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:

  1. Provide references to information sources that will teach you everything you need to know about diabetes. I don't even try to include everything you need to know about diabetes on this page.
  2. Communicate some of my own lessons learned. I feel if everyone took the time to share their lessons we would all be better off.

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 :-)

Contents:

  1. What Should You Do About Your Diabetes?
  2. Jennifer's Advice to New the Newly Diagnosed
  3. Good Diabetes Web Sites
  4. How Do You Know if You Have Diabetes?
  5. T1 Vs T2 Diabetics
  6. Do People with Type 2 Always Deteriorate?
  7. Are You to Blame For Your Diabetes Because You are Fat?
  8. Diabetics Should Eat to Their Meter
  9. Using Your A1C Test to Control Diabetes
  10. Apply Test Results to Continually Help Make Yourself Better
  11. When Should You Test Your Blood Sugar?
  12. Get Your Raw Tests Results Back from Your Doctor
  13. Eating Smaller Portions Helps Manage Diabetes
  14. Diabetic Treatment is All Over the Map
  15. Exercising and Losing Weight Helps Diabetes A Lot
  16. Diabetes Doesn't Go Away
  17. Are Carbs Evil?
  18. Diabetics Are All About the Vegetables
  19. Some Low Carb Foods I Would Hate to Live Without
  20. What junk foods are there for diabetics?
  21. Why are Your Morning Numbers So High?
  22. Help! My Numbers are Spiking. What should I do?
  23. Are You Doing everything Right and Your Numbers are Going Up?
  24. Alcohol Lowers My Numbers
  25. Having Diabetes Means You've Already Had a Heart Attack
  26. Your Doctor is Your Consultant
  27. Diabetes News Groups
  28. Diabetes Books, Magazines, and Organizations
  29. Diabetes Health Targets
  30. Dealing With Diabetic Neuropathy
  31. What Will Happen If You Ignore Your Diabetes?
  32. How do you get your morning numbers downs?
  33. Why is High Blood Sugar Bad For You?
  34. Live Longer By Brushing Your Teath and Flossing
  35. Diabetes and Insurance
  36. Diabetics at Risk of Low Testosterone and Sexual Disfunction
  37. Can a Diabetic Give Blood, Organs or Bone Marrow?
  38. Take Care of Your Feet
  39. Diabetes and Kidney Disease
  40. Which Blood Glucose Meter Should You Use?
  41. When Should You Fire Your Doctor?
  42. What Tests Might You Have Done?
  43. Blaming the Patient
  44. Should You Take a Vacation From Diabetes? Dealing with Diabetes Burnout
  45. Software for Diabetics
  46. Disaster Prep - Know Your Meds
  47. Disaster Food Supplies Considering the Diabetic
  48. Why Test On the Side of the Finger and Not the Pad?
  49. How Should You Use Your Lancet? (the thing you stick yourself with)
  50. The Stick: Stories of Complications from Diabetes
  51. The Carrot: People Do Get and Stay Better
  52. Issues to Consider at the Dentist
  53. Eat Before or After Walking?
  54. A List of Lowcarb Fruits and Vegetables
  55. Can I Go on Vacations as a Diabetic?
  56. Newly Diagnosed. Why am I so Hungry?
  57. Is Walking Getting More Painful?
  58. I Got a Gusher. Blood Sprayed Everywhere! Why?
  59. Is Coffee OK for Diabetics?
  60. Be Careful of What You Eat at Hospitals
  61. Why is My Blood Sugar Higher After Exercise?
  62. Does a Low Glycemic Diet Help Prevent Spikes?
  63. Carpal Tunnel May be Sign of Impending Diabetes
  64. Famouse Diabetics
  65. Researching Diabetes
  66. Some More Resources
  67. Recipes
  68. Anil's Advice on the Options for T2s
  69. Why are wounds slow to heal in diabetics?
  70. Why are Eyes and Nerves Easily Damaged in Diabetics?
  71. What is the highest blood sugar every recorded?


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?

  1. Read information at the American Diabetes Association (ADA) at http://www.diabetes.org/home.jsp. The ADA is a good starting point. There are other approaches to managing diabetes than what I cover here. I advocate a low or moderate carb approach, the ADA takes a different approach and you should consider that approach as well.
  2. Read the information sources in section Good Diabetes Web Sites.
  3. Then come back and read the rest of my page.
In short, the plan I follow is:
  1. Eat to my meter. Follow an appropriately carbed diet. Eat slowly digesting carbs. Spread my carb intake during the day over several small meals.
  2. Exercise every day.
  3. Lose fat, especially abdominal fat through proper diet (few processed foods, lots of veggies, lean meat) and exercise (mainly walking).
  4. Gain muscle by lifting weights and exercising.
  5. Take an anti-Insulin Resistance med like metformin.
  6. Read diabetes related news groups everyday. This keeps me caught up with any new developments, I continually learn, and I am continually mindful of treating my diabetes.

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/):

Before 1994, the American Diabetes Association’s (ADA’s) nutrition principles and recommendations attempted to define an "ideal" nutrition prescription that would apply to everyone with diabetes. Although individualization was a major principle of all recommendations, it was usually done within defined limits for recommended energy intake and macronutrient composition. The 1994 nutrition recommendations shifted this focus to one that emphasized effects of nutrition therapy on metabolic control. The nutrition prescription is determined considering treatment goals and lifestyle changes the diabetic patient is willing and able to make, rather than predetermined energy levels and percentages of carbohydrate, protein, and fat. The goal of nutrition intervention is to assist and facilitate individual lifestyle and behavior changes that will lead to improved metabolic control. This focus continues with the 2002 nutrition principles and recommendations.

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 Sites

There'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.

