Diabetes Information

Diabetes mellitus (DM) is a medical and endocrine disorder where the blood glucose level is high.  There may be a lack of insulin, insulin resistance or both. Insulin is a hormone made in the pancreas that helps to lower the blood glucose levels. Diabetes mellitus is commonly referred to as “sugar” in some cultures.  It can occur in young people, commonly referred to as Type I, or adult onset which is commonly referred to as Type II.  Pregnant women can also sometimes develop diabetes.  This is referred to as gestational diabetes.

Symptoms of Diabetes Mellitus

Some of the most common symptoms of Type I DM include:

• Fatigue
• Excessive urination
• Excessive thirst
• Hunger
• Weight loss
• Vision changes
• Nausea

Some of the most common symptoms of Type II DM include:

• Excessive urination which can be fruity smelling
• Excessive thirst
• Nausea
• Recurrent yeast infections
• Slow healing sores and ulcers

Who is at risk?

• Family history of diabetes especially if a parent or sibling has been affected
• Obesity
• Women with a history of gestational diabetes have a higher risk of developing Type II diabetes later in life
• Age over 45 years

Diabetes Complications

Diabetes mellitus can usually be diagnosed by your health care provider with a blood test that measures your fasting glucose level. HgbA1C

Sugar, sugar, honey, honey…

When diabetes is inadequately controlled, it can lead to multiple, serious medical problems.  Diabetic ketoacidosis (DKA) and hyperosmolar nonketotic coma are amongst the most serious complications.  DKA can occur in patients with insulin dependent diabetes with very elevated glucose levels.  Symptoms of DKA include fruity smelling breath, frequent urination with ketones, confusion and very high glucose levels. Hyperosmolar nonketotic coma can occur if excess glucose is released into the urine. Many urine strips can test for glucose and ketones.  You normally should not have either in urine.  DKA and hyperosmolar nonketotic coma are extremely dangerous and requires hospital admission for proper management.

Other potential diabetes complications:

• Neuropathy (the nerves’ function is reduced)- symptoms include numbness, tingling in the feet
• Nephropathy (reduced kidney function, sometimes this can lead to kidney failure)
• Retinopathy (the retina in the eyes may develop abnormalities or even detach)
• Atherosclerosis- hardening of the blood vessels
• Cardiomyopathy- the heart muscles weaken leading to reduced function of the heart
• Erectile dysfunction
• Poor healing after surgery or injury
• Bladder dysfunction
• Intestinal problems including constipation, diarrhea, delayed gastric (stomach) emptying

When silence is not golden…

Diabetes can also lead to silent myocardial infarction (heart attack).  Therefore, the usual symptoms of a heart attack such as chest pain, left arm and jaw pain may not be felt when a diabetic patient is having a heart attack.

Put your foot down…

Foot care is extremely important.  People with nerve damage or reduced nerve function in their feet may not feel when an injury occurs.  It is important to wear well fitting shoes and examine the feet.  Cuts and other injuries may take longer to heal and may need medical attention and care.

Diabetes Treatment: Take control

We can’t escape it.  Diet and exercise are a must.  A balanced, low glycemic index (less than 55), reduced carbohydrate diet and exercise helps to reduce the blood sugar levels.  Low glycemic index foods break down slower in your body than high glycemic index foods and will leave you feeling fuller.

There are multiple medications that are available with a prescription that can reduce the glucose levels.  The list includes but is not limited to Metformin, glyburide, Januvia.  The supplement chromium may also help.

For those who require insulin, the pump and injections are amongst the options.  Type I and some Type II patients will require insulin.

Hemoglobin A1C is a blood test that can measure how well the glucose has been controlled over the past 2-3 months.

How low can you go?

While the goal of diabetic treatment is to reduce the blood sugar levels, too low of a glucose level (hypoglycemia) can be detrimental as well.  Levels under 50 mg/dL can give symptoms of fainting, dizziness, trembling and sweating.  To combat this, drink orange juice or have a carbohydrate snack or other drink.

The sweet taste of victory

Diabetes mellitus can not be cured, but it is manageable.  In general, the American Diabetic Association recommends maintaining your glucose levels at 80-120 mg/dL before meals, and 100-140 mg/dL at bedtime.  Tight control of the glucose levels do help to reduce and prevent many of the unwanted complications of diabetes. If you or a loved one has diabetes, keep a close eye on the glucose levels.  Surgery, infection and some medications may also increase the glucose level, so the diabetic medications and/or insulin may need adjustments when these conditions occur.

If you have any questions or concerns, please seek medical attention.  Diabetes should never be taken lightly.  There are many organizations, including the American Diabetes Association, that provide compelling information on diabetes.

