This article on “How much carbohydrate in a meal is too much” caught my attention for the answer. Her answer is “It depends”. Read her blog of May 22, 2010. Note: link is now broken and site no longer exists.
While I must give this author high marks for her partial answer and consideration of individual height and body size, she failed by not giving a complete answer. While she mentions people living without carbohydrates, she by-passes the topic of low carb and that people can have different meal requirements. Not everyone can eat the same number of carbs at every meal.
I have to wonder about another statement when she declares “researchers have found that 60 grams per day is a minimum level that prevents diabetic ketoacidosis.” I have always read that diabetic ketoacidosis was the result of high blood sugar and lack of insulin, not the lack of carbs.
I have asked the author for links to the studies for her statement, but apparently will not receive an answer. Now if she had said ketones, then I would not have been so disagreeable. I believe David Mendosa when he writes about ketones because he provides links and lets you investigate for yourself.
There are some other conflicts in the article. How does the author reconcile the above need for minimum carbohydrates and the statement that people have gone for many days without carbohydrates, and I have to ask why is it that many of my fellow people with diabetes are on less than 45 grams of carbohydrates per day and have none of the problems the author wants us to believe will happen. The author has much to offer people with diabetes, but we need facts and information, not dogma.
When people, and even medical professionals, make blanket statements, they need to provide links so that we may read and maybe understand why they make the statements they do. This is why I provide links so that people will be able to read the same information I read. Whether they agree or disagree with me is up to them.
At this point it is important to note that ADA has (hard to believe, but true) changed their position about carbohydrates. Check out Standards of Care section of the 2010 ADA Clinical Practice Recommendations. The updated carbohydrate recommendation starts on S25 (you will need to page down to this, as the reference starts on page S11) with the paragraph “Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes....” This will now allow variation of carbohydrate consumption to fit the individual and not forcing a certain number of carbohydrates. The low fat regimen is still advocated
May 26, 2010
May 18, 2010
Doctor - Patient Relationships
As important as good doctor – patient relationships are, they do not exist with regular frequency. What prevents these relationships from forming, or at least developing into a tolerable relationship? I am not sure I have all the reasons nor will I claim to be an expert. Even though these types can fit many diseases, diabetes is the disease of choice for this analysis.
There can be more classes of patients and doctors, but further breakdowns may fragment the discussion.
Reasons patients do not fit with doctors:
Types of patients:
One. These patients want a cure, but only a natural cure; and will not cooperate by taking the medications prescribed by the doctor. These patients head for the nearest health food store or place where they can obtain something that will naturally give them the cure they want. It does not matter that there is no supporting scientific evidence to say that it may or may not give the benefits desired, as long as the clerk promotes it, it was advertised in a magazine or on TV, a neighbor claims it worked for them, etc., they have to have it. For these people with diabetes, unless they are able to control with nutrition and exercise, it is going to be a difficult case.
Two. These patients are not listening to the doctor and very seldom ask questions. These patients cause the good doctors worry as there is something wrong and all they are looking for is a quick fix and get out the door. These patients think that a doctor is like an auto mechanic. A little bottle of medicine here, and a shot there, and they will be as good as new.
Three. These patients can be a challenge for any doctor. Always contradicts the doctor and disagrees with what the doctor is saying. These patients can be a combination to some extent of one, two and four.
Four. These patients have a symptom for everything they hear about and will not let the doctor go until they have explained the symptom (most of the time may be non-existent) and tried to convince the doctor to investigate by doing this or that test. These patients can easily be classed as hypochondriacs. They are the dread of every doctor.
Five. These are the compliant patients by the medical communities definition. They blindly follow the directions of the doctor and do everything lock-step that they are told. They ask the questions that the doctors expect, are not proactive in their care, and never question the doctors advice.
Six. These patients are proactive in their care and understand patient empowerment. They may not have all the answers or questions at the first meeting, but once they have a diagnosis, they are off to the computer, the library, the pharmacist, or other resources to get an education and learn whatever they can to manage whatever is wrong with them. They will generally react favorably to what a good doctor tells them and they want to get control of the disease with the doctor’s assistance.
Reasons doctors do not fit with patients:
Types of doctors:
One. These doctors generally do not care about their patients, only the tee-off time and how they are going to win this afternoon. If it is not golf, they may follow some other sports activity. They are more concerned in getting to their seat on time, what the betting spread is, and whether they have a chance to win on the game. Or, they are looking for other ways to earn more money with only a small tax impact. These doctors are not putting their patients first.
Two. These doctors talk at the patient and let their blind spots rule in the patient – doctor relationship. They show some concern for their patients, but only if the patient fits their perception of being compliant and follows them lock- step.
Three. These doctors feel they are the only doctor that the patient needs and are very antagonistic toward any patient that is proactive in their health care. These doctors are not in favor of patient empowerment and will find ways to belittle their patients.
Four. These doctors are so impressed with the qualifications and letters they have behind their names, that they seldom listen to their patients. They also can belittle their patients and often leave their patients wondering what has been said. They know their specialty, but not how to communicate to the patient in a way that the patient understands or can even decipher what is happening, what to do, or even when to alert the doctor if a medication is causing problems.
Five. These doctors are close to number six; however, they still lack some confidence to talk with patients and can work well with a group of specialists whom they trust and work with. They are good doctors technically, but are lacking in some of the interpersonal skills that make good doctors great doctors.
Six. These doctors are self-confident of themselves and their surroundings. They are ready to take on the world one patient at a time. They know when it appropriate to joke, when to be serious, how to deal with each patient, and when to listen intently to a patient. Then they know how to talk with the patient, drawing the patient out and including them in the treatment. They know how to assess the patient’s mood and what the patient can do and what they will be capable of accomplishing. These doctors know how to surround the patient with caring specialists and have people available to answer questions and give excellent guidance when and where needed.
Getting patient type six and doctor type six together is a challenge for either side . The patients often can not find these doctors as many of them are already booked full because they are who they are.
Unfortunately, this world is not full of type six patients and type six doctors.
For another view of the doctor-patient relationship read this by Amy Tenderich and the two tips and their links, and what a doctor says – read both the articles from 11/3/09 and 11/10/09.
