2.2 million older Americans—almost one-fourth of us over age 60—are living with diabetes.
Diabetes develops when the pancreas can not manufacture enough insulin, or because the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy.
The complications from the disease can be severe. They include serious problems such as heart disease, eye and kidney damage, high blood pressure, and nerve damage that could result in amputation.
While this is a very sobering list of complications, patients themselves have the power to reduce the potential for complications, and to successfully manage the disease. Self-care practices such as healthy eating, being active and monitoring blood glucose levels make a huge difference.
So, let's review some diabetes complications, along with some positive actions that can help patients and loved ones minimize damage and improve outcome:
Nerve Damage
Nerve damage called diabetic neuropathy can appear as numbness, tingling, pain, perspiration problems and bladder problems. It is caused by high blood sugar. You can help control your blood sugar through eating the diet your healthcare provider suggests, as well as with exercise, taking medications correctly and frequent blood glucose level testing.
Increased Risk of Infection
For people with diabetes, high levels of blood sugar foster the growth of bacterial and fungal infections, especially common in the skin and urinary tract. You can decrease the risk of infection by keeping skin clean and dry, bathing regularly, drinking plenty of water, and reporting to the doctor if a cut doesn't heal quickly.
Impaired Vision
While many people develop glaucoma and cataracts, people with diabetes develop them more often and at an earlier age. Over time, high blood sugar can injure the blood vessels of the eye, including the retina, lens and optic nerve. Regular eye examinations should be part of your diabetes management program, because early intervention for eye problems will help prevent more serious problems later. Remember—damage to the eyesight may not be apparent at first, so have an annual exam even if your vision isn’t bothering you.
Foot Problems
While anyone can have foot problems, people with diabetes are especially prone to corns, blisters, calluses, dry, cracked skin. Serious infection is much more common because the nerve damage described above can reduce feeling in the feet. It is important to pay attention to your feet, inspecting them regularly so problems won't worsen. Keep feet clean and dry, and talk to your healthcare provider about the best type of shoes and socks to select.
Heart or Kidney Disease
Diabetes also makes it more likely that a person will suffer from cardiac or renal disease. A healthy lifestyle and commitment to managing those conditions is very important. This includes getting the right amount and type of exercise, complying with medication instructions, quitting smoking if you do, and regular monitoring of blood sugar.
For More Information
Visit the National Council on Aging (NCOA) website to learn about the Connect the Dots program, which helps seniors learn about the link between diabetes and high blood pressure. Included is a handy take-along checklist to detemine a patient's risk for these two conditions.
In time for American Diabetes Month, the CDC offers updated information on diabetes prevention, detection and management.
The American Diabetes Association sponsors American Diabetes Month. Their website is a great source of consumer information for people with diabetes and their families. Learn more about American Diabetes Month 2009 and the Association's new Stop Diabetes campaign.
The National Diabetes Information Clearinghouse from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) offers extensive information on preventing and treating diabetes.
By Joyce Remy, Editor, and Dennis Kenny, Co-Author, Aging in Stride–Plan Ahead, Stay Connected, Keep Moving. Copyright, 2009.
Sunday, November 29, 2009
Saturday, November 14, 2009
Planning for the End of Life
Public health strategies, coupled with medical advances, have resulted in a 30-year increase in life expectancy since the dawn of the 20th century. People are living longer and expectations about their health and quality of life are increasing. These expectations extend to wanting to ensure that the last months and years of life are lived as fully as possible, as pain-free as possible, and with dignity.
Traditionally, much of the nation’s public health network focus is about infants and children—ensuring that babies are born into the world as healthy as possible and that children thrive and are protected from injury and communicable diseases. In more recent decades, additional strides have been made in ensuring that our nation’s adults practice healthy behaviors and take advantage of preventive measures that reduce their risk of chronic disease, injury, and infectious diseases such as influenza and pneumonia.
Now, as more and more baby boomers reach their older years, opportunities exist through the nation’s public health network to focus on more about the end of life and help ensure that Americans have the resources needed to make informed choices and decisions about how their final months and days are spent.
