May 13, 2017

Managing Your Diabetes Supplies

Where do you store your diabetes supplies? I must be fortunate to have an office where I store most of mine. The only diabetes medications I use the refrigerator for is my insulin and my wife kindly allowed me one shelf for the insulin. An order of basal and bolus insulin fits very nicely and is always visible.

The test strips have a basket for the zip-lock bag I store the test strips in to keep them in the boxes in which they arrived. They have a spot on one of the shelves among the books. The syringes occupy a bottom shelf in another bookshelf. As for non-diabetes supplies or medications I take, I keep them on a shelf where they are easily accessible and I have them in a certain order to know which I take AM and which are for PM. The meds that I take AM and PM have their area between the others.

I keep a medication checklist on the computer and a supply checklist for the supplies with the prescription numbers, dosage, and when to take, plus where I obtain each.

I have some suggestions for you that will depend on how you store your diabetes supplies and your medications will also make some difference.

#1. Create a supply checklist as well as a medication checklist: Some people will have a need for more checklists. Some people have a smartphone, which you can use the notes section to track the usage to know when a supply is due for resupply.

#2. Sort your supplies for organization: For example, keep your meter, test strips, and lancets in the container the meter came in, which should allow you to carry all three as the same time. For those occasions when it is not possible to wash your hands with soap and water, maybe carry a couple packs of alcohol swabs for emergencies.

If needed, because of the medication you are taking, keep a supply of fast-acting carbohydrates, such as glucose tablets or hard candy in a place where you can locate them quickly if needed.

#3. If you have deep shelves or limited counter or cabinet space, think vertically: Drawer organizers that stack on top of each other on a shelf are the perfect way to maximize your storage. The drawers pull out, so there’s no need to unstack containers to get to the ones on the bottom. Alcohol wipes, lancets, and extra batteries should be kept together and fit nicely into these types of units. You may need to store extra meters or bulkier supplies in larger containers.

For an inexpensive and flexible option, you can hang a clear plastic shoe bag on the inside of your pantry door. This is an excellent tool for corralling your meter and other supplies for checking blood sugar levels. It’s a natural storage solution for proportioned snacks too!

This method keeps critical items at your fingertips — no more “out of sight, out of mind.” If you’re really tight on space, bring your walls into play. Hang a pegboard or no-fuss shelving on an empty wall in your kitchen, laundry room, or family room.

#5. Remember that clear is king: One of the real keys of being — and staying — organized is knowing what you already have. Clear plastic containers can help you see exactly what’s inside. If you don’t have room for the plastic containers, use large plastic storage baggies. Make sure to purchase ones that have a strong closing mechanism. A sealed-tight closure is important to prevent air from coming in and contents from spilling out. These bags also work well in your refrigerator.

Another great tip is to eliminate unnecessary packaging upon receipt of supplies. Medical supplies come in bulky bags or containers. This packaging is necessary to keep supplies sterile, but it takes up space once it’s in your home. Feel free to get rid of it and store your supplies in smaller containers.

#6. Dig drawer dividers: Drawer dividers are a great solution for partitioning drawers in order to organize your diabetes supplies. For example, you can use dividers to separate your fast-acting sources of carbohydrate from your blood sugar testing supplies and extra batteries. You can purchase these dividers at most stores that sell housewares.

#7. Label, label, and label: Have you ever pulled something out of your diabetes supply closet only to wonder when you actually bought it and why? If so, consider investing in a label maker or use masking tape and a marker to clearly label all containers. This will act as a visual check of what’s inside so you can find specific items that you need easily, and you can put them back where they belong. No more lost or forgotten items! And if you include expiration dates, you’ll know when supplies need to be used or replaced.

May 12, 2017

Managing Your Type 2 Diabetes - P2

Continued from yesterday's blog.

#4. Be Active:
To lose weight, you should try to exercise three times a week for 30-60 minutes a day. But moving your body is good for a lot more than that.

