The Glucose Club's Blog

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Will free Lap-band surgery fix the obesity or diabetes epidemic?

Christine Armarego - Wednesday, June 03, 2009

Will free Lap-band surgery fix the obesity or diabetes epidemic?

Posted by Christine Armarego AEP

Yesterday the media headlines were “Free Fat Surgery”! It related to a story about a government report which makes recommendations to the Australian Government on how to tackle the obesity crisis that costs $58 billion last year.  

One of the recommendations is for gym memberships to be subsidized.  Now this is certainly a step in the right direction especially with the GFC forcing people to make decisions based on money in the short term rather than the cost to their health in the long term.  However for many of the clients we see in “The Glucose Club” they get greater benefit from more individualized sessions rather than simply purchasing a gym membership, as this doesn’t guarantee attendance or weight loss.  Having caring, supportive and educated Allied Health professionals available who understand behavior change and are experienced in designing individualized programs, specifically if the person has injuries or a chronic health condition will make weight loss more likely.  Also not every one is interested in going to a gym – what about out-door training or a pool membership?  The government could also consider increasing the number of Enhanced Primary Care plan sessions available from 5 to 10 per year, allowing for more personalized care of those at greatest risk of developing morbid obesity.

They also recommend that Bariatric or Lap-banding surgery be subsidized by the government.  While this type of surgery is beneficial to those who are morbidly obese and who cannot exercise, there still needs to be education on nutrition and exercise and assistance in how to change these lifestyle habits to prevent the person falling into old habits. Surgery is only half the battle and it’s surgery plus support through lifestyle changes that is successful.  And bear in mind surgery has it’s own risks, including unsuccessful or procedures that need to be repeated.

I think the main problem is that the report is looking at ways to reduce weight – but have forgotten that the science shows that being fit is more important than being thin – and that is where their focus should be!  Being fit improves your glucose and insulin interaction and prevents metabolic health problems such as diabetes. Feel free to leave your comments below!

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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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