Amy Tenderich had a guest blogger on September 29 that answered some of questions about the American Association of Diabetes Educators (AADE). Yes, this is the certified diabetes educators (CDEs) we are discussing. They have made some improvements over the last year, but there is a lot more that needs to be done. These are a few of the ideas I want to cover.
First, there needs to be better continuing education. Their formal education is good. They stay up-to-date about equipment and some studies, but many CDEs are still lacking key pieces of information. Many do stay current with the latest changes in the American Diabetes Association guidance, but others seem to be stuck in the past and therefore make recommendations and mandates that are not always in the best interest of the patients.
So my first question is – does the AADE have a procedure for filing complaints about CDEs that give outdated advice or that do not work with patients? Then what do we do about those CDEs that cannot be civil when you ask a question that they do not like?
My second question is - what are they doing to help people with depression? Many CDEs seem very lost when this topic is brought up. Their eyes glaze over; they attempt to change the subject or do their best to divert the conversation away from the topic.
My third question is - are they going to allow people to use lower carb diets? Many, but not all are stuck on having people eat 60 carbs per meal and telling us that we are harming ourselves if we eat less that their mandated amount. Even the ADA has moved away from the mandate of 60 carbs per meal. For most of the CDEs I have met, this seems to be a mantra.
At this point it is important to note that ADA has (hard to believe, but true) changed their position about carbohydrates. Check out Standards of Care section of the 2010 ADA Clinical Practice Recommendations. The updated carbohydrate recommendation starts on page S25 and I quote it - “Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance as to macronutrient distribution in healthy adults, DRIs may be helpful (106). It must be clearly recognized that regardless of the macronutrient mix, the total caloric intake must be appropriate to the weight management goal. Further, individualization of the macronutrient composition will depend on the metabolic status of the patient (e.g., lipid profile and renal function) and/or food preferences. Plantbased diets (vegan or vegetarian) that are well planned and nutritionally adequate have also been shown to improve metabolic control (107,108). The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intake so as to reduce risk for CVD. Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes; therefore, the recommended goals are consistent with those for individuals with CVD (92,109).” (Emphasis is mine)
This will now allow variation of carbohydrate consumption to fit the individual and not forcing a certain number of carbohydrates. The low fat regimen is still advocated, but even this can change. In a discussion with a CDE, I was told in no uncertain terms that this was not accurate and I was to eat the 60 carbs per meal. This inflexible position is not acceptable and my discussion with this CDE ended.
There are many more questions that I have, but I need to get my thoughts organized and collect more information. The AADE still has more to correct and improve upon.
October 5, 2011
October 4, 2011
Old Problems in Diabetes Education
An examination of an article and the progress being made is in order. Amy Tenderich made some convincing arguments in her article of November 15, 2007 in Diabetes Health. Then in the reply to these problems by Donna Tomky on Amy Tenderich's blog of September 29, 2011 was a pleasant surprise, but still left many questions needing discussion, if not still needing complete answers. We can accept that an organization like the American Association of Diabetes Educators (AADE) that may be slowly coming out of the doldrums of past ineffectiveness to take some time in getting things set to the right tone and accomplishing many of its new goals.
In reading some of AADE's position papers, they are being aggressive, but the membership is slow to give support. Too many have become engrained in bad habits of the past and are not ready to support the new positions. CDEs that have turned to writing books and making speeches are not supportive of the changes. Many of these CDEs have created their ladder to success and are resisting change.
In addition, many of the problems still exist because of a healthcare system mired in more ineffectiveness and concern for profits then preventive care. Our outdated medical insurance industry is even fighting harder to further increase profits at patient expense than in looking for new ways to battle the increase in medical costs. Tests are over used in many cases and insurance just continues to pay for them and pass the costs onto patients with ever-increasing premiums.
Amy found several excellent problems in 2007 worth repeating. The first was “Create a sensible career path for new recruits, including some type of mentorship”. Has this been established? AADE would like us to think so. In Donna Tom Tomky's statement, she says: “One of the most significant ways that the discipline has been strengthened since 2007 is by the development of documents that support and clarify the roles and scope of practice for diabetes educators. In 2009, AADE released The Guidelines for the Practice of Diabetes Education and the Competencies for Diabetes Educators.”
