So You Have Diabetes: What Now?I am going to assume you found this page because you or a loved one has diabetes and you are doing some research so you can figure out what to do about it. Congratulations, it's that kind of can-do attitude that will make you successful in beating diabetes. The people who fail are the people who don't learn anything and live their lives exactly as they did before.
You may feel a little scared and unsure. Heck, you may feel petrified and think your life is over. That's normal. You may have heard as a diabetic you are destined to go blind, die of heart disease, and have all your limbs chopped off.
All that bad stuff can happen: if you don't take your diabetes seriously and do something about it. But, if you do some learning and take action, you can live a long healthy life with diabetes. Diabetes is not a death sentence. But diabetes is a wake-up call telling you to start doing things differently in your life. You may find some of what you need to do hard, but the alternative is far worse.
You may end up thinking diabetes is the best thing that ever happened to you. Diabetes has a way of slapping you upside the head and motivating you to make important changes in your life.
So relax. Don't panic. Take it slow. Learn about diabetes. Take small positive steps. You'll do great. Many, many people live long and good lives with diabetes. It's these people you need to learn from. And you can be one of those people too.
This is the page I wish I could have found when I was diagnosed. With this page I have two goals:
Dislaimer: I am not a doctor and I don't play one on TV. Everything here is my opinion and my opinion alone. Double Disclaimer: I am a T2 diabetic and to the extent I know anything that's all I know anything about. The advice here does not apply to T1s and could be dangerous if followed by T1s. The advice here does not apply to any other type of diabetic. In fact, I am not giving any advice at all. You are not here :-)
What Should You Do About Your Diabetes?The goal of this page is to show you resources that have helped me get my diabetes under control. Information is power with diabetes because diabetes is one disease you can really control with your own actions. You aren't a victim of diabetes. You can do something about it. But you have to know what to do. And as you have probably found out, there are a lot of different opinions on what to do.
So, what should you do?
Why Do People Think I Hate the ADA?I don't hate the ADA. Not at all. So put your email client down. But I get hassled a lot for not thinking the ADA is the best source of all diabetic thinking in the entire world. I think they are a great source of information. I also think the ADA's policies for treating diabetics aren't good enough.
You might be asking: who are you dimbulb to be arguing with the ADA? Good point. But don't classify me as a whack-job just yet.
In my opinion, you'll learn more practical information for handling your diabetes from the resources I link to than from the ADA.
Here is a quote from the ADA that lies at the heart of my problem with the ADA. The quote is taken fom the introduction of a document titled Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications (http://diabeticdiet.notlong.com/):
The sentence in bold may seem innocent enough and on the surface it seems perfectly reasonable. What it means, however, is the ADA tries gives advice they think you will accept rather than advice that puts you in the best position to treat your diabetes. I think you can and should do better for yourself. I think you should have the highest standards and be the best you can be (roll the Army recruitment commerical).
For example, people like high carb foods (cake, donuts, ice cream, etc). In my opinion, the ADA thinks if they tell people not to eat high carb foods then people will just give up and eat them anyway, which will only worsen their health. The ADA recommends a diet of 50% carbs which works out to about 330 grams of carbs for a 2400 calorie a day diet. That leaves a lot of room for controlling diabetes through diet. Yet, most people aren't asked to lower their carb intake, they are just given more meds.
So the ADA compromises and encourages what many people think is too high a carb consumption. And the ADA is probably right. Most people won't make the changes in their life that will help them the most.
But that's not you. You want to know what will help you the most, even if that might be a little harder than doing anything you want. You are prepared to make the changes in your life that will keep healthy and happy for a long time to come. Good. I'm glad you are the kind of person that found my page. Those other people are going to eat themselves into an early grave. But not you, thankfully.
Good Diabetes Web SitesThere's a lot of good information on the web about diabetes. There's also a lot of useless information. Here, in my opinion, is the information that can make the biggest difference in your life in the quickest amount of time. You don't need a lot of BS. You need the facts from people who are experts at handling their own diabetes. A lot of people have gone before you and have done the hard work of figuring out how to handle diabetes. We all benefit from their experience. And that's what is exciting about diabetes. Yes, it's a serious disease. But there is a very active diabetic community. If you can plug into that community you'll set yourself up for life.
Many of these links to pages created by Jenny and Jennifer, regulars on alt.support.diabetes. Their information is the best you can find. My page is not trying to replace theirs in any way. I would send people to these pages first to learn more. But I also think my page has a unique take that can help people too.
Jennifer's Advice to New the Newly DiagnosedThis advice was given by Jennifer in a post on alt-support-diabetes. I emailed asking if she had a link to it, but I got no reply, so I am including it here. I am including this version because I especially like how it talks about your Personalized Carb Number. It's different than some of the other version on the net and I've adapted it a bit to reference some supporting research.
How Do You Know if You Have Diabetes?The only real way to know if you have diabetes to be tested by your doctor.
I had symptoms for many years before I found out I had diabetes. Some clear symptoms are:
T2 Diabetes starts either 5, 6.5 or 10 years before the average diagnosis (http://www.medscape.com/viewprogram/145), so you don't want to wait.
If you have a friend with a blood glucose reader you can do some testing as a guide. With your friends meter if you see any reading over 170 then get checked. If in the morning, before eating, you see a reading above 110 then get checked. But if there is any doubt at all, go see your doctor and get tested.
You don't necessarily have to have diabetes to have higher blood glucose readings. There is something called impaired glucose tolerance (IGT). You may also have pre-diabetes. In either situation, you have a chance at preventing getting full blown T2 diabetes through better control (we'll talk about control later).
Do People with Type 2 Always Deteriorate?Jenny has put together a great page on a very important topic: Do People with Type 2 Always Deteriorate?.
The short answer is:
T1 Vs T2 DiabeticsThere are two major types of diabetics: T1 and T2. A T1 uses insulin to help control their diabetes. A T2 still has some insulin production so T2s usually don't take insulin and try to treat their diabetes with a combination of drugs, exercise, and diet. Many T2s do use insulin, so insulin isn't only for T1s.
There are several other types of diabetes (Maturity Onset Diabetes of the Young (MOBY), Latent Autoimmune Diabetes in Adults (LADA), T1b, Gestational Diabetes (GD)). The reality of diabetes is much more complicated than I am saying, but that's the general lay of the land. Wikipedia has a good overview of the different kinds of diabetes ( http://en.wikipedia.org/wiki/Diabetes). Also take a look at Types of Diabetes.
I am a T2 so I don't know anything about being a T1. So if you are a T1 then skip this page. The reason I bring this up is that T1s and T2s live in very different worlds, even though they are both diabetic. I read a lot of conversations where people are arguing about what's best to do and it turns out they are talking about what a T1 or a T2 should do. One issue is that many T1s eat a "normal" diet because they control their blood sugar with insulin. Many T2s eat a lower carb diet as a way of controlling their diabetes. The result is the two groups (T1s and T2s) often have very different ideas on diet.
The ADA primarily addresses T1s. For a T2 a perfectly good goal is to get your A1C down into the 5's. A1C is a measure of your blood sugar level over a 3 month period. For a T1 this low of an A1C goal could be very dangerous because of the heightened risk of hypos (low blood sugar). So the advice given to a T1 is very different than the advice given to a T2. Trying to treat all diabetics the same doesn't work. The formal test name is HbA1c, but people use A1C in casual conversation.
I think it would be less confusing if T1s and T2s were named as different diseases. Until then, keep the difference between T1s and T2s in mind when reading about diabetes.
Are You to Blame For Your Diabetes Because You are Fat?I don't think so. Many overweight people don't have T2 diabetes and many lean people do have T2 diabetes, so there's a clear genetic component. But it's also clear not exercising and being overweight bring out whatever genetic tendency you do have for being a T2.
I found out after my diagnosis that almost everyone on my Grandma's side of the family has diabetes, but she does not. She has also eaten moderately for her entire life.
One thought is that if you exercise and maintain a normal weight then it's possible you could postpone diabetes for your entire life. Or you could still get diabetes. In the end, you simply don't know.
So the blame game is useless because there's no real answer for you individually. What mattters is how you handle your diabetes now, that you do have control over.
You also have influence over your children. Educate your children about diabetes and how to prevent it. Teach them about exercise and proper nutrition. Give them a fighting chance of never getting diabetes, or at least delaying when they get diabetes for as long as possible. This is one situation where you'll be happy when your children don't follow in your foot-steps.
Relationship Between Obesity and Insulin Resistance (IR)For a more technical take on the relationship between obestity and diabetes, take a look at http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=diabetes.section.4
The conclusions from two studies point to inhereted IR as the
primary cause for T2:
Insulin is made by your pancrease in response to the food you eat to tell your cells to let sugar in. Sugar is a source of fuel for your cells. Being insulin resistant means your cells aren't listening to the insulin signal so your cells don't take in the sugar from your blood stream. This leaves the sugar in your blood which is one reason why T2 diabetics have high blood sugar. This is also why people with diabetes may feel tired, their cells aren't getting a source of energy they need.
Too much insulin is produced because of the insulin resistance. Your body makes more insulin in an attempt to force your cells take up the blood sugar. Insulin causes you to gain weight because insulin also helps control how much fat is stored in your body.
