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.

Heart Month: The Health of Your Heart

February 28, 2013 at 3:36 pm | Posted in Health, Heart Health | Leave a comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

The heart is an amazing organ. From the time we’re embryos until the day we die our hearts are constantly beating, ticking away at sixty to one hundred beats per minute.  The heart is the organ in the human body  we most commonly associate with emotions and passions. We can actually feel it beating fast with excitement and slowing down as we rest, sleep and dream. How do we take care of such an important organ? We can best answer this question by taking a close look at what can go wrong with the heart.

The American Heart Association estimates that approximately 600,000 people die of heart disease in the United States each year.  What we most often mean when we talk about heart disease is actually coronary heart disease. The heart is a muscular organ and just like any muscle its shape and form directly affect its ability to do its job: pumping blood carrying oxygen and nutrients to every inch of the body. And just like every other organ, the heart muscle needs the right nutrition and care to work properly. It gets its vital nutrients and oxygen not from the blood it holds and pumps out,  but from blood that travels in vessels lying along its outer walls (these vessels are called the coronary arteries). If you were to look straight on at the heart, you would see these vessels wrapping like ivy on the heart’s surface.

The coronary arteries need to remain clean so that blood can flow freely through them to nourish the heart muscle.  Atherosclerotic plaque, a mixture of cholesterol and other debris which can stick to the walls of the coronary arteries, can interfere with the delivery of nutrients to the heart.  In certain spots the lump of sticky plaque can build up to such a degree that it limits or even blocks blood flow through a particular artery. When this happens, the portion of heart muscle that depends on the blood supply from this artery becomes unhealthy, weak, and can even die. But the heart depends on every single muscle fiber to be healthy and strong in order to pump well, so bad blood flow through even a single coronary artery can potentially affect the heart’s important squeezing ability and cause heart disease.

A lot of research has gone into figuring out how to prevent and even get rid of plaque build up in the coronary arteries. Since a major component of plaque is cholesterol, it’s thought that a low cholesterol diet is a key factor for  preventing coronary plaque formation. In addition to diet, smoking and high blood pressure can increase the chances of plaque formation. For unclear reasons, people with diabetes seem to be more prone to developing coronary plaque as well.

Health care providers may recommend aspirin, blood pressure, or cholesterol lowering medications for good heart health.  Maintaining a healthy diet low in sodium and cholesterol, exercising regularly, maintaining a healthy weight, keeping your blood sugar in good control and quitting smoking can also help prevent plaque buildup and resulting heart disease. So take this moment to listen to your heart and talk with your health care provider about taking steps toward beating heart disease.

Suzie and Ray: No Exercise Excuses

February 25, 2013 at 1:00 pm | Posted in Comics, Guest Post | 2 Comments
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exercise_excuses

Exercise Excuses: Busted

January 31, 2013 at 1:00 pm | Posted in Fitness | Leave a comment
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Sign "To Gym". Photo Credit:  Christian Robertson Have you seen this commercial where a couple lists off the various reasons they couldn’t work out?  While some of the excuses are pretty funny (“Wednesdays are weird” is a favorite), they all emphasize one thing:  there is an almost limitless list of excuses for skipping out on regular exercise.  Here are some common excuses for not exercising – and ways to work around them.

I don’t have time:  We live in such a go-go-go society that sometimes knocking exercise off the To-Do list seems the only way to get everything done.  If that sounds familiar, maybe you need to rethink your approach.  In order to make regular exercise a part of your routine, you have to make it a priority.  Treat exercise like you would a meeting with your boss or a co-worker (think of it as a meeting with yourself).  If you still have a hard time carving out 30 minutes at a time to work out, try breaking it up into 10 minute segments throughout the day (this video from the Institute of Lifestyle Medicine is a great full-body workout you can do right at your desk).  If all else fails, multitask.  See if there are places you can fit in a little movement through your day, whether it’s walking around the office while on a conference call or doing some bodyweight exercises during commercial breaks at night watching TV.  Remember, a little bit of exercise is better than none at all.

Need to Care for Kids / Family:  Balancing work with the needs of kids and family is a major contributor to the lack of time mentioned above, so the same advice can apply here.  Another option is include your kids in your workout routine.  You’ll be setting a good example for the little ones, getting them on track to start healthy exercise habits of their own, and spending some quality time together as a family.

I don’t have access / like going to the gym:  Gyms and health clubs can be intimidating and aren’t a good fit for everyone.  The good news is you can still build a regular fitness routine without a gym membership.  Walking is one of the easiest ways to fit exercise into your day, and all you really need is a good pair of walking shoes.  There are a number of places to walk in Boston, and enough scenery to keep your walk interesting.  Weather causing you to move your workout indoors?  See if you can borrow a fitness DVD from your local library.  If you have Internet access, websites like sparkpeople.com have a selection of workout videos you can access any time – for free!

It’s boring!:  Okay, we’ll admit running on the treadmill, staring at the same wall day after day gets old.  If this is the reason you dread going to the gym, it might be time to try a new activity.  Adding variety to your workouts is not only good for your mind (by keeping boredom at bay) it’s good for your body too.  Changing up activities can prevent injury, and keeping your body guessing is one way to break through weight loss plateaus.  You could also try changing your scenery.  Going for a walk or bike ride outside gives you something new to look at (and you can easily add challenge by changing your route).  If all else fails, see if a friend can come with you.  Having someone to talk to while you work out can make the time fly by.

(Content reviewed by The Clubs at Charles River Park. Photo Credit: Christian Robertson)
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