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Using a Low Carb Diet to Help Treat Type 1 Diabetes

Lisa Feierstein Children's Health, Diabetes Leave a comment   , , , ,

For children with type 1 diabetes, snack time isn’t always simple. Diet is an important part of a diabetes management plan to help avoid blood sugar spikes. But new research by endocrinologists at Boston Children’s Hospital suggests that food can be used as a powerful tool to help keep blood sugar under control.

low carb veggies

About the Study

Endocrinologists Dr. David Ludwig and Dr. Belinda Lennerz from Boston Children’s Hospital conducted an observational study on diabetic children who follow a very low carb diet. The children’s very low carb diets included on average only 36 grams of carbs a day.

The parents of these children were members of a Facebook group for families with diabetic children. The observational data was confirmed by the child’s doctors and analyzed using the latest techniques.

Here are just 3 possible benefits of a very low carb diet for children with diabetes.

Greater Glycemic Control

Children in the study had what the researchers called “exceptional” glycemic control. The common target range for hemoglobin A1c values are below 7%. However, children in the study had average hemoglobin A1c values at 5.67%, within the normal range for children overall.

Researchers are very excited at the prospect of diabetic children achieving normal hemoglobin A1c values with the help of diet. More research is needed to confirm the connection, but the possibility is an amazing development in the treatment of type 1 diabetes.

Less Complications

The study found that children on the very low carb diet had lower hospitalization rates than usual. Only 1% of the children were hospitalized for hypoglycemia and only 2% were hospitalized for diabetic ketoacidosis.

Boost Mental Health

High or low blood sugar is known to negatively impact mood, mental resilience, and overall brain health. For children with diabetes prone to high or low blood sugar spikes, mental health is especially important. For more information and other ways to improve mental health in your diabetic child, see our blog on mental health for teens with type 1 diabetes.

Diet can be a powerful tool in the management of type 1 diabetes.

Ask your doctor about whether a low carb or other specialized diet could be a good addition to your child’s diabetes management plan.

Resources

Very Low Carb Diet can safely curb blood sugar in type 1 diabetes, study suggests – Boston Children’s Hospital
Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet (Original Research) – Pediatrics
New Recommendations from the ADA: Management of Type 1 Diabetes In Children and Adolescents
Added Sugar Amounts Now On Nutrition Facts Panel


Wearable Asthma Informatics – Future of Asthma Care in Children

Lisa Feierstein Asthma, Breathe EZ, Children's Health Leave a comment   , , , , , ,

wearable asthma informaticsAn incredible amount of research has gone into childhood asthma in the last few years, leading to deeper understanding of the condition and better care for children with asthma.
New technology hopes to help predict a child’s asthma attacks before they occur. A wearable asthma informatics system is under development as part of an initiative of the US National Institutes of Health.

What is PRISMS?

This new asthma monitoring system is part of the PRISMS Initiative, which stands for Pediatric Research Using Integrated Sensor Monitoring Systems. A team of researchers from University of California-Los Angeles and the University of Southern California are developing an integrated platform of wearable sensors that can gather data about the environment of children with asthma and help predict asthma attacks.

How does the Asthma Informatics Platform Work?

The platform connects a variety of sensors and equipment using bluetooth and wi-fi, compiling all the data for health professionals. The platform includes the following:

Smart Watch: acts as a hub connecting to all other devices during the day and collects bioinformatics like activity level and heart rate.
Air Quality Sensor: attached to backpack or placed nearby and measures very small particulates in the air that can make asthma worse.
Medication Sensor: receptor in inhaler that records when medicine is taken.
Spirometer: measures the volume of breath twice a day, data is automatically sent to the system.
Smartphone app: includes questionnaires to gather data from the child about their environment.

How will PRISMS help asthma care?

With the data that PRISMS collects, medical professionals can identify patterns and help families identify asthma triggers. In the future, a platform like PRISMS could send alerts when sensors detect that an asthma attack is likely.

Overall, using the data from all children in the study, researchers hope to find new trends in childhood asthma. Patterns realized from the data of the children in the study may lead to new treatments and new environmental policies to keep all children healthy.

New Technology will bring better care for children with Asthma

In the future, portable medical health devices may be commonplace, and the data collected from systems like PRISMS will help make asthma care better than ever.

Resources

Predicting Asthma Attacks in Kids – Chemical & Engineering News
PRISMS Initiative – National Institutes of Health
Got Asthma or Allergies? There’s an App for That!


Tips For Managing Type 1 Diabetes at School

Lisa Feierstein Children's Health, Diabetes Leave a comment   , , ,

Back to School 3

 

The first day of school will be here before you know it. If your child has type 1 diabetes, there should be a few extra items on your back to school checklist to make sure that your child and their school are ready for the year ahead.

Here are a few important tips for an easy adjustment back to school:

1. Make a Diabetes Management Plan

Your child’s Diabetes Management Plan is an essential tool. Work with your doctor to draft a plan containing all important information concerning your child’s diabetes care. Include all medication details, symptoms of low blood sugar, target blood sugar range, and other important details those caring for your child should know.

2. Connect with the school nurse and other staff

Provide a copy of your child’s Diabetes Management Plan to the school nurse, administration, and all of your child’s teachers, coaches, and other supervising adults. If your child’s school does not have a full time nurse, figure out which staff members are best equipped to help if the nurse is not present.

All your child’s teachers should be aware of symptoms of low blood sugar, what your child needs to do to manage their blood sugar, and what help your child will need with those steps, if any.

In addition, your child should wear a medical notification bracelet or necklace that indicates their diabetes diagnosis. This guarantees that even substitutes or other rotating staff will be aware of your child’s condition in case of an emergency.

