Welcome! This is written primarily for people with Type 2 Diabetes. Some information covers all types of diabetes. Always keep a positive attitude is my motto.
I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.
In covering the new nutrition guidelines (a PDF file) from the ADA (American Diabetes Association) from last October, I was more than a little harsh because of the registered
dietitians on the guideline committee. Yes, the guidelines are
developed by a select committee of nutrition experts and the
guidelines are evidence-based. Much of the evidence is from
randomized clinical trials, but some is called expert opinion or
expert consensus if we are to believe that is possible in dietary
nutrition. When many of the authors of the ADA nutrition guidelines
are beholden to Big Food and Big Ag, one must wonder if personal
'expert' opinions were not injected in the guidelines.
There are some new concepts not in
prior guidelines. This may be the most positive aspect to come out
of the 2013 guidelines.
Eating patterns. This has not
been discussed in guidelines before and for people with diabetes,
this is a milestone in change. Be recognizing that there are many
types of eating patterns, this makes individualizing a meal plan more
realistic. The types of meal plans include:
• The DASH (Dietary Approaches to
Stop Hypertension) eating plan • The Mediterranean-style eating
plan • Vegetarian and vegan diets • Low-fat diets •
This allows room for other eating plans
and making people with diabetes feel more relaxed about their food
plan. Just because a friend may like a vegan diet, does not mean
that your personal preferences have to be the same. It is your
personal food plan that is important to you. It will make your likes
and dislikes, cultural background, religion, economic situation, and
glycemic goals more important for your eating pattern.
Macronutrients. These are
carbohydrate, protein, and fat.
Carbohydrate – I have been one to
criticize the American Diabetes Association for promoting high
carbohydrate diets, but I need to consider that with the new
guidelines that their promotion has changed.
Until I see the Academy for Nutrition
and Dietetics (AND) stop promoting Big Food, the people with type 2
diabetes will still need to be very careful in what the registered
dietitians are promoting in the number of carbohydrates they
recommend. Many are still promoting 60 grams of carbohydrates for
each meal and 15 to 25 grams of carbohydrates for snacks. One that I
heard about recently was promoting almost 280 grams of carbohydrates
per day. Most of us with type 2 diabetes cannot consume that many
and will gain weight rapidly doing this.
Many of the registered dietitians have
switched to promoting percentages to mask the number of carbohydrates
they are promoting. They have been recommending that it is up to the
individual, but they still promote a higher percentage of
carbohydrates. With most type 2 diabetes patients needing to lose
weight (about 85 percent), reducing the number or percentage of
carbohydrates consumed is the most efficient method and if possible
adding exercise to this.
Another trick dietitian's use is
alternating between grams of carbohydrates and percentage of
carbohydrates to confuse those they are supposedly teaching. But
more often, they are just issuing mandates and mixing the terms in to
make it sound like they are individualizing the treatment for you.
The two following paragraphs are
typical examples of the language used to make the type 2 patient
think they are doing what is best for them.
a considerable amount of space in these recommendations devoted to
lower-carb eating plans and some of the research does, indeed, show
positive effects of lower-carb eating patterns, particularly in terms
of weight loss. However, the authors of the guideline do point out
that one of the downsides with low-carb diets is that there isn’t a
standard definition of “low carb.” The authors describe “very
low” carbohydrate intake as being from 21 grams to 70 grams of
carbohydrate per day and “moderate” carbohydrate intake as
comprising between 30% and 40% of total calories. But there’s no
general consensus about this.”
recommendations also, for the first time, recommend limiting the
intake of sugar-sweetened beverages. Monitoring carbohydrate intake,
whether by counting carbs or watching portions, is still considered
an effective means of controlling blood glucose. And substituting
low-glycemic-index carbohydrate for high-glycemic-index carbohydrate
may modestly improve glycemic control.”
Since there are no existing guidelines
for the different carbohydrate levels, I only offer these as a suggestion from a previous blog. If you believe differently, I have
no objection, but please be consistent and follow your personal
chart. I will have more in the next blog for protein and fat.
