'An Ounce of Prevention is Worth a Pound of Cure'

Prevention is the most important intervention in our wellness planning. Diabetes like most chronic metabolic illness provides warning signals before being diagnosed. These may be a blood glucose value above the upper limit of normal after a meal or when hospitalized. It may be an experience of 'hypoglycemia' with sweating and lightheadedness a few hours after a starchy meal. It may be unexplained mood swings that are noticed by friends and family members. The physician may comment on 'high triglycerides' on the cholesterol profile. Such hints and clues, particularly in a patient who has close relatives  with diabetes mellitus should sound the alarm to make lifestyle changes and change behaviors. 


The role of the physician is to identify these signs and symptoms of 'prediabetes' and to interpret them for the patient, emphasizing the need to make changes in diet and activity. Weight control is key. Adequate rest with quality sleep should not be neglected. Exercise should be planned. Diet education is needed.


The Diabetes Prevention Program (DPP)  incorporates many of these strategies into a one-year comprehensive interactive group education model that after being confirmed in its effectiveness, is now being offered at health care establishments across the nation.


The Diabetes Institute at Ohio University has been operating a very successful DPP program over many years. Led by Karen Bailey, RD , the program recently graduated one more class which completed the life-changing curriculum.


Attendees at the celebration described the health benefits of the changes they incorporated in their lifestyle as they implemented the teachings provided.

DPP Graduates 2018 with Karen Bailey RD (right)  and Dr. Nicholas Mezitis

The message is clear: the onset of diabetes can be delayed , if not fully prevented, through nutritious meals and adequate exercise that promotes weight control. Reducing stress, getting adequate sleep and avoiding large meals after 4 PM are likewise fundamental pieces of the new lifestyle.

The Skinny on Fat

'Fat' is the dietary villain in our industrialized society and entire industries in academic research, food technology and pharmaceuticals have flourished describing its damaging effects on the body and marketing special foods and medications to deal with the problem. 

'Fat ' however is a very broad term in chemistry and in nutrition that relates to a spectrum of compounds found naturally in plants and animals and to those synthesized in laboratories for various uses. Complicating our efforts to understand the problem is the unfortunate association of the term 'fat' -with obesity which adds emotion to meal planning. 

So great is the momentum driving the media message that 'low fat' is synonymous with health, that questioning this new age axiom may be viewed as superfluous or even heretic. 

Fortunately, in science questions are asked, evidence is reviewed and even sages ruefully acknowledge the validity of the Socratic dictum " I know one thing, that I know nothing".
It is time for us to distinguish fat based on its chemical characteristics, its provenance, and its processing before we decide on whether to add a food item to our plate. We must always bear in mind that the emotionally charged term 'cholesterol' describes the framework of some of the most important hormones in our body. Lipids form our cell walls and oils coat and protect our skin  and its appendages (hair, nails). 

The study published by Dr. Ines Birlouez-Aragon and her associates in the American Journal of Clinical Nutrition (2010) highlights the message I share with my patients, namely that fat from plants and animals in good measure adds flavor and nutritional value to our meal, if is not adulterated by heating to high temperatures. Oxidation of fat through heat transforms a valuable nutrient into a chemical nightmare. The products of fat oxidation damage the delicate lining of our blood vessels  and we suffer the consequences in 'time-delay'. 

Here is a brief summary and the link to the article: 

academic.oup.com/ajcn/article/91/5/1220/4597229?searchresult=1

Diabetes Mellitus 2018 Overview (Podcast)

Diabetes Mellitus 2018 Overview (Podcast) 

Diabetes mellitus is a major challenge for modern medicine since it afflicts an ever increasing number of patients and the treatment options are becoming more numerous and more sophisticated. Dr. Mezitis recently covered the topic in an insightful interview using simple explanations for the public. Please visit the link provided to listen.


https://www.mhsystem.org/memorialhealthradio

Chrononutrition (avoiding 'social jet-lag')

Timing of meals is becoming increasingly recognized as a very important part of  diet planning. Conventional nutrition consulting addresses food selection, cooking, meal composition, and calories consumed. Little attention is afforded to the most important topic, which is the proper time to enjoy meals.

Our digestive system and the microbiome that populates it respond harmoniously to cues from pacemakers in the central nervous system that dictate hormonal rhythms and  regulate organ function. Dawn breaks with surges in hormones that signal preparation for nutrient delivery to the gut. As midday passes and the sun prepares to set , so does our digestive system, which shifts to 'housekeeping' mode. Late 'deliveries' (meals) complicate digestion and challenge the liver, which is forced to store rather than process nutrients.

Our article on 'Chrononutrition' , recently published  in Diabetes Spectrum, focuses on the importance of this concept in the management of diabetes mellitus. The surges in blood glucose generated by late dinner persist into the next morning, while the liver suffers swelling and cellular damage. Medications cannot address the driving forces in this metabolic derangement process. Timing meals to the 4 AM - 4 PM window can.

