Circulatory Shock, types and stages, compensatory mechanisms
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DrRic Pre Diabetes....a Scary Diagnosis (slide share edition)
1. โPre-Diabetesโฆ.
โฆa scary diagnosis!
Enrique Saguil, MD
We didnโt invent the practice of medicineโฆ.
weโre just changing the way itโs provided.
2. The First Health Approach
We didnโt invent the practice of medicineโฆ.
weโre just changing the way itโs provided.
3. Your Team
Ric Saguil, MD
Jason Gruss, MD
Tom Jordan, RD
Katrina Christie, LCPC
Mike 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, MD
We didnโt invent the practice of medicineโฆ.
weโre just changing the way itโs provided.
5. This concept of โPre-Anythingโ
โข NOT COVERED ON INSURANCE
โข Your on your own (run/bike/swim)
โข Most of us -โschool knowledgeโ of
exercise, (which could be dangerous)
โฆ.โleagues?โ
โข If it was so good, why didnโt we stick with it
last new years resolution?
โข No place thatโs close enough, cheap
enough, new enough or fast enoughโฆ.but
what about your neighborhood?....or
backyard!!
6.
7. Started with the โ5-Oโ mentality
โข 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.
โข 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.
8. Facts:
โข Coronary heart disease (CHD) caused about 1
of every 5 deaths in the United States in 2005.
โข It is estimated that 195, 000 silent first
myocardial infarctions occur each year.
โข 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)
9. Waitโฆisnโt this a pre-diabetes talk?
Normal physical Overweight-Gradeschool Obese-HS Heart Attack College
51. Pre-Diabeticsโฆshould we act now?
โข Aka-Impaired glucose tolerance, impaired
fasting glucose.
โข 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)
โข Damage to end organs suspected to already
occur with pre-diabetes
โข With ignorance, move onto diabetes in 10y
53. Who gets tested?
โข Overweight and 45 or older
โข Normal weight and 45 or older (ask)
โข Overweight and younger than 45 +(ask)
+ = HBP, Low HDL, High Tri, Fam Hx DM
Gest DM, Birth of > 9lb baby,
54. Who benefits from testing
โข Doctor - noโฆI can fill your spot with another
โข Drug company โ yes (muuuhaha)
โข Family - yesโฆobserved habits rub off
โข Patient - yesโฆa chance to change
โฆknowledge is power
โฆeventually gonna need it!
55. Test Awareness
โข HA1C awareness = 14.8% to 27%
โข BP awareness =20.7% to 26.6%
โข LDL awareness =3.5% to 5.6%
Joslin Center 2009
56. โPreโ or โFull Blownโ
Endocrinologist/CDE
Family Medicine/Internist/Ob/Peds
Underserved/
Undiagnosed
72. A Quicky with DrRic
โข Strategic locations (arms reach when tired)
โข Plan ahead (pick shop day and load up)
โข Shop full, meals for the week
โข Always have a โgo toโ rewardโ (food/snack/meal)
โข Water! (tea or warm water to start the day)
โข Must have a F/V/G in sight
โข Prep a โGo-Bagโ
โข Set a deadline for success/help
76. Swimming
Excellent for joints,
Good for lung capacity
Limited by place and climate
Watch skin conditions
Watch asthma
Watch shoulder injury
77. Biking
Good for joints
Good nature contact
Good to include in work
Watch back
Watch wallet
Watch speed/coasting
78. Running
Long developed community activity
Can be done by any age
Addictive (positively-chi running)
Watch exposure (newcomers)
Watch the lower extremities
Shoes!
79. Hiking
Forest Preserves are tax supported
The fastest hikers burn as much as the slowest jogger
Slowing down can bring awareness of nature
Moving away technology cultivates the relaxation response (think kids!)
Less chances for strain and overuse injury
Watch solitude (injury, dehydration, disorientation)
Watch animals
80. Walking Stats and โgettin sweatyโ
METโs (cal/kg/hr):
Sitting for this lecture
0.0 mph - 1
Walking
2.0 mph - 91 1 min mile=60mph
2.5 mph - 87
3.0 mph - 85 2 min mile=30mph
3.5 mph - 83 3 min mile=20mph
4.0 mph - 91 4 min mile=15mph
4.5 mph - 102 5 min mile=12mph
5.0 mph โ 116
10min mile=6mph
Running 12min mile=5mph
5.0 mph - 116 15min mile=4mph
6.0 mph - 121 20min mile=3mph
7.0 mph - 119 25min mile=2.5m/h
8.0 mph - 123
9.0 mph - 121
10.0 mph - 131
Bottom lineโฆ.fastest walker burns like the slowest joggerโฆbut less knee pain
81. Timing of hikes
โข Weather.com
โข Weather.gov
โข Sunrise/sunset
โข 1-3 times a week for 30-60 minutes
(30+minutes to achieve RR)
โข Or add resistance to burn more calories
(depending on your indivi resting metabol rate)
โข Diabetics can increase to 5x week for glucose
control
โข Hypertensives can use breathwork twice a day
82.
83. Yoga!
Ancient art
Popularity high
Low injury risk
Excellent at cultivating relaxation response
Excellent flexibility/power/balance
Detoxing
Still Growing with multiple styles
84. Orโฆ.getโฆhelp!!!
Physical therapists
Exercise physiologists
Personal trainers
Life coaches
Yoga instructors
Dieticians (RD)
Has to be sustainable!!!
90. A Quicky with DrRic
IN
IN
OUT
OUT
Intructions: Thumb to index then middle with inhale, ring then pinky with exhale, repeat.
Slow, concentrate on matching breath to thumb movementโฆ.continue for 5-10 mnutes.
91. Herbal supplements
100-400mg/d? 1-3gm/d?
90-120mg/d? 1000mcg/d?
Gurmar for appetite?
Please ask a Naturopath first.
92. Halloween Treats:
โข Avoid giving out any candy combination of milk or
white chocolate with nuts or peanut butter - they rank
highest in calories.
โข 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.
โข 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
93. In summary: Pre-Diabetes Checklist:
โข Maintaining low BMI
โข Eating properly (Or Get Some Help!!!)
โข Exercising
โข Cultivating the Relaxation Response
โข Sleeping 6-8 hours
โข Community/group activity
โข Go outside insurance (outside the box)
94. One size never fits allโฆ
Make changes that not only work
your heart but come from the
heartโฆ.
Starved Rockโฆ..Thanks for Listening!!!
95. In the end, follow your โgut feelingโ
Disease
Pre-Diabetes
If something feels wrong about lifeโฆ.take the steps to change
96. Live Healthy!!!
Next Lecture:
Whole Foods Market Schaumburg
The โYogaโ of Eating Right
January TBA
We didnโt invent the practice of medicineโฆ.
weโre just changing the way itโs provided.
97. Bibliography
โข Molecular aspects of lipoic acid in the prevention of diabetes complications
Lester Packer PhD , a, , Klaus Kraemer PhDb, Gerald Rimbach PhDc
โข 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 Mรผller, P Wahl, R Ziegler and P P Nawroth
โข 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,
โข 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 Hรถflich, A Assadkhani, H J Bรถhles, A Sewell, H J Tritschler,
โข 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
โข 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
98. โข Chromium, Glucose Intolerance and Diabetes
-Richard A. Anderson, PhD, FACN
โข 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.
โข 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
โข 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 and
Russell S. Phillips, MD12
Editor's Notes
Design notes: list of providersWe want this to look much more invitingโthese 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 weโve ever seen. She lost 2# per week over 24 consecutive weeks.