DR SUGAR 's Medical Inspiration: Diabetes

Understanding Type 2 diabetes: part 1 - causes and prevention
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS Understanding Type 2 Diabetes- - so let's get started shall we...

Type 2 diabetes accounts for more than 90% of the cases of diabetes in this country. It is the kind that used to be called adult onset diabetes, as it was only seen in adults, and usually in people 50 or older. Nowadays, it is even seen in children, so it’s no longer accurate to call it adult-onset diabetes.

What are the causes of Type 2 diabetes and is there a way to prevent it? Some people are born with insulin-producing cells in the pancreas that are very sensitive while other people have very robust insulin-producing cells. In general, a person who eats lots of white carbohydrates like sugar, white flour (including white bread or tortillas) as well as white pasta and white rice will need more insulin – especially if they do not exercise regularly and are overweight. Lets compare this to a person who exercises regularly, is lean and eats a healthy diet with lots of fruit, vegetables, and whole grains - - this type of person will need much less insulin.

However, if you are born with very robust insulin producing cells lifestyle choices alone will most likely not make you diabetic. Similar to how some people who smoke cigarettes every day never develop lung cancer. Unfortunately it is a little like Russian roulette because nobody knows who has robust and who has sensitive insulin-producing cells until the first symptoms develop. So it is a great idea to maintain a healthy lifestyle now instead of taking your health for granted and just hoping for the best.

Family history of Type 2 diabetes is usually a good hint that you should be careful, and in general it is always better to err on the side of caution. Type 2 diabetes is preventable; the best way would be to always live a healthy lifestyle. Now some of you may think as you are listening that is easier said than done, and for some people the idea of preventing diabetes becomes only urgent when their Doctor diagnoses prediabetes. Prediabetes is the diagnosis we make when somebody develops subtle symptoms that their insulin-producing cells are severely stressed, but before they have actually developed diabetes.

According to the American Diabetes Association the recently completed Diabetes Prevention Program (DPP) study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. And I believe that this is EASIER DONE than SAID.

While the DPP showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes. Now lets look at this 30 minutes of moderate physical exercise – that could mean brisk walking out in the neighborhood or even at your local park, or you could go to the gym if that is more your style, how about riding a bike or swimming, or joining a yoga or Pilates class – these are all activities that could definitely be fun in addition to being very good for you. And how about that weight loss recommendation – lets say you weigh 150 pounds – a 5-10% reduction in weight is only 7 to 14 pounds. Or if you weigh 180 pounds a 5-10% reduction in weight is only 9-18 pounds. With moderate exercise and cutting back on carbs, incorporating more fruits and veggies in the diet and choosing water instead of soda, this is easily accomplished. Why don’t you start today and incorporate a healthier way of living. Think about lowering your risk of diabetes by almost 60% - that is definitely a great reason to get moving today! You can do it, I know you can.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding Type 2 Diabetes. In the next section, I will go into a lot more detail on those healthy eating choices that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 2 diabetes: part 2 – healthy eating
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding Type 2 Diabetes I will go into a lot more detail on those healthy eating choices that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

The American Diabetes Association (ADA) has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.

One way to turn the tide on diabetes when you are already showing sign of pre-diabetes is good nutrition. This is an easy meal planning guide that is great if you already have diabetes and also may help to decrease your risk for getting type 2 diabetes or preventing a host of other diseases like heart disease and even certain cancers.

Try these 6 simple steps to get started:
1. Using your dinner plate, put a line down the middle of the plate.

2. Then on one side, cut it again so you will have 3 sections on your plate.

3. Fill the largest section with non-starchy vegetables such as: spinach, carrots, lettuce, greens, cabbage, bok choy, green beans, broccoli, cauliflower, tomatoes, vegetable juice, salsa, onion, cucumber, beets, okra, mushrooms, peppers, or turnip - - - these are all NON STARCHY Veggies.

4. Now in one of the small sections, put starchy foods such as: whole grain breads like whole wheat or rye whole grain, high-fiber cereal, cooked cereal such as oatmeal, grits, hominy, or cream of wheat, rice, pasta, dal, tortillas, cooked beans and peas such as pinto beans or black-eyed peas, potatoes, green peas, corn, lima beans, sweet potatoes, winter squash, low-fat crackers, snack chips, pretzels, or fat-free popcorn
these are all considered STARCHY Foods.

