July 14, 2012

Is Nanotechnology A Threat to Our Food?

Is nanotechnology a threat to our food or even to our food supply? This is a question I do not have an answer for at this time. I can only give you what I am learning and raise additional questions. You can go about business as usual or start researching for facts yourself. We already have alarmists crying about this with few facts in hand. On the scientific side, we are being told that they are safe, but again no proof is being presented. The driving force seems to profit behind the advances in nanotechnology.

The Food and Drug Administration (FDA) has finally issued two draft guidance documents on nanotechnology on April 20, 2012. This means they are looking at the issues, but have not made any decisions or formed any planned actions. With nanotechnology having been in existence for more than a decade, we should have had firm rules and regulations. Even the Environmental Protection Agency (EPA) is only studying the subject and has not decided whether to take action. In the meantime, the barn door has been left wide open and the horses have gotten out.

We will probably not know what damage has been done for another decade or longer and then the good work of some nanotechnology will be suspect when the bad side of nanotechnology is discovered. Farm chemical companies and food manufacturing and related industries are adding nanoparticles to our fertilizers, pesticides, and other processes in the name of food production, safety, and storage. No scientific proof that this works or is safe for humans has been studied or proved. Does this remind you of another problem that we have very little science proving that the food is safe? It should remind you of genetically modified foods (GMF). Even the US Department of Agriculture is silent on both subjects. They only repeat what agribusiness is promoting.

Until the appropriate government agencies do appropriate scientific studies, all nanotechnology should be held and not put into use until proven safe for the environment and human health. As of yet neither side had proven anything about nanotechnology and its uses are safe. There are great potential benefits to be derived in many fields, medical, medical devices, human health, but until it is proven, we are playing Russian roulette with our lives and the lives of our children. We don't know that the packaging advances with nanotechnology that can wrap our foods and prevent spoilage will not have a health impact on our lives.

Some of the alarmist’s cries may have validity, but until scientific research proves one way or the other, can we accept that advances in nanotechnology will really be a benefit.

With this in mind, read what this alarmist is saying. A reasoned voice can be read here about nanotechnology in our cosmetics and food. If you have an interest, follow the links provided in the article. This second article also points out something we need to have in our minds. That is the legal way that many companies are bypassing putting information on our food and cosmetic labels.

I can envision many of the good benefits from nanotechnology such as medications being delivered to areas of the body and deposited where they will give the greatest benefit. They would not being broken down by our stomachs and intestines before getting where they are needed. In addition, these delivery nanoparticles can bypass healthy cells and not damage them while delivering the medications to the unhealthy cells.

I do not have definitive answers, and until I can find them, I will continue to have doubts about the current use of nanotechnology in our food production and food. We need to encourage the FDA and EPA to step up and promote scientific research to give us answers. Forget about the USDA, as they will continue to shield the food industry and agribusiness. For that, I will find them complicit in any harm resulting from nanotechnology.

July 13, 2012

Back to Diabetes Basics – Part 8

Learn to Count Carbohydrates

Many people say this is too complicated and try to guesstimate. This is a bad habit to get into and should be avoided. Do I guesstimate? Not that often and with eight years plus of calculating carbohydrates I have gotten fairly adept at doing this. I do make mistakes, but not that often. I hope that you will find some tips that you can use.

If you are lucky enough to have a class with a certified diabetes educator (CDE) or a registered dietitian (RD) and they cover how to read and understand food labels, absorb everything they tell you. I did not have either one that knew what they were doing and labels were to be ignored by them. Therefore, I had to learn on my own. Lucky for me a neighbor, at the time, was a nutritionist and she saw me reading labels in the grocery store one afternoon and asked if she could help. I admitted that I was having some success and that I would like to make it easier.

Now let me back up and cover a couple of other things first. Do not go out and buy cookbooks that have the word diabetic in the title. You will find that most are written by someone without diabetes and the recipes are overloaded with carbohydrates. Most are also for foods that few of us can actually afford some of the ingredients in the recipes.

Do consider buying some of the new editions of the standard cookbooks, Betty Crocker's and Better Homes and Gardens that have the nutritional information with each recipe. They also have the servings per recipe making calculations easier. Example: the recipe makes 6 servings and there is 28 grams of carbohydrates per serving, you have the information. Now I would normally say that it made 12 servings and that would mean I would have 14 grams of carbohydrates per serving. Granted, I normally chose servings of four so that I would only have eight servings to eat since at the time I was living alone.

I did cheat and have a gram scale and an ounce scale and still do and I use both. I would always weigh the container in which the food was to be cooked and then I could subtract that from the total weight or have a tare weight. If I wanted the recipe to serve six servings, I would weigh the plate or container to transfer the food to and tare the scale and then I knew how many ounces to transfer and could compute the carbohydrates. I could then add so many ounces of vegetables and compute their carbohydrates.

I do not know what food this label came from, but I will use it for a brief discussion.

