Kids at Risk For Diabetes

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

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Children need activity every day!

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Children need activity every day!

Being active for children means being active every day. Adult exercise goals are 150 minutes each week. But children need activity every day for at least 30 minutes.

Cut down on screen time!

Kids need to cut down on computer time and video games.  They need encouragement to disconnect. Put a timer on them and make a record of how much time they are spending. Be the parent, stand firm. Use screen time as a reward.

Every day children need to go for a walk, or play at their playground.

3-5 times a week they need a cardio workout that will develop a healthy heart and lungs. There are many different kinds of aerobic exercise. It is important to increase their heart rate into a cardiac range. That range should be determined by your doctor.

Aerobic exercise examples:
  • step exercises
  • cross country running
  • rowing
  • stair climbing
  • wind surfing
  • racquetball
  • tennis
  • squash, you get the idea.

There are many different kinds of aerobic exercise. It is important to increase their heart rate into a cardiac range. That range should be determined by your doctor. One of the easiest way to encourage this type of activity is to get them into an organized sport. Even golf can get them motivated.

In addition, children need muscle strengthening and stretching exercises at least 3 time a week.

Muscle strengthening exercise examples:
  • weights
  • resistance bands
  • calisthenics like push-ups, jumping jacks, or lunges.

It is easy to stretch before you do the muscle strengthening routine and afterwards as a
cool down.

Start slow with 30 minutes each day. Set a goal of 60 minutes per day. Keep a record of all your exercise.

Record your progress on a calendar and celebrate your success!

Remember, a little progress everyday will become a healthier lifestyle over time.

Find an activity that they enjoy doing!

Schedule a time and commit to doing it.

Make your family’s health a priority!

This really is a lifestyle change.  It is so important to help control your weight and exercise is a great way to improve your health. Get started, you’ll feel better.

PRECAUTION NOTE: Before beginning any exercise program consult your physician.

Complications from elevated blood sugars include hypertension, cholesterol problems, eye problems, heart disease, peripheral vascular disease, foot problems, kidney disease or gastroparesis. Adults may be requested to complete a graded exercise evaluation before starting any exercise program due to these complications.

Do you need encouragement to increase your daily activities?  That’s what a life coach does! Email me if you have questions, Julie@kidsatriskfordiabetes.com. Also check out my 30 day virtual course for your whole family! Or schedule a call with me to discuss your specific needs.

Syndrome X

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Syndrome X, aka Metabolic Syndrome or Obesity Syndrome

Syndrome X is a diagnosis you might here if you are at risk for a chronic disease, which is also known as Metabolic Syndrome. This is a group of health conditions that puts an individual at risk for chronic health problems like heart disease, strokes, and diabetes, plus high blood pressure and obesity.

Metabolic syndrome includes: (you must have at least 3 risk factors for this diagnosis)

  • A large waistline or apple shape body
  • High total cholesterol (LDL, HDL  & VLDL)
  • Low HDL cholesterol (HDL improves your blood vessels)
  • High triglycerides (caused by daily overeating)
  • High blood pressure or taking medication for high blood pressure
  • Fasting blood glucose over 126 (early signs include blood glucose 100-125)
  • Other risk factors are your genetics and your age.

Insulin resistance increase your risk for an apple shaped body. Not everyone who gains weight develops an apple shape. However, insulin resistances causes fat to be deposited within your abdominal cavity.

Another common problem in metabolic syndrome is unacceptable levels of triglycerides. Many times triglycerides go up when people eat more calories during the day than they are burning. If you have above range triglycerides or are taking medications to control your triglycerides, then you are at risk for chronic disease.

If your LDL (low-density cholesterol) levels are high, that is another risk factor for a Syndrome X diagnosis. Cholesterol is often a reflection of the food you eat. Typically this is a high fat diet. It amazes me how many adolescents today are on cholesterol lowering medications. If you don’t know your cholesterol numbers, then you need to consult your medical provider and seek a blood test. Total blood cholesterol should be less than 200. If you are taking a medication to lower your cholesterol, then technically you have this medical diagnosis.

Metabolic syndrome includes blood pressure higher than preferred. I will say, trying to get accurate blood pressure reading on teens is difficult at best. First, acceptable pediatric blood pressures are difficult to pin down. You need to be educated in pediatric medicine to know what is acceptable. (Don’t go to the drug store with your children and get a reading; adult blood pressures are different from children’s numbers. Even adult sized machines can give wrong information for children.) Teens blood pressure can swing with changing thoughts (ask them about their personal problems and it will jump quickly).

My point: if a teen is taking medication for blood pressure, then they have been diagnosed with a health problem. At that time, the blood pressure may be within normal ranges, but they still have the diagnoses. This places them at higher risk for chronic disease like heart disease and kidney disease.

Metabolic Syndrome Risk Factors include:
  • insulin resistance
  • stress
  • diet (sugar-sweetened drinks)
  • genetics & age
  • low physical activity
  • disrupted sleep patterns
  • mood disorders
  • excess alcohol
  • smoking (tobacco and other substances)
  • chronic inflammation
  • other chemical imbalances in the blood.
Metabolic Syndrome Associated Health Conditions include:
  • Polycystic ovary disease
  • Erectile dysfunction
  • Hyperuricemia (uric acid in the blood)
  • Acanthosis nigricans
  • Fatty liver & Non-alcoholic fatty live disease

(More later on teens with fatty liver disease. I have been absolutely amazed at the number of preteens that I have seen diagnosed with fatty liver disease!)

