August 5, 2015

Self-Monitoring of Blood Glucose – Part 1

Why is it that type 2 bloggers are the only ones that urge other type 2 people to test regularly? And yes, it can be tough on a budget. I will not deny that, but with the testing supplies and meter that can be purchased at Walmart, this should help many people. Other people can write the manufacturer of their meter and request financial assistance. You will need to follow their instructions carefully or financial assistance will be denied.

A great way to manage diabetes is through self-monitoring of blood glucose levels (SMBG). There are limitations and barriers to SMBG, which ultimately affect outcomes related to adherence of medications. Most people do not care and that is a shame that they are willing to let diabetes manage their lives. Even this article in Diabetes in Control does little to educate people about SMBG.

The study researchers felt the study revealed barriers to blood glucose testing and integration of testing in the lives of patients. The main outcome of this study was to find out the perspective of patients of SMBG in a clinical setting. The study suggests that patients are having a difficult time incorporating SMBG in their lives. Many patients are not even sure of their target glucose goal, which diminishes their motivation of SMBG. More education is needed to promote best practice for SMBG.

Most people on a budget refuse to use the supplies necessary to help them manage their diabetes. This forces them to operate in the blind and not manage their diabetes and then they become upset when their A1c trends upward. Others refuse to test because they don't want to prick their fingers because they fear the pain. I can only say that if the testing is done properly, there should be little pain and while I will admit that occasionally I test outside the best area on the side of my finger tips, I seldom have much pain.

This is wrong and you should expect pain here.

Still the wrong area and expect more pain here.

Image result for blood glucose testing This is the area that is generally the best for testing.

Many people do not take the necessary steps to properly test. You should wash your hands with warm (or as hot as you can tolerate) water and soap. Then rinse and thoroughly dry your hands. Do not handle test strips with wet hands, as you will make the reading unreliable. Been there, done that, and it is a great way to waste test strips. Once your hands are washed and dried, then you may consider yourself read to test.

First, have the lancet device ready for use. Second, remove one test strip from the test strip container and carefully insert it into the slot on the meter. Now set the prepared meter down and use the lancet device to prick your finger. If you do not receive enough blood, it may be necessary to increase the depth the device will penetrate the skin and reprick your finger. It may be necessary to gently squeeze the finger to obtain sufficient blood. Now, take the meter with the test strip inserted and gently guide the test strip into the blood, letting the blood wick into the test strip. Gently set the meter, with the test strip still in place, on the counter so that the number that appears after about five seconds can be easily read. Now, you are ready to record the time and the reading.

Continued in the next blog.

August 4, 2015

Joslin Pushes Carbohydrates

No, they are not pushing a certain number of grams, but pushing just the same. For those of us using a low carb/high fat food plan this should be unacceptable. The Joslin site receives many new to diabetes people and their promotion of carbohydrates will lead these people down the path to poorer A1c's and other problems.

Quote - Everyone needs carbohydrates or “carbs” to give our bodies the energy necessary to work and play. Carbs are made up of starches, sugars, and fibers. Carbs also provide us with lots of vitamins and minerals. People with diabetes need to pay particular attention to carbohydrates, as these foods become glucose in your blood. They are not the enemy. - Unquote.

Fat also is used by our bodies for energy for work and play. Often other sources of food provide us with more vitamins and minerals. Yes, we need to pay a lot of attention to carbohydrates because this is the cause of high triglycerides and is converted to glucose, which causes our blood glucose levels to spike to unreasonable highs. Many people do find that carbohydrates are our enemy.

Quote - But be selective; some carbs are really healthy and others are merely empty calories. We all know that cereal, pasta, rice, and breads are rich in carbs. Go for the whole grains, the brown rice and high fiber foods- check that food label! - Unquote

Yes, we all know that cereal, pasta, rice, and breads are heavy in carbohydrates. Be very careful about whole grains, brown rice, and high fiber foods as they don't affect everyone the same. Learn the value of “testing in pairs” as this will reveal how badly these foods raise your blood glucose levels. Joslin will not tell you about this.

Quote - Some other healthy carb choices include starchy vegetables, such as peas, corn and winter squashes. And I bet you didn’t know that beans such as those in chili or three bean salad also contain carbs. Fruits are another delicious healthy carb choice- but watch out for fruit juices. They are loaded with carbs and the very important fiber you get from eating a piece of fresh fruit is gone. So forget the juice- eat the orange! - Unquote

Starchy vegetables are loaded with carbohydrates and this includes carrots. Yes, beans also contain carbohydrates. If you need a list of low carbohydrate vegetables, please read this. Now most fruits have very few carbohydrates, but contain more sugars and fructose. Joslin is correct in their statement of forgetting the juice and eating the whole fruit if you insist on having fruit. Limiting the amount of fruit consumed is often wise unless you have done your research. Many berries can be healthful unless over consumed.

