Why Do We Need New Years Resolutions?

I have never seen the need. One time I tried a couple, by the end of January they were no more.

Everyone seems to think they are needed and many are blogging about how to make them achievable. Granted, most that I hear are so grandiose that it is small wonder they can't be kept. Many are totally impracticable and impossible to keep in the first place. So why even make them. This takes all the fun out of the new year and sets a pattern of failure which many people then follow for the rest of the year.

Jen Hubley, the About Today Editor at about dot com started her newsletter for December 29, 2010 stating “New Year's Resolutions: So easy to make, so hard to keep. Unless, like me, you resolve every year to stop setting unreasonable goals. Then you can start out by not making resolutions, and you're already a winner.”

Then she had to ruin her excellent start by proposing some ways to make New Year's Resolutions.  Not really, but she does link to lots of types of resolutions written by others at about dot com.

Have a Happy New Year!

Medically Induced Diabetes

What is this you say? Why would anyone allow diabetes to be induced. It is one of the types of diabetes that is recognized by the American Diabetes Association (ADA). I feel that there is one exception that is not officially recognized by the ADA, but still exists in daily life.

I will start with the not recognized diabetes which I will emphasize is not considered by the ADA. This is when an accident happens which severely damages the pancreas making it incapable of insulin production. This does not happen that often, but there are a few individuals in this unofficial category.

The medically induced is simply called – Drug- or chemical-induced diabetes. There are apparently many drugs that can impair insulin secretion, but not cause diabetes by themselves. These drugs can start diabetes in people with insulin resistance. When this happens, the classification is difficult because the sequence or importance of the beta-cell dysfunction and insulin resistance in unknown.

Some toxins like Vacor (a rat poison) and intravenous pentamidine can destroy pancreatic beta-cells, but these are rare. There are many drugs and hormones that can affect insulin action. A list (link is broken) in table one is not all-inclusive, but includes the more commonly recognized drug-, hormone-, or toxin-induced forms of diabetes.

When I was told recently that a friend had medically induced type 2 diabetes, I had to look this up. There is only a classification of medically induced and no type associated with it. I am not going to debate this until the ADA does more clarification or assigns a type. Then there is diabetes resulting from prescription steroids.

Medically induced diabetes is still diabetes and must be treated as such. Some are treated with oral medications and the rest with insulin depending on the damage done to the pancreas. Most of the few that have accident caused diabetes are on insulin.

Read the ADA definitions here.   This definitions for the above discussion are about one-third to one half way down the page.

Learn How to Manage Holiday Stress

Many people are telling us how to minimize the stress of the holiday season. Some are excellent, some are okay, and others almost seem to create more stress than help reduce stress. I am looking as this as a person with diabetes. What works for some may not work for all us. Stress makes management of blood glucose levels more difficult.

This article fits and includes many of the criteria for reducing stress. The most important point is not forgetting to take care of ourselves. There are many points that can be included in taking care of ourselves. These also work for minimizing depression. Learn to manage your diabetes routine and expectations to make the holidays enjoyable.

Make sure that you maintain a good sleep schedule. This means not shorting the amount of sleep and getting the eight hours needed each night. Sleep deprivation is a negative factor in managing your blood glucose levels and can make it more difficult.

Avoid overeating or loading up on carbohydrates. This will force blood glucose management out the window. Know you limits and stick to them. If you must have the extra piece of desert or extra serving of your favorite food remember to plan for some exercise before eating and some light exercise after eating to help burn the extra carbohydrates. Those of us on insulin have a much easier time, but we still need to be careful of the extra carbohydrates.

This is important – know your limits. Avoid family gatherings that include airing family issues and grievances. It is often better to miss these gatherings than feel resentful for days afterward. It is better exercising restraint beforehand than dealing with problem relatives and letting them raise your blood pressure.

Rather than staying late at gatherings, leave early when necessary to allow yourself some time unwind and relax before bed time. Allow time for taking a walk if possible or other types of exercise. Take a good hot shower or soak in the tub to wash the day's stress away. In other words, take care of yourself first and don't let little things become mountains.

Learn to budget your time and patience for the holidays to get the most enjoyment out of them for you. If you have something that reduces the stress for you, do it. You are worth it!

I cannot leave this without adding another reference that may reduce the food stress for the holidays. Even though the author does not have diabetes, he knows how to adapt for diabetes. His blog has a practical way to handle the eating stress many of us feel during the holidays. Though he probably was not thinking stress, his blog has some excellent tips. I use many of them, but never thought of them the way he presents the ideas.

Happy holidays!

Seasons Greetings

To all my readers

May you have a happy holiday season

Have a Merry Christmas!

and

A Happy New Year!

The blog will continue during the holidays. I wanted to take this opportunity to greet everyone and wish you happy holidays.

New Vitamin D Standards

Once in a while, I seem to do something right. When the first information came out on the new standards for vitamin D from the Institute of Medicine (IOM) I wanted to scream. To me they seemed to be missing the point and I thought maybe I should not write about this and set it aside. Now about three weeks later, I am glad I did not throw this reference away.

After reading several other blogs by doctors, I know as a patient that I am not out in left field for wanting to believe that many people that I like to read their blogs could not be wrong for as many years as they have been doing this. So hopefully I will not mess this up in the explanation.

First, I have been reading David Mendosa for several years and he is not bashful in recommending high quantities (International Units - IU) of vitamin D. He does tell people to find their own levels and not necessarily follow his example. Several others who shall remain nameless take Vitamin D, but not quite as high IU. Now the IOM has just raised the recommendation. The recommendation is here and because I now understand what they have done, I am still upset. The IOM level is still only a maintenance level to prevent deficiency only.

Doctor William Davis did an excellent task of pointing this out and referring to another Doctor about the topic of vitamin D. Dr. Davis also refers to another website about vitamin D. So like me, you have your reading ahead, but I feel that you will better understand the need for vitamin D and the levels suggested.

I am not sure of where to suggest starting your reading, but I would start with the recommendation above and then read three of the blogs by David Mendosa. Blog 1, Blog 2, and Blog 3. Or if you want to read more later go to the main site and use the search tool that he has on his time and type in vitamin D.

Next I would suggest reading the blog by Dr. Davis here. Then follow the links he has in this blog. Finally, read this by Dr. John Cannell.

I have to appreciate these bloggers for using common sense in recommending higher levels of Vitamin D that the IOM. It is discouraging to realize than the IOM just recognizes the minimum levels to prevent deficiency and not giving us levels for optimal health which could be set as a range – deficiency prevention to optimal health.

I find that the doctors recognize that about 30 minutes in the sun gives us about 10,000 IU of vitamin D. They also recognize that vitamin D is a hormone that was miss identified but important enough that the term vitamin has been left in place. So when they mention taking 5000 IU this is not out of line.

However, most physicians only see the recommendations of the IOM and get upset with us when they find out the number of IU we are taking. I do feel fortunate that my endocrinologist is knowledgeable and even suggests higher levels during the winter that I am currently taking.

I suggest bookmarking the reference links if this topic is of interest to you. Links in other blogs mention above but not listed by me yet include: link 1 and link 2.

Smart Hospital Beds in Our Future?

Can we have a smart hospital bed in our future? This may happen if hospital bed manufactures come on board with current technology.

