As vacation season arrives, here are travel tips for diabetics

It's vacation season. Traveling offers unique challenges for diabetics, but nothing that careful planning and a few precautions won't overcome, says the federal Centers for Disease Control and Prevention.

Image: diabeticlivingonline.com

The CDC offers these tips for diabetics to travel safely:

Before you leave

Discuss any concerns you may have about anticipated increased levels of activity, expected changes in diet and what to do if you have changes in your glucose readings with your physician. If you are traveling across time zones, let your doctor help you plan the timing of your injections. If you wear an insulin pump, make sure you know how to update the built in clock to reflect the change in time zone. The American Diabetes Association recommends making sure your blood sugars are well controlled before you leave.

Don't forget your supplies

Always keep your supplies close at hand and accessible, no matter how you travel. And don't forget to store them correctly; insulin stored in very hot or very cold temperatures may lose strength. Meters and supplies are also sensitive to extreme temperatures. There are cooling packs available made specifically for diabetes supplies.

To allow for any unexpected travel delays, it is recommended to pack twice the amount of diabetic supplies you expect to need. All supplies should be clearly labeled, with their original labels if possible, and don't forget to bring a copy your prescriptions with you.

It is also important to plan ahead for the possibility that your blood sugar might drop. Changes in what you eat, activity levels, and time zones can affect your blood glucose, so you need to monitor your blood glucose more often. If you use insulin, pack a glucagon emergency kit and all diabetics should pack glucose gel or glucose tablets, along with a few snacks.

Carry documentation and let others know

Carry a laminated 3-by-5 card in your wallet that says you have diabetes along with a list of any medications you use. Joslin Diabetes Center recommends that if you are traveling to a country where they speak a language other than your own, translate the note into this language. The ADA recommends that this card also say, "Sugar or orange juice please" in the language of the country you will be visiting.

In addition to wearing medical identification that says you have diabetes, tell the people you are traveling with that you have diabetes and tell them what to do in the case of an emergency. It is also a good idea to give them a copy of your medical card.

Keep your health insurance card and emergency phone numbers on hand at all times, including your doctor's name and phone number. First respondents are trained to look at cell phones for a contact labeled "emergency contact," so make sure you put one in there. All phone numbers should also include the country code if traveling abroad.

Once you arrive, find the closest medical care facility that could provide care if necessary. You can get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers at www.iamat.org or 716-754-4883, according to the ADA.

Nutrition

Do your homework before you go to determine the carbohydrate grams in the foods typically served where you are going. You might also want to pack a few bottles of water and some pre-measured dried fruit, nuts and seeds for snacks.

Air travel

If flying, put your diabetes supplies in a quart-size plastic bag separate from your toiletries. If you wear an insulin pump and don't want to walk through the metal detector with it on, tell the security officer about it and ask them to visually inspect the pump and do a security pat-down.

It is also important to call the airline ahead of time to assess whether your nutritional needs will be met while traveling. If a meal will be served, you can put in a request for a diabetic meal. If not, make sure to bring appropriate food with you.

Another thing to remember is that air on an airplane is probably pressurized, so when drawing up your dose of insulin, don't inject air into the bottle because the pressure differences can cause the plunger to "fight you," says the ADA. For more information about air travel and diabetes, click here.

To reduce your risk for blood clots, move around every hour or two.

Protect your feet

As always, diabetics need to protect their feet, being especially careful of hot pavement by pools and hot sand on beaches. Wear comfortable shoes and make sure to check your feet daily for blisters, cuts, redness, swelling and scratches.The general rule is to never go barefoot.

A looming danger: About 1 in 3 U.S. adults are pre-diabetic, but only about 11% say they have received such a diagnosis

Before Type 2 diabetes develops, most people experience what is called prediabetes, where the blood sugar levels are above normal, but below diabetic, Dr. Philip A. Kern, University of Kentucky professor and director of the Center for Clinical and Translational Science, writes in a UK news release.

In America, approximately one in three adults are pre-diabetic, but only around 11 percent are aware of that condition, according to the federal Centers for Disease Control and Prevention. In Kentucky, 289,000 adults, or almost 9 percent, reported that they had been diagnosed as pre-diabetic, according to the 2015 Kentucky Diabetes Report.

"Without intervention, there is a high likelihood that prediabetes will progress to diabetes within three to 10 years," Kern writes. "People with prediabetes are also at 50 percent higher risk for heart disease and stroke."

When a person is prediabetic, many of the diabetic disease processes, like nerve damage, eye problems and heart disease, begin in the body even though the person doesn't have diabetes.

And because prediabetes often has no symptoms and can affect people of all ages, Kern writes, it is important to know your blood sugar levels, especially if you have one of the following risk factors: overweight or obese, fat distributed around the abdomen, history of gestational diabetes, family history of diabetes, symptoms of diabetes (increased thirst, frequent urination, fatigue, and blurred vision), or history of elevated blood sugar levels.

Kern suggests the following lifestyle changes to help prevent the progression of prediabetes to diabetes; he notes that these changes will also help reduce your risk of heart disease, stroke, high cholesterol and high blood pressure:

• Weight loss: Losing just 10 to 20 pounds can reduce the liklihood of prediabetes progressing to diabetes.
• Healthy diet: Choose low fat, low calorie and high fiber foods, like fruits, vegetables and whole grains.
• Exercise: Incorporate 30 to 60 minutes of moderate physical activity most days of the week.
• Sleep: Research has found that getting at least six hours of sleep each night can help reduce insulin resistance. He also notes that sleep apnea can worsen prediabetes.
• Medications: Some diabetes medications are prescribed to prediabetics to prevent the condition from progressing.

