Myths about diabetes – Myths Part 1

Myths about diabetes are a dime a dozen. Everyone wants us to believe this and to believe that about diabetes. When it gets down to realities, there are some basics facts that everyone needs to know, but to me the myths have been created to sell books and articles and make people believe there are some rules that guide us.

Myth as a noun is defined as a traditional or legendary story, usually concerning some being or hero or event, with or without a determinable basis of fact or a natural explanation, especially one that is concerned with deities or demigods and explains some practice, rite, or phenomenon of nature.

Misconceptions would seem more appropriate than myths, but a long word isn't always the best.

The only rule that I am aware of as a person with type 2 diabetes is “what works for me, may not work for you” There are many ways to say this, but I will not get into all the variations. There are people that insist that their way is the only way and for a few people in the near proximity of them on the bell curve, this will work.

Many people have forgotten the principles of the bell curve. Take approximately seven million people and spread them out on the curve. On the left side, start with those who have diabetes, but are able to get by with just minor changes in nutrition and no exercise. Then move a little to the right and you have to add exercise for a larger number of people, but this group still can manage tight control without oral medications.

Now go to the far right of the curve. Here you will find people near the end of life, on dialysis and unable to exercise, or blind and needing daily assistance. Not a pretty way to see life, but this is life. While many believe that type 2 diabetes is progressive, this is partly true, but does not necessarily need to be the way of life. People die every day and may have never reached the right side of the bell curve. This is because of other causes that also can affect our daily lives and result in death. And like any curve, it can be skewed to one side or the other depending on the circumstances of the people being analyzed.

Now I take you to carbohydrates which is according to this article is myth number three, and the one that raised my ire. Some people eat very few carbohydrates or no carbohydrates, and live very well. Yet most medical personnel claim that the carbohydrates are foremost in keeping us living well, and our brains properly fueled. These medical professionals also do not understand it when people with diabetes have severe blood glucose problems with too many carbohydrates for them.

And then there are the low carb people that have to preach their religion and then wonder why some of us don't and won't listen to them. This is because some of us are able to consume different level of carbohydrates. For people eating carbohydrates the population also varies like the bell curve. Yes, there are a few people that are maintaining excellent control that are eating high amounts of carbohydrates. They have reduced their weight and their insulin resistance and with exercise are able to do this. And there are also those that must eat low carb.

The one difference that does not follow the bell curve happens in those people who do not maintain even moderate control of their diabetes, and what I would say is little to no control of their blood glucose levels. Their progress into the world of complications is a “J” shape starting out at no complications on the left and then rapidly increasing on the right. This alone is the reason for those of us with type 2 diabetes to maintain tight control of our diabetes.

Yes, I do have a book by the American Diabetes Association titled Myths of a “Diabetic Diet” and the book basically lists 16 myths. I admit it was rather convincing when I was new to diabetes. As I have gained experience, I keep the book around to remind myself about the fallacy of the “myth” doctrine. If I want to get my blood pressure up, I just read some of the book, and up it goes. Not a good thing to do, but that is what I believe today. There is one good feature to the book and I covered it here and I agree that it should be read for that reason alone - it is a well written guide for preventing excesses in eating changes.

Everyone needs a good place to start, and this book does debunk the need for some people to go on radical diets (which fail) and encourages many (although in a round about way) to stop their panic mode and start finding out what works for them.

More on some of the more dangerous myths later.

Five important lab tests – maybe six or more

I am not even sure where I got the following information, but I know that I should have blogged about this before. I know that the following five tests are very important for people with diabetes. The tests are: HbA1c, blood pressure, cholesterol tests (lipid panel), micro-albumin test for kidney damage, and annual eye exam.

These five simple tests are currently the best and only indicators of each person’s own individual diabetes health risks. They also provide you with a kind of “report card” for you to see that your efforts have made a difference. Just don't ignore these test because they show trends, areas for concern, and/or if everything is doing well.

I think after my post on the July 6, 2010 that the annual screening with a blood test be done to check for liver problems/disease. The problem is that the sensitivity of blood tests needs some study while the ultrasound is not that great for identifying fatty liver disease. A liver biopsy is not a feasible screening method. Even though there is some concern as to the reliability of liver testing, I will state that it needs to be considered as an important sixth lab test especially for many of the chronic diseases.

