Was This a Memorable Diabetes Month?

Ho-hum, I'm glad this month is over. I had hopes that some ideas would come to fruition, but the American Diabetes Association and JDRF could care less about any idea that might unify the message and present a uniform symbol for diabetes. Unless the ADA gets all the glory, do not expect them to agree with the IDF or JDRF. JDRF on the other hand does not wish to be associated with anything but type 1 diabetes. These two organizations are so full of themselves that they don't realize how insignificant they are in the scheme of things. When the USA is the only country that thumbs their nose at the rest of the world, they had better wake up and realize that the world is much larger than they are. I would not feel upset if the rest of the diabetes organizations in the world excluded them from all activities.

Riva Greenberg has an excellent blog from November 13, 2012 about the lack of unity for a diabetes symbol. She covers the disparity of opinions very well.  I will add that Diabetes Mine informed us of the choices ADA makes in raising funds and paying Ohio telemarketing firm InfoCision 78 percent of the money raised for ADA. Then the ADA has the gall to say they did not do anything wrong. If some people are reading the blog by Mike H(oskins), they may decide the ADA does not need their money. If the funds dry up, ADA may learn a lesson – but do not count on it.

I don't pretend to understand the rivalry between the ADA and JDRF, but from past information, the ADA likes to abscond with the credit for anything done by other organizations and ride roughshod over other organizations. If it wasn't for the few good things (and I emphasize few) that the ADA does do, I would say let the ADA go out of existence. The many bad things they do are starting to heavily out-weigh the good. The ADA still does not realize their one size fits all mantra is for the average person with diabetes. The rest of us that are not average are told to comply and go with the flow. This is the primary reason I do not like the ADA and the organizations that adhere to the guidelines issued by the ADA.

On November 15, 2012, the ADA sent out an email asking people to write their congressional legislators and urge them to put the reauthorization of the Special Diabetes Program (SDP) on their final to-do list. Then they paint a broad picture of the good this funding is doing for type 1 diabetes. Can't let anything be credited to the JDRF. Next, they tell us the “Native American and Alaska Native communities – which are disproportionately impacted by type 2 diabetes – SDP programs have been a lifesaving tool in the fight against diabetes.” I have to wonder what happened to the Hispanic community and other minorities, why they were left out of the conversation. Finally, the email states, “Fortunately, momentum is on our side. Most of our country’s Representatives and Senators have said they support reauthorizing SDP.” I am left wondering of any of the funds go into the ADA coffers.

As a result, I wrote my representative and two senators to support SDP, but to withhold any funds that might find their way to the ADA. I used the article from Business Week to explain my reasons for requesting this. I did hear from one senator saying he was not aware of the misdeeds of the ADA, but that he would have his staff look into it. My senator said his staff confirmed everything and more, but would only say he was not sure what would happen or when. I am happy the more was not explained, as I would have been likely to have blogged about it.

Is this blog a vent against the ADA? Not entirely, I want to include all the diabetes organizations that are so enchanted with their own importance that they cannot or will not unite behind the International Diabetes Federation (IDF) in adopting one unified symbol for the battle against diabetes. This is one time I will have to give the American Association of Diabetes Educators (AADE) a pass as they have adopted the blue circle of the IDF.

Non-diabetic Hypoglycemia Revisited

When I wrote the original blog, I did it because my daughter has non-diabetic hypoglycemia. She has a knowledgeable doctor that did properly warn her that she could later develop type 2 diabetes. She still has not developed diabetes, but her doctor is monitoring her more closely and her diet is changing regularly, as she needs to reduce her carbohydrate intake as her blood glucose levels have moved toward the prediabetes level and they adjust to keep them in the normal range.

My daughter does test her blood glucose on her own schedule that she and her doctor have worked out and the trend is the important factor. We don't talk about this often, as I cannot compare my diabetes to her non-diabetic hypoglycemia. I am just happy that she has a doctor that knows what to do and between them have managed it for now over two decades. My daughter has also modified her exercise regimen as needed for additional help.

I am surprised at the number of reads the blog has received and even more surprised that none of the links have become broken or disappeared. In reviewing the links, several have actually become better and have information that is more relevant. I am adding the link to this blog, but be careful in interpreting the information as even the Mayo Clinic seems to have problems in diagnosing non-diabetic hypoglycemia. They link most cases of hypoglycemia to diabetes, but do acknowledge non-diabetic hypoglycemia in the discussion. Their main problem is not acknowledging that it is separate and distinct from diabetes hypoglycemia, but they try in a round about way. I honestly think that because a majority of non-diabetic people with hypoglycemia do develop type 2 diabetes as they age, they are attempting to link this as only a precursor to type 2 diabetes.

