January 12, 2013

Questions about Guest Bloggers

Recently I have had several requests from others asking to write blogs for my site. Some have come from the spam crowd, but most from legitimate bloggers and some businesses.

To answer this very simply, no, I will not allow guest bloggers. I may make an exception for those in the informal peer-to-peer group that I belong to. I do have one that has volunteered to help from time to time when I need to rest my right hand. This happened last summer when the doctor ordered me to stay off the computer. I did spend time doing research when I could. I needed to use my left hand to operate the mouse and type, but after a time became fairly proficient at it. The one member would type for me and post to my blog. He will not be writing material of his choosing unless he has a topic I agree with. He will also be using my computer.

There are one or two bloggers about type 2 diabetes that I would probably allow to guest blog for me, but they have not asked and are busy themselves. Others will not be allowed is as polite as I can be.

January 11, 2013

More to Help with Testing

There were other topics I had wanted to include with the four parts of Tips for Blood Glucose Testing, but found that they were becoming too long. Therefore, I adding another blog to lay out some other sources for you to read and to give you some sources that you may wish to download for carbohydrate counting and some logs you may wish to use. I downloaded several when I started my diabetes; however, they did not meet my needs, so I used them as examples and designed my own spreadsheet that holds my blood glucose log, daily food log, and daily health log. I have added to this over the years to include test results from the doctors and more information to track my health.

I have a friend that works with databases and he had developed his own application, which he uses. I would encourage people to start with paper and pull together information that you need and want to use and then if you are good at spreadsheets or databases, then convert to one of these. Even a few of our informal group have developed notebooks they prefer to use and others have developed spreadsheets. Only two are into databases and use them. David Mendosa has a listing of software that you may explore. Or, use your search engine and search for software you can use.

For readers outside of the USA there are conversion tables for converting units used by Americans to the units you use. This is a quick one for diabetes, this is an extensive table, and I use it quite often. There is one other calculation that I like to use, the hand calculation is here - near the bottom, and the easy calculator is here.

There are many sites for help in counting carbohydrates plus books that will help. I use this site and really like it – there are two links – link 1 and link 2. Like most sites, you need to join to use it, but most are free. There are some that charge a monthly fee, but I will not join them. One piece of information you need to know is that almost all sites are linked the USDA charts and the grams of carbohydrates is taken from there. Some of the sites that are useful include site 1, site2, site 3, site 4 and site 5. Use your search engine and use these key words to help find other sites - “carb counting aids” and “carb counting for recipes” or use your own key words.

I realize I am putting many links in this blog, but it is my desire to give you other reading sources that may assist in learning about topics that will serve you well in the future. I have a writing style and the others have a different style of writing. Therefore, if I give you information that they have written that you like and understand, then you will learn and I have at least helped you to find a writer you like. Not every writer covers the same topics at the same time, but eventually we can all cover many of the same topics and it would be to everyone's advantage to know about other writers. I have been reading all of these for several years and do enjoy reading them all. Granted, all of them are people with type 2 diabetes and in general write about type 2 diabetes. Now and then, some of us write about a topic that encompasses more types of diabetes and I do write about other topics that have a relationship to type 2 diabetes, but are not type 2 focused.

As example, go to the website of David Mendosa. In the subject bar at the top and on the right side there is a search box. Type in a key word or two and see the different topics that appear. This is how I found this link – by typing “spreadsheets.” Now I knew this existed as I have found it many times. Typing in software will maybe find this link, but it did not for me on the first two pages. David has a very large website and I have not even read all of it, but there is not much left that I haven't read. David writes for Health Central here.

I found Tom Ross on a diabetes forum and really liked his thought process. I still like reading his blogs. Here is a link to one of his blogs and my blog about it.  I have done this many times when he has written about something that fits with a topic I am writing.

