CONTROLLING YOUR DIABETESStudies have shown that common diabetes complications like chronic kidney disease, eye disorders that can cause blindness, and neuropathies that can result in limb amputations and infections can be delayed or even prevented with good glycemic control and medication.

Diabetes is a chronic disease that affects 29.1 million Americans, or 9.3% of the population (including over eight million who remain undiagnosed). Diabetics have trouble regulating their blood glucose (sugar) levels due to a shortage of insulin or an inability to use insulin correctly. The disease is particularly prevalent among seniors, affecting more than one quarter of all Americans 65 and older.

Winter 2015

In This Issue:Controlling Your Diabetes

Dealing with Lymphedema

Help for the Caregiver

Are You Taking Advantage of Veterans Benefits?

Are You Eating Enough Fiber?

Foods to Keep You Healthy This Winter

Quiz Time!

Adequate glycemic control means getting as close to a normal (non-diabetic) blood glucose level as you safety can – which is between 70 and 130 mg/dl before meals and less than 180 two hours after starting a meal.

One recent study of people with type 1 diabetes had half of the group continuing standard diabetes treatment while the other half followed an intensive-control program. Those in the second group kept their blood glucose levels lower than those on standard treatment.

The group with adequate glycemic control was found to have one quarter as many people with diabetic eye disease, one-half as many cases of kidney disease and about one third as many incidents of nerve disease. In addition, far fewer of those who already had early forms of these three complications got worse. Although the study was only conducted with type 1 diabetics, experts believe the results would be similar with type 2 diabetics.

Adequate glycemic control is possible with lifestyle modifications, including diet, exercise, and frequent glucose testing at home, and by following your physician’s recommendations.

Glycemic targets are specific for each patient based on comorbidities, weight and physical activity level. Patients need to stay alert to possible adverse reactions, including low blood glucose reactions (hypoglycemia) and weight gain.

Maintaining good glycemic control should not be something you do on your own. It needs to be discussed with your health care team (doctor, diabetes educator, dietitian). They will help determine guidelines in terms of diet and exercise, and put you on the right program for maintaining adequate glycemic control.

DEALING WITH LYMPHEDEMA Lymphedema occurs when there is an interruption with the circulation as a result of the lymph vessels being unable to adequately drain lymph fluid.

Fluid builds up and causes the arm (or leg) to swell. Women who have undergone surgical or radiation treatment for breast cancer are particularly susceptible to the condition (although it can also occur after any type of cancer surgery involving lymph node removal).

With lymphedema, the limb becomes heavier because there is no place for the fluid to go. There may be cellulitis, fungus or open wounds because of the bacteria that has accumulated and the loss of protein. It can even result in “weeping,” which is when fluid actually comes out of the pores of the skin.

Lymphedema can’t be cured, but it can be managed with regular treatment. Unfortunately, many doctors remain unaware of the symptoms or current management of lymphedema, and so their patients suffer.

Feelings of tightness, heaviness or fullness in the arm, in addition to swelling or redness, are common early symptoms. Lymphedema can occur several weeks after treatment, or may not happen until as many as 15 years later.

Lymphedema is very “patient specific.” While it is not clear why some breast cancer survivors get lymphedema and others do not – for example, a patient who has undergone a mastectomy might not get it, while one who has had a lumpectomy may – several factors do increase the risk. These include removal of a large number of axillary lymph nodes during surgery (fortunately, surgeons now remove fewer lymph nodes, lessening the odds of getting lymphedema), radiation to the area, infections, or being overweight.

Physical therapists specially trained and certified in lymphedema treatment use a light superficial massage known as manual lymph drainage that directs the fluid from a patient’s arm away from the affected extremity, allowing the body to absorb it. Compression bandages or garments are used to help push the lymph fluid out of the arm. Patients are also taught light exercises to encourage movement of the lymph fluid out of the limb.

Lymphedema is a progressive disease. An untreated limb can continue to swell over time and lead to open wounds, skin changes and cellulitis. That’s why it’s strongly encouraged that patients continue treatments on their own, including self-massage, remedial exercise and compression, and, when necessary, return to a therapist for a checkup.

HELP FOR THE CAREGIVER

Alzheimer’s disease changes lives. In addition to the more than five million Americans who suffer from it, the disease also changes the lives of the family members who care for them.

The family caregiver experiences considerable burden, stress and disruption to her own life. She is at risk for emotional and physical health problems, with older adults in caregiver roles particularly vulnerable.

A caregiver for an Alzheimer’s patient must deal not only with a loved one’s memory loss, but also the disease’s other common symptoms: loss of judgment, orientation, ability to understand and communicate effectively and, frequently, changes in personality and behavior. It becomes an all-consuming job – often forcing caregivers to quit their jobs, give up personal time, and become socially isolated.

Additionally, there is exhaustion that comes from a lack of sleep and irritability. Many lose their focus or concentration and, often, because they stop taking care of their own health concerns, place themselves at risk of getting sick.

In working with patients to prevent caregiver burnout, the Alzheimer’s Association offers these recommendations:

• Find out what resources are available in the community. Adult day programs, in-home assistance, visiting nurses and meal delivery are just some of the services that can help the overwhelmed caregiver manage daily tasks.

• Get help. Seek the support of family, friends and caregivers going through similar experiences. Caregivers need to learn to delegate responsibilities to others.

