July 29, 2015

Treatment of Type 2 Diabetes – Part 2

There are two things that can tell you how well your treatment plan is working. That is your A1c and your daily blood glucose readings. The later is most important and it is sad to say that your doctor has a lot to say about how many test strips your insurance will allow and pay for your use. I strongly urge new patients to get as many as the doctor will support for testing the first three or four months.

This will allow you to test in pairs to help you determine what foods are safe in your meal plan and which foods to eliminate and others to limit. We already know that most whole grains will be strictly reduced or eliminated, as will most potatoes and rice. It is still a good idea to consume a limited quantity to see if you can handle them without the spike in blood glucose. This is one time that “what works for me, may not work for you” becomes a rule that you should know.

In other words, just because a friend can consume whole grains and have little effect on his blood glucose, does not mean that you will have the same results. Remember, you are unique and your body reacts to foods and medications differently than the next person. Yes, there are people that can be very similar to you, but if you met the person, you might wonder how. The bell curve is the example I am talking about.
On the extreme right and left of the curve are people that can consume normal meals and amounts of carbohydrates and on the opposite end are people that can consume very small amounts of carbohydrates.

This is why the medication you are taking can affect your need for testing once you know what your meal plan needs to be. Remember that as you age, your meal plan may require changes. This is the reason for recommending people investigate the meter and test strip offerings at Walmart.

There is no one-size-fits-all diabetes food plan. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to a nutritionist if you need help with your food plan, as they can be very informative on balancing nutritional needs.

Part 2 of 4 blogs.

July 28, 2015

Treatment of Type 2 Diabetes – Part 1

I think it is time to review the treatment of type 2 diabetes. This article in WebMD covers some great points, but misses many warnings that should have been included and some other points that should have been made. Will I cover them all – doubtful, as my mind is racing and I will probably miss several.

The first point that I want to cover is that diabetes is not your fault. Most doctors insist that you caused it and make it sound very discouraging and say that the diabetes complications will arrive soon enough. This not only will scare you, but many people give up and feel if they can't prevent the complications – so why try? Don't let this happen to you.

If your doctor tries to scare you, it is time to change doctors. Don't let them bully you into giving up and believing you can't manage your diabetes. I know from experience that managing my diabetes is not simple and often is more difficult than I even thought it could be. Yet, because I know that there can be times nothing seems to go right, I try to learn from each case and improve my management.

Now you should understand that you have lots of options to manage your diabetes and every person can be different. Diet (or food plan as I like to use), exercise, and medication (if necessary and there are many medications and strengths of medication) all can work together to help you manage your blood glucose levels.

Your doctor should help you, but never should the doctor set your goals. In the beginning he may help you, but never dictate what your goals should be. This is another reason to change doctors if your doctor insists on setting your goals. They only have about 60 minutes a year available to see you or less if they only see you twice a year.

Your doctor should help you determine if you need to take an oral diabetes medication or insulin. But if he will not listen to you, you will need to consider if the medication is right for you. Ask about side effects and what you need to do if you have one of the lesser-known side effects. Ask if you should take the medication if you are not feeling well and under what circumstances you may still need to take the medication.

Your A1c will probably determine how often you should take the medication and the doctor will suggest accordingly. If you are strong willed and can bring your diabetes under excellent management, will the doctor be willing to change the medication dose and when to take the dose. Also ask if you bring your A1c to within the normal range, will the doctor support you and allow you to stop taking the medication. These questions need answers and not a “we will see” answer.

As you age, the way you handle diabetes may change. Not because you can keep the same management, but your body may not be able to handle the medication or your pancreas may no longer be able to produce the needed insulin. When this happens, don't leave insulin as the 'medication of last resort.'

New medications seem to be approved the FDA more regularly, but I advise caution until they have been on the market for a few years and more of the side effects are known. Then if you agree with the doctor, make the change.

Part 1 of 4 blogs.

