August 6, 2016

Helping Your Blood Glucose Meter Be Accurate

When used correctly, blood glucose meters — small devices that measure and display your blood glucose level — are usually accurate. But, occasionally they may be incorrect. Often the inaccuracy is caused by human error. Many people learn from the pharmacist and figure they know it all, but they never read the booklet that comes with the meter. Then they compound the problem by not reading the instructions that come with the test strips.

The following chart shows some of the problems:
Factors that affect accuracy
Test strip problems
Throw out damaged or outdated test strips. Store strips in their sealed container; keep them away from heat, moisture and humidity. Be sure the strips are meant for your specific glucose meter.
Extreme temperatures
Keep your glucose meter and test strips at room temperature.
Alcohol, dirt or other substances on your skin
Wash your hands with soap and water (as hot as you can tolerate). Dry your hands and the testing site thoroughly before pricking your skin.
Improper coding
Some meters must be coded to each container of test strips. Be sure the code number in the device matches the code number on the test strip container.
Meter problems
Fully insert the test strip into the meter before pricking your finger. Replace the meter battery as needed.
Not enough blood applied to the test strip
Move the test strip into a generous drop of blood. Let the blood wick into the test strip and completely fill the area on the test strip. Too little blood will cause an incorrect reading
Testing site location
If you're using a site other than your fingertip and you think the reading is wrong, test again using blood from a fingertip. Blood samples from alternate sites aren't as accurate as fingertip samples when your blood sugar level is rising or falling quickly.
The amount of red blood cells in your blood
If you are dehydrated or your red blood cell count is low (anemia), your test results may be less accurate.

If your meter isn't working properly, contact the manufacturer of your meter and test strips.

Other common mistakes is dumping too many test strips onto a dirty table and not using them in the required time. Didn't read that did you? Yet, I have seen this done by more people than I like. Only remove one strip from the test strip container at a time and close the lid. Do not do this in direct sunlight.

I have also seen this mistake done too often. People put the test strip in the meter, then hunt for the lancing device, and sometimes need to reassemble to lancing device before they can use it. This means that the test strip has been out too long and will probably give you an incorrect reading.

I suggest that you always have the lancing device out and ready to use first. Then remove the test strip from the container and close the lid. Then insert the test strip into the meter slot and set it down to be able to prick your side of a finger tip with the lancing device. Next pick up the lancing device and prick the side of your finger near the tip of your finger and make sure enough blood has risen to the surface. If needed milk (gently squeeze) the finger to have enough of a blood amount. Next set the lancing device down and pick up the meter with the test strip already inserted and slide the test strip into the blood at a 10 to 20 degree angle and let the blood wick into the test strip. Make sure that enough blood has completely filled the area of the test strip to obtain an accurate reading.

August 5, 2016

Flu Vaccine Good at Reducing Death

I know most understand what the title means, but I cringe every time I read some of the titles like this one from Medical News Today - “Flu vaccine may reduce risk of death for type 2 diabetes patients.” We will all die someday, but we don't know when. These titles make it sound like we might live forever.

The flu vaccine may reduce the likelihood of being hospitalized with stroke and heart failure in people with type 2 diabetes, according to new research. The study, from scientists at the Imperial College London, also found patients who received the influenza vaccination had a 24 per cent lower death rate in the flu season compared to patients who weren't vaccinated.

The team, who published their findings in CMAJ (Canadian Medical Association Journal) studied 124,503 UK adults with type 2 diabetes between 2003 and 2010. Around 65 per cent of these patients received the flu vaccine. The scientists found that, compared to patients who had not been vaccinated, those who received the jab had a 30 per cent reduction in hospital admissions for stroke, 22 per cent reduction in heart failure admissions and 15 per cent reduction in admissions for pneumonia or influenza. Furthermore, people who were vaccinated had a 24 per cent lower death rate than patients who were not vaccinated.

The team also found a 19 per cent reduction in hospital admissions for heart attack among vaccinated type 2 diabetes patients during the flu season, however this finding was not statistically significant.

Dr Eszter Vamos, the lead author of the study from the School of Public Health at Imperial, said: "Most flu deaths every year occur in people with preexisting health conditions such as type 2 diabetes. This study suggests the vaccine may have substantial benefits for patients with long-term conditions. Not only might it help reduce serious illness such as stroke - and possibly heart attack - in high-risk individuals, but it may also reduce the risk of death in the flu season.”

