Tags: breathing, Diabetes, Diabetes Education, risk factors, sleep, sleep apnea
By Matt T. Bianchi, MD, PhD
Chief, Division of Sleep Medicine
In an era when advanced technologies, imaging, genetics, and personalized medicine is making heroic steps towards improving healthcare it may come as a surprise that a common and serious disorder with multiple available treatments remains largely undiagnosed. Yet such is the case for sleep apnea, which affects about 10% of adults but is diagnosed in fewer than half of these. Sleep apnea is defined as repeated obstructions in breathing during sleep, each lasting typically 20-30 seconds. These events can range from complete obstruction (apnea) to partial obstruction (hypopnea) and are often accompanied by drops in oxygen.
Sleep apnea is more common in people with diabetes, especially if other risks like obesity are present. Undiagnosed sleep apnea can increase risk of heart attack and stroke – which are already increased in those with diabetes. Sleep disturbances such as sleep apnea can also make it harder to keep blood sugars under control. Other risk factors include male sex, older age, smoking, and alcohol use. Those who have already had a heart attack or stroke, or who have poorly controlled blood pressure, are also at increased risk.
Diagnostic testing, performed in the laboratory or sometimes even at home, involves monitoring breathing and oxygen levels. Pauses in breathing (obstructions) occurring at 5 or more times per hour indicate sleep apnea is present. Increased pause rate means increased severity of the problem (15-30 is moderate; >30 is severe). This disorder often comes with snoring, sleepiness and being overweight – but not in every case.
There are many treatment options for those with sleep apnea. Wearing a mask known as continuous positive airway pressure (CPAP) while sleeping is the standard treatment. Although some initially find the prospect of this treatment daunting, there are dozens of different kinds of masks to help accommodate each person’s needs and comfort. Alternatives come in two categories: surgical and non-surgical. Surgeries include soft palate surgery and jaw advancement surgery, as well as a new stimulator device that acts like a pacemaker to prevent obstructions in sleep. Dental appliances can be made that pull the bottom jaw forward in sleep – these are made by specially trained dentists.
For some people, the sleep apnea is present mainly when they sleep on their back. In these cases avoiding that position can be helpful. This can be accomplished with a shirt/vest that has a bumper on the back that makes back-sleeping uncomfortable. (The challenge is that some people end up sleeping on their back for some or all their sleep regardless.) Finally, weight loss can be helpful for those patients who are overweight. Whichever treatment pathways are chosen, alone or in combination, it is best to speak with your doctor about your choices and how to monitor your progress.
Tags: Diabetes, DSME, educaiton, healthcare, shared decision making, visit
We’re honored to have had Leigh Simmons, MD and Karen Sepucha, PhD from the Health Decisions Sciences Center chat with us on Twitter earlier this week about using shared decision making to set healthcare goals and build stronger relationships with providers.
Click below to read the transcript.
Tags: granola, nuts, omega 3's, recipe, snack, walnuts
Sprinkle this granola on top of yogurt or fresh fruit for a healthy dessert or portion it into Ziplock bags for an on-the-go snack. The flaxseeds and walnuts provide a healthy dose of omega-3 fats, while the dried fruit adds a touch of natural sweetness.
2 cups oats
1/3 cup flaxseed (whole or ground*)
¼ cup walnuts pieces
¼ cup slivered almonds
2 tsp cinnamon
1/3 cup orange juice
1/3 cup honey
¼ cup brown sugar, packed
1 tbsp canola oil
1 tsp vanilla extract
1/3 cup dried cranberries
¼ cup dried apricots, chopped
¼ tsp salt
Cooking spray or additional canola oil
Preheat oven to 315 degrees. In a large bowl, mix oats, flaxseed, nuts and cinnamon. Combine orange juice, honey and sugar in a small saucepan and cook on medium heat until sugar dissolves; remove from heat and stir in oil and vanilla. Pour orange juice mixture over oat mixture and toss to combine. Spray cookie sheet with cooking spray (or grease lightly with additional canola oil) so that granola will not stick to pan. Spread oat mixture on cookie sheet.
