ADA Begging for Diabetes Money

The American Diabetes Association is begging people to write their federal congressional members and urge them to pass an appropriations bill that increases funds for type 1 and type 2 diabetes research and programs. Most of the money would be for the National Institutes of Health and the Centers for Disease Control and Prevention. How much of this trickles down to the ADA is unknown, but many programs are operated by the ADA with funds from these agencies.

I have already blogged about my non-support and need to make more people aware of how poorly the ADA handles any funds they get their hands on. I quote from a prior money request, “The American Diabetes Association is leading the fight against the deadly consequences of diabetes and fighting for those affected by diabetes. An impressive 72% of every dollar spent supports research, advocacy, information and public awareness for people affected by diabetes.”

I do not agree the 72% of every dollar spent supports research is impressive. The fact that the other 28% goes to administrative expenses shows how the ADA is more concerned about their own wages than actual research. Less than 15% is more reasonable for admin expenses and if the ADA requires 28%, then either ADA is top heavy with administrators or overpaying the administrators.

I am corresponding with my two senators and representative and from their comments, I doubt any diabetes bills will see action in 2015. I am urging all three to make it impossible for any research moneys to be used for anything but research and if possible cannot be used for administrative expenses.

Whenever the ADA begs individuals to work for them, then I get suspicious and look for red flags that tell me that they need money over and above what they receive from their Big Pharma partners. Also, why should I contribute money to an organization that is for doctors and spends 28% of every dollar for administrative expenses. I would and do contribute to one charitable diabetes organization that only uses 8 cents of every dollar for administrative expenses. They contribute diabetes supplies to people with diabetes that desperately need diabetes supplies.

Putting the Blame Where It Belongs

Maybe you have been wondering why doctors and others are not spending the time necessary when you see them for your appointment. I have been researching this for the last month and I have been surprised at the findings.

There are three main culprits that demand time of doctors and limit their time for properly treating you. The first is Big Government, the second is the Medical Insurance Cartel, and the third is Big Pharma. There are a few others that are related to these three, but I will leave that to your imagination.

With big government, they have forced many reports on doctors and other tasks like keeping digital records, and e-prescribing, which makes doctors work more hours to satisfy big government.

Then the medical insurance cartel, which includes Medicare and Medicaid, under the Centers for Medicare and Medicaid Services (CMS), which keeps reducing the amount they pay the doctors, the rest of the cartel follows lock-step. This forces the doctors to shorten the time spent with patients so they can earn enough money to cover office expenses and salaries of their employees. This means that they must see more patients. And yes, cartel is the correct term.

Many of the companies in the insurance cartel are paying their executives increasingly more money for their leadership. I have found records for one insurance company that pays its CEO almost 2 million dollars per year. I also know from other investigations that several of the CEOs are receiving over one million dollars per year. For an insurance company to pay a CEO this amount of money shows that they could care less if we can afford the premiums.

Of course, Big Pharma has its influence on doctors. Most send sales representatives to visit doctors, which consumes some time away from patients. They want the doctors to prescribe the medications their company manufactures and often they offer financial incentives to the doctor for each prescription written and filled. They also promote the positive side of the different drugs and skim over the harmful side effects.

Then doctors often create problems for themselves. Most are afraid of honest communications and try to confuse the issues with other terms. Patient engagement is one term they use to explain communications, which they don't use with patients.

Do DSME Programs Do Enough?

My answer to this question is “NO.” There are some decent parts of Diabetes Self Management Education programs, but in many areas, there is a deficiency. Behavioral programs for patients with diabetes (both for type 1 and type 2) provides minor benefit for glycemic control.

The authors suggest that without added support, most DSME programs provide minimal benefit. This is important when less than 10 hours of contact are provided. Patients with poor glycemic control benefit better from DSME than patients with decent control.

The weakness of the study is the fact that it was a meta-analysis and the studies used may not have had the proper controls in place.

Investigators applied published data between 1993 and January 2015 for the study on T2DM, and data from 1993 to June 2015 for T1DM. Databases used include Ovid MEDLINE, EMBASE, PubMed and others. For the study on T1DM, data was analyzed from 35 prospective controlled studies.

In the study for T2DM, researchers analyzed 132 randomized studies. Researchers found at least a 0.4% reduction in HbA1c through lifestyle and diabetes management education (DSME) in addition to support programs that provided a minimum of 11 contact hours to these individuals.

The research is important because it was conducted in Canada and not in the United States, as most insurance companies only pay for 4 hours of support and a few pay for only 2 hours. Plus, in the United States, CDEs often use mandates and not good diabetes education. They have too many strings attached to the organization that dictate many of their actions.

Responsibilities Not Taken Seriously

I am very concerned about the lack of caring by those in the business of providing education to people new to injecting medications for diabetes. I admit that I don't like to see Victoza being used, but it is and there are several other medications that are not insulins that are injected.

