Causes of Type 2 Diabetes
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Monday, January 31, 2011
Sunday, January 30, 2011
Childhood heel pain related to growing, muscle flexibility
Rest will resolve Sever’s syndrome; stretching will keep it under control. Childhood heel pain can have many causes, but the most common is something called Sever’s syndrome. This is not a growing pain, but it is related to growing and the loss of muscle flexibility in relation to the growth of the bones.
The act of growing is primarily through our bones. So, as we grow, our bones get longer and in the process our muscles have to be stretched out to accommodate that new growth. Certain areas of a child’s body are at risk for injury because of this interplay.
One area is the heel bone. On the back side of the heel bone is a growth plate (a cartilage area where the bone grows) and attached to that growth plate is the Achilles tendon. The calf muscles that attach to the Achilles tendon will frequently lose their flexibility and then during play or increased activity there is excessive pull by the Achilles tendon on the growth plate. This results in Sever’s syndrome, a painful pulling apart of the heel growth plate.
It occurs in both boys and girls, but tends to affect girls at a younger age (8-10 years old) compared with boys (10-12 years old). While the pain starts in these younger ages, many parents will tell you that it can often linger over the growth-spurt years in particular. About 50 percent of the time, it can happen on both heels, and it often hurts worse after play than during play.
Kids who seem to be at particular risk are those who wear cleated shoes for their sports. The cleats tend to increase the forced stretch of the Achilles during play, thus increasing the force of pull at the growth plate.
The fastest method of resolving this syndrome is rest from activities. Many of our families find it difficult to take time off from sports. However, the best rule to follow as a parent is to remember that if your child is limping during play, then the child should not be playing.
Stretching is the key to long-term success of this problem. A daily routine of stretching can help alleviate this pain and prevent it from returning. It can take up to six weeks for some athletes to stretch themselves adequately.
In the meantime, a few other therapies can be used. Icing and anti-inflammatory medications can be helpful. An over-the-counter heel lift will take some pressure off the heel growth plate. Finally, a cast can be used for a short period to give the growth plate a rest. Surgery is never necessary.
You should contact, or see, your doctor if the pain is not improving after two weeks of rest, or if the pain is associated with a fever.
The act of growing is primarily through our bones. So, as we grow, our bones get longer and in the process our muscles have to be stretched out to accommodate that new growth. Certain areas of a child’s body are at risk for injury because of this interplay.
One area is the heel bone. On the back side of the heel bone is a growth plate (a cartilage area where the bone grows) and attached to that growth plate is the Achilles tendon. The calf muscles that attach to the Achilles tendon will frequently lose their flexibility and then during play or increased activity there is excessive pull by the Achilles tendon on the growth plate. This results in Sever’s syndrome, a painful pulling apart of the heel growth plate.
It occurs in both boys and girls, but tends to affect girls at a younger age (8-10 years old) compared with boys (10-12 years old). While the pain starts in these younger ages, many parents will tell you that it can often linger over the growth-spurt years in particular. About 50 percent of the time, it can happen on both heels, and it often hurts worse after play than during play.
Kids who seem to be at particular risk are those who wear cleated shoes for their sports. The cleats tend to increase the forced stretch of the Achilles during play, thus increasing the force of pull at the growth plate.
The fastest method of resolving this syndrome is rest from activities. Many of our families find it difficult to take time off from sports. However, the best rule to follow as a parent is to remember that if your child is limping during play, then the child should not be playing.
Stretching is the key to long-term success of this problem. A daily routine of stretching can help alleviate this pain and prevent it from returning. It can take up to six weeks for some athletes to stretch themselves adequately.
In the meantime, a few other therapies can be used. Icing and anti-inflammatory medications can be helpful. An over-the-counter heel lift will take some pressure off the heel growth plate. Finally, a cast can be used for a short period to give the growth plate a rest. Surgery is never necessary.
You should contact, or see, your doctor if the pain is not improving after two weeks of rest, or if the pain is associated with a fever.
Friday, January 28, 2011
In U.S., Obesity Afflicts Even Some of the Tiniest Tots
American kids are becoming obese, or nearly so, at an increasingly young age, with about one-third of them falling into that category by the time they're 9 months old, researchers have found.
There are some caveats about the research, however. The infants were not studied recently: They were born about a decade ago. And it's not clear how excess weight in babies may affect their health later in their lives. The study found no guarantee that a baby who's overweight at 9 months will stay flabby when his or her second birthday rolls around.
Still, the study -- in the January-February 2011 issue of the American Journal of Health Promotion -- does present a picture of babies and infants who are carrying around a lot of extra weight.
The findings also suggest that small changes in an infant's diet can make a big difference, said Dr. Wendy Slusser, medical director of a children's weight program at Mattel Children's Hospital at the University of California, Los Angeles. For example, she said, "if you don't give your kid juice and have them eat the fruit instead, suddenly there's 150 calories less a day that can make a big difference in weight gain over a long term."
The researchers examined federal data about 16,400 children in the United States who were born in 2001. After adjusting the statistics so they wouldn't be thrown off by such factors as high numbers of certain kinds of kids, the study authors found that 17 percent of 9-month-olds were obese and 15 percent were at risk for obesity, for a total of 32 percent.
At two years, 21 percent were obese and 14 percent were at risk of becoming obese, the investigators found.
"It seems like there tends to be a shift to kids getting heavier" over time, said the study's lead author, Brian G. Moss, an adjunct faculty member at Wayne State University School of Social Work. And their weight gain, he said, is beyond that which would be expected as youngsters grow.
Hispanics and poor kids as a whole were at highest risk, the study found, whereas girls and Asian/Pacific Islanders had the lowest risk.
But why are young children so heavy and getting heavier, as a whole, over time? The study didn't examine the reasons. Moss said the changes could have something to do with changes in their lives, such as entering daycare or starting to eat regular food, but the precise causes are not clear.
However, the research does suggest that infants aren't doomed to be overweight once they put on extra pounds, said Slusser, the children's hospital medical director. "There's this fluidity," she said, "a lot of movement back and forth into these categories."
So what is her advice for those who have an infant or one on the way? "You really need to reflect on the habits you have with your child," Slusser said. For instance, make sure the infant gets regular meals and snacks along with a good night's sleep and naps, she said. And pick a daycare center that offers healthy foods and opportunities for moving around.
And breast-feeding, she said, is ideal -- especially during the first six months, when specialists recommend that breast milk should be the exclusive source of food for babies.
There are some caveats about the research, however. The infants were not studied recently: They were born about a decade ago. And it's not clear how excess weight in babies may affect their health later in their lives. The study found no guarantee that a baby who's overweight at 9 months will stay flabby when his or her second birthday rolls around.
Still, the study -- in the January-February 2011 issue of the American Journal of Health Promotion -- does present a picture of babies and infants who are carrying around a lot of extra weight.
The findings also suggest that small changes in an infant's diet can make a big difference, said Dr. Wendy Slusser, medical director of a children's weight program at Mattel Children's Hospital at the University of California, Los Angeles. For example, she said, "if you don't give your kid juice and have them eat the fruit instead, suddenly there's 150 calories less a day that can make a big difference in weight gain over a long term."
The researchers examined federal data about 16,400 children in the United States who were born in 2001. After adjusting the statistics so they wouldn't be thrown off by such factors as high numbers of certain kinds of kids, the study authors found that 17 percent of 9-month-olds were obese and 15 percent were at risk for obesity, for a total of 32 percent.
At two years, 21 percent were obese and 14 percent were at risk of becoming obese, the investigators found.
"It seems like there tends to be a shift to kids getting heavier" over time, said the study's lead author, Brian G. Moss, an adjunct faculty member at Wayne State University School of Social Work. And their weight gain, he said, is beyond that which would be expected as youngsters grow.
Hispanics and poor kids as a whole were at highest risk, the study found, whereas girls and Asian/Pacific Islanders had the lowest risk.
But why are young children so heavy and getting heavier, as a whole, over time? The study didn't examine the reasons. Moss said the changes could have something to do with changes in their lives, such as entering daycare or starting to eat regular food, but the precise causes are not clear.
However, the research does suggest that infants aren't doomed to be overweight once they put on extra pounds, said Slusser, the children's hospital medical director. "There's this fluidity," she said, "a lot of movement back and forth into these categories."
So what is her advice for those who have an infant or one on the way? "You really need to reflect on the habits you have with your child," Slusser said. For instance, make sure the infant gets regular meals and snacks along with a good night's sleep and naps, she said. And pick a daycare center that offers healthy foods and opportunities for moving around.
And breast-feeding, she said, is ideal -- especially during the first six months, when specialists recommend that breast milk should be the exclusive source of food for babies.
Thursday, January 27, 2011
Foot Care Is Essential With Diabetes
From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says podiatrist Steven Tiller, MD, of Portland, Ore. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Tillet. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. Tillet advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” says Tillet. “Skin gets moist and breaks down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can still use moisturizer to prevent dry, cracked skin — just avoid putting it between your toes.
Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them, notes Tillet. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at specialty stores and through catalogs, or you can visit your podiatrist for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.
People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Tillet. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,” says Tillet.
