Avoiding hypoglycemia unawareness

Hi fellow bloggers,

Last week I shared with you a patient story about "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia. This week I'd like to share some risk factors and possible treatment strategies for such hypoglycemia unawareness.

Long-standing type 1 diabetes. Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who've had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.

Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.

Being an older adult and having type 2 diabetes. There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.

Strict avoidance of hypoglycemia. Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don't experience the warning symptoms include:

Aim for a higher blood glucose targetTry to more accurately count carbohydratesAvoid overcorrection or stacking of insulin dosesTest your blood glucose and adjust your insulin dose more frequentlyConsider blood glucose awareness training education programs to help you learn to identify new symptoms and improve recognitionConsider a personal continuous glucose monitor (CGM) that sounds an alarm when your glucose gets too lowConsider a service dog that can recognize low blood glucose

Glucagon for emergencies. Glucagon is the treatment of choice if someone with diabetes is unconscious or unable to swallow. The length of time a person is unconscious, is more of a concern than how low the blood glucose number is.

Ask your health care provider for a prescription for Glucagon or GlucaGen and for instructions on how to use it. Instruct your family members or friends on how to use this in an emergency and on how to access the emergency response team, such as calling "911."

Have you lost any awareness of symptoms of low blood glucose? How have you coped?

Regards, and have a good week.

Nancy

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Nature Valley Crunchy Granola Bars, Variety Pack of Cinnamon, Oats 'n Honey, and Peanut Butter, 12-Count Boxes (Pack of 6)

The Nature Valley Crunchy Granola Bars Variety Pack includes Cinnamon, Oats 'N Honey, and Peanut Butter, giving you lots of choices when you want to grab a quick, healthy snack. All three varieties of granola bar are made with whole grain rolled oats and full of classic crunch, making them a completely natural energy boost that contains no cholesterol or trans fat.

Variety Pack Crunchy Granola Bars Fresh air. Big sky. Open spaces. Whether you're on the slopes or on the links, the classic crunch of Nature Valley Crunch Granola Bars is a perfect way to fuel up naturally. Nature Valley Crunchy Granola Bars are 100% natural and an excellent source of whole grain. Delicious, wholesome and easy to bring along, they're the Energy Bar Nature Intended. ® Nature Valley's Commitment to the Great Outdoors Nature Valley has a commitment to helping make nature enjoyable and accessible while protecting and preserving nature in places like our national parks. Nature Valley sponsors a wide range of groups, all of whom have one thing in common: they all serve as guides and catalysts for people who want to enjoy a healthy, active, outdoor lifestyle. About Nature Valley When you need energy for your active lifestyle, turn to the original granola bar - Nature Valley. Since 1975, Nature Valley has used wholesome ingredients to make the best-tasting granola bars around, with new flavors and types for every taste. Check out all our products available at Amazon.com and enjoy the Taste Nature Intended®. Nature Valley Granola Bars give you the energy to get to and enjoy your favorite place in nature, your own personal Nature Valley.

Price: $30.24

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Cancer survivors can thrive on inner strength

What is resilience? For you as a cancer survivor, it might be defined as the ability to recover, the strength to move forward, and the awareness of the needs of your own body.

Resilience is a strength that comes from within and is self-motivating. Research has shown that cancer survivors, when questioned, many times identify their own inner strength as one of the primary sources of strength as they experience and recover from a cancer diagnosis and treatment.

Many of you can identify with this concept, although it may be hard to put into words at first. Here are a few thoughts to consider as you reflect on your own resilience:

How do you bounce back from difficult situations? What are your coping mechanisms?How do you gain strength and courage to move forward? What motivates you?Are you able to ask for help when you need it? What is your support system?What inspires you and makes you feel whole as a person?

I have met so many survivors who have this amazing ability to survive and thrive despite the physical and emotional stress of cancer. Please share your thoughts on this topic. I would love to hear your opinion on what you feel is resilience and how this inner strength has helped you in your experience.

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Silverbiotics (American Biotech Labs) Silver Biotics

Fiber one is a super food and is deliciously simple and easy to make.

Price:

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Nutri-Grain Cereal Bars, Strawberry, 8-Count Bars (Pack of 6)

Kellogg's Nutri-Grain Strawberry Cereal Bars
Low on calories, high on nutrition, Nutri-Grain Strawberry Cereal Bars get you on track with energy in a quick and easy package. Made with a soft, golden baked crust of wheat and whole grain oats and filled with real strawberry puree, Nutri-Grain Cereal Bars offer flavor everyone will love. Not only do Strawberry Nutri-Grain Bars taste great--they are packed nine essential vitamins, eight grams of whole grains, three grams of dietary fiber, and two grams of protein--in each bar. Whether you start your day with a Nutri-Grain Cereal Bar, add it to your child's lunch box as sweet nutritious treat, or enjoy it as a mid-day snack, Strawberry Nutri-Grain Bars offer more of what your body needs to live well and help you eat better all day.

A Healthy Way to Begin the Day
Starting the day with a balanced, great-tasting breakfast can put you on the fast track to good nutrition and better overall health. While many kids and adults forget this important first meal, research has shown that a nutritious breakfast at the beginning of the day can decrease the risk of obesity, heart disease, and other nutritionally related conditions in kids and adults. Kids who eat breakfast:

• Are more alert in school, with better concentration, memory and grades
• Get more fiber, calcium, vitamins A and C, riboflavin, zinc, and iron to help build stronger bodies
• Have more energy to pursue healthy and active lifestyles

Nutri-Grain Cereal Bars help busy families on the go satisfy the nutritional requirements of breakfast in a quick and easy format that can be eaten at the table--or--as life demands, on the road.

Snacks Matter

• Start Out on the Right Foot: Studies have shown that when you make the right snack choices at the beginning of the day, you are more likely to make good snack decisions the rest of the day. Eating a Nutri-Grain Bar as a mid-morning snack provides four-times more whole grains than traditional morning snacks.
• Take Control of Your Portions: Regular snacking helps prevent over-eating at mealtime and provides children with needed energy to keep their brains and bodies going throughout the day. In fact, up to 25 percent of the average American's calories come from snacking between meals. In order to eat snacks and treats in a healthful way, it is essential to pay attention to portion size. Individually wrapped Nutri-Grain Cereal Bars provide a nutritious snack that will also satisfy your sweet tooth in one 120-calorie serving. Easy to pop into a lunchbox, a backpack or purse, Nutri-Grain Cereal Bars provide a great option for nutritious eating on the go.
• A Snack Everyone Can Agree On: Arguing with kids over the snacks they take to school is second only to arguing over bedtimes. Parents push for nutritious snacks while kids want something sweet. Nutri-Grain Cereal Bars offer the nutrition parents require with the taste that children will love--thanks to the soft, golden crust and sweet, fruit filling.

