January 24, 2015

How and When to Test Your Blood Sugar With Diabetes – Part 2

The chart below gives you an idea of where your blood sugar level should be throughout the day. Your ideal blood sugar range may be different from another person's and will change throughout the day.

Time of Test Ideal for Adults With Diabetes
Before meals 70-130 mg/dl
My suggestion is 75 to 105 mg/dl
After meals Less than 180 mg/dl
My suggestion is no more than 140 mg/dl

The above chart is the ADA chart before the latest guidelines. My suggestions are the numbers I am comfortable seeing. This is where you will need your own goals based on your tolerances. These will also vary depending on your age and abilities. Your doctor may also advise different numbers.

Home Blood Glucose Monitoring and HbA1c

Monitoring your HbA1c level is also important for diabetes control. Many home glucose monitors can display an average blood glucose reading, which correlates with the HbA1c.

Average Blood Glucose Level (mg/dl)
HbA1c (%)

For a more expanded chart, I suggest using this chart.

When Should I Call My Doctor About My Blood Sugar?

Ask your doctor about your target blood sugar range, and make a plan for how to handle blood sugar readings that are either too high or too low and when to call your doctor. Learn about the symptoms of high or low blood sugar, and know what you can do if you begin to have symptoms.

Many doctors order certain ranges for your blood glucose, but you need to decide what you are willing to tolerate and set your goals accordingly. Do talk to your doctor if you question his orders. Do this politely and ask if you can make changes if you are uncomfortable with his or her orders.

How Do I Record My Blood Sugar Test Results?

Keep good records of any blood, urine, or ketone tests you do. Most glucose monitors also have a memory. Your records can alert you to any problems or trends. These test records help your doctor make any needed changes in your meal plan, medicine, or exercise program. Bring these records with you every time you see your doctor.

Yes, keep the records! Many meters are capable of doing ketone tests, so make inquiries about this. Your records are important to find trends or problems. Discuss the changes the doctor wishes to make to your food plan, medicine, or exercise regimen. The doctor may have some good suggestions.

Do listen to the doctor, but don't let the doctor alter your goals unless you agree with what he/she has to say. He may set some short-term goals that could be better for you.

January 23, 2015

How and When to Test Your Blood Sugar With Diabetes – Part 1

I will split this blog as otherwise it will be too long. Because of the mistakes in this article at this link on WebMD, I will put my comments in red hereafter.

How and When to Test Your Blood Sugar With Diabetes

Most people with diabetes need to check their blood sugar (glucose) levels regularly. The results help you and your doctor manage those levels, which helps you avoid diabetes complications.

There are several ways to test your blood sugar:

From Your Fingertip: You prick your finger with a small, sharp needle (called a lancet) and put a drop of blood on a test strip. Then you put the test strip into a meter that shows your blood sugar level. You get results in less than 15 seconds and can store this information for future use. Some meters can tell you your average blood sugar level over a period of time and show you charts and graphs of your past test results. You can get blood sugar meters and strips at your local pharmacy.

This is not the proper procedure for any meter and test strip I have come across. First, you do not want to use a lancet by itself and if you really want pain you can try it this way, but I don't recommend it. If you wish to waste money and test strips, follow the directions above. My meter requires the test strip be inserted into the slot and be read by the meter before it is ready for the blood. While the meter reads the test strip this is when you use the lancing device (with lancet inserted) to prick the side of your finger at a setting that will furnish enough blood to then pick up the meter with the test strip and slide it slightly into the blood so that it can wick into the test strip. Most meters today will give a reading in five seconds.

Meters That Test Other Sites: Newer meters let you test sites other than your fingertip, such as your upper arm, forearm, base of the thumb, and thigh. You may get different results than from your fingertip. Blood sugar levels in the fingertips show changes more quickly than those in other testing sites. This is especially true when your blood sugar is rapidly changing, like after a meal or after exercise. If you are checking your sugar when you have symptoms of hypoglycemia, you should use your fingertip if possible, because these readings will be more accurate.

Continuous Glucose Monitoring System: These devices, also called interstitial glucose measuring devices, are combined with insulin pumps. They are similar to finger-stick glucose results and can show patterns and trends in your results over time.

Word of warning – the readings may be similar to finger-stick results, but you can only rely on the readings for patterns and trends. You will still need to use the meter and finger-stick results for accuracy.

When Should I Test My Blood Sugar?

