Tips on How to Prepare for a Hurricane (New Template)
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The Keto Diet Review for Weight Loss
talked about the vegan diet, and intermittent fasting, So I thought today I’d dive into the ketogenic diet, aka Keto diet review. There is a lot of hype surrounding this type of food, and there has been talked about a lot of benefits. So let’s talk a little bit more about what this kind of diet consists of, what you’re allowed to eat. The benefits, the side effects, everything!✓ First thing first: Keto Diet Review All diets consist of certain macronutrients, aka macros. Believe it or not, I didn’t start counting my macros until recently because my fitness coach asked me to track them during my 1month fitness plan. In general, all diets consist of 3 macros: Protein, Fats, and Carbohydrates. A healthy diet is said to consist of: 20% protein 30% of fats 50% carbohydrates is quite different from a keto diet in which your primary source of energy comes from fats and protein.✓ 30-35% protein 55-60% fat 5-10% carbs You are basically limited to up to 50g of carbs PER DAY and some even go beyond to 20g max. So what happens to your body when you decrease your carb intake this much? GLUCONEOGENESIS Another excellent work for making glucose (sugar) from scratch. Your body can get glucose (sugar) from your diet like carbs, or it can make its own in the liver through this process. Because sugar is the main thing that stimulates the release of insulin, and insulin also stimulates fat and glucose storage. This low carbohydrate state reduces fat storage and helps lower blood sugar. KETOGENESIS Once the body cannot make glucose fast enough for the energy requirements of the body, it starts to produce ketones. Just a fancy word for “making ketone bodies,” aka keto diet. These ketone bodies produce more energy than regular sugar, so it been called a kind of super fuel. So what are a few of the BENEFITS of this kind of diet? Fat loss while preserving lead body mass It can improve symptoms in patients with Polycystic Ovarian Syndrome (PCOS), including mental health-related signs. Low carb and low protein diets may reverse diabetic neuropathy (diabetic nerve pain). Can improve glycemic control in obese patients with type 2 diabetes Low carb diets can also improve blood pressure What about some SIDE EFFECTS? Well, it can include mild symptoms known as the Keto-Flu, which usually get better within a few days or weeks. This includes:✓ Headache Difficulty in exercise tolerance Nausea Vomiting Dizziness Fatigue Constipation Other side effects include: Diarrhea Insomnia Backache If you do have type 2 diabetes, it can cause hypoglycemic events (low glucose), especially if taking sulfonylureas like metformin. So make sure you consult your doctor before starting this kind of diet. Your glycemic control and the type of medication you’re on may affect your response to it, so don’t just jump into this kind of diet without guidance and observation from your doc. Those were just some short term effects. What about more long term effects? Fatty liver Kidney stones Mineral deficiencies LDL (bad cholesterol) might increase (which is odd because another study showed it might improve.. basically, we can’t be too sure). Questions you might ask yourself: What happens if you stay ketogenic long term? There was a study where obese participants maintained a keto diet for 24 weeks. It turns out that there were huge benefits to their BMI, total cholesterol, bad cholesterol decreased while good cholesterol increased. Blood glucose decreased too. DISCLAIMER = since the study was done among obese participants, we cannot extend these results to non-obese participants. Is this diet right for you? Any diet that can cause the before mentioned side effects is not sustainable, so if you react well or only have these for a short amount of time, then why not. You’re considering doing this diet, what should you do? Go see your doctor and get checked out. If you have any medical issues made worse with fatty meals, then a diet high in fats should probably not be adopted. If you’re an overall healthy person, should you do this diet? If you want to give it a try and see what happens, why not? If you have medical conditions, consult with your doctor first! Actually, consult with your doctor anyway whenever you’re starting a new diet. Fun fact: Did you guys know that colostrum: the first milk that is let down in breast milk, is ketogenic? This means that all newborns can survive and survive well-nourished on a ketogenic formula, but remember that colostrum production switches to regular milk production about day 4. Definitely nothing like a longer-term ketogenic diet, but still a fun fact, in my opinion.✓ Summary: Like any lifestyle change, it can be difficult to sustain this kind of diet. It is safe for otherwise healthy patients to try this type of diet from 2-3 weeks and even up to a year. Just make sure you follow up with your doctor so he can monitor you and your health while you’re on it. Also, remember that tapering OFF the diet is important. What does that mean? Don’t be keto for weeks, and suddenly start eating foods high in carbs again. Make sure you gradually transition from keto to regular diet. The bottom line is, we know the short-term effects of this type of diet, but the long-term effects are less known. Although there is good evidence to show that it is good for rapid weight loss that can be maintained for up to 2 years afterward and that it can help with glucose control in type 2 diabetics and even help reverse the diabetic nerve pain if the protein is also restricted; anything beyond that is something we just don’t know at this time, which is probably why it is not recommended by doctors.✓ Whether or not you have followed or will follow a keto diet, I hope you learned something new! If you have any questions, feel free to comment or just follow me on IG and let me know!
