Adding to your Physical Activity

March 2, 2015

By:  Susan Klick, MSN, RN, CNL Diabetes Educator

Aerobic exercises such as walking, cycling, swimming, and cycling are part of the focus in managing blood sugar for all diabetics.  However, there is also much to gain from other forms of exercise such as resistance, balance, flexibility and strength training.   These muscular fitness activities can slow the age-related loss of muscle mass and improve mobility, endurance and function.  Resistance training exercises include weight machines, resistance bands, or the use of one’s own body weight as seen with pushups and squats.  Because some of the main tissues in the body that are sensitive to insulin are the skeletal muscles; by increasing the amount and sensitivity of skeletal muscles with resistance exercise, many diabetics can better manage their blood glucose levels and weight by adding resistance training.

Performing resistance training two to three times per week and incorporating it with aerobics is most beneficial for type 2 diabetics.  The combination of the two improves blood glucose control and reduces cardiovascular risk factors more than either type of exercise alone.

Those diabetics with balance issues have a higher risk of falling due to slower reaction times, and an unsteady gait.  Diabetic related complications such as neuropathy, vision problems, and side effects from certain medications (lightheadedness for example) may contribute to the risk of falling.  Many people who are at risk of falling develop a fear of falling, which further limits their activity level!   These individuals can benefit from balance training, which can improve their gait and reduce their risk of falling.  Tai Chi and Yoga exercise programs involve varies combinations of flexibility, balance, and resistance training.   Lower-body and core strengthening exercises will also improve balance.

Flexibility is the ability to move our joints through a complete range of motion.  Certain activities of daily living will require more flexibility than other ones.  People with diabetes are more prone to develop changes in their joints that can limit movement.  Stretching exercises help to increase flexibility, and it may be included as part of a physical activity program.  It should not be used as a substitute for other training as its beneficial impact on blood sugar is unclear.  Flexibility training combined with resistance training increases joint range of motion, and when combined with balance training can reduce the risk of falls.  Remember though – time spent on flexibility does not count toward meeting the aerobic activity time guidelines of 30 minutes/day or 150 minutes/week.

Exercise is a vital component in managing diabetes.  Ultimately, diabetics should aim for at least 150 minutes of moderate to vigorous aerobic activity per week, together with activities that build muscular strength two to three times per week.  It is important to find activities that you enjoy and that you are able to perform safely.  If you are unsure, check with your physician.  St. Anthony’s Medical Center offers a variety of fitness classes Monday through Saturday at the Body, Mind, and Spirit Center in the Medical Plaza building.  For more information on these classes visit stanthonysmedcenter.com

 

References:

Diabetes Spectrum

St. Anthony’s Get Fit

 

 


Managing Low Blood Sugar

February 3, 2015

by:  Susan Klick, MSN, RN, CNL

Do You Know How to Manage a Low Blood Sugar?

A recent online survey of both Type I and Type 2 diabetes revealed that many are uncertain of how to prevent and manage hypoglycemia (low blood sugar). Avoiding alcohol as a way to prevent hypoglycemia was reported by 30% of the participants and 49% were unaware that glucose tablets could be used to treat an episode. Forty-two percent of participants who had never experienced hypoglycemia were unable to correctly define what it is. Let’s take a look at the What – When – Why – and How of low blood sugar.

WHAT IT IS: Hypoglycemia or low blood sugar occurs when the blood glucose drops below the normal level. For most people, a blood glucose reading below 70 mg/dl is considered below normal.

WHEN IT OCCURS: Hypoglycemia happens when there is not enough glucose in your blood to provide the energy your body needs. You may experience symptoms when the level of blood sugar in your body falls below its normal range. This may happen if you do not eat enough food at a meal or a snack, or if you skip a meal. It may happen if you take more insulin or diabetes medicine than needed for the food that you eat. It may also occur if you exercise or are more active than usual. Drink alcohol without eating food can also cause hypoglycemia.

