Category Archives: Diagnosis

Now I have Type 2 diabetes what am I supposed to eat?

source- Canstock photos

It comes as no surprise that one of the first questions someone newly diagnosed with type 2 diabetes asks is “What am I supposed to eat?”.

Let’s face it you’ve probably heard over and over again that type 2 diabetes is a ‘disease of lifestyle’. And lifestyle commonly involves food. When it comes to the food choices we make there is a lot of emotional charge attached to that. For some, it may be the way that they have eaten since they were children and this is the only way they know how to eat. Food is a connecting force between us.

So, a common answer someone diagnosed with type 2 diabetes may receive about what to eat from their healthcare provider may sound something along the lines of ‘eat healthy portion sizes, increase fruits and vegetables, cut down on processed foods’. And all these answers are great recommendations.

You’d think it seems pretty easy right to go out there and, ‘eat healthy portions, increase your fruits and vegetables, and cut down on processed foods’. But we know that’s not really what happens.

A lot of people struggle with food choices. Perhaps that’s why we have such a growing epidemic of borderline diabetes and type 2 diabetes.

Over the course of my 20 plus years as a physician, I have encountered some really strange interpretations of what a ‘healthy diabetic diet’ means to different people. Let’s face it, the amount of information out there on the internet does not help either.

So when I address the topic of what to eat with anyone diagnosed with type 2 diabetes I start by helping them to normalize their experience. Take a deep breath. This is not a punishment for what you have done wrong. And yes, you can make a choice starting today to do things differently.

My invitation is to consider that diabetes eating is healthy eating.

I intend to give a TED talk with that title because it’s something I passionately believe. If everyone diagnosed with type 2 diabetes looked at this as a way their body was inviting them to eat healthier we wouldn’t have people walking around feeling victimized.

The great news is that by making these changes to how you eat, it is possible to halt the progression of borderline diabetes, type 2 diabetes and worsening metabolic health.

Change can be stressful. So I often start by advising you take simple small steps.

This will help bypass the gargantuan alarm signals to your primitive brain- the amygdala which ends up keeping you from making any change smack in the middle of your comfort zone.

So back to the question -where do you start?

The Mediterranean diet

The Mediterranean diet is a great starting point when it comes to making some healthy changes to what you eat. The traditional mediterranean diet attracted interest because people who were living on the Greek Island of Crete had less heart disease.

What makes up the Mediterranean diet

  • whole grains
  • fruits and vegetables
  • extra virgin olive oil
  • modest amounts of poultry, red meat and fish
  • nuts
  • legumes (beans, peas etc)
  • red wine

The Mediterranean diet has been extensively researched. Over 50 studies have shown that by eating this way there is an improvement in overall metabolic health parameters- reduced waist circumference, improvement in lipid profile, blood pressure, weight and blood sugar levels.

Functional Nutrition

Perhaps you want to go a step further and you want to develop an empowered relationship to food.

Food can be used as a powerful tool, to bring about healing. In functional medicine, we call this functional nutrition.

There are several food plans used in functional medicine, each targeting different results.

The cardiometabolic food plan is a step above the Mediterranean diet.

Features of the cardiometabolic food plan

  • low glycemic foods
  • personalized targeted calories
  • helps to balance blood sugars
  • high in fiber
  • low amount of simple sugars
  • a healthy balance of quality fats

One of the exciting aspects of the THRIVE group coaching program, will be working with clients on creating a personalized cardiometabolic food plan designed to optimize their metabolic health.

If you would like more information about joining the program, please send an email to info@doctoreno.com.

What are the first steps to take after being diagnosed with type 2 diabetes?

Source: canstock photos

In my last blog post, I shared one of the common questions I get from patients when they are first diagnosed with type 2 diabetes, “How did I get diabetes?”.

One of the reasons I became so passionate about teaching patients and clients to live healthy lives with type 2 diabetes was because of the reaction I got when I told a patient they had type 2 diabetes.

Naturally, a lot of my patients expressed their dismay. However, what I noticed was some people instantly focused on the complications they could get from diabetes, instead of how they could go on living healthy lives. I realized this may have been because this was the only side of diabetes they had ever seen. Perhaps it those people with the complications had been their friends, colleagues, relatives, people in their community etc.

And so, I made it my mission to create a shift in the beliefs people had around being diagnosed with diabetes. With time, I found that I was able to engaged my patients in focusing on how to live healthy lives.

I was excited to see this. I also realized I was sharing the same kind of information that was getting my patients motivated. 

And so that is what motivated me to write my award-winning book, “Dr. Eno’s A-to-Z Guide to Thriving with Type 2 Diabetes”.

Maybe you are like one of my patients and your healthcare provider has just diagnosed you with type 2 diabetes and sent you on your way. You are feeling overwhelmed and you have no idea where to start.

Here are some steps you can take:

Step 1- Normalize your emotions

Yes, it’s important to not let your emotions run wild. Being diagnosed with diabetes or any other chronic illness can be a life altering experience. But you do not need to let it overwhelm you. First, take a step back and deal with the overwhelm. In an earlier blog article, I went into detail about how to deal with overwhelm so that it does not become overpowering. Click here to read the full article.

Step 2- Focus on the ABCs

Once we get over the shock of a life altering diagnosis, most of us want to try to want to fix it right away. In other words, we want to get straight into action. But if we want to be successful, we need to focus on what I call the ABCs of living with any chronic illness.

The ABCs is an acronym which stands for

  1. Acceptance
  2. Belief
  3. Commitment to change.

It is important that you are aware of your ABCs before you start to get into action.

Do you accept that you have type 2 diabetes? I mean face on?  Do you know have limiting beliefs around living with a chronic illness such as type 2 diabetes? Are you like a lot of my patients who instantly went from diagnosis to complications? Perhaps you know you need to make changes, but do you know there are several stages of change? Do you know what stage of change you are and what you need to do to move forward?

Click on this link to download for FREE, the first three chapters of my award-winning book.

Step 3- Focus on taking simple small steps

You’ve gotten past the initial shock and overwhelm. You’re familiar with your ABCs and the role they will play as you set out to make healthy lifestyle choices. Now you’re going to get into action. There’s one thing you need to be aware of though. We are creatures of habit. And if we try to offset the status quo, this new change sends an alarm signal to an area in the brain called the amygdala.

The amygdala is part of our primitive brain. That’s the part of the brain that is not involved in intellectual functions such as language formation, creativity or thinking. The primitive brain functions on actions related to the survival of our species and dates back to pre-historic time. The amygdala can get stimulated by fear. So, when we decide we are going to make HUGE changes, the amygdala gets triggered and it makes us stop that new thing and go back to what is familiar.

Think about a time you’ve made a major decision that involved some change. Was it easy? Or did you have a feeling of uncertainty and found yourself going back and forth about whether or not to proceed with the change? That was probably your amygdala getting fired off.

The same thing when it comes to making changes to your lifestyle when living with diabetes. You do not want to make too many changes all at once.

Start with simple small changes that are barely noticeable.

Work with someone in your support or buddy system. Create a list of say three simple things you would like to change. Notice the small number we started with.

For example, rather than say you are going to cut out all soda drinks immediately, how about working on decreasing the amount of soda you drink by say one serving every 1-3 days?

If you are not accustomed to exercise, start by for example walking for only 5 minutes. And that may also mean walking in place.

Now the great thing about simple small steps is you can build on your success. In time you’ll look back and realize you have taken large steps.

Step 4- Build in accountability team

Being held accountable for the changes you commit to helps to create results. Remember that in order to THRIVE with type 2 diabetes or any other chronic illness, over time you are going to do a lot of things differently. The reality is that it’s not always going to be smooth sailing. We may encounter bumps on the road that may challenge our resolve and even our belief in ourselves.  Building in an accountability team can help keep you on track.

Your team does not have to be complicated. But the members of your team must be people willing to support you in making those lifestyle changes.

For instance, you could have an accountability partner you check in with to make sure you have reached your weekly exercise and movement goals. Another one who helps you make sure you’re planning your meals. Another who helps you track your blood sugars etc.

Your accountability team needs to fit your needs.

Step 5- Consider joining a group coaching program

I believe that there is a lot of power in groups. Groups bring people who have things in common together and helps them move forward toward a common goal. Groups help people to produce powerful results.

By joining a group coaching program, you will not only be held accountable, but you will also get to work through different aspects of diabetes care. Group coaching programs will help you become more empowered around the choices you make.

If you have ever wondered about how a diabetes group could help you, I invite you to join my THRIVE group coaching program.

To get started, simply send me an email at info@doctoreno.com and we will be glad to send you a link to schedule a FREE no-obligation 20 minute consultation which will help us determine if this is a fit for you.

If you would like to learn about our services, please click here.

To your health and wellbeing,

How did I get type 2 diabetes?

source canstock photo

Being diagnosed with type 2 diabetes can be a very overwhelming experience. Naturally, those newly diagnosed may have a lot of questions. But one of the most common questions I get asked is ‘how did I get diabetes?’

 A lot number of people may not have a full understanding of how certain factors as well as lifestyle can put them at a higher risk for developing type 2 diabetes.

 In a recent post -summit survey I performed, several participants responded they wanted to learn more about type 2 diabetes. 

For those people who do not have diabetes, this information is still beneficial. It will help you to know what your risk and begin now to make healthy lifestyle changes.

 Insulin and the pancreas

The pancreas is an organ located in the abdomen. It produces a hormone called insulin. Insulin helps the cells in the body to use sugar as energy.

In type 2 diabetes, the cells of the body begin to resist the effects of insulin. This condition is called Insulin Resistance.

