July 26, 2014

Information for CPAP Users

I admit that I love my sleep apnea machine. It is a BiPAP and this means that two settings are input into the machine. The first is the lowest reading allowed and the second is the maximum reading allowed. Then the machine adjusts automatically between the two and provides the correct pressure. The minimum on mine is 10 and the maximum is 15. The average on the last printout obtained over 18 months ago was 12.5, with rare excursions to 10 and 15 and the majority of readings between 11 and 13.5. The data recorded includes sleeping time on a daily basis and averages.

There are different types of CPAP (continuous positive airway pressure) machines. Most insurance companies have a strict schedule of what they will cover and what they will replace and when. Do not try to get fancy, as they will not as a rule, allow exceptions to policy. Do talk to your insurance company and ask for the schedule.

Also, Federal law requires that sellers of sleep apnea equipment have a valid prescription on file before they ship or supply you with your machine or appliance. Yet there are many suppliers that are bypassing this having their own specialists ask some questions and prescribing internally. Not the wisest choice as then you will not know what pressure settings to use. Plus insurance may not reimburse you. Many of the internet advertising companies do not accept insurance or Medicare.

Because of the above, I would urge you to talk to your insurance company and find out what machines they will reimburse and cover. They may even be able to suggest the suppliers they prefer to use. I used a local supplier and Medicare reimburses the same supplier.

Speaking of Medicare, they will require another sleep study to determine your eligibility for equipment and supplies. I was required to have a sleep study in a facility separate from the hospital and I admit I was not happy with the schedule. Once the study was complete, Medicare received the results and authorized the equipment they would cover. I had three choices and no more. My supplier only carried two of the authorized machines.

The different types of machines are:

CPAP – Continuous Positive Airway Pressure

APAP – Auto Adjust Positive Airway Pressure

BiPAP – Bi-level Positive Airway Pressure

VPAP – Variable Positive Airway Pressure

Auto-titrating Continuous Positive Airway Pressure (To determine the concentration of (a solution) by titration or perform the operation of titration.) In this case, by pressure is titrated. This is the most complicated of the machines and possibly one I would be cautious about having.

After having an auto-titrating machine during the sleep study lab, I would still urge caution, but would not hesitate to consider having one. The one used for me was very quiet.

Then in addition to the above types, a determination needs to be made if you need a humidifier. This is where full disclosure to the prescribing doctor is very important. If you have allergies, sinus infections, regular colds or cold like flare-ups, sleep with mouth open and have many dry mouth mornings – discuss this information with your doctor to get the right machine and mask for you.

Next is the type of mask which will be best for you. Types are nasal masks, full-face masks, nasal pillow masks, and other headgear and chinstraps. The biggest problem is getting the correct one for you. Whoever is setting up the order should cover this and you should verify that you are getting the correct size of mask. Masks are normally small, medium, and large. There is not a standard and a medium in one type of mask may require a large in a different mask. They should also discuss with you whether you have seasonal or chronic allergies, whether you have a deviated septum, do you awaken with a dry mouth, do you need heated humidification, and they should measure your nasal bridge – average, tall, wide, narrow, or flat.

I cannot emphasize how important the two paragraphs above are. This is how you obtain the right equipment and the equipment that fits you and your needs. The next blog will cover an important accessory.

July 25, 2014

Some Signs You Need More Fat in Your Diet

I can only say that since childhood, I have seemed to know when I needed extra fat in my diet. My mother always wondered when I asked for fatty foods, but I always received them. Even as I have aged, there have been times that I craved foods with lots of fat. Currently I have needed to purchase my own foods for this, as my wife still believes in low fat. I have had her read articles that have proven that Ancel Keys was wrong, but she won't budge.

So when I want extra fat, I have to purchase them for myself and prepare them myself when she is working. The one time I wanted a piece of meat with lots of fat, she took it away from me and trimmed the fat off. Talk about a tasteless, dry meal! Fortunately, she was scheduled to work the next day. What a tasty meal!

Therefore, when I read Mark's Daily Apple blog, it did catch my attention. He named it 9 Signs You Need to Eat More Fat.

#1. You have dry skin.
Dry skin can indicate a lot of things, such as allergic reactions, imbalanced gut microbiota, topical exposure to abrasive chemicals. It often means that you simply need more fat in your diet. How so do we obtain the needed fat? Sebum is the body’s natural moisturizer, and we produce it in-house using the fatty acids that are available. Some of the fats come from our own body stores, while others have to come from the diet. Increasing fat intake, then, is a painless, simple way to potentially improve your skin’s moisture levels.

