Prediabetes:  What you Need to Know

Prediabetes is a serious health condition in which an individual’s blood sugar levels are higher than normal, but not high enough yet to be diagnosed with type 2 diabetes. Approximately 84 million American adults – more than 1 out of 3 – have prediabetes. Of those with prediabetes, 90% don’t know they have it. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

You can have prediabetes for years with no clear symptoms, so it often goes undetected until serious health problems such as type 2 diabetes show up. It’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:

  • Being overweight
  • Being 45 years or older
  • Having a parent, brother, or sister with type 2 diabetes
  • Being physically active less than 3 days a week
  • Having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds
  • Having polycystic ovary syndrome
  • Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Physical Activity
If you have prediabetes and are overweight, losing a small amount of weight and getting regular physical activity may help lower your risk for developing type 2 diabetes. A small amount of weight loss means around 5% to 7% of your body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means spending at least 150 minutes a week of brisk walking or a similar activity. That’s just 30 minutes a day, five days a week.

What should I eat?
Nutrition is key to a healthy lifestyle when you have prediabetes. Along with other benefits, following a healthy meal plan and being active can help you keep your blood sugar (or blood glucose level) in your target range. What you choose to eat, how much you eat, and when you eat are all factors that can affect your blood sugar. A registered dietitian (RD) or certified diabetes educator (CDE) can help you create a meal plan that’s full of healthy-tasty options.The key is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines. Some great food groups to include are:

  • Vegetables: Nonstarchy includes broccoli, carrots, greens, peppers, and tomatoes. Starchy includes potatoes, squash, corn, and green peas.
  • Fruits: Includes oranges, melon, berries, apples, bananas, and grapes.
  • Grains: At least half of your grains for the day should be whole grains. Includes wheat, rice, oats, cornmeal, barley, and quinoa, bread, pasta, cereal, and tortillas.
  • Protein: Includes lean meat (chicken or turkey without the skin), fish, eggs, nuts and peanuts, dried beans and certain peas (such as chickpeas and split peas), and meat substitutes, such as tofu.
  • Dairy: nonfat or low fat milk or lactose-free milk (if you have lactose intolerance) yogurt, and cheese.

Use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine. Oils with heart-healthy fats, mainly come from the following foods:

  • Oils that are liquid at room temperature, such as canola and olive
  • Nuts and seeds
  • Heart-healthy fish such as salmon, tuna, and mackerel
  • Avocado

There are also some foods that those with prediabetes should limit. Try to stay away from fried foods and other foods high in saturated fat and trans fat. Foods high in salt or sodium are also good to avoid. Cut back on sweets, such as baked goods, candy, and ice cream. It’s also wise to limit beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks. Drink water instead of these and consider using a sugar substitute in your coffee or tea.

Your primary care provider will keep a close watch on your blood glucose levels, monitoring them to make sure that your prediabetes doesn’t become type 2 diabetes. You should discuss diet and exercise recommendations with your doctor. Be honest about your habits and work together with your doctor to better control your blood glucose levels.



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A Guide to Mammograms

As part of Breast Cancer Awareness Month, October 19th is National Mammography Day. A mammogram is a low-dose X-ray that allows specialists to look for changes in the tissue of the breast. We hear this term and official recommendations regarding it often, but are you still confused about when you should start having a mammogram? And how often? You are not alone.

Over the past few years, some researchers have questioned the best timing and frequency for mammograms. However, the importance of a mammogram in the prevention and detection of cancer has not been contested. These images are the best test doctors have to find breast cancer early, sometimes up to a few years before it can be physically felt in the breast. At Medical Associates, we believe in the value of this early detection. Early detection leads to better outcomes and lowers the need for more aggressive treatments. For this reason we adhere to the recommendation of the American Cancer Society and recommend that all women age 40 and older have a yearly mammogram.

We realize a mammogram is an uncomfortable procedure for most women. The first one can be especially nerve-racking if you are not sure what to expect. Our team of professional, trained specialists want to assure you that there is nothing to fear. At your mammogram, you will stand in front of a special X-ray machine. The technologist will place your breast on a plastic imaging plate. Another clear plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is taken. You will feel some pressure during this time, but the compression of the breast only lasts a few seconds. This process is repeated to capture a side view of the breast, and then the whole process is repeated on the opposite breast. The entire procedure lasts about 20 minutes. Most X-ray techs aiding in your mammogram are women, and you and the technologist are the only ones in the room during the exam. A radiologist, a doctor trained to read mammograms and radiology exams, will later read your mammogram images.

