Tag Archives: weight loss

Weight Loss: What Are Your Options?

February 28, 2017 Teresa Stockton - Blog, General Information

The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States.

Being overweight is closely linked to many very serious health conditions. It is a significant risk factor for coronary artery disease (CAD), stroke, high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein—the “good” cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help reduce the risk or improve these conditions. Plus, practicing the behavioral changes of a healthier diet and regular exercise may actually reduce these risk factors whether weight loss occurs or not.

Energy Balance: The Simple Principle of Weight Loss
Scientists often explain weight loss quite simply in terms of the energy balance equation: energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.

This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medications, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.

Using Strategies to Get Started
Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.

The following 5 strategies are crucial to successful weight loss and can help to overcome some of these barriers:

• Set and commit to realistic goals and monitor your progress toward achieving these goals
• Slowly modify your eating and exercise behaviors, as well as habits influencing both
• Examine and restructure unrealistic, negative thoughts, or expectations
• Reduce stress
• Develop a network of social support and information

Looking at Weight Loss Aids
There is a great deal of interest in whether prescription medications or supplements can facilitate weight loss. Some medications suppress appetite by interfering with brain chemicals that affect mood and appetite. Others reduce fat absorption from the gut. Here are examples of medications that may be recommended for weight loss:

• Diethylpropion
• Lorcaserin
• Orlistat
• Phendimetrazine
• Phentermine—can be taken alone or in combination with another medication

Some studies have supported the use of these medications when combined with lifestyle changes. For example, as part of a review of weight loss drugs, researchers analyzed 15 trials involving almost 10,000 people who were either taking orlistat or placebo. Compared to the placebo group, those taking orlistat had a higher chance of achieving a 5% or 10% weight loss. These types of medications, though, are usually prescribed only for people who are severely obese when other methods of weight loss have not worked. Accordingly, these medications are not without side effects or potential adverse events and should only be used with careful monitoring by your doctor.

The same goes for dietary supplements. Supplements do not undergo the same rigorous approval process as drugs. That being said, certain supplements may provide weight loss benefits since they may contain similar mechanisms of action as drugs. Along the same line, some of the same risks and side effects may be present, as well, which is why you should talk to your doctor before taking any over-the-counter weight loss products.

Also, be sure you know what is in diet medications and supplements. Some medications and supplements that were used in the past have been pulled from the market as it was found that the dangers of taking them were higher than the benefits. Whenever you are considering taking a diet supplement, know exactly what is in the product and share this information with your doctor.

The question is: when should you consider taking these weight loss aids? While it depends on your overall health and medical history, the best approach may be a conservative one. For example, adopt lifestyle changes for 6-12 months before trying a drug or supplement. Your doctor can give you guidance as to which weight loss options you should try first.

by Jackie Hart, MD

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:
Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:
Choosing a safe and successful weight-loss program. National Institute of Diabetes and Digestive and Kidney Disorders. Available at: http://www.niddk.nih.gov/health-information/health-topics/weight-control/choosing-safe-successful-weight-loss-program/Pages/choosing-safe-successful-weight-loss-program.aspx. Updated December 2012. Accessed January 14, 2016.

Diets for weight loss. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335(7631):1194-1199.

Weight loss medications for obesity in adults. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2015. Accessed January 14, 2016.

7/6/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Seo DC, Sa J. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults. Prev Med. 2008;47(6):573-582.

10/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm. Updated Sepember 9, 2013. Accessed January 14, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 1/14/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Recommendations to Help Prevent High Blood Pressure

February 14, 2017 Teresa Stockton - Blog, General Information

Hypertension is abnormally high blood pressure. High blood pressure puts extra strain on the heart, lungs, brain, and kidneys. It carries with it an increased risk of death and disability from coronary artery disease (CAD), stroke, heart failure, and kidney disease.

High blood pressure is very common but can’t be seen or felt. Many people with high blood pressure don’t know they have it. The best way to know if you have high blood pressure is to keep track of your numbers. You can get your blood pressure checked at your doctor’s office, at home, or at your local pharmacy. It’s important to get your blood pressure checked regularly.

Defining High Blood Pressure
High blood pressure is defined by 2 numbers (systolic and diastolic). The systolic or top number measures the pressure in your blood vessels when your heart beats. The diastolic or bottom number measures the pressure in your blood vessels when your heart rests between beats.

The normal blood pressure varies with age, usually increasing as we get older. In general, systolic blood pressure (SBP) less than 120 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg are considered normal and prehypertension is a SBP120-139 mm Hg or DPB 80-89 mm Hg. Abnormal levels include:
• Stage 1 hypertension—SBP 140-159 mm Hg or DPB 90-99 mm Hg
• Stage 2 hypertension—SBP more than 160 mm Hg or DBP more than 100 mm Hg

In people with diabetes or kidney disease, the targets numbers are lower. Check with your doctor to see what your target range should be.

Common Risk Factors
There is no single cause for high blood pressure, but there are several factors that can increase your risk.

