Ideas to Consider After Diabetes Diagnosis

Many different people have different thoughts about what to do when you are initially diagnosed with type 2 diabetes. I doubt my ideas have not been exposed before, but several in our group have asked me to blog about these ideas. It is surprising the different attitudes we have encountered in the last three years.

Yes, we all have seen anger or something similar. Some have seen shock and self-blame. All these are normal reactions as is denial and many go this route and many in our group have seen this. Tim and I have often questioned why we have seen severe depression when this is not one that we see that often. Yes, later we have all seen quite a bit of depression and mostly mild versions of depression.

A couple of people we know are still in the self-blame stage and have refused to consider anything else even with several of the group working with them and explaining how they are not to blame.

We are always happy when people we are working with accept their diabetes and want to take charge of their health. Much of what we suggest depends on how long it has been since diagnosis and recent A1c results. The longer it has been or the higher the A1cs, the more we work with them to help them learn the basics and find what works for them.

I can understand if you panic about the diagnosis, but try not to make drastic changes before you understand something about diabetes. Find what you can do to manage your diabetes, as often you need to take a step back and learn what you can about diabetes. You need to learn what measures should be taken to manage diabetes, and what will help you prevent the complications.

You will need to break down the complexity of diabetes into easy to understand terms and learn why it is important to get an obtainable HbA1c reading. It is even more important to learn how to do the daily testing and learn how the different foods you consume affect your blood glucose levels. Learn to test in pairs, before you eat and about 2 hours after to discover how the meal affected your blood glucose level.

Most newly-diagnosed people with type 2 diabetes are aware that what we eat and how active we are affects our blood glucose levels. Next, we need to learn how caffeine, stress, and amount of sleep affect our diabetes management. All of this should tell you how important the different logs or journals we maintain can help us with diabetes management. Keeping information about your blood glucose readings, what you ate, when you exercised, and how stressed you were that day can provide clues or trends. Use these to discover what affected your blood glucose readings.

The more you learn about what affects your blood glucose levels, the more accurately you can tailor your diabetes management plan to avoid continual trial and error.

Having support in managing your diabetes can be a great help. Several studies have shown that having some kind of support system, whether it is family, friends, a health coach, or a behavioral health counselor, can greatly improve an individual’s ability to manage their diabetes. If you feel like you could use a boost in support, ask your primary care provider about local support groups where you might find peers who may be able to relate to what you are going through because they have been through it.

HBOT Helps Foot Ulcer Survival

When I wrote that HBOT may not help foot ulcers on April 12, 2013, I was disappointed because I felt that the researchers had missed something or used the wrong pressures. I have now seen three people being treated by hyperbaric-oxygen therapy and all three have foot ulcers that healed with HBOT.

Results of the study were presented at the European Association for the Study of Diabetes (EASD) 2015 Meeting, by lead investigator Magnus Löndahl, MD, of Lund University, Sweden.

A total of 38 patients completed hyperbaric-oxygen treatment, 37 completed placebo treatment, and 19 did not complete treatment (both groups combined). At baseline, hyperbaric oxygen and air patients had had type 2 diabetes for 23 and 21 years, respectively, had a median age of 67 and 71 years, and had foot-ulcer duration of 11.4 and 10.3 months.

What surprises me is the length of foot ulcer duration. I know one of the three had a foot ulcer for 5 months and two others for less than 4 months. In addition, three of our support group have had foot ulcers for less that 4 months and were able to have their foot ulcers healed with medications. This is one reason to see a podiatrist on a quarterly basis, as they examine your feet for foot ulcers, ingrown toe nails and other foot problems. They will also examine your lower legs for problems and refer you to another doctor if necessary.

“Now at 6 years, 63.2% of patients who received at least 37 treatments (of 40 total) of hyperbaric oxygen survived compared with 40.5% of those who got placebo.”

“Dr Giel Nijpels, from the Free University of Amsterdam, the Netherlands, the session moderator, commented on the potential clinical use of hyperbaric oxygen.”

"It seems to work, but we can speculate about the disadvantages, including the high cost. Also, I have some doubts about the way the data were analyzed — I'm unsure if this is fully accurate. The problem is that they attempted to blind the patients, and there was a huge dropout rate.

