Parents Now Have Web Site to Test Amblyopia

This is not about diabetes, but I felt that parents of young children should know about this free test to assess their children for amblyopia. What is amblyopia you ask? The definition in Merriam-Webster's Medical Dictionary says “Function: n: dimness of sight especially in one eye without apparent change in the eye structures called also lazy eye, lazy-eye blindness.”

The test was designed by David P. Taylor while he was a graduate student in the Department of Medical Informatics at the University of Utah, Salt Lake City. Researchers, led by Shaival Shah, MD, from the Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City presented the test at the American Academy of Ophthalmology 2011 Annual Meeting.

This free and widely available Web-based test will allow parents to test their own children for amblyopia. “LazyeyeTest.org assesses visual acuity, which has proven to be more reliable than other sensory tests. The online test comprises a series of 6 graphically rich, jargon-free, plain-language screens describing the test and how to interpret the findings. Typically, the test takes less than 15 minutes to complete.”

One warning to parents – follow directions carefully. The most common error was the parent putting the patch over the incorrect eye. The next most common error was measuring the distance from the screen.

“Refinements of the screen instructions might lead to fewer misinterpretations of the instructions and decrease the error rate,” according to Richard Olson, MD, also from the University of Iowa, who was head of the research team.

Please read the press release here.

Diabetes Self-Education – An Important Tool

Self-education is one of the best tools for managing diabetes. The doctors do not have the time necessary and some do not have certified diabetes educators (CDEs) available even for referral. Often the doctors do not even have a registered dietitian available that specializes in diabetes. Many, but not all of us, have had less than favorable experiences with CDEs and others, so do be careful.

Self-education is key for people to manage diabetes effectively and studies are showing that this works. My blog here with its link shows that education does work in reducing A1c's. This is just one of several studies that is receiving little attention or publication because writers cannot make it sexy enough to draw attention to it.

My second blog here is about foot care and why it is so important. However, without education, many people continue to ignore the consequences of unmanaged diabetes. Amputation is becoming a thriving money maker for many surgeons and the patients have only themselves to blame in many cases.

Another tool in the education arsenal is peer-to-peer groups. It has been shown that there is a need for these groups. The results they accomplish in reducing A1c's are positive. David Mendosa has an excellent blog about this as part of his reports from the Medicine 2.0 conference at Stanford University in Palo Alto, CA.

There are several of us with type 2 diabetes that occasional get together and exchange ideas and discuss what we have been reading. No, not a support group, but a few of us that do research and study about diabetes. We exchange emails and compare notes about different articles, press releases, and technologies to aid in our management of diabetes. An informal peer-to-peer group at best, but it has helped us in managing our diabetes more effectively.

That is also the reason for discussing the types of patients in previous blogs, here and here. This makes people more aware of what education can do to make us. Education make us more knowledgeable and assists us in making good decisions to manage our diabetes. With this now being diabetes awareness month, keep focused on education. The more education, the easier advocacy becomes and for some even activism.

Prediabetes and Its Dangers

So you think there is no danger associated with prediabetes? An acquaintance of mine in this small town told me he was not going to worry about the prediabetes diagnosis as there were no dangers associated with it and either you had diabetes or you did not. So sure was he that he constantly reminded the group of us that had type 2 diabetes that he was going to be okay.

Why we continued to accept him and his taunts still bothers me, but we did. I guess we knew that eventually he would change his tune and start asking questions, serious questions. Well that day finally arrived, but not the way we had expected. When he was not present for our get together (now over a month ago), one of the others called his wife and got a shock. He was in the hospital and was in a high blood glucose coma. We do not know how high it was, but we guessed he now had full-blown type 2 diabetes.

We asked if he could have visitors and his wife said the doctor had asked not for that day or the next for other than family. Well, we never did get to see him. Whether we will every know the full story is doubtful, but that night he passed. His wife said that their two children had arrived after work so she was on her way home to clean up and return. On her way home, their son called and said Dad was gone.

We know a little more, his heart had failed and they had been told that his kidneys were in poor condition. I have been researching and yes, cardiovascular disease does dramatically increase with prediabetes, retinopathy can develop, and kidney health can be impaired. Many with prediabetes can develop diabetic neuropathy or peripheral neuropathy. Not quite what I had expected for prediabetes. Again, this is a reminder that everyone can be affected differently when it comes to prediabetes and type 2 diabetes.

Which leads me to the question – why not treat it as diabetes. I'm sure the American Diabetes Association will not have an answer.

We have also learned that our friend had high blood pressure and had stopped taking his medications. Could we have done more for him? We have talked about this and have decided that for him we had done all we could have under the circumstances, as he would not have listened to us. How will we treat future people that come to the fringes of our group? We will invited them in if they have a diagnosis and work to get them past denial if they are in denial. Will we be successful – remains to be seen. We just know that we will make every attempt.

