Welcome! This is written primarily for people with Type 2 Diabetes. Some information covers all types of diabetes. Always keep a positive attitude is my motto.
I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.
I know some people with type 2 diabetes
are, but many are not because they are totally immersed in counting
carbohydrates and they ignore calories. How many calories have you
eaten today, how many should you eat? Many can guess how many
calories do you need? The 2000-calorie-a-day standard is just a
ballpark figure, used by FDA to calculate daily values on food
labels. The following table will give you more of a range. The
weakness of the table is no information is listed for active adults
and for children and adolescents.
These age ranges are for people in good
health and not for people with chronic diseases like type 2 diabetes.
In addition, I would question the age ranges above 51, as there
could be other ranges that need clarification for people over 70.
Since I am not an expert in counting calories, my guess would be that
for people with type 2 diabetes should probably be less that the
Again, get out the blood glucose meter
and use this before and after consuming a meal. This will also tell
you if you are eating too many calories. People that are very active
can probably consume more calories. There are calorie calculators
like this at the Mayo Clinic website. Just be aware that all calorie
calculators are based on a one-size-fits-all basis.
Just like carb counting, there are
variables to consider. Metabolism is a big variable – do you have
an unusually slow or fast burning metabolism. Fortunately, a doctor
can give you a breath test to check that. This knowledge will help
the doctor and you set an individualized calorie goal.
A majority of adults need or want to
lose weight. For this, there is a one-size-fits-all calorie formula.
This will work for some people, but many will not have success. If
you change your level of exercise, you may lose more weight and
faster than anticipated.
For people with type 2 diabetes, stick
with the carbohydrate count and start learning the calorie count.
This is because some foods are higher in calories than the
carbohydrate count and a few foods are higher in carbohydrate count
than calorie count.
Many government agencies don't want
this to happen. Chief among them is the US Dept of Agriculture
(USDA) and the National Institute of Health (NIH). Other federal
agencies also follow suit. This means that the Academy of Nutrition
and Dietetics (AND), Certified Diabetes Educators, the American
Diabetes Association (ADA), and the American Association of Clinical
Endocrinologists (AACE) follow in lock step.
Naturally, the medical insurance
industry follow the recommendations of the ADA and AACE. This means
that we as patients have to work harder to obtain the test strips to
know what our blood glucose levels are for us to manage our diabetes
more effectively. Not knowing and operating in the dark is not the
way effectively to manage diabetes.
Most blogs by CDEs and RDs never
mention using our blood glucose meters with test strips because they
don't want us to know how the different foods affect our blood
glucose levels. This is part of the reason many people get
discouraged and seldom test their blood glucose levels. This almost
guarantees that diabetes will become progressive and that the
complications will affect the quality of life. Self-Monitoring of
Blood Glucose (SMBG) is shunned by CDEs and not talked about by RDs.
If it wasn't the leadership of the USDA
and the blind following by AND, we might have reason to listen to a
few that do teach SMBG. A few CDEs that do not have to worry about
other CDEs looking over their shoulders, do teach Diabetes
Self-Management Education (DSME) of which SMBG is a part. Many will
not even teach DSME because they only believe in mandates and dogma
and expect people blindly to follow. With the internet of today,
this will only get worse as people learn what following these people
will do to damage their health.
At least some people from the Duke
University of Nursing at Durham, NC are doing something about what
the CDEs are unwilling to accomplish. Read about this in a recent blog here. They are at least reviewing various methods of delivering
diabetes self-management education (DSME) via the internet.
Then people with type 2 diabetes and
those with prediabetes will have resources to learn about managing
their diabetes. Then if the certified diabetes educators want to be
exclusive and continue to make it more difficult to become a CDE and
for their numbers to grow, we can ignore them and learn on the
The unfortunate part of this is that it
is just a study and there is no sources of DSME as such on the
internet for easy access. This in one time I sincerely wish that
people would put information on the Internet and then do a study
instead of studying other studies. Yes, I was honestly thinking that
there was a source of DSME on the Internet and that it could be
available to all people with type 2 diabetes. While the study
details were interesting, that is as far as it was taken.
