Health Connection - November 2022

Taking on Type 2 Diabetes

By Sharleen Sidhu, MD, MPH

Do any of these scenarios sound familiar to you?

Greg’s been dealing with type 2 diabetes for years, but lately he’s been having trouble managing his blood sugar.

During a recent hospitalization, Ron received an unexpected diagnosis of type 2 diabetes, which he has likely had for several years.

Elise’s annual checkup revealed that she has prediabetes, and she wants to keep it from progressing.

Chances are you or someone you love has something in common with Greg, Ron, or Elise—high blood sugar and a disease that could be destroying your health. That’s why understanding the risks and realities of type 2 diabetes and prediabetes has never been more important.

November is Diabetes Awareness month, so it’s a good time to face a cold, hard fact: type 2 diabetes has become an epidemic in the United States. According to the CDC, the number of Americans with the disease has doubled over the past 20 years. Today, 37.3 million Americans—about 1 in 10—have diabetes, and another 96 million have prediabetes. Even more concerning is the fact that more than 8 in 10 adults with prediabetes don’t know they have it, which means it is likely to progress unchecked until it’s finally diagnosed.

Because type 2 diabetes is so common and doesn’t have visible symptoms until it progresses to a dangerous degree, many people don’t realize how serious it is. Complications from diabetes are the seventh leading cause of death in the US. Diabetes is also the leading cause of kidney failure, lower-limb amputations, and adult blindness. In addition, an estimated 34.5 million people with diabetes have some type of hearing loss, a less-known complication of the disease. According to the American Diabetes Association, the rate of hearing loss among adults in the United States with prediabetes is 30 percent higher than in people whose blood sugar is in the normal range.

Another condition strongly associated with type 2 diabetes is cardiovascular disease. Poorly managed high blood sugar can damage the blood vessels and even the nerves that regulate your heart. People with diabetes are also more likely to have other conditions that puts them at higher risk for heart disease, such as:

• High blood pressure
• High LDL cholesterol (the plaque-forming, bad type of cholesterol)
• High triglycerides (a type of fat in your blood)
• Low HDL cholesterol (the good cholesterol which absorbs LDL cholesterol and carries it away from the arteries and back to the liver to be disposed of through body waste)

Whether you are trying to keep prediabetes from progressing, or have been diagnosed with type 2 diabetes, controlling your blood sugar generally starts with lifestyle modifications, including diet, exercise, sleep, and stress reduction. Medications can also help reduce blood sugar and finding the right medication (or combination of two or more) requires a highly personalized approach. Once type 2 diabetes progresses to a certain point, insulin must be used as part of the patient’s management plan. That too is highly individualized, with different types of insulins having their own onsets, peak times, and durations. Calibrating the right treatment regimen requires close medical supervision.

MarinHealth’s Braden Diabetes Center offers patient-centered care to help you stay on track and live well with diabetes. This comprehensive community resource provides self-management education programs, therapy, and support for people with diabetes. Approved by the American Diabetes Association as meeting the National Standards for Diabetes Self-Management Education, the program is designed to help patients confidently manage their blood sugar in any situation. Education and training are offered in both one-on-one and group settings.

Regardless of where you are in your diabetes journey, the caring, expert staff at the Braden Diabetes Center is ready to assist:

• Newly diagnosed adults
• Pregnant women with pre-existing or gestational diabetes
• People with prediabetes
• Adults with type 1 diabetes
• Adults with type 2 diabetes
• Children with diabetes (through a special collaboration with the UCSF Health Madison Clinic for Pediatric Diabetes)

Learn more about the Braden Diabetes Center.

Are you at risk for type 2 diabetes? Find out now by taking our free risk assessment.

Sharleen Sidhu, MD, MPH, is a board-certified endocrinologist at MarinHealth Endocrine & Diabetes Care | A UCSF Health Clinic, and the Medical Director of the MarinHealth Braden Diabetes Center.

RSV vs. Flu vs. COVID-19. Which is it?

By David Hoffman, MD - Pediatric Hospitalist at MarinHealth Medical Center

Now that Fall has come, many families in the North Bay are concerned about falling sick with one or more of the three most common virus strains swirling around our community. This is prime time for the “TripleDemic,” the coexistence of the flu, COVID-19, and Respiratory Syncytial Virus (RSV). How are we to know which symptom goes with what virus? Or when it’s time to stay home or call the doctor?

When Should I Keep My Child Home?

If your child is exhibiting any symptoms of RSV, flu, or COVID-19, health experts advise you to keep your child home from school to avoid spreading the virus to other people. It doesn’t matter which of the viruses is the culprit. Caution should be taken to prevent the spread.

