July 5, 2013

Where Will You Learn About Diabetes? - Part 2

Part 2 of 2 parts

This is the topic for this blog. Where will you learn about diabetes?

The following are just a few of the diabetes websites that I read. They are of interest to me and you may like them.

http://tcoyd.org/ Steven V. Edelman, MD is the driving force behind this site and they have conferences nationwide. In addition to good news and continuing education for the medical community, they have education for the patients and caregivers as well.

http://behavioraldiabetesinstitute.org/ This organization is based in San Diego, CA deals with the psychological side of diabetes and how to deal with this part of your life.  While this organization is still limited to Southern California area, the message is still there and provides some good guidance for those of us with diabetes. Dr. William Polonsky is the founder and president of this organization.

http://www.diabetes-solution.net/ Dr. Richard K. Bernstein has type 1 diabetes and is very vocal about what can be accomplished with keeping it under tight control. He has several related websites. These sites are good for all types of diabetes and Dr. Bernstein is read by all types of people with diabetes. He also has several books that are excellent references for us. Check out his books on Amazon dot com. The forum site is located here. Although Dr. Bernstein has type 1 diabetes, he also is a great resource for those of us with type 2 diabetes.

Use the following in your search engine to fine more on Dr. Bernstein - “dr. bernstein diabetes”. Dr. Bernstein is now writing an article at least monthly for this magazine – http://diabeteshealth.com/. It is hoped that this will give it back some of the prominence it formerly enjoyed.

http://www.diabetes.org/ This is the site for the American Diabetes Association. It is a very large site and will take you a lot of time to find all the information that may be of benefit for you. While the ADA is more for the medical community, there is much information that we can use as well. Take time to explore as much of this site as you have time for or wish. Some studies are kept behind the pay wall.

David Mendosa writes almost entirely about diabetes and related health problems, types of insulin, diabetic equipment, and testing supplies. He does write about problems not caused by diabetes, but that are often associated with having diabetes. He maintains his own web site (the one above) and writes for several magazines and web sites. He is the author of several books and is a sought after speaker on diabetes. If you have diabetes, please do yourself a favor and read his web site. You should also follow his blogs on Health Central here - http://www.healthcentral.com/diabetes/c/17/

Alan Shanley is from Australia. He combines diabetes and common sense with his down under humor which is enjoyable to read. He has battled another disease into remission and is a rather remarkable person for his accomplishments.

Tom Ross is from California. He maintains a diary of his battle to manage his diabetes with diet and exercise. His positive attitude and determination have spared him the tribulations of being on medications for management of his diabetes. He is also talented musically.

Janet Ruhl is from the northeast part of the country. Her writings are factual and well documented.

Gretchen Becker is from Vermont. She writes with the same insights and humor that are in her book. I am happy that she now has her own blog (although it is presently inactive). She writes for several web sites as well. Read her blog on Health Central - http://www.healthcentral.com/diabetes/c/5068/

http://www.healthcentral.com/ Many good writers on many topics.

http://www.healthcentral.com/diabetes/?ic=1102 For good writers about diabetes.

http://www.diabetesselfmanagement.com/Blog/ Good writers about diabetes and diabetes related topics.


http://diabetes.about.com/b/ Presently this site is lacking a writer for type 2 diabetes.

http://www.healthcentral.com/diabetes/c/110/94942/misconceptions This is a post from Nov 15, 2009 by Dr. Bill Quick. Since it is different than most that you read, I thought you should consider reading it. You may find other posts of his here on Health Central - http://www.healthcentral.com/diabetes/c/110/

http://notmedicatedyet.com/blog/2009Nov.html#110909 This is a blog by Tom Ross that will take you to Nov 2009 and you will need to scroll down to his Nov 9, 2009 post. This is an example of Tom at his best and I agree with what he says.

I belong to a couple of forums about diabetes and this repeats itself very often. All are searching for some simple rules to get their blood glucose under control so they can return to living. They do not realize that diabetes is a 24/7/365 problem they must deal with. Many, but not all, do not want to hear what they are told and never post again. Others take a different tack and reposition their question to elicit a response more in their favor. Failing with this, they post the same or similar questions on several forums. A few wake up, pay attention, and proceed to ask the real questions. They are receptive to the variables and the idea that the "rules" are the ones they discover about their own situation and body chemistry.

We can tell people that "what works for me, may not work for you," but many do not listen. When something does not work, they blame the forum and its' members and do not return. They keep looking on other forums for answers, but do not find them and never post again.

