November 21, 2014

Lessons for People New to Type 2 Diabetes, Part 3

When friends say they will help pull information together for something, I did not realize how thorough they would be. I was intending to make this blog about food plans, but they changed my mind. They feel that testing should be first and before that, care of testing supplies and washing and care of hands prior to testing. On this, I will agree.

Hand care is often overlooked for people new to diabetes. Some of this is because many doctors will not tell newly diagnosed patients about testing and therefore say nothing about hand care. Why do doctors go this far to do harm to patients. It has been said and I have read some articles that the doctors honestly say they say nothing about testing because they are concerned about the patients being frightened by the results and that they will not understand what the readings mean. Some even say they don't have the programs to read the meters and just feel that there is no need. This sounds like they were educated by Dr. RobertRatner, 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." This means that their patients are operating in the blind and have no means to manage their diabetes.

This is one reason that I encourage patients that tell me this to find a doctor that will see to it they have testing supplies and attempt to teach them a few reasons for testing. This brings up another topic that I admit should not happen, but I see this all too often. The patient says they are testing for the doctor at the doctor's request. When you ask if the doctor looks at their meter, pulls the readings from the meter, or reads the log they maintain, I get blank looks and maybe a question about firewood needs. Blood glucose logs, food logs, and health logs mean nothing to them.  Yes, I become very frustrated, but I try to educate them if they will listen, many won't.

I know the people in our community diabetes support groups read the instructions that come with their testing supplies and medications. This is a topic that a few of them are getting tired of hearing, but every time someone gets caught not paying attention, they hear about it from every member. Should we be this aggressive? We think so and are conscious of the money we may save our friend. When we see people testing in full sun and not protecting their test strips, we have to wonder if they really care about their health. For many of the common errors please read thisabout user errors in blood glucose testing.

Another blog that anyone interested in managing diabetes may find helpful is this on what ignorance does for you. And then this blog could give you some pointers to learn about obtaining testing supplies and what to expect when you are newly diagnosed. Always consider checking out the colored links is each of the blogs for more information that may lead to better understanding of why I and my support group friends feel these blogs are important.

I will attempt to provide links that will help and I do review to make sure they are applicable for newly diagnosed people with type 2 diabetes. To be honest, I knew I had written quite a few blogs, but did not realize that so many were applicable for the newly diagnosed. Since they are helping me, I send them a copy of the completed blog and they are reviewing them. They are suggesting more links, but finally admitted that too many are not productive.

November 20, 2014

Lessons for People New to Type 2 Diabetes, Part 2

Moving from the shock and anger on the day or days following learning from the doctor that you have diabetes, you will also possible experience denial and maybe some depression or sadness, grief, or sorrow. When you accept your diagnosis, then progress happens in managing your diabetes. Just because this is the list of what most people can have, does not mean that everyone has them in the same order. I have known people that have acceptance first and later have denial. Some people do not have anger or shock because they know that diabetes runs in the family. Just remember that everyone may react differently.

Another point that many people with type 2 diabetes learn quickly is not telling people they have type 2 diabetes. Secrecy can be a good thing when out in public, but when you are around other people with type 2 diabetes or attending a support group meeting, secrecy can be bad and you need to open up and ask questions to take full advantage of the experiences of others and learn as much as possible. In our community, we presently have three diabetes support groups for type 2 diabetes. Two of the groups have mainly people on oral medications and the group I belong to has most of its members on insulin. All three groups have a few members that have been able to get off of all medications.

One thing you should do after diagnosis is ask the doctor if there are support groups available, as these can be a safe place to ask questions and receive help. This does not mean that you have to become a life-long member, but you should consider this if you live alone. Several members of our group check-in on other members that live alone. We have not had any problems, but I know from talking to these members that they are more relaxed knowing that if they don't check in with their friends, someone will be checking on them. Some of our members work and their employers know if they don't show up for work without calling in, they have telephone numbers to call so that people can check on them. There can be many other advantages associated with support groups. And though I don't like to admit it, there can be disadvantages to some support groups.

