Tag: blood sugar control

Announcements

Diabetes Care Redesign: Update

Posted on by mghdiabeteseducation

Mass General Hospital ShieldMass General Hospital is undergoing a process of redesigning care delivery to increase the value and quality of care.  In the area of diabetes care, the emphasis has been on collaboration across disciplines to support patients on insulin.  To this end, the Diabetes Care Redesign Team called together a multidisciplinary team of stakeholders (including representatives from primary care, nutrition and endocrinology among others) to develop a set of best practices for starting patients on insulin.

A pilot program using this new process was developed and tested at three sites in and around the hospital.  This new process creates a diabetes care team, led by a designated diabetes nurse champion, for each practice.  Physicians work in close partnership with nurses and dietitians, making it easier to stay in touch regarding patient care.  Patients are supported between office visits through frequent follow-up phone calls by their care team and use of the Patient Gateway or iHealthSpace internet health portals.  The pilot program helped improve blood sugar control without increasing side effects. It is has now been expanded to all Mass General primary care practices.

The biggest challenge thus far has been wider implementation of this new care model at a time when the hospital is transitioning into the Patient-Centered Medical Home.  To support efforts at sustainability, twice yearly conferences were established to support teams and promote knowledge sharing.  These conferences also serve as a venue for teams to troubleshoot with peers over problems they have encountered, and review best practices.

Last May, the Diabetes Care Redesign Team was one of several groups to receive the Nathanial Bowditch Prize in recognition of their work improving quality of care while reducing cost.  Receiving the award was a gratifying experience, confirming that hospital administration believes in this new care model.  Funds received with the award are being put toward conferences and training to further support program growth.

The Diabetes Care Redesign team will be participating in the MGH/MGPO Care Redesign Fair next Wednesday, September 4th.  All are welcome to come and learn more about the ongoing work to improve care delivery across clinical areas.  The fair will be held 9am to 2pm under the Bulfinch Tent.

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Fitness, Guest Post

Overcoming Barriers to Fitness (Weight Management Part 3)

Posted on by mghdiabeteseducation

By Mike Bento, Personal Trainer
The Clubs at Charles River Park

Blue Dumbbells. Photo Credit: Christa Richert

I like to think of fitness as a risk management tool.  What you do today can have an impact on both your current state and on your future.  Developing a healthy lifestyle can help lower your blood pressure, reduces your risk of having a stroke, and can help protect against developing cardiovascular disease and certain cancers.  But there’s an emotional component to fitness as well. 

As your fitness level increases, daily activities become easier; you find you want to do more.  And more than that, you start to feel good.  Your mood improves, you have more energy (especially at the end of the day and the end of the week) and your sleep gets better.  All of these “extra” benefits are just as important as actually working out because they help you stay consistent.  Sticking with it is crucial—to really see results and get the full benefit of your routine you have to make exercise a habit.

But just as there are emotional factors that can help you build momentum, there are others that can be obstacles to beginning (or staying with) your fitness routine.  For some people, it’s fear of change.  If you’ve never really exercised before, starting a fitness program can mean moving outside your comfort zone.  Change can be difficult or even scary.  It doesn’t happen overnight; it takes time and reinforcement, but it does get easier as you go along and start seeing results.  Maybe it’s your clothes feeling a little looser, your waist getting a little smaller, or just someone commenting that you’ve lost weight.  Or maybe you notice your blood sugars are easier to control, or you’ve lowered your blood pressure.  And maybe it’s that you just feel better.  Any or all of these things can be the right motivation to keep doing what you’re doing.

At the end of the day, you are the only person who can do this for yourself.  It’s one thing in your life that you have complete control over.   And that can be very empowering.

Photo Credit: Christa Richert

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Health, Nutrition

Weight Management (Part 1)

Posted on by mghdiabeteseducation

Debra Hollon, MS, RD, CDE, LDN
Senior Clinical NutritionistPear and tape measure. Photo credit: Asha ten Broeke

Now that we’re more that three months into the year, how are you doing with your New Year’s resolutions?  If you’re still sticking with it, good for you!  It takes a lot of commitment to keep up a major lifestyle change.  For many people, maintaining a healthy weight is a key part of their Diabetes management plan.  If you’re having a hard time reaching your weight loss goals, don’t give up.  You may just need to rethink your strategy.    

