Running over the same old ground: exercise and diabetes
Filed under: Type 2, Lifestyle, Exercise, Daily News
Oh yawn, I thought to myself this morning. Upon turning on National Public Radio, I immediately heard what seems to be yet another report on diabetics and exercise. According to the results of a new study, the majority of people with Type 2 diabetes or at risk for it fail to follow through on their doctors' advice to get moving and get some good old-fashioned exercise to ward off the disease - or at least slow its progress. The study comes courtesy of a team of researchers at the University of Colorado, Denver. It's a sizable study, involving over 22,000 patients. The results are being published in Diabetes Care (February 2007) and basically conclude that fewer than forty percent of those advised to get exercise actually do so. Moreover, those most at risk are in fact the least likely to heed exercise advice. Dr. Elaine Morrato, who led both this study and an earlier one on a similar topic, says "People should exercise more, that story is out. What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'" Now, I hate to be a grumpy naysayer, but (to use an exercise-related metaphor) isn't this just a case of running over the same old ground? Is this study really contributing anything new? According to the NPR report, Morrato goes on to say that the results are "very pessimistic," but that she does not know the answer to what is perhaps the real question: how to change peoples' behavior. We already know there is a T2 diabetes epidemic going on. We already know that obesity and inactivity are to blame. Instead of studying the issue over and over, from every conceivable angle, shouldn't researchers be focusing on how to stop this national health train wreck that we're seeing? Am I being unreasonable? You tell me.
[RESEARCH] Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey
Objective To measure change in adult non-smokers' exposure to secondhand smoke in public and private places after smoke-free legislation was implemented in Scotland.
Design Repeat cross sectional survey.
Setting Scotland.
Participants Scottish adults, aged 18 to 74 years, recruited and interviewed in their homes.
Intervention Comprehensive smoke-free legislation that prohibits smoking in virtually all enclosed public places and workplaces, including bars, restaurants, and cafes.
Outcome measures Salivary cotinine, self reported exposure to smoke in public and private places, and self reported smoking restriction in homes and in cars.
Results Overall, geometric mean cotinine concentrations in adult non-smokers fell by 39% (95% confidence interval 29% to 47%), from 0.43 ng/ml at baseline to 0.26 ng/ml after legislation (P<0.001). In non-smokers from non-smoking households, geometric mean cotinine concentrations fell by 49% (40% to 56%), from 0.35 ng/ml to 0.18 ng/ml (P<0.001). The 16% fall in cotinine concentrations in non-smokers from smoking households was not statistically significant. Reduction in exposure to secondhand smoke was associated with a reduction after legislation in reported exposure to secondhand smoke in public places (pubs, other workplaces, and public transport) but not in homes and cars. We found no evidence of displacement of smoking from public places into the home.
Conclusions Implementation of Scotland's smoke-free legislation has been accompanied within one year by a large reduction in exposure to secondhand smoke, which has been greatest in non-smokers living in non-smoking households. Non-smokers living in smoking households continue to have high levels of exposure to secondhand smoke.
Mid-air crash involving radio host had diabetes link, contend US lawyers
Filed under: Type 2, Daily News
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Vehicle crashes happen all the time. Crashes involving diabetic drivers who lose control at the wheel are just a small minority of those crashes, but they also seem to happen with alarming frequency. Just sifting through recent news this morning I found two examples, one in Wisconsin and one in the UK. But here's a less-common scenario: a diabetic losing control at the wheel of a plane. US lawyers blame pilot and radio host Bob Collins (pictured) for the mid-air collision that occurred near Waukegan seven years ago. The crash killed Collins as well as his passengers and the pilot of the other plane. It's sad that now, years later, the government and the victims' families are still wrangling over who is to blame for the tragedy. The Chicago Sun-Times reports that the families blame the Federal Aviation Administration, saying the safety equipment at Waukegan Regional Airport was inadequate. They are suing the government. Government lawyers, however, contend that Collins is to blame: that he was in poor health due to his diabetes and that he should not have been flying. The Sun-Times describes the testimony at trial of Collins' widow, Christine. According to her, Bob's diabetes was under control. She maintains he was not having problems with shortness of breath or vision - the kinds of diabetes-related complaints that could possibly have caused the crash. Bob Collins was the host of a show on the radio station WGN. Stay tuned to see how this case pans out.
