Building a Better Breakfast

November 6, 2014 at 11:36 am | Posted in Announcements | Leave a comment
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Breakfast Flier

On Insulin and Weight Gain

October 2, 2014 at 2:28 pm | Posted in Uncategorized | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Does my insulin make me look fat? The answer to this question is …it might. That would make it the wrong answer because none of us want to take a medication that may cause weight gain, especially as maintaining a healthy weight is such a crucial aspect of good diabetes management. The purpose of this post is to discuss how insulin works and how it may affect your weight. I hope after reading this you’ll have fewer reservations about using insulin if it becomes necessary.

Maintaining a healthy weight is so important for general health and is particularly important for people with chronic diseases such as high blood pressure, high cholesterol, heart disease, arthritis, and diabetes. A healthy diet and weight may mean fewer daily medications or a lower dose of medications you still require. Many medications have the potential for side effects; diabetes medications are no different. Weight gain IS a possible side effect of insulin, but it may also happen with oral medications.

Let’s talk about insulin as a first step. It is, simply put, a lifesaving medication. Insulin was discovered in 1921 at the University of Toronto and has been extensively studied and improved upon since. The job of insulin is to move the glucose from the food we eat into our cells so they’re able to stay healthy and work well. It then takes the remaining glucose from the bloodstream and stores it so it can be used for energy later. People with Type 1 Diabetes are totally dependent upon this medication for survival as their pancreas does not produce insulin. People with Type 2 Diabetes can manage their disease many different ways: diet, exercise, oral medications, and insulin. Diabetes is a progressive and chronic disease that as yet does not have a cure. That is why so many people with Type 2 Diabetes will require insulin as part of their management over time.

Two common symptoms of poorly controlled diabetes are significant weight loss and excessive urination. The weight loss happens because stored fat gets broken down to provide enough fuel for bodily functions (heart and lungs, for example) to operate and maintain life. You may start to notice the numbers on the scale decrease, regardless of what you eat or drink. This is because calories consumed aren’t being properly metabolized but rather directly excreted with urination.

The treatment for extreme hyperglycemia is insulin therapy. The insulin corrects the high blood sugar, correcting the excessive weight loss in the process. The insulin is helping the body work correctly; it’s not causing new weight but rather replacing what was lost when the body was in crisis. It’s a sign the body is healing and starting to work more normally again. This is a good thing, but it can also be frustrating for people who struggle with their weight regardless of their level of glucose control. If your weight is still creeping up after your blood sugar is better controlled, there are probably other reasons for this and further investigation is needed.

Frequent episodes of hypoglycemia (low blood sugars) can cause added weight. I’ve discussed hypoglycemia in more detail in the past, but I want to review a couple of points now. Under eating, over exercising, and both oral medicines and insulin are potential causes of this frightening and potentially life threatening condition. Proper treatment is key, but it’s common for people to over treat low blood sugars because they feel so poorly and think more is faster and better. This is not the case, and the extra calories may cause added weight over time.  The strategy I encourage my patients to use is trying things like glucose tablets and gels for treatment more often than juices or regular soda because they are pre-packaged for the correct carbohydrate (15grams). It can be hard to measure out 4 oz of juice or regular soda when you are feeling so poorly and anxious during an episode of low blood sugar. I also strongly encourage all of my patients to see our RD CDE on a regular basis to review meal plans and make any adjustments as needed to assist with better weight control. It is also important to be as active as possible as any type of movement will decrease insulin resistance and improve weight and blood sugar numbers.

Insulin initiation is a daunting prospect for some. Many of my patients, especially those who are really struggling with their weight, have told me the fear of gaining weight is why they refuse insulin. I hope that my explanation helps to minimize this fear. So, this brings us back to where we started. Does my insulin make me look fat? I prefer to answer this way: It makes your body healthy so you look marvelous!!!

Spring Cleaning for Your Health

May 22, 2014 at 11:15 am | Posted in Health | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

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.

Medication Review

  • 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.

Diet Review

  • 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.

Exercise Review

  • 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.

Appointments

  • 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.

Disaster Planning

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!!!

Hypoglycemia Unawareness

November 7, 2013 at 1:05 pm | Posted in Health | Leave a comment
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By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NPWhen you have diabetes, regulating your blood sugar is a full time job without any time off for good behavior. Good control of your blood sugar is necessary to prevent potential complications but sometimes, regardless of how hard you’re working, it may seem that outside forces conspire to ruin your good control.  One of these issues can be hypoglycemia.

Hypoglycemia, or low blood sugar, is defined as a measured blood sugar that is less than 70 mg/dL. It may occur if you haven’t eaten enough, had unplanned strenuous activity, or taken too much medication. It may be accompanied by many symptoms including (but not limited to) feeling sweaty, shaky, extremely hungry, agitated, or experiencing blurry vision. If blood sugar reading is less than 70 mg/dL the recommendation is to have some fast acting carbohydrate like orange juice or glucose tablets at once and check again in about 15 minutes.

