Tag Archives: Diabetes

Eat Well, Exercise Well, Be Well: Dietary and Fitness Guidelines

March 7, 2018 Teresa Stockton - Blog, General Information

When it comes to the secrets of living a healthy life, it seems that there are no secrets. From diet gurus to celebrities, everyone seems to have the answers on healthy living. Since the 1980s, the United States government has also weighed in, with dietary guidelines that it publishes every 5 years. The intent is to provide research-backed diet and physical activity recommendations to reduce the risk of diseases linked to poor diet and activity, such as high blood pressure, heart disease, and type 2 diabetes. Here is a round-up of the government’s latest key recommendations from the publication, 2015-2020 Dietary Guidelines for Americans.

EAT WELL

Calories, Calories, Calories
In recent years, obesity has been a national concern, since it has been associated with serious conditions like cancer, heart disease, and type 2 diabetes. Controlling total calorie intake is essential to maintaining ideal body weight. If you are trying to lose weight, you will need to expend more calories than you take in. This means getting plenty of exercise and cutting down on foods that are high in calories.

So how many calories should you be consuming? This depends on several factors, such as age, gender, height, weight, and physical activity level. To keep calories under control, you want to focus on eating foods full of many nutrients, especially potassium, fiber, vitamin D, and calcium. You may want to talk with your doctor or a registered dietitian about an eating plan that is right for you. In general, try to keep calories in check. Aim to meet calorie needs, but not exceed them. Reducing portion size and eating more meals at home are great ways to avoid exceeding calorie needs. In addition, eating foods high in nutrients but lower in calories can help.

Foods to Enjoy

Eat a lot of fruits and vegetables—Fresh fruits and vegetables are lower in calories compared to processed foods. Focus on color when eating fruits and vegetables. Dark green, red, and orange vegetables are especially packed with good-for-you nutrients. When preparing a meal, try and fill half your plate with fruits and vegetables.
Eat a lot of whole grains—Examples of whole grains are brown rice, oatmeal, bulgur, and whole-wheat pasta. Your goal should be to make half your grains whole grains.
Have more dairy—Focus on low- or non-fat milk, cheese, and yogurt.
It is okay to eat certain fats—Some fats are okay to consume in moderation. These are monosaturated or polyunsaturated fats, which are found in foods like nuts and fish.
Power up on protein—Seafood, lean meats, poultry, beans, and soy products are good sources of protein. Be sure to choose protein foods that are low in saturated fat and calories.

Food to Eat Less

Limit refined grains—Examples of refined grains are white bread, corn flakes, grits, regular pasta, and white rice. These foods tend to be high in calories and sugar but low in fiber.
Limit foods containing added sugars—This includes sugar-sweetened drinks and snacks.
Limit foods high in saturated fats—This includes certain kinds of meat and dairy products (whole milk, cream, and butter). Less than 10% of calories should come from saturated fats.
Keep trans fat consumption as low as possible—You can do this by limiting foods containing solid fats and partially hydrogenated oils, such as margarine and baked goods.
Limit salt intake—Too much of it can increase your risk for high blood pressure, which can lead to kidney damage, heart disease, and stroke. On a daily basis, adults should consume less than 2,300 mg of sodium.
If you drink alcohol, do so in moderation —Women should consume no more than 1 alcoholic drink a day, while men should consume no more than 2 drinks a day. Also, keep track of the calories in each drink. Mixed drinks tend to have higher calories.

Preparing Your Plate
Remembering which foods to limit, and which to eat more of, may be daunting. To help you remember, the United States Department of Agriculture created a simple image of a sectioned plate as a guideline for healthy eating. The Choose My Plate guidelines emphasize nutrient-dense foods and beverages, such as vegetables, fruits, whole grains, low- or non-fat milk, beans, and nuts. If remembering how much and what to eat is a chore, you can just keep these simple things in mind to ensure that you are eating well when you sit down for a meal:

Fill half your plate with fruits and vegetables.
When eating grains, make sure half your grains are whole grains.
Choose fat-free and low-fat (1%) milk products.
Avoid oversized portions.
Enjoy your food, but be mindful of how much you are eating. Try to eat less.
Drink water instead of sugary drinks.
When cooking, try to use less or no salt in the recipe. When you eat your meals, do not add any extra salt. Over time, you will adjust to less salt in your food.