John LaCourse may soon have his name on a lot of hospital beds. He is a professor and chair of the University of New Hampshire's Department of Electrical and Computer Engineering. His research may soon represent a leap forward in hospital patient care. He is presently negotiating with hospital bed manufacturers to add his programmed algorithm technology to make hospital beds “smart” computerized beds.

This research looks very promising and is on the fast track to becoming a reality. It will be useful for many applications including, blood pressure monitoring, prevention of bed sores, sleep apnea, and potentially many other applications.

The microprocessors will be incorporated in the bed and must be standardized as a plug-and-play so medical devices can share information and communicate with each other. This will provide patient information which will hopefully reduce care errors.

Read the article here for more information. This is something I am looking forward to seeing come to fruition. These could prove very useful, not only in hospitals, but also in nursing homes, hospice care, and even in home care. This may also have applications for continuous blood glucose monitoring and insulin pump use.

Exercise

Before starting any exercise regimen be sure that you talk to your doctor and get his permission. Your doctor may have some advice that you would be wise to follow. And your doctor may want to do some tests that will help guide the advice s/he gives you particularly if you have any medical limitations.

Exercise is generally considered one of the keys to weight loss, managing blood glucose levels, and lowering the risk of cardiovascular problems. Many sites are touting the benefits of aerobic and resistance exercises. These are excellent for people without medical limitations.

What many people forget about is swimming. This is low impact and the water provides buoyancy for those with some medical restrictions. Your heart, your brain, and your entire body benefits from exercise. Once you have your doctors approval, select the type of exercise that fits you goals and abilities. Make sure that the exercise is something you enjoy as this will aid you in maintaining a regular routine.

Many people walk every day. Some lift two to five pound weights while in a wheelchair using their feet or hands, or use their arms to push the wheels around the block. Do what you are capable of doing on a daily or regular basis. With winter basically here, many people are fortunate enough to have indoor equipment and can and do use it.

Some cities have swimming pools that are available year round for swimming, whether they are city owned or in a YMCA or YWCA or other organization. Some will allow use for a fee and some require yearly memberships. Some hospitals have small rehabilitation pools that can be used for a fee. So check around and ask questions.

In many cities there are malls that allow walking and this is great if they are indoor areas and have good distances. In a few areas there are stores that will allow you to walk indoors during the winter. Most request that you ask permission and complete some paperwork for their protection and yours if you fall or have something like a hypo and cannot communicate yourself.

This just scratches the surface of what is available or can be done for exercise. Those with medical limitations are often capable of more than they realize and with proper instruction and desire are often to stretch their abilities. Those that have no medical limitations need to put forth more effort to exercise.

This War Must Be Fought!

Normally I would wait to post this, but this demands action now!

This war is with the government and our ill advised bureaucracy that is out to kill people with chronic diseases, namely diabetes. This would otherwise be called Medicare. And we all know this means that the insurance companies will follow this lock-step.

For the background of what is going on, please take time to read the post of December 1, 2010 by Lee Dubois. I know others will be writing about this also. Take time to read his blog now and then come back. I know that your blood pressure will go up, and hopefully you remembered to take your medication last night.

It is bad enough that we have to fight for every test strip that we can get and ask our doctors to go to bat for us to get a few extra strips, but to have medicare dictate that we will only be allowed one test strip if you are on oral medications and three if on insulin it totally out of line and could be fatal for some. We all need to test if we think we might be having an episode of hypoglycemia.

What is so frightening is this time your doctor will not be able to argue for you. This will be the rule and no exceptions will be allowed. It is bad enough that these decisions are not up for public comment before being enforced, but to ram this down our throats is totally unconscionable.

Therefore - call the Congressional Switchboard at 1-866-220-0044. If you give them your zip code they’ll connect you with your Senator’s office. Each Senator apparently has a Healthcare Liaison. Give that person an earful. I lifted this from Lee's blog and I hope that this is acceptable because of the need to do this.

I would also suggest that you email your senators at this link and make the subject attention the Healthcare Liaison. In the first sentence get their attention by stating that Medicare has overstepped their boundaries or wording to this effect.

Do this now and don't wait. Also contact any friends that you know might support you and have them do this as well.

Diabetes Awareness Month Ended

I am not sad to say good bye to this month. Some good projects were started, but at the same time a lot of money was flushed down the drain not benefiting anyone with diabetes and certainly not educating the general public.

What we need is a year-round effort to put diabetes education front and center to the nation and the world. We don't need anymore wasting money on blue lights and the electricity that lit them. This money could have been better spent on some one page advertisements (or even half-page ads) explaining the difference between the types of diabetes and educating a lot more people than lighting a few buildings.

While many people liked seeing the buildings lighted in blue, the people that understood the meaning were those that already know much of the differences between the types of diabetes. They also know about diabetes because they have this disease.

Therefore, I would like to challenge my fellow bloggers to think seriously about finding out whether their local newspapers accept columns written by them about diabetes. Some will even put them in the health section while others will put them on the opinion page. Most local newspapers will not pay for this, but this should not stop you from trying to educate their readers.

My local paper accepts letters to the editor or columns written for the Health section. After the new year, I will be submitting a monthly column for the Health section. While this will not bring me any money, at least I feel that I will be able to help educate people about diabetes in my small corner of the world.

Diabetes' civil war

This is the Chicago Tribune's attempt to stir the pot.  These people had to know when they gave permission to be quoted what the subject of the article was. If I were these people, I would not want to brag about this.

Others are a little more relaxed in their view and for this I am thankful. Check out this blogger and the links he shows, for a little more balanced view.  Note: the link in the last sentence has been broken.

This deserves no more discussion.

More Snake Oil Sales

So far I have not found this in American news sources, but this from the Jamaica-Gleaner is disturbing. Titled “The Diabetes Deception” this article is about as false as they get. While the author is correct that about 95 percent of people have Type 2 diabetes, but to say this is curable, degrades all people with diabetes.

To declare that Type 2 is a lifestyle-related disorder instead of a disease, is wording that snake oil salespeople use profusely. For many Type 2 people, the diagnosis is often made too late and the damage to the pancreas is already done. If the medical community and the American Diabetes Association (ADA) wakes up and advises doctors to be aggressive in their diagnosis, what these people advocate may be possible, but still will not be a cure. See a supporting study that I blogged about for that here.

Using exercise and nutrition may possibly delay the onset of Type 2 diabetes. If the person is overweight or obese, then the reduction of weight will aid in reducing insulin resistance. Even these measures will not ensure a cure, but still are highly advisable to delay full onset of diabetes.

Many of the lifestyle changes promoted by this article will indeed promote good health and delay full diabetes, but there is nothing that will prevent or “cure” diabetes. Let any of these people stop doing regular exercise, over eat carbohydrates, and stop following the recommendations, and Type 2 diabetes will take over without hesitation.

The other argument for eating only low glycemic foods is a good guide, but not fool-proof in preventing diabetes. Total low glycemic eating habits may also not be as healthy for diabetes as they proclaim. Dr. William Davis in his “The Heart Scan Blog” will inform you about some of the dangers in a low glycemic diet. At the same time he also believes in a cure for diabetes. See his blog here. I can't say I totally agree with him, but he at least does not promote snake oil cures.

