By: Jessica Cook MS RD LD CDE (Director of Education)
This time of year always reminds us of the things in our loves that make
us thankful. Whether you are thankful for your health, friends, family,
physician or pets, this season makes us realize that in our own ways we
are fortunate. Have you ever heard the saying “If we all put all
of our problems in a pile and read everyone else’s problems, we
would grab our problems back.” It is an interesting way to acknowledge
there are people less fortunate than you and allows you to view your problems
from a different perspective. So even if you are not the wealthiest, the
most handsome, the strongest or most educated individual think of all
the positive qualities about less or those that are less fortunate and
take time to thank everyone in your life, including yourself, for making
your life all that is has become.
Please enjoy this issue of our Healthy Living with Diabetes Newsletter to start celebrating this holiday season!
By: Rosemarie Steinsapir, MS, RD, CDE
The seriousness of a disease such as diabetes sometimes throws a person off track just by hearing the diagnosis. Healthcare professionals (doctors, nurses, and educators) most often put the patient on notice that he/she is responsible for managing the disease, regardless of the patient’s background or education level. Only those with official caretakers get off the hook for learning (such as, dementia patients.)
Sounds terrible, doesn’t it? No wonder people cry when they hear the diagnosis, get angry, or fight back suggesting “you’ve made a mistake, I don’t believe this!” Let me share this with you: healthcare professionals also get scared and upset when their own numbers trigger a diagnosis, and for exactly the same reasons.
Diabetes is complicated. It took me about 2 years after a master’s in nutrition and working in healthcare treating people with diabetes, to appreciate the depth of this disease in its relation to overall health. How can we expect so much skill and understanding from our patients?
Our patients are amazing!!! They actually do manage their disease! I’ve had patients in their 80’s and 90’s that have had diabetes for 25 plus years come in with logbooks that they were taught to keep from the first diagnosis. When I ask a patient with a log to tell me about it, he/she will point to the finger sticks they consider to be out of range. Eventually, I’m only fine tuning skills that have served them well over many years.
If you have just received the news that you are diabetic, you need an initial game plan to get you through the first year of learning. This is what I recommend for you to do (I numbered the steps because learning is about categorizing information):
Diabetes is complicated and it takes time to learn about it. One session
with anyone won’t be enough. Try to take the complete education
sessions designed just for you. If you can’t manage the long hours,
have trouble hearing, or need a slower pace, request a one-to-
one session with an educator. It should go without saying, but.., don’t bring your cell phone to any session. Learning in itself a skill: hear the sentences that are the key to good management. Try not to resist your doctor’s recommendations. An example of this might be the need for insulin. Who wants that, right? It’s never good for an educator to hear, “I stayed off insulin as long as I could.”(Everyone in healthcare will tell you delaying the right care is the worst option.)
- Learn your blood sugar goals. Just as you learned what your cholesterol levels should be, learn what normal is and where you should be to avoid the complications. The complications of diabetes are linked to your actual blood sugar numbers! (Read that sentence again.)
- Don’t wander off the doctor’s radar and show up a year after diagnosis. If you need help to accept what’s happening to you, ask for it. We have it!
- Nutrition and Food Science are also complicated. The list of foods-I-can-eat and its counterpart, foods-to-avoid list do not exist. Food management in good nutrition is portion size and what else is on the plate! Trying to simplify nutrition (instead of learning about each food and how to select a meal) doesn’t work. This is a science that overlaps many fields: physiology, agriculture, and human behavioral science. Understanding food and nutrition takes time and purpose.
- Your doctor assesses your well-being and how well your medication is working, based on your finger sticks! If you don’t supply the finger sticks your doctor requests, he or she will have to guess about your medication adjustment!
- Learn how to manage and time your medication. Diabetes medications dance around when and what you eat. The timing of these meds is important to controlling your blood sugar and how you feel. It is really important not to run out of medications at an awkward time (such as, on vacation out of the country). Setting up a review of your meds a week ahead gives you a chance to get a prescription refill during office hours.
