Why Keep
Diabetes A Secret?
Having a diagnosis of type 2 diabetes
is probably not something you would shout from the rooftop, but
should you keep it a secret? Many people do just this and will not
talk about it even to family members unless it is necessary. Extreme
secrecy can be difficult. There was a situation a few years ago near
here that made me laugh. Husband did not tell wife or anyone about
his diabetes diagnosis. Two weeks later, his wife answered the
telephone, and it was husband's doctor office calling to remind him
of his diabetes education class the next day.
When husband learned this had happened,
he hired a lawyer to sue the doctor's office for failure to keep his
medical records private. Judge had a sense of humor and asked
husband if he loved his wife and he answered yes. The judge said if
this were true, why had he attempted to keep his disease a secret
from his wife? The judge said he could understand the secrecy desire
for the husband's affair uncovered by the sheriff. He handed down
the following judgment. One-dollar fine to the doctor office – to
remind them to be more careful and court costs on the husband for the
lawsuit and wasting the court's time. He gave instructions to the
wife that should she ever decide to divorce her husband, all she
would need to do is file the paperwork and it would be granted. In
addition, he wanted the court proceeding widely published.
Presently
There Is No Cure
A topic that often surfaces shortly
after diagnosis is “the cure.” I am somewhat hesitant to discuss
this here, but if I can prevent anyone from avoiding this approach,
it will be worth it. There are charlatans out there just waiting to
separate you from your hard-earned money. They exist in small town
America, in the large cities, and on the internet. They have the
skill and arguments to make it sound very convincing and may be
doctors or just cunning salespeople. They have one thought, and it
is getting you to hand over your hard-earned money for their false
claims. Read my blog
here for more.
There are also researchers and medical
people that have plans to (as they claim) put diabetes is remission.
They promote extreme low calorie regimens and certain supplement
plans which may make it seem like diabetes is stopped and are safe to
use. Just be careful as these are for the short term and research
has not proven they will succeed for the long term. The stress on
your body using these extreme low calories diets has not been
researched beyond a few months. They have proven that they work for
the short-term and that is their promotion to obtain your money.
Then in a few months when your blood glucose levels start back toward
the stratosphere, they will try to sell you another round of the same
regimen. Your long-term health is being put in jeopardy. Do not
attempt these plans without your doctor's knowledge.
Acronyms and
Their Use
As you start reading and looking for
information on the Internet, you will come across many acronyms used
by people to avoid typing long or even short strings of words. This
can be discouraging for the new person with diabetes. What do they
mean in the context of the sentence? One that you need to be very
careful with is this one – ADA. It still means American Diabetes
Association and Americans with Disabilities Act. Many still use it
for the American Dietetic Association, but as of January 2012 it was
officially changed to AND (Academy of Nutrition and Dietetics).
Changes in names can be a good thing,
but the change above was solely to camouflage a takeover of competing
occupations and eliminate competition by criminalizing people not
becoming certified under their organization. This is not a very
professional objective.
How you see acronyms will vary with
each writer. Many will give the program or profession name in one
paragraph and then start using the acronym in the next or later
paragraphs. Others will use the full explanation followed
immediately by the acronym and then use the acronym for the rest of
the article. Some writers assume that their readers know the meaning
of the acronym and never give the full name. These are the writers
that make it difficult for all types of readers. Time after time.
when there is the possibility of confusion, I have seen comments
asking for the full definition of an acronym. Some people are
especially sarcastic about this and provide a definition they know is
wrong and abrasive, but the writer seldom clarifies. Some writers do
then provide the correct meaning for the acronym. A few writers do
correct their habits, and the rest just disappear.
I do use acronyms, and if you catch me
not giving the full meaning, please let me know. I use the full
definition and then the acronym in parenthesis or the acronym with
the full definition in parenthesis. I have used the full definition
in the first paragraph or two and then start using the acronym;
however, I am trying to break that habit.
