Small Changes, Big Difference

I hear it all the time in my office – “I’m not sure why I can’t lose weight.  I’ve tried anything and everything and still, no weight loss.  Sure a few pounds here and there and then I’ll gain it back”.  I really could put this story on repeat.  I’m not one to doubt people, and I’ll be honest, I don’t have the magic pill that people can take to help them have sustainable weight loss, but…the other day a lady came into my office and had NO clue how many calories she was eating daily.  (I don’t teach people to count calories, but I do have them log occasionally what they’re eating to gain perspective and insight into where they need to make changes).  Having said that she only needed 1,400 calories/day and was eating close to 2,400 calories daily (and I was being generous with her portions where she quite possibly was eating 3,400 calories for all I know).  This was an easy a-ha moment for her.  She could see where she needed to make changes and I used real life examples with what she was currently eating.  Then I began to show her other ideas of areas in which to change and she did seem motivated.  I’ll see her in a couple of weeks for follow-up and find out.

This is what I teach my patients – one change at a time.  Don’t go trying to do: a three-day juice cleanse, a go to the gym every day for an hour, or NO CARBS EVER – because real life will sneak up on you and before you know it you’ve inched back into your old ways.   These quick fixes don’t work in the long-term.  I believe that people have good intentions and it’s not always about one’s will power.  Truthfully I believe the reason that “diets” bomb is because of this “all or none” mentality.  And it is a vicious cycle where it may work for a little while and in the beginning one is all gung ho, but then give it a bit of time and one’s good intentions start to falter and you feel demoralized and end up doing what you’ve always done.  The truth is that sustainable weight loss lies somewhere in the middle ground – choosing one small healthy habit, implementing it and then moving on to the next – you start small without feeling like you’re changing EVERYTHING all at once.  And the key is to find the small change that you need to make as no one small change will work for everybody.  These small changes can add up to big changes!  Here are a few suggestions for some small changes:

Track your food intake.  Don’t change a thing of what you’re currently eating, but simply begin to measure the amounts.  After a day or two look back over your food intake to reflect and see what it is that you’ve been taking in.  Periodically check back into yourself and start to log the food intake again - The simple act of writing this information down has proven to be one of the most powerful weight loss tools.  The act of writing it down is about holding yourself accountable.  You might also want to note how you were feeling right before you ate it.  Were you angry, sad, or bored?  We often focus so much on foods and calories, but our emotions are a huge part of our eating habits.  (With many of the current applications, Fat Secret, My Fitness Pal, or Lose It, they will help calculate out your estimated caloric needs based on your height, weight, age, and estimated desired weight loss.  This will give you an idea of what your estimated nutrient needs are to be able to see how on point or how not on point you are). 

Track Your Sleep.  You may have heard that there’s a link between sleep and weight – and there is!  Losing just 30 minutes of sleep each night can lead to long-term weight gain in adults (not to mention a range of other ailments:  diabetes, metabolic syndrome, heart disease, stroke, and cancer).  Adults typically need between 7-9 hours of nightly sleep (according to the CDC).  If you know you’re lacking sleep, aim to get at least a little extra each night.  Incorporate a soothing nighttime routine – meditate, have a warm bath (make sure to turn off your tablet – the blue light from the screen can disrupt your circadian rhythm).  The key is to settle your wakeful brain to sleep mode – and aim for consistency. 

Eat More Vegetables.  You’ve seen the USDA’s “My Plate” where half the plate is vegetables?  Well, eat MORE vegetables.  I often call it the “fiber factor” with my patients.  The fiber does a critical job in your body.  Most people associate it with “aiding in digestion”, which it does, but more than that, it slows everything down and can give you a sense of fullness.  This is critical when it comes to helping one eat fewer calories at a meal (as vegetables are often lower calorie).  Let’s be clear when I say EAT more vegetables (I did say eat, NOT drink) – the non-starchy vegetables:  Lettuce, spinach, kale, broccoli, cauliflower, mushrooms, asparagus, peppers, eggplant, zucchini, yellow squash, garlic, onions, and more.  (Starchy vegetables like corn, potatoes, peas, and the winter squashes are technically classified as carbohydrates.  They work quite differently than the non-starchy vegetables in the body).  I’ve been challenging some of my younger patients, the kiddos (and even adults) to try one new veggie a week and try it in all different forms to maybe find the form they might like.  For instance, with cauliflower, try it raw, steamed or roasted.  You can even turn the cauliflower into cauliflower “rice” or make a cauliflower crust.  The key is to think outside the box when it comes to veggies and begin to incorporate more in for the fiber factor.

