September 18, 2010

Too many carbohydrates

When I came across this (link now broken - area deleted from site), I needed to rein in my anger level. I am not surprised at the position taken, but some RD/CDE's (Registered Dietitians/Certified Diabetes Educators) just don't understand that when they give advice, they need to be more careful and sensitive to the person needing the advice. Many just state the old ADA position and leave it at that. Plus diabetes forums are a poor place to give dietary information, like carbohydrate advice, especially when what works for one person, may not work for another person, nor meet the dietary needs.

This then makes many people upset and sometimes very disrespectful of the “Title” of the person giving the advice. We know that there is a lot of education behind the title; however, the insensitivity with which advice is given leaves a lot to be desired.

While I have written about this problem before, people need to learn that asking for dietary and nutritional advice on a diabetes forum will often result in advice that may not work for them. Normally the recommended amount of carbohydrates is too high and people want to believe this, but soon discover that the recommended amount is above the level they can tolerate and still manage their diabetes.

I will admit that I am very distrustful of RD's, CDE's, and other titles that participate on diabetes forums recommending how many carbohydrates people should eat in a 24 hour time. I very seldom see recommendations below 200 grams of total carbohydrates. If you are testing before meal and after a meal (1.5 to 2 hours) with a difference of 40 points or less, then your body can tolerate that many carbohydrates. If the difference is greater, then you should seriously consider reducing the amount of carbohydrates.

I realize that this is mostly volunteer work for these RD/CDE's and therefore we should not expect more salient and sage advice. I also know that most diabetes forum members are looking for quick solutions for carbohydrate numbers.

Now dare I mention that carbohydrate numbers are not the end-all to management of diabetes? I wish this could be so as then life could be so much simpler as some RD/CDE's would like us to believe. While those of us with diabetes need to count carbohydrates and they help determine our meter readings before and after meals, too often they do cause us to forget to balance our nutritional intake of foods.

Many people often end up lacking essential nutrients and trace elements in what we eat because we concentrate too much on just the number of carbohydrates. We also need to remember our vitamins, minerals, and certain trace elements that make up a our daily needs. Without them, we end up with other illnesses, health problems, and we constantly are battling other wars with management of our diabetes because we neglected them.

Diabetes management does need vitamins, minerals, and trace elements to be effective. Often because of carbohydrate management, we need supplements to balance what our bodies need. Just a few that come to mind include vitamin B12 for those that have been on metformin for extending periods. Vitamin D3 for those who do not get outside enough or don't include foods high is this. There are others and especially trace minerals are often lacking from our daily nutritional intake.

While I will be the first to admit that nutrition is something that I often neglect. I am working by having more tests done to determine what I am missing, and adjusting my eating habits or by taking supplements to cover the areas that I am short in my nutritional food intake. Because the quantity of carbohydrates is important in my management of my diabetes, I will continue to count them, but I am striving to include more foods high in vitamins, minerals, trace elements, and other vital nutrients important to my health.
The last point is the caloric intake in the foods we eat.  Often the carbohydrate amounts are too high for some individuals and the calories are too high to assist people in losing the weight new diagnosed people often need to lose.  This is why we need to consider the ratio of protein, fat, and carbohydrates that is optimal for each person.

September 17, 2010

Natural treatments for diabetes. (Not a cure) Part 1

The following information is for your reading and is not a cure. I am not endorsing any of these herbs, supplements, or natural remedies.

I am constantly seeing information about this or that natural remedy or supposed cure for diabetes, but I am getting so tired of the emails and constant bombardment by snake oil salespeople and their instant cures. Their constant stream of lies and enticements are indeed interesting, but under analysis are so false and not based on any form of scientific evidence. The supposed endorsers are so obviously paid to say what they are told, that you can't trust them.

In these cases I will fall back on the saying that a fool and his money are soon parted. Before I get carried away venting about these crooks (and some are doctors that should have their license pulled), I would like to cover a few items that may help those with diabetes. I say may, because many people do not derive any benefit, but a few do receive short-term benefits. I am not sure why, but there may be something in their body chemistry that was needed which the supplement, vitamin, or herb supplies to restore some balance, thus the short-term benefit.

Some items are said to have longer benefits, but there are no studies to prove this or scientific evidence to support these claims. What studies exist for some of the following items are either poorly designed, not all that conclusive, or done with such a small sample of people that it makes them suspect. Most of the natural remedies do not get much financial support for studies because there is little profit to do so.

This is important!!! WARNING If you are taking supplements or anything that is not prescribed by the doctor, please make sure that the doctor is informed. Some of the supplements when taken with oral medications and/or insulin can cause hypoglycemia or have toxic results, even cause death.

This is important enough to tell you to maintain a Supplement Diary of every herb, vitamin, and supplement you are taking and give a copy to your doctor. I am aware that many people do not feel this is important, but the consequences for persons with diabetes can have severe medical implications.

Of the items covered in this blog, I use vinegar, cinnamon, and magnesium, but not as supplements. I just use them as they come to me in different foods or as part of a recipe. Yes, I do seek out the foods rich in some of these items, especially the magnesium.

Vitamin K:
A Dutch study has found that Vitamin K (K1 and K2) may have lowered the risk of getting type 2 diabetes. Like so many studies, they want more studies and say nothing about being any help for those of us who already have type 2. About all the study is good for is disputing the American minimum daily requirement.

I will refer here to a previous blog about vinegar. I have not seen or found any more than I have referenced in that blog.

I will admit that more studies are emerging that show cinnamon has some benefits. This 12 week study only involves 22 people. I am not sure that this gives enough conclusive evidence to prove real benefit, but the different studies are continuing to add to the body of evidence for this spice. Another blog about another study appeared on October 10, 2006 with 60 men and women. No one has yet determined the length of the benefit on cinnamon, just the short-term benefits for small numbers.

