What is it and how to get started

Mindfulness has become a popular topic over the last decade, and for good reason. A growing body of research is showing incredible health, performance, and relationship benefits to adopting the practice. But what exactly is mindfulness and how does one practice it?

Mindfulness is a particular way of focusing on the present moment without judgment. It is a skill, a practice, and a state that helps counteract our brain’s natural tendency to time travel back into the past or ahead into the future. Being in the present moment more often is what enables us to build meaningful relationships and perform at our best.

Unfortunately, most of us are more familiar with not being in the present moment. Research suggests we spend nearly 50% of our time thinking about something other than what we are doing. It’s when you arrive home from work excited to see your family and just as you sit down at the dinner table you remember an email you forgot to reply to and suddenly you’ve missed your kid sharing the best part of their day. Or it’s the moment you’re at work trying to focus during a meeting and your mind wanders back to an argument you had with your spouse that morning. It can also be the moment when you are sitting down to finish a report, but you begin daydreaming about your upcoming vacation. And it’s a hundred moments in between.

Understanding Mindfulness
Mindfulness is the practice of catching our minds when they wander and intentionally bringing them back to where we are—put simply: it’s the practice of being present. The more we practice, the more quickly we’re able to reestablish our mind in the present moment before it impacts relationships or performance.

To be truly mindful is to be able to recognize as your mind wanders away from the here and now, accept the wandering, and recenter your mind back to the present to be where your feet are.

Mindfulness has a long and rich history dating back more than 2,500 years. While this may activate images of ancient monks in stillness and solitude, in the last 15 years, an enormous amount of rigorous research has been conducted supporting the benefits of a mindfulness practice—many that are particularly relevant to thriving in our fast-paced, always-on culture.

Mindfulness Benefits
Mindfulness has been shown to act as a buffer against cognitive anxiety, improve memory and learning, improve sleep, and reduce fatigue. It is also associated with increased frequency in optimal performance states, improved performance in high-intensity contexts, and better regulation of emotion and stress. Importantly, these benefits can be realized without spending hours upon hours a day in silent meditation. Mindfulness training research suggests that 8-20 minutes a day is all you need to see meaningful benefits. If you want a more exact prescription, Dr. Amishi Jha, one of the leading mindfulness researchers, has determined that 12 minutes a day, five days a week is the most effective “dose.” It balances what time-pressed people will actually commit to and it benefits their attention.

Getting Started
Magellan Federal is the world’s largest single employer of professionals with specialized training in performance psychology coaching. Our cognitive performance coaches have delivered education and training to more than 2.7 million within the Army population in the past five years. Here are some simple exercises our coaches teach to help build positive mindfulness habits:

• Practice 1 minute of mindful breathing. Set a timer for one minute and simply turn your attention to your breath. What does it feel like to inhale? What does it feel like to exhale? Try pausing at the top and bottom of each breath. If you find 1 minute too easy, aim for 3 minutes or more.
• Practice mindfulness during everyday activities. For example, while washing the dishes focus on the temperature of the water, the slipperiness of the soap, the sound of the dishes. Every time your mind wanders to something else (as it naturally will), gently guide it back to the dishes. Surprisingly, even for menial tasks like dishes, people who focus on the task, instead of daydreaming, report greater levels of happiness.
• Conduct a brief body scan. Find a quiet place to sit, start with a few mindful breaths, and then turn your attention to your body. Start at the top of your head and work downward, just noting what your body feels like. Don’t get stuck in any particular place; just notice comfort or discomfort and move on until you get to your toes. Finish with a few mindful breaths.

Know that as you try any of these activities, your mind will wander; it is completely natural. Mindfulness is the practice of gently bringing your mind back to your target. Each time your mind wanders, think of it as a repetition to strengthen the skill of returning to the present moment.

Making it Stick — Find or Build a Community of Support
Like most new habits, developing a mindfulness practice can be tricky. Research has shown that learning with and from others on a similar path has a staggering effect on success.