If needed, consider creating a 504 plan. A 504 plan is an official document that details the exact responsibilities of the school and ensures that your child has the same opportunities as all other students.

3. Pack their backpack with the essentials

Make sure your child has the tools they need for diabetes management during the school day. Build a compact kit full of testing supplies, antiseptic wipes, and backup insulin, as well as glucose tablets or other fast-acting snacks for raising blood sugar.

4. Get your child involved (as age appropriate)

As your child gets older, they should take on more responsibility for their diabetes care. Depending on the age of your child, help them identify their symptoms of low blood sugar. When your child has a greater understanding and more responsibility in their own care, they will have more confidence in the face of adversity at school and beyond.

Give your child the foundation they need to succeed in the New Year

With careful preparation, you can ensure that your child gets the most out of their school days, minimizing the stress from managing their diabetes.

Additional Resources

Tips for Managing Diabetes at School from the CDC
Monitoring Diabetes at School
Diabetic Tips: Making Sure It’s in the Bag


Back to School Tips for Kids with Asthma

Lisa Feierstein Asthma, Breathe EZ, Children's Health Leave a comment   , , ,

back to school 2It’s that time of year again. A fun summer has come and gone and it’s time to start thinking about back to school. While stocking up on school supplies, don’t forget to prepare your child’s asthma plan for the new school year.

The American Lung Association has published a “Back to School with Asthma Checklist” for a smooth adjustment back to school for children with asthma. With careful preparation, your child can focus on enjoying their school days without worrying about their asthma.

Here are some tips for making this school year a good one:

1. Schedule a checkup before school starts

Summer is the perfect time to fit in a doctor’s appointment, since your child’s schedule may be less busy. Be sure to bring any forms required by your child’s school so that you can be prepared for meeting with the school nurse (See Tip #2 below).

Discuss how your child’s asthma treatment plan has been working in the past year. In particular, make sure your child knows how to use their inhaler and spacer properly.

Review your child’s asthma triggers, and make a plan to help your child avoid exposure at school. A summer checkup is a great time to discuss any troubles with allergies, which are common in children with asthma.

2. Get the school nurse on board

If your child is starting a new school, or has a recent asthma diagnosis, make sure that the school nurse is part of your child’s asthma team. First, make sure all necessary forms documenting your children’s medication are submitted timely so they can be processed before school starts.

With the help of your child’s doctor, write an Asthma Action Plan and share it with the school nurse. If your child’s school does not have a full time nurse, include the receptionist or other staff members in the Asthma Action Plan as well.

3. Don’t forget after school activities

If your child participates in an after-school activity, make sure your child’s coach or activity leader has access to your child’s Asthma Action Plan. It’s very important that those supervising your child know what an asthma emergency looks like and how best to help your child.

Make back to school easy with these tips

After a fun summer, transitioning back to school can be hard for many kids. If your child has asthma, keeping these tips in mind can make it easier.

Additional Resources

Back to School with Asthma Checklist – American Lung Association
Does Back to School Mean Back to Allergies?


New Generics Available for 3 Asthma Medications: Advair Diskus, Ventolin, and Proair

Lisa Feierstein Asthma, Breathe EZ Leave a comment   , , , , , , ,

Asthma Rescue InhalerNew Generics available for 3 Asthma Medications: Advair Diskus, Ventolin, and Proair

Having asthma or any other chronic health condition can be costly. According to a study from the Annals of the American Thoracic Society, people with asthma spend on average around $1,800 a year on prescription medications alone.

Until recently, the options for asthma medications were limited to brand names only. But new generic versions of common asthma medications Advair Diskus, Ventolin, and Proair have been approved by the FDA and are now available as low-cost alternatives.

What is a generic?

Once a patent expires, other companies are allowed to make their version of the medicine. These alternative versions are called generics. Though generics can take a while to get developed, once they are approved by the FDA, they can make a large impact on the market.

Most generic medications are just as effective as their name-brand counterparts, but come with lower price tags. Switching to a generic can allow you to save money while still enjoying the same medical benefits.

All about the new generic inhalers

Advair Diskus is a long-acting bronchodilator that is often prescribed for asthma. Featuring a combination of fluticasone and salmeterol, Advair works as a preventative treatment. This new generic is more similar to Advair’s formula, making the switch to its generic alternative more feasible.

Ventolin is a short-acting beta agonist that is commonly prescribed as a rescue inhaler for acute symptoms. Though one generic, Proair (also known as albuterol) has been available for several years, new generic versions produced by GlaxoSmithKline have been approved by the FDA. With more new options entering the market, prices for quick-relief inhalers may drop overall.

How can I switch to a generic inhaler?

If you or your child are currently taking Advair Diskus, Ventolin, or Proair ask your doctor about switching your prescription to a generic version. If your provider feels the medicines are similar enough, they may be willing to offer you the substitute. In general, asking about generic versions whenever you receive a prescription can help you save money.

Explore affordable medication options

Prescription medications for your chronic asthma are necessary to prevent exacerbating your condition. Switching to generic can be a great way to save money while still keeping your asthma treated and under control.

Additional Resources


New Type of Immune Cell Discovered in Connection to Type 1 Diabetes

Lisa Feierstein Diabetes Leave a comment   , , , , , ,

immune cellFor many years, researchers have theorized that type 1 diabetes is an autoimmune disorder, where the body attacks healthy insulin producing cells in the body instead of bacteria and viruses. However, the exact reason why the autoimmune response occurs had not been discovered.

