December 30, 2011
The myth about weight gain on insulin happens to be fact, although in reality it is muddied up by people. For people with type 2 diabetes, taking insulin can cause weight gain. There are several reasons for this. The one factor that comes to the front is people use insulin as the medication of last resort. Normally this is fought until there is no longer any choice, insulin cannot be postponed as blood glucose levels are out of control and oral medications cannot keep blood glucose levels down.
Because insulin is often the medication of last resort, two factors can cause weight gain. The first is inactivity or sedentary lifestyle. This may be caused by diabetic neuropathy, which makes it difficult to walk more than short distances. The second is people do not reduce the intake of carbohydrates when going on insulin.
Why is the second necessary? Because insulin is necessary, when first started, insulin makes management of blood glucose levels easier. Instead of losing some of your carbohydrates in your urine when your blood glucose exceeded your urinary limits, these carbohydrates are now put to work or stored as fat. This new efficiency in blood glucose management generally causes initial weight gain.
This is the main reason that people starting on insulin should consider reducing the total carbohydrate intake for a period of time while your body adjusts to the efficiency. However, if you are a person that is able to exercise on a regular basis and you do this, your carbohydrate intake may not be reduced greatly and may be resumed shortly after starting insulin.
Weight gain is always a possibility for some body types and people must learn to manage their carbohydrate intake to avoid weight gain. The article did say that you should limit your insulin dosage, which is only possible, if you reduce your intake of carbohydrates. I will also reemphasize their statement of using exercise to aid in insulin use to burn calories and help keep insulin use low. This will aid in preventing weight gain.
In conclusion, I will state that insulin should not be considered by people with type 2 diabetes as the medication of last resort. Learn about it before the need arises and before you have the neuropathy, which can make exercise more difficult. One tip you should also consider is possibly using Byetta, which will assist you in reducing your carbohydrate intake, and help you keep extra weight off and to assist you in losing some of the extra weight you have accumulated over the years. Talk to your doctor, as this needs to be understood before using it. Consider getting an appointment with an endocrinologist for using insulin to aid you in your management of type 2 diabetes.
December 29, 2011
It appears that even with the evidence staring them in the face (from their own wheat bellies) registered dietitians are not willing to eliminate wheat from their diet recommendations. This article in WebMD clearly shows the conflict they are having with wheat. They know that it is the cause of weight gain, but do not want to give up the calories and fiber that wheat supplies. Sorry people, you cannot have it both ways.
I doubt the author of the WebMd article has read “Wheat Belly” by William Davis, MD, but she should. Then she could be more confident in her knowledge of how wheat does affect us and the reason we need to avoid bread at all costs, and not just the highly refined wheat products she identifies. Healthy whole grains are not that different from refined wheat products, just a little more fiber in the whole grains, but no other health benefits. Both types of bread can be fortified.
Those of us with type 2 diabetes are aware of the effects of the carbohydrates in wheat so when authors change to calories to emphasize the value of wheat in a low calorie diet, we know that they do not have our health as one of their interests. They are still promoting wheat even though their own research verifies that it is part of the weight problem in so many people.
Then they try to side step the issue and put the blame on highly processed wheat, meaning white bread, crackers, pretzels, and other highly refined grains that have come to symbolize the struggle with weight control. Then they return to whole wheat as the high-fiber super food.
How diabetes ended up in the discussion seems so that they could again blame highly refined wheat as the culprit and claim that whole wheat is a help. They say that whole wheat is complex carbohydrates that take longer to digest and will not cause blood glucose spikes. Then the claim is made that whole wheat has more vitamins, minerals, and fiber. What is not said is that most wheat products are fortified whether they are highly refined or whole wheat. The other fallacy of the argument is that the vitamins and minerals in whole wheat can be had in other foods.
The only reasonable discussion is on celiac disease. There is not much they can do to promote whole wheat. There is a section on limiting bread, but even then, they say if you are eating bread, make it whole-grain bread and limit the amount. I recommend that you read the article in WebMD. They are trying to have it both ways and still promote whole-grain wheat bread.
December 28, 2011
Throwing money at a problem does not get improved results. This from a study about how hospitals have invested heavily in new heart attack care programs, yet only see a one (1) percent improvement in access to that care. This seems to be a problem for much of the medical community.
So what is the problem? Apparently, the distance people have to travel before they can receive the needed attention. So of course in areas of heaviest population, people near hospitals have the best opportunity to get the needed care, while in the most rural areas of our country, care is often not available within the time frame required to treat patients before damage is done.
It does not matter that the hospitals have spent large sums of money for heart attack care programs when people are not able to get to the hospitals in time. Once the damage is done, no amount of care will be able to completely reverse the damage. Very few people are going to move closer to a hospital just to be within driving distance for heart attack care.
The study only gave two possibilities for improved care and I have to wonder if this is the only best answer. Yes, I can agree with the proposal as being needed, especially for many areas of the US that need enhanced ambulance services and establishing well-positioned heart care programs in the more rural areas. The key is well-positioned programs. Many rural hospitals are near closing because of financial problems that will reduce the number of places for well-positioned heart care programs.
Where will the funds come from for these programs? This is of course not the position of the study to state. This is a problem that needs addressing in the months and years ahead. This needs to be resolved for more than just heart care, but for several other diseases as well.
This study does highlight one of the problems happening now and needs to be solved.
December 27, 2011
This is one battle where I hope the Sugar Industries win. Yes, as a person with type 2 diabetes, both are not good for us, but what the Corn Refiners Association (CRA) is trying to convince the US Department of Agriculture to allow needs to be stopped.
The CRA wants to change the name from high fructose corn syrup (HFCS) to corn sugar. If I was them, I would like to get rid of a product name that has garnered such a bad image. However, with people being aware of this change, if they are successful the bad image should remain. I know that I will not stop my attitude because of a name change. I do live in a large corn producing state and grew up on a farm, but I do not appreciate what the corn organizations are doing to attempt to cover up a product that is so damaging to the health of our country.
Consumers are doing the right thing by avoiding the product and not purchasing food products containing HFCS. Sugar had the same molecules as HFCS, Sucrose (aka, table sugar) contains one molecule of fructose and one molecule of glucose, which are bound together chemically. HFCS also contains one molecule of each, but they are not bound together chemically.
“Unlike its cousin sucrose, when we ingest fructose, it is directed toward the liver. It does not go through some of the critical intermediary breakdown steps that sucrose does. For years nobody knew what this meant, but eventually cell biologists figured out that fructose was being used in the liver as a building block of triglycerides. Being overwhelmed by an excess of fatty acids, the liver releases them into the bloodstream. Muscles find themselves bombarded by these fats and they develop insulin resistance.”
The above is what the Corn Growers Association and the Corn Refiners Association do not want you to know. "Whether it's corn sugar or cane sugar, your body can't tell the difference. Sugar is sugar," one ad says. Reading the quote from above shows the difference and how dangerous HFCS is to our health. We need to be relentless in our opposition regardless how they try to camouflage it.
I am surprised at a statement by author Andrew Weill when he states that the corn product “is a marker for low quality food and has no place in a healthy diet.” He is correct, but this also is a marketing ploy to confuse consumers as well. Either way, this argument will be aired in court, and hopefully the Corn Refiners Association will not succeed.
