July 28, 2012

Introduction to Series on Vitamins and Minerals

Many of us are deficient in certain nutrients and our doctors do not or will not test us for deficiencies as we age. Some of us do have sufficient quantities in our diets and then take supplements, which may give us an oversupply. I will give the name of the test when it is available. Your doctor should test for all of these (that have testing available) before you run out and buy supplements. You may not need them because you are already obtaining sufficient intake from your diet. If you have a doctor that will not test because you should be eating foods with sufficient nutrients, then you will have a decision to make about retaining your current doctor.

I realize that many of you may be aware of them, but it never hurts to review them. In the coming blogs I will cover iodine, selenium, choline, manganese, magnesium, potassium, Vitamin D, Vitamin K, and Vitamin B12. These may not be what you would think is needed for those of us with diabetes; however, they are still important. If you would like more detailed information, please read the links supplied with each blog as there may be several links. Some are water-soluble and others are fat-soluble. Vitamin D is neither as it is correctly a hormone. This will not change because of acceptance.

I would be remiss if I did not give you a warning about not overcompensating and ingesting too much of some of these nutrients as there are some medical concerns with toxicity and conflicts with certain prescription medications. More is often not better and can be fatal with some supplements. I will give warnings where they apply.

When there is a list of foods that may give you sufficient supply of a nutrient, they will be listed.

Since most of these vitamins and minerals have recommended daily allowances (RDAs) that vary by age, the entire table will be given. Some sources list only the adult RDAs and I prefer to give you the full list.

Please refer back to this blog if you question something and I will update this blog with each blog as I publish it. Some of my blogs will refer to my other blogs, as the nutrients can be essential for the same thing. Example - iodine and selenium both are essential for the thyroid gland to work properly. There may be others, but as of yet, I am not into research for each of them. I had intended to put two or three nutrients in a single blog, but with all that I am discovering, this would make the blog too long and essential points less obvious.

Vitamin K

July 27, 2012

Medicare – Give Us Back Our Test Strips

Where this will go, I don't know, but those of us with type 2 diabetes need to be able to test our blood glucose and not feel restricted by when and how often we are able to test. Yes, people do need the education about testing. They also need to be taught how this will help them be better able to manage diabetes. While I do not want to vent, I have had conversations with several doctors that agree with me and wonder how we are best able to turn this around and get more people to test on a regular basis. Yes, Medicare, give us back our test strips!

Read carefully as I don't plan on pulling back in some areas and I honestly feel that there is some truth as I am getting emails that agree and some medical professionals that agree in part. Some do very carefully state some ideas, as they are not sure they can rely on me not to use their names and quote them. So continue reading about self-monitoring of blood glucose and related educational ideas.

First, I must point out that much of the research for self-monitoring of blood glucose (SMBG) is suspect. Not only are the participants carefully selected, but also most studies seem to exclude people with type 2 that have an interest in or knowledge of SMBG. Many of the studies are observational in nature or rely in participant-completed surveys, which are not reliable for scientific accuracy. In the USA, many of the studies are funded by the National Institutes of Health (NIH) or the Centers for Medicare and Medicaid Services (CMS). Then on the unscientific information, Medicare takes more test strips away from us.

I have made this accusation before and I will again. This is based on my research and in no way is it scientific. There is a conspiracy happening in the USA between government agencies and medical organizations to keep many people with type 2 diabetes unaware of the damage being caused by our grain industry and low fat mantra, which is promoted by the US Department of Agriculture (USDA). In turn, the NIH and CMS have cooperated by funding non-scientific studies giving Medicare the incentive to reduce our testing supplies.

Then the America Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE) promote the USDA line of thinking – whole grains, low fat, and people with diabetes that do not know better listen to them. Then the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) which follow the ADA and AACE do little do encourage people to think for themselves. They are pushing mantras and mandates and expect people with type 2 diabetes to accept the dogma blindly.

The AADE does nothing to promote and teach diabetes self-management education (DSME). They give mandates and mantras that patients are learning is bad for their diabetes health. Most CDEs will not teach patients about self-monitoring of blood glucose (SMBG) for fear that patients will discover the truth about whole grains and low fat. The monopolistic workers for the AND mandate that we consume a minimum number of carbohydrates per day and go ballistic when we do not and literally call us noncompliant and often refuse to work further with us. This refusal is the one good thing for us as patients.