More fat worsens IR. IR is strongly associated with fat inside your abdominal wall. This fat is called: belly fat, abdominal fat, visceral fat, and omental fat. This isn't the fat you see when you pinch an inch. In fact, you can't see this fat at all. You can't measure it directly either. You can see it with body scan though. I saw mine in a body scan and that was some of the motivation I needed to start losing weight, even before I was diagnosed with diabetes.
You end up with diabetes when your beta cells, the cells that produce insulin in your pancrease, start failing and they can no longer keep up with the amount of glucose in your blood. You may still have higher than normal amounts of insulin, but because of the IR it doesn't do any good. Much of the damage to your body has probably already occurred before you can see high blood sugar readings. Some people think high blood glucose readings show up when about half your beta cells are non-functional.
So it's a viscious circle. More fat leads to IR which leads to more insulin which leads to more fat which leads to more IR and more beta cell death.
Where does the circle begin? I haven't seen a definitive answer. My guess is like most everything else, a weakness in one part of the system can quickly make the entire system fail. If you gain weight then that might start the IR that starts the process. In another person the IR starts the process. Or it can be a little of each feeding of each other. I look forward to more research so we can learn more.
In addition to causing weight gain, excess insulin production is also thought to cause a wide range of medical problems, but without insulin your blood sugar is definitely high and high blood sugar causes death through the terrible damage it causes to your body. So you always need enough insulin to control blood sugar.
If you want to reduce insulin, say to lose weight, then you have two safe approaches:
Weight loss and exercise may not be enough to fight insulin resistance. T2 is a complex disease. Weight gain is often just a symptom of IR. You may need to drugs to truly take the fight to your IR.
More InformationJenny has added an interesting page on this subject on her site at What Really Causes Diabetes.
Diabetics Should Eat to Their MeterYou are fortunate as a diabetic because you have two tests to show how you are doing:
Get a meter and test strips from your doctor. Using the blood glucose meter tells you if your blood sugar is too high. You don't have to guess. You never have to guess. You can always tell how food is effecting you simply by eating and then testing your reaction to what you have eaten.
Once you start eating to your meter you'll notice you need to eliminate many high carb foods from your diet. You'll notice that veggies are good for your health and good for your meter. You'll notice you'll start losing weight. You'll notice eatin too much of any food will cause high blood sugar numbers. And you'll notice your blood work will show improved numbers. Your doctor may do a happy dance over your blood work.
Using your meter is easy. You just poke yourself with your needle, get a little drop of blood, and put it on the test strip that is connected to your meter. The meter will then tell you your blood sugar level. Around 80, but no lower, is an ideal "normal" number. You probably won't see that range very often. Anything above 140 could be damaging your body. You may think poking yourself to get a drop of blood hurts, but it doesn't really. You soon get used to it. Many people find they can poke the same area all the time without doing damage. Poke on the outsides of your finger, near the tip. Some people don't like poking their finger tip because then their finger hurts when they hit the tip. I don't find it hurts on the tip. As always, your mileage may vary (YMMV), so figure out what works for you.
Everyone is different. Some people can eat, without raising their blood sugar, a lot a food you can't touch. So your best bet is to try foods and test one hour after eating the food and then two hours after eating the food. You want your blood sugar at 140 or under. If it's over 140 then you ate too much. You can eat anything you want. There is no food you can't have. You just can't have too much.
You can have has much of a food as you are willing to have your blood sugar rise. Carbs directly raise your blood sugar levels. You can choose to eat a high carb food, like a potato, as long as you eat a portion that will keep your numbers within your target range. You find out how much of a food you can eat by testing.
For example, I can barely have any rice. Even small amounts of brown rice make my blood sugar skyrocket. Yet I can have a good amount of apple and oranges. I can have a couple tablespoons of ice cream as well without having any problems.
The way you figure all this out is to test. Don't rely on what anyone says. Don't rely on packaging. Test what your body does when you eat certain foods. Pretty soon you'll learn how your body reacts and you'll know what you can eat and how much you can eat.
Calories still count, so you can't only eat to your meter. With a meter only strategy you may find you can eat too much. It's not too hard to have good numbers yet eat way too many calories. Just keep your weight and calorie count in mind.
Studies show "normal" people spike at 30 minutes after eating carbohydrates. After 1 hour they are back under 120 mg/dl. They are often under 100. As a diabetic you probably won't see these numbers unless you eat low carb and smaller portions.
Some studies show your .5 hour readings don't correlate to heart disease and other problems whereas people who spiked at 1 hour were correlated with problems. So if you can only test once you might want to test at 1.5 hours after eating carbs. You'll miss your peak reading, but you'll be able to tell if your readings are heading down, which is what you want.
Using Your A1C Test to Control DiabetesAs a diabetic you have the A1C test to help you figure out how you are doing. The A1C test is usually performed by your hospital because it requires drawing blood and sending the test to a lab for processing.
You'll probabably be asked to take the test every 3 months. If you aren't asked to take the tests several times a year you may want to force the issue. Your A1C is an important marker of how you are doing. Without knowing your A1C you lose valuable input into tracking your progress and making necessary changes.
A lower A1C means your blood sugar has been generally lower than if you had a higher A1C. And a lower A1C is better because it means you have a much lower risk of diabetes related complications.
A good target A1C is in the 5 range. Lower is better. Being in the 5 range is called being in the 5 percent club. This is a club you want to be in. Research has shown being in the five range means you'll have less of a chance of complications. Anything over 6 means you are at a higher risk for a heart attack and other complications. There are no guarantees of course. Complications may still happen even if you are in the 5 percent club. But I play the odds and the odds are better if you are in the 5 percent club.
Recommendations differ widely on what's an OK A1C. You'll be tempted to accept a higher A1C because it means you'll be able to eat a more "normal" diet, but that's not healthy. Death rates are directly tied to your A1C level so you want to keep it as low as you can.
If your A1C is high it means you need to tighten your control by exercising more and being more careful about your diet. If you do those two things your number will magically go down. It's fun to track your progress that way. You'll notice that if you say screw it and loosen your control your numbers will go back up too.
Your A1C is a longer term check on how you are doing. You still need to test using your meter and make adjustments according to your meter.
Some people don't use A1C in controlling their diabetes. I believe strongly in getting the most information you can and using it. The A1C is a good measure to have. A1C is used in many studies so if you don't track it you are losing valuable insight into your health.
For example, one study found a 1% increase in A1C was associated with a 28% increased risk of death, which was independent of age, blood pressure, cholesterol, body mass index and smoking. So your A1C is an important test.
For a good explanation if A1C take a look at the diabetes FAQ at http://www.faqs.org/faqs/diabetes/faq/part2/.
Home A1C TestsYou can buy home A1C tests, relatively cheaply, online or at pharmacy. Many people have found the home kits are reliable because they match the results from their lab tests. You do not require a prescription to get a home test.
Apply the Test Results to Continually Help Make Yourself BetterJust testing won't do you any good unless you use the information to adjust your behaviour. Knowledge must be translated into practice. Diabetes is a disease you can actively control. It's not just about taking meds and letting the disease run its course.
Many people will test but not use the results to adjust their behaviour. The test results always tell you something, you just need to learn to read them.
If your numbers are rising and you think your control has been good, then it might be that you are getting a cold. Your blood sugar rises in response to sickness and stress. When I see that I immediately rest more which hopefully helps me get better faster.
You'll here people talk about control a lot. How is your control?, someone might ask. Control is keeping your blood glucose within your specific goal target range. When you are out of control your numbers are too high and that's when damage happens to your body. You stay in control through all the informaion you'll find in this page and all the sources of information you'll read. Clearly, staying in control is an important goal for a diabetic.
If your numbers are high then you need to find out why. Did you eat too much? Did a food contain hidden sugars? You can't trust labels. Are you particularly sensitive to a certain food? If you are then avoid the food or eat less of it. Or does a food not cause you to spike (really increase your blood sugar level)? It's always exciting to find a new food you can eat without worrying too much about how it will impact you.
If your numbers are trending up it could mean you aren't exercising enough or that you are gaining weight.
Every reading tells you something new. Use the information to learn and make yourself better.
Seek out a proactive doctor who is willing to give you a prescription for at least 300 test strips while you discover and customize your diet for you.
Carefully watch food does to you and base your diet on your personal response to food. You may not so low a carb diet to succeed.
To avoid complications from diabetes you do not need to maintain absolute, perfect control. That isn't physically possible anyway. What you need to do is maintain consistent control. Studies have shown that even if you make a few slip-ups in your control you are still helping yourself enormously in the times you have good control, so don't give up just because you are human and make a few mistakes.
When Should You Test Your Blood Sugar?I test in the morning, after meals/foods I haven't had before, and after dinner. If I have a meal or a snack that I've had before and have tested several times already, I usually won't test.
Test about 15 minutes before you eat so you can how many carbs you can get away with eating. If your numbers are low then you can eat more carbs than you could if your numbers are high. That might mean you could have a food you weren't planning on eating or you could have more of an old favorite.
I definitely test one hour and two hours after eating new foods or eating more of a food than I usually do. Times start from when you take the first bite of food. This is how I experiment and learn what I can eat and how much I can eat. If I try a 1/4 cup of rice, for example, and my numbers spike then I'll pretty much give up on rice for a long while. Then I'll try rice again later and see if anything has changed.
I know I can eat about 1/2 orange without spiking. I know that because I test eating different amounts of orange to see how I react. My standard is that I should never go over 140. Many people think this standard is too strict, but that's my standard.