Alan Shanley I also met on the same diabetes forum. He is from Australia and also writes in a style I enjoy. I might as well list the blogs you may wish to read – blog1, getting started; blog 2, what-to-eat-until-you-get-your-meter; blog 3, on-various-forums-i-visit-one-of-most; blog 4, breakfasts; and blog 5, breakfast-on-run. I have linked to his blogs on many occasions.

Gretchen Becker I learned about shortly after diagnosis and was looking for books on diabetes. Her book The First Year - Type 2 Diabetes, New York, Marlow & Company, 312 pages, by Gretchen Becker was one of two books purchased about a month after diagnosis. I now have the second edition of that book as well. Then I discovered her blog on Health Central when I found David Mendosa's blog. Then shortly afterward, I found her blog site. Because of her activities, her blog site has been inactive for about a year. Her Health Central activity is still great. I urge people to join so that they may get emails notices of new posts from diabetes writers they wish to follow. This is accomplished in your settings part of your profile.

January 10, 2013

Tips for Glucose Testing – Part 4

Part 4 of 4 parts

Financial Assistance
Those that have insurance or Medicare generally will not have problems with testing supplies, other than not being reimbursed for enough testing supplies. Not having insurance can create problems and needs answers. Getting free meters is not the problem; check the last paragraph of the Diabetic Connect article. That is still not a good answer, as it is the test strips that cost and without insurance, be careful. A free meter with expensive test strips is not a solution.

Ann Bartlett has an excellent blog on Health Central about finding financial assistance. It is over a year old, but is still good information. She also suggests talking to your pharmacist and it is possible that the pharmacist may have some suggestions that will be of help. Although this is now over two years old, there is some excellent information on test strips and meters, especially about where to find them. A price check on Amazon dot com can confirm prices of today.

Another alternative is to find some manufacturers and check their web site for assistance programs. You will need to follow their directions, but most do have fairly good programs.

Amy Campbell has an excellent blog on Jan 7 at Diabetes Self-Management on "Know your health plan," that covers many areas that I did not.  Dealing with most medical insurance companies requires every bit of help you can get.

Exceptions in Blood Glucose Testing
When doing blood glucose testing, there were some ideas that I did not want as part of the normal testing and I will discuss them here. The first is controversial, many can find no logical rules for it, and others say it does not exist. Most discussion happened prior to five years ago, but you should be aware it. The Somogyi effect, also known as the “rebound” effect", was named after Michael Somogyi, the researcher who first described it. It is caused by the tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar. For many people with diabetes this does not happen because these hormone regulators are not functioning properly. For some people in the early stages of diabetes they can work - as when blood glucose levels drop too low, the body sometimes reacts by releasing counter regulatory hormones such as glucagon and epinephrine. These hormones spur the liver to convert its stores of glycogen into glucose, raising blood glucose levels.

Often the effect is mistaken for the dawn phenomenon (DP) when the liver dumps glucose to start the wake up process. People have been checked with continuous glucose monitors to prove whether it is the Somogyi effect or DP. The dawn phenomenon is much more prevalent in people with diabetes than the Somogyi effect.

The other problem is what people eat. People that eat a higher percentage of fat can develop the pizza effect for testing. This means that their blood glucose high level will not happen often at the two-hour point, but can happen between the two hour and five hour marks. This depends on the person's body and how much fat is consumed. The pizza effect got its name from those that had pizza for a meal and wondered why they were still low at the two-hour mark, but later were much higher. Therefore, when you eat pizza, do not be surprised to find a high level of blood glucose at a later time than you normally would and the same can hold true if you have any other high fat meal. Fat slows the digestive process and thus the release of glucose into the blood.

Understanding Self-Monitoring of Blood Glucose (SMBG)
SMBG is just what people need to learn to assist them in managing their diabetes. In addition we also have available to us diabetes self-management education (DSME) and diabetes self-management training (DSMT). These two are discussed in this blog and this blog. These are written primarily for the elderly, but may be adapted to the younger people.

