We all learn from diabetes. Necessity is the teacher and not a patient teacher at that. If we don't follow instructions, we pay dearly for those lessons. If we think we can outsmart diabetes, are we in for a rude awakening. Diabetes does extract a toll whether we are willing to accept the charge or not.
Many of us have experienced college, but the college of hard knocks teaches us the lessons we need for life and living. The grades handed out are how we live and manage our daily living. Diabetes is its own college and can knock us around unmercifully unless we learn how to manage it. Otherwise it loves to manage us.
David Spero at diabetes self management approaches this a different way and has it as a class. To me it is a degree by itself and has many courses to cover the complications and idiosyncrasies of the disease. Some classes are easy to pass and others take some study and much patience to pass the course. Some classes are for the short term and others are lifelong.
One of the hardest lessons that many just never seem to learn is diabetes is not your fault. Whether you have Type 1 or Type 2 diabetes, LADA, or one of the MODY types, they may be caused by genetics, environment, or even some unknown genetic abnormality. This even applies if you have medically induced diabetes, see my blog here.
The second lesson is you must learn that the past is past and you must learn to live in the present and manage your diabetes. This is hard for many people also as they want to continue to heap blame on themselves and then go into denial. Diabetes loves this phase as it gets to do what it wants with your body and you are being managed by diabetes and not the other way around.
Acceptance if the final lesson and is when you have removed your fist from the panic panel and are mastering the lessons of diabetes and how to best manage this chronic disease. These lessons do not not manifest themselves in the same order for everyone and anger is another lesson that some people have a difficult time getting past. For me anger was short lived and denial can later even after I had accepted diabetes. So be careful in how you analyze your situation.
Gretchen Becker in her book The First Year, Type 2 Diabetes, discusses three of the common complications of diabetes as the three O'pathy sisters. I like her humor to get you to remember how serious these complications are. Neuropathy is damage to the nerves and for some can be very disabling. Nephropathy is damage to the kidneys, and retinopathy is damage to the retina of the eye.
Then she adds Arthur O. Sclerosis for atherosclerosis which can lead to heart attacks, strokes and open wounds on the feet and legs. Yes, indeed these can be very serious and debilitating for those that don't manage diabetes. These require you to manage diabetes by maintaining control as near to normal levels of blood glucose as possible. This management may delay or even prevent their development. These are considered the big four and most common complications.
Please read David Spero's blog here. He makes some excellent points that I chose not to cover and they are to the point. My next blog will be about some of the other complications and related problems.
February 12, 2011
February 9, 2011
Obstructive Sleep Apnea Surgery
I don't know what it is lately, but apparently surgeons are trying to build their retirement fund before the Affordable Care Act gets before the Supreme Court. I am reading more and more about surgery being the solution for more and more health problems. That in itself sets off alarms about what is happening in healthcare that has surgeons operating everywhere they can.
Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.
Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.
I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.
Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery. I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.
I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.
Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.
Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.
I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.
Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery. I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.
I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.
February 4, 2011
The New USDA Dietary Guidelines
USDA and HHS have unveiled the seventh edition of the US Department of Agriculture Dietary Guidelines. There were a few changes, but lacked the changes needed to be in line with many of the Medical Associations' current positions. Only two associations have welcomed the new edition and the American Heart Association has said the improvement is still lacking for bringing sodium in line for everyone.
I do not understand why some of the other medical associations have not issued statements. But if they were to issue acceptance or rejection, they might have to agree with something they wish to avoid. The American Caner Society says the new guidelines could reduce the cancer risk.
To read the full copy of the latest dietary guidelines go here. I used Adobe
Reader to save a copy to my files. The seventh edition has six chapters and 16 appendices.
The first chapter labeled Introduction explains how the dietary guidelines were developed. This may be of interest for many.
Chapter two is Balancing Calories to Manage Weight.
Chapter three is Foods and Food Components to Reduce.
Chapter four is Foods and Nutrients to Increase.
Chapter five is Building Healthy Eating Patterns.
Chapter six is Helping Americans Make Healthy Choices.
