What Is This Hemoglobin A1C We Keep Discussing?

So you have been told you have Type 2 Diabetes.  Now what?  Healthcare professionals keep throwing new and unusual terminology your way!  Hemoglobin A1C, Blood Glucose level, Glucometer, not to mention the crazy medication names that go along with Diabetes, right?  So what exactly do they mean by Hemoglobin A1C?  Well that is a loaded question!  So let's dive into what that means!

Hemoglobin A1C (HgA1c)

This is a measurement of your AVERAGE daily blood sugar level over the past 12 weeks.   Folks without diabetes have an A1C of less than 6.0.  Pre-diabetes is somewhere between 5.7 and 5.9.  At 6.0, you are considered diabetic. This measurement lets your healthcare provider know how well your blood sugar is controlled and is often a reference for how well your diet, exercise and medications are working!  So, that means that the birthday cake or donut you had yesterday would not have caused your A1C to go from 7.0 3 months ago to 11.5 today!  If your A1C has elevated that much, you may have been eating cake and donuts everyday for the past 12 weeks! Good glucose control is evidence by an A1C of 6.5 or less.  Alas, this magical number is very informative and important for your diabetes care! 

If you have uncontrolled blood glucose, it can lead to numerous health issues such as heart disease, kidney disease, eye problems, and poor healing.  See us today if you feel that you need help controlling your blood sugars!

Our Millbrook Primary Care team sees patients Monday thru Thursday with appointments available from 8:00 am to 4:00 pm  334-285-3222

To make an appointment with our Pine Level office call 334-358-3777
Monday - Thursday 8:00am to 5:00 pm

To make an appointment with our Holtville office call 334-543-4851
Monday- Thursday 8:00am to 4:00pm

A Time For Remembrance

Memorial Day is a day of remembrance of those that have given the ultimate sacrifice of their lives for our freedoms. The staff at Physical Express pray that while you are enjoying a safe holiday with your family that you will take a moment to remember those that care so much for all of us that they lay down their lives protecting us and our many freedoms!  We will be closed at all three of our locations on Monday but will open on Tuesday as usual.  We hope you have a safe holiday!

Tips and Tricks for Weight Loss

·         Drink at least 64 ounces of water daily, more if you are exercising.

·         Get 30 to 45 minutes of moderate intensity exercise MOST days of the week.

·         Eat 3 meals every day, do not skip meals.  You may even want to try 6 smaller, more frequent meals daily rather than 3 large meals each day.

·         Eat breakfast every morning.  Make it higher in protein and lower in carbohydrates.

·         Eat AT LEAST 1200 calories daily.

·         Limit refined sugars and simple carbohydrates in your daily meal plans.  Add more fresh fruits, veggies, and low fat proteins to your daily meal plan.

·         Have small snacks between meals that are low fat and protein based.

·         Try not to eat meals after 6 pm but a very small, healthy snack 2 hours after dinner is ok.

·         Switch simple carbohydrates for complex carbohydrates.  Examples are switching white rice for brown rice or quinoa, white bread for whole grain bread, regular pasta for whole grain pastas.

·         Swap soft drinks and sweet tea for water or unsweet tea.  AVOID diet soft drinks.  If you want flavored water, try adding lemons, limes, or other fruits to your water.  AVOID alcohol.

·         Limit your intake of fast foods and make healthy swaps when you must eat out!  Swap a salad with grilled chicken for the Big Mac.  If you want a hamburger, eat it without the bun!

·         Instead of choosing ice cream, choose fat free or low fat frozen yogurt.  Swap whole milk for skim milk.  Swap regular cheeses for fat free or low fat cheeses.

·         Choose lean meats that are grilled or baked rather than fried. Remove skin from chicken before cooking and drain fats from ground beef after cooking. Try swapping ground beef with ground chicken, turkey, bison, or venison in chili, spaghetti, burgers, and lasagna. 

·         Make your own salad dressings with low fat ingredients: Ex.  Swap regular ranch dressing for ranch dressing made with fat free or low fat plain yogurt, use olive oil based vinaigrettes rather than those made with vegetable oils. 

·         Remember, you can eat larger amounts of foods that are healthy and filling rather than small amounts of foods that are high in fats and sugar.  For example, you could eat a large grilled chicken salad with 4 ounces of chicken (about 370 calories) for the same amount of calories as a McDouble Hamburger (380) calorie (that is without the fries and coke!).