There can be more classes of patients and doctors, but further breakdowns may fragment the discussion.
Reasons patients do not fit with doctors:
Types of patients:
One. These patients want a cure, but only a natural cure; and will not cooperate by taking the medications prescribed by the doctor. These patients head for the nearest health food store or place where they can obtain something that will naturally give them the cure they want. It does not matter that there is no supporting scientific evidence to say that it may or may not give the benefits desired, as long as the clerk promotes it, it was advertised in a magazine or on TV, a neighbor claims it worked for them, etc., they have to have it. For these people with diabetes, unless they are able to control with nutrition and exercise, it is going to be a difficult case.
Two. These patients are not listening to the doctor and very seldom ask questions. These patients cause the good doctors worry as there is something wrong and all they are looking for is a quick fix and get out the door. These patients think that a doctor is like an auto mechanic. A little bottle of medicine here, and a shot there, and they will be as good as new.
Three. These patients can be a challenge for any doctor. Always contradicts the doctor and disagrees with what the doctor is saying. These patients can be a combination to some extent of one, two and four.
Four. These patients have a symptom for everything they hear about and will not let the doctor go until they have explained the symptom (most of the time may be non-existent) and tried to convince the doctor to investigate by doing this or that test. These patients can easily be classed as hypochondriacs. They are the dread of every doctor.
Five. These are the compliant patients by the medical communities definition. They blindly follow the directions of the doctor and do everything lock-step that they are told. They ask the questions that the doctors expect, are not proactive in their care, and never question the doctors advice.
Six. These patients are proactive in their care and understand patient empowerment. They may not have all the answers or questions at the first meeting, but once they have a diagnosis, they are off to the computer, the library, the pharmacist, or other resources to get an education and learn whatever they can to manage whatever is wrong with them. They will generally react favorably to what a good doctor tells them and they want to get control of the disease with the doctor’s assistance.
Reasons doctors do not fit with patients:
Types of doctors:
One. These doctors generally do not care about their patients, only the tee-off time and how they are going to win this afternoon. If it is not golf, they may follow some other sports activity. They are more concerned in getting to their seat on time, what the betting spread is, and whether they have a chance to win on the game. Or, they are looking for other ways to earn more money with only a small tax impact. These doctors are not putting their patients first.
Two. These doctors talk at the patient and let their blind spots rule in the patient – doctor relationship. They show some concern for their patients, but only if the patient fits their perception of being compliant and follows them lock- step.
Three. These doctors feel they are the only doctor that the patient needs and are very antagonistic toward any patient that is proactive in their health care. These doctors are not in favor of patient empowerment and will find ways to belittle their patients.
Four. These doctors are so impressed with the qualifications and letters they have behind their names, that they seldom listen to their patients. They also can belittle their patients and often leave their patients wondering what has been said. They know their specialty, but not how to communicate to the patient in a way that the patient understands or can even decipher what is happening, what to do, or even when to alert the doctor if a medication is causing problems.
Five. These doctors are close to number six; however, they still lack some confidence to talk with patients and can work well with a group of specialists whom they trust and work with. They are good doctors technically, but are lacking in some of the interpersonal skills that make good doctors great doctors.
Six. These doctors are self-confident of themselves and their surroundings. They are ready to take on the world one patient at a time. They know when it appropriate to joke, when to be serious, how to deal with each patient, and when to listen intently to a patient. Then they know how to talk with the patient, drawing the patient out and including them in the treatment. They know how to assess the patient’s mood and what the patient can do and what they will be capable of accomplishing. These doctors know how to surround the patient with caring specialists and have people available to answer questions and give excellent guidance when and where needed.
Getting patient type six and doctor type six together is a challenge for either side . The patients often can not find these doctors as many of them are already booked full because they are who they are.
Unfortunately, this world is not full of type six patients and type six doctors.
For another view of the doctor-patient relationship read this by Amy Tenderich and the two tips and their links, and what a doctor says – read both the articles from 11/3/09 and 11/10/09.
May 11, 2010
Sleep Apnea
Sleep Apnea Equipment
I have sleep apnea and diabetes. I was diagnosed with sleep apnea about 26 months before the diagnosis of diabetes. Sleep apnea and diabetes have links to each other and have risks for each other. Sleep apnea can and does affect our control of blood glucose levels, and not in a positive way.
However, this is not the purpose of this discussion. David Mendosa has some excellent information about the relationship of diabetes and sleep apnea on his site for your reading. Use the search engine in his site and it will return many results on his site. He also includes his struggle with getting diagnosed and obtaining good instructions on the use of a CPAP machine.
Sleep apnea can also lead to memory changes, depression, and irritability. Sometimes it contributes to high blood pressure, heart failure, stroke, and heart attack.
I wish to cover some of the developments over the last few years in equipment and the progress in education available on the internet. Until about two years ago, I was not aware of the many different types of equipment that are now available. In my research for this, I have discovered how lucky I was to have doctors willing to listen and take action. I will attempt to give you enough information to make an informed decision and to review the choices available on the internet. I would urge you to learn as much as you can before getting the equipment so that you know what your options are and to prevent getting equipment that is unsuitable for you.
Once you have completed the sleep test at a sleep lab and it is determined that you have sleep apnea and the severity level, check with your insurance company what your coverage is and what they accept for equipment. Please learn what the replacement policy is for supplies, and replacement parts. This varies from insurance company to company and with Medicare and Medicaid. The doctors only have so many codes for use of equipment so most people only receive equipment of minimal costs, which may not be the best for you.
After finding out what is allowed by your insurance company, do some investigating and ask your doctor for as much information as he can give you. Some doctors are not receptive to patients that are proactive, so be as careful as possible, but do get a copy of the information from the sleep study. Most will suggest several local suppliers and let you choose, but your choice should not stop there. Learn about the severity of your sleep apnea, what type of machine or appliance would be best for you. If a machine is best, especially if you have severe sleep apnea, learn what mask would be best for your needs. Ask whether you should have just a machine, or one with a water pass over, or a humidifier. Your doctor should be able to answer most of these questions.
