Three steps to making lifestyle changes that can help you manage your diabetes.

I think change gets harder with age. I cringe inside when I find out I’m going to have to change the way I’ve been doing something at work and learn a new way, for example. It seems the only thing we can be certain about with change is that it will happen again. Health care behaviors seem to be some of the hardest changes to make.

A number of theories about human behavior and change exist. One such theory, by Kurt Lewin and Edgar Schein, proposes that change is a three-stage process — unfreezing a behavior, changing, and then refreezing the new behavior.

Getting motivated: Unfreezing
The first stage — the unfreezing stage — is becoming motivated to change. How do we become motivated to change? A new diagnosis of diabetes, a poor A1C report from the medical care provider, nudges from a family member or self-evaluation all might motivate change. At this stage, the change process becomes a mental game of mind over matter. We realize the current situation isn’t working and that ignoring the condition won’t make things better. Real and unreal anxieties can slow down and impede the process of change. You might question if you can change, how to start or if it will make a difference.

Making changes
The change stage follows making the decision that a change needs to occur. Next, we must decide what needs to change. Activities that help us change are beneficial in the change stage. These activities might include:

* Choosing a specific behavior you want to work on changing
* Being realistic — avoid trying to change everything at once
* Writing down the change and posting it in plain sight to give yourself a daily reminder
* Discussing the change with others around you and asking for their support and encouragement
* Finding a support group
* Seeing your diabetes health care team regularly
* Changing your environment to support your change, such as getting snacks out of the home

Making it permanent: Refreezing
The refreezing stage — making the change permanent — is probably the hardest stage. This final stage is when the change becomes habitual and includes developing a new self-concept. You become a person identifying and living for wellness.

Living with diabetes

How diabetes occurs and how to treat it. Watch this and more health videos at: answerstv.com.

Free medical advice online published by Dr Vivienne Balonwu. Categorised medical advice.

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Glaucoma

This is a disease of the eye, where the normal fluid pressure inside the eye gradually increases, leading to problems with vision or even blindness on occasions.

What Causes Glaucoma?

The basic problem in glaucoma is in the small space at the front of the eye, called the anterior chamber. There is normally a steady flow of clear eye fluid in and out of this chamber, bathing and nourishing the eye. For reasons which still remain unclear, in glaucoma this fluid begins to drain out too slowly and so the fluid pressure slowly builds up in the eye. This excess pressure causes damage to the optic nerve, which connects the light-sensitive retina at the back of the eye to the brain. It is the health of this optic nerve which is necessary for healthy vision and so progressive damage to it from glaucoma slowly damages the eyesight. Most people suffer from a form of glaucoma called ‘open-angle glaucoma’.

What Are Glaucoma Symptoms And Signs?

Initially there are no symptoms in open – angle glaucoma. There is no pain, and the vision is normal. However, if the glaucoma remains untreated, a person may notice that although they can see things directly in front of them clearly, anything to one side of their vision appears blurred or foggy. They may fail to see objects to one side of them, and feel as if they are ‘looking through a tunnel’. Over time, their vision may gradually disappear to nothing.

Will I Have Any Tests Or Investigations?

Specialized tests are vital for the diagnosis of glaucoma to be accurately made.

There are 4 main tests;

* 1. Visual acuity. This involves using the well-known ‘doctor’s eye chart’ with letters of different sizes on it to measure how well you see at various distances.

* 2. Visual field. This important test measures your side (peripheral) vision, the loss of which is an early sign of glaucoma.

* 3. Pupil dilation. Special drops are put into the eye to dilate the centre of it and allow for the optic nerve to be examined. This means you will have blurred vision for some hours until the drops wear off, and you should not drive in this time.

* 4. Tonometry.There are a number of different types of this test, all of which are designed to measure the fluid pressure inside the eye. A common type is the fair puff’ test which measures the resistance of the eye to a puff of air, and is quick and painless.

What Treatment Might I Need?

Glaucoma is readily treatable, although not curable. The usual treatment is medicines, either in the form of eyedrops or pills. Some of these help to drain excess fluid from inside the eye, and others cause less fluid to be produced in the first place. These have the disadvantage of having to be taken several times each day, and they may also become less effective with time. It is important that your doctor knows any other medicines you may be taking before starting such treatment in order to avoid drug reactions or side effects. Laser surgery is becoming an increasingly popular treatment option. In this case, a strong beam of light (the laser) is focused on the anterior chamber at the front of the eye. This is painless because the eye has been numbed first with anaesthetic eye drops.

