Cheers! The Real Deal on Drinks & Diabetes

Healthy-cocktails-article (1)By: Robin Smith @Robinrjsmith

Watching what you eat is only half the story with carb-counting. To maintain good control with diabetes, you also have to pay attention to what you drink. Here are some tips:

Everyday Beverages

Checking nutritional fact labels on drinks is a useful place to start. Even if you’re not eating them, those grams of carbohydrate still count! In fact, your body processes nutrients in liquid faster than in food.

When looking for a low-impact drink, I prefer things like water, seltzer, diet beverages, coffee, and tea. There are lots of ways to sweeten your drinks that won’t affect your blood sugar. Stevia is probably my favorite sweetener, since it’s less processed than others. Plus, I can grow it myself!

Here’s how I count a serving (8 fluid ounces) of my everyday drinks:

coffee with milk= 3gm

Diet Snapple= 0gm

Diet Sprite= 0gm

herbal tea= 0gm

milk= 12gm

mineral water= 0gm

orange juice= 26gm

Vitamin Water Zero= 2gm

water= 0gm


Thanks to Dr. Karin Hehenberger’s blog video, (, I finally understand how liquor affects my system. Karin explains that your liver can become overtaxed with processing alcohol, and this limits your ability to process sugar. So after a few drinks, any carbs you consume just get put on your liver’s waitlist. If you’re trying to treat a low blood sugar, you won’t have much success until your liver has finished dealing with the alcohol.

To avoid this type of disaster, I make sure to test my blood sugar before I have any alcohol. I often eat a snack too. This way, I can be sure my glucose levels aren’t going to drop while my liver’s busy with other matters.

Distilled Liquor 

Unfortunately, it’s rare to find nutritional facts on alcoholic beverages. And I’ve discovered that most mixed drinks are packed with sugar. Lucky for those of us with diabetes though, distilled liquors are mostly sugar-free. So to keep things from getting complicated, I do my best to stay away from high-carb cocktails. My go-to bar choices are a vodka-soda or a “whiskey and DIET coke.”

Party Drinks

Be wary of those homemade summer punches. And forget about trying to ask a bartender about the carbohydrate content of a margarita. Alcoholic party drinks are almost always just different variations of liquid candy. They probably have over 60 grams of carbohydrate in a cup, which is close to a whole meal! Just test your blood, make sure you’re not going low, and then ask for something that you know doesn’t have any sugar.

I’ve never confirmed these suspicions, but I’m pretty sure beer is not a great choice for people with diabetes. I say this because it fills you up, it gives you a pot-belly, and it’s made from grains… Which leads me to believe that there are some carbs in this one. If you have more info on beer than I do, please share!


Some wines are as sweet as juice. I don’t touch these ones. But I’ve learned that in wine terminology, “dry” means “not sweet.” So I always ask for a “dry wine.”

On the back of a wine bottle, you can often find a description of what to expect once it’s been opened. These usually hint at whether the wine is dry or not, and they’re fun to read anyway. Pinot grigio and sauvignon blanc are pretty safe. They come chilled too, so they’re nice to have in the summer.

Mojito Recipe

With so many limitations on drinks, you might be wondering what to serve at your next summer event. Ideally, you’d like something that’s diabetic-friendly, but still palatable.

Don’t worry! I’m going to share my “secret,” no-carb, summer cocktail recipe with you. I hope you enjoy it:

    • lots of muddled stevia leaves (or liquid stevia)
    • muddled mint leaves
    • Crystal Lite Lemonade mixed to taste (or half lemon juice/half water with extra sweetener)
    • vodka
    • pour over ice



Curing Type 1 Diabetes at the Molecular Level

Lyfebulb_6_24_15_6020By: Robin Smith @Robinrjsmith

Thank you to the Lyfebulb team for hosting another engaging event last month (June 2015)! I was intrigued to learn about some leading technological advances in diabetes research, from speakers Dr. Jeffrey Friedman and Mr. Mike Moradi.

As a molecular genetics scientist, Dr. Friedman spoke about a hormone he has identified, leptin, which balances food intake and maintains body weight. He discussed the potential for this hormone in improving the lives of people with diabetes:

“In 1994, we identified… a new hormone called leptin. Leptin is part of a feedback loop that maintains constancy of your weight… If you lose weight, leptin level falls and that’s a stimulus to eat more. If you gain weight, leptin rises and that’s a stimulus to eat less. And by this mechanism, body weight is maintained in a narrow range.

 We realized pretty early that leptin could also affect glucose metabolism. And… there’s one aspect of this, having to do with type 1 diabetes that I’d like to tell you about:

“An investigator in Texas, named Roger Unger… did an experiment. He took a type 1 diabetic animal that made no insulin whatsoever…. [The] animals in the experimental group, are end stage type1 diabetic animals. [Without medication]… they’re all dead within a month. In one group, he just gives them saline. In the other group, he gives them leptin. The leptin treated group… lives for as long as he gives the animal leptin.  

So leptin, by that criteria, appears to have miraculous curative powers… and might have some utility either as a treatment or an adjunct for type 1 diabetes.

“If you could use leptin as a therapy for type 1 diabetes, you might diminish the needs for insulin, you might blunt hypoglycemia… Leptin doesn’t need insulin to work. Whatever it’s doing is independent of insulin altogether.”

