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May 2017

Sex and Diabetes-What you should know

By: Epoch

Source: Diabetes Forecast

For an oversexed culture that isn't afraid to push boundaries on TV, in movies, on the radio, and in books and magazines, we're awfully shy about sex when it comes to our health. In fact, even though people with diabetes are at a higher risk for sexual problems, a 2010 study in the journal Diabetes Care found that only about half of all men with diabetes and 19 percent of women with diabetes have broached the topic with a doctor.

And, truth is, many doctors don't feel comfortable prodding patients for details on sexual function. It's why the newly diagnosed quickly learn about eye, nerve, kidney, and heart damage from uncontrolled diabetes, but hardly ever hear how diabetes affects sexual health. It is important for people to be open and honest with their doctors regarding all health concerns—even problems with sexual function. Problems with sexual performance and satisfaction can signal other health issues.

Many men with erectile dysfunction, for instance, later learn that they have diabetes. For people who already have diabetes, sexual problems can indicate nerve damage, blocked arteries, and even out-of-whack hormones. Though there's a lot yet to learn about sexual dysfunction in people with diabetes, researchers are certain of one thing: Chronic high blood glucose is behind many sexual problems people face, and the first line of action is to improve glucose control.

Honey, Not Tonight

Low libido, or sexual desire, is a real problem, one that affects people with diabetes more than those without. Men and women experience low libido as a result of poorly controlled diabetes. If your sex drive is stalled, first look to your diabetes control and take steps to lower your blood glucose levels. Then consider your medications. Certain drugs, such as antidepressants, can lower sexual desire, so talk to your doctor.

Researchers theorize that inflammation may also dampen desire. "Sexual desire is a brain-driven event," says Stacy Tessler Lindau, MD, MAPP, director of the Program in Integrative Sexual Medicine at the University of Chicago. "If inflammatory molecules cross the blood-brain barrier and circulate in the area where there is sexual desire, then it's plausible the desire for sex may be affected." Another possible culprit: low testosterone, which often affects men and women with diabetes.


Studies have shown that men with diabetes, especially those who have type 2 or are overweight, or both, have about twice the risk of low testosterone as their peers without the disease, which can affect a man's passion for sex. "The treatment is to give testosterone, and it's amazing how that can work in diabetes," says Irwin Goldstein, MD, director of San Diego Sexual Medicine at Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. When low testosterone is treated through losing weight and/or testosterone therapy, many men have a renewed desire for sex.


Treating women isn't quite as simple. (Get used to hearing that.) Some studies suggest that taking testosterone can increase sexual desire in women—a 2008 article in the New England Journal of Medicine found that post-menopausal women had a greater sexual appetite after taking testosterone for almost six months—but the treatment is still understudied, particularly its long-term effects on women's health. Not only that, but it's hard for researchers to determine whether a particular woman's low libido is a result of diabetes, emotional issues, or something else because low libido is common in women regardless of the presence of diabetes.

Let's Get It On—Or Not

Here's the difference between desire and arousal: First, sexual desire must occur; the body then responds, signaling arousal. That is, if everything's working properly. Both men and women with diabetes may feel desire but struggle with arousal problems, though the mechanisms behind this sexual dysfunction are better studied and understood in men. For both men and women, a good place to start looking for possible causes is your medicine cabinet. Some blood pressure–lowering medications, for instance, can contribute to erectile dysfunction. When meds aren't behind a person's hampered arousal, diabetes may be to blame. Poor diabetes control over time can damage the blood vessels and nerves—as it does in heart disease and neuropathy (nerve damage), other complications of the disease—that make arousal possible.


One of the main sexual problems men with diabetes face is the inability to have an erection. Damage to the vascular system can impair blood flow. If the blood vessels aren't functioning properly or if an artery is blocked, not enough blood will travel to the penis, making it difficult to get an erection.