Before getting into food plans, I would like to use a few blogs to introduce some ideas for newbie's to diabetes. The first is my blog on diabetes may simplify life's choices. This is from January 2011 and shows how some opinions do change. I would now suggest ignoring the last two paragraphs as I have changed my opinion on these and have found that salt is necessary. The 2300 milligrams seems to satisfy my need for salt. 

There are two links to David Mendosa's website that should be helpful to begin with for people new to diabetes. The first one is this link which will take you to the directory for his site and also this link for newbie's. The link is a good read and gives you plenty to think about in addition to what I may write about in the blogs coming in the next few days.

November 19, 2014

Lessons for People New to Type 2 Diabetes, Part 1

On November 14, I initiated a discussion with Scott Johnson after he posted on Google + about mySugr Academy (click on the PRO link for finding the most videos). For visual learners, this may be of some help, but they are a little thin in providing actual help for people with type 2 diabetes. While it is still a work in progress, I think there is a lot of room for improvement. Three other members of the support group that I belong to were here with me when Scott posted his information on the site. Two of them had their laptops with them and I quickly forwarded a copy to them.

After some discussion amongst us, even they were less than enthusiastic about the site, especially after they made it through most of the videos that are in English. We agreed that we are not visual learners apparently and the short (very short) videos seemed not to tell us much about managing our diabetes. I said as much to Scott in an email and he said we were probably more advanced than the audience this was intended to reach. We agreed, but felt that even with this, the information was too thin.

It did not answer questions we might have had after diagnosis about food we could eat and exercise that could be safe for us. Two of the group are regular at exercise and two of us are more sedentary than active. The one factor we did not discuss with Scott was we all eat low carb, high fat. Three of us are using insulin and one is no longer on medications. The person on no medications started on insulin to obtain rapid management of his diabetes and once he lost the pounds he and the doctor agreed he needed to lose, he decided to get off medications with the approval of his doctor.

We agreed that for most people with type 2 diabetes, this would not serve as a link between the diagnosis and a class with an educator, as very few exist in our area and the few that do, do not really educate, but give out with mandates and mantras that they expect us to follow blindly. We agreed that this was not an education on managing our type 2 diabetes. After a few emails between Scott and myself, I was asked by the three why I don't pull together some of my blogs as an introduction to education and then expand into a written series on education for those people who are not visual learners, but learn by reading and having something to refer to when they have additional questions.

So while they are looking up some of my blogs and pulling together ideas to help me, I will start and work to provide some education for the newly diagnosed people with type 2 diabetes. Then I will expand this to more education and provide ideas that may assist you in your continued diabetes education.

Shortly after my diagnosis, I had to learn and accept - it was not my fault. There are too many that blame us for having diabetes and make snide remarks that if we had taken better care of ourselves, by not eating sugar, we wouldn't have diabetes. The second lesson took a lot longer - I cannot change the past - it is the past and I have to learn to live in the present. Painful, yes, and at times harder than a real job. Diabetes requires my attention 24/7 days a week and does not allow for a vacation.

Many of us have learned that there are no rules in diabetes, but I have found a few that are reliable rules.
  1. What works for me, may not work for you. That is the first rule. Some have another version – Your Mileage May Vary (YMMV)!
  2. Always discuss things with your doctor(s). That is the second rule.
  3. Always discuss changes with your doctor(s). That is the third rule.
  4. In diabetes, there are no quick fixes. That is the fourth rule.
  5. If you refuse to manage your diabetes, complications will develop. That is the fifth rule.
Another lesson that many need to learn is what type of learner they are and this will determine how they best learn about diabetes. Visual learners may benefit from the site that Scott is promoting or from the many videos that appear on youtube or other websites. Other people learn from reading and having the reading material available to reread when they need help. Another group will learn from experience and never remember something unless they go through the experience. For some this is termed the 'College of hard knocks.'

