THE MONTH TO PREVENT DIABETES

Diabetes is a lifelong, chronic disease in which blood glucose (sugar) levels are above normal. Most of the food we eat is turned into sugar for our bodies to use as energy. The pancreas makes a hormone called insulin to help glucose enter into the cells in our bodies so that the sugar can be used as energy. When you have diabetes, your body either doesn’t make enough insulin or it cannot use it as well as it should, therefore preventing the sugar from entering into the cells and causing it to build up in your blood.

There are different types of diabetes. Type 1 diabetes is when your pancreas does not make enough insulin. It is typically diagnosed in children and accounts for about 5% of all diagnosed cases of diabetes. Type 2 diabetes is when your body cannot use insulin as well as it should. It was previously known as adult-onset diabetes because it was commonly diagnosed in older adults. However, it is now becoming increasingly common among all age groups. You can also be diagnosed with pre-diabetes, which means that your blood glucose is higher than normal but lower than the diabetes range. Pre-diabetes means that you are at risk for getting type 2 diabetes. A third type of diabetes is called Gestational diabetes and can only occur in pregnant women. It develops in 2% to 10% of all pregnancies but often disappears when a pregnancy is over.

November is the month to be aware about and to prevent diabetes. It is also an opportunity to learn how to improve disease management for those already diagnosed. When not well-managed, diabetes can cause serious health problems including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes affects 25.8 million people in the United States and is the 7^th leading cause of death.

Risk Factors for Diabetes

The following factors may increase your risk for having diabetes:

·  Older age

·  Overweight or obesity

·  Family history of diabetes – having a parent, sibling, or grandparent with diabetes

·  Physical inactivity

·  Diet high in sugar and refined starches (white carbohydrates)

·  High blood pressure

·  Prior history of gestational diabetes (women only)

·  Impaired glucose tolerance

·  Certain races/ethnicities may experience a higher incidence of diabetes

You should discuss your risk factors and family history with your family physician.

Symptoms of Diabetes

Common symptoms of diabetes include:

·  Frequent urination

·  Excessive thirst

·  Unexplained weight loss

·  Sudden vision changes

·  Tingling or numbness in hands or feet

·  Feeling very tired much of the time

·  Very dry skin

·  Sores that are slow to heal

·  More infections than usual

If you are experiencing any of these symptoms you should see your family physician.

Prevention of Diabetes

Research shows that moderate weight loss and exercise can prevent or delay type 2 diabetes among those at high risk.

**Eat Right

Eat a diet rich in fresh vegetables, fiber, and lean meats. Reduce your portion sizes and each meal and try to incorporate healthy snacks into your eating habits throughout the day. Avoid foods high in fat, refined (white) carbohydrates, and sugar. Choose fruits that have higher fiber content, like apples or pears, over high-sugar fruits like oranges. Eat whole grains instead of processed starches (brown rice, whole wheat, oats, barley, etc).  Also cut back on sweetened beverages like fruit-flavored drinks, juice, soda, or tea and coffee sweetened with sugar.  While artificial sweeteners (aspartame, sucralose, saccharin) may seem like appealing alternatives, these have also been linked to diabetes.  Try to slowly cut back on the use of all added sugars and sweeteners.

**Be Active

Experts recommend moderate-intensity physical activity for at least 30 minutes on 5 or more days of the week. This may include brisk walking, mowing the lawn (with a push mower), dancing, swimming, or bicycling. Be sure to discuss your ability to be physically active with your doctor and start out with light exercise in order to condition your muscles and to prevent injury.

Treatment

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and to prevent symptoms and problems. With proper management, persons with diabetes can live a long, healthy, active life free of diabetes-related complications.

It is important to be screened for diabetes by your family physician at your annual well-visit, especially if you are over age 45 and are overweight. Screening involves talking to your doctor about your diet and eating habits, physical activity, weight, and also your blood sugar levels (glucose and hemoglobin A1C), determined by blood tests.

If you are diagnosed as pre-diabetic or diabetic and would like to work with a member of your work place health assessment team to prevent or better manage your diabetes, please contact Dr. Steffany Haaz at shaaz@corporatehealthsolutions.com.

For additional resources or to find events planned for your community, visit American Diabetes Association 

Diabetes Management Guide

THE SUNSHINE VITAMIN

WHAT IS VITAMIN D?

The term “vitamin D” is a bit misleading, because it isn’t actually a vitamin at all.  Vitamin D is a hormone that is synthesized by the body for a variety of functions.  One of these is to help the body absorb calcium for strong bones, which is why so many calcium supplements also include vitamin D.  Adequate vitamin D stores can help to prevent osteoporosis in adults and rickets in children.  It ensures proper brain development and bolsters immune function.  It may also provide protection from high blood pressure, some cancers, and other autoimmune conditions. 

AM I GETTING ENOUGH?