For more information read the following from Yahoo News, my previous blogs here and here. Also read thisblogger and the information from the two websites of the Corn Refiners Association here and here. For a very controversial study read this press release here in Medscape. The advertisements big sugar is referring to can be viewed here. And I need to thank Scott Strumello, who alerted me to this on Dec 19.
December 26, 2011
I am not surprised by this press release and I do not think this will help in the US. Insurance companies will not allow this and prevention is not a priority. Doctors here are more interested in treating patients than using the adage of “an ounce of prevention is worth a pound of cure.” No the doctors will wait until the patient is ill before offering any form of help. It is going to take intervention to force doctors to do any prevention activity in the USA. It will also take legislation to force the medical insurance companies to reimburse for prevention care.
This is starting in Medicare, but not enough emphasis has been placed on this to make it generate any cost savings in the short- or long- term. And when you wait until people reach the age of 65, most of the damage has been done to the health of an individual. A small prevention program will not succeed in generating cost savings that will amount to real savings in medical care.
The study was done in the United Kingdom at the University of London. The study indicates that there are dozens of different techniques for predicting who may develop diabetes, but next to none are currently being used. Sounds like the study could have been done in the US as well.
“The researchers say that if these tools were used by GPs and members of the public, many cases of diabetes could be prevented.”
“The team led by Dr Douglas Noble reviewed 145 different 'risk scores' for type 2 diabetes. While none were 100 per cent accurate, many gave a reasonable prediction of whether someone will develop diabetes over the next decade.”
“Research suggests that up to half of all cases of diabetes can be prevented by lifestyle measures, such as diet and exercise, or medication.”
“The team led by Dr Douglas Noble reviewed 145 different 'risk scores' for type 2 diabetes. While none were 100 per cent accurate, many gave a reasonable prediction of whether someone will develop diabetes over the next decade.”
“Research suggests that up to half of all cases of diabetes can be prevented by lifestyle measures, such as diet and exercise, or medication.”
One note to the study gives the following tool for use in assessing your risk score in greater than 20 percent. If you use this tool and your risk score is greater than 20 percent, do see your doctor and have the doctor do the tests for diabetes.
December 23, 2011
This blog (link is now broken) from Diabetes Health really hit home for me. It reminded me of my blog of December 6 and a blog last July (link now broken) by Ronnie Gregory. Why do people insist on keeping their diabetes a secret? One question has been answered, but most of us were aware of the answer because we always have the “diabetes police” on patrol at every gathering.
And yes, we get tired of their snide remarks about how we could have prevented diabetes. I admit I was surprised when one of those that has been on my diabetes police list was looking very carefully at the food on the serving table this last weekend. I asked her why she was not selecting many items and why she had passed on the deserts. Normally she would have selected two or three pieces of different deserts.
She did not answer, but her husband did. He stated that she now has type 2 diabetes! If looks could kill, he was due for some talking to as soon as she could get him alone. I kept my peace, although I would have liked to dish out some of what she was always handing me.
I purposely selected the same table to sit with her and her husband. She wanted to move to another table, but her husband said she should stay seated and maybe take some of the medicine she was due. I admit I wanted to, but I just asked her why she wanted to keep her diabetes secret. Silence. I asked what she had learned since her diagnosis. Again, silence.
At that point, I know there were two others from our type 2 group that had joined us at the table, so I asked everyone to introduce themselves and then I started talking about diabetes. Of course, I knew the others and we started a lively discussion about diabetes and what medications we were taking. I knew all of us were on insulin, so it did not take long for her to ask if we were near the end of life.
At that point the one woman from our group that does not always get together with us was just sitting down at the next table answered, “No Sweetie, we just want better management of our diabetes.” Then another of our group asked her where she had read this? The woman answered that was what she had heard. Almost in unison the rest of said, “It’s a myth”.
From that point on, she started asking questions. We interrupted just long enough to move the two tables together so we could talk and hear better without being at two separate tables. It was not long before our former “Diabetes police person” was crying. She asked why we were being so kind when she had always rubbed it in our faces. One of the group answered very well for all of us by saying that was not the way we were and we were taking this opportunity to help her when she needed it. I then added, “That she could keep her secrecy from others, but in the presence of other people with diabetes, she should learn to talk about it and get her questions answered.
We did answer most of her questions that evening and learned that she was having troubles with her blood glucose readings being too high and that the metformin did not seem to be working. She was on only 1000 MG total of twice a day of 500 Mg, and had been on it for only three weeks. We found out that she had not seen a dietitian or been counseled about counting carbohydrates or when to test. She was not a person that was overweight and really was having a difficult time accepting the diagnosis. We also suggested that she talk to her doctor about increasing the metformin.
We talked about anger, denial, and accepting the diagnosis. We warned her about depression and to recognize some of the symptoms. We talked about doctors, and getting familiar with the provisions of her medical insurance. She had a policy like two of the group and we covered some of the things she would be able to receive coverage for at no cost other than co-pay. Then we talked to the husband about his duties and what he should and should not do to assist her. That was a very interesting discussion and he was surprised at the things he learned. We did thank him for speaking up when he should have kept his peace, and his wife thanked us again for not rubbing her face in it.
She did get a few email addresses and phone numbers plus a few web sites she should read. We spent some more time discussing diabetes myths. Several times, we had to reassure her that what she had heard was incorrect and that the facts would prove otherwise. We all said that for a while we would guard her secret, but that eventually she should let others know and become an advocate for diabetes education. The woman from our group said she could talk to her anytime, and she would direct questions to the rest of us that had the information if she did not.
We concluded our discussion by saying that she should explore her options and increase her exercise. If they could afford it to get a prescription for more test strips from the doctor even if it meant paying for the prescription. Her husband said they could afford the extra strips and asked how long she should do the extra testing. We said that would depend on her and getting an appointment with a dietitian knowledgeable about diabetes. We told her that once she learned to count carbs and used the testing to learn how the different foods affect her blood glucose levels, then she could possibly reduce her testing to what insurance covered. We said she should not rule out insulin, but to learn about it before needing to use it. She ended the discussion by stating that after the talk with us that she felt like denial was behind her, and that she needed more discussion and learning. We all promised to help where we could.
I think we made another person a member of our group. Take time to read this blog about not keeping diabetes a secret (repeat of first link). It covers other reasons for getting rid of secrecy.
December 22, 2011
There are always more tests if you have diabetes. One test that you will receive or should be given every time you visit the doctor is the blood pressure (BP) test. This non-laboratory test is an indicator of your heart activity, health, and potential artery problems.
Blood pressure (also termed hypertension) is measured as systolic (upper) and diastolic (lower) pressures. BP numbers are usually written as 120/80 mmHg (120 systolic over 80 diastolic millimeters of mercury). Systolic means the pressure when the heart beats while pumping blood and diastolic means the pressure when the heart is a rest between heartbeats.
Categories for Blood Pressure Levels in Adults (measured in millimeters of mercury, or mmHg)
Less than 120
High blood pressure
160 or higher
100 or higher
The ranges in the table apply to most adults (aged 18 and older) who do not have short-term serious illnesses.
