All posts by nurseinthefamily

How Sweet are You?

If you watch commercial television, chances are you’ve seen ads for diabetic medications. They are everywhere, and for good reason, there are more people than ever with diabetes. Part of this is due to the typical American diet and lack of exercise and part is due to our genetics. But the largest reason we have more diabetics now is that those suffering with the disease  are living longer. Just one hundred years ago, developing diabetes mellitus was a death sentence.

Although the first recorded evidence of a diabetic type disease was in the writings of an Egyptian physician from 1552 B.C., no real plan of treatment was established until 1916 by a Boston scientist named Elliot Joslin. Even then, the only treatment was a modification of diet and the promotion of exercise. It wasn’t until 1922 that insulin was being manufactured and given to patients suffering from diabetes. During this time over half of the babies carried by mothers with diabetes died either before or shortly after birth. The mothers themselves often died too due to complications from delivering very large babies. Today all pregnant women are screened for diabetes.

In 1983, the first biosynthetic insulin was produced. This drug, Humulin, is identical to human insulin and can be massed produced. Since then many new drugs have been developed that help insulin receptors be more efficient and that keep the liver from making and storing too much sugar. This offers today’s diabetics a range of options in treatment.

Who gets diabetes? If you have a relative with diabetes of any kind, you have an increased risk of developing the disease. African-Americans, Hispanics, and Native Americans also have a higher risk for diabetes. Even the area of the country you live in can increase your risk. The Southeastern Region of America, especially my home state, Mississippi, has more diabetics than any of the other areas. Again, this is thought to be a combination of genetics and traditional diets that are high in fats and carbs.

Just what is diabetes? Most people are familiar with Diabetes Mellitus type 1 and type 2, but now most health care practitioners use the terms insulin-dependent diabetes (IDDM) and non-insulin-dependent-diabetes (NIDDM). Both types of the disease means that sugar that we eat in the form of carbohydrates is traveling around in our blood in high levels damaging our tissues. Eyes with their delicate vessels, the brain, the kidneys, and the heart are extremely sensitive to high levels of sugar in the blood.  The most common side effects of diabetes is blindness, heart attacks, strokes, and loss of kidney function. Another problem that diabetics have is with infections. We all know that if you set out a bowl of sugar-water, bugs will flock to it. In a matter of minutes you’ll have ants, flies, and wasps swarming around the sugar-water. High sugar content in our blood is just the same, it attracts all manner of “bugs” as well. These tiny organisms flock to the sugary blood to feed, to grow, and to multiply. Soon you have an infection growing and festering. This often leads to amputation of toes, feet, even legs.

How does diabetes work?  There are two reasons that a person is diabetic, either they are not producing insulin or the insulin receptor cells in their tissues are not working properly. Think of insulin as the big 18-wheeled trucks that deliver sugar to every cell in the body. Insulin then “parks” in an insulin receptor and deposits its sugar into the cell. Let’s think of the insulin receptors as “garages”. If your pancreas is not making enough insulin, then there are no “trucks” to carry the sugar out of the blood and into the “garages”. This is IDDM or what used to be called type 1 diabetes. People with this type of disease require injections of insulin to carry the sugar into the receptors thereby reducing the level of sugar in the blood to normal. The other type of diabetes is when the body produces insulin but the receptors or “garages” are closed. Once again, too much sugar remains in the blood.

Insulin-dependent diabetes mellitus (IDDM) is often diagnosed during childhood, but can develop in later life too. The exact cause of this disease is not known, but many people with IDDM, have what is known as the 64Kautoanibody. This antibody is a protein that is involved in the cellular communication between the brain and the pancreas. The body’s immune system attacks this protein and interferes with the brain telling the pancreas to make insulin which progresses to diabetes mellitus. The first signs and symptoms of this disease are often unusual thirst, frequent peeing, weight loss without trying, and vision changes.

A new patient with diabetes usually comes to the healthcare provider complaining that he is up at all hours of the night wanting water and going to the bathroom, and despite eating a well-nourished diet, he is constantly losing weight. This patient will often appear almost gaunt with skinny legs and arms. A test to measure the amount of sugar in the blood will reveal a very high content. Prompt regulation of diet and insulin administration can help this person minimize damage to organs and lead a nearly normal life. The hardest part of caring for a diabetic is getting the patient to understand that this is a disease that they will have forever, barring a cure. They will have to be a careful manager of their health from day-to-day. They will need to eat a moderated diet, exercise, and test their blood sugar everyday in order to know the amount of insulin to inject. These injections may be done by using a syringe or by use of an insulin pump. Whatever method is used the goal is to keep blood sugar within normal levels to spare damage caused to organs.

