This is a big one folks! I don't normally follow the Mayo Clinic that closely, but I do read one area, the Expert Blog under Diabetes.
On Monday the 13th, Scott Johnson wrote about the Mayo Clinic entering the social media. This link takes you to it. Thank you Scott. And they are not doing social media small time. This is big time!
Now I want to hear what the doctors have to say. Most will ignore you while they grimace big time. They don't want to hear it. Now they had better listen when the Mayo Clinic gets running full time and full out. Their mission statement is pretty bold and all encompassing.
The official opening is scheduled for September to coincide with Mayo's hosting of its second Social Media Summit in collaboration with Ragan Communications, September 27 to 29 at the Mayo Clinic's Jacksonville, Florida campus. However, it is up and usable now.
This is one website that I will need to check on a regular basis as there are many directions it could expand. Take time to explore the home page and what they are already involved in on YouTube, Twitter, Blogs, Facebook, and other areas. This is below the video. Explore the entire website!
September 14, 2010
September 13, 2010
More of Dangerous Myths – Myths Part 3
Some of the most dangerous problems happen to those who will not use insulin because they have heard some of the lies put forth by the people against insulin. Others originate from people who associate insulin with problems a relative had because of poor or no diabetes management.
These lies are:
1. Insulin causes blindness, amputations, and kidney failure.
2. Insulin causes sterility and sexual dysfunction.
3. Insulin use is the beginning of the end.
4. Insulin is toxic.
5. Insulin use will label me as a drug addict.
6. Insulin causes weight gain.
7. Insulin use will cause insulin shock (now termed hypoglycemia).
8. Insulin use is an inconvenience.
9. Insulin use is resisted by physicians and patients.
What causes items 1, 2, and 3 above is poor to no management of diabetes. Many people that do not manage their diabetes can have blindness, amputations, kidney failure, sterility and sexual dysfunction, and be near the end because they have not controlled their diabetes. Those that tightly manage their diabetes can live long and often healthier lives, with or without insulin.
Insulin is not toxic for the majority of people. However, some people do have allergies to some insulins. This is the only time insulin can be considered toxic.
Number five generally is not a problem; however, I have been questioned by the police about my use of syringes. Fortunately I had the insulin there and the pharmacy RX on the box and after checking, the officer was very polite.
Number six is difficult as initially the increased control insulin can give causes for some weight gain as the cells can now utilize the glucose. However, it is important for for those starting insulin to meet with a dietitian that understands diabetes and can provide guidance in nutrition and food choices. They also need education on counting carbohydrates and adjusting insulin to carbohydrates to prevent hypoglycemia.
This is also how to prevent number seven from occurring. Also the education needs to include the warning symptoms of hypoglycemia and how to test and resolve the problem with the appropriate glucose medication or other fast acting foods, mostly fruit juices.
Number eight can be a problem if you let it be a problem. It does take some adjustment and possible change in environment to manage your diabetes, but your health is more important than an inconvenience. Just remember that preventing the complications of diabetes is worth the effort.
Number nine is true because many doctors and patients resist the use of insulin for various reasons or myths. Often the doctors go along with the threat idea because patients will more readily follow the oral medications route. Often the doctors do not want to spend the time to educate their patients on the use of insulin and are worried about hypoglycemia becoming a problem on insulin.
Sometimes the doctors know that their patients cannot afford the cost of insulin. But most doctors and patients do not take into account the true cost effectiveness of each treatment. Not only are some of the oral medications costly, but the success of oral medications is not always the best when compared to insulin. Also, not everyone can get excellent control with oral medications. A few medical professionals are also not aware that some oral medications when used by themselves or in combinations will cause hypoglycemia.
For me, insulin is the only way that I will probably be able to retain some insulin production from my pancreas. Many people that go the oral medications route only, end up with a pancreas that wears itself out and can no longer produce insulin, forcing the use of insulin. I know that mine still works and that I have to be very careful when I have been able to exercise, or have had to work extra when moving from one apartment to another. I know that I will go low, need to test more often, and reduce the amount of insulin drastically for several days or even a couple of weeks.
I have also found out in the last month what an illness can do to me. I have needed to reduce my insulin usage and now that I am spending time bicycling regularly, I have needed to reduce my insulin further as my pancreas is almost producing more than I can use. A fine turn of events for me, but not one I expected as I still have to lose much more weight, but I will take what I am given. My insulin resistance has obviously dropped, but that could return at any time. So in the meantime, I am testing more often and enjoying life.
There are many more myths, but this will be the last in this series for now.
Articles used in the above:
Site 1, Site 2, Site 3. Sorry - the links have been broken - discovered 8/8/14.
These lies are:
1. Insulin causes blindness, amputations, and kidney failure.
2. Insulin causes sterility and sexual dysfunction.
3. Insulin use is the beginning of the end.
4. Insulin is toxic.
5. Insulin use will label me as a drug addict.
6. Insulin causes weight gain.
7. Insulin use will cause insulin shock (now termed hypoglycemia).
8. Insulin use is an inconvenience.
9. Insulin use is resisted by physicians and patients.
What causes items 1, 2, and 3 above is poor to no management of diabetes. Many people that do not manage their diabetes can have blindness, amputations, kidney failure, sterility and sexual dysfunction, and be near the end because they have not controlled their diabetes. Those that tightly manage their diabetes can live long and often healthier lives, with or without insulin.