Regular workouts can:
  • Lower your blood sugar.
  • Boost your heart health.
  • Lower your blood pressure.
  • Help insulin work better in your body.

If you find an activity you enjoy, you’ll be more likely to stick to it.

“Exercise shouldn’t feel like a punishment,” Fonseca says. If you want to go swimming, go swimming. If you want to go dancing, go dancing. That’s exercise, too.”

You can also call on a partner to help you stay the course. Whitney Bischoff, a registered nurse in Seguin, TX, was diagnosed with type 2 diabetes at age 48. Now 61, Bischoff says her disease has changed how she and her husband spend time together.

“It wasn't too long after my diagnosis that we had the opportunity to take an active vacation, and that began our more-active lifestyle,” she says. “It’s a favor, really. We treat our bodies better because of diabetes. We can live long and healthy lives through these recommended changes in our lifestyle, without missing out on life.”

#5. Focus on Food: If changing your diet seems daunting, remember: Your goal is to strike a healthy balance, not achieve "perfection."

“Generally, you need to avoid concentrated sugars,” Siminerio says. “I'm not saying don't eat the cake at your grandson's birthday -- just don't eat all the roses on the cake.”

Focus on getting plenty of fiber through plant-based foods like fruits, veggies, and whole grains. Keep track of your carbohydrates so you don’t go overboard, and stay away from sugary drinks.

Avoid trans fats, too. Instead, stock up on protein -- up to 25% of your plate at each meal should be protein from sources like fish, chicken, dairy, or vegetables.

“Vegetables really help me feel better,” Crim says. “And nuts are great. Have fruit on hand, and if you choose to eat sweets, moderate carefully, but don't deprive yourself so that you overindulge.”

The more people in your house that get on board with your meal plan, the better, Fonseca says.

“Very often, people try to diet in isolation, which is very hard to do,” he says. “You can't have a different diet from your spouse and your kids. Everybody's got to do it together.”

“Meds work differently in each person, and that affects when and what you should be eating,” she says. “A dietitian has your medical plan. It's not an off-the-shelf cookbook from someone.”

#6. Lower Your Stress: It makes your muscles get ready to fight or run away from danger. When your insulin isn’t working right, this process floods your blood with glucose (sugar).

“Stress pushes up blood glucose, raises your blood pressure, and increases your chance of heart disease,” Fonseca says.

If smoking is your stress-relief go-to, it’s time to quit. “Along with affecting your lungs, smoking narrows your blood vessels,” Siminerio says. “So if you smoke, have high blood pressure, and high lipid levels, that's like a time bomb in your body if you have diabetes.”

Here are some healthy ways to combat stress:
  • Do breathing exercises.
  • Tense your muscles and then release them.
  • Go on a walk or jog.
  • Stretch.
  • Start a new hobby.
  • Replace negative thoughts with positive ones.

“My advice? Have fun,” Fonseca says. “It’s a whole lifestyle change, so be sure to make it a life you enjoy.”

May 11, 2017

Managing Your Type 2 Diabetes - P1

The idea for this blog came from this article. I was not surprised at the diabetes diagnosis. I had relatives on my mother's side of the family and knew that my brother had type 2 diabetes. My brother had been able to manage his diabetes with no medications, so I was surprised that I could not. After three months, I was still in the 200's and occasionally could get into the lower 100's.

The biggest shock was after having angina surgery when a heart surgeon came to my room and called me a liar for not telling them on admission that I had type 2 diabetes. I admitted that I did not know and the surgeon called me a liar. Finally to get him our of the room, I threw the bedpan at him. I missed him because he ducked and it bounced off the wall and out onto the tiled hall floor. This brought many nurses and the heart patient in the adjoining bed asked the nurses to remove the loud mouth doctor so he could sleep.

