Sleep Apnea Makes Diabetes Harder to Manage

This study conducted in Europe supposedly, is not news to me because I have sleep apnea. It just confirms what I am already aware of and can't get one person I know to wear his CPAP mask. He has type 2 diabetes and it is poorly managed. He now refuses to tell me his A1c results because he knows that I will tell him that his sleep apnea is making his diabetes more difficult to manage.

I am not sure why he will not use his CPAP, but I know he is constantly overtired. Recently, he lost his job because of falling asleep at work and this endangered other workers. This of course has made him more upset and I have been very careful about what I say to him. However, I still ask him why he will not use his CPAP. I have informed him that he would be able to manage his diabetes more effectively.

I do tell him that with sleep apnea, he could die in his sleep when he can't recover from an apnea. He just laughs at me and all I can do is shake my head. I finally had a talk with his doctor and urged him to consider an intervention. His doctor would not say anything because of HIPAA and I just said I was informing him of a problem with this patient.

The study is not really useful as it was done with non-diabetic people. I could not confirm this, but I could not find that it had random controls as part of it. At least it was not U.S. taxpayer money wasted on a useless study.

I doubt that sleep doctors will consider this warrants attention and screening for diabetes as the lead author tries to point out.

Since I have type 2 diabetes and sleep apnea, I can confirm how important it is to use my CPAP equipment – actually a BiPAP machine. I use my equipment every night and my sleep apnea is a non-factor in the management of my diabetes as a result.

Some of the reasons people refuse to use their sleep apnea equipment include:

1. Vanity – they don't feel sexy or manly wearing the mask
2. Some feel wearing the mask is claustrophobic
3. Some do not like the lines that the mask straps cause in their skin because they have the straps too tight
4. Many complain about the noise the machine makes
5. Many have a problem with the air leaks around the mask because they aren't properly fitted or having a mask that fits properly

I have several blogs about these problems, but feel that number 3 and 5 above can be solved if people would consider nasal mask liners as discussed in my blog here. Noise can be a problem for some, but the noise has been decreased in recent years, especially in the newer machines, and should not be the problem of older CPAP machines.

Another factor is having the mask properly fitted by a sleep specialist. Many people do not do this and blame the manufacturer for their bad decision or they just won't ask the right questions.

If you have sleep apnea and type 2 diabetes, please do yourself a favor and use your equipment as you will feel better and manage you diabetes more easily.

Elevated A1c Means Elevated Dementia Risk

Are you concerned about dementia? Apparently, many people with type 2 diabetes are not concerned. Questions still need answering. What are doctors doing to help people manage their diabetes? Are patients being informed of the increased risk for dementia by having an A1c above 7.0%? Diabetes is an established risk factor for dementia.

The sad part is our doctors are doing very little to help people manage their diabetes. When it comes to dementia, doctors are not even talking about this. Yes, there are a very few that stay current and inform their patients, but the vast majority could care less. What is even more alarming is the number of patients that do nothing to learn about diabetes and managing their diabetes.

This study is reported in the New England Journal of Medicine. Sandra Adamson Fryhofer, MD reports on this study in Medscape. “The study included more than 2000 patients, about 800 men and 1200 women, with a mean age of 76 years at the start. None had dementia but about 200 of them had diabetes. The rest did not. They were followed for 7 years. Blood sugars and hemoglobin A1c levels were closely monitored. By the end of the study, 524 people had developed dementia, 74 of whom were diabetic. The remainder of those diagnosed with dementia were not.”

The study discovered that patients with higher blood glucose levels on average were more likely to develop dementia. Among people with diabetes, the risk for dementia was 40 percent higher for those averaging around 190 mg/dl when compared to those with average blood glucose levels around 160 mg/dl. Other surprising facts come from the pre-diabetes range. Those with average blood glucose of 115 mg/dl were about 20 percent more likely to develop dementia that those with average blood glucose levels of 100 mg/dl.

Insulin resistance and microvascular disease of the central nervous system may also affect dementia, but these have to be studied. Another factor that needs to be studied is patients at the certain ages may have early onset of dementia that causes them to not take care of their diabetes as well as they might otherwise.

