Tags: BBQ, DSME, flavor, grilling, healthy, picnic, side dish, summer
Tags: CDE, Diabetes, DSME, fasting, religious observance, safety
By Erika Chan
This month, over 1.5 billion Muslims will be practicing the holiday known as Ramadan. Ramadan occurs during the 9th month of the Islamic lunar calendar. This year, the religious holiday started on Saturday, June 28, 2014 and will continue until the evening of Monday, July 28, 2014. The holiday is dedicated to purifying the soul, focusing attention on God, and practicing self-sacrifice and discipline – which includes fasting from sunrise until sundown throughout the religious holiday.
If you have diabetes, Ramadan requires balancing your religious obligations with practices that will keep your body healthy and happy. You can rest assured that there is a safe way to observe this holy holiday even with diabetes, but you should be vigilant and educated on how to keep your blood sugars under control.
First, it is important to know that while most Muslims practice strict adherence to fasting during Ramadan, fasting is not required. The Quran does not recommend fasting if it could harm ones’ health– particularly for those who are sick, pregnant, or elderly. Therefore, those with poorly controlled diabetes should not fast if it puts their health at risk. However, diabetes can be safely managed while fasting. You should continue to take your medications during Ramadan, but depending on blood sugar levels, timing or dosage may require modification.
As those with diabetes know, eating consistent carbohydrates and timing of medication are important to keeping blood sugars regulated. Fasting, however, can deregulate this system and cause dangerous effects including dehydration and hypoglycemia throughout the day. Furthermore, the large influx of food when breaking the fast at sundown can cause hyperglycemia in diabetics.
For these reasons, it is important to routinely check blood sugars (which does not count as breaking your fast) and monitor your physical symptoms to avoid dehydration and hypoglycemia. Hypoglycemia is technically defined as glucose levels below 70mg/dl, and can cause dizziness, lightheadedness, hunger, and disorientation. This state should be treated immediately with small amounts of food, juice, or a glucose tab to restore normal blood sugars. If this condition occurs, there are options to avoid re-occurrence, and you should contact your medical provider to alter medications or discuss other acceptable ways of breaking the fast if necessary.
Conversely, when breaking your fast you should be cautious about consuming too many carbohydrates at one time, which can cause hyperglycemia. As usual, try to keep carbohydrate amounts close to normal goals (when not fasting), and eat adequate amounts of protein and vegetables to help blunt possible spikes in blood sugar. Furthermore, it is important to start the day with a hearty meal of complex carbohydrates and protein to slow digestion and provide fullness and adequate fuel throughout the day.
Just as Ramadan is a time for self-reflection, if you are managing diabetes it is important to be in tune with your body and its physical symptoms. While it is certainly possible to manage diabetes while fasting during Ramadan, each person’s body will react differently. It is important to contact your health care provider to discuss ways to coordinate diabetes management with your religious practices ahead of time in order to keep both your body and mind healthy and well.
(Post reviewed by Melanie Pearsall, RD, CDE, MGH Revere HealthCare Center)
Tags: DSME, illness, infection, Lyme, New England, outdoors, precaution, summer, ticks
By Eileen B. Wyner, NP
Bulfinch Medical Group
We’re hearty New Englanders but we slipped, froze and just plain suffered this past winter. We’re now reaping the benefits of our new season with bright warm sunshine and trees in full bloom, but I’m afraid we’ll be paying a price. All the snow and ice combined with a wet and soggy spring has set up a perfect storm for a tick boom in New England, which is expected to peak in the next few weeks. Here’s some basic information and guidelines for preventing and identifying tick illness while you’re outside enjoying this glorious time of year.
Lyme disease occurs when people are bitten by blacklegged ticks (more commonly referred to as deer ticks here in the Northeast) infected by a bacterium called Borrelia burgdorferi. They can attach themselves to any exposed skin area, but really like skin folds and hard to easily see places in particular. Some areas ticks are fond of burrowing into include the groin, armpit, behind the knee, the waist, and folds of the neck. They also are frequently found in the scalp as hair hides them well. Ticks need to be attached for approximately 36-48 hours or more before the Lyme disease bacteria can be transmitted.
When you’re bitten by a tick, about three-quarters of the time a rash may occur. Sometimes it will look like a small bump and resemble a mosquito bite, lasting for a day or two and disappearing. This is not a rash consistent with Lyme disease. That rash, commonly referred to as a “bull’s-eye” rash, will appear at the sight of the bite within a few days to a few weeks later. The rash may expand over time, and as it gets bigger the center may become darker and firmer while the area between the borders and the center may become clearer (this is where the term “bull’s-eye” comes from). The area may be warm to the touch but it isn’t painful or itchy.