You can find specific information on the ChooseMyPlate website.

Exercise Well
A nutritious diet and exercise go together for maintaining a healthy lifestyle. To achieve and maintain a healthy body weight, adults should aim for 150 minutes of moderate to intense physical activity each week. Some examples of activities are brisk walking, biking, and swimming. Before starting any kind of exercise program, be sure to check with your doctor if you have any health issues that may limit your exercise program.

Be Well
Guidelines provide the foundation for a healthy lifestyle. But living a healthy lifestyle takes discipline and a positive attitude. Working with your doctor and perhaps other professionals, like a dietitian or fitness trainer, can be helpful in keeping you motivated and on track for reaching your health goals. Also, a healthy lifestyle should not be a chore, but something enjoyable.

Make exercise fun—a weekend hike, a lunch-hour walk with co-workers, or a pick-up game of basketball with your neighbor are just some ideas. And when mealtimes roll around, put on your creative chef hat! Come up with new approaches to breakfast, lunch, and dinner menus that incorporate fresh, nutrient-dense foods, and get friends and family involved in preparing meals. Experiment with herbs and spices to flavor your meals instead of the old salt standby. Armed with guidance, support, and motivation, a healthy lifestyle is within your reach!

Written by Marjorie Montemayor-Quellenberg, MA

RESOURCES:
Choose My Plate—US Department of Agriculture
http://www.choosemyplate.gov

Eat Right—Academy of Nutrition and Dietetics
http://www.eatright.org

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

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

REFERENCES:

2015-2020 Dietary guidelines for Americans. US Department of Agriculture and US Department of Health and Human Services. Available at: https://health.gov/dietaryguidelines/2015/guidelines/. Accessed February 14, 2017.

BMI calculator. ChooseMyPlate—US Department of Agriculture website. Available at: http://www.choosemyplate.gov/weight-management-calories/weight-management.html. Accessed February 14, 2017.

Dietary interventions for cardiovascular disease prevention. EBSCO DynaMed Plus website. Available at: http://www.ebscohost.com/dynamed. Updated February 5, 2015. Accessed March 9, 2015.

What is MyPlate? US Department of Agriculture ChooseMyPlate website. Available at: https://www.choosemyplate.gov/MyPlate. Accessed February 14, 2017.

Last reviewed February 2017 by Michael Woods, MD, FAAP

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.

Role of Exercise in Type 2 Diabetes

February 7, 2018 Teresa Stockton - Blog, General Information

Lifestyle changes play an important role in managing type 2 diabetes. Activity decreases blood glucose and regular exercise helps by improving the way your body uses glucose.It can also reduce the risk of diabetes complications like heart disease.

How it Works
Glucose is a type of sugar that is used for energy. It is present in the blood and stored in the muscle and liver. A hormone called insulin helps most of the glucose move from the blood into cells. For those with type 2 diabetes, the body is resistant to insulin and over time the body has trouble making insulin at all. As a result, glucose has trouble getting to the cells, the body doesn’t get enough energy, and glucose builds up in the blood.

During exercise your working muscles have a greater need for energy and therefore glucose. As a result, glucose can enter the muscles and cells with far less insulin. This leads to a drop in blood glucose levels during exercise and for a few hours after while the muscles recover. This causes an immediate though temporary decrease in blood glucose.

Over time, regular activity can make the body less insulin resistant during activity or rest. This can lead to more long term benefits and may lead to a decrease in the need for medication.