Insulin is not toxic for the majority of people. However, some people do have allergies to some insulins. This is the only time insulin can be considered toxic.
Number five generally is not a problem; however, I have been questioned by the police about my use of syringes. Fortunately I had the insulin there and the pharmacy RX on the box and after checking, the officer was very polite.
Number six is difficult as initially the increased control insulin can give causes for some weight gain as the cells can now utilize the glucose. However, it is important for for those starting insulin to meet with a dietitian that understands diabetes and can provide guidance in nutrition and food choices. They also need education on counting carbohydrates and adjusting insulin to carbohydrates to prevent hypoglycemia.
This is also how to prevent number seven from occurring. Also the education needs to include the warning symptoms of hypoglycemia and how to test and resolve the problem with the appropriate glucose medication or other fast acting foods, mostly fruit juices.
Number eight can be a problem if you let it be a problem. It does take some adjustment and possible change in environment to manage your diabetes, but your health is more important than an inconvenience. Just remember that preventing the complications of diabetes is worth the effort.
Number nine is true because many doctors and patients resist the use of insulin for various reasons or myths. Often the doctors go along with the threat idea because patients will more readily follow the oral medications route. Often the doctors do not want to spend the time to educate their patients on the use of insulin and are worried about hypoglycemia becoming a problem on insulin.
Sometimes the doctors know that their patients cannot afford the cost of insulin. But most doctors and patients do not take into account the true cost effectiveness of each treatment. Not only are some of the oral medications costly, but the success of oral medications is not always the best when compared to insulin. Also, not everyone can get excellent control with oral medications. A few medical professionals are also not aware that some oral medications when used by themselves or in combinations will cause hypoglycemia.
For me, insulin is the only way that I will probably be able to retain some insulin production from my pancreas. Many people that go the oral medications route only, end up with a pancreas that wears itself out and can no longer produce insulin, forcing the use of insulin. I know that mine still works and that I have to be very careful when I have been able to exercise, or have had to work extra when moving from one apartment to another. I know that I will go low, need to test more often, and reduce the amount of insulin drastically for several days or even a couple of weeks.
I have also found out in the last month what an illness can do to me. I have needed to reduce my insulin usage and now that I am spending time bicycling regularly, I have needed to reduce my insulin further as my pancreas is almost producing more than I can use. A fine turn of events for me, but not one I expected as I still have to lose much more weight, but I will take what I am given. My insulin resistance has obviously dropped, but that could return at any time. So in the meantime, I am testing more often and enjoying life.
There are many more myths, but this will be the last in this series for now.
Articles used in the above:
Site 1, Site 2, Site 3. Sorry - the links have been broken - discovered 8/8/14.
September 8, 2010
Medic alert jewelry – pros and cons
In my previous blog about whether to wear medic alert jewelry, I said the pros and cons were for another blog.
As with any jewelry, you should consider your lifestyle and how often you have accidents with your jewelry. Medic Alert jewelry fits the same criteria. Find something that is practical and fits with your lifestyle.
Bracelets
– pros – can be worn on either arm, some even wear them as ankle bracelets. Some models are very stylish while others can be over the top depending on your budget.
- cons – people do catch them on things and they do come off at inopportune
times.
Necklaces or Dog tags
– pros – many men find necklaces more acceptable as they are covered by clothing and for some dog tags fit the bill.
- cons – while most will break if caught on something, but they can leave nasty scars.
Cards
– pros – easy to carry, can easily be updated.
- cons – easily lost, misplaced, stolen.
Shoe tags
- pros – may not be as noticeable, pant cuffs may cover.
- cons – can easily be lost, removed, or stolen.
Sports bands
- pros – see bracelets for pros and cons.
Watches
- pros - are practical and many of us do wear them.
- cons – are more expensive than many of us can afford to wear.
The above are just six of the possibilities. With Medic Alert, a card comes with any piece of jewelry so it makes sense to use them both.
One caution for those wearing necklaces – they must be removed by personnel administering a defibrillator. This must be done to prevent burns as well as other metal worn as part of clothing. Yes, women, I am talking about under-wire bras.
Other than those that believe big brother is watching and will never use an medical microchip, they could become a good thing for people with chronic diseases. The information could be stored and retrieved by readers. One problem is that many companies will want a piece of the action and their microchips will be encoded slightly different from another company so they can also sell their microchip readers. This will need federal regulation to prevent this from happening. Imagine a person from the East traveling to the Southwest part of the US and needing medical assistance, but the reader used there does not read to microchip from the East. Not good.
I personally would not like to see federal regulation, but our companies have a big habit of trying to be competitive and want to dominate the market and not cooperate when it comes to health care or assisting people with chronic illnesses. If they could cooperate, it could be good for all parties.
Another idea I mentioned is a sticker that could be displayed in a vehicle window or have a symbol on the license plate. This could be a large help to our police in knowing that something could be wrong.
An idea that I want to explore is a decal or sticker that could be placed where it would not be missed just inside the apartment and or the same for the main entrance to a house.
As with any jewelry, you should consider your lifestyle and how often you have accidents with your jewelry. Medic Alert jewelry fits the same criteria. Find something that is practical and fits with your lifestyle.
Bracelets
– pros – can be worn on either arm, some even wear them as ankle bracelets. Some models are very stylish while others can be over the top depending on your budget.
