January 16, 2016

Diabetes and Sleep Apnea - P2

After Max and I worked with three recent new members, Tim called and asked us to meet with him. When we arrived, there were the two that had been asking us questions before and five other members. Tim told us we had the floor for any questions they wanted to ask. Questions we received and Tim asked that they take turns.

I said that I should start with the experiences that I have been through as all seven would be 65 years of age in a few years. I said that Max and I had each been to separate doctors and thus our experiences are different. Both of us needed to use a sleep study lab for the first time we changed equipment under Medicare. I went to Mason City and Max went to New Hampton.

I said that even my first sleep study was a sleep study lab. A sleep study lab means that you will arrive about 7:00 PM and then you will be fitted with a harness of wires attached to sensors on your head, neck, and chest plus a few on your lower legs. Then you are expected to sleep while cameras watch you. Yes, you have covers over you. I actually had two sleep study labs for Wellmark. The first determines that you actually have sleep apnea and the second to determine the pressure settings. When I had the one for Medicare, I was set up like the first sleep lab and when I had satisfied the first requirement, I was changed over to the second part of being on a CPAP machine.

Max stated that his first was a home sleep study that determined he had sleep apnea and the second was a sleep study lab to determine what pressures would be best. Max then stated that the Medicare was the same as what I experienced, just at a different place.

Everyone wanted to know why the two times and Max said that the first is to determine the degree of sleep apnea and that you have sleep apnea. The second sleep study is to determine the upper and lower pressure settings as now most CPAP machines do operate in a range and this is important for you to get the best sleep.

Max stated that his lower pressure is set on 12 and the upper pressure is 18. When asked I said my lower is set at 10 and the upper is set at 15. My average during sleep is 12.4 and I have lows at 10.3 and upper at 14.8. Max said his average is about 14.4 with lows at 12.8 and upper level is at 17.

Several more questions followed asking if we had a favorite doctor. Max and I both agreed we liked our doctors, but I stated that this should be up to each of them. I said that three others could answer that question after they finished their in home tests. I said home tests are becoming more acceptable and are being used more than the sleep study labs.

I stated that my sleep doctor is from India, and for several years showed his heritage by ignoring women until he encountered my first wife. When she asked a question and when he did not answer, she got up in his face and asked him why he could not answer her question. She told him that in the U.S. women are considered equal to men and just because I was the one being treated, she felt her question was important and if she was to help me, she should receive an answer. I said since then he has always answered questions from my second wife and not hesitated.

Max said his doctor is from Tennessee and talks more to my wife than he does with me. She, like Bob's wife, does not like the noise from the CPAP machines and complained about the first two machines, but the last one is quiet. Also, some of the earlier CPAP machines had masks that expelled a lot of air and you had no control over where it was aimed, which makes the position you sleep in miserable for a spouse. The newer masks are somewhat better, but still can blow air on your spouse if you sleep in the wrong position. Max said this means that you will be the one adjusting to be kind to your spouse.

We talked for another hour and answered many questions, but everyone seems ready to be tested and asked for the phone numbers of our doctors. We said we would be available to answer future questions and would ask the other three if they would be willing to answer questions once they had their CPAP machines.

Max said he would send out an email showing some of the machines available and they needed to be aware that their insurance might only cover one or two machines. As is was all had the same insurance that Max and I had and so they would have at least four different CPAP machines available.

January 15, 2016

Men Become Disabled, Die Sooner Than Women

According to research behind a paywall in Diabetes Care, a middle-aged U.S. adult with diabetes will develop a disability 6 to 7 years earlier than an adult without diabetes and spend more years in a disabled state.

In an analysis of national survey data spanning 14 years, researchers found that the associations between diabetes status, disability-free years, and disabled years were similar among men and women, with disability differences between diabetic and nondiabetic adults decreasing with age.

Barbara H. Bardenheier, PhD, MPH, of the division of diabetes translation and the immunization safety office at the CDC, and colleagues wrote, “We found that diabetes is associated with a substantial deterioration of nondisabled years, and this is a greater number of years than on the loss of longevity associated with diabetes,”

The one fact that stands out is this - “Men with diabetes spent about twice as much of their remaining years disabled (20%-24% of remaining life across the three disability definitions) as men without diabetes (12%-16% of remaining life). Women with diabetes spent about 1.5 times as much of their remaining years disabled (27%-32%) than women without diabetes (20%-22%).”

