Our April Support Group Meeting

Our April meeting on April 11 turned out to be more relaxed than I thought it would be. Jason had received the materials from Brenda and was ready to have the presentation. First, Tim had Brenda's daughter give us an update on Brenda's progress and recovery. Brenda has returned home, but has a full-time nurse and other people coming in during the weekdays for physical therapy and speech therapy. Then Tim introduced the new person, Joyce and asked for a vote for membership. The voice vote was unanimous and Jason was given the floor.

Learning how to interpret blood glucose readings is the topic and Jason felt with what he and Brenda had prepared before the heart problem, we should understand more about our food intake or reducing foods or eliminating some foods from our menu. Jason continued that by using the health logs to adjust medications if the doctor allowed or recommended this for certain illnesses, it should be possible if we understand our blood glucose readings.

Tim brought up the first slide which explained the necessity of testing before a meal and testing at various times after the meal. The before meal test (preprandial test) should be determined by the type of medication being taken. Oral medications can vary on how quickly the medication takes effect and the same applies to insulin.

The after meal test is more variable and depends on the medication, the individual, and the food consumed. Only testing will help you decide the best time to test postprandial. Jason said his best time is about 2 hours after last bite and I know that several of you test about 90 minutes after first bite and a few test at 90 minutes after last bite. Others test a one hour after first or last bite. All times are fine and only you can determine this from tests. The one warning Jason stated is being consistent with first or last bite.

Jason then said that he tested every 15 minutes after last bite to determine when he had the highest blood glucose reading and stopped when he had the reading start down. Jason said to do this with several different meals and many different food combinations. Most were all near 2 hours when his blood glucose levels peaked.

Jason said that without the twin tests, preprandial and postprandial, one reading is worthless as it does not tell you what the increase in blood glucose levels are and you will not know what foods or food combinations may be causing the spike in blood glucose levels.

Then Jason asked if we wanted him to cover hypoglycemia and hyperglycemia since Bob has written about both? Only one person said he would still want it talked about. Tim asked if the resources I had used were part of what Brenda and Jason had prepared. Jason answered that I have been part of the discussion and much of what I had written was from the same sources.

Jason said several of what they had came from my blogs and they had borrowed the book that I used. Gale asked to speak and said she would like to work with the person that wanted Jason to cover the topics as she felt that if she could get their notes and use my blogs, she could explain it to her. The person said she would accept that, as she was the only one that felt there was something she missed and at the same time did not want to hold the group back.

Tim asked Jason and me if we would supply information and answer questions Gale had that would help. Both of us said we were available by email or telephone to assist if needed. Our newest member, Joyce, who had joined that evening, asked if she could participate since she was not aware of what had been covered in my blogs. She admitted that she did not understand the terms other that she was guessing that one was about having lows and the other about having highs from something the doctor had talked about when she was still in shock from her diagnosis.

Gale agreed and thanked her for speaking up. Tim asked if anyone else would want to do this. No one spoke up and Tim asked Stan, who had joined the previous meeting, if he was having any problems. Stan said that my blogs were what he needed and had read many of them. He continued that the blogs on the complications were what he needed and he was asking me questions that he had, and I was helping him gain confidence in researching different topics.

With that, Tim ended the meeting. Several people gathered around Gale and Tim decided to let that happen. I was ready to leave and several of us headed home.

Two Topics for Our January Meeting – Part 2

Next Tim introduced Brenda and Jason for their program on diabetes self-management. Brenda started out by saying you have had a portion of self-care and Jason and I will introduce you to more on self-care. In preparing for this portion, we did not anticipate all the parts involved in diabetes self-management. Therefore, more will be included in future meetings.

Brenda thanked Rose for getting this topic started. She then explained that most of the old members have discussed this in the past and would be available to answer questions after the meeting. Then she turned to me and said that they had developed their own slides and if they missed something, let them know so they could add it for future meetings.

She asked Tim to put up the first slide. It included the following:

• Blood glucose testing
• Proper care of testing supplies
• Maintaining blood glucose logs, food logs, health logs
• Keeping a medications list to include RX number, Medication common name and brand name, dose size, recommended time for taking medication, and when exceptions may be allowed, plus RX expiration date
• Understanding hyperglycemia and hypoglycemia and steps to manage them
• Learning how to interpret blood glucose readings and how they should guide food intake or reducing foods or eliminating some foods. Also using the health logs to adjust medications if recommended.
• Developing your food plan
• Counting Carbohydrates
• Self examination of your body for sores especially your feet
• Establishing an exercise regimen you can adhere to and enjoy
• Changing the lifestyles necessary to help manage diabetes
• Self-management education does work for the elderly (over 60 years of age)
• Lessons in self-monitoring of blood glucose (SMBG)
• Learning how to self-manage diabetes
• Setting realistic goals and even considering getting off all medications
• Being tested for vitamin and mineral deficiencies
• Travel with type 2 diabetes
• Handling sick days
• Problem solving skills

Next Jason handed out examples of logs and an example of a medications list/log. Brenda covered each log briefly and Jason covered the medications list/log. Brenda had borrowed my book that covered hyperglycemia and hypoglycemia and had several slides showing what the symptoms could be and how to treat each. She and Sue had developed a list for those on oral medications and a list for those on insulin.

Brenda said that Jason had some questions they should answer.

