Things to Help Manage Diabetes

You will have to excuse my rant, but when authors write about mistakes people with diabetes make, they seem to dance around the core issues and leave a lot to be desired. The author(s) always leave education off the table, self-monitoring of blood glucose seems taboo, and even self-education is not mentioned.

Managing diabetes could be more successful if these three topics were included in discussion like this WebMD article. The title of the article is 6 Diabetes Mistakes -- and How to Avoid Them. Granted the six mistakes are common and need to be put forward, but without the three topics above, they are not as meaningful.

The mistakes are:

Not Taking Control of Your Condition. It is true that you have to take control and manage your diabetes. It is your job to manage your diet, exercise, and take your medication on schedule as directed by your doctor. This does not mean that you cannot discuss your medication(s) with your doctor – this you should do to understand the purpose of the medication(s) and if you need to be aware of any adverse side effects.

Expecting Too Much Too Soon. Many of the newly diagnosed expect changes to happen immediately. You did not develop diabetes overnight, and managing diabetes does not happen overnight. You will need to use your blood glucose meter to test how foods affect your blood glucose and eat to your meter. This means reducing the quantity of some foods and removing some foods from your meal plans.

Expecting too much to change right away is a mistake – and so is doing too much before you are ready. When it comes to exercise, take small steps. If you do more than you can tolerate, you may quit, or do too much and hurt yourself. So start slowly and ease into the habit. Be sure to talk with your doctor before starting a new exercise program, especially if you aren’t already active. They can help you set realistic goals and plan a routine that’s safe and effective.

Going It Alone. One error that people make when it comes to exercise is that they try to do it without help from other people. Not only do spouses, partners, friends, and family members make great exercise buddies, but also they are also terrific cheerleaders. So don’t hesitate to ask a loved one to help you stick to your medication schedule or eat a healthy diet, or help you manage your diabetes, if needed.

Neglecting Other Problems. I wish this would not happen, but quite often does happen. Depression, stress, and often sleep apnea are totally ignored by the newly diagnosed. The lethargy common to depression can be so discouraging that you might give up your efforts to take care of your diabetes. Not only will that make your diabetes worse, it may also intensify your depression, creating a vicious cycle.

Depression and stress can also have a negative effect on blood sugar levels. Constant stress may increase hormones that hamper the ability of insulin to do its job.

Exercise helps relieve stress, and there’s evidence that meditation and massage will benefit blood sugar levels. If you are overweight, make sure you find out about sleep apnea and if your family complains about your snoring, don't put it off. Lack of good sleep makes diabetes management more difficult.

Misunderstanding and Misusing Medications. This happens all too often. Many patients perceive medications to be more powerful than their meal plan and exercise.

In many cases, type 2 diabetes can be controlled by a combination of a healthy meal plan and regular exercise without the need for medication. But for many people, medication can be helpful, too.

It’s surprising how many people miss doses of their medication. Getting off track with your medication(s) is a quick way to wreck your blood sugar level.

Making Poor Food Choices. The biggest hurdle in making good food choices is carbohydrates. You must control your carbohydrate intake to keep your blood glucose levels steady. We have been mislead for half a century to avoid fats and this is damaging our health as many advocate for high carbohydrate meal plans to go along with the low fat. For people with diabetes, this is health damaging. Extra test strips will cost you money that the insurance will not reimburse, but this may be necessary if your doctor will not request a three or four month exception to insurance policy. Until you have established a new meal, plan and have reduced the number of carbohydrates and know what to expect, eating to your meter is a wise plan.

This means keeping a meal plan diary to keep track of what you’re eating and drinking, and always reading nutrition labels so you know what’s in the food you’re choosing. It is also smart to avoid highly processed foods.

Back to Sleep Apnea

I don't know what it is about some doctors, but it seems a few don't like patients making their feelings known about sleep apnea. Two emails actually were threatening because I spoke out against sleep apnea surgery. Another was very upset that I had written about home remedies. Then the morning of the last blog, those doctors promoting surgery were very angry and could not believe that for someone that had never had surgery for sleep apnea would encourage people not to have surgery. I would only say that the source of my information was the Mayo Clinic and the links in my earlier blogs. Plus the American Sleep Apnea Association and other authorities recommend surgery as a last resort and not until all other attempts have failed. I was surprised that they would ask me to remove my blogs and I said that I would not retract or remove my blogs.

