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A concern for the PC crowd: prediabetes and obesity

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Posted 11/16/2019 2:19 AM (GMT 0)
Since diabetes and even prediabetes can worsen the prognosis in PC as well as many other health issues, it is something we and our doctors probably should be alert for. And of course, obesity has it's own worrisome side effects, so we probably ought to be working hard on that as well. (of course, what helps with one often helps with the other)

Unfortunately, we don't seem to be getting anywhere as a nation(or world), and in fact in things seem to be getting steadily worse. Apparently dietary advice, even with far more adult exercise than 50 years ago, simply has not been of any benefit. I believe I have provided links in the recent past showing that diabetes has increased by a factor of 8 in the last 50 years, a time during which dietary advice changed significantly. Whether because people won't follow the dietary advice, or because the advice is not worth much, bottom line: it continues to get worse. And it also sounds as if our doctors are often not on top of this at all, according to this study. So, as always, we should probably be educated and our own advocates:
Prediabetes:
https://www.medscape.org/viewarticle/919839?nlid=132489_2713&src=wnl_cmemp_191115_mscpedu_nurs&uac=158102pn&impid=2168841&faf=1

Somebody said...

“Clinical Context
Approximately 1 in 3 US adults has prediabetes, yet many of these patients are unaware of this condition. Can healthcare providers be contributing to the lack of action around prediabetes? Tseng and colleagues sent surveys to 1000 primary care physicians to assess their knowledge and practice habits regarding prediabetes. The survey response rate was 33%.
Of 15 possible risk factors to prompt screening for prediabetes, physicians recognized an average of 10, with factors around race/ethnicity being the most commonly missed. Less than half of physicians recognized the laboratory value cutoffs used to define prediabetes.
Only 36% of physicians referred patients to a diabetes lifestyle prevention program, even though such programs have the best history of efficacy for the prevention of diabetes, and 43% reported discussing the initiation of metformin with patients,
…………………………………………
Study Synopsis and Perspective
Despite more than 2 decades of studies showing that type 2 diabetes can be prevented or delayed by intensive lifestyle change such as the Diabetes Prevention Program (DPP), metformin therapy, or both, uptake of these remains quite low among US patients.
Indeed, study findings published online September 9 in the Journal of General Internal Medicine identified substantial gaps in prediabetes management at the primary care provider (PCP) level that significantly affect the care of this patient population.
Eva Tseng, MD, MPH, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues found knowledge gaps related to prediabetes in key areas, including screening, laboratory diagnostic criteria, and patient management recommendations. ………………………………………………..
"Some important findings to highlight include that 25% of PCPs may be identifying patients as having prediabetes when they have diabetes," she said.
"Additionally, only about a third of PCPs refer patients with prediabetes to diabetes prevention lifestyle change programs for their initial management approach ." ……………………………….
More than 15% of respondents correctly identified all 15 risk factors for prediabetes screening; typically, PCPs selected 10 of the 15 risk factors.
Similarly, only about 50% of respondents were aware of the laboratory criteria for diagnosing diabetes, and even fewer correctly identified the fasting glucose (42%) and Hb1Ac (31%) levels that would indicate prediabetes.
In addition, only 8% of PCPs were aware that the American Diabetes Association recommends patients aim to lose at least 7% of their body weight as part of a diabetes prevention lifestyle change program.
In fact, more than 20% of respondents were not following recommendations from any professional organization for the screening and management of prediabetes. ……………………..

............................................................................................................................................................

Obesity: See next post

Post Edited (BillyBob@388) : 11/15/2019 7:26:53 PM (GMT-7)

Posted 11/16/2019 2:21 AM (GMT 0)
Obesity:
https://www.medscape.org/viewarticle/920510?nlid=132489_2713&src=wnl_cmemp_191115_mscpedu_nurs&impid=2168841&faf=1

Somebody said...
Almost 40% of US Adults and Nearly 20% of Kids Are Obese
The report is based on data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (CDC) and the most recent 2015-2016 National Health and Nutrition Examination Survey (NHANES).
The nationally representative NHANES data reveal "unprecedented levels of obesity," the report states. In 2015-2016, 39.6% of adults and 18.5% of children in America were obese (body mass index [BMI]>30 kg/m2 for adults), with the increased risks for numerous poor health outcomes that go along with obesity.
"Strikingly, the incidence of obesity in the United States has increased by 70% over the last 30 years for adults and by 85% over the same time... for children, " the authors noted.
………………………………….

