Standards of Medical Care in Diabetes 2017 (Part 2)

February 2, 2017 at 8:15 am | Posted in Health, Uncategorized | Leave a comment
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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.

2017 Standards of Medical Care in Diabetes (Part 1)

January 26, 2017 at 9:05 am | Posted in Health | 1 Comment
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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.

“Everything in moderation!”

October 27, 2016 at 9:00 am | Posted in Nutrition, recipes | Leave a comment
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By Melanie Schermerhorn, Dietetic Intern

Most of us have heard the phrase, “everything in moderation.” Many say moderation is the key to success; for someone who has diabetes this phrase is especially true when it comes to what you eat. Moderation in relation to healthy eating habits, especially portion control, can have a huge effect on your overall health! To break the phrase “everything in moderation” down further, let’s talk about what it means. What your healthcare providers are saying is:  eat a balanced diet most of the time, but do not deprive yourself of the not-so-healthy things you enjoy. In other words, it’s alright to eat them but be sure to have them less frequently and in a smaller portion.

With diabetes this is important for your blood sugar management. The goal is to not completely deny yourself things like chocolate chip cookies, but instead maintain a healthy lifestyle while still treating yourself.  A tip to do this is buy smaller portion sizes, so having one small cookie won’t have as much of an effect on your blood sugar as a larger one would.  Another great way to keep track of your portions is reading the labels on packages for serving sizes. Sometimes a package could be more than one serving!  Sharing a baked good with a friend instead of eating the whole thing can help you consume less as well. You could make homemade treats with healthier ingredients like in the recipe below so you aren’t consuming a heavily processed carbohydrate.  So aim to keep your portions in check and when it comes to sweets “Everything in moderation!”

Recipe: Healthy Banana PancakesCombine 1 ripe banana, 2 large eggs, and a few shakes of cinnamon in a bowl until smooth. Heat up a pan on medium heat and spray with cooking spray. Put a few spoon fulls of the “batter” into the pan. Cook until lightly brown on each side and serve.

Post content reviewed by Department of Nutrition and Food Services

My Story: What I Learned Caring for My Grandmother with Diabetes

September 29, 2016 at 9:24 am | Posted in My Story | Leave a comment
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By Vanessa

My grandmother is a tenacious and vibrant woman who was diagnosed with type 2 diabetes earlier this year. She had uncontrolled blood sugar levels along with other health issues and limited mobility. With no formal educational background, she doesn’t know much about diabetes or possible complications. Her low health literacy makes it difficult for her to utilize diabetes related health care resources.  “There are too many rules in my diet!” she would exclaim in Twi, her native dialect.  She also has low nutritional knowledge and at times would reduce her consumption of certain staple foods. She assumed that eating less of these foods would cure her body from the disease. Her daily diet in Ghana is mostly starchy and sugary foods with low nutritional benefits.  One staple meal that she eats quite often is called fufu:  a soft dough-like mix of cassava, plantain, and other flours served with different types of warm soups full of meat and/or fish.  Fufu is relatively high in carbohydrates and has a significant and rapid effect on my grandmother’s blood sugar levels.

As my grandmother’s caregiver, I provided diabetes care management and education.  My goal was to help her avoid blood sugar spikes keep her blood sugar in a healthy range before she went back to Ghana. Every day I checked her fasting blood sugar in the morning and again two hours after eating.  These results were reviewed by her PCP and nurse case manager.  I modified my grandmother’s meals and incorporated more green leafy vegetables, fiber-rich foods, whole-grain breads and old-fashioned oatmeal with almond milk and honey for added sweetness. I also introduced her to cooked quinoa and cauliflower rice as substitutes for fufu, white rice, and other fufu-like foods to give her meals a nutritional boost. After a meal, I would encourage her to take a walk to the local shopping plaza or to circle around the neighborhood for an hour.  Despite her stubbornness and fiery temper towards changes to her diet, we were able to improve her eating habits by stressing the importance of portion control.