I may be wrong, but "rules" and "quick fixes" seem to be at the top of a list of what these people are looking to find. Very few are type 1's, and the majority is type 2's. Many, unfortunately, do not have insurance and are unable to do everything they should to test as frequently as they need to for determining what foods their body is capable of handling. Controlling their blood glucose now becomes a problem which their doctor often cannot help.

Many people become horrified when I tell them that they must become their own lab rat and conduct experiments on themselves. With type 2 diabetes folks, I am sorry to say, this is the only way you will discover what works for you. What works for others, quite often will not work for you. Testing is the only reasonable path to discover the meal plan that works for you and gets you the blood glucose levels to manage your diabetes.

http://ndep.nih.gov/ While this is a government website, the information on diabetes is good to read.

http://diabetes.webmd.com/ Please read this site with care. There is much good information with some poor information sprinkled in.

http://ginews.blogspot.com/ For those interested in learning more about the glycemic index and glycemic load, this is an excellent site. And the GI News letter is good to have. I started out as a big advocate of the GI and GL information, but that has waned to the point that I know there is often conflicting evidence available from reputable sources and treat it accordingly. I will continue to use this information as a guide, but only a guide.

http://www.glycemicindex.com/ The website for the Glycemic Index.

http://www.drugs.com/sfx/ This is not complete, but it does have its value for those who may need to look up the side effects of the medications they are taking.

http://www.cdc.gov/ This takes you to the main page and then you may research whatever you desire on the Centers for Disease Control and Prevention.

http://www.fda.gov/ This is the main page for the Food and Drug Administration.

Yes, there is a lot more diabetes information available and this only scratches the surface. Use your search engine and try to find other information. Another blog of mine may give you assistance of a different type.

July 4, 2013

Where Will You Learn About Diabetes?

Part 1 of 2 parts

This is the topic for this blog. Where will you learn about diabetes?

This is not an easy topic as there is too much poor information on the internet. I will cover what I consider good to excellent information and cover some areas that people may not agree with me. Note: I am not a follower of the American Diabetes Association (ADA), or now the American Association of Clinical Endocrinologists (AACE) because of some of the activities and levels of diabetes care they advocate. Too me they are allowing too much margin for harm in the guidelines they promote. I do cover them in some blogs, just because I feel it is necessary and to glean the good information that happens to appear from time to time. Plus, it is important to know some of what they do and what everyone is following because they set the official guidelines that doctors are supposed to follow, although I have found a few that do not adhere to them 100 percent.

Granted, I have my own biases and have my own agenda and you will know where so I will not try to deceive you or hide this from you. I do attempt to present both sides allowing you then to decide for yourself which direction or information you want to follow.

I will start with this blog that I wrote early on and it still has value for me. It is a list of books in my library and should be good reading for everyone. There are some other excellent books not on my list. When people like David Mendosa review them, I quite often add them to my library. There are some excellent books available, but there is also a multitude of mediocre and poor books.

Some of the poorest books aimed at people newly diagnosed with type 2 diabetes are books with the term diabetic in the title. Many are diabetic cookbooks and these are a very poor investment and I don't care who they are published by. The recipes are often very poor and loaded with high levels of carbohydrates. In addition many of the recipes are not common foods you and I would eat and a few have very difficult to find ingredients. I know because I purchased four of these and could not use them. They ended up in the landfill.

Internet sources are often difficult to distinguish as being great, good, fair, or poor. And then there are too many that are trash and promoting snake oil. Presently there is not a cure for diabetes. Even though there are many people that are able to avoid medications or get off of medications and live a healthy life, if they go back to prior bad habits and don't take care of themselves, type 2 diabetes will return. It is amazing the numbers of these people there are and they will attempt to convince you they are cured. I am happy they are able to manage their diabetes with a healthy meal plan and exercise, but they are not cured.

Before I continue with internet sources of information, there is another topic that needs to be covered.  I really believe this and at almost 10 full years with diabetes, they have helped me even more. They are five things that apply immediately after diagnosis, but I have found they apply later as well. I am adding a sixth item as it has helped me with the other five and especially in the battle with depression and diabetes burnout.

Develop and keep a positive attitude. This is a key for me and helped me through several minor depression periods and especially the burnout last year.

Forget about the past. This can be invaluable when diagnosed. Hanging onto the past or trying to base what you do now on the past, will normally cause problems for you. A diagnosis of diabetes requires learning new skills and starting new habits that will foster excellent diabetes management. Plus, the past can't be changed.