Post Edited (BillyBob@388) : 11/15/2019 7:28:05 PM (GMT-7)

Posted 11/16/2019 6:11 AM (GMT 0)
no more donuts for me. sad
sigh ...
Posted 11/16/2019 2:52 PM (GMT 0)
“ Almost 40% of US Adults and Nearly 20% of Kids Are Obese ”

If stop and think about it for a moment, these numbers are really stunning. And should be addressed. A call to arms is needed, perhaps, to all Primary Care physicians, to counsel patients early on, in a very aggressive way, and also to test obese patients for other conditions that could cause obesity, prediabetes, besides lack of control, like thyroid conditions, that can be addressed.
Posted 11/16/2019 3:55 PM (GMT 0)

InTheShop said...
no more donuts for me. sad
sigh ...

I love donuts. I usually have 2 blueberry DNs once a week a part of breakfast, often after a fast the day before, and then I have to fast the rest of the day until supper to partially make up for my great over indulgence. It is a habit I really need to break.

Pratoman said...
“ Almost 40% of US Adults and Nearly 20% of Kids Are Obese ”

If stop and think about it for a moment, these numbers are really stunning. And should be addressed. A call to arms is needed, perhaps, to all Primary Care physicians, to counsel patients early on, in a very aggressive way, and also to test obese patients for other conditions that could cause obesity, prediabetes, besides lack of control, like thyroid conditions, that can be addressed.

Yes, and not least just because that one base problem contributes, sometimes strongly, to so many other problems. I wonder how many of the PC bros were prediabetic- even if not diagnosed- for years as their PC was growing enough to be detected. I'm pretty certain I was. Especially during those years when my gut and blood pressure were on an ever upward trend. And the only limits to my carbs was when I was full. But it was never long until I was hungry again. My blood sugars were not quite high enough to set off alarms, but my blood insulin(which no one ever measures unless you are in a clinical trial) was probably through the roof, needed to keep my blood sugar under control despite massive carb intake. There were a lot of years like that, and who knows what all it might have contributed to other than the obvious: my gut and BP. And there have been some periods of time since I corrected most of those abuses, where I don't do so good.

My wife has finally consented to a short trial of the Plant Paradox approach. She had pretty much refused to consider it for her chronic pain for which the doctors do not seem to have much help, at least not without severe SEs. But she has refused to look into it despite my arguments that it wasn't going to kill us to try it for a week or two, and then if no good results go back to our old ways. But a light bulb seemed to turn on this morning, after she had a particularly bad night, and she noticed that about everything she had for supper was on the fairly short "don't eat this" list. So I am tickled that now she wants to at least try it, although if she sticks with it for even a week or two- long enough to maybe see some results- I will be pleasantly surprised. So, here we go, wish us luck!

Post Edited (BillyBob@388) : 11/16/2019 9:05:47 AM (GMT-7)

Posted 11/16/2019 4:43 PM (GMT 0)
I must report this good news about my wife: I have been in heaven for a few months since she finally listened to me and dared to ask her doctor about something he was treating her for. You must understand: my wife and I both were RNs. But I went on for additional years for anesthesia training(CRNA), while she was an OB nurse, birthing those babies. And we in fact met when I put an epidural in one of her patients in labor for child birth. But we have always been very different in our attitudes towards doctors. I think part of that comes from the difference in men and women(based on what I and others have observed over those decades) and also my additional training and experience. IOW, like a lot(NOT all) female RNs, she was a lot more prone than me to accept a doctors word as the final word, without questioning it, for whatever reasons.

So, between 15 and 20 years ago, I got a call that my wife was in the ER with what turned out to be a hyperthyroid crises. Her thyroid gland was producing way to much thyroid hormone, and her BP and pulse rate were through the roof, along with some other symptoms. So, the docs went in and destroyed her thyroid with some radioactive iodine(thyroid glands suck up iodine). After a while she was now severely hypothyroid(as expected) with all of those symptoms, like lethargy and feeling extremely cold even when the house was 72 degrees or higher. So then they started her on a lifetime of thyroid replacement pills, to make up for what her body could no longer produce. But she never got over being cold. Never. Always freezing while I was just fine.