Mindless eating at crowded gatherings or while watching TV needs to be replaced with mindful eating. When we are distracted, we tend to eat more than when we are consciously watching what we eat, savoring our food, and chewing it thoroughly.

And the last part of this blog is important. We all need fiber for our systems. This helps our intestines move the waste through our system as will the fat and
help the bacteria that are naturally there do its work in moving the nutrients into our blood stream where it can be utilized.

August 3, 2015

SGLT2 Diabetes Drugs May Cause Diabetic Comas

The Food and Drug Administration (FDA) recently posted a warning that three drugs used to treat type 2 diabetes—canagliflozin (brand name: Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance)—may lead to diabetic ketoacidosis, or DKA. As if this wasn't enough, several cable channels have ads for joining a class action lawsuit against the makers of canagliflozen. The other two companies may also be victims of this action in the future.

This is one reason I will never use a new drug until it has been on the market for several years. Granted I will probably never use any of the oral diabetes drugs other than metformin (this is now off the medications list for me because of stage 3 kidney disease). Thank goodness, insulin is still working wonderfully! More people with type 2 diabetes should actually consider insulin as the course of treatment.

Ketoacidosis is a condition that can lead to diabetic coma and even death. The signs and symptoms of DKA include difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. Normally, those with type 1 diabetes are at risk for DKA, whereas it is a rare condition for those with type 2 diabetes. Read my recent blog on DKA here.

This is another in a long line of examples of the harm Big Pharma’s drugs can and do cause. When it comes to the development of new ways to treat diseases, the current system drives the creation of increasingly exorbitantly priced drugs

It is possible for many diabetics to keep their blood sugar levels close to a truly normal range with an integrative approach. Below are some natural ways to control or even reverse diabetes. Please remember that any significant changes to your diet, supplement regime, testing, or lifestyle should be made only after consultation with your doctor or diabetes specialist.
  1. Diet. A diet loaded with leafy greens and other low-starch veggies, high-quality fats, and clean sources of protein are helpful in controlling blood glucose. Be sure to look for a nutritional advisor who is independent, however! Organizations like the Academy of Nutrition and Dietetics and the American Society for Nutrition receive major funding from corporate food interests, including junk food companies. In stark contrast, the Board for Certification of Nutrition Specialists is not similarly compromised.
  2. Botanicals. Jonathan Wright, MD, notes that several studies show that berberine, an alkaloid found in the herb goldenseal, can lower blood glucose as effectively as the drug metformin at similar doses (500 mg 3x/day). Indian kino gum resin (Pterocarpus marsupium) has been found to regenerate the beta cells that make insulin in the pancreas. This finding validates its long use in Indian Ayurvedic medicine for diabetes. Other herbs or food ingredients researched for control of blood glucose include cinnamon, bitter melon, and the fruit Garcinia cambogia to enhance insulin sensitivity.
  3. Supplement wisely. According to Dr. Julian Whitaker, the water-soluble antioxidants and other nutrients that protect against damage may be lost in the excessive urination that accompanies diabetes. For this or other reasons, people with diabetes are more prone to develop kidney disease. All vitamin, mineral, and amino acid levels should be checked, monitored, and kept in normal range with supplements if necessary, along with checking blood glucose, insulin, and A1c, a longer-term marker for blood glucose. Dr. Whitaker particularly recommends supplementing with magnesium and chromium, and alpha lipoic acid and acetyl-L-carnitine for peripheral neuropathy.
  4. Exercise at least thirty minutes every day. This will also control blood pressure.
  5. Take care with prescription drugs. Besides the above warnings, the FDA has launched a safety review of the diabetes drug Actos in light of new data suggesting that the drug may increase risk of bladder cancer. And a combination of two common drugs, one an antidepressant, the other a statin used to lower blood cholesterol, may put people at risk for developing diabetes. This finding is especially important because so little is known about how drugs interact with each other, and so many people are prescribed multiple drugs together. The good news is that it is often possible to control diabetes without the use of any drugs.

July 31, 2015

Treatment of Type 2 Diabetes – Part 4

Injectable Drugs and this includes insulin.

These medications slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes. Some also help your pancreas make insulin. These are GLP-1 receptor agonists. Some of them you take every day, while others last a week.

A different drug acts like a hormone, amylin that your pancreas sends out with insulin. You only take pramlintide (Symlin) if you're also using insulin. Please, and I urge you to read this blog about the injectable drugs as there are many warnings and instructions that need to be obeyed.