5. And then on the other small section, put your meat or meat substitutes such as: chicken or turkey without the skin, fish such as tuna, salmon, cod, or catfish , other seafood such as shrimp, clams, oysters, crab, or mussels, lean cuts of beef and pork such as sirloin or pork loin, tofu, eggs, low-fat cheese

One suggestion for general good health is to choose fish at least twice a week and then for at least 2 other meals a week try to substitute a soy related protein for an animal protein. Soybeans have much more protein than other beans and they can be made into a lot of different products including many that look like animal foods. The next time you are in the grocery store look in the refrigerator cases and do some experimentation to see what you like. You will often find a bigger selection at a health food store or even an oriental market. There are now many forms of TOFU and TEMPEH as well as burgers, wieners and lunchmeats made from soy protein. So consider eating more soy protein and more fish and less animal protein.

6. In addition to your meal which is now divided in to a large section of a non starchy food, a small section of a starchy food and a small section of a protein, you can add an 8 oz glass of non-fat or low-fat milk or unsweetened soy milk (you can add a splash of sugar-free syrup to make it more tasty). If you don’t drink milk or soy milk, you can add another small serving of carb such as a 6 oz. container of light yogurt or a small multi grain roll.

7. Then add a piece of fruit or a 1/2 cup fruit salad and you have your meal planned. You can choose fresh fruit, frozen fruit, or fruit canned in juice or fruit frozen in light syrup.

Now that you know what to eat add daily exercise. I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on Understanding Type 2 Diabetes In the next section, I will go into a lot more detail on exercise choices that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 2 diabetes: part 3 – lifestyle choices
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding Type 2 Diabetes I will go into a lot more detail on those exercise choices that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Ok in the last blog we talked a lot about healthy eating choices and how it really is Easier DONE than SAID once you set your mind to it. Now lets spend some time talking about another important lifestyle choice – EXERCISE.

If you don’t like the idea of joining a gym, walk your dog every day for 30 min. You don’t have a dog? Meet with a friend for a walk instead of for a blended, sugar-laden coffee-drink. Play with your kids outside. They’ll love to spend quality time with you, and you get a workout throwing balls, playing badminton, or just playing a good game of catch in the park. If you’re weight is keeping you off your hurting feet try swimming to build strength, but keep the goal of doing weight-bearing exercise in mind, as it will work better to prevent other conditions like osteoporosis.

Another great way to fit exercise into a busy schedule is using the bike to get to work, you have to get to work anyway, this way you use your commuting time to do something good for you and the environment. Many public transportation systems allow you to take you bike with you, if your commuting distance is too long to do it all on the bike. Playing team sports is also a good way to stay motivated. If you are unmotivated one day, don't worry, your teammates will kick you in the b*** and give you some motivation haha.

Try to pack some more activity into every-day living too: don’t use the elevator; take the stairs wherever you go. Take the farthest parking spot in the lot. If you need to see the results, carry a pedometer, one day with just your usual activities and the next day incorporating these simple tips. You can see the difference in steps with the pedometer. I bet you will be surprised how much of a difference you see. Try to reach 10,000 steps per day by slowly increasing your activity level steadily.

These are important changes to your lifestyle that may help to prevent or at least delay the onset of Type 2 diabetes. There is one more thing that is very important: know your risk: talk to your doctor about your risk during your yearly physical and have him or her check for signs of pre-diabetes especially if there are people with Type 2 diabetes in your family

I am Doctor Sugar - - If you have Type 2 Diabetes it is important to work with your health care team to make a plan that works for you and for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Understanding Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 1

HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS UNDERSTANDING DIABETES AND PREDIABETES TESTING- - SO LETS GET STARTED SHALL WE

According to the American Diabetes Association diabetes and pre-diabetes occur in people of all ages and races, but some groups have a higher risk for developing the disease than others. Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing pre-diabetes.

There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The fasting plasma glucose test is just as the name implies – what the glucose level in your blood is when you are fasting – generally done first thing in the morning. If your blood glucose level is too high on the FPG, your doctor will say that you have impaired fasting glucose (IFG).

You doctor may also order an oral glucose tolerance test. For an OGTT you will be asked to come in fasting and then drink a beverage with a standardized amount of glucose (sugar) in it. Your blood will be tested before you start the drink and then 2 hours after drinking the glucose drink. The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).

To determine whether you have pre-diabetes or diabetes depends on your actual values: if your FPG level is 100mg/dl or above, but below 126mg/dl, and/or your blood glucose two hours after an OGTT is over 140mg/dl but below 200mg/dl you have prediabetes.