Currently more than one-third of people with diabetes do not receive their flu vaccine year-by-year in England. By increasing the number of people receiving influenza vaccine annually, we could further reduce the risk of severe illness not addressed by other measures.

Type 2 diabetes results in a person being unable to control their blood sugar properly and affects around 2.7 million people in UK. People with the condition are at high risk of cardiovascular disease, which includes heart disease and stroke, possibly due to high blood sugar levels damaging blood vessels. Furthermore, flu infection has been found to increase the risk of heart attack or stroke in patients with cardiovascular disease, although scientists are unsure why.

In the UK the NHS offers the annual flu vaccine to children and adults with underlying health conditions such as type 2 diabetes, as well as to all over-65s and pregnant women.

Professor Azeem Majeed, co-senior author from the School of Public Health at Imperial added: "There are few studies looking at the effectiveness of the influenza vaccine in people with diabetes. Although there have been questions surrounding the effectiveness of the flu vaccine in recent years, this research demonstrates a clear advantage for people with diabetes. The findings of the study illustrate the importance of flu vaccine in reducing the risk of ill-health and death in people with long-term conditions. The flu vaccine is available free to these patients from GPs and pharmacists, and patients with diabetes should ensure they receive the vaccine every year."

In the study, the team looked at a representative sample of 124,503 patients with type 2 diabetes from a number of GP surgeries in England. They then tracked these patients over a seven-year period, and monitored the number of hospital admissions in this patient group for heart attack, stroke, heart failure, pneumonia, and influenza. They also looked at the number of deaths. The team then adjusted their figures for demographic and social factors, as well as existing health conditions.

August 4, 2016

Are Whole Grains Good for You?

While I have no allergies to wheat or wheat products, I do find myself reducing the consumption of Whole Wheat and Whole Grain products, as they do not seem to be all that everyone wants us to believe. Some grains are necessary I feel, just not what all the hype is about.

From the American Diabetes Association to the American Heart Association to the Academy of Nutrition and Dietetics, they all speak about eating healthy whole wheat and whole grain foods. We have this drummed into us and put before us in print and everywhere we may look. I know this is part of the carbohydrate push by these organizations. Now if the foods were just what they were advertised to be.

The Food and Drug Administration and the United States Department of Agriculture should enforce some of the laws already on the books. We have so much false advertising and false and misleading print on our food products that many people are beginning to accept this as the truth.

Whole grains are a mantra by most doctors, dietitians, and nutritionists. They would push this in our face 24/7 if they could. Before you purchase any product saying it is whole wheat or whole grain, read the ingredients and the label. Chances are there is just enough to keep them from getting in trouble with USDA or FDA and the balance is not whole wheat or whole grain anything.

The regulations have been relaxed to the point that there is a very small amount of wheat or whole grains in the product. Most of the product is highly refined flour and not whole grain or wheat.

I know that most people will not or do not have the time to prepare foods or bake from scratch. This is the only way to ensure that the product is wheat or whole grain. Not that I an advocate in returning to the days when we ground our wheat or grains at the local mill, but with food manufacturers today, do not count on getting them.

Also, notice that the food today has been processed to the point that they have to add some vitamins and mineral back to the product. We do lose some of vitamins and nutrients when it is cooked, baked, or processed by us even if it is fresh from the garden.

I like what Prof Jennie Brand-Miller has to say about whole grains as they are thought of today. She makes some very valid points that we all need to think about. So the next time you are purchasing “whole grain” foods, use extra care to read the label and ingredient list. You may just put it back on the shelf and look for something else. You may find that whole grain is indeed a myth.

Another writer about whole grains is Jon Barron. He has a rather lengthy discourse about whole grains and how the manufacturers are shortchanging the American public. He compares some studies as well.

August 3, 2016

Five Important Tests if You Have Diabetes

Tests of several different types are important if you have diabetes because diabetes does not just affect a person's blood glucose levels. Diabetes can affect your heart, kidneys, eyes, and even your feet. It is therefore important to manage your diabetes and the following routine tests are important to tell your diabetes healthcare team how you are doing.

The A1C Test
The hemoglobin A1C test or A1C test is the test for measuring your overall blood glucose management over the prior three months. The A1C test can be done on a sample of blood collected from a finger stick, or from a small vial of blood drawn from the arm. Most doctors and diabetes clinics recommend that this test be done every three or six months. Your goal that you want to meet should be better than what most doctors want as most doctors and diabetes clinics just want you to be below 7 percent. The better doctors and clinics will prefer that your A1C be below 6.5%. The reason for this is the development of complications happens at a much slower rate than 7 percent. The reason for the 7 percent is these doctors are very afraid of hypoglycemia and want this kept to the very minimum. You doctor can suggest an A1C goal or target for you, but should never set your A1C goal.

