Thursday, July 21, 2016

The 411 on A1C: Diabetes Education Classes Can Help

When you eat, whether the food is sweet or not, your body breaks some of the nutrients down into a sugar known as glucose. Cells need glucose for energy, but if you already have enough, the remaining glucose is left floating in the blood. The level of sugar that builds up in the bloodstream can be measured with an A1C test, also known as a glycated hemoglobin test. Levels between 5.7% and 6.4% signify pre-diabetes and an increased risk of diabetes. Levels above 6.5% indicate diabetes.

If you have diabetes, managing your A1C level is vital to ensuring you don't develop complications such as eye, nerve, foot or kidney damage. Home blood sugar testing is an important and useful tool, but it only provides a snapshot of your blood sugar levels in the moment. An A1C test provides an average from the past three months, which can provide a more accurate sense of how well you're managing your type 2 diabetes. Patients with diabetes should get an A1C test every three to six months.

There are ways to improve your blood sugar management and contribute to lowering your A1C score:
  • Register for free diabetes education classes. GBMC offers a series of two 90-minute classes in its primary care offices: Diabetes Basics and Taking Charge of Your Diabetes. Both include education, support and resources. Learn how to manage your meals, understand target blood glucose numbers and become comfortable self-monitoring. To sign up, call your PCP's office and request to speak with the RN Care Manager.
  • Get moving. Find a workout you enjoy that will encourage you to get at least 30 minutes of exercise five times a week.
  • Stick to a schedule. When you overeat or skip meals, your blood sugar levels are rising and falling too much. Have regular well-balanced meals.
  • Balance your diet. You may be surprised what one serving size of fruit looks like. A diabetes educator can help you plan a proper diet that works for you.
For qualifying patients, GBMC also offers one-on-one sessions with a registered dietitian who is also a certified diabetes educator at these practices: Hunt Valley, Family Care Associates, Hunt Manor, Owings Mills, Joppa Road and Internal Medicine Residents. If you are interested in diabetes education, call the Nurse Care Manager at your primary care practice. Feel free to forward this e-mail to a friend or family member who might need help managing their A1C level, too. In need of a primary care provider? Find one near you.

Safe Summer Travels

No one likes to think about being sick on vacation, but with so many news stories about various epidemics circulating in popular summer destinations, we turned to two of GBMC’s infectious disease physicians Maneesha Ahluwalia, MD, and Alina A. Sanda, MD, for advice. Here are their tips for a safe and healthy vacation:

Q: What is the number one precaution I should take when traveling?

Maneesha Ahluwalia, MD
A: Hand washing cannot be emphasized enough; it’s like a do-it yourself vaccine! Lather with water for at least 20 seconds (about one Happy Birthday song) and dry with a clean towel. Wash before eating, before and after treating a cut or wound, after using the toilet, after touching an animal or garbage and after changing diapers. Avoid those who are coughing and sneezing, and if you must cough or sneeze, do so into your shirt sleeve or elbow, not hand.

Q: What are some good items to pack?

A: Pack full-sized bottles of sunscreen and insect repellent, especially if visiting a tropical location. Use products with 25 percent DEET; you don’t need more than that. Apply sunscreen first, and then insect repellent. Also bring hand sanitizer or dissolvable soap, which does not require water to rinse off. Oral rehydration salts can come in handy for people who become dehydrated due to traveler’s diarrhea or vomiting. Bring along 1% hydrocortisone cream; it is helpful for a variety of skin conditions from insect bites and poison ivy to allergies, rashes and overall itchiness.

Alina A. Sanda, MD
Keep your prescription medications in your carry-on luggage and bring extra just in case. If you have any chronic illnesses, carry a card that identifies, in the local language, your blood type, medical conditions, medicines you take, and any allergies you have. Wear a MedicAlert bracelet if you have serious medical conditions.

Q: Are there foods or drinks I should avoid?

A: If you are traveling abroad to places like Africa, Asia or South America, do not drink the tap water. Brush your teeth with bottled water. Avoid eating raw fruits or vegetables unless they have a thick peel, like a banana or orange. In all locations, be wary of food served at room temperature, raw or soft-cooked eggs, raw or undercooked meat or fish, unpasteurized dairy and wild game.

Q: Should my family be vaccinated before we travel abroad?

A: Visit a travel clinic 6-8 weeks prior to traveling and bring along your vaccination history, a detailed itinerary and your travel dates. They will be able to give you reliable advice on recommended vaccines. Some vaccines and malaria prevention tablets must be started weeks prior to travel, so be sure to plan in advance. For the most up-to-date, reliable travel alerts for every country, visit the Centers for Disease Control and Prevention website at

Q: What should I do if I think one of my family members has contracted a disease?

A: Seek medical attention immediately. Hydration is usually a good first step. Find a safe and reliable doctor who speaks your language by contacting the US embassy in your destination country ( Upon returning home, make an appointment with a primary care physician, who will assess your symptoms and determine whether a referral to an infectious disease specialist is necessary.

To learn more about infectious diseases and primary care at GBMC, visit and or call 443-849-GBMC (4262).

Not Just a Headache: Managing Migraines

Migraines are often perceived as simply bad headaches but in actuality, more than 37 million Americans are suffering from a debilitating condition that can't always be handled with a dose of Tylenol. Though migraines are a type of headache, they are more severe and can be accompanied by nausea, vomiting, tingling, stroke-like symptoms and sensitivity to light and sound. Sometimes a migraine phenomenon can even occur without a headache.

According to GBMC neurologist Arash Taavoni, DO, identifying one's migraine triggers is the key to preventing them. He recommends that patients log their food, stress levels and sleep, along with other environmental factors, like weather conditions and barometric pressure, in an effort to find patterns. There are even mobile phone apps, such as MigraineBuddy, that can be useful in helping patients log their migraine symptoms, frequency, duration and intensity by automatically making data correlations to pinpoint a migraine's cause. Some of the most common food-related triggers are caffeine and MSG, which is often found in highly-processed and convenience foods, so establishing a healthy diet is the first step to addressing migraines. In addition to lifestyle and behavioral factors, genetics and hormones can make certain people more prone to migraines; they can run in families and are more common among women.

While identifying triggers as a means of trying to avoid migraines is ideal, sometimes this isn't enough and other treatments may be needed. There are two types of medications that can be prescribed – preventive and abortive. Other than pills, there are also intranasal and injectable medications for faster relief. There are even treatments without medications, such as headband-like devices patients can wear at home that use electrical impulses or magnets to reduce migraines by acting on the nerves associated with head/face pain. Dr. Taavoni notes that acupuncture may be helpful as a complementary treatment, as well.

Some patients with chronic migraines who have not had adequate success with medications and lifestyle modifications could be candidates for Botox® injections. "To prevent migraines, Botox® is injected into 31 specific spots on the head and shoulders, administered every three months by a trained physician," Dr. Taavoni says.

If you're suffering from migraine headaches, your primary care physician can likely help you find a solution. If migraines are frequent and refractory or if there are additional neurological symptoms, you should see a neurologist:

Run Safely in the Sun

If you've exercised on a treadmill through the cold winter and rainy spring, an outdoor summer run can seem so appealing. Running outdoors is a great way to mix up your fitness routine while getting a boost of vitamin D; the varied terrain activates different muscles, but it's important to be aware of how the heat and humidity can affect your physical abilities. A relative humidity of 60% or more hampers sweat evaporation, which hinders your body's ability to cool itself. Heat-related illnesses, such as heat cramps, heat exhaustion and heat stroke are all real possibilities for children, the elderly and particularly for outdoor runners, according to Mark Lamos, MD, Medical Director of Greater Baltimore Health Alliance (GBHA) and Internal Medicine physician at GBMC.

Heat cramps: If you're sweating a lot, you're losing salt, water and electrolytes as you exercise; this can cause painful and involuntary muscle spasms in the arms, calves and abdomen. Hydrate immediately with water or electrolyte-infused sports drinks or tablets.

Heat exhaustion: Severe water and/or salt depletion can lead to weakness, excessive thirst, headache, loss of consciousness, nausea, vomiting and dizziness. Heat exhaustion can also involve heat cramps. Drink plenty of fluids (not caffeine or alcohol), remove tight clothing and take a cool shower or bath. If cooling measures fail to provide relief after 15 minutes, get medical help.

Heatstroke: The most severe of heat-related illnesses, heatstroke can be life-threatening if left untreated. It causes the body's internal temperature to climb beyond 104 degrees, and the body loses its natural ability to cool off. Someone suffering from heatstroke may also have an altered mental state, throbbing headache, high temperature, rapid pulse and lose consciousness. Seek medical attention immediately while simultaneously cooling the body as quickly as possible with water and ice packs.

Dr. Lamos suggests a proactive approach to summer safety to help families avoid an unwanted trip to the hospital. Follow these tips to exercise safely in the warmer months:
  • Stay hydrated. Run in public parks or on trails that have water fountains. If you'd rather go your own way, bring a bottle of water or wear a hydration pack, like a Camelbak.
  • Make a plan. Avoid exercising outside when the sun is at its most intense, between 10 a.m. and 2 p.m. Plan routes that are well-shaded or have cool areas where you can take a break if needed.
  • Be prepared. Wear loose-fitting, light-colored, breathable clothing (like cotton) and a hat. Apply sunscreen generously at least 30 minutes before sun exposure, even if it is an overcast day.
Before exercising in the heat, talk to your doctor about the medications you are taking and how they may affect your tolerance of heat. GBMC primary care offices have extended and weekend hours to accommodate busy schedules. If you don't have a primary care physician, find one today at

Red, White and Green Grilled Cheese


1 teaspoon minced garlic (about ½ clove)
1 small onion minced (about ½ cup)
2 cups frozen, cut spinach, thawed and drained (or substitute 2 bags, 10 oz each, fresh leaf spinach, rinsed)
¼ teaspoon ground black pepper
8 slices whole-wheat bread
1 medium tomato, rinsed cut into 4 slices
1 cup shredded, part-skim mozzarella cheese
Nonstick cooking spray


Preheat oven to 400°F. Place a large baking sheet in the oven to preheat for about 10 minutes.

