The Glucose Club's Blog

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Gestational Diabetes In NSW

Christine Armarego - Monday, February 16, 2009

Posted by Christine Armarego
taken from
http://www.smh.com.au/national/diabetes-in-spotlight-as-babies-arrive-supersized-20090214-87mx.html?page=2

Diabetes in spotlight as babies arrive supersized

Danielle Teutsch

February 15, 2009

BABIES are being born bigger across NSW, prompting a study that involves women with gestational diabetes following special low-GI diets.

Researchers from the University of Sydney and Royal Prince Alfred Hospital will investigate whether diabetic women on such diets have smaller birthweight babies.

Last month, a 6.52 kilogram baby boy, Cordell Hayman, was born to a Wollongong mother with gestational diabetes - and doctors warn big babies like Cordell are becoming more common.

The percentage of NSW babies born heavier than 4 kilograms has risen from 10.9 per cent in 1990 to 12.1 per cent in 2005, data collected from midwives and published in annual Mothers And Babies reports shows.

A statewide study by the Royal North Shore Hospital and University of Sydney researchers tracking NSW birthweights over the same period is expected to uncover a similar trend. The study will be published next month in the Medical Journal of Australia.

RPA endocrinologist Dr Tania Markovic said gestational diabetes, which affects almost 5 per cent of pregnant women, was one reason for higher birthweights. It increased by 45 per cent in NSW between 1995 and 2005. Maternal obesity was the main reason why Dr Markovic was treating more and more women with gestational diabetes.

She and researchers including University of Sydney professor Jennie Brand-Miller will monitor diabetic women on low GI-diets over a two-year period and measure their babies' body fat, as well as health.

"We know that bigger babies are at risk of metabolic disease such as diabetes, hypertension and fatty liver disease," Dr Markovic said.

Dr Danny Challis, clinical director of Obstetrics and Fetal Maternal Medicine at the Royal Hospital for Women, said birthweights had increased during his 20 years at the hospital. He said large babies resulted in delivery complications such as shoulder dystocia,

where the shoulders of the baby get stuck during birth, which can cause injury and death. Large babies also resulted in more

caesarean deliveries, he said.

Kerrie Barry - mother of Cordell - knew she was going to have a big baby when her partner, Glenn Hayman, measured her girth circumference at 140 centimetres.

An ultrasound at 35 weeks gestation estimated her baby was already a whopping 6.1 kilograms. Cordell was delivered by scheduled caesarean last month at 36 weeks, weighing 6.52 kilograms - almost double the average birthweight in Australia [3.37 kilograms]. Ms Barry had gestational diabetes, which was diagnosed early in the pregnancy, and she had twice-daily insulin injections. Her daughter, Bree, 4, weighed almost 5 kilograms at birth. Cordell is now home from Wollongong Hospital and is "pretty placid", according to his mum. He wears clothes to fit a three-month-old baby and wears crawler nappies.

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Fighting obesity and keeping the kids healthy

Christine Armarego - Friday, January 16, 2009

Fight obesity and keep the kids healthy.

It’s always in the papers and on TV – Childhood obesity. It’s in epidemic proportions and not much seems to be slowing it. The great concern is that over weight children lead to overweight adolescents and in turn overweight adults. According to David Menschik, MD, MPH, from Johns Hopkins University in Baltimore "It is generally accepted that increased physical activity, independent of weight status, has many healthful effects throughout the lifespan, including increased bone mineral density, improved lipid profile, increased cardiovascular endurance, improved glucose metabolism, increased muscle strength, and lower blood pressure. In adolescents, increased physical activity has been linked to lower tobacco and marijuana use, less television watching, higher fruit and vegetable consumption, less depression, closer relationships with parents, and decreased social marginalization.”

One study has found that adolescents who are regularly physically active show less risk of becoming overweight as young adults – doesn’t sound like rocket science right? True, but the study shows some interesting relationships that might help people – teachers and parents alike, to take action and help to prevent their children falling into the overweight category. They found that each weekday that adolescents participated in Physical Education reduced the odds of being an overweight adult by 5%. This is a very clear indication of the importance of school-based activities. How many PE sessions per week does your child or teen participate in?

The authors are very clear about the regularity of PE sessions in maintaining normal adolescent body weight rather than weight reduction. Also they found that activities such as rollerblading, cycling, skateboarding and sports such as baseball, softball, basketball, soccer, swimming, and football were all associated with a lower prevalence of overweight as young adults. Activities such as gymnastics, dancing and jogging and walking didn’t show a strong relationship. Perhaps it is the intensity, competition, duration and the capacity to participate in these activities in a local adult competition in a social setting that sets it over and above the second list.

