5 Bipolar Disorder Treatments You Should Know About

Though it can be managed, when left untreated, bipolar disorder can completely disrupt a person’s life. This mental health condition causes unusual and sometimes extreme shifts in a person’s mood, energy, and activity levels, affecting their judgment, ability to think clearly, relationships, and daily life in general. That’s where treatment comes in.

There’s no one magic way to ease symptoms of bipolar disorder. Instead, experts generally recommend that people with this condition undergo psychotherapy and take medication to help stabilize their mood.

Before we dive into the medications used to treat bipolar disorder, let’s go through a quick primer of the condition.

There are two main forms of bipolar disorder based on the combination of episodes you experience. Manic episodes involve having an extremely elevated mood and energy levels for at least seven days (or for shorter than that, but severely enough to require hospitalization), according to the National Institute of Mental Health (NIMH). Hypomanic episodes consist of less extreme but still elevated and prolonged mood and energy levels. Depressive episodes involve having a downcast mood lasting at least two weeks.

If you have bipolar I, you’ve had at least one manic episode preceded or followed by a hypomanic or depressive episode, the NIMH explains. You may also have episodes that contain symptoms of depression and mania. Bipolar II means you’ve had at least one major depressive episode and a hypomanic episode, but have never had a manic episode.

While there are some medications that can treat manic, hypomanic, and depressive episodes, others will only treat certain phases, Jamie Alan, Ph.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF. “Some are also good for preventing episodes,” she says. Here are the different kinds of drugs doctors often recommend for treating bipolar disorder.

1. Mood stabilizers

These drugs, which include lithium, valproic acid, carbamazepine, and lamotrigine, are usually used to help control manic or hypomanic episodes, the Mayo Clinic says. Some of them, like lithium, can both treat and prevent these episodes, while others, like lamotrigine, only work to prevent them.

Mood stabilizers generally work by decreasing abnormal brain activity, according to the NIMH. This means that, unlike some of the other drugs on this list, mood stabilizers affect the actual pathology of the disease instead of only the symptoms, Nassir Ghaemi, M.D., professor of psychiatry at Tufts University School of Medicine, tells SELF. However, the amount of time it takes for mood stabilizers to work depends on the specific medication. For instance, lithium may kick in fully after a week, but it may take a few weeks or longer with carbamazepine and other treatments.

Side effects also vary by drug but can include itching, rash, excessive thirst, frequent urination, nausea and vomiting, an irregular heartbeat, drowsiness, weight changes, blackouts, loss of coordination, and more, according to the NIMH. Mood stabilizers may also cause more serious side effects. For instance, in rare but very serious cases, lamotrigine can lead to a life-threatening immune response, according to the U.S. National Library of Medicine. As with any medication, before starting mood stabilizers you should ask your doctor about side effects and any red flags of a negative response.

2. Antipsychotics

Psychosis involves losing contact with reality, and it can include delusions and hallucinations. Severe episodes of mania or depression may prompt psychotic symptoms, according to the NIMH, and antipsychotics might help.

There are two kinds of antipsychotics: first-generation (typical) and second-generation (atypical), the NIMH explains. First-generation antipsychotics include chlorpromazine, haloperidol, perphenazine, and fluphenazine, the NIMH says. The second-generation drugs include olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, cariprazine, and paliperidone. Antipsychotics generally work by affecting the levels of brain neurotransmitters that impact mood, like serotonin and dopamine, Dr. Alan explains.

Both first- and second-generation antipsychotics treat manic symptoms, but only second-generation antipsychotics are thought to work more broadly and target depression as well, the NIMH explains. It can take just a few days for some symptoms, like hallucinations, to recede, but it may take up to six weeks to reap the full benefit of antipsychotics, according to the NIMH.

Your doctor may prescribe an antipsychotic alone or along with a mood stabilizer. “The thought is that the antipsychotic can manage the [episodes] while the mood stabilizer has time to work,” Dr. Alan says. “The general consensus is that an antipsychotic and a mood stabilizer provide a greater benefit.”

