Diabetes Medical Management
by Spyros G.E. Mezitis, PhD

Diabetes mellitus is a disorder of the body’s sugar (glucose) metabolism that is increasing in our aging and overweight society with more sweet food intake and less aerobic exercise.  Insulin is the chemical the pancreas in the abdomen secretes into the bloodstream and lowers the blood sugar.  Insulin facilitates the sugar going into muscle and nerve cells to serve as fuel for their function.  Insulin also blocks the liver from releasing sugar into blood.
 
In most cases of type 1 diabetes, the body attacks the beta cells of the pancreas that produce insulin. The major pathological mechanisms of diabetes type 2 are less insulin production by the tiring pancreas and less insulin action blocked by the increased number of fat cells.
 
Diabetes medical management is based on using pills and/or exogenous insulin injections to maintain the three month blood sugar average Hemoglobin A1c (HbA1c) below 7 percent or blood sugar in the low 100’s mg/dl.
 
The insulin sensitizer Metformin (Glucophage) is the first line oral medication if HbA1c is below 9 percent but the patient needs to watch for nausea, abdominal bloating and check liver and kidney blood studies.  If Metformin does not control the blood sugars, other classes of oral diabetic agents may be added.
 
The long acting (Glimepiride, glipizide contain sulfa) and short acting (repaglinide, nateglinide) insulin secretagogues last from 2 to 24 hours and can reduce the HbA1c by 1-3 percent.  Newer oral medication DPP-4 enzyme inhibitors (Januvia, Onglyza, Tradjenta) once a day slow the food gastrointestinal transit and absorption and allow for more insulin production with meals.
 
The oral SGLT-2 inhibitors (Invokana, Farxiga, Jardiance, Steglatro) block the sugar in the urine from being reabsorbed at the proximal kidney tubule.  These pills lower the blood pressure, protect from heart attack, stroke and cardiovascular death but should not be used with significant renal insufficiency.  The pen injectables GLP1 agonists (Byetta, Victoza, Trulicity, Ozempic) supply the gastrointestinal enzyme needed by diabetics to secrete insulin with meals.  Accompanying nausea leads to weight loss.  Victoza (Liraglutide) has been shown to lower cardiovascular death.
 
Insulin sensitizers Avandia and Actos are not favored because of adverse effects including increased risk for congestive heart failure, kidney and urinary bladder disease, and bone fractures.  Oral sugar blockers Acarbose (Precose) and Miglitol (Glyset) are the weakest oral agents, cause gastrointestinal side effects and are rarely used.
 
The normal pancreas puts out low level insulin when not eating and increases insulin production accordingly with meals to keep the blood sugar normal (70-140 mg/dL).  If the body’s insulin is absent like in type 1 diabetes or is exceedingly low like in the severe form of type 2 diabetes, insulin is supplied by injection with a syringe, pen, insulin pump, or insulin infusion in the hospital intensive care setting. The insulins measured in units available on the market vary by their duration of action.  Only insulin should be used in diabetes type 1 and diabetic ketoacidosis.
The rapid acting insulins (Humalog, Novolog,  Novolog FiAsp, Apidra, Admelog) are administered under the skin by injection with meals to prevent the post meal sugar spikes or are continuously injected by the insulin pump (Medtronic, Omnipod, Tandem) according to a basal/bolus regimen dependent on blood sugar measurements, carbohydrate counting and meal planning.
 
The long acting insulins (Lantus, Toujeo, Levemir, Tresiba) last from 12-42 hours and control the blood sugars when not eating.  They are used in combination with pills or rapid acting insulin with meals to mimic the normal body’s function.  In the United States, insulin is costly and the older insulins NPH (intermediate acting 8-12 hours) and Regular (short acting 2-4 hours) are available in vials at low prices.  New research data are showing that Vitamin D 25 OH blood levels above 40 ng/ml prevent diabetes and improve blood sugar control.
 
The patient needs to maintain blood sugars below 200 mg/dL at all times to avoid the small vessel disease that causes neuropathy, blindness, kidney failure and the large vessel disease that causes heart attacks and strokes.  Blood sugars are measured with small meters by finger-sticks blood glucose placed on test strips or by continuous glucose monitoring (CGM - Freestyle Libre, DEXCOM).
 
The patient who adheres to a low carbohydrate diet, brisk walking for exercise to lose weight under medical supervision and receives a tailored drug regimen to maintain HbA1c below 7% has a better chance to live healthier and longer.

Spyros G. E. Mezitis, MD, PhD
Assistant Professor in Endocrinology/Clinical Medicine, Weill Medical College of Cornell University
Attending Physician and Clinical Investigator, New York Presbyterian Hospital/Cornell Medicine
Lenox Hill Hospital/Northwell Health, New York, New York.  Endocrine Practice, 220 East 69th Street, New York, NY 10021, Tel:  212-288-6661, Website: DrSpyrosMezitis.com  E mail: mezendo212@gmail.com

Hypnosis for Weight Management (Part 2 of Hypnosis Series)
by Sandy Victor

I am writing this article as a practicing hypnotist focusing mostly on personal improvement matters.  I am not recommending the use of hypnosis to diagnose, prescribe or treat any medical condition.  This is the purview of physicians and mental health professionals.
 
