Should We Be Concerned About Oral Diabetes Drugs?

Many people are concerned about the side effects of oral diabetes drugs. We have been hearing a lot about them recently and some of the drugs may be dangerous for some people while other people have little or no lasting effects. This I think has to do with the individual and the dosage they are taking. Am I personally concerned? No, and only because I am on insulin and metformin.

I am concerned about my fellow people with type 2 diabetes that are using oral diabetes drugs, and I think rightfully so. I have had blogs in this year pointing out the dangers of the sulfonylureas, thiazolidinediones, DPP-4 inhibitors, and so far, I have passed on the new seventh class of oral drugs, canagliflozin, because it is so new. The FDA has ordered more trials and is studying it further even though it has been approved.

Dr. Peter C. Butler is the chairman of endocrinology at the University of California, Los Angeles. Dr. Butler is the lone doctor fighting Big Pharma and their big guns inside the American Diabetes Association (ADA). Based on his latest study, both the Food and Drug Administration and the European Medicines Agency have begun investigations that could lead to new warnings on the drugs or even to their removal from the market.

““The data are inconclusive,” said Dr. Robert Ratner, chief scientific and medical officer of the American Diabetes Association. He said even if there were some excess risk, it would be “exceptionally low.”” This is the same Dr. Robert Ratner, chief scientific and medical officer for the ADA that says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," Therefore I have a hard time considering him reliable as he is one pushing oral medications and he will criticize anyone creating doubt.

Whether you believe Dr. Butler, you need to read some of the information in the above link. Considering that the majority of type 2 patients are over 50, when he discovers something that raises red flags, he should be listened to and heeded. “Dr. Butler said that after his group presented its rat findings to Merck, “I never heard from them again,” except from company lawyers asking when the study would be published.” “He said that studies done by the drug companies that led to the drugs’ approval by the F.D.A. tended to use young healthy animals that would not be expected to get pancreatic cancer.”

This in a big way pulls the curtains back on how Big Pharma does their research and why they have good results.

This Is Very Sad for Patients

Even though this is a study done in the UK, the question that needs to be asked is “why?”. The title could even be applied to the US. The title of the article is “Clinical Support for Patient Self-Management Is Rhetoric Rather Than Reality, Experts Say.” Unfortunately, the support for patients is even worse in the USA when it involves patients with diabetes. In the USA we have diabetes “experts” that believe that the A1c done quarterly is sufficient. From the American Diabetes Association to the Joslin Diabetes Center, these “experts” spew forth their ignorance.

Those with type 1 diabetes generally receive more education that most type 2 people with diabetes, and rightfully so. Those of us type 2 and using insulin receive more education than type 2 patients not on insulin do. Self-management education is supposed to increase the patient's ability to take ownership of their diabetes and often to self treat their condition. With the current medical healthcare crisis, this would seem prudent to insure the sustainability of health services in terms of cost.

Bringing self-management support discussions and decisions into everyday clinical practices should encourage patients to become more actively involved. Yet, we see example after example in articles where doctors are hesitant to prescribe insulin and use the fear factor to promote stacking of oral medications. As a result, diabetes often becomes progressive and the complications become part of life. In many ways, it is the patients that read blogs like this and go on a mission to educate himself or herself. Some are capable of making the necessary lifestyle changes and need to make many changes. Others have only a few changes to make as expressed in this blog.

In the study, 44 practices were trained in the new self-management approach. This training program was developed by the universities involved in the study and was to help the practices put the patient at the center of their care. It was also to use a range of self-management support resources. More than 5500 patients, one of the largest randomized controlled trials ever completed, were divided into two groups. Even the practices were randomized to receive the training or deliver routine care. Those practices providing routine care were trained after the trial was completed.

Now for the sad part. “Feedback and assessments showed that while practices engaged with and enjoyed the training, they did not use the approach to improve shared decision-making with patients or encourage the take-up of self-management support. There was no difference in results for any patient outcomes or on service use between the group that had the self-management approach and the group which received usual care.”

