Volume 1, Edition 5
M i l l e n n i u m P h y s i c i a n G r o u p ’s
HEALTHYConnections ConnectingYou to a Healthier Life
July 2019 • Diagnosing & Treating Diabetes
What we have in store in this edition: What’s Your Number? A1C Breakdown Diabetes & You – Defining Our Terms Diabetes Healthy Eating & Exercise Dr. Madera’s Utilizes New Technology for Diabetic Treatment
Dr. Tucker Hometown Hero
New! Online Check-in
Your Connection to a Healthier Life For more information about Millennium Physician Group, visit www.MillenniumPhysician.com or call (844) CALL-MPG.
Physician Spotlight
Welcome to Millennium’s Healthy Connections! This edition we focus on all things related to diabetes, including diagnosing, treating, and managing diabetes. Check out this month’s articles directly from our Millennium experts. We are proud to connect you to a healthier life!
A1C and What it Means__Controlling Diabetes____________ Written by Barbara Kropacek, Millennium Physician Group Registered Dietitian & Diabetic Educator
You’ve probably heard the term A1C countless times, but what exactly does it mean and how does it diagnose diabetes? The A1C test— also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months. It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is important if you have diabetes. A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes. The following blood glucose values help to guide you and your doctor into learning if you have diabetes or are at risk for developing diabetes:
BLOOD GLUOSE READING & RESULT
Below 100 mg/dL: Normal Good for you! Keep up the good work!
100 to 125 mg/dL: Prediabetes: Your glucose levels are higher than normal. You are at risk for developing type 2 diabetes. Take steps to prevent the diagnosis. Begin a weight loss plan including diet and physical activity.
126 mg/dL or higher: Diabetes: Work with your doctor and other health care providers (Registered Dietitian and/or Certified Diabetes Educators) to control your diabetes So, what do you do to prevent, control, and even reverse diabetes? There are steps a patient can take to embrace a lifestyle with diabetes: Know you’re A1C Know that everything you eat can influence your blood sugar level. As with any healthy eating program, a diabetic diet or prediabetic diet is more about your overall dietary pattern rather than obsessing over specific foods. So, follow these tips: Choose whole grains, lean proteins, fresh fruits and vegetables and heart healthy fats (such as olive, peanut or canola oil, walnuts, almonds and flax seed). Eat regular meals; avoid skipping or delaying meals. Eat 3 small meals and
a snack consistently and around the same time each day. And try not to go longer than 4-6 hours without eating. Watch your portions. Check the nutrition fact labels for appropriate serving sizes. The amount of carbohydrate you need will vary based on many factors. You and your health care team can figure out the right amount for you. Once you know how much carb to eat, choose your food and portion sizes to match. Avoid high-sugar foods that provide empty calories, or calories that do not have other nutritional benefits, such as sweetened sodas, fried foods, and highsugar desserts.
Eating right will help you: • Reach and stay at a healthy weight (BMI less than 30) • Keep your blood sugar in a good range • Prevent heart and blood vessel disease Engage in at least 30 minutes of exercise a day on at least 5 days of the week, such as of walking, aerobics, riding a bike, or swimming. Lastly, lose weight if you need to. When you have diabetes, being overweight or obese increases your risk for complications. Losing just a few pounds through exercise and eating well can help with your diabetes control and can reduce your risk for other health problems including developing diabetes if you don’t already have it. http://www.diabetes.org/food-and-fitness/ weight-loss/ http://www.diabetes.org/diabetes-basics/ statistics/ https://www.nhlbi.nih.gov/health/educational/ healthdisp/pdf/tipsheets/What-Is-Diabetes.pdf
Written by Stephen Piccione, M.D.
Have you been recently diagnosed with diabetes or pre-diabetes? A diagnosis of diabetes can feel overwhelming but understanding your diagnosis is a major part of controlling your symptoms.
What is diabetes mellitus (DM)? Diabetes mellitus, commonly known as diabetes, is the inability of your body to utilize glucose from what you eat and what your body makes efficiently enough to keep the circulating
blood sugar from damaging your circulatory system and organs. It is one of the main reasons for blindness, kidney disorder, male impotence and damage to the small blood vessels in the legs leading to amputations. It is also known to increase your risk of heart disease and stroke as well as cause painful dysfunction of the nerves in the arms, hands, legs and feet (peripheral neuropathy). Based on the National Diabetic Statistics Report of 2017 which analyzes information through 2015: ¡ 30.3 million Americans—nearly 1 in 10— have diabetes. ¡ 84.1 million American adults—approxi-
mately 1 in 3—have prediabetes. ¡ Over half of newly diagnosed diabetes cases were in adults 45-64 years old. ¡ New diagnosed cases of type 1 and type 2 diabetes have increased among US youth. ¡ New diabetes cases were higher among non-Hispanic blacks and Hispanics than non-Hispanic whites. ¡ For US adults diagnosed with diabetes, prevalence was highest among American Indians/Alaska Natives. ¡ Nearly 16% adults diagnosed with diabetes were smokers, nearly 90% were overweight, and more than 40% were physically inactive.