  1. If you have just been diagnosed, handling diabetes is almost all about controlling your blood sugar. A good place to start for learning how to control your blood sugar is: http://www.alt-support-diabetes.org/Newly Diagnosed.htm.
  2. What they Don't Tell You About Diabetes - This page links to many great pages on diabetes.
  3. Jenny's Low Carb Facts and Figure Page - Jenny provides many pages of excellent information that would take you years to learn otherwise.
  4. Do Patients with Type 2 Diabetes Always Deteriorate?
  5. What Really Causes Diabetes
  6. Healthy Blood Sugar Targets
  7. Research on Blood Sugar Levels and Organ Damage
  8. Why Doctors Don't Diagnose Early Diabetes
  9. alt.support.diet.low-carb Frequently Asked Questions
  10. Low Carb Strategies for People with Diabetes
  11. Diabetes FAQ - An excellent and comprehensive source of information.
  12. The Laws of Small Numbers - Big inputs make big mistakes; small inputs make small mistakes
  13. Dlife is TV show for Diabetics
  14. Dr. Bernstein's Discussion Forum

Jennifer's Advice to New the Newly Diagnosed

This 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.


Here's the advice I give all newbies:

There is so much to absorb... you don't have to rush into anything.  Begin
by using your best weapon in this war, your meter.   You won't keel over
today, you have time to experiment, test, learn, test and figure out just
how your body and this disease are getting along.  The most important
thing you can do to learn about yourself and diabetes is test test  test.

More than most anything, what you eat will affect your diabetes and
your blood glucose numbers.

And more than anything you eat, carbs will affect your diabetes and
your blood glucose numbers.

So, the most important information you can begin to compile about
yourself, is how your body handles carbs.

This sounds like you would need a low carb food plan right?

You don't... what you need to uncover is YOUR   Personalized Carb Number.

Which actually works better for most everyone.  Because low to one
person is wildly high to another, but waaaaay too low for someone
else.

Is low carb less than 30g a day?   Is it anything less than the
Pyramid reccomendations?

Finding your Personalized Carb Number is easy.

Here's how you can figure out your own Personalized Carb Number.

The single biggest question a diabetic has to answer is:

What do I eat?

Unfortunately, the answer is pretty confusing.

What confounds us all is the fact that different diabetics can get great
results on wildly different food plans.  Some of us here achieve
great blood glucose control eating a high complex carbohydrate diet.
Others find that anything over 75 - 100g of carbs a day is too
much.  Still others are somewhere in between.

At the beginning all of us felt frustrated.  We wanted to be handed
THE way to eat, to ensure our continued health.  But we all
learned that there is no one way.  Each of us had to find our own path,
using the experience of those that went before, but still having
to discover for ourselves how OUR bodies and this disease were coexisting.

Ask questions, but remember each of us discovered on our own what works best
for us.  You can use our experiences as jumping off points, but eventually
you'll work up a successful plan that is yours alone.

What you are looking to discover is how different foods affect you.  As I'm
sure you've read, carbohydrates (sugars, wheat, rice... the things our
Grandmas called "starches") raise blood sugars the most rapidly.  Protein
and fat do raise them, but not as high and much more slowly... so if you're
a T2, generally the insulin your body still makes may take care of the rise.

You might want to try some  experiments.

First:  Eat whatever you've been
currently eating... but write it all down.
Test yourself at the following times:

Upon waking (fasting)
1 hour after each meal
2 hours after each meal
At bedtime

That means 8 x each day.  What you will discover by this is how long
after a meal your highest reading comes... and how fast you return to
"normal".  Also, you may see that a meal that included bread, fruit or
other carbs gives you a higher reading.

Then for the next few days, try to curb your carbs.  Eliminate breads,
cereals, rices, beans, any wheat products, potato, corn, fruit... get all
your carbs from veggies.  Test at the same schedule above.

If you try this for a few days, you may find some pretty damn good
readings.  It's worth a few days to discover.

Eventually you can slowly add back carbs until you see them affecting your
meter.

The thing about this disease... though we share much in common and we need to
follow certain guidelines... in the end, each of our bodies dictate our
treatment and our success.

The closer we get to non-diabetic numbers, the greater chance we have of
avoiding horrible complications.  The key here is AIM... I know that
everyone is at a different point in their disease... and it is progressive.
But, if we aim for the best numbers and do our best, we give ourselves the
best shot at heath we've got.
That's all we can do.

Here's my opinion on what numbers to aim for, they are non-diabetic numbers.

Fasting                       under 100
One hour after meals          under 140
Two hours after meals         under 120

or for those in the mmol parts of the world:

Fasting                       Under 6
One hour after meals          Under 8
Two hours after meals         Under 6.5

Recent studies have indicated that the most important numbers are your
"after meal" numbers. They may be the most indicative of future
complications, especially heart problems.

There have been some new reasearch 
showing the your readings two hours after a meal may be the most important. Here's a quote:
    So very soon science will discover that not the A1C but the 2h postprandial 
    values are important.
Listen to your doctor, but you are the leader of your diabetic care team. While his /her advice is learned, it is not absolute. You will end up knowing much more about your body and how it's handling diabetes than your doctor will. Your meter is your best weapon. Just remember, we're not in a race or a competition with anyone but ourselves... Play around with your food plan... TEST TEST TEST. Learn what foods cause spikes, what foods cause cravings... Use your body as a science experiment. You'll read about a lot of different ways people use to control their diabetes... Many are diametrically opposed. After awhile you'll learn that there is no one size fits all around here. Take some time to experiment and you'll soon discover the plan that works for you. Best of luck! Jennifer

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:

  1. You feel thirsty and drink a lot of water. If they are filling up your water glass a lot at restauraunts, you may have diabetes.
  2. You notice you don't heal as well you used to from cuts or injuries.
  3. You feel pain and tingling in your hands and feet.

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:

  1. The studies showing diabetics always deteriorate are based on people with bad control. Nobody has done a study on people with good control.
  2. If you have good control, never over a number over 140, your chances of staying healthy are much better, but not guaranteed.
  3. Doctors often don't push people to maintain good control, but you can choose to have good control and improve your chances of having a long life of relatively good health.

