Selenium Supplements May Harm Not Help

Where you live makes a world of difference in your need to take selenium supplements. If you are short of selenium, then your doctor should be able to tell you to take selenium supplements. If you live in Canada, the USA, Japan, and Venezuela, you should be careful about taking selenium supplements. If you live in Europe, you may need to consider adding selenium supplements to your program.

Before you put a lot of confidence in many of the studies claiming certain health benefits, please understand that many of these benefits can happen for people that have low selenium blood levels. When people have normal selenium blood levels (above 122 µg/L - micrograms per liter) unimpressive results were obtained. American men average 134 µg/L.

The U.S. Institute of Medicine (IOM) has determined the upper limit to be 400 micrograms per day. Too much selenium can cause a condition called selenosis, which includes symptoms such as gastrointestinal upset, hair loss, white blotchy nails, garlic breath odor, fatigue, irritability, and mild nerve damage.

It is good to know that selenium has a low therapeutic range and when too much is consumed, the result may be the development of type 2 diabetes. Since I have type 2 diabetes, I do not have this concern, but I still try not to take more than a maintenance level of selenium.

In countries that are generally low in selenium for the population, low selenium intake has been linked to memory and brain decline, low immune system quality, and higher risk of death. From studies, these people may also benefit from added intake of selenium to protect themselves from certain cancers, increase male fertility, and increase antiviral solutions.

Researchers emphasize that because evidence from studies are mixed in benefits that people in countries with low natural selenium be more concerned about their levels than in North America. 

Read the two reports here and here.

CPAP Tips When You Have a Cold

Use of a CPAP (includes all types) machine when you have a cold can be difficult to say the least. I personally seldom have a cold that causes problems for me, but it has happened. For a few days, I would get very little sleep and the cold would seem to last longer.

Therefore, when this article appeared in Sleep Connect dot com, I had to read it and reread it carefully. I then had to start looking for additional sources to explain Stage 3 sleep (or delta sleep). I was already familiar with the term REM sleep, which is the source of restorative restful sleep. For those interested, read these sources: article 1, article 2, and article 3. These will give you some answers and resources for more reading. You may also use your search engine to find more.

Now back to the tips when you have a cold. I will be covering the tips in a different order than this article presents them for my own reasons.

First, I hope that you have a CPAP machine that has a heated humidifier built in or a water bath that the air passes over to supply you with warm moist air to breath while sleeping. This will assist the nasal passages in remaining open enough for sufficient air passage to your lungs. This will generally suffice except for the severe colds.

If you have a severe cold and your nasal passages just will not allow air passage, a full-face mask may be the only choice. This allows for breathing through your mouth when the nasal passages become clogged. I have not had success with a full-face mask, but I am going to talk to my doctor and see if there are other mask manufactures that have them, just to try a different one. My first one made more noise and interrupted my wife's sleep so I stopped using it. No amount of adjusting could prevent the unwanted noise. I investigated the RemZzzs web site and they do have the full face mask liners which should solve this problem.

The most common remedy that many doctors advise patients to use is over-the-counter (OTC) nasal sprays. For many people they work just fine and prevent the nasal mucus from blocking the nasal passage for much of the sleep hours. I am very cautious about using them as the majority that work are steroid based and I hesitate upsetting my diabetes with steroids. This is why I add this last. Most steroids increase my blood glucose levels more than I like and most doctors say that the amount in nasal sprays is inconsequential. I know different because my meter tells me otherwise. Yet others have no problems. Therefore, this may be a solution for you.

Note: CPAP is the term of choice for all the different types of positive airway pressure machines. These include biPAP, VPAP, A(auto)PAP, and titrating PAP. I use the VPAP, which is a variable PAP and is set with lower and upper limits for the pressure. This allows for an increase in pressure automatically if needed or lowering if not needed.

Innovative Approaches Help Sleep Apnea Sufferers

This may be a solution for some people with sleep apnea, but I can honestly say it does not work for me. I have to have my own limits and I prefer not to be coached or bothered by someone that does not understand sleep apnea. I will listen to my doctor and consider what he says, but beyond that, leave me alone and let me use my VPAP (variable positive airway pressure) when I sleep.

I did listen to my wife when she complained about the air blowing at her from my first machine – the air exit from the masks was to blame. It took me some time to adjust the hose and the direction of the air exhaust to prevent this from happening, but now with the new machine and different masks it is much easier to prevent air blowing on her. I also listened to her when she complained about the noise from my full-face mask.