Allen and I are having sessions with a
person with diabetes that has basically given up on living. Allen
has Barry and Ben both helping him with research and they came up
with this from WebMD. Since Ben is not yet comfortable with an
intervention, I asked Tim to help us. After reading all of this we
decided to talk with Dr. Tom before going forward.
As soon as Dr. Tom heard the name, he
called his office manager and asked if the person had an appointment
for the next afternoon. He was informed that the appointment had
been cancelled that afternoon. He asked that the last appointment be
moved up and that time be reserved for the patient. Then Dr. Tom
asked if we could see that he showed up. He gave us the time and
said he would call us if there happened to be a problem. Tim said he
would be unable to be there the next afternoon, but Allen, Ben,
Barry, and I said we would have him there.
The next afternoon, it took some
shenanigans, but we had him there and the office manager met us and
escorted us to the office. We were a couple of minutes late, but Dr.
Tom was waiting for us.
As soon as we were all seated, Dr. Tom
told the patient that he understood why he had given up. He said
that his father had type 2 diabetes and did not take care of it and
died about 18 months after diagnosis. Then he asked the patient how
long his mother had lived after diagnosis. He hesitated, but finally
admitted that his mother had only lived about three months, but it
was cancer that had killed her.
Dr. Tom then asked Allen when his
diagnosis happened. Allen said just over 10 years, and Dr. Tom
pointed to Barry and asked us to continue. Barry said he was
diagnosed almost 9 years ago. I stated that I was less than four
months to 11 years, and Ben stated he was at 10 years. Next Dr. Tom
asked us to tell the patient the complications we had. All of us
stated we had neuropathy and nothing more serious. I said I have
sleep apnea, but that is not part of diabetes, but could make managing diabetes more difficult. I had some heart problems, but had not had any problems in the almost 11 years since.
Dr. Tom then explained that with the
number of years each of us have had diabetes, why he was giving up
when he was not yet 60 years old. Dr. Tom explained that we were all
in our 70's. Now the patient was thinking. He turned to Allen and
asked why he had neuropathy. Allen said he had neuropathy because he
had been vitamin B12 deficient and he could not speak for the rest of
us. Barry and Ben agreed that was the cause of their neuropathy. I
said mine could have been from diabetes before my diagnosis, but I
had wondered if I had some chemical exposure at the time.
Dr. Tom then asked if he wanted a copy
of his test results. No was the answer and both Allen and I told him
to take a copy. He asked why when he was not planning to control his
diabetes. Everyone looked at him and finally Barry asked him why
with all of us here and our years of successfully managing diabetes,
would he throw his life away? Dr. Tom then asked him why with a wife
and three sons, would he not want to live to see his grandchildren.
Dr. Tom told him that just because his
father had not managed his diabetes, this did not mean that he could
not. Dr. Tom told him that the four individuals in the room with him
were managing their diabetes and he could as well.
Allen took out a copy of the WebMD
article and said this should provide him some ideas and why life is
worth living even with diabetes. Allen told him to read it and think
about it. We had taken enough of Dr. Tom's time. I will see you
this weekend and I expect some questions about what we can do to help
and educate you about managing your diabetes. I asked him if he
would mind giving me a copy of the lab results for me to go over them
and set them up on a spreadsheet for him to use.
He hesitated and finally asked Dr. Tom
to give me the last three results if he would. Dr. Tom asked the
manager to make copies and give them to me. Then he turned to the
patient and told him this was a good start and with the assistance of
the support group, he should be able to live a long life. Then Dr.
Tom told us that he would expect reports on his progress and was
available if needed. Barry thanked him and we left.
Now universities are promoting less
care for the elderly. Yes, I know many of the elderly have memory
problems and trouble with many medications. But to advocate that we
not be cared for and die seems like advocating for death panels to
rid them of troublesome patients.
