31 December 2010

Fragmentation Happens Across Multiple Care Facilities

Are you a person that moves from medical facility to medical facility for your treatments. Or do you know someone that does this. Many go from doctor to doctor or hospital emergency room to hospital emergency room. Well it is a known fact that you may not receive the best care following this habit.

Now a study shows that this can do damage as well. Not only are more younger patients doing this, but more of these people are young men. These were also more likely to have psychiatric diagnosis, more likely to be hospitalized, and had higher health care costs.

The study was done in Massachusetts from October 1, 2002, to September 30, 2007. During the study, there were 12,758,498 acute care visits made by 3,692,178 adult patients. Interesting to note that five or more hospitals were used by 43794 patients (one percent) and they accounted for neatly one tenth of all acute care visits.

The study authors advise clinicians to be aware of the level of fragmentation in acute care. They should also be especially attentive to the unintended outcomes of incomplete medical information and prior dispersed medical care.

More attempts need to be made to reconcile medical information from various sites of care for each patient and to consider integrated patient care. Possible solutions might be medical homes and establishment of comprehensive care networks to improve the quality of care.

The fragmentation of medical care can be a problem for those giving care and is often caused by those receiving care. Yes, we have the right to seek second opinions, but this is often taken by patients who are not happy with the diagnosis and are looking for the magic cure-all. I am not sure why this is always necessary, but I have known individuals in the past that seek care where ever their insurance will allow, and even across state lines.

Most often they end up with care that is less than desirable.  Read the article here.

30 December 2010

Will I Allow Spam?

The issue finally reared it ugly head on a recent post here.  I have seen other bloggers allow some of the advertisements that appear this way.  While it is not something that I like, I will continue to have comments monitored for this reason.  I will delete spam.

I will admit that this was for products fitting the blog, I am having a hard time convincing myself that I should allow these. To begin with, the reason I wrote the blog was to let people know that this is not a cure for diabetes, Type 2, as some are claiming for bariatric surgery.

To me they are promoting this as a way to have more people do unnecessary surgery to bring in more money for surgeons and referring doctors. Many people go this route as an easy way to lose weight rather than following a strict regimen of exercise and nutrition. What many don't realize is that bariatric surgery requires an even more strict nutritional diet to gain the benefits and if they go off this, there are severe consequences to pay health-wise.

So for the future, I will closely monitor comments to prevent spam. I will weigh the posts for positive support, but I haven't seen any yet that qualify for this. Personal comments are still welcome. I have not had any that I felt compelled to delete other than spam.

And then again, I was not aware of how slick some of these people can be. I actually thought someone wanted to carry on a discussion about homeopathy, but it was all a rouse to spout their homeopathic religion. I had to delete the posts after I realized the purpose. The person was not interested in any discussion, only to spout the homeopathic way and none of the disadvantages. This is a type of spam and I will not allow it.

29 December 2010

Is Medicare Going to Remain Viable?

This is starting to bother me in so many undefined ways. I must ask some questions. Has your doctor started to spread out your appointments? Is your doctor only seeing you once a year. Have you wondered why? Or has you doctor said you won't be rescheduled?

If you have read a few of my earlier blogs, you might have an idea. Yes, now I can say based on my own experience that our government is slowly making Medicare a problem and leaving its senior citizens to wander aimlessly without medical help. Many will have too much income to qualify for Medicaid and with Medicare decreasing the reimbursement to doctors, many of us senior citizens will not have a doctor to see in a year or two. And in these economic times, many states are having trouble meeting their expenses for Medicaid.

My primary care doctor is reducing my visits, as is my endocrinologist, and heart doctor. Some of the doctors I do not need to see but occasionally, which is fine by me. However, when a doctor says s/he is reducing the number of visits by one fourth, one third, or a half, you do need to be concerned.

Some doctors are putting signs up that they will no longer see Medicare patients. I have only seen one of these in a city about two hour's distance. I have talked to friends and acquaintances that are being turned away by doctors. Some are just starting Medicare on January first and they are being told that they must find another doctor because at December 31, they will no longer be served by the current office.

A few doctors are posting signs that they will take no new Medicare patients, but will work with those they have presently. How far this goes is going to depend on the new congress and what is funded or unfunded in the Affordable Care Act. A larger factor is going to be how the rules and regulations are handed down about the Accountable Care Organizations (ACOs).

This is going to be very interesting as this is mandated, but not precisely defined by the law. ACOs are to be affiliations of health care providers that are held jointly accountable for achieving improvements in quality of care with reductions in spending. The ideas that have been bouncing around are varied. Some will be cumbersome, while others will create legal headaches. This may be a topic for a future blog.

Prior blogs of mine that are related in nature - blog 1, blog 2, blog 3.

28 December 2010

Drug Companies are Costing Health Care Billions

This is interesting because it is coming from the British, specifically the British Medical Journal and the British Media. They are taking the drug industry, Big Pharma to us, to task for a campaign promoting the more expensive types of insulins. These analogue insulins for people with Type 2 diabetes are costing the British National Health Service about $390 million extra over the past five years.

They are also stating the the extra cost does not translate into equivalent benefits. They have determined that the five times of the cost when compared to conventional insulins and that published evidence did not improve glucose control or safety in Type 2 diabetes.

Even the World Health Organization is raising concerns about the more expensive analogue insulins displacing proven insulins and the way the insulin manufacturers are not producing the cheaper human insulins. With no proven cost effectiveness the companies are pushing the more expensive insulins.

In the UK analogues have about 80 percent of the market, in the USA about 70 percent, and in Europe about 60 percent of the insulin market. The two dominate analogues are detemir (Levemir) and glargine (Lantus).

So world wide, the total extra costs could be in the billions that are flowing into Big Pharma's coffers. On December 30, Nova Nordisk will end the manufacture and distribution of Mixtard 30, a well tolerated human insulin. Others will follow in removing good, cheaper insulins from the market.

This is a case of Big Pharma promotions and glitzy marketing strategies, plus the push to increase the size of profit margins at the expense of diabetes patients or taxpayers paying the costs in government health care plans. Those in the US will be forced to pay the higher costs of medical health insurance.

Read the article here.

27 December 2010

New Way to Control Blood Sugar Levels?

Normally I dislike writing about topics in the development stage. This topic is an exception for me. It is not quite the breakthrough on a cure level, but may have implications of importance for future treatment of Type 2 diabetes.

There are still unanswered questions about the level of pancreas output of insulin and whether this will be for the very early diagnosed only or will have factor in any treatment of those who already have reduced insulin capabilities. This should still be of interest to everyone in the Type 2 community.

They have discovered a protein that is present on the cells that release insulin and this protein has to be active. The protein named M3-muscarinic receptor is not only active, but must undergo a specific change to trigger insulin release for the control of blood sugar. They are testing to see if this change is one of the mechanisms disrupted in diabetes.

Read the article here.

25 December 2010

Non-Communicable Diseases

In an article presented by the International Diabetes Federation (IDF), the Non-Communicable Diseases Alliance is calling on the global development community to step up and answer the call for assistance. NCDs cause 60 percent of all global deaths. They say that 80 percent of the deaths are in the developing countries, but receive 2.3 percent of international development assistance.

The non-communicable diseases are cancer, cardiovascular disease, chronic respiratory diseases, and diabetes. This is a great call by the IDF.

Now I would like to turn this to the USA and turn up the heat on the American Diabetes Association. With the fact that diabetes kills more people than AIDS and breast cancer combined, why is there not more funds being raised by the ADA? Since there are many types of diabetes, and they are increasing in the US and around the world, we should expect to see our ADA doing more.

Considering that the ADA has finally accepted World Diabetes Day and World Diabetes Month, now we need to work on them to accept the World Diabetes Blue Circle and then have them work more diligently in getting funds to combat diabetes.

There are many areas that the ADA could work to educate people, but has chosen to bury its head in the sand of non-action and leave important activities languish because it is collectively afraid to offend a few of its more prominent doctor members.

Read the article here.

24 December 2010

Homeopathic Medicines – GOOD or BAD?

Whatever you call it, homeopathy, complementary, or alternative medicines, they have a certain amount of dangers associated with them when used for children. The dangers come from parents not knowing the side effects and problems of the combinations of medicines. Not only this, these parents do not communicate with doctors.

Two different articles describe what can happen and they do present both sides to a fair degree. The study only included 39 cases in Australia. The study stated that changes made by CAM (complementary alternative medicines) practitioners caused the adverse events.

The study group included all ages from birth to the age of 16. The study determined that the parents were the ones believing in CAM and the naturalness of the medications. They may have overdosed because of these medicines being natural. Most went against medical advice. They also assumed that “natural” meant “safe and harmless” which isn't always the case.

