July 5, 2012

Back to Diabetes Basics – Part 2

Why Keep Diabetes A Secret?

Having a diagnosis of type 2 diabetes is probably not something you would shout from the rooftop, but should you keep it a secret? Many people do just this and will not talk about it even to family members unless it is necessary. Extreme secrecy can be difficult. There was a situation a few years ago near here that made me laugh. Husband did not tell wife or anyone about his diabetes diagnosis. Two weeks later, his wife answered the telephone, and it was husband's doctor office calling to remind him of his diabetes education class the next day.

When husband learned this had happened, he hired a lawyer to sue the doctor's office for failure to keep his medical records private. Judge had a sense of humor and asked husband if he loved his wife and he answered yes. The judge said if this were true, why had he attempted to keep his disease a secret from his wife? The judge said he could understand the secrecy desire for the husband's affair uncovered by the sheriff. He handed down the following judgment. One-dollar fine to the doctor office – to remind them to be more careful and court costs on the husband for the lawsuit and wasting the court's time. He gave instructions to the wife that should she ever decide to divorce her husband, all she would need to do is file the paperwork and it would be granted. In addition, he wanted the court proceeding widely published.

Presently There Is No Cure

A topic that often surfaces shortly after diagnosis is “the cure.” I am somewhat hesitant to discuss this here, but if I can prevent anyone from avoiding this approach, it will be worth it. There are charlatans out there just waiting to separate you from your hard-earned money. They exist in small town America, in the large cities, and on the internet. They have the skill and arguments to make it sound very convincing and may be doctors or just cunning salespeople. They have one thought, and it is getting you to hand over your hard-earned money for their false claims. Read my blog here for more.

There are also researchers and medical people that have plans to (as they claim) put diabetes is remission. They promote extreme low calorie regimens and certain supplement plans which may make it seem like diabetes is stopped and are safe to use. Just be careful as these are for the short term and research has not proven they will succeed for the long term. The stress on your body using these extreme low calories diets has not been researched beyond a few months. They have proven that they work for the short-term and that is their promotion to obtain your money. Then in a few months when your blood glucose levels start back toward the stratosphere, they will try to sell you another round of the same regimen. Your long-term health is being put in jeopardy. Do not attempt these plans without your doctor's knowledge.

Acronyms and Their Use

As you start reading and looking for information on the Internet, you will come across many acronyms used by people to avoid typing long or even short strings of words. This can be discouraging for the new person with diabetes. What do they mean in the context of the sentence? One that you need to be very careful with is this one – ADA. It still means American Diabetes Association and Americans with Disabilities Act. Many still use it for the American Dietetic Association, but as of January 2012 it was officially changed to AND (Academy of Nutrition and Dietetics).

Changes in names can be a good thing, but the change above was solely to camouflage a takeover of competing occupations and eliminate competition by criminalizing people not becoming certified under their organization. This is not a very professional objective.

How you see acronyms will vary with each writer. Many will give the program or profession name in one paragraph and then start using the acronym in the next or later paragraphs. Others will use the full explanation followed immediately by the acronym and then use the acronym for the rest of the article. Some writers assume that their readers know the meaning of the acronym and never give the full name. These are the writers that make it difficult for all types of readers. Time after time. when there is the possibility of confusion, I have seen comments asking for the full definition of an acronym. Some people are especially sarcastic about this and provide a definition they know is wrong and abrasive, but the writer seldom clarifies. Some writers do then provide the correct meaning for the acronym. A few writers do correct their habits, and the rest just disappear.

I do use acronyms, and if you catch me not giving the full meaning, please let me know. I use the full definition and then the acronym in parenthesis or the acronym with the full definition in parenthesis. I have used the full definition in the first paragraph or two and then start using the acronym; however, I am trying to break that habit.