If you choose a local supplier, and I would suggest you investigate this option, you will not have restock fees (15 percent or higher), there will generally a trial period of 30 days so that if you are not satisfied you can return the equipment (this is not available from most online suppliers), and there are people that should assist you in getting the proper fit..
By using the local suppliers, normally a sleep therapist will assist in getting you what the doctor prescribed or calling the doctor to alter the prescription if there are changes needed. They should also have someone to measure you for a mask and they should explain the use and care of the different parts. Definitely ask many questions and get what is best for you, including service. Please make sure that you get a new machine and not a used one. Because of the restrictions by insurance and Medicare, make sure that you understand the rules for replaceable parts, and what your insurance will cover.
If you have mild to moderate sleep apnea, then there are more options. I will have more on that in another blog.
Until just before Thanksgiving 2009, I had an older model of CPAP with a cold water container for the air to pass over that is now longer available. The parts are no longer available. In terms some of you may understand, my equipment was three generations removed from the current technology. However, there are more manufacturers with a variety of types of machines. Some now exist for travel around the world and they will operate on the different electric standards outside and in the US.
Now I am using a VPAP machine that is much quieter. Now that I am past the test period, I have the machine set for the best results. If I need future adjustments, it will be much easier.
You should take time to read and explore the following web site.
American Sleep Apnea Association This site has a forum to answer your questions and that will lead you to other sites and provides much information. The Association does not list all machines, appliances or masks from all manufacturers. If you have sleep apnea or are interested in the equipment, please take time to explore the site and learn about sleep apnea, the equipment, and some of the processes you will need to be aware of if you have or suspect you have this disorder.
Federal law requires that sellers of sleep apnea equipment have a valid prescription on file before they ship or supply you with your machine or appliance.
The different types of machines are:
CPAP – Continuous Positive Airway Pressure
APAP – Auto Adjust Positive Airway Pressure
BiPAP – Bi-level Positive Airway Pressure
VPAP – Variable Positive Airway Pressure
Auto-titrating Continuous Positive Airway Pressure To determine the concentration of (a solution) by titration or perform the operation of titration. In this case by pressure. This is the most complicated of the machines and possibly one I would be cautious about having.
After having auto-titrating machine during the sleep study lab, I would still urge caution, but would not hesitate to consider having one. The one used for me was very quiet.
Then in addition to the above types, a determination needs to be made if you need a humidifier. This is where full disclosure to the prescribing doctor is very important. If you have allergies, sinus infections, regular colds or cold like flare-ups, sleep with mouth open and have many dry mouth mornings – discuss this information with your doctor to get the right machine and mask for you.
Next is the type of mask which will be best for you. Types are nasal masks, full-face masks, nasal pillow masks, and other headgear and chinstraps. The biggest problem is getting the correct one for you. Whoever is setting up the order should cover this and you should verify that you are getting the correct size of mask. They should also discuss with you whether you have seasonal or chronic allergies, whether you have a deviated septum, do you awaken with a dry mouth, do you need heated humidification and they should measure your nasal bridge – average, tall, wide, narrow, or flat.
Most insurance companies have a strict schedule of what they cover and what they will replace and when. Do not try to get fancy as they will not as a rule allow exceptions to policy. Do talk to your insurance company and ask for the schedule.
No Mask
Now that you have digested all of this, consider if you want a mask and check out this site. This needs to be considered by some people. Not everything works for every person. There could be medical reasons making this more important than the masks.
Many commercial web sites want to sell machines, masks, and other supplies for sleep apnea. I will not endorse any. I give this site only for the information it contains to assist you in learning about the equipment.
I have sleep apnea and diabetes. I was diagnosed with sleep apnea about 26 months before the diagnosis of diabetes. Sleep apnea and diabetes have links to each other and have risks for each other. Sleep apnea can and does affect our control of blood glucose levels, and not in a positive way.
However, this is not the purpose of this discussion. David Mendosa has some excellent information about the relationship of diabetes and sleep apnea on his site for your reading. Use the search engine in his site and it will return many results on his site. He also includes his struggle with getting diagnosed and obtaining good instructions on the use of a CPAP machine.
Sleep apnea can also lead to memory changes, depression, and irritability. Sometimes it contributes to high blood pressure, heart failure, stroke, and heart attack.
I wish to cover some of the developments over the last few years in equipment and the progress in education available on the internet. Until about two years ago, I was not aware of the many different types of equipment that are now available. In my research for this, I have discovered how lucky I was to have doctors willing to listen and take action. I will attempt to give you enough information to make an informed decision and to review the choices available on the internet. I would urge you to learn as much as you can before getting the equipment so that you know what your options are and to prevent getting equipment that is unsuitable for you.
Once you have completed the sleep test at a sleep lab and it is determined that you have sleep apnea and the severity level, check with your insurance company what your coverage is and what they accept for equipment. Please learn what the replacement policy is for supplies, and replacement parts. This varies from insurance company to company and with Medicare and Medicaid. The doctors only have so many codes for use of equipment so most people only receive equipment of minimal costs, which may not be the best for you.
After finding out what is allowed by your insurance company, do some investigating and ask your doctor for as much information as he can give you. Some doctors are not receptive to patients that are proactive, so be as careful as possible, but do get a copy of the information from the sleep study. Most will suggest several local suppliers and let you choose, but your choice should not stop there. Learn about the severity of your sleep apnea, what type of machine or appliance would be best for you. If a machine is best, especially if you have severe sleep apnea, learn what mask would be best for your needs. Ask whether you should have just a machine, or one with a water pass over, or a humidifier. Your doctor should be able to answer most of these questions.
If you choose a local supplier, and I would suggest you investigate this option, you will not have restock fees (15 percent or higher), there will generally a trial period of 30 days so that if you are not satisfied you can return the equipment (this is not available from most online suppliers), and there are people that should assist you in getting the proper fit..
By using the local suppliers, normally a sleep therapist will assist in getting you what the doctor prescribed or calling the doctor to alter the prescription if there are changes needed. They should also have someone to measure you for a mask and they should explain the use and care of the different parts. Definitely ask many questions and get what is best for you, including service. Please make sure that you get a new machine and not a used one. Because of the restrictions by insurance and Medicare, make sure that you understand the rules for replaceable parts, and what your insurance will cover.
