Kids at Risk For Diabetes

Registered Nurse, Diabetes Educator, CDE, Obesity, Children, Youth, Lifestyle

Header Right

Blog Page

7 Causes of Infertility

by Leave a Comment

7 Causes of Infertility

It can be a real challenge to determine the true source of fertility problems. This article does not include endometriosis nor is it all inclusive for the causes of infertility. To be properly diagnosed you need to consult with your medical care provider. However, this article will give you food for thought concerning multiple problems and possible underlying causes and solutions.
  1. Emotional Side Effects
  2. Abdominal Fat Storage
  3. Insulin Resistance
  4. Polycystic Ovarian Syndrome
  5. Miscarriages and Ketosis
  6. Preeclampsia
  7. Gestational Diabetes

Emotional Effects

How many times have you been told, ‘just relax, it will happen’? Stress causes increased cortisol production, which promotes weight gain, which causes insulin resistance, which causes increased insulin in the blood stream, which causes multiple problems with fertility.

Fertility problems rank high on emotional issues. Husbands and wives have broken-up over fertility problems. (Berman PhD, 2014) Families have gone bankrupt over infertility treatment costs. (Berman PhD, 2014) Telling you to relax is much easier said than done. (Berman PhD, 2014)

An underlying problem is that schools don’t teach how to handle stress! People can go through their whole life and never learn how to adequately deal with their stress. They turn to smoking, drinking, drugs (prescription and non-prescription) and other addictions to avoid dealing with stress. Everyone could benefit from instructions on how to manage stress. Unfortunately, it is not as easy as taking a college course. Stress management is individualized.

Some people pray, some people meditate, and some people take long walks in the woods. No one can tell you what will work best for you. You have to do your own discovery work. I have a great post, First-Aid Box for Emotions, which talks about how to be prepared for emotional issues.  

Uncontrolled stress can cause fertility problems. It triggers the release of adrenalin to feed your fight or flight mechanism. When you don’t fight or flight (which most of us can’t physically react to stress) then the adrenalin triggers the endocrine (hormone) system to produce cortisol. Cortisol has multiple effects on the body including infertility. Simply put; if you are fighting for your life, then you are not going to get pregnant. Another effect of cortisol is it increases fat storage.

Abdominal Fat Storage

How many times have you been told to lose weight to get pregnant? Abdominal fat can physically interfere with how the egg is delivered. (How can you lose the fat deposited around your ovaries?) Having a body mass index (BMI) over 32 is directly associated with problems of ovulation and conception as well as other challenges during the pregnancy. (Berman PhD, 2014) If you plan to get pregnant it is advisable to lose weight if your BMI is above 24. (BermanPhD, n.d.)

Abdominal fat can also interfere with the many other organs within the body cavity. Fatty liver disease is common with weight challenged individuals. The liver is the largest organ in the body and it has multiple functions. It is affected by the endocrine system. When stress triggers your fight or flight mechanism, the liver releases energy (blood sugar) to enable you to fight for your life or run a marathon. When you don’t use the extra energy, it triggers the pancreas to produce insulin to store the excess energy as fat. Over time, these increased fat stores cause insulin resistance which causes your pancreas to work harder to control your blood sugar.

Insulin Resistance

Insulin resistance and the resulting increased blood insulin are key to many fertility problems. (Insulin resistance means your body loses the ability to use the energy needed in every cell of your body. Your pancreas compensates by producing more insulin.) Thousands of people have insulin resistance and have never been diagnosed. In these women, the required excess insulin also triggers increased levels of testosterone. (Campbell, 2015) The increased testosterone can completely shut down ovulation.

Increased blood insulin can also decrease Follicle Stimulating Hormones (FSH) and Luteinizing Hormones (LH). If ovulation does occur, the quality of the egg produced is reduced which results in difficulties maintaining the pregnancy (i.e. increased miscarriages). (Campbell, 2015) Increased blood insulin also increases the production of androgen from the ovaries. (Nutritionist, 2015) Sixty to eighty-five percent of fertility problems have been identified as having increased androgen or insulin resistance. (Marc A Fritz, 2011) Insulin resistance can be diagnosed using a hemoglobin A1C blood test. Changes in reproductive hormones can be identified with elevated hemoglobin A1C levels. (Nutritionist, 2015)

Additional tests are available but often not covered by insurance. Organic Acid Test (OAT) can measure the carbohydrate metabolism rate. An elevated L-Lactate indicates insulin resistance. (Brar, 2017) Also measuring the bacteria in the gut can indicate problem in digestion. To diagnose preventable diseases before symptoms develop, the standard blood tests are not adequate. Patients need to be proactive with their health care provider by inquiring about other tests to identify preventable diseases.  