Dr. Friedman’s story strikes me as a refreshingly informed new direction for clinical research. I’ve lived with type 1 diabetes for almost thirty years, and I’m accustomed to hearing that there’s a “new cure” for me to look into. I get these recommendations from concerned acquaintances who mean well, but who don’t understand the true indications of the information that they’re referring to.

Another captivating speaker at this event was Mike Moradi, the CEO of Sensulin. He discussed the development of a new type of insulin, which would be taken once daily and respond directly to glucose detected in the blood. He explained that the molecules of this insulin are built in layers, like an onion. Glucose that is present in the blood helps disintegrate the outer layer, exposing insulin and stabilizing the blood sugar. Then the next time the patient eats and more glucose is introduced, more layers dissolve. This allows for more insulin to be released into the blood stream, and once again stabilizes glucose levels.

On the Sensulin website (, Mr. Moradi discusses this process in more detail:

“Lipozomes encapsulate the insulin. They are cross-linked with a glucose responsive linker… So you have these tiny connecting entities that, when a patient eats and their blood sugar becomes elevated, the free glucose in their subcutaneous space binds to that linker, [and] opens up that channel which has a much higher surface area for releasing insulin… It’s a really elegant chemical solution to a rather large problem.”

Glucose-responsive insulin seems to have a lot of potential for people with diabetes. It could eliminate the need for constant blood tests, insulin shots, and glucose tablets. Sensulin claims to offer us “a substantial improvement in the standard of care and chance at a normal life.”

Like most people with diabetes, I’d be hesitant to switch off of the medical therapies that I know and trust. But with a few years of successful research, some reassuring patient trials, and a significant amount of positive reviews, I’d be game to try. In that event, these might become my new favorite scientific discoveries of the 21st century.

5 Tips for Keeping Your Blood Sugar Stable All Morning

Lyfebulb8.PictureBy: Robin Smith

My blood sugar is not a morning person. It’s lethargic, moody, and slow to respond when I wake up. But I’ve discovered ways to maintain smooth sailing throughout this tricky time of day. Here’s how I do it:

1) Wait to eat breakfast. My insulin absorption tends to be delayed in the morning. It can take up to an hour before my blood sugar responds to a bolus. Because of this, I add up all the grams of carbohydrates I expect to eat, take my breakfast bolus, and then wait. In about 40 minutes, I verify that the insulin is taking effect by checking my continuous glucose monitoring system. Then, it’s time to eat!

2) Continuously review and adjust nighttime basal rates. It’s easiest to identify necessary basal rate adjustments at night. This is because I’m not eating, exercising, or blousing while I’m asleep. Thanks to my continuous glucose monitor, I can review what my blood sugar was doing when I wake up. If I notice any patterns that I don’t like, I add or take away basal insulin as needed.

3) Bolus before getting out of bed. The first thing my blood sugar wants to do each morning is hit the sky. It doesn’t matter what time I wake up or whether I wait a few hours to eat breakfast, or even if I’ve had stable glucose levels all night.  It doesn’t seem to be related to the Dawn Phenomenon or the Somogyi Effect either. But regardless of why it happens, this seems to control it: I take a small wake-up bolus of insulin, just to get my day started right.

4) Measure carbs and eat a balanced meal. Taking the right amount of insulin depends on knowing exactly how many grams of carbohydrates I’m eating. Since my blood sugar is most sensitive in the morning, I’m usually most careful with breakfast measurements. I check nutritional facts, weigh, or measure everything. I also aim to get some protein and vegetables into my meal. Today, I ate about 70 grams of carbohydrate for breakfast. The breakdown went like this:

6gm milk in my coffee

26gm toast with jam

15gm plain yogurt

15gm banana

8gm celery with peanut butter

5) Adjust for alternate routines. Saturday and Sunday are my morning boot-camp days at the gym, and I can’t eat right before these workouts. So I’ve developed an alternate routine for weekends. It goes like this:

  • Wake-up an hour before class (the gym is a five-minute walk from my apartment, so an hour is plenty of time)
  • Take 0.7 wake-up bolus, plus enough bolus to cover a mini protein shake
  • Set a one hour, temporary basal rate of .75% on my pump (this will begin to take effect when I’m working out)
  • Get ready for the workout.
  • Drink a mini protein shake.
  • Run to boot-camp class!
  • Monitor blood sugar throughout the class.
  • Get home, measure carbs, and take the breakfast bolus.
  • Shower and wait 40 minutes.
  • Eat breakfast.

I hope these tips help you start your day off on the right foot too!

Antibiotic Resistance: The Silent Terror for Chronic Disease Patients

three-pill-bottles-MediumBy: Roy Collins

What is Antibiotic Resistance?

Purel, Latex Gloves, and White Lab Coats.  Everything you associate with the doctor’s office is sterilization.  Sterile is safe.  Germs = Bad.  Clean = Good.  We’ve been taught these simple mantras since kindergarten and have not looked back since. But is there more to the story then we’ve been led to believe? Is there such a reality where killing germs may actually become problematic?

As it turns out, using antibiotics in the war against germs can lead to trouble. The world has identified one of its most silent but deadly new killers.  Antibiotic resistance is quickly becoming one of our biggest adversaries in public health.  At least 23,000 deaths and over 2 million deaths are a result of diseases caused by bacteria that are resistance to antibiotics commonly administered to treat them (Center for Disease Control and Prevention, 2013).

