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Healthy Education

Diabetes

Type 1 Diabetes: Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. Type 1 diabetes is an autoimmune disease that results in the permanent destruction of insulin producing beta cells of the pancreas. Type 1 is lethal unless treatment with exogenous insulin via injections replaces the missing hormone. Formerly known as “childhood”, “juvenile” or “insulin-dependent” diabetes, it is not exclusively a childhood problem: the adult incidence of Type 1 is significant — many adults who contract Type 1 diabetes are misdiagnosed with Type 2 due to the misconception of Type 1 as a disease of children — and since there is no cure, Type 1 diabetic children will grow up to be Type 1 diabetic adults. There is currently no preventive measure that can be taken against type 1 diabetes. Most people affected by type 1 diabetes are otherwise healthy and of a healthy weight when onset occurs, but they can lose weight quickly and dangerously, if not diagnosed in a relatively short amount of time. Diet and exercise cannot reverse or prevent type 1 diabetes. However, there are clinical trials ongoing that aim to find methods of preventing or slowing its development.

Type 2 Diabetes Mellitus is often referred to as adult onset diabetes or noninsulin dependent diabetes mellitus. This is a disease state in which glucose is not able to move efficiently from the blood to the cells. There are two possible causes. First, the pancreas produces enough insulin but the insulin is not effective in removing glucose from the blood. Second, the pancreas eventually may not produce enough insulin to properly remove glucose from the blood

Obesity

Obesity has become a global epidemic contributing to an estimated 112,000 avoidable deaths per year in the USA. Obesity alone is a significant risk factor for dying from a heart attack, regardless of whether other known risk factors are present.

Obesity also contributes to other serious health conditions including high blood pressure, high cholesterol, Type II diabetes, gallbladder disease, osteoarthritis, sleep apnea, and respiratory problems, as well as endometrial, breast, prostate, and colon cancers.

Interpretation of BMI for adults

For adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for all ages and for both men and women. For children and teens, on the other hand, the interpretation of BMI is both age- and sex-specific. For more information about interpretation for children and teens, visit Child and Teen BMI Calculator.

The standard weight status categories associated with BMI ranges for adults are shown in the following table.

How reliable is BMI as an indicator of body fatness?
The correlation between the BMI number and body fatness is fairly strong; however the correlation varies by sex, race, and age. These variations include the following examples: 3, 4

• At the same BMI, women tend to have more body fat than men.
• At the same BMI, older people, on average, tend to have more body fat than younger adults.
• Highly trained athletes may have a high BMI because of increased muscularity rather than increased body fatness.

It is also important to remember that BMI is only one factor related to risk for disease. For assessing someone’s likelihood of developing overweight- or obesity-related diseases, the National Heart, Lung, and Blood Institute guidelines recommend looking at two other predictors:

• The individual’s waist circumference (because abdominal fat is a predictor of risk for obesity-related diseases).
• Other risk factors the individual has for diseases and conditions associated with obesity (for example, high blood pressure or physical inactivity).

For more information about the assessment of health risk for developing overweight- and obesity-related diseases, visit the following Web pages from the National Heart, Lung, and Blood Institute:

• Assessing Your Risk
• Body Mass Index Table

“WHAT IS METABOLIC SYNDROME X”?

A commonly accepted definition of “Syndrome X” might be a generalized disorder whose four hallmark symptoms are hyperglycemia, hyperlipidemia, hypertension and central obesity. Presenting with two of the above is generally considered the diagnostic criteria for this disorder. Gerald Reaven, MD (Professor Emeritus -Active of Medicine at Stanford University) was the first to use the term in 1988, saying he preferred it to names like “Metabolic Syndrome” or the “Deadly Quartet”. He said “many of the manifestations of the disorder might not be considered ‘metabolic’ (i.e. increases in plasminogen activator inhibitor –1 (PAI-1) a factor regulating the process of fibrinolysis), and the “Deadly Quartet” implies obesity is an essential component while many very obese persons may have nothing resembling the syndrome (Sumo wrestlers may be an example)”.

Semantics aside, the real significance of Dr. Reaven’s work was to establish, for the first time, the link between insulin resistance (primarily with regard to insulin stimulated glucose disposal by muscle and insulin regulation of lipolysis in adipose tissue) and the four hallmark symptoms of this syndrome. He reasoned that insulin’s first function will always be to mediate glucose uptake by the muscles. If glucose levels remain elevated (due to the muscles’ insulin resistance), the pancreas will continue to produce more insulin in an attempt to control the high glycemia. Complications now appear because many of the other tissues/organs still retain their sensitivity to insulin.

The kidney is a good example. Insulin stimulates sodium retention by the kidney, thus contributing to water retention and hypertension. Dr. Reaven cites polycystic ovary syndrome (hypersecretion of androgens from the ovary) as another example of insulin sensitive organs being affected.

