Doctors Can Help People with Diabetes

I often see people coming to the diabetes forums wondering what they can do. Most are very discouraged by their diagnosis and wondering where they can learn how to manage their diabetes. Most are not too polite in describing what their doctor said to them. Many feel that their doctor was accusing them for their diabetes and others felt their doctor was ridiculing them and a few felt that they were being bullied by their doctor.

This is often quite a bit to overcome, but most answers to their questions do their best to allay their guilt and encourage them to conquer their fears and then suggest following links to some very positive messages. Others tell them that they have experienced similar problems, but the people on the forum could help them and they would learn as well.

Varun Iyengar and Adam Brown describe in the diaTribe newsletter what Dr. Bill Polonsky said when he gave a talk on diabetes distress at the recent IDF World Diabetes Congress in Vancouver. He covered what this emotional state looks like, how and why it occurs, and simple strategies for addressing it. This reflects his research dedicated to one big question: how can we help people with diabetes feel motivated to succeed?

Dr. Polonsky stressed that doctors and other providers often communicate the wrong message, rather than hope, patients hear negatives and feel fear. The reason for vigilant management is not to live a long and healthy life, but to avoid complications. That framing makes a difference, as people with diabetes often go on to develop distress: an attitude of feeling defeated by diabetes.

Dr. Polonsky shared what “diabetes distress” sounds like in practice:

• “Diabetes is taking up too much of my mental and physical energy every day”
• “I am often failing with my diabetes regimen.”
• “Friends or family are not supportive enough of my self-care efforts.”
• “Diabetes controls my life.”
• “I will end up with serious long-term complications no matter what I do.”

How common is diabetes distress? (You are not alone!)

The rate of diabetes distress is far greater than is often appreciated; 39% of type 1 and 35% of type 2 patients experience significant levels of diabetes distress at any given time. This distress cannot be treated with depression medications because…it is not depression! Rather, it requires a greater focus on acknowledging and addressing the emotional and behavioral obstacles associated with diabetes.

This statement by Dr. Polonsky is the way he turns a negative into a positive, “Well-controlled diabetes is the leading cause of nothing!” This is how Dr. Polonsky stresses the need to adapt the messages people with diabetes hear from doctors, providers, and caregivers, moving away from “blame and shame” to a new message, positive in nature.

Varun Iyengar and Adam Brown had much more to say about Dr. Polonsky's talk and I hope that the above link works, as it is very interesting.

Statins May Increase Kidney Disease

This should make everyone take notice. Long-term statin use may increase kidney disease. While we are all familiar with statins increasing the risk of type 2 diabetes, this is somewhat of a surprise, but seems logical. Many of the drugs of today have more and more side effects and many can cause harms to patients.

Considering that statins have no proven cardiovascular disease prevention or life lengthening effects, it seems that the statins all have more harm causing properties than health improving properties.

In a December 1, 2015 issue of the American Journal of Cardiology, lead author Dr, Tushar Acharya of the University of California, San Francisco, said an 8-year retrospective study with a median 6.4 year follow-up associated long-term statin use with an increased risk of kidney disease. Statin users, compared with case-matched controls that didn't use statins, showed a 30% to 36% greater prevalence of kidney disease during follow-up.

Senior author Dr. Ishak A Mansi, University of Texas Southwestern, Dallas, said, “Patients who are taking statins should not stop taking them based on this study. Our study did not examine whether the benefits outweigh the risk, as it was not designed for that. Still, this study shows that despite the use of statins for more than a quarter of a century, there are aspects about its long-term effects in noncardiac diseases that we do not know very well. We are missing more extensive, real-world data of the effectiveness of statins on total morbidity and all-cause mortality, and we need further studies specifically focusing on long-term outcomes in primary prevention."

Dr. Mansi continued, “The new [ACC] guidelines . . . are projected to increase statin use to many more hundreds of millions of healthy people, and before we do that we better make sure that we are not causing harm. Our paper says to scientists, physicians, funding agencies, [and] policy makers: 'Watch out, [it] seems that we still do not know enough about the long-term effects of these drugs on [the] overall well-being of patients.'"