Nerve function plays a role, too. If the brain isn't properly communicating with the nerves in the sexual organs, the body might not be able to shuttle blood there, impairing a man's ability to get an erection. The ability to keep an erection can also be affected, because the brain must communicate with the nerves to hold blood in the penis. (Keep in mind: A man's ability to get and hold an erection typically wanes with age.)

Fortunately, there are plenty of treatment options. Neither men nor their partners should accept male sexual dysfunction, says Janis Roszler, RD, CDE, LDN, a certified diabetes educator and author of the book Sex and Diabetes: For Him and for Her. "For men, there absolutely is a treatment that will work." Options include PDE5 inhibitors, such as Viagra and Cialis, which improve blood flow; testosterone injections or gels (if testosterone levels are low); injectable medications or suppositories; constriction rings that sit at the base of the penis; vacuum pumps that draw blood into the penis; support sleeves that hold the penis in place during sex; and penile implants.


Nerve damage may also cause vaginal dryness, which is twice as common in women with diabetes as it is in women without diabetes. It's also a result of aging. "Vaginal dryness is very common among women who are menopausal or post-menopausal," says Lindau. In those cases, a lack of estrogen is behind the dryness, and problems may be treated with prescription estrogen, available in pills, a patch, or a cream used in the vagina.

Because researchers don't understand exactly why women's bodies lose the ability to self-lubricate when menopause isn't the cause, treatment options are slim. Most experts recommend using store-bought lubricant.

Women with diabetes are also prone to the same blood-flow issues men face because of nerve or blood vessel damage. Diabetes complications may make it difficult for blood to move to the vagina and clitoris. "The question we have, as far as women go, is that there are women with excellent A1Cs who don't have any blood vessel issues," says Roszler. "They don't have any neuropathy. But they still have sexual problems."

Because studying female arousal problems is difficult for many reasons—women may have a hard time determining just how turned on they are, and there's less of a physical sign of arousal in women than there is in men—treatments are few. But Goldstein says research is promising.

A small study in the August issue of The Journal of Sexual Medicine found that women with type 1 diabetes who took 5 mg of tadalafil (Cialis) for 12 weeks reported an improved quality of life, greater arousal and orgasm, more enjoyment and satisfaction from sex, and more frequent sex. This doesn't mean you should start sneaking your partner's pills—please don't: The treatment is unapproved in women, dangerous in some people with heart problems, and generally unsafe until proved otherwise. But it does show promise for female treatments of the future. As for the present, Lindau says some women use clitoral pumps to aid blood flow but notes that the device isn't for everyone.

The Big O

An orgasm is a sought-after sexual reward, but for people with diabetes it can feel like an unattainable goal. And, yes, we're talking about women and men here. Both can struggle with the elusive O, and the first thing they and their doctors should check are the medications they take, such as antidepressants.


Though women in general report more difficulty having an orgasm than men, those with diabetes have even greater difficulty. Sure, a woman's inability to climax often has to do with her mental or emotional state (more on that later), but diabetes may be in play, too. According to a study published this August in the journal Obstetrics & Gynecology, middle-aged women whose diabetes requires insulin are 80 percent more likely to report trouble reaching an orgasm than women without diabetes.

"To the best of what we know now, the neurovascular system is necessary for arousal and orgasm," says Lindau. "If the small nerves are not working properly, then you can have sensation problems. In order for the clitoris to have the engorgement it needs to orgasm, it needs to have the blood flow and sensation."

A hormone imbalance may be to blame, Roszler says. Some scientists studying women's ovulation cycles hypothesize that off-balance hormones, and not just testosterone, may be behind women's decreased arousal and orgasm, but the research is in its infancy.


Having an orgasm is usually pretty easy for men, which is why it can be so frustrating if a man's unable to finish. Like women, men suffering from neurovascular damage—and the lack of blood flow and/or sensation it creates—can have a hard time reaching an orgasm. Men can get around erectile dysfunction with a variety of treatments, ranging from medications to vacuum pumps, but these treatments will not fix neuropathy.