Before going further, I need to point out that the FDA allows food labels to vary by 20 percent. This is bad for us with diabetes, but is the reason I always stress that you need to use your meter to see if the numbers are high or low after eating. Then you can have a variance of 20 percent with your meter. Did someone say this is a crap shoot. You may be right, but over time I have discovered that in general most canned foods are fairly close to total weight and carbohydrates. Now recipes in any cookbook with nutritional values may not be as close. There are too many variables for precise accuracy. To begin with when you purchase the ingredients, there may be a difference in the quality you purchased compared to the sample tested to arrive at the figures used in the cookbook.

This label is still a good example to use. Each serving has 40 grams of carbohydrates and only 4 grams of dietary fiber. Since I follow the rule of counting half of the fiber when fiber is 5 grams or more, I do not subtract any grams for fiber.

This is a point of debate by many and my former neighbor said only subtract one-half of the fiber if the total fiber per serving is 5 grams or higher. Some subtract all fiber regardless and others will subtract one-half of any amounts of fiber. Unknown on most labels is whether the fiber is water-soluble or not. The total grams are 275 grams so that if I have a 30-gram serving, then the carbohydrates would be 5 times 40 grams or 200 grams. Multiply 200 by 30 and divide by 275, which equals 21.8 grams of carbohydrates. Or, multiply 40 by 30 and divide by 55, which equals 21.8 grams of carbohydrates.

This is one reason I find the scales so useful as they can resolve carbohydrates amounts very quickly. So with the costs of the scales and a hand held calculator, I have gotten my money out of them many times over. Yes, I do spend a little more time getting this information, but it does allow me to be more accurate and know what I need to cover with insulin. Then my meter reading will confirm this and I will know that the serving size was correct. For oral medications, the meter becomes even more important to determine if the serving size was too large, too small, or just right.

Here are a few tools that you may find useful. First a book by Gary Scheiner M.S., titled The Ultimate Guide to Accurate Carb Counting. I have a different book, but this does come highly recommended. A website that may interest some is this one that has nutritional values that can be determined from a recipe. It is my understanding that you need to join to have access to the information here, and it is free. You may also get the nutritional value from a list of ingredients. There are other websites that you may find by using your search engine.

Diabetes Burnout

Why do people with diabetes have diabetes burnout? There are probably many reasons, but I think a majority of people just get tired of managing diabetes 24/7/365 with no vacation or time off. You test, eat correctly, exercise when capable, take your medications timely when you should and still diabetes is there waiting for you to make a mistake so it can gain the upper hand.

Will Ryan has several blogs and an introduction that often can help with diabetes burnout. His site “Joyful Diabetic” is worth reading and it does reflect his positive attitude. For many a positive attitude with managing your diabetes can help you through a down time and even burnout.

William H. Polonsky Ph.D., CDE, has written a book titled Diabetes Burnout: What to Do When You Can't Take It Anymore. This is one that I will be adding to my library. It is also available on Kindle.

Series 8 of 12

July 12, 2012

Back to Diabetes Basics – Part 7

Medical Alert Jewelry

When I started this series, I did not realize that I would find so many topics that could be considered good basics, and I haven't even covered oral medications. Medical alert jewelry is something many people do not consider until it is too late. For many, this realization happens after they have their first episode of hypoglycemia. The police may become involved because of erratic driving and because people display symptoms very similar to a drunk driver, they are arrested and jailed without treatment.

Or, a family member discovers you on the floor passed out. They do the proper thing by calling 911, but forget to say you have type 2 diabetes and you are hooked up to an intravenous (IV) solution loaded with dextrose and this is continued when you arrive at the hospital. Now you are in hyperglycemia and nobody knows you have diabetes yet. Think of the damage that could have been prevented with medical alert jewelry.

If you think I am in favor of wearing a medical alert piece of jewelry, you are right. I have talked to the first responders in areas near my town and in my town, and they are trained to look for medical alert jewelry, and even tattoos in conspicuous places. They may not find some that are tattooed in private areas. I have written several blogs and while you may not agree with every thing I say, please consider wearing a medical alert piece of jewelry or a medical tattoo. The blogs are four and can be read here, here, here, and here.

Diabetes Management and Doctors

Here is where I normally get aggressive with the doctors, but this time I will try to cut them some slack. Diabetes management is primarily the responsibility of the patient and this is the focus for most of this discussion. Why? The doctors cannot live with you (unless you are married to the doctor), they see you less than one percent of the time in a year, and the rest of the time, you are generally on your own.

Now I know that you as the patient are not always supplied with all the information necessary to understand and manage your diabetes. Don't always blame the doctor, as there is only so much time available for an appointment. If you doctor gives you some information, this shows he/she is trying. He does have time constraints especially if he does not own the practice and works for another doctor or is employed by a hospital. Both can be so profit minded that they do not often allow for proper patient care. This is why other types of medical practice are finding openings and gaining acceptance rapidly.

So just who is stopping you from managing your diabetes? Is it family members? How I dislike saying yes, but family members can be the worst in preventing good diabetes management. Why would I say this about loving family members? Well, loving family members can be the least understanding and the most unwilling to learn about diabetes. They just want you to take a pill and return to the life you had with them before diabetes.