Your readings will vary hour by hour, day by day, week by week, even for the same foods. No two days will be the same no matter how many pills you take or how much exercise you do. This will frustrate and anger you and sometimes you just will want to give up. But don't. It gets better. Then it gets worse again. Be prepared for a wild ride for a while.
Some people like to make a game of it. Your meter is like a Nintendo game machine and your blood sugar becomes the game score. You make whatever moves will get you to your score. If you are a competitive person this can be a useful way to see the whole process.
When you first start testing be prepared for how high your numbers can get after what you may consider a normal meal. It can be shocking. Until you start eating to your meter and you try to create your own low-spike diet by changing your meals, your numbers may be all over the place. You may find you have high morning numbers, high pre-meal numbers, and high post-meal numbers. As you test and eat to your meter, all those numbers will come under control.
Get Your Raw Tests Results Back from Your DoctorMany doctors will just call you up and say you are doing good. You won't know your real results and the doctor won't tell you. So how are you really doing? Without the real raw tests results you can't tell how you are doing.
The doctor may have much less strict standards than you do. If your doctor tells you you are doing fine you may actually be doing terrible.
Demand your tests results be sent to you so you can see the real numbers and make your own decisions on how you are doing.
Eating Smaller Portions Helps Manage DiabetesEating small portion sizes is the key to managing your blood sugar. It pretty much doesn't matter what you eat, if you eat a lot of it your blood sugar will raise. Keep your portions small and you'll be OK. Small food inputs means small blood sugar outputs.
Diabetic Treatment is All Over the MapOne thing you learn listening to other people with diabetes is that medical care differs everywhere. You are responsible for your own care. Do not trust any part of the health care system. Even people who have the best intentions may not be up on the latest research. You need to do your own research and make your own decisions. Do not just accept what your doctor says. Many of them still think an A1C of 8 is OK, when it most certainly is not. Ask questions. Push for tests, medicines, care, whatever you need. What do you need? Read all the sources on this page and you'll learn what you need.
Many people disagree with my statement about not trusting the health care system and want me to water down the statement to say something softer. I won't. Everyone in the system is human and is capable of making mistakes. If you happen to be one of the mistakes then you are dead. Trust but verify may be a softer way of saying it, but in the end you are responsible for you.
Exercising and Losing Weight Helps Diabetes A LotExercise and weight loss are key to controlling your diabetes. Interestingly, fat, especially fat around your belly, gives out hormones that cause insulin resistance (IR). IR means that your cells won't take up sugar which is why there's a lot of sugar in your blood. By exercising and losing weight you get rid of your belly fat and improves your IR. The better your IR is the lower your blood sugars are. The lower your blood sugars are the more carbs you can eat. The more carbs you can means you can eat more dessert. Yay!
Here are some resources you may find interesting on the exercise subject:
Diabetes Doesn't Go AwayYou can control your diabetes so well that you may think you don't have it any more. But that's not the case. You still have beta cell damage and you still have insulin resistance. If you go back to your old habits of eating and leading an inactive life then your diabetes will come back.
Don't get sucked into buying miracle cures or magic herbs. They don't work. When something really works to cure diabetes we'll all know. It won't be a secret, hidden on web page somewhere. There is no conspiracy against publishing a cure.
Exercise, eat small portions, take a few drugs if your doctor recommends them, eat to your meter, and you'll be fine. There aren't any shortcuts.
Are Carbs Evil?Carbs are treated by a lot of people like toxic sludge. So we may want to ask: are carbs evil?
I am not able to answer that question, as much as I would like to. As usual I'll give you how I see it, and you can feel free to ignore everything I say. Given how confused I personally feel about the issue, that may not be such a bad idea.
There are two general issues as I see it:
Humans don't seem to have a single perfect diet. People all over the world live on all kinds of different diets. We humans are marvelously adaptive in the foods we can eat. It doesn't seem that we can count on science to say exactly how we should eat.
From a general diet point-of-view, the opinion on carbs seems to be all over the map. It ranges from our ancestors didn't eat a high carb diet so neither should we to the only healthy diet is to eat high carbs because look at how long the Japanese (or insert your long-lived group here) live.
Most of those long-lived people eat moderately and get exercise. My guess is that has as much to do with their good health as anything. Plus, they usually eat fish which gives them all the good omega oils, which has got to help. Plus, they eat plenty of veggies and the veggies may do as much good as anything else they do.
You need vegetables and at least some fruits for vitamins and fibre, and they contain carbs. So you will need to eat some carbs to get proper nutrition.
In my mind there's no question that refined carbs, like white flour, especially when combined with fat, are both bad for your heart and bad for your weight. The more weight you gain the more medical problems you have the more likely you are to become T2.
Many of the studies saying saturated fat is bad for you don't control for carbs, so it's hard to separate out properly the interaction between carbs and saturated fat. In my mind at least, I am not going to eliminate saturated fats from my diet, as long as I am eating low carb. But I have somewhat reduced my consumption of saturated fats (steak, hamburger, etc).
If you eat unrefined carbs, from vegetables and whole grains, then it seems you'll be healthy. Could you be healthier eating some other way? Everyone says yes, but they don't agree on what way is better. It doesn't matter anyway for most people. Most people drink Big Gulps worth of sugar, eat McDonalds every day, eat candy bars, and all that high calorie low nutrition stuff. I would say refined carbs, especially in the large portions in which they are eaten, make for a really bad diet. A cookie every couple of days won't hurt.
But for diabetics that's not the whole carb story. Diabetics have a malfunctioning body when it comes to carb processing. For a diabetic a whole cookie could hurt because eating too many carbs causes a spike, a sharp rise, in your blood sugar. Spike can help make you diabetic. Spikes also cause a diabetic further damageand we want to avoid that damage if we can. And we can.
In your day-to-day life this means reducing carbs on a per meal basis so as to minimize your chance of spiking. As a diabetic an ambitious goal is to get all your calories and nutrition without spiking.
Eating carbs is a balancing act for the diabetic. That's why I'll say about 50,000 times on this page that your best friend is your blood glucose meter. Using your meter you can test how you are responding to food. It's your meter that tells you how many carbs you can eat.
There's a kind of parallel between carbs and cholesterol. Cholesterol isn't evil though it has got a lot of bad press lately. You need cholesterol for building your cell membranes. The difference between cholesterol and carbs is that you don't need to eat any carbs to survive. Your required daily intake of carbs is 0. Surprising? I thought so too. Your body will make the carbs it needs from protein and you are required to enough protein.
So you aren't required to eat carbs, but will eating carbs make your life better? I don't think you can realistically get all your nutritition in today's world without eating carbs from veggies and fruits. The Eskimos did eat mostly meat, but they ate their meat raw and they ate every part of their catch. I don't think most people will do that today.
Carbs are also likely a necessary part of endurance exercise. Carbs have been shown to help both performance during exercise, and promote healthy muscle recovery after exercise. Again, carbs come into the picture.
So I am not a frothing-at-the-mouth low carber. As a diabetic you should control your carbs to prevent spikes. Like many other T2s my choice of how to control the spikes is by eating a low to moderate carb diet. A better way to say it is that I eat an appropriate carb diet for my body and my life. If you are eating low carb as part of a weight loss program then that is another kettle of fish that I won't comment on.
I don't intend this to be a low carb advocate site. I am just telling you the decisions I have made and why.
Why I Chose a Low Carb DietThere is a lot of controversy on how you should eat as a diabetic. There are two basic approaches:
My choice is to eat low carb. My reasoning is:
Other people will make a different decision based on their own priority list. It's your choice of course. If my body could tolerate more carbs, believe me, I would eat more carbs. But through my testing program I know what I can eat and not eat. If I had more faith in medicines to keep my blood sugar under tight control I might make that choice, but I don't think medicines will meet my stringent blood sugar control targets. They may meet your personal targets however.
Low carb is not the same as no carb. You don't have to be on Atkins or a South Beach diet to be on low carb diet. You just need to limit your carb intake to what your meter shows you can eat without spiking your numbers above your blood sugar target.
In the US the the average carb intake is 350 grams or more a day. I eat at 100 or less. So I eat low carb by definition, but that's still not no carb.
Diabetics Are All About the VegetablesMany people think low carb is mainly about eating lots of meat. It's not. Low carb is mainly about eating your veggies. I eat more salad and more veggies than I ever did before my diabetes. That's because veggies are low carb. They are also very nutritious.
I find I eat acceptably well on a low carb diet. I miss bread and donuts, but I still eat them, just in very small quantities. I still eat fruit. I eat chocolate. And I eat a lot of veggies. It's not as bad a way to eat as you may think. And when you see your blood sugar and your A1C under tight control, it's a good feeling.
You won't eat a lot of processed foods on a low carb diet. I eat veggies (broccoli, carrots, lettuce, cucumber, peppers, cauliflower, etc), lean meat (chicken, turkey, fish, tuna), some not so lean meat (hamburger, steak), and some fruit (strawberry, orange, apple). More veggies than meat. I also eat a lot of cheese, salsa, nuts (almonds, cashews), sour cream, and spices. Depending on what by numbers are I made have a little potato or kidney beans.
It's the processed foods that contain sugar and trans fats and all the bad stuff for you. By eating low carb from natural foods you are eating better all the way around. That's why many of the low carb food vendors are going out of business now. You don't need specialized processed foods to eat low carb. You visit the produce section and the meat section and you are pretty much taken care of.
And I never go without a dessert, I just eat small portions or eat a low carb dessert. Food is still very fun for me.