Some of the Testing Basics

Hopefully, you are now comfortable with testing and are doing it regularly. You need to understand what the blood glucose (BG) readings mean and what actions are available to you. Whether you are endeavoring to manage your diabetes with exercise and diet without medications, or are using an oral medication, you need education about both and when to test. Most everyone tests upon rising from sleep and this is termed fasting blood glucose (FBG) and your goal should be between 80 mg/dl (milligrams per deciliter) (4.4 mmol/L) and 100 mg/dl (5.6 mmol/L, (millimole per liter). Or, as many write, keep fasting blood glucose (FBG) under 100 mg/dl.

Then we come to the next meal. Hopefully, you will be under 100 mg/dl for the pre-meal blood glucose reading (preprandial). If you are not, then consider what you ate that would keep you higher. I like the goal of one hour post meal reading being 140 mg/dl (7.8 mmol/L) or lower (postprandial). At the two hour postprandial blood glucose reading should be 120 mg/dl (6.7 mmol/L) or lower. However, if these become your goals, be careful as eating the American Diabetes Association's recommended meal consumption of carbohydrates will make these goals unachievable for many patients.

Testing is the only way you have in determining how different foods and food quantities affect your blood glucose levels. A term you will see in blood glucose management is self-monitoring of blood glucose (SMBG – is the acronym). You will also need to test more frequently in the beginning to learn how long before you reach the high level of your BG. Many suggest one hour after first bite and for some people this can be too early. If you are a speedy eater (gobble down your food) this may work; however, studies have shown that you should eat slower for greater blood glucose management. Some writers do use the word control instead of manage for the same meaning. Some will suggest testing more often until you are comfortable with when your high level of BG happens. I suggest starting at the one-hour mark and testing every half hour the first few times until you see the readings start decline. Some people will test every 15 minutes. Somewhere between the highest reading and the lower next reading, the high may have occurred.

Occasionally the high mark can happen before the one-hour mark or beyond the three-hour mark. This indicates that the food you ate enters the blood stream quickly and was easily digestible and probably contained little fiber, if any. If it is after three hours, this indicates a higher than normal amount of fat, example – pizza. If you are saying this is confusing and too much to learn, you may as well know up front that there are not firm guides or rules to follow. It is important to know that what works for me, may not work for you. It is important to know that you need to become your own lab rat to determine how the different foods affect your system and what works for you. Many people keep a detailed journal during this time of the readings, what was consumed, and other observations that they feel is important. Read my blog here for further discussion of postprandial testing.

How often you test will depend on your desire to bring diabetes under excellent management and your budget. You will also need to find out how willing your doctor is to go to bat for you with the insurance company for additional testing supplies. Some companies will allow some extra test strips in the first few months, but then want to restrict you thereafter. Other insurance companies will only allow a set number of test strips per day. I recommend that you talk with your insurance company to find out what they are willing to allow. You may need to bargain with them and attempt to convince them of the need for allowing more test strips for the first three to five months. Don't be surprised if you are denied, but it is still worth the effort. If your budget will allow for the test strips, the knowledge you gain will be worth the cost. Medicare will not allow extra test strips.

As you are testing you are also looking for trends. If you are bouncing up and down at the two-hour postprandial, looking at your food log may provide clues as to why. If your FBG is on an upward trend for a couple of weeks then be concerned and be more careful of your last meal of the day. Also do not let a lot of time pass after rising in the morning as this allows your liver to dump more glucose into the system and can distort the trend. Many people can also have what is termed the dawn phenomena (DP) which is the livers function to dump glucose into your system to give you energy for waking up and starting the day. Upward trends should always be of concern and if they continue or start to trend upward more rapidly, always consider talking with your doctor. He may request an office visit and may increase the dosage of your medication or start you on a new medication.

Never be concerned with some bouncing up or down of BG readings, as this can happen if you are coming down with an illness or can vary with the food you ate at the previous meal. Trends up or down for longer that a month should be talked about with your doctor. He/she may need to adjust you medication. Trends under 80 mg/dl should always be talked about with your doctor. More about this in the next blog.

Series 2 of 12

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