Take a second to think back to Charles Darwin and the concept of “Survival of the Fittest;” when the doctors administer antibiotics to treat an infection, there may be trace amounts of bacteria that survive the medication for one reason or another.  Whatever trait those trace amounts of bacteria possess that allows them to survive antibiotics, will allow for them to continue to be passed onto future bacterial generations.  This then renders that antibiotic useless in fighting the emerging infection.  This is why when the doctor prescribes you antibiotics, it is of the utmost importance to take the medicine to completion.  The more bacteria you allow to survive the medication, the higher a possibility for antibiotic resistant bacteria to cause serious infection to your body.

How Can this Affect the Chronic Disease Population?

As  a chronic disease patient, a growing antibiotic resistant bacteria population is a potential seriously dangerous situation.  By the very definition of a chronic disease, we as patients spend a great deal of time in and out of healthcare settings and are at great risk of extended hospitalization.  Whether or not we are ever exposed to antibiotics, the risk exists of infection from antibiotic resistant bacteria such as the highly dangerous and publicized Methicillin-resistant Staphylococcus aureus (MRSA).  If you are exposed to a common antibiotic, you may develop resistance within your own body, but simply being in the presence of other extended hospital patients can always give way to infections.

What should each of us do to avoid infection?  In case of infection in the healthcare setting, work with your doctor to avoid overuse of the same antibiotics in your treatment.  In the home setting, limit antibiotic soap and sanitizer use for everyday hand washing. Good ole soap, hot water, and scrubbing will always remain effective in living a clean, yet safe, sanitary life style.

Antibiotic resistant infections are a danger to all patients, but especially those with chronic disease.  Diabetics with High A1c’s and lose control of their blood sugars are several times more likely than other patients to contract infections. Hyperglycemia (high blood sugars) are shown to actually decrease your body’s white blood cell immune defense!  Combining poor chronic disease management with improper antibiotic use following diabetic foot ulcers or amputations are recipe’s for even further complications.

The Epidemiologic Response

Now that we’re all sufficiently scared of antibiotic resistant bacteria, what in the world are we (we as a planet) doing to remedy the problem?

From my research as an Epidemiology student in a Masters in Public Health program, I have found there to be three especially promising proposals made to combat the problem of antibiotic resistance: (1) funding from our government (NIH), (2) a grand prize, and (3) adjusted market exclusivity to whoever creates new antibiotics.

The first proposal, NIH funding, attempts to holistically attain efforts from all of the government’s public health and safety entities. The key pillars in this proposal are to: improve antibiotic stewardship by updating education and putting a stop to unnecessary and harmful doling out of antibiotics, strengthen antibiotic resistance risk assessment and surveillance by increasing surveillance and better understanding new resistance in humans and animals, and driving new research in basic life sciences to find new treatments, drugs and other hygienic alternatives to antibiotics.  The government feels that there exists too much unnecessary antibiotic usage, which adds to the opportunity for resistant bacteria to evolve and proliferate. Researching other hygienic alternatives while also spending time to educate those in charge of antibiotic distribution could potentially alleviate the problems.

The second approach is to create a grand prize for innovative new antibiotics.  The proposal specifically suggested a two billion dollar grand prize to whoever can develop new antibiotics (ones for which there are no existing resistant bacteria strains) in hopes of incentivizing pharmaceutical companies seeking a worthwhile return on their investment.

Lastly, the third proposal brought forth the idea of new laws regarding market exclusivity.  This proposal would grant pharmaceutical firms an additional five years of marketing exclusivity in addition to what would already be granted to them by the FDA.  As it stands currently, the incentive for pharmaceutical companies to spend money on research and development is to monopolize the market for this drug for several years, netting most of their income.  Not only could this add five years to their exclusivity time for their novel antibiotic drug, but this also adds the option to transfer as much as twelve months to whatever other drug they may also produce.  In a competitive market for hit novel drugs, an extra year of exclusivity for another blockbuster drug could be extremely valuable to pharmaceuticals creating drugs outside of just antibiotics.

My Solution

The grand prize proposal may not be a sustainable model for incentivizing innovation for all future public health inquiries, but in the present case of antibiotic resistance, it should prove to be a successful method towards effective new antibiotic treatments.  I would choose a combination of this proposal with NIH funding, as my recommendation for action.  Funding to investigate both ways to eliminate unnecessary antibiotic use and other alternatives to antibiotics should still be allocated.  No matter what novel antibiotics are created, we should decrease resistance across the board for both new and old antibiotics in order to avoid reaching these same issues just a few decades into the future.  A grand prize would entail cooperation among competing pharmaceutical or life science firms alongside support and resources from the governments of developed nations.  An NIH funding increase will likely raise taxes or see cuts to other governmental departments. Although combining both scenarios will require finesse and a fine-tuning of the processes final execution, they are the steps necessary to avoid antibiotic resistant catastrophe.

  • Emanuel, E. (2015, February 24). How to Develop New Antibiotics. New York Times.
  • Office of the Press Secreatary. (2015, January 25). FACT SHEET: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health.
  • Gaffney, A. (2015, April 30). Regulatory Explainer: The (Updated) 21st Century Cures Act – See more at:
  • Gelijns, A. (Ed.). (1990). Modern Methods of Clinical Investigation. The National Academies PRess, 147-203.
  • Towse, A., Kueffel, E., Kettler, H., & Ridley, D. (2010). Drugs and Vaccines for Developing Countries. In The Market for Pharmeceuticals.