Recognizing how important it is to be prepared for the end of life, CDC defined better opportunities, public health roles, and responsibilities in 2002.
As a first step, CDC’s Healthy Aging Program, in collaboration with CDC’s Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors (NACDD), worked with more than 200 key public health stakeholders to identify short-, medium-, and long-term public health priorities related to the end of life.
Of the priorities identified, five were deemed most critical and ready for action. These include the following:
Identify point of contact for end-of-life issues in state health departments.
Collect, analyze, and share data related to the end of life.
Incorporate end-of-life principles in state comprehensive cancer control plans.
Educate the public about hospice and palliative care.
Educate the public about the importance of advance directives and health care proxies.
Of these top priorities, CDC chose public education, data collection, and data analysis, to pursue initially.
Planning End-of-Life
Family members are often asked to make decisions on behalf of a loved one who is seriously ill without having a complete understanding of his or her preferences. To avoid this situation, older adults should discuss their end-of-life wishes with family members and health care providers well before the onset of a serious illness, and they should designate a surrogate decision maker for health care.
Having these conversations is the best way to protect one’s independence in a myriad of unpredictable situations. Many people find it difficult to begin a discussion about end-of-life issues, however. Fortunately, several resources are available to help foster meaningful conversations and practical planning for end-of-life care.
Understanding Palliative Care and Hospice Care
For the past several decades, the health care system has provided a number of options to ease the dying experience. Medical treatment has expanded to include palliative care and hospice care. The goal of palliative care is to achieve an optimal quality of life for patients by using a holistic approach that focuses on the alleviating of pain, symptoms, and other unique needs of the patient at any time during their experience with a serious or life-threatening illness. A combination of social support, emotional support, and attention to spiritual aspects of care and respect for the patient’s culture, beliefs, and values are essential components of this approach. Although the level of palliative care intensifies at the end of life, the focus on the relief of suffering and improving quality of life is important throughout the course of the illness, and aspects of palliative care can be provided along with life prolonging treatment during earlier phases of a patient’s illness.
Hospice care is an organized program for delivering palliative care that involves an interdisciplinary team of specially trained health professionals and volunteers. Hospice care is delivered to dying patients in inpatient units, nursing homes, or, most often, in their own homes. In addition to providing palliative care and personal support to individuals at the end of their lives, hospice provides support to the family while their loved one is dying as well as during the bereavement period. In 1982, Medicare began reimbursing for hospice services. To qualify for the Medicare hospice benefit, terminally-ill patients must have a terminal diagnosis, a life-expectancy of 6 months or less, and is willing to forgo further treatments. Patients who live longer than 6 months can be “recertified” if their situation still meets the criteria for the hospice benefit.
End-of-Life Resources
Advance Care Planning
Center for Practical Bioethics Caring Conversations
Caring Connections
Aging With Dignity-Five Wishes
Respecting Choices
Hospice and Palliative Care
National Hospice and Palliative Care Organization
National Association of Home Care and Hospice
Guardianship/Surrogacy Issues and Protection
American Bar Association Commission on Law Aging
Traditionally, much of the nation’s public health network focus is about infants and children—ensuring that babies are born into the world as healthy as possible and that children thrive and are protected from injury and communicable diseases. In more recent decades, additional strides have been made in ensuring that our nation’s adults practice healthy behaviors and take advantage of preventive measures that reduce their risk of chronic disease, injury, and infectious diseases such as influenza and pneumonia.
Now, as more and more baby boomers reach their older years, opportunities exist through the nation’s public health network to focus on more about the end of life and help ensure that Americans have the resources needed to make informed choices and decisions about how their final months and days are spent.
Recognizing how important it is to be prepared for the end of life, CDC defined better opportunities, public health roles, and responsibilities in 2002.
As a first step, CDC’s Healthy Aging Program, in collaboration with CDC’s Division of Cancer Prevention and Control and the National Association of Chronic Disease Directors (NACDD), worked with more than 200 key public health stakeholders to identify short-, medium-, and long-term public health priorities related to the end of life.
