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Rising interest rates: What's an advisor to do?
Interest rates have been on the rise since 2016. Here's a way to match interest rate risk with your clients' investment time horizons.
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Emmie Martin | @emmiemartin
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Simple ways to grow your savings without changing your life

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Only 16 percent of survey respondents say that they save more than 15 percent of what they make, which is what experts generally recommend . A quarter of respondents report saving between 6 and 10 percent of their income and 21 percent say they sock away 5 percent or less.

At this rate, many people could be setting themselves up to fall short in retirement, Bankrate warns.

"With a steady, significant share of the working population saving nothing or relatively little, it's virtually guaranteed that they'll be unable to afford a modest emergency expense or finance retirement," says Mark Hamrick, senior economic analyst at Bankrate. "That amounts to a financial fail."

The economy might be prospering now, but that won't last forever: "The party has to stop sometime, and when it does, employers will lay off workers," the study says.

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Both low and high blood sugar can cause problems and need to be treated. Your doctor will suggest how often your child's blood sugar should be checked.

See your child's doctor at least every 3 to 6 months to check how well the treatment is working. During these visits, the doctor will do some tests to see if your child's blood sugar is under control. Based on these results, the doctor may change your child's treatment plan.

When your child is 10 years old or starts puberty, he or she will start having exams and tests to look for any problems from diabetes.

Your child's insulin dose and possibly the types of insulin may change over time. The way your child takes insulin (with shots or an 2018 casual shoes top quality women mens fashion animal Snake Embroidery luxury Breathable low top slip on Loafers Sneakers Shoes 5 style outlet clearance eastbay cheap online free shipping popular excellent ha0P88Q
) also may change. This is especially true during the teen years when your child grows and changes a lot.

What and how much food your child needs will also change over the years. But it will always be important to eat about the same amount of carbohydrate at each meal. Carbohydrate is the nutrient that most affects blood sugar.

Health Tools help you make wise health decisions or take action to improve your health.

Cause

Type 1 diabetes develops because the body's immune system destroys beta cells in a part of the pancreas called the islet tissue. Beta cells produce insulin. So children with type 1 diabetes can't make their own insulin. Experts do not know what causes this to happen. But the cause may involve family history and maybe environmental factors like diet or infections.

Type 1 diabetes develops when your child's pancreas stops producing enough insulin . Insulin lets blood sugar-also called glucose-enter the body's cells, where it is used for energy. Without insulin, the amount of sugar in the blood rises above a safe level. As a result, your child experiences high and low blood sugar levels from time to time. High blood sugar can damage blood vessels and nerves throughout the body and increases your child's risk of eye, kidney, heart, blood vessel, and nerve diseases.

Causes of high blood sugar

Causes of low blood sugar

Symptoms

Because your child has type 1 diabetes, he or she will experience high and low blood sugar levels from time to time. High blood sugar usually develops slowly over hours or days, so you can treat the symptoms before they become severe and require medical attention. On the other hand, your child's blood sugar level can drop to dangerously low levels in minutes.

Be alert for:

How can you tell the difference?

Sometimes it's hard to distinguish between high and low blood sugar symptoms , especially if your child is very young. Test your child's blood sugar whenever you think it may be high or low so that you can treat it appropriately. If your child has symptoms of very high blood sugar, such as a fruity breath odor, vomiting, and/or belly pain, seek emergency care. These symptoms may point to diabetic ketoacidosis , which is a life-threatening emergency.

What Happens

Every child experiences type 1 diabetes differently.

The negative effects of diabetes are caused by blood sugar levels that are above or below a target range .

Low blood sugar

Very low blood sugar is a frightening experience for you and your child. But if low blood sugar levels are treated quickly and appropriately, your child should have no lasting effects.

Young children cannot recognize low blood sugar symptoms as well as adults can, which puts them at risk for low blood sugar emergencies. Children who develop hypoglycemia unawareness , which is the inability to recognize early symptoms of low blood sugar until they become severe, or who are trying to keep their blood sugar levels tightly within a target range are also at risk for low blood sugar emergencies.

