Health Archives - Page 4 of 11 - Diabetes Counselling Online

Diabetes and Hearing Loss

December 23, 2014 by Imagine_David Leave a Comment

**Some evidence shows people living with diabetes are at an increased risk of some level of hearing loss**

As people living with diabetes are at a greater risk of developing hearing loss, audiological tests to monitor auditory (hearing) function should be introduced into comprehensive packages of care provided by diabetes services.

The American Diabetes Association report, ‘Standards of medical care in diabetes – 2014’ recommends that hearing impairment be assessed and addressed as one of the common comorbid conditions that may complicate the management of diabetes.

The Australian RCGP Microvascular disease risks does not includehearing loss as a risk

Renal (kidney) impairment and CKD
Neuropathy (nerve damage)– peripheral, autonomic
Retinopathy (damage to the eye) more HEAR

Further research and evidence-based outcomes may support the introduction of indicators to identify hearing difficulties in the diabetes population. More HEAR

In one research paper, sensorineural hearing loss was more common in people living with diabetes than in the control nondiabetic patients, and severity of hearing loss seemed to correlate with progression of disease as reflected in serum creatinine. This may have been due to microangiopathic (small blood vessel) disease in the inner ear.

A review of the literature by these authors, and their study, suggests a moderate link between poor blood glucose control and progression of hearing loss.

Because audiologic data from patients with diabetes not experiencing hearing loss was not available, the exact impact of diabetes on hearing loss is still not clear.

However, this study does demonstrate that data mining can be used to identify poorly defined disease relationships and suggests that screening all patients with diabetes for hearing loss in a prospective manner may be useful for a clearer understanding of this disease process. More HEAR

Don't wait for your wheels to fall off..... talk to your doctor about having your hearing tested — ***Don’t wait for your wheels to fall off….. talk to your doctor about having your hearing tested***

The American Speech Language and Hearing Association comments that “building epidemiological evidence depends on a robust definition of a condition, so that results can be compared across studies.

For hearing impairment, however, no definitive definition has been established. Recently, using audiometric data from the National Health and Nutrition Examination Study, investigators evaluated hearing impairment using high-frequency (3000-, 4000-, 6000-, and 8000-Hz) as well as low- or middle-frequency (500-, 1000-, and 2000-Hz) averages, at two levels of severity (>25 and >40 dB HL), in both the worse and better ear (Bainbridge, Hoffman, & Cowie, 2008).

The results demonstrated that the prevalence of hearing impairment depends on how the condition is defined, but a greater prevalence of hearing impairment was observed among adults with diagnosed diabetes than without, regardless of the definition used”

**Talk to your doctor about having your hearing tested**

The data also suggest that people living with diabetes may experience hearing loss at earlier ages.

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Navigating the Australian Health System

December 18, 2014 by Imagine_David Leave a Comment

Health care in Australia is divided between Federal and State responsibility.

To make the most of the system it is wise to understand how to navigate these systems, so you can get the best ‘value’ to enable your diabetes self care plan to be most efficiently and affordably implemented.

The International Diabetes Foundation recognises that “People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition.This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change.”

All too often people living with diabetes do not get the opportunity to have the specialist input from a diabetes educator or dietitian.

To make your diabetes self care plan most effective it is in your best interest to have an appropriate level of diabetes self management education.

A diabetes educator provides diabetes self-management education for people with diabetes. They play a major role in self-empowering the person with diabetes by focusing on an individual’s needs, providing knowledge, motivation and support to aid the prevention of diabetes related health complications.

Diabetes Educators have many years experience (some living with diabetes themselves) and can provide you with tailored education, upon the following:

Self blood glucose monitoring.
Oral hypoglycaemic agents.
Insulin initiation and titration.
Sick day guidelines.
Hypoglycaemia recognition and management.
Complication risk management.

Accredited Practising Dietitians can, in addition, provide you with a nutritional assessment and advice tailored to your individual needs, in addition to education upon the following:

Influence of nutrition on blood glucose control.
Carbohydrate counting and information.
Weight management.
Blood lipid management.
Related health issues.
Complication management.
Hypoglycaemia recognition and management.

State Health Systems:

State health systems often provide services such a diabetes self management education courses at community health centres or in public hospitals.

