May 24, 2014

Should Food Be Regulated Like Tobacco?

According to the Consumers International (CI) and the World Obesity Federation (WOF), this is where we are headed. The new rules proposed by these two organizations will include reducing the levels of salt, saturated fat, and sugar in food. They would improve food served in hospitals and schools, impose stricter advertising controls, and educate the public about healthy eating.

I sincerely wish these do-gooders would crawl back in the cave they came from and leave the rest of us alone. We need salt to live, saturated fat is not the bad boy they claim, and sugar in moderation can be tolerated. Now if they would put high fructose corn syrup in the sugar category, then they could be on to something.

These two organizations, CI and WOF, said governments around the world should impose compulsory rules for the food and drink industry.

We already have the Academy of Nutrition and Dietetics taking over the dietary food in hospitals and this will cause more deaths as it is. The USDA has already ruined the food in our school system.

Other activities they are asking for include:
#1. Artificial trans-fats should be removed from all food and drink products within five years.

#2. Advertising to children during television programs must be restricted.

#3. Governments could review food prices, introduce taxes, change licensing controls, and start new research to make this happen.

#4. Consumers International said they were asking for the “same level of global treaty” as the tobacco industry faced.

#5. Stricter advertising controls could include pictures on food packaging of the damage obesity can cause, similar to the images of smoking-related disease on cigarette boxes.

This campaign is gathering steam and unfortunately some support. The US government is ignorant enough to buy into this and make life more difficult for us.

May 23, 2014

Five Distinct Types of Depression

Maybe, just maybe, some answers will get depression analysis on the right path and away from all the pills. This news article was an interesting read and I will encourage you to consider reading it as well. In the meantime, I will condense my thoughts to keep this shorter that I originally had it.

Most psychiatrists have felt that depression was the result of low levels of the chemical serotonin. This has been the standard treatment for depression is often selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels in the brain.  A new study suggests that there are at least five biotypes of clinical depression.

William J. Walsh, Ph.D., president of the Walsh Research Institute, and his team looked at about 300,000 blood and urine chemistry test results and 200,000 medical history factors from approximately 2,800 patients diagnosed with depression. They found that five major depression biotypes represented about 95 percent of the patients.”

Walsh and his team discovered that three of these forms of depression are not caused by fluctuating serotonin levels.” They list 5 Biotypes of depression:

#1. Undermethylated Depression This was found in 38 percent of patients in the study. This is not a serotonin deficiency, but an inability to keep serotonin in the synapse long enough. Most patients with this report excellent response to SSRI antidepressants, although they may experience nasty side effects.

#2. Pyrrole Depression This was found in 17 percent of patients. These patients said that SSRI antidepressants helped them. They exhibited a combination of impaired serotonin production and extreme oxidative stress.

#3. Copper Overload This accounted for 15 percent of the cases in the study. These patients cannot properly metabolize metals. SSRIs had no effect – positive or negative, but they reported benefits from normalizing their copper levels through nutrient therapy. Most of these patients are women who are also estrogen intolerant.
For them, this is not a serotonin issue, but an extreme blood and brain levels of copper that result in dopamine deficiency and norepinephrine overload, and this may be the primary cause of postpartum depression.

#4. Low-Folate Depression This accounted for 20 percent of the cases and SSRIs made their symptoms worse. Folic acid and vitamin B12 supplements helped. Benzodiazepine medications may also help people with low-folate depression. “Walsh said that a study of 50 school shootings over the past five decades showed that most shooters probably had this type of depression, as SSRIs can cause suicidal or homicidal ideation in these patients.”

#5. Toxic Depression This accounted for 5 percent of the cases. This type of depression is caused by toxic-metal, usually lead poisoning, but removing lead from gasoline and paint has lowered the frequency of these cases.

We are not the first to suggest that there may be other causes of depression, but we might be the first to identify the other forms of depression, and the first to suggest blood testing to guide the treatment approach,” Walsh said.

A urine test can detect pyrrole depression, while blood testing can identify the other biotypes.

If depression could be detected via a blood test or urine test, it would clearly be in the realm of ‘medical illness’ and therefore a real problem that is not due to individual weakness or other equally stigmatizing reasons.

May 22, 2014

This May Be a Partial Cause of Falls by the Elderly

If you have diabetes and are among the elderly, be careful about the use of antidepressants. Yes, many of the elderly use antidepressants because of the depression they develop from the daily duties of diabetes.

