October 15, 2016

Diabetes Is Not Your Fault

The title of this blog is finally receiving the credit it deserves. More type 2 bloggers are writing about this because we see the need. Much (but not all) of the diabetes stigma is aimed at those of us with type 2 diabetes.

In a recent issue of Type 2 Nation an excerpt from Gretchen Becker's book - The First Year: Type 2 Diabetes, they rightly quote from her book the emotional minefield that comes with a diabetes diagnosis.

You have just been diagnosed with Type 2 diabetes. If you are like most people, you are probably in a state of shock.

When you got your diagnosis, your doctor probably told you many things about diets, drugs, insulin, glucose, carbohydrates, blood tests, avoiding this, and doing that, and you probably came out of the office with your head spinning, not remembering much of what the doctor said.

Don’t worry, you’re not alone. Most people feel that way.

If no one in your family ever had diabetes, and especially if you’re thin and thought diabetes only happened to fat people, you’re probably especially puzzled. “What did I do wrong? Why is this happening to me?”

Sometimes a diagnosis comes like a thunderbolt on a sunny day. Sophie C. consulted a doctor about a toenail fungus, and he drew some blood for routine tests. “Next day the phone rang, and my doctor informed me quite bluntly that I was diabetic,” she said. “Talk about a slap in the face! I was scared out of my mind. There must be some mistake here. I wasn’t blind; my feet weren’t gangrenous. No family history of the disease, no warning signs (that I knew of at the time), not a clue.”

Or maybe you were expecting a diagnosis someday. You’ve got relatives with diabetes: your grandmother had diabetes and died from gangrene in her foot. Your father got it when he was 65 and died from a heart attack a few years later. If you’re also overweight, maybe you figured someday you’d get diabetes yourself. But you probably figured “someday” would be far in the future, when you were old. Not today. Not now.

A lot of people may tell you that if only you’d eaten less sugar, eaten less fat, exercised more, eaten more fiber, or smoked less, or done none of the things that 95 percent of the American population does, you wouldn’t have gotten diabetes. Especially if you’re overweight, because most people with Type 2 diabetes have a problem with weight, people will suggest that it’s your fault that you got diabetes because you let yourself get fat.

There’s so much to learn about diabetes, but you can’t learn it all at once. Trying to accept the diagnosis is enough for your first day. Here’s what you should remember as you deal with this: getting diabetes is not your fault.

In order to get diabetes, you need to have diabetes genes. One of the leading causes of your diabetes is a poor choice of ancestors. People without those genes can spend their lives lying around eating chips and watching TV. They’ll probably get fat, but they won’t get diabetes.

Having the genes, however, isn’t enough to give you the disease. Even if you have diabetes genes, if you live in an environment where you don’t get a lot to eat and you do hard physical labor all day, you still probably won’t get diabetes. Some people think the diabetes genes are thrifty genes that make your body use its food more efficiently, meaning that you can gain more weight with less food. In times of famine, this comes in handy, and when food was extremely scarce, your ancestors probably fared better and had more children than other families who didn’t have those genes.

But when your family moved to a different country or into a different type of lifestyle where food was plentiful and machines did all the work, those diabetes genes weren’t so handy after all. When food is limited, it doesn’t matter how hungry you are. You can’t eat enough. When food is readily available, having a good appetite can be a disaster.

October 14, 2016

Many PWD Inject Insulin Incorrectly

This study is a shock to me! I am going to need to review how I inject my insulin. Yes, I know I do some of this incorrectly as I am using a syringe that has a needle of one-half an inch in length and that is not the recommended length. The problem is this is the only size of needle the supplier has available.

Based on the results of the study, experts have crafted recommendations for people who use insulin that touch on everything from what type of needle to use to where the shot should be administered. The study and recommendations were published online September 1st in Mayo Clinic Proceedings.

"Insulin injection has been assumed to be simple and require little training, but that's not the case," senior author Dr. Kenneth Strauss wrote to Reuters Health in an email.

Insulin users "may have been injecting for years and yet have had little or no training in correct technique," said Strauss, who is medical director in Europe of the medical technology company BD. In all 42 countries in the current study, many patients were injecting improperly, "leading to worse glucose control, poorer outcomes and higher costs," he said.

The researchers surveyed 13,289 people at 423 medical centers in 2014 and 2015. Ten percent of respondents said they had never received formal injection instructions, and more than 60 percent said their primary care providers had not reviewed instructions with them recently.

