February 14, 2015

Another Gathering of Members

On the February 12, Tim called us for a meeting that evening, as he wanted a final discussion on members leaving the group. When we arrived, we could tell that Tim was very upset like many of us had not seen before. Even Allen was surprised when he was not greeted.

Tim called the meeting to order and asked if there were any other members that were thinking of leaving the group. Then he went through the members, name by name. Everyone answered no, and Tim said that he had contacted Tom with the same question and received the same answer. He then explained that the three not present had quit the group this week and Tim stated that he is not happy.

Tim continued that the three that quit would not give him a reason or even answer any questions. Jerry asked to speak and said he may have an answer. Jerry said that his now ex-wife had said she would do what she could to destroy our support group and this could be why some of the members have left. With that Norm asked to speak. Jerry said go ahead. Norm said you may have noticed that those leaving to-date are not part of the VA as I am not. Yes, Jerry's ex-wife did contact me and gave me a bunch of lies that I knew were lies because I am friends with Allen and Max. I knew better and told her she was lying and I wanted to stay with the group.

Jennifer said she contacted me as well and if the group had not helped me, I might have believed her. I hung up on her and when she called again, I would not answer. Gale said she will be contacting those that are veterans as she had called her. Gale said that after Sue's help, she would not leave. She said that anyone that had received nutrition advice from her will probably be contacted, so be prepared and decide now where you want to place you loyalty. Rose spoke up and said she had also been contacted, but had told her she was not leaving. Julie added that she had also turned her down.

Jerry asked Earl and he said he had not been contacted yet, and the last three said no also. Jerry asked if they would be considering leaving now and all four said that now they would not listen to her and had planned on staying with the group. If they had been contacted before the last two meetings they might have been easier to sway. The last two meetings made us realized the group did have our best interests in mind and while the topic was not what they wanted to hear, this has been a wake up call about how serious diabetes could be.

Ken said he would also like topics about the other complications now and Jay said this would be good. Dan said he had an appointment with the nutritionist cousin of Bob's and the few questions she had answered during the meeting meant that he was happy.

Now Jerry was unhappy and asked if he should contact those that had left. Tim said no and Allen asked him to take a vote of the members before the new group had joined. Tim asked for a show of hands and it was in favor of no. Tim did say that we would consider them if they asked to rejoin, but that it should be their request.

Tim thanked everyone for coming on short notice and told everyone to have a happy
Valentines Day. Now that he understood what was happening, he was not as unhappy as he was.

February 13, 2015

Help in Diabetes Management Education – Part 12

Part 12 of 12

This will conclude the blogs in this series. One factor in diabetes management that is often overlooked by people helping others and especially certified diabetes educators (CDEs) is the proper assessment of the person you are trying to help. Most CDEs omit this altogether or if speaking to a group will only assess to the lowest common denominator. When I wrote this blog, it was done with a little tongue-in-cheek, but does fit this discussion.

We, as people with type 2 diabetes, are often better equipped to relate to other people with type 2 diabetes. No, we do not have the training that the CDEs have, but we have our experience to rely on and are not afraid to ask questions. We are finding out that some in our support group and a few that have left want secrecy. Those of us that have been in the group since the beginning, have no time for this and we want people to help us and for us to be able to help others. This is one reason that most of us are happy to have Brenda as part of our group and the rest respect her.

We are attempting to help the new members and this has turned into a challenge for those of us that have been with the group for the longest. Even Sue's husband, Bob, is asking why they are not listening to us and trying to manage diabetes and their health more effectively.

In some email exchanges, we are asking ourselves what we are doing wrong. Are we missing some clues? Do we not understand what they are feeling? We are all trying to reassess them and figure out why we are being ignored. We have a good feeling about some of them and we are concerned about the rest. We are thankful for Jerry and James as they are listening and learning. Even James's wife Jill has become a great support for him and another of our new members.

