Does Prediabetes Mean Eventually Diabetes?

At least this one subject I can understand and partially agree with the answer given to a prediabetes question. Granted there are some terms that need better definition. This doctor missed a golden opportunity to give a great answer instead of the partial answer.

The question is does prediabetes mean that diabetes will follow. First, the answer that many people do not want to hear. If you do nothing and do not manage prediabetes, it will progress rapidly to type 2 diabetes. That you can count on.

If you take the doctor's answer, you may be able to delay type 2 diabetes for a few years if you do not let denial take over. The doctor talks about making lifestyle changes that can significantly delay or even prevent type 2 diabetes. The answer then goes on to suggest a five to ten percent weight loss. He does explain that this means about 30 minutes of exercise daily and eating healthy meals.

In describing healthy meals, he says nothing about doing any blood glucose testing to see what the food you are consuming does to your blood glucose levels. Then the answer becomes lopsided and the meals he is suggesting becomes very agenda oriented. The agenda excludes any red meat and foods containing any cholesterol. The mantra of egg whites, soy, and whole grains sounds like the American Diabetes Association mantra.

The suggestion of vegetables and fish for foods is acceptable, but do be careful of the quantity of fruit and soy or soy products and especially whole grains. The soy and whole grains can be an overdose of carbohydrates which will undue the benefits of exercise and may well cause weight gain. He says nothing about avoiding highly processed foods and educating yourself to avoid or severely limit potatoes, rice, and bread.

Final suggestions include quitting smoking, drinking alcohol in moderation if you drink and reducing stress to assist in managing your blood glucose levels. The doctor again partially covered the at risks from prediabetes. He mentions heart disease and stokes, but fails to mention any of the other complications that can or may occur in prediabetes. These include kidney damage and eye and hearing problems. Since these vary greatly from one individual to another, it is still wise to know the symptoms and solutions.

Read the short WebMd question and answer here.

Under Age 60, Have Diabetes, Get Hepatitis B Shot

The Advisory Committee on Immunization Practices (ACIP) stopped short of recommending hepatitis B vaccination for those over 60 because there is data showing that the vaccine is less likely to be effective in those who are frail and elderly.

They did have concern for many in nursing homes where proper procedures are not followed, and hepatitis B was accidentally spread by shared glucose monitors. I have some questions about whether they were talking about continuous glucose monitors or if they were talking about glucose meters. I suspect the later and more likely the lancer tool. I wonder why a nursing home would share something that is very likely to spread medical problems.

The ACIP did by a 12 to 2 vote strongly recommend that diabetes patients under the age of 60 that have not been fully vaccinated for hepatitis B have their vaccination completed. While not saying which elderly diabetes patients, they feel that many still need the vaccination over 60.

The hepatitis B vaccine is generally more effective in young adults. The ACIP advises that when people learn of their diabetes diagnosis, they should get the 3 or 4 dose series, which lasts a lifetime.

The hepatitis B virus infects the liver and for those that are not able to fight off the infection results in about 1.25 million Americans having a chronic hepatitis B infection. Hepatitis B kills 3 to 5 thousand people a year in the USA.

“The ACIP is made up of independent experts who advise the CDC and FDA on vaccination policy. The committee's recommendations form the basis of the U.S. immunization schedules.”

If you have not had the series of hepatitis B shots and have diabetes, please get the shots as recommended by the ACIP. Read the press release here.

Blame is Bad; Positive Attitude is Good for Diabetes

When we are first diagnosed with diabetes, we all tend to go through a grieving process. First, we have anger, then denial, sometimes depression, and then acceptance. We do not all experience them at the same level, order, or even all of these. Denial for me was about three years after diagnosis and I had already developed good treatment habits, which did save me from many problems because the period of denial was shortened by the good habits. Depression set in about the same time and it was good that I was courting my second wife as this helped end the depression and I think denial as well.

Now a study has looked at some of the happenings after diagnosis and how this affects us. I was a little shocked by some of the results, but still I realize that this can happen. Many “people with diabetes who see themselves as responsible for their disease onset blame themselves for making poor lifestyle choices and are significantly less likely to monitor their glucose levels, properly inject themselves and make lifestyle choices that would benefit their condition.” I know blame had something to do with this, but I was not aware that these people are significantly less likely to monitor their blood glucose levels and take proper care of themselves.

Getting rid of the blame game quickly may have been my saving force and caused me to start monitoring my blood glucose levels quickly and often. I was trying to decide what foods I could and could not tolerate, and which ones to eat less of or eliminate from my menu. This became my driving force the first several months and then when I was put on insulin; my habits became even more ingrained.

"As perceptions of responsibility for disease onset increased, so did trait anger," said Mary Turner DePalma, professor of psychology at Ithaca College, "Increases in trait anger were associated with increases in self-blame and negative social support, which were associated with the self-report of poorer disease management." This is why many people with type 2 diabetes also become angry when not so well meaning people make very impolite remarks when at public and private events when food is being served.