Putting On The Brakes

Sex is supposed to bring you and your partner pleasure, so pain is an indication that something isn't right. Even if you're shy, it's important to discuss issues of painful sex with a doctor. "See a doctor who is familiar with taking care of sexual problems because we can rectify problems in [most] patients, especially people with diabetes," Goldstein says.


Men with diabetes are at an increased risk for developing Peyronie's disease, a condition in which scar tissue inside the penis causes a curved and painful erection. Before you worry, take heart: Penises all vary in shape, and a little curve isn't a big deal. With Peyronie's disease, the curve or bend is significant and can make having sex and getting or keeping an erection difficult and painful. A doctor can advise whether you should wait it out, take medication, or have surgery.


Having sex with too little lubrication can make a woman scream—and not in a good way. Vaginal dryness is one of the main reasons women with diabetes have pain during sex, and better lubrication is the answer. Whether that comes in the form of estrogen therapy for women whose dryness is a side effect of menopause or over-the-counter lubricants, the goal is to be well lubricated before sex.

Women with diabetes are also at a greater risk for urinary tract infections (UTIs) and vaginal yeast infections, which in turn may lead to painful sex. (Rest assured, though, that people with diabetes are at no greater risk of sexually transmitted diseases than those without the disease.) Lower your chances of getting a UTI or yeast infection by keeping your blood glucose under good control, and head to the doctor at the first sign of discomfort.

Sexual Healing

So maybe your sex life isn't where it should be. If you can admit that to your health care provider, you've already fought half of the battle. Depending on the extent of your sexual dysfunction, you may be able to see improvement by getting your blood glucose in control. Even if the complications are too severe to reverse with better diabetes control alone, keeping your blood glucose levels in line can help to prevent further damage. Another tip: Quit smoking. It's linked to sexual problems, and it's all-around bad news for the rest of your body.

There are several approaches that both men and women benefit from, including seeing a doctor who specializes in sexual medicine and talking with a mental health professional. The latter is an important step because relationship problems, body issues, stress, and a host of other emotional baggage can affect all aspects of your sex life. You may be too self-conscious to get in the mood or get aroused, or maybe you're too stressed to have an orgasm.

A counselor can also help you and your partner work out any strain your sexual dysfunction may have caused. "It creates such emotional tension in a relationship that it permeates the entire relationship, not just in the bedroom," Roszler says. So talk it out and find a way to work around your sexual problems.

Finally, consider making lifestyle changes. Managing your diabetes well, including eating healthfully, exercising regularly, and reducing stress, will benefit your entire body, not just your nether regions. "I think it's very likely that a good sex life leads to better health," says Lindau. "And better health leads to good sex."



May 2017

12 Diabetes Health Tips

By: Epoch

Source: AARP

Over 29 million Americans have diabetes. Another 86 million have prediabetes. The resulting circulatory, heart and eye problems make life more difficult and, sadly, shorter. Here are 12 ways to prevent or manage the disease.

1. Seek Greek

We know you've heard this before, but the staples of a Mediterranean diet — vegetables, fruits, legumes, whole grains, fish and red wine — are a good idea anytime. And supplementing that diet with extra-virgin olive oil can reduce your risk for type 2 diabetes by 30 percen

2. Don't just sit there

An extra two hours a day spent watching television increases your risk of developing type 2 diabetes by 14 percent, according to a report published in the Journal of the American Medical Association. Our suggestion: Exercise while watching, or run around the block between episodes.

3. Have a cuppa

Numerous studies show that drinking more than two cups of coffee (16 ounces) a day is associated with a 25 percent lower risk of developing type 2 diabetes. The FDA maintains that up to 400 milligrams per day of caffeine (about four cups) is safe for healthy adults.

4. Stress less

Chronic worry and stress not only contribute to insulin resistance but also make it harder for your pancreas to move glucose out of your bloodstream. Techniques proven to help you relax and reduce stressinclude biofeedback, meditation and deep breathing.