- cons – people do catch them on things and they do come off at inopportune
times.
Necklaces or Dog tags
– pros – many men find necklaces more acceptable as they are covered by clothing and for some dog tags fit the bill.
- cons – while most will break if caught on something, but they can leave nasty scars.
Cards
– pros – easy to carry, can easily be updated.
- cons – easily lost, misplaced, stolen.
Shoe tags
- pros – may not be as noticeable, pant cuffs may cover.
- cons – can easily be lost, removed, or stolen.
Sports bands
- pros – see bracelets for pros and cons.
Watches
- pros - are practical and many of us do wear them.
- cons – are more expensive than many of us can afford to wear.
The above are just six of the possibilities. With Medic Alert, a card comes with any piece of jewelry so it makes sense to use them both.
One caution for those wearing necklaces – they must be removed by personnel administering a defibrillator. This must be done to prevent burns as well as other metal worn as part of clothing. Yes, women, I am talking about under-wire bras.
Other than those that believe big brother is watching and will never use an medical microchip, they could become a good thing for people with chronic diseases. The information could be stored and retrieved by readers. One problem is that many companies will want a piece of the action and their microchips will be encoded slightly different from another company so they can also sell their microchip readers. This will need federal regulation to prevent this from happening. Imagine a person from the East traveling to the Southwest part of the US and needing medical assistance, but the reader used there does not read to microchip from the East. Not good.
I personally would not like to see federal regulation, but our companies have a big habit of trying to be competitive and want to dominate the market and not cooperate when it comes to health care or assisting people with chronic illnesses. If they could cooperate, it could be good for all parties.
Another idea I mentioned is a sticker that could be displayed in a vehicle window or have a symbol on the license plate. This could be a large help to our police in knowing that something could be wrong.
An idea that I want to explore is a decal or sticker that could be placed where it would not be missed just inside the apartment and or the same for the main entrance to a house.
September 7, 2010
Open request to all type 2 people
As of now I have published all that I have permission to publish. I wish more would have responded to my request to publish their information. I will not publish without permission. I still have a lot of requests out and will continue requesting if I find new sites. Information will be added as I get it plus new URL's will be added for people.
I am not sure why people have not responded, either they have very tight control on their email and my emails were routed to spam, or have chosen not to participate. At some future date I may list the URL's only without any other information, but I really don't want to do this.
If you have been missed, are a person with type 2 diabetes, and want to be included, please go to my blog profile page and email me.
If you can help, please let me know. The lists are presently all here.
I am not sure why people have not responded, either they have very tight control on their email and my emails were routed to spam, or have chosen not to participate. At some future date I may list the URL's only without any other information, but I really don't want to do this.
If you have been missed, are a person with type 2 diabetes, and want to be included, please go to my blog profile page and email me.
If you can help, please let me know. The lists are presently all here.
September 3, 2010
To wear or not to wear a medic alert ID
Many people on the forums are asking about wearing a medic alert bracelet or carrying a medic alert card.
First, there is nothing that requires that you wear anything. Now that I've written that, I would like to give you a few reasons for wearing one.
Every day, somewhere in the USA, an officer of the law stops someone that appears or acts like they have had too much to drink. While many are overly full of the spirits, some are having hypoglycemia. Since the symptoms are very similar, erratic driving, slurred speech, etc., they often get locked up in the local jail. Some have problems and actually go into a diabetic coma, a few die, and others are able hang on until someone recognizes that they have hypoglycemia and they get treatment. Not the outcome that is desired for all concerned.
To begin with, people should test their blood glucose (BG) before turning the key in their car. If they are below a certain number, they should take a glucose tablet or more and retest at 15 minute intervals. When the BG is at an acceptable level, then they can drive. The only people that should be exempted from this requirement are people that are able to control their diabetes with nutrition and exercise or that the doctor has given a written permission to drive without testing because the medications they are on will not cause lows – which are very few. Many or in reality most oral medications can and will cause hypoglycemia especially when in combinations. Insulin will cause hypoglycemia.
A few states are starting to recognize this problem and are treating these people like drunk drivers and fining them and suspending their drivers licenses. I honestly hope more states follow suit. There are far too many accidents resulting in deaths caused by people with hypoglycemia. And we should take this seriously.
Now, I have to attack our insurance industry for their restrictions on covering testing supplies. People that drive a lot, should not need to be afraid of testing as often as needed nor have constraints from an insurance company that because they are people with type 2 diabetes, they should only be allowed to test twice a day. If they are on oral medications that can cause lows, they need to test more often. Of course if they are on insulin, they are allowed more testing supplies, but this still may not be enough if this person does a lot of driving. This is where a doctors orders should be allowed to increase testing supplies when needed and insurance companies should allow for these cases.
This is probably one of the biggest reasons to wear a medic alert bracelet. Some will say necklace, and others will say carry a card. A few will say that they want tattoos with the information in them. Another item to consider is a medical identification microchip as is being promoted in some parts of the country. All are reasonable and all should be considered and even in possible combinations. There are pros and cons for each, but this is a topic for another blog. I would also suggest that a medic alert sticker should be available for motor vehicles that would be visible to law enforcement.
The State of Iowa at their Police Training Academies does cover many of the medical topics since our state trains them to be first responders for all 911 situations. Hypoglycemia is one of the topics covered as is hyperglycemia.