I have stated this before and it is so true. “Each person has to learn about how their body reacts to diabetes, how much exercise they are capable of doing, and finding out what works for them. There are no firm rules other than what works for me, may not work for you. Much of what is taught is on a one-size-fits-all basis, which can be misleading for many and does not work for everyone. This is the reason for giving people other information so that they may try different approaches in finding what works for them.”

Even if this is not within SMBG, it is important to say that experimenting is allowed and encouraged to discover the best management of your diabetes. Never be afraid to take a one-size-fits-all point and adjust it to fit your needs and what works for you. Yes, I make a lot of fuss about one-size-fits-all discussions, because many times it is written as if this was the only right way to solve the problem. I have found through experimenting that what is written to be the only way is wrong and adjustments can be made and still have success.

This is why some bloggers write about SMBG being so important. I have found out that being my own lab rat has been beneficial and why testing has become so important to me. This has allowed me to become more efficient in managing my diabetes. Am I a model of perfection? No, I can still do things incorrectly, but this also teaches me what works and discover why some attempts fail. I use my testing records, food log, and daily health log to see patterns developing. Then when I get the results of the tests the doctors order for me, the light often comes on and, yes, I can see why something is improving or going in the wrong direction.

I always feel good when things go right, but I have found that when I make a mistake, sometimes they scare me, but by using them as lessons, I am able to continue to improve. Please take time to read several of my blogs on SMBG – blog 1,and blog 2.

Even though this blog was written with tongue-in-cheek, this is something that I have encountered, as have others of my friends. We need to be careful in what we accept as being the best for us and realize that some of the people that are to be considered as resources, often make it more difficult because they don't understand us. Others do and can help us.

January 9, 2013

Tips for Glucose Testing – Part 3

Part 3 of 4 parts

When Is It Best To Test?
This will depend on your budget and the amount of test strips you have available. It will also depend on the medication(s) you are using. Insulin will require, by its very nature, the most testing, especially is you are using a basal (long acting) and a bolus (short acting). Normally you will test upon waking and this will be the before breakfast test as well. Next will be your after eating (postprandial) for breakfast. You should consider doing this for all three meals and again before bedtime. This makes seven times at least per day. Then if there is a question about one of the tests, another test may be added. Doing the tests at approximately the same time each day will be of value in watching for trends and problem times when adjustments may be necessary. It is also wise to test before and after exercise. Read my blog here about safe blood glucose levels for exercise.

What the article from Diabetes Connect does not talk about is the reason for pre-meal testing. This is for determining if adding a correction factor to go with the bolus injection based on the carb count for the next meal is needed. One point I admit I have never understood is there are some sources that insist blood glucose testing should be done at approximately the same time every day. Do they mean within 15 minutes, 30 minutes, or two hours. In talking with my doctor, he suggested probably 30 minutes, but said he understood why I would be asking as being retired, I do not have a schedule. If I need to be up at 7:00 AM, that is when I do my fasting test. Other days I don't arise until 11:00 AM or later and that is my fasting test time. My wife has a work schedule and I gravitate to her schedule, but don't follow it exactly. The only thing I watch very closely is not overlapping my short-acting insulin injections.

If you are on oral diabetes medications, then I can understand holding to a more consistent schedule. By doing this you will generally get the most consistent and effective results from your medication and not be overlapping the same medication, which can cause serious problems. The other caution with oral medications is eating approximately the same number of carbohydrates per meal. This will depend on the dosage. It is wise to discuss this with your doctor and asking about times when you don't feel like eating or are ill.

Understand Daily Glucose Testing vs. Your A1C Result
Are you one of those people that believe because you have a quarterly A1c done or like some, buy the home A1c kit and test your A1c every month, think that you don't need to do daily blood glucose testing. This is the wrong line of thinking and for several reasons. For the most valid reasons for the error in thinking this, please read this blog by David Mendosa. One statement that really stands out is this, “The plasma glucose in the preceding 1 month determines 50% of the HbA1C, whereas days 60 to 120 determine only 25%,” This means that 75% of any A1c result in from the previous 60 days.

