Most of the good articles on diabetes put the burden of diabetes management and management improvements on the patient. Doctors do not seem to be in agreement and want to be in control. I hate to say this doctors, but until you live with me 24/7/365, stay in your office so that I can find you. Since you are incapable, doctor, of living with me, the management of diabetes and possibly some related complications falls to me.
I will still seek your advice and consult with you about how I manage my care, but that is where the relationship ends. If you do your best to educate me, I will probably do a much better job of managing diabetes. If you try to direct my management or micro-manage me, kiss me goodbye. It is education I need, not educated guesses from someone miles away from me. Try to use fear with me and you will not get the time of day from me.
To the rest of you that are patients, learn that if you let the doctor manage your diabetes by long distance, you have no one to blame but yourself for poor management. When you forget one important piece of information and the doctor changes your medication for a stronger one when you do not need it, it is your fault. Come on patients, the doctor is there to aid and assist you, but he does not live with you. He can ask questions, but he does not always ask the right questions – unfortunately it is called internal bias, and some will call it punctum cecum (a blind spot).
Patients, others have said this and it is worth repeating. As a patient with diabetes, you need to become your own science experiment and learn what works for you. Learn to document what happens so that you can discuss this with the doctor. Even if you decide to try some of the holistic remedies, keep a record so that when you stop having success with them, you will know it and can discuss this with the doctor. This may not make the doctor happy, but generally, if you are honest with the doctor, you will be better off for it.
Learn to be concise with your record keeping and be prepared to leave a copy with the doctor. Yes, this goes against the grain of patient privacy, but the doctor may see something in your notes that could be a clue for giving you better tips in managing diabetes. Remember, you are the science experiment and the more eyes analyzing the data, the easier it can become to manage diabetes. Granted, your doctor must work with you in this and not against you. If you have a doctor that works against you, hopefully you have the ability to be able to find a doctor that will work with you and are not locked into one doctor because of distance.
Learn to manage your diabetes and you will have a successful science experiment and probably slow the progression of diabetes to a crawl and possibly avoid some complications for many years and maybe some complications altogether. There are no guarantees, but if you chose to ignore managing diabetes, you will develop complications. You will have them and probably more of them and sooner. Once you have them, your management of diabetes will become more difficult, creating problems that you may not be able to manage.
A concept that needs more attention is the concept put out by Dr. William H. Polonsky of the Behavioral Diabetes Institute of San Diego, CA. Read the blog of David Mendosa on his presentation here. Also read this blog by Gretchen Becker on the same presentation. This concept is “diabetes causes nothing”, that is right – NOTHING! It is the lack of diabetes management that leads to complications.
July 2, 2011
July 1, 2011
Is It All Hype and A No Show?
On May 4, 2011 when I wrote about the American Association of Clinical Endocrinologists (AACE) which will be cosponsoring the new online resource with Takeda Pharmaceuticals, I had hopes that this would come to fruition and be something that would benefit patients, caregivers, as well as some physicians.
It was suppose to be available online in June. I don't think I missed anything, but were they talking June of 2012 or 2013? Today is the first of July 2011, and unless I am blind, I have not found anything resembling a site for patients, caregivers, and healthcare professionals as mentioned in the press release about this.
Now granted, the information was to be vetted by AACE diabetes experts, so maybe they found nothing that met the standards. Not that I can't be surprised, but certainly there are some websites that are acceptable – maybe.
Of course if the websites must follow the mantra of low fat, whole grains, and a lot of this nonsense, there may not be many sites. Then we have “The Type 2 Talk” which is sponsored by Bristol-Myers Squibb and AstraZeneca, in partnership with the American Association of Clinical Endocrinologists (AACE) and its educational arm – the American College of Endocrinology (ACE). Maybe this will be the only vetted site.
I doubt this, as I sure Takeda Pharmaceuticals would have something to say about such a listing. To which I would add that as a patient information site, it may work for some, but to me is a rather lack luster and uninforming site.
So AACE, what is it going to be? A lot of hot air hype, or will you step up to the plate?
Is it going online June 2011 (gone – past history), 2012, or later? I have questions – but you are providing no answers and no vetted sites.
It was suppose to be available online in June. I don't think I missed anything, but were they talking June of 2012 or 2013? Today is the first of July 2011, and unless I am blind, I have not found anything resembling a site for patients, caregivers, and healthcare professionals as mentioned in the press release about this.