There’s a wide range of potential side effects with antipsychotics, like drowsiness, dizziness, weight gain, dry mouth, constipation, blurry vision, low blood pressure, uncontrollable physical movements like tics, seizures, and lowered white blood cells, the NIMH explains. First-generation antipsychotics can come with added physical risks, like muscle spasms, tremors, restlessness, and the condition tardive dyskinesia (TD), which causes uncontrollable muscle movements, usually around the mouth. If your doctor recommends antipsychotics, ask them about if they think first- or second-generation would be a better fit for you and what side effects you can expect.

3. Antidepressants

As you’re probably aware, antidepressants help manage depression. This can be vital for those with bipolar disorder.

There are plenty of antidepressants out there, but the most common are selective serotonin reuptake inhibitors (SSRIs), which can affect mood by increasing the amount of serotonin in the brain, according to the Mayo Clinic. (Other antidepressants also work by changing the levels of brain neurotransmitters, the Mayo Clinic explains.)

Here’s the thing: Antidepressants can sometimes trigger a manic episode in people with bipolar disorder, according to the U.S. Food and Drug Administration (FDA). “They are effective in the depressive phase, [but] antidepressants alone may worsen the cycle of bipolar,” Dr. Alan says. That’s why they’re usually prescribed along with a mood stabilizer or antipsychotic.

Antidepressant side effects vary slightly by drug but can include nausea, sleep problems, increased appetite, decreased sex drive, fatigue, dry mouth, blurred vision, constipation, and dizziness, per the Mayo Clinic.

4. Antidepressant-antipsychotics

There’s only one antidepressant-antipsychotic out there right now. It combines the antidepressant fluoxetine and the antipsychotic olanzapine to give people two kinds of medication at once, helping to treat depressive and manic symptoms.

Like many other drugs used for treating bipolar disorder, experts aren’t totally sure how this drug works. It seems to affect the neurotransmitters serotonin, norepinephrine, and dopamine and takes about four to six weeks to fully kick in, Dr. Alan says.

The most common side effects here include dry mouth, fatigue, excessive sleeping, increased appetite, swelling of the hands and feet, tremors, and blurry vision, according to the U.S. National Library of Medicine.

5. Anti-anxiety drugs

Specifically, a class of drugs known as benzodiazepines may help with side effects of bipolar disorder like anxiety and trouble sleeping, the Mayo Clinic says. They can take effect in just hours or days, but are usually used on a short-term basis because they can also be habit-forming.

Benzodiazepines work by increasing signaling of GABA, a neurotransmitter that reduces the activity of your neurons, Dr. Alan says. “These are helpful in the manic stage,” she adds. The exact reason why isn’t entirely known, Dr. Alan says, but one theory is that the increased energy of manic episodes is generally associated with heightened neuron signaling, so GABA’s work to inhibit this may help offer relief. However, Dr. Ghaemi points out that anti-anxiety medication—while helpful in some cases—is “irrelevant to the underlying illness.” It can help with some bipolar disorder symptoms, but it won’t treat the underlying problem.

If your doctor does prescribe anti-anxiety drugs to help with your bipolar disorder, you may experience side effects such as dizziness, drowsiness, nausea, blurry vision, headache, confusion, and fatigue, according to the NIMH.

If you have bipolar disorder and aren’t sure which medication is right for you (or if yours is working), talk to your doctor.

Finding the right drugs can take a frustrating amount of experimentation, but trying to land on the right treatment plan is worth it. Speak with a medical professional to find a new drug or combination of drugs that can work better for you.


19 Recipes to Make With a Can of Coconut Milk

Ever since canned coconut milk became a staple in my pantry, the food I cook has been way more exciting. Coconut milk is so rich and thick that you’d never guess it’s dairy-free. That means it’s a great substitute for cream in everything from desserts like homemade ice creams to silky soups. Yes, it does have a subtle coconut flavor, but it’s not so strong that it overwhelms other, stronger flavors like chili and curry. In some cases, you can use it and your final product won’t even taste like coconut at all.