Remember......weight loss with a friend is always going to keep you on track because you can be accountable to each other for you dietary changes and exercise regimen.  Also, stick to a grocery list and purchase only the items on your list, no grazing the grocery store shelves!

Weight Loss Medications

There are so many weight loss clinics popping up these days!  I know you have seen them around town and you have likely heard advertisements for clinics and weight loss supplements on the radio!  Well, here at Physical Express, our weight loss program is designed to pair you with the most effective weight loss plan, individualized just for you!  We often will use medications in conjunction with diet and exercise to help you achieve your weight loss goals!  Below is a summary of the medication options we currently offer.  The practitioner and physician at our office will help you decide which medication may be right for you based on your current weight, goal weight, and any medical conditions you currently have!  Call our office to day for information!  334-285-3222

Medication Options For Weight Loss

**This is the list of medications that we may offer at our clinic.  We will assist you in deciding what medication is appropriate for you, based on your weight loss goals and current health condition.  This is not an all-inclusive weight loss medication list. 

**Generally, health insurance does not cover the cost of weight loss visits or medications.  You will need to check with your insurance company to see if this is covered.  We will not file weight loss visits on your insurance for you; you will need to pay for your weight loss visits at the time of check-in.  There will be no exceptions to this rule.  You will also be required to pay for drug screening if one is due at your visit.

Adipex

Cost: $

Generic: Yes

Type of medication: Stimulant, Appetite Suppressant

Prescribing: This is phentermine.  The usual dose is 37.5 mg once in the morning.  It is to be used only on a short-term basis (3-4 months) while you make necessary dietary and exercise habit changes.  This medication should not be used if you have hypertension, cardiovascular disease, hyperthyroidism, glaucoma, or with other stimulant medications or alcohol consumption.  This medication may cause elevated blood pressure, elevated heart rate, shakiness, dizziness, and inability to sleep.

Bontril

Cost: $

Generic: Yes

Type of medication: Stimulant, Appetite Suppressant

Prescribing: This is similar to phentermine.  The usual dose is 35 mg 2-3 times daily about 1 hour prior to meals. This medication can be cut in half if needed.   It is to be used only on a short-term basis (3-4 months) while you make necessary dietary and exercise habit changes.  This medication should not be used if you have hypertension, cardiovascular disease, hyperthyroidism, glaucoma, or with other stimulant medications or alcohol consumption.  This medication may cause elevated blood pressure, elevated heart rate, shakiness, dizziness, and inability to sleep.

Qsymia

Cost:$$$

Generic: No

Type of medication: Stimulant, Appetite Suppressant with a sulfamate

Prescribing:  This is phentermine with topiramate.  There are four doses.  You are started on the lowest dose and titrated up to higher doses as needed in 2-4 week intervals.  Weight loss is evaluated in 12 weeks for at least a 3% body weight decrease.  This medication must be tapered down if you wish to stop.  This medication is taken in the morning.  This medication should not be used if you have hypertension, cardiovascular disease, hyperthyroidism, glaucoma, or with other stimulant medications or alcohol consumption.  This medication may cause suicidal thoughts, elevated blood pressure, elevated heart rate, inability to sleep and / or shakiness.

Belviq and Bleviq XR

Cost:$$$

Generic: No

Type of medication: Serotonin Agonist

Prescribing:  This medication is taken either twice daily or once daily (Belviq XR).  This medication should not be used with anti-depressants, stimulants, or alcohol.  You should not take this medication if you have heart valve disease, bradycardia or other cardiac problems, depression, diabetes, or kidney disease.  Do not use this medication if you are pregnant, trying to get pregnant or are nursing. Side effects include headaches, dizziness, fatigue, nausea, dry mouth, constipation, changes in mood.

Saxenda

Cost: $$$$

Generic: No

Type of medication: Glucagon-like peptide 1, not a stimulant

Prescribing:  This is a daily injectable medication that helps to regulate your appetite.  GLP-1 receptors regulate your appetite and this medication functions like natural GLP-1 in your body.  This medication is started at a low dose and titrated up slowly.  Common side effects of this medication include nausea and diarrhea. Weight loss will be evaluated at 16 weeks and medication will be stopped if you have not lost 4% of your body weight.  You should not use this medication if you have a family or personal history of thyroid cancer.  This medication can cause hypoglycemia (low blood sugar), depression, increased heart rate, gallbladder disease, and / or suicidal thoughts.

