As a new person at the 2010 Roche Social Media Summit I have to say that I was not sure of expectations. The programs went very well and the only disconnect was the AADE (American Association of Diabetes Educators).
Meeting fellow bloggers, people with diabetes, was a heartwarming experience and one that won't be forgotten. While I was looking forward to meeting other type 2's, it was educational finally meeting David Mendosa and Gretchen Becker, both of whom I have avidly read since diagnosis. It was a real treat meeting Charlie Cherry and Rachel Baumgartel and realizing that what I have been reading, is really them.
Researching on line is an enjoyment for me and realizing that there are others with information to share and all from a different background and interest has really fired me up. Finally meeting and talking to several of the type 1 PWD that I have corresponded with really helps and I hope that the information exchange can continue.
I know now that I need to read a few people more carefully and get to know them better from a personal standpoint. From the discussions that happened, I will say that all diabetes classifications were well represented, even those not in attendance. This year, it is my feeling that while everyone is cautious, there is much more open discussion and respect for both sides. Roche's discussion of what was learned at last year's summit did not disagree in substance with the blogs written by those attending then.
By the actions taken and material presented this year, the most value is the facilitation of open discussion by Roche between the American Diabetes Association and the on-line diabetes community. While it remains to be seen what will progress from this challenging discussion, there will be plenty of information to measure a year from now. I will say I am very pleased that there may be some real progress by the ADA in taking up the banner for the patients as well as the corporate side.
I will only say that I was very disappointed with the discussion by the American Association of Diabetes Educators and my opinion of this group only became more jaded. While I know a few very excellent people in the organization, their stature was not increased by the discussion. While I do not expect to see real progress this year, the idea of having people with diabetes in an educational role was an excellent idea raised by several attendees, and especially Cherise Shockley.
I don't know about the rest of those attending; however, the food committee did a superb, marvelous job. When I was asked by Roche for type of carb meal I preferred, I said moderate to low carb. The food was more than I expected and I was able to follow my plan of moderately low carb. For those involved, I appreciate your efforts! Thank you!
I was please to be one of the attendee's and extend my thanks to Lisa Huse and Todd Siesky for a job well done and to the rest of Roche's staff in attendance for their support.
Disclosure - Roche paid for transportation and lodging for two days and meals for one day.
July 4, 2010
June 25, 2010
Is summer heat affecting your diabetes supplies?
Do you know what to do during the heat of the summer to protect your diabetes supplies and equipment? A recent survey points out that about 60 percent of people with diabetes are not aware of the effects of heat on their oral diabetes medications, glucose meters, and glucose test strips. It appears that a large number also treat themselves and their diabetes with a similar degree of disrespect.
Even the three reports out of the meeting of the Endocrine Society all focused on slightly different aspects of the report. First, Endocrinetoday dot com reported on the habits and lack of daily care by those persons with diabetes. Sciencecentric dot com emphasized the problems faced by people with diabetes have of becoming dehydrated and not know what to do. Finally Sciencedaily dot com almost duplicated Sciencecentric, but stated that one out of five people did not take heat precautions until temperatures exceeded 100 degrees. Although parts are the same, you should read each article.
Since the full report will not be published until September 2010 in the Journal of Diabetes Science and Technology, most of the problems facing people with diabetes in the northern part of the US will have passed. I will commend them for putting out part of the details as summer begins. Yet every year, many people have the information available to them, but choose not to use the information until they have medical problems because of heat, or lose supplies, equipment, or medications to heat.
I blogged about heat/sun stroke part 1 (Apr 15) to part 6 (Apr 28) and know this may have been too early for some people to take seriously, but the heat of summer is here and we all need to be reminded again. Whether you live in Arizona where the study is conducted or in the northern part of the US, leaving your diabetes supplies in your vehicle on a hot day, will cause problems for your medications, testing supplies and equipment.
If you don't have coolers for carrying your insulin and diabetes supplies in for daily trips, you need to consider getting one. Also the Frio packs work well for protecting (from overheating and not freezing) your diabetes supplies in the summer and winter. Frio wallets can keep insulin safe for up to 45 hours. For wallets, just submerse them in cold water for five to fifteen minutes to activate. Frio Bags of varying sizes can also be purchased. Some drug chains carry them, but call beforehand. Or, search on line for Frio packs. These can be used for daily use to and from work, weekend daily excursions to your favorite park, and other trips.