When Should I Go to See a Doctor?

If your child is exhibiting these symptoms, you should seek medical care right away:

• Trouble breathing (fast or hard breathing)
• Pain or pressure in the chest
• New confusion
• Inability to wake up or stay awake
• Bluish lips or face
• Severe abdominal pain
• Refusing to eat and drink

How to Keep Your Child from Getting Sick

Prevention is the best medicine, particularly with these viruses. These suggestions are good ideas to avoid seasonal viruses:

• Get your child vaccinated for flu, COVID-19, pneumococcus, and pertussis.
• Wash your hands regularly or use hand sanitizer.
• Sanitize high-contact surfaces, such as desks, tables, and doorknobs, if someone in your household is sick.
• If your child is sick, have them stay home to avoid spreading the illness.

If your child is sick and you seek a pediatrician, please call 1-888-627-4642.

Take a Holiday from Holiday Stress

As we head into the busy holiday season, is self-care on your to-do list? If not, it should be! Many of us are used to putting ourselves last, and finding time for fun and rest may even feel impossible, but self-care is truly essential. By prioritizing rest and activities that “fill your cup,” you’ll ensure that you have the energy to show up for others. Taking care of yourself benefits your overall health and wellbeing, and also promotes stronger, healthier relationships. Since a happy, healthy holiday season starts with a happy, healthy YOU, here are a few simple tips to help you minimize stress and feel your best.

Set a Calendar Reminder

If you find it hard to carve out time for things you love, try booking the time. Start with just 15-30 minutes, and set a calendar reminder for some time to yourself. Drink some tea and read a chapter, call a friend to catch up, meditate, journal—choose anything that feels fun and fulfilling, and keep your commitment when the time comes.

Stay Healthy

Get your flu shot, COVID-19 booster, and, if you are 65 and older, the pneumonia vaccine. Wash your hands often, including after coughing, sneezing, or blowing your nose, and stay home if you’re feeling sick. Carry hand sanitizer, and don’t feel self-conscious about wearing a mask indoors in crowded places.

Discover the Power of No

This is the season for giving–but that doesn't have to mean giving in to everyone’s demands until you give out. We all want to be helpful, but there is a limit to what you can take on. Before you agree to drive extra carpool trips or attend an event you're not looking forward to, take a step back and consider how much you have on your plate and whether "no" might be the better answer. Someone else will step up and you can help when you’re less busy.

Get Your Nature Fix

Tap into the healing power of nature. Hike, stroll, or just sit on the beach and feel the sun and wind on your face.

Be Comfortable in Your Winter Skin

A few simple changes in your routine can do wonders for dry, raw, itchy skin. Take shorter baths and showers and use warm water rather than hot. Moisturize as soon as you dry off. If your home gets really dry from central heating, consider running a humidifier.

Recharge at MarinHealth's Integrative Wellness Center

Our Integrative Wellness Center in Greenbrae now offers services to the entire community. Integrative therapies help activate the body’s innate healing powers, reduce stress, promote relaxation, and improve overall wellness. Better yet, they make you feel good! The Center’s offerings include:

• Therapeutic Massage. Bodywork benefits the whole person, quieting the brain, centering the mind, reducing pain, and relaxing stiff, sore muscles. Massage also enhances breathing and circulation, reduces the heart rate, lowers blood pressure, and facilitates healthy sleep and digestion. Our massage therapists use combinations of Swedish, deep tissue, acupressure, and Esalen techniques. We also offer prenatal massage, with a focus on reducing swelling and back pain.

• Acupuncture: This ancient Chinese treatment modality uses energy pathways in the body to promote balance, vitality, and healing. Acupuncture helps reduce back, neck, knee, and osteoarthritis pain, and is commonly used to prevent and/or treat migraine and tension headaches, menstrual cramps, nausea, and more.

• Jin Shin Jyutsu®: This Japanese healing practice supports the body, mind, and spirit through gentle touch. Administered while you are fully clothed, Jin Shin Jyutsu® can help increase energy, reduce fatigue, support healing, complement medical treatments, and improve bodily functions. After a session, people commonly report a significant reduction in stress and a feeling of deep and profound relaxation.

• Nutrition Counseling: Whether your goal is to lose weight, prevent the onset or progression of a disease, or simply improve your eating habits, meeting with a registered dietitian nutritionist (RDN) can help. RDNs offer highly customized counseling tailored to your specific goals and circumstances. Our nutrition offerings include one-on-one health coaching sessions; a 12-session "Healthy Weight for Wellness" program; and Medical Nutrition Therapy, in which we partner with your doctor to address a specific condition such as high cholesterol or hypertension through dietary changes.