In reading the selection by Diabetic Connect, I must respectfully disagree with the use of the ADA standard of A1c levels of less than 7%. This is still in the danger zone for allowing the onset of diabetes complications and progression of diabetes. Even the American Association of Clinical Endocrinologists (AACE) standard is 6.5% is not the best for everyone. I do agree that it is closer to ideal than the ADA standard will ever be. As a person ages, allowing the A1c to creep up toward the AACE standard is more acceptable. Still if the person is capable of obtaining A1cs of 6% or less, there is less likelihood of complications developing.

Therefore, if you receive and A1c of 7.4%, you know that something is not right and changes need to be made, but what is the question. By having your daily blood glucose log, you can review this and maybe discover where you need to make changes, especially when matched with your daily food log. If you met your A1c goal, and have not had frequent or maybe one or two minor low blood glucose readings, you can feel fairly confident you are achieving your daily blood glucose levels. Clinical research is telling us that our A1c readings is vital in predicting our future health, but our daily blood glucose readings are important in meeting our A1c goal and tells us how we are doing on a daily basis.

No Judgments, This Test You Cannot "Fail"
Always remember and never forget: testing glucose is not a judgment of your personal worth. This is not the kind of test that you either "pass" or "fail." In fact, all glucose readings are good! — good in the sense that if you hadn't checked, you wouldn't have that information.” This is what the author of the article in Diabetic Connect stated. Do you agree? I do and only because each reading is relative to that period in time and can be an indicator of the progress you are making in your diabetes management, or not. If your blood glucose readings are always above 200 mg/dl then your A1c will reflect this and your doctor will wonder what your goal is and what you are not doing to lower your A1c. So in that sense you have not succeeded, but the only person you have failed is yourself.

If your goal was an A1c of 6.5% and your A1c is over 9.0%, you have not been paying attention to your daily blood glucose readings, getting the exercise needed, adjusting your food plan, or asking the right questions of your doctor to assist you in getting lower readings. Occasional high readings can mean a lot of stress, you are becoming ill, are overtired, or had more to eat of the incorrect foods for a meal or two. Try to determine what caused the higher than expected readings.

A high reading will not bring on complications unless you have high readings consistently for months on end. Then your doctor may decide that you need to make some changes, often drastic, to reduce your A1c and stop the onset of complications. If you are consistently over 200 mg/dl, you may wish to consider using insulin for managing diabetes more effectively. At least do some reading about insulin to have an informative conversation with your doctor.

How to Choose (Or Obtain) a Meter
This is important and not to be dismissed as your meter will become a good friend and is a needed tool in your management of diabetes. Do not be put off, repeat, do not let the doctor discourage you from having a meter. It is unfortunate that there are many physicians with patients having type 2 diabetes, that won't give out meters or even encourage testing. If you have one of these doctors, I urge you to consider finding a doctor that will. I have even had a surprise that a doctor discouraged a type 2 patient on insulin from testing. This was a shock and I told the person this could be deadly to him without a meter and he should see another doctor before he even considered returning to his doctor. In discussing this with the individual, he had been told to eat only a certain number of carbs for each meal. I asked if he even knew what to do if he was ill – he was told not to inject insulin if he could not eat. Even this is bad advice without testing.

Today, many doctors and endocrinologists have meters that they will give you. If you have medical insurance, there is often nothing wrong with accepting one of these meters. Often the meter they will give you is one of the better and more reliable meters. If you do not have insurance, then read tomorrow’s blog (part 4) on financial assistance. Some medical insurance companies are very restrictive about what they will allow coverage for in test strips. Therefore, it may be necessary to talk to the insurance company before accepting a free meter from the doctor.

