Six Ways to Help Manage Type 2 Diabetes – P6

Error 6 - Making Poor Food Choices

When it comes to food, excellent diabetes management is a must. Learn to maintain logs of what you eat, when you eat, and the blood glucose levels before and after eating, especially within the first few months. Be aware of the problem of going off an eating plan. It is the long term unhealthy eating habits that need to be broken and replaced with healthy eating habits. This can take time, but steady progress needs to be a priority.

Carbohydrates become the requirement and you meter needs to be your friend while learning what foods you need to eliminate, reduce in quantity, or that are okay to eat. Since each person can handle different foods, you should talk to your doctor about classes or at least a meeting with a dietitian for guidance and directions for healthy eating. Forget about what you think is healthy eating, it may be more harmful that you imagine.

Learn to read nutrition labels. This will help you calculate the proper amounts of the foods you choose to eat and may provide you with clues as to why you are having problems with your blood glucose levels. This may be more important that you realize now, but eating at a regular time and intervals will assist you in better management of your blood glucose levels.

Do not skip meals as this is the downfall of many people with diabetes. Often you will think that because you skipped a meal, you have a built in deficit of carbohydrates – wrong! The skipped meal does not calculate into allowing for extra carbs later in the day – your liver has taken care of the blood glucose deficit, but adding blood glucose to your system to compensate for the skipped meal. Whether you like it or not, the skipped meal has gained you no carb allowances.

If you doubt me, use your meter to help you see what is happening. Depending on your medication, you may be also creating hypoglycemia and have a blood glucose low which can be dangerous. Skipping medications because you are skipping a meal is also dangerous. This is another reason to learn all you can about the medications you are taking. This can point out the problems, side-effects, and dangers of missing a dose. Plus this may also point out the dangers of not eating or skipping a meal.

Some medications are meant to operate for a set period of time in your body while others have a longer period of operation. All of this means that skipped meals can affect the medications and do more harm that you are expecting. Some combinations of medications create even more troubling complications if you skip meals.

This is why, even though I have blogged about these points separately, they are all interlinked and can be very much part of the integral plan of diabetes management. It is important to remember this and review these on a regular basis. Remember diabetes itself does not cause the complication – it is the lack of diabetes management that does the damage.  If you need to reread the article - it is here.

Six Ways to Help Manage Type 2 Diabetes – P5

Error 5 - Misunderstanding and Misusing Medications

Managing diabetes is very dependent on how well you manage your medications. Do not fall into the trap that many do and just assume because you are feeling good that you may stop your medications. This is one of the mistakes that can really do damage to your body by letting diabetes manage your body.

Warning – unless you are able to manage your diabetes with nutrition (diet) and exercise and the doctor agrees that you are, learn to take you medications when instructed to take them.

Many people fall into this problem while in denial and stop taking their diabetes medication. Diabetes will love you for this. This means that it can do unlimited damage to your body. Retinopathy will develop, neuropathy will accelerate, wounds in your lower legs and feet will not heal properly and amputations are possible. Nephropathy will start to accelerate doing damage to the kidneys and hearing problems can become worse as small blood vessels are damaged in the inner ear.

If this doesn't give you cause for concern, it should. That is why medications are so important to the management of diabetes and the better the management, the less likely you will have problems with the complications of diabetes.

One of the largest problems is people forgetting to take doses. This is a problem that can do considerable damage to your management of diabetes. This should always be a discussion item every time you meet with your doctor. Another item that should be discussed is insulin.

Forget about the insulin myths, your health is more important and insulin can be used very successfully with excellent management outcomes. This should always be considered as a medication and not the medication of last resort. Too many doctors do not understand insulin and know very little about using it. Therefore, if you are having problems with diabetes management, consider insulin and possibly getting an appointment with an endocrinologist specializing in diabetes.

In all meetings with your doctor, discuss problems that you are having so that the doctor can help devise the best treatment plan for you and one that fits your needs to make your management more effective. Yes, I am saying you need to communicate with the doctor to get the best treatment plan. This is why having a doctor that you feel comfortable in talking to about diabetes is very important. If you are not comfortable and confident about your doctor, you may not receive the best treatment plan.

This is one reason many people change doctors several times to find a doctor that will work with them and they feel comfortable about. Diabetes is that important and your health is worth it.

