December 7, 2013

Suggestions for Different Diabetes Logs - P3

Part 3 of 3 parts

In this blog, I will cover daily health log, lab test log, and other logs. The daily health log is quite simple. I put the dates across the top and times (in hourly increments) down the left column. I normally leave three rows between times. This allows for longer notes or a reference to the bottom for lengthy notes. I also use the one of the rows to record pain numbers. If the pain numbers remain unchanged, there are days when the number is written when I arise and no further numbers until bedtime.

The lab test log is also fairly straightforward. I put the dates across the top and use two columns on the left side to list the test in column A and the lab recommended range for the test in the second column. Then is just a case of entering the data.

Occasionally I need to insert a new column when there is something from a different lab with a different recommended range, but everything else remains the same. The lab name or code is always a bottom entry. I like this as it shows trends or if I am consistent. I also like to see certain tests decreasing.

My next log is problem and procedures log. When I encounter diabetes and other health problems I indicate the date and time and describe the problem listing as many details and symptoms as I can. This I do print out and take to the doctor appointment to provide the doctor. I also keep track of medical procedures and dates. In addition, I make notes of what the results were. If there were things that upset this, my blood pressure and my blood glucose reading get recorded. The positive happenings also get noted.

I do keep other information that is of value to me and helps in my management of diabetes. I do keep a list of my medications with prescription numbers and expiration dates. I do keep track of when I stop a medication for a medical procedure. I have had several of these lately because of the procedures. Now that I am past or done with all scheduled procedures, I am back on track with my medications.

I wish I had done more of this shortly after I obtained my first computer, but that is past history because I did not. Not everyone wants or needs the detail I keep, but this is done for your information. I have the time and enjoy tracking my health information.  Each month I start over and keep all files.  Each file is named by month and year.

These three blogs are just suggestions and I hope that at minimum, you will keep a written log that fits your needs.

December 6, 2013

Suggestions for Different Diabetes Logs - P2

Part 2 of 3 parts

This is a take-off from a blog by Kate Cornell. She covers the way she likes to log her blood glucose. I like her way, but I do mine differently and I thought a comparison could be beneficial or give you ideas for your own log. I transfer any written logs to a spreadsheet. Some of my friends in the diabetes support group use a database.

In this part, I will cover blood glucose logs – oral medications or insulin in my case. For my blood glucose readings, I maintain a written log, which I then transfer to the spreadsheet on page two of the spreadsheet. Some information does go to page three. Occasionally I make a note that belongs on another page. This is because my written notes include most of the activity for each day. I use a spiral top steno notebook. On the each page, I write three dates across the top. Then on the left side on the next line I write AM and the on the next line PM. Since I split my Lantus injections, under each date I write the time and units of Lantus. If you get the full 24-hours effectiveness from your long acting insulin, then you will only need one line and the time and units under each date.

My blood glucose reading spreadsheet is set up for each day of the month with the same format at the top. On both the written and spreadsheet, I list the time of the test and the meter reading and for those that are premeal or pre-prandial I record the correction and the carb portion of the injection. Like Kate, I had long ago done my intensive testing to find out what my average time is post meal or post-prandial when the peak blood glucose time is. It was about 90 minutes in the beginning, but when I increased the amount of fat in my meals, I needed to repeat the intensive testing to discover that it was about the two hours after my meals. Further intensive testing made it about 135 minutes after first bite of the meal.

Then about three years ago, I was surprised again when I reduced the eating time and enjoyed my food at a slower eating time. My blood glucose peak post-prandial remained almost within five points from 120 minutes to 160 minutes. Now I have needed to do more intensive testing because of the food changes I was required because of GERD and gall bladder surgery. It seems that I will be back at about 100 minutes to 130 minutes.

I also record the time of first bite to know when I started eating. Some people do use last bite for determining post-prandial testing. Both ways work, and I advise just being consistent.

On the back of my blood glucose readings page, I write the food eaten and carb information. Occasionally, this includes health information. With all the medical procedures lately, this has been valuable to me. I have also adapted or co-opted the pain scale used by my doctors to indicate this on my written notes and I indicate the time. With the medical procedures and neuropathy, this has been helpful in tracking pain levels and has also helped in blood glucose level problems. I don't, but I am aware of several people that use a stress scale as well.

