Complications of Using Insulin

An excellent topic came out in Joslin's blog February 6, 2012. While it does not outright list the myths that many people associate with the use of insulin, the question asked include two of the myths. The question is “Am going to lose my feet or go blind now that I am on insulin?”

Unless you have waited too long before starting insulin, and are letting your blood glucose levels remain too high, neither of these two myths need to happen. By keeping your A1c's less than 6.5, you should be able to avoid most complications. You do need to be very careful of hypoglycemia (low blood glucose below 70 mg/dl) and weight gain. If you are able to exercise, weight gain should be a minimal problem. Read my blog here on avoiding weight gain when on insulin.

Myths are the main reason many people with type 2 diabetes avoid insulin. Losing your feet is maybe one of the easiest to avoid. Have a good podiatrist that you see on a regular basis (preferably quarterly) that can check your feet. Be sure to point out any unusual bruises or cuts so the podiatrist can treat them immediately. If this is impossible, get yourself a mirror that can be used to see the bottom of your feet and talk about anything to your regular physician.

Blindness is a justifiable concern and you should have had an eye exam shortly after your diagnosis to establish a baseline for eye examinations while you have diabetes. You should have an eye exam annually to check for retinopathy, cataracts, and glaucoma.

There are other myths about insulin and you may read my blog on insulin myths here. It is important to understand that if you do not manage your diabetes and do not communicate with your doctors, complications will happen. They may be the expected complications or unexpected ones. Your doctor only has his questions and the results of lab work done, so if you do not answer his questions and remain silent about possible problems, then the complications are yours to deal with. Read my blog about who can be at fault and why.

Some doctors use the fear of insulin to keep people on oral medications and using them properly. Read my blog here about doctors using fear of insulin. If you are having success with oral medications, then continue taking them. Do not say I am doing well so I will stop the medications. Read my blog here about managing your medications. This is when the complications will develop and your diabetes may become unmanageable to the point you will need to use insulin. Some people are able to get off medications with their doctor's approval when they can show that their exercise and diet regimen is working and you are able to maintain this regimen. Yes, the doctors often need convincing.

Uncaring About Diabetes – Not an Easy Challenge

For several days, I have been wrestling with how to write about a potential member of our diabetes group. This person has type 2 diabetes and has been included in our discussions on two occasions. He is still not convinced that he has to do anything about his diabetes and we know that he is in denial. The first time he attended we knew he was very angry and not accepting his diagnosis.

Then Jan Chait who writes for Diabetes Self Management wrote an excellent blog February 14, 2012 about someone that was seeming uncaring about diabetes. This cleared the cobwebs and I am writing about this person. He is retired and lives alone. He said that he knows of no one in his family that has or had diabetes, but did lose his wife to what he says was diabetes about three years ago. She was diagnosed about three years prior to her death with diabetes and put on insulin at the start.

He does not know what caused her death other than he blames the diabetes and insulin. When he found out that six of our group was on insulin, he about passed out and asked how long we had been on insulin. I am the longest of our group on insulin at eight full years and another has been on insulin for about five years. The shortest time on insulin is almost three months. Others have been on insulin for more than one year.

This surprised him and he asked why we were all appearing to be healthy and able to get around on our own. His wife had been put on insulin and about nine months later had one foot amputated and was in a wheel chair.

When asked what his A1c was, he could not tell us. All he knew was that the doctor had told him he had diabetes and wanted him to start a medication. He could not tell us the medication, as he was not going to take it. We knew we had a challenge. How were we going to get him to accept his diabetes and take the steps to manage diabetes?

We did encourage him to get copies of his test results done by the doctor. We also talked some about food and made some suggestions we thought might help him. He seemed very receptive to most of our ideas. When we got to moderate to high fat, he balked and said his doctor has encouraged him to be on a low fat diet. We asked if he was having problems with weight gain to which he answered no. We then asked him if he was having cholesterol problems and how he was doing on the lipid panel. He said good as far as he knew.

Again, we strongly urged him to get copies of all tests the doctor had done. Then we asked, if he did not mind, bring them for him to read from to add a solid foundation for discussion. He said he would and we let him go with that. He said he will stay in contact with his closest neighbor who is one of us and had invited him to the meetings. I have since learned that he is out exercising every day that he is able. He jogs and walks every day – weather permitting and apparently has a treadmill in his house.

