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Prediabetes Q&A

Throughout the month of November in celebration of American Diabetes Month, we will bring you facts about the prevention and the management of prediabetes and diabetes – starting with prediabetes.

According to the American Diabetes Association more than 79 million Americans have prediabetes.  In other words, their blood sugar levels are elevated, but not high enough to be considered diabetes.

How do you get prediabetes? 
The body’s primary source of energy is sugar (glucose). Sugar comes from breaking down carbohydrate foods such as fruit, milk and yogurt, sweets, and starches. Once the carbohydrates are broken down into sugar (glucose), the body produces insulin which acts as a key to allow the sugar to enter the cells and produce energy. 

Before people develop Type 2 diabetes, they almost always have prediabetes. Prediabetes is the inability of the body to use all the insulin it produces (insulin resistance). With insulin resistance all the cells do not easily recognize the insulin as insulin and will not allow the sugar to move from the blood to the cell. As a result, sugar remains in the blood leading to higher than normal blood sugars.

What can contribute to prediabetes?
Family history of type 2 diabetes, weight gain, being over 45 years old, a history of gestational diabetes or of delivering a baby weighing more than 9 lbs, elevated blood pressure and an inactive lifestyle can increase your insulin resistance.

Is there a test for prediabetes?
Yes, there are three different tests for prediabetes. (All results within these ranges are considered prediabetes.)

  • A1C test does not require fasting. It gives us an average of blood sugars over a three month period and is measured in percent. An A1C result is between 5.7%-6.4%
  • Fasting blood sugar between 100-125 mg/dl
  • Blood sugar after a 2 hour oral glucose tolerance test between 140-199 mg/dl or

Why is having prediabetes a concern?
People with prediabetes almost always develop Type 2 diabetes, and already have higher than normal blood sugar levels. People with prediabetes have a 1.5-fold higher risk of developing cardiovascular disease compared to those with a normal blood sugar.

High blood sugar damages artery walls and over time allows the buildup of fatty materials such as cholesterol (plaque) in the arteries. This damage can lead to stroke, heart attack, kidney damage, blindness, nerve damage and amputation of limbs.

Does prediabetes always develop into Type 2 diabetes?  
NO! Studies have shown that people with prediabetes can delay or prevent the development of Type 2 diabetes by up to 58% through changes to their lifestyle. Under a doctor’s care, overweight patients who have a modest weight loss (5% to 7% of body weight) and participate in a regular exercise like brisk  walking, cut their risk of Type 2 diabetes by 58%.

For those over individuals over 60, their risk is cut by 71%. For some people with prediabetes , being diagnosed early and taking preventative measures can actually return elevated blood sugar levels to normal.

In the next few weeks, watch for our blogs on Type 1 and Type 2 diabetes and the skills to manage diabetes.

Carol V. White, BSN, RN-BC is a Patient Educator in the Adult Diabetes Management Program with WakeMed Health & Hospitals

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WakeMed Opens New Retail Pharmacy and Gift Shop

WakeMed recently opened a new retail pharmacy and gift shop on Raleigh Campus for added shopping convenience for patients, guests and staff.

The beautiful new Gift Shop welcomes guests into an open and bright atrium filled with unexpected treasures including jewelry, fashion accessories and thoughtful gifts for every occasion. 

The Pharmacy, WakeMed’s first true retail pharmacy, is located beside the Gift Shop just off the main entrance hallway.  Their professional and knowledgeable staff provides efficient full pharmacy services for their customers without leaving the hospital.

Interested in Visiting?

Tuesday, November 8 would be a great time to visit the Gift Shop for an Exotic Maharaja trunk show featuring an unparalleled selection of semi-previous gemstones in sterling silver.  The hours of the show are 8:30 am – 7 pm.

The Pharmacy at WakeMed is open from 8 am – 11 pm M-F, Saturday 8 am – 4 pm and closed on Sunday.