In my talks with the local police department and ambulance service manned by Emergency Medical Technicians and paramedics, all have been in agreement that they look for medic alert bracelets, necklaces, and cards. Normally the police are first on the scene and if the patient is conscious they ask questions and if unconscious, look to get information as quickly as possible from medical alert jewelry and contact sources as rapidly as possible. This way when the paramedics, (EMT's) arrive, they have as much information as possible for them to better preform their duties.
They are trained to look for glucose tablets, orange juice, or other items that can quickly raise blood glucose or be prepared the inform the EMT's that glucose need to be administered with the IV. But they cannot do this unless they have the medic alert information available. They even suggest having medical data in the refrigerator in plain view as some people have had.
It is surprising how many people with diabetes do not even consider wearing medic alert jewelry and won't. Probably because they are wanting to be private about their diabetes. I say that this is a poor reason and you life may depend on people being able to get information quickly when it may be your life that is at stake.
I have been wearing a necklace with information on a pendant, but after reading more in preparation for this blog, I am going to get a medic alert bracelet and get registered with Medic Alert Advantage program for $30 per year with a $9.95 initial set up fee. I am not sure which jewelry I will select yet, but this is on my to-do-immediately list. I do encourage everyone with diabetes to do the same. It could be a lifesaving move. There is other medical alert jewelry, but none is part of the system by Medic Alert Organization.
You need to talk to your local ambulance service and police department in your state to find out how they handle these situations. It could save your life.
First, there is nothing that requires that you wear anything. Now that I've written that, I would like to give you a few reasons for wearing one.
Every day, somewhere in the USA, an officer of the law stops someone that appears or acts like they have had too much to drink. While many are overly full of the spirits, some are having hypoglycemia. Since the symptoms are very similar, erratic driving, slurred speech, etc., they often get locked up in the local jail. Some have problems and actually go into a diabetic coma, a few die, and others are able hang on until someone recognizes that they have hypoglycemia and they get treatment. Not the outcome that is desired for all concerned.
To begin with, people should test their blood glucose (BG) before turning the key in their car. If they are below a certain number, they should take a glucose tablet or more and retest at 15 minute intervals. When the BG is at an acceptable level, then they can drive. The only people that should be exempted from this requirement are people that are able to control their diabetes with nutrition and exercise or that the doctor has given a written permission to drive without testing because the medications they are on will not cause lows – which are very few. Many or in reality most oral medications can and will cause hypoglycemia especially when in combinations. Insulin will cause hypoglycemia.
A few states are starting to recognize this problem and are treating these people like drunk drivers and fining them and suspending their drivers licenses. I honestly hope more states follow suit. There are far too many accidents resulting in deaths caused by people with hypoglycemia. And we should take this seriously.
Now, I have to attack our insurance industry for their restrictions on covering testing supplies. People that drive a lot, should not need to be afraid of testing as often as needed nor have constraints from an insurance company that because they are people with type 2 diabetes, they should only be allowed to test twice a day. If they are on oral medications that can cause lows, they need to test more often. Of course if they are on insulin, they are allowed more testing supplies, but this still may not be enough if this person does a lot of driving. This is where a doctors orders should be allowed to increase testing supplies when needed and insurance companies should allow for these cases.
This is probably one of the biggest reasons to wear a medic alert bracelet. Some will say necklace, and others will say carry a card. A few will say that they want tattoos with the information in them. Another item to consider is a medical identification microchip as is being promoted in some parts of the country. All are reasonable and all should be considered and even in possible combinations. There are pros and cons for each, but this is a topic for another blog. I would also suggest that a medic alert sticker should be available for motor vehicles that would be visible to law enforcement.
The State of Iowa at their Police Training Academies does cover many of the medical topics since our state trains them to be first responders for all 911 situations. Hypoglycemia is one of the topics covered as is hyperglycemia.
In my talks with the local police department and ambulance service manned by Emergency Medical Technicians and paramedics, all have been in agreement that they look for medic alert bracelets, necklaces, and cards. Normally the police are first on the scene and if the patient is conscious they ask questions and if unconscious, look to get information as quickly as possible from medical alert jewelry and contact sources as rapidly as possible. This way when the paramedics, (EMT's) arrive, they have as much information as possible for them to better preform their duties.
They are trained to look for glucose tablets, orange juice, or other items that can quickly raise blood glucose or be prepared the inform the EMT's that glucose need to be administered with the IV. But they cannot do this unless they have the medic alert information available. They even suggest having medical data in the refrigerator in plain view as some people have had.
It is surprising how many people with diabetes do not even consider wearing medic alert jewelry and won't. Probably because they are wanting to be private about their diabetes. I say that this is a poor reason and you life may depend on people being able to get information quickly when it may be your life that is at stake.
I have been wearing a necklace with information on a pendant, but after reading more in preparation for this blog, I am going to get a medic alert bracelet and get registered with Medic Alert Advantage program for $30 per year with a $9.95 initial set up fee. I am not sure which jewelry I will select yet, but this is on my to-do-immediately list. I do encourage everyone with diabetes to do the same. It could be a lifesaving move. There is other medical alert jewelry, but none is part of the system by Medic Alert Organization.
You need to talk to your local ambulance service and police department in your state to find out how they handle these situations. It could save your life.
August 29, 2010
Pre-diabetes vs what?