Some Low Carb Foods I Would Hate to Live WithoutI don't go without all man made foods, some definitely make my life a lot more pleasant.
Some foods I especially like are:
Some more thoughts on food:
What junk foods are there for diabetics?Some times you just gotta have it, junk food that it is. As a diabetic what junk food can you have that is more or less safe?
Why are Your Morning Numbers So High?Many people find when they test in the morning their numbers are high. This is called the "dawn phenomenon." You'll also see people referring to it as a "liver dump."
Seeing your numbers high can be depressing so it's important you know it can happen. Your body is putting more sugar into your system so you'll have energy when you wake up.
The effect seems to vary a lot by person and even the same person over time. You may never know why it happens to you. I've tried over the years to figure out what causes it, but I've never found a consistent trigger.
Your test in the morning, after 8 or more hourse of sleep, is called your fasting blood glucose (FBG).
To attack the dawn phenomenon you need to mix things up. Some possible changes you can make are:
There is a lot of discussion on this topic in the groups so pay attention when it comes up.
The dawn phenomenon is mysterious, but don't let it get you down. Your A1C can still be fine. The numbers that matter most are your post meal numbers and those you can control.
Help! My Numbers are Spiking. What should I do?Your numbers may be good and then wham, they just start going up. This can be very frigthening. What can you do?
Are You Doing everything Right and Your Numbers are Going Up?Your numbers are going up and you don't know why. You think you are doing everything right, but you are getting worse. You are eating right. You are exercising. You are taking your meds. You have lost weight. You are eating low carb. But you are getting worse.
This is something I live in fear of. Enough beta cells can die that no matter what you do you can't manage your diabetes without insulin. Now I really shouldn't afraid. Using insulin is fine, it's just that I am trying not to so I would consider a sort of defeat.
First take a look at
Help! My Numbers are Spiking. What should I do?. Then consider:
Some people expect to be normal when they just aren't. Your goal can only be
to meet your goal numbers. You can't expect to have the same numbers or near
the same numbers as a non-diabetic.
If you are meeting your goal numbers then you are doing fine, even if your
morning number isn't 80. Take a look at Jennifer's Advice to New the Newly Diagnosed
for a review of the goal numbers.
A variance means you can take a reading at noon and then
and then take another reading just a second later and the results can be very
What this means is that numbers that look different are really about the
same when you factor in the variance. So a reading of 100 and 110 are
effectively the same. If you see a reading of 110 you can think to yourself
that the reading could be 100, or it could be 120.
So if you think all pleasures have been denied you, it's not true. You can drink.
Wine is even good for your heart and as a diabetic you have a much higher risk
of heart disease, so wine drinking is a double win.
Just don't over do it. It can be tempting.
This means your doctor should be talking to you about your
cholesterol numbers (LDL, HDL, and triglycerides). If your doctor
isn't talking to you about your heart then you may need a different
Your doctor may want you to take statins to lower your cholesterol.
Consider this option carefully as many people have a bad reaction
(fuzzy mind and body pain) to statins. I have a bad reaction to statins
so I have decided not to take them. YMMV.
Because of diabetes your cholesterol targets are so low you can't possibly
hit them without taking statins. Diet and exercise won't be enough. A
low carb diet has a very positive effect on cholesterol for many people.
Your tris may drop way down. Your HDL can be increased quite a bit through
The whole cholesterol/heart diesease issue is a complex one. Do your own
research and figure out what is best for you.
The good news is that tight blood glucose control can lower your heart
disease (heart attack, stroke, and angina) risk by 50%. A good article
can be found at
"The longer we follow patients, the more we're impressed by the lasting benefits
of tight glucose control," said Saul Genuth, M.D., of Case Western University. Dr.
Genuth chairs the follow-up study of DCCT participants, called the Epidemiology
of Diabetes Interventions and Complications (EDIC) study, which has been looking
at the long-term effects of prior intensive versus conventional blood glucose
control. "The earlier intensive therapy begins and the longer it is maintained,
the better the chances of reducing the debilitating complications of diabetes."
They people in their study had an average A1C of 7%. You can do better than
that which will hopefully give you better results as well.
Some other interesting studies:
When you see your doctor:
You can read the news groups using the group reading program at
Each news group has a name. The groups you should read are:
If you want to read the news groups regularly then join groups.google.com.
It will give you an interface for reading new threads and posting questions.
http://groups.yahoo.com/ also has diabetes
related groups, though I don't have any direct experience with them. I find
the news groups provide a very vibrant and useful support community.
a site that talks about diabetes related issues.
Some people expect to be normal when they just aren't. Your goal can only be to meet your goal numbers. You can't expect to have the same numbers or near the same numbers as a non-diabetic.
If you are meeting your goal numbers then you are doing fine, even if your morning number isn't 80. Take a look at Jennifer's Advice to New the Newly Diagnosed for a review of the goal numbers.
A variance means you can take a reading at noon and then and then take another reading just a second later and the results can be very different.
What this means is that numbers that look different are really about the same when you factor in the variance. So a reading of 100 and 110 are effectively the same. If you see a reading of 110 you can think to yourself that the reading could be 100, or it could be 120.
So if you think all pleasures have been denied you, it's not true. You can drink. Wine is even good for your heart and as a diabetic you have a much higher risk of heart disease, so wine drinking is a double win.
Just don't over do it. It can be tempting.
This means your doctor should be talking to you about your cholesterol numbers (LDL, HDL, and triglycerides). If your doctor isn't talking to you about your heart then you may need a different doctor.
Your doctor may want you to take statins to lower your cholesterol. Consider this option carefully as many people have a bad reaction (fuzzy mind and body pain) to statins. I have a bad reaction to statins so I have decided not to take them. YMMV. Because of diabetes your cholesterol targets are so low you can't possibly hit them without taking statins. Diet and exercise won't be enough. A low carb diet has a very positive effect on cholesterol for many people. Your tris may drop way down. Your HDL can be increased quite a bit through exercise.
The whole cholesterol/heart diesease issue is a complex one. Do your own research and figure out what is best for you.
The good news is that tight blood glucose control can lower your heart disease (heart attack, stroke, and angina) risk by 50%. A good article can be found at http://biz.yahoo.com/prnews/050612/dcsu003.html.
"The longer we follow patients, the more we're impressed by the lasting benefits of tight glucose control," said Saul Genuth, M.D., of Case Western University. Dr. Genuth chairs the follow-up study of DCCT participants, called the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which has been looking at the long-term effects of prior intensive versus conventional blood glucose control. "The earlier intensive therapy begins and the longer it is maintained, the better the chances of reducing the debilitating complications of diabetes."
They people in their study had an average A1C of 7%. You can do better than that which will hopefully give you better results as well.
Some other interesting studies:
When you see your doctor:
You can read the news groups using the group reading program at http://groups.google.com/. Each news group has a name. The groups you should read are:
If you want to read the news groups regularly then join groups.google.com. It will give you an interface for reading new threads and posting questions.
http://groups.yahoo.com/ also has diabetes related groups, though I don't have any direct experience with them. I find the news groups provide a very vibrant and useful support community.
http://www.diabetic-talk.org/ is a site that talks about diabetes related issues.
You may decide on a different target, but I am just telling you what I do. If you want to eat more carbs on a given day, say for a treat, then you can do a lot of cardio exercise on that day. If I take a nice long hike then I can eat a lot more carbs without raising by blood sugar a lot.
Jennifer's recommendations for blood glucose targets are:
Dealing With Diabetic NeuropathyNeuropathy happens because your nerves have been damaged/destroyed because of reduced blood flow due to diabetes. You usually feel the pain from neuropathy in your hands, arms, leg, and feet. You can feel anything from a pain like your parts have fallen asleep to very sharp hurtful pains. The tingling in your extremities may be so subtle you may not even realise it is there for a long time.
Neuropathy is not pleasant. Not pleasant at all. And there's not much that can be done about it.
Asprin won't help. It's not that kind of pain.
The biggest problem I had with neuropathy is that I had it for a long time yet I didn't know I had it. I ignored or explained away all the little pains neuropathy creates. Looking back it's hard to believe how stupid I was. But I am not alone. A lot of people report ignoring the symptoms of neuropathy. What stinks is that neuropathy could tell you that you have diabetes, but you don't understand about neuropathy until you find out you have diabetes!
What can you do about neuropathy? Neuropathy can be reduced, even somewhat reversed. Here's my plan:
For more infomation see http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/.
Neuropathy also has been associated with statin use.
Not All Pain is from NeuropathyKeep in mind that you can have pain that isn't from your neuropathy, yet feels like it might be from neuropathy. Often what people will do is mistakingly chalk up any pain to their neuropathy when they could be getting better.
For example, sciatic nerve pain may feel like neuropathy, but it isn't. Keep in mind to have any pains you have diagnosed and treated on their own. You don't want to be that person that learns 10 years later that they could have avoided 10 years of pain by simply having their problem looked at.
ACE inhibitors can aslo sometimes produce symptoms similar to neuropathy.
Some people report similar symptoms when blood pressure meds push blood pressure too low. They also report pains running down their legs and waking at night with limbs asleep.
Another possibility is carpel tunnel syndrome if you keep your hands in a cupped position during sleep.
What Will Happen If You Ignore Your Diabetes?More than 18 million Americans have diabetes. We are a large (no smirking) and unfortunately growing group.
