February 22, 2017

Talking with Family about Diabetes

Talking with family or friends about diabetes is not always easy. With the myths that exist about diabetes, it can be difficult to avoid snide remarks and nagging from family or friends that feel that they are helping you manage your diabetes.

You may get comments like - "Should you be eating that?" "I found this article online, and it says that people with diabetes need to ..." "Have you tested your blood sugar today?"

If you have diabetes, you've probably heard questions and comments like these at least once from some friends and family members. How can you teach these well-meaning folks to offer the kind of help you need, instead of what they think you need?

#1. Erase myths with education. "There's a lot of misinformation about diabetes, and it's important that people understand what's true and what isn't," says Dawn Sherr, RD, a practice manager at the American Association of Diabetes Educators. "For people who are close to you -- spouses, family members, or close friends -- encourage them to attend a diabetes education class, or ask them to accompany you to an office visit to get a better understanding of how diabetes is going to affect you."

#2. Figure out what support means to you. For example, some people see reminders about what to eat or what to buy at the store as helpful -- others don't. "If someone asks me if I've tested my blood sugar today, I see it as showing that they care about me," says Elizabeth Mwanga, owner of a health care tech company. "But for other people, that can feel like nagging." Sit loved ones down and explain the kind of help that works best for you.

#3. Make family and friends part of the solution. "If you're newly diagnosed with diabetes and trying to become more physically fit or eat better, encourage your friends and family to be supportive and participate themselves," Sherr says. If you make lifestyle changes a group effort, it allows them to feel like they're contributing and lets them see just how hard you're working.

#4. Stress small steps. "Just because someone has been diagnosed with diabetes doesn't mean they will change everything about their life overnight," Sherr says. "Let the people in your life know that."

#5. Be honest with yourself. It can't hurt to take a quick look in the mirror. Are the comments bothering you because they might be a little bit on target?

#6. Let others know you appreciate their concern. Most of the time, when people "nag" you about your diabetes, they do it out of concern and love, not to be a pain. Tell your husband or mom or best friend, "It means a lot that you care so much about me and want me to be healthy. Trust me -- I've got this under control."

#7. Other tips and questions for your doctor.
Can you help me with the skills to handle diabetes?

How well do you think I'm managing my condition? What's the one thing I should focus on most?

How do I talk to my partner and family about diabetes?

What do I need to know to still enjoy going out to dinner with family and friends?

How can diabetes affect my sex life?

February 21, 2017

Talk to Your Doctor and Pharmacist

I firmly believe in this. I see too many people avoiding this and causing themselves health problems. Yes, there is a growing epidemic in this country and it is on two fronts. Many people are not talking to their doctors. And, at the same time, doctors are not talking to their patients. These are not what I am referring to, but both are part of the epidemic.

Medical situations arise every day and people think they can handle them without talking to their doctor. A brief article the other day made an excellent point about the need to talk to your doctor. Some people will disagree with what I am going to say, but they are the ones that will end up in the emergency room and the hospital or even the local mortuary. Yes, it is that serious.

When people come down with the common cold or also develop problems with mucus plugging their nose, they head for the nearest store or pharmacy to get a decongestant. If you are healthy and have no known medical problems, chances are that no damage will be done.

But if you have any of the following health conditions, doing this is not advisable. These health conditions are heart problems or high blood pressure, glaucoma, thyroid problems, diabetes, or prostrate problems. With these conditions, it is wise to consult with your doctor. Most over-the-counter products like decongestants are clearly labeled with a warning for high blood pressure but little else. Some do say they will raise blood glucose levels.

Most people will demand privacy and other grounds for avoiding what I am proposing, but after seeing a friend in the hospital recently for just the above situation, I think for the sake of safety, all over-the-counter drugs that require a warning, should only be available through a pharmacy and be kept behind the counter requiring a prescription if they have health problems listed above.

This may be an unnecessary burden on doctors and pharmacists, but in this day with computers, this should be workable. Some patients will go to extreme measures to avoid this happening and shop pharmacies to avoid the need for a prescription. They will do anything to step around the system. The dangers of doing this are there and people still want to ignore them.