An Iron Clad Diet
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you can add your new content according to the structure. or can make a new structure by just drag and drop of elements, you can add your new content according to the structure. or can make a new structure by just drag and drop of elements, Your emotions can get the best of you, especially if you don’t have family around you. Right now, yes, at this very moment, as I write this post, I am without electricity because of Hurricane Sally. Just a category two hurricane, but it just so happened to hit Foley, Alabama, and I guarantee this town was not ready for it, so I have no power. Southeast FL is very well prepared for hurricanes. Their cable lines, their building structures, emergency services, everything. Foley, AL… not so much. So this hurricane may be just a category 2, but it has felt like a category 3 and 4 because of the nearby damage, loss of power, and severe floods. This post is not research-based, and it is the first post I will write, which is based purely on my experience with hurricanes. So, if I forget something or you had a different experience than I did and found better ways to prepare, by all means, share them with me. So let’s get right down to it! Here are 16 tips on how to prepare for a hurricane. Put up your Shutters early. Whether you have actual shutters or purchase plywood to hammer over windows, make sure you start early. The winds are the most dangerous early on. Their speeds can go up to 140mph, depending on the strength of the hurricane. Debris will be thrown around. So, protecting your windows with shutters or plywood is very important to protect your home and everyone inside it. Not to mention it’s also labor-intensive and time-consuming. DO NOT underestimate it. Buy drinking water Dehydration is very dangerous. Make sure you buy enough water to last at least a week but plan for more. I know it sounds excessive. But when the electricity goes out, you won’t have A/C or fans to work. You will sweat, and you can get dehydrated. You also don’t know how long you will be without power. Buy food that won’t spoil easily and can be quickly cooked without the need for electricity, and if you have a BBQ grill, have extra gas tanks. In Miami, most people have BBQ grills out back. This helps because you can still cook things. My family did.✓ So, make sure you have extra gas tanks. BUT, if you don’t… then you depend on electricity to cook. This means that anything that needs the stove, pressure cooker, or oven will not be useful. Buy foods that you can eat without having to cook them, and foods that don’t spoil easily. Cereals are a good option. Certain fruits are great! It will help you eat healthy, even if it’s unintentional! Bananas, Oranges, Mangoes, and peaches are a few of my favorites. Peanut butter, Nutella, and bread are also good options.✓ Cans of tuna are also great! Peanuts, mixed nuts, almonds, raisins, and prunes are great snacks, too. You can also get seeds: pumpkin, sunflower, flax, etc. These are just a few ideas. You can also get unhealthy but yummy potato chips, cookies, donuts, etc. But don’t overdo it. Stress can make you change your eating habits. Hurricanes are no different. Get a flashlight and batteries. When your electricity goes out, it will get very dark. With dark skies and no power, it can get pitch black. So have flashlights and plenty of batteries. If you have kids at home, the darkness is sometimes the scariest part for them. They hear all this noise outside, but they can’t see what is happening around them, giving them light. Those battery-powered hallway lights are great. You know, the ones you press down on, and they turn on and off. Fill up your car with gas. Even if you don’t plan on going anywhere…. Have your car tank full! You never know if you will need to go somewhere to get extra food/water or help a family member. We had to drive to my sister’s house to get water and extension cords. Not a far enough drive to fill out the gas tank, but you never know. Get extra gas in those red containers. This gas can be used for the car, but also as a generator if you have one. Powering a refrigerator with a generator eats up a lot of gas. So make sure you pack plenty. Especially if you don’t know how long the lack of power will last. We had to pull gas from our car because our extra fuel ran out, trying to power our refrigerator.✓ Buy a small generator if you can afford it. Lucky for my family back in Miami, we had one. During one hurricane, our power was out for five days. The refrigerator was full of food. But we had our generator and gas to keep it running and keep all our food fresh. Besides, my nephew is asthmatic, and he started having anxiety attacks thinking that he had no power to use his nebulizer. Some medications also need to be refrigerated, so plan for that as well. Buy one or more fans. When you’re out of power, loss of A/C can be very dangerous for certain people, such as the elderly. Our wiser generations cannot tolerate heat well. Having portable fans will help keep a room cool and prevent heat exhaustion and heatstroke. Buy extension cords Since the generator uses gas, it throws off fumes. You do not want the generator inside the house! Extension cords will allow you to power your refrigerator safely. You can also plug in lights and charge your phones. We were also able to keep my nephew calm as we had power, and he’d be able to use his nebulizer if he had an asthma attack. Do not open your refrigerator unless you need to Opening the door