These courses may be a combination of individual and group self management education sessions, usually run by a diabetes educator and a dietitian. These diabetes self management programs are usually free.

Whatever type of diabetes you have been diagnosed with, this is a good place to start.

To find out more about what is available in your area make contact with your local hospital or community health service.

005 — **Navigating the System to Better Health**

Another way to find your local diabetes self management programs is via Diabetes Australia or ADEA.

What’s Next

By initially connecting with these state funded health care professionals, you can then navigate the Medicare system with your GP to connect in an affordable manner with other members of your health care team. e.g. podiatrist, exercise physiologist, psychologist/counsellor etc (ALL of whom are covered by the Medicare system).

Medicare – Federal Government Funding

Talk with your GP about the Medicare system, whats available to people with chronic health issues like diabetes.

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

In summary:

Maximum of five (5) services per patient each calendar year
Medicare rebate of $48.95 per service, with out-of-pocket costs counting towards the extended Medicare safety net
Patient must have an Enhanced Primary Care (EPC) plan prepared by their GP (your GP is paid to produce this for you)
GP refers to allied health professional (referral NOT required if that health care professionals happens to be available for free in the State health care system)
Allied health professional must report back to the referring GP

CAUTION: In creating the Chronic Disease Management Plan ensure YOU and your GP knows who is available in the State health system for you to enable the best use of this plan.

Team Care Arrangements (item 723)

Provides a rebate for a GP to coordinate the preparation of TCAs for a patient who has a chronic or terminal medical condition and also requires ongoing care from a multidisciplinary team of at least three health or care providers.
In most cases the patient will already have a GPMP in place (but this is not mandatory).
The minimum claiming period is once every twelve months, supported by regular review services.
Involves the GP collaborating with the other participating providers on required treatment/services, agreeing to arrangements with the patient, documenting the arrangements and a review date in the patient’s TCAs, and providing copies of the relevant document to the collaborating providers.

**With good self care knowledge everything is possible.**

A Diabetes Self-Management Plan Review form can be downloaded here Diabetes. This document shows a guide to the goals made in collaboration between the doctor and the person living with diabetes.

CAUTION: If you have more than one of these in place, e.g 2 different doctors making 2 different plans for you, your health care provider may end up out of pocket and may charge you the full fee for service – with no rebate owing to you.

Any questions? Please ask, even the smallest of questions.

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

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Sleep & Diabetes

December 17, 2014 by Imagine_David Leave a Comment

“I slept so badly last night; I simply have no energy to exercise.” — **“I slept so badly last night; I simply have no energy to function.”**

How are you sleeping at night? All too often, the answer is the same: not well.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss, and there’s evidence that not sleeping well can increase the risk of developing diabetes.

Symptoms

Symptoms associated with insufficient sleep include feeling tired, irritability, slurred speech, blurred vision, memory loss, inability to concentrate, episodes of confusion, hallucinations, nausea, impotence and reduced sexual drive. Extreme sleep deprivation can cause psychosis and death. However, there are no documented cases of a healthy human dying from sleep deprivation (although mortality from accidents does occur). Before death occurs in healthy, sleep-deprived humans, the brain forces itself to have ‘micro-sleeps’.

Evidence

In the past decade, there has been growing evidence that too little sleep can affect hormones and metabolism in ways that promote diabetes.

Current data suggests that the relationship between sleep restriction, weight gain and diabetes risk may involve at least three pathways: 1. alterations in glucose metabolism; 2. upregulation of appetite; 3. decreased energy expenditure. from The Metabolic Consequences of Sleep Deprivation

A 1999 Lancet study at the University of Chicago – the researchers monitored the blood glucose levels of 11 healthy young men who were allowed only four hours of sleep per night — from 1 a.m. to 5 a.m. — for six nights.

That study showed that after only a week of short bedtimes, their glucose tolerance was impaired. There could be dramatic effects even after only a week.

After 6 nights of little sleep, the men had higher-than-normal blood glucose levels. (The levels were not high enough to be diagnosed as diabetes, however). The effects went away once the men were back on their normal sleep schedule.