So I begged her to ask her doctor if she might not need a bit more thyroid. She just wouldn't do it, said her doctor was perfectly happy with her Thyroid Stimulating Hormone(TSH) so therefore so was she. I would argue "but you have major symptoms of a hypo(low) thyroid condition, the labs be darned!" The so called normal range varied over a factor of 10, from .4 to 4.5(the higher the number of this hormone that stimulates thyroid production, th lower your actual amount of thyroid). She was somewhere in the upper middle of that range, sometime 3+. I kept asking her "if the normal is .4 to 4, how the heck do you know what you were BEFORE they killed your thyroid gland? What if you ran a .5? That would still have been in the normal range and cause no alarm. If you were, and you are now 3+, then you are running 6 times over your norm. Please, ask the man". But she refused, probably unwilling to possibly insult him by questioning his decision. Then I gave up and to avoid the argument and frustration it caused in me, I just put up with he constant complaints of being cold.

The one day recently, after all these years, she came home from an check up and said "Oh, BTW, I asked the doctor if it was possible I might be low on thyroid because I have some symptoms, and is it possible to bump me up a smidgen. He said 'Sure, why not, you run on the high end of TSH anyway, no problem" and he bumped her dose up maybe 50%. Oh, miracle of miracles, within a couple of weeks and she is NEVER cold anymore! Not unless it is appropriate to be cold, like when outside and the temps are actually cold and almost every one else is cold also. But even then, now she can put on a coat and be OK! This is just wonderful! It only took about 15 years to get er done, but now I am in heaven.

Now, I realize I may be hijacking my own thread, as this has nothing to do with prediabetes that I know of. But it does have to do with the importance of being educated and our own health advocates when dealing with our doctors. They are not perfect, and sometimes they get it wrong. Or at least they need some more info from us(if they didn't ask us for this info in the first place), something like "hey, I have been near hypothermic ever since you killed my thyroid gland. Is it possible you should give me a bit more thyroid?".

Post Edited (BillyBob@388) : 11/16/2019 9:47:50 AM (GMT-7)

Posted 11/16/2019 5:00 PM (GMT 0)
Apparently dietary advice, even with far more adult exercise than 50 years ago, simply has not been of any benefit. Billy not sure where you got those stats from but the part about more exercise than 50 yrs ago is simply not true that's one of the reasons the obesity is so high! How many people sat at a chair and stared at a computer screen back then? There was no facebook if you wanted to chat with someone you went and saw them. A lot of people smoked back in the 70's which helped to keep weight down. I gained 30 lbs when I quit my 3 pack a day habit. Very little prepackaged food, maybe a pizza joint that would deliver not up in our neck of the woods. A lot of people heated with wood that burns lots of calories, And I personally believe one of the worse things today is all the amp drinks even Adults are starting to drink this crap!!!! Eating out was a treat you might do once a month if you lived high on the hog other wise all the meals were home cooked meals which is also a huge factor. There were also not robots working on the assembly line people were actually doing the work. I worked in a satellite factory buffing and polishing car parts you worked like a fool cause there were people waiting to take your place. When I first started working road construction shovels were used extensively now a bobcat does the work. So I believe the lack of exercise contributes probably more than poor diet. although JMHO

Larry
Posted 11/16/2019 7:19 PM (GMT 0)
Skypilot56, I agree that the lifestyle has become more sedentary over the past decades. That and the fact that fewer people cook from scratch and that fattening food is relatively inexpensive all are part of the problem.

How should it be addressed? It really is a personal decision what and how much to put in our mouths and whether to become more active so I am not sure that I am ready to get Big Brother involved. However, we ALL pay for this in the cost of our health care and insurance. According to the CDC, the annual cost of obesity is around $147 billion. Add to that the loss of productivity. Perhaps putting people who are overweight/obese into a separate risk pool, like bad drivers, and charging them a bit more for insurance might provide some motivation.
Posted 11/16/2019 7:42 PM (GMT 0)

