Help in Diabetes Management Education – Part 9

Part 9 of 12

Exercise can be a contentious topic for some people. I agree because too often the doctor or other healthcare professional just orders exercise and suggests walking or jogging. I even become upset when they do this to me and I ask them if they have heard of weight lifting, dancing, swimming, or other types of exercise.

I ask if aerobics is not considered exercise or if because it is recommended to do some resistance exercise with aerobics that they don't consider this exercise. I sort of get in their face and ask why they only consider walking and jogging as exercise. Do they even know that the person is capable of jogging or the area in which they can walk is even safe? I then ask if they know that the person will enjoy walking or jogging and why they do not recommend the period of time for walking and jogging.

I am probably the last person they want talking about this, as they know now that I just don't let it go. One doctor asked me to write something up for his office to use. I was a fool for not making copies of what I wrote for him more than three decades ago. I did a lot of research and talked to several people in the business side of training people and those that supplied different equipment. It amounted to more than 15 typed and double spaced pages. I thought all had been lost when the doctor died about 13 years ago, until last month when another patient of his asked me one day if I knew of a paper on exercise written by a person with the same name.

I asked him which doctor he had received it from and when he said the doctor's name, I asked if I could get a copy of it. I now have a copy and it is what I had written with a few notes and other references added. Now I can rewrite it and keep it.

An important part of any exercise regimen is doing something you enjoy, as this will help you maintain it. Please read this by Tom Ross. This is not his normal place for exercise, but he makes use of it.

When it comes to changes in lifestyles, my blog about components of lifestyle changes is a good blog to read. This will vary from person to person as not everyone will need to change every component, but others will need to change many of the components,  This blog may also help. The last blog is also about lifestyle changes, but emphasizes lifestyle changes over medications, which is refreshing.

Food plan changes and exercise seem to be the changes most often emphasized. I do believe that these are necessary, but there are other changes that can help as well. Please be careful with stress, as this is one of the most damaging and can cause any food plan to blow up and cause weight gain and make diabetes more difficult to manage.

Stress in managing your diabetes can be very upsetting for some. Another term for this is burnout as you are the only person in charge of managing your diabetes. Yes, your doctor can give your tips and advice, but in the 15 minutes that you see him or her, this will not be a lot of help. Consider that about half an hour or an hour out of the year, that you see the doctor, the responsibility rests on you, the person with diabetes.

This can cause stress and even depression. This needs to be recognized and if you have family, they can help reduce the stress by supporting you. Unfortunately, they can also increase stress. Exercise can reduce and possibly eliminate much stress.

Sleep Apnea Lifestyle and Home Therapies

I know this is a favorite way for many sleep apnea suffers to avoid facing their problem. The only reason I am even blogging about this is that if does work for some people that have mild sleep apnea. A few people with moderate sleep apnea may receive relief. If you have severe sleep apnea, get into your doctor immediately as you are at high risk for a heart attack or even a stroke.

In some cases, self-care may be the most appropriate way for you to deal with sleep apnea and possibly central sleep apnea. Try these tips:

Lose excess weight. Even a small loss in excess weight may help relieve constriction of your throat. Sleep apnea may be cured in some cases by a return to a healthy or ideal weight. If you don't already have a weight-loss program, talk to your doctor about the best course of action for weight loss.

Exercise. Getting 30 minutes of moderate activity, such as a brisk walk, most days of the week may help ease obstructive sleep apnea symptoms.

Avoid alcohol and certain medications such as tranquilizers and sleeping pills. These relax the muscles in the back of your throat, interfering with breathing.

Sleep on your side or abdomen rather than on your back. Sleeping on your back can cause your tongue and soft palate to rest against the back of your throat and block your airway. To prevent sleeping on your back, try sewing a tennis ball in the back of your pajama top.

Keep your nasal passages open at night. Use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using any nasal decongestants or antihistamines because these medications are generally recommended only for short-term use.

Stop smoking, if you're a smoker. Smoking worsens obstructive sleep apnea.

Talk to your doctor about facial and throat exercises. There are some facial and throat and jaw exercises that may strengthen the muscles to prevent them from closing when sleeping. This is no guarantee, but I have a friend with moderate sleep apnea that has been through the sleep lab and sleep apnea was confirmed. I don't know who he talked with, but the day after his sleep lab, he started exercising and did this for two months. His wife was surprised that he was not snoring and felt he was no longer having apneas. Another sleep lab six months latter showed he was normal and this time he was only tested for sleep apnea and no other sleep disorders. The other fact was that he was already at normal or ideal weight.