The overall cohort comprised 43,438 individuals: 13,626 statin users and 29,812 nonusers. The most commonly prescribed statin was simvastatin (73.5%), followed by atorvastatin (17.4%), pravastatin (7%), and rosuvastatin (Crestor, AstraZeneca) (1.7%); 38% of the statin users received high-intensity doses. The statin users took the drugs for a mean of 4.65 years.

The researchers matched 6342 statin users in the overall cohort with 6342 nonusers, according to baseline demographics, comorbidities, and presence of renal disease, healthcare utilization, and medication use. In this matched cohort, patients had a mean age of 56, and 45% were women.

"The findings of this study, though cautionary, suggest that short-term [randomized controlled trial] may not fully describe long-term adverse effects of statins," Acharya and colleagues conclude. Statins lower the risk of cardiovascular disease and cardiovascular death, but "on the other hand, statins increase the risk of incident diabetes and possibly kidney diseases, both of which paradoxically increase long-term morbidity and mortality," they continue.

ADA 2016 Guidelines – Summary of Revisions

The new American Diabetes Association 2016 guidelines are now posted and the ADA is apparently attempting to be politically correct. The word diabetic will no longer be used to describe patients, but will only be used as an adjective when describing something like diabetic neuropathy. OH -WOW! And, there are more examples of political correctness through out the guidelines.

Strategies for improving care has been revised – including recommendations on tailoring treatment to vulnerable populations with diabetes, including recommendations for those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, and a discussion on disparities related to ethnicity, culture, sex, socioeconomic differences, and disparities.

The support for only diagnosing based on HbA1c has been diminished and includes fasting plasma glucose, 75-gram oral glucose tolerance test, and the A1c test, with no preference to one test. The screening recommendations have now been revised to test all adults beginning at age 45 years, regardless of weight.

Two sections were combined – Initial Evaluation and Diabetes Management Planning and Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care, and Immunization from the 2015 Standards were combined into one section for 2016 to reflect the importance of integrating medical evaluation, patient engagement, and ongoing care that highlight the importance of lifestyle and behavioral modification. The nutrition and vaccination recommendations were streamlined to focus on those aspects of care most important and most relevant to people with diabetes.

Many people will be happy to see this - Because of the growing number of older adults with insulin-dependent diabetes, the ADA added the recommendation that people who use continuous glucose monitoring and insulin pumps should have continued access after they turn 65 years of age. Now we will need to push out congressional representatives to pass a bill to force Medicare to do this.

“Atherosclerotic cardiovascular disease” (ASCVD) has replaced the former term “cardiovascular disease” (CVD), as ASCVD is a more specific term.

A new recommendation for pharmacological treatment of older adults was added. To reflect new evidence on ASCVD risk among women, the recommendation to consider aspirin therapy in women aged greater than 60 years has been changed to include women aged 50 years and greater. A recommendation was also added to address antiplatelet use in patients aged less than 50 years with multiple risk factors.

A recommendation was made to reflect new evidence that adding ezetimibe to moderate-intensity statin provides additional cardiovascular benefits for select individuals with diabetes and should be considered. A new table provides efficacy and dose details on high- and moderate-intensity statin therapy.

“Nephropathy” was changed to “diabetic kidney disease” to emphasize that, while nephropathy may stem from a variety of causes, attention is placed on kidney disease that is directly related to diabetes. There are several minor edits to this section. The significant ones, based on new evidence, are as follows:

Diabetic kidney disease: guidance was added on when to refer for renal replacement treatment and when to refer to physicians experienced in the care of diabetic kidney disease.

Diabetic retinopathy: guidance was added on the use of intravitreal anti-VEGF agents for the treatment of center-involved diabetic macular edema, as they were more effective than monotherapy or combination therapy with laser.