There is over 90 pages of reading, but I will say it is well organized, but short of some reasonable specifics. There are many specifics and some welcomed discussions for ethnic specifics which should make this more useable than previous editions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
One of the features in this edition is the emphasis on managing body weight from age two to elder ages. This includes eating patterns for balanced nutrition and also for vegetarian adaptions. The report includes recommendations for all ages as well as for those at risk for chronic diseases, a real plus
The recommendation presently generating the most discussion is about salt. The American Heart Association recently lowered the maximum from 2300 milligrams to 1500 milligrams. The USDA only lowered the maximum for those age 51 and older. If we are serious in reducing obesity and hypertension then the limit for all ages should be 1500 milligrams.
There are many areas that this report should have covered, but it is the most comprehensive report issued yet by the USDA and does have something for almost everyone. There will be disagreements and groups that will find fault; however, this report should be read and understood by everyone. It is the first time national action has been addressed for obesity.
Read some of the takes on the press release and report here by Medscape and here by Medicine Net. You may also have seen parts of this on the nightly news. There is much information about the report and represents views not in the actual report.
I do not understand why some of the other medical associations have not issued statements. But if they were to issue acceptance or rejection, they might have to agree with something they wish to avoid. The American Caner Society says the new guidelines could reduce the cancer risk.
To read the full copy of the latest dietary guidelines go here. I used Adobe
Reader to save a copy to my files. The seventh edition has six chapters and 16 appendices.
The first chapter labeled Introduction explains how the dietary guidelines were developed. This may be of interest for many.
Chapter two is Balancing Calories to Manage Weight.
Chapter three is Foods and Food Components to Reduce.
Chapter four is Foods and Nutrients to Increase.
Chapter five is Building Healthy Eating Patterns.
Chapter six is Helping Americans Make Healthy Choices.
There is over 90 pages of reading, but I will say it is well organized, but short of some reasonable specifics. There are many specifics and some welcomed discussions for ethnic specifics which should make this more useable than previous editions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
One of the features in this edition is the emphasis on managing body weight from age two to elder ages. This includes eating patterns for balanced nutrition and also for vegetarian adaptions. The report includes recommendations for all ages as well as for those at risk for chronic diseases, a real plus
The recommendation presently generating the most discussion is about salt. The American Heart Association recently lowered the maximum from 2300 milligrams to 1500 milligrams. The USDA only lowered the maximum for those age 51 and older. If we are serious in reducing obesity and hypertension then the limit for all ages should be 1500 milligrams.
There are many areas that this report should have covered, but it is the most comprehensive report issued yet by the USDA and does have something for almost everyone. There will be disagreements and groups that will find fault; however, this report should be read and understood by everyone. It is the first time national action has been addressed for obesity.
Read some of the takes on the press release and report here by Medscape and here by Medicine Net. You may also have seen parts of this on the nightly news. There is much information about the report and represents views not in the actual report.
February 2, 2011
Suggestions for Doctors
Sometimes doctors are open to suggestions from patients and other doctors will never take suggestions from patients. But I will still make suggestions as most of my doctors have not turned them away completely. Some have even admitted that they like a few of them, but don't have the time or office staff time to put them into effect. That I do understand. Now I will need to ask some questions to find out if there is something I am able to do that would be accepted.
My main suggestion has been to have a list of acceptable web sites to get patients started in their research. Also a list of books about the disease, to be in the local library or ordered on line. These would vary by disease or illness. For this discussion I am talking about diabetes and the related complications, but this will involve more then just diabetes when I get started. I have worked on lists for one doctor recently and am encouraged again after reading a blog by Dr. Fran Cogen.
Her statement in the blog of “Families often walk into their appointments with reams of Internet papers and articles strongly suggesting a certain form of treatment.” When this is what doctors see and get, it is easy to understand why they are less than happy about the internet.
Dr. Cogen has an excellent discussion about information overload and why this is sometimes not a good thing. People on information overload often become incapable of making a simple decision. They have too many ideas to digest and this causes them to not make a decision.
Dr. Cogen also does not like “the paternalistic approach in which the physician and team reverts to the 'father knows best' mantra.” Many doctors do use this and even this is not always the best or most appropriate. Often the best decisions are made from a few well thought out possibilities that are discussed with the patient and/or their advocate.
I am taking this and trying to pare down the internet resources to a few good sources to help people find information and then ask the doctors to review the list and add or subtract from this list. This is going to take some time, but I am looking forward to see what reaction I will receive from some of the different doctors with the different specialties.
