July 5, 2014

How Well Can You Manage Your Type 2 Diabetes?

Some people will claim I am talking about reversing type 2 diabetes, which I am not. You can manage type 2 diabetes, but you cannot reverse type 2 diabetes. If you think that, just ask yourself what happens if you stop managing type 2 diabetes. Yes, it comes roaring back with a vengeance. Some people even claim you can control type 2 diabetes – no way! You can manage type 2 diabetes to the best of you abilities, but slack off on your management and diabetes rears its ugly head.

Some people do an excellent job of managing their type 2 diabetes and some don't. Others do such a good job of managing their diabetes that they can bring their blood glucose levels back into the normal range and do this for years. Others manage it for a few months and they then struggle to prevent it from taking over. We are all different and we as people with type 2 diabetes need to realize this. What many people forget is that it depends on when they were diagnosed and how quickly they start managing their diabetes.

Some of the things you can do to manage your type 2 diabetes include:

#1. For some people, it is shedding extra pounds and keeping them off. This can help you better manage your blood glucose levels.

#2. For others, reaching a healthier weight will mean taking fewer medications, or in rarer cases, no longer needing those medications at all.

#3. For the majority, it will mean if you sit most of the day, 5 or 10 minutes is going to be great. Walk to your mailbox. Do something that gets you moving, knowing that you're looking to move towards 30 minutes most days of the week.

In one study, people with type 2 diabetes exercised for 175 minutes a week, limited their calories to 1,200 to 1,800 per day, and got weekly counseling and education on these lifestyle changes. Within a year, about 10% got off their diabetes medications or improved to the point where their blood glucose level was no longer in the diabetes range, and could be classified as pre-diabetes. Remember, they still have type 2 diabetes, but are managing it in the pre-diabetes range.

Results were best for those who lost the most weight or who started the program with less severe or newly diagnosed diabetes. Fifteen to 20% of these people were able to stop taking their diabetes medications.

If you make changes to your diet and exercise routine, and your diabetes doesn’t improve, it's not your fault. You could have been diagnosed at a time when your pancreas was already too damaged to recover. You are still smart to continue your diet and exercise routine and manage your diabetes to the best of your abilities. The earlier in the course of your diabetes that you make these changes, the more likely you are to stack the deck in your favor that you won't progress to unmanageable diabetes. Don't let denial delay this.

Your weight and lifestyle aren’t the only things that matter. Your genes also influence whether you get type 2 diabetes. Some thin people are also living with type 2 diabetes. Your weight and lifestyle are things you can change, and they are important parts of your overall health, as well as steps that help manage diabetes.

Whatever your goals are, you are aiming for your best health, not someone else’s. Diet and exercise alone will control diabetes for some people. For others, a combination of medication and healthy habits will keep them at their best.

If you have been able to manage on lifestyle intervention alone, continue to do that. If you need to go on medication, do what's necessary for your health. You need to take advantage of the treatment that's going to keep your blood glucose, blood pressure, and cholesterol in check. Manage your diabetes and health to the best of your abilities and have regular doctor check-ups to assist in tracking these.

July 4, 2014

Study Claims VA Elderly Overtreated for Diabetes

If you guess that I am upset, you would be correct. More articles are being promoted in newspapers, magazines, and on the internet that are telling the elderly to roll over and die. The New York Times is no exception and the author really sensationalizes and shows her ignorance of diabetes. Among the comments, most agree with the article, but one says what I believe.

The current comments and the one I agree with is the one by Bill from SF, CA. There is one from a doctor from East Lansing, MI, that uses a lame excuse that he will be labeled a bad doctor if he does not keep his patients under an A1c of 7.0. I would not think much of this, but the study used by the NY Times is a study published on February 1, 2014, and the author had to be looking for something to sensationalize.

What many forget is that most doctors and doctors of the VA keep piling oral medication on top of oral medication until insulin becomes necessary. The elderly then pay the price for their doctor's negligence. Then we have the Centers for Medicare and Medicaid Services (CMS) limiting test strips preventing patients with diabetes from knowing what different foods or combinations of foods is doing to their blood glucose levels. Even the VA limits the number of test strips for patients on oral medications and on insulin, not as severely as CMS, but not a lot more.