I like to use the metaphor of a landlord who changes the locks to the house on his tenant.

In this metaphor, the tenant is blood sugar.  Insulin controls the lock to the house. With insulin resistance, the tenant cannot open the lock, with the insulin.

Insulin resistance is usually present in the body at least five years before type 2 diabetes is diagnosed.

Who is at risk of developing type 2 diabetes?

 Here are some of the things you should know that increases the chances of developing type 2 diabetes:

  • Family History: A big reason why people develop diabetes is genetic. If you have a first degree relative with diabetes, like a parent, sister, brother,  then your chance of getting diabetes goes up five to ten times. So it is crucial to know your family history.
  • Ethnic Groups: Type 2 diabetes is common in certain races such as African Americans, Hispanics, Asians, and Native Americans. So just by being of a certain race puts you at an increased risk.
  • Pregnancy: 3-5% of pregnant women can develop diabetes in pregnancy, also known as gestational diabetes. The difference is that once the baby is born, diabetes goes away.

If you had diabetes while you were pregnant, you are at risk of developing diabetes later on in life. Make sure that after your pregnancy, you have regular medical check-ups. Your healthcare provider will need to monitor your blood sugars closely.

  • Environmental Toxins:  Environmental toxins which can increase the risk of type 2 diabetes have been coined diabetogens. Exposure to toxins such as pesticides, arsenic, as well as ambient air pollution, to name a few, can all increase the risk of type 2 diabetes through several mechanisms.

Ongoing exposure to the toxin load increases our risk of developing type 2 diabetes.

  • Medications: Some medications can cause diabetes. Usually, this happens to people who were already at risk for developing diabetes.

One of the common drugs that can cause diabetes is steroids. Steroids are used to treat many medical conditions such as transplant patients, chronic lung disease, rheumatoid arthritis, and other autoimmune diseases to name a few.

According to the National Kidney Foundation up to 20% of patients after a kidney transplant may develop diabetes.

There are some other commonly used medications which can elevate blood sugars.

These include-

  • Statin medications -used to treat high cholesterol.
  • Thiazide diuretics -used to treat high blood pressure.
  • Beta-blockers
  • Transplant rejection medications such as tacrolimus
  • edications used to treat anxiety and/or depression.

Speak with your healthcare provider if you are concerned about any medications you are on. Do not discontinue any medications by yourself.

It is possible that the benefits of being on the medication may outweigh your risk of developing diabetes.

Trust that your healthcare provider has your best interests at heart.

If you do not feel this about your healthcare provider, then perhaps you need to search for a new one!

For more information on how to pick a healthcare provider that is the right fit for you, click here.

To download a FREE copy of the first three chapters of my award winning book which explains more about type 2 diabetes, click here.

Here’s to your Health & Wellbeing,

Some proven benefits of the ketogenic diet, but is it right for everyone?

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I recall when I first started hearing the buzz around going “keto” “ketogenic” ketolife” I was very skeptical. With the roll of my eyes I dismissed it as a soon to be done fad that would blow over. But it didn’t.

After my community talks, I’d have a few people stop by and ask my thoughts on going “keto”. Again, my response would be I thought it was just another fad and would pass away. And oh by the way if you happened to be someone living with type 2 diabetes, this probably was not for you!

How wrong I was on both counts especially the latter.  

Well you know the saying “what you resist persists”?  Keto has persisted. And now it’s becoming mainstream.

The ketogenic diet was developed almost a 100 years ago- in the 1920s- by a faith healer who was trying to help children with epilepsy. There was some success with this diet intevention at the time. However, when drugs were developed for the treatment of epilepsy it fell out of favor.

How does the ketogenic diet work?

The ketogenic diet works by converting the body’s source of predominant fuel from carbohydrates to fats which are the source of ketone bodies predominantly beta hydroxybutyrate. This leads to an increase in the production of energy source -ATP.  

The ketogenic diet is now being used to treat a host of diseases and conditions. In the article below I list some of the benefits of a ketogenic diet.

Improved insulin resistance and reduced inflammation

By utilizing fats as a source of fuel versus carbohydrates there is less need for insulin. This leads to less insulin resistance. Insulin resistance is the hallmark of type 2 diabetes. There is research showing the benefits of a ketogenic diet to reverse pre-diabetes or type 2 diabetes. Insulin resistance is also associated with more inflammation because of an increase in free radical production. Inflammation is linked to a host of chronic diseases such as auto-immune diseases, arthritis, thyroid disease, bowel disorders, mental and cognitive decline (type 3 diabetes). Less insulin resistance=less inflammation, which allows the body to heal.

Improved Fat Burning leading to weight loss
By definition, being in a state of ketosis means you’re burning fat for energy. If you have excess body fat, you’ll be able to burn it at a much more efficient rate. This trend can lead to weight loss. The advantage of using fat as fuel, is that you do not have as much hunger cravings as when you are using carbohydrates as a main source of fuel.

Mood stabilizing effects
A ketogenic diet changes the energy matrix of the body. In the brain, a ketogenic diet helps to modulate mood by not only a reduction in inflammation but also changes in monoamine oxidase levels, GABA transmission, as well as mitochondrial biogenesis.

Improved Energy
Increased energy from a ketogenic lifestyle is due to a combination of factors including less inflammation, upregulation of mitochondrial biogenesis, more ATP per molecule of ketone and more stable blood sugar.

Improved Mitochondrial Biogenesis &Anti-aging
Our bodies are trained to use glucose (sugar) as a natural source of energy.  Our mitochondria are the energy powerhouse of our bodies. With aging, we tend to have less efficient mitochondria. The ketogenic diet helps to stimulate new and stronger mitochondria. Because mitochondria have such a profound impact on energy production, inflammation levels and gene expression (and therefore an overall function of the body), promoting mitochondrial health can be of great benefit when it comes to anti-aging.

How do you know you’re in ketosis?

There are a number of kits on the market which can help you to detect when you are in ketosis. Kits that measure blood levels are more accurate than urine test strips.

How do you know if keto is right for you?

Despite it’s popularity a ketogenic diet may not be safe for everyone. Despite a plethora of websites offering do it yourself keto plans and diets, I highly recommend that you invest in working closely with a qualified healthcare professional who is well versed on what to look out for if you have any of the following conditions:

  • Type 2 diabetes
  • Very high blood triglycerides
  • Severe depression
  • Older adults
  • Cancer
  • Cognitive decline such as alzheimer’s type dementia
  • Certain gene snps such as ApoE4

The next thing to consider is – how long do you need to be on a ketogenic diet?

The reality is that maintaining ketosis for prolonged periods of time can be a challenge for most.

In summary, a ketogenic diet can be a useful tool for helping to improve metabolic health. Be sure to use it under the supervision of a qualified healthcare practitioner who will be able to customize it to your unique goals as well as determine a safe duration of therapy.

To your health and wellbeing,

Scientific citations

A low carbohydrate ,ketogenic diet to treat type 2 diabetes

Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism.

Peer-reviewed papers from Virta health on ketogenic diet and type 2 diabetes reversal

The Women’s Health Blog Series

Welcome to the second installment of the ‘blog post series’. Whether you are a new subscriber or just happened to stumble on this site through a google search or a referral, the blog post series is a collation of  3-4 prior posts that not only have a common theme but also provide the reader with some very important information.  

I have found this to be quite useful when I have to refer clients or people asking me questions about common topics.

Blog post 1

It is not uncommon after the age of 50 to develop a low acting thyroid. At times some of the symptoms a woman may be experiencing may be easily confused with menopausal symptoms and rightfully so. In this blog post, I provide you with information in an easy to understand format about the symptoms of thyroid disease What every woman needs to know about thyroid disease.

Blog post 2

Currently, the leading cause of liver failure and the need for liver transplant is not alcohol abuse, but a condition called non-alcoholic fatty liver disease (NAFLD). This article highlights what you need to know about NAFLD including common things that can place you at risk of developing this condition. I highly recommend that if you have ever been informed in the past by a healthcare provider that you have ‘fat in your liver’ that you take this information very seriously.

Blog post 3

We speak figuratively of how something broke our heart. But do you know that stress can literally lead to a form of heart failure and that women are at an increased risk? This article in the series highlights the impact of stress on a woman’s heart.

Blog post 4

One of the leading causes of infertility in women is polycystic ovarian syndrome (PCOS). It is closely linked to metabolic syndrome. By working closely with a functional healthcare provider, this condition is reversible.

I trust that this will provide a useful resource to reference articles on this blog.

As always I welcome your comments, questions or suggestions.

To your health and wellbeing,

The Women’s Metabolic Health Summit June 12-19 2019

Imagine this, you’re a woman and you’re about to hit or you’re just a little past “the big Five-O”.

Perhaps you’ve raised the kids. You’ve reached the pinnacle of your career. You may have launched that successful business. Or you’re in that sandwich generation- a caretaker for your elderly parents plus raising kids. Whatever the scenario, you’re at a reflective stage in your life and perhaps even in the process of setting new life goals.

And then BOOM! Suddenly something just doesn’t seem quite right? You start going through mood swings, just can’t seem to get control of those “hot flashes”. Hair seems to be growing (or not growing) in the most inconvenient places. And let’s not talk about the sex (what’s that I hear you say?!)

Or maybe, just maybe you go to the doctor and you’re diagnosed with a dreaded chronic illness……

This, cannot be happening to you…..

Currently there are 4 out of 10 Americans living with at least one chronic illness. Some examples of a chronic illness are type 2 diabetes, hypertension, heart disease, arthritis, thyroid disease, auto-immune diseases, arthritis, or cancer, to name but a few.

