Tags: chat, Diabetes management, DSME, exercise, fitness, health club, spring, summer
Join us Wednesday, May 22nd at 2pm EST for a chat on starting a fitness routine for spring and summer. Mike Bento, Personal Trainer at The Clubs at Charles River Park, will lead the discussion and answer your fitness-related questions.
Discussion topics will include:
- Is cardio or weight training better for diabetes?
- Are machines or free weights better for strength training?
- Is there a best time of day to exercise?
Follow #MGHDSME for more details. If you’d like to submit a question for our chat, e-mail email@example.com.
Find us on Twitter: @MGHDiabetesEd
Tags: cataracts, Diabetes management, eye health, healthy vision month
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
Much like with a camera, the lens of the human eye helps to bring the image you’re looking at into focus. The lens measures in length about half the diameter of a dime and is made of a gel-like protein called collagen. Through the work of thin muscle fibers, the lens changes its shape to bring objects into focus. With age, pigment can collect and cloud the crystal clear lens resulting in vision loss. This clouding of the lens, called a cataract, is the leading cause of blindness worldwide. Since the normal aging process is one of the main causes for cataracts, we are all at risk for developing cataracts. However, people with diabetes, those who use corticosteroids for an extended period of time (for instance as treatment for asthma or arthritis), who smoke, or have a family history of cataracts are at increased risk.
Though painless, the presence of a cataract may cause symptoms such as increased glare from lights, difficulty with night driving, difficulty reading, and reduced ability to appreciate colors. The severity of these symptoms can increase over time and begin to impact one’s lifestyle. Though your health care provider may be able to pick up the presence of a cataract during a routine visit using an ophthalmoscope, you will need a comprehensive exam and detailed vision testing by an ophthalmologist to fully assess a cataract. Recommendations on management and treatment is based on this assessment.
Currently, the only treatment for cataracts is surgery, normally done in an outpatient setting. Depending on the degree of the cataract and its impact on vision, the ophthalmologist may recommend observation and follow up vision testing for a period of time, or proceeding with surgery to treat the cataract. With surgery, the clouded lens is removed and replaced with an artificial one made of plastic or silicone to restore vision. Results are usually apparent right away within hours to a few days of post-operative healing.
Though there is no proven therapy to reduce or slow the progression of cataracts, some studies have suggested that eating a healthy diet rich in fruits, vegetables and vitamins such as lutein is associated with a lower risk of developing a cataract. In addition, since smoking is a risk factor for cataract development, quitting tobacco use may help prevent cataract formation.
Tags: ADA recommendations, complication, Diabetes management, eye care, eye health, glaucoma, treatment, types of glaucoma, vision
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
Eyesight develops from the initial rudimentary flickers of a newborn to the full kaleidoscope of adult vision over the first three to five years of life. Our sense of vision has such a powerful impact on how we define ourselves, our loved ones, and the world in which we live. Yet it’s one sense that can slowly slip away as we age. Glaucoma and cataracts are two of the most common causes of vision loss and blindness in the aging adult population. But here’s some good news: both conditions are treatable when caught and acted on early. I will look at both in depth, starting today with glaucoma and continuing next week with a discussion on cataracts.
Glaucoma is a disease of increased pressure in the eye leading to damage of the optic nerve – the nerve that carries all the visual information our eyes pick up to the brain where it is interpreted. Think of the eye as a fluid filled, globe-like structure with the optic nerve exiting the back like the electrical cord on a toaster or TV. If the flow of fluid in the eye is not kept in balance, increased fluid pressure can develop inside the globe leading to compression and irreversible damage to the optic nerve. There are two main types of glaucoma: open angle, which accounts for approximately 90% of the glaucoma in the United States, and closed or narrow angle glaucoma.
Open angle glaucoma affects about 1 in 200 people over the age of 50. A slow, chronic process, this type of glaucoma develops over a number of years. In fact, open angle glaucoma is often called the ‘silent thief of sight’ because of its painless presentation. However, once vision loss sets in, it is progressive and irreversible. People at increased risk for glaucoma include those with a family history of the disease; African Americans and Latinos; and people with heart disease or diabetes. The risk of developing glaucoma also increases with age for everyone, regardless of whether they have any of the above risk factors.