Weight loss is all about balancing calories—how many calories you consume vs. how many calories you burn.  One of your first steps is figuring out how many calories you need to consume a day in order to lose weight.  Your health care provider or a nutritionist can help you figure this out, but you can estimate your ideal calorie intake by multiplying your weight by 10 (again, this is only an estimate—you should still contact your health care provider for more tailored guidelines).  Your next step is paying attention to how many calories there are in the food you eat and watching your portion size.

I often suggest people think of their daily calorie intake as a budget.  You can “spend” those calories on whatever you like (ideally produce, whole grains and lean protein sources), but stop and think is it going to be worth it?  Keeping a food diary of everything you eat can be helpful for staying on top of your calorie intake.  Oftentimes people find they eat less simply by writing down what they ate every day.  Plus, it keeps you accountable.  There are a number of great programs out there now that can help you track your calories for free.  Lose It!, My Fitness Pal, and Fit Day are good choices. 

Remember, the scale is only one way to measure success at your weight loss efforts.  I once had someone suggest using the “pant-o-meter”, which is simply being aware of how well your clothes fit; as you lose weight, they’ll start to feel looser.  Other markers for success are better blood sugar control, lower blood pressure readings and lower cholesterol levels.  Next time, we’ll talk more about what makes up a healthy diet.  If you have any questions, leave us a comment below.

(Photo credit: Asha ten Broeke)

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Health

Diabetic Nephropathy

Posted on by mghdiabeteseducation

By Eileen B. Wyner, NP
Bulfinch Medical GroupEileen W

Diabetic Nephropathy (DN) or kidney disease is a potential complication of Diabetes. It may occur in people who have been living with Diabetes for a long time, as well as in people whose Diabetes is poorly controlled.  All people with Diabetes are at risk for DN but it appears that risk may be higher for people who are of Hispanic, African American, or Native American ethnicity.   

We are born with two kidneys which are responsible for several important bodily functions, the most well known being the making of urine (necessary for the removal of waste products from the bloodstream).  The kidneys also help to control blood pressure by regulating our water and mineral balance (also known as our electrolyte balance), and maintain red blood cell count by signaling the bone marrow to increase production of these cells.  Kidney disease occurs when blood sugars are continually too high. The filter system in the kidneys becomes damaged, allowing small amounts of protein to leak out through the urine. This is a painless condition without any symptoms at first, but over time will lead to high or hard to control blood pressure and lower extremity swelling if not treated.

The first step in preventing DN is maintaining good blood sugar control—the closer to goal you can keep your A1C safely, the better it is for your kidneys.  The next step is getting a microalbumin test when you see your health care provider.  This test checks for the presence of a protein called albumin in the urine.  Albumin is normally found in the blood and filtered by the kidneys; when kidneys are working properly albumin is not found in the urine.  When the kidneys are damaged, small amounts of albumin leak out into the urine.  This condition is called microalbuminuria.  The American Diabetes Association recommends receiving a microalbumin test at diagnosis and at least annually afterwards.

Managing elevated microalbuminuria includes working hard at getting your A1C to goal and starting a medication from the class ACE or ARB.  You may know these medications by their common names:  lisinopril or diovan. These medications are used for blood pressure control and are also a good choice for protecting your kidneys.  You may already be on one of these medications and the dose may need to be adjusted as needed.

Long term complications of DN can increase your chance of developing heart or blood vessel disease. Your kidneys may fail and you may need to start dialysis to filter your blood.  You may even need a kidney transplant. There is no cure for DN, however early identification and treatment can decrease worsening complications. When you go for your next Diabetes appointment, ask your health care provider about a microalbumin test to check your kidney status and start working on preserving it.

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