Skypilot56 said...
Apparently dietary advice, even with far more adult exercise than 50 years ago, simply has not been of any benefit. Billy not sure where you got those stats from but the part about more exercise than 50 yrs ago is simply not true that's one of the reasons the obesity is so high! How many people sat at a chair and stared at a computer screen back then? There was no facebook if you wanted to chat with someone you went and saw them. A lot of people smoked back in the 70's which helped to keep weight down. I gained 30 lbs when I quit my 3 pack a day habit. Very little prepackaged food, maybe a pizza joint that would deliver not up in our neck of the woods. A lot of people heated with wood that burns lots of calories, And I personally believe one of the worse things today is all the amp drinks even Adults are starting to drink this crap!!!! Eating out was a treat you might do once a month if you lived high on the hog other wise all the meals were home cooked meals which is also a huge factor. There were also not robots working on the assembly line people were actually doing the work. I worked in a satellite factory buffing and polishing car parts you worked like a fool cause there were people waiting to take your place. When I first started working road construction shovels were used extensively now a bobcat does the work. So I believe the lack of exercise contributes probably more than poor diet. although JMHO

Larry

Well, of course, I might be wrong and probably am. But on the other hand, whenever I drive home, often even late at night, here in MS I pass more than one gym which is full of exercising adults. Every day in my neighborhood, in addition to myself, I see adults walking fast or jogging. Many of the older guys in my church go often- even daily- to the local wellness center- associated with the hospital where I used to work- where they swim, walk/jog, and/or do some form of strength training.

I don't know about you, but I don't ever remember seeing adults exercise voluntarily, back in the 50s and 60s. Did you? Admittedly, a good number of them had to exercise in some fashion at work. But even then, most adults I knew did not make their living by consistent, hard manual labor. What about you? I see you did some hard manual labor. So did I. But I did not do much once I was an adult and finished with my education. It was not the norm of my young adult life. Even in the military, before I cross trained to the medics, I was repairing machinery. Sometimes that called for a significant short term output of energy, but most of the day I was working steady, but not really at a level that would be called hard exercise, or barely exercise at all.

Now, when it comes to children, there is no doubt at all that exercise has been vastly reduced. And, diabetes has absolutely skyrocketed in that group, as it was almost non-existent (type 2 anyway) in children back in the 50s and 60s.

But, I think my point is still valid: whatever has been going on as far as either exercise and/or dietary advice for the last 50 years, we have ended up with 8 times as many diabetics as we used to have. And we have ended up much more obese. Neither advice to exercise more nor advice to "eat right" (whatever that actually would be) has helped. That could be because advice was not followed, but again, I see lots of adults exercising all the time. And I know lots of folks who tried real hard to eat low fat for a lot of years. Not only has advice(perhaps advice not followed) not helped, in fact, seems to be the opposite, considering the huge increase in diabetes and obesity. But, I might be wrong.

Post Edited (BillyBob@388) : 11/16/2019 12:45:35 PM (GMT-7)

Posted 11/16/2019 8:02 PM (GMT 0)
Oh, Sky, I forgot to say: what about women? I was raised by women, and most that I knew did not have hard manual labor jobs, though some did. But if you were alive in the 50s and 60s, can you ever recall seeing an adult woman voluntarily exercising? I mean other than if occasionally playing a game, like bowling or tennis or soft ball? I can not remember a singe case. but every day in my neighborhood I see at least 2 women consistently either walking as fast as possible, or out right jogging/running. And I see others doing so when I drive around town.
Posted 11/16/2019 8:59 PM (GMT 0)
Billy I can see you and I grew up in different environments, Women worked from the time they got out of bed until they went to bed at night. They didn't need to go to no gym or go for walks they did that all day. Both boys and girls had chores to do before and after school there was no time to watch tv or play video games or be on facebook the only facebook was when the darn cow kicked the bucket of milk and it landed in your face!! So the few people you see going to the gym in a population of over 300 million wouldn't even make a splash in a bucket. Sorry I live in the real world. here's a great example there is a dairy farm is Wisconsin that milks 3,000 head of cattle a day a human hand never touches these cows for milking and eating it's all done by robots around the clock. Working smarter? I got my first tv in the middle seventies our remote control was telling the kids to change the channel cause we were exhausted from the day's work now we talk to our tv's! You know what's interesting is when my 8 yr grandson spends a month with me he's wanting to go on bike rides, hiking, swimming in the lake, after a month back home all he wants to do is spend time on the computer and playing his switch and telling grandpa he just wants a lazy day. Crazy what 8 yr old kid wants a lazy day? Go to a store and watch who parks in front of the door 40 and under, us old farts always park farther away cause we don't mind walking. So yes I agree with you 100% that the health crisis which includes obesity, diseases, and how we are going to pay for all of it is monumental! In fact I personally believe it is gonna be the downfall of America brought on by the almighty dollar and the in-humane treatment of people from a handful of filthy rich people running the show!!!! Good example after spending hundreds of thousands of dollars to become a doctor they are required for every 15 minutes they spend with a patient they have to spend 35 minutes doing paper work no wonder we are gonna be thousands of Doctors short in the next 10 yrs. I'm sorry I am on a rampage but just came from a funeral of a friend who lost his battle with a blood cancer. Family has no home left no cars no cash trying to fight this darn cancer. Most of us guys here have a pretty good living and decent insurance and can go to good facilities and drs. I wish I could see a solution to our health crisis but I personally don't believe that it is possible! Not until everything comes crashing down! Sorry People that's how I believe we have the best Drs, Medical Hospitals, great nurses in America that is being destroyed by the filthy rich. If anybody has any solutions gosh I would like to hear them maybe there still is hope