Of course, the diabetes, type 2, is complete, but I have a lot to do for the rest. I do believe that people are more internet conscious and savvy than ten or more years ago and people need good information. The doctors deserve consideration and not being buried in unrelated papers that have no bearing on the subject of the visit. I may even suggest that the doctors have a book list for patients to order through them.
There will always be changes to the sources as some sites shut down and other good sites appear. New books appear all the time and while many may be good, some are far better. Some of the current books will continue to be relevant as they are updated with revisions to stay current. Each type of diabetes is different and needs its own resources.
My main suggestion has been to have a list of acceptable web sites to get patients started in their research. Also a list of books about the disease, to be in the local library or ordered on line. These would vary by disease or illness. For this discussion I am talking about diabetes and the related complications, but this will involve more then just diabetes when I get started. I have worked on lists for one doctor recently and am encouraged again after reading a blog by Dr. Fran Cogen.
Her statement in the blog of “Families often walk into their appointments with reams of Internet papers and articles strongly suggesting a certain form of treatment.” When this is what doctors see and get, it is easy to understand why they are less than happy about the internet.
Dr. Cogen has an excellent discussion about information overload and why this is sometimes not a good thing. People on information overload often become incapable of making a simple decision. They have too many ideas to digest and this causes them to not make a decision.
Dr. Cogen also does not like “the paternalistic approach in which the physician and team reverts to the 'father knows best' mantra.” Many doctors do use this and even this is not always the best or most appropriate. Often the best decisions are made from a few well thought out possibilities that are discussed with the patient and/or their advocate.
I am taking this and trying to pare down the internet resources to a few good sources to help people find information and then ask the doctors to review the list and add or subtract from this list. This is going to take some time, but I am looking forward to see what reaction I will receive from some of the different doctors with the different specialties.
Of course, the diabetes, type 2, is complete, but I have a lot to do for the rest. I do believe that people are more internet conscious and savvy than ten or more years ago and people need good information. The doctors deserve consideration and not being buried in unrelated papers that have no bearing on the subject of the visit. I may even suggest that the doctors have a book list for patients to order through them.
There will always be changes to the sources as some sites shut down and other good sites appear. New books appear all the time and while many may be good, some are far better. Some of the current books will continue to be relevant as they are updated with revisions to stay current. Each type of diabetes is different and needs its own resources.
January 29, 2011
Are You Now A Person With Diabetes?
If you read the previous blog about “Are You An Undiagnosed Person With Diabetes?”, you will want to read this about what to do if you are diagnosed with prediabetes or diabetes. If you were not diagnosed with either of these, then consider that you must continue to undergo at least an annual test for diabetes. The older you are, the more important this becomes.
If you were diagnosed with Type 2 diabetes, then you will have more than likely been put on medications and been advised to watch your diet. Hopefully your doctor will have referred you to a dietitian and maybe to a diabetes educator. These should be specializing in diabetes or they may be less than useful to you. Occasionally you will encounter a nurse that specializes in diabetes and some of the complications from diabetes including depression and cardiovascular disease, but not limited only to these.
Start reading as much information as you are able. I suggest starting with two of my blogs here and here. One is about printed materials and the other about some of the many internet sources.
Do not go into panic mode. There are many tasks to accomplish and the more knowledge you obtain the easier dealing with diabetes it will be. First, you must make a lifestyle change. Some say severe, others say to do it gradually. This will depend on you and either way this change should be considered a permanent one as this will give you the best overall means to manage diabetes and prevent or delay its complications.
Next, if you have no medical limitations, you need to start an exercise regimen in something you like doing. Please talk to your doctor before starting. Your doctor may have advice you need to follow depending on your condition and weight.
If you have prediabetes, please do not take it lightly or dismiss it, and proceed as if you have diabetes because your pancreas is not functioning properly and some damage has been done. It is still possible to delay the onset of full blown diabetes and complications for many years, but only if you take this seriously and are able to follow a regimen of nutrition and exercise.
Read this blog for more details on insulin resistance. For a discussion of prediabetes read this and my blog here.
