January 19, 2013

A Positive Blog Site You Should Read

Are you having a downer of a day? Are you kicking yourself for doing something in your diabetes management that did not give you the result you were anticipating? If you need to have your confidence uplifted or an idea for a pat on the back, take time to read many of the blogs by Will Ryan at joyfuldiabetic. Here are three links you should enjoy – link 1, link 2, and link 3. Please take time to read these, and then come back. I'll wait for your return.

Now don't you feel better? This is what had me coming back to read this blogs. I can get down or disappointed and I go reading (actually rereading) some of his blogs. Then I feel more positive and ready to tackle a task that has been haunting me for several days. We can try to stay positive, but there are times when we need to have this reinforced and Will's blogs can do this for me.

You will not find long technical blogs. What you will find can be inspirational and uplifting and there are times when we need this. As primarily a speaker, Will has mastered the skill of being concise. You don't become a Toastmaster without this. I wish some of this would rub off on me. Take time to explore his site. Will usually blogs two times per week, on Sundays and Wednesdays, but life sometimes causes him to vary a day or two.

January 18, 2013

Medication Problems from Duplication

This is one feature from Diabetes Clinical Mastery that I enjoy. This does not always give me ideas for blogs, but occasionally there is a brief article that speaks volumes and points out some of the problems within our medical system. This article is not an exception and shows what happens when patients do not fill their prescriptions at one pharmacy, or provide their pharmacy of a complete list of medications they are taking,

This is one reason that more doctors are asking patients to being in all their medications in the containers in which they were received. Even then, some patients try to avoid doing this – to the point of endangering their health. The patient in this article did as she was asked and this may have saved her life. The author found two prescriptions for lisinopril. One prescription was for 20 mg and one for 40 mg, each to be taken daily.

She explained that the 20 mg was for her kidney and the 40 mg was for her hypertension. When the labels were examined, that was the case and each had been filled at different pharmacies. This explained why she had complained of being dizzy and afraid of falling when she rose from her chair. The doctor had her stop the 20 mg and her problems cleared.

The lesson learned by the author is that the same medication may be prescribed to a patient for different reasons and patients are most likely unfamiliar with the reasons for the medication. At least this author recognizes the fact that patient education is necessary to prevent the patient from either discontinuing the medication or like this example overdosing on a medication.

Even though this is listed as one lesson learned, the author did not forget that patients need to be encouraged to fill all prescriptions at one pharmacy. By doing this, the pharmacist should have recognized the problem and advised the different doctors at least or advised the patient of the problem.

There are other lessons to be learned from this example. First, every doctor should be aware of other doctors treating the patient and for what. This I make sure of and have the cooperation of all doctors concerned. I also provide at their request all medications I am taking, the dosage, when I am taking each, and who is prescribing the medication. The doctors do confer and I have only two doctors renewing my prescriptions. When a new one is needed, the conflicts are determined and the prescription issued if there are no conflicts. If the prescription if for the short-term, which all recently have been, the doctor concerned does the prescribing.

Another lesson is that patients often do not tell their doctor about supplements they are taking. Since many may conflict with medications, this always needs investigation. The last lesson is that some patients will not fill prescriptions at the same pharmacy for reasons only they are aware of. Others do not want one pharmacist to know all the medications they may be taking. Still others are receiving prescriptions that they in turn are selling for money. These are major problems within out current medical system.

January 17, 2013

Starting Small Is Good for Diabetes Prevention

This author knows how to push the wrong buttons and even though the message in general is a great idea, her delivery leaves a lot to be desired. The overarching message is for people that are hesitant about changing habits and ways of doing things is to start small and slowly develop good eating habits and other habits. Why the author could not have emphasized the positive side of this is a mystery to me. Instead, she uses scare tactics that people with diabetes do not appreciate hearing. Yes, I know, writing style and all that, but when introducing this to people that may not have diabetes yet, there has to be a better introduction.

