September 30, 2011

Introduction To Prediabetes – Part 2

Some important reminders for all people, without or with diabetes. First obtain copies of all lab reports and tests preformed by your doctor or hospital. I cannot emphasize how important this is for tracking your health. If you have a family history with type 2 diabetes, this may help you know when to see a doctor and have him/her do the necessary tests. Next, make sure that your doctor is testing you with fasting at least once a year. Also make sure your doctor knows your medical family history.

If you have a family history of type 2 diabetes, on your own, if you can afford it, buy a meter and test strips and develop a routine of blood glucose testing on a consistent basis. To start with I would suggest doing a fasting blood glucose test. If you are under 99 mg/dl, then wait a week and test again. If you are consistently under 90 mg/dl, then I would suggest testing on the same day three or four weeks apart. What you are looking for is trends in fasting blood glucose readings.

After a couple of months if the trend is holding steady (plus or minus 3 to 5 points) then space the time out to two or three months. Just don't forget to test. If you have gained weight, now is the time to lose it with exercise and diet modifications. Start making lifestyle changes now while it may be easier. Read my blog here on the different lifestyle changes, adding weight loss prominently to the list is needed. I downgraded it in my blog and was corrected by one of the commentors.

If the trend starts showing an upward trend, then you may wish to do a few one hour after meal tests as well. If your fasting blood glucose reading is 96 mg/dl (5.3 mmol/L) then you don't want to see more than a meter reading of 125 mg/dl (6.9 mmol/L). If this happens then you may wish to check several times during the day both before and after lunch and dinner. This would be just before you are ready to eat and one hour after eating. If any of the before meal reading are above 99 mg/dl (5.5 mmol/L) and one hour post meal readings (postprandial) readings are above 125 mg/dl (6.9 mmol/L), then please schedule an appointment with your doctor for testing a fasting reading and an oral glucose tolerance test. Get the test and lab reports.

If the readings are in the ranges for prediabetes (see previous blog) and the doctor does not say you have prediabetes, or just that you sugar was a little high, I urge you to consider telling the doctor to check the facts for prediabetes and treat it as such. If the doctor puts you off, consider finding a different doctor if you are able and in an area that you can. Even consider asking for a referral to an endocrinologist if there is one available.

You may need to do some research on the Internet to know if there is one specializing in diabetes that is close enough to you. One site to aid you is this site. Many other sites link back to this site. Just be aware that this may be difficult as there are about 3000 endocrinologists in the US that specialize in diabetes and about 21 million people with diabetes.

Now the lifestyle changes become imperative to avoid further erosion of your health and further damage to your pancreas. Testing becomes even more important and I suggest talking to your doctor about prescribing Metformin (extended release) XR to help while you increase your exercise and reduce your carb intake until you can prove to the doctor that you are able to manage your prediabetes by bringing the blood glucose readings back to the normal range consistently. Then the doctor may allow you to come off the medication. Yes, there are some doctors and pharmacies that will not allow this.

Once you have crossed the line above the normal range, you need to consider that you have prediabetes and treat it as such. Even consistently getting the numbers back in the normal range does not mean that you no longer have prediabetes. All it takes is a few days of mistakes and prediabetes will be back and you will need to work more diligently to maintain the normal numbers again. Continue to look for trends as an increase can indicate that you are having the potential for a type 2 diabetes diagnosis.

If you have the genetic predisposition for diabetes, denial will only make future diabetes management more difficult.

September 29, 2011

Introduction To Prediabetes – Part 1

Words of warning! Have you had your doctor say to you or a family member, “be careful what you eat, your blood sugar is a little high”, or “you have a touch of sugar so watch what you eat!”. I won't go into other phrases that have been used, but many doctors just can't bring themselves to tell a patient they have prediabetes or might be near to a diagnosis of diabetes. Some even delay the diagnosis of diabetes because they are not aware of the damage that may be possible.

Translation of the above comments –you may have prediabetes and you need to take this seriously or you may have the start of diabetes. Why can't they just tell you this and do the remainder of the needed tests. Well, unless you are one of the lucky few that has the right medical insurance and it is prediabetes, you will be billed when it is rejected by the insurance company. If it is diabetes, medical insurance should cover the lab costs providing you have medical insurance. Sad but true.

First, fasting blood glucose levels for a person without diabetes can vary from 70 mg/dl to 99 mg/dl (3.9 to 5.5 mmol/L). One hour post meal testing (postprandial) can vary depending on the food consumed but seldom gets over 120 mg/dl (6.7 mmol/L). Normally a person without diabetes will have two-hour readings back below 100 mg/dl (5.6 mmol/L) or nearer 90 mg/dl (5.0 mmol/L).