Recently, researchers at John Hopkins have discovered a new type of immune cell that may be the source of the autoimmune reaction that causes type 1 diabetes.

How the immune system works

The immune system consists of T cells and B cells, known as lymphocytes. These cells seek out, identify, and destroy antigens that are harmful for the body, including bacteria and viruses.

When an immune cell identifies an antigen, it alerts other cells to create antibodies and eliminate the threat. However, when immune cells wrongly identify a healthy cell in the body as a antigen, it triggers an autoimmune response, causing disorders including arthritis, multiple sclerosis, and type 1 diabetes.

What is the hybrid X cell?

However, groundbreaking new research has identified a different sort of hybrid immune cell with properties of both T cells and B cells. Researchers call these X cells. The dual structure of the X cells means the cells can activate both T and B cells, making them uniquely powerful actors in the immune system.

What is the connection between X cells and Type 1 Diabetes?

X cells are able to create a special protein called x-Id peptide. Scientists believe this protein mimics the signature for insulin, which wrongly identifies insulin as a dangerous antigen. Since X cells have a  hybrid structure, both T and B cells are alerted to attack insulin-producing beta cells in the pancreas.

Researchers compared the immune cells of both patients with and without type 1 diabetes. While both diabetic and non-diabetic patients had X cells, diabetic patients had substantially more X cells present.

In addition, only diabetic patients had X cells with the genetic code for producing the x-Id peptide. This leads scientists to believe that the production of this protein could be connected to the diabetic autoimmune response .

What are the next steps for diabetes research?

With the discovery of X-cells and the x-Id peptide, it is possible that a early detection procedure for type 1 diabetes could be developed. The genetic code for the production of the x-Id peptide in X cells could serve as a bio-marker, indicating a higher chance of developing the condition. Early detection can lead to better treatments and healthier lives for children with type 1 diabetes.

Researchers also explained that these discoveries about the possible mechanics of type 1 diabetes has pushed science closer to an eventual cure. Immunotherapy could be the new frontier of diabetes treatment.

Scientific discoveries lead to better diabetes treatment

With the effort of countless researchers, we have gained a deeper understanding of how diabetes works in the body. This greater understanding helps patients with type 1 diabetes get better care and pushes the medical field closer to a cure.

Additional Resources

Medical News Today – Could this unusual immune cell be the cause of type 1 Diabetes
The Scientist – Novel Type of Immune Cell Discovered in Type 1 Diabetes Patients
Five Misconceptions About Diabetes
5 Natural Remedies to Aide Diabetes


It’s Not Just Water Vapor: Risk of Secondhand Vapor Exposure

Lisa Feierstein Asthma, Breathe EZ, Children's Health Leave a comment   , , , ,

It is hard to imagine that many people still believe that the vapor produced by e-cigarettes is harmless. They believe that the sweet smelling cloud produced by someone vaping nearby is just water vapor. The secondhand vapor from e-cigarettes actually contains many of the same chemicals that are found in traditional ones. These contaminants include propylene glycol, vegetable glycerin, nicotine and many different flavoring agents.

E-Cigarettes: Continued Health Threat for YouthNo one should be inhaling any of these toxic substances because they will all cause inflammation in your lungs. Asthma sufferers and those with allergies are especially at risk of exposure to lung irritants. Studies by the National Academies of Science indicate that e-cigarette use increases asthma symptoms such as coughing and wheezing.

The good news is that e-cigarettes are different from traditional cigarettes in one way, they only emit vapor when they are being used. 

New Research Based on the Florida Youth Tobacco Survey

The Florida Youth Tobacco Survey data (link to data) was the basis for some recent research to determine the connection between electronic nicotine delivery systems (ENDS) and asthma symptoms. The survey data indicates that e-cigarette use was up almost 600% from 2012 to 2018 in youth ages 11-17. The rate of youth trying e-cigarettes is also up over 350% in the same date range.

Survey Data Demographics:

  • Study based on surveys from almost 50,000 youth and teens.
  • 33,500 respondents were in High School and another 36,000 were in Middle School.
  • Respondents were evenly split by gender.
  • One-third identified as Hispanic, one-third are white, and one-fifth as African American.
  • About 75% of survey participants lived in large or mid-sized metro areas.
  • The research focused on the 11,000 respondents diagnosed with asthma.

 

Study Definition of Exposure to secondhand vaping aerosol:  Exposure to someone vaping either in the same room or in a car within the last month.

Secondhand vaping exposure increased the likelihood of an asthma attack by 27%, regardless of whether the children themselves smoked or vaped.


Tips for Parents

Juul e-cigaretteThe statistics on the rates of vaping are staggering. In 2018 the CDC reported that 20% of high school students vaped in the past 30 days. Smoking rates in the same age group are actually lower at only 8 percent. The rate of teen smoking continues to fall; it is 50% lower than it was in 2011.

The national rate of smoking in adults is 14% (2017), down from 20% in 2005. In contrast only 2.8% of adults use e-cigarettes.

Nicotine is toxic to children, even at minimal exposure levels. Their developing bodies are even more susceptible to environmental pollutants like nicotine and the other dangerous components of e-cigarette vapor.

  • Encourage your children to avoid secondhand vaping aerosols just like secondhand smoke from traditional cigarettes.
  • Educate family members and friends who vape to do so away from children and especially not in enclosed spaces.
  • Communicate with your children about the dangers of smoking and vaping so they know the risks.

 

If your child has asthma, consider adding limiting exposure to vaping in your child’s asthma action plan – due to the possibility of it triggering an asthma attack.

