What are some of the most common health concerns among aging type 2 diabetics, and how can they be managed?

Type 2 diabetes can lead to serious health complications, and older people with the disease are especially vulnerable. The American Diabetes Association (ADA) estimates roughly 27 percent of people 65 years of age and older have diabetes, and studies have shown that the highest rates of diabetes-related heart attacks, kidney failure, and amputations are among older adults.

According to a 2012 report published by the ADA and the American Geriatrics Society, "diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization." But many complications can be delayed or even prevented with treatment and lifestyle changes. Here are some of the most common health concerns among aging type 2 diabetics.

Limited Mobility

Sam Penceal, 69, was diagnosed with diabetes almost 15 years ago. A former college basketball player, he was able to quickly jumpstart his fitness routine to help manage the disease. Though he still exercises three to five times a week, Penceal admits he now needs more time for his body to rest.

"I realize that I have to give my body more time to recoup," said Penceal, who sits on the executive committee of the ADA's Step Out Walk NYC and is captain of his Step Out Walk team. "If I exercise heavily two days in a row, it's important I give my body a day of rest."

If a person does not have a history of consistent exercise, precautions should be taken before beginning a new regimen.

"Because the risk of heart disease is higher in diabetic patients, I recommend those in the aging population talk with their physicians or even go through an exercise stress test to make sure their heart is okay for physical activity," said Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic.

Diabetics are at a greater risk for joint and bone disorders, which can impact their ability to exercise. Dr. Hatipoglu recommends working with your doctor to come up with an individualized exercise plan, which should include walking and light weight training to help with balance.

Falls and Fractures

The risk of falls and fractures is a normal part of aging, but mobility problems associated with diabetes raise the risk even higher.

Hypoglycemia, or low blood glucose, can cause symptoms including shakiness, weakness, and lack of coordination. Hyperglycemia, or high blood sugar, can cause dehydration, leg cramps, and imbalance.

Hatipoglu stresses the importance of a safe home environment complete with non-slip rugs, bed rails, and grab-bars in the shower and bathroom.

Vision and Hearing

People living with diabetes have a much higher risk of eye complications, including glaucoma and cataracts, and the risk increases with age. Retinopathy, a disorder of the retina, is also common.

There are treatment options available, but the condition needs to be caught as early as possible. "It's very important for elderly diabetics to have regular checkups with their ophthalmologist, especially if they are driving or working," Hatipoglu said.

Hearing loss is twice as common in people with diabetes as it is in those who don't have the disease. The reason for the increased risk is unclear, though it may be that diabetes damages nerves and blood vessels of the inner ear. If you suspect hearing loss, talk to your doctor.

Mental Health

"The lifestyle modification that comes with type 2 diabetes has definite psychological effects," said Xavier Jimenez, MD, a psychiatrist at the Cleveland Clinic. The stress of diabetes management can take its toll on a patient's mental and emotional well-being. Studies show that people with diabetes have a much greater risk of depression, which can compromise their self-care and commitment to a healthy lifestyle.

Even patients who have been dealing with diabetes for a long time can become demoralized. "It's basically people saying they're sick and tired of being sick and tired," said Dr. Jimenez. "It's a little less severe than depression, but should still be addressed."

Diabetics may feel isolated from family and friends. Penceal emphasizes the importance of having a stable support system to help with the day-to-day challenges. "Find a group of people who are going through the same things you are," he said. "It can be difficult when your family doesn't have to go through the same diet and lifestyle changes you do. Join a support group to discuss those challenges."

Diabetes, especially type 2, may increase a person's risk for Alzheimer's disease or vascular dementia. Evidence suggests diabetes may lead to mild cognitive and memory problems that impact a patient's ability to manage their condition.

"If a patient keeps coming back with uncontrolled high blood sugar, instead of blaming them, we should sit back and ask ourselves, 'Could this be a sign of depression or dementia?' " said Hatipoglu.

Bladder and Bowel Dysfunction

Diabetic neuropathies are disorders that damage nerves all over the body. When the autonomic nervous system ? which controls the bladder, stomach, and intestines ? is affected, patients may experience problems with bladder and bowel function. Symptoms can include constipation, diarrhea, urinary tract infections, and incontinence.