Most US pediatricians know that the types of complementary and alternative medicine varies greatly from country to country and feel that the US is better on most fronts. All agree that if CAM is used as a complement to conventional medications and not as an alternative, the outcomes are mostly positive. They also stressed that parents of children need to stay in contact with their pediatricians to get the best results and to be aware of drug interactions and how to avoid problems.

Please read this article from WebMD as it has some excellent thoughts. The other article is here. The BBC also has the article here.

23 December 2010

FDA Targets Tainted Supplements

This is not about diabetes, but just a well be. Many people with Type 2 diabetes are looking for natural, homeopathic supplements that will help them manage their diabetes. They do not check with their doctors. They seek out these remedies to let them continue to live the good life.

What they don't understand and are often found wanting is not the cure they thought they were having, but the complications of diabetes. Last week I witnessed an acquaintance that had Type 2 diabetes succumb to the complications. He had diabetes for about 13 years, but chose the path of homeopathic supplements for the first 11 years. About 2 years ago, he lost his eyesight and about 3 months later his left foot and leg below the knee. About eight months ago, his kidneys failed and he had been on dialysis until he quit the treatments.

I am not sure what supplements or medications (if any) he was taking, but said he had gone the homeopathic route for treatment for diabetes. The articles of December 16 and 17 about the FDA announcement to target harmful products marketed as dietary supplements was welcome news. The FDA is currently targeting tainted products sold as dietary supplements for weight loss, sexual enhancement, or body building.

Five trade associations are supporting the FDA letter and are planning to share the information widely. The associations are: Council for Responsible Nutrition, Natural Products Association, United Natural Products Alliance, Consumer Healthcare Products Association, and the American Herbal Products Association.

I doubt that what the gentleman was taking (if anything) was not among what the FDA is after, but I would hope that eventually some of these supplements claiming a cure of diabetes will be exposed and stopped as well.

Read two of the articles here and here.

22 December 2010

Update Family Health History During Holidays

Are you getting together with the relatives, in-laws, and out-laws for the holidays? This would be an excellent time to talk with grandparents, or aunts and uncles to find out about the health history in their immediate family.

This could be especially helpful if you don't have the history whether it be health history or just family history. Too many people just don't have this information which could be valuable at a later date. You may know your grandparents and your parent's siblings, but you may not have all the history.

If your parents happen to be like mine, I was never able to get much information. My father knew his family, but would not talk about anyone else. My mother knew her family, but you did not ask about other relatives. You did not ask health questions because you would be told it was impolite and that would be the last it was mentioned. Hopefully, you are able to get the history that could be invaluable later.

In addition to names, relationships, birth dates, and date of death, this information may lead to other information that you will need to ask more about privately. Remember, some relatives are more sensitive about health information and will not share in a group. Be sure to ask about different health issues like cancer, heart disease, diabetes, mental health disorders and other possible medical conditions.

Once you have as much family health history as possible, share it with your doctor. Your doctor may want to do some medical tests for certain potential conditions. So don't bury this information as it could save your life. Remember, ask the reasons behind early deaths, and about unusual things that may have happened.

Read about other information here (sorry - link is broken).

21 December 2010

Have Diabetes – Expect Shorter Life-Span?

This article has has some traction on a couple of diabetes forums. On one the person was lamenting about why go to all the effort to manage diabetes if they were going to have a shorter life anyway. On the other, there was some consternation, but most were saying that by managing their diabetes, they expected to beat these predictions.

This shows what can happen. One person was in a manner of speaking – throwing in the towel, while the other looked at this as a challenge to be proven wrong. That is somewhat the difference between the forums, one is pessimistic and the other is very positive in attitude. There should be little doubt about which one I participate on more actively.

With the medical advance being made today, people with diabetes can expect to live longer than in the past. Studies are still making us wonder why there is still so much doubt. On average, a 50-year-old with diabetes can expect to live 8.5 fewer years than a person without diabetes. A 60-year-old can expect to live 5.4 fewer years. By age 90, the difference is one year.

These numbers are not encouraging, but considering the number of people that do little to manage their diabetes, it is understandable. I wish there were studies that followed or tracked people that did tightly manage diabetes. I feel that these numbers on average would be better.

It would also be interesting to track the costs of diabetes between those that tightly manage diabetes to those that do little or nothing to manage diabetes. This is why I support efforts to use intervention to assist people and the use of peer to peer groups that can help people better manage diabetes. We need to totally debunk the myth that diabetes is a death sentence.

The article may be read here.

Seasons Greetings

To all my readers

May you have a happy holiday season

Have a Merry Christmas


A Happy New Year

The blog will continue during the holidays. I wanted to take this opportunity to greet everyone and wish you happy holidays.

20 December 2010

Do You Need Your Beauty Sleep?

Think mother was kidding you about needing your beauty sleep. Most of us probably smiled and ignored her. When I read this in the BBC Health News, I had to smile. This was a favor phrase my mother used for all three of her children.

Now there is some clinical proof that mother was right on. Shame on us for doubting her. Researchers from the Karolinska Institute in Sweden have revealed in the British Medical Journal conclusive proof of getting plenty of sleep does wonders for beauty and health.

The study does not identify the sex of the study volunteers, but I would guess they were all female and be wrong. The objective of the study was to determine if there was a link between attractiveness and health, and sleep. There was 23 volunteers in the study.

The study is talked about here and here. Read it for yourself and see what you think and keep smiling.

19 December 2010

Rebuttal on the Genetics of Diabetes

Sometimes you think you are doing the right thing, but later find that oops, this was possibly a mistake. So folks, the post here deserves some corrections. Even the good people make mistakes especially when some people with an agenda possibly have set out to mislead others.

You must read the article here by another geneticist when he rebuts an article in Diabetes in Control dot com that appeared a week earlier. My take on the first article is here. Now that the pot has been stirred, I can almost guess that the discussion is not over.

The author makes some good points, but before I make another mistake and a further fool of myself, I am going to wait until we hear more. I am sure that others will weigh in on this and that the discussion has not ended.

I will try to post all discussions that I find.

18 December 2010

More on High Fructose Corn Syrup

I wonder how the corn industry got all the testimonials they have on their site? Those of us with diabetes need to be aware of the advertisement they have. It is here, very simple and to the point, but at the same time they don't recognize what they are doing to those of us with diabetes.

On their web site they compare corn sugar to cane sugar, sugar, honey, brown sugar, and maple syrup. They do not mention all the foods that now have corn sugar added that never did before. Of course, many of the manufactured foods have not existed for that long either. High fructose corn syrup according to them has been around for 40 years.

If you are a person with diabetes, please take time to familiarize yourself with their web site so that you can distinguish how you are being treated.

17 December 2010

Dietitians May Play Key Role In Diabetes Management

I know that I may offend a few registered dietitians, but I would prefer using the word dietitian. And also I want to emphasize they should be trained in diabetes nutrition. Too many are not and are therefore useless to those of us with diabetes. There are some excellent dietitians that are very knowledgeable about diabetes and they deserve the respect and status from us.

The American Dietetic Association (ADA – different from Diabetes ADA) in their December issue of the Journal of the American Dietetic Association reviews the evidence and nutrition practice presented in the ADA Nutrition Practice Guidelines for Type 1 and Type 2.

The summary of the recommendations are:
  1. Consistency in day-to-day carbohydrate intake for persons with type 2 diabetes
  2. Adjusting insulin dose to match carbohydrate intake for persons with type 1 diabetes
  3. Focusing on total carbohydrate intake rather than the type of carbohydrate
  4. Cardio protective nutrition interventions
  5. Weight management strategies
  6. Regular physical activity
  7. Use of self glucose monitoring data to determine if goals are being met
I would have to ask some questions, but the basic ideas are excellent if they can be varied to fit each individual. The one point that I must disagree with is the third point above. Total carbohydrate intake being more important that the type of carbohydrate is unhealthy. Many people with diabetes know this. Why can't those that we depend on for nutritional guidance understand this?

Oh, yes, we have the American Diabetes Association to thank for this piece of stupidity, along with the American Medical Association. It seems that they do not understand the difference between good nutritional carbohydrates and poor non-nutritional carbohydrates. I cannot accept their – a carbohydrate, is a carbohydrate, is a carbohydrate mantra.

You may read the article here.

16 December 2010

Are We to Believe that Corn Sugar is Safe?

The television advertising by the corn industry is becoming very nauseous. Their advertisements that corn sugar is the same as sugar is as pretentious as any I have seen. Now that their “new” name for high fructose corn syrup is corn sugar, they are wanting us to believe that the formulation has changed (no way) and the damage it can do is the same as sugar to those of us with diabetes (again untrue).

