Why as We Age, Do Doctors Say Raise Your A1C

This seems to be the rule as I age and I have more doctors asking me to raise my HbA1c. When I ask to what level, currently, I am told between 8.0 and 9.0. I am guessing this is because I am on insulin as two others that are on metformin or another oral medication have not been told to raise their A1C.

Allen, who regularly has an A1C below 5.6 percent, has also been advised to raise his A1C, however, he continues to say it will be what it is and I can do no less. He continues to eat very low carb and eats the fats to his satisfaction.

I suspect my A1C will rise because of all the comfort food I have consumed while undergoing the radiation for my prostate cancer. I have not had a PSA test since completing the radiation, but I will have one shortly, as well as the A1c test.

I am beginning to feel better, but other things are creating stress and three good friends are also battling for their lives. These three occupy my thoughts and best wishes are going out to them. I have been reassured by all three that they are not experiencing a lot of pain and one of the three is in an Iowa hospital full time. His daughter is passing information to several of us as she can. The rest of his family is gathering and she says her father is happy to see them.

My friend in North Dakota is ready to be admitted in a hospital, but his family has encouraged him to go to the Memorial Sloan Kettering Cancer Center in New York City. He has resisted so far, but is now considering this as his son has said he will pay for the trip and the family will cover any expense insurance will not cover. They are making calls to Sloan Kettering to see if they will accept him.

Then today, a cousin notified me that another of our relatives has passed. He was killed in an auto accident and it has been proven that the other driver was under the influence and because this is the fourth accident caused by him, at least he is finally being charged and will stand trial.

Stress has been with me the last week as I thought I was healing well after the radiation, but then some of the lining has started to come loose and the pain factor is worse than the pain during radiation. This lasted for 24 hours and I did not get much sleep during this. Now a couple of days later, my system has finally relaxed and I have had two nights of 12 hours of sleep each night. Now to see how much sleep I get for the next two nights.

Ideas to Consider After Diabetes Diagnosis

Many different people have different thoughts about what to do when you are initially diagnosed with type 2 diabetes. I doubt my ideas have not been exposed before, but several in our group have asked me to blog about these ideas. It is surprising the different attitudes we have encountered in the last three years.

Yes, we all have seen anger or something similar. Some have seen shock and self-blame. All these are normal reactions as is denial and many go this route and many in our group have seen this. Tim and I have often questioned why we have seen severe depression when this is not one that we see that often. Yes, later we have all seen quite a bit of depression and mostly mild versions of depression.

A couple of people we know are still in the self-blame stage and have refused to consider anything else even with several of the group working with them and explaining how they are not to blame.

We are always happy when people we are working with accept their diabetes and want to take charge of their health. Much of what we suggest depends on how long it has been since diagnosis and recent A1c results. The longer it has been or the higher the A1cs, the more we work with them to help them learn the basics and find what works for them.

I can understand if you panic about the diagnosis, but try not to make drastic changes before you understand something about diabetes. Find what you can do to manage your diabetes, as often you need to take a step back and learn what you can about diabetes. You need to learn what measures should be taken to manage diabetes, and what will help you prevent the complications.

You will need to break down the complexity of diabetes into easy to understand terms and learn why it is important to get an obtainable HbA1c reading. It is even more important to learn how to do the daily testing and learn how the different foods you consume affect your blood glucose levels. Learn to test in pairs, before you eat and about 2 hours after to discover how the meal affected your blood glucose level.

Most newly-diagnosed people with type 2 diabetes are aware that what we eat and how active we are affects our blood glucose levels. Next, we need to learn how caffeine, stress, and amount of sleep affect our diabetes management. All of this should tell you how important the different logs or journals we maintain can help us with diabetes management. Keeping information about your blood glucose readings, what you ate, when you exercised, and how stressed you were that day can provide clues or trends. Use these to discover what affected your blood glucose readings.

The more you learn about what affects your blood glucose levels, the more accurately you can tailor your diabetes management plan to avoid continual trial and error.

Having support in managing your diabetes can be a great help. Several studies have shown that having some kind of support system, whether it is family, friends, a health coach, or a behavioral health counselor, can greatly improve an individual’s ability to manage their diabetes. If you feel like you could use a boost in support, ask your primary care provider about local support groups where you might find peers who may be able to relate to what you are going through because they have been through it.

Our Diabetes Support Group and Stress

Our February meeting was somewhat different. Tim had taken the topic and assigned different people parts of it to present. Since I was blogging about stress, Tim chose to leave me out since I had provided him with several links and a variety of stress topics. When the meeting started, he stated why some topics had been left out. He had purposely left out the positive stress topics I covered in my blog here. He said no one had asked to have them or felt the need for inclusion. He even stated that several of the other stress topics saying we don't have traffic jams and even when the river overflows, we still have routes to get to the stores for food and other supplies.

