Tag: health

Sheri Colberg: Things that can unbalance your blood sugars

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girl with a cold

Physical Activity Is Only One Part of the Equation

 

By Sheri Colberg, Ph.D.

 

Although a single bout of exercise usually improves insulin action for 2 to 72 hours afterward, the effect also depends on how much you eat before, during, and after working out, how you manage your diabetes medications (particularly insulin), your prior control over your blood glucose levels, how much sleep you get, whether you’re stressed out or not, etc. As you can imagine, it’s not easy to manage and predict all of the possible effects of these various things.

Sometimes it feels like stress can override any or all benefits you were supposed to receive from being active. Getting upset, angry, anxious, frustrated, sad, or depressed can basically erase your improvements in insulin action, although on the flip side, working out can also lower many of those negative feelings if you exercise after they occur. Not only is exercise an acute mood enhancer, but it also allows you to get tired enough that you don’t have as much energy to devote to sustaining your negative emotions.

Having a nasty cold last week also reminded me that simply being sick—even moderately so—can really wreak havoc on blood glucose levels. For me, exercising doing anything other than moderate walking is hard when I’m sick, and you really shouldn’t exercise much or intensely when you’re sick anyway or you can make your illness worse.

Exercise acutely lowers the concentration of illness-fighting immune cells in the bloodstream, and simply overtraining can increase your risk of getting colds and the flu. If you normally use exercise to manage your blood glucose levels more effectively and you’re deprived of doing that while sick, you can often find yourself dealing with not just one thing (illness) that can raise your blood glucose, but two at the same time (lack of exercise being the second). On top of that, you may not be sleeping as well as normal because of being sick, and lack of sleep raises insulin resistance as well. Nothing like a simple cold to throw your whole diabetes regimen out of whack!

It’s also so incredibly easy to override the effects of your last workout with food. You may not want to focus on how much/long you have to exercise to expend enough calories to equal what you eat on a daily basis (it’s a whole lot!), but suffice it to say that most people overestimate the impact of their exercise and underestimate the calorie content of the foods. Most people have to walk at least a mile to burn off close to 100 calories. A modest handful of nuts has closer to 200 calories, and get a burger at a fast-food restaurant and you’ll probably take in over 1,000 calories. Just keep in mind that food can easily have an even greater impact on your blood glucose levels unless you’re one of those avid exercisers that exceeds the daily recommended amounts (30 minutes of moderate activity) by exercising hours a day.

If you already exercise regularly, sometimes you fail to get the same glucose lowering effect as someone who is just starting out with training. With training, your body becomes adapted to the activity, which can make fat use higher and blood glucose use lower during the same activity. So, what used to really feel like it revved up your insulin action afterwards may not do much for you anymore, and when you don’t do your usual activities, you pay the price of having to deal with rising blood glucose levels unless you up your medications or cut back your food (or both).

It may sound like I’m trying to talk you out of exercising regularly to help with diabetes management, but really nothing could be farther from the truth. I’m simply warning you that life can throw many different monkey wrenches into your usual responses, so go easy on yourself when you don’t get it right every time. Lose the guilt, and just manage your blood glucose levels the best you can on any given day and stay active for your overall health.

In addition to my educational web site, Diabetes Motion (www.diabetesmotion.com), I also recently founded an academy for fitness and other professionals seeking continuing education enabling them to effectively work with people with diabetes and exercise: Diabetes Motion Academy, accessible at www.dmacademy.com. Please visit those sites and my personal one (www.shericolberg.com) for more useful information about being active with diabetes.

Eric Barker: How to make friends as an adult

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friendship gibran

 Originally posted in Welcome to the Barking Up The Wrong Tree weekly update for February 19th, 2017.

This Is How To Make Friends As An Adult: 5 Secrets Backed By Research

Click here to read the post on the blog or keep scrolling to read in-email.

When you were a kid it was a lot easier. In college you almost had to be trying not to make friends. But then you’re an adult. You get busy with work. Your friends get busy with work. People get married. Have kids. And pretty soon being “close” means a text message twice a year.

You’re not alone… Or, actually, the whole point of this is you really may be alone. But you’re not alone in being alone. These days we’re all alone together. In 1985 most people said they had 3 close friends. In 2004 the most common number was zero.

Via Social: Why Our Brains Are Wired to Connect:

In a survey given in 1985, people were asked to list their friends in response to the question “Over the last six months, who are the people with whom you discussed matters important to you?” The most common number of friends listed was three; 59 percent of respondents listed three or more friends fitting this description. The same survey was given again in 2004. This time the most common number of friends was zero. And only 37 percent of respondents listed three or more friends. Back in 1985, only 10 percent indicated that they had zero confidants. In 2004, this number skyrocketed to 25 percent. One out of every four of us is walking around with no one to share our lives with.
Friends are important. Nobody would dispute that. But I doubt you know how very important they are.

So let’s see just how critical friends can be — and the scientifically backed ways to get more of them in your life…

Loneliness Is A Killer

When people are dying, what do they regret the most? Coming in at #4 is: “I wish I had stayed in touch with my friends.”