For those of us with diabetes, we need to be aware that both insulin and oral medications are affected and can be rendered useless by heat. Heat will cause our test strips and meters to malfunction and quit.
The Joslin Diabetes Center also published “Five Tips for Caring for your Diabetes Supplies” They give excellent advice for caring for your meter, testing supplies, pump, and insulin plus being organized. I would only add for those with type 2 diabetes and not on insulin to take care of your oral medications and protect them from heat and freezing.
Care of your diabetes medications, supplies, and equipment is not something you will be able to ask your doctor about. Some may know, but this, like your diabetes is your responsibility as your doctor will not be with you when you forget and leave things in your hot car.
Now armed with the knowledge you need, get out and enjoy summer.
Even the three reports out of the meeting of the Endocrine Society all focused on slightly different aspects of the report. First, Endocrinetoday dot com reported on the habits and lack of daily care by those persons with diabetes. Sciencecentric dot com emphasized the problems faced by people with diabetes have of becoming dehydrated and not know what to do. Finally Sciencedaily dot com almost duplicated Sciencecentric, but stated that one out of five people did not take heat precautions until temperatures exceeded 100 degrees. Although parts are the same, you should read each article.
Since the full report will not be published until September 2010 in the Journal of Diabetes Science and Technology, most of the problems facing people with diabetes in the northern part of the US will have passed. I will commend them for putting out part of the details as summer begins. Yet every year, many people have the information available to them, but choose not to use the information until they have medical problems because of heat, or lose supplies, equipment, or medications to heat.
I blogged about heat/sun stroke part 1 (Apr 15) to part 6 (Apr 28) and know this may have been too early for some people to take seriously, but the heat of summer is here and we all need to be reminded again. Whether you live in Arizona where the study is conducted or in the northern part of the US, leaving your diabetes supplies in your vehicle on a hot day, will cause problems for your medications, testing supplies and equipment.
If you don't have coolers for carrying your insulin and diabetes supplies in for daily trips, you need to consider getting one. Also the Frio packs work well for protecting (from overheating and not freezing) your diabetes supplies in the summer and winter. Frio wallets can keep insulin safe for up to 45 hours. For wallets, just submerse them in cold water for five to fifteen minutes to activate. Frio Bags of varying sizes can also be purchased. Some drug chains carry them, but call beforehand. Or, search on line for Frio packs. These can be used for daily use to and from work, weekend daily excursions to your favorite park, and other trips.
For those of us with diabetes, we need to be aware that both insulin and oral medications are affected and can be rendered useless by heat. Heat will cause our test strips and meters to malfunction and quit.
The Joslin Diabetes Center also published “Five Tips for Caring for your Diabetes Supplies” They give excellent advice for caring for your meter, testing supplies, pump, and insulin plus being organized. I would only add for those with type 2 diabetes and not on insulin to take care of your oral medications and protect them from heat and freezing.
Care of your diabetes medications, supplies, and equipment is not something you will be able to ask your doctor about. Some may know, but this, like your diabetes is your responsibility as your doctor will not be with you when you forget and leave things in your hot car.
Now armed with the knowledge you need, get out and enjoy summer.
June 13, 2010
Non-diabetic Hypoglycemia
If you think this is about diabetes, you are mistaken. Food reactive hypoglycemia, reactive hypoglycemia, and hypoglycemia are all terms that have been used for a disease that is most often misdiagnosed. Diagnosis is often arrived at by the process of elimination. Low blood glucose is the culprit and hyperglycemia is not involved.
Why this on a blog about type 2 diabetes? Because I have a family member that has this. Even though there is a lot of misinformation (doesn't this sound familiar), there is a lot of good information available. The rule we use in discussions of diabetes of “what works for you, may not work for me” applies here as well. Not every solution will work for everyone.