Magellan Federal believes in a human-centered approach when building new habits like mindfulness. We are currently developing a solution that models the success we have found through our work with the Army, which will incorporate live coaching sessions and a community of support to further enhance successful habit change. Finding or building a group or partnership that supports your mindfulness goals and offers encouragement and motivation along the way will make you more likely to succeed in creating mindfulness habits that stick. You might consider adding a mindful minute with your family before dinner, starting a team meeting with a mindfulness practice, or finding your own unique way to build community around mindfulness practice.

Learn More
Magellan Federal’s holistic approach seeks to help people not only improve performance, but health, relationships, and culture—and mindfulness is a key piece of the puzzle for many people. If you are Interested in starting a mindfulness practice or connecting to a community of support, contact us today.

Article originally published on MFed Inform.

The destruction left by Hurricane Ian back in September serves as a reminder that times of crisis can often occur quickly with little or no warning. During these events, parents may be coping with children who feel increased worry and anxiousness. Parents and professionals can help by providing guidance on how to develop an at-home safety plan for times of crisis. Supplying children with the knowledge of what to do if an emergency occurs can reduce feelings of anxiety and provide them with a better sense of control in an uncontrollable situation. Below is guidance that our Military and Family Life counselors share with parents.

Emergency Plan Directions

• Designate a general meeting place. Establish an agreed-upon safe place to meet if a parent will be unable to pick the child up from school or will not be at home. This could be a neighbor’s house or community meeting space. Children should be reassured that the adult they are with is aware of the plan, and the parent will meet them at the arranged meeting location.
• Create an emergency backpack. The backpack should have items the child may need in the event of a crisis, specifically, items necessary if an adult was unavailable at the time of the crisis.
• Compile a list of all emergency phone numbers. These numbers should be programmed into a child’s phone, if they have one, written down at home, and placed in the emergency backpack.
• Create a social media plan. Social media sites can be very effective in times of crisis. Discuss what social media site(s) will be used for family communication and information if cell service is down.
• Develop plans for the natural disasters most likely to occur in your area. These plans could include backup locations to go in case the family must leave their home, such as a relative’s house, a community shelter, or another designated safe place.

For even more tips on preparing an emergency plan, refer to the “Make a plan” section of  Ready.gov.

Crisis Conversation Tips for Parents

In addition to creating an emergency plan for their home, parents will also need to discuss crises and other traumatic events, such as natural disasters, with their children. It can be difficult to know how to approach those topics or what to say that will be helpful. Below are tips for engaging in these conversations (Psychology Today, 7.26.22).

• Keep words and language child-friendly and age appropriate.
• Initiate the conversation in a calm manner.
• Leave time for the child to ask questions and remain silent during their questions or requests for clarification.
• Ask if they have any worries about a particular situation.
• For even more tips on preparing an emergency plan, refer to the “Make a plan” section of ready.gov.

Creating an emergency plan and having open communication about this topic can benefit both the child and adult and may reduce feelings of anxiety in the child.

There are numerous studies looking at risk factors related to suicidality. In mental health-related training and educational textbooks, lists are presented on the contributing risks for, and protective factors against, suicide. In this article, I’d like to bring attention to one of those items in particular and share a brief synopsis of a scientific experiment.

About 70 years ago in the mid 1950’s, Dr. Curt Richter conducted a series of experiments on rats. No, this is not related to suicide directly, but read on, you’ll see the connection at the end.

Remember, I’m “making a long story short” here. In the series of experiments, a research team placed wild rats in buckets of water where they had no opportunity to escape. Understandably, the rats gave their swimming best to keep afloat and survive, but after a few minutes the rats looked like they were about to drown due to exhaustion and being unable to continue swimming. The researchers rescued them right before drowning. The rats were held, dried up and helped to recover. The researchers then placed the same rats back into the bucket of water.

Knowing that the rats had just swam to near death by drowning due to exhaustion only a few minutes earlier, the researchers would’ve thought the rats would reach that level of exhaustion and feeling of “I can’t swim anymore, I’m drowning” much sooner than the last time which had only lasted no more than 15 minutes.

But this second time around, these same rats kept on swimming for hours!