There are other tests that will need to be determined on a case by case basis. One of the tests is the one for B12, which should be done for anyone that has been on Metformin for several years. Vitamin D levels need to be checked as a person gets older or does not spend very much time in the sun. Some of the other autoimmune diseases that often accompany diabetes may require tests.

One last important note – make sure that your doctor or in some cases, the lab, provides you with a copy of the lab results. This will assist you in tracking your health.

Type 2 people in the blogosphere

I am presently working on a list (this much has been posted) for type 2 people with diabetes that are blogging about diabetes. If you are ambitious and have other blogs even if they are not about diabetes, they will be included. Please know that there are other people blogging that are not on the list, either because I have not been able to contact them, or I have not found them.

Since I want this to be a current list, anyone that has not blogged for longer than 18 months is not included. If you restart and want to be included, please let me know and I will add you to the list.

I have many that are very active and I have not been able to contact a some of them, so if you are among these, please comment below or email me at the email on my profile page, and I will add you to the list. Emails will not be given out when requested. I would appreciate at least a first name if possible, but I will respect those that ask not to have it listed. Please know that I will want to contact them for permission to publish any information about them.

My request is that you must be a type 2 person with diabetes and be actively blogging about diabetes.

Now that I have said that, I find that there are several other type 2 bloggers that write occasionally about diabetes and more often on many other topics. So I am adding a second list of these bloggers.

If you don't see one of your favorites on either list, please contact me at the email in my profile. Supply all the information you may have access to. URL, contact address, and name of site would be appreciated, but not always available. If you have contact with them, please pass on my site so that they can contact me.

The same will apply to the type 2 chefs that you may follow. There are some excellent type 2 chefs and I will be working on a list for them over the next few weeks as well.

Thank you,

Keep the dialog going

Scott Johnson is really getting serious. Check out his blog here. If you have comments, put them there or on mine. We need to know your thoughts, and hopefully in a positive way.

I agree with Scott, I do not want the perception of the Roche Social Media Summit as being nothing more than marketing or as one person said to me a public relations ploy. This does not appear to be the intention at this time. Are we right in being skeptical and being cautious? This appears to be a healthy attitude and I would not want to have it otherwise.

I also want to look at it another way, if Roche wants to bring the diabetes on line community (DOC) together with some of the leading diabetes groups and organizations for a face to face, this could be a giant leap forward in communications and exposure for both sides.

Looking on the positive side, we need all the help we can get to make these organizations recognize that we are writing about diabetes and looking for answers, places that the DOC can draw on for ideas and resources. We also need to communicate from our side the concerns and problems faced by the DOC and those of us living with diabetes. And this means those are lucky enough to attend and those not in attendance.

Could Roche interact more with us throughout the year? Definitely, and I think they are contemplating doing just that. Scott asks some very good questions at the end of his blog so I will quote them here:

- I am not exactly clear on what "Social Media" means. Is it possible that there is more to "Social Media" than blogging - which is where I come from? Who else needs to come to these things? Are we too heavy on bloggers, and not heavy enough on other "Social Media" channels? What are those other channels?
- I know nothing about how people get picked to be invited. I wish there was a little more transparency here. I think I have paid my dues in the Diabetes Online Community (and hope to continue doing so), but should that mean I'm automatically invited to stuff like this?

Please folks, let me know how you feel about this stuff. I need your input to help me know if I'm doing the right things or not. Unquote

I do know how I was invited – I was recommended by a prior year attendee. Have I paid my dues? Definitely not to the extent that Scott has. However, I do see an opportunity to assist others and help communicate their needs to people like Roche. I also see an obligation to Scott and others of the DOC to aid in make diabetes and the DOC a better place for all of us.

Even though I do not participate on Twitter and Facebook, I would consider them part of the “Social Media”

So both of us do want your thoughts, questions and opinions. Please!

Hospitalization concerns for persons with diabetes

This is a complex problem. Each state can have rules of conduct for the hospitals and even each hospital can have rules more stringent than the state's rules.