Shortly the head of the heart department was there and was the surgeon that had operated on the individual and he asked what was happening. The fellow told him that I was being picked on for not knowing that I had diabetes by a doctor and the doctor was rude and loud and had awaken him. The surgeon apologized to me, called the head nurse to the room, and said that a sign would be placed just outside the door that anyone entering this room must get permission or trouble will happen to people ignoring the sign. The nurse was asking many questions, finally the surgeon stated everyone, and if she could not follow orders, he would find a new head nurse. After she left the room, the fellow in the other bed thanked the surgeon. The fellow then asked me if I objected and I said no. I thanked him and the surgeon for coming to our room when another surgeon could not be civil.

After I was discharged and at home, I realized I had many things to do. Remembering every thing now is a bit on the difficult side, but I will use the article as a guide,

#1. Build a Support Team: “It takes a village to manage diabetes,” says Linda Siminerio, RN, PhD, chair of the National Diabetes Education Program. Along with your doctor or nurse practitioner, you can get help from:
  • Diabetes educators
  • Dietitians or nutritionists
  • Pharmacists
  • Endocrinologists
  • Podiatrists
  • Dentists
  • Psychologists or Therapists

Their services are often covered by insurance.

#2. Get Involved: Having a health care team is key, but you're the most important member of it. “We want you to be informed and empowered,” Siminerio says.

Take an active role in your care. Ask questions. Learn what your medications do and how to take them properly. Practice any other healthy habits your doctor recommends. And know what your A1c levels are and what they mean.

#3. Lose Weight: “Being overweight is one of the major drivers of the epidemic of diabetes,” says Vivian Fonseca, MD, a professor of medicine and pharmacology at Tulane University.

Fat can cling to muscle and important organs like your liver and pancreas, which can lead to serious complications.

The good news: You don’t have to reach a certain target weight before seeing positive results.

“Any weight loss is beneficial,” Fonseca says. “It doesn't mean you should stop after you lose a few ounces, but it’s encouraging to know that even if you lose a little bit of weight, it is helping your body. It reverses a lot of those changes.”

It's extra-important to get rid of the extra pounds around your middle. That’s why Siminerio suggests you watch your waist.

“Folks that have the classic ‘apple shape’ -- usually men in their 40s and 50s -- are at higher risk for cardiovascular disease,” she says.

Keep your goals realistic for long-lasting change. “Losing 1 pound a week is doable,” Fonseca says.

May 10, 2017

Changing Paradigm from Management to Reversal, Type 2

While this trial is in the beginning stages, it has indicated that profound changes are possible without harming the patients. It will be very interesting to read what the results are at the end of the trial.

Results from the first 70 days of the Virta Clinic trial suggest the historic dietary approach to management of type 2 diabetes has been all wrong. Type 2 diabetes has long been viewed (by the medical profession) as a chronic condition that can be managed but is inevitably progressive.

While clinicians may be increasingly more aware that type 2 diabetes can be reversed, most think it is only possible through drastic means like bariatric surgery. With the recent findings from our ongoing clinical trial, which add to the existing literature, medicine may be on the cusp of a major paradigm shift for the treatment of type 2 diabetes: from management to reversal without the use of surgery (bold is my emphasis).

The published results highlight the first 70 days of an ongoing 2-year clinical trial collaboration between Virta Health and Indiana University Health, in which 262 patients with type 2 diabetes were enrolled in the Virta Clinic. The clinic combines online education for:
  • behavior change,
  • biometric feedback,
  • peer support and
  • an individualized nutritional approach that promotes nutritional ketosis.

After 70 days and greater than 90% retention, mean weight loss was 7.2% and the mean glycated hemoglobin (A1C) reduction was 1%, with 56% of patients achieving an A1C below 6.5%.

It is extremely important to note that this reduction in A1C was achieved while medications were reduced. At baseline, 89% of the patients were taking one or more diabetes medications, and at 70 days, 58% of patients had either reduced or completely eliminated their medications. This is unlike treatment strategies aimed to lower A1C in the past. For example, in the ACCORD trial,3, where A1C levels were lowered with aggressive medication use, the most aggressively treated patients had worse outcomes. Specifically, the intensive glycemic control group who were prescribed more medications, which often included insulin with multiple oral agents, had significantly more weight gain, more episodes of severe hypoglycemia, and greater mortality than the standard group.

