The Struggle of Smoking Cessation!

Before we get started, I would like to share with you, my joy and peace found in scripture.  I focus on literature which promotes positive thinking and reference to faith and belief in God and Christ.  This is my daily inspiration and motivation.  I recommend reading books written by Lynn R. Davis, she's very encouraging.  In her books, she provides wonderful scripture references, which will help you with prayer and daily meditation.

In my quest to quit smoking, for good this time, I decided that it would be a good idea to share my motivation.  I realize, it's difficult to quit "cold turkey", particularly for women. Maybe, you can relate and succeed in the same effort. All we have to do, is strive for better health and eliminate Stinky Winky. Here we go!

Having smoked for more than 25 years, I understand the stress and frustration factors that effect us when we're trying to quit.  I have quit, probably 8 times.  I've tried Nicotine replacement therapies and became very ill.  I've tried mood altering drugs (like Wellbutrin/Bupropion HCl), drove me nuts. I've even tried those lozenges (Commit), they had me thinking I was gonna die.  The burning pain in my stomach was horrible.  Then there was Chantix.  I loved Chantix.  The only problem was, I ended up sharing my prescription and gave up on continuing to try.  When I say shared, I would find entire packs missing.  It was pretty frustrating, so I grabbed a cigarette.........SIGH.

My final destination, which should have been my first and strongest solution, is Jesus.  Yep, I said it! Prayer helps, prayer works.  You have to want it.  You have to believe.  You have to commit and mean it!  I guess we can say that for any addictive process, but I decided to liken myself to someone addicted to narcotics.  I gave myself no slack.  After all, nicotine has frequently been compared to narcotics, when addiction is addressed.

Sometimes we feel we still need a crutch.  Well, there's no stronger, more solid, or more stable crutch than the Lord.  No, it was not instantaneous.  It will take prayer, meditation, faith, and belief.  You have to believe and simply know He will pull you through it.  Also, for once in your life, you have to take a look at all your previous challenges you've overcome, and BELIEVE IN YOURSELF.  No, you cannot do it by yourself, but you can do anything through prayer, faith, and belief in Christ Jesus.

I'll give you some words of encouragement to get started:

Lung Disease
Cancers (yes, plural)
High Blood Pressure
Reduced Stamina/Endurance
Dehydration
Fatigue
Stomach Problems
Increased Allergy Issues
Increased Risk of Stroke
Increased Risk of Heart Disease/Heart Attack
Stinky Winky

Let's break it down.  I'm gonna blend medical terms with layman terms, in effort to increase understanding of what we hear at clinic visits, as well as make an impact.

Pulmonary Disease

• COPD
• Chronic Bronchitis
• Emphysema
• Chronic or Late Onset Asthma
• Cancers
• Lung Cancer
• Upper Airway Cancer
• Oral
• Lingual (tongue)
• Buccal  (inside the mouth)
• Pharynx (We call this our throat)
• Nasopharynx (the space in your throat behind your nasal anatomy)
• Oropharynx (the part of the throat with which we are more familiar)
• Hypopharynx (the lower part of the throat, leading to the esophagus)
• Larynx (commonly known as our "voicebox", houses our vocal cords)
• Trachea (this is below the larynx, and leads to your bronchial airways, which leads to your lungs)
• Esophagus (our tubular pathway to our tummies)

The next time you hear someone speak of Laryngitis, realize is simply means inflammation (swelling) of your voicebox.

Sometimes you'll hear different suffixes for these airway terms.  When we add "itis" it means inflammation.  When we add "al" it means pertaining to.  Here are a few examples.

Esophageal, Tracheal, Laryngeal, Esophagitis, Tracheitis, Laryngitis.

Any of these pathways can be affected alone or in combination by cancerous mutations.  You will also hear the word, carcinogen or carcinogenic. This means able to create, promote, develop cancers. The beginning, as in "Genesis", of a cancerous mutation.

O.k., let's get back to our list.

