Have you noticed that daylight is lasting a few minutes longer every day in the past week? This weekend, the time changes for many areas of the country–”spring forward”. As you walk around your residence changing the time on clocks and electronic devices, don’t forget your “diabetes-related” devices; they may not change automatically. The data memory in your blood glucose meter is saved according to the time of the test; it needs to be correct. The time set in your insulin pump &/or continuous glucose monitor (CGM) determines your personal settings, including basal and bolus rates. Additionally, the “insulin on board (IOB) ” feature and time of your boluses is directly tied in to the time set in a pump. So the time setting is very important and needs to be accurate. You may also need to synchronize the clocks on your computer software diabetes data management systems to maintain the accuracy of time for data saved and downloading purposes. After you have programmed the new time, always double check your settings, especially that the AM/PM setting is correct. The Users Guide can direct you on the procedure to follow, or contact the Customer Support departments, of your various devices, by their specific website or by calling the toll-free phone numbers, usually found on the back of the device; they may request the serial number of your equipment. This same information is also important if you are traveling to different time zones. As you travel through different time zones, you should remember to update the time on your insulin pump and blood glucose (BG) meter, especially if the time change is 3 or more hours.
The current Olympic Games provide exciting and inspiring stories of hard work and perseverance. Preparing for an Olympic event can be similar to caring for any chronic disease. It involves continuous planning and evaluation of various aspects of activities and choices that can impact your performance. Education about diabetes, eating healthier, exercising at the proper time, testing blood glucose, maintaining a healthy stress level, keeping medical/lab appointments, and if appropriate, taking medications on a consistent basis can help you achieve the most important medal of all…..improved health! Olympian cross-country skier, Kris Freeman, is representing the USA, in Sochi, Russia. His story is featured in an article of the February, 2014 issue of Diabetes Forecast by Tracy Neithercott. Kris was diagnosed with type 1 diabetes at age 19. By that time, he had competed in skiing, at the Junior World Championships for the third time.He is the current 50 kilometer national Champion of cross-country skiing. Kris’ training is about 900 hours per year, in aerobic exercise, including running, swimming, kayaking, and roller skiing. Aerobic exercise is sustained activity that utilizes oxygen to fuel the muscles, stimulating and strengthening the heart and lungs. Freeman tests his blood glucose 3 to 4 times a day, uses a patch-style insulin pump delivery system, and a continuous glucose monitor. His diligence helps him to adjust his insulin dosing to match his body’s requirements. Tracy notes that Kris’ views on nutrition are simple; he doesn’t take in more fuel than he burns/utilizes….a good lesson for all of us!
For me, the most striking sentence in the article is when Tracy reports that Freeman stated: ” The way to not be terrified was to learn as much as I could about [diabetes]“. As a Certified Diabetes Nurse Educator (CDE), I often hear how frightened people are with a first-time diagnosis of diabetes. Frequently, their fears are due to many misconceptions of the disease as a result of the media, the internet, various health care Providers (HCP), well-meaning friends, neighbors, and family members. While there is a lot about diabetes that pertains to most people with diabetes, there is information that is pertinent to your situation. There are several medical conditions, syndromes, and diseases that you can’t do much to change, there is a lot you can do to improve your diabetes health. Arm yourself with knowledge of the disease and your own body, develop confidence in your blood glucose control, and establish a good support team and hopefully, you can say “thank goodness, it’s just diabetes”! The Education Staff of St Anthony’s Diabetes and Nutrition Education Services is composed of Certified Diabetes Nurse Educators and Certified Dietitian Educators and additional clinical support Staff. With a Physician’s order, they are prepared to partner with you and your health care Team to provide you with the tools and tips needed to help you achieve your best level of diabetes health. Call 314-525-4508, option 2, or access stanthonysmedcenter.com/diabetes; for more information.
The TalkDiabetes Support Program and the Diabetes Education Program at St. Anthony’s Medical Center presents its quarterly live meeting. Meetings are FREE to the public and are meant to be an extension of formal diabetes Education sessions.
