January 28, 2015

Help in Diabetes Management Education – Part 2

Part 2 of 12

Blood glucose testing will depend on how many test strips your insurance company will pay for and then on your budget. I don't expect everyone to able to test for what is ideal, but I will list the ideal first to give you a basis. This is also one reason I urge people to ask their doctor for extra test strips at the beginning to help them determine what works for their food plan and which foods to limit or eliminate. This will also allow you to determine the time from first bite or last bite to the peak in your blood glucose. This varies for each individual and you should determine what your peak is for each meal. Many have their peak at one hour and others at two hours. Some like me peak at about 90 minutes and others a two hours and thirty minutes. This is a variable that you must determine for your body. This can change as you age, so be aware of this.

The first time for testing is when you wake. This is also your before breakfast blood glucose test (termed preprandial). Then you should test about one or two hours after breakfast. Do this for each of your meals and then before going to bed. Then you should always test before and after exercise unless you are on oral medications that do not cause lows (hypoglycemia). Read my blog on blood glucose levels that are safe for exercising. Some people with type 2 diabetes do exercise with blood glucose levels that are too low or too high.

If you are on insulin, you should test before and after exercise. With the position of the ADA and actions by some states on people driving with low blood glucose levels, it is also wise to test before starting to drive and stop and test if you feel low. Some states are suspending driver's licenses when it can be determined that an accident happens that is caused by hypoglycemia. Other causes include if you are stopped while driving during an episode of hypoglycemia. In other words, know the law in your state. The above link is to a prior blog on driving, and this is the link for the 2105 guidelines for diabetes and driving – actually a use of the 2014 guidelines which was not changed for 2015.

Most people on oral medications are limited to one or two test strips per day depending on the medication. Those using insulin are generally limited to three test strips per day. This means that you are limited in the testing you can do and what you can do for experimenting. I know quite a few people on oral medications and on insulin that purchase the extra test strips to be able to experiment and determine the best postprandial time to test. They also used the extra test strips at the beginning that their doctors were able to have approved to determine what foods they could eat, what needed to be limited, and the foods they needed to eliminate.

Developing their meal plan was also a priority for them and a few that needed to spend their own money for extra test strips to do this experimenting. When I meet someone that has done this or even receive an email about the success from doing this, I always feel good for the person. This is management at its best and means to me that the person wants to learn how best to manage his or her diabetes. Oh, yes, we all make mistakes or errors, we are human, but if we learn from these, we are better for these mistakes.

January 27, 2015

Help in Diabetes Management Education – Part 1

Part 1 of 12

How many parts this will evolve into is a big question, but by the above you know that this will be in twelve parts. The first part is about knowing your equipment, how to use it, and the temperatures at which it can be operated. Yes, I have written about this before, but I still receive emails asking me where to find this information. Unfortunately, some of the emails tell me they could care less about proper storage or even using their meter at the proper temperature or even the test strips, as the doctor does not look at their logs even though he is the one telling them to test.

Sadly, this involves many patients and too many think they are testing for their doctor. Many of these are the same people that take the prescription for the pills (oral medication) and keep on the same destructive lifestyle. Yes, they take the medication or medications, but nothing else is changed. It is when they have the second or third appointment and the doctor tells them that their A1c is getting worse and really chews them out, that some wake up and decide to change, but again they don't know what to do or even how to make the changes necessary.

Knowing and learning about your diabetes equipment is saving the instructions that came with the equipment. Yes, the print is often smaller than many people my age enjoy reading, but that is why I keep a magnifier on my desk. The instructions for the meter are important and should be read. Learn the operating temperature range and the same for the test strips. Always keep the test strips in the container they are in and know the places not to store them.

A few summers ago, I had to wrap a cold pack in a towel and place it in a cooler and put my test strips in a large cooler when the air conditioner quit working. The temperature in the apartment was over 100 degrees and fans did help, but not enough for the test strips. I did not have any problems by storing them using this method.