Vascular Disease

• High Blood Pressure
• Stroke
• TIA (Transient Ischemic Attack or Mini Stroke, caused by reduced blood flow to the brain)
• CVA (Cerebral Vascular Accident or Cerebrovascular Accident, caused by a blockage or rupture in the vasculature in certain areas of the brain.)
• Aneurysm (this hemorrhagic vascular injury can rupture and lead to a massive stroke)
• Vascular Resistance (long term effect of unregulated Hypertension (High Blood Pressure)
• Heart Disease
• Heart Attack

I didn't explain the rest, because it's pretty self explanatory.  

Digestive System Problems

• Peptic (stomach) Ulcers
• Stomach Cancer
• Gastritis
• Intestinal dysfunction
• Colon Cancer

First I'm gonna tell you, mixing nicotine with alcohol and/or caffeine sets you up for a double whammy.  Caffeine and alcohol are very effective dehydrating agents.  Just either of them alone can lead to vascular disease through addiction.  Combining either or both with nicotine is an absolute pathway to increase all associated risks.

Here's one way to get a glimpse of how are soft tissues, or mucosal tissues are affected.  We can look at our skin and realize, dry patches can itch (become irritated), so we scratch and sometimes create sores.  These sores, if introduces to certain microorganisms (bacterias, viruses, etc.), will become infected.  Now let's take a look inside.  Mild irritations, when left untreated, can become ulcerous. Introduce infectious agents, and all sorts of mutations can occur.

I'm gonna list some common symptoms of illnesses we can develop over time, that we tend to ignore. Please see your doctor as soon as possible if you experience any of these.  Don't teach your body to accept this:

• Fatigue
• Shortness of Breath
• Dehydration (dry mouth or other areas of soft tissue, dark urine, little to no urine, diarrhea, increased irritability, increased thirst, dizziness, dry skin, etc.)
• Persistent headaches, also a sign of dehydration
• Persistent coughing
• "Rattling" in your chest
• Wheezing
• Chest pain
• Passing out
• Random Nausea

These are just a few of the symptoms we tend to ignore.  The American Heart Association has and continues to publish guides and information to teach us to recognize signs of symptoms of Stroke and Heart Attack.  I implore you to go to their site to learn more, www.heart.org.

I also named Stinky Winky.  I cannot stand the smell of smoke on my skin, hair, clothes, and fingers. I find myself scrubbing up frequently.  So, the solution is to QUIT.  In addition, when we're casually and comfortably smoking, we fumigate our homes, furniture, and electronics.  The only way to reduce the workload of excessive cleaning, is to eliminate the culprit.  

Earlier, I listed stress, frustration, and anxiety as triggers, these are also withdrawal symptoms. Again, I have to defer to prayer.  This is how I get my calm, my peace, my relief.  We can do this together.  At this moment, I think it's o.k. to say, "I'm a QUITTER".

LET'S GO!

Airway management for the Respiratory Therapy Student

I would like to begin by thanking everyone for being so patient with me, while I've been on a moderate hiatus.  On this blog, we will see responses from Respiratory Care Students, regarding particular modalities of airway care and respiratory infections we see frequently in the hospital setting.

This is the assignment.  The students are required to describe the symptoms of the following respiratory infections, and recommend treatment.

Adenovirus

RSV

Corona Virus

In addition, the students are required to explain to the general public, the meaning of:

Airway Clearance

Mechanical Ventilation

Bronchial Hygiene

Hyperinflation Therapy

Remember to always wash your hands!


Ready, Set, GO!

Drugs commonly used for Type 2 Diabetes

You may have noticed, that for Type 1 Diabetes, injection medications are required.  When diagnosed with Type 2 Diabetes, the patient is frequently prescribed oral medications with a diet and exercise plan.  Depending on how advanced the symptoms are, additional medications may be prescribed as a combination.  If you have sensitivities or allergic reactions to any component of any of the following medications, be sure to notify your health care provider and seek immediate care!


