Nutrition Challenges When You're Older or Sick

This was not written for those of us with diabetes; however, there are some aspects that must be considered and people with diabetes need to be extra careful in the manner which they view this. Now I realize that the persons that are quoted are registered dietitians in the Academy of Nutrition and Dietetics, and thus I must say that I at least need to be extra careful to avoid the traps that will be presented.

Having visited several nursing facilities locally, I realize that as we get older, we tend to eat less. Medications can affect our appetite and sometimes our taste. One of the largest problems I see is dental problems. Not only can this make it painful to chew food, but also dental problems may discourage intake of many foods. Ability to swallow some foods is also a problem unless water or other liquids are available to assist in swallowing.

Considering that there are reasons for appetite loss, consider when you are not feeling well or something is bothering you, how do we maintain adequate nutrition. Kathleen Niedert, RD, director of clinical nutrition and dining services for Western Home Communities in Cedar Falls, Iowa, who counsels many seniors on how to deal with loss of appetite says rightly that “no single strategy works for everyone.”

The article lists ten strategies that will fill some of the nutrition gaps. Please realize that this is written for people without diabetes. I will take each strategy and write my understanding as a person with diabetes. I may miss some items, but I will attempt to highlight the important parts.

Give Yourself Permission to Indulge in Favorite Foods

For people with type 2 diabetes, this is unhealthy advice. We need to worry about the nutritional aspect and attempt to eat properly. While we need calories, we need to find someone that can give us better guidance than the advice given as it is a total cop-out on even reasonable dietary advice.

Enjoy Meals With Friends

This advice can be excellent for some people with diabetes, especially if your friends have diabetes, or at least understand your needs. I agree with this because people generally do eat better with family and friends. The socializing can give a positive influence in what we eat and assist us in eating more slowly.

Buy Prepared or Convenience Foods

If you are a person with diabetes, this should be the last consideration for a diabetes friendly meal. I have no objections to the right foods purchased at the grocery store, but as much as possible, avoid convenience foods. Some grocery stores have a cafeteria-style area where some foods are prepared right, but you must be careful to avoid some of the foods with added sugars or I should say hidden sugars in their sauces and gravies.

I realize that many fresh and frozen foods can require a minimum of preparation and microwaves can really be a help. Do not forget that many fresh vegetables will lose nutrients when they sit around for longer than they should after being picked. Therefore, frozen vegetables can sometimes be a more nutritious choice.

Try New Flavors and Foods

This is a difficult one for people with diabetes as so many foods just do not belong on our menus. Occasionally a new food will come along that will fit our needs. At other times, we will need to use our meter to see how a new food reacts in our system.

The dietitians involved in writing this article in WebMD are very transparent and even use the term “comfort foods” to encourage their readers to eat. Those of us with diabetes should understand that we may eat some comfort foods, but in limited quantity and only what our meter allows.

Spice Up Your Meals

If you’re not hungry because food tastes bland, try adding extra spices and other flavors. This is common sense and does make some foods more palatable and some spices do add nutrient value to the meal. A sprinkling of some fruits with certain foods can also add flavor and desirability to some foods. Again, let your meter be your guide.

Add Calories to Foods Wherever You Can

If you are underweight, use creative ways to add calories to dishes, especially when you’re ill. Even if you have diabetes, these tips will work for you, just do not overdo. Switch from skim milk to 2% or even whole milk, for example. Add extra butter to help add flavor to vegetables. Try these tips as they are healthier than the dietitians are willing to admit. Just start using this tip slowly to give your body time to adjust and not all at once. Even being overweight, these tips can assist in losing some weight. Just limit the pastas and whole grains by what your meter says.

Consider Nutrition Drinks and Liquid Meal Replacements

By providing balanced nutrition in an easy-to-consume form, liquid meal replacements can help you make sure you’re getting the nutrients and calories you need. Your doctor or dietitian can discuss options that are appropriate for you. This may be in your best interest if the liquid meal in not loaded with carbohydrates, but contains a reasonable number.

