diabetes
Lets talk about
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You Can stop diabetes
Heed the pre-diabetes Warning
James L RosenzWeiG, md Chairperson, Clinical Oversight Committee, Joslin Diabetes Center; Assistant Professor of Medicine, Harvard Medical School
approximately 75 million americans
either already have type 2 diabetes or are on their way to developing it– a condition called pre-diabetes type 2 diabetes is one of the most rapidly growing diseases in the world it is a public health crisis, but there is something we can do about it one of the most important things to do is get tested if you find out you have pre-diabetes, consider it a warning not only are you then at high risk of developing diabetes, you are also at risk for heart disease and stroke But by changing your meal plan, adding more physical activity to your routine and maintaining an appropriate weight, you can stop or delay this from happening
screening for diabetes
Who should Get tested? if you are over age 45 and overweight or obese, you are at risk this is particularly true if you carry most of your extra weight around the abdomen even if you are younger than 45 and are overweight, ask your health care provider
to test to see if you have one or more of these additional risk factors:
if you are over age 45 and overweight, you are at risk
there are two ways to screen for pre-diabetes and diabetes, and both require that you dont eat or drink for at least eight hours usually overnight before blood is drawn to test for levels of glucose one test requires an additional step of swallowing a sugary liquid and having your glucose levels checked again after two hours depending on which test you have, you may be told you have impaired Fasting glucose iFg or impaired glucose tolerance igt, both of which indicate that
Youve already been told you have pre-diabetes n You are in a high-risk ethnic group: african-americans, latino americans, native americans, asianamericans and pacific islanders n You have a parent or sibling with type 2 diabetes n You are generally physically inactive n You had a baby who weighed more than nine pounds at birth, or you had gestational diabetes n You have high blood pressure n You have an Hdl cholesterol level below 35 mg/dl if you are a man or below 40 if you are a woman n You are a woman who has a condition called polycystic ovary syndrome
n
you have pre-diabetes
that means the glucose level in your blood is higher than normal but not yet high enough to be considered diabetes
proven Ways to prevent
Millions of people have pre-diabetes or diabetes but dont yet know it as a result, they are not benefiting from our advanced knowledge on
how to prevent diabetes and its medical complications if you find out you have prediabetes, there are some key things you can do a large-scale study of people with pre-diabetes called the diabetes prevention program, in which Joslin diabetes center was involved, dramatically demonstrated that moderate weight loss and 30 minutes of moderate physical activity on most days of the week can reduce the risk of developing diabetes by more than half 58 percent to be precise the study also showed that a drug called metformin can also reduce risk, though by not nearly as much You can take further steps to prevent heart attacks and strokes by getting blood pressure and cholesterol levels under control and quitting smoking Many people who have risk factors for these conditions can also benefit from taking low doses of aspirin one or two baby aspirins a day Simple steps early on can have big effects years later to prevent
major health problems
this section has been prepared with Joslin Diabetes Center in Boston, a nonprofit organization dedicated to improving the lives of people with diabetes and to research that will lead to prevention and a cure Joslin, founded in 1898 and affiliated with Harvard Medical School, is a global leader in diabetes research and has diabetes treatment facilities nationwide For more information, contact Joslin at 1-800-JoSlin-1 or wwwjoslinorg
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mentaL HeaLtH and depression the link Between diabetes
aLan m JaCobson, md Chief, Psychiatric Services, Joslin Diabetes Center; Professor of Psychiatry, Harvard Medical School
with diabetes is demanding to remain healthy, people with diabetes must constantly perform tasks such as counting carbohydrates and testing blood glucose levels it takes a lot of focused effort and is often frustrating to spend so much time on ones health You may feel overwhelmed and temporarily lose your motivation referred to as diabetes burnout, this is normal and common in patients with diabetes While this feeling of frustration is expected, it can lead to more serious emotional concerns Studies have shown that people with
diabetes are twice as likely to become clinically depressed as people without diabetes recognizing whether you are depressed or experiencing the symptoms of diabetes itself can be difficult Symptoms of depression are extremely diverse and can be physical, mental or emotional poorly controlled blood glucose levels can also mimic some of the physical and mental symptoms of depression, making it even trickier to diagnose For example, fatigue, weight loss and excessive sleeping or insomnia can occur in both instances, as can concentration or memory problems the key to recognizing depression is the more emotional symptoms: losing interest in things that once brought enjoyment, pessimism, guilt, crying and sadness Studies seem to confirm that diabetes is a risk factor in developing depression We know social and emotional stressors are key triggers for depression in all people, especially when there is a loss of control and
Living
independence living with any chronic illness stirs these feelings, and diabetes is no different the grief of receiving a diabetes diagnosis, not being able to manage it perfectly and losing the freedom of carefree living–having to carefully watch what you eat
and frequently testing blood sugar–can all cause depression to develop
What does depression mean for people with diabetes?