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Tips on How to Prepare for a Hurricane Being from Miami, I have my fair share of experiences with category 3,4, and even five hurricanes. They are not pleasant. They are quite scary. Your emotions can get the best of you, especially if you don’t have family around you. Right now, yes, at this very moment, as I write this post, I am without electricity because of Hurricane Sally. Just a category two hurricane, but it just so happened to hit Foley, Alabama, and I guarantee this town was not ready for it, so I have no power. Southeast FL is very well prepared for hurricanes. Their cable lines, their building structures, emergency services, everything. Foley, AL… not so much. So this hurricane may be just a category 2, but it has felt like a category 3 and 4 because of the nearby damage, loss of power, and severe floods. This post is not research-based, and it is the first post I will write, which is based purely on my experience with hurricanes. So, if I forget something or you had a different experience than I did and found better ways to prepare, by all means, share them with me. So let’s get right down to it! Here are 16 tips on how to prepare for a hurricane. Put up your Shutters early. Whether you have actual shutters or purchase plywood to hammer over windows, make sure you start early. The winds are the most dangerous early on. Their speeds can go up to 140mph, depending on the strength of the hurricane. Debris will be thrown around. So, protecting your windows with shutters or plywood is very important to protect your home and everyone inside it. Not to mention it’s also labor-intensive and time-consuming. DO NOT underestimate it. Buy drinking water Dehydration is very dangerous. Make sure you buy enough water to last at least a week but plan for more. I know it sounds excessive. But when the electricity goes out, you won’t have A/C or fans to work. You will sweat, and you can get dehydrated. You also don’t know how long you will be without power. Buy food that won’t spoil easily and can be quickly cooked without the need for electricity, and if you have a BBQ grill, have extra gas tanks. In Miami, most people have BBQ grills out back. This helps because you can still cook things. My family did.✓ So, make sure you have extra gas tanks. BUT, if you don’t… then you depend on electricity to cook. This means that anything that needs the stove, pressure cooker, or oven will not be useful. Buy foods that you can eat without having to cook them, and foods that don’t spoil easily. Cereals are a good option. Certain fruits are great! It will help you eat healthy, even if it’s unintentional! Bananas, Oranges, Mangoes, and peaches are a few of my favorites. Peanut butter, Nutella, and bread are also good options.✓ Cans of tuna are also great! Peanuts, mixed nuts, almonds, raisins, and prunes are great snacks, too. You can also get seeds: pumpkin, sunflower, flax, etc. These are just a few ideas. You can also get unhealthy but yummy potato chips, cookies, donuts, etc. But don’t overdo it. Stress can make you change your eating habits. Hurricanes are no different. Get a flashlight and batteries. When your electricity goes out, it will get very dark. With dark skies and no power, it can get pitch black. So have flashlights and plenty of batteries. If you have kids at home, the darkness is sometimes the scariest part for them. They hear all this noise outside, but they can’t see what is happening around them, giving them light. Those battery-powered hallway lights are great. You know, the ones you press down on, and they turn on and off. Fill up your car with gas. Even if you don’t plan on going anywhere…. Have your car tank full! You never know if you will need to go somewhere to get extra food/water or help a family member. We had to drive to my sister’s house to get water and extension cords. Not a far enough drive to fill out the gas tank, but you never know. Get extra gas in those red containers. This gas can be used for the car, but also as a generator if you have one. Powering a refrigerator with a generator eats up a lot of gas. So make sure you pack plenty. Especially if you don’t know how long the lack of power will last. We had to pull gas from our car because our extra fuel ran out, trying to power our refrigerator.✓ Buy a small generator if you can afford it. Lucky for my family back in Miami, we had one. During one hurricane, our power was out for five days. The refrigerator was full of food. But we had our generator and gas to keep it running and keep all our food fresh. Besides, my nephew is asthmatic, and he started having anxiety attacks thinking that he had no power to use his nebulizer. Some medications also need to be refrigerated, so plan for that as well. Buy one or more fans. When you’re out of power, loss of A/C can be very dangerous for certain people, such as the elderly. Our wiser generations cannot tolerate heat well. Having portable fans will help keep a room cool and prevent heat exhaustion and heatstroke. Buy extension cords Since the generator uses gas, it throws off fumes. You do not want the generator inside the house! Extension cords will allow you to power your refrigerator safely. You can also plug in lights and charge your phones. We were also able to keep my nephew calm as we had power, and he’d be able to use his nebulizer if he had an asthma attack. Do not open your refrigerator unless you need to Opening the door will let the “cold” out. If you have no power, you must limit