Some bloggers have done an excellent job of defining pre-diabetes. Our professionals have said that 126 and greater is diabetes and 125 and lower is pre-diabetes. This makes for a good reference point; however, I am not willing to accept that the numbers are right or wrong.
Many doctors are doing us a disservice when they do not investigate further. Tom Ross got me to thinking in his blog of Aug 16, 2010. My thoughts before were - either it is or it isn't diabetes. I still cling to this because I do not like what our medical community is doing with the term pre-diabetes. Patients are not being properly informed nor educated about what to do to prevent or at least delay for the short or long-term, the progress of diabetes.
At the same time, Tom is right that being arbitrary does nothing to improve the situation as both do have problems with blood glucose control or a pancreas that is not able to react properly as it needs to.
A large problem is that our insurance will not cover anything that is less than 126, but will at 126 and above. To them if you are below 126, you do not have diabetes and therefore most insurance companies will deny your claims. But that is fodder for another blog.
Bob Pedersen does very well to lay out his case. He does not accept the analogy some have loosely used about the woman being a little bit pregnant and applying this to diabetes. I like the analogy and I will use it as I believe above 100 to be indicative of diabetes.
Michael Hoskins does not like the term “pre-diabetes” and I agree with him. Why? The medical community is too quick to use terms that let themselves off the hook for not following recommended procedures. This is where Tom's line of thought becomes important. Arbitrary values often miss the underlying problems that our pancreas is having problems that need to be addressed. And our medical community does little to address this issue other that saying that below 126 you have pre-diabetes and often leaving the patient to wonder what that means.
They leave the doctor's office wondering just what the doctor was talking about and why if it is serious, didn't the doctor issue a prescription to help control things or give them more information to make a sound decision of their own about halting the progression to diabetes and larger future problems.
To many the term pre-diabetes is more descriptive that “borderline diabetes” and I have no quarrel here. I will continue to disapprove of the term pre-diabetes and hope that another term, label, or description will evolve that defines the area that means that diabetes is likely and causes doctors to better inform their patients about the seriousness of their medical status.
Now with this written, we should all take the time to read a book by Gretchen Becker titled “What You Need to Know to Keep Diabetes Away – Prediabetes”. She writes an excellent discussion of diabetes and why we get it or don't, and why we should take the steps necessary to prevent diabetes from developing. If you are likely to get diabetes, Gretchen tells us what to do to postpone it from developing or to do for early control to delay the onset of complications for many years.
After reading Gretchen's book, if you decide to use the term Prediabetes, then I will say that you at least have a more thorough understanding of the term.
Even more important is Dr. Bill Quick's blog published August 22, 2010. In it he discusses the various medications being studied for use to treat prediabetes. As of then, there are no medications approved by the Federal Drug Administration (FDA) for the treatment of prediabetes.
Dr. Quick uses the term “off label” to describe the use of diabetes medications being used by patients before diagnosis of diabetes that insurance does not cover and therefore is at the patient's expense. These medications are also not approved by the FDA for use by these patients. His blog is worth reading.
So while the term “prediabetes” is not an official designation by the American Diabetes Association, it is appearing more and more in blogs, articles, and print both on and off the internet. Either the ADA should recognize this term or preferably designate another term which reflects the seriousness of those that are not classified as type 2 diabetes.
Tom Ross is correct in his analysis that below 126 blood glucose readings do indicate cause for concern as the pancreas is not functioning like it should and this needs to be taken seriously.
I am feeling much happier after the article from the August 25 issue of WebMD. The term prediabetes has been discredited by a consensus panel of diabetes experts. I know that this is not the end of the discussion, but the new approach recommended does make good sense. However, the author of the article does not agree and several of the comments agree with him.
I have a feeling that this debate will continue for some time until the American Diabetes Association starts exercising and gets off their lazy sedentary backside and makes a decision. They do not realize how many doctors are not taking numbers below 126 seriously. It is no wonder the patients don't understand.
Many doctors are doing us a disservice when they do not investigate further. Tom Ross got me to thinking in his blog of Aug 16, 2010. My thoughts before were - either it is or it isn't diabetes. I still cling to this because I do not like what our medical community is doing with the term pre-diabetes. Patients are not being properly informed nor educated about what to do to prevent or at least delay for the short or long-term, the progress of diabetes.
At the same time, Tom is right that being arbitrary does nothing to improve the situation as both do have problems with blood glucose control or a pancreas that is not able to react properly as it needs to.
A large problem is that our insurance will not cover anything that is less than 126, but will at 126 and above. To them if you are below 126, you do not have diabetes and therefore most insurance companies will deny your claims. But that is fodder for another blog.
Bob Pedersen does very well to lay out his case. He does not accept the analogy some have loosely used about the woman being a little bit pregnant and applying this to diabetes. I like the analogy and I will use it as I believe above 100 to be indicative of diabetes.
Michael Hoskins does not like the term “pre-diabetes” and I agree with him. Why? The medical community is too quick to use terms that let themselves off the hook for not following recommended procedures. This is where Tom's line of thought becomes important. Arbitrary values often miss the underlying problems that our pancreas is having problems that need to be addressed. And our medical community does little to address this issue other that saying that below 126 you have pre-diabetes and often leaving the patient to wonder what that means.
They leave the doctor's office wondering just what the doctor was talking about and why if it is serious, didn't the doctor issue a prescription to help control things or give them more information to make a sound decision of their own about halting the progression to diabetes and larger future problems.