This study does suggest that any increase in blood glucose levels above the normal range increases the risk dementia. For those people with diabetes, the risk for dementia is more elevated. Therefore, it makes preventing dementia even more important by maintaining blood glucose levels at the normal range. This means between 80 to 100 mg/dl or below 5.7% for A1c.

The problem is eating the right foods, keeping weight in the idea range for height and frame size, as well as great management of blood glucose levels.

Staying Positive with Diabetes

I cringe when I read blog titles like this “Five Big Diabetes Fears—and What to Do About Them.” Yes, I know, writers prerogative to bring readership, but I still cringed and went on to something more positive to read, which there were a few articles and blogs. I did not need to do much searching. I discovered some positive or what I would term semi-positive news on Medscape titled “Diabetes Not Linked to Dementia.” This does not agree with many previous articles saying that there is a link to Alzheimer's disease, but this study seems very sure of itself.


After reading several more semi-positive articles, I decided to return to this negative blog. I will take the five supposed fears and see if I can make something positive out of them.


#1. Low Blood Sugars This is the one that can cause the most fear for some people. Since I am an insulin dependent type 2, why does this not create fear for me you may ask. Probably because I have not had that many severe episodes of hypoglycemia – only two that were below 50 mg/dl, one at 48 and another at 42. I was able to recover very fast with glucose tablets and did not worry further. Yes, I have had another couple of episodes below 60, but at 58 and 59, I never was overly concerned.


I do understand type 1 people getting concerned when they “rage bolus” with their pumps and don't know how much insulin they may still have had in their systems. I read several type 1 bloggers that seem to be on a yo-yo string of highs and lows in a day and that would scare the dickens out of me. This is why I will stay with my multiple daily injections and think nothing of it.


I have been fortunate to have been supplied with one of the best names in test strips and the meters to compliment them. My episodes of hypoglycemia mentioned above have come when I inject my short acting insulin too close to the last injection of the long acting insulin. I normally realize this as soon as I have put the syringe down and then I take immediate action to prevent the oncoming hypoglycemia. I start testing in the next 15 minutes and repeating at 15-minute intervals. Once I know that a low is happening, I start taking my glucose tablets. I repeat this until the trend is back to the positive side and continue until I am back above 70 mg/dl.


Only one time did I get the shakes so bad that I had trouble wicking the blood into the test strip. Once I drop near 65 mg/dl, I start sweating profusely and I reach for the meter and test strips and start testing. Most of the time, I can correct it with one 15 gram tablet of glucose. But be careful as there are several different types of tablets – from 4 gram to 15 gram tablets. I have been able to locate 15 gram tablets and prefer using them.


#2. Microvascular Complications This is no longer for most people a concern because of our equipment that we have available today. Yet, I look at those that are not managing their diabetes and wonder if they aren't having some real fears. Most type 1 people are trained how to manage their diabetes, as are most type 2 that use insulin. The microvascular complications of loss of sight, nerve pain, and kidney disease are often not a problem for these people unless they are not managing their diabetes.


Now I would be remiss in not being concerned about the type 2 people on oral medications. These are the people that our “experts” degrade and say they should depend on their A1c results for knowing how they are progressing in their diabetes management. Talk about the blind trying to lead. They are slowly forcing these people with type 2 diabetes into the dark because they have no idea of how they are managing their diabetes until they receive their A1c results. Many still don't know because their doctors don't tell them what the results are.


Recently, I was not aware of the panic in our support group when one of Barry's friends came for a visit. He and Barry had been talking about diabetes, but not being very specific. Then the second day Barry asked his friend what has last A1c had been. His friend said he did not know as the doctor had not told him. Barry said the only comment he could remember was something to the effect of watch what he was eating as it was creeping back up. I had been out of town that day and several had been called to see if they could locate an A1c test as the local doctor was out and had not received his order yet. When they finally called me, I was able to stop on my way home and found an A1c testing kit. More about this in another blog.


#3. Macrovascular Complications This is more of a concern than many will admit. Anyone with diabetes is at an increased risk for heart problems, but we still need to be concerned as most doctors shove statins and other medications at us and fight to keep us on them. Why the author did not cover the one area of greatest concern is beyond me. We all need to be aware of atherosclerosis. This can cause poor healing of wounds in your legs and feet. This is the cause of most amputations because they become infected and even more difficult to heal.