The temptation to ingore diabetes is immense because the complications seem so far in the future. You can have the donut now and nothing bad will happen now or even a month from now. The bad stuff happens later. For many people having the effect of complications so far in the future helps then pretend to be a normal person and eat whatever they want. That's a mistake.
It doesn't hurt to snatch a peak behind the curtain and see what awaits those who don't control their diabetes. Most real life T2s don't own a meter. Most don't keep their blood sugar under tight control. What can they expect?
Diabetes is really a group of serious diseases caused by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin.
Diabetes can lead to: severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. Yes, lots of people have their parts chopped off or go blind. Excess blood glucose also impairs the ability of your white blood cells to fight off infections and heal wounds.
Diabetes is the fifth leading cause of death by disease in the U.S. T2 diabetes involves insulin resistance (IR). IR the body's inability to properly use its own insulin. IR usually occurs in those who are over 45 and overweight, but IR has now become a popular disease with obese children and teens in recent years.
If you need help in taking this issue seriously, please read the BBC News article Diabetes raises early death risk. They found atients with Type 2 diabetes aged 35 to 54 were three times as likely to die early as non-sufferers of the same age.
The complications from uncontrolled diabetes can be severe. Yet you don't have to live each day in fear. Do the best you can to control your diabetes through food, exercise, and medication. Once you've truly done your best then let the chips fall where they may.
How do you get your morning numbers downs?High morning numbers are a problem almost all diabetics have to deal with. How do you get your numbers down?
This is the advice from oldal on alt.support.diabetes:
FbG is difficult to control because it represents a balance between your current level of insulin resistance; the current level of damage to your beta cells; and your liver's response to your Circadian rhythm. You can react to a 2-hour-after-eating problem by cutting your carbs for that meal but it's rather difficult to wake up some morning and decide to cut your Insulin Resistance that day (especially since you have been working diligently to cut your I.R. ever since you were diagnosed). Some approaches to reducing FbG: 1. Fool your liver somehow (low G.I./ low carb snacks at bedtime) 2. Order your liver to cut down the !#%! glucose releases (metformin, alcohol) 3. Reduce your Insulin Resistance a. Become an aerobics instructor b. Intensify your exercise regime (become an aerobics student) c. Add anti-I.R. meds to your regime (metformin, TZDs) 4. Supplement your damaged beta cells (Lantus, Levemir, NPH insulin at bedtime)
Why is High Blood Sugar Bad For You?I am still very curious about why high blood sugar causes such extensive damage to our bodies. I don't feel like I really understand what is going on. As I find more and better explanations I'll include them here in this section.
It is said the damage from high blood sugar begins with damage to blood vessels. Clinical studies have shown, over time, high blood sugar levels cause an impressive number of serious health problems: diseases of the kidney, retina, nerves and heart.
Live Longer By Brushing Your Teath and FlossingPeriodontal disease linked to mortality in T2s shows a study at Phttp://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2817.
You will definitely want to tell your dentist about your diabetes. Diabetes makes a difference in your treatment. If you have been continually hassled about your bad gums and teeth, it may be due to diabetes. Diabetics tend to have more gum disease. That's why it is especially important for you to brush and floss.
From the study:
Brushing and flossing could do more than just maintain healthy teeth and gums; they also could help prevent cardiovascular disease (CVD) in people with diabetes. The teeth may be a window into the heart," says investigator Robert G. Nelson, MD, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Ariz. "It isn't that rotten teeth are causing the heart to fail; they're just reflecting different elements of the same inflammatory process." A prospective longitudinal study of 626 people reported in Diabetes Care shows that the risk of mortality from ischemic heart disease and diabetic nephropathy among those with severe periodontal disease is more than three times that of their counterparts with normal oral health.
Diabetes and InsuranceGetting insurance with diabetes is difficult becuase diabetics typically aren't very good at controlling their disease and diabetes leads to a lot of expensive problems. You can not overestimate the black mark diabetes is for insurance. You must plan ahead if you think you may have diabetes. And if you have diabetes you must plan ahead to what will happen if you should lose your insurance.
An excellent paper on the topic can be found at Health Insurance Information for People with Diabetes. Another good article is Health Insurance for Diabetics.
It's not good news.
There are several types of insurance you may need to be concerned with:
Demonstrating good control may help you with certain kinds of insurance.
If you think you may have diabetes then get your insurance taken care of before you go in and become officially diagnosed. It is much easier and cheaper to get insurance without diabetes.
Check your life insurance to see how much it will cost you to increase it or get renewed with a diagnosis of diabetes.
If you think you may have diabetes and you have insurance then get it treated while you have insurance.
If you have diabetes you may want to consider how you'll handle it if you get fired or take another job without insurance. Without insurance your options aren't good.
Insurance in the US is messed up. I don't really have any good advice. My having good control over my diabetes made no difference to the insurance companies. I am an expensive risk and they charge accordingly.
I only see the health care problem in the US getting worse. We in the US pay more money for poorer coverage than most other developed countries. This all seems academic if when you are well or have good coverage. When you have a medical problem and don't have coverage then the reality of it is very real.
Diabets are More Expensive Patients“Annual health care costs for those with the highest pre-diabetes blood glucose levels were 31 percent above those with normal blood glucose levels, with many of the extra costs due to cardiovascular disease, which is expensive to treat but far less expensive to prevent,” said Gregory A. Nichols, PhD, Senior Research Associate, Kaiser Permanente Center for Health Research, Portland, OR, in a recent interview.
“The application of preventive medicine techniques, through early diagnostic testing and intervention, could lengthen lives and lower health care costs when pre-diabetes is spotted.”
A Kaiser study by Dr. Gregory Nichols and Dr. Jonathan Brown, found: Age and sex adjusted costs were $4,357 annually for patients with normal blood glucose levels, $4,580 for those with stage 1 pre-diabetes, and $4,960 among those with stage 2 pre-diabetes. However, costs for those with normal blood glucose were only $3,799 annually when those who later progressed to IFG or diabetes are removed, thus yielding the 31 percent difference, Dr. Nichols cited.
“The increased costs are seen in inpatient, outpatient, and pharmacy expenses,” reported Dr. Nichols.
Diabetics at Risk of Low Testosterone and Sexual DisfunctionThe study: http://www.healthsentinel.com/news.php?event=news_print_list_item&id=919
The study finds: Men over the age of 45 with diabetes are more than twice as likely as non-diabetic men in the age group to have low testosterone, making them susceptible to sexual dysfunction, according to a study presented on Saturday. "Too many times people with diabetes have gotten the short end of the deal," said study investigator Dr. Sherwyn Schwartz, director of the Diabetes & Glandular Disease Clinic in San Antonio, Texas. "This is a common problem that we need to start looking for." The study, which screened 2,162 men, with an average age of over 60, found that half of the 474 men with diabetes also had low testosterone, or hypogonadism. That means men age 45 and older with diabetes have 2.09 times higher odds of having hypogonadism compared to non-diabetic men, the researchers said. "This is an astonishing prevalence rate. The implication is that management of diabetes hinges on more than just managing glucose levels," said Dr. Natan Bar-Chama, a urologist with Mount Sinai Hospital in New York. The research was sponsored by Solvay Pharmaceuticals Inc., which sells a testosterone gel called AndroGel. Low levels of the male hormone are associated with diminished sex drive, erectile dysfunction, higher body fat, reduced muscle mass and decreased bone mineral density as well as depression and fatigue. ...
Can a Diabetic Give Blood, Organs or Bone Marrow
Donating BloodIt seems who is accepted as a blood donor is a local blood bank decision. Different locations have different rules. Each blood bank follows the advice of their medical advisor. Advisors from different blood banks may disagree, so shop around if you really want to give blood.
Some people are told taking Metformin or insulin means they can't donate. Some people are told they can't donate because taking blood may upset their blood glucose levels. Some people are told they can't donate because we aren't sure yet what causes diabetes so they don't want to take the risk. There are many possible reasons to be denied.
The Red Cross guidelines allows diabetics in good control to donate whether taking oral medications or insulin (except those who have taken Bovine insulin since 1980).
In the UK if your diabetes is treated with tablets or insulin, then you will not be able to give blood.
Overall, many diabetics give blood on a regular basis, so you might be able to as well.
Donating Bone MarrowThe same "it depends" answer seems to apply for bone marrow donation. Some diabetics have been found they are allowed to donate bone marrow and others haven't been allowed. I have found one site that said you are not eligible to be a donor if you have insulin-dependent diabetes, you are eligible to donate if your diabetes is controlled by diet
Donating OrgansPeople with diabetes sometimes can donate their organs. I am sure this varies by location as well. One site I read said that doctors will assess your organs and see if they are healthy enough to use. Diabetics often have many organ related problems, but there's no reason a diabetic could not donate a lung, for example.
Take Care of Your FeetThis section has been adapted from a press release from University of Michigan Health System on how best to treat osteomyelitis, a foot-bone infection. See http://www.med.umich.edu/opm/newspage/2005/foot.htm for more information.
A small sore on a toe may not seem like a major medical threat. But for the millions of people who have diabetes and other conditions, it can be the first step on a road that leads to the amputation of a foot - or even a leg. Now, a new study from the University of Michigan Cardiovascular Center may help more people save their limbs.
Because diabetes interferes with the body's ability to heal, even the smallest foot wounds can become infected, spread to the bone, and lead to an amputation. Poor circulation and numb feet, also common in people with diabetes, make the situation worse. More than 80,000 such amputations happen each year in the United States. Experts already recommend that people with diabetes take special care of their feet and have regular foot exams to spot problems early.