Metformin (oral medication)
Generic Name: metformin
Brand Names: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

Metformin is not for Type 1 Diabetes.  It can be used in addition to other diabetes medications, to help regulate blood sugar levels. Tell your doctor if you have a history of liver or heart disease.  If you have to have an X-Ray or CT scan, requiring the use of dye, you will have to temporarily stop using this drug.  There is an increased risk to develop a condition called Lactic Acidosis*.  This is a potentially fatal condition involving your muscle tissues.  This is potentially a higher risk if you have problems with dehydration, history of liver, kidney, severe infection, or CHF (congestive heart failure), or if you drink large amounts of alcohol.  It is very important that you are completely honest with your physician.

Metformin should not be given to a child younger than 10 years old.
Metformin Extended Release (Glucophage XR) should not be given to a child younger than 17 years old.

*Lactic Acidosis: Lactic acidosis is when lactic acid builds ups in the bloodstream faster than it can be removed. Lactic acid is produced when oxygen levels in the body drop.
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001428/

Levemir (long acting)
Generic Name: Insulin Determir
Brand Names: Levemir, Levemir FlexPen

Levemir can also be used for Type 1 Diabetes in adults and children at least 2 years old.  As with any medication, tell your doctor if you have history of liver or kidney disease.  Levemir does not interact well with all drugs (prescription or over-the-counter), be sure to tell your doctor if you need to add a medication or if you have a change to your regular management plan.  Be sure to read all pharmaceutical information provided, for proper administration and scheduling.

Januvia (oral medication)
Generic Name: Sitagliptin
Brand Name: Januvia

Januvia works by regulating insulin levels in your blood after eating.  It is not used for Type 1 Diabetes.  This medication can cause Pancreatitis and severe allergic reactions.  Seek emergency medical attention if you feel any of the following symptoms:

Related to Pancreatitis

• Nausea & vomiting
• Severe pain in your upper stomach
• Loss of appetite

Related to Allergic Reactions

• Fever
• Sore throat
• Swelling or burning in your face
• Skin pain
• Skin rash that spreads, blisters, and peels

Be sure to tell your doctor if you have a history of pancreatitis or kidney disease

Amaryl (oral medication)
Generic Name: glimepiride
Brand Name: Amaryl

Amaryl helps the body respond better to insulin produced by your pancreas, along with a diet and exercise plan. It cannot be used for Type 1 Diabetes.  Be sure to tell your doctor if you are allergic to Sulfa drugs and DO NOT TAKE if you are allergic to glimepiride.  Also inform your doctor if you have history of; heart disease, liver disease, kidney disease, an enzyme deficiency (G6PD), are under-nourished, problems with your adrenal glands or pituitary glands.

Along with Levemir, there are additional medications also used to treat Type 1 Diabetes.  These drugs are administered by injection/cartridge.  Here are a few more:

Humalog - fast acting
Generic name: Insulin Lispro
Brand name: Humalog Cartridge, Kwikpen, or Pen

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Talk to your Doctor about pediatric dosages or alternative options.


Novolog - fast acting
Generic name: Insulin Aspart
Brand name: NovoLog, NovoLog FlexPen, NovoLog PenFill

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Prescribed for adults and children as young as 2 years old.

Drugs commonly used for Type 1 Diabetes

Because of the risk of creating confusion and the enormously long list of drugs available, I will only list a few of these drugs. Please be sure to discuss all of your medications and adjustment needs with your physician, before making any changes or decisions.


Please note: All people with Type 1 Diabetes must take insulin by injection. The drugs listed below for type 1 Diabetes are to be administered subQ (subcutaneously - into the fatty tissue under your skin, not the muscle).


Humalog - fast acting
Generic name: Insulin Lispro
Brand name: Humalog Cartridge, Kwikpen, or Pen

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Talk to your Doctor about pediatric dosages or alternative options.

