January 13, 2012

Are We Going to Allow A Sugar Tax?

I have to end the week with this. This study is about imposing a “Sugar Tax” on our sugar-sweetened beverages. This is proposed on the basis that it will cut into our current obesity epidemic. The proposal is for a one cent per ounce tax. Buy a 20-ounce bottle of your favorite sweetened beverage and pay a tax of $0.20.

Does this seem steep? Not enough to stop sales is what I think. But, let them pass this, and the tax will continue upward until is could be much more expensive. These people will never stop in their crusade.

What is humorous is their estimates. They don't have accurate data, so we are seeing guesstimates. They say this and the claim that, but I don't believe their guesstimates. All that will happen will be more income generated for bloated government.

Read this doctor's blog and notice his humor. Please read article he refers to and then read this press release. Yes, this needs to be rejected, but will it.

January 12, 2012

Other Doctors Could Learn From This Doctor

This doctor apparently is teaching other doctors as an instructor, but he does have some excellent points for discussion. His one thought of “How can I be a better doctor?” really drew my attention. He then describes the 4 C’s, which he says he learned from his mentors, colleagues, and patients. This makes him a doctor I would like to meet and get to know in a doctor-patient relationship. Whether he would be my doctor could be doubtful, but just getting to know him could be a worthy experience.

The four C's he lists are – competency, communication skills, compassion, and convenience. He states that there was a fifth C, but that has been resolved some decades ago and it was confidentiality. I'm sorry to mention this doctor, but this needs a revisit. Electronic medical records are making this even more important with the hackers breaking into medical records at an ever-increasing rate. While most record keepers are doing what they can, medical records are being exposed and accessed at every turn. Not only is it by insiders looking for the latest gossip, but by outsiders wanting access to expose confidential information and obtain money for their efforts.

In addition, I am sure he is referring to The Health Insurance Portability and Accountability Act of 1996 (HIPAA). This for manual records has been great for doctors and hospitals and allows for discipline of staff that gets too curious and then collect the latest gossip about patients. The new electronic health records are supposed to covered, but as above they are being compromised.

He uses a very interesting discussion to emphasize doctor competency. This is why doctors should not be hesitant to consult with other doctors. We as patients are not supposed to be able to rate the competency of doctors, but we can often sense when a doctor is having problems with a diagnosis. We can also notice when doctors do not read the detail and ask the right questions, do some necessary testing, and sometimes we can sense by their tone of voice that they are just trying something hoping it will work.

Communication skills is a subject this doctor seems well versed in and knows what is necessary. He again uses a vivid example of lack of communication skills. We as patients need this communication. I makes us pay closer attention to the doctor and without it even the author agrees we are likely to seek doctors that will communicate with us.

Compassion can be difficult for some doctors especially if they lack communication skills. When my first wife was near death from cancer, the attending physician was probably the most compassionate doctor I have dealt with in my life. He knew her family was grieving and probably used his arsenal of communication skills to let us know that he was there for us and understood our grief. He answered our questions with compassion and described quite accurately what was ahead, but in a caring way.

The last C he covers is convenience. This is a difficult one to explain, as it will not always be convenient to get a referral even with your doctor’s intervention. Often in some rural areas, the specialist needed may be several hours away and booked up for a month or more. If you know your doctor is doing his best to get you in to see the specialist, and it is not an emergency, have patience. I have seen doctors refer patients to the emergency room to bypass logistical headaches, and get his patient taken care of, but I know this is frowned on heavily unless it is an actual emergency.

January 11, 2012

Surprise, Statins Not Shoved at Us!

This is a pleasant surprise, at the least the part of not having statins shoved at us. I am surprised that this study was allowed to go forward or even be published since statins are not mentioned. It is going to be very interesting to see how long this study stays posted before people are asking that it be pulled because statins are not mentioned or recommended.

Now, to the study, which says patients have time to learn lifestyle changes before drugs may become necessary. This is for people diagnosed with diabetes and hypertension. It could have included prediabetes and should include this. The savings for cost analysis would have been greater and possibly easier for the patients to adjust their lifestyles.

While the study mentions diabetes, it on the control of high blood pressure as the key for the time allowed before medications are needed. Yes, some people are able to manage diabetes without medications and this should be the goal for all patients. Some may need medication assistance until lifestyle changes are made to prevent potential complications from developing, but the goal should be to get off medications if possible.

This study is important as it shows there is a potential window available without severe consequences for people to adopt lifestyle changes to reduce the effects of hypertension before high blood pressure medications are necessary. To quote the study statement, “The consequences of delaying effective hypertension treatment for up to a year were small - a two-day reduction in quality-adjusted life expectancy - according to a study by University of Chicago researchers published online for the Journal of General Internal Medicine. But as the delay gets longer, the damages multiply. A ten-year delay decreased life expectancy by almost five months.”

While no mention is made about cholesterol and statins, this can be a good thing as too often this is an automatic thing for doctors to prescribe especially when diabetes and hypertension exist in the same patient. If lifestyle changes can be accomplished within one year, then it should also be possible to avoid the need for statins as the cholesterol readings generally follow the blood pressure readings brought on by lifestyle changes.

The study also emphasized the importance of working with the patients to learn how to make the lifestyle changes and receive the support for making them. The American Diabetes Association (ADA) recommends only allowing a three-month trial of medication-free lifestyle therapy for patients with moderately elevated hypertension. This is a good reason for doctors to know of this study and allow the patients up to a year for making the lifestyle changes.