Experts also believe that chronic sleep deprivation may lead to elevated levels of the stress hormone, cortisol. Elevated cortisol may in turn promote insulin resistance, in which the body can’t use the hormone insulin properly to help move glucose into cells for energy.

Low Sleep = High Blood Sugar?

High blood glucose level is a red flag for sleep problems among people with diabetes.

Diabetes and sleep problems often go hand in hand. Diabetes can cause sleep loss.

If the blood glucose level is high the kidneys want to pass this excess glucose out in the urine. Getting up to pee in the middle of the night disturbs the sleep.

People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Eating well throughout the day – having a safe and effective diabetes self care plan – to have your blood glucose level on target may have you be able to sleep better at night.

Low Sleep = Low Blood Sugar?

Conversely, having a hypo during the night is likely to wake you and destabilise your sleep.

A wise action to take would be to measure your blood glucose level occasionally at 2-3 am in order to exclude overnight hypoglycaemia.

The Link Between Lack of Sleep and Weight

Some studies show that people who get less sleep tend to be heavier than those who sleep well. People who are tired will eat more because they want to get energy from somewhere. That may mean over-eating during the day > higher blood glucose level at night> getting up to pee>poor sleep etc etc.

Sleep loss could also affect energy expenditure via its impact on the levels of leptin and ghrelin. Since several human studies have demonstrated reduced levels of leptin after sleep loss, it is possible that the reduction in leptin is associated with a reduction in energy expenditure. Similarly, the increase in ghrelin after partial sleep restriction could be associated with a decrease in NEAT (Non-exercise activity thermogenesis). *Experimental evidence is currently lacking to support either hypothesis*

Sleep Apnea?

There is also a link between diabetes and sleep apnea, a sleep disorder marked by loud snoring and pauses in breathing while you sleep. The culprit may be excess weight, which can cause fat deposits around the upper airway that obstruct breathing. So being overweight or obese is a risk factor for sleep apnea as well as diabetes.

If you have diabetes, are overweight, and snore, tell your doctor. You may need a sleep study.

Sleep apnea can prevent a person from getting a good night sleep, which can worsen diabetes. In sleep studies, you are monitored while you sleep for sleep disorders such sleep apnea.

There are many effective treatments for sleep apnea. These include lifestyle changes such as weight loss for mild cases and devices to open up blocked airways for more significant cases.

Sleep: How Important?

In general, people living with diabetes have to be very careful about sleep. Anything that throws off your routine can make you feel a lack of energy and fatigue. The more fatigued you feel, the more your motor is running, and the more likely you are to develop insulin deficiencies.

How Much Sleep?

On average, we need 7.5 hours per night, but your sleep requirement is genetically determined and varies.

It can be about four hours on the short end to 10 or 11 on the long end.

Want to know if you are sleep-deprived? The answer is simple…..If you use an alarm clock, you are. If you were getting adequate sleep, your brain would awaken you before the alarm goes off.

HELP

Improve your sleep habits: SNORE Australia

MJA (Medical Journal of Australia) Sleep Disorder Supplement

Australasian Sleep Association

So, turn off your electronic device…. and go get some sleep!

Kind Regards,

David,

Diabetes Educator @ Diabetes Counselling Online

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Christmas kindness and mindfulness

December 15, 2014 by Sally Leave a Comment

Christmas can be a tricky time for people with diabetes. As the dietitian for Diabetes Counselling Online I’d like to remind you all to be kind to yourself over the Christmas period and remember that diabetes is not a game of perfect – it’s what you do most of the time that makes the difference, especially as we’re doing it for the rest of our lives. In today’s blog I’d like to share some ideas by other dietitians and offer a few tips that will hopefully help you to be mindful of your wellbeing this Christmas/New Year period.

As we all have different types of diabetes, using different or no medications, and with so many variations in our day to day lives, I encourage you to check with your health professional before making any changes to your usual routine. These tips are meant as a guideline, so please use good sense in applying them.

Let’s start with a couple of previous Diabetes Counselling Online blogs I’ve written on food for Christmas.

A fresh look at the Christmas meal reminds us that we can choose to provide foods that although Christmassy, do not need to be laden with fat, salt and sugar.