Novolog - fast acting
Generic name: Insulin Aspart
Brand name: NovoLog, NovoLog FlexPen, NovoLog PenFill

Usually given with another long-acting insulin medication. It works by lowering the glucose level in the blood. Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. Prescribed for adults and children as young as 2 years old.

Levemir - long acting
Generic name: Insulin Determir
Brand name: Levemir, Levemir FlexPen

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Levemir cartridge also works by lowering glucose levels in the blood. Prescribed for adults and children who are at least 2 years old.

Lantus - long acting
Generic name: Insulin Glargine
Brand name: Lantus, Lantus Solostar

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Lantus cartridge also works by lowering glucose levels in the blood.

Lantus Solostar - long acting
Generic name: Insulin Glargine
Brand name: Lantus, Lantus Solostar

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Lantus Solostar cartridge also works by lowering glucose levels in the blood.

Humulin R - fast acting
Generic name: Insulin Regular
Brand name: Humulin R, Novolin R

Comes with multiple warnings, be sure to talk to your doctor about ALL additional medications and/or herbal remedies you are using. Be sure to discuss all allergies. Please refer to label/insert for information regarding drug interactions, adverse effects, and other risks. The Humulin R also works by lowering glucose levels in the blood.


Humulin N - long acting
Generic name: Insulin Isophane
Brand Name: HumuLIN N, HumuLIN N Pen, NovoLIN N


This is a synthetic (man-made) form of a hormone produced in the body, designed to lower glucose levels in the blood.


Apidra - fast acting
Generic name: Insulin Glulisine
Brand name: Apidra

Apidra is a "faster acting" form of insulin than regular human insulin. This medication can be given to adults and children who are at least 4 years old.

Symlin - triple action medication
Generic name: Pramlintide
Brand name: Symlin, SymlinPen 120, SymlinPen 60


~WARNING~ Do not mix Symlin & other insulin in the same syringe. You will need to use a lower dose of insulin than you used before starting Symlin.

Symlin works in 3 ways:
1.) It slows the rate your food moves from your stomach to your intestines. In this action, it can slow your glucose absorption.
2.) It lowers the amount of glucose your sugar produces.
3.) It triggers the feeling of fullness after meals. This will reduce your food intake and help to control your appetite.

Symlin is also a synthetic form of insulin. If you are prescribed Symlin, be sure to take specifically as prescribed. If you have any adverse effects, be sure to seek medical attention IMMEDIATELY.


Become aware of the symptoms of *low blood sugar: These medications cannot be used when your blood sugar is dangerously low. Please make sure you tell your doctor of all additional health conditions, such as kidney or liver disease. Tell your doctor about other prescribed medications, over the counter medications, as well as herbal/natural remedies you are using. You don't want to create any associated risks of drug interactions.

*Symptoms of low blood sugar: Symptoms of low blood sugar may include headache, hunger, sweating, pale skin, irritability, dizziness, feeling shaky, or trouble concentrating. Watch for signs of low blood sugar. Carry a piece of non-dietetic hard candy or glucose tablets with you in case you have low blood sugar. If you hear someone say you are "Hypoglycemic", this means your blood sugar is too low.

When you are monitoring your blood sugar, also look for symptoms of **high blood sugar. If you hear someone say you are "hyperglycemic", this means your blood sugar is too high.

**Symptoms of high blood sugar: These symptoms include increased thirst, loss of appetite, increased urination, nausea, vomiting, drowsiness, dry skin, and dry mouth. Check your blood sugar levels and ask your doctor how to adjust your insulin doses if needed.

When taking insulin, be sure to make it a part of a complete regimen of lifestyle modification, which addresses dietary and exercise needs.