We have checked the books on diabetes at our local library and they will be acquiring two more books at our request to supplement the ones they have. We are investigating other activities like making our informal group a little more known and possibly working with doctors in nearby towns if they are open to this.

This WebMD article is available as a reference on prediabetes.

Alarming Trends in Diabetes Research

When I first read the blog of September 21, 2011 by Tom Ross, I thought this is funny. Why would he write something like that? Okay, I thought he was out in left field – way out. However, as I have read many press releases since I read that, I find that a good number do fit or nearly fit the mold as he proposed it.

So I should not doubt Tom? I would have to say in hindsight that he is right. I am finding that some things do fit well within patterns or at least certain parameters and many of the press releases seem eerily alike and fit Tom's example.

This is almost as disconcerting as small studies that are hyped and really give no meaning to the overall education about the topic. Many are done just to be hyped and obtain funding for more studies. So occasionally I will find a small study that peaks my interest, but most that I come across just are filed for the future when some real studies are done involving many more people.

Now as I come across more studies that fit the mold that Tom Ross has described, I file them as well and will wait to see if further studies lend any credence to these studies. Live and learn is a good rule to follow in learning and researching about diabetes.

This is one reason that I read Tom' blogs. There are educational tidbits to be gleaned and often applied, at other times I like his humor, and then there are topics which hit home (even after the fact), and generate topics for me.

Too Much Vitamin D Can Be Toxic

When I read the following article by Dr. John Cannell, I had to reread it several times to be sure I was not missing something. I have been researching and have a couple of friends researching to find other such problems with Vitamin D toxicity. To date there have been other cases found, but none as severe as the ones Cr. Cannell reports.

Should we be concerned? Generally no, but the warning message is there and needs to be heeded. Always know what you are taking and why. Is there a possibility of taking too large a dose? Yes, as Dr. Cannell shows with the three cases, it is possible when you buy from the wrong manufacturer or misread the directions for the dosage. In general, most people do not need excessive doses of Vitamin D unless a doctor prescribes a short-term need.

One of the problems that can arise is when the doctor orders the wrong test for levels of Vitamin D. While this is not uncommon, you need to have some knowledge of the tests ordered and why. First and most common is 25-hydroxyvitamin D (25(OH)D) Vitamin D test for Vitamin D levels. Do not expect a range result as there is currently no consensus on the level which indicates deficiency and the high end is also in question. Most doctors expect high results to be under 100 ng/ml (nanograms per milliliter (ng/ml) 250 nmol/L) and reflect total serum 25(OH)D.

One word of warning – be sure to get a hard copy of your test results. “Many doctors still consider a result of 30 ng/ml (75 nmol/L) to be sufficient when studies indicate otherwise. For this reason, it is a good idea to ask for the exact number value of the results or a hard copy. Results conveyed by use of the words "normal," "within range," or similar wording might still be inadequate.” Many doctors that are knowledgeable like to see results between 50 ng/ml (125 nmol/L) and 90 ng/ml (225 nmol/L).

The other test that doctors may order (but seldom need) is 1,25-dihydroxyvitamin D.
"This test is needed if calcium is high or the patient has a disease that might produce excess amounts of vitamin D, such as sarcoidosis or some forms of lymphoma, 1,25-dihydroxyvitamin D usually is ordered. Rarely, this testing may be indicated when abnormalities of 1-alphahydroxylase are suspected.” Sarcoidosis is a disease of unknown cause, characterized by granulomatous tubercles of the skin, lymph nodes, lungs, eyes, and other structures.

Dr. John Cannell strongly advises that if you take more than 10,000 IU/day that you must check you 25(OH)D regularly.

Please read this article by Dr. Cannell about the three cases of Vitamin D toxicity. Then read this (click in the blue tabs for specific information). Dr. Cannell also discusses Vitamin D deficiency and has a video in this article.

Who Is At Fault?

I dislike preaching on a topic; however, this is one topic that I admit galls me and I have to wonder why is it that our doctors are afraid to prescribe insulin except as a medication of last resort. I have always wondered if they were not confident with prescribing insulin because they did not know enough about it to teach the patients how to use it, or if they believe some of the myths about diabetes. With the findings of this study (link is now broken), I may have to eat a little crow.

“In a current study it was found that there are certain barriers for physicians that prevent them prescribing insulin much earlier in the treatment of diabetes.... .“ The barriers are often the patients themselves. The people with type 2 diabetes are so ingrained in the myths of insulin that the patients become the barriers to improved health.

Not having been exposed to the insulin myths until several years after being on insulin has been an advantage for me. It seems that many type 2 patients really believe this gobbledygook and refuse to let their doctors prescribe insulin for them or take the prescription and do not use it. Read my blog here about the insulin myths as it shows the below reasons and needs widespread reading.

The study found that 35% of the patients believed insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death. “From the results it was concluded that among poorly controlled patients with Type 2 diabetes newly prescribed insulin, the major predictors of insulin nonadherence included plans to improve health behaviors in lieu of starting insulin, negative impact on social and work life, injection phobia, and concerns about side effects or hypoglycemia.”