It’s important to have this rash evaluated by a health care provider. The appearance of symptoms such as fever, chills, muscle and joint pain, headache, swollen lymph nodes, and fatigue also require medical evaluation. Let your healthcare provider know if you have any changes in your blood sugar as unexplained elevations can signal infection. These symptoms along with the “bull’s-eye” rash require evaluation by your medical provider to see if any blood tests or other treatments are required.
The best approach to avoiding Lyme disease is prevention. Here are a few tips to try to incorporate into your daily habits:
- Always do a thorough skin examination after being outside, especially if you’ve been in the woods or long grassed fields.
- Ticks can be very small (as tiny as a poppy seed!) and look like a black speck. Wear white or light colored long sleeved shirts and pants tucked into socks so you can spot them easily.
- Wear wide brimmed hats to protect your scalp and neck from a tick falling onto you when walking.
- Wear gloves if you are doing any gardening.
- Wear bug repellant with DEET. Apply to your clothes and to your skin and it will last for several hours. Avoid getting it in your eyes and mouth and wash your hands well after applying.
- Stay on well-marked paths.
- To avoid bringing ticks in the house, take off clothes and bag them before heading in to shower if possible.
- Check your pets. Dogs and cats can’t spread the disease directly to you, but they can carry infected tick into the house.
Also note: every bug bite isn’t Lyme disease. It’s important to correctly diagnose Lyme but it is just as important to avoid misdiagnosing it. Summer in New England has so much to offer and I hope these few simple steps will help you and your family stay healthy and enjoy this season.
Tags: colors, DSME, flowers, gardening, mind-body, relaxation, spring, stress relief
By Rebecca Ocampo
Medulla Oblongata, Phlox Subulata, Calamagrostis Acutiflora, Panicum Virgatum – they may sound alike and look alike but are all very different. The medulla oblongata is the lower stalk-like section of the brain. The rest are plants: beautiful creeping phlox and exotic perennial grass. The photograph to the right is Phlox Subulata or creeping phlox. They bloom in the beginning to late spring and are perennials. They are used for garden edges or “fillers” near a stone wall.
There is an old Chinese proverb that goes like this: “If you drink tea, you will be happy for a day. If you roast a pig, you will be happy for a week. If you get married, you will be happy for three weeks. If you garden, you will be happy forever.” My love of gardening peaked recently when I moved to the suburbs and found myself in an apartment surrounded by beautiful and lush forestry. Never did I imagine that gardening would be one of my priorities outside of work. It’s very relaxing and a healthy way to exercise. I’m outdoors and not connected to anything electronic. Most of the time, I do not use my gardening gloves and dig right in the dirt. It’s like making cake batter without utensils, if you will. The texture is soothing to the skin. It may have something to do with childhood, like making mud pies at the beach.
When I was growing up in the Philippines, my family’s ancestral home was surrounded by a variety of fruit trees (banana, avocado, mango and jackfruit) sugar cane, bamboo, and a variety of tropical and exotic flowers including different shades of hibiscus – all surrounding an in-ground (almost Olympic size) swimming pool. Flash forward to the United States where my mom, brother, and I visited several garden centers every Sunday. They would never agree to go to a mall, so it was either another pair of shoes for me or a Panicum Virgatum which is a metallic blue (sounds like shoes to me!) grass that blooms in late summer and grows up to 3’ in height and approximately 18” wide. It has pretty blue blades during the summer and turns to golden and bright yellow blades in the fall.
I mostly grow perennials: orange and red tiger lilies, pink and white English daisies, bright orange poppies, vinca with purple flowers. There are purple irises, red knock-out roses (tough roses that will come back every year no matter the weather) and some annuals like impatiens and pansies as well. The benefit of gardening is twofold. First, it’s a good form of exercise because you rake, mow the lawn, pull weeds, thatch the grass, prune trees, and design your garden so it’s esthetically pleasing. Second, gardening exercises the mind. There is a calmness and peacefulness in gardening. It’s a proven source of good mental health awareness, and releases tension. It means I have escaped confinement from my cubicle. It’s a form of exercise that soothes and calms my mood after a hectic day at the office.
Tags: Boston, DSME, farmers' market, fresh, fresh fruits and veggies, local, nutrition, Revere
By Beth Johnson
It’s time to buy local! Spring is here, and there are several varieties of fruits and vegetables already springing up at all of the local farms in Massachusetts. Right about now and for the next couple of weeks, you’ll start seeing the first crops of the year. Freshly picked foods like asparagus, arugula, beets, cabbage, strawberries, peas, spinach, lettuce and collard greens will be freshly available for you to enjoy!