10 health tips for 2025
Tips on How to Prepare for a Hurricane Being from Miami, I have my fair share of experiences with category 3,4, and even five hurricanes. They are not pleasant. They are quite scary. Your emotions can get the best of you, especially if you don’t have family around you. Right now, yes, at this very moment, as I write this post, I am without electricity because of Hurricane Sally. Just a category two hurricane, but it just so happened to hit Foley, Alabama, and I guarantee this town was not ready for it, so I have no power. Southeast FL is very well prepared for hurricanes. Their cable lines, their building structures, emergency services, everything. Foley, AL… not so much. So this hurricane may be just a category 2, but it has felt like a category 3 and 4 because of the nearby damage, loss of power, and severe floods. This post is not research-based, and it is the first post I will write, which is based purely on my experience with hurricanes. So, if I forget something or you had a different experience than I did and found better ways to prepare, by all means, share them with me. So let’s get right down to it! Here are 16 tips on how to prepare for a hurricane. Put up your Shutters early. Whether you have actual shutters or purchase plywood to hammer over windows, make sure you start early. The winds are the most dangerous early on. Their speeds can go up to 140mph, depending on the strength of the hurricane. Debris will be thrown around. So, protecting your windows with shutters or plywood is very important to protect your home and everyone inside it. Not to mention it’s also labor-intensive and time-consuming. DO NOT underestimate it. Buy drinking water Dehydration is very dangerous. Make sure you buy enough water to last at least a week but plan for more. I know it sounds excessive. But when the electricity goes out, you won’t have A/C or fans to work. You will sweat, and you can get dehydrated. You also don’t know how long you will be without power. Buy food that won’t spoil easily and can be quickly cooked without the need for electricity, and if you have a BBQ grill, have extra gas tanks. In Miami, most people have BBQ grills out back. This helps because you can still cook things. My family did.✓ So, make sure you have extra gas tanks. BUT, if you don’t… then you depend on electricity to cook. This means that anything that needs the stove, pressure cooker, or oven will not be useful. Buy foods that you can eat without having to cook them, and foods that don’t spoil easily. Cereals are a good option. Certain fruits are great! It will help you eat healthy, even if it’s unintentional! Bananas, Oranges, Mangoes, and peaches are a few of my favorites. Peanut butter, Nutella, and bread are also good options.✓ Cans of tuna are also great! Peanuts, mixed nuts, almonds, raisins, and prunes are great snacks, too. You can also get seeds: pumpkin, sunflower, flax, etc. These are just a few ideas. You can also get unhealthy but yummy potato chips, cookies, donuts, etc. But don’t overdo it. Stress can make you change your eating habits. Hurricanes are no different. Get a flashlight and batteries. When your electricity goes out, it will get very dark. With dark skies and no power, it can get pitch black. So have flashlights and plenty of batteries. If you have kids at home, the darkness is sometimes the scariest part for them. They hear all this noise outside, but they can’t see what is happening around them, giving them light. Those battery-powered hallway lights are great. You know, the ones you press down on, and they turn on and off. Fill up your car with gas. Even if you don’t plan on going anywhere…. Have your car tank full! You never know if you will need to go somewhere to get extra food/water or help a family member. We had to drive to my sister’s house to get water and extension cords. Not a far enough drive to fill out the gas tank, but you never know. Get extra gas in those red containers. This gas can be used for the car, but also as a generator if you have one. Powering a refrigerator with a generator eats up a lot of gas. So make sure you pack plenty. Especially if you don’t know how long the lack of power will last. We had to pull gas from our car because our extra fuel ran out, trying to power our refrigerator.✓ Buy a small generator if you can afford it. Lucky for my family back in Miami, we had one. During one hurricane, our power was out for five days. The refrigerator was full of food. But we had our generator and gas to keep it running and keep all our food fresh. Besides, my nephew is asthmatic, and he started having anxiety attacks thinking that he had no power to use his nebulizer. Some medications also need to be refrigerated, so plan for that as well. Buy one or more fans. When you’re out of power, loss of A/C can be very dangerous for certain people, such as the elderly. Our wiser generations cannot tolerate heat well. Having portable fans will help keep a room cool and prevent heat exhaustion and heatstroke. Buy extension cords Since the generator uses gas, it throws off fumes. You do not want the generator inside the house! Extension cords will allow you to power your refrigerator safely. You can also plug in lights and charge your phones. We were also able to keep my nephew calm as we had power, and he’d be able to use his nebulizer if he had an asthma attack. Do not open your refrigerator unless you need to Opening the door will let the “cold” out. If you have no power, you must limit
Tips on How to Prepare for a Hurricane
