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The ACA Repeal & Medicaid: What Would It Look Like For Patients With Diabetes?

The ACA Repeal & Medicaid: What Would it Look Like For Patients with Diabetes?

The ACA Repeal & Medicaid: What Would it Look Like For Patients with Diabetes?

President Obama’s signature legislation, the Affordable Care Act (ACA), has touched the lives of nearly every American. Over 20 million people are currently covered by a healthcare plan governed and facilitated by the Health Insurance Marketplaces (healthcare.gov), established by the ACA. While many discussions focus on the Marketplace and ACA in general, an important discussion needs to happen about Medicaid.
Medicaid expansion has opened up the opportunity for many people who didn’t qualify for Medicaid traditionally thanks to its income-only requirement. For people in the 32 states who have adopted the expansion, if their income is at or below 138 percent of the Federal Poverty Level (FPL), they can qualify for Medicaid.
For all of its controversy, the facts remain clear: the ACA has helped millions of people afford healthcare coverage, access contraceptives, receive mammograms and other important health screenings, and provide healthcare to their children up to the age of 26. For people with diabetes, we cannot be charged more for coverage than those without diabetes and we cannot be denied.
However, if the current Republican leadership gets its way, that’s all about to change. President Trump, Vice President Pence, and a sizeable number of Republican lawmakers in Congress have already begun to pave the way for a swift repeal of the ACA. What’s even more concerning to a large number of Americans is that they have no solid plan prepared to replace the ACA in the event of its repeal. (While they have proposed plans and two are in the markup phase, many experts hav Continue reading

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Carb counting for diabetes: Meal planning to manage blood sugar

Carb counting for diabetes: Meal planning to manage blood sugar

Carb counting is one form of meal planning that can help people with diabetes manage their blood sugar levels.
Diabetes is an incurable, yet manageable, medical condition where the body's blood sugar levels are too high. This happens when there is not enough insulin in the body, or the insulin does not work properly.
Insulin is a hormone that is made by the pancreas. It helps the body to process glucose (the simplest form of sugar), which is used by the cells to create energy. When this doesn't happen, sugar stays in the bloodstream. This can lead to serious health problems.
This article explores carb counting as a meal planning method that can help people with any form of diabetes manage their blood sugar levels.
Diabetes and the role of carbohydrates
In the United States in 2014, approximately 9 percent of Americans, totaling nearly 29 million people, were found to have diabetes. Diabetes is classified into different types and includes:
Type 1 diabetes: In this type, the body does not produce insulin. This is due to the body attacking its own insulin producing cells within the pancreas. It is most commonly diagnosed in children and young adults.
Type 2 diabetes: In this type, insulin is either not made in high enough quantities or not used efficiently. This form of diabetes affects people of all ages and is the most common type.
Gestational diabetes: Some pregnant women will develop a typically temporary form of diabetes called gestational diabetes. This raises their risk of developing type 2 diabetes later in life. Most times, once the baby is born, this form of diabetes Continue reading

Diabetes and cardiovascular disease: A deadly duo

Diabetes and cardiovascular disease: A deadly duo

Learn about the vital education patients need to improve their outcomes.
Takeaways:
Both type 1 and type 2 diabetes can lead to multiple complications.
The most common complication of diabetes is cardiovascular disease.
Nurses should use patient-centered communication when educating patients about the risks and challenges of diabetes.
By Charlotte A. Wisnewski, PhD, RN, CDE, CNE
Eugene Jones, age 66, has a 10-year history of type 2 diabetes mellitus; 1 year ago, he suffered a myocardial infarction (MI). During today’s routine clinic appointment, his fasting blood glucose level is 215 mg/dL and his blood pressure is 160/94 mm Hg. He tells the nurse he sometimes forgets to take his diabetes and high blood pressure medications—metformin, metoprolol, and low-dose aspirin. He states that he walks about 15 minutes daily and tolerates the exercise well.
Diabetes mellitus occurs in four main forms, all of them marked by hyperglycemia. The most common forms are type 1, which results from autoimmune destruction of pancreatic beta cells, and type 2, caused by insulin resistance or an insulin secretory defect. Diabetes of all types increases the risk for cardiovascular disease (CVD). (See Diabetes complications.)
Diabetes complications
Both type 1 and type 2 diabetes can lead to:
• cardiovascular disease (the most common complication)
• macrovascular problems of the cardiac vessels, resulting in myocardial infarction
• cerebrovascular damage, causing stroke
• microvascular defects involving the eye and blood vessels, leading to blindness
• vascular involvement of the kidn Continue reading

Insulin Resistance: What You Need to Know

Insulin Resistance: What You Need to Know

Chances are, somewhere alone the lines, you’ve read about or heard the phrase “insulin resistance.” It’s one of those terms that some folks in the medical profession — and in the media — often use, but it’s not always explained very well. As a result, it can seem rather vague and even be a little confusing.
Insulin: “do your job”
To understand the meaning and implications of insulin resistance, it helps to first take a look at the hormone insulin. The pancreas makes insulin in special clusters of cells called islets. Within these islets are beta cells that faithfully churn out insulin and release it into the blood where it’s set free to do its job (Coach Bill Belichick would approve!). Like all hormones, insulin has a very specific role: it helps the body use glucose from the carbs that you eat for energy. Specifically, it signals muscle, fat, and liver cells to take up glucose from the blood to be used for fuel. If the body says, “No thanks, I’m good,” that energy (glucose) gets stored as glycogen (and, if glycogen stores are full, fat) for use later on. Insulin is a blood glucose regulator, meaning that it helps keep blood sugar levels at a safe level, preventing it from going too high (hyperglycemia) or too low (hypoglycemia). In addition, insulin puts a halt on glucose release from the liver, which also prevents blood sugar levels from climbing.
When things go haywire
You have to admit — when the body is working as it should, it’s pretty amazing. The pancreas and insulin are no exception. However, things do go awry, unfortunately. Not so mu Continue reading

Elderly A1C Targets: Should Older People Have More Relaxed Glucose Goals?

Elderly A1C Targets: Should Older People Have More Relaxed Glucose Goals?

You may have read that the lower your A1C level, the better. For best health, people with diabetes should aim for glucose as close to normal as possible. But some new research shows this may not be true for older people.
According to these studies, seniors could decide not to shoot for tight control of blood sugar or cholesterol. One study from Japan showed that lower HbA1c levels (a measure of average glucose control over the previous 2–3 months) were actually linked with an increased the risk of frailty in older adults. Frailty was measured in the study as how much help a person needs in living, and how poorly he or she recovers from an illness or injury.
Toshihiko Yanase, MD, PhD of Fukuoka University School of Medicine, Japan, reported, “The risk factors of metabolic syndrome, such as high blood glucose, obesity, high cholesterol, and hypertension, in middle age may shift from an unfavorable risk to favorable factors in old age.” The study was published in the Journal of Diabetes Investigation and reported by the online site Healio.com.
Yanase and colleagues analyzed data from 132 adults aged at least 65 years with Type 2 diabetes Average age was 78. The subjects had had diabetes for an average of 17 years and their mean A1C was 7.3%.
The subjects were categorized as frail or not on a 9-point clinical frailty scale (CFS). The CFS goes from 1 (very fit) to 9 (terminally ill). People who rated 5 or higher were classed as frail. Seventy-seven were not frail; 55 were. In those with higher frailty scores, HbA1c levels were found to be significantly lower.
The causes of Continue reading

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