#4. Food Changes Many people get all tangled up in the panic panel on this one. Most are type 2 people on oral medications are not given the testing supplies necessary to help them discover what the different foods do to their blood glucose levels. By testing and eating to their meter, they could discover what foods to curtail, eliminate, reduce in quantity, and which they are able to consume in their meal plan. Since there is no specific diabetes diet, food plan, or even guidelines, many people return to eating what they had been eating and away goes their diabetes management.


Each person needs to determine what their bodies can handle and by using their meter can develop a food plan that allows them to manage their diabetes. In this determination, what another person is able to consume may not be what they are able to consume. I will always urge each person to see if their doctor will attempt to get approval for the first six months to be allowed extra test strips or if they are able to purchase the extra.


People on insulin would be better served by finding out what they are able to include in a balanced meal plan and what their meter tells them as well.


#5. Medication Issues Many people become highly agitated when they are told they must take insulin or a pill to help manage their diabetes. Those with type 1 diabetes must inject insulin and they have no choice if they wish to live. Yet, many people with type 2 diabetes, take the prescriptions, stuff them in a purse or pocket, nod to the doctor and as soon as they are outside, head for the nearest health food store, or natural supplement shop and spend money by the fist full for something “natural” that the sales clerk recommends.


What they don't admit is that they have substituted one medication for another medication. Unfortunately, the natural medications will not help them make any improvement in their diabetes and they may or may not return to their doctor until they start to develop some of the complications. But they don't care, they haven't taken any of the prescribed chemicals, so they are happy. I can only say, good luck and don't complain when the complications start.


Then I haven't mentioned those with literacy problems and can't follow medication directions and wonder what is happening when the doctor asks if they have been taking their medications because of little or no improvement in their A1c levels. Most doctors are not working to help those with any type of literacy problems.


In addition, please read these two blogs. The first is about what you need to know immediately after diagnosis and the second is about the best level of blood glucose management.

Joslin Advocates for SMBG

This is an interesting turn of events. Normally I am the one complaining about the lack of self-monitoring of blood glucose, but now Joslin Diabetes Center is asking in their book Joslin's Diabetes Deskbook, 2nd Ed, Excerpt #4: Do Your Patients Self-Monitor Their Blood Glucose Enough? For this, I have to ask if they will appeal to the Centers for Medicare and Medicaid Services (CMS) to up the number of test strips that diabetes patients can be reimbursed.

I complain because people do not test enough and use the results to help manage their diabetes in as more informed manner. I appreciate Joslin's statement, “It is imperative that people who are self-monitoring know what to do with the results of their glucose checking so that they can take active steps to improve their control. They should be given instructions on how to interpret their results, what they can do themselves in response to the results, and when they should call for help.” At least the authors know and understand the importance of education and that it should be part of every diabetes treatment plan.

Too many doctors do not even prescribe a meter and test strips for patients on oral medications, meaning patients with type 2 diabetes. This excerpt should be required reading for these self-important doctors. All doctors do either give out meters and prescribe test strips or inform their patients where to obtain testing supplies for people with type 1 diabetes and for people with type 2 diabetes on insulin.

I like what is covered in chapter 3. They state that, “Goals of diabetes treatment need to be defined in terms of self-monitoring results.” This is a great statement, which patients with diabetes need to understand. This brings both patients and physicians into the picture and makes each a participant. The patients are responsible for gathering the information, doing this diligently, and providing this information to the physicians. Then the physicians are responsible for taking this information and helping the patients set goals (whether new or revised) to help then manage their diabetes more effectively.

In summary, here are a few reasons why SMBG should be performed:

1. To provide data about glucose patterns that can be used by the healthcare team, working with the patient, to make treatment manageable.

2. To provide data with which patients themselves can make daily decisions on treatment adjustments.

3. To provide feedback on how effectively the individual is managing daily self-care routines, including medical nutrition therapy, physical activity, and medication use.

