November 15, 2014

Testing Your Blood Glucose When You Have Diabetes

At least everyone agrees how important blood glucose testing is except the American Diabetes Association and the American Association of Clinical Endocrinologists. Yet doctors will write articles for WebMD saying how important testing is. If we could only convince the ADA to take a firm stand and say we needed to test more often, then the insurance companies would allow reimbursement for more test strips with less restrictions.

For people with type 2 diabetes, there are several places to test and this depends on how well your blood glucose levels are stabilized and the medication you are taking.  If on insulin, it is your fingertips that should be use on each side and many people are able to use their thumbs. To do this, insert the new lancet into the lancing device and then insert a test strip into your meter. Then using the lancing device set to the correct depth, prick you finger. If enough blood is created, or if not carefully milk the finger to cause enough blood to pool for the test strip in the meter to be pushed carefully into the blood and wick into the test strip. Wait a few seconds and the meter will give you your blood glucose reading.

Most meters today will allow you to test at other sights and for most oral diabetes medications, this may be allowed. Just realize that for using what are termed alternate testing sites, the reading will be for a period of 15 to 25 minutes earlier than the time shown on your meter. Why the difference you ask? Because using the alternate sites is obtaining blood from a vein instead of an artery. The alternate test sites include your upper arm, forearm, base of the thumb, and thigh. You will normally receive different results from alternate sites. Blood glucose levels in the fingertips show changes more quickly than those in other testing sites. This is especially true when your blood glucose is rapidly changing, like after a meal or after exercise. If you are checking your blood glucose when you have symptoms of hypoglycemia, you should use your fingertip if possible, because these readings will be more accurate.

Checking your blood glucose levels may be required several times per day. Always as soon as your arise in the morning, before meals (preprandial), after meals (postprandial), and before retiring for the night. Depending on the medication(s) you are taking, it may be necessary before driving and before and after exercising. Because everyone is different, talk to your doctor about when and how often you should test your blood glucose. If you are sick or feeling like you are low, you will need to check your blood glucose more often.

Your blood glucose levels can be affected by many things, such as anemia, gout, high altitude, stress, illness, or if it's hot or humid. If you see unusual results, rewash your hands paying attention to the finger you will be using and thoroughly dry. If necessary, use the control solution to check the test the test strips. The following chart is published by the ADA for their ideal levels and the second chart is my suggestions.

ADA guidelines:
Time of Test Ideal for Adults With Diabetes
Before meals 70-130 mg/dl
After meals Less than 180 mg/dl

My suggestions:
Time of Test Ideal for Adults With Diabetes
Before meals 70-95 mg/dl
After meals Less than 140 mg/dl

Again, because everyone is different, learn to set your own goals with the doctor's knowledge and if things change, do not be afraid to contact the doctor.

November 14, 2014

Food Plan Study Of Interest

In a short 24-week study, HbA1c levels improved and cholesterol levels were reduced to the point of reduced need for statins. Type 2 diabetes patients are normally advised by dietitians to make dietary decisions that are high in carbohydrates and low in fat and protein. This increase in carbohydrates leads to high postprandial blood glucose levels. Because of this, there is more interest in food plans low in carbohydrates with higher amounts of fat and protein for type 2 diabetes management. Past studies have been done with food plans that are low in both carbohydrates and fat. Both have proved successful in lowering body weight, blood pressure, and insulin concentrations. Most of these prior studies have ignored the role of physical activity and glycemic variability.

This new study was designed to compare the use of a high carbohydrate, low fat diet (53% carbohydrate, 17% protein, and 30% fat) to a very low carbohydrate, high unsaturated fat diet (14% carbohydrate, 28% protein, and 58% fat). This would be used with measurements taken at baseline and end of trail to see what their impact was on glycemic control and risk factors associated with cardiovascular disease in type 2 diabetes patients.

A total of 115 obese type diabetes patients were randomly assigned to one of the two diet groups. In addition, they both participated in a supervised exercise program. The primary outcome was a change in HbA1c. Secondary outcomes included effects on glycemic variability, and changes in anti-glycemic medications, lipid profile, and blood pressure readings.

Those in the low carbohydrate diet group showed a larger decrease in HbA1c when compared to the high carbohydrate diet group and changes in anti-glycemic medications were also more likely in this group as seen by the changes in the medication effects score. Differences in the diets were not seen in weight loss, and no diet effect was observed in the fasting blood glucose, LDL reduction, or blood pressure.

The results of this study show the impact that diet selection can have on managing type 2 diabetes. While both of the diets studied in this trial showed some positive results, the very low carbohydrate diet was more effective in lowering HbA1c, reducing anti-glycemic medication requirements, and improving HDL cholesterol. And of course, they made the statement that larger trials with a similar design can be used to determine if a low carbohydrate, high unsaturated fat diet continues to have an impact on managing diabetes beyond a 24-week timeframe.