- The long muscle of the leg (the quadriceps muscle that wraps into the hip) is your best friend to help you manage diabetes. Here is why: it takes tremendous energy to contract a big muscle. Muscle contraction of the quad happens when you are walking, gardening, washing the car, etc. In order to produce the energy to contract, the cells of this long muscle need carbohydrate/sugar and this need makes them especially sensitive to insulin. If you have sugar in your blood stream and you begin to move the quad, the cells are especially quick to take in the sugar and convert it to energy. Moving the quad brings your blood sugar down. I spent many years in the diabetes clinics at the VA hospitals. Soldiers who came back from service without a leg, or ended up in a wheelchair, usually ended up on insulin in a matter of months. The actor Christopher Reeves also ended up on insulin right away. Rethink your daily routine and add some quadriceps movement!
- Diabetes is a dehydrating disease. When your sugar is elevated, you are dehydrated. Staying hydrated is important to your thinking and how you feel. It’s especially easy to get dehydrated as you age. Always rehydrate using water versus artificially sweetened beverages!
- Diabetes is a metabolic disease. That means it is system-wide. It is not confined to one organ. It’s playing out between the food you eat and every cell in your body. Taking care of yourself if you have diabetes, means a more aggressive and assertive management of your own health. You will be the first person to notice skin problems, gum problems and eye problems. If you do notice a non-healing foot sore, act on it. Call the doctor’s office and say this, “I have diabetes and I have open skin on my foot. Can I be seen today?” If you can’t get in, go to the ER!! It is your foot. You walk on it.
Don’t expect learning to be over after the first year with diabetes.
New drugs, new delivery systems and new approaches to old problems become
available every year. Do expect and plan to use refresher courses, the
internet, and diabetes magazines to stay
If you discover a technique for diabetes management that makes things easier for you, please share it with the rest of us. We take our learning seriously and we are eager to have information about diabetes management that we can apply to help other patients.
By: Kort Knudson, M.D., F.A.C.E.
The thyroid gland tends to produce nodules. Currently, 2.5% of young men and 6-8% of young women have one or more thyroid nodules. The incidence increases with age. Fifty percent of people age 50 years, 60% of people age 60 years and 70% of people age 70 years have thyroid nodules.
Most thyroid nodules do not cause symptoms. Possible symptoms include a lump in the neck, hoarseness or pain. Many nodules are discovered as incidental findings on a CT scan, MRI or ultrasounds performed to look for other conditions. Nodules smaller than 1 centimeter cannot usually be felt, but can be detected by using ultrasound technology.
When a nodule is discovered, the first question is how likely is it that the nodule will be malignant? Usually 95% of nodules that are evaluated are benign. Because thyroid nodules are very common and most likely benign, we need a strategy to decide which nodules to continue to monitor and which nodules need to be removed.
Personal history, family history and laboratory tests can help, but the main test is an ultrasound of the thyroid. Even if the nodule was discovered by an ultrasound of the neck your physician will need to do a specific ultrasound of the thyroid to get a complete picture of the whole gland to look at the particular characteristics of the nodule.
If the ultrasound shows the nodule is large or has suspicious characteristics, then the next step is to determine whether the nodule can be monitored or should be removed through a fine needle aspiration biopsy. The biopsy is done in the office with a very small needle and there is usually minimal or no discomfort with no need for anesthesia.
The aspiration biopsy shows a benign picture 80% of the time and shows cancer only 5% of biopsies performed. There are special tests that can help determine the risk in the indeterminate cases.
The nodules that are small or benign on biopsy can be watched with repeat ultrasounds every 6 or 12 months. Ninety percent of nodules will increase with time. If they become large or grow by 20% in two dimensions, then they may be biopsied. Overall, thyroid nodules are common and most are benign, so we do want to be aware of them, but proper management almost always leads to a good outcome!
At Healthy Living with Diabetes we want to ensure that you are satisfied with all services received. We also would like your input on educational workshops that you would like us to offer, the information you would like to read about in Healthy Living with Diabetes Monthly or feedback on any workshop that you may have attended.
You can contact the director of education personally by email jcook@PBDES.COM or leave a message at (561) 513-5100. We would love to hear from you!