensure ready access to key data on individual patients as well as populations of patients. A comprehensive clinical registry can enhance the care of individual patients by providing timely reminders for needed services, with summarized data used to track and plan care. At the practice level, a registry can identify groups of patients needing additional care and facilitate performance monitoring. Populated with electronic health records (EHRs), registries can provide: patient lists for specific conditions; decision support tools at the point of care to make providers aware of a patient’s hypertensive status and recommended care; exemption reports to identify hypertensive patients not meeting management goals which can be used to drive patient outreach efforts; and progress reports examining provider, staff and site performance.
Summit Medical Group, a physician-owned multispecialty practice in New Jersey, uses its EHR to develop these patient lists. On a monthly basis, color-coded lists are disseminated internally to indicate the blood pressure control of individual patients. Physicians and staff use these documents to conduct targeted outreach, schedule screenings, and appointments and re-engage patients in their care.
3. Begin engagement from the office door
Office visits provide multiple opportunities to educate patients about hypertension. Practices participating in the Measure Up/Pressure Down campaign incorporate blood pressure control into each of these patient encounters:
Check-in. As patients update medical records and insurance information, they also fill out a questionnaire to help identify blood pressure knowledge, goals and barriers that can inform the provider-patient conversation.
Waiting room. Educational materials in the waiting room cover topics related to blood pressure including lifestyle changes and medication adherence. Many groups also broadcast blood pressure-specific videos and public service announcements on waiting room televisions, while others display educational resources, like the Measure Up/Pressure Down Circulation Nation: Your Roadmap to Managing High Blood Pressure patient booklet.
Exam room. Some practices, such as Colorado Springs Health Partners and University of Utah Health Care, display posters near blood pressure cuffs that showcase accurate measurement. These signs help patients understand the rationale for staff requests (e.g., if a patient doesn’t remove a jacket as requested, their blood pressure measurement will fluctuate by 10-40 mmHg), remind staff the importance of accurate measurements and empower patients to take an active role in their own health.
Post-exam. Research suggests patients may understand and retain only half of the information discussed with a provider. Groups often provide customized materials to help patients understand and share this health information. For example, patients at Billings Clinic receive the “Your Blood Pressure Report Card” at each visit, which includes highlighted patient data from the EHR (including recent blood pressure readings, arm circumference, and weight measurements) as well as lifestyle goals and actionable tips.
4. Engage patients outside the office
The true test of engagement and adherence is when patients leave the doctor’s office and manage their conditions on their own. It is crucial to first determine the extent to which individual patients understand hypertension and how involved they want to be in their self-management.
For patients who are willing and able to plan and take action, practices and groups have implemented:
Home blood pressure monitoring. ThedaCare Physicians, a community health system in Wisconsin, equips patients with free home blood pressure monitors. Patients learn tips for accurate readings, measure and record blood pressure on a regular basis and share results with their provider for medication adjustments or lifestyle changes. California-based Arch Health Partners provides its patients with a wallet-sized tracking card to record readings.
Health coaches. In Iowa, Mercy Clinics, Inc. embedded health nurses into the system to work with diabetic patients (many with hypertension). Guided by patient data and chart review, coaches reached out to those with poor hypertension control and helped them manage their conditions with food diaries and one-on-one motivational coaching.
Mobile apps. Marshfield Clinic Research Foundation in Wisconsin developed the Heart Health Mobile app, which provides a quick heart health check, motivates users to obtain a more accurate assessment with blood pressure and cholesterol values and directs users to nearby locations offering affordable, convenient blood pressure screenings.
Learn more about these evidence-based care processes, and discover what medical groups and health systems are doing to achieve progress in improving hypertension rates from their success stories. In addition, all tools mentioned here are available for free in the Measure Up/Pressure Down Provider Toolkit.
Jerry Penso, MD, MBA, is chief quality and medical officer at the American Medical Group Association. He oversees quality initiatives through the American Medical Group Foundation, a 501(c)3 nonprofit, including best practices in care collaborative and the Chronic Care Challenge. Follow the campaign at @MUPDcampaign.
Aug 26, 2017 | Healthy Tips
ROLL UP YOUR SLEEVES… WHAT IS HIGH BLOOD PRESSURE AND HOW TO PREVENT IT
Did you know one in three young adults have high blood pressure? More than 32% of women! This costs the nation billions annually in direct medical expenses. The sad part is that 20% of people don’t even know they have it!
What is high blood pressure?
Blood pressure is the force that blood puts on the walls of your blood vessels as blood flows through them. This naturally rises and falls throughout your day, but when it’s high, it makes your heart work too hard. Like the pipes in a house, your arteries can fail if they are under too much pressure… your risk of heart disease and stroke increases.
How do you prevent high blood pressure?
Eat right: Fine tune your diet… read nutrition labels, and use herbs and spices instead of salt to flavour your food!
Be active.: It only takes 30 minutes of physical activity a day to lower your blood pressure!
Reduce stress: This has a HUGE impact on your mind and body. Find healthy ways to cope with stress!
Stop alcohol
Communicate: Write down your concerns in a journal. Talk to your doctor! Ask questions.
Stop tobacco use: Every cigarette you smoke and tobacco you chew raises your blood pressure – as does second hand smoke affect your loved ones’.
Track your numbers: Check your blood pressure often. Know your numbers! Avoid doing things (like drinking coffee) before you get checked. I always make that mistake!
Manage all your health issues: High blood pressure can worsen other conditions.
Take your medication: It only works when you actually take it – every day at the same time.
Know your risks: Know what you can control – your weight, diet, activity level, tobacco and alcohol use – and can’t control – your age, gender, race, and family history.
NOTE: you can have high blood pressure and not know it! You may have heard people call it the silent killer. This is why it’s so important to have your blood pressure checked regularly.
As you probably already know, it’s incredibly easy to get your blood pressure checked, and totally painless. You can have yours checked by your doctor, and many pharmacies have free screenings throughout the year.
