Sunday, November 22, 2015

Type 1 Diabetes

Diabetes Awareness Month -
November is American Diabetes Month®.  Earlier this month I wrote a blog to help decipher common myths associated with Type 2 Diabetes.  Today’s focus will be on Type 1.  So what is Type 1 (insulin-dependent or juvenile) Diabetes?  Type 1 Diabetes can occur at any age, but most commonly is diagnosed from infancy to the late 30s.  In this type of diabetes, a person’s pancreas produces little or no insulin.  The causes are not entirely known, but scientists believe the body’s own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas.  People with type 1 diabetes must inject several times every day or continuously infuse with insulin through a pump. 

Symptoms – may occur suddenly, however, the process may have been going on for some years:

·         Extreme thirst

·         Frequent urination

·         Drowsiness, lethargy

·         Sugar in urine

·         Sudden vision changes

·         Increased appetite

·         Fruity, sweet, or wine-like odor on breath

·         Heavy, labored breathing

·         Stupor, unconsciousness
If you think that you or someone that you know has these symptoms, call a doctor immediately.  Drink fluids WITHOUT SUGAR, if able to swallow, to prevent dehydration.  (If there is not enough insulin to get glucose into the cells to use for energy, the body turns to an alternative source of energy, and burns fat.  Ketones are a waste product of the body using fat for energy and if ketone levels get high, this can lead to a serious medical situation call diabetic ketoacidosis (DKA).  There are an estimated 29 million Americans with diabetes; about 3 million have Type 1.  This smaller proportion of people with type 1 might be part of the reason that the condition is so misunderstood.
Here are a few common tales that we’ll set the record straight and help gain a better understanding of type 1 diabetes:
Tale:  You must have OD’d on sugar to get type 1 diabetes.

Fact:  No one knows the exact cause of type 1 diabetes.  Researchers are still trying to get a clear picture about genetic and environmental factors that might play a role.  The one thing we DO know is that it’s NOT brought on by too much sugar.  Oh, and they CAN have desserts (more on that later).
Tale:  Could it come from getting a vaccine as a kid?
Fact:  Scientists have NOT found a link between vaccines and type 1 diabetes.

Tale:  You put on too much weight.  That’s what caused it.
Fact:  Weight is not to blame for this disease.  Obesity and inactivity are big risk factors for type 2 diabetes and many other health problems, but there’s no connection to type 1.

Tale:  You have the “bad” kind of diabetes.
Fact:  This is often a common comment in my ‘Diabetes Made Simple’ class.  There is no “good” kind of diabetes, nor is it a matter of being better or worse.  Type 1 and type 2 diabetes are different, and therefore have to be managed as such. 

Tale:  Do you really think you should be eating that?!
Fact:  People with type 1 diabetes can eat or drink anything they want as long as they take the right amount of insulin to balance out the carbohydrates.  Now as a dietitian I’m always teaching patients, type 1 or type 2, healthy, balanced eating.  It’s not a free for all when it comes to desserts.  However, people with type 1 diabetes should not be made to feel that there are foods that they shouldn’t eat.  They can and should.  I had a 7-year old child in my office recently diagnosed (spunky as all get out) ask me, “Can I have cake on my birthday?”  I promptly responded, “Of course you can!”  She then followed up with her spunkiness and told me that she had lots of friends and they have birthdays too.  Can she have cake on their birthdays?  I of course had to outwit this 7-year old and proceeded to ask how many friends did she have??  She wanted me to tell her she could have cake every day!!  I explained to her that cake is exactly that, meant for special occasions and she really shouldn’t be having sweets every day (and that other kids her age shouldn’t be either). 
Tale:  It’s probably not a good idea to play sports.
Fact:  Jay Cutler, Ryan Reed, Gary Hall Jr – all athletes with Type 1 diabetes.  If you pay attention to how you feel and closely watch your blood sugar levels adjusting as you need to, you can stay safe and play any sport you want to.  Kids blood sugar levels during practice might react differently than during their actual game (adrenaline can make their blood sugars elevate), so I always tell my patients to know that they can actually have different reactions from practice versus game day – the key is to always be monitoring and aware.