To learn more or schedule an Integrative Wellness Center service, visit MyMarinHealth.org/IWC or call 1-628-336-7689.

How about indulging in a little self-care right now? Relax and reboot, with this brief guided meditation.

Understanding Advanced Care Planning

If you’ve lost a loved one to illness, you know end-of-life is a challenging time for families. Decisions must often be made regarding whether and when to cease medical treatment. If you are unconscious or unable to make these decisions yourself, the burden falls on your loved ones, who may not agree on what to do or what you would want. Advanced care planning is a good idea at any age—not just for those who are elderly or ill. It involves learning about the types of decisions that may be necessary, letting your family and health care providers know your preferences, and, more importantly, putting your decisions in writing through official documents. There are several different legal documents to consider, and terms are often used interchangeably, when in fact they are distinctly different. Understanding the different options is the first step to planning for your needs.

Advance Health Care Directive (ACHD)

An advance health care directive (ACHD) is a legal document that only goes into effect if you are incapacitated and unable to speak for yourself due to illness or severe injury. Anyone over the age of 18 can have an ACHD and you can make changes to it at any time. You can use your ACHD to designate someone as your agent for healthcare power of attorney and to indicate your wishes requiring the use of emergency treatments to keep you alive, including:

• Cardiopulmonary Resuscitation (CPR)
• Ventilator use
• Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids)
• Comfort care, including limited medical testing, oxygen for shortness of breath, spiritual and emotional counseling, and medication for pain, anxiety, nausea, or constipation

Durable Power of Attorney for Health Care

This legal document names a proxy, the person you want to make care and end-of-life decisions on your behalf should you be unable to make them yourself. (Other terms commonly used for proxy include representative, surrogate, or agent.) Once written, the Durable Power of Attorney for Health Care should be signed, dated, witnessed, notarized, copied, and put into your medical record. If you have named a proxy in your ACHD, you do not need to fill out a Durable Power of Attorney for Health Care. Some people are reluctant to put specific health decisions in writing. For them, naming a health care proxy can be a good approach. Your official proxy can evaluate each situation or treatment option independently and family members would have to go to court to override the proxy’s decisions. You can change your designated proxy or decide not to have a proxy at all, at any time.

Living Will

This is a set of instructions documenting your wishes about life-sustaining medical care if you are terminally ill, incapacitated, or unable to communicate or make decisions. A living will protects your rights to accept or refuse medical care and frees your loved ones from having to make difficult decisions for you. Living wills are especially useful if someone is in a hospital, skilled nursing facility, or receiving hospice care.

Physician Order for Life-Sustaining Treatment (POLST)

A POLST is a legally recognized document that directs physicians and other healthcare providers to either provide or withhold resuscitation and other life-sustaining measures at the end of life. It is a physician’s order that reflects the patient’s preferences regarding resuscitation, general medical interventions, antibiotic use, and artificial nutrition. The POLST focuses only on health emergencies and lets EMTs and hospitals know what to do to honor your preferences.

DNR (Do Not Resuscitate) Order and DNI (Do Not Intubate) Orders

These documents let the hospital or nursing facility know that you do not want them to use CPR or other life support measures if your heart stops or starts beating in an erratic, unsustainable way. Other names for this document are a DNAR (Do Not Attempt Resuscitation) order or an AND (Allow Natural Death) order. Even though a living will might say CPR is not wanted, it is helpful to have a DNR order to help avoid confusion in an emergency. Without a DNR order, medical staff will make every effort to restore your breathing and normal heart rhythm. A non-hospital DNR order is a separate form to let emergency medical personnel know your wishes regarding measures to restore your heartbeat or breathing if you are not in the hospital. You may want to keep this form in your wallet or purse. You can also obtain a DNR wallet card or bracelet to keep with you, but you will still need to fill out the form. A DNI (Do Not Intubate) tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine.

Getting Started

It may be tempting to put off advanced care planning—especially if you are young and healthy—but having a plan in place will give you and your family peace of mind if you are ever sick or injured. MarinHealth has created a guide with more information and the document you need, so it’s easier to take the first step. This free Advanced Care Directive Guide helps you think through your preferences and what’s most important to you, and then lets you document your instructions, including:

• Personal, cultural, and religious end of life preferences
• Power of attorney for healthcare for the proxy whom you select to trust to honor your wishes
• End-of-life care, such as pain relief and the circumstances under which you want treatment to be withdrawn
• Whether or not you agree to organ donation

Download the MarinHealth Advanced Care Directive Guide in English or Spanish