DrRic Pre Diabetes....a Scary Diagnosis (slide share edition)


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DrRic lecture at Whole Foods Market Schaumburg for Diabetes month. Topic=Pre-Diabetes.

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  • Design notes: list of providersWe want this to look much more inviting—these chairs are way too cold.Had thoughts about putting the actual providers in the chairs. Could be an actual live picture with a sample patient in the red chair or could be a group of providers sitting around the table.
  • Based on a survey of our patients, we found a consistent theme of what frustrates them about conventional medicine practices and why they felt First Health was different. Since identifying these 4 key areas, we have made a consistent effort to offer our absolute best to:Listen attentively to Patients concernsMake the patient the driving force as the center of careMinimize wait timesExplain all the options for treatment, and give the patient choices (medications, alternative medicine, nutritional medicine/supplementation, psychological medicine)
  • When it comes to weight control, we can explain pretty much everything down to a T. STRESS is the one X-Factor. Kathy is a great example of this. She struggled in the first 4 weeks of the program (when everyone else was putting up huge numbers). What was holding her back was stress from her job, family, and further compounded by not losing weight. She started seeing the LCPC and went on a tear more consistent than we’ve ever seen. She lost 2# per week over 24 consecutive weeks.
  • DrRic Pre Diabetes....a Scary Diagnosis (slide share edition)

    1. “Pre-Diabetes…. …a scary diagnosis! Enrique Saguil, MD We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    2. The First Health Approach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    3. Your Team Ric Saguil, MD Jason Gruss, MD Tom Jordan, RDKatrina Christie, LCPCMike Blumberg, LCPC Jennifer Green, ND Joe Musolino, DC Amy Iaquinta, DC Nick Nowicki, DC Emery Paredes, PT Courtney Day, EP Aimee Weber, EP Yu Zhu, MD China You
    4. Ric Saguil, MDWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    5. This concept of “Pre-Anything”• NOT COVERED ON INSURANCE• Your on your own (run/bike/swim)• Most of us -“school knowledge” of exercise, (which could be dangerous) ….“leagues?”• If it was so good, why didn’t we stick with it last new years resolution?• No place that’s close enough, cheap enough, new enough or fast enough….but what about your neighborhood?....or backyard!!
    6. Started with the “5-O” mentality• You are driving along, 5-10 mph over the speed limit (like everyone else) and suddenly a police car on the side of the road. Then everyone slows down and behaves themselves.• You are not feeling any symptoms, 10-20 pounds overweight (like everyone else) and suddenly you have a physical. Then you eat right and plan to exercise more to make the change to be healthy.
    7. Facts:• Coronary heart disease (CHD) caused about 1 of every 5 deaths in the United States in 2005.• It is estimated that 195, 000 silent first myocardial infarctions occur each year.• About every 25 seconds, an American will have a coronary event, and about every minute someone will die from one. (8th slide, 60 seconds per slide-8 americans just died)
    8. Wait…isn’t this a pre-diabetes talk?Normal physical Overweight-Gradeschool Obese-HS Heart Attack College
    9. Graphic Scale BMI
    10. Visual Scale BMI
    11. Another 20 years?•1 in 2 will be obese
    12. YOU?
    13. Diabetes trend 2004
    14. Diabetes trend 2005
    15. Diabetes trend 2006
    16. Diabetes trend 2007
    17. Diabetes trend 2008
    18. 2004
    19. 2005
    20. 2006
    21. 2007
    22. Physical Inactivity 2008
    23. DiabetesInactivity Diabetes = Physical Inactivity
    24. Pre-Diabetics…should we act now?• Aka-Impaired glucose tolerance, impaired fasting glucose.• People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. (vs 2-4 fold DM)• Damage to end organs suspected to already occur with pre-diabetes• With ignorance, move onto diabetes in 10y
    25. Testing….Testing!!!
    26. Who gets tested?• Overweight and 45 or older• Normal weight and 45 or older (ask)• Overweight and younger than 45 +(ask) + = HBP, Low HDL, High Tri, Fam Hx DM Gest DM, Birth of > 9lb baby,
    27. Who benefits from testing• Doctor - no…I can fill your spot with another• Drug company – yes (muuuhaha)• Family - yes…observed habits rub off• Patient - yes…a chance to change …knowledge is power …eventually gonna need it!