Living in a state known for its corn production does not mean that I have to like that the corn industry is attempting to hoodwink the rest of the country and hoping those living in corn country will remain silent. The various states promotion boards, the various states corn growers associations, and the National Corn Growers Association are all involved in promoting every phase of corn advertising including corn sugar, corn ethanol, and other corn products. The same can be said for soybean products by the soybean industry.

Because it has been cheaper to produce than other sugars, the corn sugar has been added to so many foods that it is small wonder that diabetes has increased so dramatically.  Until the general public wakes up to this and starts demanding the restriction of its use where it is not needed, the corn industry will continue to push for continued expansion of use to the detriment of the world's population.

Since the United States has moved away from the agrarian society of small farmers to large corporate farmers, the push to more unhealthy foods and food additives has increased dramatically. Also, the corporate growth has meant larger revenues to be spent for lobbing efforts to dilute the enforcement of food safety by the Federal Food and Drug Administration and the United States Department of Agriculture.

When is this going to end, when the public starts to protest. I am doing my part by not purchasing products that I know are unsafe and detrimental to my health. This is becoming more of a chore with the genetically modified foods which have not been tested extensively. This extensive testing has not been done for the genetically modified feeds fed to our genetically modified animals (dairy, beef, and swine) and birds (poultry, turkey, ostrich, and others).

Because land is finite and the population continues to grow, this increased pressure for food production has caused our food sources to be able to avoid much of the necessary testing to determine its safety.

Remember this is name only change from high fructose corn syrup to corn sugar. Nothing else has changed so everything we learned about HFCS still applies.

15 December 2010

HFCS or Corn Sugar Again A Bad Boy

Before saying anything you must know that this is a news item from doctors and not a study by researchers.

High fructose corn syrup or corn sugar as it is now called is again on the list of culprits that are being held up as examples of just how we are being treated by our food manufacturing industries. Fructose, of which corn sugar is the big contributor, is the subject of a new review in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

The link between high intake of fructose and metabolic syndrome is constantly being reinforced. The authors of this review stated that there is more evidence that fructose may have a role in hypertension and renal disease. The negative effect of excessive amounts of sugar and high fructose corn syrup on cardiovascular and kidney health is of increasing concern.

The authors expressed increasing concern that physicians may be overlooking this health problem when advising chronic kidney disease patients to follow a low protein diet. They also urge that low protein diets include a warning to restrict added sugars containing fructose.

Therefore, we must be careful ourselves if we have diabetes, hypertension, or chronic kidney disease to limit the intake of fructose. This is also good advice for anyone, whether normal weight, overweight, or obese, as the intake of fructose may lead to these problems. Our health is important.

14 December 2010

Geneticists Say Diabetes Not Genetic

So what I believed is wrong. Yes, I had believed that diabetes was genetic. Now I must realign my thinking and forget the misconceptions I harbored. Genetic researchers have now shown there is little evidence to validate that inherited genes cause common diseases. This is hard to believe because of the families that diabetes occurs in generation after generation.

Heart disease, stroke, cancers, diabetes, and disorders like autism, ADHD, and dementia, and more do not have a genetic causation with a high degree of confidence according to researchers. Then the researchers say that the genetic link was only a hypothesis to begin with.

Yes, the other side is still holding out hope for a genetic link, but at best the links are so trivial that they lend not credence to the validity of genetic links. This means that the diseases we get can only be blamed on ourselves, our environment, and not inherited genes.

Now we must learn that the billions of dollars directed to finding these disease genes may well be directed for finding actual cures for some of these diseases. We will need to review our potential environmental causes, and possibly the genetics of our food sources.

The analysis does not diminish the significance of monogenic disorders such as cystic fibrosis, Huntington's disease or sickle cell anemia that are scientifically established. Since clinical data have shown that many diseases can be reversed or accelerated by diet and other lifestyle changes.

So in the future, no more referring to genetic links for diabetes – as of now they no longer exist. Read the information here and the related one here.  

This has happened since I posted this so read the rebuttal here.

13 December 2010

Bariatric Surgery Can Mask Diabetes

Finally, a word of caution on bariatric surgery! Some of us with diabetes have had some serious doubts about the claims by the American Diabetes Association and the American Association of Clinical Endocrinologists on the successes of bariatric surgery for stopping diabetes. Then there is the American Society for Metabolic and Bariatric Surgery endorsement of the procedure which is extremely profitable for its member surgeons.

Now, some practical in your face results are refuting the successes and pointing to a problem of the surgery masking diabetes. Although the numbers are small at this time, doctors are saying that bariatric surgery is not a cure for diabetes. Plus these doctors are calling for long-term following of bariatric surgery patients to track side-effects and mortality rates.

Researchers are now finding flaws in a meta-analysis of 621 studies by Buchwald et al, which concluded that bariatric surgery was a cure for diabetes. Bariatric surgery has been touted as a cure for Type 2 diabetes. Because of decreasing insulin resistance and secretion. Fasting plasma glucose and HbA1c have been used as evidence for that conclusion.

Fasting blood glucose and HbA1c are poor criteria to establish remission of diabetes after surgery. Using glucose tolerance tests and continuous glucose monitoring needs to be considered to make an educated assessment of the glycemic status for this group of patients. Plus postprandial hyperglycemia levels need to be measured.

This blogger warns us of the problems of weight loss surgery (bariatric) here and again here. She also has several other blogs starting in 2008. My one mention is in my blog here – in the third paragraph.

11 December 2010

New Engineered Forms of Dietary Fiber

You will have to excuse me while I get my skepticism under control. I admit that high fiber foods are a good thing and for those of us with diabetes, higher fiber consumption can be a good idea. When someone says that engineered high-fiber foods are becoming tastier and more appealing to consumers, I have to be skeptical.

When high fructose corn syrup (now corn sugar) was introduced it was hailed as a break through sweetener being cheaper than sugar. In the long-term it has caused more health problems. Those of us with diabetes can attest to this.

Fiber is not a food that is easily digested and very little is digested. Chemically created fiber needs closer scrutiny. How will the body react to the fiber? No tests on humans have been reported and from the article it is not known if the FDA or the USDA will become involved in approving the new dietary fibers.

Much of the problems with celiac disease has developed from the genetic modification of wheat. Because of the genetic engineering of wheat and rice being planned to increase fiber, we should be careful of creating more diseases that may even more difficult to treat.

The world is better off today because of some of the genetic changes to our food supply, but this change has also created health problems for a small percentage of the population. No one is testing all the genetic modifications and what it is doing to overall health of the population in general. One has to wonder if some of the disease increase is a result. There is little proof of this, but until some studies are specifically directed at this, how are we to know?

This is the reason for my questioning engineered fiber and whether the health benefits will in the long-term be justified. While the short article is encouraging, please be careful. Read the article here.

10 December 2010

Seniors Encouraged to be Screened for Diabetes

When I first read the headlines on this, I thought where is this headed when this needs to be done at all ages. Then in the first sentence, I could see that Medicare is putting up the money so naturally it would be about seniors. And for $50,000 what do they expect? For this amount of money to twenty community-based organizations (at $2500 to each) they should not expect to get much bang for the buck.

There is a growing problem in this country and through out the world of people being undiagnosed with diabetes, but for this limited effort what can we expect. Even the American Diabetes Association and the American Association of Diabetes Educators are not putting out much effort to date in getting doctors to diagnose people sooner. And the screening efforts for undiagnosed people with diabetes is all but non-existent from these associations.

Until the American Medical Association and the American Association of Clinical Endocrinologists decide to cooperate and work on screening programs, the sad state of diabetes is going to continue, especially in this country.

While I had a glimmer of hope when I wrote this, in talking to a few doctors, and endocrinologists, no action has yet been advocated at least in materials they have read.

But I have gotten away from the article that started this. Apparently beginning in 2005. the Centers for Medicare and Medicaid Services (CMS) began offering coverage under Medicare for screening for diabetes and pre-diabetes. I am having to wonder if there have been successes for them to start this program as a replacement to get screening accomplished.

Either way, I do not see much that is in line for success. I do think that their intentions are in the wrong place with the cuts in payments they are making. This is not going to encourage screening of seniors when many doctors are refusing to take on new Medicare patients and some are actually turning them away.

Read the article here. If I sound a lot cynical, I am. When a government agency wastes money by allowing so much fraud, and then cuts payments to doctors and hospitals, I have to wonder what miracles they are looking for with an expense of $50,000.

09 December 2010

Combining Byetta and Lantus Best?

This study may be true, but I wonder. The side effects can be horrendous and do affect people differently so be sure that you are aware of all of them before taking. This study promotes it a 'Best Result Ever' when used with Lantus for Type 2 diabetes.