Be careful to not over do things and stay away from extreme changes. This is sage advice although many people do need to lose weight. It is wiser to carefully plan for this and then implement a weight loss program. Doing this will help prevent the period of discouragement when you hit the weight loss plateau and have to make adjustments to restart losing weight. This also applies to other changes like exercise. It is better to consult your doctor and make sure there are no medical reasons that will stop an exercise regimen.

Realize that it is not your fault. Yes, there many variables and as to which triggered the onset of diabetes may be impossible to determine. Genetics could be the only reason, yet there could always be other factors that you had no control over. So stop kicking yourself and learn to deal with the diabetes.

Above everything, relax and don't panic. Please relax. I know that this is not what many people do and by letting panic and stress take over, you are only making your diabetes that much more difficult to manage. Learn that stress is bad for diabetes and can make excellent management more difficult. Take time to find ways to reduce stress and know what works for you to keep it to a minimum.

Be prepared to accept different treatment options. This is an area where your doctor may have some excellent suggestions based on your recent history. Some doctors do abdicate their responsibility for whatever reason, so be prepared.

Depending on your blood glucose at diagnosis, you may want to consider starting on insulin and after getting control of your diabetes then going to oral medications and then to no medications. Or if your diabetes is caught early, starting on oral medications and then moving to no medications if possible. A lot will depend on other medical conditions and your ability to control your weight with nutrition and exercise.

Just remember that others have been down this road before you and speak from experience. These are rules that most people want to ignore for some unknown reason. Granted the diagnosis is a shock to most individuals, and this will take over for some.

Overall, 15% of people with type 2 diabetes don't take any medication (managing blood glucose levels with nutrition and exercise alone), and 57% take oral medications alone, without injecting drugs like insulin. Sixteen percent of people with type 2 diabetes take insulin only, and 12% use a combination of insulin and oral medication.

I will take up internet sites for education in the next part.

July 3, 2013

Will You Be Able to Make the Lifestyle Changes Necessary?

This is the topic for this blog. Will you be able to make the lifestyle changes necessary?

When people are first diagnosed, often they do not consider the things in their lifestyle that need to be changed. I have had one person, a friend, ask me why he needed to change anything. Granted he was not overweight and if fact was underweight by a few pounds, according to his doctor. So we went to my blog here. I will list the components of lifestyle for change and our discussion:

Weight Loss: We agreed this was probably okay for him, but I did use this to help him understand that there were different tables. He was surprised when I used it. For a person 5' 6” tall, and medium frame, this table showed that at 162 pounds, he was actually (Ideal weight range is 142 - 156.2 lbs.) marginally overweight by 5.8 lbs. This surprised him and he declared that the doctor said he was underweight by about four pounds. I agreed that he could accept the doctor's verdict, or ask for a copy of the chart used by the doctor. He had an appointment scheduled for that Friday and afterwards, he did stop by and said I was right and the doctor had used no chart and only estimated. He had asked the doctor to pull up the chart I had used. He said the doctor had and when he saw it went through the process twice and his weight on their scale had been 160 pounds or 3.8 pounds overweight. The doctor thanked him for the site and said that was good to have. My friend felt better now and said that he would attempt to bring his weight into the ideal range.

Exercise: Here he said that at least six days per week he was walking for about an hour, either outside, or during bad weather, he was using his treadmill. We agreed he had this under control. 
Food: This was a different discussion and I advised him to do some reading of what others were saying about the high carb, low fat diet he was on. I suggested that he consider a medium carb, medium fat food plan, and not increase the amount of protein. He admitted that he would consider this since the high carb had caused some of the weight increase he had recently.

Sleep: On this, my friend did say that he was only sleeping for about six hours a night. Any longer was difficult for him and it seemed to him that no matter when he went to sleep, he was wide-awake after six hours. I suggested that he have a good discussion about this with his doctor. I said that he should be getting more sleep, but that it did vary from person to person. I said I would be watching for studies about this for him.

Medication: My friend said he was taking his metformin as the doctor prescribed it. He was taking 500 mg in the morning, 1000 mg at the noon meal, and 1000 mg at the evening meal. His doctor had decreased his noon to 500 mg at his last appointment and said that if he continued his improvement, he may be able to get off all medications in six months.  I said this was a good goal for him to pursue.