Some risk factors for high blood pressure include:
• Age: middle-aged or elderly—onset generally happens at 20-50 years, but likelihood increases with age
• Race: African American
• Gender: Male

Medical factors, such as:
• Diabetes
• Obesity
• Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
• A family history of high blood pressure
• Sleep apnea
• Prehypertension

Lifestyle factors, such as:
• Smoking
• Being physically inactive
• Taking birth control pills
• Having diet high in red meat, salt, and saturated and trans fats
• High alcohol intake

Risk factors don’t mean you will get high blood pressure, but that you have an increased chance of developing it. Fortunately, there are also factors that can help you prevent high blood pressure or lower your blood pressure if you already have elevated blood pressure.

Lifestyle Guidelines to Prevent or Reduce High Blood Pressure
The National Heart, Lung, and Blood Institute’s recommendations to help prevent or lower high blood pressure include:
• Losing weight if you are overweight
• Increasing levels of physical activity—Aim for 30 minutes per day on most days of the week.
• Eating a diet rich in fruits, vegetables, and low-fat dairy products
• Eating a diet that is low in saturated and total fat
• Limiting consumption of sodium (salt) to less than 2,300 milligrams per day
• Drinking alcohol only in moderation—This means 1 drink or less per day for women and 2 drinks per day or less for men.

Another approach endorsed by National Heart, Lung, and Blood Institute is use of the DASH diet. This is a special low-salt diet which has been shown effective in both preventing and treating high blood pressure.

High blood pressure is a major player in heart disease and stroke. Protect yourself and know your numbers. The next time you take a trip to the pharmacy, check your blood pressure. If you do it on a regular basis and follow the lifestyle guidelines, you may be able to avoid future problems.

by Michael Jubinville, MPH

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Heart & Stroke Association
http://www.heartandstroke.ca

REFERENCES:
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.

How can high blood pressure be prevented? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/prevention. Updated September 10, 2015. Accessed August 2, 2016.

Hypertension. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 12, 2016. Accessed August 2, 2016.

Hypertension treatment in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2016. Accessed August 2, 2016.

Preventing high blood pressure: Healthy living habits. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/bloodpressure/what_you_can_do.htm. Updated July 7, 2014. Accessed August 2, 2016.

Understanding your risk for high blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp#.V6CgG02FPIU. Updated June 29, 2016. Accessed August 2, 2016.

Whelton PK, He J, Appel LJ, et al. Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-1888.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 8/2/2016

Heart Healthy Physical Activity

February 7, 2017 Teresa Stockton - Aging, Blog, Sports and Fitness

The heart is often used as a symbol of vitality for good reasons. The heart pushes blood and oxygen to every cell in the body to be used as fuel and carries waste away. Without this process, the body cannot function. The heart plays a role in many aspects of your health and wellness.

Efficiency Matters
The heart beats an average of 60-80 beats per minute, which can add up to millions of beats in just one month. When something works this hard, it is important that it also works efficiently. Well-conditioned athletes can have resting heart rates below 50 beats/minute. Even though their heart beats slower, it can do the same amount of work or more than a heart that beats 60-80 beats/minute. An athlete’s heart pumps stronger during each beat, needing fewer beats to get the job done. Over a lifetime, a difference of 10-30 beats/minute can add up to quite a few beats.

An Ounce of Prevention…
The heart can be affected by physical and mental stressors. You can feel your heart speed up when you sprint across a busy road or when you have a burst of emotion like anger or surprise.

Physical activity can decrease the effect of stress on the heart and body. A fit body and mind will help improve heart health. Regular physical activity can:

Improve physical abilities by:
• Improving the heart’s ability to pump blood
• Increasing energy levels
• Increasing muscle strength and endurance
• Improving agility

Change physical appearance by:
• Toning your muscles which gives you a tighter appearance
• Burning calories which helps with weight loss or maintenance

Improve overall wellness by:
• Helping with stress management
• Improving self-image
• Helping to decrease anxiety and depression
• Improving relaxation
• Improving the ability to sleep
• Creating a social activity opportunity
• Promoting healthier cholesterol levels

If you have heart problems, physical activity can still play an important role. A strong and healthy body can help you manage your condition. Physical activity can help reduce the stress on a sick or weak heart and decrease secondary risks like obesity and diabetes. If you do have heart health issues, talk to your doctor before starting an exercise program.

Even if you are healthy, but have not exercised in a long time, you may need to talk to your doctor to make sure that you are in good physical condition to exercise.

Where to Start
For most people, you can begin right away. Find an activity program that you enjoy. Do not pick an activity that does not fit into your schedule, does not fit in with your personal preferences, or has too many obstacles, because you may lose interest quickly. A program that starts with too much intensity is also likely to lose your interest.

Work towards reaching these basic goals:
• 30-60 minutes of physical activity on most days of the week (total of at least 150 minutes/week)
• Include some strength activities at least 2 times/week

Make It Stick
Long-term regular physical activity will count more than a brief and spectacular burst of activity. Most people do not plan to become sedentary. It creeps up on you. Work to increase your physical activity the same way. Gradually add steps. Find activities you enjoy that can replace more sedentary activities.

Here are more tips that have been shown to be useful:
• Find an exercise partner. You are less likely to skip the activity if someone is waiting for you.
• Write it down or use a fitness tracker. Keep a log of your activities and how much you accomplished either by distance or time. It will help keep you honest.
• A long-term goal is fine, but also make short-term goals, because they provide quicker feedback.
• This is important, make it a priority. Plan it out. Find a time in your daily routine when you can regularly fit the activity in.
• Consider doing your activity in 10-minute spurts throughout the day. Spurts can be as effective as being active for 30 minutes straight.
• Be flexible. Life happens and you may find that you need to make adjustments to your routine. A rigid schedule and goal may not be worth the stress. Keep an open mind to new activities and schedules.