Whether you want your food to taste like coconut or not, these 19 recipes will help you put a can of coconut milk to work in a bunch of different ways. There are great ideas here for dairy-free yogurt and ice cream substitutes, creamy vegan desserts, spicy curries, fish stews, and more, proving that this simple ingredient is capable of so much.

Hypomanic Episodes: 9 Things to Know About Hypomania

Bipolar disorder is a complicated mental health condition that can go undiagnosed or misdiagnosed for years. Hypomanic episodes, one key aspect of the condition, can be especially tough to pick up on. This may make it even harder to receive an accurate diagnosis of bipolar disorder (or a related health issue) and get effective treatment. Here’s what you need to know about hypomania, including the subtle signs to keep in mind.

1. Hypomania means someone is experiencing an elevated, energized mood and accompanying behavioral changes.

Bipolar disorder causes a person to shift between periods of emotional and energetic highs (hypomanic and manic episodes) and lows (depressive episodes), the Mayo Clinic explains. In between those spells, they can experience little to no symptoms.

In order to be classified as having a hypomanic episode, you need to have a prolonged, unusually high mood and at least three of the following symptoms for at least four days:

  • Feeling abnormally upbeat
  • Feeling jumpy
  • Feeling euphoric
  • Increased activity or energy
  • Heightened self-esteem
  • Trouble sleeping
  • Talking more than usual
  • Irritability or agitation
  • Racing thoughts
  • Taking behavioral risks, like making poor financial decisions

2. Hypomania involves the same symptoms as mania, but on a less intense level.

“Hypomania differs from mania only by degree of symptom severity and level of impairment,” Michael Thase, M.D., professor of psychiatry and director of the Mood and Anxiety Program at the University of Pennsylvania Perelman School of Medicine, tells SELF. As Dr. Thase explains, if the episode is severe enough to damage a person’s work, relationships, or home life; requires hospitalization; or includes psychosis (losing contact with reality), then it is classified as mania.

Episodes of hypomania, on the other hand, are subtler, the Mayo Clinic says. If you’re going through one, it might just feel like you’re way more “up” than usual, but not to a potentially harmful degree.

3. You can be naturally upbeat or energetic all or most of the time without experiencing hypomania.

It’s entirely possible for someone to exhibit certain aspects of hypomania without actually going through a hypomanic episode, Nassir Ghaemi, M.D., M.P.H., professor of psychiatry at Tufts University School of Medicine, tells SELF.

Remember, you need to present with at least three signs of hypomania—along with an extended and unusually upbeat mood—for at least four days to officially have a hypomanic episode. That “unusually” in there is key because the episode needs to be a pretty sudden change from your baseline mood and behavior, Samar McCutcheon, M.D., clinical assistant professor of psychiatry at The Ohio State University Wexner Medical Center, tells SELF. So, if you looked at that list of symptoms up there and realized you embody most of them most of the time, that doesn’t automatically mean you’ve experienced hypomania.

4. Not everyone with bipolar disorder goes through hypomania.

Bipolar disorder is separated into different categories based on the mix of episodes a person experiences.

In order to be clinically diagnosed with bipolar I disorder, you have to have at least one manic episode lasting at least seven days (or severe enough to require hospitalization), per the National Institute of Mental Health (NIMH). You may also experience episodes of hypomania. While the minimum is four days, these can last up to several months, Dr. Ghaemi says. Someone with bipolar I may also experience depressive episodes lasting at least two weeks, or mixed episodes with symptoms of depression and mania. Basically, someone with bipolar I may deal with a variety of mood phases that don’t necessarily include hypomania.

In order to be diagnosed with bipolar II disorder, you must have at least one hypomanic episode and one depressive episode, but no manic episodes, the NIMH explains. Hypomanic episodes are a non-negotiable part of this diagnosis.

5. A condition called cyclothymic disorder, which presents as a less severe form of bipolar disorder, also involves hypomania.