You may see little flashes of red or green light, and the laser makes up to 100 evenly spaced burns around the anterior chamber. These allow fluid to drain more easily out of the chamber and so reduce the eye pressure. This is very effective at treating glaucoma, but pressure may slowly increase again after 1 -2 years in some patients. If medication and laser surgery have no effect, ‘conventional’ surgery is then an option and is performed at hospital. A new channel is created for fluid to drain away from the eye, and drops are needed for several weeks afterwards to prevent any swelling or infection. If the new drain in the eye closes up, a second operation is sometimes needed to re-open it again. This type of surgery works better if you have never had eye surgery before. It is always important to remember that the aim of glaucoma surgery is to save sight, not improve it and some people find that although their sight has been saved it is not quite as good as before they had their operation.

What Course Will The Illness Follow?

If untreated or unrecognised, the usual pattern is that the eyesight gradually deteriorates until vision is very poor or blindness occurs. Once treated, regular checks from eye professionals such as opticians and ophthalmologists are vital to make sure the eye pressure is steady and not increasing once more. If the pressure remains the same, the eyesight tends to stay the same also.

Can I Do Anything To Help Myself?

If you are aged over the age of 60, or have a strong family history of glaucoma, or are Afro-Caribbean in race then you should have annual eye checks, even if you are not aware of any eye problems or symptoms.

Tell Your Doctor

1. Do you think your eyesight is getting worse?
2. Can you see things in front of you better than to the side of you?
3. Do you have a family history of glaucoma or eye problems?
4. Have you ever had problems with eye tests in the past?
5. Have you had your glasses changed recently?

Ask Your Doctor

1. What are the side effects of treatment?
2. Am I allowed to drive with glaucoma?
3. What extra risk do my children have of developing glaucoma?
4. Can I go straight to laser surgery without needing to try medication?
5. Does eyestrain make glaucoma worse?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free medical advice on glaucoma is published by Dr Viv Balonwu.
For further information on glaucoma, visit International Glaucoma Association.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

A stroke is when a part of the brain suddenly becomes unable to function. This is due to a lack of oxygen, and so all strokes have the common factor of disease affecting the blood supply to the brain. This usually occurs with little or no warning, and causes weakness and paralysis of any part of the body depending on the part of the brain affected. In the United Kingdom, someone has a stroke every 5 minutes.

What Causes Stroke?

The main cause of a stroke is a blockage to the blood flow, or the bursting of an artery to the brain. When an artery is blocked, this is called a cerebral infarction. When there is bleeding into the brain, it is called a cerebral haemorrhage. There is a third kind of stroke, called an embolic stroke. This is where a blood clot travels through the body and blocks an artery in the brain to form a plug, or embolism.
The diseases which cause strokes to occur are similar to those which cause heart disease. Arteries in the brain may block due to them being furred up by fatty material in the same way that heart arteries become blocked and cause heart attacks. Blood clots can arise from heart diseases where the heart has an irregular rhythm, or where there is damage to the valves of the heart. When a cerebral haemorrhage occurs, the commonest cause is due to a weakness in the wall of an artery – called an aneurysm. These are sometimes present in people from birth as an inherited weakness, but more commonly are the result of high blood pressure.

What Are The Signs And Symptoms Of Stroke?

Any symptoms that occur after a stroke are immediate, and depend both on the area of the brain involved and the degree of damage caused. The commonest symptom is weakness or paralysis of one side of the body. There may be loss of sensation and movement of part of an arm or leg, or complete loss of any function along one side of the body. Speech is often affected, along with facial weakness and tingling or numbness of the face. If the stroke affects the base of the brain, there may be problems with swallowing, breathing and consciousness.
Some patients have a warning attack some time before a major stroke. This is often in the form of a short-lived weakness or numbness down one side, or a temporary problem with speaking. These are called TIAs – transient ischaemic attacks – and are usually completely better within 24 hours.

Will I Have Any Tests Or Investigations For Stroke?

The main test of use if a stroke is suspected is called a CT scan. This will not only rule out any other possible causes for a patients symptoms, but is also able to confirm whether a stroke is due to a clot or bleeding. If it is due to a clot, the heart will be tested for any source of these such as valve problems. It may also be necessary to perform a soundwave test called a carotid ultrasound, which looks at the arteries in the neck to see if there is any kind of blockage to the blood flow there. A neurologist – a doctor specialising in brain disorders – may assist in the diagnosis and management of stroke patients. The main care of patients who have had a stroke however remains good nursing care.

What Treatment Might I Need?

Initially, if the blood pressure is found to be high, this will be lowered by medication. If a clot is the cause, aspirin is started and if it is found there are problems with the heart valves, warfarin – a blood thinning drug – will be used. Any rise in the blood sugar level, which often occurs after a stroke, will be closely controlled, and oxygen may be needed in the early stages to try to minimise the brain damage.

What Course Will The Illness Follow?