December 5, 2013

Suggestions for Different Diabetes Logs - P1

Part 1 of 3 parts

This is a take-off from a blog by Kate Cornell. She covers the way she likes to log her blood glucose. I like her way, but I do mine differently and I thought a comparison could be beneficial or give you ideas for your own log(s). I transfer my written logs to a spreadsheet. Some people only keep written logs and others don't even record their blood glucose readings. This loss of vital information does not help in managing diabetes.

I will admit; I think - to best manage your diabetes, some form of daily logs need to be maintained, whether on paper or on the computer. You may not need the accuracy I strive for, but there is certain information that should be kept to assist you in managing your diabetes.

I not only maintain daily blood glucose logs, but daily food logs, daily health logs, and logs for lab tests. Yes, these take time, but they do help when something is off or the information tells me that things are not right. There are days when I wonder why I am doing all this, but normally then I have a puzzle to solve and I remember why I keep the information. Sometimes the puzzle is easy to solve and other times it can take a few days. The spreadsheet pages include P1, general and special log for monthly notes of interest for me. P2. Blood glucose log. P3. Daily food log. P4. Daily health log. P5. Lab test log. P6. General and problem log (some call it a miscellaneous log)

I will start with my daily food logs and see how far I can go in this blog. First, I use a spreadsheet with pages and have each log on a different page. I have the dates across the top and the top margin (4 or 5 rows) and the left column is locked or as Microsoft Excel says, freeze panes. The daily food logs are my third page each month.

Down the left column I list Breakfast, Lunch, and Dinner. I leave normally 15 rows between each, but occasionally I will need to insert more. Then, in the last six rows below each, I have the following list.
#1. Known carbs – these are from individual servings where carbs were calculated or known from package labels or nutritional information with the recipe.
#2. Estimated carbs – For those times (too often) that a calculated guess is all you can do.
#3. Total estimated carbs – add #1 and #2 for an estimated total.
#4. Correction insulin – this is based on my correction ratio.
#5. Calculated insulin - this is based on my normal insulin per carb ratio.
#6. Total injected insulin – add #4 and #5 for total injected insulin.

Note: Insulin per carb ratio can create confusion for many people. Most in the medical profession and many patients consider a carb unit to be 15 grams of carbs. On the other hand, there are people like me that set up their ratio on grams of carbs. I scared my doctor the first time I stated what my ratio was. I quickly remembered he was talking a different number than I was and this cleared up the situation. Now I normally state that my ratio is based on grams of carbohydrates and not on carb units of 15 grams of carbohydrates.

This is not rocket science, but does require thought. When I end up needing no correction insulin and I am in the range I want to maintain, then I know my carb estimation was good. I do have a food scale if I need it, but I have stopped using as generally I stay in my range. When I have several days of corrections for insulin, then I put the scale back into use. This does not always solve the problem, but often helps.

In the rows above each calculation, I list the individual foods I ate for that meal. I list the approximate weight of meat in ounces, serving size of each vegetable, and fruits if any. At the bottom, I list snacks and carb count for each. Most of the time these are blank, as I seldom eat snacks. At the very bottom, I make comments for the day such as illness. If I do not eat a meal, this is noted in the appropriate meal area. It is my notes area that often help solve problems.

Next will be the blood glucose log

December 4, 2013

The Diet Debate Will Continue

This is a take-off on a blog written by Amy Campbell on Diabetes Self-management on
October 28, 2013. She asks, “Will the 'Diet Debate' Ever End?” To this I would answer – no! We have had some softening of the debate recently by the American Diabetes Association, but the debate will continue.

When we have fanatics pushing for their way of life and their food plans to the exclusion of other food plans, this can only keep the debate focused on the negative sides of the debate. This becomes tiring for readers and causes some to take similar positions for their favorite food plans or food preferences.

I can appreciate Amy becoming tired and frustrated with the debate when one of her own members of the Academy of Nutrition and Dietetics is endorsing a fad diet based on white rice and fruit. This diet is nutritionally unsound and is not what people with diabetes can (or should even consider) consume on a daily basis.

