Questions from a Diabetes Practice – 2021

Through the years we have shared some interesting questions being asked during Diabetes Management training sessions. These specific questions have been asked recently during classes, so we are happy to share some new information to help answer your questions.

Always stay current and informed about your health and keep asking questions!

Should I take calcium supplements? Is calcium found only in dairy? Which other foods contain calcium besides dairy?

For years you were advised to take calcium supplements to support bone strength. Calcium is a mineral needed for healthy bones, enables your blood to clot, your muscles to contract and your heart to beat. Your body does not produce its own calcium. 99% of calcium is found in your teeth and bones. Women, especially during menopause, were told to take calcium tablets to avoid osteoporosis or thinning of the bones. Men are also at risk for osteoporosis at a later age.

Generally, as you age, you are more comfortable chewing a chocolate calcium square or swallowing your calcium in a pill instead of drinking 3 tall glasses of milk a day. Pills or chews are not processed in the body the same way as when eaten in a food. “Growing evidence states calcium supplements may have a negative impact on your health.” Calcium supplements have been linked to developing more colon polyps (which may lead to colon cancer), kidney stone formation and, a “possible build-up of calcium in the heart arteries”. Your body can only handle 500mg of calcium at once. If you take more, your body has to do something with the excess. Higher blood calcium levels (from supplements) may trigger blood clots or narrow the walls of your arteries.

Women need 1000mg a day and 1200mg when over age 50. Men require 1000mg a day and 1200mg when over age 70. The most common edible source of calcium is from dairy products such as low fat milk, cheese and yogurt. These foods are often recommended to bolster your calcium intake. More and more adults are being diagnosed with lactose intolerance or have diets which totally require them to avoid dairy foods. Even if you do not eat dairy, you should have no problem consuming excellent sources of calcium. Here is a list of additional sources of dietary calcium:

• Fortified soymilk, rice milk and almond milk (check labels and shake the milk before using since the calcium settles to the bottom of the container)
• Soybeans (Edamame, tofu)
• Canned sardines or salmon with bones
• Canned shrimp
• Fortified cereals and grains (e.g. Raisin Bran, Total, Special-K original, Kashi Go Lean original)
• Almonds
• Oranges
• Dried figs
• Leafy greens – kale, okra, collard greens, broccoli rabe, Bok choy, spinach, or turnips
• Garbanzo, pinto and white beans

Certain medications can pull out and deplete calcium from your bones. Included are: Lasix (a water pill for high blood pressure), Synthroid (for hypothyroidism), anti-depressants, steroids for arthritis or lung conditions and anti-coagulants. Talk to your health care provider if this becomes a concern for you. Vitamin D should be taken and can be taken in supplement form since it is difficult to get vitamin D completely from food – vitamin D helps your body absorb calcium.

Vitamin K2 is also now being suggested as well to supplement your calcium rich foods. It promotes calcium accumulation into your bones and decreases the amount allowed into the soft tissues including blood vessels. You can get vitamin K2 from eating pork, eggs, blue cheese, hard cheese and chicken. Do not take a vitamin K2 supplement without discussing it with your physician – especially if you are on blood thinners. Weight bearing exercises like walking, jogging or weight training also helps build and protect your bones.

What is heatstroke? How is it prevented/treated?

This is a frequently asked question. This year, summer weather has come with extremely high temperatures across the country. Locations which usually stay temperate even during the summer months have gotten hit hard with high heat, scorching temperatures and humidity. Fires and drought have become more common. Certain conditions which raise the risk of heat exhaustion/heat stroke include strenuous physical activity, wearing heavy clothing during hot temperatures, obesity, heart or lung disease and advancing age. Not being adequately hydrated causes problems.

Do not exercise and work outdoors in the extreme heat. Wear sunscreen, a hat and sunglasses in the sun and heat. Carry a handheld fan when possible. Take frequent breaks indoors if you have to be outside. Certain medications may raise your risk of heat related issues including water pills (diuretics), beta blockers and anti-depressants.

Heat exhaustion occurs first. During this phase, your body sweats profusely to try to lower your body temperature. You may develop a heat rash which presents as tiny red bumps on your limbs and chest. You sweat away water and salt leading to severe dehydration. First you feel clammy, disoriented and light-headed. If this is ignored you can develop heat stroke.

Heat stroke is a serious condition when your body can no longer control or regulate its temperature. It often requires medical treatment. Heat stroke raises the body temperature to 104 degrees or higher. It can damage the brain, heart, kidneys and muscles. Sweating (which is a natural cooling system) stops and you become intensely warm, flushed and dry. Your body tries to pump more blood to the surface of your skin to release the excess heat. Heat stroke can cause confusion, agitation, an elevated heart and breathing rate, nausea, vomiting and headaches. If not treated, heatstroke can result in seizures and a coma.