    28. Test Awareness• HA1C awareness = 14.8% to 27%• BP awareness =20.7% to 26.6%• LDL awareness =3.5% to 5.6% Joslin Center 2009
    29. “Pre” or “Full Blown” Endocrinologist/CDEFamily Medicine/Internist/Ob/PedsUnderserved/Undiagnosed
    30. • www.diabetes.org Diabetes Risk Test Local Events November is DM month!
    31. What not to do = Heart Attack Grill
    32. Treatment ADA (for DM)• Blood glucose control• Medications• Organ transplant• Dental health• Diabetes 24/7 (blood glu, aic, bp, chol, physical act, weight, meds)
    33. Trip down “digestive lane”
    34. Stomach acid breaks down food
    35. Insulin from the pancreas
    36. Body “puts away” the glucose (But may overcorrect)
    37. Absorption of the carbohydrate
    38. SpaghettiWhite Bread
    39. Confused? Follow ANDI…. Aggregate Nutrient Density Index…Dr Joe Furhman
    40. Largest Losers FHAMary Mary292# 227#Fasting FastingBlood Sugar: Blood Sugar:107 93
    41. Largest Losers FHAKathy Kathy204# 141# (in the 120s today)Cholesterol:245 Cholesterol: 191
    42. Largest Losers FHABill Bill254# 189#Triglycerides: Triglycerides:338 68
    43. First Health Associates Pillars of Blood Sugar Management 1) Weight Status 2) Fitness 3) Labs 4) HRA 5) Mental Fitness 6) NutritionMotion, heat, galvanic change, temp
    44. Doing it on your own?! Weight Control
    45. A Quicky with DrRic• Strategic locations (arms reach when tired)• Plan ahead (pick shop day and load up)• Shop full, meals for the week• Always have a “go to” reward– (food/snack/meal)• Water! (tea or warm water to start the day)• Must have a F/V/G in sight• Prep a “Go-Bag”• Set a deadline for success/help
    46. My “go bag” (or get help)
    47. Inject your kitchen (or get help!) Your proving ground!
    48. The exercise part….
    49. Swimming Excellent for joints, Good for lung capacityLimited by place and climate Watch skin conditions Watch asthma Watch shoulder injury
    50. Biking Good for joints Good nature contactGood to include in work Watch back Watch walletWatch speed/coasting
    51. RunningLong developed community activity Can be done by any age Addictive (positively-chi running) Watch exposure (newcomers) Watch the lower extremities Shoes!
    52. Hiking Forest Preserves are tax supported The fastest hikers burn as much as the slowest jogger Slowing down can bring awareness of natureMoving away technology cultivates the relaxation response (think kids!) Less chances for strain and overuse injury Watch solitude (injury, dehydration, disorientation) Watch animals
    53. Walking Stats and “gettin sweaty”MET’s (cal/kg/hr):Sitting for this lecture0.0 mph - 1Walking2.0 mph - 91 1 min mile=60mph2.5 mph - 873.0 mph - 85 2 min mile=30mph3.5 mph - 83 3 min mile=20mph4.0 mph - 91 4 min mile=15mph4.5 mph - 102 5 min mile=12mph5.0 mph – 116 10min mile=6mphRunning 12min mile=5mph5.0 mph - 116 15min mile=4mph6.0 mph - 121 20min mile=3mph7.0 mph - 119 25min mile=2.5m/h8.0 mph - 1239.0 mph - 12110.0 mph - 131 Bottom line….fastest walker burns like the slowest jogger…but less knee pain
    54. Timing of hikes• Weather.com• Weather.gov• Sunrise/sunset• 1-3 times a week for 30-60 minutes (30+minutes to achieve RR)• Or add resistance to burn more calories (depending on your indivi resting metabol rate)• Diabetics can increase to 5x week for glucose control• Hypertensives can use breathwork twice a day
    55. Yoga! Ancient art Popularity high Low injury riskExcellent at cultivating relaxation response Excellent flexibility/power/balance Detoxing Still Growing with multiple styles
    56. Or….get…help!!! Physical therapists Exercise physiologists Personal trainers Life coaches Yoga instructors Dieticians (RD) Has to be sustainable!!!
