“Often when we feel depleted, we reach for a cup of coffee,” says Dr. Richard Ryan, a professor of psychology at the University of Rochester, “but research suggests a better way to get energized is to connect with nature.”

He is the lead author of a series of studies that the Journal of Environmental Psychology just published in this June 2010 issue. I asked him to send me a PDF of the full-text of his research report, “Vitalizing effects of being outdoors and in nature,” and he did. You can find the abstract online.

Instead of coffee, I restore my energy by going out for a hike. In fact, one of the most popular parts of my website is my blog of photo essays, “Fitness and Photography for Fun.”

Certainly, physical activity makes us feel better. Staying fit is indeed one of the four legs that those of us with diabetes have to keep our blood glucose levels down in the normal range (the other three legs are diet, reducing stress and inflammation, and usually taking oral medication or insulin).

Over the years I have written many articles extolling the benefits of exercise. Some of those articles say how much better I feel after going out for a hike.

Nature This Morning

That’s all true. But these new studies for the first time have teased out the effects of being out in nature alone from the feel-good effects that we get from physical activity and from the socializing that we often get at the same time.

Dr. Ryan and his co-authors were able to separate out the effects of nature alone. To do so they conducted five separate experiments with 537 of the usual suspects — college students.

What they found was so clear, Dr. Ryan says, that “being outside in nature for just 20 minutes in a day was enough to significantly boost vitality levels.” The Journal of Environmental Psychology article defines vitality as having physical and mental energy giving us a sense of enthusiasm, aliveness, and energy.

When we have a greater sense of vitality we not only have more energy to do the things that we want to do but were are also more resilient to physical illnesses. “One of the pathways to health may be to spend more time in natural settings,” he says.

I’m not knocking physical activity. Most of us who have diabetes need to get up and out a lot more. If you aren’t getting out yet, this beautiful late spring weather is a great time to start. I’m saying that getting our physical activity outdoors in nature gives us two for the price of one.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

All of us feel sorry for ourselves once in a while. That goes double for those of us who have diabetes.

We do have a serious disease that can be awfully hard on us. The complications of this disease are almost too much to even think about.

But we aren’t alone. If you are as inquisitive as I am, you talk to lots of people who have diabetes. And you will find some who have even worse conditions, believe it or not.

For example, last summer I hiked 132 miles in two weeks on a Sierra Club outing. Four other people made the same High Sierra trek with me, and I assumed that none of them had any physical limitations. Was I ever surprised to learn that every one of them had serious physical conditions — some worse and much more painful than my diabetes!

And this isn’t the half of it. I seriously encourage everyone to watch a bit of Nick Vujicic’s story. Nick is an Australian of Serbian descent.

“He was bitter until age 12, when his mother showed him a newspaper article about a man dealing with a severe disability,” according to an article about him. “It would change his outlook on life. Suddenly, he wasn’t the world’s only struggling person.”

I won’t say any more. Just watch a YouTube clip about him at www.youtube.com/watch?v=Gc4HGQHgeFE

Life wasn’t fair to Nick, but he is far from bitter about it, which would be about the only thing that could be worse. Life is Beautiful.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

The odds are that you haven’t yet fully empowered your search for good health. I know this about you because a couple of months ago HealthCentral surveyed 2,888 of its registered members who have one of eight chronic conditions, including diabetes, and who completed the study. And in this respect at least people with diabetes are just like the people with the other seven chronic conditions.

HealthCentral CEO Christopher M. Schroeder and James E. Burroughs, associate professor of commerce at the University of Virginia, presented their findings at the DTC National Conference in Washington, D.C. earlier this month and shared them with me. After asking the people in the survey all sorts of standard psychological assessments, they found that about 30 percent of us take an active role in our health care plan. If you are in this group, one of your characteristics is that you are energized and engaged when you need to learn new tasks or master new subjects — you are what the survey calls a person with a need for cognition. If you are an empowered health seeker, the other characteristic you have is self-confidence — you have, in the formal terminology of the survey, high self-efficacy.

You can click to view the study, “Understanding What Motivates the Empowered Patient,” here. Mr. Schroeder and Professor Burroughs prepared it in association with Ted Smith, Ph.D., HealthCentral’s executive vice president for research.

