Three types of diabetes. Do you have one?

Posted on November 4, 2013 by drlesliegreenberg

flickr.com/photos/ petahopkins/ 10113965984Type 1, Type 2 and gestational diabetes are three types of diabetes each with different risks, all with increased blood sugars.

Type 1 diabetes is an autoimmune disease, when the body’s immune system attacks itself.  In this case the body destroys its insulin-producing pancreatic beta cells.  Type 1 diabetics must take insulin everyday to survive.  This type usually develops in children and young adults, but can appear at any age.

Type 2 diabetes is the most common form with 90% of diabetics having this type.  The risk factors for type 2 diabetes are

  • older age,
  • being overweight,
  • family history of diabetes,
  • physical inactivity,
  • history of gestational diabetes.

This type of diabetes may be controlled with weight loss, diet, exercise, medication and insulin.

Gestational diabetes develops only during pregnancy.  Women with a history of gestational diabetes have a 20 to 50% of developing type 2 diabetes within 5-10 years.  Pregnant patients routinely have a glucose tolerance test (drinking a sugary drink) and then checking blood sugars to confirm that body can control blood sugars well.

Symptoms of diabetes include increased thirst, increased frequency of urination, constant hunger, weight loss, blurred vision, extreme fatigue.

To test for diabetes, fasting blood sugar is the preferred test.  See your doctor if you have risk factors for diabetes or any of the above symptoms.  It’s best to know early so treatment can be instituted to decrease long term diabetic complications.

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Wanting to conceive?

Posted on October 26, 2013 by drlesliegreenberg

If you are a woman wanting to conceive, there is no evidence that taking antioxidant supplements will improve your fertility.

Research was compiled from 28 trials with over 3500 women attending fertility clinics.  Women who took antioxidant supplements were no more likely to become pregnant than those who took an inactive placebo or received standard treatment, including folic acid.  It was difficult for the researchers to assess whether one antioxidant was better than another.

Consider more information at www.nichd.nih.gov/

A good book to read is Taking Charge of Your Fertility–very informative, an easy read.  More at www.tcoyf.com/

.flickr.com/ photos /themikebot/ 233440718

.flickr.com/ photos /themikebot/ 233440718

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Electronic cigarettes

Posted on October 22, 2013 by drlesliegreenberg

Electronic cigarettes, or “e-cigarettes” were reportedly invented by a Chinese pharmacist who wanted to “find a safer way for smokers to inhale nicotine” after his father, a cigarette smoker, died from lung cancer.  The e-cigarette is designed with a lithium battery attached to a heating element.  This vaporizes a solution of either propylene glycol or vegetable glycerine and liquid nicotine.  Vaporization allows for inhalation, also referred to as “vaping” instead of “smoking.”

Smokers have access to these products.  They are unlikely to be  banned in the near future.  There may in the future be an age restriction.

We have two questions to answer as health professionals:

1.  Are e-cigarettes safe?  Truly, we have no idea.  There is no long-term safety data on the impact of repeated inhalation of propylene glycol or vegetable glycerin on lung tissue.  Some short-term data suggests that e-cigarettes may cause airway irritation.

2.  Are e-cigarettes effective at helping stop smoking?  There is a 2013 Lancet Journal study which compares e-cigarettes to nicotine patches to placebo pills.  The research showed that there was not a statistically significant help with e-cigarettes compared to the other two options.

We, clinicials, do know that e-cigarettes are not clearly superior to FDA-approved medications for smoking cessation, e-cigarettes are not FDA approved for smoking cessation, short-term safety data suggests that e-cigarettes cause airway irritation and NO long-term safety data exists.

.flickr.com/photos /rpmarks /4075285929/

.flickr.com/photos /rpmarks /4075285929/

My advice is to quit smoking and do not start vaping e-cigarettes.

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Pre-teens and acne. Ugh! Starting already?

Posted on October 18, 2013 by drlesliegreenberg

What agents to start? Acne has long been viewed as a teen phenomenon, but we are seeing this earlier and earlier.  This may be due to a trend toward earlier onset of puberty, but regardless, as a clinician I see this in my office frequently.

A few questions to ask of your provider is which over-the-counter creams should be used.  Does my child need prescription medication?  Are antibiotics a safe additional medicine to use.  Typical preadolescent acne involves whiteheads and blackheads in the forehead, nose and chin region.  Scarring is rare, although often is a concern for the parents and patient.

The patient should be started first on over-the-counter benzoyl peroxide.  Washing the face twice a day with a nonabrasive pH-balanced cleanser is the cornerstone of acne care.  Close follow up with your physician is needed so that if oral antibiotics or an antibiotic gel are needed that this can be added on.

Hope this helps.

.flickr.com/photos /blushingmulberry/ 4001277317/

.flickr.com/photos /blushingmulberry/ 4001277317/

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Babies need extra Vitamin D.

Posted on October 15, 2013 by drlesliegreenberg

To prevent rickets and vitamin D deficiency in healthy infants and children, 200 international units (IU) of vitamin D is needed daily.

Who needs this?  All breastfed infants unless they are weaned to at least be drinking 500 mL per day of vitamin –D fortified formula or milk.  All nonbreastfed infants who are ingesting less than 500 ml per day of vitamin D fortified formula or milk.

Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL  ( 2 1/2 cups) per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.

.flickr.com/photos/kaozkz/ 8391950499

.flickr.com/photos/kaozkz/ 8391950499

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Mediterranean diet can help prevent premature death.

Posted on October 11, 2013 by drlesliegreenberg

It’s true!  About 30% of heart attacks, strokes, and deaths from heart disease can pre prevented (in high-risk people) if they switch to a Mediterranean diet.  This diet is rich in olive oil, beans, fish, fruits and vegetables, and nuts.  Wine ( in moderation, of course) is even encouraged.

