Sep 6, 2018 | Healthy Tips
CAN YOU REVERSE TYPE 2 DIABETES?
By Sonya Collins; Reviewed by Michael Dansinger, MD
It sounds too good to be true: reversing type 2 diabetes through exercise and healthy eating.
While certain lifestyle changes are key to managing diabetes, whether you can actually turn back time so that it’s like you never had diabetes is a different matter. That depends on how long you’ve had the condition, how severe it is, and your genes.
Make Changes That Count
“The term ‘reversal’ is used when people can go off medication but still must engage in a lifestyle program in order to stay off,” says Ann Albright, PhD, RD. She’s the director of diabetes translation at the CDC.
Shedding extra pounds and keeping them off can help you better control your blood sugar.
For some people, reaching a healthier weight will mean taking fewer medications, or in rarer cases, no longer needing those medications at all.
Losing 5% to 10% of your body weight and building up to 150 minutes of exercise a week may help you to slow or stop the progress of type 2 diabetes.
“If you sit [inactive] most of the day, 5 or 10 minutes is going to be great,” Albright says. “Walk to your mailbox. Do something that gets you moving, knowing that you’re looking to move towards 30 minutes most days of the week.”
The Proof
In one study, people with type 2 diabetes exercised for 175 minutes a week, limited their calories to 1,200 to 1,800 per day and got weekly counselling and education on these lifestyle changes.
Within a year, about 10% got off their diabetes medications or improved to the point where their blood sugar level was no longer in the diabetes range and was instead classified as prediabetes.
Results were best for those who lost the most weight or who started the program with less severe or newly diagnosed diabetes. Fifteen percent to 20% of these people were able to stop taking their diabetes medications.
Don’t Blame Yourself
If you make changes to your diet and exercise routine, and your diabetes doesn’t improve, it’s not your fault, Albright says.
“The earlier in the course of the [condition] that you make these changes, the more likely you are to stack the deck in your favour that you won’t progress,” Albright says.
Your weight and lifestyle aren’t the only things that matter. Your genes also influence whether you get type 2 diabetes. Some thin people are living with type 2 diabetes, too.
Still, your weight and lifestyle are things you can change, and they are important parts of your overall health.
Know the Goal
What you’re aiming for: your best health, not someone else’s. Diet and exercise alone will control diabetes for some people. For others, a combination of medication and healthy habits will keep them at their best.
“If you have been able to manage on lifestyle intervention [or changes] alone, continue to do that. If you need to go on medication, do what’s necessary [for] your health,” Albright says. “You need to take advantage of the treatment that’s going to keep your blood sugar, blood pressure, and cholesterol in check.”
CAN YOU REVERSE TYPE 2 DIABETES?
Sep 6, 2018 | Healthy Tips
Reference Reviewed by Michael Dansinger, MD
When you have diabetes, you need to worry about other health conditions, too. The longer you have the disease — into your 50s and beyond — the greater you are at risk for problems with your feet, your vision, your heart, your kidneys, and more.
This is why it’s crucial to see your doctor often: He’ll make sure that you have your diabetes under control, and he’ll see if other health problems are cropping up. You’ll probably need to visit his office every 3 months unless he tells you to come less often. (Some people who have their diabetes well under control may only need to visit the doctor every 6 months.)
These tests will help make sure you aren’t at risk of further health problems:
Blood Sugar Test
Your doctor needs to know how well you control your blood sugar levels. He’ll give you an A1c test, which shows your average over the past 3 months. If you have it under control, he may only need to do this test every 6 months. If you’re still getting there, you’ll need to be tested every 3 months. You should aim for an A1c level of around 7% or less to avoid more health problems.
Get it done: Every 3 to 6 months
Blood Pressure Check
People with diabetes are more likely to have high blood pressure, which raises your chances of getting heart disease. Your doctor should check your blood pressure at every office visit. If it’s too high, he may suggest lifestyle changes or prescribe a drug to help lower it. You want your readings to be below 130/80.
Get it done: Every time you see your doctor
Weight
If you’re overweight, your doctor may talk to you about your diet and exercise plan. Those extra pounds can make it harder to manage your blood sugar. Losing weight can help lower your blood pressure and your risk of heart disease. It doesn’t have to be a drastic change; your health can improve if you lose even 10 or 15 pounds.