“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Tillet. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to see your doctor before your next regularly scheduled check-up.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says podiatrist Steven Tiller, MD, of Portland, Ore. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Tillet. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. Tillet advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” says Tillet. “Skin gets moist and breaks down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can still use moisturizer to prevent dry, cracked skin — just avoid putting it between your toes.
Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them, notes Tillet. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at specialty stores and through catalogs, or you can visit your podiatrist for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.
People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Tillet. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,” says Tillet.
“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Tillet. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to see your doctor before your next regularly scheduled check-up.
Tuesday, January 25, 2011
To Bandage or Not to Bandage
Q: What is the best way to treat diabetic ulcers on the legs? I have new ones every day and it's hard to decide if they should be bandaged or not. They are always seeping. Please send some advice.
A: Leg ulcers can indeed be difficult and frustrating to treat, and they usually take a long time to heal. Treatment recommendations have changed over the years; it's confusing to decide what to do. Unfortunately, the treatment of leg ulcers is not simple. Specific therapy depends on the cause, size and depth, location and duration of the ulcer. That's why there is not just one answer to the question. What Dr. Benjamin Weaver suggests is to work with your doctor to develop the best treatment plan for your specific situation.
A: Leg ulcers can indeed be difficult and frustrating to treat, and they usually take a long time to heal. Treatment recommendations have changed over the years; it's confusing to decide what to do. Unfortunately, the treatment of leg ulcers is not simple. Specific therapy depends on the cause, size and depth, location and duration of the ulcer. That's why there is not just one answer to the question. What Dr. Benjamin Weaver suggests is to work with your doctor to develop the best treatment plan for your specific situation.
Monday, January 24, 2011
How Can I Protect My Child From Gym-Class Injuries?
Q: I just read about a new study showing that injuries in kids' physical education classes have increased by 150 percent since 1997. Now I'm worried. What are the most common types of gym-class injuries, and what can be done to help kids avoid them? How can I work with my child at home to help him prevent injuries or strain in gym class? What types of PE activities pose the greatest risk of injury to my child, and how do I, as a parent, find out about the qualifications of my child's gym teacher?
A: The study you're referring to, which was recently published in Pediatrics, a journal of The American Academy of Pediatrics, highlights that strains, sprains, and contact injuries are indeed happening in physical education classes and on school sports teams in increasing numbers each year. A variety of factors contributes to this kids' health risk, many of which can be prevented.
To start, it's important to be aware of the types of activities your child is participating in; a lot of kids get overuse injuries from engaging in physical activities that work the same groups of muscles and joints each day. Just like adults, kids need variety in the types of exercises they do. Children should not be doing the same activity every single day — they need at least one day off per week. On their day off they could do a “cross-training” activity that works different joints or muscles. This helps them develop balanced muscle strength to help prevent injuries, which is particularly true for activities like throwing a baseball.
To avoid exacerbating strained muscles and putting stress on bones, tendons, and ligaments, listen to your child if he or she complains of muscle or joint soreness or pain. Rest is a good place to start with most exercise-related injuries, especially in a growing body. As noted above, different types of activities can help avoid repetitive injury to the same joints, bones, and muscles. You can also work with your child at home on strength-training and endurance exercises, and make sure they're eating a healthy diet to support their growing bones and joints.
Some children, especially girls, may have “loose ligaments." These children are often described as very flexible and can hyperextend their arms and legs. Loose joints are at increased risk for strains and sprains. Strengthening muscle groups around the joint can act like a brace for the joint and help prevent injury. If your child has ever had a sprain, he or she is at risk for recurrence. You should talk with your pediatrician about specific exercises that your child can do to help strengthen the joint. Sometimes bracing of an ankle or knee can help give stability to avoid future injury. Appropriate and properly fitting shoes can also help decrease injuries such as shin splints and plantar fasciitis.
Exercise is especially important for children who are overweight, but be aware that being overweight puts increased stress on a child's joints, so you'll need to make sure they don't overstress their joints. In general staying slim can help decrease pressure on knees, hips, and back.
It is incredibly important that children engaging in contact sports or sports that require helmets like biking have properly fitted equipment. Another important aspect of injury prevention is to make sure your child isn't being pushed too hard in gym class or on a sports team. Today, some kids are participating in an unbelievable amount of physical activity. Sports are only getting more competitive. And some activities can create a lot of psychological issues. In wrestling and gymnastics, for instance, restrictive weight requirements can put a lot of pressure on kids. So check in with your child regularly to make sure he's not being pushed past his limits.
As for the qualifications of your child's coach or gym teacher, you're certain to run into some inconsistencies here. As schools try to initiate more physical education programs — without additional funding — it's not uncommon to find that a math or science teacher is leading a sports team, rather than a well-trained physical education instructor. For gym class, this may be less of a risk when it comes to injury, but for any intense sport that your child will be participating in regularly, you'll want to make sure the instructor has been trained specifically in that activity.
A: The study you're referring to, which was recently published in Pediatrics, a journal of The American Academy of Pediatrics, highlights that strains, sprains, and contact injuries are indeed happening in physical education classes and on school sports teams in increasing numbers each year. A variety of factors contributes to this kids' health risk, many of which can be prevented.
To start, it's important to be aware of the types of activities your child is participating in; a lot of kids get overuse injuries from engaging in physical activities that work the same groups of muscles and joints each day. Just like adults, kids need variety in the types of exercises they do. Children should not be doing the same activity every single day — they need at least one day off per week. On their day off they could do a “cross-training” activity that works different joints or muscles. This helps them develop balanced muscle strength to help prevent injuries, which is particularly true for activities like throwing a baseball.
To avoid exacerbating strained muscles and putting stress on bones, tendons, and ligaments, listen to your child if he or she complains of muscle or joint soreness or pain. Rest is a good place to start with most exercise-related injuries, especially in a growing body. As noted above, different types of activities can help avoid repetitive injury to the same joints, bones, and muscles. You can also work with your child at home on strength-training and endurance exercises, and make sure they're eating a healthy diet to support their growing bones and joints.
Some children, especially girls, may have “loose ligaments." These children are often described as very flexible and can hyperextend their arms and legs. Loose joints are at increased risk for strains and sprains. Strengthening muscle groups around the joint can act like a brace for the joint and help prevent injury. If your child has ever had a sprain, he or she is at risk for recurrence. You should talk with your pediatrician about specific exercises that your child can do to help strengthen the joint. Sometimes bracing of an ankle or knee can help give stability to avoid future injury. Appropriate and properly fitting shoes can also help decrease injuries such as shin splints and plantar fasciitis.
Exercise is especially important for children who are overweight, but be aware that being overweight puts increased stress on a child's joints, so you'll need to make sure they don't overstress their joints. In general staying slim can help decrease pressure on knees, hips, and back.
It is incredibly important that children engaging in contact sports or sports that require helmets like biking have properly fitted equipment. Another important aspect of injury prevention is to make sure your child isn't being pushed too hard in gym class or on a sports team. Today, some kids are participating in an unbelievable amount of physical activity. Sports are only getting more competitive. And some activities can create a lot of psychological issues. In wrestling and gymnastics, for instance, restrictive weight requirements can put a lot of pressure on kids. So check in with your child regularly to make sure he's not being pushed past his limits.
As for the qualifications of your child's coach or gym teacher, you're certain to run into some inconsistencies here. As schools try to initiate more physical education programs — without additional funding — it's not uncommon to find that a math or science teacher is leading a sports team, rather than a well-trained physical education instructor. For gym class, this may be less of a risk when it comes to injury, but for any intense sport that your child will be participating in regularly, you'll want to make sure the instructor has been trained specifically in that activity.
Sunday, January 23, 2011
Flaxseed and Diabetes
Q: Is flaxseed beneficial for people with type 2 diabetes? Does it help my prostate gland as well?
– Frank, Mid-West
A: Yes, flaxseed may help lower your sugar levels, and it plays a role in the prevention of prostate cancer as well. However, the strength of the evidence is too weak to permit definitive recommendations. Nonetheless, flaxseed is rich in alpha-linolenic acid (ALA), an essential fatty acid that appears to be beneficial in preventing heart disease and related illnesses. Flaxseed contains the right ratio of omega-3 to omega-6 fatty acids, is high in fiber, and provides a phytoestrogen called lignan, which may have antioxidant properties that protect against certain cancers.
There is some evidence that eating flaxseed reduces blood sugar levels after a meal and increases insulin levels because of its high content of soluble fiber. (It is 28 percent fiber, of which two-thirds is soluble.) Indeed, flaxseed carbohydrate (what remains after the oil is removed) was used in a study that showed a beneficial effect. Although this result was not duplicated in other studies, flaxseed has been shown to improve insulin sensitivity. An interesting, yet unproven, potential benefit may be the prevention of type 1 and type 2 diabetes; in animal models, flaxseed has been shown to delay the onset of the disease.
Flaxseed might help your prostatic health as well. In fact, the American National Cancer Institute has singled out flaxseed as one of six foods that deserve extensive research. Why? Because flaxseed contains a large amount of phytonutrients that serve as antioxidants, as well as those omega-3 fatty acids, which seem to play a role in preventing the formation of abnormal cells in the body. In terms of your specific question, flaxseed may reduce the prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland that is often used as a marker for cancer. Also, men whose prostatic fluids contain high levels of lignan (the phytoestrogen found in flaxseed) seem to have a low risk of prostate cancer, though study results of this were not conclusive.