Contrave

Cost: $$$

Generic: No

Type of medication: Opioid Agonist with antidepressant (Wellbutrin)

Prescribing: This is a titrated medication taken orally once to twice daily in increasing amounts over a period of 4 weeks.  Response to the medication will be evaluated in 12 weeks.  Medication should be stopped if you do not loose approximately 5% of your initial body weight.  This medication should not be used if you have uncontrolled high blood pressure, seizure disorders, eating disorders, or with other opiates, stimulants, anti-depressants, or alcohol. This medication can interact with several other medications, please notify your provider of all medications you take, including over the counter medications.   You cannot use this medication if you are pregnant or breastfeeding.  Side effects may include changes in mood, nausea, constipation, headaches, vomiting, dizziness, insomnia, dry mouth, and diarrhea.

So...What Does 1800 Calories Per Day Look Like?

	Breakfast	Snack	Lunch	Snack	Dinner	Snack
MONDAY	1 cup Bran Flakes 8 ounces skim milk 1 small banana 8 ounces water	1 slice whole wheat bread 1 ounce meat 1 tsp mayo 8 ounces water	1 cup lettuce with 1 tbsp dressing 2 ounces chicken 1 cup sweet potato ½ cup green beans 8 ounces skim milk or water	1 large apple 1 tbsp peanut butter 8 ounces water	3 ounce pork loin chop 1 cup broccoli 6 ounce baked potato with 1 tsp butter 8 ounces water or unsweet tea	6 ounces non-fat yogurt ¼ cup granola without sugar 8 ounces water
TUESDAY	2 slices whole wheat toast 2 tbsp. peanut butter 1 ¼ cup strawberries, blueberries, raspberries 8 ounces water	3 sugar free graham cracker squares 8 ounces skim milk or water	2 eggs scrambles with ½ cup fresh mushrooms, bell peppers, and onions 2 6 inch whole wheat tortillas 1 cup fruit 8 ounces water	16 teff or whole wheat crackers with 1 ounce low fat hard cheese such as sharp cheddar ½ ounce almonds or walnuts 8 ounces water	3 ounces chicken breast 2/3 cup brown rice or quinoa with ½ cup water chestnuts and ½ cup carrots 1 cup sliced tomato 8 ounces water or unsweet tea	2/3 cup Fiber One Cereal with 8 ounces skim milk
WEDNESDAY	2 4inch whole wheat pancakes with 1 tbsp. peanut butter and 2 tsp sugar free jelly ½ cup apricots or prunes 4 ounces of light orange juice or 8 ounces water	½ whole wheat bagel with 1 tbsp fat free cream cheese 8 ounces skim milk or water	2 ounces roast beef with 1 tbsp fat free mayo on 2 slices whole wheat bread 1 cup asparagus 1 tsp margarine 8 ounces water	9 whole grain tortilla chips with ¼ cup sugar free salsa 8 ounces water	3 ounces round steak ½ cup brown rice with 1 tsp butter 1 cup cooked carrots 1 kiwi 8 ounces water or unsweet tea	3 cups popcorn without butter 8 ounces skim milk
THURSDAY	1 cup oatmeal 8 ounces skim milk or almond milk 1 small orange	6 whole wheat/ whole grain crackers with 2 tbsp peanut butter 8 ounces water	2 tacos, whole grain tortillas with ½ ounce of ground beef, cheddar cheese, lettuce, tomato, green pepper, and salsa 1/3 cup brown rice ½ fresh pear 8 ounces water	6 ounces non-fat yogurt 8 ounces water	Spaghetti: 1 cup whole wheat pasta, ½ red sauce (no sugar added), 3 turkey meatballs 1 cup carrot and broccoli cooked 8 ounces skim milk, unsweet tea, or water	Trail Mix: 10 peanuts, 4 pecan halves, 2 tbsp raisins, ¾ cup whole grain cheerios 8 ounces milk
FRIDAY	2 slices whole grain cinnamon toast with 2 tsp butter 1 cup cantaloupe 8 ounces skim milk	1 cup non-fat yogurt or fat free cottage cheese 8 ounces water	1 cup beef and bean chili 1 cup carrots and celery with 2 tbsp peanut butter 8 ounces skim milk or water	17 grapes 8 ounces water	3 ounces fish (tuna or salmon) 6 ounces brown rice or quinoa 1 cup green beans ½ cup salad with vinaigrette dressing 8 ounces water or unsweet tea	1 small nectarine or 4 ounces fat free hard cheese 8 ounces water
SATURDAY	2 slices whole grain French toast 8 pecan halves 1 tbsp sugar free syrup 8 ounces skim milk or almond milk	½ whole wheat / whole grain English muffin 1 tbsp peanut butter 4 ounces skim milk or 8 ounces water	Chicken kabob with 1 ½ cups of mixed grilled peppers, onions, mushrooms and ½ cup pineapple 1 cup brown / wild rice 8 ounces water	1 large apple with 2 tbsp peanut butter 8 ounces water	3 ounce lean ground beef patty on a whole wheat bun 1 ¼ cup watermelon 1 cup lettuce with radishes and peppers 2 tbsp fat free salad dressing 8 ounces water or unsweet tea	¼ cup fat free cottage cheese with ½ cup fresh peaches, diced
SUNDAY	2 scrambled eggs with ¼ cup fat free shredded hard cheese 2 slices whole grain toast ½ low fat, sugar free orange juice or 8 ounces water	1 slice whole wheat raisin bread with 1 tbsp fat free cream cheese 8 ounces water	Taco salad with 1 ½ cups lettuce, ½ cup each of tomato, peppers, fat free black beans, corn ¼ cup salsa 1 ounce fat free hard cheese, 17 tortilla chips 8 ounces water	Sugar free jello with ½ cup banana 8 ounces water	3 ounces of turkey tenders ½ sweet potato ½ cup green beans ¾ cup blueberries or raspberries 8 ounces skim milk, water or unsweet tea	8 ounces skim milk 1 fiber one cookie