Whole Grain Goodness
More people are becoming aware of the benefits of eating whole grains. Still, most people don't get enough whole grains and up to 80 percent of us are not consuming levels of whole grains recommended by the FDA. Each Nutri-Grain Cereal Bar contains half of a serving (eight grams) of the recommended three servings or more of whole grains people need each day--in a low-calorie and low fat package. Whole grains never tasted this good!

Eaten on the run, at the table, as a snack, breakfast, or treat--Nutri-Grain Cereal Bars are a fast and versatile way to ensure that you and your family get the daily nutrition you need.

About Kellogg
Kellogg Company is a leading producer of cereal and convenience foods--a company you can rely on for great-tasting, high quality foods. Kellogg was founded in 1906, in Battle Creek, Michigan. For more than 100 years, innovation and their commitment to being the best has guided the company. From being the first company to offer premiums in cereal boxes to being the first to fortify the cereals, Kellogg has historically been a leader in industry, innovation, and marketing.

The founder, W.K. Kellogg, had a strong commitment to nutrition, health, and quality. His vision continues to drive improvement in the products and processes, with the goal of providing great-tasting, nutritious products that meet the most rigorous quality standards.

With more than 100 ready-to-eat cereals around the world, consumers count on Kellogg for great-tasting, convenient, and affordable choices that meet their nutrition needs.

Price: $21.28

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Bring back the salad days

Salad is a great way to fill your plate and your body with nutritious but lower calories foods. Unfortunately, salad is only making it onto our plates 36 times a year. Yes, that's correct. Americans are making salads for less than 10 percent of meals — a decline of 20 percent in the past 15 years.

Could it be that when you think of salad you think of iceberg lettuce? I'll admit that doesn't necessary illicit excitement in me either.

Time to break the mold! Salads make a beautiful side dish or an entire meal. And the possibilities for flavor are plentiful.

Start with the base. Experiment with new lettuces and vegetables. Try one of the mixes that come right out of the bag or carton. Or mix a new variety into your usual greens. Here are a few suggestions:

Mild options: Boston and bibb lettuce and spinachMore pungent choices: Romaine and arugulaThe strong stuff: Chicory

Next top it off with a mixture of vegetable, fruit and protein for visual appeal, an abundance of nutrients and a satisfied stomach.

Sweet and chewy: Dried cranberries, cherries, apricots, dates, raisinsSweet and crunchy: Colorful bell peppers, sweet onions such as Vidalia or golden varieties, carrotsNaturally sweet: Cherries, raspberries, blackberries, blueberries, strawberries, mangosMild and crunchy: Apple, pear, zucchini, cucumberNutty: Walnuts, almonds, pecans, pistachios, sunflower seeds, soy nutsMellow and smooth: Tomatoes (try heirloom varieties), pears, grape tomatoesSharp or spicy: Hot peppers, red or purple onions, a few crumbles of blue cheese, extra sharp cheddarHearty: Meat, tofu, beans

Experiment with contrasting or complementary flavors. Combine a mild lettuce with toppings that are sweet, mild, nutty and sharp for a flavorful medley. Or combine a peppery lettuce with a few mild or mellow toppings and a sharp one to keep it interesting.

Bring back the salad! Let us know your favorite combinations.

Wishing you delicious & nutritious meals,

Katherine

blog index References The salad is in the bag. Wall Street Journal. http://online.wsj.com/article/SB10001424053111903999904576469973559258778.html. Accessed Aug. 10, 2011.

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Adrenal Fatigue: The 21st Century Stress Syndrome

Adrenal Fatigue: The 21st Century Stress Syndrome by Dr. James L. Wilson is a comprehensive book about the effects of stress on health. It explains what you can do to help yourself in an entertaining and easy to follow way. It includes a comprehensive questionnaire, simple self-tests, and dozens of cartoons, illustrations, charts, and case histories from Dr. Wilson's files - taking you step-by-step through everything you need to know to reclaim your life from the negative effects of stress.*

Price: $14.95

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Kashi GOLEAN Crunch! Cereal, 15-Ounce Boxes (Pack of 6)

Kashi Golean Crunch! cereal will satisfy your sweet cravings in a low-fat, healthy way. With 9 grams of protein and 8 grams of fiber, Golean Crunch! has more than twice the protein and fiber of the average cereal, so you stay full until your next meal

Price: $31.40

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Baby Einstein - Baby Van Gogh - World of Colors

The Baby Einstein Company's "video board books" were designed as music-focused developmental tools to stimulate babies' brains (prompted by research proving that exposure to classical melodies can improve verbal ability, spatial intelligence, creativity, and memory in youngsters). Now the company is expanding into other art forms, including color and art. The idea remains the same--taking bold, beautiful objects (toys, puppets, nature scenes) and setting them to fun renditions of classical music (their recordings are easily the best in the crowded field of child development). A new puppet--Vincent Van Goat--introduces the six primary colors and associates them with Van Gogh's paintings--"The Starry Night" for blue, "Wheat Fields with Reaper" for yellow. The only misstep is the poetry written and read by creator Julie Aigner-Clark, which is strongly reminiscent of Dr. Seuss's My Many Colored Days.

The company suggests the program is for toddlers between the ages of 1 and 4. Harsh sounds between segments--such as balloons popping and tires screeching--will draw the attention of youngsters but will probably render the video inappropriate for babes in arms. The video can be purchased by itself or with a beautifully produced 28-page book featuring Van Gogh's paintings, screen shots from the video, and Clark's poems. The combination set may be the best way to engage 3- and 4-year-olds' interest; they can follow along in the text while watching the video. Music includes "The William Tell Overture," "The Blue Danube," "Bolero," and Brahms's "Lullaby." The video also provides information on the cool toys seen in the ending "Toy Chest" segment. --Doug Thomas

Price: $19.99

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Pregnancy constipation: Seeking relief

Pregnancy triggers many physical changes in your body — some quite aggravating. During my first pregnancy years ago, the worst of these changes was constipation. In fact, after all this time, I've convinced myself that pushing out a baby was easier than having a bowel movement.

If you've never been constipated or you think all the ads about regular bowel movements are silly, don't assume you're immune to the condition. Constipation in pregnancy and after delivery can happen to anyone. It isn't inevitable, though. To prevent constipation in the first place, consider these tips:

Drink more fluids. During pregnancy, waste moves through your body more slowly than usual. This allows water to be removed from the waste, which contributes to constipation. Keeping well hydrated can help keep bowel movements soft. Fluids count after the baby is born, too, especially if you're breast-feeding. Your body will take all the fluids it can get to make breast milk. If you're not drinking enough fluids, the result might be uncomfortable constipation.Include more fiber in your diet. Think whole grains in foods such as breads and muffins, as well as fruits, vegetables and beans. With your health care provider's OK, you might also consider fiber additives that are mixed with water.Include physical activity in your daily routine. Regular physical activity can help keep your bowel movements regular.Consider stool softeners, if your health care provider approves. Stool softeners help moisten bowel movements.

