February 18, 2017

Special Diets for Diabetes – Not – Part 2

#7. You Have to Give Up Desserts if You Have Diabetes. MYTH. You could:
  • Cut back. Instead of two scoops of ice cream, have one. Or share a dessert with a friend.
  • Consider using low-calorie sweeteners. Keep in mind, there might be a few carbs in these.
  • Expand your horizons. Instead of ice cream, pie, or cake, try fruit, a oatmeal-raisin cookie, or yogurt.
  • Tweak the recipe. For instance, you can often use less sugar than a recipe calls for without sacrificing taste or consistency.

#8. Low- and No-Calorie Sweeteners Are a No-No. MYTH. Most of these sweeteners are much sweeter than the same amount of sugar, so you can use less.

Opinions about them are conflicting, but the American Diabetes Association approves of the use of:
  • Saccharin (Sweet'N Low, Sweet Twin, Sugar Twin)
  • Aspartame (NutraSweet, Equal)
  • Acesulfame potassium (Sunett, Sweet One)
  • Sucralose (Splenda)
  • Stevia/Rebaudioside A (SweetLeaf, Sun Crystals, Steviva, truvia, Pure Via)

You can ask a dietitian which ones are best for which uses, whether you’re drinking coffee, baking, or cooking. Please read my blog on artificial sweeteners. Even though the ADA has approved the above sweeteners, you should be careful.

#9. You Need to Eat Special Diabetic Meals. MYTH. The foods that are good for people with diabetes are also healthy choices for the rest of your family.

With diabetes, you do need to keep a closer watch on things like calories and the amounts and types of carbohydrates, fats, and protein you eat. A diabetes educator or dietitian can show you how to keep good records.

#10. Diet Foods Are the Best Choices. MYTH. You might be paying more for "diet" food that you could find in the regular sections of the grocery store or make yourself.

Read the labels to find out if the ingredients and number of calories are good choices for you. When in doubt, ask your doctor, diabetes educator, or a dietitian for advice.

This and the prior blog are very good at discussing some of the myths about diabetes diets. This list is not complete, but is a good start.

February 17, 2017

Special Diets for Diabetes – Not – Part 1

Have you heard that eating too much sugar causes diabetes? Or maybe someone told you that you have to give up all your favorite foods when you’re on a diabetes diet? Well, those things aren’t true. In fact, there are plenty of myths about dieting and food. Use this guide to separate fact from fiction.

#1. Eating Too Much Sugar Causes Diabetes. MYTH. The truth is that diabetes begins when something disrupts your body's ability to turn the food you eat into energy.

#2. There Are Too Many Rules in a Diabetes Diet. MYTH. If you have diabetes, you need to plan your meals, but the general idea is simple. You’ll want to keep your blood sugar levels as close to normal as possible. Choose foods that work along with your activities and any medications you take.

Will you need to make adjustments to what you eat? Probably. But your new way of eating may not require as many changes as you think.

#3. Carbohydrates Are Bad for Diabetes. MYTH. Carbs are the foundation of a healthy diet whether you have diabetes or not. But learn the limit of carbohydrates that your body can handle and learn to eat to your meter.

They do affect your blood sugar levels, which is why you’ll need to keep up with how many you eat each day. Some carbs have vitamins, minerals, and fiber. So, choose from these, such as whole grains, fruits, and vegetables. Starchy, sugary carbs are not a great choice because they have less to offer. They’re more like a flash in the pan than fuel your body can rely on.

#4. Protein Is Better Than Carbohydrates for Diabetes. MYTH. Because carbs affect blood sugar levels so quickly, you may be tempted to eat less of them and substitute more protein. But take care to choose your protein carefully. If it comes with too much saturated fat, that’s risky for your heart’s health. Keep an eye on your portion size too. Talk to your dietitian or doctor about how much protein is right for you. Read my blog here about protein and please read this blog by David Mendosa as he discusses protein.

