TAKING CARE OF YOUR DIABETES EVERY DAY

Oct 19, 2018 | Healthy Tips

STAY IN CONTROL OF YOUR DIABETES

There are four things you need to do every day to lower high blood sugar:

• Eat healthy food
• Get regular exercise
• Take your diabetes medicine
• Test your blood sugar

If you have diabetes, you should try to keep your blood sugar level as close as possible to that of someone who doesn’t have diabetes. This may not be possible or right for everyone. Check with your doctor about what the right range of blood sugar is for you.

You will get plenty of help in learning how to do this from your health care team, which is made up of your doctor, nurses, and dietitian.

Bring a family member or friend with you when you see your doctor. Ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.

Eat Healthy Food

The foods on your diabetes eating plan are the same ones that are good for everyone. Try to stick to things that are low in fat, salt, and sugar and high in fibre, like beans, fruits, vegetables, and grains.

• Eating right will help you:
• Reach and stay at a weight that is good for you
• Keep your blood sugar in a good range
• Prevent heart and blood vessel disease

Ask your doctor for the name of a dietitian who can work with you on an eating plan for you and your family. Your dietitian can help you plan meals with foods that you and your family like and that are good for you.

If You Use Insulin

• Give yourself an insulin shot.
• Eat about the same amount of food each day at about the same time.
• Don’t skip meals, especially if you’ve already given yourself an insulin shot. Your blood sugar may go too low.

If You Don’t Use Insulin

• Follow your meal plan.
• Don’t skip meals, especially if you take diabetes pills. Your blood sugar may go too low.
• Skipping a meal can make you eat too much at the next meal. It may be better to eat several small meals each day instead of one or two big ones.

Get Regular Exercise

• Being active each day is good for everyone. Good ways to do it include:
• Walking
• Swimming
• Dancing
• Biking
• Playing sports
• Cleaning your house or working in your garden count, too.
• Getting active is especially good for people with diabetes because:
• It helps keep your weight down.
• Your insulin may lower your blood sugar more easily.
• It helps your heart and lungs work better.

Exercise gives you more energy.

Before you start, talk with your doctor. If you have high blood pressure or eye problems, some exercises, like weightlifting, may not be safe. Your doctor or nurse will help you find safe exercises.

Try to exercise at least three times a week for about 30 to 45 minutes each time. If you haven’t been active in a while, ease in. Start with 5 to 10 minutes, then work up from there.

If you haven’t eaten for more than an hour or if your blood sugar level is less than 100-120, have something like an apple or a glass of milk before you exercise.

When you’re being active, carry a snack with you in case your blood sugar drops. Make sure to carry an identification tag or card that says you have diabetes.

If You Use Insulin

• Exercise after eating, not before.
• Test your blood sugar before, during, and after. Don’t exercise when it’s higher than 240.
• Avoid exercise right before you sleep. It could cause low blood sugar during the night.

If You Don’t Use Insulin

• See your doctor before starting an exercise program.
• Test your blood sugar before and after exercising if you take diabetes pills. You want it no lower than 70 or no higher than 240.

Take Your Diabetes Medicine Every Day

Insulin and diabetes pills and shots are the kinds of medicines used to lower blood sugar. These can include:

Dulaglutide (Trulicity)

Exenatide (Byetta)

Exenatide Extended Release (Bydureon)

Liraglutide (Victoza)

Pramlintide (Symlin)

Semaglutide (Ozempic)

If You Need Insulin

This is you if your body has stopped making insulin or if it doesn’t make enough. Everyone with insulin-dependent diabetes (or type 1 diabetes) needs insulin, and many people with type 2 diabetes also need it.

Insulin can’t be taken as a pill. You will have to give yourself shots every day. Some people give themselves one a day. Some people give themselves two or more a day. Never skip a shot, even if you are sick.

Insulin is injected with a needle. Your doctor will tell you what kind of insulin to use, how much, and when to give yourself a shot. Talk to your doctor before changing the type or amount of insulin you use or when you give your shots. Your doctor or the diabetes educator will show you how to draw up insulin in the needle. They’ll also show you the best places on your body to give yourself a shot. Ask someone to help you with your shots if your hands are shaky or you can’t see well.

Good places on your body for a shot are:

• The outside part of your upper arms
• Around your waist and hips
• The outside part of your upper legs
• Avoid areas with scars and stretch marks.
• Ask your doctor or nurse to check your skin where you give your shots.

At first, you may be a little afraid to give yourself a shot. But most people find that the shots hurt less than they expected. The needles are small and sharp and do not go deep into your skin. Always use your own needles, and never share them with anyone else.