Six Ways to Help Manage Type 2 Diabetes – P4

Error 4 - Neglecting Other Problems

In your efforts to manage diabetes, do not forget about other problems you may encounter. Depression, stress, and sleep disorders also have an effect on the management of diabetes. So in the process of learning about diabetes, learn about these as well. If you have other chronic illnesses, then you have more to learn and how each disease affect the other. All can lead to increased blood glucose levels.

Because diabetes is a 24/7/365 management demand, depression can be a large part of diabetes and one creates risks for the other. Learn to recognize the signs of depression so that you can take measures to minimize the effects and possibly avoid problems as depression can make diabetes management a very difficult task.

Treatment of depression definitely improves the mental and physical health of people with diabetes. So don't ignore the benefits and let the doctor discussion this and find a good medication fit for you. Even though the article in WebMD states that people with diabetes are twice as likely to have depression, studies show that this in more like 67 percent and then another 19 percent can have serious depression. Please don't ignore depression.

Stress is a factor that many people want to ignore, but please don't as it can produce hormones that hamper the ability of insulin to do what it does. Both patients and physicians need to take this into consideration and use activities that will reduce or eliminate stress. Exercise helps relieve stress and meditation and massage have benefits in improving blood glucose levels.

Some of the tips for easing depression also are applicable to stress. Read my blog here. For stress you need to add yoga and Tai Chi as they can assist in stress reduction.

Sleep disorders such as sleep apnea, insomnia, and others can wreck havoc to your diabetes management. You need to talk to your doctor about any of these so that you can manage them as well. Improper amounts of restful sleep makes blood glucose management that much more difficult to manage. Sometimes weight loss is in order and for others, just getting adequate amount of sleep for your needs helps is diabetes management.

As promised in part 1, read the entire article here.

Six Ways to Help Manage Type 2 Diabetes – P3

Error 3 - Going it Alone

In your efforts to manage diabetes, try to include those around you. If you live alone, this may be slightly more difficult, but find a friend or a buddy to assist you where possible. Others may have spouses, partners, or family members to assist in staying focused and on target with goals. While some are capable and have the ability to do some things alone, others need encouragement and support for achieving goals.

If you can afford a membership in a local YMCA or YWCA, often others that are members may be able to assist you with exercise routines and schedules. An exercise club may work for others. If you need a buddy, maybe someone from work can assist you and exercise with you.

If you are alone in life, there may be someone from your support group that you can find willing to assist in helping you keep on track and achieving your goals. I am aware of one individual that is a regular in her church and has a couple of them helping and checking on her. One exercises with her and another checks in with her on a daily basis. So don't become discouraged as often there can be someone without diabetes that is willing and looking for someone to do activities with.

There are diabetes forums online that can help with weight loss, daily record keeping and just being online for assistance. Do not forget your doctor as this person may have suggestions that may be just what is needed to get and keep you successful in your management of diabetes.

There are some individuals that can manage alone and do very well. It takes tenacity and perseverance, but some individuals exceed in these circumstances. Some individuals do not have the support and understanding of family members and must start out alone. Talk with family members and ask for their help. Sometimes it just takes the asking and you will receive help.

As you become more confident with meals and what foods do not elevate your blood glucose, if your are the cook, slowly start to change the meal plan for the entire family. This can be successful if done slowly and sometimes can be accomplished with talking to family members. If you have a spouse (and/or other family members) that accept that you need to change lifestyle habits and wants to change with you, then you are blessed. Do thank them and discuss the changes needed.

Six Ways to Help Manage Type 2 Diabetes – P2

Error 2 - Expecting Too Much Too Soon

To manage diabetes effectively, learn to set realistic goals. If goals are set that are overly ambitious, very few people will be able to achieve them. This is in fact the problem for many people – not setting realistic and achievable goals. Do not set yourself up for failure. Learn to take one step at a time and have success along the way.

Just remember that it has taken you years to develop diabetes and you will not manage diabetes overnight. This is where you need to use your meter to help you decide on the foods and quantity of food that your body can tolerate without aggravating diabetes. What? Your doctor did not authorize or prescribe a meter and test strips for you? Time for you to march into the doctor's office and ask for one. Politely at first, but if the doctor hesitates or refuses, then insist on a prescription. If you still do not obtain a prescription – I strongly urge you to consider, if you are able, to find a different doctor. If you are in a rural area with few doctors, you may need to resort to other tactics to obtain a meter and test strips, but you do need them.

