Diabetes: The lonely disease

Diabetes is the elusive, frustrating, invisible, lonely disease. It does't appear overnight, but rather builds over years and decades. It's causes are complex and patients are left to self-manage this potentially deadly disease. And it is becoming more prevalent in a fast-moving stressful world, churned by coffee, the Internet, fast food and constant advice and suggestions by well-meaning but confusing friends, partners, doctors, and pharmacists. It is a disease that demands constant attention among people in lower incomes or socio-economic groups least able to afford it. A disease that demands fast decisions at a time when, because of the abnormal blood sugar levels, the brain cannot discern clear answers.


Source: National Institute of Diabetes and Digestive and Kidney Diseases

Know Your Blood Sugar Numbers: Use Them to Manage Your Diabetes

Checking your blood sugar, also called blood glucose, is an important part of diabetes care. This tip sheet tells you:

• why it helps you to know your blood sugar numbers
• how to check your blood sugar levels
• what are target blood sugar levels
• what to do if your levels are too low or too high
• how to pay for these tests


Why do I need to know my blood sugar numbers?

Your blood sugar numbers show how well your diabetes is managed. And managing your diabetes means that you have less chance of having serious health problems, such as kidney disease and vision loss.
As you check your blood sugar, you can see what makes your numbers go up and down. For example, you may see that when you are stressed or eat certain foods, your numbers go up. And, you may see that when you take your medicine and are active, your numbers go down. This information lets you know what is working for you and what needs to change.

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How is blood sugar measured?

There are two ways to measure blood sugar.

• Blood sugar checks that you do yourself. These tell you what your blood sugar level is at the time you test.
• The A1C (A-one-C) is a test done in a lab or at your provider’s office. This test tells you your average blood sugar level over the past 2 to 3 months.

How do I check my blood sugar?

You use a blood glucose meter to check your blood sugar. This device uses a small drop of blood from your finger to measure your blood sugar level. You can get the meter and supplies in a drug store or by mail.
Read the directions that come with your meter to learn how to check your blood sugar. Your health care team also can show you how to use your meter. Write the date, time, and result of the test in your blood sugar record. Take your blood sugar record and meter to each visit and talk about your results with your health care team.

What are target blood sugar levels for people with diabetes?

A target is something that you aim for or try to reach. Your health care team may also use the term goal. People with diabetes have blood sugar targets that they try to reach at different times of the day. These targets are:

• Right before your meal: 80 to 130
• Two hours after the start of the meal: Below 180

Talk with your health care team about what blood sugar numbers are right for you.

How often should I check my blood sugar?

The number of times that you check your blood sugar will depend on the type of diabetes that you have and the type of medicine you take to treat your diabetes. For example, people who take insulin may need to check more often than people who do not take insulin. Talk with your health care team about how often to check your blood sugar.
The common times for checking your blood sugar are when you first wake up (fasting), before a meal, 2 hours after a meal, and at bedtime. Talk with your health care team about what times are best for you to check your blood sugar.

What should I do if my blood sugar gets too high?

High blood sugar is also called hyperglycemia (pronounced hye-per-gly-see-mee-uh). It means that your blood sugar level is higher than your target level or over 180. Having high blood sugar levels over time can lead to long-term, serious health problems.

If you feel very tired, thirsty, have blurry vision, or need to pee more often, your blood sugar may be high.

Check your blood sugar and see if it is above your target level or over 180. If it is too high, one way to lower it is to drink a large glass of water and exercise by taking a brisk walk. Call your health care team if your blood sugar is high more than 3 times in 2 weeks and you don’t know why.

What should I do if my blood sugar gets too low?

Low blood sugar is also called hypoglycemia (pronounced hye-poh-gly-see-mee-uh). It means your blood sugar level drops below 70. Having low blood sugar is dangerous and needs to be treated right away. Anyone with diabetes can have low blood sugar. You have a greater chance of having low blood sugar if you take insulin or certain pills for diabetes.