5. Squeeze some citrus

Eating oranges, grapefruit, lemons and other citrus fruits can slow glucose uptake, helping keep your blood sugar levels under control, a study in the journal Preventive Medicine concludes.

6. Sprinkle with cinnamon

Studies find that people with type 2 diabetes who eat one gram (just a pinch or light sprinkle) of this tasty spice every day may experience a drop in blood sugar. Try cinnamon on your morning cereal, in your coffee or dusted on yogurt.

7. Fix it with food

These foods eaten daily can help you manage your blood sugar:

  • Beans, peas and lentils: One cup of these protein-rich legumes can lower your blood sugar levels significantly.
  • Dark chocolate: It contains nutrients called flavonoids, which can both drop insulin levels and limit your cravings for sweet and salty foods.
  • Oatmeal: The magnesium in it helps your body secrete insulin properly.

8. Flex your muscles

A 2012 study in the Archives of Internal Medicine showed that men who lifted weights for at least 2 1/2 hours every week lowered their risk of diabetes by 34 percent.

9. Mind your meds

If you're already on medication for diabetes, it's important to take it as prescribed. Plus, free apps such as Mango Health and Pocket Pharmacist can alert you to possible side effects from other prescription and nonprescription drugs you might be taking. Plenty of medications can interfere with your blood glucose levels.

10. Limit red meat

An analysis of the diets of almost 150,000 people found that eating an extra half serving a day of red meat increases the risk of developing type 2 diabetes by 50 percent

11. Keep your naps short

If you routinely doze for more than 60 minutes during the day, consider this a wake-up call. A 2016 study by Japanese researchers who looked at the data of more than 21 studies showed that snoozing longer than an hour a day could increase your risk of developing type 2 diabetes by 45 percent.

12. Opt for an App

Researchers at Cardiff University School of Medicine, UK, found that type 2 diabetes patients who used apps to monitor their condition had lower blood glucose levels when compared to the control group. More good news: There are plenty of iOS and Android diabetes apps to choose from: BG Monitor, Blue Loop and Diabetes in Check are a few of the most popular.



May 2017

Fresh food that can help manage diabetes

By: Epoch


The advice to eat a healthy diet is not new. Back around 400 B.C., Hippocrates, the Greek doctor, had this missive: Let food be thy medicine.

But as a society, we've got a long way to go. About 1 out of every 2 deaths from heart disease, stroke and Type 2 diabetes in the U.S. is linked to a poor diet. That's about 1,000 deaths a day.

There are lots of places to lay the blame. Calories are cheap, and indulgent foods full of salt, sugar and fat are usually within our reach 24/7.

So, how best to turn this around? Consider Tom Shicowich's story. It begins with a toe. His left pinky toe.

"One day I looked down and it was a different color ... kind of blue," Shicowich says. And he began to feel sick. "I thought I was coming down with the flu."

The next day he was on the operating table. A surgeon amputated his toe, and it took two weeks of intravenous antibiotics to fend off the infection.

All told, he spent a month in the hospital and a rehab facility. "Oh, I tell you, it was a bad year," Shicowich recalls.

Fresh Food Pharmacy," intoned Sam Balukoff, the master of ceremonies at Geisinger Health System's recent debut of a new food pharmacy located on the grounds of a hospital in central Pennsylvania.

At this event, Shicowich was one of the stars of the show. Over the past year, he and about 180 patients with Type 2 diabetes have been participating in a pilot program aimed at getting them to change their diets and lose weight. They receive free groceries of healthy foods every week.

Shicowich has lost about 45 pounds, and he is now much more active.

Each week, Shicowich and the other participants come to the food pharmacy. In its new incarnation, it looks more like a grocery, with neatly stocked shelves filled with healthy staples such as whole grain pasta and beans. The refrigerators are full of fresh produce, greens, low-fat dairy, lean meats and fish.

