April 13, 2012

More Friday News Tidbits

Excellent study for healthy adults, but it has little or no value for anyone with type 2 diabetes. Even the small size of the study makes one have to ask if there is any value in studies like these. Of course, it is a preliminary study for determining the value for additional studies.

There is two pieces of information that I can take from this study. It explains why some people are able to eat more starchy foods than others. It also reinforces the abuse people are receiving in the one-size-fits-all approach that the American Diabetes Association, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), and the American Association of Diabetes Educators have as their mantra.

This second study is surprising from many aspects. A news organization (CNN) reporting something potentially this important and the leading medical news feeds completely ignoring the story. There have been other articles (see this ABC news article) like this in the past, but this is the most recent and seems the most promising.

I will echo the warning from the ABC news article – “The doctors expressed concern that news of this research could lead transplant patients to stop taking their immunosuppressants, which almost guarantees that they will experience organ rejection and loss of the transplant.”

So far, this has only been done for patients with kidney transplants and other organs may well be on the way for this procedure, but to date have not been openly attempted. The study was published March 7, 2012 in the journal Science Translational Medicine. The study describes the eight kidney transplant patients who each received a stem cell therapy that allowed donor and recipient immune cells to coexist in the same body thus eliminating the need for daily immunosuppressants.

The third article is about promoting breakfast that has foods with a low glycemic index that may help level out blood glucose throughout the morning and after the next meal. The researchers presented their findings at the Institute of Food Technologists' Wellness 12 meeting.

Researchers emphasized that the low glycemic index breakfast foods can increase the feelings of satiety and fullness and this may help people be less likely to overeat during the day. Even though they are emphasizing low glycemic index foods, they make no nutritional recommendations. They only state that these foods produce a gradual rise in blood glucose and insulin levels, which is considered healthier for people with diabetes.

The researchers did say the ideal breakfast has these attributes:
  • Savory
  • Portable
  • Pleasing texture
  • Fills you up for extended periods of time
  • Satiates quickly so less is consumed
  • Affordable for the whole family to eat every day
  • Non-fried
  • Delicious without making you feeling guilty
They then listed low-and non-glycemic foods that do promote satiety (feeling of fullness):
  • Rolled oats and groats (hulled and crushed grain, usually oats)
  • Pulses
  • Whole grains
  • Nuts and seeds
  • Sweet potato
  • Barley B-glucan
  • Yam flour
  • Glucomannan
  • Durum pasta
  • Vegetable flours
  • Chia / flax seed
  • Resistant starch
The researchers stated it may present challenges for food manufacturers, but it is well worth it to develop these products because of the prevalence of diabetes and prediabetes in the United States and beyond. It is estimated that by 2030, more than 16 percent of the global population will have a blood glucose problem.

April 12, 2012

Does Your Blood Glucose Testing Work?

This is a continuation of some of the recent discussions within our group with members from the second group present. We have been discussing testing rather intensely and getting mixed signals from those on oral medications. Finally, we started asking questions of them, when they were testing, and why. It seemed like we were talking to ourselves.

Allen did realize what was happening and started asking questions without saying it was for them. They politely listened and excused themselves early. Sue then asked to talk about testing for her brothers Ben and Barry who are both on insulin. Before we started, Ben said thank you to Tim. He stated that the day we had met was a very low period for him and now that he was getting his diabetes under better management, he was feeling better, more positive, and with Barry now living with him we could stop worrying about him.

We did discuss the level of his vision and he said it was not as bad as first thought, but he was going to have to get and keep his A1c much lower to save it. All of us present expressed our concern saying that we have been researching and talking about depression since Tim was the only one that really knew what to do. Ben stated that was one reason he was listening to his sister about how much we cared and that she had given us every reason to make life miserable for her, but we had not retaliated. Instead, we had done everything to make sure she got the knowledge she needed.