Of the priorities identified, five were deemed most critical and ready for action. These include the following:
Identify point of contact for end-of-life issues in state health departments.
Collect, analyze, and share data related to the end of life.
Incorporate end-of-life principles in state comprehensive cancer control plans.
Educate the public about hospice and palliative care.
Educate the public about the importance of advance directives and health care proxies.
Of these top priorities, CDC chose public education, data collection, and data analysis, to pursue initially.
Planning End-of-Life
Family members are often asked to make decisions on behalf of a loved one who is seriously ill without having a complete understanding of his or her preferences. To avoid this situation, older adults should discuss their end-of-life wishes with family members and health care providers well before the onset of a serious illness, and they should designate a surrogate decision maker for health care.
Having these conversations is the best way to protect one’s independence in a myriad of unpredictable situations. Many people find it difficult to begin a discussion about end-of-life issues, however. Fortunately, several resources are available to help foster meaningful conversations and practical planning for end-of-life care.
Understanding Palliative Care and Hospice Care
For the past several decades, the health care system has provided a number of options to ease the dying experience. Medical treatment has expanded to include palliative care and hospice care. The goal of palliative care is to achieve an optimal quality of life for patients by using a holistic approach that focuses on the alleviating of pain, symptoms, and other unique needs of the patient at any time during their experience with a serious or life-threatening illness. A combination of social support, emotional support, and attention to spiritual aspects of care and respect for the patient’s culture, beliefs, and values are essential components of this approach. Although the level of palliative care intensifies at the end of life, the focus on the relief of suffering and improving quality of life is important throughout the course of the illness, and aspects of palliative care can be provided along with life prolonging treatment during earlier phases of a patient’s illness.
Hospice care is an organized program for delivering palliative care that involves an interdisciplinary team of specially trained health professionals and volunteers. Hospice care is delivered to dying patients in inpatient units, nursing homes, or, most often, in their own homes. In addition to providing palliative care and personal support to individuals at the end of their lives, hospice provides support to the family while their loved one is dying as well as during the bereavement period. In 1982, Medicare began reimbursing for hospice services. To qualify for the Medicare hospice benefit, terminally-ill patients must have a terminal diagnosis, a life-expectancy of 6 months or less, and is willing to forgo further treatments. Patients who live longer than 6 months can be “recertified” if their situation still meets the criteria for the hospice benefit.
End-of-Life Resources
Advance Care Planning
Center for Practical Bioethics Caring Conversations
Caring Connections
Aging With Dignity-Five Wishes
Respecting Choices
Hospice and Palliative Care
National Hospice and Palliative Care Organization
National Association of Home Care and Hospice
Guardianship/Surrogacy Issues and Protection
American Bar Association Commission on Law Aging
Saturday, November 7, 2009
Seasonal Affective Disorder
By Matthew Solan, Natural Solutions
For 12 years Helena Davis’ life resembled a light switch. When daylight-saving time arrived in spring, it flipped on–she felt energetic, focused, and active. In winter, however, it switched off. She struggled to do the simplest household chores. Her weight ballooned. She could go to work and function at some level, she says, but it was obvious that something was wrong. “All winter I felt like a slug moving around in peanut butter,” says Davis, now 64.
She finally realized that her mood change coincided with her move to upstate New York, an area with few sunny days. A visit to her doctor filled in the diagnosis: Davis was one of 10 million to 25 million Americans, 75 percent of whom are women, who suffer from a subtype of depression called seasonal affective disorder (SAD).
You’ve no doubt heard of SAD. Also called “winter blues,” it often gets mistaken for clinical depression as the two share many symptoms–sadness, anxiety, lethargy, lack of sleep, diminished sex drive, and increased appetite. The difference lies in their duration and severity, according to Norman Rosenthal, MD, author of Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder (The Guilford Press, 2006). SAD typically strikes around September or October and then fades away in March and April. (Depression on the other hand can occur year-round.) Merely troublesome and potentially disruptive at first, SAD can be controlled if you take appropriate action, but “left unchecked, the changes in mood and behavior can become so powerful they can create significant problems in your life and may manifest into year-round major depression if not addressed,” says Rosenthal.