And neglecting your friends can make those deathbed regrets come a lot sooner than you’d like. When I spoke to Carlin Flora, author of Friendfluence: The Surprising Ways Friends Make Us Who We Are, she told me:

Julianne Holt-Lunstad did a meta-analysis of social support and health outcomes and found that not having enough friends or having a weak social circle is the same risk factor as smoking 15 cigarettes a day.
Maybe your grandparents lived to 100 and you take good care of yourself. You’re healthy. But if you want those years to be full of smiles, you need to invest in friendship. 70% of your happiness comes from relationships.

Via The 100 Simple Secrets of Happy People:

Contrary to the belief that happiness is hard to explain, or that it depends on having great wealth, researchers have identified the core factors in a happy life. The primary components are number of friends, closeness of friends, closeness of family, and relationships with co-workers and neighbors. Together these features explain about 70 percent of personal happiness. – Murray and Peacock 1996
The Grant Study at Harvard has followed a group of men for their entire lives. The guy who led the study for a few decades, George Vaillant, was asked, “What have you learned from the Grant Study men?” Vaillant’s response?

That the only thing that really matters in life are your relationships to other people.
So friendships are really really really important. But maybe you’re not worried. Maybe you have lots of friends. Guess what?

In seven years, half of your close friends won’t be close to you anymore.

Via Friendfluence: The Surprising Ways Friends Make Us Who We Are:

A study by a Dutch sociologist who tracked about a thousand people of all ages found that on average, we lose half of our close network members every seven years. To think that half of the people currently on your “most dialed” list will fade out of your life in less than a decade is frightening indeed.
Ouch. Scared yet? I am.

(To learn an FBI behavior expert’s tips for getting people to like you, click here.)

So what do we do? (No, going back to college is not the answer.) How do we make new friends as adults?

1) The New Starts With The Old

The first step to making new friends is… don’t. Instead, reconnect with old friends:

These findings suggest that dormant relationships – often overlooked or underutilized – can be a valuable source of knowledge and social capital.
Doing this is easy, it’s not scary, they’re people you already have history with, and it doesn’t take a lot of time or work to get to know them. Go to Facebook or LinkedIn for ideas and then send some texts. Boom. You already have more friends.

If you’re going to be strategic, who should your prioritize? You probably met a disproportionate number of your friends through just a handful of people. Those are your “superconnectors.”

Rekindle those relationships. And then ask them if there’s anyone you should meet. Next time you get together, see if that new person can come along. Not. Hard. At. All.

(To learn how to deal with a narcissist, click here.)

But maybe this feels a little awkward. Maybe your friendship muscles have atrophied. Maybe you weren’t great at making friends in the first place. So what really makes people “click”?

2) Listen, Seek Similarity, and Celebrate

Clicking with people is a lot less about you and a lot more about focusing on them. Don’t be interesting. Be interested. And what are the best ways to do that?

Listen, Seek Similarity, and Celebrate.

Studies show being likable can be as easy as listening to people and asking them to tell you more.

And mountains of research show similarity is critical. So when they mention something you have in common, point it out.

Finally, celebrate the positive. When someone talks about the good things in their life, be enthusiastic and encouraging.

Via The Myths of Happiness:

The surprising finding is that the closest, most intimate, and most trusting relationships appear to be distinguished not by how the partners respond to each other’s disappointments, losses, and reversals but how they react to good news.
(To learn more about how to be someone people love to talk to, click here.)

Alright, your superconnectors are making introductions and you’re clicking. But how do you get close to these new people? We’ve all met people we thought were cool… but just didn’t know how to take it to the next level and go from acquaintance to friend. It’s simple, but not necessarily easy…

3) Be Vulnerable

Open up a bit. Don’t go full TMI, but make yourself a little bit vulnerable. Nobody becomes besties by only discussing the weather.

Close friends are what leads to personal discussions. But personal discussions are also what leads to close friends.

Via Click: The Magic of Instant Connections:

Allowing yourself to be vulnerable helps the other person to trust you, precisely because you are putting yourself at emotional, psychological, or physical risk. Other people tend to react by being more open and vulnerable themselves. The fact that both of you are letting down your guard helps to lay the groundwork for a faster, closer personal connection.
Close friends have a good “if-then profile” of each other. Once you have an idea of “if” someone was in situation X, “then” they would display behavior Y, that means you’re really starting to understand them. And this leads to good friendships:

People who had more knowledge of their friend’s if-then profile of triggers had better relationships. They had less conflict with the friend and less frustration with the relationship.
How many close friends do you need? If we go by the science, you want to aim for at least five.

Via Finding Flow: The Psychology of Engagement with Everyday Life:

National surveys find that when someone claims to have five or more friends with whom they can discuss important problems, they are 60 percent more likely to say that they are ‘very happy.’
(To learn the lazy way to an awesome life, click here.)

So you have new friends. Awesome. Now how do you not screw this up?

4) Don’t Be A Stranger

First and foremost: make the time. What’s the most common thing friends fight about? Time commitments.

Via Friendfluence: The Surprising Ways Friends Make Us Who We Are:

Daniel Hruschka reviewed studies on the causes of conflict in friendship and found that the most common friendship fights boil down to time commitments. Spending time with someone is a sure indicator that you value him; no one likes to feel undervalued.
You need to keep in touch. (Remember: not keeping in touch is how you got into this problem in the first place.)

