November 27, 2014

Lessons for People New to Type 2 Diabetes, Part 9

I sincerely hope that you have gained information or reviewed information that could be important to you from this series. I am aware of several people that felt other topics should have been included. I do admit that one topic could be, but I seldom write about women's topics. Now if you are a woman, and have not reached menopause yet, then be aware of this variable in the management of your diabetes.

Some women have no problems and other women have extreme problems in managing blood glucose levels. One-size-fits-all cannot be applied here and I will not make any more comments that could cause me problems.

In reviewing some of my blogs, I feel this needs reemphasis about the type of patients and doctors as this could help understand what causes the actions of many patients. I had to rethink this as well when one of our new members asked me why a friend of hers would not take her medication and was refusing help. Our member was very puzzled and frustrated as well. I suggested that she read this blog carefully and see if something described her friend.

About an hour later, Tim called and asked me to come and help Brenda, Jennifer, and him see if we could do an intervention to help Jennifer's friend. Tim said that the person seems to fit patient number one and would not fill her prescriptions and Brenda said she was relying on an herbal mix which Brenda know would not help with diabetes. Brenda said she knew this because some of the ingredients would raise blood glucose levels and the other ingredients could not lower it, but could make her very ill.

Tim had already called Dr. Tom and said he would be there shortly as office hours were over. Jennifer's friend was already becoming combative and we were concerned for Brenda as she was the object of her anger. Just as Dr. Tom arrived, Jennifer's friend grabbed a broom and was striking out at Brenda and Jennifer. I caught the broom as it about struck Brenda and held on and Tim grabbed her to prevent other objects being used. It took about 15 minutes to calm her down and Dr. Tom was very careful in the words he used.

Finally, Dr. Tom asked us to go to another room while he took the herbal bottle and asked if she would listen to him describe what the ingredients in it would do to her body. Brenda said there had to be more bottles of other natural remedies and we carefully found three others in the next 20 minutes. Then Brenda found the mother lode in a kitchen cabinet.

When Dr. Tom read the labels, he asked Tim to call an ambulance immediately while he continued to talk to her. He was able to get her to explain why she had them and had last taken a couple of them. In the meantime, Dr. Tom made a couple of phone calls to find out if a couple of medications were available locally and ordered them. Tim went one way while I went another to pick up the different medications and bring them back to where we were. The ambulance was there and Jennifer's friend was in with Dr. Tom. Dr. Tom took the medications in the ambulance and asked Jennifer to ride as well.

Then Dr. Tom asked Tim to follow with Brenda if she would come. Since there was no need for me, I returned home. About two hours later, Brenda called and said they were almost back and to come to Tim's. Dr. Tom said this was one intervention that had to happen. He said that a couple of the “natural” supplements were anything but natural for the human body and could have caused her to become violently ill and if taken in quantity would have killed her. We would all be returning to her home and do a room-by-room search for other substances. Brenda has her keys and others will be present.

I cannot say what all was found, but the police were even surprised by what turned up and Jennifer was happy that everyone had come together to help her friend. Dr. Tom repeated that all went well and he considered the intervention a success. He said that this should keep her friend out of trouble for some time and he would be in contact with Brenda and Tim about future actions. He had reports to complete and would keep them posted. Jennifer asked for and receive permission to visit her friend and a phone number to call before any visit.

November 26, 2014

Lessons for People New to Type 2 Diabetes, Part 8

If you have not read Part 4 of this series, please do so. This is also about food, but I will be discussing the type of medications and food plans with them. First please understand that I use insulin and this allows me to eat some foods that people on oral medications cannot eat with any regularity.

I am still maintaining less than 80 grams of carbohydrates per day, and I am slowly working my amount of fat up. I no longer have the problems I had early on of using the porcelain fixture in the bathroom more than I wanted. I continue to adjust my protein levels – some days more, but often downward. This depends how the protein is fixed and the number of eggs I consume.

I admit that my lipid panel test results are improving and I have hope in the near future that statins will come off the list of medications I take. This to me is exciting and one more goal I have hope of accomplishing.