The comparison between hypoglycemia and diabetes reveals many common similarities. While definitely not the same, both have no special diets available, although there are many who claim otherwise, and both have many people promoting their treatments as the only way. The largest difference is there is no gain to be had by the big pharmaceutical companies and as such hypoglycemia has no large research studies to define it or few ways to educate the medical community. See an endocrinologist for the greater chance of correct diagnosis.
Although this has not been conclusively proven, there appears to be several types of hyperglycemia. Reactive hypoglycemia and hypoglycemia are generally used interchangeably although they may not be identically the same and symptoms normally appear within four hours after eating. Food reactive hypoglycemia generally occurs at the start of eating and the quantity of insulin exceeds the need. And fasting hypoglycemia occurs when food is not eaten for what ever reason, illness is often the culprit. As of yet no genetic or DNA markers have been identified to hypoglycemia,
What are the symptoms? Some of them are:
There are many good sites available. I highly recommend the first two sites. .
1.Site one Lots of pages to explore. Take time to read the surveys page.
2.Site two Many more pages to explore.
3.Site three
4.Site four
5.Site five
6.Site six
7.Site seven
8.Site eight
For more sites and to do your own research type “reactive hypoglycemia” into a search engine and read. Many sites do not properly reflect a proper separation from diabetes and hypoglycemia in diabetes. Hopefully, I have presented a diverse group of sites to show that there are many sides to the discussion and that one size does not fit all.
While many still claim that hypoglycemia is not related to diabetes, many former patients do develop diabetes later in life and many have family members or relatives with diabetes, Others say that people with hypoglycemia do not develop coma, but sites four and eight above shows that it does need to be seriously considered.
I may have raised more questions than I have answered, but there is still much that needs to be learned about hypoglycemia, its variants, and control with nutrition. Good progress is being made and more needs to be done.
Why this on a blog about type 2 diabetes? Because I have a family member that has this. Even though there is a lot of misinformation (doesn't this sound familiar), there is a lot of good information available. The rule we use in discussions of diabetes of “what works for you, may not work for me” applies here as well. Not every solution will work for everyone.
The comparison between hypoglycemia and diabetes reveals many common similarities. While definitely not the same, both have no special diets available, although there are many who claim otherwise, and both have many people promoting their treatments as the only way. The largest difference is there is no gain to be had by the big pharmaceutical companies and as such hypoglycemia has no large research studies to define it or few ways to educate the medical community. See an endocrinologist for the greater chance of correct diagnosis.
Although this has not been conclusively proven, there appears to be several types of hyperglycemia. Reactive hypoglycemia and hypoglycemia are generally used interchangeably although they may not be identically the same and symptoms normally appear within four hours after eating. Food reactive hypoglycemia generally occurs at the start of eating and the quantity of insulin exceeds the need. And fasting hypoglycemia occurs when food is not eaten for what ever reason, illness is often the culprit. As of yet no genetic or DNA markers have been identified to hypoglycemia,
What are the symptoms? Some of them are:
- fatigue
- depression
- anxiety
- having trouble sleeping for nights on end or insomnia
- headaches
- personality changes rapidly
- always hungry for something sweet
- doctor says there is nothing wrong – I advise seeing an endocrinologist
- dizziness
- blurred vision
- heavy sweating
There are many good sites available. I highly recommend the first two sites. .
1.Site one Lots of pages to explore. Take time to read the surveys page.
2.Site two Many more pages to explore.
3.Site three
4.Site four
5.Site five
6.Site six
7.Site seven
8.Site eight
For more sites and to do your own research type “reactive hypoglycemia” into a search engine and read. Many sites do not properly reflect a proper separation from diabetes and hypoglycemia in diabetes. Hopefully, I have presented a diverse group of sites to show that there are many sides to the discussion and that one size does not fit all.
While many still claim that hypoglycemia is not related to diabetes, many former patients do develop diabetes later in life and many have family members or relatives with diabetes, Others say that people with hypoglycemia do not develop coma, but sites four and eight above shows that it does need to be seriously considered.
I may have raised more questions than I have answered, but there is still much that needs to be learned about hypoglycemia, its variants, and control with nutrition. Good progress is being made and more needs to be done.
