Health

Wishing you a Healthy Holiday

Thanks to everyone who joined and followed our healthy holiday photo challenge!  Wishing you a happy and healthy new year.

BeFunky Collage

Gratitude – Gratitude can reduce stress/anxiety and improve relationships.

Colors – Quick and healthy holiday appetizer: colorful veggies and hummus.

Evergreen  – Sneak some exercise into your day:  use the season as an excuse to go for a walk and take in the holiday decorations.

Prioritize – Trying to “do it all” is a common cause of holiday stress. Focus on the things that are most important to you – anything else is bonus.

This makes me happy – Taking time to do something you enjoy (any time of year) helps reduce stress.

Relax – Research shows listening to your favorite music can help you relax.

Healthy Swap – Steamed fresh or frozen green beans are a healthy side dish alternative to green bean casserole.

Exercise – Sneak some exercise into your holiday shopping by doing an extra lap around the mall.

Breathe – When the holiday cheer starts getting to be too much, try a mini meditation like this one from the Benson-Henry Institute.

Peace – Remember to take time for activities (yoga, meditation, even a walk outside with family) that help you unwind and find peace.

Hydrate – Keep a water bottle nearby to remind you to sip water through the day.

Moderation – Using a smaller plate at meal time can help with portion control.

Decorate – Multitask to fit in some fitness:  turn up the holiday music and dance while you decorate.

Sports – Winter activities like sledding, skiing, ice skating or making a snow man are great ways to exercise outside with family in winter.

Unplug – Putting away phones and other devices for a time can reduce stress and help you feel more connected with loved ones.

Light – Happy #Hanukkah! Enjoy this sweet potato pancake recipe from MGH Be Fit.

Minimize – Over scheduled? It’s okay to say no! Only take the commitments you want/can do.

Sleep – Stick with your regular sleep routine during the holidays.

Something I enjoy – There’s so much to do during the holidays, but be sure to plan some fun activities too!

Mindfulness – Choose foods you really want to eat and focus on the taste and texture of each bite.

Fun and games – Plan family activities that take the focus away from food.

Fresh – Buying produce in season is a great way to save on fruits and veggies. DYK – Brussels sprouts (in season now) are a source of vitamin C?

Anything you like – Finding a way to laugh (like a surprise visit by a cute puppy) is a great way to relieve holiday stress.

Act of kindness – Research shows simple acts of kindness can reduce stress levels.  These gifts were wrapped as part of a charity toy drive.

Healthy treats – Don’t go to the party hungry! Have a healthy snack (like a handful of nuts) before you leave the house.

Cranberry – DYK cranberries are a good source of vitamin C? Try them in this recipe from the MGH Be Fit program: Parmesan Almond Crusted Chicken Breast Stuffed with Cauliflower and Dried Cranberries.

Positive vibes – A positive outlook will help with coping with challenges you may face during the holidays.

Memories – Remembering loved ones who aren’t there is helpful in bringing the family together. H/t MGH Clay Center for Young Healthy Minds.

Tradition – As you take part in holiday traditions, take a deep breath and savor the moment.

Community – Schedule “together time” with those you most want to see during the holidays.

 

 

 

 

 

 

 

Health

Healthy Holidays Photo a Day Challenge

Join us for a healthy holidays themed photo a day challenge starting November 27!

PhotoADay

 

How to play:  Take a photo each day of the challenge, using the prompt for that day as inspiration.  Post your photo on Instagram, Twitter or Facebook (or all three!) with the hashtag #DSMEHealthyHoliday.  Follow along on our  Instagram page for healthy holiday tips.

Daily Prompts:

Gratitude
What does gratitude look like for you?

Colors
Post a picture of something colorful you saw today.

Evergreen
Go outside sometime today and take a picture of an evergreen (or anything green).

Prioritize
What is most important to you during the holidays?

This makes me happy
What makes you happy during the holidays?

Relax
The holidays can be stressful. What’s something you do to relax?

Healthy Swap
What’s something you do to make a recipe healthier?

Exercise
There’s always so much to do during the holidays.  How do you fit in exercise?

Breathe
When you’re feeling overwhelmed, stop and take a breath.  What does that look like?

Peace
What does peace look like to you?

Hydrate
Enjoy your holiday drinks, but don’t forget water! How do you remember to drink water through the day?

Moderation
The holidays are full of treats and feasts. How do you practice moderation?

Decorating
Share how you incorporate physical activity in your holiday decorating.

Sports
Do you enjoy winter sports? Share an outdoor activity you did today.

Unplug
Power down your devices for at least an hour today. Show us what you did!

Light
How is light used in your holiday celebrations?

Minimize
Trying to do EVERYTHING is a big source of stress. Show us how you keep your “to do” list from becoming too overwhelming.