Colours of Christmas – enjoying the festive foods with no regrets helps us to understand about shopping for Christmas treats, and a whole lot more including these great Christmassy food comparisons that help make your choices more mindful.

Did you know that:

A cupful of halved fresh apricots (155g) has only 10g carb (half a serve) and 265kJ/64 calories.
A cupful of cherries without seeds (145g) has 15.8g carb (one serve) and 363kJ/87 calories.
A cupful of strawberries with no stems (150g) has only 6g carb (possibly not worth counting!) and 162kJ/39 calories.
A scoop of low-fat vanilla icecream (50g) has 11.4g of low-GI carb and 258kJ/62 calories.

Compared with:

1 small slice of a Christmas fruit pudding (50g) has 30.4g carb (2 serves) and 785jK/188 calories (plus loads of saturated fat and sodium)
1 small fruit mince pie (40g) has 26.8g carb (2 serves) and 802kJ/192 calories (plus loads of fat and sodium too)

Dietitian Christmas articles

Speaking of being mindful, these next few blogs are written by Accredited Practising Dietitians (APDs) that focus on choices (not diabetes choices, but healthier choices) and there are some great tips in them that I’d like to share with you.

First up, I love these mantras by APD Deb Blakley from this article in The Scoop on Nutrition. Deb reminds us that we should enjoy ourselves at Christmas. Deb says it’s all about good food and good company. Her mantras are very sensible to ensure that we remain kind to ourselves and to others.

The Australian Healthy Food Guide magazine has also shared a few Christmassy articles to help us to maintain our health while we enjoy the Christmas celebrations. This one by APD Caitlin Reid provides 21 tips to stay healthy over the festive season. That’s a lot of tips! Have a read as even if only one or two mean something to you, then you’ll be in a better place.

This one by APD Zoe Wilson is entitled ‘Surviving the Silly Season’. In it Zoe offers 3 quick tips to help you make it through to the New Year without regrets.

And the last of the Australian Healthy Food Guide blogs is by APD Brooke Longfield who talks about managing alcoholic intake which we know adds empty calories as well as disrupting our diabetes management. Brooke has some very helpful ideas here.

Last but not least is a blog by APD Megan McClintock. I have to say this is my favourite one because its focus is on kindness and mindfulness which is something that can be so powerful when we’re managing a chronic health condition such as diabetes. Megan shows us which questions we should be asking ourselves and reminds us that there’s no point feeling guilt or being negative with our thoughts about food. She also provides 6 very practical tips to help.

Wow! That was a BIG read. I hope you found some tips in there that mean something to you and will help you to be kind to yourself and others. In summary it’s about choosing what you have at home and enjoying it mindfully without beating yourself up, and balancing your extra food enjoyment at Christmas with plenty of activity which has benefits of it’s own. Our main focus should be being kind to ourselves and others, enjoying the social aspects of being with family and friends and using any time off to recharge our batteries for a good start to the new year.

Wishing you and your families a wonderfully happy Christmas filled with love and laughter. Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

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Blood Glucose Level in Hospital

December 11, 2014 by Imagine_David Leave a Comment

Teamwork ....will get you everywhere ... especially home sooner from hospital

Australian Diabetes Society (ADS) produced the document ‘Guidelines for Routine Glucose Control in Hospital 2012‘

**In hospital different situations require specialist guidance**

The aim of this document is to provide guidance for the management of hyperglycaemia in a range of hospital situations.

As a people living with diabetes you an use this guide to ask about your care when admitted to hospital, or as a part of your sick day management plan (in the event of an urgent hospital admission).

The ADS has focused on the management of hyperglycaemia in people with myocardial infarction and stroke, on general hospital wards, and other matters they may be admitted to hospital with.

The optimal means of achieving tight blood glucose management, the role of the specialist inpatient diabetes team, inpatient management of insulin pump therapy, and general measures for diabetes management have also been examined.

The document also provides guidance for the follow‐up of people who have been newly discovered hyperglycaemia.

The recommendations were based on evidence obtained from systematic reviews where trials had been performed; otherwise they were made by consensus.

What Glucose Target Should be Aimed for in Acute Myocardial Infarction (heart attack)?

Studies indicate that persistent hyperglycaemia, even if mild, is also associated with increased mortality following myocardial infarction.