Now if we can get him past his denial and to accept his diagnosis. Then he may be more open to some serious discussions for managing his diabetes. We are hoping that we may have another potential member. We are also aware we have a challenge ahead of us.

Vinegar, Vinegar, Vinegar Is Not a Rose

Apparently, the makers of apple cider vinegar are increasing their pressure to push the topic of vinegar into the news and increase their sales. Prior to this, it seemed to happen only once a year, but it is only 7 months since the last barrage of vinegar articles and blogs. My guess is they did not sell enough from last fall's crop and that is the reason for the early push.

At least 54 percent of physicians who answered the survey say they will not promote vinegar to diabetes patients. Only 9 percent are claiming to promote vinegar and the rest are considering mentioning it. As more complete the survey, the numbers may change.

When you read the article here, please click on the references to see that Carol Johnston, PhD from Arizona State University, Department of Nutrition is the primary source of information. After you have read this article, you may want to read my tongue-in-cheek blog about this in June of last year.

What surprises me is the number of studies listed that were done with healthy subjects that did not have diabetes and they expect us to believe that people with type 2 diabetes will have long-term benefits from vinegar.

The more I see published about vinegar, the less I enjoy reading the drivel they want us to believe. Now getting Medscape to publish an article about it shows the desperation these people have to promote vinegar. The Obama economy is hurting everyone.

Sorry folks, it just the way I see this issue.

Our Goals for A1c

Maryam Elarbi writing for Diabetes Self-management had a very well thought out blog about A1c goals. As one of the readers commented, “How mature of you to take this attitude!” And for a young person with type 1, she could not be more right.

Often, we read about young people her age that are off to college, completely coming at odds with diabetes and letting diabetes take a toll on their health. And then in later life realizing how foolish they were back when.

Maryam's blog is worth the time to read. Before I get to what I wanted to say about A1c goals her statement here is most important, “At 18 years old, I’m finally at the point where I understand that “being good” at diabetes isn’t for my parents’, CDE’s, or endo’s approval. I’m accepting the responsibility that I need to take the best control of my diabetes for me.”

Now how does this apply to type 2's? I can no longer say that maturity gets us to this point quicker when we develop diabetes in our later years, too many young people are now developing type 2 in their preteen and teen years. They are facing the same type of problems this type 1 has, accepting responsibility for their diabetes.

Denial is an ugly part of our lives that needs conquering, not only to get on with life, but to take care of diabetes and prolong life. Some get stuck in denial for periods long enough that the complications get a strong foothold on our bodies and recovery is impossible. I actually thought I was immune when denial did not happen shortly after my diagnosis. Yes, I had the anger of getting diabetes, but I knew that my family history said I was at very high risk.

It was not until the third year that I had any denial. I was on insulin four months after diagnosis and quite happy with the success I was having. My A1c's were improving and I was living with diabetes. I think that denial maybe came with the depression of dealing with diabetes 24/7. Or maybe it was a little self-blame. Again, I was fortunate that this did not last long and I was back to myself again. I must also give credit to starting my second marriage shortly before the denial/depression happened.

The American Association of Clinical Endocrinologists (AACE) recommends A1c's of 6.5 for the upper limit and in 4 of 5 times I will be under their limit. It is that fifth time that seems to grab my attention. I have, since shortly after my diagnosis, been able to maintain my A1c below 7.0 and a few times below 6.0. I had wanted to get below 5.5 regularly, but that has not happened.

As I continue to age, I have reset my goal to keep my A1c near 6.0, which has worked out very well. I have learned the hard way that if you set realistic short-term goals and can achieve them, then the long-term goals will generally take care of themselves. Yes, you may have glitches (or bumps) along the way, but you will not fail to achieve the short-term goals if they are realistic and well thought out.

Infants at Risk from Arsenic Levels in Baby Formulas

Think organic is the only way to get your food? You will want to read this article in WebMD and maybe revise your thinking for some organic products. I know I am changing my purchases until the Food and Drug issues their report on the arsenic levels in some organic products.

Presently there are no regulations governing the arsenic (As) levels in food or food products. Arsenic levels in water is regulated and many of the foods tested were three to five times higher in arsenic levels than is allowed in water.

A study, which is published in the journal Environmental Health Perspectives states that researchers analyzed arsenic levels in 17 different brands of formula made for infants and toddlers. They also tested 29 energy bars and 3 energy gels, which are portable sources of carbohydrates often used by endurance athletes.