Translation – they have made it more difficult for entry into the certified diabetes educator position and made it restrictive in who they accept. This does nothing to create a career path making it easier to attain a position as a CDE. There is still nothing in the works for college courses to aid in the study for the exam and further restricts people that are eligible to become CDEs.
The second point of change put forth by Amy is “Streamline patient access to educational services”. This was not even covered by Donna Tomky other than to restate that people need a doctor referral so that they are eligible to bill their time to insurance companies. What are patients to do when they see a doctor that will not refer them or that the doctor has no one available in the small rural community? This is not a promising answer for a solution.
The third point Amy put forth is “Garner consistent support from both physicians and insurance providers for diabetes programs”. This is partially covered along with the above point in Donna's point: “We are particularly pleased to begin work on a new demonstration project focusing on mobile health. With the Office of Minority Health, Baylor Diabetes Health and Wellness Institute and AT&T, we are facilitating a project that will connect diabetes educators with patients via mobile technology and video platforms. We believe these mobile technologies have huge potential to revolutionize the way educators can interact with their patients and increase access to diabetes education services, particularly in rural and under served areas”.
Granted this is still in the development stage and we do not know how far this will go. Will the program be for minorities only? Will the program be nationwide? These are just a few of the yet unanswered questions.
Amy's fourth point is “Establish accepted best practices for diabetes treatment that are clearly communicated throughout the field”. And, the last point in Amy's list of needed changes is “Drive more proactive participation from the patient community”.
Unless I missed something on Donna's reply, these two points were completely unanswered. In place of answering the above, we were told about “Establishing State Licensure for Diabetes Educators”. Read this for more information and if interested there are some valuable links. This could open a can of wiggly worms but may well be worth the fishing.
I will continue the discussion about more questions for the AADE and maybe a few challenges, in my next several blogs.
In reading some of AADE's position papers, they are being aggressive, but the membership is slow to give support. Too many have become engrained in bad habits of the past and are not ready to support the new positions. CDEs that have turned to writing books and making speeches are not supportive of the changes. Many of these CDEs have created their ladder to success and are resisting change.
In addition, many of the problems still exist because of a healthcare system mired in more ineffectiveness and concern for profits then preventive care. Our outdated medical insurance industry is even fighting harder to further increase profits at patient expense than in looking for new ways to battle the increase in medical costs. Tests are over used in many cases and insurance just continues to pay for them and pass the costs onto patients with ever-increasing premiums.
Amy found several excellent problems in 2007 worth repeating. The first was “Create a sensible career path for new recruits, including some type of mentorship”. Has this been established? AADE would like us to think so. In Donna Tom Tomky's statement, she says: “One of the most significant ways that the discipline has been strengthened since 2007 is by the development of documents that support and clarify the roles and scope of practice for diabetes educators. In 2009, AADE released The Guidelines for the Practice of Diabetes Education and the Competencies for Diabetes Educators.”
Translation – they have made it more difficult for entry into the certified diabetes educator position and made it restrictive in who they accept. This does nothing to create a career path making it easier to attain a position as a CDE. There is still nothing in the works for college courses to aid in the study for the exam and further restricts people that are eligible to become CDEs.
The second point of change put forth by Amy is “Streamline patient access to educational services”. This was not even covered by Donna Tomky other than to restate that people need a doctor referral so that they are eligible to bill their time to insurance companies. What are patients to do when they see a doctor that will not refer them or that the doctor has no one available in the small rural community? This is not a promising answer for a solution.
The third point Amy put forth is “Garner consistent support from both physicians and insurance providers for diabetes programs”. This is partially covered along with the above point in Donna's point: “We are particularly pleased to begin work on a new demonstration project focusing on mobile health. With the Office of Minority Health, Baylor Diabetes Health and Wellness Institute and AT&T, we are facilitating a project that will connect diabetes educators with patients via mobile technology and video platforms. We believe these mobile technologies have huge potential to revolutionize the way educators can interact with their patients and increase access to diabetes education services, particularly in rural and under served areas”.
Granted this is still in the development stage and we do not know how far this will go. Will the program be for minorities only? Will the program be nationwide? These are just a few of the yet unanswered questions.
Amy's fourth point is “Establish accepted best practices for diabetes treatment that are clearly communicated throughout the field”. And, the last point in Amy's list of needed changes is “Drive more proactive participation from the patient community”.