What causes Diabetes? Let’s talk about anatomy for a minute to make things clearer. In the pancreas (an organ that lies in the upper abdomen behind the stomach) are specific cells that produce insulin, called beta cells. Those cells increase production of insulin based on circulating glucose levels. Type 1 diabetes occurs when your immune system, the body's defense for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas (autoimmunity). Experts believe type 1 diabetes is caused by genes that cause autoimmunity and environmental factors, such as viruses, that might trigger the disease. Type 2 diabetes has several causes but the two most important are lifestyle and genetics. These factors can cause insulin resistance, when the
Diabetes & You
Defining Our Terms
cells of your body don’t use insulin as well as they should. Insulin resistance is thought to be the main cause of type 2 diabetes. Prediabetes it the state when your blood glucose is not low enough to be considered normal nor high enough to be classified as diabetes. This period is considered an opportunity to treat elevated blood sugars with diet, exercise and medication before they reach diabetic levels.
What tests are used for diagnosis? ¡ Fasting Plasma Glucose –This blood test is taken in the morning, on an empty stomach. A level of 126 mg/dl or above, on more than one occasion, indicates diabetes. ¡ Casual or Random Glucose - This blood test can be taken anytime during the day, without fasting. A glucose level of 200 mg/dl and above may suggest diabetes especially with “the Poly’s” Polyurea: frequent urination Polydipsia: the constant feeling of thirst Polyphagia: always hungry. ¡ A test called a Hemoglobin A1c (like a 3-month running average) of 6.5 or greater
Exercise is essential. The more you make your muscles work the more energy they will need in the form of glucose which will be taken from the blood and into the cells. We’re not talking about training for the Olympics! Walking, riding your bike or even swimming are good ways to burn sugar.
How do we treat Diabetes?
What about medications?
The first two treatments for diabetes includes diet and exercise. Be sure to review the article from Millennium’s Nutritionist, Barbara Kropacek on healthy eating and exercising.
Today there are many choices from injections to pills that are used to treat diabetes. Which are right for you? The ones that improve your blood glucose, those that you can tolerate and
those you can afford are those that are right for you. Ask your doctor. Most people will need more than just one medication to significantly improve their blood glucose. Just remember that medications can’t overcome a poor diet or lack of exercise.
Good exercise habits, dietary choices and the right medications can help you control diabetes mellitus. The right decisions now can help you avoid the devastating consequences of uncontrolled blood glucose later.
The Latest in Continuous Glucose Monitoring
Millennium’s Experts + Technology = Better Quality of Life for Our (Diabetic) Patients
M i l l e n n i u m Endocrinologist Dr. Arelis Madera is proud to offer diabetes patients not only the latest technology available, but also the longestlasting implantable Continuous Glucose Moni-toring (CGM) system. Now patients can go as long as 90 days without having to change the implantable sensor compared to just one to two weeks with traditional CGM systems! As diabetics know, CGM measures the amount of glucose in the blood. Most systems are comprised of a tiny implantable sensor placed under the skin of the belly or the upper arm, and
a small transmitter that reads the information the sensor collects is placed on the skin with adhesive. That glucose information is then sent wirelessly to some sort of device as a read out. Nowadays, a patient’s smart phone or watch can serve as the read-out for glucose information with the help of an app. “The monitor still needs to be calibrated twice a day with a traditional glucose meter, but this new technology offers patients a much more accurate and convenient option. They are alerted immediately when blood sugar is moving lower, and they are made aware of trends, so they can take preventive actions sooner. Also, there’s a record of their readings, so they can really take charge of their health and find out how diet, exercise, work, stress and
sleep affect their blood sugar. I want them to know diabetes is manageable”, says Dr. Madera. Dr. Madera, Virginia Bihari, Nurse Practitioner and their team placed five of the new monitors on April 19, 2019. It is considered a minor surgical procedure with local anesthetic. In all, they’ve now placed ten. The sensor, which is about ¾ of an inch long is placed in the upper arm. The transmitter is about the size of a half-dollar coin, is removable and water-resistant. Patients traveled from as far a Naples to Dr. Madera’s Port Charlotte office to undergo what took about an hour, but, she says, what the new CGM does for their lifestyle is invaluable. “I think innovation in medicine is a necessary step for every provider. I want to stay up to date, so I can offer the best care for my patients. That’s why I’m an advocate for devices; glucose sensors, insulin pumps. Technology is what helps give our patients a better quality of life. And I think this is a system that really fits with their lifestyle. They can live their lives.” In follow up visits, Dr. Madera reports her patients are “very happy.” She says the device works best for type 1 diabetes but can also be used with type 2. For more information: Phone: (941) 235-0542 Office: 3611 Tamiami Trail, Ste. B, Port Charlotte, FL 33952