They also tested three organic brown rice syrups that are sold in natural or organic sections of some supermarkets and in many health food stores. Some people use brown rice syrup as a sweetener substitute for sugar or corn syrup in baked goods.

The researchers stated that products that did not list rice or rice syrups as the top ingredients were all low in arsenic. They also stated that rice syrups themselves and products listing rice or rice syrups as one of the first five ingredients, all contained high arsenic levels. Most of the arsenic found in the energy bars or gels was the inorganic arsenic believed to be the most toxic.

Rice products are now being tested for arsenic levels as is some juices after recent tests turned up high levels in some apple juice brands. The big concern is the levels for infants because of the relative exposure based on body size. Hopefully, FDA will have guidance published in the near future.

Please take time to read the WebMD article. Then read the abstract here. If you are still interested in reading more, on the abstract page in the upper right corner you may print a copy of the full study, or download a PDF file to read the full details of the study.

Children with OSA Benefit from CPAP

This was a most timely article as it fit with an email question I received from someone discovering a blog of mine on obstructive sleep apnea surgery. The parent was wondering about why the two doctors he had taken his child to were so insistent on doing surgery. The blog was this one and he was thinking there could be more about this since October 2010. I also gave him this blog from February 2011.

After replying to the email with this article, he emailed me back asking for my phone number. I supplied it and his wife called shortly after. I supplied her with the sites I had and a listing of doctors that handled sleep apnea in their area. She discovered that the nearest sleep study lab was about 60 miles from them, but she has a sister living in the town so that was a huge plus as she would have a place to spend the night.

Both parents had read my blogs and were wondering why the doctors wanting to do the surgery had not informed them about the side effects and problems that could result. We discussed their medical insurance and I suggested they should call there for doctors and what equipment would be covered. I had given them three sleep apnea equipment sites so they could familiarize themselves with some of their options.

Two hours later, I received another phone call saying that two of the different types of equipment would be covered and she was to receive a schedule of how often replacement parts could be obtained through the policy. She found out that the doctor she was now going to call for an appointment was indicated by the medical insurance and they encouraged her to make an appointment.

Today, February 15, I received a call saying that at first it was going to be about two weeks before their appointment. Then they had received a call from the doctor this morning asking them to be there by 3:00 PM for an appointment and if a sleep lab was needed, they had a cancellation for this evening and their son would be using this appointment. The mother said the doctor asked her many questions, but her conversations with me had given her the knowledge to answer them.

She and her husband had taken time last night to count the number of apneas at two different times that their son had for a half hour period. She had counted 39 apneas when she observed her son and her husband counted 44 apneas during his time. She said the doctor was very surprised they had done this, but said this helped him know that the sleep study lab was needed. The doctor did ask her to inform the insurance company that he would be participating in the sleep study lab tonight and have the insurance company call him if they had any questions.

The husband just called me and stated that the doctor had done an evaluation and agreed that the sleep study lab was needed. The doctor had discussed with his wife and son what would happen during the study, and then clearly stated that until after the sleep study lab results were available, he could not make any recommendations. He did list the options which included surgery, but that until he knew that CPAP (continuous positive air pressure), if needed, did not work, he would prefer leaving surgery as a last resort. The father also stated that exercise was also part of the treatment options to have their son lose weight to near normal for his body structure.

I hope that I will hear what the results are, the course of action prescribed, and be able to do a follow-up blog. Here is a second article about the same study, which I had given the parents.

What Is So Discouraging About Diabetes Forums

I am talking about diabetes forums in general and not pointing out any particular forum. Diabetes forums can be a source of some valuable information – when people do not take offense to the information given. What people need to understand, but seldom do, is there are many ways to approach any given topic and you will find many of them in answers to some inane questions.

On several of the forums lately, there have been some excellent questions and many equally good answers. However, for three questions on three different forums, the persons asking the question were looking for answers they thought they should see. When the answers were not what they were looking for, they dropped out of the discussion. All the questions were for people with type 2 diabetes

Two of the questions were about carbohydrates and fat content of foods. They were looking for confirmation of some information they believed in and that is promoted by the American Diabetes Association. This did not happen; all answers were low to medium carbohydrate and medium to high fat answers. The original posters came back with the studies have shown that fat was bad for us and whole grains were good for us. None of the responders agreed and so the discussions ended on both forums.