The comments by the authors really shed no insights into the failure of this study and they are working to analyze the data further. These comments range from adding additional incentives to encourage practices to engage with a self-management agenda, to most forms of intervention fail to embed themselves into the everyday lives of the patients.

Why Is Insulin Considered the Medication of Last Resort?

These are the topics for this blog. Why is insulin considered the medication of last resort? What are the side effects of insulin?

Based on the recommendations of both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) it would appear that doctors that follow the oral medications route are doing everything correctly. However, after reading the studies, one in Canada and the USA study in Pennsylvania, I feel that the doctors fear insulin and believe in the insulin myths more than their patients. As to the patients fearing needles, yes, there are always a few that have that fear, but most just don't like needles and yet will do what is necessary to maintain their good health.

Whether this is a cover for their lack of being current with the knowledge they need about insulin or their fear of doing something wrong, there is something driving doctors to avoid prescribing insulin. This may be why some doctors use the fear of insulin to keep people on oral medications. It also may be the fear of hypoglycemia that affects their thinking. Of all the excuses, I think the doctors make, probably the more believable is this one by the Canadian doctors when the researchers discovered that many doctors were only familiar with the insulins of past usage and older delivery systems.

Yes, I have enough material to go on an extended rant about the activities of some doctors, but that will not solve the problems of their lack of staying current with the medications, research, and adverse side effects of oral medications. With the current system of shorter time per patient and declining revenues being forced on them by the Centers for Medicare and Medicaid Services (CMS) it is surprising that more serious diagnostic errors are not happening more frequently.

Most doctors will not even have sufficient time to analyze the diabetes algorithm provided by the AACE. This is how bad things are becoming for doctors. And the ADA guidelines probably don't even receive a glance.

The people that need to be hung out to dry are those of the AACE and ADA. They are the ones driving the oral medications market and the AACE algorithm is just another indication of how in bed with Big Pharma the AACE likes to be.

Two other articles create even more concern. Both are in Science Daily and the first one is about the majority of family doctors receiving little or no information about harmful effects of medicines when visited by drug company representatives. What is more disturbing is the same doctors indicated that they were likely to start prescribing these drugs. This is consistent with previous research that shows prescribing behavior is influenced by pharmaceutical promotion.

The second is about a new report that suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, more costly, and often unnecessary prescription drugs.

These two articles do point out a larger problem. If the doctors are constantly complaining about not having sufficient time for patients and the CMS cutting reimbursements, then how do they have time to see drug company representatives. Things just don't add up and someone is not counting their time correctly.

Next is a short discussion of the side effects of insulin. The most dangerous of course is hypoglycemia. This is highlighted by my blog of June 20. Apparently the ADA and the Endocrine Society are concerned enough to have issued new guidelines about hypoglycemia. This is an above average report and most people with diabetes need to read this.

Weight gain is common when people with type 2 diabetes start on insulin because they have been forced to wait too long. Their blood glucose levels are higher than they should be and insulin increases the efficiency of glucose absorption by the cells and the excess is stored as fat. If people would just reduce their carbohydrate intake until their blood glucose levels are lower, less weight gain would happen.

Another side effect that many people forget about is during renal problems and fluid retention can be a problem. I also have concern for the small numbers of people that are allergic to insulin. Some are allergic to the analogs and some people are allergic to the older insulins which can still be obtained outside the USA and are legal to import by those needing them. An even smaller percentage is allergic to both types of insulin. Some people will know that they may have an allergic reaction because of the rash that can appear in the surrounding area or this rash can develop over the entire body. The body rash should get immediate attention by a phone call to the doctor.

Many people are not aware of hypertrophy. This is the enlargement of the areas that has received too many insulin injections. This enlargement is often the result of scar tissue which causes insulin to pool in this area and this can increase the enlargement and the scar tissue can trap the insulin and prevent it from getting into the blood stream.

How Do You Find Acceptable Diabetes Food Plans?

This is the topic for this blog. How do you find acceptable food plans (diets)?