If you want to stay close friends with someone, how often do you need to check in? Research says at least every two weeks.

(To learn the four rituals neuroscience says will make you happy, click here.)

So even if you need to set a reminder on your calendar, check in every two weeks. But, actually, there’s a better way to make sure you don’t forget…

5) Start A Group

Denmark has the happiest people in the world. (I’m guessing Hamlet was an exception.) Why are Danes so happy? One reason is that 92% of them are members of some kind of social group.

Via Engineering Happiness: A New Approach for Building a Joyful Life:

The sociologist Ruut Veenhoven and his team have collected happiness data from ninety-one countries, representing two-thirds of the world’s population. He has concluded that Denmark is home to the happiest people in the world, with Switzerland close behind… Interestingly enough, one of the more detailed points of the research found that 92 percent of the people in Denmark are members of some sort of group, ranging from sports to cultural interests. To avoid loneliness, we must seek active social lives, maintain friendships, and enjoy stable relationships.
And what’s the best way to make sure you’re in a group? Start one. That makes it a lot easier to stay in touch and a lot easier to manage those big 5 friendships with 20% of the effort.

A weekly lunch. A monthly sewing circle. A quarterly movie night. Whatever works. Friends bring friends and suddenly it’s not so hard to meet cool new people. And who does everyone have to thank for this? You.

And make the effort to keep that group solid for everyone. Many studies show older people are happier. What’s one of the reasons? They prune the jerks out of their social circles:

Other studies have discovered that as people age, they seek out situations that will lift their moods — for instance, pruning social circles of friends or acquaintances who might bring them down.
(To learn the 6 rituals ancient wisdom says will make you happy, click here.)

Alright, popular kid, we’ve learned a lot. Let’s round it up and find out how to keep your new friendships alive over the long haul…

Sum Up

Here’s how to make friends as an adult:

  • The new starts with the old: Touch base with old friends and leverage your superconnectors.
  • Listen, seek similarity and celebrate: Don’t be interesting. Be interested.
  • Be vulnerable: Open up a bit. Form an “if-then” profile.
  • Don’t be a stranger: Check in every two weeks, minimum.
  • Start a group: Things that are habits get done. So start a group habit.

What does Carlin Flora, author of Friendfluence, say is the number one tip for keeping friendships alive?

Reach out to your good friends and tell them how much they mean to you. It’s just not something we’re accustomed to doing. It’ll make you feel great, it’ll make them feel great and it will strengthen the bond between you. Be more giving to the friends you already have. People in romantic relationships always celebrate anniversaries, yet you might have a friend for 15 years and you’ve probably never gone out to dinner and raised a glass to that. We need to cherish our friendships more.
Okay, you’re done reading. Time to start doing. Reach out to a friend right now. Send them this post and let’em know you want to get together.

Listen to what they’ve been up to. Celebrate their good news. Offer to help them out with something.

After all, that’s what friends are for.

Please share this. (It’s a very friendly thing to do.) Thank you!

 

Thanks for reading!
Eric
PS: If a friend forwarded this to you, you can sign up to get the weekly email yourself here.

What’s new in the prevention of the microvascular complications of diabetes?

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Apart from blood sugar control what’s new in the prevention of the microvascular complications of diabetes?

 eye-eyelashes-face-woman-63320

Retinopathy

At diagnosis, 10.5% of type two diabetics already have retinopathy. New research has shown that severe proliferative diabetic neuropathy can be predicted by measuring the size of retinal blood vessels, but this is still being developed in research centres. It could become a part of the usual screening process in the future.

Lowering blood pressure in those who are hypertensive by at least 10 points, can reduce the onset of retinopathy but does not affect the rate at which it develops into proliferative retinopathy. What does seem to work is the use of oral Fenofibrate.

Laser photocoagulation reduces the rate of progression of proliferative retinopathy and the onset of severe visual loss. Direct injection of drugs that inhibit Vascular Endothelial Growth Factor such as pegaptanib, ranibizumab, and bevacizumab also help but they are less freely available, due to cost.

dialysis

Nephropathy

NICE recommend spot urinary albumin to the creatinine ratio and glomerular filtration rate on diagnosis and then yearly. If the rate is raised on 2 out of 3 samples within six months then nephropathy is confirmed and the severity graded.

Blood pressure targets are 140/90 for those without nephropathy and 130/80 for those that have it. Some people may benefit from lower blood pressure targets of 120 systolic such as Asian, Hispanic and African American populations.

Both ACE inhibitors and Sartans (ARB) reduce nephropathy and ACE inhibitors also improve all- cause mortality.  These drugs are the first choice for most diabetics when prescribing anti-hypertensives.

Early referral to a nephrologist showed an improvement in interventions and mortality rates. There was also a small improvement in kidney function when the new drug Dapagliflozin was used.

foot-1199763_960_720.jpg

Neuropathy

There are other causes of neuropathy that may need to be considered before diabetic neuropathy is diagnosed. These are: alcohol, chemotherapy, vitamin B12 deficiency, hypothyroidism, renal disease, paraneoplastic syndromes due to eg multiple myeloma and bronchogenic carcinoma, HIV infection, chronic inflammatory demyelinating neuropathy, inherited neuropathies and vasculitis.

