Caregiving to a Parent or Loved One – Part 3

Part 3 of 3 parts

Why is it that caregivers don't feel that they can take care of themselves? Yes, they feel that this is a luxury while caring for others, but stop and think about it. If you burn yourself out, you will have nothing left to give to those that need it!  Harsh, not even,  I have seen people that were caring for a parent or spouse that did not take time for themselves. One ended up in the emergency room because he hadn't taken care of his needs and was hospitalized, his wife died the same day. His family was left to take care of the funeral. The other killed herself with exhaustion and her parent who was near death, lived for six more years.

The only advice I can give is to call on others and locate service agencies, even hospice to help if this is necessary. To be able effectively to continue to be a caregiver, you must take care of yourself. You may not be able completely to avoid stress, but you should be able to reduce it. The following steps may help to minimize the stress pressure:

Stay Connected: Here I am not talking about the person you are caring for or even your immediate family. They are important, but will not give you the stress release you need. If you have a caregiver group where you live, investigate this before you become too busy to do so. Do not forget friends that you have and that you may have shut out as you have become busier with caregiving. Even a walk around the neighborhood can keep you in touch with your neighbors and walking will help relieve some stress. Sometimes is necessary to think outside the family or the box if you must.

Accept Help: Many caregivers pass on this and have only themselves to blame when they are overstressed. Many friends and people known to you or your loved one may sincerely make an offer of help, but because you haven't thought about it, you don't accept the help. Always think about what they could do or how they could help. Rather than dismiss them, say you have not thought about it, but you will and ask when it would be best to contact them. Then do think about it and if they are able, they may be able to sit with your parent or loved one while you take a two or three hour break. If special meals are not a requirement, maybe a cooked dish would prevent you from cooking a meal or two. They will appreciate being able to help and may help you relax. Never forget community resources which may give you a much-needed time to rejuvenate.

Find Time Alone: This is important for your well-being! If you are the sole caregiver, an hour or two way from duties may relieve stress and give you the needed break that will help your health and revitalize you. This may be the time to go for a brisk walk, or go to a nearby park and just sit and watch others. This also may help you avoid burnout.

Maintain a Hobby: This will depend on you and what hobbies you already have or maybe willing to start. Let you imagination run with this one. This link provides a few that may be possible, depending on the season and the type of care your parent or loved one requires. Some may provide the stress relief you need and others may add to the stress, but this can depend on you. I knew one caregiver of a spouse that used her photography hobby to do an inventory of the house and then the area of the neighborhood. Her children were later very happy with the results.

Stay Informed: I like the suggestion the article provides, but also stay informed about what the news is, the local weather, and what others are doing. One caregiver of a parent used letters to pass the latest news on the condition of the parent and then had letters to read to her parent about other family members.

Researching on the internet may yield unsettling information and if you are not aware of it, sometime very questionable information. Use this to converse with the parent's doctor and let them know you want accurate information. This will provide information about what to expect and how fast something may progress.

Stay Spiritually Grounded: I don't care what studies may say, if you are religious or spiritual, stay grounded. Reading the religious teaching of your faith may relieve stress and assist you in accepting the status of your parent or loved one.

Take Care of Yourself: I have stressed this before and I hope it is getting through to you. As a caretaker, you have to take care of yourself, if you want to take care of others. You are no good to them if you lose your health in the process. I will not cover them, but this link may give you additional ideas for self-care. If you experience persistent feelings of fatigue, resentment, or burnout, don’t be afraid to talk to a professional and get some extra support for yourself and your loved one.

Caregiving to a Parent or Loved One – Part 2

Part 2 of 3 parts

In this part, I will be discussing some of the other aspects of caregiving. If you are the caregiver, there are some things you need to realize to prevent your becoming a casualty of doing your best in giving care. Some of the pressures you need to be aware that caregivers may face.

Fear or Uncertainty: These are not uncommon and can paralyze your actions. As a caregiver for a parent or loved one, you will have concerns about their future and this can cause fear of the unknown. If this is a child of yours, uncertainty can be a real part of what causes you anxiety.

