<0> Mayo Clinic Health Letter, August 2012 Highlights: Stopping the Progression of Prediabetes to Diabetes; Controlling Rosacea; Concussion - the Brain in Crisis </0>
Mayo Clinic
Here are highlights from the August issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Visit or call toll-free for subscription information, 1-800-333-9037, extension 9771.
How to Stop the Progression of Prediabetes to Diabetes
ROCHESTER, Minn. -- The progression from insulin resistance and prediabetes to diabetes likely can be stopped with changes in diet and lifestyle, according to the August issue of Mayo Clinic Health Letter.
In people with insulin resistance, cells do not respond normally to insulin, and the body’s fuel, glucose. As a result, the body produces more insulin to overcome the resistance. Over time, cells become more resistant, and the body can’t keep up with insulin production. Blood glucose levels rise and eventually, type 2 diabetes develops.
But the progression from prediabetes to type 2 diabetes often can be stopped. One large study, the Diabetes Prevention Program, found that modest lifestyle changes reduced the risk of progression by 71 percent in adults age 60 and older. Participants who reduced their risk the most:
* Consumed fewer calories and cut back on fat.* Exercised the equivalent of brisk walking 30 minutes a day, five days a week.* Lost a little weight. The goal was 7 percent of body weight; for example, 14 pounds for a person weighing 200 pounds.
Insulin resistance appears to be caused by a combination of genetic and lifestyle factors. A sedentary lifestyle and a family history of diabetes are risk factors. So is being black, Native American, Asian-American, Hispanic or a Pacific Islander. Being overweight, especially with excess fat around the abdomen, is the greatest modifiable risk factor for progressing to type 2 diabetes among those who already have insulin resistance.
Several medications have been shown to reduce the risk of type 2 diabetes. The best appears to be metformin (Glucophage), but studies show many limitations. This medication is least effective in adults over 45 and not recommended for those over 60. Even for younger adults, metformin isn’t as effective as losing weight and exercising.
Keeping the Flushed Face of Rosacea Under Control
ROCHESTER, Minn. -- A flushed face along with the presence of pimple-like bumps could indicate rosacea (roe-ZAY-she-uh), a common inflammatory skin condition. The August issue of Mayo Clinic Health Letter provides an overview of this progressive condition and ways to manage it.
Rosacea can begin with a tendency to blush. While anyone can develop rosacea, most often the condition occurs in women between 30 and 60 with fair skin and light eye and hair colors.
Persistent red areas may develop in the center area of the face, especially the nose. Over time, small blood vessels on the nose and cheeks may swell and become more visible. Small red bumps may appear. More than half of people with rosacea experience a burning or gritty eye sensation called ocular rosacea. Rarely, late in the course of the disease and most often in men, tissue can build up on or around the nose, giving it a bulbous appearance.
Rosacea typically requires treatment to clear up, but symptoms can often be controlled with medication and self-care.
The first step is avoiding triggers that cause facial flushing. They include:
* Temperature extremes.* Sunlight exposure.* Hot foods and beverages.* Spicy foods.* Alcohol.* Stress, anger or embarrassment.* Hot baths and saunas.* Medications that dilate blood vessels including some blood pressure medications.
Topical medications can reduce the pimple-like bumps. Commonly used options include metronidazole (Metrocream, Metrogel, others), tretinoin (Retin-A, Renova, others), benzoyl peroxide, azelaic acid (Azelex, Finacea) and sulfacetamide (Klaron). Topicals may be used alone or in combination with oral antibiotics. Once symptoms improve, topical medications alone can help keep rosacea in remission.
Concussion Jolts the Brain into Crisis
ROCHESTER, Minn. -- Concerns are growing about the prevalence of concussions in children and teens who play sports, as well as in professional athletes. The August issue of Mayo Clinic Health Letter covers what happens when concussions occur and why they can be dangerous.
Concussion is a form of traumatic brain injury. It occurs when a blow to the head or a sudden jolt shakes the head and causes the brain’s gelatin-like cortex to rapidly collide with the inside the skull or turn within it.
Immediately after a concussion, the brain is in crisis. Many brain cells become activated at once, which can cause a sudden release of brain chemicals called neurotransmitters. Within minutes to hours after a concussion, the brain’s power drain can cause headache, dizziness, nausea or vomiting, imbalance, slurred speech, fatigue and being unaware of surroundings. Symptoms that may appear later include:
* Difficulty concentrating or remembering.* Sensitivity to light and noise.* Persistent headache.* Unexplained irritability or other personality changes.* Sleep disturbances.* Depression and problems adjusting psychologically.* Altered sense of taste and smell.
If symptoms are present, avoiding another concussion is critical, because the brain is vulnerable to rare but fatal brain swelling. The focus during recovery is physical and mental rest. Most people recover completely within a week or two and have no further symptoms. When recovery takes longer, persistent headaches are common. For someone who has had multiple concussions, recovery becomes less certain with each concussion.
A head injury should always be evaluated by a medical professional. Young athletes or children with a suspected concussion should be immediately removed from play.
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