To many the term pre-diabetes is more descriptive that “borderline diabetes” and I have no quarrel here. I will continue to disapprove of the term pre-diabetes and hope that another term, label, or description will evolve that defines the area that means that diabetes is likely and causes doctors to better inform their patients about the seriousness of their medical status.
Now with this written, we should all take the time to read a book by Gretchen Becker titled “What You Need to Know to Keep Diabetes Away – Prediabetes”. She writes an excellent discussion of diabetes and why we get it or don't, and why we should take the steps necessary to prevent diabetes from developing. If you are likely to get diabetes, Gretchen tells us what to do to postpone it from developing or to do for early control to delay the onset of complications for many years.
After reading Gretchen's book, if you decide to use the term Prediabetes, then I will say that you at least have a more thorough understanding of the term.
Even more important is Dr. Bill Quick's blog published August 22, 2010. In it he discusses the various medications being studied for use to treat prediabetes. As of then, there are no medications approved by the Federal Drug Administration (FDA) for the treatment of prediabetes.
Dr. Quick uses the term “off label” to describe the use of diabetes medications being used by patients before diagnosis of diabetes that insurance does not cover and therefore is at the patient's expense. These medications are also not approved by the FDA for use by these patients. His blog is worth reading.
So while the term “prediabetes” is not an official designation by the American Diabetes Association, it is appearing more and more in blogs, articles, and print both on and off the internet. Either the ADA should recognize this term or preferably designate another term which reflects the seriousness of those that are not classified as type 2 diabetes.
Tom Ross is correct in his analysis that below 126 blood glucose readings do indicate cause for concern as the pancreas is not functioning like it should and this needs to be taken seriously.
I am feeling much happier after the article from the August 25 issue of WebMD. The term prediabetes has been discredited by a consensus panel of diabetes experts. I know that this is not the end of the discussion, but the new approach recommended does make good sense. However, the author of the article does not agree and several of the comments agree with him.
I have a feeling that this debate will continue for some time until the American Diabetes Association starts exercising and gets off their lazy sedentary backside and makes a decision. They do not realize how many doctors are not taking numbers below 126 seriously. It is no wonder the patients don't understand.
August 27, 2010
Are you really ready if disaster strikes?
If mother nature goes on a rampage, are you prepared to take immediate action? Do you have a plan available to follow for most any situation mother nature or other natural disaster throws at you? For people with diabetes, this also means protecting your health.
Create a support network so that these people know what to do and what is expected. You need to have people you can rely on. People that will check on you and provide assistance if you are in need. Make sure that at least one person lives in a different town that will not be affected so that person can relay information and provide other assistance.
Be sure to know your needs.
If you need help creating your plan, contact your local chapter of the American Red Cross or emergency management office.
If you are instructed to take shelter immediately, do so.
If you are instructed to evacuate,
Create a support network so that these people know what to do and what is expected. You need to have people you can rely on. People that will check on you and provide assistance if you are in need. Make sure that at least one person lives in a different town that will not be affected so that person can relay information and provide other assistance.
Be sure to know your needs.
- This should be a large part of your plan. Know what you will be able to do for yourself and what others will need to do for you. You need to consider the potential changes to the environment.
- Will you need help with personal care and is there special equipment you will need to be taken care of or take care of yourself?
- Will you be able to handle things if the water is cut off or you are unable to boil or heat it for several days?
- Will you need special cooking utensils to prepare food?
- Do you have special equipment that requires electricity and how will an electrical outage affect you?
- Will you be able to handle debris in and around your home and along your exit route?
- Will you need special transportation?
- Do you have a caregiver? Will you be able to do without this person or what type of help will you need?
- If there is an evacuation, what special arrangements will you need to leave your location?
- If you live in a building with an elevator, can you use the stairs? Do you know where the alarms are and can you reach them?
- This requires well thought plans. How will you communicate and call for help if you are hearing and/or visually impaired and your traditional methods are not working and/or not available? i.e., your hearing aid gets wet, you don't have an interpreter, and other sources are not available?
- If you need ramps, what will you do if they are unavailable, damaged, or inoperable?
- If you have a service dog, how will you care for it? Is there someone else who can provide care for the animal if you are unable to care for it? Do you have the necessary licenses updated and available so you will be permitted to keep your service dog in a shelter or other location outside your home?
- After you prepare your inside the residence plan, look outside your home to the community at large,
- Find out what types of disasters are most likely,
- Find out what hazards exist,
- Find out what risks you are facing,
- To find out about hazards in your local area, go to http://www.fema.gov/hazard/map/index.shtm, may not be the best, but previous link no longer exists.
- In addition to hazards, know your community response plans and what transportation will be available in the event you are in need of this assistance,
- Also, learn how local authorities will warn you of possible disaster and how they will supply information during and after the disaster,
- Learn about NOAA Weather Radio and its alerting capabilities at www.noaa.gov., and have a weather radio where you can use it and keep fresh batteries on hand for it.
If you need help creating your plan, contact your local chapter of the American Red Cross or emergency management office.
Make Sure You Have a Plan.
While it is not possible to plan for every contingency and even the best plans can fail, once you have created your primary plan, have an alternate prepared in order to ensure your safety.
- Review your plan(s) with your family members or others you will depend on.
- Agree on a meeting place.
- Create a communications plan, which will include all phone numbers for family members, your support network, your out-of-town contacts, caregivers, and places you frequent such as work or school.