If you have mild to moderate sleep apnea, then there are more options. I will have more on that in another blog.
Until just before Thanksgiving 2009, I had an older model of CPAP with a cold water container for the air to pass over that is now longer available. The parts are no longer available. In terms some of you may understand, my equipment was three generations removed from the current technology. However, there are more manufacturers with a variety of types of machines. Some now exist for travel around the world and they will operate on the different electric standards outside and in the US.
Now I am using a VPAP machine that is much quieter. Now that I am past the test period, I have the machine set for the best results. If I need future adjustments, it will be much easier.
You should take time to read and explore the following web site.
American Sleep Apnea Association This site has a forum to answer your questions and that will lead you to other sites and provides much information. The Association does not list all machines, appliances or masks from all manufacturers. If you have sleep apnea or are interested in the equipment, please take time to explore the site and learn about sleep apnea, the equipment, and some of the processes you will need to be aware of if you have or suspect you have this disorder.
Federal law requires that sellers of sleep apnea equipment have a valid prescription on file before they ship or supply you with your machine or appliance.
The different types of machines are:
CPAP – Continuous Positive Airway Pressure
APAP – Auto Adjust Positive Airway Pressure
BiPAP – Bi-level Positive Airway Pressure
VPAP – Variable Positive Airway Pressure
Auto-titrating Continuous Positive Airway Pressure To determine the concentration of (a solution) by titration or perform the operation of titration. In this case by pressure. This is the most complicated of the machines and possibly one I would be cautious about having.
After having auto-titrating machine during the sleep study lab, I would still urge caution, but would not hesitate to consider having one. The one used for me was very quiet.
Then in addition to the above types, a determination needs to be made if you need a humidifier. This is where full disclosure to the prescribing doctor is very important. If you have allergies, sinus infections, regular colds or cold like flare-ups, sleep with mouth open and have many dry mouth mornings – discuss this information with your doctor to get the right machine and mask for you.
Next is the type of mask which will be best for you. Types are nasal masks, full-face masks, nasal pillow masks, and other headgear and chinstraps. The biggest problem is getting the correct one for you. Whoever is setting up the order should cover this and you should verify that you are getting the correct size of mask. They should also discuss with you whether you have seasonal or chronic allergies, whether you have a deviated septum, do you awaken with a dry mouth, do you need heated humidification and they should measure your nasal bridge – average, tall, wide, narrow, or flat.
Most insurance companies have a strict schedule of what they cover and what they will replace and when. Do not try to get fancy as they will not as a rule allow exceptions to policy. Do talk to your insurance company and ask for the schedule.
No Mask
Now that you have digested all of this, consider if you want a mask and check out this site. This needs to be considered by some people. Not everything works for every person. There could be medical reasons making this more important than the masks.
Many commercial web sites want to sell machines, masks, and other supplies for sleep apnea. I will not endorse any. I give this site only for the information it contains to assist you in learning about the equipment.
May 8, 2010
Sunscreens and Their Use
On August 3, 2009, I wrote about sunscreens – safe or not. While there are many that are unsafe, you still need to use them when in the sun and to protect yourself from sunburn and future potential skin cancers.
Sunscreens are chemical agents that help prevent the sun's ultraviolet (UV) radiation from reaching the skin. There are two types of ultraviolet radiation, UVA and UVB, and both damage the skin and increase your risk of skin cancer.
UVB is the chief culprit behind sunburn, while UVA rays, which penetrate the skin more deeply, are associated with wrinkling, sagging, and other effects of aging. They also encourage the carcinogenic effects of UVB rays, and are being seen as a cause of skin cancer on their own. Sunscreens vary in their ability to protect against UVA and UVB.
DON'T LIKE THE FEEL OF MINERAL SUNSCREENS?
Many people don't like to use these zinc and titanium based sunscreens because they can be hard to use and they often leave a ghost-like residue. Others just want to avoid using these products. If you are among these people, see a list of the top non-mineral sunscreens. For children above six months of age and for safe sunscreens - see this list.
SPF stands for sun protection factor.
There are some problems with the SPF model: First, no sunscreen, regardless of strength, can be expected to stay effective for more than two hours without reapplication. Second, "reddening" of the skin is a reaction to UVB rays alone, but does not tell you about what UVA damage you may be getting. Damage can be done without the red flag of sunburn being raised.
Who Should Use Sunscreen?
Anyone over the age of six months should use a sunscreen. Even those who work indoors are exposed to ultraviolet radiation for brief periods throughout the day. UVA is not blocked by most windows. Children under six months of age should not be exposed to the sun. Shade and protective clothing are the best ways to protect infants from the sun.
To ensure that you get the full SPF of a sunscreen, you need to apply 1 oz – about a shot glass full. Studies have found that most people apply only half to a quarter of that amount, which means the actual SPF they have on their body is lower than the required amount on the container. During a long day at the beach, one person should use around one half to one quarter of an 8 oz. bottle. Sunscreens should be applied 30 minutes before sun exposure to allow the ingredients to fully bind to the skin. Reapplication of sunscreen is just as important as putting it on in the first place, so reapply the same amount every two hours. Sunscreens should be reapplied immediately after swimming, toweling off, or sweating a great deal.
Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. You can have fun in the sun and decrease your risk of skin cancer. Here's how to be sun aware:
Generously apply a water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30. That provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD SEAL on products that meet these criteria.
Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun's rays are strongest between 10 am. and 4 pm. Another guide to remember is “if your shadow is shorter than you are, seek shade”.
Protect children from sun exposure by playing in the shade, using protective clothing and applying sunscreen.
Use extra caution near water, snow, and sand because they reflect the damaging rays of the sun, which will increase your chance of sunburn.
Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't rely on the sun. Wearing sunscreen can cause vitamin D deficiency.
Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product; however, continue to use sunscreen with it.
Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is treatable when caught early.
Self-tanning lotions and sprays are a safe alternative to tanning. They contain dihydroxyacetone which interacts with proteins in the skin to produce an orange/tan color that does not wash off. However, the color of self-tanners only has an SPF of 4. This is not enough protection; therefore, sunscreen with a SPF of at least 15 must be used and reapplied every two hours.