Get it done: Every time you see your doctor
Foot Exam
Foot problems are common with diabetes, so you and your doctor need to stay on top of your foot health. You should carefully wash, dry, and inspect your feet at home every day. Nerve damage in your feet and legs can keep you from noticing when you hurt yourself. Your doctor will want to check them at each office visit.
People with diabetes also may have blood flow problems, which makes it harder for foot wounds to heal. A tiny cut, sore, or blister could grow into a foot ulcer that’s tricky to treat. If it gets severely infected, your foot or leg may need to be removed.
Get it done: Every time you see your doctor
Dental Check-up
Don’t neglect your mouth. When you have diabetes, you’re at greater risk of gum disease. It’s more likely when your blood sugar is out of whack. Even if you have it under control through brushing, flossing and rinsing with an antiseptic mouthwash, you should still see your dentist for checkups to make sure your mouth is healthy.
Get it done: Every 6 months
Kidney Test
You’re more likely to have kidney disease when you have diabetes, so your doctor will want to monitor them. He’ll test your urine to make sure your kidneys are working like they should. If you have kidney disease, treating it early can keep it from getting worse.
Get it done: Every year
Cholesterol Test
High cholesterol levels can lead to heart disease. Your doctor will check them at least yearly to make sure they’re in a healthy range. He can prescribe medicine to lower your cholesterol if you need it.
Get it done: Every year
Eye Exam
People with diabetes are at greater risk of vision problems. You’re more likely to have trouble with your eyes if your blood sugar or blood pressure levels are too high. To keep tabs on your vision and eye health, see an eye doctor at least yearly for a thorough exam. He’ll dilate your pupils to see whether you have any problems.
Get it done: Every year
GETTING OLDER? GET THESE TESTS.
Aug 28, 2018 | News
ALEXANDER G. LOGAN
Community programs for the prevention of cardiovascular disease have generally succeeded in lowering blood pressure (BP) and improving cardiovascular health in the general population. They have also met the challenge of raising awareness, increasing knowledge, and promoting changes in health behavior. Moreover, they have likely contributed to the improved rates of BP control among hypertensive patients in North America over the past 2 decades. Successful population-based interventions combined the power of mass media and other communication tools with screening and counselling activities. These targeted BP programs were firmly rooted in sound scientific evidence that interventions to lower BP improve health outcomes. The study by Salazar et al. adds another dimension to population-based programs by highlighting the importance of sustained public health activity to maintain good BP control. These investigators demonstrated that individuals whose BP rose during the community intervention were at higher risk of developing a cardiovascular event.
The new challenge for hypertension programs is maintaining community interest while reiterating the same health messages. A recent measles outbreak among unvaccinated adults in Canada has shown that in the absence of constant reminders, memories about serious preventable illnesses fade. To communicate effectively, community hypertension programs will need to borrow heavily from the world of technology about packaging messages to meet the changing ways that the general population consumes information. Public health interventions will need to take into account the new communication tools and fashion messages that fit the constraints of these instruments. It has amply been demonstrated that multiple approaches are required and communication strategies differ markedly among the target population to be reached. Interventions must also tap into risk factors that are products of the changing lifestyle of the community. It is apparent that lifestyle messages need to adapt to the reality of more prolonged periods of sitting at work, decreased time for meal preparation, financial constraints requiring dual-earner partnerships, and more fragmented and disrupted sleep. New public health approaches need to be rigorously evaluated to ensure that they are both cost-effective and applicable to large segments of the population. In the past, several well-thought-out, community-wide strategies for cardiovascular disease prevention, when properly evaluated, proved to have modest or no effect, leading the investigators to conclude that there was a need for new designs and new interventions.
We are now living in an age where telecommunication systems allow individuals easy access to reliable health information anytime, anywhere. Networks using 3G and 4G technology enable high-speed data transfer and support a wide variety of information technology platforms. This new technology provides patients with direct access to personal health records, web portals, and healthcare providers. Presently, it is unclear what system works best and whether there are differences between countries. There are trials demonstrating the benefits of telecommunication in both developed and developing countries.
