February 24, 2012

SMBG Claimed To Be Ineffective for Type 2

U.S. National Library of Medicine publishes PubMed Health and their first statement at the top of the article has this to say in as a preface to a German study, “Regular self-monitoring of glucose levels has not been proven to have benefits for people with type 2 diabetes who do not inject insulin. It is not known whether self-monitoring can help prevent diabetes-related complications in this group of people.”

I detest the way this is stated and I am seeing this proclaimed more and more. The one statement from a 2007 study Scottish study mentioned here really irritates me - “Self monitoring is suggested to facilitate patient empowerment, but it was evident from these participants' accounts that they were self monitoring for their health professionals' benefit, rather than for their own, even though the professionals did not show interest in the readings.”

This tells me that these people have not been educated in the value and purpose of their testing. This I must blame on the physicians and ask why there is so little education. A little education can go a long way, but these physicians must not know the purpose of testing either. Even five minutes would be a start and the patients could know some of the benefits.

There have been many studies of similar nature to discredit self-monitoring of blood glucose (SMBG). What we do not have is confirmation of the criteria used in selecting participants. For all the studies to arrive at the same conclusions, we must wonder if steps were taken to obtain type 2 patients not interested in testing and not likely to test.

Alan Shanley from Australia has three blogs about the same topic and I will refer you to my last blog, which has links to two others. It is dreadful that these studies have taken place with the results that show people with type 2 diabetes do not understand the purpose of blood glucose testing. Many of the type 2 bloggers are doing their best to dispute this and educate other people with type 2 diabetes.

In the US, most insurance companies do allow two test strips per day and follow the policy of Medicare. Therefore, within these parameters I would urge people to read my blog here about post prandial testing and follow the links to other bloggers. Then take time to read this blog about what testing can do to assist you in your diabetes management.

This blog by Will Ryan is the last blog for now that I will ask you to read. Will I stop writing about this topic? No, as long as these studies continue, I will continue to write about self-monitoring of blood glucose and the importance of doing testing.

February 23, 2012

Complications of Using Insulin

An excellent topic came out in Joslin's blog February 6, 2012. While it does not outright list the myths that many people associate with the use of insulin, the question asked include two of the myths. The question is Am going to lose my feet or go blind now that I am on insulin?”

Unless you have waited too long before starting insulin, and are letting your blood glucose levels remain too high, neither of these two myths need to happen. By keeping your A1c's less than 6.5, you should be able to avoid most complications. You do need to be very careful of hypoglycemia (low blood glucose below 70 mg/dl) and weight gain. If you are able to exercise, weight gain should be a minimal problem. Read my blog here on avoiding weight gain when on insulin.

Myths are the main reason many people with type 2 diabetes avoid insulin. Losing your feet is maybe one of the easiest to avoid. Have a good podiatrist that you see on a regular basis (preferably quarterly) that can check your feet. Be sure to point out any unusual bruises or cuts so the podiatrist can treat them immediately. If this is impossible, get yourself a mirror that can be used to see the bottom of your feet and talk about anything to your regular physician.

Blindness is a justifiable concern and you should have had an eye exam shortly after your diagnosis to establish a baseline for eye examinations while you have diabetes. You should have an eye exam annually to check for retinopathy, cataracts, and glaucoma.

There are other myths about insulin and you may read my blog on insulin myths here. It is important to understand that if you do not manage your diabetes and do not communicate with your doctors, complications will happen. They may be the expected complications or unexpected ones. Your doctor only has his questions and the results of lab work done, so if you do not answer his questions and remain silent about possible problems, then the complications are yours to deal with. Read my blog about who can be at fault and why.

Some doctors use the fear of insulin to keep people on oral medications and using them properly. Read my blog here about doctors using fear of insulin. If you are having success with oral medications, then continue taking them. Do not say I am doing well so I will stop the medications. Read my blog here about managing your medications. This is when the complications will develop and your diabetes may become unmanageable to the point you will need to use insulin. Some people are able to get off medications with their doctor's approval when they can show that their exercise and diet regimen is working and you are able to maintain this regimen. Yes, the doctors often need convincing.

February 22, 2012

Uncaring About Diabetes – Not an Easy Challenge

For several days, I have been wrestling with how to write about a potential member of our diabetes group. This person has type 2 diabetes and has been included in our discussions on two occasions. He is still not convinced that he has to do anything about his diabetes and we know that he is in denial. The first time he attended we knew he was very angry and not accepting his diagnosis.

Then Jan Chait who writes for Diabetes Self Management wrote an excellent blog February 14, 2012 about someone that was seeming uncaring about diabetes. This cleared the cobwebs and I am writing about this person. He is retired and lives alone. He said that he knows of no one in his family that has or had diabetes, but did lose his wife to what he says was diabetes about three years ago. She was diagnosed about three years prior to her death with diabetes and put on insulin at the start.

He does not know what caused her death other than he blames the diabetes and insulin. When he found out that six of our group was on insulin, he about passed out and asked how long we had been on insulin. I am the longest of our group on insulin at eight full years and another has been on insulin for about five years. The shortest time on insulin is almost three months. Others have been on insulin for more than one year.