WHY IT IS DANGEROUS: This condition is dangerous because your brain is not getting enough glucose (sugar) to work properly. If there is not enough glucose for your brain to function, you may pass out or even have convulsions.

HOW TO RECOGNIZE HYPOGLYCEMIA: A low blood glucose reaction brings on uncomfortable feelings.  Mild symptoms occur in the early stage and include sudden hunger, headache, shaking, fast heartbeat, sweating, feeling tired or drowsy, feeling dizzy, having blurry vision, nervousness, and/or numbness or tingling around the mouth and lips. If not treated, you may experience symptoms of moderate hypoglycemia which can include personality change, irritability, confusion, poor coordination, difficulty concentration, and slurred or slow speech. If the reaction is still not treated, and your blood glucose continues to fall, you may pass out or develop convulsions. This is severe hypoglycemia and will require emergency treatment.

Some people have what is called “Hypoglycemia Unawareness,” a condition in which you lose the ability to feel the symptoms of low blood glucose until the blood glucose is very low. The first symptom may be confusion or passing out. This can occurs in diabetics who keep their blood glucose very close to normal or who have had diabetes for many years. It may be the result of having many episodes of low blood glucose.

HOW TO TREAT HYPOGLYCEMIA:   Check your blood sugar if you think it may be low or if you are experiencing symptoms. If your symptoms make you very uncomfortable and you feel that you do not have the time to check your blood glucose, eat first and then immediately check your blood sugar. If your blood glucose is less than 70 mg/dl:

  1. Treat with 15 grams of carbohydrates (4 oz. juice, 3 glucose tablets, ½ can soda, 8 Lifesavers)
  2. Wait 15 minutes and retest. It takes about 15 minutes for the sugar to raise your blood glucose level.
  3. If your blood glucose is less than 60 mg/dl, treat with another 15 grams of carbohydrates.
  4. If your next meal is more than an hour away, eat a snack of 15 more grams of carbohydrate and one ounce of protein (i.e. five crackers and one ounce of low fat cheese, half of a ham or turkey sandwich)

There may be times when your blood sugar is not low, but has dropped rapidly from a very high level to a lower level. Your body is reacting to the quick drop, not the actual level. You do not want to treat a normal blood glucose and cause it to rise above normal. However, continue to pay attention to your symptoms and your blood sugar. If the symptoms become worse or your blood sugar continues to drop, eat a snack with carbohydrates and protein such as crackers and peanut butter, crackers with cheese, half of a ham or turkey sandwich, or a cup of milk with cereal.

Note: Candy bars, ice cream and chocolate are not good choices for treating hypoglycemia.   Foods with fat or protein will not raise your blood glucose fast enough.

HOW TO PREVENT HYPOGLYCEMIA: The best ways to prevent hypoglycemia are to:

  1. Eat on time
  2. Make sure you eat enough food for the medication you are taking
  3. Do not drink alcohol without eating food
  4. Take your medication on time
  5. Be prepared. Always carry some form of carbohydrate (glucose tablets, juice, hard candy) in the event that a meal is delayed or you are more active than usual.

Sources:

Healio Endocrine Today:   Survey: People with diabetes uncertain about management of hypoglycemia January 20, 2015.

BD Getting Started: Hypoglycemia and Diabetes


The Latest in GLP-1 Therapy

January 22, 2015

By Kristen Rider, BSN, RN, CDE

GLP-1 agonist medications are a common treatment for the management of Type 2 Diabetes. They work like the hormone GLP-1 (Glucagon-like peptide 1) that the body normally produces to help regulate blood glucose levels. People with Type 2 Diabetes may be deficient in GLP-1, which is why these medications are being used. GLP-1 agonists work to control blood glucose levels by decreasing the amount of glucose that the liver produces, delaying gastric emptying time, and helping the pancreas to produce more insulin when blood glucose levels are high. The first to hit the market was Byetta in 2005. Since then, several others have been launched, some within the past few months. All of the GLP-1 agonist medications are injectable, but each has a different device or mechanism for injection. Dosing varies from twice daily, daily, to once weekly. Some of these medications are FDA approved for use in conjunction with basal insulin, while others were not studied as such. See the comparison chart below for more information on GLP-1 agonists.