So if glaucoma is “silent” how can you detect changes in time for treatment to be effective? Your health care provider can detect early changes with an eye exam before noticeable vision changes develop. In addition to examining the optic nerve, they will do a formal visual field test, measure intraocular pressure (fluid pressure in the eyes), and observe for any changes in eye size and shape. Although there is no cure for glaucoma at this time, early detection and initiation of treatment can help halt or slow down the progression of the disease. Treatment may entail prescription topical eye drops, laser therapy, or surgery. If you are prescribed eye drops for glaucoma, it’s crucial you take them as directed —not keeping up with treatment is a major reason for progression to vision loss. The American Diabetes Association also recommends seeing an eye care professional (either an ophthalmologist or optometrist) for a comprehensive eye exam at least once a year. Don’t hesitate to ask if your provider is familiar with identifying and treating glaucoma and other diabetes eye conditions.
In contrast to the quiet and slow progression of open angle glaucoma, closed angle glaucoma is a medical emergency. Closed angle glaucoma presents with sudden vision loss and pain that often prompts one to seek medical care right away. In addition, a person may experience any of these symptoms: seeing halos around lights, nausea and vomiting, developing a red eye and/or a fixed and dilated pupil. Again, this form of glaucoma is considered a medical emergency – if you experience any of these symptoms seek medical attention immediately.
Tags: activity, change, Diabetes management, family, fitness, friends, spring
Changing the way we do things, especially if it’s something we’ve done for a long time, is the hardest task anyone can ask. We create a comfort zone of tranquility, serenity and calmness that our mind comes to prefer. But it is not always the best.
As we get older, our appetite changes. Our metabolism is different too, and we burn fewer calories. We need to change the way we eat and learn to substitute in healthier foods. And in order to continue to maintain a good healthy lifestyle, our daily routine needs to shift in a more active and productive way. It’s not always easy, but it can be done with support from friends and family.
Regular activity is not just for little kids or young people – we all need to be active, and it’s never too late to start. We had such a long winter; now that spring is finally here we have a chance to go outside and enjoy the warmer weather. It’s also a perfect opportunity to change some of your habits. Rather than just sitting in the sun, go for a little walk. If you can, bring along a friend or co-worker. You’ll be doing something good for yourself and getting a chance to be social at the same time.
Is there an activity you’ve always wanted to try? Go for it! Just about everyone has something they’ve said they’d like to try “someday.” Well, why not now? If you go to a gym, ask if they will let you try out a class to see if you like it. There are also some programs in Boston that plan community fitness events or offer free classes like yoga and Zumba in spring and summer. The Boston Natural Areas Network is another great group that organizes community activities like bike rides, canoeing and gardening – great opportunities for families to do something healthy and active together.
Let the change in seasons inspire you to get out there and get moving.
Need a suggestion of what to do with those extra, uncolored Easter eggs? How about whipping up a batch of these BeFit Frittatas for dinner. Bonus: any leftovers can be reheated for breakfast tomorrow. Note: you will need a muffin tin for this recipe.
2 tbsp olive oil, divided
3 medium zucchini, halved lengthwise and cut into thin 1/8 inch slices
¼ tsp salt and ¼ tsp black pepper
9 eggs, beaten
½ cup scallions, sliced
2/3 cup Parmesan cheese, divided
½ cup sundried tomatoes in oil, drained and chopped
Preheat oven to 375 degrees. Heat a sauté pan on moderately high heat; add 1½ tbsp olive oil to pan and then add zucchini slices; season with salt and pepper. Cook zucchini, stirring occasionally, until tender (about 5 minutes). Meanwhile, whisk together eggs, scallions, ½ cup Parmesan cheese, and sundried tomatoes in a bowl. With remaining ½ tbsp olive oil grease 6 muffin cups of a muffin tin.
When zucchini is finished cooking, add to egg mixture; stir to combine. Pour the mixture into a greased muffin tin and bake about 10-15 minutes; sprinkle remaining Parmesan on top of each frittata and broil until cheese is melted and golden, about 1-2 minutes. Run a knife along the edges of the muffin cups to loosen the frittata.