Drink Plenty of Liquids

Dehydration can dampen appetite, so it is important to stay hydrated by drinking plenty of liquids, preferably water, low carbohydrate vegetable juices, and if allowed unsweetened iced tea or hot tea.

Graze on Snacks Throughout the Day

For people with diabetes, if you don’t feel like eating very much when you sit down to regularly scheduled meals, try eating smaller amounts more often throughout the day.

Eating small meals six times per day can actually assist in blood glucose management, but until you try this, you will not know. This technique can assist in keep blood glucose levels lower throughout the day and prevent spikes that often occur at three meals per day.

Get Meals Delivered to Your Home

Most communities have service organizations that provide meals to older people, either delivered at home or served in community senior centers. If you’re not well enough to prepare meals yourself, check with your local social services to find out what options are available. Senior community food programs are open to anyone 60 and older, regardless of income level. If your doctor indicates that you aren’t able to leave the house, you can qualify for meal deliveries. This is good advice and the only caution I would add is when signing up, do not check the diabetes menu.

The reasoning for this is because you will get more carbohydrates than you should or possibly can eat. Most meals are high in processed grains and starches, but the diabetic meals seem to be overloaded with carbohydrates. In my community, this is very true and a couple that receive them are able to spread the meals into five meals and occasionally more to maintain carbohydrate control. Not that they are trying to spread the meals, it is just more food that they normally eat and higher in carbohydrates than they are accustom to or have had for many years. For some reason, the diabetic menu gets you more food than you would otherwise receive – strange what dietitians think.

Doctor – Are You Obtaining Enough Sleep?

A conversation between a surgeon and his patient the day before his surgery.

Doctor: Make sure you get a good nights sleep!

Patient: Speak more clearly doc – your mumbling.

Doctor: How long will you sleep tonight?

Patient: It is not me you should worry about doc. You are already having trouble speaking and it’s only nine-thirty in the morning. I think the issue is how much sleep will you get tonight?

Doctor: That is not your concern.

Patient: I think it is doc, I am the person you will be opening up tomorrow and you are already half asleep. I think it is time to ask for another surgeon, one that will be rested for the surgery.

Doctor: You need this surgery now. You cannot let this go for another doctor.

Patient: Doctor, unless you bring in another surgeon, you will be in trouble. I hope your liability insurance is paid up to date.

Doctor: I will see you at 10:00 AM tomorrow.

Patient: Not unless you have another surgeon doing the operation. I will not let a doctor that is this sleep deprived operate on me. So what is it going to be? Another surgeon or do I find another surgeon on my own?

Doctor: Have it your way – but don't expect me to give you a referral.

This is not what you want to have happen under any circumstance, but it did and to an individual I know. He was indeed lucky as the next day; the surgeon lost a patient because he was sleep deprived. Whether it would have happened to him, he does not care as he did locate another surgeon and had the surgery a week later. This time it was at the Mayo Clinic in Rochester. The surgery was successful and he is recovering quite well. There was a minor adjustment the surgeon had to take during the operation, but he said he had encountered this before and it was not life threatening.

This is a good lesson for anyone. Yes, the patient can always be very anxious before surgery and get very little sleep. This is not good for the patient, but is understandable. It is not understandable for a surgeon to be that way, yet this happens all too frequently. If this was a teaching hospital, we could expect interns to be overtired, but for a surgeon in a non-teaching hospital, this is unconscionable.

The study that got me started can be read here. It describes some of the effects of sleep deprivation, but cannot be relied on, as there were many parts of the study that caused no problems. I do understand the inability to actually follow practicing surgeons, as a study does not want to be responsible for actual harm. So all the study was done on simulators.

The Challenges in Self-Management of Diabetes

Even though this is a small UK study, it could apply to any developed country and fit the conditions found in this study. This study highlights many of the problems people with diabetes face on a daily basis. These problems include prejudice, ignorance, and stereotyping not only by medical professionals, but also by the society in general.

It is no wonder that even with a trend toward having individuals manage their own health; individuals are ready and able to do this, but need more support. Even in the USA, many doctors are not supporting having individuals manage their diabetes. They often feel that education is wasted on uncaring individuals and many doctors use fear to force people to use oral medications when insulin may make the individuals task of managing their diabetes easier. Plus many in the medical profession feel that for type 2 diabetes, insulin should be the medication of last resort.