Be careful with some insurance companies and in some areas with the meters they want you to receive from medical supply companies. Often these meters are heavily promoted on TV and in magazines and some are not the most reliable. Some have annoying bells and whistles you don't need or will not use, some talk, giving you a vocal reading and if you are one that does not want others hearing this – forget these meters. Pain free meters don't exist and as one medical supply company advertises them as virtually pain free and you don't need to prick your finger. Unless you have forearms with no feelings or spots on you thighs that have no feeling then there will be pain. Also testing on your arms will give you readings that are about 15 minutes earlier and on your thighs that are about 20 minutes earlier than testing on your fingers. Why this lag time? Because you are testing from veins rather from your arteries. Review the part 2 of this series for less pain when pricking your fingers.

1. When accepting a free meter or shopping for a meter, consider these suggestions. Unless you are house bound, you will be carrying your meter and test strips with you wherever you go, so be sure that it has a good case.
2. Some people will look for a small meter, but this will depend on your dexterity.
3. The size of the blood sample needed is not as big a factor today as it was in the past, but still deserves some consideration.
4. Important for many people is the font size and screen brightness.
5. How long from blood wicking into the test strip to reading – should be five seconds or less.
6. Alternate site testing if desired – how easy is it?
7. Cost per test strip.

There are other factors, but they may not apply to you, but do your homework to know if your insurance covers the desired bells and whistles. That means you need to have a list of factors that you desire before you call your medical insurance company to know what they cover and will reimburse.

January 8, 2013

Tips for Glucose Testing – Part 2

Part 2 of 4 parts

Information that is important for all people with diabetes.
If you are newly diagnosed or an old hand, please take time to read or reread the instructions that come with your meter and the instructions in the box with your test strips. Instructions do change and I am of the habit of trying to read mine on at least a yearly basis. Every now and then, I learn something new or find that instructions for the test strips have changed. Example, it used to say to clean your finger to be used for testing with an alcohol swab and let air dry. Recently, this instruction change to wash you hands and thoroughly dry. Even I know this is better, and would add to wash with warm water and soap and thoroughly dry. It is important not to handle the test strips with wet hands as you could cause problems and receive an incorrect reading.

Learn How to Test Almost Pain Free
At first, pricking you finger to get blood for your test strip can be intimidating. With practice and knowing your equipment, this will become almost second nature. Unless you can prove that testing on the tip of your finger is painless, learn not to test there. Learn to test on the sides of your finger. About an eighth of an inch below your fingernail and on each side and for about three sixteenth of an inch is the best area for pricking your finger. Also use the area just behind where the nail extends (area you trim) to about where the nail emerges from your skin for the boundary front to back within the area in the previous sentence. The below image shows the appropriate pricking area.
Some people are able to test like in the picture below, but not many. There are more nerves in this area for most people. I know that this area does not work for me. However, that does mean that you can’t experiment.

Next, examine your lancet device. In the picture above near the left area near the lancet area and look for a dial or adjusting slide and select the lightest setting (usually the lowest number) and start with this. The above shows the dial area, which is on the reverse side of the lancet device. Then take a lance from the box and insert it in the correct area for holding it, then carefully twist off the round-like tip and you are ready to go.  One the above lancet device, just pull of the dial and you will see the insert for the lancet.

If you have not been shown how to do this, ask a pharmacist, or if you have one, a diabetes educator for instructions. Then press the top (on most devices) until the device is cocked. (See the right side of the Softclix picture above.)   Holding the device firmly against the side of one finger, press the release button (the button to the left of the Softclix name in the picture). If there is no or very little blood, move the dial or slide to the next higher number and repeat. There is no need to change lancets yet. If there is sufficient blood for the test strip, then this is the setting to use. Repeat the above until you have sufficient blood. Most of the time nearly enough blood could be enough if you gently press your finger and move the pressure toward the area of the blood. This is what we term as milking the finger to obtain sufficient blood. Do not use a lot of force, but set the depth of the lancet deeper.

A word of caution, please. Please know that if you hand write a lot, you may have some calluses on the finger you use the most for holding the pen, pencil, or other writing tool. If you want to use this area, you may need to adjust the lancet depth more and then reset it for the rest of your fingers and thumbs. Rotate finger sides and fingers for each time you prick for blood. The strategy for using the sides of the fingers is these areas contain fewer nerves and the sole and fingertips have many more nerves.