I don't recommend laxatives for constipation during pregnancy unless you've cleared it with your health care provider. Some types of laxatives can be used safely in pregnancy while others aren't recommended.

Don't be like me with my first pregnancy. Take care so constipation doesn't become a problem — and no more laughing at fiber and laxative commercials! You could be next.

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The Gerson Therapy: The Proven Nutritional Program for Cancer and Other Illnesses

Cancer. Hepatitis. Migraines. Arthritis. Heart Disease. Emphysema. For years, the medical establishment has called these chronic or life- threatening diseases "incurable." But now, The Gerson Therapy offers hope for those seeking relief from hundreds of different diseases. Juice your way to wellness. One of the first alternative cancer therapies, The Gerson Therapy has successfully treated thousands of patients for over 60 years.

Now, in this authoritative revised and updated edition, alternative medicine therapist Charlotte Gerson and medical journalist Morton Walker reveal even more on the powerful healing effects of organic fruits and vegetables. Not only can juicing reverse the effects of many degenerative illnesses-it can save lives. The Gerson Therapy shows you:

• How to beat cancer by changing your body chemistry
• Special juicing techniques for maximum healing power
• How to combat allergies, obesity, high blood pressure, AIDS, lupus, and other diseases

This unique resource will help and inspire anyone who has ever said, "I want to get well. Just show me how." The Gerson Therapy offers a powerful, time-tested healing option that has worked for others - and can work for you!

Price: $17.00

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6 Vintage Psychology Films on 2 Dvd's: The History of Cognitive Psychology, Psychotherapy & Counseling

This 2-DVD set features 2 1/2 hours of vintage psychology movies. Table of Contents: Disc 1 - (1) Broken Appointment (1955) - This is a well-made, touching film about a woman new to the practice of nursing who begins to understand how important a role psychology plays in here day-to-day work life. - 30 minutes
(2) The Empty Life (1963) - This film is focused on the problem of "boredom." However, the film really ends up showing us a variety of psychological troubles facing Americans such as depression and anger. - 23 minutes
(3) Face in the Mirror (1940) - A psychological film for salesmen, this movie shows an introspective, self-reflective side to the art of business sales. - 26 minutes // Disc 2 - (4) Photographic Studies in Hypnosis (1940s) - This is an older silent film showing a woman getting hypnotized. - 10 minutes (5) Point of Return (1965) - This movie is about all the events leading up to a man's suicide attempt. Afterwards, a roundtable of doctors discuss the victim's actions and possible rehabilitation and psychological healing techniques that could help him. - 23 minutes (6) Unconscious Motivation (1940s) - This is a filmed unrehearsed session of hypnosis with two students who are given false memories and take psychological tests. - 39 minutes
Total Running Time: 151 Minutes

Price: $29.99

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Helping others and healing yourself

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Skippy Peanut Butter, Natural Creamy, 15-Ounce Jars (Pack of 6)

Skippy natural creamy peanut butter spread is a 100% natural peanut butter spread your kids will love. Great taste comes naturally--spread the great taste of this creamy, delicious peanut butter, and skip the stirring. It has no preservatives, artificial flavors, or colors and creates no oily mess--just the perfect spread for your kids. This is sold in pack of six 15-ounce jars.

About Skippy
The trademark for Skippy peanut butter was first obtained by Rosefield Packing Company in 1933. Since then Skippy has continued to grow and launch various different peanut butter spreads. By 2005 Skippy became America’s #1 natural peanut butter spread.

Each serving of Skippy peanut butter has seven grams of protein. When combined with healthy foods like whole grain bread, fruit and milk, Skippy helps restore energy and leaves you feeling charged. In fact, the USDA’s MyPyramid for kids includes peanut butter as a way to get the protein kids need every day. As part of a balanced diet, Skippy is good nutrition that is simple and delicious.

Today Skippy is the most famous peanut butter spread and more Skippy has been sold than any other peanut butter in the world.

Price: $18.60

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Do you have a taste for healthy foods?

You might not consider flavor as being a key player in prevention of disease or promotion of health. However, your perception of flavors contributes greatly to your acceptance and general liking of foods. For example, if you don't like the taste of vegetables, it's a good bet you avoid them. How then can you eat a healthy, balanced diet?

Instead of focusing on what you don't like, try focusing on what you do. Let's start with sweet — a flavor preference for most people. Did you know that some vegetables — sugar snap peas, red bell peppers and corn — have a sweet taste? Even onions can be sweet when you caramelize them. Another vegetable to try is winter squash. Cut in half or quarter and roast or microwave to have an easy meal of mildly sweet, slightly earthy flavors and soft texture that merits inclusion in the comfort food category. Not sweet enough for you? Peel, dice and roast the squash until slightly brown to experience a sweeter taste.

Maybe sweet isn't your first preference. The following options offer a mild sweetness that along with their other attributes might appeal to you. If you like foods that are crisp and crunchy, try jicama. You can cut it into thin strips and add it to a pita or wrap sandwich. In addition to flavor, you'll get fiber and vitamin C. Cucumbers are another good combination of cool and crisp. Mix them in vinegar for a stronger, pungent flavor.

But perhaps savory flavors are more to your liking. Mushrooms are a good bet. Try them sauteed. Or toss them in a stir fry, on a salad or in a sandwich.

Looking for something spicier? Peppers offer a spectrum of flavors — from mild and earthy to sweet and hot. Stuff a poblano or bell pepper with whole grains, veggies, and grated parmesan or blue cheese. Or add them to soups, salads and casseroles to punch up the flavor and boost the potassium and vitamin C content.

I encourage you to experiment with new foods and familiar foods prepared in new ways. Share your flavorful findings here to inspire others.

To your health,

Katherine

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The China Study: The Most Comprehensive Study of Nutrition Ever Conducted And the Startling Implications for Diet, Weight Loss, And Long-term Health

The China study presents a clear and concise message of hope as it dispels a multituse of health myths and misinformation. If you to be healthy, change your diet.

