September 1, 2014

More Myths about Type 2 Diabetes

I admit I have a difficult time following some people and where they come up with some of the ideas about diabetes. Fortunately, those in our support group know better and even we get tired of some of these ideas. A few will listen to us, but others have some of these ideas buried in their psyche and nothing we say can change their mind.

Myth 1 Obesity and laziness cause diabetes. Being obese and not exercising can be risk factors for type 2 diabetes, but they are not the cause of diabetes. Most people forget about genetic factors and heredity of type 2 being in some families. Even thin people develop type 2 diabetes, but many people conveniently forget about this. In type 2 diabetes, the body can no longer make or use insulin properly.

Myth 2 You won’t always have diabetes; your doctor can cure it. This is a belief that is hard to beat back. We are told that this is the twenty-first century and there has to be a cure. Another statement many make is that your doctor is not telling you everything and holding back the cure so there is something to treat. All I can say is BS, and I don't mean blood sugar.

Type 2 diabetes is incurable; once you have it, you will always have it. However, you can keep your diabetes under tight management with diet, exercise, and medications so that you can live an otherwise normal life with minimum damage.

Myth 3 You can’t prevent diabetes. Eating a healthful meal plan and getting daily physical activity can prevent almost 80 percent of Type 2 diabetes cases. Keeping weight in the ideal range will also help.

Myth 4 You can feel when your blood glucose is too high or low. There is no guarantee that what you are feeling is accurate. Some people are irritable during elevated blood glucose and after a recent type 2 diagnosis, many can experience shaky, dizzy, or lightheaded when blood glucose drops rapidly. Other experiences can be an increase in urinating when blood glucose is elevated, but this could indicate a bladder infection. Testing is the only way to be sure if your blood glucose is high or low. Do not trust your feelings.

Myth 5 When you have diabetes, you can’t eat sweets. This is partly true and most people don't need them. Many people think that if you eliminate other carbohydrates they can have sweets, but they don't realize that most sweets have more carbohydrates than they have allowed. Others say that they are doing extra exercise to make eating sweets possible, but again they eat more than the exercise relieved. Many people overeat sweets when their blood glucose levels drop below 70 mg/dl. Generally, they would be smarter eating glucose tablets of known glucose amounts rather than sweets which might not be known. Then they wonder why they go high and often yo-yo up and down, especially on certain oral medications and insulin.

Myth 6 If you eat right and exercise, monitor your blood glucose, and take your meds or insulin correctly, you can keep your diabetes under tight management.
Oh, if it was that easy! However, there are other factors that affect your management. Illness, injuries, stress, hormone changes, and periods of aging that can cause blood glucose to become unmanageable. Even when you do everything correct, managing diabetes isn't always easy and corrections are needed. Many people do not believe this and diabetes becomes progressive and the complications flourish.

Myth 7 Diabetes only affects old people. Diabetes affects all age groups and the sooner people wake up to this, the better prevention can become.

Myth 8 Diabetes is not a killer disease. Diabetes is a global killer, rivaling HIV/AIDS in its deadly reach. The disease kills more than 4 million people a year. Every 7 seconds a person dies from diabetes-related causes.

Myth 9 Diabetes only affects rich countries. Diabetes affects all populations, regardless of income. It is becoming increasingly common everywhere.

There are many other myths and misconceptions, but I will halt this for now. This blog and thisarticle are sources used.

August 31, 2014

Do You Know This About Diabetes?

Many of the people I correspond with and those members of the support group I belong to know most of this information and many other points. Yet, many people are not familiar with some of this information while others ignore any information about diabetes until it is too late.

Most of the following can be found in reading this.

#1. About one quarter of people with diabetes, don’t know they have it. This is unfortunately true and approximately seven million people have no idea they have diabetes. I would urge people that think they have risk factors and relatives with diabetes to be checked regularly at their doctor's office.

