A diabetes lifestyle is a demanding one, in which the majority of management is self-care. The key to managing your diabetes involves testing your blood sugar; taking diabetes medications, insulin or both; eating a healthy, balanced diet; exercising; caring for your feet; stopping smoking; and keeping your diabetes appointments with your provider. If you don't do these things, you're at great risk of developing diabetes complications.

Research has proven that complications are less likely to occur if you keep your blood glucose as near to normal as possible, yet, as diabetes educators, we hear many reasons why our clients don't make simple changes to better their own health. Here are a few.

"I'm too young to have diabetes." This is a form of denial. According to the Centers for Disease Control and Prevention (CDC), more than 13,000 young people are diagnosed with type 1 diabetes in the United States each year. The number of children and adolescents diagnosed with type 2 diabetes is growing at an alarming rate. New diagnoses for type 2 diabetes in children accounts for up to half of all diabetes diagnoses in children and adolescents."I don't have enough time." Whether you work full-time or stay at home, it's important to take time to improve your way of life. Managing your blood sugar doesn't require you to make drastic changes. Break tasks down into smaller, doable actions. For example, take a 10-minute walk twice a day instead of walking for 20 minutes at one time. There are, however, things you must make time for. To stay healthy, you must test your blood sugar and take your diabetes medications."I feel fine. Maybe high blood sugar is normal for me." High blood sugar is never normal. Normal blood sugar for people who don't have diabetes is 70 to 100 mg/dL (3.9 to 5.6 mmol/L). Diabetes is an insidious disease, often called a silent killer. You may feel fine, but damage is being done to your entire body, from your hearing and vision, to sexual function, to mental health and sleep.

Other comments we hear include everything from "I don't like vegetables" to "Lifestyle changes won't work, so just give me diabetes pills."

But no change is too small to ward off type 2 diabetes or to delay further progression of diabetes! A large, national study conducted at 27 sites around the U.S. found that small lifestyle changes are far more successful at warding off diabetes or delaying further progression of the disease than are medications. The Diabetes Prevention Program (DPP) found that participants who lost a modest amount of weight through dietary changes and increased physical activity greatly reduced their chances of developing diabetes or developing further complications of diabetes.

Get started today and set a specific goal. Choose a lifestyle change that you're willing to work on. Don't change behaviors that will make your health care team happy — change for you. Ask yourself what you'd like to change and how you're going to do it, for how long, and how many days of the week. Start with one specific, attainable goal, for example, "I will walk 10 to 15 minutes three days a week for one month."

Lifestyle changes take patience, but, with persistence, you can make them happen.

Peggy

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It seems to be common sense that hard times are associated with developing depressive symptoms. When a personal crisis occurs, many people who had been coping pretty well become clinically depressed.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

The two classic examples are losing a relationship or losing a job. However, if a company terminates 100 employees, most of them don't develop a depressive illness. An important question is why one employee manages to cope while another develops a mood disorder.

Seven years ago, an important paper published in one of our most respected scientific journals reported that people with a genetic variant of the serotonin transporter gene were more likely to become depressed when they had experienced stressful situations.

If a person had this genetic variant and wasn't exposed to very stressful situations, they weren't any more vulnerable to depression than if they had the more protective form of the gene. It was only when they had experienced severe personal distress that their depressive symptoms occurred. People without this genetic variant were often able to tolerate quite severe stress and not develop symptoms.

There has been much discussion of this finding. Many studies were done that measured stressful experiences in a variety of different ways. About a year ago, a paper reviewed only 14 of these studies and concluded that people with this genetic variant weren't very much more vulnerable to stress. There were problems with this analysis, but it was published in a good journal and it made some doctors a bit skeptical about the finding.

This week, a new analysis of 56 studies concluded that there was a strong relationship. They demonstrated that people with the less active form of the serotonin transporter gene were more vulnerable to developing depression when they experienced severe stress.

The analysis found:

The strongest relationship was between severe stresses during childhood that then seemed to haunt the person for the rest of their life. This finding supports the view that young children are particularly vulnerable and that early abusive experiences can have a long lasting impact. The next most difficult type of stress was serious medical problems. This also makes sense as we have known for many years that some people become very depressed when faced with the prospect of having to deal with a serious medical illness.The least dangerous kind of stress was the hassles of everyday living that we're all familiar with and that sometimes get out of hand. However, even this kind of stress was associated with an increased risk of depression if a person had this genetic variant.

The bottom line is that this new analysis provides strong evidence that stress can trigger depression and that the onset of depression is far more likely in people who are genetically vulnerable to developing a mood disorder.

Does this mean that if you have the variant, you are doomed to become depressed? Absolutely not. It just means that you're more vulnerable to developing symptoms.

Does the study prove that if you don't have the variant, you won't develop a depression if you're exposed to intense stress? Again, absolutely not. It just means that the risk is lower.

Perhaps the most important point that this analysis makes is that there is a biological vulnerability to depression just like there is a biological vulnerability to diabetes, asthma, or cancer.

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Hello, bloggers. I've been looking at articles from a number of popular diabetes magazines and other resources about diabetes myths. Each one seems to have its own list of the top five or 10 diabetes myths.