Price: $16.95

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Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health

This comprehensive book explains in lucid, assured terms how to practice the fertility awareness method (FAM), a natural, scientifically proven but little-known form of birth control (which is not to be confused with the woefully ineffective "rhythm" method). Author Toni Weschler has been teaching fertility awareness for almost 20 years, and it's only just now gaining in popularity. As the book explains, by using simple fertility signs including peaks in morning body temperature and changes in cervical position and cervical mucus, it's possible to determine when ovulation is taking place. Fertility awareness is therefore useful for not only couples who are trying to conceive, but for those who are aiming to avoid pregnancy without the use of chemical contraceptives. It will be of special interest to those women who have suffered from infertility; many FAM practitioners have told the author that by filling in the detailed charts in the book, they've realized that they were chronically miscarrying, even when their doctors told them they weren't conceiving at all. As the book explains, by charting body temperature, it's simple to tell when pregnancy has occurred--and when there's danger of miscarriage. Taking Charge of Your Fertility also explains how to choose the sex of your baby by timing intercourse according to certain fertility signs. It also features thorough, easy-to-understand explanations of hormones, the menstrual cycle, and menopause, along with fertility tests and treatments and their long- and short-term side effects, plus a topnotch resource section. Recommended for any woman who wants to better understand her body. --Erica Jorgensen

Price: $24.99

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Animal-pollinated crops essential to the food supply

A recent study has made me marvel at the simplicity and beauty of our ecosystem — and it's fragility.

The study evaluated the contribution of animal-pollinated crops on nutrients in the food supply. Researchers examined the nutrient availability in more than 150 animal-pollinated crops. The results were striking:

Most of the available vitamin C — a major antioxidant — comes from pollinated plants.Nearly 75 percent of food oils come from plants that rely on pollination. These fats also serve as primary sources of fat-soluble vitamins.Pollinated crops provide between 70 and 98 percent of the plant substances that the body turns into vitamin A. Vitamin A deficiency can lead to blindness.Pollinated plants also provide 58 percent of calcium and 62 percent of fluoride — minerals crucial for development of bone and teeth. Although calcium in dairy products is more bioavailable than that in plants, dairy farming is less environmentally efficient and more costly.More than one-fourth of iron is derived from pollinator-dependent crops. Iron deficiency is thought to be the most common nutrient deficiency. Iron plays a role in prevention of infection and cognitive impairment. As with calcium, iron from animal sources is more costly and taxing to the environment.

Why is this important? Because pollinating animals, including bees, butterflies, hummingbirds and bats, are in decline. Reasons for the decline include winter kill, natural diseases unique to the species, and human-induced habitat loss, disruption of migratory routes and pesticide use.

The researchers estimated that up to 40 percent of key nutrients provided by crops could be lost without pollinators. This could have dramatic impact on global health.

It makes me more mindful and appreciative of the foods I choose. It also makes me more mindful of our precious environment. Thoughts?

- Jennifer

blog index References Eilers EJ, et al. Contribution of pollinator-mediated crops to nutrients in the human food supply. PLoS ONE. 2011;6(6):e21363. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0021363. Accessed Aug. 8, 2011.Status of pollinators in North America. National Research Council Committee on the Status of Pollinators in North America. http://books.nap.edu/openbook.php?record_id=11761&page=1. Accessed Aug. 8, 2011.

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1950's Milk and Dairy Products Manufacturing: This is the Dairy Industry DVD (1957)

An educational relic, This is the Dairy Industry takes viewers on a stroll through milk and dairy products production in the 1950s. Some amazing statistics are also thrown out: it's alleged that 30% of the American diet is based on milk products. The rows upon rows of machines and masses of workers who control them demonstrate butter churning on an industrial scale. As an enriching addition to facts and information about the dairy industry, the lifestyle of the middle class and mainstream American is also beautifully represented. This is the Dairy Industry is a wonderful walk through the milk plant and 1950's culture.

Price: $7.99

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My Sister's Keeper

Grab a box of tissues and settle in for a heart-wrenching exploration of illness, morality, and familial bonds in this excellent screen adaptation of bestselling author Jodi Picoult's My Sister's Keeper. When parents Sara (Cameron Diaz) and Brian Fitzgerald (Jason Patric) find out that their daughter Kate (Sofia Vassilieva) has leukemia, they make the difficult choice to utilize the advancements of modern medicine and impregnate Sara with a child genetically ensured to be a donor match for Kate. Throughout the many years of dealing with Kate's illness, the needs of individual family members--including Kate's parents, her brother Jesse (Evan Ellingson), and her sister Anna (Abigail Breslin)--are largely ignored in light of Kate's more serious needs. Still, Kate's sister Anna rarely complains about helping Kate, even when it involves undergoing painful bone marrow aspirations. Recently, however, Anna has had a change of heart and has decided to stand up for her right to have a say in medical procedures involving herself: she's enlisted a lawyer, Campbell Alexander (Alec Baldwin), to help her sue her parents for medical emancipation. The issue is highly emotional and the familial strife is further compounded by the fact that Kate is quickly failing and needs an immediate kidney transplant for even a chance of continued survival. The emotional struggle of dealing with serious illness while trying to meet one's own needs permeates the film, as do the staggering moral dilemmas inherent in the advances of modern medicine. While Picoult's readers may be disappointed that the film doesn't delve as deeply into Anna's and Jesse's characters as the book does, My Sister's Keeper is nonetheless an intensely powerful film bursting with emotion and moral quandary that leaves viewers pondering what lengths they might go to in a similar situation. --Tami Horiuchi

Price: $14.98

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Pack lunches with a healthy punch

A new school year means new challenges, but packing your children's lunch boxes needn't be one of them. Use these tips to create healthy, kid-friendly lunches.

Be smart about food safety. Stave off food-borne illness with a few common sense precautions:

Start with a warm up. If you plan to pack soup or other hot entrees, use preheated insulated containers. To preheat, just fill with boiling water and let stand a few minutes before adding the hot food. Get the Chills. Surround your perishables with chilled items. Sandwich them between cold packs. Freeze bread, water bottles, 100% juice, or yogurt tubes to keep the inside of your lunch container cold until lunch time.Made in the shade. Encourage your children to store their lunch boxes away from direct sun and any heating or cooling sources.No worries. Pack items that aren't temperature sensitive to avoid the worry of unsafe bacterial growth.  Pack small packets/cans of meat or fish and whole grain crackers for make it yourself mini sandwiches at the lunch table.  Peanut butter, bread, bagels, and wraps, fruits, and veggies are all safe bets too.

To create nutrient-packed lunches, remember to cover the basics:

Grains. Make whole-grain bread, mini bagels, pita or tortillas the basis of healthy sandwiches. Pack in a container that keeps them from being squished or crumbled and fresh tasting.Fruits and vegetables. Make fruits and veggies easy to munch by cutting them into bite-sized pieces. Choose fresh, dried or canned. Send along a small container of yogurt for dipping. Again, pay attention to packing to protect food from unappetizing bruises. Protein. The standard PBJ is a great choice. If food allergies nix peanut butter, explore other protein-rich spreads for sandwiches. In addition to lean lunch meat, fish, beans, nuts, cheese and tofu are great protein sources for growing children.Calcium. Send milk in a thermos or let your child purchase milk at school. If you child isn't a milk drinker, pack yogurt, cheese or fortified juices — all good sources of calcium.