The New England Journal of Medicine published a study showing the magnitude of the diet’s benefits.  The study ended early (after almost 5 years) because the results were so clear that it was considered unethical to continue.  Low fat diets have not been shown in any rigorous way to be helpful.  Low-fat diets are also hard for patients to maintain.  This is different than the Mediterranean diet which allows you to eat a nicely balanced diet with fruits and vegetables and olive oil.

I’ve added my hummus recipe.  It’s easy to make and such a hit at parties.  Pair it with some vegetables and you are incorporating the Mediterranean diet in your day.

Hummus:

.flickr.com/photos/ jericho1ne/1314130848

.flickr.com/photos/ jericho1ne/1314130848

Put all ingredients into a food processor.

  • one can (15 ounce) chick peas (garbonzo beans) drained
  • 1/3 cup tahini (sesame seed paste)
  • 1 Tbsp. olive oil
  • 1/4 cup lemon juice
  • 1 tsp sea salt
  • 1/8 tsp cumin

Food process for 3 minutes.  Add water until it’s the right consistency.  Enjoy!

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Should Tylenol be given before vaccines?

Posted on October 8, 2013 by drlesliegreenberg

Probably not. Here’s why…

There was a 2010 study that showed that Tylenol given before vaccines can actually BLUNT the immune response to the given vaccine.  The CDC has since released a statement that there are basically no good studies supporting the use of Tylenol as pretreatment.  Some parents think that the Tylenol beforehand will make the poke hurt less.  I doubt this is a significant savings in pain and may decrease the ability for the body to respond to the vaccines.  If a fever occurs due to the vaccine, then Tylenol may be given, but in many cases should not be needed.  As a mom, I think that a hug and kiss do more to alleviate the “pinch” of a shot.

Of note, most patients have a fever on day 5 after their MMR vaccine.  This is the measles, mumps, rubella vaccine that is given routinely at the well-child checks at 1 year and 4-5 years.

Hope this helps.

flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

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Beware of medications that can impair your driving

Posted on September 26, 2013 by drlesliegreenberg

Legal medication can impair judgment and motor skills.  A National Highway Traffic Safety Administration study named a range of drugs (see below) which can potentially impair driving.  Past research on prescription drugs and driving has centered on narcotic medications.  Scientists have long believed that patients on stable long-term regimens of opioids develop a tolerance that allows them to drive safely.  But, recent studies have complicated this picture.

We also know that frequently more than one medicine (that can impair decision-making or fine motor skills needed to drive) are taken together.  Many medicines have what’s called a synergistic effect.  This is like one plus one equals three.  One medicine plus another one amplifies the impaired symptoms.

Drug class: possible side effects

  • Anti-diabetic medicines:  Low blood sugar
  • Anti-spasm:  Blurred vision
  • Narcotic painkiller:  Tiredness/sedation
  • Anti- high blood pressure:  Low blood pressure/foggy thinking
  • Sedatives/hypnotics:  Impaired reflexes
  • Antidepressant:  Sedation/dizziness
  • Anti-allergy: Sedation/dizziness
  • Heartbeat regulator:  Fainting
  • Anti-convulsant:  Dizziness/sedation/instability
  • Skeletal muscle relaxant:  Dizziness/sedation

flickr.com/photos/ alabadrock/ 444496369Consider the possible result of your actions—for yourself and everyone else on the road.

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A medicine may delay type 2 diabetes by up to 10 years?! Yes.

Posted on September 23, 2013 by drlesliegreenberg

This is a great feat!  Although I should place a caveat that TWICE as effective as this medicine for preventing diabetes is lifestyle modification with diet and exercise (see below for specifics).

Metformin is a medicine that reduces the risk of developing diabetes in “at-risk” adults when compared to taking placebo pills.  This effect is likely effective for up to 10 years.

Who is  “at-risk”?  Those with…

  • Elevated fasting glucose (more than 100 on a fasting lab test),
  • Hemoglobin A1c test result 5.7-6.4,
  • History of gestation diabetes with a pregnancy,
  • Obesity (BMI of more than 25),
  • Polycystic ovary syndrome,
  • Family history of diabetes,
  • Hypertension,
  • Peripheral Vascular Disease,
  • High cholesterol.

Lifestyle modification is harder than taking a pill every day, but may also positively affect many other areas of your life.  This study showed that a modest weight loss of 7% body weight and exercising 150 minutes per week was greatly effective in decreasing the risk of converting to overt diabetes.

flickr.com/ photos/ widezoom/ 4627134131//

flickr.com/ photos/ widezoom/ 4627134131//

Why not take out your walking shoes today?

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Well, med school was wrong again!

Posted on September 19, 2013 by drlesliegreenberg

flickr.com/photos/ axis/8743610464/We hear in med school that half of what we learn we will later find out is wrong.  But, which half?  We know future studies reveal different “truths” and I appreciate the need to debunk old theories if indeed they are not correct.

What is the latest debunking?  Omega-3 fatty acids have been prescribed to help cardiovascular protection and possibly help decrease all-cause mortality, heart attack, sudden death and stroke.  Well, that’s wrong.  The latest (according to a meta-analysis of over 68,000 patients) is that taking omega-3 supplements does NOT lower cardiovascular risk.  There are, however, no harmful effects of omega-3 supplements.  This brings up a point that sometimes advice we give to help actually (upon further experimentation) is found to harm.  But, omega-3 is not thought to harm.  So, if you’d like to continue to take them that’s okay!

Certainly eating two servings of fish per week may be helpful (as you may substitute this instead of greasy cheeseburgers).  Hope this helps.

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