"When you have urinary incontinence, you are at a much higher risk for infection and as a result hyperglycemia, which can cause more urinary leakage," said Hatipoglu. "It's a vicious cycle."

Hatipoglu urges patients to not be embarrassed. Report any changes in digestion and urination to your healthcare provider because early treatment is so important.

Drug Interactions

The doctor should review all medications a patient is taking, even over-the counter drugs, at every visit. Hatipoglu suggests caregivers can help as well by writing down clear, easy-to-follow instructions.

"Writing down which medications to take and when in big letters is very helpful," she said. "You have to get creative and simplify things so they can follow the instructions."

New laws, media attention and public awareness campaigns have placed a greater emphasis on bullying in recent years than perhaps ever in the nation's history.
Yet bullying remains a stubborn problem with far-reaching effects.

More than one in four students, 27.8 percent, report being bullied during the school year, according to a 2103 report by the National Center for Educational Statistics, but most victims never tell an adult.

That's one reason it's crucial that everyone - not just school officials - get involved in the battle, says TV personality Cindy "Rodeo" Steedle, who founded an anti-bullying initiative called Imagine No Bullying Now (www.imaginenobullyingnow.com) and often speaks on the subject at school assemblies.

"It's so important to me because I was bullied as a child," says Steedle, who rose to fame in 2007 as a contestant on VH1's "Rock of Love" and subsequently has made numerous other TV appearances.

Steedle recalls as a teenager enduring the taunts of other girls because she couldn't afford the nice clothes they wore. The bullying didn't stop with words.
"They would hit me on the bus," Steedle says.

The impact of bullying can be devastating. A 2012 report by the Centers for Disease Control said students who experience bullying are at increased risk for depression, anxiety, sleep difficulties and poor school adjustment.

Bullying is bad for the bullies, as well. The CDC reported that students who bully others are at increased risk for substance use, academic problems and violence later in adolescence and adulthood.

"How many times have each of us witnessed an act of bullying and said little or nothing?" Steedle asks. "After all, it wasn't our responsibility. If our kid wasn't involved, we figured, it's none of our business."

That's the wrong attitude, Steedle says. She offers keys to facing up to bullying and doing something about it.

·  No one should make excuses for bullies. Some people claim bullying is simply a part of life. If no one is physically hurt, they will say, "What's the big deal? It's just boys being boys and girls being girls." Those people are wrong, Steedle says. "We must make it clear in our actions and our words that bullying will not be tolerated," she says.

·  Parents should monitor their children's cell phone and Internet use. Bullying takes many forms and it's not always in person. Text messages and social media sites such as Facebook and Twitter can become sources of bullying.

·  Schools must be at the forefront of the battle. Too many schools don't take bullying seriously. School officials need to recognize the depth of the problem, and implement and enforce strong anti-bullying policies.

·  But the problem goes beyond the schoolhouse doors. If we want to eradicate bullying in our communities, we can't rely on schools alone, Steedle says. All public and private institutions need to do more to demonstrate that bullying is simply unacceptable in our workplaces and in our homes.

"This is not a failure of one group of kids, one school, one town, one county or one geographic area," Steedle says. "Rather, it exposes a fundamental flaw in our society, one that has deep-seated roots.

"Until now, it has been too difficult, inconvenient ? maybe even painful ? to address. But we can't keep looking away. We have to stand up and say, 'No more!' It's up to us all to get more involved."

About Cindy "Rodeo" Steedle

Cindy "Rodeo" Steedle rose to fame in 2007 as a contestant on VH1's "Rock of Love," captivating viewers with an appealing charisma that landed her further appearances on seasons 2 and 3 of "Rock of Love." Her other TV appearances include the VH1 series "I Love Money" and "Rock of Love: Charm School" with Sharon Osbourne. Three years ago, to bring awareness to bullying, Steedle founded an initiative called Imagine No Bullying Now (www.imaginenobullyingnow.com). She also is co-creator and Executive Producer of the 2015 Taste of Speed Jet Port Experience (www.tasteofspeed.com), a luxury lifestyle event scheduled May 2 in Atlanta that includes a fashion show, live entertainment, classic cars, celebrity chefs and more. This is the second annual Taste of Speed, which was created to raise money for charity.