The article in about dot com is good to read and they explain some aspects of non-diabetic hypoglycemia very well. They show that non-diabetic hypoglycemia has the same low blood glucose symptoms as diabetic hypoglycemia, which is good to know.

Some of them are:

1. fatigue

2. depression

3. anxiety

4. having trouble sleeping for nights on end or insomnia

5. headaches

6. personality changes rapidly

7. always hungry for something sweet

8. doctor says there is nothing wrong – I advise seeing an endocrinologist

9. dizziness

10. blurred vision

11. heavy sweating

There are more, but many are just subcategories of the above.

The following are important and I will quote them.

What is the cause of reactive hypoglycemia?

The exact cause of reactive hypoglycemia is still unknown, but there are several hypothesis that might explain why it can happen.

1. Sensitivity to epinephrine, a hormone that is released in the body during times of stress.

2. Insufficient glucagon production. Glucagon is also a hormone which has the opposite effect of insulin. It raises blood glucose levels.

3. Gastric surgeries can also cause reactive hypoglycemia because food may pass too quickly through the digestive system.

4. Enzyme deficiencies can also cause reactive hypoglycemia, but these are rare and occur during infancy.

How to manage reactive hypoglycemia

 Limit foods with a high sugar content, especially on an empty stomach. For example, eating a doughnut first thing in the morning can trigger a hypoglycemic episode.

 Eat small, frequent meals and snacks.

 Eat a varied, high fiber diet, with adequate servings of protein, whole grain carbs and vegetables, fruits, and dairy foods

 Carry pieces of hard candy with you, for those times when you feel your blood sugar dropping.

What to do if you are having a hypoglycemic episode.

1. Eat or drink something that is a fast sugar source, such as orange juice, regular soda, a few pieces of hard candy, or sugar cubes. This should relieve the symptoms within 15 minutes.

2. Avoid choosing chocolate as a sugar source. The fat in chocolate makes it absorb more slowly and it won't raise your blood sugar up as quickly as you need it too.

3. Make sure to eat a small balanced meal after the symptoms are gone. This will prevent another blood sugar spike and consequent drop.

*A rare type of tumor, called an insulinoma, in the pancreas can also cause hypoglycemia in people who do not have diabetes. If you do suffer from episodes of hypoglycemia, it is wise to follow up with a visit to your doctor, to rule out the possibility of an insulinoma or other medical condition.

New Joslin Diabetes Program

This information on the Joslin website does beg some questions. Are they really enthused about the “Joslin Everywhere” program? Or will this become an untenable drain on the funds and be kicked to the curb and abandoned like so many other projects? This article on the Joslin website sounds great and I wish them success. I will be watching and hopefully there will be some transparency. The introduction to the article sounds impressive, “Catherine Carver, M.S., A.N.P., C.D.E., Vice President for Advocacy and Planning is one of the key movers behind Joslin’s bid to bring diabetes care into the 21st century with Joslin Everywhere, a digital care and education platform in the works at Joslin Diabetes Center.”

The next paragraph sounds even more impressive. It says, “Imagine Joslin’s resources being available to everybody, anywhere, on their phone, on their computer or tablet, by live video chat. But not as boilerplate, instead, in a form tailored to the patient’s individual needs. For example, suppose the patient is Mexican and wants to know about nutrition and diabetes- Joslin Everywhere would present him with food choices in Spanish that are common to the Mexican food mores. Expanding beyond face-to-face office visits is the only way we can remain relevant in the face of the tsunami of new diabetes cases coming our way. The only way we can hope to stem this epidemic is to reach people through other mediums.” Since this is still “in the works,” words to watch are “boilerplate” and “patient's individual needs.”

The example really says nothing other than they will use the person's language and nothing about not boilerplating for the average Mexican. The food choices may still be heavy on carbohydrates and low fat. Also, there is no mention about having the patient use a blood glucose meter to see if what they recommend causes blood glucose to spike. This begs another question of what will be the effects for people with diabetes. Will it mean more platitudes and then the one size fits all whole grains, low fat mantra. Will we see more emphasis on testing to help people manage their prediabetes to prevent type 2 diabetes – this is highly unlikely.

Or will Joslin make use of some of the new information to test people early to prevent even prediabetes. “Researchers at Sweden's Lund University have identified a "promising candidate" for a test that will indicate an early risk for type 2 diabetes, up to 10 years before diagnosing diabetes.” If Joslin is sincere in reaching people through other mediums to stop the diabetes epidemic, this should be on the table quickly for evaluation and if it works, all doctors throughout the world should make use of it. However, I doubt Joslin will be this progressive.