"Also, let's remember you find this type of treatment only in large academic centers — it isn't that easy to administer this form of therapy," he added.

“Turning his attention to the possible reasons for the positive effect on chronic diabetic foot ulcer, Dr Löndahl said: "I have no definite explanation today. It might be a coincidence or associated with ulcer healing. It is unlikely to be due to improved macrovascular function, but we do have data that improved microvascular function might be associated with survival, not least due to improved autonomic neuropathy."

Despite the positive results, Dr Löndahl concluded that "we need more information and to further explore and verify findings before [this therapy is]…applied in clinical management of diabetic foot ulcer."

I feel that this type of treatment needs to be explored further, as the expense needs to be considered. HBOT does have its place in medicine, especially in diabetes and traumatic brain injury, and possibly other areas besides deep sea diving.

AACE Corporate Partners

It is interesting the number of corporate-partners the American Association of Clinical Endocrinologists has picked up in the last few years.

2015 = 3

2014 = 3

2013 = 2

2012 = 2

2011 = 3

They have this to say about their conflicts of interest. “The following Pharmaceutical and Medical Equipment manufacturers serve as members of the Corporate AACE Partnership. Their generous support and valuable input helps make possible the many educational programs and activities that AACE provides for its members, including this highly effective resource (AACE Online).”

CAP Member Directory

Abbott Diabetes Care
Member Since 2014 www.abbottdiabetescare.com

AbbVie
Member Since 1993 www.abbvie.com

Aegerion Pharmaceuticals
Member Since 2015 www.aegerion.com

Amgen Inc.
Member Since 2004 www.amgen.com

Apricus Biosciences, Inc.
Member Since 2015 www.apricusbio.com

AstraZeneca
Member Since 2002 www.astrazeneca.com

Bayer Healthcare
Member Since 1995 www.bayer.com

Boehringer Ingelheim Pharmaceuticals, Inc.
Member Since 2009 www.boehringer-ingelheim.com

Clarus Therapeutics, Inc.
Member Since 2014 www.clarustherapeutics.com

Corcept Therapeutics
Member Since 2013 www.corcept.com

Dexcom, Inc.
Member Since 2010 www.dexcom.com

Eisai Inc.
Member Since 2012 www.eisai.com

Eli Lilly & Company
Member Since 1993 www.lilly.com

Genentech, Inc.
Member Since 1999 www.genentech.com

Genzyme Corporation
Member Since 1998 www.genzyme.com

GlaxoSmithKline
Member Since 1996 www.gsk.com

Health Monitor Network
Member Since 2012 www.healthmonitornetwork.com

Interpace Diagnostics
Member Since 2015 www.interpacediagnostics.com

J&J Diabetes Solutions Companies
Member Since 2014 www.jjdi.com
www.animas.com
www.lifescan.com

Janssen Pharmaceuticals, Inc.
Member Since 2001 www.janssen.com

Lexicon Pharmaceuticals, Inc.
Member Since 2013 www.lexpharma.com


Medtronic Diabetes
Member Since 1995 www.medtronic.com

Merck & Co., Inc.
Member Since 1997 www.merck.com

Novo Nordisk, Inc.
Member Since 1993 www.novomedlink.com

Pfizer, Inc.
Member Since 1993 www.pfizer.com

PhRMA
Member Since 2007 www.phrma.org

Roche Diabetes Care
Member Since 1997 www.rocheusa.com

Sanofi
Member Since 1994 www.sanofi.us


Takeda Pharmaceuticals North America Inc.
Member Since 1999 www.takedapharm.com


Valeritas
Member Since 2011 www.valeritas.com


Veracyte
Member Since 2011 www.veracyte.com


VIVUS, Inc.
Member Since 2011 www.vivus.com

Why Can't We Joke About Diabetes?

This is a difficult topic for many people. Maybe I have too thick of a skin, as most diabetic jokes seldom get any emotion from me. Even some of the caustic remarks said to me won't get a rise from me. I generally ignore the food police or I hand it right back.

Why is it that people with diabetes can't develop a thicker skin? Over on A Sweet Life, there have been two blogs (one has been pulled) about how thin-skinned people can be about diabetes.

