August 13, 2016

Home Flooded – What to Do with Medications and Food

With some of the storms happening around the country, many homes have been flooded and some people were just barely escaping with their lives. This brings up many ideas about the safety of food and medications that may be affected by flood waters.

After the flood waters have receded and you can reclaim your home, be cautious about handling food and medications that were exposed to the flood or unsafe municipal water. They may be contaminated with toxins or germs that can cause illnesses, such as the flu, hepatitis, or other diseases brought on with flood waters.

This is important – do not eat any food that may have come into contact with flood water. This includes food packed in plastic, paper and cardboard containers that have been water damaged. Discard food and beverage containers with screw caps, snap lids, crimped caps (soda bottles), twist caps or flip tops, and home-canned food if they have come into contact with flood water. These containers cannot be disinfected. If in doubt, throw it out.

Undamaged, commercially prepared food in all-metal cans or in packages used to seal food for long-term unrefrigerated storage (retort pouches) can be saved if you remove the labels, thoroughly wash and rinse the outside of the containers, and then disinfect them with a sanitizing solution of 1 tablespoon bleach to 1 gallon safe drinking water. Be sure to write the food and expiration date on the containers when you're done.

Any medications, pills, liquids, drugs for injection, inhalers or skin medications, that have come into contact with flood or contaminated water should be discarded. Many sources say the following, but I still would urge caution. The exception to this is drugs that are lifesaving and not easily replaced.

In these cases, if the container is contaminated but the contents appear unaffected, for example, the pills are dry; the pills may be used until a replacement can be obtained. However, if a pill is wet or appears discolored from contact with water, it should be considered contaminated and be discarded.

Also, if the electricity to your home was out, foods and medications stored in the refrigerator may be spoiled. As a general rule, an unopened refrigerator will keep food cold for about four hours. If the outage lasted longer than that or you're not sure how long the power was out, discard the contents of the refrigerator.

After a flood, contact your doctor or pharmacist immediately about getting replacement medications.

Many people keep an emergency kit and if they have time, gather up medications into the kit and take it with them.

August 12, 2016

On Guidelines, Should Dissenters Be Heard?

After talking with three doctors, they all said dissenters should not be heard and said that this causes problems for patients who read the guidelines and the dissenting opinions. My one comment to all three doctors was, then you believe there is no room for individualism and for all patients it is a one-size-fits-all way of treatment. They felt this was the case until someone proved that something did not work for a large group of people and then the guidelines should be reflective of this.

Since I respect two of the three doctors highly, I did not pursue this further. Now I wish I had after talking to two more doctors recently. They both said that doctors that are afraid of dissent should not be on guideline committees to begin with and there are always exceptions that some forget about or try to ignore. One of the two asked me about the article from MedPage Today and if I had read it. I laughed and told him that was the reason for my questions and while the article was about the two different types of pneumonia vaccines, I said it was easy to have dissenters on this topic, but how did this apply to primary care and other medical professions and their guidelines.

Both agreed that my point was valid, but both agreed that there were times when dissent would be proper and to prevent it could create situations that made doctors follow guidelines when they should look to circumstances not covered by the guidelines or other reasons. The other doctor said he felt dissenting was good and guidelines were just that – guides that could not cover every medical situation.

Then the one doctor said that doctors that do not want dissent often feel that they are the only doctors that know the topic and others should learn from them. Not only that, but doctors that are uncomfortable with dissent often are not comfortable with their decisions and not want other doctors speaking out against the majority opinion.

The other doctor emphasized the above point and said “experts” are not always knowledgeable about everything and want to have readers of guidelines think they are experts. He continued that the article was about medical decisions that can often be complex. Rather than undermine the majority decision, He believes that dissenting opinions could strengthen guidelines by highlighting some of the nuances clinicians should consider when implementing the guidelines.

He concluded that the ability to learn about dissenting viewpoints within the framework of medical guidelines could help clinicians better perform shared-decision making, helping them guide their patients to the decision right for them.

August 11, 2016

Diabetes Caused Cognitive Decline Affects All Ages

With type 2 diabetes on the rise, it can actually be regarded as an epidemic propagating as a consequence of poor lifestyle choices, bad feeding habits and a sedentary life. The International Diabetes Federation (IDF) estimates that there are over 380 million cases of diabetes throughout the world and predict that it may rise to around 600 million in the next 20 years.