If you're interested in learning about opportunities to participate in research about prediabetes at UK, visit ukclinicalresearch.com or call (859) 323-2737.

How do diet and exercise influence risk of diabetes? Diet seems more important

Many people think exercising and eating properly are interchangeable, but a paper by Edwards Weiss, associate professor of nutrition and dietetics at Saint Louis University, asserts that exercising and restricting diet results in specific and cumulative benefits in reducing the risk of Type 2 diabetes. According to the 2013 Kentucky Diabetes Report, 6.9 percent of Kentucky adults have diabetes.

Participants in the study were sedentary, overweight middle-aged men and women who reduced their weight 6 to 8 percent through calorie restriction, exercise or both. Researchers measured their insulin sensitivity levels, which determines risk of diabetes. "Your blood sugar may be perfectly normal, but if your insulin sensitivity is low, you are on the way to blood sugar issues and, potentially, Type 2 diabetes," Weiss said.

The researchers measured twice the improvement of insulin sensitivity in the group of participants who both exercised and restricted their diets than in the other two groups. Weiss notes that exercise helps regulate glucose, even if a person isn't losing weight as a result. The researchers also found that exercised-induced weight loss didn't regulate glucoregulation more effectively than calorie restriction. "What we found is that calorie restriction, like exercise, may be providing benefits beyond those associated with weight loss alone," Weiss said.

Weiss said that though it might seem obvious that a combination of diet and exercise would engender the best results, "there are a lot of people who believe that if they maintain a healthy weight, it doesn't matter what they eat. And others have an appropriate food intake but don't exercise."

One of every three U.S. adults have a combination of risk factors that increase their risk for heart disease and diabetes

More than one-third of adults in the U.S. have a combination of health conditions that put them at higher risk of heart disease and diabetes, and this condition affects nearly half of adults aged 60 and older, according to a new study recently published in the Journal of the American Medical Association.

Image: healthyanswers.com

This combination of health conditions, when found in one person, is called metabolic syndrome. It includes abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels.

The study collected data gathered by the federal Centers for Disease Control and Prevention from adults 20 and older from 2003 to 2012. It found that about a third had a metabolic symdrome in 2011-12, and nearly half of those 60 and older did. Among those 20 to 39, the rate was 18 percent.

The study report says these were "concerning observations" because of the country's aging population. Hispanics, at 39 percent, were found to have the highest prevalence of metabolic syndrome among ethnic groups. Women had a higher prevalence than men in all age groups.

The American Heart Association says the best way to control the risk factors contributing to metabolic syndrome are to lose weight and increase physical activity. It also encourages patients to routinely monitor their weight, blood glucose, cholesterol and blood pressure and treat these risk factors according to established guidelines.

New diabetes cases in expanded-Medicaid states much higher than other states; 46,000 new Ky. Medicaid clients got screened

By Melissa Patrick
Kentucky Health News

New diabetes cases among poor Americans are much more numerous in Kentucky and other states that have embraced the Patient Protection and Affordable Care Act, a medical testing company has found. The diagnoses rose 23 percent in the Obamacare states and barely rose in the others, apparently because state Medicaid programs are encouraging screening for diabetes.

Quest Diagnostics conducted the study by analyzing laboratory test results from all 50 states and the District of Columbia in its large database over two six-month periods, Sabrina Tavernise reports for The New York Times. The authors determined that because in January 2014, 26 states and the District of Columbia had expanded Medicaid and 24 had not, it was a good time to conduct this study, which is reported in the journal Diabetes Care.

The research team used the results of the basic test for diabetes, which measures a form of hemoglobin that has interacted with glucose, A1c. "In the states that expanded Medicaid, the number of Medicaid enrollees with newly identified diabetes rose by 23 percent, to 18,020 in the first six months of 2014, from 14,625 in the same period in 2013," Tavernise reports. "The diagnosis rose by only 0.4 percent — to 11,653 from 11,612 — in the states that did not expand Medicaid."

A Kentucky study indicates that more screening isn't the only reason for such numbers; the Medicaid expansion population appears to be more susceptible to diabetes than normal.

The study by Deloitte Consulting found that chronic conditions, including diabetes, were more than twice as prevalent in the expansion population than other people of the same age and gender who were on Medicaid before it expanded. That comparative group was considered to be the group most similar to the Medicaid expansion population, since the state lacks historical data for the expansion group.

The study found that the Medicaid expansion group had a 102.5 percent higher prevalence of diabetes than the comparative group. About two of every 1,000 in the expansion group had diabetes, compared to one of every 1,000 members of the traditional-Medicaid group.

About 46,000 of the 400,000 people in the expansion group had a diabetes screening in the first year of the expansion. Both studies suggest better access and utilization of preventive care and early diagnosis will promote earlier treatment and better long-term outcomes.

Kentucky ranks 17th among the states in prevalence of diabetes, according to the 2014 "States of Obesity" report.  The state Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes. For county-by-county data on diabetes, click here.

Quest Diagnostics recognized that its study only looked at changes in raw numbers of the lab results from one company and did not have access to a federal data set. This has caused some to voice skepticism that the study results are a result of the Medicaid expansion. Others, while recognizing that the study did not "have the precision of a scientific drug trial," Tavernise writes, said "the changes in the numbers are real ... 23 percent versus zero," and that "the health-care law was the most plausible explanation for the findings." Another said, "for an observational study, it’s really very strong."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Authors of The Great Diabetes Epidemic will talk on KET about its causes, myths, complications, treatment and prevention

Kentucky Health News

The message that the authors of The Great Diabetes Epidemic: A Manifesto for Control and Prevention want readers to take from their book is that "diabetes is a serious, but preventable disease, if proper early interventions are implemented through a community-based, public health approach," KET says in a press release.