#2. You’re low-carb and feeling “off.”
Fat has bad connotations for some people. A person reduces carb intake to lose weight without realizing that they need to increase their consumption of fat to make up for some of the missing energy. They begin losing weight, but the exhaustion, lack of energy, and headaches make it hard to stick to the plan. Since fat is still bad for many people (though that’s changing), what happens all too often is a person will reduce carbs and keep their fat intake way too low. If they’re burning lots of body fat in the process, that can certainly help with energy needs, but most people will also need to increase the fat they eat.

#3. Your physical performance is below par.
People are quick to suggest upping carb intake when physical performance suffers. Depending on the nature of the performance, it may help in certain cases. But another macronutrient also plays a big role in physical performance - fat, specifically saturated fat. We use saturated fat as precursors to steroid hormones like testosterone. Without enough saturated fat in the diet, we can’t make enough testosterone. Without enough testosterone, we can’t build muscle, recover from our workouts, or enjoy that healthy feeling.

#4. Your joints ache.
Achy joints can mean different things to different people. You could have poor mobility, improper movement mechanics, and tight surrounding musculature and fascia. You could have arthritis. You could have suffered an acute injury that’s just now making itself known. Whatever the cause, reducing inflammation through dietary means can really help dull the pain and even improve the underlying issue. If you have a sore knee or a creaky hip, eat more fatty fish or increase your fish oil intake for a few days. The omega-3s are anti-inflammatory and have even been shown to improve symptoms in patients with rheumatoid arthritis. If animal models of osteoarthritis hold true for humans, omega-3 intake can even enhance wound and joint repair following joint injury.

#5. You have low HDL.
Getting regular exercise, moderate alcohol consumption, and weight loss all increase HDL. Health professionals are quick to mention those as viable options. However, eating more fat, particularly saturated and monounsaturated fats, can also increase your HDL. This isn’t very surprising, actually, as both exercise and weight loss involves the oxidation of stored body fat, which is similar to eating a bunch of animal fat. Maybe that’s one reason why losing body fat is so good for us and results in so many improvements to health markers. It inadvertently places us on a high-animal fat diet (regardless of the diet used to achieve the fat loss). Some fats are better than others at increasing HDL. Saturated fats like the ones in coconut oil increase HDL, while the PUFAs found in soybean oil tend to lower it.

#6. You’re never satisfied after meals.
Low-fat diets are notorious for making their followers extremely hungry, whereas low-carb, high-fat diets are well known for curbing out-of-control appetites. Most people attribute that to the higher protein content of low-carb diets. Both reduce appetite, to be sure. Plus, fatty cuts of meat, not just the lean meat, provides saturated and monounsaturated fats (along with protein). Saturated fats appear to confer the most satiety via the satiety hormone PPY, whereas monounsaturated fats from olive oil have favorable effects on another satiety hormone, GLP-1.

#7. You’re trying to love vegetables.
Edible vegetation is essential for optimal health. Maybe not ten cups a day of leafy greens or anything, but some really does help round out the diet and provide vital nutrients that are otherwise tough to get elsewhere. The problem for many people is the “edible” part of that equation. Plain vegetables simply don’t taste very good, at least until you develop a palate that can appreciate them. Here’s where fat comes in. Fat transforms vegetables into delicious meal additions. Steamed broccoli is tolerable plain. Toss it with some grass-fed butter, salt, and black pepper and it becomes irresistible. Toddlers, with their instinctual distrust of vegetation, develop a taste for even the dreaded Brussels sprout more quickly when paired with fat. Vegetables are loaded with vitamins, minerals, antioxidants, and fermentable fiber. They’re some of the healthiest things a person can consume, but you do have to actually eat them.

#8. Your mental edge seems dulled.
Part of the transition into lower-carb eating involves a period of mental dullness for many people. You’re eating fewer carbs, which means less glucose is available for your brain, and your metabolic system hasn’t quite caught up to begin burning fat and ketones efficiently for energy. But what if this persists? A number of studies show that eating specific fatty acids – medium chain triglycerides, whether found in refined MCT oil or in coconut oil – can improve cognitive function by increasing ketone availability. Interestingly, access to ketones (whether through ketosis or medium chain triglycerides) doesn’t impair the brain’s ability to utilize glucose. When the brain’s access to ketones increases, so does its uptake of glucose. Oh, and krill oil, which contains omega-3 fats in phospholipid form, may also improve cognitive function.