If your value for the FPG is above 126mg/dl and/or your 2h OGTT value is above 200mg/dl, you have diabetes. At this point the doctor does not yet know whether you have Type 1 or Type 2 diabetes, even though your overall appearance (Type 2 diabetics are usually older and overweight, while Type 1 diabetics usually have normal body weight and are younger) is a very good hint.

Once it is established that you have diabetes there are a number of tests that you and your doctor will perform on a regular basis to keep your health on track. Most of these tests are important for both Type 1 and Type 2 diabetics.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING In the next section, I will go into a lot more detail on those tests that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 3
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. In the last blog we talked about some of the blood tests that should be done for people with diabetes but there are a lot more blood tests that your doctor will check so lets see what those are. - - if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Another test we run on your blood is for cholesterol – we generally call this a lipid panel and we do this to Monitor blood fat levels - -the things that we look at are total cholesterol, LDL- the bad cholesterol, HDL – the good cholesterol and TRIGLYCERIDES: Lipid levels are important to monitor since high levels of cholesterol and triglycerides can contribute to such diabetic complications as heart disease. Everyone with diabetes should have his or her lipid levels tested at diagnosis. In younger children, testing at diagnosis should be done if there is a history of high cholesterol in the family or if a family member has had a cardiovascular problem before the age of 55. If the results are normal, the lipid screen should be repeated every 5 years. If abnormal, tests are repeated annually.

We will also check your blood to screen for thyroid disease: In patients with type 1 diabetes, thyroid disease is the most common additional autoimmune disease to develop. Some estimates put the rate of thyroid disease as high as one out of every three people with type 1 diabetes. Screening is done through simple blood tests and is recommended for all children and adults with type 1 diabetes at diagnosis and if normal, thyroid levels should be retested every 1-2 years.

And finally, many doctors will consider doing a Test for celiac disease: Celiac disease is the second most common autoimmune disease associated with type 1 diabetes. It occurs when the body is unable to digest gluten - which is a wheat protein. Screening is accomplished through a blood test, as well as a one-time test for gluten levels. Many physicians recommend screening at the time of diagnosis and every four years thereafter, or if you develop symptoms such as diarrhea, weight loss, abdominal pain, poor growth, or other gastrointestinal symptoms. Both thyroid and celiac disease can develop without obvious symptoms, which makes it even more important to consider doing screening tests.

I am Doctor Sugar and I want to invite you to join me for part 4 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING. We just finished up talking about all the blood tests that should be done for people with diabetes but there are a lot of other tests that your doctor will do or he may even send you to a specialist to have checked out so In the next section, I will go into a lot more detail on those tests which are also very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 1 diabetes: part 1 - causes
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS Understanding Type 1 Diabetes - - so let's get started shall we...

Many years ago the two types of diabetes were called juvenile diabetes and adult onset diabetes. However, the names have changed to type 1 which is the old juvenile diabetes and type 2, which is the old adult onset diabetes. Type 1 diabetes is the kind of diabetes that is primarily diagnosed in children. It is the kind that used to be called juvenile diabetes. However, adults can sometimes get it too.

The big reason for the name change however is that the other kind of diabetes, the one that is now called Type 2 diabetes is now being seen more and more in overweight and obese children. As the incidence of obesity rises in our country this is becoming more and more of an alarming trend. Type 2 diabetes can be caused by lifestyle and by being overweight.

So What exactly is Type 1 diabetes?
Type 1 diabetes accounts for about 5 to 10 percent of the total cases of diabetes in the United States, with type 2 diabetes making up the remaining cases. In type 1 diabetes the body’s own defense system (the immune system), whose function is to defend us against bacteria and viruses, by mistake attacks the cells in the pancreas that produce insulin. The exact causes for this attack are not well understood, but factors people are born with (which are called genetic factors) play together with things in your environment (which are called environmental triggers).

So if genetic factors play a role and you or your partner has Type 1 diabetes, you probably ask yourself will my children get it too? That depends on the environmental triggers, as even if one identical twin has Type 1 diabetes, the other one dose not necessarily get it. If scientist and doctors could understand better how these factors work together, it would be possible to predict everyone’s risk, and maybe even prevent the disease.

