Since I was kind to diabetes forums, I just had to meet the bad side. When people with initials behind their name (titles) and others that must not contradict the position of their professional organizations get involved and state the position, they bring many thoughts that are not always the full truth into the discussion and leave people new to the forums wondering who is right.
I will admit I am very passionate about the issue of the medical community dismissing prediabetes. Part of the reason is from my prior blog here. The consensus does state that damage occurs earlier than previously thought. It is unfortunate that no actual determination has been made for the blood glucose levels when damage can be the most severe.
First, when a person openly disputes a doctor's request of a patient, this really upsets me. Granted in this case there is some potentially harmful information missing that those of us that posted did not ask for. In getting to the A1c of 5.7, we don't know what medications the original poster was taking. We also don't know the number of lows this person experienced, if any. We can only guess that the doctor knows the facts and when he suggests getting an A1c of 5.5 he knows that this is possible.
The medical community needs more doctors like this person and less people that quote ADA (and AADE) that A1c's of 6.5 being okay. That means that a blood glucose average of 140mg/dl which tells us that damage is being done. An A1c of 5.7 means a blood glucose reading of 117mg/dl. My reaction would be to pay attention to the doctor and ignore the rest. This is between the patient and doctor and is the individuals choice.
Having said that, there are people that should not try to get that low because they are unable to control their levels and have some dangerous lows when trying to get down below 6.0. This action needs to be done according to what the patient is capable of managing, desires to do, and if the patient keeps an open line of communication with a doctor. Even though this is on a diabetes forum, most of us suggest and most take it as such, people with titles behind their name often forget themselves and advise against doctors.
The second incident is where we seem to get a dismissal of the seriousness of prediabetes. Prediabetes is technically not diabetes, however, if the medical community continues to ignore the need to treat prediabetes with counseling and letting people know how serious this can become, they are taking a pass on their responsibilities.
There is much that can be done for people with prediabetes to assist them in taking advantage of this diagnosis and preventing the onset of diabetes. If they are medically capable they should begin exercise under a doctors direction and make some good lifestyle changes which will likely prevent diabetes for a number of years or possibly decades. Some will even prevent diabetes altogether.
For the blood glucose and A1c conversion table from the American Diabetes Association click here, and if you will be using it, bookmark the page.
January 22, 2011
January 20, 2011
Many Think of Pre-diabetes as Non-Diabetes
Diabetes forums can be an excellent learning place. Diabetes forum dlife had a good discussion about a visit to a doctors office and a subsequent call by the nurse in the office, that basically said the patient had an elevated blood glucose level and he was to watch his diet. His blood glucose test had been 126mg/dl which by current guidelines is diabetes.
This is two sided and not as black and white as many want it to be. Here is where I fault the doctors for not weighing in and explaining what pre-diabetes or diabetes actually means. Many just say, “watch your diet as your blood glucose is a little elevated”. Why is this so easy for doctors? Two answers and both equally in error.
First, they do not know what to do because they have heard that between 100 and 125 on the blood glucose scale is pre-diabetes, but they have their doubts since they have not kept up with the latest reasoning or guidelines. And second, they don't want to get their patients alarmed. Therefore they pass on the opportunity to educate a patient and help the patient get an early start on possible prevention for many years. This is where I say the doctors are doing harm.
What many doctors fail to understand that studies are finding that damage to the pancreas occurs earlier than many realize and this is the reason for the American Diabetes Association changing the diagnosis standards. Prediabetes is at least better defined for the diagnosis and treatment for women who are pregnant. Still doctors are not following the ADA.
At least the patient was asking questions and was sincere in wanting answers to understand what was going on and what to do next on the forum. This is a common occurrence as doctors are not doing their job.
What everyone needs to realize is that a fasting blood glucose reading of 125mg/dl and 126mg/dl are just numbers. They both indicate that the pancreas is in trouble and already has damage. Both are serious.