Many family members could care less about diabetes because you do not look sick and are doing the same things for them that you were doing before diabetes. Even your loving spouse can totally ignore diabetes and not want to learn about it. Why would I say these things? Because I read about this on many diabetes forums. Husbands or wives not supporting the spouse with diabetes.

Then the family members can be very irritating when they become the diabetes food police or the diabetes police. Asking you why you can still eat that piece of candy or cake when it is loaded with sugar. Even though you have allowed for this treat and compensated for it with what you have eaten, they will still not leave the subject alone. They don't understand that sugar is not the only thing you need to be careful of consuming.

They do not understand why you will not eat many foods and have very small servings of others. They start hearing horror from well meaning friends and translate this to fear about you developing the same problems. They become your worst nightmare as the diabetes police and some can become very belligerent in their actions.

Then there are those family members that will just not cooperate. You have gotten rid of the junk food and are working to convert everyone to more healthy foods and doing more cooking and serving more fresh foods. They insist on eating no differently than the past and won't accept the change like they won't accept that you have diabetes.

There are families that do support each other and do whatever they can do to make things easier. They know and accept the change in foods and understand that things are now different and they are benefiting as well by the changes being made. This makes for a much more loving family and home. If you are so blessed, do everything to keep this blessing and make it grow.

Now back to you! Yes, I am talking about the person with diabetes. No, I'm not going to give you a pass. We have all been through the stages of grief many people experience after receiving the diagnosis of diabetes. So get over the anger, put the denial behind you and make up your mind that you want to live and manage diabetes.

Learn that diabetes is not your fault. Could you have prevented it? Not likely. If doctors would have done screening on a regular basis, maybe, if they had paid attention to the results. The one chance you had may have passed. But if you are strong willed and decide, if you are medically able, to do the exercise and nutrition with enthusiasm, you may be capable to getting off medications for a period of time. This will depend on the damage already done to your pancreas. Some are able to stay off medications for decades while others only for a few years.

Many people do not comprehend that because diabetes is often different for each person, that they now have become their own science experiment. Testing can be very difficult as Medicare and most medical insurance companies are strictly limiting test strips that they will reimburse. Testing is necessary to determine how your body reacts to different foods. Testing is also necessary to give you a report on how you are managing diabetes. Numbers are just numbers if you don't make use of them.

Good luck and learn to manage your diabetes, deal with those around you, learn to make the best use of your doctor(s), and other resources.

Suggestions for Doctors

Yes, some doctors do accept suggestions. I hope that these make sense and will help them help patients with diabetes. I urge doctors to visit this page of the Association of Clinical Endocrinologists and at least give this as a handout to their patients with diabetes. Even family members could benefit if they are receptive. While this page has existed since September 27, 2011, their experts have not seen fit to add more websites to the list. Why? That I cannot answer, but I think they have decided to stop rather than promote more sites. Note: The above link no longer exists because AACE could not do what was necessary.

Certainly many doctors do use the Internet, and have their favorites for diabetes that they could add to this list. Some doctors do have contact with nutritionists and could have a handout for this as well. A very small number of doctors are making use of peer mentors in some locations to be mentors for certain aspects of diabetes, like proper hand washing and testing locations and even use of their meters. There may be other areas of use.

Series 7 of 12

July 11, 2012

Back to Diabetes Basics – Part 6

Exercise Is a Key in Diabetes Management

Maybe some of us emphasize this too much and too often, but it is one truth that many people with diabetes just feel they can ignore. You will get tired of this as well; many type 2 people just say, “Apparently the doctor did not feel it was important as he/she did not talk about it.” I am beginning to believe these people need a hearing test, but I do know a few doctors that are afraid to say anything also. This is a deadly set of circumstances to work with in attempting to get people to exercise.

Always consult with your doctor before beginning any exercise regimen. If you are on medications, your doctor may want to give you different dosages to use under different circumstances to prevent hypoglycemia. Even if you are not on medications, the doctor may have other health concerns that you may need to consider. I have discussed blood glucose levels for safe exercising in my blog here. Knowing this information will save you from problems while you exercise.

I have more information about how a neighbor made me realize how important exercise is. He has had the second operation and is walking with a cane today. He is still unable to drive, but he walks just about everywhere and will not accept a ride. Yes, I have driven when he has too far to walk or needs to travel to another town. Even when he needs groceries, he walks and shops for only what he can carry. You have to admire him for his determination. If anyone could have given up, he could have been the person, but he has met every opportunity to educate others and show them what a person can do.

Lifestyle Changes

Do you know what this means? Many people have some idea, but it can be very general. This may be just semantics; however, I would like to clarify some parts of the term “lifestyle”. The definition from an on line dictionary says lifestyle is a way of life, the attitudes, tastes, moral standards, economic level, etc., that comprise an individual or group.

This of course says nothing about diabetes and managing diabetes. In my reading, blogging, and participation in a few diabetes forums, I have seen lifestyle described many ways. I have a slightly different perspective as most writers start with diet. I believe the elements of lifestyle change should start with exercise if you are physically and medically able. It is the key that generally makes the rest of lifestyle fall into place.