Naturally, all doctors are worried about hypoglycemia and this permeates their thinking and actions. This is one reason they will not start people on insulin when they are diagnosed at a younger age and would better understand what needs to be watched to prevent hypoglycemia. This would also give the pancreas a rest and possibly a chance to repair itself. This could mean that insulin might not be needed later when cognitive issues may be in play.

The other issue not discussed is how many VA physicians actually know how to prescribe insulin correctly. The NY Times article makes it sound like the VA prescribed a fixed amount of fast acting insulin and don't instruct patients how to titrate up or down to prevent hypoglycemia. I know this problem and am thankful I also see an endocrinologist that has worked with me.

The other missing factor is carb counting. I have had VA physicians that have a difficult time explaining carbs. Most calculate one carb as being 15 grams of carbohydrates and prescribe medications based on this. This does not work for people with insulin resistance like I have. I even need to disagree with the endocrinologist when she tries to adjust my insulin. I constantly need to remind her that I calculate on grams of carbohydrates and not carbs.

I can understand that doctors need to be very concerned about older VA patients that live alone and have no one to look in on them daily. If they are having memory problems or early stages of dementia, then there is real concern and other steps need to be considered. Social services should be contacted to find out what services can be offered.

For more reliable information, read this blog by Dr. Bill Quick. He has information that was behind the pay wall and makes more sense of the issue. The study is greatly distorted by the author of the NY Times.

July 3, 2014

Beware of Doctors Practicing Cookbook Medicine

I could say something humorous, but this is serious and patients need to be aware of the problems some key words cause. These key words will result in many unnecessary tests and procedures. Cookbook medicine is very prevalent in medical practice and even in most hospitals. Doctors follow lists and make checkmarks for each item checked off.  Dr. Leana Wen writes an excellent blog on this.

Many doctors have lost the ability to rationally think through what the patient may be saying and arrive at a diagnosis. They use checklists to practice defensive medicine and could care less about the patient. When they have a patient that they cannot properly diagnose, the checklist becomes even longer and more tests and procedures are done. Or they will make some comforting platitude and send the patient home still having the symptoms.

The disadvantage of having a doctor practicing cookbook medicine is that a “cookbook” approach where you get the same recipe of tests and medications as anyone else will result in expensive, unnecessary care, and even misdiagnoses and harm. Think about this, you have a pain from tripping over a toy and landing on another toy in the lower sternum area and you think it may be a bruised or cracked rib.  You point to the area and immediately you are set up for a blood draw, EKG, and a chest x-ray. You’re told this is all part of the “chest pain protocol”. But did you really need all of these tests done?

Heaven forbid you have a gall bladder attack or a pancreatitis attack, as you will be sent for the same tests. You may be given an IV drip of nitro glycerin, a drug or agent, that can cause dilatation of the walls of blood vessels. After the pain has subsided, you will probably be admitted to the hospital for observation, at your cost. This is what happened to me when I had a severe gall bladder attack over a year ago. When I had the second attack, I went to another hospital and they suspected gall bladder almost immediately when the blood tests came back as negative for heart problems.

The following Monday morning I was scheduled for an ultra sound exam of my gall bladder and the doctor said I was lucky to have not had the gall bladder burst. He recommended an immediate removal. Since I could not be operated on at this hospital, I transferred my records to the other hospital and was scheduled for surgery. I admit I was hesitant after the poor care I had had the first time, but since it was a different doctor, I had the operation and it was successful. After the operation, the surgeon confirmed that I was fortunate and there was good reason to have it removed.

Here are five tips to make sure you get the best, and hopefully personalized care for you:

#1. Insist on telling your story. Studies have shown that 80% of all diagnoses can be made just based on the story of your illness. Don’t just say that you have “chest pain”; explain when it started, what you were doing, and how it felt. Write down key elements if possible. Practice until you can tell it in 30 seconds or less. Most doctors will try to interrupt, but ask them to please let you finish. Please leave the drama out of the story and stick to the facts.

