July 16, 2010

A Doctor's Perspective on Patients with Chronic Diseases

Once in a while this blogger gets hit with a good one. Do I believe this, YES, but if I hadn't read it with my own eyes, maybe not.  It is also not often that I have a blog that I can write that I do not have to do much research to write.

This is one of the best blogs by doctor about doctor – patient relationships written by a doctor that is not necessarily afraid to go the extra mile for his patients, especially those with chronic diseases, and diabetes is one of the mentioned diseases.

While I will need to reread it several times, he had me crying (a man crying? – yes with happiness!) and then he had me laughing. It is so unusal the to see a doctor say something that many of us patients with diabetes have believed for a long time. His words of caution are well placed and easy to see the reasoning behind them. Many of us patients are a little overly aggressive and as such can make a good doctor very nervous, especially if we are agressively proactive about our care, and not even mentioning patient's rights!

I was expecting to see one of the comments by Trisha Torrey from About dot com and was not disappointed. While she can be argumentative, she was almost, but not quite, tame in her comment. There are lots of comments and I will let you read them for yourself.

I would have made a comment to his blog, but I am hoping that I can reach just as many with this and encourage them to also read his blog – follow the link here. I think you will agree that when placing this doctor on my types of doctors in my blog here, that Dr Rob must be a definite Type six. While there are some things that are not said, for Doctor of Internal Medicine I am not normally that much into giving praise, but an exception is demanded this time.

July 15, 2010

What would or should one do?

This question came up recently about a product that has been written about by another blogger. Don't get me wrong, the blogger did an excellent piece about this product and has great interest in it.  I have been in email contact with the company and I like the idea and the high potential usefulness of the product, but doubt I will ever need it, but who knows.

The product is about 30 months, give or take a few months, from FDA approval. So here is the question.  Do I write about it or wait until it comes on the market?  I am looking for responses whether they are positive or negative.

On the one side, this is a much needed product and will definitely have its place in the market, once it gets past the Federal Drug Administration and their crazy bureaucracy. The negative is that will not happen within 12 or 18 months, but more like 30 months.

This will be an important product for anyone with diabetes that is on insulin.  And yes, I am on insulin.  Have I been in a situation where I would have needed the product? Truthfully, no.  Do I see myself ever needing this product?  Again, no.  Have I ever come close to needing this product?  Here, I need to answer yes.  I admit that the situation could arise, but as careful as I am, the lessons I have learned, and my body has always told me what needs to be done before things get out of hand.  Fortunate, yes, I am.

There are several sides to writing about a product in the development stage that I am trying to resolve in my mind. Before giving any more information, I would like your thoughts, please.

July 12, 2010

Vinegar and diabetes

Let me preface this post by saying “what works for you may not work for me”. When it comes to natural remedies, this statement is so true. If the cost is reasonable, as in the case of vinegar, why should not people at least see if it works for them.

While the only studies (only two and very small) are done by one person, Carol Johnston PhD from Arizona State University, Department of Nutrition, and these studies are held up by many people as fact. I will list several articles, but I can tell you that all cite the studies by Carol Johnston except article 5. Study one is here and study two is here.

Other articles citing Carol Johnston:

Article 1  By The American Diabetes Association (Surprise, as they are normally more conservative).
Article 2
Article 3
Article 4
Article 5

On the internet, there are many people with articles that portray vinegar as the natural remedy for diabetes, but do not list any studies. And for some people, some benefits are derived, but not for everyone. What is more interesting is the way people reference each other and keep referencing in a manner that seems very self-serving and have no basis backed by science. Even citing Carol Johnston would have made much more sense.

July 4, 2010

Roche Social Media Summit 2

As a new person at the 2010 Roche Social Media Summit I have to say that I was not sure of expectations. The programs went very well and the only disconnect was the AADE (American Association of Diabetes Educators).

Meeting fellow bloggers, people with diabetes, was a heartwarming experience and one that won't be forgotten. While I was looking forward to meeting other type 2's, it was educational finally meeting David Mendosa and Gretchen Becker, both of whom I have avidly read since diagnosis. It was a real treat meeting Charlie Cherry and Rachel Baumgartel and realizing that what I have been reading, is really them.

Researching on line is an enjoyment for me and realizing that there are others with information to share and all from a different background and interest has really fired me up. Finally meeting and talking to several of the type 1 PWD that I have corresponded with really helps and I hope that the information exchange can continue.