The scope of youth section is more comprehensive, capturing the nuances of diabetes care in the pediatric population. This includes new recommendations addressing diabetes self-management education and support, psychosocial issues, and treatment guidelines for type 2 diabetes in youth.

The recommendation to obtain a fasting lipid profile in children starting at age 2 years has been changed to age 10 years, based on a scientific statement on type 1 diabetes and cardiovascular disease from the American Heart Association and the ADA.

There is more and I may cover some of this separately at a later date. Find the Table of Contents here.

What Is Happening at ACDE?

I am confused and I am not sure what is happening. I used to be able to access the Academy of Certified Diabetes Educators website, but since the tenth and maybe the ninth of December, I have not been able to access it by the main page, and this is the message I get on the screen. The URL is this - http://www.academycde.org/ .

The website you are attempting to access cannot be found
There is no website configured at the address you have provided.
Please try the following: If you typed the page address in the Address bar, make sure that it is spelled correctly. Contact the organziation to see if the address is correct. Search Google for the website's correct address. ERROR - URL not found Internet Information Services Technical Information (for support personnel) YourMembership.com:Contact Us

I for one did not believe they are out of business and after several experiments, I have found another way into the website on 14 December. It is this URL - https://academycde.site-ym.com/?page=OfficersAndBoard .

In exploring the site further, I had to wonder why some places look like nothing is being done. The newsletter area only shows archived newsletters through July and I remember that normally it was three months after when it was archived. They may not have issued newsletters for August and September.

The ACDE Connection July 2015

The ACDE Connection June 2015

The ACDE Connection May 2015

The ACDE Connection April 2015

The ACDE Connection March 2015

There are past newsletters from August 2014 to February 2015.

The last area that surprises me is in the Calendar of Events. After having a meeting on June 7, 2015, I would have thought a future meeting would have been posted for ACDE. I do need to be concerned about why they are pulling the main page of the website and what they are attempting to cover up. If the company that does the web page, “Professionally Managed by Capitol Consultants, Inc.” is that inept then their must be real problems or the ACDE has not paid the fee due Capital Consultants, Inc.

Should We Let Guilt about Diabetes Ruin Our Lives?

I am not sure about this, as the idea came from this blog by Karen McChesney on A Sweet Life. The way she wrote the blog, I am sure that those with type 1 diabetes agree with her feelings.

As a person with type 2 diabetes, I admit I have many misgivings about what she describes and would never allow myself to have the blood glucose readings she describes having for several hours. Many of those in our support group are talking about this and are wondering why we don't feel this way. We know that people with type 1 diabetes are afraid of hypoglycemia and we have to wonder several things.

First, are they not taught how to use correction injections and if they over bolus too often. Allen, who had a recent A1c of 5.1 percent, said he is at a loss to understand type 1 people. He said that eating a low carb, high fat food plan should prevent the problems she described. Ben asked why anyone would let his or her blood glucose levels remain in the 200's for several hours.

Ellie (a type 1 herself and an honorary member of our support group) asked if we would listen to her. She agreed with our food plan and said too many people with type 1 diabetes eat normally and plan on covering the extra carbohydrates with insulin. While she said she does not agree with this, it explains why many people yo-yo up and down and when they have lows over correct and then need to bolus for the hyperglycemia.

Ellie is a freshman in college this year and says that her type 1 friends ridicule her for her low carb, high fat meal plan and don't understand why she does not have lows and uses so little insulin. She then tells them about the support group she belongs to at home that are all type 2 people, most follow this food plan, and many have A1c's in the low 5%'s. When asked what her A1c is, many are surprised that she is also between 5.0 and 5.5%. She has only had one person ask her about her food plan, but after a few days, rejected it saying she did not like feeling hungry all the time.

She said she advised her to increase her fat percentage and add a little more salt. She finally discovered the person was following the advice of her mother to also eat low fat and realized that it was a no win situation and her friend normally had an A1c above 7.0% and had gained 20 pounds in her first semester of College. After that she decided not to talk about her A1c and her meal plan. She just thanked us for our support and being there when she needed our help, by answering her questions directly or through her parents. She asked us to pass on a special thank you to Brenda's daughter for her nutritional help. Tim said we would and we thanked her for her input.