Now granted, the information was to be vetted by AACE diabetes experts, so maybe they found nothing that met the standards. Not that I can't be surprised, but certainly there are some websites that are acceptable – maybe.
Of course if the websites must follow the mantra of low fat, whole grains, and a lot of this nonsense, there may not be many sites. Then we have “The Type 2 Talk” which is sponsored by Bristol-Myers Squibb and AstraZeneca, in partnership with the American Association of Clinical Endocrinologists (AACE) and its educational arm – the American College of Endocrinology (ACE). Maybe this will be the only vetted site.
I doubt this, as I sure Takeda Pharmaceuticals would have something to say about such a listing. To which I would add that as a patient information site, it may work for some, but to me is a rather lack luster and uninforming site.
So AACE, what is it going to be? A lot of hot air hype, or will you step up to the plate?
Is it going online June 2011 (gone – past history), 2012, or later? I have questions – but you are providing no answers and no vetted sites.
June 30, 2011
Is Weight Loss a Bizarre Paradox?
When Jen Hubley at about dot com on June 2nd stated that weight loss is one of those bizarre paradoxes, I was thinking anything but paradox. But after rereading her blog, I can understand where she is coming from – a person without diabetes, or other chronic illnesses, and thus not restricted by the foods that raise blood glucose or blood pressure. What bothers me is why people feel that dieting is the route to lose weight rather than lifestyle change which often can assist more with weight loss.
Now I have more of the answers that make sense and fit those of us with chronic diseases at the age level for them. While lifestyle change is not always the perfect way, it is making more sense that diets. David Spero covers many of the problems in weight loss with sound reasoning and spells out why it can be more difficult for some to loss weight.
It turns out that our bodies do not want to lose weight and do whatever can be done to add lost weight back. David says that we have “thrifty” genes telling our brains to relax, eat, and add more fat. At the same time those of us with diabetes encounter the problem is insulin resistance and increased adipose fat in the abdomen. Dieting is an artificial form of food scarcity and will activate our thrifty genes slowing metabolism to increase stores of energy for “hard times”.
When you diet, the leptin levels in your system drops making your brain leptin-resistant. This is called the full feeling, so as you lose weight you will become hungrier, food will taste more appealing and you gain weight. Stress also is a factor and mimics the effects of food scarcity in our bodies, making us hunger for our comfort foods. Dieting and concentrating on weight loss can also be a major source of stress.
Then Ronnie Gregory at the poor diabetic dot com states that weight loss should not be considered part of diabetes management. While I won't recommend throwing the scale out the window as he does, I will agree it does not have to be part of daily activities.
We all agree that it is better to be focused on our blood glucose and blood pressure numbers, and how you are feeling. No diet will prevent weight regain, so it is better to do what is necessary for managing our diabetes and hypertension and let the weight take care of itself. And if the lifestyle change helps with weight loss, so much the better.
So ignore the paradoxes, the diets, and hype about losing weight and manage your diabetes and blood pressure effectively. Enjoy the weight loss when it happens and if medically able, exercise to help manage all three. Forget about plateaus in weight loss and realize that your body is resisting and will eventually give up more weight as you manage diabetes and blood pressure to the maximum, plus exercise.
Now I have more of the answers that make sense and fit those of us with chronic diseases at the age level for them. While lifestyle change is not always the perfect way, it is making more sense that diets. David Spero covers many of the problems in weight loss with sound reasoning and spells out why it can be more difficult for some to loss weight.
It turns out that our bodies do not want to lose weight and do whatever can be done to add lost weight back. David says that we have “thrifty” genes telling our brains to relax, eat, and add more fat. At the same time those of us with diabetes encounter the problem is insulin resistance and increased adipose fat in the abdomen. Dieting is an artificial form of food scarcity and will activate our thrifty genes slowing metabolism to increase stores of energy for “hard times”.
When you diet, the leptin levels in your system drops making your brain leptin-resistant. This is called the full feeling, so as you lose weight you will become hungrier, food will taste more appealing and you gain weight. Stress also is a factor and mimics the effects of food scarcity in our bodies, making us hunger for our comfort foods. Dieting and concentrating on weight loss can also be a major source of stress.