Even Allen expressed his thanks for our support and for trying to talk to the others, but he felt that they may still be in denial and for the present, we were not going to change their minds. Ben agreed and started asking questions about the insulin. Since I am on the same insulins and obtain mine through the VA, I told him that as soon as he got an appointment to let me know so that I could talk to him before the appointment.

We covered a lot about testing and the importance of keeping blood glucose levels down. We also talked about reducing his carbohydrates even though he was not overweight, insulin would make food more available to the cells and he could gain weight. He said that he and his brother were starting an exercise regimen and trying to walk several miles each day, weather permitting. Barry had a treadmill that they would be using especially during bad weather and would be looking for another piece of equipment over the summer.

Then we got into this blog by David Spero. Since Tim had a laptop, we pulled it up and covered it very carefully. Ben and Barry were both surprised when we pulled up the site for the calculator for converting A1c to average blood glucose. They both wanted to see their most recent A1c converted average blood glucose levels. Surprises all around and Ben said it was no surprise now why his doctor converted him to insulin. Barry said this even made his A1c more meaningful.

Ben asked if it might be possible once he learned what his food was actually doing to his blood glucose levels and he was managing his levels better if it would be possible to get off insulin. All of us agreed that it could be a goal, but with his sight problem, he may want to consider remaining on insulin. We all explained why we would stay on insulin and he said we have given him a lot to think about and he was glad that his brother and sister were with him. We kidded him about some of the insulin myths and he agreed that was what drove his question.

I asked him if he had a computer and Barry spoke up and said he did. He gave us his email address and asked that we include him in our lists. Tim said he would send him one that evening and include the rest of our emails, my blog site, our telephone numbers, and several other sites we used to get him started. Even Ben was now more interested and asked how long it would take him to become computer literate. We asked if he could obtain a computer and he said that should not be a problem and asked several questions about what he should consider. After some more conversation, Sue said she needed to get home and we broke up for the evening and I promised to talk more with Ben and Barry.

In a few days, Ben has seen what he wants and knew of the business I took him to and the owner and his family. After seeing one set up with a monitor that would greatly assist him, he ordered a computer and would purchased the monitor of his choice. Barry said he has been surprised about the sites provided him and did not realize all the information existed about diabetes. Ben says he now understands why Allen wanted to be a member of our group and expressed his desire to belong as well. I told him that it should not be a problem, but that they should ask at our next get-together.

Barry commented that in the few days since our meeting he has learned more than he had learned the five years since diagnosis. He said he thought he was doing well to have the A1c's he was obtaining, but he now understood why and how lucky he was on his own. He even commented about how lucky it was to have a family that now understood about diabetes even if they did not want to have diabetes. He explained that his doctor had started him on insulin and that he felt lucky that even happened.

Then he surprised me when he asked why we were so open about our diabetes. He said where he lived before, he only knew one other person with diabetes and he was a type 1 and seldom talked about diabetes. He then stated that in the week of being here he has met two others from the group that Ben had been in and seven of our group. I said there were eight of us, but that Brenda had not been at the last few meetings. She is the sixth of our group to be on insulin and only Allen and Sue were not.

Tim stated that one of the reasons we were open to discussion was because we had found each other quite by accident and in the process decided to meet somewhat informally. We did not want the formality of a support group and liked the idea of not needing to attend if we had other obligations. We all had computers and enjoyed reading and researching and discussing what we found either via email or telephone. We all felt the format of our friendship was getting together and clarifying something we may have misinterpreted or misunderstood.

Ben then stated that only Allen had held the group together and that the rest, including himself, had not been all that interested. They were just good friends that had diabetes. I said that could have been the reason Allen wanted to be part of our group since he wanted to learn more. Ben agreed and said he now needed to learn more and was looking forward to learning about the computer and being able to do some reading. He admitted he would not being doing the level of research that several of our group was into, but he said that reading over his brother's shoulder was interesting and he was learning.