Having tried to account for a physiological explanation unsuccessfully, the researchers came away with postulating that the outcome was best explained by the psychological state of the rats rather than their physiological state. Sort of like, “mind over matter.”

What had changed to account for the hours of swimming was the fact that the rats experienced being rescued and cared for the previous time. They had developed an optimistic expectation of a positive outcome, namely, hope–a positive belief in their future that “we just have to keep on swimming to stay afloat until we are rescued again.”

That’s what made the rats not give up and keep on fighting (swimming) for hours. It was hope!

Now you see the answer to the title question of this article “What’s hope got to do with it?” and why having hope versus hopelessness plays a role in suicide prevention.

Putting aside the inhumane nature of how some studies were conducted 70 years ago, it is well understood that the lives of rats are much different from those of human beings.

In a vacuum, one cannot draw a simple line between this experiment and the human experience with its intricate relationships of stressors and complicating factors such as trauma and addiction.

With or without the presence of addiction, frequently there is a loving caretaker who is also fatigued. Hence, the importance of involving professionals, not only for the person who is dealing with depression, suicidality, trauma or addiction, but also for the caretaker of that person.

Having hope, a belief that things will get better and a future-oriented optimism for “better days ahead” are protective factors against suicide, whereas the opposite–hopelessness–is a contributing factor to suicide.

Fleetwood Mac exclaimed “Don’t stop” (thinking about tomorrow) in 1977. Gloria Gaynor added “I will survive” in 1978, and Journey chimed in with “Don’t stop believing” in 1981.

Perhaps famed author F. Dostoevsky said it best a century earlier, “To live without hope is to cease to live.”

Additional suicide prevention resources and support

On September 22, Magellan Healthcare hosted a webinar, “The role of mental health recovery in suicide prevention,” for Suicide Prevention Awareness Month. I participated on the panel, along with Dr. Pratt, Dr. Williams and Stacey Volz, who shared her inspiring recovery story from mental health challenges and multiple suicide attempts.

Watch a recording of the webinar as we share our knowledge and personal and professional experiences in addressing mental health and substance use challenges to prevent suicide: https://www.magellanhealthcare.com/event/the-role-of-mental-health-recovery-in-suicide-prevention/.

Visit Magellanhealthcare.com/Prevent-Suicide for more information and materials to learn more and spread awareness about suicide prevention.

Since joining Magellan Health over a year ago, Karen Riccardi has been a part of developing various behavioral healthcare products aimed at helping people to live healthy, vibrant lives.  As senior product development manager, Riccardi’s main responsibility involves the development of behavioral health products and solutions that positively impact the lives of others and drive growth for the company.   Some of the products she has worked on include Magellan Healthcare’s Digital Emotional Wellbeing tool, Senior Assistance solution, and Collaborative Care product.  Riccardi, who is a Licensed Professional Counselor based in Virginia, discusses the products she is working on below.

What sort of cool, innovative projects are you currently working on?

Most recently, I have been working on the implementation of our Collaborative Care Management solution that increases access to behavioral health screening and care for low to moderate-risk behavioral health conditions within the primary care setting.  By using NeuroFlow’s technology and Magellan’s clinical management, we can improve medical and behavioral health integration.

I’ve also been working on the launch of our new Senior Assistance solution powered by DUOS. Senior Assistance helps address older adults’ social determinants of health (SDOH) needs and assists them in aging independently in their own homes by building long-term, high trust, one-on-one relationships with a personal assistant called a Duo.  Our pilot last year successfully addressed 93% of members’ SDOH needs.

There have been several other innovative products and projects I have had the chance to work on, including the development of the Wellbeing Navigator, which provides one-on-one support and guidance for employees and their household members with complex life concerns, the launch of eMbrace, Magellan’s evidence-based solution that supports members’ wellbeing, and development of a suicide prevention solution that includes education, awareness, tools, resources, and addresses other health issues such as substance use and teen mental health.

Why is Magellan Health the best place to develop these projects?

Magellan has a long history of behavioral health innovation and is well known in the behavioral health space.  The history and knowledge, along with leaders who encourage us to be creative and explore new, innovative solutions, make Magellan the best place to develop products that benefit the lives of our members.