Make sure your child's caregivers, such as school nurses, know:

Let your doctor know if your child is having frequent episodes of low blood sugar. You can use this form (What is a PDF document?) to keep a record of your child's very high or very low blood sugar levels.

High blood sugar

Very high blood sugar puts your child at risk for diabetic ketoacidosis , a life-threatening emergency. Skipping insulin injections, stress, illness, injury, and puberty can trigger high blood sugar. Because blood sugar levels usually rise slowly, you can treat symptoms early and, most often, prevent diabetic ketoacidosis.

High blood sugar can also lead to:

What can be done?

The best way to help your child with type 1 diabetes live a long and healthy life is to keep his or her blood sugar levels within a target range. Work with your child's doctor, and monitor blood sugar levels frequently.

What Increases Your Risk

Risk factors for very high or low blood sugar levels in a child with type 1 diabetes include:

Call 911 or other emergency services right away if your child:

Discussion

Different approaches are available for defining a treatment effect on a functional outcome that is “truncated due to death.” We have focused attention on the perspective of the regulator—that is, on advantages and disadvantages of the approaches within the context of principled design and analysis of randomized controlled trials. However, the ability of clinicians to interpret and communicate the potential benefits of interventions to patients may require different considerations. In the setting of severely ill patients, what potential benefits of the interventions are most relevant to the patient? Knowing the average benefit of an intervention among survivors is important; however, the clinician must also advise on characteristics of those who survive. Communicating the SACE to patients offers unique challenges to the clinician. Even if the treatment shows benefit among the always survivors, the clinician does not have the ability to identify whether a specific patient is in this group but could provide information on the distribution of always survivors and mortality benefiters under certain assumptions.

The composite endpoint approach offers the unique ability to provide useful thresholds to patients—for example, in scenario 2, 50% of patients receiving control survive past 72 days, whereas 50% of patients receiving intervention survive to 12 months with cognition scores greater than 54 (above the population norm of 50). However, the composite endpoint approach relies on the ability to order mortality and the functional outcome, which requires extensive input from clinicians and patients before conducting a randomized controlled trial. Studies examining the values and preferences of severely ill patients suggest that some patients consider severe cognitive impairment as a state worse than death 20 ; however, more research is needed to rigorously rank mortality and functional outcomes according to patient values and preferences. We have described in detail the composite endpoint approach proposed by Lachin, yet other composite endpoint approaches exist (eg, the Glasgow outcome scale has been used in randomized controlled trials of patients with serious neurological illness, 21 and quality adjusted life years (QALYs) Hot 2018 Fashion mens Casual shoes STAN SMITH Tennis HU Primeknit men women Running Shoes Sneaker breathable Boost Runner sports Shoes clearance the cheapest sale explore H2jE0qaSa
have been used in critical care trials) with similar challenges to those described above.

We have highlighted that there is no perfect choice among the three statistical approaches for defining a treatment effect when functional outcomes are “truncated due to death.” The choice should be driven by expected effects of the intervention and by the target patient population. Keeping this in mind, we make two recommendations for planning a randomized trial among patients with a high risk of death. First, when it is biologically unlikely for treatment assignment to impact mortality, the survivors analysis provides an unbiased estimate of the effect of treatment on the functional outcome and can be used. Second, when patient mortality is the primary outcome and is hypothesized to differ across treatment groups, the survivors analysis may produce misleading results. This would be the case if the intervention promoted survival among patients with greater morbidity than the always survivors. In such studies, alternatives to the survivors analysis should be considered. If mortality and functional outcomes can be ordered, we recommend the composite endpoint approach over the SACE approach in such settings. While SACE defines a causal effect, the assumptions required to estimate the SACE are restrictive and untestable from the observed data.

Footnotes

Contributors: EC, DOS, DMN, and TDG conceived the study, designed the study, drafted the manuscript, or critically revised the manuscript for important intellectual content. EC, AL, CW, and MDH acquired, analyzed, or interpreted the data. All authors gave final approval of the version to be published and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EC and TDG are the guarantors.

Journal of Medical Internet Research ISSN 1438-8871

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