#9. You’re going out drinking.
If you plan on drinking more than a serving or two of alcohol, increasing your intake of certain fatty acids and decreasing your intake of others before can protect your liver from injury, reduce the toxicity, and diminish the resulting hangover. Saturated fats appear the most hepatoprotective, with the fats in dark chocolate and coconut/MCT oil being especially helpful. Linoleic acid/omega-6 is the most dangerous when drinking alcohol. You’ll get the best results by eating more SFA and less linoleic acid several days prior and up to drinking, since it takes a few days to shift the composition of your liver fat.

July 24, 2014

Researchers Say Pre-diabetes Label Unnecessary

Researchers from University College London and the Mayo Clinic have raised a few valid concerns, if, they had done their research properly. Too often, other factors drive research and not the true nature of research. In this case, financial considerations seem to be front and center and studies were hand picked to fit the researcher's agenda.

While people may not agree with me, this article should be read and people making their own determinations. At least the World Health Organization (WHO) has stated that the use of 'pre-diabetes' is discouraged to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies. Bold is my emphasis.

I do agree that the term pre-diabetes is a poor term and causes most people that do not understand diabetes to ignore what they could do to prevent the full onset of type 2 diabetes. The following statement bothers me and is what raised red flags for me. “The authors (of the study) showed that treatments to reduce blood sugar only delayed the onset of type 2 diabetes by a few years, and found no evidence of long-term health benefits.”

With the total absence of education by the medical profession and researchers world wide, it is small wonder that people that develop type 2 diabetes are not aware that full onset of diabetes could be delayed or prevented. These same doctors even laugh about how they will have patients to treat until they retire because people will progress to diabetes and then to the complications. This is a typical reaction by doctors that do not understand diabetes.

"Pre-diabetes is an artificial category with virtually zero clinical relevance," says lead author John S Yudkin, Emeritus Professor of Medicine at UCL. "There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway. Sensibly, the WHO and NICE and the International Diabetes Federation do not recognize pre-diabetes at present but I am concerned about the rising influence of the term.”

While I doubt this study will do anything to cause action by the American Diabetes Association (ADA), we can hope that the ADA will make the readings above 99 mg/dl,
part of the diabetes spectrum. There can be serious complications developing in this area called pre-diabetes. These complications vary by individual and with most doctors ignoring pre-diabetes and declaring that nothing happens, more people will continue to develop complications.

July 23, 2014

More Diabetes Management Tips Part 2

This is a continuation of the previous blog with five tips.

#6. Fight Everyday Stress With Activity. Living with diabetes can make you sad or unhappy at times. Stress not only affects your mood, but it can raise your blood glucose levels. Stress may cause you to make poor food choices and drink more alcohol. An easy way to feel better from everyday stress is to become active. Being active raises the levels of chemicals in your brain that make you feel good. If you don't want to exercise in a gym, join a sports team or take dance lessons to keep moving. Swimming is also another way to stay active.

#7. Exercise in Short Sessions, If Needed. Finding the time to exercise may be hard for some people. It can also be hard to keep going if you're not used to exercising for 30 minutes straight. The good news is you can spread your 30 minutes throughout the day. Three 10-minute walks are as good as 30 minutes at once. So don't hold out to exercise when you have a lot of time. Moderate physical activity (both strength building and cardio) will help you control your blood glucose, lower your blood pressure and cholesterol, and reduce stress.

#8. Try Strength Workouts If You Are Able. All types of exercise can benefit people with diabetes. But training with weights or other resistance equipment may help you prevent muscle loss (lost muscle often leads to more fat). Several studies suggest strength training. Lifting weights, for example, improves your reaction to insulin and your glucose tolerance. Of course, regular strength training can also improve your muscle mass and help you lose weight, too.

#9. Check Your Feet Every Night. Use a hand mirror or ask someone to help you look for cuts, swelling, or color changes on your feet. Don't forget to look between your toes, too. If you see unhealed cuts or broken skin, call your doctor right away. Make foot care part of your daily routine. Wash and moisturize your feet and trim your toenails as needed. Talk to your doctor about treating corns or calluses. Have your doctor examine your feet during every appointment.

#10. Choose a Date to Quit Smoking. If you smoke, picking a date to quit gives you the chance to prepare for it. You may need help beating the mental and physical parts of nicotine addiction. Stop-smoking programs, support groups, and wellness centers can offer professional help. Whether you quit cold turkey or use other treatments to help you quit, having time to prepare for it may improve your chances of success. Choose what works for you and quit as soon as possible.

#11. Drink Alcohol Only With Food. Your doctor may say it's OK for you to have an occasional drink. Drink alcohol only when you can eat something along with it, because alcohol can cause low blood sugar. Also have some water handy in case you get thirsty. Even so, mixed drinks can raise your blood sugar if you use juice or a regular soda as your mixer. Women should drink no more than one alcoholic drink per day, and men no more than two a day. Or I would suggest stop alcohol consumption completely.

