16 October 2010

The New England Journal of Medicine

I don't know if it is me, but I find this very disturbing. When a respected journal of medicine decides to weigh in on a political issue, I have to wonder what is happening and what future messages are going to be. Is this a prelude to a political positioning of medical issues.

While this is dated October 6, 2010, it appears to be almost an appeal for letting the ACA (Affordable Care Act) to continue and not be blocked, repealed, or otherwise crippled.

I am very suspicious of a medical journal (NEMJ) that covers political issues. I hope I am wrong, but I will reserve my right to continue to criticize the NEMJ for becoming involved in political issues. While the ACA is possibly our medical future, a reporting forum does not seem appropriate for this message.

Diabetes Websites Having Financial Problems

The current financial crises is now having its effects on some of our diabetes web sites many of us have come to enjoy, depend on, and learn from. So far as of October 13, 2010, I have noticed that three excellent diabetes sites are working to shore up their advertising, realigning some schedules, and another two actually is not there anymore. For the two that finally pulled the plug, I say goodbye. I have noticed one of them in the last year go from a fair site to a poor site.

I don't know the details, which is good, but the signs are there that financially they are not as sound as a few months ago. When they start paying for surveys and enlist Amazon dot com to offer certificates to bribe participation this leads to speculation. Also when news letters start going from at least weekly to monthly, this is another tell tale sign.

I will be very disappointed to see one of the three sites fall off completely. It has provided much in the way of excellent information and an outlet for several excellent writers. But in this depressed economy, there are bound to be some casualties. I do not intend to point a finger at any of them and I hope that I am wrong about two of them.

15 October 2010

Reasons for testing blood glucose

Recently on one of the diabetes forums that I read, but seldom post on anymore, someone was questioning why type 2 people not on insulin were even testing. To their mind it was simply a waste of money.

Rather than answer, I wanted to think about why type 2 people not on insulin should be testing. Contrary to what the insurance industry is trying to prove with their studies that we don't need to test or test that often and the doctors that don't want their patients testing as it will be too discouraging and depressing for them to know, I believe there are valid reasons for testing regularly, and often.

Let's start with the people that are able to manage their diabetes with exercise and nutrition. While it is possible for them to purchase the home A1c kits and test monthly, many of them will tell you that being able to test several times daily is still good knowledge and tells them if there are potential problems. It tells them if they are eating too much, not exercising enough and if they need to reduce the serving size of what they ate.

Like one of them explained to me, he wanted to test regularly to know that he was on track with his diabetes management. In addition, he wanted to stay off oral medications or insulin for as long as possible. Without testing, he would have no knowledge of how he was managing the diabetes and it would be like flying blind. By regularly, he meant being able to test four to six times per day, although he admitted that three times per day was more common now that his blood sugar levels have been stable. More testing was reserved for days of new types of food or when eating out.

The same would apply or should apply to those on metformin to check that the dosage was proper to tightly manage diabetes. This would apply to all oral medications that do not create hypoglycemia by themselves.

Since most oral diabetes medications are capable of producing hypoglycemia by themselves or in combination with other medications, testing on a regular basis would seem very prudent for people on these medications and should not be limited by the insurance industry, medicare, or medicaid. With the danger of hypoglycemia present, frequent testing needs to be available and desirable.

Of course, there are no questions about the need for testing for those type 2 people that are on insulin and the poster went out of his way to exclude these people from the discussion.

I realize that I am stepping away from the position of many insurance companies on testing; however, some discussion with the insurance company and consulting with your doctor for extra testing supplies may help get them. Just be prepared, have your points well laid out and believable and that your doctor is on board.

Even the ADA has made the testing more individually manageable and they have allowed for hypoglycemia and hyperglycemia. Read at C. Glycemic control Assessment of glycemic control (below Table 8). Testing as part of (SMBG) self monitoring of blood glucose is checked and testing supplies seemingly under the control of the doctor with some allowances for patient preferences.

