Normally I will not post the same blog to both of my blogs. I feel this topic needs the exposure so that people can determine for themselves where they want to be on this issue.
Is this what we want or what we need? I have to wonder if this will be a good thing for people with chronic diseases. I am not sure I want my medical care retailized or taken care out of a storefront. But this is the latest desire from Walgreens – to become your one-stop health care facility.
Walgreens and other large retail pharmacies are lobbying to make this a fact of life. I do not want to have nurse practitioners in charge of my medical health care. I am thankful that in some of the more remote areas or largely rural areas in the United States, nurse practitioners have been needed to get medical care to people and have done excellent work. This has been a necessity because of the lack of doctors in these areas. But for a retail store like Walgreens in non-rural area, this runs against my better nature.
Walgreens is wanting to do this because of the “national shortage of primary care doctors”. They are proposing to “assist patients in managing chronic conditions of diabetes, hypertension, and high cholesterol”.
We have to wonder if we are going to be prescribed extra drugs or medications as a result. Is the American Medical Association going to allow this to happen? Are the states going to allow this to happen? It is happening in some states that have nurse practitioners, but I hope that this does not come to pass in our more populated states.
Many pharmacies are now giving blood screening, flu shots, and other medical advice mainly under the supervision of pharmacists. This is not always the best for many patients as they do not check any medical records to verify allergies and other medical conditions which might preclude some treatments.
What many are banking on is the new health care act providing insurance to people and they want to cash in on the potential increase of cash. And Walgreens is not bashful about saying this.
Before I would want to utilize pharmacies (or what name they will change to), I would want to know who is responsible for writing the prescriptions and whether they have met the education requirements necessary to be able to write prescriptions. Are the pharmacies going to require filling the prescriptions in their store or can these prescriptions be filled at any pharmacy?
These are just some of the questions that need to be answered before I would accept pharmacies taking over primary medical care. Will pharmacies be required to have doctors available to consult or oversee and supervise prescriptions with appropriate approvals available for states to audit? Will this action create or necessitate more state agencies to oversee questionable medical decisions and audit procedures? Will this just increase medical fraud, Medicare, Medicaid, and other fraudulent practices.
And with the shortage of nurses that exists today, where will all of the nurse practitioners come from? Or will they come from our hospitals and doctors offices thus creating a more critical shortage there?
Before this becomes practice, I would hope that our federal and state legislators will examine this very carefully. The last question I would want answered or information made available to the public is the political contributions made in the last election and to whom were they made.
November 11, 2010
November 9, 2010
The Types of Diabetes
This subject is unusual for me and yet it has an appeal as I have a friend with a child which fits this very well. He has already been talked to about this and sent several emails. He notified me that he is having his infant son tested this week. After reading the background for this blog, he started checking where to have his son tested.
First I would like to set some terms which are new to me. We are all familiar with Type 1 and Type 2. The term used for these, polygenic, comes from the fact that they develop from multiple genes. The other term, used for the more rare types of diabetes is monogenic. These develop from mutations of a single gene.
This defines the types into two distinct classes. Monogenic diabetes forms comprise two to three percent of all diabetes in young people. This is either inherited for some and others have the gene mutation develop basically overnight. Both sides reduce the ability of the body to produce insulin. This is the area of greatest confusion for the medical professionals as they diagnose Type 1, when it is not.
The different types of monogenic diabetes include permanent neonatal diabetes (PND), transient neonatal diabetes (TND), and maturity onset diabetes of the young (MODY). These are the main forms and some may not respond to treatment and some are mild and should not be treated – a complete surprise. The newborn children and children generally under the age of seven months are likely to have PND or TND. MODY then normally is found in children and adolescents, but may be mild. Therefore it may not be detected until they are adults.
This is the reason I urge that all children be properly tested to determine what type of diabetes they have. I suspect that many that are diagnosed with Type 1 may not in fact have Type 1, but one of the monogenic types. If they truly have Type 1, then you will know for sure by full testing, and genetic testing is the only way to know positively.
Some monogenic forms may be treated with oral medications while others will require insulin, and still others are mild and require very little treatment. This is why I urge testing rather than relying on a doctors diagnosis if Type 1. Definitely consider testing for monogenic diabetes if you or members of your family meet the following criteria:
diagnoses with diabetes under seven months, familial diabetes in the immediate family, mild hyperglycemia, and other pancreatic features.
Testing for monogenic diabetes are often simple and inexpensive and at the time of diagnosis are not typically done. Many doctors are not even aware of the tests. Am I? No; however, two of the tests are listed here. The list of all tests is apparently are not available to non-medical people. The tests should also make management of blood glucose easier and treatment more reliable plus better long-term health.