Shift in Roles: When caring for an elderly parent, this is where roles you have grown up knowing are now reversed and this can become very difficult for both parties. The parent can be embarrassed for depending on a child of theirs and the caregiver now. As the caregiver, you are anxious about their health, well-being, and how vulnerable the parent is now. If it is a spouse, this can create unforeseen complications and exact an emotional toll on both parties.

Financial Pressure: If there is not adequate health insurance, doctor bills and other treatment fees can become burdensome, leaving less energy left for work. Caregivers often find themselves facing financial pressures as well.

Isolation: Don't do this. Do not shut yourself off from others, especially friends and others that want to be there for you and your loved one. Find someone to spell you so that you can take time for yourself. If you are caring for a parent, schedule an evening meal out with your spouse or a friend. There are people or agencies that can stay with your friend or loved one while you have time away. With cell phones and telephones, there is no reason that if something happens, contact can't be made. Learn other ways to relieve the stress of the moment, even if doing nothing more than getting exercise, which brings up the next issue.

Little Time Alone: Caregivers can certainly feel isolated, but there are times when you need a little time alone. Some are capable of rejuvenating during this time and others just want the time alone to cry and relieve stress this way. On the other side, it is also possible to feel confused by having little time alone when also feeling isolated. Caregivers have both feelings, and then be very careful as this can sometime cause stress to multiply.

Demands of Constant Care: When a parent or loved one causes a situation where you are caring for them 24/7, this “always on duty” feeling can cause a heavy toll on you as a caregiver. This type of situation can happen at any time and this is one reason to have others you can call on to allow you to get away from this. This is a reason for not waiting for this to happen and bringing people in early to acquaint them and your parent or loved one with each other. Remember, your own health is important and needs repair from time to time.

Guilt: Having this feeling is not a sign of disloyalty, although when felt with caregiver burnout may be hard to dismiss. Often guilt can be part of frustration, but needs to be separated as the feeling of guilt should not be.

Interference by other family members: This creates an overabundance of stress and because you have been selected by the parent or loved one, creates family animosity and ill will among other family members. I have seen this in other families and wondered how the caregiver was able to survive. One caregiver just walked away and said enough is enough. Another caregiver had been wise and had papers allowing her to be the only family member involved. This played out in the courts and the family was split permanently because of a meddling member. Jealousy was a large player in this family even though the parent had clearly stated what her wishes were and the caregiver was doing what needed to be accomplished.

This is only some of the “stressors” that caregivers can feel. Hopefully, this list will give you ideas and relievers that will assist you when, and if, you become a caregiver. Remember that as a caregiver, it is important that you make self-care a priority.

Caregiving to a Parent or Loved One – Part 1

Part 1 of 3 parts

Depending on whether you are on the receiving end or the one giving the care, there are many issues that are in play and it can be trying on both sides. Another factor that many people forget about when talking about caregiving is the degree to which the parent or loved one is disabled. I wish I could have had something like this available to me when I was battling giving care to my first wife over ten years ago. I was fortunate that when it started, she took it on herself to call in a couple of social agencies and eventually hospice. It did not relieve the pressure and stress I was feeling, but it did take a lot of the burden off.

The following blogs are some of the ideas and steps you need to consider and keep in mind if you are put in the situation of caregiver. This series includes this blog and two others. Here are a few of the issues you need to consider:

1. Consider a Medical Power of Attorney. Why other writers always leave this to later in the discussion, I do not understand. This is the most necessary and most important part of caring for a loved one or close relative and needs to be accomplished before it is needed. If your loved one was considerate during this time, and you are the person trusted to take care of them, then get the papers drawn up now rather than after the fact, when you may need to go before a judge to put it in force. Then sometimes other relatives may decide that they are more responsible and oppose the wishes of the parent, or loved one. While your loved one is in their right mind and can clearly show this, this is the time to sign legal documents, not after the person is already near death or incapable of signing legal documents.

In some states, other documents may be required, so check this out. Most times a medical power of attorney is sufficient to allow a trusted family member make financial decisions while a loved one is under medical care. This is no longer in effect when the loved one becomes capable of managing their affairs or the medical treatment has ended. Often a power of attorney is drawn up at the same time and can be very specific in purpose and powers. It is important to discuss this with a loved one before they are receiving medical care because both forms need to be notarized. If the parent or loved one wants special provisions in either the medical power of attorney or the general power of attorney, it is best to have the family lawyer draw up these papers early enough to prevent hostile or untrusted relatives from finding a way to contest these.