Boneless Barbecue “Wings” Diabetes & Heart Healthy Cookbook, 2nd Edition by the American Diabetes Association and the American Heart Association
These delicious, low-calorie Boneless Barbecue “Wings” are the perfect appetizer or main dish. The low-sodium ingredients and use of chicken breasts makes the dish heart-healthy and diabetes-friendly - perfect for everyone to enjoy! Serves: 14 Serving Size: 2 pieces chicken and scant 1 1/2 teaspoons sauce Ingredients ❑ Cooking spray ❑ 2 tablespoons whole-wheat flour or allpurpose flour ❑ 1/4 teaspoon salt-free seasoned pepper blend ❑ 1/4 cup low-fat buttermilk ❑ 1 teaspoon red hot-pepper sauce ❑ 1 cup crushed corn flake cereal (about 2 1/2 cups flakes) ❑ 1 pound boneless, skinless chicken breasts, all visible fat discarded, cut into 28 strips ❑ 1/4 cup barbecue sauce (lowest sodium available) ❑ 1 tablespoon cider vinegar ❑ 1 tablespoon honey Preparation 1. Preheat the oven to 350°F. Lightly spray a baking sheet with cooking spray. 2. In a medium shallow dish, stir together the flour and seasoned pepper blend. In a second shallow dish, whisk together the buttermilk and hot-pepper sauce. Put the corn flake crumbs in
Dr. Tucker Named Hometown Hero Congratulations to Dr. Michael Tucker on being named Lehigh Acres Hometown Hero by the Lehigh Kiwanis Club Friday, June 14, 2019. Dr. Tucker is a 30-year resident of Lehigh Acres and is well-loved by his patients. So much so, that when a non-compete agreement got in the way of his practice early in his career, his patients picketed and got the news involved. The agreement was summarily dropped, and he was able to return to care for his patients. The Kiwanis president says Dr. Tucker might very well be Lehigh Acres first community service organization. The following are just a few of his good deeds: ★ organizing a charity golf tournament for ★ ★ ★
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the past 28 years holding annual Christmas parties for his staff and patients with food and toys serving on the local little league board, even sponsoring 17 teams one year becoming the first medical doctor for sports programs at Lehigh Senior High School serving as a softball coach at Riverdale High School for many years building a baseball field in his back yard for teams to practice
Lehigh Acres Kiwanis Club President Rick Angelickis tells the Millennium he’s happy to shine a light on all the good things Dr. Tucker has done, and continues to do, for the community without much fanfare and is proud to acknowledge him as a Lehigh Acres Hometown Hero. a third shallow dish. Set the dishes and baking sheet in a row, assembly-line fashion. Working in batches, dip the chicken in the flour mixture, then in the buttermilk mixture, and finally in the corn flake mixture, turning to coat at each step and gently shaking off any excess. Using your fingertips, gently press the coating mixture so it adheres to the chicken. 3. Arrange the chicken in a single layer on the baking sheet. Lightly spray the top of the chicken with cooking spray.
4. Bake for 25 minutes, or until the chicken is no longer pink in the center and the coating is crisp. 5. Meanwhile, in a medium bowl, whisk together the barbecue sauce, vinegar, and honey. 6. Add the chicken to the sauce, stirring gently to coat, or serve the sauce on the side. For nutritional information, and to find more recipes like this, visit https://www.diabetes.org/ nutrition/meal-planning/quick-meal-ideas
Now Check-in Online from the Comfort of Your Home Millennium is proud to offer patients an easier way to check-in rather than at the medical office. You can now check-in at the privacy of your home! That’s right. Update your demographics, pay your bill, upload a photo of your driver’s license and insurance card before you ever leave for your appointment. Just let the front desk know when you arrive that you already checked in online. Save time and protect your privacy by updating your demographics before you arrive at the office. If you don’t have a chance to check-in before you get to the office, you can easily do so via your phone, or our convenient tablets located in the lobby. We are happy to provide our patients new solutions to make your office visit an exceptional patient experience. Look for online checkin coming to an office near you as we currently have rolled out this feature to Lee County patients.
Physician Spotlight Cardiologist Jesus Mendiolaza, M.D. Congratulations to Cardiologist Jesus Mendiolaza, M.D., on receiving the Award for Excellence in Scientific, Scholarly and Patient Care Achievement Award from his alma mater Villarreal University School of Medicine in Lima, Peru.
Your Connection to a Healthier Life
Thank you for reading! To learn more about Millennium Physician Group visit www.MillenniumPhysician.com or call (844) CALL-MPG to schedule an appointment today!