This study is published in the current issue of Sleep Medicine Reviews. The opening statement leaves much to be desired. They claim that people with obstructive sleep apnea are more likely to use the equipment and prescribed treatment when a partner or parent is involved in their treatment.

In conversations (not scientific at all) with people with sleep apnea, I have found more people do not want to use the CPAP because it leaves red marks on their face and back of the neck. Most people do not realize that shortly after waking, and preparing for the day, these will disappear. The other problem is their lack of adjustment of the mask straps and having them too tight, which will cause strap marks on their skin. When straps are too tight, the marks can last for an hour and usually longer.

The most legitimate complaint is the problem of air leaks around the masks. Then add the problem of the mask creating nose bridge irritations and even sores and this does present problems for wanting to use the mask. Again, this is a problem because either the mask does not fit your face properly, or the straps have been over tightened. This is even a concern for me and I solved this by obtaining nasal mask liners from this company. Take time to watch the video under “how it works”. The mask liners do dramatically reduce the air leaks and allows the mask to be worn properly without over tightening the straps.

I have written a blog about the nasal mask liners and I enjoy using them. I do get more than one use out of each liner by following the steps I outlined in the blog. It does take some time to process them, but I will continue to make use of them as it has allowed me to loosen the straps. I can still have some marks on my face, but they do not last long after I take the mask off.

“One of the studies that the researchers reviewed showed that about half of newly diagnosed sleep apnea patients would not use CPAP if it made them feel claustrophobic.” This is one of the better statements to come out of this study and is accurate. I have talked to people that feel this way about wearing a mask and it terrifies them whether it is a full-face mask or a nasal mask.

Even though I say the study is of little value, the proposals they set forth may work for some people. If something does work for you, make use of it. I know my way works for me and I generally wear my nasal mask for more than eight hours average per 24 hour period.

Avoiding CPAP Problems

It is interesting to read articles on approximately the same topic. One is by a doctor for other doctors and the second by hospital staff for the general public. I suspect that the hospital staff involved nurses, but it is clear to me which one is more meaningful. I think you will see this as well.

The one written by a doctor was for Medscape and the second appeared on the Mayo Clinic website. You just have to love the doctor for his use of adherence and non-adherence. These words are a show of disdain about patients and when put with the statement of “the primary goal is to promote 100 percent adherence to CPAP”, I must confess I could not even consider this doctor for my sleep apnea.

The doctor did acknowledge several problems that people encounter, but always countered with what medically could be done to alleviate the problem, even if it meant medications. His attitude showing through his writing is one of the patient must be made to comply.

The Mayo Clinic article starts with this “CPAP is an important treatment for obstructive sleep apnea, but it's not without its frustrations.” The article lists ten very real problems and suggests ways to lessen each problem.

1. The wrong size or style CPAP mask

2. Trouble getting used to wearing the CPAP device

3. Difficulty tolerating forced air

4. Dry, stuffy nose

5. Feeling claustrophobic

6. Leaky mask, skin irritation or pressure sores

7. Difficulty falling asleep

8. Dry mouth

9. Unintentionally removing the CPAP device during the night

10. Annoyed by the noise

Both articles do come up short as they are all promoting plastic masks and do not allow for people that are allergic to plastics. There are a number of aids that are available to help with the allergies and air leaks. Neither article supported other professions like sleep therapists or even sleep doctors. Both also do not recognize that there are dentists that have taken the required education to deal with sleep apnea. The dentists do use oral appliances which regular doctors cannot.

Yes, I realize that the two professions are different, but a doctor or dentist specializing in sleep apnea should realize that the other exists and acknowledge them.

To get away from plastic allergies, consider the sleepweaver cloth mask. I will give you a sales site as the two times I have tried the regular web site, I am kicked out by one or the other of my virus checkers alerting me of a Trojan virus. So unless you trust your virus checkers – you have been warned. They may have solved the problem, but as of two days ago – no.  as of June 29, it is good.

I have never used this for sleep apnea, but I have an acquaintance that says he would not use anything else. The web site is here for no mask. For those having problems with air leaks, I know this site should interest you. I use these nasal maskliners and it does prevent air leaks.

Some of the national sleep apnea organizations can be seen here, here, and here.

A Follow-up on Children with OSA Benefit from CPAP

It is a good feeling when you are asked for information about something, in this case obstructive sleep apnea. I had written about this here. Since this happened, the family and I have exchanged several emails about the progress of their son and how he is doing with his VPAP machine. The parents are happy that no surgery was required and that I have been able to direct them to more web sites about sleep apnea.