Diabetes is not a disease that can be learned easily as the information constantly changes and as we age, our bodies react differently, creating new factors to learn and remember. So, even if you are a visual learner or reading learner, in a way we all have our own 'college of hard knocks' teaching us.

November 18, 2014

A Meeting with Our Consultant

Tim sent several of us an email on Monday saying Dr. Tom wanted to meet with us that afternoon after office hours. Jason, A.J, Tim, Jerry, and I attended. Dr. Tom said several of you are aware of the request to have the same program we had on Saturday for a group about three hours northeast of us. Jason said yes, and he and his family are well known to me. His parents are now deceased, but he is still known to many of us. Dr. Tom said he had invited himself and wanted permission even though he had it from the doctor.

Tim said they had talked about March or April depending on the weather. Jason agreed that this should be okay. Tim said some of the older members our group are not happy when we have to change our meeting date to accommodate other groups for presenting programs to them. I said I thought that was why we wanted some informality in our group. I follow this up by saying I can understand when we put out the schedule, that we should follow it, as people make plans and then having to remake them can cause problems.

A.J said that we should then find out when a group for our program plans to meet and they reschedule or we not present a program. Jason said this group already has to reschedule as they normally meet on a Monday and they will move to a Saturday for us. Tim said that could be a problem with some of us still working unless we could leave work at 4:00 PM and be ready to leave then. With the three hours minimum travel time, we would need things to go almost perfectly to make it by 7:00 PM. Jason said it really takes about three hours and 15 minutes so Saturday would be better for us and certainly for Dr. Tom.

Dr. Tom handed each of us a copy of the paper he had given to the two doctors so we could all be informed in case of questions. He said he should have given this to us before our meeting and realized this when Tim called and he needed to come to the meeting. He was glad it was as late as it was, but an interruption still the same. Then Dr. Tom told us why he wanted to go with us and that was to network with different doctors and to learn what was available.

Dr. Tom also informed us that we would not be invited back to the last group. Tim said after he arrived, the doctor with his group has happy with the presentation, but the rest voted not to invite you back. That was the reason he had come here as several of his group want to break from the rest and have their own group even if it was smaller. They felt that the college group was not for them and too many showed disrespect for others. They would like to come for a few times when the weather is good, but would need to miss in bad weather. Tim said he did not see a problem with that, but did hope that they could have their own group and pick up others that were interested and have their own programs.

Dr. Tom then said he would remain as a consultant for our group, but he would be attending fewer meetings. He said that our group was well established and capable of handling most problems and even taught others a few things. He felt that we needed to spend more time with our new members and less doing programs for others. Tim said that was a goal for us and we would continue to invite his group when they felt they could benefit, but we wanted to make our new members feel welcome and a part of the group. Tim commented that we have two others that want to join at our next meeting. He then surprised us when he said one of them was a person with LADA. He is still in the phase of not needing insulin, but knows it is coming. He knows that there is not a support group for type 1 people, but knows two of our new members and feels that we might be a good fit for him.

Dr. Tom asked if we still have the honorary type 1. Tim said yes and her parents want her to stay with us until she attends college and can find a group there. Dr. Tom then said that two members of his group want to join your group and he said he told them to ask first. A.J asked if it was because they were now on insulin and Dr. Tom said that it was because of the research you do and the programs your group does. One does need to go on insulin, but does not want to do it. The other is doing very well, but feels she needs more interaction that your groups tends to provide.

Tim commented this is a goal of our group and we also have to thank Jerry and James for being very open about what they went through and discuss this with others. Presently one of the female members is working hard to help another person with type 2 diabetes, but is meeting resistance and an intervention may be necessary. The person's husband is not making life easy and keeps blaming her for getting diabetes even though it is in her family. Jerry asked where he could help. Dr. Tom said that it might be best to sit back until needed, but to Tim he asked that our member come and talk to him, as he might be able to get needed information for her.

