Clinical Preventive Services for Normal-Risk Adults

Immunization

Tetanus-Diptheria (Td): every 10 Years, 18 years and older.

Varicella (VZV): Susceptible only two doses, 18 years and older.

Measles, Mumps, Rubella (MMR): Women of childbearing age-One dose, 18-50 years.

Pneumococcal: One dose, 65 years and older.

Influenza: Yearly, 50 years and older.

Chemoprevention

Discuss aspirin to prevent cardiovascular events:

Men: Periodically, 40 years and older.

Women: Periodically, 50 years and older.

Discuss breast cancer chemoprevention with women at high risk.

Counseling Calcium Intake: Women, periodically 18 years and older.

Folic Acid: Women of childbearing age, 18-50 years. Tobacco cessation, drug and alcohol use, STDs and HIV, nutrition and physical activity, sun exposure, oral health, injury prevention and poly-pharmacy: Periodically, >18 years. Upper age limits should be individualized for each patient.

Weight

Normal body mass index (weight (kg)/height (sq. meters) for Indian Americans is <23

Waist circumference <90 cm or 36 inches (men); <80 cm or 32 inches (women)

Clinical Preventive Services for Normal-Risk Adults

Screening

Blood Pressure, Height and Weight: Periodically, 18 years and older.

Cholesterol:

Men, Every 5 years (and more frequently if at risk or abnormal), 35 years and older.

Women, Every 5 years (and more frequently if at risk or abnormal), 45 years and older.

Diabetes: Periodically, adults with hypertension or hyperlipidemia.

Pap Smear: Women, Every 1 to 3 Years, 18-65 years.

Mammography: Every 1 to 2 Years, 40 years and older.

Colorectal cancer:Periodically, 50 years and older with Stool Guiac &/or sigmoidoscopy colonoscopy.

Osteoporosis: Women, routinely, >65 years old or >60 years at risk for fractures.

Alcohol Use: Periodically 18 years and older.

Vision and Hearing: Periodically, 65 years and older

PSA Screening: In Men periodically

Some other factors that can affect Health!

Include at least 20 gms. of fiber everday. Whole grains, beans & vegetables are rich sources

Many 'fast' foods are high in fat, salt and/or sugar. Limit or avoid frequent use of such foods

If you have high blood pressure, restrict the use of salt, salty foods like regular chips and pickles

Talk to your physician about your multi-vitamin and multi-mineral supplements.

Have a routine check-up blood lipid levels.

DIABETES CAN BE MANAGED! TAKE CONTROL! YOU CAN DO IT!

Foods from different sources can be combined to make up a balanced meal. Your personal meal plan should be designed to suit your lifestyle. Your meal plan will suggest servings of each food group at every meal. The different food groups and examples of one serving in each food group are as follows: (Please note that values are approximate)

1. GRAINS/BEANS/STARCHY VEGETABLES (without added fats or oils) (ex. Rice flour, Beans/Legumes)
2. MEAT & MEAT ALTERNATIVES-VERY LEAN (ex. Chicken Turkey, Tuna in water)
3. MEAT & MEAT ALTERNATIVES-MEDIUM FAT (ex. Egg, Fried Fish)
4. MEAT & MEAT ALTERNATIVES-HIGH FAT (ex. Peanut Butter, Regular cheese)
5. VEGETABLES (no fat added) (ex. Cabbage Cauliflower, White radish)
6. FRUITS (ex. Banana, Mango, Canned fruits, Apple, Orange)
7. MILK AND MILK PRODUCTS (ex. Whole/skimmed/low fat milk)
8. FATS AND OILS (ex. cooking oil, nuts or seeds)

Methods of preparing and cooking

Sprouting legumes increases nutritional value. It can be fun sprouting different legumes!

Steam vegetables with little water Do not drain the cooking water from rice or vegetables

Limit or avoid highly processed foods or high-fat, salty fast" foods

Try to eat small, frequent meals at regular times

Drink plenty of water/liquids

6-8 glasses is the usually recommended amount. Plain water is the best. Avoid excessive use of caffeinated drinks life coffee, tea and caffeine containing drinks.

Use alcohol only after talking to your physician.

What Can I Eat To Manage My Diabetes?

