February 27, 2016

Seven Neglected Areas That Sabotage Healthy Aging – P2

This series is important and everyone needs to know something about this as they age and/or their parents age. I will be using people (including myself) with type 2 diabetes as examples and for most of the discussion. I will be listing some of my blogs that are on topic where I have blogs. I found this information in a blog by Dr. Leslie Kernisan.

Falls are problems for many as they age. People with type 2 diabetes are at risk and risk generally more severe injuries because of diabetes. Falls are common for the elderly. Many falls cause only minor injuries, but they are scary and can cause older adults to restrict their activities. In fact, fear of falling is common and has been linked to decreased involvement in activities. It is also a risk factor for future falls.

More injurious fall can cause life-changing injuries such as broken hips and head injuries. These falls are a major reason for people having to leave their homes.

Most falls in the elderly are due to a combination of underlying risk factors or health problems. Insufficient strength or balance is usually one of the problems. This can be addressed with the right exercises, but it’s good to check for other factors, such as medication side-effects or even a new illness.

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Number 2 of 8 blogs.

February 26, 2016

Seven Neglected Areas That Sabotage Healthy Aging - P1

A Healthy Aging Checklist summarizes the six fundamental activities recommended when asked what to do to maintain the best possible health while aging.

The following are some of the points promoted for healthy aging:
  1. Promote brain health and emotional well-being.
  2. Promote physical health.
  3. Check for and address common senior health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
  4. Learn to optimize the management of any chronic conditions.
  5. Get recommended preventive health services for older adults.
  6. Address medical, legal, and financial advance care planning.
In the next seven blogs, I’ll cover the third item above addressing commonly neglected senior health problems that routinely sabotage healthy aging.

These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in the 60s and 70s as well.

Virtually all of these issues affect a senior’s ability to socialize, be physically active, and take good care of himself or herself. So discussing these is key to helping you be healthier while aging, or help you guide a parent to be healthier in their aging.

Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action. This may be because many people, doctors, seniors themselves, or family members, assume nothing can be done about these, and that they are just “part of getting old.”

Don’t believe that. These problems are studied in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.

Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence. So, for healthier aging, be proactive in checking for these oft-neglected problems.

Then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed, which might mean either seeing a geriatrician (if you can find one) or making sure your usual doctor is thinking like one.

Now, I’ll admit that it can be very difficult to completely eliminate the problems talked about, in some older adults. You have to try, especially if the problem is bothering you or interfering with life activities. In addition, you have to find professionals who will use the best-available knowledge to help you, do so.

When we make a good effort, we can almost always improve our (yes, I am considered in the elderly group) ability to be out in the world, doing the things they want to be doing, and doing things that are good for our health. This promotes healthy aging. So don’t let these problems fester and sabotage late-life health. Let me know below if you have questions.

Number 1 of 8 blogs.

February 25, 2016

Resilience to Better Manage Diabetes

The concept of resilience is something people with diabetes need and many understand the need. A positive attitude goes hand in hand with resilience and is also part of being resilient.

Resilience is the ability to recover readily from illness, depression, adversity, etc. Characteristics associated with resilience include optimism, an active or adaptable coping style, and the ability to tap into social support.

A study published in the Journal of the American Academy of Nurse Practitioners in 2011 showed that high levels of resilience were significantly related to lower HbA1c levels indicating better glycemic control.

Another study with similar results was published in the British Journal of Health Psychology in 2008. It showed that those with low and moderate resilience levels showed a strong association between rising distress and worsening HbA1c results. Those with high resilience scores didn't show this same association.

Some people are fortunate enough to be born with a high level of resilience, but even if you're not one of them, there are things you can do to boost your resilience. The American Psychological Association offers the following 10 suggestions for building resilience:
  • Make connections: Good relationships with close family members, friends or others are important.
  • Avoid seeing crises as insurmountable: You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to them. Try looking beyond the present to how future circumstances may be better.
  • Accept that change is part of living: Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that can't be changed can help you focus on circumstances that you can alter.
  • Move toward your goals: Develop some realistic goals. Do something regularly, even if it seems like a small accomplishment that enables you to move toward your goals.
  • Take decisive actions: Act on adverse situations as much as you can. Take decisive actions rather than detaching completely from problems and stresses and wishing they would just go away.
  • Look for opportunities for self-discovery: People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss.
  • Nurture a positive view of self: Developing confidence in your ability to solve problems and trusting your instincts helps build resilience. A positive attitude really helps in the confidence factor.
  • Keep things in perspective: Even when facing painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
  • Maintain a hopeful outlook: An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
  • Take care of yourself: Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly.

Living with a chronic disease such as diabetes can be stressful and demanding. Arm yourself with the power of resilience and a positive attitude for success.

February 24, 2016

Understand Your HbA1c

The HbA1C test is known as the A1C test by most people. The A1C test measures the blood glucose level for the last four months. The prior month accounts for 50 percent of the A1C. The month prior to the last month accounts for 25 percent of the A1C, and the third and fourth prior months contribute the remaining 25 percent of the A1C value.