T1 Vs T2 Diabetics

There 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
Type 2 diabetes commonly occurs in adults who are obese. There are many underlying factors that contribute to the high blood glucose levels in these individuals. An important factor is the body's resistance to insulin in the body, essentially ignoring its insulin secretions. A second factor is the falling production of insulin by the beta cells of the pancreas. Therefore, an individual with type 2 diabetes may have a combination of deficient secretion and deficient action of insulin.

The conclusions from two studies point to inhereted IR as the primary cause for T2:

CONCLUSIONS: Insulin resistance is present even in young lean subjects at high risk to develop type 2 diabetes. Our data suggest that insulin resistance may be a primary abnormality in the pathogenesis of this disease.

CONCLUSIONS: These data support the hypothesis that insulin resistance in the skeletal muscle of insulin-resistant offspring of patients with type 2 diabetes is associated with dysregulation of intramyocellular fatty acid metabolism, possibly because of an inherited defect in mitochondrial oxidative phosphorylation.

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:

  1. Limit your intake of carbohydrates. Eat to your meter, as we'll discuss in section Diabetics Should Eat to Their Meter.
  2. Reduce your Insulin Resistance. Doctors prescribe medicines like Metformin and Avandia to help reduce IR. Weight loss and exercise also reduce IR.

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 Information

Jenny has added an interesting page on this subject on her site at What Really Causes Diabetes.


Diabetics Should Eat to Their Meter

You are fortunate as a diabetic because you have two tests to show how you are doing:
  1. Blood glucose meter. The meter shows you how you are doing during the day and how you specifically respond to foods.
  2. A1C test. The A1C test shows you how you are doing over a period of time.

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 Diabetes

As 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 Tests

You 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 Better

Just 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 Doctor

Many 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 Diabetes

Eating 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 Map

One 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 Lot

Exercise 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:

  1. Diabetes Treatment Breakthrough
    In what is claimed to be a world first, a Sydney hospital has reversed the severity of type 2 diabetes in obese patients through exercise rather than medication.

  2. Diet and Exercise Dramatically Delay Type 2 Diabetes
    At least 10 million Americans at high risk for type 2 diabetes can sharply lower their chances of getting the disease with diet and exercise, according to the findings of a major clinical trial.


Diabetes Doesn't Go Away

You 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:

  1. Are carbs bad in your diet if you are not a diabetic?
  2. If you are diabetic what should you think of carbs?

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 Diet

There is a lot of controversy on how you should eat as a diabetic. There are two basic approaches:
  1. Eat relatively normally and use medication to control your blood sugar.
  2. Eat low carb to control your blood sugar. Low carb means different things to different people. My personal target is between 80 and 100 grams of carbs a day. More importantly, my target is to never go over 140 on my meter, regardless of the number of carbs. Perhaps if I ate smaller more frequently meals I could eat more carbs, but that approach won't work for me as I tend to eat too much when I eat more meals.

My choice is to eat low carb. My reasoning is:

  1. Eating low carb gives me the greatest amount of control over my blood sugar. This is because if I don't eat a lot of carbs then I know my blood sugar won't spike.
  2. If I don't spike then I won't do further damage to my body.
  3. If I don't do further damage to my body then some of the damage that has been done will reverse and I won't get worse. My neuropathy has been getting better, so I know this approach works.

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 Vegetables

Many 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 Without

I don't go without all man made foods, some definitely make my life a lot more pleasant.

Some foods I especially like are:

  1. Dreamfields pasta. This is a low carb pasta that doesn't shoot my numbers (blood sugar) up and doesn't taste like cardboard. Some people find they can't eat it because it raises their blood sugar too much or causes them stomach discomfort (gas). I wouldn't like to do without this processed food item because adds more variety to my diet. It also makes it so I can fix a meal people who aren't diabetics will find more "normal."
  2. Low carb tortillas. Low carb tortillas are a great bread substitute. You can make burritos out of them for a good low carb dinner or a quick snack. They are very versatile.
  3. Low carb bread. Most low carb bread is horrible, but some is good enough.
  4. Good quality chocolate. A high quality dark chocolate (85%) is a great a dessert. It tastes wonderful and you can have quite a bit of it without a lot of carbs.
  5. Cheese. Cheese is low carb and very tasty. It is high in calories so you have to be careful about how much you eat.
  6. Diet soda. Low carb and good to drink.
  7. Splenda. Splenda is a sugar substitute that tastes very much like sugar but does not raise your numbers. It's great to put in anything. I use it to sweeten kool-aide, cheese cake, or on top of strawberries.
  8. Breyers low carb ice cream. This stuff is so good. It's as good as any ice cream you'll taste.
  9. Strawberries. Strawberries are a great low carb fruit. I can have quite a few strawberries without raising your numbers. As always test, but give them a try. Nothing is better than a fresh ripe strawberry. One my favorite desserts is fresh strawberries, cinnamon, splenda, smothered in cream. Delicious.
  10. Carl's Junior low carb hamburger. You want a good quick meal, try the Carl's Junior low carb burger. It's excellent tasting and comes with a fresh salad. That's a good meal and you can almost pretend you aren't diabetic :-)
  11. Subway salads. The problem with Carl's Junior is they aren't everywhere yet. Subway is pretty much everywhere and they have a lot of good low carb food choices in their salads. When you are on vacation and traveling you can usually always find a Subway and get a nice salad or wrap.
  12. Grocery store salad bars. Many grocery stores have salad bars these days. You can often find a good meal in a grocery store.

Some more thoughts on food:

  1. Raw carrots are usually OK. Cooked plain carrots will probably spike you.
  2. Leafy greens are probably free in either either raw or cooked form.

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?

  1. Nuts. High in calories, but very tastey.
  2. Popcorn. Works for many people but spikes others.
  3. Sugar Free Candy. Most contain sugar alcohols that spike some people. And they give you explosive diarrehea, but they do taste good!
  4. Wasa Cracker with Cheese. If you put them in the microwave they are very tastey. You can also add pepperoni and make a pizza.
  5. A bite of any dessert you love. Do some testing, but have a single bite of any dessert you really love and thoroughly enjoy it.
  6. Low carb icecream. Some is really excellent. It's still high in carbs though and high in calories.