Sleep
Getting enough enough sleep helps keep the immune system healthy which can protect against colds and flu.  How do you make sure you get in your 8 hours of sleep during the holidays?

Something I enjoy
What do you enjoy most about the holidays?

Mindfulness
How do you practice mindfulness during the holidays?

Fun and Games
Fun activities with friends/loved ones can help reduce stress. What did you do today?

Fresh
Post a picture of something new or fresh you saw or did today.

Anything you like
Wildcard! Post a picture of anything holiday related today

Acts of Kindness
Small things mean a lot. Share an act of kindness you experienced today.

Healthy treats
Do you have a go-to healthy holiday treat? Show us!

Cranberry
Cranberries are a good source of vitamin C. Show us how you use cranberries in your holiday meals.  Or, take a picture of something cranberry colored.

Positive vibes
How do you stay positive in times of stress?

Memories
The holidays can be difficult for some. Post a picture of something that brings back a happy memory.

Tradition
What are some holiday traditions in your family?

Community
How does your community come together for the holidays?

Health

Understanding Emotional Eating

Have you ever come home after a stressful day and ended up eating a pint of Chunky Monkey?  Or maybe you’ve mindlessly eaten a bag of chips at your desk willing the workday to go by faster?  Both of these examples are types of emotional eating:  eating for reasons other than hunger.  While eating when you’re  hungry addresses a physical need (providing the body with food in order to function), emotional eating uses food to satisfy an emotional need.  Some common causes of emotional eating include stress, anger, boredom and loneliness.    Emotional eating can affect your diabetes management because often the foods eaten are high in sugar, fat and calories.  This can raise blood sugar and make it hard to lose weight.

So how can you tell if you’re eating because you’re hungry or because you’re stressed out?  Physical hunger comes on gradually and can be satisfied by any type of food. You stop feeling hunger when you have eaten enough to feel full.  Emotional “hunger” comes on very quickly and is focused on a strong craving for a particular food, taste or texture. Emotional eating is also often mindless and can lead to feelings of guilt afterward.

Now that we know the difference between physical and emotional hunger, here are some strategies to help manage emotional eating:

  • Know your triggers – If you know what it is that causes you to eat (e.g. boredom, stress), you can take action to prevent mindless munching before it begins. Use another activity to distract yourself from wanting to eat. Try going for a walk, talking to a friend or loved one, or listening to music.
  • Pause – Before reaching for the bag of chips, stop and think: am I hungry, or am I bored? Wait 10 minutes and see if you are still truly hungry.
  • Eat smaller portions –   If you wait 10 minutes and still can’t stop thinking about those chips, have a smaller, individual portion to keep you from overeating.
  • Practice mindful eating – Slow down and take the time to really enjoy the smell, tastes and textures of your favorite foods. Try not to multi task – make eating your only activity.
  • Seek help if you need it – Emotional eating can sometimes be a symptom of depression or anxiety.  If you feel this may be the case, talk to your healthcare provider, a diabetes educator or a mental health specialist.

Post content reviewed by Jen Searl, MLS, CHWC

Health

Standards of Medical Care in Diabetes 2017: Diabetes Medications

Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

I recently reviewed updates to the American Diabetes Association’s (ADA) Standards of Care for 2017.  In this post, I’ll review Section 8 of the standard that talks about different medications for treating diabetes. I will also discuss some of the newer medications used to treat diabetes.

Type 1 Diabetes is always treated with insulin, either through multiple injections or an insulin pump. Type 2 Diabetes can be treated with oral medications (pills by mouth), injections, or both.  The ADA recommends that people with Type 2 diabetes start patients start with the pill metformin, as long as it safe for them to take it.    Taking metformin for a long time may lead to not getting enough Vitamin B12, stomach symptoms, and can affect how well the kidneys work (your care team will monitor your kidneys to be sure they are working properly).

If someone is taking one oral medication at the highest possible dose but their A1C is still not at goal, providers should consider adding additional medications:  another oral medication, long acting insulin (injection), or a non-insulin injectable medication called glucagon-like peptide 1 receptor agonists (GLP-1 receptor agonists).

Examples of GLP-receptor agonists are exenatide (Byetta), liraglutide (Victoza), and dulagultide (Trulicity).  These medications cause food to move through the stomach slower so people feel full sooner. This leads to less glucagon (another hormone made by the pancreas) being released after meals and lowers appetite, which helps with weight loss.  These medications need glucose to work, so there is little chance of hypoglycemia.  Side effects include nausea, vomiting and acute pancreatitis. They may also cause medullary thyroid cancer in animals. It should be noted that these medications are expensive.