When fasting blood glucose is consistently above 99 mg/dl (5.5 mmol/L), this is considered prediabetes by the ADA in their latest Care Standards published in December 2010. This means that the pancreas is not functioning properly and the condition needs attention. Most doctor dismiss this as being something needing attention, and just tell the patient to watch their diet as blood glucose in elevated. If you get this reading, insist on getting the blood glucose reading so that at least you know how to treat it. And then, find an endocrinologist that will help.
How is the patient going to take this seriously when the medical community does not. Patients often just dismiss this as well and then in the next one to five years when the diagnosis comes back of diabetes, they are shocked and think they had done enough in reducing some sugars and doing some exercising. What they don't understand is that what they did was not a plan and the carbohydrate consumption was not controlled and the exercise may have been when they thought of it.
Both doctors and patients need to take fasting blood glucose readings of 100mg/dl to 125mg/dl (5.6 mmol/L to 6.9 mmol/L) seriously and develop and plan for treating this to prevent them from getting above the upper number. This takes planning and setting goals which must be followed seriously. The doctor needs to see the patient on a regular basis and use the HbA1c to see how good, or poorly, the patient is doing. Both should be prepared to review the plan and make adjustments.
Even if the fasting blood glucose level is 126mg/dl (7.0 mmol/L) and above, many people are still capable of controlling diabetes with nutrition and exercise. This does take commitment to this goal. Some are able to do this for years and some for a few decades. So this should be a goal. For some it will not happen because of other health problems and medical reasons that prohibit exercise. Even then, proper nutrition can be of benefit in keeping off medications.
This is two sided and not as black and white as many want it to be. Here is where I fault the doctors for not weighing in and explaining what pre-diabetes or diabetes actually means. Many just say, “watch your diet as your blood glucose is a little elevated”. Why is this so easy for doctors? Two answers and both equally in error.
First, they do not know what to do because they have heard that between 100 and 125 on the blood glucose scale is pre-diabetes, but they have their doubts since they have not kept up with the latest reasoning or guidelines. And second, they don't want to get their patients alarmed. Therefore they pass on the opportunity to educate a patient and help the patient get an early start on possible prevention for many years. This is where I say the doctors are doing harm.
What many doctors fail to understand that studies are finding that damage to the pancreas occurs earlier than many realize and this is the reason for the American Diabetes Association changing the diagnosis standards. Prediabetes is at least better defined for the diagnosis and treatment for women who are pregnant. Still doctors are not following the ADA.
At least the patient was asking questions and was sincere in wanting answers to understand what was going on and what to do next on the forum. This is a common occurrence as doctors are not doing their job.
What everyone needs to realize is that a fasting blood glucose reading of 125mg/dl and 126mg/dl are just numbers. They both indicate that the pancreas is in trouble and already has damage. Both are serious.
When fasting blood glucose is consistently above 99 mg/dl (5.5 mmol/L), this is considered prediabetes by the ADA in their latest Care Standards published in December 2010. This means that the pancreas is not functioning properly and the condition needs attention. Most doctor dismiss this as being something needing attention, and just tell the patient to watch their diet as blood glucose in elevated. If you get this reading, insist on getting the blood glucose reading so that at least you know how to treat it. And then, find an endocrinologist that will help.
How is the patient going to take this seriously when the medical community does not. Patients often just dismiss this as well and then in the next one to five years when the diagnosis comes back of diabetes, they are shocked and think they had done enough in reducing some sugars and doing some exercising. What they don't understand is that what they did was not a plan and the carbohydrate consumption was not controlled and the exercise may have been when they thought of it.
Both doctors and patients need to take fasting blood glucose readings of 100mg/dl to 125mg/dl (5.6 mmol/L to 6.9 mmol/L) seriously and develop and plan for treating this to prevent them from getting above the upper number. This takes planning and setting goals which must be followed seriously. The doctor needs to see the patient on a regular basis and use the HbA1c to see how good, or poorly, the patient is doing. Both should be prepared to review the plan and make adjustments.