Speaker Nancy Trebilcock, BSN, RN, CDE, will address the topic of: “Diabetes & oral care: gateway to your body’s health!” People with diabetes can be at increased risk for periodontal (gum) disease. Like diabetes, periodontal disease starts as a silent problem that often goes unnoticed. Most of the time, periodontal disease is fairly painless, but can destroy your jaw bones and gums. Harmful bacteria can enter the main blood stream through your gums, possibly causing infection to other vital areas like the brain and heart. Even if you have full dentures, regular dental visits and good dental care is so important, that it is listed as one of the “National Standards of Diabetes Care”. Join us to learn how your diabetes control can be affected by the health of your mouth!
The meeting date is Thursday, February 20, 2014, at 1:00 p.m., in the Great Room, of the Hyland Education & Training Center, on the hospital campus; 10020 Kennerly Road, St Louis, 63128. As is our custom, we have an ongoing “Green (Recycle) Table please bring your unwanted magazines, books and coupons to donate to the exchange table.
Registration for the program is requested by calling 314-ANTHONY (800-554-9550) or via: www.stanthonysmedcenter.com/diabetes.
It seems as if we finally get the holiday treats out of the house and now another reason to have a big celebration! The “Big Game” is this weekend and if that means hosting a game-viewing party or attending one, make plans ahead of time to make healthier food choices and care for your diabetes. The American Association of Diabetes Educators has issued their version of a “Healthy Eating GAME Plan” that provides tips and recipes to help control blood glucose levels. Chair/leg exercises can be incorporated while watching the half-time show or those special commercials; and exercise is free! Enjoy the game!
Although it may not be actively snowing and you may start venturing outdoors, remember that cold weather can affect your body in different ways. A previous blog post discussed hypothermia (abnormally low body temperature) because your body can lose heat faster than you can produce it. Because hypothermia happens gradually and affects your thinking, and can cause you to be sleepy, confused, and clumsy, you may not realize you need help. A body temperature below 95° F is a medical emergency and can lead to death if not treated promptly.
This article will focus on the dangers of frostbite. Frostbite is an injury to the body that is caused by freezing, resulting in a loss of feeling and color in affected areas. It most often affects the nose, ears, cheeks, chin, fingers, or toes — those areas farthest away from the heart. The classifications and signs/symptoms for tissue damage caused by extreme cold includes: frostnip, a superficial cooling of tissues without cellular destruction; at onset, there is itching and pain, and then the skin develops white, red, and yellow patches and becomes numb. Chilblains are superficial ulcers of the skin that occur when a predisposed individual is repeatedly exposed to cold; blisters may occur 1–2 days after becoming frozen. The blisters may become hard and blackened, most of them heal in one month, but the area may become permanently insensitive to both heat and cold. Frostbite involves tissue destruction. At or below 0 °C (32 °F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities. The same response may also be a result of exposure to high winds. This constriction helps to preserve core body temperature. In extreme cold, or when the body is exposed to cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas. The muscles, tendons, blood vessels, and nerves can freeze. The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases, permanently. Frostbite can result in areas of purplish blisters which turn black and which are generally blood-filled. Nerve damage in the area can result in a loss of feeling. Extreme frostbite may result in fingers and toes being amputated if the area becomes infected with gangrene. The extent of the damage done to the area by the freezing process of the frostbite may take several months to assess, and this often delays surgery to remove the dead tissue.
The risk of frostbite is increased in people with reduced blood circulation, such as those with PAD (peripheral arterial disease), poorly controlled diabetes, peripheral neuropathy, Raynaud’s disease. At great risk are people who are not dressed properly for extremely cold temperatures; especially if you use a light jacket or no hat/mittens, because you are just running to the store for a short time, going out to eat, or not going far from home.