Wireless connectivity is growing rapidly, and mobile devices are replacing landlines, desktop computers, and workstations as the preferred method of communication. The sale of smartphones with built-in messaging systems now outstrips that of cell phones. The recent flood of mobile healthcare devices and software applications has greatly expanded self-care capabilities across the spectrum of healthcare activities. Apart from ubiquitous educational materials, there is a cornucopia of self-help wellness and fitness programs for individuals interested in maintaining or improving their health. There is also a wide range of mobile services and solutions to prevent, diagnose, and treat diseases. Mobile health applications running on wireless devices facilitate disease monitoring.They enable remote monitoring of vital parameters to ensure health maintenance and provide early signals of potentially dangerous trends away from good health. Sleek wearable medical technology, now highly fashionable, allows individuals to monitor a wide array of vital signs and symptoms effortlessly and unobtrusively. Many such devices have built-in Bluetooth capabilities to transmit the data to a secure online database using a protected Internet connection, which in turn provides immediate feedback to users.
In the past decade, there has been a shift away from the traditional medical model of healthcare delivery to a more personalized system in which individuals are encouraged to participate in health maintenance activities and, for those with health problems, to work collaboratively with their healthcare providers. In the new paradigm, community resources, and policies are integrated more closely into the health system to ensure that programs have a broad reach yet provide needed support for targeted activities. The effectiveness of this combined approach was recently demonstrated in a randomized controlled trial of a multipronged, community-based health promotion and prevention program for cardiovascular disease. The intervention, which targeted older adults, engaged public health units, community physicians, and local health organizations, significantly improved cardiovascular risk factor management, and reduced morbidity at the population level. An essential element of the study’s intervention was self-management support.
There are many domains of health under personal control. Individuals can easily learn self-care skills, become more knowledgeable about health matters, modify poor lifestyle choices, use monitoring tools that track vital health parameters, and identify ways of preventing or mitigating the effects of the disease. Interactive technologies and online resources such as social networks, video chat, and instant messaging platforms facilitate these self-help behaviours and are successfully filling gaps in the current health systems. Through social media, individuals can find or create networks with peers to share common experiences, increase problem-solving skills and gain confidence in making life-improving changes. Such interactions build a strong sense of belonging and encourage participation in communal efforts to combat health problems in targeted groups. These developments are encouraged by the US Institute of Medicine and strongly endorsed by academic leaders in the United States.
If information technology is an important key to the future of community-based programs for chronic conditions such as hypertension, it faces many challenges. Foremost, it needs to appeal to all stakeholders, including organizations representing professionals, academic and research institutions, industry, and representatives from the general public. Age is a potential barrier in building successful interventions that use health information technology. The targeted population for hypertension is mostly aged >50 years and, in general, newly acquiring the skills to use the Internet and mobile devices. Nonetheless, the number of users in this age bracket is growing rapidly. A 2010 survey by the American Association of Retired Persons found that most were comfortable using a mobile phone and 7% even had a smartphone. Furthermore, older adults are interested in acquiring the skill to use a mobile health system to track vital signs such as BP and weight. For educators, it is important to recognize that many features of mobile devices are not intuitive for users aged >50 years and developing that intuition takes time. To increase acceptability of mobile health systems for older adults who are more likely to have a hearing, vision, cognition, and mobility problems, developers need to avoid design features such as small buttons and dim screens that impede usability. Apart from age and design issues, other impediments to the use of mobile health technology include affordability and availability that may reduce access. Such barriers are not insurmountable and are amenable to thoughtful solutions such as the use of publically available devices.
In summary, there is a growing body of evidence that community programs reduce BP and improve cardiovascular health in the general population. Assessments of cardiovascular risk factors by the World Health Organization MONICA project from the mid-1980s to mid-1990s and by the National Health and Nutrition Examination Survey from 1971 to 2010 provide additional support for population-based interventions. Both surveys showed a leftward shift in the frequency distribution of BP. Importantly, the decrease in BP occurred equally at all levels of readings, indicating that the change was not specifically related to better clinical management of hypertension and the increasing application of antihypertensive medications. This evidence, along with the new findings of Salazar et al., justifies supporting community efforts to improve the management of cardiovascular risk factors. For continued success, however, community programs will need to take into account the changing way healthcare is being delivered and incorporate the advances in mobile communication technology and social media in program planning.
REFERENCES: COMMUNITY HYPERTENSION PROGRAMS IN THE AGE OF MOBILE TECHNOLOGY AND SOCIAL MEDIA
Aug 21, 2018 | Healthy Tips
Reviewed by Nayana Ambardekar, MD.
