Yoga reduces pain in people with chronic non-specific lower back pain


Image: Yoga reduces pain in people with chronic non-specific lower back pain

Chronic non-specific lower back pain, a condition affecting thousands of people, is often treated using over-the-counter medicines that can do more harm than good. But did you know that there are safer and more effective natural treatments available for this condition? Studies have suggested that yoga is an effective way to treat chronic non-specific lower back pain.

To evaluate the effects of yoga on chronic lower back pain, researchers from Cochrane conducted a review of yoga and chronic non-specific lower back pain studies. The studies included in the review involved 1,080 participants aged between 24 and 48 who had chronic non-specific lower back pain. The trials were carried out in various parts of the world, including India, the U.K., and the U.S. The researchers also compared the effects of yoga classes that involve back exercises to non-back exercises.

The findings of the review showed that yoga practice may improve symptoms of lower back pain and enhance back-related function compared to other exercises. The researchers also noted that practicing yoga for three months may reduce pain and practicing it for over six months may improve back-related function.

“Our findings suggest that yoga exercise may lead to reducing the symptoms of lower back pain by a small amount, but the results have come from studies with a short follow-up,” said Susan Wieland, lead author of the study from the University of Maryland School of Medicine.

The researchers concluded that practicing yoga may help reduce pain and improve back function in people with chronic non-specific lower back pain. They added that their findings will help people make better choices about their treatment options in the future. (Related: Treating chronic lower back pain with yoga and physical therapy.)

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Other natural treatments for lower back pain that you may have overlooked

There are many natural treatments for lower back pain. However, some of them, like the following, are often overlooked:

  • Release your feel-good hormones: Endorphins, one of the feel-good hormones, can be as effective as any synthetic pain medication. When the body releases these hormones, pain signals are blocked from registering with the brain. They also help relieve stress, anxiety, and depression – all of which are associated with chronic back pain and which often worsen the pain. Aerobic exercise, massage therapy, and meditation are some ways to promote the release of endorphins in the body.
  • Get adequate sleep: Although most people with chronic back pain suffer from sleeping problems, the lack of quality sleep also makes the pain worse. Thus, it is important to address sleeping problems, too.
  • Use cold therapy: Applying cold compress can help reduce lower back pain. It works by reducing inflammation, which is a common cause of back pain. It also acts as a local anesthetic by decelerating nerve impulses, which prevents the nerves from causing pain and spasms.
  • Use heat therapy: Like cold therapy, heat therapy can relieve lower back pain. It works by stimulating blood flow and inhibiting the pain messages being sent to the brain. You can take a hot bath or shower or use a heating pad or hot water bottle.
  • Stretch your hamstrings: Tight hamstrings also contribute to lower back pain as they stress the lower back and sacroiliac joints which, in turn, cause more pain. Try to gently stretch your hamstrings at least twice a day to relieve lower back pain.

 

Sources include:

Cochrane.org

Spine-Health.com

USPSTF: Exercise, Not Supplements, for Preventing Falls


Updated recommendations from the US Preventive Services Task Force (USPSTF) continue to support exercise and multifactorial interventions to prevent falls in community-dwelling adults aged 65 years or older, but advise against vitamin D supplementation, according to two statements published online today in JAMA.

“The USPSTF recommendation, with increased emphasis on exercise, warrants adoption and should prove helpful, especially because exercise interventions reduce injurious falls,” write Heike A. Bischoff-Ferrari, MD, DrPH, from the University of Zurich, Switzerland, and colleagues in an accompanying editorial. The editorialists add that increasing physical activity reduces risks for other chronic diseases of aging.

Fall Prevention

Falls are the leading cause of injury-related morbidity and mortality among adults aged 65 years or older in the United States, affecting 29 million people in 2014 alone (28.7% of community-dwelling older adults) with 37.5% requiring medical treatment or restricting activities for a day or longer, according to the recommendation statement. Falls caused approximately 33,000 deaths in 2015.

The new guidelines continue the B recommendation for exercise interventions, which means clinicians should offer or provide the intervention and that there is high certainty that the net benefit is moderate, or moderate certainty that the net benefit is moderate to substantial.

The task force provides a C recommendation for selective offering of multifactorial interventions, which suggests there is limited benefit for some patients.

In contrast, USPSTF now recommends against vitamin D supplementation to prevent falls, with a D recommendation. The D recommendation means the task force discourages use because of moderate or high certainty of no net benefit or that harms outweigh benefits, which is a shift from the previous 2012 recommendation, when supplementation had a B grade.

That downgrade may be in part because USPSTF did not consider individuals taking vitamin D for deficiency for the current recommendation, but did include them in 2012.