Then in the suggestions area for a food plan, the author uses the National Institute of Health (NIH) recommendations. This means the USDA food plan of high carbohydrate /low fat. As many of us with diabetes are well aware, this is the formula for failure. Low carbohydrate/high fat is more successful over time and is the food plan of choice. Yet every time we are on the topic of potential aids for stopping or reducing the effects of diabetes, we hear the same plan for high carbohydrate/low fat mantra of the USDA, the American Diabetes Association (ADA), and other organizations.

Other than the suggestion of starting small to have initial successes, which may work well for some individuals, we are left with scare tactics and the wrong food plan. The idea of starting out slowly does work for people that are hesitant to make changes. Having early successes by setting short-term goals is good for many people. In the area of exercise, this is always good to start out slowly. However, even this author does not understand the importance of discussing an exercise plan with their doctor. The doctor should understand your current health and know if there are obstacles to an exercise regimen you have planned. Your doctor may find it necessary to do some tests to determine if there may be some limitations to your regimen. Once the doctor knows that there are not limitations, he may have suggestions, which will assist you in developing a more effective exercise regimen. It is wise not to leave the doctor out of the plan and encounter problems later.

Yes, we would like to see the current increase in diabetes stop, but until people are willing to start making dietary changes, start an exercise program, and develop other changes in their habits, this will not happen. Starting with small changes and having success is good, but getting people motivated is and should be the goal of physicians to begin converting people out of the sedentary lifestyle.

January 16, 2013

Hearing Loss Now Linked to Diabetes

Since I have type 2 diabetes, this is not news to me, but from discussions I have had with a few type 2 people with diabetes, I know many are not aware of the possibility of hearing loss. A key to understanding this is this statement from the study authors, “high blood glucose levels can damage vessels in the stria vascularis and nerves diminishing the ability to hear.” Stria vascularis is the upper portion of the spiral ligament that contains numerous capillary loops and small blood vessels, and is termed the stria vascularis. It produces endolymph for the scala media, one of the three fluid-filled compartments of the cochlea.

Like vision loss, it is the small blood vessels that are damaged by extended high blood glucose levels; therefore, hearing loss develops. Yet even this is controversial as most studies are inconsistent in results, that is, they have faults in research protocols so that the results are always inconsistent. It is still believed that over time, high blood glucose levels can cause damage and diminish the ability to hear. A study by the University of Japan found that people with diabetes have more than two times higher prevalence of hearing impairment than those without diabetes.

One of the strongest critics of the study states that the study is an observational association and additional studies are needed to clarify the relationship between diabetes and hearing loss. When researchers compare diabetics with non-diabetics, these observational studies cannot prove a cause-and-effect relationship, only a correlation between diabetes and hearing problems.

The connection between hearing loss and diabetes was stronger among people who were 60 years of age or younger rather than among older adults. The likelihood of having hearing impairment in this group was 2.6 times higher. Comments agreed and said this is consistent with the idea of poor blood glucose management, which damages blood vessels and nerves throughout the body and not simply old age.

It is important to be proactive in your care. If you notice any hearing loss, report this to your doctor. According the American Diabetes Association almost 26 million people have diabetes. More than 34 million Americans have some type of hearing loss and this number is rising as the baby boom generation ages.

January 15, 2013

Nutrients - Vitamin D

Vitamin D

Many of us are deficient in certain nutrients and our doctors do not test us as we age. Some of us do have sufficient quantities in our diets and then take supplements, which may give us an oversupply. Your doctor should test for all of these (that have testing available) before you run out and buy supplements. You may not need them as part of your diet because you are already obtaining sufficient intake from your diet.

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 and herbal supplements.

Vitamin D is one large misnomer as it is a hormone, but this is now commonly accepted and will likely never be changed. It is the one that most people will have a difficult time in overdosing, but it has happened.

This is to inform you that the newer Vitamin D blood tests are over 40 percent unreliable and you need to make sure that the tests are not used. Please read this article in WebMD. Older testing procedures are the better bet.