Much like hypomania is a less severe version of mania, cyclothymic disorder (also known as cyclothymia) is a less extreme version of bipolar disorder, according to the NIMH. If you have cyclothymic disorder, you go through alternating periods of hypomanic and depressive symptoms that aren’t severe enough to fulfill the criteria of having actual hypomanic and depressive episodes. In order to qualify as having cyclothymic disorder, you must experience these symptoms on and off for at least two years.

6. Some people with a condition related to bipolar disorder may only have hypomania.

“There [is] a small subset of people who experience only hypomanic episodes,” Dr. McCutcheon says. Since this doesn’t quite fit into the categories of bipolar I, bipolar II, or cyclothymic disorder, it’s diagnosed as Other Specified and Unspecified Bipolar and Related Disorders, Dr. McCutcheon explains.

7. Experts don’t really know what causes hypomania, but genetics and neurological factors seem to play a role in bipolar disorder in general.

If you experience hypomania (and any other symptoms of bipolar disorder), it could be because it runs in your family, Dr. Thase points out. Experts aren’t yet sure of which specific genes may be involved in bipolar disorder heritability, but having a parent or sibling with the condition can increase your risk, according to the NIMH.
Similarly, it appears as though brain structure and functioning have some kind of impact in developing bipolar disorder, but researchers haven’t yet figured out the details.

8. Sometimes hypomania is so hard to identify that people with bipolar disorder are misdiagnosed.

The first issue here is that people with hypomania and mania may not recognize that the symptoms are indicative of a disorder. They can instead write off signs of these conditions as simply having more energy or motivation than usual and view it as a good thing.

Even if someone experiencing hypomania does seek medical attention, they might receive a misdiagnosis because it can be so subtle. For instance, someone with bipolar II—which involves hypomanic and depressive episodes—may get diagnosed with major depressive disorder if they or a doctor miss those hypomanic symptoms.

It’s key that doctors perform as thorough a psychiatric evaluation as possible if there’s a chance someone is experiencing bipolar disorder because so much of treatment hinges on an accurate diagnosis.

9. Several types of medications can help treat bipolar disorder, but mood stabilizers specifically are best for hypomania.

Mood stabilizers decrease levels of abnormal brain activity that contribute to hypomania (and mania), according to the NIMH. Other classes of drugs can help with different aspects of bipolar disorder. For instance, antipsychotics can help relieve persistent depression and mania that don’t respond to other drugs, the Mayo Clinic explains, and antidepressants, antidepressant-antipsychotics, and anti-anxiety medications can also do their part to treat bipolar disorder.


Altered microbiome after caesarean section impacts baby’s immune system

Together with colleagues from Sweden and Luxembourg, scientists from the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg have observed that, during a natural vaginal birth, specific bacteria from the mother’s gut are passed on to the baby and stimulate the baby’s immune responses. This transmission is impacted in children born by caesarean section. “This may explain why, epidemiologically speaking, caesarean-born children suffer more frequently from chronic, immune system-linked diseases compared to babies born vaginally,” says the head of the study Associate Prof. Paul Wilmes. His team has now published its results in the open access journal Nature Communications.

Humans are born germ-free. Yet, birth is normally the time when vitally important bacteria start to colonise the body including the gut, skin and lungs. Researchers have long suspected that this early colonisation sets the course for one’s later health. It could be, however, that a caesarean section prevents certain bacteria, ordinarily interacting with the baby’s immune system, from being passed on from the mother to the new-born. Paul Wilmes, head of the Eco-Systems Biology research group at the LCSB, and his colleagues have now found the first evidence of this in a study of new-borns — half of whom were delivered by caesarean section. Wilmes reports: “We find specific bacterial substances that stimulate the immune system in vaginally born babies. In contrast, the immune stimulation in caesarean children is much lower either because the bacterial triggers are present at much lower levels or other bacterial substances hamper these initial immune reactions to happen.”