In the three weeks their son has been using the VPAP, they have added the mask liners (the son has both the nasal mask and a full-face mask) and report that this has helped dramatically reduce the air leaks and he is using the VPAP every night now. The father reports that the entire family now exercises and the son has lost five pounds in the three weeks since starting. With the snow, they just add snowshoes and keep moving.

I was told that the number of apneas during the sleep study had varied from 76 to 92 apneas per hour. The doctor did find a way to work them in the next day because of the distance for travel. This has to be a doctor with much kindness in his heart. The mother reported that the doctor took his time to explain the two masks to them and the fitting of the masks. When asked about the mask liners, the doctor was unfamiliar with them, but took his time to go to the web site and after research, offered a prescription if they needed it.

Both parents have expressed their happiness that surgery is the last option the doctor wants to consider. They did obtain the VPAP machine and masks from a local supplier approved by their insurance. The doctor had also issued a prescription for a second disk for them to use and mail him the first disk to read the results for the first 30 days. Then he will mail it back to them for them to use when they mail the second disk for reading the next 30 days.

I told them this was normal and the doctor would be looking for the amount of time on a daily basis that the machine was being used and if there happened to be sleep problems. In addition, the insurance company would receive a report from the doctor about the results. If problems showed up, this could indicate a need to adjust the pressure and may require a second visit to the doctor. If the results show normal or near normal, the disk mailing might stop or happen at an infrequent interval, just to monitor the results.

The son even reported that his sister likes to tease him about looking like an alien with his mask on. He said he told her he does not care as he is getting a good night's sleep every night and feels so much better. He also said his grades are improving and he is more alert in school.

We do continue to communicate about questions they have and questions they should ask their doctor or equipment supplier. They are happily surprised about the support they have received from their medical insurance and this is a big plus. Their insurance had questioned both the nasal and full-face mask, but when the doctor explained his reasons, the insurance company did allow both.

This blog is the first of four blogs about sleep apnea this week.

SMBG – A Right Being Denied

Why are our insurance companies, doctors, and medical researchers focusing so heavily on self-monitoring of blood glucose (SMBG) and trying to discredit the good that it can do? I may not have the answer, but I will propose at least two possible theories.

Most people associated with the medical field including insurance are supportive of prescribing medications on top of medications. This I did not understand until I remembered Big Pharma and the ACCORD studies. Are our doctors so comfortable in bed with Big Pharma that they will not consider other approaches? Are the payoffs so great for them that the patients' well being is put on the back burner? Is the American Diabetes Association (ADA) so beholden to Big Pharma that they do not want to back potential patient centered aids that could reduce dependence on medication?

Is the above reason enough that doctors for the ADA want to do nothing about pushing a clear status for prediabetes and clearly recommending a strong course of action? Alternatively, is it our medical insurance companies that are pushing for inaction to keep current profits up in hopes that the profits will continue to go up? It is plausible, but not as sound as the above paragraph.

My second theory is that the current generation of doctors is so intrenched in the past and only want to treat something that is clearly a disease, that they do not want to promote preventive medicine. They want patients that are sheep, and not capable of thinking for themselves. When patients with diabetes do self-monitoring blood glucose (SMBG) they are not taught what the readings can mean or how to interpret the readings, or even when to test.

It is no wonder that knowledgeable people with type 2 diabetes become alarmed with these doctors. They search the internet for information that will assist them to learn how the test, when to test, and how to interpret the readings. Some will become successful at SMBG. The rest will become discouraged and continue testing, but not understand why. Then when their doctor ignores the readings, they may look further or give up completely.

The people that give up completely or are not interested in SMBG are the group that studies look for to participate and give the insurance companies and Medicare reasons to reduce the testing supplies. As a patient and a person with diabetes, I consider this criminal and demeaning toward patients.

While it may seem that I am overstating the above, please read this study, which clearly states the same accusation. I quote “The Cochrane review is a review of previously run studies, across a number of different countries, which have analyzed self monitoring and its effect on HbA1c levels. People with type 2 diabetes have previously noted the various limitations of the studies included in the review. Studies, included in the Cochrane review, have notably excluded participants who had previously demonstrated interest in self monitoring.” I added the emphasis. Please read the short article for further revelations.

Even though I write about some of the problems on diabetes forums, there is much good that can be had on some of the better forums. The problem is that you cannot be a timid participant on these forums. You must ask questions, but be sure to give enough information for people to make reasonable answers. If you do not, some will ask for additional information. Others will make assumptions and try to answer based on what their experience is.