In addition to helping control diabetes, exercise can also improve your overall health by decreasing weight, the risk of cardiovascular disease, and blood vessel damage.

Exercise Recommendations
It is important that you talk to a doctor before starting an exercise program. You and your doctor can work together to choose an exercise program that is right for you.

For greatest benefits, you will need to do both aerobic exercises and strength training. Aerobic exercises include things like walking, bicycling, and swimming. Strength training exercises and classes use things like weight machines, free weights, and resistance bands. Adults should aim for:

At least 150 minutes per week of moderate-to-vigorous intensity aerobic exercise
2-3 days of strength training per week
Try not to go more than 2 days without some type of activity

Look for opportunities during the day to add to your overall activity level. Take the stairs instead of the elevator, take a short walk during the day, or walk instead of taking the car. Even 10 minutes of activity can provide some immediate benefits.

Safety Steps
Certain diabetes medication can lead to a dip in blood glucose called hypoglycemia. Talk to your doctor to understand if this may be a problem for you. Be aware of signs of hypoglycemia during exercise such as dizziness, shaking, or confusion. If you have these symptoms, stop exercising and manage hypoglycemia. Let your doctor know about any episodes, since your medication may need to be adjusted.

Diabetes can also affect the nerves and blood flow to the feet. Inspect your feet frequently, since diabetes can sometimes lessen your ability to feel pain from a foot injury.

Keep in mind that exercise is only one piece of an overall diabetes management plan. You will also need to control your blood glucose levels with good nutrition.

by Cynthia M. Johnson, MA

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

Centers for Disease Control and Prevention
http://www.cdc.gov

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

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

REFERENCES:

Physical activity for type 2 diabetes. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T270048/Physical-activity-for-type-2-diabetes. Accessed February 20, 2017.

Physical activity is important. American Diabetes Association website. Available at: http://www.diabetes.org/food-and-fitness/fitness/physical-activity-is-important.html. Updated December 27, 2016. Accessed February 20, 2017.

What we recommend. American Diabetes Association website. Available at: http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-we-recommend.html. Updated May 19, 2015. Accessed February 20, 2017.

How to Manage Your Type 2 Diabetes with Diet. Available at: https://www.jenreviews.com/diabetes/ Accessed November 2018

Last reviewed December 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 12/22/2017

Common Causes of Carpal Tunnel Syndrome

September 28, 2017 Teresa Stockton - Blog, Wrist

Carpal Tunnel happens when the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury-causing compression to the median nerve. When compression occurs, a person can experience numbness, tingling, or a dull sensation of the thumb, index, middle and ring fingers. Symptoms may include pain during pinching and gripping, or a feeling of clumsiness and the inability to hold things. The best way to avoid carpal wrist pain is to understand the main causes of carpal tunnel and use that information at work and at home.

WHAT IS THE CARPAL TUNNEL?
The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament.

COMMON CAUSES OF CARPAL TUNNEL
Carpal Tunnel is typically not related to a specific injury. Some common causes of carpal tunnel syndrome include:

Genetic Predisposition – Many cases can be a result of physical characteristics of carpal tunnel or medical conditions associated with CTS, which also run in the family.

Repetitive Movements – Certain types of work, leisure, and sports activities require use of the hand and wrist repetitively. Occupations such as manufacturing/assembly line workers, grocery checkers, musicians, carpenters, and many others require the same movements. Common hobbies such as golfing, knitting, and gardening also require repeated movements that cause carpal tunnel syndrome.

Injury or Trauma – Sprain or fracture of the wrist can cause swelling and pressure to the median nerve.

Pregnancy & Menopause – Hormonal fluctuation in women plays a role in CTS. Such fluctuation may cause fluid retention and other changes that cause swelling in the body. Fluid retention frequently occurs during the last trimester of pregnancy and is the reason for CTS.

Medical Conditions – Diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis.