Now some will say that the AADE does promote DSME, which in a small way they do, in some sources and pamphlets, but very little of the information ever reaches the patients. A few conscientious CDEs do teach DSME and even fewer teach SMBG until they are confronted by older CDEs and encouraged to stop. So please Medicare give us our test strips back and find us doctors willing to teach us the truth. We know there are doctors that are breaking ranks with the ADA and AACE because of the lack of diabetes education being taught.

I am also aware of doctors attempting to use peer mentors to dispense some diabetes education when CDEs are not available or have taken positions in conflict with the doctors. This may become more common as the increasing numbers of patients diagnosed with diabetes come into existence and the numbers of CDEs entering the field continues at a snails pace. With this gap widening almost daily, is it not surprising that doctors are exploring other avenues to assist in diabetes education. Even more doctors are investigating shared medical appointments to expand education by presenting it to groups of patients when there is not time to do it individually.

The controversy about the registered dietitians will need to play out in the court system before we will know whether their numbers will decline. Nutritionists that are joining other organizations to continue being able to dispense nutrition information may be able to step in and fill the widening gap. This should be great for those of us with diabetes as my experience with these nutritionists has been positive. They are interested in balancing nutrition and not issuing mantras and mandates for us to follow. They will suggest ideas that some of us may disagree with, but will work with us to help us balance our nutrition whether we follow a low carbohydrate, medium fat diet, a paleolithic diet, or even other diet plans. They are not locked into telling us we must eat a required number of carbohydrates.

Patients around the globe need education about diabetes and how to apply this to their daily lives. In the USA, we need Medicare to give us back our testing supplies in sufficient quantity that newly diagnosed patients can determine how the different foods and food combinations affect our blood glucose levels. Then allow enough test strips for people to use on a daily basis and to do random checks when adding new to them foods.

Okay, why do I use Medicare as the scapegoat? Because the medical insurance industry generally follows the lead of Medicare in lock-step. If NIH and CMS are going to do studies, let’s have them do studies for three to five years and give continuous education during the studies. Have the education reinforce the principals set out at the beginning and ask the participants what they need in more information to help them. And, have the studies be scientific studies with the proper scientific methods applied and not the observational and survey format from the past. Do not exclude study participants that are interested or have knowledge of SMBG, Teach the study participants SMBG or DSME. Medicare, give us back our test strips!

I might also suggest that if doctors are going to be paid incentives, they must provide education on a continuous basis to be eligible. This should be audited for verification.
If insufficient CDEs are available, make use of peer mentors and even retired doctors if this is needed. The only way to put a halt to the increase in the diabetes epidemic is to educate the current patients and make sure they have the testing supplies to make it happen. Educated patients will not be afraid to spread the education.

July 26, 2012

Blood Glucose Meters versus Test Strips

Why is everyone blaming their blood glucose meters for being inaccurate? Even the Food and Drug Administration says the meters are not safe and accurate for the purpose many people are using them for. Read the FDA explanation here. If the FDA is this concerned, why have they not issued a warning or a recall? If meters are accurate or inaccurate, why do we need the test strips? Probably because most people think it is the meter doing all the testing, and they forget about the test strip that we insert into the slot in the meter for the meter to interpret the reading and convert it to a reading we can understand.

We need these insignificant little rascals because without them our meters would not be able to give us a reading of our blood glucose. Many doctors and endocrinologists hand the meters out for free as they have received them at no cost because the strip manufacturer knows that to use them, the test strips will be needed and in general, the tests strips are expensive.

Before you go ballistic on me, many of the manufacturers do have good assistance programs. You do have to apply for most of the assistance, but it is available to those in need. Do check with the manufacturer if you are in need of assistance and follow their directions.

I have written before about not wasting test strips. I have added additional information since then and I think it is time to cover this in more detail. First, make sure that you store and use your strips properly. The containers they come in are the proper containers to keep them in. Second, do not transfer the strips between containers as this can damage some of them.

If you are like me and have large fingers, the first few strips are often hard to remove from the container. The method I use is not approved, but it works for me. I keep a small plastic tweezers handy, that I have taken a short section of an appropriate width rubber band that I glued to the tweezer between the two sides (on each side) and one small piece on the outside (of one side) to gently pull the strip out far enough to get a grasp on it. I do this for getting out the first few. No, I did not say metal tweezers, as using them is a good way to damage the delicate strips. Check with your pharmacist for a plastic one, they are available, but may need to be ordered.