This is the reason that I only have two pharmacies and all my doctors know which ones to deal with. If I am looking for an over-the-counter medicine, I talk with the pharmacist after I have read the label. Often the pharmacist suggests another product that does not have the dangers. Occasionally I am told to not take any and go to the doctor. I respect the pharmacist for this and this is one reason for not wanting many pharmacists to deal with for my prescriptions.

I find that these relationships work for my better health care and as a result, the doctors are more confident in what I do. Plus the pharmacist is more willing to answer questions and even supplies me with additional information when it is felt that it will be of value.

February 20, 2017

Teach Children Emergency Basics

This can be controversial, but I think one that should seriously be considered. Often I read or hear of a child being a hero because they had been taught how to dial 911, or had heard about it from adult conversations and just did it, or they just do something to help save a life.

On one of the diabetes discussion groups about seven years ago, a person was asking how to get a judge to stop visitation and joint custody rights to prevent her two children from being exposed to their father (a type1) when he has hypoglycemic episodes. She was very adamant in preventing them from witnessing their father at these times. I was proud of the people in the group who asked how often this happened, was he known for the episodes, and had she ever witnessed him have a hypoglycemic episode?

She was only aware of one time when he was at work and he was rushed to the hospital. Then she was asked if the children knew how to dial 911? She did not know and said that was not the issue. Because of the one hypoglycemic incident, she wanted to be sure that he would not expose the children to any. Many felt she was doing this for her own selfish motives and asked if she had even talked to the children (ages 9 and 12) about their feelings. She never answered so I think the people were correct.

The idea of teaching our children to dial 911 is an excellent idea. At what age should they be taught? This may well depend on the children, the family circumstances, and the general health of the parent(s) or family members. Of course, they must understand that this is for emergencies only.

As to teaching the children about handling chronic diseases and the possible effects like hypoglycemia or seizures, this is will depend on the child or children and their willingness to help and be part of the support structure within the family. If an episode happens and the children or child goes running to hide, then they may not be ready.

If the children or child stays and observes, then afterward asks questions, this is the time to start the conversation. Find out what they remember and if they feel that they could help. Do answer all their questions as completely as possible, or take them to the hospital or fire station (or where ever the emergency people are stationed) so that they can see where they are located and if possible, let them ask questions of the emergency personnel.

If the children balk at anything, do not force an issue. They often understand things better than we realize and are more resilient than we give them credit. It is best to let things progress at their (the child's) pace. Just be there for them, answer their questions honestly to the best of your ability and ask them if they would like to hear an explanation from a person knowledgeable about the question they asked. Do not forget if they answer yes. It may take time to develop resources to ask questions to, but this will show the children that you care and will follow through.

Teach them at their pace and as much as they want to learn. Then ask them some questions to see how much they retain. You may be pleasantly surprised. Never force them into areas where they do not want to go, but encourage them at every opportunity.

I am not a professional and not trained in this. These are my opinions and feelings from observations of some families with chronic illnesses/diseases and how they handled sensitive or emergency situations. These children are now very knowledgeable and are assisting in many ways in our society today, and I think this because of the circumstances they were exposed to as children.

February 19, 2017

Gluten-Free May Mean Arsenic or Mercury Poisoning

Allison called Wednesday and asked if I had read this about gluten-free foods. I told her that I had and would have a blog about it in the coming week. She said she had several other articles and would be asking Brenda to have a program if we were having a meeting this or next weekend. She said she is aware of the flu among the members and that three were in the hospital. I said that only two were still in the hospital and that now I may be coming down with it.

To my blog – a new study suggests that a gluten-free diet may pose serious health risks, after finding that the eating pattern may raise the risk of exposure to arsenic and mercury.

Study co-author Maria Argos, assistant professor of epidemiology at the University of Illinois at Chicago (UIC), and colleagues recently reported their findings in the journal Epidemiology.

A gluten-free diet excludes foods that contain gluten - a protein found in wheat, barley, and rye, as well as the byproducts of these grains.