People with poorly controlled diabetes and atherosclerotic cardiovascular disease (ASCVD aka heart disease) may benefit from a new medication called empagliflozin (Jardiance), a type of medication called SGLT-2 inhibitor.  These medications work by preventing the body from reabsorbing glucose. This lets more glucose leave the body through urine.  People may have lower blood sugar values after eating and lose some weight.  Studies show empagliflozin helped reduce deaths caused by heart attack, stroke, and cardiovascular disease.  Empagliflozin is the only SGLT-2 inhibitor with these results, but other medications are being studied (liraglutide [Victoza] may have the same results, but other GLP-1 receptor agonists are not used this way).  Potential side effects include hypoglycemia, low blood pressure, dizziness, urinary tract infection, needing to urinate a lot, and increased LDL and creatinine (a waste product filtered out by the kidneys).  Again, these medications are very costly.

There are many medications available for the treatment of diabetes. These standards are general recommendations for medical care.  Always discuss questions about your care plan with your healthcare provider.

Health, Uncategorized

Standards of Medical Care in Diabetes 2017 (Part 2)

Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

This week is part two of my review of the revisions to the 2017 American Diabetes Association Standards of Care (click here to review Part 1).  First, a quick reminder that these are guidelines; always discuss questions about your personal health care plan with your health care provider.

Section 6: Glycemic Targets

The International Hypoglycemia Study Group has recommended that serious, clinically significant hypoglycemia be defined as a reading of less than 54 mg/dL. People who have experienced such measurements need to notify their health care providers immediately and be prescribed a glucagon emergency kit.

Hypoglycemia measuring less than 70 mg/dL is still treated by the rule of 15: 15 grams of fast acting carbohydrate with a blood sugar check in 15 minutes for an expected increase by at least 15 points. Repeat the process if the result doesn’t improve.

Section 7: Obesity Management for the Treatment of Type 2 Diabetes

The best blood sugar results occur with weight loss early in the management of Type 2 Diabetes, before beta cells begin to stop working. For this reason, metabolic surgery (formerly referred to as bariatric surgery) is now recommended for people with a BMI of 30 (or 27.5 for Asians with poorly controlled diabetes).

Section 9: Cardiovascular Disease and Risk Management

Any of the medications for managing high blood pressure can be used (except for beta blockers) as long as the person doesn’t have protein in the urine (albuminuria). One or more medications should be used at bedtime to improve blood pressure control.

The goal for blood pressure for pregnant women is 120-160/80-105.  When prescribing medications, providers should consider both maintaining the health of the mother and avoiding harm to the baby.

There is a discussion of new medications and the potential benefits for people with diabetes and cardiovascular disease: empagliflozin (Jardiance) and liraglutide (Victoza).

Section 10: Microvascular Complications and Foot Care

There is an increased risk for retinopathy in pregnant women with Type 1 or Type 2 Diabetes.  Thorough eye exams should be a part of preconception counseling as well as during pregnancy.

Anyone being treated for neuropathic pain should be evaluated for the addition of medication therapy with pregabalin (Lyrica) and duloxetine (Cymbalta). They should also be fitted for therapeutic footwear by a podiatrist.

Section 12: Children and Adolescents

Preconception counseling should begin in puberty to help to avoid the risk for birth defects in unplanned pregnancies.

When diabetic ketoacidosis appears in children, it is important to know if the child has Type 1 or Type 2 Diabetes as 6% of these cases are actually Type 2 Diabetes, not Type 1.

Section 13: Management of Diabetes in Pregnancy

Insulin is the preferred treatment for pregnant women.  Oral medications may harm the baby.

Targets for blood sugar are the same for gestational diabetes as for preexisting diabetes.

Section 14: Diabetes Care in the Hospital

It’s now recommended to use basal and/or basal bolus insulin regimes (instead of sliding scale insulin alone) when patients are admitted to the hospital.

Health

2017 Standards of Medical Care in Diabetes (Part 1)

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people diabetes. I will review the standards that have had changes made in them for 2017.  Section 8 (Pharmacologic Approaches to Glycemic Treatment) is a very important section with a great deal of information, so it will be covered in a separate post.

This year the Standards of Care have been updated to address psychosocial issues in all aspects of care.  This includes the importance of assessing self-management capabilities, mental health status, and complications and comorbidities.  These standards are meant to provide general treatment goals and are not meant to replace clinical judgment.   This post is a brief overview of the changes to the standards; click here to access a full list and descriptions.  Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.

Section 2: Classification and Diagnosis of Diabetes

There is a new consensus on staging Type 1 Diabetes. Three stages have been identified:

  • Stage 1 – no changes in the blood glucose values and no symptoms are present
  • Stage 2 – some impaired fasting blood glucose and possibly some impaired glucose tolerance, too
  • Stage 3 – the stage that most people are diagnosed. They may appear with dangerous hyperglycemia and have symptoms such as excessive thirst, hunger and urination

Investigators hope to use this staging system as a research road map to help better plan intervention strategies.