1. Glucose intolerance: Individuals with Syndrome X don’t have diabetes, by definition, but their plasma glucose concentration is higher than those individuals who don’t have Syndrome X.
2. Dyslipidemia: The characteristic findings are high plasma triglycerides and low HDL-cholesterol. The insulin resistance and compensatory hyperinsulinemia cause the liver to produce more triglyceride rich VLDL, thus increasing the plasma triglyceride concentration. Cholesterol ester transfer protein (CETP) transfers cholesterol from HDL to VLDL, exchanging it for triglycerides. Therefore, the HDL cholesterol falls. The increased VLDL also reduces the ability to remove postprandial newly absorbed chylomicrons. In Syndrome X, VLDL, chylomicrons and their metabolic remnants (chylomicron and VLDL remnants) are removed more slowly from the plasma by virtue of their increased concentrations, resulting in increased postprandial lipemia. In addition, there is a shift in the LDL particle diameter to smaller and denser LDL particles.
3. Uric acid metabolism: There is a tendency to increased serum uric acid concentration. There is a decrease in the ability of the kidney to excrete uric acid; therefore, renal uric acid clearance is decreased.
4. Kidney manifestation: There is an increased salt retention. It appears that half the patients with hypertension are insulin resistant. From population-based studies, the best predictor of hypertension developing has been hyperinsulinemia as a surrogate measure of insulin resistance.
5. Hemodynamic manifestations: There is evidence that the sympathetic nervous system activity is increased in insulin resistant individuals. This is another example of other tissues reacting to the hyperinsulinemia.

ibrinolytic changes: There is an increase in PAI-1, with a resultant decrease in fibrinolysis. The increase in fibrinogen tends to increase coagulation.

All of these manifestations can have some role in the development of coronary heart disease.
By Michael P. Ciell, R.Ph.

PCOS and Insulin Resistance

What You Need to Know About PCOS and Insulin Resistance

By Nicole Galan, RN, About.com Guide

Insulin Resistance

PCOS1 and insulin resistance are frequently found together, which makes it important to understand this common problem. Insulin2 is a hormone which is produced by the pancreas, a gland in the abdomen with a lot of functions. It is typically secreted in response to a large amount of glucose3, or sugar, in the blood. Once produced, insulin causes glucose to be taken into the body cells to be used for energy. Women with PCOS frequently have insulin resistance, meaning their body does not respond as quickly to insulin. The sluggish response will cause larger and larger amounts of insulin to be required before glucose is taken into the body tissues, and eventually a change in the way the body deals with sugar. Consistently high levels of glucose in the blood can lead to diabetes.

Click here to read the full article and more about screening and prevention.

11 Weight Loss Tips Leading to a Healthier Life

1.  Drink Your Water:
   It’s important to stay well hydrated on a diet.  People often mistake thirst for hunger.  So, the next time you get a hunger pang, drink a glass of water first to make sure you’re really hungry.
2.  Remove Sugar
   If you want to lose weight, you have to remove the SUGAR. Sugar makes it easy for our bodies to store fat. Removing sugar out of your life is an easy way to shed and keep off the pounds. Sugar is found in many forms, so if you are trying to reduce sugar intake you also have to stop eating the foods that act like sugar in our bodies, making it harder to store fat. For a complete list of these foods, go to our Healthy Living section.
3.  Eat Smaller Portions (use a scale)
   America is getting BIGGER and with the advent of “super-size” meals and increasingly huge portions and all you can eat restaurants, our concept of normal serving sizes is a distant memory. Be mindful of the amount of food you consume at a sitting. When possible, use a scale and avoid the “super-size” meals and huge portions when eating out.
4.  Keep a Journal
   Write down what you eat in a journal. This helps you stay aware of whether your meals are balanced, how frequently you’re eating, and how many calories you’re consuming. Meal planning is necessary for managing a balanced and calorie controlled diet.

5.  Eat Your Vegetables (replace starchy food) 
   Vegetables are a 5-star food. Not only are they low in calories, they are high in fiber. Vegetables are a great replacement for rice, pasta and other starchy foods during weight loss. Non-starchy vegetables are the best selection for weight loss; they include asparagus, broccoli, cauliflower, cabbage, cucumbers, field greens, spinach and more.
6.  Get Enough Protein
   Protein is the best fill-me-up food. It’s more satisfying than carbohydrates or fats and keeps you feeling full for longer. Protein also helps preserve muscle mass and encourages fat burning. So be sure to include healthy proteins like lean meat, sugar free yogurt, cheese, nuts, or beans into your meals and snacks.
7.  Limit Late Night Snacking
   Evening snacking occurs most often after dinner, when you finally sit down and relax. Snacking while reading or watching TV is one of the easiest ways to throw your diet off course. The best advice is to not snack after dinner. Or, allow yourself a low-calorie snack like fruit, low-fat cheese or a sugar free yogurt with a serving size of about 100 calories.
8.  Get Your Sleep
   Get your sleep! Without proper sleep (7.5 hours), your body overproduces the appetite-stimulating hormone ghrelin and under-produces the hormone leptin, which tells you when you’re full. Proper sleep makes you feel refreshed, full and limits unnecessary snacking.
9.  Alcohol
   If you enjoy drinking, be aware that calories add up quick – a five-ounce glass of wine has 125, a bottle of beer about 153. Alcohol increases our blood sugar levels, causing the pancreas to secrete insulin to stabilize blood sugars, enabling our body to store fat, thus leading to weight gain if alcohol is used in excess. Consider limiting drinking for the weekend and keep it to a drink or two each night.

5.   Get Moving
   Regular exercise is an important part of effective weight loss. It helps to control your weight by using excess calories that otherwise would be stored as fat. Physical activity also helps prevent many diseases and improve your overall health. Regular exercise can help prevent heart disease, stroke, high blood pressure, diabetes, back pain and osteoporosis. Enjoy your exercise routine whatever it may be; sports, a trip to the gym, bike riding, walking, household chores, yard work, or work-related tasks — all are beneficial.
6. See a Professional or Join a Weight Loss Program
   Getting support can help you reach your weight loss goals. Talk with a weight loss specialist or join a weight loss program to get the help and support you need to make the changes to lead a healthier lifestyle. When you feel like giving up, they will help you, keep you honest, and cheer you on, making the whole experience a lot easier.  Call and sign-up today at (518) 793-5555.