I have to take my hat off to the endocrinologists. They took a survey which puts them in a bad light and published it. Most organizations would have put this information through the shredder. Few in the medical profession are willing to to look problems in the eye and address it head on. Will they succeed? – that remains to be seen. There are a lot of hurdles to over come, the biggest is our medical insurance industry, Medicare, and the complexities of the new healthcare law.
Why are patients with diabetes unaware of hypoglycemia and what causes hypoglycemia? To me the broader implication is the lack of time by the medical community at large. Many primary care physicians and doctors in family medicine do not have the time or resources to educate patients. Many are in rural areas, small towns, and even many small city settings that do not have diabetes educators available. Many do not even have diabetes support groups to get support from.
Then add to this our medical insurance industry led by Medicare, that is cutting costs where ever possible and we have a situation ripe for failure. Many patients when they are newly diagnosed are in shock, causing very few to listen carefully to what they are being told by the doctor. Therefore, the doctors should be able to schedule another appointment shortly thereafter to do some education, but most of our insurance companies will not reimburse for the time.
The results of a survey conducted by the American College of Endocrinology therefore does not surprise me. This also shows just how reluctant our medical professionals are to recommend good web sites and help their patients get the information needed. One site listed here has some information; however, there could be a better presentation and one that is more patient oriented and not so sterile and written for doctors. The information is presented in PDF files that can be downloaded and printed for reference.
The other part of the survey, not mentioned, is where the survey was taken. If it was taken from a cross sample, then good. Otherwise from only rural areas, or only large metropolitan areas could also greatly affect the outcome of the survey. National online surveys can be notoriously misleading and little reliance should be placed on them.
The only real part of this survey is that the numbers, regardless of the method of obtaining them, show that the USA has a serious problem and needs to find a way to educate people with diabetes. Read a doctors interpretation of the survey here and the news release here. The PDF file for low blood sugar is here and the PDF file for high blood sugar is here.
April 30, 2011
April 27, 2011
Hospital and Medical Mismanagement of Diabetes
Some people with diabetes are being medically mismanaged while in the hospitals in the USA. Why? Because of lack of diabetes education by the hospital staff and outdated hospital management rules for diabetes. Scott Johnson posted an excellent example of this on his blog scottsdiabetes and you should take time to read it now. Some of the comments also bring out some of the problems faced by people with diabetes in the hospital setting.
Disturbing? Most definitely! Why is this happening? In addition to the above reason, patients also need to shoulder some of the blame. Most are not aware that there are patients' rights that must be adhered to by hospitals and many hospitals ignore these rights and enforce their own rules and regulations which most often are not in favor of the patient and the patients' rights. When the day comes that these hospitals are sued for patient neglect and failure to serve the patients and their rights, then maybe, just maybe, some of these highhanded hospitals will get the wake-up call they so desperately deserve.
When I wrote about this back on July 19, 2010, I had not anticipated the extent of medical malpractice that exists in some of our hospitals when dealing with patients with diabetes – and not just those with Type 1 diabetes. Fortunately, not all hospitals are this bad, and some are very accommodating to people with diabetes. Therefore, if at all possible, you need to do your homework before entering the hospital yourself or if a family member or relative with diabetes enters a hospital.
Learn from the experience of others like Scott Johnson writes about. Then talk to your doctors, preferable you should have an endocrinologist, but many people do not. Learn about your patient rights by reading this and related articles this article refers to. Make sure that you ask your doctor for a "self-management order," a document that will permit you to take care of your own testing and diabetes management if you are capable during your stay in the hospital.
If you know when you are entering the hospital, be sure that the hospital will accept the self-management order and that you are capable of using your own testing supplies and medications. I urge you to take time to read my previous blog above as there are some important points in it.
Now is also an excellent time to determine if you have a family member(s) or a trusted friend(s) that will be able to advocate for you if you are admitted to the hospital under emergency circumstances and make them aware of your needs and the paperwork they need to have available. This would include a limited medical power of attorney, a self-management order when you become capable of managing your own care. Do not leave this step unattended to as you cannot know when an emergency will arise.
A little planning now can actually get you better care when you desperately need it. Do not wait for mistakes and mismanagement of your health care to happen when in a hospital, it can and does happen more than we would like. Take time to read the referenced articles and blogs above to avoid many of the problems. Get the necessary paperwork completed and copies available to those that may need it!
I realize that many people will still not have taken these steps to assure their hospital stay is handled properly and I sincerely hope that I will not continue to read many more of these disturbing problems for others with diabetes that happen while in the hospital.