Unless I missed something on Donna's reply, these two points were completely unanswered. In place of answering the above, we were told about “Establishing State Licensure for Diabetes Educators”. Read this for more information and if interested there are some valuable links. This could open a can of wiggly worms but may well be worth the fishing.
I will continue the discussion about more questions for the AADE and maybe a few challenges, in my next several blogs.
October 3, 2011
Maggots May Help Diabetic Wounds
I have to be amused every time I see another article on the use of maggots. No, there is nothing wrong with using them and since their use has been around for centuries, why all the fuss. Just use them and quit making a big deal about it. Yes, I know that our MRSA infected hospitals and newly trained doctors have a revulsion to their use, but be realistic. We need this type of maggots for some wounds, especially on people that refuse to manage their diabetes. If physicians can be open-minded and catch these wounds early, maggot treatment will often prevent the dreaded amputation.
The writers of this press release just do not get it. Maggots will not heal a wound. Even the researchers should know this, but apparently, they want to have people think this. What the maggots do is clean the wound of damaged tissue, which then will allow for faster healing. This is how it may help, but maggots healing a wound – never.
This small study is just another attempt to gain funding and have more studies. I say let them have the funding if it will finally convince our physicians of the value of the treatments. I know, I know, the physicians have to have the approval of the FDA – oh really. Some of these physicians ought to have to travel in some of the remote parts of Africa where medical people have not been and see people treat wounds with maggots there. It is amazing what these little creatures can accomplish. And believe me, conditions there are not sterile and the rags used to bind the wounds do not compare to the MRSA sterility of our hospitals.
Before I get totally carried away, please read this article, my blog, this bit of history, and this article. I have to have a little tongue-in-cheek fun once in a while.
The writers of this press release just do not get it. Maggots will not heal a wound. Even the researchers should know this, but apparently, they want to have people think this. What the maggots do is clean the wound of damaged tissue, which then will allow for faster healing. This is how it may help, but maggots healing a wound – never.
This small study is just another attempt to gain funding and have more studies. I say let them have the funding if it will finally convince our physicians of the value of the treatments. I know, I know, the physicians have to have the approval of the FDA – oh really. Some of these physicians ought to have to travel in some of the remote parts of Africa where medical people have not been and see people treat wounds with maggots there. It is amazing what these little creatures can accomplish. And believe me, conditions there are not sterile and the rags used to bind the wounds do not compare to the MRSA sterility of our hospitals.
Before I get totally carried away, please read this article, my blog, this bit of history, and this article. I have to have a little tongue-in-cheek fun once in a while.
September 30, 2011
Introduction To Prediabetes – Part 2
Some important reminders for all people, without or with diabetes. First obtain copies of all lab reports and tests preformed by your doctor or hospital. I cannot emphasize how important this is for tracking your health. If you have a family history with type 2 diabetes, this may help you know when to see a doctor and have him/her do the necessary tests. Next, make sure that your doctor is testing you with fasting at least once a year. Also make sure your doctor knows your medical family history.
If you have a family history of type 2 diabetes, on your own, if you can afford it, buy a meter and test strips and develop a routine of blood glucose testing on a consistent basis. To start with I would suggest doing a fasting blood glucose test. If you are under 99 mg/dl, then wait a week and test again. If you are consistently under 90 mg/dl, then I would suggest testing on the same day three or four weeks apart. What you are looking for is trends in fasting blood glucose readings.
After a couple of months if the trend is holding steady (plus or minus 3 to 5 points) then space the time out to two or three months. Just don't forget to test. If you have gained weight, now is the time to lose it with exercise and diet modifications. Start making lifestyle changes now while it may be easier. Read my blog here on the different lifestyle changes, adding weight loss prominently to the list is needed. I downgraded it in my blog and was corrected by one of the commentors.
If the trend starts showing an upward trend, then you may wish to do a few one hour after meal tests as well. If your fasting blood glucose reading is 96 mg/dl (5.3 mmol/L) then you don't want to see more than a meter reading of 125 mg/dl (6.9 mmol/L). If this happens then you may wish to check several times during the day both before and after lunch and dinner. This would be just before you are ready to eat and one hour after eating. If any of the before meal reading are above 99 mg/dl (5.5 mmol/L) and one hour post meal readings (postprandial) readings are above 125 mg/dl (6.9 mmol/L), then please schedule an appointment with your doctor for testing a fasting reading and an oral glucose tolerance test. Get the test and lab reports.