Nearly 200 experts used the survey responses to help develop formal recommendations. For example, they recommend that patients use the shortest possible needles, which "are safe, effective and less painful." A 4-mm needle is available on insulin "pens." The shortest syringe needle is 6 mm.

"By using the shortest needles available, patients can avoid intramuscular injections which can lead to hypoglycemia, including the kind that can land them in the ER or cause an accident," Strauss said. Only half of the people surveyed were using the 4-mm or 6-mm needles.

The authors also recommend ways to prevent lipohypertrophy. These can develop when an injection site is used repeatedly, so patients need to rotate the sites. If lumps do develop, injecting into those sites will adversely affect the way the insulin is absorbed. "We saw that 'lipos' . . . are at epidemic levels, with one out of three injectors having them," Strauss said. Lipohypertrophy was tied to a number of outcomes, including a higher average glycated hemoglobin level over the past three months.

"By carefully rotating sites they will avoid 'lipos' and their insulin will work better," Strauss said. "If everyone rotated correctly 'lipos' would probably disappear, insulin consumption would fall and we'd save millions as a consequence."

Many primary care practices can refer patients to diabetes educators. Gabbay, who was not involved in the new study, said people who feel they need better education on how to inject insulin would benefit from a session with these educators.

"If anything, this opens people's eyes that there are tools out there their provider may not be aware of and to seek out a diabetes educator," he said.

October 13, 2016

Dietitians and Their Lies

Yes, I said that! I also say that some dietitians are moving away from the position of the Academy of Nutrition and Dietetics to counsel patients more reasonably and work to teach diabetes nutrition. Gary Watson writes a long blog about Tim Noakes and Bullshit and it is worth the time to read.

No doubt the trolls and self-appointed nutritional experts will be stuck in to me and no doubt Tim Noakes will continue to cop dissension too. I must admit I am very pleased to see that the cookbook, Real Meal Revolution is completely sold-out in every major city. Much to the horror of many a registered dietitian no doubt, but the onus is on them to produce the evidence in support of their often outlandish claims that low-carb eating is “risky and dangerous” and “without any scientific basis”.

Low-carb eating works for me and that’s all I know. I could never know if it would work for you or if it will be bad for you. But at least I’ll tell you I don’t know. Nutritional theory is a mine-field, but the more I research it, the more I agree with Gary Taubes. It is really just a system of personal beliefs and untested hypotheses, given a veneer of scientific respectability, when in actual fact it’s more like a religion – replete with irrational fanatics, money-making frauds and devout lemming-like followers. But each to their own I suppose, the thing that really gets my goat is this simple perpetuation of a culture in which bullsh*t trumps evidence and science loses.

Well said Gary Watson!

And so begun my journey into a land of bullsh*t and fantasy that is ‘established’ human nutrition theory. I can confidently say I do not know of any field of human endeavor in which so much bullsh*t, unsubstantiated hypotheses and complete nonsense has been presented and accepted as science and as conventional wisdom. Pick any subject from saturated fat, to fish-oil supplements, antioxidants supplementation, to the benefits of fibre in lowering cancer and you get – drum roll – nothing! Nothing but really bad science, wishful thinking and the willful misrepresentation by an industry that pretends it knows what it is doing.

October 12, 2016

Doctors Debating Prediabetes

I am not sure why these doctors are discounting prediabetes so vehemently, but they are. Not everyone that is diagnosed with prediabetes develops type 2 diabetes. Those that make changes once they know they have prediabetes, may not develop type 2 diabetes. Discounting prediabetes as these doctors are, can only be a move to have more develop type 2 diabetes for them to have patients to treat.

New research shows that a majority of US adults over age 40 is at risk for prediabetes, according to an online risk calculator, but the investigators question whether so many people should receive the diagnosis.

The findings were published online October 3 in a research letter in JAMA Internal Medicine by Saied Shahraz, MD, PhD, and colleagues, of Tufts Medical Center, Boston, Massachusetts, and are based on use of the online risk instrument "Do I Have Prediabetes?" endorsed by the American Diabetes Association (ADA), the American Medical Association (AMA), and the Centers for Disease Control and Prevention (CDC).

When applied to the US population, that instrument identifies three of five among those aged 40 and older, and eight of 10 over-60-year-olds who don't already have diabetes as being at risk for prediabetes. The tool encourages those individuals to talk to their doctors about laboratory glucose testing, in line with screening guidelines.

But Dr Shahraz and colleagues question the value of that process. "We showed that the online risk test endorsed by ADA, AMA, and CDC is identifying and medicalizing a very large at-risk population, which can lead to overutilization of resources," Dr Shahraz and coauthor David M Kent, MD, wrote in an email to Medscape Medical News.