This information does not take the place of medical advice; consult emergency medical personnel, or your physician, immediately, if you have hypothermia or frostbite . For frostbite, general guidelines may include getting into a warm room as soon as possible; unless absolutely necessary, do not walk on frostbitten feet or toes—this increases the damage. Warm the affected area using body heat, such as the heat of an armpit can be used to warm frostbitten fingers. Do not rub the frostbitten area with snow or shake/massage it at all, this can cause more damage, especially if ice crystals have formed in the tissue. Don’t use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can be easily burned (especially when diabetes is not well controlled which can lead to decreased circulation and decreased sensation).
To help prevent frostbite, dress warmly and stay dry. Adults and children should wear a hat; a scarf or knit mask to cover face and mouth; sleeves that are snug at the wrist; mittens (they are warmer than gloves); water-resistant coat and boots; and several layers of loose-fitting clothing. Be sure the outer layer of your clothing is tightly woven, preferably wind resistant, to reduce body-heat loss caused by wind. Wool, silk, or polypropylene inner layers of clothing will hold more body heat than cotton. Stay dry—wet clothing chills the body rapidly. Excess perspiration will increase heat loss, so remove extra layers of clothing whenever you feel too warm. Also, avoid getting gasoline or alcohol on your skin while de-icing and fueling your car or using a snow blower. These materials in contact with the skin greatly increase heat loss from the body. Do not ignore shivering; it’s an important first sign that the body is losing heat; persistent shivering is a signal to return indoors. Be cautious about travel: listen for media reports of travel advisories issued by the National Weather Service; don’t travel in low visibility conditions, on ice-covered roads, overpasses, and bridges if at all possible. If you must travel by car, tire chains may help, and take a mobile phone with you. Let someone know your destination and when you expect to arrive; ask them to notify authorities if you are late. Check and restock the winter emergency supplies in your car before you leave. Never pour water on your windshield to remove ice or snow; shattering may occur. Don’t rely on a vehicle to provide sufficient heat; it may break down, or your battery may die if it’s more than 3 years old. Always carry additional warm clothing appropriate for the winter conditions. Staying in your vehicle when stranded is often the safest choice if winter storms create poor visibility or if roadways are ice covered. These steps will increase your safety when stranded. Tie a brightly colored cloth to the antenna as a signal to rescuers; move anything you need from the trunk into the passenger area; wrap your entire body, including your head, in extra clothing, blankets, or newspapers; stay awake so you will be less vulnerable to cold-related health problems. Run the motor (and heater) for about 10 minutes per hour, opening one window slightly to let in air. Make sure that snow is not blocking the exhaust pipe—this will reduce the risk of carbon monoxide poisoning. As you sit, keep moving your arms and legs to improve your circulation and stay warmer. Do not eat unmelted snow because it will lower your body temperature. Huddle with other people for warmth.
Check on your family members and neighbors frequently during winter weather emergencies. In the St Louis area, those with low incomes, senior citizens, and those with disabilities, may qualify for assistance with heating bills provided by heatupstlouis.org; 314-241-7668. For help in locating heated shelters, call the United Way, dial 211 via a telephone land line. Contact your local Government Centers (blue pages of the phone book) or Community Centers in your specific location.
Sources of this information: CDC: Centers for Disease Control and Prevention; 800-CDC-INFO; (800-232-4636; TTY: (888) 232-6348; www.cdc.gov. Mayo Clinic: www.mayoclinic.com. National Institute on Aging Information Center; 1-800-222-2225 (toll-free); 1-800-222-4225 (toll-free/TTY; www.nia.nih.gov.
With the winter weather we are having in the metro-east area of St. Louis, most of us are hopefully trying to remain indoors. A hidden, and often forgotten, danger lurking indoors could be carbon monoxide (CO) poisoning! Each year, more than 500 Americans die from unintentional CO poisoning and 15,000 injuries; and more than 2,000 commit suicides by intentionally poisoning themselves. Carbon monoxide is an odorless, colorless gas that can cause sudden illness and death. CO is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, and gas ranges and heating systems. CO from these sources can build up in enclosed or semi-enclosed spaces. People and animals in these spaces can be poisoned by breathing it. Red blood cells pick up CO quicker than they pick up oxygen. If there is a lot of CO in the air, the body may replace oxygen in blood with CO. This blocks oxygen from getting into the body, which can damage tissues and result in death. All people and animals are at risk for CO poisoning. Certain groups — unborn babies, infants, and people with chronic heart disease, anemia, and respiratory problems — are more susceptible to its effects.