#2. You can reduce your risk of developing type 2 diabetes by losing a moderate amount of weight. If you are overweight, consider losing about 10 percent of your body weight. Exercise is one lifestyle change that is not easy, but losing a few pounds by walking, swimming, or dancing almost every day can help in preventing diabetes. If you have risks, talk to your doctor and make sure he understands you are sincere in your desire to prevent diabetes.

#3. Insulin isn’t just for people with Type 1 diabetes. Right, approximately 30 to 40 percent of people with type 2 diabetes are using insulin. If you are moving from oral medications to insulin, this does not mean you have failed. Fact is, the sooner you start insulin, the better you will be able to manage your diabetes. A popular myth is that starting insulin means you are near to going blind or about to lose a foot. Doctors promote this because they don't know insulin and are afraid of hypoglycemia.

Insulin is the most effective treatment for diabetes and if you keep an open mind, you should be better able to manage your diabetes. If your doctor will not prescribe insulin or says you are failing on oral medications, then it is time to change doctors.

#4. Diabetes is a leading cause of blindness in American adults. I wish this wasn't true for so many people. This happens because people with diabetes do not have a dilated eye exam every year or as often as your eye doctor recommends. It is not recommended to use the eye clinic at your local mall or retail store. If you have retinopathy or diabetic macular edema, there are effective treatments to prevent it from becoming worse.

#5. Bariatric (weight-loss) surgery is a highly effective treatment for Type 2 diabetes. I am not encouraged by this and have a difficult time even including this as there is so much they fail to tell you. Once you have the surgery, you have to eat such small amounts of food that many people cannot do this. When people are unable to lose weight and all others attempts have failed, bariatric surgery is certainly an option. There are definitely risks to this surgery and people with type 2 diabetes can only expect a remission for an undetermined amount of time and not a cure of their diabetes.

#6. An “artificial” pancreas should soon be available to help people with Type 1 diabetes more easily manage their condition. For people with type 2 diabetes, this is probably one device that will not be available to you. And if you are on Medicare, don't expect to receive one of these tools that type 1's will receive until they turn 65.

#7. Medical providers and the related professions advocate a 'one-size-fits-all' way of treatment. The harried doctors of today do not have time to individualize treatment and if something does not fit their thoughts, you will be told 'it is all in your head', or you will be referred to another doctor. Doctors are so afraid of hypoglycemia that they will accuse you of failing and threaten you with insulin to keep you on oral medications. These doctors are wrong in so many ways that you should be afraid of them. Insulin should never be a medication of last resort for excellent diabetes management.

I could really use a rant, but I will end this here before I say something I will regret later.

August 30, 2014

Important News about Dietitians

The Academy of Nutrition and Dietetics (AND) is finally being set back on its heels. In their drive to become the only organization authorized to dispense nutritional information, they are meeting stiff opposition that is foiling their every move and in 2014, the organization lost their stranglehold on Michigan.

Michigan passed its Dietitian/Nutritionist Licensure Act in 2006. This created a monopoly for Registered Dietitians and excluded other nutrition professionals whether equal or better educated and qualified. On July 15, 2014, the governor signed HB 4688 into law, repealing the state's monopolistic licensure law for nutrition professionals.

The effort was a combined effort of several organizations that are working to prevent or repeal other state licensure laws. Other notable successes this year:
  • In New York, ASB 4999, a bill sponsored by the AND which we fought, ultimately died in committee because of all the messages you sent to NY legislators.
  • In the last three years, ANH-USA and its allies have managed to block nineteen separate attempts to institute monopolistic dietetic laws across the nation. We also proactively and positively reshaped the anticompetitive law in Illinois, where the AND is headquartered.
  • The federal Bureau of Labor Statistics (BLS) keeps a list of professions where each is defined in detail and statistics about it are kept. Previously, “Dietitians and Nutritionists” were categorized together, and the AND was listed as the sole certifying organization for the entire profession. In a milestone victory on January 8, 2014, nutritionists managed to get “Nutrition” defined as a different profession than “Dietetics,” and importantly, the BCNS (Board for Certification of Nutrition Specialists) is now identified as the certifying organization for nutritionists. This national, federal recognition of the unique credentials of Certified Nutrition Specialists is extraordinarily important.
  • And don’t forget our recent federal victory in which nutritionists won equal recognition with dietitians for the right to prescribe patient diets in hospitals.”