One word of warning: Flaxseed is high in calories. Here's an idea of how much you might need to consume to obtain its beneficial effects — 1 tablespoon of flaxseed has 5 grams of fat and weighs 12 grams. You need to take 40 to 50 grams of flaxseed, which is equal to about 4 tablespoons and has a total of 20 grams of fat. Milled flax has 36 calories per tablespoon; flax oil has 124 calories per tablespoon. (Flaxseeds are more nutritious than their oil.) These caloric considerations are important in the control of your glucose level.
Stay tuned, as I am sure there will be more studies that will guide us better in using flaxseed to stay healthy.
– Frank, Mid-West
A: Yes, flaxseed may help lower your sugar levels, and it plays a role in the prevention of prostate cancer as well. However, the strength of the evidence is too weak to permit definitive recommendations. Nonetheless, flaxseed is rich in alpha-linolenic acid (ALA), an essential fatty acid that appears to be beneficial in preventing heart disease and related illnesses. Flaxseed contains the right ratio of omega-3 to omega-6 fatty acids, is high in fiber, and provides a phytoestrogen called lignan, which may have antioxidant properties that protect against certain cancers.
There is some evidence that eating flaxseed reduces blood sugar levels after a meal and increases insulin levels because of its high content of soluble fiber. (It is 28 percent fiber, of which two-thirds is soluble.) Indeed, flaxseed carbohydrate (what remains after the oil is removed) was used in a study that showed a beneficial effect. Although this result was not duplicated in other studies, flaxseed has been shown to improve insulin sensitivity. An interesting, yet unproven, potential benefit may be the prevention of type 1 and type 2 diabetes; in animal models, flaxseed has been shown to delay the onset of the disease.
Flaxseed might help your prostatic health as well. In fact, the American National Cancer Institute has singled out flaxseed as one of six foods that deserve extensive research. Why? Because flaxseed contains a large amount of phytonutrients that serve as antioxidants, as well as those omega-3 fatty acids, which seem to play a role in preventing the formation of abnormal cells in the body. In terms of your specific question, flaxseed may reduce the prostate-specific antigen (PSA), a protein produced by the cells of the prostate gland that is often used as a marker for cancer. Also, men whose prostatic fluids contain high levels of lignan (the phytoestrogen found in flaxseed) seem to have a low risk of prostate cancer, though study results of this were not conclusive.
One word of warning: Flaxseed is high in calories. Here's an idea of how much you might need to consume to obtain its beneficial effects — 1 tablespoon of flaxseed has 5 grams of fat and weighs 12 grams. You need to take 40 to 50 grams of flaxseed, which is equal to about 4 tablespoons and has a total of 20 grams of fat. Milled flax has 36 calories per tablespoon; flax oil has 124 calories per tablespoon. (Flaxseeds are more nutritious than their oil.) These caloric considerations are important in the control of your glucose level.
Stay tuned, as I am sure there will be more studies that will guide us better in using flaxseed to stay healthy.
Saturday, January 22, 2011
Are Sports Drinks Safe for Diabetics?
Q: I am working outside this week as a volunteer for a sports event. The temperature is about 110 degrees. We are constantly given sports drinks to replenish our electrolytes. As a diabetic, is it safe for me to drink these?
— Nancy
A: While it is important to prevent dehydration and replace electrolytes that you might lose through excessive sweating, you must also consider the amount of carbohydrates and calories that you are consuming throughout the day. Below is information on some common sports drinks. You can see the difference in the amount of carbohydrates and calories.
Gatorade: 50 calories, 14 carbohydrates (grams)
Mountain Dew Sport: 95 calories, 24 carbohydrates (grams)
All Sport: 70 calories, 19 carbohydrates (grams)
Rehydrate: 40 calories, 10 carbohydrates (grams)
Performance: 100 calories, 25 carbohydrates (grams)
So for example, if you consume four 8-oz bottles of Gatorade, you have taken in 200 calories and 56 grams of carbohydrates — and those values double if you are drinking 16-oz bottles. The calories and carbohydrates can add up quickly, causing high sugar levels.
The best practice is to look at each brand’s calorie and carbohydrate counts and the number of drinks that you are consuming a day to determine if it is within your daily caloric and carbohydrate requirements. It's also a good idea to supplement sports beverages with plain water.
— Nancy
A: While it is important to prevent dehydration and replace electrolytes that you might lose through excessive sweating, you must also consider the amount of carbohydrates and calories that you are consuming throughout the day. Below is information on some common sports drinks. You can see the difference in the amount of carbohydrates and calories.
Gatorade: 50 calories, 14 carbohydrates (grams)
Mountain Dew Sport: 95 calories, 24 carbohydrates (grams)
All Sport: 70 calories, 19 carbohydrates (grams)
Rehydrate: 40 calories, 10 carbohydrates (grams)
Performance: 100 calories, 25 carbohydrates (grams)
So for example, if you consume four 8-oz bottles of Gatorade, you have taken in 200 calories and 56 grams of carbohydrates — and those values double if you are drinking 16-oz bottles. The calories and carbohydrates can add up quickly, causing high sugar levels.
The best practice is to look at each brand’s calorie and carbohydrate counts and the number of drinks that you are consuming a day to determine if it is within your daily caloric and carbohydrate requirements. It's also a good idea to supplement sports beverages with plain water.
Friday, January 21, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Thursday, January 20, 2011
New Wound Treatment for Non-healing Foot Ulcers
Results are expected by the end of the month in an efficacy study on a new drug that promises to improve diabetic wound care. Derma Sciences is wrapping up work on a phase 2 trial of DSC127, a drug already shown to speed up healing in animal tests.
According to Barry Wolfenson, executive vice president of global business development and marketing for the company, the study's last patient came aboard September 27, and the trial was set to wrap by the end of December 2010. After crunching the numbers, the company will be able to say how many patients' wounds were completely healed by the end of the 12-week study period.
"Should the DSC127 trial generate positive outcomes, we believe we will be able to attract several potential partners to handle further clinical testing of this drug and ultimately bring another treatment option to market for the millions of diabetics with chronic, non-healing foot ulcers," said company chairman and CEO Edward Quilty.
How does DSC127 work? Skin contains receptors for a natural peptide called angiotensin, and DSC127 is an analog of that peptide. In other words, it's a near-duplicate of what our own bodies produce--with one important difference. In its natural form, angiotensin raises blood pressure. According to Derma Sciencies, DSC127 does not. When applied to a wound, the drug appears to speed the growth of new skin without side effects.
Derma Sciences' phase 2 study includes a 12-week measure of durability. While early results should come out this month, that means that the study technically ends on March 27, Wolfenson said. More number crunching and and submission of a report to the FDA will take place afterward.
In November, the Princeton, NJ-based medical company received a $244,479 research and development grant for its work on DSC127 as part of the US healthcare reform bill. One billion dollars in the legislation was set aside for projects that address unmet needs or chronic conditions or could cut healthcare costs.
"Not only does this grant represent a non-dilutive source of financing, but we also are pleased that the US government has recognized the potential for DSC127 to make a significant difference in patient care," Quilty said
Clay Wirestone
Jan 11, 2011
According to Barry Wolfenson, executive vice president of global business development and marketing for the company, the study's last patient came aboard September 27, and the trial was set to wrap by the end of December 2010. After crunching the numbers, the company will be able to say how many patients' wounds were completely healed by the end of the 12-week study period.
"Should the DSC127 trial generate positive outcomes, we believe we will be able to attract several potential partners to handle further clinical testing of this drug and ultimately bring another treatment option to market for the millions of diabetics with chronic, non-healing foot ulcers," said company chairman and CEO Edward Quilty.
How does DSC127 work? Skin contains receptors for a natural peptide called angiotensin, and DSC127 is an analog of that peptide. In other words, it's a near-duplicate of what our own bodies produce--with one important difference. In its natural form, angiotensin raises blood pressure. According to Derma Sciencies, DSC127 does not. When applied to a wound, the drug appears to speed the growth of new skin without side effects.
Derma Sciences' phase 2 study includes a 12-week measure of durability. While early results should come out this month, that means that the study technically ends on March 27, Wolfenson said. More number crunching and and submission of a report to the FDA will take place afterward.
In November, the Princeton, NJ-based medical company received a $244,479 research and development grant for its work on DSC127 as part of the US healthcare reform bill. One billion dollars in the legislation was set aside for projects that address unmet needs or chronic conditions or could cut healthcare costs.
"Not only does this grant represent a non-dilutive source of financing, but we also are pleased that the US government has recognized the potential for DSC127 to make a significant difference in patient care," Quilty said
Clay Wirestone
Jan 11, 2011
Diabetes + Depression Increases Risk of Dying from Heart Disease
Depression and diabetes appear to be associated with a significantly increased risk of death from heart disease and risk of death from all causes over a six-year period for women....
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Wednesday, January 19, 2011
Type II diabetes and Hypertension
In an observational cohort study of 11,526 patients with Type 2 diabetes and hypertension, the investigators, showed that 68% of patients with normal albumin excretion at baseline had developed micro- or macroalbuminuria after a mean follow-up period of 5.5 years, according to Dr. Suma Vupputuri, PhD, MPH, an epidemiologist at Kaiser Permanente Center for Health Research/Southeast in Atlanta, who presented the study.