This means that disabled men die sooner that disabled women. This is not stated in the article, but is significant. I can hazard a guess for the reason this happens. Many men refuse to manage their diabetes and develop complications earlier than most women. I see more women on diabetes forums asking for advice to help their husband or significant other that is not managing their diabetes and refuses to change their eating and other habits. Most are desperate and pleading for suggestions to help.

I have had several emails over the years of writing blogs asking for the same advice. While I have had some success, most men just won't listen to anyone, including their own doctor. Because they feel fine and have nothing that they can see or others can see, will not change their way of living. Even when they develop a complication or two, they don't believe change is necessary.

Yes, some women feel this way in the beginning, but most change when they become concerned about their children and grandchildren. Yet the male egos get in the way for most men.

January 14, 2016

Have Registered Dietitians Lost Their Usefulness?

The registered dietitians in the United States are certainly following the rest of the world. In Australia and South Africa, dietitians have restrictions on what they may teach and it is not low-carb/high-fat. Many areas of the world have it worse than we do because we have free speech. Many countries do not have this guaranteed and people who oppose what the Dietetic Associations are promoting are being punished for their opposition.

We all remember what happened to the registered dietitian in Australia – she was terminated from her position and stripped of her title.

Dietitians globally have long sought to appropriate to themselves a monopoly on diet and nutrition advice. It’s as if they’ve always believed their degrees confer a divine right to tell others what to eat and drink and an omniscience by osmosis on optimum nutrition. Doctors have colluded by deferring to dietitians, and referring patients to them for weight loss, diabetes and other serious illness.

Government regulatory bodies globally, such as the Health Professions Council of South Africa (HPCSA), have effectively sanctioned dietitians’ stranglehold on dietary dogma and input into official dietary guidelines. These guidelines are still in place in SA, and have been shown to be without any scientific foundation whatsoever when they were unleashed on an unsuspecting public globally 40 years ago.

The dietary guidelines finally published by the USDA show that science takes a back seat to political policy. Read this by Adel Hite. It is a shame that science is ignored and that the same garbage is promoted as healthy, when we know that obesity is continuing to get worse because of these guidelines.

Then there’s the global phenomenon of ‘cozy relationships’ many dietitians and their associations have with the food and pharmaceutical industries, especially sugar, soft drink and cereal companies. Yes, the dietitians are proud of their conflicts of interest and promote what they are requested to promote.

The global dietitian mantra hasn’t helped its own cause with dogged adherence to the now thoroughly discredited diet-heart hypothesis, including the demonization of saturated fat and the belief that low-carb, high-fat (LCHF, aka Banting) diets are a danger to the public, especially children, and that sugar and soft drinks can be part of healthy, ‘balanced’ diets, despite growing and compelling scientific evidence to the contrary.

For those of us with diabetes, we need to bypass the dietitians and use our blood glucose meters to discover what works for us and what the dietitians cannot teach us.

Finally, I urge you to read the following reference.

January 13, 2016

Hardening of Arteries Can Be Caused by Statins

This is a warning that statins may not be the miracle drug many cardiologists claim. People taking the drugs are more likely to suffer from hardening of the arteries, a leading cause of heart problems. And no, this is not the first time this has been said. See paragraph three below.

In addition, researchers found the drugs block a process that protects the heart.  This can “cause, or worsen, heart failure”, according to a study. The lead author says: “I cannot find any evidence to support people taking statins.”

In the research published in Diabetes Care (in 2012), scientists examining patients with type 2 diabetes and severe atherosclerosis discovered that coronary artery calcification was decidedly greater in more frequent statin users compared to those who were less frequent users. Even more disturbing, in a subgroup of participants who initially did not take statins, advancement of coronary artery calcification (CAC) and aortic artery calcification (AAC) was decidedly greater in those who used statins frequently.

Some side effects are skeletal weakness and muscle pain. Now Professor Harumi Okuyama, whose team studied a series of more than 20 major research papers on the drugs, says they could cause heart disease.

