Announcements

Are you newly diagnosed with diabetes, or struggling to control your blood sugar? If so, DMSE/S programs can help!

Diabetes is a chronic, complex disease. Self management is key, but what does that even mean?  Where do you start? Self Management is the ‘taking of responsibility for one’s own behavior and well being.’   Living well with diabetes means you need to learn new skills and behaviors. This can seem overwhelming during an already stressful time.  DSME/S programs teach you the self management skills you need to truly thrive.

You will first see a nurse or nurse practitioner (who is often usually a Certified Diabetes Educator or CDE).  You will either continue to see that clinician by yourself or attend group classes with other people just like you. Group classes are a great way to learn and be supported by people who know what you’re going through. You are not alone! During appointments or classes, you will learn about important topics like nutrition, exercise, medications and more.  You will also set specific behavioral goals to work towards between each visit.

Research has shown that DSME/S works. It can lower your A1C and stop complications from happening or getting worse. Attending can also improve your quality of life and keep you out of the hospital. Major organizations like the American Diabetes Association, American Association of Diabetes Educators and the Academy of Nutrition and Dietetics all believe that everyone with diabetes should have DSME/S at some time in their life.

Mass General DSME/S programs are offered at Chelsea, Revere, Charlestown, Internal Medicine Associates, Diabetes Associates and Bulfinch Medical Group. For more information, contact Jen Searl at jsearl@partners.org.

Health

Summer 2016: The Tale of the Mosquito

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

I have lots of fond summertime memories from my childhood. We could play outside really late, Hoodsie® Cups were allowed even if it wasn’t a birthday party, and mosquito bites made me scratch so much I got the evil eye from my mother because I was so annoying. That was the extent of thought anyone gave to bug bites. So what has changed? Playing tag until dark has been replaced with my commuter rail commute and Hoodsie® Cups are too hard to find in the supermarket these days. But the biggest change is that now if I get a mosquito bite it doesn’t itch so much as cause anxiety.

Mosquitos are more than annoying. They potentially carry serious and life threatening disease.  We all have to try harder to avoid being bitten. The best way to avoid bug bites and the possible illness (as well as the associated anxiety they may cause), is being informed about the recent facts concerning mosquitoes.  What you need to know about illnesses spread by mosquitoes:

  • West Nile Virus (WNV): This is a virus that often causes no symptoms. It is most common between the months of June and September, but people are at risk until the first frost.
  • Eastern Equine Encephalitis Virus (EEE):  EEE is a rare and severe mosquito transmitted virus that carries a 33% mortality rate. EEE may have no symptoms, but in some cases it can cause serious inflammation of the brain that can lead to coma. EEE is also present until the first frost.
  • Chikungunya: This is a virus caused by mosquito bites that always causes some sort of symptoms; usually fever, joint pain and sometimes a rash. Chikungunya can affect people of all ages but the symptoms can be greater in the very young, the elderly, or those with chronic diseases such as heart disease and diabetes. Treatment is possible and people usually feel better within a couple of weeks. This illness has not been found in mosquitoes in the United States BUT it has been seen in many other countries including the Caribbean. People who travel to infected areas can be bitten and develop illness when they return home.
  • Zika Virus: Zika has been front page news over the last few months, but it was first identified in 1947 in monkeys in Uganda. It is now frequently mentioned by the media as it has been accompanied by a rise in cases of microcephaly (a birth defect that affects the growth of the brain that is spread to the fetus during pregnancy and possibly at birth) and Guillain-Barré syndrome in South America. This past week CDC announced that infected mosquitoes have been located in parts of Miami, Florida and published guidelines for travelers to the area. Visit the CDC website for more information about Zika. The possible symptoms are very nonspecific, such as feeling tired, fever, rash, and conjunctivitis. People may be infected and not know it. There are tests available to see if Zika is the cause of the illness, but they are performed under very specialized circumstances. Ask your healthcare provider for more information. There is no treatment for Zika, but the symptoms can be treated as needed.