The original containers are made of special materials that help preserve the test strips and keep them dry. Keep the test strips in the original container and do not transfer them between containers. It is important to use the strip as soon as possible after removing it from the container. Close the container after removing the strip to use. Keep the container out of direct sunlight especially when taking strips out and do not expose the strip to direct sunlight.

Please do not put a few test strips in a baggie, in a purse, or wallet to carry them. The test strips are delicate and can be damaged beyond use. If you are out in nature, keep the test strips in the container, put the container in a small zip-lock bag, and then put this in a cooler or a Frio pack in the summer or an insulated bag during the winter. Keeping moisture away from the container of test strips is important.

Keep the container of test strips in a dry place. The bathroom or the kitchen is often the worse place to store your test strips. I will repeat what the directions are for my Accu-Chek Aviva test strips. I strongly urge you to read the instructions that come with your test strips.

Always store the test strips between 36° Fahrenheit and 90° F (2° Celsius to 32° C). Do not expose the test strips to heat, moisture, or humidity. Temperatures outside the required ranges, as well as moisture and humidity, can damage the test strips and lead to inaccurate results. Use the test strip removed from the container within three minutes or the results may be wrong, and you will need to repeat the test. You may use the test strip at temperature ranges between 43° F and 111° F (6° C and 44° C). You may also use the test strip between 10% to 90% relative humidity. Use the test strips only until the “Use by” date on the strip container. If the “Use by” date is missing or cannot be read, do not use the test strips. Do not reuse a test strip and properly discard a test strip once it has been used.

Always insert the test strip into the slot in the meter and make sure that the code number on the test strip container shows in the window. If the code does not show, remove the test strip and carefully reinsert to get the code. If it does not happen to show the code, discard the test strip and get a second test strip and repeat. Look at the meter to see if the drop of blood and the strip in the meter window is flashing. If it is, then use the lancet to prick your finger and carefully milk the finger to bring sufficient blood to the surface. Carefully insert the meter with the test strip area to wick up the blood into the drop of blood. Once the blood has wicked into the test strip, you may set the meter on a flat surface; wipe the excess blood off with a tissue or washable cloth. Then record the reading from the meter to a logbook and the time.

The above instructions have been summarized from the instruction sheet accompanying my test strips. There are other instructions that are spelled out on the instruction sheet and it is wise to know them if you are new to blood glucose testing. It also never hurts to review the instructions as they do change as technology is improved upon or like me I will be moving to a new updated test strip in the near future.

One instruction that has changed on my sheet, but I cannot say when it changed, is the instruction for preparing your hands or fingertips for testing. It used to instruct you to clean your hands with alcohol pads. Now the instructions state to first wash and dry your hands. I would correct this based on experience to, “Please wash your hands with warm water and soap, rinse carefully, and dry thoroughly before handling test strips. Never use wet or damp hands or fingers to handle the strip container or for removing a strip from the container. This should be the routine before using the lancet and wicking blood into the test strip.”

I have had two very good emails in response to my last blog informing me that when people are talking about meters, they are talking about both the test strip and meter in combination and that they function together as a unit. This is true, but I will point out that many people that are new to diabetes do not always make this connection and in fact two of the three emails I mentioned in my last blog were asking about why the test strips were not mentioned, and if it was the meters that were actually to blame. That was the purpose of this paragraph (the next paragraph down) in my last blog.

“As for meter accuracy distortion, this is understandable when they are jammed into bags, purses, pockets, and other places where they were not intended to be stored or carried. I have seen test strips wedged in the meter slots and jerked out. With this happening and no care of where the meter is stored, it is small wonder dirt, lint, and test strip particles could affect the accuracy of the blood glucose meter. This is delicate equipment and if you want accuracy within FDA guidelines, treat it accordingly. Some people even store meters and test strips in car glove boxes or on the dash in full sun and heat, so how can they expect accuracy?”

Proper storage of the meter is important for it to function correctly and properly read the test strips. To my readers, please know that there are many variables and that as things currently exist, we have reliable meters and some that are not so reliable. It is the test strips that determine meter accuracy and until our test strips can be calibrated to a more accurate degree of precision, we cannot expect our meters to be any more accurate. Please remember that when we talk about meters, most people refer only to the meter and in fact may mean the meter and test strip as a functioning unit.

Another reader brought up something I admit I had not considered. He stated, “I'm very aware of the problems involved in trying to set an accuracy specification. Very often a measurement device which actually has a tight performance spec when used properly in a stable-temperature environment ends up being given a very loose spec, because the maker is worried about what happens under less favorable conditions.”