If you were diagnosed with Type 2 diabetes, then you will have more than likely been put on medications and been advised to watch your diet. Hopefully your doctor will have referred you to a dietitian and maybe to a diabetes educator. These should be specializing in diabetes or they may be less than useful to you. Occasionally you will encounter a nurse that specializes in diabetes and some of the complications from diabetes including depression and cardiovascular disease, but not limited only to these.
Start reading as much information as you are able. I suggest starting with two of my blogs here and here. One is about printed materials and the other about some of the many internet sources.
Do not go into panic mode. There are many tasks to accomplish and the more knowledge you obtain the easier dealing with diabetes it will be. First, you must make a lifestyle change. Some say severe, others say to do it gradually. This will depend on you and either way this change should be considered a permanent one as this will give you the best overall means to manage diabetes and prevent or delay its complications.
Next, if you have no medical limitations, you need to start an exercise regimen in something you like doing. Please talk to your doctor before starting. Your doctor may have advice you need to follow depending on your condition and weight.
If you have prediabetes, please do not take it lightly or dismiss it, and proceed as if you have diabetes because your pancreas is not functioning properly and some damage has been done. It is still possible to delay the onset of full blown diabetes and complications for many years, but only if you take this seriously and are able to follow a regimen of nutrition and exercise.
Read this blog for more details on insulin resistance. For a discussion of prediabetes read this and my blog here.
January 26, 2011
Are You An Undiagnosed Person With Diabetes?
Are you a person that is undiagnosed for diabetes? If you don't know if you have diabetes and are overweight and even normal weight, please read carefully. The number of undiagnosed persons is growing every day.
About 25 percent of the adult population has already developed insulin resistance. No one knows the number that are on their way to developing Type 2 diabetes. The following are some of the symptoms that may give you some guidance that will let you learn if you should get an appointment with your doctor for a definitive check.
Depending the the source of information there are varying symptoms, but the following are good indicators. These are not the signs that are for diabetes, but for insulin resistance.
Obesity: Almost every source lists this. This is the greatest indicator of possible insulin resistance.
Hypertension: Also goes by high blood pressure, and it involves high cholesterol and high triglycerides.
High blood glucose: This means the glucose is not getting into the cells and is raising blood glucose levels.
Low blood glucose: Cells starved for food when insulin cannot escort glucose into the cells, causing prolonged periods of hypoglycemia. Hypoglycemia makes you feel agitated and jittery and the symptoms generally go away after you eat. If you get shaky when you are hungry, it may mean you have insulin resistance.
Inflammation: Inflammation is caused by high levels of insulin in the blood stream and this is the result of inflammatory compounds like C-reactive protein which in turn increases the risk of cardiovascular disease.
The other symptoms are also thought about, but not everyone includes them in the discussion. They include: fatigue, brain fogginess, intestinal bloating, sleepiness, depression, and increased weight.
According to most polls, about 25 percent of the US population has already developed insulin resistance and about another 10 percent is is not far behind. If you have doubts about where you are, please make an appointment with your doctor to confirm if you have a problem or not.
You should ask for two tests. The first if the fasting glucose test, meaning you have nothing to eat from midnight until the test is done and then you may eat. The second
test is the two-hour glucose tolerance test. Be prepared to insist on both tests if the doctor only wants one done.
Read other discussions here and here. Next blog is a suggestion of what to do with the diabetes diagnosis.
About 25 percent of the adult population has already developed insulin resistance. No one knows the number that are on their way to developing Type 2 diabetes. The following are some of the symptoms that may give you some guidance that will let you learn if you should get an appointment with your doctor for a definitive check.
Depending the the source of information there are varying symptoms, but the following are good indicators. These are not the signs that are for diabetes, but for insulin resistance.
Obesity: Almost every source lists this. This is the greatest indicator of possible insulin resistance.
Hypertension: Also goes by high blood pressure, and it involves high cholesterol and high triglycerides.
High blood glucose: This means the glucose is not getting into the cells and is raising blood glucose levels.
Low blood glucose: Cells starved for food when insulin cannot escort glucose into the cells, causing prolonged periods of hypoglycemia. Hypoglycemia makes you feel agitated and jittery and the symptoms generally go away after you eat. If you get shaky when you are hungry, it may mean you have insulin resistance.