Even if the fasting blood glucose level is 126mg/dl (7.0 mmol/L) and above, many people are still capable of controlling diabetes with nutrition and exercise. This does take commitment to this goal. Some are able to do this for years and some for a few decades. So this should be a goal. For some it will not happen because of other health problems and medical reasons that prohibit exercise. Even then, proper nutrition can be of benefit in keeping off medications.
January 18, 2011
Diabetes May Simplify Life's Choices
I can occasionally learn something by reading blogs of others, whether they are Type 1 or Type 2. Catherine Price at A Sweet Life dot org wrote a blog on January 17, 2011, that really hit home. I had not really thought about diabetes this way, but she is so right that I must add my thoughts as a Type 2 and with heart disease.
Yes, diabetes does make life simpler in so many ways. I go shopping for groceries with my wife and by myself. I do look for something to change the menu, but I seldom get past the label. It is easy to pick up fresh vegetables and some fresh fruits as from experience I know that the carbohydrate count is within the range I am looking for. Once in a while, it is easy to select a few of the higher carbohydrate fruits as we both like them and I can limit the portion size that I will eat.
Then we come to the packaged products. If it isn't the carbohydrate content, then it is the sodium content that rejects them. Most canned fruits and vegetables are ruled out because of the sodium levels or the carbohydrate levels. Some canned fruits and vegetables can be made acceptable by rinsing them and then soaking them in clear water and draining this liquid, thereby eliminating the liquid they were canned in.
Catherine says it very well that we would not choose to have diabetes, but it can be a blessing in disguise (I say it is a large blessing) as we eliminate many foods we would not otherwise reject. I add sodium because of heart disease which eliminates other foods. Now with the American Heart Association issuing their call to the public, health professionals, the food industry, and the government to increase efforts to lower the amount of sodium that we consume on a daily basis, we have more hope.
The AHA has issued their statement to get people to limit their sodium intake to 1500 milligrams of sodium per day. This is down from the 2300 milligrams that was their standard. Anyone concerned about heart disease and high blood pressure, the standard now is 1500 milligrams. Thank you to the AHA for their revision. Therefore, I now feel much safer with my personal upper limit being at 1200 milligrams of sodium intake.
Everyone should read their release published in Science Daily here. Now if the American Medical Association and other professionals organizations will follow their lead, we can all be healthier.
Yes, diabetes does make life simpler in so many ways. I go shopping for groceries with my wife and by myself. I do look for something to change the menu, but I seldom get past the label. It is easy to pick up fresh vegetables and some fresh fruits as from experience I know that the carbohydrate count is within the range I am looking for. Once in a while, it is easy to select a few of the higher carbohydrate fruits as we both like them and I can limit the portion size that I will eat.
Then we come to the packaged products. If it isn't the carbohydrate content, then it is the sodium content that rejects them. Most canned fruits and vegetables are ruled out because of the sodium levels or the carbohydrate levels. Some canned fruits and vegetables can be made acceptable by rinsing them and then soaking them in clear water and draining this liquid, thereby eliminating the liquid they were canned in.
Catherine says it very well that we would not choose to have diabetes, but it can be a blessing in disguise (I say it is a large blessing) as we eliminate many foods we would not otherwise reject. I add sodium because of heart disease which eliminates other foods. Now with the American Heart Association issuing their call to the public, health professionals, the food industry, and the government to increase efforts to lower the amount of sodium that we consume on a daily basis, we have more hope.
The AHA has issued their statement to get people to limit their sodium intake to 1500 milligrams of sodium per day. This is down from the 2300 milligrams that was their standard. Anyone concerned about heart disease and high blood pressure, the standard now is 1500 milligrams. Thank you to the AHA for their revision. Therefore, I now feel much safer with my personal upper limit being at 1200 milligrams of sodium intake.
Everyone should read their release published in Science Daily here. Now if the American Medical Association and other professionals organizations will follow their lead, we can all be healthier.
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