ACTIVITIES TO AVOID TO MINIMIZE SYMPTOMS

Avoid keeping your wrists bent in either direction. The best position for the wrist is neutral (straight)
Avoid rapid repetitive forceful or prolonged hand or arm use such as seen with factory work or data entry.
Avoid tight gripping and pinching
Avoid pressure to the palm or wrist
Avoid extreme cold or vibration.

Postural Hypotension: What It Is and How to Manage It

August 1, 2017 Teresa Stockton - Balance & Vestibular Rehab, Blog, Neurological Rehab

Postural hypotension (or orthostatic hypotension) is when your blood pressure drops when you go from lying down to sitting up or from sitting to standing. When your blood pressure drops, less blood can go to your organs and muscles. This can make you likely to fall.

What are the symptoms?
Although many people with postural hypotension have no symptoms, others do. These symptoms can differ from person to person and may include:

Dizziness or lightheadedness
Feeling about to faint, passing out or falling
Headaches, blurry or tunnel vision
Feeling vague or muddled
Feeling pressure across the back of your shoulders or neck
Feeling nauseous or hot and clammy
Weakness or fatigue

When do symptoms tend to happen?
When standing or sitting up suddenly

In the morning when blood pressure is naturally lower
After a large meal or alcohol
During exercise
When straining on the toilet
When you are ill
If you become anxious or panicky

What causes postural hypotension?
Postural hypotension may be caused by or linked to:

High blood pressure
Diabetes, heart failure, atherosclerosis or hardening of the arteries
Taking some diuretics, antidepressants or medicines to lower blood pressure
Neurological conditions like Parkinson’s disease and some types of dementia
Dehydration
Vitamin B12 deficiency or anemia
Alcoholism
Prolonged bed rest

What can I do to manage my postural hypotension?

Tell your healthcare provider about any symptoms
Ask if any of your medicines should be reduced or stopped
Get out of bed slowly. First sit up, then sit on the side of the bed, then stand up
Take your time when changing position, such as when getting up from a chair
Try to sit down when washing, showering, dressing or working in the kitchen
Exercise gently before getting up (move your feet up and down and clench and unclench your hands) or after standing (march in place)
Make sure you have something to hold onto when you stand up
Do not walk if you feel dizzy
Drink 6-8 glasses of water or low-calorie drinks each day, unless you have been told to limit your fluid intake
Avoid taking very hot baths or showers
Try sleeping with extra pillows to raise your head

This information was written by Proactive Physical Therapy, an outpatient physical therapy clinic in Sioux Falls, South Dakota. At ProActive Physical Therapy, their number one priority is the patient. They strive to provide individualized treatment with hands-on, compassionate care. They do not rush their patients or their clinicians. Rather, they perform comprehensive evaluations and encourage patient input for treatment planning and goal setting. For more information click here.

Exercise for Chronic Disease Relief

May 25, 2017 Teresa Stockton - Blog, General Information

For people in need of chronic disease relief, exercise can decrease discomfort, improve daily functioning, and enhance overall quality of life. There are many activity choices. Overall, find something that you enjoy doing and a place that is comfortable for you to do it in. Although being physically active is good for anyone, some exercises provide specific benefits. Here is how different types of exercise can help people with specific chronic diseases.

CHRONIC DISEASE RELIEF : TYPES OF EXERCISE
There are 3 basic categories of exercise:

Aerobic Exercise
These are exercises that raise your heart rate through repetitive movement of large muscles groups. The 2 types of aerobic exercise are:

Weightbearing exercise —Your muscles work against the force of gravity. Examples include jogging, walking, and dancing.
Non-weightbearing exercise —The force of gravity does not play a major role. Examples include biking, swimming, and rowing.

Strength Training Exercise
These are exercises that increase the power, tone, and efficiency of individual muscles by contracting isolated muscles against resistance. An example is lifting weights. The increase in heart rate is short-lived compared to aerobic exercise.