The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. High levels of CO ingestion can cause loss of consciousness and death. Unless suspected, CO poisoning can be difficult to diagnose because the symptoms mimic other illnesses or warning signs, such as very low (hypoglycemia) or very high (hyperglycemia) blood glucose levels in diabetes. People who are sleeping or intoxicated can die from CO poisoning before ever experiencing symptoms. So it’s very important that those who spend a lot of time with you, learn how to test your blood glucose, in case you are not capable of doing it. The test result can give Emergency personnel valuable information in how to treat you.
To help prevent the dangers of CO poisoning, don’t run a car or truck inside a garage attached to your house, even if you leave the door open. Have a mechanic check the exhaust system of my car every year. A small leak in your car’s exhaust system can lead to a build up of CO inside the car. If you drive a vehicle with a tailgate, when you open the tailgate, you also need to open vents or windows to make sure air is moving through your car. If only the tailgate is open CO from the exhaust will be pulled into the car. Tips to help prevent CO poisoning from your home appliances include having your heating system, water heater, and any other gas, oil or coal burning appliances serviced by a qualified technician every year. Other tips include: a) do not use portable flameless chemical heaters (catalytic) indoors. Although these heaters don’t have a flame, they burn gas and can cause CO to build up inside your home, cabin, or camper. If your heater has a damaged electrical cord or produces sparks, don’t use it. Do not place a space heater near things that may catch fire, such as drapes, furniture, or bedding. Use fireplaces, wood stoves, and other combustion heaters only if they are properly vented to the outside and do not leak flue gas into the indoor air space. Make sure chimneys and flues are cleaned periodically. b) If you smell an odor from your gas refrigerator’s cooling unit have an expert service it. An odor from the cooling unit of your gas refrigerator can mean you have a defect in the cooling unit. It could also be giving off CO. c) When purchasing gas equipment, buy only equipment carrying the seal of a national testing agency, such as the American Gas Association or Underwriters’ Laboratories. d) Install a battery-operated CO detector in each level of your home, including the basement, and check or replace the battery when you change the time on your clocks each spring and fall. If the detector sounds an alarm, leave your home immediately and call 911.
If you lose electricity: a) never use a gas range or oven for heating. Using a gas range or oven for heating can cause a build up of CO inside your home, cabin, or camper. b) never use a charcoal grill or a barbecue grill indoors. Using a grill indoors will cause a build up of CO inside your home, cabin, or camper unless you use it inside a vented fireplace. c) never burn charcoal indoors; burning charcoal — red, gray, black, or white — gives off CO. Do not burn paper in a fireplace. If you must use a kerosene heater, ensure adequate ventilation by opening an interior door or slightly opening a window. d) Never use a portable gas camp stove indoors. Using a gas camp stove indoors can cause CO to build up inside your home, cabin, or camper. e) Never use a generator (or power washers, or other gasoline powered tools) inside your home, basement, or garage or near a window, door, or vent. Outside, generators must be more than 20 feet away from your home, doors, and windows.
For more information about carbon monoxide poisoning and prevention visit http://www.cdc.gov/co/
At this time of the year, the Staff of Diabetes Education and Nutrition Services, of St. Anthony’s Medical Center, wishes all our patients and blog readers a Blessed Christmas and Happy Holiday season. Thank you for allowing us to be a part of your diabetes care team. We enjoy working with you and helping you realize your health goals!
Thank you also for following the TalkDiabetes blog. We hope you feel this is a source of trustworthy information and a valuable part of your diabetes support plan. Please share this site with co-workers, friends, family: www.talk-diabetes.org. If you have any comments or feedback that will help improve your experience, in 2014, please let me know! Add a comment below this post or send a message via the “Contact Us” tab.
I wish you and your loved ones a very Merry Christmas and a Happy, Healthy New Year!