Light therapy
The primary cause of SAD is light deprivation, so light therapy ranks as the first line of defense. Light boxes contain white fluorescent bulbs behind a plastic UV filter, and regular use can reset your body clock and increase serotonin. Effective light boxes generate 10,000 lux (a measurement of intensity); to put that therapeutic amount in perspective, traditional lighting produces 300 to 500 lux, and the sun produces more than 100,000 lux on a bright summer day.
Rosenthal recommends using light therapy for about 20 minutes a day at first, ideally in the morning. How early depends on the individual’s body clock, says Michael Terman, PhD, who heads the Center for Light Treatment and Biological Rhythms at Columbia Presbyterian Medical Center in New York.
If you suffer from SAD, try placing a light box 1 to 3 feet away while you eat, read, go through your mail, or meditate. If your symptoms remain unchanged, increase your treatment to 45 minutes a day, says Rosenthal. Reevaluate your symptoms on a weekly basis and make adjustments. “You should feel the effects within two to four days,” says Rosenthal. “Almost everyone should feel the benefits within two weeks.” (Find light boxes at lightforhealth.com or litebook.com.) Brighten up your living and work space with full-spectrum light bulbs that closely match natural daylight.
Diet and exercise
Dietary changes also can ease SAD symptoms, says Chris Krumm, ND, LAc, of the Bastyr Center for Natural Health, near Seattle. For breakfast, Krumm advocates a high-protein meal to boost intake of tyrosine. “Consuming this amino acid in the morning helps boost your energy throughout the day,” he says. For dinner, Krumm suggests less protein and more carbohydrates like whole grains to help the brain synthesize serotonin. “In addition to improving your mood, increased serotonin may help people sleep better,” he says.
You may want to add more fish to your diet, too, especially cold water types like mackerel and salmon that are rich in omega-3 fatty acids. People with depression often have low levels of omega 3s. A 2001 study found a correlation between increased fish consumption and decreased incidence of SAD in Iceland.
Davis has found that staying active in winter helps her feel less lethargic. She’s chosen a treadmill inside a brightly lit gym, but don’t be afraid to head outside. On bright afternoons, go for a long walk or run. Got more time? Climb on a bike or break out the skis. “You’ll get your required light exposure and also some exercise, which can help alleviate stress that may contribute to SAD-related depression,” says Rosenthal. Research in BMC Psychiatry found the combination of bright light exposure and aerobics reduced many depressive symptoms, especially those related to insomnia and other sleep problems.
Sweet dreams
Some people, like Davis, are prescribed antidepressants to ease their symptoms at first. Herbal alternatives exist, however, most notably St. John’s wort. Research from the University of Vienna, Austria found that taking 900 mg of hypericum (an extract of St. John’s wort) daily for four weeks was as effective as light therapy in treating SAD patients. And valerian root can help with insomnia caused by depression. A review of studies found that 300 to 600 mg taken 30 minutes to two hours before bedtime effectively eased sleeplessness.
Since SAD can alter normal melatonin production, which can also affect your sleep cycle, you may benefit from taking supplements. Melatonin levels increase before bedtime, peak during the night, and gradually decrease as morning approaches. Taking 2 mg of melatonin one to two hours before bedtime improved the sleep quality and resultant vitality of SAD patients, according to a 2003 study in the journal European Neuropsychopharmacology. (Caution: Children and teens should only take melatonin under a doctor’s supervision. Some experts believe extra melatonin could delay normal development during puberty.)
Short days and long nights can also disrupt your normal sleep routine since your body isn’t used to going to bed when the sun sets around dinnertime or waking up when it’s still dark. A dawn simulator can help maintain your normal spring/summer sleep cycle. The device gradually fills your bedroom with light, simulating a natural sunrise, to gently tell your body it’s time to wake up–even if it’s still dark outside. A 2005 study from the Center for Health Studies in Seattle found that dawn simulators along with light therapy helped reduce symptom severity in SAD patients.
