Mind & Body
Diabetes Awareness Month
11/1/2018 11:29:56 AM
Diabetes Awareness

According to the Centers for Disease Control and Prevention, 40% of Americans live with diabetes or pre-diabetes. Louisiana ranks 4th in the nation for percentage of adults (13.6%) with diabetes. The good news is that, generally, especially with type II diabetes, these startling statistics can be changed through education and lifestyle changes, specifically diet, exercise, and weight loss. For those who already have the disease, they can learn and make changes that will improve their quality of life. And that is what this special section is all about. Read on . . . 

The Many Manifestations of Diabetes
by Keaghan P. Wier

What’s the first thing you think of when you think of diabetes? For most people, high blood sugar levels and insulin come to mind. However, diabetes can have a much wider impact. Like many long-term health issues, diabetes can affect all aspects of a person’s physical and mental wellbeing, with far-reaching consequences to many bodily systems and functions, especially if left untreated.

Type 1 Versus Type 2 Diabetes
Before diving into a discussion of the different manifestations of diabetes, it’s key to understand the difference between the two major types of diabetes. 

Type 1, also known as insulin-dependent or juvenile diabetes, is an immune system disorder – the body attacks the insulin-producing cells in the pancreas. This leaves the person dependent on insulin medication. 

Type 2 is typically a result of poor nutrition, lifestyle, or exercise habits. Also called insulin resistance, this type results from the pancreas ceasing to use insulin effectively. Sometimes, it leads to a need for insulin medication, if the person is unable to manage it through dietary or lifestyle changes.

Endocrine System
The inability to produce or process insulin can lead to the buildup of toxic chemicals in the body, which can result in diabetic ketoacidosis. This serious complication includes symptoms like extreme thirst, fatigue, and excessive urination. If left untreated, diabetic ketoacidosis can be fatal. High blood sugar levels and extra ketone bodies in a urine sample can confirm this diagnosis and aid in early treatment. Those with undiagnosed or untreated Type 2 diabetes may also struggle with diabetic hyperglycemic hyperosmolar syndrome, which involves high blood sugar levels but no ketone bodies. This can lead to dehydration and loss of consciousness.

Kidney Damage
The presence of proteins in a urine sample can result in an early diagnosis of diabetes-related kidney disease, called diabetic nephropathy. This occurs because the kidneys aren’t sufficiently filtering waste from the blood. Doctors can evaluate and monitor kidney function to prevent lasting damage.

Circulatory System & Nerve Damage
High glucose levels can have a significant impact on blood vessels, both large and small. Hardening of the arteries and the development of blockages can decrease blood flow to the brain and heart, raising the risk of strokes and heart attacks. 

Diabetes also raises the risk of high blood pressure, putting further strain on the heart. Those with diabetes should also monitor their cholesterol levels and avoid smoking.

Because of the restricted blood flow, some with diabetes eventually develop neuropathy – decreased sensation – in their hands and feet. It’s crucial to regularly check hands and feet for injuries, especially in the presence of significant neuropathy. 

Another instance of nerve damage from diabetes comes in the form of delayed stomach emptying and overall slowing of the digestive system. This can lead to bloating and constipation.

Diabetic retinopathy is a condition where the blood vessels at the back of the retina become swollen and leak, leading to possible damage to vision. However, it is treatable, especially when caught early – so it’s important to see an eye doctor regularly.

Impact on Skin
Because of nerve damage and poor circulation that can come with diabetes, many people struggle with dry skin and slower healing of cuts and burns. The skin may also be more prone to infections. All these are treatable, and once the blood sugar is under control, most issues will self-correct.

Mental & Social Impacts
In most case, diabetes is relatively straightforward in its treatment and maintenance. However, it requires self-regulation, lifestyle changes, and awareness of diet and medication timing. Though it may not ultimately be as isolating as some other health issues, that doesn’t make it easy. People with diabetes are at higher risk of depression. Supportive friends and family can play a big role in how well they care for themselves.

This is especially true of those with Type 2 diabetes; in addition to the lifestyle adjustments required, they often face stigma based on weight and diet. If a loved one has diabetes, make an extra effort to be supportive of them and not dismiss their frustrations or stress over their health. Listen to their worries about potential complications, and encourage them to seek out professional advice if they are concerned over a new symptom.