Doctors use the A1C value as a measure of how well you are managing your diabetes or not managing your diabetes. This is the reason we as patients need to use our meters to measure our daily blood glucose readings.

If you did not have diabetes, your typical A1C level would be about 5 percent. For people with diabetes, the experts can't agree on what the A1C target level should be. The American Diabetes Association (ADA) recommends an A1C target of less than or equal to 7 percent. The American Association of Clinical Endocrinologists (AACE) recommends a target of less than or equal to 6.5 percent.

Hemoglobin A, a protein found inside red blood cells, carries oxygen throughout the body. When there is glucose in the bloodstream, it can actually stick (glycate) to the hemoglobin A protein. More glucose in the blood means that more glucose sticks to hemoglobin, and a higher percent of hemoglobin proteins become glycated.

Once glucose sticks to a hemoglobin protein, it typically remains for the lifespan of the hemoglobin A protein — as long as 120 days. The A1C test measures how much glucose is actually stuck to hemoglobin A, or more specifically, what percent of hemoglobin proteins are glycated. Thus, having a 7% A1C means that 7% of the hemoglobin proteins are glycated.

This is where disagreement often comes into play. For people with well-managed type 2 diabetes, visits to the doctor may only be required twice a year. However, for those that have poorly managed diabetes or are on insulin (not that these people have poorly managed type 2 diabetes) probably will see their doctor at least four time per year. Always be prepared to see the doctor on a different schedule.

The A1C test, typically performed by a health care professional, often doesn’t hurt. Only a single drop of blood is needed, and the sample is either analyzed on-site or is sent to a laboratory for testing. Some doctors prefer doing the A1C test from a blood draw.

While the A1C is a good measure of overall glucose control, it cannot replace self-monitoring of blood glucose (SMBG). Like other tests, A1C results may vary from lab to lab. The A1C test is not calibrated the same everywhere, though an international effort is underway to standardize the A1C test to a new International Federation of Clinical Chemistry and Laboratory Medicine standard.

A1C results can be misleading when red blood cell survival is prolonged or reduced; some health conditions can result in falsely high A1c results (as in cases of anemia) or falsely low (as in cases of hemolysis). There are other factors that can affect the A1C results.

One piece of good news: When someone has his or her A1C checked, that person does not need to worry about fasting; food eaten on the same day won’t affect the score.

February 23, 2016

See a Podiatrist If You have Diabetes – Part 2

This is something I will criticize many doctors and even patients with diabetes for not doing. There are many things that you can do at home, or your spouse can help you with these suggestions.

Check your feet daily: This is especially important if you have been diagnosed with a loss of sensation or neuropathy. A quick visual inspection will do - check the bottoms of your feet and between your toes. If you notice a change - an open cut that isn't healing or a fungal infection contact your doctor or podiatrist.

Wear protective shoes: Do not walk around barefoot or in open toed shoes. If you have any type of neuropathy, you may not sense a hot surface or an object that is caught on your foot. It's important to purchase protective shoes that conform to your feet. Avoid getting shoes that fit too snugly, which can increase the risk of rubbing your feet, creating blisters or broken skin.

Shake out your shoes before putting them on: You never know what has made its way into your shoe - a pebble, your dog's toy - shaking out your shoes reduces the risk of foot injury if you have neuropathy. Also, some spiders can bite a toe and you may not know it until it becomes a large sore. Depending on where you live will determine how carefully you need to shake out your shoes.

Dry well between your toes: Excess moisture can be a breeding ground for fungal infections. After bathing or showering, it's important to dry your feet well especially between your toes.

Keep good hygiene: Change your socks daily. Purchase cotton socks and do not go sock less in your shoes.

Do not apply lotions between your toes: Avoid putting lotion between your toes, because this can increase the risk of fungal infections. You can apply lotion to the heels of your feet to prevent dry, cracked skin.

Avoid nail salons: Getting pedicures at nail salons may not be the best idea. Nail salons can be a breeding ground for bacteria and fungus. You might be better off getting a 'pedicure' by your foot doctor where you'll know that your nails will be cut straight across and not too short with sterilized tools. If you must go to a nail salon, request that they clean the foot bath in front of you and purchase your own set of tools or bring your own from home.

Following or doing the above is important and gives you a better chance to avoid some foot problems. With diabetes, we are more susceptible to foot problems and good foot care is needed. Several of our single support group members have mirrors that they use to look at the bottom of their feet and they also see a podiatrist at least quarterly. This is something that the support group emphasizes and we have had foot inspections one time for everyone. Yes, there was some grumbling, but when it was done, everyone was glad it was done and had more questions of the two podiatrists that participated.

February 22, 2016

See a Podiatrist If You have Diabetes – Part 1

I received several emails after my last blog about seeing a podiatrist saying I was wrong to recommend them. Like any profession, I will acknowledge there are some bad apples in the podiatrist profession. I do at least admit that. I have been fortunate that I have a very good podiatrist and he has served me well.