Make It Count
Any physical activity is better than none. But at least a few days per week you should aim for more than a leisurely stroll. A moderate intensity level is best to help you make health changes. Moderate intensity activity is enough to get your heart rate up and make you feel a little out of breath but not feel worn out when you are done.

Do not forget to enjoy your activity for the daily benefits it can bring and know that your heart appreciates it as well!

by Pamela Jones, MA

RESOURCES:
American College of Sports Medicine
http://www.acsm.org

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:
American Heart Association guidelines for physical activity. American Heart Association website. Available: http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-Association-Guidelines-for-Physical-Activity_UCM_307976_Article.jsp. Updated September 10, 2014. Accessed October 22, 2014.

Guide to physical activity. National Heart and Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/phy_act.htm. Accessed July 21, 2016.

Haskel W, et al. Physical activity and public health, updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circ. 2007;116(9):1081.

How much physical activity do you need? Centers for Disease Control and Prevention website. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html. Updated June 4, 2016. Accessed July 21, 2016.

Promoting physical activity with a public health approach. American College of Sports Medicine website. Available at: http://www.acsm.org/about-acsm/media-room/acsm-in-the-news/2011/08/01/promoting-physical-activity-with-a-public-health-approach. Accessed July 21, 2016.

2008 physical activity guidelines for Americans. United States Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx. Accessed July 21, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated:10/22/2014

A Healthy Start in 2017

January 5, 2017 Teresa Stockton - Blog, General Information

It’s time to get a healthy start in 2017! We provided some general health and wellness tips to get you on your way to an amazing year! We call it the Pearls of Longevity!

PROTEIN
Eat 25 grams of protein each meal especially breakfast to prevent being hungry from carb cravings and crashes, help maintain and build muscle, and improve your immune system.

DID YOU KNOW?
For every 100 calories of protein you eat, it takes 25 calories to digest meaning you really only ate 75 calories! This is a 25% discount! For carbs and fat, you get less than a 10% discount.

EXERCISE
Exercise at least 30 minutes a day to burn calories and decrease stress. Lift weights or use body weight strengthening exercises to increase lean muscle and boost your metabolism.

DID YOU KNOW?
Exercise relieves symptoms of depression as well or even better than medication. Losing 10 lbs. decreases your risk of knee arthritis by 50%, while losing 10% of your body weight decreases joint pain by 50%!

ANTI INFLAMMATORY & ANTIOXIDANT-RICH FOODS
Fill half your plate at every meal to ensure you eat enough of these power foods.

DID YOU KNOW?
Eating lots of fruits, vegetables, nuts, olive oil, beans, salmon, spices, and even dark chocolate helps reduce inflammation and stress, decreases joint and muscle pain, and reduces your risk heart disease, hypertension, diabetes, cancer and stroke.

RELAXATION & STRESS REDUCTION
Practice inhaling slowly through your nose until you feel your belly button move out and then slowly exhale through your mouth feeling your belly button move in. Practice at least 5 minutes a day while driving, at your computer, while watching TV or when in bed. Smile, laugh and hug someone once a day.

DID YOU KNOW?
Deep breathing reduces stress, muscle pain, and blood pressure, while improving memory, concentration and performance. Happiness and affection are considered by many experts to be the fountain of youth as it lowers stress and releases hormones that help fight aging.

LIQUIDS
Drink 2 cups of water or tea when you wake up and drink 1-2 cups in between meals. Coffee does not count as it can lead to dehydration.

DID YOU KNOW?
Water reduces hunger, improves metabolism, brings nutrients, and hydrates your muscles and connective tissue. This can reduce inflammation and scar tissue which can lead to decreased muscle and joint pain.

SLEEP
Sleep at least 7-8 hours per night consistently going to bed and waking up the same time even on weekends.

DID YOU KNOW?
Sleep releases growth hormone which helps keep you young, increase lean muscle and decrease body fat!

A healthy start can lead to great endings. Best of luck to you and yours and Happy New Year!

Exercising Do’s and Dont’s

November 15, 2016 Teresa Stockton - Blog, Sports and Fitness

In the third installment of our gym series we examine the proper ways to exercise at the gym from start to finish. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your therapist at your next therapy session.

SCAPULAR RETRACTION / ROW

START POSITION
• Standing or seated with back in neutral with feet shoulder width apart.
• Squeeze shoulder blades together.
• Elbows slightly bent and forearms parallel to the floor.

ENDING POSITION
• Elbows at 90⁰ flexion.
• Shoulders pulled back.
• Hands at your sides at shoulder width and forearms parallel to the floor.

DON’T
• Swing body back and forth.
• Let the weight pull you forward between repetitions (keep the shoulders back).
• Shrug.

ANTERIOR DELTOID – FRONTAL RAISE

START POSITION
• Standing with spine in neutral position with feet shoulder width apart.
• Palms facing down.

