February 11, 2015
Help in Diabetes Management Education – Part 10
Part 10 of 12
Goals and how to set them is up to you. Beware of doctors that set the goals for you and will not discuss the reasons or why they are what they are. These paternalistic doctors need to be in control, but do not want you in charge of anything. Never mind that you only see them at most about one hour per year. If you don't make their goals, be prepared for a tongue-lashing. If you want to find out how bad they are, tell them that your goals are different short-term and you will consider their goals long-term. Be prepared to be told to find another doctor.
No, a doctor should suggest goals and give you the reasons, but if you have other ideas, they should listen. If they feel you are not setting the correct goal, they may encourage you to try for a different goal. This means that they are trying to help you, and will listen to you. Suggestions are always appropriate from doctors, until they know you and how hard you work or don't work to attain goals.
I have supplied you with reading to help you set your own goals in the last nine blogs.
Depending on the progress of your diabetes at the time of diagnosis, you might want to consider a goal of getting off medication. This will depend on many factors; the first is whether you have a doctor that will accept this. Second, you will need a plan of action that your doctor approves. Then you will need a food plan that will help keep your blood glucose levels in acceptable range.
Next, make sure that you have an exercise regimen that you will enjoy and are capable of accomplishing. Many fail when it comes to the last two items. You will need to keep testing and seeing the doctor for appointments. The next thing will be whether you are succeeding or having problems. Testing will let you know as will the A1c that the doctor sees. The important thing to realize is if you are having trouble keep your blood glucose levels down that you don't stay off medication for too long.
One of our new members tried three times before giving up when his blood glucose levels kept rising each time. The third time his doctor told him not to try again until he had kept his blood glucose levels below a set level for at least six months on medication and then for another six months at a lower level of medication. His doctor is supporting him and this makes him want to keep trying until he knows it is no longer possible.
Besides goals, people need to understand that as they age, their bodies can stop being efficient enough in obtaining the vitamins and minerals necessary for health from many foods. Most of the time the correct foods will supply everything you need.
People that are on metformin need to be concerned that they are not becoming deficient in vitamin B12. Folic acid (vitamin B9), especially when taken in high doses, can mask the symptoms of a vitamin B12 deficiency. Older and even a few middle age people with type 2 diabetes can become unable to absorb or manufacture vitamin B12 from animal foods. Vitamin B12 is found only in animal foods. Liver, sardines, and salmon rank highest, with liver running away with it. Kidney, eggs, beef, and pork are also good sources. There are no vegetarian sources.
If you develop neuropathy – a tingling or burning in your feet, and especially the toes may indicate that you may have a vitamin B12 deficiency. The quicker you have the test the more likely you will be able to prevent the neuropathy from spreading. Some of our members have had vitamin B12 shots and then prescribed a supplement and a few others have been told to start a vitamin B12 supplement.
The final bit of information on this is your blood glucose levels need to be managed to keep them below 140 mg/dl. With about 60 percent of the people with diabetes developing neuropathy, this tells us that many people are not managing diabetes and may vitamin B12 deficient.