I was twice fortunate because my wife knew what her mother's plan was. Since she will still able, she called the attorney and had the papers drawn which would prevent her mother from stepping in and dictating her care. When my parents were at this point in their lives, my father was very clear in stating that my sister would have the responsibility, and my brother and I could be called upon if necessary.

2. Know when to ask for help. No, I am not talking about the person needing the caregiving. I am talking about you as the caregiver. Forget about family pride and bringing strangers into your parent's or your home. There is no need to stress yourself out and do damage to your health when there are agencies available that can give you assistance and guidance and in a sense take some of the burden off of you. Not asking for the right help from your doctor or your parents' doctors is not the way to be the best caregiver.

Instead of pushing yourself and possibly other family members to exhaustion, learn to rely on others as well. If you are new to caregiving, learn that there can be aids like installing toilet lifts in the bathroom, trapeze bars above the bed, or even medical devices that may aid in caregiving. Talk to the parent's physician to find out what will work and ask what community agencies are available to provide assistance. Better to have assistance early and make yourself more valuable to your loved one. Some agencies' services are covered under Medicaid, Medicare, or maybe even private insurance policies. A little time spent early checking this out will prevent problems when you need the help.

3. Don’t take things personally. Remember that some individuals, who are ill, disabled, and elderly, may say things they don't mean. Try to forgive and forget, but do realize that this could be as a result of pain or a medication. Please be aware of a sudden personality change and report this to their physician immediately. A personality change may mean a medical problem, or a bad reaction to a medication or combination of medications. To be sure, always consider all possibilities.

4. Understand memory loss doesn’t equal crazy. Caregivers need to be careful here as they often make this mistake when is reality; the caregiver may be off balance. Memory loss or forgetting something happens to all of us at different times and for different reasons. Some of the reasons include a medication, disability, old age, and stress. In general, the medical condition of a parent or loved one may make memory loss very noticeable so you need to be alert for them. How you handle this, can affect how they feel about themselves, and could affect your future relationship with them.

Some of the suggestions I find valuable is a voice-activated recorder, a small notebook and some pens for making lists of things whey want to remember or want to accomplish. If they do use these, never ignore what the list says and be willing to assist them like filling in names when incomplete or phone numbers they have forgotten. Be prepared to listen when the parent or loved one repeats things and don't become exasperated at them for repeating something several times.

Finally, there could be a medical reason that needs to be addressed if they suddenly have become ‘foggy brained.’ If this happens, speak with their physician as soon as possible to investigate the cause.

Learn to listen first and act second. Some people just want another person to listen to their problem. This can be hard for people who have “take charge” personalities and want to protect their family from outsiders. Never act or do something for a parent or loved one unless they ask you to take action. Even then, you may hesitate and think about the proper way to handle the situation. I had an aunt that wanted to see an old friend one more time, but her sister was the caregiver and would not do this because she disliked the person. I stopped by on my way to see another aunt (my mother only had sisters), and this aunt asked me to stop by and ask her friend if she would come visit her. The caregiver aunt followed me outside and asked me not to do this and was very insistent.

Since I was going to be in the same town to visit my other aunt, I decided to talk this over with her. This was wise on my part, as my aunt knew what had transpired between the two several years earlier and said I had better take her friend to see her, as she was sure that her sister wanted to patch up the relationship before it was too late. My aunt even suggested we go immediately and see if her sister's friend could travel that day. She was and my aunt said she was coming along to stop her sister from preventing this. When we arrived, there was a scene and my one aunt was very angry with me. The aunt that had come with me tried to make peace, but this was not possible that day. The friend did get to see her and was very happy that we had made it possible and my aunt passed two days later.

On the return trip to take them both back home, my aunt's friend said she appreciated seeing her friend and repairing their friendship. She then handed me some money and I said no. She said this was from my aunt and she did not want to explain that I had refused. So in one day I had made one aunt very happy and another one very unhappy, and for the right reasons. Even my aunt whom I was planning to see was happy that I had helped when needed. It is sometimes difficult to know what is best and checking things out is often the best way to handle things. At the funeral a few days later, the daughter of my deceased aunt thanked me and said how happy her mother was the last day. Even my angry aunt admitted that I had done the right thing as she had seen how happy it had made her sister.