Amy states, “Other people take a firm stance or position (often zealous in nature) that the “X” diet (fill in the blank here) is really the ONLY diet to be following if one wants to lose weight or lower his blood glucose. They’ll argue and sometimes, I admit, become rather rude and dismissive if I or others won’t jump on their particular bandwagon.”

I will not promote one food plan over another. I know what works for me and what I need to avoid in the way of food plans, but I do not intend to promote or insist that is what others must do. I do firmly believe that what works for me, may not work for you. As a person with diabetes, this is the only position that makes sense. I admit that some readers have emailed me telling me that I must follow their food plan and that if I don't, I will not be able to lose weight. These are emails that get deleted and not answered.

Since my education is not in nutrition or even anything close to this, all I have to go on is what my blood glucose meter tells me about the food I do eat. Because of my age and miscellaneous health concerns, there are some foods that I need to avoid. My meter is giving me better blood glucose readings as a result. One doctor is happy with my food plan and two doctors are very upset with my food plan. One of the two has ordered me to reduce the fat I am consuming and the other says I must increase the amount of carbohydrates I consume. Both now know that this will not happen and that my blood glucose meter is not disagreeing with me.

My cousin that is a nutritionist and not a registered dietitian is working with me to balance my nutritional consumption, and is working with me on the food plan I have chosen. She is happy that my insulin requirements have decreased over the last month, but is concerned that it has decreased by the amount it has. I had to remind her that with the length of time I have been required to fast because of medical procedures I have undergone, that even I am concerned with the amount of insulin I have decreased.

The scale is happier as it has less weight to bear from me. Now if my next A1c will confirm what I am seeing in my blood glucose meter readings, I will be a happy camper.

December 3, 2013

The Diabetes Myths Will Get You Every Time

I dislike taking this position opposed to another blogger, but I feel I must when the author chooses to say that diabetes is progressive – two times.

This is the first myth – diabetes need not be progressive if properly taken care of and managed. It is when diabetes is not taken care of and managed.  Diabetes then becomes progressive. Many patients do not realize this and do not manage their diabetes and naturally, it becomes progressive. I blame the doctors for not providing the education about the care needed to prevent diabetes from becoming progressive. Too many diabetes patients trust their doctors and will not educated themselves about diabetes.

This brings us to the second myth. Doctors have your best interest in mind when they treat you. This is completely untrue as they are only concerned about the payments they receive for treating you. By not telling you that diabetes can be managed and not educating you, they know that diabetes will continue to progress. They will then continue to be able to treat you and have a steady source of revenue for their pockets.

The author of the blog lists this myth “People with type 2 diabetes can’t eat sugary foods,” the author leaves one important aspect out. Moderation is good, but even more important is blood glucose testing to determine how your body reacts to the foods you are consuming. The 'one-size-fits-all' advice is not correct if you don't use your blood glucose meter to test what the food you ate in moderation does to your blood glucose levels.

The last myth the author gives - “Being put on insulin is a sign of failing to manage diabetes,” is where the author trips him/her self up rather handily.
The Truth: Diabetes is a progressive disease. It can often initially be regulated with lifestyle changes or a combination of lifestyle modifications and oral medication.” Yes, by managing their diabetes, patients can manage their diabetes for years or even decades without it becoming progressive. “But eventually the pancreas of many people with diabetes stops producing an adequate amount of insulin, making it necessary to begin insulin injections.” Some oral medications put a burden on the pancreas and will eventually force the pancreas to quit functioning, sulfonylureas is one of the oral medications that does this.  The DPP-4 inhibitors is the other class that can make the pancreas stop functioning.

Many of our “well meaning” doctors use insulin as a threat to keep people on oral medications. Then when they need insulin, they are told they have failed to manage their diabetes and going on insulin is their punishment. It is not surprising many believe this myth.

The other myths are fairly well stated and can be read here. I have three blogs on diabetes myths and they are here, here, and here.