The following are web sites that may be of value to you. They are not in a particular order or personal preference.

http://www.diabetesforum.com/forum.php

http://forums.about.com/n/pfx/forum.aspx?nav=messages&webtag=ab-diabetes

http://www.diabetesforums.com/forum/

http://www.tudiabetes.org/forum

http://diabetescommunity.dlife.com/go/forum/viewboard

Please remember that these forums are not chat rooms and you cannot expect an immediate answer. It may take several hours to receive several answers. I think a couple of the forums may have chat rooms, but finding people using them that will answer your questions may be problematic. Normally chat rooms are used by several people that invite each other and they want to discuss one topic among themselves.

Stop Wasting Your Test Strips

This is not related to self-monitoring of blood glucose (SMBG). This is about the ways we as diabetes patients take care of our test strips and to avoid wasting them in other ways. Each test strip we waste costs us money. They are expensive so we do not need to waste them carelessly.

Yet people do just that. They do not store them properly, jam them into the meter carelessly, and do not wait until the meter says the strip is ready. These errors occur all too frequently and that is wasting money. Errors will happen, but a few precautions can save strips and save your hard-earned money.

First, make sure that you store your strips properly. The containers they come in are the proper container to keep them in. Do not transfer the strips between containers as this can damage some of them. If you are like me and have large fingers, the first few strips are often hard to remove from the container. I keep a small plastic tweezers handy for getting out the first few. No, I did not say metal tweezers, a good way to damage the delicate strips. Check with your pharmacist for a plastic one, they are available, but may need to be ordered.

The original containers are made of special materials that help preserve the test strips and keep them dry. Keep the test strips in the original container and do not transfer them between containers. It is important to use the strip as soon as possible after removing it from the container. Close the container after removing the strip to use. Keep the container out of direct sunlight especially when taking strips out and do not expose the strip to direct sunlight. Please do not put a few test strips in a baggie or in your purse to carry them. The test strips are delicate and can be damaged beyond use.

Keep the container of test strips in a dry place. The bathroom or the kitchen is often the worse place to store your test strips. Please wash your hands with warm soapy water and dry carefully before handling test strips. Never use wet or damp hands or fingers to handle the strip container or for removing a strip from the container.

It is important to perform tests with the meter and strips as close to room temperature as possible to get accurate results. Do not freeze your strips or store them in extreme cold, as this will probably produce errors or false readings. This applies to extreme heat or direct sunlight. I have seen people store them on the car dash in direct sun and then they wonder why they get weird test results.

Now that I have explained proper storage, I will return to proper use of the test strips. When you are ready to test, always have your meter out and ready to insert the test strip carefully. Push it straight into the slot provided. Then use your lancing device to prick your finger and get an adequate amount of blood available. By this time, your meter should be ready to have the test strip receive the required amount of blood. Hold the meter with the test strip inserted properly and slide the strip at an approximate 10-degree angle that will allow the strip to wick sufficient blood to get an accurate reading and move it into the blood. Do not hold the meter and test strip at a 90-degree angle to the blood spot as you may shut off the wicking of your blood before it has enough for a reading. This will get you an error message.

Good luck and may your readings be good and not receiving error messages. The test strips are important and you need to make efficient use to prevent waste.

Are Physicians Correct in Not Following ADA Guidelines?

This is one article that gave me a different message than I was expecting. When I read the headline “Many Physicians Do Not Follow ADA-recommended Prescribing Guidelines,”  I actually thought this may be a good thing. However, the article did not give me any of what I was thinking.

I had hoped that the discussion may have been about starting newly diagnosed patients with type 2 on insulin to gain maximum management quickly. No, the article was about prescribing oral medications only and not the use of cheaper, generic medications, but the more expensive oral medications. When doctors force patients to use oral medications that are more expensive by $1,120 (or more) per year, this is the wrong way to proceed.

These doctors do need to be called on the carpet and asked to explain their reasons.  There is one very effective generic that these doctors were not prescribing. It is the drug metformin that is recommended as the first line of treatment by the American Diabetes Association (ADA) and another Professional Group for persons newly diagnosed with type 2 diabetes.

This study was the work of researchers from CVS Caremark, Harvard University, and Brigham and Women's Hospital. It looked at data from pharmacy claims for 254,000 patients started on diabetes medications between January 1, 2006, and December 31, 2008. You know that insurance companies will review their records to see what the doctors are prescribing and whether they should revise their formulary.

After reading this blog and the linked article, you may wish to review your medications with your doctor to determine if you are using the correct medication and not one that is overly expensive. If your doctor has you on one of the brand medications and refuses to change to a generic, you may want to have a pointed discussion with the doctor or consider a second opinion.