Barry said that explains a lot, and we need to remember that our food plans work for us and we know they do. Other people need to experiment on their own to discover whether they can use the low carb, high fat food plans.

Our support group does not believe guilt should be any reason to diminish our

our diabetes management or our level of blood glucose maintenance. We all know that other variables can make our diabetes management more difficult, such as stress, illness, lack of sleep, and many other variables, but we need to have our diabetes held in check by what we eat and how we manage our blood glucose levels.

Managing Drug Side Effects – Part 2

When you talk to your doctor, have a list of all other medications and/or supplements you're taking - both prescription and over-the-counter. Sometimes, side effects are caused by two or more drugs reacting negatively together, and you may not need both.

Keep in mind that a new symptom may actually be a drug side effect. If you don't give your doctor the whole story, he may diagnose you with another condition entirely, and prescribe another drug to treat it.

There are a lot of factors that go into side effects -- not just the medication itself," Owen says. "You may be able to prevent them by avoiding alcohol or certain foods, or by making other small changes to your diet or lifestyle."

For example, if you take an antidepressant that helps you feel better but also causes you to gain weight, you may have to pay more attention to your nutrition and exercise plan.

Some medicines, like cholesterol drugs and blood thinners, may not work as well if you eat grapefruit or foods high in Vitamin K. Grapefruit can also make the cholesterol and blood thinners become toxic to your body. Other drugs may make you sensitive to the sun, so wear sunscreen or cover up outside.

It's smart to do your own research about your medicine. Read the label and all the instructions that come with your prescription. Talk with other people who have similar health problems. Please search reliable sources on the Internet.

If you read or hear about another drug that may have fewer side effects, ask your doctor or pharmacist about it. Side effects of newer medications may not be as well known as those on the market for years, so you might ask about switching to an older, more proven drug.

Never stop a medicine or change your dosage without your doctor's approval, especially if you're being treated for a serious health condition. You need to take some medicines, like antibiotics, for a full course to avoid getting sick again. Others don't work as well if you skip a dose, cut it in half, or take it with or without food.

You may be able to tolerate some side effects, especially if they're temporary or if the pros outweigh the cons. But, if a bad drug reaction puts you at risk for more medical problems or seriously affects your health, it may be time for a change. Always notify your prescribing doctor and explain what is happening.

Medications that cause dizziness, for example, can increase your risk of death or serious injury from falling, especially if you're an older adult. And treatments that affect your ability to enjoy time with friends or romantic partners may not be your best option if alternatives are available. If you are one of the elderly, make sure that the doctor will be monitoring you until you are sure that the drug can be effective and that your body is receiving the intended benefits.

Sometimes it takes a bit of trial and error, but often you can find a medicine that works without affecting your quality of life. Also, ask the doctor about whether grapefruit is a problem with a drug and follow the instructions carefully. Some foods need to be avoided with a few drugs.

Managing Drug Side Effects – Part 1

This article has some excellent advice that many people chose to ignore. Yes,

prescription drugs heal us when we're sick, ease our pain when we ache, and prevent or control long-term conditions. But sometimes, even when they do the job they're supposed to, they have unwelcome side effects.

Many people automatically rule out a medication, even if it's an important part of managing a health condition. But you shouldn't accept unpleasant reactions without question, either.

I find this very interesting. “Side effects can happen with almost any medicine, says Jim Owen, doctor of pharmacy and vice president of practice and science affairs at the American Pharmacists Association. “They're common with everything from birth control pills to cancer-fighting chemotherapy drugs.”

Many prescription drugs, for example, cause stomach problems like nausea, diarrhea, or constipation because they pass through your digestive system. Antidepressants, muscle relaxants, blood pressure, or diabetes medications may cause dizziness. Some might make you feel drowsy, depressed, or irritable. Some may cause weight gain. Some may disrupt your sleep or your ability (or desire) for sex.