All Kinds of Diabetes

Lyfebulb7By: Robin Smith

“What in the world is ‘pre-diabetes?”A few days ago, the doctor reported that my husband is at risk of developing type 2 diabetes.

The news hits me hard. I’ve spent most of my life struggling with type 1 diabetes. And while I think I’ve gotten reasonably good at it, I don’t want my husband to have to deal with these kinds of challenges. I worry that he won’t take care of himself and that it will cause other health complications.

“Why is the pancreas so incompetent?” I fume. Converting food into energy is a pretty important job, and yet this organ seems to fail on us frequently: Type 1, type 2, gestational, and pre-diabetes are all over the place.

I sit with my husband, holding his hand and thinking about how the pancreas can be so unreliable. I know the most about type 1 diabetes, since I have it. I know that it usually develops in children, and it happens when the pancreas stops producing insulin for good. Type 2 is what my husband may be developing. As I understand, this type generally emerges in adults. It happens when the pancreas is not able to produce a sufficient amount of insulin. My sister is now pregnant with her first child, and she is at high risk for gestational diabetes. I don’t’ know much about this type, but I think it occurs when the body is trying to produce enough insulin for both mother and child.

“I’m scared about you getting diabetes,” I tell my husband. I move closer, willing his body to be strong and resilient.

I’m apprehensive that he won’t take it seriously.

I’m anxious about his workout routines and eating habits.

I’m uneasy about how diabetes will affect his health.

I’m concerned about how this might affect our future children or grandchildren.

“I’ll be fine,” he reassures me.

But his nonchalant attitude makes me even more nervous. “But what can we do about it?” I sniff.

“Let’s look it up,” he suggests. We sit at the computer and begin typing searches into Google. I pull nutritional-health and home-remedy books off the shelf.

Our research recommends:

Get regular aerobic and anaerobic exercise.

Eat more whole grains and vegetables.

Sleep more.

Incorporate cinnamon, vinegar,and coffee into the diet.

“This is great advice for anyone!” I exclaim, gaining confidence. “Good old diabetes, keeping us healthy.”

“So what’s next?” With our new found information, we are ready to make a plan of action. First, we consider ways that my husband can fit more cardio exercise into his weekly schedule. Then we brainstorm vegetables that he likes and put them in favorite-to-least-favorite order. I make a mental note to pick up broccoli and cauliflower at Trader Joe’s tomorrow. We talk about how to make sure low carb foods are more available for meals and late-night snacks. As a tenacious business owner, he is most resistant to sleeping more. After some deliberation though, I’m at least consoled that he will keep it in mind as an important component of his health.

“Thanks for talking this through with me,” I tell my husband. “I love you so much, and I want you to get old with me.”

I make rice, salad, sausages, and collard greens for lunch. Then we blend frozen bananas with coconut milk and call it ‘ice cream,’ even though it’s kind of runny. He runs to the gym before dinner. I’m hopeful that all of this will help him to avoid developing diabetes. But even if it doesn’t, I know that we’ll continue supporting each other in resolving challenges. We’re like that now, and we’ll be that way when we get old together too.

Please share!

I’d love to hear your thoughts and experiences! What types of diabetes are you familiar with? Who in your life has been diagnosed and with what type? How do they stay positive about maintaining their health with diabetes?

Please write a comment below.

Men’s Health Month: Prostate Concerns

blue ribbonBy: Roy Collins @roycHealth

June is Men’s Heath Month! Understandably, this may have come as a surprise to us all.   Men’s health often takes a backseat to other concerns, and June is much more synonymous with the arrival of summer and the conclusion of school.  So while we’re tie shopping for Father’s Day, let us also investigate important health’s issues related to our fellow men. Today, it’s the Prostate.

First, let’s refresh ourselves on what exactly a prostate is:

The prostate is a gland, shaped like a walnut, which is an essential part of the male reproductive system. Its main function is to provide the necessary medium for reproductive fluids.  Imagine for a second, the railroad switch that shifts one operational train track to another. That shifting of tracks encapsulates the second function of the prostate, which controls the emission of either urine or reproductive fluids from the body.

All caught up? Good.

There are two major issues that arise from the prostate as men age: Benign Prostatic Hyperplasia (BPH) and Prostate Cancer.

Benign Prostatic Hyperplasia, or BPH, occurs when the prostate becomes enlarged, but is ultimately not cancerous (hence benign). Although it is not cancerous, BPH still arrives with a series of complications.  Also, it’s absurdly common! BPH is estimated to affect 50% of men between the ages of 51 to 60. The incidence spikes to a whopping 90% of men older than 80.  Statistically speaking, if you are fortunate enough to live a long healthy life as a male, it’s only a matter of time before your prostate tries to sabotage your happiness.  The symptoms that come with BPH include: urination eight or more times a day, the inability to start or stop urination, weak urination, pain from urination, and smelly urination.  Gross.  Further complications that also arise include: urinary retention, infections, and damage to the bladder and kidneys.  BPH is most commonly treated with medications such as Flomax and Uroxatral, and in serious cases can be surgically repaired. (National Institute of Diabetes and Digestive and Kidney Diseases, 2014)