Many hospitals are very friendly for people with diabetes; however, unless you have time to talk to the administrator, and even then, never take anything for granted. I mean this, never take anything at face value. Check, recheck, and then check again. This will make sure the hospital knows that you are concerned and will need to be treated with respect. Some hospitals are also very unfriendly to people with diabetes.

I will emphasize this repeatedly because of the importance. A limited medical power of attorney is more important today with all the privacy rules and regulations in place. People that you want to be able to act on your behalf are often not able to because the hospital does not know them and without a limited medical power of attorney, it is useless to think that they will, even if it is your spouse. So if you are a person with diabetes, carefully consider the value of a limited medical power of attorney for your spouse and/or if you are single, a person or other family member you can implicitly trust.

In any hospital setting, make sure that if you are on an insulin pump that once the procedure is completed and you are recovering that you are allowed to regain control and use of it. But be prepared for those that will not allow you to have or use it.

A check list for hospital care:
1. Entering the hospital with prior knowledge and under doctor ordered request.

• First discuss the situation with your doctor so that together you can plan the course of action you can have control over. Parts of the plan may be out of your control. Your doctor can often make things go smoothly and you should give them a current list of medications.
• For what can be in your control, make sure the doctor can make the staff aware that you are a person with diabetes and request you be allowed to take your medications and do the testing.
• Depending on circumstances, try to be in charge of your own diabetes in the hospital as much as you are able.
• Again attempt to avoid having hospital nurses be the ones to check your numbers and decide how much insulin or medications you should take.
• When you enter the hospital, make sure you can take your supplies in a pouch or other secure container. Also take a notebook to keep all the details written down so that you are able to discuss these things with your doctor.
• If you are unable to do your own testing, secure permission to have a relative preform this.

2. Entering the hospital under emergency conditions.

• In this situation, you may have to rely on the hospital staff.
• Be prepared to communicate (if you are able) to the doctor on duty and/or ask for someone in administration to contact your doctor. Or if you have a travel partner, have them do this if you are unable.
• Do you have anyone that has a limited medical power of attorney that needs to be contacted. This is why you need this information in your wallet or purse.
• This is also when a medical alert tag is important.

3. Entering the hospital against your will or knowledge.

• This can be very confusing, because it can be an emergency or you are having a hypoglycemic episode and are arrested and taken to the hospital, and this can depend on many factors.
• You can only hope that you get the right treatment and this should is one reason to wear a medic-alert bracelet or necklace.
• Again, do you have a person with a limited medical power of attorney that needs to be contacted?

4. Entering the hospital in another community.

• Often this will be in an emergency situation and you may not have any control over your treatment.
• As soon as you are able, make sure you doctor is notified.
• The limited medical power of attorney thing again.

Procedures can vary with many hospitals. In some, it is highly advisable when possible to notify your doctor and make sure that he is involved as they will not or may not allow you to have your medications in your possession and may absolutely not allow you to medicate yourself.

This can be very important for people with diabetes and your doctor will have to clear this and even then sometimes your medications will still be taken away upon entry or at a shift change. So double check that it is made part of your records if possible before admission. If in emergency, then make sure your doctor is somehow notified.

Also make sure before hand (if possible) of the meals you will receive and be prepared to ask for exact carb count and still be prepared to not eat some foods that will send your blood glucose into the stratosphere. Many hospitals have not learned about high fructose corn syrup and low carb or may not even have a dietitian on staff that knows anything about diabetes. Do not rely on many hospitals having a knowledgeable CDE (certified diabetes educator) on staff.

If you are admitted to the hospital through the emergency room, then everything can go haywire and you may not even have your medications or diabetes supplies with you. This is why you should also keep a list of current medications in your wallet or purse. If possible and allowable, have someone bring your medications to you as soon as you can notify them, but they must know that they are not to surrender them. Better for them to return them to your home than lose them to the hospital. Your medications while in the hospital will cost quadruple or often more per pill than if you have them available to you from your supply. I repeat that some hospitals will not allow you to use your own medications or even medicate yourself.

Also as soon as you are able, let your doctor know so that he/she will be able to smooth the way for you to use your own medications. Depending on the hospital rules and some nurses, you may be forced to hide your medications as they will take them from you, not give you a receipt, and in some instances actually dispose of them.

I'm not saying this to take anything away from how well the nurses do their job, but they can be very busy and sometimes they forget to do things that are important, so keep this in mind.