July 27, 2015

An Acquaintance Admits He Has Diabetes

On July 24, A.J called me and sounded very urgent when he asked me to come to his house. When I arrive, he and Jerry were talking to the person from this blog. When Jerry let me in, A.J stated to me that I was right and he was glad he had listened to me. A.J told the fellow to tell me what his A1c had been. We nicknamed him Jon and he said that his A1c was 10. The doctor said I was right when I told him that if I were not a person with diabetes, my blood glucose would have been back down at or below 100 mg/dl.

He said he had taken his paperwork to show the doctor and his new doctor agreed that he had diabetes and he needed to start on medication immediately to prevent complications. I asked which one he started on, he said insulin, and when he gave the names of Lantus and Novolog, I knew what he would be asking. Jerry spoke up and said between A.J and you he will be asking many questions. Jon said yes and from what A.J has said, he asked if he could get the address for my blog.

A.J said let's go to my computer and give me your email address. Jon gave him his email address and A.J showed him my blog, copied the URL, and said he would include several other URLs to give him some reading. Jon was told about communication and A.J said he would try to answer his questions at first because my computer was still not back in full operation and I had more to do to get the sound working and download a few of the tools necessary to use some programs. I suggested the he get Jon's phone number and give him our phone numbers.

The Jerry asked him if he had time for the support group. Jon said he knew some of the members like Max and Allen, he listed several other members. Jerry said we will not have another meeting until September, but some of us do get together at a restaurant every Saturday afternoon if we were in town or have the time. Sometimes it can be only two members and other Saturdays can be as many as 20 members. We have no schedule we follow, sometimes we discuss diabetes, and others time a favorite non-diabetes topic. We avoid religion and most politics.

Jon said that to start, he would be doing a lot of reading and asking us for reading resources. Jon thanked us for our interest in diabetes and for making him get the second opinion by scaring the dickens out of him. With that he said he needed to be doing something and would be in contact later.

After Jon left, A.J spoke and said that I had read Jon right the first time and he was happy I had discouraged him from pushing the subject of diabetes then. I answered that I was glad I was right, but if several more weeks had passed, I might have encouraged A.J to resume his pushing. Jerry said that creating doubt was a good thing and that had helped him when he needed it.

With that, I took my leave and said we have work to do to keep Jon learning.

July 24, 2015

Over 65 – Building a Meal Plan for Health

I had to read this several times, but to my surprise, even though this is from the USDA, they are not pushing whole grains. They are doing more for a great food plan than pushing unhealthy whole grains.

It could be that they are truly concerned about the over 65 citizens. Making healthy food choices is a smart thing to do—no matter how old you are! Your body changes through your 60s, 70s, 80s, and beyond. Food provides nutrients you need as you age. Use these tips to choose foods for better health at each stage of life. This is written of all over 65; however, I will write for over 65 with type 2 diabetes.

#1 Drink plenty of liquids. Water is best for those of us with type 2 diabetes. If the water supply is not safe, buy bottled water. Avoid most juice and all sweetened beverages.

#2 Make eating a social event. Meals are more enjoyable when you eat with friends. Invite a friend to join you or take part in a potluck at least twice a week. A senior center or place of worship may offer meals that are shared with others.
There are many ways to make mealtimes pleasing. Please use caution to avoid high carbohydrate foods.

#3 Plan healthy meals. Find trusted nutrition information from a source you trust. Be sure that what you eat is good for type 2 diabetes, be careful of how much you eat, and if necessary limit the quantity you eat. Find sensible, flexible ways to choose and prepare tasty meals so you can eat foods you need.

#4 Know how much to eat. Learn to recognize how much to eat so you can control portion size. MyPlate’s SuperTracker shows amounts of food you need, but does not have a guide for people with diabetes. When eating out, pack part of your meal to eat later. One restaurant dish might be enough for two meals or more.