An accompanying evidence report reviewed 62 randomized clinical trials involving 35,058 individuals to assess the effects of 7 types of interventions, focusing on three: 26 trials of multifactorial strategies, 21 trials of exercise, and 7 trials of vitamin D supplementation. Multifactorial and exercise interventions were associated with benefits and minimal harms, but vitamin D supplementation had “mixed results,” with one trial indicating an increase in falls, number of people falling, and injuries.

Alex H. Krist, MD, MPH, a family physician at Virginia Commonwealth University in Richmond, coauthor and vice chair of the USPSTF, is a big proponent of exercise interventions, but also embraces multifactorial approaches. “Multifactorial interventions start with assessing an individuals’ risk of falling and what’s contributing to why they might be falling. Then a tailored intervention might include physical therapy, exercise, nutrition therapy, medication management, changing the home environment, and social or community services,” he explained in a journal podcast.

Vitamin D, Calcium, and Combined Supplementation

The task force now concludes there is insufficient evidence to assess the balance of benefits and harms for vitamin D and calcium supplementation, alone or combined, to prevent fractures in asymptomatic men and premenopausal women (grade I).

Similarly, the task force says there is insufficient evidence to assess the balance of benefits and harms for supplement use by postmenopausal women for doses exceeding 400 IU of vitamin D and 1000 mg of calcium (grade I), and recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium in this patient population (grade D).

The task force, however, did find sufficient evidence confirming an increased risk for kidney stones with combined vitamin D and calcium supplementation, and indicating no increased incidence of cardiovascular disease with vitamin D supplementation.

The evidence report for supplementation evaluated 11 randomized controlled trials of 51,419 adults older than 50 years and not institutionalized or known to have vitamin D deficiency, osteoporosis, or prior fractures.

David B. Reuben, MD, from the David Geffen School of Medicine, points out in an editorial published in JAMA Internal Medicine that the recommendations are for patient actions that are ongoing, not a one-time intervention. Parsing data, however, may reveal benefits, he suggests, referring to the Women’s Health Initiative, in which hip fracture decreased 29% among women who took at least 80% of the supplement tablets. He suggests that “perhaps the Task Force’s recommendation should be for calcium or vitamin D supplementation that includes an intervention to promote high levels of adherence.”

Dr Bischoff-Ferrari and colleagues note in their editorial that “the complementary articles reinforce the importance of fall prevention in reducing the risk of fractures (and other injuries) among older adults.”

Added Dr Krist in the podcast, “We felt these topics were very similar. We decided we’d bundle the topics to make it easier to understand the evidence.”

How to Use Average Blood Glucose to Estimate HbA1c


Checking blood glucose

By John Pemberton, Head Coach at Diabetic Muscle and Fitness and Diabetes Specialist Dietitian/Educator 

Do you have this essential diabetes management skill?

Most adults only get their HbA1c checked once a year, sound familiar?

This means you have an idea how things have been going for the previous 90 days, but what about the other 275 days?

The most effective way of keeping on top of your diabetes control is by regularly checking your average blood glucose (BG).

How Often Do You Check Yours?

Do you know how to use the results to predict HbA1c?

This table shows where your HbA1c will be very close to, depending on what level your average BG has been at for 90 days. The table also shows the benefits and consequences of having different levels of control for long periods of time.

What has your average BG been for the:

  • Last 90 days?
  • Last 30 days?
  • Last 14 days?

If you are currently in the red zone – don’t freak out!

This article is your wake up call. It’s time to take action. You can change this around very quickly, that is the beauty of using average BG to guide you.

How Do I Achieve Better Average Blood Glucose Levels?

Make small incremental changes to your daily diabetes habits and regimen. You can evaluate your progress by tracking the change in average BG every two weeks.

Top Diabetes Management Tips Based on 1000s of Hours Spent in Clinical Practice

  • Test BG at least five times per day – this allows you to correct high glucose levels more often.
  • Aim to be in target before bed; this means 8 hours per day of in target levels.
  • Bolus 15-30 minutes before food to prevent high glucose levels after, remember BIFF:
    • Blood test,
    • Insulin dose,
    • Fifteen minutes wait,
    • Food, eat it.
  • Keep to 3-4 meals per day, spread equally with 3-4 hours in-between.
  • This matches with the action of quick acting insulin (Apidra, NovoRpaid, Fiasp, Humalog) perfectly.
  • Frequent snacking makes in target glucose control very difficult.
  • Eat mixed macronutrient meals. Avoid carb only snacks, unless using for exercise management.
  • Review the patterns of your glucose trends every 14 days to identify where you need to change your habits and diabetes regimen.
  • Use a written log; there is a lot to be said for writing it down. Why? You process and identify patterns as you write.
  • Use an online platform where you can upload your meter, pump, and CGM devices:
    • Diasend & Glooko
    • They are both the same platform – they have just merged.

I personally use this platform and love it. I have even made guides and videos of how to set up an account, how to review control, and how to make changes in my day job as a Diabetes Specialist Dietitian. You can access these guides and videos here.