Everyone needs sunscreen. More than 1 million cases of skin cancer are diagnosed in the United States every year. Studies have found an association between sunburns and enhanced risk for melanoma, the deadliest form of skin cancer. The Food and Drug Administration (FDA) and the American Academy of Dermatology (AAD) recognize six skin categories:
Skin Type Sun History
I Always burns easily, never tans, extremely sun-sensitive skin
II Usually burns easily, tans minimally, very sun-sensitive skin
III Sometimes burns, tans gradually to light brown, sun-sensitive skin
IV Burns minimally, always tans to moderate brown, minimally sun-sensitive skin
V Rarely burns, tans well, sun-insensitive skin
VI Never burns, deeply pigmented, sun-insensitive skin
The American Academy of Dermatology recommends that, regardless of skin type, a broad-spectrum (protects against UVA and UVB rays), water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 should be used year-round.
Added 5/12/10 The following article is worth reading about the five common sunscreen mistakes or maybe should be titled "read the instructions ......".
Sunscreens are chemical agents that help prevent the sun's ultraviolet (UV) radiation from reaching the skin. There are two types of ultraviolet radiation, UVA and UVB, and both damage the skin and increase your risk of skin cancer.
UVB is the chief culprit behind sunburn, while UVA rays, which penetrate the skin more deeply, are associated with wrinkling, sagging, and other effects of aging. They also encourage the carcinogenic effects of UVB rays, and are being seen as a cause of skin cancer on their own. Sunscreens vary in their ability to protect against UVA and UVB.
DON'T LIKE THE FEEL OF MINERAL SUNSCREENS?
Many people don't like to use these zinc and titanium based sunscreens because they can be hard to use and they often leave a ghost-like residue. Others just want to avoid using these products. If you are among these people, see a list of the top non-mineral sunscreens. For children above six months of age and for safe sunscreens - see this list.
SPF stands for sun protection factor.
There are some problems with the SPF model: First, no sunscreen, regardless of strength, can be expected to stay effective for more than two hours without reapplication. Second, "reddening" of the skin is a reaction to UVB rays alone, but does not tell you about what UVA damage you may be getting. Damage can be done without the red flag of sunburn being raised.
Who Should Use Sunscreen?
Anyone over the age of six months should use a sunscreen. Even those who work indoors are exposed to ultraviolet radiation for brief periods throughout the day. UVA is not blocked by most windows. Children under six months of age should not be exposed to the sun. Shade and protective clothing are the best ways to protect infants from the sun.
To ensure that you get the full SPF of a sunscreen, you need to apply 1 oz – about a shot glass full. Studies have found that most people apply only half to a quarter of that amount, which means the actual SPF they have on their body is lower than the required amount on the container. During a long day at the beach, one person should use around one half to one quarter of an 8 oz. bottle. Sunscreens should be applied 30 minutes before sun exposure to allow the ingredients to fully bind to the skin. Reapplication of sunscreen is just as important as putting it on in the first place, so reapply the same amount every two hours. Sunscreens should be reapplied immediately after swimming, toweling off, or sweating a great deal.
Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. You can have fun in the sun and decrease your risk of skin cancer. Here's how to be sun aware:
Generously apply a water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30. That provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD SEAL on products that meet these criteria.
Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun's rays are strongest between 10 am. and 4 pm. Another guide to remember is “if your shadow is shorter than you are, seek shade”.
Protect children from sun exposure by playing in the shade, using protective clothing and applying sunscreen.
Use extra caution near water, snow, and sand because they reflect the damaging rays of the sun, which will increase your chance of sunburn.
Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't rely on the sun. Wearing sunscreen can cause vitamin D deficiency.
Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product; however, continue to use sunscreen with it.
Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is treatable when caught early.
Self-tanning lotions and sprays are a safe alternative to tanning. They contain dihydroxyacetone which interacts with proteins in the skin to produce an orange/tan color that does not wash off. However, the color of self-tanners only has an SPF of 4. This is not enough protection; therefore, sunscreen with a SPF of at least 15 must be used and reapplied every two hours.
Everyone needs sunscreen. More than 1 million cases of skin cancer are diagnosed in the United States every year. Studies have found an association between sunburns and enhanced risk for melanoma, the deadliest form of skin cancer. The Food and Drug Administration (FDA) and the American Academy of Dermatology (AAD) recognize six skin categories:
Skin Type Sun History
I Always burns easily, never tans, extremely sun-sensitive skin
II Usually burns easily, tans minimally, very sun-sensitive skin
III Sometimes burns, tans gradually to light brown, sun-sensitive skin
IV Burns minimally, always tans to moderate brown, minimally sun-sensitive skin
V Rarely burns, tans well, sun-insensitive skin
VI Never burns, deeply pigmented, sun-insensitive skin
The American Academy of Dermatology recommends that, regardless of skin type, a broad-spectrum (protects against UVA and UVB rays), water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 should be used year-round.
Added 5/12/10 The following article is worth reading about the five common sunscreen mistakes or maybe should be titled "read the instructions ......".
April 28, 2010
Types of people you will meet on Diabetes Forums
This topic is just for fun and done to lighten the mood before going back to more serious matters about diabetes.
There are many different types of people on forums and discussion boards. You may not need to know them, but you need to recognize that they exist and you will encounter them if you participate in a forum or discussion board. Moderators (or those chosen by the administrator or forum owner to keep the forum on the straight and narrow) are not included.
Type 1. The first responder – No, not the people who come with the emergency rescue vehicles. They are people that have to always be the first to respond to any new post. They will not say much to make sure they are first. I consider what they say as spam, no content and done just to raise their post count. They will lurk on a forum to ensure they are the first to answer. Some forums ban these people or delete their useless posts. I sincerely wish that post count was not a part of any forum.
Type 2. The self-promoter - For lack of any other term, this person is a self-promoter. Wants people to think that they know everything and should be the one consulted. Always has something to promote, a product, a survey, or just his own knowledge. When put to the test, they will not respond. These people are also known as hijackers because they will do this anywhere and to anyone.