June 8, 2010
Cooking and Cookbooks – Diabetes Style
For people with diabetes, most look for carb count and fiber content. They think that maybe cookbooks with diabetic in the title are the answer. Most soon find out like I did that this route is not the answer. Many, if not most, have recipes that are not friendly to people with diabetes, most are too high in carbohydrates. These cookbooks masquerading as diabetic friendly exist for one purpose only. That is to extract money from unsuspecting newly diagnosed people with diabetes and their families. Unlike the Sears-Roebuck catalogs of old, they do not have a dual usage.
There are many websites that have good recipes, but many do not have the nutritional information with them. Some do, but often take much research to find them. I am aware of some of the diabetes forums that have a library of recipes. Some have nutritional information, but not the number of servings. Some have now gone the extra mile and made it possible to calculate the ingredients for varying servings. Two forums that have recipes with nutritional information and servings number are dLife and diabetes daily.
People should not overlook cookbooks that have been around for many years. Betty Crocker's Cookbook, ninth edition and later have the nutrition and servings number with each recipe. Better Homes and Gardens New Cookbook copyright 1996 and later has the nutritional information and includes the servings number. I have found these two cookbooks to be invaluable and have used them to approximate the nutritional value for some of the recipes in the older editions which I find to be healthier. While the older recipes often use ingredients sometimes not available on today's grocery shelves, most are available.
Another cookbook now available today is The Taste of Home Cookbook. Be sure to read the guidelines printed on the copyright page for how the nutritional data is calculated. I have tried to ask questions, but their editors have not felt it necessary to answer my emails. There may be other cookbooks that have the nutritional information and servings number; however, these are the only cookbooks in my collection that do.
When I use a recipe, I try to use those for two or three servings, realizing that I will need to cut that in half for me and possibly even more. That makes a recipe that says serves two a recipe serving at least four or six. I always plan on freezing a portion for use later.
There are more resources available to help you today than even ten years ago, so don't become discouraged and let denial get in your way of eating healthy for control of your diabetes. Alan Shanley, an outstanding blogger from Australia has some excellent pointers for people new and old to diabetes. Get started by following him here – be sure to follow his links to more information. When a fellow blogger has excellent information, I don't like reinventing the wheel, so I will always recommend reading them.
There are other ways to determine the nutritional value. Here are a few sites to assist you. On these sites you will need to join to be able to use their information.
1.Site one - There is a cost to join this site
2.Site two - I believe this one is free
3.Site three - This one is free
There are many nutrition and calorie calculators available on the web, just use caution and realize that you will not be 100% accurate as they all read from the same nutritional database and you may be off +/- 20%. Use your search engine and get started by typing in “nutrition calculator”.
And there is always the best way, using your meter to determine the serving size for you. And always follow the rule of what works for one person may not work for you.
If you don't like bland foods, check out my post of May 30, 2010. There will be more.
There are many websites that have good recipes, but many do not have the nutritional information with them. Some do, but often take much research to find them. I am aware of some of the diabetes forums that have a library of recipes. Some have nutritional information, but not the number of servings. Some have now gone the extra mile and made it possible to calculate the ingredients for varying servings. Two forums that have recipes with nutritional information and servings number are dLife and diabetes daily.
People should not overlook cookbooks that have been around for many years. Betty Crocker's Cookbook, ninth edition and later have the nutrition and servings number with each recipe. Better Homes and Gardens New Cookbook copyright 1996 and later has the nutritional information and includes the servings number. I have found these two cookbooks to be invaluable and have used them to approximate the nutritional value for some of the recipes in the older editions which I find to be healthier. While the older recipes often use ingredients sometimes not available on today's grocery shelves, most are available.
Another cookbook now available today is The Taste of Home Cookbook. Be sure to read the guidelines printed on the copyright page for how the nutritional data is calculated. I have tried to ask questions, but their editors have not felt it necessary to answer my emails. There may be other cookbooks that have the nutritional information and servings number; however, these are the only cookbooks in my collection that do.
When I use a recipe, I try to use those for two or three servings, realizing that I will need to cut that in half for me and possibly even more. That makes a recipe that says serves two a recipe serving at least four or six. I always plan on freezing a portion for use later.
