Everyday Health: How does weight affect diabetes?

Ping H. Wang, MD: Excess weight can present health risks for anyone, not just people with diabetes. But this excess weight, in combination with other indicators such as high blood glucose (hyperglycemia), high blood pressure, and high cholesterol/triglycerides (known as metabolic disorder) is implicated in heart disease and can be life threatening to patients with diabetes. Losing weight and lowering blood pressure and lipids reduces the risks associated with metabolic disorder. In addition, losing weight can "reverse" diabetes in some individuals whose excess body fat prevents the body from effectively using its own insulin (insulin resistance).

Melissa Meredith, MD (with assistance from Barb Uselman, RN/CDE, and Carol Sargent, RD/CDE) : The most common form of diabetes, type 2 diabetes, is characterized by 2 main defects. First, the pancreas is unable to produce enough of the hormone insulin. Insulin allows the body's tissues to use glucose for energy. When there is not enough insulin, blood sugars will rise. Second, what insulin is produced does not work effectively in people with type 2 diabetes. This is referred to as insulin resistance. When a person has insulin resistance, it takes more insulin to lower the blood sugar. Weight is the major factor that contributes to insulin resistance. Excess weight will lead to worsened insulin resistance. Conversely, weight loss will improve insulin resistance and therefore less insulin will be needed to control the blood sugar. As little as a 10 pound weight loss can markedly improve insulin resistance and make it much easier to manage blood sugars!

Theresa Garnero, APRN, BC-ADM, MSN, CDE: Extra weight (being overweight or obese) affects the body's ability to effectively use the hormone called insulin (also known as insulin resistance). If your body doesn't use the insulin well, whether you make it naturally or need to inject it, your blood sugar (glucose) will go up. Also, extra weight is hard on the heart. It increases the likelihood of high blood pressure ? and thus the risk for a heart attack or stroke. It is important to know you can be fit at any weight. Just get your doctor's clearance before starting a program. Even a 5-percent weight loss can improve diabetes and lessen the risk for heart disease.

Gretchen Scalpi, RD, CDE: Being overweight or obese significantly increases the risk for developing diabetes, and in people who already have diabetes, a possible worsening of their condition. Weight that accumulates around the abdomen affects the body's cell sensitivity to insulin. An overweight or obese individual can gradually develop resistance to their own insulin. Insulin resistance leads to persistently high levels of blood sugar, and, eventually, type 2 diabetes.

Gail McGovern, American Red Cross

Shy about asking, "What's the etiquette for supporting my loved one, friend or  colleague in their battle against cancer?" many people simply avoid the question altogether - and offer nothing.

"It's okay to wonder, and it's okay to ask. Be direct!" says Jane Schwartzberg, who has been battling stage 4 metastatic cancer for several years. She's the co-author with Marcy Tolkoff Levy of "Naked Jane Bares All," www.nakedjanebaresall.com, which shares her story with candor and humor.

Jane was a 31-year-old newlywed when she was first diagnosed with breast cancer. She underwent treatment and eventually was declared cancer free. She moved on with her life, giving birth to two children and launching a technology company. Then, when she was 42, the cancer returned. She's now 45.

"I'm a fighter, and the support I've received from my family and friends has given me  an immeasurable amount of strength, without which I don't know what I would do," Schwartzberg says.

What are some suggestions for providing support? She offers these:

•  Do it without any expectations or requirements for a response. "I'm often asked, 'What can I do to help?' " she says. "What I've suggested: Be in my life at my pace, let me take the lead; make your presence, availability and support known, but do it without any expectations or requirements for a response."

•  Embrace their big dream, even if it doesn't sound realistic. During a very low point, Schwartzberg was asked by a friend: If you could have anything, swinging for the fences, what would help you get out of this pit? Without skipping a beat, she answered, "I want to take [comedian] Larry David out to lunch." As impossible as it seemed, her friend encouraged her to write to the co-creator of "Seinfeld" -- and he accepted.

"As terrible as having terminal cancer is, there is that undeniable quality of embracing every moment, including asking your heroes out to lunch," Schwartzberg says. "Cancer brings out the boldness in people, which may entail a dream vacation to Hawaii. Don't be afraid to embrace their wishes."

•  Don't hesitate to say, "You look beautiful," when health has returned. After her chemotherapy treatments ended, Jane slowly started looking like her old self - healthy Jane, not cancer Jane. Part of reengaging with life is caring about the superficial things, at least to some extent. On the unforgettable day she met Larry David, the maître d had beforehand told her that she looked beautiful, to which Jane responded, "You have no idea how much I appreciate that."