The participants meet one-on-one with a registered dietitian. They're given recipes and hands-on instruction on how to prepare healthy meals. Then, they go home with a very different kind of prescription: five days' worth of free, fresh food.

Shicowich says it's a huge change from his old habit. "I would stop at a Burger King or a McDonald's or buy a frozen Hungry-Man dinner, basic bachelor food — you know, heat and eat."

But those days are over. Now, he and his girlfriend cook meals at home. He says now it's much easier to climb a flight of stairs or take a walk with his girlfriend.

"It's life-changing"

Shicowich's health has improved. His blood sugar and blood pressure have dropped so much that if he keeps on track, his doctors say they will reduce his medications.

"It's life-changing," David Feinberg, the president and CEO of Geisinger Health System, says of the results Geisinger has seen.

He says, so far, all the patients in the pilot program have made similar improvements. "It's mind-blowing," he says. And he says the range of support patients are offered — everything from dietary counseling to wellness classes and workshops — can help them succeed.

Take, for instance, the significant declines in patients' hemoglobin A1C levels. This is a blood test used to track how well patients with diabetes are controlling their blood sugar.

A year ago, Shicowich's A1C was close to 11. Now it's down in the high-6 range. Anything under 6.5 is considered below the threshold of Type 2 diabetes, according to the Mayo Clinic. Feinberg says this means that Shicowich — and other participants in the program — have a much better chance of avoiding many complications of Type 2 diabetes if they can maintain their A1C levels down in this range.

"[They] won't go blind; [they] won't have kidney disease, amputations," Feinberg says. "The list goes on and on."

Cheaper than paying for complications

When this program started, some questioned the premise of giving away free, fresh food to patients with diabetes. But keep in mind, the costs associated with diabetes in the U.S. now exceed $240 billion a year.

Once you consider that price tag, Geisinger's program can look like a bargain. Over the course of a year, the company will spend about $1,000 on each Fresh Food Pharmacy patient. All of the participants in the program are low-income, so the gift of the food eliminated a key obstacle to eating well.

But would this lead to a reduction in health care costs?

Feinberg says as his team tracks hemoglobin A1C levels in the pilot participants, it is also assessing the number of medical visits and sicknesses along with the overall cost of caring for these patients.

It's still early days, and the team plans to fully analyze its first year of data. But here's what it estimates so far: "A decrease in hemoglobin A1C of 1 point saves us [about] $8,000," Feinberg says.

And many of the participants have seen a decline in hemoglobin A1C of about 3 points. "So that's [about] $24,000 we're saving in health care costs," Feinberg says. "It's a really good value." Geisinger is now in the process of expanding the program to new locations within Pennsylvania.

Is prevention medicine the future?

This program is an example of the booming interest in prevention-oriented medicine.

The current health care system in the U.S. is often more aptly described as a disease-care system. "It's reactive," says Mitesh Patel, a physician and assistant professor of health care management at The Wharton School at the University of Pennsylvania. "We wait until people get sick and then spend lot of resources helping them get better."

But Patel says there are signs this is beginning to change. "I think the paradigm shift has already begun," he told us. Patel's take on Geisinger's new Fresh Food Pharmacy program: It includes the kind of financial and social incentives that can help motivate people to make changes.

For instance, the Fresh Food Pharmacy gives free, fresh food not just to the patients enrolled but to everyone in their household as well.

"The way we behave is really influenced by others around us," says Patel. So promoting a group effort could "make the program a lot more sticky and more likely to succeed."

It's always a challenge to get people to maintain lifestyle changes over the long term. But, Patel says, "If you get the entire family to change the way they eat, you're much more likely to improve health."

The evidence that lifestyle-modification programs can reduce health care costs is starting to accumulate.

Earlier this year, researchers published findings in the journal Health Affairs that evaluated the medical expenses of Medicare patients with prediabetes. The patients had completed a one-year diabetes prevention program focused on healthy eating and increased physical activity. The researchers found, overall, the average health care savings was about $300 per person, per quarter — compared with patients who hadn't been through the program.