This bacterial coloniser-immune system link — together with other factors — could explain why caesarean section babies are statistically more prone to develop allergies, chronic inflammatory diseases and metabolic diseases. “It could be that the immune system of these children is set on a different path early on,” suggests Paul Wilmes. “We now want to further investigate this link mechanistically and find ways by which we might replace the lacking maternal bacterial strains in caesarean-born babies, e.g. by administering probiotics.”

“Of course, it is already clear that we should not intervene too strongly in the birth process. Babies should only be delivered by caesarean section when it is medically necessary,” Paul Wilmes stresses. “We need to be aware that, in doing so, we are apparently intervening massively in the natural interactions between humans and bacteria.”

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Mischievous responders taint LGBQ health estimates in national survey

Many research studies have reported on the elevated health risk and deviance of youth who identify as lesbian, gay, bisexual, or questioning (LGBQ). But a new study using national data suggests that many of those estimates may be overstated and that LGBQ youth risk and deviance is not as different from heterosexual youth as many studies claim.

The new research was led by Joseph Cimpian, an associate professor of economics and education policy at New York University’s Steinhardt School, and published in the American Journal of Public Health. The study found that “mischievous responders,” research survey respondents who mislead researchers by providing extreme and untruthful responses to multiple items, have significantly affected overall estimates of health disparities between LGBQ and heterosexual youth.

“Not all adolescents take surveys as seriously as researchers would like,” said Cimpian. “Some youth may find it funny to give exaggerated responses, reporting they are impossibly tall, have never been to the dentist, and eat carrots with extreme frequency. Problematically, these mischievous responders also find it funny to falsely claim they are ‘LGBQ’ and to exaggerate risky outcomes such as drug use, thereby inflating estimates of LGBQ youth drug use.”

Cimpian utilized data from the Youth Risk Behavior Survey (YRBS), a large Centers for Disease Control and Prevention public health dataset on more than 140,000 high school students, to identify potentially mischievous responders and then examined how the inclusion of their responses may have an impact on estimates of health disparities in 20 different outcomes, from hopelessness to heroin use, between LGBQ and heterosexual youth.

Likely mischievous responders were identified using machine-learning techniques that seek out unusual patters of responses to items that should be theoretically unrelated to sexual identity (e.g., how often someone eats carrots, or their height) on self-administered questionnaires. After identifying the most likely mischievous youths, Cimpian and his research team were able to assess the data for changes in the estimates of the youth health disparities.

After removing the most likely mischievous respondents, Cimpian and his colleagues found that youth health disparities between LGBQ and heterosexual males dropped by an average of 46 percent, while dropping by 23 percent on average among females. Cimpian pointed out, however, that not all outcomes were affected equally.

“We found that drug and alcohol related disparities were most affected by removing potentially mischievous responders. With the suspect cases, researchers would conclude that LGBQ youth were drinking alcohol and using drugs like heroin and ecstasy at substantially higher rates than their heterosexual peers. But when the suspect cases were removed, those disparities diminished considerably and vanished in some instances,” reported Cimpian.

“Yet, outcomes like being the victim of bullying and considering suicide were virtually unaffected,” Cimpian continued. “This suggests that there are important health disparities observed in the literature, largely related to the victimization LGBQ youth experience, that are not caused by aberrant data, and that policymakers and health professionals need to pay careful attention to.”

The researchers then repeated their analyses on a separate nationally representative dataset from the Centers for Disease Control and Prevention of over 14,000 students and replicated their initial findings, this time finding average reductions of 64 percent among males and 12 percent among females, further suggesting that mischievous responders affect male disparities more than female disparities. They also performed several additional statistical tests to ensure the patterns they observed were robust to research modifications. Overall, the research provides strong evidence that mischievous responders contribute to inflated estimates of the risk and deviance of LGBQ youth. The changes in disparity estimates are most pronounced for drug- and alcohol-use and also for suicide attempts, and also among males more than among females. Disparity estimates for being bullied, feeling sad or hopeless, and thinking about suicide were not noticeably affected.