Some of the organizations working in cooperation include the Board for Certification of Nutrition Specialists (BCNS), the Alliance for Natural Health (ANH-USA), and other national groups.

August 29, 2014

Low Carb Is for People with Diabetes

Since this hit the press, more sources are picking this up and trying to make headlines with it. There are some very disappointing conclusions and what they claim are points of evidence, backed up by clinical studies. Something is very wrong and I doubt will be seriously adopted as presented. And to substitute protein for carbohydrates displaced may for many create other health problems.

Yes, the problem is that the low-carbohydrate recommendation is not low-carbohydrate/high-fat (LC/HF) that many of us are used to, but a low-carbohydrate/low-fat meal plan. This also means that it is high in protein which can also cause problems for some individuals.

This new study involving researchers from the University of Alabama at Birmingham and other institutions says patients with Type 1 and Type 2 diabetes should eat a diet low in carbohydrates. “The study, accepted for publication in Nutrition and available on the journal’s website, offers 12 points of evidence showing that low-carbohydrate diets should be the first line of attack for treatment of Type 2 diabetes, and should be used in conjunction with insulin in those with Type 1 diabetes.”

It is the 12 points I wish to draw your attention to are these:
Quoting -
The 12 points of evidence, backed up by clinical studies, are:
  1. High blood sugar is the most salient feature of diabetes. Dietary carbohydrate
    restriction has the greatest effect on decreasing blood glucose levels.
  2. During the epidemics of obesity and Type 2 diabetes, caloric increases have
    been due almost entirely to increased carbohydrates.
  3. Benefits of dietary carbohydrate restriction do not require weight loss.
  4. Although weight loss is not required for benefit, no dietary intervention is
    better than carbohydrate restriction for weight loss.
  5. Adherence to low-carbohydrate diets in people with Type 2 diabetes is at
    least as good as adherence to any other dietary interventions and frequently is
    significantly better.
  6. Replacement of carbohydrates with proteins is generally beneficial.
  7. Dietary total and saturated fats do not correlate with risk of cardiovascular disease.
  8. Plasma-saturated fatty acids are controlled by dietary carbohydrates more
    than by dietary lipids.
  9. The best predictor of microvascular and, to a lesser extent, macrovascular
    complications in patients with Type 2 diabetes is glycemic control (HbA1c).
  10. Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing high-density lipoprotein.
  11. Patients with Type 2 diabetes on carbohydrate-restricted diets reduce and
    frequently eliminate medication. People with Type 1 usually require less insulin.
  12. Intensive glucose-lowering by dietary carbohydrate restriction has no side
    effects comparable to the effects of intensive pharmacologic treatment.
The items 6 and 7 in bold are the two items I question. Replacing some of the carbohydrates with protein may work for most people, but not everyone.

By side-stepping the fat issue, they are not realizing that the lipid panel or cholesterol levels will greatly improve and statins may become unneeded. Number 8 may also be unnecessary on a medium to high fat meal plan.

August 28, 2014

Conflicts of Interest

I don't understand why some researchers seem to think that people will not check their conflicts of interest. Three recent reports have been very interesting lately. Two were about diabetes and one was about sleep apnea.

The one about sleep apnea did not mention the conflicts of interest, but further research did find the original study. Only one of the authors listed a conflict of interest as a consultant for a pharmaceutical company. By searching three other authors or researchers, two were surgeons by profession and the third was a college professor for surgery. Finding information on the remaining researchers yielded nothing.