I always have fun with this topic. I receive about two questions per month on this and a few are honest questions that are difficult to answer. Others are people just wanting permission to continue consuming the same junk foods they have been. This I will not do and I ask them why they even asked since nothing I say will change their mind. I am not happy with the way I answered one of these questions, but apparently, it was the only way that I was going to get this person's attention. The discussion after I broke through was very gratifying.

Let me be very clear about this – there is not a specific diabetes diet, food plan, or even a clear guideline. Many people eat different meal plans. The success of their meal plan is determined by what their blood glucose meter tells them. This is the key and using your meter is a must, especially at the start and for approximately the first six months. Some are able to get their doctor to work with them to obtain extra test strips and others are not. Some are able to afford extra test strips and make use of them. Still others use what insurance will allow and carefully guard their usage, watch for trends, and other variances. Is this easy when this happens? No, and I have people tell me that they were fortunate to find the extra money for one or two containers of test strips and this was a great help once they got past many of the changes necessary in their food plan.

Admittedly, the American Diabetes Association (ADA) has relaxed their position on carbohydrates, but the Academy for Nutrition and Dietetics (AND) has not. They are promoting calories in the form of whole grains and promoting them very heavily. They are proud to proclaim who their corporate sponsors include. It is not surprising that there is such a conflict of interest.

This section from the 2013 ADA guidelines (two paragraphs) is important enough to quote, “Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, a recent systematic review confirms that there is no most effective mix that applies broadly, and that macronutrient proportions should be individualized. It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal. Further, individualization of the macronutrient composition will depend on the metabolic status of the patient (e.g., lipid profile, renal function) and/or food preferences. A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.

It should be noted that the RDA for digestible carbohydrate is 130 g/day and is based on providing adequate glucose as the required fuel for the central nervous system without reliance on glucose production from ingested protein or fat. Although brain fuel needs can be met on lower carbohydrate diets, long-term metabolic effects of very low-carbohydrate diets are unclear and such diets eliminate many foods that are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability.” The bold in the two paragraphs above is my emphasis.

Now if the AND people would follow instead of mandating 180 to 230 grams per day of carbohydrates or more, we might actually put a dent in the obesity epidemic.

Most of the time I do suggest that people reduce their whole grains intake and if they are interested, they should consider this book by Dr. William Davis after reading my review and several others.

Of course, I always suggest avoiding white rice and most potatoes, but I always suggest they use their meter when possible to find out what they must reduce, limit, or exclude in their food plan. Those that have been successful have been surprised that some types of potatoes and a few types of rice in small quantities do work for them. We all get surprised occasionally when someone finds certain vegetables can be juiced and are very low carb. Most avoid carrots and everyone avoids most fruits except for a small apple (certain varieties only) that can add flavor to the mixture. Some are happy with the leafy greens they use and I will use some of them in what my wife likes.

Eating well balanced meals really makes a difference and I do use supplements when my tests show that I am at the low side or below the recommended ranges. Most of the time I am well within the recommended ranges for vitamins and minerals.

Why Do Studies Use Patients with High A1c's

The last two studies that I have become interested in have used patients with A1c's above 8.0% or above 183 mg/dl (10.2 mmol/L). To me, this is scary and frightening. Maybe I should not even write about this. These people are 1) not receiving education, 2) have received bad education, 3) not receiving support from their doctor, or 4) don't care to manage their diabetes.

Even this last study amazes me in that fact that the peer coaches had A1c's of less than 8.5%. This may have been the surprises, as they may not have expected the drop they received from the peer coached group. The number of peer coaches numbered 24.

Before the study it was stated the coaches had to be recommended by their primary care physicians and received 36 hours of training over 8 weeks. This was based on a curriculum that included instruction in active listening and nonjudgmental communication. Also covered was helping with diabetes self-management skills, providing emotional and social support, assisting with lifestyle change and medication understanding/adherence, and accessing community resources.

Again, the study number was small with almost 300 participants selected. They were randomly assigned to receive either coaching or usual care. Why the patients were assessed using questionnaires is not understood. They also received a clinical evaluation at the start to establish a baseline and again at six months.