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:

  1. Meds like Metformin may help.
  2. You may want to take your meds either earlier or later in the evening.
  3. If I exercise very hard my numbers are always lower the next morning. YMMV.
  4. Exercise in general may bring your FBG down.
  5. I think if I eat too much food the night before then my morning numbers are higher. But this isn't always true.
  6. Some people find eating a little protein before bed helps their morning numbers. The type and amount of food varies a lot by person, so you may have to experiment with different foods and when to eat them before going to bed.

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?
  1. Try Another Meter

    By another cheap meter and strips to check you meter. Meters do go bad so you definitely want to rule out any problem with your meters before you start getting really concerned.

  2. Check Your Control

    How are you doing with eating to your meter and exercising? Are you starting to eat more? Are you starting to eat different more "risky" foods lately? Are you not exercising as much? Have you been injured so it's been difficult for you to be as active lately?

    Take a look at retightenting your control. This is a constant process too. We always seem to adapt and ratchet up our less useful behaviours. Sometimes we need to reset ourselves back to our best habits.

  3. Talk to Your Doctor

    Your IR may be going up or your beta cells may be dying in greater numbers so a change of treatment may be necessary. Diabetes doesn't stand still. We are never done with it. It's always a game of act and react. Diabetes an individual desease. What works for you may not work for others.

    You may need to up dosages of your existing medicines. You may need to go on a different drugs. You may need to start insulin. There are lots of things you can do.

    So see your doctor.


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:

  1. Maybe Your Control is Fine, You May Be Overreacting

    Maybe you are really doing fine and you are worrying about nothing? Just stressing and worrying about your numbers can make them go higher, doesn't that suck?

    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.

  2. Maybe Your Diet isn't as Low Carb as You Think

    Really count how many carbs you are eating per day. Maybe you can cut more carbs out of your diet and that might have a positive impact on your numbers. Many people think the South Beach diet is low carb, for example, when it isn't. There may be room for improvement.

  3. Maybe Your are Expecting Flat Results When that's Not Possible

    Your numbers can't always stay the same. Your body isn't a computer, it can always respond the same way everytime. Some variance is natural and expected.

  4. Maybe You Think Your Meter is More Accurate than it Is?

    I've read meters have a variance of up to 20%. You'll have to check the specs on your meter to know what your situation is.

    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.


Alcohol Lowers My Numbers

I find wine and beer lower my numbers. YMMV. The alcohol is processed by the liver so while the liver is handling the alcohol it can't produce the glucose that raises your numbers.

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.


Having Diabetes Means You've Already Had a Heart Attack

One of the interesting things about diabetes is you don't die from diabetes, you die of complications from diabetes. Two-thirds of diabetics die of heart disease. The connection between diabetes and heart disease is so strong, by merely being a diabetic you are considered to be in the same risk category as someone who has already had a heart attack.

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:

  1. Macrovascular Disease Risk in Patients with Type 2 Diabetes: Beyond Statin Use CME/CE


Your Doctor is Your Consultant

Your doctor is your consultant. Your doctor is there to answer your questions. Decisions are yours to you make after you have talked to your doctor and after you have done your own research. Your doctor is not there to make decisions for you. It's your life and the responsibility for your life is ultimately yours.

When you see your doctor:

  1. Know yourself. Do you think you can stick to a strict program of diet and exercise? Or do you think you want a more medication based approach?
  2. Take a notebook for writting down notes and questions.
  3. Gather all information possible.
  4. Bring any papers you have questions about along with you. Ask your doctor about them.
  5. Ask about options, both drug, and non-drug. Make sure you cover diet and exercise options with your doctor.
  6. Tell your doctor you do not want a one-size fits all approach. Tell your doctor you want a custom program fine-tuned for you and your life.
  7. If your doctor isn't answering your questions or doesn't want to treat you like an individual, then don't be afraid to get another doctor.

Diabetes News Groups

News groups are a world wide discussion group where people from all over the world come together and discuss everything to do with diabetes. If you read these groups everyday you'll learn more about diabetes than your doctor knows. You'll get more help from these people than you can get from anywhere else.

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:

  1. alt.support.diabetes
  2. alt.support.diet.low-carb
  3. misc.health.diabetes
  4. sci.med.cardiology
To see posts for a news group just cut the news group name from this page and paste it into the search box in groups.google.com. That will let you read all the threads.

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.


Diabetes Books, Magazines, and Organizations

There are many good books and organization covering diabetes. Here are some I have personally found useful:
  1. Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars Revised & Updated - This is a great book. Dr. Bernstein is a long time diabetic and doctor who has figured out how to survive as a diabetic. He gives good practical advice that works.
  2. The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed - When you first get diabetes you need a general overview. This book offers good information to make you more comfortable with where you are at.
  3. Diabetes Care
  4. American Diabetes Association (ADA)
  5. Diabetes Mall
  6. National Diabetes Education Program

Diabetes Health Targets

What are some important health related goals? Many people, including myself, like managing their diabetes by the blood glucose meter. For me that means eating a small enough amount of carbs that I never go over 140 mg/dl on the blood sugar meter. Although there isn't a lot of hard evidence to back this up, it's thought that a reading over 140:
  1. Damages your beta cells in your pancreas which causes you to produce less insulin.
  2. Damage your large blood vessels (heart, legs, brain. etc) and small blood vessels (kidney, eyes, nerves, etc).
By keeping your blood sugar below 140 you limit all this damage. A site summarizing the research can be found at
Research on Blood Sugar Levels and Organ Damage.

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:

  1. FBG: under 100. FBG stands for fasting blood glucose and is the reading you take in the morning.
  2. One hour after meals: under 140.
  3. Two hours after meals: under 120.
Research has shown you should concentrate on keeping your after meals numbers in line as they are associated more with future complications.

Other targets:

  1. A1C lower than 6. A1C is a measure of your blood sugar is doing over 3 months or so. A lower number is directly related to having a lower chance of a heart attack and other complications.
  2. 30 minutes of exercise a day. Walking is fine. Lift weights 2-3 times a week to keep muscle on your body.