Larry
Posted 11/16/2019 10:09 PM (GMT 0)
Larry,

You make many valid points in your rampage. (did you grow up on a farm?) I don't know what the solution is either, and I think disaster is upon us as a nation. But I don't think the solution lies in the recommendations we have been given for the last 50 years, other than to increase exercise. But I don't think any one (or at least extremely few) is going to exercise enough to over come bad diet. Now exactly what makes up a bad diet is the question. It can not be ignored that the dietary recommendations of the last 50 years have coincided with the epidemic. I'm sure lack of exercise adds to the problem, most especially among our young folks who I have no doubt do not stay active a fraction of the time we did at their age. As you said, an 8 year old needs a rest day? Wow!

Now, speaking of exercise, I've got to get I'm my 2 mile walk at an average of 3.1 mph with 2 or 3 60 yd "dashes" thrown in, and then I've got to get the grill ready. We just went out to buy grass fed beef, and they were out! So it will be regular filet and T bones, with some sweet potatoes and salad leaving out the night shades and such. We are also going to attempt to get started on other dietary advice from the Plant Paradox, in hopes that it will help my wife's chronic pain. I sure do pray that we can find something that will help.

Bill

Post Edited (BillyBob@388) : 11/16/2019 3:12:17 PM (GMT-7)

Posted 11/16/2019 11:52 PM (GMT 0)
Bill I hope you and your wife will be able to find something for the pain. I suffer from degenerative arthritis pain lots of nights only get couple of hrs of sleep, I think about some of the young people that I worked with that are supposedly suffering from fibromyalgia and are on medication. I'm just to stubborn as my wife says to go get any medication I don't take anything besides a multi vitamin and a baby aspirin. I figure its partly due to getting older and as my Doctor at Mayo said you can thank your relatives for a lot of it. My Dad didn't suffer from any but my Uncle's fingers were pretty much useless when he passed away and my Grandparents were the same way which everybody contributed to the hardship of farming especially my grandfather who cleared a section of land with horses talk about bull work! he lived till 76 didn't take any medication come in from milking said he was tired went to bed and never woke up they did an autopsy and he died of a heart attack.. When the time comes I hope it will be the same for me. I do take Aleve when the pain gets overbearing the Heart Doctor at Mayo doesn't want me taking it anymore but it is the only thing that seems to work for me. Enjoy your supper sounds good! 😊

Larry
Posted 11/17/2019 2:32 AM (GMT 0)
Thanks, Larry, the steaks were good. What a great way to go (your grandfather). My uncle(a father figure for me after my father died when I was 3) went at 72, after joining the Army at 16 and being an Army drill instructor and long range sharp shooter at the start of WW2, later transferred and retired from the Air Force, followed by 20 years of civil service as a civilian working at an AF base. One day went for his 2 mile walk(just like I did right before grilling steak), came home and said he was tired, went back to the bedroom, turned the TV on and sat down to watch a while, and died in his chair. What a way to go.

Your heart doctor doesn't want you taking Aleve any more? Or any other NSAIDS I suppose? Apparently he thinks that would be bad for your heart? So does he offer any alternatives? I hope so.
Posted 11/17/2019 10:55 AM (GMT 0)
Bill your right She doesn't want me to take any NSAIDS She recommended and kinda pushed extra strength Tylenol
which doesn't do anything for me. On the days when I just want to bang my head against the wall I might take a hydro or oxycodone that I have left from my surgeries. But otherwise Alleve is my go to. Larry
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