people with diabetes who are depressed may experience poor concentration and a loss of interest, which can lead to difficulty learning about proper self-management of their diabetes and while they may know how to properly care for themselves, they may also lose interest in their health and be less willing to take the appropriate steps needed to self-manage their disease For example, studies have shown people with diabetes and depression are less likely to check glucose levels and fill medication this can be a problematic cycle, leading to poorly controlled blood glucose, which in turn can lead to complications it is extremely important that depression in people with diabetes is treated immediately, before their health is compromised people with depression who also have diabetes can receive the same treatment as those without diabetes However, the two conditions together make the treatment slightly more complex Finding the right antidepressant and dose may be complicated because of possible effects on blood glucose levels, so close monitoring is needed
people
with diabetes are twice as likely to become clinically depressed as people without diabetes
counseling and therapy can also be extremely useful, especially for those with diabetes, because when the depression ends the demands of diabetes continue Many people do best with a combination of the two methods, and studies have shown that they have positive effects on both mood and glycemic control diabetes is no 
t an easy disease to manage if you think you may be depressed, talk with your doctor or family and friends if you are a loved one of someone with diabetes, be on the lookout for any changes in his or her emotional health if there are any doubts, please start a discussion depression is a common diagnosis among people with diabetes and can be successfully treated
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WHatfor people iWith diabetes Can eat? a guide
GiLLian GRant, Rd, Cde Nutrition Diabetes Educator, Joslin Diabetes Center meLinda maRYniuk, med, Rd, Cde Associate Director, Programs and Services, Affiliated Programs, Joslin Diabetes Center
Having diabetes means not only
choosing foods that are tasty, easy to prepare and fit your budget, but also thinking about how your food choices will
affect your diabetes Meal times can feel a little overwhelming with all the choices you need to make But once you understand how the food you eat affects your blood glucose, meal planning will become much easier for you
Carbohydrate: a Fast Fuel
aim for about one-quarter of your plate as carbohydrate foods n eat meals about the same time each day n include more nonstarchy vegetables with lunch and dinner, such as green beans, spinach and tomatoes n eat whole grain foods instead of food made with white flour examples include whole grain breads, brown rice and barley n vary the amount and kinds of fruits and vegetables you eat instead of iceberg lettuce on a sandwich, try baby spinach leaves a handful of mini-carrots or grape tomatoes is also a great low-carb snack n dont forget that liquids have carbs that need to be counted too
protein: the building blocks
meal high in fat can delay the rise in blood glucose there are some fats that are good for your heart including olive and canola oil, fish, nuts, seeds and avocadoes limit unhealthy fats that can raise your cholesterol–like butter, shortening, whole milk and red meat read labels to help you determine the saturated fat content
the best way to know how a food or meal has affected your blood glucose is to check your blood glucose both before a meal and then two or three hours after the meal
carbohydrate carbs is the most important nutrient for providing fuel or energy to the body there are different types of carbs, but they all break down into sugar, or glucose Foods containing carbohydrate include breads and grains, fruits, juices, starchy vegetables such as corn and potatoes, milk, yogurt, beans, lentils and desserts each person with diabetes needs a different amount of carbohydrate, based on factors like activity level, bodyweight and age a registered dietitian can help create an individualized meal plan to make sure you get the amount of carbohydrate thats right for you remember that the goal is to control the amount of carbs you eat and keep it fairly consistent each day, not to eat as little carbohydrate as possible Some good tips for people with diabetes to keep in mind include: n try to keep the carbohydrate portion of your meal the same size
