Tags: burnout, caregiver, Diabetes, mental health, team
By Eileen B. Wyner, NP
Bulfinch Medical Group
Living with diabetes is a full time job for the patient, but what about their loved ones and family members? How do they cope with this disease and all of its implications? I would like to address the concerns of the caregivers today and how everyone can work together successfully.
Many people living with diabetes are perfectly able to care for all parts of their disease independently. However people who are visually impaired, have arthritis (particularly if their hands are involved), the elderly, and people with impaired mental functioning may require assistance in managing their diabetes. Their caregivers may include family members with whom they live or people who come to their homes as needed. The patient may work with just one person or there may be a team of caregivers available to assist.
Allow yourself to think for a minute about all that goes into daily self-care for a person living with diabetes. There are glucometer checks, medications and possibly self-titrating of insulin, meal adjustments, and the chance of unforeseen complications like hypoglycemia or an illness. Now think how stressful and difficult these responsibilities may be for a caregiver, especially for someone requiring a high level of assistance. Just as the person with diabetes can get overwhelmed and fatigued by their daily care, so too can the caregiver. That is when the caregiver needs the care.
Hopefully, if there is a team of people pitching in, no one will feel overburdened. However, many times there is just one person closely involved with the patient and it may be more difficult to realize the caregiver is suffering. It’s important that all involved in the patient’s care, including the health care team, check in with each other to see how things are going. Try to pick up on subtle clues such as off handed comments by the caregiver(s) like “I don’t always have time to get everything done, there is so much to do” or “I’m so tired all the time.” Also try to be aware of any changes in demeanor such as being impatient or more withdrawn, possible signs of fatigue or depression.
Schedules are important as well, not just for the patient but for the caregiver. It helps to still do the things that are important in their daily life so that their health and well-being are maintained. It’s important for caregivers to know that it‘s perfectly fine to ask for help. It doesn’t mean that they’re doing a bad job or can’t handle the tasks — just the opposite. Providing the best care possible really does begin with a mentally and emotionally healthy caretaker. Having responsibility in someone else’s care is a difficult and stressful job. It’s important for all involved to realize this. Caretakers should feel able to discuss their feelings with the health care team. Referral to social services may be in order to assist with identifying what other community services may be available. Support groups in the area may also be a good outlet to help to cope with the situation.
Everybody needs a little help sometime. A clear channel of communication between all the parties involved will hopefully ensure a caring environment is in place for all.
Tags: Diabetes, fall, flu, flu shot, MGH
The 2014-2015 flu season is quickly approaching. Getting a flu shot is the best way to protect you and others from getting or spreading the flu. We encourage all of our patients to consider getting a flu shot, especially those that are at high risk for getting the flu. People who are high risk are:
- People with medical conditions, like asthma and diabetes
- Pregnant women
- Children aged 6 months to 5 years
- People older than 65 years of age
- People who live with or care for others considered to be high-risk
Flu shots will be available on the MGH Main Campus on the following dates:
MGH Centralized Flu Shot Program
Wang Ambulatory Center Main Lobby
October 6th through November 21st
9:00am-3:00pm on Monday, October 13th (Columbus Day)
Tags: cranberries, fall, recipe, salad, seasonal, spinach
This salad utilizes flavorful, seasonal ingredients without derailing your healthy diet and takes minimal effort to prepare. Add grilled chicken, salmon or flank steak to make it into a meal.
1 cup pecan halves
12 cups baby spinach
½ cup dried cranberries
1 cup gorgonzola (or other blue cheese), crumbled (about 4-5 ounces)
3 tbsp olive oil
1 tbsp balsamic vinegar
1 tsp grated orange peel (optional)
Salt and pepper
Preheat oven to 350 degrees. Bake pecans on an ungreased cookie sheet for 8-10 minutes or until golden. In a large bowl, combine spinach, cranberries and gorgonzola. Pour balsamic vinegar into a small bowl, whisk in olive oil and orange peel (if using). Pour over salad mixture and toss to combine. Add pecans, season with salt and pepper to taste.
Yield: 6 servings
Nutrition Information per Serving (chicken, salmon or steak not included):
CALORIES: 300 • PROTEIN: 6g • SODIUM: 360mg • CARBOHYDRATE: 14g • FIBER: 3.5g •
FAT: 25g • Sat Fat: 6g
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.