Authors Dr. Gilbert Friedell and J. Isaac Joyner will discuss this message with host Renee Shaw, and look at the root causes of the high number of diabetes cases in the U.S. and what needs to be done about it, on "Connections with Renee Shaw" on KET2 Friday, March 27 at 5 p.m. ET and on KET Sunday, March 29 at 1:30 p.m. ET.

Other topics discussed include common misconceptions and barriers to treatment, belief systems around diabetes that aren't based on fact, and the significant health ramifications of the disease, including complications such as blindness, amputations and renal failure.

"In Kentucky alone, for example, there are 72,000 diabetes-related cases of blindness and visual impairment diagnosed each year – roughly 200 per day," KET notes.

Beshear cites signs toward better health: kids are more active and getting more dental care; adults are getting more screenings

Kentucky Health News

Kentucky is moving toward achieving the broad, ambitious goals for better health that Gov. Steve Beshear laid out when he started the "Kyhealthnow" initiative in February 2014, his office says.

"More Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services" since the initiative began, Beshear said in a press release.

The program builds on federal health reform, which has made Medicaid or private insurance available to hundreds of thousands of Kentuckians, many of whom were previously uninsured and unable to afford health coverage. According to a Gallup Poll released in February, 9.8 percent of Kentucky’s population is uninsured, down from 20.4 percent in 2013.

Kyhealthnow targets seven major health goals to be met by 2019, focusing on increasing health insurance coverage; reducing the smoking rate and tobacco use; lowering the prevalence of obesity; lowering cancer deaths; reducing cardiovascular disease; treating and reducing dental decay; and reducing drug overdoses and mental health issues in Kentucky.

The report said more adults have been screened and identified as having high blood pressure and are able to control their hypertension, and more adults have had their cholesterol checked.

Significantly more children on Medicaid are being seen by dentists, and the number of children enrolled in Medicaid receiving two fluoride dental varnishes per year has increased. The state has given money to five health departments for dental-hygiene programs, and will fund five more this year. "These programs broaden access to hygiene services, such as cleanings, screening and referrals, by providing staff and resources to supply mobile units to deliver care in schools," the release said.

School districts are showing an increase in the amount of time devoted to physical activity, the state reports. The Comprehensive School Physical Activity Program has been implemented at proficient or distinguished levels at all grade levels in 515 of the state's 746 elementary schools, 186 of the 329 middle schools and 109 of the 228 high schools. Also, more schools report they are using body-mass index data to inform school wellness policy.

The state health department is using federal funds to implement physical activity and obesity-prevention curricula in early-childhood care centers. "The goal is to develop healthy habits in children before the age of 5 and prevent obesity," the news release says.

To increase physical activity and deter obesity among older children and adults, the state is establishing “trail towns.” Morehead and Olive Hill were recently certified by the state Office of Adventure Tourism and eight more are expected to be certified this year. The Dawkins Trail, an ongoing rail-to-trail project in Eastern Kentucky, has reached a length of 18 miles.

Diabetes management has improved among adults, and a study of Medicaid patients showed an overall decrease in those with poor diabetes control, the release said. State employees now have easier access to the nationally recognized Diabetes Prevention Program, which helps people who are at risk of developing diabetes reverse the onset of the disease.

Dr. Stephanie Mayfield, the state health commissioner and vice chair of Kyhealthnow, has emphasized the importance of reducing tobacco use to make Kentuckians healthier. Beshear has expanded the ban on tobacco products and e-cigarettes on executive branch properties, making Kentucky one of only five states in the country with such a policy. Smoking bans exist in 24 communities, 37 school districts and 51 college or university campuses.

Kyhealthnow, chaired by Lt. Gov. Crit Luallen, includes people from many areas of state government who develop innovative strategies for addressing the state’s health woes and challenge local governments, businesses, schools, nonprofits and individuals to take meaningful steps toward improving health in their communities, the release said.

KentuckyOne Health teaches diabetics to manage the disease

KentuckyOne Health has launched a new program to help Kentuckians with diabetes learn how to self-manage their disease, according to a news release.

"Giving patients the tools and knowledge they need to manage their own health, including their diabetes, is an important way to empower them to take charge of their health," said Amanda Goldman, director of diabetes and nutrition care for KentuckyOne and quality and wellness director for food and nutrition services of Catholic Health Initiatives, a partner in KentuckyOne.

More than one in 10 Kentuckians have diabetes and the state ranks 17th in the nation in incidence of the disease, according to the 2014 "State of Obesity" report. The Kentucky Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes.

The new program will teach classes to help its participants learn how to manage diabetes testing and medication as well as the basics of using diet and exercise to improve their health. It will also offer individualized counseling sessions for those who need outpatient medical nutrition therapy.

The program is accredited through the American Association of Diabetes Educators and will be offered at the Healthy Lifestyle Centers at Jewish Hospital Medical Center Northeast, Sts. Mary and Elizabeth Hospital, Saint Joseph Hospital in Lexington, Saint Joseph East in Lexington, Saint Joseph Berea, Saint Joseph London, and Saint Joseph Jessamine. It will also offer outpatient services in downtown Louisville.

"Maintaining a healthy weight and a diet that's filled with nutrient-rich fruits, vegetables and whole grains can help not only to manage diabetes, but other health concerns like high blood pressure, high cholesterol, heart disease, stroke and more," says the release. The release also recommends regular exercise, under the direction of a health care provider, to "curb the effects of diabetes and other health concerns,"

Another study suggests that lack of walking and other physical activity damages blood vessels and causes many health issues

If you are looking for a reason to commit to daily exercise in 2015, here are two: The U.S. surgeon general says most of us only exercise about half the recommended amount to be healthy, and a new study shows that this lack of activity damages our blood vessels, which contributes to much of what ails us.