As a diabetic you should examine you feet daily for:
National data showed that 8.5 percent of patients hospitalized for foot osteomyelitis had a leg or foot amputated, and 23 percent had a toe amputated. About 1.6 percent died before leaving the hospital. Patients who were older, African American or had kidney problems were more likely to have an amputation.
Of the U-M osteomyelitis patients, 80 percent had diabetes, and 30 percent had chronic kidney problems. Nearly 40 percent also had blockage in the blood vessels of their legs, a condition called peripheral vascular occlusive disease. Nearly a quarter of the patients died within 31 months of their hospital stay.
The patients who had blood vessel reconstruction to improve circulation in their legs and feet were several times more likely to have successful wound healing and to keep their foot or leg. Toe amputees were also more likely to keep their limb.
Antibiotics alone are not as effective as surgery plus antibiotics, both for healing wounds and saving limbs.
Diabetes and Kidney DiseaseA good paper on diabetes and kidney disease can be found at http://www.kidney.org/atoz/atozItem.cfm?id=37.
From the paper:
The statistics seem grim, but trends are changing. There was a report recently that said kidney problems in diabetics were going down because of better control. You don't have to get kidney disease. Like for other complications from diabetes, the better control you have the better chance you have at staying healthy.
Which Blood Glucose Meter Should You Use?This is a topic I know very little about. I bought the One Touch Ultra early on and have been happy with it, so I haven't had to look into the topic. But I have picked up a few nuggets of knowledge.
You should be able to get your meter for free. Either your hospital, doctor, or the manufacturer will probably give away a monitor. They give away monitors because it is the test strips that are expensive. They must make a fortune on tests strips. You need the test strips for the rest of your life and they price accordingly.
Decide if you want to keep your free monitor. Use your free monitor for a while and then decide if you want to keep it or use another one. You'll have to do some research to see if there is another monitor that you will like better. There are different kinds and one kind may appeal to you more.
Some issues to consider when picking a meter:
Where can you buy test strips?.
How do you know if your monitor is accurate?. This is a question that I had. How do I know the number on the meter is any good? There are several methods of verifying your meter.
You will get tested regularly through your hospital. Take a reading with your meter before you go get tested at the hospital. Write down the reading from meter for later. When the results come back from the hospital compare the numbers. They should be pretty close. Blood testing is a relatively inexact procedure, so don't expect too much.
Another way to tell if your meter is accurate is to use the Check Solution. The instructions on how to run the test should be in your meter's manual. Run the test about five times. A wide spread in the readings could mean your meter is broken or that the test was run improperly. Try a new batch of strips. Perhaps your strips are old or contaminated? Or perhaps the first drop out of the Check Solution was not discarded.
Readings from your right and left side can be different. Do some testing of your own to see how your numbers differ by side. My numbers are lower on my left side so that's the side I test on :-)
If you run 10 tests on yourself in a row the numbers will be all different. Your blood glucose is changing all the time so there's no real reason to expect the readings to ever be exactly the same. Plus, there's just a natural variation because of the mechanical reading process. If you get a really high number that doesn't seem right then run another test to check. Wash and dry your hands before taking the second test.
Many meters come with sofware that will run on your PC and you can download your meter readings into the software. Then the software will culculate highs, lows, averages, and produce all sorts of pretty graphs. If that sounds good to you then be sure and check if your meter will have that feature.
For what it is worth, at the time of this writing (July 2005), Dr. Bernstein's clinic recommends the Bayer Contour meter.
Advances in MonitorsHopefully in the not to distant future we'll have continuous monitors so we don't have to test through the day. I am looking forward to these monitors so I can get a better picture of my numbers.
There's an interesting wristwatch monitor by Calistomedical at http://www.calistomedical.com. It doesn't require blood to be taken for a test, which is very interesting. I don't ware a watch, but it might be an interesting alternative for those of you who do. I have no reports yet on how well it works.
Some Useful Sites
When Should You Fire Your Doctor?Not all doctors or health care institutions provide the health care you need or deserve. When that happens your best bet is to find another doctor more aligned with the philosphy of treatment you wish to follow.
Diabetes, in particular, is a disease with a wide range of treatment options. This is partly because diabetes is defined by having blood glucose of certain levels at certains times (fasting, etc). Over time the blood glucose levels defining a diabetic have been going way down. People diagnosed as diabetics today may not have been diagnosed as diabetics 20 years ago, simply because the blood glucose entrance criteria has gone lower.
There are many cases on the news groups of people with high and even very high blood glucose levels who are being told by their doctor that they aren't diabetic. If your morning reading is high and your doctor isn't concerned, then get another doctor.
There are people with high A1Cs that are being told their control is great and they are doing great and there's nothing to change. Get another doctor.
There are people who are still given very high 1 hour post meal and 2 hour post meal blood glucose targets. Get another doctor.
There are people who are told they don't need to test frequently. Get another doctor.
If a doctor insists on treating with meds and refuses your requests to try more diet and exercise as well, then it may be time to find another doctor.
If your doctor only gives you 15 minutes of office time, that's normal.
How do you find another doctor?You may think your are stuck with your current doctor because your live out in the country or don't have a lot of money. You do have options. This is the good advice (slightly adapted by me) given by Ted Rosenberg on the alt.support.diabetes news group on finding a another doctor. Ted says try:
You are Your Own DoctorWe all have to be on top of our own medical care. Doctors, no matter how smart, no matter how caring, and no matter how well intentioned can make mistakes. Even if they don't make mistakes there are just too many details for anyone to always keep in mind.
For example, if your doctor prescribes you cough medicine, it's your responsibility to ask if it's sugarfree. Your doctor may forget you are diabetic and prescribe you normal people cough medicine.
What Tests Might You Have Done?
Blaming the PatientDiabetes is a disease where the responsibility for treatment rests primarily on the patient. This is good in that it gives you a lot of control over your health. It is bad because it means if something goes wrong, you are the easiest person to blame. And many times the patient should be blamed, but not always. To see why, I love this post by Alan S on alt.support.diabetes:
Now we have the real attitude. So it has nothing to do with poor advice and guidelines - non-compliance is the real problem! What you're implying is that it doesn't really matter what is advised - it won't be followed anyway. So it's the patient's fault. I don't comply with the ADA/Diabetes Australia guidelines either. Nor do some of the other posters here. In fact, I directly contradict their guidelines on diet and testing. Odd, that. It's also odd that back when I dropped in on the local support group people asked the CDE questions like "I'm taking the pills the doctor told me to and I lost a lot of weight and my numbers are still too high - Why? What should I do?" After the CDE had responded I would ask just two questions: "What did you eat for breakfast?" "How often and when do you test?" The answers were invariably a version of "Oh, I eat my healthy three "carbs" of cereal, skim milk, toast, just like the Diabetes Australia dietician told me" and "before breakfast and before dinner, just like the doctor told me". Well, like the doctor used to; it seems the local one is suggesting some extra testing these days. Blame the patient. How often have we heard that before? Does it never occur to those with the responsibility of advising on public health that, if the advice is not producing the right results, the problem may be the quality of the advice and not the level of compliance?
Should You Take a Vacation From Diabetes? Dealing with Diabetes BurnoutDiabetes is relentless. Diabetes is 24 hours a day every day for the rest of your life. This causes people to burnout from the constant monitoring, pressure, concern, worry, and fear. How do you deal with burnout?
One suggestion is to take a periodic vacation from your diabetes. Don't worry about what you eat. The idea is this will lessen the constant stress of dealing with your disease.
In the US Independence Day is on July 4th. Some people declare that day independence day from their diabetes as well. They will have the foods they would normally deny themselves: apple pie, buns on their hot dogs, french fries, mash potatoes, potatoe salad, corn on the cob, and all the other most excellent picnic foods.
Should you take a short vacation from diabetes? I can't answer that. As always, it's up to you.
It's impossible to have perfect control in general. So you will always have some times when you do well and other times when you do poorly. The key is not letting a relapse turn into colapse. Don't let a little bad control push you over the edge into saying it doesn't matter and then falling off the control wagon for years. A couple of weeks of bad control probably won't hurt you that badly. A year of bad control will probably do some damage.
One suggestion for when you purposely practice bad control is to still take blood glucose readings. This helps give you an idea what's happening to you and in time it will likely prompt you back into better control. Once you say screw it and stop testing then you know you are in a bad place. What will start you testing again? What will start you bad on the path of good control?
Like for exercise, an all or nothing attitude for control doesn't work. One study showed those people who exercised 30 minutes at time wouldn't get as much total exercise as those people who just tried to walk a certain number of steps a day. The reason was that the people who blocked of exercise in time chunks would skip exercise completely if they didn't have time. The people who tried to walk a certain number of steps would still get some exercise, even when they didn't reach their target.
Maybe contol is the same. When you try for perfect control you end up with a worse overall results because when you lose control you go out of control. Allowing a little bad control at times may give you better control over the long run. Forgive yourself and be understanding for the times when you don't live up to your expectations.
Software for DiabeticsHere is some software that may be of interest to diabetics.
Disaster Prep - Know Your MedsMany of the Katrina evacuees have diabetes and other health problems, but don't know which medications they are taking. You can imagine the doctors on the ground are worried about prescribing meds for patients they don't know because they could be doing more harm than good.
What can you do?