What are your thoughts Magellan’s culture and how has it impacted your projects?

Everyone at Magellan is here because they want to make a difference and are dedicated to the work they do. It is energizing to work with coworkers who are passionate about what they do.  This makes working together easier and allows us to come together as a team.

What exciting trends have you noticed in the healthcare industry? In what direction do you see healthcare going? What lessons are there to learn from other industries that can be applied to healthcare?

There has been increased recognition of the importance of mental health and how it is a vital part of one’s wellbeing.  Telehealth and digital tools have proven to be effective means of treatment and are helping to address accessibility to providers.  Individuals have more choices today on how they want to receive behavioral health care, allowing them to be more in control of their healthcare.  It is vital we continue to focus on products and solutions that are high quality, demonstrate positive outcomes, and provide an exceptional patient experience. Individuals need to feel comfortable in seeking behavioral health care when they do not feel well mentally.

Now is the time to recognize and honor family caregivers across the country. It is an opportunity to raise awareness of caregiving issues, educate communities and increase support for caregivers.

The burden of care is often placed on adult children or other family members, many of whom have full-time jobs and kids of their own. According to an Alliance for Caregiving and AARP Public Policy Institute survey, 40% of caregivers feel emotionally stressed, almost 20% say it caused financial problems, and about 20% feel physically strained. Unpaid-caregiver burnout among these “sandwich generation” individuals often impacts their performance and engagement at work.

Family caregivers comfort their elderly and/or ill companions, coordinate their care, help them bathe, clean their houses and shop for them. While many find the experience rewarding, it can also be frustrating and take a toll on their emotional and physical wellbeing. Over half of caregivers report elevated levels of depression and anxiety, worsened physical health and higher use of psychoactive medications.

These tips are a good reminder for caregivers and those who are close to caregivers:

• Seek support Ask family members for help and include them in caregiving decisions. See if your employer offers a program like Magellan’s Senior Caregiver Assistance, powered by DUOS, that combines human contact with technology that can give caregivers much-needed support and enable seniors to live full lives.
• Share the tasks When family or friends offer to lend a hand, be ready with specific ideas. Make a weekly list and share that list with others to help with shopping, housecleaning, etc.
• Take care of yourself Be sure to schedule and go to your medical checkups. Eat a healthy diet, exercise and get enough sleep.
• Make time for activities you enjoy Don’t neglect the things in your life that need attention. Read, listen to music, paint, play a game, etc.
• Plan for respite care Respite services provide someone who can stay with your family member while you get away for a few hours or days. Time off can help you manage your stress and be a better caretaker.

Visit our Behavioral Health Resources web page for free resources and expert advice to help our communities, client, members and providers.

Sources: CDC, Healthwise

In 2019, Time magazine listed virtual reality (VR) as one of the 12 innovations that will change health care and medicine in the 2020s. With this projection, the probability that you will use VR sometime in your life is high! VR is currently being used in a variety of fields, including

• Mental health
• Pain management
• Rehabilitation
• Training and education

VR is not a fad, as studies are underway for its potential efficacy to treat Alzheimer’s disease, depression, addiction, and other illnesses. This new field of medicine collectively referred to as medical extended reality (MXR), encompasses VR and augmented reality (AR). There are many aspects in the VR landscape including safety, regulations, and value to name a few. Let’s dive in and explore some of the clinical uses of this emerging trend.

Pediatric Intervention
Children are often under-treated and under-recognized when it comes to managing pain, fear, and anxiety. Thus, VR is utilized in children’s hospitals, such as Stanford Children’s Health, to engage and distract children during painful procedures. At the Lucile Packard Children’s Hospital Stanford, VR is used in several ways to reduce pain and stress, including the use of AR goggles for patients in the pre-op so they can watch movies and play games prior to surgery, and the use of VR games in the intensive care unit (ICU).

Mental Health Treatment
With an estimated 52.9 million adults suffering from mental illness in 2020 according to the Substance Abuse and Mental Health Services Administration (SAMHSA), one of the biggest challenges today is the rising demand for mental health treatment and a shortage of available providers. As another tool to tackle mental health conditions, VR now contributes to the availability of additional resources.