I know now that I need to read a few people more carefully and get to know them better from a personal standpoint. From the discussions that happened, I will say that all diabetes classifications were well represented, even those not in attendance. This year, it is my feeling that while everyone is cautious, there is much more open discussion and respect for both sides. Roche's discussion of what was learned at last year's summit did not disagree in substance with the blogs written by those attending then.

By the actions taken and material presented this year, the most value is the facilitation of open discussion by Roche between the American Diabetes Association and the on-line diabetes community. While it remains to be seen what will progress from this challenging discussion, there will be plenty of information to measure a year from now. I will say I am very pleased that there may be some real progress by the ADA in taking up the banner for the patients as well as the corporate side.

I will only say that I was very disappointed with the discussion by the American Association of Diabetes Educators and my opinion of this group only became more jaded. While I know a few very excellent people in the organization, their stature was not increased by the discussion. While I do not expect to see real progress this year, the idea of having people with diabetes in an educational role was an excellent idea raised by several attendees, and especially Cherise Shockley.

I don't know about the rest of those attending; however, the food committee did a superb, marvelous job. When I was asked by Roche for type of carb meal I preferred, I said moderate to low carb. The food was more than I expected and I was able to follow my plan of moderately low carb. For those involved, I appreciate your efforts! Thank you!

I was please to be one of the attendee's and extend my thanks to Lisa Huse and Todd Siesky for a job well done and to the rest of Roche's staff in attendance for their support.

Disclosure - Roche paid for transportation and lodging for two days and meals for one day.

June 25, 2010

Is summer heat affecting your diabetes supplies?

Do you know what to do during the heat of the summer to protect your diabetes supplies and equipment? A recent survey points out that about 60 percent of people with diabetes are not aware of the effects of heat on their oral diabetes medications, glucose meters, and glucose test strips. It appears that a large number also treat themselves and their diabetes with a similar degree of disrespect.

Even the three reports out of the meeting of the Endocrine Society all focused on slightly different aspects of the report. First, Endocrinetoday dot com reported on the habits and lack of daily care by those persons with diabetes. Sciencecentric dot com emphasized the problems faced by people with diabetes have of becoming dehydrated and not know what to do. Finally Sciencedaily dot com almost duplicated Sciencecentric, but stated that one out of five people did not take heat precautions until temperatures exceeded 100 degrees. Although parts are the same, you should read each article.

Since the full report will not be published until September 2010 in the Journal of Diabetes Science and Technology, most of the problems facing people with diabetes in the northern part of the US will have passed. I will commend them for putting out part of the details as summer begins. Yet every year, many people have the information available to them, but choose not to use the information until they have medical problems because of heat, or lose supplies, equipment, or medications to heat.

I blogged about heat/sun stroke part 1 (Apr 15) to part 6 (Apr 28) and know this may have been too early for some people to take seriously, but the heat of summer is here and we all need to be reminded again. Whether you live in Arizona where the study is conducted or in the northern part of the US, leaving your diabetes supplies in your vehicle on a hot day, will cause problems for your medications, testing supplies and equipment.

If you don't have coolers for carrying your insulin and diabetes supplies in for daily trips, you need to consider getting one. Also the Frio packs work well for protecting (from overheating and not freezing) your diabetes supplies in the summer and winter. Frio wallets can keep insulin safe for up to 45 hours. For wallets, just submerse them in cold water for five to fifteen minutes to activate. Frio Bags of varying sizes can also be purchased. Some drug chains carry them, but call beforehand. Or, search on line for Frio packs. These can be used for daily use to and from work, weekend daily excursions to your favorite park, and other trips.

For those of us with diabetes, we need to be aware that both insulin and oral medications are affected and can be rendered useless by heat. Heat will cause our test strips and meters to malfunction and quit.

The Joslin Diabetes Center also published “Five Tips for Caring for your Diabetes Supplies” They give excellent advice for caring for your meter, testing supplies, pump, and insulin plus being organized. I would only add for those with type 2 diabetes and not on insulin to take care of your oral medications and protect them from heat and freezing.

Care of your diabetes medications, supplies, and equipment is not something you will be able to ask your doctor about. Some may know, but this, like your diabetes is your responsibility as your doctor will not be with you when you forget and leave things in your hot car.

Now armed with the knowledge you need, get out and enjoy summer.

June 13, 2010

Non-diabetic Hypoglycemia

If you think this is about diabetes, you are mistaken. Food reactive hypoglycemia, reactive hypoglycemia, and hypoglycemia are all terms that have been used for a disease that is most often misdiagnosed. Diagnosis is often arrived at by the process of elimination. Low blood glucose is the culprit and hyperglycemia is not involved.