Research at the University of Missouri School of Medicine, published in Medicine and Science in Sports and Exercise, found that going from high (10,000 steps a day) to low levels of daily physical activity (5,000 steps a day) for just five days decreases the function of the inner lining of the blood vessels in the legs, according to a news release from the university.

“The impairment we saw in just five days was quite striking,” Paul Fadel, associate professor of medical pharmacology and physiology at the university, said in the release. “It shows just how susceptible the vascular system is to physical inactivity.” Previous studies have found that a decrease in blood-vessel function is linked to early cardiovascular death and hypertension.

Kentucky is the ninth most inactive state, with almost one-third (30.2 percent) of Kentuckians reporting in a national survey that they did not engage in physical activity or exercise during the previous 30 days other than doing their regular jobs, according to the State of Obesity report.

A collective New Year's resolution by Kentuckians to increase their physical activity, if kept, would help improve almost every health issue that plagues our state: obesity, diabetes, high blood pressure, heart disease. Kentucky ranks fifth in obesity, 17th in diabetes and fifth in hypertension, and is projected to have more than 1 million cases of heart disease by 2010, the report says.

“Inactivity is typically going to lead to people being overweight and obese,” Fadel said. “The next step after that is insulin resistance, which leads to Type 2 diabetes and cardiovascular disease.”

So, how much activity do we need to keep our blood vessels healthy? 10,000 steps every day, says the surgeon general. But the reality is that most of us only take 5,000 steps a day, which is considered a low activity level. The research for this study is based on 30 minutes of moderate activity a day.

“We need to teach and explain to people about the physiology of their bodies and the physiology of the disease process and help them understand that inactivity plays a foundational role in the disease process,” John Thyfault, associate professor of nutrition and exercise physiology at the university, said.

“Then we give them behavioral tools, like pedometers, to monitor and help them achieve higher physical activity so they start to see and feel health improvements. These studies are proof we need to get people to understand their activity every day plays a role in their health, and that their health is not simply a matter of body weight and how they look in the mirror.”

Ten common myths about diabetes busted

Kentucky ranks 17th in diabetes, and many Kentuckians are newly diagnosed every year with the disease, usually Type 2 diabetes. The diagnosis can be overwhelming, especially if you don't have your facts straight. A report by Healthgrades on the CNN website dispels 10 common myths about Type 2 diabetes.

The first myth is that eating too much sugar causes Type 2 diabetes. Doctors don't really know what causes it, Healthgrades writes. The body becomes resistant to insulin, the hormone that helps the body use blood sugar for energy, or stops producing enough insulin. This is what causes blood sugar to rise. 

The second myth is that only overweight or obese people get Type 2 diabetes. Being overweight or obese doesn't cause diabetes, but is a risk factor, so it's important to remember that at least one out of every three Kentuckians, those considered obese, are at risk to get the disease.

The third myth is that Type 2 diabetes always causes symptoms. In fact, symptoms may develop slowly and are often not easily recognized at first. The federal Centers for Disease Control and Prevention estimates about 8 million people with diabetes don't even know they have it.

Common symptoms of Type 2 diabetes are frequent urination, feeling very thirsty, feeling very hungry (even though you are eating), extreme fatigue, blurry vision, cuts and bruises that are slow to heal, weight loss, and tingling, pain or numbness in the hands or feet, says the American Diabetes Association.

The fourth myth is that pre-diabetes is nothing to worry about. Healthgrades reports that if you have pre-diabetes you are at "very high risk of developing Type 2 diabetes." But research shows that you can cut your risk with exercise and weight loss. Kentucky has an estimated 233,000 adults with pre-diabetes, according to the Kentucky Cabinet for Health and Family Services.

The fifth myth is that Type 2 diabetes is not as serious as Type 1 diabetes. "Left uncontrolled, both types of diabetes can cause serious complications and even be deadly," Healthgrades writes. Complications from Type 2, which can be avoided with careful management of the disease, include: kidney disease, vision loss, neuropathy, amputations, heart attack and stroke.

Another myth is that people with Type 2 diabetes don't need insulin. This is true for most of them, but Type 2 is a progressive disease, which causes "most people to eventually need insulin," Healthgrades reports. "Starting insulin for Type 2 diabetes does not mean you have failed to manage your disease. It means your disease is changing."

The seventh myth dispelled by Healthgrades is that Type 2 diabetes can be cured. "There is no cure for Type 2," it says bluntly. Remission is possible, but in those cases doctors consider the risk of relapse very high.

Another myth is that people with Type 2 diabetes can't eat sugar, sweets or starches. This isn't true. What is true is that you need to manage carbohydrates, which are in sugar, sweets and starches, because that's what makes glucose. With proper portion control, no food is off limits, Healthgrades reports.

Some think that people with Type 2 diabetes have to eat a special diet. In reality, they need to eat a "healthy diet," Healthgrades says. It is best to consult with a dietitian, or take a diabetic nutrition class, when learning how to eat as a diabetic.

The last myth Healthgrades dispels is that people with Type 2 diabetes can't lead an active life. In fact, exercise is important to controlling the disease and should be made part of the daily routine. However, it is important to consult with your doctor before you begin exercising to determine what is safe for you.

Kentucky drops two spots in America's Health Rankings, based on data since 2012 or earlier

Kentucky dropped two spots in the 25th annual America's Health Rankings report this year and finds itself once again as one of the bottom five healthiest (or unhealthiest) states.