Some people are talking about early detection of problems with the pancreas and what can be done to reverse the problems, but still these are not cures and if not followed very strictly, will still develop into diabetes Type 2. So read with care.

Components of Lifestyle Change?

This may be just semantics; however, I would like to clarify some parts of the term “lifestyle”. The definition from an on line dictionary says lifestyle is a way of life, the attitudes, tastes, moral standards, economic level, etc., that comprise an individual or group.

This of course says nothing about diabetes and managing diabetes. In my reading, blogging, and participation in a few diabetes forums, I have seen lifestyle described many ways. I have a slightly different perspective as most writers start off with diet.  I believe the elements of lifestyle change should start with exercise if you are physically and medically able. It is the key that generally makes the rest of lifestyle fall into place.

What you need to recognize is that all are interlinked and bypassing one part of lifestyle change will normally make changes generally unachievable. What different writers choose of emphasize depends on their philosophy and how they view their career. Most that work in the medical profession, be they doctors, nurses, educators, dietitians, or licensed caregivers, must follow the guidelines of the American Medical Association, the American Diabetes Association, and other professional medical groups if they want to have their license updated and current.

Since I answer to myself and a few bloggers that agree exercise should be listed first, this is where I will start. This is the list I have pulled together from various sources. It may not agree with everyone's list, but for me, the list needs to be updated as changes are found that affect the way we look at diabetes and lifestyle.

The main elements of lifestyle should or must include the following; exercise, sleep, food, medication, illness, hormones, stress, heart health care, and two other elements, alcohol and smoking. Some people would include weight loss. For me this needs to be part of exercise and food changes plus others to effect weight loss.

Exercise – If you are physically and medically able, get your doctors okay to exercise, and remember to exercise good judgment and don't do something that will be wrong and cause injury. Start out slowly and build up gradually. Regular exercise helps make insulin more readily available and reduces insulin resistance. Find a form of exercise or a mix of routines that you enjoy and follow through with it.

Food – Healthy eating is important and even more important if you are unable to exercise. It is good to be consistent in eating times and amount of food. Whether you eat low carb or another way, learn to use your meter to determine how different foods affect your blood glucose. Learn to coordinate your food with the medication you are taking.

Sleep – Where did this come from? It is not included on most lists, but should be after a study I wrote about here. I keep being surprised how important sleep is to our well being as a person with diabetes. That is the main reason I am adding it to lifestyle and encouraging all to get the sleep needed. If you are having trouble getting enough sleep, change your habits and if that does not help, talk to your doctor about doing a sleep study to determine if you have a form of sleep apnea.

Medication – Be sure that you follow the doctors instructions. Yes, I know that you want to avoid all medications. This is an excellent goal if you are diagnosed early on and can make this work. Remember that you need to consider getting the diabetes managed as soon as reasonably possible. Do discuss with the doctor getting off medications if you do it. If you do bring diabetes under good management and the doctor wants to keep you on medications, then ask yourself if a change needs to be considered.

Heart health care – Because people with diabetes are at 50 percent risk of having cardiovascular events, many of the same changes for diabetes help with heart health. It is still necessary to consider medications for heart health. Exercise and food choices become primary for heart care and managing cholesterol and hypertension.

Illness – This was a little surprising until I thought about how illness affects our diabetes management. So as an element of lifestyle change we need to learn to take our medications timely and know when to talk to the doctor about variations like illness which can cause problems unless we know not to take certain medication to prevent hypoglycemia. This means having a plan with your health care team of what medications to take or not take during an illness.

Hormone levels – This is normally for women who have problems with blood glucose swings related to the monthly menstrual cycle. I personally think the authors failed to talk about the change in life for women and problems some men can have when male hormones cause problems and can affect blood glucose as well. You need to talk about this with your doctor to be prepared for these changes.

Stress – This is definitely a lifestyle change that affects everyone with diabetes. When stressed, almost anyone can toss aside their usual good diabetes management practices, forget to eat healthy foods, and lose control of your blood glucose. Prolonged stress may prevent insulin from working properly which also creates additional problems. Some find logging your stress level (1 to 10 scale) each time you log your blood glucose level helps them see patterns and allow you to adjust accordingly. Learn about ways to relax and find ways to reduce stress.

Alcohol – This can be a bad one if not thought out. First, you need to talk this over with your doctor. Alcohol can aggravate diabetes complications like nerve damage and eye disease. If your diabetes management is excellent, and the doctor agrees, an occasional alcohol drink with a meal may be okay, but a daily drink is generally discouraged.

Smoking - This is a habit that must be broken. Many writers do not want to cover this lifestyle change that needs to happen, and the sooner the better. Not only does this increase the effects of neuropathy, but it can affect an increase in cardiovascular risks. Do not take this lightly, the effects of continuing to smoke do not make blood glucose management easier.

To sum up, these are the lifestyle changes that need attention for those of us with diabetes.

Pharmacies Becoming Sources for Medical Care?

Normally I will not post the same blog to both of my blogs.  I feel this topic needs the exposure so that people can determine for themselves where they want to be on this issue. 

Is this what we want or what we need? I have to wonder if this will be a good thing for people with chronic diseases. I am not sure I want my medical care retailized or taken care out of a storefront. But this is the latest desire from Walgreens – to become your one-stop health care facility.

Walgreens and other large retail pharmacies are lobbying to make this a fact of life. I do not want to have nurse practitioners in charge of my medical health care. I am thankful that in some of the more remote areas or largely rural areas in the United States, nurse practitioners have been needed to get medical care to people and have done excellent work. This has been a necessity because of the lack of doctors in these areas. But for a retail store like Walgreens in non-rural area, this runs against my better nature.

Walgreens is wanting to do this because of the “national shortage of primary care doctors”. They are proposing to “assist patients in managing chronic conditions of diabetes, hypertension, and high cholesterol”.

We have to wonder if we are going to be prescribed extra drugs or medications as a result. Is the American Medical Association going to allow this to happen? Are the states going to allow this to happen? It is happening in some states that have nurse practitioners, but I hope that this does not come to pass in our more populated states.

Many pharmacies are now giving blood screening, flu shots, and other medical advice mainly under the supervision of pharmacists. This is not always the best for many patients as they do not check any medical records to verify allergies and other medical conditions which might preclude some treatments.

What many are banking on is the new health care act providing insurance to people and they want to cash in on the potential increase of cash. And Walgreens is not bashful about saying this.

Before I would want to utilize pharmacies (or what name they will change to), I would want to know who is responsible for writing the prescriptions and whether they have met the education requirements necessary to be able to write prescriptions. Are the pharmacies going to require filling the prescriptions in their store or can these prescriptions be filled at any pharmacy?

These are just some of the questions that need to be answered before I would accept pharmacies taking over primary medical care. Will pharmacies be required to have doctors available to consult or oversee and supervise prescriptions with appropriate approvals available for states to audit? Will this action create or necessitate more state agencies to oversee questionable medical decisions and audit procedures? Will this just increase medical fraud, Medicare, Medicaid, and other fraudulent practices.

And with the shortage of nurses that exists today, where will all of the nurse practitioners come from? Or will they come from our hospitals and doctors offices thus creating a more critical shortage there?