In previous studies, researchers had estimated that nephropathy develops in one-third of diabetic patients, Dr. Vupputuri noted. These studies, however, were based on data that were collected when glycemic levels were higher and before aggressive treatment had been shown to reduce diabetic complications.
In the new study, micro- and macroalbuminuria rarely progressed to end-stage renal disease (ESRD). In addition, if macroalbuminuria is present at baseline, the use of ACE inhibitors or angiotensin receptor blockers (ARBs) has a protective effect, the study showed.
The study included subjects who were at least 18 years old and who had measurements of urine albumin-to-creatinine ratios (UACR) in 2001, 2002, or 2003, and at least one additional measurement three to eight years later. Investigators defined micro- and macroalbuminuria as a UACR of 30-299 and 300 mcg/mg or higher, respectively. A UACR below 30 was considered normal. The first UACR value recorded in a stage higher than at baseline defined progression.
Almost half of the patients with normal albumin excretion at baseline progressed to microalbuminuria, but few went beyond that stage. Similarly, ESRD seldom developed in patients who first presented with microalbuminuria or macroalbuminuria. Over 89 months of follow-up, patients with normal baseline UACR's showed the highest rate of progression, followed by those with microalbuminuria at baseline, and then macroalbuminuria at baseline (94.6, 44.1, and 6.7 per 1,000 patient-years, respectively).
"Among patients with normal albumin at baseline, those who progressed to a higher stage of nephropathy were in general older, had a longer duration of diabetes, had higher mean blood pressures, and higher HbA1c's," Dr. Vupputuri said.
Patients who progressed from microalbuminuria were more likely to be male, with a longer duration of diabetes, higher mean blood pressure, and higher HbA1c levels. The progressors among the group with macroalbuminuria at baseline had similar risk factors as the microalbuminuria group plus lower estimated glomerular filtration rates and a diagnosis of cardiovascular disease or heart failure. In all the baseline cohorts, most patients were receiving antihypertensive agents (78%-91%), about half were on statins, and 67%-79% were receiving antihyperglycemic drugs. Insulin use went up and oral agents down with increasing nephropathy stage. ACE inhibitor or ARB use ranged from 61%-67% for all baseline groups whether they progressed or not, except for patients with macroglobulinuria who progressed. In this group, ACE inhibitor or ARB use was only 38%.
Because nephropathy is a major cause of cardiovascular disease and ESRD, it is important to understand the progression from normal levels of albumin excretion to micro- and macroalbuminuria and to define the risk factors for nephropathy progression.
Analyses showed that while ACE inhibitor or ARB use was not significantly associated with the progression of nephropathy for patients with baseline normal albumin excretion or microalbuminuria, use of these drugs was associated with a 47% decreased risk of progression in patients with baseline macroalbuminuria. In these patients, each five-year increment in age was associated with a 21% decreased risk. Each 10 mL/min/1.73 m2 increase in estimated glomerular filtration rate was associated with a 65% reduced risk.
Estimates of risk of progression could have been limited by survivor bias of patients who died before their nephropathy might have progressed, Dr. Vupputuri said. In addition, she said, "The use of ACE [inhibitors] and ARB's was lower than expected in this population." Therefore, greater use of these drugs may further reduce the burden of disease, she observed.
Although nearly half the people with normal albumin excretion developed microalbuminuria, only 6% progressed to macroalbuminuria, and a tiny fraction (0.09%) developed ESRD.
Renal and Urology News Dec. 2010
In previous studies, researchers had estimated that nephropathy develops in one-third of diabetic patients, Dr. Vupputuri noted. These studies, however, were based on data that were collected when glycemic levels were higher and before aggressive treatment had been shown to reduce diabetic complications.
In the new study, micro- and macroalbuminuria rarely progressed to end-stage renal disease (ESRD). In addition, if macroalbuminuria is present at baseline, the use of ACE inhibitors or angiotensin receptor blockers (ARBs) has a protective effect, the study showed.
The study included subjects who were at least 18 years old and who had measurements of urine albumin-to-creatinine ratios (UACR) in 2001, 2002, or 2003, and at least one additional measurement three to eight years later. Investigators defined micro- and macroalbuminuria as a UACR of 30-299 and 300 mcg/mg or higher, respectively. A UACR below 30 was considered normal. The first UACR value recorded in a stage higher than at baseline defined progression.
Almost half of the patients with normal albumin excretion at baseline progressed to microalbuminuria, but few went beyond that stage. Similarly, ESRD seldom developed in patients who first presented with microalbuminuria or macroalbuminuria. Over 89 months of follow-up, patients with normal baseline UACR's showed the highest rate of progression, followed by those with microalbuminuria at baseline, and then macroalbuminuria at baseline (94.6, 44.1, and 6.7 per 1,000 patient-years, respectively).
"Among patients with normal albumin at baseline, those who progressed to a higher stage of nephropathy were in general older, had a longer duration of diabetes, had higher mean blood pressures, and higher HbA1c's," Dr. Vupputuri said.
Patients who progressed from microalbuminuria were more likely to be male, with a longer duration of diabetes, higher mean blood pressure, and higher HbA1c levels. The progressors among the group with macroalbuminuria at baseline had similar risk factors as the microalbuminuria group plus lower estimated glomerular filtration rates and a diagnosis of cardiovascular disease or heart failure. In all the baseline cohorts, most patients were receiving antihypertensive agents (78%-91%), about half were on statins, and 67%-79% were receiving antihyperglycemic drugs. Insulin use went up and oral agents down with increasing nephropathy stage. ACE inhibitor or ARB use ranged from 61%-67% for all baseline groups whether they progressed or not, except for patients with macroglobulinuria who progressed. In this group, ACE inhibitor or ARB use was only 38%.
Because nephropathy is a major cause of cardiovascular disease and ESRD, it is important to understand the progression from normal levels of albumin excretion to micro- and macroalbuminuria and to define the risk factors for nephropathy progression.
Analyses showed that while ACE inhibitor or ARB use was not significantly associated with the progression of nephropathy for patients with baseline normal albumin excretion or microalbuminuria, use of these drugs was associated with a 47% decreased risk of progression in patients with baseline macroalbuminuria. In these patients, each five-year increment in age was associated with a 21% decreased risk. Each 10 mL/min/1.73 m2 increase in estimated glomerular filtration rate was associated with a 65% reduced risk.
Estimates of risk of progression could have been limited by survivor bias of patients who died before their nephropathy might have progressed, Dr. Vupputuri said. In addition, she said, "The use of ACE [inhibitors] and ARB's was lower than expected in this population." Therefore, greater use of these drugs may further reduce the burden of disease, she observed.
Although nearly half the people with normal albumin excretion developed microalbuminuria, only 6% progressed to macroalbuminuria, and a tiny fraction (0.09%) developed ESRD.
Renal and Urology News Dec. 2010
Managing Diabetes With a Cold or Flu
Got the sniffles? Here's what you need to know when managing diabetes and fighting off a cold or the flu. Sick days bring everyone down. But if you have type 2 diabetes, you have some special considerations when you are burdened with a cold or the flu — for example, choosing the right cold medicine or checking in with your doctor to find out about changes in the dosing of your medications.
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
There's more content below this advertisement. Jump to the content.
“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.
Pick the Right Cold Medicine
“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.
If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.
Check Blood Sugar Often
There's more content below this advertisement. Jump to the content.
“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.
Other medications you may need to take when you are sick can affect your blood sugar levels:
Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medicationsDecongestants may raise blood sugar levels
Adjust Your Plan
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.
“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.
Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.
But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds
Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:
Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers. It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.
Illness Prevention Strategies
We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness is to keep your disease under control. “Control blood sugar when well,” advises Sam.
Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.
It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.
By Madeline Vann, MPH
Medically reviewed by Lindsey Marcellin, MD, MPH
Tuesday, January 18, 2011
Ugg Boots Achilles Heel? They May Cause Foot Pain
Podiatrists say popular slipper-like boot can be shear agony on the feet.
The wildly popular Australian boots are everywhere these days--even worthy of "how to wear them" videos on Youtube.
Forest Park Medical Center podiatrist Rachel Verville said that's probably a good idea because if not worn properly the super-comfy boots can be a real pain in the feet.
"The main thing is moderation," Dr. Verville said. "If you only wear them for a few hours every day you should be fine but if you wear them for an extended period of time or multiple days on end you can develop pain."
Dr. Verville sees a growing number of young women experiencing foot pain--she asks them all the same question: What shoes are you wearing?
"Often times its UGG's," Dr. Verville added that UGG's and knockoff-boots like them are comfortable but with their slipper-like feel they offer no support. "Basically there is a large tendon that runs down the inside of your foot called the posterior tibial tendon and if you wear non-supportive shoes for a long period of time you can develop posterior tibial tendonitis which is tendonitis of that tendon."
Which is painful enough for people to seek medical help.
Katie Taylor wears high heels at work and then slips out of them and into her UGG's on her way home. She wears them with caution and hasn't had any problems.