No one disagreed with him when he said that the extremely cold weather and frequent snow days were enough of a stress. He asked how many experienced bad batteries because of the cold. Six hands went up, and then he asked how many that worked were unable to get to work. Only one hand remained up. A.J. stated that all of his neighbors had left for work before he needed to leave and as such, he had no way to get to an auto supply to purchase a new battery. He said, he then called his work site and was told that they would be closed for the day.

With that pressure off, he raised the hood and recorded the information on the battery. Next, he called the auto supply store he did business with and asked if they would be making deliveries. They were and he ordered the battery. He paid for it when it arrived and then installed the new battery. The car started and he took the old battery to the auto supply store for credit since it was still under warranty.

Next, Tim put the topic of diabetes stress into discussion. No one disagreed that the daily management of diabetes was without some stress. Allen stated that he is happy with the success he is having with his diabetes management, but that he is worried about burnout. Allen turned to me and asked me how to overcome burnout. I said that a positive attitude is a key to help a person get through. Often people can have depression to go along with burnout. I brought up the book by Dr. William H. Polonsky and that it was a good resource - “Diabetes Burnout: What to Do When You Can't Take It Anymore”. Jason said that he had a copy that he referred to often, but he would loan it to Allen. Max said he had a Kindle version and reread it several times and he said it had helped him avoid burnout.

Brenda said she would be ordering it, now that her granddaughter had been diagnosed with type 1 diabetes. If she found that it would help her family, she would possibly order another copy. Sue then asked what burnout was. She could understand stress and depression, but could not make the link to burnout. Ben said he and Barry had been talking about burnout and was not sure he had the right answer, but they had agreed that burnout was when the repetition becomes frustrating, and the effort of the daily chores becomes overpowering. Stress may help cause burnout or be a contributing factor.

I agreed with Ben and added that even minor depression may be a factor to burnout. Jason agreed and said he believed burnout was all of these and people sometimes are at wit's end or mental resources to deal with diabetes. Rob said he would like to add that burnout can happen even when blood glucose management is going well and people just become tired of doing the same thing day after day. Tim asked Sue if she had a better understanding of burnout. Sue agreed that what we had said helped and her husband said he felt he had a handle on it and would talk about it at home.

Tim then brought up the article from Washington University in St. Louis and we covered what stress can do to the organs listed.

When we discussed what effect stress can have on the pancreas, John said that stress may have been part of the reason he developed diabetes because he was in an extremely stressful job at the time and dealing with his father nearing the end of his life. He admitted that he was not aware of anyone in his family having type 2 diabetes and had wondered why he had developed it. He stated that by leaving his job and having two sisters available to be caregivers to their father had been a big help, but he still did what he could to give the sisters some relief. The job he obtained after leaving the stressful job was actually fun to be at and not stressful.

We had some more discussion about the effects of stress and quickly covered the points in my blog here. When we discussed the use of counseling or psychotherapy, Jason said we could all think that it might not be for us, but stop and think about it. He continued that counseling had saved his marriage shortly after he was diagnosed with type 2 diabetes and now his wife and he are enjoying a stronger and closer marriage. He felt that his diabetes almost cost him his marriage because of the stress of diabetes.

Tim asked to end the meeting and interested people could continue discussions if desired. Discussion did continue for another half hour and then several decided to take the discussion to other places. All I can say is this was not the most intense meeting we have had, but it was not far from it.

Diabetes and Stress

Stress is complex and for many people difficult to deal with, manage, and it then takes a toll on health and mental health. The sad part is many people do not recognize stress and how to deal with it. There can be positive stress and negative stress. Yes, I wrote positive stress.

Consider this – buying a house, birth of a child, planning a wedding – these are considered positive stress. These are a few of the negative – being stuck in traffic, death of a family member, and job stress. There are more causes of negative stress and all make your body behave as if it were under attack. Some sources of stress can be physical, like injury or illness, and stress can be mental, like problems in your marriage, job, health, and finances.

As stress builds, your body prepares to take action. Authorities call this the fight-or-flight response. How people react to this depends on the situation. Some people become combative and others find a way to walk away from the cause of the stress.  For those of us with diabetes, the fight-or-flight energy does not happen as easily because even if the hormones are present, the glucose and fat energy often in not available to prime the body for avoiding danger. Insulin is not always present to let the needed energy into the cells, and this causes glucose levels to rise in the blood.

When dealing with long-term stress, like surgery requiring several months of recovery, stress hormones designed for helping with short-term danger stay on for a long time. This in turn can cause long-term high blood glucose levels. For mental stress, whether short or long-term, the body pumps out hormones for no purpose. Neither fighting nor fleeing can help when the enemy is your own mind. In people with type 2 diabetes, mental stress often raises blood glucose levels. Stress hormones may also affect blood glucose levels directly.