#2. Give open-ended responses to close-ended questions. If you suspect that the doctor is going through a checklist of yes/no questions, try to get the doctor to focus on you by adding personal elements to your answers. Example: If you’re asked, “when did you start feeling so tired?”, don’t just say “two weeks ago.” Add that you’re normally very energetic and exercise every day, but for the last two weeks, you can barely get out of bed to go to work. These answers help provide context to who you are.

#3. Ask about your diagnosis before you consent to tests. If you’re told you need to get blood drawn, ask why. Sometimes, that’s enough to stop the “cookbook” from taking over. Every test should be done for a specific reason, not just because it’s what’s done in this protocol, but because it helps focus the diagnosis. Also ask about what to do if the tests are negative. Just because they’re negative doesn't mean there isn’t anything wrong, so what should be next steps? Above all, be polite, but firm if necessary.

#4. Inquire about other treatment options. In very few situations is there only one test that could work or one protocol that must be followed. If your doctor says you need to do this one set of tests, ask what your other options are. Often, watchful waiting is a perfectly acceptable alternative. Discussing options may help to remind your doctor to tailor the treatment to you.

#5. Let your doctor know that you want to be a partner in your decision-making. If you still think that your doctor is following a recipe rather than individualizing care, ask the doctor to explain his/her thought process to you. Say that you respect his/her expertise, and you want to learn what it is that he/she is thinking. Your doctor may be so busy or so used to checklists that your request can help him/her to refocus on you and your individual needs.

Unless this is an emergency, do not be afraid of leaving without a diagnosis and finding another doctor especially if the doctor becomes paternalistic or insists that you follow his/her instructions. I wish I had known about this at the first gall bladder attack, as the doctor at the second time did not continue on the heart problem line of thinking after the results of the blood draw came back negative.

July 2, 2014

AHA Recommends Statins, Not Heart Healthy Foods

A lot of what the American Heart Association (AHA) does is not for the benefit of heart patients. The AHA must be raking in the money from statin manufacturers to keep promoting statins in the manner they do.

Apparently, our good heart doctors do not realize they are doing more harm than good with the advice they are giving out. The AHA has outdated dietary guidelines that are hurting the health of Americans'. In a May 2014 article in the Wall Street Journal, the notion that saturated fats and LDL clog our arteries came from a “derailment” of nutrition policy “by a mixture of personal ambition, bad science, politics, and bias.”

In addition, the AHA’s dietary guidelines are also centered on the notion that “bad” cholesterol causes heart disease, and that since saturated fat may raise “bad” cholesterol levels, it’s the ultimate dietary evildoer. Not only has this bad/good cholesterol dichotomy, (the AHA’s “logic”) been solidly debunked by study after study—it was never proven in the first place. It is a shame of the AHA that they cannot admit their error, but don't count on this becoming a reality.

Below are just a few of the items outlining the AHA's false logic:

“Reduce saturated fat!” Apparently, the AHA never heard of moderation. Raw, organic butter from grass-fed cows can be extremely healthful: it contains vitamin A in its most bioavailable form, lauric acid, antioxidants, vitamin E, and vitamin K2. But the alternatives to butter—margarine and hydrogenated or processed polyunsaturated oils—are far more detrimental to your health than saturated fat. They are actually a leading cause of heart disease.

Drink low-fat and skim milk!” A recent study has shown that children who drink whole milk are slimmer than kids who drink skim! One theory for this is that “full fat foods” promote satiety. In addition, full-fat dairy can actually reduce your risk of heart disease, as well as diabetes and cancer.

Avoid ‘bad’ cholesterol!” This has been debunked as well. Studies show that lower levels of LDL don’t necessarily lessen your risk of heart disease. One book to read is by Dr. Malcolm Kendrick and titled the Great Cholesterol Con.