Your doctor or diabetes educator will tell you how to throw away used needles safely.

Keep extra insulin in your refrigerator in case you break the bottle you’re using. Don’t keep insulin in the freezer or in hot places like your glove compartment. Also, keep it away from bright light. Too much heat, cold, or bright light can damage insulin.

If your body makes insulin but it doesn’t lower your blood sugar, you may have to take diabetes pills or some other injectable. These only work in people who have some insulin of their own. Some are taken once a day, and others are taken more often. Ask your doctor when you should take yours.

Diabetes medications are safe and easy to take. Be sure to tell your doctor if yours make you feel bad or if you have any other problems.

Remember, you’ll still have to follow an eating plan and exercise to help lower your blood sugar.

Sometimes, people who take diabetes pills may need insulin shots for a while. This may happen if you get very sick, need to go to a hospital, or become pregnant. You may also need them if the diabetes pills no longer lower your blood sugar.

You may be able to stop taking diabetes pills if you lose weight. Losing even a little bit can help lower your blood sugar.

If You Don’t Use Insulin or Take Diabetes Pills

Everyone with diabetes needs to follow their doctor’s advice about eating and getting enough exercise.

Test Your Blood Sugar Every Day

You need to know how well you are taking care of your diabetes. You need to know if you are lowering your blood sugar. The best way to find out is to test your blood. If it has too much or too little sugar in it, your doctor may need to change your eating, exercise, or medicine plan.

Some people test their blood once a day. Others do it three or four times a day. Your doctor may want you to test before eating, before bed, and sometimes in the middle of the night. Ask your doctor how often and when you should test your blood sugar.

How to Test Your Blood Sugar

You need a small needle called a lancet. You also need special blood testing strips that come in a bottle. Your doctor or diabetes educator will show you how to test your blood. Here are the basic steps to follow:

Depending on your monitoring device, prick your finger or another area of your body with the lancet to get a drop of blood.

Place the blood on the end of the strip.

Put the strip into the meter. The meter will display a number for your blood sugar, like 128.

Pricking your finger with a lancet may hurt a little. It’s like sticking your finger with a pin. Use the lancet only once, and be careful when you throw away used ones. Ask your doctor or nurse how to get rid of them safely.

You can buy lancets, strips, and meters at a drugstore. Ask your doctor or diabetes educator for advice on what kind to buy. Take your blood testing items with you when you see your doctor or nurse so that you can learn how to use them the right way.

Other Tests for Your Diabetes

Urine Tests: You may need to test your urine or blood for ketones when you are sick or if your blood sugar is over 240 before eating a meal. Your body makes ketones when there is not enough insulin in your blood. They can make you very sick.

You can buy strips for testing urine ketones at a drugstore. Also, some blood glucose meters can detect ketones with specialized strips. Your doctor or diabetes educator will show you how to use testing monitors correctly.

Call your doctor right away if you find ketones when you test. You may have something called ketoacidosis. If not treated, it can cause death.

Signs of ketoacidosis are:

• Vomiting
• Weakness
• Fast breathing
• A sweet smell on the breath

NOTE: Ketoacidosis is more likely to happen in people with insulin-dependent diabetes.

The Haemoglobin A1c Test: This shows what your average blood sugar was for the past 3 months. It shows how much sugar is sticking to your red blood cells. The doctor does this test to see what level your blood sugar is most of the time.

To do the test, the doctor or nurse takes a sample of your blood. The blood is tested in a laboratory. The laboratory sends the results to your doctor.

See your doctor for a haemoglobin A1c test every 3 months.

Keep Daily Records

Write down the results of your blood tests every day in a record book or notebook. You may also want to include what you eat, how you feel, and how much you’ve exercised.

By keeping daily records of your blood and urine tests, you can tell how well you are taking care of your diabetes. Show your book to your doctor. She can use your records to see if you need to make changes in your insulin shots or diabetes pills or in your eating plan. Ask your doctor or nurse if you don’t know what your test results mean.

Things to write down every day in your notebook are:

• If you had very low blood sugar
• If you ate more or less food than you usually do
• If you felt sick or very tired
• What kind of exercise you did and for how long

TAKING CARE OF YOUR DIABETES EVERY DAY – STAY IN CONTROL OF YOUR DIABETES

WAYS TO REDUCE YOUR RISK OF HAVING A STROKE

Oct 18, 2018 | Healthy Tips

By Mark Stibich, PhD

Controlling blood pressure and losing weight can make a difference

A study published in The Lancet called INTERSTROKE confirmed that people can reduce their risk of having a stroke by making lifestyle changes. The study found that modifiable risk factors are responsible for 88 percent of stroke risk. The excellent news here is the “modifiable” part of the equation — most of these factors can be completely avoided, or at least modified.