At baseline, the patients in the peer coaching group had a mean HbA1c of 10.1% for the 148 patients. At six months, the peer coached group had a mean HbA1c of 9.0% or a drop of 1.1%. Also the peer coached group had 22% with HbA1c's below 7.5%.

Now compare this to the usual care group. The usual care group numbered 151 patients and had a mean HbA1c of 9.8%. At six months, the mean HbA1c was at 9.5% for only a decrease of 0.3%. Only 8% in the usual care group had HbA1c levels below 7.5%.

This is significant even with a small number of participants. And yet, the American Association of Diabetes Educators continues to discourage lay people and won't open a class for them and provide any training. Think what could be the potential benefit for millions of diabetes patients not being served currently by the AADE.

Where Will You Learn About Diabetes? - Part 2

Part 2 of 2 parts

This is the topic for this blog. Where will you learn about diabetes?

The following are just a few of the diabetes websites that I read. They are of interest to me and you may like them.

http://tcoyd.org/ Steven V. Edelman, MD is the driving force behind this site and they have conferences nationwide. In addition to good news and continuing education for the medical community, they have education for the patients and caregivers as well.

http://behavioraldiabetesinstitute.org/ This organization is based in San Diego, CA deals with the psychological side of diabetes and how to deal with this part of your life.  While this organization is still limited to Southern California area, the message is still there and provides some good guidance for those of us with diabetes. Dr. William Polonsky is the founder and president of this organization.

http://www.diabetes-solution.net/ Dr. Richard K. Bernstein has type 1 diabetes and is very vocal about what can be accomplished with keeping it under tight control. He has several related websites. These sites are good for all types of diabetes and Dr. Bernstein is read by all types of people with diabetes. He also has several books that are excellent references for us. Check out his books on Amazon dot com. The forum site is located here. Although Dr. Bernstein has type 1 diabetes, he also is a great resource for those of us with type 2 diabetes.

Use the following in your search engine to fine more on Dr. Bernstein - “dr. bernstein diabetes”. Dr. Bernstein is now writing an article at least monthly for this magazine – http://diabeteshealth.com/. It is hoped that this will give it back some of the prominence it formerly enjoyed.

http://www.diabetes.org/ This is the site for the American Diabetes Association. It is a very large site and will take you a lot of time to find all the information that may be of benefit for you. While the ADA is more for the medical community, there is much information that we can use as well. Take time to explore as much of this site as you have time for or wish. Some studies are kept behind the pay wall.

David Mendosa writes almost entirely about diabetes and related health problems, types of insulin, diabetic equipment, and testing supplies. He does write about problems not caused by diabetes, but that are often associated with having diabetes. He maintains his own web site (the one above) and writes for several magazines and web sites. He is the author of several books and is a sought after speaker on diabetes. If you have diabetes, please do yourself a favor and read his web site. You should also follow his blogs on Health Central here - http://www.healthcentral.com/diabetes/c/17/

Alan Shanley is from Australia. He combines diabetes and common sense with his down under humor which is enjoyable to read. He has battled another disease into remission and is a rather remarkable person for his accomplishments.

Tom Ross is from California. He maintains a diary of his battle to manage his diabetes with diet and exercise. His positive attitude and determination have spared him the tribulations of being on medications for management of his diabetes. He is also talented musically.

Janet Ruhl is from the northeast part of the country. Her writings are factual and well documented.

Gretchen Becker is from Vermont. She writes with the same insights and humor that are in her book. I am happy that she now has her own blog (although it is presently inactive). She writes for several web sites as well. Read her blog on Health Central - http://www.healthcentral.com/diabetes/c/5068/

http://www.healthcentral.com/ Many good writers on many topics.

http://www.healthcentral.com/diabetes/?ic=1102 For good writers about diabetes.

http://www.diabetesselfmanagement.com/Blog/ Good writers about diabetes and diabetes related topics.

http://www.mayoclinic.com/health/diabetes/DS01121/TAB=expertblog

http://diabetes.about.com/b/ Presently this site is lacking a writer for type 2 diabetes.

http://www.healthcentral.com/diabetes/c/110/94942/misconceptions This is a post from Nov 15, 2009 by Dr. Bill Quick. Since it is different than most that you read, I thought you should consider reading it. You may find other posts of his here on Health Central - http://www.healthcentral.com/diabetes/c/110/

http://notmedicatedyet.com/blog/2009Nov.html#110909 This is a blog by Tom Ross that will take you to Nov 2009 and you will need to scroll down to his Nov 9, 2009 post. This is an example of Tom at his best and I agree with what he says.