Now about changing your lancets. You may have been told to change for each finger prick. This is true and probably a good habit to get into. However, after using a single lancet for several months, I have gotten into the habit on only changing mine about every three months. Some people change weekly, biweekly, or even monthly. In other words, we don't change lancets for every use. I do change lancets if I use my lancet device on my wife or any other person and change it when I use it again on myself. I do keep alcohol pads around to sanitize the area of the lancet device that presses against the skin when testing on others. I also adjust the depth setting, as I don't normally need as deep a setting for people that do not test.  Read this by Alan Shanley for another viewpoint on painless pricks and then one from Jan 5 that covers much the same ground as mine.

Do not use alcohol pads to clean the area that you will prick. Alcohol pads will dry your fingers and during the winter, they will crack, becoming very painful. It is better to use warm water and soap to wash your hands and dry thoroughly. Read this for more reasons to use water and soap.  Also, David Mendosa has a blog on Health Central about operator error that is worth reading.

Learn and know the why of testing
Yes, learn about testing and the why of testing. There are many sources for this information. Don't be like many people and think you are doing the tests for your doctor. This is a fallacy and needs to stop now. Many, if not most, doctors outside diabetes offices, never look at the data or blood glucose reading log.  Most are only interested in your A1c.  Many diabetes clinics do download the readings from your meter, print out logs, and review them with you to ask questions and give you assistance in interpreting them early on. Then they expect you to know what the readings mean and how to use them.

The best reason for testing is helping you effectively manage your diabetes. Without testing, how are you going to be able to know what is happening, what needs to be changed, and if the change was even the right change? No, you will be in a fog with no direction and cannot even know what is happening.

Test with a Purpose
One of the best blogs about testing is this one by Alan Shanley. Although this blog may suggest testing more often than many people can afford to test, it is still applicable in learning the why of testing. Once you have read that blog, I suggest reading this blog, also by Alan. What I like about Alan's style is that he can be very insightful and lead to an understanding. In addition, he is not afraid to say that you need to find what works for you and not follow what works for him. For some, following his suggestions will work and for others they will need to read for understanding and find what works for them. Do not hesitate to bookmark anything you may want to review later.

Testing is important to know what your body is doing and what food is doing to your blood glucose levels. Testing gives you what your blood glucose is at that time. Therefore, I would encourage you to read this by Jenny Ruhl – here and here – to get some guidance also in testing. You may notice that the first link is the same information as the first link for Alan. This is because this is excellent information and important to know. There is also excellent information on Jenny's site.

No, this is not what the American Diabetes Association (ADA) preaches. The more you read and learn, the more likely you may find that the dogma preached by the ADA does not work for you. The levels they suggest using are in the range that encourages diabetes to progress and does not prevent complications from developing. Management of your diabetes is the goal to prevent or slow the progression of diabetes and prevent the complications from developing. Yes, it is possible and this should always be considered a goal of diabetes management. Many of us use this from William Polonsky, “Diabetes causes nothing! It is the lack of diabetes management that causes the diabetes complications.” This means that if you don't manage your diabetes, complications are quite likely.

Yes, there is a purpose behind testing your blood glucose. You are doing the testing for your benefit and to measure your blood glucose to know that at the one or two hour time after eating that you have achieved your goals. Intensive testing to find your general time of high blood glucose after eating, start testing about three fourths of an hour after eating (use first or last bite, but be consistent), and test every 15 minutes or every half hour until the three hour mark. If you notice the reading going down, stop testing. If you have learned from intensive testing that you reach your high blood glucose level about 90 minutes after eating, then you will generally desire to test at the 90 minute mark to make sure that you haven't exceeded your goal. No, I did not use the one or two hour mark to show you that these can hold true for some people and other people can vary when they reach their high point. Many people do reach their high at the one hour mark and some studies show for many people, the the high is reached at about the 78 minute mark.