Abnormal binocular vision, which is determined by the way our eyes work together as a team, changes as we age. According to Canada’s University of Waterloo, there is a correlation (not a causation) between this condition, general health and antidepressant use.

About 27 percent of adults in their 60's have an actual binocular vision or eye movement disorder. This increases to approximately 38 percent for those over 80 years of age. In the general population, about 20 percent suffer from a binocular disorder. A binocular disorder affects depth perception and this may increase the risk of falls.

The study looked at randomly selected records of 500 older patients over the age of 60 who received treatment at the school's on-campus clinic. Thirty to forty percent of the population is a high rate of incidence for any disorder. Unfortunately, this is the first study to quantify binocular vision loss with age and show a correlation with antidepressant use and general health.

Diabetes and thyroid disease are known to cause binocular vision problems, but this is the first study to correlate binocular vision disorders with overall general health. Other writers have discussed a possible association between certain antidepressant drugs and specific binocular vision disorders. The study author, Dr. Susan Leat, a professor at the School of Optometry and Vision Science at Waterloo says, "An association does not establish that one causes the other, but rather that they co-exist. It is possible that the effects of poor vision mean that people are more likely to take anti-depressants or make less healthy lifestyle choices."

While the study suggests that binocular vision disorders is higher than expected in the elderly, most binocular vision disorders are treatable with glasses, vision therapy, or occasionally surgery. It is recommended that people keep their glasses up-to-date with regular eye examinations. This will avoid large prescription changes and is a good way to maintain good vision, decrease risk of falls, and maintain a good quality of life as you age.

May 21, 2014

Yes, I Make Mistakes

I received two emails in the last week. Both were asking why I don't list more of the mistakes I make and why I push so hard to help others prevent mistakes. My first reaction was not very positive and I almost deleted the emails. My first reaction was it is none of their business and I write my blog to help educate other type 2 diabetes patients. Now that I have thought about this for a couple of days, okay, I am human, make mistakes more often than I like, but I also don't like talking about each and every one.

Managing type 2 diabetes 24/7/365 is difficult and being on insulin makes it even more difficult. Doing multiple daily injections and not having access to an insulin pump means that I have to pay attention to the number of carbs I consume and test more often than those on oral medications. Ten years has made guessing carbs more accurate than I could have imagined, but I still make mistakes. I have found that a positive attitude and developing good habits have helped minimize the mistakes.

Having a spouse that can eat what she wants has not helped and I have gone to preparing my own meals to have a more accurate accounting of carbs. She does not like me measuring and weighing food when she is cooking. Plus she still believes in low fat foods. Meat is excessively trimmed of all fat and she purchases lean meats. This is completely opposite of my choices.

One big mistake occurred shortly after being diagnosed with type 2 diabetes. The first was purchasing three new “diabetic cookbooks.” Instead of looking at them in the bookstore and determining whether they would have recipes of value, I did not do this until I arrived home with them. They were unusable for me and the recipes all had too many carbohydrates and no nutritional values given. Since they were glossy pages, they had no other value. I donated them to the local library which did not want them either and the put them in the local book sale. In addition to having no recipes that I would use, they also used foods that are not common foods and very difficult to locate in the Midwest.

The second mistake was waiting for almost four months to start insulin. Even cutting the number of carbs was not bringing my blood glucose levels down enough. Metformin and one sulfonylurea were not lowering my blood glucose levels but a little.
Yes, but reducing my carb intake, my weight was starting downward, but my blood glucose levels only went from the 300's to the 200's.

After starting my insulin, and keeping my carb intake down, my weight started dropping. Not that I lost enough weight, but at least I was feeling better and with insulin, I was managing my diabetes and my A1c came down from almost 14 to under 6.5 percent and at one year after diagnosis, to 5.9%. I have only been able to obtain an A1c below 6.0 one additional time, but the majority have been below 6.5%.

One of the advantages that happened to me was about 6 years after diagnosis. Two of us happened to be in the same restaurant and were just talking. I needed to know my blood glucose level and just took out my testing kit and the other person asked if I was a type 1 or type 2. When he found out I was a type 2 on insulin, he stated that he was on metformin. After I had ordered the breakfast, I injected the appropriate amount of insulin just before the food arrived. We continued talking and he said there would be another fellow with type 2 joining him shortly.