 In the world of Epidemiology, there exists research that suggests patterns in the occurrence of BPH in men. For example, men from Southeast Asia have exhibited significantly lower rates of enlarged prostates than men from anywhere else. Further genetic studies show that 50% of men with BPH conditions severe enough for surgery under the age of 60 most likely inherited the disease from an immediate family member. The overall health statuses of men are important to consider. Men with heart disease or diabetes of either type are significantly more likely to develop BPH.  As is the story with most diseases, the overall health of an individual is important, and many organ systems you would not consider connected, in fact are. As a matter of fact, consistent physical activity and exercise has been strongly linked to a decrease in severe BPH symptoms that require surgical correction.  Looking ahead to other potential methods of prevention, while no diet exists, some initial studies have shown positive associations with serum testosterone treatments and decreased BPH incidence.  (Patel and Parsons, 2015)

While BPH is more common and an annoyance, Prostate Cancer, as one might imagine, is far more dangerous.  Prostate Cancer is the second most common cancer against American Men, estimated at about a quarter of a million new cases a year and resulting in over 27 thousand deaths. Similarly to BPH, prostate cancer affects older men, but instead of striking most men in their fifties, the cancer occurs primarily after the age of 65.  About 1 in 7 men will be diagnosed with prostate cancer.  While ultimately a serious matter, most men diagnosed with prostate cancer ultimately survive the disease.  Today, almost 3 million men in America who have been diagnosed with prostate cancer are still alive.   (American Cancer Society, 2015)

Of course, we would still all like to avoid prostate cancer, if possible. The Prostate Cancer Foundation offers these tips on prostate cancer prevention:

  • Eat fewer calories or exercise more so that you maintain a healthy weight.
  • Try to keep the amount of fat you get from red meat and dairy products to a minimum.
  • Watch your calcium intake. Do not take supplemental doses far above the recommended daily allowance. Some calcium is OK, but avoid taking more than 1,500 mg of calcium a day.
  • Eat more fish – evidence from several studies suggest that fish can help protect against prostate cancer because they have “good fat” particularly omega-3 fatty acids. Avoid trans fatty acids (found in margarine).
  • Try to incorporate cooked tomatoes that are cooked with olive oil, which has also been shown to be beneficial, and cruciferous vegetables (like broccoli and cauliflower) into many of your weekly meals. Soy and green tea are also potential dietary components that may be helpful.
  • Avoid smoking for many reasons. Drink alcohol in moderation, if at all.
  • Seek medical treatment for stress, high blood pressure, high cholesterol, and depression. Treating these conditions may save your life and will improve your survivorship with prostate cancer
  • What about supplements? Avoid over-supplementation with megavitamins. Too many vitamins, especially folate, may “fuel the cancer”, and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin.
  • Relax and enjoy life. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life.
  • Finally, eating all of the broccoli in the world does not take away your risk of having prostate cancer right now. If you are age 50 or over, if you are age 40 or over and African-American or have a family history of prostate cancer, you need more than a good diet can guarantee. You should consider a yearly rectal examination and PSA test, and you should discuss the risks and benefits of these screening procedures with your doctor.

Bottom-line, we men need to be aware of the potential ticking time bombs inside each of us.  While researches continue to explore new treatments and therapies, we can each control our diets, amount of exercise and general attitudes towards protecting our health.  Also, do not forget to be truthful with yourself about symptoms and be sure to be open and honest with your doctors.  As is the case with any malady, early detection can be helpful in treatment.  Some studies suggest we in America may screen for prostate cancer too frequently, but if you notice symptoms, contact your primary care physician. Stay in tune with your body and seek the best health status for yourself.

For more updates and tips on how to use fitness for diabetes management and prevention. Follow me on twitter @roycHealth


American Cancer Society. “What are the key statistics about Prostate Cancer?”. (2015). Web

Prostate Cancer Foundation “Understanding Prostate Cancer: Prevention.” (2015). Web.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Prostate Enlargement: Benign Prostatic Hyperplasia.” NIH 14-3012 (2014). Web.

Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014 Apr;30(2):170-6. doi: 10.4103/0970-1591.126900. PubMed PMID: 24744516; PubMed Central PMCID: PMC3989819.

Diabetes vs. My Teaching Job

By: Robin Smith  Diabetes.Teaching@Robinrjsmith 

“Beep beep beep.” I recognize my insulin pump’s low blood sugar alarm right away. But Eva looks up from her homework, inquisitively.

“What’s that?”

I just started tutoring Eva today. She is in second grade, she’s struggling in math, and that’s about all I know about her. What she knows about me is similarly limited.

As an early childhood educator, I’ve had to explain how diabetes affects my life to hundreds of children. But I prefer to wait until they’re more familiar with me, before launching into this topic.

Through eight years of teaching, I’ve learned that discussing my health with colleagues and students can be a delicate process. I remember one principal telling me to hide my condition from students. I explained that this would make it difficult to maintain my health, and assured her that I didn’t mind talking about it.

“No,” she replied. “These kids are from troubled homes. They see needles, and they think you’re doing drugs. How am I going to explain that to parents?”

She shook her head. “You can’t be a teacher with a disease that gets in the way.”