For people with celiac disease - an autoimmune condition whereby gluten intake leads to intestinal damage - a gluten-free diet is the only treatment for the condition.

However, according to a 2012 survey, around 28-30 percent of us restrict our gluten intake or avoid consuming the protein completely, even in the absence of gluten sensitivities.

Rice flour is a common substitute for gluten in many gluten-free products. Argos and colleagues point out that rice can bioaccumulate arsenic, mercury, and other potentially harmful toxic metals from water, soil, or fertilizers. Exposure to these metals has been associated with increased risk of cardiovascular disease, cancer, and other diseases.

"Despite such a dramatic shift in the diet of many Americans, little is known about how gluten-free diets might affect exposure to toxic metals found in certain foods," note the authors.

With the aim of investigating the link between gluten-free diets and toxic metal exposure, Argos and team analyzed the data of 7,471 individuals who were a part of the National Health and Nutrition Examination Survey between 2009 and 2014.

The researchers identified 73 participants aged between 6 and 80 who reported following a gluten-free diet. Blood and urine samples were taken from all participants and assessed for levels of arsenic and mercury.

The researchers found that levels of each toxic metal were much higher among subjects who followed a gluten-free diet than those who did not eat gluten-free products; mercury levels were 70 percent higher in the blood of gluten-free subjects, while arsenic levels in urine were almost twice as high.

According to Argos, these findings suggest that there may be "unintended consequences of eating a gluten-free diet," though further studies are needed to confirm whether this is the case.

The researchers add that:
  1. "With the increasing popularity of gluten-free diets, these findings may have important health implications since the health effects of low-level arsenic and mercury exposure from food sources are uncertain but may increase the risk for cancer and other chronic diseases.
  2. Although we can only speculate, rice may be contributing to the observed higher concentrations of metal biomarkers among those on a gluten-free diet as the primary substitute grain in gluten-free products."

Argos points out that there are regulations in Europe that limit arsenic levels in food products, and he suggests that the United States might benefit from similar regulations.

"We regulate levels of arsenic in water, but if rice flour consumption increases the risk for exposure to arsenic, it would make sense to regulate the metal in foods as well," he adds.

February 18, 2017

Special Diets for Diabetes – Not – Part 2

#7. You Have to Give Up Desserts if You Have Diabetes. MYTH. You could:
  • Cut back. Instead of two scoops of ice cream, have one. Or share a dessert with a friend.
  • Consider using low-calorie sweeteners. Keep in mind, there might be a few carbs in these.
  • Expand your horizons. Instead of ice cream, pie, or cake, try fruit, a oatmeal-raisin cookie, or yogurt.
  • Tweak the recipe. For instance, you can often use less sugar than a recipe calls for without sacrificing taste or consistency.

#8. Low- and No-Calorie Sweeteners Are a No-No. MYTH. Most of these sweeteners are much sweeter than the same amount of sugar, so you can use less.

Opinions about them are conflicting, but the American Diabetes Association approves of the use of:
  • Saccharin (Sweet'N Low, Sweet Twin, Sugar Twin)
  • Aspartame (NutraSweet, Equal)
  • Acesulfame potassium (Sunett, Sweet One)
  • Sucralose (Splenda)
  • Stevia/Rebaudioside A (SweetLeaf, Sun Crystals, Steviva, truvia, Pure Via)

You can ask a dietitian which ones are best for which uses, whether you’re drinking coffee, baking, or cooking. Please read my blog on artificial sweeteners. Even though the ADA has approved the above sweeteners, you should be careful.

#9. You Need to Eat Special Diabetic Meals. MYTH. The foods that are good for people with diabetes are also healthy choices for the rest of your family.

With diabetes, you do need to keep a closer watch on things like calories and the amounts and types of carbohydrates, fats, and protein you eat. A diabetes educator or dietitian can show you how to keep good records.

#10. Diet Foods Are the Best Choices. MYTH. You might be paying more for "diet" food that you could find in the regular sections of the grocery store or make yourself.

Read the labels to find out if the ingredients and number of calories are good choices for you. When in doubt, ask your doctor, diabetes educator, or a dietitian for advice.