Being from Miami, I have my fair share of experiences with category 3,4, and even five hurricanes. They are not pleasant. They are quite scary. Your emotions can get the best of you, especially if you don’t have family around you. Right now, yes, at this very moment, as I write this post, I am without electricity because of Hurricane Sally. Just a category two hurricane, but it just so happened to hit Foley, Alabama, and I guarantee this town was not ready for it, so I have no power. Southeast FL is very well prepared for hurricanes. Their cable lines, their building structures, emergency services, everything. Foley, AL… not so much. So this hurricane may be just a category 2, but it has felt like a category 3 and 4 because of the nearby damage, loss of power, and severe floods. This post is not research-based, and it is the first post I will write, which is based purely on my experience with hurricanes. So, if I forget something or you had a different experience than I did and found better ways to prepare, by all means, share them with me. So let’s get right down to it! Here are 16 tips on how to prepare for a hurricane. Put up your Shutters early. Whether you have actual shutters or purchase plywood to hammer over windows, make sure you start early. The winds are the most dangerous early on. Their speeds can go up to 140mph, depending on the strength of the hurricane. Debris will be thrown around. So, protecting your windows with shutters or plywood is very important to protect your home and everyone inside it. Not to mention it’s also labor-intensive and time-consuming. DO NOT underestimate it. Buy drinking water Dehydration is very dangerous. Make sure you buy enough water to last at least a week but plan for more. I know it sounds excessive. But when the electricity goes out, you won’t have A/C or fans to work. You will sweat, and you can get dehydrated. You also don’t know how long you will be without power. Buy food that won’t spoil easily and can be quickly cooked without the need for electricity, and if you have a BBQ grill, have extra gas tanks. In Miami, most people have BBQ grills out back. This helps because you can still cook things. My family did.✓ So, make sure you have extra gas tanks. BUT, if you don’t… then you depend on electricity to cook. This means that anything that needs the stove, pressure cooker, or oven will not be useful. Buy foods that you can eat without having to cook them, and foods that don’t spoil easily. Cereals are a good option. Certain fruits are great! It will help you eat healthy, even if it’s unintentional! Bananas, Oranges, Mangoes, and peaches are a few of my favorites. Peanut butter, Nutella, and bread are also good options.✓ Cans of tuna are also great! Peanuts, mixed nuts, almonds, raisins, and prunes are great snacks, too. You can also get seeds: pumpkin, sunflower, flax, etc. These are just a few ideas. You can also get unhealthy but yummy potato chips, cookies, donuts, etc. But don’t overdo it. Stress can make you change your eating habits. Hurricanes are no different. Get a flashlight and batteries. When your electricity goes out, it will get very dark. With dark skies and no power, it can get pitch black. So have flashlights and plenty of batteries. If you have kids at home, the darkness is sometimes the scariest part for them. They hear all this noise outside, but they can’t see what is happening around them, giving them light. Those battery-powered hallway lights are great. You know, the ones you press down on, and they turn on and off. Fill up your car with gas. Even if you don’t plan on going anywhere…. Have your car tank full! You never know if you will need to go somewhere to get extra food/water or help a family member. We had to drive to my sister’s house to get water and extension cords. Not a far enough drive to fill out the gas tank, but you never know. Get extra gas in those red containers. This gas can be used for the car, but also as a generator if you have one. Powering a refrigerator with a generator eats up a lot of gas. So make sure you pack plenty. Especially if you don’t know how long the lack of power will last. We had to pull gas from our car because our extra fuel ran out, trying to power our refrigerator.✓ Buy a small generator if you can afford it. Lucky for my family back in Miami, we had one. During one hurricane, our power was out for five days. The refrigerator was full of food. But we had our generator and gas to keep it running and keep all our food fresh. Besides, my nephew is asthmatic, and he started having anxiety attacks thinking that he had no power to use his nebulizer. Some medications also need to be refrigerated, so plan for that as well. Buy one or more fans. When you’re out of power, loss of A/C can be very dangerous for certain people, such as the elderly. Our wiser generations cannot tolerate heat well. Having portable fans will help keep a room cool and prevent heat exhaustion and heatstroke. Buy extension cords Since the generator uses gas, it throws off fumes. You do not want the generator inside the house! Extension cords will allow you to power your refrigerator safely. You can also plug in lights and charge your phones. We were also able to keep my nephew calm as we had power, and he’d be able to use his nebulizer if he had an asthma attack. Do not open your refrigerator unless you need to Opening the door will let the “cold” out. If you have no power, you must limit the number of times you open it.
Why is Glucose control in Diabetes so Important?