If you are a person with type 2 diabetes, you invest time and effort in managing your diabetes. This includes self-monitoring of your blood glucose levels, managing your medications, and carefully following a restricted diet. On top of this, there are the challenges of not offending relatives who think they have your interests at heart. Then we all have the food police that can be rude and offensive in their instructions about what you may consume. Lastly, we have the diabetes police that want to tell you when to test and want to know what the reading is so they can advise you. If you thought life was difficult, then consider the doctors that use fear to motivate you or doctors that belittle you for not having followed orders that were never that specific in the first place.

Since the doctor cannot be with you but only 15 to 30 minutes per appointment approximately four times per year, we must learn to manage our diabetes on a daily basis. This means that for over 99 percent of the time, you are on your own in managing your diabetes.

What is interesting about this study compared to many studies, is that the researchers shadowed the participants for several periods of two to five hours while they were living their lives. They took notes of how they managed their diabetes and the challenges they faced. Trisha Greenhalgh, Professor of Primary Health Care at Queen Mary, University of London, led the study. She said, “Until now there has been very little research on what people with diabetes do and how they cope when health professionals aren’t around. We have shown that self-management of diabetes is hard work both practically and emotionally, and that many but not all people with diabetes are skilful at undertaking and co-ordinating all the different tasks involved."

It is interesting that this part was examined and the participants praised for the efforts they put into managing diabetes. They did say that for those not managing their diabetes well, it was understandable since many were cycled in family responsibilities, some had other illnesses, and some were struggling financially, or even had a combination of these factors. The researchers correctly state that these factors can limit opportunities to manage diabetes and that those who could benefit the most from self-management were the ones least able to achieve it.

The researchers did acknowledge that more needs to be known about how patients manage diabetes outside the clinic. In reality, doctors should be more aware of the efforts patients expend to self-manage their diabetes and understand the many factors that will influence how successful patients are. Until doctors are better able to assess patients and their ability to manage their diabetes, little will be acknowledged in the value of education patients receive. Doctors will continue to resist educating patients.

Article about Academy of Nutrition and Dietetics

Are we headed for problems in the field of nutrition? If the Academy for Nutrition and Dietetics (AND) has their way, many people with chronic diseases will be worse off than they are presently. Those of us with diabetes will need to educate ourselves completely about nutrition to avoid the poor information that will be dispensed by those licensed by the AND. AND's former name was ADA (American Dietetic Association),

Currently in several states where AND licensure has been passed by state legislatures, nutritionists of all types are being force out of business. This includes, but is not limited to nutritionists having a PhD in nutrition, but other highly trained nutritionists specializing in other fields, but give out nutritional information. Am I endorsing all types of people giving out nutritional advice? No, but those that have a degree in nutrition should not be forced out of business just because they do not want to belong to AND.

However, this is what is transpiring in many states where the AND has gotten their licensure bills passed. They consider people not part of their organization as competition and are going after them with a vengeance unlike many of us have seen before. Yes, history shows that this has happened before in the medical community between different professions, but the bitterness this time is very bad for the registered dietitians (RD) and style in which the AND is attempting to end competition.

At least now several groups are fighting the efforts of the AND and their campaign to criminalize non-RD nutrition providers. These groups include the Alliance for Natural Health, USA, the American Nutrition Association, and the Weston A. Price Foundation. These groups plus other organizations are mobilizing their memberships and constituents to oppose the AND monopoly. Even consumers will lose the choice of nutrition professionals to choose from and where they wish to receive nutrition information.

If you do not wish to have policies from the American Diabetes Association, the USDA, and other government agencies that the AND follows and advocates, then you need to pay attention and oppose the actions of AND in your state. If you did not read my previous blog on the same topic, read it here and the links in the blog. Read the link for starting this blog here.

I know from correspondence with several people I consider friends in the current AND and outside, that some of them are joining other organizations where they will be able to practice nutrition outside the AND and one is retiring to avoid the squabble. A couple of current RDs will retain their membership in AND until such time as they are able to leave.