You can read more about this in my blog post, Pregnancy Diabetes and Insulin.

Polycystic Ovarian Syndrome

Insulin Resistance also promotes Polycystic Ovarian Syndrome (PCOS). Thirty percent of lean women with PCOS and 95% of overweight women with PCOS also have insulin resistance. (Nutritionist, 2015)  In PCOS, the eggs are not released from the ovary and they form cysts (abscesses) on the ovaries.

This condition can start as early as puberty and be misdiagnosed as irregular periods. The common practice of placing women on birth-control pills to regulate their periods actually allows this condition to continue untreated. Many women are not diagnosed with PCOS until they are experiencing infertility. If diagnosed and treated early, infertility from PCOS can be prevented. Before the age of 40, 55% of women with PCOS will be diagnosed with type 2 diabetes or prediabetes.

If you want to read more on this topic, I have a post, PCOS and Insulin Resistance, which gives more details on the connection between PCOS, Insulin Resistance, and Infertility.

Miscarriages and Ketosis

An increased risk for miscarriages is associated with insulin resistance and undiagnosed prediabetes or type 2 diabetes. (Alkon, 2017) When your body has difficulty using blood sugars, your body will revert to burning protein and fats for energy. This process produced ketones. (Frise, 2010) As the pregnancy progresses, the woman’s body increases in insulin resistance. (Frise, 2010) The breakdown of fats puts you into a state of ketoacidosis (DKA). Typically, if you go more than ten hours between meals, your body will revert to proteins and fats for an alternative energy source. This can be quickly reversed by eating breakfast.

Today, many people with prediabetes are being encouraged to eat a low carbohydrate/high protein diet to “control” their prediabetes. This can be very dangerous to the developing embryo during early pregnancy. (Williams, 2018) (Frise, 2010) Elevated ketones can cause your body to quickly miscarriage. Ketoacidosis can also contribute to elevated blood pressure.

Preeclampsia

Elevated blood pressure during pregnancy is often defined as preeclampsia (Frise, 2010) It is associated with high protein diets. (CNS, 2017) Diagnosis of preeclampsia results from high protein levels in urine tests. (CNS, 2017) . In developing nations, Eclampsia is the leading cause of maternal-fetus mortality. (CNS, 2017) Fifty-one babies out of 1000 are stillbirths and high blood pressure is a major contributing factor in these births. (CNS, 2017) Insulin resistance coupled with high protein/low carb diets increase the risk for high blood pressure in expecting mothers. Women who are pregnant need to eat a well-balanced diet and get regular exercise and monitor their blood pressure.

Gestational Diabetes

Diabetes during pregnancy is not your fault. During pregnancy, your body produces growth hormones as well as other hormones to promote the pregnancy and the embryo’s growth and development. Around 26 weeks, those hormones start to rapidly increase. (Stoppler MD, 2016) Around 26-28 weeks, your doctor will check for gestational diabetes. Gestational diabetes is totally hormone driven. As the hormone produced during pregnancy increase, so does your chances of developing gestational diabetes. After delivery, gestational diabetes will go away. (Stoppler MD, 2016) Unfortunately, diabetes during pregnancy indicates your body has insulin resistance. (Stoppler MD, 2016) This diagnosis places you at greater risk for developing type 2 diabetes before the age of 40.

Pregnancy can be a beautiful thing. Many people view giving birth as a miracle. It is literally the gift of life. As many women delay pregnancy into their thirties, this also increases the chance of fertility problems and other health issues associated with pregnancy. Unfortunately, pregnancy places a lot of stress on a woman’s body. What happens during pregnancy can be an indicator of other health problems you will face. If you want to learn more about how you can avoid gestational diabetes, check out my post, 8 Tips to Avoid Gestational Diabetes.

My hope is that this article, 7 Causes of Infertility, gives you some ideas of what could be going on and what you can do about it if you’re facing infertility. If you want to learn more about my Gestational Diabetes course, I have a 30-day virtual course that you might be interested in. Follow this link to get more information. If you’re not sure what kind of help or support you need, schedule a discovery call with me and we’ll figure it out together. 

Best of luck to you!