I would like to express my thanks to those that sent emails, even some of the unpleasant ones. I was very appreciative of the emails packed with information, some of which I used above, as they added to the information. I am still sorting through the information and may add some to another blog.

For a very incomplete listing and information about blood glucose meters as a meter and test strip unit, some of you may be interested is this PDF file from Diabetes Health web site. Also read this by David Mendosa published on July16, 2012 and follow the link provided for a different perspective on selecting blood glucose meters.

July 25, 2012

Electronic Prescriptions vs. Chicken Scratches

This is an interesting article from the New York Times about our handwritten prescriptions and the errors they cause. It is also alarming the carelessness of the medical and pharmacology professions in not preventing this. I have never understood how people can have such poor handwriting. If the handwriting is that poor, I have to wonder about their skills as a doctor, physician's assistant, nurse, or nurse practitioner. Generally the two do go hand in hand, but not always.

Is it the fault of our school system, or the people we allow to be doctors? By any stretch of the imagination, allowing 37 percent of hand written prescriptions to have errors says volumes about the quality of the doctors writing them. Admittedly, seven percent is still poor, but this will go higher when the careless doctors start using the computer to click buttons.

I can only say that patients had better learn to pay closer attention to prescriptions in the future and become more knowledgeable about many medications. I have heard pharmacists ask patients if they were being transferred to a new medication, or ask if they knew what the medication was for. Many had absolutely no idea, so the pharmacist had to call for clarification. Many times I could see the frustration on the face of the pharmacist when the call resulted in no change or even a medication that could not be deciphered from the prescription. I felt very sorry for a pharmacist one day that was trying to do the right thing for a patient and unfortunately the phone was not muffling the sound of the doctor screaming at the pharmacist.

On this particular day, the doctor was changing all of a patient's medications. As I was waiting for a medication for my wife, the patient came in and started with foul language at the pharmacist for not having the prescriptions ready. The pharmacist was doing her best to explain why she had questioned all the changes. Patient then unleashed a litany of profanity about the doctor not supposed to have changed any medications. Pharmacist suggested he talk to the doctor (office at most 15 minutes away) as the doctor had instructed her to change every one. More profanity, so I spoke up and said the pharmacist was attempting to help him and he should be thanking her for that. More profanity directed at me, telling me to but out. Did I? Not a chance. I stood up and told the person to apologize to the pharmacist and get a civil tongue. If he chose not to, I would be making a phone call and we would see if that changed his tune. I was surprised that I stood taller than him and he apologized immediately.

He asked what needed to be done and the pharmacist asked if he was aware of the changes in his prescription. He stated that he had made it clear to the doctor he did not want any changes although the doctor had said he should on two medications. The pharmacist asked if he knew which two and he answered. The pharmacist said that was understandable as the one medication had been pulled from the market and for the length of time he had been on the other, he should consider the change since the one the doctor prescribed was generic and not a brand name. This left three other prescriptions and he and the pharmacist discussed these. He agreed that he could change on two others, but said he had a allergy to the third one. Pharmacist checked his record and agreed that the doctor had missed the allergy.

She picked up the phone and stated she would call him. Even I could hear the doctor on the phone as he was upset. She handed the phone to the patient and he said he would be filing a complaint with the medical board unless he calmed down. He then asked if the doctor was trying to put him in the hospital as the one medication he was allergic to and would become very sick. He handed the phone back to the pharmacist and then she said okay and hung up. Pharmacist asked the patient if he was satisfied. He agreed and the pharmacist said his order would be ready in 20 minutes.

Then fellow turned to me and apologized. I said good as I did not like seeing pharmacy customers verbally abuse the pharmacists, especially when they were trying to help the customer. He agreed that he had come in with a chip on his shoulder and was not intending to be this way. He was angry at the doctor for changing prescriptions like he did without discussing the reasons for making the changes. I said that would make me upset as well, but I would have come directly here and asked the pharmacist some questions as she would have covered them like she did. Since two of the medications were for diabetes, I asked if they were for him. He admitted they were and how did I know what they were.

I said as a person with type 2 diabetes, I was fairly familiar with most diabetes medications. He asked which I was taking and I said insulin. He looked at me and said you don't look that bad. I laughed and said he had to be referring to the insulin myth, probably promoted by his doctor, that this was the medication when nothing else worked. He looked puzzled and said that this is what he had been taught by his mother and his doctor. I said that is such a lie and I would never go back to oral medications.

