Be Well - November 2011 Issue
Feature: Prediabetes – A Wake-Up Call
You may be at risk for diabetic complications even if you don’t have diabetes — if you are among the 79 million Americans estimated to have prediabetes.
“Prediabetes disposes you to increased risk of developing diabetes and implies that your risk for heart attack is already increased. It should be a wake-up call for adopting a healthier lifestyle,” says Robert Zimmerman, MD, Director of the Diabetes Center in Cleveland Clinic’s Department of Endocrinology, Diabetes and Metabolism.
Diabetes increases the risk for heart attack. Yet many heart attacks occur when blood glucose levels are not quite that high — a condition the American Diabetes Association calls prediabetes.
A matter of degree
In diabetes, the risk for cardiovascular disease is two to four times higher than normal. In prediabetes, that risk is 1.5 times higher than normal. Without preventive measures, prediabetes may become type 2 diabetes in three to 10 years.
Doctors use the same tests to diagnose diabetes and prediabetes. Diabetes is diagnosed when:
- Hemoglobin A1c levels are 6.5 percent or more
- Fasting blood sugar is 126 or more, or a glucose level two hours after eating is 200 or more
Prediabetes is diagnosed when:
- Hemoglobin A1c levels are 5.7 to 6.4 percent
- Fasting blood sugar is 100 to 125 (called impaired fasting glucose)
- Two-hour glucose is 140 to 199 after a glucose challenge (called impaired glucose tolerance)
A sticky – and serious – situation
Glucose is sticky and adheres to red blood cells. Type 2 diabetes causes glucose to build up in the bloodstream. Over time, impaired circulation of the blood to organs and tissues can result in heart attack, stroke, kidney failure, blindness and amputation.
The incidence of type 2 diabetes and prediabetes is rising along with the incidence of obesity, but genetic and environmental factors also come into play.
“There is a high incidence of type 2 diabetes in patients whose parents have the disease,” says Dr. Zimmerman. “Yet people with a genetic tendency to develop diabetes if they become overweight may not get diabetes if they maintain a normal body weight.”
The best way to lower your risk
Whether you have prediabetes or diabetes, the higher your blood glucose level, the greater the risk of complications. There are two paths to lowering risk: lifestyle change and medication.
A 2002 National Institutes of Health study documented superior results from diet and exercise. Eating a low-carbohydrate, low-fat diet and getting 35 minutes of intense exercise five days per week reduced the rate of diabetes by 50 percent. It also led to a 10 to 12-pound weight loss.
Taking a pill to lower your blood sugar may seem more appealing, but the first-line antidiabetic drug metformin lowered the rate of diabetes by just 30 percent.
“We now know that people with prediabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes. In my opinion, if lifestyle interventions make you healthier, it's the way to go,” says Dr. Zimmerman.
“Medications have potential side effects and are less effective. Exercise may help reduce weight, blood sugars and blood pressure.”
If diet and exercise are ineffective, Dr. Zimmerman then recommends a trial of metformin.
Tip: Beware the Buffet – A Recipe for Weight Gain
The fewer options our taste buds have, the less likely we are to stuff ourselves. That’s why potlucks and holiday spreads can be so dangerous. Prepare crock pot and other one-dish meals to narrow choices in an appealing way. And if you do find yourself in a buffet line, choose only those foods you really like.
Be Well – November 2011 Issue
Feature: Allergies and Aging – Dispelling 4 Myths
If you’re mystified by allergies, you’re not alone. How the body can see a bit of pollen or dust — or lifesaving penicillin — as a foreign invader boggles the mind. The body’s allergic response to the “invader” seems over-the-top — and makes allergy sufferers miserable.
Perhaps because allergies themselves are hard to understand, myths about them abound. Below, Cleveland Clinic allergist and immunologist David Lang, MD, addresses four myths that apply to allergies in older adults.
1. Myth: Older adults with medication allergies will always need to avoid them.
Fact: Allergies to medications such as penicillin and aspirin are common (even more so as we age). Once you’ve had an adverse reaction, avoiding the offending medication is smart – but you may not have to do so forever.
Say you had a bad reaction to penicillin in the past but recently developed a condition for which it is the only effective treatment. A board-certified allergist can evaluate you to determine if formal skin testing is warranted.