"We also note that even among those confirmed to have prediabetes, a substantial proportion are still at relatively low risk of progression to diabetes and at very low risk of end-organ damage," they add.

They cite as problematic the 2010 ADA guidelines that reaffirmed the prior widening of the definition of prediabetes by lowering the fasting blood glucose cutoff to 100 mg/dl from the previous 110 mg/dl and allowing the use of HbA1c for diagnosing prediabetes (cutoff 5.7%).

"This expansion increased the at-risk population twofold. Still, evidence favoring the long-term benefits of the definition change is very poor," the two investigators say.

In their discussion, the authors point out that there is no direct evidence that type 2 diabetes prevention alters the risk for diabetes-related complications.

Moreover, they say, progression to type 2 diabetes would likely be slower among those who qualify based on either HbA1c or fasting blood glucose as opposed to those who meet criteria based on an oral glucose tolerance test.

And Dr Shahraz and Dr Kent told Medscape Medical News that prior work from their group reanalyzing the landmark Diabetes Prevention Program — which showed that intensive lifestyle modification or metformin can prevent or delay the onset of diabetes in people with prediabetes — revealed that most of the benefit of these interventions can be captured by targeting just those individuals at especially high risk of progressing (BMJ. 2015;350:h454).

"This is important, since it is estimated that 80 million people have prediabetes. The resources that it would take to identify and treat all these people are potentially overwhelming."

October 11, 2016

Our October Meeting

I was more than a little surprised when I received my email for the October meeting. Normally we have our meetings on a weekend, but this was on a Monday. Since most of the members are retired, I think in retrospect, this may have been a good call.

We had seven potential new members, but only six passed the interview and were accepted as members. Again, I received a shock at the interview, but I agree with the way it was conducted, as it told us why they wanted to join our support group and issues they might have with the philosophy of the support group. I thanked Brenda and Sue for developing a comprehensive interview for new members, as it could be used in a variety of ways to uncover potential problems.

The five that several of us had helped for foot problems and a person that
Jennifer had introduced passed. A member that Allen introduced did not pass and Allen did understand and he thanked Sue for the questions that exposed him for the problems he might have caused us.

Barry moved that Brenda and Sue be thanked for the interview they had conducted and it was seconded almost unanimously. The vote was unanimous and Brenda said thank you to us and said that having the October meeting as our membership meeting makes for a more consistent way of accepting members.

Sue added that her husband and she had researched and found the interview program and brought it to Brenda for her approval. They had adapted some of the questions to fit our needs. This brought a round of applause and a big Thank-you!

Brenda then asked for some discussion about the excluded group and how many people had been harassed in the last month. Then she explained what had happened to me and those involved. She explained that one had been arrested and would be spending at least one year in jail with most of it caused by his actions after his arrest.

She then stated she had received several harassing phone calls, as had Sue and A.J. At that point, the new members all said they had been told not to join this support group. More members admitted they had been told to leave this group and they would be welcome in their group. Ben said he seriously doubted this and felt better as member of this group.

I asked who has not been harassed and no one answered. I suggested that the police needed to be notified. Then they are can take action to stop the harassing phone calls. I told them how I was working with the police and they were monitoring my telephone numbers and had arrested several of the group harassing me. I said that to date it only involved 9 of the other group and if the rest of you would join me, they could be stopped.

Brenda asked for a show of hands and only one person felt that this was not necessary. I gave Brenda the phone number and called a second number. Shortly, there were three officers present and one addressed our group and explained what could be done. Then they moved among us obtaining phone numbers and names and dates of the last calls. Each was given a card with a phone number to call after each harassing call and told that the phone company was working with them to end this.

After they were finished and answered several more questions, they thanked the group and felt that the harassing calls would end before long and maybe still happen sporadically. They did want to catch as many as possible.

Max briefly listed the problems and costs at the financial institutions.  There would be no cost breaks below certain balances, which we would not reach.  There would be other costs, which could be a burden unless we trusted an individual.  Several said they understood and there was a short discussion.  Max asked for another month before we collected dues and asked Sue's husband for assistance.  He agreed and said he might have a partial solution. 

Brenda stated the meeting was over and cleanup needed to be done. Cleanup did not take long and as we were leaving, we noticed the police were detaining several individuals. One officer indicated we should leave the area immediately, which we did. Later the officer did contact Brenda and informed her that the fellows were some of the harassers. Brenda sent out emails to all members, which had all concerned.