Stretching
These are exercises that improve or maintain the flexibility of your muscles. Good flexibility is important to keeping a full range of motion and decreasing your chances of injury. Ideally, you should stretch after each exercise session.

DISEASE IMPACT
Overall, all 3 types of exercises are important in a chronic disease relief program. However, the list below demonstrates how a certain types of exercise can directly impact your specific health condition.

Heart Disease
Researchers and healthcare professionals have found that regular exercise reduces the risk of having a heart attack, particularly for people with coronary artery disease (CAD).

Specific benefits of exercise for people with heart disease include:

Stronger heart muscle
Reduced cholesterol
Reduced plaque build-up inside the arteries
Better weight and blood pressure control

Type of exercise that can reduce risk of heart disease and heart attack: Aerobic

High Cholesterol
Cholesterol is found in cells throughout your body. Although it tends to get a bad rap, cholesterol is actually essential for life. It only contributes to heart disease when you have too much of certain types of cholesterol or too little of other types.

Exercise can help reduce cholesterol, and even better, it can help raise your HDL (good) cholesterol. Aim for at least 30 minutes of exercise most days of the week. Even short, 10-minute spurts of exercise can help. Exercise also has the added benefit of weight loss, which can also help to lower cholesterol levels.

Type of exercise that has been shown to improve cholesterol levels: Aerobic

Diabetes
Diabetes is a disorder of the body’s insulin production and usage, and it is a major risk factor for coronary artery disease. If there is not enough insulin, glucose (fuel for all cells) cannot get from the blood to the cells. As a result, the body is essentially starved and the glucose builds up in the blood. Exercise can make the cells more sensitive to insulin, and more glucose can move from the blood into cells.

Since exercise changes the way your body reacts to insulin, you may need to check your blood sugar before and after exercising. Talk to your doctor before you begin an exercise program to learn about what your levels should be.

Types of exercise that influence insulin sensitivity and cardiovascular risk factors: Aerobic and strength training

High Blood Pressure
The risk of high blood pressure increases as we age. Exercise can help to lower your risk and even control your blood pressure if it’s already high. Exercise helps with blood pressure by making your heart work more efficiently. This means your heart does not have to work as hard to pump blood, so there is less pressure on your arteries.

A good target for blood pressure is 120/80 mm Hg. Adding moderate physical activities to your normal routines can help you get there. You should aim for at least 30 minutes of aerobic activity on most days of the week. Even several 10-minute spurts throughout the day can help.

Types of exercise that have been shown to lower blood pressure: Aerobic and strength training

Stroke
A stroke occurs when not enough blood is reaching part of the brain. This causes the cells in that area to die. People who have already had a stroke are at increased risk for recurrent stroke or other cardiovascular problems.

A stroke can create some physical impairments. Exercise may improve strength and coordination of the affected muscles. Exercise recommendations may vary depending on the severity of the stroke and the person’s limitations.

Type of exercise for stroke recovery: Aerobic, strength training, and stretching

Cancer
Studies suggest that people with cancer who do not have depression have a better chance of survival than those who do. Exercise is a great way to avoid depression and improve your overall mood. It’s not clear exactly how exercise impacts mood, but it probably works by causing the brain to release chemicals, like endorphins, and increase body temperature, which can have a calming effect.

Types of exercise found to boost energy and mood: Aerobic and strength training

Lung Disease
Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is the most common form of lung disease in adults. Exercise improves activity levels and decreases symptoms.

Types of exercise shown to improve respiratory ability: Aerobic

Arthritis
Continuous motion is essential for the health of your joints, especially arthritic ones. Regular exercise promotes strength and flexibility, and helps preserve the resiliency of joint surfaces.

Types of exercise shown to improve joint health: Nonweightbearing aerobic, strength training, and stretching (water exercises are ideal)

Osteoporosis
Osteoporosis is a bone-thinning disease that can lead to fractures. Weightbearing exercises maintain bone density and strength by tipping the balance in favor of bone formation. Weightbearing activities include walking, jogging, hiking, dancing, stair climbing, tennis, and other activities that you do while on your feet.