He responded that he would have Google remove them for me. I said they would not and if he could not stand the truth, he should quit the surgery occupation. There are too many examples of unhappy people that have had the surgery and are very vocal and putting this information on the internet. With only about 25 to 30 percent of surgery being successful, this is a very poor example of improving sleep apnea. The number one complaint is the lack of success and still having sleep apnea. The number two complaint is the pain for up to two months following the surgery, but many have it for less time. The number three complaint is almost choking when trying to swallow food after surgery.

I am not sorry to have irritated a few surgeons when other surgeons do great work in areas of need that saves patients' lives, but when surgeons are so desperate to do surgery that does not prevent sleep apnea they don't belong in medicine. Most of these greedy surgeons fail to inform patients of many details and what their odds of success are. They just say that the surgery is what they need (with their fingers crossed behind their backs).

Are You Newly Diagnosed with Diabetes?

I have been recently surprised by the number of people diagnosed with type 2 diabetes. Even the members of our support group are surprised. In the last few months, our group has encountered about a dozen people that have been diagnosed since the first of the year. What has been even more shocking is they are not being secretive and are asking many questions.

Allen and Barry have been talking to many of them and answering many of their questions. Most of them are aghast when they find out how many are on insulin. Some even ask if we are type 1's and then ask how long we have to live when we say we are all type 2's. We just laugh and say that what they have heard is a myth. We also say that only God knows when we will die.

I had wanted to use a post from a diabetes forum, but the poster would not give me permission, but you can still read it here. The original poster had some very good points and directions for the newly diagnosed.

Most of us with type 2 diabetes have been through much of what we receive questions about and most of the newly diagnosed feel they are unique. They are unique as a person and with diabetes, but they often feel that their way is the only way. I hate to disagree with most of what they say, but what works for them may not work for me, and the other way around.

I will credit David Mendosa and Gretchen Becker for their guidance on eating low carb and higher fat, but the higher fat really came from reading many articles on disproving the results of statements by Ancel Keys and the American Heart Association. My heart doctor and I came to a parting of ways when he ordered me (not politely) to eat low fat. I told him that with the lipid panel being where it was that I would not eat low fat and have the lipid panel go high again. I haven't seen him since that appointment.

I am thankful that one-size-does-not-fit-all and that people are generally all different - unique. I have been able to eat 40 to 80 grams of carbs per day, depending on the food and still have room for many fruits. I only eat two meals per day – breakfast and dinner and my fruit snack between the two meals. In general, I have few problems staying under 140 mg/dl, but not always when I add a new to me food. Then I have to do a correction with rapid acting insulin to bring it back down. And when this happens I always need to be careful about the amount of insulin that still is in my system to avoid going too low.

The one word of caution to the newly diagnosed is that there is a lot of misleading information on the internet and care needs to be taken not to get separated from your money. There are too many scammers that have deals for you and diabetes is no exception. Those claiming cures and similar schemes are about the worst of the lot. Many don't have diabetes to begin with, but claim this to sell their products.

Are CDEs the Correct Support for You?

Are certified diabetes educators the correct people to go to for support? Before I answer, there are some facts that need to be stated. The American Association of Diabetes Educators (AADE) claims 13,000 members. The Academy of Certified Diabetes Educators (ACDE) makes no claims, but declares that 18,000 have passed the National Certification Board for Diabetes Educators (NCBDE) examination.

What all organizations avoid telling us or stating includes:

Not telling us how many are retired and not working as CDEs.

How many have taken up research work and not working as CDEs.

How many are its officers in ivory towers and not working as CDEs.

How many are on book promotion tours and not working as CDEs.

How many are only working part-time as CDEs.

How many are working full-time as CDEs.

There are also others that work as CDEs and RDs and therefore not full-time as CDEs. With all this missing information it is small wonder that many of us with type 2 diabetes are not seeing or receiving any education from CDEs. This also explains why many in rural areas of the United States do not have access to CDEs as most live in highly dense population areas where they have plenty of patients.

I do not begrudge the many type 1 people as they often have greater need for CDEs than many type 2 people do. And from experience, I know that most CDEs do not want to work with type 2 people. That is not to say that type 2 people refuse to see CDEs. We do mainly because we are older and understand when we are fed mandates and mantras and are just expected to follow them. A new member in our community had classes and decided to attend, but after the first class, refused to attend the next two classes. When asked why, she said the CDE was teaching to the lowest common denominator and handing out mandates. She refused to answer the simplest of questions and only answered two questions the entire class.