That’s great, you say until you look at the list. Most of us know that stopping smoking and losing weight are no-brainers for improving your health, and many of us would have done these things years ago if we knew how to go about it strategically. Learning how important lifestyle changes are for reducing stroke risk can be motivational.

Major health improvements can be made if the goals are specific, measurable, attainable, realistic and time-based, also known as S.M.A.R.T. goals for lifestyle change.

Here are the top 10 ways to cut your risk of stroke by almost 90 percent.

1. Control Your Blood Pressure

While there are medications to control hypertension (high blood pressure), lifestyle change is a key component of keeping blood pressure down. Following the DASH Diet and avoiding salt can help.

2. Stop Smoking

Smoking not only increases the risk of stroke, it is estimated to subtract 10 years from one’s lifespan. Getting tips, strategies, stories, and encouragement from people who have successfully quit smoking can be inspirational. And if that doesn’t help, consider how smoking results in premature aging.

3. Lose Weight, Especially Around Your Abdomen

You might be surprised at how easy it is to incorporate easy weight loss methods into your life. Not only can you find yourself dropping pounds, but by slowing down and being more mindful of your food, you may also find yourself enjoying meals much more.

4. Manage Your Diabetes

People with diabetes are at a higher risk of stroke than the general population. This risk is much higher when the diabetes is poorly-managed and blood glucose levels are elevated over long periods. It is important to take your diabetes seriously (even if you don’t feel “bad” from high blood sugar), which involves sticking to your treatment strategies, among other things. This will not only go a long way in reducing your risk of stroke but also will help bring down the likelihood of other complications.

5. Get Active

We know we should be exercising, but many of us simply don’t like it and when you don’t like to do something, it is very easy to find lots of excuses not to do it. Instead of starting from a place of trying to do something you simply hate to do, why don’t you wipe the slate clean and look at exercise from a new perspective? Learn to like, even love, exercise, and it will be much easier to commit to an exercise habit.

6. Improve Your Diet

There are many opinions about what exactly constitutes a healthy diet, which often leaves the average person confused to the point that they give up. However, there are some things that are pretty universal here — more vegetables, less trans fats, fewer trips through fast food restaurants.  Add fruit to increase your longevity and adopt an overall longevity diet plan.

7. Limit Alcohol, Avoid Binge Drinking

Clearly, drinking heavily is bad for your health, but much research shows that two or fewer drinks per day can be good for you, especially red wine. Any more than that starts working against you and harming your health. Heavy drinking also increases stroke risk by 45 percent and there is a link between alcohol and brain aging.

8. Improve Your Good Cholesterol

The idea here is to improve your HDL (good cholesterol) to LDL (bad cholesterol) ratio more HDL and less LDL is the idea. The goal is to have your HDL/LDL ratio above 0.3, with the ideal being above 0.4. Of course, there are medications, such as statins, that can help you do this, but there are some lifestyle changes to be made as well, even fun ones, such as eating more dark chocolate or fish.

9. Manage Heart Disease

As we age, our hearts have to adapt to our changing bodies our arteries lose flexibility, our heart walls thicken and it becomes harder for our hearts to keep up with increased demand. All of these things (and others) are made worse when we have heart diseases, such as coronary artery disease, angina or other problems that can lead to heart attacks. There are several approaches to managing heart disease, which involves medications, diet, and exercise many of the same things that will also reduce the risk of stroke.

10. Avoid Stress, Treat Depression

We know that we feel worse when we are “stressed,” but there is also significant evidence that stress impacts the frequency of negative health events, like a stroke. Depression also has serious physical consequences and can lead to victims neglecting their health.

Bottom Line

By taking steps to improve in these areas, you will no doubt feel better along the way. In addition to reducing your risk for stroke, you will also reduce your risk of heart attacks.

WAYS TO REDUCE YOUR RISK OF HAVING A STROKE

CANCER IN CHILDREN

Oct 3, 2018 | Healthy Tips

Key facts

Cancer is a leading cause of death for children and adolescents around the world and approximately 300,000 children aged 0 to 19 years old are diagnosed with cancer each year. [1]

The most common categories of childhood cancers include leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumour. [1-2]

In high-income countries, more than 80% of children with cancer are cured, but in many low- and middle-income countries (LMICs) only about 20% are cured. [2-3]

Childhood cancer generally cannot be prevented or screened.