- Know the best escape routes and places of safety. Assess these locations both inside and outside of your home.
- Make a plan for your pets and/or service animals. If you need to keep your service animal with you, determine which places are animal friendly before-hand and make a list that includes these places as well as others who may be able to care for your pet in case you are unable to. i.e. friends, family members, local veterinarians, etc.
If you are instructed to take shelter immediately, do so.
If you are instructed to evacuate,
- Try to make your first option staying with family or friends, as they know you and your needs best and may best be able to accommodate you.
- Emergency public shelters can be your next option as a source of shelter and food, but not personal health care.
- If you have a caregiver and have to go to shelter, it will be best to bring the caregiver with you.
- Listen to the radio or television for the location of emergency shelters. Note those that are accessible to those with physical disabilities and those that have other disability friendly assistance features such as TTY lines. Hopefully you own a radio that is battery operated and you have fresh batteries on hand if power is off.
- Inform members of your support network and out-of-town contact of your intentions and intended destination plus approximate time table.
- Shut off water, gas, and electricity if instructed to do so, if the shut-off places are available to you, and if time permits.
- Wear appropriate clothing and sturdy shoes.
- Take your disaster and diabetes supplies kits.
- Lock your home, apartment, or other place of residence.
- Use travel routes specified by local authorities and not shortcuts because certain areas may be impassable or dangerous.
- Confirm upon arrival at an emergency shelter that it can meet your special care needs.
- Inform members of your support network and out-of-town contact of your location and status.
Now that you have a plan for your residence and your community, now think of your corner of the world. Depending on where you live, are you able to handle natural disasters like earthquakes, tsunamis, hurricanes, tornadoes, wildfires, winter blizzards, and other potential disasters.
Disaster is not predictable, but you still need to be prepared. While the above may not be your plan exactly, it does give you a guide and a place to start. A lot of the planning needs to fit your health and abilities to do some tasks.
Note: The above was adapted from FEMA and other sources and may not fit your situation completely.
Remember that you need to plan for your area, and for the complete year.
August 23, 2010
Seek the advice of your doctor or medical team
Why am I quoting from Tom Ross so much? Because I don't like reinventing the wheel and what he says make a lot of sense. You should read many of his blogs. For someone that has been able to stay off medications after diagnosis, this by itself speaks volumes. This alone should cause you to want to read his site here. Click on the colored text to follow the link. And yes, I am promoting a fellow blogger's site for several reasons, first to give you a challenge to take your diagnosis seriously and realize that some things are definitely possible and to encourage you to take charge of your diabetes. The following is from near the bottom of his home page.
Begin quote: But first: check with your doctor. Please bear in mind that I am not your doctor. In fact... well, don't tell anyone, but I'm not a doctor at all. The only reason you have for taking my advice seriously is that I have been very successful in managing my own diabetes without medication. This suggests that I am doing something right, but it really doesn't prove that I know what I'm talking about, does it?
Therefore, if you decide to take my my advice, I'm honored, but I want you to discuss it with your doctor, too. Or perhaps I ought to say that you should discuss it with your "health care team". This phrase turns up often in diabetes literature, to my puzzlement. Does everyone but me have a team? I have a doctor, but he works solo. Perhaps the other members of my team were benched for some infraction of the rules.
Anyway, see what your doctor, or squadron of doctors, has to say about all this. There might be circumstances in your life, or in your medical history, which make my advice inappropriate in your case. For example, your doctor might think that, given your present condition, the exercise program I'm recommending would do more to increase your cardiac risk than to reduce it. (I wouldn't count on it, if I were you, but conceivably he could think that, and if he does, you need to find it out now.)
Generally speaking, when you have type 2 diabetes you are in charge of your own treatment, and you have to make a lot of significant health decisions on a routine basis. But for the really big decisions, you need to seek guidance from a doctor who knows the particulars of your case. When you are thinking of adopting a new health regimen, no matter who recommends it, and no matter how much it may have helped someone else, you need to verify with your doctor that it is safe for you to give it a try. I want you to do this in regard to the recommendations I am giving here. End of Quote.
Do I recommend this – yes, Yes, YES! I know that Tom is doing something right. I am fortunate to have the team of doctors on my side and while I am not able to use Tom's method of controlling my diabetes with nutrition and exercise, I am not ashamed of this either. My diabetes was discovered after I had the development of one of the complications (neuropathy) and another related risk for those with diabetes, sleep apnea.
Is Tom's way really possible? If you haven't read his blog, do so, as this is definitely possible. There are other people with type 2 diabetes that have been on medications and with proper nutrition and exercise have been able to get off and stay off of medications since then. Yes, it does require dedication, effort, and discipline, but the payback is well worth it.
Why don't I use the words “diet and exercise” as other writers? Because I don't believe in diets. They are not sustainable in the long term and there are not diets specifically designed for people with diabetes. Yes, many people use them, but few are able to sustain the good results and often revert to their bad habits. Lifestyle change and good nutrition are the necessary ingredients for success with diabetes and the key to making this work is exercise.
Many of us can afford to lose some pounds, I know that I can. I am working on getting back into exercise slowly again. I have some other medical problems that have prevented me from being on my feet (for walking) under doctors orders, but I have finally been given clearance to start again slowly by riding a bicycle. The doctors orders emphasized slowly and to call him if any problems reoccurred. So I will see.