What you need to recognize is that all are interlinked and bypassing one part of lifestyle change will normally make other changes generally unachievable. What different writers choose of emphasize depends on their philosophy and how they view their career. Most that work in the medical profession, be they doctors, nurses, educators, dietitians, or licensed caregivers, must follow the guidelines of the American Medical Association, the American Diabetes Association, and other professional medical groups if they want to have their license updated and current.

Since I answer to myself and a few bloggers that agree exercise should be listed first, this is where I will start. This is the list I have pulled together from various sources. It may not agree with everyone's list, but for me, the list needs to be updated as changes are found that affect the way we look at diabetes and lifestyle.

The main elements of lifestyle should or must include the following: exercise, food, sleep, food, medication, weight loss, illness, hormones, stress, heart health care, and two other elements, alcohol and smoking.

Exercise – If you are physically and medically able, get your doctors okay to exercise, and remember to exercise good judgment and don't do something that will be wrong and cause injury. Start out slowly and build up gradually. Regular exercise helps make insulin more readily available and reduces insulin resistance. Find a form of exercise or a mix of routines that you enjoy and follow through with it.

Food – Healthy eating is important and even more important if you are medically unable to exercise. It is good to be consistent in eating times and amount of food. Whether you eat low carb or another way, learn to use your meter to determine how different foods affect your blood glucose. Learn to coordinate your food with the medication you are taking. Also, learn to eat to your meter and learn to trust it.

Sleep – Where did this come from? It is not included on most lists, but should be after a study I wrote about here. I keep being surprised how important sleep is to our well-being as a person with diabetes. That is the main reason I am adding it to lifestyle and encouraging all to get the sleep needed. If you are having trouble getting enough sleep, change your habits and if that does not help, talk to your doctor about doing a sleep study to determine if you have a form of sleep apnea.

Medication – Be sure that you follow the doctor’s instructions. Yes, I know that you want to avoid all medications. This is an excellent goal if you are diagnosed early on and can make this work. Remember that you need to consider getting the diabetes managed as soon as reasonably possible. Do discuss with the doctor getting off medications if you do it. If you do bring diabetes under good management and the doctor wants to keep you on medications, then ask yourself if a change in doctors needs to be considered.

Heart health care – Because people with diabetes are at 50 percent risk of having cardiovascular events, many of the same changes for diabetes help with heart health. It may still be necessary to consider medications for heart health. Exercise and food choices become primary for heart care and managing cholesterol and hypertension.

Weight loss – This is easy for some people, while others struggle with this every day. The first goal should be stopping gaining any weight. Then adapt your food intake to help start reducing weight. Generally if you are overweight, a high carbohydtate, low fat diet will not help you reduce weight. There are more and more writing about low carb, high fat. However, you need to find what works for you in assisting to bring down the weight. I will not suggest how, since I am still working on this myself.

Illness – This was a little surprising until I thought about how illness affects our diabetes management. Therefore, as an element of lifestyle change we need to learn to take our medications timely and know when to talk to the doctor about variations like illness which can cause problems unless we know not to take certain medication to prevent hypoglycemia. This means having a plan with your health care team of what medications to take or not take during an illness.

Hormone levels – This is normally for women who have problems with blood glucose swings related to the monthly menstrual cycle. I personally think the authors failed to talk about the change in life for women and problems some men can have when male hormones cause problems and can affect blood glucose as well. You need to talk about this with your doctor to be prepared for these changes.

Stress – This is definitely a lifestyle change that affects everyone with diabetes. When stressed, almost anyone can toss aside their usual good diabetes management practices, forget to eat healthy foods, and lose control of your blood glucose. Prolonged stress may prevent insulin from working properly which also creates additional problems. Some find logging your stress level (1 to 10 scale) each time you log your blood glucose level helps them see patterns and allow you to adjust accordingly. Learn about ways to relax and find ways to reduce stress.

Alcohol – This can be a bad one if not thought out. First, you need to talk this over with your doctor. Alcohol can aggravate diabetes complications like nerve damage and eye disease. If your diabetes management is excellent, and the doctor agrees, an occasional alcohol drink with a meal may be okay, but a daily drink is generally discouraged.

Smoking - This is a habit that must be broken. Many writers do not want to cover this lifestyle change that needs to happen and the sooner the better. Not only does this increase the effects of neuropathy, but it can affect an increase in cardiovascular risks. Do not take this lightly; the effects of continuing to smoke do not make blood glucose management easier.

To sum up, these are the lifestyle changes that need attention for those of us with diabetes.

Series 6 of 12

July 10, 2012

Back to Diabetes Basics – Part 5

Diabetes Complications

Complication don't cause themselves. Poor or no management of diabetes – meaning not testing, not losing weight, not eating healthier, not making other lifestyle changes, and no blood glucose management is what causes the complications. So what are the complications?  Retinopathy, neuropathy, nephropathy, atherosclerosis, and deafness are the most common, and many don't include deafness. The first three and deafness are grouped together under the term microvascular complications because they result from damage to the small blood vessels. The macrovascular complication is atherosclerosis, which is caused by damage to the large blood vessels.

