Code Red Alert

Why Aren't Physicians Being Trained to Treat Diabetes
(click on article to open link and read article)

The article "Why Aren't Physicians Being Trained to Treat Diabetes" is a code red alert for anyone with diabetes.  If we can't trust health care providers to have the knowledge and skills to treat people with diabetes then who do we trust?  When patients challenge me and make comments about what their doctors did or did not say or do I address their concerns and I also politely respond "you are your own best advocate".  I am in no way making excuses for physicians or any health care provider to not be knowledgeable about treatment for diabetes but there is a wealth of information available for patients with diabetes, even for patients with low literary comprehensive skills.  Diabetes is a multi-faceted disease and require skills beyond physician management.  Learning self-care management skills is also an important aspect of diabetes care.  Health care has changed and it is not always for the better so be proactive.  If your physician does not know how to treat your diabetes then find another physician.  Also, attend a diabetes education class every 3-5 years, attend a local diabetes conference, join the American Diabetes Association or at least access their website for free, join a diabetes support group, ASK for a referral to a dietitian and a Certified Diabetes Educator, etc., etc.  In other words, don't let a physician or any health care provider be a barrier to your care because if you do, you alone may be the one to suffer the ill-fated consequences of poor diabetes control.  Take care of yourself and be proactive so that you will live a long, healthy, comfortable life.  Peace!

Hypoglycemia Unawareness

I am a Nurse Practitioner and Certified Diabetes Educator.  I also have type 2 diabetes and today my blood sugar was 59 mg/dL!  I was shocked at my blood sugar reading because I did NOT feel bad at all.  I take Metformin for my diabetes.  Three hours prior to checking my blood sugar today I had eaten banana-walnut pancakes with regular syrup.  I have not had any changes in activity, food intake, or medications, I  have not consumed any alcohol, and I am not stressed or depressed.  In other words, I could not think of any reason why my blood sugar was so low.  I last checked my blood sugar 2 days ago and over the past several weeks my blood sugars have consistently ranged in the 80s to low 100s range.  

Hypoglycemia unawareness is defined as a low blood sugar that occurs without any of the physical warning symptoms of a low blood sugar (i.e., shaking or nervousness, headaches, sweating or clammy wet skin, confusion or anxiety, palpitations, etc.).  It occurs more frequently in patients on insulin therapy (patients with type 1 diabetes and patients with type 2 diabetes that require insulin) but it also occurs in patients with type 2 diabetes such as elderly patients, patients that have had diabetes for several years, patients that consume alcohol, patients with diabetic neuropathy (nerve damage), and patients that take beta-blockers for heart disease and/or blood pressure control.  Hypoglycemia unawareness is potentially life threatening because low blood sugars (especially blood sugars less than 50 mg/dL) can lead to loss of consciousness, confusion and behavior changes, coma, seizures, and death.  Usually when blood sugars are low our body hormones send out physical warning symptoms that we recognize and can act upon to immediately raise our blood sugar.  With hypoglycemia unawareness we lose this response and do not experience those physical warning symptoms.  

Today was an anxiety-provoking experience for me because prior to checking my blood sugar I was preparing to travel in my car.  Had I not checked my blood sugar I could have potentially had a fatal accident and killed or injured myself, my daughter and other people.  This is why I advocate people with diabetes to check their blood sugars, including patients with type 2 diabetes that are not on insulin.  Talk to your health care providers about how often you should check your blood sugar and what blood sugar ranges are safe for you.   

Click on the following links to learn more about hypoglycemia and hypoglycemia unawareness:

http://visionsofcontrol.com/AcuteComplications.aspx

http://www.diabetesnet.com/diabetes_control_tips/hypoglycemia_unawareness.php#axzz1As2yTKLx
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

Refuel, Reshift, Refocus

It's 2011 and we made it here!  Whew, 2010 was some kind of year.  Some of us excelled, some of us were status quo and some of us were deeply challenged.  Every new day is an opportunity to refuel and overcome our challenges and we can make 2011 our best year yet.  The festive holidays have ended and most of us have returned back to work or at least re-established our daily routines.  What now?  How do we refuel, reshift, and refocus?  How do we get from the "thinking" mode ("I need to ...") to the "action" mode.  I propose 3 actions:

• Take a few minutes every day to reflect on WHY it is important to gain and maintain good blood sugar control.  Do you desire to live a long, healthy life free of complications?  How important is it to you to be able to continue to drive your own self to the places that you desire?  Do you wish to fulfill your plans to travel, shop, and enjoy your future grandkids?   What are your goals?