#5 Vary your vegetables. Include a variety of different colored vegetables to brighten your plate. Most vegetables are a low-calorie source of nutrients. Vegetables are also a good source of fiber. Not all vegetables are low carb. Watch carrots and corn as they are generally high in carbohydrates.

#6 Eat for your teeth and gums. Many people find that their teeth and gums change as they age. People with dental problems sometimes find it hard to chew fruits, vegetables, or meats. Don’t miss out on needed nutrients! Eating softer foods can help. Try cooked or canned foods like unsweetened fruit, low-sodium soups, or canned tuna. Also if you have a food grinder or even a blender, make use of it to make softer food that does not need to be chewed. Just hold the food in your mouth and gum the food to add saliva to help your stomach and intestines digest it easier.

#7 Use herbs and spices. Foods may seem to lose their flavor as you age. If favorite dishes taste different, it may not be the cook! Maybe your sense of smell, sense of taste, or both have changed. Medicines may also change how foods taste. Add flavor to your meals with herbs and spices.

#8 Keep food safe. Don’t take a chance with your health. A food-related illness can be life threatening for an older person. Throw out food that might not be safe. Avoid certain foods that are always risky for an older person, such as unpasteurized dairy foods. Other foods can be harmful to you when they are raw or undercooked, such as eggs, sprouts, fish, shellfish, meat, or poultry. This is an important point.

#9 Read the Nutrition Facts label. Make the right choices when buying food. Pay attention to important nutrients to know as well as calories, fats, sodium, and the rest of the Nutrition Facts label. Ask your doctor if there are ingredients and nutrients you might need to limit or to increase. For those of us with diabetes, carbohydrates need to be limited while fats (except trans fats) need to be increased/

#10 Ask your doctor about vitamins or supplements. Food is generally the best way to get nutrients you need. Should you take vitamins or other pills or powders with herbs and minerals? These are called dietary supplements. Your doctor may know if you need them. More is not always better. Some can create conflicts with your medicines or affect your medical conditions.

Eating healthy and being active is important at any age. That’s why MyPlate and the National Institute on Aging, National Institutes of Health, are delighted to offer a new resource on healthy eating designed specifically for people ages 65 and older. Follow the links on the site.

July 23, 2015

Authors with Conflicts Lead Most Diabetes Studies

Why am I not surprised? On October 25, 2011, the British Medical Journal (BMJ) had an article that showed just over one in five (21 percent) of articles published in six leading medical journals in 2008 have evidence of honorary and ghost authorship. This was done to hide what the latest article discloses.

Diabetes research is dominated by a small group of prolific authors, raising questions about the imbalance of power and conflict of interests in this field, argue experts in The BMJ this week. I will let you read the details as they are rather revealing and point out how much conflict of interest exist in the studies published about diabetes.

With the elderly discrimination in studies and the degree of restricted participant selection, the pharmaceutical industry is working to make sure that all trials are favorable to their products. Example: the trial with rodents that were normal rodents that ended up having Avandia pulled from the market. Then the multitude of rodent trials using extremely healthy rodents were used to get Avandia returned to the market.

In most trials, anyone over the age of 65 is normally excluded and anyone under the age of 65 with more than one medical condition is generally excluded. This way for the human studies, they have the healthiest individuals with diabetes to obtain the most positive results. An extreme example would be the glycemic index, which was, arrived at by using only healthy individuals. Yet again, those of us with multiple chronic conditions and over the age of 65 often do not receive the same results. Granted we cannot do the tests necessary to determine how the glycemic index affects us, but this is what they depend on and this is true for the pharmaceutical industry as well.

I am surprised at the doctors that just assume that because the clinical trials say a drug may be safe, they prescribe it to the elderly without the concern they should have.

Now think about the latest class of drugs, SGLT2 and the side effect of DKA (diabetic ketoacidosis). When the different drugs in this class arrived on the market, did we hear about this side effect? No, because they did not want us to know that now many people with type 2 diabetes could now develop DKA. Before this, it was a rare occurrence among people with type 2 diabetes. Yes, it did happen, but now it is more common.