 

References

Alkon, C. (2017). Risk of Miscarriage from Pre-Existing Diabetes. Retrieved January 18, 2018, from Demos Health.com: http://www.demoshealth.com/w/risk-of-miscarriage-with-pre-existing-diabetes/

Berman PhD, E. (2014, January 23). When Infertility Affects Your Marriage. Retrieved January 12, 2018, from Huffington Post: www.huffingtonpost.ca/erica-berman/infertility-and-depression_b_4251953.html

BermanPhD, E. (n.d.). Huffington Post. Retrieved January 12, 2018, from 10 Fertility Facts You may not …: http://www.huffingtonpost.ca/erica-berman/infertility-and-degression_b_4251953.html#gallery/542252/1

Brar, R. (2017, December 1). Why Bloodwork is not enough. Retrieved January 15, 2018, from Living Proof Institute: https://thelivingproofinstitute.com/bloodwork-not-enough/

Campbell, L. (2015). Natural Fertility Info. Retrieved Jan 12, 2018, from natural-fertility-info/insulin-resistance.html: http://natural-fertility-into.com/insulin_resistance.html

CNS, J. A. (2017). 5 Ways to Help Prevent Preeclampsia for a Healthier Safer Pregnancy. Retrieved January 12, 2018, from Dr. Axe Food is Medicine: https://draxe.com/preeclampsia

Frise, C. M. (2010, March 15-18). Starvation ketoacidosis in pregnancy. Retrieved January 18, 2018, from Endocrine Connections Endocrine Abstracts (2010) 21 p143: http://www.endocrine-abstracts.org/ea/0021/ea0021p143.htm

Marc A Fritz, L. S. (2011). Clinical Gynecologic Endocrinology & Infertility 8th Ed. In L. S. Marc A Fritz, & S. Seigafuse (Ed.), Clinical Gynecologic Endocrinology & Infertility 8th Ed. Philadephia, PA, USA: Lippincott Williams & Wilkins Wolters Kluwer. Retrieved from Clinical Gynecologic Endrocrinology and Infertility 8th Edition.

Nutritionist, C. G. (2015, November 23). Infertility & Insulin REsistance Explained by a Fertilty Nutritionist. Retrieved January 12, 2018, from Path to Fertility: Https://fertility-news.rmact.com/path-to-fertility-blog/infertility-insulin-resistance-explained-by-a-fertilty-nutritionist

Stoppler MD, M. C. (2016, December 5). Gestational Diabetes. (C. Davis MD, Editor) Retrieved January 18, 2018, from Medicine Net.com: https://www.medicinenet.com/gestational_diabetes/article.htm

Williams, K. (2018). Is Ketosis Dangerous During Pregnancy? Retrieved January 12, 2018, from Pregnancy Week by Week Calendar: www.pregnancyweekbyweekcalendar.info/pregnancy-tips/is-ketosis-dangerous-during-pregnancy.html

Prevent Unplanned Pregnancy

by Leave a Comment

Uncontrolled blood sugars can cause serious birth defects.

It is unfortunate that I find a need to present this information. I have experience working with thousands of teens and unfortunately many of them get pregnant. I am located in the American Bible belt. They encourage schools to teach “abstinence only” in sex education classes. In today’s society, it appears to not be effective in controlling unwanted pregnancies.

Never trust your schools to adequately prepare your children for pregnancy prevention.

All parents need to take an active role in the discussion of sex and the importance of contraception. Do not expect your child to be adequately informed by the school’s sex education classes.

Know your risks. Research shows, if the mother has gestational diabetes, the child is at increased risk for diabetes. There are a variety of risk factors that can be found on the CDC’s website on Diabetes. You can take their survey to evaluate your child’s risks.

Type 2 diabetics are at risk for the most serious complications in unplanned pregnancies. About 7% of embryos developed with high blood sugars also develop Spinal Bifida. There are other brain and heart malformations that are associated with uncontrolled diabetes.

Typically, babies born under gestational diabetes are over nine pounds. Doctors recommend C-sections due to the increased possibility of broken bones during birth (particularly the collar bone).

The most serious health issue is high blood pressure in the mothers. This can be life threatening to the pregnant woman. If the mother develops high blood pressure, she will often times be placed in the hospital on bed rest until the baby is developed enough to be induced. There is a risk of underdeveloped lungs in the newborn and high medical cost for intensive care for the newborn.