I have said this before, but it is worth repeating. Keep a positive attitude. This will serve you well.

If you have other things that help you manage diabetes, make use of them and don't forget them. Every person varies in their management and abilities to manage diabetes, but this should not deter you from managing your diabetes to the best of your abilities and seeking help from others, if needed. Your doctor may be one of these persons as well as your pharmacist.

July 22, 2014

More Diabetes Management Tips Part 1

I am using WebMD for the ideas, but not the rhetoric and the pushing of carbohydrates and high carb low fat that the articles promote. Again, like so many other sources, they do not encourage using your meter with test strips to tell you how different foods affect your body. This seems to be how they encourage people to ignore diabetes and overeat. Yet they write about decreasing obesity, but don't really support it when it comes to diabetes.

I have written about other tips for managing diabetes in this blog, and WebMD had some items that need to be discussed.

#1. Eat the Foods You Like Within Reason. Having diabetes doesn't mean you can't eat your favorite foods. However, you need to know how your food choices will affect your blood glucose. By using your meter, this will help you learn skills and reinforce diabetes skills. Learn how to count carbs, read food labels, and size up portions that will let you keep your diabetes in check while still enjoying your favorite meals. Learn which of your favorite foods spike your blood glucose more that 40 mg/dl. Then limit the quantity you consume or eliminate that food.

#2. Define Your Plate and the Plate Size. Use a rule of three to build a healthy, satisfying meal. This rule may help you lose weight and manage your diabetes by increasing your intake of non-starchy foods. Divide your plate in half. Fill one-half with non-starchy vegetables like spinach or broccoli. Next, divide the empty side into two halves. Use one for starchy foods like bread or pasta. In the last section, add meat or another protein. You can also add an 8-ounce glass of low-fat milk and a ½-cup of fruit. This may not be the best and for some will not help them lose weight. This is only a suggestion and each person needs to find what works for them. Low fat milk does not work for me as I like whole milk, but not in large glasses.

#3. Write It Down and I Mean Everything. Develop the habit of writing down your critical information. Record your daily blood sugar levels and track how food, activity, and medicines affect your blood sugar and A1c test results. A written record can show you and your doctor whether your diabetes treatment is working over the long term. Writing down your goals and feelings in a journal may also help you stay on track and better communicate with your health care providers. I admit I may over do this, but I like records that help remind me of the past and especially the mistakes I make. This reminds me not to make the mistake again.

#4. Have a Sick-Day Plan in Place. This is something missing for many people with diabetes. This should be one of the first things you do. Common illnesses like colds, flu, and diarrhea can make your blood sugar rise. Having diabetes, in turn may make it harder to fight off infections. Have a plan in case you get sick. Store snacks that are easy on the stomach but can still give you enough fluids and carbs, if necessary. Check your blood sugar more often and know when to check for ketones and when to call your doctor. Get a flu shot every year. A flu shot may not prevent the flu, but you should have a milder case and recover quicker.

#5. Manage Your Medicines and Where They Are Stored. You may take pills or injections to manage your diabetes. Try to keep, at a minimum, 3 days' worth of your diabetes medicines and supplies on hand in case of an emergency, as well as a list of all your medicines. I would suggest 7 to 10 days of your medications. Your drugs may interact with other medicines, even ones that can be bought without a prescription. Make sure to tell your doctor before you take any new medicine. And always take your list to your regular doctor and dental appointments. Do not store medicines in the kitchen or bathroom as moisture or heat is often bad for some medications and testing supplies.

I will continue with 6 more tips in the next blog.

July 21, 2014

It Seems Everyone Now Worried About Elderly Medication

For decades, no one has expressed concern for the elderly or that they were often over medicated. Since the NY Times column and several other articles, the popular theme now is flooding the internet with articles and stories about the elderly being over medicated. I am proposing another purpose for these articles. Under the Affordable Care Act, aka Obamacare, many medical procedures and medications are being withheld from the elderly. These articles are for the purpose of showing cause for the medications being withheld, as if they have been overtreated.

However, this is also a cover by the media because they also want the elderly to die from the treatments withheld from the elderly. They are backing the current administration and their objectives of euthanasia.

What I am surprised is that the Diabetes in Control (DiC) people were suckered in by the NY Times article. Dr. Bill Quick in his blog here points out the shortcoming of the study which he says did not determine many essential points.

The DiC does state that the older diabetes patients are often switched to insulin and sulfonylureas to provide intensive therapy to manage blood glucose levels. This is too often done by doctors that are not knowledgeable about diabetes and their patients are kept on oral medications until it is too late and they have to be moved to insulin as the medication of last resort.