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry, check your blood sugar. Even if you feel none of these things, but think you may have low blood sugar, check it.

If your meter shows that your blood sugar is lower than 70, do one of the following things right away:

• chew 4 glucose tablets
• drink 4 ounces of fruit juice
• drink 4 ounces of regular soda, not diet soda or
• chew 4 pieces of hard candy


After taking one of these treatments, wait for 15 minutes, then check your blood sugar again. Repeat these steps until your blood sugar is 70 or above. After your blood sugar gets back up to 70 or more, eat a snack if your next meal is 1 hour or more away.

If you often have low blood sugar, check your blood sugar before driving and treat it if it is low.

What do I need to know about the A1C test?

The A1C test tells you and your health care team your average blood sugar level over the past 2 to 3 months. It also helps you and your team decide the type and amount of diabetes medicine you need.

What is a good A1C goal for me?

For many people with diabetes, the A1C goal is below 7. This number is different from the blood sugar numbers that you check each day. You and your health care team will decide on an A1C goal that is right for you.

How often do I need an A1C test?

You need to get an A1C test at least 2 times a year. You need it more often if:

• your number is higher than your goal number
• your diabetes treatment changes

How do I pay for these tests and supplies?

Medicare, Medicaid and most private insurance plans pay for the A1C test and some of the cost of supplies for checking your blood sugar. Check your plan or ask your health care team for help finding low cost or free supplies. Ask your health care team what to do if you run out of test strips. For more information about Medicare and diabetes, go to https://www.medicare.gov/ .

What if I have trouble getting to my blood sugar goals?

There may be times when you have trouble reaching your blood sugar goals. This does not mean that you have failed. It means that you and your health care team should see if changes are needed. Call your health care team if your blood sugar is often too high or too low. Taking action will help you be healthy today and in the future.

John's Story

At each visit, John and his health care team look at his A1C test results, his blood glucose meter and his blood sugar record to see if his treatment is working. At today’s visit, John’s A1C and blood sugar numbers are too high. John and his health care team talk about what he can do to get closer to his A1C and blood sugar goals. John decides he will be more active. He will:


• increase his walking time to 30 minutes every day after dinner.
• check his fasting blood sugar in the morning to see if being more active improves his blood sugar.
• call his doctor in 1 month for a change in medicine if his blood sugar levels are still too high.
• have his A1C tested again in 3 months to see if his new plan is working.


Things to remember

• Check your blood sugar as many times a day as your health care team suggests.
• Have your A1C checked at least 2 times a year.
• Keep a record of your blood sugar and A1C numbers.
• Take your blood glucose meter and blood sugar record to your visit and show them to your health care team. Tell your health care team how you think you are doing.
• Call your health care team if your blood sugar is often too high or too low.

Work with your health care team and decide what changes you need to make to reach your blood sugar goals.


From Babies to Seniors: 7 Steps to Staying Mentally Sharp

Seven steps to keep your brain healthy from 

childhood to old age

Source:

American Heart Association

Summary:

A set of simple steps that promote heart health, called Life's Simple 7, can also foster ideal brain health, an expert panel says. Improving your health status with Life's Simple 7 may reduce the risk of dementia caused by strokes, vascular dementia and Alzheimer's disease.

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A healthy lifestyle benefits your brain as much as the rest of your body -- and may lessen the risk of cognitive decline (a loss of the ability to think well) as you age, according to a new advisory from the American Heart Association/American Stroke Association.

Both the heart and brain need adequate blood flow, but in many people, blood vessels slowly become narrowed or blocked over the course of their life, a disease process known as atherosclerosis, the cause of many heart attacks and strokes. Many risk factors for atherosclerosis can be modified by following a healthy diet, getting enough physical activity, avoiding tobacco products and other strategies.

"Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis, are also major contributors to late-life cognitive impairment and Alzheimer's disease. By following seven simple steps -- Life's Simple 7 -- not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment," said vascular neurologist Philip Gorelick, M.D., M.P.H., the chair of the advisory's writing group and executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan.

Life's Simple 7 outlines a set of health factors developed by the American Heart Association to define and promote cardiovascular wellness. Studies show that these seven factors may also help foster ideal brain health in adults.

The Life's Simple 7 program urges individuals to:

1. Manage blood pressure
2. Control cholesterol
3. Keep blood sugar normal
4. Get physically active
5. Eat a healthy diet
6. Lose extra weight
7. Don't start smoking or quit

A healthy brain is defined as one that can pay attention, receive and recognize information from our senses; learn and remember; communicate; solve problems and make decisions; support mobility and regulate emotions. Cognitive impairment can affect any or all of those functions.

The advisory, which is published in the American Heart Association's journal Stroke, stresses the importance of taking steps to keep your brain healthy as early as possible, because atherosclerosis -- the narrowing of the arteries that causes many heart attacks, heart failure and strokes -- can begin in childhood. "Studies are ongoing to learn how heart-healthy strategies can impact brain health even early in life," Gorelick said. Although more research is needed, he said, "the outlook is promising."

Elevations of blood pressure, cholesterol and blood sugar can cause impairment of the large and smaller blood vessels, launching a cascade of complications that reduce brain blood flow. For example, high blood pressure -- which affects about 1 in 3 U.S. adults -- is known to damage blood vessels that supply oxygen and nutrients to the heart and the brain, Gorelick noted. The damage can lead to a buildup of fatty deposits, or atherosclerosis as well as associated clotting. This narrows the vessels, can reduce blood flow to the brain, and can cause stroke or "mini-strokes." The resulting mental decline is called vascular cognitive impairment, or vascular dementia.

Previously, experts believed problems with thinking caused by Alzheimer's disease and other, similar conditions were entirely separate from stroke, but "over time we have learned that the same risk factors for stroke that are referred to in Life's Simple 7 are also risk factors for Alzheimer's disease and possibly for some of the other neurodegenerative disorders," Gorelick said.

The advisory also recognizes that it is important to follow previously published guidance from the American Heart Association, Institute of Medicine and Alzheimer's Association, which include controlling cardiovascular risks and suggest social engagement and other related strategies for maintaining brain health.

---

Story Source:

Materials provided by American Heart Association.      

How Diabetes Affects Memory

Becoming scientific literate helps you from getting misled.--Neil deGrasse Tyson

How Diabetes Harms the Brain

Courtesy: TIME Health

When blood sugar levels start to climb in diabetes, a number of body systems are harmed—and that list includes the brain, since studies have linked diabetes with a higher risk of stroke and dementia. Now, a new study published in the journal Neurology reports that changes in blood vessel activity in the brains of diabetics may lead to drops in cognitive functions and their ability to perform daily activities.

Dr. Vera Novak, associate professor of neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, and her colleagues followed a group of 65 older people. About half had type 2 diabetes, and half did not. After two years, the diabetic patients had lower scores on cognitive tests compared to when they began, while people without diabetes showed little change on the tests.

Novak and her colleagues showed that people with diabetes have brains that look five years older than those of similar-aged controls; for children with the disease, that could take a drastic toll on their cognitive skills as they age. 

What drove the decline, says Novak, were changes in the brains of the diabetic patients. Diabetes can cause blood vessels to be less responsive to the ebb and flow of demand in different parts of the brain. Normally, flexible vessels will swell slightly to increase blood flow and oxygen to areas that are more intensely active, such as regions involved in memory or higher reasoning during intellectual tasks...