Before this becomes practice, I would hope that our federal and state legislators will examine this very carefully. The last question I would want answered or information made available to the public is the political contributions made in the last election and to whom were they made.

The Types of Diabetes

This subject is unusual for me and yet it has an appeal as I have a friend with a child which fits this very well. He has already been talked to about this and sent several emails. He notified me that he is having his infant son tested this week. After reading the background for this blog, he started checking where to have his son tested.

First I would like to set some terms which are new to me. We are all familiar with Type 1 and Type 2. The term used for these, polygenic, comes from the fact that they develop from multiple genes. The other term, used for the more rare types of diabetes is monogenic. These develop from mutations of a single gene.

This defines the types into two distinct classes. Monogenic diabetes forms comprise two to three percent of all diabetes in young people. This is either inherited for some and others have the gene mutation develop basically overnight. Both sides reduce the ability of the body to produce insulin. This is the area of greatest confusion for the medical professionals as they diagnose Type 1, when it is not.

The different types of monogenic diabetes include permanent neonatal diabetes (PND), transient neonatal diabetes (TND), and maturity onset diabetes of the young (MODY). These are the main forms and some may not respond to treatment and some are mild and should not be treated – a complete surprise. The newborn children and children generally under the age of seven months are likely to have PND or TND. MODY then normally is found in children and adolescents, but may be mild. Therefore it may not be detected until they are adults.

This is the reason I urge that all children be properly tested to determine what type of diabetes they have. I suspect that many that are diagnosed with Type 1 may not in fact have Type 1, but one of the monogenic types. If they truly have Type 1, then you will know for sure by full testing, and genetic testing is the only way to know positively.

Some monogenic forms may be treated with oral medications while others will require insulin, and still others are mild and require very little treatment. This is why I urge testing rather than relying on a doctors diagnosis if Type 1. Definitely consider testing for monogenic diabetes if you or members of your family meet the following criteria:

diagnoses with diabetes under seven months, familial diabetes in the immediate family, mild hyperglycemia, and other pancreatic features.

Testing for monogenic diabetes are often simple and inexpensive and at the time of diagnosis are not typically done. Many doctors are not even aware of the tests. Am I? No; however, two of the tests are listed here. The list of all tests is apparently are not available to non-medical people. The tests should also make management of blood glucose easier and treatment more reliable plus better long-term health.

To repeat, NDM generally occurs in the first six months of life and only one in 100,000 to 500,000 infants. NDM is often mistaken for Type 1, but Type 1 diabetes normally occurs later after the first six months. In about half of those with NDM, the condition becomes permanent. In the other half, NDM is short lived or transient and disappears during early childhood; however, it can reoccur later in life. NDM can be identified to specific genes.

There is a point that is often overlooked with NDM. NDM can also affect the unborn. They do not grow well in the womb and are born much smaller in weight. If caught early by knowledgeable doctors, and given appropriate therapy, they can often be normalized in growth and development.

The other monogenic, MODY, usually develops during during early adolescence or adulthood. It can often be missed until later in life. MODY accounts for one to five percent of all cases of diabetes in the United States. If a parent has MODY, the children are at a greater risk for developing MODY. Each child of a parent with MODY will have a 50 percent risk.

There are several types of MODY because there are a number of gene mutations that cause MODY. It is often confused for Type 1 or Type 2 as the people a seldom overweight and do not have other risks. People with MODY can be treated with oral diabetes medications, but treatment varies with the genetic mutation causing MODY.

Commercial genetic testing for NDM and MODY is now available. See this reference for one company. The Kovler Diabetes Center at the University of Chicago offers help to parents and offers many other services related to NMD and MODY. Check out their web site here. Also check out monogenic diabetes dot org. There is a lot of good information available.

The article that got me started is this one. Continue reading the next article listed at the bottom of each section. Some of this is repeated from the monogenic diabetes dot org.

Emergency Hospitalization for People with Diabetes

Another hospitalization situation that can cause problems for people with diabetes is going into the hospital alone in an emergency situation and no medical alert identification. A case in an emergency room about 65 miles from here this summer really emphasized what can go wrong. These are the type of instances that get my feelings in an uproar when they should not have happened.

The person had collapsed and passed out from heat exhaustion (I'm guessing heat stroke). He was transported to the hospital with an IV in place per orders of the emergency room doctor. When they arrived at the hospital no alert identification was found so the IV was continued and a second one added and and then his billfold was opened. An emergency telephone number was found and called.

The person arrived at the hospital and went to the room where he had been admitted. This person was not aware he had diabetes so could give no insight into treatment or who the doctor was. So the IV's continued. The fellow did not come out of the heat exhaustion, so no changes were made. They did stop the IV's after the fifth one. On the second day the fellow still had not come around, but the emergency person had contacted an older brother, who arrived. Even he did not know about the diabetes, but knew of the doctor his brother was seeing.

Contact was made with the doctor then and it was discovered that he had diabetes Type 1. At that point they did a blood glucose test and if I understood correctly it was “HI”, so they had to do a test from a blood draw. This showed over 900 and I was not given a more accurate figure. Of course they administered insulin. Then they started testing every hour and administering more insulin every five hours. They also continued to test him regularly.

They continued monitoring him and on the fourth day he came to. When the nurse told me about the following, I nearly fell off the chair. The patient said nothing about having diabetes and asked for a Pepsi to drink. When he was told no, he got abusive, and asked for food. When he was told after his insulin, he went ballistic and refused to be treated. The fifth day he checked himself out against doctors wishes.

I don't understand totally what happened as I was not able to get more information. I do not understand why this person did not want to have diabetes identified and when it was, why he reacted this way. I know from the diabetes forums that some people will come out on them, but will not say anything to people near to them or wear a medical alert of any kind.

I can understand privacy, but not the extreme desire for it. He should be thankful that an older brother did know the doctor and that the doctor gave out the information. There are lots of unanswered questions about this, but the nurse would not identify anyone and only gave me a little that she could.

I think she was wanting me to see how important it was to have proper medical alert information on me. When I showed her mine, she asked to see it and thanked me for wearing it. I wear mine on a necklace and need to have it updated for sleep apnea which is not on it presently.

This is why I feel so strongly about educating close friends and family so that they can advocate for you and prevent these types of instances from occurring. And in this case, the person on the emergency notice did not have information. This is not what should have happened.

Enjoy Your Holiday Food!

It is interesting how families celebrate holidays. The question is how do you celebrate the holidays? Do you go overboard with the meal and deserts? For people with Type 2 diabetes holidays can be one of dread and fear of the diabetes police.

First, relax! This is not a rant about the holidays. Hopefully you have a few holidays under your belt and have found yourself able to cope or are looking for ways to do better. If you are new to diabetes, the holidays can be real problems. Hopefully this will provide some help and guidance.

For the parties and friends social gathering, read this for some tips. I would only emphasize that moderation is the key to these events. Do not overdo and select the serving size that is small enough to not raise you blood glucose into the stratosphere.

The next article is definitely for families and is one of the better articles for people with diabetes. I appreciate the statement by Marlene Schwartz, PhD, deputy director of the Rudd Center for Food Policy & Obesity at Yale University when she says “don't tell family members that they're eating more healthfully”. She calls it "stealth health".