LISTEN TO YOUR MOTHER AND YOUR DOCTOR- EAT YOUR VEGGIES.

For more health tips and info, please visit drcamillegraham.com

We have all seen the fat, jolly clowns who make us laugh till we cry. However, when we’re talking about obesity, it is no laughing matter.

Info about Obesity: Definition

BMI- body mass index is measured by weight in kilograms/ height in meters squared. For those of us who have better things to do with our day than to sit around doing calculations, many websites are available for you to plug in your weight and height and get a BMI calculation.

In general, it is thought that a BMI of:

• < 18.5- underweight
• 18.5-24.9- normal weight
• 25-29.9 – overweight
• 30-34.9 – obese
• >/= 35 – morbidly obese

The CDC reports that in 2008, only one state had an obesity rate of less than 20%. Can you guess? For those of you who guessed Colorado, you are correct! All other 49 states have an obesity rate over 20%. Childhood obesity has been escalating over the decades. Some studies show childhood obesity rates has high as 19%.

Info about Obesity – What’s the BIG deal?

Obesity is associated with many health problems including increasing your risk of getting certain cancers! Here are just a few of the disease processes:

• Obstructive sleep apnea (OSA)- pauses of at least 30 seconds during sleep. OSA can cause multiple problems including high blood pressure, strain on the heart and lung and daytime fatigue to the point of falling asleep at the wheel.
• Pseudotumor cerebri- increased pressure in the eye that mimics a brain tumor, and can cause headaches and blindness.
• Joint disorders- obese patients have an increased risk of arthritis and also needing knee and hip replacements
• Heart disease
• Reflux
• Breast, colon and prostate cancer
• Type 2 Diabetes
• Hypertension
• Stroke
• Gallbladder disease
• Increased anesthesia risk
• Decreased ability to heal wounds
• Mental disorders including depression and social isolation

What to Do About Obesity?

It is important to know the amount of calories that your body need for sustenance. Eating too few below or too much above your body’s caloric requirement may stall and hinder your weight loss efforts. There are again many websites that you can use to calculate your body’s caloric requirement. It is usually based on your gender, height and activity level.

About Obesity Diets – When it’s Great to be a Loser!!!

Being called a “loser, usually has derogatory implications. In the case of obesity, it is a great compliment with many health benefits. How can we make our move to a healthy and slimmer lifestyle? In general, 3500 calories is approximately one pound. A reduction of 500 calories a day can equal one pound of weight loss each week. For long term and effective weight loss, it is usually recommended to lose one to two pounds per week. Here are some options to improve your health:

• Food pyramid – While there are variations of the food pyramid, they all seem to encourage the intake of fruits, vegetable, whole grains and lean sources of protein. They recommend minimal intake of alcohol, sweets and salt.
• Appropriate calorie intake – As stated above, it is important to know your body’s caloric requirements. Staying at that level will help to maintain a healthy body weight.
• Prescription medications – The criteria for prescription medications for obesity include a patient with a BMI of 30 or more; or a patient with a BMI of 27 or more who also has an obesity related condition (example: hypertension). These medications include Meridia and Xenical. They are usually for short term use. Appetite suppressants such as phenterimine and sibutramine are also available. ALWAYS USE THESE UNDER THE GUIDANCE AND SUPERVISION OF A HEALTH CARE PROVIDER!
• Exercise – For significant weight loss, it is recommended to get 250 to 350 minutes of moderate exercise each week. Some weight loss and many health benefits can be derived from even 150 minutes each week. However, the fact of the matter is, it is a matter of calories burned versus calories taken in for weight reduction. Kids should also get at least one hour of outdoor activity each day if possible. Don’t forget to check with your health care provider before beginning an exercise routine.
• Weight loss surgery – Weight loss surgeries are widely available. Each patient has to meet certain criteria prior to approval for surgery however. The criteria may include having an obesity related condition such as sleep apnea, hypertension, or diabetes as well as failed serious non-surgical attempts at weight loss. A BMI of 40 or 35 with an obesity related condition is also usually required. Surgical options include lap band, gastric sleeve, gastric bypass procedures.

Let’s make our great nation a healthy one! For more information, email me at Camille@doctorcamille.com or log on to www.doctorcamille.com.

Disclaimer: This information is not intended to replace medical advice provided by your health care provider. Always seek medical attention from your health care provider. We will not be liable for any health or medical information provided.

Skin cancer causes and prevention is always a hot topic in the summer months. Summer brings rays of sunshine for us all. The sun lights up the world and brightens our day, doesn’t it? However, too much of a good thing can be harmful. This definitely includes the sun.

