Rx for kids: More recess

We know some schools are cutting back on recess. We know that childhood body-mass index can predict Type 2 diabetes later in life. And we know that over a lifetime, the cost of Type 2 diabetes is, on average, is $238,000 in the United States.

So I wonder what would happen if a pediatrician looked at an overweight child with a family history of diabetes, and prescribed 30 minutes of physical activity every day.

U.S. public schools must follow the Individuals with Disabilities Education Act, which special services for children who fall into one or more of 13 categories of disabilities: autism, deaf-blindness, deafness, emotional disturbance, hearing impairment, intellectual disability,  multiple disabilities, orthopedic impairment, other health impairment, specific learning disability, speech or language impairment, traumatic brain injury or visual impairment (including blindness).

Because it sounds vague, my attention turned to “other health impairment.” Here’s what the law says specifically:

(9) Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that–

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

(ii) Adversely affects a child’s educational performance.

There’s “diabetes.” And interestingly, the law reads “such as,” not “limited to.” Quick show of hands, who has known a child who was far more “alert with respect to the educational environment” after he or she spent 30 minutes burning off some excess energy? All the hands are up. I thought so.

So getting back to the prescription for recess, I can imagine a principal begging off. That 30 minutes could take place any time before or after school, outside the important lessons that take place inside the schoolhouse. Teachers need what little time they have with students to make sure they’ve mastered math and writing.

I get that. We ask a lot of our schools, and sometimes we parents and taxpayers make unreasonable demands. But I also get that a teacher’s job would be much easier if schools didn’t treat recess or phys ed as an afterthought.

And now, that there’s plenty of research that connects a lack of activity to an expensive life of a Type 2 diabetic, I don’t think schools can take kickball or tag or tossing a football as something less than mastering a times table or subject-verb agreement.

I know that lots of parents face greater difficulties in dealing with school systems than my family ever did. I’d love to know if you’ve tried to advocate for more recess time. I’d love to hear your efforts — positive and negative — at negotiating the 504 process.

And how much recess does your child get? It seems like few schools offer any significant amount of recess, but is that wrong? Let me know. 

Leave a comment, or write me at 



The ResearchKit link to Henrietta Lacks

Here’s a great point of view on ResearchKit. Should individuals profit from the data they provide to these massive studies? Lisa Suennen, writing for MedCityNews, compares the ResearchKit studies to the story of Henrietta Lacks, whose cancer produced cell lines that are still used today.

At what point will those who contributed their data for free wake up and say, “hey wait a minute, that new drug that made a gazillion dollars this year, they did that with my data; how do I get a piece of that action?”

It’s one thing to agree to contribute to research, it’s another to contribute to some big drug company’s corporate jet.   It would be awfully nice if Apple had figured out a way for those who contribute data to this incredible research effort also have a way of receiving royalties, or at least free iPhone minutes or iTunes downloads or 1 hour on the Merck corporate jet.

It’s a fair question. If your data contributes to a corporation’s profits, can you make a claim to some of those profits? When signed up for GlucoSuccess, I didn’t bother to read the lengthy forms the software displayed. I’ll bet I clicked a button that signed away any rights. But the larger question remains, should I be able to make a claim?

What do you think?


Thoughts on the JDRF TypeOneNation Summit

Some random thoughts on the JDRF TypeOneNation Summit which was held in Maryland recently:

— An impressive number of people took part.

Something like 900 people were in attendance. It made me think that these kinds of conferences need to happen more often in smaller communities. Lots of good information was shared that needs to reach more people. It’s easy to imagine that the breakout session on Type 1 students deserves to be in every school district.

And the burden doesn’t have to fall on JDRF’s shoulders. We have enough advocates, vendors and health care providers who can take up the challenge to create a first-class effort in more communities.

— No media attended.

A few months ago, I would have been the editor who would have told the JDRF organizers that I didn’t have a spare reporter to send to a Saturday event. An alternative might have been to put more responsibility on bloggers and others who can put the word out on social media. The organizers encouraged tweeting, but there could have been more. Talking points, press releases, background material, photos … all the things that a member of the working press might expect. Bloggers can pick up the slack.

— Many of the salespeople were diabetics themselves.

At least four people from four different companies described how they used the products they were hawking, whether it was a CGM, insulin pump or insulin itself. (BTW, Novo Nordisk EchoPen looks awesome. It’s an insulin pen that remembers your last dose. I can’t tell you the number of times I’ve had to struggle to remember whether I remembered my Levemir.)

— Carb counts at lunch

The event was at the Montgomery County Convention Center, which is run by Marriott. The hotel thoughtfully supplied the carb counts for what they served. My only quibble was that the carb counts should have been at the front of the line, not the end.


Ban the cupcakes!

Boston pediatrician Claire McCarthy used to think that schools that banned cupcakes went too far. Nothing wrong with occasional sweets, she believed, so long as the rest of your diet was healthy. She’s come around

Now, I get that banning sweets from school parties or fundraisers or whatever isn’t going to make all parents feed their children healthy foods and thereby end childhood obesity. But it does force families to think together about alternatives — and gives kids a chance to eat healthy foods with their friends, which sometimes is exactly what’s needed to break through the resistance. And when kids bring in non-food treats like those tattoos, it reinforces the idea that celebrations don’t always have to include food (so un-American, but true).

My children are grown; it’s not my problem. But I think kids get enough junk food. Giving them one less opportunity — or several considering every student has a birthday — won’t deprive them.

From the blog, a great resource to learn about what doctors are thinking.


Three days with GlucoSuccess

IMG_0420After three days using GlucoSuccess, I can say it’s a bit of a nag.