I stopped him and asked if he was a veteran? He said he was and I asked him if he was seeing the Veterans Affairs office for medicines. He said no, but until a year ago had a good medical insurance policy that covered most of his medication expense. He continued that he had seven months left on COBRA and then he would be fully on Medicare and a supplemental policy. I asked if he would be interested in talking to the local office and getting his application started. He was, and I asked if he had time to do it then. He said he was not sure where to start, but he had some time. I talked to the pharmacist and said we would both be back later, I was taking him to the VA office and we would both be back.

After we had been to the local veterans office, he was even more talkative and asked why I was promoting this so hard. I said it was still his choice, but that his medications cost would depend on his income less qualifying medical expenses (or a means test) and this could save him some money. He needed to get his DD214 form from the recorders office and complete his application. He agreed that it could save him some money especially when he found out some of the other benefits he probably qualified for.

When we arrive back at the pharmacy, he again apologized to the pharmacist for his language, saying he would make sure that it never happened again. The pharmacist thanked him and asked if he would qualify for VA assistance and he stated more than likely. She stated that it could probably save him money and have less business with the pharmacy. I covered the point that on many generic medications, he could probably get them more reasonably through the pharmacy and gave him an example. He asked if that was for real and the pharmacist assured him that was what he was paying. She also stated that the doctor would need to send the VA office a list of medications once he was accepted and he should check with her before letting the VA prescribe the medications from the central VA pharmacy on most generic medications.

He had his prescriptions and then asked me for my phone number and if I had an email address so we could communicate. We have continued since then and he is now be waiting for his VA approval.

July 24, 2012

Volunteering As a Peer Mentor

Whew, I had hoped for an easy session for the first time. It was more a complicated mix of questions about my diabetes and why I am on insulin. Also in the questions was several about why I blog about diabetes and some of the other topics I blog about. I had been warned ahead of time that there would be questions like this although I was still surprised by the questions asked.

The group of eight diabetes patients that participated in the shared medical appointment were above average patients, and I was talking to only six at a time while two others met with the doctors. The range of ages was from 30 years of age to one patient of 89 years young. Length of time for each having diabetes varied from two months to almost 20 years. All had type 2 diabetes and were comparing notes. I was also pleased by the group as all were regularly exercising and the eldest was doing the most exercising and was managing his diabetes with exercise and diet. He was the first to speak and thanked me for providing the websites to their doctors and he was enjoying reading the blog by Tom Ross, as it was easy for him to relate to his experiences.

The next question was about why I had supplied so many sites as this person could not read them all. I answered by saying, I did not expect them to want to read all of the sites. The variety was to allow each person to find one or two that they enjoyed reading and maybe a few for information that they would bookmark and visit from time to time when looking for specific information. I also stated that these were not required reading, but that many would also have tidbits from time to time that they may find worthwhile, or can adapt to their lifestyle. We covered a few type 1 bloggers that two of the group had found and I answered that each was a good site for the information presented. I then summarized by saying that each blogger had her/his style of writing and would appeal to different readers.

We moved on and the next question was about my diabetes. Why was I on insulin and why did I not have a recommendation for the best insulin to use. To begin with, I was diagnosed late after diabetes already had a good hold on my life and at the time I was already overweight and my doctor did not talk about exercise. I explained that my purpose is not to recommend any medication but I had blogged about them and given references (links) to charts on the Internet to make people aware of the different types. I then stated that it was up to them to become knowledgeable and discuss them with their doctor to see if they had what was best for them. I said this applied to any medication they may be taking. I stated that the doctor would make the best selection based on the tests done, what he learned from your history, and from the questions he had asked before prescribing the medication.

I also emphasized that when they became knowledgeable about the different medications, they would not be out of line to revisit the topic with the doctor and discuss this in more detail. I had seen one of the doctors enter the room as I started talking about this, and she stated that is what they hoped would happen and the reason for having the shared medical appointments and for me answering questions as a peer mentor. It was for them to gain confidence as patients and ask these questions. She continued that sometimes doctors do prescribe what they believe the information tells them, but that does not mean that another medication might not be better suited for them. She rightfully stated that occasionally they may find that another medication is better, and they will do their diligence to investigate the possibility. She also warned them that they (the doctors) will not be bullied into a medication change just because a patient had heard about a medication and wanted it. They would listen to the patients to find out what knowledge they had on the medication and then start asking questions to determine if a medication change should be made.