The list of potential environmental triggers for type 1 diabetes is large and includes diverse agents such as cow's milk, timing of the introduction of cereal in an infant's diet, vitamin D, viral infection, and more. Definitive identification of environmental triggers for type 1 diabetes would aid in the discovery of new drugs or behavior modifications—such as delayed use of infant cereal—that could reduce disease risk.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding Type 1 Diabetes In the next section, I will go into a lot more detail on the exciting research on how to prevention type 1 diabetes. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 1 diabetes: part 2 - prevention
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, here to continue our discussion on Understanding Type 1 Diabetes. I will go into a lot more detail on the exciting research on preventing type 1 diabetes. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

The ultimate goal for type 1 diabetes prevention may involve the development of a vaccine against a diabetes-specific trigger that would provide universal protection from the disease. This would allow eradication of type 1 diabetes over time, similar to the concept of eradicating infectious diseases such as poliomyelitis.

Prevention is the only true means of eradicating type 1 diabetes in the entire U.S. population. Preventing the disease would free up to 30,000 individuals per year from a lifetime of difficult, daily disease management and the risk of long-term complications such as blindness, limb amputation, and kidney failure.

Over time, up to 5-10 percent of the total diabetes cases in the U.S. could be eliminated if a safe and effective type 1 diabetes vaccine were available. Society would benefit from the substantial savings in the healthcare costs treating type 1 diabetes and its complications, which can be more than twice as high as medical care for non-diabetic individuals. The CDC has estimated that the annual healthcare costs for an individual with diabetes is $13,243, compared with $2,560 for someone without diabetes.

Many multi-year research projects such as the Type 1 Diabetes Genetics Consortium and The Environmental Determinants of Diabetes in Youth (TEDDY) study are being done to carefully monitor and study children in order to identify environmental triggers associated with the development of type 1 diabetes.

It is not yet possible to prevent Type 1 diabetes so instead, according to the Juvenile Diabetes Research Foundation, scientists hope to sustain and build upon recent momentum in the development of agents that can reverse type 1 diabetes after diagnosis.

I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on Understanding Type 1 Diabetes. In the next section, I will go into a lot more detail on treatment, reversal of type 1 diabetes, and a look at what the future holds. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 1 diabetes: part 3 - reversal
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on type 1 diabetes. I will go into a lot more detail on treatment and talk about what the future holds - perhaps even reversal of type 1 diabetes - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

It is not yet possible to prevent Type 1 diabetes so instead, according to the Juvenile Diabetes Research Foundation, scientists hope to sustain and build upon recent momentum in the development of agents that can reverse type 1 diabetes after diagnosis.

We now know that patients retain more insulin-producing capacity in the beginning stages of disease than previously thought so early diagnosis is critically important. Clinical trials to reverse type 1 diabetes might be more successful if interventions were undertaken during the window of opportunity as close to diagnosis as possible, when the maximal number of functioning beta cells remain.

Researchers are now developing "combination" therapies that combine drugs that regulate the immune system with other drugs that activate beta cell regeneration to attempt to restore durable beta cell function. (Remember the beta cells are the cells in the pancreas that are responsible for making insulin and they are the cells that are destroyed in type 1 diabetes). If successful, this strategy could be used to reverse established, long-term type 1 diabetes.

Unfortunately, many drugs are simply too toxic for routine use in children or adolescents. New drugs to reverse type 1 diabetes must be developed that are effective for disease reversal, yet safe for use in the vulnerable pediatric population.

I am Doctor Sugar - - If you or your child has type 1 Diabetes , it is important to work with your health care team to make a plan that works for you and for your family’s lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Type 1 and Type 2 Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

A few lessons about LOVE, HAPPINESS & the HEART
But first a little story:
The heart – one of the most important organs in the body – I remember once in medical school – I was doing a cardiothoracic rotation and I was in the middle of open heart surgery assisting the heart surgeons to do a coronary artery bypass graft- or heart bypass – I was standing there at the operating table and watching the surgeons do their work and I became completely overwhelmed with the desire to touch the heart – to feel the heart - so I asked the surgeon if she would allow me to do this. She said, “sure take a feel” – so I touched it on the surface – so smooth – the surgeon said – “Dr. Singleton, don’t just touch it – reach your hand underneath gently and carefully and hold it in your hand” – so I did. I remember that moment like it was yesterday. Holding a human heart in my hand as it continued to beat – lub-dub...lub-dub. That one experience – lasted only a few seconds but I will never forget that day and I will forever be grateful to that surgeon for allowing me the opportunity to experience this. I realized at that moment in time, that the heart – that small organ not much bigger than my hand that it is responsible for life – responsible for keeping your blood circulating and nourishing all the other organs in the body. The heart - without it - who are we - what are we??