These are by no means the only reasons and the tables uses are adapted from the American Diabetes Association and are therefore not ideal, but can only be interpreted as suggestive for patients that are elderly or have other diseases, which affect their ability to manage their diabetes more effectively. Those patients that are younger and fully able to manage their diabetes need to consider using these tables.

Another area of concern is a few of the “diabetes coaches” that tell their people not to give the information to their doctors. Granted some doctors do not know what to do with the information, but they are on their way out of practice as patients become more empowered. I have crossed paths with a few of these “coaches” and know they are attempting to hide what they are doing. Not that they are giving out advice that is out of line, but too often these “coaches” are practicing medicine without a license. They may not have intended to, but they do cross the line time after time.

Hospitals Will Destroy Your Diabetes Management

This blog got its start quite by accident and not one putting anyone or me in the hospital this time. In discussing patient centered care with David Mendosa, I rather exploded about hospital care. David, in his calm and collected way asked if I had read any of Dr. Bernstein and I had to admit I have not. David said he would provide me with a link to his blog about a letter to get signed when entering the hospital. After reading this, I may have to get up the courage to read Dr. Bernstein’s book. Unless there is something that I am researching, I seldom take time to read a book for the pleasure of reading. Since I do a lot of research about type 2 diabetes, I am not reading much published on the type 1 side of the spectrum. No one to blame but myself.

Back to hospitals and why they are on my list of “avoid if at all possible”. It is understandable that hospitals and doctors have an aversion to lawsuits and this drives many of the healthcare decisions they make. People with diabetes is one group that pays dearly for this aversion. Hypoglycemia is the fear that draws attention and dictates much of the policy for care when person with diabetes is hospitalized. The term that is used for most healthcare is defensive medicine. For patients with diabetes, this means allowing blood glucose levels to be maintained at levels that slow healing and can lead to increasing the risk for complications to develop. Thus the hospitals are caught in conundrum for care. The chance of hypoglycemia depends on the medication and if the patient is on insulin or sulfonylureas the hospitals use a level of blood glucose that will generally avoid hypoglycemia and is in the hyperglycemia range. Most, but not all, hospitals want the lower limit of blood glucose to be 180 mg/dl (10.0 mmol/l) or slightly higher. The longer your blood glucose levels remain at this level, the more you are at risk for complications. Because of the smaller likelihood of you developing complications while under hospital care, this is the goal of most hospitals.

Another area that patients with diabetes need to be concerned about is diet while in the hospital. Forget that you have diabetes and please do yourself a favor and do not request the diabetic menu. Because the dietitians for the hospital follow the American Diabetes Association in diet planning, the menu is high in carbohydrates and low in fat. This creates all sorts of problems for patients with diabetes. Those on oral medications will have extra problems because of lack of movement or any type of exercise. Those on insulin (which most that are hospitalized are converted to at least while hospitalized) will run blood glucose levels of 180 mg/dl or higher. The one procedure I will commend hospitals for is giving rapid or short acting insulin after meals so that if the patient does not or is not able to eat a meal, hypoglycemia is averted by not giving an insulin shot.

If you are scheduled for an operation or admitted to the hospital in an emergency situation, please be aware of the above problems and consider the letter in David Mendosa's blog. Even if it is an emergency admittance, if a family member or a close friend can advocate for you and have the letter presented, this may help. A reminder, you may have to stand your ground as most hospitals will refuse to allow you, the patient, to treat yourself for diabetes because they do not want the liability of something going wrong. I dislike saying this, but you are are higher risk of surgery complications and even death if the hospital keeps you on their diabetes regimen. Studies have shown this to be true and as a patient you need to be aware that this can happen.

I have a friend that lost about $300 because a nurse confiscated his insulin and testing supplies and destroyed them. Horror stories like this abound and this is because the hospital medical staff lack the training in diabetes care and some just don't care. Others do care and if you are mentally capable of managing your diabetes, they will allow this to happen even against hospital policy. So do consider the letter in David's blog and if needed adapt it to fit your needs. You will benefit your health by managing your diabetes versus letting the hospital manage it.