Try adding a handful of spinach to your daily salad. Spinach is high in vitamin B6 vitamin B9 (folic acid) and vitamins A and K. Vitamin A helps maintain eye health, mucus membrane function, skin, bone and teeth growth, and has immune and cancer protection properties. Vitamin K helps with blood clotting and regulates Calcium levels in the blood. Folate plays a large role in creating new cells, while B6 helps the body break down protein and fat for energy. What more of a reason would you need to include such a powerful vegetable in your diet? You can find spinach and other fresh and local fruits and vegetables at the following Farmers Markets around Boston:
- Boston Public Market/Greenway Farmers’ Market
- Boston/Copley Square Farmers’ Market
- Boston/Northeastern University Farmers’ Market
- Boston/South Station/Dewey Square Farmers’ Market
- Boston/SOWA Farmers’ Market
- Boylston/Hillside Farmers’ Market
- Revere/Revere Beach Farmers’ Market
Happy Spring and best of luck to you on your quest to find the freshest local fruits and vegetables possible!
(Post content reviewed by the Department of Nutrition and Food Services)
Tags: Diabetes management, disaster planning, DSME, exercise, renewal, seasons, spring, Spring cleaning
By Eileen B. Wyner, NP
Bulfinch Medical Group
I think it’s safe to say (knock wood) that winter is over and spring has arrived in Boston. I’ve finally sent my puffy coat to the cleaners, packed away my scarves and Uggs, and begun to plan for the sunshine and blue skies. I seriously believe in “spring cleaning” because my mother drilled it into me as a kid. As an adult, I see her point about cleaning. I’d like to put another spin on “spring cleaning” and share some tips on how it can apply to taking inventory of your health and improving your diabetes control.
This was a very hard winter even by New England standards, and could undermine the best of intentions. I know personally as well as from what my patients have shared with me that the cold, ice, and snow made it very hard to keep up things like exercise and doctor appointments. The cold and dark made it hard to exercise at home, while macaroni and cheese made many of us feel a lot better. Now is the time to take stock of the past and make improvements as needed.
- Go through all of your prescriptions to check for any that have expired or you are no longer being prescribed (this also refers to any over the counter or non-prescription medications). Check with the Department of Health or your local pharmacy to find the safe way to discard these medicines.
- Look through your diabetes testing supplies and check test strips for their expiration date. Check that you have an active and extra glucometer battery. If you have glucagon in your cabinet check that it is up to date.
- Check to see that all of your prescribed medications are current with your pharmacist and let the doctor’s office know if you need updated prescriptions. It’s a good idea to have an updated medication list with you at all times.
- Take some time to reflect on your eating habits. If you’ve fallen off track, set up an appointment with your RD CDE. Don’t feel upset or guilty if you need extra help – we’ve all been there! The important thing is that you recognize the need to make changes.
- Now is the time to get exercising again. If winter slowed you down, please don’t just resume your usual routine. Start slow and gradually increase your activity as tolerated. Make sure your exercise footwear fits well. You may also need to check your blood sugar more frequently to check for hypoglycemia.
- Medical appointments may have been cancelled by you or your provider because of bad weather. Review your last primary care visit, diabetes visit, ophthalmology check, dental, and podiatry appointments and schedule any that are due.
Those of you who have read this blog in the past know that I tend to focus (some say obsess) on planning for the unexpected. Natural and man-made disasters are totally unpredictable and can cause serious obstacles for managing your diabetes.
- Go through all your emergency supplies and check for content, expiration dates of food, water, batteries, and ALL medical supplies. Review your list to see if certain things are still needed or if new things need to be added.
- You should review your disaster care plan at least every 6 months (or sooner if you’ve needed to use it). I like to do this in the fall and spring because of the weather. I’ll be sure to have several warm blankets and fleeces within easy reach in October, but in May will probably take a few out but add more bottled water given the great danger of dehydration with high temperatures and bright sunshine. I’ll also add insect repellant with DEET and sunscreen. The American Red Cross has excellent up to date data on their website for disaster preparedness so please check it out at www.redcross.org.
OK…are you ready to tackle some spring cleaning? I have another idea: lace up the sneakers and head outside to see the daffodils bloom. Happy Spring!!!
Tags: farmers' market, fruits and veggies, produce, shopping on a budget, spring, storage
By Erin Boudreau
Summer is right around the corner, and with the warmer weather comes an increase in available fruits and vegetables. These products are colorful, flavorful, and nutritious, but they also spoil very quickly. Quality and flavors of all produce will begin to diminish the moment they are picked, so it is best to enjoy as soon as possible after purchase. Proper storing will help extend their life and also has a major impact on quality and taste. Most fruits and vegetables can be stored in the fridge, with a few exceptions. Many products can also be frozen to extend their life even further. Remember, even with proper storage techniques produce will still spoil quickly, so be sure to buy only as much as you can enjoy in a few days to prevent waste.