The Gift Shop is open Monday through Friday 8:30 am – 8 pm and 10 am – 7 pm on Saturday and Sunday.

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Staying Safe in the Hospital

About two weeks ago The News & Observer printed an article all about Joe and Terry Graedon’s experiences with the health care system and what they learned about what patients can do to help prevent medical errors from happening to them while in the hospital.  The entire article can be read here and is enlightening, but if you read nothing else, the checklists they created were particularly helpful.

Ways to Prevent Medical Errors

  1. Expect mistakes and have an advocate with you in the hospital.
  2. Be assertive. “Being nice can get you killed.”
  3. Check every medicine to make sure the dose is right.
  4. When in doubt, “say No.” Demand and explanation.
  5. Be vigilant during transitions, from one floor to another, or when shift changes.
  6. Alert the nurse or rapid response team if something seems wrong.
  7. When discharged from the hospital, get detailed instructions and contact information.  Know what symptoms might signal a worsening situation or infection.
  8. Hospital doctors may never speak to your primary care physician.  Take your records and don’t assume doctors already know what’s in them.
  9. Double-check everything.  Don’t assume no news is good news or that test results are always correct.  Get copies of lab results in a timely fashion.  If something seems wrong, request a repeat.
  10. Take a friend or family member to doctor’s visits.  Nearly every error made in the hospital can be also be made in the outpatient setting.  A second pair of eyes and ears can be useful in getting instructions and spotting problems.

Patient Checklist

  • Take a list of your top health concerns/symptoms
  • Ask your doctor for a recap to make sure you’ve been heard.
  • Take notes or record the conversation so you can remember.
  • Carry a list of all your medicines and supplements.
  • Find out about the most common and serious side effects your medicines may cause.
  • Ask the doctor how confident he is about your diagnosis.  Find out what else could be causing your symptoms.
  • Get a second opinion.
  • Ask health care providers to wash their hands before they examine you.
  • Keep track of your progress: keep a diary of relevant measurements such as weight, blood pressure, blood sugar
  • Be vigilant when moving from one health care setting to another.  Mistakes and oversights are especially common during transitions.
  • Ask how to get in touch with healthcare providers.  Get phone numbers or email address and learn when to report problems.
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Dr. Graham Snyder Honored as Tarheel of the Week

Dr. Graham Snyder is an emergency department physician and the medical director of WakeMed's Center for Innovative Learning.

WakeMed’s own Dr. Graham Snyder was recognized yesterday by the News & Observer at Tarheel of the Week.   

Read all about the Raleigh native’s path to becoming an emergency department physician, his love of medical simulation and the role medical simulation plays in improving patient safety by clicking here.

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Playing it Straight: Chest & Spine Issues in Teens

The teen years can be tough. Scoliosis or a chest wall deformity can make them even tougher. But the symptoms should not be ignored.

Diagnosing Scoliosis

All spines have a natural curve that extends from the neck to the base of the spine, helping the body maintain balance and alignment. Too much side-to-side or lateral curve in the spinal column results in scoliosis. Here are some red flags that your child might have scoliosis:
• Shoulders are asymmetrical, with one shoulder blade protruding out more than the other
• Head is not centered above the pelvis
• One hip appears to be raised
• Rib cages are different heights
• Waist is uneven
• Skin covering the spine shows changes in appearance or texture (dimples, discoloration or excessive hair)

Diagnosing a Chest Wall Deformity

Chest wall deformities – pectus excavatum (sunken chest) or pectus carinatum (pigeon chest) – most commonly occur in teenagers. Patients can experience symptoms such as:
• Exercise intolerance
• Shortness of breath
• Chest pain
• Embarrassment over body image
• Cannot keep up with peers while playing sports.

Spine Camp

To educate children and parents about scoliosis, chest wall deformities and treatment options, WakeMed Rehab and Children’s Surgical Services, along with Raleigh Orthopaedics, are hosting a half-day spine camp.