What can hypnosis do for you?– The list of issues that hypnosis can help people with is very long.  I will touch on a few of them that are identified in health literature. Treating a non-medical condition or dealing with a variety of symptoms can be successfully dealt with hypnosis. As each individual may have different habits and beliefs, it is imprudent to think a premade program (often available by internet vendors) for use by everyone.  Effective use of hypnosis should consider each person as an individual.

The following are some of thoughts on dealing with one of the most commonly presented issues:
 
Weight Management

Modifying habits like overeating, making poor diet choices is commonly a topic for hypnosis.   Weight loss is one of the more common problems impacting people today.  People of all ages have problems with being at the weight that they and their doctors think is best for a healthy life. Suggestions given to a person in hypnosis can assist in several ways to assist people improve their weight.  When in hypnosis, people are much more apt to follow suggestions than when they are not in hypnosis.

People can be told that they need to lose weight or eat healthier when not in hypnosis. They can be told by their family or their doctor or by friends and the conversation goes in one ear and out the other. Being told to do something that changes a long-standing habit is very difficult.  After all, you have probably been eating every day of your life (except maybe Yom Kippur) since you were born.  So simply telling somebody that they need to lose weight or eat better is generally not very effective.

Diets are also typically not effective.  When a person is on a diet, they are consciously restricting their food choices.  No matter what the diet is, it generally involves eating certain types of food and/or not eating other types of foods.  The goal of the diet is reducing the person’s weight to some target value. Once the person reaches that value (assuming that they do reach it), the diet is considered over.  People then tend to go back to their old eating habits. In many cases this results in the person putting the weight back on again.

Eating healthy varies from individual to individual based on the state of their health. A person with some medical condition will need to eat differently than somebody without that condition.  For example, a person with diabetes has to be more careful about some types of foods than a person that does not have diabetes.  The same thing is true with severe food allergies.  People should discuss with their doctors what foods should or should not be part of food selections.  Beyond foodstuffs that are required or prohibited based on a person’s medical condition, the choice of foods to be eaten in its most basic terms, rather simple. A person’s body needs some quantity of various foodstuffs to provide them with the necessary nutrients to keep their bodies operating efficiently.  Most bodies need a certain balance of vitamins, mineral, proteins, carbohydrates, water, etc. to allow their bodies to work well.  This provides their bodies with the needed energy and nutrition.  While some people’s taste preferences may make eating certain foods more difficult, the needed nutrition can typically come from more that one type of food. For example, vegetarians will not get proteins from meat but can get them from some types of vegetables.

The other main issue with weight management is the quantity of food being eaten and the timing of eating it.  Food intake is often measured in calories.  Which is a measure of the energy content within the food.  The more energy in the food the higher the number of calories. During the day people use energy to move their muscles (including the heart to pump blood), maintain body temperature, and power all the other bodily functions.  At night, the body uses much less energy while you are sleeping.  If the energy intake from food is balanced by the energy expended, the body maintains its weight.  If the body takes in more than in needs, the body will store the excess as fat (saving it for a rainy day when it needs more energy). The storing of this fat increases your weight.  If the body uses more energy than it takes in, it taps into those fat reserves, and your weight is reduced.  Eating food at breakfast is far better than eating before bed as your body has a greater chance of burning up the food during the active daytime than while you are sleeping.

So where does hypnosis fit into this process.  While in hypnosis, people will accept suggestions more readily than when they are fully conscious.    Suggestions can be provided, to eat foods that provide the best nutrition.  To avoid foods that lack much nutrition. Suggestions can be made in a positive or negative mode.  For example, when tempted by chocolate your think of not eating it based on nutrition value or picture the chocolate with a swarm of roaches crawling all over it. The first being a positive statement and the second a negative statement.  Personally, I try to avoid negative statements/images.  Suggestions are also given to limit the quantity of foods taken in.  To alter the timing of eating.  To not eat if you are not hungry.  For example, your mother’s requirement to clean your plate because other children somewhere in the world are hungry is not really a valid reason for you to eat when you are not hungry.  Suggestions are also given to increase your physical activity in some appropriate way based on the individual’s capabilities.  If you never go to a gymnasium, it is unlikely that you would be asked to work out 2 hours a day nor would that suggestion be very effective. But some increased physical activity can easily be added.  For example, parking at the far end of a parking lot instead of the closest space to the door or waking up a flight of stairs instead of taking an escalator.

Suggestions given in hypnosis are more likely to change a person’s habits into healthier habits.  Habit changes are more effective than forced conscious decisions like diets as a habit can last forever.

Sandy VIctor is a Certified Hypnotist/Hypnotherapist by the National Guild of Hypnotists in a private practice.  I am located in Buffalo Grove, IL, and have been doing hypnosis for over 40 years mainly for personal improvement matters.  For more information, contact me at - sandy_victor@hotmail.com, www.SandyVictorHypnosis.com and (847) 634-1376.