ENDING POSITION
• Arm raised to 90⁰ directly in front of you.
• Elbow in full extension.

DON’T
• Raise arm past 90 degrees.
• Swing body back and forth.
• Rotate wrist.
• Shrug shoulders.

LATERAL DELTOID – LATERAL RAISES

START POSITION
• Standing with spine in neutral position with feet shoulder width apart.
• Elbows bent at 90 degrees.

ENDING POSITION
• Arms raised to 90 degrees at your side.
• Palms facing down.

DON’T
• Raise arms past 90 degrees.
• Swing body back and forth.
• Shrug shoulders.

BENCH PRESS

START POSITION
• Lay flat on bench with both feet flat on the ground.
• Place a rolled towed in the center of the chest.
• Arms extended with wide grip to facilitate 90 degree bend at the elbow at the bottom of repetition.

ENDING POSITION
• Lower slowly until the bar touches the towel
• Elbows should not pass the height of the bench bending to about 90 degrees.

DON’T
• Lift feet off the ground.
• Arch your back.
• Bounce bar off your chest (barbell should only touch the towel lightly).

This information about exercise at the gym was written by STAR Therapy Services, an outpatient physical therapy group with six locations in Houston, Texas. At Star Houston Therapy Services, their number one priority is the patient. They strive to provide individualized treatment with hands-on, compassionate care. They perform comprehensive evaluations and encourage patient input for treatment planning and goal setting. For more information click here.

View the complete Exercising Do’s and Don’ts series below:

Type 2 Diabetes (Diabetes Mellitus Type 2; Insulin-Resistant Diabetes; Diabetes, Type 2)

November 10, 2016 Teresa Stockton - Blog, General Information

Definition
Glucose is a type of sugar. It comes from food, and is also created in the liver. Glucose travels through the body in the blood. It moves from the blood to cells with the help of a hormone called insulin. Once glucose is in those cells, it can be used for energy.

Diabetes is a condition that makes it difficult for the body to use glucose. This causes a buildup of glucose in the blood. It also means the body is not getting enough energy. Type 2 diabetes is one type of diabetes, and it is the most common.

Medication, lifestyle changes, and monitoring can help control blood glucose levels.

Causes
Type 2 diabetes is often caused by a combination of factors. One factor is that your body begins to make less insulin. A second factor is that your body becomes resistant to insulin. This means there is insulin in your body, but your body cannot use it effectively. Insulin resistance is often related to excess body fat.

Risk Factors
Type 2 diabetes is more common in people who are aged 45 years and older. It is also common in younger people who are obese and belong to at-risk ethnic groups. Other factors that increase your chance for type 2 diabetes include:
• Prediabetes — impaired glucose tolerance and impaired fasting glucose
• Metabolic syndrome — a condition marked by elevated cholesterol, blood glucose, blood pressure, and central obesity
• Excess weight or obesity, especially central obesity
• Lack of exercise
• Poor diet — high intake of processed meats, fats, sugar-sweetened foods and beverages, and calories
• Family history of type 2 diabetes
• High blood pressure
• History of cardiovascular disease
• Depression
• History of gestational diabetes, or having a baby that weighs over 9 pounds at birth
• Endocrine disorders, such as Cushing’s syndrome, hyperthyroidism, acromegaly, polycystic ovary syndrome, pheochromocytoma, or glucagonoma
• Conditions associated with insulin resistance, such as acanthosis nigricans
• Certain medications, such as glucocorticoids or thiazides
• Certain ethnic groups, such as African American, Hispanic, Native American, Hispanic American, Asian American, or Pacific Islander

Symptoms
You may have diabetes for years before you have symptoms. Symptoms caused by high blood sugar or include:
• Increased urination
• Extreme thirst
• Hunger
• Fatigue
• Blurry vision
• Irritability
• Frequent or recurring infections
• Poor wound healing
• Numbness or tingling in the hands or feet
• Problems with gums
• Itching
• Problems having an erection

Diagnosis
The doctor will ask about your symptoms and medical history. You will also be asked about your family history. A physical exam will be done.

Diagnosis is based on the results of blood testing. American Diabetes Association (ADA) recommends diagnosis be made if you have one of the following:
• Symptoms of diabetes and a random blood test with a blood sugar level greater than or equal to 200 mg/dL (11.1 mmol/L)
• Fasting blood sugar test is done after you have not eaten for 8 or more hours—showing blood sugar levels greater than or equal to 126 mg/dL (7 mmol/L) on two different days
• Glucose tolerance test measures blood sugar 2 hours after you eat glucose—showing glucose levels greater than or equal to 200 mg/dL (11.1 mmol/L)
• HbA1c level of 6.5% or higher—indicates poor blood sugar control over the past 2-4 months

* mg/dL = milligrams per deciliter of blood; mmol/L = millimole per liter of blood

Treatment
Treatment aims to:
• Maintain blood sugar at levels as close to normal as possible
• Prevent or delay complications
• Control other conditions that you may have, like high blood pressure and high cholesterol

Diet
Food and drinks have a direct effect on your blood glucose level. Eating healthy meals can help you control your blood glucose. It will also help your overall health. Some basic tips include:
• Follow a balanced meal plan. It should include carbohydrates, proteins, and fats.
• Be aware of appropriate serving size. Measure your food to help understand ideal serving size.
• Do not skip meals. Plan your meals and snacks through the day. Having meals throughout the day can help avoid major changes in glucose levels.
• Eat plenty of vegetables and fiber.
• Limit the amount of fat (especially saturated and trans fats) in your foods.
• Eat moderate amounts of protein and low-fat dairy products.
• Carefully limit foods containing high concentrated sugar.
• Keep a record of your food intake. Share the record with your dietitian or doctor. This will help to create an effective meal plan.