Limit Your Intake of Red Meat!” Again, moderation should be your guide and not what the AHA says. Even my own heart doctor insists that I eliminate red meat and eat more fish and chicken. I happen to like both, but even then, I still like my red meat,  It was not difficult to eliminate the highly process meats like hot dogs and some sandwich meats.

Red meat is an excellent source of protein and other nutrients. Among other nutrients, it contains L-carnitine, an amino acid that is helpful for heart disease. A large meta-analysis, published in the journal Mayo Clinic Proceedings, found that L-carnitine actually helps heal the heart after a myocardial infarction (heart attack). The AHA hardheads won't even acknowledge this.

July 1, 2014

More Evidence on Statins Causing Diabetes

Now that the link has been proven linking statins to causing diabetes, why is our government agencies doing nothing to bring a halt to statin use. Or at least slowing the rate of prescriptions until the new statins can be produced that don't cause diabetes. My only conclusion is that the medical profession would object because they believe that statins are the end-all for heart health and diabetes be damned.

A research team from McMaster University, Hamilton, Ontario, Canada may have found a novel way to suppress the side effect of causing diabetes. The researchers discovered one of the pathways that link statins to diabetes. Their findings could lead to the next generation of statins by informing potential combination therapies while taking the drug.

"But the side effects of statins can be far worse than not being able to eat grapefruit. Recently, an increased risk of diabetes has been added to the warning label for statin use. This was perplexing to us because if you are improving your metabolic profile with statins you should actually be decreasing the incidence of diabetes with these drugs, yet, the opposite happened."

The researchers found that statins activated a very specific immune response, which stopped insulin from doing its job properly. So we connected the dots and found that combining statins with another drug on top of it, Glyburide (one of the generic sulfonylureas), suppressed this side effect. The lead researcher says the finding has the potential to develop new targets for this immune pathway that does not interfere with the benefits of statins.

What is very plain from the lead researcher is not to worry about statins and he is promoting more research to find more out about statins and develop new strategies to minimize side effects. The lead research says the next stage of their research is to understand how statins promote diabetes by understanding how they work in the pancreas, which secretes insulin. They also hope to understand if this immune pathway is involved in other side effects of statins, such as muscle pain and life-threatening muscle breakdown.

The lead researcher also believes, “With the new federal warning label on the risk of diabetes with statin usage, people are heavily debating its pros and cons. We think this is the wrong conversation to have. Statins are a great drug for many people. What we really should be talking about is how to make them better and we are beginning to understand the basic biology of statins so we can do just that.”

The research is published in the medical journal Diabetes and was supported by funding from the Canadian Institutes of Health Research and the Canadian Diabetes Association.

June 30, 2014

Have Diabetes – Be Careful During Summer

After the past winter, most people want to be outside and enjoying life after being cooped up during the cold. For people with diabetes, extra precautions are advisable.  I have written several blogs previously about taking care of diabetes supplies, what to do for travel, and enjoying summer with diabetes. For this blog, I will be talking about food, physical activity, diabetes medications, and blood glucose monitoring.

The summer brings out the best in grilling, picnics, and the variety of summer foods.  With diabetes, it does not mean that you must avoid these treats, but be mindful of the number of carbohydrates and the size of servings you pile on your plate. The foods of summer do contain carbohydrates, especially the buns for hamburgers and hot dogs. Then don't forget the carbohydrates in potato and macaroni salad, corn on the cob, and carrots (many consider carrots as low carb, but they do have more carbs than you may think).

You don't have to have the leanest ground beef, but many will suggest this to help you maintain a high carb, low fat diet. I suggest a low carb, high fat diet with plenty of protein. Chicken and turkey can also be good for a summertime meal. Don't forget salad greens (lettuce, cabbage, cauliflower, broccoli, celery) and other vegetables (tomatoes, cucumbers).

If you wish to watch the carbohydrates, consider using water with fresh lemon, lime, or orange slices in the water. Or consider slices of cucumber and a few sprigs of mint added to the water pitcher for a refreshing drink.

Now that you have no need for shoveling snow, other activities now take priority like mowing the lawn. But that is not the activity most people were thinking about for the summer. If you’ve been cooped up all winter on the couch, it’s important to go easy so that you don’t injure yourself. Walking, running or jogging, swimming and other activity can be very enjoyable.