Hypoglycemia is a very serious complication of diabetes and left untreated can result in seizure, coma, and even death. When the sugar level gets too low, the body releases two hormones: glucagon and epinephrine.  Epinephrine is responsible for the early warnings signs of low blood sugar, such as the hunger and sweating mentioned earlier. It also signals the liver to start making more glucose. Glucagon signals the liver to release this stored glucose into the circulatory system to correct the low blood sugar. However, people living with diabetes may also experience another type of hypoglycemia that is extremely dangerous: hypoglycemia unawareness.  Someone with hypoglycemia unawareness does not feel the early symptoms of low blood sugar. People who have had diabetes for a long time are at risk for developing this condition, as are those with a history of frequent low blood sugars, frequent and extreme fluctuations in blood sugar values, and people who have very tightly controlled blood sugars.

The most important way to address this condition is AWARENESS. Check your blood sugar frequently so you’re aware of your patterns. Medication changes, activity changes, and illness are a few situations when checking your blood sugar can really pay off.  Sometimes it’s necessary to check in the middle of the night on a regular basis if nocturnal or fasting hypoglycemia is happening to you. This way you can identify the exact timing of the low and not only treat it, but take steps with your health care provider (HCP) to find a way to manage your medications or diet to avoid these episodes. Targets for your blood sugar goal may need to be adjusted. Not every person, especially the elderly or people with a history of severe hypoglycemia, needs an A1C between 6.5 and 7 so discuss this with your HCP.

It’s important to work with your CDE to identify any issues you may have with managing stress, diet factors, or even recognizing what your low blood sugar reaction is. I’ve told you some of the common symptoms, but no two people have the same experience when it comes to low blood sugar. I like to compare low blood sugar symptoms to poker: everyone has their own “tell.”  I’ve had people tell me “I know when I’m getting low. I see black spots/my tongue tingles/I get jumpy inside like I have bugs on me/I can’t hear clearly.”  This is also an opportunity to incorporate your support network (spouse, family, and friends) into the education about low blood sugars. Remember, some people get low so fast they’re not aware of the symptoms but a coworker or spouse can quickly pick up that they’re speaking without making any sense or sweating profusely. It’s also important to curtail your alcohol consumption when low blood sugars are an active problem.

I hope this information gives you the chance to start a conversation with your HCP about hypoglycemia AWARENESS so your full time job of diabetes management can be as successful as possible.

Intro to Intervals

July 18, 2013 at 1:30 pm | Posted in Fitness | Leave a comment
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A clock face. Photo credit: Robert Proksa

What’s a common excuse for not exercising?  No time.  With everything we do  every day for work and family, sometimes we’re lucky if you have 30 minutes free for anything else.  Not enough time for a good workout, right?  Well, any activity is better than nothing.  And in any case, it’s not really about how long you spend exercising that matters most but the intensity of your routine.

If you only have a few minutes in your day for exercise, intervals are a great way to get the most “bang for your buck.”  Interval training is alternating bursts of intense activity with periods of rest.  Even if you’re not pressed for time, adding intervals to your workout is an easy way to mix up your routine – good for keeping boredom at bay and breaking out of a fitness plateau.

An interval workout will start with a warm up (foam rolling and/or light activity to get the body moving), followed by a short (like just 1 minute!) burst of intense activity coupled with a recovery period.  The recovery period varies from person to person, but 3 minutes is a good starting point.  Repeat this activity/recovery pattern two to three more times, cool down and you’re done.  Total time spent:  about 20 minutes.  As your fitness level increases, you can add more intervals or adjust the activity/recovery times so your workout stays challenging.  If you have access to a trainer at a gym, they can work with you to create a personalized interval training plan that will help you reach your goals.

Interval training doesn’t require any special equipment, and it’s easy to incorporate into just about any activity.  A few ideas to get you started:

  • Add a short sprint to your walking routine
  • Increase the incline on the treadmill
  • Bump up the resistance when using an elliptical

Now for the disclaimer:  interval training may not be right for everyone.  The short burst of activity in each interval is meant to be done at a level you find strenuous but not impossible.  It’s not a good idea to jump right into interval training if you’re just getting started with a fitness routine.  Check with your healthcare provider first to make sure it’s safe for you do intervals.  If your provider gives you the OK, it’s recommended to do interval training on alternate days so your body has a chance to recover.