In my experience as an allopathic physician, it seems that living with a chronic illness seems to suck the very life out of their sufferers. I see it all the time and maybe you have also. People who seem to spend a great amount of time going from one doctor’s appointment to the next, taking medications, some of which cause side effects and all the while really not feeling any better.

Is that a way to live? Do you dread any of these scenarios happening to you?

For some people over 50 this is their reality. But it does not necessarily have to be yours.

My premise is that you can make a conscious choice to THRIVE in your golden years. And it has been proven over and over again. In my over 20 years as an internal medicine physician I have treated healthy and vibrant nonagenarians (people in their 90s) and even centenarians.

Even if you have been diagnosed with a chronic illness, you can still THRIVE into your golden years.

I recently had the pleasure of taking care of a 103-year-old woman who still cleaned her 8 room house every single day, and until a year ago was still gardening!

I dare to state boldly, that being diagnosed with a chronic illness should serve as an invitation to become deeply acquainted with yourself, and to let your body become your Divine Teacher ….

Even though I am trained as an allopathic physician, this healthcare model has not done such a great job of helping us manage or prevent chronic disease.

So, with that in mind, I decided I was going to mastermind with other experts in the functional health arena. I sent out an invitation and was I amazed at the response!

A lot of our experts have defied a chronic illness and have used functional and integrative ways to heal themselves.

Click here to learn more…

Imagine learning ways to access –

  • -Vital energy
  • -Abundant Health
  • -And yes! The ability to THRIVE well into your golden years

What’s more, you’d be setting an example for your family to follow. And this would become a ripple effect of good health affecting our communities, towns, countries and literally going around the planet! One small change at a time. We indeed are a global village.

Well, you can access all this information from the convenience of your home. And the great news is it is completely FREE!

Grab it Here

From June 12-19 2019, I will be hosting an upcoming interview series called The Women’s Metabolic Health Summit.

In this free series you will learn…

  • Tips for optimizing hormone balance over fifty
  • Why Menopause is not all about hormones
  • How to use spices in every day cooking to increase your metabolism and lose weight
  • The importance of sleep in boosting our metabolism
  • How essential oils can help to heal us
  • The little-known secret to improve your pelvic health and rev up your sex life
  • Making friends with the bugs in your gut
  • The relationship between your mental health and physical health
  • Simple ways relax and be more present (even if you are currently frazzled)

And so much more…

This virtual mastermind of over twenty healthcare experts from around the world will teach you how to honor and grow that ‘inner knowingness’ you possess as a woman.

Imagine as you embark on this next chapter- a life filled with purpose, joy, vitality, peace and presence.

Do you sometimes come across people who seem to effortlessly radiate those qualities? Well so can you. It’s all within your grasp. Click here to join me and make that life yours!

My Journey Into Functional Medicine

 

 

 

 

 

 

The Doctor of the Future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease~ Thomas Edison

 

Earlier on in my career as an internal medicine physician, I began to feel dissatisfied with the status quo. I sensed there was something wrong in the delivery of medical care. The 15 minute double booked office appointments only added to my angst and dissatisfaction. Questions plagued me such as:

  • How come my patients kept coming back time after time with the same complaints?
  • How come I was only resorting to pills to help them feel better?
  • How come I didn’t have enough time to educate them about lifestyle modifications?
  • How come those patients diagnosed with a chronic illness like diabetes, hypertension and heart disease suddenly had these ailments become the forefront of their existence spending time going from one doctor to another, filling one prescription after the other?
  • How come as time went on I saw the light in the eyes of a lot of my patients dim; there was almost a sense of resignation. Their lives had become, one doctor visit after the other, after the other.

In 2005, I left the sizeable multispecialty group I was working for in the southwestern suburbs of Chicago and went into private practice with two other business partners. Perhaps I could create a better model of healthcare delivery.

I saw my mission as not only treating acute illness but teaching my patients living with chronic diseases about taking simple small steps toward healthier living.

 

In my time in private practice, I decided to pursue training as a professional coach. I found there was power in guiding people toward possibility, so they see the answers for themselves while holding them accountable for the results they produce. Writing about the power of coaching still lights me up and gives me goosebumps.

I wanted to promote lifestyle interventions, but could not find a model I could incorporate that entirely resonated with the kind of care I was looking to deliver to my patients. Unfortunately, the practice was not going well. There was high overhead while insurance reimbursements were low.

Finally in 2010, after paying back the business loan we had taken out to start the practice, I made a decision to leave. I have been working in hospital medicine since then. Over the last eight years, I have continued to provide health information on my blog and have published and uodated a book for patients on  how to live with type 2 diabetes. But those questions have continued to plague me.

I’ve contemplated going back into private practice, but I wanted to make sure that I created a structure that would support not only my patients but also me.

As a cancer survivor, it is my responsibility to create a space that promotes my healing; where I can thrive and continue to serve my patients.

Well, I am happy to share that I have found that structure in functional medicine. So this is the beginning of my journey into functional medicine, and I am excited to share this  with you.

  • In this video blog, I share what I understand functional medicine to be

 

 

As always I welcome your comments as well as suggestions for topics you may be interested in learning more about.
To your health and wellbeing,

Health Awareness Topic- Women and Mental Health

 

 

 

This month is Mental Health Awareness month. According to the National Institute of Mental Health, there are 1 in 6 Americans (44 million Americans over the age of 18 years)  living with a mental illness. Mental illness covers a broad spectrum ranging from mild to severe and tends to affect women more than men. Depression is the most common mental illness. Women are more likely to be diagnosed with depression than men.

There are certain kinds of depression unique to women. These include premenstrual dysphoric disorder (commonly known as PMS), perinatal depression (widely known as postpartum depression) and perimenopausal depression.

Living with a chronic illness such as type 2 diabetes can be very overwhelming, and some people may experience depressive symptoms but do not have significant clinical depression.

Examples of depressive symptoms

-feelings of sadness or overwhelm nearly every day
-thoughts of worthlessness almost every day
-lack of motivation or feeling agitated almost every day
-loss of interest in everyday activities almost every day
-the inability of sleep or excessive sleep almost every day
-loss of appetite and/or a significant change in weight
-decreased ability to concentrate
-thoughts of harming oneself such as suicide

So how do you know if you are just having depressive symptoms or if you have a diagnosis of major depression?  Depressive symptoms do not last a long time. A person with major depression experiences at least three of the symptoms listed plus feeling depressed on and off for a prolonged period up- to two years.

What to do if you feel you have a mental illness

If you or someone you know is facing a mental illness, please seek help immediately. Not all depression is mental illness, and not all mental illness is depression.
There are some medical conditions especially in women that may cause a change in the mood and appear to be depression.

Some examples:
Thyroid disorder particularly hypothyroidism
-hormonal imbalances such as menopause
-food intolerances such as gluten sensitivity
-disrupted sleep patterns in conditions like sleep apnea
-vitamin B12 and/or folate deficiency
-low blood count (anemia)

Your healthcare provider may perform some blood-work to make sure you do not have a treatable medical condition.
If treatable medical conditions have been ruled out, then your healthcare provider most likely will recommend you to a mental health specialist.

Treating Mental illness

When it comes to treating mental illness, there are several options. It depends on the nature of the mental illness. Seeking treatment with a licensed mental healthcare professional is essential.  ‘Talk therapy’ may be a starting point. There are many types of talk therapy such as counseling, psychotherapy, or cognitive behavioral therapy. But some types of mental illness such as bipolar disorder, schizophrenia or severe depression may also require the use of medications right from the start.

Nutrition is also important. Pay attention to what you are eating. Eat a well-balanced diet rich in whole foods which contain a healthy ratio of proteins, carbohydrates, and fats, as well as phytonutrients (plant sourced micronutrients).

Suicide risk and mental illness

Mental health illness triggers a lot of stigmas. People with mental health issues may go through a lot of emotional pain and feel isolated. They may be afraid to seek help. Some people dealing with a mental illness may begin to have suicidal thoughts or even resort to suicide.

According to the US Department of Health and Human Services, 90% of people who commit suicide have a mental illness such as depression, bipolar disorder, schizophrenia or alcoholism. Most people who commit suicide may have attempted suicide in the past. They may do so because they want the physical and emotional pain they have been going through to stop and ending their lives may seem to be the only resort.

In summary, it is essential that as women we pay particular attention to our mental health as well as that of our loved ones. If you or someone you love is living with an untreated mental illness, please get help immediately. It is possible to prevent suicide Suicide is preventable with the right intervention.

Some mental health resources:

Depression in women- Five things you should know

National suicide prevention line

Department of Health and Human Services

 

To your health and wellbeing,

Health Awareness Topic- What every woman needs to know about fatty liver disease

 

 

 

 

 

 

It was a routine request for a preoperative consultation in the hospital.
I cheerfully introduced myself to my 33-year-old female patient. She had presented to the emergency room with upper abdominal pain. She had an ultrasound of her abdomen performed which revealed inflammation of her gallbladder. She was scheduled to have surgery the following day.

I briefly read the ultrasound report I noticed an additional abnormality. I asked her to tell me about herself. She had a history of high blood pressure otherwise considered herself healthy. She did not drink alcohol but consumed several cans of soda a day. She had a twin sister recently diagnosed with type 2 diabetes. Her mother who was present in the room, also had type 2 diabetes. It seemed to be coming together in my mind.

I assured her that I thought she would do well with the surgery, however, that I had found a slight concern on the ultrasound. The ultrasound showed that she had fat in her liver. I explained to her what this meant and some of the things in her history that had put her at risk for this happening. I shared with her that because she was obese with a history of high blood pressure as well as having a family history type 2 diabetes mellitus she was at increased risk of developing type 2 diabetes herself.