A new Japanese drug Epalrestat improved diabetic neuropathy but did not improve autonomic neuropathy.

There was insufficient evidence to show that exercise, pulse infrared light therapy, education about foot ulceration and complex interventions such as combining patient education, podiatry care, foot ulceration assessment, motivational coaching to provide self- care, worked or not.

 

BMJ 4th February 2017 Willy Marcos Valencia and Hermez Florez from Miami Florida.

 BMJ 2017;356:i6505

Obesity raises the risk of cancer

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cancer

Obesity is strongly associated with eleven different cancers.

These are: oesophageal, multiple myeloma, stomach, colon, rectum, biliary tract, pancreas, breast, endometrium, ovary and kidney.  For many cancers there seems to be a dose response.

This was found by Kyrgiou and colleagues by studying over 95 meta-analyses from various sources.

The BMJ reports, “The unavoidable conclusion is that preventing excess adult weight gain can reduce the risk of cancer. Furthermore, emerging evidence suggests that excess body fat in early life also has an adverse effect on the risk of cancer in adulthood. Clinicians, particularly those in primary care, can be a powerful force to lower the burden of obesity related cancers, as well as the many other chronic diseases linked to obesity such as diabetes, heart disease and stroke. The data are clear. The time for action is now.”

As a GP, I don’t really think that I am a “powerful force” that can turn the obesity epidemic round. It is amazing what faith the authors Yikyung Park and Graham Colditz have regarding our abilities.

 

Adapted from Adiposity and cancer at major anatomical sites BMJ 2017; 356:j477 and BMJ 2017;356:j908

What being frail means

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Miss Havisham

Getting older and frailer is something that we are all going to experience unless we die of something else. We are liable to lose weight, particularly muscle mass, tire very easily, have muscle weakness and be unable to perform our usual activities, and we will walk, if at all, much more slowly.

Along with the obvious external signs, our hearts, kidneys, immune system and bones will weaken. We are more likely to become diabetic, get dementia and other neurological disorders, break bones and get cancer. Our senses dull too, with poor vision, hearing and balance problems. Our appetites dull and we will eat less.

In the USA, a quarter of over 65s are considered frail. Other disease processes could be going on as well as simply getting more frail with age.  Poverty, lonliness, poor diet, polypharmacy and cognitive decline make the situation worse.

More than 70% of frail people have two or more chronic diseases. The commonest are hypertension and osteoarthritis. Insulin resistance leads to type two diabetes. The combination makes falls and fractures more likely than people with simple frailty.

Cardiac failure, anaemia, osteoporosis occur. Parkinson’s disease, Alziehmer’s, Vascular Dementia and Depression are several times more common in the frail population. Cancers, infections and a poorer response to vaccination occur.

Drug reactions are more of a problem in this group of people. They have accumulated more diseases and symptoms and thus more drugs, but they also have a lower body mass and poorer kidney and liver function so that drugs accumulate more easily in the system.  Some drugs cause confusion, instability and falls. A study in a geriatric day hospital showed that on average a person was on 15 different medications and that you can expect about nine of these to have the potential for some problem.

Diogenes and Havisham syndrome refers to a situation where an elderly person lives in socially isolated and filthy conditions. They continue to neglect themselves and are resistant to change. This is more common in those suffering from dementia.

Pressure ulcers may occur unless nursing care is of a very high standard.  Elder abuse can sometimes occur when demands on carers exceed what they can provide.

Although a major sign of frailty is weight loss, you can get a condition called sarcopenic obesity. The person still has too much body fat, but the muscle mass is very low. This population is increasing in numbers as the obesity epidemic continues.

The more frail a person is, the less well they come through surgery successfully.

Hypothermia is more likely in frail people, particularly older age groups, women, more chronic disease eg diabetes, social isolation and those who have sustained a hip fracture.

So, not too much to look forward too! I hope this information will help those of you who care for elderly relatives. When we are looking after ourselves, it is important to keep our muscle mass up to reduce sarcopenia and the difficulty mobilising that is a cardinal sign of the problem of normal aging.

 

Adapted from Frailty Syndrome- Medico legal considerations. Roger W. Byard, University of Adelaide, Australia. Printed in Forensic and Legal Medicine. Volume 30 Pages 34-38. Elselvier.

Dame Sally Davies reports on the health of Baby Boomers: and it’s pretty shocking stuff

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dame-sally

The Chief Medical Officer of England has released a report into the health of Baby Boomers. This is the group of people born between 1945 and 1965. I’m one of them, maybe you are too.

We are living longer but are not really in better health. A huge burden of cardiovascular disease and cancers would be reduced if we looked after ourselves better by not smoking, eating better, keeping slim,  exercising, and drinking less.

Obesity and diabetes are increasing markedly through all classes of society. Obesity, particularly central obesity, is increasing. By waist size alone 80% of us are obese!

Liver cancer is now making an impact on deaths. 

Diseases that don’t kill but make you unfit to work and miserable include musculo-skeletal problems, visual and hearing loss. These are having a considerable effect.

Smoking is reducing but more than 6 out of ten smokers say that they have NEVER been advised to stop smoking by a doctor or nurse in their entire lives. Dame Sally thinks this is shocking. I think these smokers have shockingly bad memories.