Tale:  You were feeling so good last week.  Why are you having so much trouble this week?  Don’t you have it all figured out?
Fact:  Managing diabetes can change daily.  Many things, including stress, hormones, periods of growth, and illness, can cause your blood sugar levels to swing out of control.  These ups and downs don’t mean you’ve done anything wrong.  Even if you stick to your meal plan and follow the same schedule daily, these other factors can affect your blood sugar levels.  Again, managing diabetes is a daily job and it’s not something that can be forgotten about – it takes effort daily.
Tale:  When can you stop the insulin?  Shouldn’t you be cured by now?
Fact:  People with type 1 diabetes make NO insulin and taking insulin keeps them alive.  They must have it, but it doesn’t make the disease go away.  There is no cure, but there have been lots of advances.  And as the research continues, there have been advances in treatment of diabetes as well as technology – insulin pumps, continuous glucose monitors and, someday, maybe even an “artificial pancreas”. 
Here's some of the latest research being conducted at the Diabetes Research Institute:

 Diabetes can be a complicated disease as it can affect all areas of your life.  However, it shouldn’t keep you from doing anything you put your mind to.  You can eat what you want, play whatever sport you want, get pregnant, and travel the world…you simply have to be aware of your blood sugar levels and begin to think like a pancreas.   I always tell my patients that while they self-manage their diabetes daily, it’s important to have a nurse educator, endocrinologist, and dietitian that can help support you.  We’re there to help interpret your numbers, help adjust basal rates, and remind you that you’re doing an amazing job!! I have been working at the DRI for almost 2 years now.  I can tell you that I’ve been forever changed from the kids (and adults) that I’ve met. 

Sunday, November 8, 2015


Movember – Trying to Change the Face of Men’s Health

They’re sprouting up everywhere, moustaches on men’s faces, around the world!  During the month of November, “Movember” uses the power of the Mo (slang for moustache).  Movember helps raise money and awareness to help combat men’s health issues: prostate and testicular cancer, poor mental health, and physical activity.  Getting the right screening test at the right time is one of the most important things a man can do for his health.  Screenings find diseases early, before you have symptoms, when they’re easier to treat.  The tests you need are based on your age and your risk factors.  Take control of your health and look after yourself.
Prostate Cancer

Prostate cancer is the second most commonly diagnosed cancer in American men (after skin cancer).  1 in 7 men will be diagnosed with prostate cancer in their lifetime.  In 2015, an estimated 220,800 American men will be diagnosed with prostate cancer.  It tends to be a slow-growing cancer, but there are also aggressive, fast-growing types of prostate cancer.  Screening tests can find the disease early, sometimes even before symptoms develop, when the treatments can be more effective. 
Know the Risk Factors in developing the disease:

Family History – A man with a father or a brother who developed prostate cancer will be twice as likely to develop the disease.
Ethnicity – There is an increased occurrence in black African and Afro-Caribbean males.

Symptoms, Testing, and Treating –
There are not always symptoms associated with prostate cancer.  In fact, many times it is first detected at routine check-ups.  However, here are some symptoms that might indicate the presence of prostate cancer: 

·         A need to urinate frequently, especially at night

·         Difficulty starting urination or holding back urine

·         Weak or interrupted flow of urine

·         Painful or burning urination

·         Difficulty in having an erection

·         Painful ejaculation

·         Blood in urine or semen

·         Frequent pain or stiffness in the lower back, hips, or upper thighs
If you are experiencing any of these symptoms, it is important for you to contact your doctor.  The following tests are recommended to detect prostate cancer early on (before the disease progresses):

·       The Digital Rectal Exam (DRE) – The DRE involves the doctor inserting a gloved finger in the anus, where it is possible to feel part of the surface of the prostate.

·       The PSA blood test (PSA) – The PSA blood test looks for the presence of a protein in the blood that is produced specifically by prostate cells.
Depending on the results of these tests you may be referred to a specialist for a biopsy – the only way to determine if cancer is present.

Testicular Cancer
This uncommon cancer develops in a man’s testicles, the reproductive glands that produce sperm.  Most cases occur between ages 20 and 54.  The American Cancer Society recommends that all men have a testicular exam when they see a doctor for a routine physical (even if you feel fine, it is still important to see your health care provider to check for potential problems).  Men at higher risk (a family history or an undescended testicle) should talk with a doctor about additional screening. 

Symptoms, Testing, and Treatment – Men may experience few or no symptoms of testicular cancer.  Here are some important symptoms to be on the lookout for:
·         Swelling or a lump in either testicle (usually painless)

·         A feeling of heaviness in the scrotum

·         Change in the size and shape of the testicles

·         Aches or pain in the lower abdomen or groin

·         A sudden build-up of fluid in the scrotum

·         Pain or discomfort in a testicle or in the scrotum

·         Enlargement of tenderness of the breast tissue
Regular self-examination of the testicles is important for young men.  Just like women are recommended to self-examine their breasts for breast cancer, doctors advise regular self-exams in men, gently feeling for hard lumps, smooth bumps, or changes in size or shape of the testes.  Self-examination can help find any changes in the testes EARLY on. 

Colorectal Cancer
Colorectal cancer is the second most common cause of death from cancer.  Men have a slightly higher risk of developing it than women.  The majority of colon cancers slowly develop from colon polyps: growths on the inner surface of the colon.  After cancer develops it can invade or spread to other parts of the body.  The way to prevent colon cancer is to find and remove colon polyps before they turn cancerous. 

