When you want to learn anything about diabetes beyond what you read here, the quickest and easiest way is to search the Internet. But the amount of information and misinformation there has grown so immense that the simplest search can seem like an impossible task.
In the past two decades or so, the Internet has become essentially the biggest library ever created. Nobody knows how many websites are out there, partly because that number changes so rapidly, but there are probably about one billion of them with well over four billion web pages.
Because the Internet is the new digital equivalent of a physical library, consider that the British Library in London is the world’s largest physical library. It has about 170 million items including some 14 million books. And instead of card catalogs that libraries use, the Internet has search engines and links to help you find your away around its vast resources. Although card catalogs index a library’s holdings by author and title and may list one or two subjects, the Internet’s search tools take cross-referencing to a higher dimension.
Starting an Internet search is easy. You just enter the name of your search engine of choice in whatever browser you use. You can use one of many different browsers, like Chrome, Internet Explorer, Safari, or Firefox. But for search engines, two-thirds of all Internet searches use Google. So if you haven’t used it, you might want to remember its Internet address: google.com
It’s stopping your search that’s the challenge. No matter what you ask Google to search for it will find dozens if not thousands of web pages. If you search for a big subject like diabetes, Google will show you that it found more than one-quarter of a billion results. And on almost all of the web pages that it finds are many more links to related resources.
But searching the Internet effectively is more than simply clicking on Google. Even before you decide to search the Internet for something about diabetes or for anything else, you have to take the first step. For most people this is the hardest one.
To guide us through this maze I developed an acronym: R.A.I.S.E.
The “R” stands for recognize, as in recognizing that you need to know more about diabetes. The truly sad fact about diabetes is that when most people get a diagnosis of diabetes they go into denial. Some other people panic when their doctors tell them the verdict. It’s only when you take the middle path of accepting that you have to deal with diabetes that you can begin to learn about it.
So, the second letter of the acronym is “A,” which is short for accept. Like the Apollo 13 astronauts famously radioed to Mission Control in Houston that they had a problem, we have to accept that no matter how hard it is, we have face up to our diabetes diagnosis in order to manage it. Only then can we begin to investigate what we need to do.
This brings us to the third letter of the acronym, “I,” investigate. When you are curious about the different means you can use to control your diabetes, you will begin to reach out to your doctors and other people you know, to books like this one, and finally to that huge thing we call by the little word Internet. At this point is where you actually begin to search the Internet.
The “S” of course stands for the fourth letter of the acronym, search. But this search is asking so much of your tools that in this case it’s not as simple as “seek, and ye shall find,” because whether you search with Google or one of the other search engines you will find too much unless you carefully formulate your search queries.
Just as you have to know how a person’s mind works when you ask someone a question, you have to know how computers think when you try to learn from them. Of course, computers don’t yet think, but what a computer program does is close enough for this analogy to work.
The Google search engine works so well that it actually seems to be intelligent. What sets it apart the most from other search engines is its PageRank software, which founders Larry Page and Sergey Brin developed when they were students at Stanford University. PageRank uses the Web’s link structure as an indicator of an individual page’s value. In essence, Google interprets a link from page A to page B as a vote by page A for page B. But Google also analyzes the page that casts the vote. Votes cast by pages that themselves get a lot of votes help the pages they are linked to get more votes.
Then Google combines PageRank with sophisticated text-matching techniques to find pages that are both important and relevant to your search. This means that the first pages that Google returns are usually the best ones on that subject.
Internet search engines always let you use keywords, for example, diabetes and complications to ask for what you wanted to know. But in 2013 Google’s search took a big step forward by letting you do natural language searches. It now understands you when you ask a question like this: How can I avoid the complications of diabetes?.
You can narrow the search results when you put a phrase in quotation marks. The results will only include pages with the same words in the same order.
Google also has many special features. One that I use a lot are cached links, which is what the page looked like when Google found it most recently. If for any reason the page is unavailable when you find it listed through a Google search, all you need to do is click on the inverted triangle symbol just after the site’s address. That brings up the word “Cached,” which you can click on to see the page as it looked when Google most recently found it.
If a website is temporarily down, you can get the cached version, as I noted above. But what if it’s down permanently? Even in this case you aren’t out of luck, thanks to Archive.org, which keeps back issues of websites online. Its Wayback Machine has saved more than 400 billion pages for your viewing pleasure. All you need is a little time.
Another of my favorite tricks is to search a specific website for something I think is there somewhere on the site when I can’t find the site’s search engine or it doesn’t work well. The form of this search has to be just like this:
where you substitute the name of a website that doesn’t seem to have a search tool for the name of my website mendosa.com and what you are looking for instead of the words diabetes diet that I used here. Please note that the site’s name has to follow directly after site: with no spaces.
You can now also use Google to search the full text of many books or scholarly papers. Those addresses are books.google.com and scholar.google.com, but any results that Google finds from these sites will also be included in a regular search of google.com.
It doesn’t matter whether you capitalize your search terms or not. And Google is remarkable tolerant of poor spelling, gently asking “Did you mean:” something else.
This brings us to the fifth letter of the acronym, evaluate. Choosing reliable diabetes websites is a lot trickier than picking the right browser or search engine. Be especially careful of those sites that want to sell you something. These are the hundreds or thousands of sites offering cures in exchange for your money.
Medical quacks have, of course, been buzzing around people with diseases even before the days of Hippocrates. The Internet simply makes their pitches easier. A famous New Yorker cartoon shows two dogs talking, as they do in cartoons. One dog sitting in front of the computer turns to the other and remarks, “On the Internet, nobody knows you’re a dog.”
