Diabetes and Hypertension

Hypertension (high blood pressure) is a very real problem for people with type 2 diabetes. Come to think about it, I don't know anyone in our support group with type 2 diabetes that did not have hypertension when they were diagnosed. Yes, many are able to handle their blood pressure (BP) by other means than medication, but some needed the BP medications to manage their blood glucose.

If doctors did not put people on BP medications, most would have faster and more severe forms of diabetes complications, including eye disease and kidney disease. In addition, having diabetes makes BP and other heart and circulation problems more likely. This is because diabetes damages arteries and makes them targets for hardening (atherosclerosis). Atherosclerosis can cause high blood pressure, which if not treated, can lead to blood vessel damage, stroke, heart failure, heart attack, or kidney failure.

Compared to people with normal blood pressure readings, men and women with hypertension more often have:

• Coronary artery disease (heart disease)
• Strokes
• Peripheral vascular disease (hardening of the arteries in the legs and feet)
• Heart failure

Even blood pressure that's at the higher end of normal, called prehypertension (120/80 to 139/89) impacts your health. Studies show that people with prehypertension have a two to three times greater chance over 10 years of developing heart disease.

Blood pressure readings vary, but most people with diabetes should have a reading of no more than 140/80. The first, or top, number is the "systolic pressure," or the pressure in the arteries when your heart beats and fills the arteries with blood. The second, or bottom, number is the "diastolic pressure," or the pressure in the arteries when your heart rests between beats, filling itself with blood for the next contraction.

There is some “expert” disagreement with the above numbers and some groups feel that BP readings should be 130/75-80. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels.

Usually, high blood pressure has no symptoms. That's why it's so important to check your blood pressure regularly. You should get it checked at any doctor visit and follow your doctor's recommendations about checking your blood pressure at home, too. If you do have a proper BP cuff and way to test at home, do this on a regular basis and ask your doctor when you should do this. There is some truth to the “white coat syndrome” so don't be afraid to talk to your doctor about this.

ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) are kinds of medications that are often used to treat high blood pressure for people with diabetes. Although other high blood pressure medicines are available, ACE inhibitors and ARBs treat high blood pressure and also prevent or slow kidney disease in people with diabetes.

Note: Some blood pressure medicines may make your blood glucose and lipid levels worse. Blood pressure medicines can also cause erectile dysfunction. Talk with your doctor about the side effects of prescribed medicines.

Other drugs used to treat high blood pressure in people with diabetes include drugs known commonly as "water pills" or diuretics, which help the body get rid of extra fluid.

Most doctors use ACE inhibitors or ARBs first, then add other anti-hypertension drugs if needed.

Why Are Some Advocates Hiding in Anonymity?

When a topic is well covered and fairly presented, why does the author have to take away any advocacy or justice by hiding and not declaring authorship of the topic.

Yes, this happened today at this link and ruined a great article. I would have liked to know whom to congratulate, but this will not happen as there is not a declared author.

I do not like having to compare a great website for type 1 diabetes advocacy to a website like Joslin Diabetes that hides behind anonymity about 95 percent of the time to take potshots at people, patients, and professionals they disagree with and promote questionable diabetes information.

My respect for Joslin Diabetes Center has continued to decline and now I am wondering why another website would want to follow by using anonymity.

Do You Have a Needle Phobia or Just a Dislike?

Of the several members of our support group on insulin, only one was very upset about having to inject himself several times a day with insulin. Now that he has done it for three years, he admits it is not as hard as he thought it would be. Yes, he is like the rest of us injecting insulin and admits he is getting tired of the daily injections, but with the management level he now has, he is happy he is capable of doing this.

In talking a few times this summer, we have put together several ideas that we felt could make it easier for people starting on insulin, type 1 and type 2:

#1. Learn that it won't be as bad as you imagine. Jason said the thought was worse than actually doing the injections. He continued that after the first injection, the following injections were a lot easier. Even A.J admitted he had heard many of the myths about injecting insulin and he now knows that they are not true.

Jason said that the needles are very thin and the areas where we need to inject are almost nerve free and injecting is often less painful that using the lancet on the sides of our finger tips. Jason continued that you can sometimes hit a nerve, but the pain does not last long and you sometimes have to remember this and once you get past the first injection, the fear should disappear – unless you have a real phobia about sharp objects.

#2. Use the right tool. In the past, the syringe needles were larger and this could by itself be frightening. Now most syringes have 30 gauge needles an are one-half inch in length or shorter. We even suggest asking your pharmacist for the shortest needles and the thinnest needles available. Although I occasionally use a syringe more than one time, it is best to use a fresh needle or syringe only once, as even one use dulls the point of the needle enough to cause discomfort if reused.