My posts here at HealthCentral and your many comments are just one small corner of this huge health resource. HealthCentral is a collection of condition and wellness websites providing clinical information, tools, and mobile applications. Its sites provide a platform for more than 3,000 bloggers, 200 expert patients, and more than 12 million monthly visitors sharing real-life experiences about specific conditions. [Read more →]

One little problem with disasters is that when they strike it’s too late to start preparing for them. You never know when or where they will hit.

Those of us who have diabetes are particularly vulnerable, because we have so many things that we have to consider. That’s why the American Association of Clinical Endocrinologists working with Eli Lilly and Company created the “Power of Prevention: Diabetes Disaster Plan.”

Todd Frieze, M.D., who practices diabetes, endocrinology, and metabolism in Biloxi, Mississippi, spoke on the organization’s disaster plan for those of us with diabetes this morning at a media briefing during the last full day of the AACE’s annual meeting in Boston. He said that they developed this checklist of items that we need to plan for after thousands of people were caught unprepared as a result of Hurricane Katrina in 2005.

Dr. Frieze Plans

In such an emergency we may well be totally on our own. “When something does happen, access to medical care may be curtailed or absent completely,” Dr. Frieze said. He noted that in 2005 his patients were out of touch with him for seven weeks.

Here is the checklist. As the Boy Scouts say, “Be Prepared:”

Prepare a portable diabetes disaster kit that is both insulated and waterproof containing the following items:

• List of all medical conditions and prior surgeries.
• Information about your diabetes, including past and present medications, any adverse reactions to medications, and past and present complications.
• List of all your health care professionals with their contact information.
• Letter from your diabetes health care professionals detailing most recent diabetes medication regimen (especially for insulin) and containing most recent laboratory results.
• List of all medications, which should also include pharmacies and active prescription information and eligible refills.
• A 30-day supply of medications for diabetes and all other medical conditions. This should include insulin, oral anti-diabetic agents and severe hypoglycemia emergency kit (if prescribed by your physician).
• Blood glucose testing supplies including lancets, test strips and preferably at least two glucose meters with extra batteries.
• A cooler and at least four refreezable gel packs for storing insulin (do not use dry ice when storing your medication).
• Empty plastic bottles and/or sharps container for syringes, needles, and/or lancets.
• Source of carbohydrate to treat hypoglycemic reactions (e.g. glucose tablets). Ideally should also have one or two day’s supply of food that does not require refrigeration (e.g. non-perishable).
• At least a three-day supply of bottled water.
• Pen and/or pencil and notepad to record blood glucoses and any other test results and any new signs/symptoms suggesting medical problems.
• Additional medical/first aid supplies like bandages, cotton swabs, dressings, and topical medications (antibiotic ointments or creams) to treat cuts or abrasions.

Other recommendations:

• Wear shoes at all times and examine your feet often for infection.
• Make sure that all immunizations including tetanus are updated.
• Pack extra comfortable clothing including undergarments.
• Take a cellular phone with extra batteries for you and family members.
• Consider choosing a designated meeting place in case you are separated from your family and unable to reach them by phone.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

If you never heard about Atul Gawande, M.D., you don’t know the best medical writer in the world. As a medical writer myself, I consider my naming him that to be about the highest praise I can offer.

When the people at the American Association of Clinical Endocrinologists told me that Dr. Gawande would be the keynote speaker at this year’s meeting in Boston, I didn’t think twice about accepting their invitation. Listening to his address this morning, I was as impressed by his talk as I was earlier by reading his three books and his many articles in the New Yorker magazine.

But if Dr. Gawande were just a writer, this organization of practicing endocrinologists wouldn’t have made him their keynote speaker today. This incredibly talented young man, born in 1965, also happens to be associate professor of surgery at Harvard Medical School and a general and endocrine surgeon at Brigham and Woman’s Hospital in Boston — two list just two of his many positions.

At least he didn’t have to travel far in order to speak to speak to about 1,000 of us today. I made sure to get to the auditorium early so I could sit in the front row to photograph him.

Dr. Atul Gawande Speaking This Morning to Endocrinologists

I also wanted to take a close look at Dr. Gawande to see if he looked frazzled from all his work. As you can see from my photo, somehow he looks quite relaxed.

Earlier in one of my articles here I named Dr. Gawande as as inspiration for my writing style. He even takes time to answer my emails when I write him. No wonder that the John D. and Catherine T. MacArthur Foundation a few years ago named him a MacArthur Fellow, which well deserves its nickname, “the genius award.”