Drug Dose Mixing

Required

Pre-injection waiting time

Dosing

Approved for use with basal insulin

Byetta

Twice daily

No

No

5mcg, 10mcg

Yes
 

Bydureon Kit

 

Once weekly Yes No

2 mg

No
Bydureon Pen
Once weekly Yes No 2 mg

No

Tanzeum

Once weekly

Yes

Yes 15 min

30mg       50mg

Yes

 

Trulicity

Once weekly

No

No  

0.75 mg

1.5mg

No

Victoza  

Once daily

No No 0.6mg

1.2mg

1.8 mg

Yes

Package Insert (PI) list

Byetta (exenatide) AZ – http://www.azpicentral.com/byetta/pi_byetta.pdf#page=1 Bydureon Pen and Kit (exenatide extended release) AZ – http://www.azpicentral.com/bydureon/pi_bydureon.pdf#page=1 Tanzeum (albiglutide) GSK – http://www.gsksource.com/gskprm/htdocs/documents/TANZEUM-PI-MG-IFU-COMBINED.PDF Trulicity (dulaglutide) LILLY – http://pi.lilly.com/us/trulicity-uspi.pdf Victoza (liraglutide NOVO – http://www.novo-pi.com/victoza.pdf

This information is not meant to replace your healthcare Provider’s advice. It is not an endorsement of these products or of the pharmaceutical companies. The Outpatient Diabetes and Nutrition Services Department at St. Anthony’s Medical Center can assist you with questions you may have regarding this change or other questions you have regarding your diabetes self-management. Call us at 314-525-4523 for more information.

Sources:

www.diabetesincontrol.com

www.victozapro.com


Happy New Year – Happy Feet

January 5, 2015

You may have heard that diabetes can lead to foot problems. It can be tempting to ignore your feet, but diabetes can be hard on the feet over time because high blood glucose levels may lead to neuropathy, or nerve damage. Nerve damage can make your feet numb. So you may not feel a small cut or a tight-fitting shoe that can lead to calluses, blisters, or other wounds. Such wounds can get infected and be slow to heal, especially if you have high blood sugar levels and poor blood flow in your feet and legs.

Most people can prevent any serious foot problems and keep feet feeling their best by following these simple steps:

  1. Check your feet every day.

Look for calluses, blisters, scaling (dry skin), cracks in the skin (especially between toes and on your heels), redness, and swelling. If you can’t turn your leg to see the bottom of your foot, try placing a magnifying mirror on the floor and hold your foot above it to check the bottom for trouble spots, or ask someone for help.

Neuropathy can result in both pain and loss of sensation in your feet. When you can’t feel pain, you won’t feel a wound forming (that’s why daily checks are so important!).

  1.  Wash your feet every day and moisturize. Cut nails carefully.

After washing your feet in lukewarm water (not hot!), dry them carefully, especially between the toes. You can avoid dry skin and cracking by using a thick moisturizer on your feet. Rub it in well, but don’t put it between your toes—those dark, moist areas are great hosts for infection.

Cut nails straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. Have a foot doctor trim your toenails if you cannot see or feel your feet, if you cannot reach your feet, if your toenails are thick or yellowed, or if your nails curve and grow into the skin.

  1. Wear shoes that fit your feet and don’t go barefoot. Don’t forget socks!

Wear comfortable shoes that fit well and protect your feet. Wearing shoes that rub or pinch makes it more likely for a blister or wound to form. Look for a snug but not tight shoe fit, with room to wiggle your toes. For hard-to-fit feet or if you already have foot problems, you may need therapeutic shoes. Ask your doctor about Medicare and other insurance coverage for special shoes. Walking/athletic shoes are good for daily wear. They support your feet and allow them to “breath”. Avoid vinyl or plastic shoes because they do not stretch or breath. Avoid shoes with pointed toes or high heels as they put too much pressure on your toes. And buy shoes at the end of the day when your feet are the largest so that you can find the best fit.

Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside. If you keep your shoes in the garage or outside, look to make sure no spiders or other critters have taken refuge in the warmth of your shoes!

Wear clean, dry socks and change them daily. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks as they can fit poorly and irritate the skin.

  1. Protect your feet from hot and cold and don’t go barefoot!

Never walk barefoot! Wear shoes at the beach or on hot pavement. Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it. If your feet get cold at night, wear socks. Be sure to wear proper foot wear in the winter months to prevent frost bite and don’t let your feet get wet in snow or rain.

  1. Show your feet to your health care provider at every office visit.

Ask your doctor to look at your feet at every visit. Take your shoes and socks off once you are in the exam room. Your health care provider should perform a complete foot exam at least annually – more often if you have foot problems. This exam should include checking the sense of feeling and pulses. Call your doctor right away if a cut, blister, or bruise on your foot does not begin to heal after a few days.

  1.  Keep the blood flowing to your feet.

Poor circulation means you won’t get enough blood flow to heal wounds, so it will take longer to get well. Some signs of poor circulation include weak pulses in your feet or legs, shiny and hairless skin, and discolored skin.

Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to help blood flow in your feet and legs. Don’t cross your legs for long periods of time.

Don’t smoke. Smoking restricts blood flow in your feet.

  1. Try to hit your blood glucose targets

High blood glucose levels can lead to slow-healing foot wounds and slow the body’s ability to fight infection. High sugar in the blood acts like a food source for the bacteria in infections, making them become more powerful and spread more quickly!

  1. Get help for open wounds

Don’t risk your health! Get treatment for foot wounds as soon as possible. Visit your physician or a podiatrist, a doctor specializing in foot care, if you have an open cut, blister, or sore on your foot that isn’t healing. Do not try to treat yourself with over-the-counter antibiotic ointments.

 

If you take care of your feet every day, you can lower your chances of losing a toe, foot or leg. Begin taking care of your feet today!

 

Sources:

www.diabetes.org/living-with-diabetes/complications/foot-complications

www.diabetesforecast.org

www.foothealthfacts.org

www.ndep.nih.gov

 

 


Balancing Holiday Festivities and Diabetes

December 24, 2014

Merry Christmas from the Outpatient Diabetes and Nutrition staff at St. Anthony’s Medical Center. With the Christmas and New Year holidays comes plenty of feasting and merriment. Enjoying the season is important, but if you or a family member have diabetes, it’s also very important to maintain a healthy routine for managing the condition.

Having diabetes doesn’t mean missing out on the festivities. What it does mean is balancing holiday indulgence with healthy diet and exercise choices. The American Diabetes Association has some helpful guidelines to help you keep your diabetes managed well this holiday season and into the New Year:

  • Enjoy holiday foods, but don’t overdo it. Instead, spend more time with your family members sharing stories, playing games or heading out to the park for a pickup game of football or basketball. Make the celebration about the people you’re with instead of food.
  • Bring something to share. If you count carbohydrates to balance out your medication, offer to bring a dish you like to the celebration. Look up the nutrition information beforehand so you know how many carbohydrates are in a serving.
  • Plan to get out. After everyone has enjoyed the meal and the dishes are washed, invite everyone out for a walk around the neighborhood to enjoy the Christmas lights.
  • Monitor what you drink. Many holiday cocktails use high-sugar mixers like regular soda and juices. The calories in these drinks can add up quickly. Look for ways you can incorporate sugar-free options to avoid letting your blood glucose levels go out of control. It’s also important to avoid drinking on an empty stomach in order to prevent low blood glucose. If you opt to imbibe, keep in mind that the Association recommends one drink or less per day for women and two drinks or fewer per day for men.

Enjoy this holiday season with your friends and family without losing control of your diabetes management. Sit down around the table to enjoy a delicious orange and walnut salad or spiced sweet potato casserole with these healthy guidelines in mind, and then take a short walk after dinner.

Wishing you the best of health in 2015.