Most of us have thought about using a pen, but the cost for us is the deciding factor. Others do prefer the pen to the syringe. They find it easier to dial the dose on a pen than it is to see the markings on a syringe.

#3. Focus on fat. In this case, "Fat is good!" Allen says. To work properly, insulin is supposed to be injected into fatty tissue. Allen is thin and we sometimes kid him about finding fat so he can inject. Even he says that it is good getting shots in fleshy sections of your body is less painful than it would be in leaner areas. The stomach, upper arms, thighs, and buttocks all tend to be good spots.

We all agree that to make shots as painless as possible:

• Always inject insulin at room temperature.
• Let the alcohol you use to clean your skin dry so it doesn't burn if you even use alcohol.
• Relax the part of your body you're targeting.

You should also insert and remove the needle in a swift, smooth manner without shifting direction. Most of us count to five or ten seconds to prevent leaks when we remove the needle from the area where we inject. We also rotate the areas where we inject to prevent scar tissue from building up and making it more difficult for the insulin to disperse.

Jason said he learned if you're still bothered by the prick of the needle, use a cold spoon to numb the area first. And, it helps to take some deep breaths and calm yourself, especially when you’re new to the process.

#4. Talk to your doctor immediately if you suspect an allergy. Very few people have an allergy to the insulins of today, but a few do.

#5. Do not let your doctor use insulin as the medication of last resort. Many doctors do this and insulin is often delayed until complications begin to develop. Many doctors are uncomfortable with insulin and do not want to prescribe insulin until they are forced to prescribe insulin. It is unfortunate that many of these same doctors will belittle patients to have them stay on oral medications and others will tell the patients they have failed if they need insulin.

If number 5 (#5) happens to you, find another doctor or possibly an endocrinologist.

Processed Foods, 100% or Adulterated? - Part 3

Fruit Juices

These may be watered down or diluted with a cheaper type of juice, such as pear or grape. Some may only contain water, dye, and sugars, but fruit will still be listed as an ingredient on the label.

Pear is often used in apple juice. Pricey pomegranate juice frequently includes blends of apple and grape juice, despite being about five times more expensive than grape juice.

The above is done too often and even the local grocery stores have sent product back that was diluted more than it should have been.

Issues Remain This is an understatement when it comes to the regulations for the FDA to enforce. The FDA is charged with monitoring food adulteration under the Food, Drug, and Cosmetic Act.

To supplement that law, the agency has also published regulations about the specific type of information that must be on a product’s label, McSeveney says. “The FD&C Act and supporting regulations are there, in part, to help ensure consumers are in fact receiving the product they believe they are paying for.”

But, the congressional report found it might not be possible for the agency to prosecute every food adulteration incident because of other responsibilities, limited resources, and lack of evidence.

“Their [FDA] focus is on safety -- so they spend most of the time on predicting these incidents before it becomes a major health risk,” says John Larkin, PhD, research director of the National Center for Food Protection and Defense.

The Food Safety Modernization Act, which is being implemented, provides the FDA with “new inspection and enforcement tools” to help ensure food companies are “carrying out their responsibilities,” McSeveney says. It will also allow the FDA to establish a program where the food industry will reimburse the agency for some inspection and enforcement activities.

Larkin and Michigan State University food expert John Spink, PhD, say industry is taking a more active role in policing itself. Spink is director of the Food Fraud Initiative at Michigan State. He also helped create standards for food safety set by the Global Food Safety Initiative. It is a group of non-government food companies working to create universal food safety standards.

“Companies are more integrated now and are working more with their suppliers, so they are more aware about the types of fraud that occur,” Spink says. “There’s a process in place, and what gets measured gets better. Now people are looking at food fraud, so there is more information and more research for prevention.”

Grocery Manufacturers Association member companies have programs and procedures, including testing, to help ensure safe and high-quality products, Kennedy says. Most manufacturers continuously monitor and review these.

Cheese importer Schuman says it is also an issue of transparency.

Karen Everstine, PhD, MPH, of the National Center for Food Protection and Defense, offers these tips to help you avoid food fraud:

1. Buy products locally if you can, such as honey. Talk to the producer.
2. Buy foods in a minimally processed form, such as whole spices vs. ground.
3. Be wary of prices that appear too good to be true, such as low-priced extra virgin olive oil.
4. Buy from reputable brands and sources, because they want to maintain their reputation.