Recommended Daily Allowance
The current RDA for vitamin D is being revised, and some experts suggest that adults should take at least 2000 IU of vitamin D daily. I personally use 3000 IU of Vitamin D3 daily and some that I know take as high as 10,000 IU.

Recommended dietary allowances currently for vitamin D are listed below. Seniors and people who don't get exposed too much sunlight may need to take supplements. Seniors may be at risk of developing vitamin D deficiency because, as we age, the body does not make as much vitamin D from sunlight, and it has a harder time converting vitamin D into a form it can use.

If you are concerned about your vitamin D levels, ask your doctor whether you should take a supplement, and how much.
1. Infants birth to 12 months: 400 IU (adequate intake)
2. Children 1 - 18 years: 600 IU (recommended dietary allowance)
Note: The American Academy of Pediatrics (AAP) recommends 400 IU of vitamin D daily for breastfed infants until they are weaned and drinking at least 1 liter of whole milk or formula fortified with vitamin D. The AAP also recommends that children and teens who drink less than 1 liter of milk a day take 400 IU of vitamin D.
Ask your doctor before giving a vitamin D supplement to a child.
1. 19 - 50 years: 600 IU (recommended dietary allowance)
2. 70 years and older: 800 IU (recommended dietary allowance)
3. Pregnant and breastfeeding females: 600 IU (recommended dietary allowance)

Food Sources
There are two dietary forms of vitamin D:
1. Cholecalciferol - D3
2. Ergocalciferol - D2
These are naturally found in foods and are added to milk. Not all yogurt and cheese are fortified with vitamin D. Food sources of vitamin D include:
1. Cod liver oil (best source). Cod liver oil often contains very high levels of vitamin A, which can be toxic over time. Ask your health care provider about this source of vitamin D.
2. Fatty fish such as salmon, mackerel, tuna, sardines, herring
3. Vitamin D-fortified milk and cereal
4. Eggs

Taking the proper amount of vitamin D may help prevent several serious health conditions. These conditions include:

1. Osteoporosis - Vitamin D helps your body absorb and use calcium, which you need for strong bones. Getting enough vitamin D throughout your life is important, since most bone is formed when you are young. For post-menopausal women who are at higher risk of osteoporosis, taking vitamin D along with calcium supplements can reduce the rate of bone loss, help prevent osteoporosis, and may reduce the risk of fractures.

2. Other Bone Disorders - Vitamin D protects against rickets and osteomalacia, softening of the bones in adults. Seniors who live in northern areas and people who do not get direct sunlight for at least 45 minutes per week should make sure they get enough vitamin D through fortified milk and dairy products. Or, they can take a vitamin D supplement or a multivitamin with vitamin D.

3. Prevention of Falls - People who have low levels of vitamin D are at greater risk of falling, and studies have found that taking a vitamin D supplement (700 - 1000 IU daily) may reduce that risk. In seniors, vitamin D may reduce falls by 22%.

4. Parathyroid Problems - The four parathyroid glands are located in the neck. They make parathyroid hormone (PTH), which helps the body store and use calcium and phosphorus. Vitamin D is often used to treat disorders of the parathyroid gland.

5. High Blood Pressure (Hypertension) - People with low levels of vitamin D seem to have a high risk of developing high blood pressure than those with higher levels of vitamin D. However, there's no proof that low levels of vitamin D cause high blood pressure in healthy people. Evidence about vitamin D and blood pressure has been mixed.

6. Cancer - There is some evidence that getting enough vitamin D may lower your risk of certain cancers, especially of the colon, breast, prostate, skin, and pancreas. This evidence is based mostly on studies of large groups of people, population studies, and doesn't prove a connection between taking vitamin D and lowering your cancer risk. Some research suggests that postmenopausal women who take calcium and vitamin D supplements may have a lower risk of developing cancer of any kind compared to those who don' t take these supplements.