The real problem now is doctors don't know how to treat it as almost every indication is that there is nothing wrong, blood glucose levels are in the normal range and there is no arrow saying that DKA is present. Yet, it is as deadly as DKA in type 1 diabetes.

This is the result of conflicts of interest not revealing this problem before the drug became available on the market.

This is the reason a few writers (including me) keep pointing out the conflicts of interest as we can see what can happen with the doctors and patients that blindly follow evidence based medicine and think they have all the answers when the trial is based on random controlled trials. What many people forget is the principal of the bell curve in which the majority can be covered, but there is always some that fall at the extremes and present problems that often are ignored during the trial phase. Those with conflicts of interest wish these outliers would disappear.

July 22, 2015

Too Much Sleep May Be Linked to Type 2 Diabetes

I almost passed this by when I read the title - Longer Sleep Duration Linked to Type 2 Diabetes. I thought this must be a joke or a very poor study. When I read the article, I admit that it is worse than most studies and has some obvious weaknesses. Italics are my thoughts.
  1. An increased risk for developing type 2 diabetes was observed in participants slept for an average of less than 5.5 per night or more than 9 hours per night. I thought this was about too much sleep and they talk about five and one half hours per night.
  1. BMI and weight changes may serve as confounding factors affecting the results of the study. They did not keep track of this during the trial to the extent they should have.
  1. Sleep and diabetes are often affecting each other. Normally we hear about this after a person has type 2 diabetes when lack of sleep makes type 2 diabetes more difficult to manage.
People who sleep 9 or more hours per night are associated with higher risk of incident diabetes according the study. Evidence suggests that diabetes and sleep problems are linked to each other. Diabetes can cause insomnia in some people and sleep deprivation may increase for developing diabetes. Yes, “may” is the operative word. Someone blew this, if you have diabetes, how do you develop diabetes?

This was a 20-year study that consisted of four periods of five years each. I would have thought they could have done a more thorough job of research instead of saying, “Further studies are recommended before the association between sleep and diabetes can be established.”

The researchers recorded and calculated the changes in sleep duration for a total of 17,841 participants without diabetes. At the end of each period, incident diabetes was defined using 1) fasting glucose, 2) 75-g oral glucose tolerance test, and 3) glycated hemoglobin, in conjunction with diabetes medication and self-reported doctor diagnosis.

When compared to the controlled group of persistent 7 hours sleepers, results of the study showed "an increase of greater than or equal to 2 hours of sleep per night was associated with a higher risk of incident diabetes in analyses adjusted for age, sex, employment grade, and ethnic group. This association was partially weakened by adjustment for BMI and change in weight. An increased risk of incident diabetes was also seen in persistent short sleepers (average of less than or equal to 5.5 hours of sleep per night).

According to the study, the significance of the results was weakened when researchers factored in adjustment for BMI and changes in the weight. The authors suggest that, "greater weight and weight gain in this group partly explain the association."

The findings of this study provides some understanding about the role of sleep and its effect on the development of diabetes. I am still disappointed by the study.

July 21, 2015

Algae, Quinoa, Legumes - Alternative Protein Choices

The vegans are pushing hard to eliminate meat from our diets. The latest is from a July 12th presentation at IFT15: Where Science Feeds Innovation hosted by the Institute of Food Technologists (IFT) in Chicago.

But knowing the food industry, I will not be surprised if they mess this up by putting too many chemicals in the food that will erase any good that the new foods can garner.

Algae, quinoa and pulses (legumes) are considered by some food technologists to be the best protein sources and strong alternatives to slow meat consumption, reduce food waste, and help feed the world’s growing population.