If sandwiches are losing their appeal, try a twist to deliver the same great nutrition:

Shape up. Cut sandwiches into fun shapes using cookie cutter to add pizzazz.Switch it up. Instead of bread, sandwich your protein, veggies or fruit between crackers, rice cakes, bagels, pita pockets or tortillas. Put in the subs. Try packing whole grain pasta or rice with sliced veggies and olives; peanut butter dip for fruit; dry cereal mixed with dried fruit and nuts, or yogurt with fruit and granola. Cube leftover chicken and pair it with grapes or bell pepper chunks on a toothpick for a tower of fun.Containers and more.  Kids begging for those pre-packed lunches they see ads on TV? Do it yourself with fun multi pocket containers — sliced cheese, pita pocket squares, cut up fruit or veggies. Got an eco conscious kiddo? Pack items in reusable sandwich bags in fun, fashionable prints for girls and guys.

Brighten your child's day by writing a note and stashing it the lunch box. Or go all out and use a small amount of food coloring to "stamp" your child's sandwich with a secret code or symbol.

I've got you started. Now I'm going to call on you. What do you do to ensure that lunch boxes come home empty — and not because the healthy food you packed got thrown away?

Here's to a great school year,

Katherine

blog index References Keeping bag lunches safe. U.S. Department of Agriculture. http://www.fsis.usda.gov/PDF/Keeping_Bag_Lunches_Safe.pdf. Accessed 8/31/2011

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Melissa & Doug Wooden Shape Sorting Clock

It's time to "block" around the clock! Two toys in one, this colorful clock combines shape sorting and learning to tell time. Place the numbered and shaped pieces in their proper place on the face of the clock, then move the hour and minute hands to make telling time fun! Measures 9" x 5".

Price: $14.99

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Managing diabetes: Is there an app for that?

I love technology and all the gadgets that go along with it, including diabetes apps (applications) that help with managing diabetes. I recently read in Health Data Management news that the use of mobile and internet tools helped a group of people with diabetes lower their blood glucose levels. The group that used these tools saw an average A1C level decrease of almost 2 percent, which was more than twice the decrease seen in the control group. Other research has shown that even a 1 percent decrease in A1C helps to prevent complications of diabetes.

I typed in "diabetes" on my mobile device and downloaded several different diabetes apps that aim to help with managing diabetes. Costs varied from free to around $12. You have many diabetes apps to choose from to quickly record your blood sugar, blood pressure, pulse, weight, medications, food (usually carbohydrates) and exercise. You even have the ability to print or email your blood glucose record to your health care provider.

In our practice, I find that most people don't mind testing their blood sugar, but they don't care for writing down their readings. We understand busy schedules and know that it can be difficult to find the time to test your blood sugar, let alone write it down. However, keeping a record of your blood sugar levels can help you identify patterns of blood sugar levels that are too high or too low. A blood sugar record also helps your health care team evaluate the effectiveness of your diabetes medications, including insulin.

If you're comfortable with the technology, consider a mobile diabetes app to help you record your blood sugar levels. Mobile technology isn't for everyone, and that's all right! But it can be a good option for many.

We'd love to hear your experiences with mobile technology and diabetes management.

Peggy

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Choosing your treatment team

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If you're someone who has just been diagnosed with cancer, it is overwhelming to deal with all of the information and decisions needed to move forward in your cancer care. It's important to learn all you can and ask questions along the way so that you have confidence in your treatment plan and the team leading you through treatment. Here are a few questions to consider as you start to make decisions:

Is this the person (doctor, nurse practitioner, etc.) you want to lead you through your treatment experience? Do you have confidence in them? Are you comfortable with them? Do you feel that they're able to listen and respond to your concerns? If the answer is no to any of these questions, it's OK to ask for a different provider.Do you have enough information to make a decision about your treatment? If not, what is needed? Take time to understand all aspects of your treatment options.Does the treatment facility specialize in your cancer type? Ask about their experience with your cancer type, success rates and resources.Should you ask for a second opinion? Remember that it's OK to request this. What are the risks involved with treatment? Ask about short- and long-term side effects.What about when treatment is over? Ask about the long-term plan for care after treatment ends.Do you have a support person (or persons) to be with you along the way? This might be a family member or friend who can help you absorb and reflect information and decisions. They can also be there when you need emotional and physical support. If you don't have someone, ask about resources that are available to help you, such as mentors, coaches, navigators, social workers and educators.

One of the most important things is confidence in your treatment team. Take time to get your questions answered so that you can make informed decisions. I know that many of you can add to this list, as you learn so much from each other. Share your ideas and suggestions as you coach each other through this experience.

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Forgive yourself as a caregiver, and relieve anger

In a book I highly recommend, "Ten Thousand Joys & Ten Thousand Sorrows", by Olivia Ames Hoblitzelle, she writes, "The strain of helping Hob (my husband) with his disease kept stretching me to the breaking point. My frustration and anger concealed the grief that lay at deeper levels ... The ravages of this illness spark powerful feelings in everyone ... We need to experience our humanness, including all the so-called dark emotions like anger and fear, because they are natural given the situation. It's natural to think you're losing it at times."

As stated in my last posting, anger is a real, normal and expected emotion in caregivers. In reading your comments, there's a prevailing theme — anger is triggered in caregivers when there is lack of validation and support from family members. As a result, anger is further exasperated by not having time for you.

Mark and so many of you wrote that you must get away and have some breaks — the right advice for sure, but easier said than done. Gisele said it helps to simply "put a voice to the frustration."

To find some relief, it's essential to first distinguish between what is, and what isn't, within your power to change. Often anger bubbles when we try to change an uncontrollable circumstance. The easiest way to find some calm may be to stop trying so hard to make things different.

When we resist, blame, or reject, we stay trapped in our anger. I don't mean that you can't actively work to make things better by asking for the help of family members. I simply mean that you make peace with the way things are today. Choosing to operate from a place of acceptance is a way to keep your anger in check and is a form of self-care.

A second consideration in relieving anger is to believe that there's something you can control. You can control your thoughts and ultimately how you respond. Each of us can learn to modify our thoughts. How we think about a situation greatly influences how we react and how much excess stress and anger we carry. As caregivers, our thoughts are often not unhelpful.

For example, have you found yourself taking responsibility or blaming yourself for a negative occurrence that's beyond your control?  Or perhaps you're stewing about a situation that hasn't happened, but your mind is already anticipating the outcome. Too often it's our thinking (not the actual situation) that causes anger and prevents us from looking at things objectively. This ultimately limits our ability to find a better way to deal with it.