  • Use APPS such as MySugar and Diabetes:M
  • If you are struggling to identify solutions and find it hard to make changes, get professional help.

Your diabetes team or a professional with the requisite skills and qualifications should be able to guide and empower you.

If they just tell you what to do without teaching you how to do it, they are not setting you up for long-term success!

I work on the premise that as long as my average BG is less than 8.0 mmol/L (145mg/dL), I am all good.

If it’s above there, I need to focus on improving my control.

A special note: it’s no good having an average BG of 6.0 mmol/L (110mg/dL) if it means you are hypo all the time.

Research suggests having 3-4 mild hypos a week that you can treat yourself is usual for people with good control. But if more than this you are at risk of becoming hypo unaware. This research is from people on MDI and pumps who adjust their doses based on food intake and activity.

Being hypo unaware will mean you will not be able to drive (in the UK and most places if your physician knows or you call out an ambulance), and you will be at much higher risk of having a severe hypo. This is not a worthwhile trade-off for a HbA1c of 5.0%!

It’s all about balance.

Everyone is different, so set your target according to your circumstances.

As a general rule these are two good markers to aim for:

  1. Average BG less than 8.0 mmol/L (145 mg/dL).
  2. Less than 3-4 mild hypos per week, but no severe hypos and you can detect your hypos.

Checking average BG every 14 days will mean you stay in control and catch issues early! A Wiseman one told me: “If you’re not assessing, you’re guessing!”

Hope that helps!

References

  1. DAFNE Research Database Study

The Artificial Pancreas: What Is It and When’s It Coming?


 

You’ve probably heard about the artificial pancreas, but are you up to speed on what’s happening in this rapidly evolving field?

First of All, What Is It Really?

The artificial pancreas (AP) is a device that mimics the blood sugar function of a healthy pancreas. It has three parts: a sensor for continuous glucose monitoring, a pump to deliver insulin, and a laptop or cell-phone component that directs the pump to deliver insulin as needed.

Most systems will deliver insulin alone, but some will be able to deliver both insulin and glucagon*.

How It’s Different from CGM

Artificial pancreas systems are often called “closed-loop” because they talk to both the sensor and the pump, bridging the gap between the two. The goal is to make a continuous loop without the need for human intervention. In testing so far, AP systems have often resulted in more time in target glucose ranges with less hypoglycemia, and they have also shined in controlling blood sugars overnight. They are not a cure by any means, but they are a huge improvement and will allow for diabetes management to go a little more on autopilot in the near future.

50 Years in the Making

The first precursors of the artificial pancreas date back to the 1970s. In the 50 years since, improvements have been made on all fronts: control algorithms are getting more predictive and less reactive, and pumps and glucose sensors are getting more accurate. Yet many challenges remain, such as the need for faster insulin, more stable glucagon, and systems that can work without user intervention, e.g., during meals and exercise.

The Future Is Almost Here

In June of 2017, Medtronic launched the first commercialized product, Minimed 670G.

The Medtronic device is a “hybrid” system due to the need to manually interact for meals and exercise. Hailed as a major advance towards a fully-automated artificial pancreas system, the 670G will be followed by other closed-loop systems in the coming months and years, with more and more academic group and industry collaborations being announced.

MiniMed 670G

One such effort – the IDCL (International Diabetes Closed Loop) Trial – is another example of the degree of collaboration between academic centers and industry. Led by the University of Virginia in conjunction with centers in Europe, companies like TypeZero Technologies, Tandem Diabetes CareDexcom and Roche Diagnostics are also involved. Other companies like Insulet (Omnipod) and Bigfoot are developing AP systems as well.

If You Just Can’t Wait

Alongside conventional development of AP systems, “Do It Yourself” or DIY movements spearheaded by patient and engineering communities are gaining visibility with a reported 400+ PWD currently using DIY artificial pancreas systems. Initiatives such as DIYPS.org and #wearenotwaiting are providing information on the internet to help people with diabetes build their own AP systems using commercially available CGM and pumps while providing information on how to set up control algorithms.

These systems require a great deal of user learning and commitment. While probably not for everyone and regulatory authorities sending out caveats on the potential risks involved, they can be a way for people to access artificial pancreas technology now before other systems are cleared for use.

At the 2017 Taking Control Of Your Diabetes Conference & Health Fair in San Diego, there was a panel discussion with five people who experimented with DIY systems and shared their thoughts, advice, and personal experiences.  You can watch the seminar and hear what they had to say here.

As a result, we can expect several artificial pancreas options in the coming years, which is amazing news! Systems will differ, but the goal will be the same: to reduce the burden of living with diabetes until a cure is found. We look forward to seeing more and more options in this space, and send kudos to all involved for their perseverance, passion, and commitment!