All of the above discussion is premised on your having a doctor that knows how to communicate and discuss with you your diabetes and steps to manage it. If you do not have such a doctor, them find one that will. Yes, I am saying “Fire the one you have and find one that will” Maybe finding one that will work with you would be best before firing the current doctor. Yes, again this can be a very frustrating endeavor until you find the doctor that is a good fit for you. Some doctors are very put off with patients that are pro-active in their health care. A good blog written by a doctor about this very issue is here. Yes, this is a repeat from a previous blog, but understanding this is so important. NOTE: Link is Broken.
Also consider finding an endocrinologist as they specialize in diseases of the endocrine system and diabetes is one of these diseases. They normally (but not always) work with other specialists like a Certified Diabetes Educator (CDE) and a Certified Diabetes Dietitian or Registered Dietitian (CDD OR RD) who can assist you with the education and nutrition you need to learn. Just learn that the advice of these specialists can be changed or adapted to fit your needs.
Some doctors and endocrinologists are changing and working to change. They are seeing the handwriting on the wall. They are beginning to see a small decline in the “pill cure” generation and a giant increase in internet savvy patients. These primary care providers will not be able to dictate and prevent their patients from finding evidence that the doctors are out of touch and not doing the patients right. This has been a pleasant revelation.
Begin quote: But first: check with your doctor. Please bear in mind that I am not your doctor. In fact... well, don't tell anyone, but I'm not a doctor at all. The only reason you have for taking my advice seriously is that I have been very successful in managing my own diabetes without medication. This suggests that I am doing something right, but it really doesn't prove that I know what I'm talking about, does it?
Therefore, if you decide to take my my advice, I'm honored, but I want you to discuss it with your doctor, too. Or perhaps I ought to say that you should discuss it with your "health care team". This phrase turns up often in diabetes literature, to my puzzlement. Does everyone but me have a team? I have a doctor, but he works solo. Perhaps the other members of my team were benched for some infraction of the rules.
Anyway, see what your doctor, or squadron of doctors, has to say about all this. There might be circumstances in your life, or in your medical history, which make my advice inappropriate in your case. For example, your doctor might think that, given your present condition, the exercise program I'm recommending would do more to increase your cardiac risk than to reduce it. (I wouldn't count on it, if I were you, but conceivably he could think that, and if he does, you need to find it out now.)
Generally speaking, when you have type 2 diabetes you are in charge of your own treatment, and you have to make a lot of significant health decisions on a routine basis. But for the really big decisions, you need to seek guidance from a doctor who knows the particulars of your case. When you are thinking of adopting a new health regimen, no matter who recommends it, and no matter how much it may have helped someone else, you need to verify with your doctor that it is safe for you to give it a try. I want you to do this in regard to the recommendations I am giving here. End of Quote.
Do I recommend this – yes, Yes, YES! I know that Tom is doing something right. I am fortunate to have the team of doctors on my side and while I am not able to use Tom's method of controlling my diabetes with nutrition and exercise, I am not ashamed of this either. My diabetes was discovered after I had the development of one of the complications (neuropathy) and another related risk for those with diabetes, sleep apnea.
Is Tom's way really possible? If you haven't read his blog, do so, as this is definitely possible. There are other people with type 2 diabetes that have been on medications and with proper nutrition and exercise have been able to get off and stay off of medications since then. Yes, it does require dedication, effort, and discipline, but the payback is well worth it.
Why don't I use the words “diet and exercise” as other writers? Because I don't believe in diets. They are not sustainable in the long term and there are not diets specifically designed for people with diabetes. Yes, many people use them, but few are able to sustain the good results and often revert to their bad habits. Lifestyle change and good nutrition are the necessary ingredients for success with diabetes and the key to making this work is exercise.
Many of us can afford to lose some pounds, I know that I can. I am working on getting back into exercise slowly again. I have some other medical problems that have prevented me from being on my feet (for walking) under doctors orders, but I have finally been given clearance to start again slowly by riding a bicycle. The doctors orders emphasized slowly and to call him if any problems reoccurred. So I will see.
All of the above discussion is premised on your having a doctor that knows how to communicate and discuss with you your diabetes and steps to manage it. If you do not have such a doctor, them find one that will. Yes, I am saying “Fire the one you have and find one that will” Maybe finding one that will work with you would be best before firing the current doctor. Yes, again this can be a very frustrating endeavor until you find the doctor that is a good fit for you. Some doctors are very put off with patients that are pro-active in their health care. A good blog written by a doctor about this very issue is here. Yes, this is a repeat from a previous blog, but understanding this is so important. NOTE: Link is Broken.
Also consider finding an endocrinologist as they specialize in diseases of the endocrine system and diabetes is one of these diseases. They normally (but not always) work with other specialists like a Certified Diabetes Educator (CDE) and a Certified Diabetes Dietitian or Registered Dietitian (CDD OR RD) who can assist you with the education and nutrition you need to learn. Just learn that the advice of these specialists can be changed or adapted to fit your needs.
Some doctors and endocrinologists are changing and working to change. They are seeing the handwriting on the wall. They are beginning to see a small decline in the “pill cure” generation and a giant increase in internet savvy patients. These primary care providers will not be able to dictate and prevent their patients from finding evidence that the doctors are out of touch and not doing the patients right. This has been a pleasant revelation.
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