We are dividing the older members into groups of three to approach those that are not as open about their diabetes to see what we can do to help them. Barry, Ben, and Allen are asking to work with those that are veterans and we have agreed, but will help if needed. Allen has agreed to let Brenda take his place for the three women veterans. Sue and her husband Bob will work with the other two women with Jason.

Tim and I are available to anyone needing help and will support other members that feel the need. We are not sure where this is going, but all have stated that we must find out those that want secrecy and those that are willing to learn. We have decided to take our time and assess and reassess to help us find a common basis for an open dialogue and overcome the secrecy within the group.

Tim did receive one phone call after we started, telling Tim he would not stay in the group and some of the questions we were asking were none of our business. He did listen to Tim when he explained that we are a caring support group and may be taking some things too far, but we don't believe we are being nosy. The fellow said he did not feel we were being nosy, he just did not feel we needed to know the information. Tim did let him go with the understanding that if he could accept us in the future, we would be willing to reconsider him for membership again.

February 12, 2015

Help in Diabetes Management Education – Part 11

Part 11 of 12

Traveling with type 2 diabetes will depend on the medication(s) you are taking. I would advise having a letter from your doctor on the doctor's letterhead about the fact that you are a person with type two diabetes and are taking the medication(s) that you are prescribed. If you are on insulin, this should also be stated and that you are using insulin pens or vials and syringes.

I did this for several trips overseas and had no problems except for a slight delay while they located a translator for English. I had my medications in the original container with the prescription label on them and these were accepted with no questions. One of the TSA employees in the USA made a point of looking at each vial of insulin and each medication. The rest of the times, all they needed was a look at the doctor's letter.

How do you handle sick days? Many people refuse to say they have diabetes and can be fired for unexplained sick days if they do not have a doctor's letter explaining the reason for an absence. Then, if they find out you have lied on your application, you also risk losing your job. Developing diabetes while working for a company can also create problems, but not as serious.

Wellness campaigns by many companies today will also disclose your diabetes. Therefore, I think it is wise to have a talk with the human resource department and be honest with them. They may respect you more as an employee and even be willing to move you out of jobs that are more hazardous if you develop neuropathy. Not all companies do this, but more are learning. Some companies are only concerned that you show up for work and can perform your job. In small companies, there may be even more latitude in what they allow. If you have allowed sick days, or paid sick days, use them wisely and don't abuse the system.

Problem solving skills is part of daily life and diabetes makes them more important. I had one individual with diabetes laugh at me when I said this and could not believe that daily living required problem solving skills. I just said you had someone side swipe your auto and it was going too fast for you to get a license number, what do you do. He said just call my insurance agent and if the car is driveable, I will go to the repair shop. I said you failed.

First, you call the police to report a hit and run. You should have them check for evidence of paint and file a report. Then you request a copy of the report for the insurance company. Then you may call your agent and do what he directs you to do.

With diabetes, this means that if you can't solve the problem by observation, you look at the logs you keep and try to analyze what needs to be done. Then if you are unable to solve the problem, decide how serious the problem is at the moment and whether you should call your doctor, drive to the hospital, or call an ambulance. All cost different money and this may affect your decision as will whether this is a true emergency or a perceived emergency. Or it may be as simple as doing some additional exercise and eating a little less at the next meal. But problem solving it is and your skills should improve as you gain experience, ask questions of your doctor, and talk to other people with type 2 diabetes.

February 11, 2015

Help in Diabetes Management Education – Part 10

Part 10 of 12

Goals and how to set them is up to you. Beware of doctors that set the goals for you and will not discuss the reasons or why they are what they are. These paternalistic doctors need to be in control, but do not want you in charge of anything. Never mind that you only see them at most about one hour per year. If you don't make their goals, be prepared for a tongue-lashing. If you want to find out how bad they are, tell them that your goals are different short-term and you will consider their goals long-term. Be prepared to be told to find another doctor.