Type 3. The preacher – This person will use any excuse to change the discussion to his favorite topic and then proceed to pronounce his judgment for all to read. The preacher and the expert are sometimes lumped together, but should not be as the preacher always has a ready and lengthy response for any argument. They can be like the expert when talking down to people.
Type 4. The expert – These people talk down to the rest of the posters. Also known as the smugly superior, they often have some excellent suggestions and points that are on target, but they are hard to follow. If you offer something that is not their position, you will be corrected back to their position. They will use quotes and cite references in a long essay to prove their points. They seldom use an original thought of their own. Often these people are the purveyors of low carb way of eating and/or supplements that have little known or questionable benefits. Although low carb is a popular and useful topic, the preacher and the expert diminish the value with their long winded arguments. On the topic of low carb, the preacher is the worse of the two in his pronouncements.
Type 5. The antagonizer - The can’t let it go person will pick a point to make a stand on and anyone who dares disagree, will probably be flamed on, called out, or just downright disrespected. They sometimes seem to agree with everyone until they are ready to make their stand. These people are difficult to avoid and they tend to drive the good people from the forum.
Type 6. The moderator – This self-appointed person sits on a forum and if anyone happens to open a topic that was covered anytime in the past, you will be sure to hear about it with appropriate link and comment about doing your research. If you dare stray off in a topic, they will be right there to remind you what the topic is about and if you are new to the forum, you can count on being properly chastised and put in your place.
Type 7. The peacekeeper - Another long-standing character common to forums is the peacekeeper. This person has been a regular at a particular site as long as the proprietor, but his goal as a participant has somehow devolved from saying something interesting to keeping the peace--and he has no problem peppering every thread with his efforts to intervene.
Though the peacekeeper's intentions are good, his actions end up clogging the forum with pages of useless and often long-winded discussions of propriety that are every bit as annoying as the attacks themselves. Worse, unlike the antagonizer's antics, the Peacekeeper's contributions can be virtually impossible to silence, even if you are the site's administrator. After all, how do you tactfully tell someone to stop pacifying?
Type 8. The smarty-pants (know-it-all’s) - If the peacekeeper is on a search-and-destroy mission against offensive content, the Smarty Pants' goal is to find and expose inaccuracies--no matter how insignificant--solely as a means to demonstrate intellectual superiority. A Smarty-Pants constantly runs a fine-toothed comb through both a site's posts in search of nits to pick, factual errors, grammatical errors, typos--it does not matter. The instant he finds one, pounces on the offending poster, telling all about the error and how not to make them. Some of these hair-splitters will spend their days doing the spadework necessary to prove a minor mistake in someone else's words. The most obnoxious--and yet most grimly satisfying--kind of smarty-pants, though, is the one who bases his corrections on his own "infallible" knowledge base.
Type 9. The drama queen/king – This person is maybe known as the too much information person as they lay out the situation in extreme detail with as much drama as they can. They expect everyone too agree with enthusiasm and can’t handle any disagreement. Look out when the moderator, the peacekeeper, and the smarty-pants come to this person’s defense. This combination can divide a good forum.
Type 10. The troll – conspiracy theorist or alarmist. They exist on every forum. Always post about something that is troubling and sees it as his duty to awaken everyone to a problem and draw their sympathy. Their favorite comeback if challenged is how can you allow this to go on, can you not accept progress, or the facts are on my side.
Type 11. Signature hound – This person has to detail every reading, one reading per single line and goes for the maximum – never heard of tables or condensing. A real pain for readers to scroll past his page of signature items to get to the next post. Fortunately, some forums have clamped down on these people, either by limitation of characters allowed or by editing out.
Type 12. The one time poster – These people are the problem of many forums and diabetes forums are no exception. They think they want to participate, but when they actually post, they never return. Or, when they do not get the answer or sympathy they were expecting, never post again. And most forums keep them as members to keep the member count inflated for advertising purposes.
Type 13. The needy – The people that have posted that are crying out for help. They do not always know how to express themselves, but the sincere cry for help is there. That they are often ignored is sometimes the shame of some forums.
Type 14. The contributor – These people are for real. Normally they are on target and offer valuable advice and positive contributions to real problems. On most diabetes forums, these are the valuable participants. Sometimes they are actually under appreciated.
They are often under attack by the preacher, the expert, the antagonizer, and the smarty-pants. They are often defended by the moderator and the peacekeeper.
Type 15. The advertiser – The pain of every forum. Most forums do an excellent job of removing them shortly after posting. They do not read the rules and if they even care, they will ignore the rules as their only mission is to advertise a product and make sales. Generally, they will come back and do more posting until their site address is banned or until the forum puts an approval in place for each first post or first few posts.
Yes, there are other terms for some of the types above. There are also some types that have been left out on purpose as I do not wish to acknowledge these persons. Some forums are excellent in minimizing the efforts of the worst offenders.
There are times when it is enjoyable watching some of these types at work and other times when they grate on our nerves.
Other types: The below types can be part of any of the above types except types 11, 12, 13, and 15.
Too little information person.
Copy-cat
Satirist
Humorist
Poet
Comic
The last four can make for interesting discussions and sometimes be beneficial members.
If you have types you would like mentioned, let me know.
There are many different types of people on forums and discussion boards. You may not need to know them, but you need to recognize that they exist and you will encounter them if you participate in a forum or discussion board. Moderators (or those chosen by the administrator or forum owner to keep the forum on the straight and narrow) are not included.
Type 1. The first responder – No, not the people who come with the emergency rescue vehicles. They are people that have to always be the first to respond to any new post. They will not say much to make sure they are first. I consider what they say as spam, no content and done just to raise their post count. They will lurk on a forum to ensure they are the first to answer. Some forums ban these people or delete their useless posts. I sincerely wish that post count was not a part of any forum.
Type 2. The self-promoter - For lack of any other term, this person is a self-promoter. Wants people to think that they know everything and should be the one consulted. Always has something to promote, a product, a survey, or just his own knowledge. When put to the test, they will not respond. These people are also known as hijackers because they will do this anywhere and to anyone.
Type 3. The preacher – This person will use any excuse to change the discussion to his favorite topic and then proceed to pronounce his judgment for all to read. The preacher and the expert are sometimes lumped together, but should not be as the preacher always has a ready and lengthy response for any argument. They can be like the expert when talking down to people.