Help for managing your Asthma

Here are a few links to help you with a little research of your own:

• http://www.cdc.gov/asthma/management.html
  
  
  
• http://www.lung.org/lung-disease/asthma/taking-control-of-asthma/
  
  
  
• http://kidshealth.org/parent/medical/lungs/asthma_mgmt.html

I didn't want to post a full bibliography, so we'll start with those few. There are so many resources for everyone, whether you are a health care provider or someone who is learning about Asthma for the first time, as a patient. My goal is to provide ease of receiving information, which will ultimately allow for improvement of self management. We will talk about Asthma as a chronic pulmonary disease and Asthma as an allergic reaction. Your Pulmonary Medical Team will discuss with you, the many tools and medications available to fit your specific classification of Asthma. You can refer to my first Asthma post, "Asthma Kills", to learn the basics of Asthma Classifications. I chose that title strictly for the purpose of shocking everyone into truly paying attention. Your health is nothing to play with. People with Asthma can lead very active lives, depending on severity and management.
In diagnosing Asthma, your physician will ask you questions which will help determine:

• If you actually have asthma
  
  
  
• What are your Asthma "triggers"
  
  
  
• If you have nocturnal (nighttime) awakenings
  
  
  
• What are your symptoms - (wheezing, persistent cough, chest tightness, shortness of breath/"dyspnea", recurrent "episodes" related to specific triggers, etc.)
  
  
  
• How you respond to Asthma specific therapy
  
  

As health care providers, we categorize these symptoms to determine how they fit into the 4 Asthma classifications. As an airway inflammatory disorder, Asthma will definitely cause you to experience most or all of these symptoms. This is where assessing your lung function with a series of tests come in handy. The moment your primary physician becomes aware of your symptoms, he/she should talk to you about Asthma education and making an appointment with a Pulmonologist, referrals are always welcome!
FYI: In addressing Allergies & Asthma data show:

• There are more than 15 Million asthmatics in America
  
  
  
• 85% react with positive skin tests to specific allergens
  
  
  
• Allergic disease is as common and Hypertension & Diabetes combined

Asthma Triggers
Asthma presents either as a genetic disorder or a response to environmental factors. Genetically, we look at specific tests and parental/familial history. In assessing environmental triggers, the irritants are numerous. There are allergens, diet, air pollutions, tobacco smoke, infections, pests, pets, etc. Be completely open and honest about your living environment when discussing symptoms with your physician and/or medical team.
I promised to discuss medications prescribed for both, management of Asthma and of Diabetes. This will be done in a separate blog.
Next Asthma blog, we will talk more about environmental triggers and lifestyle modification!

Asthma Kills!

For so long, I have heard people say things to make excuses for not adhering to their health care regimen. "I grew out of my asthma" (that's #1 on the list), "I really don't need all those medications", "I only have an attack once in a while, when I have a cold", "I couldn't find my inhaler", "My inhaler ran out", the list goes on and on.

This is the very reason, we need to be better educated about the effects and dangers of this Inflammatory Process which strong effects our Airways (breathing). I spoke with a woman after her recovery from what is called Status Asthmaticus, and she said, "all I could think about, was getting in one good breath". She arrived by ambulance to the hospital, ended up in our ICU (intensive care unit), breathing with the assistance of a ventilator. She was someone who we caught in time. There was a woman, who figured she could finish up her workday before going to the hospital, knowing she needed to treat the "attack" she felt coming on. She persisted, until someone at work insisted she go. Apparently, she felt she could drive herself, her thoughtful co-worker called an ambulance. Without sharing all the details, after we worked on her for well over an hour, she didn't make it.

I implore everyone who has been diagnosed or shows symptoms of Asthma, to see your doctor and be specific in describing your symptoms. You should be referred to a Pulmonologist to receive specific testing. We will talk about these tests later on in this blog. I want to share with you, the four classifications of Asthma:

• 1.) Mild Intermittent. This classification addresses people who rarely experience an exacerbation (attack) without the presence of an irritant. This person has symptoms less than twice weekly, and nighttime symptoms less than twice monthly. Their FEV (Forced Expiratory Volume, a Pulmonary Function test) greater than 80%.
  