No, a doctor should suggest goals and give you the reasons, but if you have other ideas, they should listen. If they feel you are not setting the correct goal, they may encourage you to try for a different goal. This means that they are trying to help you, and will listen to you. Suggestions are always appropriate from doctors, until they know you and how hard you work or don't work to attain goals.

I have supplied you with reading to help you set your own goals in the last nine blogs.
Depending on the progress of your diabetes at the time of diagnosis, you might want to consider a goal of getting off medication. This will depend on many factors; the first is whether you have a doctor that will accept this. Second, you will need a plan of action that your doctor approves. Then you will need a food plan that will help keep your blood glucose levels in acceptable range.

Next, make sure that you have an exercise regimen that you will enjoy and are capable of accomplishing. Many fail when it comes to the last two items. You will need to keep testing and seeing the doctor for appointments. The next thing will be whether you are succeeding or having problems. Testing will let you know as will the A1c that the doctor sees. The important thing to realize is if you are having trouble keep your blood glucose levels down that you don't stay off medication for too long.

One of our new members tried three times before giving up when his blood glucose levels kept rising each time. The third time his doctor told him not to try again until he had kept his blood glucose levels below a set level for at least six months on medication and then for another six months at a lower level of medication. His doctor is supporting him and this makes him want to keep trying until he knows it is no longer possible.

Besides goals, people need to understand that as they age, their bodies can stop being efficient enough in obtaining the vitamins and minerals necessary for health from many foods. Most of the time the correct foods will supply everything you need.

People that are on metformin need to be concerned that they are not becoming deficient in vitamin B12. Folic acid (vitamin B9), especially when taken in high doses, can mask the symptoms of a vitamin B12 deficiency. Older and even a few middle age people with type 2 diabetes can become unable to absorb or manufacture vitamin B12 from animal foods. Vitamin B12 is found only in animal foods. Liver, sardines, and salmon rank highest, with liver running away with it. Kidney, eggs, beef, and pork are also good sources. There are no vegetarian sources.

If you develop neuropathy – a tingling or burning in your feet, and especially the toes may indicate that you may have a vitamin B12 deficiency. The quicker you have the test the more likely you will be able to prevent the neuropathy from spreading. Some of our members have had vitamin B12 shots and then prescribed a supplement and a few others have been told to start a vitamin B12 supplement.

The final bit of information on this is your blood glucose levels need to be managed to keep them below 140 mg/dl. With about 60 percent of the people with diabetes developing neuropathy, this tells us that many people are not managing diabetes and may vitamin B12 deficient.

February 10, 2015

Help in Diabetes Management Education – Part 9

Part 9 of 12

Exercise can be a contentious topic for some people. I agree because too often the doctor or other healthcare professional just orders exercise and suggests walking or jogging. I even become upset when they do this to me and I ask them if they have heard of weight lifting, dancing, swimming, or other types of exercise.

I ask if aerobics is not considered exercise or if because it is recommended to do some resistance exercise with aerobics that they don't consider this exercise. I sort of get in their face and ask why they only consider walking and jogging as exercise. Do they even know that the person is capable of jogging or the area in which they can walk is even safe? I then ask if they know that the person will enjoy walking or jogging and why they do not recommend the period of time for walking and jogging.

I am probably the last person they want talking about this, as they know now that I just don't let it go. One doctor asked me to write something up for his office to use. I was a fool for not making copies of what I wrote for him more than three decades ago. I did a lot of research and talked to several people in the business side of training people and those that supplied different equipment. It amounted to more than 15 typed and double spaced pages. I thought all had been lost when the doctor died about 13 years ago, until last month when another patient of his asked me one day if I knew of a paper on exercise written by a person with the same name.

I asked him which doctor he had received it from and when he said the doctor's name, I asked if I could get a copy of it. I now have a copy and it is what I had written with a few notes and other references added. Now I can rewrite it and keep it.