Type of exercise shown to improve bone density: Weightbearing aerobic and strength training

In any condition, a well-rounded exercise program will have all 3 types of exercise involved. Aerobic exercise will increase your endurance and ability to get through longer workouts. Strength training will build muscle strength and allow you to tolerate higher intensities as well improve balance and agility. Stretching can decrease stiffness and increase mobility.

Talk to your doctor before beginning any exercise program. You can also consult with an exercise specialist to help you develop a routine.

by Carrie Myers Smith, BS

RESOURCES:
National Institutes of Health
http://www.nih.gov

The American Orthopaedic Society for Sports Medicine
http://www.aossm.org

CANADIAN RESOURCES:
Canadian Society of Exercise Physiology
http://www.csep.ca

Healthy Canadians
http://www.healthycanadians.gc.ca

REFERENCES:
Depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 11, 2016. Accessed March 23, 2016.

Exercises for arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/living-with-arthritis/exercise/. Accessed March 23, 2016.

Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 33. S484-S492; 2001.

Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T. AHA scientific statement: Physical activity and exercise recommendations for stroke survivors. Circulation. 2004;109: 2031-2041. Circulation website. Available at: http://circ.ahajournals.org/content/109/16/2031.full. Accessed March 23, 2016.

Junnila JL, Runkle GP. Coronary artery disease screening, treatment, and follow-up. Primary Care: Clinics in Office Practice. 2006 Dec; 33(4).

Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006 Sep; 28(5): 396-402.

Physical activity for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed March 23, 2016.

Physical activity guidelines for Americans. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2013. Accessed March 23, 2016.

Weightbearing exercise for women and girls. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00263. Updated October 2007. Accessed March 23, 2016.

Last reviewed March 2016 by Michael Woods, MD Last Updated: 5/8/2014

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

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.

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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.

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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.

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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

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

Long Work Hours May Increase Risk of Stroke

April 14, 2016 Teresa Stockton - Blog, Neurological Rehab

Stroke is a brain injury caused by an interruption in blood flow. It is a leading cause of death in the US, and can also cause disability, decreased quality of life and increased healthcare expenses. There are many lifestyle factors that affect you risk of stroke including diet, exercise, smoking and stress. Other lifestyle habits like long periods of standing or long work hours are also being reviewed for their impact on stroke risk.

Earlier research has suggested that long working hours may be linked to stroke, but the evidence is limited. Researchers wanted to determine if there was a possible connection between long work hours and the risk of stroke. The study, published in Lancet, found that employees who work long hours have a higher risk of stroke than those who do not.

About the Study
The systematic review of observational studies included 528,908 men and women from Europe, the U.S. and Australia who were free from history of stroke at the beginning of the study. The participants volunteered their work hours and were tracked for the development of stroke. During an average 7.2 year follow up there were 1,722 stroke-related events.

Compared to those who worked standard hours (35-40 hours/week), participants who worked 49-54 and more than 55 hours a week had an increased risk of stroke.

The effects remained apparent even when other stroke factors like age, sex and health history were accounted for.

How Does This Affect You?
A systematic review pools a large number of trials to create a larger pool of data. The larger the pool of data, the more reliable outcomes are. However, the review is only as reliable as the trials that are included. The included studies were all observational studies which means a direct cause and effect link could not be established and the studies can only show a potential link between factors.

There is a reasonable link between extra work hours and stroke since longer hours are often associated with extra stress and less relaxation time. If you have long work hours, you may want to talk to your doctor about your personal risk factors for stroke and follow other stroke prevention methods such as:
• Exercising regularly
• Maintaining a healthy weight
• Eating more fruits, vegetables and whole grains and limiting dietary salt and fat
• If you smoke, talking to your doctor about way to quit
• Increasing your consumption of fish
• Drinking alcohol in moderation
• Managing chronic medical conditions, such as high blood pressure, high cholesterol and diabetes

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What is a Stroke?
A stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

• A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

What are the Effects of Stroke?
The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can’t reach the region that controls a particular body function, that part of the body won’t work as it should. Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living.