Regular acupuncture treatments can also help control SAD. Stimulating the yintang point, between the eyebrows, relieves many of the symptoms, says acupuncturist Skya Abbate, DOM, executive director of the Southwest Acupuncture College in Santa Fe, New Mexico. “Needling yintang stimulates the pineal gland, which helps produce more melatonin and decreases lethargy and depression,” says Abbate.
No one can control the seasons, but you can stop them from controlling you. Davis has held her SAD in check for four years now. It takes effort, but her combination of exercise and light therapy has kept her light switch permanently in the “on” position. “I’m still not a winter person,” she says. “But now I can enjoy the parts of winter I used to, like the beauty of snow and the joy of holidays. I now have the confidence that I can function in a more normal way.”
Do You Have SAD?
You may, if your depression begins every September or October and ends each spring in March or April, and if your depressive episodes occur at least two years in a row. If you suspect SAD, it’s a good idea to first rule out hypothyroidism, anemia, hypoglycemia, and chronic viral illnesses, since these conditions may mimic SAD.
Core SAD symptoms:
Increased sleep (70 to 90 percent of SAD patients)
Increased appetite (70 to 90 percent)
Significant weight gain (70 to 90 percent)
Carbohydrate cravings (80 to 90 percent)
Other symptoms:
Fatigue/inability to carry out normal routine
Feelings of misery, guilt, low self-esteem, despair, apathy
Irritability
Avoidance of social contacts
Increased susceptibility to stress
Decreased interest in physical contact and sex.
For 12 years Helena Davis’ life resembled a light switch. When daylight-saving time arrived in spring, it flipped on–she felt energetic, focused, and active. In winter, however, it switched off. She struggled to do the simplest household chores. Her weight ballooned. She could go to work and function at some level, she says, but it was obvious that something was wrong. “All winter I felt like a slug moving around in peanut butter,” says Davis, now 64.
She finally realized that her mood change coincided with her move to upstate New York, an area with few sunny days. A visit to her doctor filled in the diagnosis: Davis was one of 10 million to 25 million Americans, 75 percent of whom are women, who suffer from a subtype of depression called seasonal affective disorder (SAD).
You’ve no doubt heard of SAD. Also called “winter blues,” it often gets mistaken for clinical depression as the two share many symptoms–sadness, anxiety, lethargy, lack of sleep, diminished sex drive, and increased appetite. The difference lies in their duration and severity, according to Norman Rosenthal, MD, author of Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder (The Guilford Press, 2006). SAD typically strikes around September or October and then fades away in March and April. (Depression on the other hand can occur year-round.) Merely troublesome and potentially disruptive at first, SAD can be controlled if you take appropriate action, but “left unchecked, the changes in mood and behavior can become so powerful they can create significant problems in your life and may manifest into year-round major depression if not addressed,” says Rosenthal.
Light therapy
The primary cause of SAD is light deprivation, so light therapy ranks as the first line of defense. Light boxes contain white fluorescent bulbs behind a plastic UV filter, and regular use can reset your body clock and increase serotonin. Effective light boxes generate 10,000 lux (a measurement of intensity); to put that therapeutic amount in perspective, traditional lighting produces 300 to 500 lux, and the sun produces more than 100,000 lux on a bright summer day.
Rosenthal recommends using light therapy for about 20 minutes a day at first, ideally in the morning. How early depends on the individual’s body clock, says Michael Terman, PhD, who heads the Center for Light Treatment and Biological Rhythms at Columbia Presbyterian Medical Center in New York.
If you suffer from SAD, try placing a light box 1 to 3 feet away while you eat, read, go through your mail, or meditate. If your symptoms remain unchanged, increase your treatment to 45 minutes a day, says Rosenthal. Reevaluate your symptoms on a weekly basis and make adjustments. “You should feel the effects within two to four days,” says Rosenthal. “Almost everyone should feel the benefits within two weeks.” (Find light boxes at lightforhealth.com or litebook.com.) Brighten up your living and work space with full-spectrum light bulbs that closely match natural daylight.