Because we are fighting an uphill battle with our medical insurance companies that are determined to limit our testing, many people become discouraged and stop testing because of the cost. If you are able and can afford additional test strips, by all means the first several months, do regular testing to determine how foods and exercise affect your body. Learn how to negotiate with your insurance company to get the strips needed. Read this blog for testing procedures and long term goals.

Most people with Type 2 diabetes are started on oral medications. These may take a week or two to become effective and you need to be aware of this. Some oral medications also have side-effects when first taken that may make you want to stop. I am talking about Metformin. If the doctor prescribes this, ask if this is the regular or extended release version. Many people will not have loose bowels with the extended release and when taken with food.

If you are just starting to exercise, talk to your doctor to see that there are not problems you need to be aware of and make sure not to over exert yourself when starting an exercise regimen. Start slowly and increase the activity as you body and muscles become accustomed to the added activity.

A good blogger to follow if you have your heart set on managing diabetes with diet and exercise is this one by Tom Ross. Even if you are started on medications, talk to your doctor and ask questions about when you can consider stopping the medications. If your A1c's are at the right levels and the doctor can see that you are serious, he may encourage you and let you know when is may be safe. It is often an advantage to start on medications to get the management of diabetes accomplished early.

Also be aware that you can make mistakes. Learn from them and return to good management. This can happen to anyone at any time so just realize this and get back to management immediately.

Six Ways to Help Manage Type 2 Diabetes – P1

Much of the following has application for all types of diabetes. However, I am concentrating the discussion to Type 2 diabetes and may expand this beyond the pointers in the WebMd article. Their point is six ways to wreck your blood sugar levels or what not to do. I would like to approach this from what to do to manage you blood glucose levels.

First I would do away with the term used by many writers “blood sugar”. This term continues the misinformation about sugar being the culprit for diabetes. In fact this can have an affect, but the larger culprit is carbohydrates which is converted to blood glucose by our bodies. And we don't measure blood sugar with our meters, but blood glucose.

Type 2 diabetes is a serious chronic disease and therefore a tough adversary requiring constant vigilance to keep ahead of it as part of your individual management plan.

The article uses the following with a short discussion: Not knowing your disease, expecting too much too soon, going it alone, neglecting other problems, misunderstanding and misusing medications, and finally making poor food choices. Yes, these are six easy mistakes to make and everyone at some time in their diabetes lives will make them. It is what we learn from these falls and how fast we recover after making a mistake that determines how well we manage our diabetes.

Error 1 - Not Knowing Your Disease

The first one can be a key for assistance in managing the rest more effectively. As a person with diabetes, you need to learn about diabetes. Andrew Ahmann, MD, director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University in Portland, Oregon, makes a statement rarely uttered by doctors. He says “You are your own doctor 99.9 percent of the time.”

He does mean that you are the one managing your diet, making sure you do exercise, and taking your medication on schedule. Dr. Ahmann also states, “classes on coping with diabetes are an excellent but underused resource. Not enough patients seek them out, and not enough doctors send their patients to them.” People need to learn how diabetes works to be able to make more informed decisions and better manage diabetes.

The only comment I make to that is that people often receive information that they will need to adapt to their lives and needs. The people presenting the information instruct from materials and fundamentals from the American Diabetes Association which is presented as a one size fits all approach. They will soon learn that one size does not fit all and that they have individual needs as well, so learning to adapt becomes essential.

Too many doctors discourage use of the internet, and for them rightfully so, because of all the misinformation that exists on the internet. Some doctors are providing short lists of good information, but not enough to make a dent for all the people needing information. So I will encourage people newly diagnosed with Type 2 diabetes to search the internet on their own and look for reliable information – discarding information that seems to or offers cures, as this just is not possible.

The one source that had promised some assistance, the Association of American Clinical Endocrinologists (AACE) has failed in their attempt to provide reliable information. See my blog here. I will provide the site link for this blog in part four of six parts.

Is There A Link Between Insulin And Weight Gain?

This blog about insulin and weight gain is one of the better blogs on the topic I have seen. And it is written by a certified diabetes educator (CDE), so I will need to be cautious. I do have a greater understanding of the difficulty of losing weight as a person on insulin. Would I go back to oral medications if I could – no way – the management of of my diabetes as a person with Type 2 diabetes is so much easier and more effective than oral medications.