Dealing With Diabetic Neuropathy

Neuropathy 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:

  1. Get your blood sugar under control. Controlling your blood sugars is the most important thing you can do to control neuropathy. Control means getting your morning numbers (fasting) and your post meal (post-prandial) numbers under control. Both need to be under control, not just one or the other.
  2. Take Evening Primrose. I take 1300 mg at night.
  3. Take ALA (Alpaha Lipoic Acid). I take 300 mg evening and night.
Many people have found ALA and Evening Prim Rose effective and there are supporting studies, so it's not pure mumbo jumbo. If you have felt the pain you will be ready to try anything. Give these a try. But don't forget controlling your blood sugar is the key.

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 Neuropathy

Keep 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.

More Information...

  1. Intensive Therapy Relieves Diabetes Neuropathy

    The relationship between blood sugar control and neuropathy suggests that intensive therapy has a durable effect on neuropathy similar, similar to what has previously been reported for diabetic eye disease and kidney disease, the authors conclude.


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.

  • Joslin Diabetes Center White Paper June 2005

    Summary of more than 20 years of study dedicated to understanding the molecular mechanisms by which hyperglycemia damages vascular tissues, and testing PKC inhibitors to prevent the long-term complications of diabetes.

    You may find this paper helps explains some things, but I wasn't able to learn a lot from it. When I don't learn from a paper I usually assume it's because I don't know enough yet to figure out what it is saying. Maybe later.

  • LifeExtension on The Diabetes Damage Cascade

    Glycation and oxidative stress are central to the damage caused by diabetes. Unfortunately, neither of them figures into conventional treatment for diabetes, which is generally concerned only with blood sugar control.


Live Longer By Brushing Your Teath and Flossing

Periodontal 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 Insurance

Getting 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:

  1. Health Insurance
  2. Life Insurance
  3. Long Term Care and Disability Insurance

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 Disfunction

The 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 Blood

It 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 Marrow

The 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 Organs

People 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 Feet

This 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:

  1. Signs of redness, blisters, cuts or sores.
  2. Wear well-fitting shoes and protect your feet from injury.
  3. Remove your shoes and socks at each diabetes-related checkup so feet can be examined.

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 Disease

A good paper on diabetes and kidney disease can be found at
http://www.kidney.org/atoz/atozItem.cfm?id=37.

From the paper:

With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

About 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure.

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:

  1. Strip Cost. Test strips are designed for a particular meter or meter family. As part of your meter selection process take a look at what you can buy test strips for. Strips vary widely in price and it could make a big difference to you.
  2. Amount of Blood. Meters differ in the amount of blood they need to get an accurate test. Some meters require smaller drops and that means you need a smaller prick which should hurt less. This may be an important consideration.
  3. Strip Loading Style. Some meters uses a motorized drum like device which loads a bunch of strips at once. It can make testing a much simpler experience, especially if you aren't coordinated or have a medical condition that makes gripping difficult. Test strips are small and can be hard to handle.
  4. Bulk. Meters differ in their size. Having a small meter may be important to you or it may not matter at all.

Where can you buy test strips?.

  1. Meter manufacturer. If they sell the strip they might be cheaper than other sources. They may just direct you to another more expensive source.
  2. Ebay. This may not be your cheapest source, but it is a source.
  3. Your pharmacy or other retail store.
  4. Your doctor may give them to you for free.

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 Monitors

Hopefully 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

  1. Glucose Meters & Diabetes Management
  2. How Accurate Is Your Meter?

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:
 
  1. Your county health department.
  2. Your state health department.
  3. If you are on a reservation, or inside a federal area of some type, the USPHS.
  4. The American Medical Association (AMA) at http://www.ama-assn.org/.
  5. The American Board of Medical Specialties (ABMS, for family or internal medicine) at http://www.abms.org/.
When my daughter lived in Chestertown, conventional wisdom was that to get a better doctor, or a specialist, you had to go to Baltimore. In fact, the county ride-along program scheduled monthly vans to Baltimore that went to the VA, University, and Hopkins. Sure, if you seeded first class hospitals they were right, but almost every small town they passed through also had basic family physicians, and many had specialists, and many medical complexes and fairly large hospitals were in closer towns, but none that people in Chestertown HEARD of.

You are Your Own Doctor

We 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?

  1. c-peptide - This test indirectly determines the amount of insulin your pancreas produces. Sometimes people are misdiagnosed as being a type T2 diabetic when they are really a T1. Very high fasting BGs can be and indication that you are really a T1. Not all docts will do the c-peptide test and that test can help confirm which type of diabetic you are.
  2. complete thyroid analysis
  3. estrogen/progesterone/testosterone
  4. lipid profile

Blaming the Patient

Diabetes 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 Burnout

Diabetes 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 Diabetics

Here is some software that may be of interest to diabetics.
  1. http://wave.prohosting.com/ugleeeee/index.html - Health is a software application designed for people with Diabetes and/or Hepertension (High Blood Pressure).

Disaster Prep - Know Your Meds

Many 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?

  1. Keep a list of the medications you take.
  2. For each medication know your dosage. Many people (like me) just take the right numbr of pills and couldn't tell you what dosage they take.
  3. Keep your meds together you can quickly take them if you have to evacuate.
  4. Have an ID with you to help with expedite your medical care. At least have your social security number memorized.
  5. Keep a copy of your meds list in your wallet.