Bake for 10 minutes; stir mixture and bake for an other 10-15 minutes or until golden brown. Stir in dried fruit and let cool completely.
Store in an airtight container at room temperature for up to 2 weeks or in the refrigerator for up to several months.
*Ground flaxseed will provide more omega-3 fats
Yield: About 4½ cups (serving size: ¼ cup)
Nutrition Information per Serving:
CALORIES: 125 • PROTEIN: 3g • SODIUM: 35mg • CARBOHYDRATE: 20g • FIBER: 2.5g • FAT: 4.5g • Sat Fat: 0.5g
(Recipe adapted from Cooking Light)
Tags: almonds, fiber, heart healthy, nutrition, nuts and seeds, pumpkin seeds, snack, walnuts
By Leslie Wall
Why are dietitians so crazy about nuts and seeds?! Nuts and seeds are morsels of heart healthy fats that can be added to meals and snacks or eaten alone. They pack a nutrient-dense punch of vitamins, minerals, and heart healthy fats that can lower cholesterol and reduce inflammation. They are also an excellent source of protein and fiber that help us feel full and satisfied, and add texture and flavor to many dishes.
Nuts and seeds vary in shape and size, and can be prepared in a variety of ways including toasted, roasted, raw, blanched, and salted. Aim to add a variety of nuts and seeds in their most natural form to your diet—raw or dry roasted are great choices. A serving of nuts is 1 ounce (about a palm full). Try mixing it up, as each variety of nuts and seeds contain different vitamins and minerals.
The MVPs of Nuts and Seeds – Here is a list of our favorites.
1. Almonds: Available year round, these nuts are rich in calcium, vitamin E, manganese, magnesium, copper, vitamin B2 (riboflavin), and phosphorus.
2. Cashews: High in antioxidants. Has a buttery taste when pureed, and often used to replace cheese sauces in vegan dishes. Chop and sprinkle on pizza for a meaty, flavorful texture.
3. Pecans: Buttery and slightly bittersweet, they’re typically used in pies, quick breads, cakes, cookies, candies and ice cream.
4. Pine Nuts: The edible seeds of pine trees, pine nuts are the key ingredient in fresh pesto and are out of this world sprinkled over salads, pasta, and pizza.
5. Flax Seeds: The richest plant source of omega-3 fatty acids. Add to breads, cookies, pancake mix, yogurt, and smoothies or sprinkle on cereal and salads.
6. Pumpkin Seeds (a.k.a. Pepitas): A great source of potassium, zinc and vitamin K. Roasted pumpkin seeds can be eaten alone as a snack, or and in salads and breads.
7. Sunflower Seeds: Sunflowers belong to the daisy family and are native to North America. The seeds are high in selenium, vitamin E and magnesium. Shelled seeds are delicious eaten raw or toasted, added to cakes and breads or sprinkled on salads or cereals.
Tips for Toasting: While nuts and seeds are certainly delicious eaten raw, toasting them on the stove or in the oven enhances their flavor.
- On the stove: Place nuts in a skillet and toast for 5 to 10 minutes over medium heat. Shake and stir nuts until they’re golden brown and fragrant, then remove from the pan immediately and allow to cool.
- In the oven: Arrange a single layer of nuts or seeds in a shallow baking pan and toast in a 350°F oven for 5 to 10 minutes, stirring occasionally.
Homemade Granola Bars ~ FitDay
Perfect for hiking, camping, and snacking.
(Post content reviewed by MGH Department of Nutrition and Food Services)
Tags: BBQ, chat, cookout, healthy, nutrition, recipes, summer
Summer is prime season for grilling, BBQs and outdoor parties. Erika Chan, a dietetic intern with the MGH Department of Nutrition and Food Services, led a discussion about healthy, flavorful ideas for your next cookout.
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.