What Is Unmanaged Diabetes?

When reading this blog, some very definite thoughts came to mind. I do like the topic,

but I become nervous with the wording. I would like to be a little more definitive and clear a couple of points.

The American Diabetes Association (ADA) does use the HbA1c measurement of 7.0% for their guidelines. At least the American Association of Clinical Endocrinologists (AACE) uses the guideline of 6.5%. For those that are very capable of managing type 2 diabetes, many like to keep their A1c's in the 5% range. Others feel great if they can maintain A1c's in the 6% range.

Because doctors and endocrinologists are so fearful of patients having episodes of hypoglycemia, or low blood glucose they become very cautious of anything below the guidelines. Then, when we consider people aging, again they become even more cautious about peoples' A1c. At age 65, they start encouraging A1c's of 7.0 to 7.5%. Then at the age of 70, they want the range to increase to 8.0%.

This is where I disagree with their one-size-fits-all philosophy. I could agree if they were properly assessing us and individualizing our treatment. Some people are able to manage diabetes and maintain lower A1c's. Some lose diabetes management abilities as they age and this must be properly assessed and adjusted to maintain quality of life. Hopefully as they become less capable of managing their own diabetes, there will family or other caregivers available. They will lose quality of life when incarcerated in nursing homes or care facilities.

So what is unmanaged diabetes? Following the above discussion, there are many variables depending age and patient capability. My suggestions would be that for people on oral medications and below the age of 65, then unless they are on medications or a combination of medications that can cause hypoglycemia, the daily blood glucose readings should be used to see how often they get below 70 mg/dl. If they consistently show readings below 60 mg/dl then they need to be assessed to see if they are capable of managing their own diabetes.

This assessment needs to be continued as patients continue to age. Even more careful assessments will be needed if the patient is on insulin. Warning: Insulin should never be the medication of last resort. This is the habit of too many doctors and can lead to complications setting in before insulin is used.

Pardon Me, I Have to Release Some Pressure

No, this is not gas I need to vent, it is just a few things I need to vent to relieve the build up of frustration, and I don't want to become angry, as that solves nothing. Blood glucose levels are difficult as it is to manage when anger isn't in the mix.

In the last few weeks, emails have been coming in at a good number, but I am surprised at the number asking why I don't blog about the cure and even more about natural remedies. Let me be very clear readers, as of yet there is no cure – read that – there is NO cure!

Yes, I know there are people on the internet claiming there is, but they did not have diabetes in the first place. Then they claim to be cured so that they can separate you from your money. They sound very convincing, but are part of the low-life that preys on people to make their life easier because they do not want to work for a living to earn money. They know there are suckers that will easily part with money for false information.

I could write many blogs about natural remedies, but people would not understand that diabetes does not go away and natural remedies only help in the short-term and once what the body needs is replenished, seldom will there be more benefits. Why, you ask? Most people want the quick fix so they can continue living life and consuming the same foods. They are unwilling to change the way of living they are accustomed to and to use exercise and nutrition changes necessary to stop diabetes from gaining a strong foothold in their lives. They are very comfortable living the current lifestyle and refuse to change.

I do blog about two of the natural remedies, exercise and proper meal plans, but most will not use these because it requires some effort which they are unwilling to put forth. I personally know two individuals with type 2 diabetes that go from natural healer to natural healer looking for the help they want.

One just had two toes amputated and still believes in natural medicine. Allen and I have both asked what his last A1c was, but he says he doesn't go to that doctor anymore. The other fellow is now legally blind and very upset that the doctor did not tell him that was possible. Allen said his last A1c was 12.3. He still is looking for a natural remedy. Neither will fill their prescriptions for diabetes medications and tell us we should not be taking insulin.

It is difficult just being around the two individuals, as they believe there is a cure that the doctors are not telling them about and the one that is blind has filed a lawsuit to have the doctor disclose the cure. Is he in for a shock!

More Myths about Type 2 Diabetes

I admit I have a difficult time following some people and where they come up with some of the ideas about diabetes. Fortunately, those in our support group know better and even we get tired of some of these ideas. A few will listen to us, but others have some of these ideas buried in their psyche and nothing we say can change their mind.