protein is used to build and repair muscle it has very little effect on blood glucose levels after a meal including protein at each meal will help you feel
full, and promotes a balanced diet good sources of protein include lean meat, poultry, fish, low-fat cheese, nuts, nut butters, egg and egg substitutes and soy protein tofu aim for meat portions between three and six ounces, about one-quarter of your plate
Fat: keeps Hanging on
Limit unhealthy fats that can raise your cholesterol — like butter, shortening, whole milk and red meat
Your blood glucose should not rise more than about 40 points after a meal everyone is different, so learn how different foods affect your own blood glucose levels if you have any questions about meal planning, make an appointment with a registered dietitian or diabetes educator
Fat also does not have a direct impact on blood glucose after a meal, but affects your diabetes in other ways Fat slows down digestion in the stomach, and therefore slows carbohydrates from reaching the blood this means that a
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men, diabetes and Sexual Health
kennetH J snoW, md Medical Director, Sexual Function Clinic, Acting Chief, Adult Diabetes, Joslin Diabetes Center; Assistant Professor of Clinical Medicine, Harvard Medical School
the link between sexual dysfunction
and diabetes is well known
More than half of the estimated 10 million men with diabetes experience erectile dysfunction ed at some point during their lifetime with the disease the risk increases the longer a man has diabetes it is a common concern among men with diabetes, and there are many treatment options available ed, however, is also one of the least talked about complications of diabetes Just like any other health issue, you should discuss it with your partner and your diabetes specialist You should not hesitate to raise any concerns about your sexual health to your diabetes specialist
diabetes-related ed is caused by a loss of the ability of the small blood vessels in the penis to open up wider and bring more blood into the penis during sexual excitement other factors common in men with diabetes–such as high cholesterol, obesity, depression and high blood pressure–can also contribute to poor sexual function, as can certain medications for these conditions a mans best weapon in preventing sexual dysfunction is good selfmanagement of his diabetes another critical factor in protecting ones sexual health is not smoking
treatment options
the most common treatment for ed are medications called pde5
inhibitors, consisting of viagra, levitra and cialis these medications are safe for most men with diabetes, but cannot be taken with a class of medications called nitrates Make sure that you are taking the
a mans best weapon in preventing sexual dysfunction is good self-management of his diabetes
medication properly, and if the starting dose of medication does not work, it should be increased if there are no side effects if drug therapy does not succeed there are other options to help you achieve a healthy sexual life alternatives include injection therapy, vacuum pumps and implants recent studies have begun to shed light on the significance of low testosterone levels in men with diabetes low testosterone levels can affect sex drive, physical features and mood Symptoms include fatigue, depressed mood, decreased sex drive, loss of or poor erections and increased breast size testosterone levels drop as men age, and obesity can cause a greater decline according to recent research, up to one-half of men with diabetes may have low levels of testosterone Men with diabetes and low testosterone levels are more likely to fail at drug therapies Studies have shown that men with low
testosterone levels who had previously failed using pde5 drug therapy to treat their ed become more responsive once adding testosterone replacement therapy if drug therapy is not working, you may want to request that your doctor test your testosterone levels the choice of treatment for ed varies by individual, and the decision is a personal choice that must be made between the patient and doctor it is a common concern among men with diabetes and there are many treatment options available, but an honest and frank discussion must first take place
a tiMe Special advertising Section produced by tiMe Marketing in collaboration with Joslin diabetes center in Boston editor/creative Services director: liza greene; art director: andrea costa; production: cindy Murphy
Source:joslin.org