The sun is over 93 million miles from the earth. The sun is needed for vitamin D, and antioxidants. Only about 15 minutes a day several times a week is needed for vitamin D. While vitamin D production is vital for the body’s health, the sun also emits ultraviolet rays- UV A and UV B. UV A rays are longer and penetrate deeper into the skin. UV B rays are shorter and primarily go into the outer layers of the skin. Therefore, it is postulated that UV B rays can cause burning and are thought to be more damaging than UV A rays. UV A rays can cause tanning.

Types of Skin Cancer

Dogs, shirts, faces—the less wrinkles the better. Have you really ever seen a cute sharpe dog? I haven’t. Prolonged sun damage may lead to wrinkles, yes, but more importantly it can also cause both cancerous and precancerous conditions. Skin cancers include basal cell carcinoma, squamous cell carcinoma and melanoma.

Melanoma- making a mountain out of a molehill

Melanoma is considered to be the worst type of skin cancer. Sun exposure up to age 20 is sometimes felt to be one of the biggest risk factors in developing melanoma. Melanoma is usually a pigmented lesion that has changed color, size, shape or has irregular borders. They are famous for undergoing in-transit metastasis. This means that it can spread to a location that is not close to the original site of the cancer. Some researchers have even linked melanoma to breast cancer. Melanoma comprises less than 5% of all skin cancers, but it is considered to be the worst one with the most fatalities. Melanomas can occur on the skin, but can also occur in the eyes, mouth, nose, esophagus, rectum, as well as in the vagina. On the skin, melanoma can be broken down into four categories:

• Superficial spreading- this is the most common melanoma. It usually arises from an existing mole.
• Nodular- these are more aggressive than superficial spreading melanomas.
• Lentigo maligna- this type is usually seen on the faces of lighter skinned individuals. It tends to metastasize less frequently than other types.
• Acral lentiginous melanoma- this is mainly on the soles of the feet and the palms. They tend to be large and are aggressive. This is the most common type seen in darker skinned individuals.

Basal cell carcinoma

Basal cell carcinoma is the cause of 90% of skin cancers. They may have an indented area in the middle of the lesion or have “pearly” edges, be scaly or bleed easily. These are just some of the signs however. While basal cell cancer does not have the same mortality as melanoma, it can spread locally. Lifetime and cumulative sun exposure is the risk factor associated with development of basal cell cancer.

Squamous cell cancer (SCC)

Lifetime and cumulative sun exposure is also the risk factor associated with squamous cell cancer. HPV (Human Papillomavirus) infections can also increase the risk of some SCC. Injury to the skin such as burns and scars, as well as tanning bed use can also at times increase the risk of SCC. Squamous cell cancer can spread to local lymph nodes. Some of the signs of SCC include, but not limited to raised, irregular lesions that easily bleed or recur.

Actinic keratoses

AK is considered to be a pre-malignant condition. 1 in 100 can lead to squamous cell carcinoma. They usually look like scaly, crusty growths that have a “sandpaper feel”. They can be found on the scalp, face, hands or anywhere on the body that is frequently exposed to the sun.

Skin Cancer Prevention

Love the skin you are in

For skin cancer prevention, “an ounce of prevention is better than a pound of cure.”
It is important to know the ABCDEs of melanoma and other skin cancers:

• Asymmetry- the mole is uneven
• Border- the borders are irregular
• Color- a variety of color is present
• Diameter- more than ¼ inch
• Evolving- there is a change such as crusting, bleeding, growth is size, change of shape etc.

For skin cancer prevention it is recommended to use sunscreen with SPF of least 15, helioplex (available in many sunscreens), protective eyewear and clothing, as well to perform skin and mole checks regularly.

Skin Cancer Treatment:

If you suspect that you are a loved on has a cancerous or precancerous lesion, it is highly recommended that you visit your health care provider. Excising (cutting out) the lesion as well as other surgical skin cancer treatment plans such as Moh’s surgery may be recommended. More extensive procedures including removal of affected lymph nodes and organs may be needed in more aggressive cases. Radiation therapy and sometimes chemotherapy may be needed. Like with many cancers, skin cancers even melanoma can be curable if detected and treated early!

As we enjoy the summer, don’t forget the sunscreen, sunglasses, wide brimmed hats and protective clothing. Have SAFE fun in the sun.

For more information, email me at Camille@doctorcamille.com or visit the website at www.doctorcamille.com.

Disclaimer: This information is not intended to replace medical advice provided by your health care provider. Always seek medical attention from your health care provider. We will not be liable for any health or medical information provided.

Click here to listen

Click here to listen

Click here to listen

For questions or a transcript of this show, Camille@doctorcamille.com

For questions or a transcript of this show, email Dr. Camille.