The use of VR software simulates real-world settings that closely resemble the surroundings of daily life so that triggering stimuli such as anxiety, paranoia, fear, and cravings can be assessed and treated. Anxiety disorders are already being treated using virtual reality exposure therapy (VRET) as a potentially scalable tool. In addition to anxiety-like disorders, VR is being studied for several other disorders.

There is evidence that VRET reduces post-traumatic stress disorder (PTSD) symptoms, with sustained improvements at six and twelve months after treatment. Among children with autism spectrum disorder (ASD), a recent research initiative demonstrated that VR combined with cognitive behavioral therapy (CBT) improved specific phobias. For seniors who suffer from social isolation, Rendever has developed a VR platform designed to reduce depression and loneliness.

Chronic Pain Treatment
A Centers for Disease Control and Prevention (CDC) survey in 2019 found that 20.4% of US adults have experienced chronic pain. Persistent pain is linked to depression and anxiety and can become an overlapping symptom.

In a study conducted by Cedars Sinai, VR reduced hospitalized patients’ pain scores by 24% and was most effective for patients with severe pain. In November 2021, a prescription medical device (RelieVRx) was authorized by the US Food and Drug Administration (FDA) as the first at-home VR therapeutic as an adjunct to treat chronic lower back pain.

Virtual Rehabilitation
While the benefits of physical therapy have long been established, some patients who would benefit from PT do not have access to it. In recent years, VR rehabilitation has been gaining traction with a host of conditions from chronic pain, stroke, and Parkinson’s disease to multiple sclerosis, dementia, and cerebral palsy. VR-assisted rehab may offer advantages for patients such as improved patient engagement and motivation, poststroke functional recovery, and improved mobility in Parkinson’s patients.

Training and Education
It can be challenging for educators to meet learning objectives through standardized medical training, especially as healthcare systems evolve. VR training and education, allow personnel, students, and residents to learn in a controlled environment while minimizing risks to real patients. As a result, VR systems are increasingly used in hospitals to train residents, assist surgeons with surgical planning, and educate patients. In a UCLA study, participants using the Osso VR platform significantly improved their overall surgical performance compared to conventional training methods.

Health Inequities
The healthcare system continues to be affected by structural racism, affecting the well-being of all people, especially those who have historically been marginalized. The use of VR as a training tool is currently being explored for a better understanding of the cultural needs of patients, with the possibility of VR becoming a tool for increasing empathy and giving people a broader perspective when interacting with individuals of different racial and economic backgrounds.

With VR technology developing at record speed and its potential to transform healthcare, we are keeping VR on our radar. We encourage you to learn more about VR and the world of MXR by visiting our website to explore our latest white paper: Virtual Reality – An Emerging Paradigm in Healthcare

This is just the beginning!

Written by Noushin Izadifar Hart, MD

As the second leading cause of death among U.S. women, most of us know someone who has or have experienced breast cancer ourselves. One in eight of us will develop it in our lifetime, and every 13 minutes one of us dies from it. Understanding breast cancer and early screening can increase survival and help us all live happier, healthier lives, including men, who have a 1 in 833 lifetime risk.

What factors increase my breast cancer risk?

In women, the risk of breast cancer increases with age, with the average woman being diagnosed at age 63. Other contributing factors are:

• Personal and family history of breast cancer, including ductal cancer in situ

• Benign (non-cancerous) breast conditions, including lobular cancer in situ

• Radiation treatments to the chest before age 30

• Physical inactivity, alcohol use and obesity

• Inherited gene mutations

• Risk factors for men are similar, and also include liver disease, Klinefelter’s syndrome, estrogen treatment and testicular conditions.

What are the signs and symptoms of breast cancer?

Breast cancer is caused by a growth of abnormal cells in the breast, which should die but don’t. It is often found when a new lump or mass is discovered. Signs and symptoms of breast cancer include:

• Lump or mass in the breast area

• Persistent changes to the breast, including:

Skin thickening
Nipple abnormalities/discharge
Skin redness or swelling

While most early-stage breast cancer does not have symptoms, it is important to quickly identify any changes to your breasts.