In the study, Novak measured the changes in the flexibility of the blood vessels and found that among the diabetic patients, their flexibility declined, while it remained essentially the same for those without the condition. When blood sugar levels fluctuate as they do among people with diabetes, it can damage cells and nerves and trigger inflammation. What’s concerning, says Novak, is that these changes occurred even among people who were taking medication and had their diabetes under relatively good control. “Blood sugar control alone cannot treat [cognitive declines] associated with diabetes," Novak says. "We need a new medication to improve [blood vessel] reactivity, cognition and brain function in diabetics.”

Her group is continuing to study ways that brain function can be improved by addressing the health of blood vessels; one method they are investigating involves using insulin inhaled through the nose or blood pressure medications to get brain vessel activity back to normal.

Figuring out whether such therapies can improve the brain function among people with diabetes is critical, since more people are diagnosed with the disease earlier in life, including in childhood. In previous studies, Novak and her colleagues showed that people with diabetes have brains that look five years older than those of similar-aged controls; for children with the disease, that could take a drastic toll on their cognitive skills as they age. “We really don’t have any treatment for cognitive decline in diabetes,” she says, “because the brain is not listed as an organ of risk for this disease. So we need more research and evidence like this.”

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Praise for Healing the Brain

"A book that can help medical professionals as well as the general public, Mr. Balog has tackled a subject that is complex and he makes it quite approachable. It has added and enriched my own practice of medicine by making me more aware of issues not often discussed in medical circles."--Peter Paganussi, MD, Virginia

"Author David Balog has done an excellent job of creating a book for educators (or anyone working with youth) that explains the complicated workings of the brain in an easy to understand manner. Balog goes on to discuss various types of trauma and how the adolescent brain responds to trauma such as depression, stress, addiction, risk taking, PTSD, etc. LGBT/Q youth may experience trauma in ways majority youth often do not. The author shares important coping strategies....I highly recommend this book!"--Carol Dopp, M.Ed. 

"David Balog understands the strain of alienation, so he tackles this subject with compassion and concern. Mr. Balog draws on his knowledge of brain science to give readers insight into what happens to young people under tremendous stress, and he offers practical advice on how to help and cope."--Gary Cottle, author

"Provides comfort and learning to the reader. Flows easily from one topic to the next and knits tidbits of information together in a unifying mosaic. Easy to read. Difficult to put down." --Michael J. Colucciello, Jr., New York State Dept. of Mental Health researcher, retired.

"Well researched, fleshed out with relevant case histories, this book packs a lot of solid information into its 152 pages. Written in an engaging style for the layman, it covers a wide range of topics. One learns a great deal about the biology of stress, particularly the vulnerability of the brain in the pre-adult years. This book also provides a glossary of key brain science terms and a listing of organizations serving the LGBT /Q community and resources on the brain."--Gary Bordzuk, librarian

Autism: Thinking in Pictures

In this blog we will look at topics on the brain. Learn along with a copy of our book series, Healing the Brain. Get your copy today. 

My Mind Is a Web Browser:
How People With Autism Think
By: Temple Grandin, Ph.D. (/Authors/Temple_Grandin,_Ph_D_/)
The struggle that made possible Temple Grandin’s early development, graduate education, and notable career as a professor of animal behavior, designer of animal facilities worldwide, and celebrated writer, speaker, and researcher on autism, is told in her books, Emergence: Labeled Autistic (1986) and Thinking in Pictures and Other Reports From My Life With Autism* (Vintage Books, 1996). 

Courtesy the Dana Foundation.
 
Since writing Thinking in Pictures, which described my visual way of thinking, I have gained further insights into how my thought processes are different when compared to those of people who think in language. At autism meetings, I am often asked, “How can you be effective at public speaking when you think in pictures that are like video tapes in your imagination?” It is almost as though I have two levels of consciousness that operate separately. Only by interviewing people did I learn that many of them think primarily in words, and that their thoughts are linked to emotion. In my brain, words act as a narrator for the visual images in my imagination. I can see the pictures in my memory files. 