I know some people with or without
diabetes that cannot stomach eggs. For the rest of you, eggs are a
great source of protein and cholesterol will not be a problem –
much to your disbelief.
According to Nicholas Fuller, PhD, from
the Boden Institute Clinical Trials Unit, University of Sydney,
Australia, the findings of a study suggest that eating two eggs per
day, 6 days a week can be a safe part of a healthy diet for people
with type 2 diabetes. The study lasted for 3 months, a time-span in
which a change in cholesterol levels can become clear. It was
supported by a research grant from the Australian Egg Corporation.
Yes, I know, this suggests a study that
may not be without bias. A study for three months can also hide some
trends and give results desired. At least Fuller said there is a
lack of research into the effects of eating high amounts of eggs in
people with type 2 diabetes. National guidelines on eating eggs and
total cholesterol limits are inconclusive, though, and guidelines
vary between different countries.
Researchers also found that eating an
egg-rich diet for 3 months was linked to better appetite control, and
may provide a greater sense of satiety (feeling full). Fuller said
the study was motivated by the negative perception widely held toward
eggs in the diets of people with type 2 diabetes.
I was a little surprised when I looked into the study and discovered that it was also a weight-control
study. The study participants were required to report to the clinic
each month. During the visit, they were given advice that had to
follow about the types of foods and amount they could eat. Saturated
fats were not allowed, but certain unsaturated fats were.
The number of participants was 140
overweight people with type 2 diabetes and they were divided into two
groups – one group that would eat less than two eggs per week and
the second group that would eat two eggs per day at breakfast for six
days per week. Too small a study to begin with, but the results is
now questionable, even the low-egg group consuming matching protein
with the high-egg group. As expected, both groups were tested for
The other expected statement was the
lead author calling for more research to confirm whether a high-egg
diet in people with type 2 diabetes does raise HDL (good)
cholesterol. Fuller commented that despite both groups being
equalized for protein consumed, the high-egg group reported less
hunger and greater fullness after meals.
Eggs may also help with greater weight
loss, less weight regain than a conventional diet, due to the greater
fullness, and less hunger reported with a high-egg diet. The
high-egg group also reported more enjoyment of foods, less boredom,
and more satisfaction with the diet.
I can speak to the latter quite easily
now that I can eat eggs again after having my gallbladder removed.
Prior to that, every time I ate hard-boiled eggs or egg salad, I
would have a severe gallbladder attack. I like my eggs cooked in a
wide variety of ways and can eat four to seven per day without
thinking about it. I like scrambled, poached, hard &
soft-boiled, fried, egg salad, and several other methods. Since my
cholesterol levels are remaining where they should, I will continue
to enjoy my eggs.
First, diets fail and are considered
for the short term. People with type 2 diabetes do not need
something for the short term, but the long term – for the rest of
our lives. As with any article written by doctors or professional
writers, they forget about one crucial fact. People with type 2
diabetes should use their blood glucose meter with test strips to
determine how the food affects their blood glucose levels.
Now I may be wrong, but I generally
ignore writers that don't mention the above and write as if they have
all the answers for food that people with type 2 diabetes should be
eating. I did take time to talk with my cousin and she looked up the
WebMD article and read it. She commented that they were some
powerful diets and most were not suited to good weight loss. She
said if they were careful about the number of calories consumed they
could lose weight, but otherwise with many of the diets, they would
maintain weight and maybe lose a few pounds before they gave up the
She continued that many are not into
lifestyle changes and thus a diet is the way possibly for short-term
weight loss, but not keeping the weight off. I agree with this and
said this was my thinking as well. Both of us were upset by the
slides referred to in the article. We agreed that everything had to
be high carb, low fat and that the recommended number of
carbohydrates in slide 2 of 21, of 45-75 grams for every meal is
totally unreasonable for everyone. With this recommendation, most
people will gain weight, and we have to wonder whom the experts were
to make this statement.