People with type 2 diabetes sometimes need insulin. It could be a short-term fix for a stressful situation, or because other medicines aren't enough to control their blood sugar. Some people need insulin because the oral medication has caused their pancreas to stop producing insulin.

You can take insulin with a needle and syringe, with a device called an insulin pen, or with an inhaler. Some people use an insulin pump to get it continuously.

Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

Weight loss surgery is now a fad and can create large medical problems and nutrition deficiencies. Once done it often cannot be undone and most of the real problems are not made known to you by the surgeons because they don't want to lose the money they can make off of you.

Surgery apparently raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication.

It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds. Most surgeons use BMI for their guidelines and they could care less about the warnings they should be giving you.

Other doctors will recommend a weight loss drug. I will also urge you to read my blog about weight loss drugs not being what they are advertised to be.

Part 4 of 4 blogs.

July 30, 2015

Treatment of Type 2 Diabetes – Part 3

Physical activity, yes, exercise, can be from doing chores or another activity like running. The most important thing for you to do is find a physical activity that you enjoy and can perform on a daily basis. This will help manage your blood glucose levels and generally helps lower blood glucose. It definitely helps your cell and muscles use glucose and insulin.

Now don't be foolish about physical activity. Too many people exercise when their blood glucose levels are too high or too low. My blog here explains the correct blood glucose readings for exercising. It is always a good thing to check your blood glucose levels before and after exercise.

Using the right meal plan and being active can help you lose extra pounds and stay at the proper weight for you. This will also help you manage your blood glucose levels. Unless your doctor has already given you the okay to exercise, always ask if there are any limitations you should be aware of before establishing an exercise regimen.

The next discussion will be on oral medications and I will give you several blogs instead to a lengthy discussion here about each class of oral diabetes medications. The first blog covers several classes including metformin.

Metformin should be the first medication your doctor recommends. Yet, many doctors go with other medications. The Sulfonylureas seem popular in this area. I am not sure why it is this way. The sulfonylureas basically force your pancreas to make more insulin, which can result in hypoglycemia or low blood glucose readings below 70 mg/dl.

The next drug class is Meglitinide and is covered in this blog. Basically this drug replaces sulfonylureas if you are allergic to sulfa as I am very allergic. Prandin is the only drug in this class.

DPP-4 inhibitors are the next class and its task is to slow the hormones that give your pancreas the signal to produce insulin. This allows the insulin to work longer to lower your blood glucose after a meal.

Thiazolidinediones, TZDs, or glitazones is the next class and its purpose is to lower insulin resistance to help you pancreas work less.

Alpha-glucosidase inhibitors help slow the digestion of complex carbohydrates and prevents your blood glucose from spiking after your eat.

Some work by letting your kidneys pee out extra sugar. They're SGLT2 inhibitors.

Cholesterol-lowering drugs called bile acid sequestrants can also help lower your blood glucose.

You can take these medications by themselves or in combination with others, including insulin. Some pills have included more than one kind of drug and they are combination pills.

Part 3 of 4 blogs.

July 29, 2015

Treatment of Type 2 Diabetes – Part 2

There are two things that can tell you how well your treatment plan is working. That is your A1c and your daily blood glucose readings. The later is most important and it is sad to say that your doctor has a lot to say about how many test strips your insurance will allow and pay for your use. I strongly urge new patients to get as many as the doctor will support for testing the first three or four months.

This will allow you to test in pairs to help you determine what foods are safe in your meal plan and which foods to eliminate and others to limit. We already know that most whole grains will be strictly reduced or eliminated, as will most potatoes and rice. It is still a good idea to consume a limited quantity to see if you can handle them without the spike in blood glucose. This is one time that “what works for me, may not work for you” becomes a rule that you should know.

In other words, just because a friend can consume whole grains and have little effect on his blood glucose, does not mean that you will have the same results. Remember, you are unique and your body reacts to foods and medications differently than the next person. Yes, there are people that can be very similar to you, but if you met the person, you might wonder how. The bell curve is the example I am talking about.
On the extreme right and left of the curve are people that can consume normal meals and amounts of carbohydrates and on the opposite end are people that can consume very small amounts of carbohydrates.

This is why the medication you are taking can affect your need for testing once you know what your meal plan needs to be. Remember that as you age, your meal plan may require changes. This is the reason for recommending people investigate the meter and test strip offerings at Walmart.

There is no one-size-fits-all diabetes food plan. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to a nutritionist if you need help with your food plan, as they can be very informative on balancing nutritional needs.

Part 2 of 4 blogs.