High blood pressure, is a persistent elevation in blood pressure that taxes the heart and can, over time, cause damage to organs such as the kidneys, brain, eyes, and heart. BP is the amount of force blood exerts on the walls of the arteries and veins. BP depends on the force and rate of the contraction of the heart as it pumps oxygenated blood from the left ventricle (compartment) of the heart into the arteries and the resistance to that flow. The amount of resistance depends on the elasticity and diameter of the blood vessels and how much blood is flowing through them.
Blood pressure is dynamic; it rises and falls depending on a person’s level of activity, time of day, and physical and emotional stresses. In healthy people, it is largely controlled by the autonomic nervous system but is also regulated by hormones, including:
- Angiotensin II — produced by the kidneys, it causes increased resistance in blood vessels.
- Aldosterone — produced by the adrenal glands in response to angiotensin II, it affects the amount of sodium, potassium, and fluids excreted by the kidneys.
- Catecholamines — such as epinephrine, also called adrenaline, produced by the adrenal glands in response to stress and increases heart rate and resistance in blood vessels.
When one or more of the regulating factors is not able to respond appropriately to the demands of the body, then the pressure of the blood may become persistently increased.
With diabetes you should schedule yourself or an annual eye exam. Retinopathy is what the eye doctor should be monitoring. Normally your doctor will advise you to have this done. The purpose is to establish a baseline early to help determine if retinopathy is happening or progressing. Retinopathy is caused by the rupture of small blood vessels in the eye and over time causes dimming of sight and eventually blindness. This is a major reason for managing diabetes and maintaining excellent blood glucose levels. BP levels can also have an effect.
Another exam that needs to happen is a hearing test. This will also develop a baseline for future tests to determine if there is hearing loss happening. Small blood vessels in your inner ear can be damaged by high blood glucose levels and over time will rupture and cause hearing loss. It is important to maintain excellent blood glucose levels and BP readings.
Many people and even doctors forget about establishing a baseline for the thyroid gland by giving a TSH test. People with all types of diabetes may develop thyroid problems. The test is also known as Thyrotropin with the formal name of Thyroid-simulating Hormone. Related tests include T4, T3, Thyroid Panel, Thyroid Antibodies. The reason to have the test is to screen for and help diagnose thyroid disorders - to monitor treatment of hypothyroidism and hyperthyroidism. This test may be given anytime you have blood drawn and some medications can affect the results so it is important that you tell your doctor about all medications and supplements you are taking. For more information see this web site.
A person may develop hyperthyroidism when TSH levels are increased. Symptoms include rapid heart rate, weight loss, nervousness, hand tremors, irritated eyes and difficulty sleeping. If TSH levels decrease, hypothyroidism may develop. Symptoms include weight gain, dry skin, constipation, cold intolerance, and fatigue. Thyroid diseases may alter thyroid hormone levels regardless of the amount of TSH present in the blood.
If you are taking metformin, know that the B12 test is important because metformin does deplete the level of vitamin B12. If you obtain a lot of B12 from the food you are eating, B12 supplements may not be necessary. All persons that have been on metformin for any length of time should ask for the B12 test. Generally once a year is sufficient unless there are problems and then it may be done more often by your doctor.
A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. This test is becoming more important in the analysis of heart disease in everyone, but since people with diabetes are even more at risk for heart disease, this could be especially important for people with diabetes. Persons with diabetes are twice as likely to develop heart and vascular disease. About 60 percent of diabetes patients are likely to die from a vascular event. Read this article about CAC.
One last item is to obtain copies of all tests to allow you to track the results. You may see something that your doctor misses and by charting the results, this will give you a good insight into your own health and show favorable and unfavorable trends.
Part 4 of 4. This concludes the lists of tests for people with diabetes discussion. There are always others tests for other conditions.
December 21, 2011
The discussion of this blog will be about tests doctors should use to track your diabetes and related possible complications. The first test helps analyze the status of your kidneys, liver, blood proteins, electrolytes, and acid/base balance. This is a Comprehensive Metabolic Panel (CMP) and is typically a group of 14 specific tests that have been approved, named, and assigned a CPT code (a Current Procedural Terminology number) as a panel by Medicare. Read about the different tests here.
The CMP includes these tests: glucose and calcium; albumin and total protein (proteins); electrolytes – sodium, potassium, CO2 (carbon dioxide, bicarbonate), and chloride; liver tests - ALP (alkaline phosphatase), ALT (alanine amino transferase, also called SGPT), AST (aspartate amino transferase, also called SGOT), and Bilirubin; kidney tests - BUN (blood urea nitrogen) and creatinine.
Next is the Basic Metabolic Panel (BMP), a group of 8 specific tests that have been approved, named, and assigned a CPT code. Many doctors use this test instead of the CMP. Read about the different tests here and compare to the CMP. Both tests are done from a blood draw. Neither the BMP or CMP are diagnostic in nature, but can help the doctor decide if more specific tests need to be completed for diagnosis of a problem.
The BMP includes these tests: glucose and calcium; electrolytes – sodium, potassium, CO2 (carbon dioxide, bicarbonate), and chloride; kidney tests - BUN (blood urea nitrogen) and creatinine.
More of us are probably familiar with the cholesterol tests (lipid panel). This is a group of tests that should be performed on a quarterly basis, but may not be if you have had no problems in the past. This is a very important groups of tests and give the doctor good information about cardiovascular health. The lipid profile is a group of tests done to determine the risk of coronary heart disease and are good indicators if someone is likely to have a heart attack or stroke caused by blockage of blood vessels or atherosclerois (hardening of the arteries. Read about the different tests that make up the lipid panel here.
The lipid profile normally includes - total cholesterol, high-density lipoprotein cholesterol (HDL-C) — often called good cholesterol, low-density lipoprotein cholesterol (LDL-C) —often called bad cholesterol, and triglycerides. An extended profile may also include very low-density lipoprotein cholesterol (VLDL-C) and non-HDL-C. Some labs also include ratios in the test results.
The last test in this group is the microalbumin test for kidney damage. This test is preferred annually if you have diabetes or hypertension and is extremely important for those not managing their diabetes or hypertension. For those with higher A1c's that are not managing their diabetes, the tests may be done more frequently. It screens for metabolic and kidney disorders plus urinary tract infections.
You will be asked to collect either a random sample of urine while you are at the doctor's office or laboratory, a timed urine sample (such as 4 hours or overnight), or you may be requested to collect a complete 24-hour urine sample. Your doctor or the laboratory will give you a container and instructions for properly collecting a timed or 24-hour urine sample.
The National Kidney Foundation recommends that everyone with diabetes between 12 and 70 years of age have a urine test for microalbuminuria at least once a year. According to the American Diabetes Association, everyone with type 1 diabetes should be tested annually, starting 5 years after onset, and all those with type 2 diabetes should start at the time of diagnosis.
If microalbuminuria is detected, it should be confirmed by retesting and, if positive on 2 of 3 determinations over a 3-6 month period, it is considered to be present and appropriate treatment should be given. Patients with hypertension may be tested at regular intervals, with the frequency determined by their doctor.
Part 3 of 4
December 20, 2011
Back in August 2010, I wrote about five or six important lab tests for people with type 2 diabetes. I need to update this and add more tests and be a little more detailed than I was then. It is not my intention to discuss the tests for gestational diabetes, but a few are common across all diabetes types. The discussion for this blog is about monitoring diabetes, by your doctor and by you.