To use a computer analogy: The language part of my brain is the computer operator, and the rest of my brain is the computer. In most people, the brain’s computer operator and the computer are

merged into one seamless consciousness; but in me they are separate. I hypothesize that the frontal cortex of my brain is the operator and the rest of my brain is the computer.

When I lecture, the language itself is mostly “downloaded” out of memory from files that are like tape recordings. I use slides or notes to trigger opening the different files. When I am talking about something for the first time, I look at the visual images on the “computer monitor” in my imagination, then the language part of me describes those images. After I have given the lecture several times, the new material in language is switched over into “audio tape-recording files.” When I was in high school, other kids called me “tape recorder.”

Non-autistic people seem to have a whole upper layer of verbal thinking that is merged with their emotions. By contrast, unless I panic, I use logic to make all decisions; my thinking can be done independently of emotion. In fact, I seem to lack a higher consciousness composed of abstract verbal thoughts that are merged with emotion. Researchers have learned that people with autism have a decreased metabolism in the area in the frontal cortex that connects the brain’s emotional centers with higher thinking (the anterior cingulate).1 The frontal cortex is the brain’s senior executive, like the CEO of a corporation. Brain scans indicate that people with autism use problem-solving circuits in social situations. Unlike non-autistic people, the emotion center in their amygdala is not activated, for example, when they judge expressions in another person’s eyes.

I do have the ability to control the rate at which pictures come onto the “computer screen” in my imagination. Some people with autism are not able to do this. One person with autism told me that images explode into a web of a pictures that are interrelated. The decision-making process can become “locked up” and overloaded with pictures coming in all at once.

UNMASKING TALENT

I have been fascinated with research indicating that the detailed, realistic pictures that autistic savants—autistic individuals with extraordinary talent in a specific area— make may be created by directly accessing primary memory areas deep in the brain. Researchers in Australia hypothesize that autistic savants may have privileged access to lower levels of information.3 A study with a non-autistic “human calculator,” who could solve multiplication problems twice as quickly as a normal person, indicated that his brain had enhanced low-level processing.4 EEG recordings of his brain waves showed that brain activity was greatest, as compared with a normal person, when the multiplication problem was first flashed on the screen.
When designing livestock equipment in my business, I can do three-dimensional, full-motion videos of equipment and can test-run the equipment in my imagination. I can walk around it or fly over it.
I hypothesize that I am able to access primary visual files in my brain. When designing livestock equipment in my business, I can do three-dimensional, full-motion videos of equipment and can test-run the equipment in my imagination. I can walk around it or fly over it. My ability to rotate the image is slow. I move my mind’s eye around or over the image. 

When I read an article in Neurology about frontal temporal lobe dementia, I became extremely excited. It provided a scientific foundation for the idea of hidden visual thinking under a layer of verbal thinking. Research on frontal temporal lobe dementia, an Alzheimer’s-like condition that destroys language and social areas in the brain, demonstrated that, as the condition progressed, visual skills in art emerged in people who had no interest in art.5 The increase in creativity was always visual, never verbal. Brain scans found the highest activity in the visual cortex. As the patient’s cognitive abilities deteriorated, the art became more photo realistic. Artwork published with the journal article looks like the art of autistic savants.

I SEE THE DECISION PROCESS

I see the decision-making process in my mind in a way most people do not. When I tried to explain this to a person who thinks in language, he just didn’t get it. How my decision-making works is most clearly seen in an emergency. 

On a bright, sunny day, I was driving to the airport when an elk ran into the highway just ahead of my car. I had only three or four seconds to react. During those few seconds, I saw images of my choices. The first image was of a car rear-ending me. This is what would have happened if I had made the instinctive panic response and slammed on the brakes. The second image was of an elk smashing through my windshield. This is what would have happened if I had swerved. The last image showed the elk passing by in front of my car. The last choice was the one I could make if I inhibited the panic response and braked just a little to slow the car. I mentally “clicked” on slowing down and avoided an accident. It was like clicking a computer mouse on the desired picture. 

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