Move More.  The latest trend has been and still is fitness tracking devices.  They count your steps all day (and some even measure your heartrate!)   I’ll admit, I’m a little bit obsessed with my Fitbit.  Obsessed in a good way.  When I first got my Fitbit, I started to notice that by the end of the workday I’d be averaging 3,000 steps in a day (just while at work).  If I did my morning run I’d tack on between 5,000-7,000 steps on those days, but on the days when no exercise was happening, I was at less than 50% of what the recommended goal is of 10,000 steps/day.  What I started doing over this last year, was beginning to incorporate a morning walk, a walk at lunch, or an evening walk.  The key for me was simply moving more.  I was conscious of the fact that my job was sedentary but seeing the steps was the motivation for me to use those 10 minutes I’d arrive at work early to go for a quick walk.  The lunch time walk is important for me to simply get out of the building and get some fresh air (many times people think that they’ll get more work done if they eat their lunch at their desk.  Sadly, that’s not the case.)  Since this New Year started I’ve gone every day except for two on a lunchtime walk and I can honestly say I’m more productive and feel better when I do get my mid-day walk in.  Remember, small steps.  If hearing 150 minutes/week sounds like too much and un-obtainable, simply aim to get 10 minute intervals in when you can.  The movement makes a difference. 

Hydrate, Hydrate, Hydrate.  And I’m talking hydrate with WATER.  We’ve had an unseasonably hot and humid winter thus far in Miami.  And with that humidity needs the replacement of the water loss daily through sweating, etc.  More so, water is calorie free and the only drink that can truly quench your thirst.  The patient I mentioned above was having 2 sodas daily (the 20 ounce bottle size).  She admitted to being addicted to soda, but that was an additional 500 calories daily that by simply removing would allow for her to lose a pound/week.  She knew that they were extra calories, but wasn’t quite sure of how to eliminate them completely.  She wasn’t willing to eliminate them completely (too extreme), so I explained that maybe the way in which she could begin to make the change was to simply change the size of her soda.  Instead of a 20-ounce, 240 calorie drink, could she be satisfied with their 8-ounce, 90 calorie drink.  Remember, small changes.  Sure I’d love for her to completely eliminate them but I also need to be realistic.  She was willing to work on the amount that she was taking in when she realized I didn’t tell her to eliminate it completely.  Believe me, the end goal is to remove sodas completely, but it’s all in how you approach it.  We cut back 300 calories alone just with her drinks.  I then proceeded to show her other ways in choosing healthier options at the restaurants she was eating at to cut back even more.  Working where she was at and beginning to make small changes. 

When making dietary changes, start small and set realistic goals.  The path to a healthier lifestyle begins one little habit at a time.  Make the commitment to making healthy changes and by this time next year, you’ll be in a much better place.  Balance, moderation, variety, and one step at a time.  It’s not a diet; it’s a way of life.

 

 

Fuel Happiness

Fuel Happiness

A few weeks back while scrolling through Twitter I saw a picture posted by Lululemon:

I re-tweeted the picture and challenged people to write down three things they were grateful for.  Little did I know all that was to unfold just from a simple re-tweet (more on that later).  Over this last year I’ve been writing down daily at least two things I am grateful for:

I’ve always seen the gratitude jar and the idea surfaces each New Year, but have never really committed to doing so.  Last year, I decided I was going to do it.  I started reading through all of my notes (from this past year) on New Year’s Day and there were days as I am looking back that were just simple entries, “birds chirping, sun rising, and the smell of fresh cut grass (seen on my run)” and then there were days that were a little deeper, “thankful my friend made it out of surgery – while it was more intensive than previously thought, she’s going to be okay – grateful for her friendship and all that she means to me.”  It’s hard to put into words how the gratitude jar changed me.  But it did do just that, change me.  The simple truth is that each and every day there is something to be grateful for.  I’m blessed with a good job, a family that loves me (and friends too), and my health.  I believe the change came in looking at challenges/stresses that I would face as growth and opportunities to learn versus having a negative attitude/reaction about them.  One example is that I had my purse stolen the day before Thanksgiving.  The gentleman came into our work area under the premise that he had just been diagnosed with diabetes and what was he going to do as it was the day before Thanksgiving.  He said he needed “help”.  A thief preying on our good nature and the essence of what we do, helping people.  Having my purse stolen before I probably would’ve reacted by letting it ruin my whole day.  As it was, I definitely had a moment right after it happened (he used the card at the Dollar Store for $337 – how did they not check his ID with that big a purchase?!) but within an hour I was already reflecting on the good – I was safe, my purse/license, etc. could be replaced, and this gentleman was obviously stealing because he didn’t have enough.  Total different reaction than what I would’ve had before.  I’ve been using this as my mantra:  “gratitude always in all ways” – in a weird way I was actually grateful my purse was stolen.    My purse was/is just a material possession and everything that was in there was able to be replaced.  Sure we’re a little more careful around the office and close our doors and lock them whenever leaving the area.  But even though this gentleman preyed upon us by using the “recent diabetes diagnosis”, I knew that I can’t/won’t change who I am as a person – the next person that walks through the door really might need help with a recent diagnosis of diabetes.  This one rotten apple won’t spoil the whole bunch – I’m grateful that I am able to educate people and help them with their diagnosis.  This thief was good but he won’t leave me jaded.  The gratitude jar allowed me to start my day with something that I was grateful for and also end my day with something that I was grateful for.  Even on those tough long days I always made time to reflect on the day.  It would have been easy to skip the jar, but reflecting at the end of the day I always was able to see the good in the bad (as they say). 

After I re-tweeted the picture from Lululemon it began to create a dialogue with one of their employees through email.   As part of the picture and the tweet I said something to the effect that meditation helps me to be grateful.  She asked me how I meditate and what has been my experience with meditating? I told her my goal is to meditate daily, however, my struggle has been with consistency.  Let’s be honest, my mind races!!  It’s hard for me to sit still and just be.    There are times when I’ll sit at my desk at lunch (another unhealthy habit I plan to work on in the coming year) but where I take a moment and just sit and breathe and block everything out.  Sometimes my meditation is just for a minute or two.  And while this allows me to focus and work on the rest of the day, by the time I do get home I’m exhausted.  If I close my eyes, I might be down for the count.  So, consistency in meditating has been my challenge.  The Lululemon representative wrote back and told me to be on the lookout for a “surprise”.  A week or two went by and lo and behold there was a surprise in the mail.  Enclosed in the package was a letter giving me a year subscription to Headspace – a meditation app.  The letter said that Headspace is an app that “offers support in practicing mindfulness which is so important to maintain over the holidays” – um, just what I needed!!  Again, I am no expert when it comes to meditation.  I call it an exercise in breathing and doing nothing to help you focus when it really matters (with your mind wandering and re-focusing as many times as needed).  I know I’m not the only one, but as I said, my mind races all the time.  During my yoga teacher training, my teacher made me cover my eyes with a scarf because obviously I was looking around at everything (my mind racing).  Taming your mind is hard work!  The app has helped me to be more consistent.  I would meditate before, but just wasn’t truly consistent and so every time that I would start would be like starting over for the first time.  Meditating is truly just that – breathing and beginning to focus, getting lost and starting over, and then getting lost and starting over all again – it’s what we do!  But the important part is I’m aiming now more on my consistency.   Meditation is a bicep curl for the brain.  My hope is that with consistency in meditating I get stronger and will truly be more present and “in the now”, simply put, being focused and present in all that I do.  I’ll keep you posted. J

The next little gift that was enclosed were a deck of cards enclosed with a separate note.  It asked, “What if the only thing you practiced this holiday was happiness?”  It went on to say that “happiness is a practice” and said that there were 35 research-based practices on the cards that can help to fuel our happiness this holiday.  One card for example was labeled “Positivity” –

This past week I gave up listening to music.  It might sound like that’s an easy thing to give up (and I thought it was something easy I was starting with).  But for me, when I’m cooking I listen to music.  There’s been a lot of cooking this past week (I’ve been off from work) and with no music it gave me a LOT of time to think.  Today when the week was up, I played some music while cooking and believe me when I tell you how MUCH I appreciated having the music play J   Now to think about what I’ll give up next month for a week.  I am looking forward to continuing this month after month to get the full effects as they say.  Cultivate positivity.  Try giving something up. 