Yield: 6 frittatas
NUTRITION INFORMATION PER SERVING (per frittata):
CALORIES: 255 • PROTEIN: 16 g • SODIUM: 400 mg •
CARBOHYDRATE: 9 g • FIBER: 2 g • FAT: 18 g • Sat Fat: 5 g
(Recipe adapted from Gourmet Magazine)
Tags: autoimmune, celiac, gastrointestinal, gluten, Type 1 Diabetes
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
It seems like many people these days are being diagnosed with celiac disease. While this phenomenon may be the result of increased screening, celiac disease has been recognized in the medical community in both children and adults since the 19th century.
Celiac is an autoimmune illness sparked by a reaction to gluten, a protein found in wheat, affecting approximately 1 in 105 people in the United States. Because there is a genetic basis to celiac, it’s thought to have a possible association with other illnesses such as Type 1 Diabetes. In people with celiac disease, exposure to gluten triggers a reaction, causing their own immune system to target and attack an enzyme located in the lining of the intestine. Part and parcel of this attack is inflammation and damage to the intestinal lining. Since this is where food is absorbed into the bloodstream, people with celiac disease are unable to effectively absorb digested food. Thus, they may develop deficiencies in minerals and nutrients such as calcium, iron and Vitamins A, D, E and K. Without a healthy lining, people with celiac are also unable to absorb carbohydrates and fats; in sum, these deficiencies can cause weight loss, fatigue and slowed growth (particularly in children).
In addition, unabsorbed food in the intestine stimulates diarrhea and gas, both of which may lead to abdominal bloating, cramping, and pain. In some people celiac disease may be a silent or subtle illness showing up only as a borderline anemia due to poor absorption of iron. In others, celiac may present full force with the entire spectrum of symptoms.
Gastrointestinal symptoms such as recurrent diarrhea and bloating or weight loss should prompt a discussion with a healthcare provider. Because other conditions such as lactose intolerance and irritable bowel disease can present in a similar fashion, it is important to talk to a healthcare provider first rather than making diet modifications or other lifestyle changes based on ‘self diagnosis’. Healthcare providers may themselves suggest testing for celiac disease for someone with unexplained nutritional deficiencies or, given the genetic basis of celiac disease, with Type 1 Diabetes or other autoimmune illnesses. Testing for celiac disease is a multi-step process that often begins with a blood test and may include a biopsy of the small intestine.
Unlike many other diseases, we know the underlying cause of celiac disease: gluten. Treatment then rests in avoidance of this trigger – a task that may be easier said than done. Though ‘gluten-free’ is a quickly growing food category in restaurants and grocery stores alike, adherence to this diet requires care and attention. If you have been diagnosed with celiac, a nutritionist can help develop an eating plan that works best for you.
Tags: autoimmune, celiac, Diabetes Education, diet, gluten, protein, sensitivity, Type 1 Diabetes, wheat
Perhaps you’ve noticed many items in the grocery store now have the words “gluten-free” on their labels, or “gluten-free” menu options appearing at your favorite restaurant. Gluten-free foods seem to be everywhere lately, and gluten-free diets have developed a reputation for being an all-around healthier way to eat (helped along by numerous celebrity endorsements). But what is gluten, and is there really a reason to avoid it?
Gluten is a protein found naturally in wheat, barley and rye. It helps give breads and other baked goods their chewy texture, and can sometimes be used to thicken sauces and soups. Most of us can eat products containing gluten with no problems. For some people, though, eating foods containing gluten can lead to serious health concerns. People with celiac, an autoimmune disease affecting a small portion of the population, are gluten intolerant. Eating even a small amount of gluten causes a reaction in the body that damages the small intestine so that it is unable to absorb nutrients in food. According to the American Diabetes Association, about 10% of people with Type 1 Diabetes also have celiac.
There are also some people who have gluten sensitivity, meaning they experience unpleasant reactions to eating gluten (gas, bloating, diarrhea, etc.) but do not have the damage to the small intestine associated with celiac. Only a medical professional can diagnose celiac (it requires a blood test and a biopsy of the intestine). If you have any questions or concerns, it’s best to talk with your health care provider.