If the readings are in the ranges for prediabetes (see previous blog) and the doctor does not say you have prediabetes, or just that you sugar was a little high, I urge you to consider telling the doctor to check the facts for prediabetes and treat it as such. If the doctor puts you off, consider finding a different doctor if you are able and in an area that you can. Even consider asking for a referral to an endocrinologist if there is one available.
You may need to do some research on the Internet to know if there is one specializing in diabetes that is close enough to you. One site to aid you is this site. Many other sites link back to this site. Just be aware that this may be difficult as there are about 3000 endocrinologists in the US that specialize in diabetes and about 21 million people with diabetes.
Now the lifestyle changes become imperative to avoid further erosion of your health and further damage to your pancreas. Testing becomes even more important and I suggest talking to your doctor about prescribing Metformin (extended release) XR to help while you increase your exercise and reduce your carb intake until you can prove to the doctor that you are able to manage your prediabetes by bringing the blood glucose readings back to the normal range consistently. Then the doctor may allow you to come off the medication. Yes, there are some doctors and pharmacies that will not allow this.
Once you have crossed the line above the normal range, you need to consider that you have prediabetes and treat it as such. Even consistently getting the numbers back in the normal range does not mean that you no longer have prediabetes. All it takes is a few days of mistakes and prediabetes will be back and you will need to work more diligently to maintain the normal numbers again. Continue to look for trends as an increase can indicate that you are having the potential for a type 2 diabetes diagnosis.
If you have the genetic predisposition for diabetes, denial will only make future diabetes management more difficult.
If you have a family history of type 2 diabetes, on your own, if you can afford it, buy a meter and test strips and develop a routine of blood glucose testing on a consistent basis. To start with I would suggest doing a fasting blood glucose test. If you are under 99 mg/dl, then wait a week and test again. If you are consistently under 90 mg/dl, then I would suggest testing on the same day three or four weeks apart. What you are looking for is trends in fasting blood glucose readings.
After a couple of months if the trend is holding steady (plus or minus 3 to 5 points) then space the time out to two or three months. Just don't forget to test. If you have gained weight, now is the time to lose it with exercise and diet modifications. Start making lifestyle changes now while it may be easier. Read my blog here on the different lifestyle changes, adding weight loss prominently to the list is needed. I downgraded it in my blog and was corrected by one of the commentors.
If the trend starts showing an upward trend, then you may wish to do a few one hour after meal tests as well. If your fasting blood glucose reading is 96 mg/dl (5.3 mmol/L) then you don't want to see more than a meter reading of 125 mg/dl (6.9 mmol/L). If this happens then you may wish to check several times during the day both before and after lunch and dinner. This would be just before you are ready to eat and one hour after eating. If any of the before meal reading are above 99 mg/dl (5.5 mmol/L) and one hour post meal readings (postprandial) readings are above 125 mg/dl (6.9 mmol/L), then please schedule an appointment with your doctor for testing a fasting reading and an oral glucose tolerance test. Get the test and lab reports.
If the readings are in the ranges for prediabetes (see previous blog) and the doctor does not say you have prediabetes, or just that you sugar was a little high, I urge you to consider telling the doctor to check the facts for prediabetes and treat it as such. If the doctor puts you off, consider finding a different doctor if you are able and in an area that you can. Even consider asking for a referral to an endocrinologist if there is one available.
You may need to do some research on the Internet to know if there is one specializing in diabetes that is close enough to you. One site to aid you is this site. Many other sites link back to this site. Just be aware that this may be difficult as there are about 3000 endocrinologists in the US that specialize in diabetes and about 21 million people with diabetes.
Now the lifestyle changes become imperative to avoid further erosion of your health and further damage to your pancreas. Testing becomes even more important and I suggest talking to your doctor about prescribing Metformin (extended release) XR to help while you increase your exercise and reduce your carb intake until you can prove to the doctor that you are able to manage your prediabetes by bringing the blood glucose readings back to the normal range consistently. Then the doctor may allow you to come off the medication. Yes, there are some doctors and pharmacies that will not allow this.