Please, please do not think that you can tough it out and severe sleep apnea can kill you. Do it for your loved ones so that you can live with them and they with you.

Lifestyle Changes More Important Than Medications

This blog from the Center for Advancing Health (CFAH) is written by a person that attended the Diabetes + Innovation 2013 conference. I found her blog most interesting and while I am generally not able to attend such conferences, there are many thoughts she put forward that I have known and thus am not surprised. The following are lifted from that blog:

#1. Diabetes management falls squarely on the patients' shoulders. While many patients with diabetes feel that they should be receiving more information from their doctors, time does not allow for this. People with type 2 diabetes on oral medications often see their doctors at most two times a year. This will vary by the level of their HbA1c, but often depends on the doctor. The better managed their diabetes is, the less time their doctor will want to see them. Many patients managing diabetes with nutrition and exercise will not see their doctors but once a year once they have proven they can do this.

#2. The responsibilities and tasks of diabetes management can seem overwhelming. The fact that there is no vacation from diabetes can cause this and leave patients feeling alone and otherwise isolated. This is one reason our diabetes support group works so well and we enjoy each other's input. If you are feeling isolated, search out a support group in your community. Or if needed consider organizing a diabetes support group.

The following are three patient themes highlighted by Milly Dawson, the blog author:

#3. The main caregiver for a person with diabetes or prediabetes is himself or herself.

Diabetes prevention and treatment efforts should make it easier for people to make choices, but not in isolation, but within families and communities. The goal should be to make good choices about food and exercise. This “default choice” involves healthy eating at work and at home. It also means finding the right exercise regimen that the person can accomplish and enjoys on a daily basis.

#4. Behavior or lifestyle changes should be the first in treatment plans. Review the lifestyle changes from my blog – components of lifestyle change. Be sure to include weight loss if needed. Many of the lifestyle changes also reduce a person's risk of heart disease, cancer, mental illness, severe depression, and other health issues.

#5. People often have a hard time changing habits. To succeed, people often need other support besides doctors. Again, a support group, family, and community support may be needed. Do not forget caregivers, social workers, nutritionists, health coaches, and even peers, trained or untrained, online connections, and social media.

Presently, primary care physicians (PCPs) are not in a position to give the needed assistance. Often your time with a PCP is very limited and your insurance carrier generally is of no help.

The blog author rightly emphasizes food and exercise over medications. The American Diabetes Association and the American Association of Clinical Endocrinologists do not and push oral medications heavily, even before insulin. Food and the right food plan is critical in the management of diabetes.

Back to Diabetes Basics – Part 6

Exercise Is a Key in Diabetes Management

Maybe some of us emphasize this too much and too often, but it is one truth that many people with diabetes just feel they can ignore. You will get tired of this as well; many type 2 people just say, “Apparently the doctor did not feel it was important as he/she did not talk about it.” I am beginning to believe these people need a hearing test, but I do know a few doctors that are afraid to say anything also. This is a deadly set of circumstances to work with in attempting to get people to exercise.

Always consult with your doctor before beginning any exercise regimen. If you are on medications, your doctor may want to give you different dosages to use under different circumstances to prevent hypoglycemia. Even if you are not on medications, the doctor may have other health concerns that you may need to consider. I have discussed blood glucose levels for safe exercising in my blog here. Knowing this information will save you from problems while you exercise.

I have more information about how a neighbor made me realize how important exercise is. He has had the second operation and is walking with a cane today. He is still unable to drive, but he walks just about everywhere and will not accept a ride. Yes, I have driven when he has too far to walk or needs to travel to another town. Even when he needs groceries, he walks and shops for only what he can carry. You have to admire him for his determination. If anyone could have given up, he could have been the person, but he has met every opportunity to educate others and show them what a person can do.

Lifestyle Changes

Do you know what this means? Many people have some idea, but it can be very general. This may be just semantics; however, I would like to clarify some parts of the term “lifestyle”. The definition from an on line dictionary says lifestyle is a way of life, the attitudes, tastes, moral standards, economic level, etc., that comprise an individual or group.

This of course says nothing about diabetes and managing diabetes. In my reading, blogging, and participation in a few diabetes forums, I have seen lifestyle described many ways. I have a slightly different perspective as most writers start with diet. I believe the elements of lifestyle change should start with exercise if you are physically and medically able. It is the key that generally makes the rest of lifestyle fall into place.