A new risk test has been developed to help to identify people with prediabetes and undiagnosed diabetes as soon as possible. Click here to see the test and share with loved ones.

Dentists are also are important in identifying people with diabetes. One study shows 30% of people over 30 that are treated for periodontal disease have abnormal glucose levels. Educating dentists to refer these individuals to their health care providers for formal assessment will be helpful in identifying at-risk people sooner.

Birth weight of infants is no longer a risk factor for Type 2 Diabetes. Women who had gestational diabetes should have their fasting glucose test done 4 to 12 weeks after having their baby (instead of 6 to 12 weeks).  The hope is that most women will have the test done before the 6 week checkup so they can discuss results and implications with their provider.

Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities

This is a new section highlighting screening for, and management of, comorbid conditions in people with diabetes. Assessment of sleep pattern and duration has been added as well as HIV, autoimmune diseases, depression and anxiety, and disordered eating patterns. Please refer to the full standards to see the entire list of conditions.

Section 4: Lifestyle Management

People following a flexible rapid acting insulin schedule should work closely with a registered dietician for education on counting fat and protein values as well as carbohydrates to be sure they are using correct insulin amounts.

Sitting is the new smoking! Stand up and move a little every 30 minutes. Aim for 150 minutes of exercise per week and try to do strength training 2 to 3 times a week. Balance and flexibility are priorities for older adults, and activities like yoga or Tai Chi are recommended.  There is also a table providing information about situations that may require referral to a mental health professional.

Health

Healthy New Year’s Resolutions

By Annabella He
MGH Dietetic Intern

It’s 2017! At the start of year, you may be making a New Year’s resolution to better manage your diabetes by eating healthier and exercising more. In order to stick to the plan, your New Year’s resolutions should be specific, measurable and reasonable. The following are some specific tips to get you started. Pick one or a couple to work on!

  1. Cut down on portion size: The amount of food you eat for each meal has a huge impact on your blood glucose and weight control. Having a smaller meal keeps your glucose and insulin levels more stable. Also research shows that lowering total calorie intake helps with long-term weight loss, so portion control is the key. Use food labels and measuring cups to accurately gauge your intake.
  2. Eat breakfast: Have a filling breakfast to keep yourself full for longer. Eating breakfast reduces your hunger levels later in the day. A balanced breakfast like whole-wheat cereal with low fat milk and nuts, or scrambled egg with some vegetables are good options. Instead of topping the toast with butter, try avocado to make it tasty and healthy.
  3. Make a balanced plate: Fill half plate with fruits and vegetables, especially brightly colored ones, ¼ plate protein, ¼ plate starch.
  4. Eat more non-starchy vegetables: We always say eat more vegetables, but the kinds of vegetables we eat also matter. Starchy vegetables like corn, green peas, winter squash and potatoes are high in carbohydrate. Eating too much of those will increase your blood sugar, so it’s important to moderate the portion size of these vegetables. Non-starchy vegetables like carrots, broccoli, salad greens and beets contain little or no carbohydrate. Eating more of those vegetables not only stabilize your blood sugar level, but also help fill you up without gaining much weight.
  5. Choose healthy snacks: It’s okay to have some snacks throughout the day to keep your blood sugar stable and promote energy levels. Again, make sure to control the portion size and make healthy choices. Here are some examples of healthy snacks: whole fruits, cut vegetables, almonds, Greek yogurt and low-fat popcorn.
  6. Learn a new healthy recipe every month: Search for new healthy recipes and practice. Cooking at home is fun and it saves money. You are in full control of what’s in your meal. Also, by December, you will master cooking 12 recipes. How exciting is that?!
  7. Drink more water: The daily recommendation is 8 cups of water or other non-caffeinated beverages. Drinking enough water helps you stay hydrated and energetic. Sometimes you may feel hungry, but actually you are dehydrated. Drinking water helps you to not get hunger and thirst confused.
  8. Go to bed early and get enough sleep: Going to bed early keeps you from eating too late at night. Also, getting a good night sleep helps your body process carbohydrate and has a positive effect on weight control.
  9. Exercise more: Try different types of exercise such as walking, running, hiking, yoga or a group class at the gym. Get a pedometer or use phone app to record your steps while walking. Recording your steps can motivate you to try to reach a higher goal by walking more miles.
  10. Stay up to date with medical appointments: See your provider regularly to make sure everything is going well with your diabetes and that you are up to date on your health screenings (including eye exams).
Content reviewed by Melanie Pearsall, RD, CDE