Part 3 of 3 Parts

Processed Foods, 100% or Adulterated? - Part 2

According to a congressional report and food “experts,” here are a few products often found to be adulterated.

Olive Oil

Olive oil may be thinned out with hazelnut, soybean, corn, peanut, vegetable, or canola oil. The final product may even contain no olive oil at all. “When oil is ordered in bulk, the bottle will say 100% olive oil, but most times it’ll be 70% canola or soybean oil,” says Selina Wang, PhD, research director at the University of California Davis Olive Center. The olive oil you buy in the store may be adulterated as well, she says.

Honey

More than three-fourths of honey sold in U.S. stores is not what is claimed on the label, says Vaughn Bryant, PhD, professor of anthropology at Texas A&M University. He regularly tests honey in grocery stores. Bryant says it is estimated that 91 million pounds of honey entered the U.S. illegally from other countries last year.

Imported honey may contain pesticides and antibiotics. To save money, some companies will add cane, corn, or beet sugar, as well as rice syrup and high-fructose corn syrup.

Seafood

Seafood producers may substitute less-expensive fish for costlier ones. This is one thing I personally have seen and I refuse to purchase from certain companies because of this.

Red snapper, mahi mahi, swordfish, and cod are often replaced with Pacific rockfish, yellowtail, or mako shark. Producers also add coloring agents to make fish seem fresher and to add weight during storage.

A 2015 congressional report says these agents “may mask visual cues indicating that such flesh is decomposed and toxic.” Also, "fish high in mercury are substituted for another species,” wrote congressional analyst Harold Upton in a 2015 report.

Parmesan Cheese

Cheese importer Neal Schuman used an independent company to begin testing products that are labeled as parmesan or Romano cheese. He says what he’s found is “appalling.”

He estimates that up to a quarter of all the products sold as parmesan cheese violate the government’s “standard of identity” -- basically, the rules for what can legally be called cheese.

One of the most common ways manufacturers break the law is by adding too much cellulose. Cellulose in food comes from wood fiber, and it is used to keep products from clumping together. “It should be used at 2 to 3 up to maybe 4 percent. And we see it in the marketplace anywhere from 14 to 32 percent,” Schuman says. Other companies make their cheese with vegetable oils instead of milk.

Real cheese should have milk as its first ingredient, followed by salt and maybe enzymes for flavor, Schuman says.

The State of Iowa has put two companies out of business for adding too high a percentage of cellulose in certain foods. One was a bread company and the other was a Romano cheese producer. This was over 25 years ago, but it was welcomed at the time.

Part 2 of 3 Parts

Processed Foods, 100% or Adulterated? - Part 1

Is the food you are buying at the grocery store or convenience store what it says it is? For many people that buy very little processed food, it could be what it says on the label. Others foods may not measure up and may be in technical terms - adulterated.

Is that olive oil 100% olive oil? It could have canola oil or peanut oil in the bottle. I was surprised about honey as about 40% was cane syrup. Now what surprised me is this about Parmesan cheese. The author states that you might be shaking a little wood pulp out with the cheese.

True, there is no way of really knowing – unless you can afford to have it tested by a competent laboratory. Food adulteration happens when something is added or taken away from a product without including it on the label. A recent Congressional Research Service report estimates that it affects about 10% of all products sold, although it says that number is probably a fraction of how often it really happens.

The fallout may cost the global food industry $10 billion to $15 billion per year, according to an estimate from the Grocery Manufacturers Association. There’s another cost that’s harder to explain in numbers: Loss of consumer trust.

“It’s a very unsettling issue, because we all depend on food, and it’s devastating for consumer trust,” says Markus Lipp, PhD, senior director of food standards at US Pharmacopeia. The nonprofit agency helps set quality standards for food, drugs, and supplements. Lipp says adulteration is driven by money. It costs less money to thin out or substitute the product with cheaper ones.

The substitutions could also have a health impact, particularly for people with food allergies. The FDA reported at least 12 allergic reactions caused by cumin from India that was contaminated with peanut proteins. The cumin was part of a recall in 2014.

The FDA can take action, including working to remove a product from shelves, when “economically motivated adulteration is identified in a regulated food product,” agency spokeswoman Megan McSeveney says. “Combating food fraud is the responsibility of both industry and regulatory authorities.”

Ensuring products’ safety, integrity, and maintaining consumer confidence is “the single most important goal of our industry,” says Brian Kennedy, spokesman for the Grocery Manufacturers Association. “That is why food, beverage, and consumer products companies take economic adulteration, or product fraud, very seriously.”

Spices are among the most common food products that are adulterated, according to the congressional report.

Part 1 of 3 Parts