There is a wide variety of birth defects associate with high blood sugars.

All diabetics need to seek pre-conception counseling before getting pregnant.

If you are interested, I have a 30 day course for gestational diabetes.

Prevent PCOS

by 2 Comments

Polycystic Ovary Syndrome

By Julie Stelting RN CDE

Girls as young as 12 years old have been diagnosed with polycystic ovarian syndrome (PCOS). But what is the connection between PCOS and insulin resistance?

Many teenage girls are placed on birth control pills to regulate their cycles, improve pain associated with their periods and improve acne. These are all signs of PCOS. Although birth control pills improve the symptoms, they mask this potential problem which can create fertility problems in their future. (Gambineri, 2012) Irregular cycles, period pain, and acne are all signs of PCOS. When diagnosed early, PCOS can be cured and future infertility problems can be avoided. PCOS is increased with abdominal fat. To prevent PCOS, we must consider how abdominal fat effects body chemistry.

What is the PCOS and Insulin Resistance Connection?

The exact cause of PCOS is unknown. PCOS is involved with the endocrine system which is a feedback hormone system that involves the whole body. Since this is involved with the hormones, it is understandable that young girls going through puberty are at higher risk. These hormone changes during puberty also encourages weight gain. Biologically, their body is preparing for a pregnancy. Unfortunately, young girls who are not thin are at risk for gaining too much weight which can result in insulin resistance and contribute to PCOS.

As body mass index (BMI) increases, the incidence of PCOS also increases. Up to 70% of women with PCOS are classified as obese. (Barber & Franks, 2012) When diagnosed early, PCOS frequently resolves with substantial weight loss. (Barber & Franks, 2012) Many people who are trying to lose weight benefit from a support group or an individual coach.

How do you test for PCOS?

Sex Hormone Binding Globulin (SHBG) is a common blood test used to predict PCOS. Increased body fat and insulin resistance decreases the liver’s production of SHBG. (Sex Hormone Binding Globulin and PCOS, n.d.) In fact, the decreasing SHBG levels are being used to identify insulin resistance and prediabetes before the pancreatic beta cells die off and blood sugar levels rise. (Gambineri, 2012) Diabetes can be prevented with early detection before the beta cells die.

Fifty percent of women with PCOS will develop prediabetes or Type 2 diabetes before the age of 40. ((APS), 2015) Increasing weight is associated with insulin resistance and hyperinsulinemia (increased levels of insulin in the blood). (Barber & Franks, 2012) Before blood sugar levels are uncontrollable, the pancreas goes into high production. When the problems associated with insulin resistance are not resolved, the beta cells will die off. This triggers uncontrolled blood sugar which is diagnosed as prediabetes or type 2 diabetes.

How is PCOS and Insulin Resistance related to Fertility Issues?

Insulin resistance in PCOS is well recognized. Up to 90% of women with PCOS are insulin resistant. (Spero, 2016) The presences of high levels of insulin inhibits ovarian folliculogenesis (the development of the follicles). (Willis, Watson, Mason, Brincat, & Franks, 1998) Think of this like fruit with its seeds inside. When the outside of the fruit (follicles) don’t ripen, the seed (or eggs) inside are not released and it forms a cyst. This is easy to see on diagnostic pictures.

Increased levels of insulin not only inhibit folliculogenesis but also stimulates the production of testosterone which suppresses the ovaries. (Spero, 2016) High levels of testosterone is associated with acne. One of the benefits of taking birth control pills is improved acne. Acne can also be caused by bacteria, so it is important to be properly evaluated for this problem.

How is PCOS treated?

Metformin is the first prescription used for PCOS. It is also the first medication used in diabetes management. (Gambineri, 2012) It works to improve the liver functions. The liver synthesizes SHBG as well as helps to regulate blood glucose. (Gambineri, 2012) Real improvements in liver function will result in improved PCOS and blood sugar control. Unfortunately, Metformin has a side effect of GI upset. If it is started at a low (tolerable) dose and increased as tolerated, most of the side effects can be avoided. Many clinicians are starting Metformin at a lower dose than is recommended to improve patient compliance. Metformin also has a time released formula available. Clients need to be encouraged to take this Rx.

Can PCOS be prevented?