So what is fatty liver disease?

My patient had is a condition called non-alcoholic fatty liver disease, commonly called fatty liver disease. Fatty liver disease is becoming more common with some studies showing that up it affects up to 46% of adult Americans. It is more common in women. It usually develops between 40 and 50 years of age, although there are some young people in their teens being diagnosed with fatty liver disease. Many people do not know that they have fatty liver disease. Up to 2-3% of people have a more condition called nonalcoholic steatohepatitis (NASH). NASH can progress to advanced liver disease called cirrhosis.

Some Conditions associated with fatty liver disease

  • Obesity– more than 70% of people with fatty liver disease are obese. Of more concern is abdominal obesity. The waist circumference is a measure of fat in the abdominal cavity. Measuring the waist circumference helps to determine abdominal obesity. A waist circumference (over 31.5 inches in women and 37 inches in men). Fat can accumulate around organs as well as inside organs such as the liver. Fat cells produce harmful substances increase inflammation in the body and can lead to chronic illness. In the liver the fat cells can cause inflammation called nonalcoholic steatohepatitis (NASH) and can eventually lead to a condition called cirrhosis.
  • Type 2 diabetes – Up to 75% of people with fatty liver disease have type 2 diabetes
  • Metabolic syndrome– Metabolic syndrome is not a disease, but a collection of symptoms. Metabolic syndrome increases the risk for type 2 diabetes, hypertension and heart disease. Click here to read more about an article I wrote about metabolic syndrome and the link between type 2 diabetes and hypertension.
  • High triglycerides– Between 20-80% of people with fatty liver disease have high triglycerides.
  • Exposure to certain toxins and drugs– some medications that are used to treat medical conditions can cause fatty liver disease. These include steroids (prednisone and hydrocortisone, methyl prednisolone) amiodarone, tamoxifen

What are the signs or symptoms of fatty liver disease?

Unfortunately most people with fatty liver disease do not have any symptoms. At other times a routine blood test performed by your healthcare provider might show abnormal liver enzymes which may be a clue that there may be some inflammation in the liver .

How do you to treat fatty liver disease?

The good news is that if addressed early, fatty liver disease is reversible. Here are some things you can do:

  • Weight loss- If you have been informed by your healthcare provider that you have fatty liver disease, please take this seriously. Lose weight. Lose weight gradually. Rapid weight loss has been found to worsen fatty liver disease. Do not just look at this as a ‘weight loss plan’, rather look at ways to improve your lifestyle. Work with your healthcare provider to create a lifestyle plan that works for you and allows you to thrive.
  • Eliminate high fructose corn syrup- High fructose corn syrup is a manufactured chemical sweeter that is present in a lot of foods. It is very common in soda as well as several other processed foods including salad dressing and even ketchup. There are some studies that show a relationship between high fructose corn syrup and liver disease.
  • Reduce processed foods. Increase fruits and vegetables- processed foods contain a lot of simple carbohydrates. These simple carbohydrates get turned into sugar. Excess sugar gets taken up into the liver and converted to fat. Reduce simple sugars and increase the amount of fruits and vegetables in your diet. This way you are getting more fiber, vitamins, minerals and powerful nutrients that have healing properties.
  • Treat diabetes – If you have been diagnosed with type 2 diabetes or borderline diabetes get this treated.

This is the time to focus on making healthy lifestyle changes. If left untreated, fatty liver disease could progress and cause severe damage to the liver. Be proactive. This is your life. I want to see more women thrive into their older years rather than suffer from the effects of chronic illness. If you would like more information about working with me click here.

To your health and wellbeing,

Five tips on how to live with a chronic illness and still thrive

 

 

 

 

 

 

Hello and welcome back,

In my last blog post I highlighted there are about 117 million people in the United States living with one or more chronic illnesses such as diabetes, hypertension, heart disease, cancer, obesity, arthritis, etc.

Do not isolate yourself. I thrived through a diagnosis of cancer. As a practicing primary care specialist and professional life coach, I know what it felt like to be on the other side facing my mortality head on.

I opted for the support of my life coach, my support network and tapped into my innate wisdom to become my best teacher through this journey.

Through my experience, having been a patient as well as a practicing physician, I have chosen to be a stand for other people living with a chronic illness or life-threatening diagnosis.

Below, are five tips  I learned from my journey. I share them with the hope that they can help others.

Tip number one- pay close attention to your mental, physical and emotional wellbeing

Know that you will experience a myriad of emotions when facing a chronic illness. Your mind and body have just received some life-altering news. Be kind to yourself. Try to make healthy adjustments to your diet and exercise regimen. When considering making a change, consider making simple, small steps Your body is in a state of heightened alert right now. This heightened state causes a rise in the stress hormone called cortisol. If cortisol is released continuously into the body due to prolonged stress, it can have harmful effects. Your body is doing its best to heal. It needs your help. Seek out ways to support your overall wellbeing.

For example, explore practices that allow you to become more centered such as yoga, qi gong, tai chi, diaphragmatic breathing, etc. Look for ways to support or cultivate a spiritual practice. Consider taking on a mindfulness practice. Current research suggests a benefit when it comes to healing that the mind-body connection is essential. For more information on how your mindset affects living with chronic illness click here

Tip number two- choose a healthcare provider that is the right fit for you

You should have confidence in your healthcare provider. I recall when I casually shared my cancer diagnosis with another physician over lunch. He seemed to think that the treatment option being offered me was a little too extreme and that perhaps I should get a second opinion.
But I had confidence in my surgeon. He had taken the time to outline the plan of care, and so I did not feel I needed to get a second opinion.

If you have any doubts or questions, you may want to get a second opinion. Having the right healthcare provider is vital your overall wellbeing.

You need to be proactive in searching for a healthcare provider who is the right fit for you.

For some tips on how to choose the right healthcare provider click here.

Tip number three- take regular social media and internet fasts

One of the first things people do when they are experiencing an illness is to turn to the internet and social media. Remember not everything on the internet is right! Remember that people posting their experiences on social media are just that-their experiences!

You can use the internet and social media to network with other people going through a similar experience as yours.There are many reputable websites. But be careful about information overload. Do not spend countless hours online reading up symptoms. Try not to stay connected 24/7. Consider taking some downtime so that you do not suffer from information overload.

Tip number four- ask for the support of friends and family

People react differently to being diagnosed with a chronic illness. Some people may choose to isolate themselves from friends and family as a coping mechanism. This kind of behavior is not healthy. Isolation can lead to high levels of stress. As humans, we thrive on being connected. People want to know if they can help. Do not be afraid to ask for what you need.

One way you can do this is to create a support system rather than depending on one person. So you have different people who you can call on for different things. For more information on how to build a support system click here.

Tip number five- Learn to define a new normal

You cannot ignore being diagnosed with a life-threatening condition or living with a chronic illness. Too often we spend a lot of idle time and energy pining for the way things used to be, rather than focus on where we are right this moment. Learning to define a new normal is perhaps one of the most empowering things you can do for yourself.

So how do you know what your new normal is?

A new normal differs from one person to the next. Defining a new normal is a journey of self-discovery. I think it is important that people living with a chronic illness should not give up and sit around waiting for the worst to happen.  It is easy to become the person living with diabetes, or cancer or hypertension. Do not allow yourself to be defined by your illness.

Today I call myself a THRIVOR, not just a survivor. In my opinion, a survivor is someone who has just made it through a challenging circumstance.

THRIVOR is a word I coined to mean someone who has taken the lessons learned, is better for it and is choosing to thrive in their lives.

My mission is to create a global online platform providing women living with a chronic illness with tools and support in order to THRIVE.

I invite you to join me in creating this empowering tribe.

To your health and wellbeing,

 

How stress can cause a ‘broken heart’

Hello there and welcome back,

February is heart disease awareness month. In my last article, I promised that I would share how stress can cause heart disease.

I recall the first time I met a patient diagnosed with this condition more than seven years ago:

She was close to 80 years old. She came in ‘feeling poorly’ for the last few months. Her husband had died from a chronic illness almost 15 years ago, and she never remarried. Despite being afflicted with constant back pain, she still tried to remain active. She attended regular outings of her red hat society and other senior activities. She was a delight to interview. I admitted her to the hospital, and we began running a battery of tests to find out what was the problem.

By the next day, her test results started to come in. Her heart enzyme levels were dangerously high. But she had never complained of chest pain to explain this. A cardiologist (a heart specialist) was asked to see her. She had a heart test called an echocardiogram. The results of the analysis showed that she had a heart condition called Takotsubo Cardiomyopathy.

OK before your eyes glaze over, I know this sounds like a mouthful. But let me gently break the news to you- it is also called ‘Broken Heart Syndrome.’ This particular heart condition could be caused by-you guessed right if you said STRESS!

It was first described in Japan and is more common amongst women. The kicker is that either intense emotional or physical stress causes it. Anything from a medical illness, to domestic abuse, heated arguments, devastating financial loss, the death of a close relative. The list goes on. The word ‘Takotsubo’ in Japanese means ‘octopus pot.’ It describes the unique way it causes the bottom part of the heart to balloon up.

It is not sure how precisely takotsubo cardiomyopathy damages the heart. It is thought to be related to the release of a significant amount of the stress hormone called epinephrine released into the bloodstream. Unlike the more common type of heart disease-coronary artery disease- that is caused by blockage of the arteries.

The use of over the counter cold medication called phenylephrine, as well as illicit drugs like methamphetamine and cocaine, can also cause takotsubo cardiomyopathy.

It can cause the same symptoms as a heart attack like chest pain. Some patients may have shortness of breath (like my patient) or have a fainting spell.