The best treatment for any of these viruses is PREVENTION:

  • Mosquitoes breed in moist spaces. It is important to remove standing water such as watering cans, wading pools, or rubbish cans.
  • Mosquitoes are known to be most active at dawn and dusk. However, Zika infected mosquitoes are mostly DAYTIME biters. It is still the best idea to make sure that window screens are intact. Close windows and use air conditioning if possible.
  • Wear protective clothing (e.g. long sleeves, pant legs tucked into socks) when outside during potential peak activity hours.
  • Use mosquito repellent. Products that include DEET, picaridin, oil of eucalyptus, or para-menthane-diol are appropriate to use. It is important to read the directions as many of these products are harmful to infants and children.
  • Zika presents another challenge as far as prevention. Zika can be spread through sexual activity, so it is necessary to observe safe sex practices if there is any chance of infection.

This is a beautiful time of year in the Northeast and sooner than I care to think about, I’ll be worrying about ice dams. I hope that you will all join me and go outside and play. Just don’t forget to add the right clothing and some bug spray in your backpack.

Health

Hydration, Hydration, Hydration!

By Marjorie Clapp, MGH Dietetic Intern

The human body is comprised of roughly 60-70% water. For this reason, maintaining proper fluid balance can dramatically influence how well our bodily systems work, including nerves and muscles, cognition, and immune function. Unfortunately, staying hydrated isn’t always easy. In fact, about 70% of Americans are chronically dehydrated. Here are some tips and tricks to help keep you hydrated this summer.

How do I know if I’m dehydrated? Feeling thirsty is the most obvious indicator that you need to drink more. The color of your urine can also help determine your hydration status. Your urine should be pale yellow or clear. If it’s darker than that, it’s time to drink! Other common signs of dehydration include headache, dizziness, fatigue, confusion, and irritability.

Hydration Tip: Keep a tall glass of water on your bedside table and drink before getting ready for your day.

How much fluid do I need? Although fluid needs depend on many factors, including size, activity level, and climate, a good goal is to consume no less than 64oz each day, although some research estimates needs to be much higher (~90oz/day for women, ~125oz/day for men).

Hydration Tip: Exercisers require additional fluids to replenish water lost through sweat and respiration. Weigh yourself before and after working out and aim to consume 3 cups of water for every pound lost during exercise.

When is the best time to hydrate? Anytime! Aim to sip fluids throughout the day to prevent dehydration. Although it’s recommended to consume the majority of your fluid from water; milk, juice, soda, and caffeinated beverages count towards your fluid goal. Just remember to read labels. Calories from sweetened beverages can add up quickly! Food can also help you reach your fluid goals. Water-rich foods include lettuce (96% water), watermelon (92% water), grapefruit (91% water), broccoli (91% water) and yogurt (89% water).

Hydration Tip: Keep a water bottle on hand in your bag or purse to encourage hydration throughout the day.

What about sports drinks? Most sports drinks contain electrolytes (sodium, potassium, chloride, phosphorus) and added sugars to help your body refuel after strenuous exercise. If you’re sweating heavily or exercising for more than 60 minutes, a sports drink may be appropriate. However, most people can rehydrate appropriately with water and a balanced post-workout snack such as an apple with string cheese, hummus and whole grain crackers, or a banana with 1-2 Tablespoons of nut butter.

Hydration Tip: Try diluting/cutting your sports drink with water to provide some electrolytes but reducing the sugar and calories.

(Post content reviewed by MGH Department of Nutrition and Food Services)
Guest Post, My Story

My Story: Overcoming Fears of Starting Insulin

By Kevin

Rock climbing. Photo Credit: Bryan Wintersteen

Writing a blog post on “Overcoming Fears of Starting Insulin” turned out to be harder than I thought. I mean, who knew writing something like this would be that much more difficult than composing an e-mail at work or posting a snarky comment on Facebook? And to be completely honest, after extending (read: missing) my deadline a few times I was starting to feel a bit hopeless that I could actually pull it off.