When she started mandating the number of carbohydrates we should eat at every meal, one of the class members told her that a dietitian would be having a class following her class and she should stick to diabetes education and not what we should eat. Only two of the class were on insulin and those were the questions she answered. When one of the class asked about burnout and depression, she quickly pickup up her materials and said she had a patient appointment to go to and left.

The dietitian followed and would not discuss any questions and stuck to her prepared material. She was also mandating that everyone should eat a minimum number of carbohydrates per meal (55 grams minimum) and to make sure that they stayed on a low fat meal plan (no more than 10% of total calories). When a class member asked why everyone had to eat the same one-size-fits-all meal plan and could not adapt their meal plan to what worked for them, the RD said she was the instructor, had the needed education, and they were to follow her instructions. At that point most of the class got up and left.

When the person showed us the schedule and who the CDE and RD were, a few of our support group could see that they both had the titles of CDE and RD. So when many of us type 2 people see this, we understand the conflict of interest (COI) because of the support of the AADE by Big Pharma and the Academy of Nutrition and Dietetics (AND) by Big Food and Big Agriculture.

The person started asking questions of those present and we took the time to explain and answer all of his questions. Tim got his email address and said he would be sent email addresses for the rest of the members and we would try to answer most of his questions. Allen told him that a one-size-fits-all solution did not work for type 2 diabetes and that if CDEs and RDs would not properly assess his as an individual, then he was right not to attend classes.

Sleep Apnea, Alternative Medicine and Other Info

There is not an abundance of information about alternative medicine and sleep apnea. I have seen some on acupuncture and sleep apnea, but most is very short and limited like this by the Mayo Clinic. There is also dental (oral) appliances for sleep apnea which I wrote about in September 2010.

Oral appliances are available and some dentists have been through the sleep specialist training to qualify to fit oral appliances for sleep apnea. If you are a person that sleeps on you stomach and tosses and turns a lot in your sleep, these may not be for you and they can do damage to your teeth. This information was received from a dentist that fits oral appliances for sleep apnea. More dentists now are qualified to handle mild to severe obstructive sleep apnea. I have written about oral appliances here. The national group for oral appliance part of dentistry is here.

Most of the discussion to this point has been about patients with sleep apnea that have been overweight. However, people with normal weight can develop sleep apnea as they age. So if you happen to be in this group, be careful as well. Also if you were an overweight person with sleep apnea and have lost weight, this does not mean that you have cured your sleep apnea problem. A friend of mine stopped using his CPAP when his weight was at his normal or ideal weight. Two months later, he complained about being so tired he could not stay awake.

After several days of discussion, he said it was six years since he received his CPAP machine and Medicare would maybe consider another sleep study and definitely a new machine. After talking to his sleep doctor, it was determined this would be best. After the sleep lab, it was determined that he still had sleep apnea and averaged about 50 apneas during the lab. Now he is waiting for the new APAP machine. He told me that in most of his reading they have said losing weight normally took care of the sleep apnea problems. He now knows better.

Two of the organizations for sleep apnea are:

http://www.sleepapnea.org/support/here-to-help/all-about-a.w.a.k.e.html

http://sleepfoundation.org/sleep-disorders-problems/sleep-apnea

http://www.ninds.nih.gov/disorders/sleep_apnea/org_sleep_apnea.htm

This one also lists the previous two organizations.

I have written about surgery for sleep apnea and from my reading would discourage considering this. Two blogs are here:

http://bobsdiabetes.blogspot.com/2011/02/obstructive-sleep-apnea-surgery.html

http://bobsdiabetes.blogspot.com/2010/10/sleep-apnea-surgery-options.html

Some other blogs that may be of interest are:

http://bobsdiabetes.blogspot.com/2013/04/sleep-apnea-are-you-prepared-patient.html

http://bobsdiabetes.blogspot.com/2012/03/avoiding-cpap-problems.html

http://bobsdiabetes.blogspot.com/2012/02/children-with-osa-benefit-from-cpap.html

This article from CardioSource is very informative and contains some straight forward information about CPAP use and the effects on lipids, hypertension, and diabetes.

Even with firm evidence that lack of sleep has a proven effect of making diabetes more difficult to manage, CPAP has mixed results on improving insulin resistance.

This concludes this series on sleep apnea.  I have come across more information and will have a few blogs in the near future.  