Once you are diagnosed with diabetes, the glucose (or blood glucose) test will become very important to you. This test has other names starting with fasting blood glucose (FBG), or fasting plasma glucose (FPG). This is done either in a lab or in the doctor's office lab. Normal fasting is required of a minimum of 8 to up to12 hours. This is done by drawing blood from you and gives two results. The first is the fasting plasma glucose reading and the second is the A1c results. Normally other tests are done at the same time, but this discussion is on glucose. An A1c test can be accomplished without fasting and is often done this way.
These tests can be performed at various intervals depending on the patient and the doctor. If the doctor is overworked and the patient is active in his/her care, some doctors only see a patient once a year. Others see their patients twice a year, but most doctors still try to see their patients with diabetes four times per year.
The blood glucose (or glucose) test will become one of your daily tests. This is not the same as the blood glucose test taken in the doctor’s office or lab. This requires a blood glucose meter and test strips and is done several times per day depending on the type of diabetes you are diagnosed with and the limits of test strips mandated by your medical insurance or Medicare. This will also depend on whether you are on oral medications, insulin, or a combination of the two.
If you can afford to purchase test strips on your own over and above what your insurance or Medicare covers, please consider doing this. If extra test strips are over your budget, pick times for study like your fasting after arising in the morning. Know what you wish to attain and look to this test for guidance. Then pick another time during the day, which will assist you in maintaining your goals. Then after a period of time switch your testing times and use them for about a month. Be prepared to return to the original testing times if the secondary times are well managed.
One of the reasons for encouraging people to purchase extra test strips over what insurance reimburses is to test what different foods do to your blood glucose levels. This requires you to test after every meal at approximately 1 to 2 hours. This will tell you if you need to reduce the portion or eliminate the food from the menu. Because everyone's body chemistry is different, it is important to become you own chemistry experiment and learn by testing how the different foods affect you.
Until you learn to count carbohydrates from a dietitian or certified diabetes educator or another professional, the testing will only give you general ideas. Get a referral by your doctor and lacking that, call your insurance company and ask them for permission or a list of registered dietitians knowledgeable in diabetes.
Yes, we can say to eliminate certain foods and often encourage people to do so because of our own history and the history of others with type 2. However, everyone being different, it is still best to test for yourself. It is almost like a symmetrical bell curve with carbohydrates. Some people can only tolerate a small number of carbohydrates and people at the other end of the curve can tolerate more than the average person. The American Diabetes Association treats everyone the same in the number of carbohydrates they can consume. This is far from the truth and is a reason for testing more shortly after diagnosis. Once you have found your level of carbohydrates, then reduce testing to what insurance or Medicare will reimburse.
I would also suggest that more testing be done again when foods are changed or blood glucose levels from your tests show an increasing trend. Maybe you can reduce the number of carbohydrates consumed without increasing testing, but for those of us that are very conscious of blood glucose levels, we like to be sure. Read my blog here for testing.
What we are looking for is trends and hopefully the levels are steady and not increasing. When blood glucose levels are trending upward, this will most likely be reflected in your next A1c test and you should be ready to discuss this with your doctor. Most endocrinologists will want to take readings from your own meter and see what readings you are getting. Not all doctors want or can deal with this information so always be prepared.
Several bloggers have also discussed this topic and I offer their discussions for your reading as they can possibly shed a different perspective on this subject of testing that will make more sense to you. Tom Ross has two blogs that may assist you in knowing how to test if on a limited supply of test strips. The first is here and the second with additional thoughts is here.
Joslin Diabetes Center has a blog here and Alan Shanley has a blog here about the importance of testing. Alan's second blog is here. The blogs by Tom and Alan are important as they also have type 2 and presently Tom is managing his with diet and exercise.
Part 2 of 4.
December 19, 2011
Diagnosis of diabetes for type 2 is often a sticky topic in the last few years. This is very true for all types of diabetes. Too often physicians make assumptions that are not correct. They look at a person, the age, and often do one of the required tests. Often they are correct, but what a disappointment for those that are incorrectly diagnosed. Even the American Diabetes Association makes mistakes and this one could be very large.
There are tests for screening, tests for diagnosis, tests for monitoring, tests to evaluate glucose levels, and tests for the complications of diabetes. Read this blog as well by Joslin Diabetes Center about tests for diagnosis.
The tests for screening and/or to diagnose pre-diabetes and diabetes can be used as part of a regular physical, when a patient has symptoms suggesting diabetes, when a patient has a condition that is associated with diabetes, and when a patient presents to the emergency room with an acute condition.
Screening tests generally include:
- Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast. Also fasting plasma glucose (FPG).
- A1c (also called hemoglobin A1c or glycohemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended more recently as another test to screen for diabetes.
- Sometimes a random blood glucose level is used for screening when a fasting test is not possible, such as when a person is seriously ill.
- Sometimes random urine samples are tested for glucose, protein, and ketones during a physical. If glucose and/or protein or ketones are present on the indicator strip dipped in the urine sample, the person has a problem that needs to be addressed. This is a screening tool, but it is not sensitive enough for diagnosis or monitoring.
If you trust the American Diabetes Association (ADA), they promote first the A1c test, then the FPG and finally the oral glucose tolerance test. You must use care with all tests and know the limitations of each.
- The FBG requires an 8-hour fast.
- The OGTT requires that the person have a fasting glucose test, followed by the person drinking a standard amount of glucose solution to "challenge" their system, followed by another glucose test 2 hours later.
- With the A1c, people do not have to fast for 8 hours or endure multiple blood samples being taken over several hours, but the test is not recommended for everyone. It should not be used for diabetes diagnosis in people who have had recent severe bleeding or blood transfusions, those with chronic kidney or liver disease, and people with blood disorders such as iron-deficiency anemia, vitamin B12 anemia, and hemoglobin variants. In addition, only A1c tests that have been referenced to an accepted laboratory method (standardized) should be used for diagnostic or screening purposes. Currently, point-of-care tests, such as those that may be used at a doctor’s office or a patient’s bedside, are too variable for use in diagnosis but can be used to monitor treatment (lifestyle and drug therapies). Also, the A1c is of questionable value in diagnosis of young people (read this).
If the initial result from one of the above tests is abnormal, the test should be repeated on another day to confirm a diagnosis of diabetes. Once the diagnosis had been made then it may be wise to have the diabetes autoantibodies test, which should help distinguish between type 1 and type 2 diabetes if the diagnosis is unclear. The presence of one or more of these antibodies indicates type 1 diabetes.
Now for pre-diabetes and diabetes, the guidelines are as follows: The A1c test can be used to either monitor diabetes treatment in a person that has diabetes or to screen for and diagnose diabetes and prediabetes. An A1c of less than 5.7% is not diabetes, an A1c of 5.7% to 6.4% says prediabetes, and an A1c of greater than 6.4% is diabetes.
Some doctors use the fasting plasma glucose (FPG) test and the A1c to make a diagnosis. The FPG reading of less than 100 mg/dl (5.6 mmol/L) means no diabetes, a FPG reading of 100 to 125 mg/dl (5.6 to 6.9 mmol/L) is prediabetes, and a FPG reading greater than 125 mg/dl (6.9 mmol/L) is diabetes.