Kathryn wrote that she's able to ask for help from a family member to care for her brother with Alzheimer's so she can get a break. However, she wrote, "Then I get ANGRY at myself because I just sit on my couch and enjoy having my house to myself — I am not being productive."

This is a great example of how our thoughts about what we think we "should" do are in conflict with what we want to do. You end up feeling angry, guilty, or depressed. Yet, we can modify our thoughts (with practice) by thinking instead, "I need time to do nothing. It's OK for me to take a break from caregiving and just sit. The laundry and chores will wait. I am being productive right now in my own self-care."

The booklet titled "Pressure Points — Alzheimer's and Anger" from the Duke Family Support Program offers some questions to ask yourself that can assist in modifying your thoughts, relieving your stress and ultimately seeing possible solutions more clearly. Ask yourself these questions when you start to feel overwhelmed or angry:

What am I really angry at? Do I really need to be concerned with, think about, or worry about this?What are the consequences if I ignore this?Is this something that must be done now?Why am I doing this? Is this someone else's expectation? Can I settle for a "good-enough-for-now solution"?

Remember, you're entitled to feel angry. Forgive yourself when things go wrong, and believe what you are doing is good enough for now.

"You will not be punished for your anger, you will be punished by your anger" — Buddha

(Pressure Points — Alzheimer's and Anger. Ballard, E., Gwyther, L., Toal, T.P. Durham, NC: Duke Family Support Program. 2000. 70 p. is available from the Alzheimer's Disease Education and Referral (ADEAR) Center, P.O. Box 8250, Silver Spring, MD 20907-8250. (800) 438-4380. E-mail: adear@nia.nih.gov. Website: www.nia.nih.gov/Alzheimers/Publications/pressurepoints.htm. Price: $12.50 for print copy.)

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Protect yourself from workplace stress

Our institution is in the midst of one of the largest construction projects in our history. It will involve years of construction and hundreds of workers. When you walk by the site, it's obvious that there's a tremendous emphasis on safety. Throughout the complex signs are posted that say safety is everyone's responsibility.

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

Each worker is required to wear a construction-grade helmet, protective eyewear when appropriate, steel-toe shoes and a safety harness when working above ground level. Some of the work involves creating pedestrian tunnels, and those workers receive additional instruction in the high-risk aspects of the job.

This experience made me reflect that each of us works in high-risk situations. You may not use heavy equipment or be at risk of falling, but is your work environment one of stress, deadlines and demands that often exceed your resources?

The risks are different but no less real. If you sit back and do nothing, you run the risk of a major injury, which might be a stroke, a heart attack, diabetes, or a host of emotional issues such as anxiety and insomnia. So what can you do to protect yourself?

Taking care of your physical and mental health is your best defense. You can shift the odds in your favor with a few simple rules, such as getting a good night's sleep, exercising and reaching out to others when you need help. No person is an island, and we depend on each other for strength and comfort.

What have I missed from this construction scene?

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Start early to encourage healthy eating

Working with mothers-to-be and new moms, I field many questions about what foods are best to eat and which are best avoided.

My common response is, "Eat what you like." If you like spicy foods and can tolerate them while pregnant, eat them. Recipe calls for 2 cloves of garlic, but you usually add 4? Go for it.

Lots of nursing mothers wonder about broccoli, cauliflower and those other gassy veggies. Again, if you tolerate them and your baby tolerates them, keep eating them. If you think a food is making your baby fussy and gassy, don't eliminate it right away. To be sure it was that food, try it again, in a smaller amount.

My advice isn't just for moms. It's also good advice for their kids. In utero and while receiving mother's milk, a baby is also experiencing all those wonderful, unique flavors. Studies have shown that babies who are exposed to a variety of flavors are more likely to except these flavors later in life. To put it quite simply, if you want to have children who like a variety of foods, expose them early on. And keep exposing them to nutritious foods as toddlers and adolescents.

We all want to raise a healthier generation of kids — and if we lessen childhood obesity then we lessen the risk of chronic disease. Exposing kids to the flavors of vegetables, fruits and spices early is the first step to getting them to accept and eat more of these foods. This is a big win for parents and kids alike.

To your children's health,

Katherine

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Focus on the light at the end of the tunnel

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Teenage pregnancy: Advice for parents of teens

When my kids were teenagers, I would occasionally subject them to "the talk" during dinner. The talk wasn't about sex — it was about not having sex. They'd roll their eyes, look at each other and usually the oldest would say, "You saw a pregnant teenager today, right?" Of course that was true. Throughout their teens and early 20s, I lived in fear that one of them would get pregnant or father a baby. My fear was probably magnified by all the pregnant teens I'd encountered in my professional life.

I believe it's important to talk about teenage pregnancy with your teens and preteens — both girls and boys. Adolescents aren't known for their ability to see actions and consequences or to project into the future. They're also likely to romanticize challenging situations, such as teenage pregnancy. These tendencies might be compounded by the celebrity status of pregnant teens featured in popular reality shows on TV.

Ask your teen if he or she knows anyone who's been pregnant while still in school. Talk about how your teen's life would change if he or she had a baby. Get specific. For example, would your daughter want to go to prom pregnant? Would your son want to drop a favorite sport so he can work to earn money for the baby? Would it be possible to finish school? What would it feel like to be responsible for a helpless infant? Who would support the baby? Let your teen know that he or she can come to you with questions or concerns. Also remind your teen that it's essential to tell you if a pregnancy happens. You don't want a surprise delivery.

If you're faced with a teenage pregnancy, it's tough to predict how you'll feel. You'll probably experience a mass of emotions: anger, disappointment, fear. All of these feelings are real and you can't decide that you just won't feel them. Instead, acknowledge your emotions and work with them. If you're angry, say so. If you're caught up in your emotions and don't think you can have a productive conversation right away, let your teen know that you need to put some distance between you and the news — then agree on a specific time to sit down and discuss the decisions that need to be made.

When you talk to your teen about the options, remember that any decisions about the pregnancy are your teen's to make — including whether to keep the baby, have an abortion or place the baby for adoption. Your decisions focus on how you'll support your teen and his or her decisions. If you have strong feelings against abortion, how will you handle a decision to end the pregnancy? If you feel that keeping the baby is the wisest choice, how actively will you participate in caring for or supporting the baby?

When you talk with your teen, discuss how the pregnancy will change your teen's life — as well as how it will change your family's life. Talk finances, talk responsibilities, talk school. Talk about everything. Listen to what your teen is saying and ask how he or she is feeling. Let your teen know that his or her feelings are important to you. Above all, love your teen no matter what.

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When it comes to weight loss, there's no magic bullet

Human nature being what it is, we want to believe there's a quick fix somewhere to help us lose weight, and we just need to find it.  This belief can be strong, so strong that even when we know something makes little sense, we still want to try it, hoping that at last we've found the magic bullet for weight loss.