For a person with prediabetes, fasting blood glucose levels will vary from 100 mg/dl to 125 mg/dl (5.6 to 6.9 mmol/L). With prediabetes, postprandial one or two hour testing can get to 140 mg/dl (7.8 mmol/L). Within three hours blood glucose readings should return to below 125. Blood glucose readings for prediabetes is also called impaired fasting glucose and impaired glucose tolerance.

For a prediabetes diagnosis, some doctors are using the A1c only which may not be reliable. Doctors use the ADA A1C range of 5.7–6.4%. Most doctors should also be using the oral glucose tolerance test (OGTT) and the fasting blood glucose test. With OGTT the blood sample is drawn two hours after drinking a 75-gram glucose drink. If the results are from 140 to 200 mg/dl (7.8 to 11.1 mmol) it is considered prediabetes. If the results are over 200 mg/dl (11.1 mmol/L) then the diagnosis should be diabetes.

Okay, now you have the diagnosis of prediabetes, what is the next step. Stop blaming yourself – it is not your fault. You may have accelerated the condition by your lifestyle, but you did not cause it. Family genetics has a lot to do with prediabetes and type 2 diabetes.

Yes, if you haven't noticed – others are all too willing to blame you and tell you to lose the weight and stop having diabetes. You do not have to be overweight to have pre-diabetes. If they only knew that they could be diagnosed the next week and they may not be overweight. And how do they account for those that are overweight and never get diabetes. Truth is they don't care, you are their scapegoat now.

Then learn to forget the past and live in the present. The quicker you learn this and put denial behind you, the better you will be able to manage prediabetes and put yourself in a position to possibly prevent the progression to type 2 diabetes, or at least delay it for many years. It is possible.

Previous blogs on prediabetes are – blog 1, blog 2, and blog 3.

September 28, 2011

Terms Used for Diabetes

If you get nothing else from this blog, I want you to get in the habit of asking for a copy of your lab test results and make sure that you get a copy before leaving the doctor's office. The good news is that if the current proposal David Mendosa wrote about in his blog here goes into effect, we will have the right to receive them from the lab even before our appointment. Some do receive them this way now, but for many access has been denied until the doctor receives them and gives you a copy. Even then many doctors have been reluctant to give patients copies of their lab reports.

Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 (HIPAA) is one area you should spend to time becoming familiar with as this spells out your rights to your medical records. Use this link to assist in your learning and follow other links on the page and page two. This site will be helpful as well. There are other sites so use your search engine. I have not been through the entire act.

This site will help US citizens in learning what their legal rights are to obtain copies of their medical records and this site will provide information about what procedures to follow if you are refused rights to you medical records - there are five pages.

You may not know what all the results mean, but you are capable of learning. Most, but not all lab reports will be divided into three columns. The first column is normally name of the test or event to be measured, the second column is usually the test results and may or may not include the letters L for low or H for high. The last column is normally the reference range for the test or what is considered normal.

Then you can take your lab report and go to this web site to do some learning. Be sure to explore as more than diabetes is covered on this site. I have given you the direct link to understanding the diabetes part and you may explore on your own. Be careful in thinking all labs are alike in their reference ranges – they can differ depending on the test analysis used. Also, very few tests are standardized nationally so lab results will vary.

Example: Blood glucose – reference range for the lab my doctor uses is 70 to 110 mg/dl. The mg means milligrams and the dl means deciliter, so mg/dl is milligrams per deciliter. The USA is the only country that uses this. The rest of the world uses millimoles per liter (mmol/L). This site has many terms and explanations of them and this site may also be helpful. There are many sites that have conversion calculations, but I do like this site and click on G for glucose.

Sometimes it is not necessary to know the technical meaning so much as knowing the acronym definition. HbA1c (A1c) is glycated hemoglobin (further definition is found here) measurement for approximately the last three months. The result is somewhat weighted in favor of the last month (ideally the cells would have the same life span) as the cells in the blood die off at random and new are always being created.

September 27, 2011

Finally, the AACE/Takeda Site Is Operational

Sorry, but AACE has removed the site referred to in the first and last links of this blog

Finally, the American Association of Clinical Endocrinologists and Takeda Pharmaceuticals approved resource site is up and available to the online community. Am I surprised about the site? I am surprised a little, but it is about what I expected for the start – very spartan and very closed in what they are recommending for approved sites. For those of us that may have hoped for more and maybe a little less of the professional sites that everyone should have known to begin with, I will have to say that I will have to wait for further approvals in the future.