May 2017

How Sugar Affects Your Body

By: Epoch

SOURCE: MensHealth.com


It’s no secret that Americans love sugar. It’s everywhere, and even in places you wouldn’t expect—everything from sandwich breads to granola bars are packed with the sweet stuff. We’re not talking about the natural sugars you’d find in fruit or milk. If you read your packaged-food labels, you may notice words like maltose, sucrose, high-fructose corn syrup, and more on your box—these are all sugars that are added to your food as it’s processed, according to the American Heart Association (AHA).

Men should consume no more than 36 grams of added sugar a day, the equivalent of 9 teaspoons and 150 calories, the AHA recommends.

But many Americans go way overboard: From the late 1970s to 2010, sugar consumption increased by more than 30 percent in the United States, according to study from the University of North Carolina at Chapel Hill. The top 20 percent of adult sugar-lovers eat an average of 721 calories of added a sugar every day, the researchers found. That’s eating about nine chocolate frosted caked donuts from Dunkin’ Donuts every single day.

Let’s be clear: Eating some sugar isn’t going to kill you—but consuming too much added sugar puts your body at risk for deadly diseases. Read on for six ways your sweet tooth can get you into trouble.


 Consuming too many heart disease than those who at less than 10 percent of their calories from added sugars.

Past research suggests that overloading on sugar can increase your blood pressure, triglycerides levels, and inflammation in your body—all precursors to cardiovascular disease, the study authors say.



Foods with a high glycemic index (GI) ranking—which is based on their potential to spike your sugar levels—may be behind your pesky breakouts, according to the American Academy of Dermatology. High GI foods are generally higher in added sugars or refined carbs, and include things like white bread, white rice, potato chips, and ice cream.

While a lot more research needs to be done to understand the complex relationship between your diet and acne, multiple studies have found that following a low-GI diet may help improve your skin, according to a review published in the Journal of Clinical and Aesthetic Dermatology.

Why? Higher sugar levels leads to more production of the hormone insulin, which in turn, increases sebum, or oil, production in your skin. Eating a diet rich in low-GI foods—like whole grains, fruits, and vegetables, which don’t cause as big a blood sugar spike—may actually reduce the size of your oil glands and decrease inflammation in your skin, the review concluded. And that can mean smoother skin.


Unsurprisingly, sugary foods pack on the pounds—so much so that sugar has been identified as one of the main culprits behind America’s obesity epidemic. In fact, in a meta-analysis of 68 trials and studies, researchers concluded that people who ate however they wanted typically weighed more when they loaded up on sugar and less when they didn’t consume as much.

Why? Sugary drinks don’t keep you feeling full like naturally sweet foods do, so you’re more likely to go overboard with a sweetened beverage, which, of course, packs in the extra calories. And sugary foods (we’re looking at you, delicious chocolate chip cookies) are typically higher in calories than the more nutrient-dense stuff, the researchers say. The more extra calories you eat, the heavier you’ll be.

To put it in perspective, just one gram of sugar equals about four calories, according to the AHA. So if you eat something with 15 grams of sugar in it, you’re downing 60 calories from the sugar alone.

Plus, once you eat one cookie, you won’t really want to stop. Your brain craves sugar more than fat and can cause you to overeat, a study in the American Journal of Clinical Nutrition suggests. (Don’t want the extra calories to sneak up on you?


Steer clear of sugar in bubbly form, too: People who sipped on one or more regular sodas daily had a 23 percent higher risk of developing kidney stonesthan those who drank less than one serving a week, according to a study published in the Clinical Journal of the American Society of Nephrology.

That’s because the soda’s fructose content can increase how much calcium, uric acid, and oxalate you pee out, the researchers say, which boosts your risk of stones.

Skeptical? Keep in mind that passing a stone may be more painful than childbirth for some guys


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