UAB Magazine Weekly - Features on Health Care
UAB Exercise Physiologist Evaluates Popular “Toning” Shoes
By Matt Windsor
When UAB exercise scientist Jane Roy, Ph.D., sees the sexed-up commercials for new “toning” shoes from the likes of Reebok and Skechers, she can’t help but think about something a little less attractive: ankle weights.
Toning shoes feature a curved sole that is intended to re-create the instability of walking on a less stable surface, like sand. Forcing the body to overcome that instability, shoe manufacturers claim, turns a normal walk into a whole-body workout capable of sculpting the legs, bottom, and chest. (These areas get far more screen time in commercials than the shoes themselves.)
The slick ads and celebrity endorsements have fueled blockbuster sales—toning shoes are now the fastest-growing corner of the athletic shoe market. But despite all the hype, the craze is reminiscent of “the ankle-weight fad of the 1980s and ‘power walkers’ swinging hand weights,” Roy says. For modern toning shoes and their fitness cousins, the idea is the same, she notes: “to make movement more difficult and challenging, and to increase energy expenditure.”
UAB Comprehensive Diabetes Center Director Sheds Light on Common Myths
By Tara Hulen
Though diabetes is prevalent in Alabama—one recent study placed the state in a Diabetes Belt stretching across the southern United States—there are many myths about its causes and treatment options. And these misconceptions often lead people to make bad decisions based on bad information, says Anath Shalev, M.D., director of the UAB Comprehensive Diabetes Center and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism. Here, Shalev shares the truth about the most common myths.
Myth: "Sugar or eating sweets is the cause of diabetes."
It’s not the sugar; it’s the effect of too many calories of any kind, because obesity is a major risk factor for type 2 diabetes. Lack of exercise is another major contributor to type 2 diabetes, especially a sedentary lifestyle combined with large portions of high-caloric, fatty, food. But the scientific answer about the cause of diabetes is far more complicated than whether you have fried chicken, fries, sweet tea, and banana pudding at lunch, then take a nap instead of a walk.
Fact: There is no magic bullet for treating or avoiding type 2 diabetes.
Shalev says the best prescription to help avoid type 2 diabetes is simply to eat a healthy diet and maintain a healthy weight and exercise.
A number of different genetic factors have started to be unraveled and there are different types of diabetes. “Type 1 diabetes is caused by an autoimmune process that destroys the beta cells (which produce insulin) in the pancreas. With that, the sole source of insulin —the hormone responsible for maintaining normal blood sugar—is destroyed,” Shalev says. “Type 2 diabetes, on the other hand is the result of insulin resistance (which is most often caused by obesity) and beta cell dysfunction.”
Myth: “Kids with type 1 diabetes can’t have anything sweet.”
While in the past people with diabetes were discouraged from having any sweets, advances such as fast-acting insulin therapies and different monitoring protocols allow for the occasional treat and make meal planning easier for children and adults, Shalev says. A child can have a piece of birthday cake, for example, as long as parents dose him or her properly beforehand and monitor closely. “It’s an intensive insulin regimen, so patients check more frequently, but they gain more freedom,” Shalev says. “It is a lot of work, but they can enjoy the simple pleasures in life.”
Myth: “Only obese people get diabetes.”
“While obesity is the strongest risk factor for type 2 diabetes, patients with type 1 diabetes or other less common forms of diabetes are often very lean,” Shalev says. “I have seen several triathletes who are type 1 diabetics.” Patients such as these who participate in high-intensity sports or a strenuous exercise programs should have a careful monitoring and dosing plan created in consultation with an endocrinologist, she adds.
Myth: "Type 1 diabetes, in the past often called juvenile diabetes, only affects the very young."
In fact, type 1 diabetes can affect people at any age, though it is more common for younger age groups. “Excessive thirst, urination, and weight loss should always be warning signs and warrant a doctor’s visit,” Shalev says.
Myth: “There is nothing you can do about type 2 diabetes.”
Some people look at their family tree and their own waistline and assume they are doomed to get diabetes. “Some people will have a constellation of genes that put them at a higher risk,” Shalev says. “But that doesn’t mean they will develop diabetes. In most cases, type 2 diabetes can be delayed and sometimes even prevented with adequate lifestyle modifications, including exercise and healthy diet. Monitoring and early intervention are important to improve the overall outcome.”
Myth: “Starting insulin injections in type 2 diabetes is the beginning of the end.”
“It’s a myth that the prognosis will just get worse and worse once you need insulin,” Shalev says. Still, patients often panic and resist when told the injections are necessary. Actually, it’s just the next logical step if oral medication doesn’t work, Shalev says.