Men are drinking less than 20 years ago but women are drinking more. The new guideline is less than 14 units a week for everyone.

One thing we are doing less of is physical activity and exercise. This is down from even just ten years ago with two thirds of Baby Boomers doing less than 30 minutes of exercise in the last month.

 

Here is a large chunk of the report:

Physical health

A key finding is that whilst life expectancy in 2013 increased compared with that of men and women in the same age group in 1990, overall morbidity remained unchanged. This means that we live longer but our health and well-being has not actually improved.

The data report substantially decreased death rates from each of the leading causes of disease in both male and female adults aged 50–69 years in 2013 compared with people who were in the same age group in 1990. These declines in mortality are success stories.

In particular, mortality rates from ischaemic heart disease (IHD) fell by over three- quarters in 50–70 year-olds during this time. Nevertheless, the fact that it still remains the leading cause of mortality in this age group is indicative of another issue; the leading risk factors for premature mortality in this group are IHD risk factors that are all modifiable, the top three being smoking, poor diet and high body mass index. The cancer types (oesophageal cancer in men, uterine cancer and liver cancer) that thwart the downward trend in premature mortality from cancer also have associations with modifiable risk factors such as alcohol and obesity.

In terms of morbidity, risk factors responsible for a remarkable 45% of disease burden in 50–69 year-olds in 2013 were again modifiable, with the leading three risks for both men and women being poor diet, tobacco consumption and high body mass index (BMI). The implication of this is huge: a large proportion of the disease burden in Baby Boomers is amenable to prevention.

Perhaps most striking is the case of diabetes. Morbidity from diabetes rose by 97% among men and 57% among women aged 50–69 years between 1990 and 2013. Although this definition includes both type 1 and type 2 diabetes, the attributable risk from factors including obesity, diet and low physical activity rose by 70%. There is a deprivation inequality in diabetes, as there is with all the leading causes of morbidity and indeed life expectancy. However, with diabetes the gap is decreasing, showing that this is an increasing problem regardless of social stratum. Interestingly, compared with tobacco consumption, which is strongly socially stratified, body mass index is now less socially stratified in terms of the size of the attributable burden of risk factors. These data suggest that it is extremely important that we strive to reduce inequalities in the health of Baby Boomers. In addition, weight and obesity must be addressed across the board.

Despite the fact that tobacco consumption in adults overall is decreasing, it remains an important risk factor in this group, remaining the leading risk factor for premature mortality and the second leading cause of total disease burden. Socioeconomic inequalities in tobacco consumption and related illnesses are well recognised and exemplified in this group. However, an additional inequality is the fact that the decline in premature mortality from lung cancer in women is less than half that in men.

Several issues highlighted in my previous surveillance reports hold true for Baby Boomers. My concerns, as Chief Medical Officer, about the increase in premature mortality in England due to liver disease in England (compared with mortality figures for our European counterparts) have been echoed by the trend in premature mortality from liver cancer in this age group. My calls for more robust systems for surveillance of high burden diseases, such as musculoskeletal disease, and sensory (visual and hearing) impairment, which impact more on quality of life and productivity than on premature mortality, are strengthened. Sensory impairment is the second highest cause of morbidity in this age group in men and the fifth in women. Yet needs are likely to be unmet, given the considerably lower prevalence of hearing aid use compared with the estimated prevalence of objective hearing loss. Musculoskeletal disease has again been highlighted as having a lack of high-quality routine information at a national level. However, we do know that the burden is high, demonstrated by the tripling in the rate of elective admissions for back pain and primary knee replacement in 50–70 year old adults between 1995/96 and 2013/14.

Datasets on oral health are also limited. While the improved oral health of Baby Boomers compared with that of their predecessors is a considerable triumph, it is important that we have sufficient data to inform the provision of services given that, counterintuitively, this success may mean that demand increases.

smoking

Annual Report of the Chief Medical Officer 2015, On the State of the Public’s Health, Baby Boomers: Fit for the Future

Chapter 1

Lifestyle factors

The authors of Chapter 5 analyse data concerning Baby Boomers generated from the Health Survey for England 2013 and the English Longitudinal Study of Ageing (ELSA, 2012/13), a wealth of information on adults over 50 years of age. They analyse key factors affecting health such as smoking, alcohol, diet, physical activity and obesity, all of which are modifiable.

Baby Boomers had lower rates of smoking than those of the same age 20 years previously. The extent of the difference between the rates increases with age within the cohort. This is despite data from the physical health chapter which identify tobacco consumption as a leading cause of both mortality and morbidity in Baby Boomers. I find it shocking that, by this stage in their lives, in current and ex-smokers, 66% of baby boomer men and 71% of baby boomer women have never been recommended to stop smoking by a doctor or nurse. There is an unquestionable need for adequate support for smokers trying to quit and this questions whether services are targeting and reaching those who require them. Continued provision of Stop Smoking services is vital. A sustained decrease in the prevalence of smoking risks underestimating the needs of the baby boomer population for these services. They have lived through the height of the tobacco era and continue to experience substantial ill-effects from it. Locally appropriate services are also essential to reduce the resounding socio-economic inequalities and the geographical variation evident in smoking prevalence among Baby Boomers.