Rehabilitation doesn’t reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke.

What Will I Do in Rehabilitation?
What you do in rehabilitation depends on what you need to become independent. You may work to improve your independence in many areas. These include:
• Self-care skills such as feeding, grooming, bathing, toileting and dressing
• Mobility skills such as transferring, walking or self-propelling a wheelchair
• Communication skills in speech and language
• Cognitive skills such as memory or problem solving
• Social skills for interacting with other people

by Cynthia M. Johnson, MA

RESOURCES:

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

American Stroke Association
http://www.strokeassociation.org

Kivimäki M, Jokela M, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015 Oct 31;386(10005):1739-1746. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960295-1/fulltext. Accessed January 19, 2016.

Risk factors for stroke or transient ischemic attack. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2015. Accessed January 19, 2016.

Last reviewed January 2016 by Michael Woods, MD

Frozen Shoulder: How Physical Therapy Can Help

April 6, 2016 Teresa Stockton - Blog, Shoulder

Physical therapy can help patients experiencing frozen shoulder regain movement faster. If your initial pain doesn’t go away with usual pain relievers, it’s probably time to check with a physical therapist. That’s because it can take up to TWO YEARS to go away on it’s own! This is definitely not something to be ignored.

Adhesive capsulitis is more commonly known as frozen shoulder, and with good reason: It can render your shoulder so stiff, it’s almost impossible to button your shirt — that is, if you aren’t in too much pain to get dressed in the first place.

Where does this injury Come From?
In general it comes on after an injury to your shoulder or a bout with another musculo-skeletal condition such as tendinitis or bursitis. Quite often its cause can’t be pinpointed. Nonetheless, any condition that causes you to refrain from moving your arm and using your shoulder joint can put you at risk for developing this injury.
It affects 10-20 percent of people with diabetes according to the American Academy of Orthopedic Surgeons. Women are more likely to develop this injury than men and it occurs most frequently in people between the ages of 40 and 60.

Where does the diabetes come in?
Well, doctors still aren’t exactly sure. But they believe that excess glucose impacts the collagen in the shoulder. Collagen is a major building block in the ligaments that hold the bones together in a joint. When sugar molecules attach to the collagen, it can make the collagen sticky. The buildup then causes the affected shoulder to stiffen, and the pain prevents you from moving your arm. Ouch!

This injury has Three Stages:
FREEZING
Pain slowly becomes worse until range of motion is lost.
(Lasts 6 weeks to 9 months)

FROZEN
Pain improves, but the shoulder is still stiff.
(Lasts 4 to 6 months)

THAWING
Ability to move the shoulder improves until normal or close to normal.
(Lasts 6 months to 2 years)

Physical therapy is often very effective in treating frozen shoulder. If your initial pain doesn’t go away with the usual pain relievers, it’s probably time to check with a doctor. That’s because it can take up to two years to go away on its own! This is definitely not something to be ignored.

TREATMENT
Treatment focuses on controlling pain and getting movement back to normal through physical therapy. Sometimes surgery is also considered. Talk to your doctor about treatment options that are right for you.

PREVENTION
Because doctors don’t really understand the causes, it can be difficult to prevent them in most cases. Keeping your blood sugars under control is always key to avoiding all complications. Doctors have also found that people who’ve suffered an injury to their shoulder or stroke are also at an increased risk, because of the immobility the other condition has caused. If you have diabetes and have had a shoulder injury, talk to your doctor or a physical therapist about what kind of exercises you can do to make sure this doesn’t happen to you.

Written by the Therapy Team at Advanced Physical Therapy