Essentially the message seems to be that getting kids moving as a part of their everyday routine in sports or activities that they can continue into adulthood is the key to maintaining healthy weight and activity levels and schools seem to have a large role in this. Other studies from the UK (Sacher et al 2006) specifically targeting children are working together with parents to give them the tools to help children change their eating and activity habits and theirs in the process. They have shown significant decreases in waist circumference and body mass index and improvements in their hours of physical activity.

Posted by Christine Armarego
References:
1.Laurie Barclay, Désirée Lie, MD, Brande Nicole Martin Arch Pediatr Adolesc Med. 2008;162:29-33.
2. Sacher PM, Chadwick P, Kolotourou M, Cole TJ, Lawson M, Singhal A. The Mend RCT: Effectiveness on Health Outcomes in Obese Children. International journal of Obesity. 2007 31 S1

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Gestational Diabetes - What is it and exercise can I do?

Christine Armarego - Wednesday, January 14, 2009

Gestational Diabetes

Becoming pregnant catapults you into a whole new world. There are so many things to consider, what name to choose, nursery colour scheme, what pram will suit all your needs and the all-important one do you tough it out and have a natural birth or do you cruise through with chemical support. So many things to consider and such little time! One thing that is rarely on people’s pregnant radar is how are your blood glucose levels going? Gestational diabetes is a very real concern for more and more women. Between 3 and 8% of pregnant women will go on to develop Gestational Diabetes in the second and third trimesters of pregnancy (around 24 to 28 weeks).

Gestational Diabetes is a temporary form of diabetes where women have difficulty managing their blood glucose levels. What causes it? Some of the hormones produced by the placenta are thought to interfere with the action of insulin (a hormone that carefully controls our glucose levels) so that the mother’s body becomes “resistant” to insulin. When the body becomes resistant to insulin, glucose levels no longer stay stable and tend to fluctuate.

It must be noted that Gestational Diabetes is very different to someone that had diabetes and then became pregnant. Gestational Diabetes is temporary and usually goes away after the baby is born.

Gestational Diabetes does leave you at risk of some other conditions. First of all women who develop Gestational Diabetes are at a greater risk (30 to 50%) of going on to develop Type 2 diabetes later in life. They are also thought to be of greater risk of developing pre-eclampsia (high blood pressure during pregnancy). In terms of the effect on the baby, babies are often born at a heavy birth weight and this is due to the high levels of insulin in the baby’s blood stream. High insulin levels turn the body into storage mode and leads to weight gain.

Who is at risk?
•   Women over the age of 35 years
•   Have previously had Gestational Diabetes
•   Have a family history of diabetes
•   Women who are overweight
•   Indigenous Australians, Polynesian, Chinese, Indian and Middle Eastern ethnic backgrounds

One of the most important factors that can prevent or control Gestational Diabetes is physical activity. Regular exercise helps to control blood glucose levels by increasing insulin sensitivity. In other words following exercise insulin works much better in the body. A recent study of 22,000 pregnant women found that women who performed regular physical activity prior to pregnancy were far less likely to develop Gestational Diabetes. Interestingly the same study showed that women who spent 20 h/wk or more watching TV were at greater risk of developing Gestational Diabetes than women who spent less than 2h/wk watching TV.

Not only is it a great idea to exercise before you fall pregnant but it is also important to remain physically active during the pregnancy. The American College of Sports Medicine recently released a statement providing clear evidence for the benefits of physical activity for both baby and mother. They showed that in addition to controlling blood glucose levels exercise during pregnancy had the following benefits:

•   Improved recovery from the birth
•   Improved posture
•   Stronger back muscles to reduce back pain
•   Improved sleep quality
•   Stress relief
•   Body weight management
•   Improved mood
•   Greater ability to cope with the demands of motherhood

However when you are pregnant there are some guidelines you need to follow to ensure that you are exercising correctly and safely, they are:

•   In the later stages of pregnancy your body starts to release a hormone called relaxin. This softens ligaments and obviously puts them at greater risk of injury. So avoid high impact jarring exercise in the later stages of pregnancy.
•   In the second trimester you often see changes in blood pressure, therefore avoid quick changes in body position, ie. Move slowly from lying/seated positions to standing.
•   In the past it was generally considered unwise to exercise at a heart rate above 140 beats per minute. However this advice does not take into account a number of things. First, it does not consider the fitness level of individuals. For example people who are athletes or were very fit before the pregnancy can exercise at a higher intensity then someone who is not very active. Secondly, it does not take into consideration a woman’s age, should the heart rate target for an 18 year old woman be the same as a 42 years old woman? The current advice around intensity is to go by how you feel. Women are recommended to work at a maximum intensity of somewhat hard, this means that you are working at an intensity that challenges you but is manageable. Of course always discuss and consult your medical professional before starting any exercise plan.
•   After about 4 months of pregnancy avoid lying on your back for long periods as the weight of the baby can compress the veins and arteries going to the heart.
•   Be aware that as the baby grows your centre of gravity is shifted and may affect your balance.
•   Avoid letting yourself get too hot, don’t exercise in the heat or to the point where you are excessively sweating.
•   Most of all listen to your body and when it is telling you that you need a rest, take it!

Posted by Christine Armarego 14/1/09
Reference:
Zhang, C. Solomon, C.G. et.al A prospective study of pregravid physical activity and sedentary behaviours in relation to the risk of gestational diabetes mellitus. Arch Intern Med 2006 Mar 13; 166(5): 534-538.

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Exercising in Summer - Safely with diabetes

Christine Armarego - Tuesday, January 13, 2009

Exercising in Summer Safely!

One of the biggest challenges to a regular exercise routine is cold, miserable weather. We have all woken up early in the morning, strapped on the runners only to hear that freezing cold wind, suddenly the excuse board comes out and we convince ourselves to stay in bed. As summer rolls around and day light savings kicks in we tend to be more active and spend far more time in the sun. While we welcome the hot days and sunny weather, they do bring some significant dangers such as, skin damage and heat stress.

Exercising in hot conditions is vastly different to exercising in cool conditions. When we exercise the body generates heat that it needs to get rid of, add hot weather to the mix and you can get a lot of heat building up in the body. When you have more heat being absorbed into the body than is lost you run the risk of heat stress.

How the body gets rid of heat?

Step 1. When your temperature starts to rise, more blood is pumped towards your skin to try and cool your blood down. This is why your skin gets redder in the heat.

Step 2. Once the blood gets near the skin it relies on the outside environment to take the heat away. Usually it is the air around our body that absorbs the heat. If we are in water it is the water that absorbs the heat.

Step 3. If this is not enough to cool us down the sweat glands kick in. You have about 4 million sweat glands over the surface of the body. When sweat comes in contact with our skin, the hot air makes the sweat evaporate and we get a cooling effect. The amount of sweat that is evaporated off our the skin depends on:
•   How much skin is exposed (the more skin you expose to the air the faster you cool down)
•   How humid the air is (When humidity is high, the air is saturated with water and the evaporation off your skin is reduced. A sign that sweat is not being evaporated is when you have beads of sweat rolling or dripping off you)
•   Speed of the air over the body (The quicker the speed at which the air moves over our skin the quicker the heat is lost. This is why fans cool us down more than still air.)

When you can't get rid of excess heat it starts to build up in your body and you are at risk of heat stress.
The signs of heat stress are:
•   Rapid pulse
•   Dry swollen tongue
•   Weakness
•   Light-headedness
•   Confusion
•   Clammy skin
•   Fatigue
•   nausea
•   Vomiting

What to do if someone has heat stress:
•   Move them to a cool area
•   Remove excess clothing
•   If conscious give them water to sip
•   Cool with cold compresses, rapid fanning and water

Here are some simple tips to follow in the summer months to protect against heat stress and skin damage.

1. Get your timing right: Avoid exercising in the hottest part of the day, this is between 11am and 3pm. Early morning or late afternoon is the best time to get active in summer.

2. Wear the right gear: Exposing lots of your skin to the environment helps to maximise evaporation however it leaves you at risk of sunburn. This problem has been solved by ASICS who have brought out an excellent range of exercise clothing that feature moisture wicking and breathable material to allow you to regulate your temperature better. They are also treated so that they have UV protection, equal to wearing SPF 15+ sunscreen. Is it essential to have good quality exercise clothing that will protect you from the sun’s damaging rays while keeping you cool. You will be able to find them in any good sports store.

3. Stay Hydrated: The most effective defence against heat stress is adequate hydration. Proper hydration levels help to maintain the right plasma volume in your blood to keep circulation and sweating at an optimal level. Before you head out to exercise is a great idea to consume 500ml of cold water 20 minutes (why cold water? Cold fluids are emptied from the stomach at a faster rate then fluids at body temperature). During exercise drink 250ml of water every 15 to 20 minutes. Don’t worry about drinking water while you are exercising, the absorption of water from the stomach is not retarded by exercise.