You may need to check your blood sugar several times a day, such as before meals or exercise, at bedtime, before driving, and when you think your blood sugar levels are low.

The above is more complete than most are willing to say and definitely goes against the teaching of the American Diabetes Association. What is ignored is the after meal testing or “Testing in pairs” which helps us know how the food we consumed affects our blood glucose.

Many people will need to purchase test strips out of their own pocket because insurance will not pay for that many test strips. For those that cannot afford the extra test strips, they must decide when to test to get the information they desire.

Everyone is different, so ask your doctor when and how often you should check your blood sugar. If you're sick, you'll probably need to test your blood sugar more often.

What Affects Your Results

If you have certain conditions, like anemia or gout, or if it's hot or humid or you're at a high altitude, that can affect your blood sugar levels.

They don't mention recent blood transfusions or dialysis which makes blood glucose testing and HbA1c results unreliable. Recalibrating your meter or checking your test strips will only waste them.

If you keep seeing unusual results, recalibrate your meter and check the test strips.

January 22, 2015

Taking Care of Your Feet

Every time I talk about this, I receive at least two emails telling me I am off base and I don't need to talk about foot care. If there were not amputations happening, then they might be right. As long as people continue to ignore their feet and amputations keep happening, I will consider this an important topic for blogs. Even our member Jerry is happier that his deepest foot ulcer is about healed. Yes, he is unhappy that it has taken this long, but he says at least he knows how important foot care is now.

I enjoyed writing this blog back in December 2012 and it has generated a few good emails. Yes, getting the correct fitting shoes is more important for people with diabetes, but I am amazed that many could care less until they get foot ulcers or severe heal cracks. I was very surprised when I saw one of our new members standing in line for her prescriptions in front of me. She was wearing slippers in cold weather with no socks.

When I asked her why she was not wearing shoes, she did recognize me and admitted that she had a deep heal crack and it hurt too much to wear shoes. I asked if she has been to the doctor and she said there was no need. I said you are too young to have an amputation and she should see a doctor as soon as possible. She shook her head as she was next to pick up her prescription. When I returned home, I called Brenda. I had to leave a message, as she did not answer. Early that evening, she returned my call and when I explained the activity of earlier, she said that I had got her attention and she had called when she arrive home.

Brenda said that she had taken her to her doctor and even he was surprised that she had waited so long. Brenda said he had some rather blunt words for her. She has been admitted to the hospital for at least two days to be treated and antibiotics applied on a schedule. They will use a dry skin buffer to remove dead skin near the cracks and then examine the cracks at the end of two days to see if more treatment in the hospital is needed. If not she will be sent home and will need to see her doctor every other day for a while since she had not cared for her feet. Brenda said she had agreed to transport her for a week and Sue would do the next week if needed.

Brenda continued that Sue was working with another new member that was having foot ulcer problems. I asked what is going on with people that they will not take care of themselves. Brenda said she does not understand this either and is thinking of asking for a second meeting this month. I agreed that this may be a good thing and I would back her up if Tim was hesitant.

An hour later, Tim called me and said we would have a Saturday meeting at late notice. He said Brenda and Jason will have the meeting on foot and wound care and they will have slides ready. I said I agreed on this topic as we apparently have others that are not taking care of their feet and we need to convince our members they don't need an amputation.

We will have our meeting on January 24, 2015.

January 21, 2015

Conflicts of Interest at All Levels of Medicine

From researchers that have their agendas and take money from people wanting certain results to healthcare providers taking money from drug manufacturers, it is small wonder any progress is being made in medicine. I have not found any medical group or other provider group that does not have a serious conflict of interest that affects their policies and guidelines to the detriment of patients. Even the people on guideline committees have conflicts of interest, so how can we trust the guidelines. Read this by Tom Ross.

I have been reading Dr. Malcolm Kendrick at this link. Down the right column below the books “Doctoring Data” and “The Great Cholesterol Con,” there is a search box. Just type in “conflicts of interest.” After using the enter key, you will find many blogs he has that show conflicts of interest for many of the medical organizations, both in Britain and the United States.

Another of my blogs on junk science being big business is very interesting and I am reading more about this in many studies. What I do not understand is why no one is stopping the actions of these researchers. In my reading, many doctors are complaining about the lack of reliable studies and clinical trials being done that could help them in their practice. If it was one or two doctors, I might discount it, but more and more doctors are asking why there are so few reliable studies.