Tim agreed and asked if there was anything else. Dr. Tom said not that I can talk about at this time, but you should know within a month or two and he would tell him when he knew that it might happen. With than we ended our conversation and Tim said on the way out that he would call me later.

November 17, 2014

Our November Meeting

When we gathered for our November meeting on the fifteenth, we were pleasantly surprised. The doctor that Jason and several others had met during the summer was present and had four members of the support group that he and his wife led with him. Another bonus was a doctor and five of the group that we had presented the program for the week before. After introductions, Tim said that one of the programs had been omitted the previous week because the audience did not seem receptive after the third presentation and this was A.J and his presentation on interventions.

Since we have guests and some of our members were not present during the three meetings on interventions, we felt this would be good for A.J to do his presentation and if time allows we will have Barry redo his presentation on Self-monitoring of Blood Glucose.

A.J started his presentation by introducing James and Jerry and explained that James had an intervention by a another doctor as part of his presentation to several groups. A.J asked James if he would explain why the intervention became necessary. James stood and explained that he was in denial and thought he had everyone fooled. However, the doctor knew something was not right and had me come to the meeting where he was doing a presentation on interventions. He said that was probably the most intense time he had in his life, as he had not wanted to admit he had diabetes.

James concluded that he was not prepared for the questions that the intervention specialist and Dr. Tom had asked him and when they could see that the questions were getting to me they took me to another room where they could really counsel me and prepare me for the session when we came back to the larger group. He said that between his wife and a few members of the support group, they had prevented him from going back into denial and now he had accepted his diabetes and was happy for the support in learning how to manage his diabetes.

Next A.J introduced Jerry and said that he had been able to help him out of a situation. Jerry said he knew that his A1c was heading in the wrong direction, and because Barry and Allen had been working on him about carbohydrates, he knew when A.J had asked him to go for a ride that it was time to do just that. He had been taken to Barry's and Allen was soon there. They then called Dr. Tom, he was taken there, and after an hour of talking with Dr. Tom, he knew what needed to be done. Back to Barry's and a discussion of where he could live for a temporary period. A.J had room available and that is where he now lived.

Jerry said his A1c had increased after diagnosis and it was going in the right direction now that he is separated from his wife. He concluded that being separated from his wife was not what he had wanted, but in order to manage his diabetes, it had become necessary and the rest of his family and children were in agreement which made him feel better. He said being on insulin was a big help and having A.J available for assistance was a big plus.

A.J then said that several others that many of our group had been working on to help them adjust their carbohydrate consumption downward had been helped by Jerry and with his encouragement, most were now members of our support group and he hoped were feeling better about their diabetes management. One of the new members asked why my cousin was not at the meeting. A.J called on me and I said she is helping another person across the state to work on her food plan to bring down her cholesterol and maybe get off statins. I said she was taking time to visit another cousin while working with this person. I said she would be back on Tuesday and available to answer questions after that.

At than point, A.J opened the meeting for questions. The doctor that Jason knew asked why we did not work with the dietitian that is Jerry's wife. A.J said because she was operating on Munchausen syndrome by proxy (MSP) which means that she was determined to make Jerry unable to manage his diabetes. The doctor said he had never heard of this and Tim said he would see if Dr. Tom could stop by and explain this to them. Allen said this often in a parent of a child that does this, but after research by several of us and Dr. Tom, we felt this was what Jerry's wife was doing to him. Tim said Dr. Tom would be there shortly.

The Doctor from the group we had met with the prior week asked if we could invite more of the group we had done presentations for to a regular meeting of ours in the future. He said he had heard of MSP, but had not seen it in his practice. He said he also wanted to talk with Dr. Tom about having the intervention specialist make a presentation to the support group.

Then Dr. Tom arrived and had two handouts for the two doctors and answered several questions from the group. Tim asked if there were other questions and he said the meeting was done and the doctors would be talking and to let them talk and he, Allen, Barry, and the others would be available to answer individual questions.

