The Potential Threat of Diabetes

You know what scares me more than a crazy North Korean man with nuclear weapons?...  Diabetes. Yeah that's right, the extreme poor health of our citizens scares me more than having missiles fired at my house. This may sound absurd to some, but for those of us who work in the trenches of healthcare this my friends is a reality. As a nurse you start to worry about things that most other people wouldn't pay attention to; like washing your hands before and after you go to the bathroom, just to be safe. I was at the beach the other day just relaxing when I noticed a group of school children getting off a bus. For a moment I had trouble determining who were the children and who were the teachers because virtually every one of them was obese. I eventually discovered that the children were all wearing the same color shirt... Smart on the teachers part (I'm sure I am not the only one who has noticed this phenomenon). I was extremely bothered by this but didn't quite realize why.  I didn't think too much more about it until I went to work the next day and met one of the nicest young ladies I have ever met. This young lady came in to the ER complaining of shortness of breath, fatigue and that she was peeing a lot (which are all hallmark signs of diabetes). Now, because she is only 21, no one, including her doctors even considered diabetes as a potential diagnosis. Not only was she diabetic, but she was also suffering from DKA (diabetic ketoacidosis) which is a potentially life threatening complication of diabetes. DKA occurs when there is not enough insulin to transport sugar into the cells; if the sugar doesn't make it into the cells than the body assumes that there is no sugar present and begins to breakdown fat as an alternative fuel. This may sound awesome for those trying to lose weight but I promise you this is not the way to go. The breakdown of fat causes a build up of acids in the body, causing a whirlwind of life threatening problems. DKA usually occurs in patients who have type 1 diabetes but it can also occur in type 2 diabetics in some instances. This patient was officially diagnosed with type 2 diabetes and a urinary tract infection, which is what most likely caused her to be in DKA.
This patient was very aware of what diabetes was because her father had it but was unaware of how serious the disease really is. I truly believe that most people do not understand the seriousness of diabetes and all the potential health complications associated with it; such as losing their eyesight and limbs, increased risk for infection and slower healing, increased risk for heart attack and stroke, chronic pain from nerve damage, vascular disease, kidney disease leading to dialysis and even death. A survey completed in 2006 indicated that a substantial number of people with prediabetes were unaware that they even had it. Prediabetes means that you are already starting to have higher than normal blood sugars but aren't officially diabtetic. How are we suppose to prevent people from going into full blown type 2 diabetes if they don't even know that they are going down that road? How do we recognize the risk factors for diabetes and prediabetes before it's too late?

Risk Factors We Can Control

• Obesity - BMI and Waist circumference are commonly used screening tools to identify weight problems and associated health risks. BMI calculators and charts are available online. A "normal" BMI is considered 18.5 and 24.9. Waist circumference can be done at home. Place a tape measure around the bare abdomen just above the hip bone. Excess waist circumference is considered 40 inches for men and 35 inches for nonpregnant women. If you have a BMI greater than 24.9 and you have excess waist circumference you are very likely to develop diabetes and cardiac disease. If you are concerned that your child is overweight please seek the help of someone who can help you improve your nutritional habits. Fast, processed and sugary foods are the main reason for childhood obesity.
• Sedentary Lifestyle - I think most people know in the back of their minds whether or not they are exercising enough. There are different types of exercise and finding the one that fits your lifestyle is going to be the most beneficial. A lot of people go "all or nothing" and become easily discouraged when starting. Instead, try easing into an activity such as walking. 
• Low HDL cholesterol and high tryglyceride levels - To improve your HDL score you have to exercise. Some studies show eating Omega 3 fatty acids also helps. To decrease your trigylceride levels avoid sugary foods such as soda and pastries as well as trans fats, which are identified as hydrogenated oils on a food label and are also found in fried foods. 
• Polycystic Ovarian syndrome - Many physicians believe that this cannot be prevented but I have heard of and know a few woman who have reversed this disease with proper nutrition so I am going to count this one as one we can control.

Risk Factors Out of our Control

• Age older than 45 years
• Family History of diabetes (parent, brother or sister)
• Belonging to certain racial and ethnic groups, including African Americans, Hispanic/Latino, Asian Americans, Pacific Islanders, American Indians, Alaska Natives
• History of gestational diabetes
• Women who have delivered a baby weighing 9 pounds or more
• History of cardiovascular disease
• Receiving antipsychotic therapy for schizophrenia or bipolar disorder

It wasn't until after I left work that day that I realized the significance of those school children at the beach and my patient. Seeing those kids was like seeing the life of the healthcare system flashing before my very eyes. Not only is there a large amount of baby boomers getting older but now there is even larger amount of young people getting sicker. Most of those obese schoolchildren are or will suffer from diabetes at some time in their life. The annual economic burden of diabetes in the U.S. exceeds $200 billion and spending is expected to triple in the next 25 years. If we don't do something about this sometime soon this country will not only be broke, we will also be unproductive, unemployed, not motivated, and unhappy; in other words North Korea has nothing on diabetes. 

