November 20, 2012

Diabetes Diets and Your Meter

In reviewing some of my blogs, I have found several that have gained readership beyond what I anticipated. This says there is a need for people to understand what they need to know at the early stages and to review some topics after they have gained additional knowledge. It is important to say that I am not an expert, but hopefully my readers are finding some information that they have been able to apply with the help of their meters and that they are adapting some information to their own management of diabetes.

Also, this statement may prove helpful to some as they read other diabetes blogs or websites – “what works for me, may not work for you.” Other people use this - “your mileage may vary” to help them understand that the results worked, but not as well as they hoped. Those of us that blog about diabetes understand that, and know that some ideas are helpful, some ideas make sense, but don't get the great results for them, and a few ideas just don't help. I have found this happens to me and I have a few – now many pages of helpful sites (the URLs and a brief summary) that I use to review from time to time. I apply what I find works for me and keep the information for future reference. Sometimes when one thing quits working, I return to my list and see if something else is now working.

I may overuse this, but testing is important and goes a long way to helping you discover what you body will allow and still get the test results you want. The meters are not expensive (often your doctor will hand them out free), but it is the test strips that are expensive. Insurance will only cover a limited number. I have found it worthwhile to talk with the medical insurance people about allowing extra testing shortly after diagnosis. Some will allow extra for a couple of months and then go back to their allowance, but most will require a letter from your doctor. Forget Medicare, they will only allow one or two test strips unless you are on insulin and then you are allowed four test strips per day. This is unreasonable at best and criminal what they will do to people needing to learn how different foods affect blood glucose readings. For those unable to obtain or afford extra test strips, okay, check with the manufacturer for financial assistance. Most do have this and if you follow their instructions, you may qualify.

In writing about diabetes diets, I made some statements about the collusion between four government agencies and four diabetes organizations. Now another blogger on the nutrition side is speaking out about two government agencies and taking their “experts” to task for our obesity epidemic. She also has an excellent discussion about her organization and their part in promoting the obesity epidemic. This is also why they do not want us testing to see how different foods affect our diabetes management. This last sentence is what drove my thoughts in writing about getting our test strips back from Medicare. It even caused me to listen to one of the candidates for congressional representative from my district and ask some rather direct questions about why USDA was working so hard to give out bad nutritional advice – to which I was totally ignored and then several others asked similar questions which were also ignored. Since the candidate is the wife of our current Secretary of Agriculture, it did my spirits good to see her defeated.

There are many good reasons to ignore some of the quasi professionals in the Academy of Nutrition and Dietetics and the American Association of Diabetes Educators when they do not attempt to help many of us with type 2 diabetes which I blogged about here. Even my cousin that is a certified diabetes educator has now disowned me for some of my positions. Another cousin that has been helping me with nutrition when I am a volunteer peer mentor says she likes working with me and was very surprised at the reception she has received and has continued to have with some of one doctor’s patients. Once she stated she would not be pushing high carbohydrates and low fat, but wanted to work with them at the level they were at, whether low carb or what ever type of regimen they were wanting to discuss, she has been well received. She has now consulted with another group of patients with the same doctor that are interested in nutrition.

My second peer mentoring session with a husband and wife practice in Kansas for October was good. The primary discussion was on different meters and the proper blood glucose levels or guidelines they should follow. I wish I would have had the second question from Diabetes Mine and the second comment to the discussion, but we did cover most of the points. Many were not enthused about the ADA guidelines and wondered about the points in Jenny Ruhl's website here and here. I stated that they were excellent targets for many people. I asked if anyone was hypoglycemically unaware or recently had a low that they were not aware of until they tested. No one had such an experience that they were aware of and I warned them about this and knowing the signs of sweating, nervousness, being lightheaded, and the other symptoms. That did bring one admission from a patient saying now that he knew what to look for; he may have had one in the last month. He admitted that when he tested the reading was 73 mg/dl and an hour later the reading was 88 mg/dl.