 

Source:  National Heart Lung & Blood Institute  www.nhlbi.nih.gov/health/health-topics/topics/ms

https://en.Wikipedia.org/wiki/Metabolic-syndrome

 

Children at Risk for Adult Diabetes

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Children at risk type 2 diabetes due to obesity

In previous generations, the medical profession had few occasions to monitor children for adult health issues. Today, children are experiencing increasing problems with high blood pressure, high cholesterol and other health problems related to obesity. Although obesity is ever increasing in children, many times our health care system is lagging behind in identification and approved treatment.   

Obesity is the main cause for kids being at risk for Type 2 diabetes and heart disease. Children are classified as overweight who are above the 85th percentile for age and sex. To be classified as obese, a child’s BMI will be over the 95th percentile for age and sex or their weight is greater than 120% over ideal for height(1). But being at risk for diabetes is much more than just a weight issue.

First: If one or both parents have been diagnosed with diabetes, then the child has the genetics putting them at risk for diabetes.

According to the SEARCH study, at least 75% of youth diagnosed with type 2 have at least one close family member who has diabetes. (Close family members include mother father sisters or brothers.)  (searchfordiabetes.org)

Second: If the child’s BMI (body mass index) is over 28, it indicates that their life-style places them at additional risk. 

BMI can be misleading on its own. You should also consider waist circumference. (http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html)

(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851850/) 

Third: If they have high blood pressure. This one is tricky because blood pressure can be affected by many things including anxiety. If you or your child become anxious about going to the doctor, then chances are your blood pressure will be elevated. Taking several deep breaths before taking the blood pressure can help. It is important to get an accurate reading. 

If you would like to monitor a child’s blood pressure, there are automatic machines available at most pharmacies and many department stores. I recommend using one of these machines because they are more reliable (ensure accurate readings) as compared to home monitors. Doctors are wanting blood pressure reading less than the 90th percentile on at least three measurements.(2) You can refer to the CDC guidelines for these recommended values.

(http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module3/text/bloodpressure.htm)

The rule of thumb for children age 7-15 years old is: multiple 2 times your child’s age and add 90. This gives you the median for systolic pressure (the upper number). For the diastolic (lower number) subtract 30-45 from your systolic number. This is just an average number, the number you get can be higher or lower (for more information see: http://www.fpnotebook.com/CV/Exam/PdtrcVtlSgns.htm)

Fourth: Dyslipidemia. Now that is a big word! It means high cholesterol or high triglycerides. You need a fasting blood test to check for these conditions. Ask your doctor for this information.

Fifth: High Blood Sugar. Teens with a fasting blood glucose (FBG) 100 – 125 mg/dL or a random blood test greater than 199 mg/dL are at risk. For children younger than their teens, you should consult your pediatrician for this information. A1C is a non-fasting blood test. The results will vary with the age of your child. 

A1C is not recommended to use to diagnose diabetes in children so it may not be covered by insurance. It is a good indicator if your teen’s tolerance to sugar is a problem. Younger children run higher blood sugars and the A1C test is not recommended for them. The readings for A1C are determined by the age of the child and industry standards have NOT be determined (as of this writing).

American Diabetes Association recommends testing asymptomatic youth for Type 2 if they are overweight plus any 2 of the following risk factors:  

  • Diabetes screening should be repeated every three years.
  • Family history of Type 2 in first or second degree relatives
  • Native American, Latino, African American, Asian or Pacific Islander ethnicity
  • Mother with a history of gestational diabetes during the child’s gestation
  • Signs of insulin resistance or conditions associated with insulin resistance including acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome or small for gestational age birth weight(3)

Symptoms of high blood sugar include:

  • Unusual Thirst (they can’t drink enough)
  • Frequent urination (going to the bathroom more than once in the night)
  • Headaches, especially after eating sugary foods
  • Tired, no energy; especially after a meal
  • Unusually hungry; (I have seen these kids start eating two full lunches – this indicates a hormone imbalance)
  • Anxious (there are times when they want food NOW)

For more information about how to teach your kids and your family good habits for a healthy future, check out my healthy kids and family 30 day virtual program.

1) American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care. 2013;36 (suppl 1): S11-S66.

2) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report. Pediatrics. 2011;128 (suppl 5):S213-S256.

3) American Diabetes Association. Diabetes Care. 2013;36 (suppl 1) S11-S66

 

Prevent PCOS

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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!

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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

Munchies with Marijuana

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Munchies with Marijuana

Many states are passing laws to legalize marijuana for medical uses. Sometimes diabetics use this to treat diabetes related complications like pain from neuropathy. But beware – we all know marijuana increases your cravings (gives the munchies) and it usually is toward sweets…. This is because marijuana can temporarily lower your blood sugar.

Marijuana Effects Blood Sugar

Please check your blood sugar before you start eating. After all, pain can make your blood sugars too high. You don’t know if you have low or high blood sugar. Be careful of the snacks you consume. You will probably be craving sweets or salty snacks like popcorn or potato chips. Limited portions is important. Remember it takes 20 minutes for your stomach to communicate with your brain concerning feeling full. You should not be continuously eating for 20 minutes. If you are on insulin, you will need to take additional insulin to cover your snacks. This will enable your body to use the carbohydrates. If you don’t take extra insulin, you may continue to crave sweets.

If you want to contact me with more questions, email me at Julie@kidsatriskfordiabetes.com.