One of the more serious side effects is that it overworks an already in trouble pancreas and can cause pancreatitis (inflammation of the pancreas). This is just one of the side effects and people have not had any problems with this. Then you add nausea, vomiting, and diarrhea and the side effects can be very unpleasant.

The other benefit is exenatide (Byetta) does promote weight loss and for some people this is a good thing. When used with Lantus, there appears to be some good benefits in that hypoglycemia is generally not a problem. Yes, it can happen if you are careless and overdose with either.

With this being an interesting study, I question why it was only 30 weeks and only used 261 participants in five countries. This has been published in the Annals of Internal Medicine on December 7, 2010. You may read it here.

The study was funded and sponsored by an alliance of Eli Lilly and Company and Amylin Pharmaceuticals, who are collaborating to market Byetta, and they have the most to gain from this study. This is another reason I question the value of the study.

08 December 2010

When Do You Take Your Blood Pressure Pills?

This sounds reasonable and right. I have been taking mine at night since shortly after I started, and have had excellent results from day one. Yes, originally I was to have taken mine in the AM, but because I was forgetting them, I changed to night without asking the doctor. That was just over seven years ago.

New research shows that we should be taking blood pressure pills at night. The research has found that those taking their blood pressure medications before going to bed have at least one-third less cardiovascular episodes of those taking medications in the morning. This is significant by anyone's measure.

There is no information to relate this to those of us with diabetes, but even then I would have to estimate that the results would be statistically the same if not slightly better.

The five year study is very interesting and should be read by everyone. This is the link to the report of the study.

07 December 2010

Random and Divergent Thoughts

Sometimes a thought will come to you and at other times you are left thinking. This time the thought is there, but how to present it is wanting. This has to be easier, but I have not found it.

On a few of the diabetes forums that I participate, quite a few people are asking good and sensible questions. When they receive advice from people's experiences, they seem to ignore it and move on to other topics. Others join several forums as the same time and ask the same question then select the forum that gives what is desired to continue the discussion on. I have seen this so often that you can almost tell what they are looking for.

When they don't get the answers they are looking for, they head off to other diabetes forums or discussion groups to test their question. The last one that came across this way was a question about the necessity of exercise. Three of the diabetes forums were very pro-exercise and very emphatic about it. The fourth was pro-exercise, but only with two answers.

So I continued to watch a couple of discussion boards and my wife watched a Facebook group. Sure enough they showed up on one of the boards and Facebook. The discussion board basically said exercise is necessary if they were medically able.

What was interesting was the Facebook group's answer. Three people jumped right in with promotions for natural remedies and said exercise was not necessary. The person responded that finally he had found a group that felt like he did about exercise. The number of promotions of natural remedies was immediate and almost 15 people had promotions up in less than an hour. The person thanked them and has not been seen since.

This is somewhat typical of some people. They are there for one reason, to find someone that agrees with what they want to hear that will give them justification for their attitudes about diabetes. Many of the regular members and participants in the forums can see right through these masked attempts to find information to let them off the hook. They normally answer with the right advice and will not back down.

The other problem I am having is how to deal with certain Certified Diabetes Educators (CDE's). I have been surprised lately at the number of inflexible CDE's that I have met. I made a comment about the new CDE position paper that I wrote about here, and I was told by a CDE that it would not be enforced in her office. I asked why not and was told that because it went against the American Diabetes Association (ADA) guidelines. I asked guidelines for what year and was told the general guidelines.

I could see that she was so rigid in her beliefs that further discussion was going to be futile. This is totally discouraging for me, but I know that some of the professionals get stuck in their beliefs and are unwilling to change. A lot like many people that get comfortable and resistant to change. This is why I probably get surprised as I have had to learn to change. This is something that diabetes forces on you.

06 December 2010

Legal Euthanasia Vs Rationing

This is a discussion that needs attention in the USA. Many refer to this as rationing of our health care, others refer to it as legal euthanasia, and some call it decision by death panels.  Call it what you want, but this is becoming more common as our health care costs continue it rocket upwards.

Where will it end? No one is sure. Even some doctors are beginning to wonder.  Dr. Rob at medrants dot com is writing about it. Bob Doherty at The ACP Advocate Blog also writes about it. Both are very careful as they need to be, but at least they are making us aware of what is going on in the world when dealing with Medical Insurance, Medicare, and Medicaid.

Dr. Rob at medrants dot com quotes from the LA Times dot com about what our senators are talking about – rationing. Every time reduction of health care is mentioned at least they admit that this means health care rationing.

The article in the LA Times states quite accurately (quote) “Both Republicans and Democrats are in denial on this point (about rationing). Republicans pretend that our current system doesn't stop anyone from getting all the care they need. Democrats pretend that efforts to control costs won't limit medical choices and treatment. But most real-world consumers know better: There is no free lunch.” (end quote)

The article makes some other good statements and deserves to be read by all. At lease they lay the problem out and point out where the rationing is coming from – the top down. When congress cuts costs, Medicare and Medicaid, with the insurance industry following suit, decide what they will not cover.

Although I cannot read it, in the November 24 issue of JAMA there is a statement by Drs. Meltzer and Detsky which says (quoting from Bob Doherty), “rationing already takes place in the United States in many ways in health care. Managed care is exactly a form of rationing in which a private insurer determines whether patients should or should not receive services. In addition, private sector rationing injects profit motives into the calculations... It is critical that Americans learn that rationing currently exists and is inevitable and focus their thinking on how its vagaries are best minimized, rather than use the word to instill fear.” (End of quote).

I will agree that using words like “death panels” and “death by budget cuts” creates fear. However, these words are going to appear in the media and must be recognized for what they are. We cannot put our heads in the sand and hope that they will go away. And as more people are denied medical care, these words will be used.

Over the next months as we see how the Affordable Care Act is carried forward, funded or unfunded, we will see a lot more of fear words and probably a larger number of severe rationing decisions. A lot of people are not going to be pleased about this.

This follows when we consider what potentially may happen to our testing supplies if Medicare is not stopped in their proposal to cut our testing supplies for diabetes. This should be considered preventative supplies and should not be limited like Medicare is planning. This is form of rationing we cannot afford.

04 December 2010

Cholesterol On The Brain?

Diabetes, what are you doing to me? The more studies are done, the more questions that are raised. This one, while done with mice, still raises more concerns and questions about what is happening in people with diabetes.

There is so much information that we have to wonder where it will all end. That the brain is packed with cholesterol has to make me wonder what else is affected by diabetes. The brain produces insulin and cholesterol. This study says that this cholesterol synthesis in the brain is derailed in mice with diabetes.

More explanations of the neurologic and cerebral complications that come with diabetes, include cognitive dysfunction, depression, and the increased risk of Alzheimer's disease. This shows that people with diabetes can have many problems with brain functions, and especially if the diabetes is uncontrolled.

The other important issue raised by the study is the effect of statins on the cholesterol in the brain. This has indicated the strong need for science to learn more about the cholesterol metabolism in the brain and what might affect it. This study points out the possible problems for cholesterol-lowering statins that can cross the blood-brain barrier and cause unintended problems for the brain and its function. Previous studies have had conflicting results.

If for no other reason, this points out how unintended results can wreck havoc with our bodies. This has encouraged me to work harder to reduce the number of medications that I am on by increasing my exercise levels, especially with the idea of getting off of statins.

While I have had good management of my blood glucose levels, I can also see the need to monitor them even closer to better manage them.

03 December 2010

We Need to Understand Diabetes Insipidus

I had heard the term some years ago, but never read anything about it, thinking it was diabetes related. It is not. Some of the symptoms, excessive thirst and urination, are similar, but that is where it ends. This also has it's own organization named Diabetes Insipidus Foundation. There are some cases of diabetes insipidus that doctors never diagnose or incorrectly diagnose.

Diabetes insipidus is a problem with possible triggers including kidney disorders, medication side effects, and/or damage to the brain or pituitary gland. Some mild cases do not need medication or treatment; however, the more serious cases require drugs to help the body produce or make better use of anti-diuretic hormones.

Diabetes insipidus (DI) is a condition in which the kidneys are incapable of conserving water as they perform their function of filtering blood. The amount of water conserved is controlled by the anti-diuretic hormone (ADH), also called vasopressin. This is produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland.

There are four types of DI. Central diabetes insipidus is usually caused by damage to the pituitary gland or hypothalamus. This can be the result of surgery, a tumor, an illness (meningitis for example), inflammation or a head injury. All of these can cause a disruption of normal production, storage, and release of ADH.

Nephrogenic DI happens when there is a defect in the kidney's tubules where the water is excreted or reabsorbed. The kidneys are therefore unable to properly respond to AHD and be due to an inherited (genetic) disorder or a chronic kidney disorder. The drugs such as lithium and tetracycline can also cause this.