What is not stated in the study is how many had other conditions (comorbid) that could have caused worry for over treatment. Memory problems and conditions of dementia are not made known. It could even be that many of the veterans had no other conditions and had no memory problems. Then to say that they were overtreated could be in error when the patients were knowledgeable and wanted tight management their blood glucose levels.

The worry of hypoglycemia is often overstated because doctors do not know how to treat patients with diabetes. They could be over treating their patients with oral medications and causing serious side effects because they do not have the knowledge or information needed.

I admit that I am becoming irritated at doctors that keep ordering me to let my blood glucose levels rise above 7.0%. I am 72 years of age and on insulins, Lantus and Novolog, and while I have had levels that occasionally scare me, I have only had one level requiring my wife to assist me in recovering. Unless I develop memory problems, I will not let my blood glucose levels rise to the 8% to 9% that the people at DiC and other doctors want for the age of 75 or older.

I do have other comorbid conditions, high blood pressure, cholesterol problems, heart disease, and weight problems. The blood pressure and cholesterol are well managed by medications. I need to have a discussion with the doctor about my blood pressure levels that are constantly creeping lower. So far, I have not had any dizziness or other problems when getting up quickly, but today's BP readings have been 102 over 54 on rising and three hours later 110 over 60. I would think that I should be nearer 120 over 70, but I am afraid that the guidelines of 140 over 80 are not what I want.

July 20, 2014

Managing Your Medicines

Of course, for many seniors with memory problems or those with different forms of dementia, managing medications can be extremely difficult and often requires family assistance or caregiver assistance. Don't look the other direction or ignore these people, as they deserve to be cared for and have quality of life until the end.

Their problems with memory issues can often lead to not taking medications or taking them only when remembered. This can mean doubling up of medications sometimes as well. Making sure that medications are stored properly, have not expired, and are taken as directed requires time and attention. Many of the elderly take many medications at the same time and remembering what each if for, when to take each, and how to take each can be difficult.

There are some strategies that can be used to help manage medicines wisely.
#1. Maintain a checklist. For all prescriptions and over-the-counter medications you take, keep and update a checklist. The suggested format here may work for some people. It can be printed out or modified to a spreadsheet. Try to have at least two copies of your checklist. Put one on the refrigerator door or where your medications are stored and have one copy for your wallet or purse.

#2. Review your medicine record or list often. Do this before every visit to your doctor and when every your doctor prescribes a new medicine. Also do this whenever you stop or start a new over-the-counter medication or dietary supplement. Whenever your doctor discontinues a medication, adds a new medication, or changes the dosage of a medication, ask the doctor to write this information out with instructions for each medication. Keep this information handy.

#3. Ask your pharmacist to provide your medications in large, easy to open containers with large-print labels, if needed. Never put more than one medicine in the same container unless it is a multi-day dispenser. Always keep medicines in their original containers – again unless they have been organized in a multi-day dispenser. You may want to have multi-day dispensers that organize your medicines by the day and time you should take them.

#4. Determine how each medication should be stored. Ask your doctor or pharmacist how best to store each medicine. Insulin and some medicines must be stored in the refrigerator. Your kitchen cabinet near the stove and the bathroom medicine cabinet is not a good place to store most medicines because of the moist warm conditions that can exist and cause the drugs to break down more quickly. Many medicines have temperature range requirements for storage.

#5. Do not taking a prescription drug unless your doctors orders it or says it is okay. It is not okay just because you are feeling better. Some medicines are for a specific length of time and are not fully effective until the full amount it taken.

#6. Get prescriptions refilled early to avoid running out. Check with your insurance to find out how early they authorize refills. Also, running out of a medicine can cause problems. Check expiration dates and ask your doctor for a refill prescription if needed.

#7. Keep all medicines out of sight and reach of children. Store all medicines securely and away from pets. If children do visit your house, be extra cautious and have the phone number of the nearest poison control center handy.

Always remember that your pharmacist is an excellent resource for information about your medicines. Your pharmacist will answer questions and help you select non-prescription medications. It is wise to have your prescriptions filled by one pharmacist because this provides a backup for stopping medication conflicts

Be prepared in case of accidental poisoning involving medications or other substances. Call Poison Help at 1-800-222-1222 to speak with a poison expert at the poison center serving your area. The service is free and available 24 hours a day, 7 days a week, and calls are always free and confidential. Interpreter services are also available in 160 languages. Keep the number programmed in your home phone and mobile device.”

For more information, visit the Poison Help website at www.poisonhelp.hrsa.gov