Dr Okuyama, of Nagoya City University, Japan, said: “We have collected a wealth of information on cholesterol and statins from many published papers and find overwhelming evidence that these drugs accelerate hardening of the arteries and can cause, or worsen, heart failure. I cannot find any evidence to support people taking statins and patients who are on them should stop.”

The researchers say the hypothesis that statins protect the heart by lowering cholesterol is flawed and that high cholesterol is not necessarily linked to heart disease. They also found statins have a negative effect on vital body processes linked to heart health.

They discovered patients taking the drugs were more likely to have calcium deposits in their arteries, a phenomenon directly linked to heart attacks. This is because statins block a molecule needed for the body to produce a vital K vitamin, which prevents calcification of the arteries. Dr Okuyama and his team say many earlier industry-sponsored studies, which show the benefits of statins, are unreliable.

Researchers says that high cholesterol is not necessarily linked to heart disease.  They claim this is because they were carried out before new European regulations were introduced in 2004, which insisted on all trial findings, both negative and positive, being declared.

The study states that before these new rules came into effect “unfair and unethical problems were associated with clinical trials reported by industry-supported scientists”.

Dr Okuyama’s team looked at studies before and after 2004. They found: “The epidemic of heart failure and atherosclerosis (hardening of the arteries) that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically re-evaluated.”

Dr Malcolm Kendrick, who has studied heart health and statins, said: “This study demolishes the argument that these drugs should be prescribed to anyone, as the harms clearly outweigh any previously suggested benefits.”

Dr Peter Langsjoen, a heart specialist based in Texas who is co-author of the study, said: “Statins are being used so aggressively and in such large numbers of people that the adverse effects are now becoming obvious. These drugs should never have been approved for use. The long-term effects are devastating.”

January 12, 2016

Treat Prediabetes as Diabetes

What can we as people with type 2 diabetes do to encourage our doctors and other professionals to help people with prediabetes? This is a difficult question and David Mendosa tackles prediabetes from a different perspective that is interesting to read.

David says, “If you have prediabetes, taking the diabetes drug metformin might stop you from getting diabetes and could also help you in other ways. But persuading your doctor to prescribe it could be a challenge.” Yes, many doctors will not prescribe metformin “off label” and probably because they do not feel this is the correct thing to do.

Lifestyle intervention is not working because most doctors and certified diabetes educators refuse to work with people with prediabetes. Without education and reinforcement, most people will fail here because of the term prediabetes and the lack of seriousness by doctors and CDEs.

The biggest factor hurting people with prediabetes is the American Diabetes Association. The ADA only gives prediabetes a casual mention and even ignores many people with type 2 diabetes when 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.

It is this attitude that discourages doctors and especially patients when they know that people inside the ADA are not on their side and working to make management of diabetes work for them. Dr. Ratner wants people with type 2 diabetes to manage diabetes in the dark and make diabetes progressive.

Fortunately, many people are learning to buy the testing supplies on their own, are reading on their own to manage prediabetes and type 2 diabetes, and are ignoring the ADA. I have many people that ask me why I cover some of the ADA guidelines when they don't care about people with prediabetes and diabetes. I have to tell them that we still need to be aware of what they are saying and if there is any hope for change. The ADA has changed some in recent years, but still done very little for helping people with prediabetes, which is a group of people they created in 2003 with their experts.

David does cover some of the known side effects of metformin and gives some of the proper warnings. You should take the time to read his blog.

January 11, 2016

Diabetes and Sleep Apnea P1

This article from WebMD has several of our newer members asking questions that are serious. Two of the women are overweight and three of the men are well overweight. We do make an issue of this, but accept them as they are. When this showed up in their email on January 5, three of them were talking to Max and me about what they should be concerned about. Max and I both have obstructive sleep apnea and use a type of CPAP machine when we sleep.

All three were stating they were tired during the day and did not feel like they were getting enough sleep. Two said that even if they tried to get nine hours of sleep, they still felt sleepy during the day. All three said they often were fighting to stay awake during the day and have been warned about sleeping on the job.