Disturbing? Most definitely! Why is this happening? In addition to the above reason, patients also need to shoulder some of the blame. Most are not aware that there are patients' rights that must be adhered to by hospitals and many hospitals ignore these rights and enforce their own rules and regulations which most often are not in favor of the patient and the patients' rights. When the day comes that these hospitals are sued for patient neglect and failure to serve the patients and their rights, then maybe, just maybe, some of these highhanded hospitals will get the wake-up call they so desperately deserve.
When I wrote about this back on July 19, 2010, I had not anticipated the extent of medical malpractice that exists in some of our hospitals when dealing with patients with diabetes – and not just those with Type 1 diabetes. Fortunately, not all hospitals are this bad, and some are very accommodating to people with diabetes. Therefore, if at all possible, you need to do your homework before entering the hospital yourself or if a family member or relative with diabetes enters a hospital.
Learn from the experience of others like Scott Johnson writes about. Then talk to your doctors, preferable you should have an endocrinologist, but many people do not. Learn about your patient rights by reading this and related articles this article refers to. Make sure that you ask your doctor for a "self-management order," a document that will permit you to take care of your own testing and diabetes management if you are capable during your stay in the hospital.
If you know when you are entering the hospital, be sure that the hospital will accept the self-management order and that you are capable of using your own testing supplies and medications. I urge you to take time to read my previous blog above as there are some important points in it.
Now is also an excellent time to determine if you have a family member(s) or a trusted friend(s) that will be able to advocate for you if you are admitted to the hospital under emergency circumstances and make them aware of your needs and the paperwork they need to have available. This would include a limited medical power of attorney, a self-management order when you become capable of managing your own care. Do not leave this step unattended to as you cannot know when an emergency will arise.
A little planning now can actually get you better care when you desperately need it. Do not wait for mistakes and mismanagement of your health care to happen when in a hospital, it can and does happen more than we would like. Take time to read the referenced articles and blogs above to avoid many of the problems. Get the necessary paperwork completed and copies available to those that may need it!
I realize that many people will still not have taken these steps to assure their hospital stay is handled properly and I sincerely hope that I will not continue to read many more of these disturbing problems for others with diabetes that happen while in the hospital.
April 19, 2011
How Much Fiber Is Enough?
I do have to wonder when the different medical groups are going to become unified in their recommendations for daily dietary fiber intake. I see different ranges quite often. One group orders 31 grams of fiber for everyone, another claims that women only need 25 grams, and men need 38 grams of daily dietary fiber. Most seem to recommend within this range, but I have seen more precise suggestions based on age and other factors.
Do we need standardization? It would seem wise as too many medical groups recommend on one number fits all. They do not specify what age range they are talking about or even if there are other factors involved in the determination. I am not sure whose recommendation to use. People may have their own opinion, but I find the best table for dietary fiber is this table by the World Health Organization and you can find it here. You may wish to bookmark it for future reference. It does account for children and the table is about one third down the page.
The recommendation (2nd page) from the Mayo Clinic does not account for children for which I fault the National Academy of Sciences' Institute of Medicine, and Mayo Clinic for using the IOM table which does not take into consideration fiber levels for children. The IOM does say that age 50 and younger for women the amount of daily dietary fiber should be 25 grams and for women age 51 and older the need drops to 21 grams. For men age 50 and younger the amount of daily dietary fiber should be 38 grams and for men age 51 and older the need decreases to 30 grams.
Dietary fiber is sometimes referred to as bulk or roughage. Dietary fiber is found in plants, fruits, vegetables, and grains plus part of a heart-healthy diet. It adds bulk and the full feeling quicker which helps control weight, aids digestion and makes bowel movements easier.
Dietary fiber is of two types – soluble and insoluble. Insoluble fiber facilitates easier movement through you digestive system and increases stool bulk. Soluble fiber dissolves in water and forms a gel-like material. This helps lower blood cholesterol and glucose levels. The amount of each type of fiber varies by plant foods. This is why everyone recommends eating a wide variety of high fiber foods.
Benefits of a proper level of fiber in your diet are many and this is the reason for making this known over and over to people. Of course, the correct amount of fiber in your diet makes bowel movement easier and can help with preventing loose stools and for some people it may provide assistance from irritable bowel syndrome. Other benefits of a proper fiber diet is that it may lower your risk of developing hemorrhoids, and possibly other colon diseases.
I was intending to have a two part series, but upon closer reading of the study I had in mind, I decided to let you read it here. I do not like studies that try to factualize estimated values of cardiovascular risks and have a cardiologist state that the “results of this study make a lot of sense”. This to me just invalidates the purpose of studies and indicates that what they were after did not come to be fact. It indicates that the study was inconclusive.
You need to read this just to see an example of what lengths they will go to to justify a poor study.