Personal Foul ... Excessive Snacking

DAVENPORT, Iowa -- Jan. 22, 2015 -- About the time the clock is winding down on the game on Sunday night and you've survived your own Super Bowl wardrobe malfunction -- a popped button, or a loosened belt -- you may have consumed 3,000 calories or more.

Personal foul, excessive snacking.

Topping the year for caloric intake, Super Bowl Sunday can be hard on your waist line and also makes your heart work harder to digest those calories.

To put the traditional Super Bowl gluttony into perspective, here are a few favorites of Super Bowl parties and their approximate calories:

10 cocktail size sausages with barbeque sauce .... 360 calories

10-12 nacho chips with beans, beef, sour cream and cheese ... 600 calories

2 loaded tacos .... 700 calories

6 spicy chicken wings .... 440 calories

2 ounces of chips with dip ... 400 calories

3 light beers .... 330 calories

1 piece of chocolate cake (3 ounces) ... 312 calories

That is how you get to 3,000 calories, or about 1,000 more than are necessary on a daily basis for an adult.

"To burn off that many calories is going to take some work,'' explained Jan Treftz-Allen, Health Promotion Manager, Genesis Health System. ''Biking indoors at a moderate pace burns about 400 calories per hour. Walking at a fast pace is about 350 calories per hour. Cleaning the house burns about 150 calories per hour.

"To burn off all of those 3,000 calories, you'd have to be on the stationary bike for about eight hours.''

But there are ways to limit the excesses of Super Bowl Sunday. Here are some tips from Treftz-Allen to help you score physically and nutritionally at your Super Bowl party:

• Warm-up like the players before the game. Go for a walk, go to the gym, clean the house. Halftime festivities take 40 minutes or more. That's enough time to burn off 200 or more calories on a treadmill, a bike, or on a fast walk through the neighborhood.

• Choose some healthier snacks. Make sure you've got vegetables and fresh fruit available (see below).

• Portion control. Pick the smaller plate and try everything you want, but take smaller portions.

• Skip the soft drinks and beer and stick with water.

• Don't "save'' calories. Don't skip breakfast or lunch before the game. You'll be too hungry by the time the first of about 70 beer and snack commercials come on the television and you'll be more likely to make bad food choices.

• Adjust the recipe. For example, use ground turkey for the chili and tacos. Use low-fat cheese and sour cream. Choose the low-fat dips and chips. Make a vegetable soup instead of chili.

Super Bowl Recipes That Trim Calories from Teresa Pangan, dietitian, Genesis Cancer Care Institute

The recipes below cover sweet, spicy, satisfying, healthy and of course, super delicious. When planning your Super Bowl menu, be sure to include a tray of fresh vegetables for dipping (see dip recipe below) and fresh fruit - no dip required. These stay for hours on the table and are healthier alternatives for those wanting to make healthy choices. Also, salsa (jar or homemade) is a super choice for dipping chips.

Brownies Delish

The secret in these is the black beans. Sounds crazy but it works. No one will know. Serve them and watch them disappear - don't tell anyone. Watch the compliments come in.

Ingredients:

1 (15-oz) can black beans, rinsed and drained

¼ cup chocolate chips and some for the top

3 Tbsp. canola oil

3 eggs

2/3 cup packed brown sugar

½ cup unsweetened cocoa

1 tsp. vanilla

½ tsp. baking powder

1/8 tsp. salt

Instructions:

1. Preheat oven to 350'F. In blender or food processor, combine the beans, chocolate chips and oil. Blend until smooth. Add the eggs, brown sugar, cocoa, vanilla, baking powder and salt. Blend until smooth.

2. Transfer to a 9x9 square baking pan coated with cooking spray.

3. Bake for 20 - 25 minutes or until a toothpick inserted near the center comes out clean.

4. Sprinkle with extra chocolate chips, if desired and cool on a wire rack. Cut into 8 desert bars or 16 appetizer bars.

Note: If you like cake-like brownies, increase baking powder to 1 Tbsp.

Nutrition Info (per desert bar): 262 cal; 10 g fat (2g sat); 7 g fiber; 8 g protein

Red Pepper and Bean Dip

Serve this with a variety of vegetables for dipping (carrots, cherry tomatoes, sugar snap peas, broccoli, and cauliflower.)