"They're warm, my feet get cold a lot so I really wanted to have a warm shoe," Katie said. "But also whenever I'm at work I wear really uncomfortable shoes and I change into my UGG's when I can't take the pain from my other shoes."
Dr. Verville also owns a pair of UGG's and says many women wear theirs without socks which can turn the sheepskin lined boots into bacteria traps.
"I suggest one should wear socks," Dr. Verville said. "Just a thin layer of sock inside the boots because if you sweat, moisture develops and athlete's foot and that kind of thing can develop."
So with UGG's and other sensible shoes like them--use a little common sense.
The wildly popular Australian boots are everywhere these days--even worthy of "how to wear them" videos on Youtube.
Forest Park Medical Center podiatrist Rachel Verville said that's probably a good idea because if not worn properly the super-comfy boots can be a real pain in the feet.
"The main thing is moderation," Dr. Verville said. "If you only wear them for a few hours every day you should be fine but if you wear them for an extended period of time or multiple days on end you can develop pain."
Dr. Verville sees a growing number of young women experiencing foot pain--she asks them all the same question: What shoes are you wearing?
"Often times its UGG's," Dr. Verville added that UGG's and knockoff-boots like them are comfortable but with their slipper-like feel they offer no support. "Basically there is a large tendon that runs down the inside of your foot called the posterior tibial tendon and if you wear non-supportive shoes for a long period of time you can develop posterior tibial tendonitis which is tendonitis of that tendon."
Which is painful enough for people to seek medical help.
Katie Taylor wears high heels at work and then slips out of them and into her UGG's on her way home. She wears them with caution and hasn't had any problems.
"They're warm, my feet get cold a lot so I really wanted to have a warm shoe," Katie said. "But also whenever I'm at work I wear really uncomfortable shoes and I change into my UGG's when I can't take the pain from my other shoes."
Dr. Verville also owns a pair of UGG's and says many women wear theirs without socks which can turn the sheepskin lined boots into bacteria traps.
"I suggest one should wear socks," Dr. Verville said. "Just a thin layer of sock inside the boots because if you sweat, moisture develops and athlete's foot and that kind of thing can develop."
So with UGG's and other sensible shoes like them--use a little common sense.
Seniors' Walking Speed May Predict Life Expectancy
Gait speed correlated with expected years of life remaining to people aged 65 years and older, with increased walking speed predicting longer life expectancy....
Dr. Stephanie Studenski of the division of geriatric medicine at the University of Pittsburgh, and her associates, stated that, for both sexes and at any age older than 65 years, a gait speed of 0.8 meters per second correlated with the median life expectancy for a person's age and sex. Faster walking speeds consistently correlated with extended survival, they said.
They assessed the relationship between gait speed and survival in a pooled analysis using data from nine cohort studies of community-dwelling adults. Each study included at least 400 people, gait speed data at baseline, and follow-up for at least 5 years. All of the studies measured gait speed by having subjects walk at their usual pace from a standing start for 6-8 feet indoors.
There were 34,485 study subjects, including "substantial" numbers of African American and Hispanic patients, as well as 1,765 who were older than 85 years. Follow-up ranged from 6 to 21 years, with a median of 14 years. Gait speed ranged widely, from less than 0.4 meters per second (in 1,247 people) to more than 1.4 meters per second (in 1,491 people). There were 17,528 deaths during follow-up.
Predicted years of life remaining correlated with gait speed for patients of both sexes and all ages.
A walking speed of approximately 0.8 meters per second was associated with the predicted median life expectancy for a subject's age and sex. Gait speeds faster than that rate predicted longer-than-average life expectancy, while slower gait speeds predicted shorter-than-average life expectancy. Gait speeds of 1.2 meters per second and faster predicted "exceptional" life expectancy, the investigators said
Gait speed "was especially informative after age 75 years" in patients who had no, or only minor, functional limitations. It may be less helpful in predicting life expectancy for patients who already report functional impairments and dependency on others for performing the activities of daily living, the investigators noted.
The data allowed Dr. Studenski and her colleagues to calculate survival estimates for a broad range of gait speeds, and to calculate absolute rates and median years of survival. "Compared with prior studies that were too small to assess potential effect modification by age, sex, race/ethnicity, and other subgroups, we were able to assess multiple subgroup effects with substantial power," the researchers said.
"Because gait speed can be assessed by nonprofessional staff using a 4-meter walkway and a stopwatch, it is relatively simple to measure compared with many medical assessments," they added.
In practice, gait speed can be used to identify elderly patients with a high probability of living 5-10 more years, who can then be targeted for preventive interventions that require a long time before benefits are realized. It can also identify patients at increased risk for early mortality, who can then be targeted for interventions to maximize health and survival, the researchers explained.
If gait speed is tracked over time, it can serve as an indicator that new health problems have arisen. It can also be helpful in stratifying risks from surgery or chemotherapy, the investigators said.
Dr. Stephanie Studenski of the division of geriatric medicine at the University of Pittsburgh, and her associates, stated that, for both sexes and at any age older than 65 years, a gait speed of 0.8 meters per second correlated with the median life expectancy for a person's age and sex. Faster walking speeds consistently correlated with extended survival, they said.
They assessed the relationship between gait speed and survival in a pooled analysis using data from nine cohort studies of community-dwelling adults. Each study included at least 400 people, gait speed data at baseline, and follow-up for at least 5 years. All of the studies measured gait speed by having subjects walk at their usual pace from a standing start for 6-8 feet indoors.
There were 34,485 study subjects, including "substantial" numbers of African American and Hispanic patients, as well as 1,765 who were older than 85 years. Follow-up ranged from 6 to 21 years, with a median of 14 years. Gait speed ranged widely, from less than 0.4 meters per second (in 1,247 people) to more than 1.4 meters per second (in 1,491 people). There were 17,528 deaths during follow-up.
Predicted years of life remaining correlated with gait speed for patients of both sexes and all ages.
A walking speed of approximately 0.8 meters per second was associated with the predicted median life expectancy for a subject's age and sex. Gait speeds faster than that rate predicted longer-than-average life expectancy, while slower gait speeds predicted shorter-than-average life expectancy. Gait speeds of 1.2 meters per second and faster predicted "exceptional" life expectancy, the investigators said
Gait speed "was especially informative after age 75 years" in patients who had no, or only minor, functional limitations. It may be less helpful in predicting life expectancy for patients who already report functional impairments and dependency on others for performing the activities of daily living, the investigators noted.
The data allowed Dr. Studenski and her colleagues to calculate survival estimates for a broad range of gait speeds, and to calculate absolute rates and median years of survival. "Compared with prior studies that were too small to assess potential effect modification by age, sex, race/ethnicity, and other subgroups, we were able to assess multiple subgroup effects with substantial power," the researchers said.
"Because gait speed can be assessed by nonprofessional staff using a 4-meter walkway and a stopwatch, it is relatively simple to measure compared with many medical assessments," they added.
In practice, gait speed can be used to identify elderly patients with a high probability of living 5-10 more years, who can then be targeted for preventive interventions that require a long time before benefits are realized. It can also identify patients at increased risk for early mortality, who can then be targeted for interventions to maximize health and survival, the researchers explained.
If gait speed is tracked over time, it can serve as an indicator that new health problems have arisen. It can also be helpful in stratifying risks from surgery or chemotherapy, the investigators said.
Monday, January 17, 2011
New Balance Faces Potential Class Action Over Toning-Shoe Claims
Boston, MA: New Balance, the Boston-based sneaker maker is being sued over allegations of deceptive advertising, specifically, that its toning shoes create more sculpted legs than traditional walking shoes are not accurate.
The complaint, filed on Monday in the US District Court of Boston, is seeking class action status, and $5 million in damages.
The suit was filed by Bistra Pashamova of California, who claims that she and others like her have been harmed by New Balance. New Balance has promoted its toning shoes with claims that the shoes increase muscle activation by about 27 percent and increase calorie burn by as much as 10 percent with each step.
However, results from a study completed by the American Council on Exercise, released in the summer of 2010, showed that "toning shoes" do not live up to the claims made by several manufacturers. The report concluded there was “no statistically significant increases in either exercise response or muscle activation’’ as a result of wearing toning sneakers."
Additionally, reports of injuries have raised concerns that the shoes, which retail for about $100 a pair, could in fact do more harm than good.
Pashamova is also seeking to “halt the dissemination of this false and misleading advertising message, correct the false and misleading perception New Balance has created in the minds of consumers, and to obtain redress for those who have purchased any New Balance toning shoes.’’
The complaint, filed on Monday in the US District Court of Boston, is seeking class action status, and $5 million in damages.
The suit was filed by Bistra Pashamova of California, who claims that she and others like her have been harmed by New Balance. New Balance has promoted its toning shoes with claims that the shoes increase muscle activation by about 27 percent and increase calorie burn by as much as 10 percent with each step.
However, results from a study completed by the American Council on Exercise, released in the summer of 2010, showed that "toning shoes" do not live up to the claims made by several manufacturers. The report concluded there was “no statistically significant increases in either exercise response or muscle activation’’ as a result of wearing toning sneakers."
Additionally, reports of injuries have raised concerns that the shoes, which retail for about $100 a pair, could in fact do more harm than good.