Back to Diabetes Basics – Part 7

Medical Alert Jewelry

When I started this series, I did not realize that I would find so many topics that could be considered good basics, and I haven't even covered oral medications. Medical alert jewelry is something many people do not consider until it is too late. For many, this realization happens after they have their first episode of hypoglycemia. The police may become involved because of erratic driving and because people display symptoms very similar to a drunk driver, they are arrested and jailed without treatment.

Or, a family member discovers you on the floor passed out. They do the proper thing by calling 911, but forget to say you have type 2 diabetes and you are hooked up to an intravenous (IV) solution loaded with dextrose and this is continued when you arrive at the hospital. Now you are in hyperglycemia and nobody knows you have diabetes yet. Think of the damage that could have been prevented with medical alert jewelry.

If you think I am in favor of wearing a medical alert piece of jewelry, you are right. I have talked to the first responders in areas near my town and in my town, and they are trained to look for medical alert jewelry, and even tattoos in conspicuous places. They may not find some that are tattooed in private areas. I have written several blogs and while you may not agree with every thing I say, please consider wearing a medical alert piece of jewelry or a medical tattoo. The blogs are four and can be read here, here, here, and here.

Diabetes Management and Doctors

Here is where I normally get aggressive with the doctors, but this time I will try to cut them some slack. Diabetes management is primarily the responsibility of the patient and this is the focus for most of this discussion. Why? The doctors cannot live with you (unless you are married to the doctor), they see you less than one percent of the time in a year, and the rest of the time, you are generally on your own.

Now I know that you as the patient are not always supplied with all the information necessary to understand and manage your diabetes. Don't always blame the doctor, as there is only so much time available for an appointment. If you doctor gives you some information, this shows he/she is trying. He does have time constraints especially if he does not own the practice and works for another doctor or is employed by a hospital. Both can be so profit minded that they do not often allow for proper patient care. This is why other types of medical practice are finding openings and gaining acceptance rapidly.

So just who is stopping you from managing your diabetes? Is it family members? How I dislike saying yes, but family members can be the worst in preventing good diabetes management. Why would I say this about loving family members? Well, loving family members can be the least understanding and the most unwilling to learn about diabetes. They just want you to take a pill and return to the life you had with them before diabetes.

Many family members could care less about diabetes because you do not look sick and are doing the same things for them that you were doing before diabetes. Even your loving spouse can totally ignore diabetes and not want to learn about it. Why would I say these things? Because I read about this on many diabetes forums. Husbands or wives not supporting the spouse with diabetes.

Then the family members can be very irritating when they become the diabetes food police or the diabetes police. Asking you why you can still eat that piece of candy or cake when it is loaded with sugar. Even though you have allowed for this treat and compensated for it with what you have eaten, they will still not leave the subject alone. They don't understand that sugar is not the only thing you need to be careful of consuming.

They do not understand why you will not eat many foods and have very small servings of others. They start hearing horror from well meaning friends and translate this to fear about you developing the same problems. They become your worst nightmare as the diabetes police and some can become very belligerent in their actions.

Then there are those family members that will just not cooperate. You have gotten rid of the junk food and are working to convert everyone to more healthy foods and doing more cooking and serving more fresh foods. They insist on eating no differently than the past and won't accept the change like they won't accept that you have diabetes.

There are families that do support each other and do whatever they can do to make things easier. They know and accept the change in foods and understand that things are now different and they are benefiting as well by the changes being made. This makes for a much more loving family and home. If you are so blessed, do everything to keep this blessing and make it grow.

Now back to you! Yes, I am talking about the person with diabetes. No, I'm not going to give you a pass. We have all been through the stages of grief many people experience after receiving the diagnosis of diabetes. So get over the anger, put the denial behind you and make up your mind that you want to live and manage diabetes.

Learn that diabetes is not your fault. Could you have prevented it? Not likely. If doctors would have done screening on a regular basis, maybe, if they had paid attention to the results. The one chance you had may have passed. But if you are strong willed and decide, if you are medically able, to do the exercise and nutrition with enthusiasm, you may be capable to getting off medications for a period of time. This will depend on the damage already done to your pancreas. Some are able to stay off medications for decades while others only for a few years.