All in all, it is important to remember that most of these long-term effects only impact those with unmanaged diabetes. Seeking care and following the regimen put together by your doctor will help keep you healthy and happy.

Take Steps to Prevent Foot Problems from Diabetes
By Kristy Como Armand

Foot problems are a well-known risk associated with diabetes and the reality of the risks are quite serious. Diabetes is the number one cause of lower limb amputations in the United States, with over half of amputations performed caused by the disease. 

The disease can cause reduced blood flow to the feet, depriving them of oxygen and nutrients. This makes it more difficult for blisters, sores, and cuts to heal.  Diabetic nerve damage called peripheral neuropathy can cause numbness in your feet. "When you can’t feel cuts and blisters, you’re more likely to get sores and infections,” explains Dr. Tyson Green, foot and ankle specialist with the Center for Orthopaedics and medical director of CHRISTUS Wound Center. "If you don’t notice or treat these sores, they can become deeply infected. This is what typically leads lead to amputation. Unfortunately, having a toe, foot, or lower leg surgically removed is 10 times more likely in people with diabetes.”

As frightening as this sounds, Dr. Green stresses that serious foot problems are not an inevitable part of having diabetes. "At least half of the amputations related to diabetes each year could be prevented through proper care of the feet – and that’s a conservative estimate.  The key is learning about the risks for foot problems and making sure you do everything you need to do to prevent these potential complications.” 

Dr. Green offers the following tips for putting your feet first:

Check feet daily. 
Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. This is even more important if you have nerve damage or poor blood flow. Be sure you check between all of your toes because blisters and infections can start there, and if you have diabetic neuropathy, you may not feel them until they’ve become irritated or infected.

Wash with warm water. 
Wash your feet briefly each day with warm water. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet, and dry your feet well, especially between your toes. 

Make sure your shoes fit well. 
If you have diabetes, good shoes are an investment worth making. Even the slightest tightness or rubbing in the wrong place can cause a blister that could turn into a sore that won’t heal. Shop for shoes at the end of the day when your feet are bigger, and before buying or putting on shoes, check inside for rough edges or other irregularities that could hurt your feet. Also, when you get new shoes, break them in gradually by wearing them for short periods of time – an hour or two a day to make sure they don’t cause any problems.

No bare feet.
Always wear shoes or slippers, and always wear socks with your shoes. Direct contact with leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters. And although you might prefer the look of hose or thin socks, these don’t give your toes or heels enough protection.

Stay soft - but dry. 
High glucose levels can cause dry and cracked skin – this means double trouble for the feet.  It makes it easier for bacteria to get under the skin, and harder for infections to heal. Use a small amount of skin lotion daily, but be sure to rub it in well.  You want your feet to be dry, not damp or sticky, and you don’t want to get lotion in between your toes.”

Practice foot maintenance.
File corns and calluses gently with an emery board or pumice stone after your bath or shower, when skin is softer. Keep your toenails trimmed and filed smooth to avoid ingrown toenails.  It is best to cut them to the shape of the toe and not too short, and then to file the edges with an emery board.

Fix problems. 
If you have bunions (the big toe slants sharply in toward your other toes, with a big bump on the knuckle of your big toe), corns (spots of thick, rough skin on the toes), or conditions that make it difficult for shoes to fit properly, which can lead to blisters and other problems.  

Dr. Green says the underlying message of all these recommendations is to be extra vigilant about your feet if you have diabetes.  "It’s also important to talk to your doctor if you have any concerns, regardless of how minor it may seem. Tell them about any changes in sensation in your toes, feet, or legs. It’s far better to be overly cautious than to ignore a symptom that could be a sign of a serious problem. Your feet are your foundation for mobility and independence, and your doctor can only help you keep them healthy if you keep him or her informed.” 

For more information about diabetes and foot care, call Dr. Green at the Center for Orthopaedics, (337) 721-7236 or visit centerforortho.com. 

Dr. Tyson Green Receives "Master" Wound Care Designation

Dr. Tyson Green, foot and ankle specialist with Imperial Health Center for Orthopaedics, has been awarded the Master in Wound Care Certification from the American Professional Wound Care Association (APWCA). This certification is awarded once a year to recognize key opinion leaders who have impacted wound care through education, research and advocacy. Honorees are selected by an appointed APWCA committee and then approved by the Board of Directors. 