Do we need standardization? It would seem wise as too many medical groups recommend on one number fits all. They do not specify what age range they are talking about or even if there are other factors involved in the determination. I am not sure whose recommendation to use. People may have their own opinion, but I find the best table for dietary fiber is this table by the World Health Organization and you can find it here. You may wish to bookmark it for future reference. It does account for children and the table is about one third down the page.
The recommendation (2nd page) from the Mayo Clinic does not account for children for which I fault the National Academy of Sciences' Institute of Medicine, and Mayo Clinic for using the IOM table which does not take into consideration fiber levels for children. The IOM does say that age 50 and younger for women the amount of daily dietary fiber should be 25 grams and for women age 51 and older the need drops to 21 grams. For men age 50 and younger the amount of daily dietary fiber should be 38 grams and for men age 51 and older the need decreases to 30 grams.
Dietary fiber is sometimes referred to as bulk or roughage. Dietary fiber is found in plants, fruits, vegetables, and grains plus part of a heart-healthy diet. It adds bulk and the full feeling quicker which helps control weight, aids digestion and makes bowel movements easier.
Dietary fiber is of two types – soluble and insoluble. Insoluble fiber facilitates easier movement through you digestive system and increases stool bulk. Soluble fiber dissolves in water and forms a gel-like material. This helps lower blood cholesterol and glucose levels. The amount of each type of fiber varies by plant foods. This is why everyone recommends eating a wide variety of high fiber foods.
Benefits of a proper level of fiber in your diet are many and this is the reason for making this known over and over to people. Of course, the correct amount of fiber in your diet makes bowel movement easier and can help with preventing loose stools and for some people it may provide assistance from irritable bowel syndrome. Other benefits of a proper fiber diet is that it may lower your risk of developing hemorrhoids, and possibly other colon diseases.
I was intending to have a two part series, but upon closer reading of the study I had in mind, I decided to let you read it here. I do not like studies that try to factualize estimated values of cardiovascular risks and have a cardiologist state that the “results of this study make a lot of sense”. This to me just invalidates the purpose of studies and indicates that what they were after did not come to be fact. It indicates that the study was inconclusive.
You need to read this just to see an example of what lengths they will go to to justify a poor study.
April 18, 2011
New AACE Guidelines Emphasize Individualized Care
I know why many diabetes professional groups fear recommending that individuals strive to attain lower HbA1c's; however, I have to disagree with the way they do it. Here the American Association of Clinical Endocrinology (AACE) does recommend individualized care plans at least. They get very shy when it comes to recommending anything lower that an A1c of 6.5 for fear of hypoglycemic episodes. This is standard practice among the diabetes professionals.
The comprehensive individualized care plans for patients with Type 1 and Type 2 diabetes was developed by a panel of 23 leading diabetes experts. They wisely set the care plans to account for the patients' risk for complications, other chronic health conditions, and the psychological, social, and economic status. Because of that fact that they are concerned about the safety of people being able to achieve an A1c of 6.5 all recommendations emphasize taking into account a patients risk for development of severe hypoglycemia.
For once the recommendations do take into account the use of technologies such as insulin pumps, and continuous glucose monitoring. They they surprise me with adding the importance of other conditions that sometimes may not be obvious to the treating physicians – sleep and breathing disturbances and depression. These conditions have been neglected to the detriment of diabetes patients in the past.
Now if they will take this information and work to alleviate sleep disorders, sleep apnea, and minimize depression, this could work to make life a lot better for people with diabetes. Other factors missing from the guidelines is handling other illnesses such as the occasional cold, flu, and other common maladies.
The guidelines do stress hyperglycemia but also the associated cardiovascular risk factors. Also in the guidelines is the recommendation for comprehensive diabetes lifestyle management education at the time of diagnosis and to continue this throughout the time the person has diabetes. Other topics of the education is medical nutrition therapy, physical activity, not using tobacco, and importance of adequate sleep.
I applaud the latest guidelines as far as they go. It seems that individualized care plans should include other objectives. No provisions have been made for those of us desiring to attain lower A1c goals. So again the diabetes professionals are ignoring many patients that can and do work to attain A1c goals lower than 6.5. So it is still up to us to work independently of these medical professionals who have no desire to support us in achieving better health, avoiding complications, and in general doing better that others in our treatment of diabetes.
Why do I say we have to work independently? I am slowly discovering that the diabetes medical professionals are working to reduce the time spent with us, stopping continuing education for us, and just praising us and ushering us out of the office. This is a shame that the guidelines do not make provisions for those of us that wish to attain A1c's lower than 6.5.