Type 4. The expert – These people talk down to the rest of the posters. Also known as the smugly superior, they often have some excellent suggestions and points that are on target, but they are hard to follow. If you offer something that is not their position, you will be corrected back to their position. They will use quotes and cite references in a long essay to prove their points. They seldom use an original thought of their own. Often these people are the purveyors of low carb way of eating and/or supplements that have little known or questionable benefits. Although low carb is a popular and useful topic, the preacher and the expert diminish the value with their long winded arguments. On the topic of low carb, the preacher is the worse of the two in his pronouncements.
Type 5. The antagonizer - The can’t let it go person will pick a point to make a stand on and anyone who dares disagree, will probably be flamed on, called out, or just downright disrespected. They sometimes seem to agree with everyone until they are ready to make their stand. These people are difficult to avoid and they tend to drive the good people from the forum.
Type 6. The moderator – This self-appointed person sits on a forum and if anyone happens to open a topic that was covered anytime in the past, you will be sure to hear about it with appropriate link and comment about doing your research. If you dare stray off in a topic, they will be right there to remind you what the topic is about and if you are new to the forum, you can count on being properly chastised and put in your place.
Type 7. The peacekeeper - Another long-standing character common to forums is the peacekeeper. This person has been a regular at a particular site as long as the proprietor, but his goal as a participant has somehow devolved from saying something interesting to keeping the peace--and he has no problem peppering every thread with his efforts to intervene.
Though the peacekeeper's intentions are good, his actions end up clogging the forum with pages of useless and often long-winded discussions of propriety that are every bit as annoying as the attacks themselves. Worse, unlike the antagonizer's antics, the Peacekeeper's contributions can be virtually impossible to silence, even if you are the site's administrator. After all, how do you tactfully tell someone to stop pacifying?
Type 8. The smarty-pants (know-it-all’s) - If the peacekeeper is on a search-and-destroy mission against offensive content, the Smarty Pants' goal is to find and expose inaccuracies--no matter how insignificant--solely as a means to demonstrate intellectual superiority. A Smarty-Pants constantly runs a fine-toothed comb through both a site's posts in search of nits to pick, factual errors, grammatical errors, typos--it does not matter. The instant he finds one, pounces on the offending poster, telling all about the error and how not to make them. Some of these hair-splitters will spend their days doing the spadework necessary to prove a minor mistake in someone else's words. The most obnoxious--and yet most grimly satisfying--kind of smarty-pants, though, is the one who bases his corrections on his own "infallible" knowledge base.
Type 9. The drama queen/king – This person is maybe known as the too much information person as they lay out the situation in extreme detail with as much drama as they can. They expect everyone too agree with enthusiasm and can’t handle any disagreement. Look out when the moderator, the peacekeeper, and the smarty-pants come to this person’s defense. This combination can divide a good forum.
Type 10. The troll – conspiracy theorist or alarmist. They exist on every forum. Always post about something that is troubling and sees it as his duty to awaken everyone to a problem and draw their sympathy. Their favorite comeback if challenged is how can you allow this to go on, can you not accept progress, or the facts are on my side.
Type 11. Signature hound – This person has to detail every reading, one reading per single line and goes for the maximum – never heard of tables or condensing. A real pain for readers to scroll past his page of signature items to get to the next post. Fortunately, some forums have clamped down on these people, either by limitation of characters allowed or by editing out.
Type 12. The one time poster – These people are the problem of many forums and diabetes forums are no exception. They think they want to participate, but when they actually post, they never return. Or, when they do not get the answer or sympathy they were expecting, never post again. And most forums keep them as members to keep the member count inflated for advertising purposes.
Type 13. The needy – The people that have posted that are crying out for help. They do not always know how to express themselves, but the sincere cry for help is there. That they are often ignored is sometimes the shame of some forums.
Type 14. The contributor – These people are for real. Normally they are on target and offer valuable advice and positive contributions to real problems. On most diabetes forums, these are the valuable participants. Sometimes they are actually under appreciated.
They are often under attack by the preacher, the expert, the antagonizer, and the smarty-pants. They are often defended by the moderator and the peacekeeper.
Type 15. The advertiser – The pain of every forum. Most forums do an excellent job of removing them shortly after posting. They do not read the rules and if they even care, they will ignore the rules as their only mission is to advertise a product and make sales. Generally, they will come back and do more posting until their site address is banned or until the forum puts an approval in place for each first post or first few posts.
Yes, there are other terms for some of the types above. There are also some types that have been left out on purpose as I do not wish to acknowledge these persons. Some forums are excellent in minimizing the efforts of the worst offenders.
There are times when it is enjoyable watching some of these types at work and other times when they grate on our nerves.
Other types: The below types can be part of any of the above types except types 11, 12, 13, and 15.
Too little information person.
Copy-cat
Satirist
Humorist
Poet
Comic
The last four can make for interesting discussions and sometimes be beneficial members.
If you have types you would like mentioned, let me know.
April 26, 2010
Heatstroke/Sunstroke - Part 6
Part 6 - Prevention
How can heat stroke be prevented?
Drink plenty of fluids. Keeping the body well-hydrated is the easiest and most reliable way to prevent heat-related illness. Under normal conditions, you should consume at least enough water per day, depending on your body structure and weight, to stay hydrated. During strenuous activity, it is essential to replenish fluid at least every 20 minutes, even if you are not thirsty. Avoid caffeinated and alcoholic drinks; these act as diuretics and dehydrate the body
Avoid exposure to excessive heat. Stay in shaded, cool, or air-conditioned areas whenever possible. In addition, schedule your activities to avoid being outside during the hottest times of the day (from 10am to 6pm). When you must be outside, wear loose-fitting, lightweight, light-colored clothing. Wear a hat that shades your face, neck, and ears.
Avoid strenuous activity in warm and humid climates. If you want to exercise outside, do so during the early morning, which is the coolest part of the day.
The body normally generates heat because of metabolism, and is usually able to dissipate the heat by either radiation of heat through the skin or by evaporation of sweat. However, in extreme heat, high humidity, or vigorous exertion under the sun, the body may not be able to dissipate the heat and the body temperature rises, sometimes up to 106°F (41.1°C) or higher.