“This research demonstrates why it is essential for researchers to perform a wide range of tests to ensure their survey data lead to robust findings,” Cimpian added. “The research we put out can have a substantial effect on public policy and on what gets communicated to the public. It is critical that we take the necessary steps to make sure that what we present is accurate and to be forthcoming about the assumptions and limitations of research.”

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Why the BOSU Ball Is a Worthy Exercise Tool—and 6 Exercises to Try With It

For the longest time, I had no idea what a BOSU ball was. I called it “that weird half stability ball thing” and assumed it wasn’t something people actually used at the gym. And then I became a fitness editor and payed a lot more attention to what many different people actually use during workouts, and, yes, I realized the BOSU ball was indeed legit.

I’ve seen Instagram posts of celebrities like Shay Mitchell and model Jasmine Tookes using the exercise tool; I’ve watched random people at the gym drag it to their corner and put it to work; I’ve even seen some of my favorite trainers use them in their own workouts. The reason people like it? It’s a great tool for adding an extra stability (hello, core!) challenge to any workout.

“The beauty of a BOSU is that you can perform all types of exercises with it—everything from leg exercises balancing on it, to core exercises and even upper-body and cardio work,” says Autumn Calabrese, Beachbody super trainer and creator of 80-Day Obsession. In any of those scenarios, it simply adds an extra element of instability, which requires you to engage more of the small muscles in your core that help you control your body and stay balanced.

Ultimately, you’ll get a more intense core workout—no matter what muscles the exercise technically targets—and improve your balance by using a tool that challenges stability like a BOSU ball. “It also can help improve proprioception (knowing where your body is in space),” says Calabrese. Having a greater sense of body awareness helps you better control your movements, positioning, and ultimately, both your posture and ability to do exercises with proper form. So like, it’s kind of a big deal.

“The BOSU is absolutely a tool worth trying,” Calabrese says, though she does note that adding a stability challenge isn’t a good idea for every single exercise, namely any one that has you lifting a lot of weight and doesn’t leave your hands free in case you fall. “An example of this would be having the unstable side of the BOSU (the blue side) on the ground, standing on the black side (the hard flat side), putting a barbell on your shoulders, and performing squats. That is a very dangerous exercise that could cause serious injury if you were to lose your balance,” she says. “A way to correct that would be to hold dumbbells at your sides—those you can let go of easily if you start to fall.”

Like any new exercise or piece of equipment, it’s best to start with the basics and work up to more complex moves after you’ve built your stability a bit. Before you do anything else, simply stand on the blue side of the BOSU to get a feel for it. Yes, you’ll feel wobbly, but with time, you’ll start to feel more stable. Then, try out some of the moves below.

Babies kicking in the womb are creating a map of their bodies

The kicks a mother feels from her unborn child may allow the baby to ‘map’ their own body and enable them to eventually explore their surroundings, suggests new research led by UCL in collaboration with UCLH.

For the study, published today in Scientific Reports, researchers measured brainwaves produced when newborn babies kick their limbs during rapid eye movement (REM) sleep, finding that fast brainwaves — a brainwave pattern typically seen in neonates — fire in the corresponding hemisphere.

For example, the movement of a baby’s right hand causes brainwaves to fire immediately afterwards in the part of the left brain hemisphere that processes touch for the right hand. The size of these brainwaves is largest in premature babies, who at that age would usually still be in the womb.

The findings suggest that fetal kicks in the late stages of pregnancy — the third trimester — help to grow areas of the brain that deal with sensory input, and are how the baby develops a sense of their own body. The fast brainwaves evoked by the movement disappear by the time babies are a few weeks old.

“Spontaneous movement and consequent feedback from the environment during the early developmental period are known to be necessary for proper brain mapping in animals such as rats. Here we showed that this may be true in humans too,” explained study author Dr Lorenzo Fabrizi (UCL Neuroscience, Physiology & Pharmacology).

Kimberley Whitehead (UCL Neuroscience, Physiology & Pharmacology) said: “We think the findings have implications for providing the optimal hospital environment for infants born early, so that they receive appropriate sensory input. For example, it is already routine for infants to be ‘nested’ in their cots — this allows them to ‘feel’ a surface when their limbs kick, as if they were still inside the womb.