Additional Resources


Mental Health for Teens with Type 1 Diabetes

Lisa Feierstein Children's Health, Diabetes Leave a comment   ,

Research shows that diabetics are at higher risk for mood disorders and other mental illness. During the often tumultuous teenage years, it’s important for parents and caregivers of teens with diabetes to understand how diabetes and mental health interact.

Why mental health is crucial for teens with diabetes

teen mental healthAccording to the American Diabetes Association, diabetic teens tend to show 2-3 times the rate of psychological distress than their peers without diabetes.

Living with diabetes is not easy and can add to the other stress that teens experience. Stress has a negative effect on diabetes, leading to a feedback loop if both a teen’s stress and diabetes are not managed correctly.

Here are some tips for supporting the mental health of teens with diabetes.

Encourage independence

Every teenager wants to be more independent, including those with diabetes. New technology can make it easier than ever for teens to take on a larger role in their diabetes care. Cell phone apps can sync to continuous glucose monitors (see our previous blog “The 411 on CGM” for more information), allowing teens to take initiative while their parents are kept in the loop with automatic updates.

Prioritize self-care

The busy lives of teens can leave no room for personal time to recharge. Especially during stressful times like finals, encourage your teen to take short breaks. Spending a few minutes to take a walk, listen to music, or do something else enjoyable can do wonders to lower stress.

Build a foundation of self-esteem and acceptance

Insecurity can cause teens with diabetes to try and hide their condition from peers. From a young age, educate your child about diabetes and how each part of their diabetes management plan is important. This will instill self-confidence and a greater sense of self-understanding in your child.

Be aware of warning signs

Early detection of psychological distress is important, especially for teens with diabetes. If you notice your teen has lost interest in their favorite activities or has unexpectedly lost or gained weight, check in with your teen and consider getting the help of a professional if needed.

Take care of your own mental health as a caregiver

Several studies have shown that caregivers of children with diabetes have a higher likelihood of depression. While caring for your child, don’t neglect your own mental health. Try joining a local support group for parents of children with type 1 diabetes. Talking with other parents in the same situation can do wonders to boost your outlook.

Wellness of body and mind for diabetic teens is possible

The teenage years are the best time to develop good habits for both physical and mental health. For teens with diabetes, these good habits allow a smooth transition into self-sufficient diabetes management in adulthood.

Additional Resources

ADA Position Statement

JDRF (Triangle/Eastern NC ) – Support Resources for Parents of Children with Type 1 Diabetes

CDC: Diabetes & Mental Health

Teen Focus: Dangerous Duo Type 1 Diabetes and Drinking

Can Diabetes Give You The Blues?

The Lowdown on Stress and Diabetes


The Dangers of Hypoglycemia – New Educational Resources

Lisa Feierstein Diabetes Leave a comment   , , ,

One of the biggest fears of people living with Type 1 Diabetes (T1D) and their caregivers is a low blood sugar event, also known as hypoglycemia. While people with T1D may not recognize the signs of dropping blood sugar, most know how dangerous it can be if left unnoticed or untreated.

What is Hypoglycemia?

  • Low blood glucose levels – outside of your target range
  • Typically less than 70 mg/DL
  • Triggers your fight/flight response due to a release of adrenaline
  • If left untreated, may lead to seizure or coma.

What is Hypoglycemia Unawareness?

Diabetes Blood Glucose TestingHypoglycemia unawareness is a complication of T1D where the patient misses the typical symptoms of a blood sugar drop (palpitations, sweating, anxiety, etc.). When their body does not release adrenaline there are no warning symptoms and then they are at risk for life threatening complications.

Online Interactive Resource – Hypoglycemia Education

We recently came across a new educational resource about hypoglycemia from the ‘Diabetes Sisters.’ This online resource includes basic information about hypoglycemia as well as video-based and interactive learning, infographics and more. Topics include “What Does Hypoglycemia Feel Like?” and “How to Talk to Your Doctor About Hypoglycemia.”

Each topic includes videos, quick tips and a quiz to test what you’ve learned. Visit the website to test your knowledge and share with family and friends so that they can be familiar with the signs of low blood sugar and help you if needed. It is important that people with diabetes know the risks of hypoglycemia as part of your diabetes management plan.

Additional Resources

Diabetes Sisters – visit this online community to read stories of how others deal with the real life challenges of diabetes.

411 on the CGM

American Diabetes Association – Hypoglycemia (Low Blood Glucose)


Asthma and Allergy Awareness Month 2019

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment   , , ,

World Asthma Day - Stop for AsthmaEach May we celebrate Asthma and Allergy Awareness month. Additionally, the first Tuesday of May is also designated as World Asthma Day. This year it falls on Tuesday May 7.

The theme for this year’s World Asthma Day is ‘Stop for Asthma’. Each year the Global Initiative for Asthma (GINA) suggests activities to support asthma awareness in our communities.

Over 6 million children, and 26 million people total live with asthma in the United States.

We see the impact of asthma in missed days of school and increased emergency room visits due to out of control symptoms. Additionally sufferers often experience increased complications during respiratory illnesses like cold and flu.

Constant evaluation and adjustment of treatment protocols is the key to controlling asthma. Since there is no cure for asthma the goal is management of symptoms to improve quality of life.

Visit the CDC website for helpful resources for people with asthma, their friends and families, teachers, and coaches. Resources include tips for creating and updating your asthma action plan and how to use your inhaler. Check out the Meet the Challenge page for recommendations on asthma and physical activity.


Active Healthcare Donates Nebulizers

Active Healthcare Nebulizer Donation to WCPSSActive Healthcare recently donated a significant number of nebulizers to the Wake County Public School System. The nebulizers will be used in elementary schools by school nurses to help students manage their asthma.