Treatment for heat stroke includes:

• Sipping cool fluids
• Finding a cooler, shaded area
• Removing wet and excessive clothing
• Being placed in a cool tub or shower
• Dousing with a garden hose
• Using ice packs under your arm pits and in between your legs and groin
• Placing cool, wet towels over your forehead, face and neck region
• Applying ice to your wrists

Question: Does everyone with diabetes always have the same blood sugar goals?

This is a very common question. There is no one way to manage your diabetes whether you have type 1 or type 2 diabetes. Your health care provider should come up with an individualized plan along with your diabetes team. You will need to follow an individualized eating plan since there is no one best diabetes diet. You should meet with a dietitian who specializes in diabetes or a Diabetes Care and Education Specialist for recommendations. Most of the time you will be medically managed with several different medications regulated by your physician.

There are so many new diabetes pills and injectables and you and your providers should find the best combination specifically for you. Exercise should be included and practiced. Hypoglycemia may be detrimental to some individuals with diabetes. Diabetes blood sugar numbers and specific control also depends on how long you have had diabetes and if you have any current diabetes complications. Although 6.5-7% still remains the gold standard for your A1C, work with your provider to see what goals are appropriate just for you.

What are the 4 components of total fitness? Do I really need them all?

Although walking 5-6 times a week when you have diabetes may be perfect for some of you, there should be an overall fitness plan that includes other fitness aspects. If possible, you should incorporate all 4 components of exercise to help control your diabetes and stay strong.

• Cardiovascular activity. You are most generally familiar with this one. It includes walking, swimming, hiking, spin classes, dancing, elliptical and bike riding. These activities raise your heart and breathing rate, burns calories, increase your insulin sensitivity and decrease your insulin resistance. A minimum suggestion would be 30 minutes 3-4 times a week. You can break that into smaller sessions if you need to.
• Strength training. “Building muscle helps burn calories by increasing your metabolic rate.” Strength training helps your muscles use glucose to do the work which keeps blood sugars regulated. Aging causes loss of muscle mass which makes it more difficult to regulate blood sugars. Weight training keeps us strong, active and independent. Start out slowly by using your own body weight. Do leg squats, lunges, planks, sit-ups and push-ups. Pace yourself. As you gain strength you can add rubber resistance bands. Eventually, move towards weight circuit machines and free weights. Make sure to have a spotter when using free weights for safety. Consider getting a fitness trainer at the beginning of your program to avoid injuries. Weight or resistance band train 2-3 times a week for 20-30 minutes. Take a day off to give your muscles time to recover. Work various muscle groups during different sessions: arms, legs, core and back to get a complete workout.
• Flexibility. Most of you skip this fitness component. Stretching and flexibility are “important for preventing injuries and essential to staying active with less pain”. As you age, this component is crucial to keep you less stiff and more limber. You can create your own stretches using a chair, a large rubber ball and a wall or join a yoga or Pilates class. Try to include 10-15 minutes of stretching before and after a workout. Your body will appreciate it.
• Balance. Diabetes leads to balance issues since circulation and nerves can be impacted by high blood sugars. Balance is usually the first thing to go as we age. Working on your balance can prevent falls, broken bones and other severe injuries. You can simply do your own thing like balance on one foot for 15-45 seconds or join a balance class such as Tai Chi. Walking heel to toe is also excellent for building and maintaining your balance.

Question: What is Rybelsus?

Rybelsus is a relatively new prescription medication for type 2 diabetes that comes in a tablet and is taken just once a day. It should be taken 30-60 minutes before your morning meal on an empty stomach. It is available in 2 strengths: 7mg or 14mg. Your doctor will decide which one is best for you. Until now, Semaglutide (GLP-1) was only available in an injectable. A GLP-1 increases insulin from your pancreas, decreases sugar made in your liver and slows food leaving from your stomach which reduces your appetite. It is not prescribed for weight loss but generally weight loss is achieved. Along with proper eating and exercise, Rybelsus can help you lower your A1C. It is not recommended for your first diabetes medication so talk to your physician if you are interested. Certain side-effects have been noted while taking Rybelsus: kidney problems, pancreatitis or low blood sugars.

Question: Is there really something called “Needle Phobia”?

Many times, for the treatment of diabetes, there are needles involved – whether it be lancets for finger sticks, syringe or pen needles for insulin or injectables, or pump infusion sets which require a catheter to be placed into the skin and under the subcutaneous fat layer. Nobody enjoys being poked, but there are “up to 10% of the population who have a real needle phobia”. It generally happens more with children, but many adults are severely afraid of needles.