Then Ronnie Gregory at the poor diabetic dot com states that weight loss should not be considered part of diabetes management. While I won't recommend throwing the scale out the window as he does, I will agree it does not have to be part of daily activities.
We all agree that it is better to be focused on our blood glucose and blood pressure numbers, and how you are feeling. No diet will prevent weight regain, so it is better to do what is necessary for managing our diabetes and hypertension and let the weight take care of itself. And if the lifestyle change helps with weight loss, so much the better.
So ignore the paradoxes, the diets, and hype about losing weight and manage your diabetes and blood pressure effectively. Enjoy the weight loss when it happens and if medically able, exercise to help manage all three. Forget about plateaus in weight loss and realize that your body is resisting and will eventually give up more weight as you manage diabetes and blood pressure to the maximum, plus exercise.
June 29, 2011
Prediabetes – Please Take It Seriously!
Why? Why do I write about prediabetes so often? I do this whenever I feel there is something more to say. I do it because many people are still not talking about prediabetes like they should and doctors are not doing their job of proper screening. Yes, a few more are screening, but very few are educating their patients about the meaning of prediabetes.
Emilia Klapp, R.D., B.S. blogged about this back in March, and did a good deed for those with prediabetes. She gave a example of what doctors are not doing. She talked about doctors ignoring the symptoms of prediabetes and patients not being aware of them.
Then in May, Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N. writing for the Mayo Clinic diabetes blog about prediabetes. They used numbers to tell us how serious prediabetes is and if you think that 57 million people in the United States alone is significant, chances are you don't think prediabetes is serious.
If your fasting blood glucose is over 99 mg/dl (5.5 mmol/L), but less that 126 mg/dl (7 mmol/L), then you are considered to have prediabetes. There is already some damage being done to the pancreas, the heart and circulatory system. Just because the doctor does not take this seriously, you should. Many doctors tell you that you are “borderline diabetic”, or that you have a “touch of sugar”.
Two tests can help determine (diagnose) prediabetes. The first is the fasting blood glucose test. For a normal person measuring fasting blood glucose (FBG) should be between 70 and 99 mg/dl (3.8 to 5.5 mmol/L). Prediabetes with FBG is 100 to 125 mg/dl (5.6 to 6.9 mmol/L).
The second test is the oral glucose tolerance test (OGTT). This measures the blood glucose after fasting and again two hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dl (7.8 mmol/L) two hours after the drink. Prediabetes means a blood glucose is 140 to 199 mg/dl (7.8 to 11.0 mmol/L). If the two hour blood glucose rises to 200 mg/dl (11.1 mmol/L) or above, you are considered having diabetes.
If you have questions about whether you have prediabetes and can afford it, buy yourself a meter and test strips and do some morning FBG's. If you are consistently in the prediabetes range, think seriously about talking to your doctor for the tests. Or you can do something to help prevent or delay the development of Type 2 diabetes. You can reduce the carbohydrates you consume and if needed reduce some weight. Even a 5 to 7 percent loss and increasing physical exercise can have a huge impact.
Even people that have been diagnosed with diabetes have been able to prevent going on medications by reducing weight and exercising regularly. Prediabetes can be reversed and not go on to become diabetes if lifestyle changes are made now and you make them permanent. A good nutrition plan and regular exercise can have wonderful results. Don't get lax as prediabetes can come back with little invitation.
Read the blog by Emilia Klapp here and the Mayo Clinic diabetes blog here.
Emilia Klapp, R.D., B.S. blogged about this back in March, and did a good deed for those with prediabetes. She gave a example of what doctors are not doing. She talked about doctors ignoring the symptoms of prediabetes and patients not being aware of them.
Then in May, Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N. writing for the Mayo Clinic diabetes blog about prediabetes. They used numbers to tell us how serious prediabetes is and if you think that 57 million people in the United States alone is significant, chances are you don't think prediabetes is serious.
If your fasting blood glucose is over 99 mg/dl (5.5 mmol/L), but less that 126 mg/dl (7 mmol/L), then you are considered to have prediabetes. There is already some damage being done to the pancreas, the heart and circulatory system. Just because the doctor does not take this seriously, you should. Many doctors tell you that you are “borderline diabetic”, or that you have a “touch of sugar”.