So I wanted to share some thoughts about the heart - some of which I learned from a great book by Marci Shimoff called "Happy for no Reason"

THE HEART IS THE CENTER OF OUR SOUL –
THE ELECTROMAGNETIC FIELD AROUND OUR HEART IS 5 TIMES BIGGER THAN THE BRAIN.
THE ELECTROMAGNETIC FIELD OF OUR HEART EXTENDS 8-10 FEET AROUND US AND CAN ACTUALLY BE MEASURED.

HAPPY PEOPLE LET LOVE LEAD –
HAPPY PEOPLE FEEL GRATITUDE –
HAPPY PEOPLE EASILY FORGIVE –
HAPPY PEOPLE WISH OTHERS WELL
Happy people tell the people in their life that they appreciate them.

So my tip for today
To make your heart feel good and to make your heart happy
EVERY DAY - TELL THE PEOPLE AROUND YOU THAT YOU APPRECIATE THEM AND TELL THEM WHY.

HAPPY VALENTINES DAY

Love
Dr. Sugar

Understanding the Complications of Diabetes part 5
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, here to continue our discussion on Understanding the Complications of Diabetes. I will go into a lot more detail on what is needed in the future and talk about some great ideas for lifestyle modification to prevent complications. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

There are just a few other miscellaneous complications from diabetes that I think we should be aware of and those are that people with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

Persons with diabetes aged 60 years or older are 2-3 times more likely to report an inability to walk one-quarter of a mile, climb stairs, or do housework, or to use a mobility aid compared with persons without diabetes in the same age group.

Diabetes is the fifth-deadliest disease in the United States, and it has no cure. The prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with age. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing.

All of these complications sound very scary, but your best chance for avoiding them is working closely with your doctor to have your diabetes as well controlled as possible. Keep up on having yourself checked regularly for symptoms of complications, so they can be detected and treated early, when they are not really bad yet.

What Is Needed?
In ideal circumstances, women with diabetes will have their disease under good control and be monitored frequently by a health care team knowledgeable in the care of diabetes. Patient education is critical. People with diabetes, with the help of their health care providers, can reduce their risk for complications if they are educated about their disease,

It is important to learn and practice the skills necessary to maintain excellent control of blood glucose levels, as well as have excellent control of blood pressure and cholesterol levels. This can and should be done through a variety of medical treatments as well as lifestyle modifications. If you haven’t already done so be sure to check out all of the medical inspiration blogs on diabetes care. There are several that deal specifically with diabetic treatment options as well as lifestyle modifications to assist you.

Patients with diabetes should receive regular checkups from their health care team. Smokers should stop smoking, and overweight women with diabetes should develop moderate exercise regimens under the guidance of a health care provider to help them achieve a healthy weight.

Health care team education is vital. Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease. A team approach to treating and monitoring the complex facets of this systemic disease is ideal.

I am Doctor Sugar - - If you have Diabetes, it is important to work with your health care team to make a plan that works for you and for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Understanding Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 2
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. I will go into a lot more detail on those tests that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

According to the American Diabetes Association and the Juvenile Diabetes Research Foundation there are a number of important tests that should be done to care for diabetic patients to prevent and monitor for any complications. The most important tests that should be done for diabetic patients are monitoring of blood sugar levels, test A1c, check cholesterol, screen for thyroid and celiac disease, check blood pressure, check feet, eyes, urine, and teeth. So lets spend some time now talking about each of these tests and how they are done. I’ll begin by talking about the different tests that are done on your blood. I am sure if you have diabetes that you wonder why we take so much darn blood so lets see what is done with that.

Lets start with just the basic finger stick. If you have diabetes you should have some kind of a home glucose monitor to Monitor blood sugar levels: Daily blood sugar testing is one of the best ways you and your doctor can evaluate everyday management of diabetes and determine the effectiveness of the treatment plan. Your doctor should evaluate the blood sugar meter results you'll be keeping track of at each visit.

If you don’t already have one, make sure to get a blood sugar log and record your numbers in it daily. Many of my patients would also write comments – for example if they had a particularly high reading one day they might write in “my grandson’s birthday – ate cake” – to explain what was going on in their life at that particular time. I found this to be very helpful. Depending on how long you have had diabetes, and how good of control your diabetes is in will determine how many times a day you should be checking your sugars. Talk with your doctor about his or her recommendations.
Be sure to always take your log AND your personal blood glucose monitor in to the doctor with you for each of your visits. This makes it much quicker, easier and more effective for your doctor.