Disaster Food Supplies Considering the DiabeticWe live in earthquake and fire country so the topic of what should be in our emergency food supply kit for a diabetic has come up. Other people live in volcano country, tornado country, hurricane country, tsunami country, or winter storm country. Everyone lives in some sort of country where an emergency can happen.
I try to eat as much fresh and unprocessed foods as I can so my normal pantry would not otherwise have the foods I could eat in a disaster. Your situation may be different.
Some thoughts on what you need and/or could do:
If you have some lead time before the disaster get what you need before everyone else hits the store. On a permanent basis keep as many of the items on hand as you can.
Why Test On the Side of the Finger and Not the Pad?A question new people often ask is why when testing should you stick the side of your finger and not the pad (fingertip) of your finger?
No technical reason that I know of. It doesn't matter. Use any part of your finger from which you can get a good drop of blood.
People say they use the side of your finger because it hurts less. Fingertips in general are pretty sensitive because they have many nerves which means they have more feeling and are more likely to hurt when poked. As we use our fingers all the time any injury on the fingertips may be more annoying.
There is some thought that a wound on the sides of your fingers are less likely to get irritated by friction because they are more protected.
But you can pick the part of your finger that hurts less for you.
If you bruise easily, you may want to test on the pad of your thumb as the bruises will be less visible. People with slender fingers also may want to try testing on their fingertips. Bruising and irratation can be minimized by holding direct pressure on the test site for at least thirty seconds.
If you play a musical instrument you may want to restrict testing to your off hand or select a suitable part of your hand. If you play the guitar, for example, you may not want to test on the fingertips of your fingerpicking hand.
Perhaps other jobs have similar considerations? People who type a lot may not want to test on their fingerips either because their fingertips will be constantly hitting the keys.
Many people end up using the same finger and the spot all the time because they don't see any spots and don't create painful areas over repeated tests.
The side of the finger close to the fingernail is an area many people have found works for them.
Some people have complex rotation patterns so they can cycle through different tests sites over time. This ensures when you cycle through your test sites again your wounds should be completely healed. One example rotation pattern is to use both hands, try the outside edge of each finger, then try the inside edge of each finger. Every pass through pick a different test site so you don't use the same test sites again for a long time. This kind of pattern gives you a lot of testing options and should help you reduce your pain.
How Should You Use Your Lancet? (the thing you stick yourself with)A lancet is the needle you poke into yourself to get a drop of blood to test. What is some advice on how best to user your lancet?
Painless Fingerstick MethodThe steps are:
How often should you change your lancet?Is it unsafe to clean and reuse the lancet before replacing? Some people rarely change their lancet. Some people change them a few times a year. Some people change every month. Some people change them every two weeks. Some people change them more frequently. I wait until I notice it hurts and then I change the lancet. That may not be the smartest approach, but it works for me so far.
Daniel Einhorn, MD, FACP, FACE, has this to say about the safety of reusing lancets:
But other people are concerned about infection from finger testing:
The Stick: Stories of Complications from DiabetesThis is the stick part of the paper, the part the doesn't sugar coat how bad diabetes can be if you don't figure out a way you can control it.
Being afraid isn't bad if it motivates you to do something different from what you have been doing. Use the fear to rethink your life and find the motivation to make changes. The average T2 doesn't make changes and bad things happen to them. Once you learn to take personal responsibility and you learn what changes you can make, you can end up feeling better than you ever have before.
Misc Bad Things
Yes, It's SeriousFrom KPWelther in the news group alt.support.diabetes:
Foot Problem Story #1From dsaurus in the news group alt.support.diabetes:
Missing ToeDiabetes: No way to downplay the dangers. Every time Edward Braley looks at his left foot, he sees what he calls the "Grand Canyon" -- the hole where his little toe used to be. Braley, a 63-year-old diabetic who lives in Bellingham, had his toe amputated just before Thanksgiving, becoming one of more than 80,000 diabetics who undergo amputations in America each year.
The Carrot: People Do Get and Stay BetterThe good news is: people using the resources I link to in this paper do well. It's not all disaster. It's not all doom and gloom. Or it doesn't have to be if you take action. Diabetes moves slowly so you have some time to make things better of you make the right moves now.
If you read the news groups you'll read about people all the time that start of with really high A1Cs and blood glucose levels and bring them down very fast with a good diet and exercise. It can be done and people do do it. So can you. Don't every think that you can't. It can be done. And you can do it. You really can.
Issues to Consider at the Dentist
Bad Gums and TeethBecause diabetics don't heal very well it's possible you have dental problems. I consistently got nastied at by the dental hygienist because she thought I wasn't taking care of my teeth. Well I was, at least I was doing a lot more than she was giving me credit for! But because of my undiagnosed diabetes it just didn't look like I was brushing and flossing.
Now that my numbers are under control my teeth and gums are better. They aren't great, they are just better.
I think dental hygienists could be a big help in diagnosing diabetes if they would bring it up to their patients who have problems and appear to be a little overweight.
Feeling Jittery and Heart RacingAnother issue appears to be sensitivity to pain killers. If you feel jittery and your heart is racing and your numbers seem normal (so it's not a hypo), then the issue might be the pain killers you are getting as part of your treatment.
Novocaine has epinephrine in it to limit bleeding. Epinephrine is adrenalin and causes tachycardia (rapid heart rate) and increases blood pressure.
Discuss it with your dentist. Consider asking your dentist to use a local with less epinephrine.
Good Teeth Care is Also Good Heart CarePeriodontal Disease Linked to Mortality in Type 2 Diabetes. "Brushing and flossing could do more than just maintain healthy teeth and gums; they also could help prevent cardiovascular disease (CVD) in people with diabetes. Inflammatory processes may be the key to an emerging link between periodontal disease and an increased risk of mortality among people with type 2 diabetes, recent research suggests. "The teeth may be a window into the heart," says investigator Robert G. Nelson, MD, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Ariz. "It isn't that rotten teeth are causing the heart to fail; they're just reflecting different elements of the same inflammatory process." A prospective longitudinal study of 626 people reported in Diabetes Care shows that the risk of mortality from ischemic heart disease and diabetic nephropathy among those with severe periodontal disease is more than three times that of their counterparts with normal oral health..."
Eat Before or After Walking?When you exercise your body uses glucose for fuel. This is a great reason to walk or exercise after eating, especially if you ate a little too much.
But your liver may sense falling glucose and it can dump glucose in support of your effort. This is like the dawn liver dump that happens to many people and is why your numbers can sometimes be higher after exercise. Having your numbers higher after exercise can be very frustrating because exercise is supposed to help, not hurt!
Some people are more sensitive to exercise that others. How sensitive are you? Test! You may find there's a lot of variability in your response to exercise and food. I know patterns are hard to find.
I usually eat a small snack before exercise and after exercise just to try and even my numbers out. Other people don't need to do this. You'll have to figure out what you need to do.
I know you are thinking "I'll just skip this whole problem and not exercise!" Naughty naughty.
A List of Lowcarb Fruits and VegetablesI hate summer for the heat, but I love summer for the deliciously ripe fruits and vegetables. My favorite is a big juicy perfectly ripe strawberry. I love a little fresh corn, peaches, and string beans. I am sure you have your own favorites too.
A common misconception about low carb is that it's all about eating meat. It's not. You can have fruits too, in moderation, and you can have almost all the veggies you can eat. Personally, I think one of the great pleasures of life is eating fresh summertime veggies and fruit, I would never give those up for the sake of any diet. They are one life's great pleasures and a gift of nature. When eaten properly there are no worries.
What are some good low carb fruit options?Fruits are like the finest candy. As a diabetic you can still have fruit.
Berries of all sorts are often safer for diabetics than other fruit. Try them in cottage cheese or yogurt. Sugarless berry jams are also very tastey.
What are some good low carb veggie options?
To see how much of a fruit or vegetable you can safely eat, what you do? Test. That's the only way you'll know for sure. Don't stop eating high quality foods like fruits and veggies just because you think they are too high in sugar. Test and find out.
If you want to advance the quality of your diet a little you may want to look at the benefits of phytonutrients and antioxidants. Many of the best fruits for antioxdants are also diabetic-friendly in smaller quantities.
Can I Go on Vacations as a Diabetic?Yes! You can do anything you want to do. Don't be afraid. You just need to prepare a bit more than you did before you were a diabetic.
Newly Diagnosed. Why am I so Hungry?If you are newly diagnosed with diabetes you may find you always deeply hungry in a starving sort of way. That's kind of weird, why would that happen?
Diabetics can suffer from a condition called "Glucose Toxicity." Glucose Toxicity is caused by extended exposure to high blood sugars before diagnosis.
Many people find when their blood glucose is very high they get very hungry, extremely tired, and feel lots of aches and pains. When the blood sugrar comes under control then so will many of the symptoms.
But getting your blood sugar under control is difficult because Glucose Toxicity messes up your already messed up glucose metabolism. Yet you have to get your blood sugars under control and keep them that way for a while.
That's why for the newly diagnosed diabetic the early Days can be frustratingly difficult.
Is Walking Getting More Painful?If your walking is getting more painful you may be suffering from Peripheral Vascular Disease (PVD) or Peripheral Artery Desease (PAD) or Raynaud's disease.
It can be caused by high blood glucose, like Peripheral Neuropathy. Both nerves and the wall of the arteries get stiff and brittle by the glycation process.