Retinopathy causes damage to the retina, which may lead to poorer eyesight or blindness. Neuropathy causes damage to the nerves, which cause pain and can be more than annoying pain. Nephropathy causes damage to the kidneys or increased renal problems leading to kidney failure or chronic kidney disease (CKD). Deafness or hearing loss is caused by the eardrum losing the ability to transmit sound because of short blood supply. Atherosclerosis can lead to heart attacks, stroke, or poor healing of wounds in the feet and legs. This is the cause of amputations.

These are the reasons those of us that blog about diabetes for people with type 2 diabetes discuss this so often. We are encouraging you to manage your diabetes by maintaining your blood glucose levels at or as close to normal as possible to prevent the complications from starting. The closer your A1c is to 7.0 percent or above, the greater the chances are for the complications developing. That does not mean that people with A1c's of 6.0 will not develop complications, just that their risks are smaller and increase the closer to 7.0 they become. Above 7.0, the risk of complications rises dramatically as A1c's goes up.

That does not mean that once you have an A1c above 7.0 that you give up. By managing your diabetes more carefully and bringing the A1c back to 6.0 or lower, you can stop the complication from progressing or slow it dramatically. Damage will still likely have been done, but if stopped or slowed, you may not notice any change and if early enough your body may be able to heal the damage. Continued forays above 7.0 may mean that the damage will become worse and your body may not be able to heal or repair the damage. Keep a positive attitude about managing your diabetes and work to manage your diabetes and not diabetes managing you.

Diabetes Myths

Diabetes myths are a dime a dozen and I keep hearing about them again and again. Why people have to believe them is not something I understand. I was not exposed to many of them until after I had diabetes for a year and had been on insulin for about as long. I knew immediately when confronted with them by a person that is no longer a friend that there was little or no truth in what he was telling me. In an hour, I lost track of the number of myths he was repeating and finally had to ask him to leave.

That evening after cleaning up after my evening meal, I did go on the computer looking for some of what this person was telling me. Even then, there was not a lot of information about some of what he said. I started looking on David Mendosa's website, but even he did not have a lot in December 2004 about what we refer to now as myths. I did locate this item and it got me started looking for more. Eventually I did find a site that today no longer has the page David wrote about, but back then, it was as David described it, “While several Web sites around the world have a page like this, Diabetes UK's is the best and most authoritative of any that I've seen.”

I now wish I had copied the page, as I am no longer able to locate it. They covered a lot of myths and then gave an authoritative explanation. There were sites that listed myths with no explanation, but many were like or similar to things my visitor had sought to enlighten me. The following evening, he returned with a fresh list and wanted to educate me with his diabetes knowledge. I patiently informed him that these were myths and had no basis in fact or scientific evidence. He went ballistic on me and said I did not know what he was talking about and if I truly had diabetes, I would understand what he was saying. With that, I walked him to the door and informed him that I had diabetes and was on insulin. “Oh,” he said, “I did not know you were that close to the end.” I then told him to leave and never come back if he was going to talk about diabetes.

I have also blogged about diabetes myths. Rather than repeat them, I will link them and let you read them - Blog 1, Blog 2, and Blog 3. Another blog that talks about a myth here and then this one on insulin and weight gain which is often a fact for many people, unless they are aware of the things to do right and prevent this from happening. One myth that I find little to support was told to me by a diabetes educator and it was that type 2 people could not see an endocrinologist. Funny, I see many type 2 people having appointments with an endocrinologist.

Diabetes Scams and Scammers

Diabetes is ripe with scams and scammers. To get you started, read this article by David Mendosa. In the article, the government list no longer is a valid link, but David did list some of them and I don't know if they all work, but I like the list just for show of the types of sites trying to scam us. Many more have appeared since David wrote this in October 2006. Some sites are very slick in their design and enticing to any readers they can lure to their sites. I have had several email me in the last year wanting me to advertise their products. After a thorough investigation of their site and the claims some make, I can see right through the scam or falsehood, if you will allow.

I am unlike David and I will not even give you a link to any scamming site as I will not give them any notice since they do not deserve being noticed. Yes, I could educate you by listing them, but I don't need the hate mail several of them are well known to retaliate. There would still be readers that would fall for some of the information so I feel better not listing them.

If you think these are the only types of diabetes and other scammers, guess again. Tom Ross has a blog here that uncovers some that are involved in research and scamming funds to do research. I was almost in disbelief, but after checking with a couple of sources within the pharmaceutical industry, they confirmed this blog, but would not be specific about what had been done.

Food for Diabetes Patients and Introduction to Glycemic Index

This is not a topic to be taken lightly by people with type 2 diabetes. However, the one comment I get all too frequently is, “the doctor just told me to eat more healthy,” or “my doctor said nothing about what foods to eat or not eat.” I often have to wonder if this is selective hearing, or the doctor really did say nothing. I know many doctors are not knowledgeable in nutrition for people with diabetes so this is possible. I also know some people bypass the appointments for a class in nutrition and feel it is too late for them to change. Unhappily their A1c results are reflective of their habits – above 8.0 and often much higher.