This made sense because of the way they were heavily promoting sleep apnea surgery over other treatments. When the American Sleep Apnea Association recommends CPAP first and surgery as the last resort, for these authors pushing surgery first, this tells me that they are only interested in the money and not the health of the patient.

One of the diabetes studies was funded by a pharmaceutical company and the authors after some extensive searches were all employees of the same company. Not much confidence to be gained from that study.

The other diabetes study was also funded by the same pharmaceutical company, but the researchers were all employees or students of the same university. The lead researcher was the only one to declare a conflict of interest and that was to the study funder. And they want us to believe the studies and that the data shows legitimate information. When a study shows data that is completely contrary to other studies and what we have seen in life, how can we be expected to believe the researchers were not influenced by the funder?

No, I am not giving the names of the studies, as I see no value in spreading their messages. Three days of searches and tracing information has left me with a severely bad taste in my mouth to the point I will probably not read another study funded by this pharmaceutical company. I have had too many bad experiences with the medications this company manufactures and am fortunate that my doctors have been able to substitute other medications not from this company. I will leave it at that.

This article should be read by more people as it covers what happens when a reputable journal is sold to unknown enterprises and for $1,200 will print anything. This may be what is happening to other journals and we are not told about the sale and are therefore surprised by the junk articles we a being asked to read.

August 27, 2014

New Approach for Diabetes Patients

William H. Polonsky, PhD, CDE, has it correct when it comes to dealing with diabetes patients. Dr. Polonsky is a clinical psychologist and co-founder of the Behavioral Diabetes Institute in San Diego, CA. He said, “We've got the right medications, we have so much knowledge, and we have great tools to help people manage their diabetes effectively. Unfortunately, none of those things will work if we can't convince our patients to make use of them, and that is why we all know it comes down to behavior.”

I will be using his article in Medscape to write about this. He wrote this column based on the talk he gave when accepting the Richard R. Rubin Award at the 2014 annual meeting of the American Diabetes Association.

Dr. Polonsky says all he has done for the past 25-30 years is focus on the behavioral aspects of diabetes, both as a clinician and as a researcher. I may not be quoting him correctly, but he has said, “Diabetes causes nothing, it is the lack of diabetes management that causes complications.” I firmly believe he is correct, yet there are some that have been very vocal in their desire to have him be more politically correct and stop using this statement. Shame on them.

In some cases, Dr. Polonsky says, “The way that we use behavior-change interventions with our patients may work very, very well. But sometimes, these seemingly simple and brilliant behavior-change interventions -- such as collaborative goal setting and action planning -- just don't work at all.”

I think the reason we have so many frustrations with trying to encourage and promote behavior change with our patients is because we make 3 fundamental mistakes. I often make them myself.”

I feel that Dr. Polonsky is writing as a clinical psychologist, but I see this also in CDE's. The three mistakes he outlines are:

#1. Probably the most important mistake is that we push a little too hard. “Most of us are so concerned about our patients -- we so much want to help and we are so overtrained as problem-solvers -- that we essentially demand behavior change before our patients are ready for it. They may not be convinced that what we are encouraging them to do is really worthwhile, even if they seem to be cooperating with us. They may harbor suspicions about medications, or question whether they can really make dietary changes, or whether those changes will even make any difference.”

He says that learning to take your time and setting the right mood is important for patients.

#2. The second mistake involves what he calls the principle of the mundane. “We often "overfocus" on the obstacles that our patients face. We view these barriers to behavior change as big, dramatic complications, and that is probably the fault of researchers like me. I have made a big deal out of these things over the years: depression, eating disorders, fear of hypoglycemia.”

The one Dr. Polonsky focuses on is what he calls "meh," or apathy or indifference. Many of the patients do not view diabetes as a priority in their lives, and that may be totally justified because the patients are much like us. Life gets in the way.