I’m not one to set “resolutions” in the New Year.    However, I do sit and reflect on the past year to see what changes I will make to help better myself in the New Year – I’d rather call it an aim or an intention.  In my professional life this past year, my intent was to learn and soak up as much as possible at work and aim to take the Certified Diabetes Educator (CDE) exam.  I did just that and PASSED! Yay!!  I think there is always more to learn and while I now have this title after my name I truly believe that I was a CDE even had I not passed the exam.  Luckily I passed J  So, it got me thinking about this next year.  What would be my intention?  The gift from Lululemon made it clear and evident.  First and foremost, meditate.  I have a tool (the Headspace app) that enables me to focus and improve on taming this mind of mine.  I look forward to hearing the 10-minute sequence that is set before me each day.  I started before the New Year in hopes that I would truly begin to be consistent.  I’m currently on Day 13.   There hasn’t been an easy day yet.  But that’s okay.  I’m exercising my brain and that takes work.  My goal is simply to be more focused and really truly present when I’m engaged in different activities.  Secondly, I’m going to work on “fueling my own happiness” – I know that happiness is a skill, a practice, something that I can train (meditation suggests so).  It doesn’t mean that my external circumstances aren’t going to impact my happiness.  It just means that with meditation it will help me to navigate it with a little bit more ease.  Where will I start?  How does one “practice being happy?” That deck of 35 research-based cards (given to me) will be a start.  They have ideas of ways that can help “fuel my happiness” that have been proven to boost my mood and truly help me to flourish.  Why wouldn’t I try some of these out?  “Fueling my happiness” will make my days happier, interactions with others happier, and maybe, just maybe, I’ll spread happiness to the people in my life.  I’ll share throughout the year (Twitter and Instagram) some of the ways I’m fueling my happiness J

So, again, it’s that time of year when you take time to reflect on the closing year and begin to make resolutions, goals, intentions (whatever you care to call them).   You probably have already done so, but let me challenge you to include one of the concepts I’ve presented to you today:

1.       Keep a gratitude jar (or journal)

2.       Meditate.  Breathe.  Focus.

3.      Fuel Happiness – find what fills you with passion and purpose.  It’s all up to you.  Ignite a ripple effect in your community.

The Holidaze

Over the past month…

Really the last three months, it’s been ALL about studying.  I recently took my CDE exam (certified diabetes educator) and PASSED!!  I will start off by saying that an exam doesn’t make me a CDE, however, I now have the credentials showing that I am.  I have been at the Diabetes Research Institute, DRI, for almost two years now.  When I first started there I set out a lot of goals that I wanted to achieve and becoming a CDE was definitely on the list.  During the first year I  was learning a lot and had to slow down on what I thought I’d accomplish in my first year (the master’s is still on the list, there was/is  a period of adjustment that had to happen) and I’ll be honest, my type A personality kind of took over thinking I could do it all.  Diabetes is a complicated disease – Type 1 and Type 2.  There are many myths associated with the disease and one being that if you’re overweight you’ll get diabetes (Type 2).  Not true.  Not every overweight person has diabetes.  Does it increase your risks?  Absolutely.  But diabetes is more complicated than that.  Take a look at this picture of your organs affected by diabetes.  It’s not just your pancreas!

So when we’re treating someone with diabetes it takes a lot of teaching to help people understand what all is functioning/not functioning in their body.  People with diabetes many times don’t have the sensation of feeling full – their gut hormone is not functioning 100%.  If there is at least this understanding, this allows me to teach my patients at least better ways to put together meals that will help to make them feel full.  First and foremost, everyone should eat as if they had diabetes.  The problem is that people don’t.  We are a society on carbohydrate overload and we need to start cutting back.  Just look at breakfast as an example.  Cereal.  Maybe the worst food ever created (yep I said it).  1 cup of regular Cheerios has 20 grams of carbohydrate.  A real serving size might be more like 3 cups worth (or more depending on the individual, let’s be honest).  3 cups = 60 grams of carbohydrate and that’s not including the milk that is added.  An average meal for a female should consist of just 45 grams of carbohydrates and men up to 60 grams.  The problem with cereal is that being that it’s almost all carbohydrate and virtually no protein (Cheerios did just get in trouble for their claim that their “protein” cereal had more protein than the regular Cheerios) you’re hungry all over again in just under an hour!

http://cspinet.org/new/201511091.html

In the world of digestion protein keeps you fuller longer, so you need protein at each meal AND we need to lessen the load of carbs at each meal if you have diabetes or don’t have diabetes.  And just for the record, I picked what is believed to be a cereal that is “healthier” than others.  I have another cereal in my office to use as an example that in it’s one cup serving has 39 grams of carbs.  That’s ludicrous.  Just saying.  (If you had 3 cups worth along with a cup of milk that totals ~130 grams of carbs, what is the total grams of carbs needed for some people in a WHOLE day!)