• Find out where you are (realistically, no guessing).  What are the values for your A1C, blood pressure, cholesterol, weight, and BMI?  This may require a visit to your health care provider.  We make time to do the things that are important to us so why not start with making your health a priority in 2011.  

• Start with where you are.  We have different challenges but everyone has challenges that can be overcome.  Maybe one person needs to complete their eye exam.  Maybe one person can stop eating cookies (That would be me ... thank God that all of the holiday treats are gone!).  Maybe one person needs to refill a prescription.  Maybe one person needs to restart home monitored blood sugar checks.  What are your challenges?

It's okay that you fell off the bandwagon in 2010.  The 2011 wagon is 

coming along so jump on, refuel, reshift, and refocus!  Peace!

Ouch, this hurts!

"I'm not claiming diabetes.  I don’t like to stick my fingers.  I don’t like insulin.  I can’t eat more than 1 time a day.  I don’t have time for exercise. I went to a diabetes class 10 years ago and I have that information at home, I just need to find it and read it.  Everybody in my family has diabetes so it’s no big deal.  I’ve been on a cruise last week and I ate too much, that is the reason why my A1C is too high.  My BS are 200 and that's good for me; they used to be higher than that.  I take too many pills already.  When my blood sugars are less than 180 I feel bad so I try to keep them above 200.  Just give me 3 more months to change my diet and lose weight; yeah, I know I said that 3 months ago, I just need some extra time.  My medicines are too expensive.  It costs too much to buy healthy foods.  The medicine makes me feel worse when I take it.  I take my medicine once a day and that is enough for me.  I don’t want to start insulin because I will never get off of it and I don't want to make my body dependent on insulin.  What happened to pancreatic transplants?, I want one.  When I don’t eat my blood sugars are still too high anyway so what's the point?  I don’t know why my blood sugars are high because I don’t eat a lot of meat.  I just need to cut down on what I drink.  I promise you my labs will be better the next time.  I’m too busy to take my medication.  I can’t get a day off of work to come to the doctor.  I’m too stressed out.  I don’t want any more pills for my diabetes, I only want you to give me some Viagra and Penicillin.  I hate cooking for me and then a different meal for my family, it's just too much!  I'm not taking any medicine for my diabetes, I'm going to a herbal doctor.  I don't want that medicine, I'm going to to cleanse my blood.  I just need a colon cleanser to clean my colon and then my blood sugars will go down; it worked for me 5 years ago and it will work again.  I'm too depressed to make any changes.  I don't know what to do.  No, I can't do that because it won't work for me."

Can you relate to any of the above excuses?  Some excuses are legitimate, some are real challenges, and some are just that - excuses.  However, what is inexcusable is not taking control of your diabetes before it takes control of you.  Research and large studies have established without a doubt that uncontrolled diabetes cause major, irreversible long-term complications.  Diabetes is a silent sneaky disease.  If you has a tooth abscess you will go to the doctor or dentist and ask for medication and you will take it because a tooth abscess hurts.  Diabetes does not hurt so it is easy to ignore it and sweep it under the rug.  As a person living with type 2 diabetes and a Certified Diabetes Educator I challenge you to find the motivation to take control of your diabetes and overcome your excuses and challenges.  Ask yourself the following questions:  What do I want my life to look like 10, 20, 30 years down the road?  Who will care for me when diabetes cause a complication such as kidney disease and blindness and I can no longer care for myself?  How will I pay my bills if I have to stop working; who will support me? 

Unfortunately, we can't put an ointment on our diabetes then cover it up with a band-aid until it heals like we can with a boo-boo.  However, we can thrive and live long, healthy lives with type 2 diabetes.  Yes, it does require effort and planning.  Yes, it can be discouraging sometimes.  Yes, sometimes we do have to take medications, maybe even insulin.  Yes, we do have to LEARN about carbs and healthy meal planning.  Yes, we really do need to attend that diabetes education class sometimes.  Yes, we can take a day off of work if we plan in advance.  Yes, we really do need to check our blood sugar.  We must stop looking at all of the "no's" of diabetes and find some "yes's" of diabetes.  Yes, we can ... yes, we can ... yes, we can.  After all, what is the price tag for quality of life?  Life is beautiful.  Take control.  Peace!

http://visionsofcontrol.com/default.aspx

Are Artificial Sweeteners Safe?