This entirely depends on the severity of the stroke and how much damage it has caused. In the early stages there may be problems with swallowing, which in turn can lead to breathing difficulties or chest infections. Once a patient’s condition has settled however, attention is turned to maximising the function that remains. This involves intensive treatment by physiotherapists to improve mobility, occupational therapists (who use a wide variety of activities to help regain dexterity), and speech therapy. The aim is always for the patient to resume as many of their pre-stroke activities as possible, but a total return to their previous condition is the exception rather than the rule. Physical therapy may continue following discharge home, but some stroke patients cannot be cared for adequately at home and so need residential or nursing home care long-term.

Can I Do Anything To Help Myself?

The main factor is to identify and treat high blood pressure – this alone reduces the risk of stroke considerably. Just as important is stopping smoking since the furring up of arteries in the brain and neck is greatly speeded up by smoking. If there is any diabetes, a good control of the body’s sugar level is very important as is controlling the level of cholesterol in the blood, either by diet or tablets. Should the heart be beating irregularly, tablets such as digoxin should control this. This is often used in combination with aspirin or warfarin as blood thinning medicines to reduce the risk of any further strokes.

Tell Your Doctor

1. Did your symptoms occur suddenly?
2. Do you smoke?
3. Does anyone else in your family have similar problems?
4. Have you been treated for high blood pressure in the past?
5. Have you ever had what have seemed like stroke symptoms, but which have disappeared after 24 hours?

Ask Your Doctor

1. Am I at risk of a further stroke?
2. How often will I need my blood pressure checked?
3.What help can I get at home to help me with mobility and my daily activities?
4. If I am able to do them, will activity or exercise hurt me?
5. Will I need to stay on Aspirin or other tablets for life?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free Medical Advice Online, Published by Dr Vivienne Balonwu. Get advice, further information and help from The Stroke Association.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Cholesterol Plague In Blood Vessel

Cholesterol is one of the fats present in the body. It is essential for life, and is found in all human and animal tissues. It is carried around the body by the blood. Some cholesterol comes directly from food, and some is made by the liver.

High blood cholesterol is usually due to eating too much fat. It can also be caused by not getting enough exercise. Occasionally, high cholesterol runs in the family, and in these circumstances it is due to the body not coping well with normal amounts of cholesterol being eaten.

Why Are High Levels Of Cholesterol A Problem?High blood cholesterol can cause health problems. The most important of these is heart disease, including heart attacks. High cholesterol levels cause fatty deposits to build up inside blood vessels. Eventually the vessels can block and blood cannot flow through them. This is particularly likely to happen in the narrow vessels which supply blood to the muscle of the heart (the coronary arteries). This may cause damage to the heart and can cause a heart attack. If you have high blood cholesterol, whatever the cause, it is possible to do something about it and so reduce your risk of developing heart disease.

What else causes heart disease?

High blood cholesterol is only one of several things which can lead to heart disease. Other things include smoking, high blood pressure, stress and lack of exercise. These are called ‘risk’ factors because they increase the risk of heart disease.

The more risk factors you have, the more likely you are to develop heart disease. To reduce your risk of heart disease, it is important to identify and control as many of your risk factors as possible. High blood cholesterol is only one of the risk factors to consider. Your doctor will be able to assess and advise you on all your risk factors.

Healthy levels of blood cholesterol

Your doctor or nurse will take a blood sample to measure your cholesterol level. Measurements can vary slightly, so it may be necessary to take more than one sample to be certain of the real level. Your doctor might also want to measure the levels of different types of cholesterol in the blood. These are HDL (high-density lipoprotein) cholesterol and LDL (low-density lipoprotein) cholesterol. They affect how likely it is that a high cholesterol level will lead to heart disease. Knowing about these will help your doctor to assess your risk of heart disease.

High Cholesterol Levels – What Can Be Done?

There are three main ways of reducing cholesterol levels: 1. to change what you eat; 2. increase the amount of exercise you take; and 3. take medication.

For most people, the doctor will recommend trying the first two approaches. This is often enough to get levels down to normal. If this doesn’t work, your doctor may prescribe a tablet. You are more likely to need medication if your cholesterol level is very high, if you have a lot of other risk factors, or if you have already had a heart attack.

Foods High In Cholesterol – Eating Habits

Changing what you eat can lower your cholesterol level. The main aim is to cut down the amount of fat you eat. However, the type of fat you eat is also important. Saturated fats (such as butter) tend to raise cholesterol. Cutting down saturated fats can lower your blood cholesterol by 20 per cent. Changes in your eating habits have to be long-term to be effective.

So you need to find a healthier eating pattern which you are happy with and can stick to. You can still enjoy your favourite food in moderation, and you don’t have to feel guilty about indulging yourself now and then.

What About Exercise?

Regular exercise can reduce cholesterol and so the risk of heart disease. Exercise also helps other risk factors for heart disease, including high blood pressure, stress and being overweight. The best activity is one that you enjoy. It does not have to be particularly strenuous. Walking, swimming, cycling and gentle jogging are all effective.