While we both agree that, “No food is
off-limits with diabetes,” and without using our meters with test
strips, we will never understand or be able to manage diabetes. Our
meters tell us if the number of carbohydrates we consumed is too
large. Then we have to decide whether to reduce the number of
carbohydrates or eliminate that food from our food plan.
The DASH Diet, The Mediterranean Diet,
Mark Bittman's VB6 Diet, The Volumetrics Diet, The Biggest Loser
Diet, American Diabetes Association Carbohydrate Counting, Ornish
Diet/The Spectrum, Weight Watchers are the diets listed in the WebMD
article. I will let you read the article, but
none of these diets will work for the long term.
While many people praise these diets, I
will not, primarily because they contain too many carbohydrates, too
little fat, and too little protein. I also am concerned about the
amount of whole grains many of the diets promote. If you use your
meter, and if you are meeting your blood glucose goals, then okay.
If your blood glucose levels spike above 140 mg/dl, then by all means
consider reducing the serving size or eliminating the food from your
This blog was a little surprising after
my two blogs on prescription errors, but we can always learn more.
Yes, most doctors will not issue prescription over the phone and here
are some instances when a doctor will not refill the requested
One of his/her partner’s
patients calls after hours for a refill on narcotics - they can become adictive.
A patient wants a refill beyond
his/her expertise. He/she won’t be refilling your cardiac
medicines as this should be done by the prescribing physician for
several self-evident reasons.
He/she hasn't seen the patient
Most doctors hesitate for valid reasons
for wanting to see a patient before issuing a prescription(s). The
author lists these six reasons:
Does this specific drug still make
Can the dosage be lowered?
Have any new symptoms developed
that might require diagnostic investigation? Suppose the patient
has been losing weight, for example? What if the heartburn has
worsened and a new disease is responsible?
Is the patient experiencing side
effects from the medicine that he or his primary care physician
might not appreciate?
Could the heartburn medicine
interfere with new drugs that the patient is now taking?
Is the patient up to date on other
issues within a gastroenterologist’s responsibility such as colon
Refilling routine medicines may not be
routine and should be done with care and caution. The author uses
this example - a patient from 2 years back who has GERD might think
he needs Nexium for his heartburn. What if his symptom is actually
angina? Get my point?
The author says, when we ask you to
stop in for a brief visit, it’s not because we delight in hassling
you or are hungry for your co-pay. We’re trying to protect you and
to keep you well. Doesn’t this seem like the right prescription?
Some prescriptions can be written
without seeing the patient if the patients keeps regular
appointments. I have had this happen quite often. This is because I
have been seeing the doctor almost quarterly for over 14 years and
have always been up front with him. I needed some heavy duty pain
killers, and for that he wanted to see me which I had no problems
with this because my research had told me this would be necessary as
the medication would be a narcotic and they don't like prescribing
those. After doing an examination and another doctor had done a few
tests, I was able to get my prescription and several refills.
When I asked that the strength be
reduced about two months later, he did, but told me I would need to
see him before any more refills. Since I would have an appointment
two weeks later, I reminded him of that and he said he would
prescribe enough to get me to that appointment. By my appointment, I
was out and told the doctor I did not need any more as the pain had
subsided a few days before. I am happy that I have not had any
further pain and even the doctor is happy that I don't need the
We knew that our meeting was going to
be different, but how different we did not know until our meeting
started. Even Tim was caught off guard. Sue and her husband were
absent because Sue's mother had passed. However, the number of new
members more than made up the difference. We had expected six new
members, but were in shock when 14 people showed up.