The blog that has been pulled was complaining about a remark made by President Obama and the comments all felt that the remark was not that offensive and was innocent enough. But, the author had the blog deleted. I could see both sides and either side was correct depending on what you were looking for in the remark. The blog author was highly incensed by the remark.

The second blog, which is still posted is a great post and shows that we should be able to laugh at ourselves. I would encourage you to read the blog by Melissa Lee as it could be the answer you need.

Yes, some jokes are cruel and insensitive and out of place, but others can be a lot of fun and we need to laugh at these. Plus, we need to be able to laugh at ourselves even with diabetes. If we can't laugh at ourselves, then we are the worse for this.

I can understand those that are newly diagnosed, not finding many things humorous and there is a lot of education that needs to be done for people to understand the difference between the different types of diabetes. I am not talking about the people with diabetes, but the general public and some doctors.

Metformin Has Link to Neuropathy, B12 Deficiency

Called me puzzled! I have never understood why the American Diabetes Association had never called for testing of vitamin B12 deficiency for people taking metformin for any length of time. Even this article shows a lack of this testing and only calls for more research. This is why I am reversing the situation and listing what Diabetes-in-Control lists as practice pearls first.

Practice Pearls:

1. Metformin has been linked with vitamin B12 deficiency.
2. A randomized placebo-controlled trial showed that metformin use is associated with an increase in neuropathy scores for patients.
3. Current guidelines do not offer specific instructions on metformin and B12 deficiency, but future research is warranted.

Yes, one of the most common and beneficial T2DM drugs may contribute to neuropathy and vitamin deficiency – metformin.

The link between metformin and vitamin B12 lowering is well-known and mentioned in American Diabetes Association guidelines as a disadvantage of the drug. However, the ADA gives no recommendations for monitoring and prevention of vitamin B12 deficiency for patients taking metformin. Vitamin B12 deficiency is associated with adverse effects such as anemia, fatigue, mental status changes, and neuropathy. Given the prevalence of neuropathy in diabetic patients, metformin-induced vitamin B12 deficiency is clinically relevant.

The relationship between vitamin B12 deficiency and metformin was studied in a recent randomized placebo-controlled trial. The trial lasted 52 months and included 390 type 2 diabetes patients. They were treated with 850 mg metformin at doses up to three times a day or a placebo. Patients with baseline vitamin B12 deficiency or patients taking vitamin B12 supplements were excluded from the trial.

Metformin is prescribed around the world, so this relationship warrants more investigation according to the study authors. Future studies may clarify the relationship and will help the authors of guidelines decide whether to recommend testing or supplementation.

Be Concerned About What CDEs Teach You

I am happy that I don't currently use insulin pens. Hopefully, I will not make the mistakes some of these people did. My blog here explains one mistake a patient made and I am writing about another.

Yes, I admit I do not understand why patients are not properly taught how to use insulin pens, or for that matter any diabetes equipment. This time I am surprised as the instructor has RN (registered nurse) as her first title and CDE is the last one listed. It is apparent that assumptions were made about using insulin pens that should not have been assumed. When this happens, patients can often receive bad results.

I would have thought the patient would have thought to ask more questions and would have noticed earlier that things weren't right, but apparently, some patients blindly go about treating themselves and think nothing is wrong. Please readers don't let this happen to you.

“Lessons Learned:

• It’s not always clear to patients that they need to change pen needles. As part of insulin pen teaching, include safe ways of removing, and disposing of, the needle. Always remove the needle, so the patient sees that step.
• When I receive reports of high carb intake, I won’t always rely on what I’m told on the phone. I will request the patient come in to see me sooner so I can assess technique.
• Don’t always blame high carbs for the high glucose levels. There are many reasons for high glucose levels.”

Comments to lessons learned above – why is the patient not required to show that he/she understands by removing the needle. Some patients do require doing this several times before they fully comprehend the procedure. Apparently, there is more than one type of pen needle and all types should be taught.

The second point above is common sense and should done if proper procedures were not taught in the first place. The last statement is also common sense and should not be overlooked.

If you have questions about what the CDE tells or mandates that you do, always ask for a re-explanation or if there are other types of that same equipment that may operate differently.

Always learn as much as possible and read any instructions that come with the equipment to find out if you have more questions and if necessary call the CDE if possible to have these questions answered.