I commented that it was good to have new people asking questions because this helped us review old topics for us and incorporate new material. Plus with others asking questions, this would keep us on our toes and remembering to not let new articles and blogs get by-passed because we thought we knew it. This was why we had used the recent blog by David Spero as it had some points that were good review for us as well.

April 11, 2012

The Importance of SMBG for Type 2 - Beyond the Basics

If you have diabetes, you have responsibility in your medical care. The role means self-monitoring of blood glucose to manage the health you have. I find that managing diabetes is challenging. It can be a burden, but only if you let it. There are enough challenges to keep a person reaching for that higher level of diabetes management. One thing for all of us to remember is the importance of a positive attitude. This will generally help us through the tough times and keep us motivated to stay on top of our efforts to manage our diabetes.

With type 2 diabetes, our care may be sporadic from our health care providers and since they do not live with us 24/7, it is urgent that we learn how to care for ourselves. Is this easy at the start? I would be lying to myself and to you if I said it was, because there are many things to learn. It does get easier and at the same time more frustrating as we learn more about diabetes and its idiosyncrasies. We have to learn how to manage diabetes without assistance on many fronts.

Diabetes is termed a chronic condition for many reasons. This aside, we can usually manage diabetes by changing the way we live. This means exercise, if we are medically able, changes in diet, getting rid of bad habits, and other changes that I discuss here. The main goal is to maintain blood glucose levels in or at a near-normal range and the only way this is possible is with testing.

Each of us may have different testing objectives and testing times depending on how we manage our diabetes. In the early stages, it is for knowledge of how different foods affect our individual blood glucose levels. Once this has been established, we need to realize that our bodies change and foods that were taken off the list may be added back in small quantities and other foods may need to be taken off the menu. We need to test when we are ill and our blood glucose may fluctuate rapidly, or not, depending on the illness.

Many people have serious blood glucose problems when undergoing an operation or having problems with pain. If a doctor suggests a steroid shot, be prepared to discuss this as steroids tend to drive blood glucose levels upward dramatically and make their management very difficult. Sometimes the treatment is necessary and a discussion needs to take place with your diabetes doctor about the temporary use of insulin to manage your blood glucose levels during this period of steroid treatment.

Your doctor will periodically order a laboratory blood test to determine your blood glucose level and hemoglobin A1c test. The A1c is an approximate three-month look back at your blood glucose levels. This is the test doctors rely on to determine how you are managing your diabetes. This is why you need to monitor your own blood glucose levels on a daily basis.

For those of us with type 2 diabetes, testing is based on individual factors. These factors are the type of treatment (diet versus oral medication versus insulin), A1c, and treatment goals. Some doctors will be able to help you determine how frequently to test and others will rely on a certified diabetes educator (CDE) to assist you. Unless you have a very knowledgeable doctor, learn on your own and read what others have to say. Self-monitoring of blood glucose is not a one-size-fits-all regimen.

There are many other factors that should affect when and how you test your blood glucose levels. I have covered some of them in the past, but I recommend you reading this blog by Jenny Ruhl. Then follow this link to more information. I suggest starting in the second row of icons and the middle icon. This is a very excellent discussion on some of the reasons for testing.

Blood glucose meters today are reasonably accurate. There can be some variability from one unit to the next, so it is wise to exercise caution and common sense when using the readings from these devices. As an example, if a reading does not fit with your symptoms (or lack of symptoms), take a second reading or use an alternate method for testing your blood sugar (such as a different meter). Blood glucose meters are least accurate during episodes of low blood sugar. Be sure that if a meter reading is out of range that you think is right, do a rewash of your hands with warm water and soap and dry thoroughly. Then go through the retest.

We cannot leave this topic without emphasizing changes that need to be made. I have them laid out in aprevious blog as lifestyle changes, but each lifestyle is spelled out to a greater degree than most do. In the process of making changes, this blog may assist you in what you need to do. For those medically able to exercise, my blog on safe blood glucose levels for exercise should be of help once you have talked it over with your doctor.