In conclusion, as a caregiver, learn how to make things pleasant for the parent or loved one while not losing your place in the day-to-day activity. Rely on others to assist you and make the best use of the different service agencies available. They often can make your load a lot lighter and your time as a caregiver more fulfilling. Learn about ways to assist your loved one while they are under medical care, such as using a Medical Power of Attorney. Finally, try to forge a better relationship by being a good listener and trying to understand that memory loss doesn’t always equal dementia; it may just be a by-product of a medical condition or medication.

Another Reason to Consider Insulin

Outside of one type 2 diabetes oral medication, I am happier than even to be on insulin and not oral medications. More of them are showing nasty side effects and creating other potential health problems. Sulfonylureas are suspected of causing heart problems. Avandia has been pulled from the market and Actos is a problem for bladder cancer. Thiazolidinediones (glitazones) is their class of oral medications. Now the oral class of DPP-4 inhibitors or Januvia is on the block for being a cause of irregular growth of cells in the pancreas. These may cause cancerous tumors.  Even if I have thought good about Byetta, this is also now an injection to be cautious about.

This leaves only three classes of oral medication, plus a new class just approved, but with much more testing required by the FDA. Janssen Pharmaceutical’s new type 2 diabetes treatment, Invokana (canagliflozin); Invokana is the first in a new class of medications called sodium glucose co-transporter 2 (SGLT2) inhibitors to be approved in the United States. There are several types of trials required before all restrictions are lifted. From my reading, I would be very hesitant to consider the new oral medication. Others agree and have expressed this as well.

The three classes presently considered safe, but causing minimal concerns include Biguanides (Metformin), Alpha-glucosidase inhibitors (Glyset, Precose), and Glitinides (Meglitinides) (Prandin).

Never stop taking any medication you are taking; however, it would be wise to talk with your doctor and see if a change needs to be made. Do not forget to investigate insulin as there are very few side effects and what you need to be concerned about is hypoglycemia. The informal group is happy that so many of us are on insulin and the three on oral medications are asking many questions about insulin now. We have suggested that since two are on metformin and one is on a sulfonylurea that they now get too upset. We are talking to them about insulin however.

Diabetes Questions to Ask Your Doctor – Part 3

Part 3 of 3 Parts

Are you ready for you doctor appointment? The following is the rest of the questions to ask your doctor if you suspect diabetes or if you have just received a diagnosis of diabetes, type 2. The 14 questions can be read here. I am quoting the questions and adding my comments to give possible solutions. I have split the two-part questions.

Will I always need medications/insulin? It is always too early to be sure, but if possible, the goal should always be to get off medications if possible. Until you have attempted this, there is no way of knowing if you will always need medications and insulin is a medication and should not be considered the medication of last resort or as a punishment as many doctors are prone to do. If you have a doctor that does this, please do your health a favor and find a different doctor.

How will you evaluate whether these medications are the best treatment for me?

Your doctor should do a complete evaluation, noting any allergies, foods that cause problems, and several tests to determine kidney health, and heart health before prescribing medications for diabetes. Then the doctor should discuss with you what the findings recommend and then discuss the side effects with you so that together you can make a decision. A doctor that does not do any of this is not a doctor to be retained.

What are the long-term complications of diabetes, and how can I avoid them?

There are not long-term or short-term complications. They are complications and they need to be avoided if possible.

Complications don't cause themselves. Poor or no management of diabetes – meaning not testing, not losing weight, not eating balanced meals, not making other lifestyle changes, and no blood glucose management is what causes the complications. So what are the complications? Retinopathy, neuropathy, nephropathy, atherosclerosis, and deafness are the most common, and many don't include deafness. The first three and deafness are grouped together under the term microvascular complications because they result from damage to the small blood vessels. The macrovascular complication is atherosclerosis, which is caused by damage to the large blood vessels.