Max said they probably had sleep apnea and needed to be tested and then follow what the doctor recommended. Max knew the local doctor that could help them and gave them the name and phone number. The next day they all had appointments and by Friday, they were scheduled for in home sleep studies.

Now they were asking more questions about how the studies were done and what the studies would show. Both Max and I said they should wait until they received the sleep study kits and instructions. I said I had never had a home sleep study and had always been in a sleep study lab and been hooked up to many sensors and had been observed while I slept. They asked how many times I had this. I said the insurance I had before age 65 required a sleep study and when I turned 65, Medicare also required a sleep study lab. They do not accept that I had sleep apnea and that is why they require it.

I said that sleep apnea involves pauses in breathing during sleep. The periods of stopped breathing are called apneas, which are caused by an obstruction of the upper airway. Apneas may be interrupted by a brief arousal that does not awaken you completely -- you often do not even realize that your sleep was disturbed. Yet, if your sleep is measured in a sleep laboratory, technicians would record changes in the brain waves that are characteristic of awakening. In other words, you have been awakened out of REM sleep by the apnea and now must relax enough to reenter REM sleep.

Sleep apnea results in low oxygen levels in the blood because the blockages prevent air from getting to the lungs. The low oxygen levels also affect brain and heart function. Up to two-thirds of the people who have sleep apnea are overweight. Researchers have found a possible link between sleep apnea and the development of diabetes and insulin resistance (the inability of the body to use insulin).

Peripheral neuropathy, or damage to the nerves in the feet and legs, is another cause of sleep disruption. This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain.

Now the three were very anxious and wondered if the sleep study was worth the effort. Max answered with an emphatic – YES and I said it is such a great feeling to not feel tired during the day. If there is a link to diabetes, since they already had diabetes, this should not affect their decision and using a CPAP machine should help with insulin resistance and possibly weight loss.

Max and I both stated that we had neuropathy and sleep apneas before we were diagnosed with diabetes and felt that we were better able to manage our diabetes by using the CPAP machine. We told them that the lack of sleep did make diabetes more difficult to manage. They wanted to talk more after the sleep study and after meeting with their doctor. Max and I agreed and said we could go with them to pick out the CPAP accessories.

January 10, 2016

There Must Be Big Money in Drug Promotion

Endocrinologists and cardiologists must make big money for pushing statins and blood pressure drugs. They have been doing this with enthusiasm in which they prescribe these drugs like a religion. In the last month, this religion has taken on a new urgency and they are now promoting statins for increasingly more people that have not been promoted to before. In addition, the children are now being screened for statins and heavily prescribed to children over 5 years of age. The cardiologists are also promoting the blood pressure lowering drugs to people with normal blood pressure.

What seems to be more harm to patients is that fact that most doctors do not test for CoQ10, which the statins deplete from the body. 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. 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.

Statins are known for causing:
  • Liver Injury Called Rare
  • Reports of Memory Loss
  • The Risk of Diabetes
  • The Potential for Muscle Damage

The above is in a FDA Notice - FDAExpands Advice on Statin Risks

FDA has found that liver injury associated with statin use is rare but can occur. Patients are advised to consult their health care professional if they have symptoms that include unusual fatigue, loss of appetite, right upper abdominal discomfort, dark urine or yellowing of the skin or whites of the eyes.

FDA has been investigating reports of cognitive impairment from statin use for several years. The agency has reviewed databases that record reports of bad reactions to drugs and statin clinical trials that included assessments of cognitive function. The reports about memory loss, forgetfulness and confusion span all statin products and all age groups.

Diabetes occurs because of defects in the body’s ability to produce or use insulin—a hormone needed to convert food into energy. If the pancreas doesn't make enough insulin or if cells do not respond appropriately to insulin, blood sugar levels in the blood get too high, which can lead to serious health problems. A small increased risk of raised blood sugar levels and the development of Type 2 diabetes have been reported with the use of statins.

Some drugs interact with statins in a way that increases the risk of muscle injury called myopathy, characterized by unexplained muscle weakness or pain. Egan explains that some new drugs are broken down (metabolized) through the same pathways in the body that statins follow. This increases both the amount of statin in the blood and the risk of muscle injury.