Gestational DI as the name implies occurs only during pregnancy and when an enzyme made by the placenta destroys ADH in the mother.

Dipsogenic diabetes insipidus also known as primary polydipsia is in general caused by excessive fluid drinking that leads to suppression of ADH. This just amplifies the damage. Diseases like sarcoidosis or mental illness can cause this.

For information on the five tests that can be used to assist in diagnosis, please go to “Diagnostic Tests” here. Continue to explore the site starting here.

01 December 2010

This War Must Be Fought!

Normally I would wait to post this after midnight, but this demands action now!

This war is with the government and our ill advised bureaucracy that is out to kill people with chronic diseases, namely diabetes. This would otherwise be called Medicare. And we all know this means that the insurance companies will follow this lock-step.

For the background of what is going on, please take time to read the post of December 1, 2010 by Lee Dubois. I know others will be writing about this also. Take time to read his blog now and then come back. I know that your blood pressure will go up, and hopefully you remembered to take your medication last night.

It is bad enough that we have to fight for every test strip that we can get and ask our doctors to go to bat for us to get a few extra strips, but to have medicare dictate that we will only be allowed one test strip if you are on oral medications and three if on insulin it totally out of line and could be fatal for some. We all need to test if we think we might be having an episode of hypoglycemia.

What is so frightening is this time your doctor will not be able to argue for you. This will be the rule and no exceptions will be allowed. It is bad enough that these decisions are not up for public comment before being enforced, but to ram this down our throats is totally unconscionable.

Therefore - call the Congressional Switchboard at 1-866-220-0044. If you give them your zip code they’ll connect you with your Senator’s office. Each Senator apparently has a Healthcare Liaison. Give that person an earful. I lifted this from Lee's blog and I hope that this is acceptable because of the need to do this.

I would also suggest that you email your senators at this link and make the subject attention the Healthcare Liaison. In the first sentence get their attention by stating that Medicare has overstepped their boundaries or wording to this effect.

Do this now and don't wait. Also contact any friends that you know might support you and have them do this as well.

Dementia and Its Parts - 3

Now that I have given you some background on Alzheimer's Disease, I want to let your know what a wonder drug Metformin may be. It is being written about more and more in relationship to how Metformin helps with lung cancer, now Alzheimer's, and of course diabetes. This article says that it could be a potential treatment of Alzheimer's disease.

The paper published in the Proceedings of the National Academy of Sciences of the United States of America, found that metformin can reduce the amount of the abnormal tau protein in the brains of mice. Healthy nerve cells produce tau; however, in Alzheimer's, the abnormal form is produced and does not function correctly.

The Alzheimer's Society made the following comment - “Previous research has suggested that metformin reduces the risk of dementia in diabetic people.” What is of value is that this drug is already safe for people and can tested more quickly than a new drug. While research will still be necessary to understand the link between diabetes and Alzheimer's disease, this is a great piece of news.

The next piece of good news for those facing alzheimer's is the finding that people who are already taking TNF blockers for rheumatoid arthritis may possibly reducing their chances of developing Alzheimer's disease. The study shows that TNF blockers lowers the risk by 55 percent of preventing or stopping the development of Alzheimer's disease.

TNF blockers neutralize a protein called tumor necrosis factor alpha (TNF) that overproduce in inflammatory diseases like rheumatoid arthritis. TNF is also elevated in the cerebrospinal fluid of Alzheimer's patients and the higher levels correlate with the progression of the disease.

With both of these drugs, metformin and TNF blockers, this gives more hope for potential help in slowing or even stopping the progression of Alzheimer's.

This is the final in this series. More may be available in future studies.

30 November 2010

Dementia and Its Parts - 2

Alzheimer's Disease (AD) is often difficult to separate from others at the start. The exact causes are still unknown. This is being studied very intensively and some of the
suspected causes include diseased genes, abnormal protein buildup in the brain, and environmental toxins. Now there is a link to diabetes and some identified proteins and a possible link to lack of insulin production by the brain.

The brain changes that occur with AD are the neurons (nerve cells) in the brain that affect memory, thinking, and judgment are damaged. This interrupts the passage of messages between cells by chemicals called neurotransmitters. One specific neurotransmitter is absent in people with AD. The cortex (thinking center) of the brain shrinks (atrophies). This causes a decrease on surface area, which plays a role in how well a person can think and function.

The spaces in the center of the brain (ventricles) become enlarged and the neurons develop specific changes that are key indicators of the disease as seen on autopsy after death. These nerve cell changes are called neurotic plaques (abnormal patches) and neurofibrillary (nerve fiber) tangles. The Diabetic Guy writes about this here.

There is no single test for AD. The Alzheimer's Association has a list of ten warning signs of Alzheimer's. Read them here. AD can only be positively diagnosed by examining a small piece of brain tissue after death (autopsy). The number and concentration of plaques and tangles in the short-term memory center of the brain confirm diagnosis. At present there is no specific medical treatment for AD.

A little history, please. Dr. Alois Alzheimer detected signs of the brain disease that is now named after him. Like so many doctors, he thought many patients had mental health problems or mental illness. During the autopsy, he found dense deposits outside and around the brain nerve cells in the brain of a patient. The deposits are now called neurotic plaques and the tangles inside the cells are twisted nerve fibers.

Today this still a lot to be learned about AD, but progress is being made with more and more information being made available every year. This has been a hard topic for me to face and still concerns me. I am starting to study it more carefully, as my risks are greater for several of the reasons. Age, having diabetes and several other indicators all raise concerns.

This is part two of three parts.

29 November 2010

Dementia and Its Parts - 1

This is a lot more complex than I thought. I have written about Alzheimer's and diabetes, but much of the reading has been fairly straight forward. Then I noticed in researching this that alzheimer's and dementia were being used almost interchangeably which did not make total sense. This was to to be about Metformin and TNF blockers and their effects on Alzheimer's, but that will need to wait for some groundwork. And this is important as about 50 percent of people with Type 2 diabetes are at risk for Alzheimer's.

I am relying on resources and knowledge of my wife from her books and work to clarify the relationship. I know it is enlightening for me and hopefully will help you in your understanding. So this may be in several parts and may not all relate to diabetes, but if I understand things, I am hoping that I will be able to show some of the relationships.

Dementia is not a disease itself, but a group of symptoms. Dementia encompasses many disorders. First dementia is divided into two groups – those that are reversible and those that are irreversible. Reversible can be considered temporary. The following are potentially reversible – intoxication, affective mood disorders, infections, nutritional disorders, metabolic disorders, vascular disorders, head injuries, and brain tumors.

The other causes of dementia are irreversible or permanent. This is the group that I am focusing on. Included are Alzheimer's Disease (AD), Multi-Infarct Dementia (MID), Parkinson's Disease (PD), Huntington's Disease, Creutzfeldt – Jakob Disease (CJD), and Picks Disease. It is Alzheimer's Disease that I will be concentrating on because of the link to diabetes.

AD is the most common cause of dementia disorders affecting possibly 4.5 million Americans. It progresses gradually and results in total disability and death. The rate of progression varies among individuals and is most common in people over the age of 65. It affects more women than men.

AD is a brain disease and not normal aging. Symptoms of AD may vary from a pattern of gradual decline to fast deterioration. From the first recognized symptoms, the life span can range from three to 20 or more years.

The symptoms include gradual memory loss, decline in ability to perform routine tasks, disorientation to time and place, impaired judgment, personality change, difficulty in learning, and loss of language and communication skills. These symptoms lead to wandering, sundowning, hallucinations, delusions, disorientation, and poor judgment.

Understand that many people use the overall term of dementia when talking about any of the disorders and diseases. This makes it easier for them to accept what is happening and they are not referring to the disease itself as in Alzheimer's, Parkinson's, and others.

For more information on Alzheimer's, check out their web site here.

This is the end of part one of three parts.

27 November 2010

More Prognostications About Diabetes - 3

This is part three of prognostications. There are no predictions in this one.  This is about another medical insurance company setting up a pilot program with the Medical Clinic of North Texas (MCNT). Aetna is saying this is a year-long initiative and will include adding a part-time bilingual diabetic educator. Claiming this pilot program strengthens Aetna's efforts to reduce disparities in health care, it also will develop and deliver culturally appropriate care for its members.

While this is a noble idea, what took them so long. While approximately 5000 persons will be involved in this pilot program, the program will use 17 distinct measures. They are generalized as improving levels of diabetic control, such as medication compliance, blood pressure, blood sugar and cholesterol rates, eye and foot screening rates, as well as other measures of quality health care, such as reducing avoidable inpatient and emergency room stays.