One of the consequences or complications of diabetes is cognitive decline. There are several studies showing that diabetes causes an acceleration of age-related cognitive decline. But it’s not just age-related cognitive decline, patients with diabetes also have a higher risk of developing cognitive decline associated with different brain pathologies. Diabetes increases the likelihood of developing vascular diseases, Alzheimer’s disease, mild cognitive impairment and dementia. Although these diseases have different onset mechanisms, they can all be intensified by diabetes.

Hyperglycemia is known to increase neuronal cell death through oxidation processes and generation of free radicals, thereby having neurodegenerative effects. Hyperglycemia can also cause damage to blood vessels through inflammatory mechanisms, leading to reduced blood flow to the brain and, consequently, reduced oxygen delivery, which results in the development of brain injuries.

If we add hypertension to the equation, which is commonly observed in patients with diabetes, vascular deficits become even worse, increasing the risk of stroke, for example, which is indeed more common in diabetic patients.

This effect of diabetes is not only observed in the elderly. Although type 2 diabetes accelerates age-related cognitive decline, younger patients also show signs of cognitive impairment. In a study that followed dementia-free diabetic patients with a mean age of 40 years at the start of the study it was shown that, seven years later, diabetes had led to a degradation of memory, visual perception, and attention performance, as well as to a loss of brain integrity. Diabetes and higher fasting blood glucose levels were correlated with gray matter loss in the brain. This shows that cognitive decline is clearly anticipated in diabetes patients.

Another study, which followed patients with an average initial age of 54 throughout 10 years, showed that, compared with healthy participants, those with diabetes had a 45% faster decline in memory (10 year difference in decline), a 29% faster decline in reasoning, and a 24% faster decline in the global cognitive score. Furthermore, diabetes patients who had a poorer glycemic control had a faster decline in memory and reasoning, while participants with pre-diabetes or newly diagnosed diabetes had similar rates of decline to those with normal glycemia.

It seems that the earlier the onset of diabetes, the higher the risk of accelerated cognitive decline. And even teenagers can be affected by the neurological consequences of type 2 diabetes. A pilot study following adolescents with type 2 diabetes showed that there are significant volume losses in a number of areas of the brain, as well as reduced white matter integrity. Given the fast increase in the incidence of type 2 diabetes (and other metabolic diseases) that is being observed in teenagers, this is clearly a reason for concern.

Therapeutic strategies designed to control glycemia will most likely help reduce the effects of diabetes on the brain. Many of the mechanisms of diabetes-associated dementia and cognitive impairment can be counterbalanced by a good diet and by exercise. Early intervention is fundamental. Yet our doctors are not knowledgeable in how to do this and don't understand nutrition.

Just to show how important diet and exercise are to diabetes care: there is scientific evidence showing that lifestyle changes are actually more effective than antidiabetic drugs. But instead of using diet and exercise as a way to control all the detrimental effects of diabetes, it would actually be better to use them to prevent it. Diet needs to be thought of as a way of eating and lifestyle of eating and not as a diet.

August 10, 2016

With Diabetes, Aspirin Therapy Is Beneficial

Has your doctor prescribed aspirin therapy? If you have diabetes, chances are you have been told by your doctor to take one 81 mg aspirin tablet daily. The aspirin acts as a blood thinner and aids in preventing blood clotting.

Diabetes does increase your risk of having a heart attack or clot-related stroke (cardiovascular event). Peripheral artery disease, a condition in which your arteries narrow, reducing blood flow to your arms and legs, also increases your risk of cardiovascular events.

Aspirin interferes with your blood's ability to clot. Because diabetes increases your risk of cardiovascular events, daily aspirin therapy typically has been recommended as part of a diabetes management plan. Research has shown that aspirin therapy is effective at reducing the risk of heart attack and clot-related strokes if you've had a previous cardiovascular event. It also appears to reduce these risks if you're experiencing symptoms of peripheral artery disease, such as leg cramping, numbness or weakness.

What's not clear is whether aspirin lowers the risk of a cardiovascular event if you haven't experienced one before and you aren't experiencing symptoms of peripheral artery disease. More study is needed on the potential benefits and risks of aspirin therapy in these people.

If you have diabetes, peripheral artery disease or both, ask your doctor about daily aspirin therapy, including which strength of aspirin would be best.