The American Diabetes Association recommends that all patients with diabetes receive an annual comprehensive foot exam. People with diabetes are at increased risk of developing peripheral neuropathy - loss of sensation in the feet and hands. Foot care can be used as a preventative service and surveillance of abnormalities. A comprehensive foot exam should be done by your primary doctor, certified diabetes educator or podiatrist. I disagree with the ADA and feel that you should see a podiatrist a minimum of twice a year. I personally see my podiatrist four times per year.

If you have recently been diagnosed with Type 2 diabetes or have had diabetes for some time and have not received a comprehensive foot exam, it's important that you schedule an exam - ask your physician at your next appointment. Your doctor should request that you take your shoes and socks off (both feet).

He or she will visually inspect the bottoms of your feet and between your toes to check for ulcers, wounds, fungal infections, and bony abnormalities. Next, he or she will check your feet for pulses, which can be a predictor for blood flow. Lastly, they will conduct a sensation assessment using a 128-Hz tuning fork, 10 g monofilament tool or another device. You will be asked to close your eyes and answer when you feel sensation - either a light pulsating vibration from the tuning fork or a gentle touch of the plastic monofilament tool. If the doctor detects any visual abnormalities such as hammer toes, corns, bunions, hard-thick nails, wounds, cracked skin, fungal infections, you will likely be referred to a podiatrist.

If you have diminished sensation or loss of sensation, you may also be referred to a podiatrist or vascular doctor for further testing to rule out peripheral arterial disease.

A podiatrist is a doctor of podiatric medicine (DPM), also known as a podiatric physician or surgeon. Podiatrists diagnose and treat conditions of the foot, ankle, and related structures of the leg. Today, many podiatrists specialize in diabetes foot care. If you have a foot injury, ulcer, or other abnormalities such as bunions and calluses a podiatrist can prescribe accomodative orthotics or custom made diabetes shoes. If you have a bunion, for example, getting a pair of extra wide or deep shoes to aid in comfort and safety. As preventive services, a podiatrist can trim your nails and scale your feet.

February 21, 2016

Our February '16 Meeting

Tim talked to me several times and I said he had the right to use whatever he needed from my blogs. When the meeting started on February 20, Tim took time to thank Sue, Brenda, and me for the discussion we had about a few of Sue and Bob's friends that were promoting gluten-free foods. He asked for a show of hands of people that did not know what gluten was. Seven hands were raised and Tim said not to be afraid to admit this, as most people may not know about gluten.

This caused three more people to raise their hands. Tim said that most of the longer term members knew about gluten and those that had been in the group from the start definitely knew about gluten, as this had been a topic of discussion many times. Gluten is the tough, viscid, nitrogenous substance remaining when the flour of wheat or other grains is washed to remove the starch. Tim said the wheat and other grains are the important words and they contain the gluten.

Since celiac disease is an autoimmune disease, it is generally the people with type 1 diabetes that develop celiac disease. There are a few other people that can develop celiac disease, but this would be a very small number and even smaller number that have type 2 diabetes, but it is possible.

Tim said some people with type 2 diabetes do develop an intolerance for gluten, and when this happens, not eating wheat or grain products can really help. As he was talking, Tim was rotating some slides and pausing when people were asking questions. Among the newer members, there were quite a few questions and Tim was taking time to answer every one. When he put the slide up with these statements, (Celiac disease is one of the most commonly misdiagnosed diseases by doctors. A doctor should monitor the diet in order to prevent complications. The diet will also help people with non-celiac gluten sensitivity.), this raised several questions.

Tim explained that many doctors don't think about autoimmune diseases and don't see celiac disease that often and many doctors never see a person with celiac disease.

Tim then started on gluten-free foods and that several people are presently promoting gluten-free as a weight loss diet. Yes, they're heavily promoting gluten-free and hoping to make a sale of their products. Tim called on Sue to explain what she had seen in products.

Sue said they had several cereals, pasta, and other products that were labeled gluten-free. Most of the other products could be found much cheaper in the grocery stores and wouldn't have the sugar added that their products included. All products were over-priced and had more sugar or fructose than comparable products. And they say this is a weight loss diet – right.

Tim stated this is what they are promoting and even some of the foods in the grocery store that claim to be gluten-free also have added sugar and high fructose corn syrup and this is why we don't recommend these products for people that have diabetes.

Then Tim showed his last slide, which said “LCHF.” He turned to me and asked what this meant. I said that it meant we did not eat high carb foods that included any grains and other foods heavy in starch. By doing this most of us would never have any problems with gluten and even is we were gluten sensitive, we did not need to worry, as we would be eating foods that did not contain any gluten. I finished by saying that the low carb, high fat way of eating was better than eating gluten-free foods.

Tim said this is correct and concludes my presentation. We will take time to answer more questions, but the meeting is over. Questions consumed the next thirty minutes and the members started leaving. When we finished cleaning, Tim stated that he could not believe people would try to promote gluten-free foods to people with type 2 diabetes. Sue said this is what her husband said and that is why they told them about LCHF way of eating which costs less and results in easier weight loss.