This sounds to me like a model for establishing criteria for claims denial in the future and not improved health care or even preventative health care. I can only hope that this is untrue and that these are not the motives.

The pilot program is located in Dallas, Texas. The patients and staff will be provided bilingual, and culturally correct educational information. The racial and ethnic data has been gathered and will be used to determine if the targeted interventions will improve the lives of the patients with diabetes.

Aetna says they will make an effort to see that all its members receive quality health care irregardless of the race or ethnicity. They also say they are committed to getting past the disparities in health care for minorities to lead to better health care for these populations.

Now I would challenge all medical insurance companies to be more open and actually do more all their members.

This is the final part in this series.

26 November 2010

More Prognostications About Diabetes - 2

This is part two of prognostications. I vented a little with the last one so I'll try to stay with the positive on this one. When dealing with Type 2 diabetes, overweight/obesity is normally part of the discussion as it will be this time. One of the largest concerns by some in the insurance industry is the overweight/obesity from youngsters to the elderly.

While I am surprised by some in the insurance industry, they actually are starting to realize that if they can step in and do some preventative actions, the amount of money that can be saved is very substantial. By working with the medical community and encouraging them to intervene and to work with the people of all ages to encourage them to lose weight, later health problems will be reduced.

What surprised me is a few doctors are actually doing this and actually testing many more people for diabetes. If the medical community can succeed with this, many people will be able to prevent onset of diabetes or delay it for many years. When there is over two-thirds of US adults and 17 percent of children that are overweight/obese and still rising, this means that diabetes and prediabetes will continue to rise.

The authors quote studies showing if a person increases in body weight by 11 to 16 pounds of they are doubling their risk of Type 2 diabetes and an increase of body weight by 17 to 24 pounds triples their risk. Since diabetes generally follows the course from obesity, to prediabetes, and then diabetes, many feel that the place to start is before prediabetes.

The United Health Group offers four solutions. Three of the solutions involve intervention strategies and the other is a medication and care compliance program. Interventions would involve lifestyle to include public health and more extensive use of wellness programs, community-based intervention programs, and public-private partnerships for lifestyle intervention.

This is where I have to say, not well done. They are looking to unproven and unreliable public health and community-based programs which also are notoriously unreliable. There are a few community-based programs that are successful because of the strong people operating them. I have to ask why the UHG is unwilling to work wit the medical community and pay the doctors to do the intervention? Also in some areas of the country there are strong nurse groups that are capable to this work.

This is the second part of three parts.

25 November 2010

More Prognostications About Diabetes - 1

Everyone this fall and because this is Diabetes Awareness Month is making forecasts for the potential size of the Type 2 diabetes epidemic. I doubt that the predictions are accurate, but this still leaves a lot of people that will develop diabetes. We don't even want to think of the costs this will generate.

A study by United Health Group (UHG) predicts a $3.35 trillion cost over the next ten years. Ouch!, and Double ouch! At least the the study did have some positives and hopefully some of them will happen.

When I read about the health industry (at stated by United Health Group) needing to become proactive in preventative care – you could have knocked me over. This goes against their past philosophies by 180 degrees and even what they practice today that I have to wonder “up who's are they blowing smoke”? If they had said that they would deny claims for people overweight, I might have believed them, no way, in the past they have said and done what they wanted to without regard to the benefit of their consumers or policy holders.

Now I have to speculate about why. Is it because of the Affordable Care Act that has the insurance industry saying things it would not otherwise even consider? Or are there actually enlightened people at the helms of some of the companies? Or is this a form of advertising to get new clients and then stick it to them? I will let you decide what is driving the insurance industry after you have read the articles.

According to the report, UHG has been quietly tackling some preventive measures, but on the peripheries. I say if they are really serious, they should be more vocal and up front about it. They should openly challenge others in the insurance industry to participate and get out in the open about their efforts.

Read about the new article here and the full 60 page report here.

This is the first part of at least two parts.

24 November 2010

B Vitamins Helps Slow Alzheimers

Thanks to fellow blogger Diabetic Guy, I have found the courage to do more research about alzheimer's disease. Yes, I have written a few blogs about this, but when something as insidious as this scares the daylights out of me with the link to diabetes, it is depressing.

Now in the last few months several studies are giving me hope that there may be measures that can slow the progression of alzheimer's and maybe even slow the onset of alzheimer's. This is the B vitamins, B6 and B12, plus folic acid. Granted this will need more studies to determine how helpful this will be, but the discovery of this was surprising even to the researchers. No one expected a 50 percent slow down in the progression of alzheimer's.

The B vitamins, folic acid, B6 and B12 are protecting the brain and controlling the substance homocysteine in the blood. High levels of this substance are in direct correlation with the speed of brain shrinkage and alzheimer's progression.

All the researchers involved urge caution until more trials are completed because scientists are aware that high levels of the B vitamins can cause health problems which may offset the good. B vitamins are found naturally in meat, fish, eggs, and green vegetable which are all good for those of us with diabetes. B12 is also found in milk and some fortified cereals which may not be beneficial for some because of the levels of carbohydrates which many cannot tolerate well.

Many people that have been on Metformin may already be taking vitamin B12 and others are on B12 for anemia. Therefore, it is wise to consult your doctor before taking increased doses of the B vitamins. Rebecca Wood, the chief executive of the Alzheimer's Research Trust urges caution about the findings.

While these findings are very encouraging, we should wait for more research before overdoing vitamin B consumption. This will determine the correct amounts for best results and give doctors a clearer path to help diabetes patients avoid or slow the progression of alzheimer's.

Read about alzheimer's and B vitamins here and here. Read related blogs here and here.

23 November 2010

The Future of Health Care Reform

When I wrote this on October 16, 2010, I wasn't sure of what was coming next. I thought I knew, but not this. This insertion in the New England Journal of Medicine has no place being given space. This author cries fowl because the GOP now can block, de-fund, and generally make the ACA (Affordable Care Act) generally ineffective.

Congress cannot presently repeal the ACA, but it can now pick and chose the parts that may get support. While I don't like many parts of the ACA, I can support other parts. I do not like that our medical insurance industry is being so greedy and determined to reap their profits before they are regulated and this needs to stop. The other problems are that many of the insurance companies will be slowly forced out of business so that people will demand universal care insurance from the government. There is no balance in what is happening.

There are issues in all this, but a respected medical journal is not the place for politics. This is more appropriate for blogs and other places. That the NEJM chooses to air the political furor of its members degrades it's place in medical journals and should be on the boycott list by the medical community and research community. Will this happen?
I doubt it, but there are other medical journals that have recently gained traction and this position may lose this journal some respect.

While the author tries to present his arguments fairly, it is easy for me to see where this is heading and this is the reason I am so against this in a medical journal.

22 November 2010

Diabetics Underusing Statins

Oh really??? While I would like to get my hands on this study and see if this is really correct, I do have to wonder who paid for the study? If a study finds something like this being underused, it may not be a good thing.

Just because roughly a third of eligible patients with Type 2 diabetes do not receive a statin, does not mean that they should. I am taking a statin because I have cardiovascular problems that make it necessary. Two friends with Type 2, are not on statins and have no problems with cholesterol or triglycerides. When we read this, they had a good laugh.

They both expressed the desire to remain off medications if at all possible. One has been talked to about taking statins, but has refused and the other has not been talked to. Both are still controlling their diabetes with exercise and nutrition and are not on any other medications.

While many patients with Type 2 diabetes are at risk for cardiovascular problems, I sincerely wonder if statins are the answer if lipid tests are normal. If cholesterol tests show an increase, then it should be watched and statins may be appropriate. Giving someone statins just because they have diabetes and qualify does not seem right.

This article lists no standards for normal cholesterol levels or where statins should be considered and without the full text, I am hesitant to criticize too much more. Just seems like this could be bad advice.

20 November 2010

Hospital Care Deadly for Some

A new government study makes my blood boil and should raise concern for everyone. I may sound a little harsh, but having seen the results of some of the carelessness recently, I was not surprised. This study and another version by the Department of Health and Human Services need attention and broad public attention.

I am not trying to single out one medical profession as it appears that all medical professions are at fault if they work in and around hospitals. I would like to know how other patients fare, but I can believe that non-Medicare patients could be better off. According to the study, hospital care-related problems account for about 15,000 deaths per month.

One in seven Medicare patients receives injuries or other harm from hospital care. This includes infections, bed sores, and excessive bleeding from blood-thinning drugs. This works out to be 13.4 percent of one million Medicare patients. Another 13.4 percent suffer temporary harm which is detected in time and corrected and the patients receive no lasting harm from these events.