To find out how mental stress affects your blood glucose management, before using your meter, write down a number rating of your mental stress level on a scale of 1 to 10. Then record your blood glucose level next to it. Then in a week or two, look for a pattern. Look for trends by graphing the data to make then stand out. Then ask yourself if high stress levels often occur with high blood glucose levels, and do low stress levels go with low blood glucose levels? If these are true, stress is affecting your blood glucose management.

The above should let you know that you need to make changes. You need to minimize stress or eliminate stress in your life. Some suggestions to help:

1. Find a new route to work, leave earlier, or use mass transit if available.
2. Have a talk with your boss, apply for a transfer if available, and change jobs if necessary or possible.
3. Find a way to patch up a relationship.
4. Start an exercise program.
5. Take dance lessons or join a dance club.
6. Learn a new craft or hobby.
7. Volunteer at a hospital or charity.
8. Obtain financial counseling.
9. Find new ways to cope with situation causing stress.

For some people, the art of learning to relax can help. Relaxation therapy does work, but requires dedication. This tends to work for people with type 2 diabetes more than for people with type 1 diabetes. Some people with type 2 diabetes may be more sensitive to some stress hormones and relaxation therapy can help reduce this sensitivity.

Some to the different relaxation therapies include:

1. Breathing exercises – sit or lie down and uncross your legs and arms. Take a deep breath followed by exhaling as much air as possible. Breathe in and out again, but this time relax your muscles as much as possible. Keep this up for about 10 to 20 minutes at a time and do this at least once a day.
2. Progressive relaxation therapy – this is a technique, which you can learn in a clinic or from an audio tape. It involves tensing your muscles and then relaxing them.
3. Exercise – This involves relaxing your body by moving it through a wide range of motion. Use circling, stretching, and shaking parts of your body. Remember the activity you did as a child – put your right foot out, put your right foot in, shake your right food and move it all about. They repeat for the different parts. Adding music may also help.
4. Replace bad thoughts with good thoughts – Every time you have a bad thought, purposefully thing of something that makes you happy. Some people use a memorized poem, a prayer, or a quote and use it to replace a bad thought.

Some people will use a combination of the above; however, any method you use will take practice to learn relaxation. Practice, practice, and more practice.

Dealing with diabetes-related stress may be one source of stress that just does not go away. One suggestion is finding a diabetes support group and participating in it. Yes, that means the secrecy is gone and for some this stress nags at them, but letting others in the support group in will often make this stress disappear. You can learn other people's hints or aids for coping with problems. Making friends in a support group may lighten the burden of diabetes related stresses.

Some find dealing directly with diabetes care issues are helpful. What creates stress for you? Is it taking your medication when you should, pricking you finger to check your blood glucose level, exercising, or finding the right meal plan that is best for you?

If none of the above work and you need help, ask a member of your diabetes team for a referral. There is no need to suffer if the stress is severe enough that you feel overwhelmed. Yes, I am saying counseling or psychotherapy might help. Talking may help you come to grips with your problems and relieve the stresses. You may learn new methods of coping or changing you behavior. Stress needs to be conquered.

Caregiver Care Done Right

Most people enter caregiving as amateurs and forget about what they may need to be quality caregivers. Some continue and become embroiled in the fight for their own health and often develop major depression. The better caregivers have realized that things happen beyond their control, consult with others early, accept help from friends and neighbors, and develop a relaxed but vigilant style of caregiving. These are the people that make great caregivers.


This article in WebMD covers caregiver stress and depression, both of which are real problems for caregivers. If you are providing near end of life care, or care for someone with a chronic painful condition, be aware that the rewards for this caregiving are real and can vary greatly.


Stephen Zarit, PhD, professor of human development at Pennsylvania State University, has been studying caregivers for more than 30 years. He finds that 40% to 70% of caregivers are significantly stressed. Zarit also says that about half of these seriously stressed caregivers “meet the diagnostic criteria for major depression.”