4. Keep it simple: Water is the best way to stay hydrated, consumption of drinks that contains concentrated simple sugars can actually slow down the rate at which fluid is absorbed from the stomach.

As we all know people with diabetes have to ensure that they look after their feet. This is essential during the warmer months. When exercising in warmer temperatures there is a great chance of your feet sweating. Sweaty feet are more susceptible to the following:

•   Increased friction between your feet and the shoe
•   Cracking and splitting of the skin especially between the toes
•   Fungal infections like tinea, as these love warm, wet and dark areas

In addition another hurdle is that in the heat feet tend to swell, especially as the day goes on. What this means is that in the summer months you are putting a larger foot in your shoes. This creates great rubbing and friction and more chance of foot damage.

Here are some foot wear tips for summer:

1.   Stay Dry: Regularly change your socks so that they stay dry during exercise. Also choose cotton rather than synthetic socks

2.   Air Out: After wearing them make sure you air and dry out your shoes

3.   Allow for the swell: When buying shoes in summer, buy them in the afternoon when your feet are at their most swollen

4.   Get the best: The quality of your shoes is not something you should compromise on. The premier exercise shoe for people with Diabetes is the GEL-Assist and GEL-Cardio by ASICS. They are specifically designed to meet the criteria put forward by Diabetes Australia. They have a one piece upper with no exposed stitching inside the shoe to minimise rubbing and friction.
Posted by Christine Armarego

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New research confirms fibre & Low GI important for people with diabetes

Christine Armarego - Monday, January 12, 2009

Recommended Diet for Diabetics May Need Changing, Study Suggests

By RONI CARYN RABIN

Published: December 18, 2008
http://www.nytimes.com/2008/12/19/health/19diet.html?_r=1&ref=health

People with Type 2 diabetes on a high-fiber diet kept their blood sugar under better control when they ate foods like beans and nuts instead of the recommended whole-grain diet, researchers have found.

Beans and nuts are among foods that only modestly increase blood glucose levels; scientists describe these foods as having a low glycemic index. The new study, which lasted six months, is one of the largest and longest to assess the impact of foods with a low-glycemic index, researchers said.

Participants on the low-glycemic diet also saw significant improvements in cholesterol after six months, with increases in HDL, the so-called “good” cholesterol associated with a reduced risk of heart disease, the study found.

“That’s an important issue today, because there’s a double whammy for people who are diabetic," said Dr. David J. A. Jenkins, lead author of the report and a professor of nutritional sciences at the University of Toronto. "If they’re men, they have twice the risk of heart disease, and if they’re women, they have four times the risk. If you can hit the heart disease to which they’re particularly vulnerable, you may have something useful."

“Pharmaceuticals used to control Type 2 diabetes have not shown the expected benefits in terms of reducing cardiovascular disease,” he added.

The study was published on Tuesday in the Journal of the American Medical Association.

Some 210 patients with Type 2 diabetes were randomly assigned to a low-glycemic diet or a high-cereal, high-fiber diet.

The high-cereal high fiber diet emphasized “brown foods” such as whole-grain bread and breakfast cereal, brown rice and potatoes with the skin on. The low-glycemic diet included beans, peas, lentils, pasta, quickly boiled rice and certain breads, like pumpernickel and rye, as well as oatmeal and oat bran cereals.

Both diets are low in saturated fat and trans fat. Both groups were told to limit their consumption of white flour and to eat five servings of vegetables and three servings of fruit each day.

Participants on the low-glycemic diet saw their hemoglobin A1C levels — a measure of blood glucose levels over recent months — reduced slightly, by 0.5 percent on average, but experienced significant improvements in HDL, which increased by 1.7 milligrams per deciliter of blood on average. Those on the high-cereal diet saw smaller reductions in hemoglobin A1C and slight drops in HDL.

Dietitians who work with people who have Type 2 diabetes said earlier studies had not demonstrated the benefits of low-glycemic index foods as clearly as this report.

“We’ve been telling people to eat whole grains for a long time," said Emmy Suhl, a nutrition and diabetes educator at the Joslin Diabetes Center in Boston. "What this study shows is that it’s not enough to have whole grains. It’s these very specific low-glycemic carbohydrates that do a much better job."

But, she said, following such a diet is complicated, since the glycemic index of a food can change depending on how it is prepared and served.

“People tell us again and again that diet is the hardest part of diabetes management,” she added.

Posted by Christine Armarego - Printed in New York Times in 18th December 2008

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Fitness Vs Fatness

Christine Armarego - Monday, January 12, 2009

Thin vs. Fit - where does your focus lie?