This and the prior blog are very good at discussing some of the myths about diabetes diets. This list is not complete, but is a good start.

February 17, 2017

Special Diets for Diabetes – Not – Part 1

Have you heard that eating too much sugar causes diabetes? Or maybe someone told you that you have to give up all your favorite foods when you’re on a diabetes diet? Well, those things aren’t true. In fact, there are plenty of myths about dieting and food. Use this guide to separate fact from fiction.

#1. Eating Too Much Sugar Causes Diabetes. MYTH. The truth is that diabetes begins when something disrupts your body's ability to turn the food you eat into energy.

#2. There Are Too Many Rules in a Diabetes Diet. MYTH. If you have diabetes, you need to plan your meals, but the general idea is simple. You’ll want to keep your blood sugar levels as close to normal as possible. Choose foods that work along with your activities and any medications you take.

Will you need to make adjustments to what you eat? Probably. But your new way of eating may not require as many changes as you think.

#3. Carbohydrates Are Bad for Diabetes. MYTH. Carbs are the foundation of a healthy diet whether you have diabetes or not. But learn the limit of carbohydrates that your body can handle and learn to eat to your meter.

They do affect your blood sugar levels, which is why you’ll need to keep up with how many you eat each day. Some carbs have vitamins, minerals, and fiber. So, choose from these, such as whole grains, fruits, and vegetables. Starchy, sugary carbs are not a great choice because they have less to offer. They’re more like a flash in the pan than fuel your body can rely on.

#4. Protein Is Better Than Carbohydrates for Diabetes. MYTH. Because carbs affect blood sugar levels so quickly, you may be tempted to eat less of them and substitute more protein. But take care to choose your protein carefully. If it comes with too much saturated fat, that’s risky for your heart’s health. Keep an eye on your portion size too. Talk to your dietitian or doctor about how much protein is right for you. Read my blog here about protein and please read this blog by David Mendosa as he discusses protein.

#5. You Can Adjust Your Diabetes Drugs to ‘Cover’ Whatever You Eat. MYTH. If you use insulin for your diabetes, you may learn how to adjust the amount and type you take to match the amount of food you eat. But this doesn't mean you can eat as much as you want and then just use additional drugs to stabilize your blood sugar level.

If you use other types of diabetes drugs, don't try to adjust your dose to match varying levels of carbohydrates in your meals unless your doctor tells you to. Most diabetes medications work best when you take them as directed. When in doubt, ask your doctor or pharmacist.

#6. You'll Need to Give Up Your Favorite Foods. MYTH. There’s no reason to stop eating what you love. Instead, try:
  • A change in the way your favorite foods are prepared. Can you bake it instead of deep-frying it?
  • A change in the other foods you usually eat along with your favorites. Maybe have a sweet potato instead of mashed potatoes?
  • Smaller servings of your favorite foods. A little bit goes a long way.
  • Not using your favorite foods as a reward when you stick to your meal plan. Do reward yourself, but with something other than food.

A dietitian can help you find ways to include your favorites in your diabetes meal plan.

February 16, 2017

Don't Beat Yourself Up for Diet Mistakes

This article in WebMD is somewhat enlightening if it weren't so poorly written and only emphasizing one side of the weight loss battle. Yes, diets fail and quite often. So I would like to change the wording from 'diets' to “a way of life,” meaning this is a permanent change and not a temporary way of living, or a diet.

Human beings, even those with fantastic willpower, are known to have weak moments. So, whatever the reason is that caused your way of life to go off track, repeat after me: It’s really and truly OK.

Still beating yourself up? Take a look at some of the common ways people are too hard on themselves, and why they shouldn't be:
  • But... I should have more willpower.
  • But... I hate that I’m always making excuses.
  • But... I should have picked a different diet.
  • But... I’m just not a good dieter.
  • But... I’m doomed to be stuck at this weight forever.
  • But... I’ve always been overweight so I just don’t think I can do it.

Humans are wired to reject things they don’t enjoy and embrace those they do. So, if you’re not happy on a particular way of life, chances are good that you’ll wind up cutting out early.