The UK Chief Medical Officers published new guidelines on low risk drinking in August 2016. For both men and women the guideline is that to keep health risks from alcohol to a low level it is safest not to drink regularly more than 14 units a week and that for those who drink as much as 14 units per week it is best to spread this evenly over three days or more, and that several drink-free days in the week aid cutting intake. Although in terms of units per week, baby boomer men were drinking less than those in the same age group 20 years earlier, the proportion of men now drinking on five days a week increased with age, with the highest rate of 30% in 65–69 year-olds. Whilst still within the guidance for low risk drinking it is of concern to me that, on average, baby boomer women reported drinking more than women of the same age 20 years previously, with a maximum difference of 3 units per week (from, on average, 4.5 units per week in 1993 to 7.5 units in 2012-13) in women aged 60-64 years

Given the increase in obesity rates seen in recent years, it is of little surprise that overweight and obesity levels were significantly increased in Baby Boomers compared with adults of the same age 20 years earlier. The authors found that nearly half of baby boomer men and over a third of baby boomer women were overweight. Around a startling 75% of men and 80% of women were classified as centrally obese if raised waist circumference (defined as 102cm in men and 88cm in women), a risk factor for diabetes, was used instead of BMI (with 77% of men and 83% of women being classified as obese by 65–69 years of age using this criterion). These statistics are staggering. If these adults are to reduce their current risk and maintain their health through older age, it is critical that this is addressed. I have previously expressed my concern regarding the ‘normalisation’ of overweight and obesity, referring to the increasing difficulty in discerning what is normal from abnormal due to the fact that being either above a healthy weight or obese is now so commonplace. The fact that 1 in five men and nearly half of women classified as having a ‘normal’ BMI were in fact found to be centrally obese is extremely concerning, and underlines the importance of promoting awareness of metabolic risk factors such as increased waist circumference, in addition to BMI.

The UK Chief Medical Officers’ guidelines on physical activity recommend that adults participate in 150 minutes of moderate intensity, aerobic, physical activity every week . Physical activity was found to be low among Baby Boomers. Not only did the authors find that people in their 50s were less active than those of the same age 10 years earlier, they also found that two-thirds of all Baby Boomers in their sample had undertaken no physical activity lasting more than 30 minutes in the past month. Significant geographical, socio-economic and ethnic inequalities exist in physical activity. I was surprised, for instance, to find that rates of inactivity were as high as 80% in Gateshead and Stoke on Trent. Physical activity has benefits in terms of cardiovascular health, mobility, weight management and even cognition. Clearly, this age group could benefit greatly from optimising physical activity levels to maximise their health both currently and in impending ‘older age’.

Lifestyle of older adults in England

Physical activity and weight

1 in 3 OF THOSE AGED 50-70 ARE OBESE according to BMI and this is much worse if you rely on waist circumference.

 

18% women and 19% of men smoke

65-70% who are smokers/ex smokers have never been asked to stop smoking by a doctor or nurse (so they say!)

 

65.6%    of Baby Boomers have not engaged in any moderate physical activity lasting 30 minutes or longer in the  past month

Amongst 50-60 year olds: Men are drinking  approx. 4-5 units a week less than 20 years earlier Women are drinking approx. 2 units a week more than 20 years earlier

 

Rowan Hillson:Diabetes and fracture risk

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fractures.png

Adapted from:

 

Fractures and Diabetes

Rowan Hillson MBE

National Clinical Director for Diabetes England 2008-18

 

Practical Diabetes Jan/Feb 17

Summary

Fractures are more likely in diabetics compared to non- diabetics. Metabolic factors, an increased risk of falls, complications, infection, medications and the effects of low blood sugars all contribute. Neuropathy is a particular problem. This can cause an abnormal gait, stumbling, and a lack of awareness of actually sustaining injury. Even fractures may not cause anything like the expected pain. Charcot’s foot can cause lifelong disability. Visual problems also cause falls as does the effects of stroke and amputation.

It can help if someone goes round the house to check for trip hazards. Vitamin D supplements and increasing dietary calcium can help. Be aware that sulphonylureas can cause low blood sugars as well as insulin.

If a diabetic, particularly one who has neuropathy, presents with an injury they need careful evaluation to avoid missing fractures.

Fracture risk

Type one women  are six times more likely and type twos are twice as likely to sustain a fracture of the hip than a non diabetic. The longer the diabetes, the more the risk.

Low blood sugars

Low blood sugars are probably under reported by diabetics due to fears about losing their driving licences.

 

charcot-foot

Charcot Foot

Charcot foot presents as a swollen, red foot. There can be an underlying fracture. Because the person does not realise they have a fracture, they continue to weight bear, and this produces deformity of the foot. Best advice is that if a diabetic with neuropathy gets an unexplained inflammation of a foot that they stay off of it and get an urgent assessment by a multi disciplinary team at a diabetic foot clinic. Trouble is, that these are not available for all patients in the UK.

Drugs

Glitazones, eg Pioglitazone, doubles the risk of upper limb fracture in women.  Flozins such as Canaglifozin is suspected of increasing fracture rates and Sulphonyureas definitely do, but probably due to the hypoglycaemic effect.