What you need to recognize is that all are interlinked and bypassing one part of lifestyle change will normally make other changes generally unachievable. What different writers choose of emphasize depends on their philosophy and how they view their career. Most that work in the medical profession, be they doctors, nurses, educators, dietitians, or licensed caregivers, must follow the guidelines of the American Medical Association, the American Diabetes Association, and other professional medical groups if they want to have their license updated and current.

Since I answer to myself and a few bloggers that agree exercise should be listed first, this is where I will start. This is the list I have pulled together from various sources. It may not agree with everyone's list, but for me, the list needs to be updated as changes are found that affect the way we look at diabetes and lifestyle.

The main elements of lifestyle should or must include the following: exercise, food, sleep, food, medication, weight loss, illness, hormones, stress, heart health care, and two other elements, alcohol and smoking.

Exercise – If you are physically and medically able, get your doctors okay to exercise, and remember to exercise good judgment and don't do something that will be wrong and cause injury. Start out slowly and build up gradually. Regular exercise helps make insulin more readily available and reduces insulin resistance. Find a form of exercise or a mix of routines that you enjoy and follow through with it.

Food – Healthy eating is important and even more important if you are medically unable to exercise. It is good to be consistent in eating times and amount of food. Whether you eat low carb or another way, learn to use your meter to determine how different foods affect your blood glucose. Learn to coordinate your food with the medication you are taking. Also, learn to eat to your meter and learn to trust it.

Sleep – Where did this come from? It is not included on most lists, but should be after a study I wrote about here. I keep being surprised how important sleep is to our well-being as a person with diabetes. That is the main reason I am adding it to lifestyle and encouraging all to get the sleep needed. If you are having trouble getting enough sleep, change your habits and if that does not help, talk to your doctor about doing a sleep study to determine if you have a form of sleep apnea.

Medication – Be sure that you follow the doctor’s instructions. Yes, I know that you want to avoid all medications. This is an excellent goal if you are diagnosed early on and can make this work. Remember that you need to consider getting the diabetes managed as soon as reasonably possible. Do discuss with the doctor getting off medications if you do it. If you do bring diabetes under good management and the doctor wants to keep you on medications, then ask yourself if a change in doctors needs to be considered.

Heart health care – Because people with diabetes are at 50 percent risk of having cardiovascular events, many of the same changes for diabetes help with heart health. It may still be necessary to consider medications for heart health. Exercise and food choices become primary for heart care and managing cholesterol and hypertension.

Weight loss – This is easy for some people, while others struggle with this every day. The first goal should be stopping gaining any weight. Then adapt your food intake to help start reducing weight. Generally if you are overweight, a high carbohydtate, low fat diet will not help you reduce weight. There are more and more writing about low carb, high fat. However, you need to find what works for you in assisting to bring down the weight. I will not suggest how, since I am still working on this myself.

Illness – This was a little surprising until I thought about how illness affects our diabetes management. Therefore, as an element of lifestyle change we need to learn to take our medications timely and know when to talk to the doctor about variations like illness which can cause problems unless we know not to take certain medication to prevent hypoglycemia. This means having a plan with your health care team of what medications to take or not take during an illness.

Hormone levels – This is normally for women who have problems with blood glucose swings related to the monthly menstrual cycle. I personally think the authors failed to talk about the change in life for women and problems some men can have when male hormones cause problems and can affect blood glucose as well. You need to talk about this with your doctor to be prepared for these changes.

Stress – This is definitely a lifestyle change that affects everyone with diabetes. When stressed, almost anyone can toss aside their usual good diabetes management practices, forget to eat healthy foods, and lose control of your blood glucose. Prolonged stress may prevent insulin from working properly which also creates additional problems. Some find logging your stress level (1 to 10 scale) each time you log your blood glucose level helps them see patterns and allow you to adjust accordingly. Learn about ways to relax and find ways to reduce stress.

Alcohol – This can be a bad one if not thought out. First, you need to talk this over with your doctor. Alcohol can aggravate diabetes complications like nerve damage and eye disease. If your diabetes management is excellent, and the doctor agrees, an occasional alcohol drink with a meal may be okay, but a daily drink is generally discouraged.

Smoking - This is a habit that must be broken. Many writers do not want to cover this lifestyle change that needs to happen and the sooner the better. Not only does this increase the effects of neuropathy, but it can affect an increase in cardiovascular risks. Do not take this lightly; the effects of continuing to smoke do not make blood glucose management easier.