Retinopathy causes damage to the retina, which may lead to poorer eyesight or blindness. Neuropathy causes damage to the nerves, which cause pain and can be more than annoying pain. Nephropathy causes damage to the kidneys or increased renal problems leading to kidney failure or chronic kidney disease (CKD). Deafness or hearing loss is caused by the eardrum losing the ability to transmit sound because of short blood supply. Atherosclerosis can lead to heart attacks, stroke, or poor healing of wounds in the feet and legs. This is the cause of amputations.

Although these are not complications, there is a strong relationship with diabetes and as such, they are called comorbidities. The 2012 ADA guidelines listed the following:

1. Hearing impairment,

2. Obstructive sleep apnea,

3. Fatty liver disease,

4. Low testosterone in men,

5. Periodontal disease,

6. Certain cancers,

7. Fractures, and

8. Cognitive impairment.

Then for the 2013 guidelines, they added depression, almost as an afterthought.

How do other factors such as high cholesterol and high blood pressure affect me if I have diabetes? As studies are beginning to prove, some types of cholesterol are less of a problem than thought and even the ADA has raised the blood pressure threshold for blood pressure for people with diabetes. I will not quite go to the extreme to wish statins away, but their usefulness may be in doubt, but at present are still needed. Extremely high blood pressure should be lowered with medications until changes can be made in lifestyles that make high blood pressure normal.

How often should I be seeing my doctor to optimize my diabetes management?

This will be determined by your doctor and the medication(s) you are taking. People with type 2 diabetes and not on medications may be limited to one time per year. People on most oral medications will probably be seeing a doctor only twice a year. And, people with type 2 diabetes and using insulin will probably be seeing a doctor four times per year or maybe less. The American Diabetes Association in their efforts to deny people with type 2 diabetes the treatment they need have lowered treatment expectations and some of those that are in positions of authority are making statements that some people with type 2 diabetes only need to see a doctor once a year and may not need to test at all. See my blog here for what some ADA officers are saying. You may also read this about the position of ADA and how Joslin may have affected the situation.

How often you see your doctor may also depend on how often your insurance company will reimburse the doctor for office visits.

Diabetes Questions to Ask Your Doctor – Part 2

Part 2 of 3 Parts

Are you ready for your doctor appointment? The following are more of the questions to ask your doctor if you suspect diabetes or if you have just received a diagnosis of diabetes, type 2. The 14 questions may be read here, but I have separated the two part questions to answer them more completely. I am quoting the questions and adding my comments to give possible solutions.

What are the warning signs or symptoms that my blood glucose levels are too high? The most common symptom is none at all. This is the reason many people do not know they have type 2 diabetes. The best idea is to know your family and if there is a history of diabetes. Many of the signs of diabetes can also be indicative of other problems, therefore is best to see a doctor for an accurate diagnosis. Some of the signs are tiredness, increase in urination, thirst, weight loss, change in vision, moodiness, and a few others. Some people do become irritable when they get too high, but there are no firm numbers when this happens. Read this article for more.

If you already have a diagnosis, testing is the best way to detect high BG levels. Dehydration can occur of high blood glucose levels are allowed to stay for several hours. Treatment to lower blood glucose levels is important and should be started quickly. Read these articles here and here for a better understanding of high BG or properly hyperglycemia.

What do I do if my blood glucose levels are too high? There is a multitude of possible solutions. Be honest with yourself as the only person you will be hurting is yourself. Eating food out of anger is not wise, yet this often happens the first few weeks when patients are angry about the diagnosis. Then later if you are in denial, you can also overeat or eat out of anger as well. I can say that both anger and denial are useless, but this will not prevent it from happening. Soon or later, this will happen, as they are two of the four stages people are quite likely to experience.

Yes, medication (the prescribed medication) is one way to bring down high blood glucose levels, but only take the medication when you are directed to on the medication. Walking or some exercises are another aid to bringing BG levels down. If during the first month or two you are not able to bring your blood glucose down with the medication or medications you are taking, then please investigate insulin and be prepared to talk to your doctor about this.

The most reliable method of bringing blood glucose levels down is by adapting a food plan that works for you. Because there is no exact food plan for people with diabetes, you will need to find what works for you.

