Get Moving Not Only for Weight Loss!
By: Jessica Cook, Director of Education MS, RD, LD, CDE
Spring is in the air and the weather is perfect to get moving outside!
Many people dread the word “Exercise” and usually people associate
this word with spending hours torturing yourself in a gym with a bunch
of strangers feeling uncomfortable. Well physicial activity doesn’t
have to include a gym or agonizing hours on a treadmill to have great
effects on your body!
Physical activity can not only aid in blood sugar reduction, but may lead to less medications needed for blood pressure, blood sugars and cholesterol. Many people that participate in physical activity on a regular basis have better sleeping patterns, less depression, improved anxiety and have higher immune functioning. Not to mention physical activity coud lead to weight loss, increase in self confidence and an increase in energy! It’s hard to find a reason NOT to move your body!
- Go for a walk. Cardiovascular fitness can help prevent high cholesterol, high blood pressure, provide better blood glucose readings and aid in having a stronger heart. It is recommended each American aim for 150 minutes minimum of physical activity per week. Walking for even as little as 10 minutes can reduce blood sugar values up to 40 points!
- Go for a swim or walk in the pool. Walking in the pool provides for a great low impact way to reduce blood sugars and improve circulation.
- Practice stretching. Stretching before getting out of bed in the morning can help improve stiffness and relieve pain. Also remember to stretch after workout to limit tight muscles and promote flexibility.
- lose muscle, flexibility and bone density, therefore everyone needs a good strength training routine to prevent falls, fractures or muscle wasting.
To learn more about diabetes, health and weight loss call 561-659-6336 ext 8012 to schedule an appointment with a certified diabetes educator today. Please enjoy our Spring 2018 Living Well with Diabetes Newsletter.
Insulin Timing
By: Kort C. Knudson M.D., FACE
Diabetes in general is characterized by decreased ability of the pancreas to produce insulin. We can sometimes compensate for this deficit by using pills, but sometimes we need to add insulin to the body directly. Insulin is a protein which would be digested if we tried to give it by mouth. So we deposit it into the body through the skin. This can be done with a syringe or a pen or a pump. In order to be effective the insulin must be absorbed into the bloodstream. The various insulins which we are familiar with are designed to be absorbed more or less rapidly.
One job of insulin is to maintain the balance between sugar coming into the blood stream from the liver, and sugar leaving to be used for energy in the muscles, fat and brain. For this function, the pancreas usually maintains a low basal level of insulin in the bloodstream to slow down release of sugar into the system to match the rate of sugar leaving the system. This is called the basal insulin. It is maintained at a low constant level.
Manufacturers have designed basal insulins to be absorbed slowly from under the skin. These have various lengths of activity and usually follow a trajectory with gradual increase in the bloodstream and then gradual decrease. All of the basal insulins have different characteristics. Levemir has more of a peak and taper off more rapidly to last about 16 hours. It provides good basal coverage during the day but then tapers rapidly in the evening. If it is going to be used for 24-hour coverage it is usually given twice per day. Lantus is a little longer-acting, but it does taper off significantly the last 6 hours of a 24-hour period. Tresiba is the longest acting and is much more flat throughout the day.
The timing of administration of the basal insulin will depend on the patient’s requirement throughout the day and the characteristics of the insulin absorption. We can use basal insulin at night to control the fasting blood sugar, but then it may taper off through the day. This would work for patients who use rapid acting insulin or oral medications to control the blood sugar in the daytime.
Another function for insulin is to reduce liver output of sugar and increase movement of sugar into the cells after we eat. We need to rapidly absorb the carbohydrates from the diet so we do have sugar stored up to use throughout the day. The body normally produces a large rapid spike of insulin as soon as we started eating and then a more prolonged elevation of insulin while the food is being absorbed from the gut into the body. The manufacturers have designed insulins that are absorbed more rapidly. They include regular (R) which will peak after 2 hours and then taper off for another several hours or Humalog or NovoLog which will peak after 1 hour and then taper off or Fiasp which will peak before one half hour and taper off much more rapidly. These insulins are usually given before a meal to allow time for them to reach the bloodstream when needed after eating. Depending on the speed of absorption they can be given right before eating (Fiasp) or 10 minutes before eating (Humalog or NovoLog) or ½-1 hour before eating (R).
The timing of the insulin would depend on the body’s fluctuating resistance with more requirement in the morning and less in the evening and also on the composition of the meal with sugary drinks absorbed the most rapidly and mixed foods with fiber and fat and protein absorbed more slowly.
We give basal insulin in the morning if we want it to be strong during the day and taper off through the night and we vary the time between short acting insulin and the meal depending on the characteristics of the insulin absorption. For these reasons the insulin dose needs to be customized for every individual patient. Sometimes trial and error is needed to determine the best approach. The goal is to keep the blood sugars constantly within a narrow range by varying the blood levels of insulin. Changing the type of insulin, the dose and the timing are the tools we use to keep the glucose balanced.
*Insulin dosing and timing should always be prescribed by your physician and should not be altered without the consent of your physician.
Gaining Back Control
By: Gail Starr LCSW, CDE
The diagnosis of Diabetes may cause an initial reaction of denial, that “big river in Egypt.” This is a way of coping, of hiding feelings that may include anxiety, depression, sadness, anger, embarrassment and feeling out of control … all feelings that come from feeling vulnerable, helpless or hopeless. Are you in denial, feeling as if you are drowning? Maybe it’s time to begin accepting the diagnosis and gain back control of your blood sugars and your health.
Diabetes doesn’t go away, so the big question is: How do you gain control? The first step is by getting educated, learning what you can do to control the blood sugars. Knowledge is power! It’s not the diagnosis of diabetes that causes the problem, it is allowing the high blood sugars to take over the body. If you choose to follow the advice education provides, your life will be healthier and happier.
A second way to feel more in control is to learn about your medications and how they work in your body. There are many diabetes medications available that can work in different areas of the body. It is good to know how the medication(s) your doctor prescribes for you work in your body, and how to take them. It is important to ask questions and to read labels. This is also part of the Living Well with Diabetes 1-2-3 Workshop’s agenda. Pharmacists are a wealth of knowledge and impart it freely and willingly. And of course the internet also has much information. It is important though to know that the internet may not be as accurate.
Some people do not like taking their medications. Know that high blood
sugar is like a poison to the body, causing inflammation all over. It
would be wise to compare the side effects of the meds with the complications
of high blood sugars and make an educated choice.
Palm Beach Diabetes and Endocrine Specialists’ Workshops provide the information and materials that give you the knowledge that will help you feel hopeful and capable of gaining back control. The 1-2-3 Workshops not only provide information, but also provide support. Calling and making an appointment to take the workshops can be your first step in gaining back control 561-659-6336 Ext 8012. You can also meet with a registered dietitian and certified diabetes educator for ongoing personalized diabetes support.
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