"Live with Passion." ~ Anthony Robbins

People with diabetes can enjoy  the same healthy meal plans as people without diabetes but it is a fact that people with diabetes have to be careful with their food and beverage choices.  Too many carbohydrates in the diet from sweetened food and beverages are guaranteed to raise the blood sugar and negatively impact blood sugar control.  So what about artificial sweeteners, are they safe alternatives to table sugar?  Are the rumors true that artificial sweeteners are dangerous to your health because they cause brain cancer and actually cause weight gain?    Below is a link to an excellent article from the American Diabetes Association on artificial sweeteners.  Enjoy.  Peace!

http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/artificial-sweeteners/

Cold and Flu Sick-Day Guidelines for People With Diabetes

Aaaa choo-Cough-Blow-Sniff!  

A Cold or the flu?  

This is the season to be jolly, falalalala-lalalala!  The Thanksgiving, Christmas, and New Year holiday season is a festive time for most people.  Celebrations with family and friends are common during this time and we celebrate our moments via eating, shopping, family get-togethers, gift exchanges, weddings, music, etc.  Unfortunately, upon arrival with the holiday season are those uninvited and unwelcome viral nuisances known as colds and the flu.  Prompt attention to these viral illnesses is necessary for people with diabetes because these illnesses stress the body and can wreck havoc on blood sugar control.  Physical illnesses cause our body to produce stress hormones which are designed to help our body fight infections.  These stress hormones also raise the blood sugar which further contributes to you not feeling well.  Cough, sniffles, sneezes, fever, body aches, congestion, and sore throat - so how do you determine if you have a cold or the flu? 

http://www.helpfulhealthtips.com/Images/D/Difference-cold-flu.jpg

Important steps to take to manage diabetes control during times of illness include:                  

• Check your blood sugar levels often, about every four hours.  Call your health care team if you do not feel well and your blood sugars are less than 70 mg/dL or greater than 240 mg/dL.

• Check urine ketones if your blood sugar levels are above 240 mg/dL.  Ketones are a warning sign that the diabetes is not under good control.  High levels of ketones in the body can poison the body and lead to complications such as a diabetic coma or death.  It is usually recommended that urine ketones be checked every 4-6 hours when the blood sugars are 240 mg/dL or higher.   Urine ketones can be checked at home by using urine ketostixs which are available for purchase over-the-counter without a prescription from your local pharmacy.  

• Stay hydrated.  Drink 1 cup of a calorie free beverage (ex. water, crystal light, sugar-free/diet sodas, sugar-free koo-laid, tea with artificial sweeter, etc.) every hour while you are awake.  If you are unable to keep fluids down due to vomiting or if you have persistent diarrhea then call your health care team or you may need to go to an urgent care clinic or the emergency room.

• Take your medications, including insulin, daily as prescribed even if you are unable to eat solid foods unless you are told to do otherwise by your health care team.  Some oral pills (ex. Metformin) may need to be discontinued during times of dehydration, diarrhea, and/or vomiting.  Also, your insulin doses may need to be adjusted during this time.  Always check with your health care team before discontinuing a medication or changing the dose of your medication if you are unsure what to do.

• If you need to take over-the-counter medications for a cold, cough or flu then make sure that the medication is sugar-free.  Also, be careful if you have high blood pressure because some over the counter cold/flu medications can raise your blood pressure.  Check with your health care team if you are not sure which medications to take.  You can also ask the pharmacist.  Some prescription medications like antibiotics and steroids can lower or raise your blood sugars so discuss all new prescription medications with your health care team. 

Call your health care team if: 

• Your temperature greater than 100 degrees Fahrenheit for 24 hours or more
• You have diarrhea or vomiting for 6 hours or more
• Your blood sugars are less than 70 mg/dL or greater than 240 mg/dL
• You have moderate to large amounts of urine ketones
• You have signs of ketoacidosis (vomiting, headaches, stomach pains, trouble breathing, chest pains, fruity smell on breath) and signs of dehydration (fever, dry tongue and dry, cracked lips)
• You don't know what to do

What to eat/drink when you are not feeling well:

It is important to avoid dehydration and get healthy nutrients from fluids and meals when you are sick.  It is generally advisable to consume 15 grams of carbohydrates (1 carb serving) every hour or 45-65 grams of carbohydrates (3-4 carb servings) every 4 hours. (1 carbohydrate servings = 15 grams of carbohydrates.  For example, 1/2 cup of fruit juice equals to 1 carb serving or 15 grams of carbohydrates).