  
• 2.)Mild Persistent. This classification addresses people who experience an exacerbation more than twice a week, but less than daily. So, perhaps this person feels "tightness of the chest" or wheezing from time to time in the course of a week. The nighttime symptoms also occur more than twice monthly. Their FEV is around 80% with a variance of 20 - 30% at onset.
  
  
• 3.)Moderate Persistent. This person has daily symptoms with nighttime symptoms occurring at least once weekly, and absolutely MUST use their "rescue" inhaler daily. This medication is classified as a Beta2 Agonist (i.e., Albuterol), and works immediately on the smooth muscle tissue of the airway to quickly allow for improved airflow. The FEV for this person is definitely ranges between 60% - 80%. 80% is being very optimistic.
  
  
• 4.)Severe Persistent. This person has very little daily activity. Symptoms occur early and a strong medication regimen is required. There are very frequent nighttime symptoms and the FEV of this person is definitely going to remain below 60%.

Let's talk a little bit about these classifications. If you should find yourself between two different classifications, then you should defer to the strongest of the two. For example, during the day, you rarely ever have any symptoms, yet you have problems sleeping at night due to symptoms more than twice a month, you should consider your symptoms as Mild Persistent instead of Mild Intermittent. Once you visit a Pulmonary Specialist, and receive your Asthma Action Plan, you should definitely stick to that plan, as if your life depends on it. After all, it's true. Your life really does depend on your diligence and commitment to this plan. I won't fill this blog with a lot of technical jargon and spirometric values, that will only cause confusion. I will however, strongly urge you to talk openly and specifically to your physician about onset and frequency of symptoms.

Keep in mind, AGE IS NOT A FACTOR for new diagnosis of Asthma. As a matter of fact, there was a time, when we did not diagnose a child with Asthma until that child reached 2 years old. Thank God things have changed and advances in health care have provided for much stronger diagnostic tools and skill sets. On the flip-side of the age chart, don't feel that if you're well over 35 years old, you cannot be diagnosed with new onset Asthma. It's quite possible.

Here are a few statistics for you:

• Prevalence: 20.5 Million Americans are diagnosed with Asthma. 6.2 Million of these 20.5 Million, are children.
• Morbitity (effect of illness): Patients experience a combined 100 Million days of limited activity. There are 485 Thousand hospitalizations annually, with 1.9 Million Emergency Room visits per year.
• Mortality: 4,200 deaths are reported annually.

Please understand, this data is available because of recorded reports. The number of people who are not addressing the seriousness of this Airway Disease, remain unknown. I guess we'll continue to count on the mortality rates.

Hold on to your hats, there's much more to come!!!

Ongoing Efforts in Managing Diabetes

Be sure to speak to your doctor openly and honestly about your dietary, exercise and "recreational" practices and habits. It will make a huge difference in how your approach to feeling better works for you. Proper diagnosis and treatment is key to improvement. Over time, it is natural for our bodies to develop into a process called insulin resistance. This occurs over cell development and emergence of systematic changes in our bodies' cellular demands. Excess insulin resistance causes diabetic incidences.



Search the web to find aerobic exercise that works best for you. What your friend or sibling does for exercise, might not be best for your body. Go with what feels comfortable and doesn't cause excessive pain. Never believe pain is a good thing. Pain is an indicator that your body isn't digging what's happening and PLEASE STOP DOING IT. Short lived (less than 48 hours) of muscle pain isn't a bad thing, but when you're experiencing full muscle strains and sprains, it's NOT acceptable. If you find yourself short of breath, stop and take a rest. If you have to take frequent rest periods when getting started, that's fine. Give your body the opportunity to adjust to this new activity you're sending it through. Do not take pain prescription pain medications which were not prescribed to you by YOUR physician. Your neighbor, your sibling, your cousin, your parents all have their own thing to deal with. Think of it as sharing underwear, WE JUST DON'T DO THAT!