Active Healthcare’s Back 2 Life Program works with local medical practices and community partners in the Triangle area of North Carolina to help facilitate various medical equipment supplies to needy patients.

We collect and refurbish the donated equipment. Visit our website donate nebulizer equipment you no longer need.

Additional Resources

World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. A staggering 300 million people worldwide live with asthma.

World Asthma Day - Stop for Asthma

Global Initiative for Asthma (GINA) – sponsor of World Asthma Day

The CDC website has tons of resources for people with asthma and their families.

Test your asthma knowledge for Asthma and Allergy Awareness month: 7 Asthma Myths


Summer Camp for Everyone – Even Kids with Asthma!

Lisa Feierstein Asthma, Breathe EZ, Children's Health Leave a comment   , ,

Many families may already be planning for the upcoming summer. Attending camp is one of many rites of passage for children, and those with asthma shouldn’t have to miss out. We’ve previously shared tips for families of children with asthma on choosing and preparing for summer camp. This year we’d like to highlight a couple of summer camp options in North Carolina.

Camp Victory Junction: Heart/Lung/Kidney – July 14 – 18 2019

Children with chronic medical conditions, such as asthma, and others with serious illnesses that would preclude them from attending a traditional summer camp program should look into the options at Camp Victory Junction.

This summer, children ages 6 to 16, with asthma can register for Camp Victory Junction in Randleman, NC. The week of July 14-18 is designated especially for kids with heart, lung, kidney, and immunological diseases. Camp Victory Junction provides a typical camp experience within a medically-safe environment.

Visit the camp website (https://victoryjunction.org/ ) for additional information about the schedule and registration.

Camp Coast: Helping Kids Control Their Asthma

The Vidant Medical center Pediatric Asthma program and Children’s Miracle Network in Greenville NC sponsor Camp Coast. This program includes day camps at a variety of locations like school and wellness centers. Weekend retreats are also offered throughout the year.

The fall weekend retreat is for children ages 7 to 17, along with their parents. This unique program includes all the activities you’d expect to experience at camp, along with educational sessions about asthma and tips to improve control of the disease.

Camp Coast is staffed by volunteer physicians, nurses and respiratory therapists.  These respiratory professionals are on hand to provide medical care and also observe campers’ medication administration to ensure proper usage for optimal treatment.

Transportation from Greenville to the camp location in Columbia, NC is available.

Visit their website for additional information and to contact camp staff about registration information. (https://www.vidanthealth.com/Programs-Support/Childrens/Camps)

Additional resources:

Children’s Asthma Camps – Find A Camp – Nationwide

5 Keys to a Fun and Safe Summer Camp Experience for Kids with Asthma and Allergies


New OTC Primatene Mist Approved By FDA

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment   , , , ,

Should you consider using it as part of your Asthma Treatment Plan?

Primatene Mist ® was removed from the market back in 2011 due to the propellant used in the inhaler medication. Late last year the FDA approved a new over-the-counter version of the drug, which is now widely available. This new version uses the same active ingredient but does not contain CFCs (chlorofluorocarbons) which are known to deplete ozone in our atmosphere.

Asthma Experts Urge Caution

A number of asthma organizations have voiced strong concerns over the new Primatene Mist inhaler since it creates the impression that the management and treatment of asthma is a do-it-yourself proposition. Asthma is a chronic condition that requires ongoing management with your healthcare provider – whether it is mild, moderate or severe.

As a chilling reminder: 10 people die every day from asthma related complications

The active ingredient in Primatene mist is racemic epinephrine. This medication is not a recommended asthma treatment and can also give a false sense of control by masking asthma symptoms.

Lack of control and the often associated over use of quick-relief medications leads to respiratory complications and sometimes death in people with asthma. Experts worry that this new over-the-counter medication option will only escalate that scenario. Out of control symptoms followed by over use of a medication that masks symptoms can in turn lead to life-threatening complications.

FDA Approval and Recommendations

Asthma Rescue InhalerFDA officials approved the new medication in hopes of providing another cost effective treatment option, especially to patients with mild asthma. The active ingredient in the medication is the same, just a new propellant to allow it to be administered via a metered dose inhaler and with new administration instructions.

The FDA has only approved the medication in patients over 12 years of age. They caution that the medication should only be used by those already diagnosed with asthma, and not to treat symptoms such as wheezing, chest tightness or shortness of breath that may be related to other conditions.

The Manufacturer Weighs In

Amphastar, the manufacturer of Primatene Mist, indicates the over-the-counter medication is to be used for “temporary relief of mild symptoms of intermittent asthma” on their product website.

A Plan for Asthma Control

Remember to always check with your healthcare provider before making a change to your or your child’s asthma treatment regime and asthma action plan. Check out these additional resources for more information about this new medication, tools to navigate treatment options and a refresher on understanding asthma control.

Additional Resources

FDA – Safely Using the Newly Available OTC Asthma Inhaler Primatene Mist

Shared Decision Making Tool developed by the American College of Allergy, Asthma, and Immunology (ACAAI), American College of Chest Physicians (CHEST), and the Allergy and Asthma Network

Asthma Statistics and Understanding Asthma control


Upcoming Diabetes Educational Event – Taking Control of Your Diabetes

Lisa Feierstein Diabetes Leave a comment   , , , , ,

Patient Education is one of our favorite topics here at Active Healthcare. We wanted to share the exciting news about an upcoming diabetes educational event coming to the Triangle area of North Carolina in a few months.