To repeat, NDM generally occurs in the first six months of life and only one in 100,000 to 500,000 infants. NDM is often mistaken for Type 1, but Type 1 diabetes normally occurs later after the first six months. In about half of those with NDM, the condition becomes permanent. In the other half, NDM is short lived or transient and disappears during early childhood; however, it can reoccur later in life. NDM can be identified to specific genes.
There is a point that is often overlooked with NDM. NDM can also affect the unborn. They do not grow well in the womb and are born much smaller in weight. If caught early by knowledgeable doctors, and given appropriate therapy, they can often be normalized in growth and development.
The other monogenic, MODY, usually develops during during early adolescence or adulthood. It can often be missed until later in life. MODY accounts for one to five percent of all cases of diabetes in the United States. If a parent has MODY, the children are at a greater risk for developing MODY. Each child of a parent with MODY will have a 50 percent risk.
There are several types of MODY because there are a number of gene mutations that cause MODY. It is often confused for Type 1 or Type 2 as the people a seldom overweight and do not have other risks. People with MODY can be treated with oral diabetes medications, but treatment varies with the genetic mutation causing MODY.
Commercial genetic testing for NDM and MODY is now available. See this reference for one company. The Kovler Diabetes Center at the University of Chicago offers help to parents and offers many other services related to NMD and MODY. Check out their web site here. Also check out monogenic diabetes dot org. There is a lot of good information available.
The article that got me started is this one. Continue reading the next article listed at the bottom of each section. Some of this is repeated from the monogenic diabetes dot org.
November 5, 2010
Emergency Hospitalization for People with Diabetes
Another hospitalization situation that can cause problems for people with diabetes is going into the hospital alone in an emergency situation and no medical alert identification. A case in an emergency room about 65 miles from here this summer really emphasized what can go wrong. These are the type of instances that get my feelings in an uproar when they should not have happened.
The person had collapsed and passed out from heat exhaustion (I'm guessing heat stroke). He was transported to the hospital with an IV in place per orders of the emergency room doctor. When they arrived at the hospital no alert identification was found so the IV was continued and a second one added and and then his billfold was opened. An emergency telephone number was found and called.
The person arrived at the hospital and went to the room where he had been admitted. This person was not aware he had diabetes so could give no insight into treatment or who the doctor was. So the IV's continued. The fellow did not come out of the heat exhaustion, so no changes were made. They did stop the IV's after the fifth one. On the second day the fellow still had not come around, but the emergency person had contacted an older brother, who arrived. Even he did not know about the diabetes, but knew of the doctor his brother was seeing.
Contact was made with the doctor then and it was discovered that he had diabetes Type 1. At that point they did a blood glucose test and if I understood correctly it was “HI”, so they had to do a test from a blood draw. This showed over 900 and I was not given a more accurate figure. Of course they administered insulin. Then they started testing every hour and administering more insulin every five hours. They also continued to test him regularly.
They continued monitoring him and on the fourth day he came to. When the nurse told me about the following, I nearly fell off the chair. The patient said nothing about having diabetes and asked for a Pepsi to drink. When he was told no, he got abusive, and asked for food. When he was told after his insulin, he went ballistic and refused to be treated. The fifth day he checked himself out against doctors wishes.
I don't understand totally what happened as I was not able to get more information. I do not understand why this person did not want to have diabetes identified and when it was, why he reacted this way. I know from the diabetes forums that some people will come out on them, but will not say anything to people near to them or wear a medical alert of any kind.
I can understand privacy, but not the extreme desire for it. He should be thankful that an older brother did know the doctor and that the doctor gave out the information. There are lots of unanswered questions about this, but the nurse would not identify anyone and only gave me a little that she could.
I think she was wanting me to see how important it was to have proper medical alert information on me. When I showed her mine, she asked to see it and thanked me for wearing it. I wear mine on a necklace and need to have it updated for sleep apnea which is not on it presently.
This is why I feel so strongly about educating close friends and family so that they can advocate for you and prevent these types of instances from occurring. And in this case, the person on the emergency notice did not have information. This is not what should have happened.
The person had collapsed and passed out from heat exhaustion (I'm guessing heat stroke). He was transported to the hospital with an IV in place per orders of the emergency room doctor. When they arrived at the hospital no alert identification was found so the IV was continued and a second one added and and then his billfold was opened. An emergency telephone number was found and called.