A fairly recent development in mammography technology is something called a 3D mammogram. This type of image is done in tandem with the standard 2D exam. Compression of the breast may last a few seconds longer while the additional information is acquired. A recent study published in the Journal of the American Medical Association concluded that 3D mammography, when compared to 2D mammography, finds a 41 percent increase in the detection of invasive breast cancers and 29 percent increase in the detection of all breast cancers. 3D mammography also provides a 15 percent reduction in recall rates, decreasing the number of patients that need further imaging to make a determination. Medical Associates does offer this technology, but we ask you to check with your insurance company on your coverage. Because 3D mammography technology is fairly new, some insurance companies do not cover the additional charge.

Some women do experience discomfort during the mammogram process described above. Your breasts may be more tender or swollen close to or during your period. Try to avoid scheduling your mammogram during this time to help reduce any discomfort. Our technologists also advise that you not wear any deodorant, powder, or cream under your arms or chest on the day of your mammogram. Some of these items can show up on the images as white spots, prompting the need for new images. Mammograms are also best interpreted when compared with previous exams. This allows the radiologist to compare the images and look for changes in the breast tissue. If possible, try to get your mammogram from the same place each year, or provide the medical facility with a copy of any past mammograms.

You will usually get the results of your mammogram within a few weeks. If you are asked to come in for more imaging after a mammogram, do not be alarmed. This is fairly common and it does not mean that you have cancer. Additional imaging typically means more pictures, or even an ultrasound, may need to be done to look at a certain area more carefully. This is more common the first time you have a mammogram, as there are no previous images to compare your recent exam to. It is also fairly common in mammograms done in women before menopause.

It’s also important to note that an abnormal mammogram does not always mean you have cancer. You will need to have additional testing or procedures before the doctor can make that determination. You may also be referred to a specialist, but it does not necessarily mean you have cancer. It simply means an expertly trained physician will work with you providing follow up tests to either make a diagnosis or determine there is no cancer.

The mammography program at Medical Associates is accredited by the State of Iowa and the Food and Drug Administration. Our radiology technologists are educated, trained, and licensed professionals. If you would like to schedule your annual mammogram or have further questions regarding this test, please call your primary care provider.


Flu Vaccine FAQs

Influenza (flu) is a contagious disease which affects the lungs and can lead to serious illness, including pneumonia. Even healthy people can get sick enough to miss work or school for a significant amount of time or even be hospitalized. A flu vaccine is your best defense against this common virus. Vaccines have changed the face of healthcare, especially for children. But you may still have some questions, like why you have to get it every year, or when it’s best to receive the vaccine. Our expert providers give answers to these questions and more below.

Are vaccines safe?
Yes!  They have been given to hundreds of millions of people for more than 50 years and have a very good safety track record. Each year, the Centers for Disease Control and Prevention (CDC) works closely with the U.S. Food and Drug Administration (FDA), and other partners to ensure the highest safety standards for flu vaccines. Before a vaccine is approved for use in the U.S., it goes through years of careful testing and clinical studies. The FDA also inspects the sites where vaccines are made to ensure they follow strict manufacturing guidelines. And once a vaccine is licensed, the CDC and FDA continue to monitor its use, effectiveness, and safety.

Can I get sick with the flu directly from the vaccine?
No. Flu vaccines cannot cause flu illness. The viruses used to make the vaccines are ‘inactivated’ (killed) or attenuated (weakened). Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. Like any medication, some may experience side effects from the vaccine. For example, some may feel achy or may have a sore arm where the shot was given, but these side effects are NOT the flu. Instances of these reactions are also usually mild and last only 1-2 days.

Why do I need to get a flu vaccine every year?
Because the flu viruses are constantly changing, flu vaccines are updated each season. Scientists and physicians use research to make a vaccine that will protect against the viruses that are most likely to circulate each season. A person’s immunity toward a particular virus does decline over time. Annual vaccination against the flu is necessary for optimal protection.

There are several types of flu vaccines. What is the difference and which is best for me?
For years, flu vaccines were designed to protect against three different flu viruses (trivalent). This type of vaccine included protections against an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one influenza B virus. But there are two different lineages of B viruses that circulate during most flu seasons, leaving the public vulnerable to one of these groups. The quadrivalent vaccine was designed to combat this problem, providing protection against two influenza A viruses, and two influenza B viruses.

The vaccine is recommended for everyone six months of age and older, with rare exception. The CDC recommends a high-dose vaccine for those 65 and older, as they are especially vulnerable to the risk of flu. Receiving any type of flu vaccine is better than no vaccine at all, but it is best to consult with your primary care provider. Other high risk populations include young children, pregnant women, and people with certain chronic medical conditions like asthma, diabetes, and heart disease.