Inflammation: Inflammation is caused by high levels of insulin in the blood stream and this is the result of inflammatory compounds like C-reactive protein which in turn increases the risk of cardiovascular disease.
The other symptoms are also thought about, but not everyone includes them in the discussion. They include: fatigue, brain fogginess, intestinal bloating, sleepiness, depression, and increased weight.
According to most polls, about 25 percent of the US population has already developed insulin resistance and about another 10 percent is is not far behind. If you have doubts about where you are, please make an appointment with your doctor to confirm if you have a problem or not.
You should ask for two tests. The first if the fasting glucose test, meaning you have nothing to eat from midnight until the test is done and then you may eat. The second
test is the two-hour glucose tolerance test. Be prepared to insist on both tests if the doctor only wants one done.
Read other discussions here and here. Next blog is a suggestion of what to do with the diabetes diagnosis.
January 24, 2011
RDA for Vitamin D Needs Change
At least I feel vindicated by what I said in my blog of December 20, 2010. Others including Dr. Miller are also pointing out more accurately the problems of the report issued by Institute of Medicine of the National Academies of Science (IOM). There are some glaring errors that punch holes in the report by IOM. These errors make me wonder how these men of science could miss this or do they simply lack the education necessary for their duties.
Harsh, yes. But these errors are serious. Even David Mendosa has told me to be careful not to take vitamin-D2, but to take vitamin-D3. What bothers me is that people will go to the doctor for a vitamin D prescription and pay the doctor fee and a higher cost for vitamin-D2, when vitamin-D3 is on the shelves and a lot cheaper.
Vitamin-D2 is much less effective in humans than vitamin-D3. D2 is largely human made and added to foods as a fortifier. Vitamin-D3 is also consumed by consuming animal based foods. So those on non-meat lifestyles, should have their doctor check their vitamin D levels and consider taking vitamin-D3 supplements.
Vitamin D, also known as calciferol, comprises a group of fat-soluble seco-sterols. The two major forms are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). In addition to having markedly lower potency, D2 also has a significantly shorter duration of action relative to vitamin D3. Both forms of vitamin D produce similar initial rises in serum 25OHD over the first 3 days, but 25OHD continues to rise with D3 supplementation, peaking at 14 days, and serum 25OHD falls rapidly in D2 treated subjects.
I think that this statement in the American Journal of Clinical Nutrition is most effective and needs to be heeded. They say that vitamin-D2 should not be used as a nutrient suitable for supplementation or fortification.
Dr Miller's blog is well stated and has some excellent comments to read here and read his latest blog here. Jon Barron writes his understanding of the IOM study and publishing of standards here. He is very factual and reports on the errors. NOTE: The two links for Dr. Miller's information are no longer functional.
Harsh, yes. But these errors are serious. Even David Mendosa has told me to be careful not to take vitamin-D2, but to take vitamin-D3. What bothers me is that people will go to the doctor for a vitamin D prescription and pay the doctor fee and a higher cost for vitamin-D2, when vitamin-D3 is on the shelves and a lot cheaper.
Vitamin-D2 is much less effective in humans than vitamin-D3. D2 is largely human made and added to foods as a fortifier. Vitamin-D3 is also consumed by consuming animal based foods. So those on non-meat lifestyles, should have their doctor check their vitamin D levels and consider taking vitamin-D3 supplements.
Vitamin D, also known as calciferol, comprises a group of fat-soluble seco-sterols. The two major forms are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). In addition to having markedly lower potency, D2 also has a significantly shorter duration of action relative to vitamin D3. Both forms of vitamin D produce similar initial rises in serum 25OHD over the first 3 days, but 25OHD continues to rise with D3 supplementation, peaking at 14 days, and serum 25OHD falls rapidly in D2 treated subjects.
I think that this statement in the American Journal of Clinical Nutrition is most effective and needs to be heeded. They say that vitamin-D2 should not be used as a nutrient suitable for supplementation or fortification.
Dr Miller's blog is well stated and has some excellent comments to read here and read his latest blog here. Jon Barron writes his understanding of the IOM study and publishing of standards here. He is very factual and reports on the errors. NOTE: The two links for Dr. Miller's information are no longer functional.