#5. You Can Adjust Your Diabetes Drugs to ‘Cover’ Whatever You Eat. MYTH. If you use insulin for your diabetes, you may learn how to adjust the amount and type you take to match the amount of food you eat. But this doesn't mean you can eat as much as you want and then just use additional drugs to stabilize your blood sugar level.

If you use other types of diabetes drugs, don't try to adjust your dose to match varying levels of carbohydrates in your meals unless your doctor tells you to. Most diabetes medications work best when you take them as directed. When in doubt, ask your doctor or pharmacist.

#6. You'll Need to Give Up Your Favorite Foods. MYTH. There’s no reason to stop eating what you love. Instead, try:
  • A change in the way your favorite foods are prepared. Can you bake it instead of deep-frying it?
  • A change in the other foods you usually eat along with your favorites. Maybe have a sweet potato instead of mashed potatoes?
  • Smaller servings of your favorite foods. A little bit goes a long way.
  • Not using your favorite foods as a reward when you stick to your meal plan. Do reward yourself, but with something other than food.

A dietitian can help you find ways to include your favorites in your diabetes meal plan.

February 16, 2017

Don't Beat Yourself Up for Diet Mistakes

This article in WebMD is somewhat enlightening if it weren't so poorly written and only emphasizing one side of the weight loss battle. Yes, diets fail and quite often. So I would like to change the wording from 'diets' to “a way of life,” meaning this is a permanent change and not a temporary way of living, or a diet.

Human beings, even those with fantastic willpower, are known to have weak moments. So, whatever the reason is that caused your way of life to go off track, repeat after me: It’s really and truly OK.

Still beating yourself up? Take a look at some of the common ways people are too hard on themselves, and why they shouldn't be:
  • But... I should have more willpower.
  • But... I hate that I’m always making excuses.
  • But... I should have picked a different diet.
  • But... I’m just not a good dieter.
  • But... I’m doomed to be stuck at this weight forever.
  • But... I’ve always been overweight so I just don’t think I can do it.

Humans are wired to reject things they don’t enjoy and embrace those they do. So, if you’re not happy on a particular way of life, chances are good that you’ll wind up cutting out early.

Life happens. Sometimes good stuff, like impromptu vacations, causes people to relax their way of life efforts. Sometimes the kids get sick, preventing even the most devoted person from heading to the grocery store to stock up on healthy fare. Occasionally, you just really want to eat whatever you want. The reason you stopped watching your nutritional goals isn’t really important.

Fad diets, (here is that word again) are all the rage and have been for centuries. Everyone loves a diet that promises unbelievable results, especially in short order. So, if you want to participate in a diet that allows only Twinkie or baby food consumption, I guess you can give it a shot. However, Centers for Disease Control & Prevention (CDC) recommends picking a plan rich in fruits, veggies, lean meats and low-fat dairy products, to name a few. If you're unsure what's right for you, ask your doctor to recommend a diet plan that incorporates the nutrients your body needs to function and thrive, and, yes, lose weight. Something tells me that Twinkies have few, if any, nutrients.

There’s a way of life out there for absolutely everyone. All you have to do is find it and commit to it! If food preparation is the problem, pick one of those services that provide your meals for a monthly fee. If you’re often hungry when out and about, pack a healthy snack that’ll keep you from picking a high-calorie option. Figure out what your Achilles heel is and fix it.

Motivation is a key factor in weight-loss success. Overweight or obese patients are given the tools to lose weight, but their own hang-ups often get in the way. People need to learn how to deal with daily problems, stay motivated and address setbacks in a healthy manner if their way of life is really going to be successful.

For many people who’ve been overweight for life, weight loss can seem unattainable. If self-esteem or other issues are keeping you from truly focusing and believing in yourself, it might be time to work with a professional to figure out how to give yourself the boost you need for a better way of life.

No matter how many diets you’ve abandoned, it’s important to never let your self-esteem pay the price. With the right tools, focus and motivation, you can find a nutrition plan that helps you feel healthier and happier. Just be sure that you are committed in a permanent way and leave the temporary ways behind.