Consider this — if there was a magic bullet, wouldn't everyone be using it and successful at losing weight? People spend literally billions of dollars on dietary supplements. Yet, despite the promises of all the many supplements out there, virtually none of them are effective in promoting long-term weight loss.

The only over the counter product that has any effect is orlistat, which is also available by prescription. However, weight loss is usually very modest at best, and at a relatively large cost. When it comes to supplements, save your money.

Fad diets have been popular for years and the list is long. Some of them were falsely called "The Mayo Clinic Diet", and they seemed to change from year to year. Cabbage soup, grapefruit, and bacon and eggs were some of the foods emphasized on these so called Mayo Clinic diets, but none of them were associated with Mayo Clinic.

The HCG diet has made a resurgence in the past few years. Years ago, it was originally used along with a 500 calorie per day diet — anyone would lose weight eating that few calories. But it's not safe and not recommended.

Recently, I looked at some of the fad diets that were popular years ago. I didn't recognize many and hardly any of them are still around.  Most tend to run their course until the next fad comes along.

When considering a dietary program for weight loss, you should ask some basic questions:

Is it safe? Does it promote good nutrition and improve health?Is it enjoyable? Is it practical and sustainable — can you continue it for a long time to keep excess weight off?

The answer should be yes to all of these questions before embarking on any weight loss diet.

While it's tempting to jump in and try a product or program promising effortless weight loss, consider it carefully before investing time and money. The old adage holds true in this case — if it sounds too good to be true, it probably is.

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New antidepressant offers hope

For those of you with depression who've been struggling to find the right antidepressant medication, the introduction of a new antidepressant is always a hopeful event. Recently, the antidepressant vilazodone became available to U.S. patients. The trade name of this new medication is Viibryd.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

The mechanism action of vilazodone is somewhat different from many antidepressants. While vilazodone does inhibit the reuptake of serotonin like so many other antidepressants, it's also a "partial agonist" of the serotonin 1A receptor. This second mechanism may be particularly helpful for some people based on the receptivity of their serotonin 1A receptor.

It's not clear who will be most likely to respond well to vilazodone as a result of its effect on the serotonin 1A receptor. However, future research focusing on differential response may well lead to clues that will help us identify who will respond to vilazodone.

The metabolic profile of vilazodone makes it quite likely that most people will be able to tolerate it at the recommended dose. However, since vilazodone is metabolized by the cytochrome P450 3A4 enzyme, a small number of people who have deficient copies of the gene that codes for this enzyme are unlikely to tolerate vilazodone at the standard dose. This problem with tolerance will also be true for people who have a normal metabolic capacity, but who take medications that inhibit the function of the 3A4 enzyme.

One of the most attractive aspects of this newly released antidepressant is that the initial clinical trials reported a quite low incidence of sexual side effects. If these initial reports are confirmed as larger numbers of people are treated, vilazodone will clearly become the antidepressant of choice for those who have struggled with sexual side effects while taking either the SSRI's or the SNRI's.

At this point, there's been little pharmacogenomic research focused on this new drug. However, as individualized molecular psychiatry becomes more prominently practiced, future research will hopefully provide some clues as to which of you will be most likely to respond to vilazodone.

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Anger: A normal emotion for Alzheimer's caregivers

Doug and so many of you wrote about the perplexing nature of acceptance.  Many of you agreed that accepting your situation as it is offers up room for ease and coping, but nevertheless isn't easy.

As Doug wrote, "accepting is not a onetime process...it is a work in progress". And Joy wrote, "Sometimes we just get tired out and have to holler." How true those statements are!

Acceptance isn't the same as liking it, and acceptance doesn't mean we aren't allowed to get angry. You, as caregivers, have every right to feel all of your emotions and to let them out. You're entitled to bad days — no judgment or apology necessary.

Although Joy recognizes her anger, not all caregivers can see it in themselves. Often you may not be in tune with your emotions because you're immersed in someone else's needs and consumed with the tasks at hand.  Yet you live in extraordinary circumstances and have understandable reasons to be angry.

You take on difficult and unpleasant tasks and often feel unappreciated. You have little time for yourself and less time for friends and personal relationships. In addition, you often set unrealistic expectations for yourself and often believe it's a sign of weakness to ask for help, or believe that no one can do the job quite like you can.

It's common to feel anger toward the one you're caring for.  Sometimes, the anger may be a symptom of the fear most caregivers experience when faced with such an ambiguous loss. Undoubtedly, caregivers are at risk for feeling angry. However, feeling angry isn't the real problem. As caregivers you're entitled to (and should) feel anger if that's what you feel. The problem comes with not knowing what to do or how to relieve the anger.

An excellent booklet titled "Pressure Points — Alzheimer's and Anger", from the Duke Family Support Program at Duke University Medical Center, states that anger is a normal and expectable emotion. The booklet offers ways of responding that support the caregivers' well-being and that of the person they're caring for.

I'm going to highlight some of the ways to manage anger in my next blog. But for now, I want to leave you with an excerpt from the booklet and ask that you offer some thoughts on your own anger triggers (or pressure points) and what, if any, helpful ways you respond when you get angry.

"Anger is an emotional response to a grievance, real or imaginary, in the past, present or future. The pain of anger is very real. If we don't know how to relieve it the right way, we will react to it in ways that make things worse instead of better."

— Mitchell Messer as cited in the booklet "Pressure Points — Alzheimer's and Anger"

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Understanding hypoglycemia unawareness

A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy

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Think multitasking saves you time? Think again

We're always reminded, especially in our younger years, of the importance of staying focused and not getting distracted. I write about this frequently in this blog, but sometimes I don't follow my own advice. Let me explain.

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

A short while ago, I was invited to speak before a professional audience. As happens on occasion, one or two colleagues came up to the stage and asked if they could have my presentation on a USB flash drive. Of course I agreed. The procedure to do this is somewhat complicated and requires some focus on my part.

As I was trying to accommodate this request, another colleague came up to me and asked some very complicated questions. When my computer nearly melted down, I realized that I couldn't simultaneously complete the task and respond to questions. I then had to spend precious time dealing with the technical tsunami I'd created for myself.

Let me give you another example of why staying focused is so vital. A week or so ago, my wife and I had blocked out several hours on our calendars to pack and prepare for a trip. Despite that, we both accepted a number of other commitments for this time. We became distracted. We lost focus and energy and, as a result, we failed to follow some basic rules of travel, such as making sure we had our passports, confirming flight times, and so on. As you can imagine, our trip was punctuated by a number of misadventures.

These experiences served to remind me of the importance of protecting my time so that I can focus on the task at hand. Some lessons take repeating, I guess. Can anyone relate?