Two tests can help determine (diagnose) prediabetes. The first is the fasting blood glucose test. For a normal person measuring fasting blood glucose (FBG) should be between 70 and 99 mg/dl (3.8 to 5.5 mmol/L). Prediabetes with FBG is 100 to 125 mg/dl (5.6 to 6.9 mmol/L).
The second test is the oral glucose tolerance test (OGTT). This measures the blood glucose after fasting and again two hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dl (7.8 mmol/L) two hours after the drink. Prediabetes means a blood glucose is 140 to 199 mg/dl (7.8 to 11.0 mmol/L). If the two hour blood glucose rises to 200 mg/dl (11.1 mmol/L) or above, you are considered having diabetes.
If you have questions about whether you have prediabetes and can afford it, buy yourself a meter and test strips and do some morning FBG's. If you are consistently in the prediabetes range, think seriously about talking to your doctor for the tests. Or you can do something to help prevent or delay the development of Type 2 diabetes. You can reduce the carbohydrates you consume and if needed reduce some weight. Even a 5 to 7 percent loss and increasing physical exercise can have a huge impact.
Even people that have been diagnosed with diabetes have been able to prevent going on medications by reducing weight and exercising regularly. Prediabetes can be reversed and not go on to become diabetes if lifestyle changes are made now and you make them permanent. A good nutrition plan and regular exercise can have wonderful results. Don't get lax as prediabetes can come back with little invitation.
Read the blog by Emilia Klapp here and the Mayo Clinic diabetes blog here.
June 28, 2011
Gluten-free Foods Will Accelerate Onset of Diabetes
Yes, you are reading this correctly! Why should you not expect this from the US Food Industries? Because they are trying to make America fatter, and they are doing an excellent job of this! Don't blame those who have developed celiac disease as they cannot help it as it is an autoimmune disease like Type 1 diabetes.
When we have called on the US food industries to supply a solution for a problem, they manage to make us pay with more junk food and junk carbohydrates. Per Dr. William Davis in his blog here, saturated fat was replaced with hydrogenated fat and polyunsaturates, sucrose was replaced with high-fructose corn syrup, and now they are replacing wheat gluten-containing foods with junk carbohydrates.
If you don't think so, almost all gluten-free foods now use brown rice flour, cornstarch, tapioca starch, and potato starch. Sometimes they do use amaranth flour, teff flour, or quinoa flour and other less popular, but still gluten-free grains.
The foods prepared with these gluten-free ingredients, which are free of gliadin and gluten, will add weight to you and probably make you diabetic. They do increase visceral fat, cause your blood glucose levels to head for the stratosphere higher and faster than most foods – even wheat, which is notorious by itself. In addition to diabetes, your chances of cardiovascular disease also increases because of the lipoprotein distortions.
As Dr. Davis says, “eliminating all things wheat from the diet is one of the most powerful health strategies I have ever witnessed. But replacing lost wheat with manufactured gluten-free foods is little better than replacing your poppy seed muffin with a bowl of jelly beans”.
What even bothers me is that gluten-free is becoming a fad and therefore the increase of manufactured gluten-free foods that are harmful to your health are proliferating in the market place. They are more expensive and have a higher profit margin thereby exciting the food industry into more production.
When people like Oprah Winfrey promote gluten-free, you know people will try it. There are many pitfalls and health problems that can result from going gluten-free without guidance from a doctor and dietitian.
An article in USA Today dot com from August 17, 2008 about gluten-free is very interesting and surprisingly gives some excellent warnings about doing this yourself. It explains some of the health problems of do-it-yourselfers. Please take time to read it.
When we have called on the US food industries to supply a solution for a problem, they manage to make us pay with more junk food and junk carbohydrates. Per Dr. William Davis in his blog here, saturated fat was replaced with hydrogenated fat and polyunsaturates, sucrose was replaced with high-fructose corn syrup, and now they are replacing wheat gluten-containing foods with junk carbohydrates.
If you don't think so, almost all gluten-free foods now use brown rice flour, cornstarch, tapioca starch, and potato starch. Sometimes they do use amaranth flour, teff flour, or quinoa flour and other less popular, but still gluten-free grains.
The foods prepared with these gluten-free ingredients, which are free of gliadin and gluten, will add weight to you and probably make you diabetic. They do increase visceral fat, cause your blood glucose levels to head for the stratosphere higher and faster than most foods – even wheat, which is notorious by itself. In addition to diabetes, your chances of cardiovascular disease also increases because of the lipoprotein distortions.