Myth 1 Obesity and laziness cause diabetes. Being obese and not exercising can be risk factors for type 2 diabetes, but they are not the cause of diabetes. Most people forget about genetic factors and heredity of type 2 being in some families. Even thin people develop type 2 diabetes, but many people conveniently forget about this. In type 2 diabetes, the body can no longer make or use insulin properly.

Myth 2 You won’t always have diabetes; your doctor can cure it. This is a belief that is hard to beat back. We are told that this is the twenty-first century and there has to be a cure. Another statement many make is that your doctor is not telling you everything and holding back the cure so there is something to treat. All I can say is BS, and I don't mean blood sugar.

Type 2 diabetes is incurable; once you have it, you will always have it. However, you can keep your diabetes under tight management with diet, exercise, and medications so that you can live an otherwise normal life with minimum damage.

Myth 3 You can’t prevent diabetes. Eating a healthful meal plan and getting daily physical activity can prevent almost 80 percent of Type 2 diabetes cases. Keeping weight in the ideal range will also help.

Myth 4 You can feel when your blood glucose is too high or low. There is no guarantee that what you are feeling is accurate. Some people are irritable during elevated blood glucose and after a recent type 2 diagnosis, many can experience shaky, dizzy, or lightheaded when blood glucose drops rapidly. Other experiences can be an increase in urinating when blood glucose is elevated, but this could indicate a bladder infection. Testing is the only way to be sure if your blood glucose is high or low. Do not trust your feelings.

Myth 5 When you have diabetes, you can’t eat sweets. This is partly true and most people don't need them. Many people think that if you eliminate other carbohydrates they can have sweets, but they don't realize that most sweets have more carbohydrates than they have allowed. Others say that they are doing extra exercise to make eating sweets possible, but again they eat more than the exercise relieved. Many people overeat sweets when their blood glucose levels drop below 70 mg/dl. Generally, they would be smarter eating glucose tablets of known glucose amounts rather than sweets which might not be known. Then they wonder why they go high and often yo-yo up and down, especially on certain oral medications and insulin.

Myth 6 If you eat right and exercise, monitor your blood glucose, and take your meds or insulin correctly, you can keep your diabetes under tight management.

Oh, if it was that easy! However, there are other factors that affect your management. Illness, injuries, stress, hormone changes, and periods of aging that can cause blood glucose to become unmanageable. Even when you do everything correct, managing diabetes isn't always easy and corrections are needed. Many people do not believe this and diabetes becomes progressive and the complications flourish.

Myth 7 Diabetes only affects old people. Diabetes affects all age groups and the sooner people wake up to this, the better prevention can become.

Myth 8 Diabetes is not a killer disease. Diabetes is a global killer, rivaling HIV/AIDS in its deadly reach. The disease kills more than 4 million people a year. Every 7 seconds a person dies from diabetes-related causes.

Myth 9 Diabetes only affects rich countries. Diabetes affects all populations, regardless of income. It is becoming increasingly common everywhere.

There are many other myths and misconceptions, but I will halt this for now. This blog and thisarticle are sources used.

Do You Know This About Diabetes?

Many of the people I correspond with and those members of the support group I belong to know most of this information and many other points. Yet, many people are not familiar with some of this information while others ignore any information about diabetes until it is too late.

Most of the following can be found in reading this.

#1. About one quarter of people with diabetes, don’t know they have it. This is unfortunately true and approximately seven million people have no idea they have diabetes. I would urge people that think they have risk factors and relatives with diabetes to be checked regularly at their doctor's office.

#2. You can reduce your risk of developing type 2 diabetes by losing a moderate amount of weight. If you are overweight, consider losing about 10 percent of your body weight. Exercise is one lifestyle change that is not easy, but losing a few pounds by walking, swimming, or dancing almost every day can help in preventing diabetes. If you have risks, talk to your doctor and make sure he understands you are sincere in your desire to prevent diabetes.

#3. Insulin isn’t just for people with Type 1 diabetes. Right, approximately 30 to 40 percent of people with type 2 diabetes are using insulin. If you are moving from oral medications to insulin, this does not mean you have failed. Fact is, the sooner you start insulin, the better you will be able to manage your diabetes. A popular myth is that starting insulin means you are near to going blind or about to lose a foot. Doctors promote this because they don't know insulin and are afraid of hypoglycemia.