Others also add the oral glucose tolerance test (OGTT). This requires the person to drink a 75-gram glucose drink. At the two-hour mark a blood sample is drawn. If the results are less than 140 mg/dl (7.8 mmol/L) then you do not have diabetes or prediabetes. If the results are from 140 to 200 mg/dl (7.8 to 11.1 mmol/L) it is considered prediabetes. If the results are over 200 mg/dl (11.1 mmol/L) then the diagnosis is diabetes.
Part 1 of 4
December 17, 2011
December 16, 2011
On July 15, 2011, I wrote a blog about the FDA asking for help in nanomedicine. Now we are seeing the first research making an appearance in the area of eyesight. What an appropriate arena for this to happen.
“Hitching a ride into the retina on nanoparticles called dendrimers offers a new way to treat age-related macular degeneration and retinitis pigmentosa. A study by investigators at Mayo Clinic, Wayne State University and Johns Hopkins Medicine shows that steroids attached to the dendrimers target the damage-causing cells associated with neuroinflammation, leaving the rest of the eye unaffected and preserving vision.”
Macular degeneration is the primary cause of vision loss in older Americans. According the National Institutes of Health this affects more than 7 million people. Retinitis pigmentosa results from many genetic conditions and affects about 1 in 4,000 Americans. There is presently no cure for these diseases and an effective treatment could offer hope to millions of patients around the world.
This research has been done in the rat model, but at least proved that it is possible. Expect to see clinical trials in the future and hopefully I will be able to blog about the results when it happens. Read the press release here.
December 15, 2011
This type of article can really ignite the imagination. Microneedle is not a term that I had heard before, to say nothing about the applications for this. It was with keen interest that I skimmed the article looking for key points. There were many points where I was nodding my head and saying to myself, what next?
“Researchers from North Carolina State University, Sandia National Laboratories, and the University of California, San Diego have developed new technology that uses microneedles to allow doctors to detect real-time chemical changes in the body -- and to continuously do so for an extended period of time.”
Without reading farther, this should have gotten your interest whether you have knowledge of this or just enjoy reading. How far from becoming a reality in daily treatments is unknown, but just the thought of the potential for microneedles gives me hope for the future and what it could mean for our children.
Initial applications may be limited and acceptance may be slow, but for scientific application and research, the benefits may be beyond our imagination at present. “"We've loaded the hollow channels within microneedles with electrochemical sensors that can be used to detect specific molecules or pH levels," says Dr. Roger Narayan, co-author of a paper describing the research, and a professor in the joint biomedical engineering department of NC State's College of Engineering and the University of North Carolina at Chapel Hill.”
“Existing technology relies on taking samples and testing them, whereas this approach allows continuous monitoring, Narayan explains.”For example, it could monitor glucose levels in a diabetic patient," Narayan says. Microneedles are very small needles in which at least one dimension -- such as length -- is less than one millimeter.”
I hope this gives you cause to think about this and the fact that there is essentially no pain could even be more exciting as they explore other ways to utilize microneedles.
One of the sensors developed incorporates three types of sensors that can measure pH, glucose, and lactate.
This is another of the topics I will watch very carefully over the coming years. Read the press releasehere.
December 14, 2011
I know that you are seeing this topic more and more often and I think you can stand another dose. If you think you have it tough, guess again! The gentleman that I wrote about in this blog is doing very well and loves to exercise. He has regained almost full use of his left leg over the summer and is looking forward to this December as the doctor is now convinced that the operation on his right leg is worth the effort.
Although he had been told originally that he would be confined to a wheel chair, he has proven those doctors wrong. Granted he is still on crutches and still uses his manual wheel chair, he now has hope for not using or depending on the wheel chair in the future.
This blog is about the exercises that people with different diabetes complications can accomplish and should provide possibilities. The key is talking with your doctor and getting his/her input about what you want to do. The link within this blog (repeated here) to the Joslin blog discusses exercise for those with diabetes complications. The author also repeats advice and has some excellent suggestions.
So rather than remain sedentary, consider exercise. Find what you can do daily, enjoy, and start exercising. Being sedentary will only assist diabetes in its control over you. Moving within your limits can only help and make your management of diabetes easier.
If you have no limitations, then not exercising should not be an option. Always discuss your plan with the doctor and then find something that you can enjoy even if it is only walking. Find a walking partner or if you have children that can keep up with you, get out there!
More on exercise appeared on the Joslin blog September 23, 2011 for those that are able to exercise and have little or no limitations. They have taken information from several recent studies and are emphasizing interval training. This means high intensity activity for a period followed by low intensity activity. It is a good read but mentions nothing about resistance training verse aerobic exercise.
The big reference they gave us is this link to many more discussions on exercise. These tip topics are for both type 1 and type 2. Included are some good do's and don’ts about exercise for people with diabetes.
To assist you with your choice and show that running or intense exercise is not for everyone, read David Mendosa's blog of October 4, 2011. I like his style. Exercise needs to include everyone.
December 13, 2011
Doctors, doctors, what must we do to get you out of politics and back to the practice of medicine. The American Medical Association is pulling out all the stops and concentrating their efforts on maintaining their profit margins. As a result expect to see patients' suffering increase and fewer Medicare patients being seen by doctors. They want you to think otherwise, but profits are profits, and that is what the latest efforts are all about, keeping the profits healthy, not the patients.
The resolution passed by the AMA House of Delegates at their 2011 Interim Meeting says it is for strengthening physician-patient bond, but with this also goes allowing patients to contract privately with physicians and Medicare to pick up the tab. We all know what will be the result. Medicare will refuse to reimburse many of the charges and the patient will be on the hook for the balance of the bill.
No wonder this resolution in one of its “highest priorities.” Profits are protected and Medicare patients will have to foot the bill. This will separate the Medicare protection of over and unneeded charges by doctors and leave the patient paying the differences. If the doctors succeed, they can run up the charges with unneeded tests which the patient will be forced to pay. Many patients may not be the brightest of patients, but this is one ploy that begs for exposure and what the physicians are trying to slide by Congress to “empower that relationship (the patient–doctor relationship) by empowering the patient and his or her self-determination."
This is how the physicians are trying to sugar-coat the bill and keep their profits healthy or increase them at the expense of the patient. We do not need a light shined on this to see the intentions. We can read this even using infrared luminescence.
Read the press release here.
December 12, 2011
With the mounting deficit and calls to curtail government spending, what is in store for Medicare and Medicaid patients? Will we see more healthcare rationing, more hospital supervised euthanasia, or will these patients be left where they are to suffer an undignified death? As a retired person on Medicare, I can believe all of this and more as our government forces euthanasia on the less fortunate.
Inhumane is a word that comes to mind. Just how far will all this be taken remains to be seen; however, I foresee some of our worst nightmares coming true as the medical community lobbies for higher and higher profit margins. I do not like raising these alarms, but as the saying goes, I do not want to be the only one left speaking out when they come for me.
Will the votes of the “baby-boom generation” and earlier generations be nullified by legislators that refuse to listen to their constituents? Judging by what the trend has been for the last few years, this seems likely to happen. Just because our federal legislators are insulated with extremely good medical care, they can look past those that have a need for medical care.