Created by Massachusetts General Hospital, the iPhone app uses ResearchKit and it’s meant to make it easier for Type 2 diabetics to manage what they eat and how much they exercise. It succeeds on some levels, but it still could use a bit of polish.

Where it works: It integrates with LoseIt, an app that monitors what food you eat. It has a large database of products. Focus a barcode with the phone’s camera, and LoseIt pulls up calorie and carbohydrate information. GlucoSuccess’s developers were smart to let an existing, working app to do this chore.

And GlucoSuccess does a fair job integrating food and exercise.

But it’s a real nag.

Every morning it reminds me to check my feet. OK, I’m not going to fault it for encouraging me to keep tabs on a very real complication from my illness. But at 5 p.m. every day, I’ve gotten a message from the app reminding me to complete my daily tasks, which includes my pre-dinner glucose test. Dinner, for me, won’t be till about 7:30 p.m., and it would be great if the app could figure that out.

GlucoSuccess has a “Diet Insights” function that lists food I’ve eaten that are high in carbs or sugar. Near the top of the list is my bowl of kamut with a half cup of flax milk. If you’ve never eaten kamut, it’s a bit like the marriage of puffed wheat on Styrofoam packing peanuts. I eat it because 1 cup is 11 grams of carbohydrates (0g sugar). Top the kamut with a half cup of flax milk — carbs 4g (4g sugar) — and it’s a bowl of cereal with milk for 15g carbs.

But GlucoSuccess doesn’t like it because 88 percent of the calories come from carbohydrates. (I’m not sure how the math works out.) I don’t expect a gold star for my morning bowl of tastelessness, but I don’t expect to get cyber-dinged either.

I’ll stick with the app in the hopes that the insights become more thoughtful. But I’ll be expecting GlucoSuccess to do a better job at managing my data so I can do a better job managing my diabetes.


Two sides of health care

Two recent blog posts got me thinking about the health care professionals who care for us. One is Peg Abernathy’s piece on the Huffington Post, “Why I Told My Diabetes Doctor to Back Off.” The other was a post on K.L. Register’s blog called, “But, I Didn’t Call You Old.” Register is a dentist and between the two blogs, you get both sides of dealing with patients.

I read both women regularly, and strongly recommend both pieces are worth reading to the end.

Abernathy, who has become a “diabetes subject matter” expert on the Huffington Post, describes seeing her endocrinologist when in the middle of the exam, she felt her blood sugar fall. She pulled out her meter and tested, recording a 177. “[M]y doctor rolled her eyes and quickly plopped back down in her chair, looking at me like I was an idiot.” Abernathy was insulted and told the doctor so, who then suggested she see a psychiatrist.

Not the medical profession’s finest moment.

Just the opposite happened in Register’s dentist office. She was seeing a patient who needed two teeth pulled. An infection had spread and nothing could save them. In their place, Register would provide a partial. The patient objects, saying that partials are for old people, hence the title. The patient ends the appointment.

A week later, the patient agrees to have one tooth removed, which results in a salty taste in her mouth. That, Register tells her, is the pus from the infection. That gives the patient pause, and she relents to have the second tooth removed as well. The matter plays out without any drama.

Register—whose blog, “The Ninth Life,” mostly covers her personal history with heavy doses of inspiration—uses the story to express how people need their own time to accept good advice. She offers a good perspective, but I finished the piece thinking Abernathy’s endo should have just a portion of the wisdom Register shows.

Blog, Commentary

Finding a path toward insulin independence

Dr. Claresa Levetan has a great blog post at describing her 30 years of diabetes research.

It is hard to see the whole diabetes picture when most of us have our own focus of research and especially when the picture is large; diabetes isn’t simple, and there isn’t just a single form of Type 1 or Type 2 diabetes.

This is definitely worth reading, especially to get the perspective of someone who realizes the research translates into helping the lives of real human beings.

Blog, Commentary

Some history on carbohydrates

A few days ago, the DFP published an item that a pair of studies are hinting that diabetes rates are leveling off.

Dr. Osama Hamdy, at the Joslin Diabetes Center in Boston, offers a bit of history that might offer an explanation. (Correlation doesn’t mean causation, I know. I just think this is interesting.)

Writing for the Joslin website, Dr. Hamdy says that in 1977 the Select Committee On Nutrition and Human Needs of the U.S. Senate recommended that people increase their carbohydrate intake to 55 to 60 percent of the total caloric intake, while reducing fat consumption from approximately 40 percent to 30 percent of the total daily calories.

oldFoodPyramidThe thinking was that the changes would reduce health care costs and improve Americans’ quality of life.

That recommendation led to the familiar food pyramid where grains were at the base. Hamdy writes:

What has been aptly described as a “national nutritional experiment” contributed, as we know now, to the increased prevalence of obesity.  And, contrary to the main aims of the recommendations, the prevalence of type 2 diabetes — and cardiovascular disease — went up significantly.

Hamdy continues, and offers some fascinating history on diabetes treatment. If you need that link again, here it is.

new_food_pyramid_2012But think about it this way: In the 70s, some (well-meaning) politicians tried to manipulate what people eat, and possibly launched the diabetes epidemic. In essence, they created an abnormally high incidence of diabetes.

But in the last 10 years or so, Americans have been returning to a more “normal” level. We’re rethinking the role carbohydrates play in our diet. We’re eating fewer carbs, not just because we’re worried about our pancreases, but because we want to be healthier.

The abnormal high is not regressing to the mean, as my sabermetric friends might say. Maybe not, but like I said, I just think it’s interesting.