I think there will be some surprises in the future, but I will not hold my breath. If you are interested in the sites currently listed – here they are – all 15 of them. Only two sites for me were somewhat of a surprise, this site ( – a diabetes forum site) and this site (American Council on Exercise).  Sorry, the AACE removed the site.  Apparently they did not think it was important.

What disappoints me the most is when looking for the list of approved sites; it is not a prominent feature. It is hidden in the “About” area and is the last item. Then I am very upset about using the links to the approved sites. The links are not what I would call intuitive. I normally open (right click) any link in another tab to be able to come back and open the next link.

What I got was a copy of the page I started with. So to repeat, if you right click (and open in a new tab) on the link for ( you will get a copy of the page you were on. Now is the problem of what to do. Do not double click on the site you want to explore. Slowly left click one time and you will receive a message box outlined in red that states:

“You are now leaving the Diabetes Navigator website.”

“The American Association of Clinical Endocrinologists (AACE) and Takeda Pharmaceuticals North America, Inc. are not responsible for the content, privacy policies, or any other information included in the external website, unless otherwise noted. Please click "OK" if you wish to leave our website to receive additional information.”

This I can appreciate, but the wording leaves a lot to be desired. Since the site is on the approved list, why do we need words of warning unless there is something making this a legal requirement since they are not the authors. By clicking on okay, you are taken to the Mayo Clinic website. You had better be ready to explore, as there is little about where to go if you are doing research. You are forced to use the search box and hope that you have the right key word or words.

Yes, if you are looking for a doctor, requesting an appointment, or planning to make a contribution you are on the right page. Yes, there is “Health Information” to help you at the bottom of the page and other information. Explore you will need to do. There is a lot of information on the Mayo Clinic website – finding what you are looking for is the key.

Since I am a blogger, I knew where the blog for diabetes is located and had that are bookmarked already. Once you are there, the page also lists other good sources for diabetes information to be explored. What would have been a great help from the people assembling the information is a few of the better links within each site.

Exploring will still be up to each individual and his or her interests. Do take time to explore the diabetes navigator website. A lot of information is housed within the site with links to other sites. At the bottom of the page under “Lifestyle” is some great informational links, but you will need to go through the red box to get to the site. Enjoy exploring!!!

Watch for a post later

Watch this spot for a post later today as I am not allowed to post it now.  Thank you.

September 26, 2011

The Discussion On Wheat

Dr. William Davis has published his book “Wheat Belly” and expected much of the outcry from the wheat industry. The wheat industry is coming out swinging and is pushing wheat with the all the medical associations and anyone that will listen. They are also under other pressures because of the gluten-free requirements of celiac disease and the latest gluten-free fad that is sweeping the country.

For me it will be interesting to see the damage control program they develop, or if they are going into panic mode and will make statements that are easy to disprove. So far it seems to be the latter.

Quote Cutting out one specific food is not only unrealistic, it is dangerous. Omitting wheat entirely removes the essential (and disease-fighting!) nutrients it provides including fiber, antioxidants, iron, and B vitamins. Unquote

Omitting wheat entirely does not remove nutrients and fiber, antioxidants, iron, and B vitamins from our diet. There are more and better sources for these so this statement begs the question of - what are they thinking? It is easy to replace these nutrients with foods that are more nutritional and contain a lot fewer carbohydrates.

Then they cite the USDA nutrition guidelines as if they are the gold standard. Many people may believe this, but it is far from the gold standard for nutrition. Dietitians and nutritionists can be wrong and the United States Department of Agriculture is for farmers so they cannot say otherwise than to recommend grains for our diets.

The blog posted at the Grain Foods Foundation ends by saying: Quote So, let common sense prevail. When it comes to nutrition advice, look to the real experts and remember that weight control is all about one key equation: calories in must equal calories out. Unquote

When they say look to the real experts, why don't they name them? And where did they dream up the statement – calories in must equal calories out? If they truly believed this they would realize that wheat calories recommended by the unnamed experts often exceeds what people need and this is why wheat is a contributor to the obesity epidemic. To undo the damage from wheat and shed the weight, calories in needs to be less than calories out.

As a person with type 2 diabetes, I need to shed some weight and I am finding that reducing my wheat intake will do what I need to reduce the carbohydrate limit to help me. Do I believe that reducing the amount of wheat or eliminating wheat from my diet will make diabetes better? No, but it will help in the management of diabetes like the elimination of corn products and especially high fructose corn syrup from my diet helped make my management of diabetes considerably easier.

With the number of people with testimonials of wheat elimination to Dr. Davis's blog and to the blog by Tom Naughton, the stage is set to show people that wheat is a large component of our health problems. Take the time to read these blogs by Dr Davis also.

Since writing this Tom Naughton has had a two-part interview with Dr. Davis and you may read them here and here.