    57. Not that I’m biased but….yoga has hidden prizes!!!
    58. Not that I’m biased but….yoga has hidden prizes!!!Pancreas massage Balance/Strength Cultivation of Relaxation Response
    59. Hidden prize-controlling Stress eating
    60. Godzilla VS GhandiControl these hormones!!! Cultivate these !!!
    61. RR and breath IN IN OUT OUT- 1st 2nd 3rd 4th
    62. A Quicky with DrRic IN IN OUT OUTIntructions: Thumb to index then middle with inhale, ring then pinky with exhale, repeat. Slow, concentrate on matching breath to thumb movement….continue for 5-10 mnutes.
    63. Herbal supplements 100-400mg/d? 1-3gm/d? 90-120mg/d? 1000mcg/d? Gurmar for appetite? Please ask a Naturopath first.
    64. Halloween Treats:• Avoid giving out any candy combination of milk or white chocolate with nuts or peanut butter - they rank highest in calories.• Chocolate with mint or marshmallows has fewer calories, as do caramels and non-chocolate candy such as licorice, taffy, lollipops and flavored fruit candies. However, these are cavity-makers and not very nutritious.• Consider giving out small squares of dark chocolate with at least 70 percent cocoa, little boxes of organic raisins, organic granola bars, organic fruit wraps or snack-size bags of air-popped popcorn. www.DrWeil.com
    65. In summary: Pre-Diabetes Checklist:• Maintaining low BMI• Eating properly (Or Get Some Help!!!)• Exercising• Cultivating the Relaxation Response• Sleeping 6-8 hours• Community/group activity• Go outside insurance (outside the box)
    66. One size never fits all… Make changes that not only work your heart but come from the heart…. Starved Rock…..Thanks for Listening!!!
    67. In the end, follow your “gut feeling” Disease Pre-Diabetes If something feels wrong about life….take the steps to change
    68. Live Healthy!!! Next Lecture:Whole Foods Market Schaumburg The “Yoga” of Eating Right January TBA We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    69. Bibliography• Molecular aspects of lipoic acid in the prevention of diabetes complications Lester Packer PhD , a, , Klaus Kraemer PhDb, Gerald Rimbach PhDc• Advanced glycation end product-induced activation of NF-kappaB is suppressed by alpha-lipoic acid in cultured endothelial cells. -A Bierhaus, S Chevion, M Chevion, M Hofmann, P Quehenberger, T Illmer, T Luther, -E erentshtein, H Tritschler, M Müller, P Wahl, R Ziegler and P P Nawroth• Enhancement of glucose disposal in patients with type 2 diabetes by alpha-lipoic acid. -Jacob S, Henriksen EJ, Schiemann AL, Simon I, Clancy DE, Tritschler HJ, Jung WI, Augustin HJ,• alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type 2 diabetes. -T Konrad, P Vicini, K Kusterer, A Höflich, A Assadkhani, H J Böhles, A Sewell, H J Tritschler,• Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes -Alam Khan, MS, PHD123, Mahpara Safdar, MS12, Mohammad Muzaffar Ali Khan, MS, HD12, Khan Nawaz Khattak, MS12 and Richard A. Anderson, PHD3• Effects of a cinnamon extract on plasma glucose, HbA1c, and serum lipids in diabetes mellitus type 2 B. Mang1, M. Wolters1, B. Schmitt1, K. Kelb1, R. Lichtinghagen2, D. O. Stichtenoth2, A. Hahn1
    70. • Chromium, Glucose Intolerance and Diabetes -Richard A. Anderson, PhD, FACN• Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. -R A Anderson, N Cheng, N A Bryden, M M Polansky, N Cheng, J Chi and J Feng Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin- dependent diabetes mellitus patients K. Baskaran, B.Kizar Ahamath, K.Radha Shanmugasundaram , E.R.B.• Antidiabetic effect of Gymnema montanum leaves: effect on lipid peroxidation induced oxidative stress in experimental diabetes R. Ananthana, , , C. Baskara, V. NarmathaBaia, L. Parib, M. Lathab, K.M. Ramkumarb• Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes -Gloria Y. Yeh, MD, MPH12, David M. Eisenberg, MD1, ed J. Kaptchuk, OMD1 andRussell S. Phillips, MD12