The following are some links to add to what I have written and first one covers some tips that are also important.

• Article one
• Article two
• Article three

Limited medical power of attorney – disclosure statement. While this example is for the state of Texas, some of the principals apply to any medical power of attorney. Any medical power of attorney should be well spelled out and the necessary limits carefully spelled out. Just be careful of the attorneys that want to draw up a durable medical power of attorney.

While there are forms online that are state specific, I am not sure that some of the limited medical power of attorneys can be made to fit. One limit that should be spelled out is that when you are able to resume charge of your care, that the limited power of attorney is mute and not in force again until you again become unable to manage your health.

A Doctor's Perspective on Patients with Chronic Diseases

Once in a while this blogger gets hit with a good one. Do I believe this, YES, but if I hadn't read it with my own eyes, maybe not.  It is also not often that I have a blog that I can write that I do not have to do much research to write.

This is one of the best blogs by doctor about doctor – patient relationships written by a doctor that is not necessarily afraid to go the extra mile for his patients, especially those with chronic diseases, and diabetes is one of the mentioned diseases.

While I will need to reread it several times, he had me crying (a man crying? – yes with happiness!) and then he had me laughing. It is so unusal the to see a doctor say something that many of us patients with diabetes have believed for a long time. His words of caution are well placed and easy to see the reasoning behind them. Many of us patients are a little overly aggressive and as such can make a good doctor very nervous, especially if we are agressively proactive about our care, and not even mentioning patient's rights!

I was expecting to see one of the comments by Trisha Torrey from About dot com and was not disappointed. While she can be argumentative, she was almost, but not quite, tame in her comment. There are lots of comments and I will let you read them for yourself.

I would have made a comment to his blog, but I am hoping that I can reach just as many with this and encourage them to also read his blog – follow the link here. I think you will agree that when placing this doctor on my types of doctors in my blog here, that Dr Rob must be a definite Type six. While there are some things that are not said, for Doctor of Internal Medicine I am not normally that much into giving praise, but an exception is demanded this time.

What would or should one do?

This question came up recently about a product that has been written about by another blogger. Don't get me wrong, the blogger did an excellent piece about this product and has great interest in it.  I have been in email contact with the company and I like the idea and the high potential usefulness of the product, but doubt I will ever need it, but who knows.

The product is about 30 months, give or take a few months, from FDA approval. So here is the question.  Do I write about it or wait until it comes on the market?  I am looking for responses whether they are positive or negative.

On the one side, this is a much needed product and will definitely have its place in the market, once it gets past the Federal Drug Administration and their crazy bureaucracy. The negative is that will not happen within 12 or 18 months, but more like 30 months.

This will be an important product for anyone with diabetes that is on insulin.  And yes, I am on insulin.  Have I been in a situation where I would have needed the product? Truthfully, no.  Do I see myself ever needing this product?  Again, no.  Have I ever come close to needing this product?  Here, I need to answer yes.  I admit that the situation could arise, but as careful as I am, the lessons I have learned, and my body has always told me what needs to be done before things get out of hand.  Fortunate, yes, I am.

There are several sides to writing about a product in the development stage that I am trying to resolve in my mind. Before giving any more information, I would like your thoughts, please.

Vinegar and diabetes

Let me preface this post by saying “what works for you may not work for me”. When it comes to natural remedies, this statement is so true. If the cost is reasonable, as in the case of vinegar, why should not people at least see if it works for them.

While the only studies (only two and very small) are done by one person, Carol Johnston PhD from Arizona State University, Department of Nutrition, and these studies are held up by many people as fact. I will list several articles, but I can tell you that all cite the studies by Carol Johnston except article 5. Study one is here and study two is here.

Other articles citing Carol Johnston:

Article 1  By The American Diabetes Association (Surprise, as they are normally more conservative).
Article 2
Article 3
Article 4
Article 5

On the internet, there are many people with articles that portray vinegar as the natural remedy for diabetes, but do not list any studies. And for some people, some benefits are derived, but not for everyone. What is more interesting is the way people reference each other and keep referencing in a manner that seems very self-serving and have no basis backed by science. Even citing Carol Johnston would have made much more sense.