Is this only for Joslin patients? And the next question - how is Joslin being reimbursed or paid? Initially this is all it can be as there are many hoops to jump through to be reimbursed for time spent. In the state of Massachusetts, there is a law in place effective November 5, 2012 that states: “Alternative payments have the potential to provide incentives for efficiency in the delivery of services that are absent in the fee-for-service system, while potentially promoting improvements in quality through better coordination of care.” In other words, private insurers are beginning to understand there are benefits of touching patients in the best venue for the patient. This often means reduced costs for the insurer in the long-term.

As I learn more, I may have more questions.

News from Our Informal Peer-to-peer Group

One of the members asked me why I have not blogged about our group lately. I asked what happened this summer and fall. He said many of the group traveled during the summer and some had just recently returned the first part of October. Some of us had gotten together occasionally, but not regularly, as there were not a lot of new things to occupy us as a group. Even now, we have not had the entire group present.

Some of us are excited about the new study from Sweden that identifies a new marker for determining diabetes approximately ten years before diagnosis. True this needs further study, but may be a lead in the right direction. It means nothing to those of us that already have type 2 diabetes, but if this can assist in making potential diabetes patients make lifestyle changes now and delay or even prevent diabetes - this is a good thing. We will be watching for further research on this topic.

In addition to my having to take a forced writing vacation per my doctors to let my wrist heal, two of the group has had some illness and another has a family member with an illness that put the spouse in the hospital. This has caused us to be more careful and less likely to take time to get together. Some of have been exchanging emails of late attempting to figure out a convenient time after the holidays for all to get together and possibly introduce three new members. I have the two women that I met recently and Barry and Ben have a new friend as well. There may be others that we haven't heard from yet.

Several of the members are quizzing me heavily about my peer mentoring experiences. Three of the group is asking if they could sit in on a session, see how I answer questions, and possibly consider doing something similar. We have talked extensively about how I answer questions. I first told them that I do not make suggestions in many areas unless it preface it with “you must talk to your doctor.” I make sure the question is answered with talking with your doctor and suggest two or three possibilities to help guide the questions. I warned them about making recommendations that might sound like advising people to take a certain medication. I said that we cannot do this and this type of advice can create legal liabilities we don't need. I explained about one participant that was trying to get me to do just that. I also said I would need to talk to the doctors and see if they were willing to have others sitting in. I said it could be beneficial having more than one person relating experiences. They agreed I should get permission first. We also are looking for a place to allow more than one person since my office is not the most convenient.

Allen and Max have been on my case and in my face lately about being a turncoat and helping a type 1. I know this is good-natured as Allen lives three houses away from the now 14 year-old young girl that I wrote about here. He did not realize I knew them until one day this last summer when he saw me visiting with the family. He came over and then Max who happens to live directly across the alley saw us together and joined in. They all knew each other, but not that Lily had type 1 diabetes and her family did not know that Allen and Max were people with type 2 diabetes. What was to have been a short visit from me concluded about four hours later after the evening meal. We all had an enjoyable time and Lily had a great time teasing the three of us asking questions since we are all on insulin.

Diabetes - Safety Tips for All Seasons

I agree that many people need reminding for what to do during the heat of summer and then again when winter comes around. I had intended to do one blog for summer and winter, but why not for the entire year. The suggestions and tips do vary somewhat by the season, but need to become second nature to prevent loss of diabetes supplies to nature's whims and brutal elements. Each season also has its own unique problems for your health.

In thinking this over, I am surprised at how many are applicable every day. Those with type 1 diabetes can determine when they wish to take a pump vacation. Let's not mistake that I live in the northern part of the USA and I am writing for this area. The southern part of the USA will require some modifications for hotter summers and milder winters. Others will have to adapt this for where they live.

Staying hydrated is important for all seasons. Too many people are lured into a false sense of well-being except in summer when we know we must stay hydrated. It is this false security that gets people into trouble in spring and fall when they have been working outdoors. They think that they don't need water as they have not been doing strenuous activity and have been sweating very little. Little do they realize they have been losing moisture to evaporation and because it is cooler or there is a breeze that their system hasn't needed to create sweat.

Don't think you need to worry about drinking water in the winter? That false sense of security will cause you damage and dehydration problems. Most people do not realize how hard it is to walk in snow, shovel snow, or just how much they sweat just moving around outside. With today's clothing, moisture may be wicked away from the skin and you will not feel wet until you are back inside and removing layers. When you come to the wet clothing, just realize that you may be more dehydrated than you realize.

You may not need to drink as much water in the fall, winter, and spring as you do in the summer, but dehydration is just as possible and in some ways more dangerous because you think you are not dehydrated. This article about electric fan use in the summer heat is very interesting about the dangers involved for the very young and elderly.