Then our medical insurance companies take these results and are searching for ways to cut testing supplies, necessary related tests, and other procedures because we work to have better health. We must fight an uphill battle with no support from either group and chances that in the drive to curtail rising medical costs, we will be discriminated against and have necessary medical support withheld in the name of health care rationing. Just does not seem fair.
Read the two articles here and here.
The comprehensive individualized care plans for patients with Type 1 and Type 2 diabetes was developed by a panel of 23 leading diabetes experts. They wisely set the care plans to account for the patients' risk for complications, other chronic health conditions, and the psychological, social, and economic status. Because of that fact that they are concerned about the safety of people being able to achieve an A1c of 6.5 all recommendations emphasize taking into account a patients risk for development of severe hypoglycemia.
For once the recommendations do take into account the use of technologies such as insulin pumps, and continuous glucose monitoring. They they surprise me with adding the importance of other conditions that sometimes may not be obvious to the treating physicians – sleep and breathing disturbances and depression. These conditions have been neglected to the detriment of diabetes patients in the past.
Now if they will take this information and work to alleviate sleep disorders, sleep apnea, and minimize depression, this could work to make life a lot better for people with diabetes. Other factors missing from the guidelines is handling other illnesses such as the occasional cold, flu, and other common maladies.
The guidelines do stress hyperglycemia but also the associated cardiovascular risk factors. Also in the guidelines is the recommendation for comprehensive diabetes lifestyle management education at the time of diagnosis and to continue this throughout the time the person has diabetes. Other topics of the education is medical nutrition therapy, physical activity, not using tobacco, and importance of adequate sleep.
I applaud the latest guidelines as far as they go. It seems that individualized care plans should include other objectives. No provisions have been made for those of us desiring to attain lower A1c goals. So again the diabetes professionals are ignoring many patients that can and do work to attain A1c goals lower than 6.5. So it is still up to us to work independently of these medical professionals who have no desire to support us in achieving better health, avoiding complications, and in general doing better that others in our treatment of diabetes.
Why do I say we have to work independently? I am slowly discovering that the diabetes medical professionals are working to reduce the time spent with us, stopping continuing education for us, and just praising us and ushering us out of the office. This is a shame that the guidelines do not make provisions for those of us that wish to attain A1c's lower than 6.5.
Then our medical insurance companies take these results and are searching for ways to cut testing supplies, necessary related tests, and other procedures because we work to have better health. We must fight an uphill battle with no support from either group and chances that in the drive to curtail rising medical costs, we will be discriminated against and have necessary medical support withheld in the name of health care rationing. Just does not seem fair.
Read the two articles here and here.
April 11, 2011
Just Diagnosed and In a Panic? Part 3
As a newly diagnosed person with diabetes, this is the lesson that most find a way to ignore, avoid, or outright forget. Carbohydrates are the biggest concern in the management of diabetes. Some like to insist it is sugar, but the truth is sugar is a carbohydrate. A simple carbohydrate and comes in many forms. It is sugar that is added to more foods than ever before. It was in the form of high fructose corn syrup, which is now renamed corn sugar. It is added to more and more of our highly processed foods to get people to eat them. In the U.S., this is one of the causes of our obesity epidemic.
In addition to the simple carbohydrates, there are complex carbohydrates like whole grains, and starchy vegetables. Carbohydrates are a source of energy, but not the only source.
Because of the uniqueness of each individual, I do not like to recommend the amount of carbohydrates each should eat. A few are able to handle a fair number of simple carbs, but most cannot. Many people have trouble with some complex carbohydrates. This is why I strongly urge each individual to use their meter to find out how their body reacts. That is also why each person with Type 2 has to become their own science laboratory to determine what works for them.
Some people are able to eat many carbohydrates while others need to limit their carbs. When it comes to ranges, here again there are varying ranges depending on who you read. Most of the time the ranges are for the entire day and you will need to divide them into your meals depending on how your react at different times of the day. Some have large morning meals while many skip the first meal of the day and have the largest meal in the evening. You meter can assist you in making this evaluation.
I will not recommend low carb, medium carb, or high carb regimens as each person must decide for themselves according to what their meter tells them. I will say that the guidance from the American Diabetes Association (ADA) is out of line for me. The American Associations of Diabetes Educators and the American Dietetic Association have the same mantra, meaning they follow the ADA.
The other source of energy is fat. Yes, I do not follow the low fat mantra of many health groups as new studies are showing this to be not quite the truth everyone likes to believe. In fact many of the things we hold on to are slowly being proven wrong and the studies from decades ago were to satisfy an agenda of the authors of the studies.