With the sight of a needle, the nervous system may kick in causing a racing heart, clammy skin, feeling faint and nauseated as well as experiencing shortness of breath. These are all real symptoms. True needle phobia can prevent diabetes self-care, leading to out of control blood sugars and diabetes complications. The phobia could have originated from a previously bad experience with needles, a high level of personal anxiety or even a family trait.

Psychotherapy, hypnosis and medications have been used for treatment with successful results. One type of therapy is called Exposure therapy. The constant exposure to needles or lancets decreases the anxiety level, builds up confidence and changes the way you think about injections. The underlying causes of anxiety must be addressed before progress can be made in taking the injections.

Small changes can help, such as if you do not inject or test yourself, try to look away. Make sure you change the needle or lancet each time, since a sharp needle actually hurts less. Deep breathing before the injection can relax you, or visualizing something peaceful can be comforting. Numbing the site before the stick can reduce the fear. The goal is to eventually get to a place where you should experience a short moment of mild discomfort from the needle.

What is brain fog? Can it be caused by diabetes?

Although brain fog is not a true medical disease, “it is a term used for certain symptoms that can affect your ability to think”. You may feel like you are moving in slow motion or have severe mood swings for no reason. Forgetfulness is common as is lack of clarity. Brain fog can be distressing and disorienting. You may find it difficult to focus, think straight or put your thoughts and ideas into words. Chemically speaking, brain fog may be due to high levels of inflammation. Certain conditions can lead to a higher incidence of brain fog. Included would be:

• Pregnancy (due to changes in hormones)
• Menstruation due to hormonal changes
• Anxiety/depression without proper treatment
• Anemia may cause low oxygen levels due to less red blood cells
• Chemotherapy (chemo-brain) due to harsh chemicals makes it difficult to remember names, dates and incidences
• Multiple sclerosis can cause memory issues, attention deficits and language problems.
• Menopause changes in hormone levels
• Lack of sleep/lack of quality sleep may make you foggy since you do not experience sleep cycles
• Lupus effects the immune system causing brain fog, confusion and lack of concentration
• Diabetes. Unstable blood sugars may cause brain fog. “Your neurons are not receiving enough energy to function. They communicate poorly causing brain fog.” Low blood sugars can give you brain fog with headaches, irritability and anxiety. Low blood sugars can be from too much insulin, skipping meals or not eating enough complex carbohydrates. High blood sugars can cause brain fog with fatigue. Reasons for high sugars could be forgetting your diabetes medication, chronic over-eating or eating too many processed carbohydrates. Reduced circulation often seen with diabetes deprives the brain of oxygen and nutrients leading to brain fog.
• Poor gut health. Leaky gut, which is an inflamed small intestine, can lead to brain fog, anxiety, depression, poor memory and a decreased ability to concentrate or learn. A high level of Candida or yeast may be found in the gut causing brain fog.
• Pollution, environmental toxins and insecticides. These can all be a contributing factor in brain fog.

Understanding the reasons for brain fog and then treating them are well worth it. Keeping your mind alert and attentive with the ability to concentrate is especially important as you age. Take frequent mental and physical breaks. Exercise regularly and avoid alcohol, excess caffeine, and smoking. Take breaks from your computer, phone and other blue light devices. Eat whole foods and stay hydrated with sugar-free beverages.

Question: What is Wegovy?

On June 4, 2021, the FDA approved a new medication for those who are obese or overweight specifically for weight loss called Wegovy. It is a semaglutide GLP-1, (like Rybelsus) which was previously only used to treat patients with diabetes. Wegovy comes in a once a week injection of 2.4mg. It should be combined with a reduced calorie eating plan plus an increase in daily physical activity.

It can be prescribed if you have a 30% or higher body mass index (BMI) or above or a 27% BMI plus a health condition such as high cholesterol, high blood pressure or pre-diabetes. “Almost 70% of American adults are obese or overweight.” Wegovy works by “mimicking a hormone called a GLP-1 that targets the area of the brain that regulates appetite and food intake”. Common side-effects may include nausea, diarrhea, vomiting, indigestion, dizziness and gastric reflux.

There are new and exciting things to learn about diabetes each and every day! Learn how to manage and treat your diabetes. See which new products are available and those coming down the pipeline. Keep asking questions and keep learning!

Sources:

• Diabetes-self-management.com (Summer 2021, hard copy)
• https://www.rybelsus.com/
• www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
• Diabetes-self-management.com (May/June 2020)
• https://www.uchealth.org/today/how-children-and-adults-can-overcome-needle-phobia
• https://www.hopkinsmedicine.org/health/wellness-and-prevention/calcium-supplements-should-you-take-them
• https://www.webmd.com/brain/ss/slideshow-brain-fog
• https://www.mayoclinic.org/diseases-conditions/heat-stroke/symptoms-causes/syc-20353581