To sum up, these are the lifestyle changes that need attention for those of us with diabetes.

Series 6 of 12

Surprise, Statins Not Shoved at Us!

This is a pleasant surprise, at the least the part of not having statins shoved at us. I am surprised that this study was allowed to go forward or even be published since statins are not mentioned. It is going to be very interesting to see how long this study stays posted before people are asking that it be pulled because statins are not mentioned or recommended.

Now, to the study, which says patients have time to learn lifestyle changes before drugs may become necessary. This is for people diagnosed with diabetes and hypertension. It could have included prediabetes and should include this. The savings for cost analysis would have been greater and possibly easier for the patients to adjust their lifestyles.

While the study mentions diabetes, it on the control of high blood pressure as the key for the time allowed before medications are needed. Yes, some people are able to manage diabetes without medications and this should be the goal for all patients. Some may need medication assistance until lifestyle changes are made to prevent potential complications from developing, but the goal should be to get off medications if possible.

This study is important as it shows there is a potential window available without severe consequences for people to adopt lifestyle changes to reduce the effects of hypertension before high blood pressure medications are necessary. To quote the study statement, “The consequences of delaying effective hypertension treatment for up to a year were small - a two-day reduction in quality-adjusted life expectancy - according to a study by University of Chicago researchers published online for the Journal of General Internal Medicine. But as the delay gets longer, the damages multiply. A ten-year delay decreased life expectancy by almost five months.”

While no mention is made about cholesterol and statins, this can be a good thing as too often this is an automatic thing for doctors to prescribe especially when diabetes and hypertension exist in the same patient. If lifestyle changes can be accomplished within one year, then it should also be possible to avoid the need for statins as the cholesterol readings generally follow the blood pressure readings brought on by lifestyle changes.

The study also emphasized the importance of working with the patients to learn how to make the lifestyle changes and receive the support for making them. The American Diabetes Association (ADA) recommends only allowing a three-month trial of medication-free lifestyle therapy for patients with moderately elevated hypertension. This is a good reason for doctors to know of this study and allow the patients up to a year for making the lifestyle changes.

“This study argues that caregivers should work with patients to help them gain the knowledge and develop the necessary skills gradually rather than rushing to drug treatment, especially if their blood pressure is only mildly elevated. It suggests that patients and providers "have more time," the authors write, "at least up to one year, to focus on diabetes self-management and lifestyle modification."”

The ideas put forth from this study are needed, but I would agree that sometimes it might be necessary for medications to be used when the test results are in excess of the upper limits. Patient safety should be exercised to bring diabetes and hypertension under good management while the patient is taught how to use and manage lifestyles changes to the fullest.

Making Changes in Managing Diabetes

Changes – life is full of changes and we need to know how to make them for the improvement of our health. This blog from the Mayo Clinic makes some excellent suggestions and will hopefully start you on the right path to change. I know it is helping me, but I still need to make more changes.

First they lay out three steps or fundamentals in making changes and then walk you through the steps.

The first step is the unfreezing step. In other words becoming used to the new idea or change needed and motivating yourself to make the change. In diabetes, this involves or can involve many ideas and some motivators. The diagnosis itself can be a huge motivator. Then later an increase in A1c can become a change motivator. A great motivator for me was my doctor asking me what I could do to make a change and did I want his help. It took some discussion, but after he had laid out some possible changes, I was able to select two for starters and discuss them with him.

Others can realize that changes are needed when family members ask the right questions and we realize the current path is not working and that staying the course will not make the situation get better. When you realize a change is necessary, the mind over matter mental game needs a resolution. Real or imagined anxieties can get in the way of making the change.

The second step in making the change. This step involves deciding on what changes need to occur. This is when laying out the pros and cons on paper can often show you what needs changing and sometimes can become a boost in making the change. Other activities may also help. This can include may of the following. Choosing the specific change or changes you want to work on changing. Please be realistic and avoid trying to change everything.

Write the change or changes down and post it where you will see it every day. This can be your daily reminder of what you need to accomplish. If you have others (family members or significant other) available, ask for their help and encouragement. If necessary find a support group to assist you. See you diabetes health care team on a regular basis. Track you test results and work to keep the test results where they belong or improving.

The third and last step is making this change permanent or freezing the behavioral change. While this may be the most difficult step, it does need to become a habit and something you can do automatically. Succeeding here makes you a better person, dedicated and living for better health.