Improving outcomes for children with cancer requires early and accurate diagnosis followed by effective treatment.

Most childhood cancers can be cured with generic medicines and other forms of treatments including surgery and radiotherapy. Treatment of childhood cancer can be cost-effective in all income settings. [2]

Avoidable deaths from childhood cancers in LMICs result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.

Childhood cancer data systems are needed to drive continuous improvements in the quality of care, and to drive policy decisions.

The problem

Cancer is a leading cause of death for children and adolescents worldwide.  In high-income countries, more than 80% of children with cancer are cured, but in many LMICs, only 20% are cured [2-3].

The reasons for lower survival rates in LMICs include an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and excess relapse, in part due to lack of access to essential medicines and technologies addressing each of these gaps improves survival and can be highly cost-effective [2-3].

What causes cancer in children?

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or a tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.

Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and other pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.

Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Ongoing research is needed to identify factors impacting cancer development in children.

Improving outcomes of childhood cancer

Because it is generally not possible to prevent cancer in children, the most effective strategy to reduce the burden of cancer in children is to focus on a prompt, correct diagnosis followed by effective therapy.

Early diagnosis

When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care. A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy.

Early diagnosis consists of 3 components:

awareness by families and accessing care

clinical evaluation, diagnosis and staging (determining the extent to which a cancer has spread)

access to treatment

Early diagnosis is relevant in all settings and improves survival for many cancers.⁶ Programmes to promote early and correct diagnosis have been successfully used in countries of all income levels, often through collaborative efforts of governments, civil society, and non-governmental organizations, with vital roles played by parent groups. Childhood cancer is associated with a range of warning symptoms that can be detected by families and by trained primary health care providers.⁶

Screening is generally not helpful for childhood cancers. In some select cases, it can be considered in high-risk populations. For example, some eye cancers in children can be caused by a mutation that is inherited, so if that mutation is identified in the family of a child with retinoblastoma, genetic counselling can be offered and siblings monitored with regular eye examination early in life. Genetic causes of childhood cancers are relevant in only a handful of children with cancer. There is no high-quality evidence to support population-based screening programmes in children.

Treatment

A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world.

However, a cure is possible for more than 80% of children with cancer, in most cases with inexpensive generic medications that are listed on the WHO List of Essential Medicines (EML). WHO EML for children, defined as those meeting the priority health care needs of the population, includes 22 cytotoxic or adjuvant medicines and 4 hormone treatments for childhood cancer. Children who complete treatment require ongoing care to monitor for cancer recurrence and to manage any possible treatment-related toxicity.

Palliative care

Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Paediatric palliative care should be appropriately considered as a core component of comprehensive care starting when the illness is diagnosed and continued regardless of whether or not a child receives treatment with curative intent.⁷

Palliative care programmes can be delivered through community- and home-based care to provide pain relief and psychosocial support to patients and their families. Adequate access to oral morphine and other pain should be provided for the treatment of moderate to severe cancer pain, which affects more than 80% of cancer patients in the terminal phase.

WHO response

In 2018, WHO launched the Global Initiative for Childhood Cancer with partners to provide leadership and technical assistance to support governments in building and sustaining high-quality childhood cancer programmes. The goal is to achieve at least 60% survival for all children with cancer globally by 2030. This represents an approximate doubling of the current cure rate and will save an additional one million lives over the next decade. The objectives are to:

Increase capacity of countries to deliver best practices in childhood cancer care

Prioritize childhood cancer and increase available funding at the national and global levels

WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to:

increase political commitment for childhood cancer diagnosis and treatment;

support governments to develop high-quality cancer centres and regional satellites to ensure early and accurate diagnosis and effective treatment for children with cancer;

develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care inclusive of the needs of childhood cancers;

improve access to affordable and essential medicines and technologies;

support governments to safeguard families of children with cancer from financial ruin and social isolation as a result of cancer care.

This initiative is part of the implementation of the World Health Assembly Resolution Cancer Prevention and Control through an Integrated Approach (WHA70.12), which urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan and 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer.

References

Steliarova-Foucher E, Colombet M, Ries LAG, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719-731.

Gupta S, Howard SC, Hunger SP, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. In: Disease Control Priorities, volume 3.  http://dcp-3.org/chapter/900/treating-childhood-cancers-low-and-middle-income-countries

Howard SC, Zaidi A, Cao X, et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol. 2018;19(5):e252-e266.

Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, et al. Germline Mutations in Predisposition Genes in Pediatric Cancer. N Engl J Med. 2015 Dec 10;373(24):2336-2346.

CANCER IN CHILDREN