January 22, 2011
The Problem Side of Diabetes Forums
Since I was kind to diabetes forums, I just had to meet the bad side. When people with initials behind their name (titles) and others that must not contradict the position of their professional organizations get involved and state the position, they bring many thoughts that are not always the full truth into the discussion and leave people new to the forums wondering who is right.
I will admit I am very passionate about the issue of the medical community dismissing prediabetes. Part of the reason is from my prior blog here. The consensus does state that damage occurs earlier than previously thought. It is unfortunate that no actual determination has been made for the blood glucose levels when damage can be the most severe.
First, when a person openly disputes a doctor's request of a patient, this really upsets me. Granted in this case there is some potentially harmful information missing that those of us that posted did not ask for. In getting to the A1c of 5.7, we don't know what medications the original poster was taking. We also don't know the number of lows this person experienced, if any. We can only guess that the doctor knows the facts and when he suggests getting an A1c of 5.5 he knows that this is possible.
The medical community needs more doctors like this person and less people that quote ADA (and AADE) that A1c's of 6.5 being okay. That means that a blood glucose average of 140mg/dl which tells us that damage is being done. An A1c of 5.7 means a blood glucose reading of 117mg/dl. My reaction would be to pay attention to the doctor and ignore the rest. This is between the patient and doctor and is the individuals choice.
Having said that, there are people that should not try to get that low because they are unable to control their levels and have some dangerous lows when trying to get down below 6.0. This action needs to be done according to what the patient is capable of managing, desires to do, and if the patient keeps an open line of communication with a doctor. Even though this is on a diabetes forum, most of us suggest and most take it as such, people with titles behind their name often forget themselves and advise against doctors.
The second incident is where we seem to get a dismissal of the seriousness of prediabetes. Prediabetes is technically not diabetes, however, if the medical community continues to ignore the need to treat prediabetes with counseling and letting people know how serious this can become, they are taking a pass on their responsibilities.
There is much that can be done for people with prediabetes to assist them in taking advantage of this diagnosis and preventing the onset of diabetes. If they are medically capable they should begin exercise under a doctors direction and make some good lifestyle changes which will likely prevent diabetes for a number of years or possibly decades. Some will even prevent diabetes altogether.
For the blood glucose and A1c conversion table from the American Diabetes Association click here, and if you will be using it, bookmark the page.
I will admit I am very passionate about the issue of the medical community dismissing prediabetes. Part of the reason is from my prior blog here. The consensus does state that damage occurs earlier than previously thought. It is unfortunate that no actual determination has been made for the blood glucose levels when damage can be the most severe.
First, when a person openly disputes a doctor's request of a patient, this really upsets me. Granted in this case there is some potentially harmful information missing that those of us that posted did not ask for. In getting to the A1c of 5.7, we don't know what medications the original poster was taking. We also don't know the number of lows this person experienced, if any. We can only guess that the doctor knows the facts and when he suggests getting an A1c of 5.5 he knows that this is possible.
The medical community needs more doctors like this person and less people that quote ADA (and AADE) that A1c's of 6.5 being okay. That means that a blood glucose average of 140mg/dl which tells us that damage is being done. An A1c of 5.7 means a blood glucose reading of 117mg/dl. My reaction would be to pay attention to the doctor and ignore the rest. This is between the patient and doctor and is the individuals choice.
Having said that, there are people that should not try to get that low because they are unable to control their levels and have some dangerous lows when trying to get down below 6.0. This action needs to be done according to what the patient is capable of managing, desires to do, and if the patient keeps an open line of communication with a doctor. Even though this is on a diabetes forum, most of us suggest and most take it as such, people with titles behind their name often forget themselves and advise against doctors.
The second incident is where we seem to get a dismissal of the seriousness of prediabetes. Prediabetes is technically not diabetes, however, if the medical community continues to ignore the need to treat prediabetes with counseling and letting people know how serious this can become, they are taking a pass on their responsibilities.
There is much that can be done for people with prediabetes to assist them in taking advantage of this diagnosis and preventing the onset of diabetes. If they are medically capable they should begin exercise under a doctors direction and make some good lifestyle changes which will likely prevent diabetes for a number of years or possibly decades. Some will even prevent diabetes altogether.
For the blood glucose and A1c conversion table from the American Diabetes Association click here, and if you will be using it, bookmark the page.
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