This is sound and sage advice. If the food is just served without comment, everyone should be content. They also advise you to involve immediate family members in planning of the menu, especially if they are picky eaters and the younger generations.
There are many good tips and from experience I know that they will work for most families.

The third article is another take on planning for the holidays. It does suggest making a game plan to avoid problems and if you make it work, you can still enjoy the holidays. The best plan is sticking to the plan. Realize that this is the holidays and one day (at a time) is the best method for not being overwhelmed. If you happen to overindulge do not berate yourself. Just be careful the next few following days, and take care of yourself.

From Thanksgiving to at least New Year's Day is often very tempting for people with Type 2 diabetes. Be assured that you will find yourself being tempted, but by careful planning and conservative food selection you should survive. So relax and happy holidays!!!

Goals for the New Type 2 Organization

I am a bit disappointed in the response to the first blog on Type 2 diabetes needing their own organization, but just in the comments. The emails were only from one person and not very friendly.

Outside of the need to have an organization for those of us with Type 2 diabetes, I had hoped to get some more objectives and goals that would give us more ideas. So with that in mind, I will attempt to list a few of them and hope that we can draw some responses.

Besides raising funds for research, finding the proper research venues will be a big priority. There seems to be some areas that are coming to light now that may need more exploration that may lead to keys for managing diabetes. Being more accurate in the diagnosis of diabetes should not be overlooked as the ADA has opted to support the A1c test only.

Something will need to be done for educating the medical profession in being more aggressive in diagnosis, early treatment, and follow up. See this for some hope. Patient education also needs to be strongly promoted. I am not sure how this would be best accomplished, but one suggestion would be on line resources. This could be accomplished by having pamphlets or booklets that every doctor or endocrinologist can hand out when diagnosed.

Sadly in need of education are the insurance companies in preventative medicine and early work for patient education, patient followup, and working with other doctors for overall health. This may include, heart disease prevention, sleep apnea, kidney health, neuropathy, eye health, and many other related areas.

Research will need to be done to find out what other people with diabetes want for support, what education they want and need, and what services would better serve them. I suspect some work will be needed with government agencies, medical groups, and diabetes manufacturers of all types.

Because of the problems specific to women and to men, there should be special education and on line help for each. Education will need to be considered for the younger people now being diagnosed with Type 2 diabetes.

Education programs will need to be developed for hospitals and elder-care facilities. This will develop new standards for how patients with diabetes should be treated, allowed to be self-medicated while in these facilities, and procedures for reducing errors in IV solutions and medications. The attitudes of hospitals does need to be adjusted in many situations.

There has to be more objectives and goals. Help!

Which sweeteners are you consuming?

When I started this, I had no idea what I was getting into. The way the sweeteners are looked at and discussed varies more than a person might think. Much depends on site objectives and manufacturer influence. Sugar and sweeteners are generally viewed as a poison by some groups, and should not even be looked at for people with diabetes irregardless of type. So those articles have been ignored as I wanted something that made some sense and might be of interest.

While the glycemic index values may vary from what I have located, generally they are within a few points in the sources checked. A few values could not be found and I used (??) to indicate that. The value can also change when processed differently as in pasteurized and raw honey. The GI values listed are therefore only guides and can vary depending on method of processing.

Various sweeteners   Glycemic Index Value

Sugar                               GI  80

Other calorie containing sweeteners:
all have approximately 15 grams of carbohydrates per teaspoon
   Honey, pasteurized        GI  75
   Raw Honey                   GI  30
   Maple syrup                  GI  54
   Pancake syrup               GI (??)
   Malt syrup                     GI  42
   Karo syrup                    GI (??)
   Corn sweeteners            GI  62
   Molasses                       GI  58
   Jellies                           GI (??)
   Jams                             GI  46
   Marmalades                   GI  55
   Agave syrup, nectar       GI  15
   Brown Rice syrup          GI  25

Brown sugar                     GI  64
Fructose                           GI  22
Lactose                            GI  46
Glucose                           GI  96
Blackstrap Molasses          GI  55
Stevia – FOS Blend           GI  <1

Artificial sweeteners          GI <1
Name                          Brands
Aspartame              NutraSweet, Equal
                        People who have a condition called phenylketonuria should avoid
                        this sweetener.
Acesulfame K         Sunett, Sweet One, Swiss Sweet
Sucralose               Splenda
Saccharin               Sweet'nLow, Sugartwin
                        Avoid this sweetener if you are pregnant or breastfeeding

Sugar alcohols - These are neither sugars or alcohols, but pure carbohydrates. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol and are called “polyols”. There are other manufactured sugar alcohols, but these occur naturally in plants. This article explains more on sugar alcohols.

The key to non-artificial sweeteners is to use in moderation. Overuse of any sweetener is not good for maintaining tight management of diabetes and for many people will cause weight gain.

The above information is knowledge you should make use of when reading labels. While the GI values will not be listed, these are listed here to hopefully give you ideas when you are looking at labels. This article in WebMD may answer some more questions.

Hospital Awareness for People with Diabetes

Since the this post, more information keeps coming to light that people with diabetes need to be aware of when entering the hospital. There are some nasty situations that can arise even when the hospital is aware that you have diabetes. The nasty problems are life threatening if the hospital is unaware that you have diabetes.

If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.

So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.

Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.

If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.

If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.

Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.

This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.

Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.

It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.

The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.

Diabetic Wound Care of Feet

If this was not so serious, maybe we could all laugh about it, but taking care of foot injuries is very important if you have diabetes and no laughing matter.

Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.

Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.

Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.

Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.

Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.

Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.

Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.

The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.

The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.

Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.

Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.

The article has a ten point checklist that make a lot of sense.

Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes

They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.

I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.

Two other sites worth reading are: Site 1 and Site 2.

Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
 
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting.  Even for regular food care this should be done.  For injuries see your regular doctor promptly.

Sleep apnea and hospitalization Part 2

This part provides some issues you need to be aware of for treatment of sleep apnea in a hospital or out-patient setting whether for a surgical or other treatment. This is information I wished I have made myself aware of for past procedures. I will be ready for any future procedures.

Oral appliance users will need to consult with their prescriber for procedures to follow, but much of the following may apply. Just substitute oral appliance when CPAP is discussed.

When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices. When reading about obstructive sleep apnea (OSA) please use the terms mild or moderate sleep apnea if applicable.

For all sleep apnea patients, knowledge is important to get proper care and treatment in the hospital or out-patient area. If at all possible - DO NOT LEAVE YOUR EQUIPMENT AT HOME. This is important in so many ways as sleep apnea therapy is as important in the hospital as it is at home.

If you do not inform your physicians or surgeon of your need for sleep apnea therapy
during and after medical procedures, this can create problems in healing and delay recovery time leading to longer hospital stays. Do not assume that the physicians and nurses will know how to manage your OSA. If they are not aware, they will not be prepared to care for OSA.

Please ask if you may use your own CPAP equipment. This will be when you will find out what the hospital policy says and you should talk to your doctor as well as your surgeon and the anesthesiologist if you are having surgery to confirm the hospital's policy. If they say no, then ask if they have a form called “Permission and Release for use of Outside Medical Equipment/Appliance for Patient Treatment” so that you may use your own equipment. At this time also ask if they will need a letter from your doctor or a consultation with your sleep doctor.