While the study found these legitimate concerns, they are myths, which the doctors need to correct. Adding more oral medications does not seem to bring about improvement in blood glucose levels. Many studies have shown more oral medications can have unhealthy effects and increase the risk of cardiovascular events.

“Not previously reported is the finding that nonadherent patients frequently felt their provider had not adequately explained the risks and benefits of insulin.” This statement saves me from having to eat too much crow. There is a lot of work that need to be done on both sides – physician and patient, to educate everyone concerned about the use and benefits of insulin.

Toning Shoes for Exercise Gets a Black Eye

And rightly so, attention is deserved in this case. Greed, the rule rather than exercise safety seem rampant in the shoe industry. Because everyone is being encouraged to exercise, shoe companies decided to cash in with less than safety in mind and are turning out shoes that have brought them to the attention of the Federal Drug Administration because of unproven health claims.

While denying any wrong doing, September 28, 2011, Reebok settled with the FDA over claims of health benefits from use of their shoes. Reebok has also stated the shoes will remain on the market. Other shoe companies are also being investigated though apparently no charges have yet been filed.

“Can a pair of shoes help you burn more calories, tone your butt, banish cottage cheese thighs, and curb joint pain?” This is the nature of claims by exercise shoe companies.

Researchers at the University of Wisconsin-La Crosse tested the claims and found that there was no significant value to the claims. The shoes have an unstable sole and walking in them feels like walking on a balance beam or barefoot along a sandy beach. This forces you to use muscles commonly not used, but the damage is they can change your posture and gait.

Several spokespeople for the shoe industry are saying this is no more than a turf war and the studies have nothing of any value. What else can we expect from the shoe industry – they have the most to lose.

Shoes for walking or jogging should be comfortable and give proper foot support. I urge you to talk with a podiatrist or food specialist for recommendations of proper footwear for the type of exercise you wish to do. Read this article in WebMd about this and consider what they discuss.

Choosing The Right Blood Glucose Meter

For a person that is newly diagnosed with diabetes, selecting a blood glucose meter is not high on their list of things to do. Most often the certified diabetes educator or a dietitian, or in some cases the doctor or his/her nurse will present you with a limited selection and briefly discuss each and ask which you want. In my case it was a hospital CDE that had done her homework and knew which blood glucose meters were covered by my medical insurance. What many writers on this topic forget, in their push to discuss blood glucose meters, is what brands will the readers medical insurance cover.

So unless you are independently wealthy enough to purchase any brand, check with your medical insurance company to know what brands are included in their coverage. Do not forget to ask if the strips are covered for each brand. There have been some mix ups in the past where they covered a meter, but not the test strips. The test strips are the major cost and needs to be considered. For those on Medicare, most all brands and their test strips are available and covered.

Two of the better discussions are done by Joslin Diabetes and the Mayo Clinic. So take time to read their discussion of choosing you blood glucose meter. This site by the FDA while not the best, has some very good pointers.

One important word of caution. We all have probably seen the advertising on TV for the meters that cause no pain. They are right in that statement only. It is not the meters, but the lancets that can cause pain and if used properly, even they cause none to minimal pain. Many of these meters are advertised for use on your arm. If you want or need more accurate and time sensitive blood glucose readings, you will not use these meters. This is especially important if experiencing a low – hypoglycemia – or are doing a post meal reading – postprandial reading. Their accuracy is suspect and at least 20 to 30 minutes after the fact.

So if you are on insulin or oral medications capable of causing hypoglycemia, avoid any meter recommended for arm testing. You need the almost instant readings that you obtain from your finger tips. If you are dropping rapidly, a reading 20 minutes after the fact may be too late to prevent severe hypoglycemia.

New meters are coming on the market fairly regularly, so if you do have time to research them and your insurance does cover them, do yourself favor and check them out. Many have new features that can be helpful and some have too many bells and whistles you will never use. I do like some that now have a feature of giving you a voice announcement of your blood glucose reading, but if you are out in public a lot when you need to test, this feature may not be something you want if you like your privacy.

If you are unemployed or underemployed and cost is a factor, definitely shop around for the cost of the meter and the test strips. Inquire of the manufacturers if they have programs for assistance (many do) and search the web for support groups that offer assistance with testing supplies. There is a wide range of this type of support and the biggest task is finding a good fit. There are groups or individuals taking advantage of you by getting the money and sending outdated strips, so be careful and ask for references. Some diabetes sites can also offer guidance in finding reputable assistance.

If you have served honorably in the US military and are eligible for Medicare, make sure that you apply for Veterans Assistance from the Veterans Administration. This requires copies of your DD214. What you may have for co-pay is based on your income (means test = income less qualifying medical expenses). Testing supplies are normally no charge, but medications are subject to co-pay.