So to the person that believes this is a waste of money, I have to ask if he intends to control his diabetes, or is it going to control him. I am thinking the latter.

Just remember that the insurance companies are looking to cut costs and are funding studies to prove themselves right in their decisions.

14 October 2010

Whole Grains - a Myth?

While I have no allergies to wheat or wheat products, I do find myself reducing the consumption of Whole Wheat and Whole Grain products as they do not seem to be all that everyone wants us to believe. Some grains are necessary I feel, just not what all the hype is about.

From the American Diabetes Association to the American Heart Association, they all speak about eating healthy whole wheat and whole grain foods. We have this drummed into us and put before us in print and everywhere we may look. I know this is part of the carbohydrate push by the ADA. Now if foods were just what they were advertised to be.

The Food and Drug Administration and the United States Department of Agriculture should enforce some of the laws already on the books. We have so much false advertising and false and misleading print on our food products that many people are beginning to accept this as the truth.

Whole grains is a mantra by most doctors, dietitians, and nutritionists. They would push this in our face 24/7 if they could. Before you purchase any product saying it is whole wheat or whole grain, read the ingredients and the label. Chances are there is just enough to keep them from getting in trouble with USDA or FDA and the balance is not whole wheat or whole grain anything.

The regulations have been relaxed to the point that there is a very small amount of wheat or whole grains in the product. Most of the product is highly refined flour and not whole grain or wheat.

I know that most people will not or do not have the time to prepare foods or bake from scratch. This is the only way to ensure that the product is wheat or whole grain. Not that I an advocate in returning to the days when we ground our wheat or grains at the local mill, but with food manufacturers today, do not count on getting them.

Also notice that the food today has been processed to the point that they have to add some vitamins and mineral back to the product. We do lose some of what the food is when it is cooked, baked, or processed by us even if it is fresh from the garden.

I like what Prof Jennie Brand-Miller has to say about whole grains as they are thought of today. She makes some very valid points that we all need to think about. So the next time you are purchasing “whole grain” foods, use extra care to read the label and ingredient list. You may just put it back on the shelf and look for something else. You may find that whole grain is indeed a myth.

13 October 2010

Researchers and FBI

The one big question going through my mind lately is how reliable is the research being done today? Are the researchers above reproach? Are we being told the truth?

From all that has started to become public, apparently we are being lied to and researchers are not to be trusted. The big Pharmas slant the research to suit their corporate needs and not the needs of us the patients. Avandia is the drug I am talking about here. And finally the FDA is doing the right thing.

Fellow bloggers have written about other situations. Alan Shanley in his blog of February 26, 2010 titled his “Should Detectives, Not Just Academics Review Drug Research” graphically lays out the abuses of people involved in drug research and how studies are slanted to give results favorable to Big Pharma.

Now on October 5, 2010, Tom Ross points out another problem everyone should be aware of. He used an incident from the European Association for the Study of Diabetes. Here a paid lecturer for Big Pharma misrepresents statin drugs. He states that anyone with diabetes and over the age of 40 should be put on statins. He said that statins are safe, effective, and that complaints about their side effects are false.

There are many more instances where money changed the results of studies and greed ruled over patient safety. Alan suggests that the FBI in the USA and comparable agencies in other countries should be responsible for following the money that changes hands and reviewing all documents for correctness before the FDA or comparable agencies in other countries even gets their hands on the information.

This will have to be put in federal legislation, but I am in favor of this if it will stop companies from withholding data, researchers from falsifying data and slanting research to fit corporate interests. How long are we as patients going to put up with being guinea pigs for the greed of Big Pharma. This has gone on unchecked for far too long.

12 October 2010

Train our children in the emergency basics?

This can be controversial, but I think one that should seriously be considered. Often I read or hear of a child being a hero because they had been taught how to dial 911, or had heard about it from adult conversations and just did it, or they just do something to help save a life.