Many people do not comprehend that because diabetes is often different for each person, that they now have become their own science experiment. Testing can be very difficult as Medicare and most medical insurance companies are strictly limiting test strips that they will reimburse. Testing is necessary to determine how your body reacts to different foods. Testing is also necessary to give you a report on how you are managing diabetes. Numbers are just numbers if you don't make use of them.

Good luck and learn to manage your diabetes, deal with those around you, learn to make the best use of your doctor(s), and other resources.

Suggestions for Doctors

Yes, some doctors do accept suggestions. I hope that these make sense and will help them help patients with diabetes. I urge doctors to visit this page of the Association of Clinical Endocrinologists and at least give this as a handout to their patients with diabetes. Even family members could benefit if they are receptive. While this page has existed since September 27, 2011, their experts have not seen fit to add more websites to the list. Why? That I cannot answer, but I think they have decided to stop rather than promote more sites. Note: The above link no longer exists because AACE could not do what was necessary.

Certainly many doctors do use the Internet, and have their favorites for diabetes that they could add to this list. Some doctors do have contact with nutritionists and could have a handout for this as well. A very small number of doctors are making use of peer mentors in some locations to be mentors for certain aspects of diabetes, like proper hand washing and testing locations and even use of their meters. There may be other areas of use.

Series 7 of 12

Tackling Diabetes Care Challenges

Another “Expert Group” for diabetes is not something that gives me a lot of hope. Again, they do not include any people from the patient side. Granted there are not a lot of experts these professionals would classify as patient experts.

The name of the program is called “Improving Quality in Type 2 Diabetes: A national Initiative to Assess Guideline Adherence and Physician/Pharmacist Coordination.” This is part of a U.S. multiphase initiative that is setting out to assess the effects of current in-practice behavior across multidisciplinary professions in caring for patients with type 2 diabetes. Sounds impressive, but will this really assist patients?

I always get a sickening feeling when I read things like this as I wonder what other limits are going to be imposed on those of us with type 2 diabetes. Is this another program to declare that type 2 patients on oral medications do not need to spend time testing? Or, will someone finally realize that the physicians are not doing their duty of educating patients on the value and meaning of self-monitoring of blood glucose (SMBG).

This is always a possibility and should be high on the priorities for any expert group, but will it? “The aims of the program are:

• To reveal practice-specific obstacles of appropriate glycemic control in primary care and endocrinology in multiple locations and practice environments across the U.S.
• To assess current pharmacist practices in terms of medication education and patient monitoring of those with type 2 diabetes, and
• To determine the critical factors of successful interdisciplinary diabetes care by considering the behaviors and attitudes of physicians, staff, pharmacists and patients.”

Notice that the only mention of patients is in the last point above. Everything else is dedicated to practice level discussion. How will they determine the behaviors and attitudes of patients? Will this be just another adhering or non-adhering discussion about the patients? Or, will they actually consider the feelings and problems patients encounter in lack of diabetes education, continuing support and updated education, and the benefits of continuing education to assist the patients?

As a patient, I can only suspect that it will be more of the same lack of concern for the welfare of the patient and no thought about the lack of education provided. This will leave patients out in the cold and the “medical professionals” patting themselves of the back for again claiming to have improved life for the patient.

Until the professionals change their thought process and include patients with type 2 diabetes in any discussion, nothing will change from a patient perspective. No education will be provided to the patient, SMBG will continue to be downgraded, and patients will continue to wonder where to get reliable information and help in their management of diabetes.

Six Ways to Help Manage Type 2 Diabetes – P2

Error 2 - Expecting Too Much Too Soon

To manage diabetes effectively, learn to set realistic goals. If goals are set that are overly ambitious, very few people will be able to achieve them. This is in fact the problem for many people – not setting realistic and achievable goals. Do not set yourself up for failure. Learn to take one step at a time and have success along the way.

Just remember that it has taken you years to develop diabetes and you will not manage diabetes overnight. This is where you need to use your meter to help you decide on the foods and quantity of food that your body can tolerate without aggravating diabetes. What? Your doctor did not authorize or prescribe a meter and test strips for you? Time for you to march into the doctor's office and ask for one. Politely at first, but if the doctor hesitates or refuses, then insist on a prescription. If you still do not obtain a prescription – I strongly urge you to consider, if you are able, to find a different doctor. If you are in a rural area with few doctors, you may need to resort to other tactics to obtain a meter and test strips, but you do need them.