When researchers for the University of Michigan make the statement, “Harm to
quality of life outweighs benefits of treatment for older patients
and those with negative feelings about side effects, burden of
medication,” this not only harms patients with their
words, but also shows that they could care less about the elderly.
What else they say shows their
ignorance about diabetes. They claim that patients with type 2
diabetes that are over age 50 should not have frequent insulin shots
because the side effects of weight gain trumps the benefits of drugs.
Why can't they teach patients about cutting carbohydrates and how to
exercise? All they can emphasize is insulin and how this harms
patients. The fear of hypoglycemia rules their thinking.
As a person with type 2 diabetes and
over 70 in years, this is an insult and says I should not be on
insulin. Well, I intend to stay on insulin and these researchers can
take a hike. The study by the University of Michigan Health System,
the VA Ann Arbor Healthcare System, and University College London was
published in the Journal of the American Medical Association
Internal Medicine. They claim that for many, the benefits of
taking diabetes medications are so small that they are outweighed by
the minor hassles and risks.
I would like to know when the benefit
of diabetes medications depended less on blood glucose and more on
hassles. Yes, safety and side effects are important, but when these
factors of hassles becomes all important, I think these researchers
have their priorities scrambled.
To my way of thinking, these
researchers are challenging the diabetes guidelines for the wrong
reasons and because they are setting the age of 75 as their goal for
people to have reduced treatment because of hassles seems very
arbitrary and smacks of discrimination against the elderly. When our
elders develop dementia and Alzheimer's disease, there needs to be
concern and different guidance for treating them.
However, to pick an age of 75 and put a
one-size-fits-all equation in place is not practical and basically
says – let people over 75 die. This is discrimination of the worst
type and researchers at universities are trying to set parameters on
treatment of the elderly to help them die. Their tactics need to be
recognized for what they are and opposed at every turn.
I suggest that the elderly that develop
memory problems be seen by someone that can properly assess them and
then be allowed to develop community assistance programs that would
help them in their treatment and prevent the hassles those of the
university say exist.
Should you have a spouse, a trusted
friend, or a patient advocate accompany you to a doctor's
appointment? This will vary by the person and the situation. Some
spouses do not work well enough together, some don't have a trusted
friend, or even a trusted family member. Many cannot afford to pay a
patient advocate. What are they to do?
First, if you are asked, think about
what you must do. How do you become the best
companion? You will need to listen,
record (please ask first), and ask questions. You will need to ask
the person you are going with why you are going. Ask what the person
wants to accomplish during the appointment? Don't forget to ask why
they want you to accompany him/her?
Next, there are many types of doctor
visits. Routine visits, routine physical, unknown issues, new acute
issue, or a follow up appointment for an acute issue or a chronic
It is a good idea to prepare for any
type of appointment:
#1. Have a list of current
medications, both prescription and over-the-counter, and any
questions the patient has about them. Make sure for a list that the
information is all there and when they are taken. If necessary,
bring the medications in their containers to the appointment.
#2. Have a list of all the members of
the patient's health team, both medical and non-medical.
#3. Record anything medical or health
related happening that has occurred since the last visit with this
doctor or clinic.
#4. Record questions that come up
during this preparation and seek answers.
At the appointment be an active
listener and make sure you understand. Repeat back what you hear.
Ask if you can record the session. If possible, use your phone or
bring a tape recording machine. Ask for a copy of the doctors notes.
If someone brings up HIPAA as a reason for not sharing this
information, remind him/her that the person needs this and they have
a right to the information. HIPAA mandates the sharing with the
person having the appointment. Before leaving, ask the person with
the appointment if he/she understands what the doctor has said and if
they have any final questions.
As soon as possible after the
appointment, go over what happened and what both of you learned.
Recall for most people can fade quickly. That is why to discussion
needs to take place, recording or not.
Choosing the right food plan is a major
part of managing diabetes. It is easier to keep track of what you’re
eating when you’re the one in charge of putting nutritious meals on
Learn how to use your blood glucose
meter with test strips to monitor your blood glucose levels to prevent
people from convincing you to eat too many carbohydrate-rich foods.