Jerry said that four were others that
he had unable to contract for our prior meeting with the
nutritionist, and four of the six had brought another person with
type 2 diabetes. After introductions, Tim asked each of the
potential new members to think of a nickname to use. Tim then
explained that we use the nicknames to keep tabs on each other and
allow them to talk to other members without letting others around
them know whom they are talking about.
Then Tim opened it up for questions
from the new members. Most wanted to know how often we meet. Barry
told them that this varies. We try to meet once a month, but this
can be upset by other events. Barry continued that we normally do
not have meetings in June, July, and August. However, this year, we
had two meetings in August, but not for everyone. We had two
meetings in September and now two meetings in October. In addition
to our November meeting, several will be making a presentation to
Jerry spoke up then and said two of the
meetings were for him and those seeing his dietitian wife. He
continued that they take things as they happen and try to make the
most out of events. He said if they need three meetings to
accomplish something, they will have three meetings. Tim said that
is right. Sometimes it is only five or more people that can have a
special meeting, but we have one meeting per month for everyone.
Brenda said this happens because we are not secretive about our
diabetes and different numbers of us can be working on different
Allen said that this happened this year
as we had three meetings on interventions to help us know how to help
other people with type 2 diabetes. James said that he was the
subject on one intervention, but not by this group, but during a
meeting of several groups. Tim said Jerry was an intervention
project of several of the members and those that Jerry was able to
contact were brought to a meeting not requiring an intervention.
The next question was about membership
and would we be limiting membership. Jason spoke and said this is
something I think all of us have thought about. At one time, we were
at almost 20 members, but because we like our somewhat informal
nature, a few split off from our group. Greg is the leader of that
group now. They wanted formal officers, meetings on a specific day
each month, and other set rules.
Tim said that he was elected as group
leader, Barry was program chairperson, and A.J is group historian.
We don't have a treasurer because we don't collect dues and or other
officers because we don't need them. Two of us send out meeting
summaries after each meeting, with one waiting until the other has
sent out an email and then that person adds other points if
necessary. Bob generally blogs about our meetings so we have several
reminders of what transpired. This way if someone needs to miss a
meeting, they don't feel like they were left out.
Tim stopped then, and said for all
those new people present, to be sure he had their email address and
telephone number given to him. Email addresses for meeting notices
and summaries. The phone numbers in case they were needed for
something special. He stated that all those new to the group would
be sent the email addresses and phone numbers for the rest of the
The meeting continued for another hour
with more questions from the new members and some from our group.
Max said we have a question that needs a vote or thought until the
next meeting. Tim said yes, do we want to limit members or add more
members. The group agreed that for the present, we would not limit
membership, but would take up the question again when we were near 45
members. Everyone present did want to become members. The vote was
unanimous and we went from 17 to 31 members that quickly.
A couple of the new members asked if
they could attend the meeting when we presented the program. Tim
asked if they knew the place and the one answered that he had grown
up there. Tim said he would ask and let them know if they had room
for visitors. This brought several more requests and Tim took the
count (9 wanted to go) and said he wanted emails to be able to
contact everyone. This ended the meeting and Tim collected email
addresses and phone numbers.
On October 21, I received an email from
the ADA promoting the US Preventive Services Task Force (USPSTF)
pronouncement. While I can agree with much of what they are
advocating, I am totally turned off when they label USPSTF as
alphabet soup because the acronym is six letters
long. To me this means that the ADA is belittling the USPSTF and
does not show respect.
Then they use scare tactics by listing
the serious complications that diabetes may cause supposedly to show
how serious diabetes can be. If the ADA was actually calling for
action and supporting the pronouncement of the USPSTF, you would
think they could choose a more positive introduction. Diabetes
receives enough bad publicity without the ADA adding to this.
Why they use the term Diabetes
Advocates to apply to themselves is a puzzle. The email author then
says, “This month our years of hard work paid off and the USPSTF
recommended – for the first time – that Americans with key risk
factors should be tested for diabetes. Studies show that currently
more than half of people with undiagnosed diabetes are not tested
because they do not meet the current diabetes screening guidelines.