Brace yourself for some good news, we finally have scientific proof that you can have your cake and eat it too - just as long as you run to the shop for it! Groundbreaking research from the Cooper Institute in Dallas, Texas, has completely changed the way we look at the health benefits of exercise. For many years we have known that people who exercise live longer, than people who don’t. However it was thought that the reason for the life preserving effect of exercise was due to the fact that it kept you slim and therefore protected you from various life threatening diseases associated with being overweight (heart disease, diabetes, cancer, to name a few). However this study from Texas has shown that in terms of living longer, it is more important to be fit than to be thin. Yes you heard right, it is more important to be fit than thin! Your fitness level has a significant impact on your chances of dying, irrespective of how much excess body fat you’re carrying. Specifically the study showed that individuals who had the lowest fitness levels were 4.6 times more likely to die at any point than individuals with the best fitness levels. Hence, an overweight person who exercises regularly will live longer than a thin person who is unfit.

One of the main reasons why this finding is so exciting is that in the past we judged the success of an exercise program by how much weight we lost. Many of us would start exercising and if we hadn’t lost weight after two weeks we would think, what is the point? Well there is a point!

“These findings have placed a new perspective on the benefits of exercise for those persons who are overweight or obese,” says Ryan Ellmoos, an Exercise Physiologist. “This research provides an excellent source of motivation for people who are exercising but may not be experiencing significant reductions in weight, they can exercise knowing that they are receiving huge health benefits even if they are not getting any lighter.”

This new perspective is also having an effect on the medical community, which is becoming aware of the benefits of improved fitness levels. “In the past medical practitioners have merely used exercise as a tool for weight loss. However, these new findings, show that improved cardio-respiratory fitness from exercise has health benefits irrespective of whether the person shows any weight loss,” says Dr John Cummins owner of Sydney’s Executive Medicine Centre.

So how fit do you have to get to see any benefit? The answer is not very. The group with the lowest fitness levels who graduated into the moderate fitness level showed the largest benefits. To get into the moderate fitness level group you only needed to do 30 minutes of moderate aerobic activity every day. What is moderate physical activity I hear you ask, it is any exercise that elevates your heart rate so that you are breathing heavier. A perfect example would be a brisk walk where you can still hold a conversation.

Winston Churchill once said, “every time I get the desire to exercise I lie down and it goes away”. Unfortunately almost 60% of Australians share his view and do not perform any regular physical activity. As a society we are becoming incredibly sedentary. There have been studies to show that our average physical activity levels have dropped dramatically since the late nineteenth century, or the industrial revolution. Basically, the average person today uses a lot less energy, about the equivalent of walking 17 kilometers each day (yes, that’s 17 kilometers!) less than our relatives did only 120 years ago. This dramatic change in activity is catching up with us and leading to a large increase in the incidence of diseases such as diabetes, heart disease, syndrome X, osteoporosis, depression, cancer and obesity. Yet with just 30 minutes of exercise each day we can dramatically reduce our chances of getting the above diseases. Physical activity has been shown to reduce the chances of developing breast cancer by 40%, the chances of developing diabetes by 50%, it strengthens our bones protects our heart and even makes us happier, thus reducing our chances of depression. Gee not a bad return on investment for just 30 minutes a day. If there was only one thing you could do to improve your health regular physical activity should be it.

Here are some tips to help you be more physically active:
•   If you are just beginning to exercise start off slowly and don’t try to do too much too soon. Don’t aim for 30 minutes straight off, start with 15 minutes, three times per week and build up from there.
•   Start off gently. Don’t exercise too hard at the beginning of an exercise program, choose a level that is easy and slowly increase the intensity over time.
•   Choose an activity that you enjoy, boring forms of exercises like using an exercise bike or treadmill while staring at the wall will do little for you enjoyment and mood. Try different things like outdoor activities, dancing and team sports.
•   Involve other people: enlist friends and family to exercise with you. In this busy world why not kill two birds with the one stone; exercise is a great opportunity to spend time with others.

The old adage of ‘moderation is the key’ still rings true. You don’t need a six-pack to be healthy, just get out there, do some exercise each day and there’ll be no reason to feel guilty about reaching for that extra piece of cake.
Posted by Christine Armarego 12/1/09

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The Glucose Club's Blog

Gestational Diabetes In NSW

Diabetes in spotlight as babies arrive supersized

Fighting obesity and keeping the kids healthy

Gestational Diabetes - What is it and exercise can I do?

Exercising in Summer - Safely with diabetes

New research confirms fibre & Low GI important for people with diabetes

Recommended Diet for Diabetics May Need Changing, Study Suggests

Fitness Vs Fatness

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