President Obama cited Dr. Gawande’s article last year in the New Yorker, “The Cost Conundrum,” which used as an example the town of McAllen, Texas, to argue that unnecessary medical tests and procedures were a primary factor in driving up the cost of health care in this country. That article affected the President’s thinking dramatically, according to Senator Ron Wyden, and soon after its publication, he showed the article to a group of senators including Wyden and said, “This is what we’ve got to fix.”

Today, Dr. Gawande spoke on “Beyond Reform: Facing the Complexity of Health Care.” The key word is complexity.

He mentioned diabetes a couple of times in his talk. But for now please think of diabetes as subsumed within our country’s much broader health care problems. Here are some of the passages of Dr. Gawande’s talk that immediately caught my attention as I recorded them.

“The deepest struggle of health care is its complexity,” he said. “This is the reason why health care often doesn’t work. Just half a century ago medicine wasn’t either expensive nor effective.

“We have identified now more than 13,600 diagnoses. And for each of them we have identified steps in their care that can reduce people’s suffering, if not actually cure their disease. But that arsenal has now accumulated to become more than 6,000 drugs currently that you and I can prescribe and more than 4,000 medical and surgical procedures that we can provide.

“It’s incredibly hard. There is no industry in the world that has to provide 13,600 different service lines to every community in the country, let alone the world, and customize it to every customer. It is man’s most ambitious endeavor.

“The value it’s producing, though, is already excellent. Life expectancy has increased five years since 1960 and nearly all of it has accumulated after the age of 65. It’s brought longer lives and later disability, and that has produced its own problems, because during that same time period we have reduced the average retirement age from 67 to 61. Somewhere this is not going to add up (he smiles).

“We are at the point where the volume and complexity of the discoveries we have had in the last century has now exceeded our ability as individuals to delivery optimal care reliably and safely. I think we were fooled by penicillin. It was miraculous for a couple of reasons: number one was the idea that you could treat this incredible range of infectious disease that could never be reliably treated before, and the second thing was that this took only an injection.

“It was that simply. And it led us to imagine that the future of medicine would look like that. There would be an injection for cancer. There would be an injection for heart disease. But it hasn’t turned out to be anything like that at all.

“We were fooled into imagining that discovery was the only hard part and that execution would be easy. And that couldn’t be further from the truth.

“What’s missing is innovations for great care. It’s innovations not as we are used to thinking, where we think of drugs and devices as the sole carrier of innovation; it’s about systems innovation in health care.

“Making food of higher quality at lower cost was the fundamental question of the 20th century. Now, we are coming to a basic understanding of how we will make better care at lower cost. This is the fundamental issue of the 21th century.”

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Health Central sent me to the meeting, where I interviewed Dr. Sachmechi this morning. He is clinical associate professor of medicine at Mount Sinai School of Medicine in New York City and Queens Hospital Center in Jamaica, New York.
Dr. Sachmechi presented his poster and abstract, “Impact of Diabetes Education on HbA1C and Weight Reduction at the meeting.” He told me that he designed the study and involved the chief resident and one of his colleagues. Certified Diabetes Educators and nutritionists provided the diabetes education.

Dr. Sachmechi Supports Diabetes Education

Don’t people with diabetes generally get diabetes education? “No,” Dr. Sachmechi replied. “In many areas of the country people with diabetes don’t get nutritional advice or see CDEs. The CDEs show them how to do home glucose monitoring, how to prevent hypoglycemia, the importance of exercise, and other things that are needed for the care of diabetes.”

But doesn’t it cost a lot of money? “I don’t think so,” Dr. Sachmechi replied. “Certainly, a session with a CDE costs less than a session with a physician!”

The study group of 150 people included people with type 2 diabetes who their primary care physician referred to two CDEs and a dietitian. A control group of 150 people with type 2 diabetes didn’t get to see either a CDE or a dietitian.

The researchers compared the A1C and weight of the study participants before and then six months after the study. A1c went down 1.02 percent in the study group but only 0.59 percent in the control group. The average weight went down 2 pounds in the study group but only 0.71 pounds in the control group.

“This is one of the few studies demonstrating a measurable improvement in diabetes control and weight loss solely due to diabetes education and diet counseling in a municipal hospital with limited resources,” Dr.Sachmechi concluded. Dr. Sachmechi’s study worked with people with diabetes who are largely uninsured and generally have poor health literacy. My conclusion is if diabetes education works there, it can work for you too.