Weight Loss
If you are overweight, weight loss will help your body use insulin better. Talk to your doctor about a healthy weight goal. You and your doctor or dietitian can make a safe meal plan for you.

These options may help you lose weight:
• Use a portion control plate
• Use a prepared meal plan
• Eat a Mediterranean-style diet

Exercise
Physical activity can:
• Make the body more sensitive to insulin
• Help you reach and maintain a healthy weight
• Lower the levels of fat in your blood

Aerobic exercise is any activity that increases your heart rate. Resistance training helps build muscle strength. Both types of exercise help to improve long-term glucose control. Regular exercise can also help reduce your risk of heart disease.

Talk to your doctor about an activity plan. Ask about any precautions you may need to take.

Medication
Certain medications will help to manage blood glucose levels.

Medication taken by mouth may include:
• Biguanides reduce the amount of glucose made by the body
• Sulfonylureas encourage the pancreas to make more insulin
• Insulin sensitizers to help the body use insulin better
• Starch blockers to decrease the amount of glucose absorbed into the blood
• Sodium-glucose co-transporter 2 (SGLT-2) inhibitors to increase glucose excretion in urine
• Bile acid binders

Some medications needs to be given by injection, such as:
• Incretin-mimetics stimulate the pancreas to produce insulin and decrease appetite, which can assist with weight loss
• Amylin analogs replace a protein of the pancreas that is low in people with type 2 diabetes

Insulin
Insulin may be needed if:
• The body does not make enough of its own insulin
• Blood glucose levels cannot be controlled with lifestyle changes and medications

Insulin is given through injections. There is one short-acting inhaled insulin which may be available for select persons.

Blood Glucose Testing
You can check the level of glucose in your blood with a blood glucose meter. Checking your blood glucose levels during the day can help you stay on track. It will also help your doctor determine if your treatment is working. Keeping track of blood sugar levels is especially important if you take insulin.

Regular testing may not be needed if your diabetes is under control and you don’t take insulin. Talk with your doctor before stopping blood sugar monitoring.

An HbA1c test may also be done at your doctor’s office. This is a measure of blood glucose control over a long period of time. Doctors advise that most people keep their HbA1c levels below 7%. Your exact goal may be different. Keeping HbA1c in your goal range can help lower the chance of complications.

Counseling
Depression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your depression and diabetes.

Decreasing Risk of Complications
Over a long period of time, high blood glucose levels can damage vital organs. The kidneys, eyes, and nerves are most affected. Diabetes can also increase your risk of heart disease.

Maintaining goal blood glucose levels is the first step to lowering your risk of these complications. Other steps:
• Take good care of your feet. Be on the lookout for any sores or irritated areas. Keep your feet dry and clean.
• Have your eyes checked once a year.
• Don’t smoke. If you do, look for programs or products that can help you quit.
• Keep track of your moods and be alert for persistent depressive symptoms.
• Plan medical visits as recommended.

Prevention
To help reduce your chance of type 2 diabetes:
• Participate in regular physical activity
• Maintain a healthy weight
• Drink alcohol only in moderation (2 drinks per day for a man, and 1 drink per day for a woman)
• Eat a well-balanced diet:
– Get enough fiber
– Avoid fatty foods
– Limit sugar intake
– Eat more green, leafy vegetables
– Eat whole fruits, especially apples, grapes, and blueberries

by Debra Wood, RN

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:

American Association of Clinical Endocrinologists, American College of Endocrinology. Medical guidelines for the management of diabetes mellitus. The AACe system of intensive diabetes self-management. 2002 update. Endocrine Practice. 2002;8(suppl 1):S40-S82.

American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33:S62-S69.

Boren SA, Gunlock TL, Schaefer J, Albright A. Reducing risks in diabetes self-management: a systematic review of the literature. Diabetes Educ. 2007;33:1053-1077.

Causes of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/causes-diabetes/Pages/index.aspx. Updated June 2014. Accessed September 3, 2015.

Diabetes. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/diabetes/home/index.html. Updated August 18, 2015. Accessed September 3, 2015.

Diabetes mellitus type 2 in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults. Updated August 29, 2016. Accessed September 29, 2016.

Diabetes mellitus type 2 in children and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901364/Diabetes-mellitus-type-2-in-children-and-adolescents. Updated June 9, 2016. Accessed September 29, 2016.

Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28(suppl 1):S37-42.

Dietary considerations for patients with type 2 diabetes. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T270045/Dietary-considerations-for-patients-with-type-2-diabetes. Updated January 19, 2016. Accessed September 29, 2016.

Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;248:383-393.

Harsch IA. Inhaled insulins: their potential in the treatment of diabetes mellitus. Treat Endocrinol. 2005;4:131-138.