David Mendosa has no agenda and reports on both sides of many issues. His blogs on Health Central about fat and about diet are very enlightening. Dr. William Davis has his blog and here he likes to report on the whole grains mantra everyone is familiar with. His blogs about wheat and fat are well thought out. Here are four of his blogs, blog 1, blog 2, blog 3, and blog 4.
Why do I agree with them? Because even before I had diabetes, I would crave foods high in fat. After having a serving or two of these foods, sausages or beef with fat, my carvings disappeared for several weeks or longer. By not eating wheat or other whole grains for several days or weeks, I often feel much better. When I over eat wheat or other whole grains, I know it and often find myself fighting minor depression.
Finally, every person with Type 2 diabetes must experiment and find what works for them. Be cautious about the mantras of our diabetes professionals until you know they are okay for you and that your meter has told you that they are okay. Moderation and exercise will help you manage diabetes.
For reading Part 1 and Part 2 of this blog, click on the links.
In addition to the simple carbohydrates, there are complex carbohydrates like whole grains, and starchy vegetables. Carbohydrates are a source of energy, but not the only source.
Because of the uniqueness of each individual, I do not like to recommend the amount of carbohydrates each should eat. A few are able to handle a fair number of simple carbs, but most cannot. Many people have trouble with some complex carbohydrates. This is why I strongly urge each individual to use their meter to find out how their body reacts. That is also why each person with Type 2 has to become their own science laboratory to determine what works for them.
Some people are able to eat many carbohydrates while others need to limit their carbs. When it comes to ranges, here again there are varying ranges depending on who you read. Most of the time the ranges are for the entire day and you will need to divide them into your meals depending on how your react at different times of the day. Some have large morning meals while many skip the first meal of the day and have the largest meal in the evening. You meter can assist you in making this evaluation.
I will not recommend low carb, medium carb, or high carb regimens as each person must decide for themselves according to what their meter tells them. I will say that the guidance from the American Diabetes Association (ADA) is out of line for me. The American Associations of Diabetes Educators and the American Dietetic Association have the same mantra, meaning they follow the ADA.
The other source of energy is fat. Yes, I do not follow the low fat mantra of many health groups as new studies are showing this to be not quite the truth everyone likes to believe. In fact many of the things we hold on to are slowly being proven wrong and the studies from decades ago were to satisfy an agenda of the authors of the studies.
David Mendosa has no agenda and reports on both sides of many issues. His blogs on Health Central about fat and about diet are very enlightening. Dr. William Davis has his blog and here he likes to report on the whole grains mantra everyone is familiar with. His blogs about wheat and fat are well thought out. Here are four of his blogs, blog 1, blog 2, blog 3, and blog 4.
Why do I agree with them? Because even before I had diabetes, I would crave foods high in fat. After having a serving or two of these foods, sausages or beef with fat, my carvings disappeared for several weeks or longer. By not eating wheat or other whole grains for several days or weeks, I often feel much better. When I over eat wheat or other whole grains, I know it and often find myself fighting minor depression.
Finally, every person with Type 2 diabetes must experiment and find what works for them. Be cautious about the mantras of our diabetes professionals until you know they are okay for you and that your meter has told you that they are okay. Moderation and exercise will help you manage diabetes.
For reading Part 1 and Part 2 of this blog, click on the links.
April 10, 2011
Just Diagnosed and In a Panic? Part 2
People may get tired of my stating this as some form of this is used in every blog I write about herbs, supplements, vitamins, minerals, and natural remedies. Until people realize how important this is, and how deadly ignoring this can be, I will continue to write this. I am a patient and not in the medical profession.
Because of some of the problems, and the fact that many people will not read labels, or follow their doctor's instructions, I feel compelled to say this for all non-medical subjects.
The following information is for your reading and is not a cure. I am not endorsing any herb, supplement, or natural remedy. At best, many have short-term benefits only until your body gets what it is missing, with a few exceptions.
WARNING! This is important!!! If you are taking supplements or anything not prescribed by a doctor, please make sure that the doctor is informed. Some supplements and natural remedies, when taken with oral medications and/or insulin can cause hypoglycemia, have toxic effects, or even cause death.
It is important that everyone maintain a list of every herb, vitamin, mineral, supplement, and home remedy you are taking and give a copy to your doctor (and do indicate anything new since the last visit). I am aware that many people do not feel this is important, but the consequences for persons with diabetes can have severe medical implications. If you have other medical problems plus diabetes, this may even be more critical.
One statement I get from the naturalists or homeopath followers is what I take is natural and found in nature - the doctor does not need to know. Wrong! Even natural herbal remedies can cause problems when used with prescribed medications. In the USA, not all are manufactured under the Food and Drug Administration's specifications, and some may not be quality checked. They can often have ingredients not mentioned on the label, and some even have chemicals added that when combined with prescriptions can cause severe reactions.