"I tell my patients that chronic symptoms are not acceptable," says Lisa Liu, MD, a family doctor at Gottleib Memorial Hospital in Melrose Park, IL. "I won't allow them to have ongoing pain or discomfort unless we have tried every alternative."

When your doctor prescribes a new medicine, ask about common side effects.

"You, your doctor, and your pharmacist should be working together so everyone has the same information," Jim Owen says. "You should know which side effects are serious, which ones will go away on their own, and which ones can be prevented."

“Once you start taking a drug, mention any unexpected symptoms to your doctor or pharmacist as soon as possible. This includes changes in your sex life,” Liu says, “Which many patients are embarrassed or afraid to talk about.”

Some side effects go away over time as your body gets used to a new drug, so your doctor may recommend you stick with your current plan for a little longer. In other cases, you may be able to lower your dose, try a different drug, or add another one, like an anti-nausea medicine, to your routine. As you age, your body may not be as efficient in using the drug and your doctor should be made aware of this.

"People often think that just because they have a bad reaction to one drug, they can't take any other drugs in the same class, but that's not always the case," Liu says. "Sometimes side effects are due to very specific ingredients that not every brand uses."

Changing the time of day you take your medicine may help, too, if your doctor gives you the okay or if your pharmacist tells you to ask the doctor. "If someone is on four blood pressure medications, for example, I tell them not to take them all at once," Liu says. "For patients whose birth control or antidepressant makes them dizzy, I have them take it right before bed."

Personal Emergency Response Devices

This is a service, which I may have missed in the past, but as I continue to age, I admit I am looking more into these products – personal emergency products. Products exist that are interesting and some that have been in existence for years, but do little. Some cover decent distances and others only short distances. Some have hidden fees, long contracts, and are expensive. Others have the equipment and only have a monthly fee. There are always some costs that aren't explained and these can turn you off to the equipment.

I understand why people are drawn to personal emergency devices, but many are not willing to wear it. Many forget or don’t want to have something around their neck or on their wrist. A personal emergency device also has to activate when an emergency occurs, either by automatically detecting a fall or problem, or because the user triggers it. Currently, most devices do not have this ability and only work if you are within operating range and the wearer pushes the button.

I am investigating only one device currently, but I have a couple others to investigate is I become serious. The equipment cost is $0.00 and the activation fee is $0.00. Monthly monitoring costs $29.95 per month or cellular monthly monitoring is $34.95 per month. This is from Medical Alert and is the basic cost.

There no long term commitment required, but – surprise - for liability purposes, they do require a Monitoring Agreement to be signed. A non-refundable deposit is required prior to a Medical Alert system being shipped. This deposit is the equivalent of three months monitoring. At the end of those 3 months, the Medical Alert service can be canceled with no penalty with 30 days notice (or you are required to have the service for 4 months). This is one of the more reasonable conditions.

I do not advise letting them have open access to your credit cards or auto draws to a checking or savings account. Unless a specific date was requested, credit card payments are processed on the 1st of the month and checking and savings account payments are processed on the 5th of the month. Invoices are mailed the first week of the month.

The cost of the unit if it’s lost or damaged is this schedule:
The PERS replacement cost is $350.
The Mobile Alert replacement cost is $350.
The Alert 911 replacement cost is $150.

The company has a Better Business Bureau rating of A+ as of 12/22/15 and has the Good Housekeeping seal of approval.

Some companies have long-term contracts and others have high activation fees and you pay for the equipment before it is shipped.

The one thing I have not found out is how close you have to be to the station for you to have access for a household monitor (PERS)(personal emergency response system). This is a weakness of several of the companies. Also before you sign anything, make sure you read the fine print, get all the facts, and addresses if you need to break the contract. For a couple of companies, you will pay dearly if you don't.

For research, type life alert or medical alert in your search engine.