Taking Control of Your Diabetes (TCOYD) is a non-profit charitable educational organization that sponsors educational events in cities across the United States for people with diabetes, their families, and caregivers.

Taking Control of Your Diabetes“TCOYD educates, motivates, empowers and inspires people with diabetes — and family and friends who care about them — to take a more active role managing their diabetes, and being self-advocates. We do this by providing the best diabetes conferences & educational programs!”

Save the Date: TCOYD in Raleigh on Saturday May 11

This educational conference is for patients with both Type 1 and Type 2 diabetes. The conference has sessions specifically designed for each group. Attendees can get the latest info on their disease and treatment options via keynote speakers and breakout sessions. Lunch is included in the $25 registration fee. Conference goers will also have the opportunity to ‘Ask a Specialist’ (Endocrinologists, Diabetes Educators, Dietitians, Nurses, and Pharmacists), visit the event’s health fair, meet with equipment vendors and also participate in a number of free health screenings.

The Triangle event will be held at the Raleigh Convention Center on Saturday, May 11th.

Full Raleigh Conference Schedule

For those of you outside of the Triangle Area, check out the TCOYD website for their full schedule of 2019 events. The conference will be in Charlotte NC area this fall on Saturday, November 2nd.

Additional Resources

Check out the TCOYD website for additional educational resources including videos and blog posts.

New Recommendations for Treatment of Type 1 Diabetes in Children and Adolescents

Diabetes Rates Among Children and Teens


Hidden Spots for Germs: Home, Office and Doctor’s Office

Lisa Feierstein Allergies, Asthma, Breathe EZ 1 , , ,

The winter season is peak time for cold and flu. Getting vaccinated against the flu is always a good idea but remember that germs are sneaky and can lurk in the most unlikely places.

Bacteria and viruses are spread by both direct and in-direct contact. A sick person can sneeze or cough near you. You might touch something that has been contaminated by a sick person who has passed by before you.

Remember that people with asthma can often be more susceptible to any respiratory illness. Small children are still working to build their immune systems. When they catch a cold or virus from other kids or pick up germs in their environment, they get sick and share the illness with their family members.

Germs in Your Office

Pens - clipboardsYour desk is ground zero for germs in the office. Recent studies showed that your desk can have 400 times more bacteria than a toilet seat. These unfriendly office visitors can survive up to three days on these surfaces. Everyone should disinfect their desk work surfaces including the keyboard, mouse and phone on a regular basis, but during cold and flu season it is even more important.

Don’t forget about shared work spaces like the break room, copy machines and shared workstations. At our office, we encourage those who are sick to stay home. Fellow team members have been known to swoop in to wipe down the desks and work areas of their contagious colleagues to keep the sickness from spreading.

Germs in Your Home

germs, cleaningThe dirtiest parts of your home include the kitchen sink and drain, along with the sponges and dish rags you use to wipe the counter or wash dishes.

Any location where water is present is highly susceptible to bacterial accumulation. Again, if someone at home is sick, you’ll have to step up your disinfecting efforts.

Germs at the Doctor’s Office

Many pediatricians’ offices separate ‘well’ and ‘sick’ children in different waiting areas. This can be a great way to avoid others who are coughing and sneezing if you are well. Since the same doctors and staff are caring for both sets of patients, here are a few ways to avoid germ magnets at your MD office.

Bring your own pens and reading materials. Test swabs show that those waiting room clipboard pens are far dirtier than door handles and waiting rooms chairs.

Don’t be afraid to ask the staff to wash their hands, especially after touching hand held devices and stethoscopes, and before touching you.

Bottom line, wash your hands frequently, avoid contact with people that are obviously sick, and schedule frequent cleanings around your home and office. As a favor to everyone one else, if you’re sick, stay home and rest rather than spread the contagion.

Additional Resources:

CDC Flu Information

Cold weather Tips for Asthma Sufferers

Five Flu Myths Debunked


New Recommendations from the ADA: Management of Type 1 Diabetes in Children and Adolescents

Lisa Feierstein Children's Health, Diabetes Leave a comment   , , , , , ,

The American Diabetes Association recently shared an updated position statement on the management of type 1 diabetes in children and Adolescents. This statement is an update to their previous position statement issued in 2005. Their statement highlights the common sense idea that children are not just mini-adults. Treatment plans for children with Type 1 diabetes need to be tailored to both their current situation and their future growth and development.

The following areas were highlighted in the updated statement of recommendations for children and adolescents with Type 1 Diabetes (T1D):

  • Diagnosis of Diabetes
  • Blood Glucose Level Management
  • Lifestyle Considerations
  • Self-Management of Diabetes
  • Complications and Comorbidities
  • The Transition from Childhood to Adolescence and Adulthood

Diabetes Blood Glucose Testing

New Recommendations for Blood Glucose (BG) Management in Children and Adolescents

Most children’s T1D should be treated with insulin regimens with either multiple daily injections or via insulin pump therapy. Healthcare professionals should measure A1C levels of their non-adult patients at 3 month intervals. The target level of A1C should be 7.5 %. Patients or their caregivers should monitor BG levels multiple times a day, typically 6 to 10 times.

Medical devices such as insulin pumps and continuous glucose monitors (CGM) can be very helpful in the management of T1D. The ADA recommends that the CGM be considered in all children and adolescents, even though not using insulin pump therapy. Studies have found that compliant use such devices correlates with better BG control, lower A1C levels and reduction in hypoglycemic events.

Adjunctive Therapies for Children with T1D

One highlight in their recommendations between the management of type 1 diabetes in children versus adults is in regard to adjunctive therapies. They do not recommend the use of adjunctive therapies, such as the medication metformin in children. Clinical trials showed that despite the advantages of such therapies to help with weight loss or other diabetes comorbidities, there are more risks than benefits for children.

