Diabetes ABCs

Diabetes ABCs: K


Letter K

When the body is unable to get energy from glucose – often because there’s not enough insulin to move it out of the blood and into the cells – it starts to break down fat for fuel.  Ketones are substances created during this fat breakdown.  A buildup of ketones is harmful and can lead to a serious condition called ketoacidosis.  There are some at-home test kits you can use to check for ketones in the urine.  Test for ketones if you have high blood sugar (greater than 300 mg/dL); are sick, feel nauseous, or are vomiting; or if you are overly thirsty.  Contact your healthcare provider if results show moderate or large ketones present.

(Content reviewed by MGH Diabetes Center)

(Summer) Safety First

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

Summer has arrived in a fashion that will be hard to forget. That’s what life in New England is all about:  blink and the weather will change.  I really love summer, weather and all. It’s a time where I slow down the daily pace, enjoy the long hours of daylight, and remember being a kid where my only responsibility was reading the 7 books required from the Boston Latin School Summer Reading List. Well, adulthood has a few more responsibilities and I want to give you some pointers that will hopefully keep this summer healthy and happy for you and yours. 

 Managing your Diabetes can get a little tricky with the advent of heat and humidity, so a little pre-planning can help ensure you’re able to enjoy this magical season completely.  Remember, extreme heat can lead to heat exhaustion and heat stroke, both of which can be serious medical conditions requiring urgent medical attention.  Symptoms of heat exhaustion include dizziness, extreme sweating, muscle cramps, and clammy skin. This is best treated with cool fluids in a cool location and close monitoring of your glucose levels. Heat stroke is much more serious and characterized by a dangerous rise in your body temperature along with decreased ability to perspire. This potentially life threatening condition always requires urgent medical attention. 

  • It’s so important to stay well hydrated. The best choices are water and sugar free liquids.  Caffeinated beverages can actually cause dehydration so drink those sparingly. It’s also a good idea to use caution when drinking alcohol. Small amounts of diluted sports drink may be necessary if you’re exercising in the heat. It’s best to develop a plan with your health care provider to determine if you need additional fluids.
  • Exercise is important to maintain all year round, but extra caution is required with the heat, humidity, and bright sun. Outdoor exercise is best done before and after the high sun and heat of the day. However, with very hot temperatures and elevated heat indexes, outdoor exercise may need to be postponed. Indoor activity should be done in air conditioned facilities.  If you don’t have access to a gym you can try walking around the mall, or up and down all of the aisles of the store while doing your food shopping.
  • The sun isn’t always your friend. ALWAYS wear sunscreen during any outside activity, not just when you’re at the beach. The sun’s rays are strong and present, even when the sky is hazy, and you have to protect your skin. It’s also important to use the sunscreen correctly. Dermatologists recommend using a shot glass worth of lotion for the whole body. Reapplication is needed every 3 hours or so, especially after swimming or sweating. Another way to help to protect you from the sun and heat is to wear a wide brimmed hat and light colored, light weight loose clothes that will help to deflect the sun.
  • Your blood sugar control may be affected by the heat. Your appetite may fall off or you may be eating those special treats of summer: corn on the cob, potato salad, and lots of berries. All these things are fine in moderation, but may make your blood sugars a little erratic. You also have to be really careful about your supplies and medications. Your glucometer, test strips, oral medications, and insulin are all extremely heat and sunlight sensitive. Prolonged exposure to extremes of weather will cause malfunction and possible inactivation of your medications. This could be life threatening. Always store these things in moderate temperatures and use a well insulated gel pack for travel or any weather related storage. NEVER use a freeze pack for your insulin: it will freeze, not cool, your insulin and it will be deactivated.
  • NO bare feet. EVER. Good foot care is always in season. Always wear socks when doing heavy exercise, walking, and hiking as they will help to absorb moisture and protect the skin from breaking down. Change your socks frequently if they get too sweaty and always make sure your shoes fit well. Wear closed toe shoes with outdoor work like lawn mowing or painting to provide extra protection in the event of an accident. I ask all my patients, regardless of their medical conditions, to always wear water shoes or beach shoes when at the beach, in the ocean, and even poolside. It is very common to get a cut or abrasion from debris in the water or on the shoreline and this could be very serious for anyone, and especially so for people with Diabetes.  Avoid flip flops as the rubber piece that separates the toes can cause friction and lead to skin breakdown.

I hope that this list will help you and your families have a wonderful summer.  Now if you’ll excuse me, I have to go and start working on my self-appointed summer reading list.  Happy summer to all!


Fitness, Guest Post

Overcoming Barriers to Fitness (Weight Management Part 3)

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


Getting Enough Sleep

Woman Sleeping

Do you know how much sleep you get a night?  Are you one of the lucky people who gets the recommended 7-8 hours, or do you usually make do with 5-6 (or less)?  In today’s world of 24/7 communication, sleep can be a luxury when the work day continues even after getting home, or seem like a waste of time—after all, there are countless TV shows to watch, blogs and news feeds to read and e-mails to send.  

The Centers for Disease Control and Prevention (CDC) recently reported that about a third of Americans don’t get enough sleep.  Back in December, the Boston Globe had an article suggesting getting enough sleep as a New Year’s resolution.  Last month the Washington Post ran a special feature devoted to sleep, and the National Sleep Foundation designated March 7-13, 2011 as National Sleep Awareness Week® in an effort to raise awareness of the importance of sleep.  We all sleep, so why all this attention on something so, well, ordinary? 

Sleep is a necessary part of life and the amount and quality of sleep you get each night touches on nearly every aspect of waking life.  Probably the most obvious benefit of getting a good night’s sleep is feeling rested and refreshed the next morning.  Getting enough sleep at night can stave off drowsiness and fatigue the next day and improve concentration, learning and memory.  Beyond that, regular adequate sleep helps support the immune system, making it easier for the body to resist illness and fight infection.   

On a much grander scale, too little sleep may be a contributing factor to weight gain and obesity.  Studies have shown that sleep deprivation affects the levels of two hormones that regulate appetite—leptin and ghrelin—which may prompt overeating, especially of high calorie foods.  Maintaining a healthy weight can help lower blood pressure and reduce risk of heart attack or stroke; so a good night’s sleep is just as important as diet and exercise in maintaining a healthy lifestyle.  

As important as a restful night’s sleep is, there are a number of sleep disorders that can interfere with falling asleep and staying asleep.  Sleep apnea, for example, is a condition where breathing stops briefly while asleep.  These interruptions in breathing occur multiple times throughout the night, and can make it difficult to get a sound night’s sleep.  Risk factors for developing sleep apnea include smoking, being overweight and narrowing or obstructions in the airways.  

Do you wake up feeling tired in the morning?  Does your spouse complain about your snoring?  Sleep apnea is common in people with Type 2 Diabetes; talk to your healthcare provider if you have difficulty sleeping.  Stop by the National Sleep Foundation’s website for tips and suggestions for developing healthy sleep habits. 

(Information reviewed by MGH Diabetes Center)