Dr. Green is board certified in foot and ankle surgery by the American Board of Podiatric Surgery and serves as the Medical Director of the CHRISTUS St. Patrick Wound Center and Program Director for the CHRISTUS St. Patrick Podiatric Medicine and Surgical Residency Program. He was recently elected President of the Louisiana Podiatric Medical Association (LPMA) and serves as the LPMA Delegate to the House of Delegates. Dr. Green is a member of the American Podiatric Medical Association, the American Diabetes Association and the American College of Foot and Ankle Surgeons.

The American Professional Wound Care Association® (APWCA) is a non-profit medical association recognized as a worldwide leader in clinician advocacy and education for the prevention and treatment of acute and chronic wounds. This association provides an informational and educational forum for healthcare providers, while promoting excellence in wound healing and patient advocacy.

Diabetes Support Groups

CHRISTUS Lake Area Hospital
CHRISTUS Lake Area Hospital offers Diabetes Education classes with a referral of a physician. Participants learn about diet management, blood sugar target levels, how to control blood sugar, diabetes medications, short and long-term effects of diabetes, and more. Located at 4200 Nelson Road. 
For more information, call Keidra Clark at 337-475-4075 or email keidra.clark@christushealth.org.

Beauregard Memorial Hospital
The Diabetes Nutrition Education Class meets monthly on the 3rd Wednesday 12:00 – 1:00 p.m. A diabetes-friendly lunch is provided along with informational handouts. The class is presented by Missy Hennigan, RDN, LDN. 
For more information, call (337) 462-7418.

Lake Charles Memorial Hospital
Don’t underestimate the importance of education and peer support when living with diabetes. Support group meets on the first Tuesday of every month from 10 a.m. until 11 a.m., in Memorial’s Diabetes Education Office. The office is located at 2804 Second Avenue. 
For more information, call (337) 494-6425.

West Calcasieu Cameron Hospital
West Calcasieu Cameron Hospital will host a free seminar on diabetes on Tuesday, November 13 from 10 a.m. until 12 p.m. at Dynamic Dimensions Fitness Center, 545 Cypress Street in Sulphur. "Living Well with Diabetes” will feature guest speakers Kevin Schlamp, MD, family medicine physician and Daniel T. Hall IV, DPM, Foot and Ankle Specialist. Lunch will be provided but seating is limited. The seminar is open to the public. 
Register by calling (337) 527-4282.

Diabetic? Get Your Flu Shot. That Goes for your Family, Too!
by Kristy Como Armand

The flu is a miserable condition for anyone, but for people with diabetes, it has the potential for far more serious complications. 

"Having the flu can increase your blood glucose level, and it may keep you from eating regularly, which also affects your blood sugar. Because your immune system is typically weaker, you may also have more severe flu symptoms,” says Dr. Jason Burklow, MD, family medicine specialist with Imperial Health. "Having a chronic condition like diabetes also puts you at higher risk for developing a secondary illness, such as pneumonia, that can be triggered by the flu.”
The Centers for Disease Control recommends that all diabetics get a seasonal flu shot, preferably during October or November to protect against the peak of flu season, which typically hits in January and February. "Even after that time, you should still get one,” stresses Dr. Burklow.

Although flu shots do not provide 100 percent protection, they do make it much less likely that you will get the flu for a period of about six months – the typical length of flu season. For extra safety, Dr. Burklow recommends those who live with a diabetic also get a flu shot, to decrease the risk of direct exposure.

"The flu virus is transmitted by contact, so avoid being near people you know are sick whenever possible. Use a tissue to cover your nose and mouth when coughing or sneezing, and throw the tissue away. Try not to touch your nose, eyes, or mouth to reduce the spread of germs, and keep hand sanitizer with you to use frequently throughout the day,” Dr. Burklow says. "If you know a flu outbreak is taking place in your community, try to avoid crowded areas to reduce your risk of exposure.”