The third forum had a question about insulin and when to go on insulin. I thought this could be an interesting discussion, but for every answer, the original poster would ask about another insulin myth. There were some good responses, but the person was not convinced. Finally, one person listed many of the insulin myths and the correct answers to them. This infuriated the original poster and she said there had to be some truth to the myths. She then stated that was the reason she would avoid insulin as long as she could as insulin was only for people with severe complications and near the end of life.

I had not participated in the discussion about insulin since the other answers were good and to the point. The last statement above is the myth to end all myths. This is because insulin for people with type 2 diabetes is thought to be the treatment of last resort. Many doctors and most type 2 patients hold this to be true. By doing this, they are diminishing their quality of life and their lifespan by possibly years if not a decade, or longer.

People with type 2 diabetes should become knowledgeable about insulin and the myths so they can understand the value of insulin and how it can enhance their life and prevent the complications from gaining a foothold in their lives. I have now been on insulin for a full eight years and am very happy that I have this medication to hold the complications at bay. Yes, I have neuropathy, but I had this several years before the diabetes diagnosis. I can say that it has not gotten worse since diabetes and going on insulin.

So if you are an active participant on any diabetes forum, be aware that many that come to the forums do so only for confirmation of what they believe and not for the truth. They believe in many of the myths about diabetes and are fearful of insulin. Some are more fearful of the needles, but they can learn to overcome this. Insulin can be a very powerful tool in the battle to manage diabetes. There is a need for education, but the information is available, whether in printed form, or online.

Diabetes Support Groups Aren't for Everyone

Diabetes support groups can be a valuable asset for some and a pain in the backside for others. They do have advantages and disadvantages like any other group, club, or meeting. In the last four years, I have been involved in six different support groups in a 100-mile radius. I thought a regional group would get it going, but in three months it has flopped – fees for meeting places were probably to blame. Is it the region, area, or the general population that causes diabetes support groups not to succeed? I don't have an answer.

I do know what has been the bane of several of the groups – the diabetes police. No, I am not talking about the diabetes food police, as this is another topic. The diabetes police are well-intentioned spouses (male and female) that come to the meetings for whatever reason. Then at some point during the meeting, they make inappropriate comments that many dislike and do not want to put up with in a meeting for support. The atmosphere was supposed to be supportive and nourishing to allow attendees to ask the questions they needed answers to for assistance and to help guide them. However, these well-intentioned spouses cannot stand to be left out and feel they have to add their drivel even if they are wrong and demeaning to others.

This has happened at every support group I have been a participant in and it casts the death knell on the meeting, if not the group. This is one reason I will not allow my own spouse to attend – which sometimes means I do not attend. Some of the comments by the spouses have been very caustic and others have been almost innocent at the start, but later evolve into belittling attitudes of why we are not able to manage our weight, food consumption, and even our feelings. We do not need these comments when we are in a discussion about depression, testing, or changing lifestyles.

I thought one group (type 2 only) had moved past this problem until a new member came with his family – spouse and her parents. Not even ten minutes into the meeting, and his family was berating people for allowing themselves to get diabetes, inability to manage their diet, and lack of self-discipline. It only took five minutes for the meeting to disband, and people were gone. This group does still meet (thanks to the doctor that leads the group), but they are not allowing new members until they have been talked to by several of the members and understand that spouses and other family members (non-diabetic) are not allowed.

Another death sentence for diabetes support groups is certified diabetes educators as group leaders. Those that insist following the American Diabetes Association guidelines cut off discussions that are outside of the guidelines and stifle personal experiences being shared. They will not allow discussions about low carb, high fat, or other discussions that are of interest to members of the group.

I have now limited myself to the small – intentionally – informal group that I participate in and we are now seven members. Two are women and do not attend that often. All but one of us now are on insulin and we are all type 2, with the newest member now officially off all medications thanks to her diet and exercise regimen. Two of the group are still working and therefore unable to attend every time we get together. We do get together more frequently now that all of us have Skype. We exchange emails and all of us do research and we discuss this among ourselves. I am the only one of the group that blogs publicly, but I am supported by the group. In a way they can be my best supporters and harshest critics, but I thank them.

This is just a guess on my part, but another reason for limited participation in diabetes support groups is the secrecy that people want to maintain. This may or may not have anything to do with the diabetes police or the diabetes food police.