The good news is that takotsubo cardiomyopathy if discovered and treated early is reversible. The sad story is that if left untreated eventually the heart muscle becomes too weak and can eventually lead to heart failure. Unfortunately, this was the case for my lovely elderly patient.

I share this information with you because it became clear to me that just as stress is insidious in our lives, so can it’s effects be in our hearts.

Who would believe that a heart could break from our life experiences?

The truth is that there are far too many women out there just like my patient. They are going through life oblivious to the effects that stress has on them.

They are our sisters, our neighbors, mothers, co-workers, and yes- even ourselves.

How many times have you felt a twinge of chest pain and chalked it down to ‘just stress’? Now I’m not saying to you that every twinge that you feel is a heart attack about to happen. What I am saying is that as women we have been given an ‘innate knowingness’ about our bodies. It is called a woman’s intuition. It is that intuition that signals that heart pain (ache). Then we dismiss it as ‘only stress.’ It is our body’s inner knowingness signaling us to stop and pay attention, to search within.

I know from firsthand experience as a primary care provider that being diagnosed with a chronic illness such as type 2 diabetes adds another layer of stress. But I am also here to assure you it does not have to be this way.

I do not want to see one more woman suffer from a broken heart.

It is my vision to form a TRIBE of likeminded women who want to THRIVE and experience ‘stress less’ lives.

Here are some things you can start doing today:

  • Pay attention to the signals that your body sends to you. Be still, take notice, and check within.
  • If these symptoms persist, please schedule an appointment to see your healthcare provider.
  • If you are not satisfied with the answer that your healthcare provider gives you, please be persistent. Don’t get blown off.
  • Make it a priority to learn how to handle stress
  • If you are a woman living with chronic illness find ways to create a network that supports you.

As always I look forward to your comments.

To your Health and Wellbeing,

 

Five Simple Strategies To Cope with Diabetes Distress

diabetes distress

A lot of people living with diabetes may sometimes become overwhelmed and stressed out. From checking blood sugars, watching your diet, making time for exercise, taking medications, appointments with healthcare providers, the fear of complications, or simply whether you are doing the right thing. The list of things to know and do may seem unending. It may seem that diabetes is taking over who you are. You can’t take a break from being a diabetic. All this can place a huge emotional toll on people living with diabetes.

These mixture of emotions was first described by two psychologists and is called diabetes distress. Diabetes distress is not just depression, although research has shown that there is a higher incidence of depression in people living with diabetes. And these feelings may not be the same thing for everybody. Every person living with a chronic illness- such as type 2 diabetes-experiences it a different way.

The important thing is to pay attention to your feelings. If you are feeling overwhelmed then it may be time to speak with your healthcare provider. It is important that you have a healthcare provider who has empathy and is able to validate your feelings. Your healthcare provider should not brush off your feelings or simply suggest that you start taking medications for depression.

Not all sad feelings associated with living with a chronic illness such as diabetes is because someone is depressed.

In addition to speaking with your healthcare provider it is also a good idea to learn some ways to cope with these feelings.

Here are five simple strategies that you can learn to overcome some the feelings related to diabetes distress. You may also find that you can apply these to any area of your life.

Identify the breakdown

What is a breakdown? I’m not describing a nervous breakdown here, although to some people it may feel that way. A breakdown is an emotional response that happens when things do not go as planned. For instance let’s just say that your goal was to get your A1C less than 7% at the next visit to your healthcare provider. But this did not happen.

So, you have not reached the goal you set for yourself. State in one simple sentence what it is that you say should have happened.

For instance you could simply say, “My A1C is not less than 7%’. In this example, not getting your A1c less than 7% is the breakdown.

Identify the upset

Write out your thoughts, feelings and emotions. For some people this may be a good time to journal. Even if journaling is not your thing, simply take out a sheet of paper and write. Try not to be judgmental about what it is that you are writing down. Just take the time to write these all down.

So going back to our example, about the A1C you could write something like “I feel upset, and discouraged, because I did not get my A1C to less than 7% as I promised myself”

Upsets can keep us stuck. This is because we become judgmental about ourselves. We let this judgement mean something about us that may not be true. I suggest you keep writing your feelings down until you feel like you are no longer judging yourself. Some people may begin to feel more compassion toward themselves. This is not the same thing as making excuses.

Write out the facts surrounding this breakdown

How would a news reporter describe this breakdown? Try doing this in one sentence. So back to the situation here, “I did not get my A1C to my goal of less than 7%”

If you cannot summarize the facts of the situation in one sentence then you may still be feeling upset. If that’s the case then circle back to the upset and continue writing until you begin to feel compassion for yourself.

What you are committed to next?

Now it is time to commit to reaching your goal. It is okay to commit over and over again. Don’t feel that because you failed to reach your goal before, that you will never reach your goal. If Thomas Edison had felt that way, we would not have had the lightbulb.

When we commit to something we have the power to create something better. What are you committed to? It may be time to look at a bigger picture than simply getting your A1C less than 7%. It may be living a powerful life and thriving despite having type 2 diabetes!

Write whatever you are committed to out as a statement. For instance our goal of achieving an A1C of less than 7% may be transformed into a statement that says “I am committed to getting my A1C to less than 7% so that I can experience vibrant health and serve to inspire other people living with diabetes to reach their goals!”

Ready, set ACTION!

After completing these steps you will be inspired to get into action. There is no time like NOW to get into action. Remember what you are committed to. Do not be discouraged.

You may notice that you can use these strategies to not only deal with setbacks when it comes to living with diabetes but all aspects of your life.

So get curious and see how many other areas of your life you can get past overwhelm, feeling stuck and back into action.

To your health and wellbeing,

Today’s Health Awareness Topic – Women and Heart Disease

 

heart healthFebruary is heart health month. I am committed to helping women, especially women living with chronic illnesses such as diabetes, learn all they can to enhance their health and wellbeing.

But I have found that a lot of women do not know the facts when it comes to heart disease. Only 54% of women know that heart disease kills more women than breast or lung cancer.
According to the most recent statistics by the Centers for Disease Control, heart disease is the leading cause of death in the United States in women over the age of 35 years.

Although the rate of death from heart disease for men has dropped in the last thirty years, they have not done so for women. In 2013, heart disease was responsible for killing close to 290,000 women. This translates to 1 in every 4 women dying due to heart disease.

There used to be a time when there was a general belief in the medical community that women under the age of 50 could not suffer a heart attack. So you can imagine what happened if you were a woman and you went to see your doctor with a complaint of chest pain. Your doctor would usually reassure you that it was not your heart and perhaps you had indigestion or were under a lot of stress and prescribe something for that.

As a woman it is extremely important to arm yourself with facts about your heart health.

Some other heart health facts that you need to be aware of:

  • Heart disease will kill six times more women this year than breast cancer.
  • 71% of women do not experience the early signs of a heart attack as chest pain as do men. They may experience a sudden onset of weakness. Almost 2/3rds of women who die suddenly of heart disease did not have any symptoms.
  • Women who smoke are twice as likely to have a heart attack as men who smoke. The risk of a heart attack is 19 years earlier than women who do not smoke. So think about it, if you are a woman and you have been smoking since you were in your teens (which by my experience is the time that most people start a bad habit like smoking ☺), then your risk of having a heart attack begins to rise toward your forties.
  • Type 2 Diabetes increases a woman’s risk of developing heart disease. Women living with diabetes who have had a heart attack have double the risk of having a repeat heart attack in their lifetime or developing heart failure.
  • Women with metabolic syndrome have an increased risk of developing heart disease, especially at a younger age.
  • Women under the age of 50 have twice the risk of dying from a heart attack as men in the same age range. This is all the more reason to be persistent when something does not seem right. I have often shared that as women we have an inner knowingness about ourselves and/or situations. This is called intuition and you can learn to use it to guide you in all aspects of your life.
  • Marital stress worsens the outcome of a heart attack.

What happens to you when you have a heart attack?

When you develop a heart attack, the blood supply to an area of the heart muscle gets blocked off. Sometimes the blockage may not be a complete blockage and blood can still get by to the heart muscle. This is called ischemia or angina. The classic symptoms of angina are chest pain, chest discomfort, and chest heaviness. Sometimes the pain or discomfort may go down the left arm or into the jaw.

As women we may have what is called ‘atypical symptoms’ like unusual weakness, heartburn, dizziness, etc.

But remember just as I pointed out, some women may not have the classic presentation of a heart attack or angina.

The good news is that if the blood supply is restored at this point, then no permanent damage occurs to the heart muscle.

When the blood vessel to a particular are of the heart remains blocked for a period of time, eventually the heart muscle begins to die off. Sometimes the damage cannot be reversed and the heart muscle dies and it is replaced by scar tissue. Scar tissue reduces the functioning of the heart and eventually causes heart failure and death.

It is important to get to an emergency room as soon as possible if you develop any symptoms suspicious for a heart attack. This is because the sooner you get intervention by a heart specialist to open up the blocked vessels the less the risk of permanent damage to your heart.

What you can start doing today:

  • Become knowledgeable about your risk for heart disease. Even if you do not have a family history of heart disease you can still be at risk!
  • If you smoke then quit. No more excuses! It’s still early in the year and you know you can do it.
    If you are obese or even over 10% of your ideal body weight, then commit to losing weight.
  • Schedule your annual physical and know your numbers! These numbers include- your blood pressure, fasting lipid profile (cholesterol), and blood sugar. If any of these numbers are outside of normal range then take action and work on getting them back to normal.
  • If you have high blood pressure or borderline diabetes or type 2 diabetes, then make sure that you are being treated by the appropriate healthcare professional. Do not ignore this part of your care. Denial only worsens things in the long run.
  • Find ways to cope with stress in your life. Stress is so prevalent that we as humans do not believe they can live a stress free life. It is our perception of stress that matters and what we do to modulate its effects.