“Eighty-five to 90 percent of the patients we see with a history of ‘allergy’ to penicillin have negative penicillin skin tests,” says Dr. Lang. “This means that they can safely take penicillin and penicillin-like drugs.” Of course, 10 to 15 percent of patients tested must continue to avoid penicillin.
Unfortunately, aspirin and many other medications have no valid skin or blood test to assess the allergic response. In these cases, the allergist can weigh the risks and benefits of an “oral challenge.” This involves taking a dose of medication (such as aspirin) under careful medical supervision. If no reaction occurs, you can be cleared to use aspirin for a heart, musculoskeletal or rheumatic condition for which an alternative such as acetaminophen (Tylenol®) is ineffective.
2. Myth: It's unusual for older adults to have allergy symptoms.
Fact: Although allergic conditions such as asthma and seasonal allergic rhinitis (hay fever) are more commonly encountered in children and younger adults, older adults are susceptible to them too. “Evidence supports the contention that allergic potential declines with aging,” says Dr. Lang. Yet an American College of Allergy, Asthma and Immunology survey revealed that approximately one in five patients cared for by allergy/immunology physicians is age 55 or older, and one in 17 patients is 70 or older.
3. Myth: Allergy symptoms are different in older versus younger people.
Fact: Whatever your age, asthma can cause wheezing, a tight chest, difficulty breathing or a cough. Similarly, allergic rhinitis can cause sneezing, a runny nose, postnasal drip, and itchy, watery eyes. Symptoms may be seasonal or situational, developing when you mow the lawn or walk into a pet store and improving when you live in air conditioning during the warmer months.
The difference is that chronic nasal symptoms that occur when we’re older are more likely to have other causes. “For example, a medication commonly taken by men with a prostate condition, Flomax®, is frequently associated with nasal congestion that may be misattributed to allergy,” says Dr. Lang.
4. Myth: Allergy symptoms are treated the same no matter how old you are.
Fact: The immunology underlying allergic symptoms is fundamentally the same at all ages. “However, treatment in older adults is frequently more complicated, because the prevalence of conditions such as hypertension, diabetes, reflux and arthritis is considerably higher,” says Dr. Lang.
Not only might allergy medications interact with one or more of the medications prescribed for these conditions, but the conditions themselves might impact treatment.
“For example, older adults are more sensitive to drowsiness or performance impairment associated with many over-the-counter antihistamines. They are also at increased risk for fractures caused by falls,” says Dr. Lang. That’s why it’s important for older adults to choose non-sedating antihistamines.
Be Well – November 2011 Issue
Free Guide: Foot and Ankle Problems
Twenty-six bones, 33 joints and over 100 muscles, tendons and ligaments make up the foot and ankle. No wonder nearly three-quarters of Americans develop foot or ankle problems. Learn about common conditions and how we treat them.
Recipe: Cinnamon Apple Cranberry Crisp
This tasty dessert is perfect for a fall potluck. It features cranberries, an excellent source of disease-fighting phytochemicals and antioxidants that reduce overall inflammation in the body. The vitamin C and fiber in apples and other ingredients help to boost immune function and regulate digestion.
6 medium apples, peeled and sliced
1 cup dried cranberries
1 teaspoon ground cinnamon
1 tablespoon lemon juice
¾ cup old-fashioned oatmeal
¾ cup all-purpose flour
½ cup brown sugar, packed
1/3 cup light butter
½ cup black walnuts, chopped
- Heat oven to 375° F.
- In a large bowl, mix apples, cranberries, cinnamon and lemon juice. Spoon into ungreased 11″ x 7″ or 12″ x 8″ glass baking dish.
- In another large bowl, mix remaining ingredients with fork until crumbly. Sprinkle over fruit mixture.
- Bake for 35 to 40 minutes or until apples are tender, juices bubble, and topping is golden brown. Serve warm.
Makes 8 servings
Total fat: 9.5 g
Saturated fat: 2.7 g
Cholesterol: 9.9 mg
Sodium: 70 mg
Total carbohydrate: 55 g
Dietary fiber: 5.8 g
Sugar: 33 g
Protein: 4.4 g
Potassium: 247 mg
Recipe from our Children's Hospital Pediatric Nutrition Support Team
Be Well – November 2011 Issue
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