7. Seasonal Affective Disorder (SAD) - SAD is a type of depression that happens during the winter months, when there's not much sunlight. It's often treated with photo (light) therapy. A few studies suggest that the mood of people with SAD improves when they take vitamin D. Talk to your doctor about whether vitamin D might help your treatment for SAD.

8. Diabetes - Studies find that people who have lower levels of vitamin D are more likely to develop type 2 diabetes than people who have higher levels of vitamin D. But there is no evidence that taking vitamin D can help prevent or treat type 2 diabetes. One study found that giving infants doses of 2,000 IU per day of vitamin D during the first year of life may help protect them from developing type 1 diabetes when they are older.

9. Heart Disease - Studies suggest that people with low levels of vitamin D have a greater risk of developing heart disease, including heart attack, stroke, and heart failure compared to people with higher levels of vitamin D. Low levels of vitamin D may increase the risk of calcium build-up in the arteries. Calcium build-up is part of the plaque that forms in arteries when you have atherosclerosis and can lead to a heart attack or stroke.

10. Multiple Sclerosis (MS) - Studies have found that women who take at least 400 IU of vitamin D daily lower their risk of developing MS. And higher levels of vitamin D in the blood seem to be associated with a lower risk of developing MS in white men and women, although the same may not be true of African American and Hispanic men and women. However, this does not mean that vitamin D supplements will help prevent or treat MS in people.

11. Obesity - Studies have found that people who have lower levels of vitamin D are more likely to be obese compared to people with higher levels of vitamin D. One high-quality study also found that postmenopausal women who took 400 IU vitamin D plus 1,000 mg calcium daily for 3 years were less likely to gain weight than those who took placebo, although the weight difference was small. Women who were not getting enough calcium to start with (less than 1,200 mg per day) saw the most benefit.

12. Overall Mortality - Studies suggest that people with lower levels of vitamin D have a higher risk of dying from any cause.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider.

Taking too much vitamin D can cause several side effects. However, scientists don' t all agree on how much is too much. The National Institutes of Health has set the maximum tolerable upper limit at 1,000 IU daily for infants 0 - 6 months, 1,500 IU daily for infants 6 months to one year, 2,500 IU daily for children 1 - 3 years, 3,000 IU daily for children 4 - 8 years, and 4,000 IU daily for anyone over 9. Ask your doctor to determine the right dose for you or your child.

Side effects may include:
  • Being very thirsty
  • Metal taste in mouth
  • Poor appetite
  • Weight loss
  • Bone pain
  • Tiredness
  • Sore eyes
  • Itchy skin
  • Vomiting
  • Diarrhea
  • Constipation
  • A frequent need to urinate
  • Muscle problems
You cannot get too much vitamin D from sunlight, and it would be very hard to get too much from food. Generally, too much vitamin D is a result of taking supplements in too high a dose.

People with the following conditions should be careful when considering taking vitamin D supplements:
High blood calcium or phosphorus levels
Heart problems
Kidney disease

Possible Interactions
If you are currently being treated with any of the following medications, you should not use vitamin D supplements without first talking to your health care provider.
Atorvastatin (Lipitor) -- Taking vitamin D may reduce the amount of Lipitor absorbed by the body, making it less effective. If you take Lipitor or any statin (drugs used to lower cholesterol), ask your doctor before taking vitamin D.
Calcipotriene (Dovonex) -- It's possible that taking vitamin D supplements and using calcipotriene, a medication applied to the skin for psoriasis, could cause calcium levels to get dangerously high in the blood.
Calcium channel blockers -- Vitamin D may interfere with these medications, used to treat high blood pressure and heart conditions. If you take any of these medications, do not take vitamin D without first asking your doctor. Calcium channel blockers include:
Nifedipine (Procardia)
Verapamil (Calan)
Nicardipine (Cardene)
DiltiaZem (Cardizem, Dilacor)
Amlodipine (Norvasc)
Corticosteroids (prednisone) -- Taking corticosteroids long-term can cause bone loss, leading to osteoporosis. Supplements of calcium and vitamin D can help maintain bone strength. If you take corticosteroids for 6 months or more, ask your doctor about taking a calcium and vitamin D supplement.
Digoxin (Lanoxin) -- a medication used to treat irregular heart rhythms. Taking vitamin D if you take digoxin may cause levels of calcium to get dangerously high in the blood.