"That perceptions of responsibility for diseases onset are associated with health behavior illustrates their importance in the specific context of diabetes," DePalma said. "Our study shows that interventions designed to improve anger management and increase disease acceptance may offer additional mechanisms to improve diet, exercise and perform appropriate blood glucose testing in individuals with diabetes."
This last statement is very important and is one of the factors that need to be considered more. Positive interventions can go a long way to improve diabetes care and patient support by the medical community should be part of this. The medical community seems not to care about attitudes that they display to patients with diabetes and many physicians use the blame and fear tactics to get patients to follow their directions. Positive attitudes by physicians and nursing staff could go a long way to provide good examples for patients with diabetes and other chronic diseases.

Drugs for Depression Can Cause Hypoglycemia

Damn if you do, and damn if you do not, seems to be the current dilemma if you have diabetes and suffer from depression. This is the warning that needs to be on every box of certain depression medications. If you suffer from depression, take time to read the instructions for the drug you are prescribed and do ask the doctor what side effects it will cause for people with diabetes. Be sure that you understand the instructions.

A term you should be knowledgeable about is antidepressant medications called SSRIs (selective serotonin reuptake inhibitors). There are several drugs that fit this class and not all have warnings. Either they are different, or are so new that no cases have been reported. Since first introduced in the 1980's, Prozac has been very effective for treating depression. Another drug Zoloft introduced later is also effective. Viibryd, a late comer to the depression treatment has no warnings.

The warning for this class of depression drugs is they can cause hypoglycemia while taking the drugs and can cause hyperglycemia when you stop taking the drug. This means for all medications, insulin and oral, a reduction in dosage may be needed when starting any of the SSRIs. Then this reduction may need to be reversed when you are taken off any of the SSRIs.

Be sure to talk this over with your doctor. Who knows, you may educate the doctor and you will be safer for knowing how to look out for and treat the side effects. Read the blog by Dr. Quick here. Make sure also that your pharmacist gives you complete instructions.

What is up at Health Central?

There are some excellent diabetes bloggers writing for Health Central, but I do not know whether I am missing something, but with two diseases receiving national attention in the month, Alzheimer's and Diabetes, I would have thought Diabetes Month would have also rated some space. It is just for the number of times I have visited the site recently, I thought I would have seen something on the site about this being Diabetes month or that tomorrow November 14 is World Diabetes Day.

Granted, I have not visited the entire site, but the home page features National Alzheimer's Awareness Month, as does the page for Alzheimer's. When you go to the page for diabetes, nothing is mentioned about Diabetes Month or World Diabetes Day. This seems a little odd considering the bloggers for diabetes. Not only am I disappointed, but I am also wondering about the position of Diabetes Health. I have been skimming the site regularly since the beginning of November, but nothing appears on the pages for Diabetes, and Diabetes and Teens, about Diabetes Month or World Diabetes Day.

The official organizations representing diabetes in the USA may not agree on a symbol to represent diabetes, but they do recognize Diabetes Month and World Diabetes Day.  There are people trying to get the diabetes organizations to accept one symbol and I applaud their efforts. We need unity to give us recognition like breast cancer.

This unity needs to come from the American Diabetes Association, the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators and the JDRF. Presently all are going their separate ways and seem to have little interest in accepting something that the World Diabetes Federation is promoting for the world. Many in the diabetes online community are working to bring this about, but Health Central is not one of them.

Byetta Has Powerful Anti-inflammatory Effect

Byetta is a diabetes medication that I have wrestled with for several years about using. My endocrinologist and several friends have encouraged me to use it, but I have resisted because of the unpleasant side effects. Then along comes a press release that has me thinking about it again.

Exenatide (Byetta) is a drug prescribed to diabetes patients to improve blood glucose management. Now according to a University of Buffalo study, it has a powerful and rapid anti-inflammatory effect.

“"Our most important finding was this rapid, anti-inflammatory effect, which may lead to the inhibition of atherosclerosis, the major cause of heart attacks, strokes and gangrene in diabetics," says Paresh Dandona, MD, UB Distinguished Professor in the Department of Medicine, UB School of Medicine and Biomedical Sciences, and senior author.” This is a gigantic plus and will factor into my decision.

It is interesting that the study reports that this anti-inflammatory effect happens completely independent of weight loss over the 12-week study period. This is important as obesity is an inflammatory problem and adipose tissue contributes to inflammation. Weight loss on its own can lead to an anti-inflammatory effect.

The authors of the study state that corticosteroids and insulin which are anti-inflammatory, but neither drug demonstrates such a powerful and rapid anti-inflammatory effect. Plans are under way to use exenatide in acute inflammatory cases in intensive care units or following heart attacks and strokes, where rapid anti-inflammatory effect is required and such drugs may be of potential use and helpful.