Allen suggested that the potential problem was the member he had promoted and his objective was to inform the others. He said he would inform the police.

October 10, 2016

Artificial Sweetener Studies like Sugar Studies

Like sugar, sweetener manufacturers influenced studies to receive positive results on studies in their favor. University of Sydney researchers have confirmed widespread bias in industry-funded research into artificial sweeteners, which is potentially misleading millions by overstating their health benefits.

In the same week that the sugar industry came under fire for influencing the integrity of scientific research, this new comprehensive review of artificial sweetener studies reveals that reviews funded by artificial sweetener companies were nearly 17 times more likely to have favorable results.

The review, published in the latest edition of PLOS ONE journal, analyzed 31 studies into artificial sweeteners between 1978 and 2014. The reviews considered both the potentially beneficial effects of artificial sweeteners, such as weight loss, as well as harmful effects like diabetes.

"It's alarming to see how much power the artificial sweetener industry has over the results of its funded research, with not only the data but also the conclusions of these studies emphasizing artificial sweeteners' positive effects while neglecting mention of any drawbacks," said co-author Professor Lisa Bero, head of the Charles Perkins Centre's bias node. "The results of these studies are even more important than the conclusion, as the actual results are used in the development of dietary guidelines."

Alarmingly, this analysis of artificial sweetener studies also found financial conflicts of interest created bias at all levels of the research and publication process. Almost half (42 percent) of the reviews of artificial sweetener studies had authors that did not disclose their conflicts of interest, with about one-third of studies failing to reveal their funding sources altogether.

Studies by authors with a conflict of interest were about seven times more likely to have favorable conclusions. None of the nine studies that had authors without a conflict of interest reported positive results.

"Transparency around an author's conflicts of interest and research funding sources for this area of nutrition science is sadly lagging behind other fields," said Professor Bero.

"Our analysis shows that the claims made by artificial sweetener companies should be taken with a degree of skepticism, as many existing studies into artificial sweeteners seem to respond to sponsor demands to exaggerate positive results, even when they are conducted with standard methods.”

"Ultimately it is consumers who lose out from this practice because our findings show that the results of reviews on the health benefits of artificial sweeteners cannot always be trusted. Measures to eliminate sponsor influence on nutrition research are desperately needed."

Four of the studies assessed in this latest review were funded by 'competitor companies' that marketed sugary drinks or water, with all four of these reviews reaching conclusions, which did not promote the health benefits of artificial sweeteners.

"It's important to be critical of reviews that are funded by any food- or beverage-related companies, not just the sugar industry," said Professor Bero, who is also based in the Faculty of Pharmacy.

The PLOS ONE study is the first major review of the effects of funding bias in nutrition research from the Charles Perkins Centre's Bias in Research project node, a unique research collaboration aimed at improving health policy by encouraging unbiased and evidence-based research.

The study was conducted in collaboration with researchers from the Johns Hopkins Bloomberg School of Public Health, the University of California San Francisco, and the Ramazzini Institute.

October 9, 2016

Many Bloggers Need This

With exceptions, like David Mendosa, Gretchen Becker, and several others, many bloggers with type 2 diabetes just do not seem to understand the importance of including the following information:
  1. Date of blog post – less important is the time
  2. Source of information – unless the post is personal information, like this post
  3. Many pages with blogs scattered among the different pages and some on sub-pages
  4. Infrequent blogs and skipping several months at a time
  5. Some allow comments and others do not
  6. Some use comment moderating and some do not
I could go on, but I don't want too make it too long. I really appreciate that many of the bloggers still blogging today use email notification to alert those that subscribe that a new post is ready for reading. I also appreciate that more bloggers are including contact information rather than hiding from readers.

#1. The date of the blog post is important and I am surprised at people that want readers, but don't date the blog.

#2. The source of the information used in the blog is very important unless the information is all personal in nature.

#3. I admit that some times I am busy and don't take the time to read a blog by another writer and a few days later go to the blog page. Some times, I cannot find the blog because of the number of pages or sub-pages and the system used by the blog writer of organizing the blogs.

#4. I do understand people being on vacation or being sick and not being able to blog, but too often, I see some bloggers not posting for several months. Then they blog for several months and stop for three to five months again. This doesn't bother me, but one of these bloggers asked me why his readership had dropped drastically. Unfortunately, I told him and he has since stopped blogging.

#5 and #6. If you chose to allow comments, please use comment moderation to prevent being the victim of spam. Yes, I tried this and had to delete many spam messages. Even with comment moderation, I still receive many spam comments, but at least I am able to delete these before they are posted.