Ingredients:

¼ cup chopped fresh basil

2 tsp. balsamic vinegar

1 (16-oz) can cannellini beans, rinsed and drained (let sit in colander 10 min to drain well)

1 (7-ounce) bottle roasted red bell peppers, rinsed and drained (let sit in colander 10 min)

3 large garlic cloves minced

2 Tbsp. extra virgin olive oil

½ tsp. salt

½ tsp. freshly ground black pepper

Instructions:

1. Best if made ahead couple hours to let flavors marinate. Also, if drained red peppers are not dry, pat with paper towel to remove moisture.

2. Place all ingredients in a food processor or powerful blender and blend until smooth.

Nutrition Info (per ¼ cup): 62 cal; 3.5 g fat (0.5g sat); 1.5 g fiber; 1.5 g protein

Molasses-Lime Meatballs

The molasses-lime sauce will have guests headed to the table for more. The bonus of this recipe is that it makes 72 meatballs and the final cooking takes place in a slow cooker.

Ingredients:

1 ½ pounds extra-lean ground beef

8 oz uncooked hot Italian turkey sausage links, casings removed

1 cup quick-cooking rolled oats

1 cup egg substitute, lightly beaten

1 cup finely chopped green onions (8 - including much of the green part)

4 tsp. Worcestershire sauce

1 tsp. crushed red pepper

6 Tbsp. molasses

¼ cup reduced sodium soy sauce

2 Tbsp. lime juice

Instructions:

1. Coat 3 ½ or 4 quart slow cooker with cooking spray; set aside. In a large bowl combine ground beef, sausage, oats, egg substitute, green onions, Worcestershire sauce and crushed red pepper. Shape mixture into 72 meatballs 2-inches in diameter.

2. Put ½ Tbsp vegetable oil in 12-inch nonstick skillet and use paper towel to spread oil around entire pan. Cook meatballs, one-fourth at a time, over medium heat until brown, turning once. Transfer to prepared cooker.

3. Cover and cook on low-heat setting for 4 to 5 hours or on high-heat setting for 2 to 2 ½ hours.

4. In a small bowl whisk together molasses, soy sauce, and lime juice. Pour over meatballs. Toss gently to coat. Serve immediately or keep warm, covered, on warm or low-heat setting for up to 1 hour.

Nutrition Info (per 4 meatballs): 140 cal; 4 g fat (2g sat); 1 g fiber; 14 g protein

Sweet and Spicy Orange-Soy Chicken Wings

This is a great alternative to the traditional buffalo-style wings. These wings have a tangy Asian flavor and are easy to prepare.

Marinade/Glaze:

1 cup sweet orange marmalade

½ cup honey

1/3 cup light soy sauce

1 ½ Tbsp. rice wine vinegar (can substitute with cider vinegar)

3 Tbsp. grated fresh ginger (found in produce section; use peeler to peel outer layer and then a zester or fine grater to grate the 3 Tbsp.)

1 Tbsp. minced garlic

1 tsp. crushed red pepper

Marinade/Glaze:

3 pounds chicken wings, cut in half at center joint

Garnish: sliced scallions and orange wedges

Instructions:

1. Marinade/glaze: whisk ingredients in a medium bowl to blend. Transfer half into a large baggie bag. Add wings to the marinade in the baggie; turn to coat.

2. Refrigerate at least 2 hours, turning bag occasionally. Refrigerate and cover the remaining marinade in the bowl.

3. Chicken wings: heat over to 450'F. Line two rimmed baking sheets with foil. Put a wire rack in each pan; coat with nonstick spray.

4. Place wings in a single layer on racks (discard baggie and contents). Bake 20 minutes; turning once. Then brush with some of the reserved marinade. Bake an additional 10 minutes, turning once and brushing again, until wings are lightly browned. If you want a charred look, broil 1 to 2 minutes per side.

3. Transfer to a serving platter. Pour remaining marinade into a bowl; serve as a dipping sauce. Garnish serving platter with scallions and orange wedges.

Nutrition Info (1 serving: recipe makes 10 servings): 147 cal; 7.2 g fat (2g sat); 8.5 g protein

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Despite decades of medical research and public campaigns to ease the problem, heart disease is the No. 1 killer in the United States and throughout the Western world.