Even though I am a little over expressive in this blog on diabetes diet, it still covers some important points. Another blog is here. I have mentioned the glycemic index for foods. The best reference is here in the books blog, The New Glucose Revolution, New York, Marlow & Company, 349 pages, by Dr. Jenny Brand-Miller, et al. It is in a sense the best available currently.

Do take time to study the glycemic index tables for foods. Do not believe these are gospel because the index is determined by testing normal people and not people with diabetes. Do use it only as a guide for determining which foods may rapidly raise your blood glucose. By using your search engine, there are many available (key words – glycemic index). Table sugar has a glycemic index of 80, so compare that to the white potato.

My words of warning are good, and a guide is what it should be. It is not about complete food nutrition and is good for giving you guidance to foods that will not spike your blood glucose levels.

Series 5 of 12

July 9, 2012

Back to Diabetes Basics – Part 4

Proper Hand Care for Blood Glucose Testing

Hand washing is an important part of preparation for blood glucose testing. Laugh if you will, but about 95 percent of people testing blood glucose skip hand preparation over 50 percent of the time. I am also guilty as charged, but I calculate it is about 10 percent of the time that I don't wash my hands a well as I should. Being on insulin makes me more careful and much more concerned in obtaining the right reading before injecting insulin.

My eye opener was a reading before having my evening meal about two years after diagnosis. I knew what my carbohydrate count for my meal was and then added my correction to the reading. About three hours later, I was nervous, sweating, and wondering what was happening. I thought to test my blood glucose and it was over 200 mg/dl (11.1 mmol/l). I knew that was wrong as I would not be feeling nervous and sweating. I did think to wash my hands very carefully and dry them and retest. Reading then was 42 mg/dl (2.3 mmol/L). I grabbed three glucose tablets, started chewing, waited 15 minutes, and retested. Only up to 65 mg/dl (3.6 mmol/L), so had another glucose tablet and repeated. My blood glucose was 77 mg/dl (4.3 mmol/L) and I figured that I would wait another 30 minutes and test again. This time the reading was 81 mg/dl (4.5 mmol/L) and I knew I was okay.

Yes, the low reading scared me. I realized that I had eaten something with my fingers and one of them was the same finger I used for testing. From then on, I was careful about washing my hands and drying carefully. 

I had a very smart pharmacist who asked me why I was buying so many alcohol pads shortly after being diagnosed. I told her they were for cleaning my hands before blood glucose testing. She suggested that I put them back on the shelf and not use them. She examined my fingers and said no damage yet. She then said the alcohol pads would dry out my skin and the skin would start to crack. Since this was December, I knew what she was saying and when they did crack, my fingers would be sore. Testing would not be painless and I would dread doing it. Yet our companies still want us to use alcohol pads instead of warm water and soap to clean our hands before testing. Ignore their advice, please for the sake of your fingers and testing reliability.

One huge example of this appeared January 31, 2011 in Diabetes Care. The same study then appeared in Reuters Health on February 9, 2011 and is worth reading. If you needed to be reminded of the importance of washing your hands with warm water and soap, this should be a good reminder. So if you have a BG reading that seems too high or too low, please ask yourself if you washed your hands properly and thoroughly dried them (particularly the finger you will use for testing). If you are using insulin, this is very important. You want to inject the correct amount of insulin to prevent hypoglycemia especially, and you want to prevent your BG levels from rising into the levels for hyperglycemia.

Another good article with tips to make testing less painful is here. Please read tip number 8 because he does not mean the front of your fingertips so read the entire point.

Importance of Self-monitored Blood Glucose (SMBG) and Type 2 Bloggers

I started this topic in Part 2 of the series in “Some of the Testing Basics.” Knowing when, where, and how to test needs to be supplemented with the why. First, you should know where to test. Use the side of your fingertips. This has two advantages: there are less nerve-ends than on the pads, and it doubles the number of test-points so you can rotate through the positions. I also use the pads, which does get me to change the lancets a little more frequently, but you don't need to do what I do.

Alan Shanley has three blogs that are all on the topic of testing and for his perspective read his blogs – “painless pricks”, “test, test, test”, and “test, review,adjust.” You may use the search box on his site to search for and read his blogs on SMBG. Another website that should be on your listfor reading is by Jenny Ruhl. These sites cover the reasons, the why, how, where, and when.

You may also test on other parts of you body, arms being to next most popular area. If you are generally consistent in your blood glucose, you may be okay testing there. If you are inconsistent, please avoid other areas of your body. The blood glucose readings will be about 15 to 20 minutes behind your fingertips. When you are having hypoglycemia, you do not want this delay, as this could mean going lower than you want without treating properly. This is one reason many of us discourage using other body areas and staying with the fingertips.