*Glucagon causes the liver to release stored glucose, raising blood sugar levels. It can be used to treat severe hypoglycemia.

Supercharge Your Insulin Sensitivity Naturally with These 5 Proven Daily Routines


 

Insulin sensitivity refers to the biological response of target tissues such as muscle to the actions of insulin. In other words, insulin sensitivity refers to how well insulin performs its role of transporting and storing fuels in specific cells in the body, particularly glucose.

Insulin sensitivity varies between individuals and is reduced in people with diabetes.

Medication aside, lifestyle plays an important role in helping boost insulin sensitivity and prevent impaired tissue responses (insulin resistance), which, in turn, supports blood glucose disposal and improves diabetes management.

Lifestyle choices do this in a number of ways:

  • Strength training increases muscle mass which serves as a major storage house for glucose.
  • Walking and other forms of low-intensity exercise can reduce blood glucose.
  • Stress management including meditation and a good quality sleep pattern help control excess production of counterregulatory stress hormones, such as cortisol and adrenaline, which increase blood glucose levels.

All of the above help improve the action of diabetes medication and whatever is left of natural insulin production. Obviously, the effects of each lifestyle factor will vary depending on how often they are conducted, their intensity and, of course, inter-individual physiology and genetics.

Treat this article like an accountability checklist.

If you live with diabetes and aren’t following any of the five lifestyle behaviors listed, you might be missing a few tricks for improving health, managing your diabetes, and building that body you always wanted.

Daily Routine #1 – Perform at Least 20-45 Minutes of Anaerobic Exercise Every Single Day

Anaerobic exercise is defined as physical exercise that is intense enough to generate lactate.

You know you have generated lactate when you start feeling a burning sensation in your muscles. High rep squats and sprint intervals get you burning pretty quick. Strength training and high-intensity interval training are prime examples of anaerobic exercise.

The human body responds differently when trained with anaerobic exercise compared to aerobic exercise. The adaptions that occur to the muscle energy systems are of particular interest and benefit to people with diabetes.

Anaerobic training increases insulin sensitivity and stimulates skeletal muscle tissue to absorb glucose from the bloodstream independently of insulin. This is achieved through the stimulation of specific glucose transporters called GLUT-4. The more anaerobic work a muscle fiber has to contend with, the greater number of GLUT-4 rise to the surface of a muscle cell for the purpose of glucose extraction. Once glucose is absorbed from the bloodstream it is stored as muscle glycogen.

Increased insulin sensitivity is just one of the many benefits of anaerobic exercise. There are plenty more, which I will cover another time.

How often and how much anaerobic training should I perform?

Perform anaerobic training at least 3 times per week in the form of:

  • 20-60 minutes of strength training – whole body, body part splits, etc.
  • 10-20 minutes high-intensity interval training – skipping, spinning, battle ropes, sprints etc.

All of these training bouts will improve glucose uptake and improve blood glucose management in people living with diabetes.

Daily Routine #2 – Get and Stay Lean

It is well-established that high levels of body fat result from living in a calorie surplus for a prolonged amount of time. Excess body fat accumulation is not only unsightly, but highly inflammatory and detrimental to the effectiveness of your insulin.

Also proven is the fact that the biological response of target tissues to the actions of insulin (insulin sensitivity) are majorly affected by adiposity, or the amount of body fat one carries. 1

The leaner you are, the better your insulin will work. Period.

5 top tips for getting lean with diabetes:

  • Create a calorie deficit by sensibly increasing your physical activity and reducing food intake in a controlled way.
  • Strength train at least 4-5 times per week.
  • Manage your diabetes.
  • Achieve at least 7 hours sleep each night.
  • Aim to lose between 0.5-1% of your body weight each week.

Daily Routine #3 – Have a Toolbox of De-Stressing Activities

In today’s modern day age, we are increasingly exposed to more chronic stress than ever before: mobile phones, social media, traffic, bills, etc.

Stress stimulates a flight or fight response within the body, a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. The body responds to stress by activating the sympathetic branch of the central nervous system. Stress increases muscle tone, constricts blood vessels, and increases the production of counterregulatory stress hormones which increase blood glucose.

In small doses stress is healthy. It can save your life.

However, excessive stress is unhealthy and works against diabetes management.2

The greater and more prolonged the stress, the more insulin is required to balance blood glucose. It is well established that stress can influence whole-body glucose metabolism and promote insulin resistance. 2,3

Any forms of stress management, like meditation, massage, yoga, breathing exercises, or personal development, are worthwhile if they help reduce stress. Reducing your daily stress is a surefire way to improve insulin sensitivity and reduce incidents of high blood glucose.

Even Apple have cottoned on to this with their new “take a minute to breathe” reminder on their Apple Watch.

Daily Routine #4 – Have a Structured Sleeping Plan

Sleep could also be considered a form of stress management, especially for individuals who are highly active and live with diabetes.