Sleep Apnea Lifestyle and Home Therapies

I know this is a favorite way for many sleep apnea suffers to avoid facing their problem. The only reason I am even blogging about this is that if does work for some people that have mild sleep apnea. A few people with moderate sleep apnea may receive relief. If you have severe sleep apnea, get into your doctor immediately as you are at high risk for a heart attack or even a stroke.

In some cases, self-care may be the most appropriate way for you to deal with sleep apnea and possibly central sleep apnea. Try these tips:

Lose excess weight. Even a small loss in excess weight may help relieve constriction of your throat. Sleep apnea may be cured in some cases by a return to a healthy or ideal weight. If you don't already have a weight-loss program, talk to your doctor about the best course of action for weight loss.

Exercise. Getting 30 minutes of moderate activity, such as a brisk walk, most days of the week may help ease obstructive sleep apnea symptoms.

Avoid alcohol and certain medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.

Sleep on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.

Keep your nasal passages open at night. Use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using any nasal decongestants or antihistamines because these medications are generally recommended only for short-term use.

Stop smoking, if you're a smoker. Smoking worsens obstructive sleep apnea.

Talk to your doctor about facial and throat exercises. There are some facial and throat and jaw exercises that may strengthen the muscles to prevent them from closing when sleeping. This is no guarantee, but I have a friend with moderate sleep apnea that has been through the sleep lab and sleep apnea was confirmed. I don't know who he talked with, but the day after his sleep lab, he started exercising and did this for two months. His wife was surprised that he was not snoring and felt he was no longer having apneas. Another sleep lab six months latter showed he was normal and this time he was only tested for sleep apnea and no other sleep disorders. The other fact was that he was already at normal or ideal weight.

Please, please do not think that you can tough it out and severe sleep apnea can kill you. Do it for your loved ones so that you can live with them and they with you.

Sleep Apnea Surgical Treatments

Even though many articles mention treatment and drugs for sleep apnea, as of yet there are only devices that FDA approved and no drugs. Some drugs are approved for other sleep disorders, but they are ineffective for sleep apnea.

I should say for the next part of this that I have a strong bias and dislike for even bringing this up. That would be surgical procedures for the treatment of sleep apnea. I now know two people that have had surgery and regret every day that they had the surgery. It did not end their sleep apnea and both had several months of pain and discomfort. One has had trouble swallowing food every since his operation and the other has more trouble sleeping even using a BiPAP machine. The best warning I can give you is that surgery is not for everyone. Keep reading for those that it may be appropriate.

Surgery should be the option of last resort when other treatments have failed. Normally, it will depend on the doctor, but most doctors do not recommend surgery until they find something requiring surgery.

Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure, which is known as maxillomandibular advancement, may require the cooperation of an oral surgeon and an orthodontist, and at times may be combined with another procedure to improve the likelihood of success. This surgery is not done that often, but for some people is recommended and is one of the more successful is x-rays indicate a need.

Implants. This is probably the most reasonable and least problematic. Plastic rods are surgically implanted into the soft palate while you're under local anesthetic. This procedure may be an option for those with snoring or milder sleep apnea who can't tolerate CPAP.

Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat. We have all seen these in people that have had throat cancer.

Tissue removal. During this procedure, which is called uvulopalatopharyngoplasty (UPPP), your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. However, it may be less successful in treating sleep apnea because tissue farther down your throat may still block your air passage. UPPP usually is performed in a hospital and requires a general anesthetic.

Removing tissues in the back of your throat with a laser (laser-assisted uvulopalatoplasty) isn't a recommended treatment for sleep apnea. Radiofrequency energy (radiofrequency ablation) may be an option for people who can't tolerate CPAP or oral appliances.

This procedure has the least success and seldom stops sleep apnea. Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:

1. Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum). This is often successful if needed.
2. Surgery to remove enlarged tonsils or adenoids

Treatments for central and complex sleep apnea may include: (These types of sleep apnea can be a dangerous as obstructive sleep apnea.)

Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea.

Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs.

Continuous positive airway pressure (CPAP). This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. The mask is attached to a small pump that forces air through your airway to keep it from collapsing. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made. All the different types of CPAP machines may be used with success.

Along with these treatments, you may read or hear about different treatments for sleep apnea, such as implants. Although a number of medical devices and procedures have received Food and Drug Administration clearance, there's limited published research regarding how useful they are, and they aren't generally recommended as sole therapies.