Since the rankings were first released in 1990, with the exception of 2008 when it ranked 39th, Kentucky has ranked in the bottom 10 states for health. This year it ranks 47th.

The rankings are based on data gathered in the last two to three years, or even earlier, a fact state officials noted as they mentioned the Patient Protection and Affordable Care Act.

"While we have made much headway in the last year, we still have much work to do," said a statement from the Cabinet for Health and Family Services. "We expect that Kentucky’s statistics will begin to improve over time as the full effect of the ACA is reflected in future rankings. However, this change may take time, as Kentucky will be compared to other states that may more quickly see their health outcomes improve.”

Gov. Steve Beshear has made changing health behaviors to create a healthier population a priority for the state. He initiated the Kyhealthnow initiative, which established seven major measurable goals to improve the health status of Kentuckians over the next five years. He has also banned the use of tobacco products on most state properties.

Kentucky's latest ranking should come as no surprise since the state ranks in the bottom five states for eight of the measures: smoking, drug deaths, obesity, children in poverty, preventable hospitalizations, poor mental health days, poor physical health days and cancer deaths. Additionally, it ranks in the bottom 10 states for physical inactivity, air pollution, cardiovascular deaths and premature deaths.

Kentucky has already shown an improvement in smoking. While Kentucky still ranks second in smoking, fewer Kentuckians are smoking. In the past two years, smoking has decreased by 9 percent to 26.5 percent from 29 percent. In 1990, 35.3 percent of Kentuckians smoked.

"The decline in smoking rates stands out as a significant health improvement over the past 25 years," says the American Health Rankings news release. "Cigarette smoking is still associated with one of every five deaths in the United States, making it the leading cause of preventable death in the country."

Kentucky, like the rest of the nation, is getting fatter and becoming more sedentary.

Kentucky ranks fifth in obesity, with 33.2 percent of its adults having a body mass index of 30.0 or higher. In 1990, only 12.2 percent were obese. Kentucky doesn't fare much better with physical inactivity, ranking ninth with 27.4 percent reporting inactivity in the last 30 days.

Nationwide, obesity rates increased by 7 percent to 29.4 percent from 27.6 percent and the percentage of adults reporting inactivity in the last 30 days increased to 23.5 percent from 22.9 percent.

Kentucky has also seen a steady increase in the percentage of its adults with diabetes. Kentucky ranks 33rd in diabetes, with 10.6 percent of its adults reporting they have been told by a doctor that they have diabetes. In 1996, 3.6 percent of Kentuckians reported having diabetes.

Drug deaths have increased by 30 percent in the last two years, to 24 per 100,000 population from 18. Kentucky ranks third in this measurement.

Kentucky ranks first in four measures: children in poverty (31.8 percent), preventable hospitalizations (94.4 per 1,000 Medicare beneficiaries), poor mental health days (4.5 days reported in the previous 30 days), and cancer deaths (228.3 deaths per 100,000 population).

The number of children in poverty has increased by 36 percent in the past two years (31.8 percent from 23.3 percent).

Kentucky does have a few bright spots on the evaluated health measures including a low prevalence of binge drinking, a low violent crime rate and high immunization coverage among children.

Hawaii, Vermont, Massachusetts, Connecticut and Utah are ranked as the top five healthiest states. Mississippi is ranked 50th this year, preceded by Arkansas (49), Louisiana (48), Kentucky (47) and Oklahoma (46). West Virginia and Alabama moved out of the bottom five.

The report, published by United Health Foundation in partnership with American Public Health Association and Partnership for Prevention, uses data from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau.

To see the Rankings in full, visit www.americashealthrankings.org.

Tips for diabetics to stay healthy during the holiday season

Most people are not affected by occasional overindulging at holiday parties, but diabetics can get in serious health trouble if they aren't careful.

“If you are someone who is not in good control of your diabetes throughout the year, the holiday season can really make your situation worse,” Laila Tabatabai, an endocrinologist with Houston Methodist Hospital, says in a news release from the hospital. “If you are not mindful, eating foods with too many carbohydrates or sugars can send your blood sugar levels into a dangerously high range."

An abundance of high-fat, high-carbohydrate foods, parties with alcohol, desserts, food gifts and a change in routine that often doesn't allow time for exercise during the holiday season are some of the challenges that make it difficult for diabetics to maintain healthy blood sugar levels during the holidays.

The American Association of Diabetes Educators says in a news release that the best way to meet these challenges is to plan ahead.

“With the holidays coming, take some time to think about how you’ll deal with the events, the family you’ll be visiting and all of the to-dos,” Joan Bardsley, president of the group, said in its release. “By planning ahead you can enjoy the fun and still be healthy.”

The diabetes educators offer some tips on how to plan for these challenges:

• Make a healthy eating contract before attending a big meal, write down some goals and stick to them.
• Plan your plate: fill half of your plate with veggies, one-quarter with carbs (whole grain if possible), and one quarter with lean meat
• Avoid dark meat and remove any skin from your meat before eating
• Avoid gravy, and if you must have it, use only a little.
• Check with your doctor to make sure it is safe for you to have alcohol as it can interfere with some medications, including insulin. Sparkling water with a lime twist is a nice alternative.
• If alcohol is allowed, limit your intake. Have one glass of wine per party and skip the mixed drinks, which have more carbs. Or have a spritzer, half sparkling water and half wine. If drinking alcohol, make sure you eat, to avoid low blood sugar.
• Stay active during the holidays. Involve the family in activities that gets everyone up and moving, volunteer or sign up for a holiday run or walk.
• Minimize stress. Make time to unwind and relax.
• See a diabetes educator; they can help you make a plan for the holidays.