Once you have crossed the line above the normal range, you need to consider that you have prediabetes and treat it as such. Even consistently getting the numbers back in the normal range does not mean that you no longer have prediabetes. All it takes is a few days of mistakes and prediabetes will be back and you will need to work more diligently to maintain the normal numbers again. Continue to look for trends as an increase can indicate that you are having the potential for a type 2 diabetes diagnosis.
If you have the genetic predisposition for diabetes, denial will only make future diabetes management more difficult.
September 29, 2011
Introduction To Prediabetes – Part 1
Words of warning! Have you had your doctor say to you or a family member, “be careful what you eat, your blood sugar is a little high”, or “you have a touch of sugar so watch what you eat!”. I won't go into other phrases that have been used, but many doctors just can't bring themselves to tell a patient they have prediabetes or might be near to a diagnosis of diabetes. Some even delay the diagnosis of diabetes because they are not aware of the damage that may be possible.
Translation of the above comments –you may have prediabetes and you need to take this seriously or you may have the start of diabetes. Why can't they just tell you this and do the remainder of the needed tests. Well, unless you are one of the lucky few that has the right medical insurance and it is prediabetes, you will be billed when it is rejected by the insurance company. If it is diabetes, medical insurance should cover the lab costs providing you have medical insurance. Sad but true.
First, fasting blood glucose levels for a person without diabetes can vary from 70 mg/dl to 99 mg/dl (3.9 to 5.5 mmol/L). One hour post meal testing (postprandial) can vary depending on the food consumed but seldom gets over 120 mg/dl (6.7 mmol/L). Normally a person without diabetes will have two-hour readings back below 100 mg/dl (5.6 mmol/L) or nearer 90 mg/dl (5.0 mmol/L).
For a person with prediabetes, fasting blood glucose levels will vary from 100 mg/dl to 125 mg/dl (5.6 to 6.9 mmol/L). With prediabetes, postprandial one or two hour testing can get to 140 mg/dl (7.8 mmol/L). Within three hours blood glucose readings should return to below 125. Blood glucose readings for prediabetes is also called impaired fasting glucose and impaired glucose tolerance.
For a prediabetes diagnosis, some doctors are using the A1c only which may not be reliable. Doctors use the ADA A1C range of 5.7–6.4%. Most doctors should also be using the oral glucose tolerance test (OGTT) and the fasting blood glucose test. With OGTT the blood sample is drawn two hours after drinking a 75-gram glucose drink. If the results are from 140 to 200 mg/dl (7.8 to 11.1 mmol) it is considered prediabetes. If the results are over 200 mg/dl (11.1 mmol/L) then the diagnosis should be diabetes.
Okay, now you have the diagnosis of prediabetes, what is the next step. Stop blaming yourself – it is not your fault. You may have accelerated the condition by your lifestyle, but you did not cause it. Family genetics has a lot to do with prediabetes and type 2 diabetes.
Yes, if you haven't noticed – others are all too willing to blame you and tell you to lose the weight and stop having diabetes. You do not have to be overweight to have pre-diabetes. If they only knew that they could be diagnosed the next week and they may not be overweight. And how do they account for those that are overweight and never get diabetes. Truth is they don't care, you are their scapegoat now.
Then learn to forget the past and live in the present. The quicker you learn this and put denial behind you, the better you will be able to manage prediabetes and put yourself in a position to possibly prevent the progression to type 2 diabetes, or at least delay it for many years. It is possible.
Previous blogs on prediabetes are – blog 1, blog 2, and blog 3.
Translation of the above comments –you may have prediabetes and you need to take this seriously or you may have the start of diabetes. Why can't they just tell you this and do the remainder of the needed tests. Well, unless you are one of the lucky few that has the right medical insurance and it is prediabetes, you will be billed when it is rejected by the insurance company. If it is diabetes, medical insurance should cover the lab costs providing you have medical insurance. Sad but true.
First, fasting blood glucose levels for a person without diabetes can vary from 70 mg/dl to 99 mg/dl (3.9 to 5.5 mmol/L). One hour post meal testing (postprandial) can vary depending on the food consumed but seldom gets over 120 mg/dl (6.7 mmol/L). Normally a person without diabetes will have two-hour readings back below 100 mg/dl (5.6 mmol/L) or nearer 90 mg/dl (5.0 mmol/L).