Gestational Diabetes

Gestational Diabetes Many are aware of health hazards and risks while pregnant. One additional hazard, which is frequently overlooked, is the development of diabetes while pregnant. The woman’s body is experiencing numerous hormonal changes and extremes at this moment. Diet becomes essential not only for nutritional value, but for your complete health. As I mentioned before, the hormone regulation and protein system of transport that occurs when the body is breaking down sugars, requires a well-functioning organic system. We compromise our body’s organizational plan, when our hormones and diet are off balance.

Typically, when we hear about a friend or family member developing Gestational Diabetes, the condition is present until after the child is born. However, we have to consider the potential permanent risks to both mother and infant, if Gestational Diabetes goes undetected and unmanaged. Symptoms are typically mild, and can be easily overlooked. Increased thirst, fatigue, vaginal infections, frequent urination, & skin irritation are symptoms which are frequently overlooked simply because they can occur with pregnancy anyway. This is why we absolutely MUST keep up with our prenatal visits. Even though Gestational Diabetes specifically occurs during pregnancy, your risk of developing Type 2 Diabetes is increased. Be sure to adhere to your physician’s advice regarding diet, exercise, and possibly medication regimine. Keep in mind, the particular risks to your unborn infant.

Tests done during pregnancy help determine specific dietary needs, detect possibility of birth difficulties, and these tests can help detect specific delivery risks and expectations. Prenatal care is paramount to ensuring the safest delivery possible. I’ve heard women say, “I don’t know why they have to keep drawing blood from me, every time I go to the doctor”. Well, your body is undergoing constant change with each stage of your pregnancy. There is no need to take additional risks, pregnancy is taxing enough on the body, without the help of additional co-morbidities. We will talk more about Pregnancy and Prenatal care in a later blog.

Here is an insert from the Mayo Clinic:



Causes

By Mayo Clinic Staff

Researchers don't yet know exactly why some women develop gestational diabetes. To understand how gestational diabetes occurs, it can help to understand how pregnancy affects your body's normal processing of glucose. Your body digests the food you eat to produce sugar (glucose) that enters your bloodstream. In response, your pancreas — a large gland behind your stomach — produces insulin. Insulin is a hormone that helps glucose move from your bloodstream into your body's cells, where it's used as energy. During pregnancy, the placenta that connects your growing baby to your blood supply produces high levels of various other hormones. Almost all of them impair the action of insulin in your cells, raising your blood sugar. Modest elevation of blood sugar after meals is normal during pregnancy. As your baby grows, the placenta produces more and more insulin-blocking hormones. In gestational diabetes, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of your baby. Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but usually not until later.

Risk factors

By Mayo Clinic Staff

Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

• • Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
• • Family or personal health history. Your risk of developing gestational diabetes increases if you have pre-diabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also more likely to develop gestational diabetes if you had it during a previous pregnancy, if you delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if you had an unexplained stillbirth.
• • Excess weight. You're more likely to develop gestational diabetes if you're significantly overweight with a body mass index (BMI) of 30 or higher.
• • Nonwhite race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications

By Mayo Clinic Staff

Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for you and your baby, including an increased likelihood of needing delivery by C-section.

Complications that may affect your baby: If you have gestational diabetes, your baby may be at increased risk of:

• • Excessive birth weight. Extra glucose in your bloodstream crosses the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.
• • Early (preterm) birth and respiratory distress syndrome. A mother's high blood sugar may increase her risk of going into labor early and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is growing so large. Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they're not born early.
• • Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
• • Jaundice. This yellowish discoloration of the skin and the whites of the eyes may occur if a baby's liver isn't mature enough to break down a substance called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Although jaundice usually isn't a cause for concern, careful monitoring is important.
• • Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.

Untreated gestational diabetes can result in a baby's death either before or shortly after birth.