Now more than ever we as women need to become more pro-active in our overall health and wellbeing. We need to stop making excuses for poor lifestyle choices. More importantly we need to accept that these lifestyle choices not only shorten our lives, but also the quality of the life that we have left. I’m not sure about you but I want to be health and vibrant into my 90s and beyond!

My mission in creating this blog is to provide a whole person approach to living with type 2 diabetes and other chronic illnesses.

Along those lines, over the next few months, in addition to the release of my updated book, Dr. Eno’s A-Z Guide to Living Powerfully with Type 2 Diabetes’, I will  be rolling out several programs. I look forward to working closely with those who are willing to invest the time and effort to enhance their health and wellbeing.

 

 

How Type 2 Diabetes Can Affect The Skin

diabetesType 2 diabetes affects many organs in the body. The skin is one of the largest organs in the body. There are several skin conditions that can happen just because of diabetes. For the most part very few of these skin conditions are life threatening. More importantly, a lot of these conditions may show up when the blood sugars are not well controlled.

These skin conditions can be very frustrating, especially for women living with diabetes. By knowing about these conditions will allow you to become a more vigilant. It also helps to hasten healing if you should get any one of these.

Acanthosis Nigricans

This skin condition gives the skin the appearance of soft velvety wart like growth. It is usually seen at the back of the neck, the armpits, beneath the breasts, the flexure surface of the elbow.

It is typically seen in those who are  overweight or obese.

There are other conditions that can cause this skin condition, but usually acanthosis nigricans is a warning sign of  insulin resistance. Insulin resistance can eventually lead to diabetes.

I take the time to point this out to my patients. Especially patients who do not have diabetes. This is a great time to start making lifestyle changes.

Scleroderma diabeticorum

This is a skin condition that causes the skin of the back and the upper neck to become very thick.

The treatment for this is to get the blood sugars well controlled.

Lotions can be applied that will help to soften the skin.

Vitiligo

In vitiligo, the skin loses it’s pigment and causes white patches. Vitiligo is an autoimmune disease. Vitiligo is more common in type 1 diabetes. It is very important to use a sunscreen, to reduce the risk of developing skin cancer.

Vitiligo is treated with skin lightening creams to try to even out the appearance. Some people even attempt to tattoo back in pigment into the white areas.

Eruptive Xanthomatosis

These are lumpy yellow deposits of fat beneath the skin. It is usually an indication that cholesterol and triglyceride levels are high.

Once blood sugars and the cholesterol are better controlled then these may disappear.

Digital Sclerosis

Tight waxy skin on the back of hands, the toes and also the forehead. This condition happens more commonly in people with type 1 diabetes and can cause the hands to become stiff.

Just as in most of the other skin conditions we have discussed thus far, the treatment is to normalize the blood sugars.

Disseminated Granuloma Annulare

Raised oval patches that are either skin colored or red or brown. They usually occur on parts of the body away from the trunk such as the legs or the ears.

In addition to controlling the blood sugars, there are several ways to treat this condition. So please be sure to see your healthcare provider.

Diabetic Blisters (Bullosis Diabeticorum)

These blisters may be large but are usually large and look like burns. They are not painful. They can occur on the fingers, feet, and hands and even sometimes on the forearms.

The treatment is to get the blood sugars within control. They heal by themselves within a few weeks. It’s important to keep them clean.

Necrobiosis lipoidica diabeticorum

This is caused by fat and collagen accumulating beneath the skin. Most times these lesions happen on the legs. The overlying skin then gets thin and can break down easily especially when exposed to injury. It can also get itchy.

It is important to see your primary care physician especially if the lesions break open as it may take a longer time to heal.

Allergic reactions

Allergic reactions that can cause rashes and bumps can also occur in type 2 diabetes. It is even possible to develop an allergic reaction to a particular type of insulin. So be very observant and if this happens inform your physician.

Bacterial infections

These can happen especially when blood sugars are not well controlled. The common culprit is staphylococcus aureus. This can cause boils, folliculitis or impetigo. There is a particular strain of Staphylococcus called MRSA (Methicillin Resistant Staphylococcus Aureus).

It is very important to treat MRSA early and promptly. So be sure to bring any boils to the attention of your physician.

Fungal Infections

These are usually caused by candida (yeast) organisms. Women with borderline or full-blown diabetes may also be at risk of vaginal candidiasis. Fungi can affect various body parts. For instance between the toes it can cause athlete’s foot. It is very important to make sure that the webs between the toes are kept dry to prevent athlete’s foot, as this could become an entry point for bacterial infections. Fungi can also infect the toenails causing the nails to become dark and discolored. This is called onychomycosis. In the groin it can cause a jock itch.

There is a potentially fatal fungal infection that is very common in diabetes called Mucormycosis. This fungus invades the nasal passage and then can spread to the eye and brain.

If you have a ‘sinus infection’ that does not seem to be getting better, especially associated with eye pain, and fever should be evaluated immediately by a physician.

It is important to get evaluated and treated for these skin conditions. Your healthcare provider may refer you to a dermatologist. This is a doctor who specializes in skin diseases.

As you can see from this article, in addition to treating these skin diseases, it is also important to get the sugars under good control.

As with any other complication associated with diabetes, I like to emphasize the importance of prevention rather than treatment.

You may be experiencing difficulty getting your blood sugars under control. Do not despair. It starts with your mindset. You have control over how you choose to live with a chronic illness.

To learn more about this click here to download a free copy of the first three chapters of my upcoming book.

Be persistent. Stay the course.

To your Health and Wellbeing,

Pregnancy and Diabetes

Gestational DiabetesDiabetes in pregnancy is called gestational diabetes. Women who develop gestational diabetes usually did not have either borderline or type 2 diabetes before they got pregnant.

According to the centers for disease control, gestational diabetes occurs in about 9.2% of pregnancies. Just like type 2 diabetes, the incidence of gestational diabetes is rising.

Women with gestational diabetes usually do not have any symptoms. This is why it is important to screen for it in all pregnant women.

 

How gestational diabetes is diagnosed

Gestational diabetes is usually diagnosed after 24 weeks of pregnancy. If diabetes is diagnosed before 24 weeks, more than likely this is type 2 diabetes. Your healthcare provider will order a test called the oral glucose tolerance test. For more information about the oral glucose tolerance test, click here.

 

The cause of gestational diabetes

Gestational diabetes is felt to be caused by insulin resistance just as in type 2 diabetes. The high levels of insulin cross the placenta into the baby. The excess insulin converts glucose into fat. Babies born to women with gestational diabetes usually have a high birth weight of over 9 lbs. This is because they are large. This can lead to the baby getting injured as it is being delivered through the birth canal. If the baby is too large to be delivered naturally it may have to be delivered by cesarean section. Cesarean section is major surgery and just like any surgical procedure there are inherent risks to both the mother and the child. A woman who has a cesarean section may have to have another cesarean section in future pregnancies.

 

Treatment for gestational diabetes

 Women with gestational diabetes will need to be monitored very closely by an obstetrician who specializes in high-risk pregnancies. This is to prevent complications to the mother as well as the unborn child. Sometimes these appointments may be on a weekly basis as the pregnancy advances. It is important to know when these appointments are and to keep them.

Diet and moderate exercise are usually the first steps to treating gestational diabetes. If a woman has not been physically active before getting pregnant this is not the time to start a vigorous exercise program. Starting a walking program is a good idea, however it is important she speak with her healthcare professional prior to starting any physical activity.

If diet and exercise do not get control the blood sugars, then it may be necessary to start on medications. A lot of women are started on insulin because it allows for better control of insulin. It is also important that to check blood sugars frequently when pregnant with diabetes. Just as in type 1 or type 2 diabetes this can be taught and will need to be done at home several times a day. It is important to inform your healthcare provider if the blood sugars are not in the target range.

 

Gestational diabetes and future risk of developing type 2 diabetes

Gestational diabetes usually resolves after pregnancy. However women who have had gestational diabetes have an increased risk of developing type 2 diabetes. There is also a chance for recurrence in future pregnancies.

Risks for developing gestational diabetes

 

  • Certain ethnic groups such as African Americans, Latina, or Native Americans
  • Having borderline diabetes
  • Being overweight or obese
  • Family history of type 2 diabetes
  • Being over the age of 25 years

 

Steps to reduce gestational diabetes

 Just as in type 2 diabetes prevention is the key. Taking preventive steps does not reduce the risk of developing gestational diabetes to zero, but it is still a step to having a pregnancy with few complications and delivering a healthy baby.

Here are a few steps every woman planning a pregnancy can take to reduce her risk of developing gestational diabetes

 

  • Try to get as close as possible to your ideal body weight prior to getting pregnant.
  • Start an exercise program. I am a proponent of walking as a simple form of exercise. If you are planning to get pregnant now may not be the time to start training for a marathon, but it is easy to start walking. Purchase a fitness tracker and commit to walking 10,000 steps a day.
  • Eat more fresh fruit and vegetables. These contain nutrients rich in antioxidants, is a good source of fiber. Fiber helps with weight control. Fruits and vegetables are also a good source of folic acid that is necessary to prevent birth defects and support a healthy pregnancy. Juicing is an excellent way to get a variety of fruits and vegetables into your diet.
  • Get an annual physical. Inform your healthcare provider that you are planning a pregnancy and they may order some blood tests such as a fasting glucose, lipid profile and blood chemistry. For instance if you find out through blood tests that you have borderline diabetes, you can take some pro-active measures prior to getting pregnant.

