December 26, 2015

Should We Let Guilt about Diabetes Ruin Our Lives?

I am not sure about this, as the idea came from this blog by Karen McChesney on A Sweet Life. The way she wrote the blog, I am sure that those with type 1 diabetes agree with her feelings.

As a person with type 2 diabetes, I admit I have many misgivings about what she describes and would never allow myself to have the blood glucose readings she describes having for several hours. Many of those in our support group are talking about this and are wondering why we don't feel this way. We know that people with type 1 diabetes are afraid of hypoglycemia and we have to wonder several things.

First, are they not taught how to use correction injections and if they over bolus too often. Allen, who had a recent A1c of 5.1 percent, said he is at a loss to understand type 1 people. He said that eating a low carb, high fat food plan should prevent the problems she described. Ben asked why anyone would let his or her blood glucose levels remain in the 200's for several hours.

Ellie (a type 1 herself and an honorary member of our support group) asked if we would listen to her. She agreed with our food plan and said too many people with type 1 diabetes eat normally and plan on covering the extra carbohydrates with insulin. While she said she does not agree with this, it explains why many people yo-yo up and down and when they have lows over correct and then need to bolus for the hyperglycemia.

Ellie is a freshman in college this year and says that her type 1 friends ridicule her for her low carb, high fat meal plan and don't understand why she does not have lows and uses so little insulin. She then tells them about the support group she belongs to at home that are all type 2 people, most follow this food plan, and many have A1c's in the low 5%'s. When asked what her A1c is, many are surprised that she is also between 5.0 and 5.5%. She has only had one person ask her about her food plan, but after a few days, rejected it saying she did not like feeling hungry all the time.

She said she advised her to increase her fat percentage and add a little more salt. She finally discovered the person was following the advice of her mother to also eat low fat and realized that it was a no win situation and her friend normally had an A1c above 7.0% and had gained 20 pounds in her first semester of College. After that she decided not to talk about her A1c and her meal plan. She just thanked us for our support and being there when she needed our help, by answering her questions directly or through her parents. She asked us to pass on a special thank you to Brenda's daughter for her nutritional help. Tim said we would and we thanked her for her input.

Barry said that explains a lot, and we need to remember that our food plans work for us and we know they do. Other people need to experiment on their own to discover whether they can use the low carb, high fat food plans.

Our support group does not believe guilt should be any reason to diminish our
our diabetes management or our level of blood glucose maintenance. We all know that other variables can make our diabetes management more difficult, such as stress, illness, lack of sleep, and many other variables, but we need to have our diabetes held in check by what we eat and how we manage our blood glucose levels.

December 25, 2015

Managing Drug Side Effects – Part 2

When you talk to your doctor, have a list of all other medications and/or supplements you're taking - both prescription and over-the-counter. Sometimes, side effects are caused by two or more drugs reacting negatively together, and you may not need both.

Keep in mind that a new symptom may actually be a drug side effect. If you don't give your doctor the whole story, he may diagnose you with another condition entirely, and prescribe another drug to treat it.

There are a lot of factors that go into side effects -- not just the medication itself," Owen says. "You may be able to prevent them by avoiding alcohol or certain foods, or by making other small changes to your diet or lifestyle."

For example, if you take an antidepressant that helps you feel better but also causes you to gain weight, you may have to pay more attention to your nutrition and exercise plan.

Some medicines, like cholesterol drugs and blood thinners, may not work as well if you eat grapefruit or foods high in Vitamin K. Grapefruit can also make the cholesterol and blood thinners become toxic to your body. Other drugs may make you sensitive to the sun, so wear sunscreen or cover up outside.

It's smart to do your own research about your medicine. Read the label and all the instructions that come with your prescription. Talk with other people who have similar health problems. Please search reliable sources on the Internet.

If you read or hear about another drug that may have fewer side effects, ask your doctor or pharmacist about it. Side effects of newer medications may not be as well known as those on the market for years, so you might ask about switching to an older, more proven drug.