Dr. Sachmechi tells me that he is now working on the impact of support groups on the impact of A1c and other measures of diabetes control. Do support groups help us? That’s what he hopes to find out, and I will let you know here the results of that study.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.

At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.

This week he told me that I was free to reproduce that guide here. What happened was this.

One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.

When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.

“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.” [Read more →]

Sometimes the best way to understand something is to look at it from the other side. Those of us who have diabetes think a lot of the time about the special problems that we face. This makes thinking and acting as if we didn’t have diabetes all the more necessary. We all feel better when, for example, we can say that I am a lucky man or woman.

Yet sometimes it can help us to see the dark side of things. When we can fully envisage what we know in our hearts is what we want to avoid, we can move away from that negativity.

Someone who once was very close to me rarely if ever got excited about anything. In an emergency situation she was great, because she was always unflappable. But when things were great, by the same token she seldom if ever showed any enthusiasm. I admired her stoicism at the time, but now I feel sorry for her inability to experience emotion.

She came to mind today when I sat down to share a poem with you. This poem helped me see more clearly the value of emotion in our lives, and I think that it can help you too.

The author of this poem is the daughter of a friend of mine, and I reproduce it here with their permission. She wrote it as her essay to gain admission into an honors program at a Boston college. After you read it, I’m sure that you will appreciate that they accepted her application.

Life Without Emotion
By Ashley Adamson

Cones without ice cream
Sleep without sweet dreams
Beginning without end
Email without send
Stars without night
Wrong without right
A watch without time
Punishment without crime
Sports without competition
Practice without repetition
Studying without learning
Separation without yearning
Color without eyes
Graduation without good-byes
Birds without calls
Triumphs without falls
Sand without an ocean
Kids without commotion
Marriage without devotion
Life without emotion
Life without emotion?!?
Then you realize;
Dying is only one of many ways
You can lose your life.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Many of you comment on my articles here, and I appreciate the chance that this gives me and everyone else to know what’s on your mind. But many other people would rather talk than write about your challenges and successes in controlling your diabetes.

So to enlarge the opportunities for exchanging information and feelings I’m will start a way for us to talk about diabetes. On February 15 — just next Monday — I will kick off the first call. This is a pilot project for me and indeed for the Health Central Network. If it works — in other words if enough people want to participate and actually benefit from the discussion — I’ll lead more of these discussions.

The best time of day to accommodate most of the people who might call in would seem to be 8 p.m. Eastern, which is 7 p.m. Central, 6 p.m. Mountain, and 5 p.m. Pacific. That’s obviously not perfect for everyone, but looks like the best we can do.

We will be able to talk for one hour. I understand that we will be cut off at that time no matter now exciting the discussion turns out to be.

For this first conference call I would like to focus on the most controversial aspect of diabetes control — the best dietary recommendation. My take on the best eating plan, as most of you certainly know, is a very low-carb diet. Let’s talk about the pros and cons, how easy or how difficult that this diet strategy is for controlling our blood glucose levels and our weight. We may also want to talk about whether we eat fructose and/or grains and starches.

If you like, perhaps before joining in the discussion you can review one or more of these articles that I have written about my journey leading me to a very low-carb diet:

1. Here four years ago I outlined the nature of the conflict in “The Carb Controversy” at www.healthcentral.com/diabetes/c/17/1490/carb-controversy

2. A very-low carb diet does not mean eliminating all carbs. So here about two years ago I reviewed “The Good Veggies” at www.healthcentral.com/diabetes/c/17/20167/good-veggies

3. Then about a year ago in an article that I wrote for the website of Diabetes Self-Management I explained “Why I Low Carb” at
www.mendosa.com/lowcarb.htm

Finally, the call-in number is 1 (800) 977-8002. When you call, a robotic voice will ask for the participant code, so enter 82611869#.

While I have called in to discussions before, this will be my first time leading one. I hope that it will work and will do my best to ensure that it does.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

When we pick a doctor to help us control our diabetes, with luck we can find one who will support us with action and not just words. Getting practical support is important for us in improving our blood glucose levels.

When our doctors help us to set goals and proactively follow up their recommendations, their actions are a lot more meaningful than if they are just good listeners and help draw out our preferences. Some of us probably already suspected this, but a new analysis of 3,897 Germans who have diabetes show that empathic listening and eliciting our preferences doesn’t help us to achieve lower A1C levels.

The lead author, Jochen Gensichen of University Hospital Jena, says contrary to what they expected, good communicative support alone didn’t help. [Read more →]