The landscape and attitudes of doctors is changing, albeit slowly. My blog here discusses a few of the actions and a little of what is happening. This doctor did surprise me and garnered himself two patients and was more understanding than I have heard about many doctors. He is in a largely rural area and apparently understands diabetes better than many doctors.

I am hearing more about doctors advising a low carb, high fat, medium protein food plan for people with diabetes and this surprises me. Yes, I think this is right, but for doctors to suggest this is unusual when most are still following the low fat mantra.

I will again emphasize that there is not a one-size-fits-all food plan. The quicker you accept this, the easier it will be to build your own plan or adapt another food plan that fits your needs. Use your meter to help you adapt or build your food plan, as this will aid you in finding one that you can accept and use on a daily basis. Other people often build a week's worth of menus so that they can vary what they eat. Several members of our support group have done this and they exchange recipes and test to see how their body reacts to the recipe and then adapt it if they need to do this.

One of our new members has tried a few recipes that A. J and James have been eating and said he was having trouble feeling full. They explained that he needed to test and see what his blood glucose level was at about one hour and again at two hours. He reported that his blood glucose had only increased 15 mg/dl from before to after meal testing. A.J suggested that he eat 10 more grams of carbs with the meal and see what happened. He did and said his blood glucose had only risen 20 mg/dl from his premeal reading. He added that he felt better and less hungry. A.J told him that was what worked for him and he could try adding another 5 grams of carbohydrates and do the same. He reported that he felt full then and his blood glucose had only increased 3 mg/dl above what the 10 grams of carbohydrates had been.

He and A.J discussed this and he now understood what could be done with different recipes that were testing too high and if he did this regularly, he could adapt more for himself. A.J is presently off all medications and the new member is on metformin. James is on insulin and has been long enough that he has been able to reduce his insulin use and he is no longer hungry. He has lost the few pounds he needed to lose and then his weight loss stopped. 

A.J suggested that he eat more slowly and chew his food more thoroughly, as this could help him feel full sooner and this could help him cut his carbohydrates.  The new member said this worked well for him and he was now maintaining his carb level below 60 grams of carbohydrates with no problems.

November 25, 2014

Lessons for People New to Type 2 Diabetes, Part 7

“Go To” Diabetes Resources – These are some of the internet sources and written sources that I use and our support group uses. We always use these as a baseline for our learning experience. They are also a baseline for us to improve our diabetes management.

The First Year - Type 2 Diabetes, New York, Marlow & Company, 312 pages, by Gretchen Becker. I discovered this book within a month of diagnosis. It gave me information that I was not receiving from my doctor. Gretchen has type 2 diabetes and she gives the best definitions and reasons for controlling diabetes in non-technical language. Look for the Second Edition.

Most of our support group has read this book, but some of the new members are now reading. Her blog on Health Central is at http://www.healthcentral.com/diabetes/c/5068/

http://www.webmd.com/diabetes/ A good general discussion on many topics and often we use this as a benchmark for making our decisions as the articles are generally in compliance with the ADA guidelines. This is a starting point for us to improve on.

http://www.mendosa.com/ We like to follow David's blogs and Health Central blogs and we like using his site for some research. Some of his earliest articles are only found here. His blog on Health Central is at http://www.healthcentral.com/diabetes/c/17/

http://www.notmedicatedyet.com/ This was more popular when he was blogging five days per week and is still good for helping people that want to get off and stay off medications.

http://loraldiabetes.blogspot.com/ This is a great resource for testing and information for the newly diagnosed. Later blogs are not as popular and he seldom blogs lately.

http://www.battlediabetes.com/ For type 1 and type 2 diabetes - some of our group use this for research and most of us read the information for type 2.


Other miscellaneous websites that some of us follow for information: (All of our group follows some of them and some are more popular than others).





We also have other sources that we read and some variety as each person has his/her own interests. We do correspond among ourselves when we have something that others might have an interest in reading.

If you enjoy videos, then this by Dr.Anne Peters from the Keck School of Medicine at the University of Southern California should interest you. Below the video are 21 more videos, some are good and a couple could be better. Browse as you have interest.  You will have to listen to the advertisements to get to the videos. 