The person arrived at the hospital and went to the room where he had been admitted. This person was not aware he had diabetes so could give no insight into treatment or who the doctor was. So the IV's continued. The fellow did not come out of the heat exhaustion, so no changes were made. They did stop the IV's after the fifth one. On the second day the fellow still had not come around, but the emergency person had contacted an older brother, who arrived. Even he did not know about the diabetes, but knew of the doctor his brother was seeing.
Contact was made with the doctor then and it was discovered that he had diabetes Type 1. At that point they did a blood glucose test and if I understood correctly it was “HI”, so they had to do a test from a blood draw. This showed over 900 and I was not given a more accurate figure. Of course they administered insulin. Then they started testing every hour and administering more insulin every five hours. They also continued to test him regularly.
They continued monitoring him and on the fourth day he came to. When the nurse told me about the following, I nearly fell off the chair. The patient said nothing about having diabetes and asked for a Pepsi to drink. When he was told no, he got abusive, and asked for food. When he was told after his insulin, he went ballistic and refused to be treated. The fifth day he checked himself out against doctors wishes.
I don't understand totally what happened as I was not able to get more information. I do not understand why this person did not want to have diabetes identified and when it was, why he reacted this way. I know from the diabetes forums that some people will come out on them, but will not say anything to people near to them or wear a medical alert of any kind.
I can understand privacy, but not the extreme desire for it. He should be thankful that an older brother did know the doctor and that the doctor gave out the information. There are lots of unanswered questions about this, but the nurse would not identify anyone and only gave me a little that she could.
I think she was wanting me to see how important it was to have proper medical alert information on me. When I showed her mine, she asked to see it and thanked me for wearing it. I wear mine on a necklace and need to have it updated for sleep apnea which is not on it presently.
This is why I feel so strongly about educating close friends and family so that they can advocate for you and prevent these types of instances from occurring. And in this case, the person on the emergency notice did not have information. This is not what should have happened.
November 2, 2010
Enjoy Your Holiday Food!
It is interesting how families celebrate holidays. The question is how do you celebrate the holidays? Do you go overboard with the meal and deserts? For people with Type 2 diabetes holidays can be one of dread and fear of the diabetes police.
First, relax! This is not a rant about the holidays. Hopefully you have a few holidays under your belt and have found yourself able to cope or are looking for ways to do better. If you are new to diabetes, the holidays can be real problems. Hopefully this will provide some help and guidance.
For the parties and friends social gathering, read this for some tips. I would only emphasize that moderation is the key to these events. Do not overdo and select the serving size that is small enough to not raise you blood glucose into the stratosphere.
The next article is definitely for families and is one of the better articles for people with diabetes. I appreciate the statement by Marlene Schwartz, PhD, deputy director of the Rudd Center for Food Policy & Obesity at Yale University when she says “don't tell family members that they're eating more healthfully”. She calls it "stealth health".
This is sound and sage advice. If the food is just served without comment, everyone should be content. They also advise you to involve immediate family members in planning of the menu, especially if they are picky eaters and the younger generations.
There are many good tips and from experience I know that they will work for most families.
The third article is another take on planning for the holidays. It does suggest making a game plan to avoid problems and if you make it work, you can still enjoy the holidays. The best plan is sticking to the plan. Realize that this is the holidays and one day (at a time) is the best method for not being overwhelmed. If you happen to overindulge do not berate yourself. Just be careful the next few following days, and take care of yourself.
From Thanksgiving to at least New Year's Day is often very tempting for people with Type 2 diabetes. Be assured that you will find yourself being tempted, but by careful planning and conservative food selection you should survive. So relax and happy holidays!!!
First, relax! This is not a rant about the holidays. Hopefully you have a few holidays under your belt and have found yourself able to cope or are looking for ways to do better. If you are new to diabetes, the holidays can be real problems. Hopefully this will provide some help and guidance.
For the parties and friends social gathering, read this for some tips. I would only emphasize that moderation is the key to these events. Do not overdo and select the serving size that is small enough to not raise you blood glucose into the stratosphere.
The next article is definitely for families and is one of the better articles for people with diabetes. I appreciate the statement by Marlene Schwartz, PhD, deputy director of the Rudd Center for Food Policy & Obesity at Yale University when she says “don't tell family members that they're eating more healthfully”. She calls it "stealth health".
This is sound and sage advice. If the food is just served without comment, everyone should be content. They also advise you to involve immediate family members in planning of the menu, especially if they are picky eaters and the younger generations.
There are many good tips and from experience I know that they will work for most families.
The third article is another take on planning for the holidays. It does suggest making a game plan to avoid problems and if you make it work, you can still enjoy the holidays. The best plan is sticking to the plan. Realize that this is the holidays and one day (at a time) is the best method for not being overwhelmed. If you happen to overindulge do not berate yourself. Just be careful the next few following days, and take care of yourself.