But then I saw Steve Martin, the actor, comedian, author, and banjo virtuoso (don’t believe me? Check this out, I think you’ll like it) on Late Show with David Letterman and inspiration struck. Martin’s appearance on Letterman reminded me of one of my favorite scenes from his 1986 comedy ¡Three Amigos!

To set the scene, at this point in the film The Amigos (played by Martin, Chevy Chase, and Martin Short) have decided that although they are merely Hollywood actors who play hero gunfighters in the movies, they will help the inhabitants of a small Mexican village confront and defeat the very real bandits and their ruthless leader, El Guapo (played by Alfonso Alau), who have terrorized the town for years. Lucky Day (Martin’s character) attempts to inspire the villagers with this speech.

What on Earth does this have anything to do with “Overcoming Fears of Starting Insulin”? Well, I think for most people with Type 2 diabetes, like yours truly, our “El Guapo” is starting insulin. It’s something we will have to face eventually and something that once we do, we will be better and healthier for it. For me, when my endocrinologist suggested insulin five years ago, there were two very different fears I had to overcome.

The first was the fear of admitting failure. The suggestion that it was time to start insulin was, for me, like admitting that I had failed myself, my wife, my family – everyone who cared about me.  If I had eaten better, I wouldn’t need insulin. If I had exercised more, I wouldn’t need insulin. And now if I needed insulin, then clearly I failed at managing my diabetes.

When I met with my diabetes educator, however, she reminded me that Type 2 diabetes is a progressive disease, moving on to insulin was merely the next step in my treatment, and that it was my previous treatments that were failing to adequately treat the disease. In short, it wasn’t me it was my treatment that was failing. Once I heard this I was much more accepting of insulin as an option. I wanted to feel better than I was feeling at the time, and insulin was just the next phase of my diabetes management.

The second fear was about the administration of insulin. I had visions of not being able to do anything spontaneously with friends or family anymore (“Sorry I can’t make it, I forgot my insulin so I need to head home.”). I was pretty nervous (and admittedly still am) about hypoglycemia after a previous episode with another class of drug. And while not generally afraid of needles, I had never self-administered an injection. How long is the needle we’re talking about here? I thought it was going to be about six inches long. Would it hurt? I was sure it would be agonizing.

Again, a little education went a long way to allaying these fears. Injecting insulin turned out to be pretty anti-climactic, really. It’s had no negative impact on my life whatsoever. Being on insulin has not limited me socially. With help from my health care practitioners I have had no issues with hypoglycemia. The mini-pen needle is about as long as my pinky fingernail and causes no pain at all.

And most importantly, I’m healthier and happier ever since I faced the Type 2 diabetic’s “El Guapo” – and won.

Health

Hypoglycemia Unawareness

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.

Announcements, Health

UPDATED: Survival Kit for Cold & Flu Season * 2013-2014 *

Just Announced: Due to high demand for flu vaccine, the Central Flu Clinic has been extended to Friday, November 8th.

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Your primary care doctor and the Massachusetts General Hospital want to do everything possible to keep you healthy during the flu season. People with certain chronic health conditions, even if the conditions are well managed, have a higher risk of becoming dangerously sick from the flu.

Here is what you can do:

• Get a flu shot every year*.
• The best time to get a flu shot is in the fall. The MGH will have a Central Flu Clinic in the Main Lobby of the Wang Building, Monday, September 23 – Friday, November 1, 2013. Monday to Friday, 8:00 AM – 6:00 PM (9:00 AM — 3:00 PM on Columbus Day, Monday, October 14).  No Saturday dates are planned for this year.  Please call the Toll Free Flu Shot Hotline at 1-877-733-3737 before you come in to confirm that we have vaccine in stock and that the clinic is open.
• If you live outside of Boston, your health center or primary care practice may have flu shot clinics as well. You may also get a flu shot at many locations in your community including boards of health, senior centers, or local drug stores.
For further information go to the MGH FluShot website at: http://www.massgeneral.org/flu
*if you think you are allergic to eggs, please contact your doctor

To protect your family’s health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow, not your hands.
Wash your hands often with soap and water. You can also use alcohol-based hand cleaners.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Keep your home and work spaces clean.
Try to avoid close contact with sick people.
If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care. Keep away from others as much as possible to keep from making them sick.
If you think you have the flu, call your primary care doctor’s office for advice. They are here to help!