 

Diabetes in pregnancy affects both a woman’s health as well as the health of her unborn baby. To avoid complications, it is important to seek medical care during pregnancy and to follow the advise of your healthcare professional.

To your health and wellbeing,

 

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Five Physical Symptoms Women Should Never Ignore

Type 2 Diabetes

As women, it is not unusual that we may ignore our health and wellbeing. For women living with a chronic illness such as borderline or type 2 diabetes, it is important to make our overall health and wellbeing our number one priority.

I have seen female patients who have ignored symptoms that later turned out to be very serious.

In this article I outline five common symptoms that should never be ignored. This is because contrary to ‘popular wisdom’ these symptoms may be a sign of more serious illness.

Rule of thumb is that if you experience any of these symptoms for more than a few weeks then it is time to schedule an appointment to see your healthcare provider.

1-Persistent Heartburn

Heartburn is a common complaint. It is also called ‘indigestion’, or ‘reflux’. It is caused when stomach acid moves back up the swallowing tube (called the esophagus).

There are many things that can cause heartburn. Some of the common reasons include certain foods such as spices, tomatoes. Caffeine intake, emotional stress and fat around the abdomen (abdominal obesity) are also causes of heartburn.

One uncommon symptom that may mimic heartburn but is something more serious is a heart attack!

 The heart sits in the chest wall directly above the stomach and is separated by the diaphragm. The diaphragm is a muscle that separates the chest from the abdomen. It is very important in breathing. If you have a heart attack that affects the bottom of the heart that sits on the diaphragm part, it may mimic the symptoms of heartburn.

How do you know it’s not heartburn?

 If you have never experienced heartburn before and right out of the blue you begin to experience this more frequently -this is a strong clue! Also if you break out in a sweat, feel your heart racing or have nausea or vomiting. Another thing to observe is if you don’t recall anything that you may have eaten that could be causing you to feel this way.

Rule of thumb when it comes to heartburn that you cannot explain, get checked out immediately. This is especially important if you have a family history of heart disease

 

2-Frequent vaginal yeast infections

A common reason for vaginal itching is a yeast infection called candida albicans. Candida is not sexually transmitted. It can cause a rash on the labia, itching and also a thick vaginal discharge that looks like cottage cheese.

There are many reasons why a woman may get yeast infections. This may include wearing tight underwear, stress, antibiotics, and hormonal contraceptives to name a few.

However frequent candida infections may be a hidden sign of diabetes mellitus. Yeast love sugar; the candida spores usually live in the digestive tract, but diabetes mellitus affects that acidity of the vagina and this way promotes the growth of yeast.

Rule of thumb, if you have frequent yeast infections more than 2 -3 times a year, then inform your healthcare provider. A simple fasting blood sugar is a great screening tool to find out if you have borderline or type 2 diabetes.

 

3-A constant dry cough

Have you ever met people who constantly have a cough and short of breath? Perhaps you or someone you know may have even gone to your doctor and been told that you have ‘allergies’. The fact is that this may be a sign of a serious lung disease called sarcoidosis.

The medical profession does not really know what causes sarcoidosis. It is common between the ages of 20 and 40 years old and can affect both men and women. It is three to four times more common in black people. If you have a family member with sarcoidosis then this increases the probability of another family member having it.

Sarcoidosis can progress from a very mild illness to a very serious illness.

Rule of thumb if you have a cough especially with shortness of breath and chest pain that persists for more than a month then I recommend that you schedule a visit with your healthcare provider.

4-A facial rash that won’t go away

 Do you have a red rash around your nose and cheeks that gets worse in the summer? This could be a disease called systemic lupus erythematosus –‘lupus’ for short.

Once again this is one of those illnesses that we in the medical community really can’t pin down a definite cause for. We do know that it is an autoimmune disease. This means that the body forms compounds that literally fight itself breaking it down. These are called antibodies. Because it is an autoimmune disease it can affect literally any organ in the body. This is why it can be a challenge to diagnose.

Lupus is more common in women and recently there have been campaigns to increase the public awareness of this disease.

Rule of thumb if you have a rash with an outline that looks like the wings of a butterfly over your nose and cheeks, gets worse in the sunlight and just does not seem to go away, see your healthcare provider to get blood tests for lupus.

 Lupus can show up in many ways, for more information click here

5-Constant Fatigue

Now this is a tough one. I mean as women we are built to be resilient, right?. We are super mommies, caregivers, professional women, working women. We burn the candle at both ends trying to meet each and every obligation thrust upon us. So naturally we will become fatigued right?

Well here are some additional clues that that fatigue may be a sign of something more:

 

  •        Weight gain
  •        Constipation
  •        Feeling cold even in warm weather
  •        Growing fuzzy fine hair on your skin
  •        Dry brittle skin and nails
  •        A feeling of depression

      

These symptoms may be due to a low active thyroid called hypothyroidism. The thyroid gland produces a hormone that is responsible for maintaining our metabolism. Hypothyroidism becomes more common in women over the age of fifty.

Rule of thumb- if you are experiencing constant fatigue that you can’t explain then you can get a simple test called TSH from your primary care provider.

Well I hope that you find this information helpful. Always remember it’s better to be safe than sorry. By tuning in to the wisdom of our bodies we can live more fulfilling lives.

Remember an ounce of prevention is worth a pound of cure.

 

To your health and wellbeing

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When Is It Necessary to Manage Type 2 Diabetes With Insulin?

Type 2 DiabetesWhen does it become necessary to start using insulin in type 2 diabetes? Here is a familiar scenario: You have just returned from your three-month diabetes check up with your doctor. Your doctor has just told you that she will be starting you on insulin. You have been dreading this day for the last several months. The truth is your doctor, so has your doctor.

You are experiencing a mixture of emotions. Some of them are intense. This cannot be happening you think to yourself.

Maybe if your doctor had allowed you a few more weeks, you would have been able to achieve a normal blood sugar range.

Maybe you’ll get a second opinion. Or it may be time to switch your healthcare provider.

If this scenario or something similar has happened to you or to anyone that you know, I want to assure you that you are perfectly OK with experiencing all these thoughts and emotions.

It is a normal response to be resistant to change. 

Starting insulin represents a change in your life. In my over 20 years of experience as a primary care physician, I have met very few patients who were ecstatic that I was starting them on insulin.

So take a deep breath in, relax. You are fine.

This article will explain in simple terms why sometimes it may be necessary for a person living with type 2 diabetes to start on insulin.

My mission is to provide my readers with information in an easy to understand way so that they can get into action- FAST.

There is a common misconception that once a person with diabetes type 2 starts insulin that they now have type 1 diabetes. That is not the case.

There is a difference between, diabetes type 2 and type 1. The pancreas is the organ in the body responsible for producing insulin. It is located in the abdomen. In type 1 diabetes, the pancreas produces little or no insulin. People with type 1 diabetes must use insulin in order to survive. In type 2 diabetes, the pancreas is still able to produce insulin.

So how come someone diagnosed with type 2 diabetes all of a sudden needs to start using insulin?

Insulin is responsible for a variety of functions. The most important function of insulin is managing how the body uses sugars and fats.  The secretion of insulin from the pancreas varies. For instance, if you have not eaten, insulin sends a message to the fat stores in the body. The stored fat gets sent out as a form of fuel for the body to function.

In a person without diabetes, this whole process works well to maintain healthy blood sugars.

In type 2 diabetes oral medications help to stimulate the pancreas to produce more insulin. However over time, the cells in the pancreas begin to wear down and die. When this happens, the pancreas is no longer able to keep up with insulin production.

At this point, oral medications no longer work.

When I bring up the difficult subject of starting a patient on insulin, I explain to my patients that if we continue to use just pills, it’s like beating a dying racehorse.

Think about it, beating that horse to get it back in the race is not going to work. In fact I summise that the more you beat the horse, the wearier it becomes and this may even hasten it’s demise. The same thing happens with the pancreas.

When a person with type 2 diabetes starts on insulin to get healthy blood sugar control, it gives the pancreas a much needed rest.

There are times that I have had to start a patient newly diagnosed with  diabetes 2 on insulin. It is possible later on, to transition to oral medication or reduce the amount of insulin they were taking.

The human body has an amazing capacity to heal itself.

I tell this to my patients and clients all the time. The body has an innate desire to see itself healed and ‘not dis-eased’.

Insulin is known as one of the wonder drugs of science. Recent research shows the benefit of lowering blood sugars very early, in order to reduce potential complications. While oral agents may help, they do not reduce blood sugar nor A1C levels as dramatically as insulin can.

In order to live powerfully with type 2 diabetes, it is important to dispel the misconceptions that surround being placed on insulin.

No doubt this is one of the times when living with diabetes can be challenging. But it is not impossible. So do not give up on yourself.

This is when it is important to check in with your mindset.  In my soon to be released free e-book I outline the importance of mindset. This is an excerpt from the first three chapters of my upcoming book “Dr. Eno’s A-Z Guide to Powerfully Living with Diabetes”

  1. Acceptance
  2. Belief
  3. Commitment to change

Use the ABCs as an anchor. They can help you grow and stretch outside your comfort zone. As time goes on and with the natural course of type 2 diabetes, the way that you and your doctor manage type 2 diabetes will change.

So the first step begins with your acceptance of the fact that you have reached a stage in your diabetes management that you require insulin.

The next step is a belief in yourself that you will do what it takes to learn all you can about insulin therapy.

And then finally that you make a commitment to change. Change perhaps the way that you have been doing things previously. Change whatever your hangups or misconceptions were about insulin.