It is a shame that so much of the then ADA (American Dietetic Association) and now Academy of Nutrition and Dietetics licensure requirements was pushed through many state legislatures so quietly. Now the battle will be to have the laws repealed or changed to prevent the monopolization of nutrition. Check the licensure requirements for you state here,

HFCS Denied Name Change to 'Corn Sugar'

Score one for those that opposed the name change by 'big corn'!  The Food and Drug Administration on May30, 2012, officially announced the denial of the request of the Corn Refiners Association for the name change from high-fructose corn syrup to corn sugar.  For those desiring to read the technical reasoning the link is here.

I am happy the decision went against the corn industry and kept the current name in place.  Many of us with diabetes know what this does to our blood glucose levels and that we need to avoid products containing this. There are many that believe that HFCS is a large factor in our obesity epidemic. There are studies for and against, and I firmly believe many are agenda driven.

The above being said, apparently the corn industry is thinking about continuing the advertising and doing other questionable activities. I have noticed several products on grocery shelves in the last week that do not list high fructose corn syrup, but definitely list corn syrup. Since I was looking, I checked many of the canned items, and refrigerated foods. Since this was before the FDA ruling, I was surprised to see corn sugar listed on a couple of products. Also seen were corn products, corn byproducts, and cornstarch. I would expect these and admit I was even more surprised to see corn byproducts on an ingredient label with high fructose corn syrup.

Now on to some serious information. This article has put some reality into our problems with high fructose. Even though is is from the animal model, the researchers have declared the findings have relevance for humans. The finding is that diets high in fructose impair cognitive function. Then in the next sentence, they state that if the diet is supplemented with the correct intake of omega-3 fatty acids, the fructose impairment is reversed.

Coauthor Fernando Gomez-Pinilla, PhD, from the UCLA Brain Injury Research Centre, Los Angeles, California, states, "High fructose consumption can induce some signs of metabolic syndrome in the brain and can disrupt the signalling of the insulin receptors and reduce the action of insulin in the brain."

Then he adds, "On the other hand, consumption of omega-3 fatty acids, particularly decosahexanoic acid [DHA], seems to protect against the effect of this high fructose consumption. That was the most interesting thing for us, to find that these changes in the brain that the fructose was triggering, the poor learning and the other molecular changes, could be buffered by omega-3 fatty acids."

The study is published in the May 1 issue of the Journal of Physiology.

I am sure we will see more studies on HFCS and more agenda driven studies as the corn industry wants to preserve their stranglehold on the cheap product added to many foods.

Is Diabetes Causing You Burnout?

This blog in Diabetes Health is interesting. Yes, diabetes burnout is common and happens more often than we might like. Many people have burnout and wonder why they feel like they do. Some people do not recognize this and have a difficult time dealing with this for a period of time. Others become depressed and know they have something that needs correcting, but it can take time. Some that have depression and don't know they have it. As a result, their management of diabetes takes a vacation. Some of the solutions are unrealistic for many people and others will not be able to consider the solutions offered.

The second article is from About dot com and is a little more realistic. I enjoy this analysis of diabetes burnout. Unlike the first article, the author recognizes that recovery happens, but not all at once. She says rightly so that it often takes baby steps to overcome diabetes burnout. I know this is right because even though I have been blogging consistently, I am fighting burnout myself. I am not enjoying this at all and wish I could say that I have not had depression. The depression is behind me now and I am working on correcting the areas of diabetes management that have suffered for the last two months.

No, this is not easy to write, but it needs to be written about by people that have been through the wringer. What started it, I am not totally sure. I know an argument with a doctor did not help. I can think of a lot of little things that add up and make you want to find something to take it out on. I have a couple of people that are what I term “the food police” and I see them more often than I like. I try to ignore them, but when they are constantly in my face, they are hard to ignore.

There have been other health concerns as of late and until mid June, I won't have an answer. I also know that I had about a week that blood glucose readings got higher than I like and by more than I like, and with a lot of analysis, I could not figure out what or why it happened. This may have been much of the trigger and the food police that just aggravated the situation. Now it is climbing out of the pit I have gotten myself into.