Disaster Food Supplies Considering the Diabetic

We 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:

  1. The Red Cross will probably start distributing water if you don't have power for a while.
  2. Leave right away if your local authorities tell you to evacuate.
  3. Call your Red Cross shelters if you don't have transportation.
  4. Without electricity food in your refrigerator will only be good for about 2 days. Food in your freezer will probably last 4 days. The more you open the door the shorter your food will last.
  5. I have all my medications in a central place so I can just scoop them up within a minute. Acutally my plan is take the whole drawer with me. I try to keep at least a weeks worth of meds at all time, including test strips.
  6. Gallons and gallons of bottled water. Have individual sized bottles for each person as well.
  7. Buy as much ice as you can store. If you have some lead time get and make as much ice as you can and store it in whatever coolers you can.
  8. Lots of toilet paper and paper towels.
  9. Can you flush your toilet using a bucket of water? Modern toilets may need pressure/electicity to work so you may need to make some alternative arrangements for going to the bathroom.
  10. Have lights and a radio that don't require a battery. We have crank versions of each.
  11. Good solid hiking shoes with socks.
  12. Manual can opener.
  13. Fill the gas tanks of all vehicles.
  14. Fill the bathtub with cold water.
  15. Aspirin and other first aid kit items.
  16. Vitamins.
  17. Pet food.
  18. Important photographs and papers.
  19. Packets of condiments like mayo, mustard, relish, ketchup.
  20. Penut butter.
  21. Wasa crackers.
  22. Canned fruits and vegetables of all descriptions. They can be eaten directly from the can.
  23. Jerky.
  24. Nuts.
  25. Dark chocolate.
  26. Sugar of some sort if you have hypos.
  27. Diet soda.
  28. Low carb bread.
  29. Low carb protein bars.
  30. Cans of tuna, salmon, corned beef, chicken, spam, chili, and corned beef.
  31. Powdered milk.
  32. Coffe and tea.
  33. MRIs- which are ready to eat meals you can purchase over the web or at survival stores. They won't work for diabetics, but they will work for other people in your party and that leaves more of the other food for the diabetics in your household.
  34. Candles.
  35. Fresh Veggies: lettuce (for the first day or so), celery, cucumbers, tomatoes, peppers, apples.
  36. Ice chest full of ice. Put the stuff you use frequently (milk, mayo, cheese, etc) in the ice chest, not your fridge or freezer as these get warm fast when opened.
  37. Before your food goes bad have a big party with your neighbors so it doesn't go to waste.
  38. If you are a T1 you need to consider your insulin supplies. I don't know what special considerations are appropriate.

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?

  1. Change lancets often so it's always at its sharpest. I don't change mine that often because it doesn't hurt me that much. YMMV.

  2. To get a drop of blood many people just quickly poke themselves with the lancet.

  3. Try a lancet pen. The lancet is intalled into the tip of the pen. To use a lancet pen you cock it, press it against your test site, and press the pen's button. The pen will send the lancet a certain depth into your flesh. A dial on the pen controls how deep the needle will go. The deeper the setting the more it hurts and the better chance you have of getting a nice drop of blood.

  4. Dial down the setting as low you can on your pen while still getting a drop. Try to have the lightest setting on your pen you can. On the lowest setting of my pen I can barely feel it and no blood is drawn. On the highest setting it definitely hurts a bit. When you find a good setting remember which setting it is so you don't have to guess. You may need different settings for different parts of your hand. A higher setting is needed to get through thick skin.

    Many people think they need the highest setting when they really don't. If you are hurting then try dialing down the strength on your pen. Sometimes jostling around in a drawer magically changes the setting.

  5. The Softclix lancing device might also help you if you are very sensitive. It "provides maximum comfort for patient self-testing and for use in physicians’ practices." Take a look at http://www.roche-diagnostics.com/products_services/accuchek_softclix.html for more information.

  6. The needles for different meters are different sizes. So you may want to look for a meter with the smallest size needle if you are concerned about pain. For example the One Touch Ultra needle is smaller than the Rite-Aid needle.

Painless Fingerstick Method

The steps are:
  1. Wash hands in warm water and soap.
  2. Place the downside of your finger on a table.
  3. Select "1" or "2" or a similar shallow setting on your penlet.
  4. Hold the penlet against the up side of your finger between the knuckle and the finger nail.
  5. Exhale forcefully as you press the penlet button, 6) continue inhaling and exhaling as you massage the finger to elicit the blood drop.

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:
  Since the lancet goes into the subcutaneous space and is not being used intravenously, and since blood is flowing out of the body, sterility is generally not an issue. The rate of infections and injury from lancets is extremely low. Many people, however, are not able to reuse lancets because they feel discomfort or they experience scarring if the lancet is not in optimal condition. Once a lancet has been used, its surface is rougher, the lubricant wears off and the point is duller. Any handling of the lancet, such as cleaning with alcohol, tends to worsen it. For these individuals, using a new lancet each time is well worthwhile.

But other people are concerned about infection from finger testing:

  1. Japanese Doctors Warn of Dangers of Blood Sampling from Fingers
  2. Felons - not that kind. Felons and paronychias account for approximately one third of all hand infections.


The Stick: Stories of Complications from Diabetes

This 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

  1. Four out of five diabetics will develop some sort of complications.
  2. 95% of amputations not related to trauma are from diabetes.
  3. Diabetes is a leading cause of blindness
  4. Ron Santos, a former major league ball player, lost his legs.

Yes, It's Serious

From KPWelther in the news group alt.support.diabetes:
  I was diagnosed with T2 diabetes. I am scared. I have seen what this disease can do. My mom and my sister both died because of complications from this disease.

Foot Problem Story #1

From dsaurus in the news group alt.support.diabetes:
  Last year I had major foot problems. There were gangrenous wounds on my feet that were so bad it literally made me sick to look at (or smell) them. Ultimately three toes and part of my left foot was amputated. But before that I was packing dressings into those wounds that went well >over an inch deep. Very nasty and a good reason to check your feet ... EVERY DAY. I'm lucky that I can still walk and not in a wheelchair or dead.

Missing Toe

Diabetes: 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 Better

The 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 Teeth

Because 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 Racing

Another 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 Care

Periodontal 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..."

More Information...

  1. Kids with Diabetes Prone to Periodontal Disease

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 Vegetables

I 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.
  1. Avocado
  2. Blackberries
  3. Blueberries
  4. Cantaloupe
  5. Cherries
  6. Honeydew
  7. Peaches
  8. Plums
  9. Raspberries
  10. Strawberries

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?