Should Yom Hashoah Be A Powerful Force In Our Lives?
by Gary Smith

I know this is Passover and we will certainly read and talk about the story of Passover but the Shoah was such an intoxicating force in our grandparents and parents lives that it should never be forgotten.  It is up to us to keep the memory alive.  What are we doing by celebrating Passover every year?
 
---YOM HASHOAH is officially known as Holocaust and Heroism Remembrance Day. It is a day dedicated to memorial and somber reflection in recognition of the millions of lives lost under Nazi persecution. But Yom HaShoah also reminds us to reflect on the acts of resistance that took place throughout the war.  For this reason, an early proposal favored by many survivors and Zionists called for the holiday to be commemorated on the 14th of Nisan, the anniversary of the Warsaw Ghetto uprising, perhaps the most well-known of the many revolts against Nazi aggression. The recommendation was dismissed because of the day’s proximity to Pesach, but the spirit was maintained when the Knesset approved a plan calling for Yom HaShoah to be observed within the timeline of the actual uprising just two weeks later. The 27th of Nisan was ultimately chosen, placing the commemoration in between Passover and Yom Ha’atzmaut, Israel’s Independence Day.  With Israel’s Memorial and Independence Day holidays only a week later, all Israelis are keenly aware of the tragic Jewish past and the importance of struggling for continued survival.

---The word holocaust comes from a Greek word meaning “sacrifice by fire.
 
---It is not accidental that Yom HaShoah is just after Passover. The pairing of the two holy days in our Jewish calendar creates a narrative. The prominent Modern Orthodox rabbi, Yitz Greenberg  links the two in History: “Passover joy is shadowed by Yom Hashoah. In effect, Passover is wounded but not destroyed, which is the truth witnessed by Jewish life after the catastrophe. Wounding but not destroying Passover is another way of saying the covenant is broken but not defeated or replaced.”       
 
---There is another connection between Pesach and Yom Hashoah. Both are holy days that are fixed in our calendar to help us remember or to never to forget events in our Jewish history: Pesach, the Exodus from Egypt, and Yom Hashoah, the Holocaust. Dr. Yehudah Kurtzer, President of the Hartman Institute of North America and author of the book “Shuva: The Future of the Jewish Past”, observes that while these are both days that ask us to remember historical events, the observance of Passover and Yom Hashoah couldn’t be more different.
 
---What are the similarities between Passover and Yom Hashoah?  What are the dissimilarities?  Yehudah Kurtzer begins his book Shuva with the following quote from Elie Wiesel’s 1986 Nobel Lecture.  “The opposite of the past is not the future but the absence of future; The opposite of the future is not the past but the absence of the past. The loss of one is equivalent to the sacrifice of the other.” 
 
How do we view our own relationship to the Holocaust if we ourselves are not a survivor or the child or grandchild of a survivor?  Here is a poem by Ron Adler that you might include in your seder.
 
        "Who am I to Speak of a Time?"
        Who am I to speak of a time of families crushed,
        of crimes of mankind,
        of children in hiding and living in fear,
        of mothers trying to hide all their tears,
        of fathers praying to an empty heaven,
        of people dying again and again?
         
        Who am I to know what it was like to be persecuted by day and trapped by the night,to be surrounded by a world turned upside down,to be starved and tortured and beaten to the ground,
        to witness a nation of hate marching past,
        to see all their dreams broken and shattered like glass?
         
        Who am I to mention their suffering and pain,the ghettos, the camps, life and death inhumane?
        I wasn't even born,
        I wasn't even there,
        it happened long ago,
        it could never happen here.
         
        Who am I to know what God had in mindwhen the virtues of man were buried alive, when good lost to evil and hope turned to despair, when hell upon earth seemed everywhere?
 
        Who am I to let their memories be forgotten,
        to say and do nothing as if it never happened,
        to forsake the loss of our Jewish family,
        to live in a world of complacency?
         
        The Blessing of the Yellow Candle

        We light this yellow candle to rekindle God's flame, to shine His light upon the world once again,to sanctify the memories of the millions of souls, to honor their prayers and all their lost goals. We bless their existence by being aliveto light this yellow candle as proof we survived. Ron Adler
         
        As I light this Yellow Candle, I vow never to forget the lives of the Jewish men, women, and children who are symbolized by this flame. They were tortured and brutalized by human beings who acted like beasts; their lives were taken in cruelty. May we be inspired to learn more about our six million brothers and sisters as individuals and as communities, to recall their memory throughout the year, so that they will not suffer a double death.
 
        May we recall not only the terror of their deaths, but also the splendor of their lives.
 
        May the memory of their lives inspire us to hallow our own lives and to live meaningful Jewish lives so that we may help to ensure that part of who they were shall endure always.
 
        Here is the name of a child who perished in the Holocaust (including name, age, birthplace, and place and date of death).  Please remember this child in your meditation.  Name: ODETTE ABOULAFIA, Child of MARCO, Age: 8, Born: FRANCE, Died: A USCH WI TZ, Year of Death: 1944