- Store bananas, pineapple, citrus, and other tropical fruits in a cool, dry area. They should NOT be stored in the fridge. Citrus fruit will absorb the odors of the fridge but will last for a long time at room temperature. The sugar is most concentrated at the base of a pineapple, so store it upside down for a few days in order to allow the sugar to distribute throughout the fruit.
- Potatoes will keep fresh for a couple of weeks if stored in a cool, dry, ventilated place (not the fridge). Cold temperatures can turn the starch in a potato to sugar, creating a sweeter potato while warmth and light will cause them to sprout. Sweet potatoes are more delicate and should only be kept for about a week.
- Garlic and most types of onions should be kept in a well ventilated area at room temperature or cooler, but not refrigerated. Vidalia onions have higher water content and can be stored individually wrapped in paper towels in the refrigerator.
- Tomatoes are very finicky. Refrigeration can give them an unpleasant, mealy texture, and can alter their taste and aroma. They’re best stored unwashed at room temperature.
- Mushrooms should be kept in a cool, dry place and lightly washed immediately before use.
- Asparagus should be stored in the fridge with a damp paper towel wrapped around the stems. You can also stand them in a glass of cold water with a damp paper towel wrapped around the tops to keep them crisp.
- Store carrots in a plastic bag in the fridge to hold in moisture. Wash and peel right before using.
- Herbs should be washed, dried completely, and stems clipped prior to refrigeration. Store in a glass of water or with a damp paper towel wrapped around the stems. A plastic bag or paper towel can be wrapped around the leaves to lock in moisture.
- Break off lettuce leaves and dip them in a large bowl of cold water. Dry completely with paper towels or a salad spinner and store in a plastic bag with paper towels in the fridge.
- Apples will keep in the fridge for several months.
- Mangos, peaches, plums, and pears can be ripened at room temperature, and then kept in the fridge to prolong their life.
- Melon can develop a rubbery texture if kept in the fridge, and should never be frozen. Storing at room temperature is best.
- Berries are fragile, and have a very short self-life. Store in the fridge and wash lightly just prior to use. Fresh berries can also be frozen for later use.
- Wrap rhubarb in plastic and store in the fridge. This fruit also holds up well in the freezer.
(Post reviewed by Anne Lukowski, RD, CDE. Foodnetwork.com was referenced for this article)
Tags: activity, community, FitBit, fitness, health tracker, lifestyle change
By Rajani Larocca, MD
Charlestown HealthCare Center
with Chrisanne Sikora, Senior Project Specialist
Diabetes Self-Management Education Program
Lifestyle change is ultimately in the hands of the individual, and our job as medical providers is to find a way to empower people to make those changes. It’s an old problem, but the question is: how do we get there? And can new technology help us solve the problem in new and innovative ways?
In spring 2013, I ran a series of six weekly group visits with a group of my patients at MGH Charlestown HealthCare Center. The group was originally intended for those with metabolic syndrome, but the majority of the patients already had Type 2 Diabetes. The idea for this program came from an interest in applying a public health approach to medicine. All of the patients volunteered for the program on my recommendation. The focus of the visits was to educate the participants about healthy lifestyle change, to help motivate them to implement this change, and to provide a support system to help keep them motivated.
Each session focused on a different topic. In addition to the introduction in the first week and a summary group in the last week, we discussed nutrition, exercise, stress reduction, and social connection. A key part of the sessions included removing the all-or-nothing mentality that many people adopt when they are trying to be healthier, focusing instead on taking what steps you can and forgiving mistakes in the past.
During the meeting in which we discussed exercise, everyone who participated was given a FitBit activity tracker to wear. Once the trackers were on, the group went on a short walk through the neighborhood. Many were surprised to learn they didn’t have to walk far to reach 1,000 steps.
In subsequent sessions, reviewing the Fitbit data was part of what we did during our time together. Interestingly, everyone liked the Fitbits – even those who didn’t have ready internet access or who weren’t really internet-savvy. Because the trackers had a display which showed results in real time, everyone could tell whether they were reaching their goals on a daily basis. While there was some friendly competition among participants, most were only competing against themselves, trying to beat their totals from the previous week.
After the program ended, the participants were allowed to keep their FitBits, and some were still wearing them eight months later. Some of those who stopped wearing them said it was because they had incorporated their new habits into their routine and didn’t need the tracker anymore. When asked how he would keep up with his daily walks during the winter, one gentleman responded “I’ll wear a coat!”
Electronic trackers like the FitBit make developing healthy lifestyle habits more fun, but we can’t underestimate what the social connection of the group did to foster people’s success. The participants really enjoyed the group setting, especially the sense of community that developed and the confidence they gained from learning that others face many of the same challenges. Living with a chronic disease can be isolating, but in this group, people realized that they were not alone.