Saturday, October 29 – 9 am to Noon
WakeMed Raleigh CampusRehab Health Park

Learn more and register online at events.wakemed.org or by calling 919-350-4179.

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After Being Paralyzed for 10 Years, WakeMed Rehab Patient Begins Walking

WRAL reports on a paralyzed WakeMed Rehab patient who begins walking again near the 10 year anniversary of her injury.

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North Carolina Seasonal Sensation – Pumpkin Recipes

Fall is finally here! And that means it’s time to snuggle up with warm, comforting foods as good for the body as they are for the soul. Here in North Carolina,  pumpkins are grown more than any other veggie in the month of October. And as a dietitian, I couldn’t be more excited.

Pumpkins are loaded with vitamins and minerals that boost the immune system, promote healthy vision and eye function and reduce the risk of some cancers and heart disease. Both the pumpkin’s flesh and its seeds are rich in alpha-carotene, beta-carotene, fiber, potassium, zinc and vitamin A. So eat those pumpkins, but be wary of the delectable treats the pumpkin is deliciously know for.

Usually found in pie, cake, bread, muffins and cookies, pumpkin can quickly go from a healthy choice to one that piles on those unwanted pounds. But don’t worry; there are tons of pumpkin dishes ready for the making and as healthy as they are delicious. Let’s start with savory wild rice and pumpkin cakes and hearty pumpkin soup.

In honor of this month’s seasonal sensation, here are deliciously healthy pumpkin recipes straight from WakeMed’s Heart Smart Cooking Series and the chefs at the WakeMed Raleigh Campus cafeteria, Cafe 3000.

Wild Rice and Pumpkin Cakes
From WakeMed’s Heart Smart Cooking Series
Serves 6

1 cup wild rice blend, cooked and cooled
1/3 cup dried cranberries
1/3 cup dried apricots, diced small
1/3 cup carrots, diced small
½ cup toasted pecans, chopped
¼ cup part-skim milk mozzarella, shredded
1 cup pumpkin puree
olive oil or cooking spray
Mesclun greens

Cook rice according to the directions on package. Fold in cranberries, apricots and carrots for the last 10 minutes of the cooking time. (You just want to cook the carrots and plump up the cranberries and apricots.) Gently fold in pecans, cheese and pumpkin. Divide rice into 10 balls, flatten each into a cake, and place on an oiled, foil-lined baking sheet. Bake 10 minutes at 35, or just to heat through, serve over a handful of mesclun greens.
Per serving (one patty): 200 calories; 8 g fat; 27 g carbohydrates; 79 mg sodium; 3 g fiber

Pumpkin Soup
From Jennifer Lagrand and Chris Zebney, WakeMed’s Café 3000 Chefs, WakeMed Food & Nutrition Services
Serves 8, 1 cup per serving
3 lbs pumpkin, peeled and cubed
4 shallots, minced
1 tbsp garlic, minced
2 tbsp fresh ginger, minced
2 stems fresh thyme leaves
2 tbsp olive oil
1 1/2 cups apple cider
1 1/2 cups vegetable broth
1 large bunch fresh sage leaves
1/2 tsp salt
1/2 tsp pepper
2 to 3 tbsp unsalted butter

Preheat your oven to 375°F. Cut the pumpkin in half and scrape out the seeds. Using a knife or fork, poke several holes through the pumpkin’s skin. Drizzle olive oil over the flesh of the pumpkin and season very lightly with salt and cracked pepper. Lay the pumpkin on a baking sheet with the flesh facing down. Roast until the pumpkin is soft and a fork passes through smoothly – about 30 minutes. Remove from oven and set aside.

In a large pot or Dutch oven over medium-high heat, add the olive oil and shallots. Let the shallots sweat for 5 minutes, stirring until they start to caramelize. Add the ginger and garlic and sauté for another 2 minutes, being careful not to burn the ginger.
Scrape the pumpkin away from the skin and add it to the pot. Add the stock, cider and thyme. Bring the ingredients to a simmer, then cover and cook until the pumpkin is very tender.