The next question was about statins. I could see the doctor stop almost out the door. I said this was a question that was open to discussion and would depend on the health of the patient, the lab test results, family history, and other factors that only the doctors would be qualified to discover. I went on that there were two sides to the controversy and they should not be afraid to ask questions of their doctor. I would provide URLs to anyone needing them to help educate themselves about statins. The doctor gave me a thumbs up and let the door close. I asked how many were on statins and only two of those present were. Both were women and I asked for their ages. I asked one more question (both nodded yes), and asked if they had gotten my email address which they said they would use. I said I would send a copy to the doctor and both agreed.

We then moved onto testing and the questions were mostly about obtaining sufficient numbers of test strips. I said I knew of another doctor that was working on this problem and I would email him asking about their progress and make sure the doctors were aware of his progress. I would also give their doctors his email address so they could communicate.

The next was about the actual pricking of their finders and alternate sites. I demonstrated on my fingers and watched as they flinched, and knew that I had their attention. I showed them my lancet device and said there were others, but thought that all had an adjustment area and they needed to learn to use it. I showed that mine was set on 4 and that the number one would be the lightest setting and a click past 5 would be the deepest setting. I explained that they should try to see what it felt like after a few more instructions.

I next took a ballpoint pen and drew the best area on the sides of two fingers. I expected the next question, which was about the fingertips themselves and the pads of the fingertips. On two other fingers, I drew these areas and they said yes that was where they were testing and it often caused pain. I said that the first areas I had drawn contained less nerves and the second areas were full of nerves so there would be more pain. I could see one person getting out her lancet device so I stopped and said go ahead. She did and said OMG he is right. She said she was never exposed to the best places, so this was very surprising for her. I held up my hand and carefully showed them the areas I had outlined as I could see others going for their lancet devices. I also suggested that they consider the same areas of their thumbs unless for some it was too painful. I also described rotating the sides of the fingers and emphasized not to repeat on the same site for days on end.

I took time to show them the alternate area on their arms and demonstrated on mine. Since I have mine set a little deeper than some, it hurt, but I had a good supply of blood. I explained that this site would be between 15 and 20 minutes later than the fingertips and if they were experiencing a low blood glucose episode, this delay could be deadly. One woman said that at home she often did this on her legs and I reminded her that again the readings would be about 20 minutes behind a reading on her fingers. I explained that even though this was called lagging, the reading from alternate test sites were actually about 20 minutes older that one taken from the fingertips now. I asked her what her readings typically were and she came prepared and started giving them to us. I asked her the readings for her fasting blood glucose readings and they were very consistent. I then asked why she was avoiding her finders and got a logical response. She did a lot of needlepoint design and embroidery work and did not want to desensitize her fingertips. She stated she was on an oral medication and had never had as reading below 70 mg/dl.

Others were now saying they had no pain in the areas I had shown them and asked how I knew this. I referred them to my blog series number four and the links to Alan Shanley's blog. I also said I would find the other links I had with diagrams that I would send to the doctors for them to forward out. I went back to the woman that had been using areas on her legs and I suggested that she was probably okay where she was testing. She countered that she wanted to try the sides of her fingertips like I had shown as she had tried the tips and pads and did not like the pain. I then showed them that I could lance there and not have pain also as long as I stayed away for the area closest to the nail. I also stated that this would not work for most people. A couple reminded me that was where they always tested and did not like the pain.

We discussed when to test and how often to test. I asked how many test strips their insurance would reimburse and the answer was two per day. I suggested that they analyze the day and when they were having the most trouble, the highest readings, and adjust to them if they were satisfied with their fasting blood glucose readings. We talked about not jumping around on times but selecting times before or after a meal and doing this for a month. I emphasized the importance of looking for trends and if the readings were creeping up for the times selected, they needed to discuss this with their doctor. If the readings were consistent for a month then the following month select another time to test. Also covered was what to do during an illness and this encouraged more questions.

We then had two questions about medical alert jewelry. Why was it important and is there a real need. I answered yes to both questions and started to explain why it is important. At this point both doctors returned and the eight patients were all together. I repeated the two questions. Both said continue and I explained that if for no other reason, in an emergency situation, most emergency responders would look for a medical alert bracelet, a necklace, or a tattoo in a conspicuous place. With diabetes, if they need to start an IV of fluids, most would contain dextrose and this would normally be continued in the emergency room. This could raise your blood glucose to unacceptable levels. If one of the responders found your medical ID, they would know then that they would then need to monitor your blood glucose levels and administered insulin once your blood glucose was above a certain number. Or, if you had hypoglycemia, they would know that dextrose would be needed in a more concentrated level.

