Metformin use in obese adolescents with insulin resistance
By Erin Cattey, RN, PNP Student
Wouldn't it be great to have a drug that could counteract insulin resistance, inhibit the process in which sugars convert to fats, reduce fasting glucose and insulin concentrations, and improve insulin sensitivity (Freemark & Zeitler, 2006)? Research shows metformin can do all of these things.
Metformin is an oral diabetes medication used to reduce sugar production and help insulin work better. Other benefits of Metformin include decreased appetite, possible weight loss and improved lipid levels. Metformin is not recommended for patients who have:
- Renal or hepatic disease.
- Conditions that lead to hypoxia or severe infection.
- Alcohol abuse issues (Gahagan & Silverstein, 2003).
One randomized control study looked at 29 adolescents with normal blood sugar levels, increased fasting insulin levels and a family history of type 2 diabetes. Half the participants received Metformin and the other half received a placebo. Compared with the placebo, Metformin reduced the body mass index, fasting blood sugar level and insulin concentrations (Freemark & Zeitler, 2006).
In a second randomized control study, researchers followed 28 obese adolescents with elevated fasting insulin levels for six months. "Compared with placebo, Metformin was associated with a loss of 4.8 percent of total body weight and statistically significant reductions in BMI, waist circumference, fasting glucose and fasting insulin" (Freemark & Zeitler, 2006, p. 12).
Clearly, there is evidence to support the fact that Metformin could complement the effects of dietary and exercise counseling and reduce the risk of obesity, glucose intolerance, and type 2 diabetes in certain adolescents (Freemark & Bursey, 2001).
References
Freemark, M., & Bursey, D. (2001). The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. Pediatrics, 107(4), 1-7.
Freemark, M., & Zeitler, P. (2006). Should metformin be used to treat adolescents with insulin resistance? Internal Medicine News, 39(18), 12.
Gahagan, S., & Silverstein, J. (2003). Prevention and treatment of type 2 diabetesmellitus in children, with special emphasis on American Indian and Alaska native children. Pediatrics, 112(4), 328-347.
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Ensure youth sports safety this summer
Stacy Stolzman, MPT, Children's Hospital of Wisconsin
Colleen Dolan, exercise science student, Marquette University
As the weather gets warmer, kids get eager to enjoy outdoor activities. Help your patients protect themselves with these helpful tips.
Equipment
- A helmet should be used for any activity faster than a run (scooters, skateboards, bikes and rollerblades). Certain sports require styles of helmets that meet sport-specific risks.
- Wrist guards should be worn with any skating or rollerblading activity.
- Protective eyewear should be used with any racquet or paintball activity.
- The American Dental Association recommends that a mouth guard be worn for sports including football, martial arts, volleyball, soccer and skateboarding.
- Learn more about bicycle, in-line skating, skateboarding safety and injury prevention tips here.
- Safety helmets may be purchased at the Emergency Department/Trauma Center at Children's Hospital of Wisconsin. Care partners provide correct sizing and fitting of helmets for $10 to $15. No appointment is necessary. Get directions here.
Hydration
Proper hydration is especially important in hot weather conditions. It can prevent heat disorders including cramps, syncope (fainting), exhaustion and heat stroke. If heat stroke is suspected (symptoms include cease in sweating, seizures, unconsciousness, fast heart rate) immediate first aid should be provided.
According to the American College of Sports Medicine the following are guidelines for proper fluid intake:
- Sixteen ounces of fluid two hours before exercise.
- Warm days should include an additional 8 to16 ounces fluid intake 30 to 60 minutes before exercise.
- Fluids should be regularly consumed during exercise.
Environment
- Ensure safe surroundings from traffic or other people.
- Check for clear, clean and safe areas (free of glass or debris).
- When outdoors, wear proper sun protection even on days that are overcast (protective clothing, hats, long sleeves and sunscreen at least 15 SPF).
Other safety risks and precautions beyond this list do exist. For more information about youth sports safety visit the National Youth Sports Safety Foundation.
References
Brown, Stanely. "Exercise Physiology: Basics of Human Movement in Health and Disease." Lippincott Williams and Wilkins. Philadelphia. 2006
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Educating patients about nutrition facts
Michelle Smith-Beckley, RD, CD
Sometimes, a nutrition label just isn't enough to communicate why a food is appropriate to eat. Many of our patients need visual pictures or real-life examples of what a food item includes instead of units of grams or milligrams located on a food label.
The Centers for Science in Public Interest provides a report of nutritional value and food safety from chain restaurants across the U.S. The organization also publishes a monthly newsletter, Nutrition Action, which presents startling nutrition facts. For example, one Chipotle chicken burrito has about the same calories and artery-clogging fat as three Subway 6" steak and cheese sandwiches.
Another way to educate patients about calorie intake is by displaying a variety of sweetened beverages. Here's how it works:
- Collect a variety of sugar-sweetened beverages you know your patients drink.
- Examine the sugar content of each serving. If your example has more than one serving in a bottle, make sure you multiply the nutritional value by the number of servings in the bottle.
- Divide the grams of sugar by four. This is equal to the number of teaspoons found in each container.
- Measure the amount of sugar found in each beverage into a reclosable plastic bag. This will show patients how much sugar they actually are drinking.
Sometimes, the simple act of substituting one food for another can make a big difference for our patients.
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Put play in your day with Healthy Kids Day
The YMCA of Metropolitan Milwaukee is helping kids and families put play in their days Saturday, April 25. YMCA Healthy Kids Day uses free, fun and creative activities to get kids and families moving.
YMCA Healthy Kids Day is part of the YMCA's response to growing health problems in America. The YMCA works with people of all ages who want to get healthy but don't know where to start.
Here are a few of the problems that the YMCA will focus on during this program:
- Poor health choices adding to higher rates of disease and lower quality of life.
- Families finding it difficult to balance work, family and social life.
- Youth not getting the support they need to develop positive skills and values.
YMCA Healthy Kids Day activities for kids and grown-ups include:
- Fitness classes.
- Martial arts.
- Healthy eating tips and cooking activities.
- Arts and crafts.
- Safety information.
- Youth sports and day camp information.
Families can learn more about eating right, getting healthy and fun activities that everyone can enjoy. Information will be available for kids and families when they visit any of the YMCA locations on Healthy Kids Day.
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