There are more resources available to help you today than even ten years ago, so don't become discouraged and let denial get in your way of eating healthy for control of your diabetes. Alan Shanley, an outstanding blogger from Australia has some excellent pointers for people new and old to diabetes. Get started by following him here – be sure to follow his links to more information. When a fellow blogger has excellent information, I don't like reinventing the wheel, so I will always recommend reading them.
There are other ways to determine the nutritional value. Here are a few sites to assist you. On these sites you will need to join to be able to use their information.
1.Site one - There is a cost to join this site
2.Site two - I believe this one is free
3.Site three - This one is free
There are many nutrition and calorie calculators available on the web, just use caution and realize that you will not be 100% accurate as they all read from the same nutritional database and you may be off +/- 20%. Use your search engine and get started by typing in “nutrition calculator”.
And there is always the best way, using your meter to determine the serving size for you. And always follow the rule of what works for one person may not work for you.
If you don't like bland foods, check out my post of May 30, 2010. There will be more.
May 30, 2010
Avoiding the Bland Foods
Complaints about tasteless and bland food by other people with diabetes leaves me wondering how I got so lucky to have wonderful tasting food. No, not really, as I knew about herbs and spices. I was lucky to learn from some great cooks and what caused these foods to taste so wonderful. Spices and herbs can really create a royal taste for the palate.
The problem is many people pan fry their foods and dry them out, do not use spices or herbs, and thus they have bland, tasteless food. Many people forget about the crock pot or slow cooker, pressure cooker (the ones available today are very safe and useable and not like your grandmother's), and steam cookers. All, if used properly, can really make foods taste delicious.
Granted, some foods (but not many) are best fried. There are other ways of cooking some foods, including poached foods, stews and soups, and casseroles, some can be very low carb and loaded with flavor and nutrition. Then there are other ways of preparing foods, stir-frying, roasting, barbecuing, broiling, and baking.
There are a lot of ways, methods, and techniques that can be used to add flavor to foods. Spices and herbs are just two ingredients in the arsenal used by good cooks.
Storage, shelf-life, and refrigeration are part of what you need to know about the individual herbs and spices. Then you need to know which type(s) to use and with which foods. Here I am talking about dried, crushed, diced, ground, or other forms.
First, do not run out and buy a lot of different herbs and spices. Fresh herbs will not last but for a short time, about a week. Shelf-life of dried herbs and most spices varies from about six months to one year. Some spices like garlic vary with storage requirements. Crushed, diced, and minced garlic require refrigeration after opening, while garlic cloves and powdered garlic can be stored in a cool dry place.
Herbs and spices definitely lose their potency with age, and seeds such as poppy and sesame will get rancid. Most whole herbs and spices will retain their flavor about 1 year, dried and ground versions are best used within 6 months.
In many home kitchens, herbs and spices are stored on shelves above the stove or along side the stove. These locations are not good for shelf-life and the heat and humidity will shorten the life to a matter of days for some herbs and spices. Spices and herbs not requiring refrigeration should be stored in a cool, dark, and dry area away from the stove or oven. I strongly suggest only having those that you use regularly available near the stove and that will not be affected by heat and humidity.
For complete information, you should check out books about herbs and spices. You do not need books containing recipes using spices unless this is your way of learning.
Mainly, you should check your local library first, or Amazon.com for one of the following books.
Book one, is The Complete Idiot's Guide to Spices and Herbs [Paperback]. This is a straight forward book with no pictures. This is very similar (looking at the table of contents) to one that I had ten years ago, but have lost.
Book two, is The Spice and Herb Bible [Paperback]. This book is written by Ian "Herbie" Hemphill, an Australian with over four decades of working in the spice and herb business. This colorful 608-page book (with photographs) is a comprehensive book of information about virtually any spice and herb. He has traveled all over the world to identify and introduce the most unique and exotic herbs and spices. He serves his customers at his popular Herbie's Spices store in Sydney, Australia.