So, we need to appreciate that the biggest barriers to behavior change may not be big stuff but little stuff. People may simply be overwhelmed by diabetes, just stressed and confused, and not dealing with the disease at the best problem-solving level.”

#3. The third principle is what he calls ATMs (actions that matter). “Many of my colleagues who are somewhat skilled in behavior change have fallen into this trap of diabetes empowerment: When they talk to their patients and ask where they might want to make some lifestyle changes, they imply that the particular answer doesn't matter. "Mrs. Smith, what do you want to do?" "Well, I guess I should drink more water every day. I can do that. Or maybe I should have fewer tortillas at every meal, or maybe..."

Certainly, the patient should be the decision-maker in this, but I think we must remember to get the most "bang for the buck." Instead of giving the impression that any change is admirable and will lead to even more positive behavior, we should be willing to collaborate and inform our patients about the facts. "Look, you have diabetes and there are probably 100 different things that you could do to improve your health, but they are not all equally important. We can put them in order of priority: knowing your glucose numbers is critical; smoking is a bad thing; being on the right medication and then taking it may be the most important thing. That is where you can get the biggest bang for your buck."

I quoted much of his article because it is important. There is much we as patients can learn from this. I will also be using this in my role as a peer mentor and as a peer-to-peer worker. Too often I find myself pushing and expecting because I have experiences to relay that the others should be more willing to accept my words. I have found out this does not always work and that those I am working with do not want to make changes and are looking for something easier that they can do.

One person that Allen and I had been working with kept insisting that there had to be something that he could take and reverse his diabetes. Nothing we were saying was accepted and we could tell he was not even following us. After several meetings, we had to tell him that after he wasted his money, he would be back, probably having complications, and then we would be able to help him. We did not have that chance as he passed the following week. We have learned that his blood glucose became so high that he went into a coma and died the following day.

His daughter did tell us this and asked for information on several bottles she had found on his table. We were able to find information on them and as you might have guessed, they were either for supposed cures or reversing diabetes and none were of any value. We suggested that she have a talk with his doctor and have him consider showing them to other patients and explain that they do not help. His doctor agreed and has been successful with this approach.

August 26, 2014

Leg Cramps and Possible Prevention

In order to keep the title readable, I left out muscle spasms, charley horse, and calf cramps. All may be related and are often caused by similar problems. All can be painful, wake us up during sleep, and prevent us from getting a good night's sleep. Some of us even have them during the day.

Many of us with diabetes can suffer from the pain, and not knowing the cause can be as painful when we don't know how to prevent this.

First, I want to discuss some of the probable causes.
#1. Dehydration Some people are not aware that they are dehydrated, while others when asked can admit that they could have been. If there is a chance that this is the cause, I suggest increasing fluid intake (water) during the day, unless you have a medical restriction.

#2. Potassium deficiency Are you taking a diuretic for hypertension, many people with diabetes are taking at least one. Doctors hesitate to do the necessary tests to determine deficiencies of potassium. Magnesium, calcium, and vitamin B12 and a few other minerals need to be tested.

#3. Neuropathy If the person has neuropathy, there may be hyperactivity of the nerve/muscle causing the cramps. Malfunctioning nerves, which could be caused by a problem such as a spinal cord injury or pinched nerve in the neck or back? For neuropathy, vitamin B12 is often the culprit.

#4. Overuse Have you been exercising more than usual? Muscles that are overused can cramp. This is often the least cause and generally will disappear after a few days. Be careful of exercising in the heat and not stretching correctly before exercising.

#5. Exposure to cold temperatures or cold water Take a warm shower or bath before bed to relax the muscles and make sure your body is warm before going to bed.

#6. Other medical conditions Blood flow problems in the legs (peripheral arterial disease), kidney disease, thyroid disease, and multiple sclerosis can cause cramps..

#7. Sitting for a long time This is something many people miss, as well as standing on a hard surface for a long time, or putting your legs in awkward positions while you sleep.