Because we are fighting an uphill battle with our medical insurance companies that are determined to limit our testing, many people become discouraged and stop testing because of the cost. If you are able and can afford additional test strips, by all means the first several months, do regular testing to determine how foods and exercise affect your body. Learn how to negotiate with your insurance company to get the strips needed. Read this blog for testing procedures and long term goals.

Most people with Type 2 diabetes are started on oral medications. These may take a week or two to become effective and you need to be aware of this. Some oral medications also have side-effects when first taken that may make you want to stop. I am talking about Metformin. If the doctor prescribes this, ask if this is the regular or extended release version. Many people will not have loose bowels with the extended release and when taken with food.

If you are just starting to exercise, talk to your doctor to see that there are not problems you need to be aware of and make sure not to over exert yourself when starting an exercise regimen. Start slowly and increase the activity as you body and muscles become accustomed to the added activity.

A good blogger to follow if you have your heart set on managing diabetes with diet and exercise is this one by Tom Ross. Even if you are started on medications, talk to your doctor and ask questions about when you can consider stopping the medications. If your A1c's are at the right levels and the doctor can see that you are serious, he may encourage you and let you know when is may be safe. It is often an advantage to start on medications to get the management of diabetes accomplished early.

Also be aware that you can make mistakes. Learn from them and return to good management. This can happen to anyone at any time so just realize this and get back to management immediately.

Exercise – The Key to Managing Diabetes

I have said this before and will say it again – exercise. I have learned a few morsels to this in the last few years. Some have even told me to get lost as they are not medically able to exercise. Oh, really. A neighbor just reminded me of how false this is, except for a person that is a quadriplegic and others having some types of back injuries. Even another with a prosthetic limb said exercise is encouraged.

A neighbor is confined to a wheelchair with Type 2 diabetes and still exercises. He works very hard lifting five and ten pound or higher weights and once the snow is gone, I will see him out wheeling himself around several blocks in his wheelchair. He lost the use of his legs in an auto accident several years ago and has worked very diligently to build his muscles in his arms and body. He had an operation on one leg this winter and doctors are now hopeful that he may regain partial use of his left leg.

He has talked about this with me and he hopes that his right leg will be operated on next winter, and is hoping that the new procedure will give him full use. He did qualify for a powered chair, and has one for longer trips to the grocery store and other places, but he seldom uses it as he wants the exercise. I have seen him twice this winter and the second time he was standing on his left leg. Even that was an effort, but he wanted to show me the progress. The leg is still very stiff and it is difficult to stand on for lengthy periods, but he is working the leg and has a therapist in three days a week working with him.

So for my more sedentary friends, exercise generally is possible and for many people will require a doctors permission and developing a regimen with the doctors approval. Even lifting small weights can do good things for blood glucose control.

The main key is finding a type of exercise you enjoy and doing it can help. Many think running or jogging is the only exercise for them and if that works – great. Others have found that swimming is good for them and is something that they can do year round even here in the Midwest because the indoor pools are open. Others must use exercise equipment and if they do – good for them.

The idea is to be doing something that you enjoy, can do three to seven days a week and at varying times. Walking is always good for those that can't run or jog. Your management of diabetes will improve and you will not need to rely solely on nutrition (diet) to manage your blood glucose levels. Plus, if you want to reduce your chances of developing the complications of diabetes, exercise is an excellent tool.

I have to end this with an observation about what many people with diabetes seem to think is important. On one of the forums I participate on occasionally, one member was mourning the lost of carbs. In the responses to this, exercise was never mentioned. There were some excellent suggestions about cutting carbs and finding substitutes, but I am also surprised at the lack of nutritional advice as well.

This is an area of weakness in most forums and not just diabetes forums. A few forums have members that practice what they preach and will mention exercise without hesitation while others very seldom even think of exercise.

Most forums would be well advised to have a broad range of medical professionals, dietitians and nutritionists, and people that know exercise available to offer advice and answer questions.