(Content reviewed by The Clubs at Charles River Park. Photo Credit: Robert Proksa)

De-Mystifying Pilates

June 13, 2013 at 1:15 pm | Posted in Fitness | Leave a comment
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By Janet Livingston, Fitness Instructor
The Clubs at Charles River Park

Pilates is a complete range of exercises that can be done anywhere, can increase flexibility and core strength, and help improve postural awareness.  People from all walks of life can do Pilates – you don’t have to be an athlete or a dancer (or even super flexible).  It’s especially user friendly for “non-gym” people as it’s very easy on the joints and there’s very low risk of injury.  I like to say if you can get on and off the floor, you can do Pilates!

While Pilates doesn’t elevate the heart rate (it’s not cardio based and doesn’t involve lifting weights), it is a good compliment to more traditional workout programs.  Mat Pilates focuses on strengthening the core – the abs, back, hamstrings and glutes – which can help improve posture.  We spend so much of our day hunched over (driving to and from work, typing on a computer, etc); I’ll sometimes describe Pilates as a way of undoing what we did all day.  Poor posture is the cause of many back problems, but as you become more aware of your posture you’ll start to catch yourself if you start slipping into bad habits.  Another “side benefit” many people experience with Pilates is a sense of relaxation:  they’re so focused on what they’re doing in class that they can’t think of anything else.

When you arrive at your first class, one of the first things you want to do is tell the instructor you’re new and let them know about any injuries or recent surgeries.  This will help your instructor modify exercises during class – with all the modifications available there are very few injuries we can’t work around.  However, if anything hurts something is not right. Don’t be afraid to tell your instructor if something feels wrong.

People can sometimes feel anxious with all the cues given during class, but know you can choose which ones to follow. The most important thing is that you remember to breathe!  Also, don’t feel discouraged if you can’t do a certain exercise the first time.  Classes are built on a pattern of progression and regression to build up the difficulty. If you start feeling a little frustrated, focus instead on what you can do and don’t give up.

Still not sure you’re ready to sign up for a class?  Give it a try at home first.  Comcast has Pilates and yoga videos in their On Demand library.  If you have Internet access, YouTube is another great place to find free Pilates videos (I recommend the ones by Winsor Pilates).  And always, check with your healthcare provider first before starting a new exercise program.

Janet is a STOTT® Pilates certified instructor and NASM Certified Personal Trainer at the Clubs at Charles River Park

Healthy Vision Month: Cataracts

May 16, 2013 at 2:48 pm | Posted in Guest Post, Health | Leave a comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Much like with a camera, the lens of the human eye helps to bring the image  you’re looking at into focus.  The lens measures in length about half the diameter of a dime and is made of a gel-like protein called collagen. Through the work of thin muscle fibers, the lens changes its shape to bring objects into focus.  With age, pigment can collect and cloud the crystal clear lens resulting in vision loss. This clouding of the lens, called a cataract, is the leading cause of blindness worldwide.  Since the normal aging process is one of the main causes for cataracts, we are all at risk for developing cataracts.  However, people with diabetes, those who use corticosteroids for an extended period of time (for instance as treatment for asthma or arthritis), who smoke, or have a family history of cataracts are at increased risk.

Though painless, the presence of a cataract may cause symptoms such as increased glare from lights, difficulty with night driving, difficulty reading, and reduced ability to appreciate colors. The severity of these symptoms can increase over time and begin to impact one’s lifestyle. Though your health care provider may be able to pick up the presence of a cataract during a routine visit using an ophthalmoscope, you will need a comprehensive exam and detailed vision testing by an ophthalmologist to fully assess a cataract. Recommendations on management and treatment is based on this assessment.

Currently, the only treatment for cataracts is surgery, normally done in an outpatient setting.  Depending on the degree of the cataract and its impact on vision, the ophthalmologist may recommend observation and follow up vision testing for a period of time, or proceeding with surgery to treat the cataract.  With surgery, the clouded lens is removed and replaced with an artificial one made of plastic or silicone to restore vision. Results are usually apparent right away within hours to a few days of post-operative healing.

Though there is no proven therapy to reduce or slow the progression of cataracts, some studies have suggested that eating a healthy diet rich in fruits, vegetables and vitamins such as lutein is associated with a lower risk of developing a cataract. In addition, since smoking is a risk factor for cataract development, quitting tobacco use may help prevent cataract formation.

Healthy Vision Month: Glaucoma

May 9, 2013 at 11:17 am | Posted in Guest Post, Health | Leave a comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Eyesight develops from the initial rudimentary flickers of a newborn to the full kaleidoscope of adult vision over the first three to five years of life. Our sense of vision has such a powerful impact on how we define ourselves, our loved ones, and the world in which we live.  Yet it’s one sense that can slowly slip away as we age.  Glaucoma and cataracts are two of the most common causes of vision loss and blindness in the aging adult population. But here’s some good news:  both conditions are treatable when caught and acted on early.  I will look at both in depth, starting today with glaucoma and continuing next week with a discussion on cataracts.