Pashamova is also seeking to “halt the dissemination of this false and misleading advertising message, correct the false and misleading perception New Balance has created in the minds of consumers, and to obtain redress for those who have purchased any New Balance toning shoes.’’
Out-of-Control Sugar Cravings
Q: I am a type 2 diabetic. I do well with meals, but I crave something sweet (like cookies, cake, candy) constantly, and most times I lose the battle to resist. How can I get rid of this craving once and for all?
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
— Jacqueline, Kansas
A: Despite popular beliefs about how blood sugar levels relate to craving, there is very little if any evidence indicating this to be true. Food cravings are largely a psychological phenomenon that relates to old habits and learning. The most likely reason that we see cravings in folks like you who have developed type 2 diabetes may simply be that the history of eating patterns that contributed to the development of the diabetes is persisting. Here's the good news: As is the case with all learned behavior, cravings can be "unlearned."
Cravings can arise in several ways. If you have used food to reward yourself, make yourself feel better when stressed or upset, or celebrate certain special events, depending on how frequently you do this, those foods can become associated with any of the above examples. When you feel these emotions, or are in the situations associated with that food, that association triggers thoughts about the food — in other words, a craving. The problem is that over a lifetime, the number of subtle triggers that become solidly paired with these foods grows. So it’s sometimes impossible to put your finger on the cause of the craving, which leads people to assume it’s being triggered by some internal physiological need (which is probably not the case).
The good news is that there is a simple answer: Stop pairing consumption of the craved food with the craving. Of course, even simple answers are not always easy. Fighting cravings can be tough. They are powerful and very real. So here are a few tips to get you started:
Delay. Wait 10 to 20 minutes (or as long as you can) before giving into the craving. In the best-case scenario, often the craving will subside in that time period, and you will not eat the food at all. However, even at those times when you aren’t able to fully fight off the craving, the time delay helps reduce its power.
Distract. Just thinking about the craved food during the delay can maintain the power of the craving. By distracting yourself and trying not to think about the craved food, you will ensure that the craving weakens.
Avoid. Finding alternatives to your most difficult-to-control foods that are equally satisfying and consuming these in moderation in a planned way (not in response to a craving) allows you to not feel deprived while controlling consumption of the food. Alternatively, some people seem to do well consuming a small amount of the actual craved food at planned times, but recent evidence suggests that this may in fact prolong the removal of the cravings.
Remember, you can take control of cravings.
More Diabetic Nephropathy in the Winter
Researchers found a seasonal variation in urinary albumin-to-creatine ratios (UACR) in patients with Type 2 diabetes....
AdvertisementResearchers have found a seasonal variation in urinary albumin-to-creatinine ratio (UACR) in patients with Type 2 diabetes and early nephropathy, with the highest values in winter and the lowest in summer.
Systolic blood pressure (BP) also followed this pattern, raising the possibility of a causal link. The investigators suggested that clinicians consider this seasonal variation in UACR when evaluating the effects of drugs on diabetic nephropathy.
A group led by Yoshiharu Wada, MD, of the Center for Diabetes and Endocrinology at the Tazuke Kofukai Foundation Medical Research Institute Kitano Hospital in Osaka, Japan, recruited a study cohort of 430 patients (275 male, 155 female, mean age 64.8 years) with Type 2 diabetes, early nephropathy, and microalbuminuria. Subjects visited the clinic every three months from 2006 to 2009. The researchers defined microalbuminuria as a UACR of 30-300 mg/g of creatinine. They excluded patients with advanced nephropathy with elevated creatinine.
Dr. Wada said readings were categorized according to season: winter (December through February), spring (March through May), summer (June through August), and fall (September through November).
Although UACR and systolic BP were highest in the winter, HbA1c peaked in spring. Estimated glomerular filtration rate (eGFR) and diastolic BP showed no significant seasonal variations.
UACR and systolic BP showed a significant correlation, with UACR rising as systolic pressure rose. The investigators observed no correlation between BP and HbA1c or between HbA1c and UACR.
The fact that both UACR and systolic pressure were highest in winter and lowest in summer "suggest that the seasonal change in systolic blood pressure… may contribute to the variations in UACR," Dr. Wada said.
Some attendees at the poster session raised questions about possible explanations for the observations. One suggested the seasonal variations could be related to the amount of exercise people engaged in. Another wondered if the findings could be related to seasonal variations in serum vitamin D levels. Dr. Wada said he had not measured exercise levels or vitamin D in his subjects.
Previous work based on data from the U.S. Third National Health and Nutrition Examination Survey (Am J Kidney Dis. 2007;50:69-77) demonstrated an increased prevalence of albuminuria with decreasing quartiles of serum 25-hydroxyvitamin D concentration. Compared to the highest quartile of serum vitamin D level, the lowest quartile was associated with a 37% increased relative risk of albuminuria. As this study was retrospective and observational, no conclusions could be drawn as to causality.
AdvertisementResearchers have found a seasonal variation in urinary albumin-to-creatinine ratio (UACR) in patients with Type 2 diabetes and early nephropathy, with the highest values in winter and the lowest in summer.
Systolic blood pressure (BP) also followed this pattern, raising the possibility of a causal link. The investigators suggested that clinicians consider this seasonal variation in UACR when evaluating the effects of drugs on diabetic nephropathy.
A group led by Yoshiharu Wada, MD, of the Center for Diabetes and Endocrinology at the Tazuke Kofukai Foundation Medical Research Institute Kitano Hospital in Osaka, Japan, recruited a study cohort of 430 patients (275 male, 155 female, mean age 64.8 years) with Type 2 diabetes, early nephropathy, and microalbuminuria. Subjects visited the clinic every three months from 2006 to 2009. The researchers defined microalbuminuria as a UACR of 30-300 mg/g of creatinine. They excluded patients with advanced nephropathy with elevated creatinine.
Dr. Wada said readings were categorized according to season: winter (December through February), spring (March through May), summer (June through August), and fall (September through November).
Although UACR and systolic BP were highest in the winter, HbA1c peaked in spring. Estimated glomerular filtration rate (eGFR) and diastolic BP showed no significant seasonal variations.
UACR and systolic BP showed a significant correlation, with UACR rising as systolic pressure rose. The investigators observed no correlation between BP and HbA1c or between HbA1c and UACR.
The fact that both UACR and systolic pressure were highest in winter and lowest in summer "suggest that the seasonal change in systolic blood pressure… may contribute to the variations in UACR," Dr. Wada said.
Some attendees at the poster session raised questions about possible explanations for the observations. One suggested the seasonal variations could be related to the amount of exercise people engaged in. Another wondered if the findings could be related to seasonal variations in serum vitamin D levels. Dr. Wada said he had not measured exercise levels or vitamin D in his subjects.
Previous work based on data from the U.S. Third National Health and Nutrition Examination Survey (Am J Kidney Dis. 2007;50:69-77) demonstrated an increased prevalence of albuminuria with decreasing quartiles of serum 25-hydroxyvitamin D concentration. Compared to the highest quartile of serum vitamin D level, the lowest quartile was associated with a 37% increased relative risk of albuminuria. As this study was retrospective and observational, no conclusions could be drawn as to causality.
Top 10 First-Aid Essentials for Child Safety
What all parents need to have in their medicine cabinet for handling minor and major mishaps. Lots of words can describe kids. "Naturally exuberant," "naturally active," and "naturally curious," are three phrases that Ken Haller, MD, associate professor of pediatrics at Saint Louis University School of Medicine, chooses to use.
Natural excitement and curiosity are normal and healthy parts of development, but they present special challenges for child safety. Children don't usually spend much time thinking about how to stay safe and healthy. That's mom and dad's job. While scrapes and bruises are also a normal part of childhood, there are more serious threats, such as poisoning and burns. Keeping key first-aid supplies handy for common injuries is a great first step in a child safety plan.
Child Safety: The Top 10 First-Aid Essentials
1.Your local poison control number. Almost 80 percent of reported poisoning cases involve children, and most of those are among children age 5 and under. Haller recommends placing the phone number for your local poison control center in your medicine cabinet and on your refrigerator, and programming it into your cell phone. "The centers are open 24 hours a day and have a nurse on call who can tell you exactly what to do after you describe the situation," Dr. Haller says. According to the Centers for Disease Control, in a life-threatening emergency situation, dial 911. If the victim is awake and alert, you can call your local number or the national hotline, 1-800-222-1222.
2.Pain relief medication. Child safety choices include acetaminophen (Tylenol) and non-steroid anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve). Monitor children's dosages carefully. For instance, if they're sick with a cough and congestion and you've already given them a medicine with acetaminophen (like a cold remedy), you don't want to give them another dose of Tylenol at the same time.
3.An assortment of bandages. A two-inch-square sterile gauze pad can clean almost any wound, says Haller. In addition, have adhesive-free dressings, other sizes of sterile pads, or a roll of gauze for minor burns or kneecap scrapes. Tape and strip bandages in a variety of sizes work for cuts and blisters, and an elastic wrap like an Ace bandage is effective for sprains.
4.Soap for clean-up. "For most wounds, cleaning with soap and water is good enough," says Haller. Always wash a wound before dressing it. You might also want to have an antiseptic solution or towelettes handy, and rubbing alcohol, which Haller says makes a good disinfectant.