I am seeing more and more Disasters Averted, Near Miss Case Studies reported in Diabetes-in-Control weekly newsletters that involve people either using equipment the wrong way or injecting a medication in the same spot day after day and wonder why they are having problems.

This makes me wonder what professional people missed giving out information to have these things happen. Some are even reported anonymously which means someone has to be ashamed of what they did not teach correctly. Most have been CDEs reporting these incidents.

Just reading these, makes me wonder about the competency of the people doing the prescriptions or the people the patients have been referred to for education.

Common themes include:

• Injecting medications in the same area day after day.
• Not having operation of insulin pens explained properly.
• Over prescribing of same medication because patient sees several doctors.

The first should be taught to all people using injectable medications to prevent the build up of scar tissue just below the skin. When this happens, the medications are prevented from being used by the body as they become trapped in the scar tissue.

The second applies to many pieces of equipment because patients beg for equipment and no one teaches the patient the proper use of the equipment. I have seen pharmacists spend a lot of time explaining equipment when patients ask and even contact patients using the equipment when they are busy and can't take the time to explain everything.

The last point above happens over and over. Several of our support group have had doctors try to do this to them and refused the prescription after explaining they were already taking a medication, which the doctor's office had not requested any information to know what was being taken. Blood pressure drugs and statins seem to be the favorites in our area and most doctors push these without determining what the patients is already taking.

Some doctors are requiring patients to bring in all supplements and prescription medicines and making a record of each. When a patient does not bring in any supplements, they are warned that no more prescriptions can be issued so that conflicts with prescription medications can be prevented. When a patient says they are natural and don't need to be considered the doctors are becoming even more insistent on getting all supplements.

Barry said he had a friend that would not tell his doctor what supplements he is taking, as it is none of the doctor's business. Both Ben and Barry have warned him that some medications have conflicts with some supplements and can even cause death if this information is ignored. Yet he held fast to this belief and just tells the doctor he is not taking any supplements. The only thing that might have saved him was when he had one prescription filled, the pharmacist noticed the supplements he was purchasing and advised him of the conflict and what could happen if he took the supplement with the new prescription. Barry was with him and advised him to follow the pharmacist's advice.

We know what happened as Barry's friend ended in the hospital two days later and died the next day.

Make the Right Decision about Protein

Many people are becoming enamored with protein and eating more protein that some should eat. Because of the misinformation put out by many doctors, registered dietitians, and nutritionists, about avoiding fat and overloading us with carbohydrates, more people are moving toward more protein and away from fats and carbohydrates. This is often to their own detriment and is causing some people additional health problems.

First, excess protein can be converted to fat by many people. This is because your body can only use a certain amount of protein each day. If you take in too much protein, you may gain weight. Each gram of protein has 4 calories. If you take in 100 grams of protein, but your body can only use 50 grams of it, your body will store the extra 200 calories' worth of protein as fat. Doing this daily can cause you to take in 1,400 extra calories per week, resulting in a weight gain of almost 2 pounds per month.

Second, too much protein can damage your liver. An excessive protein intake can be harmful to your liver, brain and nervous system. When you eat protein, your body produces ammonia, a toxin that your liver normally makes harmless. Eating too much protein over a long period of time can cause your liver to become overworked, allowing ammonia and other toxic substances to build up in your bloodstream. This can lead to hepatic encephalopathy, a condition marked by a decline in brain and nervous system function.

Third, protein can increase your levels of cholesterol. Many high-protein foods, particularly from animal sources, contain an abundance of cholesterol. The National Heart, Lung and Blood Institute recommends limiting your cholesterol intake to no more than 200 milligrams per day, but a 6-ounce broiled porterhouse steak has 126 milligrams of cholesterol and half a roasted chicken breast has 83 milligrams of cholesterol. Eating too much animal protein can cause you to exceed the National Heart, Lung and Blood Institute's guidelines, putting you at risk for dangerous conditions.

Fourth and the final problem is protein in your urine. Protein in your urine may be an early sign of kidney disease. Proteinuria means protein in your urine. Your kidneys make urine by cleaning extra fluid from your blood. Your kidneys also help prevent the loss of things that your body needs, like protein. Proteinuria happens when your kidneys let protein leak into your urine. Protein in your urine may also be called albuminuria or microalbuminuria.

A very tiny amount of protein in your urine may be common from time to time, but a larger amount of protein in your urine may be an early sign of kidney disease. If proteinuria is not controlled, the increased amount of protein in your urine can lead to more kidney damage. Over time, this can cause your kidneys to fail, and you may need dialysis or a kidney transplant. If you find and treat the problem that is causing your proteinuria, you may be able to stop or slow down the damage. Testing is the only way to determine if you have this.

The Institute of Medicine recommends that protein-rich foods represent 10 to 35 percent of the calories you take in. The average woman should get about 46 grams of protein a day and men should get about 56 grams of protein daily. Active people need more protein than sedentary people, so if you engage in moderate to vigorous exercise on a regular basis, talk to your doctor to see if you should increase your protein intake.