OK – so how about the actual blood draw that we do – one of the main tests that is done is called the Hemoglobin A1C test. It is a test that checks the amount of sugar stuck to your red blood cells – that is why the word hemoglobin is in the name: The "A1C" is a blood test that reflects the average blood sugar control over a 2 to 3 month period – or the average lifespan of a red blood cell - your A1C sample will include cells that are a few days, a few weeks and a few months old. That's how the test result covers a span of about three months. The A1c test allows doctors to evaluate the effectiveness of the treatment plan. The test should be repeated every three months.

For people without diabetes, the normal range for the A1C test is between 4 to 6 percent. In poorly controlled diabetics it can be above 8. The goal for people with diabetes is to have an A1C less than 6.9 percent, although glycemic goals may be modified somewhat with a young child. To give you an idea of what an A1c means - - An A1c of 7 correlates to an average blood sugar over the last 3 months of about 170. So our goal should be to make sure that the average sugar is less than 170.

Research studies have shown that the risks for diabetic complications decrease significantly for people with A1C levels less than 7 – so make sure to keep your sugars down to avoid the complications that can come from uncontrolled diabetes.

I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING In the next section, we will talk about the other blood tests that we do and why they are very important so make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!


References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 4
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. In the last blog we talked about all the blood tests that should be done for people with diabetes but there are a lot of other tests that your doctor will do or he may even send you to a specialist to have checked out so lets take some time now so I can go into a lot more detail on those tests which are also very important for all diabetic patients. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

So you have diabetes – why does your doctor always want you to pee in a cup?

It is very important to Test for kidney disease: The American Diabetes Association recommends an annual urine test to detect small amounts of protein in the urine. We call this microalbuminuria. We do this annually to screen for diabetic nephropathy – or diabetic kidney disease. If we start to see small amounts of protein spilling into your urine, then your doctor will want to start you on a medicine that is protective for your kidneys if you are not already taking it.

At each visit your doctor will also Monitor height and weight. This is especially important in children with diabetes, as doctors will want to assure that the child is growing adequately. Checking the weight regularly is also very important for adults with Type 2 diabetes as gaining weight usually worsens the symptoms.

At each visit, the nurse will check your blood pressure and report this number to the doctor: Since elevated blood pressure can lead to complications, blood pressure should be tested at each doctor visit. Before diagnosing high blood pressure, doctors take readings on three separate days. Diabetic patients should keep their blood pressure less than 130 / 80 according to the latest Joint National Committee on prevention detection evaluation and treatment of high blood pressure JNC7 report. It is very important to keep your blood pressure within the levels appropriate for your age.

Another important preventive measure for people with diabetes is to make sure and Get an annual flu shot: A yearly flu shot is recommended for all people with chronic illnesses, including diabetes. At present, it is not recommended that people with diabetes take the live oral/nasal form of the flu vaccine. Instead, they should receive their flu vaccinations by injection. Flu shots are given in the fall months.

Your doctor will also recommend that you See your dentist regularly: Good oral health is essential for all people with diabetes. Schedule a thorough dental cleaning and examination every six months, informing your dentist and hygienist that you have diabetes.

You will also need to have your eyes tested: Your family doctor will probably look into your eyes with their ophthalmoscope at every visit but in addition, at least once a year, they will send you to an ophthalmologist – a doctor who specializes in diseases of the eye to do a special diabetic eye exam. This eye test involves dilating the eye and doing a thorough examination of the retina. An annual eye exam is recommended for everyone with diabetes, although some ophthalmologists may recommend testing less often in young children.

Lets talk a minute about the Diabetic Foot Exam: - Each time you go in to see your doctor, make sure to remove your shoes and socks as your doctor will want to examine your feet to screen for diabetic neuropathy (damage to the nerves)– they will also want to make sure you are not developing any worrisome blisters, corns, calluses, cracks or lesions that could become infected or a non healing ulcer. If there are any problems with your feet, you may be sent for an annual foot exam with a podiatrist or a doctor who specializes in disease of the feet.

And the last thing I should mentions is - - - the main reason we do all these test in our diabetic patients is to screen for complications and catch things early before they become a problem: Now that most doctors and most patients adhere to a treatment plan calling for tighter control, the incidence of long-term complications related to the eyes, kidneys, nerves, and cardiovascular system are lower than in the past and these complications are rare in children.