Know What to Do With the Numbers
Numbers are just numbers unless you know what they mean. To start with, most normal people without diabetes the range for blood glucose is between 70 and 120 mg/dl (milligrams per deciliter - the American measure), or 3.9 to 6.7 mmol/l (millimole per liter – as the rest of the world measures). This is what the “experts” don't say after the previous statement. Most normal people without diabetes can have readings above 100 mg/dl, but they don't stay above 100 very long and are back below 100 quickly. This can happen after a very carbohydrate heavy meal and is not the normal happening. They also don't say that readings of 100 to 125 mg/dl are the range of people that have prediabetes.

If you have morning fasting readings of over 120 mg/dl, you need to consider making some food changes the evening before. Maybe a smaller snack (less grams) before bedtime or not eating for longer before bedtime other than the snack. If this does not help, then you need to discuss the dawn phenomenon with your doctor. This is or can be caused by the normal wake up reaction of your body and your liver dumping glucose into your blood in preparation for waking up.

Some people notice that after an evening meal that their blood glucose levels are elevated over 180 mg/dl. This may mean that the evening meal was too large or carbohydrate heavy and the number of carbohydrates need to be reduced. Or, it is possible that an evening walk will help bring blood glucose numbers back in range. Other people will notice that after exercise that they are low, (below 70 mg/dl) and need to consider having as least a 15 gram (or larger) snack before exercising.

By knowing your blood glucose numbers, this will help you adjust your food intake and possible changes in your exercise regimen that will help in maintaining lower blood glucose levels. This in turn will help return a lower A1c reading and help in your diabetes management.

Know what your blood glucose numbers are will also help you know if you need to talk to the doctor about reducing your carbohydrates or if the doctor will need to consider, reducing medications, adding   additional medications, a change in medications, or even the need for insulin.

January 7, 2013

Tips for Glucose Testing – Part 1

Part 1 of 4 parts

I continue to receive emails asking me about certain of my blogs. A concern is other type 2 patients asking where to get testing supplies and where to learn how to use these supplies. I have had two emails a few weeks ago now saying that their doctor had not even told them about testing and when they called asking for a prescription for a meter and testing supplies, they were told this was not what the doctor wanted them to do. Someone needs to hang these doctors up by their toenails and drip water over them for a few days.

Yes, I can be that heartless about doctors that do not want their patients to learn about diabetes and how to monitor their blood glucose. One of the doctors near here does not tell patients either. I happened to see him in a store recently and asked him why he did not prescribe testing supplies. He just said it was none of my business. Now, I should not have been rude, but I had to ask, which grain producers were subsidizing him not to promote testing? Or, was it the USDA giving him money not to teach people about testing? He did what I expected, turned his back on me and walked away. Another person that was with him I did not know, but he stopped and asked me what I was talking about. I said that the good doctor was not teaching his patients with diabetes about blood glucose testing. He would not tell them about testing or getting testing supplies.

The person introduced himself as a doctor and asked what I knew about this. I said that I am a person with type 2 diabetes and that I happened to know several of his now former patients that he had not told about testing. I explained that he was known for not discussing diabetes with his patients other than prescribing medications. He asked if I had been a patient of his and I said fortunately no. I did say that I knew several of his patients that had diabetes and knew he did not discuss diabetes with them and discouraged their testing. He seemed concerned, but wondered how it involved me. I said that I am asked questions by people when they find out I have diabetes and how I know about testing. I said I blog about type 2 diabetes and have several friends that have type 2 diabetes. I said we do not keep it a secret like many type 2 patients and are willing to answer questions. I told him that a group of us are an informal peer-to-peer group and teach each other and reach out to other type 2 people. Our discussion ended when the doctor came looking for his friend.