Let the the pumpkin cool for several minutes then, working in batches scoop the mixture into a blender or food processor, being very careful not to overflow the container. Once you transfer the mixture to the blender, allow it to cool a few additional minutes, then puree until smooth. Transfer pureed pumpkin soup into another pot and keep warm on the stove. Garnish with roasted pumpkin seeds, cracked pepper and a few shavings of Romano parmigiano cheese.
Per serving: 148 calories; 6.5 g fat; 330 mg sodium; 23 g carbohydrate; 1.7 g protein

This post is part of the NC’s No Diet Diet series.  View previous posts here: February Sweet Potato, March Lettuce, April Strawberries, May Broccoli and Cabbage, June Peaches, July Vegetables, August Watermelon, September Muscadine Grapes

Tina Schwebach is a clinical dietitian at WakeMed Cary Hospital.

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WakeMed Breaks Ground on North Hospital

WakeMed North Hospital Rendering

Today, WakeMed broke ground on WakeMed North Hospital, Wake County’s fifth hospital and the county’s first women’s focused hospital.

The groundbreaking took place during the Ladies Day event, where women throughout the community attended seminars, got health information and participated in screenings.

“As the northern Wake County community continues to grow, there is an increase in the demand for our services. The increased patient volumes we are seeing at WakeMed North Healthplex more than supports the development of a hospital at this location,” explained Carolyn Knaup, vice president, WakeMed ambulatory services. “While we fully expect WakeMed North Hospital to eventually expand into a full-service hospital, serving men, women and children, the immediate need is for women’s services.”

With an anticipated opening date of fall 2014, WakeMed North Hospital will be a 61-bed acute care hospital with a focus on inpatient women’s specialty services, offering a full range of obstetric and gynecological services, including comprehensive preventive, diagnostic, surgery, and therapeutic care.

The addition of a women’s focused-hospital further complements WakeMed’s dedication to women’s services across the system. This month, WakeMed also opened a newly renovated and expanded Women’s Pavilion and Birthplace on the Raleigh Campus. This renovation/expansion was made possible when the pediatric care unit was vacated last year due to the opening of the WakeMed Children’s Hospital on the Raleigh Campus.

The changes will allow for the renovation and expansion of Wake County’s only level IV Neonatal Intensive Care Unit (NICU). This expansion is the second phase of the WakeMed Foundation’s Just For Kids Kampaign.

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Clayton Fear Farmer’s Unique Way of Giving Thanks

Why I photographed a cornfield from the air

Glenn Boyette will tell you that he has been farming for all of his 59 years. With 100 acres in Johnston County, he has worked his farm 11 hours a day, seven days a week.

That changed after one of Boyette’s rare trips away from the farm. While vacationing in the Outer Banks, he and his wife Bonnie decided to climb the 268 steps to the top of the Cape Hatteras lighthouse, but severe chest pain cut their ascent short.

Upon his return to Raleigh, a nuclear stress test revealed that three of the arteries leading to Boyette’s heart were blocked and that he needed triple bypass surgery. Cardiothoracic surgeon Robert Peyton, MD, performed Boyette’s procedure at the WakeMed Heart Center.  His cardiologist Matthew Hook, MD, and the highly skilled WakeMed Heart Center staff cared for him after the procedure.

Once home, Boyette thought about the incredible care and caring he received as a patient at the WakeMed Heart Center and wanted to find a way to properly thank the staff and physicians for all they did to save his life. 

It just so happens that Boyette is the founder of one of the most successful Halloween attractions in the area, The Clayton Fear Farm.  Each year, the Boyettes create a massive corn maze with more than two miles of trails.  He thought, “What better way to say thank you than to carve the WakeMed Heart Center logo out of corn?”

A beautiful day

A few months later I climbed aboard Air Mobile, WakeMed’s helicopter for a fuel run to Johnston County.  Air Mobile must fly over the cornfield each time it refuels. 