How do I screen for breast cancer?

Monthly self-breast exams are one way you can detect any breast changes that may need to be reported to or discussed with your healthcare provider. Self-screening is easy to do and can be incorporated into a regular routine. Learn how here.

Yearly mammograms are another way to identify any abnormalities. These low-dose breast X-rays are used to set a baseline and determine if changes have occurred. From 1989 to 2019, mammograms decreased breast cancer death rates in the U.S. by 42%. The American Cancer Society recommends the following mammography screening guidelines for women:

• 40-44 years old—Option of yearly mammograms
• 45-54 years old—Yearly
• 55 years and older—Yearly or every other year, and continue with overall good health and a life expectancy of 10 or more years

If you have a higher risk of developing breast cancer, you should create a screening plan based on your family history and risk level with your doctor, regardless of your age. This may include adding magnetic resonance imaging as part of regular screening.

What advancements are being made in breast cancer screening?

The FDA recently approved, iSono Health wearable 3D breast ultrasound, an automated whole-breast ultrasound system and intuitive software for image acquisition and analysis. The 3D breast ultrasound unit can automatically scan and analyze your entire breast in under two minutes. This unique system does not require a trained sonographer (someone who uses imaging equipment and soundwaves to form images of parts of the body) and allows for 3D visualization of the breast tissue. Breast ultrasound is a useful supplement to mammography to improve breast cancer detection in women with dense breasts. This system has the potential to improve breast cancer screening worldwide, especially in countries with limited resources.

Currently, iSono Health is conducting prospective case studies to validate the deep learning software that aids clinicians in localization and classification of breast lesions. This up-and-coming technology made for point-of-care physicians should be monitored by healthcare professionals as it could potentially be performed during an in-office visit by a breast surgeon or gynecologist.

What treatment options are available if I am diagnosed with breast cancer?

The earlier a diagnosis is made, the greater the options for treatment. This is another reason why self-screening and yearly mammograms are so important. Healthcare providers review each case for individual factors that assist in selecting the best treatment plan for each patient. Treatment options include the following, or a combination of them.

• Surgery to remove breast cancer involves two main types:

Breast-conserving surgery, also known as a lumpectomy, quadrantectomy, partial mastectomy or segmental mastectomy, is used to remove the part of the breast containing the cancer. It depends on where and how large the tumor is, as well as other factors, how much breast is removed. Sometimes surrounding normal tissue may also be removed as a precaution.

Mastectomy involves removing the entire breast, including the breast tissue and sometimes adjacent tissues. Some individuals may have both breasts removed. This is called a double mastectomy.

• Chemotherapy is the use of drugs to target and destroy breast cancer cells. The drugs can be administered intravenously or taken orally in the form of a pill. Chemotherapy can help those with breast cancer live longer and have a better quality of life, including increasing the chances of a cure, decreasing the risk of breast cancer returning and alleviating symptoms. Depending on the type and dose of chemotherapy drugs given, and the length of treatment, chemo drugs may cause side effects. Some of the most common side effects include hair loss, nail changes, mouth sores, loss of appetite or weight changes, nausea and vomiting, diarrhea, fatigue and nerve damage.

• Radiation therapy is a localized treatment that destroys cancer cells with high-energy rays delivered directly to the cancer. Potential side effects include skin changes and feeling tired, which can be managed with skincare techniques and creams, and rest and hydration to aid in the body’s repair and recovery process. Three types of radiation therapy utilized to treat breast cancer are:

External beam radiation therapy uses a machine called a linear accelerator that produces a radiation beam administered to the cancerous region outside of the body. The machine has parts that shield the normal organs from exposure, and others that target and focus the beam on the treatment site. Depending on the breast cancer’s stage and other factors, 5-36 treatments could be prescribed and are usually given five days a week.

Brachytherapy, or radiation inside the body, usually consists of 1-10 treatments administered over a couple of days.