The first step to prevention is recognizing what puts us at risk and becoming mindful of our bodies and our lifestyle. We often know in the back of our minds and our bodies will often tell us exactly what we need to be doing to stay healthy. You cannot wait for government to provide you with healthcare to make yourself healthier. Many of these changes only require education and motivation. There are many healthcare professionals and health coaches, including myself, out there for those of you who need guidance in the areas of nutrition and lifestyle changes. Find someone to inspire and support you in this process. Now is the time to improve your health. 

I will be hosting monthly online webcasts starting next month on how to improve your health. I'm looking for suggestions on topics for my webcasts. Feel free to comment on this blog with any suggestions.

Savor the Flavor: Why you should Enjoy your Meal Now

Have you ever thought to yourself "what would I do if I could never eat again"? If you are like the majority of people in the United States, this unfortunate situation has probably never crossed your mind; So lets take the time to think about it now. How would you feel if someone told you that you could never enjoy the refreshing taste of a cold glass of water or the sweetness of fresh strawberries (if you don't like healthy foods then you can imagine cold beer or ice cream). This unfortunate situation happens to many patients in the hospital on a daily basis. I recently took care of a gentleman who was unable to swallow after we removed the breathing tube from his lungs. Now this is not an uncommon occurrence in the world of ICU. If you are on a breathing machine this means you are not eating or swallowing. If you do not use your swallowing muscles they tend to get weak just like any other muscle and when you swallow food, liquid or even saliva it tends to go into the lungs instead of the stomach; we call this aspiration. It causes a nasty pneumonia and is often the cause of death for many elderly people. When this gentleman found out he did not pass his swallowing test he was devastated. I think many people associate their last meal with death row or Jesus, not the hospital. Many of his physicians found it odd that he was so devastated by the thought of never eating or drinking again. This made me realize how out of touch we are with the importance of eating. I will not get into  the details of nutrition on this blog, but I do want to discuss the importance of how we eat.
 People eat in a variety of ways: standing up, driving a car, watching television, reading a book, eating at the nurses station (yes JAHCO we eat at the nurses station). What we don't realize is that we absorb not only vitamins and nutrients in our food but also the energy that is happening in the environment around us. If we eat quickly or in an ugly, noisy environment that energy is going to penetrate us. This negative energy can present itself as acid reflux, irritable bowel syndrome, diarrhea, constipation and more. It is the nature of our bodies to "rest and digest." Our body likes to be relaxed, inactive and in an peaceful environment when eating. It does not want to be in "fight or flight" mode ( I feel like nurses and patients are in this mode in the hospital). So how can we learn to really experience and enjoy our food on a daily basis?

1.  If you are at work, try to find a quiet place to eat your meal. I prefer to sit outside and play some music on my phone. I find that sitting in the break room at work is the worst place to break. If you are home, turn off the television or computer and really pay attention to how you eat. You will find that you will feel more satisfied with your meal. 
2. Apply a simple ritual to your mealtime like lighting a candle or saying a blessing before eating. 
3. Eat meals with your family. There is a reason for the saying "families that eat together stay together." If everyone is eating different foods at different times, there will most likely be different levels of energy and moods. Experiment with eating a home cooked meal once a week and see what difference it makes. 
4. Focus on Chewing. Chewing prepares your entire gastrointestinal system for the digestive process. It enables you to breakdown your food better and also allows you to taste more of it. Try chewing your food 20 times before swallowing or setting your utensils down before taking the next bite. 
5. Try not to get intubated or have a stroke. I know this sounds far fetched but in some circumstances you do have a choice in the matter. I will get into the details of life support in a later blog but what I can say is that if you are elderly, like over the age of 70, or have some chronic disease like COPD or emphysema from smoking cigarettes please consider all of the risks for having a breathing tube put into your lungs. The likely hood that you will recover 100% is small and often you will be left with a feeding tube of some sort. As far as stroke goes eat healthy, exercise, don't smoke and recognize the symptoms of a stroke and if you have an irregular heart rate, take your blood thinners as ordered. 

Now is the time to really start thinking about what kind of food you are putting into our bodies and how you are doing it. The food you eat is the single most important decision you make on a daily basis. It is more important than the clothes you wear, the car you drive or what the Kardashians are doing. Now is the time to appreciate the fact that you have a choice in the type of food you consume and when you consume it. Appreciate that you do not have a tube down your nose or in your stomach with Jevity tube feeding infusing; if you're lucky you will get a side of 2 scoops of protein powder twice a day. I can tell you it smells horrible and I'm sure it doesn't taste good. If this doesn't sound enjoyable to you, then write it down. Make a living will or five wishes that states that you do not want a feeding tube placed. More importantly, take the time today to make better food and lifestyle choices because you never know when these choices will be taken away.

P.S. I have a five wishes that states that I never want a feeding tube. If it so happens that no one is around and I get one I want you to know that I am really intolerant to soy and if you give me that crappy tube feeding I will probably blow up like a balloon and have really bad diarrhea. I have also stated that I do not want a rectal tube either. Instead I expect top of the line smoothies with veggie protein powder. I will have the recipe written out. Also, I am really bony so make sure you turn me every two hours.

Thanks