Aspirin therapy does have potential side effects, such as bleeding and stroke caused by a leaking or burst blood vessel (hemorrhagic stroke). Some people suffer stomach problems because of aspirin. Therefore, is you suspect that the stomachache you are having is caused by the aspirin, talk to your doctor immediately. It is also a good idea to chat periodically with your doctor about the aspirin you are using especially of you are using a dosage higher the 81 mg.

August 9, 2016

The Value of SMBG Testing – Part 3

I like the last paragraph and sentence in Gretchen's blog in the referenced blog, as I can agree with this. I would like to see the use of the continuous glucose monitor used for a minimum of 4 months after diagnosis.

I think every type 2 should be provided with a continuous monitor for the first 2 or 3 months after diagnosis. Then they could switch to test strips and intensive testing for the next year, and finally to testing only for new foods, sickness, new lifestyle patterns, or when they felt something was not right.

Test strips are much cheaper than dialysis.

The purpose or goal of SMBG is to collect information about blood glucose levels at different times during the day to assist you in creating a more level blood glucose. You will use this information to adjust your regimen in response to the blood glucose values. This will mean adjusting your food intake, physical activity, and possibly medications with your doctor’s direction.

SMBG can aid in diabetes control by:
  • facilitating the development of an individualized blood glucose profile, which can then assist health care professionals in treatment planning for an individualized diabetic regimen;
  • giving people with diabetes, and their families, the ability to make appropriate day-to-day treatment choices in diet and physical activity as well as in insulin, oral agents, and even no medication;
  • improving patients’ recognition of hypoglycemia or severe hyperglycemia; and
  • enhancing patient education and patient empowerment regarding the effects of lifestyle and pharmaceutical intervention on glycemic control.

Patients properly educated and with some experience with SMBG can benefit from the empowerment that SMBG bestows. Diabetes specialists believe that patients should use the SMBG data for daily regimen changes and health care professionals should use SMBG data to guide changes in medication regimens.

The use and frequency of SMBG is the area of much disagreement among the various specialists and advocates of SMBG. From my prospective, I feel it will depend on what your budget allows and insurance will cover. With all that is happening with studies it is surprising we still have testing supplies. Some doctors will not even give prescriptions for testing supplies and others will delay this until the patient insists. Most insurances will cover a meter and test strips up to what Medicare allows for the type of diabetes you have and the medication you are taking. SMBG is the battleground for all people that need testing supplies. Medicare restricts testing supplies and most insurance companies follow in lock step.

If you are able to afford additional testing supplies, by all means, make good use of them. Shortly after diagnosis, you need to use your meter to determine how different foods affect you blood glucose. This will assist you in knowing which foods to decrease in quantity, which to eliminate from the menu for now and which are safe to continue eating. Most people that are conscientious about their testing and realize that readings are trending upward will want to retest their foods again and find out what is changing.

We all need to understand the reasons for doing certain tasks and the more we understand about self-monitoring of blood glucose, the more effectively we will use it. I am not in agreement with the current trend in testing for people with type 2 diabetes. The powers that be just do not allow for proper testing or frequency of testing needed to cover periods when your body chemistry may change, for determining what foods do for your blood glucose levels, whether an illness is affecting your blood glucose, or if a medication, especially steroids, is driving your blood glucose above normal levels. These are concerns all insurance companies do not even allow for. Even our medical community shows little interest in this and will deem you to be not watching your blood glucose when your A1c rises unreasonably.

For patients with type 2 diabetes, optimal SMBG frequency varies depending on the pharmaceutical regimen and whether patients are in an adjustment phase or at their target for glycemic control. If a patient is on a stable oral regimen with A1c concentration within the target range, specialists recommend infrequent SMBG monitoring. In such cases, patients can use SMBG data as biofeedback at times of increased stress or changes in diet or physical activity.

Just remember that in testing at the beginning, you use “testing in pairs.” This means before eating and one or two hours after eating. This will tell you if the food combo you are eating is driving up your blood glucose and whether you need to reduce the quantity you consumed or possibly eliminate the combo completely.

If you have diabetes, you have responsibility in your medical care. The role means self-monitoring of blood glucose to manage the health you have. I find that managing diabetes is challenging. It can be a burden, but only if you let it. There are enough challenges to keep a person reaching for that higher level of diabetes management. One thing for all of us to remember is the importance of a positive attitude. This will generally help us through the tough times and keep us motivated to stay on top of our efforts to manage our diabetes.