Lee DC, Sui X, Church TS, Lee IM, Blair SN. Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men. Diabetes Care. 2009;32:257-262.

Marre M. Reducing cardiovascular risk in diabetes. J Hypertens. 2007;(supp 11)S19-22.

Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-62.

Rosenbloom AL, Silverstein JH, Amemiya S, et al. ISPAD Clinical Practice Consensus Guideline 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes. 2008;9:512-526.

Rosenzweig JL, Ferrannini E, Grundy SM, et al. Primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:3671-3689.

Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE and VA diabetes trials: a position statement of the American Diabetes association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Circulation. 2009;119:351-7.

Standards of medical care in diabetes—2009. Diabetes Care. 2009;32:S13-61.

Statement by an AACE/ACE Consensus Panel on Type 2 Diabetes Mellitus: An Algorithm for Glycemic Control. Endocr Pract. 2009;15:540-559.

Traina AN, Kane MP. Primer on pramlintide, an amylin analog. Diabetes Educ. 2011;37(3):426-431.

Type 2. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-basics/type-2/?loc=HomePage-type2-tdt. Accessed September 3, 2015.

UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet. 1998;352:954-965.

US Preventive Services Task Force: Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;148:846-854.

11/29/2006 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.

9/19/2006 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Syst Rev. 2006;CD002968.

6/1/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457-2471.

7/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Farmer A, Wade A, Goyder E, et al. Impact of self-monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132.

12/13/2007 DynaMed Plus Systematic Literature Surveillance.http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Milman U, Blum S, Shapira C, et al. Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both type 2 diabetes mellitus and the haptoglobin 2-2 genotype. A prospective double-blinded clinical trial. Arterioscler Thromb Vasc Biol. 2008;28(2):341-347.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Davies MJ, Heller S, Skinner TC, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336(7642):491-495.

2/28/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Christian JG, Bessesen DH, Byers TE, Christian KK, Goldstein MG, Bock BC. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008;168:141-146.

6/18/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-2572.

2/24/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Liese AD, Weis KE, Schulz M, Tooze JA. Food intake patterns associated with incident type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009;32:263-268.

5/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Loimaala A, Groundstroem K, Rinne M, et al. Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:972-977.

8/19/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Li TY, Brennan AM, Wedick NM, Mantzoros C, Rifai N, Hu FB. Regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes. J Nutr. 2009;139:1333-1338.

10/12/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

11/20/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Lund SS, Tarnow L, Frandsen M, et al. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. BMJ. 2009;339:b4324.

12/21/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420.

2/15/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-61).

2/15/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-69).

7/2/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-2283.

10/5/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229.

1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Pan A, Lucas M, Sun Q, et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010;170(21):1884-1891.

5/6/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Muraki I, Imamura F, Manson J, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013;347:f5001.

4/14/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Xi B, Li S, et al. Intake of fruit juice and incidence of type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2014;9(3):e93471.

7/21/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Afshin A, Micha R, et al. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(1):278-288.

9/11/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Tovote KA, Fleer J, Snippe E, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37(9):2427-2434.

9/16/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113993/Diabetes-mellitus-type-2-in-adults: Zhou D, Yu H, He F, et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2014;100(1):270-277.

Last reviewed January 2016 by Kim Carmichael, MD

PT News

September 27, 2016 Teresa Stockton - Blog, PT News

This Month in PT News. Featuring articles from PTandMe partnering clinics!

2. Going in Reverse: When Your Back Impedes Driving
Written by the Therapy Team at the Jackson Clinics – Middleburg, VA

When backing up your car, do you find it difficult to turn around to see what’s behind? Loss of rotational ability in the back is one of the problems we develop as we age. Read more

3. 4 Ways To Improve Your Quality of Life Today
Written by the Therapy Team at Momentum Physical Therapy – San Antonio, TX

How often do you get home tired from a long day, frustrated with work, traffic, or co-workers? Our blood pressure has increased, stress levels have caused emotional, behavioral, and physical changes in us that otherwise would not be part of our normal calm day. Read more

Exercise and Bone Health

September 1, 2016 Teresa Stockton - Aging, Blog, Sports and Fitness

Bone is living tissue that is constantly undergoing a process called remodeling. In remodeling, cells called osteoclasts are breaking down old bone, as cells called osteoblasts are replacing it with new tissue. Many factors can affect the remodeling process and leave you with bones that are less dense and more fragile.

Some factors that interfere with bone health and remodeling are:
• Increased age
• Low vitamin D—The body makes vitamin D in response to sunlight. You can also get vitamin D by eating certain kinds of food or by taking a supplement.
• A diet low in calcium
• Smoking
• Lack of exercise—especially weight bearing and resistance exercise

Why Exercise Is Good for Bone Health
Regular weight-bearing and resistance exercise helps build muscle, as well as maintain and increase bone strength. Exercise causes the muscle to contract against the bone. This action stresses or stimulates the bone, and the bone becomes stronger and denser. The 3 main types of exercise are (some activities can be more than 1 type):

Aerobic (Cardiovascular) Exercises to Improve Bone Health
In aerobic exercise, you continually move large muscles in the legs, shoulders, and buttocks. This action causes you to breathe more deeply, and your heart to work harder pumping blood, thereby strengthening your heart and lungs. Examples include:
• Walking
• Jogging
• Running
• Aerobic dance
• Bicycling
• Swimming