Many were led to conclude from the ACCORD trial that strictly lowering glucose may actually be detrimental. However, it may be that how glucose is lowered is a critical consideration. In the Virta 70-day trial, there were no serious adverse events and no episodes of serious symptomatic hypoglycemic events requiring medical intervention.

The concept of reversing type 2 diabetes by non-surgical means is relatively new, but is gaining attention in both the scientific literature and popular press. So, what does reversal of type 2 diabetes actually mean? It means that patients who previously were on medications to control elevated blood glucose now maintain blood glucose below the diabetes threshold despite reducing or eliminating the need for hypoglycemic medications. This is exactly the opposite of what was thought to be the inescapable progression of a disease that puts patients at high risk for so many complications, including cardiovascular disease, blindness, renal failure, and amputations.

A major reason that the concept of management to slow progression of T2D has prevailed for so long is the standard nutritional recommendations, which focus dietary macronutrient intake on carbohydrate. Basic physiology dictates that carbohydrate ingestion causes blood glucose to rise, particularly in the face of the insulin resistance that underlies type 2 diabetes. In fact, the most recent edition of the Nutrition Therapy Recommendations for the Management of Adults With Diabetes6 from the American Diabetes Association states that “total amount of carbohydrate eaten is the primary predictor of glycemic response.” This makes basic science sense, and the practical response would be to decrease dietary carbohydrates if the goal is to decrease blood glucose. This approach has been shown to be effective in improving glycemic control while reducing or eliminating medications in prior smaller studies.

In addition to adjusting dietary carbohydrate to each patient’s level of insulin resistance, patients need individualized support and medical management. The Virta Clinic specializes in being able to provide the personalized treatment needed on a personalized schedule. While barriers exist to convenient and accessible care in a brick-and-mortar clinic, the Virta Clinic is able to overcome these by providing a full medical specialty clinic online. Each patient receives a health coach who guides patients through appropriate nutrition changes while considering lifestyle, cultural, and financial barriers. Specialty-trained physician supervision for each patient ensures that medications are decreased safely and efficiently.

Ultimately, our current trial will add to the compelling evidence that:
1. Diabetes can be reversed while reducing medication and without risk, cost, or side effects of bariatric surgery and
  1. Reversal can happen in a large percentage of patients, not only in outliers.

At the very least, our results beg the question: has the medical profession been approaching the dietary management in type 2 diabetes all wrong? I firmly believe the dialogue has to change to let patients know that reversal is possible. By not doing so, we are complicit in the continued staggering rise of this disease.

With the increasing cost of health care, including $1 of every $3 in Medicare going to the treatment of type 2 diabetes and its comorbidities, we have to look for solutions. In doing so, we must be willing to acknowledge that there have been past shortcomings in both dietary recommendations and treatment goals. Our patients deserve the opportunity to gain control of their health. They want more than just another prescription or procedure. To help them, we need to change the dialogue. We need to talk about reversal and provide the knowledge and support to achieve it.

May 9, 2017

In Memory of David Mendosa

On May 8, 2017, the diabetes community lost one of it icons. David Mendosa was a writer about diabetes and maintained a positive attitude while doing it. David had many followers around the world that thanked him for many of his articles. They made this known as his health was declining.

On Tuesday, April 4, a CT scan at Good Samaritan Hospital in Lafayette, Colorado (near his home in Boulder) showed that he had liver cancer.

Later that day, the hospital took a biopsy, and the results came back on Thursday, April 6. The results of the biopsy showed that David had angiosarcoma of the liver, a rare form of sarcoma, and it is incurable.

David's attitude was from the beginning and remained absolutely normal. David is a Buddhist and this has given him compassion for himself and has taught him not to deny reality.

