When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.
At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.
This week he told me that I was free to reproduce that guide here. What happened was this.
One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.
When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.
“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.”
My most recent post here reviewed a new study indicating that resting after meals is hard on the pancreas, could lead to diabetes, and could make existing diabetes worse. This is an interesting hypothesis and one that you can check out yourself.
But one of my correspondents suggests that the results might be related to the fact that overweight people who overeat at a meal are more likely to lie down. “Edgy thin people probably jog instead,” she says.
That’s a good suggestion, and I’m not sure that the authors of the new study controlled for weight. But now comes a closely related study that indirectly offers support for the hypothesis that lying down after we eat isn’t a good idea.
People in China in the 50s and over who regularly take naps after a meal increase their risk of diabetes by 28 to 36 percent, according to a study just published in Sleep, the official publication of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The authors of the study are associated with universities and hospitals in China and the U.K.
Correlation, of course, doesn’t prove causality. It is suggestive and may be a good suggestion to follow, because the only downside is probably being a bit tired, which in fact could lead to a better night’s sleep. Anyway, a little jog after a meal will do a lot more to reduce blood glucose than lying down ever will.
The authors of the study that I review last week are in Kazakhstan and Ukraine, while the new study is China-based. Some of the most interesting research on diabetes now seems to be coming from countries that hadn’t been at the forefront of diabetes research. This Internet age seems to be leveling the playing field.
This article is based on an earlier version of my article published by HealthCentral.
Bayer Diabetes Care’s A1CNow+ monitor for us to test our A1C level at home carries the highest certificate of accuracy. As I wrote here in June, the NGSP (formerly the National Glycohemoglobin Standardization Program) certified this device as having documented traceability to the Diabetes Control and Complications Trial reference method, which established relationships between A1C levels and risk for complications of diabetes. The DCCT method is the gold standard for reliable A1C testing.
So I was surprised to read an article in the journal Clinical Chemistry indicating that this was one of the A1C testing devices that didn’t meet “the general accepted analytical performance criteria.” Two Dutch researchers led by Erna Lenters-Westra reported that the local distributor in the Netherlands of the A1CNow+ Bayer “concluded that the EP-10 [protocol] outcome data did not warrant progression” to the two other protocols the study used.
But the key sentence — buried in the full-text of the study and missing from the online abstract — is this, “The bias found with the EP-10 protocol of the A1CNow was probably due to EDTA interference problems.”
I had to ask Bayer representatives what all this means. This is what the company told me:
“Bayer has reviewed the Lenters-Westra study published in Clinical Chemistry that used Bayer Diabetes Care’s A1CNow+® monitor as part of their evaluation,” the company wrote back. “Bayer believes that the results that the study authors obtained did not accurately capture the proven performance of the A1CNow+ device due to use outside the manufacturer’s specifications [emphasis added].
For people with diabetes the so-called “vital signs” that health care people talk about have to include our blood glucose level. So I couldn’t think of a better name for a blood glucose meter than “Vital.”
Arkray in Edina, Minnesota, seems to agree. At least that’s what the call their new meter. You may not be familiar with Arkray, but it is the world’s fifth largest manufacturer of diabetes self-monitoring systems. This company calls their new meter the “Glucocard Vital.”
The U.S. Food and Drug Administration approved the Glucocard Vital in November. Arkray just ramped up production and sent me one of the first of these meters, the newest meter on the market.
Yesterday I put my Glucocard Vital through its paces. It performed perfectly for me. Since I test so many blood glucose meters, I like to use them before ever looking at the user instruction manual.
I just pulled out one of the test strips, inserted it in the meter, which then turned out automatically with the battery already in place. Even the date was already correctly set. Later, of course, I did read the manual to see if it contains anything of importance that I need to tell you about.
The Newest Blood Glucose Meter
A few days ago an Accu-Chek Aviva blood glucose meter arrived in my mail. The meter itself was nothing new. Three years ago when Roche Diabetes Care introduced the Aviva I wrote a glowing review of it, appropriately titled “Viva Aviva!“
What is new is the smallest item in all those papers that accompany a new meter nowadays. It’s a wallet-sized card that Roche calls the Accu-Chek Connect.
This is one powerful little card! For some people it means that we don’t have to pay more than $15 for each prescription we get for Accu-Chek Aviva test strips.
The Front of the Discount Card
Today people who have diabetes can be thankful that the United States doesn’t have a single-payer health care system. Based on two Canadian studies released today, most of us could face the prospect that our health insurance would soon cease to cover the cost of testing with blood glucose strips.
The studies both proposed that Canada could save money by cutting benefits to people with type 2 diabetes who are using drugs other than insulin. Last year 63 percent of people with diabetes in the province of Ontario who weren’t using insulin used on average 1.29 test strips per day. Although many of us would say that’s too little, one of the studies concluded that it’s too much.
The Canadian Medical Association Journal CMAJ on December 21 released these studies subject to revision. You can read the full-text of one study at “Blood glucose test strips: options to reduce usage.” The full-text of the other new study is at “Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin.”
Each article recognizes that those of us who inject insulin have to test regularly to avoid hypos, if for no other reason. All type 1s and about one-fourth of type 2s inject insulin.