From Thanksgiving to at least New Year's Day is often very tempting for people with Type 2 diabetes. Be assured that you will find yourself being tempted, but by careful planning and conservative food selection you should survive. So relax and happy holidays!!!
October 28, 2010
Goals for the New Type 2 Organization
I am a bit disappointed in the response to the first blog on Type 2 diabetes needing their own organization, but just in the comments. The emails were only from one person and not very friendly.
Outside of the need to have an organization for those of us with Type 2 diabetes, I had hoped to get some more objectives and goals that would give us more ideas. So with that in mind, I will attempt to list a few of them and hope that we can draw some responses.
Besides raising funds for research, finding the proper research venues will be a big priority. There seems to be some areas that are coming to light now that may need more exploration that may lead to keys for managing diabetes. Being more accurate in the diagnosis of diabetes should not be overlooked as the ADA has opted to support the A1c test only.
Something will need to be done for educating the medical profession in being more aggressive in diagnosis, early treatment, and follow up. See this for some hope. Patient education also needs to be strongly promoted. I am not sure how this would be best accomplished, but one suggestion would be on line resources. This could be accomplished by having pamphlets or booklets that every doctor or endocrinologist can hand out when diagnosed.
Sadly in need of education are the insurance companies in preventative medicine and early work for patient education, patient followup, and working with other doctors for overall health. This may include, heart disease prevention, sleep apnea, kidney health, neuropathy, eye health, and many other related areas.
Research will need to be done to find out what other people with diabetes want for support, what education they want and need, and what services would better serve them. I suspect some work will be needed with government agencies, medical groups, and diabetes manufacturers of all types.
Because of the problems specific to women and to men, there should be special education and on line help for each. Education will need to be considered for the younger people now being diagnosed with Type 2 diabetes.
Education programs will need to be developed for hospitals and elder-care facilities. This will develop new standards for how patients with diabetes should be treated, allowed to be self-medicated while in these facilities, and procedures for reducing errors in IV solutions and medications. The attitudes of hospitals does need to be adjusted in many situations.
There has to be more objectives and goals. Help!
Outside of the need to have an organization for those of us with Type 2 diabetes, I had hoped to get some more objectives and goals that would give us more ideas. So with that in mind, I will attempt to list a few of them and hope that we can draw some responses.
Besides raising funds for research, finding the proper research venues will be a big priority. There seems to be some areas that are coming to light now that may need more exploration that may lead to keys for managing diabetes. Being more accurate in the diagnosis of diabetes should not be overlooked as the ADA has opted to support the A1c test only.
Something will need to be done for educating the medical profession in being more aggressive in diagnosis, early treatment, and follow up. See this for some hope. Patient education also needs to be strongly promoted. I am not sure how this would be best accomplished, but one suggestion would be on line resources. This could be accomplished by having pamphlets or booklets that every doctor or endocrinologist can hand out when diagnosed.
Sadly in need of education are the insurance companies in preventative medicine and early work for patient education, patient followup, and working with other doctors for overall health. This may include, heart disease prevention, sleep apnea, kidney health, neuropathy, eye health, and many other related areas.
Research will need to be done to find out what other people with diabetes want for support, what education they want and need, and what services would better serve them. I suspect some work will be needed with government agencies, medical groups, and diabetes manufacturers of all types.
Because of the problems specific to women and to men, there should be special education and on line help for each. Education will need to be considered for the younger people now being diagnosed with Type 2 diabetes.
Education programs will need to be developed for hospitals and elder-care facilities. This will develop new standards for how patients with diabetes should be treated, allowed to be self-medicated while in these facilities, and procedures for reducing errors in IV solutions and medications. The attitudes of hospitals does need to be adjusted in many situations.
There has to be more objectives and goals. Help!
Which sweeteners are you consuming?
When I started this, I had no idea what I was getting into. The way the sweeteners are looked at and discussed varies more than a person might think. Much depends on site objectives and manufacturer influence. Sugar and sweeteners are generally viewed as a poison by some groups, and should not even be looked at for people with diabetes irregardless of type. So those articles have been ignored as I wanted something that made some sense and might be of interest.
While the glycemic index values may vary from what I have located, generally they are within a few points in the sources checked. A few values could not be found and I used (??) to indicate that. The value can also change when processed differently as in pasteurized and raw honey. The GI values listed are therefore only guides and can vary depending on method of processing.
Various sweeteners Glycemic Index Value
Sugar GI 80
Other calorie containing sweeteners:
all have approximately 15 grams of carbohydrates per teaspoon
Honey, pasteurized GI 75
Raw Honey GI 30
Maple syrup GI 54
Pancake syrup GI (??)