Vitamins: Vitamins can be very beneficial and sometimes are not emphasized enough. Vitamin D, Vitamin B12, and several others are critical if you are on some oral medications. Talk to your doctor about them. Metformin is an example as it can deplete the B12 and additional may be needed. If you have been on Metformin for a long time, your doctor should be testing you for B12 levels. Another issue is some lifestyles can be short of B12 and Omega-3's. See my blog here. I encourage people to find the lifestyle that is comfortable for them. The big caution here is understanding the nutritional needs to avoid problems.
Minerals: This should be divided into two groups, supplemental and trace minerals. WARNING, taking minerals should always be done under a doctors supervision to avoid problems with prescription medications and toxicity. Many people take too large a dosage of trace minerals for too long a period and this can lead to toxic side effects.
Some people avoid all the problems because they are consuming the right fruits and vegetables in quantities that have the vitamins and minerals in sufficient quantities. Talk to your doctor about doing the necessary tests. Most will not need to be done on a regular basis and most U.S. medical insurance companies will cover the tests on a yearly or longer basis. They will cover testing more often if problems are found.
Make sure the doctor covers the test results and gives you a copy for your records.
Part 2 of 3. To read Part 1 and Part 3 of this blog, click on the links.
Because of some of the problems, and the fact that many people will not read labels, or follow their doctor's instructions, I feel compelled to say this for all non-medical subjects.
The following information is for your reading and is not a cure. I am not endorsing any herb, supplement, or natural remedy. At best, many have short-term benefits only until your body gets what it is missing, with a few exceptions.
WARNING! This is important!!! If you are taking supplements or anything not prescribed by a doctor, please make sure that the doctor is informed. Some supplements and natural remedies, when taken with oral medications and/or insulin can cause hypoglycemia, have toxic effects, or even cause death.
It is important that everyone maintain a list of every herb, vitamin, mineral, supplement, and home remedy you are taking and give a copy to your doctor (and do indicate anything new since the last visit). I am aware that many people do not feel this is important, but the consequences for persons with diabetes can have severe medical implications. If you have other medical problems plus diabetes, this may even be more critical.
One statement I get from the naturalists or homeopath followers is what I take is natural and found in nature - the doctor does not need to know. Wrong! Even natural herbal remedies can cause problems when used with prescribed medications. In the USA, not all are manufactured under the Food and Drug Administration's specifications, and some may not be quality checked. They can often have ingredients not mentioned on the label, and some even have chemicals added that when combined with prescriptions can cause severe reactions.
Vitamins: Vitamins can be very beneficial and sometimes are not emphasized enough. Vitamin D, Vitamin B12, and several others are critical if you are on some oral medications. Talk to your doctor about them. Metformin is an example as it can deplete the B12 and additional may be needed. If you have been on Metformin for a long time, your doctor should be testing you for B12 levels. Another issue is some lifestyles can be short of B12 and Omega-3's. See my blog here. I encourage people to find the lifestyle that is comfortable for them. The big caution here is understanding the nutritional needs to avoid problems.
Minerals: This should be divided into two groups, supplemental and trace minerals. WARNING, taking minerals should always be done under a doctors supervision to avoid problems with prescription medications and toxicity. Many people take too large a dosage of trace minerals for too long a period and this can lead to toxic side effects.
Some people avoid all the problems because they are consuming the right fruits and vegetables in quantities that have the vitamins and minerals in sufficient quantities. Talk to your doctor about doing the necessary tests. Most will not need to be done on a regular basis and most U.S. medical insurance companies will cover the tests on a yearly or longer basis. They will cover testing more often if problems are found.
Make sure the doctor covers the test results and gives you a copy for your records.
Part 2 of 3. To read Part 1 and Part 3 of this blog, click on the links.
April 9, 2011
Just Diagnosed And In A Panic? – Part 1
Some people put their entire fist through the panic panel while others throw a pity party and will milk it for all they can as the world is so unjust. Go ahead, I'll wait for you to calm down. You are not ready to read this.
I read this all the time on several of the diabetes forums which I follow. Even then some are unwilling to believe what the doctor told them and don't understand that we have all been in this situation. They claim we could not possibly understand how distraught they are. Yes, we do!!!
Some say they are mourning the carbohydrates they have had to give up. Many feel that it is only sugar they have to give up, but are they in for a surprise! This blog is primarily for those with Type 2 diabetes, but others can gain some information.