Importance Of Glucose Control In Diabetes: Depending on how high your A1c is, your doctor may try “lifestyle modifications” first. It includes all the preventive things I discussed in my post, “The Sweet Tea on Diabetes.” Why is Glucose control in Diabetes so Important? A healthy diet, regular activity, and sufficient sleep with a probable follow up in 3 months to recheck your A1c to see how you’re doing. But sometimes, your doctor will know that even if you do your part, your A1c is too high to start with to reach the goal with just lifestyle changes, or you may have tried the lifestyle modifications without enough of an effect on your A1c. So, they will likely recommend medical therapy. There are so many options, too extensive to discuss here. But the most common first choice in treatment is a medicine called Metformin as long as you don’t have any contraindications. I’ll think about writing a post on different treatment choices for type 2 diabetes, but let us put that on hold. But why all the fuss on how high your sugar is? Why do you need to control so much? Well, it’s because you want to prevent complications. Let’s go over them. Now, this does not mean everyone with lower blood sugars will experience these complications. It does mean that if your control of blood sugar levels for a long time, your chances of experiencing these complications are enhanced. COMPLICATIONS – Glucose Control: These can be divided into an effect on Small blood vessels (Microvascular) or Large blood vessels (Macrovascular). Effects on large blood vessels include – Stroke, heart attack, and low blood flow in lower legs. In contrast, effects on small blood vessels include kidneys, eyes, and nerves. Let’s go over each of these and why they occur, and then I’ll even throw in some complications of uncontrolled Gestational Diabetes. Increase risk of Stroke (Large Blood Vessels) On its own, reducing blood glucose due to diabetes is a considerable risk factor for stroke. There is a 4-fold increased risk of stroke in people with uncontrolled diabetes. This risk is due to the effect of high sugar on blood vessels. Many people who have diabetes don’t know ways of controlling glucose levels, and it results in generating high blood pressure and high cholesterol. In this way, it further increases risk factors for a stroke. Not only is the risk of stroke higher, but so are the number of days in the hospital, risk of more significant disability after the stroke, higher risk of another stroke, and a higher risk of stroke-related dementia (memory issues). Coronary Artery Disease (Large Blood Vessels) Increased risk of a heart attack. Your heart has its blood supply, called coronary arteries. Since diabetes affects blood vessels, damage to these blood vessels can lead to decreased blood flow to the heart muscles. Less blood flow means less oxygenation of the tissue. Your muscles need oxygen to keep living. When the blood vessels are significantly affected, this is when it leads to chest pain and even a heart attack if severe enough. Peripheral Artery Disease (Large Blood Vessels) As I mentioned above, your coronary arteries are affected. But, you also have arteries that feed your arms, hands, lower legs, and feet. These are referred to as peripheral arteries. At the periphery, get it? Your hands and feet are the most distant from your heart. Your feet are even farther away than your hands. So it takes extra power to supply these areas with blood. If your heart is not getting enough blood because of damaged coronaries, it will have a hard time working well. It means that less blood will be pushed out to your peripheral arteries. If you also have damaged peripheral arteries, your feet will be getting even less blood. Good healing requires good blood flow. So this can lead to decreased wound healing, therefore, chronic ulcers and infections. It can even lead to amputations. Besides, sometimes walking too much can cause pain or cramping in your lower legs. It is termed ‘claudication.’ It sometimes gets better once you sit and rest. It’s kind of like a ‘chest pain’ of your legs. It happens because when you perform an activity, your muscles need more blood, but it doesn’t get it because of your affected blood vessels. Diabetic Neuropathy It happens when the sugar in your blood coats your nerves. Short term, this is not too bad. But, in a long time, it causes nerve damage and nerve death. Your entire body is filled with nerves. Nerves that help you feel things on your skin, nerves that help stimulate your stomach for digestion, and even nerves necessary for erections. You might experience things like tingly sensations, like ants crawling on you in your feet or hands. You may have issues with erections or impotence. You might even notice you have slow stomach emptying called gastroparesis. It can lead to feelings of fullness after a meal, nausea, vomiting, or acid reflux. Diabetic Retinopathy The long-term high sugar in your bloodstream leads to damage to both the nerves and the arteries that supply your eyes, leading to progressive blurry vision and loss of visual acuity. Diabetes is known to be the most prominent reason for damaged vision in people 25-74 years old. Your doctor will likely schedule a yearly ophthalmology check to make sure your eyes remain healthy. Diabetic Nephropathy Nephro means kidney, yes, that’s right. Long-term uncontrolled diabetes can lead to kidney damage. One of the leading causes of chronic kidney disease and end-stage renal disease is diabetes. Many of these patients require dialysis to help filter their blood because their kidneys can’t do it anymore. You might experience changes in your urinary frequency and amount. You might also notice swollen ankles or lower legs, and even puffiness under your eyes. Remember that some of these symptoms might occur with many other medical conditions. They are not specific to kidney disease. Decreased wound healing Diabetes affects your circulation and
The Sweet Tea on Diabetes| Type 1 & Type 2
Diabetes is such a broad topic! I have personally noticed that the general public doesn’t know much about it, other than “you have to be on insulin.” Or, “you got it because you’re fat.” Both are incorrect. So, I have chosen to write this post to give you all the ‘sweet tea.’ We will go over what it is, some of the risk factors, symptoms of diabetes, and things you can do to prevent it. I would add that even if it is a disease, it does not mean that you have no control. There are ways you can help manage your diabetes aside from any medications. Like many others, including high blood pressure or high cholesterol, the beauty of this chronic illness is that your lifestyle and daily habits play a massive role in its progression and control. Even if you’ve been diagnosed with a chronic disease, there IS something YOU can do about it. So don’t let that keep you down! With the combination of your effort and your physician’s help, you can lead a very healthy life without complications of the disease. It takes a partnership for anything to work, and this includes your health.✓ Types Of Diabetes: Listed below are the two types of diabetes, but I will be focusing on the signs and symptoms of type 2 diabetes. Type I Diabetes Mellitus Insulin-dependent diabetes mellitus Previously: Juvenile-onset diabetes. Type 2 Diabetes Mellitus Insulin-resistant diabetes mellitus Previously: Adult-onset diabetes. Both types of Diabetes are issues with insulin. Insulin regulates the amount of sugar level in your bloodstream. Having too much sugar in your blood for too long can lead to specific health issues, which I will discuss in a different post. The most notable difference is that – in type 1 diabetes, your pancreas makes little to no insulin. In contrast, in type 2 diabetes, your pancreas makes plenty of it, but your body is just not responding to it, AKA resistant to it. The treatment of these two types is, therefore, quite different. If your body isn’t making it such as in diabetes mellitus type 1, treatment would be to give yourself insulin. It is the reason why it’s called insulin-dependent diabetes mellitus But in type 2, your body does make it; it’s just not sensitive enough to it to respond, so it’s treated with different medications. Eventually, if still not controlled, insulin may be necessary, BUT not always. DEFINITION OF RISK FACTORS Before I discuss specific risk factors for diabetes, I just want to make you guys aware that there are different “classes” of risk factors. In medicine, risk factors are divided into – those you can change, and those you cannot change. We refer to them as modifiable vs. non-modifiable risk factors, respectively. Things you can change include – your diet, your sleeping patterns, your level of physical activity, whether or not you smoke, or drink alcohol. These are the things you can change. Things you cannot change include – your family history (genetics), age, height, race, and ethnicity. Further still, some can be a combination of the two: it can include your social economic status, which can affect your access to health care or even healthier food options. It affects your neighborhood, which can affect how safe it is for you to exercise outside. Some of these you can change with time, but sometimes it will take longer than expected, or they may always be that way. We call these determinants of health. These things can get in the way of you achieving your healthier lifestyle goals; they have nothing to do with your motivation or will to do something. So let’s get started on this sweet topic! Pun intended. Family history of type 2 diabetes If your family members have diabetes type 2, it increases your risk of developing it in the future as well. ✓ Even though type 1 diabetes can be caused by autoimmune disease, which can run in families, type 2 diabetes has a more robust “hereditary” pattern than type 1. Past medical history of gestational diabetes (GDM) Did you know that being diagnosed with diabetes during pregnancy increases your chances of retaining it or developing it later even after delivery? Gestational diabetes is a whole other topic for another day, but for it to be called Gestational Diabetes Mellitus (GDM), you must develop it after 20 weeks of pregnancy. Sugar issues during pregnancy are due to glucose intolerance, and most resolve after delivery. But did you know that your risk of developing diabetes is about a 3-7x higher than the average person, even 5-10 years after delivery and resolution of gestational diabetes? ✓ Also, infants born to mothers who had GDM are at higher risk of obesity and diabetes throughout their lives. So there is a higher risk of diabetes in both mother and child later in life. Obesity, current or in youth Excess adipose tissue (fat), and in particular visceral (abdominal) fat, increases your risk of insulin resistance and, therefore, diabetes type 2. Why? There are a few theories on that. It’s believed that visceral fat might cause two things. One, the accumulation of fat in the liver and muscle, which causes insulin resistance in both organs; and two, visceral fat causes the release of cytokines, and proteins that help with signaling in the body, which affects your whole body’s response to insulin. Your liver is responsible for sugar creation (gluconeogenesis) and sugar storage (fatty acids, glycogen, and triglycerides– energy for later use). Insulin stops gluconeogenesis because it is a signal that there is enough sugar in your blood; there’s no need to make more. Insulin also promotes the creation of fatty acids (building blocks of triglycerides). If your liver is resistant to insulin, it won’t be able to stop gluconeogenesis, which contributes to high sugars, while still promoting fatty acid production and deposition as triglycerides. It is the reason why diabetes can also cause high cholesterol and triglycerides. Your muscles are involved in the use of sugar. Insulin makes your muscles
First Year Family Medicine Resident | Life of a 1st year
Congrats! You’ve matched. What should you expect as First-Year Family Medicine Resident family medicine! Welcome to the best position in the world! You must be thrilled! But right about now, you begin to have questions. First-Year Family Medicine Resident What should I expect? What is expected of me? Is there more than just medicine? And then one of the most haunting questions I ever had: “Will I kill someone?”. I had the same questions. Except I never got any of the answers. Not until now. Now I know. So I’ve decided to share them. I hope this post helps all of you about to start your 1styear of FM. Both to ease your mind.. or maybe even open it. So what is it like to start a family medicine residency? What are the hours like? I will say this. Full disclosure it depends on which rotation you are on, also depends on who your attendings are AND even on the program you matched into. This is the experience I have had at my program. Ours may differ. On average, expect to work between 8-13 hours a day. On outpatient rotations, you have weekends off. On inpatient rotations like ICU, Inpatient medicine, which my program calls adult medicine, and Emergency medicine… you will work six days a week, between 10-13 hours daily. On outpatient rotations, you have clinic hours, 8-5 pm. There will be days where you have a clinic for half a day, usually in the afternoon. You are on inpatient medicine, so you need to be in the hospital in the AM and then go back to the hospital after the clinic is over to do your PM rounds, finish notes, check-in on patients, and leave everything ready for the next day. These days are the toughest because you have inpatient notes AND clinic notes to finish. It takes time and practice to get better at time management. You’ll get there. WHAT IS EXPECTED OF YOU ✓ Punctuality: If you are on the dot…you are late. Be places 10-15 min early to allow yourself time to set up, turn on computers, sign on. Etc. It shows you respect your position and respect those you work with. Their time is as valuable as yours. ✓ Accountability: Hold yourself accountable for things you say you will do, for when you forget or order something wrong, or write the wrong something. Hold yourself accountable. Admit your mistakes and doubts. This allows others around you to trust you and depend on you to follow through. ✓ Honesty: If it’s in your notes, make sure you’ve done it. For example – if in your physical exam, you say “no lymphadenopathy,” make sure you’ve palpated the lymph nodes. Trust is not only essential but crucial. Defensive medicine is NOT great, but… if your charts ever become used in legal situations, be sure your chart is exactly what was done. The chances of you remembering what you’ve done at each patient encounter are low. You will one day refer back to these notes to remind yourself of what you saw, felt, and observed/appreciated. So be honest. ✓ Respect: Be courteous to everyone around you, including cafeteria staff, cleaning staff. The environment you foster will benefit you in the long run. You want to come to work in a pleasant atmosphere. Respect others’ privacy as well as their boundaries! Don’t demand things or “order” things. Request, and then say thank you. You are a team. ✓ Read up on your patients: The best way to learn is to read up on your patients. Treatment plans, options, side effects benefits. Everything. It will help your patients in the future and help you help them. Also, it will make sure you know how to answer questions if you’re ever pimped. WHAT TO EXPECT ✓ Long hours: As mentioned above, some days run as long as 12-14 hours, and if you’re having fun, you may stay later..I’ve done it. The average workweek is about 70 or more hours, with a limit at 80 hours a week. It means if you hit the 80 mark. You must go home. ✓ Some weekends off, You get one day off a week during inpatient rotations, and both weekend days off in outpatient ones. Make the best of them. Do what helps you keep your sanity! Whether it be the Gym, outdoor activities, family time, etc… Whatever it is. Do it and be present. ✓ Vacations days: Each program is different. I have about 21 vacation days, including sick days, so I plan wisely. I haven’t used a sick day yet, but let’s not jinx it. Oh, and no vacations during inpatient services (ER, inpatient medicine, and ICU). ✓ Fatigue: You will get tired. Very. Personally, when I get tired, I get emotional, sensitive, and it takes me a bit longer to finish notes and documentation. Know yourself! Know how you react to fatigue, know what you need to help it, and adjust your workday and workflow to account for it. I need a hot bath with candles and meditation music, other times I just need a good cry, others a quick workout sesh is just what the Doc ordered. Depending on where I am at in my fatigue. I know what I need. It is essential to know these things so that it does not interfere with your work, patient care, and so you don’t BURN OUT. Recognize your fatigue and do something early on to help it. ✓ Support: Lean on those around you. Your co-residents, your family. Your attendings. You are keeping things bottled up leads to BURN OUT. Don’t let yourself get to that point. You will be surprised how quickly you bond with your class. You will have a village supporting you whether you ask for it or not. That has been my personal experience at my program, and I hope it is yours when you start.✓ ✓ Fun: Medicine is fun. It is detective work. And you will be doing it with other people who share your interest in it. Aside from that: downtime between patients, between work, between note writing and patient presentation there, will