I decided to develop my own list of the top 10 diabetes myths that I've heard as a diabetes educator at the Mayo Clinic in Rochester, Minn. I'll reveal five this week, five next week.

Here goes (drum roll).

I have borderline diabetes or just a touch of diabetes.

Either you have it or you don't. Two fasting blood sugar readings over 126 milligrams per deciliter (mg/dL) or 7 millimoles per liter (mmol/L); a random blood glucose over 200 mg/dL (11.1 mmol/L); or an A1C of 6.5 percent or higher are all considered diabetes.

I don't know why I got diabetes, I never eat sweets.

Just about everything you eat is converted into glucose — sugar — so for most people with type 2 diabetes, what you eat is not as important as how much you eat. When you overeat, you're adding extra calories your body doesn't need for energy, so your body will convert these extra calories into fat. Being overweight is a predisposing factor for developing diabetes. 

I can't eat carbohydrates; it makes my blood sugars go high.

Of course they do — even people who don't have diabetes will see an elevation in their blood glucose after eating. Carbohydrates should be approximately 50 percent of your daily food intake each day. Carbohydrates are your fuel, without them you will have little energy.

If I have to go on insulin; that must mean my diabetes is really bad.

You know, insulin has gotten a bad rap through the years. It's the blood glucose control that determines whether you go on insulin; if diet alone or diet along with oral or noninsulin-injectable diabetes medication(s) is not controlling the blood glucose, insulin is necessary.

Insulin causes complications of diabetes.

Again, insulin has gotten a bad rap. Insulin is a natural hormone and is probably one of the safest medications around. Insulin helps control the blood glucose, which in turn slows down or prevents diabetes complications.

Your thoughts? What are some of the diabetes myths you have come across?

Have a great week,

Nancy

I love technology and all the gadgets that go along with it, including diabetes apps (applications) that help with managing diabetes. I recently read in Health Data Management news that the use of mobile and internet tools helped a group of people with diabetes lower their blood glucose levels. The group that used these tools saw an average A1C level decrease of almost 2 percent, which was more than twice the decrease seen in the control group. Other research has shown that even a 1 percent decrease in A1C helps to prevent complications of diabetes.

I typed in "diabetes" on my mobile device and downloaded several different diabetes apps that aim to help with managing diabetes. Costs varied from free to around $12. You have many diabetes apps to choose from to quickly record your blood sugar, blood pressure, pulse, weight, medications, food (usually carbohydrates) and exercise. You even have the ability to print or email your blood glucose record to your health care provider.

In our practice, I find that most people don't mind testing their blood sugar, but they don't care for writing down their readings. We understand busy schedules and know that it can be difficult to find the time to test your blood sugar, let alone write it down. However, keeping a record of your blood sugar levels can help you identify patterns of blood sugar levels that are too high or too low. A blood sugar record also helps your health care team evaluate the effectiveness of your diabetes medications, including insulin.

If you're comfortable with the technology, consider a mobile diabetes app to help you record your blood sugar levels. Mobile technology isn't for everyone, and that's all right! But it can be a good option for many.

We'd love to hear your experiences with mobile technology and diabetes management.

Peggy

It's all too clear that while many of you experience a dramatic positive response to antidepressant medications, others are frustrated and angry with the ineffectiveness of the treatment you've received.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

It's long been recognized that electroconvulsive therapy is an effective treatment, but the cost is high and problems with memory following treatment are not uncommon. For many years, treatment resistant patients have been waiting for an alternative treatment. In 2009, the FDA approved transcranial magnetic stimulation (TMS) as an alternative form of treatment for these individuals.

While transcranial magnetic stimulation has its own limitations, it can be quite effective for those of you who don't tolerate treatment with medications and aren't willing to consider electroconvulsive therapy. Since the FDA approval, the treatment has become much more widely available. While new strategies for providing TMS are being developed, the basic strategy is to provide daily treatments that last for approximately 40 minutes and don't require anesthesia.

A real advantage of transcranial magnetic stimulation is that it has a very low incidence of side effects. While some patients can begin to feel better during the first week, others require as many as six weeks before their depression resolves. While we are only beginning to understand the factors that increase the risk for relapse following a full course of treatment, some evidence suggests that a relatively modest number of ongoing treatments will maintain a positive effect.

The biggest barrier to obtaining transcranial magnetic stimulation at this point in time is concern about insurance coverage. However, as the efficacy of TMS becomes more firmly established, it's likely that insurance coverage will become more universal. The bottom line if you've struggled with antidepressant medications is that there's now an effective and safe alternative treatment.

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It's well known that depression symptoms can be caused or worsened by many medical illnesses. National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)One of these is thyroid disease.

Your thyroid gland is important in controlling metabolism. If it's not functioning properly, it can affect your mood. Your thyroid can be underactive or overactive, as well as normal.

Interestingly, there is a thyroid hormone produced by your brain that travels through your bloodstream to the thyroid gland in your neck. The thyroid gland, in turn, produces other hormones that regulate metabolism.

Your health care provider may check your thyroid with a blood test. Additionally, thyroid hormone is sometimes added to the antidepressant you are currently on to give it a boost.

Some medical conditions preclude the use of oral thyroid hormone. Talk with your health care provider about options as not everyone is a candidate for this.

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A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy