Diabetes and Depression: Managing Both for Better Senior Health

Diabetes can be a frightening and expensive diagnosis. With testing materials, insulin, needles and additional doctor visits with specialists, it can seem daunting. Thats why were going to look at what Original Medicare coverage for diabetes looks like and what you can expect from different parts of Medicare.Medicare Part A Diabetes CoveragePart A coverage is for hospital stays, which can occur for diabetics if their blood sugar is unregulated. If you are diagnosed with diabetes after 65, you will probably need to be hospitalized for a day or two when first diagnosed to get your levels back to normal, receive diabetes education and counseling, and determine a course of action based on your health care needs.Medicare Part B Diabetes CoverageMedicare Part B offers coverage for doctor visits and medical screenings, which includes diabetes management. It will also cover diabetic supplies to help you manage your blood sugar, such as blood sugar testing strips.Doctor visitsPart B covers a one-time Welcome to Medicare doctor visit to review your health when you first join Medicare. If you already have diabetes when you join Medicare, this visit will include an overview of what materials you use to manage your blood sugar and what type of insulin you use. If you are diagnosed after 65, you will likely need to schedule a doctors appointment with your primary care physician to establish a care plan after your diagnosis.Once youve had Part B for longer than 12 months, you have coverage for a yearly wellness visit. This visit is to review your medical and family history, update your list of providers and prescription drugs, and review a treatment and screening plan for the upcoming year.If you have diabetes-related nerve damage (which is called diabetic neuropathy) in either foot, Part B will cover one foot exam every six months with a podiatrist. Diabetes nerve damage on your feet is a safety risk for diabetics, as they may not be able to feel dangers from heat or sharp objects. As part of this coverage, Medicare may cover therapeutic shoes and insoles in certain conditions.Regardless of your diabetic diagnosis, Part B will pay for flu shots, pneumococcal shot to prevent pneumonia and COVID-19 vaccinations, including boosters. Diabetes increases your chances for serious health complications from these and other illnesses.Blood tests & screeningsIf youre at risk for diabetes or diagnosed with pre-diabetes, Part B may pay for up to two screenings, such as fasting blood sugar, in a 12-month period to monitor blood sugar levels. This is used to determine if your blood sugar levels are normal or if you are becoming increasingly insulin resistant.Other screenings include hemoglobin A1C tests and glaucoma tests. Hemoglobin A1C tests measure how well your blood sugar has been controlled over the last three months. Part B will cover an eye check for glaucoma once every 12 months, as diabetes increases the risk of glaucoma.Diabetic servicesPart B covers the Diabetes Prevention Program. Sessions of the program include training on diet and exercise improvements, weight management strategies, and health coaching. To be eligible for the program, you must meet certain criteria, such as body mass index and blood test results.Medicare will cover an outpatient program to teach you how to manage your diabetes upon diagnosis. They will instruct on diet, exercise, monitoring your blood sugar, medication administration and reducing the risk of complications. Part B will also cover nutrition therapy services with a registered dietitian or nutritionist if your blood sugar levels meet eligibility.Supplies & equipmentBlood sugar self-testing equipment and supplies are covered by Part B. This includes blood sugar monitors, blood sugar test strips, lancet devices and lancets, and glucose control solutions for checking the accuracy of testing equipment and test strips. Part B covers these supplies for people with diabetes whether or not they use insulin, although coverage amounts may vary. Medicare Part B may also cover external insulin pump devices, including the insulin used with the pump, if eligible.Medicare Part D Diabetes CoverageMedicare Part D is coverage for prescription drugs. Diabetics rely on medications and Part D covers many of those.Insulin: Injectable insulin, insulin used in pumps and inhaled insulin may all be covered.Anti-diabetic drugs: Your plan may cover drugs to help blood sugar levels.Diabetes supplies: The supplies you use in conjunction with insulin may be covered. These may include syringes, needles, alcohol swabs, gauze and inhaled insulin devices.It is important to note that, starting in 2023, many insulin types will have a monthly $35 copay cap. Check your drug plans formulary for more information on what your specific costs may be.ConclusionOriginal Medicare offers a variety of services for those with diabetes. Additionally, drug coverage is essential for those who rely on insulin. The most important thing those with diabetes can do is manage their condition to prevent complications. If you have questions about diabetic Medicare coverage, including additional coverage options, please reach out to one of our licensed insurance agents and we will be happy to assist you.PlanEnroll is a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.

It is a sad commentary on our current cultural worldview that sunlight is widely perceived to be harmful, a cancer-causing threat. But what does the research actually say? And does this research affect older adults differently than other people?Spectrum: For starters, we should understand that sunlight is a complex combination of photons, with different wavelengths and properties. The sun is the original full-spectrum illumination, while both incandescent and LED lights emit, as one might expect, mostly visible-spectrum light.Intensity: The other important variable is the intensity of light, measured in LUX units (a foot away from one candle): direct sun comes in at 100,000; a cloudy day at 1,000; a kitchen or office measures 500; and a living room only 50. Thats why you need to get outside.UV: At one extreme is ultraviolet light (UV), whose wavelength is slightly shorter than visible violet. With regard to our health, UV is a mixed bag.It does cause sunburns, damages DNA, and triggers the aging of skin. It is also statistically associated with malignant melanoma, although, curiously, not with increased deaths from melanoma (because these cancers are mostly treatable).On the other hand, there are numerous health benefits: UV lowers the risk of hypertension, diabetes, atherosclerosis (hardening of the arteries), blood inflammation, and COVID infections. UV also stimulates Vitamin D synthesis in the skin. A large-scale study of 500,000 Brits, with a 12-year follow-up, found that frequent UV exposure lowered all-cause mortality by 14%, with cardiovascular deaths down 21% and total cancer mortality decreased by 13%. It gives one pause to reconsider the vast sums spent on sunscreen lotions. Just wearing light summer clothing blocks 80% of UV.IR: UV radiation represents only about 3% of the sunlight that strikes the surface of the earth, while about 50% is infrared (IR), whose lightwaves are just beyond (longer) than visible reds. IR radiation is more predominant at the beginning and end of days, while UV is strongest when the sun is overhead. A thick cloud cover reduces IR significantly more than UV. In a recent superb Huberman Lab podcast, Dr. Roger Seheult touted the many benefits of IR radiation. Most severe and chronic diseases also involve mitochondrial dysfunction (mitochondria are the small organelles within a cell that produce the energy-generating chemical ATP). One aspect of aging is that we lose 70% of our mitochondrial functioning after age 40. Unlike UV, IR radiation passes through light clothing and the surface of the skin to penetrate deep into body tissues, where it significantly stimulates mitochondrial ATP synthesis.Effects: The effects of improved mitochondrial functioning are pervasive, correlated empirically with sun exposure. Dr. Seheult cited statistics demonstrating that the greatest number of all-cause mortality comes soon after the shortest day of the year, and the lowest number of deaths occurs close to the longest days.People who live far north or south of the equator where days are particularly short in winter have higher overall mortality rates, particularly in mid-winter. In a study of almost 30,000 Swedish women, avoidance of sun exposure carried the same risk of premature death, as did smoking.There is well-replicated rigorous research that moderate IR exposure lowers the risk of cancer, heart disease, diabetes, hypertension, and it reduces blood lipids and chronic inflammation. IR increases immune system response to infections, such as influenza, COVID and pre-cancerous cells.On a sunny day, just 15 minutes outside can make a big difference. If youre in a green space with lots of grasses, leaves, bushes, and trees, you can receive two to three times the IR dose because plants reflect much of the IR that strikes them (notice that most leaves dont get hot in the sun because of these reflective properties).Red Light Therapy: There are many red-light therapy devices now available if you are considering them, be sure to carefully research IR wavelengths, dosage, safety, and therapeutic benefit. One study, utilizing an IR desk unit shining only on face, neck, and hands, proved to be quite therapeutic.Forest Bathing? Dr. Seheult delighted in reminding us of the wisdom of the ancient beliefs that sunlight and fresh air promote convalescence. Forest bathing has become a thing the air around trees is infused with phytoncides that defend plants from bacteria, fungi, and insects. When inhaled by humans, they up- regulate immune functioning and lower stress levels, and reduce stress hormones. The beauty and serenity of such an environment further enhances these benefits, some of which are detectable by lab tests a month later. Furthermore, getting up with the sun (and out from behind the filtering effects of plate glass windows) helps to set your circadian rhythm, which can improve sleep patterns. Take home message: forests, parks and even golf courses soothe the soul, and the body. And early morning and late afternoon may be particularly beneficial.Sweat Benefits: Dr. Seheult is a pulmonologist who treats many respiratory infections he also reminded us about how previous generations treated patients with hot baths and hot packs, as if to sweat out infections. Its been recently discovered that body temperatures a little over 100 degrees Fahrenheit actually accelerate the production of interferon, a powerful anti-viral protein. Maybe weve been a little too quick to reduce our fevers with aspirin, Tylenol, and Advil. And maybe the saunas so favored by Scandinavians and Russians are more therapeutic than weve realized.Conclusion: As spring has sprung, we encourage everyone to get away from your screens, go outside and enjoy the benefits of the sunshine that so amply surrounds us. Residents at Kavod Senior Life have a myriad of ways to get outside, whether it be on the sunlit patio areas, in the resident gardens, on the nearby walking paths in Cherry Creek or on the many benches and sitting areas surrounding the campus. Come for a visit and see for yourself!Ben and Scott  https://theagingwiselyproject.com/