This surprised him and he asked why we were all appearing to be healthy and able to get around on our own. His wife had been put on insulin and about nine months later had one foot amputated and was in a wheel chair.

When asked what his A1c was, he could not tell us. All he knew was that the doctor had told him he had diabetes and wanted him to start a medication. He could not tell us the medication, as he was not going to take it. We knew we had a challenge. How were we going to get him to accept his diabetes and take the steps to manage diabetes?

We did encourage him to get copies of his test results done by the doctor. We also talked some about food and made some suggestions we thought might help him. He seemed very receptive to most of our ideas. When we got to moderate to high fat, he balked and said his doctor has encouraged him to be on a low fat diet. We asked if he was having problems with weight gain to which he answered no. We then asked him if he was having cholesterol problems and how he was doing on the lipid panel. He said good as far as he knew.

Again, we strongly urged him to get copies of all tests the doctor had done. Then we asked, if he did not mind, bring them for him to read from to add a solid foundation for discussion. He said he would and we let him go with that. He said he will stay in contact with his closest neighbor who is one of us and had invited him to the meetings. I have since learned that he is out exercising every day that he is able. He jogs and walks every day – weather permitting and apparently has a treadmill in his house.

Now if we can get him past his denial and to accept his diagnosis. Then he may be more open to some serious discussions for managing his diabetes. We are hoping that we may have another potential member. We are also aware we have a challenge ahead of us.

February 21, 2012

Vinegar, Vinegar, Vinegar Is Not a Rose

Apparently, the makers of apple cider vinegar are increasing their pressure to push the topic of vinegar into the news and increase their sales. Prior to this, it seemed to happen only once a year, but it is only 7 months since the last barrage of vinegar articles and blogs. My guess is they did not sell enough from last fall's crop and that is the reason for the early push.

At least 54 percent of physicians who answered the survey say they will not promote vinegar to diabetes patients. Only 9 percent are claiming to promote vinegar and the rest are considering mentioning it. As more complete the survey, the numbers may change.

When you read the article here, please click on the references to see that Carol Johnston, PhD from Arizona State University, Department of Nutrition is the primary source of information. After you have read this article, you may want to read my tongue-in-cheek blog about this in June of last year.

What surprises me is the number of studies listed that were done with healthy subjects that did not have diabetes and they expect us to believe that people with type 2 diabetes will have long-term benefits from vinegar.

The more I see published about vinegar, the less I enjoy reading the drivel they want us to believe. Now getting Medscape to publish an article about it shows the desperation these people have to promote vinegar. The Obama economy is hurting everyone.

Sorry folks, it just the way I see this issue.

February 20, 2012

Our Goals for A1c

Maryam Elarbi writing for Diabetes Self-management had a very well thought out blog about A1c goals. As one of the readers commented, How mature of you to take this attitude!” And for a young person with type 1, she could not be more right.

Often, we read about young people her age that are off to college, completely coming at odds with diabetes and letting diabetes take a toll on their health. And then in later life realizing how foolish they were back when.

Maryam's blog is worth the time to read. Before I get to what I wanted to say about A1c goals her statement here is most important, “At 18 years old, I’m finally at the point where I understand that “being good” at diabetes isn’t for my parents’, CDE’s, or endo’s approval. I’m accepting the responsibility that I need to take the best control of my diabetes for me.”

Now how does this apply to type 2's? I can no longer say that maturity gets us to this point quicker when we develop diabetes in our later years, too many young people are now developing type 2 in their preteen and teen years. They are facing the same type of problems this type 1 has, accepting responsibility for their diabetes.

Denial is an ugly part of our lives that needs conquering, not only to get on with life, but to take care of diabetes and prolong life. Some get stuck in denial for periods long enough that the complications get a strong foothold on our bodies and recovery is impossible. I actually thought I was immune when denial did not happen shortly after my diagnosis. Yes, I had the anger of getting diabetes, but I knew that my family history said I was at very high risk.

It was not until the third year that I had any denial. I was on insulin four months after diagnosis and quite happy with the success I was having. My A1c's were improving and I was living with diabetes. I think that denial maybe came with the depression of dealing with diabetes 24/7. Or maybe it was a little self-blame. Again, I was fortunate that this did not last long and I was back to myself again. I must also give credit to starting my second marriage shortly before the denial/depression happened.

The American Association of Clinical Endocrinologists (AACE) recommends A1c's of 6.5 for the upper limit and in 4 of 5 times I will be under their limit. It is that fifth time that seems to grab my attention. I have, since shortly after my diagnosis, been able to maintain my A1c below 7.0 and a few times below 6.0. I had wanted to get below 5.5 regularly, but that has not happened.

As I continue to age, I have reset my goal to keep my A1c near 6.0, which has worked out very well. I have learned the hard way that if you set realistic short-term goals and can achieve them, then the long-term goals will generally take care of themselves. Yes, you may have glitches (or bumps) along the way, but you will not fail to achieve the short-term goals if they are realistic and well thought out.