Tabatabai also suggested to be selective in the foods you choose to eat, only eating the special holiday dishes instead of everything; to bring a healthy dish that you enjoy; to avoid "white" carbohydrates such as potatoes; to limit portion sizes and to make sure family and friends are aware of your diabetes so that they can accommodate your food choices.

“Planning ahead and being smart with your choices will give you the chance to eat the foods you want while maintaining healthy glucose levels,” Tabatabai said in the release.

The AADE also offers these tips on traveling with diabetes:

• Bring extra medication and supplies if you are traveling.
• Pack two weeks worth of medication and supplies for one week of travel in case of travel delays or lost supplies. Make sure you include insulin, syringes, testing strips, insulin pump supplies, a first-aid kit, glucagon emergency kit, etc.
• Bring a prescription from your doctor for insulin or oral medication in case of emergency.
• If you are traveling by air, keep your medications and supplies with you at all times.

Americans' sweet tooth blamed for increases in obesity and diabetes; new website explains the dangers of too much sugar

A new website called SugarScience is now available to help consumers understand the health dangers of sugar in our lives, Lisa Aliferis reports for NPR.

This University of California, San Francisco project examined 8,000 studies and research papers and "found strong evidence that over-consumption of added sugar contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease," Aliferis writes.

"Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American ... consume too much added sugar," Laura Schmidt, a professor of health policy at UCSF and leader of this project, told Aliferis.

SugarScience is a user-friendly website that partners with health departments across the country to educate the public. Two departments have already agreed to participate in the outreach, Aliferis writes.

Schmidt told Aliferis that the food environment is the driver of the increased obesity of Americans in the last generation: "Sugar isn't just making us fat, it's making us sick."

"It's not like Americans suddenly lost their will power," she said. "The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s."

What our average daily diet of added sugar looks like

Schmidt said that while not all sugar is bad, we need to determine how much sugar is too much, pointing out that Americans consume the "equivalent of 19.5 teaspoons a day in added sugar, " Aliferis reports. She also suggest there is a need for federal guidelines to recommend a limit.

"SugarScience suggests the same limits advocated by the American Heart Association and the World Health Organization: no more than 9 teaspoons a day for men and no more than 6 teaspoons a day for women," Aliferis writes.

A taste of what the SugarScience website tells us is: Added sugar hides in 74 percent of packaged foods; fructose, a common type of sugar, can damage your liver more than other kinds of sugar; and one 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third, Aliferis reports.

It also suggest the best way to cut down on sugar is to stop drinking sugar-sweetened drinks, saying this is where we get more than one-third of added sugar in our diets. Another suggestion is for us to read nutrition labels, suggesting that if a chemical on the label ends in "ose," it is probably sugar.

Dean Schillinger, a professor of medicine at UCSF and a primary care doctor at San Francisco General Hospital, is also part of the SugarScience team. He told Aliferis that beds in his hospital that used to be filled with AIDS patients are now filled with diabetes patients.

"The ward is overwhelmed with diabetes — they're getting their limbs amputated; they're on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life,"Schillinger told Aliferis.

"We're at the point where we need a public-health response to it, " he said.

Kentucky meets the diabetes challenge with a comprehensive plan that 15 other states have modeled, advocates say

Kentucky has not simply accepted the dire diabetes statistics that affect so many of its citizens, but instead is meeting this challenge head on with The Kentucky Diabetic Action Plan, Stewart Perry and Bob Babbage write in an op-ed piece for The Courier-Journal.

Perry and Babbage wrote this piece to draw attention to World Diabetes Day, held every year on Nov. 14 to engage people in advocacy and awareness about the disease.

 "Thanks to the efforts of health care providers, political leaders and diabetes advocates and volunteers, Kentucky is a leader among the states in efforts to address the diabetes epidemic," the authors write.

"The incidence of diabetes has tripled in Kentucky since 1995. We have the fifth-highest incidence of diabetes among all the states. Almost 1 in 5 Kentuckians has diabetes or prediabetes. Diabetes costs Kentucky an estimated $4.8 billion a year in direct and indirect costs," the authors write.

They summarize the Action Plan, proudly saying that "no fewer than 15 states have used Kentucky's bill as a model for their own legislation."

"In 2011 Kentucky became the first state to mandate the development of a statewide, comprehensive diabetes action plan," they write. "The first Kentucky Diabetes Report was presented to the General Assembly in 2013 and will be updated every two years. Two years later, Kentucky became the first state to license diabetes educators. This year Kentucky passed Safe at School legislation which makes it easier for students to manage health care needs during school hours, provides that every school has trained personnel to assist students when necessary and assures that students with medical needs are not excluded from extracurricular activities."

The reason so many states are attempting to adopt this model, what makes it unique, say the authors, is that "the plan requires agencies to work together to develop a seamless, cooperative plan." The law requires the state Department of Public Health, the Department for Medicaid Services, the Office of Health Policy and the state Personnel Cabinet to collaborate in the development and implementation of the plan.

"We celebrate because Kentucky is not shrinking from the challenge of confronting diabetes but is instead at the forefront of efforts to prevent the disease and care for those who have diabetes," the authors write.

Brown fat, already known as a super calorie burner,' could also be a key to treating Type 2 diabetes, study shows

Better understanding brown fat could lead to future ways of treating obesity and type 2 diabetes, Abby Phillip reports for The Washington Post.

A recent study published in The Journal of Cell Biology found that brown fat cells are not only great "super calorie burners," burning calories as they help keep the body warm in cold temperatures, but are also a "super vacuum," producing a substance that sucks up excess glucose in the blood and transports that sugar into the brown fat cells, where it can be burned to produce heat, Phillip writes.