Travelling with Diabetes

TRAVELLING WITH DIABETES

The summer months are a time for travel for many patients with diabetes and their families.

Leaving home for unfamiliar surroundings with time spent in transportation generates insecurity 

and many questions.

My advice is summarized in the following bullet points:

1.   Prepare for the unexpected (trip delays, lost baggage, local unavailability of basic        supplies)

2.   Have an insulated carry-on bag specifically for medication and supplies.

3.   Use clear plastic zip-lock bags to package supplies.

4.   Carry a supply of insulin pens (or vials)

5.   Carry pen needles and syringes

6.   Carry glucose monitors (2) with adequate strips (2 -3 vials) and extra battery

7.   Carry alcohol pads and gauze pads

8.   Bring cartridges for the insulin pump you may be using

9.   If you are using an insulin pump, carry a supply of long-acting insulin for use in pump emergencies

10. Carry glucose tablets

11. Carry a glucagon injection kit

12. Prepare a few easy snacks: small sandwich, peanut butter crackers, trail mix

13. Ensure access to water

14. Use your departure point time to decide on timing of meals during travel and arrival 

15. Use local time (at destination) for meals, starting  with breakfast the day after arrival.

16. Have letter from your doctor for airport personnel checking your carry-on luggage.

17. For patients over age 45, have a copy of your recent ECG

16. Keep your medication bag with you at all times during your trip

The Gut Microbiome in Diabetes 

The American Diabetes Association 78th Annual Session in Orlando, Florida this past June featured several abstracts and presentations highlighting the important role our gut flora (microbiome) plays in glucose metabolism. Diabetes mellitus reflects derangement in the glucose profile and the bacteria in our gut have a central role to play in this process. Coming to terms with our flora through our diet and with medications serves to improve blood glucose control and may even 'cure' diabetes. 

Dr. Xiaoyu Liao and his associates in Chongqing, China published an abstract featured in the Scientific Sessions, which demonstrated that a very popular class of antidiabetic drugs known as DPP-4i produces changes in gut bacteria in mice that serve to lower blood glucose. This mechanism of action was not known for this class of drugs and was not shared by another class of antidiabetic medication known as 'starch blockers' (disaccharidase inhibitors), which were tested in the same experiments for comparison. 

We  are coming to respect our fellow travellers more and more as their role in diabetes management is gradually revealed. 

 

Alteration of Gut Microbiota Induced by DPP-4i Treatment Improves Glucose Homeostasis

Poster 1119-P

July 11, 2018

Presentation at Ohio University Diabetes Institute - Diabetes Coalition

Hyperglycemia management in the hospitalized patient. 
Diabetes Coalition  from  Nicholas Mezitis

High blood glucose levels contribute to inflammation and suppress the immune system. Hospitalized patients are particularly vulnerable to the damage these processes generate, since their condition requires acute care and their recovery depends on the body mobilizing all its resources for the healing process. 

For those patients with diabetes mellitus, whether known or newly diagnosed, it is important to rapidly stabilize their glycemic profile without causing a dangerous low blood glucose experience (hypoglycemia). This is achieved through careful monitoring and judicious insulin administration. In the hospital, insulin will usually replace the oral agents patients may have been taking, permitting flexibility in dosing when meals are withheld or procedures are planned. 

 Dr. Mezitis discussed the management method developed by his group at 
St. Luke's/Roosevelt Hospital Center in New York City and published for use in the hospital setting (2006). The novel 'wheel concept' graphically describes dosing levels for insulin and the decision sequence to be used by  physicians and nursing staff in safely managing patients with high blood glucose levels. 

We live in an era when our lifestyle puts us at risk for diabetes mellitus, particularly as we age.
This screening tool helps us in estimating our risk and should prompt us to seek medical advice.
If your score is 9 or more, your risk is high for having prediabetes.
If you score 3 - 8, losing extra weight, staying active, selecting a healthy diet with meals early in the day,
and enjoying restful sleep will reduce your risk.

MER at 'Sweet and Sour' event in Belpre, Ohio 06.30.2018

Meeting little friends at the 'Sweet and Sour' youth with diabetes event today in Belpre, Ohio. Celebrating one year from the founding of this group, which has grown to include many children from the surrounding communities and their parents. 

Our message of 'Restoring Rhythm. Preserving Health.' was well received, as we emphasized the importance of balanced meals, properly timed in improving glycemic profiles and restoring confidence in our young patients.

We provided table placemats and stickers with our 'Health Plate' concept popularized in my book 'A Blueprint for Healthy Eating: Your Diet Guide for the New Millennium' (2017). A generous buffet of foods from the grill, fresh vegetables and fruit was provided by the Marietta Memorial Hospital Diabetes Endocrine Center staff. 

Living with diabetes is a challenge to be met. Learning to cope at an early age instills discipline and helps form habits that enable our young charges to live long, healthy lives.