Alison, Cathy, Darla, Denise, Diane, Kim, Kristen, Sue

 

 

Source: Milwaukee Journal Sentinel and the  American Diabetes Association

 


Clean – Separate – Cook – Chill: Basic Food Safety Steps

December 10, 2014

by Alison Brinker, RD, LD

The holidays are a great time to review food safety guidelines. A person with diabetes is at higher risk for foodborne illnesses. With diabetes, your immune system may not readily recognize harmful bacteria or other pathogens. This delay in the body’s natural response to foreign invasion places a person with diabetes at increased risk for infection. If a person with diabetes contracts a foodborne illness they are more likely to have a lengthier illness and require hospitalization compared to a person without diabetes. During the holidays many people are preparing food for friends and family. Making sure it is prepared safely is a must to prevent anyone from getting a foodborne illness.ID-10026109

Four basic steps to food safety:

  • Clean
  • Separate
  • Cook
  • Chill

Clean: Wash hands and surfaces often. Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, counter tops, and food. Wash hands in warm soapy water for at least 20 seconds before and after handling food and after using the bathroom, changing diapers or handling pets. Wash cutting boards, dishes, utensils, and counter tops with hot soapy water between the preparation of raw meat, poultry, and seafood products and preparation of any other food that will not be cooked. You can also sanitize cutting boards and counter tops by rinsing them in a solution made of one tablespoon of unscented liquid chlorine bleach per gallon of water. Plastic cutting boards may be run through the wash cycle in your automatic dishwasher. Wash produce by rinsing under warm tap water, including those with skins and rinds that are not eaten. Clean the lids of canned goods too before opening.

Separate: Don’t cross-contaminate. Cross-contamination occurs when bacteria are spread from one food product to another such as with raw meat, poultry, seafood, and eggs. Always keep these foods and their juices away from ready-to-eat foods such as salad. Never place cooked food on a plate that previously held raw meat without first washing the plate with hot soapy water. Don’t use marinades used on raw foods unless you bring them to a boil first. Consider having two cutting boards; one designated for raw meat, poultry and seafood and the other for ready to eat foods such as bread, fruits, raw vegetables and cooked meat.

Cook: Cook all meats to the recommended temperature. Use a food thermometer to measure the internal temperature in several places to make sure that the meat, poultry, seafood or egg product is cooked to the correct temperature to prevent foodborne illness.


Looking for Something to do with those Turkey Leftovers?

November 28, 2014

Thanksgiving Leftovers

by Alison Brinker, RD, LD

What to do, what to do with all that leftover turkey? Below is a great recipe for using the turkey you just couldn’t finish on Thanksgiving Day. This will make a great lunch or light dinner. The avocado provides a good source of healthy, unsaturated fat, after a holiday that is usually full of unhealthy saturated fat from butter, gravy and cream sauces.

Turkey and Avocado Wraps

Serving size: 1 wrap, recipe makes 4 servings

½ avocado

3 tablespoons plain, fat free yogurt

¼ teaspoon chili powder

2 cups chopped lettuce

2 small tomatoes, finely diced

2 tablespoons fat-free Italian dressing

4 10-inch whole grain flour tortillas

12 ounces sliced, leftover turkey

1 cucumber, thinly sliced

  1. In a small bowl, mash the avocado with a fork. Add yogurt and chili powder to avocado and mix well.
  2. In a medium bowl, toss lettuce and tomato with Italian dressing.
  3. Spread 1-1/2 tablespoons of avocado mixture on one tortilla. Add 3 ounces of turkey, ¼ of the lettuce and tomato mixture, and ¼ of the sliced cucumber.
  4. Create a wrap by folding in the left and right side of the tortilla until the edges are about 1 inch apart and then roll from the top down. Repeat this process for remaining 3 tortillas.

Nutrition Information:

Total carbohydrate, 45 grams, 3 ounces meat, 2 fat choices

Source: Healthy Calendar Diabetic Cooking, a full year of delicious menus and easy recipes

 

 


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