Since I am researching diabetes burnout, I have to say this makes the most sense to me so I will use the points that Elizabeth Woolley lays out and make comments about each.

Accept that you can't be perfect. Being the near perfectionist that I am, makes this almost as bad as the lesson I had to learn when I was diagnosed. What has happened can't be changed so accept it and move on. It is almost behind me and I have got to keep it there.

Remember it's all about you. Yes, I am the only one that can take responsibility and make the changes necessary. I cannot blame anyone else for my errors or shortcomings. I have to get my good habits back in control for better management. I think that a positive attitude helped me from sinking too low, but now I have to recapture this as well.

Become proactive in solving management challenges. I am hoping the fact that in dealing with the medical community I am a proactive person will aid me in being proactive in improving my diabetes management.

Connect regularly to the diabetes world. This will not be difficult, as I will have my appointment next week with the endocrinologist. The A1c will have to be what it is. Approximately two months of poor management can't be corrected in a week. In reviewing my first month’s records, I was doing so well – shame it has to be this way.

Now I wish I had the list that comes next in the article. A couple of them may have made it harder, but I am still using this list so that next time, I may be able to short-circuit some of the problems. Here is the list and my comments.

Take small steps in the right direction. Sometimes this is the best and then if you succeed you are able to celebrate a success. If you fail, you won't have lost a lot of ground. Continue with the small successes and eventually you will have your diabetes management back.

Take a doctor-guided break if needed. I will definitely give this some consideration, as this may be a way to lessen the effect of burnout. Hopefully, this will be possible, communication has been good, and this looks like something I could handle.

Find inspiration. I will have to work on this. Yes, I was reading, but reading for research and blogging. I had to work harder to write blogs and often reread some articles. I missed several of our group meetings and spent much of my time just writing and rewriting when it was not making sense.

Reestablish a connection with the diabetes community. I am hoping that just by continuing to blog will aid me in getting rid of this down feeling or energize me to be myself. According to the author, I am to reconnect with the diabetes social community.

See a diabetes educator. This is not possible. Insurance will not cover at this time and I am in no mood to have mantras shoved at me. This is me and I feel that this would put me back in depression. I know, I know, for some people this will be an advantage and serve them well. What will work for some, will not work for me this time.

Count your blessings. This can be important for many. This will also aid in getting you back to a positive attitude and feeling good about yourself. Give this an honest try.

Make peace with the diabetes police. If you are able, this may go a long way in restoring peace in a family or among your friends. Include the diabetes food police, as they can be worse than the diabetes police. I am in luck with two of these individuals, but with the third person, I am not sure this is going to be possible. I feel this may be one that has to remain at arms length.

Make sure you are not experiencing depression. Sorry, I've already been through a minor depression and have my life back. For anyone reading this, sometimes a person is able to work their way through and out of even a minor depression and at other times, it may be necessary to talk with your doctor or other qualified professional to help you. They can also determine if other means may be needed for the short and long-term.

Depression is not sometime to take lightly and sometimes professional help is the best solution. I admit that I have not needed it, but I am prepared if it becomes necessary and have talked to my doctor about just that. The doctor will give me a referral if needed.

I have several blogs about depression, but I find it a difficult topic to define and the professionals just like their technical jargon and apparently find it difficult to write about it in laymen terms. My attempt may be read here.

How you handle diabetes burnout depends on you and your attitudes. I have found that having a positive attitude about diabetes has generally served me well and made it easier to handle diabetes burnout. Not everyone will react the same. Another article on how diabetes can take a toll on our emotional health may be read here.

There is one important topic missing.  Take your medications, if you are on any.  I feel fortunate that through the burnout and depression something kept reminding me to take my medications.  Yes, often it was after I had gone to bed, but something in the back of my mind would not let me sleep and was saying insulin, insulin, until I got up and took my medications.  I guess after almost ten years, habits are good at times like this.