Your doctor, of course, will have to diagnose what's really wrong, and there are treatments.
What is important is to not just ignore the pain you are feeling as nothing. It could be something so get it checked out.
For more information take a look at:
I Got a Gusher. Blood Sprayed Everywhere! Why?Sometimes, hopefully rarely, a finger prick may cause a blood gusher to happen. Bloods jets from your finger all over the place.
It seems to happen most when you are wearing white.
I haven't seen explanation of why this happens. But it does seem to be fairly common, so there doesn't seem to be a reason to be concerned.
Some people think it happens more when you have been active and your heart rate up, but this hasn't been true for me.
The gusher is one reason I would never test in public or at an eating table. It's disturbing enough to me when it happens, it would probably freak other people out.
For suggestions on how to get blood out of your clothes take a look at ehow.
Is Coffee OK for Diabetics?It seems the verdict on coffee for diabetics contually ping-pongs between coffee is OK for diabetics, coffee is horrible diabetics, and coffee actually makes diabetics better.
Who should you believe?
May current opinion is that coffee is fine for me and the majority of science is on the side of coffee being Ok to even being protective. I test after drinking coffee and my numbers seem fine. You should do your own tests too.
And there's a larger point here about acceptable risk. Even if coffee was a little bad for you, does that mean you shouldn't drink coffee? That is of cource a personal opinion. I love coffee and I drink a lot of it. I don't want to give up one of the few simple pleasures I have left without a darn good reason. Your mileage may very.
Be Careful of What You Eat at HospitalsYou may think as a diabetic at a hospital you'll be offered appropriate diabetic meals. That's not always true, it varies a lot by hospital. What passes as an acceptable diabetic meal at a hosptial may contain white bread, cereal, juice, sugary deserts, and so on. These will have all been recommended by hospital dieticians.
To get the food you want you may need to become the "patient from hell." That doesn't be mean or nasty, but it means you need to take charge of your diet and don't meekly go along to get along. You need to make sure you are being taken care of and you are getting the diet appropriate for you.
Some points to consider:
Why is My Blood Sugar Higher After Exercise?You might see your BG rise after exercise. This seems counterintuitive at first, because doesn't exercise use blood sugar? Shouldn't your BG be lower?
What is happening is you are probably using enough glucose during exercise to cause your blood sugar to drop. Your liver sees this and causes more glucose to be dumped to help you sustain your exercise level.
This is a known effect so don't get worried.
Try eating 2 or 3 gram dose of pure glucose every 15 minutes while you exercise. That might prevent the glucose dump. Glucose will go straight to your blood stream and might work better than eating food because food must be digested and may dump a lump of sugar into your system all at once.
Or try eating a light carb snack, like a slice of bread or a portion of fruit, before exercising. If you know you are going to exercise hard you may want to eat more carbs before exercising.
Some people exercise after eating. Most people don't feel comfortable exercising after eating though.
Muscle holds about 6 - 7 minutes of stored glucose to handle energy demands. When you need to suddenly run away from a lion, this is the energy that's used.
Then your muscles start using the blood glucose which doesn't require insulin during exercise.
Then when your blood glucose is lowered to a point your liver releases more glucose to replinish the blood. But because of your diabetes your liver may overshoot and doesn't stop releasing sugar when the previous level is reached.
You may find the less strenuous exercise, like walking, just lowers your numbers. More extreme exercise may raise your numbers. If you exercise really hard you may blow through the spike and your numbers will lower again. Exercise hard for 90 minutes and your numbers will probably be low. They may go really low, so be careful.
The solution isn't to stop exercising. That would be too easy :-) Exercise helps:
You'll have to experiment to find what works best for you. Test all throughout various exercise lengths and intensities using different strategies for handling your BG.
Does a Low Glycemic Diet Help Prevent Spikes?A low glycemic diet is one where you try to eat slower releasing carbs. White bread will dump immediately into your system because it is made up of simple carbs. Whole grain bread may have the same number of carbs, but because it is made of complex carbs, it will release carbs slower.
I can't answer this question for you. You'll need to perform your own testing to see a low glycemic approach works for you.
For me though it doesn't work. They raised my blood sugar, it just took longer to see the raise, which at first lead me to believe my numbers were better. They weren't better. Instead of seeing a spike at 1 hour after eating I might see the spike at 1.5 hours instead.
So the spike was still there. And as the goal is to not have a spike a LG diet wasn't effective for me. Controlling the number of carbs I eat works, the type isn't as important.
Your mileage may vary though. You'll have to test to find out.
The glycemic index approach works better for people with normal second phase insulin release because by the time the slower carb hits their system their beta cells have produced enough insulin to have caused the glucose to be taken up by their cells. For most T2s this doesn't work because their second phase insulin response isn't enough. If you don't know what this means don't worry about it, but you may want to do a little research.
Remember, you'll need to test later after eating when eating slower acting carbs. Your numbers may peak at 1.5 or 2 hours after eating instead of .5 hours after eating.
Carpal Tunnel May be Sign of Impending DiabetesFrom an article from Reuters:
NEW YORK (Reuters Health) - In more cases than would normally be expected, people who develop type 2 diabetes have a history of carpal tunnel syndrome. The wrist nerve problem sometimes predates the onset of diabetes by up to 10 years, according to a UK study.
Led by Dr. Martin C. Gulliford, a team at King's College in London examined medical records for 644,495 patients in England and Wales. They identified 2647 patients diagnosed with diabetes between November 2003 and October 2004, and selected a comparison group of 5,294 "control" subjects matched for age, gender, and location.
Medical records for up to 10 years before diabetes was diagnosed were reviewed for the first occurrences of carpal tunnel syndrome. Also, according to their report in the medical journal Diabetes Care, the researchers identified subjects diagnosed with Bell's facial palsy, a nerve disorder causing temporary paralysis of facial muscles.
Results showed that, after accounting for other risk factors, the pre-diabetes group was 36 percent more likely to have had carpal tunnel syndrome in the past than the control group.
Researching DiabetesResearch is how we learn. If you want to do your own research then take a look at:
You'll be quite amazed at all the work that has been done on various subjects. Research can be hard to read. It's all technical and complicated and can take a long time to get through until you start learning enough that everything starts making sense. So don't worry, it's not you, but it is hard going for a while.
Some More Resources
A Low BG 4th of July by JenniferThese recipes were given by Jennifer on the news group alt.support.diabetes. She can be contacted at jenniferNOSPAM@earthlink.net.
For a low BG fourth of July Jennifer suggests the following very tasty sounding meal plan:
Fauxtato SaladThis tastes almost exactly like potato salad, and the texture is pretty darn close too.
Serves 6, Per serving: 4.8g carbs.
Anil's Advice on the Options for T2sThis is an adaptation of an excellent post from Anil on the newsgroup alt.support.diabetes. It has a lot of good information in it.
As a lifestyle modification statement, T2's have few options. When ever possible they should max out on exercise. This is true for non-T2s as well. There are simply way too many benefits for maxing out on this option.
Folks who max out on exercise
Folks who do not exercise or can not exercise
Why are wounds slow to heal in diabetics?One of the frustrating things about being a diabetic is that we are slow to heal. This also seems to mean we more easily create scar tissue. Why?
Here's an interesting scientific explanation for why. You can find the link at http://www.sciencedaily.com/releases/2007/05/070504141456.htm.
Why Wounds Are Slow To Heal In Diabetics Science Daily — Individuals with diabetes often experience slow or limited wound healing. Endothelial progenitor cells (EPCs), which derive from bone marrow, normally travel to sites of injury and are essential for the formation of blood vessels and wound healing. In a study reported in the May 1st issue of the Journal of Clinical Investigation, Omaida Velazquez and colleagues from University of Pennsylvania Medical Center reveal why the numbers of these vital EPCs are decreased in the circulation and at wound sites in diabetes. The authors examined diabetic mice and found that increased oxygen levels (hyperoxia) enhanced the mobilization of EPCs from the bone marrow to the peripheral blood circulation. The high oxygen levels increased the activation of the bone marrow enzyme eNOS, which stimulated nitric oxide production, helping to produce greater numbers of EPCs. However, local injection of the chemokine stromal cell--derived factor 1 alpha (SDF-1alpha) was required to recruit these EPCs from the circulation to the wound site. The increased presence of EPCs at the wound site resulted in accelerated wound healing. The authors concluded that impaired eNOS activation and decreased SDF-1alpha expression in diabetes are responsible for the defect in diabetic wound healing. In an accompanying commentary, Harold Brem and Marjana Tomic-Canic from Columbia University and Cornell University, respectively, reinforce that future therapeutics for diabetic wound healing will have to correct multiple deficiencies simultaneously. Therapeutic interventions, including correcting EPC activation via hyperbaric oxygen therapy and correcting EPC homing via administration of SDF-1alpha, may significantly accelerate diabetic wound healing by correcting the deficit in EPC number that is inherent to diabetic wounds. Article: Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and SDF-1alpha
Why are Eyes and Nerves Easily Damaged in Diabetics?The eye is one of those organs that is not protected by a barrier that needs insulin to penetrate so whenever the blood glucose level rises glucose floods into the eye. Nerves, testes and some other tissues behave similarly and are likely to suffer similarly from poorly controlled blood glucose levels.
What is the highest blood sugar every recorded?Michael Dougherty at 12 years old in November 1995 was found to have a blood sugar level of 2,350 and was still conscious. The normal blood sugar range is between 80-120.
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