Vitamin D is not plentiful in the food supply.* Unlike other vitamins, however, the body can manufacture vitamin D when exposed to natural sunlight.  Just 15 minutes each day in adequate sunshine is sufficient for maintaining a healthy level and there is no risk of overdose because the body will only make as much vitamin D as is needed.  In many locations, however, there is not sufficient sunlight year-round to ensure adequate vitamin D.  For anyone living north of the line between San Francisco and Baltimore, it is impossible to rely on the sun for vitamin D during 6 months of the year.  Even south of that line, many people do not spend sufficient time outdoors with enough skin exposed to synthesize the amount of vitamin D they need. 

At higher risk for deficiency are people with darker skin tone, the elderly, obese persons, and anyone with a fat absorption condition such as cystic fibrosis or irritable bowel disease.  While wearing sunscreen is recommended for preventing skin cancer and wrinkles, it prevents vitamin D absorption.  Those who wear sunscreen regularly are also at higher risk for deficiency.

SIGNS OF DEFICIENCY

The signs of a mild vitamin D deficiency are ambiguous.  Most Americans are unaware that they have inadequate vitamin D stores.  They may experience increased risk of fracture, muscle weakness, fatigue, or low mood.  The best way to determine if you are vitamin D deficient is with a simple blood test. 

SUPPLEMENTATION

 If you have a vitamin D deficiency, it can be easily treated with supplementation, not to exceed 2000 IUs daily (including whatever may be in your multivitamin and/or calcium supplements).  Talk with your family doctor before beginning any new dietary supplements.  Your doctor might recommend supplementation only during the winter months.  If you are substantially deficient, it might be advised that you take a higher dose for a short period, followed by another blood test.  If you suspect you might be low in vitamin D during the winter months, speak with your family doctor now, as the fall season begins.

If you have low bone density or muscle weakness resulting from a vitamin D deficiency, add regular physical exercise to your daily routine, along with any supplementation.  This should include some form of weight bearing activity to build bone and muscle, such as walking/jogging, lifting weights or yoga.

*Note: Some people aim to increase vitamin D by consuming “vitamin D milk.”  This is another term for “whole milk” which is very high in saturated fat and cholesterol.  Whole milk does not contain more vitamin D than fat-free (skim) milk.  All milk and milk substitutes (soy, rice, almond, etc.) are fortified with vitamin D.  It is not nutritionally advised, however, to consume enough of these products to supply the full daily requirement of vitamin D.

KNOW YOUR FAMILY HEALTH HISTORY

Not only do families share a household and holiday dinners, but they also share genes, behaviors, lifestyles, and often live in similar environments. These are all details that influence overall health, chronic diseases, and conditions such as diabetes, cancer, heart disease, obesity, and high blood pressure.

Individuals who have a close relative (parent, grandparent, aunt, uncle, cousin, sibling, or child) with a chronic disease or condition may have a higher risk of also having that same illness than someone who does not have a family history. Therefore, it is important to know what illnesses your relatives have experienced throughout their lifetime in order to better understand your risks.  Many of these diseases are preventable and taking precautions, such as eating a healthy diet, exercising, and being screened can help you to delay or avoid experiencing the same illnesses.

A complete family health history should include 3 generations of your biological relatives, diseases or conditions present, the age at diagnosis, and the age and cause of death of deceased family members.

How to Collect Your Family Health History

·     List names of close relatives and record conditions that each relative had or has and at what age the condition was first diagnosed. For relatives who are deceased, include the cause of death and age at death.

·     Use the US Surgeon General’s online tool for collecting family histories: My Family Health Portrait 

·     Bring your family health history to your doctor and discuss it with him/her.

·     Update your family health history as relatives are diagnosed with new conditions.

Take advantage of family gatherings to find out and share important health information. Just as knowing their experience benefits you, your experiences may benefit them, too.

Practice Prevention

As mentioned above, many chronic conditions can be prevented or delayed if preventive measures are practiced.

·     Eat a well-balanced diet rich in fruits, vegetables, whole grains, and lean meats.

·     Exercise consistently. How much physical activity do you need?

·     Participate in SCA’s annual health assessments to have your labs drawn and to learn how you can become healthier.

·     Visit your doctor annually to discuss your family history and to share your lab results. Talk to your doctor about additional ways to prevent the health conditions that run in your family.

·     Get screened at the appropriate age and frequency. Talk to your doctor about being screened early if a particular disease or condition runs in your family.

ARTHRITIS AND JOINT HEALTH

WHAT IS ARTHRITIS

Arthritis is actually a category that includes over 100 different diseases.  By far, the most common form is osteoarthritis.  Osteoarthritis (OA) is generally thought of as “wear and tear” arthritis.  It involves a loss of joint cartilage resulting from friction in the joint over time.  OA is most common in weight bearing joints, such as knees, hips and spine, or in overused joints, such as knuckles and fingers.  Other forms of arthritis, including rheumatoid arthritis (RA), involve a loss of joint tissue due to an overactive immune system.  This tends to happen symmetrically in many small joints.  Neither type of arthritis can be fully cured, but there are many ways to treat and manage arthritis to improve function, decrease symptoms and enhance quality of life.