July 28, 2015

Treatment of Type 2 Diabetes – Part 1

I think it is time to review the treatment of type 2 diabetes. This article in WebMD covers some great points, but misses many warnings that should have been included and some other points that should have been made. Will I cover them all – doubtful, as my mind is racing and I will probably miss several.

The first point that I want to cover is that diabetes is not your fault. Most doctors insist that you caused it and make it sound very discouraging and say that the diabetes complications will arrive soon enough. This not only will scare you, but many people give up and feel if they can't prevent the complications – so why try? Don't let this happen to you.

If your doctor tries to scare you, it is time to change doctors. Don't let them bully you into giving up and believing you can't manage your diabetes. I know from experience that managing my diabetes is not simple and often is more difficult than I even thought it could be. Yet, because I know that there can be times nothing seems to go right, I try to learn from each case and improve my management.

Now you should understand that you have lots of options to manage your diabetes and every person can be different. Diet (or food plan as I like to use), exercise, and medication (if necessary and there are many medications and strengths of medication) all can work together to help you manage your blood glucose levels.

Your doctor should help you, but never should the doctor set your goals. In the beginning he may help you, but never dictate what your goals should be. This is another reason to change doctors if your doctor insists on setting your goals. They only have about 60 minutes a year available to see you or less if they only see you twice a year.

Your doctor should help you determine if you need to take an oral diabetes medication or insulin. But if he will not listen to you, you will need to consider if the medication is right for you. Ask about side effects and what you need to do if you have one of the lesser-known side effects. Ask if you should take the medication if you are not feeling well and under what circumstances you may still need to take the medication.

Your A1c will probably determine how often you should take the medication and the doctor will suggest accordingly. If you are strong willed and can bring your diabetes under excellent management, will the doctor be willing to change the medication dose and when to take the dose. Also ask if you bring your A1c to within the normal range, will the doctor support you and allow you to stop taking the medication. These questions need answers and not a “we will see” answer.

As you age, the way you handle diabetes may change. Not because you can keep the same management, but your body may not be able to handle the medication or your pancreas may no longer be able to produce the needed insulin. When this happens, don't leave insulin as the 'medication of last resort.'

New medications seem to be approved the FDA more regularly, but I advise caution until they have been on the market for a few years and more of the side effects are known. Then if you agree with the doctor, make the change.

Part 1 of 4 blogs.

July 27, 2015

An Acquaintance Admits He Has Diabetes

On July 24, A.J called me and sounded very urgent when he asked me to come to his house. When I arrive, he and Jerry were talking to the person from this blog. When Jerry let me in, A.J stated to me that I was right and he was glad he had listened to me. A.J told the fellow to tell me what his A1c had been. We nicknamed him Jon and he said that his A1c was 10. The doctor said I was right when I told him that if I were not a person with diabetes, my blood glucose would have been back down at or below 100 mg/dl.

He said he had taken his paperwork to show the doctor and his new doctor agreed that he had diabetes and he needed to start on medication immediately to prevent complications. I asked which one he started on, he said insulin, and when he gave the names of Lantus and Novolog, I knew what he would be asking. Jerry spoke up and said between A.J and you he will be asking many questions. Jon said yes and from what A.J has said, he asked if he could get the address for my blog.

A.J said let's go to my computer and give me your email address. Jon gave him his email address and A.J showed him my blog, copied the URL, and said he would include several other URLs to give him some reading. Jon was told about communication and A.J said he would try to answer his questions at first because my computer was still not back in full operation and I had more to do to get the sound working and download a few of the tools necessary to use some programs. I suggested the he get Jon's phone number and give him our phone numbers.

The Jerry asked him if he had time for the support group. Jon said he knew some of the members like Max and Allen, he listed several other members. Jerry said we will not have another meeting until September, but some of us do get together at a restaurant every Saturday afternoon if we were in town or have the time. Sometimes it can be only two members and other Saturdays can be as many as 20 members. We have no schedule we follow, sometimes we discuss diabetes, and others time a favorite non-diabetes topic. We avoid religion and most politics.

Jon said that to start, he would be doing a lot of reading and asking us for reading resources. Jon thanked us for our interest in diabetes and for making him get the second opinion by scaring the dickens out of him. With that he said he needed to be doing something and would be in contact later.

After Jon left, A.J spoke and said that I had read Jon right the first time and he was happy I had discouraged him from pushing the subject of diabetes then. I answered that I was glad I was right, but if several more weeks had passed, I might have encouraged A.J to resume his pushing. Jerry said that creating doubt was a good thing and that had helped him when he needed it.

With that, I took my leave and said we have work to do to keep Jon learning.