Your ultimate goal--and your doctor's--is not to see any long-term complications. Nevertheless, many doctors will take baseline kidney, liver function, and eye exams soon after diagnosis, and may repeat those tests at varying intervals. Such baseline tests help your doctor make sure that no underlying problem existed before diabetes occurred.

A lot of these test sound like a real drag, but keep in mind that diabetes increases your chances of developing a number of serious and sometimes life-threatening complications. If you haven’t already seen it, be sure to catch the entire blog series I did on diabetic complications for a lot more information. While this may sound very scary, your best bet for avoiding diabetic complications is to work together with your doctor as closely as possible with the goal of the whole team being to keep your diabetes well controlled.

Get your A1c less than 6.9 and keep it there. If you will do this consistently your chances of developing any long-term complications will go way way down. You are in the drivers seat and your healthcare team is here to help you. The better your control is, the less risk you have for complications. Keep up on the all the tests we’ve talked about today so that if you develop any complications they are detected early when they are much easier to treat.

I am Doctor Sugar - - If you have Diabetes or Pre-Diabetes, it is important to work with your health care team to make a plan that works for you and for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Understanding Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding the Complications of Diabetes part 1
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS Understanding the Complications of Diabetes- - So let’s get started shall we.

Even though the diabetes control is now much better that it has ever been in the past, which has reduced the number of patients that develop serious complications, there are still a number of serious or life-threatening diseases that might develop as a consequence of having diabetes. In addition, there are also some diseases that are more common among diabetic patients than among the general populations. These are taken together under the big label ”Diabetes Complications” so lets spend some time today talking about these different complications to try and get a better understanding of why it is ever so important to take care of your diabetes and to maintain tight blood sugar control.

According to the American Diabetes Association complications, which occur more frequently in diabetic patients than in the general population, are heart disease and stroke, high blood pressure, blindness and kidney disease, as well as nervous system disease, amputations and dental disease. There are also many complications related to pregnancy and sexual dysfunction. So lets jump right in and get started.

Heart disease and stroke
Heart disease and stroke account for about 65% of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher AND the risk of death from stroke is almost 3 times higher among people with diabetes.

Deaths from heart disease have decreased significantly among men with diabetes in recent years, but unfortunately, that trend has not been true in women. From 1971 to 2000, the rate of death from heart disease among men with diabetes decreased from 16.8 deaths to 8.1 deaths per 1000 men. This was a very significant decline. Among women with diabetes, however, deaths from heart disease did not decline from 1971 to 2000, and the difference in death rate from all causes between diabetic and nondiabetic women more than doubled, (Gregg et al., Annals of Internal Medicine, 2007).

DKA and Coma
Uncontrolled diabetes with high sugars can often lead to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. DKA, often called diabetic coma, is a condition brought on by poorly controlled diabetes. Although high blood glucose levels accompany it, DKA is not caused by high blood sugar; it is caused by lack of insulin. Before insulin therapy was available, DKA was the predominant cause of death from diabetes.

High blood pressure
About 73% of adults with diabetes have blood pressure higher than 130/80 or use prescription medications for hypertension. We certainly see a high association between high blood pressure and diabetes and unfortunately having the two together increase the risk of heart disease and stroke.

Blindness
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year making diabetes the leading cause of new cases of blindness in adults 20-74 years of age. A study in the New England Journal of Medicine showed that in people with type 1 diabetes, therapy that keeps blood sugar levels as close to normal as possible reduces damage to the eyes by 76% (New England Journal of Medicine, September 30, 1993). Many Experts believe that these results can also be applied to those with type 2 diabetes. Another reason why it is ever so important to maintain tight blood sugar control.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding the Complications of Diabetes In the next section, I will discuss details on other complications such as kidney disease, amputations, nerve damage and dental disease. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding the Complications of Diabetes part 4
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding the Complications of Diabetes. So now lets talk a lot more about women and the special implications that diabetes can have on pregnancy. - - if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Another condition specific to women is of course pregnancy, which is dramatically affected if you have diabetes. So lets spend a little time talking about the different ways in which pregnancy is affected.

Pregnancy demands more insulin in the body than normal because of the increased production of hormones that can lead to insulin resistance. For women with diabetes, excellent blood glucose control before conception and then throughout pregnancy is vital to the health of the baby and the mother.