Check back next month for our follow-up blog talking about the unique behavioral aspects of managing diabetes in children and adolescents. We’ll focus on the challenges of self-management of their disease and other related health and wellness concerns.

Additional Resources

411 on CGM
Exercise for Children with Diabetes
ADA Position Statement


Time To Rake the Leaves – Fall Allergy Season

Lisa Feierstein Allergies, Asthma, Breathe EZ 1 , , , ,

Many of you may think that the springtime is the worst season for allergy sufferers. Everyone has different triggers, so the fall can also be troublesome for those with allergies and asthma. During the fall we enjoy beautiful scenery as the leaves change from green to brilliant shades of red, yellow and orange. As the season progresses, all those colorful leaves fall, becoming an allergy trigger of their own.

Fall Allergy Triggers: Pollen and Mold Spores

Although each allergy sufferer has different triggers, many people are allergic to plants that produce pollen in the fall season, such as ragweed. Another common fall allergen is mold spores. Remember all those beautiful fall leaves? Once they fall and linger on your lawn they get rained on – creating a perfect environment for the growth of mold spores.

Fall Leaves

When you rake all those leaves into a big pile – maybe for the neighborhood kids to jump into or to compost or bag up for pickup, all those mold spores are released back into the air.

Once exposed, your body reacts to the triggers and you’ll likely have a runny or stuffy nose, itchy or watery eyes and an irritated nose and throat. Doesn’t that sound like fun!

Outdoor Yardwork Tips: Protect Yourself Before and After

Since you can’t escape the yard work, if you suffer from allergies you can take these steps to minimize your symptoms this fall.

  • Wear a filter mask, especially when raking leaves
  • Rake often giving less time for mold spores to develop
  • Choose long sleeves and wear gloves to minimize exposure to your skin
  • Avoid touching your nose and eyes during yardwork
  • Choose early morning and evening times for yardwork when pollen counts are lowest

Once your yardwork is complete remember to leave your shoes at the door and change your clothing to limit tracking allergens into your home. Shower as soon as possible as allergens will linger on your skin and hair.

Even if you are not doing yardwork, just going outside can trigger an allergy attack. Remember it is best to stay inside when you hear one of your neighbors firing up their leaf blowers!

Allergy Medications Can Help

You can also work with your healthcare provider to choose the best over the counter and/or prescription medications to manage your seasonal symptoms. Some medications need to be taken in advance of the season for maximum effect. Consider adding nasal saline irrigation on a regular basis during the fall months to clear mucous and allergens from your system.

Additional Resources:

House Plants and Allergens

Holiday Planning For Those With Asthma and Allergies

Climate Changes and Outdoor Allergies


Asthma Sufferers – Plan for Fun at the NC State Fair

Lisa Feierstein Allergies, Asthma, Breathe EZ Leave a comment   , ,

Are you excited about the North Carolina State Fair?

Here are some pointers to help you enjoy all the fair has to offer, even if you have asthma.

October is Not Too Early for Flu Shots

The flu causes inflammation and narrowing of your airways which can in turn trigger an asthma flare-up.

People with asthma should always get their yearly flu shot to both avoid catching the flu and suffering its complications that can trigger asthma attacks.

Sheep and Rabbits and Ponies Oh My!

State FairOne of the favorite kid friendly attractions at the fair is the petting zoo. Take the proper steps to protect yourself when visiting all of the adorable baby animals. Close contact with animals can trigger an asthma attack because you may come in contact with proteins that are found in animal saliva, skin flakes, urine and feces.

Animal fur collects pollen, mold and other outdoor allergens that can be another trigger of your asthma symptoms. Remind your family members to wash their hands after visiting the petting zoo. Do not touch your eyes or any part of your face until you wash your hands!

Navigating Fair Food: Be Aware of Food Allergies

Each year the food vendors at the North Carolina State Fair come up with new and existing food offerings. In 2017 a few of the special treats on the menu were Deep Fried Key Lime Bites, Flamin’ Hot Cheetos Corn on the Cob, and the Blue Hawaii Funnel Cake. If you are unsure about what you are ordering, ask for an ingredients list. Those with severe food allergies may want to skip the fair food altogether and pack their own snacks. Always remember to keep food allergy medication on hand.

Watch for Exposure to Second Hand Smoke

Big crowds at outdoor venues can mean increased exposure to second hand smoke. If you are exposed to second hand smoke it is best to try to remove yourself from the area. Smoke will irate your airways and can cause them to swell and narrow. Secondhand smoke is harmful to children and adults with asthma and is a common trigger.

Travel with an extra inhaler and asthma medications. Everyone can enjoy their day out at the fair when they are prepared to manage asthma flare-ups.

Now that you’re prepared, what are you looking forward to seeing at the fair this year? Share this post with family and friends.

Additional Resources:

North Carolina State Fair Website
Best and Worst Foods for Asthmatics
Five Flu Myths Debunked


Teen Focus: Dangerous Duo – Type 1 Diabetes and Drinking

Lisa Feierstein Children's Health, Diabetes 3 Comments , , ,

Drinks in GlassesYou might suspect that drinking alcohol would cause your body to react similarly to consuming other carbohydrates. Alcohol is filled with calories. The surprising difference is that alcohol needs to be processed by the liver. Teen type 1 diabetics who drink can actually experience a drop in their blood glucose (BG) levels as their liver focuses on processing the alcohol and doesn’t work on its other function – releasing glycogen into the blood stream.