Life happens. Sometimes good stuff, like impromptu vacations, causes people to relax their way of life efforts. Sometimes the kids get sick, preventing even the most devoted person from heading to the grocery store to stock up on healthy fare. Occasionally, you just really want to eat whatever you want. The reason you stopped watching your nutritional goals isn’t really important.

Fad diets, (here is that word again) are all the rage and have been for centuries. Everyone loves a diet that promises unbelievable results, especially in short order. So, if you want to participate in a diet that allows only Twinkie or baby food consumption, I guess you can give it a shot. However, Centers for Disease Control & Prevention (CDC) recommends picking a plan rich in fruits, veggies, lean meats and low-fat dairy products, to name a few. If you're unsure what's right for you, ask your doctor to recommend a diet plan that incorporates the nutrients your body needs to function and thrive, and, yes, lose weight. Something tells me that Twinkies have few, if any, nutrients.

There’s a way of life out there for absolutely everyone. All you have to do is find it and commit to it! If food preparation is the problem, pick one of those services that provide your meals for a monthly fee. If you’re often hungry when out and about, pack a healthy snack that’ll keep you from picking a high-calorie option. Figure out what your Achilles heel is and fix it.

Motivation is a key factor in weight-loss success. Overweight or obese patients are given the tools to lose weight, but their own hang-ups often get in the way. People need to learn how to deal with daily problems, stay motivated and address setbacks in a healthy manner if their way of life is really going to be successful.

For many people who’ve been overweight for life, weight loss can seem unattainable. If self-esteem or other issues are keeping you from truly focusing and believing in yourself, it might be time to work with a professional to figure out how to give yourself the boost you need for a better way of life.

No matter how many diets you’ve abandoned, it’s important to never let your self-esteem pay the price. With the right tools, focus and motivation, you can find a nutrition plan that helps you feel healthier and happier. Just be sure that you are committed in a permanent way and leave the temporary ways behind.

February 15, 2017

Diabetes HbA1c Test Still Faulty

Tell me why this is not unexpected. This news has been known for some time, but with the lack of other tests, we were rather limited to criticize them too much. Now the science of our tests (A1c and OGTT) is being exposed and everyone can see the faults of both tests.

The data is alarming, or should be for those who may have diabetes, but have not yet been diagnosed. This is why the International Diabetes Federation (IDF) and the World Health Organization (WHO) have opposed the A1c as the standard for diagnosis. Yet, the American Diabetes Association (ADA) continues to choose to forge ahead with a defective test. See this reference and start reading at B. Diagnosis of diabetes Recommendations. This is below table 1.

The ADA claims that the A1c test has been standardized, but really folks, who are they kidding. There are still too many variables that exist that keep it a faulty and defective diagnostic tool by itself. It might work well of some races, but for others it will give faulty readings. So I have to ask, WHEN is the ADA going to wake up and learn. Never, if this is the way they continue to do business.

I say quite openly, when those of us with Type 2 diabetes have an organization like the adult Type 1 diabetes people seem to now have in JDRF, then we might find our way into the twenty-first century. As long at the ADA continues to be by and for the medical community, those of us with diabetes (the patients) will continue to be ignored and given lip-service.

Some of the variables that affect the A1c test include anemia, for African-Americans that carry the sickle cell trait can have anemia as well. Other problems include blood transfusions and dialysis that can affect the accuracy of the tests. Some even claim that electrolyte levels will affect the A1c tests. My advice would be to question any A1c test that seems unreasonable and ask the doctor to perform the necessary tests for anemia or electrolyte levels. You should know if you have had any transfusions or dialysis.

To go along with this, I am finding more and more diabetes news on the BBC, Reuters, and Telegraph UK. The US has a few sources, but more researchers are reaching out to news organizations outside of the US to get their research recognized. In the US, it gets buried inside the ADA website and unless a few good sources like Diabetes in Control dig or mine the information, it stays hidden in the ADA archives.

Most of us do not have the time to mine the information on the ADA website. I occasionally find something there, but I am lucky most of the time. I admit that I find more information on government agency websites that I do on ADA.