At this point, the husband of the two doctors, asked to have the floor. He stated that in some areas, first responders now have glucose solutions to add to the IV in cases of hypoglycemia. Without the medical alert jewelry, the first responders do not have a clue that a person is diabetic and may need special treatment. At that point the eldest patient held up is arm to show his medical alert bracelet and stated that about six months after diagnosis, this had saved his life when he passed out from over extending his exercise and he had a low he was not aware of. A passer by had discovered him and called 911 and reported that he was wearing a medical ID bracelet that said he was a person with diabetes. When the first responders arrived, they tested his blood glucose and immediately attached a glucose bag to the IV and adjusted the rate per the doctor's instructions. When he came to in the hospital (he had been admitted), he asked what his blood glucose was reading. He was told it was being held at 180 mg/dl. He asked to have the level brought to 120 mg/dl and was refused.

He said he then asked to talk with his doctor and was refused, but another doctor did come in and told him hospital policy was to maintain at 180 mg/dl. Since he was not sure what to do, he thought he would see of he could get up. Then he found that he was strapped down by his feet. He said at that point he was angry and insisted upon being released. That brought on the wrist straps and now he knew he was in trouble.

He now asserted that he was dismissing himself from the hospital against advice of doctor's orders, and expected to be allowed to leave, but was ignored. When the staff had left his room he was able to convince his roommate to dial 911 and get the police there. He was dismissed and one of the police officers did drive him home. He immediately tested this blood glucose and found it at almost 300. To shorten his story, he said he settled for no bill from the hospital, attorney costs, and an apology for their treatment. I asked about the ambulance cost and he said his insurance paid for that. The doctors asked how long it took him to get his blood glucose level down and he said he had gone to his doctor then and had it down within four hours with insulin and then a glucose tablet.

The doctors asked to call a halt to things for that day. I could hear a few groans. The doctors both asked if I would be available for email questions and I said as long as they did not expect an immediate answer, and I could copy them with my answer. Everyone agreed and the computers were shut off.

I had fun even with some pretty direct questions and the finger pricking discussion got the most interest. This is one facet of telemedicine I had never expected to become part of, but it was enjoyable. I have received several emails with thanks for the areas that had interested them and quite a few questions which now I will need to do some research to answer. From a few questions, I see that I need to develop a paragraph that will explain that it is not in my agreement or authority as a volunteer peer mentor to provide recommendations about medications, that only the doctors can do this. If there are several issues to a question like I had on statins, I can present articles from both sides of the issue for them to read, and a recommendation to make this a question for discussion at the next appointment.

July 23, 2012

High-fat Meals May Set off Inflammation

This is a very interesting article about high-fat meals causing inflammation in people with type 2 diabetes. What is even more interesting is it sounds like this was only done for one meal and the measurements were taken before and after. The irony is that this is natural when people have not been eating high fat as a routine, and have a high fat one time after an overnight fast, they will display elevated endotoxins in their blood after their first high fat meal.

This is why they do idiotic studies like this to people so researchers can follow their agendas and prove their points. What the researchers are even afraid to disclose is the level of fat in their high-fat meal. This would also make a large difference in the level of endotoxins in the blood. Was it a 50 percent fat meal or a 70 percent fat meal or even higher? Also unstated is the type of fat, and this should be considered a fatal error in the study. Another error is no statement of high glycemic index carbohydrates and the level in the meal. This can also lead to inflammation.

About the only true statement in the article that can be relied on is, “Although the research doesn't show cause and effect ….”  This is true because anyone that is considering increasing their fat levels in their daily diets have, or should have learned to increase the levels of fat over time and not all at once. This is what I was taught and by starting out from my low fat meals of approximately 5 to 10 percent, I took approximately six months to bring my fat levels up to 50 to 60 percent.

Some say I took too long and others have agreed with me. That is why I find this study to be a farce and not worthy of the Society for Endocrinology. This is Britain’s national organisation (British spelling) promoting endocrinology and hormone awareness. Since they asked for mention, they are getting it.
The last link is a PDF file and you will need a PDF reader to open it.