Certain educators and dietitians will try to push carbohydrates and
this is when you will need this knowledge.
#1. Watch the level of whole grains
you can tolerate.
A few of you will be able to consume
higher levels of whole grains and others should probably avoid them.
Use your meter to serve as your guide. Many of us find that
eliminating all wheat products serves us best and some find that
limited quantities will meet their needs.
#2. Try to add more fiber to your
Consider at least 8 grams of fiber per
meal, or more if you can consume carbohydrate-rich foods. Select
vegetables such as peas, beans, artichokes, celery, parsnips,
turnips, acorn squash, brussels sprouts, cabbage, broccoli, carrots,
cauliflower, asparagus, and beets. Eat some fruits, but don't over
eat from these - apples, mangoes, plums, kiwis, pears, blackberries,
blueberries, strawberries, raspberries, peaches, citrus fruits, and
A fiber-rich diet also curbs the risk
of heart disease, which is higher in people with diabetes.
#3. Replace some carbs with good
Monounsaturated fats meaning nuts,
avocado, olive, and sunflower oils can help lower blood sugar. Add
nuts and avocado to salads and entrees. Use olive and sunflower oils
to cook dinner dishes. Look for products that contain either oil,
such as salad dressings, marinades, marinara, and pesto(if needed
make your own). Still, keep portions modest, so you don't get too
#4. Eat foods that won't spike blood
Foods that aren’t likely to cause a
significant rise in blood sugar include meat, poultry, fish,
avocados, salad vegetables, eggs, and cheese. Eating these foods
will help balance carbohydrate foods excluded in your meal.
#5. Choose recipes with moderate
Look for the following – fish, beef
(grass fed if available), pork, chicken, full fat dairy, and avoid
#6. Know the nutritional values in
the recipes you use.
There are digital scales that can help.
Find out the amount of carbohydrates, fiber, and fat per serving.
Then stay close to the appropriate portions by serving up your food
on smaller plates.
#7. Use butter and shortening with
sunflower or olive oil.
Both sunflower oil and olive oil are
better choices. Read my blog here about them. There may be other
quality oils, but avoid canola or vegetable oils.
#8. Prep for salads ahead of time.
Store a large spinach salad or
vegetable-filled romaine lettuce salad without dressing in an
airtight container. You can have crisp, wonderful salad with your
dinner or as a snack for the next several days.
#9. Make an easy fruit salad.
With a few chops of a knife, you can
turn a few pieces of fruit into a beautiful fruit salad. Drizzle
lemon or orange juice over the top. Then toss to coat the fruit. The
vitamin C in the citrus juice helps prevent browning.
#10. Choose drinks wisely.
Instead of soda, sweetened drinks, or
fruit juice, drink protein-rich drinks such as whole milk. Or sip
no-calorie tea, coffee, or water.
#11. Slow down or don't eat so
Fast eaters tend to eat more. It takes
at about 20 minutes for your brain to get the message that your
stomach is officially “comfortable” and that you should stop
eating. So, eat slowly and chew your food thoroughly. As you do,
you'll become more aware of the textures and flavors and feel more
#12. Avoid late-night snacks.
Avoid late night snacking unless your
blood sugar is too low and your doctor or certified diabetes educator
recommends having an evening snack. Only do this is your blood
glucose is too low. Drink a cup of no- caffeine tea instead. Talk
to your doctor if you are always experiencing high fasting blood
glucose levels or the dawn phenomenon.
Finally, it is great to see a federal
agency advocating for personalized medicines. The agency is the
National Institute of Health, Senior Health. I am especially
thankful with the opening statement - Medicines: One Size Does Not
Fit All (Bold is my emphasis).Studies have shown that even properly prescribed medicines cause
a number of hospitalizations each year.