In the second type of diabetes the body is producing insulin into the bloodstream, but the insulin receptors, the garages, will not open for the insulin trucks to pull into and deposit their sugar. In non-insulin-dependent diabetes, (NIDDM) for some reason, the receptors are malfunctioning and will not accept the sugar laden insulin. The effect is the same as other diabetes, too much sugar is in the blood. Although no one knows exactly why this change occurs, there does seem to be a genetic factor present. This means that if someone in your family has diabetes you may have inherited the risk to develop the disease. Recent research suggests that obesity, a carb diet, and not enough exercise will often trigger the disease. Even if you don’t know of any family member with diabetes, you may still have the gene, so the best advice is to keep in shape and eat a healthy diet to avoid ttiggering this disease.

Other types of diabetes are gestational diabetes and trauma related diabetes. Gestational diabetes only happens to pregnant women. Although the exact workings are not completely known, it is thought that immune changes in a pregnant woman’s body somehow trigger gestational diabetes. A woman with this condition needs careful monitoring by her physician to avoid having a her baby die before birth, and may require an early delivery to keep from having a very, very large baby. A newborn from a gestational diabetic mother also needs constant monitoring during the first few days of life with frequent blood sugar tests to avoid a serious drop in its blood sugar level that can result in death. A woman with gestational diabetes has a significant increase in her risk of developing diabetes later in life and needs to be aware of common signs and symptoms.

Trauma related diabetes is just now being recognized and researched. As a result of the thousands of blunt force trauma injuries in the wars in Iraq and Afghanistan, it has been noted by the veteran’s medical system that many individuals who received injuries in the area of the pancreas are developing diabetes. Overall, veterans have more diagnosed diabetes than the rest of the population. Causes for this are thought to be better screenings due to all veterans having access to medical care, more minorities in the military, and lower-incomes resulting in a poor diet.

Despite the cause or type of diabetes mellitus, one thing is for certain, a constant vigilance is required to keep blood sugar levels as normal as possible for people with this disease to lead healthy, long lives. When a diabetic gets common colds or stomach viruses, a doctor should be consulted to avoid complications. If you or a family member has signs and symptoms of diabetes, see your physician immediately and for more information go to diabetes.org, the official site of the American Diabetes Association.

Why are We All So Fat?

Almost everyone reading this blog, needs to lose ten, twenty, even fifty pounds. Why are we all so fat? Well, the most common reasons given to us by the medical community are not enough exercise and a high fat, high carb diet. Those are great plausible reasons, but are they the only ones?

New scientific evidence now points to two other cause of excess weight.  Chronic Constipation and Dehydration.

We’ll deal with Constipation first. I made an informal survey of friends and family and the ones in their advised weight range had a normal bowel movement nearly everyday. What is a normal bowel movement? Most of us don’t know the answer to that question. BM’s are a taboo subject to normal conversations, but not to nurses, we are always asking about bowel movements. Did you have one? What color and consistency was it? Nurses are nosy like that, because we know that bowel movements can give us a significant amount of information about your overall health. Aren’t you glad you now have a nurseinthefamily?

Normal BM’s vary from person to person, having a bowel movement up to three times a day is normal, as is having only three BM’s a week. It’s all about what is your normal. If you have had two bowel movements a day, every three days for as long as you can remember, that’s your norm.  Nurses worry when your normal changes.

What do your bowel movement look like? If it’s thin and watery and happens more than three times a day, you may have chronic diarrhea. If you are having to trouble going and are passing hard, small pellets, you may have chronic constipation. Very thin, pencil sized stools can sometimes indicate serious disorders of the intestines including cancers, so see your health care practitioner pronto if you have these or any aforementioned problems.