The only way you should accept the hospital's equipment is if clear that it has the same or better benefits as you equipment. If they cannot meet these requirements, you should be able to use your own equipment for your own well being and comfort. Always make every attempt to use your own mask to control leaks and for comfort.

If they allow your equipment, ask if they need to inspect the equipment to see that it is functioning correctly and does not pose any hazards. Ask when they want to inspect the equipment as you do not want to do this too far in advance.

Important - Label your equipment, CPAP carrying case, mask, and CPAP machine. When you are admitted, labels identifying you, and for your chart are printed. Be sure to ask for enough extras to label your equipment.

Again important, if supplemental oxygen is required, your mask may have ports for attaching an oxygen line. If your mask does not have oxygen ports, contact you equipment provider or the manufacturer to find out if an oxygen port adapter is available for your mask. Most of the time the hospital may have an adapter that will work with your mask.

If you are having surgery and will have a breathing tube inserted into your windpipe, your CPAP will not be required. After the tube is removed, you should be put on the CPAP machine. If you are not intubated, then remind the hospital staff that the CPAP need to be used.

Show your family and/or friends who will be visiting as well as the doctor and shift nurses how to use your equipment. Let them know and reinforce with them that if you are sedated or sleeping, your CPAP needs to be operating.

Normally while you are in what is termed pre-operation stage and being prepared by the nurse, your surgeon and anesthesiologist will stop by to discuss concerns and surgical plans. Do not forget to remind them that your CPAP needs to be in use at all times (if not intubated), and that they need to check your oxygen saturation and to monitor your heart rate.

Be ready if there are exceptions to any of the above when applied to your upper airway surgical procedures and if this should be cleared with the treating physicians and discussed with your sleep physician.

Good luck.

Sleep Apnea and Hospitalization Part 1

If you have sleep apnea and use a positive airway pressure machine, are you aware of what to do when if you are admitted to a hospital, or if you have an outpatient surgical procedure where you will be put under? I admit I was not! So it was with great interest that I read the article here from the American Sleep Apnea Association (ASAA).

Not included as part of the above link are the procedures for those who use oral appliances. This is the reason for making sure the dentist that prescribed your oral appliance is included in the following discussion.

When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices.

The ASAA makes several recommendations for us as patients to accomplish prior to being admitted and what to do once we are admitted. I am concerned that this is aimed only a those of us with obstructive sleep apnea (OSA). So I will mention that this might will be considered by those with mild to moderate sleep apnea. It would be wise to consult with your doctor or dentist in charge of your sleep apnea to have their input in resolving any sleep apnea issues while undergoing medical procedures.

Know you patient rights to be properly treated for OSA and mild to moderate sleep apnea during all surgical procedures whether in a hospital setting or in an outpatient surgical center. This includes any same-day procedure that requires sedation or anesthesia, including but not limited to a colonoscopy or an angiogram.

You will need to determine whether you will be able to use your own CPAP equipment that is set to your prescribed pressure or whether the hospital or facility will supply an identical mask and/or identical or better equipment. You will also need to know whether you will be allowed to have humidification if you use this and whether there are any contraindications for its use. You will need to consult with your oral appliance prescriber for how to handle oral appliances.

To supplement the above, you, as the patient are required to notify your physicians and other caregivers that you have sleep apnea and what pressure the equipment must be set at. You will need to describe the therapy required and provide the contact information for your doctor or dentist so that they can provide the diagnosis information and prescribed pressure or equipment use.

Be prepared to provide your own clean mask and, if needed, your own CPAP machine. Be ready to label your equipment with your name and required identifying information. If possible meet with the surgeon and anesthesiologist to inform them that you have sleep apnea and require therapy.

Important! Make sure that your family, and if necessary friends, know that you are a sleep apnea patient and that they know you require the equipment. They should also know the parts of the equipment and how it is used for your sleep apnea treatment. Lastly, you should make sure that you have the information as part of your medical alert jewelry and on your wallet emergency information card so that medical emergency personnel will be able to take proper action for you.

Watch for Part 2

More on Sleep Apnea

Sleep apnea is not a simple problem. There are problems that I have not covered and there is not one size fits all solution.

I have been covering obstructive sleep apnea (OSA) from mild, moderate, to severe.
OSA is the most common type of sleep apnea. It happens when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring). Snoring is one of the symptoms of sleep apnea, but does not always mean that your have sleep apnea. (Don't let your non-snoring spouse see this).

Now I must add - central sleep apnea and mixed (complex) sleep apnea. Central sleep apnea, while much less common, is still serious. It involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. This is what makes it so serious – it is more difficult to diagnose.

Complex sleep apnea (some use the term of mixed sleep apnea) is a combination of OSA and central sleep apnea. Be sure to read this about sleep apnea.

Unlike OSA, in which you can't breathe normally because of upper airway obstruction, central sleep apnea results when your brain doesn't send the signals to the muscles that control your breathing. Central sleep apnea is less common, accounting for less than five percent of sleep apneas.

Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea. Other medical conditions also cause central sleep apnea. Life-threatening problems with the brain stem is also a cause. Read this for more on other medical problems.

Treatment can include CPAP or oral appliances, but often requires oxygen being supplemented. Your physician may preform a physical exam in addition to a sleep study. Other test that may be included are lung function studies and a MRI.

Central sleep apnea patients should avoid the use of any sedative medications Some types of central sleep apnea can be treated with drugs that will stimulate breathing. If it is due to heart failure, the goal will be to treat the heart failure itself. Other symptoms may include apnea due to neurological condition. The symptoms depend on the cause of the disease and what parts of the nervous is affected, but may include difficulty in swallowing, voice changes, and weakness or numbness throughout the body.

Identifying Sleep Apnea – Part 2

Who can have sleep apnea? Anyone at any age can suffer from sleep apnea, whether they are young children to the elderly. Risk factors become important in both obstructive and central sleep apnea.

The risk factors for obstructive sleep apnea include being overweight, a male, over the age of 65, black, Hispanic or a Pacific Islander, being related to someone who has sleep apnea, and a smoker. Other factors would be having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids. You must also include other medical factors that cause nasal congestion and blockage.

The risk factors for central sleep apnea can have many factors, but is most common in males and people over the age of 65. Central sleep apnea is often caused by serious illnesses like heart disease, stroke, neurological disease, and spinal or brain stem injury.

When diagnosed with sleep apnea, there are some things that you can do to lessen the problems with mild to moderate OSA. Lifestyle modifications are the biggest area to improve the condition. These include losing weight, quit smoking, avoid alcohol, sleeping pills, sedatives, avoid caffeine, heavy meals before going to bed, and maintaining regular sleep hours.

When going to bed, learn to sleep on your side as this will help keep your tongue from relaxing and obstructing your airway. Prevent yourself from rolling onto your back by having something at your back that is rigid enough to stop you. Some people are able to elevate their head with a foam wedge or by using a cervical pillow. If you have nasal problems, use a nasal dilator, saline spray, or breathing strips.

Many people do not use some aids that should be done. Throat exercises can be successful in reducing the severity of sleep apnea by strengthening the muscles in the airway making them less likely to collapse.

Some of the exercises you can try (I found the first the most helpful but try them for yourself) include pressing the tongue flat against the floor of mouth and brush top and sides with toothbrush. Repeat brushing movement 5 times, 3 times a day.