With over a quarter of our Medicare patients receiving poor care in our hospitals, is it any wonder that our elderly do not want to be admitted into the hospitals. Patient safety is not getting the attention it deserves and this makes me wonder what happens to those on Medicaid and those younger patients with insurance. The studies make no accusations, but I have to raise the question about euthanasia being practiced by some in our medical system.

The CMS (the Centers for Medicare and Medicaid Services) has been called on to hold hospitals accountable for adoption of evidence-based practice guidelines. This is to be enforced through the survey and certification procedures that hospitals must go through to be eligible for Medicare Reimbursement.

The Office of the Inspector General also recommended a greater effort by CMS and the Agency for Healthcare Research and Quality to pinpoint the incidence of adverse events, at the individual hospitals and across the healthcare system. This would include doctor's offices, clinics, and nursing homes.

19 November 2010

Now That World Diabetes Day is Over

Now that the day is over, what was accomplished? I have thought about this the last few days and wonder how many people were better off for it? Have the goals been met? Yes, I know that this is Diabetes Month and that there are days left in the month, but that still leaves me less than enthusiastic about one day. I would like to think more of what could be accomplished if the energy of one day could be channeled into 365 days.

I started to think about the money spent in advertising world diabetes day and diabetes month, the money spent for lighting buildings, monuments, and all the promotions that were done. How many people were truly educated by this. The one great idea was originated by a few people and with Roche donating money for those in developing countries to get insulin to those that otherwise would not have it. That is a positive and money wisely contributed!

The biggest goal I thought was to educate people about diabetes. If all the money spent on advertising and lighting buildings, was used for articles on diabetes and advertising with a personal story in newspapers, magazines, and in other media, a lot more people would probably have better, if not greater, knowledge of diabetes.

Another thought would be wearing the blue circle every day. This would always give you something to talk about and educate others about diabetes. Some of us will need an extra dose of patience to deal with some people, but it could be worth the extra patience. This would help put all types of diabetes in front of the public on a year-round basis and should reach more people than a one day event.

While the ADA has finally recognized World Diabetes Day, they still are hung up on the color red and have not recognized the blue circle that the JDRF and IDF have adopted for diabetes. We also need to encourage ADA to adopt a more realistic approach to the different types of diabetes. They could publish small pamphlets for the medical profession and pharmacies to hand out explaining the different types of diabetes. And I mean all types – polygenic and monogenic.

I am a little tired of having to explain that Type 2 does not progress into Type 1, or that diabetes is a disease. Just because we appear normal to people around us, does not mean that daily, we do not have to carefully manage our diabetes to prevent the complications from developing. This is what our neighbors and acquaintances do not see, the testing, taking medications, and the worry of getting it right.

There was really nothing locally to celebrate World Diabetes Day, so I just had to do my thing and be happy.

18 November 2010

Your Legal Rights to Medical Records in the USA

Your medical records are important to you. A federal law called the HIPAA Privacy Rule gives you the right to see, get a copy of, and amend (correct) your medical record by adding information to it. This link should get you most of the information necessary under the federal law and the laws of your state. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996.

Why is this so important? Because everyone should be able to track what is entered in their medical records for accuracy and completeness. Everyone is human and mistakes can be made. Test results are important and getting copies of these allow you to track the test results over time and discern for yourself what is happening to your health. The test will show you trends, whether they are good or bad and can alert you to something the doctor may have missed. You normally should be able to get copies of test results almost immediately.

When compared to the standards for that test, what do the results mean? Before this can be explained, you need to know what the standards are for the lab doing the tests. These should be with the results. Standards for testing labs in the United States can vary between labs and labs in different states even if owned by the same firm. If you made the statement that this is not good, you are right.

An observation – even though the American Diabetes Association had declared that the lab standard variances for the HbA1c test has been corrected and standardized, this is not necessarily the case. Some labs have a long way to go to improve and meet a national standard. The need is great for federal set of standards which each lab would be mandated to follow or face being put out of business or at minimum face punitive fines.

Test results over time for an individual done by the same lab should point out changes in a person's health and which direction the changes are occurring. Now getting to your medical records may be more difficult. There are delaying tactics used by many physicians and by most hospitals that are quite effective. This is to allow them time to sanitize the records and remove personal comments entered by medical personnel that they don't want you to see. If they think there is a possibility of legal repercussions, the delaying tactics can be very convincing. Unfortunately, they generally have 30 days that they can legally delay access to an individual and most will use as much of this time as they need.

Do not think that you can just go in and ask to see your medical records. Won't happen! They do not keep enough people on staff for this and they want to review them before you see them. All will still tell you that you must request specifically what you want and they will make copies for you. They will not allow you to handle the records (for good reasons). Also be prepared to pay a handsome fee for this service. The thicker your records are the greater the fee, if you ask for everything.

17 November 2010

Study Urges - Beware of Facebook for Diabetes Info

Social media is good for distribution information. This study indicates that this can be dangerous as well. It raises valid concerns about the accuracy on these sites. It is this type of information that causes concerns for doctors and helps them doubt all information from the internet.

I personally stay away from Facebook because I know that there is bad information especially from advertisers promoting their “cures” which are false and more dangerous than helpful. This study just confirms that about 25 percent of the information is not what many people need.

The researchers examined 15 of the largest Facebook communities about diabetes and discovered that one in four comments on these sites were promotional in nature. This means that people are advertising products that are not approved by FDA. This says that a quarter of the people on these sites are most likely non-diabetic and are there to make sales.

Another area of concern are the number of surveys, marketing, and efforts to get people for clinical trials where the identity of the poster was unknown or even remotely discernable. These people prey on the people desperate for information and line their pockets with their schemes.

Now I understand why doctors may not like you getting your information from the internet. They are aware that often people are not as discriminating as they should be in what they select to read. This is why I have a list of sites I visit regularly to give the doctor. This does not always please him, but he finally did ask that I send him the list in an email. Now we are able to talk about things and he is not as likely to tune me out. I also send a list of questions and which site generated them.

I agree with the results of the study concluding that there is often much good on some of the sites, but little control in the advertising and promotional position of the site. This is why I also warn you to fact check the information and be prepared to discard the misinformation.

This is also why I recommend sites that are monitored to prevent promotional advertising and that monitor the site for misinformation, correcting it or giving warnings to information that misses the mark. Some diabetes forums are excellent and provide a safe place to ask questions and guard their members from unsafe practices. From the information in the study and from talking to friends about their experiences on Facebook I do feel safe in urging people to check out the diabetes forums and sites I have listed here.

16 November 2010

Sufficient Sleep is Part of Lifestyle Change

Yes, I am back to encourage you to get more sleep. This time, I am concerned for several reasons. Another study now tells us that lack of sleep makes it more difficult to successfully lose weight. The message is now “eight hours plus of sleep, exercise, and nutrition”.

People that can regularly get 8.5 hours of restful sleep burn more fat than people getting 5.5 hours of sleep. They have concluded that sleep loss while dieting increases the ghrelin (a hormone that stimulates appetite) associated changes in hunger, glucose and fat utilization, and energy metabolism which slows or halts weight loss.

The researchers reported that sleep-deprived participants reported feeling hungrier during the study. They agreed that sleep may be an important factor in successful weight loss and that adequate sleep may be a significant part of the lifestyle change that has normally concentrated on diet and exercise.

The message to physicians is that they need to explain to overweight patients with diabetes that people who slept 8.5 hours reduced their weight than those who slept for less time. Doctors also should remind patients that the lack of sleep causes more hunger and they expend less energy to compensate for the reduction in sleep.

So if you have been losing weight, but now or have hit a weight loss plateau, you may want to add sleep to the other remedies to break through the plateau and get on with losing weight. This is just another part of the lifestyle change so important for people of diabetes. Good luck!

15 November 2010

Diabetes and Alzheimers now linked?

I have to thank fellow blogger, Diabetic Guy, for getting me thinking and finding more information on diabetes and alzheimers. Now I have found a study that points out that there is a link between diabetes and alzheimers. The information is more technical than I am comfortable with, so if I confuse you, I am providing the links for you to read.

The study was conducted at the Mount Sinai School of Medicine and was co-authored by geneticist Alan Attie, PhD, Professor of Biochemistry, University of Wisconsin. They have analyzed the relationship between alzheimers and diabetes and identified a single gene to the causes of both Alzheimer's and Type 2 diabetes.

This fact is very bothersome for me. Yes, I am concerned about developing Alzheimer's since I have Type 2 diabetes. A gene for a protein called SorCS1 which may cause Type 2 diabetes, also impacts the the accumulation of amyloid-beta (Abeta) which plays a prominent role in the development of Alzheimer's.