November 24, 2014

Lessons for People New to Type 2 Diabetes, Part 6

This blog is about some of the variables involved in your management of your diabetes. This also emphasizes the saying of what works for me, may not work for you. Get used to this and do not think you can use what someone can use. Also, there is definitely not a one-size-fits-all that you can depend on. This is what many people new to diabetes are looking for and when they don't find it, they become very discouraged, some go into denial, and others give up on managing their diabetes.

I must review some of the material from part 1. Yes, I missed something in preparing that blog. There are seven, not three ways of learning. I was going to add audio, but this caused me to do more research. I am not sure that what I learned many years ago is the same, but I will cover them as they are currently stated. The seven learning styles as defined today include:

  1. Visual (spatial): You prefer using pictures, images, and spatial understanding.
  2. Aural (auditory-musical): You prefer using sound and music.
  3. Verbal (linguistic): You prefer using words, both in speech and writing.
  4. Physical (kinesthetic): You prefer using your body, hands, and sense of touch.
  5. Logical (mathematical): You prefer using logic, reasoning, and systems.
  6. Social (interpersonal): You prefer to learn in groups or with other people.
  7. Solitary (intrapersonal): You prefer to work alone and use self-study.

If you think this complicates learning, then you are right. Many people can use a combination of these learning styles and comprehend material quicker and more accurately. Some only comprehend using one style and this puts them at a disadvantage and requires constant repetition to something to remain in memory. Everyone has a mix of learning styles. Some people may find that they have a dominant style of learning, with far less use of the other styles. Others may find that they use different styles in different circumstances. There is no right mix, or are your styles fixed.

By recognizing and understanding your own learning styles, you can use techniques better suited to you. This improves the speed and quality of your learning. My preferred learning style is reading. I do not enjoy visual as a rule, and even watching TV is a task. I can work with the TV on and when I hear something that peaks my interest, I will turn and watch to see what is being talked about.

Now that I have better explained learning styles, I have to wonder what learning style causes people to throw common sense out the window and hold fast to ideas that are false. What am I talking about you ask? I constantly have people asking me where they can find the pill that will allow them to continue living the life they are accustomed to living. When I say there isn't a pill that will allow this, they look at me in disbelief. Others just proclaim that this is the twenty first century and there has to be a cure.

One additional point that I want to share is on what is the right amount of knowledge for people with type 2 diabetes to have. This is a tough call and my blog link in the previous sentence explains how I feel about this and the many variables involved in deciding. I feel that the more I can learn, the better off I will be in the long run, but there are still many concepts that I need to wrap my brain around. If you live in a largely rural area and do not have certified diabetes educators available, you will need to learn mostly on your own and from the internet. Support groups are also valuable sources of information and finding people willing to talk about their experiences.

November 23, 2014

Lessons for People New to Type 2 Diabetes, Part 5

There is more to food and finding your own food plan than meets the eye. I would urge readers to read some of the mistakes I made shortly after diagnosis. The first link is this, the second link is this, and the third link is here. Before I start with the next subject, I would appreciate you taking time to read this on lifestyle change. Why this you ask? Because effectively to manage your diabetes, some lifestyle changes often need to be made.

The components of lifestyle does start with exercise which in the topic for this blog. To start exercising, if you have not been a regular exerciser, please talk to your doctor for his approval as he may have something that could limit you. He may know from your history and lab reports that you need to be more careful at the beginning before really becoming a regular at exercising. If you are not medically able to do some exercises, your doctor may suggest some forms of exercise that you can do.

While discussing exercise with the doctor, do not forget to talk about blood glucose levels and learn that you do not exercise if the reading is over 250 mg/dl. Some doctors will suggest not over 200 mg/dl for an upper level. On the lower end, a reading below 100 mg/dl will be discouraged. Now this can vary if you are limited in what you can do for exercise.