[RESEARCH] Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey
Objective To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006.
Design Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation.
Setting Scotland.
Participants 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation).
Outcome measures Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation.
Results The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland—a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation.
Conclusions The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation.
My Friend, Jeff - the Trucker
Filed under: Type 2, Adult Onset, Lifestyle, Research, Opinion, Services
About a year ago, I met a guy named Jeff Mather. Well, we never met, personally. But we spoke many times over the phone about diabetes and how it has affected our paths in life. Jeff had lost his job, the one he had for over 10 years. The job he wanted to have since he was a little kid. According to Federal Safety Guidelines, if a trucker takes insulin - they are no longer safe to drive across state lines.
Jeff wrote letters every day. He posted to online forums. He contacted politicians and pleaded to every diabetic organization in existence to get him back on the road. And sure enough - his perseverance paid off. He took his predicament all the way from Washington D.C to National Public Radio. The story on NPR included details on how Jeff was able to qualify to drive again.
While diabetes advocates are pleased that it's now easier for truckers to keep their jobs when they go on insulin, they're not entirely happy with the way that the Federal Motor Carrier Safety Administration (FMSCSA) will decide whether a trucker is safe to drive. In order for a trucker to be considered "safe" to drive, his HgA1c must be between 7 and 10. This means that in order to keep trucking - one must sustain a blood sugar between 140 mg/dL and 200 mg/dL. Yes, this is flawed. I was going to use another choice F phrase to describe it.
FMCSA expressed it wants to see a higher test result because they feel people with lower scores who are aggressively managing their diabetes with insulin, may be more likely to have periods of very low blood sugar, or hypoglycemia, that could make them pass out or feel woozy. Diabetes expert Christopher Saudek, at Johns Hopkins Hospital, says the agency's reasoning is flawed. And he says it puts diabetics in a bind.
"Essentially what you're saying with this kind of a rule is that if you are controlling your diabetes at all well, if you get it to 6.8 or 6.5, then you're liable to lose your job," Saudek says. "So congratulations. Your A1c is in a good range, but you aren't going to be able to drive your truck anymore. That doesn't make any sense."
Jeff, I'm so proud of you for not giving-up. You're driving your truck and I'm sure you're doing it in good health. Enjoy all that you've worked so hard to regain. Best of luck to you!
Higher or Lower - How do you Like it?
Filed under: Type 1, Type 2, Childhood, Adult Onset, Lifestyle, Opinion, Support
The Rule when it comes to managing diabetes is maintaining a blood sugar between 80 and 120 mg/dL by all means necessary. This does not take into consideration that some people might function better with a higher blood sugar. For all intents and purposes this is for safety reasons. Clocking in at no higher than 120 mg/dL is evidenced to delay the onset of long-term diabetic complications.
However, in my blog about Jeff the Trucker, in order for Jeff to be considered safe to drive -- the Federal Standards said that he must maintain blood sugars between 140 and 200. Whereas conventional medicine says the safest range for blood sugars is between 80 and 120. If Federal Standards say that you can function better with a higher sugar - why is it that we are encouraged to keep them lower? I understand this from a clinical perspective this is to delay the onset of complications. But in reality - the complications result from the fluctuations in blood sugar level and not so much the level at which it is sustained.
So herein lies my question for all diabetics out there - do you feel better or worse when your blood sugar is 80 compared to a blood sugar of 130? Compare being high and being low - what are the strengths and weaknesses of each?
I'll start - I prefer my blood sugar to be higher (<120 mg/dL) rather than lower (<80 mg/dL). When I am higher I know I am never on the verge of being disoriented, uncoordinated, or likely to lose my ability to think clearly. Having a higher blood sugar allows me to continue on without worrying if I'm too close to having a reaction. My weakness of being high is the inconvenience of needing water - ice, cold water. Now how do you all feel about your highs and your lows? It's okay. I know it's frustrating as H-E-double hockey sticks to test, treat, and repeat - only to find that your numbers aren't always perfect. Tell me about it. No, really -- please, do!!