#8. Taking certain medicines Medicines, such as antipsychotics, birth control pills, diuretics, statins, and steroids are common causes of leg and muscle cramps and can be side effects of the medications. For a more comprehensive list, read this article in WebMD.

#9. Poor blood circulation in the legs This should be checked by your doctor as this can become serious and lead to other problems.

What if muscle cramps keep coming back?
Have a serious talk with your doctor if the muscle cramps keep coming back are severe enough to consistently interrupt you sleep. These may be symptoms of another problem, such as restless legs syndrome. If cramps keep coming back, bother you a lot, or interfere with your sleep, your doctor may prescribe medicine that relaxes your muscles. If any of the above conditions exist and the doctor will not test for the deficiencies in number 2 above, it may be necessary to consider a new doctor.

Other help for muscle cramps include calf muscle stretches done routinely before going to bed. This is a pretty low-risk intervention and should be worth a try. You may read about this in this blog.

How can you prevent muscle cramps?
These tips may help prevent muscle cramps:
  1. Drink plenty of water and other fluids, enough so that your urine is light yellow or clear like water.
  2. Limit or avoid drinks with alcohol or caffeine. These can make you dehydrated, which means your body has lost too much fluid.
  3. Make sure you are eating healthy foods that are rich in calcium, potassium, magnesium, and vitamin B12.
  4. Ride a bike or stationary bike to condition and stretch your muscles.
  5. Stretch your muscles every day, especially before and after exercise and at bedtime.
  6. Don't suddenly increase the amount of exercise you get. Increase your exercise a little each week.
  7. Take a daily multivitamin supplement.
  8. Use a heating pad on the affected muscle.

If you are taking medicines that are known to cause leg cramps, your doctor may prescribe different medicines or change to dose to provide relief.

August 25, 2014

Children and Sleep Apnea

This study found overweight kids who had surgery were more likely to become obese within seven months. Tonsillectomies are commonly done to relieve sleep apnea in children, but a new study confirms that the treatment can speed kids' weight gain -- especially if they're already overweight. This is often the problem and many surgeons will not tell the family that this happens and urge them to exercise with their children to prevent this from happening.

The researchers did say that it is a concern, because obesity is a risk factor for a range of health problems, including sleep apnea. They are not advising against tonsillectomy for the children who need it. They are saying that doctors (plus surgeons) and parents should be taught that a healthy diet and exercise become even more important after the children have surgery. The researchers state that the surgery does create a 'certainty' that weight gain is an effect of the surgery.

That's because children in the study were randomly assigned to have surgery or to "watchful waiting" -- putting off surgery and staying with other options, such as medications to better control any nasal allergies or asthma symptoms. Altogether, 204 children aged 5 to 9 were assigned to have surgery right away, while 192 stuck with watchful waiting. It was found that over seven months, children who underwent surgery showed a quicker average weight gain, versus kids in the comparison group.

It was a small difference overall. And for children who were normal weight, there was no major effect. It was not making normal-weight children obese. It was alarming that of those children that were overweight before surgery, 52 percent had become officially obese seven months after surgery. 21 percent of overweight children in the watchful-waiting group were obese.

Sleep apnea also causes metabolic changes. The growth hormone is released at night, and sleep apnea can interfere with that. The body may adapt metabolism in an effort to maintain a child's growth. Then when sleep apnea is managed, the children are set up for rapid weight gain. Now, with childhood obesity on the rise, many kids with sleep apnea are already overweight or obese. If they rapidly put on pounds, their sleep apnea might return in six months to a year.

Diet and exercise are key for children with sleep apnea. Many can do well without surgery using CPAP, proper nutrition, and exercise. This reminds me of blogs from February and March 2012 when I was sending articles to a set of parents in another state that were trying to avoid surgery on their son. Their insurance and I agreed that surgery should be the last resort and they are very happy this was possible. Their sleep doctor emphasized proper nutrition and exercise with the CPAP use and the entire family has responded very positively.