Never stop a medicine or change your dosage without your doctor's approval, especially if you're being treated for a serious health condition. You need to take some medicines, like antibiotics, for a full course to avoid getting sick again. Others don't work as well if you skip a dose, cut it in half, or take it with or without food.

You may be able to tolerate some side effects, especially if they're temporary or if the pros outweigh the cons. But, if a bad drug reaction puts you at risk for more medical problems or seriously affects your health, it may be time for a change. Always notify your prescribing doctor and explain what is happening.

Medications that cause dizziness, for example, can increase your risk of death or serious injury from falling, especially if you're an older adult. And treatments that affect your ability to enjoy time with friends or romantic partners may not be your best option if alternatives are available. If you are one of the elderly, make sure that the doctor will be monitoring you until you are sure that the drug can be effective and that your body is receiving the intended benefits.

Sometimes it takes a bit of trial and error, but often you can find a medicine that works without affecting your quality of life. Also, ask the doctor about whether grapefruit is a problem with a drug and follow the instructions carefully. Some foods need to be avoided with a few drugs.

December 24, 2015

Managing Drug Side Effects – Part 1

This article has some excellent advice that many people chose to ignore. Yes,
prescription drugs heal us when we're sick, ease our pain when we ache, and prevent or control long-term conditions. But sometimes, even when they do the job they're supposed to, they have unwelcome side effects.

Many people automatically rule out a medication, even if it's an important part of managing a health condition. But you shouldn't accept unpleasant reactions without question, either.

I find this very interesting. “Side effects can happen with almost any medicine, says Jim Owen, doctor of pharmacy and vice president of practice and science affairs at the American Pharmacists Association. “They're common with everything from birth control pills to cancer-fighting chemotherapy drugs.”

Many prescription drugs, for example, cause stomach problems like nausea, diarrhea, or constipation because they pass through your digestive system. Antidepressants, muscle relaxants, blood pressure, or diabetes medications may cause dizziness. Some might make you feel drowsy, depressed, or irritable. Some may cause weight gain. Some may disrupt your sleep or your ability (or desire) for sex.

"I tell my patients that chronic symptoms are not acceptable," says Lisa Liu, MD, a family doctor at Gottleib Memorial Hospital in Melrose Park, IL. "I won't allow them to have ongoing pain or discomfort unless we have tried every alternative."

When your doctor prescribes a new medicine, ask about common side effects.

"You, your doctor, and your pharmacist should be working together so everyone has the same information," Jim Owen says. "You should know which side effects are serious, which ones will go away on their own, and which ones can be prevented."

Once you start taking a drug, mention any unexpected symptoms to your doctor or pharmacist as soon as possible. This includes changes in your sex life,” Liu says, “Which many patients are embarrassed or afraid to talk about.”

Some side effects go away over time as your body gets used to a new drug, so your doctor may recommend you stick with your current plan for a little longer. In other cases, you may be able to lower your dose, try a different drug, or add another one, like an anti-nausea medicine, to your routine. As you age, your body may not be as efficient in using the drug and your doctor should be made aware of this.

"People often think that just because they have a bad reaction to one drug, they can't take any other drugs in the same class, but that's not always the case," Liu says. "Sometimes side effects are due to very specific ingredients that not every brand uses."

Changing the time of day you take your medicine may help, too, if your doctor gives you the okay or if your pharmacist tells you to ask the doctor. "If someone is on four blood pressure medications, for example, I tell them not to take them all at once," Liu says. "For patients whose birth control or antidepressant makes them dizzy, I have them take it right before bed."

December 23, 2015

Personal Emergency Response Devices

This is a service, which I may have missed in the past, but as I continue to age, I admit I am looking more into these products – personal emergency products. Products exist that are interesting and some that have been in existence for years, but do little. Some cover decent distances and others only short distances. Some have hidden fees, long contracts, and are expensive. Others have the equipment and only have a monthly fee. There are always some costs that aren't explained and these can turn you off to the equipment.

I understand why people are drawn to personal emergency devices, but many are not willing to wear it. Many forget or don’t want to have something around their neck or on their wrist. A personal emergency device also has to activate when an emergency occurs, either by automatically detecting a fall or problem, or because the user triggers it. Currently, most devices do not have this ability and only work if you are within operating range and the wearer pushes the button.

I am investigating only one device currently, but I have a couple others to investigate is I become serious. The equipment cost is $0.00 and the activation fee is $0.00. Monthly monitoring costs $29.95 per month or cellular monthly monitoring is $34.95 per month. This is from Medical Alert and is the basic cost.

There no long term commitment required, but – surprise - for liability purposes, they do require a Monitoring Agreement to be signed. A non-refundable deposit is required prior to a Medical Alert system being shipped. This deposit is the equivalent of three months monitoring. At the end of those 3 months, the Medical Alert service can be canceled with no penalty with 30 days notice (or you are required to have the service for 4 months). This is one of the more reasonable conditions.

I do not advise letting them have open access to your credit cards or auto draws to a checking or savings account. Unless a specific date was requested, credit card payments are processed on the 1st of the month and checking and savings account payments are processed on the 5th of the month. Invoices are mailed the first week of the month.

The cost of the unit if it’s lost or damaged is this schedule:
The PERS replacement cost is $350.
The Mobile Alert replacement cost is $350.
The Alert 911 replacement cost is $150.

The company has a Better Business Bureau rating of A+ as of 12/22/15 and has the Good Housekeeping seal of approval.

Some companies have long-term contracts and others have high activation fees and you pay for the equipment before it is shipped.

The one thing I have not found out is how close you have to be to the station for you to have access for a household monitor (PERS)(personal emergency response system). This is a weakness of several of the companies. Also before you sign anything, make sure you read the fine print, get all the facts, and addresses if you need to break the contract. For a couple of companies, you will pay dearly if you don't.

For research, type life alert or medical alert in your search engine.

December 22, 2015

Why Is Everyone Worried about A1c Overtesting?

Disclosure for me – I am a person with type 2 diabetes and am managing my diabetes with insulin. I only have two HbA1c tests per year and I do not feel this is often enough. Admittedly, I discontinued seeing an endocrinologist because I was consistently being asked to raise my A1c to level above 7.5%. When my A1c was under 6.5%, I was told rather sternly to let my A1c rise. I, of course do not believe this and believe I should manage my glucose levels to the best of my ability.

Fortunately, my VA nurse practitioner believes this also and with the other tests they run, she can determine that my meal plan is not affecting my health and the tests clearly show this. So I will continue to follow the low carb, high fat, moderate protein food plan and hopefully my next A1c test will be better and I won't have a couple of infections and another problem that will keep it as high.

It seems that certain doctors feel that for persons with well-managed diabetes, that they only need at most two HbA1c tests per year. Fortunately, some doctors disagree and feel that their patients need four tests per year. And some individuals buy their own kits to test on a monthly basis. This must drive these doctors into a tizzy.

Dr. Rozalina McCoy, a professor of medicine at the Mayo Clinic, in Rochester, Minn. is one of these doctors and a lead researcher that states - "I think part of the problem is that we often think more testing is better."

Her research showed that over 60% of adults in the United States with well-controlled type 2 diabetes receive more than the recommended number of tests for HbA1c. And excessive testing increases the risk of treatment being intensified despite a patient having normal HbA1c levels, a new retrospective analysis of an administrative claims database demonstrates.

The test, which gauges a person's average blood sugar control over the past three months, is routinely used to diagnose and monitor type 2 diabetes. But guidelines say it should be done only once or twice a year if a patient has been showing good blood sugar control, according to the study.

First, the HbA1c test reflects the prior four months and this is from David Mendosa's blog. I think this is a common mistake that the article author made, as the author of the second article did not even mention this.

"I think the most important drivers of HbA1c overtesting in the US are multifactorial," Dr McCoy told Medscape Medical News.