  1. alfalfa sprouts
  2. arugula
  3. artichoke
  4. artichoke hearts
  5. asparagus
  6. bamboo shoots
  7. bean sprouts
  8. bok choy
  9. broccoli
  10. broccoli rabe
  11. brussel sprouts
  12. cabbage
  13. cauliflower
  14. celery
  15. chard
  16. chicory
  17. chives
  18. collard greens
  19. cucumber
  20. dandelion greens
  21. endive
  22. eggplant
  23. escarole
  24. fennel
  25. hearts of palm
  26. kale
  27. kohlrabi
  28. leeks
  29. lettuce
  30. mushrooms
  31. onion
  32. parsley
  33. radicchio
  34. radishes
  35. red, green, yellow and hot peppers
  36. rhubarb
  37. sauerkraut
  38. scallions
  39. snow peas
  40. spaghetti squash
  41. spinach
  42. string or wax beans
  43. summer squash
  44. zucchini

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.
  1. Have a letter from your doctor stating that which medications you need for which particular problems. Make sure to include your strips and meter. If they are lost or stolen insurance should pick up the tab for buying new ones.
  2. Get extra scripts to take with you in case something is lost or stolen.
  3. Leaving medications and test strips in your car can destroy them if the car temperatures get too high.
  4. Keep your medications in their original packaging. Cops, airlines, and pharmacists react better to medicines in their original bottles.
  5. Be prepared to have you medications and devices confiscated. In this era of paranoia about terrorism all sorts of wierd things can happen.
  6. I take low carb protein bars along just in case I can't find any food I can eat.
  7. Take a backup meter and replacement batteries.
Remember: have a great time and have fun. Diabetes doesn't define who you are. Be who you want to be.


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:

  1. http://www.umm.edu/patiented/articles/what_risk_factors_peripheral_artery_disease_000102_3.htm
  2. http://www.emedicinehealth.com/articles/12122-6.asp
  3. http://www.diabetes.org/type-1-diabetes/well-being/peripheral-arterial-disease.jsp

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?

No idea.

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.

  1. Coffee May Lower Risk of Type 2 Diabetes

Be Careful of What You Eat at Hospitals

You 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:

  1. Read this useful article: Don’t Permit Hospitalization to lmpair Your Patients Blood Sugar Control.
  2. Make sure the hospital knows you need the diabetic menu. They may need to know that you are a T2 diabetic and that you have different needs than a T1.
  3. Talk with the dietician and agree that a high BG was not in your best interest. Try and communicate that you aren't being difficult, you are doing what you need to do to stay healthy, and as a professional they should help you.
  4. Tell them what your dietary goals are as to carb levels and anything else appropriate for your situation.
  5. Tell them about any foods you can't have.
  6. Monitor your meals to make sure they comply with your requests. If they don't then stick to your guns until they do.
  7. If you are too sick to handle this tiring task, ask a friend or relative to help you.
  8. Talk with your nurses so they know what you want to accomplish. Explain how you are trying to hit certain numbers two hourse after eating and that you need to test often and whatever else you do. Once the nurses know you take treating your diabetes seriously they will probably help you.
  9. Recognize hospitals aren't restauraunts, so that they may not be able to serve you exactly what you want is to be expected. Be flexible.
Hopefully your hospital will be nice and do the right thing. Many will. But if they don't you need to stand up for yourself, nobody else will.

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:

  1. Your blood sugar control all day every day.
  2. Reduce your risk of heart disease. A critically important point for diabetics who are at increased risk of CHD.
  3. Improve your overall life quality.

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.

You can take a look at the GI table here and here.

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 Diabetes

From 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.


Famouse Diabetics

  1. Mary Tyler Moore
  2. Billy Talbert
  3. Ham Richardson
  4. Halle Berry
  5. Larry King
  6. Dick Clark
  7. B B King
Turns out there's a whole site listing famous diabetics at
http://www.angelarose.com/FamousDiabetics/.


Researching Diabetes

Research is how we learn. If you want to do your own research then take a look at:
  1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
  2. http://scholar.google.com/

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

  1. Nutrition Counters - A list of web sites where you can find nutritional information (calories, carb count, etc) on various foods.
  2. http://www.diabetes-normalsugars.com/ - Dr. Bernstein is on the leading edge of diabetes treatment, being one himself, being the first to do home glucose testing, etc. I highly recommend the book. I use a slightly relaxed form of his lifestyle method of diabetes management and have normal, non-diabetic BG, A1C and lipid panel numbers.
  3. http://www.mercola.com/2002/may/25/fasting.htm - If Your Fasting Blood Sugar is Above 90 You Are At Risk of Heart Disease
  4. http://www.diabetesincontrol.com/bernstein/
  5. http://www.mayoclinic.com/printinvoker.cfm?objectid=01D1244A-496B-42D2-99EC4D7C2A9F1898 - Blood sugar tests: What's normal?
  6. http://www.joslin.org - Joslin's Diabetes Center
  7. http://www.geocities.com/lottadata4u/ - What they Don't Tell You About Diabetes
  8. http://www.diabetesroundtable.com - Your Resource for Practical Patient Care
  9. http://www.mendosa.com/ - a freelance medical writer and consultant specializing in diabetes.
  10. The Progression and Natural History of Type 2 Diabetes
  11. NIH Researchers Discover How Insulin Allows Entry of Glucose Into Cells
  12. The Fat Connection To Beta Cell Burnout
  13. Lions, Hypoglycemia, Insulin Roller Coasters, and Heart Attacks
  14. ADA Message Board
  15. Stress Delays Post-Prandial Glucose Metabolism in Diabetic Patients
  16. The Metabolic Syndrome: Time for a Critical Appraisal
  17. Inactivity, exercise, and visceral fat. STRRIDE
  18. Randomized, controlled study of exercise intensity and amount
  19. Effect of the volume and intensity of exercise training on insulin sensitivity
  20. Exercise Can Trim Deep Abdominal Fat
  21. Zeroing In On Inflammation
  22. Diabetes Study Verifies Lifesaving Tactic - Tight control of blood sugar prevents heart attacks and strokes,
  23. Nature Insight: Obesity and Diabetes
  24. The case for low carbohydrate diets in diabetes management.

