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Living With Diabetes

Psychosocial

Diabetes Disaster Plan

One little problem with disasters is that when they strike it’s too late to start preparing for them. You never know when or where they will hit.

Those of us who have diabetes are particularly vulnerable, because we have so many things that we have to consider. That’s why the American Association of Clinical Endocrinologists working with Eli Lilly and Company created the “Power of Prevention: Diabetes Disaster Plan.”

Todd Frieze, M.D., who practices diabetes, endocrinology, and metabolism in Biloxi, Mississippi, spoke on the organization’s disaster plan for those of us with diabetes this morning at a media briefing during the last full day of the AACE’s annual meeting in Boston. He said that they developed this checklist of items that we need to plan for after thousands of people were caught unprepared as a result of Hurricane Katrina in 2005.

Dr. Frieze Plans

In such an emergency we may well be totally on our own. “When something does happen, access to medical care may be curtailed or absent completely,” Dr. Frieze said. He noted that in 2005 his patients were out of touch with him for seven weeks.

Here is the checklist. As the Boy Scouts say, “Be Prepared:”

Prepare a portable diabetes disaster kit that is both insulated and waterproof containing the following items:

List of all medical conditions and prior surgeries.
Information about your diabetes, including past and present medications, any adverse reactions to medications, and past and present complications.
List of all your health care professionals with their contact information.
Letter from your diabetes health care professionals detailing most recent diabetes medication regimen (especially for insulin) and containing most recent laboratory results.
List of all medications, which should also include pharmacies and active prescription information and eligible refills.
A 30-day supply of medications for diabetes and all other medical conditions. This should include insulin, oral anti-diabetic agents and severe hypoglycemia emergency kit (if prescribed by your physician).
Blood glucose testing supplies including lancets, test strips and preferably at least two glucose meters with extra batteries.
A cooler and at least four refreezable gel packs for storing insulin (do not use dry ice when storing your medication).
Empty plastic bottles and/or sharps container for syringes, needles, and/or lancets.
Source of carbohydrate to treat hypoglycemic reactions (e.g. glucose tablets). Ideally should also have one or two day’s supply of food that does not require refrigeration (e.g. non-perishable).
At least a three-day supply of bottled water.
Pen and/or pencil and notepad to record blood glucoses and any other test results and any new signs/symptoms suggesting medical problems.
Additional medical/first aid supplies like bandages, cotton swabs, dressings, and topical medications (antibiotic ointments or creams) to treat cuts or abrasions.

Other recommendations:

Wear shoes at all times and examine your feet often for infection.
Make sure that all immunizations including tetanus are updated.
Pack extra comfortable clothing including undergarments.
Take a cellular phone with extra batteries for you and family members.
Consider choosing a designated meeting place in case you are separated from your family and unable to reach them by phone.

This article is based on an earlier version of my article published by HealthCentral.

by David Mendosa

Psychosocial

Don’t Let Hospitals Ruin Your Control

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.” Continue Reading

by David Mendosa

Diabetes Diet

The Trouble with Naps

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.

by David Mendosa

Diabetes Diet

The Rest Trap

Learning that you have diabetes can be overwhelming. All at once your life has changed.

In fact that is really good. Now you can be healthier than you ever were — if you get more active, lose weight, take your medicine, and cut your stress.

Those are the essentials. The rest are optional tweaks and theory.

Like this one today. The journal Medical Hypotheses deals only in theory, as its title implies.

This journal has an “article in press” that it will publish soon. It’s not online yet.

One of the authors, Alexander Dynyak, M.D., lives and works in Almaty, Kazakhstan. If you don’t know where that is, join the crowd. But Kazakhstan is in Eurasia and is the ninth largest country in the world in land area. It is also the world’s largest landlocked country.

Another author, Andrey Dynyak, is currently pursuing his M.D. degree in Ukraine. Andrey also publishes their research findings on diabetesnewfrontiers.org and sent me a copy of the Medical Hypotheses study.

The study has the usual technical title: “Diabetes mellitus: Hypoxia of the islets of Langerhans resulting from the systematic rest prone on the back after a meal?” In plain English, that means that the islet cells in our pancreas might not get enough oxygen and cause diabetes if we lie down in the two hours after we eat.

Who would have thought of that! I certainly never did. But the islets are especially susceptible to oxygen deficiency. This study investigated whether the pressure on the pancreas of food in the stomach after a meal might be related to diabetes. To test their hypothesis, the authors surveyed people with diabetes compared with a control group. The people with diabetes numbered 91 and those in the control group numbered 20. Every one of the people with diabetes had been resting after eating at least three or four times each week. But only 2 of those in the control group, or 10 percent, did.