Chromium or chromium picolinate:
One of the more (to my understanding) beneficial supplements is chromium, there are some health warnings about chromium picolinate. While this is a trace element that has an effect on insulin production, many people are overdosing with this supplement and may be causing some harm to their systems. What is it that people do not understand about the word trace element. Only a small amount should be used and probably not on a consistent basis. This article is very informative and clearly states that little information is available on the safety of chromium. Other studies have not confirmed the benefits.

The North American ginseng shows in the studies to be the best form of ginseng for benefits for those of us with diabetes in that it may improve blood sugar control. While again, not enough studies have been done, there are indications it may have some benefits.

Studies here do indicate that low magnesium levels may make blood glucose control more difficult and that proper levels may help with insulin resistance. A fellow blogger has written a blog (sorry, link is broken) about magnesium and you should read it and the comments.

This mineral comes with some warnings about over use and the side effects that it can cause. There are also some problems with heart medications so use only under a doctors supervision.
End of Part 1 of 4.

September 14, 2010

Mayo Clinic has entered the Social Media Arena

This is a big one folks! I don't normally follow the Mayo Clinic that closely, but I do read one area, the Expert Blog under Diabetes.

On Monday the 13th, Scott Johnson wrote about the Mayo Clinic entering the social media. This link takes you to it. Thank you Scott. And they are not doing social media small time. This is big time!

Now I want to hear what the doctors have to say. Most will ignore you while they grimace big time. They don't want to hear it. Now they had better listen when the Mayo Clinic gets running full time and full out. Their mission statement is pretty bold and all encompassing.

The official opening is scheduled for September to coincide with Mayo's hosting of its second Social Media Summit in collaboration with Ragan Communications, September 27 to 29 at the Mayo Clinic's Jacksonville, Florida campus. However, it is up and usable now.

This is one website that I will need to check on a regular basis as there are many directions it could expand. Take time to explore the home page and what they are already involved in on YouTube, Twitter, Blogs, Facebook, and other areas. This is below the video. Explore the entire website!

September 13, 2010

More of Dangerous Myths – Myths Part 3

Some of the most dangerous problems happen to those who will not use insulin because they have heard some of the lies put forth by the people against insulin. Others originate from people who associate insulin with problems a relative had because of poor or no diabetes management.

These lies are:
1. Insulin causes blindness, amputations, and kidney failure.
2. Insulin causes sterility and sexual dysfunction.
3. Insulin use is the beginning of the end.
4. Insulin is toxic.
5. Insulin use will label me as a drug addict.
6. Insulin causes weight gain.
7. Insulin use will cause insulin shock (now termed hypoglycemia).
8. Insulin use is an inconvenience.
9. Insulin use is resisted by physicians and patients.

What causes items 1, 2, and 3 above is poor to no management of diabetes. Many people that do not manage their diabetes can have blindness, amputations, kidney failure, sterility and sexual dysfunction, and be near the end because they have not controlled their diabetes. Those that tightly manage their diabetes can live long and often healthier lives, with or without insulin.

Insulin is not toxic for the majority of people. However, some people do have allergies to some insulins. This is the only time insulin can be considered toxic.

Number five generally is not a problem; however, I have been questioned by the police about my use of syringes. Fortunately I had the insulin there and the pharmacy RX on the box and after checking, the officer was very polite.

Number six is difficult as initially the increased control insulin can give causes for some weight gain as the cells can now utilize the glucose. However, it is important for for those starting insulin to meet with a dietitian that understands diabetes and can provide guidance in nutrition and food choices. They also need education on counting carbohydrates and adjusting insulin to carbohydrates to prevent hypoglycemia.

This is also how to prevent number seven from occurring. Also the education needs to include the warning symptoms of hypoglycemia and how to test and resolve the problem with the appropriate glucose medication or other fast acting foods, mostly fruit juices.

Number eight can be a problem if you let it be a problem. It does take some adjustment and possible change in environment to manage your diabetes, but your health is more important than an inconvenience. Just remember that preventing the complications of diabetes is worth the effort.

Number nine is true because many doctors and patients resist the use of insulin for various reasons or myths. Often the doctors go along with the threat idea because patients will more readily follow the oral medications route. Often the doctors do not want to spend the time to educate their patients on the use of insulin and are worried about hypoglycemia becoming a problem on insulin.

Sometimes the doctors know that their patients cannot afford the cost of insulin. But most doctors and patients do not take into account the true cost effectiveness of each treatment. Not only are some of the oral medications costly, but the success of oral medications is not always the best when compared to insulin. Also, not everyone can get excellent control with oral medications. A few medical professionals are also not aware that some oral medications when used by themselves or in combinations will cause hypoglycemia.

For me, insulin is the only way that I will probably be able to retain some insulin production from my pancreas. Many people that go the oral medications route only, end up with a pancreas that wears itself out and can no longer produce insulin, forcing the use of insulin. I know that mine still works and that I have to be very careful when I have been able to exercise, or have had to work extra when moving from one apartment to another. I know that I will go low, need to test more often, and reduce the amount of insulin drastically for several days or even a couple of weeks.

I have also found out in the last month what an illness can do to me. I have needed to reduce my insulin usage and now that I am spending time bicycling regularly, I have needed to reduce my insulin further as my pancreas is almost producing more than I can use. A fine turn of events for me, but not one I expected as I still have to lose much more weight, but I will take what I am given. My insulin resistance has obviously dropped, but that could return at any time. So in the meantime, I am testing more often and enjoying life.

There are many more myths, but this will be the last in this series for now. 
Articles used in the above:
Site 1,  Site 2,  Site 3.  Sorry - the links have been broken - discovered 8/8/14.