Heat garlic with cooking spray in a medium-size pan over medium heat. Cook until soft, but not browned. Add onions, and continue to cook until the onions are soft, but not browned.

Add spinach and toss gently. Cook until the spinach is heated throughout. Season with pepper and set aside to cool.

When the spinach and onions are cool, assemble each sandwich with one slice of bread on the bottom, one tomato slice, ½ cup of spinach mixture, ¼ cup of cheese, and a second slice of bread on the top.

Spray the preheated, nonstick baking sheet with cooking spray. Place the sandwiches on the baking sheet. Bake for 10 minutes, or until the bottom of each sandwich is browned.

Carefully flip sandwiches and bake for an additional 5 minutes, or until both sides are browned. Serve immediately.

Nutrition Information

Servings: 4
Calories: 254
Fat: 8 g
Saturated Fat: 4 g
Cholesterol: 18 mg
Sodium: 468 mg
Fiber: 6 g
Protein: 24 g
Carbohydrates: 29 g
Potassium: 364 mg

Recipe retrieved from Keep the BeatTM Recipes: Deliciously Healthy Family Meals provided by the U.S. Department of Health and Human Services. December 2010

Thursday, June 16, 2016

Is it Time for Your Child’s Annual Check-up?

It’s easy to get caught up in summer fun when report cards, homework and exams seem so far away, but now is the time to schedule an appointment for your child’s back-to-school physical.

Nearly all schools require that children between the ages of four and 17 undergo annual physicals or “well-checks” that include immunizations and vision/hearing tests. These appointments are especially important if you have a young athlete who may encounter sports-specific issues and needs to learn about proper nutrition, exercise and rest.

Having annual physicals can also help your son or daughter establish a happy and healthy relationship with his or her primary care physician, should there be another reason to visit in the future. You can expect the care provider to do the following during the exam:

  • Discuss nutritional and sleep needs
  • Order tests depending on risk factors for conditions like anemia or high cholesterol
  • Perform age- and gender-specific height and weight checks
  • Conduct a physical examination
  • Review and update immunizations

In addition to the exam’s requirements, you can take this opportunity to ask your child’s physician to address any concerns you may have about health, weight, safety, and even attitude, peer pressure and feelings.

If it’s time for you to schedule your child’s next check-up, or if you’d like to select a new primary care physician for you or your child, call 443-849-GBMC (4262) or visit A GBMC team member will call you back within one business day to schedule an appointment.

Getting out of the Prediabetes Danger Zone

More than 29 million people in the United States have diabetes, but many more are at risk and are living with a condition called prediabetes. Patients whose blood glucose is too high to be considered normal but are not diabetic are considered to be in the danger zone. "The criteria for prediabetes is a fasting blood sugar between 100-125 and the results of another test called a hemoglobin A1C, which checks what blood sugar has been over the last three months," says Dr. Ruth S. Horowitz, Chief of the Division of Endocrinology at GBMC. "If the A1C is between 5.7 and 6.4, the blood sugar is moderately elevated and indicates prediabetes.”

Luckily, if you've been diagnosed with prediabetes, the progression to type 2 diabetes is not inevitable. There are lifestyle changes you can make to take control of your blood sugar. Focus on cutting high-carbohydrate foods, which easily break down into glucose and raise blood sugar levels faster than the body can produce sufficient insulin. By limiting the amount of carbohydrates you consume, the body can dispose of the glucose more effectively and maintain a normal blood sugar level. Dr. Horowitz recommends the following:

  • Limit highly-concentrated sweets, such as sugared drinks, juices, candy and cookies. 
  • Replace starchy dishes like potatoes, rice, pasta, peas and corn with complex carbohydrates such as broccoli, asparagus and spinach. 
  • Watch your fruit portion sizes. One serving of fruit is 1 small apple, orange or pear, half a banana or a ½ cup of chopped, cooked or canned fruit. Space out your servings of fruits throughout the day, rather than consuming them all at once. 

Working out is another effective way to stop diabetes in its tracks. Muscle is the largest consumer of glucose. By exercising, you increase the movement of glucose into the muscle, where it is broken down into energy and lowers blood glucose levels. Try to get 30 minutes of moderate exercise that raises your heart rate at least five times a week.

If you want to learn more about prediabetes or diabetes, visit for information. Some GBMC primary care practice locations offer free educational classes and one-on-one sessions for people with type 2 diabetes. Learn about controlling your diabetes, meal planning, regulating medication and more. Visit to find a primary care provider who can help you develop a healthy action plan and connect you with a Registered Dietitian and Certified Diabetes Educator.