When to test will depend on the number of test strips you are able to utilize. You should be able to test at least two times per day if on oral medications or no medications. If you are using insulin you should be able to use four test strips. Whether you are able to test more will depend on your own budget and possible assistance from the manufacturer of your meter and test strips. Some do have good assistance programs. It is generally suggested that one of the testing times be your fasting blood glucose test upon waking. If you are limited to two times per day and unable to afford additional test strips, then consider saving them for a needed time when you have messed up a strip, have an emergency, or need to use them to prevent them from passing the expiration date. You may also use them for testing after a meal. I suggest using them at the 1 hour mark after your heaviest meal, or the meal having the most carbohydrates.

Make sure you use a logbook or other form. I use a steno pad or wire spiral notebooks for recording my BG readings, the time, insulin injected, and food log and time of eating including snacks. Most meter manufacturers have software and cables available for use at a price. I do use mine and like the charts and graphs, which shows trends and readings in the hypoglycemia area and hyperglycemia range. Otherwise you have to chart your readings to see trends. This is the why, when, where, and how of testing for type 2 diabetes.

This is to inform you of the need for extra testing if you have an emergency and the doctor puts you on steroids. Make sure you know the name of the steroid to be used and discuss diabetes management with your doctor while taking steroids. I believe all steroids, and know most steroids cause blood glucose to be extremely elevated and make steroid use undesirable. However, they are often medically necessary. Do not be afraid of using insulin to assist temporarily in the management of blood glucose while on steroids. Oral medications can seldom manage blood glucose levels during steroid use.

For those looking for other good type 2 blog sites, David Mendosa writes here and here and the last one has pages and pages of excellent information. Gretchen Becker writes on the Internet here and here. Jenny Ruhl also writes here in addition to the above linked site. Tom Ross writes here and is not on medications as he has managed his diabetes with diet and exercise for ten plus years.

If you are looking for books, read my blog here. Check with your library to see if they have the book so that you may preview it. I own and have read all the books listed and own several more.

I have given you many links so that you become familiar with the sites and bookmark those that you enjoy, if you have not found them already.

Series 4 of 12

July 8, 2012

Why Can’t BG Meters Tell Me My BG levels?

This blog upsets me in so many ways. First, blood glucose meters are just that; designed from the beginning to read the blood glucose levels from the test strips containing a sample of your blood. Sugar is sugar and not blood glucose. Sugar is a carbohydrate and is converted in the body to glucose.

Why do writers of articles and blogs make the assumption that blood sugar is blood glucose? I would guess because they do not understand the chemistry that takes place and think they are doing their readers a service. This also means that they do not understand diabetes equipment; correct, they do not understand or even know about their diabetes equipment. Even this type 1 writer does not know diabetes equipment, just how to con readers and attempt to sensationalize something. It is this type of misinformation that creates problems for the rest of us with diabetes. And to this, I say BS does not mean blood sugar, but bullshit.

Readers see one person misusing terms and think when they confront others with diabetes that they are knowledgeable. This really makes it difficult for us to educate people about blood glucose and diabetes equipment.  In the last week, I have had three panic emails about this post.  I have had to explain to people new to diabetes what is really at issue and how to read misinformation like this.

The writer's complaint about the lack of blood glucose accuracy is the only valid point she makes. Even our Food and Drug Administration can't figure out how to solve this. While the FDA does acknowledge that many of us are using our blood glucose meters for tight blood glucose management, the FDA admits this is not the intended purpose. If the blood glucose meters are not safe and effective as they should be, why did the FDA allow them on the market? It is the test strips that need to be more accurate.

Now I know my meter can give me erroneous readings because of expired test strips or contaminated test strips, but when checking it against the laboratory results of a blood draw, my meter reading has always been within 5 mg/dl (0.3 mmol/L) of the blood glucose results, and a few times the same reading. As a result, I have confidence in my meter and test strips – although the FDA says I should not. People that use different meters consistently should expect large variances in their readings. We do not know if the meters used were stored properly or not. We also do not know how the test strips were stored.

The author of the blog laments about the accuracy and further states “we’re on the launch pad for an artificial pancreas — where accuracy will be even more critical — why don’t I have a meter that gives me an accurate reading of my blood glucose.” I say then that they need to have the continuous glucose monitor (CGM) mounted on the fingertips for greater accuracy instead of other places on the body where the readings are always 15 to 20 minutes later than the fingertip readings.

Maybe the FDA needs to withhold approval of the artificial apparatus until the problem can be solved for placing nanosensors in the fingertips and nanofilaments or nanowires under the skin to the CGM. Or maybe a reader of nano or microsensors will be developed to solve this problem. This writer should not have to realize that she is 15 to 20 minutes behind time when needing a reasonably accurate blood glucose reading.

As for meter accuracy distortion, this is understandable when they are jammed into bags, purses, pockets, and other places where they were not intended to be stored or carried. I have seen test strips wedged in the meter slots and jerked out. With this happening and no care of where the meter is stored, it is small wonder dirt, lint, and test strip particles could affect the accuracy of the blood glucose meter. This is delicate equipment and if you want accuracy within FDA guidelines, treats it accordingly. Some people even store meters and test strips in car glove boxes or on the dash in full sun and heat, so how can they expect accuracy?