April 10, 2012

The Importance of SMBG for Type 2 - The Basics

Self-monitoring of blood glucose (SMBG) is important for people with all types of diabetes; however, I want to cover this for type 2. Just recording the results of your blood glucose readings in a log or journal gives you much information about your health. This recording of your blood glucose levels gives you visual evidence of your diabetes and how you are managing it. It also means that you are looking for ways to manage diabetes more effectively.

SMBG is an important task manager and a constant reminder on a daily basis of your goal for effective diabetes management. SMBG does require knowledge of what you are doing and the reasons for doing this important task. Some physicians will assist in encouraging you to test regularly and others could care less as all they want to see is the HbA1c (A1c) results as this gives them a three-month look back at how you are managing your diabetes.

We as patients also need the A1c results as this will give us information needed for adjusting our testing routines and it will tell us if we are doing it correctly. A good calculator for converting the A1c to average blood glucose readings is found here. If you use this and compare your average readings, you will be able to see how well, or not, you are managing your blood glucose. This will let you know if you are managing to prevent the spikes in your blood glucose. If not then you know that you have work to do to adjust when you are testing your blood glucose and that you need to work on managing what you are eating.

The purpose or goal of SMBG is to collect information about blood glucose levels at different times during the day to assist you in creating a more level blood glucose. You will use this information to adjust your regimen in response to the blood glucose values. This will mean adjusting your food intake, physical activity, and possibly medications with your doctor’s direction.

SMBG can aid in diabetes control by:
  • facilitating the development of an individualized blood glucose profile, which can then assist health care professionals in treatment planning for an individualized diabetic regimen;
  • giving people with diabetes, and their families, the ability to make appropriate day-to-day treatment choices in diet and physical activity as well as in insulin, oral agents, and even no medication;
  • improving patients’ recognition of hypoglycemia or severe hyperglycemia; and
  • enhancing patient education and patient empowerment regarding the effects of lifestyle and pharmaceutical intervention on glycemic control.

Patients properly educated and with some experience with SMBG can benefit from the empowerment that SMBG bestows. Diabetes specialists believe that patients should use the SMBG data for daily regimen changes and health care professionals should use SMBG data to guide changes in medication regimens.

The use and frequency of SMBG is the area of much disagreement among the various specialists and advocates of SMBG. From my prospective, I feel it will depend on what your budget allows and insurance will cover. With all that is happening with studies it is surprising we still have testing supplies. Some doctors will not even give prescriptions for testing supplies and others will delay this until the patient insists. Most insurances will cover a meter and test strips up to what Medicare allows for the type of diabetes you have and the medication you are taking. SMBG is the battleground for all people that need testing supplies. Medicare restricts testing supplies and most insurance companies follow in lock step.

If you are able to afford additional testing supplies, by all means, make good use of them. Shortly after diagnosis, you need to use your meter to determine how different foods affect you blood glucose. This will assist you in knowing which foods to decrease in quantity, which to eliminate from the menu for now and which are safe to continue eating. Most people that are conscientious about their testing and realize that readings are trending upward will want to retest their foods again and find out what is changing.

We all need to understand the reasons for doing certain tasks and the more we understand about self-monitoring of blood glucose, the more effectively we will use it. I am not in agreement with the current trend in testing for people with type 2 diabetes. The powers that be just do not allow for proper testing or frequency of testing needed to cover periods when your body chemistry may change, for determining what foods do for your blood glucose levels, whether an illness is affecting your blood glucose, or if a medication, especially steroids, is driving your blood glucose above normal levels. These are concerns all insurance companies do not even allow for. Even our medical community shows little interest in this and will deem you to be not watching your blood glucose when your A1c rises unreasonably.

For patients with type 2 diabetes, optimal SMBG frequency varies depending on the pharmaceutical regimen and whether patients are in an adjustment phase or at their target for glycemic control. If a patient is on a stable oral regimen with A1c concentration within the target range, specialists recommend infrequent SMBG monitoring. In such cases, patients can use SMBG data as biofeedback at times of increased stress or changes in diet or physical activity.