The color of your stool is also important. Dark, black-colored stools can be a sign of an upper GI bleed, but can also occur if you are taking supplements with iron or if you have taken that one of those over-the-counter upset stomach remedies containing bismuth subsalicylate. A very light colored or yellow stool that is greasy and often foul smelling and floats in the toilet is called stetorrhea. Stetorrhea is often caused by a very high fat meal, or if it persists, can indicate gall bladder or pancreatic problems. Celiac disease, a severe sensitivity to gluten, can also cause stetorrhea. If you see blood either in your stool or on the tissue, you may have hemorrhoids or another more serious condition. With all of this said, your diet highly influences the color of your stool. Beets, tomatoes, cranberries, anything red, can look like blood in the stool. Dark green leafy vegetables and anything artificially colored purple will often result in a green stool. So if you had a spinach salad with cherry tomatoes for lunch and then had a grape drink with the kids, your stool may look like Christmas. Think about your diet, and if any of these unusual BM’s continue for two weeks or more see your doctor.  The exception is seeing real blood or pus in your stool or on the tissue. If those things occur, especially if you are having belly pain or rectal pain, see your doc immediately.

So now that we know what a normal bowel movement should not look like, what should it look like? A normal BM should look like a banana or may be even longer. It should be firm but soft and easy to pass and should be a medium brown.

Okay you say, “I think I am constipated.” What do I do? The easiest fix is to add at least 25 grams if you are a woman, or 38 grams if you are a man, of fiber to your diet daily. The average American only eats about 15 grams of fiber a day, so no wonder we are fat and constipated.

Plant foods, fresh or frozen, are loaded with fiber as are whole grains.  Dry beans, lentils, and peas are also high in fiber. Replacing refined grains, such as white pasta, rice, and flour with whole grain options can make a huge difference. And add those fruits and veggies to your diet. That old adage, an apple a day keeps the doctor away, is true in this case, apples are full of fiber, especially if you eat the skin.

I’m a nurse and know all of this and it’s still hard for me to get enough fiber everyday. My solution is a dietary supplement. I have hereditary high cholesterol, so to add fiber and to help reduce my cholesterol level I take a 100% psyllium seed husk bulk forming fiber laxative/dietary supplement everyday. I prefer the smooth texture, orange flavored products. Another choice that doctors often recommend is polyethylene glycol. Take either one in an 8 ounce glass of water or juice.

Now don’t be put off by the word laxative, neither of these are in the class of laxatives that you can become dependent on.  Those dangerous laxatives are usually saline based.  Ask your pharmacist to show you the selection of safe, non-habit forming constipation preventives available in your area and use as directed. And drink water, water, water everyday.

That brings use to our second topic, Dehydration. Dehydration is defined as when water loss exceeds water intake and the amount varies from person to person due to body size and activity levels. We lose a large amount of water just breathing every day, add that to physical exertion, hot flashes, or just sweating because we are in a warm environment and you can see why we need to be concerned by our water intake each day. Human bodies are about 75% water, so even a small percentage of dehydration, a five to eight percent, can cause fatigue, irritability, headache, and even dizziness. A ten to fifteen percent loss can cause mental and physical deterioration such as muscle spasms, dimmed vision, reduced or painful urination and even delirium. Above a fifteen percent loss can often result in death.

Americans, with our busy schedules, tend not to drink nearly enough water each day, leaving us in the five percent dehydration range. I know, if we drink we have to pee, and that can be inconvenient to our work day. But peeing like BM’s, can tell you about your health. Your urine should be a very light yellow to clear color and unclouded. If your pee is yellow or amber, drink more fluids and see if it clears up. If it burns to pee, or if it’s persistently dark, or if you see blood in your urine, see your doctor immediately.

If you feel thirst, you are already  dehydrated. Dehydration also causes you to feel hungry, when really you are thirsty, thereby causing snacking between meals and weight gain. Other side effects of dehydration are increased cholesterol levels, dry, itchy skin that looks older than you really are, increases in any allergy or asthma attacks, increased blood pressure, kidney dysfunction, joint stiffness, and our other topic – Constipation.

A large part of nursing is educating. I hope I have educated you to increase your exercise, add fiber and reduced processed foods and fats from your diet, and drink at least 2 liters or 9 cups for women, or 3 liters or 13 cups a day for men, of water a day. Make water your primary beverage, with only and occasional soft drink, tea, coffee, or adult beverage.

Good health to you and return often for more pertinent topics on the care and feeding of the human body from a nurseinthefamily.