I can believe medications taken can possibly affect blood glucose readings, but I have no information as to which medications or dosage required. The article referenced mentions maltose given while people are in the hospital. Surprise, maltose and dextrose are commonly used in the hospitals. We should expect elevated blood glucose readings from dextrose and administer insulin accordingly. Maltose does give a falsely elevated blood glucose reading on most test strips. This is why people need to be aware of what the hospital administers. Hospitals are nefarious for not informing patients about medications they deliver and ask patients to take or inject into patients.

I know how improper hand care and washing can affect blood glucose readings, been there, done that. Still people insist on accuracy even though they will not wash their hands or fingers after handling food. Many ignore the fact that they should wash with warm water and soap and dry properly and then declare their meter is inaccurate.

To my readers, please know that there are many variables and that as things currently exist, we have reliable meters and some that are not so reliable. It is the test strips that determine meter accuracy and until our test strips can be calibrated to a more accurate degree of precision, we cannot expect our meters to be any more accurate.

Even I occasionally will have a lapse in memory and say meter when I should say test strips. The meter can only relay what it reads from the test strips. This is the purpose of the battery in the meter to create electronic communication to interpret what the test strip is reporting and translate this information to a reading on the meter. If the meter has dirt or lint in the slot that the test strips are inserted in, then it may be difficult for the meter to accurately read the test strips. The meter just interprets the results of the test strips in a language we can read on the meter. The test solution use to determine test strip accuracy does not change the meter. It can only let you know that the test strips are good or bad. This can happen to a container of test strips.

The meter is calibrated at the time of manufacture and can be altered by improper storage and dropping the meter. The test strip box has an expiration date so that reasonable reliability is maintained. Storing the container in moist conditions or direct sunlight can alter the reliability of the test strips in the container. It is possible for the meter to malfunction or go bad like it is possible for test strips to become unreliable. Proper storage and handling of both is important. Dirty (or contaminated) fingers handling the test strips improperly can affect the readings as can food on the area of blood wicked into the test strip.  For more information on storage and use of test strips, read my blog here.

For information, I use the Accu-Chek Aviva meter and currently the Accu-Chek Aviva test strips. I have been notified that the next order of test strips will change to the Accu-Chek Aviva Plus test strips. They will work in the current meter. The notice states, this is to improve the accuracy and sensitivity of my blood glucose test results. The information I was able to locate about the Aviva Plus test strips says, “New generation of test strips offers advanced chemistry and safety for self-monitoring of blood glucose.” The next paragraph states, “The new maltose-independent test strip is designed to prevent the interference of maltose on blood sugar readings which can occur in rare cases when drugs containing or metabolizing to maltose are parenterally administered.” This takes away the concern about maltose above.

Position Statement on Diabetes in the Elderly

American Diabetes Association (ADA), pay attention, you just might learn something!  Three international groups have taken the first step in the establishment of guidelines for a global initiative to improve diabetes care for the elderly.  They will address age related problems for their care.

The three groups are the International Association of Gerontology and Geriatrics, the European Diabetes Working Party for Older People, and the International Task Force of Experts in Diabetes.  The group realizes that most international clinical diabetes guidelines fail to address problems common in the elderly, such as frailty, functional limitation, mental health changes, and increasing dependency on others for help.  This is a problem that is ignored in the USA.  Yes, the ADA pays lip service to the individual needs, but has not addressed the needs of the elderly.  It is still a “one-size-fits-all” policy.

The authors write, "the effective management of the older patient with diabetes requires an emphasis on safety, diabetes prevention, early treatment for vascular disease, and functional assessment of disability because of limb problems, eye disease, and stroke. Additionally, in older age, prevention and management of other diabetes-related complications and associated conditions, such as cognitive dysfunction, functional dependence, and depression, become a priority."

The authors list in the purpose of the position statement the following:
  1. Arrive at a consensus on how we approach the management of key issues of diabetes care for older people.
  2. Identify a series of key areas for diabetes-related surveys and/or audits of clinical care within a range of countries. These may take the form of surveys of particular drug usage, mortality and comorbidity rates, models of care, and use of clinical guidelines in clinical decision making.
  3. Recommend up to 3 to 4 research areas that could be considered for further investigation using selected research tools, and that could form the basis of one or more collaborative research proposals.

The authors then identified major research areas that need to be explored, including:
  1. the use of exercise, nutrition, and glucose-lowering therapies in the effective management of type 2 diabetes in older people;
  2. practical community-based interventions to reduce hospitalization;
  3. methods to decrease hypoglycemia rates in various clinical settings;
  4. health economic evaluations of metabolic treatment;
  5. interventions to delay/prevent diabetes-related complications that are important in older age, such as cognitive impairment and functional dependence; and
  6. development of technical devices that help to maintain autonomy and safety for older people with diabetes.

Now we will need to wait and see what is issued in the guidelines and if other areas come to the surface during the formation of the guidelines.  If this was the ADA doing this, I could guess that it would be more platitudes and lip service, and the old ways of doing things would not change.