Analyze the feelings or symptoms is especially important in the summer when you may think you are experiencing hypoglycemia, but the symptoms might just as easily be heat exhaustion or on the verge of sunstroke. First get to an air conditioned area if one is available and have a good drink of water. If an air-conditioned building is not available, get to a shaded area and make sure that you are not constricted by heavy clothing or unable to pull the blouse or shirt out of jeans, skirt, or pants to allow for easier evaporation. Test your blood glucose to help you determine if you are low. If this is correct, definitely chew on a glucose tablet and retest in 15 minutes. Otherwise make plans to get to an air conditioned facility or hospital as soon as reasonably possible. Heat or sunstroke is a medical emergency and should be dealt with immediately.

Yes, you probably may not experience heat exhaustion during the winter, but during the spring and fall, hot days do happen. Always be prepared.

Wear appropriate footwear is very important. This means probably different footwear for the different seasons and where you will be. Because of blood glucose levels, many people must wear proper footwear to prevent injury and having the injury become infected. This is important for healing when injury could have been prevented. Too many people like to wear nothing on their feet during the summer months whether inside or outside. All it takes a shard of glass, a nail, or other sharp object to do the damage, and if you have neuropathy or numbness in your feet, you may not to notice that you have injured yourself. Then if this area becomes infected, you may not catch it in time to prevent proper healing and this can be when the fear of amputation sets in.

Keep diabetes supplies in appropriate containers is sound advice. The container that holds your test strips keeps them fresh and ready to use. Avoid exposing the container and the test strips to direct sunlight and prevent moisture from getting into the container. Depending on where you are, consider keeping the container of test strips in a zip lock bag and the bag in a cooler with ice packs or a Frio container. Also keep you meter out of direct sunlight and in the same manner as the test strips. Always store the test strips between 36° Fahrenheit and 90° F (2° Celsius to 32° C). Do not expose the test strips to heat, moisture, or humidity. Temperatures outside the required ranges, as well as moisture and humidity, can damage the test strips and lead to inaccurate results.

Insulin that is unopened should be stored in the refrigerator between 36–46°F (2–8°C). If the insulin becomes frozen, it must be destroyed. Once the vial has been opened, it may be stored at room temperature below 86°F (30°C). Keep the vial in a place away from direct sunlight and heat. Do not use after 28 days once the vile is opened. For carrying insulin vials or insulin pens outside, use a cooler with ice packs or a Frio container. In the winter, use insulated packs for carrying insulin as insulin cannot be frozen, and if frozen it must be destroyed.

Oral medications should also be protected from direct sunlight and moisture. Some oral medications have specific storage instruction. Therefore carefully read the instructions that come with your oral medications, or have a long talk with your pharmacist for specifics. Read this for safety tips on insulin and syringes.

Wear appropriate clothing for the season. Protect yourself from sunburn during the entire year. We are all aware of the late spring through early fall, but sunburn also happens in the winter when the sun reflects off the snow. If you are outside for an extended period of time, beware of sunburn. Protect yourself from frostbite during the coldest part of winter.

Rules for driving are important to know as each state is different and the doctors in each state may have different reporting requirements for people with diabetes. So learn as much as you can about the rules in your state. Many states require doctors to report hypoglycemic tendencies and evaluate your risk for doing the testing and maintaining of safe blood glucose levels while driving. Some states maintain records of accidents caused by hypoglycemia and do suspend driving privileges for these accidents. If you are a person that has hypoglycemia frequently, always be sure to test before you start driving. It is always good to test before driving if you have type 1 diabetes or are a type 2 on insulin or sulfonylureas or the other oral medications that cause hypoglycemia.

For the applicable laws of your state, please read this.

Suggestions for exercising are not something to be taken lightly. Too many people do not discuss exercising regimens with their doctor and get themselves in danger for not having routines that are safe for their health condition. Most doctors will encourage exercise and offer suggestions for safe exercise. They will also do tests to assist in determining the limits, if any, that need to be in place for the season or the location for the exercise. It is important to know your blood glucose before you exercise and I have written about this here. More safety tips for exercising may be read here.

Tips for skin care are important in any season. People with diabetes are very susceptible to many skin problems. Thirty three percent of people with diabetes can expect the have a skin disorder caused by or affected by diabetes some time in their lives. If a skin condition is caught early it can be easily treated and many skin conditions can be prevented. Read this for more information. 

Some skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis.

Tips for foot care can be important all the time. Everyone should have good foot care, but for people with diabetes, a daily self-care routine is a must habit. If you have feet or leg nerve damage (neuropathy), you may have an injury and not realize it. This is why a daily check is so important to discover small cuts or wounds before they become infected.

Too many people ignore this advice and wonder why they develop serious problems or complications – leading to amputations. About 85% of amputations could be prevented if the patient has it treated early. For more information please read this.

Safety tips for summer – read this.

Safety tips for winter – read this.