Have I had hypoglycemia from taking insulin? Yes, but very rarely. In the eight years of being on insulin, I can still count the number of episodes on ten fingers and have a few to spare. Is my carb counting that exact – I doubt it, but I don't inject all the insulin at once and generally test to see if I might need more and how much more. In general this means keeping my blood glucose levels under 150 and closer to 120 two hours after eating. For the few times I get above 150, I immediately add the extra insulin to assure myself of bringing it back down to approximately 90 at four hours.

Nora Saul at the Joslin Diabetes Center, does an excellent job of explaining why people have such a large problem with weight gain and lays the blame squarely where it belongs, on both the patient and doctor. The patient for not wanting insulin and the doctor who encourages patients to stay on oral medications. It is this treatment of last resort that makes for problems of weight gain. It is also the myths about insulin and the fear of the patient and doctor about hypoglycemia that prevents using it early on when when it would be beneficial.

Both the patient and doctor need education in the use of insulin to make it an efficient treatment without the fear of hypoglycemia. Plus what many people forget, by starting insulin use early, this allows the pancreas some rest instead of complete burn out and not requiring the quantity of insulin when the pancreas is all but done and insulin is used as the treatment of last resort.

Also important is the consideration of nutrition and exercise which is often easier before the weight gain. Quoting Nora Saul, “one reason people with type 2 diabetes often see the pounds pile on after they begin taking insulin is that they've waited too long to start.” I have written about this before and do believe this to be very true.

Please read the full blog by Nora Saul for her full explanation of what happens when you as the patient and your doctor avoid the use of insulin until it is absolutely necessary. You are not doing yourself any favors and only damaging your body by letting your blood glucose get too high and thereby undermining the normal metabolism of carbohydrates and fat. I have several Type 2 friends that can agree that waiting too long to start insulin is not a good idea. They will tell you it is better to start early.

Many people are not educated in counting carbs correctly and then enter the vicious cycle of hypoglycemia and eating to correct it. They often eat too many carbs for correction and then develop hyperglycemia – too high a blood glucose level. Another problem is the injected insulin (the short acting) stays in your body about twice as long than your own insulin ever did and as a result you end up feeling hungry. This is when you need to learn that you don't need food, and must force yourself to avoid food.

Eating at regular times becomes more important to know how to gain the advantage of ignoring the hunger as too many people feed the hunger and the management of diabetes goes out the window. It does take some discipline at the start, but with time the hunger pangs will subside and become easier to manage.

She does recommend seeing a CDE for education, but I would urge you to see a good dietitian or nutritionist, specializing in diabetes, that may not push the old American Diabetes Association way (unless you are a patient at Joslin Diabetes Center), but will use the new guidelines of individual needs and desires being more important. The key here is balancing the nutritional aspects of the food you eat and learning that the old ADA way often has too many carbs which will (I mean will) help increase your weight and keep you on an upward trend. You will need to adapt to the number of carbs that works for you and does not increase your weight.

Investigation Uncovers Disturbing Doctor Discrimination

Even if this was only researched in Illinois, you can depend on this happening across the USA. I know that this happens, but I did not realize the magnitude and numbers of children affected. Can this be corrected for the benefit of the children involved – a lot of actions will be needed by all concerned to begin to make this happen.

There was to have been a survey of doctors using at technique employed by stores called mystery shoppers, but titled stealth patients. It was to have been conducted by the Department of Health and Human Services (HHS) and was published in the Federal Register.

As of June 28, 2011, this survey has been put on hold when the American Medical Association (AMA) publicly complained and got the support of Rep. Tom Price, MD (R-GA). This survey was to discover how patients on Medicaid and Medicare are treated when attempting to obtain appointments when compared to those with regular medical insurance.

For doctors, it does reveal that it is all about the money. I say that if they have a standard of living that is so high there is no room for tightening of the financial purse strings, let them go out of business and live like many people are living that can't find jobs in today's economy. Except they will end up employed by hospitals.

The first investigation shows how the medical profession treats the children that have public insurance in the state of Illinois. The second investigation with stealth patients is about adults and what the medical community is not doing for those on Medicaid and Medicare. Hopefully this can be resolved and the survey can go forward, but much of the information is already out and the survey may be a waste now.

Until many issues are resolved for children on public insurance and Medicaid and Medicare reimbursement issues are resolved, the problems will continue to exist and these patients will continue to avail themselves of the Emergency Departments of hospitals where they cannot be refused treatment, but the taxpayers are saddled with the costs.

Read about the Illinois investigation here. The first article about the HHS survey is here, and the article stating the survey is on hold.