What are the warning signs or symptoms that my blood glucose levels are too low? Hypoglycemia causes symptoms such as hunger, shakiness, nervousness, sweating, dizziness or light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness. Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include crying out or having nightmares, finding pajamas or sheets damp from perspiration, and feeling tired, irritable, or confused after waking up.

The best way to determine the level of hypoglycemia is to test. If you have a diabetes diagnosis, then you should have a supply of glucose tablets on hand at all times. Don't take this lightly if you live alone. If you have a family, then make sure they know where all supplies (including the glucose tablets) are located. I lived alone for about three years and I kept my testing supplies on the nightstand when I went to bed along with the glucose tablets. One person that I know has a small refrigerator in the bedroom with other supplies that he relies on, but I have been fortunate that I have never needed to go that far.

What do I do if my blood glucose levels are too low? If you are capable, be sure to test as soon as you feel that you are low. Now if this is within the first months of your having diabetes, then you should be concerned any time you reading is below 80 mg/dl (4.4 mmol/l) and consider this a low. If you are below this but not below 70 mg/dl (3.9 mmol/l) take one glucose tablet and test 15 minutes later. If you are back above 80 mg/dl, then consider yourself okay. If you are not back above 80 mg/dl, take a second glucose tablet and test again 15 minutes later. Repeat if necessary.

A fairly simple rule to follow is to subtract the number of the reading from 80 and divide by 15 to determine the number of glucose tablets to take. This means that if the number is 45 mg/dl (2.5 mmol/l) this would be 35 or three tablets you should take and test about 15 to 20 minutes later. Yes, I am suggesting a full tablet for 5 mg/dl that would be the remainder. Repeat as necessary with one glucose tablet until you are above 80 mg/dl.

If you live alone and do not have glucose tablets, call 911 immediately if you are able. Yes, this can be a little drastic, but rather than take chances with unknown carbohydrates that are not as fast acting, I would suggest this. Some would suggest other remedies like juice. However, they may work, but are not as fast acting and the low could become severe, putting you in a coma and at risk of death. This is the reason for always having glucose tablets on hand.

How can I change my lifestyle and diet in a way that will be healthy? Or maybe not ideal, but more healthy. If you are a person that has led a sedentary life, then it is time to start some exercise that you enjoy and can maintain on a daily basis. Your goal should be at least 10,000 steps on a daily basis. Always make sure that you discuss this with your doctor before starting for medical reasons. This will give your doctor the opportunity to know what you are planning and be able to give you the go-ahead or say whoa; you will cause this or that problem. He may have suggestions that will allow for exercise in a safe manner that will not cause harm. Always start slowly and warm up to prevent injury.

For food plan (forget diet) you need to discuss this with a nutritionist that understands diabetes. Some will suggest a registered dietitian (RD), but be careful here. Many, but not all, will mandate (never a good thing) whole grains and that you consume so many carbohydrates and this may not work for you. There are so many food plans that it is difficult to know what is best for you. I would suggest maintaining a food log and blood glucose test results to see how different foods affect you. Generally, highly processed foods should be limited if not eliminated. If your budget allows, convert to fresh foods where possible and foods that have limited processing. This blog may be of help.

What are the side effects of my medications/insulin? Here is the resource you should use and become familiar with and maybe bookmark it. Find the medication or medications you are taking and look them up in the tables.

Diabetes Questions to Ask Your Doctor – Part 1

Part 1 of 3 Parts

Are you ready for your doctor appointment? The following is some of the questions to ask your doctor if you have recently received a diagnosis of diabetes, type 2. Some questions just lead to more questions and can make it difficult to follow what is and what is not important to know immediately. I have tried to stay with what is important at the start and good to learn at the beginning of your journey. Each question tells you which of my blogs contain an applicable discussion if you wish to read more or I will refer you to a blog by another writer.

I have tried to sprinkle in the acronyms that you will learn and see very often. I will also try to point out terms that you will need to learn. Why? Because you will see them used by most people that have had diabetes for several years and once you learn the language, you can learn to read without a dictionary. You may still want one handy, and there are several online. I prefer this medical dictionary, but I will also use this medical dictionary. There are others and you may search for them and see if you like them.