Weight-Bearing Exercises to Improve Bone Health
In weight-bearing exercises, your bones and muscles work against gravity, and your feet and legs bear the weight. Your bones adapt to the weight and pull of the muscle during weight-bearing exercise. Examples of weight-bearing exercises include:
• Jogging
• Walking
• Stair climbing
• Dancing
• Soccer

Resistance Exercises to Improve Bone Health (Strength Training)
Resistance exercises use muscle strength to improve muscle mass and strengthen bone. Examples include:
• Weight lifting, using:
• Free weights
• Weight machines
• Elastic tubing

• Calisthenics such as push-ups and chin-ups

Tips for Beginning:
Aerobic or Weight-bearing Exercises to Improve Bone Health
• Warm up for 5 minutes before activity. This can consist of dynamic stretches that involve movement and a light walk.
• Start the activity slowly for the first 5 minutes.
• Slowly increase your intensity so that your heart rate increases. A person doing moderate-intensity aerobic activity can talk. A person doing vigorous-intensity activity cannot say more than a few words without stopping to take a breath.
• Gradually increase your workout until you are working out at least 150 minutes a week at moderate–intensity or 75 minutes a week at vigorous intensity.

Resistance Exercises to Improve Bone Health
• Begin each exercise with light weights and minimal repetitions.
• Slowly (over weeks) increase weight, never adding more than 10% in a given workout.
• Do these exercises 2-3 times a week. Allow for 1 day between each workout for your bones and muscles to rest and repair themselves.
• Gradually increase the number of repetitions to 2-3 sets of 8-10 repetitions with a rest period of 30-60 seconds between sets.
• Although stiffness the day after exercise is normal, if you are in pain, you did too much. Decrease the intensity or the duration of your exercise.

Before starting any type of exercise program, check with your doctor about any possible medical problems you may have that could limit your ability to exercise.

by Mary Calvagna, MS

RESOURCES:
National Osteoporosis Foundation
http://www.nof.org

The President’s Council on Physical Fitness, Sports, and Nutrition
http://www.fitness.gov

CANADIAN RESOURCES:
Canadian Orthopaedic Foundation
http://www.canorth.org

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:
2008 Physical Activity Guidelines for Americans. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx#toc. Published October 2008. Accessed January 21, 2016.

Bone remodeling. University of Washington website. Available at: http://courses.washington.edu/bonephys/physremod.html. Updated March 30, 2007. Accessed January 21, 2016.

How much physical activity do adults need? Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Updated June 4, 2015. Accessed January 21, 2016.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 13, 2015. Accessed January 21, 2016.

Skeleton keys. Smithsonian Museum of Natural History website. Available at: http://anthropology.si.edu/writteninbone/young_old.html. Accessed January 21, 2016.

Last reviewed January 2016 by Michael Woods, MD

What Does It Really Mean to Have Prediabetes?

June 9, 2016 Teresa Stockton - Blog, General Information

Type 2 diabetes usually occurs as a result of genetics and lifestyle. It is marked by abnormally high levels of blood sugar, known as glucose. Glucose is the primary source of energy for our cells that the body makes from food we ingest. The onset of type 2 diabetes is triggered when the body is no longer able to properly use insulin, the hormone that helps cells take in glucose from the blood. When glucose stays in the blood stream instead of moving into the cells, nerves and blood vessels can be damaged. This increases the risk of cardiovascular disease, stroke, blindness, kidney disease, and circulation problems.

What Is Prediabetes?
Prediabetes is a condition that precedes the onset of type 2 diabetes. It is characterized by blood glucose levels that are elevated, though not high enough to be classified as diabetes. Doctors usually refer to prediabetes as impaired glucose tolerance or impaired fasting glucose. The American Diabetes Association (ADA) recommends screening for all adults 45 years old and older. Also, if you are younger than 45 and are overweight or obese and have risk factors for diabetes, you should be screened. Risk factors include:
• Family history of diabetes
• Having hypertension, high cholesterol, or high triglycerides
• Sedentary lifestyle
• History of gestational diabetes or giving birth to a baby weighing more than 9 pounds (4 kilograms)
• History of cardiovascular disease
• Having a condition associated with insulin resistance, such as polycystic ovary syndrome or metabolic syndrome

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

How Do You Know If You Have Prediabetes?
During a routine office visit, your doctor can order tests, such as:
• Fasting plasma glucose test—For this test, you fast overnight and have your blood glucose measured in the morning before eating. Results in the range of 100-125 mg/dL (5.6-6.9 mmol/L) may indicate prediabetes.
• Oral glucose tolerance test (OGTT)—Again, you fast overnight and have your blood glucose measured after the fast. Then, you consume a sugary drink and have your blood glucose measured two hours later. Results in the range of 140-199 mg/dL (7.8-11 mmol/L) indicate prediabetes.
• Hemoglobin A1c (HbA1c)—This is an indicator of your average blood sugar levels over the previous three months. Results in the range of 5.7%-6.4% indicate prediabetes.