David decided to forgo chemo and accept the normal course completely. David reported that on April 28, he started to have falls and was getting weaker. He was also having help with putting up the daily journal entries and several of his friends were helping him.

For me, I have lost a valuable friend that helped me in many ways – from diabetes to writing about diabetes. He also introduced me to others that became important to me.

Rest in peace David, until we meet again.

May 8, 2017

Health Cover-up Largest of Our Time - P2

Continued from yesterday's blog.
Kurt Mosley, the vice president of strategic alliances for Merritt Hawkins health consultants, said the documentary brings up several important points. The first is the unhealthy aspects of the average American diet. “I think that is key,” Mosley told Healthline. “It’s our fast food diet.”

He does disagree with the filmmaker’s contention that eating well is cheaper than eating poorly. “I try to eat healthy and it’s expensive,” he said.

Mosley said the potential conflicts between the health organizations and industry are interesting, but he’d like to know exactly what support they’re getting, what percentage of their budget comes from those sources, and who else provides backing. “I’d like to see what sponsorship is across the board,” he said.

Mosley said one of the big “takeaways” from the film is the point that many organizations try to help people cope with a disease, as opposed to preventing it either through lifestyle or medical advances.

“We need to cure diseases rather than live with them,” he said. “We need to advise people on how to take better care of themselves.” Mosley said this is a prime topic when he discusses poverty’s effect on healthcare with various groups.

Overall, he said the documentary could serve as an impetus for discussion of all these important issues. “This is really good as a start,” he said. “We have to start the conversation.”

Representatives from some of the organizations highlighted in the film are criticizing Andersen’s film for a number of reasons.

Suzanne Grant, vice president of media relations and issues management at the American Heart Association, said her organization’s recommendations on diet have always followed a “rigorous, systematic review system of the best available scientific information.”

She said the association’s most recent lifestyle guidelines, for example, recommend that adults follow a diet that emphasizes vegetables, fruits, and whole grains. It also includes low-fat dairy products, poultry, and fish, and suggests limiting red meat as well as products laden with sugar and salt.

As for the recipes on the association site, Grant said it’s part of the organization’s goal of “meeting people where they are.”

“A vegan or vegetarian dining pattern is not the dominant one in the U.S. today,” Grant said. “While we recommend that adults who could benefit from lowering their LDL cholesterol or their blood pressure should limit their red meat intake, we also recognize that red meat is a common feature of the American diet, and we urge all Americans to make informed choices to follow the recommended overall heart-healthy dietary pattern noted above if they choose to eat meat.”

She added that nearly 80 percent of the American Heart Association’s revenue comes from sources other than corporations. Grant noted that the association is transparent about the money it receives from industry.

“Financial support from a wide variety of corporations from across the country helps us achieve our goals of improving the cardiovascular health of all Americans and saving more lives,” she said.

Officials at the American Cancer Society had a similar reaction. They point out they have a detailed list of dietary and lifestyle guidelines on their site. Included in those guidelines are warnings about potential cancer risks with processed meats.

Officials add the nonprofit organization has participated in studies that have shown a link between red meat and cancer.

Critics also noted that Andersen uses only one study to link dairy to breast cancer when there is other research concluding there is no link. Miller, of the National Dairy Council, said the documentary’s statements about healthy eating and dairy foods “are not supported by the science community.”

He said there are numerous ways to build a healthy diet. Dairy foods, he added, “play an essential role due to their unique set of nine essential nutrients.” He said emerging research shows that dairy foods like milk, cheese, and yogurt are associated with a reduced risk of type 2 diabetes and cardiovascular disease.

Miller also dismissed the notion that any research funded by industry is biased.
“The assumption that research sponsored by industry which shows a favorable outcome is biased is disappointing to say the least,” said Miller. “What people may not realize is that without funding from industry, high-caliber research may not be possible. By focusing on funding bias, we risk dismissing what are potentially important contributions to scientific literature.”