I stopped trying to explain after that. Instead, I started looking for work elsewhere. Despite her misguided theories, I knew that:

  • doing my job did not need to conflict with staying healthy
  • hiding my “drug paraphernalia” was challenging and unnecessary
  • parents would not object to positive diabetes management
  • given the proper information, students could distinguish between narcotics and medical treatments

Balancing my career while still maintaining my health has become a focus for me since then. I’ve found better ways to help the people around me feel comfortable with diabetes. The trick is to be positive, informative, and matter-of-fact. I’ve been fairly successful in helping both young and older people acclimate to my blood tests, medical devices, and snacks.

I’m caught off guard today though. Eva has known me for only 20 minutes, and I’m not sure how she’ll respond. Does she know anyone who’s dependent on medical equipment? Has she ever heard of diabetes? Has she had a negative experience with blood tests or health conditions?

“It’s my medicine machine,” I tell her, as brightly as I can. I pull it out of my pocket, showing it to her as I silence the alarm.

“Why did it make that noise?”

“It’s telling me I need some medicine.” I fish the tube of glucose tablets out of my purse, and show it to her. I pop one tablet into my mouth.

“Oh.” Satisfied with the explanation, she turns back to her work.


Several days later, Eva smiles when she hears the pump alarm. “It’s your machine again,” she announces.

“Yes,” I say, glancing down at it. “It’s telling me to take a blood test. Have you ever taken a blood test?”

“Yeah,” she responds. “At the doctor’s office.”

“I’m going to do it now. You can watch if you want.” I’m finished in 30 seconds, faster than she expected.

“Does it hurt?” She wants to know.

“Not too much,” I say. “It’s just a little prick.”

We return to the task of snapping together cubes and counting sums of ten. I’ve successfully conveyed to her that diabetes isn’t something to feel distressed or uncomfortable about. And she knows that if she thinks of more questions, my answers will be positive, informative, and matter-of-fact.

Please share!  I’d love to hear your thoughts and experiences! How does diabetes affect your career? What has been most challenging? What is your approach in discussing your condition with colleagues or clients?

Please write a comment below.

Advances in Cancer at ASCO 2015

Riccardo Braglia

By: Riccardo Braglia

The American Society of Clinical Oncology (ASCO) annual meeting is the place and time to present new advances in technology and science in the cancer therapeutical area.

In Chicago this year, from the May 30th through June 2nd, more than 30,000 healthcare professionals and industry representatives met to discuss and present new updates in the fight against cancer.

An important topic of this years annual meeting was cancer prevention, and the cancer survivors behavior and suggested changes. In this area some companies have presented new supports available for cancer patients in the area of supportive care such as specific high quality food supplements.

In breast cancer chemoprevention, with the prophylactic use of anti-estrogen therapies in women at high risk of breast cancer, a new study showed that taking tamoxifen is associated with reduced breast cancer incidence over a median 16-year follow-up.  A clinical trial is currently underway to test whether this therapy is effective in increasing chemoprevention, and the results are expected in the next few years. Additionally, new data suggests that the prophylactic use of chemo drugs could also play a role in the prevention of colorectal cancer.  Further, another new study showed that aspirin is associated with improved survival in colorectal cancer patients.

One of the main focuses of ASCO’s annual meeting this year has been the immunotherapy against cancer and different companies such as BMS, AstraZeneca, Roche, Merck, and Amgen, has each presented their new drugs.  New studies on the use of immunotherapy to treat melanoma, have shown an improvement in survival by years.  Further, a new study showed that nivolumab alone or combined with ipilimumab is associated with longer progression-free survival than ipilimumab alone in patients with advanced melanoma. The combination of both drugs led to a reduction in tumor size in the majority of patients.

Another new clinical trial highlighted the potential of nivolumab for treating lung cancer and showed that the drug more than doubles overall survival in patients with non-small cell lung cancer.

Another breast cancer trial showed that palbociclib more than doubles progression-free survival in patients with hormone receptor positive, HER2-negative breast cancer.

Merck and Amgen are testing a combination of their immunotherapies, pembrolizumab and talimogene laherparepvecin, in patients with head and neck cancer. The Phase I trial will involve patients with recurrent or metastatic squamous cell carcinoma of the head and neck and investigate whether the two drugs could offer a new treatment option.

Pfizer’s sirolimus, an immunosuppressant, recieved a new indication from the FDA to treat a rare progressive lung cancer, called lymphangioleiomyomatosis. This is the first drug approved to treat this disease, based on data from a trial which showed that those who received the drug for one year had stabilization of lung function.

Roche’s immunotherapy drug, MPDL3280A, doubled the survival rate of lung cancer patients in a study. In the mid-stage of the trial patients with non-small-cell lung cancer, who received the drug were for the majority less likely to experience fatality than those who received another chemotherapy drug.

Bear in mind, the progress made at ASCO is not only related to drugs, but in fact also the progression on the exchange of information and increased communication.  This year at ASCO the first beta software of Cancer Link, a new cancer database, was presented and attendees realized with the support of private donations towards this software, that we will have millions of cancer patient records in the U.S. in the near future.  These patient records will help doctors to make the correct and most effective choice of therapy, as well as lead to better compliance with the oncology guidelines (

Moreover, it is also important to mention the efforts for better information about the molecular nature of tumors, to better personalize treatment options. Many pharma companies are working on this idea, and are looking to select patients for clinical trials based on whether their tumors carry certain specific biomarkers. As an example, the Foundation Medicine, built a DNA sequencing technology that helps doctors find common genetic abnormalities that drive tumors.  They then demostrated that targeting these abnormalities led to promising new treatment against biliary tract cancer.