All of this so that you can indeed start living a powerfully as a woman living with diabetes!

To your health and wellbeing,

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What is Polycystic Ovarian Syndrome?

Polycystic Ovarian SyndromePolycystic ovarian syndrome (PCOS) is a health condition in women caused by a predominance of male hormones called androgens.
 
The exact cause of this condition is not known, it affects about 5 million women are affected by polycystic ovarian syndrome.
 
         PCOS affects many systems in the body. The symptoms vary between women.
 
Some common symptoms of PCOS include-
  • Obesity or overweight
  • Irregular menstrual cycle
  • Male pattern hair or balding
  • Obesity
  • Facial hair such as a beard or moustache
  • Infertility
Some women may have very subtle symptoms that are barely noticeable. Others may have more typical symptoms.
 
Polycystic ovarian syndrome (PCOS) affects about 1 in 10 to 1 in 20 million women. There is no single test available to detect PCOS.
 
The relationship between polycystic ovarian syndrome and insulin
 
Research has shown that insulin resistance may play a role in the development of polycystic ovarian syndrome. In the revised edition of my upcoming book ‘Dr. Eno’s  A to Z guide to living powerfully with Diabetes’, I explain how insulin resistance as a precursor to the development of diabetes. When the body’s cells become resistant to insulin, more insulin is required to break down sugar in the body.
 
Too much insulin circulating in the body can cause a number of problems. In women with PCOS, insulin resistance causes an increase in the production of androgens. High levels of androgens cause acne; facial hair, irregular menses and weight gain in women with PCOS.
 
PCOS places a woman at risk of several serious health conditions:
 
  • More than 50% of women with PCOS develop type 2 diabetes.
  • Women with PCOS have a 4-7 times risk of developing a heart attack.
  • Women with PCOS have a higher risk of high blood pressure
  • There is an increased risk of a sleep disorder called sleep apnea
  • Higher risk of anxiety and depression
  • Women with PCOS have an increased risk of endometrial cancer

How is Polycystic Ovarian Syndrome (PCOS) diagnosed?

There is no single blood or diagnostic test that can be used to diagnose PCOS. A woman who suspects that she has PCOS needs to pay close attention to her body, especially if the symptoms are initially subtle. It is also important to be persistent and realize that it may require more than one visit to the doctor to get a diagnosis.
 
In addition to a detailed history your doctor may also need to perform some tests, which may help such as:
  • A pelvic examination
  • Weight and BMI
  • A pelvic ultrasound
  • Hormone levels

How to treat PCOS 

Treatment of PCOS depends on the goals of the woman living with this condition.
 
For instance if the goal is to get pregnant, then using fertility medications will help. If the goal is to have more regular periods then starting on an oral contraceptive will help.
 
Metformin can help to reduce the chance of getting type 2 diabetes.
 
Ultimately, the mainstay of treatment of PCOS is making a consistent change in diet and exercise.
It does not matter how long you have been diagnosed with PCOS, what’s important is to begin to make the necessary adjustments in your lifestyle starting right now. That way you will reduce your chances of getting type 2 diabetes, heart disease and high blood pressure.

What do you think?

Do you or someone you know have PCOS? Are you ready to get into action and to take the steps necessary to reduce your risk of diabetes, heart disease and high blood pressure? I’d like to share how I may support you in one of my coaching programs. Click here to contact me.

 
To your Health and Wellbeing,
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The ABC’s of Knowing Your Diabetes Numbers

I was once admitting a patient to the hospital. He had been living with type 2 diabetes for over 15 years. Unfortunately he had developed kidney failure and so now had to be on hemodialysis.

He seemed to know how his blood sugars were doing. He even recognized that a recent infection was the reason that his blood sugars were high.

I was impressed and excited. Then I asked him this, ‘So what’s your A1C?’  ‘What’s that?’ he replied with a blank stare. I was taken aback at his response, ‘You know your glyco hemoglobin?’ I ventured again. Another blank stare. ‘Never heard of that’ he responded off offhandedly.

Here was a man who by all intents and purposes seemed actively engaged in managing his diabetes. And yet he had NEVER heard of the A1C!

So this week, I will discuss getting to know your diabetes numbers.

One of the keys to Living powerfully with diabetes is to know your numbers.

I love acronyms. They help to make learning easier. For instance in my soon to be released book, Dr. Eno’s  A-Z Guide to Living Powerfully with Diabetes’ I use the letters of the alphabet to cover different topics related to  type 2 diabetes.

I am going to use the simple acronym ABCs to show how to remember some diabetes numbers. The uppercase letter will be for what I’ll call actual numbers. The smaller ‘a’ will go with some of the lifestyle adjustments that need to be made as a person living with type 2 diabetes.

So here goes:

  • A – A1C
    • activity
  • B – Blood sugar
    • bmi
  • C – Cholesterol
    • calories

A1C

A1C is a short name for glycosylated hemoglobin. That may sound like a mouthful, so it’s been abbreviated it to the A1C. The A1c is calculated as a percentage point. The A1C measures the average of the blood sugar levels over the prior 6- 8 weeks. The A1C measures the amount of sugars that attached to the red blood cells.

The higher the blood sugars, the higher the A1C. Typically the red blood cells live for about 120 days before they die off.

The goal is to keep the A1C less than 7%. An A1C less than 7% correlates with sugars on average less than 140 mg/dl.

How to get tested for the A1C:

You do not have to fast overnight before getting tested for the A1C. Most healthcare providers can do this test in their office; otherwise it can be done in the laboratory.

activity

I encourage everyone to try to adapt some form of physical activity. Research has shown that prolonged sitting and a sedentary lifestyle increases your risk of heart disease, cancer and diabetes by up to 40%. Research also shows that increased physical activity helps to control blood sugars.

A lot of people use the excuse of lack of time for not getting enough physical activity. Here are some creative ways to incorporate physical activity into your daily life:

  • Purchase a fitness tracker so that you can track your movement. When you track any activity you become more aware of that and this makes you want to do more of what you track.
  • Encourage your friends and colleagues to purchase fitness trackers. Have them join you in a fitness tracking challenge. A good idea would be to check with your health insurance company to see if fitness trackers are a covered benefit.
  • Instead of looking for a 30-45 minute block of time, how about creating three to four 10-15 minute blocks of time throughout the day?
  • Rather than taking the elevators, look for every opportunity to take the stairs.
  • Get to work 15 minutes earlier park further away and get a brisk walk.
  • Get up several times during your workday and do squats at your desk.
  • Do leg raises when you are sitting down
  • Spend time during your lunch break walking outdoors.
  • Instead of delegating that task of walking the dog to your kids, get a long leash and walk it!

Blood Sugar

It is important to keep your blood sugars within a healthy range. Depending on the treatment goals that your healthcare provider sets, you may have to check your blood sugars at home. This is known as self-monitoring of blood glucose. I’m often surprised to find patients who do not want to check their blood sugars. Perhaps they feel it is painful or they are scared stick themselves.

A healthcare provider only gets to see their patients on average 4-5 times a year. That’s every 3-4 months! Knowing your blood sugar levels gives you instant feedback as to how well you are managing your diabetes. It alerts you to a problem and you can work with your healthcare provider to make corrections.

Knowing your blood sugars is key to living powerfully with diabetes. 

bmi

Currently there are more than two third of adult Americans are overweight or obese.

BMI correlates with body fat and is relatively unaffected by height. It is calculated from the weight and square of the height as follows:

BMI   = body weight (in kg) ÷ stature (height, in meters) squared

Know your BMI

The definition of overweight and obesity varies by race.

According to the WHO and NHBLI guidelines, overweight for Caucasians, Hispanics and blacks is a BMI between 25 and 29.9 kg/m2.

Obesity is when the BMI of 30 kg/m2 or more.

For Asians, overweight is a BMI between 23 and 29.9 kg/m2. Obesity a BMI >30 kg/m2.

There are several apps that can help to calculate your BMI once you enter in your weight and height. You can also check with your healthcare provider on a routine visit.

Cholesterol

Cholesterol is produced in the liver. It gets transported from the liver to the cells of the body where it performs a variety of functions. If the cholesterol levels run high then there is a risk for heart disease.

It is important to know your cholesterol numbers.

You should get a fasting lipid panel as part of your routine diabetes care.

The fasting lipid panel is made up of several parts:

  • HDL (High Density Lipoprotein) I call it the ‘happy cholesterol’ This level should be more than 40 mg/dl. More than 60 mg/dl is excellent.
  • LDL (Low Density Lipoprotein) I call it the ‘lousy cholesterol’. You want to keep this as LOW as possible. The current guidelines are to get the LDL as low as 70 mg/dl.
  • Triglycerides – These are all the fatty substances in your blood. The goal is to keep the triglycerides less than 150 mg/dl.

calories

The amount and quality of calories that you eat plays a crucial role in how well controlled your blood sugars are going. Calories are also tied directly to how much weight you gain or lose. It’s a very simple equation.

Calories in more than calories out = gain in weight (high BMI + High blood sugars + high A1C)

Calories in less than calories out = weight loss (lower BMI + normal blood sugars + normal A1C)

Ways to monitor your calories:

  • A simple way to start of is to simply watch your portion sizes.
  • Don’t fill your plate or use a smaller plate.
  • Eat only till you are about 80% full. This is a principle that the Okinawans in japan use. They live into their 100s.
  • Increase your intake of fruits and vegetables.
  • Drink at least half your body weight in ounces of water per day. This helps to keep you full.
  • Increase the intake of fiber. This also helps control your blood sugars.

So there you have it. Know your ABCs.

As always I welcome your questions and comments.

Here’s to your Health & Wellbeing,