Type 2 Diabetes Myths and Mistakes – Part 2

This is continued from the previous blog.

#7. Diabetes means having to give yourself shots, and I can’t stand needles. Only people who are on injectable medications need to deal with needles. Today there are insulin pens that don’t require you to inject yourself and blood glucose meters that make drawing blood painless. Plus, there are many new medications that control diabetes without needles or risk of low blood glucose reactions.

#8. Eating too much sugar causes diabetes. Diet does not cause diabetes, although there is recent evidence that drinking many sugared drinks can increase your risk of developing diabetes if you are already at risk. And while sugar per se does not cause diabetes, it does contribute to obesity, which is a major cause of diabetes. Obese people tend to eat many sweets. But they also eat a lot of junk food and other high-calorie foods. Sugar is bad for diabetics because it elevates blood glucose, but so are foods that break down quickly into glucose in the blood, such as plain pasta, bread, noodles, and white rice.

#9. I know when my sugar is high or low. You can’t rely on how you’re feeling when it comes to your blood glucose level. You may feel shaky, lightheaded, and dizzy because your blood glucose is low, or you may be coming down with the flu. You may urinate a lot, because your blood glucose is high, or because you have a bladder infection. The longer you have diabetes, the less accurate those feelings become. The only way to know for sure is to check your blood level.

#10. People with diabetes can’t eat sweets. There is no reason type 2 diabetics can’t eat sweets as part of their healthy meal plan. When eaten in small portions or as a special treat, diabetics can eat whatever they want. The problem is that most of us eat too much of what we like. Diabetes doesn’t mean you can never have a piece of cake again, just a smaller piece, and you’ll have to be careful about what you eat with that piece of cake. Dessert a couple of times of a month is OK, but not every night.

#11. You are more likely to get colds or the flu if you have diabetes. Diabetes does not make you more vulnerable to contagious illnesses. However, you should get your flu shots, because diabetics are more likely to suffer serious effects from the flu.

#12. If you are put on insulin that means you didn’t take proper care of your diabetes. When you’re first diagnosed, your blood glucose may be controlled adequately by diet, exercise, and/or oral medications that help your body absorb glucose. Eventually, however, your pancreas may stop producing enough insulin. At this point you will need insulin injections. This is not your fault, but simply what happens as we age as the disease ages with us.

I had not heard or seen all of the items in the two blogs, but in talking with others, there could be many more. The misinformation often becomes accepted by people without diabetes and this often makes it more difficult for people who become diagnosed with diabetes.

Type 2 Diabetes Myths and Mistakes – Part 1

Like bad nutritional advice and the belief by many doctors that fat is still bad, misinformation about diabetes is everywhere. It is better to use facts than believe the bad information.

#1. Diabetes is not a serious disease. Diabetes is a serious, chronic disease that can be controlled, but it still causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke. Many people don't see diabetes as serious because people with diabetes often look like normal people, and this makes diabetes the invisible disease.

#2. Diabetes is a death sentence. Not true. The progress of this disease is in your hands. It takes a time to progress until you lose limbs. Medications can be provided, but the initial treatment is often diet and exercise. If you choose to follow the recommendations you’ll do well. It is often difficult to change your lifestyle, but it is definitely possible.

#3. If you are obese or overweight you will get diabetes. Weight is a risk factor for diabetes, but there are other factors, such as family history and genetics that also play an important role. Most overweight people never develop type 2 diabetes, and there are many normal-weight type 2 diabetics.

#4. If you have diabetes, you can’t do too much exercise or you might get a low blood sugar attack. If you are on insulin or a medication that increases insulin production in the body, you have to balance exercise, insulin, and food. However, many type 2 diabetics are not on insulin, and the most commonly used oral medications for diabetes, such as metformin and sitagliptin, don’t cause low blood glucose at all, no matter how much exercise you do. In fact, exercise is crucial to controlling diabetes, along with weight loss.

#5. Insulin will harm you. I don’t want to be on insulin because as soon as Grandma went on insulin she died. This is a common assumption and often happens because the doctor kept the person on oral medications until it was too late. Insulin is a lifesaver, but it’s also difficult to manage for many people, but mostly for doctors because they are not up to date and fear hypoglycemia. It’s crucial to test your blood glucose levels many times a day when you’re on insulin to avoid low blood glucose reactions that will harm you.

#6. Diabetes means your body doesn’t produce enough insulin. This is true in type 1 diabetes, where the pancreas stops producing insulin completely. People who develop type 2 diabetes, which is the most common type of diabetes, usually have sufficient insulin, at least when they are first diagnosed. Their problem is that the insulin doesn’t work properly. It fails to cause the cells in their bodies to absorb glucose from the food they eat. Eventually their pancreas may stop producing enough insulin, so they will need insulin injections.

This will be continued in the next blog.