Back to studying for the CDE.  The hardest part for me was learning all of the drugs and their mechanism of action.  I typically have an hour with a patient and obviously as a dietitian I need to educate them on the food as that’s a critical component in diabetes self-management.  I realized when I started studying the only way I was going to learn the drugs would be to include them in my counseling.  So as a patient came in, I knew what medications they were on and then would ask if they wanted to know why they were on what they were on.  ½ did, ½ didn’t.  But that was my in.  If they did want to know I explained to them exactly why they were on the medicine they were on.  The repetition helps, but in all honesty that’s they only way I was able to learn and commit to memory the medications.  It then would allow me to segway in to teaching the patients about food and how it’s all interrelated. 

I really do aim to teach patients as they come in on what their needs are for that day.  I had a patient come in the other day with an insulin pump.  She had her settings in the pump but had no idea what they were or how to navigate her pump to see what they were.  I explained to her that an insulin pump is great, but she’s the brains behind the pump and in order to obtain better blood sugar control she needed to understand her settings.  She was only testing her blood sugar two times per day and we focused on increasing the frequency of her checks as that too allows her to make sure she’s correcting an elevated blood sugar and not just staying high all day.  In that hour, sure I talked a little bit about food (it always returns to the food!) but we spent the majority of our session focusing on the barriers of why she wasn’t testing and what we could do to help her bolus 15 minutes prior to her meals – something so simple but so critical in helping her to have better blood sugar control.  I’m supposed to talk with her tomorrow and see how her weekend went with checking her blood sugar levels as well as if her current settings are working at the ratios they are set & if she’s been able to bolus ahead of meals. 

The definition of a CDE, “is a health professional who possesses comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention.”  I’m proud to say I passed the test and am a CDE; however, knowledge goes beyond test taking.  There were many questions that I could’ve added an answer “E” to because there wasn’t really a “best answer”.  I’m in a place where not a day goes by that I don’t learn something knew or see something knew…all making me an even better CDE J

So as I was studying my days and nights away, Thanksgiving happened and now Christmas is just 5 days away!!  So it’s that time of year again when we gather with friends and family to celebrate the holidays.  The holidays are filled with lots of tasty food, seasonal goodies, and cheer that can/may result in a few extra pounds that can wrap around your middle. 

Dangerous pounds!  Research shows that most adults will gain a few pounds over the holidays.  Not only will they gain a few pounds but they’ll also lose one or two of those added pounds, and then usually hold onto at least one pound each year.  This slow and steady weight gain creeps up on us over the years and can lead to adults becoming overweight by middle age.

 

You can take pleasure in the holidays and enjoy delicious foods.  The holidays shouldn’t be a time of deprivation; no one wants to face Thanksgiving, Christmas, Hanukkah, or any holiday party without being able to enjoy their favorite foods.  The key is having a plan so that you can avoid the annual trap of gaining weight.  Here are a few tips that will help you this holiday season:

·        Keep up your regular physical activity.  Make sure to get in a good workout on the day of the party or event.  NO excuses! 

·       Eat a small, nutritious snack before leaving for the party.  Sometimes we show up to the party famished.  A small snack will help take the edge off of your appetite and allow you to resist the hors d’oeuvres, saving your calories for the meal.

·       Watch your alcohol calories – they add up fast!  Alternate alcoholic beverages with non-calorie beverages such as sparkling water.

·        Look over all the food offerings before you decide what you are going to eat.  If there are foods that you love but know are decadently rich, just sample a tasting portion.

·        Eat slowly and savor every bite.

·        Don’t linger around the food table!  Move to another location that is less tempting.

·        Portion control and moderation are the keys to success (our eyes are always bigger than our stomachs!)

Remember that social gatherings during the holidays are a time to embrace and give thanks for our family and friends.  Spend less time focused on food and more time enjoying the camaraderie of your loved ones.  Holiday time does not need to be synonymous with weight gain.  Make this your year not to gain those few extra pounds that you adamantly proclaim to lose on New Year’s Day.  Happy Holidays!

 

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.

http://m.mlb.com/news/article/107770944/as-sam-fuld-determined-not-to-let-diabetes-hamper-him-others

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:

http://www.diabetesresearch.org/biohub

 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. 

 

Movember

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.”