Try to take regular, moderate exercise, preferably every day. If possible, make it part of your daily routine. For example, walk short distances rather than take the bus or the car, or walk up stairs instead of using the lift. The more you do, the better, but any exercise beats none at all. If you are not fit, start gradually and build up your activity level over several weeks. Vigorous exercise can be dangerous. If you plan to do vigorous exercise, it is wise to see your doctor first if you:

Medication For High Cholesterol

Medication can be an effective way of lowering very high cholesterol levels. If you need medication, it usually needs to be taken long term. Your doctor will tell you whether or not you should consider taking medication.

By Dr Scott Lennox, MB, ChB, MRCG.

Free medical advice online published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Diabetes

Diabetes is a condition which affects the body’s ability to take glucose (sugar) from the bloodstream and use it inside cells. Glucose is essential to the body as an energy source. It is a component of carbohydrate foods (sugars and starches). Glucose is helped into the body’s cells by the hormone insulin, which is produced by the pancreas. In diabetes, the level of glucose in the blood rises because the body isn’t producing enough insulin or the body’s cells don’t respond to it as well as they should.

There Are Two Types Of Diabetes.

accounts for about 15 per cent of people with diabetes and usually occurs in younger age groups. With this type, the body stops producing insulin so that diet and insulin injections are required for treatment.

makes up 85 per cent of people with diabetes. Although people with this type still produce insulin, their body’s cells do not respond to it as well and they cannot keep their blood sugar in the normal range (between 4 and 8 mmol/L). This type occurs later in life and requires diet and possibly tablets or insulin for treatment.

What Causes Diabetes?

Type I diabetes is caused by the body producing antibodies that attack and destroy the insulin-producing cells in the pancreas. It is usually ‘triggered’ in susceptible people by a viral infection. There are several problems in the body that lead to Type II diabetes but the exact cause remains unknown. It is brought out in susceptible people particularly by being overweight and physically inactive. Diabetes can also develop in people who have other diseases of the pancreas, it can develop following treatment with some medications (such as high doses of cortisone that may be required to treat asthma or arthritis), and it occasionally develops in association with other rarer inherited conditions. The tendency to develop diabetes can be inherited. Stress and shock do not cause the pancreas to stop working (and hence do not cause diabetes), but stress usually causes the blood sugar level to rise in people with diabetes. This sometimes brings previously undiagnosed diabetes to light.

What Are The Risk Factors?

Having a close relative with Type I diabetes raises the risk of diabetes. In Type II diabetes, the risks include:

What Are The Symptoms?

Tiredness, thirst, passing water frequently, blurred vision, increased skin or bladder infections and occasionally leg cramps are common symptoms. Any combination of these can occur. Sometimes few or no symptoms occur. However, it is important for people with any of these risk factors to be tested for diabetes.

What Treatment Is Available?

If you have diabetes and it is not treated properly, a number of problems can result. High blood sugar levels increase your risk of infections and poor healing of cuts and wounds. In the long term, there can be other complications including problems with large blood vessels (causing increased risk of heart attack, stroke and foot problems), small blood vessels (in your eyes or kidneys) or with the nerves in your feet (causing numbness or sometimes burning pain). It is important to avoid complications from diabetes by following appropriate treatment that keeps blood sugar levels as close as possible to the normal range.All people with diabetes need to have a healthy lifestyle with regular meals and some exercise. If you have Type I diabetes you will require daily insulin injections which can be given by needle and syringe, or by an insulin pen device. If you have Type II diabetes you may be able to manage the condition with diet alone, particularly if you lose weight and exercise regularly. Some people with Type II require tablets or perhaps insulin injections in addition to dietary measures.

What Is A ‘Hypo’?

If you take insulin or some types of tablets to control diabetes, you may occasionally suffer a ‘hypo’. A hypo, or hypoglycaemic reaction (also called an insulin reaction), occurs when the blood sugar falls below danger level (below 4 mmol/L). It is usually accompanied by any combination of the following symptoms: sweating, blurred vision, hunger, light headedness, and/or you may have a change in mood, becoming either quieter, perhaps appearing drunk or even becoming aggressive. If untreated, you may lose consciousness. A hypo can occur if you delay or miss a meal, exercise more than usual, or take excess tablets or insulin by mistake. If this happens you should eat something sweet immediately, for example glucose tablets, two barley sugars, seven jelly beans, ordinary lemonade or cola (not diet or low calorie drinks) to build your sugar level up. You should then have some starchy food, for example biscuits or a piece of fruit to keep your sugar level up. This treatment is taken in addition to your normal diet. You will need to discuss with your GP whether you need to alter your medication. This will depend on the cause of the hypo.

By Dr Peter Stott

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.