Individual questions were heavy and even I had a few. I had several questions about my blog and if I had an email address available. A.J had his laptop, brought up my blog, and then showed them my email address. I asked everyone to please give their email address to A.J, and Tim, and they would be sent a summary of the meeting, and then they would have access to the rest of us as well. A.J went to Tim and asked him to announce that if they wanted a summary of the meeting to give him email addresses.

The doctors were ready to talk to the rest of us and the doctor that Jason knew wanted to talk to Jason and me. He commented that the few that had come with him were very impressed with our program and more enthused to build the support group they were in. He said the travel was too far for many to want to come, but would we consider doing a presentation program for his group next year. He had permission to duplicate the handout from Dr. Tom and that could be the topic even if four had heard it. Jason said we would discuss this and the doctor said that the driver would be given some money for gas. Dr. Tom then approached and asked if he could attend when we agreed to do a presentation. The doctor said yes and Dr. Tom said he would have Jason send him his email address and he would be in contact.

Dr. Tom said the other doctor had apologized for the problems at the meeting the prior week and everyone felt that more than two topics per meeting should not happen. He said this was a lesson for all of us.

November 16, 2014

If You Have Type 2 Diabetes, Avoid Most Potatoes

This is a little off topic, but when I read this in Diabetes Health, I had to think about what I had just read. Did I believe this? No, I do not believe this. Why do I not believe this? In the way the study was done, I have to believe that it may work for some people and the study in essence is too small and too short a time frame. Twelve weeks and 90 people assigned to three groups do not make sense.

And for this to be in a diabetes magazine make me wonder why it did not include people with type 2 diabetes. For a person with diabetes, most types of potatoes will bust a diet and destroy good management of blood glucose. Those on no medications or on oral medications will develop problems with diabetes management. A few on insulin can manage blood glucose, but even then, they must be careful.

I can understand why the blog is very short, as the author has no intention of getting into detail of any significance because the study itself was lacking detail often seen as part of the better studies. And being from the Journal of the American College of Nutrition, this is easy to understand that the study would be small and short to avoid problems that could be experienced from an longer study.

In viewing the full report, this seems very typical of nutrition studies - “Exclusions for study participation were the following: food allergies or intolerances to potatoes, cigarette smoker, currently modifying diet or exercise patterns to gain or lose weight, excessive exercisers or trained athletes, taking any medications that would affect glucose metabolism, or the presence of other health problems requiring ongoing intervention by their personal physician. Eligible men and women were overweight based on their body mass index (BMI = 25–37 kg/m2), over 18 years old, light to moderate exercisers and had normal fasting plasma glucose and were able to meet the time and effort requirements required for study participation.”

Some of the above are reasonable exclusions, but selection was apparently looking for participants that fit very limited criteria and help the people doing the study arrive at the desired results. Probably why the study was only 24 weeks,

November 15, 2014

Testing Your Blood Glucose When You Have Diabetes

At least everyone agrees how important blood glucose testing is except the American Diabetes Association and the American Association of Clinical Endocrinologists. Yet doctors will write articles for WebMD saying how important testing is. If we could only convince the ADA to take a firm stand and say we needed to test more often, then the insurance companies would allow reimbursement for more test strips with less restrictions.

For people with type 2 diabetes, there are several places to test and this depends on how well your blood glucose levels are stabilized and the medication you are taking.  If on insulin, it is your fingertips that should be use on each side and many people are able to use their thumbs. To do this, insert the new lancet into the lancing device and then insert a test strip into your meter. Then using the lancing device set to the correct depth, prick you finger. If enough blood is created, or if not carefully milk the finger to cause enough blood to pool for the test strip in the meter to be pushed carefully into the blood and wick into the test strip. Wait a few seconds and the meter will give you your blood glucose reading.