As Dr. Davis says, “eliminating all things wheat from the diet is one of the most powerful health strategies I have ever witnessed. But replacing lost wheat with manufactured gluten-free foods is little better than replacing your poppy seed muffin with a bowl of jelly beans”.
What even bothers me is that gluten-free is becoming a fad and therefore the increase of manufactured gluten-free foods that are harmful to your health are proliferating in the market place. They are more expensive and have a higher profit margin thereby exciting the food industry into more production.
When people like Oprah Winfrey promote gluten-free, you know people will try it. There are many pitfalls and health problems that can result from going gluten-free without guidance from a doctor and dietitian.
An article in USA Today dot com from August 17, 2008 about gluten-free is very interesting and surprisingly gives some excellent warnings about doing this yourself. It explains some of the health problems of do-it-yourselfers. Please take time to read it.
June 27, 2011
Are You Enjoying Summer with Diabetes Yet?
Now that summer is officially here, are you ready to enjoy it. If you are doing some traveling, do you have the proper supplies and information you may need? Hopefully this will give you some help and resources for additional help.
First, know what to do to take care of yourself first. People often remember their supplies, but forget about taking care of themselves. What type of trip is it? What means of transportation will you be using? These help determine the actions needed to take care of yourself.
If it is on an airline, sorry you will need to purchase the expensive water after you have cleared security. Transportation Security Authority (TSA) is unrelenting on this. Just make sure that you can have enough water to stay hydrated while traveling, but not so much that you wear a path in the isle carpet from your seat to the nearest lavatory on the plane.
For all types of travel, your diabetes supplies should be in your carry-on case (preferably one that will fit under a seat). I suggest having extra prescriptions with you and a letter from your doctor on the doctor's letterhead spelling out the medications and supplies you are carrying and the medical necessity for the supplies and medications.
If you are traveling by train, you may be able to carry your water supply, but I am not totally sure just how restrictive they are. Make sure that you carry your diabetes supplies with you regardless of the type of ticket you travel on. If you travel by bus, make sure that you carry enough snacks and water to last for the trip or until you can again purchase additional.
If you are traveling by auto, then you should know how to travel. Read an excellent post here for other ideas and needs whether you are a person with Type 1 or Type 2 diabetes. I would also encourage you to consider following the link to FRIO case in the blog or use this link. These are handy cases or packs for everyday use as well as travel. I have a couple of different sizes and use them regularly. There are many tips for women and traveling necessities.
Also read this article by the Centers for Disease Control (CDC) about precautions in travel for people with diabetes. This is another good resource for information.
Enjoy you summer, your travel, and recreation time!
First, know what to do to take care of yourself first. People often remember their supplies, but forget about taking care of themselves. What type of trip is it? What means of transportation will you be using? These help determine the actions needed to take care of yourself.
If it is on an airline, sorry you will need to purchase the expensive water after you have cleared security. Transportation Security Authority (TSA) is unrelenting on this. Just make sure that you can have enough water to stay hydrated while traveling, but not so much that you wear a path in the isle carpet from your seat to the nearest lavatory on the plane.
For all types of travel, your diabetes supplies should be in your carry-on case (preferably one that will fit under a seat). I suggest having extra prescriptions with you and a letter from your doctor on the doctor's letterhead spelling out the medications and supplies you are carrying and the medical necessity for the supplies and medications.
If you are traveling by train, you may be able to carry your water supply, but I am not totally sure just how restrictive they are. Make sure that you carry your diabetes supplies with you regardless of the type of ticket you travel on. If you travel by bus, make sure that you carry enough snacks and water to last for the trip or until you can again purchase additional.
If you are traveling by auto, then you should know how to travel. Read an excellent post here for other ideas and needs whether you are a person with Type 1 or Type 2 diabetes. I would also encourage you to consider following the link to FRIO case in the blog or use this link. These are handy cases or packs for everyday use as well as travel. I have a couple of different sizes and use them regularly. There are many tips for women and traveling necessities.
Also read this article by the Centers for Disease Control (CDC) about precautions in travel for people with diabetes. This is another good resource for information.
Enjoy you summer, your travel, and recreation time!
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