I hate to tell you the obvious, but sleep is essential for good health and diabetes management.

Many laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of insulin resistance and diabetes.4,5,6,7

One of the best pieces of advice is to set a fixed bedtime and wake time. Not only does this provide structure for your day, but it ensures you get enough restorative sleep for health and optimal diabetes management.

Again, the major tech company Apple and their recent focus on health tech apps have included a set wake/bedtime function in their alarm clock.

At Diabetic Muscle and Fitness, we take sleep seriously. We even developed a 3.5+ hour video module on sleep optimization for improving hormone profiles and body composition.

Daily Routine #5 – Perform Aerobic Exercise Daily

Aerobic exercise such as a light jogging or a brisk walk can increase glucose disposal and lower blood glucose levels – independently of insulin.

One of the main reasons aerobic exercise lowers blood glucose levels so well is due to the fact that there is little to no counterregulatory hormone response like that which occurs during high-intensity anaerobic exercise.

Please bear in mind, it is important to monitor insulin intake around aerobic exercise in order to avoid hypoglycemia.

I highly recommend buying an activity monitor like a Fitbit, Apple Watch, or Garmin. These are awesome for building the habit of doing more aerobic exercise throughout your day.

Take Home

Each and every daily routine I’ve shared in this article will improve insulin action and help your body clear glucose easier. Each and every one of these routines is a prerequisite for a great looking body and high levels of mental and physical performance.

Identify which areas you need to work on and get to it!

References

  1. Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005 May; 26(2):19-39.
  2. Li L et al. Acute psychological stress results in the rapid development of insulin resistance. J Endocrinol. 2013 Apr 15;217(2):175-84.
  3. Nolan et al. Insulin Resistance as a Physiological Defense Against Metabolic Stress: Implications for the Management of Subsets of Type 2 Diabetes. Diabetes Mar 2015, 64 (3) 673-686;
  4. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131–6.
  5. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.
  6. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.
  7. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–30.

How To Exercise To Reduce Inflammation (And Avoid Creating More)


When it comes to reducing inflammation, we often turn to a healthy diet, hot baths, and nourishing massages. While there’s nothing wrong with beating inflammation using these tactics, exercise is also an effective way to lower inflammation. In fact, one study that followed 4,000 middle-aged people over a 10-year period found that those who exercise for two and a half hours per week lowered their inflammation by 12 percent.

But when it comes to lowering inflammation, which types of exercise are best? Here’s what the experts say.

Go for a walk.

When your body is inflamed, whether it’s from intense exercise or something else, a light walk is an excellent way to reset. “I tell my clients, especially the ones who tend to really push themselves, to ease up a bit and just go for a long walk when their body is really dreading a tough workout,” says Michelle Cady, health coach and FitVista founder. “Walking is a great way to let your muscles recover—it brings down inflammation by sending fresh blood and oxygen throughout your body, pumping the lymphatic system for waste removal, and gently restoring your digestive system if it feels off.”

Hike.

Want to take your walk to the next level? Immerse yourself in nature and go for a hike. “Find a safe trail, bring a friend, and go on an easy one-hour ramble through the woods,” says Cady. “Just like walking, easy hiking stimulates muscle recovery and reboots your system. As an added bonus, ‘forest bathing,’ or time spent surrounded by trees, lowers the body’s cortisol stress-response (which is linked to inflammation) by up to 20 percent.”

Foam roll.

While it does have core-strengthening benefits, foam rolling is often considered a recovery tactic, and for good reason: It helps with muscle soreness, improves flexibility, improves sleep, helps with digestion, and lowers inflammation. “To reduce inflammation with a foam roller, lie on a roller and use gravity to apply pressure to a muscle,” says Nicholas M. Licameli, physical therapist at Professional Physical Therapy. “The roller is pressed into the muscle belly, and the user rolls up and down the length of the target muscle.”

Do yoga, meditate, and deep breathe.

This one probably doesn’t come as much of a surprise, but the power of deep breathing and yoga as an inflammation-busting tactic can’t be underestimated. “Deep, controlled breathing and meditation induce a state of physical and mental relaxation,” says Licameli. “This is incredibly helpful when you want to lower inflammation in the body.”

Disordered Eating with Diabetes


eating disorder with diabetes

 

“Are you hungry?” my husband asked me after a particularly difficult hike in the Rocky Mountains last summer that lasted over 12 hours, where all we ate during the day was trail mix and some dried fruit. He was starving.

“I’m fine,” I replied. “My blood sugar is 115.”

He looked at me quizzically, and lovingly reminded me that blood sugar and hunger are not the same thing.