This article in Medscape points out how our medical community thinks. It points out how our physicians are willing to protect their profits. While I can believe a little of their needs, they seem most unwilling to consider any compromise and will stop seeing Medicare patients if congress does not give them what they want. They are laying out their intentions with a boldness unheard of before.
When 82% of the physicians say they will stop seeing new Medicare patients or severely limit access to existing Medicare patients, this cannot be a good thing for the patients.
While the Medscape article says nothing about the stance of hospitals, many of the physicians are employed by hospitals. It seems likely that the hospitals are in this as well
This is a warning to current and future Medicare patients about the future access to medical care – it is not going to be there for us, unless you are independently wealthy enough to pay your way.
December 9, 2011
This is an excellent topic to fit with the last two on supplements and multivitamins. I do not think about it generally because I am aware of the difference between fat and water-soluble nutrients. I do not consciously think about this because of the few supplements I do take, but I do tend to be more careful with fat-soluble because the body does not automatically flush excess out of the body.
The body sometimes does not automatically flush excess water soluble, but in general, it does. Water-soluble excess is generally flushed and not stored by the body. There are exceptions that you need to be aware. Too much vitamin B6 can cause nerve damage. Excess niacin can cause flushing and excess vitamin C may cause kidney stones. A serious problem may be caused by excess folic acid, which may mask vitamin B12 deficiency and is most common in people over the age of 50.
Fat-soluble is dissolved in fat and stored by body tissues for use later. However, fat-soluble is not equal as Vitamin D is a hormone and apparently allows higher tolerances than other fat-soluble vitamins. Vitamin D is one of the more controversial vitamins as many think the Institute of Medicine (IOM) has set the limit too low for the needs of the body. Many are claiming vitamin D has more health benefits than it may have.
Vitamins A, E, and K are also fat-soluble. Because they are stored, over time they can rise to dangerous levels and lead to a condition called hypervitaminosis. This means excess amounts of a vitamin in the body that are unhealthy and can cause health consequences. Excess vitamin A in women can cause birth defects and too much vitamin E may increase the risk of hemorrhaging. Excess vitamin K can reduce the effect of blood thinner medications and prevent normal blood clotting.
Exceeding the recommended daily allowance (RDA) of many nutrients can cause the vitamins to act like drugs and may lead to health problems. Research has shown at what levels nutrients can cause potential problems and these levels do take into account all sources of vitamins and minerals from food, fortified food and supplements.
Fortified foods is a way for people to help fill the nutrient gaps and has resulted in production practices of adding iodine to salt, enriching grains with vitamins B and iron, and milk fortified with vitamins A and D. In combination with whole foods, supplements, and fortified foods is raising concerns from the experts. These concerns are that the supplements may cause the diets of people to exceed the safe upper limits and potentially lead to a toxic buildup of certain nutrients.
Even though the article advises consulting a doctor, I am leery of this because many doctors will advise against supplements without doing any testing to determine if there are deficiencies to be concerned about. Consulting a dietitian is good advice. Even with this, it is still wise to know the upper limit for vitamins and minerals that you are taking, check all labels of your food choices to know which food are enriched with the same nutrients.
Carefully read the article by WebMD and read the previous two blogs on supplements and multivitamins. Here's to your good health!
December 8, 2011
Again, WebMd has an article when needed. The last blog about supplements was inline with this. We do need to be aware of supplements and which ones are age appropriate. It appears that the food industry goes out of their way to prevent balanced nutrition with the highly processed foods we are exposed to in the stores. It should not be that difficult to eliminate the highly processed foods, but occasionally they can be substituted with little nutritional damage, but only occasionally.
If you are using supplements to fill in the nutritional gaps, you may want to consider a multivitamin. We do not always use the best eating plans or have a dietitian or nutritionist available to consult on a regular basis, so depending on the test results from your doctor, you may need a multivitamin to fill in the gaps. If so, which one do you chose when you are looking at the large variety on the shelf? I would encourage you to read the WebMd article as it covers many points.
First, make sure that your daily food intake includes a variety to be complete in nutrients as possible. This may eliminate the need for a multivitamin, but depending on the tests done by your physician, do consider supplements or a once daily multivitamin if necessary. “The 2010 Dietary Guidelines for Americans identified calcium, vitamin D, dietary fiber, and potassium as nutrients of concern for inadequate intake in adults and children. All of these nutrients, except fiber, come packaged in a multivitamin. Fiber can be obtained as a separate supplement, but it's still best to try to get all your fiber from the foods you eat.”
Some pointers to consider while looking over the variety of multivitamins include: reading the label carefully, getting the basic vitamins and minerals, check the percentages of what the multivitamin has listed, look for extras that you may not need or do need, check the formulas for men, women, and age, and do not overdo the multivitamin routine.
Look for the multivitamin that fits your sex, stage in life, and your health conditions. This more than a salesperson's promotion should determine what is appropriate for you. Most multivitamins are sold in capsule form, but they are also available as tablets, powders, chewables, and gummies. Liquids and injectable formulations can be found that can be administered by healthcare providers.
Supplements and multivitamins can lose their potency over time and especially when improperly stored. Also, check expiration dates, store in a cool dry place and avoid hot, humid places like the bathroom. Make sure that the location is secure and out of the reach of children.
It really does not seem to matter when you take the multivitamin, but taking it with food can be an advantage in lessening stomach discomfort. “A measure of safety is to look for the designation "USP" on the label. A multivitamin that meets the requirements of the U.S. Pharmacopoeia (USP) meets the standards and ensures the product is pure and actually contains the listed ingredients.” Always consult your health care provider when taking any supplement or multivitamin to be sure that they will not have conflicts with prescription medications.
December 7, 2011
Are you using supplements for the right reason? Many do not and take a cocktail of supplements based on what the salesperson says. This can lead to over taking many of the supplements and creating a toxic effect when the supplements are not needed. Think about it for a while and decide if you are on this path.
The promises of the salesperson and claims on the packages are not the reason to be taking them. We all know that there may be a temporary energy boost, but this will not last long. The supplements will not help with weight loss, reduce stress, or reduce wrinkles. Yet many people take supplements for these reasons and spend money for pie-in-the-sky reasons.
Experts agree that there is a proper place for vitamin and mineral supplements to fill gaps in our nutrition. They should not be used to take the place of real food because they will not replace other important nutrients we obtain from eating healthy meals. Yet it is common knowledge that may people do this and can create other shortages in their diet that real food can meet the needs for and fulfill.
This blogger has the right attitude about supplements and rightly believes in obtaining supplements in their natural state from food. Supplements cannot replace every nutrient and benefits of whole foods. Supplements are meant to do just that, supplement gaps occurring in your diet. It is best to obtain your nutrients from food first and fill the gaps with supplements. A pill does not contain the phytochemicals and fiber necessary that eating whole foods can supply.
Learn that your doctor does many tests to see which essential nutrients you are not getting in the foods you eat. By obtaining copies of your lab tests and tracking them, you will soon learn which supplements to add to your intake and avoid those that have little to no benefit. We all need to keep the levels of calcium, potassium, magnesium, vitamin D and Vitamin B12 at proper levels and your doctor can help determine these with the proper tests. You may need to have a long conference with your doctor as many do not see the value in any supplements and will tell you not to take them. This is where research on the internet may become necessary for some of them.