I asked him how long it had been since eating and he said about 7 hours because he had not felt good and skipped the noon meal. I asked what medication he was taking and he stated it was one of the sulfonylureas and yes he had taken it at noon. I advised him to talk to the doctor before leaving that afternoon and ask about skipping the medication when he felt like not eating. When the doctor came to get the next patient he did ask and she stated he should not have taken the medication unless he was above 150 mg/dl. He said he had not tested and she advised him to always test if he knew he would not be eating. She stated this would guide him on taking the medication. She asked if there were other questions on medication and not eating – there were so she said they would cover this later before the session ended. I then explained what can happen if someone was high and took their medication without eating and got the hypoglycemia symptoms, but their test showed they were in the upper 80s or in the 90s. I said the symptoms of hypoglycemia can happen when they have a rapid drop in blood glucose levels. One person spoke up and said like a false positive. I agreed, but warned them that testing was important just the same.

Next I asked if any of them had pizza from time to time. Of the 12 patients in the room eight admitted to having a piece or two with the family. So I then asked how many were on a regimen of higher that 40 percent fat for a meal. Six answered yes, and I talked about not testing at one or two hours post meal, but at three or four hours and said this was known as the “pizza effect” because of the fat content that would slow the absorption of carbohydrates. I said I realized many of them could not use that many test strips, but for those that could, they should test at half hour intervals starting at 2 and one-half hours after eating and test until the 4 and one-half hour mark. One woman said she had read this someplace and had tested at the 2 hour, 3 hour, and 4 hour points and her high had been somewhere between the 3 and 4 hour points, so she knew I was right. I stated that it would vary from person to person, but that even a few people might have the high after four hours. One person asked if this would apply to her being on insulin. I said yes, and asked which insulin. She said Novolog and I said definitely, and advised her that she could be like me and only have a 3 and one-half hour effective period. She stated that as far as she could determine she was getting a 4 to 4 and one-half hour effective period. I suggested that she think about not injecting her insulin until after she had eaten, but to test before meals as always and count her carbs she would be eating to determine the dose, but not to inject until the end of the meal. She said she would ask the doctor.

I then had a few other questions before the end. I wished everyone happy holidays and both doctors asked me to remain online until all questions had been answered. The first question was the woman on insulin and the doctor said let her think on it, and she faced the video cam and asked if I had suggested this and why. I responded that this had been raised when discussing the “pizza effect” and the doctor said now she understood the question and that she agreed with my suggestion and it would maximize the effectiveness of the insulin. Then she stated that this would also be a good idea for those on sulfonylureas. Then she asked if anyone thought they had slow emptying stomachs although she did not think anyone did. No responses, so she continued that injecting after eating could also help these people in case anyone had friends with this problem.

The rest of the questions were answered and the husband asked how people felt this was working. Of the 14 people present, only one said it was not helpful and that was because he was still not on medications. The other person that was not on medications said it still was a help for him because he knew what needed to be done if he had pizza with the grandchildren. He said he would have to exercise longer, but how to test was still valuable to him. The husband asked how many would attend in January and 13 of the 14 said yes. Then a person asked a question about something I had written in my blog about the reason insurance companies limited test strips. The wife asked, “the one saying about the collusion between four government agencies and the four diabetes professional groups and them not wanting us to learn what high carb and low fat diets did to our health.” The person said yes, and the doctor said she agreed and her husband said he agreed as well. He went on to say that how were we going to maintain our health on the limited number of strips.

He then announced something that surprised even me. They had written all of the test strip manufacturers and all of the insurance companies they knew were being used by people there and were waiting to receive replies from two of the manufacturers. He said the responses to date would require copies of the front page of each person's federal form 1040 for the prior two years and they would need two copies of each, one set for the test strip manufacturer and one set for the insurance company. Once they had all the copies, they would send them all in and then they would be provided with a list and what would be allowed for each person. At that time, an email would be sent to each person with the details and a return form to say if they wanted to participate or not, and what their cost would be and the amount the insurance company would allow.  He concluded by saying that it may not benefit everyone, but unless they participated, they would not know.

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