For people with type 2 diabetes, whose bodies do not use insulin properly and as a result have high blood glucose levels, these findings could lead to new drugs that can activate brown cells and reduce blood glucose levels without insulin, Phillip reports.

"If you can start the tissue to burn and produce heat, then you can actually in a way take away excess glucose in the blood," Tore Bengtsson, one of the study's authors told Phillip. "Now we actually understand how this production of these glucose transporters work."

Kentucky has the fifth-highest incidence of diabetes and obesity among all the states, with almost one in five Kentuckians diagnosed with diabetes or prediabetes and one in three adults in considered obese. Obesity can lead to the development of Type 2 diabetes.

"The implication of this is normally when you have Type 2 diabetes you have to inject insulin to reduce your blood sugar levels," Bengtsson told the Post. "However you could make a medicine which is not based on insulin signalling. It's a completely new pathway that can be targeted for taking up glucose in the blood."

Bengtsson told the newspaper "that he is working on the next step in the research -- looking for specific ways of activating the cells, which will be crucial for the development of new drugs."

Diabetes is an epidemic and needs to be treated like one, with a public-health approach, Lexington policy experts say in new book

Diabetes is often called an epidemic, but is not treated as such. Two Lexington health policy experts argue in a new book that this has to change, Tom Eblen reports for the Lexington Herald-Leader.

The Great Diabetes Epidemic: A Manifesto for Control and Prevention was written by Dr. Gilbert Friedell, former director of the Markey Cancer Center at the University of Kentucky and founder of the Friedell Committee, a statewide health care policy organization; and Isaac Joyner, a public-health policy analyst who has worked on a variety of issues in Kentucky, Texas and the Carolinas. It outlines specific steps that people, communities and the government should take in its approach to diabetes, saying the solution is a "major public health response."

"If we continue to treat diabetes on a one-patient-at-a-time basis, we can't deal with an epidemic," Friedell told Eblen. "Unless you take a public health approach to an epidemic, it doesn't work."

Kentucky has seen a 158 percent increase in cases over the last 15 years, "outpacing every other state except Oklahoma," according to the Centers for Disease Control and Prevention. Eblen reports that most cases are Type 2 diabetes, which is related to obesity.

"A flu epidemic of such magnitude would create public alarm and swift official response," Eblen writes.

The authors say the first step in changing diabetes in America is widespread, routine screening. They cite Centers for Disease Control and Prevention estimates that more than one-fourth of the people who have diabetes don't know it because they have not been tested.

In Kentucky, that means that 370,000 Kentuckians know they have diabetes, but 137,000 more might have it and not know it, Eblen reports. Officials estimate 233,000 Kentuckians have pre-diabetes, meaning they are at immediate risk of developing the disease.

"You have to find cases early, which means you have to screen people who seem well," Friedell said. "The symptoms of diabetes come on maybe 10 years after the disease starts. But nobody knows they have the disease. We're wasting 10 years that we could be doing something good for people."

Current recommendations for diabetes screening is for people with high blood pressure, or anyone older than 45. The authors say everyone older than 20 should be screened. They say this has to be viewed as a societal problem, not an individual one, Eblen reports.

The authors call for increased government and community funding and efforts toward proven diabetes prevention programs and for insurance companies to revise the way they reimburse for diabetes saying, " the longterm payoff would be huge" with these changes. Most importantly, they also call for increased public awareness and urgency.

"There has to be a sense of urgency, and there is no sense of urgency about diabetes," Friedell told Eblen. "We need to do something to get the public involved, and the public has to feel that it's important."

Friedell and Joyner will speak about the book and sign copies at 5 p.m. Friday, Nov. 14, which is World Diabetes Day, at The Morris Book Shop, 882 East High Street. They also are scheduled to testify Nov. 18 in Washington to the Congressional Caucus on Diabetes.

Five things you can start doing today to decrease your risk of getting diabetes, which affects one of every 10 Kentuckians

By Melissa Patrick
Kentucky Health News

Diabetes is a real problem in Kentucky and one that is not projected to get any better. You may be at risk of getting it, but there are things you can do to decrease your risk of becoming diabetic.

"Type 2 diabetes is still entirely preventable with certain lifestyle changes," Dr. Manny Alvarez writes for Fox News. "I always preach to my patients the importance of exercise and diet."

Kentucky ranks 17th in diabetes. One in 10 adult Kentuckians have been diagnosed with it and 40 percent of Kentuckians age 40-74 have pre-diabetes, according to the state Department for Public Health.

Even more worrying is the 2014 "States of Obesity" report that projects a 51 percent increase of Kentuckians with diabetes by 2030, going from an estimated 400,000 in 2010 to almost 600,000 in 2030.

Alvarez cites a study that identifies five simple habits to cut your risk of developing diabetes by as much as 80 percent:

1. Have a healthy diet, including lots of fruits and vegetables
2. Exercise three times a week for at least 20 minutes.
3. Maintain a normal body weight, which means a BMI between 18.5 and 24.9
4. Don't smoke.
5. Consume alcohol in moderate amounts.

Maintaining a normal body weight is the single most effective factor to prevent getting diabetes, according to the study, Alvarez reports. "Men of normal weight were 70 percent less likely to develop diabetes than overweight or obese men, while normal weight women were 78 percent less likely to develop diabetes."

But that doesn't mean overweight people don't benefit from incorporating these healthy lifestyle changes. "Overweight people who adopted just one of the other healthy lifestyle factors, such as exercising three times a week, could still reduce their risk of diabetes," Alvarez writes.

These suggestions should offer some hope to Kentuckians as lifestyle changes are things we have some control of and often come at little to no cost.