An important part of any exercise regimen is doing something you enjoy, as this will help you maintain it. Please read this by Tom Ross. This is not his normal place for exercise, but he makes use of it.

When it comes to changes in lifestyles, my blog about components of lifestyle changes is a good blog to read. This will vary from person to person as not everyone will need to change every component, but others will need to change many of the components,  This blog may also help. The last blog is also about lifestyle changes, but emphasizes lifestyle changes over medications, which is refreshing.

Food plan changes and exercise seem to be the changes most often emphasized. I do believe that these are necessary, but there are other changes that can help as well. Please be careful with stress, as this is one of the most damaging and can cause any food plan to blow up and cause weight gain and make diabetes more difficult to manage.

Stress in managing your diabetes can be very upsetting for some. Another term for this is burnout as you are the only person in charge of managing your diabetes. Yes, your doctor can give your tips and advice, but in the 15 minutes that you see him or her, this will not be a lot of help. Consider that about half an hour or an hour out of the year, that you see the doctor, the responsibility rests on you, the person with diabetes.
This can cause stress and even depression. This needs to be recognized and if you have family, they can help reduce the stress by supporting you. Unfortunately, they can also increase stress. Exercise can reduce and possibly eliminate much stress.

February 9, 2015

Our Group's February Meeting

With two relatives doing the topics for this meeting, I had to be there. Yes, I had several emails from them and a few phone calls asking questions about what we had discovered in our meetings and if there was a lot of secrecy among our new members.  Both said Tim had warned them that this could be a possibility and I had to agree with Tim. I did say that our long time members would not be a problem and that some of the new members would not be either.

Beverly asked if she should avoid calling on people and I suggested that she ask for volunteers the first time. I knew the topic she had planned and knew some of our new members might not appreciate the topic. Suzanne said she had several minor topics to discuss and would see how Beverly was received before using one of her topics.

Saturday, February 7, arrived and everyone was present plus a few from the third support group in our town. Tim called the meeting to order and thanked the group for being present. He introduced Beverly and she started her program. She explained that she was a nurse that assisted several surgeons during operations, but that in the last two months she had been part of a team involved in amputations. She continued that before you tune me out, I have been informed about the last meeting you had with two podiatrists and I think you have a great group that cares and this should prevent the members from needing this surgery in the future.

Next, she asked A.J and Jerry to stand and explain what had happened that possibly had prevented them from needing an amputation. A.J said he and I had been talking about diabetes and while he had not wanted to hear what I was saying, when I described some of the symptoms of diabetes; he knew that he had better listen. When I had mentioned sores that were slow to heal, A.J said he had to show Bob a sore on my leg. A.J said I had not hesitated, but had called his doctor for an appointment and told the nurse about the symptoms he had and made a special point of telling her about his sore.

A.J said the doctor had carefully cleaned the sore and applied a gel to the sore and told him to bring his diabetes under quick management to help it heal. He covered the sore with breathable gauze and had told him how to take care of it with the prescription he gave me. Next, he started me on insulin for managing diabetes and within 30 days, my sore was healed. I still have a small scar to know that it was there, but I am a lot more careful now with sores.

Next Beverly asked Jerry to talk about his problem. Jerry said he had a foot ulcer and A.J had asked Bob to have a look at it. They had me see a doctor that day and the doctor had discovered a new ulcer developing on my other foot. The doctor had prescribed medications and coverings for both ulcers. The new one was gone in three weeks, and the bad one is almost completely healed and Jerry said he has been given permission to walk on that foot without crutches before having his shoe fitted with orthotics later this month. He explained that he still uses his mirror to look at his feet daily, but is thankful that A.J and I have been there for him when he needed assistance.

Gale was next and she was still using crutches, but was happy to have a ride to the meeting. She explained that she had never thought about foot problems until she noticed blood in her slipper. She said she had called Sue for help and had also been taken to the doctor immediately. She said that she was sorry for missing the last meeting, but felt that even with crutches, she should not come. She commented that she was still using medication for her foot ulcer and had a mirror to look at her feet now. She commented that belonging to this group was a good thing as they wanted to help and went out of their way to help when other members were in need.