For a person with prediabetes, fasting blood glucose levels will vary from 100 mg/dl to 125 mg/dl (5.6 to 6.9 mmol/L). With prediabetes, postprandial one or two hour testing can get to 140 mg/dl (7.8 mmol/L). Within three hours blood glucose readings should return to below 125. Blood glucose readings for prediabetes is also called impaired fasting glucose and impaired glucose tolerance.
For a prediabetes diagnosis, some doctors are using the A1c only which may not be reliable. Doctors use the ADA A1C range of 5.7–6.4%. Most doctors should also be using the oral glucose tolerance test (OGTT) and the fasting blood glucose test. With OGTT the blood sample is drawn two hours after drinking a 75-gram glucose drink. If the results are from 140 to 200 mg/dl (7.8 to 11.1 mmol) it is considered prediabetes. If the results are over 200 mg/dl (11.1 mmol/L) then the diagnosis should be diabetes.
Okay, now you have the diagnosis of prediabetes, what is the next step. Stop blaming yourself – it is not your fault. You may have accelerated the condition by your lifestyle, but you did not cause it. Family genetics has a lot to do with prediabetes and type 2 diabetes.
Yes, if you haven't noticed – others are all too willing to blame you and tell you to lose the weight and stop having diabetes. You do not have to be overweight to have pre-diabetes. If they only knew that they could be diagnosed the next week and they may not be overweight. And how do they account for those that are overweight and never get diabetes. Truth is they don't care, you are their scapegoat now.
Then learn to forget the past and live in the present. The quicker you learn this and put denial behind you, the better you will be able to manage prediabetes and put yourself in a position to possibly prevent the progression to type 2 diabetes, or at least delay it for many years. It is possible.
Previous blogs on prediabetes are – blog 1, blog 2, and blog 3.
September 28, 2011
Terms Used for Diabetes
If you get nothing else from this blog, I want you to get in the habit of asking for a copy of your lab test results and make sure that you get a copy before leaving the doctor's office. The good news is that if the current proposal David Mendosa wrote about in his blog here goes into effect, we will have the right to receive them from the lab even before our appointment. Some do receive them this way now, but for many access has been denied until the doctor receives them and gives you a copy. Even then many doctors have been reluctant to give patients copies of their lab reports.
Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 (HIPAA) is one area you should spend to time becoming familiar with as this spells out your rights to your medical records. Use this link to assist in your learning and follow other links on the page and page two. This site will be helpful as well. There are other sites so use your search engine. I have not been through the entire act.
This site will help US citizens in learning what their legal rights are to obtain copies of their medical records and this site will provide information about what procedures to follow if you are refused rights to you medical records - there are five pages.
You may not know what all the results mean, but you are capable of learning. Most, but not all lab reports will be divided into three columns. The first column is normally name of the test or event to be measured, the second column is usually the test results and may or may not include the letters L for low or H for high. The last column is normally the reference range for the test or what is considered normal.
Then you can take your lab report and go to this web site to do some learning. Be sure to explore as more than diabetes is covered on this site. I have given you the direct link to understanding the diabetes part and you may explore on your own. Be careful in thinking all labs are alike in their reference ranges – they can differ depending on the test analysis used. Also, very few tests are standardized nationally so lab results will vary.
Example: Blood glucose – reference range for the lab my doctor uses is 70 to 110 mg/dl. The mg means milligrams and the dl means deciliter, so mg/dl is milligrams per deciliter. The USA is the only country that uses this. The rest of the world uses millimoles per liter (mmol/L). This site has many terms and explanations of them and this site may also be helpful. There are many sites that have conversion calculations, but I do like this site and click on G for glucose.
Sometimes it is not necessary to know the technical meaning so much as knowing the acronym definition. HbA1c (A1c) is glycated hemoglobin (further definition is found here) measurement for approximately the last three months. The result is somewhat weighted in favor of the last month (ideally the cells would have the same life span) as the cells in the blood die off at random and new are always being created.
Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 (HIPAA) is one area you should spend to time becoming familiar with as this spells out your rights to your medical records. Use this link to assist in your learning and follow other links on the page and page two. This site will be helpful as well. There are other sites so use your search engine. I have not been through the entire act.