An example is blood sugar (BS), which I do not like, but most writers insist on using this term. Correctly, both scientifically and medically, the term should be blood glucose (BG). I would urge people new to diabetes to read this by David Mendosa. One example that I see all too often is the use of the word glucometer. This is correct only if you are referring to the meter registered to Bayer as a trademark. Correctly, your meter is just that, a meter. Also, be careful as most people refer to a meter and test strip as a unit even though you must change test strips.

The 10 questions are really 14 questions and I have divided them accordingly.

1. Should I check my blood sugar levels at home with a glucose monitor? How often should I check them?

2. What are my goals regarding blood sugar levels?

3. What are the warning signs or symptoms that my blood sugars are too high? What do I do if my blood sugars are too high?

4. What are the warning signs or symptoms that my blood sugars are too low? What do I do if my blood sugars are too low?

5. How can I change my lifestyle and diet in a way that will be healthy?

6. What are the side effects of my medications/insulin?

7. Will I always need medications/insulin? How will you evaluate whether these medications are the best treatment for me?

8. What are the long-term complications of diabetes, and how can I avoid them?

9. How do other factors such as high cholesterol and high blood pressure affect me if I have diabetes?

10. How often should I be seeing my doctor to optimize my diabetes management?

I will list each question and give my response as a patient to them. They are still questions worth considering for asking your doctor, but you will not see them answered this way.

Should I check my blood sugar levels at home with a glucose meter? Yes, you definitely should check (test) your blood glucose at home, at work, or where ever you are when testing is needed or desired. Many doctors discourage this for various reasons and this is wrong. Many doctors do not want you to know what they are or do not want you to be depressed with the high readings. If your doctor does not have a meter to give you one and a prescription for more strips, then insist (even demand) on a prescription for a meter, lancet device, lancets, and test strips before you let the doctor leave the exam room. If your doctor remains uncooperative, then you have a decision to make about possible change in doctors. For your diabetes health, the sooner you make this decision, the healthier you can be.

Testing is the only way you have for determining how different foods and food quantities affect your blood glucose (BG – is the acronym). A term you will see in blood glucose management is self-monitoring of blood glucose (SMBG – is the acronym). You will also need to test more frequently in the beginning to learn how long before you reach the high level of your BG. Many suggest one hour after first bite and for some people this can be too early. If you are a speedy eater (gobble down your food), this may work; however, studies have shown that you should eat slower for greater blood glucose management. Some writers do use the word control for the same meaning. Some will suggest testing more often until you are comfortable with when your high level of BG happens. I suggest starting at the one-hour mark and testing every half hour the first few times. When the reading is lower than the previous reading, then you may stop.  Your high point has occurred between these two readings.

Having said this, I must warn you that most, if not all, insurance companies will limit the number of test strips they will reimburse for your use. Therefore, your budget may not allow for the testing you should attempt. And, these vital test strips are expensive.

How often should I check my blood glucose? This is not an easy question to answer, even for new people with type 2 diabetes. This will depend to a great extent on your medication(s), what your insurance will cover, your budget, and your comfort zone. Many people with type 2 do purchase extra test strips out of their own pocket because they can afford this. Those people with a limited budget that are on oral medications probably will need to use what the insurance will reimburse. People on sulfonylureas that have had problems with hypoglycemia should encourage their doctor to write a letter explaining this and asking for additional test strips. There are other combinations that may cause use of extra test strips and your doctor should make you aware of them and request extra test strips. Please read my blog here for some of the oral medications that can create troublesome hypoglycemia.

How often you test will depend on your desire to bring diabetes under good management and your budget. You will also need to find out how willing your doctor is to go to bat for you with the insurance company for additional testing supplies. Some companies will allow some extra test strips in the first few months, but then want to restrict you thereafter. Other insurance companies will only allow a set number of test strips per day. I recommend that you talk with your insurance company to find out what they are willing to allow. You may need to bargain with them and attempt to convince them of the need for allowing more test strips for the first three to five months. Don't be surprised if you are denied, but it is still worth the effort.