I found this very difficult - press length of tongue to roof of mouth and hold for 3 minutes a day. The next exercise is place finger into one side of mouth. Hold finger against cheek while pulling cheek muscle in at same time. Repeat 10 times then rest and alternate sides. Repeat sequence 3 times.

I have not tried this one - purse lips as if to kiss. Hold lips tightly together and move them up and to the right the up and to the left 10 times. Repeat sequence 3 times.

If nothing more this will strengthen your lungs, but it seems to help. Place lips on a balloon to inflate. Take a deep breath through your nose then blow out through your mouth to inflate balloon as much as possible. Repeat 5 times without removing balloon from mouth.

One exercise that also helped me is holding both hands together at the back and forming a V, take the thumbs and massage the jaw area starting at the back near the jaw hinge and pulling the thumbs forward in the soft area under the jaw. Start at the outside and work toward the center. Just use care not to depress the arteries at the side of the neck, stick to the underside of the jaw.

What ever you do, find out what works for you and give it a consistent trial and a chance to work. Even though I have severe obstructive, the most aid I have received is by sleeping on my side and using a strong back support to prevent me from turning on onto my back. I still use my VPAP machine to get the restful sleep I need.

Identifying Sleep Apnea – Part 1

Do you know what a sleep apnea episode is? Unless you have a recorder and record yourself, you are probably like the rest of us, you could describe in words, but not what it sounds like. Since I have not really discussed this in previous blogs, I am taking this blog and the next blog to write about the areas not covered previously.

A sleep episode is basically when the air flow stops and the oxygen level in your blood drops. This drop causes your brain to jump start your breathing and briefly disturb your sleep. This often causes a gasp or choking sound as you body restarts the breathing. If you have obstructive sleep apnea (OSA), chances are you may not remember these brief awakenings as you will stir just enough to tighten your throat muscles and open your windpipe. In central sleep apnea, you may be conscious of your awakenings.

In sleep apnea that is untreated, breathing is briefly interrupted or becomes shallow during sleep. These breathing interruptions normally last ten to twenty seconds and can happen hundreds of times each night thus preventing you from getting a restful night's sleep.

When breathing is paused, you can be jolted out of your normal sleep, and I can remember this happening, sometimes completely waking me up. It did not happen all the time, but still I was not getting the restful, restorative sleep I needed. This meant that I was sleepy during the day, I had poor concentration, and I was extra careful to avoid accidents.

Sleep apnea can also bring on other serious health problems including diabetes, high blood pressure, heart disease, stroke, and weight gain. Once I was on a CPAP machine, I felt more refreshed and alert and not sleepy during the day, but I still got diabetes.

My wife was smart enough to have me get an appointment with a doctor that was a sleep specialist. She said I was snoring loudly and most of the night, and I was choking or gasping for air during my sleep. I was waking up with a dry mouth, but not a sore throat. I did not have morning headaches, but was still tired the entire day. I don't remember going to the bathroom more frequently or being moody and irritable and at least my wife agreed with me.

My sleep specialist asked lots of questions of both me and my wife. He did feel from that answers that I had sleep apnea. He did tell me that not all people that snore have sleep apnea, but based on the answers to his questions, he was scheduling me for a sleep study.

One thing you may do for yourself is keep a sleep diary. Record the hours in bed, any nighttime awakenings, and whether you feel rested and refreshed after waking. If you are married or have a significant other sleeping with you, get them to add what they witnessed and have them make a note about any gasping, choking, or other sounds.

If you live alone and have video or audio equipment, set them up to record you while sleeping. Hopefully you can set the equipment up to be sound activated or have a connection to your computer to do the actual recording.

The sleep study did show that I had very severe obstructive sleep apnea and though I was not the worse he has seen, I was near the top. Not what I wanted to hear, but at least with the CPAP, I started to get the restful and restorative sleep that I desperately needed.

Sleep Apnea Surgery Options

So you have sleep apnea and want to have surgery. Before you settle on something like surgery, do your homework. Many surgeries do not accomplish what was wanted and once done, you will have to live with it.

After I was diagnosed, I was made aware of this, but discouraged by my sleep doctor until after I had tried other options and learned more about the different surgeries. I am happy that he had that attitude. After doing a lot of reading and research, I will put up with a nasal mask before I will do something that can't be reversed.

In my second year shortly after I was diagnosed with diabetes, a surgeon specializing in obstructive sleep apnea (OSA) surgery was brought in to examine about a dozen of us. There was only one person that fit the criteria he was willing to do surgery for. I don't know what happened, but I am very thankful he felt I did not qualify for surgery.

From my knowledge now, I would try different CPAP equipment and if necessary all of the oral dental appliances until I had exhausted every other facet before I would consider surgery.

Now that I have said that, for those that cannot accept the continuous positive pressure (CPAP) for OSA or oral dental appliances, the following surgery options are available.

1. Uvulopalatopharyngoplasty (UPPP)
2. Tracheostomy
3. Other Surgical Options

I will not summarize these, but urge you to read about them here. It does discuss the complications involved especially UPPP.

More sites that will give you a better understanding of the successes and failures of surgeries for sleep apnea.

Site 1 This site does have information about surgeries for adults and children.
Site 2 Excellent coverage about treatments and drugs.
Site 3 Conversations with two individuals who regret having the surgery.
Site 4 From Sleep Apnea Organization.
Site 5 The U of Maryland an excellent discussion about the success rates and types of complications to expect.

I urge you to do your homework and research diligently before accepting surgical solutions.

Sleep apnea – using oral appliances

When I wrote the first blog on Sleep Apnea, I was not intending for this much time to pass until the second, actually third. A short one about nasal mask liners was the second. I am a confirmed CPAP user, but I want to explore the area of oral appliances.

Yes, people do use oral appliances for sleep apnea. Oral appliances for sleep apnea have now existed for about 16 years. At one time oral appliances were only for mild to moderate sleep apnea. Now even severe obstructive sleep apnea can be handled by some dentists. Not all dentists are trained for treating sleep apnea, or I should say trained in sleep medicine.

Also be careful of dentists, and doctors, as well, that prescribe sleep apnea equipment without a sleep study. A sleep study tells the doctor or dentist the severity of your sleep apnea so that it can be properly treated. There are some of each on the internet where I would seriously wonder about their ethics. Some do have you do the home sleep study which is now accepted by most insurance companies.

For a discussion about oral appliances, read this. Oral appliances work very effectively for many sleep apnea patients. If you are interested, use the following link to find a qualified dentist, or try this link.

You will need to investigate oral appliances and talk to a qualified dentist as I have no experience other than having communicated with the dentist about two hours distant from me. She is very experienced and it was her advertising on the radio station I listen to, that woke me up to know that there were dental appliances for treatment of sleep apnea.

Oral appliances and oral appliance therapy is helpful for those that snore and have mild obstructive sleep apnea and do not respond to behavioral modifications such as weight loss or sleep-position changes. It is helpful for those with moderate to severe OSA who can not or will not tolerate nasal CPAP and those who are not open to tonsillectomy, adenoidectomy or other medical procedures.

Please research carefully any medical procedure as often they can make the condition worse and not solve the problem.