In many rural or less populated areas of the United States, certified diabetes educators are not available so hopefully your doctor will give your some help or have a nurse that can help you. Diabetes support groups are also a good resource provided they share information and teach.

In the area I live in, I am aware of two certified diabetes educators; however, they have the title of registered dietitian (RD) listed before the CDE title. We have discovered they do more to preach high carbohydrate – low fat than they talk about managing diabetes or even how to test. We have determined that they don't want us to test to discover how their food plans spike our blood glucose levels. The emphasis is very heavy on whole grains and we all have found that this does not work for most of us with type 2 diabetes.

We are happy that my cousin, Suzanne, has been working with the members of our support group. Even the new members have been appreciative of her help and are asking when we will have her back. I have said that they may contact her when they have questions and that is why she gave them a business card with her telephone number on it. Most say that they don't want to abuse this as she can only charge their insurance or Medicare for two hours and they don't want to use up their time immediately. I tell them to ask questions the next time she will be present, as we are planning that for February.

January 26, 2015

Gift Ideas for a Person with Diabetes During the Year

We are all aware of getting gifts for people with diabetes during the holidays, but do we think of gifts for birthdays, anniversaries, and other special days. With that in mind, here are a few ideas that are not just for Christmas, but also for anytime.

Medical alert jewelry is always a great gift; however, make sure that the recipient will wear it. I have been shocked at the number of people with diabetes that will not wear anything that identifies them as having diabetes. In conversations with several emergency medical technicians (EMTs) over the last few months all commented how few people actually wear medical alert jewelry of any type.

All agreed that too often people are given medication that they are allergic to or have bad reactions after a few minutes. Several commented that the police that often arrive at a person's residence do a search for medications and check the refrigerators looking for medications requiring refrigeration. One of the EMTs stated that he likes people that have medical alert information where it can be found as this often means better treatment and a phone call will alert them to medications that could be life saving for the person.

Another commented that in many cases where the husband and wife are both alive, sometimes one spouse will not be aware of what medications the other spouse is taking. He has also seen one spouse refuse to give information that could be critical to the treatment of the spouse in trouble. Often they have brain freeze and cannot think when a loved one is in trouble.

Fresh food is always appreciated. Avoid 'food of the month clubs,' as you will often pay more than at the local grocery store and for poorer quality. If your friend lives in a cold climate, warm gloves, thermal socks, cashmere scarves (even the wool variety), and warm hats are often much appreciated. These will help in the cold winds and help reduce the stress on the organs.

If you have the funds, exercise machines can be a great exercise aid. Before spending the money, be sure that there is space available and that the person has the ability to use the equipment. If the person is one that likes massages, facials, or other pampering sort of things, then consider these. Be sure to avoid tanning beds, as these are not safe. The tanning bed manufacturers will claim otherwise, but they are still not safe.

If you have youngsters on your list, how about lessons in Karate, dancing, fencing, basketball, or other sport they may have an interest? Always be sure that the parents will support the youngster in this. Some children and even teens enjoy reading and will love books. Check to be sure if they have an interest in a series or particular author.

If a person with diabetes works, buy them a slow cooker. They can leave for work in the morning and come home to a cooked meal at night. If necessary, consider adding a slow cooker cookbook.

If the person with diabetes needs to be in contact with others because of health issues, think of a cell phone. This might help allay anxiety when they are alone. Be sure that you can afford or the person can afford the monthly bill.

For an elderly parent, an alert necklace with a button that can be pushed to summon help by the police can help after falls or other events where the person is threatened or fears outsiders can be of help. Even web cameras if the parent will allow them can help and make the elderly parent more comfortable. Then you can keep tabs on them from your computer at home and in some cases from work. Be sure your employer will allow this first.

January 25, 2015

Our Second January Meeting and a Surprise

As soon as Tim said we would have our second meeting this month, Brenda and Jason have been busy, and both Brenda and Sue have been in contact with me about images to use. I pulled up several images like the ones below and emailed them to both.

Brenda said she was forwarding both to Tim and she said the top picture was close to the one she saw. She was not sure she could get the name of the antibiotics used, but she knew the place where the member received her prescriptions and maybe the member would let her see them.