“Beyond filling in gaps, other studies have demonstrated that supplemental vitamins and minerals can be advantageous. However, the exact benefits are still unclear as researchers continue to unravel the potential health benefits of vitamins and supplements.”
If your doctor agrees that you need supplements, remember to take them. They can do nothing if left in the bottle. Set up a daily routine for taking them and follow it. Remember too if what the salesperson or the packaging advertising says is something that is too good to be true, it probably is. You should avoid those making unrealistic claims. Expect only what it would do for you if you were eating sufficient quantities in your food, not what people want you to believe to make a sale.
Take time to read the WebMD article carefully as it has some pointers not included above.
December 6, 2011
I could list many people that write about this, but I am interested in why they let teaching moments for diabetes get away from them. This raises many questions and provides very few answers.
Is it the setting, the time, or the place that stops them? Are they people that want to keep their diabetes a secret to be kept in a closet? Are they too embarrassed to speak up? Or, is this an invisible disease that keeps people tongue-tied?
When compared to breast cancer, awareness on a national level is more recognizable and better advertised. People have ribbon stickers on their cars, have larger, more publicized events and in general have come out of the closet in their battle against breast cancer.
What is it going to take to get the diabetes community to come out of the closet? The International Diabetes Federation (IDF) is trying to lead the way in a color and a symbol. But the American Diabetes Association (ADA) is determined not to become part of this effort. They want their own color and their own symbol and seem to downplay the efforts of the IDF.
However, let the IDF have some success and the ADA will find a way to either hog the credit or say they had a large part in it. Sometimes they have a legitimate claim to a little of the credit, but they seem to want to have it all. Not a very professional or humanitarian thing to be doing is the way I view this.
The ADA does little to promote coming out of the closet and using education to promote the prevention of diabetes or giving the support to adult patients with diabetes. The ADA does not promote discussing diabetes to help people understand this chronic disease to the general public. They do not promote many activities for the cure of diabetes. The ADA is basically an association of and for doctors and this they do poorly. Why else would there be so many doctors that will not aggressively work to diagnose diabetes and try to stem the rising epidemic of obesity.
The only claim that the ADA can make is their enforcement of laws on the books protecting children and their rights in the public school system. They do also use the Americans with Disabilities Act laws to protect the rights of people with diabetes. This is their only claim to fame. While medical professionals look to the ADA for guidance in the field of diabetes, the ADA is very much behind the times in its pronouncements and guidance about the types of diabetes and effective ways to treat diabetes. Often this is five to ten years after the medical professionals have made the decision on their own.
There is research available and verifiable, but the ADA keeps looking for more on which to base a directive or issue guidance. This in turn leaves the patient with little to rely on in discussions and trying to make sound decisions for their own health.
Therefore I lay the fault of why patients avoid educating others about diabetes on the steps of the ADA and the medical profession. They wish to be the ones controlling the patients and having patients totally rely on them. The ADA feels that patients are incapable of learning about this chronic disease called diabetes. Before you think I am totally against the ADA (which I am), they are responsible for American Diabetes Month, but do little to promote education within this month.
Now that the American Association of Clinical Endocrinologists (AACE) has a web site of approved and vetted diabetes sites (this is still in the formative stage and more sites need to be added), will the ADA follow and claim credit. I can see the press release about how they have had all the information available on their site. Yes, it may be there, but finding it and having access to it are two different things, both equally difficult and often costly, as they will not offer much freely, but for a fee. The AACE did think to include the ADA on their list of approved and vetted sites.
December 5, 2011
Apparently, with changes in the health care system and the likely decrease in Medicare funding projected for the next year, changes are happening especially in medical offices that now have electronic record systems in place and operating. On Tuesday, I was in the lab for tests and on the wall was a sign asking patients to notify lab personnel of any lab work done in the last 30 days in the hospital and hospital clinics.
I did this and the person headed for the computer and pulled up the lab results and said that makes only the A1c test left. Therefore, that was the only test that needed to be performed before seeing the endocrinologists. Before, this would not have stopped duplicate tests. Times are changing.
A1c was the same as my last visit. This was better than I had expected considering the surgery and my blood glucose results since then. Maybe my extra care in the two preceding months helped. I would like to think so and hopefully it would have been under 6.0 if not for the surgery.
I did comment on this to the endocrinologist and she stated this was a new policy and that yes they were doing this to avoid duplication of tests performed within the last 30 days. I asked how they liked the computer system. It is saving money and making communications between doctors, labs, clinics, and the hospital much easier. They are still keeping the manual records and updating them as fast as possible into the computer.
I am sure what they are all waiting for is the Medicare payments to come faster and the savings to be distributed. I cannot say I blame them with the proposed cuts that may take place unless our Congress gets their act together. Does not seem likely considering the status of affairs. Yet, the Department of Transportation keeps awarding millions almost weekly for this project and that project.
December 3, 2011
This November was a big disappointment for an American Diabetes Awareness Month and World Diabetes Day. Number one, none of the US diabetes groups or organizations seems to want anything to do with the International Diabetes Federations blue circle. This is a disappointment for many in the DOC. This should mean that we will need to lobby the entire year to convert any organization.
Another disappointment for me is the total lack of promoting diabetes month or diabetes day on the HealthCentral website. We were regaled about Alzheimer's National Alzheimer's Awareness Month on the home page and Alzheimer's page. Only one diabetes blogger, Amylia Grace mentioned the diabetes day or month with no mention of anything by Health Central.
The bloggers that decided to write a blog each day, well that was somewhat better, but those that followed other's guidelines for daily topics, it was a little disappointing. There were some excellent blogs and I applaud those that took on the challenge. I like writing, but definitely happy that I choose my own topics and did not write for 30 days on topics of little interest to me.
I had hoped that the American Association of Clinical Endocrinologists would have added to the approved and vetted type 2 diabetes resource sites. Since the original publication on September 27, 2011, nothing has been added to the list of 15 sites.
To pass out grades on the American Diabetes Month would be unfair. Activities are so disjointed and each organization has its own agenda. Forget about finding a common ground for increasing diabetes awareness, everyone wants to think their way is the best. So as a group, nothing of value is generated to aid in the fight against the increasing rate of diabetes diagnosis.
Until the people start demanding action and the medical communities realize that the diabetes pandemic will not go away, little will be accomplished. The divided we fail signs seem to have no meaning to the diabetes community. In addition, since diabetes seems to be such an invisible disease, people in general tend to ignore our cries for help.
I fear that until there is a change in culture, one that can get past the politics, uncaring people within the medical community, and the handouts and influence of the large pharmaceutical companies, there will be little accomplished in the near future. I hope that I can be proven wrong. At present, everyone is so enamored with his or her corner of the world; they seem to accomplish little for the education awareness about diabetes or making a change in the culture of diabetes.
December 2, 2011
I am going to start this topic and maybe others will be able to help me along the way. Yes, how do you educate people with type 2 diabetes that refuse to learn, or for that matter tune you out? I have had minor successes along the way, but few as difficult as one gentleman that just refused to listen or pay attention to anything I said for almost a year. He told me point blank that if he wanted information, he would ask his doctor.