Currently there are about 70 different oral appliances available. They are classified into two main categories of oral appliances. The first is tongue retraining appliances and works by holding the tongue in a forward position by means of a suction bulb. This prevents the tongue from relaxing or collapsing during sleep and obstruction the airway in the throat.

The second category is the mandibular retraining appliances which reposition and maintain the lower jaw in a protruded position during sleep. This also opens the airway by indirectly pulling the tongue forward and stimulating activity of the muscles in the tongue and making it more rigid. It aids by holding the lower jaw and other mouth parts in a stable position to prevent the mouth from opening.

Dentists with training in oral appliance therapy and sleep medicine are familiar with the various designs of appliances. They can determine which oral appliance is best suited for your needs and will work with and consult your doctor as part of a medical team in your diagnosis, treatment and continued care.

The initial evaluation can several weeks or months to determine the most effective oral appliance, the fitting, adaptation of the appliance and function of the appliance. Continued care will include short and long-term follow-up to assess the effectiveness of the treatment, the condition of your appliance, how you are adapting to the appliance, and check the comfort of the appliance.

Oral appliance are generally comfortable and easy to use. Many find that in a couple of weeks they have become accustom to using it. Oral appliances are small and easy to carry when traveling.

Please check out these sites:  Site 1, Site 2, and Site 3.

There will be more blogs about sleep apnea.

Natural treatments for diabetes. (Not a cure) Part 4

Because of some of the problems and people that won't read labels or follow their doctors directions, I feel that the following is in order for all natural remedies.

The following information is for your reading and is not a cure. I am not endorsing any of these herbs, supplements, or natural remedies.

This is important!!! WARNING If you are taking supplements or anything that is not prescribed by the doctor, please make sure that the doctor is informed. Some of the supplements when taken with oral medications and/or insulin can cause hypoglycemia or have toxic results, even cause death.

This is important enough to tell you to maintain a Supplement Diary of every herb, vitamin, and supplement you are taking and give a copy to your doctor. I am aware that many people do not feel this is important, but the consequences for persons with diabetes can have severe medical implications.

This discussion is about natural treatments known as Naturopathy. This is a system of healing (not curing) in which diseases are assisted by natural remedies. I am not sure I agree with their reasoning, but I do find it interesting. I find their claims not backed by science, however, while they do claim a multitude of healing, some may have short-term benefits and very little is likely to cause serious harm, except make your wallet lighter.

Then they start to make some sense when they say that the various type of natural methods – normally the natural method aims at educating people about adopting the type of lifestyle which promotes good health.

First is treatment based on nutrition and diet in which the dietitian decides a menu for healthy diet for diabetic patients. You may read about this here.

The next discussion is about hydrotherapy. This I can understand and agree that there can be some very real benefits for type 2 diabetes. Just the relaxation can reduce stress since it is done in hot tubs of various sizes and shapes.

Then they cover detoxification. Short periods of fasting, controlled diets, and supplements to help the body rid itself of toxic substances. This is then followed by methods to control and reduce stress.

The next item of natural treatment takes some gumption. I am not sure that I can handle mud therapy. Read about it yourself down the page on the first link above.

Massage is something that I have had done to me by my wife, and it is very relaxing, reducing stress and relaxing muscles. Here there may be some short-term benefits when the person giving the massage can do the many types of massage. The deeper manual techniques can really assist in helping the body relax.

Herbal medicines has been around for years and have some minor benefits. I also have my doubts about chromotherapy. I know people believe in color therapy and the use of certain colors for enticing people to eat and for other functions, but I still have my doubts.

There are many other web sites selling home remedies which doubtfully will not do anything other than make your wallet lighter or drain your bank account.

While some of the home concoctions do contain some of the herbs and spices in the first two blogs (Part 1 & 2), they are not FDA approved and manufactured in often less than ideal or sanitary conditions and with little or no quality control.

There are many more articles, blogs, and snake oil advertisements, but these are basically repeats of the information I have given you. Most do not warn of the side effects or medication conflicts that can occur. Most do not encourage or even advise you to talk to your doctor before taking. Those I would advise strongly against using.

This will be the final in this series for now. Part 4 of 4.

Natural treatments for diabetes. (Not a cure) Part 3

Because of some of the problems and people that won't read labels or follow their doctors directions, I feel that the following is in order for all natural remedies.

The following information is for your reading and is not a cure. I am not endorsing any of these herbs, supplements, or natural remedies.

This is important!!! WARNING If you are taking supplements or anything that is not prescribed by the doctor, please make sure that the doctor is informed. Some of the supplements when taken with oral medications and/or insulin can cause hypoglycemia or have toxic results, even cause death.

This is important enough to tell you to maintain a Supplement Diary of every herb, vitamin, and supplement you are taking and give a copy to your doctor. I am aware that many people do not feel this is important, but the consequences for persons with diabetes can have severe medical implications.

Having a healthy diet and lifestyle, emphasis on exercise, are the most important factors in preventing or managing Type 2 Diabetes. There are a number of herbs, vitamins and minerals that have been shown to give some help to people with diabetes. Here are a few more herbs and plants that may have some benefits.

Prickly pear cactus:
When you look at a cactus plant it’s difficult to imagine that the plant can have any benefits, especially after a few of the spines have pierced your hand! However, some scientists have discovered that blood sugar levels can be decreased by 17% or higher in people with type 2 diabetes when the cactus pad is eaten on a regular basis. The fruit also has similar blood sugar lowering properties.  Check the benefits under the "Uses" tab.

Turmeric:
Turmeric is a yellow herb that is often found in Indian and Indonesian dishes. There is some scientific research that suggests that using this herb may aid in reduction of inflammation which leads to obesity and diabetes. There is also some suggestions that it may aid in blocking some carbohydrates from being totally digested and entering the blood stream.

Milk thistle:
Many people are familiar with milk thistle and use it to help cleanse their liver of toxins that have been accumulated especially fatty liver disease. Fatty liver disease affects over 50% of people with diabetes. Milk thistle may also aid in decreasing blood sugar levels, cholesterol, HbA1c, and triglycerides. Read this by David Mendosa.

Holy Basil, also called Hot Basil:
An extract of Holy Basil may decrease fasting blood sugar levels up to 17.6%. Holy Basil may also help decrease you blood sugar level if you eat too much food at a meal. The relevant studies are small in size; however, some success was achieved.

Psyllium:
Are you familiar with the over-the-counter product called Metamucil? It’s used to help keep you regular. This product basically contains psyllium, a plant that is high in fiber, and some additives and preservatives.

Psyllium is similar to other fibers that reduce serum glucose levels and insulin levels. The extra benefits of psyllium include lowered total cholesterol levels and lowered LDL cholesterol levels. There is little evidence that diabetes is greatly helped.

Other berries:
Many people are climbing on the nutritional bandwagon when it comes to berries. They consume acai berries, strawberries, blueberries, blackberries, raspberries, hawthorne berries and exotic berries. The berries are often prepared in fruit drinks that tend to be pricey. These berries have high nutritional value and are loaded with antioxidants.

If you’re interested in these herbs for lowering blood sugar, please investigate their dosages, contraindications, and length of time the herbs can be used safely. I would recommend reading much of the information listed in the post mentioned about Milk Thistle above by David Mendosa and this post on blueberries.

Part 3 of 4