The doctors in the U.S. can be very subtle about how they say things and at times I wonder if they don't want to even mention diabetes, to say nothing about diagnosing it. They like to say “watch your food intake, your sugar was a little high” as they usher you out the door. Now just what does that mean? This is when you need to stop and look the doctor squarely in the eye and ask for an explanation. Did I? Unfortunately, no, and I paid the price and needed to go on insulin within a few months after being diagnosed officially. It is no wonder that many patients feel very lost in the beginning with diabetes.
If they do tell you that you have diabetes, some doctors will not refer you to a dietitian, nutritionist, or certified diabetes educator (CDE). If they are in a largely rural area, they may not have these available. Other doctors may have had less than positive experiences and so will not work with them. As a patient, I have had experiences that have been very positive with these supporting occupations, and a few that left me wondering if they even have heard about diabetes. Some are prone to contradicting the doctor and undermining the good he may have done.
While you are waiting to have meetings or classes, I recommend that you stop by the blog site of Alan Shanley. He has some excellent information about what to eat while you are waiting for your meter. If you do not have access to the dietitians, or CDE's, then Alan has three other excellent blogs; for getting started, testing, and reviewing and adjusting. While meters can deviate up to 20 percent, what you are looking for is trends and how different foods affect your body. Learn to trust your meter and use it. Alan also has an excellent blog on painless pricks to assist you in testing and care of your hands.
Those of us in the USA may have limitations imposed upon us by Medicare and our medical insurance companies if we are on oral medications. Some still decide it is worth the out-of-pocket expense to learn how our bodies react to different foods, being our own science experiment. Much of the time the doctors, educators, dietitians, or nutritionists will supply you with a meter, it is the test strips that will cost money.
Rather than run this into pages and pages, I would refer you to some books and websites so that you may read them at your leisure. I have a blog on books here, and another with some websites here. There are many more, but this will get you started and hopefully enthused that you can do something to manage this chronic disease called diabetes. If your local library does not have copies of any of the books, obtain them at your local bookstore, or order them online at a source you trust and try to obtain the latest edition.
More in my next blog about medications and home remedies. Part 1 of 3. To read Part 2 and part 3 of this blog click on the links.
I read this all the time on several of the diabetes forums which I follow. Even then some are unwilling to believe what the doctor told them and don't understand that we have all been in this situation. They claim we could not possibly understand how distraught they are. Yes, we do!!!
Some say they are mourning the carbohydrates they have had to give up. Many feel that it is only sugar they have to give up, but are they in for a surprise! This blog is primarily for those with Type 2 diabetes, but others can gain some information.
The doctors in the U.S. can be very subtle about how they say things and at times I wonder if they don't want to even mention diabetes, to say nothing about diagnosing it. They like to say “watch your food intake, your sugar was a little high” as they usher you out the door. Now just what does that mean? This is when you need to stop and look the doctor squarely in the eye and ask for an explanation. Did I? Unfortunately, no, and I paid the price and needed to go on insulin within a few months after being diagnosed officially. It is no wonder that many patients feel very lost in the beginning with diabetes.
If they do tell you that you have diabetes, some doctors will not refer you to a dietitian, nutritionist, or certified diabetes educator (CDE). If they are in a largely rural area, they may not have these available. Other doctors may have had less than positive experiences and so will not work with them. As a patient, I have had experiences that have been very positive with these supporting occupations, and a few that left me wondering if they even have heard about diabetes. Some are prone to contradicting the doctor and undermining the good he may have done.
While you are waiting to have meetings or classes, I recommend that you stop by the blog site of Alan Shanley. He has some excellent information about what to eat while you are waiting for your meter. If you do not have access to the dietitians, or CDE's, then Alan has three other excellent blogs; for getting started, testing, and reviewing and adjusting. While meters can deviate up to 20 percent, what you are looking for is trends and how different foods affect your body. Learn to trust your meter and use it. Alan also has an excellent blog on painless pricks to assist you in testing and care of your hands.
Those of us in the USA may have limitations imposed upon us by Medicare and our medical insurance companies if we are on oral medications. Some still decide it is worth the out-of-pocket expense to learn how our bodies react to different foods, being our own science experiment. Much of the time the doctors, educators, dietitians, or nutritionists will supply you with a meter, it is the test strips that will cost money.
Rather than run this into pages and pages, I would refer you to some books and websites so that you may read them at your leisure. I have a blog on books here, and another with some websites here. There are many more, but this will get you started and hopefully enthused that you can do something to manage this chronic disease called diabetes. If your local library does not have copies of any of the books, obtain them at your local bookstore, or order them online at a source you trust and try to obtain the latest edition.
More in my next blog about medications and home remedies. Part 1 of 3. To read Part 2 and part 3 of this blog click on the links.