One of the problems driving heart disease is the messaging, says Robert Thompson, M.D., an integrative medicine specialist deemed by his peers to be in the top 5 percent of U.S. physicians. While there's plenty of good research to indicate good advice, the general public, and many of his peers in the medical community, are stuck with faulty conclusions, he says.

"Perhaps the biggest misconception is that an overabundance of calcium, which may include supplements, is very good for people, especially women, but that's simply not true," says Thompson, author of "The Calcium Lie II: What Your Doctor Still Doesn't Know," (calciumliebook.com), a new book that details the roles minerals play in overall health and how to identify and correct deficiencies and imbalances.

Calcium is just one of 12 substances, as well as traces of 64 other minerals, that make up our bones. Excessive amounts of calcium hurt our bodies in many ways, especially the heart and the brain, he says. We cannot possibly replace minerals with just calcium, which hardens concrete and makes bones more brittle.

One study, published in the British Medical Journal in 2008, was meant to assess the effect of calcium on bone density and fractures in postmenopausal women. Researchers found that participating women were significantly more likely to suffer heart attacks while taking calcium supplements.

"This is far from an isolated study - there are others, including 15 studies combined into a meta-analysis yielding similar heart-health results, which show an increased risk of heart disease by at least 30 percent," says Thompson, who offers practical recommendations for what individuals can start doing for better overall health in recognition of American Heart Month, celebrated in February.

•  Drink at least 64 ounces of water a day. As a general rule, we need to drink half of our bodyweight in ounces of water daily. For a 150-pound individual, that's 75 ounces of water. Those who are overweight, or are heavy exercisers or live in warm climates may need more. Take care to drink quality water. Get a quality filtration system at home, which can range from $200 to $3,000.

•  Take ionic sea salt-derived minerals. We all need a diverse range of minerals and virtually none of us get enough. Ionic minerals are the only ones that are completely available for our bodies to use because they are water-soluble and they naturally carry an electrical charge that allows them to be carried through the cell membranes. All sea salt-derived trace mineral products are recommended - at least three grams per day.

•  Use only vitamin supplements made from 100 percent organic whole foods that have been vine-ripened. Almost all of us need supplements because contemporary food supplies lack adequate amounts of vitamins and minerals, thanks to soil depletion. Most store-bought vitamins include just one component of the many complex molecular elements contained in the naturally occurring vitamin source. You need all of the nutrient components to get the full benefits.

•  Get your fill of essential fatty acids; raw nuts and/or seeds are a good source. In 2003, the Food and Drug Administration approved the following health claim for seven kinds of nuts: "Scientific evidence suggests but does not prove that eating 1.5 oz. per day of most raw nuts as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease." Omega-3 and Omega-6 are considered essential because humans can't manufacture them within our bodies. Research has now shown that plant-derived Omega 6, and not fish oil, is the best oil for humans.

•  Eat high-quality proteins. Seafood, eggs, beans, chicken, game meat, duck and turkey are excellent sources of essential amino acids that are the building blocks of every protein molecule, hormone, neurotransmitter, cell membranes and immune molecules. Proteins can also be obtained from grains, sprouted grains, raw nuts and raw seeds. Vegetarians and vegans need to play close attention to combine protein sources to get the full complement of amino acids.

•  Walk at least 30 minutes every day. This activity has a huge effect on relieving the physiologic effects of stress on the human physiology. Exercise is good, but walking is amazing. No other single activity will more significantly or more rapidly affect the adrenal stress response in humans than walking, which probably works so well because it slows us down. And, it is an incredible way to build relationships.

"Also, I recommend ingesting essential monosaccharides, which is new and unknown territory for most people," he says. "They are the simplest form of carbohydrate molecules found in the body, are essential for protein molecules and can be found in maple syrup, sweet potatoes, parsnips, beets and onions."

*Robert Thompson, M.D., was added to the peer-reviewed directory, "Best Doctors in America," in 1996.

About Robert Thompson, M.D.

Dr. Robert Thompson is a board-certified obstetrician and gynecologist, and a nutrition specialist who helps patients get long-term relief from chronic disease, including obesity, diabetes, hypothyroidism and adrenal fatigue. His newest book, "The Calcium Lie II," is available for free at calciumliebook.com. Dr. Thompson received his medical training at the University of Kentucky and has been a leader in medical advances for more than 30 years.