Intraoperative radiation therapy is a less common treatment type consisting of a dose of radiation delivered at the time of breast cancer surgery.

What are the survival rates for breast cancer?

Survival rates are directly correlated with the stage of the disease. While the five-year survival rates for localized breast cancer (i.e., no cancer has spread outside of the breast) and regional (i.e., cancer has spread to nearby structures or lymph nodes) are 99% and 89%, respectively, the survival rate drops dramatically to 29% for distant disease (i.e., cancer has traveled to the bones, liver, lungs, etc.). Therefore, early screening, detection and diagnosis are extremely important and greatly improve your chances of breast cancer survival.

This article was co-authored by Toby Shutters, CMD, R.T.(R)(T) and Carrie Carter, RT (T).

Resources:

• Breast Cancer Statistics | How Common Is Breast Cancer?
• Breast Cancer | Breast Cancer Information & Overview
• Cancer Facts & Figures 2022| American Cancer Society
• Chemotherapy for Breast Cancer | Breast Cancer Treatment
• Chemotherapy for breast cancer – Mayo Clinic
• Get Involved to Stop Breast Cancer – National Breast Cancer Coalition
• Radiation Therapy | Radiation Treatment for Cancer
• Stop the Clock! – National Breast Cancer Coalition (stopbreastcancer.org)
• Surgery for Breast Cancer | Breast Cancer Treatment
• What Is Breast Cancer? | American Cancer Society

November is National Diabetes Awareness Month. Perhaps you, a family member, or a friend has diabetes. By reading this article, you can share this information and/or use it yourself to help manage diabetes. The first step to effective management is a good understanding of the diabetes disease process. From there, you can build upon that foundation to know signs or symptoms, how to monitor, knowing when to call your provider before symptoms worsen, importance of provider follow up, and most importantly adhering to the non-pharmacological (diet and exercise) and pharmacological prescribed regimens. This article will focus on four key questions surrounding diabetes and diabetes management.

1) How does diabetes affect Americans?
In 2019, 37.3 million Americans, or 11.3% of the population, had diabetes. Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents.1 1.4 million Americans are diagnosed with diabetes every year, making the U.S. #3 in countries with the highest rate of Diabetes.2

2) What are the different types of diabetes?

Type 1 Diabetes:
Type 1 diabetes is a disease that starts when the pancreas stops making enough of a hormone called insulin. Insulin helps the body use sugar from food as energy or store it for later use. If there isn’t any insulin, too much sugar stays in the blood. Over time, high blood sugar can harm many parts of the body. These include the eyes, heart, blood vessels, nerves, and kidneys.
Type 1 diabetes can occur at any age, but it usually starts in children or young adults. It’s a lifelong disease. But with treatment and a healthy lifestyle, people can live a long and healthy life.3

Gestational Diabetes:
Gestational diabetes is high blood sugar that first occurs during pregnancy. High blood sugar can cause problems for you and your baby. But with treatment, most women can control their blood sugar and have healthy babies. Blood sugar levels usually go back to normal after the baby is born.4

Prediabetes:
Prediabetes is a warning sign that you are at risk for getting type 2 diabetes. It means that your blood sugar is higher than it should be, but not high enough to be diabetes. Prediabetes is also called impaired glucose tolerance or impaired fasting glucose. Most people who get type 2 diabetes have prediabetes first.5

Type 2 Diabetes:
Type 2 diabetes is a condition in which you have too much sugar (glucose) in your blood. Glucose is a type of sugar produced in your body when carbohydrates and other foods are digested. It provides energy to cells throughout the body. Normally, blood sugar levels increase after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, which causes the body to absorb sugar from the blood and lowers the blood sugar level to normal.When you have type 2 diabetes, sugar stays in the blood rather than entering the body’s cells to be used for energy. This results in high blood sugar. It happens when your body can’t use insulin the right way. Over time, high blood sugar can harm many parts of the body, such as your eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).6

3) What are some potential complications associated with diabetes?
There is no cure for diabetes. Management of diabetes is important to prevent and/or delay long term complications (risk for getting other health problems). This is especially true if your blood sugar levels stay high. Over time, high blood sugar can damage many parts of your body. It can lead to a variety of problems, including problems with your:

Eyes: High blood sugar levels may cause temporary blurred vision. Blurry vision, floaters, or flashes of light may be a sign of diabetic retinopathy, which can lead to severe vision loss. Having diabetes also puts you at risk for cataracts and glaucoma.
Heart and blood vessels: High blood sugar damages the lining of blood vessels. This is called hardening of the arteries, or atherosclerosis. It can lead to stroke, heart attack, peripheral arterial disease, or heart failure. Erection problems can be an early warning sign of blood vessel disease and may mean a higher risk of heart disease.

Nerves: High blood sugar levels can damage nerves throughout your body. This damage is called diabetic neuropathy. There are different types of neuropathy. They may be caused by damage to nerves that sense things like pain or touch or that control things like your heartbeat, digestion, or blood pressure. Nerve damage can be painful, especially in the feet.
Feet and skin: You may have less feeling in your feet. This means that you can injure your feet and not know it. Common infections from blisters, ingrown toenails, small cuts, or other problems can quickly become more serious when you have diabetes.

Kidneys: High blood sugar can damage tiny blood vessels in your kidneys that help filter waste from your blood. This kidney damage is called diabetic kidney disease (sometimes called diabetic nephropathy). You may not have any symptoms until the damage is severe. Then you may notice swelling in your feet or legs or all over your body.

Infections related to diabetes: High blood sugar from diabetes can affect the body’s immune system. The immune system is the body’s natural defense system that helps fight infections.
People with high blood sugar from diabetes can be more severely affected by common infections, such as influenza and pneumonia. They also are more likely to be infected with unusual organisms, such as Gram-negative bacteria or fungi.7

4) What can you or someone you know do to help prevent and/or manage diabetes?

Prevention – You can help prevent or delay complications by keeping your blood sugar in a target range. You also need regular medical checkups to look for early signs of complications. If complications are treated early, the damage may be stopped, slowed, or reversed. 7

Management of diabetes –
• Follow up with your physician. Your physician will monitor lab values (hemoglobin A1C) (defined below), kidney function tests, and others as needed/warranted] on a routine basis. Eye and foot exams are also recommended to be performed every year.
• Stay up to date with recommended vaccinations.
• Keep up on latest education, treatments for diabetes. Diabetic educators are available to assist and educate with diabetes. The ADA (American Diabetic Association) is a great resource.
• Monitor your blood sugar based on your physician’s treatment plan.
• Understand the signs and/or symptoms of low and/or high blood sugar.
• Diet, nutrition, exercise – follow your physician’s suggestions. Coaches, Dieticians, Care managers, and/or Diabetic educators are available to assist, check with your health plan for benefit coverage.
• Take your medications/insulin as prescribed by your physician.
• Utilize your smart phone application(s) that help with managing Diabetes.
• Joining a support Group (online and/or in person sessions) may be beneficial in connecting with others that are affected by Diabetes.

• List of Sources:
  1) American Diabetes Association. Website url: https://diabetes.org/about-us/statistics/about-diabetes. Accessed 10/19/22
  2) Medical News Today. Website url: https://www.medicalnewstoday.com/articles/diabetes-rates-by-country#type-2. Accessed 10/23/22
  3) Healthwise: Website url link: Type 1 Diabetes (healthwise.net). Accessed 10/19/22
  4) Healthwise: Website url link: Gestational Diabetes (healthwise.net). Accessed 10/19/22
  5) Healthwise: Website url link: Prediabetes (healthwise.net). Accessed 10/19/22
  6) Healthwise: Website url link: Type 2 Diabetes (healthwise.net). Accessed 10/19/22
  7) Healthwise: Website url link: Diabetes Complications (healthwise.net). Accessed 10/19/22
  List of additional Resources:
  1) https://www.heart.org/en/health-topics/diabetes/diabetes-tools–resources
  2) https://professional.diabetes.org/search/site?f%5B0%5D=im_field_dbp_ct%3A32&retain-filters=1