Jason said yes, and asked for a show of hands among the new members that were having some foot pain, like something of a thousand pins sticking them or a burning feeling. Including Julie and Earl, six others raised their hands. Jason said this indicates something important. This means that you need to be tested for vitamin B12 and vitamin D deficiency. The neuropathy pain that you are experiencing is often related to these deficiencies. This caused another of the new members using the VA to speak up and he asked if that was why his VA doctor had prescribed vitamin B12. Julie answered yes and said this is what happened at her appointment. Julie added that her deficiency was severe enough to require shots and a supplement. Brenda had Tim put up the next slide. She said we learned about this the hard way when Allen required shots for Vitamin B12 and Vitamin D3. Several were surprised that we were recommending vitamin D3. Tim put the last slide up from my blog and the discussion really started. The slide included the foods rich in vitamin B12 and the statement that many people with diabetes do lose the ability properly to utilize this form of vitamin B12.

The questions and discussion lasted for another hour and the older members were very active answering questions of the new members. As we ended the meeting, Tim received a call that the member, Albert had passed. Tim called on Allen to explain the circumstances surrounding his hospitalization and death. Allen said that he was not storing his meter and test strips properly and most had become damaged in the way he stored them and he had gone into hyperglycemia and then into a coma. He said that he had visited with Albert several times and attempted to have him store his testing equipment more carefully, but with no success. He had an episode of hypoglycemia on fourth of this month putting him in the hospital. Even that had not got his attention. On Friday he had been admitted to the hospital a second time and this time in a coma because he had not kept a watch on what he was eating and had stopped testing.

Tim could see Allen start to waiver and finished by saying that the long-term members were concerned about our newer members. Tim concluded that before anyone else has this happen, please speak up, as we were there to help, and would do whatever we can do individually or as a group to help them avoid what happened to Albert. Tim asked if everyone had emails for all the members and he would send this with phone numbers to anyone wishing another copy. The meeting was over, but everyone stayed for about a half-hour, asking questions and this surprised and pleased those of us that had been in the group for a longer time.

Two Topics for Our January Meeting – Part 1

Our January meeting was different from many of our meetings. Two members were unable to attend because of other commitments. Another member that was absent we could understand, as he was in the hospital and we could understand why, as he was in a diabetic coma because of extreme high blood glucose. His prognosis was questionable and the doctors were not optimistic about his recovery. Another member was at the hospital to alert us if anything happened.

Tim called the meeting to order and introduced Barry and A.J for the program on testing and storing the testing supplies correctly. Barry said he was feeling good about having slides for the meters and test strips used by all but one of the members. We discussed the different temperature ranges that the different meters could be stored or used in and many were surprised that the ranges varied as they did. The meters used by those in the VA system had the greatest range by a few degrees and the two meters sold by Walmart had the next temperature range. The ones supplied by the Medicare had the narrowest temperature range. The fourth meter was just above the Medicare specifications. When asked, Barry stated that the last meter statistics would be available later this month.

Then A.J started the slides for the test strips and this generated a lot of questions about storage of the test strips and use in temperatures outside the recommended temperatures. Among the new members, many were shocked and surprised at the directions given. Only one of them said she was using them within the recommended ranges as she had read the directions. A.J covered the errors from my blog here and this caused more questions. A.J said too many people waste test strips and had Tim put up the slide he had developed from my blog here. He stated that if the A1c reading was significantly higher than what the daily readings were, then people were possibly having errors in their test strips.

Barry called for a show of hands on how many on insulin were having episodes of hypoglycemia because they believed their test strips. Five hands were raised and A.J said this could could happen because they did not store their test strips properly. Then A.J emphasized the order for proper testing. Always have all the equipment available and ready to use. Barry emphasized that the case that came with their meter was probably the best for this purpose. A.J said that you should also have your testing log available at the same time.

First, have the lancing device (with new lancet inserted if needed) ready for use. Next, remove a test strip from the container, close the cap on the test strip container, insert the test strip in the slot on the meter, and once the meter reflects the code, pick up the lancing device and prick the side of a finger. Make sure there is enough blood and pick up the meter, slide the test strip slightly into the blood, and let the blood wick into the test strip. In most cases you will have a reading within five seconds. Then he said make sure that you do this out of direct sunlight and you should take less than 30 seconds from taking the test strip out of the container to wicking the blood into the test strip. A.J had me do this with Barry holding a stopwatch and it took me 27 seconds from start to finish.

This generated more questions about having enough blood. A.J said this is why you need to adjust your lancing device to receive enough blood and not forcing more blood out if it can be avoided. A.J stated that forcing blood could cause interstitial fluid out with the blood, which would cause an incorrect reading. Milking the finger is acceptable for slightly more blood. I added that I had used an alcohol pad since no water was available and I had not been handling fruit or food. I asked if anyone had noticed how I held my hand downward until I was ready to push the test strip into the blood. A few nodded their heads and Barry said this is one way to ensure enough blood.

Barry concluded that there are several things that can affect your blood glucose levels. Anemia, gout, a recent blood transfusion, and dialysis can all lead to false readings and affect these and your A1c levels. Also if you are at a high altitude, your blood glucose readings will be affected, as they will when it is very humid or hot.

A.J said we don't want to forget that handling some foods and especially fruit without washing your hands thoroughly with soap and water can create high blood glucose readings that are false. This can be the cause of episodes of hypoglycemia.

Continued in tomorrow's blog.