When the date arrived, January 24, we were ready. Only one member was absent and that was the one that Sue was working with to heal the foot ulcer. Sue said the doctor had ordered her to stay off her feet for a week or more and she did have crutches. Tim called the meeting to order and stated that we have told you we are interested in helping each and every one of you and for you to ask questions. He said we have one member absent because of a foot ulcer and another person that is here while still recovering from a cracked heel. The doctor has also ordered her on crutches. So before we start this evening, everyone sit down, take off your shoes and socks or stockings, and have your feet ready for inspection.

There was a lot of grumbling, but everyone complied. Allen brought out the two stools for the people to rest their feet on during the inspections. Tim had not told us he had two podiatrists coming, and he went to the door and invited them in. Tim introduced them and said he had arranged for everyone to obtain a free foot inspection. The one podiatrist that knew me came to me first while the other went to Allen first. When they had finished with us they explained what they had seen and the podiatrist that examined me asked me to sit on the rolling stool and pushed me around the group to show them the big toe that he knew about and he announced that it had not changed much since he had last seen me. He did say that the damage was under the toenail and not the toenail as he had originally thought as the toenail was growing. He said I had notified him at my last checkup and he would keep watching it. With that he asked me to notify his office if there were more changes, but for now he was not concerned. He asked me to put my socks and shoes back on and assist him.

The podiatrist that had examined Allen said he found nothing and that Allen's feet were in good condition and to get ready to help him. With that we moved the stools while the doctor took the chairs they would use. They checked the older members first and found nothing other than one scratch on Rob's ankle which Rob said he was using Neosporin on it before bed each evening. The podiatrist said it looked like it was healing. Next they started with the member with the cracked heel and the podiatrist said it was healing well and if she continued to follow the treatments she should be okay in another two or three weeks.

Next, my podiatrist examined Jerry and said that the foot ulcer was healing nicely and as long as he continued the treatment the doctor has prescribed, it should be okay in another month. Jerry said that was what the doctor had told him. We continued with the rest of the new members and found two more members with minor cracked heels and another member with the start of a foot ulcer.  One in-grown toenail was also found. They were advised to see their doctor as quickly as possible or to make an appointment with one of them the following week. The three were told if they wanted prescriptions to help them start the healing, they would be given one.

Tim said that this evening was done for their benefit and the rest of the members wanted what was best for them. But with the problems happening the prior two weeks, this was what brought this meeting about. Then he asked if anyone did not have insurance. When no hands were raised, he asked why people were not taking care of their health. He apologized to the doctors for interrupting and asked them to finish their talk about proper shoes.

The doctors said most of the cracked heels were probably caused by wearing the incorrect shoes or foot support around the house or apartment. During the winter, wearing shoes without proper heel protection helps aggravate dry and cracked heels, and he was not talking about high or spike heels for women. If they wanted to wear elevated heels with proper foot support, those could work.

For the foot ulcers, they strongly recommended wearing foot support in the shoes and these needed to be custom fit by a specialist and they could give them at least three that the person could chose from. They had seen the supports that Max had and asked him. Max gave the name and they agreed that the person was good. Jerry asked how soon he should consider getting fit for them and they said not until the ulcer had healed, but that he could get one for the other foot anytime.

Tim asked if anyone else had any questions and there were a lot of questions from the newer members and a few from the older members. In the meantime he told Brenda and Jason that he had taken over the program when he got acceptance from the two podiatrists as he felt that this was best. Brenda and Jason agreed that this was more effective and had been well received. Tim thanked them and said he would not do this again without notification, but he had only received confirmation about an hour before the meeting.

I went to thank the podiatrists and they admitted they had hesitated, but after seeing the number and the interest, they admitted that it was worth the trip. I commented that they should pick up a few patients as well. They both agreed and Tim said the meeting is over. About another half hour was spent with many asking questions and then the two doctors needed to leave. Many of the members said thank you to us as they left.