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3 Ballerina Tea Extra Strength Dieters Drink Value Pack - 54 Tea Bags (In 3 Boxes)

Excellent remedy for constipation, weight control in natural way. Ingredients: Malva Verticellata (Chinese Mallow) No Caffeine No Chemical Additives Warning: This product contains Malva verticellata (Chinese Mallow) and Cassia Angustifolia (Senna) herbs. Read and follow directions carefully. Pregnant & nursing women, children, the elderly and individuals suffering from any illness or health condition should not consume this tea. Do not use this tea if you have or develop diarrhea, loose stools or abdominal pain. Consumers are urged to consult a licensed physician prior to using this or any herbal supplement. Hint: Extra bowel movements may be expected in the 1st or 2nd day after using this tea.

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Dr. Bernstein diet and beyond

I'd like to respond to some of the feedback we've been receiving about the topic of carbohydrates and their place in your diet. I'm not a dietitian, so I've consulted with Jennifer Nelson, M.S., R.D., a Mayo Clinic dietitian, who says, "The American Diabetes Association generally recommends that around 50 percent of the calories in your diet come from carbohydrates — preferably healthy carbohydrates such as vegetables, whole grains and fresh fruit. Lean proteins or fat-free dairy and healthy fats should make up the rest of the calories."

The Dr. Bernstein diet, which has been mentioned in some comments, is low-carbohydrate and calorie restrictive. In some cases, it proposes limiting calories to 800 to 1350 a day. The program also includes behavior modification, education and vitamins and mineral supplements. People with diabetes who follow the Dr. Bernstein diet are required to do intensive management of their diabetes, including blood glucose testing five to eight times a day. The main function of Dr. Bernstein's diet for those who have diabetes is to maintain constant, near-normal blood glucose levels — desirable for anyone with diabetes. Good glucose control can reduce or prevent the chronic complications of diabetes such as nerve damage, kidney damage, eye disease and heart disease risks.

When carbohydrates are reduced, you must make up the difference in fat and proteins. Consuming total daily calories at an amount needed to maintain a healthy weight is key and, over the long run, is probably more important than diet composition.

Can good glucose control be achieved on a traditional diet? It most certainly can. Good glucose control involves paying close attention to the balancing act of healthy eating, insulin use (and diabetes medications, if required), exercise and blood glucose monitoring.

Good diabetes management takes self-direction and work, no matter how it's achieved.

According to Jennifer Nelson, M.S., R.D., "The bottom line is to find a healthy eating plan that works for you lifelong."

Thanks, Jennifer. And, I hope you all have a good week.

Regards,
Nancy

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Know your blood glucose target range

Wow, what a tremendous response to the new diabetes blog. You are showing the huge impact diabetes has on an individual's life, family, community, and society as a whole.

Peggy and I would like to thank all of you for sharing your stories about living with diabetes. As you all know, diabetes is a complex issue and there are many facets involved in managing and living with the disease.

In viewing the comments, we would like to thank you for sharing your personal experiences, challenges, burdens, and successes. This is your opportunity to share information and tips, and Peggy and I plan on choosing a couple items each week to respond to.

This week I would like to talk about the blood glucose target range. What should it be? A normal fasting blood glucose target range for an individual without diabetes is 70-100 mg/dL (3.9-5.6 mmol/L). The American Diabetes Association recommends a fasting plasma glucose level of 70–130 mg/dL (3.9-7.2 mmol/L) and after meals less than 180 mg/dL (10 mmol/L).

Individuals with hypoglycemic unawareness (limited or no awareness of low blood glucose symptoms) may require a lower target range. Your healthcare provider may personalize your blood glucose target for specific medical conditions. Blood glucose targets should be in a healthy range to prevent diabetes complications, but also keep you safe from serious low blood glucoses.

Remember, blood glucose targets are targets. Diabetes is a balancing acting and blood glucoses will fluctuate; even sharpshooters don't hit the bull's-eye every time.

Once again, thank you. Keep the comments coming. We will try to address some of your concerns in the upcoming weeks.

- Nancy

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Focus is essential for success

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

View the original article here

What's OK to eat after gallbladder removal?

I just got a phone call from a retired Mayo Clinic doctor asking why we don't have a gallbladder removal diet. He went on to explain that he'd had a very uncomfortable and embarrassing incident after eating a large meal that contained lots of fat. My response was that there isn't a set diet people should follow after gallbladder removal because the guidelines depend on the individual.

It's helpful to know a little background: The gallbladder collects bile, a fluid that is produced by the liver, and releases it when you eat to aid the breakdown and absorption of fat. Between meals, bile collects in the gallbladder and is concentrated. When the gallbladder is removed, bile is less concentrated and it drains continuously into the intestine. This affects digestion of fat and fat-soluble vitamins. How much of a problem it is varies from person to person. With time, the body often adjusts and becomes better at digesting fatty foods.

The amount of fat eaten at one time also factors into the equation. Smaller amounts of fat are easier to digest. On the other hand, large amounts can remain undigested and cause gas, bloating and diarrhea.

Although I don't have a specific gallbladder removal diet to recommend, I can offer general advice for avoiding problems after you've had your gallbladder removed:

Eat smaller, more frequent meals. This may ensure a better mix with available bile. Include small amounts of lean protein, such as poultry, fish and nonfat dairy, at every meal, along with vegetables, fruit and whole grains.Go easy on fat. Avoid high-fat foods, fried and greasy foods, and fatty sauces and gravies. Instead, choose nonfat or low-fat foods. Read labels and look for foods with 3 grams of fat or less a serving.Gradually increase the fiber in your diet. This can help normalize bowel movements by reducing incidents of diarrhea or constipation. However, it can also make gas and cramping worse. The best approach is to slowly increase the amount of fiber in your diet over a period of weeks.Be aware that after gallbladder surgery some people find that the following are difficult to digest: caffeinated beverages and dairy products.

Talk with your doctor if your symptoms are severe, don't diminish, continue over time or if you lose weight and become weak.

I'd like to hear from anyone who has had gallbladder surgery — do you have problems — or are you able to eat almost everything? Any advice you can share?

- Jennifer

blog index References Barrett K. Gastrointestinal Physiology. http://www.accessmedicine.com/content.aspx?aID=2306279&searchStr=gallbladder#2306279. Accessed July 6, 2011.Nutrition Care Manual: Gallbladder disease process and meal plan. American Dietetic Association. http://nutritioncaremanual.org/content.cfm?ncm_content_id=81517 Accessed July 6, 2011.Fisher M, et al. Diarrhoea after laparoscopic cholecystectomy: Incidence and main determinants. ANZ Journal of Surgery. 2008;78: 482.Surawicz CM. Mechanisms of diarrhea. Current Gastroenterology Reports. 2010;12:  236.

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