A few doctors are calling for transparency, but are meeting resistance. This Medscape article covers the activities of one doctor. A few doctors are supporting her, and they are also meeting resistance. Apparently too many doctors at the “expert” level are unwilling to give up the monies that Big Pharma is paying them. The amount of money generally is substantial and more than they would earn practicing medicine.

The U.S. spends $2.7 trillion on healthcare, 30% of which is waste in the form of unnecessary tests and unnecessary treatments. Conflicts of interest are rampant, with 94% of doctors reporting an affiliation with a pharmaceutical or device manufacturing company, and many more insidious influences including salaries being tied to “productivity.” Dozens of studies have shown that these conflicts of interest have a real impact on care, and are a major driver of excessive cost and avoidable harm.

January 20, 2015

Are Older Adults Really Being Overtreated for Diabetes?

The people publishing studies in the Journal of the American Medical Association (JAMA) Internal Medicine seem determined to destroy healthcare for the elderly. The topic in the Endocrinology Advisor is titled “Older Adults May Be Overtreated for Diabetes.” To this, I am saying, in whose determination.

They do use the American Diabetes Association guidelines of course and state, “Despite the prevalence of diabetes in older people, optimal glucose levels are still poorly defined. Currently, the American Diabetes Association (ADA) and American Geriatrics Society (AGS) agree that glycemic targets should be higher for older patients with compromised health. I say that these “experts” have not done their homework and have very few studies available to justify their pronouncement.

They are claiming that most patients with diabetes aged 65 and older still maintain HbA1c levels of less than 7%. In older patients, there are limited benefits to such tight glycemic control, and they have a high risk for complications, such as hypoglycemia, with the use of some glucose-lowering medications.

Researchers wanted to determine if older adults with diabetes were potentially being overtreated for the condition.

The study included data from 1,288 patients aged 65 years and older with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010. The patients were divided into three groups based on health status. 

The first group was considered as having very complex/poor health, where patients had difficulty with ≥2 integral daily tasks or dialysis dependence. The second group was categorized as complex/intermediate, where patients had difficulty with ≥2 integral daily tasks or had ≥3 chronic conditions. The third group was composed of relatively healthy participants if they did not fit the criteria for the other groups.

Tight glycemic control was considered an HbA1c level <7 i="">

Using these parameters, 21.2% had very complex/poor health, 28.1% had complex/intermediate health, and 50.7% were relatively healthy. Out of all the participants, 61.5% achieved tight glycemic control; this proportion did not significantly differ based on health status.

Of the patients with tight glycemic control, 54.9% were treated with either insulin or sulfonylureas; again, this proportion did not significantly differ based on health status.”

Now this study is more reasonable in the method used in placing people in the three groups, but one thing still bothers me. Why are not people being given an opportunity to express their opinion about their care? Everything seems to be determined for them and though not mentioned in the abstract, the three groups were determined by a one-size-fits-all determination.

Again, hypoglycemia and the fear of hypoglycemia by the researchers play a big role in the group they were placed in for the study. The other weakness of the study is about 55 percent of all groups were on insulin or sulfonylureas. Unknown is the medications that the other 45 percent were taking.

To my way of thinking, the study was done to provide information to discriminate against the elderly and not to find out if the elderly are capable of managing diabetes in what they determined was tight control of less than 7.0% for A1c.

The only time I could agree with the researchers would be if there was cognitive issues and they did not have a capable caregiver available.

For another interesting read, this on Medscape is good and has some very interesting comments that express a few of my conclusions.  Then Gretchen Becker has a different source and writes about this topic from a different perspective.

There are other blogs about this topic, but I still believe that this is discrimination against the elderly, especially the way the study was performed and even more the way it was presented. 

January 19, 2015

Twelve, No, Eleven Diabetes Healthy Eating Tips

This WebMD article is another example of people refusing to give up on the USDA dietary guidelines and the low fat way that Ancel Keys fostered with false information. The article uses these guidelines:
  • 1. Switch to whole grains.
  • 2. Get more fiber.
  • 3. Replace some carbs with good fat.
  • 4. Eat foods that won't spike blood sugar.
  • 5. Choose recipes with less saturated fat.
  • 6. Know the nutritional values in the recipes you use.
  • 7. Replace butter and shortening with canola or olive oil.
  • 8. Prep for salads ahead of time.
  • 9. Make an easy fruit salad.
  • 10. Choose drinks wisely.
  • 11. Slow down.
  • 12. Cut out evening snacks.