With type 2 diabetes, our care may be sporadic from our health care providers and since they do not live with us 24/7. it is urgent that we learn how to care for ourselves. Is this easy at the start? I would be lying to myself and to you if I said it was, because there are many things to learn. It does get easier and at the same time more frustrating as we learn more about diabetes and its idiosyncrasies. We have to learn how to manage diabetes without assistance on many fronts.

August 8, 2016

The Value of SMBG Testing – Part 2

This is a continuation of yesterday's blog on SMBG. Gretchen's blog had this to say - “The Diabetes Educator article notes that the International Diabetes Federation has concluded that "simply recommending SMBG to patients without instructions for testing or use [of] results in [is] a waste of time, money, and resources." That's what we patients said.” In the long run, self-testing along with education about what to do with the results is one of the best way for our medical system to save money."  This is from the blog referenced in the August 1 blog.

When we think about the problems and complications that happen with unmanaged diabetes, we can see many costs escalate beyond the cost of test strips, yet the Centers for Medicare and Medicaid Services (CNS) is looking to the short-term cost savings only. And the insurance cartel follows the lead of the CMS. When they start seeing the rising long-term costs, they may begin to understand what their short-term cost savings have wrought.

First, I must point out that much of the research for self-monitoring of blood glucose (SMBG) is suspect. Not only are the participants carefully selected, but also most studies seem to exclude people with type 2 that have an interest in or knowledge of SMBG. Many of the studies are observational in nature or rely in participant-completed surveys, which are not reliable for scientific accuracy. In the USA, many of the studies are funded by the National Institutes of Health (NIH) or the Centers for Medicare and Medicaid Services (CMS). Then on the unscientific information, Medicare takes more test strips away from us.

I have made this accusation before and I will again. This is based on my research and in no way is it scientific. There is a conspiracy happening in the USA between government agencies and medical organizations to keep many people with type 2 diabetes unaware of the damage being caused by our grain industry and low fat mantra, which is promoted by the US Department of Agriculture (USDA). In turn, the NIH and CMS have cooperated by funding non-scientific studies giving Medicare the incentive to reduce our testing supplies.

Then the America Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE) promote the USDA line of thinking – whole grains, low fat, and people with diabetes that do not know better listen to them. Then the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) which follow the ADA and AACE do little do encourage people to think for themselves. They are pushing mantras and mandates and expect people with type 2 diabetes to accept the dogma blindly.

The AADE does nothing to promote and teach diabetes self-management education (DSME). They give mandates and mantras that patients are learning is bad for their diabetes health. Most CDEs will not teach patients about self-monitoring of blood glucose (SMBG) for fear that patients will discover the truth about whole grains and low fat. The monopolistic workers for the AND mandate that we consume a minimum number of carbohydrates per day and go ballistic when we do not and literally call us noncompliant and often refuse to work further with us. This refusal is the one good thing for us as patients.
Now some will say that the AADE does promote DSME, which in a small way they do, in some sources and pamphlets, but very little of the information ever reaches the patients. A few conscientious CDEs do teach DSME and even fewer teach SMBG until they are confronted by older CDEs and encouraged to stop.

We know there are doctors that are breaking ranks with the ADA and AACE because of the lack of diabetes education being taught.

I am also aware of doctors attempting to use peer mentors to dispense some diabetes education when CDEs are not available or have taken positions in conflict with the doctors. This may become more common as the increasing numbers of patients diagnosed with diabetes come into existence and the numbers of CDEs entering the field continues at a snails pace. With this gap widening almost daily, is it not surprising that doctors are exploring other avenues to assist in diabetes education. Even more doctors are investigating shared medical appointments to expand education by presenting it to groups of patients when there is not time to do it individually.

The controversy about the registered dietitians will need to play out in the court system before we will know whether their numbers will decline. Nutritionists that are joining other organizations to continue being able to dispense nutrition information may be able to step in and fill the widening gap. This should be great for those of us with diabetes as my experience with these nutritionists has been positive. They are interested in balancing nutrition and not issuing mantras and mandates for us to follow. They will suggest ideas that some of us may disagree with, but will work with us to help us balance our nutrition whether we follow a low carbohydrate, medium fat diet, a paleolithic diet, or even other diet plans. They are not locked into telling us we must eat a required number of carbohydrates.