Finally, the following steps should be part of your guidelines for testing blood sugar levels; you should get specific details for your blood glucose monitors from the package insert or your healthcare provider. Never share blood glucose monitoring equipment or fingerstick lancing devices. Sharing of this equipment could result in transmission of infection, such as hepatitis B.
  • Wash hands carefully with soap and warm water paying attention to the finger you will use, and thoroughly dry your hands.
  • Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet, and can cause more pain and injury to the skin. This is the recommendation from the manufacturers, but I change mine only once a month or when testing on my wife's finger.
  • Prepare the blood glucose meter and test strip (instructions for this depend upon the type of glucose meter used).
  • Use the lancing device to obtain a small drop of blood from your fingertip or alternate site (like the skin of the forearm). Alternate sites are often less painful than the fingertip. However, results from alternate sites are not as accurate as fingertip samples when the blood glucose is rising or falling rapidly. Actually they can be approximately 20 minutes behind the levels obtained from your fingertips. This is not good when blood glucose levels are falling rapidly.
  • Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds.
  • Dispose of the used lancet in a puncture-resistant sharps container (not in household trash). Sharps containers may be obtained from your local pharmacy and occasionally you may need to wait a few days to allow them to receive a new order.

April 9, 2012

When Talking About SMBG – Researchers Rig Results

When I was diagnosed with type 2 diabetes, I wondered what was ahead. Experiences in my life have been varied, but in my research on self-monitoring of blood glucose (SMBG), I experienced something unlike anything else. I did not realize that whole industries and governments rely on and participate in funding studies fabricating false and misleading information to demean and direct fraudulent intent at a group of people with type 2 diabetes on no medications or oral medications.

These fabricated studies have been reported in trusted reviews, belying the truth in the way the studies were assembled and carried out. The editor of leading diabetes community website Diabetes.co.uk, Benedict Jephcote states: “There are a number of problems with the way results are presented within the Cochrane review. For instance, in the UK, there are many people with type 2 diabetes that are actively interested in self-testing and significant numbers of these people have to buy test strips from their own income. Studies which exclude these people cannot therefore give a fair representation of people with type 2 diabetes in the UK."

Cracks along the above line are already showing evidence to prove just that. In addition, in the future, researchers that are more honest will begin to refute these false studies. What is astounding is that the US Government has participated in this cover-up of studies that are done to show patients with type 2 diabetes do not need to self-monitor their blood glucose levels. The National Institute of Health leads the way and the Center for Medicare and Medicaid Services follows by cutting testing supplies for people needing them. By not educating Medicare and Medicaid patients about the value of self-monitoring of blood glucose and showing them how and when to test, they can support many studies proving that people with type 2 diabetes do not need the testing supplies.

This study by Roche shows that when a study is properly organized and follows the Structured Testing Protocol (SteP) standards, the results are more accurate and SMBG does help people with type 2 diabetes and not on insulin obtain lower A1c's and better glycemic control without harming the quality of life.

Other writers proclaim that the studies are right and say that the results beyond a year do not hold up. I can understand this because these study participants are no longer given the supplies with which to self-monitor blood glucose. Many of the study participants probably are unable to afford the testing supplies and therefore without them the results would be expected to not hold up. That is one reason to have long-term studies of three to five years.

The key in studies is the education which I blogged about here. Whom do you think will obtain the best results? Those just handed a meter and testing supplies and told to test are not likely to understand the results or possibly even care? My bet would be on people that were handed a meter and testing supplies and required to attend classes where they learn when to test, the reasons for testing, how to interpret the test results, and the overall benefits in watching for trends. Better results and longer-term results will be obtained when additional education is done to reinforce good habits and find and attempt to eliminate bad habits.

Although it would be great to have physicians trained at the same time, patients that are educated in testing and have learned the value of managing diabetes for better health will in the long-term be able to do this without physician assistance. With physician assistance, they will do even better.