For this short of a trial or study, the few conclusions show that people with type 2 diabetes need to make lifestyle changes in both diet and exercise. While both diets showed improvements in weight, a very low carbohydrate, high unsaturated fat diet showed more beneficial in lowering HbA1c, anti-glycemic medication requirements and increasing HDL cholesterol.

November 13, 2014

A Reason to Consider a LCHF Food Plan

In the year since I had helped this person get her VA benefits and her original doctor had gotten her an appointment with an endocrinologist, we have stayed in contact infrequently until this month. Now she was seeking my assistance in avoiding statins as her cholesterol levels had taken an upward trend and her regular doctor has prescribed a statin. She knew that she could not avoid them as the readings for her lipid panel had jumped way over the upper limit and her triglycerides were way too high – almost 400.

I asked her what her recent A1c's had been and these were 5.7%, 5.5%, and 5.9%. Very good and gave no indication on why her cholesterol could have increased so dramatically. My next question was about changes in her food plan and what had changed there. The next email started with an Ohh, No, and she admitted that she had increased the number of carbs she was eating, but had thought with the amount of fat she was consuming that she would be okay.

I suggested that she continue with the statin and start lowering the carbohydrates she was consuming. I also suggested that she pay attention to the amount of protein she might not be eating. Then I suggested that she have her doctor refer her to a nutritionist for more balancing of her food plan. The next day I received an email from her doctor asking if I knew of a nutritionist as he did not and he knew I was not referring to a dietitian.

I called my cousin and asked her if she could do this. She said she would as another of our cousins lived in the same town and she was overdue for a visit. I gave her the doctor's email and phone number and she said she would call him. I sent my friend an email saying the doctor could be calling shortly with a referral and that it would be with a cousin of mine. Our emails crossed and she was letting me know she had an appointment for Saturday at her house. She was wondering why on the weekend and at her house.

I had just about finished a response, when I received another email. She was excited and had heard from my cousin by phone and why she wanted it at her home. She asked why I had not told her about a cousin (also a second cousin) that lived in her town. She was glad I had someone to refer to her doctor and even if it was a relative. She knew from my blogs that I had a cousin that was a nutritionist, but had not expected her to want to travel that far.

I completed my response and said that she was the only one I was aware of and I was happy that she was given the phone number to call her directly as I was going to have her call me and give me her my phone number so that I could set up a three way call. Now I did not need to and this was good.

I said that I was not sure where my other cousin lived, but knew she could be in the same part of the state. I have too many second and third cousins and am not sure where many of them live, as we haven't kept in close contact.

She answered that she would let me know how things went and would give my cousin permission to talk to me.

November 12, 2014

Why I Won't Follow ADA's Glucose Guidelines

The above chart published in WebMD shows how the American Diabetes Association does not care for people with type 2 diabetes. Granted the above cannot cover every situation and each person must set their own goals. Hopefully your goals will be less than this chart displays.

The only point in the chart that I can agree with is the reading before exercise. In my research, it has been difficult to find conclusive answers for type 2 diabetes. Everyone agrees that a blood glucose level of 250 mg/dl (13.9 mmol/L) or higher means that you must not exercise until your levels have come down below this. The blood glucose guidelines for exercising for all types of diabetes are 100 to 250 mg/dl (5.6 to 13.9 mmol/L). For most people, this is a safe pre-exercise blood glucose range. If you are not on insulin or sulfonylurea treatments, then it is still necessary to discuss this with your doctor if you are about to start an exercise regimen after a long period of being sedentary. This applies to people controlling their blood glucose levels with diet and exercise as well to prevent possible cardiovascular problems.

Each time you test your blood glucose, log it in a notebook or online tool, or with an app. Note the date, time, results, and any recent activities:
  1. What medication and dosage you took
  2. What you ate
  3. How much and what kind of exercise you were doing
This will help you and your doctor see how your treatment is working.

Well-managed diabetes can delay or prevent complications that affect your eyes, kidneys, and nerves. Diabetes doubles your risk for heart disease and stroke, too. Fortunately, controlling your blood glucose will also make these problems less likely.

Tight blood glucose management; however, means a greater chance of low blood glucose levels, so your doctor may suggest higher targets.

Before meals, glucose levels should be 70 to 95 mg/dl and not 70 to 130 mg/dl. After meals, glucose levels should be less than 140 mg/dl. The maximum increase from preprandial to postprandial readings should not exceed 40 mg/dl.

Even the A1c level of 7.0% is way above what we should strive to manage and while 5.0% may be too low for those of us on insulin, we do have people that are capable of managing their diabetes at this level. This is why we always declare that people are all different and vary in their abilities to manage their diabetes.