Be prepared to call 911 if the need arises.
Some of the places or links to find more information include:
There are more sites and references that can be found with the search engine. This will get your started. Above all, enjoy your summer and take the necessary precautions if you are a person with diabetes. If you don't have diabetes, take precautions to prevent heat/sun stroke.
Review Heatstroke/Sunstroke - parts 1 through 6 to say healthy. If necessary, call 911, (if in the USA) to get emergency help.
There are more sites and references that can be found with the search engine. This will get your started. Above all, enjoy your summer and take the necessary precautions if you are a person with diabetes. If you don't have diabetes, take precautions to prevent heat/sun stroke.
Review Heatstroke/Sunstroke - parts 1 through 6 to say healthy. If necessary, call 911, (if in the USA) to get emergency help.
April 23, 2010
Heatstroke/Sunstroke - Part 5
Part 5 - Treatment
Urgent Care
If someone shows the signs of sunstroke, seek medical treatment or call 911 immediately. Before medical treatment arrives, move the individual to a cool area. Look for any medical alert notices – bracelet or necklace or even ankle bracelet. Provide cool drinks, preferably a cool (not cold) drink containing both a little sugar and salt. Remove any constricting clothing. If the person has diabetes, do not give liquids containing sugar unless meter readings can be taken to verify blood glucose readings.
Treatment strategies depend on the severity of the symptoms. Treatment for sunstroke begins immediately upon diagnosis by a medical doctor. In mild cases, the body can be effectively cooled by taking the patient to a shaded or air-conditioned area, removing most clothing and applying cool water or ice packs to the skin. Drinking iced fluids also helps return the body temperature to a safe level. In severe cases, treatment involves rapid cooling, either by immersing the body in an ice water bath or by evaporative cooling. In the latter procedure, large circulating fans blow cool air across wet skin.
Self Care
Take steps to prevent heatstroke and sunstroke. Drink plenty of water, stay out of the sun, and avoid strenuous activity during hot weather. In addition, avoid drinking caffeinated beverages to keep yourself from becoming dehydrated.
If you start to experience the symptoms of heatstroke, move to a cool, shady area and drink something cool, preferably a beverage containing both sugar and salt. Warning – be careful giving sugar to a person with diabetes.
Prognosis
Recovery from sunstroke depends on the speed and effectiveness of diagnosis and treatment. When treatment for sunstroke is administered promptly, the patient can expect a full recovery in one or two days. In severe cases, when body temperature climbs to 106°F (41.1°C), sunstroke can cause shock. After prolonged exposure to such high body temperatures, brain damage can occur. Death occurs in about 20% of heatstroke cases according to one study. The likelihood of dying from heatstroke increases with a longer duration of heat exposure.
Follow-up
After a full recovery from heatstroke, little follow-up care is needed. Recovered patients may want to rest and stay in cool areas for several days. Patients should also adopt aggressive prevention strategies to keep sunstroke from recurring.
How do you treat a heat stroke victim?
Victims of heat stroke must receive immediate treatment to avoid permanent organ damage. First and foremost, cool the victim.
- Get the victim to a shady area, remove clothing, apply cool or tepid water to the skin (for example you may spray the victim with cool water from a garden hose), fan the victim to promote sweating and evaporation, and place ice packs under armpits and groins.
- Monitor body temperature with a thermometer and continue cooling efforts until the body temperature drops to 101-102°F (38.3-38.8°C).
- Always notify emergency services (911) immediately. If their arrival is delayed, they can give you further instructions for treatment of the victim.
April 21, 2010
Heatstroke/Sunstroke - Part 4
Part 4 - Diagnosis
Sunstroke is typically diagnosed on the basis of symptoms alone. To get the best measure of your body's core temperature, your doctor may use a rectal thermometer. Your doctor may also take your blood pressure and ask for a blood or urine sample.
Your doctor may perform tests to rule out conditions with symptoms similar to those of sunstroke. Irregular heartbeats, a heart attack, a fever-causing infection, fluid loss related to medications, or cocaine intoxication can mimic sunstroke by causing elevated blood pressure and body temperature.
Risk Factors for Sunstroke:
Very old or very young age
Low level of physical activity
Obesity
Smoking, drug, and alcohol use
Heart disease
High blood pressure
Diseases of the skin, kidney, or liver
Decreased ability to sweat, such as in scleroderma and cystic fibrosis
Medications that can aggravate sunstroke, including water pills (diuretics), allergy pills (antihistamines), tranquilizers, anticholinergics, and amphetamines
Heavy, restrictive clothing
Poor ventilation or lack of air conditioning in home
High humidity
This is why it is so important to get someone suspected of having heatstroke or sunstroke to a doctor or emergency room as quickly as possible. Using the 911 call is the fastest and best way and the reason this is repeated through out this discussion. Other items are repeated as well to emphasize their importance.
Sunstroke is typically diagnosed on the basis of symptoms alone. To get the best measure of your body's core temperature, your doctor may use a rectal thermometer. Your doctor may also take your blood pressure and ask for a blood or urine sample.
Your doctor may perform tests to rule out conditions with symptoms similar to those of sunstroke. Irregular heartbeats, a heart attack, a fever-causing infection, fluid loss related to medications, or cocaine intoxication can mimic sunstroke by causing elevated blood pressure and body temperature.
Risk Factors for Sunstroke:
Very old or very young age
Low level of physical activity
Obesity
Smoking, drug, and alcohol use
Heart disease
High blood pressure
Diseases of the skin, kidney, or liver
Decreased ability to sweat, such as in scleroderma and cystic fibrosis
Medications that can aggravate sunstroke, including water pills (diuretics), allergy pills (antihistamines), tranquilizers, anticholinergics, and amphetamines
Heavy, restrictive clothing
Poor ventilation or lack of air conditioning in home
High humidity
This is why it is so important to get someone suspected of having heatstroke or sunstroke to a doctor or emergency room as quickly as possible. Using the 911 call is the fastest and best way and the reason this is repeated through out this discussion. Other items are repeated as well to emphasize their importance.
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