There is no known prevention for PCOS. (Clinic, 2017)

Improved lifestyle habits are key to improving PCOS. (Spero, 2016)

Lifestyle changes include:

  • Reduce refined carbohydrates
  • Increase dietary fiber
  • Regular exercise
  • Eating for your body’s limitations with small frequent meals
  • Reduce processed foods
  • Eliminate alcohol, smoking and caffeine
  • Be evaluated for individual needs of supplemental vitamin D and chromium

It is far better to understand the causes of your teen’s problems than it is to simply mask the symptoms. Placing teens on birth control pills to control the symptoms can cause significant fertility problems in their future by masking the signs of PCOS.

To assist individuals with PCOS to get pregnant, many women benefit from a life coach.  For a life coach with a specialty in insulin resistance, please see my qualifications at www.kidsatriskfordiabetes.com. Or schedule a discovery call with me and we can talk about your needs and options.

Get my FREE list: 10 Signs of Prediabetes.

 

References

(APS), A. P. (2015, June 3). Polycyctic oavary syndrom and diabetes: Researchers find out why the two are linked. Retrieved from ScienceDaily: https://www.sciencedaily.com/2015/06/150603181739.htm

Barber, T., & Franks, S. (2012, August). Women’s Health. Retrieved from The Link between Polycycystic Ovary Syndrome and Both Type 1 and Type 2 Diabetes Mellitus: https://medscape.com/viewarticle/759835_5

Clinic, C. (2017, March 3). Polycystic Ovary Syndrome. Retrieved November 28, 2017, from Cleveland Clinic: https://my.clevelandclinic.org/health/articles/polycystic-ovary-syndrome

Gambineri, A. P. (2012, Sept). Polycystic Ovary Syndrome is a Risk Factor for Type 2 Diabetes. American Diabetes Association Diabetes, pp. 2369-2374.

Sex Hormone Binding Globulin and PCOS. (n.d.). Retrieved November 28, 2017, from PCOS.com: https://pcos.com/shg6-sex-hormone-binding-globulin-and-pcos/

Spero, D. (2016, October). Pcos (Polycystic Ovary Syndrome and Diabetes. Retrieved from Diabetes Self-Management: https://www.diabetesselfmanagement.com/blog/pcos-polycystic-ovary-syndrome-diabetes/

Willis, D., Watson, H., Mason, H. G., Brincat, M., & Franks, S. (1998). Premature response to luteinzing hormonne of granulosa cells from anovulatory women with pcos: relevance of mechanism of anovulation. Journal of Clinical Endocrinology Metabolism, 3984-3991.

 

Focus Forward!

by Leave a Comment

Focus Forward on your future versus living by default.

The world can be a very scary place. I have a fear of heights. If I were walking on that bridge I would be frozen if I started looking around. Focus forward and be determined to put one foot in front of the other.  Your health is like that too.

Most of us live by default, taking care of the business at hand, instead of planning for your future. But when it comes to your health, prevention is the best medicine.

We all do preventative health, like taking vitamins or brushing your teeth or vaccinating our kids. We know the value of prevention. But it is easier to live by default. For example, not making a plan to include exercise in your daily routine is so much easier than failing to do your exercises.

None of us want to face failure! When you make plans you run the risk of failing to complete it. So we just don’t plan for our future. I call this living by default.

We get busy! Or we fill our days with things to do. But what if you set a priority on your future health? How would that change what you do every day?

Sometimes we need a motivation and sometimes our body gives us a hint like high blood pressure. Your doctor puts you on a prescription for blood pressure and you start to think about what you are doing that contributes to it. Doctor says cut down on fatty foods and avoid salt and of course lose weight.  We might watch our diet, we might try to avoid adding salt. What if your doctor said, “High blood pressure is the first sign of heart failure.” Would you take it more seriously? Would you start to look at your genetics to identify who died of heart disease? What did they do wrong?

Many chronic conditions are a result of things we do in our everyday lives that contribute to our future health over years. For example: take weight gain.  Most of us gain a little more weight each year of our lives. When you live by default, you have the attitude of ‘I’ll get around to it later.’ When you focus on your future health, you don’t let it build up. You see what is happening and take action.

Sometimes you are motivated by your own body. Personally, I have arthritis in my knees and when I gain weight, my knees hurt and I start doing less due to chronic pain. I don’t want to live that way.  I make a conscious choice to change it. But many people need a support buddy.

A support buddy is key to avoid living by default. You can do this through a social media group or individual counseling. My point, “Focus Forward!” on your future for your family. Your family needs you at your best!

Genetics is not everything. You can overcome your genetics through healthy living. Make the decision to make your life a high priority.