Insulin is the most effective treatment for diabetes and if you keep an open mind, you should be better able to manage your diabetes. If your doctor will not prescribe insulin or says you are failing on oral medications, then it is time to change doctors.

#4. Diabetes is a leading cause of blindness in American adults. I wish this wasn't true for so many people. This happens because people with diabetes do not have a dilated eye exam every year or as often as your eye doctor recommends. It is not recommended to use the eye clinic at your local mall or retail store. If you have retinopathy or diabetic macular edema, there are effective treatments to prevent it from becoming worse.

#5. Bariatric (weight-loss) surgery is a highly effective treatment for Type 2 diabetes. I am not encouraged by this and have a difficult time even including this as there is so much they fail to tell you. Once you have the surgery, you have to eat such small amounts of food that many people cannot do this. When people are unable to lose weight and all others attempts have failed, bariatric surgery is certainly an option. There are definitely risks to this surgery and people with type 2 diabetes can only expect a remission for an undetermined amount of time and not a cure of their diabetes.

#6. An “artificial” pancreas should soon be available to help people with Type 1 diabetes more easily manage their condition. For people with type 2 diabetes, this is probably one device that will not be available to you. And if you are on Medicare, don't expect to receive one of these tools that type 1's will receive until they turn 65.

#7. Medical providers and the related professions advocate a 'one-size-fits-all' way of treatment. The harried doctors of today do not have time to individualize treatment and if something does not fit their thoughts, you will be told 'it is all in your head', or you will be referred to another doctor. Doctors are so afraid of hypoglycemia that they will accuse you of failing and threaten you with insulin to keep you on oral medications. These doctors are wrong in so many ways that you should be afraid of them. Insulin should never be a medication of last resort for excellent diabetes management.

I could really use a rant, but I will end this here before I say something I will regret later.

Important News about Dietitians

The Academy of Nutrition and Dietetics (AND) is finally being set back on its heels. In their drive to become the only organization authorized to dispense nutritional information, they are meeting stiff opposition that is foiling their every move and in 2014, the organization lost their stranglehold on Michigan.

Michigan passed its Dietitian/Nutritionist Licensure Act in 2006. This created a monopoly for Registered Dietitians and excluded other nutrition professionals whether equal or better educated and qualified. On July 15, 2014, the governor signed HB 4688 into law, repealing the state's monopolistic licensure law for nutrition professionals.

The effort was a combined effort of several organizations that are working to prevent or repeal other state licensure laws. Other notable successes this year:

• “In New York, ASB 4999, a bill sponsored by the AND which we fought, ultimately died in committee because of all the messages you sent to NY legislators.
• In the last three years, ANH-USA and its allies have managed to block nineteen separate attempts to institute monopolistic dietetic laws across the nation. We also proactively and positively reshaped the anticompetitive law in Illinois, where the AND is headquartered.
• The federal Bureau of Labor Statistics (BLS) keeps a list of professions where each is defined in detail and statistics about it are kept. Previously, “Dietitians and Nutritionists” were categorized together, and the AND was listed as the sole certifying organization for the entire profession. In a milestone victory on January 8, 2014, nutritionists managed to get “Nutrition” defined as a different profession than “Dietetics,” and importantly, the BCNS (Board for Certification of Nutrition Specialists) is now identified as the certifying organization for nutritionists. This national, federal recognition of the unique credentials of Certified Nutrition Specialists is extraordinarily important.
• And don’t forget our recent federal victory in which nutritionists won equal recognition with dietitians for the right to prescribe patient diets in hospitals.”

Some of the organizations working in cooperation include the Board for Certification of Nutrition Specialists (BCNS), the Alliance for Natural Health (ANH-USA), and other national groups.

Low Carb Is for People with Diabetes

Since this hit the press, more sources are picking this up and trying to make headlines with it. There are some very disappointing conclusions and what they claim are points of evidence, backed up by clinical studies. Something is very wrong and I doubt will be seriously adopted as presented. And to substitute protein for carbohydrates displaced may for many create other health problems.

Yes, the problem is that the low-carbohydrate recommendation is not low-carbohydrate/high-fat (LC/HF) that many of us are used to, but a low-carbohydrate/low-fat meal plan. This also means that it is high in protein which can also cause problems for some individuals.