• Use relaxation techniques to relieve stress. There are several simple relaxation techniques that can help relieve stress. This may include visualization, meditation, breathing exercises and muscle relaxation which can be done in the comfort of your home.

• Get moving. Physical activity can help reduce stress and improve overall well-being. Even 10 minutes of exercise a day can help and that can include taking a walk and going up and down the stairs.

• Make time for yourself. Experts recommend that caregivers carve out some time every week for themselves, where they can get away to spend time with a friend, shop, or take a class.

• Become educated. Alzheimer’s is a progressive illness and caregivers need to know what to expect at each stage and have a plan in place for coping with it. This involves researching the internet, getting involved with support groups and talking to specialists.

• Take care of yourself. Visit your doctor regularly. Watch your diet, exercise and get plenty of rest.

ARE YOU TAKING ADVANTAGE OF VETERANS BENEFITS?

Unfortunately, according to the Veterans Administration, many elderly veterans and their widows miss out on benefits they deserve because they are unaware of it. These are benefits that could help defray the cost of senior care, including home care.

In fact, according to a VA estimate, only one in seven of the widows of vets and about one in four veterans who would probably qualify for benefits receive them.

Aid in Attendance, for example, offers the highest level of benefits to veterans and their spouses (more than $2,000 per month tax free,

or an estimated 20 – 25 hours of home care per week) – although eligibility is restricted and requires extensive medical documentation. In order to qualify for the pension, veterans must be over the age of 65, served at least 90 days of active duty in the military with at least one day during wartime (although they don’t have to have served in a war zone), be at least 60 percent homebound, and meet income and asset limits.

ARE YOU EATING ENOUGH FIBER?We all need a daily dose of it, but experts say we aren’t including enough fiber in our diets.

Fiber helps the immune system work properly, supports bowel regularity and improves bone health. Yet, we get about half of the daily dose of fiber our bodies need.

Dietary fiber – found mainly in fruits, vegetables, whole grains and legumes – not only prevents or relieves constipation, but can help you maintain a healthy weight and lower your risk of diabetes and heart disease. Unlike other food components, such as fats, proteins or carbohydrates – which your body breaks down and absorbs – fiber isn’t digested by the body. Instead, it passes relatively intact through your stomach, small intestine, colon and out of your body.

Some creative thinking can make taking more fiber, well, easier to swallow. For example:

• Ground flax seed into soups or into tomato sauce

• Serve plenty of side dishes that include beans, lentils and multiple grains

• Mix Sunfiber (which has no smell or taste), an invisible fiber supplement, into pancakes, waffles, muffins, chili, soups and yogurts

• Add fiber into fruit kebobs

• Use high-fiber bread for sandwiches

• Add oatmeal (which is high in fiber) to desserts, such as fruit cobblers

FOODS TO KEEP YOU HEALTHY THIS WINTER Nutritionists say that winter is a terrific time to enjoy foods that are rich in fiber, B-vitamins, minerals, and are good sources of protein. Here is a look at some healthy choices:

LegumesLegumes – including kidney, garbanzo, and pinto beans, lentils, and white and black beans – are a healthy and hearty ingredient for winter recipes. They are rich in important nutrients like fiber and protein, legumes, and make a tasty addition to winter soups and stews.

TurkeyTurkey is a lean source of protein, and has few calories. This can include turkey soup, a turkey sandwich on a hearty whole-grain bread and turkey on its own.

CranberriesCranberries are not only delicious when they’re fresh, they’re low in calories. Fresh whole cranberries add snap to salads, breads, and muffins.

Winter SquashAcorn and butternut squash are loaded with vitamins and nutrients, and while you can buy them year round, they make great recipes during this time of year. These foods burst with nutritional value, and shouldn’t be smothered with high-calorie condiments like butter and syrup. Instead, use a teaspoon of low-fat margarine in the cavity of the squash while you bake it, or just a sprinkle of brown sugar.

Citrus FruitsWinter is the season for fresh citrus, and oranges are loaded with vitamin C. One orange alone offers up more than 100% of your daily requirement of power-packed vitamin C, as well as other disease fighting nutrients. Oranges also have folate, a B vitamin that may help to keep your heart healthy, as well as fiber and potassium.

Cabbage and KaleRed cabbage is low in calories, has plenty of vitamin A and contains the natural phytochemicals lutein and zeaxanthin. Kale is a power source of a multitude of healthy nutrients, including beta-carotene, vitamin C, folate, iron, magnesium, and a number of phytochemicals. Served in salads, soups, and stews, cabbage and kale add flavor and zest to hearty winter recipes.

QUIZ TIME!

OSCAR WINNERS! With many of us thinking about the annual Academy Awards ceremony, now is a good time to look back at past Oscar winners. Let’s see how well you can match these award winning actors with the real life characters they played.

A. Mahatma Gandhi B. Margaret Thatcher C. Virginia WoolfD. Edith PiafE. Abraham LincolnF. Truman CapoteG. Harvey Milk H. Ray CharlesI. Erin BrockovichJ. Idi AminK. Queen Elizabeth IIL. Claus von Bulow

1. Forrest Whitaker 2. Marion Cotillard3. Meryl Streep4. Helen Mirren5. Daniel Day-Lewis6. Philip Seymour Hoffman7. Jeremy Irons8. Sean Penn 9. Julia Roberts10. Nicole Kidman11. Jamie Foxx12. Ben Kingsley

A-12B-3C-10D-2E-5F-6

G-8H-11I-9J-1K-4L-7

Answer Key