Now this will change!”
The author also says this matters
because doctors around the country follow USPSTF recommendations.
Then the email author says this is vital testing will be completely
paid for by a patient's health insurance. Now this is where the two
doctors I have been corresponding with have expressed caution. They
both agreed that most private insurance companies may pay for the
screenings, but will they pay for the follow-up appointments if the
tests are positive. Medicare is the other concern as they have been
in the habit of not paying.
The doctors do have a large concern
about those that fall into the prediabetes range. Without the ADA
making this an official classification, they feel this will still be
an area that will not be covered, even with a prediabetes diagnosis.
The author of the ADA newsletter
declared that the change is critical citing the estimated annual
economic cost of undiagnosed diabetes is a staggering $18 billion.
With this change, the 10 million Americans with undiagnosed diabetes
and the 86 million with prediabetes will have a fighting chance to
take action before the devastating complications of diabetes take
hold, saving both lives and dollars.
The one thing that makes me hopeful –
will the ADA do something about renaming prediabetes and make it an
official diabetes designation? One can only hope.
We are nearly finished for our November
presentation to the group south of us. Their doctor has seen the
outline and asked us to add the topic of prescription errors and
maybe leave off the sleep apnea topic, as he would have a speaker for
that. He was happy that Allen would be talking about the VA and
those benefits, as several of his patients were veterans. He has
asked us to arrive at 6:00 PM, as he wants to lengthen the meeting
because of the topics we will be presenting.
A.J will be presenting about
interventions, Allen will be presenting about the VA, Barry will be
presenting about self-monitoring of blood glucose, Sue will be
presenting about getting off medications, and I will cover the topic
of prescription errors. My cousin will answer the questions she
could not answer at the last meeting. Tim will operate the slide
projector for all the presentations and Dr. Tom will answer a few
questions that we may need help answering.
Dr. Tom has reviewed all of our topics
and made a few suggestions to help us in our presentations. Dr. Tom
asked Max to finish his topic on sleep apnea just in case and to come
with the rest of us. Tim and Dr. Tom will be driving. My cousin
will be driving alone. We will be attempting to keep our
presentations under 15 minutes and allow 15 minutes for questions.
Today Tim received an email and
forwarded it to the rest of us. The group will have about 35 members
present and they are looking forward to our presentations. Dr. Tom
has asked us to have some of the group we will be making a
presentation to for our October meeting. We said no, because we
wanted to welcome our new members and work with them during a meeting
before exposing them to a meeting with other groups. We feel that it
is important for them to get to know us and be able to ask questions
in front of a smaller group.
Dr. Tom also informed us that Dr. Jay
would not be discouraging our two groups, but he would not be
promoting us. He said that he appreciated our honesty and that we
did not dodge his questions. Dr. Tom did say that he was
disappointed that we did say that we would not be favorable to
doctors leading our groups. He continued that he told Dr. Jay that
we encourage people to be testing their blood glucose levels more
often than the ADA or the AACE. He told Dr. Jay that we encourage
patients with diabetes to be tested for vitamin B12 and vitamin D,
particularly those that had been on Metformin for several years.
He did ask if we had people with
prediabetes in our groups. Dr. Tom said that each group only had at
most one person with prediabetes. Dr. Tom did warn him that if he
was not encouraging people to test or not giving out prescriptions
for testing supplies, we would be opposing him and encouraging his
patients to find another doctor. He said Dr. Jay was surprised by
that, but said he was encouraging people to test and was requesting
extra supplies for patients for at least six months even including
the prediabetes patients who could not receive reimbursement. Dr.
Tom did say that he was encouraging people to shop around for the
testing supplies, but had found that the most reliable and least
expensive was the Relion meter and test strips. He also suggests the
Relion Prime and that people check Amazon for prices.