Complications that may affect you

Gestational diabetes may also increase the mother's risk of:

• • High blood pressure, preeclampsia and eclampsia. Gestational diabetes increases your risk of developing high blood pressure during your pregnancy. It also raises your risk of preeclampsia and eclampsia — two serious complications of pregnancy that cause high blood pressure and other symptoms that can threaten the lives of both mother and baby.
• • Future diabetes. If you have gestational diabetes, it's more likely to happen again during a future pregnancy. You're also more likely to develop type 2 diabetes as you get older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes. Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than one in four develop type 2 diabetes.

I hope the information provided here proves to be very helpful. Whether you are expecting a child now or plan to in the future, be sure to consider all associated health risks. Diabetes is very prevalent in our “minority” communities. Join the fight against Diabetes by arming yourself with understanding, management, and prevention!

Diabetes, from new diagnosis to management.

First, I'll define the difference between Type 1 and Type 2 Diabetes:
Type 1: Only about 15% of Diabetics are considered Type 1 Diabetes. With Type 1 Diabetes, the patient has trouble producing insulin. The purpose of insulin is to facilitate the absorption of glucose in our blood, to be metabolized and assigned various duties throughout our bodies on a cellular level. Short of providing a biology class, we'll focus on one branch of our topics at a time. Where is insulin produced? Well our pancreas produces our insulin. Now I see your cogwheels turning, be patient, we'll get there soon. The average patient who has Type 1 diabetes is someone who has to take insulin regularly to stay alive.

Type 2: With Type 2 insulin, our bodies do not properly respond to insulin, leading the pancreas to believe not enough insulin is being produce, and ultimately causing the pancreas to overproduce.

Let's take a basic glimpse of the path of glucose. Glucose enters the body, knowing our cells love it so much. The thing is, it can't get into our cells by itself, it needs a transport mechanism, a catalyst. Well, proteins are catalysts. Hormones are proteins. Insulin is a hormone. The pancreas recognizes the glucose, sends the insulin out to give it a shove into our cellular triphospholipid bi-layers (I couldn't help myself, I just had to say it), at which time cellular respiration occurs metabolizing the glucose to become glycogen for our liver and skeletal muscles and triglycerides for our fatty cells. Now, we come to the topic of dieting.

We've all heard about sugars stored around our tummy fat. Well, there are truths hidden inside popular myths. This happens like the whisper game in a circle. By the time the original (or factual) statement reaches the first person, the statement is completely distorted. Happens with gossip too, actually, lol. So anyway, this is the thing. The fat in the tummy doesn't cause Diabetes, the fat is the result of non-metabolized triglycerides which just sit there and pile up and pile up and pile up and pile up, because our bodies have been tricked to believe we don't need to produce insulin. How did we trick out bodies? Well, we consumed things, that contains chemical agents which act as the catalyst to send those sugars into cellular metabolism. In doing this, the pancreas says, "hmmm, I don't have produce any insulin to transport glucose, so I'll just relax for a while". The body goes, "Wow, my cells are getting a ton of sugar, pretty soon I won't be able to keep up". Eventually, the pancreas begin to fail at producing insulin very much at all.

We absolutely MUST think about our consumption of processed foods, food and beverages containing "enhanced" sugars, and definitely eat and drink in moderation. Quality wins over Quantity hands down, in all areas of life. Eat as many fresh fruits and vegetables as possible daily. Eat grains in moderation. Drink plenty natural fluids and water. Teach your body, to respond naturally to what you ingest, as it was designed to.

Managing Diabetes doesn't have to be very difficult. Most people who have been diagnosed with diabetes, are aware of what's called the A1C. This number is different from the blood sugar number we take daily or in some cases, multiple times daily. This is assessed over a period of time, typically every 2- 3 months. Take the questions asked at your clinic visits for your check ups very seriously. The sooner we are aware of our complete health snapshot, the better we can do at managing our overall health. We all should do a fasting glucose level when we get our annual check ups. Cholesterol isn't the only reason why you cannot eat or drink anything the night before that clinic visit.

Non-compliant or confused???

"Do you understand what we just discussed about your discharge planning and documents/instructions provided"?