This new study involving researchers from the University of Alabama at Birmingham and other institutions says patients with Type 1 and Type 2 diabetes should eat a diet low in carbohydrates. “The study, accepted for publication in Nutrition and available on the journal’s website, offers 12 points of evidence showing that low-carbohydrate diets should be the first line of attack for treatment of Type 2 diabetes, and should be used in conjunction with insulin in those with Type 1 diabetes.”

It is the 12 points I wish to draw your attention to are these:

Quoting -

The 12 points of evidence, backed up by clinical studies, are:

1. High blood sugar is the most salient feature of diabetes. Dietary carbohydrate
   restriction has the greatest effect on decreasing blood glucose levels.
2. During the epidemics of obesity and Type 2 diabetes, caloric increases have
   been due almost entirely to increased carbohydrates.
3. Benefits of dietary carbohydrate restriction do not require weight loss.
4. Although weight loss is not required for benefit, no dietary intervention is
   better than carbohydrate restriction for weight loss.
5. Adherence to low-carbohydrate diets in people with Type 2 diabetes is at
   least as good as adherence to any other dietary interventions and frequently is
   significantly better.
6. Replacement of carbohydrates with proteins is generally beneficial.
7. Dietary total and saturated fats do not correlate with risk of cardiovascular disease.
8. Plasma-saturated fatty acids are controlled by dietary carbohydrates more
   than by dietary lipids.
9. The best predictor of microvascular and, to a lesser extent, macrovascular
   complications in patients with Type 2 diabetes is glycemic control (HbA1c).
10. Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing high-density lipoprotein.
11. Patients with Type 2 diabetes on carbohydrate-restricted diets reduce and
    frequently eliminate medication. People with Type 1 usually require less insulin.
12. Intensive glucose-lowering by dietary carbohydrate restriction has no side
    effects comparable to the effects of intensive pharmacologic treatment.
    Unquote

The items 6 and 7 in bold are the two items I question. Replacing some of the carbohydrates with protein may work for most people, but not everyone.

By side-stepping the fat issue, they are not realizing that the lipid panel or cholesterol levels will greatly improve and statins may become unneeded. Number 8 may also be unnecessary on a medium to high fat meal plan.

Conflicts of Interest

I don't understand why some researchers seem to think that people will not check their conflicts of interest. Three recent reports have been very interesting lately. Two were about diabetes and one was about sleep apnea.

The one about sleep apnea did not mention the conflicts of interest, but further research did find the original study. Only one of the authors listed a conflict of interest as a consultant for a pharmaceutical company. By searching three other authors or researchers, two were surgeons by profession and the third was a college professor for surgery. Finding information on the remaining researchers yielded nothing.

This made sense because of the way they were heavily promoting sleep apnea surgery over other treatments. When the American Sleep Apnea Association recommends CPAP first and surgery as the last resort, for these authors pushing surgery first, this tells me that they are only interested in the money and not the health of the patient.

One of the diabetes studies was funded by a pharmaceutical company and the authors after some extensive searches were all employees of the same company. Not much confidence to be gained from that study.

The other diabetes study was also funded by the same pharmaceutical company, but the researchers were all employees or students of the same university. The lead researcher was the only one to declare a conflict of interest and that was to the study funder. And they want us to believe the studies and that the data shows legitimate information. When a study shows data that is completely contrary to other studies and what we have seen in life, how can we be expected to believe the researchers were not influenced by the funder?

No, I am not giving the names of the studies, as I see no value in spreading their messages. Three days of searches and tracing information has left me with a severely bad taste in my mouth to the point I will probably not read another study funded by this pharmaceutical company. I have had too many bad experiences with the medications this company manufactures and am fortunate that my doctors have been able to substitute other medications not from this company. I will leave it at that.

This article should be read by more people as it covers what happens when a reputable journal is sold to unknown enterprises and for $1,200 will print anything. This may be what is happening to other journals and we are not told about the sale and are therefore surprised by the junk articles we a being asked to read.

New Approach for Diabetes Patients

William H. Polonsky, PhD, CDE, has it correct when it comes to dealing with diabetes patients. Dr. Polonsky is a clinical psychologist and co-founder of the Behavioral Diabetes Institute in San Diego, CA. He said, “We've got the right medications, we have so much knowledge, and we have great tools to help people manage their diabetes effectively. Unfortunately, none of those things will work if we can't convince our patients to make use of them, and that is why we all know it comes down to behavior.”