Foot Exam
People with diabetes are at a higher risk of developing foot problems due to decreased circulation and lack of feeling in the foot from high glucose levels. A common foot complication is diabetic neuropathy, which typically occurs when nerves in your feet become damaged, resulting in the inability to feel pain or discomfort from injuries or sores. Diabetes can also cause circulation problems that prevent you from healing as quickly as people without diabetes do.

Most good doctors and diabetes clinics recommend that you have your feet checked at least annually, and preferably at every medical visit, for altered sensation, decreased circulation or infection. During the exam, the doctor will perform a visual inspection and look for skin color changes, cuts, and other damage. The doctor will also take a pulse at key points of the foot to determine circulation levels. There will be a test of sensation, where the doctor uses a tuning fork, pinwheel, or tin gram fiber to evaluate awareness of touch, dull versus sharp pain, and movement of the tool across the skin. Always see a podiatrist if your doctor does not check your feet at least annually.

Eye Exam
Diabetic eye disease is painless and often has no symptoms until advanced stages, meaning many people with diabetes can have the disease and not even know it. Diabetic retinopathy is the most common eye disease for people with diabetes and occurs when the small blood vessels in the eye are damaged by high levels of glucose in the blood. Diabetes also puts people at risk for cataracts, glaucoma, and other complications.

The earlier diabetic eye diseases are diagnosed, the more that can be done to halt vision loss. Serious eye damage can prevented if complications are found early, so it is important to get an eye exam annually or as often as the doctor orders, even at every six months or quarterly. The exam can take up to two and a half hours, and includes dilating the pupil to be able to see the back of the eye. The entire exam is painless, but you should be prepared to wear sunglasses after the appointment, as your pupils will become sensitive to light after they are dilated.

Blood Pressure Test
High blood pressure is more common in people with diabetes, and controlling your blood pressure is essential in preventing serious complications such as heart failure, stroke, or eye and kidney disease. Most doctors check your blood pressure at every medical visit. The suggested blood pressure goal is less than 140/90 mmHg for people under the age of 18 and less than 130/80 mmHg for individuals without cardiovascular disease or multiple risk factors. If you already have complications due to diabetes, such as kidney disease, your blood pressure goal may be different. Be sure to ask your healthcare provider what your goal should be.

Kidney Test
There are two types of kidney exams that should be performed annually. The first is a special type of urine test that tracks excess protein in the urine, a condition known as microalbuminuria. The normal albumin level in the urine is less than 30 mg. Anything above that is abnormal and reflects an early sign of kidney disease. The second test is a blood test that measures the blood creatinine level. The creatinine is a substance that is always in the blood, but when there is kidney failure, the level of this substance will rise. By checking the glomerular filtration rate (GFR) of your kidneys, your doctor can tell how well your kidneys are filtering your blood. Remember to always ask your doctor what your GFR is.

Word of caution, always ask for these tests when they should be scheduled and if the doctor says not to worry, consider finding a different doctor as your health depends on knowing this information. I also urge all diabetes patients to receive a copy of the lab reports done by any doctor.

August 2, 2016

Do You Have a Doctor That Bullies You?

This is a problem for many patients with diabetes. I have had experiences that caused me to leave doctors and I am not happy about this, but I refuse to be one of their patients. Several members of our support group have also needed to leave doctors that bullied them.

What started this is a recent blog by David Mendosa on type 2 diabetes stigmas. I know this is true and he had it well documented, but I could not find anything on the stigma doctors add to our problems. In another blog, David wrote that trust is a major factor in helping patients and sometimes it is necessary to change doctors because you don't trust them.

Doctors that bully diabetes patients just add to the stigma. If you are overweight, have you had a doctor say that having diabetes is your fault? I know I have had this happen to me. The same doctor also told me I had failed because I was on insulin and not an oral medication. He would not listen to anything I tried to tell him and kept repeating that I was a failure. When I got tired of listening to him, I was not too polite when I called him out and told him that he was a bully and I could understand why he needed to transfer so often when patients refused to see him.

Fortunately, I do not need to change doctors since he was another doctor in the office, I had a nurse practitioner managing my diabetes, she knew my history and had never caused concern for me, and I trust her. The bully doctor is no longer in the office and I don't know where he is now.