The article explains that allergy
medicines don't work for everyone and for others, the standard dosage
of a prescription pain reliever can cause side effects that are
uncomfortable or life threatening. As the person ages, fat and
muscle content change. This then affects how the body absorbs and
processes drugs. Other factors also affect how a person responds to
medicines and some of these factors are exercise habits, diet, and
general health condition.
A key factor in how we react to
medicines is heredity. In other words the genes we inherit from our
ancestors. These genes influence the way people respond to many
types of medicines including many blood pressure and asthma
medicines. Your genes affect the shape and function of your
proteins. As the different drugs travel through your body, they
interact with dozens of proteins.
Remember, everyone’s genes are
slightly different and thus everyone’s proteins are different.
Variations in some proteins can affect the way we respond to
medicines. These proteins include those that help the body absorb,
metabolize, or eliminate drugs.
I know this personally. I have no
problems with Lisinopril, for blood pressure. However, my wife
developed one of the side effects and could not shake it until one
week after she stopped taking it with the doctor's order. She now
takes a different medication that works for her, but I had a severe
reaction to it until I was prescribed Lisinopril.
A new type of research is taking place
around the country to understand how genes affect the way people
respond to medicines. This research is called pharmacogenomics.
pharmacogenomics research progresses, it will become increasingly
important to identify all the possible variations in genes that play
a role in drug response. To identify which versions of these genes a
person has, researchers examine DNA from that person. An easy,
painless, and risk-free way to obtain DNA is from mouth cells that
stick to a cotton swab rubbed on the inside of a volunteer's cheek.”
If you have watched any of the CSI TV shows, you know that this is
done. It takes longer than it does on TV, but the results
As this research progresses, finding the differences in people's
genetic backgrounds will help doctors prescribe the right medicine in
the right dosage for each person. This will make medicines safer and
effective for everyone.
With everyone going ga-ga over FDA approving Afrezza, I have some serious doubts about how many people
will be able to use it. I know that I will not be one of them. This
is because of one thing – I would have difficulty getting the
correct dose into my system because of sinus problems which can occur
anytime and make breathing difficult. When this happens, I am forced
to breath through my mouth.
This is not one of the problems even
listed, but if you have this problem, getting the mist into your
lungs may be difficult. Afrezza has a Boxed Warning advising that
acute bronchospasm has been observed in patients with asthma and
chronic obstructive pulmonary disease (COPD). Afrezza should not be
used in patients with chronic lung disease, such as asthma or COPD
because of this risk. The most common adverse reactions associated
with Afrezza in clinical trials were hypoglycemia, cough, and throat
pain or irritation.
With the above information, I would
also be concerned about people with diabetes that develop pneumonia.
In addition, nothing is mentioned about any testing for the elderly.
People at all ages can have respiratory problems causing breathing
problems and often the necessity for oxygen use. From the way drug
reps promote drugs and doctors prescribe, I can see patients with
respiratory problems being prescribe Afrezza. To me it seems that
the FDA has missed some information and at a minimum left their
brains at home when they approved Afrezza.
Afrezza is not recommended for the
treatment of diabetic ketoacidosis, or in patients who smoke. Even
then it was approved and it will work for some people and that is a
good thing. At least the FDA is requiring some post-marketing
studies for Afrezza. These studies include a clinical trial to
evaluate pharmacokinetics, safety and efficacy in pediatric (young
people under the age of 19) patients. The second study is a clinical
trial to evaluate the potential risk of pulmonary malignancy with
Afrezza. This trial will also assess cardiovascular risk and the
long-term effect of Afrezza on pulmonary function.
Two additional trials have been
ordered. They are pharmacokinetic-pharmacodynamic euglycemic
glucose-clamp clinical trials, one to characterize dose-response, and
one to characterize within-subject variability. Both are important
and hopefully will help regulate the dosage on an individual basis.
I would hope that individuals with any
of the problems mentioned above would hesitate before letting the
doctor prescribe it for them. Let the people with diabetes without
significant health problems be the ones to find out if Afrezza works