Friday Tidbits 06-01-12

Is this crying in the wilderness? From the comments to his blog, you would have to think that is true. Greed is the creed of many doctors and they will ride the current healthcare system to the end and take every dollar they can. At least Bob Doherty is talking about the issue on the Advocacy Blog.

There are efforts in many areas to reduce the rising costs, but little is being accomplished because of the attitudes of the medical profession. Almost every person in the medical profession believes that the current system is broken and needs to be fixed, but from the top down, they are unwilling to anything other than acknowledge the problem.

What surprises me is the opposition by many medical groups against groups that are attempting to lower costs. Two of attempts are shared medical appointments (SMAs) and concierge medicine. There are also small practices throughout the country attempting other experiments away from traditional medicine and the medical organizations are attempting to squash them early on. How backward do we have to become in our medical treatments before we have a patient uprising that will put some of the organizations out of business and demand better healthcare?

The second article is a different discussion that I have wondered about for some time. I am also happy to see this, as we need to finally sweep the low-fat mantra under the rug where it needs to be. I am not sure how accurate the research is as I am always suspicious of agendas from researchers. However, is written to show that certain fats are very beneficial for out brain activity.

This research is probably more reliable and evaluates almost 6200 women over the age of 65. It determined that consumed more monounsaturated fat than saturated fat retained greater levels of overall cognitive functioning. Those consuming more saturated fat actually had a decline in cognitive function. I do feel that there is an agenda associated with the study considering they singled out the saturated fat in butter, cheese, and red meats. These may not be the best, but in moderation should not be forbidden.

The third article disturbs me personally. Are our veterans considered second-class citizens or even third class? Veterans may be causing this themselves, but this is difficult to understand. I know when I was discharged, I was given no information about veterans benefits and it appeared like they were just glad to dump us on the street as the downsizing was already underway as the Viet Nam War was getting downsized.

Today, with a volunteer military force, this should not be happening. When discharged, those people should spend at least two days being taught about the benefits available to them. Handouts should be given explaining each benefit and the address and phone number for each local Veterans Affairs office.

It is shameful that so many veterans are without medical insurance and not availing themselves of medical services with the Veterans Administration. “It is true that the VA is “the nation’s largest health system and provides health care for many veterans through a system of medical centers, clinics, and other facilities…However, some veterans do not use VA health care services. Eligibility is based on veteran status, service-related disabilities, income level, and other factors, and even within the groups eligible for VA care, other factors, such as their proximity to VA facilities and the cost-sharing requirements, may affect the likelihood that they seek care in the VA system.””

Yes, there are hoops to jump through and some are tired of the treatment they have received by the military complex. Once you have been qualified, every year, you are required to submit a “means report” to determine your level of eligibility for benefits and the amount of your co-pay. Without this report, you may be denied benefits.

The last item is more for the political types and is indicative of what is happening in our government. If a sitting president can fund a campaign with government funds, then it is time to bring these funds back under an oversight committee and end the handouts.

Problems for Diabetes Patients

As I research diabetes and the related occupations that treat those of us with diabetes I keep making small discoveries that are upsetting to me at least. I read several medical blogs by doctors and read some of the blogs by diabetes educators and a few other blogs by other professions related to the treatment of diabetes topics. With a few notable exceptions, many doctors, all diabetes educators, and all dietitians want us to be complaint and stupid, letting them tell us what to do and what not to do.

I am reading about more people on diabetes discussion boards and diabetes forums who think like I do and are tired of being treated this way. Even those in my local diabetes group are now echoing these feelings. Although we tend to all go our own way and have differences of opinion on many topics, we are all in agreement that the current atmosphere for people with diabetes is a lose – lose situation. While we are doing exceedingly well as individuals, all of us have learned to ignore anything from the USDA and the medical groups that promote and advocate following this way of eating and nutritional advice.

Yes, we all want nutritionally balanced meals as much as possible, but we know that we cannot depend on our medical and related diabetes professionals to give us good advice. They constantly repeat the same thing – whole grains, low fat, and they will not budge from this mantra. This is what the USDA preaches, the American Diabetes Association trumpets, and the American Association of Clinical Endocrinologists follows. Then you add the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics and you are hammered again and again and again with the same boring meaningless mantra.