The pilot and I didn’t know the exact location of Clayton Fear Farm, so I looked it up on my smartphone.  The pilot and crew checked of their pre-flight list, doors shut, seatbelts fastened. We donned helmets and headsets for communication, and to seal out the roar of spinning rotors.

I thought of my then-five year old daughter’s description of takeoff on her first flight as the helicopter lifted from the pad: “I feel joy in my stomach!”

We made a beeline to the farm. It was a perfect time of the day to make photographs. In fact, photographers call it “the golden hour,” when the light is most beautiful, about an hour before sunset.  “Great time to get fuel,” I thought.

I took out my smartphone from one of the many pockets of my flight suit, using the onscreen map as a guide. The gps locator that represented the aircraft blipped toward our destination. We were close now, so we began to look for the maze.

Tom Parker, our pilot, saw it first. “That is PRET-TY cool,” he said. It took me another 15 seconds to spot it. It was a thing of beauty. The corn maze looked like a huge green welcome mat, and it was greeting us. On closer observation it looked like each stalk of corn was a pixel on a computer screen.

Cut paths formed the logo for the WakeMed Heart Center, with more paths cut around it to create a complex picture frame surrounding the logo centerpiece. The maze was exquisitely executed, precise and clean.

“I would not like to get lost in this maze,” I thought.

I opened a small hatch in the door, and stuck the camera lens out of the hole, and started pressing the shutter button, taking pictures in rapid succession as the aircraft circled the maze. The emerald green patch of crops fit in the context of the patchwork of the surrounding farmland.

Glenn Boyette and his family had found a most unique way a farmer could to say thanks for the gift of health regained.

Patients who experience above-and-beyond service and care at a WakeMed facility show their appreciation to physicians and staff in many ways.  But only one has ever displayed his thanks in five acres of corn.  I witnessed his appreciation from a height where it is best understood. I am honored to share with you what I saw that day.

Julie Macie is a graphic design architect with WakeMed.  One of the roles she fills at WakeMed is that of photographer. She makes photographs all over our health care system, from employee portraits, to heart surgeries; from documenting employees in action in our emergency department, to capturing teaching sessions in our medical simulation laboratory.  Suffice it to say, that Julie was quite surprised when she was asked to make an aerial photograph of the Clayton Fear Farm corn maze.

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Count Down to the Scrub Run and Fun Fest

We’re only two days away from the first WakeMed Scrub Run and Fun Fest.  And, there is still time to register and to plan to come out for the fun!

WakeMed’s Scrub Run offers events for both running enthusiasts and families. Featuring competitive 5K and 10K races that accommodate both runners and walkers, along with a 100-Yard Kids Dash, this event is designed to involve our entire community.

Scrub Run Start Times & Entry Fees
• 10K – Starts at 8:30 am – $30
• 100-Yard Kids Dash – Starts at 9:45 am – $5
• 5K – Starts at 10 am – $25

Awards will be presented to the Top Three Overall Men & Women, the Top Three Masters Male & Female, and Top Three in male & female age divisions. Course maps are online at events.wakemed.org or ncraces.com.

Race packet & shirt pick-up
• Friday, September 30 from 4 to 6 pm at Marbles IMAX Theatre, 201 E. Hargett Street, Raleigh
• Saturday, October 1 from 7 to 9 am at Moore Square

Register Today!
Register online at events.wakemed.org. By entering one of the Scrub Run races, you will support WakeMed Children’s and the children of our community.

Fun Fest – 9 am to 2 pm
In addition to the race, WakeMed and its community partners will continue the celebration with a free Fun Fest event in Moore Square. Racers, their family and friends, and all members of the community will enjoy a variety of activities, including:

• Games & activities
• Live music from Bull City Syndicate
• Entertainment
• Face painting
• Arts & crafts
• Mascots, including Twinkle, WakeMed Children’s mascot

Come help us celebrate our 50th year of service to the community!

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