I belong to a couple of forums about diabetes and this repeats itself very often. All are searching for some simple rules to get their blood glucose under control so they can return to living. They do not realize that diabetes is a 24/7/365 problem they must deal with. Many, but not all, do not want to hear what they are told and never post again. Others take a different tack and reposition their question to elicit a response more in their favor. Failing with this, they post the same or similar questions on several forums. A few wake up, pay attention, and proceed to ask the real questions. They are receptive to the variables and the idea that the "rules" are the ones they discover about their own situation and body chemistry.

We can tell people that "what works for me, may not work for you," but many do not listen. When something does not work, they blame the forum and its' members and do not return. They keep looking on other forums for answers, but do not find them and never post again.

I may be wrong, but "rules" and "quick fixes" seem to be at the top of a list of what these people are looking to find. Very few are type 1's, and the majority is type 2's. Many, unfortunately, do not have insurance and are unable to do everything they should to test as frequently as they need to for determining what foods their body is capable of handling. Controlling their blood glucose now becomes a problem which their doctor often cannot help.

Many people become horrified when I tell them that they must become their own lab rat and conduct experiments on themselves. With type 2 diabetes folks, I am sorry to say, this is the only way you will discover what works for you. What works for others, quite often will not work for you. Testing is the only reasonable path to discover the meal plan that works for you and gets you the blood glucose levels to manage your diabetes.

http://ndep.nih.gov/ While this is a government website, the information on diabetes is good to read.

http://diabetes.webmd.com/ Please read this site with care. There is much good information with some poor information sprinkled in.

http://ginews.blogspot.com/ For those interested in learning more about the glycemic index and glycemic load, this is an excellent site. And the GI News letter is good to have. I started out as a big advocate of the GI and GL information, but that has waned to the point that I know there is often conflicting evidence available from reputable sources and treat it accordingly. I will continue to use this information as a guide, but only a guide.

http://www.glycemicindex.com/ The website for the Glycemic Index.

http://www.drugs.com/sfx/ This is not complete, but it does have its value for those who may need to look up the side effects of the medications they are taking.

http://www.cdc.gov/ This takes you to the main page and then you may research whatever you desire on the Centers for Disease Control and Prevention.

http://www.fda.gov/ This is the main page for the Food and Drug Administration.

Yes, there is a lot more diabetes information available and this only scratches the surface. Use your search engine and try to find other information. Another blog of mine may give you assistance of a different type.

Where Will You Learn About Diabetes?

Part 1 of 2 parts

This is the topic for this blog. Where will you learn about diabetes?

This is not an easy topic as there is too much poor information on the internet. I will cover what I consider good to excellent information and cover some areas that people may not agree with me. Note: I am not a follower of the American Diabetes Association (ADA), or now the American Association of Clinical Endocrinologists (AACE) because of some of the activities and levels of diabetes care they advocate. Too me they are allowing too much margin for harm in the guidelines they promote. I do cover them in some blogs, just because I feel it is necessary and to glean the good information that happens to appear from time to time. Plus, it is important to know some of what they do and what everyone is following because they set the official guidelines that doctors are supposed to follow, although I have found a few that do not adhere to them 100 percent.

Granted, I have my own biases and have my own agenda and you will know where so I will not try to deceive you or hide this from you. I do attempt to present both sides allowing you then to decide for yourself which direction or information you want to follow.

I will start with this blog that I wrote early on and it still has value for me. It is a list of books in my library and should be good reading for everyone. There are some other excellent books not on my list. When people like David Mendosa review them, I quite often add them to my library. There are some excellent books available, but there is also a multitude of mediocre and poor books.