Beverly thanked them and said this is the way to prevent problems and avoid amputations. She explained that she had been present at six amputations and the problems following the operations. She believed five of them could have been prevented if those people had been members of a support group like this. Four were from sores on a leg and two were from foot ulcers that had not been cared for properly or early enough.

Next, she opened the discussion up for questions and questions that took the rest of the meeting. Suzanne had a few questions as well and she answered them. She said she would schedule anyone that wanted help after Valentines Day. Tim was ready to end the meeting, but I took the floor and asked Beverly to introduce her husband, Tom, to the group and she did, explaining that he had type 2 diabetes and was taking metformin. Tom then asked if we were taking new members, as he was not aware of any groups in the town they lived in that were this positive or active.

Tim thanked him for asking and asked him a couple of questions. Then Tim asked our members for a vote and it was unanimous. Tom was accepted and Tim said the meeting was over. Questions happened for another half-hour and people started leaving. Beverly and Tom came to talk to me. Tom said I am about finished reading your blogs, and asked if I took suggestions. I said yes, but some topics are difficult and if he has a topic with articles, I do ask for a copy of the article. Tom said he had my email address and would send me a couple of articles. Tim then obtained Tom's email address and told him about the summary of the meeting that he would receive even when he was in attendance. We did this for everyone and this way people could miss a meeting if they needed to and still be kept up to date on the meetings. With that, we left the meeting.

February 8, 2015

Diabetes 'Experts' Forcing Complications on Patients

Yes, I am making this accusation and it makes sense to me. Why else would people of importance in the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) speak so confidently about type 2 diabetes not needing to test regularly and to rely on their A1c results only.

Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association and Alan J. Garber, M.D., Ph.D., Professor of Medicine, Biochemistry & Molecular Biology, and Molecular & Cellular Biology at Baylor College of Medicine, Houston, Texas are both recipients of money from Big Pharma. I also have to wonder if they also receive large sums of money from Big Food, Big Agriculture, and Big Chemical. These two doctors and others within these organizations received big sums of money to limit what most patients can do.

This is why they insist that we do not test to make the complications happen. This in turn is a favor to the rest of the doctors to give them patients to treat. It is a shame that the insurance industry has to go along with the pronouncements of these doctors, but they are in the business of showing a profit. Therefore, their leaders are more than happy to limit testing supplies. What they do not realize is that the complications will cause greater expenses in the future than the test strips will cost now.

This is part of the reason I have such a dislike for the people in the ADA and the AACE that are in a position to influence guidelines and position statements. This in turn affects most of the actions of other healthcare professionals in the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND). This is also the reason most of their members do not talk about testing or promote testing.

This leaves people with type 2 diabetes who cannot afford extra test strips, managing their diabetes in the dark without the means to use testing supplies that will aid them in more efficient diabetes management. These patients will not be able to determine the most reliable time to test postprandial and often find it impossible to test in pairs to help them decide how a meal affects their blood glucose levels. Those of us that have been able to do this have found that we are better able to manage our diabetes.

We have found that by reducing the number of carbohydrates consumed, we are better able to manage our diabetes. Yet both members of the AADE and AND continue to promote carbohydrates and reduced fat and this makes diabetes management more difficult for most people with diabetes. Yes, the ADA has opened the door for low carbohydrate consumption, but the members of these organizations have yet to put this into practice. Maybe the officers have accepted this, but the general membership still follows the old guidelines and the two organizations have not produced new position statements to affirm to the membership the acceptance of anything but the prior guidelines.

All of this creates an uphill battle for people with diabetes that desire to manage diabetes at a level to prevent complications. It is still possible, but takes more effort and education which most with type 2 diabetes do not receive. Most are required to self-educate to be able to manage their diabetes.