April 7, 2011
Diabetes Bariatric Surgery – Is It Effective?
Why are bariatric surgeons becoming so active in the diabetes field? Quite simply, primary care physicians and endocrinologists have abdicated their position. Sound a little dire? It might, but considering that these doctors are not rising to the challenge of taking care of and getting people out of the moderate to mildly obese categories. The bariatric surgeons are stepping in to the void to increase the thickness of their wallets and retirement plans.
As long as no one is explaining the side-effects and hyping the benefits, these surgeons will be happy to fatten their wallets and retirement accounts at the expense of other doctors, patients, and medical insurance companies. Is there a need for this surgery? While I don't like to say so, yes, there is a need. For those individuals that have tried and failed, e.g., exhausted with honest efforts other ways to reduce weight, and are among the morbidly obese, then the surgery is probably the only route available to them for weight reduction and possible management of diabetes.
Am I opposed to bariatric surgery. YES, except for the case above, I think the bariatric surgeons are into the vanity game for many people. I am thankful that the American Heart Association has taken a position in this and I can agree with their position. Read the article about this here.
The fees for bariatric surgery are steep and unless you have exceptional medical insurance, you may need to pay a healthy part of the bill. A discussion of medical insurance, Medicare, and Medicaid can be found here. Be sure to study this carefully.
An article by the Mayo Clinic is here. This is one of the better discussions about the different types of bariatric surgery and does list most of the risks involved with the surgery and even some risks by type of surgery. If you are seriously considering bariatric surgery, please read this article in its entirety. The consequences of not following exactly the plan and lifestyle changes can be very costly and even deadly. Most medical insurance companies require that you complete a training period and know each and every risk in detail. Some vary in length, but six weeks seems to be a minimum.
Some surgeons may try to get you past the insurance requirements fearing that you will want to back out of the surgery. So even with this, I strongly urge you to do your homework and know what you will be facing beforehand. Bariatric surgery is not for everyone so don't feel that you can slide past the requirements for lifestyle changes as they are mandatory and you will have problems if you ignore them. These lifestyle changes are permanent for the rest of your life which many people cannot accept and this gets them into serious problems.
If you think I am being overly dramatic, use your search engine and do some checking on your own. Also read my blog here about bariatric surgery possibly masking diabetes. Do not think it is the absolute cure the bariatric surgeons want you to believe. There are news articles almost weekly now hyping bariatric surgery and all refuse to discuss the serious risks. Even though I have an agenda against this surgery, I hope that I have pointed you in the right direction to arrive at an informed decision.
As long as no one is explaining the side-effects and hyping the benefits, these surgeons will be happy to fatten their wallets and retirement accounts at the expense of other doctors, patients, and medical insurance companies. Is there a need for this surgery? While I don't like to say so, yes, there is a need. For those individuals that have tried and failed, e.g., exhausted with honest efforts other ways to reduce weight, and are among the morbidly obese, then the surgery is probably the only route available to them for weight reduction and possible management of diabetes.
Am I opposed to bariatric surgery. YES, except for the case above, I think the bariatric surgeons are into the vanity game for many people. I am thankful that the American Heart Association has taken a position in this and I can agree with their position. Read the article about this here.
The fees for bariatric surgery are steep and unless you have exceptional medical insurance, you may need to pay a healthy part of the bill. A discussion of medical insurance, Medicare, and Medicaid can be found here. Be sure to study this carefully.
An article by the Mayo Clinic is here. This is one of the better discussions about the different types of bariatric surgery and does list most of the risks involved with the surgery and even some risks by type of surgery. If you are seriously considering bariatric surgery, please read this article in its entirety. The consequences of not following exactly the plan and lifestyle changes can be very costly and even deadly. Most medical insurance companies require that you complete a training period and know each and every risk in detail. Some vary in length, but six weeks seems to be a minimum.
Some surgeons may try to get you past the insurance requirements fearing that you will want to back out of the surgery. So even with this, I strongly urge you to do your homework and know what you will be facing beforehand. Bariatric surgery is not for everyone so don't feel that you can slide past the requirements for lifestyle changes as they are mandatory and you will have problems if you ignore them. These lifestyle changes are permanent for the rest of your life which many people cannot accept and this gets them into serious problems.
If you think I am being overly dramatic, use your search engine and do some checking on your own. Also read my blog here about bariatric surgery possibly masking diabetes. Do not think it is the absolute cure the bariatric surgeons want you to believe. There are news articles almost weekly now hyping bariatric surgery and all refuse to discuss the serious risks. Even though I have an agenda against this surgery, I hope that I have pointed you in the right direction to arrive at an informed decision.
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