Doctors that bully patients also threaten patients and in diabetes, many doctors use the threat of insulin to keep patients on oral medications. Other doctors threaten the health of patients when they do not wash their hands between patients in the office and in the hospital. I have seen a few doctors that do wash their hands after contact with some patients, but not with other patients in the office setting.

This article describes the types of bullies and what to do about them. While I don't agree with some of the statements, it is still a good article about what to do with the different types of bully doctors.

This article proves that men are not the only bullying doctors. The patient describing this does an excellent job of being polite and still making her point. Please consider reading both articles.

August 1, 2016

Thank You to My Readers

Yes, it is time for thanking my readers from many countries. I admit I was giving some serious thought to stopping my blog, but when the emails starting really coming in at almost 20 per day, I began to realize that I needed to keep publishing my blog. Many of the emails had some serious questions, but not being a doctor, on many of them I could only suggest talking to their own doctor and giving them a few suggestions of questions to ask.

There were several emails agreeing with what a blog said and I appreciate that. That is always good to know. A few thought I could have added something and a few others felt I was missing a point. Finally, a few felt that the study I used was worthless and poor science, which a few were and I had stated this on a few of them.

A few readers were apologizing for their English. I have told all of them that if I can understand what they were saying or asking, that was the important issue and I could care less about their halting English or even some of the spelling.

A few readers were asking how I could put up with some of the criticism that I might be receiving and still post a daily blog. I am always happy to explain to these people that I have a thick skin and criticism doesn't bother me if I can learn from it.

A few other emails asked how I handled some of the comments that must be about cures and explaining that doctors are hiding this from people with diabetes. I explain to them that I have set up comment moderating and before a comment is published, I try to check the comment for hidden links and even other obvious links to articles and websites for propaganda about supposed cures (which as of today there is no cure for type 1 or type 2 or any other form of diabetes). Occasionally, some links are so well disguised that I publish them - and once published, the link shows up and I then delete the comment.

Yes, there are a few legitimate ways of putting type 2 diabetes into remission, but many of those promoted are nothing more than a way to sucker people out of their hard earned money. The people with good ways to put type 2 diabetes into remission generally are not charging people money for this, but are publishing them for people to use if they are able. These suggestions I can appreciate, but when a writer refers you to a site that charges for their solution, then red flags go up and I seldom follow this any further as I know it is a scam.

I won't name all the countries that show up in the analytics, but when I say they are around the world, this is what the statistics show.

I feel recharged with the interaction from some of my readers and this is what keeps me writing. The blogs on bariatric surgery was the result of several emails about this and these in turn generated many new emails.

Again, thanks for reading my blog.

July 31, 2016

Diabetes Complications

Here are most of them:
Retinopathy – leading to blindness
Neuropathy – Affects nervous system and can affect major organs
Nephropathy – Leading to kidney failure and dialysis
Heart disease – Possible death, but often creating disability
Foot problems – This can lead to infection and possible amputation unless treated early

The above have been mentioned and are often the most serious.
The following are other complications and can range from minor to serious

Cognitive decline – can often lead to dementia or Alzheimer's, but not always
Sexual dysfunction - in men and women
Fatty liver disease – this can be problematic to fatal
Skin diseases – most of the diseases are treatable
Infections – do not let these become serious
Periodontal disease – care of you teeth is a must with diabetes
Deafness – there is a link, but more pronounced the younger a person is
Gastroparesis - also called delayed gastric emptying and this can be good and bad
Hyperglycemic Hyperosmolar Nonketotic Syndrome - can happen to people with either type 1 or type 2, but most often in people with type 2 diabetes, most often in people with unmanaged diabetes. This and the following one require immediate medical treatment.
Diabetic Ketoacidosis – Can happen to both types, but most often in people with type 1 diabetes, as glucose builds to high levels in the blood stream
Hyperglycemia – elevated blood glucose levels, but not as high as the two types above
Hypoglycemia – low blood glucose levels below 70 mg/dl. This requires immediate treatment to avoid coma and possible death.
Depression – often happens to people with either type of diabetes and now there is a proven link

The most productive way to avoid the complications of diabetes is to manage your blood glucose levels and maintain A1c under 6.0%. Eating healthy and avoiding highly processed foods is important in managing diabetes.

If you are medically able, do exercise of some type that will help. Many wheelchair patients are often capable of lifting some weights and many are capable of moving around in their wheelchair.