What are my goals regarding blood glucose levels? This will depend on what you are willing to tolerate. I suggest reading this for an excellent guide. Some people set lower goals and do not like being over 125 mg/dl (milligrams per deciliter) at the high point in BG. For a person just getting started, my link is a good goal. Try not to have fasting BG under 80 mg/dl, especially at first. Gain some confidence in what you are doing before letting the numbers become overly important. Yes, learn first, and then work toward them. Do not become discouraged when you cannot achieve them the first few weeks. Remember you did not develop diabetes overnight, and it can take time to set goals and achieve them. These are goals you are working to achieve and you have a lot to learn at first. I have been at this for over nine years, and there are times when I have difficulty in maintaining the range of numbers I want to achieve.

Tips for Patients Who Use the Internet

I occasionally come across something of interest in my many email newsletters, but seldom something when I am looking for it. So this was a pleasant surprise when I came across this blog about doctors using the internet. Yes, many doctors use the internet for their personal life and a few do follow some medical news and some even blog. Most physicians don't like patients using the internet to find information about what may be a problem for them. Remember, that is why doctors exist – to answer our illness questions and to take care of our medical needs.

But in this day of technology, doctors may become a thing of the past. Computers are already diagnosing some illnesses (think of IBM's "Watson") and as programmers become more proficient, computers can only get better. This is one thing most doctors do not like, and I can't blame them. This doctor knows that people are turning to the internet because doctors are not educating them and more people want to know what is possible for their problem. In other words, doctors are setting themselves up for trouble unless they overcome their aversion to patients looking up information on the internet.

This doctor, Wendy Sue Swanson, MD really speaks to what the problems are within the world of healthcare. From monitored emails and computer activity restricted and monitored in many clinics and hospitals to interference by insurance prohibiting reimbursement for providing time to patients to give them internet information. I know this, as I cannot get three of my doctors to consider using the internet. They quickly say they are restricted and move on to other topics. The one time I tried to get more information, the doctor quietly told me to use the telephone – at home.

At least this doctor is not afraid of the internet. She quotes, “For at least 1/3 of American adults, the internet is a diagnostic tool.” The doctor also says this, “In my world prevention is key. The internet is one of those keys.” She uses a Pew report to show statistics of internet use among patients. The link is here and I encourage people to read the online version. This should make you feel better about doing online searches even though your doctor may not appreciate this. For those that really get into research you will experience what many of us come across time after time – the pay wall.

Approximately one in four people looking for health information online do run into a pay wall. This is normal for many studies and research documents. I have found that sometimes these pay walls are beneficial and prevent us from seeing studies that are bad science, junk science, and unreliable science. We do have to wonder, but that is part of the excitement in research.

Numerous studies have found that what parents learn in the doctor's office needs to be relearned and according to Dr. Swanson, that is where “Dr. Google” comes in. She is a pediatrician that wants her parents to know as much about their children's health as is possible. She believes that offering online sites to parents is part of her job as a doctor. She believes that more than one third of the parents of the children she sees have at some time used the internet to learn about the health of their children.

“Contrastingly, in acute care visits for things like cough, ear infection, or colds parents rarely report that they have been online.

Tips for “online diagnosers”

1. Keep a breadcrumb trail as best you can. When we’re online we forget where we go and often don’t know who we’re listening to. Confusion comes in when families don’t remember where they have been garnering information and when they become confused by myths, personal anecdotes, and stories that lead them astray. Everything on the internet is clearly not in our best interest as parents. One solution: print things out or refer to specific links with your physician when you’re in to see them so you can look up online information together.

2. Look for advice from experts (psychologists, physicians, researchers). As parents and patients, we don’t make all of our health decisions using science but when we have the opportunity to use solid data to steer decisions, we want the correct sources. Your doctor can help vet the online voices to which you tune in. Ask your pediatrician or clinician what sites they trust the most.

3. Look for sites affiliated with academic medical centers or health care institutions. Often those sites vet and scrutinize content with their expert researchers and clinicians. I tend to encourage families to avoid sites heavily laden with advertising as I’ve learned that content on those sites can sometimes be edited to meet requirements in tone, scope, or opinion by advertisers.”

She also says, “It’s my opinion that the last thing we physicians should do is shut down our patients’ online searches. It’s a new world; we must join our patients online since nearly 1/2 of many groups are using Dr. Google to diagnose. We must guide families to trusted and valuable voices and then help confirm or redirect the results of their online learning.” You may wish to read some of her blog site as well. Dr. Swanson makes a lot of good points.