Another issue common to many companies and to accessing new therapies is the reimbursement challenges with new expensive medicines and molecular tests. The consumers have the option to pay out of pocket, however this is quite expensive.  This is a barrier to getting genetic information that could help guide their treatment for cancer or other diseases. High prices of the new therapies is becoming a major burden for patients and payors.

Other outcomes from ASCO 2015 include information from Immunogen, a company that makes targeted antibodies loaded with toxins, making very potent tumor-killers.  Immunogen presented some encouraging results in the therapy against ovarian cancer.

Additionally, a group of breast cancer surgeons had presented at ASCO about a study which showed that if they sliced out just a little more tissue when removing a tumor, the patients performed better, without noticing any cosmetic difference.

The company Oncothyreon offered some preliminary results from small trials that enrolled heavily pre-treated patients with tumors that over express the HER2 protein. The company’s drug appeared to help some patients whose tumors had spread to the brain.

The Puma Biotechnology company presented data from a Phase III study that offered a marginal benefit for HER2-positive patients, along with significant diarrhea as a side effect.

Another technology that is important to mention is the medical device from the company Novocure, that is a revolutionary tool for the treatment of recurrent glioblastoma in adult patients with cancer.

In the area of managing side effects, some important advances were presented by the company Helsinn. Helsinn provides the new and only combination product which helps with nausea and vomiting induced by chemotherapy by targeting two different receptors, and they discussed a new product for the treatment of cachexia/anorexia syndrome in non-small cell lung cancer patients.

Riccardo Braglia, Lyfebulb board member

Dynamic Stretching for Diabetics

stretch-and-toneBy: Roy Collins @roycHealth

Benefits of Stretching

The weather is finally great, and you’re running out of excuses so it’s time to exercise. Hopefully your outfit is acceptable and your favorite playlist is rockin’, so it’s time to jump in. But what first? From the days of gym class in elementary school to reading this piece, you might feel inclined to begin with some traditional, static (or still) stretching. While the traditional school of thought is that static stretching prevents injuries, in actuality static stretching before exercise has been found to be ineffective. Some studies actually find it harmful and a decrease in performance may be seen as a result from static stretching.

To avoid those tragedies, try instead coupling dynamic stretching with warm up activities like a short jog or bike ride before moving on to your scheduled workout. Dynamic stretching is a newer take on stretching that involves leg and arm swings designed to gently push the limits of your range of motion. The key is avoiding bouncing or jerky movements that contribute to actual harm of the muscles in your limbs. Another benefit of dynamic stretching is that you can address several muscles at once while you work on balance and coordination, all while warming up your body. Dynamic stretching is so effective because it causes rapid muscle activation (Minshull, 2013). Rapid muscle activation is crucial to dynamic joint stability, which is important for injury prevention throughout your workout.

How Stretching Affects Diabetes

Dynamic stretching should exist somewhere between low and medium on the spectrum of intensity. The key, again, is to prepare your body for whatever real strenuous exercise is next. In order to warm up your body for activity, you need to first perform easier exercises, but easier exercises are still exercise. This means dynamic stretching has implications on your blood sugar levels. In contrast to high intensity workouts, where adrenaline may actually raise your blood sugar, dynamic stretching is most likely caused by a dramatic drop in your levels, depending on the duration of your activity.

Stretching Examples

Alternating Arm Crosses. Start with your arms stretched out to your sides and then proceed to attempt to touch each hand to your opposite shoulder. Alternate which arm is above the other between each cross.You should feel a stretch on your shoulders, deltoids, triceps, and biceps.

Floor Touch. Walk forwards. As you take each step, pause on your heel and try and touch the ground (or your ankle) while keeping your forward leg straight. You should feel the stretch in your hamstring.

The Rockette. Continue walking forward. As you take a step this time, balance your weight on the ball of one foot and kick the other leg straight forwards, aiming for as high as possible. You should also feel this stretch in your hamstring along with your calves.

Quad + Dip: A different take on the traditional quad stretch. Rather than simply finding a wall and grabbing your ankle, instead transition from grabbing your ankle upright to simultaneously reaching for the floor with your other hand. Maintaining your balance is important in the stretch, so start slow to begin. You should feel the stretch in your quads, calves, hips and also the hamstring.

Buttocks Kick. Mimicking the pace of jogging in place, balance your weight forward on your toes. While hopping on each alternating foot on a time, kick your heels back against your rear end while moving forward. You should feel a stretch in your quads and ankles.

High Knees + Lunge + Twist. For this multi-part stretch, first grab one foot at the middle of your shin while moving your weight forward to the ball of your other foot, stretching tall. Grabbing your shin, hold your up leg against your body. Then release, and take an exaggerated step forward, Step out so that as you come down into the lunge, your forward knee bends at a perpendicular 90 degree angle. After lowering your body into the lunge, pause at the bottom raise your arms upwards, and twist your lower back against your forward knee to that your head is facing the opposite direction as the inside of your forward foot. Raise out of the lunge and repeat all steps on the other leg. You should feel this stretch on your calves, hips, quads, and lower back.