Don't Weight......

Physical Express Weight Loss Program

Congratulations!  You are taking the first step in transforming your health for the better by deciding to make important life-style modifications to control you weight.  Taking control of your weight is not an easy, straightforward task.  It takes willpower and hard work.  There are no quick fixes in weight management; rather it is an ongoing and often lifelong process of lifestyle modifications.  Weight management must include a plan for both dietary changes and physical activity to be successful.  At Physical Express, the goal for our weight management program is to partner with you to formulate a plan customized to your health needs and your weight management goals. Below you will find the outline of our weight management plan.  Please feel free to call or email our office with any questions.

Prior to enrollment in our program you will need to:

1.       Keep a food diary for at least 2 weeks and bring with you to your initial appointment

2.      Fill out the form for your personal healthcare and weight loss goals and bring to your initial visit as well as agreeing to and signing our weight loss program packet

3.      Have initial lab work completed or bring with you to the initial visit if it has been done elsewhere (must be within last 6 months), for females of childbearing age, you will need to have a negative urine pregnancy test the day of your first visit

4.      You must also have a calculated Body Mass Index (BMI) of greater than or equal to 30 with no health risk factors (such as cardiovascular disease, high blood pressure, diabetes, etc.) OR a BMI of equal to or greater than 27 with at least one health risk factor (such as cardiovascular disease, high blood pressure, diabetes, etc.) to be on certain medications for weight loss

BMI Calculator

To remain in the weight loss program you will need to:

1.       Come to the office for weight checks and review of diet and exercise plan monthly

2.      Pass random urine drug screens if you are prescribed controlled substances for weight loss such as phentermine

3.      Loose a certain amount of weight each month to remain on medication for weight loss

4.      Once you reach your weight loss goal, we will help you to transition off weight loss medications and maintain your new, healthy weight

***Please be aware that some insurance plans will not pay for weight loss programs or weight loss medications.  You are responsible for all charges, up front, for weight loss visits.

Clinic Hours

Millbrook Location Physical Express Primary Care Clinic Hours

Monday - Thursday 8:00 am to 4:00 pm Appointment Only

Physical Express Urgent Care Clinic Hours 

Monday - Thursday 7:00 am to 6:00 pm Walk-ins Welcome

Holtville Location

Monday - Thursday 8:00 am to 4:30 pm

Pine Level Location

Monday - Thursday 8:00 am to 5:00 pm