“As the movements we observed occur during sleep, our results support other studies which indicate that sleep should be protected in newborns, for example by minimising the disturbance associated with necessary medical procedures.”

The babies’ brainwaves were measured using electroencephalography (EEG), and were recorded continuously during sleep. Active sleep was identified behaviourally according to cot side observation of rapid eye movements, largely irregular breathing and frequent, isolated limb movements.

A total of 19 newborns aged two days on average took part in the study, and they were between 31 and 42 weeks corrected gestational age when studied. Corrected gestational age takes into account their age if they were still in the womb; a baby born at 35 weeks and being one week old would have a corrected gestational age of 36 weeks.

The research was carried out at UCL Neuroscience, Physiology & Pharmacology and the Elizabeth Garrett Anderson Obstetric Wing at UCLH, and was kindly supported by the Medical Research Council. Ethical approval was obtained from the NHS Research Ethics Committee.

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Intensive Insulin Therapy: Tight Blood Sugar Control

If you have type 1 diabetes—and in some cases if you have type 2 diabetes—intensive insulin therapy may be the key to long-term health.

This aggressive therapy isn’t easy, but the benefits are real. Find out how intensive insulin therapy can help you achieve desired blood sugar control and what intensive insulin therapy requires of you. Then you and your health care team can decide if intensive insulin therapy is the best approach for you.

What is intensive insulin therapy?

Intensive insulin therapy is an aggressive treatment approach designed to control your blood sugar levels. Intensive insulin therapy requires close monitoring of blood sugar levels and multiple doses of insulin.

Fortunately, research is ongoing into new methods of blood sugar monitoring and insulin delivery that may make it easier and reduce the risk of intensive insulin therapy. One such method is a closed-loop insulin delivery system that combines continuous blood sugar monitoring with insulin pump delivery.

If you choose to try intensive insulin therapy, you’ll work with your doctor to set various goals based on your age, overall health, and other individual factors. Ideally, this could mean:

  • Blood sugar level before meals: 70 to 130 milligrams per deciliter (mg/dL), or 3.9 to 7.2 millimoles per liter (mmol/L)
  • Blood sugar level two hours after meals: less than 180 mg/dL (10 mmol/L)
  • Hemoglobin A1C (glycated hemoglobin, an indicator of your blood sugar control for the past few months): less than 7 percent

What are the benefits of intensive insulin therapy?

Intensive insulin therapy can prevent or slow the progression of long-term diabetes complications.

Several studies indicate that intensive insulin therapy can:

  • Reduce the risk of eye damage by more than 75 percent
  • Reduce the risk of nerve damage by 60 percent
  • Prevent or slow the progression of kidney disease by 50 percent

And there’s more good news. Intensive insulin therapy can boost your energy and help you feel better in general.

What’s the commitment?

To achieve tight blood sugar control with intensive insulin therapy, you must follow a strict treatment regimen.

  • You’ll need frequent doses of insulin. You may need an injection of short-acting insulin before each meal and an injection of intermediate or long-acting insulin before you go to bed.

    Or you may choose to use an insulin pump, which releases insulin into your body through a plastic tube placed under the skin on your abdomen. The pump delivers a continuous infusion of short-acting insulin and a bolus—extra insulin to cover an expected rise in blood sugar—before meals.

  • You must check your blood sugar often. You’ll need to check your blood sugar at least four times a day, before meals, and bedtime—probably more often than you’re used to. It’s also important to track the results of each blood sugar test.

  • You must closely follow your eating and exercise plans. What you eat has a direct effect on your blood sugar. Physical activity also influences blood sugar. Your doctor may ask you to track what you eat and how much you exercise in a detailed diary.

What are the risks of intensive insulin therapy?

Intensive insulin therapy may lead to:

  • Low blood sugar. When you have tight blood sugar levels, any change in your daily routine—such as exercising more than usual or not eating enough—may cause low blood sugar (hypoglycemia).