• Eat your normal daily meals if tolerable
• Consume liquids or soft foods such as those foods listed below if nausea, vomiting, diarrhea are present or you don't have a healthy appetite.  (Each item equals to between 10-15 grams of carbohydrates).

•  Fluids:
• 1 cup broth or soup
• 1/2 cup fruit juice
• 1/2 cup gatorade or powerade
• 1/2 cup gelatin
• 1/2 cup regular (not diet) soda
• 1 cup milk

• Solids:
• 6 saltine crackers
• 5 vanilla wafers
• 3 gram crackers
• 1 double stick popsicle
• 1/2 cup of ice cream or sherbert
• 1 slice toast (regular bread, not "lite/low carb" bread)
• 1/3 cup rice
• 1/2 cup cooked cereal (grits or oatmeal)
• 1/2 cup sugar-free pudding
• 1/2 cup regular (not sugar-free) jello

These sick-day guidelines are for informational purposes only and should never replace the medical advice and care of a licensed health care provider.  Always consult your professional health care providers before changing your treatment plan and/or medications.
 

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Holiday Eating Tips

Little Johnny Joke:

Little Johnny refused to eat.  So his mother, in desperation, took him to the psychiatrist, who tried many methods, to no avail.  The psychiatrist asked, "What would you like to eat?"

"Worms" Little Johnny said.  The psychiatrist was gleeful as he sent his nurse for a cupful.  Placing them on a plate, he said, "Here they are."

"I want them fried" was the response.

The nurse took them and had them fried.  When presented with them, Little Johnny replied that he only desired one.   The psychiatrist took one and in a strong voice said, "Here is only one.  Now eat it."

"I only want half and you eat the other" was the reply.

The psychiatrist swallowed one half and gave the other to Little Johnny. Just then Little Johnny began to cry.

The doctor asked what was wrong.  Little Johnny said, "You ate my half!"

Unlike Little Johnny, eating worms is not on our holiday menu. As a matter of fact, a warm, fuzzy worm casserole would be rather easy to avoid.  This is not true for the many other choices on our tables during the holiday season.  Staying committed to eating healthy meals is very challenging for most people on Thanksgiving, Christmas, and New Years Day.  These holidays are typically festive and it is easy to veer off track and stick to a "low fat, low cholesterol, low sodium, low to moderate carbohydrate" meal plan.  Ugghhh!, not for the holidays!   It is possible to enjoy your holiday meal without the remorseful, guilty feelings that we feel when we over-indulge.

• Plan ahead.  Know when you are going to attend parties, dinners, land festivities with family, friends, relatives and co-workers and be prepared to mentally deal with the with the fact that  the temptation to over-indulge will run high on these days.  Stick to your healthy meal plan in between these days.

• Eat holiday foods outside the home.  Try to avoid having these foods readily available by bringing them into your home. 

• Exercise.  Gather a friend or two and take a 15-30 minute walk. 

• Take your medications.  This is NOT the time to "forget" to take your daily medications as prescribed.

• Volunteer to bring the sugar-free beverages (diet soda, powerade lite, crystal lite, sugar-free kool-aid, tea or lemonade sweetened with artificial sweeteners such as Splenda or Equal).  Don't drink your carbs because they reduce they limit the carbs you should have from solid foods.  

• Bring healthy snack foods (veggie and fruit tray, walnuts/almonds, or a cheese tray) so that they will be available for you and others to enjoy.  Remain conscientious of "sampling and tasting".  Every bite counts.

• If you overindulge in food with your first plate and desire to eat more then choose meats and nonstarchy vegetables as your second helping. 

• Choose your battles and dodge the guilt.  If you fall off the bandwagon, then get back on the next day.

• If you are hosting the dinner then ask family, friends and relatives to take left over plates.  

• Enjoy your holiday.  Laugh loud and often with your family, friends, and relatives.  Who knows, this may be the last time ...  Peace!

•  View my website:  http://visionsofcontrol.com/default.aspx

 "An optimist is a person who starts a new diet on Thanksgiving Day."
~ Irv Kupcine