This will generate more studies and possibly new drugs for the treatment of both diseases. This is going to take time and patience. Alzheimer's professionals have for several years maintained that there is a link, and now part of this has come true. Now it is learned that those with Type 2 diabetes are at risk of developing Alzheimer's about 50 percent of the time.

13 November 2010

Smart Phone Apps Put Doctors in Charge

This is meant to bring Doctors into the twenty-first century, but there may be some serious doubts. I think the right people (John Hopkins) are involved. This also should make it more convenient for the medical community to stay more current with the latest developments in diabetes.

This is now available on all smart phone devices and something more bulky which should help. I have to wonder if this will be available for the computers systems found in many doctors offices to be more effective. This will be potentially a great asset for nurses and other healthcare providers since this is portable.

I not have seen this application; however, according to the reviews, it provides real-time advice for diabetes management to medication side-effects. Since this is written by physicians, it should be an excellent source of information and offer the latest expert opinions in diabetes care. At least we can hope that it is the correct information.

Named the POC-IT, the application should raise the standard of care and improve patient safety. This is the third POC_IT application. The other two were successful guides on antibiotics and HIV.

I hope this guide starts eliminating problems that many patients have with uninformed nurses and diabetes educators that do not have their information correct.

12 November 2010

Why is Diet Always Listed First?

I had intended on another post today; however, my thoughts and heart just weren't in it. It is almost complete, but my final thoughts just went away when I read another study advocating diet and lifestyle changes to manage diabetes. Others have already written about this, but now it is my turn.

I must state that I have some doctor's and medical limitations, but I do believe in what I am advocating. Understanding why almost every article and study about lifestyles and the need to change lifestyles starts with diet and lifestyle changes is something that does not set well with me. Many of these articles do mention exercise someplace, but the emphasis definitely excludes exercise. If the article is about nutrition, often exercise is not even mentioned.

So with this in mind, I need to look at why this happens. The quickest thought is that there is no money in covering exercise. While the next thought applies to exercise and diet, they are something that people choose to do themselves and habits can be hard to change. Most people do use the term diet to mean what we eat and nutrition. What many writers forget is that many people have tried diets (way of losing weight) and have discovered that diets fail. This generally leads to people not reading some articles when diet is the lead.

Lifestyle is harder to define. Does lifestyle not include exercise, diet, and healthcare habits. Or are we supposed to think this is couch-potato habits and other unhealthy habits? Maybe I am reaching to think that researchers are not totally defining lifestyle, and possibly using this to avoid talking about issues that they know people will not accept.

I have and will probably continue to use the word lifestyle, I would define it as including exercise, nutrition, and other habits such as smoking, drinking, and not leading a sedentary life. When a person has diabetes, they must, if health allows, exercise, normally change the types of foods consumed or restrict the quantity, and stop the unhealthy habits as quickly as possible.

I will more than likely continue to wish that exercise is given a more prominent position in studies, and articles about many chronic diseases and especially diabetes. Some writers seem to consciously seem to separate exercise and diet (nutrition) and discuss each separately and then cover lifestyle. This I understand and accept. I would hope that writers about diabetes would re-prioritize their writing so that exercise is number one, nutrition is number 2, and lifestyle is number 3.

11 November 2010

Pharmacies Becoming Sources for Medical Care?

Is this what we want or what we need? I have to wonder if this will be a good thing for people with chronic diseases. I am not sure I want my medical care retailized or taken care out of a storefront. But this is the latest desire from Walgreens – to become your one-stop health care facility.

Walgreens and other large retail pharmacies are lobbying to make this a fact of life. I do not want to have nurse practitioners in charge of my medical health care. I am thankful that in some of the more remote areas or largely rural areas in the United States, nurse practitioners have been needed to get medical care to people and have done excellent work. This has been a necessity because of the lack of doctors in these areas. But for a retail store like Walgreens in non-rural area, this runs against my better nature.

Walgreens is wanting to do this because of the “national shortage of primary care doctors”. They are proposing to “assist patients in managing chronic conditions of diabetes, hypertension, and high cholesterol”.

We have to wonder if we are going to be prescribed extra drugs or medications as a result. Is the American Medical Association going to allow this to happen? Are the states going to allow this to happen? It is happening in some states that have nurse practitioners, but I hope that this does not come to pass in our more populated states.

Many pharmacies are now giving blood screening, flu shots, and other medical advice mainly under the supervision of pharmacists. This is not always the best for many patients as they do not check any medical records to verify allergies and other medical conditions which might preclude some treatments.

What many are banking on is the new health care act providing insurance to people and they want to cash in on the potential increase of cash. And Walgreens is not bashful about saying this.

Before I would want to utilize pharmacies (or what name they will change to), I would want to know who is responsible for writing the prescriptions and whether they have met the education requirements necessary to be able to write prescriptions. Are the pharmacies going to require filling the prescriptions in their store or can these prescriptions be filled at any pharmacy?

These are just some of the questions that need to be answered before I would accept pharmacies taking over primary medical care. Will pharmacies be required to have doctors available to consult or oversee and supervise prescriptions with appropriate approvals available for states to audit? Will this action create or necessitate more state agencies to oversee questionable medical decisions and audit procedures? Will this just increase medical fraud, Medicare, Medicaid, and other fraudulent practices.

And with the shortage of nurses that exists today, where will all of the nurse practitioners come from? Or will they come from our hospitals and doctors offices thus creating a more critical shortage there?

Before this becomes practice, I would hope that our federal and state legislators will examine this very carefully. The last question I would want answered or information made available to the public is the political contributions made in the last election and to whom were they made.

10 November 2010

Writing about the same topic

Over the last year I have had several email discussions with fellow Type 2 bloggers on writing about the same topics. Most have felt like the first person I discussed this with. He said that we could always write about the same topic and we would seldom repeat what the other person had written about. He stated further that our life's experiences are all different and as such we will emphasize different aspects and relate differently to the same topic.

Another blogger has told me that if one blogger writes about a topic, he feels that blogger has “dibs” on the topic, and as such he will attempt to avoid the topic as he does not want what the other person wrote to influence his presentation. This was the way I had felt in the beginning, but now I have found that I enjoy writing about whatever topic peaks my interest. Often I find topics like my last post that are from personal experiences, good and bad.

I like it when another blogger has written about the same topic as I don't mind and actually prefer giving them credit for their work and I like the challenge of bringing my thoughts out about similar ideas and giving readers the opportunity to read both. What the other blogger covered may be what the reader was looking for which he may not have found without my link. Other readers may find mine is what they are looking for and at the some time, he has the opportunity to compare insights between two bloggers.

I sometimes will start a blog, find that my thoughts are not coming together and set it aside. Then another blogger writes about it from another perspective and it brings my thoughts together. Even though I try to write mainly for type 2 topics, there are often ideas and other interests that get my attention.

What brings these to the forefront? Often it is is one of the newsletters I subscribe to. At other times it can be a combination of newsletters and a friend, acquaintance, or family member that has something that really drives the topic home. Even a comment from a casual acquaintance can spark interest in a topic. There are times when another blogger writes about something that begs for further thoughts, whether, to disagree, add a point or points that may have not been covered, agree with their thoughts, or just take off on a different tangent.

What got me started on this today? I am reading many blogs written about the same topic because that is what someone had suggested a few years back. This will be a day late, but because I wanted to read what others had written for D-blog day. There are many interesting points that we would like people to know about diabetes. Scott Strange did an excellent two blogs and you should read Nov 8 and then Nov 9. I am one that appreciates his idea of two sides to the suggestion of what we want people to know.

Then the other blog that caught my attention is by Kerri at six until me, dated Nov 9, 2010. Yes, there are many others, but I don't have time to read all of them, so please read your favorites. Kerri's sixth point resonated with me. It is this that I would like to expand on. Her thoughts and last sentence “We deserve a cure” really says it all. Her other points are well stated, but the last sentence drove it home for me.

With the millions of people with various types of diabetes, we need to get many of them writing, emailing, or otherwise notifying our representatives, senators, and even our governors asking them to support a cure, maybe, just maybe, we could bring a cure to the front faster.

A few hundred bloggers from the diabetes online community will get minimal attention, but if family members and friends can do this as well, plus ask other people to do the same, it will get their attention. This is what is needed to energize our elected officials to take action. Here are a few of the sites I chose in searching for congressional email addresses and some also have suggestions for making your email get noticed.

A prime example if having a diabetes organization send a list of names supporting their position as well as a personal email. I know that the elections have taken place and many representatives and senators will not have email addresses until probably after the new session starts. This still should not stop us from getting our message across.

I personally have written mine, since none of my congressional members were defeated, but I will need to wait for the new governor to take office. This is my one and only thing I want people to know and to do for the coming days and year.