I will be using his article in Medscape to write about this. He wrote this column based on the talk he gave when accepting the Richard R. Rubin Award at the 2014 annual meeting of the American Diabetes Association.

Dr. Polonsky says all he has done for the past 25-30 years is focus on the behavioral aspects of diabetes, both as a clinician and as a researcher. I may not be quoting him correctly, but he has said, “Diabetes causes nothing, it is the lack of diabetes management that causes complications.” I firmly believe he is correct, yet there are some that have been very vocal in their desire to have him be more politically correct and stop using this statement. Shame on them.

In some cases, Dr. Polonsky says, “The way that we use behavior-change interventions with our patients may work very, very well. But sometimes, these seemingly simple and brilliant behavior-change interventions -- such as collaborative goal setting and action planning -- just don't work at all.”

“I think the reason we have so many frustrations with trying to encourage and promote behavior change with our patients is because we make 3 fundamental mistakes. I often make them myself.”

I feel that Dr. Polonsky is writing as a clinical psychologist, but I see this also in CDE's. The three mistakes he outlines are:

#1. Probably the most important mistake is that we push a little too hard. “Most of us are so concerned about our patients -- we so much want to help and we are so overtrained as problem-solvers -- that we essentially demand behavior change before our patients are ready for it. They may not be convinced that what we are encouraging them to do is really worthwhile, even if they seem to be cooperating with us. They may harbor suspicions about medications, or question whether they can really make dietary changes, or whether those changes will even make any difference.”

He says that learning to take your time and setting the right mood is important for patients.

#2. The second mistake involves what he calls the principle of the mundane. “We often "overfocus" on the obstacles that our patients face. We view these barriers to behavior change as big, dramatic complications, and that is probably the fault of researchers like me. I have made a big deal out of these things over the years: depression, eating disorders, fear of hypoglycemia.”

The one Dr. Polonsky focuses on is what he calls "meh," or apathy or indifference. Many of the patients do not view diabetes as a priority in their lives, and that may be totally justified because the patients are much like us. Life gets in the way.

“So, we need to appreciate that the biggest barriers to behavior change may not be big stuff but little stuff. People may simply be overwhelmed by diabetes, just stressed and confused, and not dealing with the disease at the best problem-solving level.”

#3. The third principle is what he calls ATMs (actions that matter). “Many of my colleagues who are somewhat skilled in behavior change have fallen into this trap of diabetes empowerment: When they talk to their patients and ask where they might want to make some lifestyle changes, they imply that the particular answer doesn't matter. "Mrs. Smith, what do you want to do?" "Well, I guess I should drink more water every day. I can do that. Or maybe I should have fewer tortillas at every meal, or maybe..."

“Certainly, the patient should be the decision-maker in this, but I think we must remember to get the most "bang for the buck." Instead of giving the impression that any change is admirable and will lead to even more positive behavior, we should be willing to collaborate and inform our patients about the facts. "Look, you have diabetes and there are probably 100 different things that you could do to improve your health, but they are not all equally important. We can put them in order of priority: knowing your glucose numbers is critical; smoking is a bad thing; being on the right medication and then taking it may be the most important thing. That is where you can get the biggest bang for your buck."

I quoted much of his article because it is important. There is much we as patients can learn from this. I will also be using this in my role as a peer mentor and as a peer-to-peer worker. Too often I find myself pushing and expecting because I have experiences to relay that the others should be more willing to accept my words. I have found out this does not always work and that those I am working with do not want to make changes and are looking for something easier that they can do.

One person that Allen and I had been working with kept insisting that there had to be something that he could take and reverse his diabetes. Nothing we were saying was accepted and we could tell he was not even following us. After several meetings, we had to tell him that after he wasted his money, he would be back, probably having complications, and then we would be able to help him. We did not have that chance as he passed the following week. We have learned that his blood glucose became so high that he went into a coma and died the following day.

His daughter did tell us this and asked for information on several bottles she had found on his table. We were able to find information on them and as you might have guessed, they were either for supposed cures or reversing diabetes and none were of any value. We suggested that she have a talk with his doctor and have him consider showing them to other patients and explain that they do not help. His doctor agreed and has been successful with this approach.