I’m pregnant, so I shouldn’t get the vaccine, right?
You should absolutely get the vaccine. The flu vaccine actually protects babies from getting influenza in the months following their birth. Pregnant women who get the vaccine pass their immunity to their babies through the flu antibodies they develop. This protection lasts for several months after birth. Studies have documented influenza protections in newborns up to 4 months after birth.

Where can I receive a flu shot? Do I have to schedule a separate appointment?
For your convenience, Medical Associates Clinic offers flu vaccine at all of our clinic locations. If you have an appointment already scheduled with your primary care provider this fall, you do not need to schedule a separate flu shot appointment with us. Simply ask to receive your vaccine then. If you do not have an appointment coming up with your primary care provider, click this link to view all the information on flu clinic locations, dates, and times. Find the one that works best for you and call to schedule an appointment.

Also, to better accommodate our busy patient families, our pediatrics department will vaccinate all children and parents in one visit.

Please be sure to keep record of when you received your vaccine and avoid getting a duplicate shot. And if you have any further questions regarding the flu vaccine, please call your doctor’s office.

For further general information about flu vaccination, visit




Delivering Positive Experiences – Birth Plan Options for Expecting Moms

Settling on the right OB and birth plan are very personal choices for expecting mamas. However, it is important to know the facts and learn about each option before creating the right birth plan for you. One key decision of your plan is how you will labor. The board certified obstetricians at Medical Associates have summarized several of the main options and facts below to help you make this decision.

Laboring in an upright position has many benefits. Whether it be standing, leaning forward with your hands on your knees, sitting, or squatting, many women find gravity to be a natural helper during labor. When you’re lying down, the brunt of the weight and force is going against gravity. Being upright or leaning forward allows your contractions to work in a more efficient manner, working with your body, not against it. Your blood flow (the baby’s oxygen supply) is less likely to be compressed while upright, and it helps to open up your pelvis as well. Movement such as swaying, walking, and even dancing can help reduce discomfort, as well as help move your baby into the optimal position to navigate the birth canal.

Another popular method is laboring in warm water. Our obstetricians encourage any expecting mom to labor in the tub if they wish. There is evidence that laboring in a tub can be a successful method of pain management for women, and it may even shorten labor for some. This is because immersion in warm water promotes increased blood flow back to the heart and fluid movement within the body which reduces swelling. Advocates say it also helps to relax laboring moms by reducing their stress.

However, once it’s time to deliver that baby, we believe it’s also time to get out of the tub. On the topic of water births, Medical Associates follows the recommendations of the American College of Obstetricians and Gynecologists (ACOG). They advise that “given the facts and case reports of rare but serious effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery)”2 is not recommended. The American Academy of Pediatrics (AAP) have also agreed with this recommendation.

There will come a time when you need to lie down for a break or for other health reasons. While lying down, there is another birthing tool that can help with your labor’s progression. It’s called a peanut ball and it’s a new option to moms delivering at Mercy Medical Center – Dubuque. Mercy offers the first and only certified ambassador for the peanut ball in Iowa. The peanut ball is an exercise or therapy ball that is shaped like a peanut and can be used in a variety of labor positions:

  • With mom in a semi-reclined position, one leg is placed to the side of the ball, and the other leg over it. A nurse then pushes the ball as close to the mother’s hips as is tolerable to her. This position promotes dilation and descent with a well-positioned baby.
  • If mom is in a side-lying or semi-prone position, the peanut ball can be used to lift the upper leg and open the pelvic outlet. This position helps rotate a baby in a less-favorable posterior position to a more favorable position for delivery.

The use of the peanut ball helps with the descent of your baby in your pelvis. Utilizing this birthing tool has even proven to help reduce the need for an emergency C-section.

At Medical Associates, we take the care of mom and baby very seriously while also being supportive of your wishes. What you will find most helpful during labor will depend on many things. And even the most perfectly prepared birth plan can also change in an instant. Knowing your options and preparing different techniques before birth can help your labor to progress more smoothly.

To help you formulate your birth plan and communicate your needs and wishes to your obstetrician, please utilize this Birth Plan Worksheet offered by Mercy Medical Center in Dubuque.


The Department of Obstetrics/Gynecology & Infertility provides complete obstetrical and gynecological care. Specialized services offered by our board certified physicians include: diagnosis and treatment of diseases, problems, or pathology affecting the female reproductive system. Professional infertility services include routine evaluation of infertile couples, diagnosis of infertility problems and treatment such as induction of ovulation and artificial insemination. Call 563-584-4435 to schedule an appointment.