The rate of major congenital malformations in babies born to women with preexisting diabetes varies from 0 to 5 percent among women who receive preconception care to 10% among women who do not receive preconception care. I am sure you can figure it out but preconception care is actually care that takes place BEFORE conception occurs and it is different from PRENATAL care which takes place during the pregnancy.

According to the American Diabetes Association, Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and miscarriage in as many as 15% to 20% of pregnancies. Sadly, Between 3 to 5 percent of pregnancies among women with diabetes result in death of the newborn within 28 days. This is 2 to 4 times higher that the rate for women who do not have diabetes.

Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child. Macrosomia which simply means large birth weight, occurs 2 to 3 times more often in diabetic pregnancies as it does in the general population. Because of the increased risk of fetal macrosomia, women with diabetes are also 3 to 4 times more likely to have a cesarean section.

Women with diabetes are up to 5 times as likely to develop toxemia. Toxemia is also called pre-eclampsia. It is a disorder of unknown cause, which is usually thought of as high blood pressure during pregnancy. But it is a bit more complicated that just high blood pressure. In fact in addition to high blood pressure, we also expect to see protein in the urine, swelling of the feet, hands and face, headache, and sometimes visual disturbances). Women with diabetes are also up to 5 times as likely to develop polyhydramnios or excessive amounts of amniotic fluid as women without diabetes.

Approximately 2 to 5 percent of all non-diabetic pregnant women develop gestational diabetes, a form of diabetes that occurs only during pregnancy. Non-diabetic pregnant women should be checked for gestational diabetes between the 24th and 28th weeks of pregnancy unless they are in the low-risk category. You are at LOW risk for diabetes if you are a women who is less than 25 years of age, have no family history of diabetes, have a normal body weight and are not a member of an ethnic/racial group with high prevalence of diabetes (i.e., Hispanic/Latino, African American, Native American, and Asian). If you do not fall into ALL of these categories then you are not at low risk and should be screened for gestational diabetes appropriately.

Approximately 40 percent of women with gestational diabetes who are obese before pregnancy develop type 2 diabetes within 4 years. The chance of developing diabetes during this same period is lower if the women maintain a healthy weight.

Diabetes and Birth Control
Birth control pills can affect blood glucose levels and diabetes control. The intrauterine device (IUD) may lead to infections. Because women with diabetes are already at a higher risk of infection, most should not use the IUD.

Sexual Dysfunction
Diabetes significantly increases the risk for sexual dysfunction in both men and women.

I am Doctor Sugar and I want to invite you to join me for part 5 of my blog series on Understanding the Complications of Diabetes In the next section, I will go into a lot more detail on what is needed in the future and talk about some great ideas for lifestyle modification to prevent complications. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding the Complications of Diabetes part 3
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding the Complications of Diabetes. So now lets talk a lot more about women and the special implications diabetes can have and lets also talk about diabetes and pregnancy. - - if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

There are circumstances that make it especially difficult for women to have diabetes. According to the American Diabetes Foundation, the burden of diabetes on women is unique, because the disease can affect both mothers and their unborn children. Diabetes can cause difficulties during pregnancy such as a miscarriage or a baby born with birth defects. Women with diabetes are also more likely to have a heart attack, and at a younger age, than women without diabetes.

According to the American Diabetes Association, Women with diabetes have an increased risk of vaginal infections such as yeast infections amongst others. Women with diabetes are also at increased risk of complications during pregnancy.

For women who do not currently have diabetes, pregnancy brings the risk of gestational diabetes. Gestational diabetes develops in 2% to 5% of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes are at an increased risk for developing type 2 diabetes later in life.

Women and Diabetic Complications
The risk for cardiovascular disease, the most common complication attributable to diabetes, is more serious among women than men. Deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years, compared to a 27 percent decrease in women without diabetes.

The risk of diabetic ketoacidosis (DKA) is 50 percent higher among women than men. DKA, often called diabetic coma, is a condition brought on by poorly controlled diabetes.

Women with diabetes are also more than 7 times as likely to suffer from peripheral vascular disease (PVD) than women without diabetes. PVD is a disorder resulting in reduced flow of blood and oxygen to tissues in the feet and legs. The principal symptom of PVD is intermittent claudication (pain in the thigh, calf, or buttocks during exercise).

I am Doctor Sugar and I want to invite you to join me for part 4 of my blog series on Understanding the Complications of Diabetes In the next section, we will learn lot more about women and the special implications that diabetes can have on pregnancy. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007