Heart health care: My friend felt good after his last appointment where the doctor had lowered the dose of the statin he was taking. He had been instructed to purchase a blood pressure measurement device and check his own BP twice a day and record these for the doctor. If he continued to show improvement, he would be taken off that medication.

Illness: Here he said this was not a problem.

Hormone levels: My friend said his doctor was testing him and that he was in the correct range.

Stress: My friend said he did not realize that this was a lifestyle change. I asked him if he felt stressed, and he said almost all the time except at home. He said work was very stressful and that he would be retiring at the end of the year when he was over 65. I said this would be good and should help his diabetes management considerably. I suggested that he should also cover this with his doctor and consider remaining on metformin until the A1c results after his retirement. He admitted this might be wise.

Alcohol: He said this is not a problem as he does not drink and hasn't for over 15 years.

Smoking: My friend said he has never smoked and therefore this was not a problem.

He asked about the logs he should keep. I asked if he had the software program for his blood glucose meter and he said he was not aware of one. Since he uses the same meter that I use, I said there was and we looked on the internet. When he saw the price and the cable price, he said he would be ordering these that evening. I knew he was testing more that once a day, so I asked if he was purchasing extra on his own. He said he was and that the pharmacy was aware of this and that under Medicare he would be limited to two. He said his insurance limited him to one per day so that would be a help. I asked him is he had asked the doctor to write a letter to his insurance company and he said no. I told him to do this and see if that helped.

We talked about food logs and daily health logs. He said that his wife was keeping the daily food logs for both of them since she was interested in preventing diabetes for herself as well. She had diabetes on her father's side. Daily health logs he did not know about. I showed him mine and then my spreadsheet and he asked for copies. I converted them to his system and attached them to an email to him. Then he asked to look, if I did not mind, at my health logs. He said that he could understand why I did it and said he would show the spreadsheets to his wife and maybe together they could do them.

I mentioned the support group I was a member of and asked if he was interested. He said not at this time, but that after he retired, he would be interested. We discussed this and he was surprised by the number of people he knew in the group. I also told him there were two other groups in our town and a little about each. He admitted he had not realized there were this many with diabetes. I said this was only those with type 2 diabetes. There were also some with type 1 diabetes, but I was not aware if they had a support group.

He thanked me and said he would stay in contact.

July 2, 2013

Will Your Family Accept the Diagnosis of Your Diabetes?

The following is the topic for this blog. Will your family accept the diagnosis of your diabetes?

This is one of those topics where it is hard to say this applies or that applies. And it certainly is not one where you can even consider a one-size-fits-all solution. Every family is different and has their own unique family values. In this blog are two such cases and the resulting depression. The dynamics within a family can bring about various actions, some of which are not always pleasant or even desired.

Another family had this happen. The wife had a diagnosis of diabetes and except for her husband, kept this away from the rest of the family. Since the three children were all teenagers, they were not told. The last child had just graduated from high school and was home alone one day when the diabetes clinic called to remind the mother of her appointment the next morning. When the parents arrived home, all three were present and not in a good mood. The first question from one of the children was when she was going to have her legs amputated.

The husband spoke up and said that they would be going with their mother the next day to the appointment and that they could ask their questions then. There was a lot of grumbling, but every time they tried to ask a question, they were told to write them down and ask them the following morning.

The appointment the next morning was very tense as the three children asked question after question and the doctor carefully answered each one with the amputation question given its time. The doctor asked where they had heard this and the youngest daughter said one of her friend's father had his leg amputated. The doctor explained that it was always possible, but very seldom happened to people like their mother who was managing her diabetes very well. He then took time to show them a couple of pictures of sores that caused this to happen. He asked them if they saw anything that looked like these on their mother's legs. He then showed a picture of a foot ulcer and had them look at the bottoms of her feet.

The doctor then told them that in the six years their mother had diabetes, she was having no problems with either. At that statement, the three children sputtered – six years? Their father said that was right and the reason they had been kept in the dark was exactly the reason they were not putting up with the questions that had been raised. They had arranged the call the previous day to have them present at the appointment to have their questions answered.

The doctor answered a few other questions about diabetes and it effects on the body and he said as long as their mother continued to manage her diabetes as well as she had, she would be unlikely to have any of the complications. He informed the children that their mother was managing her diabetes without medications and had been since a few months after her diagnosis. He explained that with the meal plan she was following and the exercise plan she and their father were using, she should be able to stay off medications for many years. He said that could not be promised, but he could say that it was a good chance with the management practiced by their mother.