People who have diabetes often have poor sleep habits, including difficulty falling asleep or staying asleep. Some people with diabetes get too much sleep, while others have problems getting enough sleep. According to the National Sleep Foundation, 63% of American adults do not get enough sleep needed for good health, safety, and optimum performance.
There are several causes of sleep problems for people with type 2 diabetes, including obstructive sleep apnea, pain or discomfort, restless legs syndrome, the need to go to the bathroom, and other problems associated with type 2 diabetes.
Sleep Problems and Type 2 Diabetes
Sleep Apnea
Sleep apnea involves pauses in breathing during sleep. The periods of stopped breathing are called apneas, which are caused by an obstruction of the upper airway. Apneas may be interrupted by a brief arousal that does not awaken you completely — you often do not even realize that your sleep was disturbed. Yet if your sleep was measured in a sleep laboratory, technicians would record changes in the brain waves that are characteristic of awakening.
Sleep apnea results in low oxygen levels in the blood because the blockages prevent air from getting to the lungs. The low oxygen levels also affect brain and heart function. Up to two-thirds of the people who have sleep apnea are overweight.
Sleep apnea alters our sleep cycle and stages of sleep. Some studies have linked altered sleep stages with a decrease in growth hormone, which plays a key role in body composition such as body fat, muscle, and abdominal fat. Researchers have found a possible link between sleep apnea and the development of diabetes and insulin resistance (the inability of the body to use insulin).
Peripheral Neuropathy
Peripheral neuropathy, or damage to the nerves in the feet and legs, is another cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.
Restless Legs Syndrome
Restless legs syndrome is a specific sleep disorder that causes an intense, often irresistible urge to move your legs. This sleep disorder is often accompanied by other sensations in the legs such as tingling, pulling, or pain, making it difficult to fall asleep or stay asleep.
Hypoglycemia and Hyperglycaemia
Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can affect sleep in those with diabetes. Hypoglycemia may occur when you have not eaten for many hours, such as overnight, or if you take too much insulin or other medications. Hyperglycaemia occurs when the sugar level rises above normal. This may happen after eating too many calories, missing medication, or having an illness. Emotional stress can also cause your blood sugar to rise.
Obesity
Obesity, or too much body fat, is often associated with snoring, sleep apnea, and sleep disturbance. Obesity increases the risk of sleep apnea, type 2 diabetes, heart disease, hypertension, arthritis, and stroke.
How Are Sleep Problems Diagnosed?
Your doctor will ask you about your sleep patterns, including whether you have trouble falling or staying asleep, are sleepy during the day, have difficulty breathing while asleep (including snoring), have pain in your legs, or move or kick your legs while sleeping.
Your doctor may refer you to a sleep specialist who may do a special sleep study called a polysomnogram to measure activity during sleep. The results of the sleep study can help your doctor make an accurate diagnosis and prescribe an effective and safe treatment.
How Are Sleep Problems Treated in Type 2 Diabetes?
There are several treatments for sleep problems in people with diabetes, depending on the condition:
Sleep Apnea
If you are diagnosed with sleep apnea, your doctor may suggest that you lose weight to help you breathe more easily.
Another potential treatment is continuous positive airway pressure (CPAP). With CPAP, patients wear a mask over their nose and/or mouth. An air blower forces air through the nose and/or mouth. The air pressure is adjusted so that it is just enough to prevent the upper airway tissues from collapsing during sleep. The pressure is constant and continuous. CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or is used improperly.
Peripheral Neuropathy
To treat the pain of peripheral neuropathy, your doctor may prescribe simple pain relievers such as aspirin or ibuprofen, antidepressants such as amitriptyline, or anticonvulsants such as gabapentin (Gralise, Neurontin), tiagabine (Gabitril) or topiramate (Topamax). Other treatments include carbamazepine (Carbatrol, Tegretol), pregabalin (Lyrica), lidocaine injections, or creams such as capsaicin.
Restless Legs Syndrome
Various medications are used to treat restless legs syndrome, including dopamine agents, sleeping aids, anticonvulsants, and pain relievers. Your doctor may also prescribe iron if you have low iron levels.
There are also several medications that treat insomnia, including:
Over the counter drugs such as antihistamines including diphenhydramine (such as Benadryl). These drugs should be used short-term and in conjunction with changes in sleep habits.