As a person with diabetes, I have had to separate my hunger from my need of food. There have been countless instances when at dinner time my blood sugar was over 400, and I had to wait until insulin brought me down to a safe level before digging in. Conversely, there have been many times (too many to count) where I was not hungry at all, but of course had to eat something because my blood sugar was under 60. I am always cognizant of my blood sugar, but not always of the crucial hunger and fullness cues. This is problematic.

People with diabetes have a tricky relationship with food. Diabetes requires one to be diligent when it comes to tracking what and how much they eat. There is also constant monitoring of food intake (carbohydrates in particular), exercise, and insulin. Additionally, people with type 1 diabetes, whose beta cells have been destroyed by the body’s immune system, secrete none of the hormone called amylin at all. Amylin is a peptide hormone that is co-secreted with insulin, and inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent. This may be why some people with diabetes struggle to feel full after meals. As a result of all of this constant tracking of food, plus the inability to regulate our hunger cues, people with diabetes may be inherently more prone to issues around disordered eating.

According to the National Institutes of Health, adolescents (ages 12-21) with type 1 diabetes experience elevated rates of disordered eating behaviors in 37.9% of females and in 15.9% of males. For adolescents without diabetes, the rates are 3.8% and 1.5%, respectively. The most common type of disordered eating among people with type 1 diabetes is a little known condition called diabulimia, where people intentionally reduce their insulin intake to lose weight. This is a serious condition that leads to diabetic ketoacidosis (DKA) and even death, if not treated.

One in three teenagers (more often than not a girl) will face disordered eating in her lifetime with type 1 diabetes. We’re bombarded with magazines and ads, fad diets and “quick fixes.” We also have to maintain a healthy HbA1c, measure every portion of food we eat, and make sure we get adequate exercise and take our insulin appropriately. It’s stressful. And how “normal” is it that every 12 year old with diabetes knows the carb counts for not only every sandwich they eat, but all of the snacks they eat at sleepovers, as well as their birthday cake?

Holding all of that healthy knowledge inside is overwhelming, especially in a society that values thinness over all else. It is also powerful that every diabetic holds the keys to their health literally in their hands. If they mismanage their diabetes, they will lose weight (losing weight is also a classic symptom of diabetes, so it stands to reason that diabulimia and the mismanagement of the condition leads to weight loss). People with diabetes face many tough battles, and food is a major source of stress for most people with the condition.

Since many people’s relationship to food is warped, it’s important to note the symptoms of diabulimia if your loved ones are showing any of the following signs, and to seek help if you think they have a problem:

According to the National Eating Disorder Association, signs of diabulimia include:

  • Hemoglobin A1c level of 9.0 or higher on a continuous basis
  • Unexplained weight loss
  • Persistent thirst/frequent urination
  • Preoccupation with body image and a fear that insulin will cause weight gain
  • Blood sugar records that do not match hemoglobin A1c results (falsifying sugar logs)
  • Depression
  • Secrecy about blood sugars, shots, and eating
  • Repeated bladder and yeast infections
  • Low sodium/potassium
  • Increased appetite especially in sugary foods
  • Cancelled doctors’ appointments

If you think that you or someone you know is struggling with disordered eating or diabulimia, contact the diabulimia helpline or call their hotline, open 24 hours a day: (425) 985–3635.

Have you seen drastic dietary or behavioral changes in someone you love that has diabetes? Do you recognize any of the aforementioned symptoms in your own life? If so, please seek the help you need. Your diabetes and your life depend on it.

 

Why Don’t People Take Diabetes Seriously?


 

When we hear that a loved one or friend has a serious illness it can evoke in us strong emotions of fear, worry, sadness and compassion. “I’m so sorry” and “How can I help?” are commonly offered sentiments in these difficult situations. Hearing the news that someone has diabetes does not often herald the same degree of concern.

Why is this? I believe that the reasons are multifactorial.

Broad Terms Contribute to Confusion

If we consider the word “cancer” people typically have an immediate reaction of alarm. However, cancer is a large umbrella representing over 100 distinct diseases depending on the organ or system affected. Prognoses for cancer are widely variable and many cancers are curable with early diagnosis and treatment.

These important distinctions reflective of cancer’s diverse landscape are often lost on the public’s perception. Thus, people may endure unnecessary anxiety, dread and anguish. Society’s increased understanding of the medical and scientific advances in cancer treatments would alleviate a lot of suffering and fear and replace it with hope and optimism. Even those who can’t be cured are often able to have significantly lengthened periods of disease-free survival and enhanced quality of life due to new treatments.

While the term diabetes is not as deceptively broad as cancer it does represent over seven distinct conditions each with its own pathophysiology. If you consider that diabetes may occur as a result of another disease or condition like cystic fibrosis, hemochromatosis or chronic pancreatitis, just to name a few, there are even more types of diabetes.