This site will help US citizens in learning what their legal rights are to obtain copies of their medical records and this site will provide information about what procedures to follow if you are refused rights to you medical records - there are five pages.
You may not know what all the results mean, but you are capable of learning. Most, but not all lab reports will be divided into three columns. The first column is normally name of the test or event to be measured, the second column is usually the test results and may or may not include the letters L for low or H for high. The last column is normally the reference range for the test or what is considered normal.
Then you can take your lab report and go to this web site to do some learning. Be sure to explore as more than diabetes is covered on this site. I have given you the direct link to understanding the diabetes part and you may explore on your own. Be careful in thinking all labs are alike in their reference ranges – they can differ depending on the test analysis used. Also, very few tests are standardized nationally so lab results will vary.
Example: Blood glucose – reference range for the lab my doctor uses is 70 to 110 mg/dl. The mg means milligrams and the dl means deciliter, so mg/dl is milligrams per deciliter. The USA is the only country that uses this. The rest of the world uses millimoles per liter (mmol/L). This site has many terms and explanations of them and this site may also be helpful. There are many sites that have conversion calculations, but I do like this site and click on G for glucose.
Sometimes it is not necessary to know the technical meaning so much as knowing the acronym definition. HbA1c (A1c) is glycated hemoglobin (further definition is found here) measurement for approximately the last three months. The result is somewhat weighted in favor of the last month (ideally the cells would have the same life span) as the cells in the blood die off at random and new are always being created.
September 27, 2011
Finally, the AACE/Takeda Site Is Operational
Sorry, but AACE has removed the site referred to in the first and last links of this blog
Finally, the American Association of Clinical Endocrinologists and Takeda Pharmaceuticals approved resource site is up and available to the online community. Am I surprised about the site? I am surprised a little, but it is about what I expected for the start – very spartan and very closed in what they are recommending for approved sites. For those of us that may have hoped for more and maybe a little less of the professional sites that everyone should have known to begin with, I will have to say that I will have to wait for further approvals in the future.
I think there will be some surprises in the future, but I will not hold my breath. If you are interested in the sites currently listed – here they are – all 15 of them. Only two sites for me were somewhat of a surprise, this site (dlife.com – a diabetes forum site) and this site (American Council on Exercise). Sorry, the AACE removed the site. Apparently they did not think it was important.
What disappoints me the most is when looking for the list of approved sites; it is not a prominent feature. It is hidden in the “About” area and is the last item. Then I am very upset about using the links to the approved sites. The links are not what I would call intuitive. I normally open (right click) any link in another tab to be able to come back and open the next link.
What I got was a copy of the page I started with. So to repeat, if you right click (and open in a new tab) on the link for (www.mayoclinic.com) you will get a copy of the page you were on. Now is the problem of what to do. Do not double click on the site you want to explore. Slowly left click one time and you will receive a message box outlined in red that states:
“You are now leaving the Diabetes Navigator website.”
“The American Association of Clinical Endocrinologists (AACE) and Takeda Pharmaceuticals North America, Inc. are not responsible for the content, privacy policies, or any other information included in the external website, unless otherwise noted. Please click "OK" if you wish to leave our website to receive additional information.”
This I can appreciate, but the wording leaves a lot to be desired. Since the site is on the approved list, why do we need words of warning unless there is something making this a legal requirement since they are not the authors. By clicking on okay, you are taken to the Mayo Clinic website. You had better be ready to explore, as there is little about where to go if you are doing research. You are forced to use the search box and hope that you have the right key word or words.
Yes, if you are looking for a doctor, requesting an appointment, or planning to make a contribution you are on the right page. Yes, there is “Health Information” to help you at the bottom of the page and other information. Explore you will need to do. There is a lot of information on the Mayo Clinic website – finding what you are looking for is the key.
Since I am a blogger, I knew where the blog for diabetes is located and had that are bookmarked already. Once you are there, the page also lists other good sources for diabetes information to be explored. What would have been a great help from the people assembling the information is a few of the better links within each site.
Exploring will still be up to each individual and his or her interests. Do take time to explore the diabetes navigator website. A lot of information is housed within the site with links to other sites. At the bottom of the page under “Lifestyle” is some great informational links, but you will need to go through the red box to get to the site. Enjoy exploring!!!
Watch for a post later
Watch this spot for a post later today as I am not allowed to post it now. Thank you.
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