In the summer, heat is a concern. Early morning is often the best time for physical activity and doing it in the afternoon and early evening or heat of the day just does not make sense. If you live in a city with a mall, this may be used instead of walking during the heat of the day. Wear sunscreen and stay hydrated. Check your feet every day for cuts, blisters, redness, or swelling. Treat cuts and blisters properly. Call your doctor if they don’t seem to be healing or going away.

Try to remember to check your blood glucose levels before and after your activity. If you tend to go low during or after exercise, talk to your doctor about changing the dose of your diabetes medication, if possible or exercising after a meal. Always wear the right footwear and if needed invest in a good pair of shoes or sneakers for the exercise you are doing. Also, invest in a few pair of socks that will wick moisture away from your feet.

Medications for diabetes are important and you should always protect them from heat. Always make sure you take all your medications as prescribed by your doctor. Frio packs work well for protecting (from overheating and not freezing) your diabetes supplies in the summer and winter. Frio wallets can keep insulin safe for up to 45 hours. For wallets, just submerse them in cold water for five to fifteen minutes to activate. If you are going to be out of the U.S., always wear or carry some form of medical identification stating that you have diabetes.

This last on monitoring should apply to all seasons and not just the summer. Anytime you do something out of your normal routine, you may need to test your blood glucose more than usual. This will be if you travel or your routine changes. If you take insulin or oral medications that can cause lows, make sure you always have a treatment for low blood glucose with you.

With the proper precautions, summer can be enjoyable and fun.

June 29, 2014

Natural, Gluten-Free, Organic, Or Are You Confused?

The big trend today is certain terms which are in the title. There are a few more that you need to add and they are:

GMO” stands for genetically-modified organisms. Generally, you will see this as “Non-GMO.”
All-natural This is a term used too frequently when all the contents or ingredients are not natural.
Trans-fat-free This too is misleading when there may be .5 percent trans-fat per serving.
Low-carb Be careful with this term. I looked at a packaged food in the grocery store today with this advertised on the front of the package. In looking at the food label (which was in smaller than normal print) there were six servings with 49 grams of carbohydrates per serving. There was no fiber and 28 grams of sugar in the 49 grams.
Health Halo.” Using all the terms that lead you down the path to health problems.

Many people consume foods in excess because the food manufacturer uses many of the above terms. I have friends without diabetes that tell me I can eat more than I do. When I ask how they know this, they say that the food in natural, or organic, and therefore it is healthful. Yes, it may, and I say this with caution, but just because it may be healthful does not mean that it can be consumed with abandon. Organic food can be very problematic and too often when not properly processed can be contaminated with pathogens such as E. coli and Campylobacter.

Yet, I see and hear of more people doing just that – overeating because something is healthful. I don't have to worry about gluten, but I do worry about foods containing GMOs. I admit I do not believe the USDA and Big Agriculture that GMOs are safe. Few tests have been done, and the few that have been tested, have returned mixed results.

Being a person with diabetes, my wife used to become exasperated with me reading labels. Then one day, I showed her an article about certain fish being packed in China and have certain bacteria that made people sick and now she reads food labels and ingredients as carefully as I do and sometimes more carefully.

Also as a person with diabetes, many of these terms mean that I have to be extra cautious. Why? Because many of the foods are loaded with extra sugar and carbohydrates. The food manufacturers have climbed on the gluten-free bandwagon and in doing so, have added extra sugars in various forms to make the gluten-free foods tastier. As much as I dislike saying this, gluten-free foods can cause more weight gain that some of our regular foods.

Have you heard this - “Everything in moderation?” This applies to many of the food traps companies are using with the above terms. Studies are proving that people are ignoring this good advice and overeating many of the foods using the above terms. If you do not believe this, use your meter with test strips to test your blood glucose before the meal and about 1 to 2 hours after the meal. If your blood glucose level increases by over 40 points, then you have generally consumed more than you should have of carbohydrates and sugars.