What Can You Do If You Have Prediabetes?
If you are diagnosed with prediabetes, it is important to take action to manage your condition. If you are overweight, your doctor may recommend that you lose weight. Reducing your body weight, even by 5%-10% can help improve your health. In general, changing your diet and being physically active and exercising at least 30 minutes a day will help you stay on track. Participating in a behavioral modification program may further help you achieve your weight loss goals.

Because many of the lifestyle-related risk factors associated with diabetes are also risk factors for other health issues, making lifestyle changes to reduce your risk of diabetes may have a positive effect on your overall health.

Some people can take medication to manage their blood glucose levels, though lifestyle modification should be the first approach to manage prediabetes. Medications that may be used include metformin, pioglitazone, and acarbose.

How Can You Prevent Prediabetes?
The same strategies that are used to lower your risk of type 2 diabetes can be applied to prediabetes, as well. The American Diabetes Association (ADA) recommends these strategies:
• Lose excess weight.
• Exercise for at least 150 minutes per week.
• Reduce your intake of calories and fat.
• Try to eat more fiber and whole grains.

If you do have prediabetes, you can take steps that may slow or avoid the progression to type 2 diabetes. It will take a lot of effort on your part, but the potential benefits—being healthy and living longer—are worth it.

by Julie J. Martin, MS

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Education Program
http://www.ndep.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:
Am I at risk for type 2 diabetes? Taking steps to lower the risk of getting diabetes. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/risk.pdf. Published June 2012. Accessed April 26, 2016.

American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. The prevention or delay of type 2 diabetes. Diabetes Care 2002;25:1-8.

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. NEJM. 2002;346:393-403.

Diabetes mellitus type 2 prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 22, 2016. Accessed April 26, 2016.

Diagnosing diabetes and learning about prediabetes. American Diabetes Association website. Available at: http://www.diabetes.org/are-you-at-risk/prediabetes. Updated December 9, 2014. Accessed April 26, 2016.

Kanaya AM, Narayan KM. Prevention of type 2 diabetes: Data from recent trials. Primary Care. 2003;30:511-526.

Narayan K, Imperatore G. Targeting people with prediabetes. British Medical Journal. 2002;325:403-404.

Nathan DM. Diabetes Care. 2007;30:753.

Prediabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2016. Accessed April 26, 2016.

Tuomilehto J, Lindstorm J. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2004;344:1343-1350.

10/21/2008 DynaMed’s Systematic Literature Surveillance: http://www.ebscohost.com/dynamed: Greaves CJ, Middlebrooke A, O’Loughlin L, et al. Motivational interviewing for modifying diabetes risk: a randomised controlled trial. Br J Gen Pract. 2008;58:535-540.

10/12/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-S61).

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-S69).

Last reviewed April 2016 by Michael Woods, MD Last Updated: 6/3/014

Exercise May Reduce Risk of Low Back Pain

May 12, 2016 Teresa Stockton - Back, Blog

Low back pain is a common complaint that can last a few days or weeks or become a chronic condition with significant impact on well being. Treatments can vary depending on the cause.Chronic back pain can be difficult to successfully treat and it may take some time to find what treatment works best for each person. Since treatment is not guaranteed to work, prevention is the best option. Back pain is often the result of long term stress on the back such as poor posture, sedentary behavior, or regular strain on the back. Prevention will likely involve a number of different steps to reduce these stresses. However, existing studies have not found clear recommendations for the best methods to go about it.

Researchers wanted to investigate the effectiveness of a number of interventions for the prevention of low back pain. The study, published in JAMA Internal Medicine, found that exercise alone or in combination with education was most effective for preventing low back pain.

About the Study
The systematic review of 21 randomized controlled trials included 30,850 men and women without low back pain. The participants were randomized to 6 different prevention strategies, including exercise, education, exercise plus education, back belt, and shoe insoles. The control groups received no intervention, minimal interventions, or placebo.

When compared to the control group exercise was associated with:
• Fewer low back pain episodes in the first 12 months (in 4 trials with 898 people)
• Fewer sick days due to back pain in follow up 12 months or longer (in 2 trials with 128 people)
• Reduction in short-term (4 trials with 422 people) and long-term low-back pain episodes (2 trials with 138 people) when combined with education

Education alone, back belts, and shoe insoles did not appear to have any benefit during the trials.

How Does This Affect You?
A systematic review combines the results of several smaller studies to arrive at one result. The benefit of this type of review is that it increases the number of participants which increase reliability of results. However the review is only as reliable as the studies that are included and the method used to combine the results. There were some flaws in every trial that were included in this analysis. For example, many of the included trials had a high dropout rate during the trial which decreases the reliability of their results.

Low back pain is often associated with an imbalance or weakness of certain back muscles. An exercise program will improve your physical fitness, strengthen your back muscles, and help you maintain a healthy weight. Regular physical activity may also help maintain a healthy weight which can also put strain on your back. Choose exercises or activities that you enjoy and will make a regular part of your day. For most people, this could include 30 minutes of moderate aerobic exercise per day.

Check with your doctor before starting any exercise program.

by Cynthia M. Johnson, MA

RESOURCES:
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Ortho Info—American Academy of Orthopaedics
http://orthoinfo.aaos.org

SOURCES:
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 2, 2016. Accessed March 22, 2016.

Steffens D, Maher CG, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016 Feb 1;176(2):199-208.

Last reviewed April 2016 by Michael Woods, MD