Then the researchers attempted to get the people with diabetes to change their resting behavior. The researchers recommended that the people with diabetes not lie down within two hours of a meal. That’s because this is the average time it takes for food to pass through our stomachs.

But only 20 percent of the people with diabetes were consistent in not resting during those two hours. Of those, however, the researchers found general improvements, an increased capacity for work, better blood glucose control, and less need for diabetes medication.

The article indicates that resting during the two hours after a meal might lead to diabetes. I wondered if this might, however, imply that people who already have diabetes should also avoid resting then.

“Yes, that is basically what it implies,” Andrey Dynyak replied. “In general, a passive rest within one to two hours after a meal in a recumbent position should be avoided. However, being more specific for diabetes, a passive rest after a meal prone on the back or reclined is what should be avoided.

“Unfortunately, it is becoming such a common and usual behavior that by many is regarded as normal. Fortunately, it is easy to test, and positive results can be seen shortly after changing this specific behavior.”

I think that these far-off researchers might be onto something. It’s definitely worth testing if you have been lying down during the two hours that it takes for your stomach to digest your food. It won’t make your life worse, and could well make it a lot better.

This article is based on an earlier version of my article published by HealthCentral.

by David Mendosa

Diabetes Diet, Exercise For Diabetes, People With Diabetes

Vacation Control

At the end of my five-week vacation on the South Island of New Zealand I am returning to the reality of my everyday life with diabetes. For me, reality means controlling my blood glucose level with diet and exercise. Since 2007 I haven’t had to use any diabetes medications to keep good control.

But, like all of us, I do have to watch my diet and exercise. And like most people on vacation my attention sometimes wandered.

While I have diligently following a very low-carb diet since 2007, I readily admit that I enjoyed a few servings of potatoes in New Zealand. Worse, I ate two slices of toast. While I have broken my addiction to all types and forms of grain, the toast in eggs benedict was sometimes impossible for me to ignore.

On the other hand, I ate more seafood than ever before in my life. Seafood is our best source of heart-healthy omega-3 fats. I ate everything from the well-known salmon, prawns, shrimp, oysters, and calamari to butterfish, groper, smooth dory, gurnard, ling, monkfish, and blue cod and on to fish I never heard of before — warehou, tarakihi, whitebait, bluenose, trumpeter, and green shell mussels. They all tasted wonderful to me while at the same time helping to balance out my dietary lapses.

Wild game also has a better ratio of omega 3 to omega 6 fats. That helped me to feel virtuous while enjoying a venison cassarole that a ranger on the Milford Track prepared for my lunch. I wrote about this and my other New Zealand adventures on my “Fitness and Photography for Fun ” blog.

Normally, I minimize the amount of fructose that I eat, since it’s so hard on the liver. I do eat some berries when I am at home. The berries that I especially enjoyed in New Zealand are called kiwiberries, miniature (grape-sized) versions of the kiwi fruit we have in America. But kiwiberries are especially sweet and juicy.

New Zealand is rightfully famous for its dairy products. I don’t think that the country has any of the infamous concentrated animal feeding operations (CAFOs), where we tightly pen our lifestock and chickens and feed them a grain diet, which in turn worsens our omega-3 to omega-6 ratio.

New Zealand dairy products are therefore not only healthier than most of ours but also taste better. I particularly enjoyed their cheese and their “Fresh’n Fruity” brand of natural (no fruit) Greek style yoghurt (as they spell it).

The other major deviation from my diet besides some additional carbohydrates was going back on coffee after almost a year without. I stopped drinking coffee because it was giving me awful headaches. But I can handle one cup a day now. I make sure that it’s a good cup, which the Kiwis do know how to make. In all the better restaurants I can find excellent coffee that is somewhat diluted espresso that for some reason the Kiwis call a “long black.”

In contrast to my somewhat slacker dietary habits on vacation I have been walking and hiking more than usual. I convinced myself that I need the extra calories to give me strength on the trail. I’m hoping that it has been a wash.

This article is based on an earlier version of my article published by HealthCentral.

by David Mendosa

Diabetes Complications

Should You Get a Shot for H1N1 (Swine Flu)?

For months the question has been whether we could gear up production of vaccine for the H1N1 flu virus — formerly swine flu — fast enough. Now that the first doses have reached some distribution centers this week, we have the answer to that question.

This answer leads to the next question that we all have to face. Should we get the vaccine?

The Centers for Disease Control and Prevention, or CDC, says that people “at increased risk of severe illness” most need the H1N1 vaccine. One of these groups includes people with diabetes.

This makes sense. Those of us who have diabetes can get very sick and may even have to go to a hospital. Our impaired immune system makes us more vulnerable to getting a bad case of the flu.

Just getting sick can raise our blood glucose level. Then, it can stop us from eating right, and that further affects our blood glucose. Continue Reading

by David Mendosa

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