Tests for Colon Cancer -
Screening begins at age 50 in average-risk adults.  A colonoscopy is a common test for detecting polyps and colorectal cancer.  A doctor views the entire colon using a flexible tube and a camera.  Polyps can be removed at the time of the test.  A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon.  Some patients opt for a virtual colonoscopy – a CT scan – or double contrast barium enema – a special X-ray – although if polyps are detected, an actual colonoscopy is needed to remove them.

Skin Cancer
The most dangerous form of skin cancer is melanoma.  It begins in specialized cells called melanocytes that produce skin color.  Older men are twice as likely to develop melanoma as women of the same age.  Men are also 2-3 times more likely to get non-melanoma basal cell and squamous cell skin cancers than women are.  Your risk increases as lifetime exposure to sun and/or tanning accumulates; sunburns accelerate risk.

Screening for Skin Cancer
The American Cancer Society and the American Academy of Dermatology recommend regular skin self-exams to check for any changes in marks on your skin including shape, color, and size.  A skin exam by a dermatologist or other health professional should be part of a routine cancer check-up.  Treatments for skin cancer are more effective and less disfiguring when it’s found early.

High Blood Pressure (Hypertension)
Your risk for high blood pressure increases with age.  It’s also related to your weight and lifestyle.  High blood pressure can lead to severe complications without any prior symptoms, including an aneurysm – dangerous ballooning of an artery.  But it can be treated.  When it is, you may reduce your risk for heart disease, stroke, and kidney failure.  The bottom line:  Know your blood pressure.
Screening for High Blood Pressure
Blood pressure readings are two numbers.  The first (systolic) is the pressure in your arteries when the heart beats.  The second (diastolic) is the pressure between beats.  Normal blood pressure is less than 120/80.  High blood pressure is 140/90 or higher, and in between those two is prehypertension.  How often blood pressure should be checked depends on how high it is and what other risk factors you have.

Cholesterol Levels
A high level of LDL cholesterol in the blood causes sticky plaque to build up in the walls of your arteries.  This increases your risk of heart disease.  Atherosclerosis – hardening and narrowing of the arteries – can progress without symptoms for many years.  Over time it can lead to heart attack and stroke.  Lifestyle changes and medications can reduce this “bad” cholesterol and lower your risk of cardiovascular disease.
Determining Cholesterol Levels
The fasting blood lipid panel is a blood test that tells you your levels of total cholesterol, LDL “lousy” cholesterol, HDL “healthy” cholesterol, and triglycerides (blood fat).  The results tell you and your doctor a lot about what you need to do to reduce your risk of heart disease, stroke, and diabetes.  Men 20 years and older should have a new panel done at least every five years.  Starting at 35, men need regular cholesterol testing.

Type 2 Diabetes
One-third of Americans with diabetes don’t know they have it.  Uncontrolled diabetes can lead to heart disease and stroke, kidney disease, blindness from damage to the blood vessels of the retina, nerve damage, and impotence.  This doesn’t have to happen.  When found early, diabetes can be controlled and complications can be avoided with diet, exercise, weight loss, and medications.

Screening for Type 2 Diabetes
A fasting plasma glucose test is most often used to screen for diabetes.  More and more doctors are turning to the A1C test, which tells how well your body has controlled blood sugar over time.  Healthy adults should have the test every three years starting at age 45.  If you have a higher risk, including high cholesterol or blood pressure or a family history, you may start testing earlier and more frequently.

Poor Mental Health
3 out of 4 deaths by suicide are men.  Anyone can be affected by poor mental health.  Many men might find it difficult to share their problems and feelings with others.  Many men might try to remain ‘strong and silent’ rather than get the support that they need.  It’s important to be proactive about your mental health and be aware of the risk factors and symptoms:
·         Family history of mental health problems

·         Drug and alcohol use

·         Serious medical illness

·         Isolation or loneliness

·         Unemployment, homelessness, conflict, or other stressful life situation
If someone that you know is at risk, encourage them to contact their doctor, a mental health professional or access support.   Take action, stay connected, and look after your mental health. 

Physical Inactivity: is the fourth leading risk factor for global mortality.  Sitting is the new smoking.  It’s killing us.  Being active is essential to prevent and reduce risks of many diseases and improve both physical and mental health.  Make time and MOVE more!!

The bottom line
Stop avoiding the doctor.  Routine physicals are meant to screen for diseases and assess the risk of future medical problems.  Take action to reduce your risks.  Start with healthy lifestyle choices – eat a healthy diet, stay physically active and quit smoking.  The impact of the changes now will be greater than you’ll ever know. 
Movember’s vision:  “have an everlasting impact on the face of men’s health.”