Glaucoma is a disease of increased pressure in the eye leading to damage of the optic nerve – the nerve that carries all the visual information our eyes pick up to the brain where it is interpreted. Think of the eye as a fluid filled, globe-like structure with the optic nerve exiting the back like the electrical cord on a toaster or TV. If the flow of fluid in the eye is not kept in balance, increased fluid pressure can develop inside the globe leading to compression and irreversible damage to the optic nerve.  There are two main types of glaucoma:  open angle, which accounts for approximately 90% of the glaucoma in the United States, and closed or narrow angle glaucoma.

Open angle glaucoma affects about 1 in 200 people over the age of 50.  A slow, chronic process, this type of glaucoma develops over a number of years. In fact, open angle glaucoma is often called the ‘silent thief of sight’ because of its painless presentation. However, once vision loss sets in, it is progressive and irreversible. People at increased risk for glaucoma include those with a family history of the disease; African Americans and Latinos; and people with heart disease or diabetes.   The risk of developing glaucoma also increases with age for everyone, regardless of whether they have any of the above risk factors.

So if glaucoma is “silent” how can you detect changes in time for treatment to be effective? Your health care provider can detect early changes with an eye exam before noticeable vision changes develop. In addition to examining the optic nerve, they will do a formal visual field test, measure intraocular pressure (fluid pressure in the eyes), and observe for any changes in eye size and shape. Although there is no cure for glaucoma at this time, early detection and initiation of treatment can help halt or slow down the progression of the disease. Treatment may entail prescription topical eye drops, laser therapy, or surgery. If you are prescribed eye drops for glaucoma, it’s crucial you take them as directed —not keeping up with treatment is a major reason for progression to vision loss. The American Diabetes Association also recommends seeing an eye care professional (either an ophthalmologist or optometrist) for a comprehensive eye exam at least once a year.  Don’t hesitate to ask if your provider is familiar with identifying and treating glaucoma and other diabetes eye conditions.

In contrast to the quiet and slow progression of open angle glaucoma, closed angle glaucoma is a medical emergency. Closed angle glaucoma presents with sudden vision loss and pain that often prompts one to seek medical care right away. In addition, a person may experience any of these symptoms:  seeing halos around lights, nausea and vomiting, developing a red eye and/or a fixed and dilated pupil. Again, this form of glaucoma is considered a medical emergency – if you experience any of these symptoms seek medical attention immediately.

Spring/Summer Fitness Twitter Chat

April 29, 2013 at 10:59 am | Posted in Announcements, Fitness | Leave a comment
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A big thanks to everyone who tuned-in to our fitness chat this week – our best one yet!  We’ve put a transcript up on Storify, so if you missed it you can still catch up.  Lots of good info on starting a fitness routine in there, so definitely worth a read.


MGH logo with blue circle

Join us Wednesday, May 22nd at 2pm EST for a chat on starting a fitness routine for spring and summer.  Mike Bento, Personal Trainer at The Clubs at Charles River Park, will lead the discussion and answer your fitness-related questions.

Discussion topics will include:

  • Is cardio or weight training better for diabetes?
  • Are machines or free weights better for strength training?
  • Is there a best time of day to exercise?

Follow #MGHDSME for more details.  If you’d like to submit a question for our chat, e-mail diabetesviews@partners.org.

Find us on Twitter: @MGHDiabetesEd

Changing Seasons, Changing Habits

April 18, 2013 at 1:13 pm | Posted in Fitness, Guest Post | Leave a comment
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By Monica

Changing the way we do things, especially if it’s something we’ve done for a long time, is the hardest task anyone can ask.  We create a comfort zone of tranquility, serenity and calmness that our mind comes to prefer.  But it is not always the best.

As we get older, our appetite changes.  Our metabolism is different too, and we burn fewer calories.  We need to change the way we eat and learn to substitute in healthier foods.  And in order to continue to maintain a good healthy lifestyle, our daily routine needs to shift in a more active and productive way.  It’s not always easy, but it can be done with support from friends and family.

Regular activity is not just for little kids or young people – we all need to be active, and it’s never too late to start.  We had such a long winter; now that spring is finally here we have a chance to go outside and enjoy the warmer weather.  It’s also a perfect opportunity to change some of your habits.  Rather than just sitting in the sun, go for a little walk.  If you can, bring along a friend or co-worker.  You’ll be doing something good for yourself and getting a chance to be social at the same time.

Is there an activity you’ve always wanted to try?  Go for it!  Just about everyone has something they’ve said they’d like to try “someday.”  Well, why not now?  If you go to a gym, ask if they will let you try out a class to see if you like it.  There are also some programs in Boston that plan community fitness events or offer free classes like yoga and Zumba in spring and summer.  The Boston Natural Areas Network is another great group that organizes community activities like bike rides, canoeing and gardening – great opportunities for families to do something healthy and active together.

Let the change in seasons inspire you to get out there and get moving.

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