    Be aware of early signs and symptoms, such as anxiety, sweating, and shaking, and respond quickly. Drink a glass of orange juice or suck on a few pieces of hard candy. Your doctor may recommend carrying glucose tablets.

  • Weight gain. When you use insulin to lower your blood sugar, the sugar in your bloodstream enters cells in your body instead of being excreted in your urine. Your body converts the sugar your cells don’t use for energy into fat, which can lead to weight gain. To limit weight gain, closely follow your exercise and meal plans.

Is intensive insulin therapy right for you?

Intensive insulin therapy is recommended for most people who have type 1 diabetes and for some people who have type 2 diabetes—but it isn’t right for everyone.

Intensive insulin therapy may not be for you if:

  • You struggle with frequent or severe bouts of low blood sugar
  • You are a child
  • You are an older adult
  • You have heart disease, blood vessel disease, or severe diabetes complications

Ultimately, it’s up to you and your health care team to decide if intensive insulin therapy is right for you. This decision should be based on the potential risks and benefits the therapy may offer for your specific situation.

Updated: 2017-02-25

Publication Date: 2004-11-11

The Wizard of Oz most ‘influential’ film of all time according to network science

The Wizard of Oz, followed by Star Wars and Psycho, is identified as the most influential film of all time in a study published in the open access journal Applied Network Science.

Researchers at the University of Turin, Italy, calculated an influence score for 47,000 films listed in IMDb (the internet movie database). The score was based on how much each film had been referenced by subsequent films. The authors found that the top 20 most influential films were all produced before 1980 and mostly in the United States.

Dr. Livio Bioglio, the lead author, said: “We propose an alternative method to box office takings — which are affected by factors beyond the quality of the film such as advertising and distribution — and reviews — which are ultimately subjective — for analysing the success of a film. We have developed an algorithm that uses references between movies as a measure for success, and which can also be used to evaluate the career of directors, actors and actresses, by considering their participation in top-scoring movies.”

Applying the algorithm to directors, the five men credited for The Wizard of Oz are all in the top eight, with Alfred Hitchcock, Steven Spielberg and Stanley Kubrick ranked third, fifth and sixth respectively. When the authors used another approach to remove the bias of older movies — which, because they were produced earlier, can potentially influence a greater number of subsequent films — Alfred Hitchcock, Steven Spielberg and Brian De Palma occupied the top spots instead.

When applied to actors, the algorithm ranked Samuel L. Jackson, Clint Eastwood and Tom Cruise as the top three. The authors noticed a strong gender bias towards male actors; the only female in the top ten was Lois Maxwell, who played the recurring role of Miss Moneypenny in the James Bond franchise.

Dr. Bioglio said: “The scores of top-ranked actresses tend to be lower compared to their male colleagues. The only exceptions were musical movies, where results show moderate gender equality, and movies produced in Sweden, where actresses ranked better compared to actors.”

To calculate the influence score for the 47,000 films investigated in this study, the authors treated the films as nodes in a network and measured the number of connections each film has to other films and how influential the films connected to it are. Similar network science methods have already been widely applied to measuring the impact of work in other fields, such as scientific publications.

Dr. Bioglio said: “The idea of using network analysis for ranking films is not completely new, but to our knowledge this is the first study that uses these techniques to also rank personalities involved in film production.”

The authors suggest that their method could be used for research in the arts and by film historians. However, they caution that the results can only be applied to Western cinema as the data on IMDb are strongly biased towards films produced in Western countries.

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15 Top-Rated Foundations at Ulta, According to Customer Reviews

Using the right foundation is a key step in my daily routine and it lays the groundwork for the rest of my face makeup. Since I’m all about the “no-makeup makeup” look, I try to apply my foundation seamlessly, so it isn’t visible to the naked eye. While I usually opt for liquid foundations, there are also many powder-to-liquid formulas that apply differently but leave a similar finish. (And it’s important to note that if your foundation includes SPF, experts still suggest wearing additional sunscreen under your makeup to protect skin from both UVA and UVB rays.)

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