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareVietnam War veterans face unique obstacles throughout the twilight of advanced illness. For hospice care providers to tailor care to meet the needs of veterans who have served in this theater of war, they must consider the tribulations these patients face as they reach the end of their lives.The Vietnam War era was a very tumultuous time to be a soldier. The United States' prolonged involvement in a war of questionable motivation left society with disdain toward the government and its institutions, especially the military.Coupled with horrific images shown on television, constant controversy was a new reality and negative public opinion formed around this conflict, of which those serving the nation were not spared.Careful consideration is necessary when treating patients facing these traumas.Tours of duty proved to be traumatizing in many ways. Young soldiers, some having just turned 18, were drafted into a war that many of them did not believe in. They were not fighting for love of country and God; rather, they were fighting for survival and out of fear for their lives.Intimate battles in the dense jungle led many to be subjected to the horrors that come with fighting in a foreign land that was only familiar to the elusive guerilla enemy soldiers.Servicemembers did not receive a warm welcome when returning home from Vietnam, often being judged and labeled as cruel and even inhumane.Moral Injury Can Impair Mental HealthThis perfect storm of trauma led to lasting moral injury that plagues many veterans for their entire lives. Veterans returning from the war were marginalized and pushed into isolation, often turning to alcohol and substance abuse, which worsened their anxiety and exacerbated their strife.Questions like Ive never spoken about the war, can I now? Was the war moral or immoral? and Was I a good soldier? come bubbling to the surface later in life as their illnesses intensify and their defenses weaken.Careful consideration is necessary when treating patients facing these traumas.The restlessness that can result from post-traumatic stress disorder (PTSD) is often treated with benzodiazepines. In most cases, these medications can bring relief through calming the patient.Yet, there is a common trend amongst veterans who cope with trauma that results in the opposite effect.Benzodiazepines can lower the walls that Vietnam veterans have built up throughout a lifetime of suppressing trauma and negative memories. This class of medications can exacerbate the symptoms of PTSD as traumatic experiences and feelings of regret resurface. Benzodiazepine-induced inhibition of neurotransmission can even lead to agitated toxic psychosis, increased anxiety, hostility, and rage.1The Value of Compassion Along with Clinical CareRemaining considerate does not end with simply staying mindful during the planning of clinical solutions. Providing care for Vietnam veterans requires a high level of empathy.A key to an empathetic approach is taking the time to listen nonjudgmentally. Though seemingly simple, practicing nonjudgmental, open communication with patients facing trauma from war can help avoid the all-too typical responses of Its okay and You did what you had to do.These patients do not need sympathy, because they have been judged enough throughout their lives. When care teams approach them without judgment, they honor the sacrifices these heroes have made.VITAS hospice care provides compassionate care approaches that are tailored to meet the distinctive needs of Vietnam veterans. With the Veterans Administration (VA) offering hospice care as part of its medical package, VITAS team members can provide empathetic psychosocial support, while utilizing clinical solutions that help manage symptoms.The qualifications for veterans to receive hospice benefits include: A life-limiting illness Treatment goals that focus on comfort, rather than curative treatments A life expectancy of 6 months or less, if their illness runs its normal course Veterans also benefit from the option to receive concurrent care through the VA. The VA can provide curative treatments as the patient simultaneously receives symptom-managing comfort care administered by the hospice care provider of their choosing.Offering solace, while remaining compassionate when patients need it most, is too often overlooked in the busy practice of healthcare. Acknowledging the adversity that Vietnam War veterans have had to face throughout their lifetimes and adapting care approaches to meet their needs is the best way for healthcare providers to give back to those who have sacrificed so much for the preservation of freedom.1Paton, C. (2018, January 2). Benzodiazepines and disinhibition: A review: Psychiatric bulletin. Cambridge Core. Retrieved November 2, 2022, from https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6