Unless you’ve personally known someone with diabetes and seen firsthand either a complication of the disease or its daily, labor-intensive management you may not grasp the seriousness of the diagnosis. Perhaps we’ve heard the word so much that we are desensitized to it. This is unfortunate since diabetes has become one of the fastest growing risks to human health throughout the world.

Since my own child was diagnosed with type one diabetes in 2013 I’ve become very attuned to how diabetes is perceived both in personal encounters and in the media. In our circle of family, friends and teachers, the reactions to my son’s diagnosis were a mix of bewilderment, sadness and nonchalance. Most people simply didn’t know what it was.

The knowledge gap with T1D may partially be attributed to its name. For clarity, I tell people that it was previously called Juvenile Diabetes. That charged term usually captures attention. Putting “juvenile” in front of any word will often do that (e.g., juvenile delinquency, juvenile detention center, etc.)

In my experience people generally assumed that my son would now need some sort of low-level lifestyle tweaks. The word sugar was always coming up. Should we get some sugar-free foods for him? Can he have cake? Wouldn’t some exercise, a “balanced diet” and a Crystal Light or two keep this thing in “control?”

Someone once told me to ditch my son’s insulin and go macrobiotic. Although disturbing, at least one of my son’s classmates understood that diabetes was serious. Lacking a filter he felt compelled to share that he had a relative who had his leg amputated. My husband who is an ICU physician had to reassure my son that these complications are very rare.

Pre-Diabetes

With so many different types of diabetes it’s no wonder that such a knowledge deficit exists. Take prediabetes as a perfect example.

According to the American Diabetes Association, in 2015 an astonishing 84.1 million Americans or more than 1 out of 3 adults had pre-diabetes. A person may leave an annual doctor’s visit with this news and a general recommendation to lose weight and exercise more. He may compare notes with his friends and discover that some of his buddies are in the same boat. With the tendency to feel like there is safety in numbers one might be inclined to either ignore the diagnosis or just try a few lifestyle tweaks like joining a gym or eating brown rice instead or white.

Unlike those with type 1, those with pre-diabetes don’t leave the doctor’s office with an abrupt and permanent new way of life requiring 24/7 insulin. Perhaps this is another factor that contributes to a lack of urgency to reverse pre-diabetes. Some will gamble that they can coast along with no lifestyle changes without converting to type 2 diabetes. They might be right but they need to know the real risks of this strategy.

Pre-diabetes means that something is wrong with a fundamentally important body function: glucose metabolism. Even if an individual does not ultimately receive a type 2 diagnosis he is still at risk for serious complications like retinopathy and neuropathy. So, feeling “fine” with this relatively silent condition is, indeed, a false sense of security.

Inspiration from a Type 2

Before my own child was diagnosed with type one I had a grim, skewed perception that diabetes was either coping with spirit crushing food restrictions or trying to persevere through difficult complications. Two relatives with type 2 succumbed to those complications. I just didn’t understand the other perfectly viable scenario of a healthy life filled with abundance.

One type 2 thriver who has intruigued me so much is the acclaimed English actor, Robin Ellis. In the 1970s he was the heartthrob leading man, Captain Ross Poldark, of the beloved BBC and Masterpiece Theatre series, Poldark.

A remake of it is currently thrilling millions on Masterpiece Theatre.

A huge fan of the original, I was fascinated to discover that Mr. Ellis is an inspiring type 2 diabetic. He has contributed to the diabetes community by being very transparent about his condition and his successful journey adapting to it.

An accomplished chef, Mr. Ellis’s lushly photographed and delectable diabetic-friendly cookbooks are a wonderful resource. Anyone with diabetes perusing these books may begin to feel that there is, indeed, another way to not just live with diabetes, but flourish as a result of it.

His latest, Mediterranean Cooking for Diabetics: Delicious Dishes to Control or Avoid Diabetes, is a go-to book in my cookbook collection. My type one son is a big fan of Mr. Ellis’s lower carb recipes and it makes me feel good to cook his healthy and flavorful dishes for my entire family.

So why do some people with diabetes like Robin Ellis become converts to a new way of living with diabetes? Growing up with a mother with type 1 diabetes who passed away from a heart attack due to her condition, Robin was cognizant of the dangers of diabetes as a result of this terrible loss.

However, I believe his motivation for a lifestyle change was not simply motivated by fear. Living in the French countryside with his supportive wife, Meredith, Mr. Ellis embraced the healthy culinary treasures of this region. He used his diagnosis as a springboard to explore new possibilities in food, exercise and wellbeing.

As the mighty Theodore Roosevelt used to say, “get action.” Take diabetes seriously no matter what type you have. Don’t let denial put your health at risk. You can shift from a place of worrisome vulnerability to one of hopeful optimism and fortitude if you are open to change.

There is a full life of abundance waiting for you.

What Can Exercise Do for People With Type 1 Diabetes?


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In a meta-analysis done to look at exercise training in those with type 1 diabetes, researchers report which benefits were observed.