Taking care of women's hearts
Filed under: Heart Centers Online, Research, Women Heart Health
As you may know, The Cardio Blog is being retired today. It's been an honor to write for this blog, and I hope that the information we brought to you was useful and informative. Since this will be my last post for The Cardio Blog, I thought I'd write about a topic that is near and dear to my heart (pun, lamely, intended): women's heart health. We've seen it in the headlines again and again -- women, and often their doctors, don't always prioritize their health, and this seems to be especially an issue when it comes to heart health. But the fact is that heart disease is public enemy number one for women, and we all need to better understand and deal with our risk factors.
So I'll leave you with this post from Her Daily News. In it, they talk about Heart Truth, the National Institute of Health's campaign to bring heart education to women. They also include a checklist of questions to take to your doctor, as well as a list to help you understand your own risk. Do yourself -- and your heart -- a favor today and read through the questions to determine if you need to do more to protect your health.
Thanks for reading The Cardio Blog, and don't forget to come visit us at That's Fit for all of the latest news in health and fitness!
[RESEARCH] Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997-2003
Objective To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis.
Design Case-control study with self reported infections from a computer assisted telephone interview.
Setting National birth defects prevention study, a multisite, population based study including 10 surveillance systems for birth defects in the United States.
Participants Mothers of 505 offspring with gastroschisis and 4924 healthy liveborn infants as controls.
Main outcome measure Adjusted odds ratios for gastroschisis with 95% confidence intervals.
Results About 16% (n=81) of case mothers and 9% (n=425) of control mothers reported a genitourinary infection in the relevant time period; 4% (n=21) and 2% (n=98) reported a sexually transmitted infection and 13% (n=67) and 7% (n=338) reported a urinary tract infection, respectively. Case mothers aged <25 years reported higher rates of urinary tract infection alone and in combination with a sexually transmitted infection compared with control mothers. In women who reported both types of infection, there was a greater risk of gastroschisis in offspring (adjusted odds ratio 4.0, 95% confidence interval 1.4 to 11.6).
Conclusion There is a significant association between self reported urinary tract infection plus sexually transmitted infection just before conception and in early pregnancy and gastroschisis.
[RESEARCH] Folic acid supplements and risk of facial clefts: national population based case-control study
Objective To explore the role of folic acid supplements, dietary folates, and multivitamins in the prevention of facial clefts.
Design National population based case-control study.
Setting Infants born 1996-2001 in Norway.
Participants 377 infants with cleft lip with or without cleft palate; 196 infants with cleft palate alone; 763 controls.
Main outcome measures Association of facial clefts with maternal intake of folic acid supplements, multivitamins, and folates in diet.
Results Folic acid supplementation during early pregnancy (≥400 µg/day) was associated with a reduced risk of isolated cleft lip with or without cleft palate after adjustment for multivitamins, smoking, and other potential confounding factors (adjusted odds ratio 0.61, 95% confidence interval 0.39 to 0.96). Independent of supplements, diets rich in fruits, vegetables, and other high folate containing foods reduced the risk somewhat (adjusted odds ratio 0.75, 0.50 to 1.11). The lowest risk of cleft lip was among women with folate rich diets who also took folic acid supplements and multivitamins (0.36, 0.17 to 0.77). Folic acid provided no protection against cleft palate alone (1.07, 0.56 to 2.03).
Conclusions Folic acid supplements during early pregnancy seem to reduce the risk of isolated cleft lip (with or without cleft palate) by about a third. Other vitamins and dietary factors may provide additional benefit.
Free cholesterol screenings in September!
Filed under: Prevention, Services
Unfortunately it seems that even though heart disease is one of the biggest health threats we face today too many people are completely unaware of what their cholesterol levels are and what they should be doing about it. So in an effort to help educate people, and in honor of National Cholesterol Education Month, Polymer Technology Systems (PTS) will be offering free cholesterol screenings nationwide throughout the month of September. Find out your cholesterol numbers and get great info on steps you can start taking today at Kroger Pharmacy locations all throughout this month and at Sam's Club stores on September 15th. They'll be using the handy hand-held CardioChek gadget and giving information on where you can get one of your own if you want to keep track at home. Here's to good health!