December 2, 2013

Speaking to Other Support Groups

Tim did contact the other groups that have been included in our meetings previously, about Sue and A.J. speaking to their groups about getting off medications.  The closest group asked that they address their group in early December and the other group did have them in their meeting on the last day of November.  Sue and A.J. did update their information and from the information Tim presented me about the meeting, it came off well received and they had a very interesting and lengthy discussion.

The doctor leading the group was able to have two other doctors plus our local doctor in attendance.  It was even surprising that of their 17 members, only one person was unable to attend because of the holiday.  Their doctor started the session and explained that the other doctors were present because they needed to understand what was behind the information being presented and to understand when they were approached by their patients to get off of medications. 

Our local doctor said that at first, he was not in favor of three of his patients doing this, but after hearing what Sue and A.J. had presented, he is fully behind any patient of his that wanted to do this. 


At that point, Sue started the conversation and covered what she and A.J. felt were the points to consider.  Sue stated that the important first step was talking to the doctor and discussing this.  Without the doctor's consent, she felt that people would not be prepared to stop all medications.  While the doctor might not agree that this was the best thing for the patient to attempt, he should hear them out. 

Sue then stated that anyone interested should attempt to get extra testing supplies as they could greatly benefit from the extra testing for up to three months.  A.J. stated this was important because they would need seriously to consider cutting their carbohydrate intake and testing would be key to determining if they were having success.  Sue confirmed this and said testing was also important to determine if they were letting diabetes gain the upper hand and doing damage, which could not be undone. 

Next, she said that an exercise regimen was necessary that they could adhere to. She felt this also should be discussed with their doctor to get the doctor's input, as there could be something that could be harmful and to have the doctor's input into the planned regimen of exercise.  Sue said she and her husband used jogging and walking, swimming, and dancing. Now that the weather is changing, they have two exercise machines available for them to use when the weather is too cold or snow would be difficult to jog or walk in outside.

A.J. continued that he was running about 4 miles during the evening and up to 10 on the weekends. He said that he occasionally sees Sue and Bob swimming when he uses the pool as well. He said he also has a machine for when the weather is such that he will not be able to run. He said his doctor had approved of his regimen and felt this was important. He said many would need to reduce the amount of food consumed until they build up their routine and become used to the amount of exercise.

Sue confirmed this and said it was good that her husband was participating with her and admitted this may be necessary for some people to become committed to a routine. She said A.J. has been able to do this alone, but they do see each other from time to time and she said this is good even if a group wants to exercise together.  She said that some are able to get off of all medications and in her correspondence; she has found that some are not able to develop the regimen strong enough to be successful in staying off medications. This is part of the reason for the additional testing and to make sure that if you need medications; you do not let your diabetes get out of hand before getting back on medications.

A.J. confirmed this and said that the doctor may wish to see you more frequently until you have succeeded and proven that your blood glucose levels are in range to stay off medications.  Sue stated it is wiser to get back on medications than let diabetes get out of management.  Sue emphasized not to consider yourself a failure for going back on medications.  Some may be to the point with their pancreas that medications are necessary. 

A.J. said he had started on insulin at diagnosis because of kidney problems, and that his doctor had done a series of tests to see what level of insulin he was producing before allowing him to attempt to get off of insulin.  He continued that he had been in great shape until his wife died about three and a half years ago so he only needed to lose 15 pounds to be back at ideal weight.  Sue said it takes dedication and work and for some people that don't have support from family, friends, or a support group like she has, it may not be for everyone.

Tim had his projector set up and covered this blog by David Mendosa and the discussion started.  The four doctors asked to speak and were pleased that Sue and A.J. emphasized the importance of including the doctor in the plans.  One doctor said he was aware of two of his patients having done this, one with success and the other ending up in the hospital in serious condition because he should never have tried it alone.  He admitted that until this evening, he would have opposed any suggestion about getting off medications, but felt that if his patients followed what Sue and A.J. presented, he would work with them.

A.J. was asked which tests, and he answered that he was not sure, but if Tim was given an email address, he would see that they received the test information on Monday.  The one doctor asked if one had been the C-peptide and A.J. affirmed it was. Tim stated he received all the email addresses for the doctors and obtained email addresses for the members of the group he did not have.