Do you notice the conflicts in the 12 items? Number one and number four should get your attention. Whole grains cause spikes in blood glucose and yet it is the first item listed and then number four is listed further down in hopes people will let it go. Many of us with type 2 diabetes find that whole grains spike our blood glucose and that is the reason for saying there are only 11 tips.

Then we come to number 2 in which they advocate soluble fiber over unsoluble fiber. I say have a mix of the two fibers. Eight grams of fiber per meal is a good goal, but if you insist on eating more carbohydrates, then try to add more fiber. They do have an excellent list of soluble fiber foods. Carrots are good, but one of the more carby vegetables. For the fruits, be careful, as some of them are too rich in sugars which those of us with diabetes need to limit. A fiber-rich diet helps lower the risk of heart disease, which is higher in people with diabetes.

In number seven, do not use canola oil, as this is not good for helping with diabetes. Olive oil is good and can be used instead of butter, but I like both and use both, depending on what I am cooking.

For number ten, at least they are not talking about alcoholic drinks. Instead of soda, sweetened drinks, or fruit juice, drink protein-rich beverages such as milk. Or sip no-calorie tea, coffee, or water. I prefer whole milk even with the carbohydrates, but I drink a smaller serving of 4 ounces and water for the rest of my liquids. This is one way of getting the fat I need.

I feel that number eleven is worth emphasizing. David Mendosa got me started on this and it does make a difference. Fast eaters tend to eat more. It takes at least 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 calmly. As you do, you'll be more aware of the textures and flavors and feel more satisfied.

Number 12 is a good idea. Avoid late-night snacking unless your blood sugar is too low or your doctor recommends this because of being too low. Drink a cup of no-caffeine tea instead.

Number five is a sore point for me as I eat what ever saturated fat happens to be in the food and use it to replace the carbohydrates I eliminate from the meal plan.

The WebMD website is still written and reviewed by doctors and others that still believe in the high-carb/low fat mantra and we have to understand this and adapt our thinking accordingly.

January 18, 2015

A Gathering of a Few of Our Members

The Saturday after our January meeting, Jason, Tim, Brenda, Sue, Allen, A.J, Barry, Ben and I gathered at our favorite restaurant for a brief meeting. Allen was still feeling that we should have been able to do more to help Albert and we knew that he needed our support. After talking with him for about half an hour, he finally admitted that there probably was not much more we could have done even if we wanted to.

Tim turned the discussion to the topic Brenda and Jason had started and suggested even though he wanted to move on and have a nurse and nutritionist speak to our February meeting, maybe we needed to have more on the topics of diabetes self-management that had not been covered. Brenda spoke and said there was a lot of preparation that needed to be done and Jason agreed saying that he thought both were relatives of mine and not just the nutritionist. I said yes, and since talking to her, I have found out that her husband has type 2 diabetes also.

Tim continued that for being a chief surgery nurse, he was very surprised how much she knew about diabetes since she is not a certified diabetes educator. He continued that we should enjoy hearing her. Everyone agreed that Brenda and Jason should have more time and it was decided to have my two cousins do a presentation on February 7 or the alternate dates depending on the weather. Then Brenda and Jason could have March 7 or alternate dates for continuing their topic of diabetes self-management.

Everyone agreed and we asked A.J how he and Jerry were doing. A.J said he is very proud of Jerry and the way he has turned his life around since not living with his wife. His right foot ulcer is gone and the other is almost healed. He is very careful with it and changes the dressing twice a day and will be on once a day next week. A.J said that he has had one blood glucose reading at 66 mg/dl and was going to over-treat it, but asked me before he did. A.J asked him to carefully wash his hands and dry and retest and the second reading was 71 mg/dl. Since they were ready to eat breakfast, he had him count the carbs he would be eating and add this to his reading and he probably would not need any insulin.

A.J continued that at 90-minutes after eating, he had a reading of 102 mg/dl and said he would test at three hours. The reading then was 96 mg/dl and this was after an hour of weight lifting with his arms. At lunch time his before meal reading was 82 mg/dl and the reading after 90 minutes post meal was 112 mg/dl. He said Jerry said he was not going to inject insulin, as he would be doing more weight lifting that afternoon. Jason asked if Dr. Tom had approved his weight lifting and A.J said he had advised doing this, as the ulcer should not bother him since he was not on his feet.

Tim said he would confirm the dates with Beverly and Suzanne for February 7 and we asked Allen if he was going to be okay. When he said yes, we went our separate ways.