Falls

Diabetics fall more than their non-diabetic counterparts. 18% of women over the age of 67 with diabetes fell at least once a year. The rate is higher in insulin users, neuropathy,  renal impairment, poor vision and low Hba1cs.

 

 

Heri: Understanding your biological clock

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Synchronizing with our biological clock

biological_clock_human
Biological Human Clock

The 24-hour light–dark cycle is a fundamental characteristic of Earth’s environment and profoundly influences the behaviour and physiology of animals and humans.

The illustration above highlight how hormone production and vital signs fluctuate during the day. This is called the circadian rhythm.

And it can be an important tool to help you schedule tasks and daily routine!

For example, cortisol production is at its highest in the morning. It lets us wake up, be alert and start our day. Cortisol then slowly decreases throughout the day. It’s at its lowest during the night to let us sleep and repair us physically and psychologically.

sleeplight2

Melatonin secretion starts when our retina senses less light, and will stop after sunrise. The inner retina is especially sensitive to the lack of blue light wavelengths. Studies show for example that blue light will increase our alertness, performance and positive mood during the day. On the other hand, blocking blue light 3 hours before sleep significantly improves sleep quality.

Besides light, circadian rhythm is also sensitive to temperature. Lower temperatures in the evening will decrease alertness, metabolism as well as heart rate.

Other factors include meal times, stress and exercise. Weight training at 8pm can delay optimal sleeping time by 2 to 4 hours.

It is important to understand this biological human clock. Review the illustration above and look how you can (re)schedule work, nutrition, exercise and sleep. Your body will respond better, and your performance can improve, as well as your overall mood, health and well-being.

For example, if you usually sleep around 10:30pm, it is a good idea to stay away from 7:30pm blue light emitting devices such as iPads, mobile phones, TVs and most light bulbs. Studies show that you don’t have to be an active user: just having them in your bedroom is enough to show an effect. Of course, using actively an iPad or computer screen will increase stimulation, as well as increased potential stress from important emails and notifications.

sun

Here are a few take-aways from the illustration and recent studies:

  • Optimal time to wake up is around 7 to 7:30am, when melatonin production stops
  • 8am or earlier is a good time for breakfast, for best ingestion of carbs.
  • Testosterone production is at its highest at 9am. A few will schedule their weight training for best results. But statistically, this is also a peak time for heart attacks or strokes. Adjust accordingly if you have hypertension or at risk for CVD.
  • Schedule your most important work between 10:00am and 11:30. This is where you are the most alert, good memory, and best ability to focus. Work in an area with plenty of blue natural light, as well as comfortable temperature. Lack of blue light such as working in a window-less office, or working in a cold environment will make you less productive and more frustrated.
  • Noon to 2:30pm is a dead time. Adrenal glandes and hormones are their lowest, and lunch digestion will drag you down. Have one cup of coffee (or better yet healthier coffee alternatives), and schedule light work, such as emails or follow-ups.
  • 2:30pm to 6pm is good for more active work. Go meet and talk to colleagues.
  • 5pm is the best time for cardiovascular activities. Your lungs will be most efficient around that time. Take your Garmin or Suunto GPS sports watch, and hit the road!
  • 6:30pm to 7:30pm is when your blood pressure and temperature are at their highest. Don’t be stuck in traffic or have a heated emotional argument at that time!
  • Avoid carbs at dinner. Pasta, rice, bread will be transformed quickly into fat if ingested in the evening. Salad with a bit of your favourite protein is a better choice.
  • Stay away blue light 3 hours before you sleep. Exposure to amber light can help on the other hand.
  • night

If you work in night shifts, the best investment is a portable blue light for work (such as this) as well as a pair of blue light blocking glasses when you are going to sleep, to minimize circadian rhythm disruption. However, asking to take day shifts instead is better for your health.

In case there is daylight savings, shift circadian times above so timing syncs with your local sunrise time.

References:

  • Antoine U Viola, Lynette M James, Luc JM Schlangen and Derk-Jan Dijk. Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality. Scandinavian Journal of Work, Environment & Health.  Vol. 34, No. 4 (August 2008), pp. 297-306
  • Dijk D-J, Archer SN (2009) Light, Sleep, and Circadian Rhythms: Together Again. PLoS Biol 7(6): e1000145. doi:10.1371/journal.pbio.1000145

Learning and Diabetes: A vicious circle

kaitiscotland8 Comments

Learning and Diabetes

Rowan Hillsoncalculator

Practical Diabetes Nov/Dec 16

Only 32% of type one diabetics and 78% of type two diabetics are currently offered structural education in England. Even then, not all will attend. Will it have any positive long term effects for those who do? Many issues affect learning. This article discusses some of them.

Literacy and numeracy

In England in 2011, 15% of the population aged 16-65 had the learning that is expected of an eleven year old child. This is considered “functionally illiterate” by the National Literacy Trust.  Although they would not be able to pass an English GCE, they can read simple texts on familiar topics. More than 50,000 UK diabetics are at this basic level of reading ability.

Numeracy problems are higher with 24% of adults function at the same level as your average eleven year old. Testing diabetics shows that numeracy and literacy are linked and that blood sugar control is better in those with better numeracy and literacy. This is not surprising since so many tasks need these skills.