Okay, a small crack in the armor was showing itself. I started asking him questions about what his doctor was telling him. How often does he see the doctor? Answer: once a year. What medications was he taking? No Answer. How old was he? Answer: 73. Did he feel like he was seeing the doctor often enough? Answer: No. How often did he think he should see the doctor? Answer: at least once a quarter. Was he getting his questions answered? Answer: No. How long had he had diabetes? Answer: almost 4 years.
I kept the questions flowing and got very short answers, but I had him talking and thinking and I came back to some of the above questions and got mostly the same answers. I then asked him if he would like some of his questions answered? Surprise, he answered yes. So, I asked what he asked that he never had answered. Again a surprise. He asked what he should be eating with diabetes? Now we were getting somewhere.
I again asked him if he had seen a dietitian on referral from the doctor? Answer: No. Had he ever asked for a referral? Answer: No, and he asked was this possible and would his insurance pay for it. My answer, it should be possible and Medicare does cover it in most cases. Now the tables turned and he was asking the questions. I answered them to the best of my ability and did get a question in. Did he use a computer? He looked at me surprised and said, yes. I asked him if he did any research on the computer? Now I had a questioning look and no for an answer. He stated that all he used it for was emails with his children and grandchildren.
His three children had purchased a computer for him and only showed him to use email. I asked him if he wanted to learn more. He asked, like what? At that point, I asked him if this was something his children wanted him to do. So we went to his home and he sent them an email. The answers back were yes, that is what they had hoped he would do on the computer and find answers he was not getting from his doctor.
Now he was full of questions and wanted answers. So I examined the computer and found out what he had and how much storage he had. Plenty, I could only dream about this for a computer. I asked him if he had finances for a few tools and he answered yes. So we started looking and I found several programs he should be able to use, a virus checker, and several other tools. I explored what he had on the computer for programs and found several programs that he could learn and set them up so he could access them and at least explore and become familiar with them. I downloaded a free program and set that up for him to use. I also showed him several sites and he did bookmark them to go back and look at them and possibly subscribe to their free newsletters.
I knew I had a book for one of the programs, so I offered to lend it to him. He accepted and said it would be a big help. I promised to return and help him on another day. I left him with my email address and telephone number. He is now full of questions and I will admit I am enjoying my time with him and educating him about diabetes, via email, at his home, and on the telephone.
Yes, he is now a willing student, and set to see his doctor quarterly. He has an appointment with a dietitian knowledgeable about diabetes. I know my method worked this time, but I have not been able to get it to work on any other persons. I keep hoping to find a way, but of the several tactics I have tried, none have succeeded. So if anyone has other suggestions, please let me know. One person does not have a computer and as such, I am working on getting him to work with my first friend, but he does not want to do this.
December 1, 2011
On 15 November, I experienced what I consider to be both sides of outpatient care, the good and bad. I was pleasantly surprised to be told when scheduled for my surgery that I must bring my own sleep apnea equipment. In my blogs before this, I had warned people that they may need to get prior approval from the hospital to use their own equipment. At least in my case this is no longer necessary.
I had to think about this for some time, but I think I can answer this now. With the new health care laws and the fact that Medicare is clamping down on expenses, it makes good sense for hospitals to have people bring their own sleep apnea equipment. First, because they are familiar with the equipment and know how to use it, and second, the hospitals can avoid using expensive equipment and maintaining it, having people knowledgeable in setting the equipment requirements for different patients. This means cost savings. It also means cost savings because people generally do better and leave the hospital sooner when they use their own equipment.
This is a positive for the hospital and the patient. Did I need the equipment with me? Turns out, I did not, but this is now a standard for outpatient surgeries to have the equipment present in the event that you are admitted to the hospital or have troubles in the recovery area. A few years ago, this was seldom considered and is good procedure saving the patient problems and requiring someone to make an extra trip to locate and bring the equipment back.
Now the not so positive side. The reception area for the incoming outpatients was almost too friendly, like they were trying to put you at ease so you would forget and not keep your wits about you. Yes, indeed and in the following hours, I could see why. Talk about like being treated like cattle and the impersonal nature in which you were treated. I have been a patient for very few hospital stays or even outpatient surgeries not counting colonoscopies, but this was one experience I do not want to repeat unless there are some changes in the way I am treated as a patient.
From the patient in processing room to the recovery room, I felt like the more they could keep from me, the better off for them. Why? That probably will never be answered. I do know I made some statements that I did not want an intern or new resident doing the procedure. I also asked that the IV not contain any dextrose because I was a diabetic. Can I say with any certainty that these requests were followed? Maybe and definitely no.
The anesthesiologist was around and said he would be the one administering it, but did I see him in the surgery – again no. There were several people in the surgery room, but no one wanted to introduce themselves and explain what they would be doing. I forced the issue, but never was allowed to complete it as they opened the spigot on the IV tube and put me under very quickly. I remember six people in the room and could not identify any of them other than the first person who would only admit that he was a nurse. My doctor was there, but other than this, I felt like I was being ignored.
Then when things went blank, I do not remember anything until I was seeing several nurses around the cart I was on. Next thing I was wheeled into the room where my wife was waiting and a nurse rapidly asking questions and giving me a pain pill and saying I could get dressed. Dismissed and that was it. Sort of had the feeling of being on a belt moving me through the system.
Now comes the part where I became very angry. I was assured that the IV was dextrose free and that I would receive a minimum of two doses. Well from the meter test results after being shuttled out and in the vehicle, my blood glucose reading was over 300 mg/dl. Therefore, from a reading of 106 mg/dl at entry to 309 mg/dl after leaving, I would conclude that one or both IV's had dextrose in them. Not a comforting thought about how they are concerned about patient safety. I would rate them a flunking grade for several reasons.
The previous time I had the surgery, I was introduced to all people in the room and made to feel like they were interested in the outcome that would be best for me. This time was very impersonal and like they were herding cattle through the vaccination chute and could care less about the outcome. True, the first time for this surgery was before diabetes, but even when I have had colonoscopies since diabetes, I still knew who was in the room, their names, and given reassurances. There will be some changes made before I will willingly submit to surgery in the future.
November 30, 2011
This is a topic that more bloggers are writing about, and some are covering it very well. They cover some of the more popular social media sites and give some excellent pointers for people that want to get involved, but are either very timid, or become overwhelmed in their search. Spend some time looking at the different aspects of social media.
This blog says a lot and introduces you to some of the products, blogs, Facebook, Google+, Twitter, forums, and others. This blog covers some of the forums and a few of the social media sites. To include all of the sites would make this a very long blog and could take days to sort out those that still exist from those that have ceased to exist.
I participate in very few sites because of my interests. I would suggest that to start, you read the two blogs already mentioned and use your search engine to search for others. I am on Facebook, but not that active. I am slightly more active on Google+, but that is not saying much. I have a Twitter account and seldom use it. I personally am more comfortable here and enjoy blogging about different topics of which most relate to diabetes. Yes, occasionally I write about other topics, but only because I feel there is a need to bring it to my reader’s attention.
I do participate on one site,MyDiaBlog, which suits me fine. There are others, but I will let you find the one that suits your needs. My one warning is to be very wary of sites that proclaim a cure. These are only interested in separating you from your money and presently there is no cure for diabetes.