5.Antibiotic ointment. Choose today's gold standard, Polysporin, or the old standby, bacitracin. For a large open wound on a frightened young patient, you can put the ointment on the bandage pad, instead of directly on the injury.
6.Tweezers. Essential for the removal of splinters or dirt particles from a cut or puncture wound, tweezers should be wiped with alcohol before using. If possible, have both a pointed tip and a slanted tip pair.
7.Itch relief. Choose a few different formats to cover all itchy bases. Calamine lotion is still a soother for poison ivy and the like. Over-the-counter (OTC) hydrocortisone cream is great for dermatitis-type skin rashes and irritations, while an OTC antihistamine like Benadryl (a cold symptom and nasal allergy mainstay), is handy for an itchy initial reaction to a wasp or bee sting. If your child breaks out in hives and has any throat swelling, signs of a serious allergic reaction, call your doctor immediately.
8."Instant" ice packs. These disposable packs don't need to be kept frozen and are literally a snap to use to reduce swelling after an injury.
9.A tooth-preserving storage device. Should one of your child's permanent teeth get knocked out by accident, a product like Save-A-Tooth will hold and protect it on your way to the dentist, improving the chances of it being replanting.
10.A sterile eye wash. This is handy to flush out any dirt or foreign particles that get into the eyes.
Child Safety: What to Toss
Here are a few medicine chest items that can be cleared out to make room for the top 10 child safety items:
Ipecac (a poison treatment). "Ipecac is not recommended anymore," says Haller. Not only can ipecac cause a number of side effects, it can also make the damage of certain harsh poisons worse. Each poison affects the body differently and needs a different treatment approach.
Neosporin. This antibacterial ointment may cause redness or inflammation and has been largely abandoned in favor of Polysporin or bacitracin.
Aspirin is not recommended for children, unless specifically directed by your physician, because of the risk of a condition called Reye's syndrome.
Expired products. Check your medicine cabinet every three months and get rid of products that have reached their expiration date. "It's not that they become toxic, but that the components break down, so they're simply no longer effective," Haller explains. "If you notice that your product is only past the date by a week or so and you need it right then, go ahead and use it. Just make a mental note to replace it soon." This advice goes for both over-the-counter and prescription items.
Taking time to ensure child safety is important. With a carefully thought-out shopping list and a trip to your favorite drugstore, you can easily outfit your medicine cabinet for most of life's little bumps along your child's road to discovery.
By Connie Brichford
Medically reviewed by Cynthia Haines, MD
Natural excitement and curiosity are normal and healthy parts of development, but they present special challenges for child safety. Children don't usually spend much time thinking about how to stay safe and healthy. That's mom and dad's job. While scrapes and bruises are also a normal part of childhood, there are more serious threats, such as poisoning and burns. Keeping key first-aid supplies handy for common injuries is a great first step in a child safety plan.
Child Safety: The Top 10 First-Aid Essentials
1.Your local poison control number. Almost 80 percent of reported poisoning cases involve children, and most of those are among children age 5 and under. Haller recommends placing the phone number for your local poison control center in your medicine cabinet and on your refrigerator, and programming it into your cell phone. "The centers are open 24 hours a day and have a nurse on call who can tell you exactly what to do after you describe the situation," Dr. Haller says. According to the Centers for Disease Control, in a life-threatening emergency situation, dial 911. If the victim is awake and alert, you can call your local number or the national hotline, 1-800-222-1222.
2.Pain relief medication. Child safety choices include acetaminophen (Tylenol) and non-steroid anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve). Monitor children's dosages carefully. For instance, if they're sick with a cough and congestion and you've already given them a medicine with acetaminophen (like a cold remedy), you don't want to give them another dose of Tylenol at the same time.
3.An assortment of bandages. A two-inch-square sterile gauze pad can clean almost any wound, says Haller. In addition, have adhesive-free dressings, other sizes of sterile pads, or a roll of gauze for minor burns or kneecap scrapes. Tape and strip bandages in a variety of sizes work for cuts and blisters, and an elastic wrap like an Ace bandage is effective for sprains.
4.Soap for clean-up. "For most wounds, cleaning with soap and water is good enough," says Haller. Always wash a wound before dressing it. You might also want to have an antiseptic solution or towelettes handy, and rubbing alcohol, which Haller says makes a good disinfectant.
5.Antibiotic ointment. Choose today's gold standard, Polysporin, or the old standby, bacitracin. For a large open wound on a frightened young patient, you can put the ointment on the bandage pad, instead of directly on the injury.
6.Tweezers. Essential for the removal of splinters or dirt particles from a cut or puncture wound, tweezers should be wiped with alcohol before using. If possible, have both a pointed tip and a slanted tip pair.
7.Itch relief. Choose a few different formats to cover all itchy bases. Calamine lotion is still a soother for poison ivy and the like. Over-the-counter (OTC) hydrocortisone cream is great for dermatitis-type skin rashes and irritations, while an OTC antihistamine like Benadryl (a cold symptom and nasal allergy mainstay), is handy for an itchy initial reaction to a wasp or bee sting. If your child breaks out in hives and has any throat swelling, signs of a serious allergic reaction, call your doctor immediately.
8."Instant" ice packs. These disposable packs don't need to be kept frozen and are literally a snap to use to reduce swelling after an injury.
9.A tooth-preserving storage device. Should one of your child's permanent teeth get knocked out by accident, a product like Save-A-Tooth will hold and protect it on your way to the dentist, improving the chances of it being replanting.
10.A sterile eye wash. This is handy to flush out any dirt or foreign particles that get into the eyes.
Child Safety: What to Toss
Here are a few medicine chest items that can be cleared out to make room for the top 10 child safety items:
Ipecac (a poison treatment). "Ipecac is not recommended anymore," says Haller. Not only can ipecac cause a number of side effects, it can also make the damage of certain harsh poisons worse. Each poison affects the body differently and needs a different treatment approach.
Neosporin. This antibacterial ointment may cause redness or inflammation and has been largely abandoned in favor of Polysporin or bacitracin.
Aspirin is not recommended for children, unless specifically directed by your physician, because of the risk of a condition called Reye's syndrome.
Expired products. Check your medicine cabinet every three months and get rid of products that have reached their expiration date. "It's not that they become toxic, but that the components break down, so they're simply no longer effective," Haller explains. "If you notice that your product is only past the date by a week or so and you need it right then, go ahead and use it. Just make a mental note to replace it soon." This advice goes for both over-the-counter and prescription items.
Taking time to ensure child safety is important. With a carefully thought-out shopping list and a trip to your favorite drugstore, you can easily outfit your medicine cabinet for most of life's little bumps along your child's road to discovery.
By Connie Brichford
Medically reviewed by Cynthia Haines, MD
Tuesday, January 4, 2011
Diabetes And Feet: Why A Podiatrist Is A Vital Part Of A Diabetic’s Care
Diabetes is a serious disease that affects millions of Americans, and that number is going to astronomically grow as the baby boomer generation ages further. Complications associated with diabetes can be devastating, and can lead to organ failure and even death. Foot-related complications in particular are very common in diabetes, and unfortunately cause the majority of leg amputations performed by surgeons. Comprehensive care by a podiatrist can identify foot problems early before they lead to leg loss, and in many cases can prevent those problems in the first place. This article will discuss the ways a podiatrist can protect diabetic feet, and ultimately save a diabetic’s limb and life.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ’sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.
Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.
A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.
To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.
The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author (thediabeticfoot.blogspot.com). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.
Monday, January 3, 2011
Actress Zsa Zsa Gabor's lower leg to be amputated
LOS ANGELES (Reuters)– Actress Zsa Zsa Gabor was admitted to hospital in Los Angeles on Sunday to undergo a partial amputation of her right leg, her husband told Reuters.
Gabor, believed to be 93 and in ill health since July when she broke her hip, has been infected by a lesion that turned gangrenous, her husband Frederic Prinz von Anhalt said.
After doctors warned she would die unless her leg was amputated above the knee, Gabor was "screaming and yelling" about wanting to spend New Year's Eve at home for her traditional celebration of champagne and caviar, he said.
She was finally admitted to UCLA Medical Center and was being prepared on Sunday evening for surgery, he said.
Gabor faces obvious complications because of her age but a successful operation could add a few years to her life, said her spokesman John Blanchette.
As an actress, the Hungarian-born Gabor is best known for her roles in the 1950s movies "Moulin Rouge" and "Lili."
Along with her sisters Eva and Magda, she was a fixture on Hollywood's social circuit where she called everyone "dah-ling" in her thick accent.
She has been married nine times and earned a degree of infamy in 1989 when she served a three-day jail term for slapping a Beverly Hills policeman who had pulled her over. Unbowed, she emerged from jail complaining about the food.
Gabor, believed to be 93 and in ill health since July when she broke her hip, has been infected by a lesion that turned gangrenous, her husband Frederic Prinz von Anhalt said.
After doctors warned she would die unless her leg was amputated above the knee, Gabor was "screaming and yelling" about wanting to spend New Year's Eve at home for her traditional celebration of champagne and caviar, he said.
She was finally admitted to UCLA Medical Center and was being prepared on Sunday evening for surgery, he said.