This study argues that caregivers should work with patients to help them gain the knowledge and develop the necessary skills gradually rather than rushing to drug treatment, especially if their blood pressure is only mildly elevated. It suggests that patients and providers "have more time," the authors write, "at least up to one year, to focus on diabetes self-management and lifestyle modification."”

The ideas put forth from this study are needed, but I would agree that sometimes it might be necessary for medications to be used when the test results are in excess of the upper limits. Patient safety should be exercised to bring diabetes and hypertension under good management while the patient is taught how to use and manage lifestyles changes to the fullest.

January 10, 2012

Do We Need Diabetes Hero Worship?

Apparently, this is a need or many diabetes newsletters would not be featuring a celebrity with diabetes in almost every issue. Now comes the difficult part. No, I do not admire them because I seldom follow them or know who they are. To me they are just another person with diabetes.

Where I will agree with the hero worship is what these celebrities are doing to shed light on diabetes at the risk of their own careers. With so many people keeping their diabetes a secret, at least they can see other people proclaiming diabetes openly. If this will loosen some people up and have them come out of the closet, then that is a good thing.

We do need leaders to step to the fore and help people unite to gain recognition for diabetes and the invisible chronic disease it is. Until people recognize this, we will continue to lag behind breast cancer and other diseases like Alzheimer's and heart disease that are receiving attention on a national basis and even world basis. This should be a goal of diabetes and we need to work harder in 2012 to bring the American Diabetes Association and the other associations in the USA into step with the World Diabetes Federation.

We need to unite under one symbol and speak in unison for the research for a cure. There have been many discoveries in the last years that could relieve the stress of diabetes, but unfortunately, the division in this country including FDA is not helping these earn their recognition as popular aids in the battle against diabetes. Granted they are not cures, but they could help many individuals in their management of diabetes.

Until the celebrities unite with us in this cause, their voices are muted and the value they could do only benefits a few people with diabetes in need of accepting their diabetes and advocating for education of more people.

So rather than dismiss celebrities like I have been known to do, I will be attempting to be more accepting of them. It is my hope to encourage more of them to advocate not only for education, but to unite with us to unify people in the Diabetes Online Community to unite behind one symbol. We need to have the celebrities work for the unification of the diabetes organizations in accepting one symbol. That symbol is the blue circle of the World Diabetes Federation.

January 9, 2012

Knowing When to Test Post-Prandial

When do you test your blood glucose after a meal? Many people do it at one hour and others do it at two hours after eating. In my reading and experiences, either may be correct and either may be false. It is for this reason I encourage people to find their own post meal high point in blood glucose levels. Since there are so many variables involved, you need to find out what is best for you. Not every day will be the same or every meal.

Rather than repeat what other excellent bloggers have written, I will refer you to their blogs. Tom Ross has three, one here, and the addition to it here, then he had a surprise (these do happen) and has a blog here. Yes, we do correspond about these topics. Alan Shanley has two blogs on the topic with a different perspective here and here. I have written a blog on what your meter tells you about what you eat. Even Will Dubois has a blog post related to meters and their importance – meaning testing..

Cannot afford the extra test strips, then you may need to talk to, or write your test strip manufacturer, and see if there is any assistance available. You may be surprised. I am aware of one enterprising young woman that was able to get a vial of test strips just by asking and explaining why and for what she would be using them. Do not expect to be as lucky as she was, but in her case, she did have a need. Some manufacturers have assistance available to obtain them at reduced cost. There are different organizations available on the internet, but I urge caution in dealing with some of these. They overcharge and often send out out-dated test strips. Check this out for avoiding some of the problems.

If you can afford or get extra test strips, learn your time of high blood glucose levels post prandial. Also, use the extra test strips to find out how the different foods affect you. Use the extra test strips wisely in your own lab. Find out what the different foods do to your blood glucose. Do take time to study the glycemic index tables for foods. Do not believe these are gospel because the index is determined by testing normal people and not people with diabetes. Do use it only as a guide for determining which foods may rapidly raise your blood glucose. Here is one small table and by using your search engine, there are many available (key words – glycemic index). Table sugar has a glycemic index of 80, so compare that to the white potato.

Some people are able to eat potatoes without a high spike in blood glucose while others are able to eat rice without a high reading. If you do not have problems with grains or celiac disease, whole grains and foods with whole grains may cause high levels. So be prepared to find out whether you are able to consume them or able to have a small serving. I can eat certain types of potatoes and most rice (at separate meals, of course) without a high spike, but if I eat any whole grain or even refined grain products, and look out high blood glucose levels. I also limit the amount the above foods accordingly to prevent unnecessary spikes above my limit.

Too much of any food with carbohydrates can cause blood glucose levels to rise higher than desired. So test to see how they affect you. Every person is different and can be different at different times depending on the combination of foods consumed. As you find out which foods cause you to spike, decide whether to eliminate them from your menu or reduce the amount consumed. Be careful of many fruits and certain vegetables and eat them in moderation.

Now, find out the average time from first bite, or last bite, (your choice) to your high level, but be consistent. Some of us learn to do it one way and there is some confusion, but select one method and stay consistent in using it. Once this is determined, be ready to do more testing. This is not a precise science, and that is why each individual needs to do their own testing. Yes, you could be one of the lucky ones and make all the right guesses, but I urge you to do this about once a year to see if something has changed. Definitely consider this if you know things have changed. And be aware that there can be surprises. This can negate your confidence in your testing method, but please do not let it.

Good testing!