By helping to control blood sugar levels better, insulin can help patients avoid complications such as stroke and heart attack, Shalev says. Emerging research suggests that starting insulin treatment early in the disease process also can reduce strain on the beta cells. “These cells are under continuous stress to produce more and more insulin, and at some point they just can’t do it anymore. That’s when oral medications are no longer sufficient,” Shalev explains. Injections “give beta cells a break.”
She adds that the need for insulin injections is not always permanent. Some patients with type 2 diabetes can eventually stop taking insulin if they also make lifestyle changes to help with their disease.
UAB Clinic Offers Centralized Care
By Jo Lynn Orr
Kirklin Clinic and the UAB School of Nursing aims to change that by replacing the poorly coordinated, episodic, acute-care focused model with a more comprehensive, proactive, team-based approach that engages patients as partners in their own health care.Sometimes a trip through the health-care system can seem like an endurance contest, requiring multiple visits to a range of specialists and other health-care providers in offices all over town. But a unique partnership between primary-care physicians at UAB’s
Six physicians at the clinic’s Internal Medicine-1 practice have joined together to establish a Patient-Centered Medical Home (PCMH). The concept has gained popularity in recent years and is a key component of the health-care reform measures passed by the federal government in 2010. A PCMH coordinates all patient care, including referrals to subspecialties such as cardiology, orthopedics, and rheumatology; following up with patients who have been hospitalized; and providing education on managing chronic diseases.
At UAB’s PCMH, all patient information—including X rays, lab results, and hospital and subspecialist records—is available electronically at the touch of a computer keyboard, which allows all providers access to crucial information.
Nurses and Nuance
Because managing chronic disease is the medical staple of primary-care offices, the Kirklin Clinic medical home staff includes a full-time nurse practitioner and two part-time nurse practitioners who are members of the School of Nursing faculty. “In addition to their advanced nursing education and experience, they have experience in teaching, which augments the medical home’s patient education efforts relating to chronic diseases,” says Stuart Cohen, M.D., who heads up the PCMH group and is medical director of Prime Care Internal Medicine at the Kirklin Clinic.
Helping Teens Take over Diabetes Care
By Cary Estes
Carol Dashiff, right, is testing a new form of group support and education to help teens with diabetes take responsibility for their own care and to help their parents cope with the anxiety surrounding this difficult transition period.
The stretch of road where adolescence merges into young adulthood is one of the most awkward intersections along life’s highway. For teens, this transition period involves countless lessons to learn and, undoubtedly, mistakes to make. Parents are also in for an education—they must master the difficult art of letting go.
This process can be especially difficult for families dealing with chronic diseases such as type 1 diabetes. Parents accustomed to managing or monitoring insulin injections and regulating diet have to trust their increasingly independent teens to manage more on their own. And since teens with diabetes are just as likely to be forgetful and overconfident as any other adolescent, their parents tend to be especially anxious. This in turn can lead to tension and turmoil during the teen years—especially the middle years, when teens are more and more away from home.
UAB School of Nursing professor Carol Dashiff, Ph.D., hopes to help teens and their families better cope with this difficult process through a new form of group support and education. In a pilot study, she is working with teens age 15 to 17 and their parents in a multifamily format with twin goals: helping adolescents improve their ability to manage their diabetes and helping their parents become less anxious and offer non-obtrusive support.
High-Tech Hearing Aids Put Seniors Back in the Conversation
By Dorothy Foltz-Gray
Audiologist Cara Snable says that advances in technology have made modern hearing aids virtually undetectable—and have vastly improved sound quality.
Five years ago, Ida, 68, a widow in Fort Payne, Alabama, began noticing she had to work hard to follow conversations. The pleasure of discussion had become a chore. “I knew someone was speaking, but I was missing words,” she says. “When I couldn’t hear my grandchildren, that motivated me to do something.” At UAB’s Kirklin Clinic, audiologist Cara Snable fitted Ida with tiny hearing units on each ear that have made a big difference in her quality of life.
New audio technologies have shrunk hearing aids to the point that they’re almost undetectable, while sound quality has improved tremendously, Snable says. And that’s good news for the estimated 20 to 40 percent of older adults with some sort of hearing impairment, notes UAB geriatrician Andrew Duxbury, M.D., a professor in the Division of Gerontology, Geriatrics, and Palliative Care.
It’s important to keep in mind that hearing well isn’t a perk—it’s a health necessity, Duxbury says. A person with hearing loss may not detect oncoming traffic as he or she crosses a road, for example. “When people feel less safe, they shrink their world,” says Duxbury. “They stop driving and socializing. If you cannot hear properly, you become isolated from what is going on in the world, from your family, and from your peer group.”