One person that I know was discouraged from exercising by his doctor, but in talking with the doctor, he was allowed to do some weight lifting up to 25 pounds in each hand while sitting in his wheel chair and was later able to increase the weights to 50 pounds. After two operations on his legs and two years of therapy, he was finally allowed to do some walking and swimming. He is hoping to do more this coming summer. The doctor has set 200 mg/dl as his upper limit and he is not supposed to exercise above this. Since he keeps his blood glucose levels below 140 mg/dl on a regular basis, the doctor is very happy and has allowed longer periods of exercise.

I know that some people exercise below the minimum and too many exercise above the 250 mg/dl level. Those that exercise above this level are flirting with danger and other problems.

The type of exercise you decide to do should be something you enjoy and will do. Consider walking, jogging, swimming, aerobics, resistance exercises, jumping rope, weight lifting, bicycling, and using various types of treadmills in the winter or at times when you don't want to be out in bad weather.

For people with type 2 diabetes, the length of the various exercises can vary. Walking can be for 30 minutes or for three periods of 10 minutes. There are variances for each type of exercise and the number of repetitions you need to do. As you condition yourself, consider increasing the time or number of repetitions. This can depend on the amount of weight you need to lose or even if you need to lose weight. Or it can depend on the need to reduce internal fat and convert it to muscle. These are all things that need discussion with your doctor.

Once you reach your goal, then you will need to schedule exercise to maintain that weight or muscle and not regain weight or lose muscle.

November 22, 2014

Lessons for People New to Type 2 Diabetes, Part 4

If you are new to diabetes, have you demolished the panic panel yet? Many people new to type 2 diabetes have panicked and delayed their acceptance for a longer period. In this blog, I will focus on food plans and try to suggest something that will help you in finding a food plan that will work for you.

An important lesson you need to learn is – just because another person with type 2 diabetes can do something and have good results – does not mean that it will work for you. This does not mean that you give up. This tells you that your diabetes is further or less advanced than it is for the other person and your body reacts differently than their body does. Do not forget this! There is not a one-size-fits-all solution for you! Yes, many doctors, dietitians, and even some nutritionists operate in this mode. This happens because they don't know how to properly assess patients and adapt something for them on an individual basis.

Something that was published recently on Health Central by Gretchen Becker might help in getting started. Her book is an excellent read and I refer to it more than I thought. Information - The First Year - Type 2 Diabetes, New York, Marlow & Company, 312 pages, by Gretchen Becker. I discovered this book within a month of diagnosis. It gave me information that I was not receiving from my doctor. Gretchen has type 2 diabetes and she gives the best definitions and reasons for controlling diabetes in non-technical language. Look for the Second Edition.

The other information that should be absorbed is on this site. Then down the page to the horizontal bar that has the following – Home, Diabetes Basics, Food, etc. in the bar. Select Food, explore, and read all you can as David writes a lot about diabetes. The only item that I have reservations about is the Glycemic Index. It was developed using healthy individuals and not people with diabetes. I use it as a guide and then let my meter tell me if a food item is one that I can eat, if I need to limit it, or eliminate it from my food plan. I encourage you to read as much of David Mendosa's website as you can.

I do encourage you to consider a food plan that is low carbohydrate, medium to high fat, and medium protein. All the experts are still pushing low carbohydrate, low fat, and more protein. Many are still concerned about saturated fat, but it can be consumed and the prior study by Ancel Keys has been shown to be false and more doctors are starting to see this.

Another problem for dietary advice is our own U.S. Department of Agriculture (USDA). The congressional mandate that created the Dietary Guidelines Advisory has been over stepping the boundaries and created the climate of obesity and increase in other diseases, such as diabetes and heart disease. The chart below displays this rather well.
 

The Healthy Nation Coalition has some great points on nutrition and is attempting to obtain information on whom and how policy decisions are made.

Please be careful of many food plans that government agencies and many registered dietitians promote. In general they will tell you that you need the carbohydrates and whole grains for your brain and that you will miss too many nutrients if you don't follow their advice. I have found that most of the nutrients are available in other foods without the added carbohydrates. Learn what works for you and not the mandates of others. If you can adapt their high carbohydrate meals to a level that your meter says fits you and your goals, then you have accomplished your needs and goals.