Once this is accomplished, repeat the steps for the next change or changes. There is nothing better than having success to make you want to do more changes. But often it takes doing them one or two changes at a time.

Have success and live healthy!

Six Ways to Help Manage Type 2 Diabetes – P3

Error 3 - Going it Alone

In your efforts to manage diabetes, try to include those around you. If you live alone, this may be slightly more difficult, but find a friend or a buddy to assist you where possible. Others may have spouses, partners, or family members to assist in staying focused and on target with goals. While some are capable and have the ability to do some things alone, others need encouragement and support for achieving goals.

If you can afford a membership in a local YMCA or YWCA, often others that are members may be able to assist you with exercise routines and schedules. An exercise club may work for others. If you need a buddy, maybe someone from work can assist you and exercise with you.

If you are alone in life, there may be someone from your support group that you can find willing to assist in helping you keep on track and achieving your goals. I am aware of one individual that is a regular in her church and has a couple of them helping and checking on her. One exercises with her and another checks in with her on a daily basis. So don't become discouraged as often there can be someone without diabetes that is willing and looking for someone to do activities with.

There are diabetes forums online that can help with weight loss, daily record keeping and just being online for assistance. Do not forget your doctor as this person may have suggestions that may be just what is needed to get and keep you successful in your management of diabetes.

There are some individuals that can manage alone and do very well. It takes tenacity and perseverance, but some individuals exceed in these circumstances. Some individuals do not have the support and understanding of family members and must start out alone. Talk with family members and ask for their help. Sometimes it just takes the asking and you will receive help.

As you become more confident with meals and what foods do not elevate your blood glucose, if your are the cook, slowly start to change the meal plan for the entire family. This can be successful if done slowly and sometimes can be accomplished with talking to family members. If you have a spouse (and/or other family members) that accept that you need to change lifestyle habits and wants to change with you, then you are blessed. Do thank them and discuss the changes needed.

Diabetes Bariatric Surgery – Is It Effective?

Why are bariatric surgeons becoming so active in the diabetes field? Quite simply, primary care physicians and endocrinologists have abdicated their position. Sound a little dire? It might, but considering that these doctors are not rising to the challenge of taking care of and getting people out of the moderate to mildly obese categories. The bariatric surgeons are stepping in to the void to increase the thickness of their wallets and retirement plans.

As long as no one is explaining the side-effects and hyping the benefits, these surgeons will be happy to fatten their wallets and retirement accounts at the expense of other doctors, patients, and medical insurance companies. Is there a need for this surgery? While I don't like to say so, yes, there is a need. For those individuals that have tried and failed, e.g., exhausted with honest efforts other ways to reduce weight, and are among the morbidly obese, then the surgery is probably the only route available to them for weight reduction and possible management of diabetes.

Am I opposed to bariatric surgery. YES, except for the case above, I think the bariatric surgeons are into the vanity game for many people. I am thankful that the American Heart Association has taken a position in this and I can agree with their position. Read the article about this here.

The fees for bariatric surgery are steep and unless you have exceptional medical insurance, you may need to pay a healthy part of the bill. A discussion of medical insurance, Medicare, and Medicaid can be found here. Be sure to study this carefully.

An article by the Mayo Clinic is here. This is one of the better discussions about the different types of bariatric surgery and does list most of the risks involved with the surgery and even some risks by type of surgery. If you are seriously considering bariatric surgery, please read this article in its entirety. The consequences of not following exactly the plan and lifestyle changes can be very costly and even deadly. Most medical insurance companies require that you complete a training period and know each and every risk in detail. Some vary in length, but six weeks seems to be a minimum.

Some surgeons may try to get you past the insurance requirements fearing that you will want to back out of the surgery. So even with this, I strongly urge you to do your homework and know what you will be facing beforehand. Bariatric surgery is not for everyone so don't feel that you can slide past the requirements for lifestyle changes as they are mandatory and you will have problems if you ignore them. These lifestyle changes are permanent for the rest of your life which many people cannot accept and this gets them into serious problems.

If you think I am being overly dramatic, use your search engine and do some checking on your own. Also read my blog here about bariatric surgery possibly masking diabetes. Do not think it is the absolute cure the bariatric surgeons want you to believe. There are news articles almost weekly now hyping bariatric surgery and all refuse to discuss the serious risks. Even though I have an agenda against this surgery, I hope that I have pointed you in the right direction to arrive at an informed decision.