How Many Pharmacies Do You Need?

After years of complaining about people using multiple pharmacies to prevent tracking of duplicate prescriptions and preventing one pharmacy from having all the information on a patient or family, I come across an article recommending two pharmacies. I admit I have some learning to do. Most of the time people using many pharmacies think they are hiding their narcotic or opiate usage.

Apparently, with the prevalence of mail-order pharmacies and Medicare pushing them and many insurance companies forcing patients to them, there is concern for emergencies.

The author of the Diabetes-in-Control article (article no longer available) does cover an interesting point. He has always recommended that his patients use their local pharmacy for at least one prescription. This is in case an emergency arises and they need a medication or supplies right away, they can get great service locally because they have established a relationship.

This makes good sense as mail order pharmacies are not the most prompt in sending supplies or medications and a four to 10 day wait may not be practical or the most healthy.

“Lessons Learned:

• Recommend that your patients have at least one local pharmacy. If one is a small pharmacy, that’s fine, but also establish a relationship with a national chain. The national chain can be very helpful when traveling.
• Always discuss the importance of having long- and short-acting insulin available for patients who are on pumps.”

The lessons learned can be important when traveling and an emergency arises. Since I am a person with type 2 diabetes on insulin, I always travel with a sufficient quantity of insulin and use a cooler if necessary to keep extra vials cool enough. Normally for other prescriptions, I can get extra to cover me while traveling and if needed a partial prescription and have the rest filled when I return home.

Medical ID Importance

I don't understand people that email me and tell me that medical identification is not necessary or needed. I even had one fellow say that he has not told anyone that he has diabetes, not even his family. I asked what medication he was using and the answer came back that he was not using any medication and managed his diabetes with diet and exercise.

In this instance, I told him that I still recommend that he wear some sort of medical identification on his person. I told him that if he was involved in an auto accident and was unconscious, he could be fed with IVs that had glucose that could cause his blood glucose levels to rise rapidly. If he could not tell the hospital who his doctor is, his treatment could push him into dangers that they might not catch in time and he could die.

Even this did not convince him as he said he wanted to keep it a secret that only his doctor and he knew. I emailed him that this is something he should reconsider as accidents do happen. Then six days later, I received another email from the fellow. It turns out that the day I sent the last email, he did have an accident and was unconscious for four hours. When he asked to have his blood glucose checked, the reading was 389. He said the hospital used insulin and rechecked in five hours and he had only decreased to 245. This meant a second shot and another check in five hours. This time the reading was 102 and they did not give him another shot.

At the end, he said he would be getting a medical ID necklace with the needed information to prevent this from happening in the future. He said that the four days in the hospital had shown him how important this could be. He thanked me for pushing on the medical identification. For the present until he would be able to exercise (in about four months), he would be on two insulins, Lantus and Novolog. He asked me if it would be difficult to get off insulin. I responded that if he was determined, he should be able, if too much damage had not been done by the accident.

I suggested that he get back into the habit of exercising slowly until things felt right, watch his blood glucose readings until that happened; talk with his doctor about reducing his doses of insulin when his exercise showed improvement in blood glucose readings, and not get anxious if he needed insulin for a while longer.

He promised that would happen and he asked if he should obtain Dr. Bernstein's book, “Diabetes Solution” and consider a low carb, high fat way of eating. I said that would be a good thing and I sent him several of the URLs from this blog. I did suggest that he take it slow as his injuries could make it difficult for a while and he should not become impatient with his recovery.

His return email stated that he would as his doctor had made this clear to him and he was to be careful the first few months. It sounds like I have made a friend and he is opening up about his diabetes. 

Previous blogs about medical identification:

http://bobsdiabetes.blogspot.com/2010/09/to-wear-or-not-to-wear-medic-alert-id.html

http://bobsdiabetes.blogspot.com/2010/09/medic-alert-jewelry-pros-and-cons.html

http://bobsdiabetes.blogspot.com/2011/05/why-are-you-not-wearing-medic-alert.html

http://bobsdiabetes.blogspot.com/2012/05/should-we-standardize-diabetic-medical.html

http://bobsdiabetes.blogspot.com/2013/11/importance-of-medical-alert-jewelry.html