These drugs may raise the amount of vitamin D in the blood:
Estrogen -- Hormone replacement therapy with estrogen seems to raise vitamin D levels in the blood, which may have a positive effect on calcium and bone strength. In addition, taking vitamin D supplements along with estrogen replacement therapy (ERT) increases bone mass more than ERT alone. However, that may not be true if you also take progesterone.
Isoniazid (INH) -- a medication used to treat tuberculosis.
Thiazide -- A diuretic or water pill that helps your body get rid of too much fluid. It can increase vitamin D activity and lead to high calcium levels in the blood.

Vitamin D levels may be lowered by the following medications. If you take any of these medications, ask your doctor if you need more vitamin D:
Antacids -- Taking certain antacids for long periods of time may alter the levels, metabolism, and availability of vitamin D.
Anti-seizure medications -- these medications include:
Phenytoin (Dilantin)
Primidone (Mysoline)
Valproic acid (Depakote)
Bile acid sequestrants -- used to lower cholesterol. These medications include:
Cholestyramine (Questran, Prevalite)
Cholestipol (Colestid)
Rifampin -- used to treat tuberculosis
Mineral oil -- Mineral oil also interferes with absorption of vitamin D.
Orlistat (Alli) -- a medication used for weight loss that prevents your body for absorbing fat. Because of how it works, orlistat may also prevent the absorption of fat-soluble vitamins such as vitamin D. Doctors who prescribe orlistat tell their patients to take a multivitamin with fat-soluble vitamins.

January 14, 2013

Points to Consider About Food

The glycemic index (GI) and the glycemic load (GL) are two of the more meaningful terms in understanding the value of food and how each affects our blood glucose levels. This is a topic everyone with diabetes needs to be aware of and learn the general principles.

Everyone also needs to be aware that to some this is a religion, and therefore they can endanger their health. I will warn that this topic and the principles behind this should be used as a guide, but not as a bible. First, the glycemic values were determined using healthy people and not patients that were obese or that had any diseases. Therefore, we cannot be positive that the tables are exactly right for us. We do need a starting point, so I accept the tables as a starting point.

I will direct your reading to several people that have influenced my thinking about the glycemic index and glycemic load. The first was this book - The New Glucose Revolution, New York, Marlow & Company, 349 pages, by Dr. Jenny Brand-Miller, et al. I currently have the third edition.

Computing the glycemic load is fairly easy and will help in determining whether you are safe in eating the particular food, or will have high blood glucose levels briefly or for a longer period. Using the example from a blog by Dr. William Davis, we have the following: (quoting) “GL = (GI x amount of carbohydrate) / 100.
GL is therefore the GI that incorporates the glycemic potential of the food of interest. GI does not vary with portion size; GL varies with portion size.

Let’s take whole-wheat pasta, a food regarded by most people as a healthy choice. Whole-wheat pasta has a GI of 55–fairly low–and a GL of 29. A serving of 180 g (approximately 6 oz cooked) provides 50 g carbohydrates.” So using the formula above the GI of 55 X 50 g carbohydrates = 2750 divided by 100 = 27.5 for GL – not the 29 that Dr. Davis has. In either case when you look at the graph from David Mendosa's web site, you will see that the GI of 55 is the top end of the low range and the GL is well into the high range. This means that the whole-wheat pasta will raise blood glucose for a long period. This will depend on your body chemistry so actual time is difficult to measure. This is a good reason to avoid whole-wheat pasta.

Doctor Davis also has another blog on the glycemic index. By entering “glycemic index” in the search box on David's site, it will return many more articles by David and many that you may wish to read. Here and here are two of the articles.

If you have more interest in blogs on glycemic index go to this site and subscribe for a monthly newsletter.