Book three, is Herbs & Spices: The Cook's Reference [Hardcover]. This book has appeal for home and professional cooks, and for gardeners. It is filled with photographic illustrations. Each herb and spice lists what parts are utilized, where it can be purchased, how to grow it and how to harvested it. The book has a flavor profile of the herbs and spices, a history, common cooking techniques, recipes, herb blends, and food pairings.
Before investing in any of the books, check your local library. I also suggest going to Amazon.com and finding the books. Then on each book, find the “click to look inside” and move the cursor over this area, then select table of contents to click on. Explore other areas you desire and read the reviews. Except for the last one, there are normally good and bad reviews.
Some articles for reading one by Peggy Trowbridge Filippone, and this one. All have excellent tips for spices and herbs.
And please do not forget ethnic spices and ethnic cooking!
The problem is many people pan fry their foods and dry them out, do not use spices or herbs, and thus they have bland, tasteless food. Many people forget about the crock pot or slow cooker, pressure cooker (the ones available today are very safe and useable and not like your grandmother's), and steam cookers. All, if used properly, can really make foods taste delicious.
Granted, some foods (but not many) are best fried. There are other ways of cooking some foods, including poached foods, stews and soups, and casseroles, some can be very low carb and loaded with flavor and nutrition. Then there are other ways of preparing foods, stir-frying, roasting, barbecuing, broiling, and baking.
There are a lot of ways, methods, and techniques that can be used to add flavor to foods. Spices and herbs are just two ingredients in the arsenal used by good cooks.
Storage, shelf-life, and refrigeration are part of what you need to know about the individual herbs and spices. Then you need to know which type(s) to use and with which foods. Here I am talking about dried, crushed, diced, ground, or other forms.
First, do not run out and buy a lot of different herbs and spices. Fresh herbs will not last but for a short time, about a week. Shelf-life of dried herbs and most spices varies from about six months to one year. Some spices like garlic vary with storage requirements. Crushed, diced, and minced garlic require refrigeration after opening, while garlic cloves and powdered garlic can be stored in a cool dry place.
Herbs and spices definitely lose their potency with age, and seeds such as poppy and sesame will get rancid. Most whole herbs and spices will retain their flavor about 1 year, dried and ground versions are best used within 6 months.
In many home kitchens, herbs and spices are stored on shelves above the stove or along side the stove. These locations are not good for shelf-life and the heat and humidity will shorten the life to a matter of days for some herbs and spices. Spices and herbs not requiring refrigeration should be stored in a cool, dark, and dry area away from the stove or oven. I strongly suggest only having those that you use regularly available near the stove and that will not be affected by heat and humidity.
For complete information, you should check out books about herbs and spices. You do not need books containing recipes using spices unless this is your way of learning.
Mainly, you should check your local library first, or Amazon.com for one of the following books.
Book one, is The Complete Idiot's Guide to Spices and Herbs [Paperback]. This is a straight forward book with no pictures. This is very similar (looking at the table of contents) to one that I had ten years ago, but have lost.
Book two, is The Spice and Herb Bible [Paperback]. This book is written by Ian "Herbie" Hemphill, an Australian with over four decades of working in the spice and herb business. This colorful 608-page book (with photographs) is a comprehensive book of information about virtually any spice and herb. He has traveled all over the world to identify and introduce the most unique and exotic herbs and spices. He serves his customers at his popular Herbie's Spices store in Sydney, Australia.
Book three, is Herbs & Spices: The Cook's Reference [Hardcover]. This book has appeal for home and professional cooks, and for gardeners. It is filled with photographic illustrations. Each herb and spice lists what parts are utilized, where it can be purchased, how to grow it and how to harvested it. The book has a flavor profile of the herbs and spices, a history, common cooking techniques, recipes, herb blends, and food pairings.
Before investing in any of the books, check your local library. I also suggest going to Amazon.com and finding the books. Then on each book, find the “click to look inside” and move the cursor over this area, then select table of contents to click on. Explore other areas you desire and read the reviews. Except for the last one, there are normally good and bad reviews.
Some articles for reading one by Peggy Trowbridge Filippone, and this one. All have excellent tips for spices and herbs.
And please do not forget ethnic spices and ethnic cooking!
May 26, 2010
Eat How Many Carbohydrates?
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
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 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.
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