Food Labels May Get Overhaul

This press release in HealthDay News is somewhat confusing and makes me wonder whom the writer works for, HealthDay News or the food industry.

First off, food labels are rarely on the front of food and beverage packages. Most are on the back, side, and occasionally even the bottom. Do they need to be simpler? Maybe not simpler, but a lot more informative and accurate is my point. Presently there are gaping holes in the current food label requirements that the food industry are taking full advantage of and abusing to the maximum.

"There are a lot of different [rating] systems out there," said Ellen Wartella, chair of the IOM committee that wrote the report, and director of the Center on Media and Human Development at Northwestern University. "But no one system has all the features we think are most helpful. Our goal is to say no one has to be a nutrition scientist to discern whether a packaged food is healthy or not healthy."

"We want something that's readily identifiable, easily understood and that cues the consumer that this is a healthy product," Wartella added.

This is about the sum of the report issued by the Institute of Medicine (IOM). I do have to agree with the author that some standardization is due and the package fronts could very well be the place to put this so that consumers would know where to look instead of having to flip the box around to look on the back or sides.

The IOM report suggests a rating system based on the serving size that tells the consumer whether the package contains ingredients that are more or less healthy than recommended for fats, sodium, and sugar. The report also suggests the label be located in the same spot on all products.

Now I may have to disagree on using the USDA healthy dietary recommendations and even many of the Medical Groups recommendations. I do agree with the report that the food and beverage industry be motivated to reformulate products to be healthier. I also agree that foods that do meet these requirements be prominently displayed in food stores.

The report also urges that a single system would let consumers quickly compare choices within a variety of food categories just by looking at the front of the packages.  “Determining whether or not a product can carry a healthy food package label would be done on a point system based on how much sugar, salt and fat it contained. These were picked because they are linked to obesity, diabetes and high blood pressure, among other illnesses.  To be eligible for a "healthy" label, the product would have to have limited amounts of sugar, salt and trans fats, the IOM committee said.”

“The Grocery Manufacturers Association has already come up with its own labeling system. "In January, the Grocery Manufacturers Association and the Food Marketing Institute launched Facts Up Front, a fact-based, front-of-pack nutrition labeling system to help busy consumers -- especially parents -- make informed decisions when they shop," said association spokesman Brian Kennedy.”

No matter how this is accomplished, there are bound to be discussions about who gets favored status and whether the labels meet any standards that are easier to read and assess whether the food and beverage industry have more loopholes to be able to sidestep the requirements. It is clear that current labels are not meeting the needs of consumers and the loopholes are being abused.

One example is the term “contains whole wheat” and this can mean maybe if we are lucky ten percent whole wheat and the remainder is not whole wheat. In addition, whole wheat in its current form may not be the healthiest for us. Moreover, those of us with diabetes know that high fructose corn syrup raises our blood glucose levels faster and higher than we should have them increased, and the same goes wheat.

What Your Meter Tells You About Your Eating

We have all read this, but have you really tested this? Eating to your meter can be very beneficial in helping you manage your blood glucose. For those with type 2 diabetes and on oral medications, this is a philosophy you almost must adopt to manage diabetes effectively. Counting carbohydrates is even more important so that you learn how to manage the food intake to get the greatest efficiency from your diabetes medications.

The medications you are taking will only manage so many carbohydrates effectively and then you start to lose control. This then becomes more important to know what your blood glucose meter is telling you about the quantity of food you consumed. Using your meter also can indicate which foods you need to severely limit and which you can consume or may need to eliminate altogether from your menu.

This is your reason for supporting my previous blog here for having extra test strips available after diagnosis and for other times when you are having diabetes management problems and need to figure out what may be wrong with your menu selections.

On limited test strips, eating to you meter may be very discouraging because you do not have a lot of information to guide you. That is one reason, I suggest that if you can afford it for a few months, buy extra test strips. The extra testing supplies will give you confidence in your carb counting and portion of food intake. It will also make it easier to determine what foods are best left off the menu.

There are various plans discussed for those on limited test strips so you will need to work with what works best for you. A food log after diagnosis is also an aid that many people just do not understand the need to keep. I can attest to how many times this has told me why my postprandial blood glucose levels were higher than they should have been and what I did not do. The important part is not lying to yourself, but keeping accurate logs.

Knowledge is power, and therefore knowing what each test is telling you, watch for trends in fasting blood glucose levels and use your meter to learn more from pre-meal testing to tell you about your prior meal. If you can afford extra test strips for a month or two, learn that you do not want your preprandial and postprandial readings to increase more than 40 mg/dl if possible. You should also develop an exercise regimen with your doctor's approval to help get your blood glucose numbers to become the best for you.

If you do have trouble with managing your blood glucose levels, give insulin a consideration and study about it before the need arises.

Read a couple of other articles about eating to you meter here and here.