Psychologist Michael Williams, senior program associate at Wellness House, a caregiver support center in the Chicago area says caregivers seldom realize they are becoming depressed. He also states, "Depression builds over time due to the physical and emotional symptoms the caregiver experiences,"


I appreciate what Philip Higgins, MSW, director of palliative care outreach at Boston's Dana Farber Cancer Center has to say. He says, "You don't become depressed because of the symptoms; you become depressed because they are extreme and persistent,"


Symptoms of major depression include:

• Sad, anxious, or "empty" feelings
  
• Feelings of hopelessness or pessimism
  
• Irritability, restlessness, and anxiety
  
• Feelings of guilt, worthlessness, or helplessness
  
• Loss of interest in once pleasurable hobbies or activities, including sex
  
• Fatigue and decreased energy
  
• Difficulty concentrating, remembering details, and making decisions
  
• Insomnia, waking up during the night, or excessive sleeping
  
• Overeating or appetite loss
  
• Persistent aches or pains, headaches, cramps, or digestive problems that do not ease, even with treatment
  
• Thoughts of suicide or suicide attempts
  

“People caring for a loved one with a terminal illness should add "feelings of anticipatory grief" related to a sense of impending loss to the list, says Ruth Steinman, a psychiatrist at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia. "This is a symptom where a palliative care service can be especially helpful," Steinman says.”


It is important to recognize that the stress you are experiencing can sometimes lead to depression. This is the first step to preventing it and burnout from happening. Then take the second step and find a palliative care team's social worker or mental health professional. Talk about your feelings, frustrations, and fears. This talking will help you understand what is happening to you and the person in your care. When caregivers understand that they are not in total control of the situation, this alone can bring on a great sense of relief. This will also allow the caregiver to have goals that are more realistic.


I will quote this as it contains important information.
“In addition, to keep depression at bay:

• Maintain a life outside of caregiving. Stay connected to friends. Don't give up your daily routines.
  
• Maintain your health. Get regular check-ups, eat a balanced diet, and exercise. "It wasn't until I was hospitalized that I started thinking about my own health. That was a real wake-up call," says Nancy Knitter, who is caring for her husband with Parkinson's disease in their Rochester Hills, Mich., home.
  
• Exercise. It un-kinks tense muscles, revs up the cardiovascular system, and floods the brain with feel-good chemicals, such as endorphins.
  
• Use simple de-stressing techniques: deep breathing, muscle relaxation, meditation, and self-massage. And laugh. "People don't think of humor as a way to cope with stress, but they should," says Irv Ginsburg, of Ooltewah, Tenn., who cared for his wife, Nada, while she had brain cancer.
  
• Join a support group. In support groups, you validate your role as caregiver, voice your fears, vent your frustrations, and learn coping strategies and techniques. Hospitals and most disease-specific organizations sponsor groups. If you can't get out to a group, many organizations sponsor online support groups, and the Veterans Administration has a free caregiver support line (855-260-3274).
  
• Ask for help from the palliative care team, family, and friends. Delegating lessens stress and provides ways for others to show they care. "People want to help, they just don't know what needs doing," says Helene Morgan, MSW, clinical social worker in the pediatric palliative care program at Children's Hospital Los Angeles.
  
• Use respite care. Organizations -- home health agencies, adult day care programs, nursing homes, faith groups, Area Agencies on Aging, the Veterans Administration -- and friends can provide short breaks that lessen stress and allow batteries to recharge. "Using respite care didn't just help me with the caregiving, it helped my wife and me have a social life."
  

Some of the above points are covered in three prior blogs - here, here, and here.

Six Ways to Help Manage Type 2 Diabetes – P4

Error 4 - Neglecting Other Problems

In your efforts to manage diabetes, do not forget about other problems you may encounter. Depression, stress, and sleep disorders also have an effect on the management of diabetes. So in the process of learning about diabetes, learn about these as well. If you have other chronic illnesses, then you have more to learn and how each disease affect the other. All can lead to increased blood glucose levels.

Because diabetes is a 24/7/365 management demand, depression can be a large part of diabetes and one creates risks for the other. Learn to recognize the signs of depression so that you can take measures to minimize the effects and possibly avoid problems as depression can make diabetes management a very difficult task.

Treatment of depression definitely improves the mental and physical health of people with diabetes. So don't ignore the benefits and let the doctor discussion this and find a good medication fit for you. Even though the article in WebMD states that people with diabetes are twice as likely to have depression, studies show that this in more like 67 percent and then another 19 percent can have serious depression. Please don't ignore depression.

Stress is a factor that many people want to ignore, but please don't as it can produce hormones that hamper the ability of insulin to do what it does. Both patients and physicians need to take this into consideration and use activities that will reduce or eliminate stress. Exercise helps relieve stress and meditation and massage have benefits in improving blood glucose levels.

Some of the tips for easing depression also are applicable to stress. Read my blog here. For stress you need to add yoga and Tai Chi as they can assist in stress reduction.

Sleep disorders such as sleep apnea, insomnia, and others can wreck havoc to your diabetes management. You need to talk to your doctor about any of these so that you can manage them as well. Improper amounts of restful sleep makes blood glucose management that much more difficult to manage. Sometimes weight loss is in order and for others, just getting adequate amount of sleep for your needs helps is diabetes management.

As promised in part 1, read the entire article here.