Diabetes Tips: For Quick Warm-Ups

If immediately following your dynamic stretching, you are then continuing on to the more strenuous exercises, then allow for only a small drop in blood sugar. A majority of your focus should be on tweaking your blood sugar for whatever major activity which you are participating in. The actual stretching aspect of your workout, should only take a couple of minutes, so proportionately, only small adjustments should be made.

Diabetes Tips: For Extended Warm-Ups

If you are coupling your dynamic stretching with a warm up activity like jogging or peddling on a bicycle, then prepare yourself for a more dramatic drop in blood sugar levels. If you use a pump, lower your basal rates significantly about an hour prior to the beginning of your warm up to avoid a crash. Alternatively, you can eat a snack prior to or during your warm-up to somewhat cushion the drop in blood sugar levels.

While we’re on the subject of stretching, be sure to save time for a cool-down exercise of traditional static stretching at the end of your workout for better recovery. Try it out, and watch your performance and mood increase!

For more updates and tips on how to use fitness for diabetes management and prevention. Follow me on twitter @roycHealth

Minshull C, Eston R, Bailey A, Rees D, Gleeson N. The differential effects of PNF versus passive stretch conditioning on neuromuscular performance. Eur J Sport Sci. 2014;14(3):233-41. doi: 10.1080/17461391.2013.799716. Epub 2013 May 20.

Diabetes and Mental Health

Robin on a bridge.MHpostBy: Robin Smith

Type 1 diabetes affects my brain. Not all the time, and I prefer to think of myself as a reasonably stable person… But there’s an undeniable mental component to diabetes.

And since May is Mental Health Awareness month, I’d like to share some examples of how diabetes influences my mental health:

I’m confused.  My blood sugar is low, and while I know something is wrong… I’m just not sure what to do about it. I wander into the kitchen and peer into the fridge. I stand there, sweating and pondering what to do next. In a moment of clarity, I gulp down a cup of juice.

But a few minutes go by, and… I can’t remember if I poured a full cup or maybe it was just half full? I still feel low, so maybe I should take more regardless.

I stare into my empty cup, uncertain and shaky.

I’m lethargic.  My blood sugar is high, and I take a correction dose of insulin. “I don’t feel great,” I tell my friend. “Let’s stop walking and sit down for a minute.” I sink onto a park bench, and put my head in my hands.

“What do you need?” my friend asks.

“To wait,” I sigh. “I mean, we can keep walking. It’s just that my blood sugar usually takes a few hours to come down.” I sit there, feeling tired and listless.

I’m frustrated.  Halfway through my boot-camp class, I start to fade. I clearly haven’t been putting in my best effort, and I’m annoyed with myself. Despite the careful preparations I always take for this workout, my blood sugar is dropping. I excuse myself and sprint down the stairs to confer with my glucose meter and buy a juice from the vending machine.

“Are you alright?” the instructor asks when I reappear. “Do you need to sit out?”

“No,” I tell him. “It’s just my blood sugar. I should be fine in a few minutes.”

But I’m still not hitting my peak performance, and my blood sugar is refusing to pick up. After ten more minutes, I take some more juice. I worry that I might end up with high blood sugar if I take too much.

I’m finally forced to sit out, feeling defeated and disappointed.

I’m motivated. There’s just an hour left, and a few other cyclists pass me on their way to the last checkpoint. I’m a fan of the Bike the Branches event, which was designed to get Brooklyn bikers out in support of public libraries. At this point though, I’m tired. Six hours of biking is a lot more than I’m accustomed to!

I recognize that I’m at a disadvantage: I’ve bean trying to maintain control of my turbulent blood sugar all day. But I’m still going strong, despite the mental challenges of feeling confused, lethargic, and frustrated at different points throughout the tour.

As I stand in line at the final checkpoint, I find myself smiling. I look at the athletes around me. While we’re standing at the same finish line… I’m pretty sure that I’ve persevered and accomplished more in getting here than my non-diabetic cohorts.

Mental health treatment is something we don’t always consider with diabetes. But mental and physical health are so closely aligned.When my blood sugar is low, high, or choppy, it affects my thinking and my emotions.

I remember having a yearly check-up once with a general practitioner who I’d never worked with before. As she was wrapping up the appointment, I started to feel confused and upset. Tears welled up in my eyes. I became more and more agitated. I didn’t recognize the symptoms of low blood sugar, and she just seemed impatient with me.

“I’m sorry,” I sniffled. “I don’t understand what you mean. Can you repeat that?” I knew I shouldn’t be crying. I felt embarrassed to be acting this way.

The doctor looked at me coolly. “You need to chill out,” she remarked. “There’s nothing to cry about.” She referred me to a therapist, saying I was suffering from anxiety.

On my way out of the office, I realized that the root of my emotional outburst was actually diabetes. I took a few glucose tablets in the bathroom and rinsed my face with cool water. I never actually made it to the therapist’s office, but I did begin to consider taking better care of my emotional health.

Because of diabetes, I’m not always in my full mental capacity. Acknowledging this helps me to be more patient with myself. I try to consider whether the way I’m feeling is a result of physical imbalances. I also do my best to teach people about my condition. This way, I don’t always have to explain myself in the middle of a crisis. With the support of my friends, family, and co-workers, I’m better able to accept how diabetes affects me both physically and mentally.

Please share!  I’d love to hear your thoughts and experiences! How does diabetes affect your mental health? What has been most challenging? What do you find motivating?

Please write a comment below.