On one of the diabetes discussion groups, a person was asking how to get a judge to stop visitation and joint custody rights to prevent her two children from being exposed to their father (a type1) when he has hypoglycemic episodes. She was very adamant in preventing them from witnessing their father at these times. I was proud of the people in the group who asked how often this happened, was he known for the episodes, and had she ever witnessed him have a hypoglycemic episode?

She was only aware of one time when he was at work and he was rushed to the hospital. Then she was asked if the children knew how to dial 911? She did not know and said that was not the issue. Because of the one hypoglycemic incident, she was wanting to be sure that he would not expose the children to any. Many felt she was doing this for her own selfish motives and asked if she had even talked to the children (ages 9 and 12) about their feelings. She never answered so I think the people were correct.

The idea of teaching our children to dial 911 is an excellent idea. At what age should they be taught? This may well depend on the children, the family circumstances, and the general health of the parent(s) or family members. Of course, they must understand that this is for emergencies only.

As to teaching the children about handling chronic diseases and the possible effects like hypoglycemia or seizures, this is will depend on the child or children and their willingness to help and be part of the support structure within the family. If an episode happens and the children or child goes running to hide, then they may not be ready.

If the children or child stays and observes, then afterward asks questions, this is the time to start the conversation. Find out what they remember and if they feel that they could help. Do answer all their questions as completely as possible, or take them to the hospital or fire station (or where ever the emergency people are stationed) so that they can see where they are located and if possible, let them ask questions of the emergency personnel.

If the children balk at anything, do not force an issue. They often understand things better than we realize and are more resilient than we give them credit. It is best to let things progress at their (the child's) pace. Just be there for them, answer their questions honestly to the best of your ability and ask them if they would like to hear an explanation from a person knowledgeable about the question they asked. Do not forget if they answer yes. It may take time to develop resources to ask questions to, but this will show the children that you care and will follow through.

Teach them at their pace and as much as they want to learn. Then ask them some questions to see how much they retain. You may be pleasantly surprised. Never force them into areas where they do not want to go, but encourage them at every opportunity.

I am not a professional and not trained in this, but these are my opinions and feelings from observations of some families with chronic illnesses/diseases and how they handled sensitive or emergency situations. These children are now very knowledgeable and are assisting in many ways in our society today, and I think this because of the circumstances they were exposed to as children.

11 October 2010

What is the current ADA position?

Just when there is a glimmer or faint ray of hope, the American Diabetes Association has something like this. Granted the sidebar says August 2003, but the copyright is 2010. So I am wondering if this has been superseded or is still in force. My guess is that though not talked about, it still is as CDE's continue to refer to this, Doctors are still using this information.

The emphasis is on carbohydrates and more carbohydrates. They will not include the glycemic index or glycemic load as factors to help choose the right carbohydrates. Just that persons with diabetes must eat carbohydrates.

This is also disturbing to me. They (ADA) states “However, after reviewing the evidence, it was concluded that the total amount of available carbohydrate in meals or snacks is more important than the source (starch or sugar) or type (low or high GI) (A-level evidence), and although low-GI foods may reduce postprandial hyperglycemia, there was not sufficient evidence to recommend use of low-GI diets as a primary strategy in food/meal planning (B-level evidence).

Then when you compare the above information and full discussion with the 2010 position statement, which I referred to in my blog of May 26, 2010 which states - Check out Standards of Care section of the 2010 ADA Clinical Practice Recommendations. The updated carbohydrate recommendation starts on S25 (you will need to page down to this, as the reference starts on page S11) with the paragraph “Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes....” This will now allow variation of carbohydrate consumption to fit the individual and not forcing a certain number of carbohydrates. The low fat regimen is still advocated.

I must wonder why if they have changed policies, do they continue to leave past information up and readily available for the public to view. It is no wonder that the medical community stays on the old publications if they don't like the new.

When policy changes, should not the ADA at least archive out of date material and clearly indicate that it has been superseded and list the URL for the current policy. When called out about this, they will always refer to the most current position statement, yet they will quote from prior position and related statements when it serves their purpose.