Fortunately, some of us have friends or relatives that are nutritionists that are not under threat from the Academy of Nutrition and Dietetics (AND), and they will work with us at various carbohydrate, protein, and fat levels to help us balance our nutrition. Their only concern is seeing that the balance of nutrition is present. For this we listen and thank them. We also promise to support them and stay in touch with our state legislators to prevent the AND from slipping something through without a fight. And they have tried, but thankfully nothing came of it this year.

The other common item most of our group agrees about is all the studies that insist that we eat certain foods if we have diabetes as we have decided that most of these studies are misleading and not for us. Most of the time these studies have a specific agenda and nothing to do with balanced nutrition or even fair nutrition. We are tired of studies claiming red meat is bad for us, that a specific vegetable or fruit is a super food that benefits people with diabetes. What they do not even consider is that more and more people with diabetes are figuring out that what works for one person does not always work for another person. We are downright tired of this one-size-fits-all advice that we know probably does not work for us.

Another common agreement is the studies that are done to prove that one medication on top of another medication, plus additional medications added to these is the only way to treat type 2 diabetes; we know this is not for us.. We are disappointed that our researchers have a very limited ability to think for themselves and that they jump to the tune of Big Pharma every time the bell jingles. We are disgusted that our researchers are incapable of thinking outside the box to give us something to hope for and solutions not requiring medications stacked one on top of another. This is one of the reasons most of us are using insulin. We obtain better diabetes management results and have none of the side effects associated with the oral diabetes medications.

When the researchers start calling the tune and telling Big Pharma that their ideas are unworkable, then we may see some innovation and meaningful studies where study participants are everyday people and not those that fit the strict criteria to slant the study in the direction desired. We understand age ranges and people with other chronic diseases being eliminated from some studies. What we disagree with is studies where people that might be concerned about testing their blood glucose on a frequent basis are automatically eliminated because the researchers and the funding agencies are looking for people that do not care about testing so that they can show a reason for limiting testing supplies for those that want to test and maintain excellent diabetes management.

When we think about all the money funneled into poor and useless studies, we have to think about how much closer we might be to an actual cure if the money had been utilized more efficiently. Efficacy in our studies and their usefulness should be a priority. Another topic that is a sore point with us is universities that have results from research that is on the cutting edge of a breakthrough and this is purchased by a pharmaceutical corporation and that is the last we hear about it. These are things that need to be exposed and if the research is useless, the American public should be told. While we may not always believe the results, because we are suspicious by nature, we deserve to know whether it was purchased to be buried and nothing more done with it or if it was indeed only a minor piece of the puzzle.

To this, I would say that if nothing was forth coming in three years (or maybe longer), but no more than five years, then rights would return to the originating university for continued research and development. Only if some checks and balances are put in place can we be sure that good research will not be put in mothballs because a large pharmaceutical company wants to make larger profits by burying promising research.

It was a little surprising that while we have been discussing the above; a study would be published adding to our perception of what happens. This study published in the Journal of the American Medical Association on May 1, 2012, declares that the majority of clinical trials are small. The study points out there are significant differences in methodical approaches including randomizing, blinding and even the use of data monitoring committees. This is the largest comprehensive analysis of data in Clinicaltrials.gov and finds that clinical trials are coming up short of producing high-quality evidence needed to guide medical decision making in a clinical setting.

This evidence points out the problems we a patients will continue to face in obtaining informed information and proper treatment of medication usage, clinical care with application of the latest techniques and possible best treatments. If our doctors are unable to rely on proper evidence, how are we going to have confidence we are obtaining the best in care.

Our group does agree that there needs to be an independent agency (or committee) that oversees all of the study applications before they receive a penny of funds. This agency should be independent of any pharmaceutical company, university, or government. Where they would obtain their funds to make a modest living is a point we have not solved. We do agree that the number should be an odd number, but no more than fifteen members, and that if someone is absent, an alternate could be selected. We also agree that the members should be from retired researchers, patients, and some non-pharmaceutical or related CEOs. Term should be limited to five years and some replaced every year on a rotation.