Then he introduced the CDE and said they would have another hour to ask questions of her. He emphasized that they were being told now and that they were at an age where they should understand and not listen to their friends and what they were being told by them. He concluded by saying that if they used the next hour wisely, they should learn a lot more about diabetes. If afterward, they had more questions he would answer the questions if they would write then down and either drop them by the office, send them in with their parents, or mail them.

As they left the office, they started asking more questions and the CDE asked them to wait until she could turn on the recorder. Then they could ask their questions and she would answer each one until the time ran out and then either the doctor or she would answer any questions remaining and mail the answers to them. The doctor turned to the parents after they left and said now I understand why you would not tell them. They would not have listened to you, but would have believed their friends.

The trip home was more peaceful. The son said he now remembered that the foods had changed and less processed foods were brought into the home, but they had been allowed a few. The oldest daughter remembered the walks that had increased to slow runs and then longer. She said that now she understood why they were never discouraged from joining in, but had not been forced to participate. The youngest daughter now knew she had been set up to receive the information and call the other two.

Yes, every family is different and needs thought in the method used to discuss a diagnosis with them. This blog discusses a study and what the people with diabetes feels his or her family thinks about their diabetes. This blog covers some useful tips for the person with diabetes and how to manage some situations. The final blog I offer is about some of the reasons loving family members can be the worst at assisting good diabetes management.

Hopefully, you have not had any of these problems with family members or if you have just been diagnosed, you will carefully consider how to handle the situation.

July 1, 2013

Is Diabetes Progressive?

When I started thinking about blog topics, I had a few ideas that I have blogged about that I wanted to include. As I searched for the different blogs, more ideas flooded my memory. I will start and see where each topic takes me.

The topic for this blog: Is diabetes progressive?

I have received several emails on this topic, asking me how I know this, and to provide proof. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists generally ignore this and lay out what they think as being a progressive disease. See the blog by Tom Ross here and my blog here about their thoughts.

They do have some information under Diabetes Care section for preventing diabetes once you have prediabetes, and even some about preventing prediabetes. Read my blog here about one of them. One article can be found here and is on target for this.

Tom Ross is an honest to goodness example of someone that has prevented the progression of type 2 diabetes. By using his meal plans and his exercise program, he was able to avoid medications after diagnosis with the knowledge of his doctor. Yes, he still has type 2 diabetes and he will be the first to tell you this. He has been able to prevent the progression to the complications and like the title of his site, he is not medicated yet. Notice I said his plans and not someone else's plans. He tests to monitor his blood glucose and confirm what he is doing works for him.

Take time to explore and read his website. Take time to read his journey here. Then read this page. For an example of his analytical side read his first blog linked above. For an example of his wry humor read this blog. His blogs range from the hilarious on occasion and to the serious side. In his occupation as a technical writer, his blogs show a wide range which keeps me reading.

My younger brother had diabetes for approximately 35 years and managed it with a meal plan and exercise without medications. Finally, cancer and its treatments forced him on insulin until his death about three years later. Therefore, I know that it is possible to delay the progression of diabetes for decades.

Next, David Mendosa has struggled to lose weight and had peripheral neuropathy that he was not aware of until a doctor and his tuning fork told him he had it. He has been working to improve that condition. He was successful using Byetta to reduce his weight and uses his meal plan and exercise to manage his diabetes. He has succeeded in halting the progression of diabetes and he also blogs about his successes and occasionally a mistake he catches himself making. He writes about diabetes at Health Central and on his own site, especially about his exercise when he does photography.

I especially like his blog here when he quotes Dr. William Polonsky when Dr. Polonsky says, “What’s true is that poor management causes those problems (in talking about the diabetes complications). Well managed diabetes is the leading cause of NOTHING.” You may also enjoy reading David's blog here about the progression of diabetes and what the doctors think of it.

Now me, I have not been as fortunate. I was diagnosed late (probably about three or more years late) and was not even able to manage it with oral medications. Therefore, after about three months, my doctor and I had a good discussion, and I started on insulin. Since then I have been able to manage my diabetes, with the help of insulin. My neuropathy has gotten better although there is still a lot of improvement to obtain. My hearing loss may have some loss from diabetes, but most is attributable to my time in the military and the loud noises I was exposed to. Moving up in age is not helping either.

Basically, the onset of most complications is caused by the lack of diabetes management or poor diabetes management. I have seen this in a few other type 2 patients, but yet I am a member of a group of type 2 people with diabetes and they are managing diabetes extremely well.