That’s all too true. A website costs very little and yet offers a forum for the most vicious animals to sell their wares. The real dogs of the Internet are the cyber quacks.
All of us have to understand the playing field and make our own evaluations. As in all research, the key is consistency. Is the information on the site internally consistent? Is it consistent with what you know of the world otherwise?
For example, you have to know that a site offering an eternal life device for $99.95 stretches credibility beyond reason. But even less outrageous claims should not pass your smell test.
Does the author of the Web page have some authority in the field? Here an endocrinologist can often be trusted, but not necessarily a chiropractor or dentist several of whom have diabetes websites.
Can you communicate with the site? Does it provide a physical address as well as email?
Is the information current? If there are a number of broken links or no news for several months, what does this say about the credibility of the information?
Remember as you read that if it sounds too good to be true, it probably is. If it claims to cure many diseases, it probably won’t cure any. And if it claims to cure diabetes, it won’t because no pill or supplement will do that.
Some websites are so important to people with diabetes that you shouldn’t have to search for them. So let’s discuss them now.
When it comes to the science of diabetes, you have to recognize that not everything you believe is true. Not even everything that the scientists who investigate diabetes think they know will always stand the test of time. Science is a work in progress, and every one of us has to keep learning all the time.
The best studies are randomized double-blind, placebo-controlled clinical trials reported in a high quality peer-reviewed of a large enough group of people over a long enough time to warrant generalizations. My friend, Steven Bratman, M.D., has a great article about these studies at mendosa.com/bratman.htm.
You will find all of these topnotch studies — and many inferior ones — online. In some cases the full text of the study is free online, although in most cases you will be able to get only the abstract. While a Google search will find many of these studies, usually it’s more efficient to use PubMed.
PubMed provides free access to more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. MEDLINE is the U.S. National Library of Medicine’s bibliographic database of studies reported since 1946 in more than 5,000 journals worldwide in about 60 languages. The Web address of PubMed is pubmed.gov. Although a basic search with PubMed is straightforward, this website has some special tricks that you can learn there.
The website of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at niddk.nih.gov was the first website to provide information about diabetes in 1994. It is still one of the most valuable for anyone with diabetes who is looking for basic information that is reliable. The NIDDK is part of the U.S. National Institutes of Health, our leading medical research agency. It conducts and supports biomedical research and then makes available research findings and health information to the public.
Like PubMed and the NIDDK, the Centers for Disease Control and Prevention (CDC), is a part of the U.S. Government. The diabetes website of the CDC’s Division of Diabetes Translation at cdc.gov/diabetes is the authoritative source of diabetes data, statistics, and trends in the United States. The name of the division refers to translating science into practice, not words from one language to another.
The most comprehensive source of quality nutrition data that I am aware of is the appropriately named website Nutrition Data at nutritiondata.com A lot of the information in the website’s database comes from the USDA’s National Nutrient Database (which is available online directly at nal.usda.gov/fnic/foodcomp/search, but is not as easy to use). Nutrition Data’s website supplements the government’s database with listings provided by restaurants and food manufacturers. In addition to food composition data, Nutrition Data also has several tools to analyze and interpret that data. CondéNet, a digital subsidiary of Condé Nast Publications, which owns such publications as Bon Appétit, Epicurious, and The New Yorker, also owns Nutrition Data.
Calculators and Converters
The most important numbers that people with diabetes need to watch are blood glucose (BG) and weight levels.
People with diabetes check BG levels with a meter that in the United States reports the level in mg/dl. They also check the average BG level over the previous two or three months at a lab or with a home A1C meter. This level is the measure of the percentage of the sugar stuck to the hemoglobin in our red blood cells. Because these tests use different units, converting your results from one measure to the other isn’t straightforward. You need a calculator to do this, and one of the major manufacturers of BG meters provides one at accu-chek.com/us/glucose-monitoring/a1c-calculator.html.
The United States and countries in continental Europe use mg/dl to measure BG levels. But the United Kingdom and many other countries use a different measure, mmol/dL. So a British diabetes website provides a conversion tool at diabetes.com.uk/blood-sugar-converter.html.
The other number that is important to people with diabetes is body mass index (BMI). Several BMI calculators, which measures the amount of body fat that adult men and women have, are available online, but I prefer the standard calculator that the U.S. government provides at http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm (you can also type BMI calculator into Google, and this site should be at the top of the list). This calculator lets you enter your height in fractions of an inch and offers the choice of the standard measure used in the United States or the metric measure used elsewhere.
You can read the latest news about diabetes online on several websites. But Google again has the easiest way to get a summary of daily news reports. Start at news.google.com and click on Personalize. From there in the search block “Add any news topic” enter what aspects of diabetes interest you. Although I search for all of the news about diabetes, that returns far too many articles for most people. Google will email links and summaries of relevant items every day, every week, or as they go online, depending on what you choose.
I would be amiss if I failed to mention my website. You can find one or two new articles that I write about diabetes every week at mendosa.com/blog. You can easily search within the site too.
I also have a free Diabetes Update newsletter that I will deliver into your email inbox once a month after you subscribe. You can subscribe by sending an email message to mendosa.com/subscribe, and you can contact me directly at [email protected] for more information.
These are the tools that you need to start exploring the wealth of information about diabetes on the Internet. There’s so much you can learn about diabetes and anything else that interests you there that the only limits are your time and imagination. Go to it.
An earlier version of this article appeared in The First Year: Type 2 Diabetes an Essential Guide for the Newly Diagnosed, third edition, by Gretchen Becker (Da Capo Lifelong Books, 2015), pages 320-327.
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