Weighing foods and estimating portion sizes

Addition

Converting between metric and imperial systems

Multiplying and dividing

Using decimals

Recognising and understanding fractions

Working with ratios, proportions and percentages

Readability

Arial 12 point font, upper and lower case, on white or off white backgrounds, using short words, short sentences and short paragraphs all improve readability.

Health Literacy

Health literacy includes reading, writing, numeracy, listening, speaking and understanding.

In the type two diabetes population, lower health literacy was significantly associated with less knowledge of diabetes, poorer glucose self- management, less exercise and more smoking.

In the USA people understood food labels better if they had higher income and education.  Overall 31% gave the wrong answer to food label questions. Many diabetics have problems with misinterpreting glucose meter readings, miscalculating carbohydrate intake and medication doses.

Lower scores were associated with being older, non-white, fewer years in education, lower income and lower literacy and numeracy scores.

When an internet based patient system was offered, those with limited health literacy were less likely to sign in and had more difficulty navigating the system.

Cognitive impairment

Alzheimer’s disease, vascular dementia and other cognitive impairments are more likely in diabetics particularly those with type two diabetes. A longer duration of diabetes and a younger age of onset were associated with cognitive impairment.

Hyperglycaemia

High blood sugars can cause poor concentration, tension, irritability, restlessness and agitation. In experiments, high blood sugar induced delayed information processing, poorer working memory, and impaired attention.

In five to eighteen year olds with new type one diabetes most neuropsychological tests showed considerable impairment.  One year post diagnosis, dominant hand reaction time was worse in those with poor glycaemic control.

Long term, type ones diagnosed before the age of 18 had five times the risk of cognitive impairment compared to their non- diabetic counterparts. Chronic hyperglycaemia increased the risk.

Hypoglycaemia

Most friends and relatives can recognise if someone well known to them has a low blood sugar, often faster than the individual. Cognitive performance drops at blood sugars of 2.6-3 in non- diabetic subjects.  In type one children, those who had recurrent severe hypoglycaemia had more impaired memory and learning.

Psychological issues

Both depression and anxiety can impair test performance. Both of these and other mental illnesses are more common in diabetics.

Sensory and motor problems

Visual impairment and deafness can make some learning methods difficult.

Conclusion

We all learn in different ways. A substantial proportion of the population has low literacy and numeracy. This impairs health literacy which impairs diabetes knowledge for self -care. Poor numeracy may worsen blood sugar control. Clearly written, easily readable information helps everyone. Having diabetes increases the risk of cognitive impairment both at diagnosis and long term. Both high and low blood sugars affect current ability to learn and may have long term adverse effects on cognition.

Before teaching diabetics it is worth having a think about any difficulties your patient could be having assimilating the learning. If so, how can you tailor your teaching to their needs?

The BBC has adult learning resources at http://www.bbc.co.uk/learning/adults/

 

 

Scotland ‘Should Take Lead Role in Type 1 Research’

Emma5 Comments

Catriona Morrice of the Juvenile Diabetes Research Foundation (JRDF) talked to the Scotsman this week about how Scotland could lead the field to cure type 1 diabetes.

The Foundation’s development manager cites bioscience expertise where Scottish institutions, scientists and charities are already working in support of this aim, but she believes Scotland’s role could be even bigger.

A child diagnosed at the age of five can need more than 19,000 insulin injections before his or her 18th birthday [incidentally, where does that put you? I’m in my 33rd year of diabetes] so there’s no doubt that a cure will be welcomed by us, if not by the insulin-production companies…

Greater Focus

Morrice says the JDRF wants the Scottish Government to encourage an even greater focus on type 1 diabetes research. Scotland has among the world’s highest rates of incidence, and the JDRF has invested nearly £4 million in projects at the Universities of Edinburgh and Glasgow.

Across the international JDRF network, Morrice says, the organisation is delivering ground-breaking work. There are three areas of work which are of particular importance – encapsulation, immunotherapy and medicinal foods. The encapsulation research being carried out in the US is looking at ways to implant insulin-producing cells in the body while protecting them from the immune system. The basic idea is that they are wrapped in a protective coating and can do the same job as the ones in a healthy pancreas.

Immunotherapy works to alter what the immune system does, retraining it to no longer attack cells such as the insulin-producing beta cells of the pancreas. In Boston, a research team is working on a technique which will ‘hijack’ red blood cells, attaching insulin fragments to them. These blood cells travel quickly through the body and don’t cause an immune response themselves, as the individual produces them.

Food as Medicine

Then, there are medicinal foods. JDRF-funded research in Australia has shown that types of bacteria in our gut can have an impact on overall health. This has opened up debate about food could be used as medicine, helping to treat or prevent type 1 diabetes without harmful drugs.

But Scotland has something almost every other country doesn’t, Morrice adds – a database of people with type 1 diabetes that allows collaboration with families affected by type 1 diabetes who want to join clinical trials. Called the Scottish Care Information – Diabetes Collaboration, Morrice says it’s a vital resource for research scientists and the Foundation’s “overwhelming wish” is for Scotland to take the lead role in type 1 diabetes research.