Spread the word! Don’t spread the Flu!

Health

Let’s Talk About Sex…No Really…Let’s Talk About It

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

I’m going to go out on a limb and make an assumption (despite what my father always told me):  Everybody reading this has seen at least one advertisement on TV or in a magazine about erectile dysfunction and the medications available for treatment. In fact, sometimes I look at my bath tub and just chuckle. But that’s not true for everyone. These ads refer to a topic that is no laughing matter for people living with diabetes who have sexual dysfunction.

Sexual dysfunction affects both men and women so I want to break this down for you. Erectile dysfunction (ED), or impotence, is defined as the inability to achieve or maintain an erection that is suitable for sexual intercourse. Poorly controlled blood sugars can cause damage to the blood vessels and nerves in the genital area that can lead to ED.  Over 30 million men are affected by ED, with somewhere between 35%-75% of men with diabetes affected at some level across the lifespan. There are many potential reasons for ED, including but not limited to medication side effects, fatigue, stress, poorly controlled blood sugars, excessive alcohol intake, increased age, increased weight, and high blood pressure.

Another potential culprit in ED may be low testosterone levels. Testosterone is a hormone responsible for the development of male reproductive tissue.  This condition is twice as likely to occur in men with poorly controlled diabetes. Low testosterone may present with complaints of decreased libido, depression, fatigue and decreased energy, and a decrease in lean body mass. Testosterone levels can be checked by a blood test if your health care provider thinks this is indicated. A treatment plan can then be established if necessary.

One very important treatment for ED is attaining better control of your blood sugar. Oral medications are another available treatment option, but there are certain medical conditions where the use of these agents is contraindicated.  Men with heart disease or on certain cardiac or blood pressure (antihypertensive) medications may have very serious low blood pressure if they take any of these agents, so it is important to discuss your medications with your health care provider. Men that are able to use ED medications may have less serious side effects such as headache, facial flushing, back pain, and nasal congestion. These side effects are related to how these medications work.  They are vasodilators, which means they cause a systemic effect to all the body’s blood vessels so they open more fully. Some non-medication treatment options for ED include assistive devices such as vacuum pumps, local injections, and in some cases surgical intervention for penile implants.  Talk to your health care provider about what treatment options are best for you.

Women with diabetes may also have symptoms of sexual dysfunction. Women may experience symptoms such as decreased libido, vaginal dryness, and decreased orgasmic ability again due to damage to blood vessels and nerve endings in the genital area. Elevated blood sugars may cause vaginal yeast infections and urinary tract infections that compound vaginal dryness and make sexual intercourse uncomfortable.  The possible treatment  modalities in this case also include achieving better blood sugar control and discussing with your health care provider  if prescription or over the counter medications are indicated.  Once you and your health care provider discuss your issues with sexual dysfunction, they may refer you to another provider to assist in developing a treatment plan. Men may benefit from an evaluation with a urologist and women may require an evaluation with a gynecologist.

The key to dealing with a problem, any problem, is discussing it with your health care provider. Talking about sex isn’t easy. It may be hard for you and your partner to admit there is a problem, and it may be embarrassing to discuss with your provider (especially if they are a member of the opposite sex). I want you to think that a problem in the bedroom is a problem just like numbness in your toes or hypoglycemia with exercise. You need to let your provider know so you can get help.  I will share with you that as a provider it can also be hard to ask about sex. I have no trouble asking Are your toes numb? or Are you checking your blood sugar before driving? But I stop and think a second before I ask if there are any problems in your sex life. I want to make you feel comfortable enough with me to talk about this because sexual health is an important part of our general health— and I don’t want to miss any part of you when you come to see me. So what do you think? Ready to talk? I hope so.