Gabor faces obvious complications because of her age but a successful operation could add a few years to her life, said her spokesman John Blanchette.
As an actress, the Hungarian-born Gabor is best known for her roles in the 1950s movies "Moulin Rouge" and "Lili."
Along with her sisters Eva and Magda, she was a fixture on Hollywood's social circuit where she called everyone "dah-ling" in her thick accent.
She has been married nine times and earned a degree of infamy in 1989 when she served a three-day jail term for slapping a Beverly Hills policeman who had pulled her over. Unbowed, she emerged from jail complaining about the food.
Sunday, January 2, 2011
Wearing High Heels Can Lead to Osteoarthritis of the Foot
If you wear low heels or sturdy one- to two-inch heels or limit your wearing of high heels to evenings or special occasions, you're probably okay. However, if you wear very high heels day in and day out, you may increase your risk for developing osteoarthritis of the foot. “It’s harder to stand straight when wearing high heels, and this causes a lot of stress on the balls of your feet and your toes” says Dr. Weaver. Feet are one of the chief areas to be hit by osteoarthritis. In addition, high heels that are tight across the toes can aggravate bunions, or arthritis of the toes. You're better off wearing low heels and leaving the stilettos to the models
Saturday, January 1, 2011
Sugar Substitutes: What's Their Real Value?
About 15 percent of Americans use sugar substitutes to cut calories, control diabetes, or prevent cavities. Yet just how much is safe to consume?
Sugar-free foods and drinks are lower in calories than their full sugar alternatives, but are they good options for weight loss? While sugar substitutes are generally safe, the debate about how they should be used continues.
Sugar Substitutes: A Short and Sweet History
The first sugar substitute, saccharin, was discovered in the late 1800s and gained prominence in manufacturing during the World Wars, when sugar was rationed. The business of sugar-free foods and drinks began to boom in the 1960s when clinicians realized the importance of controlling weight gain in the management of diabetes.
Since then, as people became more health-conscious and wanted to shun sugar, manufacturers responded with a host of sugar substitutes. They are:
• Aspartame, approved in 1981 by the U.S. Food and Drug Administration (FDA) and now in more than 6,000 foods and drinks
• Acesulfame-K, FDA-approved in 1988
• Sucralose (Splenda, SucraPlus), approved in 1998 for limited use and in 1999 for general use
• Neotame, approved in 2002
Other sugar substitutes are being developed, and many products contain a mix of sugar substitutes to enhance flavor. Each sugar substitute is several thousand times sweeter than sugar, but has a slightly different flavor. Whether you reach for the pink, blue, or yellow packet to sweeten your coffee is a matter of personal taste. Sugar substitutes are now so common that many people use them without consciously considering their use as a weight-loss strategy.
Sugar Substitutes: Their Role in Your Diet
As part of an overall healthy diet, sugar substitutes are believed to reduce calories and the risk of cavities. Interestingly, controlled studies that compare weight loss between people who use sugar substitutes and those who consume sugar show very little difference in weight loss between the two groups, although over the long term, sugar substitutes can help maintain weight loss.
Conscious calorie-cutting strategies can include sugar-free products. Replacing a sugary drink with a sugar-free drink will reduce your calorie intake, and cutting back by just one full sugar soda a day could result in losing over 1.4 pounds in 18 months. The key to losing weight using sugar-free products is to use them strategically.
Sugar Substitutes: How Much Can You Have?
A big question surrounding sugar substitutes is how much diet soda is safe to drink. Though you might never consider consuming this much in a day, the FDA says these are the maximum amounts allowable for daily consumption, listed by type of sugar substitute:
• Aspartame: 18 to 19 cans of diet soda
• Saccharin: 9 to 12 packets
• Acesulfame-K: 30 to 32 cans of diet soda
• Sucralose: 6 cans of diet soda
Sugar Substitutes: Reality Check
A realistic use of sugar-free products looks quite different.
A regular amount for a sugar substitute is two servings a day, says dietitian Liz Weinandy, RD, MPH, a dietitian in the non-surgical weight-loss program at Ohio State University Medical Center in Columbus. “My concern comes when people do multiple servings, like a six-pack of diet pop a day. Many times they are trying to use a sugar substitute in place of food. Some are very nutritious, like light yogurt, but while sugar-free soda doesn’t have calories, it also doesn’t have stuff in it that’s good for you.”
Further, consuming a lot of sugar-free drinks could hurt your weight-loss strategy. Studies show that when a sugar substitute is added to a product that has no other nutritional content (such as water), it increases hunger. This is true regardless of the type of sugar substitute used. Sugar substitutes in foods do not have this effect.
Sugar Substitutes: Who Should Avoid Them
While sugar substitutes are generally considered safe, Weinandy advises against giving children sugar-free foods and drinks — unless a doctor has said otherwise — and says pregnant women also should be cautious. “Drink water or fruit juice during pregnancy,” Weinandy suggests. “Limit diet pop to one per day at most.”
Additionally, people who have the disease phenylketonuria need to avoid aspartame, which contains phenylalanine, one of the amino acids in protein. Phenylketonuria is a genetic disorder in which the body cannot fully break down phenylalanine. If levels of it get too high in the blood, mental retardation could result.
For most people, sugar substitutes are a safe alternative to sugar. They may be helpful, in reasonable amounts, with weight loss and weight management when they are part of a balanced, healthy diet.
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Sugar-free foods and drinks are lower in calories than their full sugar alternatives, but are they good options for weight loss? While sugar substitutes are generally safe, the debate about how they should be used continues.
Sugar Substitutes: A Short and Sweet History
The first sugar substitute, saccharin, was discovered in the late 1800s and gained prominence in manufacturing during the World Wars, when sugar was rationed. The business of sugar-free foods and drinks began to boom in the 1960s when clinicians realized the importance of controlling weight gain in the management of diabetes.
Since then, as people became more health-conscious and wanted to shun sugar, manufacturers responded with a host of sugar substitutes. They are:
• Aspartame, approved in 1981 by the U.S. Food and Drug Administration (FDA) and now in more than 6,000 foods and drinks
• Acesulfame-K, FDA-approved in 1988
• Sucralose (Splenda, SucraPlus), approved in 1998 for limited use and in 1999 for general use
• Neotame, approved in 2002
Other sugar substitutes are being developed, and many products contain a mix of sugar substitutes to enhance flavor. Each sugar substitute is several thousand times sweeter than sugar, but has a slightly different flavor. Whether you reach for the pink, blue, or yellow packet to sweeten your coffee is a matter of personal taste. Sugar substitutes are now so common that many people use them without consciously considering their use as a weight-loss strategy.
Sugar Substitutes: Their Role in Your Diet
As part of an overall healthy diet, sugar substitutes are believed to reduce calories and the risk of cavities. Interestingly, controlled studies that compare weight loss between people who use sugar substitutes and those who consume sugar show very little difference in weight loss between the two groups, although over the long term, sugar substitutes can help maintain weight loss.
Conscious calorie-cutting strategies can include sugar-free products. Replacing a sugary drink with a sugar-free drink will reduce your calorie intake, and cutting back by just one full sugar soda a day could result in losing over 1.4 pounds in 18 months. The key to losing weight using sugar-free products is to use them strategically.
Sugar Substitutes: How Much Can You Have?
A big question surrounding sugar substitutes is how much diet soda is safe to drink. Though you might never consider consuming this much in a day, the FDA says these are the maximum amounts allowable for daily consumption, listed by type of sugar substitute:
• Aspartame: 18 to 19 cans of diet soda
• Saccharin: 9 to 12 packets
• Acesulfame-K: 30 to 32 cans of diet soda
• Sucralose: 6 cans of diet soda
Sugar Substitutes: Reality Check
A realistic use of sugar-free products looks quite different.
A regular amount for a sugar substitute is two servings a day, says dietitian Liz Weinandy, RD, MPH, a dietitian in the non-surgical weight-loss program at Ohio State University Medical Center in Columbus. “My concern comes when people do multiple servings, like a six-pack of diet pop a day. Many times they are trying to use a sugar substitute in place of food. Some are very nutritious, like light yogurt, but while sugar-free soda doesn’t have calories, it also doesn’t have stuff in it that’s good for you.”
Further, consuming a lot of sugar-free drinks could hurt your weight-loss strategy. Studies show that when a sugar substitute is added to a product that has no other nutritional content (such as water), it increases hunger. This is true regardless of the type of sugar substitute used. Sugar substitutes in foods do not have this effect.
Sugar Substitutes: Who Should Avoid Them
While sugar substitutes are generally considered safe, Weinandy advises against giving children sugar-free foods and drinks — unless a doctor has said otherwise — and says pregnant women also should be cautious. “Drink water or fruit juice during pregnancy,” Weinandy suggests. “Limit diet pop to one per day at most.”
Additionally, people who have the disease phenylketonuria need to avoid aspartame, which contains phenylalanine, one of the amino acids in protein. Phenylketonuria is a genetic disorder in which the body cannot fully break down phenylalanine. If levels of it get too high in the blood, mental retardation could result.
For most people, sugar substitutes are a safe alternative to sugar. They may be helpful, in reasonable amounts, with weight loss and weight management when they are part of a balanced, healthy diet.
By Madeline Vann, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
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