February 15, 2017

Diabetes HbA1c Test Still Faulty

Tell me why this is not unexpected. This news has been known for some time, but with the lack of other tests, we were rather limited to criticize them too much. Now the science of our tests (A1c and OGTT) is being exposed and everyone can see the faults of both tests.

The data is alarming, or should be for those who may have diabetes, but have not yet been diagnosed. This is why the International Diabetes Federation (IDF) and the World Health Organization (WHO) have opposed the A1c as the standard for diagnosis. Yet, the American Diabetes Association (ADA) continues to choose to forge ahead with a defective test. See this reference and start reading at B. Diagnosis of diabetes Recommendations. This is below table 1.

The ADA claims that the A1c test has been standardized, but really folks, who are they kidding. There are still too many variables that exist that keep it a faulty and defective diagnostic tool by itself. It might work well of some races, but for others it will give faulty readings. So I have to ask, WHEN is the ADA going to wake up and learn. Never, if this is the way they continue to do business.

I say quite openly, when those of us with Type 2 diabetes have an organization like the adult Type 1 diabetes people seem to now have in JDRF, then we might find our way into the twenty-first century. As long at the ADA continues to be by and for the medical community, those of us with diabetes (the patients) will continue to be ignored and given lip-service.

Some of the variables that affect the A1c test include anemia, for African-Americans that carry the sickle cell trait can have anemia as well. Other problems include blood transfusions and dialysis that can affect the accuracy of the tests. Some even claim that electrolyte levels will affect the A1c tests. My advice would be to question any A1c test that seems unreasonable and ask the doctor to perform the necessary tests for anemia or electrolyte levels. You should know if you have had any transfusions or dialysis.

To go along with this, I am finding more and more diabetes news on the BBC, Reuters, and Telegraph UK. The US has a few sources, but more researchers are reaching out to news organizations outside of the US to get their research recognized. In the US, it gets buried inside the ADA website and unless a few good sources like Diabetes in Control dig or mine the information, it stays hidden in the ADA archives.

Most of us do not have the time to mine the information on the ADA website. I occasionally find something there, but I am lucky most of the time. I admit that I find more information on government agency websites that I do on ADA.

February 14, 2017

Frailty a Risk of Polypharmacy

Polypharmacy is a problem for many of the elderly. As we age, many people often develop more chronic health conditions. These chronic health conditions mean that the elderly often are taking many medications. This means polypharmacy for many of the elderly and it can increase the risk for harmful side effects.

Interestingly, taking more than five medications is linked to frailty; perhaps because the medications interact to affect our ability to function well as we age. Frailty is a problem associated with aging. Someone who is frail can be weak, have less endurance, and be less able to function well. Frailty increases the risk for falls, disability, and even death.

Recently, a team of researchers examined information from a large German study of older adults called ESTHER (Epidemiological Study on Chances for Prevention, Early Detection, and Optimized Therapy of Chronic Diseases at Old Age) to learn how taking more than five medicines might affect frailty in older adults. The study was published in the Journal of the American Geriatrics Society.

The researchers looked at information from nearly 2,000 participants in the ESTHER study, which began in 2000 with nearly 10,000 participants. Follow-ups on participants were conducted after two, five, eight, and 11 years. People in the study were between 50- and 75-years-old when the study began.

At the eight-year follow-up, study physicians visited the participants at home for a geriatric assessment. During the visit, participants were asked to bring all the medications they took--both prescription and over-the-counter (OTC)--to assess the kinds and number of medications participants were taking. The researchers then separated participants into three groups:
1. People who took from 0 to 4 medicines (non-polypharmacy)
2. People who took 5 to 9 medicines (polypharmacy)
3. People who took 10 or more medicines (hyper-polypharmacy)

Two pharmacists individually reviewed all medications taken and excluded medicines and supplements that were not known to cause side effects.

After adjusting for differences in patient characteristics including illnesses, the researchers learned that people who were at risk for frailty, as well as people who were frail, were more likely to be in the polypharmacy or hyper-polypharmacy groups compared with people who were not frail. Researchers also discovered that people who took between 5 to 9 medicines were 1.5 times more likely to become frail within 3 years compared with people who took fewer than 5 medications.