•  Don't sugarcoat it. "If you want to really infuriate me, you'll tell me that this whole mess is beshert, Yiddish for 'meant to be' - that it's all part of a plan from a higher power," she says. "Maybe terminal cancer is part of some crazy plan, but I promise you that these are the last things I want to hear from anyone."

Don't sugarcoat or try to put a positive spin on what's going on - in fact, it's more of a comfort to Jane when others acknowledge that her situation stinks and that she is looking at a life that's far different from, and likely to be shorter than, anything she'd imagined.

About Jane Schwartzberg

Jane Schwartzberg, 45, is the co-author of the new book, "Naked Jane Bares All," www.nakedjanebaresall.com, the many-layered story - told with humor and candor -- of how she learned to embrace life when she was down for the count. Jane is a financial services executive and founder and former CEO of a start-up technology company.
"Naked Jane Bares All" was co-written by veteran writer Marcy Tolkoff Levy. Following a year of interviews and many late nights with Jane, her family and friends, Marcy formed the foundation of a colorful, poignant and even humorous collection of vignettes about how Jane continues to get back up when life throws her down.

Legislation Will Help Protect Health and Wellness of All Illinois Residents

CHICAGO - Governor Pat Quinn today signed critical legislation to address urban flooding and to help ensure clean drinking water supplies and a cleaner environment. Today's action is part of Governor Quinn's agenda to protect our natural resources and ensure a clean and healthy environment for future generations.

"Water is a tremendous resource except when you have too much of it or it's not fit to drink," Governor Quinn said. "These new laws will help us better control the damaging urban floods we've had recently, and will help maintain our clean drinking water systems."

"These laws continue to support the Governor's work to provide additional protections for the state's cities and our water resources," Illinois Environmental Protection Agency (IEPA) Director Lisa Bonnett said. "They include additional environmental protections that will provide for clean and healthy water for Illinois residents."

"Urban flooding is an equal opportunity problem," Ryan Wilson, Stormwater Program Manager at the Center for Neighborhood Technology, a Chicago-based nonprofit focused on sustainable cities, said. "Our own research shows that urban flooding can happen anywhere, not just in floodplains. The legislation Governor Quinn signed today will help Illinois communities better understand urban flooding, and identify innovative stormwater solutions that can protect our homes, our investments and our environment from the threat of increasingly frequent and severe storms."

Senate Bill 2966, sponsored by State Senator Heather Steans (D-Chicago) and State Representative Kelly Cassidy (D-Chicago), creates the Urban Flooding Awareness Act. The new law forms a working group with representatives from state, federal and local agencies and other interested parties who will review and evaluate the latest research, policies and procedures regarding urban flooding. The group will then submit a report by June 30, 2015 to the Governor and General Assembly with recommendations on how best to prevent and control urban flooding. The law is effective immediately.

"Flooding in urban areas is a growing challenge that demands the combined expertise of local, state and federal agencies," Senator Steans said. "We're taking the problem seriously and making sure we know what's happening and why so we can adopt effective measures that protect lives and property."

"With recent heavy rainfall, our neighborhoods, cities and state saw a dramatic increase in flooding, causing serious damage to property," Representative Cassidy said. "This bill will bring together stakeholders, experts and State agencies to examine the causes of urban flooding and how our infrastructure and technology can mitigate the impacts in the future."

In addition, Senate Bill 2770, sponsored by State Senator Pamela Althoff (R-McHenry) and State Representative Michael Tryon (R-Crystal Lake), requires each community water supply system to designate an operator who will be directly responsible for that system's water supply and distribution. An initiative of the IEPA, it also updates the duties and responsibilities of operators to ensure they hold the proper certification and skills to operate the community water supply. The law is effective immediately.

Governor Quinn also signed Senate Bill 2928, sponsored by State Senator Terry Link (D-Waukegan) and State Representative JoAnn Osmond (R-Antioch), which allows law enforcement agencies to collect pharmaceuticals and other controlled substances from residents and safely store and transport them for disposal at IEPA-approved sites. Increased options for residents to safely and properly dispose of pharmaceuticals and controlled substances will help ensure that fewer unused medications are flushed down the toilet, which has serious negative impacts on water supplies. The law is effective immediately.

Governor Quinn has a long record of support for measures that ensure a clean and healthy environment. On July 23 Governor Quinn signed Senate Bill 2780, which expands the Governor's Clean Water Initiative to include stormwater and green infrastructure projects. In 2013, Governor Quinn signed Senate Bill 1869 which gives Illinois municipalities greater ability to build and invest in innovative stormwater management infrastructure to help mitigate damaging floods such as green roofs, rain gardens, bioswales, tree boxes, porous pavement, native plantings, constructed wetlands and more. The law expanded existing law to include these items, among others.