I do answer the emails and often get further questions. I can tell that they have read the list of URLs because many of the questions come from these. I have a list of blogs from Tom Ross, David Mendosa, Gretchen Becker, and Alan Shanley that I like to use for different questions. Many find it difficult to believe that people can get off and stay off medications. Tom Ross has never been on medications and David Mendosa has been able get off and stay off. One of the more frequent questions is about self-monitoring of blood glucose. Apparently, this is a question that many doctors fail to answer and even many certified diabetes educators only touch on for people with type 2 diabetes. For many of the people, I urge them to read many of Alan Shanley's blogs and several of mine.

Another question is often how to obtain more test strips when they do not have the resources to purchase them out of pocket. These are hard to answer without knowing what meter is being used and who manufactures it. This often requires several emails to get information. I admit I like people that are not secretive and realize they are the one asking the questions and give me the information I might need. In the next few blogs, I will try to answer some of these questions in general and in specific where possible. See part 4 in the financial aid section of obtaining assistance this Thursday.

Recently I did receive an email newsletter that I will probably use for a little information. This was from “Diabetic Connect.” I will use some of it along with information from other sources.

Even with all the information, until you have a meter and test strips, and have read the directions for the meter and for the test strips, you are not ready to use either. I have seen too many people not take proper care of either and then look for someone to blame. I will repeat what I have said before – the meter and test strips are delicate equipment and need to be treated as such. Don't jam test strips into the meter, store the meter in the case to keep as it as lint free as possible. Keep the test strips in the container they come in for best care. Do not throw the meter up on the car dash and let it bake in the sun. I have seen this more times, than I can count. Some may have been in the case (hopefully those cases were empty) and others not even in a case. I would be surprised if they even worked and probably were inaccurate. On several occasions, even a container for test strips was baking alongside the meter. Hopefully the container was empty, as I doubt the strips in that container would work. If the people with diabetes could do this with their testing supplies, I must wonder if they even take care of their diabetes.

Another question I receive is about food and why they can eat this, but should not eat that. This question is not easy to answer because I do not know your body chemistry and without testing, I have no idea what your body is capable of handling. Some people become horrified when I say that they are now their own lab rat in their own experiments. This is why testing is extremely important. This will let you know how different foods and even different quantities of food affect your blood glucose levels. And because something works today, does not mean that the same thing will work tomorrow. Your day-to-day health can cause variances and even large variances. If you think my suggestion of heaving intensive testing for two or three months is too long, just wait until a large variance happens and you are unable to tell from your food log and daily health log what caused the variance. This is part of the education of being your own lab rat. You will need to be honest with your food log and daily health log. The only person you will be fooling is yourself. Yes, a great doctor can look at these and maybe give you assistance in adjusting what you eat, but the A1c will give the doctor an idea if you are not being truthful. To be honest, he does not care if you lie to yourself, but if you lie to him/her, they may not be willing to spend time trying to assist you.

If you have a great doctor that gives you excellent information, great! Once you leave the office, you are generally on your own. You have to interpret your food log, health log, and blood glucose readings on your own and learn what the answer may be for a blood glucose reading that is excessively high or why you had the low blood glucose reading. I will advise people with blood glucose reading below 70 mg/dl (milligrams per deciliter) to have glucose tablets available to take one immediately and then 15 minutes later test again, and repeat if necessary. Why the chalky glucose tablets? Because these are not candy and it is important that you remember why you had to chew one or more of these 15-gram glucose tablets. They are fast acting and better than drinking (or over drinking) a juice pack or over consuming other food. These glucose tablets are available at most pharmacies without a prescription and it is advisable to have about 6 to 12 on hand at all times. This means carrying them when you are at work, travel, or are out for a walk.

Life with diabetes can be challenging, especially when you are new to diabetes. You may not appreciate this if you are new to diabetes, given that you may be in denial or haven't accepted the diagnosis, but when you finally come to realize that you must accept the fact that you have diabetes, learn how to deal with it, and what you are capable of in managing diabetes, you will be thankful for these abilities. Those of us that have had diabetes longer often feel that even with diabetes, we are healthier than we were before diabetes.