Algae: This is a new vegan source of protein. It contains 63 percent protein, 15 percent fiber, 11 percent lipids, 4 percent carbohydrates, 4 percent micronutrients and 3 percent moisture. It is said to be easily digested and considered heart healthy. It’s found in the ingredient lists of some protein shakes, crackers or bars, cereals, sauces, dressings and breads.

There are thousands of algae strains, which can be melded in a variety of produces and consumers seem anxious to learn about algae.

Quinoa (keen-OH-wa): This is a centuries-old “poor man’s” crop grown in the High Andes Mountains of Bolivia and Peru, which continues to grow in popularity. There are more than 1,400 quinoa products currently on the market. It is a nutritious, sustainable food and protein source.

Pulses: Pulses, also known as legumes, beans, chickpeas and lentils, are also high in protein, vegetarian, gluten-free, non-allergenic, non-GMO and sustainable.

The important thing about all three is the lack of GMO at present and this appeals to many people that don't trust our USDA when the department claims there is no health risk posed by GMOs.

My concern is the mess Big Food will make of the products and add too many chemicals and sugar to the products before they read the store shelves.

Founded in 1939, the Institute of Food Technologists is committed to advancing the science of food. Our non-profit scientific society—more than 17,000 members from more than 95 countries—brings together food scientists, technologists and related professionals from academia, government, and industry. For more information, please visit ift.org.

July 20, 2015

Statins Are Not Good Drugs

The medical professions have a dismal record for being wrong more than right. Now they can add statins to their losing record. Like the issue of fat in our diet, there will be holdouts and others that will double down to defend their right to be wrong. They won't admit to this and will defend their mistakes and claim they were right because they want to continue receiving the lucrative fees from Big Pharma.

Here is a listing of some of these findings that show the error of their ways:
  • Statins interfere with the production of coenzyme Q10, which supports the body’s immune and nervous systems, boosts heart and other muscle health, maintains normal blood pressure, and much more.
  • Statins weaken the immune system, make it difficult to fight off bacterial infections, and increase the production of cytokines, which trigger and sustain inflammation.
  • They make some patients unable to concentrate or remember words, and are linked to muscle and neurological problems, including Lou Gehrig’s Disease.
  • Statins inhibit the beneficial effects of omega-3 fatty acids by promoting the metabolism of omega-6 fatty acids, which increases insulin resistance and the risk of developing diabetes.
  • There is evidence that statin use blocks the benefits of exercise. Exercise increases the activity and numbers of mitochondria, cells’ “power plants” that process sugars and fat. The study found that with statin use, mitochondrial activity actually decreases with exercise.
  • Statins work by reducing the body’s ability to produce cholesterol, which is essential to brain health—the brain is 2% of the body’s weight, but contains 25% of the entire body’s cholesterol.
  • Statin users have a higher incidence of nerve degeneration and pain, memory loss, confusion, depression, and a higher risk of ALS and Parkinson’s, according to Dr. David Williams in his July 2014 Alternatives newsletter. Statins also decrease carotenoid levels. Carotenoids, which are found in fresh fruits and vegetables and act as antioxidants, have a number of benefits, including protecting against cell damage, aging, and chronic diseases.
  • Statin drugs may also be driving Americans to overeat: a twelve-year study published in JAMA Internal Medicine found that statin users increased their calorie intake by 9%, and fat consumption by 14.4%, over the study period, whereas those who didn’t take statins didn’t significantly change in either measure.
  • An animal study linked statin use to muscle damage. Animals that exercised on statins had 226% more muscle damage than those not given statins.
  • They affect the quality of sleep.
  • Statins increase the risk of prostate and breast cancer.
  • Statins are known to cause liver damage by increasing the liver’s production of digestive enzymes.
  • Statins also speed aging and lower sex drive.
  • Statins have been linked to aggressive and violent behavior in women.

Despite these widely documented risks, the media’s coverage of any adverse side effects is typically followed by the reassurance that the benefits of statins outweigh the risks.

There is much more that should be convincing, but many doctors are not convinced to change their thinking. Read the full article here.