Diabetes is a condition where your body is not able to make enough insulin onr the insulin is not being used properly. Insulin enables your body to get energy from glucose – the sugar broken down from the foods you eat. A poor balance between insulin and blood glucose levels can result in high glucose (hyper-glycemia) or low blood glucose (hypoglycemia ) levels in your blood. Maintaining blood glucose levels around acceptable levels is important and research has shown that it can help prevent complications in your eyes, kidneys, blood vessels and more. Under your physicians guidance, diabetes and blood glucose levels are managed with Medical Nutrition Therapy, an individualized meal plan, exercise and medications as needed. The foods you eat, total calories, activity and body weight are some of the factors that can affect blood levels. Foods that contain carbohydates can raise blood glucose levels. Fats and protein can also affect weight, if eaten in excess. Keep a daily log of your meals and blood glucose levels to better understand fluctuations. Include a daily exercise plan into your regimen (after talking to your physician). Become familiar with food labels and ingredients. Your Dietitian can help you with this.

My doctor says I don’t need to see a specialist for my diabetes. How do I know if my doctor is right?

At the time of writing, there are estimated to be about

16 million adults in the United States who are aware that they have diabetes. There are, however, only about

4000  certified  adult  diabetes  specialists in  clinical practice and not all of these are in full-time practice. Some, perhaps  one  in four, do not see patients with diabetes at all. This translates to one diabetes specialist for every 5000 people with  diabetes. 

The average diabetes specialist carries a clinic census of several hundred active patients, each of whom he or she sees from two to several times per year. From these statistics, it is clear that  the  vast majority of people with diabetes will not be able to consult  a specialist. However, not all people with diabetes need  specialist input, and those who do will usually not require it for the majority of the course of the disease, especially in the  case  of type 2 diabetes. Much  of the  education necessary to  effectively manage  diabetes,  especially that  centering  on  glucose monitoring  and  diet  and nutrition,  is accessible by  referral directly from your family doctor. Given its frequency, many family doc- tors see a considerable number of patients  with dia- betes and are competent in its routine management. They  also generally make effective judgments as to when specialist consultation is advisable.

Some of the circumstances in which consultation with a diabetes  specialist is often advisable

How does the sugar in fruit drinks differ from the sugar in sodas?

The sugar in fruit juices is predominantly fructose, which is a disaccharide, meaning that it contains two molecules of glucose joined together and must be bro- ken down to glucose in  order to be absorbed, which may cause a delayed or  muted  effect on  the  blood sugar. Fruit juices will also contain a moderate amount of some vitamins and minerals. Sodas do not contain significant amounts of vitamins or minerals. The sugar in  regular non-diet  sodas is glucose, which  is very readily  absorbed and sweeter tasting. The amount of sugar in a  standard 12-ounce can of regular soda is equivalent to about 9 teaspoons of table sugar (which is neither  glucose nor fructose,  but  sucrose, another disaccharide) and therefore provides a large amount of calories, which can raise the  blood sugar level very quickly. This is helpful if a low blood sugar reaction is being treated, but not a recommended part of the dia- betic diet, as it causes a very sharp rise in blood glucose to levels above those  recommended. This rise is hard to prevent with either pills or  insulin, without giving doses that will later lead to low blood sugar levels.

I have heard that depression is more common in people with diabetes. Is this true?

Yes, it is true that  people with diabetes (and with other long-term illnesses) can experience higher rates  

of depression. This can be due to factors relating to the diabetes itself, or it can be unrelated. There is no convincing evidence that the actual blood sugar level itself is  reliably  predictive of mood,  even in  those with a tendency to  depression. The  severity of the diabetes and its complications,  as well as its impact upon a person’s  lifestyle and aspirations,  can be an important  predictor  of  depression.  For  some  the impact may be major and for others much  less so, even though the degree of severity of the diabetes is the same. It is  important to remember that the vast majority of people in our  society with treated dia- betes  (more  than  15  million  in  the  United  States alone) are able to  adjust to  the  disorder and  have happy, productive, and  rewarding lives. Some have even achieved astonishing things in all walks of life. Examples  include the gold medal winning Olympic swimmer  Gary   Hall,  the  NBA  basketball  player Adam Morrison, and the  actresses Halle Berry and Mary Tyler Moore and Supreme Court Justice Sonia Sotomayor,  all  of  whom  have  lived  with  diabetes while achieving great success.  If you are experiencing unusual degrees of sadness, reduced  enthusiasm  or  interest  in  life, or  excessive stress that  you  perceive is related to your diabetes, your doctor or certified diabetes educator may be able to help you to identify resources  that  can help you cope. Some of these resources are discussed in Ques- tion 82. Many certified diabetes educators (CDEs) are  trained  to  provide  such  psychosocial support. If you are  truly suffering from depression, your dia- betes may or may  not  be an underlying cause, even though it may seem that  way. Your doctor or CDE will help you to identify whether expert professional psychological or psychiatric consultation is needed.