Some of the poorest books aimed at people newly diagnosed with type 2 diabetes are books with the term diabetic in the title. Many are diabetic cookbooks and these are a very poor investment and I don't care who they are published by. The recipes are often very poor and loaded with high levels of carbohydrates. In addition many of the recipes are not common foods you and I would eat and a few have very difficult to find ingredients. I know because I purchased four of these and could not use them. They ended up in the landfill.

Internet sources are often difficult to distinguish as being great, good, fair, or poor. And then there are too many that are trash and promoting snake oil. Presently there is not a cure for diabetes. Even though there are many people that are able to avoid medications or get off of medications and live a healthy life, if they go back to prior bad habits and don't take care of themselves, type 2 diabetes will return. It is amazing the numbers of these people there are and they will attempt to convince you they are cured. I am happy they are able to manage their diabetes with a healthy meal plan and exercise, but they are not cured.

Before I continue with internet sources of information, there is another topic that needs to be covered.  I really believe this and at almost 10 full years with diabetes, they have helped me even more. They are five things that apply immediately after diagnosis, but I have found they apply later as well. I am adding a sixth item as it has helped me with the other five and especially in the battle with depression and diabetes burnout.

Develop and keep a positive attitude. This is a key for me and helped me through several minor depression periods and especially the burnout last year.

Forget about the past. This can be invaluable when diagnosed. Hanging onto the past or trying to base what you do now on the past, will normally cause problems for you. A diagnosis of diabetes requires learning new skills and starting new habits that will foster excellent diabetes management. Plus, the past can't be changed.

Be careful to not over do things and stay away from extreme changes. This is sage advice although many people do need to lose weight. It is wiser to carefully plan for this and then implement a weight loss program. Doing this will help prevent the period of discouragement when you hit the weight loss plateau and have to make adjustments to restart losing weight. This also applies to other changes like exercise. It is better to consult your doctor and make sure there are no medical reasons that will stop an exercise regimen.

Realize that it is not your fault. Yes, there many variables and as to which triggered the onset of diabetes may be impossible to determine. Genetics could be the only reason, yet there could always be other factors that you had no control over. So stop kicking yourself and learn to deal with the diabetes.

Above everything, relax and don't panic. Please relax. I know that this is not what many people do and by letting panic and stress take over, you are only making your diabetes that much more difficult to manage. Learn that stress is bad for diabetes and can make excellent management more difficult. Take time to find ways to reduce stress and know what works for you to keep it to a minimum.

Be prepared to accept different treatment options. This is an area where your doctor may have some excellent suggestions based on your recent history. Some doctors do abdicate their responsibility for whatever reason, so be prepared.

Depending on your blood glucose at diagnosis, you may want to consider starting on insulin and after getting control of your diabetes then going to oral medications and then to no medications. Or if your diabetes is caught early, starting on oral medications and then moving to no medications if possible. A lot will depend on other medical conditions and your ability to control your weight with nutrition and exercise.

Just remember that others have been down this road before you and speak from experience. These are rules that most people want to ignore for some unknown reason. Granted the diagnosis is a shock to most individuals, and this will take over for some.

Overall, 15% of people with type 2 diabetes don't take any medication (managing blood glucose levels with nutrition and exercise alone), and 57% take oral medications alone, without injecting drugs like insulin. Sixteen percent of people with type 2 diabetes take insulin only, and 12% use a combination of insulin and oral medication.

I will take up internet sites for education in the next part.

Will You Be Able to Make the Lifestyle Changes Necessary?

This is the topic for this blog. Will you be able to make the lifestyle changes necessary?