    Nutr Metab (Lond). 2005 Jul 14;2:16.

    Comment in: Nutr Metab (Lond). 2005 Aug 31;2:21.

    Arora SK, McFarlane SI.

    Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA. surenderkarora@yahoo.com

    A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption.

    This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term.

    These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis.

    Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.


Recipes

A Low BG 4th of July by Jennifer

These 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:

  1. Grilled chicken with sweet and spicy rub (use the spices you like, add Splenda... rub on and grill)
  2. Turkey burgers (add in some veggies - onions, mushrooms chopped FINE in a food processor, they'll keep your turkey burger moist)
  3. If your food plan allows... regular hamburgers and hot dogs are also low carb.
  4. Faux Potato Salad made with cauliflower (recipe follows)
  5. Cole Slaw (if your recipe calls for sugar, sub in Splenda)
  6. Red and Blue Berries for dessert

Fauxtato Salad

This tastes almost exactly like potato salad, and the texture is pretty darn close too.

Serves 6, Per serving: 4.8g carbs.

  1. 1 medium head of cauliflower, broken into florets
  2. 1/2 C sliced scallions, including the firm green
  3. 3 celery ribs, chopped fine, including some inner leaves
  4. 1/2 green pepper, chopped fine
  5. 1/4 C chopped parsley
  6. Salt & Pepper to taste

Dressing

  1. 2 teaspoons Colman's dry mustard
  2. 2 Tablespoons cider vinegar
  3. 1C mayonnaise (I use the new Best/Hellmans made with Canola oil... no trans fats)
  4. 3 hard cooked eggs, chopped
  5. 1/2 to 1 teaspoon celery seeds to taste
  6. Paprika for garnish
  1. Steam the cauliflower florets until tender, but not soft. Set aside to cool.
  2. Put the scallions, celery, bell pepper, and parsley in a large salad bowl, add salt and pepper.
  3. Make the dressing: mix the mustard, vinegar and mayo together in a small bowl until smooth.
  4. When the cauliflower is cool, chop and add it to the veggies and mix with enough dressing just to coat the vegetables (you may have dressing leftover, depending on the size of your cauliflower). Stir in the eggs and celery seeds and mix well. Sprinkle paprika on top and cover with plastic wrap. Let sit in fridge for at least 2 hours for flavors to develop.

Anil's Advice on the Options for T2s

This 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

  1. These guys have larger wiggle room in their total energy input in their diet. They can consume a bit more ready to digest high energy density processed foods. Depending on age and stage at which their diabetes is discovered the wiggle room may be more or less. Examples of high energy density (HED) foods: Candy, Pizza, Pasta, various examples of white bread, grain based products with all the fiber removed, icecream, many tropical fruits like Banana, Mango, Grapes, Pineapple.
  2. Depending upon the stage at which the their diabetes is uncovered, they may or may not need medication. I suspect Tom, Roger, are an example of later while many of us who do take exercise seriously still need some medication.
  3. To get good A1c results, the amount of exercise one has to do will change and is based on Age, Gender, fitness level before discovery of T2. Basically how much have you have neglected your self before discovery and how much you pigged out on your way to this place will influence intensity of lifestyle change necessary.
  4. Exercise includes all the physical day to day activity. So a person who is bicycling for 30-40 miles a day may not need much more exercise as long as one has a prudent diet (i.e. diet free of HED foods).
  5. When a person has been very active from the early discovery stage the need for medication is substantially less. If such person is further careful in either eliminating HED foods early on, the person is less likely to need much of medication. Assumption here is of course that the person is otherwise healthy.

Folks who do not exercise or can not exercise

  1. They have to be very strict about intake of HED foods.
  2. If they manage to reduce their weight and come near BMI 19-21 they may be able to do with few medication or no medication.
  3. If the person's BMI is outside the "normal" range, need for medication does not go away no matter what the diet is. The further away you go the more cocktails of medication you may need. Again diet will influence only the strength and mix of medication you may need.
  4. Diet strictness will control regression rate. But the rate of regression is steeper for these folks than one in first group.
  5. The older you are (60 and above) harder it would be to control T2 with diet alone.
  6. Possibility of other related diabetes related complications significantly increase when exercise is not part of ones lifestyle. Medication may be able to help for a while but over the lifetime it may not be possible completely avoid complications.
  7. Side effects from the medications alone get aggravated for folks in sedentary lifestyle.
In general all the above applies to sustained changes in lifestyle and have very little implication for occasional (e.g. Thanksgiving diner :-)) digressions. For example if I am constantly peaking at 120/130 after my regular meals, a thanksgiving dinner with 200 peak will not suddenly give me peripheral neuropathy nor is it likely to aggravate it permanently. The above observations are based on my what I have read so far most of it can be found in the following three papers which were discussed in ASD not too long ago Ref: http://tinyurl.com/ybuf8f.

References

  1. Physical Activity and Life Expectancy With and Without Diabetes Jacqueline T. Jonker, MSC1, Chris De Laet, PHD1, Oscar H. Franco, MD, DSC1, Anna Peeters, PHD2, Johan Mackenbach, MD, PHD1 and Wilma J. Nusselder, PHD
  2. Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D., Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and Walter C. Willett, M.D
  3. Effects of exercise and diet on chronic disease J Appl Physiol 98: 3-30, 2005; doi:10.1152/japplphysiol.00852.2004 http://jap.physiology.org/cgi/content/full/98/1/3

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.

If you would like to contact me for any reason then send email to tmh@possibility.com. I especially appreciate corrections and suggestions. When I pull content off a news group I try to give the best attribution I can. If you don't want me to use something then just tell me and I'll remove it. I don't ask permission first because I figure when something is posted on the net you mean to share it and as long as my attribution is correct then I've done the fair thing.