He said the dairy council sponsors research at national and international universities that adheres to scientific principles. “That’s why it’s important to look beyond the funding acknowledgments and make sure the research is rigorous and not biased toward outcomes to determine how it fits in the totality of science,” Miller said.

May 7, 2017

Health Cover-up Largest of Our Time - P1

The typical American diet is the number one cause of deadly and chronic illnesses in this country. In addition, the companies that produce some of the food products Americans eat aren’t likely to try to help reduce these serious problems.

Don’t look for assistance from government agencies and some of our best-known health-related organizations. They have conflicts of interest because they receive funding from the meat, dairy, and pharmaceutical industries. That’s the main premise of a new documentary that premiered online last week.

“What The Health,” which is streaming now on Vimeo, seems to have garnered early attention. The hour-and-a-half long documentary was the top trending video on Vimeo On Demand in the first few days after its release on Mar. 22.

Filmmaker Kip Andersen was not available this week for an interview, but in press materials, he said the documentary “reveals possibly the largest health cover-up of our time.”

Officials at some of the organizations criticized in Andersen’s film are not impressed. They accuse Andersen of cherry-picking studies and ignoring the importance of industry-funded research. Just a reminder – industry-funded research can seldom be trusted.

“There’s no doubt that poor diet and lack of exercise can lead to various health problems, including heart disease and type 2 diabetes,” Greg Miller, PhD, FACN, chief science officer for the National Dairy Council, told Healthline in an email. “People want to do their best when choosing a healthy diet, but so much information — and misinformation — makes it hard to know who and what to believe. That’s why it’s unfortunate when films such as ‘What the Health’ misrepresent sound nutrition science.”

Andersen begins his film by discussing how his family medical history got him interested in the topic.

“Like a lot of Americans, I have a family history of diabetes, heart disease, and cancer, so it was important to me to learn more,” Andersen, who co-directed “What the Health” with Keegan Kuhn, said in a press statement. Andersen proceeds to detail the health hazards of some of the favorite foods in the United States, citing numerous studies along the way.

He says meat, in particular processed meats, is a major cause of cancer and cardiovascular disease. This includes all meat products from beef to chicken to turkey to even fish. Chicken, he points out, is the top producer of cholesterol in Americans’ diets.

Andersen, who also made the film “Cowspiracy,” then goes after the dairy industry. He says the health risks of products such as milk, cheese, and eggs have been underplayed. He states that eggs are pure fat and cholesterol.

Andersen then checks the websites of some of the country’s major organizations. He says the American Cancer Society has no warning about meat on its site and even has suggested recipes that include processed meat.

Andersen also finds recipes for meat dishes on the American Diabetes Association website. There are also “heart healthy” recipes for beef dishes on the American Heart Association website.

Andersen also notes the Susan G. Komen foundation has no warning about dairy products on its site even though he quotes research linking dairy products to breast cancer.

Andersen calls each of the organizations for an explanation but does not get answers.

He finally lines up an interview with an official at the American Diabetes Association. That interview ends with the official walking out of the room.

After feeling stonewalled, Andersen goes online and looks up the funding sources for these various organizations.

He finds each of them has a long list of corporate sponsors.

The American Diabetes Association receives support from Dannon yogurt, among others.

The American Cancer Society receives support from Tyson Foods, among others.

The Susan G. Komen foundation receives support from Kentucky Fried Chicken and Yoplait, among others.

And, the American Heart Association receives support from the Texas Beef Council, among others.

He adds that the organizations also receive funding from the pharmaceutical industry.

Andersen points out the federal commission that formulates U.S. dietary guidelines every five years is filled with members who have received corporate support.

During the course of the film, Andersen interviews a dozen people in health-related fields including physicians and dietitians.

He also profiles three people with chronic illnesses near the end of the documentary that are faring better after two weeks of cutting out medications and eating a more plant-based diet.