Some of the
Testing Basics
Hopefully, you are now comfortable with
testing and are doing it regularly. You need to understand what the
blood glucose (BG) readings mean and what actions are available to
you. Whether you are endeavoring to manage your diabetes with
exercise and diet without medications, or are using an oral
medication, you need education about both and when to test. Most
everyone tests upon rising from sleep and this is termed fasting
blood glucose (FBG) and your goal should be between 80 mg/dl
(milligrams per deciliter) (4.4 mmol/L) and 100 mg/dl (5.6 mmol/L,
(millimole per liter). Or, as
many write, keep fasting blood glucose
(FBG) under 100 mg/dl.
Then we come to the next meal.
Hopefully, you will be under 100 mg/dl for the pre-meal blood glucose
reading (preprandial). If you are not, then consider what you ate
that would keep you higher. I like the goal of one hour post meal
reading being 140 mg/dl (7.8 mmol/L) or lower (postprandial). At the
two hour postprandial blood glucose reading should be 120 mg/dl (6.7
mmol/L) or lower. However, if these become your goals, be careful as
eating the American Diabetes Association's recommended meal
consumption of carbohydrates will make these goals unachievable for
many patients.
Testing is the only way you have in
determining how different foods and food quantities affect your blood
glucose levels. A term you will see in blood glucose management is
self-monitoring of blood glucose (SMBG – is the acronym). You will
also need to test more frequently in the beginning to learn how long
before you reach the high level of your BG. Many suggest one hour
after first bite and for some people this can be too early. If you
are a speedy eater (gobble down your food) this may work; however,
studies have shown that you should eat slower for greater blood
glucose management. Some writers do use the word control instead of
manage for the same meaning. Some will suggest testing more often
until you are comfortable with when your high level of BG happens. I
suggest starting at the one-hour mark and testing every half hour the
first few times until you see the readings start decline. Some
people will test every 15 minutes. Somewhere between the highest
reading and the lower next reading, the high may have occurred.
Occasionally the high mark can happen
before the one-hour mark or beyond the three-hour mark. This
indicates that the food you ate enters the blood stream quickly and
was easily digestible and probably contained little fiber, if any.
If it is after three hours, this indicates a higher than normal
amount of fat, example – pizza. If you are saying this is
confusing and too much to learn, you may as well know up front that
there are not firm guides or rules to follow. It is important to
know that what works for me, may not work for you. It is important
to know that you need to become your own lab rat to determine how the
different foods affect your system and what works for you. Many
people keep a detailed journal during this time of the readings, what
was consumed, and other observations that they feel is important.
Read my blog
here for further discussion of postprandial testing.
How often you test will depend on your
desire to bring diabetes under excellent management and your budget.
You will also need to find out how willing your doctor is to go to
bat for you with the insurance company for additional testing
supplies. Some companies will allow some extra test strips in the
first few months, but then want to restrict you thereafter. Other
insurance companies will only allow a set number of test strips per
day. I recommend that you talk with your insurance company to find
out what they are willing to allow. You may need to bargain with
them and attempt to convince them of the need for allowing more test
strips for the first three to five months. Don't be surprised if you
are denied, but it is still worth the effort. If your budget will
allow for the test strips, the knowledge you gain will be worth the
cost. Medicare will not allow extra test strips.
As you are testing you are also looking
for trends. If you are bouncing up and down at the two-hour
postprandial, looking at your food log may provide clues as to why.
If your FBG is on an upward trend for a couple of weeks then be
concerned and be more careful of your last meal of the day. Also do
not let a lot of time pass after rising in the morning as this allows
your liver to dump more glucose into the system and can distort the
trend. Many people can also have what is termed the dawn phenomena
(DP) which is the livers function to dump glucose into your system to
give you energy for waking up and starting the day. Upward trends
should always be of concern and if they continue or start to trend
upward more rapidly, always consider talking with your doctor. He
may request an office visit and may increase the dosage of your
medication or start you on a new medication.
Never be concerned with some bouncing
up or down of BG readings, as this can happen if you are coming down
with an illness or can vary with the food you ate at the previous
meal. Trends up or down for longer that a month should be talked
about with your doctor. He/she may need to adjust you medication.
Trends under 80 mg/dl should always be talked about with your doctor.
More about this in the next blog.
Series 2 of 12