Patients around the globe need education about diabetes and how to apply this to their daily lives. In the USA, we need Medicare to give us back our testing supplies in sufficient quantity that newly diagnosed patients can determine how the different foods and food combinations affect our blood glucose levels. Then allow enough test strips for people to use on a daily basis and to do random checks when adding new to them foods.

Okay, why do I use Medicare as the scapegoat? Because the medical insurance industry generally follows the lead of Medicare in lock step. If NIH and CMS are going to do studies, let’s have them do studies for three to five years and give continuous education during the studies. Have the education reinforce the principals set out at the beginning and ask the participants what they need in more information to help them. And, have the studies be scientific studies with the proper scientific methods applied and not the observational and survey format from the past. Do not exclude study participants that are interested or have knowledge of SMBG. Teach the study participants SMBG or DSME.

August 7, 2016

The Value of SMBG Testing – Part 1

Gretchen Becker's blog of August 1 got me thinking and now I want to review prior blogs of mine on self-monitoring of blood glucose (SMBG) to attempt to make the message of the value of SMBG testing stronger.

In the past several years, many reports have been published saying that self-testing of blood glucose (BG) by people with type 2 diabetes is useless, a waste of money, and simply increases rates of depression. I can understand this because there is no education of value given to help people use the testing data and change their way of eating that will help manage diabetes to lower blood glucose levels to near normal.

What the studies omit is that the medical professions in all countries are lax in giving patients the education necessary to understand how to use the blood glucose readings. They provide very little in guidance to their patients for proper decision-making when looking at blood glucose readings.

Some of us have been fortunate to receive some education in what to do with our blood glucose test results. Others have been able to research online and self-educate themselves. It is knowing how to adjust diet and exercise to keep blood glucose levels as close to normal as possible that gives meaning to testing. The readings are truly of no value unless you know what to do to bring high readings down and how different foods affect your blood glucose levels. This also applies to preventing lows and all extreme highs and lows.

In essence, you need to become your own science experiment with yourself as your own lab rat or mouse. This is where the challenge is and where learning how diet and exercise affect your blood glucose proves, knowledge can be very powerful. There are many factors like general health, other diseases, mental or medical conditions can make this even more of a challenge.

Alan Shanley at loraldiabetes has been writing about the lack of respect and understanding SMBG has been receiving since at least 2006 and he has not missed much in the lack of understanding by researchers and the medical community.

When I was diagnosed with type 2 diabetes, I wondered what was ahead. Experiences in my life have been varied, but in my research on self-monitoring of blood glucose (SMBG), I experienced something unlike anything else. I did not realize that whole industries and governments rely on and participate in funding studies fabricating false and misleading information to demean and direct fraudulent intent at a group of people with type 2 diabetes on no medications or oral medications.

These fabricated studies have been reported in trusted reviews, belying the truth in the way the studies were assembled and carried out. The editor of leading diabetes community website, Benedict Jephcote states: “There are a number of problems with the way results are presented within the Cochrane review. For instance, in the UK, there are many people with type 2 diabetes that are actively interested in self-testing and significant numbers of these people have to buy test strips from their own income. Studies which exclude these people cannot therefore give a fair representation of people with type 2 diabetes in the UK."

Cracks along the above line are already showing evidence to prove just that. In addition, in the future, researchers that are more honest will begin to refute these false studies. What is astounding is that the US Government has participated in this cover-up of studies that are done to show patients with type 2 diabetes do not need to self-monitor their blood glucose levels. The National Institute of Health leads the way and the Center for Medicare and Medicaid Services follows by cutting testing supplies for people needing them. By not educating Medicare and Medicaid patients about the value of self-monitoring of blood glucose and showing them how and when to test, they can support many studies proving that people with type 2 diabetes do not need the testing supplies.

Other writers proclaim that the studies are right and say that the results beyond a year do not hold up. I can understand this because these study participants are no longer given the supplies with which to self-monitor blood glucose. Many of the study participants probably are unable to afford the testing supplies and therefore without them the results would be expected to not hold up. That is one reason to have long-term studies of three to five years.

We have many factors working against us in the way people are selected for most of the studies and this discrimination and falsification in studies continues to harm people with type 2 diabetes. Tomorrow I will include more information about SMBG.