Another worry is the length of time it takes the liver to process alcohol. Did you know that your liver can be busy for one to one and a half hours handling just one alcoholic drink? Teens who drink multiple alcoholic beverages risk a low blood sugar event.

The symptoms of inebriation are similar to those of low blood sugar – sweating, lightheadedness, shakiness, weakness, anxiety, hunger, headache, problems concentrating, and confusion – which can make it more difficult for teens to sense that their blood sugar is trending too low. The best answer is to test BG levels.

Top Tips for Teens

If your teen decides to attend a party or share a drink with friends, they can minimize the negative impacts by heeding these ideas:

  • Make Moderation your Mantra – alternate alcoholic drinks with water or other non-sugary beverages to prevent dehydration. Wait between drinks to allow your body to catch up.
  • Food is Your Friend – Eat healthy snacks including fats and protein before, during and after drinking. Consider enjoying a drink along with a meal instead. Eating prior to bedtime will also help prevent hypoglycemic events during sleep.
  • Don’t Guess -Test – Bring along testing supplies – don’t rely on how you feel as an accurate gauge of your BG level, test to confirm. A Continuous Glucose Monitor can be a great tool to monitor BG levels.
  • Alert your Friends – Educate your friends on the symptoms of low and high BG level events. Have a buddy that can help just like a designated driver to watch for worrisome symptoms. They can remind you to test and eat snacks. Consider wearing a diabetic alert bracelet or necklace.

If you vomit it is even more important to test BG levels and consume non-alcoholic drinks to rehydrate.

Tips for Parents

Communicating with teens about drinking is a challenge for all parents. As with most difficult topics, open, and honest communication goes a long way. Talk about your concerns in advance – before any party invitations. Educate yourself and your teen about the effects of drinking in general and the special considerations for those with type 1 diabetes.

Even if there will be consequences if your underage teen drinks, consider creating an agreement so that they know they can contact you for help if they run into trouble. This will keep them safe and keep their diabetes in control. Seek support from your teen’s healthcare providers and/or diabetes educators if needed.

Once your son or daughter knows all the potential and possibly life-threatening side effects to their health from drinking, we can hope they will seek out other activities that aren’t focused solely on drinking.

Additional Resources

JDF – Teen Tool Kit
The 411 on CGM
American Diabetes Association – Teens & Parties


E-Cigarettes: Continued Health Threat for Youth

Lisa Feierstein Breathe EZ, Children's Health Leave a comment   , , ,

Juul e-cigarette

Kids are now facing a new threat that is taking over high schools and middle schools across the United States – a new type of E-cigarette called Juul. Many parents may lack information on how E-cigarettes are spreading throughout their children’s schools and in their own neighborhoods.

Some teens and young adults find the E-cigarette Juul attractive because of its sleek design. The device can be easily charged on a laptop and go unnoticed by parents and teachers. Teens are drawn to Juul for a number of reasons, like its trendy decal skins, and the multiple flavors.

Studies have shown that most teens and young adults do not know that they are smoking nicotine, they think they are smoking water vapor when they are using Juul. Since nicotine is the prime ingredient in these devices, parents and school administrators are concerned.

Not only can nicotine be extremely addictive but it can be very harmful to teens and young adults in many ways such as:

  • Memory loss and attention loss for a developing teenage brain
  • Also increased risk for future addiction to other drug

Schools Educate about the Dangers of Juul E-Cigarettes

Parents and school administrators should worry about the long term effects of students using Juul or any other E-cigarettes.

Schools are trying their best to prevent usage of E-cigarettes on school grounds. Some schools have even installed detectors that scan the air for chemical changes and alert an administrator. Schools are also holding classes to review the dangers of using Juul with their students. They are also holding workshops to educate teachers and support staff on what a Juul is and how it works.

For more information about E-Cigarettes, the Juul device and the effects of using it check out the website www.tobaccofreekids.org

Additional Resources:

The Double Threat of Vaping

More information on E-Cigarette usage among youth from the Surgeon General

Image of Juul e-cigarette: By Mylesclark96 [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons


Surviving Summer Asthma Flare-Ups

Lisa Feierstein Asthma, Breathe EZ Leave a comment   , ,

summer asthma flare upsSummer is here! People with asthma should always be prepared for asthma triggers as the weather continues to get hotter.

You may experience triggers like coughing and shortness of breath due to the hot weather. Here are some tips for surviving summer asthma flare ups.

Tip 1: Exercise smart.

People with asthma may be more sensitive to extreme temperatures and the pollution that comes with it. That is why it is important to avoid outdoor exercising if air pollution is high. If you are going to work out, try to plan outdoor activities for early morning and late evening.

Tip 2: Check air quality

Always check the air quality before going outside. You can reduce the impact of your asthma triggers by being prepared and knowing your limits.

Sign up for air quality alerts by visiting airnow.gov.

Tip 3: Traveling Smart.

It is always best to plan ahead when you have asthma, especially before you take a trip. Whether you are traveling by airplane, train, or car it is always best to keep your asthma medications on hand at all times. Consider purchasing a portable nebulizer, which allows you to do treatments while traveling.

Tip 4: Talk to your Doctor.

If you are experiencing asthma symptoms and you cannot get your symptoms under control, it may be time to see your healthcare provider. Make sure to keep your asthma action plan up to date.

Tip 5: Exposure to Bad Environments

Change clothes and shower after outside work to remove allergens that could trigger an asthma attack. It is always best to be aware of what can be harmful to you and your asthma and take the proper steps to prevent yourself from having an attack.

Additional Resources

Ozone and Air Quality

AirNow – Air Quality Basics


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