Diet and exercise
Dietary changes also can ease SAD symptoms, says Chris Krumm, ND, LAc, of the Bastyr Center for Natural Health, near Seattle. For breakfast, Krumm advocates a high-protein meal to boost intake of tyrosine. “Consuming this amino acid in the morning helps boost your energy throughout the day,” he says. For dinner, Krumm suggests less protein and more carbohydrates like whole grains to help the brain synthesize serotonin. “In addition to improving your mood, increased serotonin may help people sleep better,” he says.
You may want to add more fish to your diet, too, especially cold water types like mackerel and salmon that are rich in omega-3 fatty acids. People with depression often have low levels of omega 3s. A 2001 study found a correlation between increased fish consumption and decreased incidence of SAD in Iceland.
Davis has found that staying active in winter helps her feel less lethargic. She’s chosen a treadmill inside a brightly lit gym, but don’t be afraid to head outside. On bright afternoons, go for a long walk or run. Got more time? Climb on a bike or break out the skis. “You’ll get your required light exposure and also some exercise, which can help alleviate stress that may contribute to SAD-related depression,” says Rosenthal. Research in BMC Psychiatry found the combination of bright light exposure and aerobics reduced many depressive symptoms, especially those related to insomnia and other sleep problems.
Sweet dreams
Some people, like Davis, are prescribed antidepressants to ease their symptoms at first. Herbal alternatives exist, however, most notably St. John’s wort. Research from the University of Vienna, Austria found that taking 900 mg of hypericum (an extract of St. John’s wort) daily for four weeks was as effective as light therapy in treating SAD patients. And valerian root can help with insomnia caused by depression. A review of studies found that 300 to 600 mg taken 30 minutes to two hours before bedtime effectively eased sleeplessness.
Since SAD can alter normal melatonin production, which can also affect your sleep cycle, you may benefit from taking supplements. Melatonin levels increase before bedtime, peak during the night, and gradually decrease as morning approaches. Taking 2 mg of melatonin one to two hours before bedtime improved the sleep quality and resultant vitality of SAD patients, according to a 2003 study in the journal European Neuropsychopharmacology. (Caution: Children and teens should only take melatonin under a doctor’s supervision. Some experts believe extra melatonin could delay normal development during puberty.)
Short days and long nights can also disrupt your normal sleep routine since your body isn’t used to going to bed when the sun sets around dinnertime or waking up when it’s still dark. A dawn simulator can help maintain your normal spring/summer sleep cycle. The device gradually fills your bedroom with light, simulating a natural sunrise, to gently tell your body it’s time to wake up–even if it’s still dark outside. A 2005 study from the Center for Health Studies in Seattle found that dawn simulators along with light therapy helped reduce symptom severity in SAD patients.
Regular acupuncture treatments can also help control SAD. Stimulating the yintang point, between the eyebrows, relieves many of the symptoms, says acupuncturist Skya Abbate, DOM, executive director of the Southwest Acupuncture College in Santa Fe, New Mexico. “Needling yintang stimulates the pineal gland, which helps produce more melatonin and decreases lethargy and depression,” says Abbate.
No one can control the seasons, but you can stop them from controlling you. Davis has held her SAD in check for four years now. It takes effort, but her combination of exercise and light therapy has kept her light switch permanently in the “on” position. “I’m still not a winter person,” she says. “But now I can enjoy the parts of winter I used to, like the beauty of snow and the joy of holidays. I now have the confidence that I can function in a more normal way.”
Do You Have SAD?
You may, if your depression begins every September or October and ends each spring in March or April, and if your depressive episodes occur at least two years in a row. If you suspect SAD, it’s a good idea to first rule out hypothyroidism, anemia, hypoglycemia, and chronic viral illnesses, since these conditions may mimic SAD.
Core SAD symptoms:
Increased sleep (70 to 90 percent of SAD patients)
Increased appetite (70 to 90 percent)
Significant weight gain (70 to 90 percent)
Carbohydrate cravings (80 to 90 percent)
Other symptoms:
Fatigue/inability to carry out normal routine
Feelings of misery, guilt, low self-esteem, despair, apathy
Irritability
Avoidance of social contacts
Increased susceptibility to stress
Decreased interest in physical contact and sex.
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