They sought to “establish the relationship between exercise training and clinical outcomes in people with type 1 diabetes.”

The study authors searched for prospective randomized or controlled trails involving exercise training in people with type 1 diabetes for 12 or more weeks though MEDLINE, Cochrane Controlled Trials Registry, CINAHL, SPORTDidscus, and Science Citation Index.

What Does Exercise Help With if You Have Type 1 Diabetes?

In those who exercised, researchers found that exercise lowered daily insulin needs, BMI (body mass index), peak VO2, resting heart rates, resting systolic blood pressure (the top number), LDL cholesterol, and triglycerides.

Children who exercised, specifically had lowered insulin doses, waist circumference, and triglycerides.

They didn’t find any effects from exercise on A1c levels however, nor fasting blood glucose, body mass, or HDL cholesterol levels.

What About  You?

If you have type 1 diabetes, what does exercise personally help you with? Share in the comments!

What Does It Mean to Be Healthy With Diabetes?


Being healthy, and being healthy with diabetes, means different things to different people!

Because there’s no single answer when it comes to what constitutes being “healthy,” this post won’t be about how I think you should live your life in order to be healthy, but rather the different components of being healthy with diabetes and how I think about them.

Then it’s up to you to make your own definition of what health looks like to you.

Why is it important to think through what health is and how you would define it, you might ask? Well, it’s important because:

  1. It can help you evaluate what health aspects of your life you need to focus on,
  2. It can help you set tangible goals for what you want for your health and can make goal setting easier, and
  3. It can remove some of the emotional noise surrounding the word “health,” making it less important how others define it and only truly important how you define it.

When identifying the components of health, I lean towards the definition that health includes physical, mental, and social balance rather than simply the absence of illness.

What I like about that definition is that it recognizes that those of us living with a chronic condition can still be healthy. And I truly believe that we can be!

I have diabetes, but I still consider myself quite healthy.

Physical Health

When it comes to physical health, I think of it as a body that is well nourished, exercised, rested, in general balance, and with well-managed blood sugars. That’s a tall order and it could be even taller, for as mentioned, the exact definition will be up to you.

If I were to evaluate my physical health, I would ask myself:

  • Am I eating the right amount of calories and macronutrients to fuel my activity level and fitness goals?
  • Am I drinking enough water?
  • Is my exercise routine (volume and intensity) giving me energy and building stamina and strength or is it taking energy, making me feel drained or bored?
  • Am I getting enough quality sleep?
  • How do I feel? Is my digestion working as it should, am I energized, etc.?
  • Is my diabetes affecting my physical well-being, and if it is, am I spending the energy needed to manage my diabetes according to my diabetes management goals?

An assessment like this is, of course, subjective, but I think it’s a good starting point for identifying what’s important to us individually when it comes to physical health and help make an improvement plan if needed.

Mental Health

There is a lot of overlap between our physical and mental health, especially when it comes to living with diabetes. Mental health, of course, encompasses so much more than what’s related to diabetes, but I will focus on diabetes in this post.

My top 3 list for a mental health self-check would be:

  • Am I at risk of any degree of diabetes burnout and what are some of the preventive measures I can take?
  • Am I being kind to myself by building myself up and not talking myself down? Am I accepting that I can’t control everything about my diabetes and therefore never will be in complete “control?”
  • Do I prioritize my happiness and continue to have a positive outlook on life and my diabetes management?

I find that just thinking through these three points can help address unhealthy mental behavior and be a cornerstone for making positive changes if needed.

Social Health

Finally, we have social health. This one took me a little longer to define since I tend to bundle it in with mental health checks. However, the more I think about it, the more I think that it needs to stand on its own.

When I think of social health in a diabetes context, I think of how we as people living with diabetes allow others to interact with our condition. It’s how we react when people ask about it, how we interact with other people living with diabetes, and how we tackle food choices when “in the wild.”

The things I’ve found useful to work on when it comes to my social (diabetes) health are:

  • How do I handle times when I’m not comfortable sharing my diabetes with others? I think it’s okay to not want to talk diabetes with others sometimes, but I also acknowledge that people don’t necessarily know or understand that, so I need strategies to handle those situations.
  • Acknowledging that my diabetes management is “mine” because only I can define what success is. It may differ significantly from other people’s definitions of success when it comes to blood sugar control and food choices. And that’s okay.
  • Learning how to say no to food pushers or people implying (or telling me directly) that there are certain things I can’t eat.
  • Developing strategies for dealing with food (carb counting) uncertainty when I am eating out or in social settings.

As mentioned, this is how I think about the three health categories and what’s important to me when it comes to my physical, mental, and social balance.

I encourage you to think of minimally three things for each category that are important to you and then make them a priority. Sometimes all it takes to see a significant improvement in one’s health is to focus and make a few small adjustments.

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