Medications used to treat sleep problems such as eszopiclone (Lunesta), suvorexant (Belsomra), zaleplon (Sonata), and zolpidem (Ambien).
Benzodiazepines are an older type of prescription medicine that causes sedation, muscle relaxation, and can lower anxiety levels. Benzodiazepines that were commonly used for the treatment of insomnia include alprazolam (Xanax), diazepam (Valium), estazolam (ProSom), flurazepam, lorazepam (Ativan), temazepam (Restoril), and triazolam (Halcion)
Antidepressants such as nefazodone and very low doses of doxepin
How Can I Improve my Sleep?
In addition to medications, recommendations to improve sleep are:
Learn relaxation and breathing techniques.
Listen to a relaxation or nature sounds CD.
Get regular exercise, no later than a few hours before bedtime.
Don’t use caffeine, alcohol, or nicotine in the evening.
Get out of bed and do something in another room when you can’t sleep. Go back to bed when you’re feeling drowsy.
Use the bed only for sleeping and sexual activity. Don’t lie in bed to watch TV or read. This way, your bed becomes a cue for sleeping, not for lying awake.
Are There Other Links Between Sleep and Type 2 Diabetes?
People who have poor sleep habits are at greater risk of becoming overweight or obese and developing type 2 diabetes, according to several studies. Chronic sleep deprivation may lead to insulin resistance, which can result in high blood sugar and diabetes.
Some studies show that chronic sleep deprivation can affect hormones that control appetite. For example, recent findings link inadequate sleep with lower levels of the hormone leptin, which helps control the metabolism of carbohydrates. Low levels of leptin have been shown to increase the body’s craving for carbohydrates regardless of the number of calories consumed.
WebMD Medical Reference
TYPE 2 DIABETES AND SLEEP
Aug 17, 2018 | Healthy Tips
6 LIFESTYLES TO CONTROL YOUR DIABETES
Working closely with your doctor, you can manage your diabetes by focusing on six key changes in your daily life.
- Eat healthily. This is crucial when you have diabetes because what you eat affects your blood sugar. No foods are strictly off-limits. Focus on eating only as much as your body needs. Get plenty of vegetables, fruits, and whole grains. Choose nonfat dairy and lean meats. Limit foods that are high in sugar and fat. Remember that carbohydrates turn into sugar, so watch your carb intake. Try to keep it about the same from meal to meal. This is even more important if you take insulin or drugs to control your blood sugars.
- Exercise.If you’re not active now, it’s time to start. You don’t have to join a gym and do cross-training. Just walk, ride a bike, or play active video games. Your goal should be 30 minutes of activity that makes you sweat and breathe a little harder most days of the week. An active lifestyle helps you control your diabetes by bringing down your blood sugar. It also lowers your chances of getting heart disease. Plus, it can help you lose extra pounds and ease stress.
- Get checkups. See your doctor at least twice a year. Diabetes raises your odds of heart disease. So learn your numbers: cholesterol, blood pressure, and A1c (average blood sugar over 3 months). Get a full eye exam every year. Visit a foot doctor to check for problems like foot ulcers and nerve damage.
- Manage stress. When you’re stressed, your blood sugar levels go up. And when you’re anxious, you may not manage your diabetes well. You may forget to exercise, eat right, or take your medicines. Find ways to relieve stress — through deep breathing, yoga, or hobbies that relax you.
- Stop smoking. Diabetes makes you more likely to have health problems like heart disease, eye disease, stroke, kidney disease, blood vessel disease, nerve damage, and foot problems. If you smoke, your chance of getting these problems is even higher. Smoking also can make it harder to exercise. Talk with your doctor about ways to quit.
- Watch your alcohol. It may be easier to control your blood sugar if you don’t get too much beer, wine, and liquor. So if you choose to drink, don’t overdo it. The American Diabetes Association says that women who drink alcohol should have no more than one drink a day and men should have no more than two. Alcohol can make your blood sugar go too high or too low. Check your blood sugar before you drink, and take steps to avoid low blood sugars. If you use insulin or take drugs for your diabetes, eat when you’re drinking. Some drinks — like wine coolers — may be higher in carbs, so take this into account when you count carbs.
WebMD Medical Reference Reviewed by Neha Pathak, MD