People who took more than 10 medicines were twice as likely to become frail within three years as people who took less than five.

The researchers concluded that reducing multiple avoidable prescriptions for older adults could be a promising approach for lessening the risks for frailty.

If you're an older adult, or if you're caring someone who is older, it's important to understand that taking multiple medicines can cause interactions. The medicines can interact with each other and with the human body in harmful ways (by increasing negative side effects or decreasing desired effects, for example). As a result, the risk for falls, delirium, and frailty also increases.

Primary care providers are aware of these negative effects, but they cannot properly react if they are not fully informed about all the medicines you or an older adult in your care may be using. That's why it's extremely important to let your healthcare provider know about all medicines you or a person in your care is taking, as well as about OTC medicines and medicines prescribed by other healthcare providers. Your can then evaluate whether one or more drugs might be changed or discontinued.

"In a perfect world, your physician would talk about your medications with a pharmacist and a geriatrician. This might help to reduce avoidable multiple drug prescriptions and possibly lessen medication-induced risks for frailty and other negative effects of unnecessary, avoidable polypharmacy," said study co-author Kai-Uwe Saum, PhD, MPH.

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

February 13, 2017

Barriers to Insulin Therapy

The fear of needles or sharp objects is not that uncommon among people with diabetes. While I dislike needles, I do not have a fear, or technically – belonephobia.

Yet, I have met several people with type 2 diabetes that do have belonephobia. Two of these people need to start on insulin, but they are refusing and both are now on five different oral medications and their meter readings are still becoming higher. Both are considering insulin, but one of the two has COPD so the Afrezza is out. The other has finally accepted Afrezza.

I came across the following and found it interesting:
The Fear of Needles Has Many Names - But It Is Very Real
If you've ever tried to search for "needle phobia" or "fear of shots," you've probably come across some very odd and confusing terms. But this condition is very real, and a whopping 20 percent of people have a fear of needles. There are a lot of risks associated with the fear of needles. It can prevent people from going to the doctor, getting routine blood tests, or following prescribed treatments. Modern medicine is making increased use of blood tests and injectable medications, and forgoing medical treatment because of a fear of needles puts people at a greater risk for illness and even death. For example, diabetics who skip glucose monitoring and insulin injections can put themselves in serious danger of complications.

Here are the six medical terms that are related to fearing needles:
  • 1. Aichmophobia: an intense or morbid fear of sharp or pointed objects
  • 2. Algophobia: an intense or morbid fear of pain
  • 3. Belonephobia: an abnormal fear of sharp pointed objects, especially needles
  • 4. Enetophobia: a fear of pins
  • 5. Trypanophobia: a fear of injections
  • 6. Vaccinophobia: a fear of vaccines and vaccinations

Back to my thoughts -
For many people with type 2 diabetes, doctors will not prescribe insulin and will use the threat of insulin as a way to get patients to follow orders. Then when they need insulin the patient blames him/her self and feels that he/she is a failure.

I have personally seen examples of people who fear needles while in the military, out of a group of over 100 men; six went down, succumbing to trypanophobia. The way medical professional should handle type 2 patients is presented here. This article also covers other fears about insulin that many people with type 2 diabetes have and explains these.

For those people that need some encouragement about using syringes, view the following video from BD on using insulin syringes.

Insulin is necessary for many people with type 2 diabetes when their pancreas can no longer produce sufficient insulin.

February 12, 2017

Some Notes to My Readers

Just to let you know that with the health problems and radiation for prostate cancer, I am finding that being tired is zapping me, my concentration is difficult and hard right now. I will blog when I can, but I am not promising much.

I am still having problems with my left shoulder and have not fully recovered. My physical therapy has been stopped because of my tiredness from radiation and I hope that I will be able to resume with doctor's orders, but that will be determined.

It has been suggested that I revisit some of my early blogs and add updates when needed and maybe reword a parts. This I am considering and may do this.