Remember – Knowledge is Power

Could cell phones be causing weight gain?

by Leave a Comment

Can cell-phones cause weight gain?

I-phones have been around for 10 years now. They have revolutionize our lives. Never before did we have the internet in our pocket and accessible at all times. Multiple articles have been written about people doing stupid things while being glued to their phone.
Is it possible that i-phones are the cause of weight gain? Think about it.

When counseling people concerning the need to increase exercise, they are advised to be aware of their amount of “screen-time”, which includes television viewing, computer games, movies, and even i-phones. Increased screen time means you are not up and moving around.

There are many many changes that have happened in our society in the past decade or two. Think back on how the life of your parents or grandparents was different. I bet your grandmother did not have to work outside the home plus she cooked most of their meals from scratch. I know when I was young, my mother and grandmother made extra money doing other people’s laundry at their homes. We felt lucky to eat out once a week. Most restaurants want you to really enjoy their food (as compared to their competitors), so they add extra sugar, salt and fat. If you are eating most of your meals out, you are getting those hidden calories. Are you beginning to understand the cause and effects of some of our cultural changes?

Other cultural changes include increased serving sizes. For example, the original cupcakes were about a third of the calories of the ones today. Many jokes have been made about super-sizing servings. But it is real and happening every day. Customers have demanded it therefore the food industry will provide it. For example – do you recognize “Grand biscuits” as normal size and the regular biscuits are too small? Have you looked at the difference in calories between the two sizes?

The internet in our pocket means quick fixes. Unfortunately with weight issues, there are no real results from quick fixes. Fad diets can sometimes result in in quick weight loss but it will not be maintained. To maintain weight loss, you need to change your daily habits. Chances are you are eating more calories on most days than you are burning up. One clinical sign of this is high triglycerides. If you require medication to control your triglycerides, you are eating more on most days than what you need, which will result in slow weight gain.

I believe many of our problems today stem from the changes in our society. You need to be willing to identify changes in your life that will result in a slow weight loss. This may include putting your i-phone down, increasing your activities and becoming aware of hidden calories.

My next blog will be about why fad diets don’t work in today’s world.

Watch for it!

First-aid box for emotions

by 1 Comment

First-Aid Box for Emotions

In today’s world of high stress, we often need reminders to take care of our emotional needs. Making a first-aid box for times of depression will help you be prepared for those times when you have the blues.

Please note: if you are suicidal, please seek professional help!

Here are some suggestions, please feel free to add you suggestions to this list!

A Journal. As a teen, many of us had a journal. Writing helps us to allow our mind to go in different directions. So many times, when you give yourself the opportunity to slow down through writing, your own thoughts will reveal your best solutions. If you need a subject to get started, you can always count your blessings. Many times thinking about the advantages you have will change your perceptions. Being depressed is a result of your perceptions. Changing one thought can change your whole day.

Mementos! Make a box with a few of your favorite things. Mementos help us recall better times. Sometimes it is the soft touch of a stuffed toy or the smell of something that brings back your memories of good times. Pictures help us remember those people who connect with us on a personal level. Take pictures of bigger items, and make real copies of your pictures so you can hold them in your hands. There are many different kinds of mementos, but try to keep your box small.

Music! Your favorite songs will improve your mood. Songs from your childhood can bring a smile back to your face. Whatever music from your past, keep a copy of it. Remember to play your music when you are blue. Also, if the electricity goes out, have a printout of the lyrics. You can sing them and really put a smile on your face and everyone else. Music is powerful. Remember to use it!

Inspirational quotes and encouraging articles or books. We all have quotes we admire. Write them onto 3” x 5” cards and include them in your first-aid box. Make notes of inspiration from books you have read. Print off an encouraging article and keep it in your box. Any time you find something that gives you a lift, write it down and add it to your box. If you are religious, include Bible verses.

Candy? Be careful, foods can draw bugs. But individually wrapped candies could be added, in which the quick acting carbohydrates can give you a lift. Just don’t get carried away!

Contacts. Be sure to keep a written list of people you can call. Sometimes we lose track of people. It is important to reach out for help. It may be someone from your past. Keep their contact information in your first-aid box.

Our situation in the United States could change quickly. Nobody knows what is going to happen next. Bad storms could knock out the electricity for days. Earthquakes could change everything. It is always best to be prepared. Taking time now to consider your emotional needs will help you and your family. Others will appreciate your efforts too.