Malt syrup GI 42
Karo syrup GI (??)
Corn sweeteners GI 62
Molasses GI 58
Jellies GI (??)
Jams GI 46
Marmalades GI 55
Agave syrup, nectar GI 15
Brown Rice syrup GI 25
Brown sugar GI 64
Fructose GI 22
Lactose GI 46
Glucose GI 96
Blackstrap Molasses GI 55
Stevia – FOS Blend GI <1
Artificial sweeteners GI <1
Name Brands
Aspartame NutraSweet, Equal
People who have a condition called phenylketonuria should avoid
this sweetener.
Acesulfame K Sunett, Sweet One, Swiss Sweet
Sucralose Splenda
Saccharin Sweet'nLow, Sugartwin
Avoid this sweetener if you are pregnant or breastfeeding
Sugar alcohols - These are neither sugars or alcohols, but pure carbohydrates. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol and are called “polyols”. There are other manufactured sugar alcohols, but these occur naturally in plants. This article explains more on sugar alcohols.
The key to non-artificial sweeteners is to use in moderation. Overuse of any sweetener is not good for maintaining tight management of diabetes and for many people will cause weight gain.
The above information is knowledge you should make use of when reading labels. While the GI values will not be listed, these are listed here to hopefully give you ideas when you are looking at labels. This article in WebMD may answer some more questions.
While the glycemic index values may vary from what I have located, generally they are within a few points in the sources checked. A few values could not be found and I used (??) to indicate that. The value can also change when processed differently as in pasteurized and raw honey. The GI values listed are therefore only guides and can vary depending on method of processing.
Various sweeteners Glycemic Index Value
Sugar GI 80
Other calorie containing sweeteners:
all have approximately 15 grams of carbohydrates per teaspoon
Honey, pasteurized GI 75
Raw Honey GI 30
Maple syrup GI 54
Pancake syrup GI (??)
Malt syrup GI 42
Karo syrup GI (??)
Corn sweeteners GI 62
Molasses GI 58
Jellies GI (??)
Jams GI 46
Marmalades GI 55
Agave syrup, nectar GI 15
Brown Rice syrup GI 25
Brown sugar GI 64
Fructose GI 22
Lactose GI 46
Glucose GI 96
Blackstrap Molasses GI 55
Stevia – FOS Blend GI <1
Artificial sweeteners GI <1
Name Brands
Aspartame NutraSweet, Equal
People who have a condition called phenylketonuria should avoid
this sweetener.
Acesulfame K Sunett, Sweet One, Swiss Sweet
Sucralose Splenda
Saccharin Sweet'nLow, Sugartwin
Avoid this sweetener if you are pregnant or breastfeeding
Sugar alcohols - These are neither sugars or alcohols, but pure carbohydrates. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol and are called “polyols”. There are other manufactured sugar alcohols, but these occur naturally in plants. This article explains more on sugar alcohols.
The key to non-artificial sweeteners is to use in moderation. Overuse of any sweetener is not good for maintaining tight management of diabetes and for many people will cause weight gain.
The above information is knowledge you should make use of when reading labels. While the GI values will not be listed, these are listed here to hopefully give you ideas when you are looking at labels. This article in WebMD may answer some more questions.
October 25, 2010
Hospital Awareness for People with Diabetes
Since the this post, more information keeps coming to light that people with diabetes need to be aware of when entering the hospital. There are some nasty situations that can arise even when the hospital is aware that you have diabetes. The nasty problems are life threatening if the hospital is unaware that you have diabetes.
If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.
So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.
Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.
If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.
If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.
Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.
This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.
Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.
It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.
The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.
If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.
So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.
Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.
If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.
If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.
Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.
This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.
Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.
It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.
The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.
October 22, 2010
Diabetic Wound Care of Feet
If this was not so serious, maybe we could all laugh about it, but taking care of foot injuries is very important if you have diabetes and no laughing matter.
Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.
Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.
Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.
Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.
Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.
Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.
Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.
The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.
The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.
Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.
Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.
The article has a ten point checklist that make a lot of sense.
Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes
They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.
I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.
Two other sites worth reading are: Site 1 and Site 2.
Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting. Even for regular food care this should be done. For injuries see your regular doctor promptly.
Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.
Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.
Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.
Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.
Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.
Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.
Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.
The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.
The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.
Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.
Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.
The article has a ten point checklist that make a lot of sense.
Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes
They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.
I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.
Two other sites worth reading are: Site 1 and Site 2.
Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting. Even for regular food care this should be done. For injuries see your regular doctor promptly.
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