She and her colleague identified some factors that seem to play a role in how frequently patients are tested, including the number of different healthcare providers each patient sees and whether their endocrinologist also treats type 1 diabetes patients, who do require more frequent monitoring. Also, there was a wide geographic variation in frequency of testing.

Current guidelines recommend patients with stable glycemic control receive HbA1c tests once or twice a year. While this is true, often once a year is insufficient and because the American Diabetes Association only recommends A1c tests, patients often need to pay for their own test strips or completely operate in the dark. Dr. Robert Ratner, chief scientific and medical officer for the ADA that says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," in talking about oral medications.

With all this stacked against diabetes patients, it is small wonder, many patients see several doctors to be HbA1c tested several times per year. Unlike the following statement, with the ADA against you, I believe that overtesting of HbA1c is over researched. This is just another way the medical community is working to harm patients with well managed type 2 diabetes.  The researchers also use a value of A1c greater that 7 percent for increased A1c testing.  When will they learn that A1c values above 6.5 percent can lead to complications.  It is no small wonder that this is why doctors consider type 2 diabetes progressive.  They want to limit testing and give no education.

And in an accompanying editorial, Rodney Hayward, MD, University of Michigan, Ann Arbor, says the current study "probably greatly underestimates" the size of the overtreatment problem among US patients with type 2 diabetes. This common belief that there is "no harm in looking" continues to result in not just waste in the healthcare system but palpable patient harm, he stresses.”

For an HbA1c test the cost is very reasonable and a few extra tests are minimal cost and often great security for type 2 patients and generally create little harm.

December 21, 2015

Holiday Greetings

To all my readers

May you have a happy holiday season

Have a Merry Christmas!


A Happy New Year!

The blog will continue during the holidays. I wanted to take this opportunity to greet everyone and wish you happy holidays! 

I must apologize, as before my computer crashes in August and September, I had a blog written for gifts for people with diabetes, but it did not survive the crashes.  I had intended to publish it right after Thanksgiving, but I completely forgot about it since I no longer had it.

December 20, 2015

Doctors Now Advocating Statins for Children

It seems that endocrinologists, cardiologists, and several other medical groups in the medical world are promoting statins like never before. Not only are they now promoting them for children above the age of five years of age, but the also have flooded the medical journals with information that many (almost 50 percent) of eligible adults are not taking statins.

I cannot prove this, but it seems that there must be a lot of money to be made from promoting statins and many medical groups are thus promoting statins. This statement is beginning to have more significance - “Statin use has become what appears to us to be a kind of religion, an unchallengeable article of faith among some doctors.”

One in five children and adolescents had at least one abnormal cholesterol measure, according to new data from the CDC. "While the authors do not focus on this, some of the very high total cholesterol and non-HDL-cholesterol values are likely due to genetic causes such as familial hypercholesterolemia," wrote Daniels, who was not involved with the study. "The heterozygous form of familial hypercholesterolemia occurs in approximately one in 250 individuals."

Obesity is also listed as a potential risk factor, as nearly half (44.3%) of obese children and adolescents had some form of abnormal cholesterol, more than three times that of their normal weight peers (13.8%). Obese children and adolescents also saw statistically significant differences in high total cholesterol (11.6%) compared with those who were normal weight (6.3%) and overweight (6.9%).

Switching to the adults, nearly half of American adults who should be taking cholesterol-lowering drugs do not, according to research published in the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The CDC study team analyzed national data from 2005 to 2014 and found that 36.7% of U.S. adults — 78.1 million people aged 21 and older — were eligible to take cholesterol-lowering medications or was already taking them.

Many of the medical groups now believe that with statins now being generic, the benefits now favor statins and are pushing them very aggressively. There are few doctors that warn about the side effects and most never even consider that most statins deplete the levels of CoQ10 or Coenzyme Q10 made by our bodies. Most doctors do not even test for this and some people will develop problems because of this.

According to the University of Maryland Medical Center (UMMC), statins lower your body’s levels of coenzyme Q10. As your levels go down, the side effects of statins increase. Taking CoQ10 supplements might help increase the levels in the body and reduce problems.