So should you start eating gluten-free? Well if you have celiac, a gluten-free diet is mandatory and a nutritionist can help create an eating plan that works for you. If you don’t have any type of gluten sensitivity, then there’s really no reason to spend the extra money on gluten-free foods. Just because an item is gluten-free, it doesn’t mean it’s necessarily healthier – in fact some products can be higher in calories and fat (and lower in some nutrients like fiber) than similar products containing gluten. A diet emphasizing fresh fruits and veggies, whole grains, lean protein and low-fat dairy while limiting packaged and processed foods will serve you well. Just make sure you’re watching your portion size!
(Content reviewed by MGH Nutrition Department. Photo credit: Steven Goodwin)
By Shelby Keys
Ever wonder how you can easily browse recipes, track food, activity, and calories, and access key nutrition information and trends - even while you're on the go? With today’s technology, it’s easier than ever before. Look no further for a collection of websites and apps that will leave you with health information at your fingertips.
Research shows that individuals are more likely to be successful if they track their health and fitness progress.
Tags: 2013, ADA, blood pressure, Diabetes Education, DSME, Hep B, hepatitis b virus, recommendations, vaccinations
By Eileen B. Wyner, NP
Bulfinch Medical Group
This week I want to finish reviewing the revisions to the ADA Standards of Care (click here to review Part 1). Please remember that these are guidelines. Always review your personal health care plan with your health care providers
Many people associate immunizations with childhood, but there are several immunizations that are required throughout the lifespan. I reviewed these in the past (which you can find here), so today I will just address the ADA revisions. Annual influenza and appropriate pneumococcal vaccination is still strongly recommended for all people living with diabetes. Late in 2012 the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices decided to recommend vaccination against hepatitis B virus (HBV) for all people living with diabetes between 19 and 59 years old. People older than 60 are also considered vaccination candidates, but will first need to first be assessed by their providers as the immune response is sometimes decreased in seniors.
The CDC was prompted to make this recommendation after reviewing reports of outbreaks of HBV in long-term care facilities and hospitals where monitoring devices may have been shared by patients. HBV is a highly contagious disease transmitted through contact with blood and infected bodily fluids. This virus can live for a long period of time on surfaces such as lancet devices, glucometers, and the reservoirs of insulin pens (even when there is no visible blood). This is the reason that these tools shouldn’t be shared with others.
Many people are vaccinated against HBV as this is a required childhood vaccine. Many professions require this vaccine as well. I suggest discussing this with your health care provider at your next appointment.
Blood Pressure Control
Well controlled blood pressure is imperative for people living with diabetes and this year the ADA changed their target goal for well controlled blood pressure to <140/<80 (previously <130/<80). This recommendation was developed after reviewing several randomized controlled trials published within the last 5 years demonstrating little improvement in the reduction of cardiovascular events with the previous target. Instances when a lower blood pressure goal is appropriate will be determined by the health care provider on an individual basis.
Retinopathy Screening and Treatment
The revised recommendations to this standard have to do with the treatment options for Diabetic Macular Edema (DME), a complication of long term and/or poorly controlled diabetes. DME occurs when damaged blood vessels in the eye leak fluid into the macula, causing swelling and blurry vision. Since 1985 the only treatment available for this condition was laser photocoagulation therapy, which could help reduce the risk of future visual loss but had no effect on damage that had already occurred. In August 2012 the FDA approved Ranibizumab (Lucentis), a medication that is given as a monthly eye injection, for DME treatment. Studies have shown improvement in vision for people treated with this medication.
Lowering LDL (“bad” cholesterol) levels with the use of statins has been well documented as a method to reduce cardiovascular events. However, many people have trouble tolerating these medications due to side effects. The ADA is advising providers work with patients to find a dose or alternative statin that is better tolerated as the benefits of this therapy is well proven. It is documented that very low, even less than daily, doses of statins can be beneficial.
Diabetes Care in the Hospitalized Patient
The ADA is recommending that patients admitted to the hospital may need some level of screening for diabetes. Providers should consider obtaining an A1C if there is no recent value available and/or if the patient has any risk factors for diabetes and hyperglycemia while in the hospital. In the latter case, follow up care needs to be set up to address these results.
There are several more updates and recommendations we did not touch on. To view the full set of 2013 Clinical Practice Recommendations, click here.