Why this on a blog about type 2 diabetes? Because I have a family member that has this. Even though there is a lot of misinformation (doesn't this sound familiar), there is a lot of good information available. The rule we use in discussions of diabetes of “what works for you, may not work for me” applies here as well. Not every solution will work for everyone.

The comparison between hypoglycemia and diabetes reveals many common similarities. While definitely not the same, both have no special diets available, although there are many who claim otherwise, and both have many people promoting their treatments as the only way. The largest difference is there is no gain to be had by the big pharmaceutical companies and as such hypoglycemia has no large research studies to define it or few ways to educate the medical community. See an endocrinologist for the greater chance of correct diagnosis.

Although this has not been conclusively proven, there appears to be several types of hyperglycemia. Reactive hypoglycemia and hypoglycemia are generally used interchangeably although they may not be identically the same and symptoms normally appear within four hours after eating. Food reactive hypoglycemia generally occurs at the start of eating and the quantity of insulin exceeds the need. And fasting hypoglycemia occurs when food is not eaten for what ever reason, illness is often the culprit. As of yet no genetic or DNA markers have been identified to hypoglycemia,

What are the symptoms? Some of them are:
  • fatigue
  • depression
  • anxiety
  • having trouble sleeping for nights on end or insomnia
  • headaches
  • personality changes rapidly
  • always hungry for something sweet
  • doctor says there is nothing wrong – I advise seeing an endocrinologist
  • dizziness
  • blurred vision
  • heavy sweating 
There are more, but many are just subcategories of the above.

There are many good sites available. I highly recommend the first two sites. .

1.Site one    Lots of pages to explore. Take time to read the surveys page.
2.Site two    Many more pages to explore.
3.Site three
4.Site four
5.Site five
6.Site six
7.Site seven
8.Site eight

For more sites and to do your own research type “reactive hypoglycemia” into a search engine and read. Many sites do not properly reflect a proper separation from diabetes and hypoglycemia in diabetes. Hopefully, I have presented a diverse group of sites to show that there are many sides to the discussion and that one size does not fit all.

While many still claim that hypoglycemia is not related to diabetes, many former patients do develop diabetes later in life and many have family members or relatives with diabetes, Others say that people with hypoglycemia do not develop coma, but sites four and eight above shows that it does need to be seriously considered.

I may have raised more questions than I have answered, but there is still much that needs to be learned about hypoglycemia, its variants, and control with nutrition. Good progress is being made and more needs to be done.

June 8, 2010

Cooking and Cookbooks – Diabetes Style

For people with diabetes, most look for carb count and fiber content. They think that maybe cookbooks with diabetic in the title are the answer. Most soon find out like I did that this route is not the answer. Many, if not most, have recipes that are not friendly to people with diabetes, most are too high in carbohydrates. These cookbooks masquerading as diabetic friendly exist for one purpose only. That is to extract money from unsuspecting newly diagnosed people with diabetes and their families. Unlike the Sears-Roebuck catalogs of old, they do not have a dual usage.

There are many websites that have good recipes, but many do not have the nutritional information with them. Some do, but often take much research to find them. I am aware of some of the diabetes forums that have a library of recipes. Some have nutritional information, but not the number of servings. Some have now gone the extra mile and made it possible to calculate the ingredients for varying servings. Two forums that have recipes with nutritional information and servings number are dLife and diabetes daily.

People should not overlook cookbooks that have been around for many years. Betty Crocker's Cookbook, ninth edition and later have the nutrition and servings number with each recipe. Better Homes and Gardens New Cookbook copyright 1996 and later has the nutritional information and includes the servings number. I have found these two cookbooks to be invaluable and have used them to approximate the nutritional value for some of the recipes in the older editions which I find to be healthier. While the older recipes often use ingredients sometimes not available on today's grocery shelves, most are available.

Another cookbook now available today is The Taste of Home Cookbook. Be sure to read the guidelines printed on the copyright page for how the nutritional data is calculated. I have tried to ask questions, but their editors have not felt it necessary to answer my emails. There may be other cookbooks that have the nutritional information and servings number; however, these are the only cookbooks in my collection that do.

When I use a recipe, I try to use those for two or three servings, realizing that I will need to cut that in half for me and possibly even more.  That makes a recipe that says serves two a recipe serving at least four or six.  I always plan on freezing a portion for use later.

There are more resources available to help you today than even ten years ago, so don't become discouraged and let denial get in your way of eating healthy for control of your diabetes. Alan Shanley, an outstanding blogger from Australia has some excellent pointers for people new and old to diabetes. Get started by following him here – be sure to follow his links to more information.  When a fellow blogger has excellent information, I don't like reinventing the wheel, so I will always recommend reading them.