All adults over 45 should be screened for diabetes every three years, but only half are, and the poor are less likely to do so

Only about half of U.S. adults that the American Diabetes Association recommends to be screened for diabetes are actually being screened, according to a study published in the American Journal of Preventive Medicine.

The ADA recommends that all adults over 45 be screened for diabetes at three-year intervals, but the study found that only 53.2 percent of people in that age group had been screened in the last three years. "Up to one-third of people with diabetes are undiagnosed," the researchers noted in a release from Health Behavior News Service.

Kentucky ranks 17th among the 50 states in diabetes, according to the 2014 "State of Obesity" report. The study also found that screening was less prevalent in minorities and those with lower socioeconomic status, which is prevalent in Kentucky.

The ADA's president of health care and education, Marjorie Cypress, said in the release that she wasn’t surprised by the study’s findings. She explained some reasons why under-served and high-risk populations aren't screened and suggested it might be time to take screenings to where the people are.

“Fear keeps some people from being screened,” she said. “They’re afraid of what they may learn. Others only seek medical care when they are sick, and at that time they may not be screened for diabetes because the illness that brought them to a clinic is the priority at hand. Still others stay away from health care and screenings altogether because they don’t have health insurance, although that may be changing as more people gain coverage.”

Researchers reviewed self-reported responses from 21,519 adults taking part in the 2005-2010 National Health and Nutritional Examination and the 2006 national Health Interview Survey who were screened for diabetes in the last three years. The study found that 66.4 percent of participants were overweight, yet only 47.7 percent had a blood screening test for diabetes. 49.5 percent of participants were over age 45 but only 53.2 percent of them had been screened.

Researchers say aggressively treating pre-diabetes could stop or delay future diabetic complications

Treating pre-diabetes as if it is diabetes could delay or prevent future related health complications, according to doctors from three leading research institutions and the American Diabetes Association, says a press release from the University of North Carolina School of Medicine.

The researchers writes in the journal Diabetes Care that "by not devising a treatment strategy for people with pre-diabetes, doctors run the risk of creating a pool of future patients with high blood sugar who then become more likely to develop serious complications, such as kidney disease, blindness, amputations, and heart disease."

Type 2 diabetes is diagnosed with a fasting blood sugar of 126 or higher; most of these patients are treated with medication. Prediabetes is diagnosed with sugar levels between 100 and 125, and the release says such patients are usually not treated aggressively.

"Diabetes is generally diagnosed and first treated about 10 years later than it could be. We waste this critical opportunity to slow disease progression and the development of complications," lead author Lawrence Phillips of Emory University said in the release.

Kentucky ranks 17th in diabetes, according to the 2014 "State of Obesity" report. The report projects that there will be an increase of 51 percent of people with diabetes in Kentucky by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. The Kentucky Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes.

“We need to screen and track patients with pre-diabetes to manage their blood sugar more aggressively,” John Buse, professor of medicine and director of the UNC Diabetes Care Center, said in the release. “We’re very confident this would spare our patients serious health issues down the road.”

Evidence for this study comes from clinical trials where "lifestyle changes and/or glucose-lowering medications decreased the progression of pre-diabetes to Type 2 diabetes," says the release. The future development of diabetes also remained less in those who implemented these changes and then withdrew from them compared to a pre-diabetic control group who did not get any interventions.

Patients who achieved a normal glucose level, even for a short time during the trials, showed a "substantial reduction in subsequent development of Type 2 diabetes," says the release.

The authors say in the release that based on this evidence diabetes management should change to include regular screening in adults for pre-diabetes and early Type 2 diabetes and if a patient has either one of these conditions and is determined to benefit from treatment, they should get "management that will keep their blood glucose levels as close to normal as possible."

Most overweight diabetics don't know how much to exercise for weight loss, and they don't exercise enough

By Melissa Patrick
Kentucky Health News

Many overweight people with diabetes don't exercise enough for weight loss, and they also don't have a clear understanding of the recommended amount of exercise, according to a study reported by the Health Behavior News Service, part of the Center for Advancing Health.

The study, which looked at the exercise habits in people with diabetes, found that men with diabetes exercise more than women with diabetes, and, not surprisingly, that diabetic women who are trying to lose weight exercise more than those who aren't. But no one in the study was exercising the recommended amount for weight loss, according to the study report, published in American Journal of Health Promotion.

“We were not surprised that, overall, people with diabetes trying to lose weight were not engaging in enough physical activity,” study co-author Gina Pariser, associate professor at Bellarmine University in Louisville, said in a press release. "This finding emphasizes the need for health care professionals to provide more detailed and individualized education on exercise.”

Kentucky ranks 17th in diabetes and fifth in obesity, according to the 2014 "The State of Obesity: Better Policies for a Healthier America" report. It also says that more than 80 percent of people with diabetes are overweight or obese.

"Adults who are overweight or obese are at an increased risk for developing diabetes," the release notes. "Regular participation in physical activity may not only help reduce weight, but also help treat diabetes, and may prevent consequences associated with physical inactivity."

Health-care professionals need to do more than just encourage their diabetic patients to exercise, the researchers say in the release.

“Education about specific amounts of physical activity is needed to achieve goals such as weight loss and blood sugar control,” Pariser said. “Plus, instruction in the use of tools to objectively measure the amount of physical activity, like pedometers, should be provided.”

This study analyzed the association between exercise and weight control in 733 adults with diabetes and 4,572 without diabetes. Participants used a device to measure their physical activity and were asked if they were trying to lose weight, trying to maintain their weight or neither trying to lose nor maintain weight. For more information about diabetes and exercise, click here.