My grandmother does not know how to pronounce diabetes or manage her care on her own, but making sure she understood that her medications, changes to her diet, and daily walks to her favorite consignment stores are effective tools for managing her blood sugar levels were key components to her care plan.  My experience as a caregiver was a wonderful opportunity to spend time with my grandmother, and it also highlighted the importance of diabetes education in following a care plan and reducing risk of complications.  I also learned how that approaching care in a culturally tailored manner that respects individual preferences, opinions and ideas is necessary for reaching optimal health.

 

My Story: Journey Through Weight Loss Surgery

September 3, 2015 at 1:35 pm | Posted in My Story | Leave a comment
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By Isabel

When I was diagnosed with diabetes in 2010, it was a total shock. Even though diabetes runs in both sides of my family (both my grandmothers had it as well as some aunts and uncles), I never felt I would get diabetes. My primary care provider reassured me that WE would get through this and started me on metformin and I learned how to use a glucometer. At the time I thought I’ll just learn what I need to do. When I got home and started looking through my materials, it hit me hard. I broke down and started to cry. I felt that diabetes was a death sentence. I was also angry because I had been going to Weight Watchers and started losing weight! The diagnosis was devastating, but I said: I. Will. Beat. This.

I continued with Weight Watchers, but started thinking what else could I do to help me lose more weight and control my diabetes. So I thought about gastric bypass surgery. Would it be a good option for me, am I thinking this is an easy way out? So I started doing research about diabetes and weight loss surgery. I attended support groups and talked to people about how they felt after having the surgery. I realized that I was going to be 40 in a few years. I said I wanted to be healthy plus, I wanted to have children and would need to be healthy for them. Because of these reasons I decided to move forward with the surgery. My primary care physician was very supportive of my decision and gave me recommendations for weight loss surgeons at a local hospital.

My surgery went well with no complications, however I started to have doubts during my first month of recovery. You can’t eat anything except liquids, and the protein shakes I was supposed to drink made me feel sick. That, and dealing with the pain, made me feel depressed and defeated. To get through it, I kept reminding myself why I had the surgery to begin with. At my first month follow up I had lost 40 pounds and my A1C had dropped way down. I was able to stop taking metformin and my blood pressure medication. Beyond that, I started feeling better and noticed my clothes feeling looser.

As I continued to lose weight eventually I did plateau, but I was ready for it. I kept up with my healthy eating habits, making adjustments until I reached a weight range I felt comfortable with. I had my surgery in 2012, and I’ve lost a total of 95 pounds. Much of my success comes from the lessons learned from Weight Watchers and the “no guilt” attitude of my support group. I have gained a few pounds above my goal range, but it’s okay – I know I can lose the weight again and what I need to do to get there.

Diabetes was like a hit below the belt, but never once did I say “Why me?!” I know it will always be there, and it may come back down the line. For me, gastric bypass was a tool to use to control my weight and beat diabetes. Since my surgery, I have more confidence, am more accepting of my body, and have more energy. I’ve become an educator and advocate for taking charge of your own health. Gastric bypass was a good fit for me, but it’s not for everyone. If you are considering surgery, I encourage you to educate yourself about the different types of surgery available and talk to people who have done it. Do some research to prepare yourself for what happens afterward, and make sure you surround yourself with a strong support network. Do not let anyone make you feel ashamed for having weight loss surgery. Your health is yours, and in the end it’s about you, not them.

Profile: Mushrooms

August 6, 2015 at 11:15 am | Posted in Nutrition, Secret Ingredient | Leave a comment
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By Reneé Ortolani
Dietetic Intern

When talking about fruit and veggie consumption, it’s usually recommended to look for the brightest colors of the bunch (i.e. bright red tomatoes, rich purple eggplant or green leafy spinach). The vibrant colors means the fruit or veggie is packed with vitamins and nutrients. While you’re painting your plate with color, leave room for the less vibrant hues too! While they don’t make for as striking a presentation as a carton of blueberries, paler veggies like cauliflower; onions and mushrooms are good sources of nutrients and antioxidants.