Most meters today will allow you to test at other sights and for most oral diabetes medications, this may be allowed. Just realize that for using what are termed alternate testing sites, the reading will be for a period of 15 to 25 minutes earlier than the time shown on your meter. Why the difference you ask? Because using the alternate sites is obtaining blood from a vein instead of an artery. The alternate test sites include your upper arm, forearm, base of the thumb, and thigh. You will normally receive different results from alternate sites. Blood glucose levels in the fingertips show changes more quickly than those in other testing sites. This is especially true when your blood glucose is rapidly changing, like after a meal or after exercise. If you are checking your blood glucose when you have symptoms of hypoglycemia, you should use your fingertip if possible, because these readings will be more accurate.

Checking your blood glucose levels may be required several times per day. Always as soon as your arise in the morning, before meals (preprandial), after meals (postprandial), and before retiring for the night. Depending on the medication(s) you are taking, it may be necessary before driving and before and after exercising. Because everyone is different, talk to your doctor about when and how often you should test your blood glucose. If you are sick or feeling like you are low, you will need to check your blood glucose more often.

Your blood glucose levels can be affected by many things, such as anemia, gout, high altitude, stress, illness, or if it's hot or humid. If you see unusual results, rewash your hands paying attention to the finger you will be using and thoroughly dry. If necessary, use the control solution to check the test the test strips. The following chart is published by the ADA for their ideal levels and the second chart is my suggestions.

ADA guidelines:
Time of Test Ideal for Adults With Diabetes
Before meals 70-130 mg/dl
After meals Less than 180 mg/dl

My suggestions:
Time of Test Ideal for Adults With Diabetes
Before meals 70-95 mg/dl
After meals Less than 140 mg/dl

Again, because everyone is different, learn to set your own goals with the doctor's knowledge and if things change, do not be afraid to contact the doctor.

November 14, 2014

Food Plan Study Of Interest

In a short 24-week study, HbA1c levels improved and cholesterol levels were reduced to the point of reduced need for statins. Type 2 diabetes patients are normally advised by dietitians to make dietary decisions that are high in carbohydrates and low in fat and protein. This increase in carbohydrates leads to high postprandial blood glucose levels. Because of this, there is more interest in food plans low in carbohydrates with higher amounts of fat and protein for type 2 diabetes management. Past studies have been done with food plans that are low in both carbohydrates and fat. Both have proved successful in lowering body weight, blood pressure, and insulin concentrations. Most of these prior studies have ignored the role of physical activity and glycemic variability.

This new study was designed to compare the use of a high carbohydrate, low fat diet (53% carbohydrate, 17% protein, and 30% fat) to a very low carbohydrate, high unsaturated fat diet (14% carbohydrate, 28% protein, and 58% fat). This would be used with measurements taken at baseline and end of trail to see what their impact was on glycemic control and risk factors associated with cardiovascular disease in type 2 diabetes patients.

A total of 115 obese type diabetes patients were randomly assigned to one of the two diet groups. In addition, they both participated in a supervised exercise program. The primary outcome was a change in HbA1c. Secondary outcomes included effects on glycemic variability, and changes in anti-glycemic medications, lipid profile, and blood pressure readings.

Those in the low carbohydrate diet group showed a larger decrease in HbA1c when compared to the high carbohydrate diet group and changes in anti-glycemic medications were also more likely in this group as seen by the changes in the medication effects score. Differences in the diets were not seen in weight loss, and no diet effect was observed in the fasting blood glucose, LDL reduction, or blood pressure.

The results of this study show the impact that diet selection can have on managing type 2 diabetes. While both of the diets studied in this trial showed some positive results, the very low carbohydrate diet was more effective in lowering HbA1c, reducing anti-glycemic medication requirements, and improving HDL cholesterol. And of course, they made the statement that larger trials with a similar design can be used to determine if a low carbohydrate, high unsaturated fat diet continues to have an impact on managing diabetes beyond a 24-week timeframe.

For this short of a trial or study, the few conclusions show that people with type 2 diabetes need to make lifestyle changes in both diet and exercise. While both diets showed improvements in weight, a very low carbohydrate, high unsaturated fat diet showed more beneficial in lowering HbA1c, anti-glycemic medication requirements and increasing HDL cholesterol.