There are other ways to determine the nutritional value. Here are a few sites to assist you.  On these sites you will need to join to be able to use their information.

1.Site one - There is a cost to join this site
2.Site two - I believe this one is free
3.Site three - This one is free

There are many nutrition and calorie calculators available on the web, just use caution and realize that you will not be 100% accurate as they all read from the same nutritional database and you may be off +/- 20%. Use your search engine and get started by typing in “nutrition calculator”.

And there is always the best way, using your meter to determine the serving size for you. And always follow the rule of what works for one person may not work for you.

If you don't like bland foods, check out my post of May 30, 2010. There will be more.

May 30, 2010

Avoiding the Bland Foods

Complaints about tasteless and bland food by other people with diabetes leaves me wondering how I got so lucky to have wonderful tasting food. No, not really, as I knew about herbs and spices. I was lucky to learn from some great cooks and what caused these foods to taste so wonderful. Spices and herbs can really create a royal taste for the palate.

The problem is many people pan fry their foods and dry them out, do not use spices or herbs, and thus they have bland, tasteless food. Many people forget about the crock pot or slow cooker, pressure cooker (the ones available today are very safe and useable and not like your grandmother's), and steam cookers. All, if used properly, can really make foods taste delicious.

Granted, some foods (but not many) are best fried. There are other ways of cooking some foods, including poached foods, stews and soups, and casseroles, some can be very low carb and loaded with flavor and nutrition. Then there are other ways of preparing foods, stir-frying, roasting, barbecuing, broiling, and baking.

There are a lot of ways, methods, and techniques that can be used to add flavor to foods. Spices and herbs are just two ingredients in the arsenal used by good cooks.

Storage, shelf-life, and refrigeration are part of what you need to know about the individual herbs and spices. Then you need to know which type(s) to use and with which foods. Here I am talking about dried, crushed, diced, ground, or other forms.

First, do not run out and buy a lot of different herbs and spices. Fresh herbs will not last but for a short time, about a week. Shelf-life of dried herbs and most spices varies from about six months to one year. Some spices like garlic vary with storage requirements. Crushed, diced, and minced garlic require refrigeration after opening, while garlic cloves and powdered garlic can be stored in a cool dry place.

Herbs and spices definitely lose their potency with age, and seeds such as poppy and sesame will get rancid. Most whole herbs and spices will retain their flavor about 1 year, dried and ground versions are best used within 6 months.

In many home kitchens, herbs and spices are stored on shelves above the stove or along side the stove. These locations are not good for shelf-life and the heat and humidity will shorten the life to a matter of days for some herbs and spices. Spices and herbs not requiring refrigeration should be stored in a cool, dark, and dry area away from the stove or oven. I strongly suggest only having those that you use regularly available near the stove and that will not be affected by heat and humidity.

For complete information, you should check out books about herbs and spices. You do not need books containing recipes using spices unless this is your way of learning.

Mainly, you should check your local library first, or Amazon.com for one of the following books.

Book one, is The Complete Idiot's Guide to Spices and Herbs [Paperback]. This is a straight forward book with no pictures. This is very similar (looking at the table of contents) to one that I had ten years ago, but have lost.

Book two, is The Spice and Herb Bible [Paperback]. This book is written by Ian "Herbie" Hemphill, an Australian with over four decades of working in the spice and herb business. This colorful 608-page book (with photographs) is a comprehensive book of information about virtually any spice and herb. He has traveled all over the world to identify and introduce the most unique and exotic herbs and spices. He serves his customers at his popular Herbie's Spices store in Sydney, Australia.

Book three, is Herbs & Spices: The Cook's Reference [Hardcover]. This book has appeal for home and professional cooks, and for gardeners. It is filled with photographic illustrations. Each herb and spice lists what parts are utilized, where it can be purchased, how to grow it and how to harvested it. The book has a flavor profile of the herbs and spices, a history, common cooking techniques, recipes, herb blends, and food pairings.

Before investing in any of the books, check your local library. I also suggest going to Amazon.com and finding the books. Then on each book, find the “click to look inside” and move the cursor over this area, then select table of contents to click on. Explore other areas you desire and read the reviews. Except for the last one, there are normally good and bad reviews.

Some articles for reading one by Peggy Trowbridge Filippone, and this one. All have excellent tips for spices and herbs.

And please do not forget ethnic spices and ethnic cooking!