If, in spite of all your precautions, you are diagnosed with the flu, there are steps you can take to minimize your risk of complications. It’s important to check your blood glucose more frequently – several times a day – during the course of the illness. "When you have the flu, you’re feeling tired and awful and may not be aware of your blood sugar soaring high or dipping low.  The flu may mask diabetes-related symptoms that you would normally notice right away,” warns Dr. Burklow.

Even if you feel sick and aren’t eating as much as usual, Dr. Burklow says you must continue to take your glucose-lowering medications. "Blood glucose may rise even without food during an illness because of hormone imbalances. Not taking enough insulin during an illness is a common cause of diabetic ketoacidosis.” He says you should also be aware that over-the-counter medicines may contain ingredients that can affect blood glucose levels, such as sugar, pseudoephedrine and alcohol, all of which can wreak havoc with glucose levels.

Loss of appetite or vomiting can make staying nourished an added challenge when fighting the flu. If your stomach is upset, Dr. Burklow advises trying to consume soft foods or drinks that contain similar carbohydrate levels to your normal diet. "If you are not able to do this, talk to your doctor about adjusting your diabetes medication. A big change in your food intake can affect the amount of medication that you need. Taking too much or too little can send blood sugar levels spiking too high or too low.”

Dr. Burklow says it’s important to say hydrated to fight the illness and prevent complications. "Drink plenty of calorie-free liquids, like water, and try sports drinks to help replace the carbs you are missing or losing. This may help prevent hypoglycemia.”

You should call your doctor if:  
  • You aren’t feeling better after a few days. 
  • Vomiting or diarrhea lasts for more than six hours.
  • Your blood glucose levels remain consistently above 250 mg/dl. 
  • You have signs of very high blood glucose like dry mouth, fruity breath odor, or disorientation.
  • Abdominal or chest pain is severe.
  • Breathing becomes difficult.
For more information about diabetes and the flu, call Dr. Burklow’s office at 
(337) 474-7290 for an appointment.

Helping Kids Manage Diabetes
by Christine Fisher

Over 200,000 children and teens in the United States have diabetes, according to the National Institutes of Health. While this life-long, chronic disease has no cure, by getting an early diagnosis and following a healthy exercise and nutrition plan, these individuals can live a long, healthy life.

"Diabetes is a serious condition and must be treated; but a diagnosis of diabetes today is not as negative as it used to be. Today, children with diabetes have more options for blood glucose testing and insulin administration than ever before and new developments and management techniques are becoming available,” says Dr. Sarah Hickey-White, pediatrician with The Pediatric Center of Southwest Louisiana and medical staff member of West Calcasieu Cameron Hospital.

Each year, more than 13,000 young people in the United States are diagnosed with type 1 diabetes. Also called juvenile diabetes, it occurs when the body stops producing insulin, which helps the body regulate the amount of glucose in the blood, or blood sugar.

"Insulin is a hormone that helps convert sugar, starch, and other food into energy. Diabetes prevents the body from making or using insulin. As a result, individuals with diabetes have high blood sugar levels, which prevent the body’s cells from obtaining the energy needed to function properly,” Dr. Hickey-White says. "If blood glucose levels are too high, your body could sustain serious damage, which can lead to amputations, blindness, and kidney and heart damage.”

As obesity rates in children continue to soar, type 2 diabetes, a disease that historically was seen primarily in adults over age 35, is becoming more common in young people. "The key reason for the rise in type 2 diabetes in children is the increasing number of children who are significantly overweight,” says Dr. Hickey-White. Childhood obesity rates have more than doubled in children and tripled in adolescents in the past 30 years, according to research published in the Journal of the American Medical Association.

"The bottom line is that today’s children engage in less activity and have access to more calories than children in past decades. The result is more overweight children and an increased risk for type 2 diabetes,” she explains.

The following are symptoms of diabetes in children:
  • Thirst and increased urination
  • Constant hunger and weight loss (especially unplanned weight loss even when a person is eating a lot) 
  • Blurred vision  
  • Feeling tired all the time 
  • The appearance of dark, thick, or velvety skin around the neck, armpits, or other folded skin surfaces (this is called acanthosis nigricans, and in type 2 diabetes, it may be the first physical sign of insulin resistance).
Dr. Hickey-White says children with diabetes require constant attention to eating habits, exercise, and monitoring of blood glucose levels. "Glucose control is the single most critical factor in assuring your child’s health and in preventing complications. Very young children often cannot recognize the symptoms of low blood sugar, which is why frequent blood glucose monitoring is especially important for them.”