RISK AND PREVENTION

Risk factors for OA include: overweight, older age, former injuries, family history, and being female.  Risk factors for other forms of arthritis are less clear, although genetics seem to play a larger role.  Most older Americans have some form of arthritis.  Maintaining a healthy body weight, limiting activities that create strain for a particular joint, and properly treating injuries can help to prevent or delay arthritis onset.

MEDICAL MANAGEMENT

The progression of OA is not changed by medication, but medication can be used to help treat symptoms and allow you to be more comfortable and/or more active.  For more advanced OA, occasional injections may be helpful.  Eventually, when most or all cartilage has deteriorated, a partial or full joint replacement may be advised to dramatically improve long-term function.  Autoimmune arthritis, such as RA, requires ongoing medical treatment, usually through a rheumatologist, to help slow disease progression and prevent/reduce disease flares.

LIFESTYLE MANAGEMENT

As with most chronic conditions, the choices you make each day can impact how you feel and how your health changes over time.  Arthritis management is most effective when regular medical care is combined with healthy behaviors.

Weight loss.  Extra body weigh increases the stress on joints and speeds up the loss of cartilage in OA.  In fact, every extra pound of body weight translates to 7 extra pounds of pressure on active knees.  For this reason, weight loss of just 10 lbs has been shown to dramatically reduce arthritis symptoms in weight-bearing joints.

Appropriate activity.  Physical activity is recommended as part of all arthritis management.  It helps to maintain physical function, enhance joint stability, and promote weight loss.  It also reduces the loss of muscle tissue that can result from autoimmune overactivity in RA or the sedentary lifestyle that is common for people with OA.  It is important, however, to find activities that do not aggravate arthritis symptoms.  This may mean changing the type of activity (ie. from walking to swimming) or changing to smaller, more frequent bouts of activity (ie. 10 minutes, 3 times per day).  Be sure to speak with your doctor before beginning any new physical activity.

Appropriate rest.  If it hurts your joints, don’t do it.  While staying active is important, too much of the wrong activity could exacerbate your symptoms and prevent activity for days to come.  It is important to learn the difference between muscle stretching or exertion and joint pain.  If you feel mild sensation in the belly of the muscle during activity, or mild soreness in the day or two after a new activity, that is normal.  If you feel any sharp pain or sensation at the arthritic joint, stop immediately.  You may need to adjust your form, the activity, or the level of intensity.  For example, some people find that switching from an upright stationary bicycle to a recumbent (leaning back) one alleviates the stress on hips and knees.

Stress management.  It is stressful to be confronted with a painful condition that limits your activities, challenges your lifestyle, and makes you rethink your relationship with your body.  Don’t hesitate to rely on your support system.  Ask for help when you need it and talk with your spouse, friends, or family about how you feel. You may also want to find out what resources, events, and classes are available through your local Arthritis Foundation chapter.

Especially if you have autoimmune arthritis, stress can actually exacerbate symptoms.  Be sure to find time to relax, unwind and participate in activities you enjoy.  If you are struggling with stressful life circumstances, you may want to contact your EAP for additional support.

Diet.  One form of arthritis that is particularly impacted by diet is gout.  Gout has been called a “rich man’s disease” because flares can be brought on by a diet high in red meat and rich dairy.  Some people may also notice that specific foods bring on increased arthritis symptoms.  This varies from one person to another in the same way that other food reactions such as allergies can vary.  The best way to determine if your arthritis is associated with diet is to work with an allergist or keep food records to look for a pattern.  Regardless, a diet high in fresh fruits and vegetables with limited processed foods or additives is beneficial for overall health.

OTHER CAUSES OF JOINT PAIN

OA can only be diagnosed with an x-ray or other scan that shows how much space remains between the bones of a joint.  To diagnose RA, a rheumatologist will do some blood tests and assess symptoms to look for factors associated with the disease.  A family doctor may have suggested that your symptoms could be the result of arthritis without actually testing for a clear diagnosis.  If you are concerned that you may have arthritis, speak with your doctor.  You may also have joint pain for other reasons.  The connective tissue surrounding a joint can be irritated due to overuse, imbalance due to misalignment, or the result of an acute injury such as a ligament tear.  If you are experiencing increased pain in a joint, see your doctor to determine the cause and receive appropriate treatment.

If you have joint pain from arthritis or other causes, you may feel frustrated at the limitations it creates.  Those who are most effective at coping with such conditions have a positive outlook about adapting to these changes.  You might see it as incentive to finally lose weight, which will improve many aspects of your health.  In adjusting your activities, you may find a new pastime you enjoy.  You may also start taking better care of your body in a variety of ways that will serve you as you age.  Most older Americans live with some arthritis pain, and many can serve as examples of what a full life you can lead if you and your doctor work together with medical care and lifestyle change to manage it optimally.