Shortly after, his friend joined us. After introductions, we talked until the noon lunch crowd started coming in. We agreed to meet a week later and that was how the group started. Both were on oral medications and having trouble with blood glucose levels and were always surprised at my levels. We talked about insulin and A1cs and both were over 7% while I was at 6.1%. This had their interest and they kept asking me questions about insulin. Within the next six months, both started using insulin and are continuing as of today.

May 20, 2014

Insulin Medications Very Prone to Error

As much as I advocate for insulin use,this study from the Pennsylvania Patient Safety Authority (PPSA) does explain some problems many diabetes patients encounter. The Institute For Safe Medication Practices states that insulin accounts for more than 10% of all drug mistakes. Even scarier is this drug class has been rated as having the most mistakes every year for the last 20 years.

The PPSA did their study of state hospitals focusing on medication errors. Dispensing insulin was the most frequent of all medication mistakes made.

  1. 20 percent of patients were given the wrong kind of insulin from the pharmacy.
  2. 18.4 percent of patients were supplied with the wrong mix of insulins.
  3. 17.4 percent of mistakes were due to misreading of prescriptions.

Obviously one of the reasons for the error rate seems to be due to simple confusion – with 13 different types of insulin available in five different categories and four similar names. The five categories are:

  • Premixed
  • Long-Lasting
  • Intermediate Acting
  • Short Acting
  • Rapid Acting

The similar names are:

  • Humalog
  • Humulin
  • Novolog
  • Novolin

See the chart here for the types of insulin. Now consider that in the next few years we can expect to see at least 3 to 6 more unique insulins that could be slower in action, more rapid onset, longer acting, and many more combinations. The number of mistakes can be expected to increase when the medication is insulin.

Many of the insulin medication errors can be very dangerous and cause death. This can lead to legal action and higher insurance rates. If you are hospitalized and you are able, always be prepared to check and recheck that you are getting the same insulin you use and check the carb count to be sure that you are not overdosed in the process.

I have had problems and the hospital wanted to give me Levemir only, but I use Lantus and Novolog. Since I had my own insulin and they did not have either, I politely refused and used my own. The second time I had just had an operation and was only allowed broth so I did not need insulin and politely declined other foods and knew I would be home before I would have reading near 140 mg/dl. The nurses did test my blood glucose and were surprised I knew what my readings would be (always within 5 points) and upon arriving home, my reading was only 132 mg/dl.

May 19, 2014

We All Need Salt

At least Dr. Malcolm Kendrick has humor and writes with it. The subject is serious and he takes it apart bit by bit and shows how we can be led astray by what we think we know. Even I have been caught in this. Talk about mistakes in blog writing, then read this where I made a serious mistake.

Keep in mind that salt (NaCl) and sodium (Na) are two different things. I like Dr. Kendrick's way of explaining it and I urge you to take time to read his blog linked in the first sentence.

May 18, 2014

Diabetes Cure – Not Today

Excuse me for being blunt, but someone needs to be. When certified diabetes educators with other titles like registered dietitian, we need always to be concerned about which conflict of interest we are receiving. Is it Big Food or Big Pharma that is being promoted? I always take the first title behind the name as being the one of most concern.

That led to a surprise in this blog on the American Association of Diabetes Educators (AADE) website. I had a difficult time swallowing her reasoning for letting a myth take over her discussion. After her class hears the myth, she concluded the blog by asking, “So why is it still so difficult to get patients to “buy in?””

Why she had to ask this, when she answered her concluding question in the paragraph above it, still puzzles me. “Most are looking for that “miracle pill” that helps them lose weight and improve physical abilities while allowing them to eat as much as they want.” It would seem to me that she has more educating to do and very unwilling listeners. I have no sympathy in this case because she allowed a myth to be promoted in a diabetes class.

Yes, I have had people tell me that this is the twenty-first century, so there has to be a cure. I try not to let this go any further and if it does, I say until they can produce the article or advertisement, it is not part of the discussion. I have had one person produce the advertisement and with that, I was able to show the person why and how he had been mislead. No, he was not happy, but after making him answer questions about the advertisement, he had a better understanding. After that, he thanked me for making him decipher the advertisement.

Back to the blog, and why I have a problem with CDEs. Yes, the author did mention diet and exercise, but it was more like a mandate than education. Rather than stretch their brains, many CDE’s resort to mandates and expect people to follow. This is also a reason for lack of buy-in by patients.

I am surprised that the dogma of consuming whole grains was not introduced. That is the only positive I can identify in the blog.