Children with diabetes are not as restricted in what they can eat as they used to be in the past. "Eating at the same time every day helps to keep blood glucose levels steady. Depending on the insulin regimen, snacking between meals may be important. Children with diabetes can have sweet foods occasionally, so long as insulin doses are adjusted if needed,” she says.

Exercise is also a must to help lower blood sugar, so regular activity is an important part of treatment for children with diabetes. "There is no reason for them to sit on the sidelines during gym class or to avoid joining teams,” Dr. Hickey-White says.

Through diligent efforts from the child and the parents, along with guidance from a skilled pediatrician, a child with diabetes can have a full, rewarding life. 

For more information, call The Pediatric Center at 337-477-0935. Located at 2800 Country Club Rd, Lake Charles.

The Diabetic Diet - Good Nutrition Plays a Primary Role in Diabetes Management

Type II diabetes is quickly becoming an epidemic. Physicians are seeing adult-onset diabetes in patients as young as their early teens. Dr. Anatole Karpovs, a pediatrician and a certified culinary medical specialist, says, "The sad reality is most diabetes cases are preventable. We would much rather prevent the disease than have to treat it and put teens on potentially toxic medications for the rest of their lives.”

Establishing healthy eating habits from a young age is the key to disease prevention. When parents encourage whole plant foods and whole grains, their children have a much lower risk of developing diseases such as diabetes. "Parents need to make regular consumption of fruits and vegetables a normal thing if they want to avoid chronic diseases such as diabetes.”

Dr. Karpovs recommends the "Healthy Eating Plate” guidelines developed by the Harvard T.H. Chan School of Public Health. The guide can be viewed for free at hsph.harvard.edu/nutritionsource. "It is a simple way to visualize what constitutes a healthy meal for both adults and children,” says Dr. Karpovs. "I like it because the website is free and easy to understand, and is based on real science. They are not trying to sell you something.”

Dietary changes are the cornerstone to stopping diabetes. "We used to believe that type II diabetes was a death sentence. We are now learning that patients can halt the progress of the disease and even reverse it in some cases.”

"For a diabetic, blood sugar control is critical,” explains Dr. Karpovs. "That is best achieved by eating foods containing fiber and starchy carbohydrates. These foods usually have a low glycemic index.” Glycemic index is a measure of how rapidly a certain food raises blood sugars. The glycemic index can help give diabetics an idea of which types of foods to limit on their plates.

Extra care should be taken when consuming packaged foods. Manufacturers commonly add sugars and salt to increase sales. A diabetic must be savvy about reading labels and ingredient lists to make sure they aren’t eating something that will worsen their condition. The nutrition label will list sugars and "added sugars”. Avoid foods with large amounts of added sugars as this will quickly raise blood sugars. For breads, look for brands with the whole grain stamp printed on the label. "Don’t believe anything on the front of the package,” warns Dr. Karpovs. "Manufacturers can put almost any claim they want on the front. The first place I look when shopping is the nutrition facts label.”

Dr. Karpovs says that sugars aren’t the only food item that can affect diabetics. "Some recent evidence shows that diets high in animal fats can increase insulin resistance. This may be why some patients have been able to reverse type II diabetes completely by following a plant-based, whole food diet and exercising regularly.”

While a plant-based diet may seem unrealistic to some people, it may be the best way to control and reverse diabetes if medications don’t work or the side effects are too harsh. Dr. Karpovs practices a plant-based diet and has felt tremendous health and energy benefits including improved cholesterol and weight loss. "When I made the switch, I worried I wouldn’t find anything I liked. The opposite was true. I ended up eating a larger variety of foods and I found my tastes and preferences changed.”

Diabetes does not have to be a death sentence. Medications can help improve glucose control and with proper diet and exercise, many type II diabetics can overcome their disease and feel better. Dr. Karpovs believes it’s better to see diet as a lifestyle change. "Look at it as a way to treat yourself and not as depriving yourself. Life is too short to feel sick all the time.”
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