When people are first diagnosed, often they do not consider the things in their lifestyle that need to be changed. I have had one person, a friend, ask me why he needed to change anything. Granted he was not overweight and if fact was underweight by a few pounds, according to his doctor. So we went to my blog here. I will list the components of lifestyle for change and our discussion:

Weight Loss: We agreed this was probably okay for him, but I did use this to help him understand that there were different tables. He was surprised when I used it. For a person 5' 6” tall, and medium frame, this table showed that at 162 pounds, he was actually (Ideal weight range is 142 - 156.2 lbs.) marginally overweight by 5.8 lbs. This surprised him and he declared that the doctor said he was underweight by about four pounds. I agreed that he could accept the doctor's verdict, or ask for a copy of the chart used by the doctor. He had an appointment scheduled for that Friday and afterwards, he did stop by and said I was right and the doctor had used no chart and only estimated. He had asked the doctor to pull up the chart I had used. He said the doctor had and when he saw it went through the process twice and his weight on their scale had been 160 pounds or 3.8 pounds overweight. The doctor thanked him for the site and said that was good to have. My friend felt better now and said that he would attempt to bring his weight into the ideal range.

Exercise: Here he said that at least six days per week he was walking for about an hour, either outside, or during bad weather, he was using his treadmill. We agreed he had this under control. 
 

Food: This was a different discussion and I advised him to do some reading of what others were saying about the high carb, low fat diet he was on. I suggested that he consider a medium carb, medium fat food plan, and not increase the amount of protein. He admitted that he would consider this since the high carb had caused some of the weight increase he had recently.

Sleep: On this, my friend did say that he was only sleeping for about six hours a night. Any longer was difficult for him and it seemed to him that no matter when he went to sleep, he was wide-awake after six hours. I suggested that he have a good discussion about this with his doctor. I said that he should be getting more sleep, but that it did vary from person to person. I said I would be watching for studies about this for him.

Medication: My friend said he was taking his metformin as the doctor prescribed it. He was taking 500 mg in the morning, 1000 mg at the noon meal, and 1000 mg at the evening meal. His doctor had decreased his noon to 500 mg at his last appointment and said that if he continued his improvement, he may be able to get off all medications in six months.  I said this was a good goal for him to pursue.

Heart health care: My friend felt good after his last appointment where the doctor had lowered the dose of the statin he was taking. He had been instructed to purchase a blood pressure measurement device and check his own BP twice a day and record these for the doctor. If he continued to show improvement, he would be taken off that medication.

Illness: Here he said this was not a problem.

Hormone levels: My friend said his doctor was testing him and that he was in the correct range.

Stress: My friend said he did not realize that this was a lifestyle change. I asked him if he felt stressed, and he said almost all the time except at home. He said work was very stressful and that he would be retiring at the end of the year when he was over 65. I said this would be good and should help his diabetes management considerably. I suggested that he should also cover this with his doctor and consider remaining on metformin until the A1c results after his retirement. He admitted this might be wise.

Alcohol: He said this is not a problem as he does not drink and hasn't for over 15 years.

Smoking: My friend said he has never smoked and therefore this was not a problem.

He asked about the logs he should keep. I asked if he had the software program for his blood glucose meter and he said he was not aware of one. Since he uses the same meter that I use, I said there was and we looked on the internet. When he saw the price and the cable price, he said he would be ordering these that evening. I knew he was testing more that once a day, so I asked if he was purchasing extra on his own. He said he was and that the pharmacy was aware of this and that under Medicare he would be limited to two. He said his insurance limited him to one per day so that would be a help. I asked him is he had asked the doctor to write a letter to his insurance company and he said no. I told him to do this and see if that helped.

We talked about food logs and daily health logs. He said that his wife was keeping the daily food logs for both of them since she was interested in preventing diabetes for herself as well. She had diabetes on her father's side. Daily health logs he did not know about. I showed him mine and then my spreadsheet and he asked for copies. I converted them to his system and attached them to an email to him. Then he asked to look, if I did not mind, at my health logs. He said that he could understand why I did it and said he would show the spreadsheets to his wife and maybe together they could do them.

I mentioned the support group I was a member of and asked if he was interested. He said not at this time, but that after he retired, he would be interested. We discussed this and he was surprised by the number of people he knew in the group. I also told him there were two other groups in our town and a little about each. He admitted he had not realized there were this many with diabetes. I said this was only those with type 2 diabetes. There were also some with type 1 diabetes, but I was not aware if they had a support group.

He thanked me and said he would stay in contact.