Okay, so technically mushrooms aren’t really vegetables, but rather a type of edible fungi. They have more in common with yeast than most of what you’ll find in the supermarket’s produce section. Some of the most common varieties of mushrooms include: portabello, shiitake, cremini, and chanterelle but there are thousands of different types of mushrooms. Mushrooms range in color from white to tan to golden and generally have a mild to strong (depending on variety) earthy flavor. Not all mushrooms are edible, though. Because some poisonous mushrooms look very similar to edible varieties, it’s best to leave mushroom picking to the expert mushroom hunters.

So why are mushrooms so great? Let’s break down their nutrients. Mushrooms are naturally low in sodium, fat, cholesterol, and calories making them a healthy option to add to any meal. Mushrooms are also packed with the B vitamins riboflavin, folate, thiamine, pantothenic acid, and niacin. They’re also the only non-fortified dietary source of vitamin D, a huge benefit to vegans. The list goes on with several minerals that mushrooms can add to the diet such as selenium, potassium, copper, iron, and phosphorus.

If you thought that was all that mushrooms offered, keep reading. Not only does this food from the fungi kingdom rate high on the nutrient scale, they provide a slew of possible health benefits as well. Beta-glucans (a type of fiber found in mushrooms) has recently been studied to evaluate its effect on improving insulin resistance and blood cholesterol levels, while lowering the risk of obesity. Choline, another nutrient, aids in sleep, muscle movement, learning, and memory, while also helping support fat absorption and reduce chronic inflammation. The mineral selenium delivers cancer-fighting qualities by assisting in detoxifying cancer-causing compounds in the body. It also prevents inflammation, lowers tumor growth rates, and is important for liver enzyme function. The list goes on with supporting cardiovascular health, improving immunity, aiding in weight management, and increasing satiety too.

With all of these nutrient benefits, where can you go wrong with incorporating mushrooms into your lifestyle? There are so many ways that mushrooms can be added to a dish. Whether replacing your burger with a grilled and marinated portabello, adding creminis to an egg frittata, or mixing shiitake mushrooms into your favorite pasta dish, this powerhouse of a “veggie” is sure to be a crowd pleaser.

So, what are you waiting for? Add mushrooms to your grocery list and try them in this delicious portobello mushroom burger recipe from the MGH Be Fit Program, the perfect addition to your palette this summer season!

Be Fit Basics: Stacked Summer Veggie Portobello Burger

Ingredients:

6 portobello mushrooms (any dirt brushed off with a paper towel), stems removed
¼ cup balsamic vinegar
4 tbsp olive oil, divided
4 rosemary sprigs (or 1 tsp dried rosemary)
3 peaches cut in half with peach pits removed
3 bell peppers cut in half with seeds and stems removed
3 small onions, skins removed and sliced in half (preserving onion rings)
1 lemon
Salt and pepper (salt estimated at ½ tsp)

Instructions:

Place mushroom caps in a large bowl; add balsamic vinegar and 2 tbsp of olive oil. Tear leaves off rosemary sprigs and add them to the bowl. Add salt and pepper and toss all ingredients until mushrooms are fully coated (Adding additional balsamic as needed). In another large bowl place peaches, peppers and onions. Cut lemon in half and squeeze juice into bowl. Add remaining 2 tbsp olive oil with along with salt and pepper; toss to combine.

Light grill; allow it to come to medium-high heat or when you can hold your hand about 5 inches above the grill (being careful not to burn your hand) for 3-5 seconds. The process for lighting your grill will vary depending on whether you have a charcoal or gas grill. [Note: If you don’t have a grill you can roast the mushrooms, peaches, peppers and onions on a large baking sheet in a 425 degree oven for about 30-40 minutes. (The cooking time may vary slightly depending on your oven.)]

Place mushrooms, peaches, peppers and onions on grill. Grill until slightly charred and cooked through, about 5-15 minutes. Turn vegetables once half way through cooking.

Assembly: On bottom of a wheat bun place peppers, onions, peaches and mushroom cap. Place other bun half on top

Yield: 6 serving

Nutrition Information per Serving (not including bun):

Calories: 180 • Protein: 4g • Sodium: 210mg • Carbohydrate 22g • Fiber: 5g •
Fat: 10g • Sat Fat: 1.5g

(Content reviewed by MGH Department of Nutrition and Food Services)

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.

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